Post-Surgical Repair of Cleft Scar Using Fractional CO2 Laser

BACKGROUND: Postoperative scarring is a common cause of patients dissatisfaction. Several modalities have been developed to overcome such a problem following surgical repair. Despite precise surgical technique, still, some scars would remain over the time, mostly due to the weak formation or inadequately replaced collagen fibres in the underneath dermis especially those following unilateral or bilateral cleft lip repair surgery.AIM: of this study is to evaluate whether a 10,600 nm fractional ablative carbon dioxide (CO2) used early during the healing period would result in better postoperative scars.METHODS: In the present study six patients complained from cleft lip scars resulting from lip revision surgery. Each patient had six fractional ablative CO2 laser sessions for treatment along six months to obtain a complete collagen cycle. Vancouver Scar Scale VSS was used as a method of evaluation of the scar using 4 points scale evaluating vascularity, pliability, thickness & colour of the skin and Visual Analogue Scale VAS from (0-10) was used to assess the severity of pain as well as a survey questionnaire for the rate of patient’s satisfaction. Also, digital clinical photos assessment before&after were compared.RESULTS: Patients expressed a significantly greater degree of satisfaction with the treatment using a subjective 4-point scale. All patients observed dramatic improvement in their lip scars after FCO2 laser sessions following their surgeries with the better psychological state. The assessment was done by clinical observation according to VSS before (9.17 ± 2.2) while after (3.33 ± 1.9) with a highly significant P value <0.001 and VAS for the rate of pain & satisfaction that ranged from (8.0 ± 0.9) as well as series of photos taken before and after the procedure. No long-term complications were noted however patients complained of annoying pain during the session as well as crust formation that lasted up to 5 days after surgery. In the present study, we introduce the effectiveness of ablative fractional 10,600 nm CO2 laser for treatment of postoperative cleft lip scar after secondary surgical cleft repair rather than ablative CO2 due to its reported complications such as postoperative infection, erythema and pigmentary changes along with prolonged downtime healing. In the current study, we chose early laser treatment within the first six months before complete collagen organisation which will be easier to manage the older scars. Patients mostly complained about the pain during the session as well as dark-coloured crust formation post session that stayed from 3-5 days however they all observed a massive improvement of their scars following treatment protocol.CONCLUSION: Facial wounds sutured in layers heal in a good manner. Patients prefer early treatment with a fractional CO2 ablative laser for postoperative surgical scars. The use of a CO2 fractional laser is safe and effective also causes high patients satisfaction

Surgical Management of Facial Features of Robinow Syndrome: A Case Report

BACKGROUND: Robinow Syndrome is an extremely rare genetic disorder characterised by abnormalities in head, face and external genitalia. This disorder exists in dominant pattern with moderate symptoms and recessive pattern with more physical and skeletal abnormalities. It was first introduced by Menihard Robinow in 1969. It was related to chromosome 9q22 ROR2 gene related to bone and cartilage growth aspects.CASE PRESENTATION: A 17-year-old Egyptian male presented to National Research Centre Orodental genetics Clinic with typical features of short stature and facial dysmorphism weighted 50 Kg and measured 150 cm height complaining of facial disfigurement. There was no significant prenatal history, and family history was negative for congenital disabilities and genetic disorders. Clinical examination revealed macrocephaly and special facial features as prominent forehead, deformed ear pinna, hypertelorism, flat nasal tongue tie, deficient malar bone, bow-shaped upper and lower lips and dimpled chin. Orally the patient suffered from tonetie, gingival hypertrophy and dental malalignment. The orthopantomogram showed multiple impacted teeth. The physical examination revealed that the patient had deformed spine, short limbs with ectrodactyly, micropenis & hypospadias. Surgical management included correction of midface deficiency with zygomatic augmentation, closed rhinoplasty for the broad nose, lips muscles release and tongue tie relief. The patient is currently undergoing orthodontic treatment for his teeth.CONCLUSION: Improvement of facial features and a good psychological impact on the patient and his family

Alveolar Cleft Reconstruction Using Different Grafting Techniques

BACKGROUND: Cleft lip and palate CLP is a frequent congenital malformation that manifests in several varieties including unilateral or bilateral anomalies due to either genetic or acquired causes. Alveolar cleft graft ACG remains controversial as regard timing, grafting materials and surgical techniques. The primary goal of alveolar cleft grafting in ACG patients is to provide an intact bony ridge at the cleft site to allow maxillary continuity for teeth eruption, proper orthodontic treatment for dental arch alignment, oronasal fistula closure and providing alar support for nasal symmetry. AIM: This study aims to compare different grafting techniques to treat the alveolar cleft defect. METHODS: This study included 24 cases divided into three groups of patients: Group A was treated with autogenous iliac crest bone; Group B was treated with nano calcium hydroxyapatite with collagen membrane and Group C was treated with tissue engineering method using bone marrow stem cells extract and PRF membrane. RESULTS: According to clinical and radiographic examination measuring bone density in the CT preoperatively compared to six months postoperatively. Group C with bone marrow stem cells extract showed superior results among all followed by group B, while group A with autogenous iliac crest showed resorption in some cases and gave the least values, in addition to its drawbacks as regard donor site affection with pain & scar formation. CONCLUSION: Bone substitutes as Nano calcium hydroxyapatite and bone marrow stem cells extract showed to be reliable methods for bone grafting than autogenous iliac crest