RESUMEN
Repair of cleft palate in the adult population is controversial. We present a case of a 66-year-old woman who underwent secondary cleft palate repair. The patient was born with a cleft palate and at age 15 years underwent palate repair that subsequently broke down. She had profound velopharyngeal incompetence, was difficult to understand in conversation, and had a long history of hearing issues requiring hearing aids. She underwent revision palatoplasty and insertion of bilateral grommets. Postoperatively she had marked improvement in her speech, hearing, and quality of life. This case demonstrates the utility of secondary repair of cleft palate in the adult population.
Asunto(s)
Fisura del Paladar , Insuficiencia Velofaríngea , Adolescente , Adulto , Anciano , Fisura del Paladar/diagnóstico por imagen , Fisura del Paladar/cirugía , Femenino , Humanos , Calidad de Vida , Estudios Retrospectivos , Habla , Resultado del Tratamiento , Insuficiencia Velofaríngea/diagnóstico por imagen , Insuficiencia Velofaríngea/cirugíaRESUMEN
The objective was to describe the use of a maxillary obturator supported by dental implants and ball abutments in an adult edentulous unilateral cleft patient. Adult edentulous cleft patients who have had no corrective surgeries or failed attempts at cleft repair in childhood suffer from oronasal communication resulting in hypernasal speech, dysphagia, and compromised masticatory ability. Tissue-supported obturator prostheses in such patients provide for compromised function due to instability and lack of retention. The treatment using fibromucosal-supported obturators is well established in the literature; few articles have also described osseointegrated implants supporting the prosthesis in adult cleft patients supported by bar attachments and magnets; however, reports of implant-supported maxillary obturators retained by ball/stud attachments are scarce. The implants provided retention and stability to the prosthesis, simplifying the laboratory procedure using ball abutments, improving swallowing, speech, and the patient's general quality of life. This article reports the rehabilitation of an adult cleft palate patient with a totally edentulous maxilla using an implant-retained prosthesis.
RESUMEN
OBJECTIVE: The purpose of this study was to investigate the differences in facial profile development between unoperated adult cleft palate (UACP) patients and normal controls and to analyse the reasons for the differences. MATERIALS AND METHODS: A total of 50 individuals with a unilateral cleft palate and 20 normal controls were selected to undergo angular measurement of their facial profiles. Data with significant differences between the two groups were analysed. RESULTS: Seven angle measurements of the facial profile showed that the mid-facial protrusion of the UACP patients had no significant differences from the control group (p > 0.05). But their angle of the medium face (N'-Trg-Sn) was significantly lower than the non-cleft controls (p < 0.05), suggesting a worse vertical development of the middle face. A significantly larger nasal tip angle (Cm-Sn/N'-Prn) for UACP patients suggested they had a rounder and blunter nasal tip (p < 0.05). The soft tissue facial angle and chin-lip angle of UACP patients had significant differences from non-cleft controls (p < 0.05), but the head position angle (Sn-Sm-THP) had no significant difference between two groups (p > 0.05), which suggested a steep mandibular plane for UACP patients but without severe retraction of the chin. CONCLUSION: The development of facial protrusions in UACP patients is similar to that in normal adults, but the vertical development in the middle face is insufficient. Such hypoplasia may be related to the intrinsic deficiency of the maxilla. There is a tendency for flat nasal growth and insufficient development of the chin in UACP patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Asunto(s)
Cefalometría/métodos , Fisura del Paladar/diagnóstico , Asimetría Facial/diagnóstico , Adulto , Estudios de Casos y Controles , China , Fisura del Paladar/cirugía , Cara/anatomía & histología , Asimetría Facial/etiología , Músculos Faciales/anatomía & histología , Femenino , Hospitales Universitarios , Humanos , Masculino , Nariz/anatomía & histología , Procedimientos Quirúrgicos Ortognáticos/efectos adversos , Procedimientos Quirúrgicos Ortognáticos/métodos , Selección de Paciente , Procedimientos de Cirugía Plástica/métodos , Valores de ReferenciaRESUMEN
Objective@#To assess the voice recoverment of pharynplasty given at the same time with the velopharyngeal closure surgery.@*Methods@#36 cases of cleft palate patients aged 18-32 years were divided into control group (18 cases) and experimental group (18 cases). Only cleft palate surgery was given in the control group, while pharyngoplasty combined with the palate closure surgery were given in the experimental group. Wound healing assessment were performed after 1 week , and voice improvement were compared in the 2 groups after 3 months.@*Results@#Well wound healings without any infections were achieved in all the cases, except for 1 case had a palate dehiscence 1 week after the operation. Dysarthria and nasal leak were improved significantly in the experiment group (P < 0.05), however the nasal resonance improvement between the 2 groups were not significantly different (P > 0.05).@*Conclusion@#Adult cleft palate surgery combined with the pharyngeal angioplasty is a recommended method.
RESUMEN
Introduction : The benefits or otherwise of late palate repair in older children or adults are uncertain. The outcomes, particularly without appropriate speech therapy, are often disappointing. The issue is of special importance in the poorer countries where these patients are most commonly seen and where limited capacity and facilities may have to be rationed. Method : A task force was set up to report back to the International Congress in Orlando in May 2013. The chairman and some members were nominated by the organizers and further members were added during the discussion process. Some of the members had considerable experience of late palate repair. The task force compiled a report after 9 months of e-mail correspondence. The report includes reports of some previously unpublished studies. A summary of the report was presented at Cleft 2013 in Orlando. Conclusions : There was a general consensus that late palate repair is of benefit for many patients and that, even if normal speech is not attained, outcomes are positive. Outcomes depend on the age of the patient (the younger the better), on the skill of the surgeon and, ideally, on the availability of appropriate speech therapy. A protocol for a prospective international multi-center study is proposed.