Aarne Rintala

Treatment of severe developmental asymmetry of the female breast

In a material of 49 female patients with severe developmental breast asymmetry, Polands syndrome and isolated unilateral hypoplasia were the most frequent etiological factors (69%). Prosthetic augmentation alone, transfer of the de-epithelialized latissimus dorsi musculocutaneous flap to fill up the infraclavicular hollow, combined with an expander prosthesis for the breast, or augmentation with tissue from the contralateral healthy hypertrophic breast were found to be the methods of choice in selected cases. In order to achieve optimum symmetry the contralateral ptotic/hypertrophic breast should be corrected in most patients.

One-Stage Closure of Isolated Cleft Palate with the Veau-Wardill-Kilner v to y pushback Procedure or the Cronin Modification I. Comparison of Operative Results

The long term operative results of one-stage closure of isolated cleft palate with either the Veau-Wardill-Kilner V to Y pushback procedure or the Cronin modification were evaluated and compared retrospectively. A total of 116 consecutive patients with isolated cleft palate who had been operated on at the age of 18-24 months were followed up until 17-20 years of age. Twenty-four of the patients needed one or more additional operations on the palate, mainly pharyngeal flaps (20%) and repair of fistulas (10%). There was no significant difference in the number of patients who needed further operations, either between the two different operations or between the sexes, but the patients who presented with the most extensive clefts required the most operations.

Primary Hereditary Systemic Amyloidosis (Meretoja's Syndrome): Clinical Features and Treatment by Plastic Surgery

The characteristic, bloodhound-like appearance, which degenerates gradually, of patients with primary hereditary systemic amyloidosis, also called Meretojas syndrome (MS), is attributable to amyloid degeneration of the craniofacial skin and peripheral facial nerves, but apparently also to amyloid deposits in the muscles; a finding not previously described. A material of five patients treated with plastic surgery is presented, and the peculiarities and differences of this rare disease in comparison with other peripheral neuropathies is discussed from a reconstructive viewpoint.

Spontaneous Narrowing Of The Palatal Cleft During The First Year Of Life: A Quantitative Study

In 44 clefts of the hard palate the relative size of the cleft, as a percentage of the total palatal area, decreased by an average of 7% between the ages of 3 and 17 months. The relative size of the cleft at the second examination was only 52% of that at the first evaluation. The length of the cleft (per cent of the palatoalveolar length) shortened by 7%. The palatal height increased by 2.2 mm in this group and by 2.4 mm in a control group (23) with only minor posterior clefts. The spontaneous narrowing, most evident in wide anterior clefts, seems to be primarily due to actual growth, and not to bending or collapse. This phenomenon should be taken into consideration in the choice of the optimum age for surgery, which, in selected cases, should not take place before the age of one year.

Cleft Palate in Diastrophic Dysplasia

Forty-one of 95 Finnish patients (43%) with diastrophic dysplasia had open cleft palate (CP). Submucous CP or its microforms were observed in an additional 30 patients (32%). Even though most of the patients have micrognathia, the high frequency of submucous clefts speaks against the role of the interposed tongue in the pathogenesis of CP in the Pierre Robin sequence. There was no hypernasality of speech in 27 of the 30 patients with submucous CP or its microforms, and the spontaneous speech of the other three was good. This is in contrast with observations in isolated submucous CP in general. No operative treatment was indicated in any case. Results after treatment of open CP and speech problems were in good agreement with results from the patients with isolated CP from the same period of time. As newborns 11 of the patients (12%) had severe respiratory difficulties caused by glossoptosis, and a Douglas operation was performed in three patients. Spinal compression due to abnormalities in cervical vertebr...

Comparison of quality of speech after Veau-Wardill-Kilner pushback operation and the Cronin modification in the primary treatment of cleft palate.

The quality of speech was compared in 124 young adults with isolated cleft palate. Forty-seven subjects were excluded because of the presence of factors that might have biased the evaluation of the success rate of the two operations studied, leaving 77 subjects who had undergone primary palatoplasty for analysis. One stage closure of the soft and hard palate was done for 43 patients by the mucoperiosteal palatal V to Y pushback technique (Veau-Wardill-Kilner, group V), and 34 underwent the Cronin modification (group C). Their speech was tape recorded, analysed by three qualified listeners, and hypernasality assessed by four published hypernasality indexes. More subjects in group C achieved normal resonance than in group V, who had higher hypernasality index scores than group C. The groups managed pressure consonants similarly. Only a few patients had weak plosives, audible nasal air emission, or compensatory articulation. Similar numbers of secondary operations were done for both groups. However, group V would have actually required secondary surgery more frequently than group C.

Bacteriological Investigation of Secretory Otitis Media in Children with Cleft Palate

Altogether 92 middle ear effusion samples from 89 children with cleft (lip) palate and secretory otitis media aged from two months to 15 years were cultured and analyzed bacteriologically. Known middle ear pathogens were isolated from 49 (53%), these accounted for 68% of all positive cultures. The frequency of occurrence of middle ear pathogens was significantly higher in the age group younger than 36 months. The most common bacteria found were S. pneumoniae, B. catarrhalis and H. influenzae. The only anaerobe was a strain of B. fragilis. We believe that by defining culture methods, more pathogens can be isolated from the middle ear of cleft children than has previously been reported. Pathogenic bacteria seem to be found with a higher frequency in children with cleft palate, when compared to normal children.

Oblique lateral oro-ocular facial cleft: Case report

2 patients are presented, and the oblique lateral oro-ocular clefts discussed with emphasis on classification, dentition and microforms. A review of the literature revealed 10 patients with oblique lateral oro-ocular facial cleft (no. 5 in Tessiers classification), 3 bilateral and 7 unilateral. 5 unilateral cases had a median oblique facial cleft (no. 4) on the other side. 3 cases had a cleft lip and palate. The site of the alveolar cleft was in the region of the first and second premolar in 2 and slightly posterior to the canine tooth in 3 of 5 reliably documented cases. The dentition was documented only in 1 child with a lateral and median oblique facial cleft, resulting in full permanent dentition. The authors 2 cases had a bilateral oblique lateral oro-ocular facial cleft with the alveolar defect in the region of the first and second premolar. An isolated cleft (no. 6 in Tessiers classification) has to our knowledge not been reported at all. Furthermore, there are transitional forms between Tessiers clefts 5-8. Based upon our observations, it is also evident that variations inside one type occur as well. More attention should be paid to the exact location of the cleft and especially to the skeletal deformity, alveolar site and dentition. This would facilitate both classification and diagnosis of microforms.

Oblique Facial Clefts

In a material of about 3600 facial clefts eleven oblique clefts were observed (3.1%o). The most frequent types were the medial oro-ocular and naso-ocular clefts and their combinations. There were two atypical cases and one lateral oro-ocular variety. The oblique clefts were frequently associated with other types of clefts and/or more distant anomalies. No genetic, chromosomal or environmental factors were found to explain their etiology. Amniotic bands could possibly be thought to be responsible for the severe malformations in two instances. The lacrimal apparatus was always involved to some degree with the exception of a few incomplete forms. In the alveolar arch the clefts seemed to be situated between the medial incisor and the canine.

Comparison of Sanvenero-Rosselli and modified Honig velopharyngoplasties in the secondary treatment of cleft palate speech stigmata in cleft patients

The study compares the speech of patients who underwent a Sanvenero-Rosselli (SR) or a modified Honig (MH) velopharyngeal flap as the secondary treatment of persistent cleft palate speech stigmata. The occurrence of cleft palate speech stigmata reflecting velopharyngeal insufficiency was analyzed from the hospital records of 53 SR and 72 MH subjects. Hypernasality in terms of nasalance scores was examined with the Model 6200 Nasometer (Fletcher et al., 1989) in a subset of 47 SR and 38 MH subjects. Both listener judgements and nasalance measurements showed that normal resonance was achieved more frequently by the MH subjects than by the SR subjects. The SR and MH subjects did not differ in relation to the elimination of audible nasal air emission or misarticulations related to velopharyngeal insufficiency after velopharyngoplasty.