The management of a patient with cleft palate is complex. Various prevalent surgical techniques are presented, but no universal agreement exists on the appropriate treatment strategy. There is a consensus of opinion that normal speech should be the most important consideration in the therapeutic plan. Growth disturbance should be minimized, but not at the expense of speech impairment because facial distortion can be satisfactorily managed by surgery, whereas speech impairment can often be irreversible. There is a need for well-controlled, prospective studies to establish the validity of the widely different claims of superior results from various techniques. Cleft patients should be managed in a center with a multidisciplinary team. Cleft palate remains a significant and interesting challenge for current and future plastic surgeons.

Craniofacial microsomia (CFM) is the second most common craniofacial anomaly treated surgically in craniofacial centers worldwide. This craniofacial condition is variably associated with anomalies of the ears, jaws, orbits, soft tissue of face and function of the facial nerve. It can also be associated with extra-cranial deformities like cervical and rib anomalies. Largely, the etiology of CFM is unknown, but prenatal exposures of some drugs and genetic abnormalities may be associated with the condition. Diagnosis and treatment of CFM is challenging due to a wide spectrum of deformities (both osseous and soft tissue). Depending upon the severity of the deformity a wide variety of surgical treatment plans exist. After treating forty cases of CFM, we experienced that, though the treatment of severe form of CFM is difficult, but a coordinated multi-specialty team approach, especially of Reconstructive plastic surgery, orthognathic surgery, ear, nose and throat specialists leads to a successful and rewarding outcome.

Introduction: Craniosynostosis is a pathologic condition resulting from the premature fusion of cranial vault sutures, resulting in craniofacial deformities. Anterior craniosynostosis can involve a combination of metopic/unicoronal or bicoronal sutures. Aims and Objectives: Fronto-orbital advancement (FOA) is the standard surgical treatment. This article attempts to highlight the importance of modifying the osteotomies and reshaping of the cranial vault based on individual requirements to achieve the best possible result. Method and Results: Three consecutive cases of anterior craniosynostosis (metopic with unicoronal, unicoronal with sphenoethmoidal, bicoronal) with individual modifications of the technique used in each case are presented. Conclusion : FOA has to be tailored for each variant of anterior craniosynostosis and its requirements. The Technical variations can be applied to any combination of anterior craniosynostosis.

Background: Area and volume of the pharyngeal airway in surgically treated unilateral cleft lip and palate (UCLP) patient: A cone beam computed tomography (CBCT) study. Context: Surgical repair of cleft causes restriction of maxillary growth and mid face but the effect of this reduced growth on volume of the pharyngeal airway has not been investigated thoroughly. Aims: The aim of the study was to assess the area, volume and smallest cross-sectional area of the pharyngeal airway in individuals with UCLP using CBCT and compare with age and sex matched noncleft controls. Settings and Design: Retrospective study. Materials and Methods: The study was carried out on 20 surgically treated UCLP patients and compared with 40 normal non cleft subjects with Class I skeletal relation within age group of 7-14 years. CBCT image processing and analysis were performed using Dolphin Imaging software (11.7 version premium; Dolphin Imaging and Management Solutions, Chatsworth, Calif) and volumetric rendering was done for airway analysis. Statistical Analysis Used: All statistical analyses were performed with SPSS software (version 15.0J for Windows; SPSS, Inc., Chicago, IL). An independent sample t-test was used to determine the significance of the difference between the means. Results: No significant difference was found in the area and volume of nasopharynx, oropharynx, hypopharynx, total pharyngeal volume (P = 0.86) and minimum axial area (P = 0.69) of the pharynx between the groups. Conclusions: Using CBCT, this study found that there was no significant difference in the pharyngeal area and volume between UCLP and noncleft groups. Further investigations are necessary to clarify the relationship between pharyngeal structure and airway function in patients with CLP.

Background: The development of pre-speech vocalizations, from the period of canonical babbling, is important for a child to develop speech and language. This is the stage when infants produce strings of consonant-vowel combinations with adult-like intonation patterns. Aims: The current study was aimed at analyzing the vocalizations of children with unrepaired cleft palate to compare the distribution of consonants, vowels, and syllable structures; and the development of receptive and expressive language with respect to age and gender matched typically developing children. Materials and Methods: Vocalizations of 10 children between 11 and 18 months of age with and without cleft of the palate were recorded during play and interaction with their mothers. One thousand utterances were transcribed using International Phonetic Alphabets by a speech language pathologist and analyzed for the above parameters. Language development was assessed using three-dimensional language acquisition test. Statistical Analysis: Mann-Whitney test was used to analyze the significance of differences between the two groups. Results: Statistically significant differences were obtained in the distribution of vowels and consonants among the utterances. The pattern of consonants and vowels noticed in children with cleft reflected the effects of structural constraints on sound production. An expressive language delay of 2-6 months was evidenced among children with cleft, though not statistically significant. Conclusion: Differences in prespeech vocalizations are noticed in children with cleft compared to typically developing children. The results highlighted the need for early intervention in children with cleft palate.

Objective: The aim of this study was to evaluate functional and speech outcomes of superiorly based pharyngeal flap (SBF) pharyngoplasty combined with radical intravelar veloplasty (RIVVP) for the management of velopharyngeal insufficiency (VPI) following surgically repaired cleft palate. Design: A case series with chart review. The study was conducted in academic tertiary care medical centre. Patients and Methods: Fifteen patients with VPIs following surgically repaired cleft palate were managed between May 2011 and August 2014, with SBF pharyngoplasty combined with RIVVP. Results: We found that the speech defects improved by a success rate of 93.4%; the VP function became normal (circular pattern of closure) in 80% of patients and the postoperative overall success rate of VP competence grades was 93.4%. Moreover, we found that the overall incidence of complications were 33.3%. Conclusion: By doing SBF pharyngoplasty combined with RIVVP the surgical procedure was satisfactory in both functional and speech outcomes.

Background: Long-term health of the stomatognathic system as well as esthetic aspects are the therapeutic goals in patients with orofacial clefts. Aim: The aim of this study is to compare the oral hygiene and dental caries status among patients with cleft lip (CL), cleft palate (CP), and CL alveolus and palate (CLAP) reporting to a hospital in India. Materials and Methods: The study group consisted of 80 cleft patients. Subjects were divided into three groups. Group 1: Patients with CL, Group 2: Subjects with CP and Group 3: Subjects with CLAP. Oral Hygiene Index-Simplified (Greene and Vermillion in 1964), decayed, missing and filled teeth (DMFT) (Klein, Palmer and Knutson in 1938) and deft Index (Grubbel in 1944) were recorded. Results: The maximum number of subjects having fair and poor oral hygiene was found in CLAP groups (42.9% and 7.1%). The mean DMFT was high in CLAP subjects (2.93 ± 2.94) compared to CL (2.73 ± 2.52) and CP subjects (2.58 ± 2.65). The mean deft was high in CP subjects (1.04 ± 2.22) compared to CL (0.28 ± 0.89) and CLAP subjects (0.26 ± 0.76). Conclusion: Oral hygiene status of CLAP patients was found to be fair, and they had moderate risk of dental caries.

Objective: The objective was to identify the behavioral problems if any, in children with cleft lip and palate (CLP) and its relationship with their parents' quality-of-life (QOL) and negative emotions. Design: A cross-sectional explorative study. Setting: Both inpatient and outpatient department of Cleft Care Center, in the hospital. Patients: Participants were 50 parents of CLP children in the age group of 1΍-5 years. Main Outcome Measures: Outcome measures are QOL, Depression, Anxiety, Stress Scale-21, and child behavior checklist. Results: There is a significant positive relationship between internalizing problems such as emotional reactivity, somatic complaints, withdrawn behavior, and on the stress. There was a positive relationship between attention problem of children with parental depression and stress and also between internalizing and externalizing behavioral problems with various aspects of QOL. Conclusion: This study has implications in understanding how CLP children's behavioral problems influence the parent's QOL.

Background: In the minimum standards for care of children with cleft of the lip and/or palate (CL/P), cleft teams are expected to undertake research as well as participate in multicenter audit. This cross sectional survey aimed at reporting the research experience of cleft specialists working in Nigeria Hospitals. Materials and Methods: The research question was to find out if cleft care teams in Nigeria conduct research as recommended by World Health Organization minimum standards of cleft care. To answer the research question, semi-structured interviews were conducted over the telephone with 40 cleft team coordinators working in Nigerian hospitals. The interviews covered questions on cleft teams' experience and knowledge with research in the field of CLP. Coordinators were also asked to give reasons why they were not conducting research. Results: The result revealed that majority (n = 30; 75%) of the cleft teams in Nigeria do not conduct research and those cleft teams (n = 10; 25%) that conduct research use quantitative research methods mainly. Reasons given for not conducting research were "time constraint" 14 (35%), "inadequate sample size" 14 (35%), "lack of funding" 8 (20%) and "research in cleft not a priority" 4 (10%). Conclusion: Findings of this study are informative and highlights shortcomings of CLP research in Nigeria.

Median cleft of lower lip and mandible is a rare congenital anomaly and is also described as Tessier's no 30 cleft. It is also associated with other congenital abnormalities with varying degree of severity. The condition was first described by Couronine in 1819 and since then very few cases have been reported. We report a case of median cleft of lower lip and ankyloglossia, which was surgically treated. The etiology, clinical feature and treatment are discussed.

Enlarged persistent parietal foramen is rare congenital skull defect and associated anomalies like underlying encephalomalacia, and venous malformations are known. We here report a very rare association with persistent occipital foramina and occipital encephalocele. This patient presented later in life with complaints of headache and seizure. Basic clinical examination like palpation of scalp was helpful in diagnosing this rare condition. Radiological investigations later revealed an array of associated congenital abnormalities like hypoplastic inferior sagittal sinus, which is even rare finding in a single case.

A simple subcutaneous lesion such as an epidermoid cyst can present as an aesthetic challenge when located in the nasal tip. Usually the nasal dermoid presents as swelling over the dorsum of nose extending from the nasal tip to the nasal bridge with or without intracranial extensions. In some cases, the overlying skin gets rupture and underlying abnormal structures developed from pluripotent cells of dermoid become visible with variable discharges such as cerebrospinal fluid or sequestrum. Origin of nasal dermoid sinus cyst (NDSC) during embryological development requires two necessary and sufficient conditions. One is competence of the ectodermal and meso-ectodermal cells to form dermoid tissue with epithelial-mesenchymal interactions and second, presence of a topographical site of ectodermal inclusion, which fits well with the various clinical presentations of NDSCs. The case presented here has naso-ethmoidal dermoid cyst with ectopic teeth at the tip of the nose. The patient had a cranial defect with bulging of tissue in naso-ethmoidal region that was in line of 1-13 facial cleft of Tessier. Computerized tomography revealed a bony gap in the region of right fronto-ethmoidal region and brain cyst with craniosynostosis in left frontoparietal suture. Transcranial approach was used to manage the case and all the teeth at the tip of the nose were removed.

Dehiscence of the mucoperiosteal flap from the alveolar margin is one of the rare complications reported after cleft palate surgery. This situation has been termed a "hanging palate". ^[1] In these cases, secondary suturing is bound to fail. Intraoperative use of adhesives can obviate this problem. Although the adhesion system cannot and should not replace surgical suture, it provides valuable assistance in tissue synthesis and in local hemostasis at the time of primary surgery, particularly in cases where conventional suture methods are difficult to apply. In addition to good adhesion and good tissue compatibility, the adhesive is completely absorbed. This paper emphasizes on the effectiveness of the fibrin glue for the prevention of such a complication.