Use of autologous platelet derivatives for secondary alveoloplasty in patients with cleft lip and palate: a systematic review and meta-analysis.

This study aimed to evaluate the effectiveness of autologous platelet derivatives (APD), specifically platelet-rich plasma (PRP) or platelet-rich fibrin (PRF), combined with autogenous iliac crest bone grafts in secondary alveoloplasty for patients with cleft lip and palate. Electronic databases, relevant journals, and reference lists of included studies were searched until July 2022. Best-evidence synthesis was performed to draw conclusions. After the search strategies, 12 randomized controlled trials were included that provided data on six outcomes: newly formed bone, mean bone loss in height and width, bone density, functionality, and postoperative complications. Two authors independently assessed the risk of bias, and the certainty of evidence was assessed using the GRADE approach. The pooled results suggest that there is uncertainty as to whether the combination of APDs with autogenous iliac crest bone grafts improves the percentage of newly formed bone, as the certainty of the evidence was assessed as very low. It may slightly improve the functionality of patients (with low certainty of the evidence) and probably slightly reduces the incidence of postoperative complications (with moderate certainty of evidence). Further randomized clinical trials with standardized methodologies are required to validate these findings.

Laparoscopically harvested omental flap for breast reconstruction in Poland syndrome.

BACKGROUND/PURPOSE: Poland syndrome (PS) is a congenital anomaly of the thoracic wall characterised by a variable degree of unilateral agenesis of pectoralis major and minor muscles associated with ipsilateral breast, rib and upper-arm anomalies. In female patients, breast reconstruction is particularly challenging because of cranial pectoralis muscle defects and partial or complete breast agenesis. Different techniques have been used to treat the thoracic anomaly, including the positioning of an implant, fat transfer or latissimus dorsi transposition, but in some cases these techniques are not feasible resulting in a poor reconstruction. METHODS: We present our experience in correction of the chest anomaly of PS in a teenage population by using a pedicled laparoscopically harvested omental flap (LOF) to cover a pectoral or breast prosthesis. Procedures were performed by a surgical team which included experienced plastic surgeons and general paediatric surgeons. Preoperative endocrinological and psychological evaluation helped to determine the best timing for the correction. RESULTS: The technique was adopted in 20 patients aged 14-18 years, affected by the syndrome. In all cases, it was possible to harvest an adequate amount of pedicled omentum laparoscopically. Neither significant complications nor conversions to open surgery occurred. The aesthetic outcome of the LOF technique was, in all cases, a soft, natural-looking breast and a satisfactorily corrected infraclavicular defect. CONCLUSIONS: The LOF technique is a valid alternative to reconstruction in selected PS cases. It provides a satisfactory reconstruction of the breast and pectoral region and corrects the infraclavicular defect by filling in the area. It avoids the invasiveness and morbidity of a latissimus dorsi transposition.

Distracción ósea en secuencia de Pierre Robin / Distraction osteogenesis at Pierre Robin Sequence

Los niños afectados de Secuencia de Pierre Robin a menudo presentan hipoplasia mandibular severa asociada que provoca obstrucción de la hipofaringe por retroposición de la base de la lengua dentro de la vía aérea faríngea posterior. Su manejo dependerá de la severidad de la obstrucción de la vía aérea. En la mayoría de ellos puede controlarse mediante colocación en decúbito prono hasta que el problema se resuelve en torno a los 3 a 6 meses de edad. En casos más severos, tendremos que recurrir a la monitorización de los niveles de saturación de oxígeno, a la intubación nasofaríngea temporal o a la colocación de un tubo endotraqueal. La traqueotomía resulta un método eficaz en aquellos casos más severos, pero las traqueotomías de larga permanencia conllevan una alta morbilidad y en ocasiones mortalidad. La distracción mandibular supone una nueva técnica para el alargamiento mandibular y una excelente alternativa de tratamiento para pacientes con Secuencia de Pierre Robin, con apnea obstructiva crítica secundaria a hipoplasia mandibular. La evaluación preoperatoria de estos pacientes debe considerar el examen clínico, estudios cefalométricos, TAC, fibrobroncospia, monitorización de los niveles de saturación de oxígenos y estudios polisomnográficos. El alargamiento mandibular se consigue en 3 a 4 semanas y va seguido de un período de consolidación ósea de entre 4 a 6 semanas dependiendo de la edad del paciente. La mejoría de la obstrucción aérea se controla mediante los registros polisomnográficos y las cefalometrías laterales. El alargamiento mandibular mediante distracción gradual representa un método satisfactorio para el tratamiento de pacientes jóvenes con hipoplasia mandibular severa que provoca apneas obstructivas críticas. El evitar la traqueotomía o la decanulación precoz en pacientes previamente traqueotomizados representa una gran ventaja en el tratamiento de pacientes afectados por la secuencia de Pierre Robin o por cualquier otra malformación congénita craneofacial con micrognatia severa (AU)

Distracción maxilar en pacientes fisurados con distractor externo / Maxilary distraction in cleft patients with external distractor

El presente artículo revisa el tratamiento de pacientes fisurados con hipoplasia maxilar severa mediante un distractor externo. Estos pacientes presentan múltiples problemas a resolver por el equipo médico, que incluyen déficit óseo, fisura residual y cicatrices; tradicionalmente debían esperar hasta alcanzar la maduración ósea para que se les pudiera practicar una cirugía ortognática clásica. Empleamos esta nueva alternativa de tratamiento a base de distracción maxilar mediante un distractor externo con un sistema parecido al sistema RED descrito por Polley y Figueroa en 1997. Hicimos algunas pequeñas modificaciones sobre el sistema y sobre los alambres de tracción. Su coste es mucho menor del regular. Presentamos una descripción de la técnica que incluye: fabricación del dispositivo intraoral, cirugía mediante osteotomía tipo Lefort I y emplazamiento del sistema de distracción rápida, a un ritmo de 1 mm. diario durante 3 semanas hasta que conseguimos las proporciones adecuadas. En ese momento se retira el halo cefálico y se continúa la distracción mediante una máscara externa durante 6 - 8 semanas. Las complicaciones fueron menores y correspondieron a insuficiencia velofaríngea o desplazamiento del halo. En todos nuestros pacientes conseguimos un avance horizontal del maxilar de 8 mm. de media con una relación normal entre el maxilar y la mandíbula. Este procedimiento puede ser aplicado a partir de los 5 años, es bien tolerado y requiere de una gran coordinación entre el cirujano y el ortodoncista (AU)

Distraction osteogenesis for obstructive apneas in patients with congenital craniofacial malformations.

Infants with congenital craniofacial malformations often have associated severe mandibular hypoplasia causing obstruction of the hypopharynx by retroposition of the base of the tongue into the posterior pharyngeal airway. Management depends on the severity of the airway obstruction. Most cases can be managed by prone positioning until the infant outgrows the problem at 3 to 6 months of age. In more critical cases, monitoring of oxygen saturation, temporary placement of a nasopharyngeal tube, and placement of an endotracheal tube will be useful procedures. Tracheotomy is an effective method for more severe cases, but longstanding tracheotomies result in high morbidity and occasional mortality. Mandibular distraction was performed in seven patients, ranging in age from 1 to 18 months, with critical obstructive apnea secondary to mandibular hypoplasia characterized by an apnea/hypopnea index greater than 20 apneas per hour and oxygen saturation below 80 percent. Two patients were tracheotomized previously. Mandibular lengthening, from 16 to 25 mm on the left side and from 10 to 22 mm on the right, was achieved in 21 to 25 days. Improvement of airway obstruction parameters was measured on polysomnograms and lateral cephalograms. Mandibular lengthening by gradual distraction is a successful method for young patients with severe mandibular hypoplasia causing critical obstructive apneas. Avoidance of tracheotomy or early decannulation in previously tracheotomized patients is a great advantage for patients with congenital craniofacial malformation.

Primary unilateral cleft nose correction: a 10-year follow-up.

Primary nasal correction at the time of rotation-advancement of the lip has been rendered practical by developing a symmetrical nasal platform by presurgical orthodontics and a gingivoperiosteoplasty. The nasal correction involves unilateral columella lengthening, alar cartilage positioning, and alar base cinching to present a nose within normal limits. This is accomplished before the age of recall, and by avoiding retention of the nasal deformity through childhood, it by-passes the ridicule that invariably accompanies it.