Secondary alveolar bone grafting--five-year periodontal and radiographic evaluation in 100 consecutive cases.

A prospective study of secondary alveolar bone grafting based on the Norwegian (Oslo) team approach has been conducted by the CLP Unit at the Princess Margaret Hospital for Children in Perth, Australia, since 1982. The 5-year results of 100 consecutive cases of uni- and bilateral cases are presented according to periodontal and radiographic parameters of tooth support. The vast majority of cases grafted (98%) resulted in the eventual eruption of the cleft side cuspid/lateral incisor within acceptable parameters of tooth support. The results confirm the predictability of this safe procedure when utilized within a strict clinical protocol involving the whole CLP team.

Primary repair of the unilateral cleft lip nose: completion of a longitudinal study.

The first 10 consecutive unilateral cleft subjects operated on in 1975 by a technique of primary cleft nose correction, developed by the author (HKM), were reviewed at ages 10 and 18. No further nasal surgery had been performed on these cases. The anteroposterior and inferior facial appearances of each of the cases have been published for evaluation. A computer-based method of measuring nasal asymmetry was used to objectively analyze the results and compare them with normal and cleft control faces that were age matched. The results support the observation that nasal growth of the cleft side of the nose is unaffected by early primary nasal surgery and that the vertical shortening of the nose by the alar lift technique is preserved into adult life. Residual nostril asymmetry from septal deviation persists into adulthood.

Primary repair of the bilateral cleft lip nose: a 4-year review.

Four years ago, a new method of primary repair of the bilateral cleft lip nose was described. The splayed-out alar domes and columellar crura that lie within the nasal tip were exposed by an open-tip rhinoplasty. They were united to re-form the columella and narrow the nasal tip. This report is the first stage of a longitudinal study of the nasolabial growth and development of the first seven consecutive patients who were treated by this method at Princess Margaret Hospital. At 3 to 4 years of age, the columellae are well developed, and there appears to be no interference with growth. The external nasal scars create minimal disfigurement.

Osseointegrated titanium implants for the attachment of facial prostheses.

The ability to penetrate skin permanently with posts of pure titanium has led to a dramatic breakthrough in the attachment of facial prostheses. The posts are attached to screws of titanium that are completely integrated in the underlying bone, without any intervening soft tissue. This precise and rigid fixation permits rehabilitation of patients with complex defects that would be otherwise untreatable.

Nasal symmetry: a 10-year comparison between the Pigott and McComb nasal correction.

The objective assessment of the symmetry of the cleft lip nose has not been properly evaluated. A simple technique using enlarged photographs and area assessment is described. Two different techniques were assessed, the Pigott "alar leapfrog" technique and the McComb alar lift technique. The children were assessed at 10 years of age. The results show no differences in the linear measurements or when the symmetry is assessed in the frontal view. In the worm's eye view, the Pigott correction was shown to produce a more asymmetric nose when compared with the McComb technique. Both corrections produce significant asymmetry when compared with a control group.

Primary repair of the bilateral cleft lip nose: a 15-year review and a new treatment plan.

For 15 years a forked flap has been used for columella reconstruction in primary repair of the bilateral cleft lip nose. With the adolescent growth spurt, three unfavorable features have become apparent: (1) the columella may grow too long and the nostrils too large, (2) often the nasal tip remains broad, and (3) there is a drift of the columellar base and the lip-columellar angle is transgressed by scar. This procedure has therefore been discontinued. A new treatment plan is presented in which the columella is reconstructed from tissues in the splayed-out nasal tip.

Cleft lip and palate: new directions for research.

In this personal essay, presented as the keynote address at the inaugural meeting of the Australasian Cleft Palate Association, the author provides an overview of what many might call "the state-of-the-art." But beyond that, the author also plots direction to our efforts so our science can progress.

Primary correction of unilateral cleft lip nasal deformity: a 10-year review.

A 10-year follow-up of patients who underwent primary correction of their cleft lip nasal deformity is presented. These are the first 10 consecutive patients who were treated following a change in treatment plan in 1973. Primary correction of the cleft lip nasal deformity essentially consists in elevating the displaced alar cartilage at the time of lip repair. There has been no interference with nasal growth, and the position of the alar cartilages and nasal tip has been maintained.

The structure and function of the Burns Unit at the Royal Perth Hospital.

This article describes the design of the Burns Unit at the Royal Perth Hospital, and emphasizes the importance of flexibility, while at the same time providing opportunities for isolation and the control of infection. The manner in which the Unit functions is described with special reference to a modified hospital bed which facilitates bathing of the patient. Control of infection and early replacement of full thickness skin loss have been regarded as essential. The facilities and the treatment regime adopted have been shown to produce excellent results.

An overview of plastic surgery.

In addition to many technical refinements during the past decade, plastic surgery has made particular advances through the use of microsurgery, in the control of burn wound infection, by the use of implantable silicones, in the correction of craniofacial deformities and through the development of axial-pattern and other specialized flaps.

Treatment of the unilateral cleft lip nose.

Unilateral nasal shortening is an essential step in both the primary and the secondary treatment of the unilateral cleft lip nose. Procedures for this are described.