Zygomatic Hypoplasia in Patients with Non-syndromic Cleft Lip and Palate: A Case-Control Study.

BACKGROUND: Patients operated for cleft deformities may have zygomatic hypoplasia secondary to impaired growth of the maxilla. This has, however, not been evaluated in the past. SUBJECTS AND METHODS: This study was a prospective, case-control study. This included 32 patients, aged between 19 and 25 years, who were divided into cleft and non-cleft groups. The cleft group was further divided into unilateral clefts, bilateral clefts and isolated palatal clefts. In both groups, the zygoma was assessed and compared on both sides clinically using indirect photogrammetry and radiographically using 3D CT. The results were analyzed statistically using the unpaired t test. RESULTS: There was a significant difference in the zygomatic projection on cleft and non-cleft sides in the unilateral cleft group. There was no significant difference in the zygomatic projection of both sides in the other subgroups and the control group. CONCLUSION: The present study shows that there is a global effect of palato-alveolar cleft repair on the midfacial skeleton. Further studies are required to correlate the impact of age, gender and the technique of palato-alveolar cleft repair with the quantum of malar hypoplasia.

Distraction osteogenesis in complex facial asymmetry corrections.

This article highlights the authors' experience in the management of facial asymmetries with the use of distraction osteogenesis. It is a narrative based on the clinical experience at the Meenakshi Cleft & Craniofacial Center at Chennai.

Impact of mandibular distraction osteogenesis on the oropharyngeal airway in adult patients with obstructive sleep apnea secondary to retroglossal airway obstruction.

AIM: To evaluate the impact of mandibular advancement by distraction osteogenesis on the oropharyngeal airway in adult patients with retroglossal airway obstruction using two different techniques of mandibular distraction. MATERIALS AND METHODS: 13 adult patients with mandibular hypoplasia secondary to TMJ ankylosis with OSAS and radiographic, CT and polysomnographic evidence of OSAS were included in the study. MDO was performed (corpus distraction in 8 cases and morphometric distraction in 5 patients). Post-operatively the patients were followed up by radiographs, CT and polysomnography after 1 month and 6 months. RESULTS: There was an increase in the linear dimension of mandible by 11.07 mm, the volume by 19.3% and a decrease in AHI from 44.8 to 13.2. CONCLUSION: Mandibular distraction (corpus and orthomorphic-equivocal results) is an effective method of relieving the retroglossal airway obstruction in adult patients with OSAS.

Reconstruction of Nasal Cleft Deformities Using Expanded Forehead Flaps: A Case Series.

INTRODUCTION: Reconstruction of the nasal clefts is a challenging task considering the nasal anatomic complexity and their possible association with craniofacial defects. The reconstruction of these defects needs extensive amounts of soft tissue that warrant the use of forehead flaps. Often presence of cranial defects and low hairline compromise the amount of tissue available for reconstruction warrenting tissue expansion. AIM: To evaluate the efficacy of tissue expansion in reconstruction of congenital nasal clefts. SUBJECTS AND METHODS: 9 patients with congenital nasal clefts involving multiple sub units were taken up for nasal reconstruction with expanded forehead flaps. The average amount of expansion needed was 200 ml. The reconstruction was performed in 3 stages. RESULTS: Expanded forehead flaps proved to be best modality for reconstruction providing the skin cover needed for ala, columella and dorsum with minimal scarring at the donor site. CONCLUSION: Expansion of the forehead flap is a viable option for multiple sub unit reconstruction in congenital nasal cleft deformities.

A rare case of multiple oblique facial clefts with supernumerary teeth: case report.

Oblique facial clefts are rare congenital anomalies that can present alone or in association with other craniofacial anomalies. A high degree of clefting in the embryo may lead to hyperdontia secondary to dichotomy of the dental lamina. Multiple facial clefts with hyperdontia are clinically challenging and demand comprehensive rehabilitation. This article reports a case of multiple oblique facial clefts of variable severity with multiple supernumerary teeth in a 12-year-old boy. The varied clinical presentation along with the rarity of the occurrence mandate documentation.