Interdisciplinary collaboration in cleft problems: surgeon-stomatologist.

During treatment of patients with clefts, reliable interdisciplinary collaboration of plastic surgeons and stomatologists-orthodontists is essential. The authors describe the principles and procedures of these disciplines that are linked and mutually interconnected. These have been elaborated on the basis of many years experience and have proven very satisfactory in the long-term care of patients.

Significant differences in the incidence of orofacial clefts in fifty-two Czech districts between 1983 and 1997.

Between 1983 and 1997 a total of 2029 children with CL/P (cleft lip, cleft lip and palate or cleft palate), who were born in the Bohemian districts of the Czech Republic and who underwent surgery and treatment at the Clinic of Plastic Surgery in Prague, were analysed. One possibility for decreasing the risk of delivery of a child with CL/P is to decrease or eliminate its prenatal exposure to embryotoxic factors. Detection of the embryotoxic factors acting at the individual level (e.g. elevated temperature, drug consumption, x-ray examination or infection) is easier than the detection of embryotoxic factors operating at the population level (e.g. water contamination, air pollution). When searching for the latter factors, we first have to reveal regional differences in CL/P incidence. The aim of the present paper was to determine significant differences in the mean incidence of newborns with CL/P in Bohemian districts during a 15 year period. The correlation between the incidence of CL/P and the birth rate in the different districts was also examined. The mean incidence of CL/P in all Bohemian districts was 1.86 per 1000 newborns (1.86/1000). Districts were divided into three groups, according to significant differences in the incidence of CL/P using a confidence interval. The lowest mean incidence of CL/P was detected in the Svitavy district (0.72/1000) and Louny (1.05/1000). The highest mean incidence was found in the Beroun district (2.86/1000). Besides Beroun, a high mean incidence of CL/P (more than 1.96/1000) was also found in Klatovy, Melník, Tábor, Kolín, Semily, Ceská Lípa, Pardubice, Teplice, Ceský Krumlov, Sokolov, Chomutov, Praha-západ, Jicín, Rakovník, Kladno, Prachatice, Rokycany, Tachov, Liberec, Pelhrimov. Paradoxically, the districts with a higher or lower birth rate exhibited a lower (1.62/1000) or higher (1.92/1000) incidence of CL/P, respectively. Future studies should elucidate whether the significant regional differences in the incidence of CL/P can be related to differing exposure of pregnant women to harmful environmental embryotoxic factors.

Influence of primary septal cartilage reposition on development of the nose in UCLP.

The preceding study (Smahel, 1987) showed that after the abolishment of osteoplasty and introduction of primary reposition of nasal septum base in the 1970's the nasal deviation and asymmetry of nasal wing length in patients with unilateral cleft lip and palate had been reduced. The present study shows that this reduction continues after the introduction of total septum reposition. The deviation of septal base (columella) from the median plane and asymmetry in nostril position is reduced as well. The surgeon's experience however is the decisive factor determining the final shape of the nose.

Care of patients with facial clefts at the Department of Plastic Surgery in Prague.

The multidisciplinary care of cleft defects in the Prague Department of Plastic Surgery has a long tradition. The authors describe the team care of patients including the timing of the surgery as well as the conservative therapy.