Comparison of Furlow's Double Opposing Z-plasty and Straight-Line Intravelar Veloplasty as Methods of Cleft Palate Repair.

Background One of the common craniofacial abnormalities is cleft lip and palate. Various surgical procedures have been employed to repair the cleft. However, immediate post-operative complications and formation of palatal fistula post surgery are common in surgical procedures. The study aims to compare the fistula rate, soft palate lengthening, and immediate complications of cleft palate repair of Furlow's Z-plasty and straight-line intravelar veloplasty techniques. Method Fifty Patients with isolated or unilateral cleft palate and lip with age between 9-18 months were randomly divided into two groups. One group underwent Furlow's Z-plasty while the other underwent straight-line intravelar veloplasty procedures. Post surgery, after discharge, the patients were followed up at 2 weeks, 1 month, and 3 months intervals. Immediate post-operative complications and fistula formation rate were compared along with other parameters like fistula width, duration of the procedure, intra-operative soft palate length, etc. Results Straight-line procedures took less time as compared to Furlow's Z-plasty. Bleeding (N=2, 8%) and dehiscence (N=1, 4%) of the wound were the immediate post-operative complications found in the straight-line group. Bleeding was also present in the Furlow's group (N=1, 4%). At 1-month follow-up, in the straight-line group (N=3, 12%) patients had fistula while (N=2, 8%) had minimal nasal regurgitation of liquids when compared to the Furlow's group. At 3-month follow-up, patients in the straight-line procedure group (three out of N=25, 12%) exhibited fistula, whereas in the Furlow's group, fistula occurrence was observed in one out of N=25 participants (4%). Intra-operative soft palate lengthening was 6.44 ± 0.768 mm and 1.64 ± 0.952 mm in the Furlow and straight-line groups, respectively. Conclusion Furlow's Z-plasty was observed to be the better surgical procedure for cleft repair as it had low immediate post-operative complications, and fistula development and had higher intra-operative soft palate lengthening.

Review of Cross-Leg Flaps in Reconstruction of Posttraumatic Lower Extremity Wounds in a Microsurgical Unit.

Since the advent of microsurgery, and expanding expertise in the field, extensive traumatic wounds of leg have been managed successfully with free tissue transfer. Various patient-related factors may preclude the use of free flaps even in units with available expertise and infrastructure. It is in such situations that the "cross-leg flap" comes into play. In these cases, instead of attempting complicated anastomotic techniques or anastomosis in the zone of trauma, it is better to perform the simpler and more reliable cross-leg flap. In this study, we try to show the utility of a cross-leg flap based on a retrospective study of 198 patients who underwent cross-leg flap in our institute over a period of 15 years extending from November 2003 to March 2018. MATERIALS AND METHODS: Case sheets of all patients who underwent cross-leg flap from November 2003 to March 2018 were reviewed. The location of defect in the leg, the indication for cross-leg flap, the pattern of cross-leg flap, and perioperative complications were noted. RESULTS: A total of 198 patients underwent cross-leg flap for traumatic soft tissue injury of leg during this period. The most common reason for performing cross-leg flap was poor pulsatility of the recipient artery as seen intraoperatively, followed by the economics of the procedure wherein the initial cost of free flap was found significantly higher compared with cross-leg flap. All flaps survived with partial necrosis occurring in 23 patients. All flaps settled well by 2 years' time. Bony union/fracture healing evaluation was not a part of this study. CONCLUSION: Cross-leg flap is still a useful tool for leg wound coverage even in microsurgical unit in situations precluding free flap coverage.

Nasopharyngeal Dermoids and Cleft Palate.

Nasopharyngeal dermoids associated with cleft palate present as intraoral protruding masses. Only 5 cases of nasopharyngeal dermoids associated with cleft palate have been reported in the literature. We are reporting 4 such cases encountered by us in the last 10 years in our series of 900 cleft palate surgeries. Imaging studies were done to know the extension of dermoid and to look for any associated congenital intracranial anomalies. We observed that nasopharyngeal dermoids are usually nonmalignant and can be easily managed by complete local excision followed by palatal closure after 6 months.

Evaluation of Secondary and Late Secondary Alveolar Bone Grafting on 66 Unilateral Cleft Lip and Palate Patients.

OBJECTIVE: The aim of this retrospective study was to evaluate the outcomes of secondary alveolar bone grafting and late secondary alveolar bone grafting in 66 unilateral cleft lip and palate patients. MATERIALS AND METHODS: The total patients were 66 unilateral cleft lip and palate patients, out of which 19 patients underwent secondary alveolar bone grafting and 47 patients underwent late secondary alveolar bone grafting. Autogenous anterior iliac crest cancellous bone graft was harvested and used for grafting the alveolar clefts. Radiographic assessment based on Enemark's scoring according to the marginal bone levels was done on the intraoral periapical radiographs taken 6 months after performing the surgery. RESULTS: Twelve (63%) out of the 19 patients on whom secondary alveolar bone grafting was done achieved score 1 (optimal marginal bone levels), whereas only 12 (25%) out of the 47 patients achieved score 1 amongst the late secondary alveolar bone graftings. Overall results showed, probability, P = .034 (statistically significant). CONCLUSION: This study reaffirmed the fact that alveolar bone grafting when done in preadolescent age group (secondary alveolar bone grafting) gives better results in terms of marginal bony consolidation and maintaining the continuity of the alveolar arch, but the late presentation (late secondary alveolar bone grafting) should not be the refusal criteria for performing the alveolar bone grafting. Although the latter patients may not be rewarded in terms of bony consolidation as much as the preadolescent patients the potential of successful surgery in them still exists in terms of providing a platform for the dental implant placement, improvement in the soft tissue symmetry and aesthetics of the face.

OBJECTIF: La présente étude rétrospective visait à évaluer le résultat des alvéoloplasties secondaires et des alvéoloplasties secondaires tardives chez 66 patients ayant une fente labio-palatine unilatérale. MATÉRIEL ET MÉTHODOLOGIE: Au total, 66 patients ayant une fente labio-palatine unilatérale ont participé à l'étude, dont 19 ont subi une alvéoloplastie secondaire et 47, une alvéoloplastie secondaire tardive. Les plasticiens ont prélevé de l'os spongieux autologue au niveau de la crête iliaque pour le greffer dans la fente alvéolaire. Six mois après l'opération, ils ont attribué un score d'Enemark à la hauteur de l'os marginal d'après leur examen des radiographies périapicales intraorales. RÉSULTATS: Douze des 19 patients (63 %) qui avaient subi une alvéoloplastie secondaire ont obtenu un score de 1 (hauteur optimale de l'os marginal), par rapport à seulement 12 des 47 patients (25 %) qui avaient subi une alvéoloplastie secondaire tardive. Les résultats globaux ont démontré une probabilité p=0,034 (statistiquement significative). CONCLUSION: La présente étude confirme que l'alvéoloplastie réalisée chez des préadolescents (alvéoloplastie secondaire) assure une meilleure consolidation osseuse marginale et la continuité de l'arc alvéolaire, mais une présentation tardive (alvéoloplastie secondaire tardive) ne devrait pas constituer un critère pour refuser l'alvéoloplastie. Même si les patients plus âgés ne profitent pas d'une aussi bonne consolidation osseuse que les préadolescents, il se peut tout de même que l'opération leur fournisse la plateforme nécessaire pour installer l'implant dentaire, améliorer la symétrie des tissus mous et l'esthétisme du visage.

Role of tongue flap in palatal fistula repair: A series of 41 cases.

INTRODUCTION: Despite the improved techniques of repair of cleft palate, fistula occurrence is still a possibility either due to an error in the surgical technique or due to the poor tissue quality of the patient. Though commonly the fistula closure is established by use of local flaps but at times the site and the size of the fistula make use of local flaps for its repair a remote possibility. The use of tongue flaps because of the central position in the floor of the mouth, mobility and the diversity of positioning the flaps make it a method of choice for closure of anterior palatal fistulae than any other tissues. The aim of this study was to analyse the utility of tongue flap in anterior palatal fistula repair. MATERIALS AND METHODS: We had 41 patients admitted to our hospital during the period 2006-2012 for repair of palatal fistula and were enrolled into the study. In the entire 41 cases, fistula was placed anteriorly. The size of the fistulae varied from 2 cm × 1.5 cm to 5.5 cm × 3 cm. The flaps were divided after 3-week and final inset of the flap was done. OBSERVATION AND RESULT: None of the patients developed flap necrosis, in one case there was the dehiscence of the flap, which was reinset and in one patient there was bleeding. None of our patients developed functional deformity of the tongue. Speech was improved in 75% cases. CONCLUSION: Leaving apart its only drawback of two-staged procedure and transient patient discomfort, tongue flap remains the flap of choice for managing very difficult and challenging anterior palatal fistulae.