Prospective evaluation of the effect of early nasal layer closure on definitive repair in cleft palate patients / Avaliação prospectiva do efeito do fechamento precoce da camada nasal no reparo definitivo em pacientes com fenda palatina

Abstract Introduction The cleft palate is one of the most common congenital anomalies treated by plastic surgeons. The cleft width increases the tension of repair and necessitates excessive dissection that might affect maxillary growth. Decreasing the width of cleft minimize tension, dissection and may limit the impact on maxillary growth. Objectives The purpose of the study was to evaluate the effect of nasal layer closure of the hard palate at the time of cleft lip repair in patients with complete cleft lip and palate, to demonstrate the efficacy of narrowing the gap and to reduce the incidence of fistulae or other complications. Methods Thirty patients less than 1 year of age were included in this prospective observational study. A superiorly based vomer flap was used to repair the nasal layer of the cleft hard palate at the time of primary cleft lip repair. 12-14 weeks after the vomer flap, the cleft soft and hard palate was definitively repaired. Alveolar and palatal gaps were recorded during the 1st and 2nd operations to demonstrate the reduction of the gap defect. Results The mean reduction of the alveolar cleft width in patients who had a vomer flap in the first stage was 4.067 mm and the mean reduction of the palatal gap was 4.517 mm. Only 3 patients developed small fistula on the repaired nasal layer that was discovered and corrected during definitive palatoplasty. Conclusion Nasal layer closure is a simple surgical technique that can be used to close the hard palate at the time of cleft lip repair. It is a valuable addition to cleft lip and palate repair that may prevent some cleft palate surgical complications.

Resumo Introdução A fenda palatina é uma das anomalias congênitas mais comumente tratadas por cirurgiões plásticos. A largura da fenda aumenta a tensão do reparo e requer dissecção extensa que pode afetar o crescimento maxilar. Diminuir a largura da fenda minimiza a tensão, a dissecção e pode limitar o impacto no crescimento maxilar. Objetivos Avaliar o efeito do fechamento da camada nasal do palato duro no momento do reparo da fenda labial em pacientes com fenda labiopalatina completa, demonstrar a eficácia do estreitamento do gap (abertura) e reduzir a incidência de fístulas ou outras complicações. Método Trinta pacientes com menos de um ano foram incluídos neste estudo observacional prospectivo. Um retalho do vômer de base superior foi usado para reparar a camada nasal da fenda do palato duro no momento do reparo primário da fenda labial. Doze a 14 semanas após o retalho do vômer, a fenda no palato mole e duro foi submetida a reparo. Os gaps alveolares e palatais foram registradas durante a 1ª e a 2ª cirurgias para demonstrar a redução do defeito. Resultados A redução média da largura da fenda alveolar nos pacientes que apresentaram retalho do vômer no primeiro estágio foi de 4,067 mm e a redução média do gap palatino foi de 4,517 mm. Apenas três pacientes desenvolveram uma pequena fístula na camada nasal submetida a reparo, que foi identificada e corrigida durante a palatoplastia definitiva. Conclusão O fechamento da camada nasal é uma técnica cirúrgica simples que pode ser usada para fechar o palato duro no momento do reparo da fenda labial. É uma adição valiosa ao reparo de fenda labial e palatina que pode prevenir algumas complicações cirúrgicas da fenda palatina.

Prospective evaluation of the effect of early nasal layer closure on definitive repair in cleft palate patients.

INTRODUCTION: The cleft palate is one of the most common congenital anomalies treated by plastic surgeons. The cleft width increases the tension of repair and necessitates excessive dissection that might affect maxillary growth. Decreasing the width of cleft minimize tension, dissection and may limit the impact on maxillary growth. OBJECTIVES: The purpose of the study was to evaluate the effect of nasal layer closure of the hard palate at the time of cleft lip repair in patients with complete cleft lip and palate, to demonstrate the efficacy of narrowing the gap and to reduce the incidence of fistulae or other complications. METHODS: Thirty patients less than 1 year of age were included in this prospective observational study. A superiorly based vomer flap was used to repair the nasal layer of the cleft hard palate at the time of primary cleft lip repair. 12-14 weeks after the vomer flap, the cleft soft and hard palate was definitively repaired. Alveolar and palatal gaps were recorded during the 1st and 2nd operations to demonstrate the reduction of the gap defect. RESULTS: The mean reduction of the alveolar cleft width in patients who had a vomer flap in the first stage was 4.067mm and the mean reduction of the palatal gap was 4.517mm. Only 3 patients developed small fistula on the repaired nasal layer that was discovered and corrected during definitive palatoplasty. CONCLUSION: Nasal layer closure is a simple surgical technique that can be used to close the hard palate at the time of cleft lip repair. It is a valuable addition to cleft lip and palate repair that may prevent some cleft palate surgical complications.

Outcome of Recurrent Auricular Keloid Treatment with a Combination of Surgical Excision and Perioperative Corticosteroid Injection.

Background: Auricular keloids that occur after ear piercing or other traumas can challenge surgeons as recurrence is frequent; there has been no consensus about the best management protocol. Surgical excision combined with perioperative corticosteroid injections is frequently used as first-line therapy, but recurrent auricular keloids are usually shifted to a combination of radiotherapy and surgical excision. Objectives: The objective is to evaluate the rate of recurrence when recurrent auricular keloids are treated with surgical excision with perioperative corticosteroid injections. Materials and Methods: Between February 2017 and January 2020, 41 patients (52 auricles) with recurrent auricular keloids were treated by extralesional keloid excision combined with five corticosteroid steroid injections (two preoperative, one intraoperative, and two postoperative doses). Recurrence was recorded if the surgical scar showed hypertrophy or started to rise above the level of the margins. Results: The mean postoperative follow-up was 13.04 months (ranging from 6 to 24 months). Recurrence was recorded in five auricles (9.6%) during the follow-up period. Conclusion: Perioperative corticosteroid injections combined with surgical excision of auricular keloids are still a valid option in recurrent cases, and it is a useful choice when radiotherapy facilities are limited.

Surgical outcomes of 14 consecutive bilateral cleft lip patients treated with a modified version of the Millard and Manchester methods.

BACKGROUND: Bilateral cleft lip deformity is much more difficult to correct than unilateral cleft lip deformity. The complexity of the deformity and the sensitive relationships between the arrangement of the muscles and the characteristics of the external lip necessitate a comprehensive preoperative plan for management. The purpose of this study was to evaluate the repair of bilateral cleft lip using the Byrd modification of the traditional Millard and Manchester methods. A key component of this repair technique is focused on reconstruction of the central tubercle. METHODS: Fourteen patients with mean age of 5.7 months presented with bilateral cleft lip deformity and were operated on using a modification of the Millard and Manchester techniques. Patients with a very wide cleft lip and protruded or rotated premaxilla were excluded from this study. We analyzed 30 normal children for a comparison with our patients in terms of anthropometric measurements. RESULTS: By the end of the follow-up period (between 9 and 19 months), all our patients had obtained a full central segment with adequate white roll in the central segment and a deep gingivolabial sulcus, and we obtained nearly normal anthropometric measurements in comparison with age-matched normal children. CONCLUSIONS: We recommend this modified technique for the treatment of bilateral cleft lip deformity.