Evaluation of the Millard technique associated with zetaplasty in the treatment of patients with unilateral cleft lip

INTRODUCTION: Cleft lips are very common congenital deformities that affect, in varying degrees, the soft tissues and bone structures of the middle third of the face. Surgical treatment should be performed early and a protocol must be followed, which varies according to the reference center. There are numerous surgical techniques for lip repair, and among them, the Millard technique is the most used. The objective is to evaluate the association of the Millard type I with zetaplasty mucosal technique (used by the author) as the surgery of choice for primary lip repair in patients with unilateral cleft lip, and to understand whether the techniques are appropriate when the number of second surgeries (reoperation) is low. METHODS: Sixty-five patients underwent operations by this technique from January 2007 to December 2012 in Santos, all of whom were followed for at least four years. RESULTS: Of the 65 patients, 10 (15%) were considered to present "unsatisfactory results" and underwent reoperation. CONCLUSION: Primary cheiloplasty with zetaplasty-associated Millard type I is appropriate when the number of reoperations is low, and our results agree with the current literature

Columellar reconstruction with chondrocutaneous graft after injury caused by CPAP

Introduction: Continuous positive pressure in the nasal airways (CPAP) is a non-invasive form of ventilation used in premature newborns in intensive care units. However, it can affect the nose of these patients, even evolving with ischemia and columellar necrosis. Several techniques are described to reconstruct the columella, such as skin grafts, composite grafts, local flaps, and free flaps, but the atrial chondrocutaneous graft has stood out. This study aims to describe a case of columella necrosis using CPAP with reconstruction using posterior atrial chondrocutaneous grafting. Case Report: A brown, female patient, with a history of prematurity and prolonged use of CPAP when she was born due to hyaline membrane syndrome, developed columella necrosis. The patient underwent posterior auricular chondrocutaneous grafting to reconstruct the columella. She presented a satisfactory surgical result, evolving with 100% graft vitality. Discussion: Columellar necrosis associated with the use of CPAP can be aesthetically and functionally debilitating, and represents a reconstructive challenge. The options for obtaining acceptable results are limited. However, the use of ear grafts is technically straightforward, uses structurally similar donor tissues, does not cause additional scarring on the nose, is performed in a surgical period, and generally has an excellent result. Posterior auricular composite grafting for columellar reconstruction proved safe, with satisfactory aesthetic and functional results and minimal morbidity in the donor area