Maxillary distraction resulting in facial advancement at Le Fort III level in cleft lip and palate patients: a report of two cases.

An 18-year-old female and a 14-year-old male who had previously received surgery for primary repair of a nonsyndromic cleft lip and palate (including alveolar defect bone grafting) unintentionally developed facial advancement at the Le Fort III level after surgical correction of their maxillary hypoplasia. The Le Fort I osteotomy, originally performed for their maxillary dentoalveolar hypoplasia, was an incomplete osteotomy. It was performed without down-fracture, leaving the pterygomaxillary and septal junctions intact. The gradual advancement of the maxilla during distraction osteogenesis was planned to correct the hypoplastic maxilla, and also prevent subsequent hypernasality; however, during the distraction procedure by means of a rigid external device both patients developed an unintentional facial advancement at the Le Fort III level

Asymmetrical soft palate cleft repair: Preliminary results

The reconstructions of the asymmetrical soft palate cleft is a surgical challenge when it comes to achieving symmetry and optimal soft palate muscular function. Three different versions of the intravelar veloplasty have been used: the intravelar veloplasty (1969) (type I), the modification according to anatomical defects (1991) (type II), and the modification using part of Sommerlad’s technique and part of Ivanov’s technique (2008) (type III). The perioperative outcomes of the type II and type III intravelar veloplasty were assessed and compared in asymmetrical cleft cases. Two hundred and seventy-seven soft palate clefts were reconstructed: 153 type II and 124 type III. Of these, 49 were asymmetrical (17.7%); 23 underwent the type II procedure and 26 the type III procedure. Of the type II procedure cases, 30.4% remained asymmetrical postoperatively compared to 3.8%of the type III cases. The uvula appeared subjectively atrophic in 47.8% of the type II cases and in 7.7% of type III cases. Oro-nasal fistula occurred in 13.0% of the type II cases and 3.8% of the type III cases. Speech results will only be assessed after 4 years of age. The type III modified intravelar veloplasty has had a major beneficial impact on patients who had an asymmetrical soft palate cleft.http://www.sciencedirect.com/science/journal/09015027hb201

Columella pressure necrosis: a method of surgical reconstruction and its long-term outcome

Nasal continuous positive airway pressure (nCPAP) in premature babies may rarely lead to necrosis of the columella. Subsequent functional and cosmetic impairments require surgical corrections to restore nasal anatomy and architecture. The objective of this report is to document the technique of reconstruction in a baby with columella necrosis due to nCPAP treatment. A 21-month-old baby was referred to the oral and maxillofacial unit with a necrotic columella following nCPAP ventilation in a neonatal intensive care unit. Nearly 75% of the vertical columella length was affected. A neocolumella was created using tissues mobilised from the nasal sill region. This report provides a detailed description of a columella reconstruction technique which is valuable to restore aesthetics and function.http://casereports.bmj.comhb201

Oblique lip-alveolar banding in patients with cleft lip and palate

We report an oblique lip-alveolar band, a rare banding of soft tissue that involves the lip and alveolus, which we have found in five patientswith cleft lip and palate (0.2%), compared with an incidence of the Simonartz lip-lip band of 5.7%). To our knowledge this has not beenreported previously. In two patients the bands affected the cleft lip and alveolus bilaterally, with or without the palatal cleft, and in three thebands were unilateral cleft lip and alveolus with or without the palatal cleft.http://bjoms.comhttp://www.journals.elsevier.com/british-journal-of-oral-and-maxillofacial-surgery2016-04-30hb201

Familie: zwischen Elternrechten und Kindeswohl

Vor dem Hintergrund der These, dass in der Kinder- und Jugendhilfe nicht mehr länger nur einer Familien-Orientierung, sondern zugleich auch einer Kindfokussierten-Orientierung gefolgt wird, die bestimmte Vorstellungen von Familie, Elternrechten, der staatlichen Verantwortung für die Wahrung des Kindeswohls und der gesellschaftlichen Positionierung von Kindern beinhaltet, werden in diesem Beitrag nachfolgend zunächst die historischen Bemühungen, Kinder vor Gefährdungen ihres Wohls in Familien zu schützen, die damit einhergehenden rechtlichen Reformen sowie die Verständnisse und gesellschaftspolitischen Positionierungen von Kindern, Eltern und Familie in Deutschland erörtert. Diese Befunde werden daran anschließend theoretisch reflektiert, kritisch analysiert und in Bezug zu ausgewählten aktuellen Forschungsbefunden gesetzt, um hierüber das Verhältnis von Elternrechten und Kindeswohl zu eruieren