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Adhikari M, Jha K, Aryal S, Adhikari G. Comprehensive surgical reconstruction of Tessier number 7 congenital craniofacial cleft. A rare case report. Int J Surg Case Rep 2023; 111:108826. [PMID: 37716065 PMCID: PMC10509715 DOI: 10.1016/j.ijscr.2023.108826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023] Open
Abstract
Introduction and importance Tessier 7 craniofacial congenital cleft is a rare anomaly, occurring in about 1 in 80,000 to 1 in 300,000 live births, comprising 0.3% to 1.0% of total cleft cases. A total of 24 cases have been reported since 2000. This case is the 25th instance and possibly the first reported in Nepal. PRESENTATION OF THE CASE A 3-year-old child, accompanied by parents, presented at the Department of Oral and Maxillofacial Surgery with complaints of feeding difficulties, speech impediment, and aesthetic concerns. Diagnosis revealed Tessier number 7 congenital cleft. Surgical intervention successfully repaired the cleft, involving straight-line closure of mucosa and skin, suturing of perioral muscles to establish a new modiolus and formation of a new commissure. Postoperative follow-up over 6 months demonstrated excellent functional and aesthetic results without any complications. CLINICAL DISCUSSION Tessier 7 congenital cleft arises from anomalous fetal development, stemming from incomplete fusion of the maxillary and mandibular processes of the first pharyngeal arch. Surgical correction poses challenges due to atypical anatomical positioning and cleft appearance. The repair involves layered closure, linear mucosal closure, perioral muscle reorganization to establish a new modiolus, skin closure via straight-line or z-plasty techniques, culminating in the creation of a new commissure. CONCLUSION Given its rarity, surgeons must be well-versed in the intricate surgical protocol for Tessier 7 cleft treatment. Early intervention is crucial for optimal functional and cosmetic results. Key steps encompass establishing a new modiolus, forming a new commissure, and achieving effective skin closure.
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Affiliation(s)
- Manoj Adhikari
- Nepalese Army Institute of Health Sciences, College of Medicine, Affiliated to Tribhuvan University, Bhandarkhal, Sanobharyang, Kathmandu, Nepal.
| | - Kanistika Jha
- College of Medical Sciences, Affiliated to Kathmandu University, Bharatpur, Chitwan, Nepal
| | - Sameer Aryal
- Nepalese Army Institute of Health Sciences, College of Medicine, Affiliated to Tribhuvan University, Bhandarkhal, Sanobharyang, Kathmandu, Nepal
| | - Galav Adhikari
- Nepalese Army Institute of Health Sciences, College of Medicine, Affiliated to Tribhuvan University, Bhandarkhal, Sanobharyang, Kathmandu, Nepal
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Heng SSL, Ganandran T, Gan YH, Mat Zain MA, Basiron N, Wan Sulaiman WA. Surgical correction of Tessier cleft no. 7: A single center 18-year experience. J Plast Reconstr Aesthet Surg 2023; 85:187-192. [PMID: 37499560 DOI: 10.1016/j.bjps.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 06/07/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Tessier cleft 7 are rare craniofacial clefts. Live-birth incidence varies from 1/80,000 to 1/300,000, with the incidence of 1 in 120 craniofacial clefts among Asians. Its clinical presentation varies widely in severity, thus, complicating diagnosis and contributing to the lack of consensus regarding its surgical management. The aim of this study is to describe clinical findings, types of Tessier cleft 7 soft tissue repair, and its outcomes in Kuala Lumpur Hospital. METHODS This retrospective study reviewed records of children operated from January 2001 to July 2019. Data regarding concurrent congenital anomalies, complications, type of surgery, etc., were collected from outpatient records, operative notes, and clinical photographs. RESULTS Twenty-eight children were treated, and 33 clefts (5 bilateral) were repaired. The male-to-female ratio was 1.3:1 (16 males and 12 females). Twenty-three patients had unilateral clefts (82.14%), with 14 right (60.86%) and 8 left (34.78%). Bilateral clefts were less common (17.86%). Twenty-three patients (82.14%) were Malay, 3 (10.71%) Chinese, 1 (3.57%) Indian, and 1 (3.57%) Cambodian. Eleven medical records were untraceable (discontinued due to duration of inactivity). There were 10 straight-line repairs, 5 Z-plasties, and 1 W-plasty performed; 3 cases did not detail the type of repair. One child required scar revision, and 1 had hypertrophic scarring requiring corticosteroid injection-no disturbances in speech or oral incompetency while eating were reported. Duration of follow-up ranged from 3 to 14 years. CONCLUSION Our center has a higher rate of Tessier cleft 7 attendance. Straight-line cutaneous repairs combined with inferior vermilion mucosal flap can be used with low rates of complication and revision surgery.
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Affiliation(s)
- Sophia Si Ling Heng
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia; Reconstructive Sciences Unit, Department of Surgery, Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia; Reconstructive Sciences Unit, Faculty of Medicine and Health Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia.
| | - Thevarasan Ganandran
- Reconstructive Sciences Unit, Department of Surgery, Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia; Reconstructive Sciences Unit, Faculty of Medicine and Health Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia
| | - Yin Hui Gan
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia.
| | - Mohamad Ali Mat Zain
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, 50586 Kuala Lumpur, Malaysia
| | - Normala Basiron
- Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, 50586 Kuala Lumpur, Malaysia
| | - Wan Azman Wan Sulaiman
- Reconstructive Sciences Unit, Department of Surgery, Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia; Reconstructive Sciences Unit, Faculty of Medicine and Health Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia.
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Talanker MM, Fallah KN, Hartline CA, Freet DJ. Total Reconstruction of Lower Lip and Chin Following Firework Injury Using Composite Bilateral Radial Forearm-Fascia Lata Flaps: A Case Report. Eplasty 2023; 23:e5. [PMID: 36817361 PMCID: PMC9912048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Background Primary explosion injuries with fireworks can lead to devastating and geometrically complex facial traumas that present a challenge to the reconstructive surgeon. Our patient, a woman in her early thirties, was hit directly in her chin by a large artillery shell firework. This caused complete soft tissue loss of the lower lip and chin beyond the oral commissures, complicated further by a comminuted mandible fracture. Methods After external fixation, our patient underwent a 2-stage reconstruction with a novel composite flap arrangement. Soft tissue coverage and lip reconstruction were performed with opposing bilateral radial forearm free flaps. The outer flap constituted the soft tissue of the new chin and outer lower lip, whereas the inner flap composed the intraoral lining. In the second stage, portions of the inner upper lip mucosa and superior orbicularis oris muscle were flipped down as a bipedicle, axial pattern "bucket-handle" type flap to the lower lip to reconstruct the vermilion. A graft of fascia lata was attached to the modioli of the orbicularis oris and interpositioned beneath the vermilion flap and the radial forearms to restore static and some dynamic sphincter control. One month later, the mandibular fractures underwent open reduction and internal fixation. Results Two months after soft tissue reconstruction with no complications, our patient had satisfactory aesthetic outcomes, oral competence, and speech. Conclusions This case has shown that use of bilateral, fascia lata-reinforced radial forearm flaps may be an effective choice for soft tissue reconstruction and oral competence restoration in cases of severe facial explosion trauma.
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Affiliation(s)
- Michael M Talanker
- Division of Plastic Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Kasra N Fallah
- Division of Plastic Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Cassie A Hartline
- Division of Plastic Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Daniel J Freet
- Division of Plastic Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX,Correspondence: Daniel J Freet, MD;
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Oliver C, Prévost A, Cavalier Z, Corre P, Lauwers F, Bertin H. Correction of congenital macrostomia by double reversing Z-plasty: A technical note. J Stomatol Oral Maxillofac Surg 2022; 123:527-531. [PMID: 35346869 DOI: 10.1016/j.jormas.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
Congenital macrostomia is a rare congenital deformity that consists of an enlargement of the commissure of the mouth. The malformation may be unilateral or bilateral and has a polymorphic presentation. Various surgical techniques have been described to correct macrostomia, with only a few cases illustrating the expected results. The surgical repair must consider both esthetic as well as functional impacts for the patient. We here propose a technical note to refine and provide additional information for good achievement of "Double Reversing Z-Plasty" for correction of macrostomia. Our case series also reports good long-term functional and esthetic results obtained with this technique, especially in case of a minor cleft.
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Affiliation(s)
- Charlotte Oliver
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France
| | - Alice Prévost
- Service de Chirurgie Maxillo-Faciale et Plastique de la Face, CHU de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, 31059 Toulouse cedex 9
| | - Zoé Cavalier
- Service de Chirurgie Maxillo-Faciale et Plastique de la Face, CHU de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, 31059 Toulouse cedex 9
| | - Pierre Corre
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France; Regenerative Medicine and Skeleton (RMeS), Faculté de Chirurgie Dentaire, 1 Place Alexis Ricordeau, 44042 Nantes, France
| | - Frédéric Lauwers
- Service de Chirurgie Maxillo-Faciale et Plastique de la Face, CHU de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, 31059 Toulouse cedex 9
| | - Hélios Bertin
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes, France; CRCI2NA INSERM-CNRS-Nantes Université-Université d'Angers - Équipe 9 (CHILD), faculté de médecine, 1 rue Gaston Veil, 44000 Nantes, France.
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Goudjo EUEM, Miaffo OEDD, Metchihoungbe CS, Houegban ASCR, Koco H, Akpo OS, Kante TB, Gnassingbe K. Congenital macrostomia management in children in a country with limited resources: A case series. Int J Surg Case Rep 2021; 90:106738. [PMID: 34968985 PMCID: PMC8717225 DOI: 10.1016/j.ijscr.2021.106738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 11/27/2022] Open
Abstract
Congenital macrostomia is an uncommon facial malformation in children. The choice of the surgical procedure should be based on functional, aesthetic results and the surgeon's experience. Even in underdeveloped countries, Z-commissuroplasty could be performed with good results. Further research should focus on long-term follow-up of large series, regardless of the type of surgical procedure.
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Affiliation(s)
| | | | | | | | - Houenoukpo Koco
- Department of Pediatric Surgery, Sylvanus Olympio Teaching Hospital of Lome, Togo
| | - Okassate Sibabi Akpo
- Department of Pediatric Surgery, Sylvanus Olympio Teaching Hospital of Lome, Togo
| | - Tely Bailo Kante
- Department of Pediatric Surgery, Sylvanus Olympio Teaching Hospital of Lome, Togo
| | - Komlan Gnassingbe
- Department of Pediatric Surgery, Sylvanus Olympio Teaching Hospital of Lome, Togo
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Affiliation(s)
- Filip P Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
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Huby M, Neiva-Vaz C, Rougier G, Picard A, Vazquez MP, Kadlub N. Commissuroplasty for macrostomia: surgical technique and long-term aesthetic and functional results assessment. J Stomatol Oral Maxillofac Surg 2021; 123:329-336. [PMID: 34224921 DOI: 10.1016/j.jormas.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Macrostomia or lateral cleft lip is a rare congenital deformity. In this article we describe a surgical technique of macrostomia repair developed. The objective of this article is to assess the results of our surgical technique and to validate a method for macrostomia surgical result evaluation. METHODS We included retrospectively patients with unilateral and bilateral macrostomia, operated from 1995 to 2014 in our department. First part of the study was a satisfaction questionnaire completed by patients. The second part was subjective evaluation of frontal photography (closed mouth, wide open and smiling) by surgeons and lay people with a questionnaire. Both group completed a second questionnaire within one to six months. RESULTS Eighteen patients answered the questionnaire. The satisfaction for all patients were considered as very good for 38.9% (n = 7) of patients and good for 44.4% (n = 8). 21 patients were photographed, 5 isolated macrostomia, 13 macrostomia with minor facial asymmetry and 3 with a major asymmetry. Surgeons evaluated the result as very good for isolated macrostomia and good for syndromic macrostomia. Layperson evaluated the result as good in isolated macrostomia and macrostomia with minor facial asymmetry and average with major facial asymmetry. P < 0.0001. The evolution of the results between medical and non-medical assessors in our two questionnaires, were non-significant. CONCLUSION In this study, we propose a new methodology to assess commissuroplasty surgical results, with a 3 type of evaluator: patients, surgeons and laypeople. We present a simple surgical technique, that allows good results in syndromic and isolated macrostomia.
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Affiliation(s)
- Marine Huby
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Cecilia Neiva-Vaz
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Guillaume Rougier
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Arnaud Picard
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Université de Paris, Paris, France
| | - Marie-Paule Vazquez
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Université de Paris, Paris, France
| | - Natacha Kadlub
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France; Université de Paris, Paris, France.
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Abstract
Caustic soda ingestion causes strictures in the respiratory, gastrointestinal systems and even death. In the oral and perioral areas it causes contractures leading to microstomia that is difficult to manage to restore structure and function of the oral cavity. The present case is of a 42-year-old female who presented with microstomia, no endoscopic esophageal injury and ankyloglossia following ingestion of caustic soda in an attempted suicide following a dispute with her spouse. Satisfactory mouth opening and tongue movement were achieved by bilateral release of buccal contractures, commissuroplasty and release of the tongue that was tethered to the floor of the mouth.
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Affiliation(s)
- Midion M. Chidzonga
- Department of Dentistry, University of Zimbabwe, College of Health Sceinces, Harare, Zimbabwe
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Luo T, Meng X, Yan Z, Zhan Y, Popal MS. Commissuroplasty as a Main Operative Technique in Rheumatic Mitral Valve Repair: Surgical Experiences and Mid-Term Results. Heart Lung Circ 2019; 29:940-948. [PMID: 31307914 DOI: 10.1016/j.hlc.2019.05.189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 04/20/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
AIM We aimed to evaluate the therapeutic effectiveness of commissuroplasty in mitral valve repair for rheumatic mitral valve disease. For this purpose, we summarise our experience with this technique and analyse the mid-term postoperative outcomes. METHOD We retrospectively evaluated the records of patients with rheumatic valve disease who underwent mitral valve repair between January 2011 and January 2018 at our centre. Detailed follow-up data were collected. A Kaplan-Meier survival curve for survival free from reoperation and valve failure was constructed. Multivariate Cox regression analyses were performed to identify predictors of relevant end points (death, reoperation, and valve failure). RESULTS A total of 362 patients underwent rheumatic mitral valve repair during the study period. Mitral valve stenosis was the primary pathological feature. Almost all surgeries were accomplished via commissuroplasty. The mean duration of follow-up was 25.57 ± 19.91 months. Twenty-two (22) endpoint events were noted during follow-up. The 2- and 7-year rates of survival free from reoperation and valve failure were 93.9%±1.4% and 91.5%±2.0%, respectively. Multivariate Cox regression analysis revealed that left atrial anteroposterior diameter >60 mm (hazard ratio, 5.2; p < 0.001) was an independent predictor of all endpoints. CONCLUSIONS Most Chinese patients with rheumatic valve disease were treated effectively via commissuroplasty combined with other surgical procedures, and the mid-term postoperative outcomes were satisfactory.
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Affiliation(s)
- Tiange Luo
- Cardiac Valve Centre, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xu Meng
- Cardiac Valve Centre, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
| | - Zhiguo Yan
- Department of Cardiothoracic Surgery, Calmette Hospital, No. 1 Hospital of Kunming, Kunming, China
| | - Yufei Zhan
- Cardiac Centre, Department of Cardiac Surgery, No. 181 Hospital of the Chinese People's Liberation Army, Guilin, China
| | - Mohammad Sharif Popal
- Cardiac Valve Centre, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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Tuersunjiang M, Long X, Fu Y, Ke J, He H, Li J. Reconstruction of the oral commissure in patients with unilateral transverse facial cleft. Br J Oral Maxillofac Surg 2018; 56:621-625. [PMID: 30017577 DOI: 10.1016/j.bjoms.2018.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
The normal commissure is not a simple joint of the upper and lower lip, but a triangular mucosal area. To reconstruct a symmetrical oral commissure in patients with a unilateral transverse facial cleft, we designed composite vermilion flaps, including triangular flaps. We retrospectively studied 17 patients with unilateral transverse facial clefts from 2013-2016. Three-dimensional images were obtained with a 3-dimensional photogrammetry system at the 1-year follow-up, and we used an anthropometric method to evaluate the postoperative symmetry of the commissure. No obvious deformity was found during the follow-up examination, and comparison of the cleft and non-cleft sides by the paired samples t test showed that in all cases both horizontally and vertically symmetrical commissures had been achieved.
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Affiliation(s)
- M Tuersunjiang
- Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, #237 Luo Yu Road, Wuhan, Hubei, PR China.
| | - X Long
- Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, #237 Luo Yu Road, Wuhan, Hubei, PR China.
| | - Y Fu
- Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, #237 Luo Yu Road, Wuhan, Hubei, PR China.
| | - J Ke
- Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, #237 Luo Yu Road, Wuhan, Hubei, PR China.
| | - H He
- Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, #237 Luo Yu Road, Wuhan, Hubei, PR China.
| | - J Li
- Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, #237 Luo Yu Road, Wuhan, Hubei, PR China.
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Sugimoto A, Ota N, Murata M, Sakamoto K. Extra-aortic commissuroplasty concomitant with fenestrated Fontan operation for neoaortic valve regurgitation after Norwood reconstruction. Interact Cardiovasc Thorac Surg 2014; 19:329-30. [PMID: 24813901 DOI: 10.1093/icvts/ivu130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We introduce a simple, less invasive surgical technique for treating neoaortic valve regurgitation (neoAR) after the Norwood procedure, with the aim of delaying reoperation for neoAR. A 31-month-old girl, with hypoplastic left heart syndrome, previously underwent 4 median sternotomies and was admitted to our hospital for a fenestrated Fontan operation. She presented with moderate neoAR, originating from a tricuspid neoaortic valve (neoAV), with the regurgitation oriented from the centre. Her neoAV annulus was dilated to twice its normal size. With the aim of delaying future neoAV intervention and minimizing the surgical invasiveness, we performed extra-aortic commissuroplasties on the 2 commissures that could be approached from the front during the Fontan operation, without inducing cardiac arrest. We used direct echocardiography and transoesophageal echocardiography to confirm the feasibility before applying this procedure. Her postoperative course was uneventful, and the postoperative echocardiography did not reveal any residual neoAR 5 months postoperatively. We believe that this technique is a useful surgical option for patients with moderate neoAR oriented from its centre and well-balanced tricuspid native pulmonary valves, and it might help to delay future neoAV interventions, with minimal surgical risk.
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Affiliation(s)
- Ai Sugimoto
- Division of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan Division of Thoracic and Cardiovascular Surgery, Niigatta University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Noritaka Ota
- Division of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaya Murata
- Division of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kisaburo Sakamoto
- Division of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
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