Morphological Presentation of Orofacial Clefts: An Epidemiological Study of 5004 Patients in a Tertiary Care Hospital of Central India.

To analyse the morphological presentation of orofacial clefts, gender, syndromes and systemic anomalies associated with them.This was an epidemiological study performed in the patients who were registered for cleft lip and palate surgeries in our centre. The data was evaluated both retrospectively as well as prospectively.The patients registered from November 2006 to April 2021 were studied. Out of 5276 patients, data of 5004 cases were analysed, rest 272 patients were excluded due to lack of information. Statistical analysis and Chi square test were applied.Cleft deformities were more common in males than females. Cleft lip with palate was the commonest phenotype (52.2%). It was followed by isolated cleft lip (22.9%), isolated cleft palate (22.1%), rare clefts (1.62%) and syndromic clefts (1.18%). Unilateral variants were more frequent than bilateral. In unilateral, left side was more common than the right side. Among bilateral, most of the cases had premaxillary protrusion. In the present study, 3.46% of all the patients had associated anomalies affecting their other organs. Less common cleft phenotypes like microform cleft lip and submucous cleft palate ± bifid uvula showed frequency of 0.62% and 0.64% respectively.Thorough examination of cleft deformity should be done as it may appear as an isolated deformity or part of a syndrome and have associated systemic anomalies. This may help us to deliver comprehensive care to the patients and can prevent potential operative complications.

Modified Uvuloplasty for Achieving Aesthetically Desired Uvula in Cleft Palate Repair.

Background: Uvula is a delicate structure in comparison with the rest of the palate. During cleft palate repair, surgeons may find it challenging to suture both the hemi-uvulae meticulously with conventional repair technique and achieve satisfactory aesthetic results. We have adopted few surgical steps in conventional uvular repair to make this procedure simpler and more effective in terms of aesthetic outcome. Methods: From 2016 to 2019, 386 patients underwent primary palatoplasty in our centre. Their uvula was repaired with conventional technique with having those modifications. Out of 386, 211 patients were followed for the 6 months postoperatively. Results: The uvular appearance was satisfactory in 82% of the cases. Undesired appearances of uvula were noted as deviated, bifid and small in 1%, 7% and 10% of cases, respectively. In none of the cases, complete dehiscence of the uvula was seen. Conclusion: The authors advocate simple modifications in conventional uvuloplasty to improve uvular aesthetics. This modified uvuloplasty is easy to practice and very promising in achieving an aesthetically desired uvula in cleft palate surgery.

A Simple and Economical Nasal Conformer for Clefts!

AIM: To develop a nasal conformer for cleft lip repair which should be easily available and economical. METHOD: We have used 'Luer mount' of the infant feeding tube as a nasal conformer in 14 patients. RESULT: Follow-up period ranged from 2 weeks to 3 months. Results were satisfactory in all the patients. No significant complications were noticed in any of the patients. CONCLUSION: This nasal conformer is easy to use and cost-effective. Though it is not as soft as silicon-based nasal stent but, it provides good support for maintaining the shape of nasal cartilage.

Palatal lengthening by double opposing buccal flaps for surgical correction of velopharyngeal insufficiency in cleft patients.

AIM: To assess the efficacy of double opposing buccal flap in lengthening the soft palate for velopharyngeal insufficiency correction, and its potential complications in different age groups. CASE SERIES: From March 2016 to June 2019, 50 patients (24 children, 12 adolescents and 14 adults) underwent palatal lengthening using double opposing buccinator myomucosal flaps. Postoperative complications were assessed by two surgeons and the speech outcomes were evaluated by two speech-language pathologists after assessing changes in the hypernasality and intelligibility using a scoring approach. Following the procedure, mild-to-moderate surgical complications were seen, mostly among the adults. There was a significant improvement in hypernasality and intelligibility in all the groups. None of the patients showed hyponasal speech postoperatively. CONCLUSION: To conclude, the double opposing buccal flap technique is an effective and safe surgical treatment option for the management of velopharyngeal insufficiency in all age groups of patients.

An infant with a palatal fistula secondary to Candida infection.

Candida osteomyelitis affecting maxillofacial bones has been scantly documented in the literature. Infantile osteomyelitis is an uncommon and life-threatening disease. Candida osteomyelitis causes significant morbidity. The present report describes a case of a 9-month-old infant with infantile osteomyelitis secondary to Candida infection. This report describes its presentation and the management of palatal fistula in an infant.

Lag screw fixation of the premaxilla during bilateral cleft lip repair.

In synchronous primary premaxillary setback and cleft lip repair for bilateral cases with severely protruding premaxilla, stabilization of the premaxilla is mostly achieved by gingivoperiosteoplasty. This kind of repair carries risk of impairment of blood supply to the premaxilla and/or prolabium, and at the same time it cannot ensure adequate stabilization of the premaxilla postoperatively. To overcome these problems, we have developed a unique technique of fixation of the premaxilla. In this paper, we discussing this technique, its advantages, and potential complications associated with it. From 2016, 10 patients aged 4-10 months, with bilateral cleft lip and palate with premaxillary protrusion (≥10 mm) underwent premaxillary setback and cheilorhinoplasty in the same stage. Instead of gingivoperiosteoplasty, a 'lag screw' fixation technique was used to stabilize the premaxilla. The follow-up period ranged between 5 and 32 months. In all the cases, we achieved adequate stabilization of the premaxilla. None of the patients had any issue related to the vascularity of the premaxilla or prolabium. There was no impairment in the eruption process of deciduous teeth in the premaxillary segment. Overall aesthetic outcomes of the lip and nose were acceptable. This technique of premaxillary fixation with lag screw gives us the liberty to perform primary cheilorhinoplasty along with premaxillary setback in the same stage, without risking the vascularity of premaxilla and prolabium. It ensures adequate stabilization of the premaxilla, but evaluation of regular growth of the midface and, if needed, corrective orthodontic and surgical treatment in the follow-up periods are advisable.

Bilateral ectopic third molars in maxillary sinus associated with dentigerous cyst-A rare case report.

INTRODUCTION: Ectopic eruptions of a tooth in a non-dentate region is a rare entity and such cases have been reported to occur in the nasal cavity, orbital floor, maxillary sinus, mandibular condyle, chin, palate and coronoid process. CASE PRESENTATION: We report a case of bilateral ectopic eruption of maxillary third molars associated dentigerous cyst. A 27 years old female patient reported to us with chief complaint of purulent discharge form nose and recurrent facial swelling for last 2 years. Complete removal of cystic lining and extraction of ectopic maxillary third molars along with mandibular third molars was carried out. RESULTS: Post-operative healing was uneventful. DISCUSSION: Bilateral ectopic eruptions of maxillary third molars in Antrum of Highmore (Maxillary sinus) are rarely seen and scantly documented in the literature. Dental ectopia may occur in antrum and present with local sino-nasal symptoms attributed to chronic sinusitis. Due to its rarity and lack of consensus over its management, the incidence deserves to be added to the literature & discussed.