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An analysis of a modified intravelar veloplasty technique
Oral Presentation The da Vinci surgical robot was used on a cadaver and assessed for the optimal positioning of the patient and robot, the introduction of the videoscope and 2 of the 8 mm end effectors of the robotic system as well as the dexterity, precision, and depth perception that it allowed the surgeon during trans-oral soft palate surgery. The da Vinci surgical robot was used through a transoral approach to attempt reconstruction of palatal muscles in ten patients with palatal cleft under general anesthesia. Procedures were documented with video and still photography. Results: Use of the surgical robot on cadaver provided great dexterity and precision, delicate tissue handling, excellent 3-dimensional depth perception, and relatively easy transoral suturing. The transoral access proved to be efficient and safe for precise dissection, reorientation and suturing of palatal muscles. Conclusions: A surgical robotic approach can be used safely for palatal surgery. We believe that the precise dissection of the palatal muscles provided by robotic system might reduce the chance of damaging vascularization and innervation of these muscles, as well as damage to mucosal surfaces resulting in fistula formation, and might improve palatal function and Eustachian tube function in cleft patients. http://dx.doi.org/10.1016/j.ijom.2015.08.712 Philtrum aesthetics in primary cleft lip repair S. Naidoo 1,∗ , K.-W. Bütow 1,2,3 1 Facial Cleft Deformity Clinic, Department of Maxillofacial and Oral Surgery, University of Pretoria, South Africa 2 Wilgers Hospital, South Africa 3 Department of Health Sciences, University of KwaZulu-Natal, South Africa
Background: Various surgical techniques have been described for enhancing the philtrum topography (philtrum dimple and philtrum edges) to improve aesthetics. Previous enhancements have been described for secondary revision surgery. Objectives: Novel orbicularis oris muscle suturing techniques is assessed during primary cleft lip surgery for unilateral and bilateral cleft lip cases to accentuate the philtrum dimple-column sub-aesthetic unit. The unilateral repair was achieved by utilizing the anatomical lipplasty technique, while the bilateral repair was performed by utilizing a modified Broadbent or Noordhoff–Trott technique and evaluated with a new muscle approximation technique. Methodology: In unilateral cleft lip cases, edge-to-edge orbicularis oris muscle suturing was compared to obliquely overlapping the muscle fibers (vertical mattress suture) and rolling up of the muscle edges (horizontal mattress suture). In bilateral cases, edgeto-edge muscle repair was compared to a technique performed by creating a gap between the orbicularis muscle ends in the region of the prolabium. In both unilateral and bilateral cases take down sutures were placed in the philtrum dimple area to accentuate the philtrum escarpment. Finding: Muscle roll-up technique with a take-down suture provides best aesthetic outcome in unilateral cleft lip cases. In bilateral cases, creation of a gap between the muscle stumps and inclusion of a take-down suture creates a philtrum-like effect. Orbicularis muscle continuity is maintained by a fibrotic connection between the muscle ends. Conclusion: Special suturing techniques during primary cleft lip repair results in improved aesthetic outcomes in both unilateral
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and bilateral cases. These techniques may limit the need for or extent of secondary revision surgery. http://dx.doi.org/10.1016/j.ijom.2015.08.713 An analysis of a modified intravelar veloplasty technique S. Naidoo 1,∗ , K.-W. Bütow 1,2,3 1 Facial Cleft Deformity Clinic, Department of Maxillofacial and Oral Surgery, University of Pretoria, South Africa 2 Wilgers Hospital, South Africa 3 Department of Health Sciences, University of KwaZulu-Natal, South Africa
Background: Soft palate closure is a challenge to the cleft surgeon with no technique proven to be ideal. Significant advances by Veau, Braithwaite and Maurice and Kriens led to the development of the intravelar veloplasty (IVV). Sommerlad’s modification of the IVV with meticulous muscle approximation, together with Ivanov’s modification in uvula repair was assessed in this study. Objectives: This is a prospective analysis of 102 patients repaired with the IVV with modification of Sommerlad and Ivanov. Pre-operative and immediately post-operative dimensions were measured to assess dimensional changes specifically pertaining to soft palate lengthening. Methodology: Cleft soft palates were categorized into four groups according to the width of cleft defect. Soft palate dimensional changes were analysed within respective categories. Uvula anatomy was objectively assessed and positioning was determined according to the mid-tuberosital distance. Findings: Soft palate lengthening occurred in all cases. Cleft defects of between 1 and 5 mm resulted in least amounts of lengthening which could be attributed to a restricted area for de-rotation of levator palatine muscle. The median lengthening achieved in all groups was 2.44 mm. In most cases the Ivanov uvula reconstruction appeared more bulky and natural. Conclusion: This study provides empiric evidence of dimensional changes related to the IVV-technique. The soft palate lengthening achieved may have a positive influence on speech. This technique also provides a method with limited periosteal stripping with reduced midfacial growth disturbances when compared to other techniques. The results from this study indicate that the Sommerlad–Ivanov modified IVV should be considered as a first option for soft palate closure. http://dx.doi.org/10.1016/j.ijom.2015.08.714 Efficacy of freeze-dried platelet rich plasma on bone engineering Y. Nakatani ∗ , H. Agata, Y. Sumita, T. Koga, I. Asahina Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan Background: Platelet-rich plasma (PRP) is know to promote wound healing and widely utilized in bone engineering. PRP is freshly isolated and applied on site of the operation in general, but it is time consuming and is sometimes hard to prepare the adequate amount. Then, it is useful if PRP can be stored. Objectives: We evaluate the efficacy of freeze-dried PRP (FD-PRP) comparing to freshly isolated PRP (f-PRP) on bone engineering. Methods: f-PRP was lyophilized to prepare FD-PRP and it was subsequently preserved at −20 ◦ C for 1 month. Then, we
Background: Various surgical techniques have been described for enhancing the philtrum topography (philtrum dimple and philtrum edges) to improve aesthetics. Previous enhancements have been described for secondary revision surgery. Objectives: Novel orbicularis oris muscle suturing techniques is assessed during primary cleft lip surgery for unilateral and bilateral cleft lip cases to accentuate the philtrum dimple-column sub-aesthetic unit. The unilateral repair was achieved by utilizing the anatomical lipplasty technique, while the bilateral repair was performed by utilizing a modified Broadbent or Noordhoff–Trott technique and evaluated with a new muscle approximation technique. Methodology: In unilateral cleft lip cases, edge-to-edge orbicularis oris muscle suturing was compared to obliquely overlapping the muscle fibers (vertical mattress suture) and rolling up of the muscle edges (horizontal mattress suture). In bilateral cases, edgeto-edge muscle repair was compared to a technique performed by creating a gap between the orbicularis muscle ends in the region of the prolabium. In both unilateral and bilateral cases take down sutures were placed in the philtrum dimple area to accentuate the philtrum escarpment. Finding: Muscle roll-up technique with a take-down suture provides best aesthetic outcome in unilateral cleft lip cases. In bilateral cases, creation of a gap between the muscle stumps and inclusion of a take-down suture creates a philtrum-like effect. Orbicularis muscle continuity is maintained by a fibrotic connection between the muscle ends. Conclusion: Special suturing techniques during primary cleft lip repair results in improved aesthetic outcomes in both unilateral
e115
and bilateral cases. These techniques may limit the need for or extent of secondary revision surgery. http://dx.doi.org/10.1016/j.ijom.2015.08.713 An analysis of a modified intravelar veloplasty technique S. Naidoo 1,∗ , K.-W. Bütow 1,2,3 1 Facial Cleft Deformity Clinic, Department of Maxillofacial and Oral Surgery, University of Pretoria, South Africa 2 Wilgers Hospital, South Africa 3 Department of Health Sciences, University of KwaZulu-Natal, South Africa
Background: Soft palate closure is a challenge to the cleft surgeon with no technique proven to be ideal. Significant advances by Veau, Braithwaite and Maurice and Kriens led to the development of the intravelar veloplasty (IVV). Sommerlad’s modification of the IVV with meticulous muscle approximation, together with Ivanov’s modification in uvula repair was assessed in this study. Objectives: This is a prospective analysis of 102 patients repaired with the IVV with modification of Sommerlad and Ivanov. Pre-operative and immediately post-operative dimensions were measured to assess dimensional changes specifically pertaining to soft palate lengthening. Methodology: Cleft soft palates were categorized into four groups according to the width of cleft defect. Soft palate dimensional changes were analysed within respective categories. Uvula anatomy was objectively assessed and positioning was determined according to the mid-tuberosital distance. Findings: Soft palate lengthening occurred in all cases. Cleft defects of between 1 and 5 mm resulted in least amounts of lengthening which could be attributed to a restricted area for de-rotation of levator palatine muscle. The median lengthening achieved in all groups was 2.44 mm. In most cases the Ivanov uvula reconstruction appeared more bulky and natural. Conclusion: This study provides empiric evidence of dimensional changes related to the IVV-technique. The soft palate lengthening achieved may have a positive influence on speech. This technique also provides a method with limited periosteal stripping with reduced midfacial growth disturbances when compared to other techniques. The results from this study indicate that the Sommerlad–Ivanov modified IVV should be considered as a first option for soft palate closure. http://dx.doi.org/10.1016/j.ijom.2015.08.714 Efficacy of freeze-dried platelet rich plasma on bone engineering Y. Nakatani ∗ , H. Agata, Y. Sumita, T. Koga, I. Asahina Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan Background: Platelet-rich plasma (PRP) is know to promote wound healing and widely utilized in bone engineering. PRP is freshly isolated and applied on site of the operation in general, but it is time consuming and is sometimes hard to prepare the adequate amount. Then, it is useful if PRP can be stored. Objectives: We evaluate the efficacy of freeze-dried PRP (FD-PRP) comparing to freshly isolated PRP (f-PRP) on bone engineering. Methods: f-PRP was lyophilized to prepare FD-PRP and it was subsequently preserved at −20 ◦ C for 1 month. Then, we