Unilateral cleft lip repair: Technical maneuvers to achieve vermilion and mucosal height

Patients with unilateral cleft lip often require secondary procedures due to asymmetric fullness or deficiencies along the mucosal free margin of the upper lip. Here, we describe our technique for mucosal advancement and repair to attain symmetry. Methods: Maneuvers to obtain vermilion and mucosal height include (1) use of a tailored vermilion flap; (2) supraperiosteal release of the lesser segment; (3) backcut poker incision to mobilize the mucosal flap on the lesser segment; (4) transverse release of mucosa across the greater segment; (5) accurate reduction along vermilion-mucosal junction; and (6) bilateral medial mucosal advancement. To examine postoperative outcomes, photographic data were available for 14 patients with unilateral complete cleft lip. The Cleft Lip Component Symmetry Index was then calculated as a ratio of upper lip height on cleft to noncleft sides, where an index of 1 indicates symmetry. Results: Sixteen consecutive patients underwent unilateral cleft lip repair with this technique over a 3-year period, none of whom have required secondary operations. The symmetry index for 14 of 16 patients was 1.02 ± 0.11 (95% confidence interval [0.96, 1.08], Conclusions: Postoperative asymmetry after unilateral cleft lip repair, particularly along the free margin, continues to be a common problem, necessitating secondary procedures. The technique of mucosal repair merits more careful attention than it has previously received, and here we describe in detail a method that has allowed for improved symmetry

Ethical considerations in the use of Pernkopf's Atlas of Anatomy: A surgical case study

The use of Eduard Pernkopf's anatomic atlas presents ethical challenges for modern surgery concerning the use of data resulting from abusive scientific work. In the 1980s and 1990s, historic investigations revealed that Pernkopf was an active National Socialist (Nazi) functionary at the University of Vienna and that among the bodies depicted in the atlas were those of Nazi victims. Since then, discussions persist concerning the ethicality of the continued use of the atlas, because some surgeons still rely on information from this anatomic resource for procedural planning. The ethical implications relevant to the use of this atlas in the care of surgical patients have not been discussed in detail. Based on a recapitulation of the main arguments from the historic controversy surrounding the use of Pernkopf's atlas, this study presents an actual patient case to illustrate some of the ethical considerations relevant to the decision of whether to use the atlas in surgery. This investigation aims to provide a historic and ethical framework for questions concerning the use of the Pernkopf atlas in the management of anatomically complex and difficult surgical cases, with special attention to implications for medical ethics drawn from Jewish law

Ethical considerations in the use of Pernkopf's Atlas of Anatomy: A surgical case study

The use of Eduard Pernkopf's anatomic atlas presents ethical challenges for modern surgery concerning the use of data resulting from abusive scientific work. In the 1980s and 1990s, historic investigations revealed that Pernkopf was an active National Socialist (Nazi) functionary at the University of Vienna and that among the bodies depicted in the atlas were those of Nazi victims. Since then, discussions persist concerning the ethicality of the continued use of the atlas, because some surgeons still rely on information from this anatomic resource for procedural planning. The ethical implications relevant to the use of this atlas in the care of surgical patients have not been discussed in detail. Based on a recapitulation of the main arguments from the historic controversy surrounding the use of Pernkopf's atlas, this study presents an actual patient case to illustrate some of the ethical considerations relevant to the decision of whether to use the atlas in surgery. This investigation aims to provide a historic and ethical framework for questions concerning the use of the Pernkopf atlas in the management of anatomically complex and difficult surgical cases, with special attention to implications for medical ethics drawn from Jewish law

sj-jpg-4-cpc-10.1177_10556656221128413 - Supplemental material for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis

Supplemental material, sj-jpg-4-cpc-10.1177_10556656221128413 for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis by Abdullah M. Said, Ema Zubovic, Kristin D. Pfeifauf, Gary B. Skolnick, Jude Agboada, Penina Acayo-Laker, Sybill D. Naidoo, Mary C. Politi, Matthew Smyth and Kamlesh B. Patel in The Cleft Palate-Craniofacial Journal</p

sj-jpg-8-cpc-10.1177_10556656221128413 - Supplemental material for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis

Supplemental material, sj-jpg-8-cpc-10.1177_10556656221128413 for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis by Abdullah M. Said, Ema Zubovic, Kristin D. Pfeifauf, Gary B. Skolnick, Jude Agboada, Penina Acayo-Laker, Sybill D. Naidoo, Mary C. Politi, Matthew Smyth and Kamlesh B. Patel in The Cleft Palate-Craniofacial Journal</p

sj-jpg-2-cpc-10.1177_10556656221128413 - Supplemental material for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis

Supplemental material, sj-jpg-2-cpc-10.1177_10556656221128413 for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis by Abdullah M. Said, Ema Zubovic, Kristin D. Pfeifauf, Gary B. Skolnick, Jude Agboada, Penina Acayo-Laker, Sybill D. Naidoo, Mary C. Politi, Matthew Smyth and Kamlesh B. Patel in The Cleft Palate-Craniofacial Journal</p

sj-jpg-3-cpc-10.1177_10556656221128413 - Supplemental material for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis

Supplemental material, sj-jpg-3-cpc-10.1177_10556656221128413 for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis by Abdullah M. Said, Ema Zubovic, Kristin D. Pfeifauf, Gary B. Skolnick, Jude Agboada, Penina Acayo-Laker, Sybill D. Naidoo, Mary C. Politi, Matthew Smyth and Kamlesh B. Patel in The Cleft Palate-Craniofacial Journal</p

sj-jpg-5-cpc-10.1177_10556656221128413 - Supplemental material for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis

Supplemental material, sj-jpg-5-cpc-10.1177_10556656221128413 for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis by Abdullah M. Said, Ema Zubovic, Kristin D. Pfeifauf, Gary B. Skolnick, Jude Agboada, Penina Acayo-Laker, Sybill D. Naidoo, Mary C. Politi, Matthew Smyth and Kamlesh B. Patel in The Cleft Palate-Craniofacial Journal</p

sj-jpg-9-cpc-10.1177_10556656221128413 - Supplemental material for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis

Supplemental material, sj-jpg-9-cpc-10.1177_10556656221128413 for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis by Abdullah M. Said, Ema Zubovic, Kristin D. Pfeifauf, Gary B. Skolnick, Jude Agboada, Penina Acayo-Laker, Sybill D. Naidoo, Mary C. Politi, Matthew Smyth and Kamlesh B. Patel in The Cleft Palate-Craniofacial Journal</p

sj-jpg-1-cpc-10.1177_10556656221128413 - Supplemental material for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis

Supplemental material, sj-jpg-1-cpc-10.1177_10556656221128413 for Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis by Abdullah M. Said, Ema Zubovic, Kristin D. Pfeifauf, Gary B. Skolnick, Jude Agboada, Penina Acayo-Laker, Sybill D. Naidoo, Mary C. Politi, Matthew Smyth and Kamlesh B. Patel in The Cleft Palate-Craniofacial Journal</p