Anaesthesia for primary repair of cleft lip and cleft palate: a review of 244 procedures

The peri-operative course of 194 patients undergoing 244 procedures for primary repair of cleft lip and palate over an 8-year-period was studied. A marked increase in the extent of intra-operative monitoring was noted during this period. The Pierre Robin syndrome was the most common associated abnormality and was found in 17% of patients in this series. There were no deaths. A total of 101 procedures were undertaken in infants with cleft lip of whom 10% received an intra-operative blood transfusion. Post-operative opiate analgesics were administered following 97% of these procedures and profound respiratory depression was observed in three children. The use of lignocaine and noradrenaline did not significantly reduce the operative blood loss. A post-operative pyrexial illness was significantly associated with the presence of a positive pre-operative nasal and throat swab and this could be significantly reduced by pre-operative antibiotic treatment. A total of 143 children underwent repair of cleft palate and of these 16.8% received an operative blood transfusion. An elective tracheostomy was required in one patient because of unsuccessful attempts at endotracheal intubation. One patient developed a respiratory arrest after two doses of diamorphine peri-operatively. The use of lignocaine and noradrenaline significantly reduced the operative blood loss. The presence of a positive bacteriological nose or throat swab did not influence the development of a post-operative pyrexia which could however be significantly reduced by the use of pre-operative antibiotics.     

The abnormal anatomy of cleft lip and its correction

Summary The importance of the premaxillary position, size and shape in the development of the face and nose is discussed. The anthropological development of the premaxilla is studied. These factors are to be considered when cleft lip repairs are being planned and developed. Several cases are presented and discussed.     

Sialolipoma of the hard palate

Sialolipoma is a new variant of salivary gland lipoma, which was first proposed by Nagao et al. (Histopathology 2001; 38: 30) in 2001. We report this rare case of sialolipoma in the hard palate. A 60-year-old Japanese woman was referred to our department complaining of a painless swelling on the right side of the hard palate. Intra-oral examination revealed a soft, elastic, dome-shaped mass with 1 cm in diameter located in the posterior part of the hard palate. Magnetic resonance imaging examination revealed high intensity on T(1)-weighted image and isointensity on T(2)-weighted image. Incisional biopsy revealed that the tumor was encapsulated by fibrous tissue, consisted of adipose tissue, and also contained normal salivary gland tissue peripherally. First diagnosed as an ordinary lipoma of the hard palate, the tumor was excised. According to the recent criteria of histologic findings of sialolipoma, we rediagnosed the tumor as sialolipoma of the hard palate.     

Effects of N-acetyl-L-cysteine on Teratogenicity of Cadmium in Mice

ABSTRACT Embryotoxicity and teratogenicity of cadmium (Cd) and modulation of its effects by N-acetyl-L-cysteine (NAC) were evaluated in mice. Pregnant ICR mice were intraperitoneally injected with 3.5 mg/kg of CdCl₂ on day 10 or 11 of gestation (vaginal plug = day 0). Pregnant mice were pretreated with 160 mg/kg of NAC intravenously 2 hours before dosing with CdCl₂. Pregnant mice were killed on day 17 of gestation. Fetuses were examined for external malformations, especially limb malformations, cleft palate and abnormal palatal rugae. There was little difference in body weight gain of dams during the gestation period in the groups treated with NAC plus Cd as compared with the groups treated with Cd alone. Pretreatment with 160 mg/kg of NAC decreased the fetal mortality, incidence of cleft palate and abnormal palatal rugae induced by Cd on day 11. On day 10, pretreatment with NAC decreased the incidence of Cd induced abnormal palatal rugae. These results clearly indicate that NAC exerts protective effects against embryotoxicity and teratogenicity of Cd.     

牙槽裂植骨改善唇腭裂患者鼻底塌陷畸形

分析唇腭裂患者牙槽裂植骨与改善鼻底塌陷畸形的关系。方法：对同一术者所行牙槽裂植骨术的单侧唇腭裂患者48例进行临床研究，结合X线片及面部正侧位照片探讨植骨成功与否与鼻底塌陷畸形改善的关系。结果：植骨成功组的患侧鼻底塌陷畸形的改善较未成功组有明显差异，明显高于未成功组。结论：牙槽裂植骨成功后患侧鼻底塌陷畸形可以得到明显改善。     

唇腭裂患者手术后上颌骨发育的评价研究

目的　研究唇腭裂术后患者上颌骨发育特征及手术对发育造成的影响。方法　将 6 0例婴幼儿期手术的完全性唇腭裂患者作为研究对象 ,采用X线头影测量方法进行测量 ,拍摄标准侧位头影测量片 ,并选择 12个标志点及 12个测量项目 ,并与同年龄段正常患者的测量值进行比较分析。结果　单纯唇裂患者与正常对照组比较出现∠SNA [(76 .4± 3.0 6 )° ,P 0 .0 5 ]、N A Pg[(- 4 .8± 6 .31)mm ,P 0 .0 5 ]值变小 ;单纯腭裂及唇腭裂患者出现∠SNA[(74 .5± 4 .0 1)° ,P 0 .0 5 ;(75 .1± 1.0 7)°,P 0 .0 1]、N ANS[(47.3± 2 .4 1)mm ,P 0 .0 1;(49.8± 1.91)mm ,P 0 .0 1]等多项指标均小于正常对照 ,提示不同程度、不同表现形式的上颌骨发育受限。结论　唇腭裂患者术后上颌发育不足是先天及后天因素综合影响的结果。唇裂修复术是影响上颌前后向发育的重要因素之一 ,腭裂修复术是影响上颌骨高度及宽度发育的重要因素之一。     

双侧唇裂继发鼻畸形的矫正

目的通过对双侧唇裂继发鼻畸形进行细致的病理解剖学分析，制定出具体的治疗目标，探讨矫正的有效手术方法。方法以双侧唇裂继发鼻畸形的病理解剖学为基础，将手术程序分为鼻小柱及鼻尖整形、鼻翼软骨的整形、鼻底的整形3个连续的步骤。结果自2000年以来应用上述方法手术矫正36例，其中畸形严重的双侧完全性唇裂术后患者22例，占61．6％。所有病例术后伤口均Ⅰ期愈合，鼻外形明显改善，无感染及皮瓣坏死等并发症发生。术后随访10～24个月，平均17个月，满意率高达100％。结论双侧唇裂继发鼻畸形具有其特有的病理解剖学特征，以解剖学特征基础制定具体手术方案，确保了最终疗效的满意率。     

Secondary reconstruction of the short philtrum in the bilateral cleft deformity

Summary This technique for reconstruction of the short philtrum requires an understanding of the viscoelastic properties of the skin and how to use these to increase skin dimensions. This is combined with contouring and splinting with a subcutaneous cartilage graft. Three representative cases are presented to illustrate the method to achieve an aesthetically acceptable lip and its long-term follow-up. No complications have been encountered using this over a 15-year period. The technique can be combined with other secondary reconstructive procedures on the lip and palate. Work completed at: Providence Hospital, 16001 West Nine Mile Road, P.O. Box 2043, Southfield, Michigan 48037, USA     

A new method for the correction of secondary unilateral cleft lip nose

Summary In 1982, Dibbell described a procedure to correct this distortion by rotating and advancing the nostril medially and superiorly. We used this method in our department for several years, but as Dibbell himself experienced, we didn't always obtain satisfactory results. Like many authors, I agree that the best approach for proper correction of the secondary unilateral cleft lip nose deformity is the external approach using transcolumellar incisions, because the lower lateral cartilage exposure is inadequate with Dibbell's method. I added the transcolumellar incision similar to Bardach's to solve this problem. In this paper, this combination technique will be presented and contrasted with Dibbell's and Bardach's techniques.     

单侧唇裂功能性修复320例护理体会

目的:探讨单侧唇裂功能性修复的护理特点和方法。方法:对我院320例行单侧唇裂功能性修复患儿的护理行回顾性分析和总结。结果:患儿及家属能积极配合,患儿术后恢复良好,家属满意。结论:在常规护理的基础上,患儿特别是家属对疾病和手术方案的认识将对手术和护理效果产生重要影响。