Janusz Bardach

Late Results of Primary Veloplasty: The Marburg Project

Forty-five randomly selected patients with unilateral cleft lip, alveolus, and palate, all operated upon by Dr. Wolfram Schweckendiek were evaluated by three American specialists to assess the validity of primary veloplasty. Examination revealed an unusually high incidence of short palate and poor mobility of the soft palate. Facial growth was found to be highly acceptable in the majority of the patients. Unusually high incidence of velopharyngeal incompetence was found in these patients.

Clinical results of pharyngeal flap surgery: the Iowa experience.

Sixty-five patients with cleft palate, with or without cleft lip, who received previous pharyngeal flap surgery for chronic velopharyngeal dysfunction in our department, were examined for velopharyngeal status, speech production patterns, and evidence of nasal airway obstruction. Of the 65 subjects, 54 (83.1 percent) showed velopharyngeal function within normal limits, 43 (66.1 percent) showed normal or near-normal speech production, and 58 (89.2 percent) reported snoring sometimes or often. Of the 58 reporting snoring, electrocardiogram (ECG) data for 33 were examined for evidence of right ventricular hypertrophy. Only one (3 percent) of the 33 showed such possible indication. We conclude that by our methods, pharyngeal flap surgery is an effective treatment for velopharyngeal dysfunction. After surgery, patients may report symptoms of nasal airway obstruction during sleep but are not expected to show ECG changes in cardiac function resulting from oxygen deprivation.

Repair of craniofacial defects with hydroxyapatite cement

PURPOSE The objective of this study was to evaluate the course of healing of craniofacial bone defects when filled with hydroxyapatite cement and to determine whether adding various percentages by weight of demineralized bone powder to the cement will result in enhanced bone formation. MATERIALS AND METHODS The model for the study was the canine calvarium. The implants were placed into cranial defects and harvested at 3 or 6 months for qualitative evaluation by light microscopy, microradiography, and quantitative histomorphometry. RESULTS The implantation of hydroxyapatite cement resulted in characteristic replacement of the material with new bone ingrowth. The addition of demineralized bone powder to the hydroxyapatite cement appeared to improve the handling characteristics of the cement; however, improvement in the replacement of the material by bone was not observed. The implantation of only allogeneic demineralized bone showed limited new bone formation within the defect site. CONCLUSIONS Hydroxyapatite cement formed an effective osseoconductive scaffold for bone replacement. The addition of demineralized bone powder to the cement to serve as a carrier of osseoinductive factors did not result in additional bone being formed.

Reconstruction Of The Oral Cavity With A Free Flap

Free groin flaps were used successfully within the oral cavity in 4 patients after ablative operations for cancer. Preoperative or postoperative radiation (cobalt therapy) had no apparent detrimental effect on the survival of these free flaps.

The relationship between lip pressure following lip repair and craniofacial growth: an experimental study in beagles.

In the present study with beagles, various states of lip pressure (decreased and increased) following surgical creation of the lip and palatal defects and subsequent lip repair were found to be significantly related to craniofacial growth aberrations and disproportions. These aberrations are discussed in terms of an imbalanced functional skeletal-soft-tissue matrix. Significantly elevated lip pressure following lip repair in group III animals was found to be more detrimental to craniofacial growth than decreased lip pressure resulting from the surgical creation of a defect left unrepaired. Results of the study present, for the first time, documented evidence of a significant relationship between lip pressure following lip repair and craniofacial growth. Caution should be employed in extending these conclusions to the clinical setting, yet the findings underscore the need for well-controlled clinical studies designed to assess the influence of cleft lip repair on craniofacial growth.

Cranioplasty in the growing canine skull using demineralized perforated bone

This study was designed to test the hypothesis that demineralized perforated bone matrix implant from canine skull and tibia induces new bone formation within the calvarial defect comparable with the bone induced by autogenous graft. We also were interested in determining whether demineralized perforated bone matrix implants from membranous bone have greater osseoinductive capacity in the calvarial area than demineralized perforated bone matrix implants from endochondral bone. Forty 12-week-old purebred beagles were used. Group I consisted of animals with unrepaired surgically created calvarial defects healed by secondary intention (n = 10). Group II consisted of animals with surgically created calvarial defects in which the bone was removed and replaced with an autograft (n = 10). Group III consisted of animals with surgically created calvarial defects in which the bony defect was closed with a demineralized perforated bone matrix implant obtained from beagle calvaria (n = 10). Group IV consisted of animals with surgically created calvarial defects in which the bony defect was closed with a demineralized perforated bone matrix implant obtained from beagle tibia (n = 10). The two control groups (I and II) allowed us to isolate the inductive capacity of demineralized perforated bone matrix implants and compare it with the healing of the bone defects left unrepaired or repaired with calvarial autografts. Animals were sacrificed after 8 and 12 weeks. In the present study we were able to verify that demineralized perforated bone matrix implants are well accepted in the calvarial defects with little tissue reaction and remarkably little osteoclastic activity. In arguing for the osseoinductive potential of demineralized perforated bone, we must realize that it is likely that much of the bone consists of demineralized implant that has been invaded by host cells along with new bone in the area of the implant. This study revealed no statistically significant differences between new bone formation following the insertion of demineralized perforated bone matrix implants of the tibia or calvarium. (Plast. Reconstr. Surg. 96: 770, 1995.)

Results of multidisciplinary management of bilateral cleft lip and palate at the Iowa Cleft Palate Center

Bilateral cleft of the lip and palate is by many standards the most complex and severe form of the defect. The complexity and severity of the defect require an unusual degree of cooperation among all specialists and especially between the surgeon and the orthodontist. There are no published findings that we know about in which comprehensive data from a number of disciplines are reported for the same group of bilateral cleft patients. Fifty randomly selected patients with bilateral complete clefts were examined by the Iowa team and two orthodontists from other institutions. The evaluations revealed that a large number of patients over the age of 10 have multiple residual problems requiring further treatment. Only 23 percent of the older patients studied were judged to have had treatment completed by the surgeon, speech pathologist, and orthodontist. It is very difficult to state whether the results obtained by our team can be considered satisfactory because there are no comparable studies that have attempted to evaluate the same parameters in multidisciplinary management.

Multidisciplinary treatment results for patients with isolated cleft palate.

Fifty-eight patients with cleft palate only who had received treatment in the Department of Otolaryngology-Head and Neck Surgery at the University of Iowa were examined for treatment results. Forty-one (70.7 percent) of the 58 patients showed a syndrome or suggestive factors. An unusually high percentage (36 percent) of the 58 patients required secondary surgery for velopharyngeal dysfunction or showed indications for surgery at examination. Some but not all of the relatively low success rate appears related to surgical experience. Speech proficiency, hearing acuity, and dental status were within normal limits or nearly so. The 20 patients with pharyngeal flap surgery were doing well, with minimal indications of functional obstruction.

Late results of multidisciplinary management of unilateral cleft lip and palate.

A model was designed for evaluating protocol and management strategies in the multidisciplinary approach to cleft lip and palate treatment. The treatment history and present status of 45 patients 14 to 22 years of age were evaluated by a plastic surgeon, orthodontist, and speech pathologist. Results indicated that only about half of these patients had completed treatment by one of the specialties by the time they were 14 years or older. Even more surprisingly, only 7 patients (16%) had completed treatment by all three specialties by this age. Factors that may contribute to this low percentage of completed treatments are discussed.

Basal cell carcinoma arising in a sebaceous nevus during childhood

It is uncommon for malignancy to develop in a sebaceous nevus before puberty. We report a case of basal cell carcinoma arising in a sebaceous nevus during childhood in a normal-appearing lesion. Periodic evaluation to detect malignant degeneration is recommended for children even if removal is encouraged at a future date.