NAM e queiloplastia promovem simetria na face e arco superior em pacientes com fenda unilateral completa / NAM and chiloplasty promote face and upper arch symmetry in patients with complete unilateral cleft

As fissuras congênitas de lábio e/ou palato, também conhecidas como fenda labial, fenda labiopalatina e fenda palatina, fazem parte de um conjunto de doenças que afetam a cavidade oral e os lábios. As causas ainda são desconhecidas, mas podem estar relacionadas a fatores genéticos e ambientais. As fendas orofaciais estão dentre as malformações crânio-faciais mais comuns presentes desde o nascimento. O bebê afetado precisará desde o seu nascimento até a sua vida adulta de acompanhamento e tratamento com equipes multidisciplinares, e dentre eles o tratamento ortodôntico é fundamental. O modelador nasoalveolar (NAM) consiste em uma placa intraoral onde o intuito é de diminuir a gravidade da deformidade da fenda original, no pré-cirúrgico e permitir que o cirurgião obtenha um melhor reparo do alvéolo, lábio e nariz nos pacientes que possuem a fissura. Sendo assim, o objetivo do seguinte trabalho é de avaliar o resultado do uso do NAM e da queiloplastia na obtenção da simetria facial e da maxila em bebês fissurados tratados na Faculdade de Odontologia da Universidade Federal de Minas Gerais, por meio de análise de imagens fotográficas realizadas durante os atendimentos clínicos num período de pré-cirúrgico, cirúrgico e pós-cirúrgico, além de modelos digitais moldados antes do tratamento e pós o uso do NAM.

Congenital cleft lip and/or palate, also known as cleft lip, cleft lip and palate, and cleft palate, are part of a set of diseases that affect the oral cavity and lips. The causes are still unknown, but they may be related to genetic and environmental factors. Orofacial clefts are among the most common craniofacial malformations present from birth. The affected baby will need, from birth to adulthood, follow-up and treatment with multidisciplinary teams, and among them, orthodontic treatment is essential. The Nasoalveolar Modeler (NAM) consists of an intraoral plate whose purpose is to reduce the severity of the deformity of the original cleft, in the pre-surgical period and allow the surgeon to obtain a better repair of the alveolus, lip and nose in patients with cleft. Therefore, the objective of the following work is to evaluate the result of using NAM and cheiloplasty in obtaining facial and maxillary symmetry in cleft babies treated at the Faculty of Dentistry, Federal University of Minas Gerais, through photographic image analysis performed during clinical care in a pre-surgical, surgical and post- surgical period, in addition to molded digital models before treatment and after the use of NAM.

Should Cleft Surgery Always be Performed During the Matutine Time? Analysis of Early and Late Postoperative Complications in a Cleft Center.

OBJECTIVE: Surgeries performed in the afternoon schedule were discouraged by Smile Train Foundation for patients younger than 2 years. The aim of this study is to present the incidence of complications discriminating time of surgery (morning/afternoon) in a reference center in Curitiba (Brazil) during 2017. DESIGN: Retrospective study that evaluated all cleft surgeries that were performed at Assistance Center for Cleft Lip and Palate during 2017. Complications correlated with surgery period (morning/afternoon), type of surgery, and operating surgeon were studied. Statistical analysis was performed to find any association between discrete variables. SETTING: Tertiary, institutional. PARTICIPANTS: One hundred eighty-seven patients with cleft lip and/or cleft palate/cleft lip and palate, who were evaluated and submitted to surgery in the center and had less than 24 months of age, were included in the study. INTERVENTIONS: One hundred twenty-four cheiloplasties and 63 palatoplasties were performed. MAIN OUTCOME MEASURE: Incidence of complications. RESULTS: From the total of cheiloplasties, the number of complications was 2 (1.6%) and from the total of palatoplasties the number of complications was 11 (17%); 8.1% of surgeries that were performed in the morning had any complication compared to 5.1% of surgeries performed in the afternoon. Statistical analysis of discrete variables with χ2 test showed no correlation between surgery schedule and complications (χ2 = 0.62). CONCLUSION: The number of complications was not higher in the afternoon scheduled surgeries. Surgeon expertise had a statistically significant correlation with the absence of complications (χ2 = 20.57).

Tratamiento quirúrgico de la hendidura labial en las primeras 24 horas del nacimiento / Surgical treatment of cleft lip in the first 24 hours of birth

OBJETIVO: Evaluar los resultados de la cirugía realizada en las primeras 24 horas de vida en niños con hendidura labial. MÉTODOS: Presentamos una serie de 40 pacientes en los últimos veinte (20) años, operados de hendidura labial bajo anestesia local dentro de las primeras 24 horas de vida. Previo a la intervención quirúrgica evaluamos las condiciones físicas y los análisis de laboratorio del recién nacido, constatándose que no había ningún elemento de importancia en el examen físico ni en las cifras de hematología y química sanguínea, que impidiera la realización de la cirugía. RESULTADOS: Encontramos en los pacientes un estado de relajación que favoreció la realización de la intervención quirúrgica y valores de hemoglobina, que oscilaron entre los 16 y 19,58 g y de glóbulos rojos que sobrepasaron los 5 000 000 x mm³. A todos los pacientes intervenidos se les practicó la evaluación preoperatoria por el neonatólogo quien reportó cifras de peso, talla y circunferencia cefálica dentro de los límites normales. En ninguno de los casos se reportó patología asociada. Desde los 6 meses a los15 años se comprobó un normal crecimiento del labio, de la nariz y de los segmentos maxilares, con un resultado estético y funcional satisfactorio. CONCLUSIÓN: La cirugía del labio hendido en las primeras 24 horas del nacimiento con anestesia local constituye un reto para los cirujanos que se dedican a este tipo de cirugía y su realización precoz tiene múltiples ventajas.

OBJECTIVE: To evaluate the results of the surgery in the first 24 hours of life in children with cleft lip. METHODS: We present a series of 40 patients in the last twenty (20) years, operated for cleft lip under local anesthesia in the first 24 hours of life. Prior to surgery we evaluate the physical conditions and laboratory analysis of the newborn, confirming that there was no element of importance on physical examination or hematology and blood chemistry figures, which contraindicate the completion of surgery. RESULTS: We found in patients in a state of relaxation that favored performing surgery and hemoglobin, which ranged between 16 and 19.58 g of red blood cells exceeded 5 million x mm³. All operated patients underwent preoperative evaluation by the neonatologist who reported figures for weight, length and head circumference within normal limits. In none of the cases associated pathology was reported. From 6 months to age of 15 years old it was found normal growth lip, nose and jaw segments, with satisfactory aesthetic and functional results. CONCLUSION: Cleft lip surgery in the first 24 hours of birth under local anesthesia is a challenge for surgeons who are engaged in this type of surgery and its early implementation has multiple advantages.

Ascher syndrome: report of a case with early manifestations.

Ascher syndrome is a disease of unknown etiology first described in 1920 by Ascher, an ophthalmologist from Prague. It presents with recurrent edema of the lip and upper eyelid resulting in double lip and blepharochalasis. In 10% of cases the idiopathic nontoxic thyroid enlargement also occurs. Because of its rarity, it is often undiagnosed. A case of early onset is presented with its respective surgical treatment and outcome.

Use of botulinum toxin in cheiloplasty: A new method to decrease tension.

OBJECTIVE: To determine if the use of botulinum toxin during cheiloplasty could help in the management of tension at the surgical wound level. INTERVENTIONS: Five children younger than six months of age, who were born with complete cleft lip and palate, were treated with a dose of 10 units of botulinum toxin injected into the upper lip during surgery. Before the surgery, an electromyographic study was carried out on the patients' upper lips. A Millard-type cheiloplasty was performed and 10 days later, a second electromyographic study was performed on the upper lips of all the patients. RESULTS: There was a significant change (P<0.039) in the electromyographic tracing obtained after the application of botulinum toxin, especially during rest. CONCLUSION: As confirmed by electromyography, botulinum toxin effectively inhibits the action of the orbicularis oris muscle, especially when at rest; consequently, the tension is decreased at the level of the surgical wound.