Bilateral Lip Research Articles

Analysis of Different Facets of the Rule of 10 for Cleft Lip Repair for Their Application in the Current Era.

To evaluate the relevance of the "rule of 10" as a deciding factor preoperatively for patients undergoing cleft lip repair in the Indian sub-continent. A questionnaire survey was conducted. All tertiary cleft care centers in the Indian subcontinent participated in an online questionnaire survey with anesthetic and surgical professionals. The primary goal of this survey was to determine the relevance and applicability of various aspects of the rule of 10 as a preoperative guideline for determining the timing of cleft lip repair in ASA I infants. The survey also aids in understanding the systemic factors that need to be prioritized and factors that are no longer of primary relevance indefining the timeline to undertake cleft lip repair in infants inthe current era. Surgeons and anesthetists from 31 tertiary cleft centers in India responded to the questionnaire. Specifically, 64.5% do not apply the "rule of 10" for deciding the timing of cleft lip repair, and 77% of the centers reported that cleft lip repair can be taken up in infants with hemoglobin levels in the range of 9-10 g/dL and an average weight of 4.5 kg. The average blood loss in unilateral lip repair ranged between 5 and 10 mL and 10 and 40 mL in children with bilateral lip repair. Three to six months was the average age at which cleft lip repair was undertaken at most of the centers in India. The rule of 10 is not considered a gold standard by most of the centers in India, and the decision-making was based on the overall physiological status of the patients, the experience of the surgeon, and the anesthetic and post-operative care facilities available at the center.

An ex vivo model for education and training of bilateral cleft lip surgery

BackgroundBilateral cleft lip surgery is very challenging and requires a high level of skill, knowledge and experience. Existing high-fidelity simulation models that can be used by novice cleft surgeons to gain experience and expand their knowledge are rare and expensive. In this study, we developed a bilateral cleft lip model using porcine snout discs, which are available anywhere and inexpensive.MethodsAnatomic reference points of a patient with a bilateral cleft lip were superimposed with landmarks of the porcine snout disc on a foil template. The template was used to construct an ex vivo bilateral cleft lip model. Surgery was performed on the model according to Millard and the surgical steps were photodocumented analogous to two clinical cases of bilateral cleft lip surgery. The suitability of the model was further tested by twelve participants and evaluated using self-assessment questionnaires.ResultsThe bilateral cleft lip ex vivo model made of a porcine snout disc proved to be a suitable model with very low cost and ease of fabrication, as the template is reusable on any snout disc. The Millard procedure was successfully performed and the surgical steps of the lip plasty were simulated close to the clinical situation. Regarding the nasal reconstruction, the model lacks three-dimensionality. As a training model, it enhanced the participants comprehension of cleft surgery as well as their surgical skills. All participants rated the model as valuable for teaching and training.ConclusionsThe porcine snout discs can be used as a useful ex vivo model for bilateral cleft lip surgery with limitations in the construction of the nose, which cannot be realistically performed with the model due to anatomical differences with humans. Benefits include a realistic tissue feel, the simulation of a multi-layered lip construction, a wide and rapid availability and low cost. This allows the model to be used by novice surgeons also in low-income countries. It is therefore useful as a training model for gaining experience, but also as a model for refining, testing and evaluating surgical techniques for bilateral lip plasty.

Three-dimensional analysis of lip soft tissue changes and related jaw changes in patients with skeletal class III malocclusion and facial asymmetry.

To investigate three-dimensional soft tissue changes of lips and related jaw changes in patients with skeletal class III malocclusion and facial asymmetry using cone-beam computerized tomography (CBCT). This study included 46 CBCT scans of patients with aforementioned character before (T1) and 6-12 months after orthognathic surgery (T2). Subjects were divided into 2 groups according to two types of orthognathic surgery namely, the one-jaw surgery group who underwent bilateral sagittal splint ramus osteotomy (BSSRO) and the two-jaw surgery group who underwent Le Fort I osteotomy and BSSRO. Mimics 19.0 software are used for model reconstruction, landmark location and three-dimensional cephalometric analysis. Descriptive statistics and correlation analyses are used to investigate jaw hard tissue and lip soft tissue changes. In one-jaw group, the mandible shows changes in contour and position (p < 0.05), and the surgery causes changes of lip structure on the deviated side. While in two-jaw group, jaws only show changes in spatial position, and surgery changes contour of bilateral lips and nasolabial angle (p < 0.05). At the same time, lip symmetry increases significantly in both groups postoperatively. Orthognathic surgery can improve lip aesthetics in patients with skeletal class III malocclusion and facial asymmetry. However, changes induced by two surgical approaches are different. Surgeons should have a clear acquaintance with this difference to deal with different situations.

A Guide to Bilateral Cleft Lip Markings: An Anthropometric Study of the Normal Cupid's Bow.

The aim of this study was to define the ratio of the heights of the vermilion between the peaks and trough of the Cupid's bow and hence assist in defining the point of closure on the lateral lip element to achieve a balanced Cupid's bow in bilateral lip repair based on our findings. This study is a retrospective observational study of the anthropometrics of the upper lip's Cupid's bow. Three-dimensional (3D) images of toddlers between 2009 and 2016 were extracted from a normative 3D image database of toddlers at the Royal Children's Hospital, Melbourne. Participants from the normative 3D image database at the age of 1 year were studied. This excluded any patients with prior trauma or surgical intervention of the nasolabial region. Landmarks measured were right and left crista philtri (cphR and cphL), labial superius (ls), stomion (sto), right and left chelion, and labial fissure (lf). Vermilion height of the right peak, trough, and left peak of the Cupid's bow was calculated by analyzing the vertical linear distance between cphR-lf, ls-sto, and cphL-lf. The ratio between the median and paramedian heights were recorded. The paramedian height of the upper lip vermilion is consistently greater than the midline height. There was no significant sexual dysmorphism between ratio of paramedian to midline height on the right (P = .538) and left (P = .410). We describe an anthropometric observation of the vermilion relationship at the Cupid's bow and define a specific lateral lip marking for bilateral cleft lip repair based on our anthropometric findings.

Preoperative analysis of upper lip in patients with upper cleft lip/palate before lip repair.

BackgroundThe postoperative morphological appearances vary widely patients with unilateral cleft lip with or without cleft palate (UCL/P), whether it is complete or incomplete cleft. The main reason of bilateral lip asymmetry after cleft lip surgery lies in the lack of personalized measurement and design before surgery. In this study, we aim to individually investigate areas of the upper lip on cleft and non-cleft sides in patients with unilateral cleft lip with or without cleft palate (UCL/P).MethodsNinety-two patients with UCL/P (group 1: <1 year, group 2: 1–2 years) were included in the study. Group 1 included 37 patients with incomplete UCL/P and 29 with complete UCL/P; group 2 included 11 and 15 patients, respectively. The total area of the upper lip on the cleft side (Q8) was divided into Q3, Q4, and Q5 (further divided into a1 and a2), and the upper lip on the non-cleft side (Q7) was divided into Q2 and Q1 (further divided into A1 and A2). Area ratios between the cleft and the non-cleft sides were calculated, and certain parameters were tested for correlations with these ratios.ResultsValues of Q8/Q7 were partially overlapped between patients with complete and incomplete UCL/P. Significant correlations were noted between differences in height of the philtrum column (a–h) and the prolabial area ratio between the cleft and the non-cleft side (Q3/Q2) (P=0.032). Moreover, a significant correlation was noted between a1/A1 and the ratio of the lateral labial area between the cleft and the non-cleft side (Q5/Q1) (P=0.001).ConclusionsThe conventional classification of unilateral cleft lip as incomplete and complete does not completely and accurately reflect individual malformations. Therefore, it is necessary to analyze unilateral cleft lips individually to determine the repair technique and to predict postoperative outcomes.

Osteotomy of the Premaxilla in Bilateral Cleft Lip: A Useful Technique Following Failure of Primary Lip Closure.

Successful aesthetic repair of the bilateral cleft lip and palate (BCLP) is one of the most challenging cases encountered by a surgeon. This challenge is heightened when the premaxilla is anteriorly protruded in relation lateral maxillary segments. Our aim is to demonstrate a useful technique for reducing the cleft size before secondary lip repair. We use a premaxillary osteotomy to posteriorly reposition the premaxilla between the lateral segments. Six patients with BCLP underwent repositioning of the protruded premaxilla. Five patients had previous primary lip closure procedures with unsatisfactory results. The cleft size was reduced by premaxillary osteotomy from nasal septum and partial removal of the vertical vomer. The osteotomized premaxilla was then repositioned, fixed with a custom-made orthodontic appliance. Following this procedure, the lip was closed in a traditional fashion. All patients demonstrated satisfying lip closure without tension. In each case, the premaxilla was vital and exhibited partial stabilization during follow-up. In this study the authors demonstrate the usefulness of a premaxillary segment setback as an adjunct to improved function and aesthetics in bilateral lip repair. This method serves as useful technique for previously unsuccessful closure of BCLP.

Surgical Nasoalveolar Molding: A Rational Treatment for Bilateral Cleft Lip Nose and Systematic Review.

Background:The purpose of this study was to evaluate the surgical outcome after using primary surgery to address bilateral cleft lip nose and palate deformities. In addition, the authors performed a systematic review to evaluate the effects of the nasoalveolar molding on non-syndromic bilateral cleft lip and palate.Methods:A prospective cohort study on a surgeon’s surgical outcome of 25 consecutively performed primary bilateral cleft lip nasal deformity repairs was conducted and a systematic review of the literature for studies published until December 2019 was done to evaluate the effect of presurgical NAM on nasolabial aesthetics and alveolar gap.Results:Since 2014, 25 consecutive patients with complete bilateral cleft have undergone primary anatomical repair of the cleft nasal deformity using primary cheilorhinoplasty. The average columella length was 4.3 ± 1.3 mm. The average ratio of the columella height to nasal height was 0.48 mm 1 year postoperatively and 0.52 mm 5 years postoperatively. Statistically significant differences have been observed between the pre and postoperative alveolar and palatal gaps after using primary cheiloplasty or bilateral lip adhesion. After systematic literature searching, 14 identified studies were qualified for the final analysis, which included 433 patients. The overall study quality according to Oxford CEBM and GRADE scale was low.Conclusions:The results of this study suggest that the proposed primary cheilorhinoplasty is a good alternative to improve nose appearance and alveolar gap in patients with primary bilateral cleft lip nose and palate deformity. Based on the available scientific evidence, definitive conclusions about the effectiveness of presurgical Naso Alveolar Molding on nasolabial aesthetics cannot be drawn. Quality of the included articles were too low to make a conclusion.

Mouth opening is mediated by separation of dorsal and ventral daughter cells of the lip precursor cells in the larvacean, Oikopleura dioica.

Mouth formation involves the processes of mouth opening, formation of the oral cavity, and the development of associated sensory organs. In deuterostomes, the surface ectoderm and the anterior part of the archenteron are reconfigured and reconnected to make a mouth opening. This study of the larval development of the larvacean, Oikopleura dioica, investigates the cellular organization of the oral region, the developmental processes of the mouth, and the formation of associated sensory cells. O. dioica is a simple chordate whose larvae are transparent and have a small number of constituent cells. It completes organ morphogenesis in 7 h, between hatching 3 h after fertilization and the juvenile stage at 10 h, when it attains adult form and starts to feed. It has two types of mechanosensory cell embedded in the oral epithelium, which is a single layer of cells. There are twenty coronal sensory cells in the circumoral nerve ring and two dorsal sensory organ cells. Two bilateral lip precursor cells (LPCs), facing the anterior surface, divide dorsoventrally and make a wedge-shaped cleft between the two daughter cells named the dorsal lip cell (DLC) and the ventral lip cell (VLC). Eventually, the DLC and VLC become detached and separated into dorsal and ventral lips, triggering mouth opening. This is an intriguing example of cell division itself contributing to morphogenesis. The boundary between the ectoderm and endoderm is present between the lip cells and coronal sensory cells. All oral sensory cells, including dorsal sensory organ cells, were of endodermal origin and were not derived from the ectodermal placode. These observations on mouth formation provide a cellular basis for further studies at a molecular level, in this simple chordate.

Functional Characterization of a Novel IRF6 Frameshift Mutation From a Van Der Woude Syndrome Family.

BackgroundLoss-of-function mutations in interferon regulatory factor-6 (IRF6) are responsible for about 70% of cases of Van Der Woude Syndrome (VWS), an autosomal dominant developmental disorder characterized by pits and/or sinuses of the lower lip and cleft lip, cleft palate, or both.MethodsWe collected a Chinese Han VWS pedigree, performed sequencing and screening for the causal gene mutant. Initially, species conservation analysis and homology protein modeling were used to predict the potential pathogenicity of mutations. To test whether a VWS family-derived mutant variant of IRF6 retained function, we carried out rescue assays in irf6 maternal-null mutant zebrafish embryos. To assess protein stability, we overexpressed reference and family-variants of IRF6 in vitro.ResultsWe focused on a VWS family that includes a son with bilateral lip pits, uvula fissa and his father with bilateral cleft lip and palate. After sequencing and screening, a frameshift mutation of IRF6 was identified as the potential causal variant (NM.006147.3, c.1088-1091delTCTA; p.Ile363ArgfsTer33). The residues in this position are strongly conserved among species and homology modeling suggests the variant alters the protein structure. In irf6 maternal-null mutant zebrafish embryos the periderm differentiates abnormally and the embryos rupture and die during gastrulation. Injection of mRNA encoding the reference variant of human IRF6, but not of the frame-shift variant, rescued such embryos through gastrulation. Upon overexpression in HEK293FT cells, the IRF6 frame-shift mutant was relatively unstable and was preferentially targeted to the proteasome in comparison to the reference variant.ConclusionIn this VWS pedigree, a novel frameshift of IRF6 was identified as the likely causative gene variant. It is a lost function mutation which could not rescue abnormal periderm phenotype in irf6 maternal-null zebrafish and which causes the protein be unstable through proteasome-dependent degradation.

Clinical application of autologous costal cartilage transplantation in repair of upper lip depression in secondary repair of cleft lip

To discuss the clinical application and effectiveness of autologous costal cartilage transplantation in the repair of upper lip depression in the secondary repair of cleft lip. The clinical data of 10 patients of secondary repair of upper lip depression with cleft lip by autologous costal cartilage transplantation between January 2017 and January 2019 were retrospectively analysed. There were 7 males and 3 females with an average age of 24 years (range, 18-33 years). There were 8 cases of bilateral lip fissure and 2 cases of unilateral lip fissure. All of them underwent early lip repair at the age of 2-3 years old. The change of the profile of the soft tissue profile of the upper lip of the patient was quantitatively analyzed before operation and at immediate after operation, including the soft tissue facial angle (G-Sn-Pg'), the nasolabial angle (Cm-Sn-UL), the mentolabial angle (UL-LL-Pg'), the distance between the most salient point of the upper lip to the aesthetic plane (UL-E), the highest point of the frontal part, the projection distance of the most salient point of the upper lip on the plane of the orbital ear (G-UL), and the upper lip protrusion (ULP). One case had incision infection and healed after dressing change, and in the other 9 patients, the incisions healed by first intention, and no acute infection and other complications occurred. The appearance of the lateral morphology of the upper lip at immediate after operation was significantly improved when compared with that before operation. The value of UL-LL-Pg', UL-E, G-UL, and ULP were significantly increased and G-Sn-Pg' was significantly decreased when compared with preoperative ones ( P<0.05). There was no significant difference in Cm-Sn-UL between pre- and post-operation ( t=0.821, P=0.433). All the 10 patients were followed up 6-24 months, with an average of 15 months. During the follow-up, the soft tissue morphology of the upper lip was good. No long-term complications such as cartilage absorption and cartilage displacement were found. Autologous costal cartilage transplantation is a safe and effective treatment for upper lip depression in the secondary repair of cleft lip.

LATE RECURRENCE OF BURKITT LYMPHOMA IN THE JAW: NUMB CHIN SYNDROME AS THE ONLY SYMPTOM

Late recurrence of Burkitt lymphoma (BL) is rare, especially in the oral region. A 58-year-old woman, treated 9 years ago for a BL in the tonsil, described a 2-week history of sensitive alteration and pain in the chin region. Physical examination revealed a complete paresthesia involving the bilateral chin and lower lip. No other alterations were found at cone beam computed tomography and at clinical examination. Through magnetic resonance exam, it was possible to identify an alteration in the mandibular body extending to the entire right side. An intraosseous biopsy was performed and the immunohistochemical profile revealed positivity to BCL-6, CD-10, CD-20, C-MYC, and PAX-5 demonstrating the presence of a mature B cell lineage, consistent with the diagnosis of BL. The in situ hybridization was negative for Epstein-Barr virus. The rescue chemotherapy treatment was initiated and the patient is under follow-up care.

Comparative Aesthetic Evaluation of Lip Reconstruction Using Abbe's Flap in Secondary Cleft Lip Deformities: A Retrospective Study.

To objectively evaluate the surgical outcome of deformed cleft lip treated by Abbe's flap using Digimizer image analysis software. Fifteen Abbe's flap (AF) reconstruction cases with satisfactory photographic records were acquired in Digimizer image analysis software. Anthropometric landmarks were marked on the lip. Bilateral lip lengths, height and width were measured preoperatively and postoperatively after AF reconstruction for comparison. It was observed that by AF reconstruction, we could increase vermillion lip length and Cupid's bow width, hence providing adequate bulk to the middle of the lip. In addition to it, in some cases we could achieve the acceptable anatomy of the centre of the Cupid's bow with which it was sometimes disturbed during primary cheiloplasty. Lip length and lip height became proportionately equal bilaterally, leading to adequate lip symmetry in all cases. Computer-assisted anthropometric analysis of photographs using Digimizer image analysis software (MedCalc Software, Belgium) demonstrates that AF lip reconstruction technique produces aesthetic lip consistently.

Early cleft lip and palate repair: Experience of the National Orthopedic Hospital Enugu, Southeast Nigeria

Background: Surgical treatment of clefts during infancy poses a challenge for the plastic surgeon and anesthetists. The timing of the procedures has been fraught with controversies with no consensus. Due to the many different treatment philosophies, the timing of treatment varies among cleft centers. Historically, anesthetic risk-related data suggest that the safe time period for surgery in this population of infants could be outlined by the rule of 10's. However, more sophisticated pediatric techniques and advances in intraoperative monitoring and pediatric anesthesia have resulted in the provision of safe general anesthesia for younger infants. This article attempts to provide an audit of the outcome and complications of cleft lip/palate repair performed earlier than the hitherto defined period. Aims/Objectives: The aims of the study were to evaluate the perioperative safety profile of early cleft lip and palate repairs and to evaluate early postoperative surgical complications. Materials and Methods: A retrospective audit of all patients that had early cleft lip and palate repair at the National Orthopedic Hospital Enugu, Nigeria, between May 2006 and May 2014. Early cleft lip and palate repairs were defined as repair done before 10 weeks and 9 months, respectively. Information was obtained from the folders of the patients and the smile train express database. The anesthetic technique was general anesthesia with endotracheal intubation and halothane as the inhalational agent. Armored tubes were used for palatal repairs. The Mohler's technique and Mulliken's technique were used for unilateral and bilateral lip repair, respectively. Intravelar veloplasty ± relaxing incisions/Bardach two-flap palatoplasty were used for palate repairs. All the procedures were carried out by one consultant plastic surgeon. Results: Four hundred and ninety-three cleft-related surgeries were performed in the period. Forty-one were early cleft lip/palate repairs. Thirty-one of these early procedures were done on the lip, whereas ten procedures were on the palate. There were no mortalities. One patient (2.4%) developed anesthetic complication (prolonged recovery time). There was neither need for intra- nor postoperative transfusion. One patient had a need for supplemental oxygen therapy beyond 1 h. There was no need to take any patient back to theater. The most common early complications following lip and palate repairs were wound dehiscence and palatal fistulae, respectively. Conclusion/Recommendation: These procedures can be safely carried out when performed early. The surgical complication rates appear to be few following early procedures. Further study on long-term cleft repair on facial growth and speech needed.

Prominent premaxilla management on bilateral cleft lip and palate

The treatment cleft lip and palate (CLP) should start at an early age with a multidisciplinary team and with a comprehensive approach. The aim of the management of protruded premaxilla in patients with bilateral CLP is to relocate the premaxilla to achieve surgical closure of the lip. The objective of the case report is to present the surgical-orthodontic treatment for the surgical reposition of the protruded premaxilla in a 3-year-old patient with BCLP. A patient of 3 years old with BCLP his treatment plan is a surgical reposition of the premaxilla and posterior closure of the primary lip. The surgical reposition of the premaxilla was made planning the osteotomy with dental casts. After 6 months of starting the surgical-orthodontic treatment, the patient meets bilateral lip closure satisfactorily without reported complications. Planning of the treatment allows performing a procedure that reduces the likelihood of complications and achieving the closing of the lip to reestablish the function, anatomy, and esthetics.

COMPREHENSIVE REHABILITATION OF DISABLED CHILDREN WITH BILATERAL THROUGH-CLEFT LIP AND PALATE IN KRASNODAR REGION

Aim.This study was designed to evaluate the immediate and long-term results of the Protocol of complex rehabilitation of 15 Kubanskij nauchnyj medicinskij vestnik 2018; 25 (5) children with bilateral through-cleft lip and palate (BTCLP) developed by the Department of pediatric dentistry, orthodontics and maxillofacial surgery of KSMU.Materials and methods. There was conducted the evaluation of the immediate and long-term results of the complex treatment of 25 patients with BTCLP aged 0 to 18 years according to the Protocol developed by the Department of pediatric dentistry, orthodontics and maxillofacial surgery of KSMU.Results. There was carried out a detailed analysis of the results of the application of the function-forming plate (FFP) in patients with BTCLP aged 0 to 1 year. The results of the models measurement in dynamics showed a significant growth and development of the upper jaw, the approximation of the shape and size of the upper alveolar arc to the norm, reducing the distance between its fragments to the minimum. There was established that long-term gradual orthodontic treatment provides conditions for physiological growth and development of the facial skeleton and for the formation of physiological occlusion in children with BTCLP. The usage of gentle methods of uranoplasty reduces the risk of dentoalveolar anomalies in children with BTCLP. The complex of therapeutic measures and terms of surgical intervention should be planned individually. The elimination of the defects of the alveolar process of the upper jaw by the method of autoosteoplasty is a necessary step in the complex rehabilitation of children with BTCLP during the periods of changing and forming permanent dentition. The planning of the stage of prosthetics of patients with BTCLP is individual and involves the creation of conditions for fullfledged functions of chewing, swallowing and speech, and it is recommended to carry it out with the help of modern aesthetic constructions that ensure the preservation of the results of the complex, including orthodontic, treatment.Conclusion.The analysis of the photographs of the face, TRG, CT and jaws diagnostic models obtained during the treatment of children and adolescents with congenital cleft lip and palate confirms the high morphofunctional and aesthetic result of the application of the developed at the Department of pediatric dentistry, orthodontics and maxillofacial surgery of KSMU Protocol of comprehensive rehabilitation of children with BTCLP.

PC115: Multidisciplinary approach to functional and esthetic therapy of the patient with bilateral palatal and lip cleft

PC115: Multidisciplinary approach to functional and esthetic therapy of the patient with bilateral palatal and lip cleft

Case series of rare cases of bilateral open lip Schizencephaly presenting with Status Epilepticus

Case series of rare cases of bilateral open lip Schizencephaly presenting with Status Epilepticus

Gelfoam Interposition Minimizes Risk of Fistula and Postoperative Bleeding in Modified-Furlow Palatoplasty.

Failure to accomplish a tension-free, watertight closure predisposes the palatoplasty patient to fistula formation. Perioperative bleeding also places the patient at risk for adverse airway events (AAE). This study introduces the incorporation of a hemostatic gelatin sponge (Gelfoam) into layered palatoplasty to minimize adverse postoperative bleeding and fistula formation. A retrospective chart review was performed to identify subjects who underwent Furlow palatoplasty with insertion of Gelfoam from 2010 to 2015. Exclusion criteria include age >3 years, prior palate surgery, <30-day follow-up, immunosuppressive state, and diagnosis of Treacher-Collins or Apert Syndrome. Demographic data include age, sex, cleft laterality, prior surgeries, Veau classification, Pierre Robin status, and tracheostomy dependence. Primary outcome was fistula formation. Secondary outcomes included perioperative metrics and AAE.One hundred subjects met criteria, 45% female. Average age was 14.6 months. Subjects with syndromes comprised 28%, with 16% diagnosed with Pierre Robin. Two subjects were tracheostomy-dependent. Prior cleft and mandibular procedures were performed in 55%. Isolated palatal defects were seen in 46%, unilateral lip and palate in 41%, and bilateral lip and palate in 13%. The majority of defects were Veau II and III (35% and 34%, respectively). Adverse airway events occurred in 2%, one of which resulted in reintubation. One subject (1%) was found to have a postoperative fistula.The incorporation of Gelfoam in the modified-Furlow palatoplasty results in a low rate of oronasal fistula (1%) and low perioperative risk of AAE. Further prospective comparison of this method to others will be the focus of future work.

Clinically Available Assessment Measures for Lingual and Labial Somatosensation in Healthy Adults: Normative Data and Test Reliability.

High-quality orofacial somatosensory inputs are essential for achieving rapid and accurate motor outputs. Little somatosensory testing is currently being completed in clinical settings. The purpose of this study is to assess the feasibility and test-retest reliability of clinical assessment tools for orofacial somatosensory testing in healthy young adults. A total of 45 healthy young adults (ages 20-41 years) was recruited. Participants reported basic health information, completed pure-tone hearing thresholds, and were assessed using two-point discrimination discs and Von Frey hair detection and discrimination thresholds for bilateral lip and tongue. A subsample of participants (n = 18; 40%) returned to complete reliability testing. Descriptive results are presented for the normative group as well as the reliability group. Difference scores between Tests 1 and 2 for each testing measure and location show high agreement. Two-point discrimination and Von Frey hair monofilament assessment for both detection- and discrimination-threshold estimates have high test-retest reliability in a healthy young population. These testing measures could be a way to easily complete objective somatosensory testing of the orofacial region in a clinical context.

Bilateral cleft lip revision: techniques and results

Bilateral cleft lip deformities can be difficult to correct and it is universally agreed that a large number of cases will require further revisions after the primary repair. The need for secondary repair and the type of secondary deformities is determined by the following:1.Type and severity of the initial cleft.2.The principles applied in the primary repair of these deformities. This presentation will look at the effect of different principles applied during the primary repair and how to manage the secondary deformities resulting from use of different principles of repair. The principles of repair will be considered under the following heads:1.Presurgical orthopaedics2.Lip adhesion procedures3.Staging of bilateral lip repair4.The utilisation of the prolabial tissues5.Muscle approximation6.Reconstruction of the central vermilion7.Sulcal release incision8.Management of the nasal deformities.