RESUMEN
Nasal glial heterotopia (NGH) is a rare benign tumor of the median line. We describe the case of a child presenting a lateral nasal mass. The characteristics of the prenatal ultrasound and the postnatal clinical examination argued in favor of a congenital hemangioma (CH). The MRI performed at 6 weeks of life suggested glial heterotopia. This diagnosis was confirmed by the pathological analysis. Congenital hemangiomas and nasal glial heterotopies have similar clinical presentations. Prenatal ultrasound diagnosis between NGH and CH is difficult. Fetal MRI is not yet highly specific for these two lesions, but it can eliminate an intracerebral connection in cases of NGH. Postnatal exams are more specific. Flow on the Doppler exam is rapid for CH and slow for NGH. On MRI, these two lesions appear as a hypersignal on T2-weighted sequences, but less intense for NGH than for CH. Distinguishing between NGH and CH can be difficult. This does not have a direct incidence on treatment because it is surgical in both cases.
Asunto(s)
Coristoma/diagnóstico , Hemangioma/diagnóstico , Neuroglía , Enfermedades Nasales/diagnóstico , Neoplasias Nasales/diagnóstico , Adulto , Coristoma/congénito , Coristoma/cirugía , Diagnóstico Diferencial , Femenino , Hemangioma/congénito , Humanos , Recién Nacido , Imagen por Resonancia Magnética/métodos , Enfermedades Nasales/congénito , Enfermedades Nasales/cirugía , Neoplasias Nasales/congénito , Embarazo , Diagnóstico Prenatal/métodos , Ultrasonografía PrenatalAsunto(s)
Daño del ADN/efectos de los fármacos , Terapia de Inmunosupresión , Rayos Ultravioleta , Ácido Urocánico/farmacología , Animales , Antioxidantes/farmacología , Línea Celular , Supervivencia Celular/efectos de los fármacos , Supervivencia Celular/efectos de la radiación , Daño del ADN/efectos de la radiación , Epidermis/efectos de los fármacos , Epidermis/inmunología , Epidermis/efectos de la radiación , Galectinas/biosíntesis , Humanos , Queratinocitos/efectos de los fármacos , Queratinocitos/metabolismo , Queratinocitos/efectos de la radiación , Ratones , Protectores contra Radiación , Transducción de Señal/efectos de los fármacos , Transducción de Señal/efectos de la radiación , Piel/efectos de los fármacos , Piel/efectos de la radiación , Linfocitos T/efectos de los fármacos , Linfocitos T/efectos de la radiación , Ácido Urocánico/químicaRESUMEN
INTRODUCTION: Congenital dacryocystoceles are rare and often misunderstood pathologies. Their treatment varies and consists in simple follow-up, lacrimal catheterization or endoscopic surgical drainage, depending on medical teams. The aim of our study was to discuss the place of endoscopic drainage in the treatment of congenital dacryocystocele. METHODS: We conducted a retrospective review on 18 cases of congenital dacryocystoceles taken in charge in a tertiary care center between 2009 and 2012. RESULTS: Thirteen newborns, including five bilateral cases, were taken in charge. The average age was 14.6 days. Six newborns presented with an acute dacryocystitis at the time of diagnosis. No respiratory complications were observed. Spontaneous drainage of the dacryocystocele was observed in 38.8% of the cases, occurring at 22 days of life on average. Endonasal endoscopic drainage was performed in 66.6% of the cases. No recurrence or complication was observed after surgery. After spontaneous drainage, one recurrence was observed. The mean follow-up period of these patients was 8.8 months. DISCUSSION: Spontaneous drainage is common. Conservative management may therefore be considered in absence of infection. In case of infection and/or persistence of dacryocystocele after 4 weeks of life, endonasal surgical drainage should be considered. Imaging of the facial structure should be performed before any surgical treatment.
Asunto(s)
Dacriocistitis/congénito , Dacriocistitis/terapia , Mucocele/congénito , Mucocele/terapia , Dacriocistitis/cirugía , Endoscopía , Infecciones del Ojo/congénito , Infecciones del Ojo/etiología , Infecciones del Ojo/terapia , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Aparato Lagrimal/patología , Aparato Lagrimal/cirugía , Masculino , Mucocele/cirugía , Estudios Retrospectivos , Espera VigilanteRESUMEN
INTRODUCTION: Maxillary hypoplasia is a common sequela of cleft lip and palate. Its surgical treatment consists in a maxillary advancement by distraction or by conventional orthognathic surgery but morphological results are unpredictable. Our goal in this study was to see if the esthetical results (on the lip and the nose) of maxillary advancement were correlated to the preservation of lateral incisor space of the cleft side. PATIENTS AND METHOD: This retrospective study included 38 patients operated between 2002 and 2013. Unilateral clefts were studied independently from bilateral clefts. Profile aesthetics was evaluated independently and subjectively by two surgeons and scored on an 8-point scale. The result was classified as "good" if the score was superior or equal to 6. The score was correlated to the following parameters: amount of maxillary advancement, upper incisor axis, preservation of the missing lateral incisor space. RESULTS: In the "good result" group, the space of the lateral incisor was less often preserved. The nasolabial angle was more open and the upper central incisor axis more vertical. These results were more pronounced in bilateral clefts, but also found in unilateral clefts. DISCUSSION: Under reservation of the subjective evaluation and of the small number of patients, it seemed that lateral incisor space closure improved the profile of patients treated by maxillary advancement for cleft lip and palate sequelae.
Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Labio/cirugía , Maloclusión/cirugía , Osteotomía Maxilar/métodos , Nariz/cirugía , Procedimientos de Cirugía Plástica , Adolescente , Adulto , Niño , Labio Leporino/complicaciones , Fisura del Paladar/complicaciones , Estética , Femenino , Humanos , Masculino , Maloclusión/complicaciones , Maxilar/cirugía , Procedimientos Quirúrgicos Ortognáticos , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Adulto JovenRESUMEN
We are exposing the case of a 22 year-old patient presenting a wound of the right cheek, with a palsy of the right corner of the mouth. He has been sent to us 6 days after the trauma for secondary exploration. A section of the buccal branch of the right facial nerve with a 1cm gap has been brought out. We have bypassed the loss of substance with a collagen absorbable biological conduit. The 6-months clinical and electromyographic follow-up has shown a clear improvement of the function of the orbicularis oris, as well as its reinnervation by the buccal branch of the right facial nerve.
Asunto(s)
Colágeno/uso terapéutico , Traumatismos del Nervio Facial/cirugía , Nervio Facial/cirugía , Humanos , Masculino , Adulto JovenRESUMEN
A 4 year-old female patient was treated for persistent right-sided dacryocystitis and xerostomia. MRI was performed to screen for a dry syndrome; which resulted in the diagnosis of agenesis of the parotid and submandibular glands as well as lacrimal duct malformation. An MRI of each parent was normal. The mother's history revealed 4 days of pyrexia during the 8th week of amenorrhea. This was an isolated case, with no family history, characterized by a febrile episode during pregnancy at the period of main salivary gland genesis. Epigenetic mechanisms could be implicated.
Asunto(s)
Anomalías Múltiples/diagnóstico , Aparato Lagrimal/anomalías , Glándula Parótida/anomalías , Glándula Submandibular/anomalías , Biopsia con Aguja , Preescolar , Dacriocistitis/diagnóstico , Dacriocistitis/etiología , Femenino , Humanos , Inmunohistoquímica , Aparato Lagrimal/parasitología , Imagen por Resonancia Magnética/métodos , Glándula Parótida/patología , Enfermedades Raras , Glándula Submandibular/patología , Xerostomía/diagnóstico , Xerostomía/etiologíaAsunto(s)
Dacriocistorrinostomía , Obstrucción del Conducto Lagrimal/congénito , Femenino , Humanos , LactanteRESUMEN
INTRODUCTION: Cleft lip and palate (CLP) patients often present with a class III malocclusion in connection with a three dimensional maxillary hypoplasia. Twenty-five to 60% of these patients need maxillary advancement. Two solutions are possible: orthognathic surgery and maxillary distraction. The purpose of this study was to evaluate the complications of maxillary distraction in CLP patients. PATIENTS AND METHODS: Data was collected from the records of patients treated in our surgery unit between 2000 and 2007. Among the eight patients (four male and four female), five presented with a bilateral CLP, two with a unilateral CLP, and one with a unilateral cleft lip associated to a soft palate cleft. The average age at surgery was 17 years. All underwent a Le Fort I osteotomy with a pterygomaxillary disjunction. An external distractor was used for the first two patients and an internal distractor for the six following patients. After a seven-day latency, activation was implemented at a rate of 1mm twice a day. The average period of consolidation was four months. Maxillary advancement ranged between 7 and 19mm, with an average of 12.6mm. The average follow-up was four years. RESULTS: Complications were noted in seven patients: one intra-operative hemorrhage, one avulsion of a tooth anchored at the pterygoid process during osteotomy, three cases of device dysfunction, two cases of significant pain during activation, one loosening of the orthodontic arch in an external system, two cases of labial ulceration, and one maxillary sinusitis due to migration of a wisdom tooth. DISCUSSION: Complications of maxillary distraction in CLP patients were very frequent. Most were related to the device and did not interfere with the final result. This must be taken into account when indicating distraction and choosing the device. Two types of complications can occur during distraction: those related to the osteotomy and those related to the device. The complications related to the osteotomy are linked to the cicatricial ground of previous surgery. They are not specific to distraction. The comfort of the internal device is undeniable, but the design of some models must be reviewed to improve their tolerance.
Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Osteogénesis por Distracción/efectos adversos , Adolescente , Adulto , Pérdida de Sangre Quirúrgica , Placas Óseas , Niño , Falla de Equipo , Fijadores Externos , Femenino , Estudios de Seguimiento , Humanos , Fijadores Internos , Enfermedades de los Labios/etiología , Masculino , Maloclusión de Angle Clase III/cirugía , Maxilar/anomalías , Maxilar/cirugía , Sinusitis Maxilar/etiología , Tercer Molar/patología , Mordida Abierta/etiología , Úlceras Bucales/etiología , Osteogénesis por Distracción/instrumentación , Osteotomía Le Fort/métodos , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias , Estudios Retrospectivos , Avulsión de Diente/etiología , Diente Impactado/complicaciones , Adulto JovenRESUMEN
INTRODUCTION: Cleft lip and palate (CLP) patients often present with a class III malocclusion in connection with a three dimensional maxillary hypoplasia. Twenty-five to 60% of these patients require a maxillary advancement. Two solutions are possible: orthognathic surgery and maxillary distraction. The purpose of this study was to evaluate the complications of the maxillary distraction in CLP patients. MATERIALS AND METHODS: Data was collected from the records of patients treated at our Surgery Unit between 2000 and 2007. Among the eight patients (four male and four female), five presented a bilateral CLP, two a unilateral CLP and one a unilateral cleft lip associated to a soft palate cleft. The average age at surgery was 17 years old. All had a Le Fort I osteotomy with a pterygomaxillary disjunction. The first two patients had external distractors and the six following internal ones. After a seven-day latency, activation was led to the rate of 1mm per day twice. The period of consolidation was four months on average. The maxillary advancement varied between 7 and 19 mm with an average of 12.6mm. The average follow-up was four years. RESULTS: We encountered difficulties and/or complications in seven patients: one intraoperatively haemorrhage, one avulsion of a tooth fixed at the pterygoid process during the osteotomy, three device failures, two cases of significant pains during activation, one dissociation of the dental anchorage of an external system, two labial ulcerations and one maxillary sinusitis by migration of the 18. DISCUSSION: Difficulties of maxillary distraction in CLP patients are very frequent. The majority is related to the distractors and did not interfere with the final result. But this frequency must be taken into account in the indication and in the choice of the material. Two types of complications can occur during distraction: those related to the osteotomy and those related to the material. The complications related to the osteotomy are in connection with the cicatricial ground of the CLP. They are not specific of the distraction. We especially managed complications related to the material. The social benefit of the internal distractors is undeniable, but the design of certain models must be reexamined to improve their tolerance.
Asunto(s)
Labio Leporino/cirugía , Fisura del Paladar/cirugía , Maxilar/cirugía , Osteogénesis por Distracción/efectos adversos , Adolescente , Adulto , Pérdida de Sangre Quirúrgica , Niño , Falla de Equipo , Fijadores Externos , Femenino , Estudios de Seguimiento , Humanos , Fijadores Internos , Enfermedades de los Labios/etiología , Masculino , Maloclusión de Angle Clase III/cirugía , Maxilar/anomalías , Sinusitis Maxilar/etiología , Úlceras Bucales/etiología , Osteogénesis por Distracción/instrumentación , Osteotomía Le Fort/efectos adversos , Osteotomía Le Fort/métodos , Dolor Postoperatorio/etiología , Estudios Retrospectivos , Hueso Esfenoides/cirugía , Factores de Tiempo , Avulsión de Diente/etiologíaRESUMEN
Primary nasal deformity is characterized by apparent prolabio-columellar skin shortness due to alar cartilage dislocation worsened by lack of muscular support. The secondary deformation retains part of the initial deformity, sometimes even worsened by the primary lip repair. Multiple surgical lengthening techniques were used in nasal defect correction, suggesting both technical complexity and unsatisfactory results. Indeed, columellar insufficiency has more to do with abnormal columello-apical skin distribution due to alar mispositioning than an effective lack of skin. Secondary correction by open rhinoplasty allowing careful cartilage reconstruction of the nose tip seems to be widely accepted. However, the nasal defect can be limited by performing a primary intervention focusing on two principles: columellar lengthening by early alar repositioning and simultaneous lip and nose repair.
Asunto(s)
Labio Leporino/cirugía , Deformidades Adquiridas Nasales/etiología , Cartílago/cirugía , Cartílago/trasplante , Labio Leporino/complicaciones , Procedimientos Quirúrgicos Dermatologicos , Humanos , Labio/cirugía , Nariz/anomalías , Nariz/cirugía , Deformidades Adquiridas Nasales/cirugía , Procedimientos de Cirugía Plástica , Reoperación , Rinoplastia/métodos , Colgajos QuirúrgicosRESUMEN
INTRODUCTION: The purpose of this study was to determine the types of facial injuries treated in a one-year in a maxillo-facial unit operating in a mountainous region. METHODS: All patients admitted to the Grenoble University Hospital maxillo-facial unit for a one year period were studied. We noted cause of trauma, age, sex, type and location of fracture, type of soft tissue injury, time between trauma and surgery. RESULTS: A total of 994 patients presenting maxillo-facial trauma underwent surgery over one year; 30% of the unit's maxillo-facial surgical activity. On average, 80 patients were treated for maxillo-facial trauma per month, with a peak of 97 facial injuries in July; 65.6% were hospitalized in the maxillo-facial unit; 25,4% of the injured were aged between 21 and 30 years. Sex-ratio was 2.7M/1F. The most frequent cause was sports injuries (25.8%) followed, in decreasing order, by traffic injuries (23.1%), home injuries (17.6%), fight injuries (3.4%), work injuries (3.4%) and dog bites (3.2%). 10.5% of the injuries occurred in a mountainous setting and 40.7% were sports injuries, 95% of which during practice of winter's sports. Injuries included facial fractures (65.5%) with or without soft tissue damage, and soft tissue injuries only (34.5%); 33.6% of the patients had other lesions of the body. 67.2% underwent surgery within the first 24 hours and 86.9% before the fifth day. DISCUSSION: Sports accidents are the leading cause of facial trauma in the mountainous regions. Most facial injuries result from ski, surf and other winter sports accidents. Most of the victims were given surgical care within the first 24 hours following the accident.
Asunto(s)
Traumatismos Faciales/epidemiología , Accidentes Domésticos/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Animales , Traumatismos en Atletas/epidemiología , Mordeduras y Picaduras/epidemiología , Niño , Perros , Estudios Epidemiológicos , Huesos Faciales/lesiones , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/epidemiología , Factores Sexuales , Fracturas Craneales/epidemiología , Traumatismos de los Tejidos Blandos/epidemiología , Violencia/estadística & datos numéricosRESUMEN
The dacryo-cysto-rhinostomy via the external approach is indicated for obstruction of the lacrymal duct. It consists in the creation of short-circuit between the lacrymal sac and the external nasal wall. The operation stages starts by paracanthal incision, the subperiosteal dissection stops anteriorly to the posterior insertion of the medial canthal ligament (to preserve lacrymal function). An ostectomy is performed between the maxillary bone and the unguis. A stomy is created by individualizing two mucosal flaps. The bicanaliculonasal intubation is systematic and maintained for 10 to 12 weeks.
Asunto(s)
Dacriocistorrinostomía/métodos , Humanos , Aparato Lagrimal/anatomía & histología , Cuidados PosoperatoriosRESUMEN
INTRODUCTION: Fractures of the mandible angle raise the risk of infectious complications. We searched for factors predictive of these complications. MATERIAL AND METHODS: We reviewed retrospective all cases of mandibular angle fracture treated during a 26-month period. We compared two groups: fractures with wisdom teeth and fractures without wisdom tooth. For each group we noted clinical and radiological characteristics of the fractures and infectious complications. RESULTS: The series included 72 mandibular angle fractures, 30 with a wisdom tooth against 42 without. Most of the patients were treated within 2 days, generally using mini-plate screw fixation. In the wisdom tooth group, 16.6% of patients developed infectious complications versus 9.5% in the without wisdom tooth group. All patients of the wisdom tooth group presented a potentially infectious focus on the preoperative x-rays. For without wisdom tooth group, irregular follow-up was found to be the only risk factor. DISCUSSION: The angular localization increases the risk of infectious complications especially if the wisdom tooth is in the fracture. We propose a decision tree to determine when to preserve or not the wisdom tooth.
Asunto(s)
Fracturas Mandibulares/cirugía , Infección de la Herida Quirúrgica/etiología , Adolescente , Adulto , Anciano , Placas Óseas , Tornillos Óseos , Niño , Femenino , Estudios de Seguimiento , Predicción , Fijación Interna de Fracturas , Humanos , Masculino , Fracturas Mandibulares/clasificación , Fracturas Mandibulares/patología , Persona de Mediana Edad , Tercer Molar/patología , Estudios Retrospectivos , Factores de Riesgo , Factores de TiempoAsunto(s)
Fijación Interna de Fracturas/métodos , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/diagnóstico por imagen , Accidentes de Tránsito , Adulto , Placas Óseas , Tornillos Óseos , Humanos , Técnicas de Fijación de Maxilares , Masculino , Fracturas Mandibulares/cirugía , Traumatismos Maxilofaciales/diagnóstico por imagen , Traumatismos Maxilofaciales/cirugía , Traumatismo Múltiple , Radiografía , Fracturas Craneales/diagnóstico por imagen , Fracturas Craneales/cirugíaRESUMEN
Surgeons have long been preoccupied with continuity of the bone in the repair of cleft lips and palates. It is no longer necessary to demonstrate the deleterious effect of employing osteoplasty in a first stage procedure; very few practitioners still rely upon it. On the other hand, a great number of authors now advocate a bone graft as a secondary operation, although they have not been able as yet to reach a consensus on its timing, nor upon exactly what its objectives should be. An early bone graft, carried out at the time of the primary dentition, would have as its goal stabilization of the maxillary segments and prevention of relapse of the maxillary retrusion as the dentition becomes mixed. Any hopes that such an intervention would have a beneficial effect with regard to the area of the lateral incisors, which are usually malformed or absent, seem to us illusory. A secondary bone graft, undertaken during the mixed dentition before the eruption of the canines, when a maxillary bony deficit is present with accompanying alveolar insufficiency. We consider that a distinction between the areas of bone, the maxillary and the alveolar, is essential because a continuity of maxillary bone, a guarantee of skeletal stability, can be obtained in more than 70% of cases by perio-osteoplasty (a graft of tibial periosteum or gingivo-perio-osteoplasty). When this cannot be done, a massive bone graft will be needed at the close of orthopedic treatment. Continuity of alveolar bone, the guarantee of occlusal stability, can be obtained at the close of orthodontic treatment with the use of a provisional prosthesis followed by a permanent replacement after completion of gingival correction. We believe a graft to prepare for an implant in an area where scar tissue can be a problem would be risky especially since implants, in our opinion, do not provide the same stability to a dental arch that a fixed bridge affords.
Asunto(s)
Trasplante Óseo/métodos , Fisura del Paladar/cirugía , Procedimientos Quirúrgicos Orales/métodos , Adulto , Factores de Edad , Proceso Alveolar/anomalías , Proceso Alveolar/cirugía , Niño , Labio Leporino/cirugía , Fisura del Paladar/terapia , Femenino , Gingivoplastia , Humanos , Lactante , Masculino , Maloclusión de Angle Clase III/cirugía , Maloclusión de Angle Clase III/terapia , Maxilar/cirugía , Ortodoncia Correctiva , Periostio/trasplante , Procedimientos de Cirugía Plástica/métodos , TibiaRESUMEN
Treatment teams that conceive and nourish their ideas in a multi-disciplinary environment are best suited to elaborate therapeutic protocols. Their concepts should be based on consistent evaluation of their treatment results as documented by precise and reproducible records. In the wide array of maxillo-facial anatomical deformities presented clinically, bilateral cleft lips and palates are the rarest (20%), but they are also the most serious because of the inherent disconnection of maxillary structures that accompanies them and because of the grave disturbances they inflict on the development of the middle third of the face. Surgeons have devised an extraordinary gamut of protocols to correct these disorders and then abandoned them because of the problematical and ephemeral results they provided. The authors, after evaluating their own results, modified their therapeutic approach in 1994. They present their current protocol, which calls for an orthopedic phase carried out when the patient is 2 months old and two surgical phases when the patient is 3 and then 7 months old.
Asunto(s)
Labio Leporino/patología , Labio Leporino/cirugía , Fisura del Paladar/patología , Fisura del Paladar/cirugía , Procedimientos Quirúrgicos Orales , Trasplante Óseo/métodos , Preescolar , Protocolos Clínicos , Humanos , Lactante , Ortodoncia Preventiva/instrumentación , Obturadores Palatinos , Periostio/trasplante , Cuidados Preoperatorios , Procedimientos de Cirugía Plástica , Resultado del TratamientoRESUMEN
The logic of lip repair derives from the morphologic and structural specificity of this region. We review various techniques of upper lip reconstruction with special focus on cheek advancement. This simple and reliable procedure fulfills the criteria for satisfactory repair of the lateral unit of the upper lip.
Asunto(s)
Labio/cirugía , Procedimientos de Cirugía Plástica/métodos , Humanos , Labio/anomalías , Labio/lesiones , Colgajos Quirúrgicos , Técnicas de Sutura , Resultado del TratamientoRESUMEN
PURPOSE OF THE STUDY: The purpose of this study was double: appreciate the osteogenic and growth capacities of the free tibial periosteal graft concerning the alveolar and hard palate repair in the complete unilateral cleft lip and palate, and evaluate long-term follow-up concerning maxillo-mandibular morphology and palatal air-tight. MATERIAL AND METHOD: This retrospective study concerns 51 patients, of more than 13 years of age, treated for complete unilateral cleft lip and palate. The treatment included a Skoog type cheiloplasty, a tibial periosteal graft between 4 and 6 months (as described by M. Stricker) and a staphyloraphy between 8 and 18 months. Our documentation was: figures, pictures and precise description of the initial cleft, dental casts, teleradiographies, dental panorams performed at different stages of treatment, orthodontic, orthophonic and otologic follow-up. Growth was evaluated using casts during the first 6 years then by profil teleradiographies after puberty. Ossification was evaluated quantitatively by CT scan in 18 patients. RESULTS: Results confirm an ossification of the periosteal graft in 72% of cases and the advantage of periosteal graft in palatal air-tight. 85% of cases show equilibrated squeletal growth with good occlusion, and 13.7% of cases needed deferral osteotomy. CONCLUSION: We propose a method for long-term cleft results evaluation, with the use of periosteal graft.
Asunto(s)
Proceso Alveolar/anomalías , Proceso Alveolar/cirugía , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Maxilar/anomalías , Maxilar/cirugía , Periostio/trasplante , Tibia/trasplante , Adolescente , Adulto , Proceso Alveolar/diagnóstico por imagen , Fisura del Paladar/diagnóstico por imagen , Femenino , Humanos , Masculino , Maxilar/diagnóstico por imagen , Radiografía , Procedimientos de Cirugía Plástica/métodos , Estudios RetrospectivosRESUMEN
The wide diversity of bilateral facial clefts makes it most difficult to assess surgical success, particularly in terms of long-term outcome. The aim of this work was to examine the rationale for the current protocol used for cleft surgery at the Grenoble University Hospital. In a first group of 28 children, a 3-step surgical protocol was applied. The first two steps were performed between 4 and 8 months with at least 3 months between each procedure. Skoog's unilateral cheilo-rhino-uranoplasty was used, associated with a periosteal tibial graft. The third step, performed between 10 and 12 months, was for staphylorraphy. Outcome was analyzed at 15 years and evidenced the deleterious effect of excessive and asymmetrical premaxillary scars, of the 2-step cheiloplasty and of columella lengthenings from the lip. The frequency of secondary revision of the superior labial vestibule and the medial labial tubercule (43%) was considered to be high; this procedure should be re-examined as should be osteotomy (32% revision). Palatine closure, acquired in 82% of the cases and premaxillary stability, achieved in 86%, would appear to favor use of the periosteal tibial graft. The osteogenic capacity of this graft tissue was less satisfactory after a second harvesting (from the same tibia three months later). These results have led us to modify our protocol, favoring early and total closure of the bony palate and continued use of the periosteal tibial graft. We now use the following operative protocol: premaxillary alignment using an active orthopedic plate at 2 months, lip adhesion associated with staphylorraphy and passive palatine contention plate at 3 months, definitive bilateral cheilo-uranoplasty associated with a single periosteal graft at 7 months. The preliminary results with this protocol in a group of 12 children have shown better quality scars, more harmonious maxillary arches, an excellent occlusion of the deciduous dentition, and preservation of the positive results obtained with the periosteal tibial graft.