Tratamiento de las fracturas subcondíleas y de cuello de cóndilo mandibular mediante abordaje intraoral endoscópicamente asistido / Treatment of subcondilar and condilar neck mandibular fractures by the intraoral endoscopically-assisted approach

INTRODUCCIÓN: El tratamiento de las fracturas de cóndilo sigue generando controversia, optándose en la mayoría de los casos por reducciones cerradas con tratamientos subóptimos. Presentamos nuestros resultados en 26 pacientes con fracturas subcondíleas o de cuello de cóndilo mandibular tratados mediante abordaje intraoral endoscópicamente asistido. MATERIAL Y MÉTODO: Seguimiento prospectivo observacional de 26 pacientes que fueron atendidos en nuestro Servicio de Cirugía Oral y Maxilofacial del Hospital Universitario Virgen del Mar de Cádiz, desde marzo de 2010 hasta enero de 2018. De estos 26 pacientes, 23 fueron hombres y 3 mujeres, con una edad media de 29 años. RESULTADOS: De los 26 casos operados, 6 fueron fracturas de cuello y 20 fueron fracturas subcondíleas. Todos los pacientes salieron de quirófano con la boca abierta, una oclusión estable y buena apertura oral. La complicación más importante fue una infección que se resolvió con antibioterapia. Discusión: Nuestro equipo ha seguido la filosofía de otros autores de abordar todas las fracturas de cóndilo, incluso aquellas con un desplazamiento menor de 10°, atendiendo a la premisa de que si no se bloquean otras fracturas no desplazadas mandibulares que previamente a la introducción de placas de osteosíntesis se bloqueaban, ¿por qué hemos de realizar esta práctica en las fracturas de cóndilo, con la consiguiente agresión a la articulación?. CONCLUSIÓN: La reducción abierta con abordaje intraoral asistido por endoscopia constituye una técnica segura, reproducible y eficaz en la mayor parte de las fracturas extracapsulares

INTRODUCTION: The treatment of condylar fractures continues to generate controversy, opting in most cases for closed reductions with suboptimal treatment. We present our results in 26 patients treated by endoscopically assisted intraoral approach as treatment for subcondylar and neck condyle fractures. MATERIAL AND METHOD: Prospective observational follow-up of 26 patients who were treated at our Oral and Maxillofacial Surgery Service at the Virgen del Mar University Hospital of Cádiz from March 2010 to January 2018. Of these 26 patients, 23 were men and 3 women, with an age average of 29 years. RESULTS: Of the 26 operated cases, 6 were neck fractures and 20 were subcondylar. All the patients came out of the operating room with their mouths open, a stable occlusion and good oral opening. The most important complication was an infection that resolved with antibiotic therapy. Discussion: Our team has followed the philosophy of other authors to address all condylar fractures, even those with a displacement of less than 10°, following the premise that, if other non-displaced mandibular fractures are not blocked prior to the introduction of osteosynthesis plates were blocked, why should we perform this practice in the fractures of condyle with the consequent aggression to the joint?. CONCLUSION: Open reduction with endoscopic assisted intraoral approach is a safe, reproducible and effective technique in most extracapsular fractures

Valoración de la oxidación proteica en pacientes con apneas del sueño / Evaluation of protein oxidation in patients with sleep apnea

Introducción: en el síndrome de apneas-hipopneas del sueño (SAHS) son frecuentes los episodios de hipoxemia-reoxigenación que pueden producir sustancias oxígeno reactivas y estrés oxidativo. Pacientes y método: estudio prospectivo, con muestreo consecutivo, para determinar si la hipoxemia nocturna puede provocar oxidación proteica. Fueron incluidos pacientes con sospecha de SAHS, indicación de una polisomnografía, edad comprendida entre 25 y 49 años, y ausencia de enfermedad sistémica. Se compararon los resultados observados en un grupo clínico (IAH > 10) con los de un grupo control (IAH < 5). Resultados: se excluyeron 3 pacientes por presentar un IAH entre 5 y 10. Fueron incluidos 36 sujetos (edad = 40 ± 6,1 años, 30 hombres y 6 mujeres, IMC = 31 ± 5,9), 23 pertenecientesínas carboniladas fueron de al grupo clínico y 13 al grupo control. En el grupo clínico, los valores de prote 0,14 ± 0,179 nmol/mg y de 0,10 ±0,066 nmol/mg en el grupo control (p = 0,348). No se observó correlación significativa entre las cifras de proteínas carboniladas y el índice de apneas-hipopneas (rho = 0,197; p = 0,249), índice de de saturación >3% (rho = 0,129, p = 0,452) y porcentaje de sueño con SaO2 <90% (rho = 0,058, p = 0,736). Conclusiones: en pacientes con edad media y SAHS moderado, las proteínas carboniladas séricas se observaron más elevadas, aunque sin alcanzar diferencias significativas (AU)

Introduction: episodes of hypoxemia-reoxigenation are frequent insleep apnea-hypopnea syndrome (SAHS) and can produce reactiveoxygen substances and oxidative stress.Patients and methods: prospective study, with consecutive sampling to determine if nocturnal hypoxemia can produce oxidation. Patients with SAHS suspicion, polysomnography indication, age between 25-49 years old and without systemic disease were included. Results obtained in clinical group (IAH > 10) were comparedwith control group (IAH < 5). Resul years old, 30 men and 6 women, BMI = 31 ± 5.9), 23 patients were from clinical group and 13 from control group. In clinical group, carbonylated proteins values were 0.14 ± 0.179 nmol/mg and 0.10 ± 0.066 nmol/mg incontrol group (p = 0.348). There was not significative correlation between carbonyl proteins and apnea-hypopnea index (rho = 0.197, p = 0.249), desaturation index >3% (rho = 0.129, p = 0.452) and sleep time spent with SaO2 <90% (rho = 0.058, p = 0.736). Conclusions: in patientes with mean age and moderate SAHS, protein carbonyls were higher althout not reaching significant differences (AU)

Poligrafía domiciliaria en pacientes con patología cardiovascular y sospecha de un SAHS / No disponible

OBJETIVOS: Validar la poligrafía domiciliaria en pacientes con comorbilidad vascular y sospecha de un síndrome de apneas hipopneas del sueño (SAHS) y determinar, en aquellos enfermos con cardiopatía isquémica, si el tratamiento con CPAP influye en el control de esta enfermedad. PACIENTES Y MÉTODOS: Fueron incluidos 42 enfermos (29 hombres y 13 mujeres, edad: 53 ± 7,8 años, IMC: 33 ± 5,2). Se les realizó poligrafía domiciliaria y polisomnografía convencional. Dieciséis pacientes con cardiopatía isquémica fueron evaluados tras el tratamiento con CPAP. El diagnóstico de SAHS se estableció ante un índice de apnea-hipopnea (IAH), en la polisomnografía> 5 y se indicó tratamiento con CPAP si el IAH fue > 15. RESULTADOS: Se observa una correlación y concordancia significativa (p < 0,01) entre la polisomnografía y poligrafía, en el IAH (36 ± 19,9 frente a 32 ± 17,4), r = 0,903 y CCI = 0,938, y en el índice de saturación (33 ± 23,5 frente a 35 ± 22,1), r = 0,896 y CCI = 0,948. Respecto a un IAH > 5 en la polisomnografía, la poligrafía obtiene un área bajo la curva ROC = 1 y para un IAH > 15el área bajo la curva ROC fue de 0,945. Tras el tratamiento con CPAP, los enfermos con cardiopatía isquémica acudieron menos frecuentemente al servicio de urgencias. CONCLUSIONES: La poligrafía domiciliaria es válida para el diagnóstico e indicación de tratamiento. En pacientes con cardiopatía isquémica, la CPAP mejora su control, descendiendo el número de consultas al servicio de urgencias (AU)

OOBJETIVES: To validate home poligraphy in patients with vascular comorbidity and suspicion of obstructive sleep apnea syndrome (OSAS), and to determine in patients with is chemicheart disease if treatment with CPAP influences in their control. PATIENTS AND METHODS: Forty-two patients were included (29 men and 13 women; Age: 53 ± 7.8 years; BMI: 33 ± 5.2)who were made home sleep study and conventional polysomnography. Sixteen patients with ischemic heart disease were evaluate dafter CPAP treatment. Diagnosis of OSAS was stablished when apnea-hypoapnea index (AHI) was > 5 in polysomnography and treatment with CPAP was indicated when AHI > 15. RESULTS: A significative correlation and concordance (p<0.01)were observed between the polysomnography and polygraphy in the AHI (36 ± 19.9 vs 32 ± 17.4), r = 0.903 and CCI = 0.938, and the desaturation index (33 ± 23.5 vs 35 ± 22.1), r = 0.896 and CCI = 0.948.When AHI >5 in polysomnography, the polygraphy obtained an are aunder the ROC curve = 1 and for IAH >15 the area under the ROC curve was 0.945. After CPAP treatment, patients with ischemic heart disease went less frequently to the hospital. CONCLUSIONS: Poligraphy is valid for diagnosis and treatment indication. Patients with ischemic heart disease, CPAP improves their control and reduces visits to the hospital (AU)

Trastornos del sueño en pacientes con hemodiálisis. Estudio polisomnográfico con grupo control / Sleep disfunctions in haemodialysis patients. Polysomnographic study with control group

Objetivos: Respecto a población sana, se evalúan los trastornos del sueño en enfermos con enfermedad renal crónica estadio 4-5 (ERC 4-5) y hemodiálisis. En estos últimos se estudia la prevalencia del síndrome de apneas-hipopneas del sueño (SAHS) y algún marcador analítico asociado independientemente al SAHS. Pacientes y Método: fueron estudiados 32 pacientes en hemodiálisis(24 hombres y 8 mujeres, edad: 54 ± 16, IMC: 25 ± 3.9), 14enfermos con ERC 4-5 y 14 sujetos sanos. Estos dos últimos grupos, pareados por edad, género e IMC con el grupo en hemodiálisis. Se les realizó una historia clínica y una polisomnografía diagnóstica, estableciéndose el diagnóstico de SAHS ante un índice deapnea-hipopnea (IAH) ? 10.Resultados: Respecto al grupo control sano, los pacientes con ERC 4-5 muestran peor calidad de sueño y un mayor IAH, aunque sin significación estadística, mientras el grupo en hemodiálisis presenta menos cantidad y peor calidad de sueño, un IAH significativamente elevado (4.3 ± 1.44 vs 19.1 ± 18.5, p:0.007) y un mayor número de descensos en la SaO2 (9.9 ± 5.15 vs 26.5 ± 17.81,p:0.011). Un 78% de los enfermos en hemodiálisis presentaban algún trastorno del sueño, destacando el SAHS (48%). La creatinina y el eKt/V se asociaron con el IAH (R2:0.219, p: 0.028).Conclusiones: El SAHS es frecuente en la IRC. Los pacientes en hemodiálisis muestran un elevado IAH y de hipoxia intermitente que deben evitarse en estos pacientes con mortalidad cardiovascular elevada. Únicamente las cifras de creatinina y eKt/ Vexplican parcialmente la variabilidad del IAH

Objetives: To evaluate the quality of the sleep and sleep disorders breathing in patients with chronic kidney disease stage 4-5(CKD4-5) and in hemodialysis respect healthy population. In addition, to study in these last ones, the prevalence of the obstructive sleep apnea-hypoapnea syndrome (SAHS) and the existence of some analytical marker associated to SAHS. Patients and methods: There were studied 32 patients with CKD in hemodialysis (24 men and 8 women, age of 54±16, BMI of25±3.9), 14 patients with CKD 4-5 and a group of 14 healthy subjects; these groups were matched for age, gender, and BMI with the hemodialysis group. All of them were studied with a clinical history and a overnight polisomnography. We stablished the diagnostic of SAHS when the apnea-hypoapnea index (AHI) ?10.Results: Patients with CKD 4-5 showed worse quality of sleep and more episodes of AHI respect healthy control group, although without statistic signification. The group in hemodialysis had less quantity and worse quality of sleep than the control group with an AHI significatly higher (4.3 ± 1.44 vs 19.1 ± 18.5, p:0.007) and more decreases of the SaO2 (9.9 ± 5.15 vs 26.5 ± 17.81, p:0.011).78% of the patients in hemodialysis suffered some sleep disorder, emphasizing the SAHS (48%). The serum creatinine and the eKt/ v were independently associated with the AHI (R2: 0.219, p: 0.028).Conclusions: The sleep disorder is a prevalent pathology in the CKD. Patients in hemodialysis show a elevated AHI and of intermittent hypoxia, that must be avoided in these patients with an elevated cardiovascular mortality. Only, the levels of creatinine and the eKt/v explain partially the variability of the AHI

Estenosis traqueal postintubación / No disponible

No disponible

Linfoma no Hodgkin de bajo grado estadio IV con afectación endobronquial / No disponible

No disponible

Poligrafía domiciliaria. ¿es una técnica válida para el diagnóstico del síndrome de apneas obstructivas del sueño? / Home polygrafhy. Is it a valid technique for the diagnosis of obstructive sleep apnoea syndrome?

FUNDAMENTO: En el síndrome de apnea obstructiva delsueño (SAOS), la poligrafía es una alternativa diagnóstica, aunqueson infrecuentes los estudios realizados en el domicilio del paciente.El objetivo de este estudio es comparar la validez diagnóstica de lapoligrafía domiciliaria respecto a la polisomnografía convencional,en pacientes con moderada y alta sospecha clínica de SAOS, ademásde valorar el grado de satisfacción.PACIENTES Y METODOS: En una muestra seleccionada, serealizó un estudio aleatorio y ciego analizando el grado de satisfaccióndel paciente mediante una escala visual analógica y la utilidadde la poligrafía domiciliaria frente a la polisomnografía estándarcomparando el IAH (índice de apnea-hipopnea) obtenido enambas pruebas.RESULTADOS: Se estudian 33 enfermos (25 hombres y 8mujeres), edad media (± DE) de 53,4 ± 11 años y un índice de masacorporal de 33 ± 5 kg/m2.Para un IAH ≥ 10 obtenido en la polisomnografía, la poligrafíapresenta una sensibilidad del 90,3%, una especificidad del 50%,un valor predictivo positivo del 96,5% y un valor predictivo negativodel 25%, encontrándose un área bajo la curva ROC de 0,863.En un SAOS grave (IAH >30) la poligrafía obtiene una sensibilidaddel 88,2% (72,9-100) y una especificidad del 100% con un áreabajo la curva ROC de 1.El IAH obtenido en la poligrafía comparado con el de la polisomnografía(33,70 ±22,38 y 36,36 ±22,09, respectivamente) muestrauna alta correlación con un valor de r:0,975 (p<0,0001) y unaelevada concordancia con un coeficiente de correlación intraclasede 0,968. La puntuación de la polisomnografía fue de 7,5 y de 9para la poligrafía, al expresar el grado de satisfacción los pacientes(p<0,0001).CONCLUSIONES: En una muestra seleccionada, la poligrafíadomiciliaria muestra una alta correlación y concordancia con lapolisomnografía, siendo una prueba válida para el diagnóstico conun mayor grado de satisfacción para el paciente

BACKGROUND: Polygraphy is an alternative diagnoses techniquein the sleep apnea syndrome (SAS), although is infrequent toperform the studies at patients home. This study aims to comparethe diagnoses validity of home polygraphy with conventional polysomnographyin patients with moderate and high clinical suspicionof SAS, as well as valorating the grade of satisfaction.PATIENTS AND METHODS: On a selected sample, a randomizedblinded study was performed analizing the degree of satisfactionof the patient by an analogic visual scale and the diagnosticvalidity of home polygraphy versus standard polysomnographycomparing the apnea hypopnea index (AHI) obtained from bothtests.RESULTS: Thirty four patients are studied (25 men and 8women), middle age (±SD) of 53,4± 11 years old and a body massindex of 33± 5 kg/m2.For an AHI ≥10 obtained after polysomnography, polygraphyrepresents a sensitivity of 90,3%, especificity of 50%, a positivepredictive value of 96,5% and a negative predictive value of 25%,finding an area under the ROC curve of 0,863. In a severe SAS(AHI≥30) polygraphy obtains a sensitivity of 88,2% (72,9-100) anda especificity of 100% with an area under the ROC curve of 1.AHI obtained after polygraphy compared with polysomnography(33,70±22,38 and 36,36±22,09 respectively) shows a highcorrelation with a value of r:0,975 (p<0,0001) and a high concordancewith a coefficient of correlation intraclass of 0,968. Scoreafter polysomnography was 7,5 and 9 after polygraphy, whenexpressing the patients satisfaction grade (p<0,0001).CONCLUSIONS: On a selected sample, home polygraphyshows a high correlation and concordance with polysomnography,being a valid technique for the diagnoses with a higher patientsatisfaction grade

[Endoscopic treatment of central airway stenosis: five years' experience]. / Cinco años de experiencia en el tratamiento endoscópico de las estenosis de la vía aérea principal.

OBJECTIVE: To describe our experience with interventional bronchoscopy in the treatment of central airway stenosis. PATIENTS AND METHODS: We reviewed patient records and bronchoscopic findings. Clinical data, findings from computed tomography, techniques performed, complications, and results were recorded. RESULTS: One-hundred and thirty-six patients (90 males and 46 females) were treated. The mean (SD) age was 57 (7) years (range, 3-81). A total of 320 therapeutic interventions were performed: 145 laser treatments, 33 balloon or mechanical dilatations, 26 electrocauterizations, and 116 stent insertions. Pathogenesis varied: in 64 (47%) patients, the stenosis was caused by a tumor (48 were bronchopulmonary and 16 nonpulmonary); in 72 (53%) patients, stenosis was secondary to a nontumor-related process, of which the most common was prolonged intubation (42% of these cases). Central airway patency was achieved in 92% (59/64) of the tumor-related stenoses and 96% (69/72) of those unrelated to tumors. Improvement in dyspnea was observed in 96% of all patients. Two deaths (due to hemoptysis and to acute myocardial infarction) occurred in the first week, for a 1.4% mortality rate. The most common complications were stent migration (8%; 9/116 cases) and the formation of granulomas (9%; 11/116). CONCLUSIONS: Interventional bronchoscopy is an effective technique to resolve life-threatening obstructions of the central airways. Dyspnea improves immediately and there is no significant morbidity or mortality.

Cinco años de experiencia en el tratamiento endoscópico de las estenosis de la vía aérea principal / Endoscopic treatment of central airway stenosis: five years' experience

Objetivo: Describir nuestra experiencia en estenosis de la vía aérea principal (VAP) tratadas mediante broncoscopia intervencionista. Pacientes y métodos: Se han revisado las historias clínicas e informes de broncoscopia y se han registrado los datos clínicos, informe de tomografía axial computarizada, técnicas realizadas, complicaciones y resultados. Resultados: Se trató a 136 pacientes (90 varones y 46 mujeres), con una edad media ± desviación estándar de 57 ± 7 años (rango: 3-81), en quienes se realizaron 320 procedimientos terapéuticos, que incluyeron 145 tratamientos con láser, 33 dilataciones con balón o mecánicas, 26 tratamientos mediante electrocauterio y la colocación de 116 prótesis. La etiología de la estenosis fue diversa: hubo 64 (47%) de causa tumoral (48 de origen broncopulmonar y 16 tumores extrapulmonares), mientras que en 72 pacientes (53%) la estenosis fue secundaria a una enfermedad no tumoral; de éstas, la causada por intubación prolongada fue la más frecuente (el 42% de los casos). La permeabilidad de la VAP se logró en el 92%(59/64) de las estenosis de etiología tumoral y en el 96% de las no tumorales (69/72), y se observó mejoría de la disnea en el 96% de todos los pacientes. En la primera semana hubo 2 fallecimientos (por hemoptisis e infarto agudo de miocardio), lo que representa una mortalidad del 1,4%. Las complicaciones más frecuentes fueron la migración de prótesis en un 8% (9/116) y en un 9% la formación de granulomas (11/116). Conclusiones: La broncoscopia intervencionista es una técnica eficaz para resolver las situaciones de riesgo vital de la VAP, con mejoría inmediata de la disnea y sin morbimortalidad significativa

Objective: To describe our experience with interventional bronchoscopy in the treatment of central airway stenosis. Patients and Methods: We reviewed patient records and bronchoscopic findings. Clinical data, findings from computed tomography, techniques performed, complications, and results were recorded. Results: One-hundred and thirty-six patients (90 males and 46 females) were treated. The mean (SD) age was 57 (7) years (range, 3-81). A total of 320 therapeutic interventions were performed: 145 laser treatments, 33 balloon or mechanical dilatations, 26 electrocauterizations, and 116 stent insertions. Pathogenesis varied: in 64 (47%) patients, the stenosis was caused by a tumor (48 were bronchopulmonary and 16 nonpulmonary); in 72 (53%) patients, stenosis was secondary to a nontumor-related process, of which the most common was prolonged intubation (42% of these cases). Central airway patency was achieved in 92% (59/64) of the tumor-related stenoses and 96% (69/72) of those unrelated to tumors. Improvement in dyspnea was observed in 96% of all patients. Two deaths (due to hemoptysis and to acute myocardial infarction) occurred in the first week, for a 1.4% mortality rate. The most common complications were stent migration (8%; 9/116 cases) and the formation of granulomas (9%; 11/116). Conclusions: Interventional bronchoscopy is an effective technique to resolve life-threatening obstructions of the central airways. Dyspnea improves immediately and there is no significant morbidity or mortality

Comparison of aceclofenac with piroxicam in the treatment of osteoarthritis.

A multicentre, double-blind, randomised, parallel group study was undertaken to investigate the efficacy and safety of aceclofenac (123 patients, 100 mg twice daily) in comparison to piroxicam (117 patients, 20 mg once daily and placebo once daily) in patients with osteoarthritis of the knee. The treatment period of two months was preceded by a washout period of one week duration. On completion of the study, patients in both aceclofenac and piroxicam-treated groups exhibited significant improvement in pain intensity and functional capacity of the affected knee, as represented by the Osteoarthritis Severity Index (OSI) (p < 0.0001 and p < 0.001 respectively). This was further substantiated following the patient's assessment of pain intensity using the Visual Analogue Scale (VAS), in which significant improvements were demonstrated at all time points for each treatment group (p < 0.001). Although both treatment groups showed a significant improvement in all investigator's clinical assessments (functional exploration of the knee, knee flexion and extension (EXT)), there were no significant differences between the groups. There was, however, a more rapid improvement in knee flexion in the aceclofenac group after 15 days of treatment. Both aceclofenac and piroxicam were well tolerated by patients, the most commonly reported adverse events being gastrointestinal, although their incidence was low. Only 24 patients on aceclofenac, as opposed to 33 on piroxicam complained of dyspepsia, epigastralgia and pyrosis. While 7 patients in each group were withdrawn because of adverse events, only one patient with piroxicam was withdrawn because of severe upper gastrointestinal bleeding. Twice as many reports of fecal blood loss were made in the piroxicam group in comparison to the aceclofenac group. In summary, this study confirms the therapeutic efficacy of aceclofenac and suggests that it is a well-tolerated alternative NSAID to piroxicam in the treatment of osteoarthritis.

Sheen's tip graft in primary rhinoplasty: critical analysis

In 1975, Sheen reported on a technique of nasal tip projection by means of a cartilaginous graft [1[. This technique, allied to some general principles in primary and secondary rhinoplasties presented in his book [2[, revolutionized the nasal surgery. Unfortunately, the execution of Sheen's technique of nasal tip grafting, as originaly described, is not easy nor is the procedure troublefree, and the fantastic esthetic results obtained by the author seem to be irreproducible for a less skilled surgeon. The authors of this article present their experience with Sheen's tip graft in primary rhinoplasty and analyze critically the procedure, stressing the necessity of correct selection of patients.

[Usefulness of bronchofiberscopy in the study of pleural effusion]. / Utilidad de la broncofibroscopia en el estudio del derrame pleural.

We revised our own experience in 208 patients with pleural effusion to whom fiberoptic bronchoscopy was made in part of the diagnostic study. In our population the most frequent cause was neoplastic origen, observing that in 97 patients (46%), 60 of them were due to bronchogenic carcinoma. In relation to the presentation symptoms, just when haemoptysis was present bronchoscopy exhibited bigger diagnostic profitability (17 of 29), p < 0.001. There were 106 patients (51%) who had some or several parenchymatic injuries going with the pleural effusion. In this group, in 55 cases, fiberoptic bronchoscopy was useful to the diagnosis; on the contrary when the only radiologic abnormality was pleural effusion, 102 cases, in 96 of them the procedure was not diagnostic, p < 0.001. A close relationship was noticed between diagnostic profitability of bronchoscopy with the existence of pulmonary neoplasm; about the 61 diagnosed patients using bronchoscopy, 53 of them had bronchogenic carcinoma, p < 0.001. We conclude then in our experience bronchoscopy is useful to the diagnosis of pleural effusion if it goes with haemoptysis or parenchymatic lesions in the radioly. Its diagnostic profitability has close relationship with the existence of bronchogenic carcinoma.

Orbicularis oris muscle: a double-breasted suture for its repair in the unilateral cleft lip.

The release of abnormal insertions of orbicularis oris muscle from the columella and ala base, and from their inferior attachments along the labial margin, provides muscle flaps for a double-breasted suture in cleft lip repair. Using the muscle flaps for double-breasted sutures realigns the orbicularis oris muscle fibers to achieve an anatomical and functional repair that is characterized by a symmetrical lip length, nostrils, philtral column, and philtral dimple. Double-breasted sutures also increase muscle thickness surrounding the lip and consequently provides better symmetry for the nostril floor.