Submucous Cleft Palate Repair: Furlow Double-Opposing Z-Palatoplasty

32-month-old male with Coffin Siris syndrome, bilateral middle ear effusions, and velopharyngeal insufficiency who presents with a submucous cleft palate.

Anteriorly-based Tongue Flap for Large Palatal Fistula

This video presents a case of a large hard palate fistula, which was repaired with an anterior tongue flap. The details of the procedure are described and demonstrated in detail, including both stages of the reconstruction, which were timed 3-4 weeks apart.

Repair of Tessier 7 Cleft Lip Deformity

The most common of the rare craniofacial clefts, Tessier’s No. 7 cleft is represented by a deficiency of tissue that may span from the oral commissure to the ear. (1)  The repair of the cleft of the lip must include especial attention to restoring continuity of the orbicularis oris muscle as well the vermillion.  This case is presented as an example of the repair of the Tessier 7 cleft lip deformity.

DOI #: http://dx.doi.org/10.17797/4h2edlts5zz

Bilateral Cleft Lip Repair

Contributors: Larry Hartzell

Repair of the bilateral cleft lip deformity can be challenging to the cleft and craniofacial surgeon.  The goals of an acceptable repair must include precise continuity of the cupid’s bow, maximizing philtral length, and establishing a mucosa lined sulcus.  We present an example of a repair of the bilateral incomplete lip as described by Millard.

DOI: http://dx.doi.org/10.17797/qefi9lqbam

Mandibular Distraction for Micrognathia in a Neonate

Introduction

Patients with Pierre-Robin Sequence (PRS) suffer from micrognathia, glossoptosis, and upper airway obstruction, which is sometimes associated with cleft palate and feeding issues.  To overcome these symptoms in our full-term male neonate patient with PRS, mandibular distraction osteogenesis was performed.

Methods

The patient was intubated after airway endoscopy.  A submandibular incision was carried down to the mandible. A distractor was modified to fit the osteotomy site that we marked, and its pin was pulled through an infrauricular incision.   Screws secured the plates and the osteotomy was performed.  The mandible was distracted 1.8 mm daily for twelve days.

Results

During distraction, the patient worked with speech therapy.  Eventually, he adequately fed orally.  He showed no further glossoptosis or obstruction after distraction was completed.

Conclusion

In our experience, mandibular distraction is a successful way to avoid a surgical airway and promote oral feeding in children with PRS and obstructive symptoms.

By: Ravi W Sun, BE

Surgeons:

Megan M Gaffey, MD

Adam B Johnson, MD, PhD

Larry D Hartzell, MD

Department of Otolaryngology – Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Arkansas Children’s Hospital, Little Rock, AR, USA

Recruited by: Gresham T Richter, MD

Primary Repair of Unilateral Complete Cleft Lip and Nose Deformities

The following video demonstrates the author’s method for repairing wide unilateral complete cleft lip and cleft nasal deformities.  Details of surgical markings as well as nuances of technique are demonstrated.  Video documentation of immediate results as well as progress of healing over the following year are included.

Pre-operative marking for the Fisher technique in unilateral cleft lip repair

This video outlines the steps taken for pre-operative markings that need to be made prior to performing unilateral cleft lip repair using the Fisher anatomic subunit approximation technique. The technique has been written about in detail by Dr. David Fisher in his article “Unilateral Cleft Lip Repair: An Anatomical Subunit Approximation Technique”. This video simply outlines the markings that are made prior to performing this technique, which are crucial for correctly carrying out the repair.

Incomplete Cleft Palate Repair: Von Langenbeck Converted to Two-flap Palatoplasty with Furlow Double Opposing Z-Plasty

Title:

Incomplete Cleft Palate Repair: Von Langenbeck Converted to Two-flap Palatoplasty with Furlow Double Opposing Z-Plasty

Authors:

Nima Vahidi, MD1; Nilan Vaghjiani, BS1; Rajanya Petersson, MS, MD1,2

1Virginia Commonwealth University School of Medicine, Richmond, VA

2Children Hospital of Richmond at VCU, Richmond, VA

Overview:

10-month-old male with 18q deletion syndrome, Pierre Robin sequence (cleft palate, glossoptosis, and micrognathia), eustachian tube dysfunction, cardiac disease including ASD, VSD and WPW, pulmonary hypertension, as well as tracheostomy and G-tube dependence.

In preoperative evaluation he was noted to have an incomplete cleft palate involving the hard and soft palate. He was noted to have bilateral eustachian tube dysfunction with effusions present. After discussion with family decision was made to proceed with surgical intervention.

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