[Surgical approaches and efficacy analysis of hallux valgus deformity in children and adolescents].

OBJECTIVE: To analyze the clinical results of different surgical approaches in treating hallux valgus deformity in children and adolescents. METHODS: From April 2000 to April 2007, 18 cases of hallux valgus deformity (30 feet) were treated. According to different ages, they were divided into children group (< or = 10 years) and adolescent group (11-18 years). In children group, 4 female patients included 2 bilateral and 2 unilateral hallux valgus deformity (2 left feet, 4 right feet). Each patient underwent a combination of Austin osteotomy and McBride procedure. The American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) score was 55.0 +/- 15.0, and the visual analogue scale (VAS) score was 6.0 +/- 2.0. The hallux valgus angle (HVA) and 1st-2nd intermetatarsal-phalangeal angle (IMA) were (35.0 +/- 4.0) degrees and (14.4 +/- 2.0) degrees. In adolescent group, 14 patients included 3 males (4 feet) and 11 females (20 feet), 10 bilateral and 4 unilateral hallux valgus deformity (10 left feet, 14 right feet). Each patient underwent the modified Mitchell osteotomy. The AOFAS-HMI score was 55.6 +/- 14.0, and the VAS score was 7.0 +/- 1.0. The HVA and IMA were (38.5 +/- 5.0) degrees and (15.0 +/- 3.0) degrees. RESULTS: All incisions healed primarily. The patients of two groups were followed up 12-32 months (21 months on average). In adolescent group, pain of metatarsophalangeal joint occurred in 1 case and the symptom disappeared after 3-month physical therapy; 1 case recurred after 21 months of operation and achieved satisfactory results after Lapidus operation. In children group, the AOFAS-HMI score was 92.1 +/- 5.0, the VAS score was 1.0 +/- 0.6, HVA was (14.7 +/- 3.0) degrees, and IMA was (5.5 +/- 2.0) degrees; showing significant differences (P < 0.05) when compared with those before operation. In adolescent group, the AOFAS-HMI score was 90.0 +/- 6.0, the VAS score was 1.0 +/- 0.6, HVA was (13.7 +/- 3.0) degrees, and IMA was (6.8 +/- 2.0) degrees; showing significant differences (P < 0.05) when compared with those before operation. CONCLUSION: It has the advantages of rapid bone healing, short course of treatment, and less complication to treat hallux valgus deformity in children with a combination of Austin osteotomy and McBride procedure and in adolescent with the modified Mitchell osteotomy.

[Clinical results of primary and complex resection of levator palpebrae superioris musculus in treatment of blepharophimosis-ptosis-epicanthus inversus syndrome].

OBJECTIVE: To observe the clinical outcome of treating blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) by means of primary and complex resection of levator palpebrae superioris musculus. METHODS: From May 2001 to May 2007, 12 patients with BPES were treated, including 6 males and 6 females aged 4-15 years old (average 7 years old). All patients marked signs of BPES--typical ptosis of the upper eyelids, epicanthus inversus, palpebral fissure, and increased distance between inner canthus. The eye fissure width was (2.8 +/- 1.8) mm, the eye fissure length was (19.8 +/- 4.7) mm, and the inner canthi diameter was (41.6 +/- 6.5) mm. The muscular strength of levator palpebrae superioris was deficient in 4 cases, the muscular strength of levator palpebrae superioris was (2.0 +/- 0.6) mm in 8 cases. All patients were associated with visual function congenital defects of varying degrees. The surgical technique included shortening of the internal canthal ligaments, resection of the tarsus and levator muscle, and skin plasty. RESULTS: All the incisions healed by first intension. Twelve patients were followed up for 12-48 months (average 30 months). Amelioration of ptosis and epicanthus was achieved. At 18 months after operation, the eye fissure width of 10 patients was (9.0 +/- 2.1) mm, the eye fissure length was (26.5 +/- 3.5) mm, and inner canthi diameter was (30.2 +/- 2.7) mm, the muscular strength of levator palpebrae superioris increased to (5.6 +/- 1.9) mm, showing significant difference when compared with preoperation (P < 0.05). CONCLUSION: The primary and complex resection of levator palpebrae superioris musculus can provide relating good cosmetic and functional results for the correction of BPES. Patients with BPES should receive surgery as early as possible.

[Nasal septum cartilage-silica gel complex for repairing nasal deformities of unilateral cleft lip].

OBJECTIVE: To evaluate the operative methods and therapeutic effects of nasal septum cartilage-silica gel complex for two-stage repair of nasal deformities of unilateral cleft lip. METHODS: From June 2001 to June 2007, 38 cases of secondary nasal deformity and septum deviation of cleft lip were treated with transplanting nasal septum cartilage-silica gel complex. Among of them, there were 21 males and 17 females, aging 14-23 years with an average of 17.6 years. All cases were with nasal deformities of unilateral cleft lip, including 21 cases of complete cleft lip and 17 cases of incomplete cleft lip. The locations were left side in 26 cases and right side in 12 cases. Nasal deformities were columella nasi deflexion, flattened nasal tip, pteleorrhine and alanasi collapse. The patients received 1-4 times operations, and the interval of two operations was 3-10 years (mean 5.5 years). According to nasal deformity, the nasal septum cartilage of 1.8 cm x 1.2 cm was cut, and transplanted into the nose point phantom surface forming "the shield" to extend nose column and to raise the tip of the nose. At the same time the nasal tip fat-connective tissue flap graft with fat knot was given. After fixation, the nasal alar cartilage and soft tissues were reduced to normal position. RESULTS: Primary healing of the incisions was achieved in all cases. The nasal deformity was corrected. The postoperative follow-up period was 12-18 months with an average of 15.6 months. All the patients of regional cartilage scars had no complication. The figure of nose was slinky, the height of apex of nose and the shape of nose was natural, the apex of nose, nasal ala, nostrils and nasal columella were satisfactory [(the results were satisfactory in 30 cases (78.9%), general in 8 cases (21.1%)]. The nose department overall esthetics shape was improved in all the patients, no complications of the phantom sliding, shifting and exposure, hemorrhage and infection occurred. CONCLUSION: The nasal septum cartilage-silica gel complex to repair the nasal deformities of unilateral cleft lip is an ideal operation style.