http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Thu, 16 May 2013 11:53:06 +0000 http://www.hindawi.com/journals/psi/2013/861348/ Introduction. Dyslipidemia like other chronic degenerative diseases is pandemic in Latin America and around the world. A lot of patients asking for body contouring surgery can be sick without knowing it. Objective. Observe the lipid profile of patients with dyslipidemia, before and three months after an abdominoplasty. Methods. Patients candidate to an abdominoplasty without morbid obesity were followed before and three months after the surgery. We compared the lipid profile, glucose, insulin, and HOMA (cardiovascular risk marker) before and three months after the surgery. We used Student's test to compare the results. A value less than 0.05 was considered as significant. Results. Twenty-six patients were observed before and after the surgery. At the third month, we found only statistical differences in LDL and triglyceride values ( 0.04 and 0.03). The rest of metabolic values did not reach statistical significance. Conclusion. In this group of patients with dyslipidemia, at the third month, only LDL and triglyceride values reached statistical significances. There is no significant change in glucose, insulin, HOMA, cholesterol, VLDL, or HDL. Guillermo Ramos-Gallardo, Ana Pérez Verdin, Miguel Fuentes, Sergio Godínez Gutiérrez, Ana Rosa Ambriz-Plascencia, Ignacio González-García, Sonia Mericia Gómez-Fonseca, Rosalio Madrigal, Luis Iván González-Reynoso, Sandra Figueroa, Xavier Toscano Igartua, and Dector Jiménez Copyright © 2013 Guillermo Ramos-Gallardo et al. All rights reserved. Tue, 19 Mar 2013 15:28:09 +0000 http://www.hindawi.com/journals/psi/2013/140704/ Background. Breast developmental anomalies (BDAs) are abnormalities of breast tissue that arise during breast development. Some of the anomalies can have negative impact on the person's life. This study seeks to assess the prevalence of BDA in the Dormaa Municipality in Ghana and its impact on the life of the individual. Materials and Methods. A descriptive study involving 500 female respondents aged between 11 and 25 years from selected schools in the Dormaa Municipality using self-administered questionnaires and interviews. Results. From the study, it was found that the prevalence of BDA in the municipality was 12.8%. The commonest BDA was bilateral hypoplasia which accounted for 31.3% of the BDAs found in the study. Nine (14.1%) complained of the BDA affecting their lives with most being teased in school. Twenty-two (34.4%) girls out of the 64 with BDAs had a family member with a BDA. Conclusion. BDA is a worry; therefore, comprehensive educational programs for health workers and the general public are needed to increase awareness. Also, work should be done to include education on BDA when awareness is being raised about breast cancer and on the importance of breast self-Examination (BSE). P. Agbenorku, E. Otupiri, and S. Fugar Copyright © 2013 P. Agbenorku et al. All rights reserved. Tue, 12 Mar 2013 13:40:15 +0000 http://www.hindawi.com/journals/psi/2013/641570/ Background. High-quality clinical and genetic descriptions are crucial to improve knowledge of orofacial clefts and support specific healthcare polices. The objective of this study is to discuss the potential and perspectives of the Brazilian Database on Orofacial Clefts. Methods. From 2008 to 2010, clinical and familial information on 370 subjects was collected by geneticists in eight different services. Data was centrally processed using an international system for case classification and coding. Results. Cleft lip with cleft palate amounted to 198 (53.5%), cleft palate to 99 (26.8%), and cleft lip to 73 (19.7%) cases. Parental consanguinity was present in 5.7% and familial history of cleft was present in 26.3% subjects. Rate of associated major plus minor defects was 48% and syndromic cases amounted to 25% of the samples. Conclusions. Overall results corroborate the literature. Adopted tools are user friendly and could be incorporated into routine patient care. The BDOC exemplifies a network for clinical and genetic research. The data may be useful to develop and improve personalized treatment, family planning, and healthcare policies. This experience should be of interest for geneticists, laboratory-based researchers, and clinicians entrusted with OC worldwide. Isabella Lopes Monlleó, Marshall Ítalo Barros Fontes, Erlane Marques Ribeiro, Josiane de Souza, Gabriela Ferraz Leal, Têmis Maria Félix, Agnes Cristina Fett-Conte, Bruna Henrique Bueno, Luis Alberto Magna, Peter Anthony Mossey, and Vera Gil-da Silva-Lopes Copyright © 2013 Isabella Lopes Monlleó et al. All rights reserved. Wed, 27 Feb 2013 12:04:08 +0000 http://www.hindawi.com/journals/psi/2013/247908/ This study investigated the prevalence of oral habits in children with clefts aged three to six years, compared to a control group of children without clefts in the same age range, and compared the oral habits between children with clefts with and without palatal fistulae. The sample was composed of 110 children aged 3 to 6 years with complete unilateral cleft lip and palate and 110 children without alterations. The prevalence of oral habits and the correlation between habits and presence of fistulae (for children with clefts) were analyzed by questionnaires applied to the children caretakers. The cleft influenced the prevalence of oral habits, with lower prevalence of pacifier sucking for children with cleft lip and palate and higher prevalence for all other habits, with significant association (). There was no significant association between oral habits and presence of fistulae (). The lower prevalence of pacifier sucking and higher prevalence of other oral habits agreed with the postoperative counseling to remove the pacifier sucking habit when the child is submitted to palatoplasty, possibly representing a substitution of habits. There was no causal relationship between habits and presence of palatal fistulae. Paula Caroline Barsi, Thaieny Ribeiro da Silva, Beatriz Costa, and Gisele da Silva Dalben Copyright © 2013 Paula Caroline Barsi et al. All rights reserved. Wed, 20 Feb 2013 09:21:44 +0000 http://www.hindawi.com/journals/psi/2013/129692/ Objective. The objective of this study is to determine the incidence of PUs, the distribution of PUs, common injuries contributing to the occurrence of PUs in patients admitted to the Department of Plastic and Reconstructive Surgery Kosovo for surgical interventions of PUs, localization of PUs in body, the topical treatment of pressure ulcers before surgical intervention, the methods of surgical interventions, number of surgical interventions, duration of treatment, complications, and mortality. Materials and Methods. This study includes 55 patients with PUs treated surgically in 2000–2010 period in the Department of Plastic and Reconstructive Surgery Kosovo. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Data processing was done with the statistical package In Stat 3. From statistical parameters arithmetic median and standard deviation were calculated. Data testing is done with -test and the difference is significant if . Conclusion. Despite preventive measures against PUs, the incidence of Pus remains high. Shkelzen B. Duci, Hysni M. Arifi, Mimoza E. Selmani, Agon Y. Mekaj, Musli M. Gashi, Zejn A. Buja, Vildane H. Ismajli, Adem N. Kllokoqi, and Enver T. Hoxha Copyright © 2013 Shkelzen B. Duci et al. All rights reserved. Thu, 17 Jan 2013 13:56:01 +0000 http://www.hindawi.com/journals/psi/2013/538364/ Wide margin resection of extremity tumor sometimes leaves a huge soft tissue and bony defects in limb salvage surgery. Adequate management of these defects is an absolute requirement when aiming for functional limb. Multidisciplinary management in such cases is an answer when complex biologic reconstruction is desired. We aim to present cases of osteogenic sarcoma of lower extremity requiring combined surgical approach to achieve effective musculoskeletal reconstruction. Patients and Methods. From 2006 to 2010 ten patients were operated on for osteogenic sarcoma of lower extremity requiring complex musculoskeletal reconstruction. Results. Six patients had pathology around knee joint, whereas one each with mid tibia, mid femur, proximal femur, and heel bone. Locking compression plate was used in 7 patients including six with periarticular disease. Eight out of ten patients underwent biologic reconstruction using autograft; endoprosthetic reconstruction and hindquarter amputation were done in the remaining two patients. Vascularized fibula was done in five patients, sural artery flap which was primarily done in three patients, spare part fillet flap, free iliac crest flap, and Gastrocnemius flap was done in one patient each. Secondary hemorrhage, infection, nonunion, wound dehiscence, and flap failure were notable complications in four patients. The Average Musculoskeletal Tumor Society score was 89%. Conclusion. Combined surgical approach results in cosmetically acceptable and functional limb. Kashif Abbas, Masood Umer, and Haroon ur Rashid Copyright © 2013 Kashif Abbas et al. All rights reserved. Wed, 16 Jan 2013 11:57:48 +0000 http://www.hindawi.com/journals/psi/2013/671786/ Background. Humanitarian surgical organizations consider both quantity of patients receiving care and quality of the care provided as a measure of success. However, organizational efficacy is often judged by the percent of resources spent towards direct intervention/surgery, which may discourage investment in an outcomes monitoring system. Operation Smile's established Global Standards of Care mandate minimum patient followup and quality of care. Purpose. To determine whether investment of resources in an outcomes monitoring system is necessary and effectively measures success. Methods. This paper analyzes the quantity and completeness of data collected over the past four years and compares it against changes in personnel and resources assigned to the program. Operation Smile began investing in multiple resources to obtain the missing data necessary to potentially implement a global Surgical Outcomes Auditing System. Existing personnel resources were restructured to focus on postoperative program implementation, data acquisition and compilation, and training materials used to educate local foundation and international employees. Results. An increase in the number of postoperative forms and amount of data being submitted to headquarters occurred. Conclusions. Humanitarian surgical organizations would benefit from investment in a surgical outcomes monitoring system in order to demonstrate success and to ameliorate quality of care. Luis Bermudez, Kristen Trost, and Ruben Ayala Copyright © 2013 Luis Bermudez et al. All rights reserved. Sun, 13 Jan 2013 10:05:29 +0000 http://www.hindawi.com/journals/psi/2013/237308/ In 1971, Micheal Hogan introduced the Lateral Port Control Pharyngeal Flap (LPCPF) which obtained good results with elimination of VPI. However, there was a high incidence of hyponasality and OSA. We hypothesized that preoperative assessment with videofluoroscopy and nasal endoscopy would enable modification and customization of the LPCPF and result in improvement in the result in both hyponasality and obstructive apnea while still maintaining results in VPI. Thirty consecutive patients underwent customized LPCPF. All patients had preoperative diagnosis of VPI resulting from cleft palate. Patient underwent either videofluoroscopy or nasal endoscopy prior to the planning of surgery. Based on preoperative velar and pharyngeal movement, patients were assigned to wide, medium, or narrow port designs. Patients with significant lateral motion were given wide ports while patients with minimal movement were given narrow ports. There was a 96.66% success rate in the treatment of VPI with one patient with persistent VPI (3.33%). Six patients had mild hyponasality (20 %). Two patients had initial OSA (6.67%), one of which had OSA which lasted longer than six months (3.33%). The modifications of the original flap description have allowed for success in treatment of VPI along with an acceptably low rate of hyponasality and OSA. Sean Boutros and Court Cutting Copyright © 2013 Sean Boutros and Court Cutting. All rights reserved. Wed, 02 Jan 2013 14:13:36 +0000 http://www.hindawi.com/journals/psi/2013/406375/ Background. Most women with breast cancer today can be managed with breast conservation; however, some women still require mastectomy for treatment of their disease. Skin-sparing mastectomy (SSM) with immediate reconstruction has emerged as a favorable option for many of these patients. The authors combined the SSM technique with the preservation of a small part of the areola with immediate nipple together with with breast reconstruction. Methods. In an 8-year-period 155 female patients (age: 20–52 years old; mean age: 37.5 years) with extensive ductal intraepithelial neoplasia (DIN) or invasive breast cancer were treated with areola skin sparing mastectomy with immediate nipple and breast reconstruction. Patients were followed up prospectively by the breast surgeon, the plastic surgeon, and the oncologist for complications and recurrence. Results. After treatment, only 2 cases (1.29%) had a local recurrence. 8 out of 155 (5.5%) patients developed early complications (infections, seroma, haematoma), and 5 out of 155 patients (3.22%) developed delayed complications (implant rotation, aestethic deterioration) in the post operative time period. The final aesthetic outcome was judged as positive in 150 out of 155 patients (96.78%). Conclusion. In our experience, immediate nipple reconstruction after skin-sparing mastectomy is a technically feasible procedure which can give excellent cosmetic results. Raffaele Serra, Anna Maria Miglietta, Sergio Abonante, Vincent Giordano, Gianluca Buffone, and Stefano de Franciscis Copyright © 2013 Raffaele Serra et al. All rights reserved. Sun, 30 Dec 2012 09:29:06 +0000 http://www.hindawi.com/journals/psi/2012/651863/ Due to ethical and medical-legal drawbacks, high costs, and difficulties of accessibility that are inherent to the practice of basic surgical skills on living patients, fresh human cadaver, and live animals, the search for alternative forms of training is needed. In this study, the teaching and learning process of basic surgical skills pertinent to plastic surgery during medical education on different inanimate bench models as a form of alternative and complementary training to the teaching programs already established is proposed. Rafael Denadai, Andréia Padilha Toledo, and Luis Ricardo Martinhão Souto Copyright © 2012 Rafael Denadai et al. All rights reserved. Thu, 20 Dec 2012 16:59:41 +0000 http://www.hindawi.com/journals/psi/2012/206481/ Objective. To compare the cutaneous lip height at early and late postoperative periods and to objectively determine the average amount of lip height improvement during the first year of unilateral complete cleft lip repair using Cutting extended Mohler technique. Methods. In this prospective cohort study, 26 unilateral complete cleft patients and 50 noncleft subjects were included. Photographs were taken between 12 and 16 weeks (T1) and also taken between 12 and 13 months after surgery (T2). The cutaneous lip height distance (photogrammetric lip analysis) obtained in these two periods of time were measured and statistically analyzed. Results. The average lip heights were in T1 and in T2 (). The average lip height asymmetry in the noncleft individuals was . Conclusion. Since all principles to obtain a symmetrical Cupid’s bow were performed, the postoperative pull-up of Cupid’s bow is probably owed to the scar contracture, which improves by 2 times during the first year after surgery. Cassio Eduardo Raposo-Amaral, André Pecci Giancolli, Rafael Denadai, Frederico Figueiredo Marques, Renato Salazar Somensi, Cesar Augusto Raposo-Amaral, and Nivaldo Alonso Copyright © 2012 Cassio Eduardo Raposo-Amaral et al. All rights reserved. Thu, 20 Dec 2012 07:55:25 +0000 http://www.hindawi.com/journals/psi/2012/892437/ Global cleft surgery missions have provided much-needed care to millions of poor patients worldwide. Still, surgical capacity in low- and middle-income countries is generally inadequate. Through surgical missions, global cleft care has largely ascribed to a vertical model of healthcare delivery, which is disease specific, and tends to deliver services parallel to, but not necessarily within, the local healthcare system. The vertical model has been used to address infectious diseases as well as humanitarian emergencies. By contrast, a horizontal model for healthcare delivery tends to focus on long-term investments in public health infrastructure and human capital and has less often been implemented by humanitarian groups for a variety of reasons. As surgical care is an integral component of basic healthcare, the plastic surgery community must challenge itself to address the burden of specific disease entities, such as cleft lip and palate, in a way that sustainably expands and enriches global surgical care as a whole. In this paper, we describe a diagonal care delivery model, whereby cleft missions can enrich surgical capacity through integration into sustainable, local care delivery systems. Furthermore, we examine the applications of diagonal development to cleft care specifically and global surgical care more broadly. Pratik B. Patel, Marguerite Hoyler, Rebecca Maine, Christopher D. Hughes, Lars Hagander, and John G. Meara Copyright © 2012 Pratik B. Patel et al. All rights reserved. Thu, 06 Dec 2012 15:47:28 +0000 http://www.hindawi.com/journals/psi/2012/731029/ In 1955, Millard developed the concept of rotation-advancement flap to treat cleft lip. Almost 6 decades later, it remains the most popular technique worldwide. Since the technique evolved and Millard published many technical variations, we decided to ask 10 experienced cleft surgeons how they would mark Millard’s 7 points in two unilateral cleft lip patient photos and compared the results. In both pictures, points 1 and 2 were marked identically among surgeons. Points 3 were located adjacent to each other, but not coincident, and the largest distances between points 3 were 4.95 mm and 4.03 mm on pictures 1 and 2, respectively. Similar patterns were obtained for points 4, eight of them were adjacent, and the greatest distance between the points was 4.39 mm. Points 5 had the most divergence between the points among evaluators, which were responsible for the different shapes of the C-flap. Points 6 also had dissimilar markings, and such difference accounts for varying resection areas among evaluators. The largest distances observed were 11.66 mm and 7 mm on pictures 1 and 2, respectively. In summary, much has changed since Millard’s initial procedure, but his basic principles have survived the inexorable test of time, proving that his idea has found place among the greatest concepts of modern plastic surgery. Renato da Silva Freitas, Pedro Bertoco Alves, Gisele Keiko Machado Shimizu, Júlia Fortes Schuchovski, Marlon Augusto Câmara Lopes, Ivan Maluf Jr., Antonio Jorge V. Forte, Nivaldo Alonso, and Joseph Shin Copyright © 2012 Renato da Silva Freitas et al. All rights reserved. Thu, 06 Dec 2012 11:30:30 +0000 http://www.hindawi.com/journals/psi/2012/973240/ Goals/Background. To evaluate children’s growth in the first year of life, who have cleft palate and lip, without the use of palatal plates. Materials/Method. Chart review was conducted, retrospectively, in the Center for Integral Assistance of Cleft Lip and Palate (CAIF), in Brazil, between 2008 and 2009. Results for both genders were compared to the data published by the World Health Organization (WHO) regarding average weight gain in children during their first year of life. Results. Patients with syndromic diagnosis and with cleft classified as preforamen were excluded, resulting in a final number of 112 patients: 56 male and 56 female. Similar patterns were seen comparing the two genders. Although it was observed weight gain below the average until the 11th month in male patients and until 9 months in female patients, both genders remained at the 50th percentile (p50) and improved after the 4th month of age for boys and the 9th month of age for girls. Conclusion. Children with cleft palate weigh less than regular children during their first months of life. At the end of the first year, weight gain is similar comparing normal and affected children. However, factors that optimized weight gain included choosing the best treatment for each case, proper guidance, and multiprofessional integrated care. Renato da Silva Freitas, Andrey Bernardo Lopes-Grego, Helena Luiza Douat Dietrich, Natacha Regina de Moraes Cerchiari, Tabatha Nakakogue, Rita Tonocchi, Juarez Gabardo, Éder David Borges da Silva, and Antonio Jorge Forte Copyright © 2012 Renato da Silva Freitas et al. All rights reserved. Tue, 04 Dec 2012 15:51:56 +0000 http://www.hindawi.com/journals/psi/2012/620302/ In Brazil, the classic timeline for operating on cleft lip and palate is three months old for cheiloplasty and is 12 to 18 months old for palatoplasty. As from Brazilian treatment centers are usually located in major cities, patients living in more remote areas are often unable to receive treatment at the ideal ages. Data were analyzed retrospectively on 45 patients with cleft lip and/or palate, consecutively operated at the Reference Center, Rio de Janeiro Federal University, Brazil. Particularly noteworthy among these data are gender, clinical presentation, operations performed, age of surgery, and the distance between their homes and the hospital. The average age of patients undergoing primary cheiloplasty was 9.4 months, with primary palatoplasties performed at an average age of 7.2 years. As 67% of these patients lived in other towns, they encountered difficulties in seeking and continuing specialized care. Despite attempts to decentralize cleft palate care in Brazil, suitable conditions are not yet noted for following the treatment protocols in a full and adequate manner. Diogo Franco, Marcella Iani, Ronaldo Passalini, Ivan Demolinari, Marcio Arnaut, and Talita Franco Copyright © 2012 Diogo Franco et al. All rights reserved. Thu, 29 Nov 2012 15:48:28 +0000 http://www.hindawi.com/journals/psi/2012/542078/ Objective. Few orofacial cleft (OFC) studies have examined the severity of clefts of the lip or palate. This study examined associations between the severity of cleft of the lip with cleft type, laterality, and sex in four regional British Isles cleft registers whilst also looking for regional variations. Design. Retrospective analysis of cleft classification in the data contained in these four cleft registers. Sample. Three thousand and twelve patients from cleft registers based in Scotland, East England, Merseyside, and Belfast were sourced from the period 2002–2010. Submucous clefts and syndromic clefts were included whilst stillbirths, abortuses, and atypical orofacial clefts were excluded. Results. A cleft of the lip in CLP patients is more likely to be complete in males. A cleft of the lip in isolated CL patients is more likely to be complete in females. Variation in the proportion of cleft types was evident between Scotland and East England. Conclusions. Association between severity of cleft of the lip and sex was found in this study with females having a significantly greater proportion of more severe clefts of the lip (CL) and CLP males being more severe . This finding supports a fundamental difference between cleft aetiology between CL and CLP. K. Carroll and P. A. Mossey Copyright © 2012 K. Carroll and P. A. Mossey. All rights reserved. Tue, 27 Nov 2012 12:22:32 +0000 http://www.hindawi.com/journals/psi/2012/247104/ Cleft lip with or without palate (CL±P) is common congenital anomalies in humans. Experimental evidence has demonstrated that bone morphogenetic protein 4 gene (Bmp4) is involved in the etiology of CL±P in animal models. The nonsynonymous polymorphism rs17563 T>C (p.V152A) in the BMP4 gene has been associated to the risk of nonsyndromic CL±P in Chinese population and microforms from different ethnic backgrounds. The aim of this study was to investigate the role of BMP4 gene in CL±P in Brazilian sample using genetic association approach. Our sample was composed by 123 patients with nonsyndromic CL±P and 246 controls, in which absence of CL±P was confirmed in 3 generations. The rs17563 polymorphism was genotyped by PCR-RFLP technique. Logistic regression was performed to evaluate allele and genotype association. Our data showed statistical power to detect association (86.83%) in this sample. Logistic regression results showed significant association between C allele and CL±P (, OR , and 95% CI = 0.25–0.65), as well as CC genotype and CL±P (, OR , and 95% CI = 0.19–0.66). So, there is a strong association between nonsyndromic CL±P and BMP4 rs17563 polymorphism in our sample and the C allele had a protective effect against the occurrence of nonsyndromic CL±P. Tânia Kawasaki Araújo, Milena Simioni, Têmis Maria Félix, Liliane Todeschini de Souza, Marshall Ítalo Barros Fontes, Isabella Lopes Monlleó, Josiane Souza, Agnes Cristina Fett-Conte, Rodrigo Secolin, Iscia Lopes-Cendes, Cláudia Vianna Maurer-Morelli, and Vera Lúcia Gil-da-Silva-Lopes Copyright © 2012 Tânia Kawasaki Araújo et al. All rights reserved. Sun, 25 Nov 2012 12:21:22 +0000 http://www.hindawi.com/journals/psi/2012/415781/ In this study we evaluated sensory alteration in nasal tip and adjacent upper columella (territory of external nasal nerve) after open rhinoplasty. Two groups were randomly selected, each containing 25 patients with thick nasal skin; sensory testing was done preoperatively in all patients; in group one, subdermal soft tissue in tip and supratip areas was removed but in group two no soft tissue removal was done; we compared sensory pressure threshold values 3 weeks and 6 months postoperatively. Results showed no statistical difference between the two groups in nasal skin sensibility at these times; also this study showed that 6 months after rhinoplasty normal sensation of nasal skin will be achieved. Alireza Bakhshaeekia and Sina Ghiasi-hafezi Copyright © 2012 Alireza Bakhshaeekia and Sina Ghiasi-hafezi. All rights reserved. Wed, 21 Nov 2012 14:00:35 +0000 http://www.hindawi.com/journals/psi/2012/563734/ Objective. To evaluate characteristics of smile related to visibility in individuals with cleft lip, alveolus, and palate. Design. Cross-sectional. Setting. HRAC/USP, Brazil. Patients. Individuals with repaired complete unilateral cleft lip and palate , aged 15–30 years. Interventions. Frontal facial photographs were obtained in natural and forced smiles . Six specialists in periodontics evaluated the photographs as to the smile line, thickness, and curve of the upper lip. Main Outcome Measures. The cleft area was compared with the contralateral region. Results were expressed as percentages and means. The findings were compared between groups of periodontists. Results. Statistically significant relationship was observed in the smile line between examiners and between natural and forced smiles, regardless of the association with the cleft side. The lip was thicker at rest and thinner in the forced smile, as also evaluated by the group not experienced with cleft care. The curve of the upper lip in natural and forced smiles was considered as close to straight by both groups, regardless of the cleft. Conclusion. The smile in individuals with clefts was regarded as average for both cleft and noncleft sides. The thickness was characterized as average to thin, being thinner in forced smile and when analyzed by the group not experienced with cleft care. In the average, the curve of the upper lip was considered as straight. The present study elucidates some characteristics related to the smile in individuals with repaired unilateral cleft lip, alveolus, and palate. Luis Augusto Esper, Michyele Cristhiane Sbrana, Mércia Jussara da Silva Cunha, Guilherme Santos Moreira, and Ana Lúcia Pompéia Fraga de Almeida Copyright © 2012 Luis Augusto Esper et al. All rights reserved. Thu, 08 Nov 2012 18:23:13 +0000 http://www.hindawi.com/journals/psi/2012/834364/ Mandible is the second most common facial fracture. There has been a significant increase in the number of cases in recent years with the advent of fast moving automobiles. Mandibular fractures constitute a substantial proportion of maxillofacial trauma cases in Lucknow. This study was undertaken to study mandibular fractures clinicoradiologically with an aim to calculate incidence and study pattern and the commonest site of fractures in population in and around Lucknow. Patient presenting with history of trauma at various centers of maxillofacial surgery in and around Lucknow were included in this study. Detailed case history was recorded followed by thorough clinical examination, and radiological interpretation was done for establishing the diagnosis and the data obtained was analyzed statistically. Out of 66 patients with mandibular fractures, highest percentage was found in 21–30 years of age with male predominance. Road traffic accidents were the most common cause of fracture with parasymphysis being commonest site. Commonest combination was parasymphysis with subcondyle. There was no gender bias in etiology with number of fracture sites. The incidence and causes of mandibular fracture reflect trauma patterns within the community and can provide a guide to the design of programs geared toward prevention and treatment. Subodh S. Natu, Harsha Pradhan, Hemant Gupta, Sarwar Alam, Sumit Gupta, R. Pradhan, Shadab Mohammad, Munish Kohli, Vijai P. Sinha, Ravi Shankar, and Anshita Agarwal Copyright © 2012 Subodh S. Natu et al. All rights reserved. Tue, 06 Nov 2012 07:57:03 +0000 http://www.hindawi.com/journals/psi/2012/259419/ Several authors have proposed classifications to analyze the quality over time of secondary alveolar bone grafting. However, little discussion has been held to quantitatively measure the secondary bone grafting for correction of nasal deformity associated to cleft palate and lip. Twenty patients with unilateral alveolar cleft, who underwent secondary alveolar bone grafting, were studied with 3D computer tomography. The height between the inferior portion of the pyriform aperture and the incisal border of the unaffected side (height A) and the affected side (height B) was measured using a software Mirror. A percentage was then obtained dividing the height B by the height A and classified into grades I, II, and III if the value was greater than 67%, between 34% and 66%, or less than 33%. Age, time of followup, initial operation, and age of canine eruption were also recorded. All patients presented appropriate occlusion and function. Mean time of followup was 7 years, and mean initial age for operation was 10 years old. 16 patients were rated as grade I and 4 patients as grade II. No cases had grade III. We present a new grading system that can be used to assess the success of secondary bone grafting in patients who underwent alveolar cleft repair. Antonio Jorge V. Forte, Renato da Silva Freitas, and Nivaldo Alonso Copyright © 2012 Antonio Jorge V. Forte et al. All rights reserved. Thu, 01 Nov 2012 14:18:32 +0000 http://www.hindawi.com/journals/psi/2012/562892/ Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs). Method. Searches were made in PubMed, Embase, and Cochrane Library on cleft lip and/or palate. From the 170 articles found in the searches, 28 were considered adequate to guide clinical practice. Results. A scarce number of RCTs were found approaching cleft treatment. The experimental clinical approaches analyzed in the 28 articles were infant orthopedics, rectal acetaminophen, palatal block with bupivacaine, infraorbital nerve block with bupivacaine, osteogenesis distraction, intravenous dexamethasone sodium phosphate, and alveoloplasty with bone morphogenetic protein-2 (BMP-2). Conclusions. Few randomized controlled trials were found approaching cleft treatment, and fewer related to surgical repair of this deformity. So there is a need for more multicenter collaborations, mainly on surgical area, to reduce the variety of treatment modalities and to ensure that the cleft patient receives an evidence-based clinical practice. Pedro Ribeiro Soares de Ladeira and Nivaldo Alonso Copyright © 2012 Pedro Ribeiro Soares de Ladeira and Nivaldo Alonso. All rights reserved. Thu, 01 Nov 2012 09:31:37 +0000 http://www.hindawi.com/journals/psi/2012/782821/ Cleft lip or palate (CL/P) is a common facial defect present in 1 : 700 live births and results in substantial burden to patients. There are more than 500 CL/P syndromes described, the causes of which may be single-gene mutations, chromosomopathies, and exposure to teratogens. Part of the most prevalent syndromic CL/P has known etiology. Nonsyndromic CL/P, on the other hand, is a complex disorder, whose etiology is still poorly understood. Recent genome-wide association studies have contributed to the elucidation of the genetic causes, by raising reproducible susceptibility genetic variants; their etiopathogenic roles, however, are difficult to predict, as in the case of the chromosomal region 8q24, the most corroborated locus predisposing to nonsyndromic CL/P. Knowing the genetic causes of CL/P will directly impact the genetic counseling, by estimating precise recurrence risks, and the patient management, since the patient, followup may be partially influenced by their genetic background. This paper focuses on the genetic causes of important syndromic CL/P forms (van der Woude syndrome, 22q11 deletion syndrome, and Robin sequence-associated syndromes) and depicts the recent findings in nonsyndromic CL/P research, addressing issues in the conduct of the geneticist. Luciano Abreu Brito, Joanna Goes Castro Meira, Gerson Shigeru Kobayashi, and Maria Rita Passos-Bueno Copyright © 2012 Luciano Abreu Brito et al. All rights reserved. Wed, 31 Oct 2012 08:54:42 +0000 http://www.hindawi.com/journals/psi/2012/282959/ The absence of the palmaris longus (PL) has been shown to vary based on body side, gender, and ethnicity. In prior studies, homogenous ethnic populations have been shown to have differences in rates of absence. However, no study thus far has analyzed the differences in palmaris longus prevalence in a multiethnic population. We prospectively collected data on 516 patients visiting the outpatient hand clinics at LAC+USC Medical Center and Keck Medical Center. Analysis of the data was then performed for variables including ethnicity, laterality, and gender. There were no differences in the absence of the PL based on laterality or gender. Ethnically, there was no difference between white (non-Hispanic) and white (Hispanic) patients, with prevalence of 14.9% and 13.1%, respectively. However, African American (4.5%) and Asian (2.9%) patients had significantly fewer absences of the PL than the Caucasian, Hispanic reference group ( and , resp.). African Americans and Asians have a decreased prevalence of an absent PL. The Caucasian population has a relatively greater prevalence of an absence of the PL. This epidemiological study demonstrates the anatomic variation in this tendon and may be taken into account when planning an operation using tendon grafts. Ali M. Soltani, Mirna Peric, Cameron S. Francis, Thien-Trang J. Nguyen, Linda S. Chan, Alidad Ghiassi, Milan V. Stevanovic, and Alex K. Wong Copyright © 2012 Ali M. Soltani et al. All rights reserved. Wed, 24 Oct 2012 09:54:07 +0000 http://www.hindawi.com/journals/psi/2012/580769/ Objective. To compare the asymmetry displayed by Philippine, Colombian, and Ethiopian unaffected parents of patients with nonsyndromic cleft palate (NSCLP) and a control population. Methods. Facial measurements were compared between unaffected parents of NSCLP patients and those in the control group for three populations from South America, Asia, and Africa by anthropometric and photographic measurements. Fluctuating and directional asymmetries, height and width proportions, were analyzed and compared. Results. Fluctuating asymmetries (ear length, middle line to Zigion perpendicular for left and right sides) and variations in the facial thirds demonstrated statistical significance in the study group of unaffected parents from Colombia and Philippines, while increased interorbital distance was evident in the unaffected Ethiopian parents of NSCLP patients. Conclusions. The facial differences in unaffected parents could indicate an underlying genetic liability. Identification of these differences has relevance in the understanding of the etiology of NSCLP. Liliana Otero, Luis Bermudez, Karina Lizarraga, Irene Tangco, Rocelyn Gannaban, and Daniel Meles Copyright © 2012 Liliana Otero et al. All rights reserved. Mon, 22 Oct 2012 10:06:52 +0000 http://www.hindawi.com/journals/psi/2012/185725/ Background. Humanitarian medical missions may be an effective way to temporarily overcome limitations and promote long-term solutions in the local health care system. Operation Smile, an international medical not-for-profit organization that provides surgery for patients with cleft lip and palate, not only provides surgery through short-term international missions but also focuses on developing local capacity. Methods. The history of Operation Smile was evaluated globally, and then on a local level in 3 countries: Colombia, Bolivia, and Ethiopia. Historical data was assessed by two-pronged success of (1) treating the surgical need presented by cleft patients and (2) advancing the local capacity to provide primary and ongoing care to patients. Results. The number of patients treated by Operation Smile has continually increased. Though it began by using only international teams to provide care, by 2012, this had shifted to 33% of patients being treated by international teams, while the other 67% received treatment from local models of care. The highest level of sustainability was achieved in Columbia, where two permanent centers have been established, followed by Bolivia and lastly Ethiopia. Conclusions. International missions have value because of the patients that receive surgery and the local sustainable models of care that they promote. William P. Magee, Haley M. Raimondi, Mark Beers, and Maryanne C. Koech Copyright © 2012 William P. Magee et al. All rights reserved. Wed, 17 Oct 2012 14:11:51 +0000 http://www.hindawi.com/journals/psi/2012/913807/ Background. Many studies have demonstrated the effectiveness of mandibular distraction osteogenesis (MDO) in alleviating the micrognathia-associated upper airway obstruction but very few studies have focused on long-term dental outcomes. Objective. To report the effect of MDO on developing deciduous molars in the distraction area. Methods. A retrospective chart review was performed to identify patients with Pierre Robin sequence who underwent MDO with documented long-term dental assessments. Results. Ten children (mean age at surgery 69.8 days; 6 boys and 4 girls) were included for analysis. All patients underwent bilateral MDO with an inverted L-shaped osteotomy to avoid injuring tooth buds. The dental developmental stage was primary dentition in all children. Overall, 3 patients developed minor dental problems involving 4 molar teeth (2 root malformations and 2 shape anomalies) but they did not require any interventions. Conclusion. Significant primary molar developmental complications were not seen in our patients. The use of internal distractor device with an inverted L-shaped osteotomy seems to be a safe surgical approach in regards to dental outcomes. Paul Hong, Elise Graham, James Belyea, S. Mark Taylor, Donald B. Kearns, and Michael Bezuhly Copyright © 2012 Paul Hong et al. All rights reserved. Thu, 04 Oct 2012 08:50:23 +0000 http://www.hindawi.com/journals/psi/2012/918345/ Background. To evaluate the use, indications, and short-term outcomes for human acellular dermis. Methods. We retrospectively reviewed patients having human acellular dermis placed for ventral hernia repair from January 2008 through October 2009. Demographic information, operative details, and outcomes of patients with and without recurrences were compared; a P value <0.05 was considered significant. Results. 115 patients met inclusion criteria. The average age was 60 years (range, 24–89). The technique of repair included primary repair with overlay of mesh in 76%, bridge repair in 13%, and underlay in 11%. Average cost of mesh per operation was $3,709 (range $191–10,630). Open repairs were performed in 90% of patients with addition of component separation in 12%. At an average of 13 months, 58 patients were available for followup (50%), with a 47% recurrence rate. The morbidity rate was 48% and the mortality rate was 2%. Technique of repair was the only significant risk factor for recurrence with bridge repairs associated with a higher rate of recurrence (). Conclusions. The use of biologic grafts for ventral hernia repair is becoming more popular especially in clean cases. Although followup is limited, there remains a high recurrence rate associated with the use of human acellular dermis. William W. Hope, Devan Griner, Ashley Adams, W. Borden Hooks, and Thomas V. Clancy Copyright © 2012 William W. Hope et al. All rights reserved. Wed, 26 Sep 2012 14:36:25 +0000 http://www.hindawi.com/journals/psi/2012/834212/ Achieving a level of technical skill and confidence in surgical operations is the main goal of plastic surgical training. Operating rooms were accepted as the practical teaching venues of the traditional apprenticeship model. However, increased patient population, time, and ethical and legal considerations made preoperation room practical work a must for plastic surgical training. There are several plastic surgical teaching models and simulators which are very useful in preoperation room practical training and the evaluation of plastic surgery residents. The full thickness skin with its vascular network excised in abdominoplasty procedures is an easily obtainable real human tissue which could be used as a training model in plastic surgery. M. Erol Demirseren, Candemir Ceran, Yakup Duman, and Murat Sarici Copyright © 2012 M. Erol Demirseren et al. All rights reserved. Sun, 05 Aug 2012 10:49:18 +0000 http://www.hindawi.com/journals/psi/2012/138090/ Ample data exists about the high precision of three-dimensional (3D) scanning devices and their data acquisition of the facial surface. However, a question remains regarding which facial landmarks are reliable if identified in 3D images taken under clinical circumstances. Sources of error to be addressed could be technical, user dependent, or patient respectively anatomy related. Based on clinical 3D photos taken with the 3dMDface system, the intra observer repeatability of 27 facial landmarks in six cleft lip (CL) infants and one non-CL infant was evaluated based on a total of over 1,100 measurements. Data acquisition was sometimes challenging but successful in all patients. The mean error was 0.86 mm, with a range of 0.39 mm (Exocanthion) to 2.21 mm (soft gonion). Typically, landmarks provided a small mean error but still showed quite a high variance in measurements, for example, exocanthion from 0.04 mm to 0.93 mm. Vice versa, relatively imprecise landmarks still provide accurate data regarding specific spatial planes. One must be aware of the fact that the degree of precision is dependent on landmarks and spatial planes in question. In clinical investigations, the degree of reliability for landmarks evaluated should be taken into account. Additional reliability can be achieved via multiple measuring. Rebecca Ort, Philipp Metzler, Astrid L. Kruse, Felix Matthews, Wolfgang Zemann, Klaus W. Grätz, and Heinz-Theo Luebbers Copyright © 2012 Rebecca Ort et al. All rights reserved.