Palatal fistulae resulting from cocaine abuse.

Cocaine fistulae require repair with well-vascularized material. In the technique used this is accomplished by closure of the nasal layer by delayed palatal flaps and the oral layer with a tongue flap. Three cases are presented.

Use of buccal myomucosal flap in secondary cleft palate repair.

BACKGROUND: The purpose of this study was to assess the effectiveness of the buccal myomucosal flap in secondary repairs of cleft palate. METHODS: Twenty-two patients who underwent secondary palatoplasty between 1989 and 2004 in which a buccal myomucosal flap was used were reviewed retrospectively. All patients had undergone at least one previous attempted repair at other institutions. Indications for the secondary repair included velopharyngeal incompetence and/or oronasal fistula. Patients were evaluated preoperatively for oronasal fistula status, velopharyngeal competence, nasal resonance, speech quality, and nasal escape. RESULTS: The buccal myomucosal flap was used in all patients. The patients' mean age was 8.5 years (range, 1 to 23 years). Correction was indicated in seven patients with velopharyngeal incompetence (32 percent), five patients with oronasal fistulas (23 percent), and 10 patients with both conditions (45 percent). Preoperative assessment revealed four patients (18 percent) with an associated syndrome, 17 of 20 patients with hyperresonance (85 percent), 16 of 20 patients with nasal escape (80 percent), and 12 of 20 patients with poor speech (60 percent). The buccal myomucosal flap technique was used alone in 50 percent of patients, six patients had a staged correction (27 percent) and five patients required multiple procedures (23 percent). All fistulas remained closed. Two patients showed mild velopharyngeal incompetence (p = 0.001) and two patients continued to display hyperresonance (p < 0.001). Speech quality improved to a good level in 17 patients (77 percent) (p < 0.001). CONCLUSION: Palate re-repair combined with a buccal myomucosal flap, occasionally in conjunction with other techniques, is an effective method for correcting failed cleft palate repairs.

Assessment of cleft lip and palate patients treated with presurgical orthopedic correction and either primary bone grafts, gingivoperiosteoplasty, or without alveolar grafting procedures.

The effects of alveolar grafting on the development of the craniofacial complex have been reported by numerous investigators. The reported results vary in the literature from significant to very little impediment of maxillary growth. The present work evaluates and compares facial form at age six years in complete unilateral cleft lip and palate patients treated with presurgical orthopedic correction and primary reconstruction with (1) primary bone grafts (n = 14), (2) gingivoperiosteoplasty (n = II), or (3) without alveolar grafting procedures at the time of lip repair (n = 13). The cohort groups were analyzed with a one-way analysis of variance (ANOV A). Statistical analysis revealed significant differences between the three groups for only one of the 12 parameters analyzed. The primary bone grafted group demonstrated less vertical descent-of the anterior maxilla compared to the gingivoperiosteoplasty and non-grafted groups (P = .0027).