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Historically at The Hospital for Sick Children in Toronto, pharyngeal flap pharyngoplasty has been the treatment of choice for treatment of velopharyngeal insufficiency, regardless of velopharyngeal closure pattern. The authors hypothesize that pharyngeal flap pharyngoplasty is more effective in treating velopharyngeal insufficiency in patients with circular or sagittal velopharyngeal closure and less effective in treating the coronal closure pattern. Ninety-three patients who underwent superiorly based pharyngeal flap surgery for velopharyngeal insufficiency were evaluated in a retrospective chart review. Closure pattern was determined preoperatively by nasopharyngoscopy or multiview videofluoroscopy. Nasalance was assessed preoperatively and at 6 weeks and 1 year postoperatively. Nasalance during nonnasal speech was decreased on average, for all closure patterns, postoperatively. However, a significantly higher percentage of patients were corrected to normal nasalance scores in thenoncoronal group than in the coronal group (57 percent versus 35 percent, respectively) at 1 year postoperatively (p< 0.05). Surgical overcorrection, as determined by postoperative hyponasality, occurred at a rate of 13 percent in the coronal group versus 7 percent in the noncoronal group (not statistically significant). The results demonstrate that hypernasality in patients with a coronal velopharyngeal closure pattern can be improved by pharyngeal flap pharyngoplasty. This procedure, however, is more frequently effective in correcting noncoronal closure pattern velopharyngeal insufficiency than coronal pattern velopharyngeal insufficiency. The authors are now more selective in their approach to the management of velopharyngeal insufficiency and are more inclined to treat coronal pattern velopharyngeal insufficiency with sphincter pharyngoplasty.

The purpose of this study was to analyze the geometry of the primary cleft lip nasal deformity using threedimensional computerized tomography in a group of 3monthold infants with complete unilateral cleft lip and palate before surgical intervention. Coordinates and axes were reconfigured after the threedimensional image was oriented into neutral position Frankfurt horizontal, true anteroposterior, and vertical midline. Display and measurement of skin surface and osseous tissues were achieved by adjusting the computed tomographic thresholds. SN, NANS, SNO, and SNANS were measured from true lateral views. Biorbital LOLO, interorbital MOMO, intercanthal enen, and nasal alal widths were measured from the anteroposterior view. The bony alveolar cleft width was measured from the inferior view. The study group was divided into two groups on the basis of skeletal alveolar cleft width six patients with clefts narrower than 10 mm and six patients with clefts wider than 10 mm. Only the SNANS angle differed between the two groups, i.e., it was greater in the group with the wider clefts p< 0.05. Coordinates of six landmarks at the base of the nose sellion se, subnasale sn, cleftside and noncleftside subalare sbalcl and sbalncl, and the most posterior point on the lateral piriform margins PPACL and PPANCL were obtained for analysis of the nasal deformity. On average, the subnasale point was anterior to sellion and deviated to the noncleft side the cleftside sbal point was more medial, posterior, and inferior than the noncleftside sbal point and the PPA point on the cleftside piriform margin was more lateral, posterior, and inferior than the PPA point on the noncleft side. These discrepancies were not universally observed. However, in all patients, four findings were observed without exception p< 0.01 1 subnasale sn was deviated to the noncleft side mean distance from midline, 5.0 mm range, 2 to 9.5 mm, 2 the cleftside alar base sbalcl was more posterior than the noncleftside alar base sbalncl mean difference, 3.6 mm range, 1 to 5.5 mm, 3 the noncleftside alar base sbalncl was further from the midline than the cleftside alar base sbalcl mean difference in lateral distances of sbalncl and sbalcl from the midline, 2.8 mm range, 0.5 to 7 mm, and 4 the cleftside piriform margin PPACL was more posterior than the noncleft side piriform margin PPANCL mean difference, 2.1 mm range, 0.5 to 4 mm. In conclusion, the nasal deformity in unilateral cleft lip and palate that has not been operated on is characterized by these four features and increased SNANS angle with increased alveolar cleft width. Plast. Reconstr. Surg.103 1826, 1999.

Described is a technique that has evolved from the challenges of closure of larger cleft palate defects and that we are now using in preference over other techniques to repair a wide variety of clefts. Softpalate closure and muscular sling reconstruction are accomplished using a modified Furlow technique. An associated cleft of the hard palate and the gaps produced by posterior displacement of the reconstructed soft palate are closed by adding tissue, buccal flaps, rather than by closure under tension or leaving residual raw surfaces. Palate lengthening is achieved both by the Zplasty effect and by the interposition of buccal flaps between the hard and soft palate. Seventysix palates have been repaired using this procedure. There were three postoperative fistulas. Plast. Reconstr. Surg.100 1139, 1997.

Our study was designed to measure the transcutaneous PO2of the scalp to determine if there was a relative microvascular insufficiency and associated tissue hypoxia in areas of hair loss in male pattern baldness. A controlled prospective study was performed at Butterworth Hospital, Grand Rapids, Michigan. Eighteen nonsmoking male volunteers aged 18 years and older were studied. Nine men had male pattern baldness Juri degree II or III, and nine were controls no male pattern baldness. Scalp temperature and transcutaneous PO2were obtained at frontal and temporal sites in each subject. Peripheral circulation was assessed from postocclusive transcutaneous PO2recovery time by means of maximum initial slope measurements. Statistical significance was assessed at p <0.05.