RESUMO
BACKGROUND AND PURPOSE: Mexican cleft surgeons provide multidisciplinary comprehensive cleft lip and palate care to children in Mexico. Many Mexican cleft surgeons have extensive experience with foreign, visiting surgeons. The purpose of this study was to characterize Mexican cleft surgeons' domestic and volunteer practice and to learn more about Mexican cleft surgeons' experience with visiting surgeons. METHODS: A cross-sectional validated e-mail survey tool was sent to Mexican cleft surgeons through 2 Mexican plastic surgery societies and the Asociación Mexicana de Labio y Paladar Hendido y Anomalías Craneofaciales, the national cleft palate society that includes plastic and maxillofacial surgeons who specialize in cleft surgery. We utilized validated survey methodology, including neutral fact-based questions and repeated e-mails to survey nonresponders to maximize validity of statistical data; response rate was 30.6% (n = 81). RESULTS: Mexican cleft surgeons performed, on average, 37.7 primary palate repairs per year with an overall complication rate of 2.5%; 34.6% (n = 28) of respondents had direct experience with patients operated on by visiting surgeons; 53.6% of these respondents performed corrective surgery because of complications from visiting surgeons. Respondents rated 48% of the functional outcomes of visiting surgeons as "acceptable," whereas 43% rated aesthetic outcomes of visiting surgeons as "poor"; 73.3% of respondents were never paid for the corrective surgeries they performed. Thirty-three percent of Mexican cleft surgeons believe that there is a role for educational collaboration with visiting surgeons. CONCLUSIONS: Mexican cleft surgeons have a high volume of primary cleft palate repairs in their domestic practice with good outcomes. Visiting surgeons may play an important role in Mexican cleft care through educational collaborations that complement the strengths of Mexican cleft surgeons.
Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Comparação Transcultural , Médicos Graduados Estrangeiros , Colaboração Intersetorial , Missões Médicas , Voluntários , Atitude do Pessoal de Saúde , Criança , Competência Clínica , Estética , Humanos , Comunicação Interdisciplinar , México , Complicações Pós-Operatórias/cirurgia , Reoperação , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Providing long-term multidisciplinary care for cleft lip/palate is a challenge for international humanitarian organizations that perform surgery across borders. The use of telemedicine as a means of evaluating speech in patients with cleft lip/palate has not been studied previously. We looked at determining whether a speech evaluation performed by a speech-language pathologist (SLP) using telemedicine would be equivalent to a speech evaluation performed in-person, in an international setting between Tijuana, Mexico and San Diego, CA. Spanish-speaking SLPs developed an informal protocol to evaluate several speech characteristics. Patients were simultaneously evaluated by 2 SLPs, one in-person in Tijuana and the other over telemedicine videoconference from San Diego, CA. In addition, we obtained data regarding the parents experience with telemedicine through a satisfaction survey. Results showed no statistically significant differences between the 2 methods of speech evaluation, particularly in oral muscle tone, resonance, lingual lateralization, oral pressure, and dentition. The satisfaction survey showed family satisfaction with the speech evaluation performed using telemedicine. Thus, telemedicine represents an effective medium for conducting speech assessment in patients with cleft lip/palate, allowing for increased access to care for underserved populations.
Assuntos
Fenda Labial/reabilitação , Fissura Palatina/reabilitação , Distúrbios da Fala/diagnóstico , Telemedicina/estatística & dados numéricos , Adolescente , California , Criança , Pré-Escolar , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estudos Transversais , Estudos de Viabilidade , Humanos , Masculino , Área Carente de Assistência Médica , México , Equipe de Assistência ao Paciente/organização & administração , Cuidados Pós-Operatórios , Controle de Qualidade , Distúrbios da Fala/reabilitação , Inteligibilidade da Fala , Fonoterapia/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Mandibular distraction is an effective treatment for mandibular hypoplasia. Special care must be done while performing the corticotomies to prevent injuries to blood vessels or nerves nearby. A rare iatrogenic severe injury occurred while performing this operation. REPORT OF PATIENT: A 3 year-old girl was operated upon to correct mandibular hypoplasia. A rotating saw was used to perform corticotomies in the mandibular angle. In the right side occurred acute bleeding and in the saw there was a piece of a blood vessel that was 15 mm long and 2 mm in diameter with an open lumen. Exploration of the neck revealed that the most distal segment of the internal carotid artery was severed, with a thrombus in the proximal end. The distal segment retracted into the temporal bone without bleeding. The proximal artery was ligated. After recovery she moved well. A computed tomogram was normal and further condition improved clinically. CONCLUSION: This complication from the use of a rotary saw has not been documented previously and it must be prevented by using some protection behind the bone.
Assuntos
Lesões das Artérias Carótidas/etiologia , Doença Iatrogênica , Mandíbula/cirurgia , Avanço Mandibular/efeitos adversos , Osteogênese por Distração/efeitos adversos , Trombose das Artérias Carótidas/etiologia , Artéria Carótida Interna , Pré-Escolar , Feminino , Humanos , Avanço Mandibular/instrumentação , Micrognatismo/cirurgiaRESUMO
Introducción. De los tumores pediátricos los hemangiomas son los más comunes y frecuentemente se localizan en las regiones de cabeza y cuello. Rara vez están asociados a síndrome dismórficos. En este reporte se presenta a una niña con un hemangioma y labio hendido bilateral; se revisan las teorías acerca de la embriogénesis del labio hendido y el posible origen de estos hallazgos clínicos. Caso clínico. Paciente del sexo femenino de 15 meses de edad con labio hendido complejo bilateral y un hemangioma localizado en el prolabio, en ambos segmentos laterales, nariz, mejilla y ceja superior izquierda; el paladar y el reborde alveolar estaban normales. La primera evidencia de la proliferación de la lesión apareció sobre el prolabio al poco tiempo del nacimiento. No se le apreciaban otras malformaciones. La extensión del tumor sobre la nariz mostró crecimiento a las 2 semanas de edad. A las 4 semanas, la lesión era evidente sobre los segmentos laterales del labio superior, mejilla izquierda, y ceja superior izquierda. Los estudios radiológicos, que incluían tomografía computada de cabeza y cuello, no mostraron evidencia de compromiso de huesos subyacentes o de otras estructuras vitales. El plan de tratamiento incluyó una reparación en línea recta de la hendidura bilateral y resección parcial del hemangioma. Se incluyen también los resultados postoperatorios. Conclusión. La correlación temprana de la fisura puede ser un tratamiento opcional en un niño que además de labio hendido tiene un hemangioma localizado, contrario a la reparación tardía acostumbrada