phenylephrine-hydrochloride and Respiratory-Tract-Fistula

Techniques vary for addressing the nasal floor during cleft lip repair in patients with a cleft lip and palate. Sometimes, no closure is performed, leaving a symptomatic alveolar fistula until the time of alveolar bone grafting. Often, medial and lateral skin flaps are used, but these are often thin and unreliable. Anatomical nasal lining flaps are used to improve closure with robust, well-vascularized flaps that anatomically close the nasal floor.. A retrospective chart review was performed to identify patients with a unilateral or bilateral cleft lip and palate who underwent primary cleft lip repair with nasal lining flaps or with medial and lateral flaps. The primary outcome was presence of a symptomatic and/or visible oronasal fistula.. Sixty-four patients were included. Thirty-seven underwent closure with nasal lining flaps, whereas 27 underwent closure using Millard medial and lateral flaps. The rate of symptomatic/visible fistulas after cleft palate repair was 19 percent (seven of 37) for patients with nasal lining flaps and 44 percent (12 of 27) for patients with medial and lateral flaps (p = 0.0509, Fisher's exact test). The alveolar fistula rate was 3 percent (one of 37) for patients with nasal lining flaps and 30 percent (eight of 27) for patients with medial and lateral flaps (p = 0.0032, Fisher's exact test).. Nasal lining flaps at the time of cleft lip repair effectively close the anterior nasal floor in patients with a unilateral or bilateral cleft lip and palate. Decreasing the presence of alveolar fistulas after cleft palate repair improves the quality of life for patients with cleft deformities.. Therapeutic, III.

Topics: Cleft Lip; Female; Humans; Infant; Male; Nose; Nose Diseases; Oral Fistula; Quality of Life; Respiratory Tract Fistula; Retrospective Studies; Surgical Flaps; Treatment Outcome; Wound Closure Techniques

A cleft lip and palate consists of fissures of the upper lip and/or palate, and is the most commonly seen orofacial anomaly that involves the middle third of the face. Early treatment of patients with a cleft lip and palate is important because of esthetic, functional, and psychological concerns. Nasoalveolar molding provides excellent results when started immediately after birth. This clinical report describes the presurgical management of an infant with a complete unilateral cleft of the soft palate, hard palate, alveolar ridge, and lip.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Dental Prosthesis Design; Humans; Infant, Newborn; Nose; Nose Diseases; Oral Fistula; Palatal Obturators; Palate, Hard; Palate, Soft; Preoperative Care; Respiratory Tract Fistula; Stents

The aim of this publication is to offer teams specializing in the primary and secondary treatment of labio-alveolar-palatal clefts a prosthetic evaluation for more rational management of the dental sequellae of clefts for patients who, when they reach adulthood, often wish to improve their facial esthetics, in which the dental element plays a significant part. The reorganization and restoration of the upper anterior teeth, and their esthetic integration with respect to the face and lips, would then be less of a problem for plastic surgeons or orthodontists. In this respect, the installation in this sector of implants, following ambitious bone surgery involving the sacrifice, in bilateral forms, of the teeth of the medial process is a protocol that could usefully be taken into account.

Topics: Anodontia; Bone Transplantation; Cleft Lip; Cleft Palate; Cooperative Behavior; Dental Implants; Dental Prosthesis, Implant-Supported; Esthetics, Dental; Humans; Incisor; Lip; Nose; Nose Diseases; Oral Fistula; Orthodontics, Interceptive; Palate, Soft; Patient Care Planning; Patient Care Team; Plastic Surgery Procedures; Respiratory Tract Fistula; Tooth Abnormalities; Tooth Extraction; Wound Healing

We investigated the effect of the bacterial flora of the nose and throat on the outcome of the initial repairs of the cleft palate in the presence of prophylactic antibiotics.. A retrospective review of 90 procedures in 66 patients who had cleft palate repair between April 2005 and June 2007 was conducted at Booth Hall Children's Hospital, Manchester, U.K. Both isolated cleft palate and cleft lip and palate patients were included. Exclusion criteria included syndromic cases, other medical disorders, and revisions of previous cleft palate repairs. Nose and throat swabs were taken on admission. Benzyl penicillin and flucloxacillin were given perioperatively. The occurrence of oronasal fistulas was correlated with the bacteria grown on culture.. The oronasal fistula rate was 15.9%. The highest fistula rate in procedures with positive swabs was seen with Moraxella catarrhalis.. M. catarrhalis has not been previously recognized as a pathogen in cleft palate repairs. This study demonstrates a higher fistula rate in procedures positive for M. catarrhalis. Other factors that may have contributed to the fistula formation include the severity of the initial cleft and technical factors. Further study is required before a definitive link can be established.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Cleft Lip; Cleft Palate; Floxacillin; Follow-Up Studies; Humans; Moraxella catarrhalis; Moraxellaceae Infections; Nose; Nose Diseases; Oral Fistula; Penicillin G; Pharynx; Postoperative Complications; Respiratory Tract Fistula; Retrospective Studies; Staphylococcus aureus; Streptococcus; Treatment Outcome

Repairs of the cleft nose, lip, and palatal deformity remain challenging endeavors for reconstructive surgeons. Postsurgical nasomaxillary hypoplasia is a common finding in patients with extensive clefts. This complex deformity has a pronounced impact on the social behavior and self image of the subject. Esthetic and functional rehabilitation of this postsurgical defect is scarcely reported in the literature. Support in the form of prostheses or stents to prevent tissue collapse is usually required in these patients following surgery. This clinical case presentation discusses the fabrication of an internal nasal stent for a cleft nose, lip, and palate patient following surgical reconstruction. Two prostheses using two prosthetic materials (Polymethyl methacrylate, flexible resin) were prepared to compare their efficacy. The final prostheses improved the patient's appearance, making the postsurgical defect less conspicuous.

Topics: Adolescent; Biocompatible Materials; Cleft Lip; Cleft Palate; Dental Prosthesis Design; Denture Design; Denture, Partial; Female; Humans; Maxilla; Nose; Nose Diseases; Oral Fistula; Palatal Obturators; Plastic Surgery Procedures; Polymethyl Methacrylate; Postoperative Complications; Prostheses and Implants; Prosthesis Design; Respiratory Tract Fistula; Stents; Treatment Outcome

This paper reports the case of a 50-year-old man who underwent superselective embolization after severe posterior rhinorrhagia caused by hypertension. Twelve hours after the procedure, left-sided hemiparesis and right-sided facial nerve paresis developed, followed by ulceration and necrosis of the soft palate, diaphragm, and right nasal ala. Reconstruction was implemented with porous polyethylene for the nasal pyramid, a forehead flap and a mucosal flap from the oral vestibulum for polyethylene coverage, and a rotational palatal flap for closure of the oroantral fistula. Exposure of the material occurred after 4 weeks, and removal was followed by satisfactory maintenance of the shape and function of the nose. Postembolization necrosis is a rare complication of the area, and there are very few similar reports in the literature.

Topics: Embolization, Therapeutic; Epistaxis; Facial Nerve Diseases; Facial Paralysis; Follow-Up Studies; Humans; Ischemia; Male; Maxillary Artery; Middle Aged; Mouth Mucosa; Necrosis; Nose; Nose Diseases; Oral Fistula; Palate, Soft; Paresis; Plastic Surgery Procedures; Polyethylene; Prosthesis Design; Prosthesis Implantation; Respiratory Tract Fistula; Skin Transplantation; Surgical Flaps

The aim of this study was to evaluate a modified surgical technique for premaxilla repositioning with concomitant autogenous bone grafting in bilateral trans-foramen cleft lip and palate patients.. The study included 50 bilateral trans-foramen cleft lip and palate patients. Bone graft was harvested from the mandibular symphysis in 24 patients. Whenever more grafting was necessary, the iliac crest bone was used as the donor site (26 patients). The premaxilla was displaced by rupturing the bone and the palatine mucosa, and repositioned in a more adequate position using a surgical guide. The premaxilla and the grafts were fixed with miniplates and screws or screws only. The surgical guide was kept in place for 2 months, whereas the miniplates and screws were removed after 6 months, together with the complete bilateral lip and nose repair. Follow-up examinations were performed at 3, 6, and 12 months by means of periapical and occlusal radiographs, and by clinical examination. Thereafter, the patients were referred for completion of the orthodontic treatment.. Overall, in 48 cases (96%) the treatment achieved total graft integration, with complete closure of the bucconasal and palatal fistulas, and premaxilla stability (either at first surgery or after reoperation). In the remaining 2 patients (4%), the treatment failed, due to necrosis of the premaxilla.. The procedure is complex and involves risk. However, the patient's social inclusion, especially at the addressed age group, is the best benefit achieved.

Topics: Bone Plates; Bone Screws; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Female; Follow-Up Studies; Graft Survival; Humans; Male; Maxilla; Nasal Cavity; Necrosis; Nose; Nose Diseases; Oral Fistula; Osteotomy; Palate; Periosteum; Postoperative Complications; Respiratory Tract Fistula; Surgical Flaps

To determine the presence of Staphylococcus aureus in a nasal flora and oral environment, the correlation between frequency of transmission of S. aureus and oronasal fistula size, and the pattern of methicillin resistance on S. aureus strains in children with cleft lip and palate (CLP).. Thirty-two CLP children with and without oronasal fistulas, ranging in age from 5 to 13 years were examined for oronasal fistula presence and size. Stimulated saliva samples and nasal swab samples were taken and investigated for S. aureus presence. S. aureus presence and counts were correlated with fistula presence and size.. Saliva samples showed statistical differences between the groups with and without oronasal fistulas with an area ranging from 0.80 to 28.26 mm2. The S. aureus counts were significantly higher (r = .535, p = .002) in saliva samples from children with larger oronasal fistula. The S. aureus count was not significantly different (r = -.013, p = .942) in nasal samples compared with oronasal fistula size. Methicillin resistance with disk-diffusion method was recorded as sensitive (> or =13 mm) in all S. aureus strains.. The results of this study indicate a positive correlation between fistula size and S. aureus transmission to one oral environment through oronasal fistulae, and a positive correlation between frequency of S. aureus transmission and fistula size. All S. aureus strains were sensitive to methicillin. These results may have implications for preventive treatment of CLP children.

Topics: Adolescent; Child; Child, Preschool; Cleft Lip; Cleft Palate; Colony Count, Microbial; Disk Diffusion Antimicrobial Tests; Humans; Methicillin-Resistant Staphylococcus aureus; Nose; Nose Diseases; Oral Fistula; Respiratory Tract Fistula; Saliva; Staphylococcus aureus

Patent nasopalatine ducts connecting the oral and nasal cavities are a rare developmental anomaly that has not been reported in the orthodontic literature. Only 36 cases of unilateral, central, or bilateral patent nasopalatine ducts are documented since the first publication in 1881. Some patients with this condition exhibit clinical symptoms, but not all elect to have definitive treatment with surgical repair or chemical ablation. This report describes the appearance of nasopalatine ducts in an adolescent male after rapid maxillary expansion [corrected]

Topics: Adolescent; Humans; Male; Nose; Oral Fistula; Palatal Expansion Technique; Palate, Hard; Respiratory Tract Fistula

Twelve days after a dog fight, a 2-year-old sexually intact female Bulldog was evaluated because of subcutaneous emphysema of increasing severity throughout the dogs body. Thoracic radiography revealed severe pneumomediastinum from which free air had extended into the retroperitoneal space, resulting in pneumoperitoneum. Tracheoscopic examination did not reveal a discontinuity of the trachea, pharynx, or larynx. A breach between the nasal cavity and subcutaneous tissues of the nasal region was suspected. Further diagnostic investigations included positive contrast rhinography and intranasal sinography. Via an angiographic catheter inserted into the left naris, positive contrast intranasal sinography revealed a sinus tract extending between the left nasal cavity and the subcutaneous tissue of the dorsal aspect of the nasal planum. Resolution of subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum began 1 day after surgical closure of the intranasal opening of the sinus tract. To the authors' knowledge, this radiographic technique has not been reported.

Topics: Animals; Dog Diseases; Dogs; Female; Mediastinal Emphysema; Nasal Cavity; Nasopharyngeal Diseases; Nasopharynx; Nose; Nose Diseases; Radiography, Thoracic; Respiratory Tract Fistula; Subcutaneous Emphysema

We report 3 new cases of a centrofacial destructive process associated with chronic nasal abuse of cocaine. This complex first described in 1988 is a rare entity involving sinonasal tract necrosis after cocaine abuse. Of special interest in this report is a male patient with columella and lip involvement instead of the more usual rhinopalatal destruction. This cocaine abuse complex should be included in the differential diagnosis of centrofacial midline destructive processes in young patients as the first diagnostic possibility. We suggest a management strategy for these patients.

Topics: Adult; Bone Transplantation; Chronic Disease; Cocaine-Related Disorders; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Nose Diseases; Oral Fistula; Oroantral Fistula; Palatal Obturators; Respiratory Tract Fistula; Rhinoplasty; Surgical Flaps; Turbinates

It is universally acknowledged that correction of a cleft lip nasal deformity continues to be a difficult problem. In developing countries, it is common for patients with cleft lip deformities to present in their early or late teens for correction of severe secondary lip and nasal deformities retained after the initial repairs were carried out in infancy or early childhood. Such patients have never had the benefit of primary nasal correction, orthodontic management, or alveolar bone grafting at an appropriate age. Along with a severe nasal deformity, they present with alveolar arch malalignments and anterior fistulae. In the study presented here, a strategy involving a complete single-stage correction of the nasal and secondary lip deformity was used. In this study, 26 patients (nine male and 17 female) ranging in age from 13 to 24 years presented for the first time between June of 1996 and December of 1999 with unilateral cleft lip nasal deformity. Eight patients had an anterior fistula (diameter, 2 to 4 mm) and 12 patients had a secondary lip deformity. An external rhinoplasty approach was used for all patients. The corrective procedures carried out in a single stage in these patients included lip revision; columellar lengthening; repair of anterior fistula; augmentation along the pyriform margin, nasal floor, and alveolus by bone grafts; submucous resection of the nasal septum; repositioning of lower lateral cartilages; fixation of the alar cartilage complex to the septum and the upper lateral cartilages; augmentation of nasal dorsum by bone graft; and alar base wedge resections. Medial and lateral nasal osteotomies were performed only if absolutely indicated. The median follow-up period was 11 months, although it ranged from 5 to 25 months. Overall results have been extremely pleasing, satisfactory, and stable. In this age group (13 years of age or older), it is not fruitful to use a technique for nasal correction that corrects only one facet of the deformity, because no result of nasal correction can be satisfactory until septal deviations and maxillary deficiencies are addressed along with any alar repositioning. The results of complete remodeling of the nasal pyramid are also stable in these patients because the patients' growth was nearly complete, and all the deformities could be corrected at the same time, leaving no active deforming vector. These results would indicate that aesthetically good results are achievable even if no primary nasal corr

Topics: Adolescent; Adult; Cleft Lip; Female; Follow-Up Studies; Humans; Male; Nose; Respiratory Tract Fistula; Rhinoplasty; Time Factors