Vipul Nanda

Width of cleft palate and postoperative palatal fistula – do they correlate?

This study was conducted to evaluate any correlation between the measured width of cleft palates and postoperative fistula formation. Prospective study design was used where 43 consecutive cases of patients with cleft lip and palate or isolated palate who underwent cleft palate repair in an institution were observed. A preoperative or peroperative dental impression of the upper jaw was taken for the measurement of various cleft parameters. Palatoplasty was done using the Von-Langenbeck procedure or modified Veau-Wardil-Kilner-type repair. Among these, only 31 patients could be followed up for at least 4 weeks after the surgery and were included in the study. The patients developing fistulas were evaluated with respect to size, site and initial cleft dimensions. Statistical evaluation of multiple variables was performed. It was found that the width of the cleft palate has a bearing on the occurrence of postoperative palatal fistula formation, with a width of 15 mm or more having a statistically significant risk of fistula formation. The strongest association was found for the ratio of cleft width to the sum of the palatal shelves width. As this ratio increases to 0.48 or more, the risk of fistula becomes statistically significant. The ratio of cleft width to the posterior arch width is also a strong predictor of fistula formation with the risk becoming higher if the ratio is more than 0.41. Thus, the concept of wide-cleft is not vague or irrelevant but has a bearing on postoperative fistula formation, as shown in this study.

Problems of middle ear and hearing in cleft children

The hearing loss in a cleft patient is a well known complication, but generally gets ignored. These children continue to have recurrent otitis media with effusion that affects the hearing abilities. Unfortunatley the middle ear function may not improve with palatoplasty.Cleft palate teams need to follow up all such children beginning at birth and going into adulthood, decades after a ‘successful’ palate repair. These patients should have careful otological and audiological surveillance with appropriate interventions whenever required. The review article discusses the current status of hearing management in patients with cleft palate.

Treatment of depressed scars with a dissecting cannula and an autologous fat graft.

Contemporary options for the improvement of depressed scars include scar revision with an elliptical excision, z-plasty, w-plasty, and geometric broken-line closure. Dermabrasion and laser treatment has been used to obtain a uniform skin surface. When scars are hypertrophic, intralesional steroids and silicone pressure therapy may be useful. Occasionally, scars may be adherent to the underlying fascia. The resulting depression along the length of the scar worsens the aesthetic deformity. Fat injection is an established method for treating depressions and contour deformities. We report encouraging results with the use of this fat injection technique into a pocket made with a sharp cannula in treating 30 patients with postsurgical scars that were depressed and adherent to the underlying fascia. This technique is a useful addition to the surgeon’s resources when treating scars.

Linear Hypopigmentation After Triamcinolone Injection: A Rare Complication of a Common Procedure

The development of linear hypopigmentation after intralesional or intraarticular injection of triamcinolone acetonide has been reported in the literature as a very rare side effect. This case report describes a patient with linear hypopigmentation and discusses the possible pathophysiology. Clinicians involved in the care of hypertrophic scars and keloids need to be aware of this rare side effect so that they can guide their patients appropriately. They need to understand the pathogenesis of this complication better so that it may become avoidable.

Amyloidosis Complicating Rhinophyma

Rhinophyma is the advanced stage of acne rosacea and a source of embarrassment for the patient. Secondary localized cutaneous amyloidosis complicating rhinophyma is not reported in the literature. A patient with rhinophyma was treated by excision and primary closure. The histologic examination showed amyloidosis.

Lateral approach to the levator veli palatini: a preliminary report.

The abnormal anatomy in the cleft palate has been of interest to surgeons for a long time. Different authors have independently evolved the techniques of radical reconstruction of the palatal musculature and have suggested the medial approach to dissect the levator. We hereby report the technique in which the levator is identified through the lateral incision of the soft palate. This lateral approach helps in the complete release of the levator from all abnormal attachments and ensures reconstruction of an effective sling. This technique is of particular benefit in a palate re-repair.

Delayed buccal fat pad herniation: An unusual complication of buccal flap in cleft surgery.

Buccal musculomucosal flap is commonly used in cleft palate surgery for providing additional lining when nasal mucosa is inadequate. We report an unusual complication of progressively increasing fat herniation from the sutured donor site which started appearing on the third postoperative day. This necessitated excision of the protruding fat pad on the seventh postoperative day. The possible mechanism and precautions for prevention of this complication are discussed.

The faun tail and the plastic surgeon

Congenital spinal abnormalities seen with spinal dysraphism, when not recognized and treated in a timely fashion, can cause devastating neurological deficits. These anomalies are often accompanied by cutaneous markers, e.g., faun tail. Early recognition of the association of these lesions with the underlying spinal anomalies will reduce the morbidity associated with this condition. At times, the management of the cutaneous marker will be of primary importance. A review of Roman mythology surrounding the name ascribed to this clinical condition is included.

Appeal for an “e-Group” to Be Formed

Plastic surgery has achieved great heights in the past few decades as the members of the community have continued to share their ideas, clinical acumen, surgical skills, and new research. We are a rather small community, so it is all the more important that we reach out and grow together. Although the Internet and other sources of telecommunication have helped a lot in knowledge sharing within the community, a lot more can be done. The problems faced by plastic surgeons in developing countries are different from those faced by their counterparts in the developed world. We believe that the formation of an ‘‘e-group’’ of plastic surgeons all over the world, under the Editorial Board of Aesthetic Plastic Surgery (it being the most widely circulated journal of aesthetic plastic surgery), could go a long way in nurturing cooperation within the fraternity. In this group, each member would fill in his or her particulars and areas of interest. The members of the proposed e-group could be further divided into subgroups such as breast surgeons, facial plastic surgeons, and the like. The members of a subgroup could discuss difficult clinical problems among themselves and pose their queries to experts in that field. This discussion within the subgroup could be moderated by a specialist nominated by the editor. Such an online discussion would provide surgeons working in the peripheral centers of a developing country easy access to the best advice in the world. All forthcoming events such as continuing medical education programs, workshops, and conferences could be communicated to all the members of the group. Information about training programs and fellowships could be sent to all the members of this e-group. We think such an e-group not only would help plastic surgeons all over the world in sharing ideas, knowledge, and expertise, but also would go a long way toward bridging the gap between the privileged (developed) and the not so privileged (developing countries). Shall Aesthetic Plastic Surgery again be the leader in this endeavor?