Mixed Dentition Period Follow-up of Primary Unilateral Cleft Nose Deformity Repair.

Background: Recently, there has been an increased acceptance of the primary cleft rhinoplasty providing acceptable outcomes. Nose reconstruction, and specifically cleft nose deformity, should be addressed based on this philosophy. The purpose of this study was to evaluate surgical outcomes during the mixed dentition period after primary surgery to address unilateral cleft lip nose deformity based on the proposed technique. Methods: This is a retrospective cohort study. Thirty-two primary complete unilateral cleft lip patients were operated on by a single surgeon using the V-Y-Z cleft rhinoplasty. This method combines a composite V-Y advancement flap with lateral Z-plasty. Data collection was accomplished by evaluation of nasal symmetry through anthropometric measurements performed under general anesthesia during primary cleft palatoplasty and alveolar bone graft. The outcomes were evaluated through anthropometric measurements of the repaired nose during the mixed dentition period of follow-up, and no type of presurgical management was performed for any of the patients. Results: Total nasal symmetry has been observed in 34.37% of patients at 7 years or more and 40.62% at 1-year follow-up. Nonstatistically significant differences were observed during follow-up, and major revision requirement (>3 mm of asymmetry in any of the nose measurements) was observed in 9.37% of patients. Conclusions: The proposed primary cleft rhinoplasty is a good approach to improve nasal appearance in patients with complete unilateral cleft lip and palate.

Postoperative Nasal Conformers in Cleft Rhinoplasty: Are They Efficacious?

BACKGROUND: Lip and nose symmetry the goal of repair of unilateral cleft lip and different preoperative and postoperative treatments have been developed with this purpose. The objective of this study was to compare 2 techniques used for primary cleft lip nose repair. MATERIALS AND METHODS: This is an retrospective study between 2 groups of patients with unilateral cleft lip and palate who underwent primary nasolabial repair either with or without postoperative nasal conformers. Data collection was accomplished by evaluation of nasal symmetry through anthropometric measurements under general anesthesia during primary cleft palate repair. RESULTS: Our comparative study did not find a statistically significant difference regarding percentile indexes of nasal asymmetry between the 2 groups. Major revision requirement (>3 mm of asymmetry in any of the nose measurements) was observed in 3.84% of nasal conformer group and 4.65% of the group without nasal conformers. CONCLUSIONS: The results obtained from this study provides showed that placement of postoperative nasal conformers did not improve nasal symmetry in patients with unilateral cleft lip and palate. Based on these findings and available scientific evidence, definitive conclusions about the effectiveness of these devices on nasal symmetry after unilateral cleft lip nose repair cannot be drawn.

Cleft Lip and Palate Surgery during COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has caused a negative impact in every sector of life, especially in the health sector. Patients with different medical conditions are suffering delays in their surgical treatments. Cleft lip and palate is a common congenital disease that requires early interdisciplinary attention, and there is uncertainty about the safety of performing its surgical treatment during the COVID-19 pandemic. The objective of this study was to evaluate the safety of a surgical cleft protocol for cleft lip and palate used during the COVID-19 pandemic at a high volume cleft center in Lima, Peru. METHODS: This is a comparative study between two groups of patients with nonsyndromic cleft lip and palate who were operated on before and during the COVID-19 pandemic. Data collection was done by evaluation of presurgical condition, and surgical and nonsurgical postoperative outcomes and complications. RESULTS: Significant differences were observed regarding both the age of the patients at the time of the primary surgeries, and surgical times between the two groups. Nonstatistical significant differences were observed between the two groups regarding the presurgical conditions, postoperative outcomes, and complications. Rate of COVID-19 infection was 1.25%. CONCLUSIONS: The surgical protocol used for cleft lip and palate repair during the COVID-19 pandemic is a safe method based on the observed postoperative outcomes. However, the COVID-19 pandemic caused delays of the time of the primary cleft lip and palate repair, and its long-term impact should be well evaluated.

Factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis in Lima, Peru.

The objective of the study is to analyze the factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis. The methodology used is based on a cross-sectional study in patients receiving hemodialysis at the Centro Nacional de Salud Renal. Severe pruritus was defined as a score on the visual analogue scale greater than or equal to 7, and the strength of association with the possible risk factors was assessed by calculating prevalence ratios. Regarding the results, 264 patients were included, 59.9% were male, with a mean time on hemodialysis of 10.26 ± 7.14 years. 75% experienced pruritus, of this group, 1 in 3 presented severe pruritus. Hyperphosphatemia and the use of antihistamines were associated with a higher prevalence of severe pruritus (RP 1.71, 95% CI 1.09-267 and RP 2.39, 95% CI 1.51-3.75, respectively). The positive serology for Hepatitis C Virus was described as a protective factor for presenting severe pruritus (RP 0.55, 95% CI 0.33-0.89). In conclusion, severe uremic pruritus is a frequent problem in patients with chronic terminal kidney disease who have hyperphosphatemia and treatment with antihistamines independently of the time they have been on hemodialysis.

Surgical Technique for Whistler Deformity Repair in Bilateral Cleft Lip Patients: An Anthropometric Study.

OBJECTIVE: The purpose of this study was to evaluate the surgical outcome of secondary bilateral cleft lips after using a surgical technique for whistler deformity repair. DESIGN: A prospective cohort study of one surgeon's outcome of 38 consecutive performed bilateral whistler deformity repairs was conducted. SETTING: Data from the Outreach Surgical Center Program, Lima, Peru, were used. PATIENTS: Thirty-eight patients with lip deformity related to unsatisfactory bilateral cleft lip repair were operated on using the proposed surgical technique since 2008. All these patients met the study criterion of having anthropometric measurements performed at least 1 year postoperatively. MAIN OUTCOME MEASURES: Measurement of lip height, lip width, vermilion height, cupid bow, and nasal base width was performed at the right and left side of the lip, preoperatively and at least 1 year postoperatively. ANALYSIS: The matched pair t test analyses were performed when the assumptions required were met. When the normality assumption was not met, the Wilcoxon signed rank test, a nonparametric test was used to assess the statistical significance of differences between the studied sample and control group. RESULTS: The study found statistically significant differences between the preoperatory and control groups in most of the lip measurements. In addition, we have found statistically significant differences between the preoperatory and postoperatory groups in most of the anthropometric lip measurements, in favor of the second group, after lip repair using the proposed technique and measured at least 1 year postoperatively. CONCLUSIONS: The findings suggest that the proposed technique is a good alternative to address the whistler deformity related to the bilateral cleft lip primary repair.

A Comparative Study to Evaluate the Functional Effect of Unilateral Uvuloplasty after Primary Palatoplasty.

BACKGROUND: The conventional method for uvular repair suturing the 2 hemi-uvulas of the palatal cleft together in the midline does not allow us to obtain a proper anatomical repair. In our hands, the midline straight closure frequently causes retraction of the uvular tissues with the consequent abnormal appearance of the uvula. We described before a method for uvular repair in patients with cleft palate. The technique consists in preserving one of the hemi-uvulas, which is moved to the midline to form the definitive uvula. The purpose of this study was to evaluate the functional effects of the unilateral uvuloplasty for uvular repair in a group of patients with bilateral cleft palate. METHODS: This is a retrospective, single-blinded cohort study between 2 groups of 90 patients with bilateral cleft palate who were operated on using the conventional and unilateral uvuloplasty methods of uvular repair from 2000 to 2009. Data collection was accomplished by physical examination to evaluate the presence of postoperative fistulas and hypernasal speech determined at 6 months to 5 years after surgery. In addition, postoperative dimensions of the velopharynx were measured by a single-blind examiner using a computed tomography scan. RESULTS: Our comparative study found statistically significant differences between the 2 groups in favor of the unilateral uvuloplasty group. CONCLUSIONS: We observed that the use of unilateral uvuloplasty for uvular reconstruction reduces the velopharyngeal space and the frequency of hypernasality in patients with bilateral cleft palate.

Association between palatal index and cleft palate repair outcomes in patients with complete unilateral cleft lip and palate.

IMPORTANCE This study evaluates a technique to estimate cleft severity and tissue hypoplasia in patients with cleft palate. Current classifications are limited to the morphologic characteristics of the clefts. A new classification is proposed in relation to the palatal index, which allows more individualized surgical attention for the cleft palate. OBJECTIVE To evaluate the relationship of palatal index and cleft palate repair surgical outcomes (palatal fistula and velopharyngeal insufficiency) in patients with unilateral cleft lip and palate. DESIGN, SETTING, AND PARTICIPANTS Retrospective study performed by the Outreach Surgical Center Program Lima, Lima, Perú, of surgical outcomes of 152 consecutive pediatric patients, aged 12 to 15 months, with nonsyndromic unilateral complete cleft lip and palate treated during from 2001 to 2007. Findings were obtained at 1 to 5 years' follow-up. INTERVENTIONS Palatoplasty using the 2-flap technique plus intravelar veloplasty. Palate index was measured preoperatively with the patient under general anesthesia. MAIN OUTCOMES AND MEASURES Postoperative analysis via the χ2 test to assess the statistical significance of association between the palatal index and surgical outcomes. RESULTS Palatal fistula rates correlated directly with the cleft severity, as estimated by the palatal index (P = .01), but there was no association between postoperative velopharyngeal insufficiency and palatal index (P = .76). CONCLUSIONS AND RELEVANCE The palatal index was a good predictor of fistula development in the studied group. There was an association between the cleft severity and tissue deficiency (estimated using this index) and presence of palatal fistula. Further long-term study is needed to evaluate the relationship between the palatal index and maxillary growth.

Evaluación de la aplicación de una nueva metodología para la enseñanza aprendizaje del tratamiento quirúrgico de la fisura labial unilateral, para médicos residentes de Cirugía Plástica / An assessment of the use of a new method for teaching and the learning surgical management of unilateral cleft lip, in plastic surgery residents

Introducción: Uno de los principales problemas que enfrentan los médicos durante su capacitación como especialistas en áreas quirúrgicas, tales como cirugía plástica, es la falta de métodos apropiados que les permitan adquirir destrezas quirúrgicas necesarias para tratar las diferentes patologías relacionadas a su especialidad. Se busca sustentar la utilidad de una nueva metodología de enseñanza aprendizaje para generar capacidades en los Residentes de Cirugía plástica en el tratamiento quirúrgico de la fisura labial unilateral. Material y Métodos: El estudio fue de tipo descriptivo para el desarrollo de la metodología empleada y de tipo correlacional (quasi experimental) para la valoración de los resultados obtenidos con dicha metodología. El estudio se aplicó a residentes del tercer año de cirugía plástica de la Universidad Nacional Mayor de San Marcos y se realizó en niños con fisura labial unilateral completa atendidos en hospitales regionales del Ministerio de Salud entre los años 2010 y 2011. Resultados: En los pacientes operados no se observaron diferencias significativas entre el lado sano y el operado en los siguientes parámetros: altura labial, altura del bermellón y ancho labial. Se observaron diferencias significativas entre el lado sano y el operado en relación al ancho de la base nasal. Conclusión: El método empleado en este estudio es eficaz para la obtención de buenos resultados en el manejo quirúrgico de la fisura labio palatina con la técnica de doble rotación y avance superior, por parte de médicos residentes de tercer año de cirugía plástica.

Introduction: A common problem during medical training in surgical areas like plastic surgery, is the absence of proper methods to obtain the necessary surgical skills to address the different pathologies related to this field.The medical training is performed in educational hospitals in Lima, however the methods are limited to the observation or assistance and don't let to the doctor obtain adequate competences to repair surgically this pathology once they finish their training.Material and Methods: This is a descriptive study for the development of the used methodology and a co relational study to evaluate the results obtained with the methodology. This is a quasi experimental study. It is used to third year plastic surgery training surgeons from San Marcos University of Lima and has been done in children with complete unilateral cleft lip attended in Regional Hospitals from Ministry of Health between 2010 and 2011. Results:We haven't seen significant differences between the non-cleft side and cleft side in these parameters: lip height, lip width and vermilion height. We have seen significant differences between the non-cleft side and cleft side in relation with the nasal base width. Conclusions: This developed methodology to teach and learn the upper double rotational advancement technique used in this study is efficient to obtain good results in the surgical management of unilateral cleft lip with our technique by third year training residents in plastic surgery.

A comparative study to evaluate a simple method for the management of postoperative bleeding following palatoplasty.

Bleeding, is one of the most common postoperative complications after palatoplasty in patients with cleft palate. The purpose of this article is to present our experience using a Foley catheter balloon for perioperative palatoplasty bleeding management. A retrospective data analysis was performed for all cases of palatoplasty performed by the author from 1999 to 2012 that experienced postoperative hemorrhage. These patients were managed by utilizing posterior nasal compression with a Foley catheter balloon for the period 2006 to 2012. We have compared two methods (we use before 2006 the reoperative method) with regards to the later development of palatal fistulae and cases with reoperative hemostasis. The study found no statistically significant differences between the conventional and proposed method in relation to the development of palatal fistulae (P=0.7). These findings suggest that nasal packing using a Foley balloon is a safe and effective method for postoperative bleeding control after palatoplasty in patients with cleft palate.

Asymmetric bilateral cleft lip: classification and a surgical technique.

OBJECTIVE: The purpose of this study was to evaluate the symmetry in lip height after using our technique for bilateral cleft lip repair. A retrospective audit of 1 surgeon's outcome of 35 consecutively performed bilateral cleft lip repair with asymmetry between the right and left segments of the lip. Data were from the Outreach Surgical Center Program Lima Peru. METHODS: Since 2007, 158 patients with bilateral cleft lip were operated on using the Outreach Surgical Center Program Protocol. Of these patients, 35 (repaired using our technique) met the study criterion of having anthropometric measurements performed at least 1 year after surgery. Under general anesthesia, collection of lip height data (right and left sides) was performed immediately before the lip (before surgery) and palate (after surgery) surgery. Lip measurements were obtained using calipers. RESULTS: A 2-sample t-test with equal-variance analysis was performed to assess the statistical significance of differences between the right and left sides of the lip after surgery. This study found no statistically significant differences between the height of the right and left sides of the lip (P = 0.12) after lip repair using our technique. CONCLUSIONS: These findings suggest that this technique is a good alternative to repair asymmetric forms of bilateral cleft lip. The operative strategy for repair of an asymmetric bilateral cleft lip is determined by the degree of severity of the cleft.

Técnica quirúrgica para el tratamiento de fisuras labiales bilaterales asimétricas / Surgical techniquefor treating bilateral assymetric cleft lip

Introducción: La anatomía de la fisura labial bilateral es diferente para cada paciente y varios autores han descrito modificaciones de técnicas tradicionales en la búsqueda de obtener un diseño más individual con mejores resultados. Las técnicas de Millard y Mulliken son probablemente las técnicas quirúrgicas más usadas por los cirujanos alrededor del mundo en el manejo de la fisura labial bilateral, sin embargo existen algunas limitaciones en esta técnica en casos bilaterales con asimetría. En ese sentido, se ha diseñado la presente técnica que busca corregir la asimetría en la fisura bilateral. Esta técnica se basa en un doble avance y rotación lateral localizando las cicatrices sobre las líneas naturales del labio entre las unidades estéticas del mismo. Material y Métodos: Este es un estudio retrospectivo del tipo de serie de casos. Este artículo presenta una nueva técnica para el tratamiento quirúrgico de la fisura labial bilateral usada por el autor en 125 pacientes a manera de estudio retrospectivo descriptivo. Esta técnica está basada en el concepto de doble avance y rotación lateral permitiendo el alargamiento del segmento labial lateral más corto. Estas incisiones son ubicadas sobre las líneas naturales del labio, entre las subunidades estéticas del labio superior, en su mayoría. Se evaluaron los resultados obtenidos con esta técnica considerando el número de malos resultados observados a través del seguimiento de los pacientes en un plazo mayor a un año a través del examen físico directo y el análisis de las fotos postoperatorias estandarizadas.Resultados: Desde 2009 al 2011 esta técnica ha sido usada en 125 fisuras labiales bilaterales. Se obtuvo un buen resultado estético y funcional del labio superior y la nariz con esta técnica. Se observaron 15 / 125 (12 %) de malos resultados. Estas son cirugías que necesitaron revisión secundaria mayor. ...

lntroduction: The anatomy of bilateral cleft lip is different for each patient, and many authors have described modifications of the traditional repairing techniques in order to achieve more individualized designs and better results. The techniques described by Millard and Mulliken are probably the most commonly used all over the world for repairing bilateral cleft lip; however, there are some short-comings when trying to repair asymmetric forms of bilateral cleft lip. So, we designed this technique aiming to correct asymmetry in bilateral cleft lip. This technique is based on a double advancement and lateral rotation concept placing the scars over the naturallines between theesthetic subunits ofthe upper lip. Material and Methods: This is a retrospective and descriptive studybased on a case series. We present a new technique usedfor surgical repair of bilateral cleft lip in 125 patients. The technique is based in the double advancement and lateral rotation concept which allows lengthening of the shortest laterallip segmento Most of the incisions are performed on the natural lip landmarks, between the aesthetic subunits of the upper lip. Results were assessed considering the number offailures observed after following up patients for more than one year,performing physical examination and analyzing standardized postoperative pictures. Results: This technique has been used in 125 procedures for repairing cleft lip. We obtained good functional and esthetic outcomes for bothnose and lips using this technique. The rate ofpoor results was 15/125 (12%). These latter procedures had to undergo major secondary surgical revisions. Conclusions: We describe a new technique for surgical repair of asymmetric bilateral cleft lip. This technique led to the elongation of theshortest lateral labial segment, allowing us to achieve good esthetic and functional results on upper lip and nose reconstruction in cases of bilateral asymmetric cleft lip.

Upper double-rotation advancement method for unilateral cleft lip repair of severe forms: classification and surgical technique.

BACKGROUND: The purpose of this study was to evaluate the symmetry in lip height and lip width after double-rotation advancement unilateral cleft lip repair. STUDY DESIGN: This was a retrospective audit of 1 surgeon's outcome of 72 consecutively performed unilateral cleft lip with short lateral segment. Two hundred fifty patients with unilateral cleft lip were operated on using the upper double-rotation advancement technique since 2007. Of those patients, 72 met the study criterion of having anthropometric measurements performed at least 1 year postoperatively. DATA COLLECTION: Measurement of lip height, lip width, vermilion height, and alar base width was performed at the cleft and noncleft side under general anesthesia, immediately before the lip (preoperative) and palate (postoperative) surgery. The lip measurements were obtained using calipers. The matched-pair t-test analyses were performed when the assumptions required were met. When the normality assumption was not met, a nonparametric test was used, the Wilcoxon signed rank test, to assess the statistical significance of differences between the cleft side and the noncleft side. RESULTS: The study found no statistically significant differences between cleft-side and noncleft-side lip height (P = 0.058), lip width (P = 0.295), and vermilion height (P = 0.237) after lip repair. CONCLUSIONS: The findings suggest that the upper double-rotation and advancement technique is a good alternative to repair short lateral segment and severe forms of unilateral cleft lip.