Mucoperiosteal Flap Research Articles

Oronasal Fistula Incidence Associated With Vomer Flap Repair of Cleft Palate: A Systematic Review and Meta-Analysis.

To determine the incidence of oronasal fistulas (ONF) associated with primary repair of the anterior palate using a single-layered, superiorly based, vomer mucoperiosteal flap. A systematic review of MEDLINE, PubMed, Cochrane, and Web of Science databases using the keywords: "vomer flap" and "cleft palate repair" were carried out. A meta-analysis was performed using random effect modeling with stratified analysis by syndromic diagnosis, number of surgeons, and mean age. Incidence of ONFs. The meta-analysis included 9 studies with a total of 464 children who met inclusion criteria. The overall ONF rate was 3.0% (95% CI: 1.0-9.0). Fistula rates were not significantly different in studies that included syndromic patients compared to studies that did not, 5.0% (95% CI: 1.0-24.0) versus 3.0% (95% CI: 1.0-6.0), respectively. There was no significant difference between studies in which there was a single surgeon versus multiple surgeons, 3.0% (95% CI: 1.0-13.0) versus 4.0% (95% CI: 1.0-8.0), respectively. Age at the time of cleft repair showed no statistically significant difference in fistula rate when comparing children with a mean age less than 12 months to those greater than 12 months, 3.0% (95% CI: 1.0-5.0) versus 5.0% (95% CI: 1.0-28.0), respectively. The vomer flap technique in cleft palate repair appears to be associated with a low ONF rate unaffected by syndromic diagnosis, number of surgeons, or patient age at time of repair.

Clinical and radiographic diagnostic study of strontium ranelate and metal-substituted hydroxyapatite bone graft materials in diabetes mellitus with chronic periodontitis

Background The present study aimed to assess the clinical and radiographic effect of strontium ranelate and metal-substituted hydroxyapatite as bone graft materials on treating chronic periodontitis among diabetes mellitus patients. Methods A randomized split-mouth study was conducted on 20 sites in 10 controlled type II diabetic patients suffering from chronic periodontitis. After phase I therapy, the sites were randomly allocated by a computer-generated table into two groups. Group 1: A mucoperiosteal flap was elevated in 10 sites, followed by the placement of strontium ranelate mixed with Gengigel. Group 2: A mucoperiosteal flap was elevated in 10 opposite sites, followed by the placement of metal-substituted hydroxyapatite mixed with Gengigel. Clinical parameters were assessed at baseline and 3- and 6-month intervals. Cone-beam computed tomography (CBCT) was used at baseline and after six months to assess bone gain. Results The two treatment modalities resulted in a statistically significant reduction in clinical parameters at the 3- and 6-month intervals compared to the mean baseline value. Intergroup comparison showed a significant reduction in probing pocket depth and clinical attachment loss in group 1 compared to group 2. Comparison of the two sides by CBCT showed a significant increase in the alveolar bone height in the SR group than the metal-substituted hydroxyapatite group. Conclusion Clinical and radiographic results showed a significant improvement in the two groups and provided evidence that strontium ranelate is promising in treating periodontal diseases.

Use of Platelet-Rich Fibrin for Jaw Osteonecrosis: A Case Report

Summary We present tooth extraction in a patient treated with bisphosphonates (BPs) for cancer and at risk of osteonecrosis of the jaw. The administration of platelet-rich fibrin (PRF) is an innovative method of promoting wound healing that allows hermetic closure at the surgical site after extraction without mucoperiosteal flaps or periosteal release sections. Here, we describe the case of a 60-year-old man who had osteonecrosis of the upper jaw and underwent surgery for prostate cancer in 2012. In 2014, bone metastases were detected, and the patient was treated with Xgeva and Zometa: a two-year therapy with Xgeva, followed by treatment with Zometa. In 2018, after extraction of a tooth in the upper right jaw, a healing wound of extraction and stripping of the maxillary bone occurred. The patient was admitted for hospital treatment and underwent surgery to remove the osteonecrotic lesion, sequester and administer PRF (platelet-rich fibrin), and sew tightly. As a result of the treatment, complete re-epithelialization of the wound without infection occurred. Generally, in more invasive surgical procedures, the use of PRF to close the wells after extraction in patients receiving BP appears to be a promising alternative. Additional clinical trials will be essential t to clarify the effectiveness of PRF in preventing BP-related osteonecrosis after tooth extraction.

СРАВНЕНИЕ ПОКАЗАТЕЛЕЙ АКТИВНОСТИ МАТРИКСНЫХ МЕТАЛЛОПРОТЕИНАЗ ПРИ УСТАНОВКЕ ДЕНТАЛЬНЫХ ИМПЛАНТАТОВ ПО СТАНДАРТНОЙ МЕТОДИКЕ И С ИСПОЛЬЗОВАНИЕМ НАВИГАЦИОННЫХ ИМПЛАНТОЛОГИЧЕСКИХ ШАБЛОНОВ

Subject. Recent clinical studies have shown that implant placement is highly predictable using 3D computer-generated implant guides, but there is no clinical comparison between the body's response to trauma during a dental implant surgery. After bone surgery (implant placement), intracellular chemical signals trigger a suitable cellular response to external changes in order to develop specific and adaptive responses in tissues to external stimuli.
 The aim is to compare the severity of the release of matrix metalloproteinases in the oral cavity during dental implantation operations using implant templates and flapless techniques and using the standard technique. Collection and comparison of data on the possibility of using matrix metalloproteinases in saliva/oral fluid as a biomarker and predictor of the activity of healing and tissue remodeling during dental implantation.
 Methodology. The oral fluid of 22 patients was studied for the quantitative content of matrix metalloproteinases 2, 3, 9, 8, 12 before and after 3, 14 and 30 days after the dental implantation operation. All study participants were divided into two groups: control and experimental. In the control operation, it was carried out according to the standard technique with folding the muco-periosteal flap, in the experimental one - using implant templates according to the flapless technique.
 Results. The data obtained indicated a change in indicators in both groups. In the control group, there was a significant excess of indicators, which indicates a more pronounced reaction of the body.
 Conclusions. The positive influence of the use of implant templates in order to minimize trauma during the dental implantation operation was established.

Analysis of treatment methods for children with bilateral complete cleft of the lip and palate in mixed bite

Relevance. According to the World Health Organization, it was found that cleft lip and palate cases ranges from 0.6 to 1.6 cases per 1000 newborns. According to the severity of the lesion, bilateral cleft lip and palate takes the first place, however, it occurs much less common – 15-25%.Purpose – to analyze methods of treatment in children with bilateral cleft lip and palate during the period of the mixed dentition.Materials and methods. An analysis of 51 sources Russian and foreign articles for the period from 1951 to 2019 was carried out. The features of the development of occlusion in children with bilateral cleft lip and palate during the period of a changeable occlusion, as well as methods of treating this pathology, are considered.Results. It was found that the main anatomical features of the maxillofacial region in children with bilateral cleft lip and palate during the period of a changeable bite are -narrowing of the upper and lower jaws, the presence of soft tissue scars. The main methods of treatment for such children are reconstructive surgery, including the closure of a hard palate defect using a mucoperiosteal flap cut out in the lateral part of the hard palate, as well as orthodontic treatment methods, the main purpose of which is to expand and extend the dentition using single jaw removable plate apparatuses, fixed plate apparatuses.Conclusions. Taking everything into account, surgical reconstructive operations, as well as complex orthodontic treatment, the main purpose of which is to expand and extend the upper and lower jaws, are the integral methods of treating such children. Orthodontic treatment should be aimed at eliminating myofunctional disorders with the helpof orthodontic trainers and elastopositioners. Conducting a comprehensive surgical and orthodontic treatment can reduce the rehabilitation time of children with bilateral cleft lip and palate.

Enhancement of bone perfusion through cortical perforations to improve healing of medication-related osteonecrosis of the jaw: a retrospective study

Medication-related osteonecrosis of the jaw (MRONJ) is generally difficult to treat. So far, no optimal strategy for MRONJ has been established. The aim of this study was to determine whether a new surgical technique, i.e. curettage with cortical perforations of healthy adjacent bone that enhances bone perfusion would be more effective than standard curettage in treating patients with MRONJ. Twenty-eight MRONJ patients who underwent curettage treatment with or without cortical perforation technique at our institution between June 2014 and May 2016 were included in this retrospective study. Ten cases treated using cortical perforation technique were completely cured after primary wound closure with mucoperiosteal flap. During a long-term follow-up, two cases from the cortical perforation group relapsed at the mandibular sites 6 and 40 months post-operation, respectively, while in the control group, 77.8% (14/18) cases relapsed due to infected mucosa fistula or bone exposure 1–3 months after treatment. It was concluded that the new treatment approach might be more effective in treating patients with MRONJ caused by antiresorptive drugs. However, more extensive randomized trials are needed to further evaluate its efficacy in clinic.

Alveolar ridge split technique and immediate implant placement in atrophic maxilla. Case series

Background: Alveolar ridge split technique (ARST) is a surgical procedure performed for horizontal ridge augmentation in cases of narrow crestal ridges. It is a biologically oriented technique, taking advantage of the osteogenic and osteoconductive dynamic of the native bone. Recently, the utilization of devices such as thin diamond disks or piezoelectric cutting devices has enhanced ARST success rate, reduced surgical time and patient's morbidity, regardless of bone quality. Aim/Hypothesis: The purpose of this poster is to present and discuss our experience in a series of clinical cases where ARST was performed for horizontal bone augmentation with simultaneous implant placement, using classical or piezoelectric-assisted surgical procedures. Materials and Methods: ARST was performed in 6 patients with 10 sites of horizontal defects. Under local anesthesia, a crestal incision was performed and a full thickness mucoperiosteal flap was reflected. Initial osteotomy was done using the classical technique in 6 cases (diamond disk, rotary burs), while a piezoelectric device was used to the remaining 4 cases. Osteotomes and chisels with gradually increasing dimensions were used to expand the alveolar ridge to facilitate the immediate placement of 18 implants, approximately 2 mm subcrestally in order to prevent marginal bone loss. The remaining space between bony plates was filled with allograft or xenograft and covered with collagen membrane in 9 cases, while in one case no bone graft or membrane were used. Primary closure without tension was achieved with periosteum releasing incisions of the buccal flap. Post-operative instructions included administration of antibiotic and analgesic, chlorhexidine solution, smoke cessation and thorough oral hygiene. Results: Sutures were removed 10 days postoperatively. Follow up was uneventful for 5 out of 6 patients. One patient did not comply with the postoperative instructions, applying poor oral hygiene and continuing smoking as before which resulted in exposure of the collagen-membrane the second week, leading to secondary wound closure compromising the augmentation. A new CBCT was performed 4 months following the split which revealed successful bone augmentation and implant osseointegration without any significant bone loss around the implants. Oral rehabilitation with either fixed or removable prosthetics was accomplished and the patients remain under systematic review. Conclusions and Clinical Implications: ARST is a predictable and reliable procedure characterized by its low invasiveness and morbidity. The major advantage is the simultaneous bone augmentation- implant placement, which provides reduced treatment time and cost. Piezoelectric devices make the split technique easier and safer, decreasing the risk of complications in the treatment of extremely atrophic crests. ARST's success and efficacy depends greatly on patient selection in order for the basic anatomical criteria to be fulfilled. Keywords: ridge splitting, horizontal bone augmentation, piezoelectric device

Efficacy of Platelet Rich Fibrin on Angiogenesis

In this experiment we used platelet-rich fibrin (L-PRF) with the protocol of its production, in this study we tried to investigate the angiogenetic efficacy of L-PRF on s soft tissue. Blood samples of 8 sheep were used to establish the protocol of the L-PRF formation to develop the work. The mucoperiosteal flaps were filled with autologous L-PRF in the mandible and maxillary jaws of the sheep. Samples taken from the surgical sites stained with haematoxylin and eosin for diagnosis of the sections, then immunohistological tests were confirmed on these sections. We noticed that after 14 days of membranes implantation there was no significant differences between their histological sections. While in histological section of 28 days, the sections with PRF has more angiogenic effect in soft tissue with much and more organized vessels in compare with control one.

A firm mass of the maxillary gingiva

A firm mass of the maxillary gingiva

Effectiveness of a 655-nm InGaAsP diode laser to detect subgingival calculus in patients with periodontal disease.

Previous in vitro studies have proven laser fluorescence measurement using a 655-nm Indium Gallium Arsenide Phosphide (InGaAsP) based diode laser radiation to be a useful tool to detect subgingival calculus. The aim of this prospective study was to evaluate the 655-nm InGaAsP diode laser in detecting subgingival calculus in patients with periodontal disease compared with photographic assessment during periodontal surgery. Twelve patients (six women, six men) aged between 21 and 75 years with periodontitis scheduled for periodontal surgery were included in this prospective study. All laser fluorescence measurements were made before periodontal surgery. Intraoperatively a mucoperiostal flap was performed, subgingival calculus was visualized, and photographic images were taken. The presence of calculus was recorded for each evaluated site. A total of 115 tooth surface sites of 32 teeth from the 12 patients were evaluated before (laser) and during surgery (image). Compared with image evaluation the laser assessment showed a sensitivity of 0.70 (CI0.025 0.53 to CI0.975 0.83) and a specificity of 0.97 (CI0.025 0.85 to CI0.975 0.99). The overall probability to correctly detect subgingival calculus with the laser (accuracy) was 0.82 (CI0.025 0.74 to CI0.975 0.88). The 655-nm diode laser was able to detect subgingival calculus. Hence, the 655nm diode laser may be used as an additional tool for calculus detection in non-surgical periodontal therapy.

Custom-Made Cleft Palate Models to Teach V-Y Pushback Palatoplasty.

We developed custom-made cleft palate (CP) models to teach V-Y pushback palatoplasty, with a focus on design and mucoperiosteal elevation.A model (23 cm wide, 30 cm long, and 13 cm high) was made using silicone (model 1; M1). On the palate of a skull model, 2 layers of colored rubber clay were applied to represent the superficial oral mucoperiosteum and deep nasal mucosa (model 2; M2). From the greater palatine foramen, threads of dental floss were inserted inside the clay, representing the greater palatine artery. In a workshop, a mouth gag was applied on M1, and participants designed 2-flap palatoplasty and 4-flap palatoplasty. On the palate of M2, incisions were made with a #15 blade. On M2, a mucoperiosteal flap (rubber clay over the hard palate) was elevated using a periosteal elevator, avoiding injury to the dental floss mimicking the greater palatine artery. Six participants were recruited for the workshop and were asked to rate their satisfaction with the outcome on a Likert scale.For CP design, participants answered that they had learned useful knowledge from this workshop, reflecting a significant improvement (4.0 ± 1.1 for incomplete CP, 4.2 ± 1.2 for complete CP). They became confident in this skill after the workshop (4.2 ± 0.8 for incomplete CP, 3.8 ± 0.8 for complete CP). For cleft mucoperiosteal flap elevation, they likewise learned useful knowledge (4.7 ± 0.5 for incomplete CP, 4.5 ± 0.5 for complete CP) and became confident in this skill (3.8 ± 0.8 for incomplete CP, 4.0 ± 0.6 for complete CP.)These models can be useful for V-Y pushback palatoplasty training for medical personnel.

ПРИМЕНЕНИЕ СУБЭПИТЕЛИАЛЬНОГО ВАСКУЛЯРИЗИРОВАННОГО НЕБНОГО ЛОСКУТА И PRF В КОМПЛЕКСНОЙ ТЕРАПИИ ОСТРОГО ОДОНТОГЕННОГО ПЕРФОРАТИВНОГО ВЕРХНЕЧЕЛЮСТНОГО СИНУСИТА

Subject. The article presents the results of a comprehensive method for the treatment of acute perforated maxillary sinusitis using the developed surgical method for eliminating perforation with a subepithelial vascular palatal flap with simultaneous use of PRF. The effectiveness of the proposed method of treatment was confirmed by x-ray data characterizing the intensity of the inflammatory reaction caused by surgery, morphological parameters of soft tissues in the alveolar process of the upper jaw in the area of intervention and the state of the maxillary sinus before and 3 months after surgery. The aim of the study was to evaluate the effectiveness of the use of subepithelial vascular palatal flap and PRF in the complex treatment of acute odontogenic perforated maxillary sinusitis. Methodology. An assessment and comparative analysis of the activity of the inflammatory process caused by surgery, as well as the study and comparison of the morphological parameters of the alveolar ridge (the depth of the vestibule of the oral cavity, the width of the keratinized gums, and the thickness of the mucous membrane), the X-ray data evaluating the state of the maxillary sinus, before and after 3 months were carried out. after surgical procedures. The study involved 50 patients with acute perforated maxillary sinusitis (J01.0), who were divided into two groups: the main and comparisons. In the main group (25 people), a new developed method of surgical treatment was used (a method of subepithelial vascularized palatal flap with simultaneous use of PRF), in the comparison group (25 people), the traditional method of complex treatment, including a mobilized mucoperiosteal cheek flap to eliminate perforation of the maxillary sinus . Results. Based on the analysis of the data, pronounced manifestations of the inflammatory process of the postoperative period and negative treatment results using the traditional technique, which were absent in the treatment of patients with the developed surgical method, were revealed. Findings. An analysis of the results obtained during the study revealed the high efficiency of the developed method in comparison with the traditional one.

Wound closure and alveoplasty after preventive tooth extractions in patients with antiresorptive intake-A randomized pilot trial.

To compare success rates between the sub-periosteal prepared (SPP) muco-periosteal flap and the epi-periosteal prepared (EPP) mucosa flap and the feasibility of alveoplasty after surgical tooth extractions in patients undergoing/after antiresorptive treatment. Patients with an indication for preventive tooth extraction undergoing/after antiresorptive treatment were enrolled over a 24-month period in a parallel-group randomized clinical pilot trial and randomly assigned for primary wound closure to either the SPP or the EPP group. The primary outcome was treatment failure 8weeks after surgery. To assess the feasibility of alveoplasty, necrotic bone changes at the time point of tooth extraction were evaluated. One hundred and sixty patients were randomized to the SSP (n=82) or the EPP (n=78) group. One hundred and fifty-seven patients met the primary endpoint 8weeks after surgery with five treatment failures for the SPP group (6.3%) and 18 (23.4%) for the EPP group (p=.004). A significant relationship (p<.0001) was observed between symptomatic teeth and non-vital bone found in 54.8% of all biopsies. The strong superiority of the muco-periosteal flap as primary wound closure revealed the feasibility and effectiveness of the study. The large number of necrotic biopsies emphasizes the importance of alveoplasty as a preventive measure.

To assess the role of lingual flap for the removal of lower wisdom tooth.

Objectives: To assess the role of lingual flap in encountering lingual nerve injury during the surgical elimination of lower wisdom tooth. Study Design: Cross Sectional Case Control study. Setting: Department of Oral &amp; Maxillofacial Surgery, Institute of Dentistry, Liaquat University of Medical &amp; Health Sciences Jamshoro / Hyderabad. Period: January 2016 to September 2016. Material &amp; Methods: Subjects were categorized into two categories: Group-A (lingual flap) &amp; group-B (control group) each having 52 patients by Lottery method. In group A an envelope mucoperiosteal flap followed by lingual flap elevation carried out and in group B only envelope flap was carried out. All patients were reviewed on the first postoperative day and again 1 and 3rd week after surgery. At each postoperative visit, patient was examined for sensory nerve impairment of the lingual nerve by same observer. Results: Total 104 cases were studied, all the cases categorized among two groups 52 in each group. In group-A 34 were males and 18 were females, while in group-B 44 were male and 8 were females. There was no significant difference among both groups according to the pre-operative assessment. According to objective findings, lingual nerve paresthesia was found among 2 cases of group A on 1st visit, while no any case was found with nerve injury in group B. Out of 2 cases, one case was improved and only one had presented with complain at 2nd visit and 3rd visit, no significant difference among both groups, p-values were quite insignificant. Conclusion: It was concluded that lingual nerve injury (LNI) occurred among few cases of lingual flap group which was insignificantly higher as compare to control group, but the nature of injury was temporary.

Surgical treatment of advanced medication-related osteonecrosis of the jaws: Comparison of soft tissue closure techniques and evaluation of side effects

The aim of the study was to evaluate the surgical outcome of patients with advanced medication-related osteonecrosis of the jaw (MRONJ) treated with different flaps for soft tissue closure. Only MRONJ stage III patients with a minimum follow-up of 6 months were included in our prospective study. The soft tissue closure techniques were: Mylohyoid Muscle Flap, Buccal Fat Flap and mucoperiosteal flap alone. Potential risk factors and surgical side effects were analyzed. Relapses occurred in 12 of 44 included cases and 38 reached mucosal integrity within the follow-up. Cases treated with the muscle or fat flap showed better results regarding the recurrence rate (p < 0.001) and soft tissue healing (p = 0.002): only 3 of 33 developed a relapse, and 31 of 33 reached mucosal integrity. The outcome was worse if MRONJ occurred at the front areas of the jaw (p = 0.025). Postoperative, the pain level was reduced significantly (p < 0.001). Partial hypoesthesia of the lip arose in 18 cases. An impairment of the long-term prosthetic rehabilitation has not been seen.Patients with MRONJ stage III undergoing surgery benefit from extensive soft tissue closure.

PRP Injection Effect on Palatal Fistula Repair: A Comparative Study

Background: Palatal fistula after primary palate repair isan annoying problem for both patients and plastic surgeons.The incidence of fistula depends on the severity of the primarydefect, the technique used for repair and the tension appliedover the wound. Different methods are described for palatalfistula repair, starting from local mucoperiosteal flaps to freeflaps.The recurrence rate of fistula after primary repair is about23%, on the other hand the recurrence rate of fistula after itsrepair is higher as 25-33% up to 100%. Fistulas are classifiedaccording to its site and size. PRP is an autologous bloodproduct, it promotes healing of wounds by its high plateletconcentration and multiple growth factors, and also it decreasesthe risk of infection and increases neovascularization. PRPis used in several clinical applications as in oral maxillofacial,cardiac and plastic surgery.Methods: A comparative study was conducted on 20patients with posterior palatal fistulas, who were divided intotwo groups, group A in which PRP was injected with fistularepair and group B fistula was repaired without PRP injection.Two flap palatoplasty (9 cases in each group) and Furlowtechnique (one case in each group) were used for both groups.Results: A total of 16 patients were followed-up forrecurrence rate of fistulas, statistical analysis showed that ingroup A 25% had a recurrence, while in group B 50% of casesshowed recurrence.Conclusion: PRP injection with the surgical repair of thepalatal fistula has a role in decreasing the recurrence rate ofthe fistula and decreasing the need for further surgical interventionsalso, it is an easy, safe procedure and at an economicprice.

Guided modern endodontic microsurgery by use of a trephine bur

Surgical guides and three-dimensional (3D) planning softwares used in everyday dental implantology open new possibilities in other fields of dentistry. While using the operation microscope in endodontic microsurgery provides more precise apicectomy, there is still no consent on the exact localisation and size of the bony window to be prepared for this surgery. Our aim is to describe a new, guided endodontic microsurgery method when osteotomy and apicectomy are planned in a 3D software and performed with a trephine bur. Based on data from Cone Beam Computed Tomography, planning of the surgical guide was performed with a 3D planning software (Smart Guide, dicomLAB, Hungary) in order to define the size of the bony window, the angulation and the depth of the trephine bur during the apicectomy. After preparing a mucoperiosteal flap, with the help of the dentally supported surgical guide, the trephine bur removes the cortical bone and the apex of the root simultaniously. Following the modern microsurgical protocol, after performing the ultrasonic retrograde preparation, mineral trioxide aggregate (ProRoot MTA; Dentsply Maillefer, Ballaigues, Switzerland) is placed as a retrograde filling to close the resected area. After the uneventful healing period, a complete bony regeneration can be seen on the 1-year follow up X-ray. The patient is symptom-free. This technique is considered to be faster and more precise than the non-guided endodontic microsurgery carried out without the utilization of a trephine bur. Orv Hetil. 2020; 161(30): 1260-1265.

Using MRI and Nasopharyngeal Endoscopy for Assessment of Soft Palate Following Cleft Palate Surgical Repair Using Two Surgical Techniques

Purpose: to compare and assess the results obtained by using 2 different surgical techniques that utilize two stage palatoplasty to repair the palate, Furlow’s technique and intravelar veloplasty. Material and Methods: This study was performed on 14 patients suffering from cleft palate, patients were divided into 2 groups, in group I Furlow’s technique was used in palatal repair, in group II IVVP technique was used in palatal repair. All cases were selected from the Outpatient Clinic of the Faculty of Dental Medicine, Al-Azhar University for Girls. Results: Postoperative results of the MRI showed that the velum and the length of the muscle has become longer in each group, even though, there was no significant change between both techniques. The postoperative results of the nasopharyngeal endoscope proved that the increase in the levator muscle length increased the movement of the velum, in each group, however, between both group there was no significant difference. Conclusions: Both Furlow palatoplasty and intravelar veloplasty are efficient techniques that can be used in the repair of cleft soft palate. Both techniques can lengthen the soft palate together with palatal muscle reorientation; without the need to raise large mucoperiosteal flaps from the hard palate. Both techniques, with their modifications had shown success in the primary closure of different varieties and sizes of cleft gaps. The two stage palatoplasty can eliminate the need to raise large mucoperiosteal flaps from the hard palate.

Authors' Comments—Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Authors' Comments—Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Transnasal endoscopic surgery of choanal atresia after radiotherapy for nasopharyngeal carcinoma

Objective: To discuss the effect of endoscopic dilatation and plasty for choanal atresia after radiotherapy for nasopharyngeal carcinoma. Methods: Nineteen patients with choanal atresia who were admitted to the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Nanchang University from Jan. 2011 to Dec. 2018 were reviewed, with 12 males and 7 females aging from 33 to 59 years old. All of the patients had a history of radiotherapy for nasopharyngeal carcinoma and were confirmed by electronic nasopharyngoscope and nasopharyngeal imaging. Among 19 patients, there were 3 cases of unilateral occlusion and 16 cases with bilateral atresia, and all of them were membranous atresia. All patients received the transnasal endoscopic surgery of resecting partial vomer bone while trying to keep normal mucosa tissues and using the septonasal mucoperiosteal flap to repair under general anesthesia. One week after operation, the patients were told to do physiological saline nasal irrigation and received regular clean and observation under endoscope. Descriptive statistical method was used to analyze the outcome. Results: The patients were followed up for 1 year postoperatively by electronic nasopharyngoscopic examination. There was no failure case in all the 19 patients including 16 patients with a wide choana and 3 patients had narrowing of the choana (<50%), with adequate and satisfactory airway. Conclusions: Transnasal endoscopic surgery was an effective treatment for choanal atresia after radiotherapy for nasopharyngeal carcinoma. Application of septonasal mucoperiosteal flap for repairing nasal and nasopharyngeal mucosa would avoid recurrence.