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   Table of Contents - Current issue
July-December 2021
Volume 8 | Issue 2
Page Nos. 85-168

Online since Monday, June 7, 2021

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The war on another shore Highly accessed article p. 85
Divya Narain Upadhyaya
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Development of craniofacial surgery at postgraduate department of plastic surgery, King George's medical university, lucknow p. 87
Arun Kumar Singh, Harsha Vardhan
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In memory and tribute to Kenneth E. Salyer MD: 1936-2020. A great surgeon with a passion for excellence Highly accessed article p. 91
Akira Yamada
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Kenneth Salyer 1936–2020: The legendary craniofacial surgeon p. 96
Rajiv Agarwal, Devisha Agarwal
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Building an ecosystem of safe surgery and anesthesia through cleft care p. 98
Susannah Schaefer, Erin Stieber
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Cleft lip and palate: Relationship between phonological awareness and audiological characteristics in children Highly accessed article p. 103
Mônica Elisabeth Simons Guerra, Vanessa Magosso Franchi, Beatriz Cavalcanti Albuquerque Caiuby Novaes, Mariana Lopes Favero, Sulene Pirana
Context: Cleft lip and palate (CLP) stands out due to its esthetic-functional impact and its high incidence. Phonological awareness involves skills related to the structure of language, and children with CLP may experience impairment in these skills due to auditory impairment resulting from otitis media and fluctuating hearing loss. Aim: The aim of this study was to correlate phonological awareness with audiological characteristics in children with CLP. Materials and Methods: Thirty children, 13 (43%) with cleft palate (CP) and 17 (57%) with CLP from 6 to 9 years old, were evaluated at a specialized center in Brazil to determine their phonological awareness skills and were classified into low, medium, and high skills categories. Phonological awareness was related to the speech reception threshold (SRT) at two time points: at 3 years old and at the time of data collection. Results: The study population was homogeneous in terms of age, sex, and socioeconomic status. In terms of phonological awareness skills, 8 children (26.7%) were classified as having low skills, 9 (30%) were classified as medium, and 13 (43.3%) were classified as high. Low phonological awareness skills were associated with worse mean SRT at 3 years old (mean = 34.4 dB, standard deviation [SD] = 11.2, P = 0.046) and at the time of data collection (mean = 22.2 dB, SD = 17.2). Conclusion: The association of phonological awareness with SRT suggests that prolonged or transient hearing loss can lead to changes in phonological skills and auditory processing.
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Influence of native language on Nasalance values in Kannada and Malayalam speakers p. 111
KS Girish, M Pushpavathi, HV Satish
Introduction: Nasalance values vary across languages. Therefore, establishing separate normative values of nasalance for each language and studying their influence on each other becomes important for the assessment and management of persons with resonance disorders. So the present study aimed at comparing the nasalance values of vowels, unvoiced syllables, and voiced syllables between native Kannada speakers and native Malayalam speakers. The present study also compared the nasalance values of meaningful words, oral sentences, and nasal sentences (for both English and Kannada languages) between native Kannada speakers and native Malayalam speakers. Materials and Methods: Twelve native Kannada speakers and 12 native Malayalam speakers (age range – 18–23 years) served as participants. The test stimuli included a standardized set of meaningful words, oral sentences, and nasal sentences in both English and Kannada, vowels, unvoiced syllables, and voiced syllables. The data were recorded and the values were obtained from the Nasometer. Results: The results revealed a higher nasalance value for Malayalam speakers (/a/-29,i/-45.41,u/-19.50, unvoiced syllables-16.96, voiced syllables-21.63, words-22.71, oral sentences-21.40, and nasal sentences-60.15) than for Kannada speakers (/a/-14.90,i/-32.60,u/-10.50, unvoiced syllables-11.59, voiced syllables-16.99, words-15.83, oral sentences-13.62, and nasal sentences-56.18) across all the stimuli considered. However, a statistically significant difference was found only on vowels. Conclusions: The present study indicated that in bilingual or trilingual speakers, there is an effect of native language on the Nasalance Values of second and/or third language.
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Ease, harvesting, and accuracy of cancellous versus corticocancellous bone graft materials used in cleft alveolar bone grafting: A randomized controlled trial p. 119
Abhay Datarkar, Bhavana Valvi, Suraj Parmar
Aim: The aim of this study was to compare and evaluate the difference between cancellous and corticocancellous bone graft harvested from the anterior iliac crest in the management of unilateral complete cleft alveolus patients. Materials and Methods: A total of 20 patients of unilateral complete cleft alveolus with age ranging from 7 to 15 years were enrolled. Patients were divided into two groups. Group I comprises 10 patients treated with cancellous bone graft and Group II consists of 10 patients treated with corticocancellous bone graft. Trapdoor technique for cancellous and enblock removal for corticocancellous bone graft was done. Both the grafts were evaluated for ease of harvesting and handling and ease, adequacy, and accuracy of graft filling. Results: Harvesting and graft handling was easy in Group I patients, whereas in patients of Group II, it was moderate. In Group I, ease of graft filling was adequate in 90% of patients and acceptable in 10% of patients. In Group II, ease of graft filling was acceptable in 100% of patients. In Group I, the mean time required for bone harvesting was 9.28 ± 2.97 min, whereas in Group II, it was 15.00 ± 1.98 min. Accuracy of graft filling was adequate in both the groups, and no statically significant difference was found between both the groups in terms of accuracy of graft filling. Conclusion: Corticocancellous bone graft is equally good as cancellous bone graft and it can be used successfully as a substitute for cancellous bone graft.
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Impact of cleft lip and palate before and after treatment in a low-income population p. 127
Anthony Markus, Srinivas Gosla Reddy, Rajgopal R Reddy, Monal Karkar
Background: Individuals with cleft lip and palate (CLP) and other craniofacial deformities are often perceived negatively in various social circumstances, resulting in failure to achieve full socio economic potential. Aim of the study: This study aimed to identify social stigmata and their causes associated with CLP and other deformities in an Indian population from a low socio-economic background, ways to reduce such effects and the potential reduction of disability following surgery. Methods: To assess the general awareness of the patients and their families regarding clefts, A GSR Institute: Cleft-Awareness Questionnaire (Reddy SG et al 2018) was used for data collection. 100 consecutive patients treated in GSR Institute for Craniofacial and Facial Plastic Surgery in Hyderabad, Telangana, were invited to join the study Statistical analysis regarding consanguineous marriage, understanding of clefts by parents and members of their community and of their societal conditions and the impact before and after surgery was carried out. Results: Statistical analysis using chi-squared test regarding the frequency of consanguineous marriage revealed no significant difference between the expected and observed frequencies in Telangana whereas there was a significant difference (p<0.001) between the values in India and also for understanding of clefts by parents (p<0.001) and friends/neighbours (p<0.001). On Kruskall-Wallis test and Pearson Chi-Squared Goodness of Fit test, no significance was observed on social conditions and associated problems faced by child before and after surgery respectively. Conclusion: These results confirm the impact of social stigmata in an Indian population with CLP and other craniofacial deformities predominantly related to the lack of education due to low socio-economic background and a heightened sense of superstitions of family, friends/neighbours of the affected individual thereby, causing embarrassment and depression. However, these were alleviated by surgical intervention and adequate speech therapy, thereby, improving social acceptance.
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A cross-sectional study on epidemiology and clinical profile of cleft lip and palate at a tertiary care hospital in Manipur, India p. 134
Indranil Dutta, Nilamani Sharma Guruaribam, Palin Khundongbam
Background: Cleft lip (CL) and palate have a complex etiology with both genetics and environment playing a role. The risk factors such as folic acid deficiency, maternal age, and maternal smoking have been linked to the development of clefts. Objectives: The objective of this study is to study the different types of CL and palate with respect to age distribution, gender, caste, religion, socioeconomic status, and the clinical factors such as congenital anomalies, blood group, and the relationship with maternal addiction during pregnancy. Materials and Methods: The present study conducted among 260 patients of Manipur with primary CL, palate, and orofacial clefts of any age group. Statistical analysis of the data was performed by the descriptive statistics as mean, standard deviation, percentage/proportions, etc. For the qualitative data, the association between various variables was done by applying one-way Chi-square test at 5% (P = 0.05) level of significance. Results: Female (51.2%) children are more affected with CL and palate. Association of A +ve blood group is statistically significant. 36.2% belongs to lower middle class socioeconomic status. The proportion of consanguineous marriages was higher. 60% of mothers smoke cigarettes or consume tobacco at the time of pregnancy in association with CL and palate. Majority of the cases had left-sided CL and palate and 47.3% were Group III CL and palate. There was significant association of congenital anomalies (38.5%) among CL and palate patients. Conclusion: There is a strong association of maternal smoking or tobacco consumption, maternal alcohol consumption, consanguineous marriages, and A +ve blood group in relation to CL and palate.
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The use of hyaluronic acid in individuals with cleft lip and palate: Literature review p. 143
Kelly Fernanda Molena, Lidiane de Castro Pinto, Gisele da Silva Dalben
Since the Resolution 198/2019 of Brazilian Dental Council, which regulates orofacial harmonization as a dental specialty, and the advent of various uses of facial fillers, such as hyaluronic acid (HA), it is possible to perform both esthetic and functional corrections in individuals. Individuals with cleft lip and palate (CLP) present lip irregularities even after orofacial rehabilitation with an interdisciplinary team with several corrective surgeries, interfering with the esthetics, which can cause problems in self-esteem and social insertion. Thus, facial filling is an innovation that, together with dentistry, contributes to the individual's esthetics and well-being. Considering the patient safety and health, more research is progressively being conducted to make such procedures less invasive. This work conducted a literature review on the use of HA as a facial filler to correct lip scars in patients with CLP. By a literature and transverse search in Scientific Electronic Library Online and PubMed databases using specific descriptors, the studies that met the inclusion criteria were selected, from 1990 to 2020. It can be concluded that the use of HA as a facial filling material in the correction of lip scars from reparative surgeries related to CLP has been shown to be effective both for correction of facial asymmetry and to improve the quality of life of patients who used the procedure.
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Cleft lip and palate with diabetes insipidus: Perioperative management p. 149
Deepak Bhaskaran, T M Sheeja Rajan
Nasal desmopressin spray is used for the management of diabetes insipidus (DI). Difficulties arise during the perioperative period of cleft repair for the management of DI with nasal desmopressin due to decreased nasal absorption and reduced oral intake. Key to successful peri-operative management is strict monitoring of serum electrolytes, serum and urine osmolality, and fluid administration titrating to urine output. Oral and intravenous desmopressin needs to be used in the perioperative period for managing the condition.
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Nasolabial island flap for management of post osteo-odonto-keratoprosthesis oroantral fistula p. 151
Nikhil Panse, Aditya Narsimhan, Prasad Dadhe
Osteo-odonto-keratoprosthesis (OOKP) is a procedure that is beneficial to patients with end-stage ocular disease, which is not amenable to corneal transplantation. It involves the harvest of tooth lamina and implantation of lamina cortex into the eye. The oroantral fistula (OAF) is one of the most disastrous complications of this procedure. The complication of an OAF during the harvest of a molar for an OOKP procedure can be prevented by applying a sound surgical technique. However, in case an OAF develops, it can be managed by a variety of options depending on the dimensions of the defect. In this report, we present the use of a nasolabial flap along with an upper sulcus flap for coverage of an OAF after undergoing an OOKP procedure. Measures to avoid this disastrous complication have also been discussed.
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Optimizing cleft care during COVID pandemic p. 154
Devi Prasad Mohapatra, MT Friji, S Dinesh Kumar, Ravi Kumar Chittoria, Imran Pathan, K Shijina
The COVID-19 pandemic has created disruptions worldwide with unprecedented interruption of non-COVID health care. Cleft care services toward children with cleft lip and palate have also been affected worldwide leading to stress among cleft caregivers. The use of remote consultation and therapy finds a definitive application in such situations. We present our method of providing uninterrupted cleft care through remote consultations service during this pandemic.
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Millard's rotation advancement technique for unilateral cleft lip repair p. 157
Puthucode V Narayanan
The unilateral cleft lip deformity includes defects of the lip and also the associated deformities in the nose. The Millard's rotation advancement technique is a versatile one for the repair of these deformities. The principle of the technique is that the raised Cupid's bow point medial to the cleft is brought down level with its noncleft side counterpart by a rotation incision, which extends to the base of the columella and ends with a back cut. The resulting defect beneath the base of the columella is filled with an advancement flap from the cleft side. The advantages of the techniques are many. The most significant one is that it adheres to the basic principles of esthetic surgery, with the main scars being along the relaxed skin tension lines. It is a versatile technique producing optimal results in all types in unilateral cleft lip patients ranging from the microform to the widest of complete clefts. The incision in this technique is so placed that there is easy access to address the associated defects of the nose. Technical refinements have been added to the classical description of the procedure to address the deficiencies in the repair. We describe important refinements introduced at our center by Dr. H. S. Adenwalla. Universally, this technique is still the most popular.
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Triangular flap technique for unilateral cleft lip deformity p. 163
Ramesh Kumar Sharma
The triangular flap lip repair is one of the two main techniques used for the correction of a cleft lip deformity worldwide. Many surgeons in Indian subcontinent and Europe use the triangle flap technique as their first choice. This CME article describes the details of the triangular flap technique as modified by Dr. C P Sawhney. The rationale of the technique, lip markings, planning of incisions, and the detailed operative steps are described. The merits and demerits of this versatile technique are also discussed.
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