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A new folded pharyngeal flap: Preliminary report
ABSTRACTS
840
Fifty cases of first branchial cleft cysts and sinuses from the period 1949-1973 are reviewed. Fifteen were branchial cleft cysts found within the parotid gland, and the remaining 35 were both cysts and sinuses related to and around the ear. The embryologic explanation is described as an apparent incomplete closure or developmental resolution of the clefts (and pouches) appearing among the branchial arches. The paper lists the derivatives of the first branchial arch. The diagnosis is based on the appearance of the cyst and sinuses in relation to the external ear canal, angle of the mandible, or upper lateral neck. The age of presentation varies from the neonatal period to senescence. Sinuses in general appeared earlier-infancy through young adulthood-with the cyst appearing at a median age of 42.5 yr. The pathology is clearly presented. The microcospic picture, along with the pathologic changes that may alter it, is detailed. The preoperative evaluation with dye contrast material is not encouraged. General anesthesia is advised. The surgical treatment, along with advice and suggestions to simplify the removal of the complex case, is described. Finally, three illustrative case reports are given with preoperative, operative, and specimen photographs to further the reader’s knowledge of this entity.--d. E. Sokol Cleft lip and Palate.
H. J.
Keller. Praxis (Beme)
63:378-392, 1974. In order to assess the frequency of occurrence of the different forms of cleft lip and palate, 500 case histories were reviewed. Combined cleft lip and palate show a predominance of 41.8x, with cleft lip alone accounting for 28.8% and cleft palate accounting for 29.8%. Unilateral clefts predominate on the left side. Cleft lip as well as cleft lip and palate show a male predominance, whereas cleft palate alone occurs more frequently in females. Statistical figures are given about the type and number of primary corrections needed as well as about preand postoperative orthopedic and orthodontic procedures.-G. Egli Combined
Orthopedic
and Surgical
Treatment
and M. Per&o.Schweiz. Med. Wochenschr. 104:718-723, (May), 1974. of Cleft
lip
and
Palate.
M.
Hofz-Jenny
A combined orthopedic and surgical approach to cleft lip and palate is described. Be-
cause experience has shown that maxillary growth is disturbed by too early surgical interventions, the authors describe their new time schedule of surgical interventions that they have used since 1967. Coordination of pre- and postoperative maxillary orthopedics with appropriate timing of surgery to match the requirements of regular speech development serves to minimize the formerly observed sequelae. Final evaluation will need to be based on longitudinal data from birth to 18 yr. To date, results of present procedures are considerably better than those of corresponding age groups in former investigations (1960).G. Egli A Conservative
Program
Palate
Use of
Without
for
Managing
Mucoperiosteal
Cleft Flaps.
R. B/c&ma, C. A. Leuz, and K. E. Mellerstig. Plast. Reconstr. Surg. 55:160-169, (February), 1975. All cleft palate surgery performed during the period 1963-1973 in the Butterworth Hospital Clinic was analyzed and a total of 309 patients was studied. Of these, 107 had the conservative, modified Von Langenbeck procedure. The remainder had various modifications of mucoperiosteal flaps referred to in the article as radical palatoplasties. The Von Langenbeck procedure used was modified to meet the special requirements of the team in order to reduce the socalled damage to the underlying palatal shelves and thus reduce the frequency of later maxillofacial and dental irregularities. The results of this lo-yr study were that hypoplasia of the superior maxilla was found in 23% of 137 patients who had undergone mucoperiosteal flap surgery, whereas none was found in patients who had undergone the conservative, modified Von Langenbeck technique. Secondary pharyngeal flap surgery was required in equal numbers of patients after radical versus conservative palatal closures. It is noteworthy that 61% of the mucoperiosteal flap techniques required secondary pharyngeal flap surgery, an extraordinarily high percentage. Conservative closure patients saved an average of two hospital days. The authors recommend that conservatism be exercised in palatoplasties, closing the soft palate with a modified Von Langenbeck technique in incomplete cleft palates. Where complete cleft palates exist, the authors recommend a two-stage closure of the palate, the soft palate being repaired at 18-24 mo of age and the hard palate repair being deferred to a later date that is unspecified.--d. B. Sokol
840
Fifty cases of first branchial cleft cysts and sinuses from the period 1949-1973 are reviewed. Fifteen were branchial cleft cysts found within the parotid gland, and the remaining 35 were both cysts and sinuses related to and around the ear. The embryologic explanation is described as an apparent incomplete closure or developmental resolution of the clefts (and pouches) appearing among the branchial arches. The paper lists the derivatives of the first branchial arch. The diagnosis is based on the appearance of the cyst and sinuses in relation to the external ear canal, angle of the mandible, or upper lateral neck. The age of presentation varies from the neonatal period to senescence. Sinuses in general appeared earlier-infancy through young adulthood-with the cyst appearing at a median age of 42.5 yr. The pathology is clearly presented. The microcospic picture, along with the pathologic changes that may alter it, is detailed. The preoperative evaluation with dye contrast material is not encouraged. General anesthesia is advised. The surgical treatment, along with advice and suggestions to simplify the removal of the complex case, is described. Finally, three illustrative case reports are given with preoperative, operative, and specimen photographs to further the reader’s knowledge of this entity.--d. E. Sokol Cleft lip and Palate.
H. J.
Keller. Praxis (Beme)
63:378-392, 1974. In order to assess the frequency of occurrence of the different forms of cleft lip and palate, 500 case histories were reviewed. Combined cleft lip and palate show a predominance of 41.8x, with cleft lip alone accounting for 28.8% and cleft palate accounting for 29.8%. Unilateral clefts predominate on the left side. Cleft lip as well as cleft lip and palate show a male predominance, whereas cleft palate alone occurs more frequently in females. Statistical figures are given about the type and number of primary corrections needed as well as about preand postoperative orthopedic and orthodontic procedures.-G. Egli Combined
Orthopedic
and Surgical
Treatment
and M. Per&o.Schweiz. Med. Wochenschr. 104:718-723, (May), 1974. of Cleft
lip
and
Palate.
M.
Hofz-Jenny
A combined orthopedic and surgical approach to cleft lip and palate is described. Be-
cause experience has shown that maxillary growth is disturbed by too early surgical interventions, the authors describe their new time schedule of surgical interventions that they have used since 1967. Coordination of pre- and postoperative maxillary orthopedics with appropriate timing of surgery to match the requirements of regular speech development serves to minimize the formerly observed sequelae. Final evaluation will need to be based on longitudinal data from birth to 18 yr. To date, results of present procedures are considerably better than those of corresponding age groups in former investigations (1960).G. Egli A Conservative
Program
Palate
Use of
Without
for
Managing
Mucoperiosteal
Cleft Flaps.
R. B/c&ma, C. A. Leuz, and K. E. Mellerstig. Plast. Reconstr. Surg. 55:160-169, (February), 1975. All cleft palate surgery performed during the period 1963-1973 in the Butterworth Hospital Clinic was analyzed and a total of 309 patients was studied. Of these, 107 had the conservative, modified Von Langenbeck procedure. The remainder had various modifications of mucoperiosteal flaps referred to in the article as radical palatoplasties. The Von Langenbeck procedure used was modified to meet the special requirements of the team in order to reduce the socalled damage to the underlying palatal shelves and thus reduce the frequency of later maxillofacial and dental irregularities. The results of this lo-yr study were that hypoplasia of the superior maxilla was found in 23% of 137 patients who had undergone mucoperiosteal flap surgery, whereas none was found in patients who had undergone the conservative, modified Von Langenbeck technique. Secondary pharyngeal flap surgery was required in equal numbers of patients after radical versus conservative palatal closures. It is noteworthy that 61% of the mucoperiosteal flap techniques required secondary pharyngeal flap surgery, an extraordinarily high percentage. Conservative closure patients saved an average of two hospital days. The authors recommend that conservatism be exercised in palatoplasties, closing the soft palate with a modified Von Langenbeck technique in incomplete cleft palates. Where complete cleft palates exist, the authors recommend a two-stage closure of the palate, the soft palate being repaired at 18-24 mo of age and the hard palate repair being deferred to a later date that is unspecified.--d. B. Sokol