Respiratory Polysomnographic Findings in Patients Treated Primarily for Unilateral Cleft Lip and Palate.

Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. Obstructive sleep apnea syndrome (OSAS) is a highly prevalent but underdiagnosed disease and is frequently associated with craniofacial anomalies. There are few studies describing the sleep breathing pattern of children with CLP. This study sought to characterize the respiratory profile of 23 children with unilateral cleft lip and palate, aged 7-12 years, who had undergone cleft lip and nasal repair at age 3-4 months and palatoplasty at 12-15 months, with a particular focus on evaluating the presence of OSAS in children with CLP. Polysomnography was performed and findings were analyzed descriptively. We found a mean and median for apnea/hypopnea index (AHI) of 1.11/h (SD = 0.78) and 0.9/h, respectively. The mean obstructive apnea index (OAI) was 0.27/h (SD = 0.38) and the median, 0.1/h. Nearly 30% of patients had an AHI above 1.4 events/h. There was no significant oxyhemoglobin desaturation in the study group. In this group, the prevalence of OSAS was higher than in noncleft populations when compared to the normality values adopted. This sample of patients with unilateral cleft lip and palate exhibited an increased prevalence of OSAS during the mixed dentition stage. Although the results showed that OSAS was mild, we advise closer observation of these patients. Polysomnography is recommended for the assessment of children with airway abnormalities, to individualize the extent of treatment.

Neonatal Mandibular Distraction Osteogenesis Reduces Cleft Palate Width and Lengthens Soft Palate, Influencing Palatoplasty in Patients With Pierre Robin Sequence.

The aim of this study was to evaluate the influence of neonatal mandibular distraction osteogenesis (MDO) on cleft dimensions and on early palatoplasty outcomes in patients with Pierre Robin Sequence (PRS). In a prospective cohort study that enrolled 24 nonsyndromic patients with PRS, 12 submitted to the MDO group and 12 patients not treated (non-MDO group), the authors compared patients for cleft palate dimensions through 7 morphometric measurements at the moment of palatoplasty and for early palatoplasty outcomes. At palatoplasty, the MDO group presented a significant shorter distance between the posterior nasal spines (PNS-PNS, P < 0.001) and between uvular bases (UB-UB, P < 0.001), representing a reduction in cleft palate width. They also had significant soft palate lengthening represented by a larger distance between UB and retromolar space (UB-RM, P < 0.001) and UB and PNS (UB-PNS, P = 0.014). Their UB moved away from the posterior wall of the nasopharynx (UB-NPH, P < 0.001). The MDO group had a length of operative time significantly shorter (P < 0.001) and no early palatoplasty complications compared with the non-MDO group. In conclusion, MDO acted as an orthopedic procedure that reduced cleft palate width and elongated the soft palate in patients with PRS. These modifications enabled a reduction of around 11% in the length of operative time of palatoplasty (P < 0.001).

Development and testing of an absorbable spring for cranial expansion in rabbits.

OBJECTIVE: Use of metal springs for treatment of craniosynostosis is gaining ground in the surgical armamentarium, as these springs simplify operative technique, help to avoid extended approaches, and thus minimize morbidity. Nevertheless, these devices have to be removed eventually. The purpose of this study was to perform cranial expansion with a fully integrated, biodegradable polymer spring in an animal model and to assess the efficacy of and histological reaction to this device. MATERIAL AND METHODS: This was an experimental, unblinded, prospective study. Twelve female New Zealand rabbits (Oryctolagus cuniculus) aged 6 weeks were randomly allocated to two groups. Control animals underwent linear craniectomy alone. Intervention animals underwent craniectomy with placement of a poly(lactic-co-glycolic acid)/polyisoprene (PLGA/PI) copolymer blend spring for cranial expansion transverse to the ostectomy. Expansion was measured radiographically over 12 weeks with amalgam markers. At the end of the experiment period, histological analysis was performed to quantify inflammatory reaction. RESULTS: The copolymer blend springs had a mean strength of 4.2N. In the intervention group, cranial expansion at the frontal markers was 9.6-11.67 mm (significantly greater than in controls). Histological analysis showed minor inflammatory reactions. CONCLUSION: In this animal model, cranial expansion by linear craniectomy followed by bioabsorbable spring placement was feasible and well tolerated by adjacent tissues.

Reconstrução nasal neonatal na Síndrome do Warfarin Fetal / Neonatal nasal reconstruction in Fetal Warfarin Syndrome

O objetivo deste trabalho é relatar um caso de reconstrução nasal precoce em um paciente com síndrome do Warfarin fetal, onde um paciente de 23 dias com apresentava hipoplasia nasal isolada. O ganho ponderal estava estagnado e não havia possibilidade de introdução de sonda nasoentérica devido à deformidade. Foi realizada rinoplastia aberta com incisão transcolumelar. Dois enxertos de cartilagem tragal foram confeccionados e introduzidos na região da ponta, porção cranial do septo cartilaginoso e alares. O paciente apresentou melhoria da permeabilidade ventilatória, diminuição do ruído inspiratório, ganho de peso e também da forma. Após um ano de seguimento o resultado continuava satisfatório. Concluímos que a intervenção precoce é satisfatória e pode minimizar ou mesmo prevenir procedimentos futuros.

The aim of this work is to report a case of early nasal reconstruction in a 23-day-old patient with fetal Warfarin syndrome and isolated nasal hypoplasia. Weight gain was arrested and the deformity precluded the use of a nasogastric tube. An open rhinoplasty with transcolumellar incision was performed. Two grafts of tragal cartilage were made and introduced in the tip area, cranial portion of the cartilaginous septum, and alar cartilages. The patient presented improved ventilatory permeability, decrease of inspiratory noise, and weight and shape gains. At the one-year follow-up the result was still satisfactory. We concluded that early intervention is satisfactory and may minimize or even prevent future procedures.

Ulceras de pressäo: quando está indicado o tratamento pelo cirurgiäo plástico? / Pressure sores: when to indicate platic surgery?

Tlceras de pressÝo fazem parte da rotina de muitos médicos. SÝo lesSes de manejo complexo, que atuam de forma a prejudicar a melhora clínica do paciente. os autores estabelecem os tio de úlceras de pressÝo de acordo com as classificaçSes vigentes, de forma a demonstrar como é possível impedir a evoluçÝo dessas lesöes. Ademais, é dado ênfase especial à profilaxia e tratamento, esclarecendo o papel da cirurgia plástica no manejo desta patologia