Effect of the parent focused approach to the communication skills of children with cleft palate

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Transoral robotic cleft palate surgery

Objective This study aimed to assess the safety and feasibility of transoral robotic surgery for the reconstruction of soft palatal clefts. Design The application of transoral robotic surgery for soft palate muscle reconstruction was investigated. The da Vinci Surgical Robot was first used on a cadaver to assess the optimal positioning of the patient and the robot. The robot was then used for the dissection and reconstruction of palatal muscles in 10 consecutive patients with palatal clefts. The procedures were documented using video and still photography. A group of 30 control patients were subjected to surgery with manual instruments. Surgical and clinical outcomes were evaluated with at least 6 months of follow-up (8 ± 1 months). Results The use of the surgical robot on a cadaver provided great dexterity and excellent 3D depth perception. The transoral access was efficient and safe for the precise dissection, reorientation, and suturing of palatal muscles. In our series, the surgical duration was longer for the robotic approach than for the manual approach (87 ± 6 minutes versus 122 ± 8 minutes, P &lt; .0001). No intraoperative or postoperative complications occurred in either group. Conclusions A robotic surgical approach can be used safely for palatal surgery. We believe that the precise dissection of the palatal muscles provided by the robotic system might reduce damage to the vascularization and innervation of these muscles, as well as damage to the mucosal surfaces that could cause fistula formation. In addition, this technique might improve palatal function and Eustachian tube function in cleft palate patients. </jats:sec

Very fast soft tissue predictions with mass tensor model for maxillofacial surgery planning systems

Maxillofacial surgery treats abnormalities of the skeleton of the head. Skull remodelling implies osteotomies, bone fragment repositioning, restoration of bone defects and inserting implants. In this field there is a huge demand from the surgeons to be able to predict the new facial outlook after surgery. Besides the big interests for the surgeon during planning, it is also an essential tool to improve the communication between surgeon and patient. Mass Spring Models (MSM) are widely used to simulate the deformation behavior of soft tissues. The usage of these models has however some serious disadvantages. Most important is that the MSM has no real bio-mechanical foundation. The Finite Element Model (FEM) on the other hand has a strong bio-mechanical foundation but the high computational cost and a difficult architecture make it not very useful for fast simulators. In this paper we present the usage of a Mass Tensor Model (MTM) to simulate the soft tissue deformations after bone displacement. This model tries to combine the advantages of FEM and MSM. Moreover by combining this MTM with a new static solution scheme and a dynamic threshold, we were able to reduce the calculation time seriously when compared to MSM or FEM. © 2005 CARS and Elsevier B.V.Mollemans W., Schutyser F., Nadjmi N., Suetens P., ''Very fast soft tissue predictions with mass tensor model for maxillofacial surgery planning systems'', International congress series 19th international congress and exhibition on computer assisted radiology and surgery - CARS 2005, vol. 1281, pp. 491-496, June 22-25, 2005, Berlin, Germany.status: publishe