A Surgical and Educational Video of the Inferior Turbinate Mucosal Flap for the Nasal Floor and Intraoral Reconstruction in Unilateral Complete Cleft Lip Repair.

Since the original description of Millard rotation advancement principle for cleft lip repair, many important contributions have subsequently been described by other surgeons worldwide. However, the reconstruction of the nasal floor and intraoral lining has received less attention over time. This article demonstrates a modified unilateral complete cleft lip repair using the rotation advancement principle plus multipurpose inferior turbinate mucosal flap. The accompanying videos display the 10 key steps for rationale, design, and proper execution of the inferior turbinate mucosal flap for the nasal floor and intraoral reconstruction.

The Medial Subcoronoid Process Region as a Novel Source of Bone Grafts in Orthognathic Surgery and Genioplasty.

BACKGROUND: Since 2012, the authors have adopted the medial subcoronoid process bone interpositional grafting in OGS and genioplasty procedures. The purpose of this study was to present the technical details and clinical outcomes of this alternative bone interpositional grafting for LeFort I and chin osteotomies. METHODS: Consecutive patients (n = 50) who underwent single-splint bimaxillary OGS with or without genioplasty and received medial subcoronoid bone interpositional grafting were included. Standardized facial and intraoral photographs at early and late postoperative periods (12.2 ±â€Š3.3 and 44.8 ±â€Š8.4 months postsurgery, respectively) were blindly rated to assess facial symmetry, chin, and occlusion status based on qualitative rating scales. Complication and reoperation rates were also reviewed. RESULTS: The medial subcoronoid bone interpositional grafts were adopted to stabilize different LeFort I maxillary movement types or lengthening/advancing genioplasty (36 and 14 patients, respectively). Overall, the early facial symmetry, chin, and occlusion status were maintained at late evolutions. None of the patients had donor-site or bone graft-related complications (i.e., bad split, undesired mandible fracture, infection, fibrous union, nonunion, and/or permanent neurosensory deficit) or revisionary surgery during follow-up. CONCLUSION: The medial subcoronoid process bone grafting was a feasible alternative for bone interpositional defects of LeFort I and chin osteotomies with no significant morbidity and avoiding secondary donor sites.

Treating nasoethmoidal encephalocele in a low-resource country: a surgical experience from a Philippine multidisciplinary craniofacial team.

PURPOSE: It was described that nasoethmoidal encephalocele repair in the Philippines has been limited by insufficient resources, financial constraints, and a lack of surgical expertise. The purpose of this study was to report initial results and complications of Philippine patients with nasoethmoidal encephalocele surgically managed with an approach adapted to an environment with limited financial resources. METHODS: All patients (n = 21) with nasoethmoidal encephalocele who underwent intracranial and extracranial repairs (frontal wedge osteotomy to access the encephalocele cyst and cranial base defect, dural defect repair, split frontal grafts fixed with polydioxanone sutures to reconstruct the cranial defect and nasal dorsum, and medial canthopexy) from January 2015 to May 2017 were included. The correlations between sizes of masses and cranial defects with the occurrence of complications were tested. The surgical results were classified based on a previously published outcome grading scales I-IV on the need for additional surgery. RESULTS: Nineteen patients (90.5%) had unremarkable post-operative course. Two patients (9.5%) presented with complications (cerebrospinal fluid leak and surgical site infection) which were successfully managed with no additional surgery. The sizes of masses and cranial defects were not correlated (p > 0.05) with complications. The overall rate of surgical results ranked according to the need for additional surgery was 2.4 ± 0.5 (between categories II and III). CONCLUSIONS: We reported successful surgical repair of nasoethmoidal encephaloceles in Philippine patients by a local multidisciplinary craniofacial team.