Pudendal nerve block for circumcision of pediatric patient with Pierre Robin Sequence: case report

Abstract Pierre Robin Sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and cleft palate that presents with airway obstruction and developmental delay with or without other congenital anomalies. These patients' anesthesia management is challenging because of difficult ventilation and intubation. Regional anesthesia methods should be considered for these patients on a case-by-case basis. This report presents primary use of regional anesthesia for circumcision of a 9-year-old boy with PRS.

Effectiveness of iliac cancellous bone grafting in alveolar cleft repair and analysis of factors affecting it / 华西口腔医学杂志

OBJECTIVES@#To review the effectiveness of secondary alveolar bone grafting using iliac cancellous bone in patients with unilateral complete alveolar cleft and to investigate the factors influencing it.@*METHODS@#A retrospective study of 160 patients with unilateral complete alveolar clefts who underwent iliac cancellous bone graft repair at the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, was conducted. Eighty patients in the young age group (6-12 years) and 80 in the old age group (≥13 years) were included. Bone bridge formation was determined using Mimics software, and the volume was measured to calculate the iliac implantation rate, residual bone filling rate, and resorption rate. The factors that affected bone grafting in both subgroups were investigated.@*RESULTS@#Using bone bridge formation as the clinical success criterion, the success rate for the entire population was 71.25%, with a significant difference of 78.75% and 63.75% for the young and old age groups, respectively (P=0.036). The gap volume in the latter was significantly larger than that in the former (P<0.001). The factors that influenced bone grafting in the young group were the palatal bone wall (P=0.006) and history of cleft palate surgery (P=0.012), but only the palatal bone wall affected the outcome in the old age group (P=0.036).@*CONCLUSIONS@#The results of alveolar bone grafting for the old age group were worse than those for the young age group. The palatal bone wall was an important factor that affected alveolar bone grafting, and alveolar bone grafting in the young patients was influenced by the history of cleft palate surgery.

Two-stage alveolar bone grafting for nasal floor reconstruction in adult cleft patients / 华西口腔医学杂志

Alveolar cleft is one of the key links of cleft lip and palate reconstruction due to its close relationship with tooth and jaw coordination and nasolabial deformity. The alveolar bone graft repairs the hole in the gum ridge and stabilizes the bone arch, providing better support for the base of the nose and new bone for the roots of the developing teeth to grow into. Unfortunately, bone graft failure in the traditional way, even among minor clefts, bony hypoplasia, or absence that affects the nasal base and piriform rim, is common. Two-stage alveolar bone grafting, which has advantages in addressing the underlying skeleton and deficiency, could be an optional surgical procedure for nasal floor reconstruction in adult patients with a broad alveolar cleft.

Planificación quirúrgica de colgajo faríngeo a medida para insuficiencia velofaríngea secundaria a fisura de paladar: reporte de caso y revisión de literatura / Surgical planning of a tailor-made pharyngeal flap for velopharyngeal insufficiency secondary to a cleft palate: case report and literature review

Resumen La insuficiencia velofaríngea (IVF) es una de las principales secuelas estructurales tras la palatoplastía primaria en casos de fisura de paladar. La IVF se caracteriza por la ausencia de tejido suficiente para lograr un cierre adecuado del mecanismo velofaríngeo durante el habla, lo que conlleva a una resonancia hipernasal y la emisión nasal de aire durante la producción de sonidos orales. Al respecto, el tratamiento ideal para corregir la IVF es quirúrgico, dentro de los cuales el colgajo faríngeo de pedículo superior es uno de los procedimientos más utilizados en nuestro país. Para su realización es fundamental determinar el ancho necesario, lo cual puede ser determinado mediante una videofluoroscopía multiplano (VFMP). Por esto, con el objetivo de potenciar el trabajo multidisciplinario en la corrección quirúrgica de la IVF, a continuación, se presentan los procedimientos de evaluación fonoaudiológica, videonasofaríngoscopía flexible y videofluoroscopía multiplano utilizados para la planificación quirúrgica de un colgajo faríngeo en un adolescente chileno diagnosticado con IVF secundaria a fisura palatina operada. Además, se describe el uso de la VFMP en la planificación quirúrgica del colgajo faríngeo mediante una revisión de literatura.

Abstract Velopharyngeal insufficiency (VPI) is one of the main structural sequelae after primary palatoplasty in cases of cleft palate. VPI is characterized by the absence of sufficient tissue to achieve adequate closure of the velopharyngeal mechanism (VFM) generating hyper-nasal resonance and nasal emission during the production of oral sounds. In cases of cleft palate, the ideal treatment to correct VPI is surgery. The upper pedicle pharyngeal flap is one of the most widely used procedures. To plan it, is essential to determine the appropriate width, which can be determined by means of multiplane videofluoroscopy (MPVF). For this reason, and with the aim of promoting multidisciplinary approach in the surgical correction of VPI, the following procedures such as speech and language evaluation, flexible videonasopharyngoscopy and multiplane videofluoroscopy used for the surgical planning of a pharyngeal flap, in a Chilean adolescent diagnosed with VPI secondary to operated cleft palate, will be presented. In addition, the use of MPVF in pharyngeal flap surgical planning is described through a literature review.

Pharyngeal bulb prosthesis and speech outcome in patients with cleft palate / Obturador faríngeo e resultados de fala em pacientes com fissura palatina

Abstract Introduction: Individuals with cleft palate can present with velopharyngeal dysfunction after primary palatoplasty and require a secondary treatment due to insufficiency. In these cases, the pharyngeal bulb prosthesis can be used temporarily while awaiting secondary surgery. Objective: This study aimed to investigate the outcome of treatment of hypernasality with pharyngeal bulb prosthesis in patients with history of cleft palate presenting with velopharyngeal insufficiency after primary palatal surgery. We hypothesized that the use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency in patients with cleft palate. Methods: Thirty speakers of Brazilian Portuguese (15 males and 15 females) with operated cleft palate, ages ranging from 6 to 14 years (mean: 9 years; SD = 1.87 years), participated in the study. All patients were fitted with a pharyngeal bulb prosthesis to manage velopharyngeal insufficiency while they were awaiting corrective surgery to be scheduled. Auditory-perceptual analysis of speech recorded in the conditions with and without pharyngeal bulb prosthesis were obtained from three listeners who rated the presence or absence of hypernasality for this study. Results: Seventy percent of the patients eliminated hypernasality while employing the pharyngeal bulb prosthesis, while 30% still presented with hypernasality. The comparison was statistically significant (p < 0.001). Conclusion: The use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency.

Resumo Introdução: Indivíduos com fissura palatina podem apresentar disfunção velofaríngea após a palatoplastia primária e necessitam de um secundário devido à insuficiência velofaríngea. Nesses casos, o obturador faríngeo pode ser usado temporariamente enquanto se aguarda uma cirurgia secundária. Objetivo: Investigar o resultado do tratamento da hipernasalidade com o uso de obturador faríngeo em pacientes com histórico de fissura palatina que apresentam insuficiência velofaríngea após a palatoplastia primária. Nossa hipótese é que o uso do obturador faríngeo seja uma abordagem eficaz para eliminar a hipernasalidade relacionada à insuficiência velofaríngea em pacientes com fissura palatina Método: Participaram do estudo 30 indivíduos falantes do Português Brasileiro (15 homens e 15 mulheres) com fissura palatina operada, de 6 a 14 anos de idade (média: 9 anos; DP = 1,87 anos). Todos os pacientes receberam obturador faríngeo para o tratamento da insuficiência velofaríngea, enquanto aguardavam vaga para a cirurgia secundária. A análise perceptivo-auditiva da fala, realizada nas condições com e sem obturador faríngeo, foi realizada por três ouvintes, quanto à presença e ausência da hipernasalidade. Resultados: 70% dos pacientes eliminaram a hipernasalidade de fala com o uso do obturador faríngeo, enquanto 30% não eliminaram. A comparação foi estatisticamente significante (p < 0,001). Conclusão: O uso temporário do obturador faríngeo é uma abordagem efetiva para eliminar a hipernasalidade decorrente da insuficiência velofaríngea.

Qualitative Assessment of Surgical Repair of Three Types of Unilateral Cleft Lip

Abstract Objective: To assess the effect of the three types of unilateral cleft lip (UCL) [cleft lip only, cleft lip and alveolus, and cleft lip alveolus and palate] on the outcome of the repair. Material and Methods: This study was a case series of effect of types of UCL on the outcome of the repair. Fifteen subjects each were in three UCL phenotypes groups. Evaluation of the scar, lip, and nose was done qualitatively by both parents/guardians and professionals using a modified form of the criteria described by Christofides et al. (2006). Results: In the assessment of the surgical scar, the parents found a difference between the three types of cleft in terms of texture, shape, and width of the scar and presence of columella deviation. The professional assessors, however, only found the three types of cleft to be different in the presence of alar flattening. Conclusion: Differences truly exist in the outcome of surgical repair of the three types of unilateral cleft lip, especially in the aesthetics of the nose and in the width and shape of the residual lip scar. Thus, it is important to consider this in the assessment of UCL repair because putting the subtypes together might have a negative impact on the assessment.

Tratamiento del Fisurado Labio Alvéolo Palatino (FLAP): casos clínicos y tratamiento interdisciplinario / Treatment of the cleft lip and palate (CLP) patient: case reports and interdisciplinary treatment

Objetivo: Describir el plan de tratamiento completo para el manejo de pacientes con fisura labio alvéolo palatina (F.L.A.P.), basado en nuestra experiencia clínica de más de 40 años. Casos clínicos: En nuestro protocolo consideramos fundamental el tratamiento ortopédico, teniendo en cuenta los tiempos de crecimiento y desarrollo del maxilar superior de cada paciente, para luego aplicar las técnicas quirúrgicas en un maxilar armónico, con un éxito más predecible. Se describirá una serie de casos clínicos con seguimiento de pacientes. Conclusión: Con este protocolo que pregonamos desde hace muchos años, nos diferenciamos principalmente de otras propuestas por considerar los tiempos biológicos de cada paciente en cuanto a crecimiento y desarrollo, y no por basarnos en tiempos quirúrgicos preestablecidos. Aplicando este protocolo obtenemos resultados predecibles que entendemos que solo son posibles de evaluar, al realizar el seguimiento del paciente hasta completar su desarrollo (AU)

Objective: To describe the comprehensive treatment plan aimed at managing patients with cleft lip and palate (CLP) on the basis of our more than forty years of clinical experience. Case reports: e orthopedic treatment is deemed fundamental in the present protocol, which takes into account the maxilla growth and development periods of each individual patient, to later perform a surgical technique in a harmonized maxilla, with a more predictable success. Clinical cases with the patient follow-up shall be described. Conclusion: e main difference between the present protocol that has been held for many years and others proposed approaches mainly lies in considering the unique growth and developmental biological stages of each patient and not in drawing on pre-established surgical timing. When applying this protocol, predictable results are achieved and they are only meant possible to be assessed during the thorough patient follow-up (AU)

Innovative method to assess maxillary arch morphology in oral cleft: 3d-3d superimposition technique

Abstract This study aimed to analyze the maxillary growth and development of children with oral clefts using the innovative method of 3D-3D superimposition technique. Children with unilateral complete cleft lip (UCL) and unilateral cleft lip and palate (UCLP) participated in the study. The impressions of the dental arches were executed 1 day before and 1 year after lip repair surgery. A 3D laser scanner digitized the dental models and the stereophotogrammetry system software analyzed the 3D-3D superimpositions in two groups of matches (same child, UCL and UCLP) and one group of mismatches (different individuals). The differences were evaluated by Root Mean Square (RMS) and expressed in millimeters (mm). Kruskal-Wallis test followed by post-hoc Dunn test and Mann-Whitney test were assessed to compare the groups (α=5%). RMS was 1.34 mm (± 0.37) in UCL group, 1.41 mm (± 0.32) in UCLP group, and 3.38 mm (± 1.28) in mismatches group. RMS was significantly greater in mismatches than in matches groups (p<0.0001). No statistically significant differences occurred between genders. The 3D-3D superimposition technique showed the maxillary development after lip repair surgery in the anterior region of the palate. Thus, it is suggested that the cleft amplitude and the palatal segments proportion influenced the morphological heterogeneity and, consequently, the development and maxillary growth of children with orofacial cleft.

Resumo O objetivo deste estudo foi analisar o crescimento e desenvolvimento maxilar de crianças com fissuras orais por meio de um método inovador da técnica de sobreposição 3D-3D. Participaram do estudo crianças com fissura unilateral completa de lábio (FL) e fissura unilateral de lábio e palato (FLP). As moldagens dos arcos dentários foram realizadas 1 dia antes e 1 ano após o reparo cirúrgico labial. Um scanner a laser 3D digitalizou os modelos dentários e o software do sistema de estereofotogrametria analisou as sobreposições 3D-3D em dois grupos correspondentes (mesmo indivíduo, FL e FLP) e um grupo não-correspondente (indivíduos diferentes). As diferenças foram avaliadas pelo Root Mean Square (RMS) e expressas em milímetros (mm). O teste de Kruskal-Wallis seguido do teste post-hoc de Dunn e teste de MannWhitney foram avaliados para comparar os grupos (α=5%). RMS foi de 1.34 mm (± 0.37) no grupo FL, 1.41 mm (± 0.32) no grupo FLP e 3.38 mm (± 1.28) no grupo não-correspondente. RMS foi significativamente maior no grupo não-correspondente (p <0.0001). Não houve diferenças estatisticamente significativas entre os gêneros. A técnica de sobreposição 3D-3D evidenciou o desenvolvimento da maxila após a cirurgia labial na região anterior do palato. Assim, sugere-se que a amplitude da fenda e a proporção dos segmentos palatinos influenciam na heterogeneidade morfológica e, consequentemente, no desenvolvimento e crescimento maxilar de crianças com fissura orofacial

Effect of the prophylactic use of antibiotics on wound infection after cleft lip surgery / 华西口腔医学杂志

OBJECTIVES@#To study the effect of preoperative prophylactic use of antibiotics on wound infection in patients with cleft lip.@*METHODS@#Aretrospective study was conducted on the clinical data of 1 361 patients who underwent one-stage cleft lip repair in the Department of Cleft Lip and Palate in West China Hospital of Stomatology, Sichuan University, from January 2015 to November 2018. The patients were divided into two groups according to whether prophylactic antibiotics were used or not. There were 594 patients in the prevention group, including 373 unilateral incomplete cleft lip (UICL) patients, 157 unilateral complete cleft lip (UCCL) patients, 25 bilateral incomplete cleft lip (BICL) patients, 39 bilateral complete cleft lip (BCCL) patients. There were 767 patients in the non-prophylactic group, including 482 UICL patients, 211 UCCL patients, 31 BICL patients, 43 BCCL patients. The relationship between preoperative and postoperative leukocyte count, preoperative and postoperative body temperature, and postoperative wound infection were compared between the two groups.@*RESULTS@#No significant difference was observed in the leukocyte count and body temperature between both groups (@*CONCLUSIONS@#The preoperative prophylactic use of antibiotics has no significant effect on the incidence of postoperative infection in patients undergoing cleft lip repair.

Analysis of middle ear function of the patients with cleft palate after palatoplasty / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the middle ear function of the patients with cleft palate pre and post palatoplasty. Methods: 76 patients with cleft palate were investigated by clinical history and audiology examinations including electric otoscopy,tympanometry and click-ABR threshold. Results: The risk for middle ear function decreased with advancing age in the first 5 years. It was noticed that the otologic outcomes was related to the CP type. During long time follow-up, the frequency with the middle ear function disorder was always high within the CP patients but the proportion of the patients received tympanostomy tubes was low relatively. The prevalence of middle ear dysfunction did not differ with the time of cleft palate repair. Conclusion: The patients with cleft palate have middle ear function dysfunction in a long period of time,therefore a standard long-time follow-up system is necessary.

Cephalometric predictors of hypernasality and nasal air emission

Abstract During times of increasingly recognized importance of interprofessional practices, professionals in Medicine, Dentistry, and Speech Pathology areas cooperate to optimize treatment of velopharyngeal dysfunction (VPD), after primary palatoplasty for correction of cleft palate. Objective Our study aims to compare velar length, velar thickness, and depth of the nasopharynx of patients with unilateral cleft lip and palate (UCLP) with the presence, or absence, of hypernasality and nasal air emission; and to verify if the depth:length ratio, between nasopharynx and velum, would be predictive of consistent hypernasality and nasal air emission (speech signs of VPD). Methodology Cephalometric radiographs and outcome of speech assessment were obtained from 429 individuals, between 6 and 9 years of age, with repaired unilateral cleft lip and palate. Velar length, velar thickness, depth of the nasopharynx, depth:length ratio, scores of hypernasality, and scores of nasal air emission were studied and compared; grouping the radiographs according to presence or absence of hypernasality and nasal air emission. Results For the group with speech signs of velopharyngeal dysfunction (those with consistent hypernasality and nasal air emission), the velums were shorter and thinner; the nasopharynx was deeper and the depth:length ratio was larger than the group without hypernasality and nasal air emission. Velar length was significantly shorter in individuals with consistent hypernasality and nasal air emission (p<0.001) and with history of palatal fistula (p=0.032). Depth of nasopharynx was significantly greater in individuals with consistent hypernasality and nasal air emission (p<0.001). Depthlength ratio was significantly larger in individuals with consistent hypernasality and nasal air emission (p<0.001). A depth:length ratio larger than 0.93 was always associated with speech signs of VPD. Conclusion Estimated with cephalometric radiographs, a depth:length ratio greater than 0.93, between the nasopharyngeal space and the velum, was 100% accurate in predicting hypernasality and nasal air emission after primary repair of unilateral cleft lip and palate.

Intensive therapy for speech rehabilitation of a patient with cleft lip and palate: a case report / Terapia intensiva para a reabilitação da fala em paciente com fissura labiopalatina: relato de caso

ABSTRACT Intensive therapy is an alternative to accelerate the therapeutic process of individuals with cleft lip and palate. The purpose of this study is to describe an intensive speech therapy program and compare the results before and after the program on a child with previously operated right unilateral cleft lip and palate and velopharyngeal insufficiency, using a speech bulb. Sixty therapy sessions were carried out over a 4-week period. Before and after, anamnesis, speech assessment and evaluation of the velopharyngeal function with nasofibroscopy, were performed. The patient presented with adequate resonance and speech intelligibility, reduction of obligatory disorders and compensatory articulations, after intensive therapy with the speech bulb and reduction of velopharyngeal gap, after intensive therapy with and without the speech bulb. Progress was achieved with the intensive speech therapy.

RESUMO A terapia intensiva é uma alternativa para acelerar o processo terapêutico de indivíduos com fissura labiopalatina. O objetivo desse estudo foi descrever, aplicar um programa de terapia intensiva e comparar a evolução antes e após o programa de fonoterapia de uma criança com fissura transforame incisivo unilateral direita operada e insuficiência velofaríngea em uso de prótese de palato obturadora. Foram realizadas 60 sessões de terapia, durante 4 semanas. Antes e após, aplicou-se anamnese, avaliação da fala e nasofibroscopia. Como resultado, a paciente apresentou adequação da ressonância e da inteligibilidade de fala, diminuição dos distúrbios obrigatórios e das articulações compensatórias após terapia intensiva com prótese de palato obturadora; e redução do gap velofaríngeo após a terapia intensiva com e sem o uso da prótese. Concluiu-se que a fonoterapia intensiva proporcionou evolução do caso.

Association between speech and dental occlusion changes in children with cleft lip and palate and time of primary plastic surgeries / Associação entre alterações de fala e dento-oclusais em crianças com fissura labiopalatina e a época das cirurgias plásticas primárias

ABSTRACT Purpose: to describe the changes in speech and dental occlusion in children with cleft lip and palate and verify their association with each other and with the time of primary plastic surgeries. Methods: a cross-sectional study with collected data on the subjects' identification, age at the time of primary surgeries, and clinical assessment of speech and dental occlusion. The chi-square test, Fisher's exact test, and t-test were used to verify the associations between the variables at the 5% significance level (p < 0.05). Results: the sample comprised 11 children aged 6 to 10 years, most of whom were males, self-reported white, with trans-incisive foramen cleft, predominantly on the left side. The mean age at lip repair surgery was 6 months, and 13 months at palatoplasty. Among the main dental occlusion changes, posterior and anterior crossbite stood out. All the subjects presented changed speech, with a prevalence of cases with dentoalveolar and palatine deformities, followed by passive and active changes. Subjects with anterior crossbite tended to have undergone primary lip repair surgery at a mean of four months earlier than the subjects without anterior crossbite. Conclusions: the associations between speech and dental occlusion changes, and between these and the time of primary plastic surgeries were not statistically significant. Even though it is known that early lip repair surgery is ideal to favor oral functions and aesthetics, the results revealed a tendency towards anterior crossbite, in these subjects.

RESUMO Objetivos: descrever alterações de fala e dento-oclusais em crianças com fissuras labiopalatinas, verificar a associação entre si e destas com a época das cirurgias plásticas primárias. Métodos: estudo transversal, com coleta de dados de identificação, idade nas cirurgias primárias, avaliação clínica dento-oclusal e da fala. Utilizou-se o teste Qui-quadrado, teste exato de Fisher e teste t para verificar as associações entre as variáveis, com um nível de significância de 5% (p < 0,05). Resultados: amostra composta por 11 crianças entre seis e dez anos, sendo a maioria do sexo masculino, etnia autodeclarada branca e fissura transforame incisivo (com prevalência de acometimento do lado esquerdo). A média da realização da labioplastia foi aos seis meses e palatoplastia aos treze meses. Dentre as principais alterações dento-oclusais, destacam-se: mordida cruzada posterior e mordida cruzada anterior. Todos os sujeitos apresentaram alteração de fala com prevalência de alterações em casos com deformidades dentoalveolares e palatinas, seguidas pelas alterações passivas e alterações ativas. Houve tendência dos sujeitos que apresentaram mordida cruzada anterior terem sido submetidos à labioplastia primária, em média, quatro meses antes dos sujeitos sem mordida cruzada anterior. Conclusões: as associações entre alterações de fala e dento-oclusais e destas com a época das cirurgias plásticas primárias não foram estatisticamente significantes, e ainda que se saiba que a labioplastia precoce é o ideal para favorecer funções orais e estética, os resultados demonstraram tendência a mordida cruzada anterior nestes sujeitos.

Fisura palatina con paladar hendido. Presentación en un neonato / Cleft lip and palate. Presentation in an infant

Se presentó un recién nacido del sexo femenino, hijo de madre de 31 años con antecedentes patológicos referidos de hipertensión arterial y abuela materna con diabetes mellitus. En el examen físico realizado se comprobó la base de labio y paladar hendidos unilaterales izquierdo completos. Fue atendida en el Hospital Provincial Ginecobstétrico "Fe del Valle Ramos", provincia Granma, por un equipo de salud multidisciplinario. Es importante una vez diagnosticada la patología, desarrollar a través de un equipo multidisciplinario acciones que permitan restaurar la adecuada funcionalidad de la vía digestiva, así como todas las problemáticas estéticas y fonética, mejorando de esta manera la calidad de vida del niño, de sus padres y familiares, lo que permitirá al paciente una mejor integración a la sociedad.

A female newborn was presented, son of a 31-year-old mother with a referred pathological history of high blood pressure and grandmother on mother´s side with diabetes mellitus. The physical examination showed a unilateral complete cleft lip and palate in the left side. She was treated at the "Fe del Valle Ramos" Gynecobstetric Hospital in Granma Province, by a multidisciplinary health team. When pathology has been diagnosed, it is very important a multidisciplinary team to develop actions that allow the restoration of the adequate functionality of the digestive tract, as well as all the aesthetic and phonetic problems, using this way to improve the quality of life of the child, his parents and relatives, which will allow the patient a better integration to society.

Intervención educativa para la evaluación de la simetría nasal en pacientes operados de labio y paladar hendido / Educational intervention for the evaluation of nasal symmetry in cleft lip and palate operated patients

Resumen Introducción: La asimetría nasal es una de las características más frecuentes de los pacientes con labio y paladar hendido; la medición antropométrica (MA) es un método accesible y confiable que puede ser utilizado por los especialistas para evaluarlo. El objetivo de este estudio fue evaluar la efectividad de una intervención educativa aplicada a especialistas que tratan pacientes con labio y paladar hendido para incrementar la precisión en las MA en la evaluación de la asimetría nasal. Métodos: Estudio cuasiexperimental. Resultados: En la primera fase del estudio, 5 de las 13 medidas antropométricas reportaron una diferencia de medias (DM) > 1.5 mm, y 12 de las 13 MA mostraron resultados mayores a dos desviaciones estándar (DE). Los resultados en la segunda fase evidenciaron 11 de las 13 MA con DM < 1 mm, y 9 de las 13 MA fueron menores a dos DE. Conclusiones: La intervención realizada con el Manual de medidas antropométricas aumentó los conocimientos de los especialistas sobre la anatomía, puntos y MA que se pueden utilizar para evaluar la asimetría nasal en pacientes con labio y paladar hendido. La intervención educativa ayuda a aumentar el acuerdo entre los evaluadores para realizar una evaluación confiable de la asimetría nasal en pacientes con estos padecimientos.

Abstract Background: Nasal asymmetry is one of the most frequent characteristics of patients with cleft lip and palate. The anthropometric measurement (AM) is an accessible and reliable method that can be used by specialists to evaluate nasal asymmetry in patients with cleft lip and palate. The aim of this study was to evaluate the effectiveness of an educational intervention applied to cleft lip and palate specialists to increase the accuracy of AM in the evaluation of nasal asymmetry. Methods: Quasi-experimental study. Results: In the first phase of the study, five of the 13 AM reported a mean difference (MD) > 1.5 mm, and 12 of the 13 AM showed results greater than 2 SD (standard deviations). In the second phase, the results showed 11 of the 13 AM with MD < 1 mm, and 9 of the 13 AM were less than 2 SD. Conclusions: The intervention carried out with the manual of AMs increased the knowledge of the specialists on the anatomy points and AM that can be used to evaluate the nasal asymmetry in patients with cleft lip and palate. Educational intervention help to increase the agreement between examiners to perform a reliable evaluation of nasal asymmetry in patients with these conditions.

Manejo de secuencia de Pierre Robin con distracción externa mandibular y palatoplastia de incisiones mínimas / Managment of Pierre Robin Sequence with external mandibular distraction and palatoplasty of minimal incisions

Antecedentes. La secuencia de Pierre Robin es una patología poco frecuente y entendida en la literatura latinoamericana . La incidencia en el mundo es variable y en Latinoamerica no existen cifras exactas. La etiopatogenia es poco clara y aminorar y manejar las complicaciones respiratorias constituyen un objetivo primordial en el tratamiento de estos pacientes. El objetivo de este artículo es presentar el manejo del Pierre Robin en nuestro Servicio desde un punto de vista íntegro presentando un caso ejemplo. Presentación de caso. Masculino de 9 meses con diagnóstico de Pierre Robin, quien fue tratado con distractores mandibulares y retiro de los mismos tres meses después, con una excelente evolución posoperatoria. Posterior a esto, se realizó una palatoplastia sin complicaciones, con excelentes resultados respiratorios a los 6 meses de seguimiento. Conclusiones. El manejo del síndrome de Pierre Robin es un desafío para el cirujano plástico, con muchas opciones quirúrgicas disponibles, pero la distracción mandibular es actualmente la técnica que tiene mejores resultados confirmados para los parámetros respiratorios a largo plazo.

Background. Pierre Robin's sequence is a rare pathology. The incidence in the world is variable and in Latin America is unknown. The etiopathogenesis is unclear and respiratory complications are a challenge for surgical treatment. The objective of this article is to present the management of Pierre Robin from an integrative point of view through a case presentation. Case presentation. 9 month old male with Pierre Robin diagnosis who was treated with mandibular distractors with subsequent removal 3 months later with excellent postoperative evolution. Later on, a la palatoplasty was performed with no complications, with good respiratory injuries function at 6 month follow up. Conclusions. The management of Pierre Robin syndrome is a challenge for the plastic surgeon, with many surgical options available, with mandíbular distraction currently being the technique of choice because of its confi rmed favorable long term respiratory results

Avanço cirúrgico de maxila e ressonância de fala: comparação entre os tipos de fissura / Surgical maxillary advancement and speech resonance: comparison among cleft types

RESUMO Objetivo Investigar a influência do tipo de fissura sobre o aparecimento da hipernasalidade após o avanço cirúrgico da maxila (AM). Método A nasalidade foi determinada por meio da medida de nasalância (correlato acústico da nasalidade) utilizando-se a nasometria. Foi realizada a análise dos escores de nasalância de 17 indivíduos com fissura isolada de palato (FP), 118 com fissura de lábio e palato unilateral (FLPU) e 69 com fissura de lábio e palato bilateral (FLPB), de ambos os sexos, com idades entre 18 e 28 anos, submetidos ao AM. Apenas indivíduos com escores de nasalância indicativos de ressonância equilibrada previamente ao AM foram incluídos neste estudo. A nasometria foi realizada, em média, três dias antes e 15 meses após o AM. A proporção de pacientes que apresentaram escores de nasalância indicativos de hipernasalidade após o AM foi calculada por meio do teste ANOVA e a comparação entre os diferentes tipos de fissura foi realizada utilizando-se o teste Qui-quadrado (p < 0,05). Resultados Não foi observada diferença significante entre as proporções de indivíduos com hipernasalidade, de acordo com o tipo de fissura. Conclusão A nasometria mostrou que o aparecimento da hipernasalidade após o AM, em indivíduos com fissura de palato envolvendo ou não o lábio, ocorreu em proporções similares independentemente do tipo de fissura.

ABSTRACT Purpose This study investigated the influence of the cleft type on the appearance of hypernasality after surgical maxillary advancement (MA). Methods Nasality was determined by measurement of nasalance (acoustic correlate of nasality) by nasometry. The study involved analysis of the nasalance scores of 17 individuals with isolated cleft palate (CP), 118 with unilateral cleft lip and palate (UCLP) and 69 with bilateral cleft lip and palate (BCLP), of both sexes, aged 18 to 28 years, after MA. Only individuals with normal nasalance scores indicating balanced resonance before MA were included in this study. Nasometry was performed 3 days before and 15 months after MA, on average. The proportion of patients who presented nasalance scores indicating hypernasality after surgery was calculated by the ANOVA test, and comparison among the different cleft types was evaluated by the chi-square test (p < 0.05). Results No significant difference was found in the proportions of individuals with hypernasality among the cleft types. Conclusion Nasometry showed that the appearance of hypernasality after MA in individuals with cleft palate with or without cleft lip occurred in similar proportions, regardless of the cleft type.

Injertos óseos en el fisurado labio-alvéolo-palatino (FLAP): casos clínicos / Bone grafts in the cleft lip and palate (CLP) patient: clinical cases

Objetivo: mostrar el tratamiento que realizamos en comunicaciones a nivel del reborde alveolar en los FLAP, tanto para pacientes con fisura unilateral como bilateral, realizados con cresta ilíaca tomada del paciente y basados en nuestra experiencia de más de 40 años. Casos clínicos: nuestro protocolo está dentro de lo que es el tratamiento que proponemos para FLAP, ortopédico y quirúrgico, teniendo en cuenta el crecimiento y desarrollo del maxilar superior, realizando dentro de éste lo que son las periostioplastías y los injertos óseos, con el correspondiente seguimiento de pacientes en el tiempo. Conclusión: se realiza un protocolo adecuado para cada paciente, para realizar el cierre de la comunicación bucosinusal, teniendo siempre en cuenta el crecimiento y desarrollo de cada paciente y no un tiempo fijo en general para todos ellos. Nos diferenciamos de otras personas que lo hacen en forma sistemática en tiempos quirúrgicos preestablecidos, igual para todos los pacientes (AU)

Velopharyngeal closure pattern and speech characteristics of patients congenital velopharyngeal insufficiency / 华西口腔医学杂志

OBJECTIVE@#To analyze velopharyngeal closure patterns and speech characteristics of patients with congenital velopharyngeal insufficiency.@*METHODS@#Patients visiting the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University between 2009 and 2017 were reviewed. Outcomes of subjective speech evaluation, including resonance, consonant articulation, and correction rate, were analyzed. Furthermore, the mobility of soft palate and pharyngeal walls under nasopharyngeal fiberscope were analyzed retrospectively.@*RESULTS@#A total of 47 cases were retrieved and subjected to nasopharyngeal fiberscopic examination. Among them, 29 (61.7%) demonstrated a circular closure pattern, 16 (34.0%) showed a coronal pattern, and 2 (4.3%) had a sagittal pattern. Furthermore, 25 (53.2%) presented medium soft-palate mobility, 22 (46.8%) had weak lateral pharyngeal wall mobility, and 41 (87.2%) had no posterior pharyngeal wall mobility. Among all of the patients, 23 (48.9%) presented medium hypernasality, accounting for the highest proportion. Consonant misarticulation occurred in 89.4% of the cases. The articulation manners with the highest correction rate were in the following order: nasal, lateral, fricatives, stops, and affricates. The articulation places with the highest correction rate were in the following order: bilabial, alveolar, velar, and linguadental.@*CONCLUSIONS@#Circular closure was the most prevalent velopharyngeal closure pattern among patients with congenital velopharyngeal insufficiency, and consonant omission was the most common articulation abnormality.

Finite element analysis of the comprehensive impact of scar and maxillary expansion combined with protraction on the development of maxilla with cleft lip and palate after repair operation / 华西口腔医学杂志

OBJECTIVE@#To study the comprehensive impact of scar and maxillary expansion combined with protraction on the development of maxilla with cleft lip and palate after repair operation.@*METHODS@#In the original finite element model of the maxilla with cleft palate, a finite element model of the maxilla with cleft lip and palate was established by using Boolean operation in ANSYS. Scar force after cleft lip and palate repair and maxillary expansion force combined with protraction were added simultaneously to process the stress analysis.@*RESULTS@#Maxillary deformation occurred in the three-dimensional direction. The comparison of displacements was as follows: X-axis>Z-axis>Y-axis.@*CONCLUSIONS@#Maxillary growth is significantly inhibited in the three-dimensional direction under the comprehensive impact of scar and maxillary expansion combined with protraction after repair operation, especially transverse and sagittal growth.