Late cutaneous lip height in unilateral incomplete cleft lip patients does not differ from the normative data.

BACKGROUND: Characterizing the cutaneous upper lip height changes after unilateral cleft lip repair is very important to plan the surgical maneuvers, anticipate the need for overcorrection of the vertical dimension of the lips, and instruct the family on the postoperative outcomes. The aim of this study was to objectively analyze the asymmetry of upper lip height in patients with unilateral incomplete cleft lip who underwent Cutting extended Mohler repair. METHODS: A prospective study of consecutive patients with unilateral incomplete cleft lip who underwent primary lip repair without facial orthopedics was performed. Fifty children without craniofacial abnormalities were used as a control. Frontal view photographs taken at the preoperative (T0) period and early (3-5 months; T1) and late (12-14 months; T2) postoperative periods were used to measure the cutaneous upper lip height. A comparative analysis between affected and unaffected lip heights (control group: right and left sides, respectively) was accomplished using a computerized photogrammetric evaluation. RESULTS: The patients with cleft lip (n = 9) showed a significant (P < 0.01) progressive reduction in lip asymmetry within the studied period (T0 > T1 > T2). The lip asymmetry was higher (P < 0.01) in the cleft lip group (n = 9) than in the control group (n = 50), except in the T2 period (P > 0.05). The average improvement of lip height during the first year after surgery was 9%. CONCLUSIONS: There is a progressive reduction in lip asymmetry following primary lip repair. Patients with unilateral incomplete cleft lip presented lip height average similar to children with noncleft lip in the late postoperative period.

Avaliação de déficit neurossensorial em pacientes com síndromes craniofaciais submetidos a avanço horizontal do mento / Evaluation of neurosensory disturbance in patients with craniofacial syndrome subjected to horizontal chin advancement

INTRODUÇÃO: Embora os distúrbios neurossensoriais após genioplastias tenham sido avaliados em diferentes estudos, não existe uma padronização de como testar e classificar tais alterações. Por essa razão, a incidência de distúrbios neurossensoriais varia de 0 a 100%, dependendo da definição da lesão dos nervos, da sensibilidade do método diagnóstico e do período de seguimento. Portanto, o propósito deste estudo foi avaliar objetivamente o déficit neurossensorial permanente em pacientes submetidos a avanço horizontal do mento. MÉTODO: Foi realizado estudo retrospectivo de todos os pacientes submetidos a avanço horizontal do mento no Hospital SOBRAPAR, no período de 2009 a 2010. A avaliação neurossensorial objetiva do lábio inferior e do mento foi realizada com dois testes neurológicos (teste dos limiares de pressão de Semmes-Weinstein e teste de sensibilidade térmica). O déficit neurossensorial permanente foi definido como testes clínicos anormais com no mínimo 12 meses de pós-operatório. RESULTADOS: Foram avaliados 13 pacientes, sendo 8 deles portadores de síndromes craniofaciais. Houve predomínio de pacientes com os testes de sensibilidade tátil à pressão e térmica (quente e frio) normal (P < 0,05). A análise dos pacientes sindrômicos revelou que a maioria teve o teste de sensibilidade tátil à pressão normal (P < 0,003), não existindo diferenças no teste de sensibilidade térmica (P = 0,317). Não foram identificadas diferenças entre as regiões anatômicas com testes de sensibilidade anormais (P > 0,05). CONCLUSÕES: A maioria dos pacientes apresenta sensibilidade tátil (pressão e temperatura) do lábio inferior e mento preservada 12 meses após terem sido submetidos a avanço horizontal do mento.

BACKGROUND: Although neurosensory disturbances after genioplasty have been evaluated in different studies, standardization for testing and grading of neurosensory injuries is lacking. For this reason, the incidence of neurosensory disturbance varies from 0% to 100%, depending on the definition of nerve damage, the sensitivity of the diagnostic test method, and the follow-up period. Therefore, the aim of this study was to perform an objective evaluation of the permanent neurosensory disturbances in patients who underwent horizontal chin advancement. METHODS:A retrospective study of all patients who underwent horizontal chin advancement at the Hospital SOBRAPAR between 2009 and 2010 was conducted. The objective neurosensory assessment of the lower lip and chin was performed using 2 neurological tests, namely the Semmes-Weinstein pressure and thermal sensitivity tests. Permanent neurosensory disturbance was defined as abnormal clinical test results obtained at least 12 months after surgery. RESULTS: Thirteen patients (8 with craniofacial syndrome) were evaluated. The prevalence of the patients who showed normal results for sensitivity to pressure/touch and thermal sensitivity (warm and cold; P < 0.05) was significantly high. The analysis of the data of the patients with craniofacial syndrome revealed that most of the patients had normal pressure sensitivity test results (P < 0.003). Results from the thermal sensitivity tests showed no significant difference between these patients (P = 0.317). No significant differences were observed between the anatomical regions with abnormal sensitivity test results (P > 0.05). CONCLUSIONS: Tactile sensitivities of the lower lip and chin to pressure and temperature were preserved in most of the patients 12 months after horizontal chin advancement.

Avaliação de parâmetros antropométricos nasais após queiloplastia primária pela técnica de Mohler / Assessment of nasal anthropometric parameters after primary cleft lip repair using the Mohler technique

INTRODUÇÃO: Os esforços para obtenção de melhores resultados da região nasal de pacientes fissurados são contínuos, portanto é necessário o correto diagnóstico das alterações da anatomia nasal sofrida com o decorrer do tempo após uma intervenção cirúrgica. Os objetivos do presente estudo foram: 1) avaliar o porcentual de assimetria do nariz de pacientes portadores de fissura labiopalatina unilateral completa e incompleta submetidos a queiloplastia primária com a técnica de Mohler, no pós-operatório imediato (T1) e após um ano da cirurgia (T2); e 2) comparar o porcentual de assimetria nasal em ambos os períodos pós-operatórios com os mesmos índices obtidos em crianças não-portadoras de fissura labiopalatina. MÉTODO: No período de março de 2007 a dezembro de 2010, 27 pacientes portadores de fissura labiopalatina unilateral foram submetidos a queiloplastia primária. Foram obtidas medidas de área, altura, largura, altura em » medial da largura e altura da base narinar identificados na fotografia em duas dimensões por meio do programa Adobe Photoshop CS5 Extended®. Foi utilizado o teste de ANOVA para comparação estatística entre os valores da assimetria nasal no pós-operatório imediato e um ano após a cirurgia. RESULTADOS: Foram obtidos índices porcentuais de assimetria nasal entre os pacientes fissurados e o grupo controle, demonstrando diferença estatística em todas as variáveis quando comparado ao grupo controle, exceto quanto à altura da base narinar. CONCLUSÕES: Os resultados obtidos demonstraram melhora da simetria nasal, porém tendência a recidiva do resultado obtido em T1. Os pacientes com fissura completa são mais suscetíveis à recidiva em relação à posição do nariz.

BACKGROUND: Efforts to obtain the best possible results in the nasal region of cleft patients are an ongoing process; it is therefore essential to correctly diagnose any changes in the nasal anatomy of cleft palate patients that occur over time and after surgical intervention. The aims of the present study were: (1) to evaluate the percentage of nose asymmetry in patients with either complete or incomplete unilateral cleft lip and palate who underwent primary cleft lip repair with the Mohler technique, both in the immediate postoperative period (T1) and after 1 year (T2); and (2) to compare the percentage of nasal asymmetry in both postoperative periods using the same indexes in children without cleft lip and palate. METHODS: During the period from March 2007 to December 2010, 27 patients with unilateral cleft lip and palate were submitted to primary cleft lip repair. Measurements of area, height, height at » of the medial width, and height of the base of the nose were obtained from two-dimensional photos by using Adobe Photoshop CS5 Extended®. Statistical comparison of the values obtained for nasal asymmetry in the immediate postoperative period and 1 year after surgery was performed with ANOVA. RESULTS: Percentile indexes of nasal asymmetry for cleft patients showed statistical differences in all variables when compared to controls, with the exception being the base of the nose. CONCLUSIONS: The results we obtained showed an improvement in nasal symmetry, although there was a tendency to relapse from the result obtained in T1. Patients with complete cleft were more susceptible to relapse with regard to the position of the nose.

Lip Height Improvement during the First Year of Unilateral Complete Cleft Lip Repair Using Cutting Extended Mohler Technique.

Objective. To compare the cutaneous lip height at early and late postoperative periods and to objectively determine the average amount of lip height improvement during the first year of unilateral complete cleft lip repair using Cutting extended Mohler technique. Methods. In this prospective cohort study, 26 unilateral complete cleft patients and 50 noncleft subjects were included. Photographs were taken between 12 and 16 weeks (T1) and also taken between 12 and 13 months after surgery (T2). The cutaneous lip height distance (photogrammetric lip analysis) obtained in these two periods of time were measured and statistically analyzed. Results. The average lip heights were 24% ± 9% in T1 and 8% ± 6% in T2 (P < 0.01). The average lip height asymmetry in the noncleft individuals was 4.52% ± 1.89%. Conclusion. Since all principles to obtain a symmetrical Cupid's bow were performed, the postoperative pull-up of Cupid's bow is probably owed to the scar contracture, which improves by 2 times during the first year after surgery.