Cleft Lip Surgery Research Articles

Cleft Lip and Palate Surgery: Prevalance of Intraoperative Airway Complications in a Tertiary Center in Nepal

Introduction: Cleft lip and palate is one of the most common congenital malformations. Different syndromes have been described in association with cleft lip and palate, some of which have considerable anesthetic implications, and many involve potential airway problems.
 Objective: This study aimed to find the incidence of airway complications during cleft surgeries.
 Methods: The descriptive cross sectional study was conducted in College of Medical Sciences and Teaching Hospital, Bharatpur, Chitwan, Nepal over a period of one year from March 2017 toFebruary2018. All the 146 patients received general anesthesia. The parameters studied were incidence of difficult mask ventilation, difficult intubation, laryngospasm, bronchospasm, aspiration of blood and secretion. Univariate analysis of demographic and occurrence of complications was done.
 Results: A total of 146 patients underwent cleft surgery over the study duration out of which 42(28.76%) were female and 104(71.23%) were male. Isolated cleft lip was seen in 104 (71.23%) patients among whom 42 (28.76%) had right sided, 50 (34.24%) had left sided and 12 (8.21%) had bilateral cleft lip. Isolated cleft palate was seen in 12 (8.21%) patients. Combined cleft lip and palate was seen in 30 (20.54%) patients. Prevalence of difficult mask ventilation, difficult laryngoscopy, difficult intubation, incidence of bleeding during intubation, bronchospasm and post extubationlaryngospasmwere4 (2.73%), 11 (7.53%), 6 (4.10%), 2 (1.36%), 2(1.36%) and 4(2.73%).
 Conclusion: In cleft repair surgeries, difficult laryngoscopic view is the most common problem followed by difficult intubation and difficult mask ventilation. Complications like laryngospasm, bronchospasm and laryngoscopy related bleeding are not uncommon. Vigilant perioperative preparation and continuous monitoring is essential to prevent complications during cleft repair surgery in paediatric patients.

A Comparative Study of Atracurium and Cisatracurium in paediatric cleft Lip and Cleft palate surgeries

General anaesthesia with intubation with RAE tube is preferred in children undergoing cleft lip and palate surgeries. Neuromuscular blocking drugs (NMBDs), are given to infants and children to attain ideal intubating conditions by providing adequate muscle relaxation. In contrast to routinely used atracurium, cisatracurium is comparatively a newer drug with lesser histamine release. The study was designed with the aim to compare the efficacy of atracurium (2×ED95) and cisatracurium (4×ED95).90 patients, 6 months-5 years, ASA class I &II were randomly allocated to cisatracurium and atracurium group. After administration of induction agent, dose of neuromuscular blocking drug atracurium 0.5mg/kg or cisatracurium 0.2mg/kg was given to the patients. The intubating conditions were graded using ‘Cooper et al’ scoring system. Neuromuscular blockade was assesed using train of four ratio. Alongwith intubating conditions, onset and duration of action, hemodynamic effects, and signs of histamine release were measured in both the groups. In the atracurium group the mean score according to ‘Cooper et al'scale was 6.86±0.54, whereas in the cisatracurium group it was 8.12±0.64, the difference between the groups was statistically significant. Time of onset was found to be 2.7±0.12 minutes in the cisatracurium group and 3.28±0.64 minutes in the atracurium group. Duration of action was 64.6±6.18minutes in the cisatracurium group as compared to 35.4±4.64minutes in the atracurium group. Cisatracurium(0.2mg/kg) is more efficacious as compared to atracurium(0.5mg/kg)with respect to intubating conditions, it has a faster onset of action, good intraoperative hemodynamic parameters, longer duration of action with no side effects.

Perioperative Management in Patients With Cleft Lip and Palate.

In cleft care, perioperative treatment strategies like ear nose and throat (ENT) diagnostics as well as postoperative antibiotics, feeding, and duration of inpatient stay are nonstandardized procedures varying between different centers. Likewise, intraoperative choice of suture materials and time of suture removal are performed inconsistently. Therefore, we wanted to collect information on protocols focusing on these topics to summarize and subsume currently approved treatment strategies of centers around the world. We ask members of international cleft centers for their respective treatment strategies and performed descriptive statistics.Absorbable suture material is used for reconstruction of the outer lip skin in 20 of 70 centers. Removal of skin sutures is conducted after 7.0 ± 1.5 days. Suturing of the orbicularis oris muscle, the enoral and nasal mucosa, as well as the palatal musculature is predominantly performed with absorbable suture materials. Intraoperative antibiotic prophylaxis is applied in 82.9% of the participating centers. In contrast, 31.9% of the departments do not apply any antibiotic postoperatively. Postoperative feeding is performed in 27 centers via a nasogastric tube for 4.6 ± 2.3 days on average. Mean length of postoperative inpatient stay is 4.1 ± 2.6 days in children after cleft lip surgery and 4.5 ± 2.7 days after cleft palate surgery. ENT consultation before surgery is routinely conducted in 52.8% of the centers and 82.9% of ENT colleagues investigate middle ear pathologies in the same operation in which cleft repair is performed.Closure of the lip skin is predominantly performed with nonabsorbable suture material followed by a suture removal after 1 week. Intraoperative antibiotic prophylaxis as well as inpatient hospital stay of 4 to 5 days in combination with oral feeding and a preoperative consultation and intraoperative cooperation with the ENT department seems to be well-proven concepts in cleft lip palate patient care. However, this analysis illustrated the variations and differing approaches in perioperative care emphasizing the need to verify perioperative management concepts in cleft surgery-preferably in the context of multicenter studies.

The Utility of an Open-Access Surgical Simulator to Enhance Surgeon Training

Smile Train, an international children's charity committed to improving cleft care around the world, empowers local medical professionals in developing countries to provide quality comprehensive cleft care in their own communities. As part of their sustainable model, Smile Train developed a web-based, interactive virtual simulator to improve surgical training of cleft procedures for surgeons around the world, replicating the anatomical and technical steps involved in cleft surgery. This study evaluated the simulator as a tool for enhancing surgical training. A pre-test and questionnaire addressing cleft care, surgical knowledge, and confidence level was administered to surgeons-in-training at an academic institution. Participants completed 3 simulator modules followed by a post-test and questionnaire to measure changes in knowledge and confidence levels. Sixteen surgeons-in-training participated in this study. The mean score on the knowledge examination increased after reviewing the modules for both junior residents (33.1%-64.4%) and senior residents (46.9%-70.8%). Reviewing the modules increased participants' confidence in the knowledge of cleft anatomy, understanding of surgical procedures, and ability to follow along meaningfully while assisting in operations. The Smile Train Virtual Surgery Simulator increased knowledge and reported surgeon confidence in understanding and assisting in cleft lip surgery, signifying its usefulness as a training tool for surgeons-in-training. Virtual simulation is a valuable resource for improving understanding and competence of the craniofacial surgeon while serving as an educational resource to other members of the comprehensive cleft care team, patients, and families.

Establishing cleft services in developing countries: Complications of cleft lip and palate surgery in rural areas of Indonesia.

BackgroundCleft treatment is frequently performed in Indonesia, mostly in charity missions, but without a postoperative protocol it is difficult to establish the risks and complications of cleft treatment. The present study was designed to give an overview of current cleft lip and palate treatment strategies in Indonesia and to assess the complication rates during and after surgery.MethodsThis prospective study evaluated anesthetic, intraoperative surgical, and short-term postoperative complications in patients undergoing primary, secondary, or corrective surgery for cleft lip and palate deformities. The population consisted of 98 non-syndromic cleft patients. The main anesthetic complication that occurred during general anesthesia was high blood pressure, whereas the main intraoperative surgical complication was excessive bleeding and the main early postoperative complication was extremely poor wound hygiene.ResultsIn this study, there were no cases of perioperative or postoperative mortality. However, in 23 (23.4%) of the 98 operations performed, at least one perioperative complication related to anesthesia occurred. The intraoperative and early postoperative complications following cleft lip and/or palate were assessed. There was a significant difference in the complication rate between procedure types (χ2=0.02; P<0.05). However, no relationship was found between perioperative complications related to anesthesia and the occurrence of postoperative complications (χ2=1.00; P>0.05). Nonetheless, a significant difference was found between procedure types regarding perioperative complications and the occurrence of postoperative complications (χ2=0.031; P<0.05).ConclusionsFurther evaluation of these outcomes would help direct patient management toward decreasing the complication rate.

Marked Variation Exists Among Surgeons and Hospitals in the Use of Secondary Cleft Lip Surgery.

To identify child-, surgeon-, and hospital-specific factors at the time of primary cleft lip repair that are associated with the use of secondary cleft lip surgery. Retrospective cohort study. Forty-nine pediatric hospitals. Children who underwent cleft lip repair between 1999 and 2015. Time from primary cleft lip repair to secondary lip surgery. By 5 years after primary lip repair, 24.0% of children had undergone a secondary lip surgery. In multivariable analysis, primary lip repair before 3 months had a 1.22-fold increased hazard of secondary surgery (95% confidence interval [CI]: 1.02-1.46) compared to repair at 7 to 12 months of age, and children with multiple congenital anomalies had a 0.77-fold decreased hazard of secondary surgery (95% CI: 0.68-0.87). After adjusting for cleft type, age at repair, presence of multiple congenital anomalies, and procedure volume, there remained substantial variation in secondary surgery use among surgeons and hospitals (P < .01). For children with unilateral cleft lip repaired at 3 to 6 months of age, the predicted proportion of children undergoing secondary surgery within 5 years of primary repair ranged from 4.9% to 21.8% across surgeons and from 4.5% to 24.7% across hospitals. There are substantial differences among surgeons and hospitals in the rates of secondary lip surgery. Further work is needed to identify causes for this variation among providers.

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: maxillary growth at eight years of age.

To assess differences in craniofacial growth at 8 years of age according to the different protocols for primary cleft surgery in the Scandcleft project. Prospective, randomized, controlled clinical trial (RCT) involving 10 centres, including non-syndromic Caucasians with unilateral cleft lip and palate (UCLP). In Trial 1, a common surgical method (1a) with soft palate closure at 3-4 months of age and hard palate closure at 12 months of age was tested against similar surgery but with hard palate repair at 36 months (delayed hard palate closure) (1b). In Trial 2, the common method (2a) was tested against simultaneous closure of both hard and soft palate at 1 year (2c). In Trial 3, the common method (3a) was tested against hard palate closure together with lip closure at 3 months of age and soft palate closure at 1 year of age (3d). Participants were randomly allocated by use of a dice. Operator blinding was not possible but all raters of all outcomes were blinded. The total number of participating patients at 8 years of age was 429. Lateral cephalograms (n = 408) were analysed. The cephalometric angles SNA and ANB were chosen for assessing maxillary growth for this part of the presentation. Within each trial (Trial 1a/1b, Trial 2a/2c, and Trial 3a/3d), there was no difference in cephalometric values between the common and the local arm. There were no statistically significant differences in the SNA and ANB angles between the common arm in Trial 1a (mean SNA 77.8, mean ANB 2.6) and Trial 2a (mean SNA 79.8, mean ANB 3.6) and no difference between Trial 1a and Trial 3a, but a statistical difference could be seen between Trial 2a and Trial 3a (mean SNA 76.9, mean ANB 1.7). However, the confidence interval was rather large. Intra- and inter-rater reliability were within acceptable range. The timing and the surgical method is not of major importance as far as growth outcomes (SNA and ANB) in UCLP are concerned. ISRCTN29932826. The protocol was not published before trial commencement.

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate. Dental arch relationships in 8 year-olds.

The Scandcleft intercentre study evaluates the outcomes of four surgical protocols for treatment of children with unilateral cleft lip and palate (UCLP). Originally 10 cleft centres in Denmark, Finland, Norway, Sweden, and the UK participated in a set of three randomized trials of primary surgery. Three groups of centres (Trials 1, 2, and 3) tested their traditional local surgical protocols (Arms B, C, and D) against a common protocol (Arm A). To evaluate dental arch relationships at age 8 years after four different protocols of primary surgery for UCLP. These results are secondary outcomes of the overall trial. Study models of 411 children (270 boys, 141 girls) with non-syndromic UCLP at a mean age of 8.1 (range 7.0-10.0) years were available. Dental arch relationships were analysed using the GOSLON Yardstick by a blinded panel of 11 orthodontists. To assess reliability, Kappa statistics were calculated. The trials were tested statistically with t-tests. Comparisons within each trial showed no statistically significant differences in the mean 8-year index scores or their distributions between the common protocol and the local team protocol. The mean index scores were Trial 1: Arm A 3.03, Arm B 2.82, Trial 2: Arm A 2.78, Arm C 2.64, and Trial 3: Arm A 3.06, Arm D 3.08. Comparisons between the trials detected a significantly (P < 0.005) better mean index score Trial 2 Arm C than in Trial 3 Arm D. The intra- and inter-rater reliabilities were acceptable. The results of these three trials do not provide evidence that one surgical protocol is better than the others. ISRCTN29932826.

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: dental anomalies in 8-year olds.

Children born with unilateral cleft lip and palate (UCLP) are reported to display several dental anomalies including agenesis, supernumeraries, as well as variations in dental size, shape, and path of eruption. The extensive sample of individuals with UCLP included in the Scandcleft randomized control trials offers the opportunity to study more rare conditions, which is seldom possible with limited samples. The aim was to study dental anomalies at 8 years of age in children born with UCLP included in the Scandcleft randomized control trials. Panoramic and intraoral radiographs from 425 individuals (279 males and 146 females) with a mean age of 8.1 years were assessed by four orthodontists regarding dental anomalies. Agenesis was found in 52.5 per cent and supernumerary teeth in 16.9 per cent of the participants. The cleft lateral was missing in 43.8 per cent and was found peg shaped in 44.7 per cent. The distribution of ectopic eruption was 14.6 per cent, mainly affecting maxillary first molars, while transposition was found in 3.4 per cent of the individuals. In addition, infraocclusion of one or several primary molars was registered in 7.2 per cent of the participants. We conclude that 8-year-old children born with UCLP display multiple dental anomalies. The Scandcleft sample allowed rarely studied conditions such as infraocclusion of primary molars and transposition to be studied in children born with UCLP. ISRCTN29932826.

Anatomical Location of the Infraorbital Foramen in Infant Dry Skulls: Implications for Cleft Surgery.

Infraorbital foramen (IOF) is an important anatomical landmark in cleft lip surgery. The location of IOF within the maxilla of infants is different from adults. However, little information about anatomy of IOF in infants exists in the literature. This study aims to determine the location of IOF in infant dry skulls based on key surgical landmarks. All dry skulls under age 2 years old were selected from the Hamann-Todd Human Osteological Collection at the Cleveland Museum of Natural History (Cleveland, OH). Specimens without cranial bones or complete maxilla were excluded. Seven anatomical measurements were taken on each side of the face for each individual skull (14 measurements for each skull). Anatomical landmarks used for the measurements included infraorbital rim, aperture piriformis, alveolar ridge, zygomaticomaxillary buttress, anterior nasal spine (ANS), and inferolateral corner of the aperture piriformis. Twenty-seven halves of 14 dry skulls were included in the final analysis. The mean age of specimens was 0.57 years. Mean distances from infraorbital foramen to infraorbital rim, aperture piriformis, alveolar ridge, zygomaticomaxillary, and ANS buttress were 4.11 ± 0.82, 9.4 ± 1.62, 12.7 ± 2.71, 11.7 ± 1.54, and 18.4 ± 2.11 mm, respectively. This study also shows that the infraorbital foramen in infants is located at the level of the ANS or within 2 mm higher and that the distance between the infraorbital rim and foramen is only 3 to 4 mm. These findings should be applied to the cleft population with discretion.

Application of the Nasal Septal Cartilage graft For the correction of nasal deformity of unilateral cleft lip

Background:&#x0D; An intranasal surgical approach is often taken in reconstruction of the tip as a part of the cleft rhinoplasty. A rim incision provide maximal exposure to the nasal tip and usually obviates the need for external incisions.&#x0D; The asymmetrical nasal deformity of unilateral cleft lip can be resistant to correction. All the components of the nose are involved; the cover, support lining and platform. Pathological anatomy of unilateral cleft nose includes (1) deflection of the nasal tip toward the side of the cleft, (2) posterior and inferior displacement of the dome of the alar cartilage on the cleft side, (3) an abuse angle between the medial and the lateral crura of the alar cartilage, (4) obtuse alar facial attachment, and (5) inward buckling of the alar on the cleft side. The alar-collumella web is unsightly and is difficult to correct in both secondary and primary surgery. The purpose of this article to improve the appearance of the nose by the correction of the alar web deformity in patients with unilateral cleft lip nasal deformities by introducing our cartilage graft technique inside the web.&#x0D; Methods:&#x0D; The article include 15 patients with alar webbing had underwent cleft lip surgery between May 2002 to July 2015. Most of the patient’s age are ranged between 13-25 years at the time of the surgery. The incision was an open rhinoplasty that including a reverse U shape incision. After that the cleft side was equalized with the dome angle of the healthy side, we use a nasal septal cartilage graft as a stiffy pattern to fix and stabilize the deformed converted web skin. The septal cartilage graft fixed to the cleft side web skin’s inner with (3-4) sutures to maintain the tackling of the vestibular skin. &#x0D; The Results:&#x0D; Many views basal and frontal are included postoperatively that have been showed, that the nostril and collummella had better shape. Our results showed that most patients demonstrated correction of the dropping alar and nasal tip and correction of the symmetry of the nostrils. The web cartilage graft was fixed to the deformed cleft side web skin’s inner with 3-4 sutures to prevent the tackling of the vestibular skin. Most of the patients have been followed up for a period ranged fro, 1-15 months.

Correction of labial tubercle defect in repaired bilateral cleft lips using bilateral vermilion musculomucosal sliding flaps: Case series.

Rationale:Insignifificant, asymmetrical or lack of labial tubercle often occurs after cleft lip surgery due to improper treatment of vermilion tissue. Especially in the cases of bilateral cleft lip, because of short front lip and insuffificient vermilion tissue, the median vermilion depression often occurs after surgery, forming a “whistling” deformity. The object of this study is to verify the outcomes of patients with median labial tubercle detects after treatment with bilateral vermilion musculomucosal sliding flflaps (VMSF).Patient concerns:Six patients with median labial tubercle defect after bilateral cleft lip repair from March 2015 to May 2017 were enrolled in our department and subjected to bilateral lip deformity correction under general anesthesia.Diagnoses:Secondary deformity of bilateral cleft lip forming a “whistling” deformity were diagnosed in all the patients.Interventions:Bilateral VMSF were designed and used to reconstruct the median labial tubercles by sliding downward so as to eliminate the whistling deformity.Outcomes:During the 10 to 37 months of follow-up, the reconstructed vermilion tubercles had stable morphology showing no whistling deformity and the overall lip shapes were satisfactory.Lessons:Reconstructing MVTD and eliminating whistling deformity using the scar tissues that need to be removed previously on the vermilion musculomucosa has achieved stable and satisfactory results and is worthy of clinical application.

Cleft lip surgery with fisher technique and millard technique comparative work

Cleft lip surgery with fisher technique and millard technique comparative work

Long term longitudinal follow up of individuals with unilateral cleft lip and palate, cleft lip surgery: one stage palatoplasty outcome: language and maxilar growth

Background: The maxillary retrusion is a prominent feature of the facial deformity that is frecuently observed in patients who have been treated for unilateral cleft lip and palate. Speech therapists say that having an early stage surgical repair of the cleft palate produce highly satisfactory results in terms of articulation development and language.

Three-Dimensional Affordable Stone Models for Cleft Lip Markings: A Prospective Study of Learner Satisfaction.

Knowledge of surgical markings for unilateral cleft lip (UCL) repair is critical for surgical competency. However, few appropriate models are accessible to residents and affordable and accurately reproduce this 3-dimensional (3D) deformity. We propose that cleft care units have the capability of creating affordable 3D stone models to teach UCL markings. Polyvinyl siloxane and SnapStone were used to create UCL stone models. Thirteen plastic surgery residents were prospectively recruited, provided with a textbook chapter and online module for studying surgical markings for UCL repair, and then asked to perform the markings on a UCL stone model and standardized patient photograph. Learner satisfaction was evaluated using a modified survey based on the Student Evaluation of Educational Quality survey. The production time of each model was 10 minutes, whereas the cost was $1.84. Participants reported that the stone model was more stimulating (4.77 ± 0.44 vs 3.92 ± 0.86; U = 38.0; P = 0.008), increased their interest more (4.70 ± 0.48 vs 3.53 ± 1.20; U = 33.5; P = 0.005), allowed better learning (4.61 ± 0.51 vs 3.08 ± 0.86; U = 10.0; P < 0.001), was clearer (4.62 ± 0.51 vs 3.15 ± 0.90; U = 12.5; P < 0.001), and was more effective for learning cleft lip markings (4.77 ± 0.44 vs 3.08 ± 1.04; U = 9.0; P < 0.001). They were also more likely to recommend it (4.85 ± 0.38 vs 3.15 ± 1.07; U = 7.0; P < 0.001). Plastic surgery residents report that 3D cleft lip stone models are superior training tools to learn cleft lip markings compared with patient photographs. These educational tools have the potential to overcome significant financial, logistic, and time constraints in teaching cleft lip surgery markings.

A study of anaesthetic management of cleft lip and palate surgery in children

Introduction: Anaesthetic management in paediatric patient can present anatomically and physiologically challenges to the anaesthetics. Therefore, surgery of cleft lip and palate in children will require careful consideration and thorough knowledge and clinical application in preparation by the anaesthetics as they are not miniature version of adults. Objective: To evaluate the anaesthetic outcomes including pre-operative selection of cases, intra-operative and post-operative complications in children underwent cleft lip and palate surgery. Materials and Methods: 30 patients of cleft lip and/or cleft palate malformation scheduled for surgical repair under general anaesthesia at plastic surgery unit of tertiary care teaching hospital were selected for the study. All patients with age more than 3 months; weight more than 5 kg; no history of URTI / fever; normal chest x-ray; and leukocyte count less than 10000/cum, were included in the study. The patient’s haemoglobin less than 10 gm% were excluded from the study. Results: A majority of patients (22, 73.33%) belonged to less than 3 years of age. Patients were divided in 2 groups with 15 patients in each group according to induction technique. Group I which was induced by inhalation technique with Oxygen, Nitrous Oxide and Halothane and group II which were induced by intravenous Ketamine and Succinylcholine. Intubation was difficult in one patient of Group II. Increased intratracheal secretion occurred in 2 patients of Group II. Laryngospasm was found in 1 case of group II and there was also vomiting in 1 case of group II. Conclusion: A favourable outcome can be expected in cleft lip and palate surgery in children by adequate understanding of the anatomy, physiology, and psychology of the paediatric patients; and proper selection and through pre-operative assessment and preparation. Keywords: Cleft lip and palate, Laryngospasm, Vomiting, Anaesthetic management.

Evaluation of Patient and Parent Satisfaction After Orthodontic Treatment/Orthognathic Surgery for Cleft Lip and Palate Deformity.

Objectives:The objectives of this study were to evaluate the satisfaction of patients, parents, and individuals other than health professionals (neighbors or relatives), regarding the quality of care, and to evaluate the patients general care, facial appearance, dental changes, and psychological assessment by social outlook and emotional quotient.Materials and Methods:Sixty patients with cleft lip and palate reporting to a dental institution were divided into two age groups, 0–15 years (G1) and 15–30 years (G2), their parents (P1 and P2) and a group comprising their neighbour’s or relatives (T1 and T2) were also divided according to G1 and G2. To evaluate their satisfaction toward the treatment received, three separate questionnaires were given to the three groups and their responses were subjected to statistical analysis.Results:The results showed that majority of patients (74%) and their parents (60%) were satisfied with the orthodontic treatment they received to align the teeth. But they were not satisfied with the appearance of lip (61.6% and 56.6%), nose (60% and 53.3%), and speech (62%). This study showed that cleft-affected individuals were teased mainly for speech (60%) followed by lip and teeth. Sixty percent of the patients admitted that their self-confidence was quite affected because of cleft and 36.6% expressed that their school/college results have been affected.Conclusion:Majority of cleft lip and palate patients as well as their parents were satisfied with their child’s dental appearance; they were unsatisfied with the appearance of nose, lip, smile, and speech.

Minimal closure in cleft lip and palate surgery

No abstract available.

Morphometric analysis of infraorbital foramen in South Indian dry skulls

Objective- The infraorbital foramen is located on the maxillary bone 1 cm under the infraorbital margin. Infra orbital nerve blocks are done in children for managing the postoperative pain which can occur after cleft lip operation and endoscopic sinus operation. Infraorbital nerve can also be damaged in cases of zygomatic complex fractures which are one of the most common facial injuries. So, this study was undertaken to analyze the anatomical variations by comparing various morphometric measurements of infraorbital foramen in dry skulls of adult South Indian population.Materials and methods- 60 dry skulls of unknown sex were used for the study. Various measurements and distance from various surgical landmarks were measured to evaluate the location of infraorbital foramen on both sides. Statistical Analysis was done for the above measurements mean and standard deviation, median, range, and mode were calculated.Results: The mean distance of infraorbital foramen from piriform aperture, lower end of alveolus of maxilla and infraorbital margin was 18.39, 27.88 and 7.09mm on the right and 17.89, 27.31 and 6.95mm on the left side. The mean vertical and horizontal diameter was 3.78 and 3.50mm on the right side and 3.48 and 3.35mm on the left side. In our study, the most common site of IOF in Indian skulls was found to be in line with the second premolar tooth (59.01%), followed by its position between the first and second premolar tooth (27.87%).Conclusion- These results will be helpful for surgeons while doing maxillofacial surgery and regional block anesthesia.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.562-566

A High Fidelity Cleft Lip Simulator.

Cleft lip surgery is technically difficult requiring precise planning and understanding of 3-dimensional structures to obtain an optimal outcome. A physical cleft lip simulator was developed that allows trainees to gain experience in cleft lip repair and primary rhinoplasty before operating on real patients. A cleft lip simulator that comprises multilayered soft tissues, bone, and realistic dissection planes was developed using 3D printing, adhesive and polymer techniques. Four experienced cleft surgeons performed a total of 7 simulated repairs on the simulator. Feedback on the realism and value of the simulator was obtained from the surgeons. Six of the repairs were a Fisher anatomic subunit approximation technique, and 1 was a rotation advancement repair. All repairs were completed with successful performance of markings, incisions, dissections, and multilayered closure. All surgeons agreed that the simulator is realistic and that the simulator is a valuable tool for training in cleft lip surgery. A cleft lip simulator that allows performance of a cleft lip repair and primary rhinoplasty from start to finish was developed and pilot tested. The simulator provides a training platform to gain experience in cleft lip repair before operating on real patients.