Does a Premaxillary Setback and Lip Adhesion Have a Negative Impact on Lip Outcome in Bilateral Cleft Patients?

BACKGROUND: The early premaxillary setback and lip adhesion remains as a controversial maneuver in the treatment of bilateral cleft lip and palate patients. This study aimed to assess extent of preoperative deformity and lip outcomes during the first year after surgery in bilateral cleft patients who underwent premaxillary setback and lip adhesion and to compare to those with primary lip repair. METHODS: A retrospective observational study was conducted of 16 nonsyndromic consecutive bilateral complete cleft lip patients (with and without Simonart band), who underwent primary cleft lip repair. Patients were allocated in group 1 without premaxillary setback and group 2 with premaxillary setback and lip adhesion. Preoperative and postoperative linear measurements were used for intergroup and intragroup comparisons. RESULTS: Cutaneous lip height of patients in group 2 significantly (P < 0.05) improved after combined premaxillary setback and lip adhesion and primary cleft lip repair. There were no significant (all P > 0.05) differences in intragroup 1 comparisons, and in intergroup comparisons. CONCLUSION: Bilateral cleft patients with a protruded and deviated premaxilla over 10 mm discrepancy of the lateral maxillary achieved noninferior lip symmetry 1 year postoperatively compared with patients with less severe original deformity.

Strategies for the Optimal Individualized Surgical Management of Craniofacial Fibrous Dysplasia.

BACKGROUND: The surgical management of craniofacial fibrous dysplasia is controversial. The purpose of this study was to report the surgical outcomes of individualized management of craniofacial fibrous dysplasia of a single institution. METHODS: Data from patients (n = 20) with craniofacial fibrous dysplasia, who were surgically treated between 2007 and 2014, were analyzed. Surgical approach (radical or conservative surgery) was individualized according to age, craniofacial anatomical site (zones I to IV of Chen and Noordhoff), functional issues, aesthetic impairment, patients/parents' preferences, and surgical team experience. The surgical outcomes (radical surgery group versus conservative surgery group) were compared based on the age at the time of the procedure, the length of hospital stay, reoperation, recurrence and complication rates, and the Whitaker grading system. RESULTS: Significant (all P < 0.05) differences were observed in patients with craniofacial fibrous dysplasia who were treated with radical excision (65%) compared with those treated with limited reduction burring (35%), according to age (19.22 years versus 12.57 years), the length of hospital stay (3.56 days versus 1.29 days), recurrence (15% versus 71%), and number of subsequent procedures (1 intervention versus 2.4 interventions), respectively. The radical surgery group presented a significantly (P < 0.05) lower initial Whitaker outcome score than the conservative surgery group (1.89 and 2.57, respectively). Similar (all P > 0.05) final Whitaker outcome scores (1.56 versus 1.71) and surgical complication rates (11% versus 14%) were recorded between the treatment groups. CONCLUSIONS: Based on clinical experience and surgical outcomes presented in this study, the surgical approach of craniofacial fibrous dysplasia should be tailored to individual patient's needs.

Cleft Patient-Reported Postoperative Donor Site Pain Following Alveolar Autologous Iliac Crest Bone Grafting: Comparing Two Minimally Invasive Harvesting Techniques.

BACKGROUND: Autologous bone grafting is still considered the standard method for alveolar cleft repair. However, donor site morbidities remain a relevant problem in cleft care. Thus, the authors assessed postoperative donor site pain in cleft patients who underwent alveolar cleft repair by iliac crest bone graft transferring through a prospective randomized study comparing 2 minimally invasive harvesting techniques. METHODS: Fifty-six consecutive patients with cleft lip and palate who underwent iliac crest bone grafting for alveolar cleft repair were randomly divided into 2 groups: bone graft harvested by minimally invasive techniques without (group 1) and with (group 2) periosteum elevation. Postoperative donor site pain was evaluated using a unidimensional numerical pain intensity rating scale (0, "no pain;" 10, "worst pain imaginable") at 1, 3, 6, 9, and 12 hours after the procedures and on the 3rd, 7th, 14th, 21st, and 28th days after surgeries. Intergroup comparisons were performed. RESULTS: The mean measurements of donor site pain revealed no significant differences (all P > 0.05) in any of the evaluated postoperative period comparisons between groups 1 and 2. There was a greater number (P < 0.05) of group 1 patients who reported "no pain" in the donor site compared with group 2, suggesting that periosteum elevation may play a role in pain intensity measurement. CONCLUSIONS: This prospective randomized study showed no difference in pain intensity among cleft patients who had postoperative pain. However, a greater number of patients in group 1 reported "no pain" in comparison to patients in group 2.

Posttraumatic eyebrow reconstruction with hair-bearing temporoparietal fascia flap.

The temporoparietal fascia flap has been extensively used in craniofacial reconstructions. However, its use for eyebrow reconstruction has been sporadically reported. We describe a successfully repaired hair-bearing temporoparietal fascia flap after traumatic avulsion of eyebrow. Temporoparietal fascia flap is a versatile tool and should be considered as a therapeutic option by all plastic surgeons.

Posttraumatic eyebrow reconstruction with hair-bearing temporoparietal fascia flap / Reconstrução de sobrancelha após trauma com retalho de fáscia temporoparietal associado à ilha de pele de couro cabeludo

The temporoparietal fascia flap has been extensively used in craniofacial reconstructions. However, its use for eyebrow reconstruction has been sporadically reported. We describe a successfully repaired hair-bearing temporoparietal fascia flap after traumatic avulsion of eyebrow. Temporoparietal fascia flap is a versatile tool and should be considered as a therapeutic option by all plastic surgeons.

O retalho de fáscia temporoparietal tem sido usado em inúmeras reconstruções craniofaciais. No entanto, sua utilização para a reconstrução de sobrancelha tem sido relatada esporadicamente. Descreve-se aqui o reparo com retalho de fáscia temporoparietal associado à ilha para a reconstrução de sobrancelha, após avulsão traumática, realizado com sucesso. O retalho de fáscia temporoparietal é uma ferramenta versátil e deveria ser considerada no arsenal terapêutico de todos os cirurgiões plásticos.

The inverted-T mammaplasty: a modified winch suture to reduce horizontal scar length.

Mammaplasty performed with an inverted-T skin resection pattern is a useful technique to treat moderately or severely ptotic breasts. This method of skin resection is conducted via 3 incisional components: periareolar, vertical, and horizontal. In this report, the authors describe a simple modified winch suture that can be inserted with the inverted-T technique to reduce the length of the horizontal incision.

Cirurgia radical versus cirurgia conservadora no tratamento da displasia fibrosa craniofacial: estratificação da abordagem cirúrgica / Radical versus conservative surgery for craniofacial fibrous dysplasia: stratification of surgical strategies

To date, there is no consensus regarding the best surgical approach (conservative or radical) for craniofacial fibrous dysplasia. This study presented the experience of a single institution in the surgical treatment of craniofacial fibrous dysplasia. Method: This was a retrospective analysis of patients with craniofacial fibrous dysplasia who underwent surgery between 1997 and 2012. Surgical treatment was individualized according to patient age, the involved anatomical site (zones l-IV), aesthetic and/or functional impairment,and the preferences of the patients and surgical team. The surgical results were classified on the basis of the Whitaker system. Results: Ten, 1, 1, and 1 patients with zone I, zone11, zone II, and zone I/IV involvement, respectively, were included in the study. In total,conservative surgeries and 9 radical surgeries were performed for the treatment of primary bone tumors. There was 1 surgical complication, and 6 recurrences were identified during the post operative follow-up period. The global average of surgical outcomes, according to the Whitaker scale, was 1.69 ± 0.94. ConclusÍons: According to the experience and surgical results presented in this study, the surgical approach for craniofacial fibrous dysplasia should be individualized.

Até o momento, não existe consenso sobre qual a melhor abordagem cirúrgica (conservadora ou radical) da displasia fibrosa craniofacial. O objetivo deste estudo foi apresentar a experiência de uma única instituição no tratamento cirúrgico da displasia fibrosa craniofacial. Método: Trata-se de uma análise retrospectiva dos pacientes com displasia fibrosa craniofacial, operados entre 1997 e 2012. O tratamento cirúrgico foi individualizado de acordo com idade, sítio anatômico envolvido (zonas I-IV), comprometimento estético e/ou funcional e preferências dos pacientes e da equipe cirúrgica. Os resultados cirúrgicos foram classificados com base no sistema de Whitaker. Resultados: Dez pacientes com acometimento da zona I, um da zona 11, um das zonas I e lU, e um das zonas I e IV foram incluídos. Nove cirurgias conservadoras e nove cirurgias radicais foram realizadas para o tratamento de tumores ósseos primários. Houve uma complicação cirúrgica. Seis recidivas foram identificadas durante o seguimento pós-operatório. A média global dos resultados cirúrgicos, de acordo com a escala de Whitaker, foi de 1,69 ± 0,94. Conclusões: De acordo com a experiência e resultados cirúrgicos apresentados neste estudo, a abordagem cirúrgica da displasia fibrosa craniofacial deve ser individualizada.

Lip Height Improvement during the First Year of Unilateral Complete Cleft Lip Repair Using Cutting Extended Mohler Technique.

Objective. To compare the cutaneous lip height at early and late postoperative periods and to objectively determine the average amount of lip height improvement during the first year of unilateral complete cleft lip repair using Cutting extended Mohler technique. Methods. In this prospective cohort study, 26 unilateral complete cleft patients and 50 noncleft subjects were included. Photographs were taken between 12 and 16 weeks (T1) and also taken between 12 and 13 months after surgery (T2). The cutaneous lip height distance (photogrammetric lip analysis) obtained in these two periods of time were measured and statistically analyzed. Results. The average lip heights were 24% ± 9% in T1 and 8% ± 6% in T2 (P < 0.01). The average lip height asymmetry in the noncleft individuals was 4.52% ± 1.89%. Conclusion. Since all principles to obtain a symmetrical Cupid's bow were performed, the postoperative pull-up of Cupid's bow is probably owed to the scar contracture, which improves by 2 times during the first year after surgery.