Kurt-Wilhelm Butow

A classification and construction of congenital lateral facial clefts

BACKGROUND The repair of the lateral or transverse facial cleft is a surgical challenge on the account of the abnormal positioning and appearance of the cleft. MATERIALS AND METHODS Over a twenty-seven year period, 22 lateral facial cleft cases were evaluated at a cleft lip (CL) and palate clinic and seven children underwent reconstruction of the lateral CL. RESULTS Twenty-two of 3187 (0.69%) cases presented with a lateral CL. Five of these 22 cases (23%) had a bilateral, eight (36%) had a right-sided and nine (41%) had a left-sided cleft. The evaluation of these cases resulted in a new classification (namely an extension of the Tessier 7 cleft) classification for the cutaneous and muscle involvement: a superior (T7.1), middle (T7.2), inferior (T7.3) and agenetic (T7.4) lateral CL. The altered surgical construction: an internal mucosal straight-line closure, a curved cutaneous-mucosal red-lip/vermilion-lined flap for the lip commissure, muscle reconstruction at the modiolus and a positional cutaneous z-plasty for the rare lateral cutaneous cleft. CONCLUSION The paper introduced a new classification for the lateral CL, as well as an altered surgical reconstructive technique for the most natural functioning of the lateral part of the face.

Comparative study of the effect of antiretroviral therapy on benign lymphoepithelial cyst of parotid glands and ranulas in HIV-positive patients

OBJECTIVE This studys aim was to assess the effect of highly active antiretroviral drugs (HAART) on benign lymphoepithelial cysts (BLEC) of the parotid and ranulas. STUDY DESIGN The records of 10 HIV-positive patients who presented with BLEC were reviewed, and 14 HIV-positive patients who presented with ranulas were prospectively enrolled. Patients in both groups received the same combination of HAART and were clinically evaluated for the first 3 months. Patients with ranulas were followed for an additional 3 months. A clinical reduction in the size of the lesions was considered to be a positive outcome. RESULTS All parotid glands with BLEC resolved within 3 months. No positive results were observed in ranulas during the first 3 months. However, some of the ranulas displayed a positive result after the initial 3 months of HAART. CONCLUSIONS In contrast to BLEC, ranulas in HIV-positive patients seem to present a mixed and delayed response to HAART.

Oral mucoceles and ranulas may be part of initial manifestations of HIV infection.

It is well documented and generally accepted that enlargement of parotid salivary glands, as part of HIV-related salivary gland diseases (HIV-SGD), may be the initial symptoms/manifestations of the HIV infection. Oral mucoceles and ranulas are also frequently described as oral manifestations, in association with HIV infection. However, little is known about these latter lesions as being the initial symptoms indicative of an HIV infection. This prospective study has investigated the possibility that oral mucoceles in general, and ranulas in particular, could be the initial symptoms of an underlying and undiagnosed HIV infection. A total of 50 patients including cases of oral mucoceles and ranulas were consulted in a tertiary referral hospital set up. Nineteen (63%) out of 30 HIV-positive patients presenting with oral mucoceles/ranulas, did not know their HIV status at the first consultation. Oral mucoceles/ranulas were for these patients, the only motives for visiting the health facility, and they were also the only clinical identifiable features (symptoms). Oral mucoceles and ranulas should, in the context of HIV-salivary gland diseases, be considered as initial symptoms and early manifestations of HIV infection. Routine HIV testing in all patients with oral mucoceles and ranulas is, according to this study, justified and should be recommended.

Construction of the congenitally missing columella in midline clefts

BACKGROUND Repair of the rare median cleft lip occurring with agenesis of the columella is a challenge as there is a major deficiency of skin and underlying structures. MATERIAL AND METHODS Over a 23- year period, five children underwent construction of a columella. A new surgical technique was designed for this: an internal dorsal nasal flap was used to create a cutaneous-cartilaginous flap inside the nasal dome, and was then sutured inferiorly against a superior triangle of the repaired median cleft lip. RESULTS Projective nasal growth could be seen in three of the five surgically constructed columellae in whom the medium-term results could be evaluated. CONCLUSION Five holoprosencephaly cases, all with a median cleft lip and agenesis of the columella, underwent a median cleft lip repair and the creation of a columella by means of an internal nasal dorsal skin flap procedure.

Nonsyndromic palate Synechia with floor of mouth

To discuss the embryological basis, sequela and management of intraoral synechia, and to report on the incidence of this condition at a facial cleft deformity clinic (FCDC), with specific attention to two rare cases of mucosal bands involving the floor of the mouth and palate. Review of the literature and a retrospective analysis of FCDC and case report of two cases. During the period of 30 years (1983-2013), the FCDC - University of Pretoria has managed in excess of 4000 cases. A review of the clinic statistics revealed only six cases in which intraoral synechiae occurred. The rarity of this condition at the FCDC is in keeping with the rare incidence in the international literature. Four syndromic cases were identified. Three cases were cleft palate lateral synechia syndrome, and one was an orofacial digital syndrome. Two nonsyndromic cases were identified, and both cases involved the floor of the mouth and palate. The attending physicians and surgeons should be aware of the most appropriate timing for management of this condition, in order to avoid unwanted sequelae. Supportive care should be provided, and emergency airway protocol should be available for all cases. A differential diagnosis should be considered which includes syndromic conditions.

A radiological evaluation of alveolar bone regeneration between the left and right mandibles and maxillae of the Chacma baboon

There is a lack of information in comparing the healing rate between the left and right sides of the maxilla and mandible. Osteogenesis of alveolar bone was evaluated with digital radiology by comparing differences in bone density (BD) at different time points within the left and right maxilla and mandible. Alveolar bone defects were created in five healthy Chacma baboons. Standardised x-ray images were acquired over time and the densities of the selected trauma areas were measured pre-operatively, post-operatively and at 3 and 6 weeks post-operatively. Differences in densities were statistically tested. There was no significant difference when the grey scale averages of the combined first and fourth quadrants (right side) and combined second and third quadrants (left side) were compared pre-operatively (t = 0.70), immediately post-operatively (t = 0.34), 3 weeks post-operatively (t = 0.40) and 6 weeks post-operatively (t = 0.66). There was also no significant difference between the values for the first and second quadrants (maxilla) pre-operatively (t = 0.37), immediately post-operatively (t = 0.30), 3 weeks post-operatively (t = 0.30) and 6 weeks post-operatively (t = 0.38); the third and fourth quadrants (mandible) were also not significantly different pre-operatively (t = 0.29), immediately post-operatively (t = 0.69), 3 weeks post-operatively (t = 0.07) and 6 weeks post-operatively (t = 0.06). However, the results showed an increased predisposition of the right side to regenerate faster than the left side and indicated sufficient information to investigate the effect of laterality and preferred side of mastication on the rate of healing and alveolar BD in the maxilla and mandible.

Asymmetrical soft palate cleft repair: Preliminary results

The reconstructions of the asymmetrical soft palate cleft is a surgical challenge when it comes to achieving symmetry and optimal soft palate muscular function. Three different versions of the intravelar veloplasty have been used: the intravelar veloplasty (1969) (type I), the modification according to anatomical defects (1991) (type II), and the modification using part of Sommerlads technique and part of Ivanovs technique (2008) (type III). The perioperative outcomes of the type II and type III intravelar veloplasty were assessed and compared in asymmetrical cleft cases. Two hundred and seventy-seven soft palate clefts were reconstructed: 153 type II and 124 type III. Of these, 49 were asymmetrical (17.7%); 23 underwent the type II procedure and 26 the type III procedure. Of the type II procedure cases, 30.4% remained asymmetrical postoperatively compared to 3.8% of the type III cases. The uvula appeared subjectively atrophic in 47.8% of the type II cases and in 7.7% of type III cases. Oro-nasal fistula occurred in 13.0% of the type II cases and 3.8% of the type III cases. Speech results will only be assessed after 4 years of age. The type III modified intravelar veloplasty has had a major beneficial impact on patients who had an asymmetrical soft palate cleft.

A comparison of mandibular and maxillary alveolar osteogenesis over six weeks: a radiological examination

IntroductionInsufficient information exists on comparing radiological differences in bone density of the regeneration rate in the alveolar bone of the maxilla and mandible following the creation of similar defects in both.MethodsAlveolar bone defects were created from five healthy Chacma baboons. Standardized x-ray images were acquired over time and the densities of the selected defect areas were measured pre-operatively, directly post-operatively and at three- and six weeks post-operatively. Differences in densities were statistically tested using ANOVA.ResultsThe maxilla was significantly more radiologically dense (p = 0.026) than the mandible pre- operatively. No differences were obtained between the maxilla and mandible directly postoperatively and three- and six weeks post-operatively respectively; i.e. densities were not significantly different at the different time points after the defects had been created (three weeks: t = 1.08, p = 0.30; six weeks: t = 1.35, p = 0.19; three to six weeks: t = 1.20, p =0.25). The increase in density in the mandible was 106% (8.9 ± 7.6%/time versus 4.3 ± 2.7%/time) over three weeks, 28% (15.0 ± 8.1%/time versus 11.7 ± 8.0%/time) over six weeks and 56% (12.5 ± 9.7%/time versus 8.0 ± 6.9%/time) over three-to-six weeks and was higher than in the maxilla over the same intervals.ConclusionsRadiological examination with its standardized gray-scale analysis can be used to determine the difference in bone density of the maxilla and mandible. Although not statistically significant, the mandible healed at a faster rate than the maxilla, especially observed during the first three weeks after the defects were created.

Columella pressure necrosis: a method of surgical reconstruction and its long-term outcome

Nasal continuous positive airway pressure (nCPAP) in premature babies may rarely lead to necrosis of the columella. Subsequent functional and cosmetic impairments require surgical corrections to restore nasal anatomy and architecture. The objective of this report is to document the technique of reconstruction in a baby with columella necrosis due to nCPAP treatment. A 21-month-old baby was referred to the oral and maxillofacial unit with a necrotic columella following nCPAP ventilation in a neonatal intensive care unit. Nearly 75% of the vertical columella length was affected. A neocolumella was created using tissues mobilised from the nasal sill region. This report provides a detailed description of a columella reconstruction technique which is valuable to restore aesthetics and function.

Alveolar band in patients with cleft lip and cleft alveolar deformities.

A complete cleft of the lip is often interrupted by a Simonarzt band. Very rarely, a similar fibrous soft tissue band can be seen interrupting the complete cleft of the alveolus. This alveolar band has not been previously described in the literature.