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Objective: To present a rare case of an isolated paramedian cleft of the lower lip. We describe the second case of isolated paramedian cleft of the lower lip. The pregnancy was realized in the fifth month prior to which the mother gives history of consumption of non-steroidal anti-inflammatory drugs (N.S.A.I.D.s) and a computed tomography (C.T.) scan. The cleft was repaired with a z-plasty for the mucosa and a z-plasty for the skin. We achieved good vermilion bulk, white roll continuity and functionality. We attributed this cleft to maternal exposure to NSAIDs and radiation during early pregnancy.

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OBJECTIVE: The Furlow palatoplasty is a proven procedure in the management of secondary velopharyngeal dysfunction in patients with cleft palate. But the selection of cases, the degree of clinical success, and the preoperative predictors of the same are less established. This study is an effort to retrospectively look at outcomes, in a large series of velopharyngeal dysfunction cases treated with the Furlow palatoplasty alone. DESIGN: Retrospective analysis of preoperative and postoperative speech and videofluoroscopic data. SETTING: Tertiary care center. PATIENTS/PARTICIPANTS: Ninety-two patients who were diagnosed with velopharyngeal dysfunction post primary cleft palate repair. INTERVENTIONS: Furlow palatoplasty for velopharyngeal dysfunction post primary cleft palate repair. MAIN OUTCOME MEASURES: Variables analyzed were perceptual speech parameters and, closure ratios obtained from lateral video-fluoroscopic images. RESULTS: Overall, 81.5% had postoperative improvements in their lateral video-fluoroscopic parameters, 63% improved their nasality scores, and 65.2% had improved speech intelligibility. A simple linear regression was done to predict the postoperative closure ratio. Preoperative closure ratio, hypernasality (moderate and severe), and audible nasal air emission are predictors for postoperative closure ratio. CONCLUSIONS: The Furlow palatoplasty alone led to complete resolution, or significant improvement of velopharyngeal dysfunction in a majority of patients, despite the cohort having a wide range of severity in terms of degree of dysfunction. The predictive formula will be validated in a further study.

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Fisura del Paladar , Insuficiencia Velofaríngea , Fisura del Paladar/complicaciones , Fisura del Paladar/cirugía , Humanos , Paladar Blando/cirugía , Estudios Retrospectivos , Inteligibilidad del Habla , Resultado del Tratamiento , Insuficiencia Velofaríngea/complicaciones , Insuficiencia Velofaríngea/cirugía

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BACKGROUND: The cleft lip-nose deformity in unilateral cleft lip and palate is one of the most challenging problem for surgeons to correct. Although nasoalveolar molding has been shown to be effective in improving presurgical symmetry in patients with complete unilateral cleft lip and palate, there is need for better evidence regarding the long-term nasolabial aesthetics of patients who have received this therapy. METHODS: Thirty-eight patients treated with nasoalveolar molding and 48 patients not treated with nasoalveolar molding (but otherwise treated similarly) with unilateral cleft lip and palate were studied to assess and compare the nasolabial aesthetics. The objective evaluation of the nasal symmetry was performed on the basal view of two-dimensional photographs and the subjective nasolabial aesthetic evaluation was performed using the Asher-McDade scale. RESULTS: At 5-year postoperative follow-up, nasoalveolar molding group patients had better mean values on the objective scores; however, these were not statically significant. The nasoalveolar molding group of patients had a statistically significant improvement in the subjective evaluation in comparison to the non-nasoalveolar molding-treated patients. The number of lip revisions was also statistically higher in the non-nasoalveolar molding-treated group of patients. CONCLUSIONS: In this retrospective, single-center study, the authors found that at 5-year postoperative follow-up, nasoalveolar molding-treated patients had improved nasolabial aesthetics and fewer revision operations. These are, however, preliminary results and the patients will be followed up until the end of growth to assess the longer term effects of nasoalveolar molding on the nasolabial aesthetics in unilateral cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Labio Leporino/cirugía , Fisura del Paladar/cirugía , Modelado Nasoalveolar/métodos , Preescolar , Labio Leporino/diagnóstico , Fisura del Paladar/diagnóstico , Estética , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Modelado Nasoalveolar/instrumentación , Obturadores Palatinos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento

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OBJECTIVE: To evaluate and compare early maxillary growth in 2 groups of patients with repaired bilateral cleft lip and palate (BCLP) who had and had not received nasoalveolar molding (NAM) therapy in infancy. HYPOTHESIS: Nasoalveolar molding does not have any effect on maxillomandibular growth at the early mixed dentition period. DESIGN: Retrospective study. PATIENTS: The study group consisted of forty-two 7-year-old patients with BCLP-20 in the NAM group and 22 in the no-NAM group. The control group consisted of nineteen 7-year-old noncleft, normal patients. INTERVENTIONS: Nasoalveolar molding was carried out prior to surgeries in those children who were brought in within 8 weeks of birth. Children brought in later were treated without a presurgical intervention. All patients were treated with a single-stage modified Millard cheiloplasty without gingivoperiosteoplasty. Palatoplasty was done by single-stage Bardach palatoplasty with muscle repositioning. MEAN OUTCOME MEASURES: Hard tissue and dental cephalometric values measured on lateral cephalograms, recorded at 7 years of age. RESULTS: A comparison of the mean sagittal values showed a statistically significant maxillomandibular retrusion and incisor retroclination of both BCLP groups in comparison to the control group. None of the cephalometric parameters varied statistically between NAM and no-NAM groups. The maxillomandibular relation, lower face height ratio, mandibular plane, and mandibular axis angles did not show statistically significant difference between all 3 groups. CONCLUSIONS: On the basis of this study, NAM does not have any effect on maxillomandibular growth at the early mixed dentition period.

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Dentición Mixta , Niño , Labio Leporino , Fisura del Paladar , Humanos , Lactante , Nariz , Estudios Retrospectivos

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CONTEXT: Presurgical nasoalveolar moulding (PNAM) is a non-surgical method of reshaping the cleft lip, alveolus, palate and the nose to minimize the severity of the cleft deformity, before primary cheiloplastyand palatoplasty. In this context, PNAM proves to be an invaluable asset in the management of unilateral cleft lip and palate. AIMS: The study was conducted to evaluate the efficacy of PNAM in the management of unilateral cleft lip and palate with the following objectives: (1) To assess and compare the degree of reduction in the size of cleft palate and alveolus (pre-PNAM and post-PNAM). (2) To evaluate and compare the improvement in columellar length and correction of columellar deviation (pre-PNAM and post-PNAM). (3) To assess the changes in the position of the alar base and the alar cartilages. SETTINGS AND DESIGN: Prospective study. SUBJECTS AND METHODS: A prospective study consisting of, which included 20 patients with complete unilateral cleft lip and palate was conducted. The age at the start of PNAM treatment of the infants ranged from 2 to 44 days of age reporting to our institute between December 2011 and August 2013. All the patients underwent PNAM therapy before primary cheiloplasty at 6 months of age; clinical parameters were assessed pre- and post-therapy using photographs and dental study models of the maxilla. STATISTICAL ANALYSIS USED: Student's t-test for paired comparisons. RESULTS: Results of the study showed a promising reduction in the cleft size before the surgery, significant improvement in nasal symmetry, including the columellar length on the cleft side. CONCLUSIONS: PNAM is a valuable adjunct to our surgical armamentarium in dealing with the challenges of primary closure of unilateral cleft lip and palate thereby enhancing the overall surgical outcome. The advantages of this method include the simplicity of the procedure and improving the quality of surgical repair, particularly in obtaining tension free muscle closure in unilateral clefts.