Management of congenital cleft lip: an eight-year experience

From1988 to1996, 461 patients with congenital cleft lip underwent a total of 505 surgical procedures. Most of the patients were operated upon in their childhood, but 16% underwent surgery in their teens and early adult life. A unilateral deformity was present in 384 patients, 73 had a bilateral cleft while 4 patients had a median cleft. The epidemiological data was consistent with that reported in literature. Millard repair was the commonest procedure for unilateral clefts being used in 86% cases. For the bilateral clefts an Hagedorn or a Millard procedure was used. The overall complication rate was 3%, with 3 perioperative deaths in the series. Results were assessed at a minimum of 6 months post-operatively. In 79% of patients, a good result was obtained. Secondary/revisional surgery was required in 33[7.2%] patients. About 25% of patients with bilateral clefts had a fractured premaxilla and it is recommended that surgery be performed early in these patients. Patients with incomplete clefts had a slightly higher percentage [83.1%] of good results as compared to complete clefts [77.2%]. This indicates that the more severe the deformity, the poorer the results. It was shown that results have more to do with the attention to detail and skill of the individual surgeon rather than any specific technique

Frequency of consanguinity and its effect on congenital malformation - a hospital based study

A consecutive sample of 5,000 families of Armed Forces personnel was analysed to study the prevalence of consanguineous marriage and its effect on the prevalence of hereditary gross [physical] malformations. The overall frequency of inbreeding was 76% with a coefficient of 0.04151 which is probably the highest figure reported in literature. The overall prevalence of congenital malformations in children of related parents was 40% [1530 out of 3820] and in non-related parents 26% [305 out of 1180] [p = < 0.01]. Considering the prevalence of malformations with the types of relationship of parents, the inter-marriage with first cousins, alone, was highly significant [p = < 0.01]

Antibiotic prophylaxis in paediatric surgery

Effect of antibiotic prophylaxis was studied in 400 children undergoing various types of surgery. Patients were divided into different classes according to the type of operation and each was further randomized into a routine or trial group. The routine group received antibiotics for prolonged periods. In the trial group, "clean" cases [class A] did not get any antibiotics. The "clean-contaminated" [class B] and "contaminated" cases [class C] received peri-operative antibiotics only. Frankly infected cases were not included in this trial. There were 131,213 and 56 cases in classes A, B and C respectively; of these 13 [3.25%] cases were diagnosed as infected, four in the trial group and nine in the routine group. It was found that a short course of peri-operative antibiotics was equally, if not more effective. Prolonged courses of antibiotics were not only useless and expensive but could also be harmful. For clean cases there is no need for antibiotic prophylaxis. Children behave no differently and these results may be extrapolated to adults