analysis of deformities in revision surgeries for secondary unilateral cleft lip

To analyze the secondary cleft lip deformities and the possible causes in a cohort of cases. A case series. Services Institute of Medical Sciences and WAPDA Teaching Hospital Complex, Lahore, from September 2008 to March 2012. Consecutive cases of secondary unilateral cleft lip deformities were selected for the study. These cases were interviewed and deformities recorded. Pre and postoperative photographs were taken for comparison. Per operative photographs were taken, after marking of the incisions, to keep a record of the intervention needed to correct the deformities. These cases were then further analyzed to know the deformities and interventions needed for correction of these deformities. Study subjects comprised 114 males and 75 females. Secondary correction was the most common in second decade of life with 82 cases in this group. The most common deformity was unfavorable scar in 150 cases followed by notch at the vermilion border in 124 cases. Short lip was found in 119 cases. Complete revision of the repair was required in 158 cases and 25 cases required partial redo of the initial repair. In other 6 cases, only scar revision was carried out. Unfavorable scar followed by vermilion notch and short lip were the most common secondary cleft lip deformities. Better technique helps favorable scar. Vermilion notch and short lip can be overcome by switching from rotation advancement repair to the triangular flap repair of Noordhoff

Frequency of sensory deficit in terms of two point discrimination in split thickness skin grafts and local flaps for soft tissue defects of fingers

The minimum distance between two stimulus points on the skin, which are perceived as distinct points, is defined as two point discrimination [TPD]. Among the two types of TPD, i.e., static and dynamic, static two-point discrimination [STPD] is commonly used to determine digital nerve integrity. Local flaps usually do well in maintaining sensibility of the covered area in terms of two-point discrimination in contrast to split thickness skin grafts [STSG]. Aim was to determine the frequency of sensory deficit in terms of Two Point Discrimination [TPD] in Split Thickness Skin Grafts [STSG] and local flaps for soft tissue defects of fingers three months postoperatively. Thirty-five patients underwent local flap coverage and other thirty-five had split thickness skin grafting for soft tissue defects of fingers depending upon nature of defect. Patients were followed up at 2, 4, 8 and 12 weeks. TPD, measured at 3 months of follow-up, of 7 mm was considered normal [no sensory deficit] and TPD of 8mm or more was considered as sensory deficit. The sensory deficit observed at the end of 12[th] week post operatively was 8.6% in the patients with local flap coverage [3 patients] and 45.7% with STSG [16 patients]. Patients with no sensory deficit were 91.4% [32 patients] in the local flap coverage and 54.3% [19 patients] in the STSG at 12th week of follow up. The relative ratio [RR] of sensory deficit in local flaps and STSG was 5 [>2]. Local flaps are better options in terms of TPD preservation as opposed to STSG for soft tissue defects of fingers.

Presurgical orthodontic management and secondary bone graft in the cleft patients

Three cases of cleft lip and palate are presented which were dealt with presurgical orthodontics followed by secondary bone grafting of the alveolar defects. This combined approach improved the deranged occlusion, arch malalignment, problems of cross bite and localized open bite at cleft site along with the midface cosmesis

Temporal fascia as interpositioning material in cases of temporomandibular ankylosis

To evaluate the efficacy of temporal fascia as interpositioning material after treatment of TMJ ankylosis with gap arthroplasty. An interventional study. The study was carried out at the Department of Oral and Maxillofacial Surgery, Mayo Hospital, Lahore, during June 1999 to June 2001. A total of 51 patients, 23 males and 28 females, of temporomandibular ankylosis were treated with gap arthroplasty and temporal fascia was used as interpositioning material. Out of 51 cases, 28 had excellent results, 20 were declared good and 3 presented with recurrence. Temporal fascia works as excellent interpositioning material with minimum morbidity and no complications. Moreover, it is easier to raise, comes from same operation field and is dispensable

analysis of etiologies, patterns and treatment modalities of fracture mandible

Etiologies of maxillofacial trauma, and thus the pattern of fractures, differ in various setups depending upon socioeconomic status, life style, type of industry, and out door activities. All these factors further dictate on management of these cases. Record of 457 cases of fracture mandible was reviewed to analyze the incidence, pattern of fractures and various treatment modalities. It included 384 males and 73 females with second and third decades of life being most commonly involved age subgroups. Isolated mandible fractures were noted in 345 [75.49%] cases while in rest of the 112 [24.51%] cases either zygomatic bone or maxilla or both of them were also found involved. Most common etiology was road traffic accidents recorded in 230 [50.33%] cases, followed by fall from height in 114 cases. Body of mandible was the most commonly effected area, i.e. 177 [38.73%] cases, followed by parasymphysis region in 139 [30.42%] cases. A total of 317 [69.37%] cases were treated with closed reduction and intermaxillary fixation and 108 [23.63%] cases had open reduction and fixation with interosseous wiring or miniplates

Evaluation of role of chest physical therapy in thoracic surgery

Study was conducted to evaluate the efficacy of post operative chest physiotherapy in cases of thoracic surgery. Eighty patients who underwent various surgical procedures were divided into two groups: one where adequate physiotherapy was carried out and the other where adequate physiotherapy could not be carried out. It was found that rate of postoperative complications was double in the group where chest physiotherapy could not be carried out due to any reasons

Zygomatic bone fracture

To find out the number and etiology of fractures of zygomatic bone. Design: Observational study. Place and Duration of Study: This study was carried out at the Department of Oral and Maxillofacial Surgery, Mayo Hospital, Lahore from January 2001 to December 2002. Patients and A total of 209 cases were treated during a period of two years. A detailed history and examination was done and findings were confirmed radiologically. There were 184 [88.04%] male and 25 [11.96%] female patients. In 117 [56%] cases only the zygomatic bone was involved while in the rest of the 92 [44%] cases, fracture occurred in combination with fracture of other facial bones. The youngest patient in the series was 9 years of age and the oldest of 80 years. Most of the patients were in the third decade of life [35%]. Most common etiology was road traffic accidents, followed by interpersonal violence. In half of the road traffic accidents, motorcyclists were involved. Most common etiology of the fractured zygomatic bone was road traffic accidents. Measures, like various awareness campaigns, raising the traffic sense in public, wearing helmets while driving the motorcycle, can minimize number of these cases