RESUMEN
OBJECTIVE: Evaluate facial changes after Presurgical Naso-Alveolar Molding (PNAM) in unilateral cleft lip and palate (UCLP) patients treated with Modified Grayson Technique and AlignerNAM (with DynaCleft nasal elevator) using a 3D facial scan. DESIGN: Randomised clinical trial. SETTING: Institutional study. Participants: 20 UCLP patients allocated to two groups (10 patients each). INTERVENTIONS: Group A patients underwent PNAM with Modified Grayson Technique and Group B patients underwent AlignerNAM (with DynaCleft nasal elevator). Their 3D facial scans were obtained by using an iOSbased application (Bellus3D FaceApp) mounted on a novel frame. These .stl files were analysed using 3D software (GOM INSPECT) at three-time intervals; before intervention (T0), after intervention (T1) and one month after lip repair surgery (T2). MAIN OUTCOME MEASURE(S): Changes in facial and nasolabial morphology. RESULTS: Both techniques brought significant improvement in the columellar length, nasal tip projection, columella angle, nasal tip angle and a significant reduction in cleft width. At T1, a statistically significant difference in angular and linear measurements was present in both groups. At T2, no statistically significant difference in linear parameters was observed between the two groups except for the outer lateral height of the non-cleft side, basal lateral height of the non-cleft side, and philtrum width. Similar pattern was observed in angular measurements with no statistically significant difference between the two groups except in nasolabial angle, anterior nasal base triangle III, and anterior nasal root triangle. CONCLUSIONS: Aligner NAM and Modified Grayson technique are equally effective PNAM methods with similar clinical results in nasolabial morphology after lip repair surgery.
RESUMEN
A comparative evaluation of 4 operations designed to treat sacrococcygeal pilonidal disease is presented, to show the duration of treatment time and the recurrence rate. Case records of 112 patients (131 operations) were studied. The results indicate that the healing times with the excision and Z-plasty operation are clearly less than those obtained by incision with drainage and packing, excision with primary closure, or excision and lay open. The overall recurrence rate in this series was 28 percent, all occurring within 3 years of the first operation. With the exception of the Z-plasty operation, other methods required considerable outpatient treatment time and were more susceptible to recurrence. We suggest that by reconstructing the intergluteal cleft, the likely effect of the Z-plasty operation is to eliminate factors that may promote pilonidal disease in this region.
Asunto(s)
Seno Pilonidal/cirugía , Atención Ambulatoria , Femenino , Hospitalización , Humanos , Masculino , Recurrencia Local de Neoplasia , Seno Pilonidal/epidemiología , Cuidados Posoperatorios , Complicaciones Posoperatorias/etiología , Cirugía Plástica/métodos , Reino Unido , Cicatrización de HeridasRESUMEN
We present a case of major pulmonary embolization from a hemolymphangiomatous malformation of the loin and lower extremity. Treatment was with a low-dose infusion of urokinase for a short period directly into the pulmonary artery, and dramatic clinical improvement was noted. Prolonged maintenance therapy was with a low dose of heparin.