Unilateral cleft lip: evaluation and comparison of treatment outcome with two surgical techniques based on qualitative (subject/guardian and professional) assessment

OBJECTIVES: The outcomes of the treatment of unilateral cleft lip can vary considerably due to variations in repair techniques. The aim of this study was to evaluate and compare treatment outcomes of surgical repair of unilateral cleft lip using either the Tennison–Randall or Millard technique based on (qualitative) parent/subject and professional assessments. MATERIALS AND METHODS: This was a prospective, randomized, controlled study conducted at Lagos University Teaching Hospital between January 2013 and July 2014. A total of 56 subjects with unilateral cleft lip presenting for primary surgery who satisfied the inclusion criteria were recruited for the study. Subjects were randomly allocated to surgical groups A or B through balloting. Group A underwent cleft repair with the Tennison–Randall technique, while group B underwent cleft repair with the Millard rotation advancement technique. Surgical outcome was assessed using qualitative evaluation by the guardian/subject and independent assessors based on a modified form of the criteria described by Christofides and colleagues. RESULTS: Of the 56 subjects enrolled in this study, 32 were male, with a male to female ratio of 1.3:1. Fifteen of the guardians/subjects in the Tennison–Randall group were most bothered about the lower part of the residual lip scar, while 12 guardians/subjects in the in the Millard group were most bothered about the upper part of the scar. More noses were judged to be flattened in the Millard group than in the Tennison–Randall group. Assessors observed a striking disparity in scar transgression of the philtral ridges between the two groups. CONCLUSION: Essentially, there were no major difference in the overall results between Millard rotation-advancement and Tennison–Randall repairs. Both Millard and Tennison–Randall's techniques require significant improvements to improve the appearance of the scar on the upper part and lower part of the lip, respectively.

Influence of surface treatment and cyclic loading on the durability of repaired all-ceramic crowns

OBJECTIVE: This study investigated the durability of repaired all-ceramic crowns after cyclic loading. MATERIAL AND METHODS: Eighty In-ceram zirconia crowns were fabricated to restore prepared maxillary premolars. Resin cement was used for cementation of crowns. Palatal cusps were removed to simulate fracture of veneering porcelain and divided into 4 groups (n = 20). Fracture site was treated before repair as follows: roughening with diamond bur, (DB); air abrasion using 50 µm Al2O3, (AA) and silica coating using Cojet system followed by silane application, (SC). Control group (CG) 20 specimens were left without fracture. Palatal cusps were repaired using composite resin. Specimens were stored in water bath at 37ºC for one week. Ten specimens of each group were subjected to cyclic loading. Fracture load (N) was recorded for each specimen using a universal testing machine. Two-way analysis of variance (ANOVA) and Tukey honestly significant difference (HSD) test (a=.05) were used for statistical analysis. RESULTS: There was statistically significant difference between control and tested groups, (p<0.001). Post Hoc analysis with the Tukey HSD test showed that cyclic loading fatigue significantly decreased means fracture load of control and test groups as follows (CG, 950.4±62.6 / 872.3±87.4, P = 0.0004), (DB, 624.2 ±38 / 425.5± 31.7, P <.001), (AA, 711.5 ±15.5 / 490 ± 25.2, p <0.001) and (SC, 788.7 ± 18.1 / 610.2 ± 25.2, P <.001), while silica coating and silane application significantly increased fracture load of repaired crowns (p<0.05). CONCLUSION: Repair of fractured In-ceram zirconia crowns after chairside treatment of the fracture site by silica coating and silane application could improve longevity of repaired In-ceram zirconia crowns.

Prognosis of Immediate Operative Closure in Myelomeningocele and Meningoencephalocele: Report of Three Operative Cases

A child born with spinal dysraphism and encephalocele faces the multiple and serious hazards of meningitis, hydrocephalus, paralysis and deformity of the lower limbs, and urinary bladder paralysis. The improvement in surgical management, and the advent of the shunt device for the control of hydrocephalus have so greatly altered the immediate prognosis that even a child with an extensive myelomeningocele must be considered to have a good chance of survival. We have presented a case of myelomeningocle, and two cases of meningoencephalocele and immediate repair techniques, and prognosis. 1) Surgical repair should be undertaken urgently, if possible within the first 48 hours of life and its role was the preservation of motor, sensory and intellectual function. 2) Carefully dissected the nerve filaments from the sac and replaced them into the dural canal and excised the functionless filament for prevention of spine deformity. 3) Shunt surgery should be considered before operation or immediate postoperation, in situation of huge meningoencephalocele.