Evaluating the Effect of Low Power Diode Laser 806†nm on the Healing of Unilateral Cleft Lip Scar: An Open-Label Comparative Study.

OBJECTIVE: To investigate the effect of laser bio-modulation irradiation therapy on the scar after surgical correction of unilateral cleft lip. DESIGN: a comparative, open-label study. SETTING: we conducted the study in a university based tertiary hospital that recruited early wound healers of unilateral cleft lip correction. PATIENTS: Eighty patients were divided into two groups: In study's group, patients undergo laser bio-modulation irradiation (n = 60); in the control group, patients were followed-up without intervention (n = 20). INTERVENTION: In the study's group, patients underwent low-power diode Laser with wavelength of 806 nm and power of 100 mw. MAIN OUTCOME: The change in the scar of cleft lip patients, which was assessed by clinical examination and ultrasound. RESULTS: The median pigmentation score was significantly lower in the laser group (median = 1; IQR = 1-2) than the control group (median 2; IQR 1-3), with p-value of <0.001. Likewise, the median height score was significantly lower in the laser group (median = 1; IQR = 1-1) than the control group (median 1.5; IQR 1.5-2), with p-value of 0.001. The median pliability score was significantly lower in the laser group (median = 1; IQR = 1-1) than the control group (median 2.5; IQR 1-3), with p-value of <0.001. Finally, the median vascularity score was significantly lower in the laser group (median = 1; IQR = 1-1) than the control group (median 1.5; IQR 1-2), with p-value of <0.001. CONCLUSION: laser bio-modulation irradiation therapy demonstrates a potential efficacy in managing the hypertrophic scars after surgical repair of unilateral cleft lip.

Does Presurgical Taping Change Nose and Lip Aesthetics in Infants with Unilateral Cleft Lip and Palate? A Randomized Controlled Trial.

BACKGROUND: The aim of this randomized controlled trial was to assess the effectiveness of taping alone in changing nose and lip aesthetics in infants with unilateral complete cleft lip and palate before and after surgical lip repair. METHODS: The study design was a prospective, balanced, randomized, parallel-group, single-blinded, controlled trial. All the steps were carried out in the Department of Orthodontics of Cairo University in Egypt. Thirty-one infants with nonsyndromic unilateral complete cleft lip and palate were randomly assigned to either no treatment (control) or taping groups. In the taping group, all infants received horizontal tape between the two labial segments, aiming to decrease the cleft gap. No other interventions were performed in this group. Standardized photographs and videos were taken of the infants in both groups at the beginning of the treatment (T1), directly before surgical lip repair (T2), and 2 weeks after surgical lip repair (T3). Photographs and shots from videos were calibrated and used for outcome assessment. Blinded assessors carried out all the measurements digitally on the standardized photographs at T1, T2, and T3 using computer software. RESULTS: Significant changes in all the measurements were recorded in the taping group at T2 before surgical lip repair in comparison with the control group. At T3, no differences were found between the two groups. CONCLUSIONS: Taping is a successful intervention in changing nose and lip aesthetics before surgical lip repair. After surgical lip repair, both groups had matching aesthetics. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Implant to Fat: A Breast Augmentation Technique Validated by BREAST-Q.

Implant-based breast augmentation is the number one cosmetic procedure performed in the United States. However, it is associated with relatively high revision rates, reaching up to 24% at 4 years. This case series presents our experience in implant explantation with simultaneous breast augmentation using fat. METHODS: This case series was conducted by the authors in Cairo, Egypt, during the period from January 2018 to June 2019. Following a detailed data collection, careful physical examination was done. Implant-to fat conversion was done for all cases. None of the cases needed >1 session of fat injection following the implant removal. Size of the implants removed ranged from 200 -350 cm3 (average of 310). Volume of fat injected ranged from 300 to 550 ml (average of 430). Patients' satisfaction was evaluated using the BREAST-Q questionnaire. RESULTS: Twenty patients were included, with a mean age of presentation of 33.1 years (range, 26 -42 years; SD, 5.3). Mean body mass index was 26.9 kg/m2 (range, 24 -30; SD, 1.9). Implant complications were as follows: capsular contracture (10cases), implant migration (3 cases), breast asymmetry (3 cases), poor aesthetic outcome (3 cases), and palpable implant (1 case). Overall patient's satisfaction was evaluated by the BREAST-Q 1-year following surgery. The overall satisfaction score was 3.8, where a score of 4 indicates very satisfied and a score of 1 indicates very dissatisfied. CONCLUSIONS: Implant-to-fat conversion is a good option for complicated breast implant cases, with good long-term results and excellent patient's satisfaction as verified by the BREAST-Q.

Effectiveness of a Novel 3D-Printed Nasoalveolar Molding Appliance (D-NAM) on Improving the Maxillary Arch Dimensions in Unilateral Cleft Lip and Palate Infants: A Randomized Controlled Trial.

OBJECTIVE: The aim of the current study was to introduce and measure the effectiveness of a new 3D-printed nasoalveolar molding (D-NAM) appliance on improving the maxillary arch dimensions (MADs) in infants with unilateral complete cleft lip and palate (UCLP) before surgical lip repair. DESIGN: A prospective, balanced, randomized, parallel groups, single-blinded, controlled trial. SETTING: All the steps of the current study were carried in the Department of Orthodontics, Cairo University in Egypt. PARTICIPANTS: Thirty-four, nonsyndromic infants with UCLP. INTERVENTIONS: The eligible infants were randomly assigned into either no-treatment (control) or to the new D-NAM groups. In D-NAM group, the maxillary models were 3D scanned into virtual models onto which segmentation and alveolar segments approximation were performed. Approximation movements were divided into 3 models representing 3 activation steps. On each of these models, virtual appliance construction was performed followed by 3D printing of the appliance. Nasal stent was added manually to the appliances of the second and third steps. Horizontal tapes were applied to infants in the D-NAM group only. MAIN OUTCOMES MEASURES: A Blinded assessors carried all the MADs measurements virtually on digital models collected at the beginning (T1) and after (T2) treatment. RESULTS: Clinically and/or statistically significant improvements in all the measured MADs were recorded in D-NAM group at T2 before surgical lip repair in comparison to control group. CONCLUSIONS: The introduced D-NAM/3D-printed appliance is a simple and efficient technique to improve the MADs in infants with UCLP before surgical lip repair.

Is Taping Alone an Efficient Presurgical Infant Orthopedic Approach in Infants With Unilateral Cleft Lip and Palate? A Randomized Controlled Trial.

OBJECTIVE: The aim of the current randomized controlled trial (RCT) was to assess the effectiveness of taping alone in changing the maxillary arch dimensions (MADs) in infants with unilateral complete cleft lip and palate (UCLP) before surgical lip repair. DESIGN: A prospective, balanced, randomized, parallel-group, single-blinded, controlled trial. SETTING: All the steps of the current study were carried in the Department of Orthodontics, Cairo University in Egypt. PARTICIPANTS: Thirty-one, nonsyndromic infants with UCLP. INTERVENTIONS: The eligible infants were randomly assigned to either no-treatment (control) or taping groups. In the taping group, all the infants received horizontal tape between the 2 labial segments aiming to decrease the cleft gap. No other interventions were performed to infants included in this group. Rubber base impressions were made to all the included infants in both groups at the beginning of the treatment (T1) and directly before surgical lip repair (T2). All the produced models were scanned using a desktop scanner producing digital models for outcome assessment. MAIN OUTCOMES MEASURES: A blinded assessor carried out all the MAD measurements virtually on the produced digital models at the beginning (T1) and after (T2) treatment. RESULTS: Clinically and/or statistically significant changes in all the measured MADs were recorded in the taping group at T2 before surgical lip repair in comparison to the control group. CONCLUSIONS: It seems that taping alone is an efficient tool in changing the MADs before surgical lip repair in infants with UCLP.

Is PRP Effective in Reducing the Scar Width of Primary Cleft Lip Repair? A Randomized Controlled Clinical Study.

OBJECTIVE: To evaluate and analyze the effect of platelet-rich plasma (PRP) injection on the scar formed after unilateral complete cleft lip scar repair using a modified Millard technique. HYPOTHESIS: An unavoidable cheiloplasty scar is a result of the wound healing process that not only influences patient self-esteem for life but also affects muscle function. DESIGN: Blind, randomized, controlled clinical trial. PATIENTS: From December 2016 to February 2018, 24 patients with unilateral complete cleft lip undergoing primary cheiloplasties were equally assigned to study and control groups. INTERVENTION: All patients were treated by modified Millard cheiloplasty. In the study group, PRP was injected into the muscle and skin layers immediately after wound closure, while the control group patients were treated with no PRP injection. OUTCOMES MEASURES: Scar width was assessed after 6 months through the muscle using ultrasonography and at the skin surface via photographs. RESULTS: Scar width showed a significant improvement in the study group. CONCLUSIONS: Injection of autologous PRP provides effective improvement of cutaneous and muscular wound healing and decreases scar tissue formation.