Impact of cleft lip and/or palate in children on family quality of life before and after reconstructive surgery.

BACKGROUND: The aim of the study was to evaluate the impact of cleft lip/palate children together with consequent treatment on quality of family life using standardized questionnaire. Different to previous studies the evaluation of quality of family life by questionnaire was realized twice in the same group of families (before the reconstructive surgery and several months after palatoplasty). METHODS: The study was conducted in 40 families divided in two groups: 20 families with children with cleft lip (CL), 20 families with children with cleft lip and palate (CLP). The questionnaire of the Impact on Family Scale was used for evaluation of the influence of orofacial clefts on parent´s quality of life. Evaluations were made at the second month of child´s life and at one year of child´s life with reciprocally comparison. RESULTS: The higher impact of children with CLP on quality of family life was noted at 2 months and 1 year of child's age as compared to the impact of children with CL. The reduction of impact on quality of life after surgical correction was observed in families of children with CL at one year of child's age. This decrease of influence on family quality of life was due to significantly lower impact in strain and economic dimensions in families with CL children after operation. However, in the group of families with CLP children no significant changes in the impact on family quality of life were noted when compared to the values before and shortly after the reconstructive surgery. CONCLUSIONS: This study showed that orofacial clefts in children influence markedly the quality of their family life. The higher impact of children with CLP on quality of family life as compared to children with CL was noted and this impact in CLP group was not influenced shortly after reconstructive surgery. It is suggested that appropriate medical care in Cleft Centre with special psychological support may lead to improvement in quality of life for families with cleft lip and palate children (Tab. 2, Fig. 2, Ref. 14).

Body proportions as possible predictors for free gracilis one-stage facial reanimation.

BACKGROUND: Gracilis muscle and its motor nerve belongs to most commonly used flap for facial reanimation. However, it is performed in two steps, which is time consuming. One stage technique can be also performed, but the length of the motor nerve cannot be currently determined before surgery. AIM: The present study was conducted in order to evaluate the body composition on the length and suitability of the motor nerve of gracilis muscle for one stage facial reanimation. METHODS: The gracilis flaps along with the motoric nerve were dissected from 20 fresh cadavers (6 females, 14 males). The length of the lower extremity from superior iliac anterior spine to the bottom of the heel and BMI were measured. Regression analysis of lower extremity length and BMI to the actual length of the motor nerve of gracilis flap was performed. RESULTS: The linear regression analysis showed a positive correlation between the length of the lower limb and the size of the motor nerve length (r = 0.5060, p < 0.05), as well as between the BMI and the size of the motor nerve length (r = 0.5073, p < 0.05). Also, the males had longer motor nerve when compared to females by 13 % (p < 0.05). No difference between females and males in BMI was observed. CONCLUSION: The length from the superior iliac anterior spine, BMI and gender seemed to be potential factors that could help to predict the length of the gracilis flap motor nerve for the one stage facial reanimation. However, further studies evaluating other anatomical factors and validating the possible prediction rule for one stage reanimation success are needed (Fig. 3, Ref. 14).

Maggot therapy in treatment of a complex hand injury complicated by mycotic infection.

Complex injuries of the hand remain a therapeutic challenge for surgeons. We present the case of a male who suffered a devastating injury of the hand caused by a conveyor belt. The patient developed a progressive Absidia corymbifera infection of the affected soft tissues. Initial treatments with serial surgical debridement and topical and intravenous itraconazole were unsuccessful in eliminating the infection. We decided to use maggot debridement therapy in a new special design to debride all necrotic, devitalized tissue and preserve only healthy tissue and functioning structures. This maneuverer followed by negative pressure therapy allowed progressive healing. In such complex hand injuries, maggot debridement combined with negative pressure therapy could be considered to achieve effective and considerable results, although future functional morbidity may occur (Fig. 4, Ref. 18).

Application of negative pressure wound therapy in scalp reconstruction.

Scalp defects in old polymorbid patients are still therapeutic challenge for reconstructive surgeons. We present the case of a male who underwent an excessive tumour resection with the unsuccessful skin graft coverage. The patient developed a progressive skin graft necrosis and infection with an exposure of calvarial bone. Initial surgical debridement and topical treatment resulted in an excessive bone exposure. We decided to use a negative pressure therapy after multiple bone trephinations, to improve growth of new vital tissue in bone-exposed area. This maneuverer, followed by a split thickness skin graft coverage, allowed a progressive defect healing. In such old polymorbid patient, calvarial bone trephinations with a negative pressure therapy could be considered to achieve effective and considerable results (Fig. 4, Ref. 16).

Changes in metabolic syndrome parameters after liposuction.

Liposuction - one of the most frequent procedures in cosmetic surgery - is the surgical aspiration of fat from the subcutaneous layer leaving a more desirable body contour and leaving a smooth transition between the suctioned and nonsuctioned areas. Metabolic syndrome is epidemiologically important medical condition that includes insulin resistance, dyslipidemia, central obesity, hypertension, impaired glucose tolerance or diabetes mellitus, and high rates of atherosclerotic disease. According to the latest findings, liposuction reduces the amount of subcutaneous fat, which changes the abdominal - superficial adipose tissue ratio and thus might affect the potential of metabolic syndrome by the means of its separate parameters and clinical manifestations. Results that can be found in the published literature remain controversial and often contradictory, thus leaving enough space for further investigations regarding the relation of these two clinical entities (Ref. 33).

Primary reconstruction of pharyngo-oesophageal defects in oncologic patients.

OBJECTIVES: Majority of patients that undergo total or partial removal of the hypopharynx and cervical oesophagus are oncologic patients. Optimal management of head and neck malignancies requires multimodal therapy including surgical ablation, reconstruction, and adjuvant oncologic therapy. Despite aggressive surgical and adjuvant therapy, a five-year survival rate is achieved only in 25-35 %. METHODS: In the presented retrospective study, the choice of reconstructive method was influenced by type, length and extent of the defect, and condition of patient. The flap was indicated when the defect not allowed for primary suture of the hypopharynx and/or cervical oesophagus. Two-team approach was used. RESULTS: The study was based on the data of ten patients. Radial forearm flap was used in 8 cases; pectoralis major myocutaneous flap was used in 3 patients, and ALT perforator free flap in 1 case. A total of 12 flaps were used for 10 patients. Two patients developed free flap necrosis. These necrotic flaps were substituted with pedicled pectoralis major myocutaneous flaps. CONCLUSIONS: The primary reconstruction of the pharyngo-oesophageal defects could be the method of choice. For the partial defects, the best choice could be a radial forearm free flap. For circumferential defects, jejunal flap could be the best. The pectoralis major pedicled flap could be a safe procedure for elderly patients with multiple medical problems (Tab. 6, Fig. 2, Ref. 34).

Nasoalveolar molding in complete cleft lip nasal deformity patients.

OBJECTIVES: The aim of this study was to compare nostril height, width, collumelar length, interalar distance and nostril symetry between unilateral complete cleft lip/palate patients undergoing nasoalveolar moulding (NAM) and incomplete cleft lip patients/palate with no need of presurgical moulding before and after cheiloplasty with primary nasal correction. Our study group included 18 patients from whom 9 were NAM cleft lip/palate nasal deformity cases and 9 incomplete cleft lip/palate cases. All measurements were obtained by two independent investigators and averaged, standard deviations and symetry ratios were calculated, and paired and unpaired t-test was performed to compare the groups. RESULTS: Our study results showed no statistically significant difference in nostril height, width, collumelar lenght, interalar distance in unilateral cases in preoperative and postoperative measurements between these two groups. Symetry measurements included nostril width on the affected and nonaffected side, nostril height on the affected and nonaffected side before (T1) and after (T2) cheiloplasty. The nostril height ratio was 1.2 and 1.03 for T1 to T2 and the nostril width revealed a ratio of 0.5 and 0.8 for T1 to T2 in unilateral NAM cases. In the incomplete cleft lip group the height ratio was 1.04 and 1.03 for T1 to T2 and the width ratio was 0.59/0.93 in pre-/postoperative measurements. These symetry values showed also no statistical significance between NAM and incomplete cleft lip cases. CONCLUSION: Our study results showed no statistical significant difference in nostril height, width, collumelar lenght, interalar distance and nostril symetry between unilateral complete cleft lip/palate patients undergoing NAM and incomplete cleft lip patients/palate with no need of presurgical moulding, proving NAM combined with primary nasal correction is a very efficient management for cleft lip/palate children with outstanding results (Tab. 5, Fig. 4, Ref. 25). KEYWORDS: nasoalveolar molding, complete cleft lip nasal deformity, cleft lip, nostril height, width, collumelar lenght, interalar distance, nostril symetry.

Prevalence of cleft lip and palate in western Slovakia in the years 2001-2007.

OBJECTIVES: The aim of this study was to investigate the prevalence of orofacial clefts (OC) in live newborns from 2001 to 2007 in Western Slovakia and correlate their occurrence with a number of relevant seasonal and geographical factors and epidemiological trend of this condition. In this study we used retrospective active survey collecting clinical data of 220 children with OC registered and operated at the cleft centre in Bratislava. Our study group included 67 patients from Bratislava region and 151 patients from the remaining Western Slovakia (Nitra, Trnava, Trencín regions). Data of live births was obtained from Health Statistics of the Slovak Republic. RESULTS: Total incidence (TI) of 1.49/1000 live births (LB) in the region of Western Slovakia in 2001-2007 marked a decrease of prevalence compared to 1.64/1000 LB in the years 1985-2000. Bratislava region dominated in total prevalence of 1.82/1000 LB compared to the rest of Western Slovakia regions with 1.37/1000 LB. Most observed cleft type was the CP with 38.6 % frequency, followed by CLP with 35.5 % and CL with a frequency of 24.1 %. The frequency of AM with 1.82 % was the lowest. CONCLUSION: The results showed that the frequency risk rate of a birth of a child with OC was 1 to 671 LB in Western Slovakia. The data proved a higher prevalence of OC in Bratislava region with 1 child with this type of congenital anomaly to 549 LB compared with 1 child with OC to 730 LB in the rest of the Western Slovakia regions (Tab. 7, Ref. 16).

Interaction of human adipose tissue-derived mesenchymal stromal cells with breast cancer cells.

Human adipose tissue was shown to be a very attractive source of mesenchymal stromal cells that have a wide scale of potential applications in reconstructive plastic surgery and regenerative medicine. However, these cells were described to have profound effects on biological behaviour of tumour cells. The aim of this study was to analyze the influence of adipose tissue-derived human mesenchymal stromal cells (AT-MSC) on the proliferation of breast cancer cells. We have tested proliferation of three different human breast cancer cell lines under the influence of AT-MSC derived soluble factors as well as in the direct cocultures. These data were supplemented with the expression analysis of cytokines and their cognate receptors on the target cells. We have observed stimulation of proliferation in breast cancer cells MDA-MB-361, T47D and EGFP-MCF7. AT-MSC were found to secrete wide scale of cytokines, chemokines and growth factors, thus we concluded that this pro-proliferative effect was a result of their synergistic action. These data bring out a need to evaluate whether primary breast tumour derived human cells would respond to these type of stimuli in a similar manner in order to exclude any potential clinical risk related to the application of human mesenchymal stromal cells under the context of patient with history of breast cancer malignancy.

Timing of primary lip repair in cleft patients according to surgical treatment protocol.

OBJECTIVES: The goal of this article is to focus on the results of meeting the primary lip repair timing in compliance with the surgical treatment protocol used at the Cleft Center, Bratislava. METHODS: Retrospective analysis of 45 initial lip repairs among all cleft operations in a period of 3 years (2006-2008). The object of the analysis was the "day of surgery after birth". The defined time period was that of 90th-180th day (3-6 months) for the initial lip surgery according to surgical protocol. Histories of patients who underwent surgery before the 90th or after the 180th day were examined. RESULTS: 40 patients (89%) underwent primary lip surgery in the defined time period of 3-6 months following the surgical treatment protocol. 5 patients (11%) underwent primary lip surgery at a later age than 6 months only because of pediatric reasons: recurrent bronchopneumonia (3 patients), recurrent respiratory infections plus prematurity (1 patient) and sideropenic anaemia (1 patient). There were no operative and postoperative surgical or anesthesiological complications. There were only serious pediatric reasons for surgery delays. CONCLUSION: The determined timing of primary lip closure in 3-6 months is considered adequate according to the achieved results. In most of the cases this timing offers reliable conditions to perform early surgery in baby patients. The successfull realisation of the primary lip repair in the defined time period of 3-6 months is very important for proper timing of subsequent surgeries as well as for that of consecutive completion of treatment (Tab. 1, Fig. 1, Ref. 8).

Cleft lip and palate in Western Slovakia in the years 1985-2000.

Orofacial clefts are common congenital anomalies. The aim of this study was to assess the incidence in Western Slovakia. The study material were the case records of infants from the Bratislava and Western Slovakia regions, born between 1985 and 2000, and operated on in the Department of Plastic Surgery, Faculty of Medicine, Commenius University, General Hospital Ruzinov, in Bratislava. Of 409,205 live births in this period, 670 children were born with OC (orofacial clefts) and operated in the above-mentioned department. This study found a total incidence of 1.64/1000 live births. Compared to the Western Slovakia region, the incidence was higher in Bratislava. Of the different types of OC, CLP was the commonest, with a male preponderance of OC at the rate of 1.16:1. The available data showed significant differences of clefts in some of the studied districts, which could be a base for an intensive follow-up of endemic (genetic and exogenous) factors.

Reconstruction of a circular defect of the hypopharynx and cervical part of esophagus by a free jejunal flap (case report).

Patients with impaired continuity of the upper gastrointestinal tract are dependent on gastrostomy or jejunostomy tube feeds, which significantly reduce their quality of life. Reconstruction of the hypopharynx and esophagus is desirable in cases of congenital deformities, corrosive injuries, or defects after tumor resections. Free flap allows for easier reconstruction of head and neck defects. In this article, the authors present a case of complete hypopharynx closure in an oncology patient with a larynx carcinoma. The patient is a 60-year-old male diagnosed in 2002 with epidermoid carcinoma of larynx. The patient underwent laser resection of the tumor followed by radiotherapy and chemotherapy. In 2003 the patient underwent pharyngo - laryngectomy for relapse of the larynx carcinoma. Postoperatively the patient developed pharyngo - cutaneous fistula, which was reconstructed at the otorhinolaryngology department by a muscle - cutaneous flap from the pectoralis major muscle. During the course of healing the patient developed complete hypopharynx and cervical esophagus closure. Free flap of jejunum was recommended. The surgery team used a 10 cm long section of jejunum; the recipient blood vessels were arteria transversa colli and internal jugular vein. On the second day after the surgery patient developed salivary fistula in the wound. The fistula healed spontaneously in five weeks. Pharyngoscopy revealed that the transplanted jejunum was fully vital. Free flap of the jejunum allowed for upper gastrointestinal tract reconstruction and allowed the patient to restart peroral intake.

Fifty years of the Cleft Centre in Bratislava.

In our paper, we would like to present and analyse the activities in the Cleft Centre in Bratislava between 1952 and 2001. We document the gradual development of the complex treatment and the important changes in the usage of the operative techniques and in the primary and secondary operations timing, as well as the application of the new trends in the field of plastic surgery, maxillofacial surgery, anaesthesiology, orthodontics, speech therapy, paediatrics, human genetics and psychology.

Giant basal cell carcinomas: a result of neglect?

Although the occurrence of giant basal cell carcinoma in clinical practice is quite rare, there are some references to these malignancies in the literature. Our study includes 12 patients without previous treatment who had giant basal cell carcinoma with no evidence of metastatic dissemination. Depending on the anatomic region, we used a primary suture, local flap and split-thickness skin grafts for the reconstruction of the defect after the wide excision of the carcinoma. All patients have been followed up and no recurrence has been detected to date. Nine lesions diagnosed on the face (69%) were obvious, and therefore they should have been diagnosed at their early stage. In our series most of the patients had had tumors for more than 3 years (except 2 cases) with no history of radiation exposure or recurrence after previous treatment. Therefore our findings suggest to us that the primary reason for a tumor to achieve this giant size was neglect.

Orofacial clefts and their influence on chosen anthropometric parameters of craniofacial part children at the age of eight.

The aim of this study was to choose and to measure craniofacial parameters that were expected to be influenced by cleft defects. Eight-year-old children (both boys and girls) with operated clefts (15 antropometric parameters) were measured. The measurements were carried out at the Department of Reconstructive Surgery, Hospital Ruzinov, Bratislava. The obtained parameters were compared to 4 types of clefts by means of modification t-test, and also with healthy population by means of normalization indices, on the base of which morphograms were performed. On the base of our results, we can say that the most significant deviations when compared with healthy population were found in children with the worst type of cleft, i.e. complete bilateral cleft.

Polythelia is not a mere aesthetic issue.

Anomalies in breast development include an increase in the number of breast (polymastia), nipples (polythelia), areolas (polythelia areolaris) and the tissue of the breast gland. Of the many forms, the most common is an accessory nipple, polythelia. It commonly develops along the embryonic "milk line" (Fig. 1). It constitutes a diagnostic problem only sporadically. Excision is indicated for diagnostic, treatment or cosmetic reasons. In the literature, the evidence of these anomalies suggests that they could be markers for others, most notably urologic malformations and malignancies.

Coxsackie viral infection and orofacial cleft.

The incidence of orofacial cleft (OC) in newborns was compared with the occurrence of virus-neutralizing antibodies to coxsackie viruses in the serum of newborns and their mothers. No significant difference was found when comparing the seropositivity rates between the group of patients and the control group of healthy newborns. If the patients were divided according to the place of residence however, marked differences occurred between the regions. The lowest incidence of both--coxsackie infection and OC was determined in the region of Bratislava and the highest in the region of Zilina. The explanation of these findings recquires a more detailed analysis of genetic background, social and hygienic status, style of life and other factors, known to influence the development of OC as multi-etiological developmental disorder. (Tab. 2, Fig. 4, Ref. 12.).

New trends in the complex treatment in the Cleft Centre in Bratislava.

The last decade of the second millennium has brought some major changes into the concept of comprehensive treatment of the cleft lip and palate patients commonly accepted by the cleft center in Bratislava. Important events occurred, which surely had and in future they probably still would have an important impact on the comprehensive medical care of children with cleft lip and palate. There is beyond any doubt that an ongoing application of new trends in such fields as plastic surgery, anesthesiology, maxillofacial surgery, orthodontics, phonetics, speech therapy, paediatrics, human genetics or teratology will contribute to the progress and improvement of functional and aesthetic results and to better social adaptation of the cleft lip and palate patients. The study focuses on the following issues: cleft incidence, timing of the primary surgical repair, as well as the need of secondary operations (closures of communications, bone grafts, pharyngeal flaps, corrections of the lip and nose) and the achieved standard of speech quality and articulation, as well as on the early and late otological states and phonation. (Tab. 7, Fig. 3, Ref. 8.)

Alternative method for the reconstruction of defects with a loss of more than half of the upper eyelid.

The authors wish to present an alternative technique for the reconstruction of defects involving the loss of more than half of the upper lid. In a situation where the standard techniques could not be used due to the specific nature of the local findings, the described method seems to be a sound alternative for lid reconstruction.

[Alternative method of reconstruction in traumatic loss of the upper eyelid]. / Alternatívne riesenie rekonstrukcie stratového poranenia horného viecka.

The authors wish to present an alternative technique of more than half upper lid defect reconstruction. In a situation, where the standard techniques couldn't be used due to the specific nature of the local findings, the described method seems to be a sound alternative for the lid reconstruction.