Unilateral Lip Research Articles

Zygoma Asymmetry in Non-Syndromic Patients with Unilateral Cleft Lip and Palate

Background: Cleft lip and palate are often accompanied by maxillary asymmetry and midface hypoplasia. However, there has been limited examination of the symmetry of the zygoma in these patients. In this study, computed tomography scans prior to alveolar bone grafting are utilized to examine zygomatic symmetry through width, projection, and volume. Methods: Retrospective review was conducted of patients with nonsyndromic unilateral cleft lip and palate with eligible scans prior to alveolar bone grafting at our institution. Anterior zygomatic width, posterior zygomatic width, and zygomatic projection were measured on axial images oriented to the Frankfort horizontal, and three-dimensional digital models of each zygoma were created from the computed tomography data to estimate zygoma volume. These measurements were then compared on cleft and noncleft sides. Results: Twenty-two patients were included in this study. The mean (95% CI) zygoma volume of the cleft side and non-cleft side was 4219 mm3 (3858-4574 mm3) and 4286 mm3 (3932-4660 mm3), respectively, with a mean difference of −67 mm3 ([−402-266 mm3]; P = .704). The zygomatic projection of the cleft side was 43 mm (41-45 mm) in comparison to 47 cm (45-49 mm) for the non-cleft side. Mean difference in zygomatic projection was −4 mm (−5 to −2 mm, P < .001). Mean anterior zygomatic width was greater on the cleft side (42 mm [41-44 mm]) than the non-cleft side (41 mm [40-42 mm]; P = .037). No significant difference was found between posterior zygomatic width of the cleft side (59 mm [58-60 mm]) and non-cleft side (58 mm [57-59 mm]; P = .118). Conclusions: Upon preoperative image analysis in patients with non-syndromic, unilateral lip and palate clefts, zygomatic projection was significantly different between cleft and non-cleft sides. Evaluation of zygoma asymmetry should be included as a component of the physical exam when assessing a patient with unilateral cleft lip and palate, as improved awareness of existing zygomatic asymmetry could aid in setting patient expectations, improving satisfaction/outcomes, and in planning for potential surgical correction.

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 unilateral cleft lip surgery

BackgroundUnilateral cleft lip surgery is a complex procedure, and the outcome depends highly on the surgeon’s experience. Digital simulations and low-fidelity models seem inadequate for effective surgical education and training. There are only few realistic models for haptic simulation of cleft surgery, which are all based on synthetic materials that are costly and complex to produce. Hence, they are not fully available to train and educate surgical trainees. This study aims to develop an inexpensive, widely available, high-fidelity, ex vivo model of a unilateral cleft lip using a porcine snout disc.MethodsA foil template was manufactured combining anatomical landmarks of the porcine snout disc and the anatomical situation of a child with a unilateral cleft. This template was used to create an ex vivo model of a unilateral cleft lip from the snout disc. Millard II technique was applied on the model to proof its suitability. The individual steps of the surgical cleft closure were photo-documented and three-dimensional scans of the model were analysed digitally. Sixteen surgical trainees were instructed to create a unilateral cleft model and perform a unilateral lip plasty. Their self-assessment was evaluated by means of a questionnaire.ResultsThe porcine snout disc proved highly suitable to serve as a simulation model for unilateral cleft lip surgery. Millard II technique was successfully performed as we were able to perform all steps of unilateral cleft surgery, including muscle suturing. The developed foil-template is reusable on any porcine snout disc. The creation of the ex vivo model is simple and inexpensive. Self-assessment of the participants showed a strong increase in comprehension and an eagerness to use the model for surgical training.ConclusionsA porcine snout disc ex vivo model of unilateral cleft lips was developed successfully. It shows many advantages, including a haptic close to human tissue, multiple layers, low cost, and wide and rapid availability. It is therefore very suitable for teaching and training beginners in cleft surgery and subsequently improving surgical skills and knowledge. Further research is needed to finally assess the ex vivo model’s value in different stages of the curriculum of surgical residency.

Systemic Contact Dermatitis to Sodium Metabisulfite Presenting As Episodic, Unilateral Lip Swelling.

Dermatitis®Ahead of Print Pearls & ZebrasSystemic Contact Dermatitis to Sodium Metabisulfite Presenting As Episodic, Unilateral Lip SwellingHadley Johnson and JiaDe YuHadley Johnsonhttps://orcid.org/0000-0002-0101-2017University of Minnesota Medical School, Minneapolis, Minnesota, USA.Search for more papers by this author and JiaDe YuAddress reprint requests to JiaDe Yu, MD, MS, Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, Suite 200, Boston, MA 02114, USA. E-mail Address: jiade.yu@mgh.harvard.eduDepartment of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.Search for more papers by this authorPublished Online:2 May 2023https://doi.org/10.1089/derm.2023.0039AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Systemic Contact Dermatitis to Sodium Metabisulfite Presenting As Episodic, Unilateral Lip Swelling." Dermatitis®, , pp. FiguresReferencesRelatedDetails Volume 0Issue 0 Information© 2023 American Contact Dermatitis Society. All Rights Reserved.To cite this article:Hadley Johnson and JiaDe Yu.Systemic Contact Dermatitis to Sodium Metabisulfite Presenting As Episodic, Unilateral Lip Swelling.Dermatitis®.ahead of printhttp://doi.org/10.1089/derm.2023.0039Online Ahead of Print:May 2, 2023PDF download

Longitudinal Anatomic Analysis of Primary Cleft Lip Rhinoplasty Outcomes.

Background: The unilateral cleft lip deformity is associated with nasal deformities with secondary functional and aesthetic challenges. Objectives: Compare the change in nasal symmetry before and incrementally after primary endonasal cleft rhinoplasty concurrent with lip repair. Methods: This is a retrospective chart review of infants undergoing unilateral cleft lip repair. Data collection included demographics, surgical history, and pre- and postoperative alar and nostril photographs analyzed with Image J. Statistical analysis was done using linear and multivariable mixed effect models. Results: Twenty-two patients with a near even gender distribution (46% female) and primarily left-sided cleft lips underwent unilateral lip repair at a mean age of 3.9 months (median 3.0, range 2-12). Mean pre- and postoperative alar symmetry ratios were 0.099 (standard error [SE] 0.0019) and -0.0012 (SE 0.0179), with zero representing perfect symmetry and negative values indicating overcorrection. These values at 1, 2-4, 5-7, 8-12, 13-24, and 25+ months were 0.026, 0.050, 0.046, 0.052, 0.049, and 0.052 (SE range: 0.0015-0.0096), respectively, demonstrating stability of the alar symmetry 4 months postrepair. Conclusions: In this study, patients who underwent an overcorrective primary cleft rhinoplasty concurrent with lip repair had an initial regression of symmetry within the first 4 months postoperatively, followed by observed stabilization.

Philtral Height Discrepancy in Patients with Complete and Incomplete Cleft Lips + /-Palate - Results from a Single Nation Consecutive Cohort.

The aim of unilateral cleft lip repair is to restore form and function, including symmetrisation of cleft and non-cleft philtral height. Expectation of best outcome is achieved in situations with minimal asymmetry and is assumed occurs most often in incomplete cleft lip only patients. We sought to investigate philtral height discrepancy (PHD) in children with unilateral cleft lip + /-palate from a single nation cohort. Review of prospectively collected PHD measurements taken at time of surgery for all children undergoing unilateral cleft lip repair in Scotland born Jan 2017-December 2020. Data was collected using Microsoft Excel and analysed using embedded statistical software. 102 consecutive patients with unilateral lip involvement were identified from the national database. 94 had prospectively documented PHD (92.2%). The majority of patients had an isolated cleft lip (51.1%). Incomplete clefts presented more frequently (52.1%) than complete clefts (47.9%). Mean PHD for the whole cohort was 3.91mm (standard deviation 1.01mm, range 1-6mm). The difference in mean PHD (in-complete versus complete) was 1.1mm (3.4 vs. 4.5, p < 0.001). For lip only versus lip and palate the difference in mean PHD was 1.0mm (3.4 vs. 4.4, p < 0.001). This single country consecutive cohort review of PHD in children undergoing unilateral cleft lip repair statistically supports the anecdote that patients with an incomplete cleft lip and isolated cleft lip have lesser asymmetry at presentation. This study presents a consecutive cohort with a greater range of PHD than has previously been reported in the literature.

Clients' Facial Expressions of Self-Compassion, Self-Criticism, and Self-Protection in Emotion-Focused Therapy Videos.

Clients' facial expressions allow psychotherapists to gather more information about clients' emotional processing. This study aims to examine and investigate the facial Action Units (AUs) of self-compassion, self-criticism, and self-protection within real Emotion-Focused Therapy (EFT) sessions. For this purpose, we used the facial analysis software iMotions. Twelve video sessions were selected for the analysis based on specific criteria. For self-compassion, the following AUs were significant: AUs 4 (brow furrow), 15 (lip corner depressor), and the AU12_smile (lip corner puller). For self-criticism, iMotions identified the AUs 2 (outer brow raise), AU1 (inner brow raise), AU7 (lid tighten), AU12_smirk (unilateral lip corner puller), and AU43 (eye closure). Self-protection was combined using the occurrence of AUs 1 and 4 and AU12_smirk. Moreover, the findings support the significance of discerning self-compassion and self-protection as two different concepts.

Hyaluronic filler for lip augmentation and scar correction in cleft lip Egyptian patients

Objectives: The goal of the current study was to assess how hyaluronic acid dermal filler was applied and how well it worked to conceal lip abnormalities after surgery in a group of Egyptian cleft lip and palate (CLP) patients.Methods: This research included sixteen female patients with unilateral lip scars between 15 and 20 years of age. Hyaluronic acid dermal filler (HADF) was injected with needle in upper lip at the scar site. Evaluation was done clinically and by digital photography before and after the procedure. Visual Analog Scale (VAS) from (0-10) was used as a patient satisfaction assessment survey. Follow up period was made one week and one month post injection.Results: All these patients noted a significant improvement in their lip scars following HA filler injection with better psychological state. The VAS satisfaction rate assessment was high and ranging from 7-9 with a mean of (8.0 ± 0.9). Clinical observation showed no long-term complications, however patients complained of some discomfort due to fibrosed tight lips during the injection.Conclusion: HADF is a safe noninvasive temporary method used for masking cleft lip scars and restoring vermilion border volume which promotes the appearance and psychological status of the CL patient.

Nasopalatine duct cyst occurring after secondary alveolar bone grafting: A case report

AbstractBackgroundWe describe an exceedingly rare case of a nasopalatine duct cyst that developed after bone grafting into an alveolar cleft.Case presentationA 10‐year‐old male patient with a unilateral lip and alveolar cleft underwent alveolar bone grafting. Computed tomography at the 1‐year follow‐up revealed a well‐defined, round radiolucency including the grafted bone and the incisive canal. Cystectomy and bone grafting were performed, and the resected specimen was histopathologically diagnosed as a nasopalatine duct cyst. The postoperative course was good and bone bridging was achieved, including at the alveolar cleft.ConclusionBased on our observations and the findings of previous reports, surgical stimulation due to alveolar bone grafting was suggested to have caused the NDC.

Pattern of Orofacial Clefts at A Tertiary Care Hospital in Ethiopia.

Clefts of the lip and/or palate are the most common craniofacial birth defects. The worldwide birth prevalence is 1/700 live births. There are varying reports from Africa. This study investigated the patterns of orofacial clefts at a tertiary care hospital in Addis Ababa. A retrospective descriptive study was performed to assess the patterns of Orofacial clefts at the main cleft care center in Ethiopia. The Data of cleft patients operated at the main cleft care center in Ethiopia from January 2007 to April 2020 with the support of Smile Train was used for this study. Their demographic and clinical data was retrieved from the Smile Train data base and analyzed using Stata version 16. A total of 1919 patients' data was retrieved, excluding 16 patients' data (.83%). The data of 1903 (99.17%) patients were enrolled in this study. Cleft lip and palate were found in 53.0% of the patients. Cleft lip only was found in 731 (38.4%) and cleft palate only in 166 (8.6%) patients. The commonest surgery performed was primary unilateral lip nose repair. Most patients were operated after the age of five years old. Many were operated after the age of five years, which is not in line with international recommendations. This needs improvement: establish more cleft care centers, distribute health care information and education.

Pattern of Orofacial Clefts at A Tertiary Care Hospital in Ethiopia

BACKGROUND፡ Clefts of the lip and/or palate are the most common craniofacial birth defects. The worldwide birth prevalence is 1/700 live births. There are varying reports from Africa. This study investigated the patterns of orofacial clefts at a tertiary care hospital in Addis Ababa. METHODS: A retrospective descriptive study was performed to assess the patterns of Orofacial clefts at the main cleft care center in Ethiopia. The Data of cleft patients operated at the main cleft care center in Ethiopia from January 2007 to April 2020 with the support of Smile Train was used for this study. Their demographic and clinical data was retrieved from the Smile Train data base and analyzed using Stata version 16. RESULTS: A total of 1919 patients’ data was retrieved, excluding 16 patients’ data (.83%). The data of 1903 (99.17%) patients were enrolled in this study. Cleft lip and palate were found in 53.0% of the patients. Cleft lip only was found in 731 (38.4%) and cleft palate only in 166 (8.6%) patients. The commonest surgery performed was primary unilateral lip nose repair. Most patients were operated after the age of five years old. CONCLUSION: Many were operated after the age of five years, which is not in line with international recommendations. This needs improvement: establish more cleft care centers, distribute health care information and education.

RECURRENT ANGIOEDEMA FOLLOWING ANGIOTENSIN CONVERTING ENZYME INHIBITOR DISCONTINUATION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Angiotensin converting enzyme inhibitors (ACEIs) are guideline recommended first-line treatment for hypertension. Angioedema is a recognized side effect of ACEI therapy, yet clinicians are often unaware that limited case reports describe recurrent angioedema following ACEI discontinuation. This is a case of ACEI-induced angioedema occurring after discontinuing ACEI therapy. CASE PRESENTATION: An elderly male with medical history of hypothyroidism, hypertension, and heart failure presented from his long-term care facility complaining of face, tongue, and throat swelling with dysphagia and voice changes starting 24 hours prior. Examination showed normal vital signs and edema of aforementioned areas. He denied family history of similar occurrences. It was reported 12 days prior he was seen for unilateral lip swelling and his enalapril was discontinued without further treatment. Medication administration record review showed ACEI was appropriately discontinued by his care facility. He was given methylprednisolone, diphenhydramine, intramuscular epinephrine, C1 esterase inhibitor, and 2 units of fresh frozen plasma prior to admission. The patient was monitored in the intensive care unit due to mild airway compromise but did not require invasive airway protection. A serum complement factor 4 level was checked and returned normal. He was discharged after 5 days in stable condition with resolution of symptoms. DISCUSSION: ACEIs are the most common cause of drug induced angioedema in the United States. ACEI-induced angioedema is a self-limiting swelling that may involve the lips, tongue, upper airway, and rarely intestinal wall. Swelling is said to occur because of ACEI inhibition on the angiotensin converting enzyme preventing degradation of vasoactive substances such as bradykinin (1). Recurrence of angioedema after ACEI discontinuation was reported in 46% of cases in one retrospective study (2). The precise etiology of this delayed reaction is not well described, though it is reasonable to hypothesize in part, a drug washout period must occur. The adverse drug reaction probability scale score was 5 (probable) in this patient (3). Recurrence has been documented more commonly in elderly male patients (2). The mainstay of treatment for non-allergic angioedema caused by ACEIs is discontinuation of the offending drug and acute airway management if needed. No drug therapy has been proven effective in the treatment of this condition (1). CONCLUSIONS: Increased awareness of delayed ACEI-induced angioedema following ACEI discontinuation is important among health care providers for appropriate diagnosis and monitoring. While self-limiting without a known effective treatment, close airway monitoring is critical for patient survival. Improved awareness would also allow patients with a history of ACEI-induced angioedema to be cognizant of the potential for recurrence early following drug discontinuation. REFERENCE #1: Erickson DL, Coop CA. Angiotensin-converting enzyme inhibitor-associated angioedema treated with c1-esterase inhibitor: A case report and review of the literature. Allergy Rhinol (Providence). 2016;7(3):168-171. REFERENCE #2: Beltrami L, Zanichelli A, Zingale L, Vacchini R, Carugo S, Cicardi M. Long-term follow-up of 111 patients with angiotensin-converting enzyme inhibitor-related angioedema. J Hypertens. 2011 Nov;29(11):2273-7. REFERENCE #3: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Adverse Drug Reaction Probability Scale (Naranjo) in Drug Induced Liver Injury. [Updated 2019 May 4]. DISCLOSURES: No relevant relationships by Mark Malesker, source=Web Response No relevant relationships by Shraddha Narechania, source=Web Response No relevant relationships by Bryton Perman, source=Web Response

The Operation Rainbow Canada Technique for Unilateral Cleft Lip Revision.

Purpose of this article is to demonstrate the "Operation Rainbow Canada" cleft lip revision technique. This is a surgical technique used by Operation Rainbow Canada on volunteer surgical missions in developing nations. We show how to convert previous Millard or straight line cleft lip repairs to a Fisher anatomic subunit repair, placing a favourable scar along the philtrum. We show a case series of results and explain how this technique gives satisfying aesthetic results for patients seeking unilateral cleft lip revision. This technique combines the principles of the anatomic subunit repair for primary cleft lip repair as described by Fisher and the correction of the cleft nose deformity as described by McComb. We apply these 2 techniques to unilateral cleft lip revision at the same operation. Patients for revision unilateral lip and nose deformities were treated with this technique over the course of several international surgical missions. There were over 90 cases of revisions performed by our group on previous repaired cleft lips. These procedures were done in India, China, and Cambodia. Previously repaired cleft lips can be improved by our revision procedure. We show how incorporating 2 triangular flaps to lengthen the cleft side of the repaired lip can be done in a revision setting. During lip revision, McCombs sutures can be placed to improve the aesthetic of the nose and correct the nasal alar dome.

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.

Effect of a novel rotating advancing method on reconstruction of nasal lip symmetry

Objective To introduce the application of muscle reconstruction torque balance theory in the new rotating advancement method, and to evaluate the postoperative effect of this method on the nasal lip symmetry of patients with unilateral cleft lip. Methods A total of 62 patients with unilateral cleft lip were treated with two-dimensional radiography of posterior anterior position and mandibular chin position before, immediately and one-year follow-up. Five indexes representing the symmetry of lip and nose were measured by photoshop software. T test was used to compare the measurement results of each angle or distance index at different times. P<0.05 showed that there was significant difference between the two groups. Results All the patients who were treated with the technique described in this study obtained satisfactory lip and nasal symmetry immediately and one-year follow-up. Conclusions The new theory of oral muscle strength balance is a new breakthrough on the basis of the application of muscle reconstruction. It is suitable for the primary repairment of unilateral lip, and good results have been obtained. Key words: Cleft lip; Orthopedic procedures; Muscle reconstruction; Muscle strength balance; Torque; New rotating advancement method

Influence of infancy care strategy on hearing in children and adolescents: A longitudinal study of children with unilateral lip and /or cleft palate

ObjectivesTo evaluate the relation between ventilation tube insertion, otitis media with effusion duration and otologic outcomes in unilateral cleft lip and/or cleft palate children from infancy to teenage age. Design and populationRetrospective longitudinal charts review of patients from the multidisciplinary cleft team of the University Hospital of Lausanne over a 30-year period. 146 charts from consecutive patients with non-syndromic unilateral cleft lip and/or cleft palate who were born between January 1986 and January 2003 were included. ResultsThe earlier in life a cleft child experience his first otitis media with effusion (OME), the worse his long-term hearing will be. Along with the age of onset of OME, we disclosed an influence of the duration of OME without ventilation tube (VT) insertion on short and long-term hearing outcomes. Different patterns were observed between cleft palate (CP) and cleft lip palate children (CLP), with a higher incidence of otitis media with effusion for the CLP group than the CP group. Direct positive relationship between VT insertion and hearing were disclosed and evaluation of long-term complications did not reveal significant relation with VT insertion. Of note, OME in CLP children led to a higher rate (but not statistically significant) of chronic ear complications than in the CP group, that may indicate more persistent OME or different adverse effect on the middle ear mucosa between CP and CLP children. ConclusionsIndividualized counseling should take into account different factors such as the type of cleft, the age of onset of OME and duration of OME, keeping in mind the adverse effect of persistent middle ear fluid. In the present report, results prone an early ventilation tube insertion to prevent short and long-term injury to the middle ear homeostasis, hearing loss and related issues.

Lateral intraparietal area (LIP) is largely effector-specific in free-choice decisions

Despite many years of intense research, there is no strong consensus about the role of the lateral intraparietal area (LIP) in decision making. One view of LIP function is that it guides spatial attention, providing a “saliency map” of the external world. If this were the case, it would contribute to target selection regardless of which action would be performed to implement the choice. On the other hand, LIP inactivation has been shown to influence spatial selection and oculomotor metrics in free-choice decisions, which are made using eye movements, arguing that it contributes to saccade decisions. To dissociate between a more general attention role and a more effector specific saccade role, we reversibly inactivated LIP while non-human primates freely selected between two targets, presented in the two hemifields, with either saccades or reaches. Unilateral LIP inactivation induced a strong choice bias to ipsilesional targets when decisions were made with saccades. Interestingly, the inactivation also caused a reduction of contralesional choices when decisions were made with reaches, albeit the effect was less pronounced. These findings suggest that LIP is part of a network for making oculomotor decisions and is largely effector-specific in free-choice decisions.

Quality of Speech Following Cleft Palate Surgery in Children

Background: Surgical treatment of cleft palate is accompanied with speech problems. Speech therapy in these children after surgery can improve their speech. In this study, we aimed to evaluate the quality of speaking in operated cleft palate patients and speech therapy effects in a small group of these patients. Methods: In this cross-sectional study, speech quality of 55 children with operated cleft palate was assessed regarding resonance, audible nasal emission, consonant production and speech acceptability. Speech outcomes after therapy were evaluated in 19 patients. Results: Cleft palate types were unilateral cleft and lip palate in 18 cases, bilateral cleft and lip palate in 4 cases, secondary cleft palate type in 30 cases and of mere-soft palate in 3 cases. Thirty-five children were operated during the first year of life and 20 were operated after the first year. More than 55% of patients had normal hypernasality with few cases of severe hypernasality and less than 45% had error in consonant production. Patients operated during first year of life had more speech problems. Speech parameters were improved in 19 patients after speech therapy. Conclusion: In conclusion, children with cleft palate have some degrees of speech disorders after repair surgery than could be improved by the speech therapy. Speech therapy should be considered as one of the main treatment protocols along with repair surgery in children with cleft palate.

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.

Literature Review: Is the Emotional Expression of Contempt Recognized Universally or Culturally?

The universal facial expression of contempt is often described as one lip corner raised and tightened. This literature reviews whether or not this expression is recognized universally. After examining theories and methods, low agreement of this expression recognized as contempt was found across cultures. Evidence so far is not sufficient enough to support the unilateral lip corner as an universal expression for contempt. The expression and recognition of contempt is highly dependent on culture and context.