ISSN:1049-2275    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1049-2275    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Rarely does the appearance of a child with a repaired bilateral cleft lip compare favorably with that of a child with a repaired unilateral cleft lip. However, there has been a major change in operative strategy during the past decade, and as a result, the typical bilateral cleft nasolabial stigmata are no longer so obvious. The senior author restates the principles for correction of bilateral cleft lip and nasal deformity, and underscores the essential role of preoperative premaxillary positioning. He reviews his method of single-stage closure of the cleft primary palate, including three-dimensional adjustments based on predicted four-dimensional changes. Operative modifications are described for variations of bilateral cleft lip. The authors emphasize the surgeon's obligation for periodic assessment. In a consecutive series of 50 patients with repaired bilateral complete cleft lip/palate, the revision-rate was 33% as compared with 12.5% if the secondary palate is intact. No revisions were necessary for philtral size or columellar length. The authors propose that nasolabial appearance and speech are the priorities in habilitation of the child with bilateral cleft lip/palate rather than the traditional emphasis on maxillary growth.

ISSN:1049-2275    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A single surgeon's 20 year experience in one cleft center with differential diagnosis for differential management of velopharyngeal dysfunction (VPD) is reviewed. The specific diagnostic and functional status of each affected individual is determined to select the method of VPD management. Two types of diagnostic evaluation of velopharyngeal function, perceptual and instrumental, are used to make that determination. There are four broad etiologic categories of VPD: anatomic deficiency, myoneural deficiency, anatomic and myoneural deficiency, and neither anatomical nor myoneural deficiency. The type of VPD management is specific for each etiologic category. The management options are between prosthetic appliances (lift, obturator, “liftorator”) and operations (intravelar veloplasty, velar Z-plasty, pharyngeal flap, sphincter pharyngoplasty, posterior pharyngeal wall augmentation). The objective of differential management based on differential diagnosis is to optimize the function of the velopharynx for speech tasks while minimizing the morbidity of the intervention on the upper airway. A personal experience, in the context of an interdisciplinary cleft team, with such an approach over the past 20 years validates the assumption that differential management of VPD based on differential diagnosis can achieve this goal.

ISSN:1049-2275    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1049-2275    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Attachment of a posterior pharyngeal flap is commonly performed for the surgical management of velopharyngeal insufficiency. Obstructive sleep apnea has been found to occur in as many as 38% of patients undergoing posterior pharyngeal flap attachment. Often, this is temporary in the early postoperative period. When it occurs later after surgery, however, it can require active treatment. Many patients improve with the use of nighttime nasal C-PAP. Those patients who do not improve sufficiently with nasal C-PAP may require surgical flap division. We report surgical flap division in 12 such patients. All patients had preoperative and postoperative perceptual speech evaluations, and most had preoperative and postoperative pressure flow studies. In 11 of the 12 patients who underwent surgical flap division, velopharyngeal function did not deteriorate. We hypothesized that the persistence of the speech improvement in those patients is either secondary to the bulk of tissue from the flap, which remains in the posterior pharyngeal wall and provides a pad to assist with velopharyngeal closure, or is secondary to the speech mechanisms that the patients learned with the flap in place and were able to continue even after flap division.

ISSN:1049-2275    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Patients born with severe dysmorphology involving the ears usually have hearing derangements as well as other areas of the craniofacial skeleton affected. To correct the functional problem, the usual and customary treatment is augmentation of the hearing with a bone conducting hearing device. The patients have to wear these devices with an external band. The new advances in osseointegrated implant allowed us today to utilize the same technology in the patient with the application of a bone anchored hearing device. The advantages are related to the obviation of the need to use a hearing band across the head, that most children object to, and the new device is much smaller than the large and cumbersome banded device. There is also an added advantage in the improvement of the hearing as the units are anchored internally in the bone. The device utilizes digital technology and can be calibrated easily. The patient can apply the device in the morning by a simple application click. The disadvantage to the patient is that the area requires consistent maintenance and care, however, this operation can be done very easily. A sleeper osseointegrated unit is kept as a spare that can be utilized if any osseo-integrated functional problem appears. The functional changes in the hearing and the audiological improvements are well documented.

ISSN:1049-2275    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Prominent ear deformity is the most common abnormality of the external ear. Over two hundred different techniques have been described to correct this deformity. Many of these techniques have proven successful in their ability to achieve high patient satisfaction despite the significant variations in these techniques. From this perspective otoplasty is a privileged procedure allowing the surgeon great latitude in his approach and ability to achieve patient satisfaction. Despite high patient satisfaction, each technique has inherent strengths and weaknesses. The art of otoplasty is in the ability to realize the strengths and weaknesses of a cadre of procedures so as to maximize benefit and minimize complication.Analysis and correction of prominent ears should be approached in a rational, step-wise fashion. The external ear is an infinitely complex structure with great variation between individuals and between the two sides of the same individual. Appropriate evaluation is essential to the application of the appropriate corrective technique. Our approach to otoplasty includes a careful evaluation and description of the deformity in the context of normative standards and the goal of symmetry. When the patient is judged to be sufficiently mature we proceed with an algorithmic application of cartilage-sparing techniques suited to the specific deformity. In this approach, correction of the prominent ear can go beyond patient satisfaction, maximizing outcome in form and symmetry.

ISSN:1049-2275    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A broad range of therapeutics is currently available for the treatment of keloids, but none have been shown to be completely effective in flattening existing keloids, reducing associated symptoms or preventing recurrence. Therefore, newer treatments not routinely used for keloids have been examined more recently, including laser therapy, intralesional interferon and imiquimod, which have had variable success as therapies for keloids. This article briefly reviews such experimental data and presents recommendations for management of keloids as well.

ISSN:1049-2275    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The incidence of basal cell carcinoma and the need for prophylactic excision in children with nevus sebaceus of Jadassohn have been a topic of controversy. The authors performed a retrospective analysis of 757 cases from 1996 to 2002 in children aged 16 years or younger. No cases of basal cell cancer were found in the nevus sebaceus group. Recent studies in children corroborate these findings and question the need for prophylactic surgical removal of the nevus sebaceus.

ISSN:1049-2275    

出版商:OVID    

年代:2003

数据来源: OVID