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   Table of Contents - Current issue
July-December 2020
Volume 7 | Issue 2
Page Nos. 69-134

Online since Friday, July 31, 2020

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Dr. H.S. Adenwalla: The man, the mission Highly accessed article p. 69
Puthucode V Narayanan
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Dr Jyotsna Murthy 1962-2020 Highly accessed article p. 71
Mukund R Thatte
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Management of cleft deformities in the times of COVID-19 Highly accessed article p. 73
Krishnamurthy Bonanthaya
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Outcome measures in cleft lip and palate: An Indian perspective Highly accessed article p. 75
Karoon Agrawal, Anshumali Misra
Outcome measurement is the definitive way to prove or disprove the usefulness of a procedure and its impact on a disease process. Cleft lip and palate is a disease with many facets and involvement of many subspecialties in its treatment. It is therefore necessary to have a comprehensive approach towards outcome measures for satisfactory treatment endpoint. Patient opinion even in case of children is very important and should actually form a very important component of overall outcome measures. Authors' experience in the Indian subcontinent shows that many children have been very happy with results that may be found wanting by some. In some cases that proved a boon for the child to grow in the world facing adversities. Authors' have proposed a simplified standard of points for outcome measures for uniformity of results.
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Width of cleft palate and postoperative palatal fistula – Do they really correlate? Highly accessed article p. 80
Rakesh Kumar Khazanchi, Hardeep Singh
Background: Palatal Fistula according to previous studies is directly proportional to width of the clefts. The fallacies with these studies were presence of multiple confounding factors such as multiple surgeons using different techniques of repair. Aim: This study attempted to assess the correlation between the actual width of cleft (W) and ratio of cleft width to sum of width of palatal shelves (R) with the incidence of palatal fistula done by single surgeon using same standardized repair thus eliminating bias due to multiple variables. Methods: This study includes consecutive cases of palatoplasty over 18 months. Bardachs 2 flap palatoplasty with radical Muscle dissection was performed. Palatal fistula was assessed at 3 weeks and at 2months. Results were analyzed with Wilcoxon signed rank test. Results: The values of W and R were analyzed in 45 patients. At 3 weeks 4 patients had fistula (8.9%) while at 2 months follow up only one patient (2.2%) had it. In patients without a fistula (n=41), the mean W was 1.22+0.31 cms SD (range 0.4 to 1.9cm) and R was 0.47+0.14 SD (range 0.15 to 0.83). In 4 patients with fistula at 3 weeks, the mean W was 1.28+0.39 cm SD (range 0.90 tp 1.8 cm) and R was 0.60+0.37 SD (range 0.35 to 1.13). This difference was not statistically significant (P value- 1.000 and 0.968 respectively). Conclusion: This study shows correlation between the width of the cleft or the width of palatal shelves have no significant influence on palatal fistula. The high incidence in previous studies may be related to surgical techniques.
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The effect of surgical correction on craniofacial growth in unilateral cleft lip and palate patients: A prospective study p. 84
Rohit Kulshrestha, Mohamed Abdul Wajid, Kamlesh Singh, Shailesh Shenava, Robin Mathew, Shradha Katpale, Amit Agarwal
Aim: The aim of this study was to evaluate the effects of surgical repair on craniofacial growth in patients with complete unilateral cleft lip and palate. Materials and Methods: Forty patients were taken and were divided into two groups: Group 1 consisted of 20 patients presenting with a nonsyndromic complete unilateral cleft lip and palate and Group 2 (control) consisted of 20 patients without any clefts. The lip closure was done by Millard's cleft lip repair technique. Palatal closure was performed by Bardach two-flap palatoplasty. Lateral cephalograms were traced and studied by the same operator. Composite cephalometric analysis was done to measure the various parameters of craniofacial growth. Results: Values of only lower facial height angle and nasion perpendicular to point A were found to be higher in patients with cleft lip and palate as compared to noncleft participants. The values of the rest of the variables were found to be higher in noncleft participants as compared to patients with cleft lip and palate. Differences were found to be statistically significant only for maxillary length (condylion–point A) (P = 0.027), mandibular length (condylion–gnathion) (P = 0.045), upper 1–point A (P = 0.001), lower 1–point A/pogonion (P = 0.039), and upper lip thickness (P = 0.001). Conclusions: Surgical repair of cleft lip and palate affects the growth of maxilla and mandible. There is a restraining effect on the basal part of the premaxilla, and it is influenced by cleft palate and lip repair.
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Cephalometric evaluation of skeletal base relationship in patients with cleft lip and palate in a tertiary hospital in South India p. 89
Meguja K Johnson, Maria John Kuriakose, N K Sapna Varma, VV Ajith, Pramod Subash
Objective: The study is aimed at assessing the cephalometric characteristics and distribution of skeletal base patterns in patients with cleft lip and palate (CLP) in a cohort of patients reporting to a tertiary hospital in South India. Materials and Methods: A retrospective observational study was carried out on 44 consecutive patients with CLP and 43 age- and sex-matched control orthodontic patients. Linear and angular measurements were obtained from the digitally traced lateral cephalograms using Dolphin software, and the data were analyzed. Results: Patients with CLP exhibit reduction in maxillary as well as mandibular length. Maxilla and mandible are both retropositioned and retrognathic. However, the maxillomandibular relationship shows the prevalence of Class I skeletal pattern (47.73%). Conclusion: Patients with CLP demonstrated smaller, retrognathic and retropositioned jaws, however with Class I skeletal relationship. The present data would be beneficial in determining the orthodontic requirements of patients with cleft in South India.
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Three-dimensional assessment of craniofacial parameters in subjects with cleft lip and palate: A cone-beam computed tomography study p. 99
Priyawati Moungkhom, Amit Nagar, Pradeep Tandon, Gulshan Kumar Singh, Alka Singh, Ranjit Kumar Patil, Veerendra Prasad
Objective: The objective of this study is to observe the differences in craniofacial parameters in subjects with cleft lip and palate and compare with normal subjects and also evaluate the association between chin deviation and asymmetry of face. Materials and Methods: Fifty cone-beam computed tomography (CBCT) scans (25 each) of the control group (Group I: normal) and study group (Group II: cleft lip and palate) subjects residing in Uttar Pradesh were obtained using care-stream CS 9300 3D system (care-stream Health, Inc. 2004). The digitizations and measurements were carried out in Dolphin Imaging software (Dolphin imaging version premium). All subjects were within the age group of 15.1–18.9 years. Asymmetry indices (AI%) of the parameters were calculated as proposed by Habets et al. Results: Mean ± standard deviation of the differences in the variables between noncleft side (right side) and the cleft side (left) among the study group showed significant differences for Nasal width (P < 0.001), Ramus length (P < 0.004); mandibular body length (P < 0.021), total mandibular body length (P < 0.023), gonial angle (P < 0.034), nasal height (P < 0.043), maxillary dental width (P < 0.039), and mandibular dental width (P < 0.01). The asymmetric index value was >3% threshold value for nasal width (5.08% ± 5.72%) and for nasal height (−4.80 ± 10.81%) in the study group. Conclusion: From the study, it was observed that asymmetry exists in the region of the defect that lies in the area of the contracture. Mandibular asymmetry has also been expressed with deviation of chin to the cleft side. The asymmetry index (AI%) values were >3% threshold value only in the region of the defect.
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A retrospective study of the epidemiological characteristics of patients with orofacial clefts: Craniofacial anomalies unit of the University Hospital of Maracaibo p. 108
Nicolás E Solano, Manuel Alejandro Linares, Jondalys López, Mariela Fox, Luis Sarmientos, Blanca Álvarez
Aims: The aim of this study was to describe the epidemiological characteristics of patients with orofacial clefts attended at the Craniofacial and Cleft Surgery Unit of the University Hospital of Maracaibo. Settings and Design: This was a retrospective, epidemiological, cross-sectional study. Subjects and Methods: The sample was constituted by clinical histories of patients with orofacial clefts attended in the Craniofacial Surgery and Clefts Unit of the University Hospital of Maracaibo from September 2015 to March 2018. Demographic data of the patient, family history, anatomical structures involved in the cleft and syndromic association. were collected, and analyzed in accordance with the type of research and the objectives set, a descriptive analysis of each variable was performed, represented by absolute and relative frequency. Results: There were 137 patients with cleft lip and/or palate in the unit, with an average age of 5.3 ± 9.8 years, evidencing an almost equitable distribution in relation to gender. Of the facial clefts, the most common was cleft palate (CP), followed by cleft lip and palate. A low incidence of the presence of craniofacial anomalies was observed in the family history and the syndromic association. Conclusions: It was observed that the prevalence of cleft lip and CP has increased in recent years; these epidemiological figures vary by region, age, and gender. However, a greater knowledge on the part of health professionals is necessary to understand the clinical and epidemiological aspects of orofacial cleft and is crucial to improve the understanding of pathogenesis, promote preventive strategies, and guide multidisciplinary clinical care.
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Partial facial hemihypertrophy: A case report and review of literature p. 114
Adity Bansal, Gosla Srinivas Reddy, Ashi Chug
Hypertrophy of the facial region is rare developmental malformation. The aim of this study is to report a case of partial facial hemihypertrophy describing its clinical features and debatable heterogeneity of etiologies, along with the review of literature to supplement to its current knowledge in English literature. PubMed search was done from 1986 to 2018, using the terms “Partial facial hemi-hypertrophy” or “Facial hemi-hypertrophy” or “Facial Gigantism” and 95 articles were identified. After manual reviewing and screening, 27 results were included in the analysis. Men are more commonly affected than women, with right side showing more involvement than the left side. Both hard and soft tissues are involved on the affected site. Reconstructive surgeries are usually planned after cessation of physiological growth. It includes orthognathic surgeries or osteotomies. Multiple soft tissue debulking procedures may be performed including excision of excess subcutaneous tissue and masticatory muscles, face-lift surgeries, lip reduction surgery, or parotidectomy. No malignant transformation has been reported in literature. The great variation of asymmetries caused by facial hemihypertrophies requires a combination and variety of sequential treatment procedures to gain adequate functional and cosmetic results. Hence, treatment of such malformation varies radically.
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Progressive facial deformity from childhood to adulthood in a patient of Parry-Romberg syndrome p. 121
Neeraj Yadav, Deepak Kumar Gupta, Ashok Utreja, Arun Kumar Garg
Parry-Romberg syndrome (PRS) is an uncommon degenerative craniofacial condition characterized by a slow, progressive, and unilateral atrophy of facial tissues, including muscles, cartilage, nerves, bones, and skin. This article reports a severe case of PRS in a 22-year-old adult female, exhibiting facial asymmetry, hypoplasia of the right side of the face, areas of skin hyper pigmentation, and oral changes involving the mandible and teeth in whom orthodontic intervention is being done.
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A novel approach in managing an arteriovenous malformation of head and neck region using sclerotherapy p. 125
B Sarat Ravi Kiran, Uday Kiran Uppada, Prabhat K Tiwari, Keerthi Rapolu
Arteriovenous malformations are unusual fast-flow lesions that arise as a result of dysplastic arterial and venous development, with the lack of a normal intervening capillary bed. Treatment options for small and peripheral vascular lesions are numerous in the form of conventional surgical excision, laser therapy, cryotherapy, selective embolization, and sclerotherapy. Less invasive medical treatment in the form of beta-blocker or steroid is also used. We report a patient who was diagnosed with arteriovenous malformation managed with a sclerosing agent in the form of sodium tetradecyl sulfate.
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The double coil molder: A modified presurgical nasoalveolar molding appliance for bilateral cleft correction p. 129
Farhan Nadeem Farooq, Amala Rita Jose, K Mithun, Nillan K Shetty
A cleft formation in infants is quite disturbing for the parents as it extremely affects the esthetics of the infant. Other than esthetics, it also disturbs the normal functioning of the infant. The reduction of this deformity in bilateral cleft patients is done by bringing the deviated premaxilla medially using a technique called presurgical nasoalveolar molding (PNAM) technique. The deviated premaxilla is mainly due to the growth of the nasal septum and the effect of its growth on the vomero-premaxillary suture. We present a case of bilateral cleft lip and palate which is treated by a double coil molder which is a modified PNAM appliance, followed by surgery of the lip and the palate. A follow-up inspection is done to check the outcome of the therapy on the long term.
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The effect of surgical correction on craniofacial growth in unilateral cleft lip and palate patients: A prospective study p. 133
Madhumitha Natarajan
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