Utilization of pedicled buccal fat pads for coverage of the lateral relaxing wound : a review of literature and a case series of 15 patients

The buccal fat pad (BFP) is an encapsulated mass originated from a specific fat tissue in various volume throughout the life of each person and BFP has been used in various surgeries as a source of useful graft material due to its easy accessibility and rich vascularization. This report describes fifteen patients who were treated with buccal fat pads (BFP) as a pedicled graft for lateral relaxing wound closure in primary cleft palate surgery. A review of relevant literature is also presented. All patients had a mean follow-up of 3.7 weeks with a minimum follow-up time of three weeks and a maximum follow-up of four weeks. All patients who had an uneventful immediate postoperative period showed signs of BFP epithelialization characterized by a yellowish tissue beginning in the first week and ending within 3?4 weeks after surgery. The use of BFP for the small to medium-sized defects reconstruction in palatoplasty is a safe and reliable method with fast healing. Even older patients who would not be able to tolerate time-consuming flap reconstruction procedures had good results

A combined targeted mutation analysis of IRF6 gene would be useful in the first screening of oral facial clefts

BACKGROUND: Interferon Regulatory Factor 6 (IRF6) is a member of the IRF family of transcription factors. It has been suggested to be an important contributor to orofacial development since mutations of the IRF6 gene has been found in Van der Woude (VWS) and popliteal pterygium syndromes (PPS), two disorders that can present with isolated cleft lip and palate. The association between IRF6 gene and cleft lip and palate has also been independently replicated in many populations. METHODS: We screened a total of 155 Taiwanese patients with cleft lip with or without cleft palate (CL/P); 31 syndromic (including 19 VWS families), 44 non-syndromic families with at least two affected members, and 80 non-syndromic patients through a combined targeted, polymerase chain reaction (PCR)-based mutation analysis for the entire coding regions of IRF6 gene. RESULTS: We found 11 mutations in 57.89% (11/19) of the VWS patients and no IRF6 mutation in 44 of the non-syndromic multiplex families and 80 non-syndromic oral cleft patients. In this IRF6 gene screening, five of these mutations (c.290 A>G, p.Tyr97Cys; c.360-375 16 bp deletion, p.Gln120HisfsX24; c.411_412 insA, p.Glu136fsX3; c.871 A>C, p.Thr291Pro; c.969 G>A, and p.Trp323X) have not been reported in the literature previously. Exon deletion was not detected in this series of IRF6 gene screening. CONCLUSIONS: Our results confirm the crucial role of IRF6 in the VWS patients and further work is needed to explore for its function in the non-syndromic oral cleft with vary clinical features

Three-dimensional computer-assisted surgical simulation and intraoperative navigation in orthognathic surgery: A literature review

By incorporating three-dimensional (3D) imaging and computer-aided design and manufacturing techniques, 3D computer-assisted technology has been applied widely to provide accurate guidance for assessment and treatment planning in clinical practice. This technology has recently been used in orthognathic surgery to improve surgical planning and outcome. The modality will gradually become popular. This study reviewed the literature concerning the use of computer-assisted techniques in orthognathic surgery including surgical planning, simulation, intraoperative translation of the virtual surgery, and postoperative evaluation. A Medline, PubMed, ProQuest, and ScienceDirect search was performed to find relevant articles with regard to 3D computer-assisted orthognathic surgery in the past 10 years. A total of 460 articles were revealed, out of which 174 were publications addressed the topic of this study. The purpose of this article is to present an overview of the state-of-art methods for 3D computer-assisted technology in orthognathic surgery. From the review we can conclude that the use of computer-assisted technique in orthognathic surgery provides the benefit of optimal functional and aesthetic results, patient satisfaction, precise translation of the treatment plan, and facilitating intraoperative manipulation

Applications of three-dimensional imaging techniques in craniomaxillofacial surgery: A literature review

Three-dimensional (3D) imaging technologies are increasingly used in craniomaxillofacial (CMF) surgery, especially to enable clinicians to get an effective approach and obtain better treatment results during different preoperative and postoperative phases, namely during image acquisition and diagnosis, virtual surgical planning (VSP), actual surgery, and treatment outcome assessment. The article presents an overview of 3D imaging technologies used in the aforementioned phases of the most common CMF surgery. We searched for relevant studies on 3D imaging applications in CMF surgery published over the past 10 years in the PubMed, ProQuest (Medline), Web of Science, Science Direct, Clinical Key, and Embase databases. A total of 2094 articles were found, of which 712 were relevant. An additional 26 manually searched articles were included in the analysis. The findings of the review demonstrated that 3D imaging technology is becoming increasingly popular in clinical practice and an essential tool for plastic surgeons. This review provides information that will help for researchers and clinicians consider the use of 3D imaging techniques in CMF surgery to improve the quality of surgical procedures and achieve satisfactory treatment outcomes

Complications following orthognathic surgery for patients with cleft lip/palate: A systematic review

The purpose of this systematic review is to update the available data for complications following orthognathic surgery in cleft lip and/or palate patients. Methods: Three electronic databases (Medline, Embase, and Cochrane) were searched for publications from 1990 to 2014. Results: A total of 26 articles were selected including 1003 patients (male: 391, female: 353, 259: not mentioned) who underwent maxillary osteotomies for cleft lip/palate. Mean age at surgery was 19.3 years (range: 8.5–60 years). Overall perioperative complications were reported in 126 cases (12.76%). The most common complication was closure failure of pre-existing palatal fistula (28.57%), followed by velopharyngeal impairment (16.79%), closure failure of pre-existing alveolar fistula (10.74%), gingival recession (4.55%), and failure of premaxilla stabilization in bilateral cases (4.55%). Severe vascular complications included one arteriovenous fistula (0.10%), one maxillary aneurysm (0.10%), and one cavernous sinus thrombosis (0.10%). Mean horizontal relapse rate was 17.9% (range: −20.0% to 37.2%), and mean vertical relapse rate was 35.4% (range: −25.9% to 162.5%). Reoperation rate was 12.2% (range: 0.0–64.0%). Prospective studies or randomized trials were rare. Conclusion: To obtain a dataset with higher evidence, a prospective multicenter study should be conducted with clearly defined criteria for each complication

Long-Term Nasal Growth after Primary Rhinoplasty for Bilateral Cleft Lip Nose Deformity: A Three-Dimensional Photogrammetric Study with Comparative Analysis

Nasal deformity is associated with congenital cleft lip and palate. Primary rhinoplasty for reconstruction of the nasal deformity at the time of bilateral cleft lip repair is a controversial issue in cleft care due to traditional teaching concerning the potential impairment of nasal growth. This study assessed long-term nasal growth in patients with bilateral cleft lip and palate who underwent primary rhinoplasty by a single surgeon between 1995 and 2002 and reached skeletal maturity (n = 39; mean: 19 ± 2 years). Normal age-, gender-, and ethnicity-matched subjects (n = 52) were enrolled for comparative analyses. Three-dimensional nasal photogrammetric measurements (10 linear, 4 angular, 6 proportional, 1 surface area, and 1 volume parameter) were collected from patients with bilateral cleft lip and palate and normal subjects. Patients who underwent rhinoplasty presented with significantly (all p < 0.05) smaller nasal tip projection and nasal tip angles, but greater values for nasal dorsum length, nasal protrusion, alar width, columellar height, dome height, columellar angle, labiocolumellar angle, nasal tip height ratio, nasal index, alar width/intercanthal distance ratio, and alar width/mouth width ratio compared to normal subjects. There were no differences (all p > 0.05) in nasal height, tip/midline deviation, nasal dorsum angle, dome-to-columella ratio, columella height/alar width ratio, area surface, and volume parameters between the two groups. This study shows that primary rhinoplasty performed in patients with bilateral cleft lip and palate during infancy does not result in deficiency of the nasal dimensions relative to controls

3D printing in orthognathic surgery − A literature review

With the recent advances in three-dimensional (3D) imaging, computer-assisted surgical planning and simulation are now regularly used for analysis of craniofacial structures and improved prediction of surgical outcomes in orthognathic surgery. A variety of patient-specific surgical guides and devices have been designed and manufactured using 3D printing technology, which rapidly gained widespread popularity to improve the outcomes. The article presents an overview of 3D printing technology for state-of-the-art application in orthognathic surgery and discusses the impacts on treatment feasibility and patient outcome. The current available literature regarding the use of 3D printing methods in orthognathic surgery including 3D computer-aided design/computer-aided manufacturing, rapid prototyping, additive manufacturing, 3D printing, 3D printed models, surgical occlusal splints, custom-made guides, templates and fixation plates is reviewed. A Medline, PubMed, ProQuest and ScienceDirect search was performed to find relevant articles over the past 10 years. A total of 318 articles were found, out of which 69 were publications addressing the topic of this study. An additional 9 hand-searched articles were added. From the review, we can conclude that the use of 3D printing methods in orthognathic surgery provide the benefit of optimal functional and aesthetic results, patient satisfaction, and precise translation of the treatment plan. Keywords: Orthognathic surgery, 3D printing, Computer-aided design, Computer-aided manufacturing, Rapid prototyping, Additive manufacturin

Time trend of incidence rates of cleft lip/palate in Taiwan from 1994 to 2013

Background: This study was to estimate the incidence rate of cleft lip and/or cleft palate (CL/P) in Taiwan from 1994 to 2013, and to assess the time trend over these years. Methods: Retrospective data analysis was performed on records of all newborns with CL/P treated at Chang Gung Craniofacial Center, the only treatment center for CL/P in Taiwan, from 1994 to 2013. Three-year moving average rates were computed and linear regression was used to explore the annual average percentage change. Results: From 1994 to 2013, 7282 newborns with CL/P were identified, corresponding to an annual rate of 1.48‰ (95% confidence interval (CI) = 1.45‰–1.52‰). There was a significant decline of rate of cleft lip with or without cleft palate (CL ± P) (−2.9% ± 0.2%, p < 0.0001) but slightly increase of rate of cleft palate (CP) only (+0.2% ± 0.07%, p = 0.004). Conclusion: From 1994 to 2013, the annual rate of incidence of CL/P was 1.48‰ in Taiwan. The 2.9% annual decline of the rate was mainly from the CL ± P group, not the CP group