Divya Narain Upadhyaya

Apert's Syndrome - A Case Report

Craniosynostosis is the term that designates premature fusion of one or more sutures. Reduced or asymmetrical skull growth ensues, causing deformity of the skull vault or the base. Virchow in 1851 noted that there is a cessation of growth in a direction perpendicular to that of the affected suture while growth proceeds in a parallel direction. There are also distinct craniofacial synostosis syndromes that share common features such as suture synostosis, midface hypoplasia and facial and limb abnormalities.

Sincipital Encephalocele With Corpus Callosum Agenesis And Intracranial Lipoma: A Case Report

Encephaloceles are extracranial herniations of intracranial structures through defects in the skull and dura. Meningoceles are herniations of meninges alone and meningoencephaloceles are herniations of brain tissue and meninges. If part of a ventricle is also included, it is called hydroencephalomeningocele. In most cases, these are detected prenatally by obstetric ultrasound or at birth by clinical presentation of a subcutaneous mass. Encephaloceles may be isolated anomalies, or they may be seen in conjunction with other anomalies, or may be a part of a syndrome. Agenesis or hypogenesis of the corpus callosum is a commonly associated finding.

Evolving consensus in cleft care guidelines: Proceedings of the 13 th annual conference of the Indian society of cleft lip palate and craniofacial anomalies

Introduction: The multi-disciplinary approach to cleft care has been a reality since the beginning of the last century, but there is a paucity of literature discussing or recommending specific cleft protocols. This is understandable due to the significant difference in cleft protocols around the world and the controversies surrounding each of them. Material and Methods: The Indian Society of Cleft Lip Palate and Craniofacial Anomalies in its 13 th Annual Conference discussed threadbare the different protocols around the world and propose a guideline to Indian surgeons delivering cleft care. Results and Discussion: These guidelines though not binding, are supposed to be pointers to a generally accepted standard for cleft care, considering the unique circumstances and limitations of cleft care providers in developing countries like India. It is a best practice indicator which, if adhered to by all the cleft care providers, will soon bring about uniformity in cleft care deliverance and allow us to evaluate our results on a much larger scale than has hitherto been possible.

MR neurography in traumatic, non-obstetric paediatric brachial plexopathy

ObjectivesMany studies have elaborated on the role of magnetic resonance neurography (MRN) in evaluating traumatic brachial plexopathies. Most of these deal with MR findings in adult traumatic plexopathies or children with obstetric brachial plexus palsy (OBPP). Hence, the authors felt the need for this particular study, which focuses on MRN findings in children with non-obstetric traumatic brachial plexus palsy, to find out the distribution and severity of injuries in these patients.MethodsThis was a single-institution, prospective study conducted between April 2015 and June 2016. All children presenting to the hospital with features of brachial plexopathy and a history of non-obstetric trauma were included in the study.ResultsAt MRN, we looked for signs of injury at three levels: roots, trunks and cords. Signs of injury were found at the level of the roots in 22 patients (88%), at the level of the trunks in 20 patients (80%) and at the level of the cords in 22 patients (88%).ConclusionsThis study, conducted on children suffering from non-obstetric, traumatic brachial plexopathy returned some interesting conclusions including that when the paediatric plexus is injured, the injury is severe and multi-level, with a very high incidence of root injuries.Key Points• Brachial plexus injury in paediatric age group is a devastating injury.• The most common cause of this is trauma sustained during birth.• Other causes include road traffic accidents and blunt injury.• MR neurography has revolutionised the diagnosis of brachial plexopathy

Multidisciplinary treatment focussing on comprehensive orthodontic approach for improving facial esthetics in cleft lip and palate patients

Cleft lip and palate (CLP) is one of the most prevalent congenital craniofacial deformities. CLP may result in impairments that stigmatize the individual and have an impact on health, emotions, and social interactions. This article describes the comprehensive orthodontic approach in the treatment of unilateral cleft of the lip and the palate. It also emphasizes the importance of orthodontic intervention to improve the facial esthetics in CLP patients. The treatment planning procedures and the results are presented below.

Evolving consensus in cleft care: Reply to letter to the editor

Sir, The scenario of cleft care in India is rapidly changing and has taken rapid strides forward in the last decade or so. Thanks to the role of many NGOs who have come forward to fund free cleft care for the children suffering from this affliction in the developing world. However, controversies abound in this field as far as cleft protocols, timing, and effectiveness of various procedures are concerned. This is true not only in the developing world but in the western world too where societies and organizations are trying to find common ground to recommend or refute definite timelines or procedures to the surgeons performing cleft surgeries. It is in this context that the Indian Society of Cleft Lip Palate and Craniofacial Anomalies (ISCLPCA) sought to flesh out a “Consensus in Cleft Care” and recommend the same (timelines and procedures) to the surgeons performing cleft surgeries in India. The panels which discussed the various issues in cleft care sought to temper the “ideal” with a practical knowledge of the ground realities in India and thus, recommend a protocol which, while being targeted toward delivering world class results, were practical enough to be easily followed by various cleft centers across our country. The recommendations took hours of deliberations and personal communications and some work, thereafter, before they could see the light of the day and be accepted for print in the official organ of the ISCLPCA. It is unfortunate that some typographical errors inadvertently crept into the manuscript and also as commented upon by my colleague in the previous letter, escaped the careful eye of authors, reviewers, and the editorial board. The mistakes have hence been promptly rectified in the online version of the article. The authors sincerely regret this unfortunate slip-up and hope that this would not distract the attention of the reader from the important message that the article carries. Another issue that my colleague has touched upon is the recommendation for the timing of the cleft lip surgery. However, the authors wish to remind the readers that this is the considered recommendation of the panel regarding the preferred age of lip repair and does not stop any person from operating upon a patient if he or she turns up late for lip repair. Furthermore, it has been noted by various authors that cleft surgeons in various centers across India catering to cleft patients are already operating the lip at 3-6 months of age [1] and that the percentage of patients presenting before 1 year of age is nearly 15% [2] and almost 43.62% of children are operated before 2 years of age. [3] This is amazing statistics compared to a decade ago when the proportion of children to adults was much less than it is today. Most smile train centers today are seeing a perceptible fall in the mean age of children reporting for cleft surgery. Thanks to the aggressive outreach programs of these centers and the various information campaigns that these centers run (Khanna V. 2013. Personal communication). Keeping this very encouraging trend in mind, the panelists have no hesitation in recommending the preferred age of lip repair in India (permeated as it is by centers running various charity programs funding cleft care) as between 3 and 6 months of age. It was our sincere hope that the recommendations would bring uniformity in cleft care across India and stimulate better results and better research.

Rehabilitating the burn patient: An unfulfilled goal

Burns is a devastating injury with far reaching effects for the patients, their families as well as for the care providers. Approximately, 11 million people suffered burns globally in the year 2004[1] with the greater part of this burden being borne by the low (per capita income < USD 1,000) and middle income (per capita income USD 1,000-4,000) countries (LMICs). India stands apart in this as a country having the highest incidence of burns[2] as well as having a very high mean total body surface area (TBSA) of burns.[3] Burn patients require aggressive acute medical and surgical care as well as long-term and intensive rehabilitation effort. The world literature is littered with studies debating the economic burden of acute burn care,[4-6] but hardly any papers discussing the long-term burden of burn rehabilitation.[7] It is heartening to note that the authors have taken up an aspect of burn care hitherto largely neglected by the burn surgeons in the developing world and accorded it its due importance.