Background: Correction of the secondary cleft lip nasal deformity is a real challenge for the esthetic surgeons. Grafts are an integral part of modern rhinoplasty with costal cartilage being increasingly used in the secondary case. The use of costal cartilage is fraught with problems like visibility and warping. Introduction: We propose an innovative alternative technique, "Diced Cartilage Under perichondrial carpet with reinforcement (DCUP) technique" keeping in mind, the Indian noses which usually do not support the liquid (filler) or semisolid (diced cartilage in fascia [DCF]) augmentation due to thick skin and weak structural support. Aims and Objective: To introduce a technique which can provide both a softer and natural looking dorsum and a strong framework to withstand the stress of healing forces in early postoperative period. Materials and Methods: Over the past 3 years we have used this technique in 25 patients with primary as well as secondary rhinoplasties including posttraumatic and secondary cleft lip nose deformity. Postoperative follow-up was done with clinical examination and photography. Results: In our study, a total of 25 patients were operated, there were 9 males and 16 females, giving a male:female ratio of about 1:2. Mean follow-up was 18 months. All patients had rounded, well contoured, and smooth dorsum. There was no incidence of fracture, warping, visibility or extrusion of graft, or palpable or visible sutures. Conclusion: Proposed technique of "Diced Cartilage Under Perichondrial carpet with reinforcement (DCUP) technique" is a very good alternative especially in Indian setting to keep the good effects of DCF that is, smoother, softer, and natural looking dorsum and also able to withstand postoperative contracting forces owing to its stable base of costal cartilage graft.

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Objective: The purpose of this study was to report the epidemiological profile and surgeries done on patients with cleft lip and palate from August 2007 to December 2014. Materials and Methods: A retrospective study was done to evaluate the patients operated for either cleft lip (with or without alveolus), cleft palate or secondary correction. The age of operative intervention, sex distribution, type of cleft, laterality, type of surgery, and duration of stay were reported. Results: A total of 411 cleft patients were seen during this period (August 2007-December 2014). Among this 36 (8.7%) patients had an incomplete cleft lip, 57 (13.9%) had a complete cleft lip, and 29 (7%) had cleft lip with alveolus. Isolated cleft palate was seen in 104 (25%) patients and cleft lip and palate were seen in 185 (45%) patients. Eighty percentage patients were aware of the surgeries for cleft lip and palate by various hospital communications. The mean age of patients operated for cleft lip was 5.3 months and Randall Tennison modified repair was done in 88% of these patients. The mean age of patients undergoing palatoplasty was 1.6 years and the most common surgery done was pushback palatoplasty with intervelar veloplasty (73.6%). Seventy-six patients underwent a secondary correction, out of which 30 patients got lip revision and 26 got fistula repair. A total of 15 patients had other associated anomalies. The average duration of stay in hospital for a cheiloplasty patient was 7 days, of palatoplasty was 8 days and of secondary surgery was 5 days. Conclusion: This study indicates that cleft lip and palate are most common types of cleft predominantly on the left side and males being more. Newspapers, various medical institutions, and media are useful measures to spread public awareness about early surgery, follow-up, secondary corrective surgeries, speech and dental therapy. Early diagnosis and appropriate timings of these surgeries produce satisfactory results with minimal morbidity.

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Objective: Aim of this study was to assess satisfaction with facial appearance and function following cleft lip and palate (CLP) surgeries. Materials and Methods: The surgical outcome of 70 consecutive patients who had CLP surgeries between October 2008 and December 2009 were prospectively evaluated at least 4 weeks postoperatively. Data collected included age, sex, type of cleft defects and type of surgery done, and postoperative complications. For cleft lip repair, the Pennsylvania lip and nose score was used to assess surgical outcome whereas the integrity of the closure was used for cleft palate repair. Results: A total of 70 subjects were enrolled in this study with 40 females (57.1%) and 30 males (42.9%) (female:male = 1.3:1). The age of the subjects at presentation ranged from 1 day to 26 years. Majority of the study group were infants 74.3% (52) and 25.7% (18) presented after age one. 19 (39.6%) of subjects were operated within the ages of 3 months for lip repair and 10 (45.5%) subjects after 18 months for palate repair. There was a good surgical outcome of 71.4% with an overwhelming parents/subjects satisfaction of 94.8% with the treatment outcome. Twelve cases (15.6%) in which surgical outcome was rated fair, the subjects or their parents were still very satisfied with the surgical outcome. Conclusions: There was a high patient satisfaction irrespective of treatment outcome. This satisfaction reflects not only the technical competence of the cleft surgeons, but also the dedicated performance of other supporting staffs of the hospital.

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Cleft lip and palate is the most common congenital disorder affecting facial region. Van der Woude syndrome is a rare autosomal dominant disorder characterized by varying degree of cleft lip and/or palate, distinctive pits on the lower lip and hypodontia. A case of Van der Woude syndrome treated successfully with fixed orthodontic treatment is presented. The main feature of treatment planning and execution included moving the premaxilla to midline with gentle orthodontic force.

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Background: Community-based rehabilitation (CBR) by trained and supervised CBR workers is an emerging alternate mode of service delivery for providing speech correction. Resource material in the vernacular language is essential to aid CBR workers. There is no step-by-step training material that could be used in Tamil language. Aims: To develop and validate a video film in Tamil for CBR workers/parents/caregivers on basic principles of speech therapy for individuals with cleft palate. Materials and Methods: The method involved the development of a short video film and evaluation of its validity. The development phase included designing the content, developing the script of the film, selecting participants, and shooting of the video film. The validation of the video film involved developing a video evaluation form, screening the video film, and administrating the video evaluation form. Thirty participants including 20 speech-language pathologists, five CBR workers, and five technical experts in filmmaking were involved in the process of validation. Statistical Analysis: Cronbach's alpha was used to estimate content validity; descriptive statistics to analyze results of the video evaluation form. Results: Cronbach's alpha was 0.863 indicative of a high content validity. The overall mean rating on the video evaluation form was 8.5 (standard deviation = 0.57). Conclusions: The results illustrate that the content and delivery style of the video film was appropriate. Further research is required to examine the efficacy of the video as a resource material in the training of CBR workers.

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Objective: Various risk factors (RFs) have been associated with cleft lip and/or cleft palate (CL/P) in many populations, but none has been identified in a South-Western Nigerian population. We sought to identify the prevailing RFs for nonsyndromic CL/P in the South-Western Nigerian population. Study Design: We conducted a case-control study at Obafemi Awolowo University Teaching Hospital (OAUTH) Ile-Ife. Patients with nonsyndromic CL/P presenting at the OAUTH and randomly selected infants conceived and delivered in the same zone as the patients were studied. We elicited information on RFs for CL/P around subjects' conceptions. Results: 157 patients aged 1 day to 4 months and 157 controls were reviewed. A female preponderance was observed (F:M= 1.24:1). Chi-square tests reveal that mother's age, gravidity at the birth of index child, pregnancy illnesses, child's birth rank, maternal medication use in the first trimester (FT), the absence of antenatal care (ANC), positive family history; and parent's occupational exposure differed significantly between these groups. A logistic regression revealed increased odds of having a child with CL/P with paternal age ≥40 years, maternal age ≤20 years, pregnancy illness, febrile illness in FT, attempted abortion, and birth rank ≥4 ^th . Furthermore, primigravid status at birth of index child, the absence of ANC, history of neonatal death, medication use in the FT, as well as parent's occupation demonstrated varying increased odds that attained statistical significance. Conclusion: Multiple interrelated factors may be implicated in the etiology of CL/P in the studied population. We advocate prompt health education and public enlightenment directed at addressing and eliminating these RFs.

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Background: Children affected with cleft lip and/or palate often present with difficulties in feeding, hearing, speech, and dental occlusion. Caring for these children starts at birth and aims at providing holistic treatment so that they can live a normal life. Shortcomings of cleft care services in Nigeria have been reported previously and include lack of comprehensive care, shortage of personnel and equipment as well as difficulty in accessing services. Accessing governmental funding may impact greatly on the quality of services being provided and may solve many problems associated with cleft care. One way of accessing governmental funding in Nigeria is through health parastatals and agencies which have resources to fund health care and may possibly fund cleft care if they are well informed. The aim of this study is to discuss the possible ways that cleft care may be integrated into the Nigerian health care system to allow for governmental funding. Materials and Methods: This study employed a narrative literature review method, using key search terms to collect useful information in Nigeria about cleft care, health care system, and funding. Salient points concerning the organization of the Nigerian health care system and the place of cleft care were identified; these have been summarized and reported. Results: The Nigerian health care system operates at three levels: Tertiary, secondary, and primary. Cleft care services are available at the tertiary and secondary levels only, and rarely at the primary level, where majority of affected children are recruited for surgical repair. The Nigerian government does not fund cleft care services; funding is mainly from donor agencies or borne on an "out-of-pocket basis." Conclusion: This study has reported useful information on how cleft care can be integrated into the current health care system in Nigeria that may serve as a useful guide when planning health policies.

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Cleft lip and palate (CLP) is one of the most prevalent congenital craniofacial deformities. CLP may result in impairments that stigmatize the individual and have an impact on health, emotions, and social interactions. This article describes the comprehensive orthodontic approach in the treatment of unilateral cleft of the lip and the palate. It also emphasizes the importance of orthodontic intervention to improve the facial esthetics in CLP patients. The treatment planning procedures and the results are presented below.

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Oral synechiae also called intraoral bands or congenital alveolar synechiae are extremely rare. The patient is usually a neonate with difficulty in breathing and feeding. We report the case of a 4-year-old child brought to the hospital for cleft palate repair having no history of breathing or feeding difficulty other than what was attributed to the cleft palate.

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