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Encephalocele is a malformation due to a defect in the closure of the neural tube causing herniation of brain tissue and/or meninges through this congenital skull defect. The size of encephalocele varies from a few centimeters to a huge mass called "giant encephalocele". Content usually consists of degenerative neural tissue, meninges and a cystic part. We here report the case of a 4-month-old infant, born of non-consanguineous parents, who was referred with congenital occipital mass. Upon arrival at our clinic, clinical examination revealed a weight of 3500g, a head circumference of 33 cm, with a non-bulging anterior fontanelle. She presented with a huge renitent occipital mass measuring 43X25cm, with a height of 15cm was found. absence of both eyelids, bilateral lip and palate fissures; a constriction ring on the right leg, absence of toes on the right and left feet. A diagnosis of an amniotic band syndrome was made, with as components: occipital encephalocele associated with a bilateral palpebral coloboma, a bilateral cleft lip and palate, and amniotic bands on the right leg, and amputation of the toes of the right and left feet., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Matthieu Aza Sumai et al.)

The labio-maxillofacial cleft (LMFC) penalizes the child from birth by its aesthetic, functional, psychological and social repercussions. The prognosis is conditioned by a multidisciplinary care that starts from the antenatal period to continue until the end of growth. The treatment is long and complex. This explains the multiplicity of techniques and the variability of schedules according to the teams. The purpose of this article is to describe the protocol of management of the LMFC within the multi-disciplinary team in Lausanne and to emphasize the novelties in both surgical and organizational plan., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In the course of treatment of cleft lip and palates, the quality of primary cheilo-rhinoplasty is essential to limit aesthetic and functional complications. This is why these primary reconstructions come under the domain of specialised centres with multidisciplinary teams. Unfortunately, residual imperfections often remain, especially in bilateral clefts, and secondary cheiloplasties represent for us a complex challenge. They aim at functional and aesthetic correction, and the choice of time is very random and depends largely on the psychological repercussions of the deformation in the child. It often occurs at the age of school entry and is combined with alveoloplasty. We then speak of alveolar transplantation with vestibulo and labio-plastie, the GPVP. Then we propose to combine all the resources of cosmetic surgery to improve the aesthetic and functional result of these children., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

We report the first case described in the literature of lateral, paracommissural cleft of the lower lip in a 2-year-old child. This anomaly caused labial incompetence requiring surgical correction. Different surgical techniques have been described for the treatment of the cleft of the upper lip. We studied each of them, analyzed the advantages and disadvantages of these techniques by inverting them and adapting them for the lower lip. We opted for the double "Z" plasty of Malek because the difference in height between the cleft side and the healthy side was important. In addition, this plasty hides part of the scar in the labiomental groove. The functional and aesthetic result at 6 months after surgery is satisfactory., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Primary repair of cleft lip and palate has become a nasal and lip repair. In the aim to improve our nasal results on symmetry we perform an extensive septoplasty to put the nose in a good shape and a median axis. This septoplasty without resection of cartilage does not cause growth disorders to the nose and it promotes maxillary growth by improving early nasal breathing. It can prevent secondary rhinoplasty, source of new scars (externally, fork). But rhinoplasty will increase the incidence of scar contraction, thus shaping with a nasal conformer is essential., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Introduction: The alveolar bone graft (ABG) is an important phase in the surgical treatment of cleft lip and palate (CLP). The purpose of alveolar bone grafting is to eliminate oronasal fistulas, restore the continuity of the maxilla and provide optimal periodontal support for spontaneous eruption of permanent canines adjacent to the cleft. The purpose of this systematic review was to determine the ideal timing of the ABG that would achieve these goals., Material and Methods: Databases consulted were MEDLINE, Embase et EBSCOhost, using keywords present in the MeSH: [cleft lip and palate] and [alveolar bone graft] and [tooth eruption]. Selection criteria included retrospective studies, prospective studies and meta-analyzes dating from January 2005, with available full text., Results: Among 105 references, 9 articles met our selection criteria. ABG carried out before or just after the eruption of permanent canines adjacent to the cleft, between 8 and 12 years old, has the best success rate of the transplant (71% to 89%) and the lowest risk of canine inclusion (5% to 19%)., Conclusion: According to literature data, the optimal timing of ABG that provide best results is located between 8 and 12 years, before or just after the eruption of permanent canines adjacent to the cleft. However, this timing could be modified by the multidisciplinary team according priorities, particularly aesthetic, defined for each child., (© EDP Sciences, SFODF, 2017.)

Introduction: Cleft palate requires surgery in the first years of life, furthermore repairing anatomically the soft and hard palate is complex on a surgical level because of the fine tissues and the local intraoral configuration. It is valuable to train first on simulators before going to the operating room. However, there is no material dedicated to learning how to perform intraoral sutures in cleft palate surgery. We made one, in an artisanal manner, in order to practice before the real surgical gesture., Building the Simulator: The simulator was designed based on precise anatomical data. A steel pipe, fixed on a rigid base represented the oral cavity. An adapted split spoon represented the palate. All pieces could be removed in order to apply a hydrocellular dressing before training for sutures., Use of the Simulator: Our simulator was tested by 3 senior surgeons in our department in close to real-life conditions in order to evaluate its anatomical accuracy., Conclusion: It is valuable to have a simulator to train on cleft palate sutures within teaching university hospitals that manage this pathology. Our simulator has a very low cost, it is easy to make and is anatomically accurate., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Le Fort I osteotomy is often needed in bilateral cleft patients. The usual approach to the maxillae may compromise the premaxillary vascularisation. We present a subperiosteal exposure preserving two paramedian vascular pedicles that respect premaxillary blood-supply., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

If the multiplicity of functional protocols of cleft lip and palate treatment has been bewildering, it is now a source of learning. The lessons we can draw from them assist us to choose the best age for the primary surgery and a chronology that prevents the palate from the worst scaring. Eventually, with 18 years of follow-up, the best functional achievement comes unexpectedly from an ambitious primary rhinoplasty that had till now been condemned. Not only do the patients have good appearance and social integration, but the nasal mode of breathing established at the time of the primary surgery favors a good facial growth without any compromise. Reciprocally, all the interacting functions benefit from a nasal ventilation., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

For 18 years our protocol has corrected the cleft lip nose and achieved an intravelar veloplasty at the time of the first operation, leaving the least scaring as possible. No doubt that the best treatment of the sequellae is their prevention: - the oro-nasal fistulas have disappeared; the nostril is almost normal; the continuity of a wide maxillary arch is restored in primary dentition - all that favor a nasal ventilation. This context has changed the nature of the secondary treatment described here. When lip and nose are not good enough we must address the residual deformities with the primary surgery principles. The velopharyngeal insufficiency calls for a velar re-repair and the pharyngeal depth is to be reduced by lipofilling. The rare cases of failure are improved by an Orticochea sphincteroplasty., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Introduction: The aerophonoscope allows for recording buccal and nasal airflow during breathing and speech and the sounds emitted by the patient. It is known to be useful in the postoperative follow-up of cleft lip and palate children, but there are currently no studies that quantitatively validate its reliability in pathological or non-pathological situations. The aim of our study was to measure the reliability of aerophonoscopic measures in adult healthy volunteers., Material and Methods: A quantitative evaluation of the reliability of aerophonoscopy has been carried out in 30 healthy adult volunteers by measuring its inter- and intra-individual reproducibility and its sensibility in relation with the degree of the velopharyngeal sphincter constriction using a test-retest protocol., Results: The aerophonoscope allows for inter- and intra-individual reproducible measures in healthy adult volunteers. Its sensibility to velopharyngeal sphincter constriction is good in healthy adult volunteers., Discussion: The interest of aerophonoscopy in the treatment strategy of cleft lip and palate patients remains unclear. More reliable quantitative data would be of major interest to determine whether this device is suitable for the follow-up of cleft lips and palate patients or not. This would also allow for planning a second soft-palate operation and for assessing the efficacy of revision surgery such as superior or inferior pedicled pharyngoplasty., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Hay-Wells syndrome is a rare form of ectodermal dysplasia. We report a case of a 5-year-old girl, the daughter of non-consanguineous parents. She had the characteristic of facial dysmorphia of Hay-Wells syndrome. Molecular analysis confirmed diagnosis. The patient had a cleft palate, which is considered one of cardinal signs of this syndrome. She underwent Veau-Wardill-Kilner palatoplasty with satisfactory results. Through this case report, we describe the maxillofacial manifestations of this syndrome with a literature review., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objectives: Anomalies of the maxillofacial development concern 1 for 700 births. About 30% of prenatal diagnoses of isolated primary cleft palate or associated with a cleft of secondary palate will be corrected in postnatal. This retrospective observational study was designed to compare the antenatal data and postnatal diagnosis regarding a series of clefts., Materials and Methods: All children born between 1 December 2009 and 31 January 2014 in a prenatal diagnostic reference center and having a cleft palate were included. Newborns with an abnormality associated with the cleft were excluded. A comparison was made between the data in the antenatal ultrasound reports and postnatal those described by the surgeon during surgery., Results: Forty-four children were included and three infants were excluded due to associated anomalies. Of those 41 children, 27 children have been screened. Ultrasound and clinical diagnosis was the same for 23 cases (85.2%) and inaccurate for 4 patients (14.8%). In case of primary cleft palate prenatal diagnosis was performed to 19 cases of 21 (90.5%), but only 8 of 20 if only secondary cleft palate (42.1%) including 7 with a Pierre-Robin sequence., Discussion: Antenatal screening sensitivity of primary and secondary cleft palate increase in recent years with a rate of 85.2% in our series. By contrast, diagnosis of isolated secondary cleft palate seems to be more difficult and 3D ultrasound does not always improve screening performance., Conclusion: Ultrasound 2D seem sufficient for screening of primary and secondary cleft palate. The 3D ultrasound may be useful for a better representation of the cleft for future parents. The same language concerning the classification of the clefts facilitates harmonization of reporting and understanding between professionals. The presence of the maxillofacial surgeon ultrasound room would allow the sonographer to direct its ultrasound accurately or improve its learning curve., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: Maxillary hypoplasia is a common sequela of cleft lip and palate. Its surgical treatment consists in a maxillary advancement by distraction or by conventional orthognathic surgery but morphological results are unpredictable. Our goal in this study was to see if the esthetical results (on the lip and the nose) of maxillary advancement were correlated to the preservation of lateral incisor space of the cleft side., Patients and Method: This retrospective study included 38 patients operated between 2002 and 2013. Unilateral clefts were studied independently from bilateral clefts. Profile aesthetics was evaluated independently and subjectively by two surgeons and scored on an 8-point scale. The result was classified as "good" if the score was superior or equal to 6. The score was correlated to the following parameters: amount of maxillary advancement, upper incisor axis, preservation of the missing lateral incisor space., Results: In the "good result" group, the space of the lateral incisor was less often preserved. The nasolabial angle was more open and the upper central incisor axis more vertical. These results were more pronounced in bilateral clefts, but also found in unilateral clefts., Discussion: Under reservation of the subjective evaluation and of the small number of patients, it seemed that lateral incisor space closure improved the profile of patients treated by maxillary advancement for cleft lip and palate sequelae., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Our practice in a humanitarian (or crisis) context differs from what we experience in daily practice. There are several reasons for this. First, the diseases encountered are sometimes unfamiliar, such as sequelae of noma, or the presentation of familiar diseases may be unusual, such as facial malformations seen at a late stage. Secondly, these missions take place in developing countries, and consequently, evaluation and anticipation of possible malnutrition should be considered, especially because facial diseases themselves may be responsible for nutritional problems. Lastly, conditions are often difficult, occurring in an unusual environment, and we sometimes have to face communication and equipment problems. The goal of our work, based on a 15-year experience (in Bamako and Mopti with the Association "Santé et Développement", and in Ouagadougou with the organization "Les enfants du noma") and the analysis of literature, is to point out these features and maybe to be helpful to others., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: The management of cleft lip, alveolar and palate sequelae remains problematic today. To optimize it, we tried to establish a new clinical index for diagnostic and prognostic purposes., Technical Note: Seven tissue indicators, that we consider to be important in the management of alveolar sequelae, are listed by assigning them individual scores. The final score, obtained by adding together the individual scores, can take a low, high or maximum value., Discussion: We propose a new classification (ACS: Alveolar Cleft Score) that guides the therapeutic team to a prognosis approach, in terms of the recommended surgical and prosthetic reconstruction, the type of medical care required, and the preventive and supportive therapy to establish. Current studies are often only based on a standard radiological evaluation of the alveolar bone height at the cleft site. However, the gingival, the osseous and the cellular areas bordering the alveolar cleft sequelae induce many clinical parameters, which should be reflected in the morphological diagnosis, to better direct the surgical indications and the future prosthetic requirements, and to best maintain successful long term aesthetic and functional results., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Purpose, Objective: The aim of our study was to investigate the quality of life of patients undergoing cleft lip or cleft lip and palate as well as the perception of quality of life of patients perceived by their parents slot., Patients and Methods: Fifty-one adolescents and young adults (29 boys and 22 girls) who underwent cleft lip (FL 22) or lip and palate (CLP 29) and their parents have received psychological and surgical joint consultation. The minimum age for inclusion was 10 years (mean age 15.5 years). A quality of life questionnaire (VSP-A) "children" was given between 10 and 11 years and a questionnaire "adolescents" beyond. Parents have them answered a questionnaire of perceived quality of life of their children. The results were analyzed and compared to a control population (Statistics Student test). Perceived parents lived in relation to their children was obtained through the study of linear regression curves., Results: The response rate to the questionnaires was 66.7% for parents, 85.7% for children and 63.6% for teenagers. The quality of life of the patients was assessed by the patients to 65.1/100 on average. The index of overall quality of life was superimposed on the control population (p=0.66). Perceived quality of life of patients by their parents was fairly close to the quality of life described by patients (66.5). On the areas of family, education, recreation, quality index was proportionately less than for other areas. For each of these areas, parents overestimated the quality of life of their child. Compared to the control group the fields of education, leisure, vitality quality index were significantly lower in the/FL population P., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Despite fifty years of statistics, congresses, publications, the cleft nose remains an enigma to the great majority of cleft specialists. Most of the published papers give recipes to camouflage the cleft deformity, very few are concerned by the functional anatomy and its relation with facial growth. The complexity of the matter, the results frequently disappointing, the lack of awareness of the necessity of early nasal breathing, and the academic condemnation of any imperfect attempt to correct the nose at the time of the first operation have led to resignation. For the last forty years, we have been involved in a careful and obstinate research about the early correction of the cleft nose deformity. We wish to present our conclusions in this chapter with at least 17 years of follow-up. They are as following: in cleft patients the nasal cartilages are only deformed. We can achieve sub periosteal and sub perichondrial dissections by 6 months of age without being harmful for facial and nasal growth. Repositioning accurately the nasal structures is enough if we are able to control the healing process and prevent endonasal wound contraction. We have not to do any compromise and favor one function with regard to the others, nasal ventilation being the most important for a good facial growth. In a word, nasal pediatric surgery is necessary at the time of the first operation from 6 months of age and should be carried on with a double demand, aesthetic and functional. To achieve this goal, we must have a sound knowledge of the cleft nose deformity, of the adequate surgical techniques and of the logic chronology to reach the best result. The nose repair cannot be limited to the nasal cartilages. The whole nasal structure is concerned especially its bony framework, the width of which at the level of the piriform orifice and the nasal floor depends on the outcomes of any surgical step that it would relate to the lip, palate or alveolar closure. Interaction of all these factors calls for an appropriate answer in adequation with the diagnosis of the deformity and a coherent answer as we know that any local action may induce an unfavorable chain reaction and should integrate a global and logic project. After the primary surgery, additional correction for aesthetic or functional purpose as well, may be useful during the period of growth. For cleft teenagers or adults, the rhinoplasty can simply be indicated for harmonization after a good primary nasal correction and optimal facial growth. On the contrary, the rhinoplasty may be more or less a complex operation for the usual and severe deformities. In the last case, the diagnosis must take into account all the residual deformities, even the labial and alveolar ones, and the treatment plan integrate all the principles and techniques of the primary surgery. What has not been done at the time of the primary surgery, should be done secondarily: all the structures are present, only deformed and embedded in scarred tissues. Primary or secondary cleft rhinoplasty must be undertaken by surgeons accustomed to cleft patients, but also trained in the other fields of nasal surgery, aesthetic and reconstructive., (Copyright © 2014. Published by Elsevier Masson SAS.)

This second part follows on from part 1 published in the previous issue of this journal. The aim of this publication is to offer teams specializing in the primary and secondary treatment of labio-alveolar-palatal clefts a prosthetic evaluation for more rational management of the dental sequellae of clefts for patients who, when they reach adulthood, often wish to improve their facial esthetics, in which the dental element plays an important part. The reorganization and restoration of the maxillary anterior teeth and their esthetic integration with respect to the face and lips would then be less of a problem for plastic surgeons and orthodontists. In this regard, the installation in this sector of implants, following ambitious bone surgery involving the sacrifice of the teeth of the medial nasal process in bilateral forms, is a protocol that could usefully be taken into account., (Copyright © 2014 CEO. All rights reserved.)

Patients with cleft lip and palate frequently develop dento-facial deformity requiring orthognatic surgery. The origin of this deformity is therapeutic and surgeons are currently trying to prevent this iatrogenicity. The maxillary dento-facial deformity in these patients is a retrognathia with infragnathia, associated with endognathia, obliquity of the occlusal plane, with deviation of the superior incisive midline in case of unilateral clefts. The difficulties in the treatment of these skeletal deformities are due to the palatal, labial, and pterygomaxillary scar tissue. Orthognathic surgery is most of the time bimaxillary with a 3-dimensional movement of the jaws including maxillary advancement. The aims of surgery are occlusal, esthetic, and functional improvement. The first step is gingivoperiosteoplasty (ideally performed during childhood), orthodontic treatment including, if necessary, transversal maxillary distraction to obtain enough space to replace the lateral incisor; extraction of premolars should be avoided if possible. Planning and performing the treatment are difficult for the orthodontist and for the surgeon. Maxillary advancement by distraction may be an interesting alternative to prevent partial relapse. Obtaining normal oro-facial functions are required for a stable result. These should be monitored after the primary treatment by the whole staff, surgeons, speech therapist, and orthodontists. Performing Le Fort 1 osteotomy is more difficult than in other patients because of scar fibrosis than needs to be released., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

The aim of this publication is to offer teams specializing in the primary and secondary treatment of labio-alveolar-palatal clefts a prosthetic evaluation for more rational management of the dental sequellae of clefts for patients who, when they reach adulthood, often wish to improve their facial esthetics, in which the dental element plays a significant part. The reorganization and restoration of the upper anterior teeth, and their esthetic integration with respect to the face and lips, would then be less of a problem for plastic surgeons or orthodontists. In this respect, the installation in this sector of implants, following ambitious bone surgery involving the sacrifice, in bilateral forms, of the teeth of the medial process is a protocol that could usefully be taken into account., (Copyright © 2014 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Van der Woude syndrome is known to be the first syndromic cause of oral cleft. Apart clefts the cardinal signs are lower lip pits and hypodontia. IRF6 gene mutations have been recently identified as potential cause in this syndrome which permits to better understand its phenotype heterogeneity. Based on a literature review, we tried to cover the different aspects of this syndrome with an emphasis on genetic counselling and surgical correction of lip pits., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: There is no international consensus on timing for surgical repair of cleft lip and palate. We argue that neonatal timing for repair of the lip deformity allows a better integration of the baby in his family and is of major support for the parents. Recent studies tend to challenge this neonatal practice., Patients and Methods: We want to study retrospectively the perioperative safety and the surgical outcomes of this procedure over the past 20 years in a series of 42 non-selected babies who had labial repair during the first four weeks of their life. All of them have been operated by the same senior surgeon., Results: Median operative time is 45 minutes for unilateral cleft and 70 minutes in case of bilateral malformation. Oral feeding is initiated at the end of the operative day. Children's hospital stay is four days. The results show no anaesthetic complication. Four children had secondary lip correction., Conclusion: The risk of anaesthetic and surgical interventions limited to the lip before the age of 28 days is very low in a medical care environment specialized in neonatal surgery and postoperative care. The over all complication rate is very low., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Bone wax or Horsley wax, which is used very frequently in bone surgery, is a non-absorbable mixture of beeswax (70%) and Vaseline. It permits the haemostasis of bone gaps by mechanical obstruction of bone pores containing blood capillaries. Complications due to this product are rare but sometimes quoted in literature. We report the case of a 17-year-old patient who, 10 months after surgery and after an asymptomatic period, presented an inflammatory granuloma at the scar of iliac bone harvest, which had been used as a maxillary graft. This complication necessitated a first exploratory and cleansing surgery, as well as a second surgery, which clarified the origin of the inflammation and made it possible to eliminate the wax remains. We think that bone wax should be used sparingly and with caution, firmly applied to the bleeding site without leaving any free particles., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objective: The aim was to determine the overall sensibility changes in the area of the infraorbital nerve on patients with unilateral clefts lips and unilateral clefts lips and palate who had undergone primary surgical correction according to the principles of Delaire., Patients and Method: Twenty patients (7-20years) with unilateral cleft lips (and palate) who had undergone surgery in infancy according to Delaire were included. Cutaneous sensibilities of the nasolabial fold and of the upper lip were tested using four cutaneous modalities. A tactil superficial sensibility light touch test, a two-point discrimination test (McKinnon-Dellon Disk-Criminator), and the determination of cold and warm detection thresholds (Quantitative Sensory Testing, Medoc Thermal Sensory Analyser). The possible difference of the sensibility between operated and controlateral sides of the face were compared. Results were finally compared to a control group of twenty healthy volunteers., Results: No significant difference could be found between the operated and non-operated side of the cleft group. There was also no difference between the cleft and the control group. Specific difference of perception between nasolabial fold and lip encountered in the literature were confirmed by the experiments., Conclusion: The large subperiostal approach according to Delaire during the primary surgical procedure have not affected long term infraorbital sensibility of patients with unilateral complete cleft lip., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objective: This study aims to present the epidemiological profile of clefts lip/palate observed in the eastern of Democratic Republic of Congo (DRC) from January 2002 to May 2004, period of civil wars., Method: It is a retrospective study realized at Doctors on Call for service Learning Center (DOCS LC) in Goma/DRC concerning 89 cases of cleft lip/palate operated during the same period. The data processing was facilitated by the software package SPSS 17.0 installed in the IT center of DOCS., Results: The average age of the consultation is 9.9 years with extreme of zero and 42 years. Both sexes are concerned: 50.6% of male and 49.4% of female. The more cleft extends from the superior lip to the palate through the alveolus, the more the frequency of the various types of clefts lips/palate decreases: 59.6% (simple clefts lip), 37.1% (labio-alveolar clefts), and 2.2% (cleft palate). The left incomplete cleft lip variety represents 33.7% of all varieties. Most of clefts lips/palate come from the first to the fifth pregnancy with a peak of frequency (19.1%) in the second pregnancy. No family history about congenital deformation was found from 97% of our patients., Conclusion: The epidemiology of cleft lip/palate in our area would be more connected to environmental factors than genetics: no family history of congenital deformation was seen for most of our patients during this period of civil war., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

The management of patients with a cleft lip in developing countries is often the prerogative of humanitarian missions from developed countries. The goal of our work is to conduct a first epidemiological, clinical and therapeutic assessment of the management of cleft lips by a local team and to evidence the difficulties faced by us in our working conditions. In a retrospective study covering a period of about five years (January 2004 to March 2009), 205 cases of nasolabial clefts are assembled. The mean age at the time of the first visit is 17 months. A slight female predominance is observed. The majority of patients are from the capital city. A close relative with a cleft is found in 6.8% of them. In 44.9% of cases, it is a simple cleft lip. A cleft palate is associated in 47.8% of cases. Associated malformations are observed in 10.5% of cases. We operated on 110 patients. The mean age at the first surgery is two years. Millard's technique is our technique of choice. No operative mortality is observed. In 17.4% of cases, operative morbidity occurred in the form of suppuration with partial or complete early suture release. The esthetic result is satisfactory in 67.7% of cases. This management could be improved by creating a multidisciplinary team including--in addition to surgeons--dentists, speech-language pathologists, psychologists, etc., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: Bone substitutes are rarely used in the reconstruction of cleft lip and palate. The graft material of choice is cancellous bone, harvested in the hip or tibia. Tibial harvesting may lead to postoperative morbidity, or even complications. This has lead surgeons to develop alternative solution. We present a secondary alveolar bone grafting technique using synthetic calcium phosphate ceramics., Observation: A patient presenting with a complete unilateral cleft lip and palate was treated by alveolar bone grafting at the age of nine years, using a mixture of autologous bone, harvested on the operative field, and particles of biphasic calcium phosphate (BCP); the graft was included in a platelet rich plasma (PRP) gel. The patient was followed up for eight years after the procedure. No sign of early or late infection was observed. At the end of facial growth, the cuspid had erupted correctly in a safe periodontal environment. Sequential X-rays showed complete filling of the initial bone defect, progressive resorption of ceramics, and spontaneous eruption of the cuspid., Discussion: In this long-term follow-up report, the use of BCP mixed with autologous bone did not interfere with dental eruption or maxilla growth. A second bone-harvesting site was thus avoided. BCP could be a suitable alternative to autologous bone graft for secondary alveoloplasty., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Introduction: The orofacial clefts include 30 variant according to Tessier classification: the number 30 contain mandibular arc damage isolated or associated with damage of surrounding soft tissue., Case Report: Our patient was a newborn with median mandibular cleft associated with ankyloglossia, bifid tongue and a top cervical fistula. We have not found polymalformative syndrome. The early surgical management included one time and after-effect were simple within 11 months., Discussion: We point out difficulties for antenatal diagnosis and controversy about appropriate time for surgical management of the bone defect. The last physiopathologic hypotheses were explicated., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

We describe the particularities of cleft lip and palate treatment in the department of plastic surgery managed by Pr Hosaka at the Showa University in Tokyo. Their surgical technic inherited from Pr Onizuka, their multidisciplinary approach, and their experience with over 300 cases a year were not reported in a non-Japanese journal. Therefore, we found interesting to describe their whole management., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

One of the many questions which parents ask with regard to the malformation of the oral cavity of their child at birth concerns feeding. By answering all the couple's questions, the antenatal consultation aims to prepare the baby's birth and its admission into its family and society.

Introduction: Gingivoperiosteoplasty associated to bone graft is part of a therapeutic strategy applied to the first 20 years of a patient's life. Management is pluridisciplinary. Most authors recommend a bone graft in mixed dentition at the end of premaxillary growth. Retroalveolar and panoramic radiography are the most often used to assess the bone height of the grafted site. We retrospectively studied the radiographies of 57 alveolar grafts in 44 patients., Material and Methods: Between 1999 and 2005, 44 patients underwent gingivoperiosteoplasty associated to bone graft. Thirteen underwent bilateral reconstruction. The surgical interventions were performed by the same surgeon. One year after surgery, the panoramic radiographies were analyzed by a single expert. The bone height compared to roots of adjacent teeth was classified in four grades. Grades 1 and 2 were considered as satisfactory or good and grades 3 and 4 not satisfactory and an indication for a new bone graft. In case of bilateral cleft, each side was analyzed independently., Results: Grades 1 and 2 accounted for 84.2% of grafts. There was no statistical difference in alveolar bone height between patients presenting with agenesis of the lateral incisive. Eighty-one percent of patients grafted with mixed dentition (66% of the cases) had satisfactory results (35% of grade 1 and 46% of grade 2). Patients operated on after 15 years (n=15) had good results in 75% of the cases, 33% were bilateral cleft patients. There was no statistical difference between patients operated on early and those with delayed surgery., Discussion: Radiological results for gingivoperiosteoplasty associated to bone graft are satisfactory. The procedure is easy, cheap, and reproducible. Evaluation with panoramic radiography is not as accurate as with the Denta Scan. CT scan is not used systematically to follow up alveolar cleft palate in children so as to limit irradiation. Volumetric tomography (cone beam) may be the best assessment.

A cleft can be labial, labial-maxillary, unilateral or bilateral labial-maxillary-palatal, or isolated palatal. A multidisciplinary team includes several specialists who will handle the diverse problems of children born with a cleft. This team will follow the child through each developmental stage and assemble an optimal treatment plan, thus reducing the onus on the family. Depending on the type of cleft and the age of the child, feeding, speech, ORL, dental, orthodontic, esthetic and possibly also psychological problems will be taken care of. This is why cleft treatment starts at the time it is diagnosed, before or after birth, and ends when the child is fully grown. It requires a complete interdisciplinary team and the collaboration with obstetricians and geneticians.

Study Objective: The aim of this retrospective study is to describe and evaluate the long term morphologic results of patients who present unilateral complete cleft lip and palate., Patients and Methods: Thirty-two patients with non syndromic unilateral complete cleft lip and palate were operated early by the same surgeon, at the mean age of 70,4 days old, with two operating procedures. The first group was operated of cheiloplasty with the Millard method during the neonatal period, associated to the closure of the palate in the same time. The second group was operated with a modified Millard method during the neonatal period associated to a closing of the palate by the Wardill method at the age of ten months old. The criteria of evaluation were the anatomic remaining abnormalities after surgery of nose, lips, primary and secondary palate (back of 17 years)., Results: Our results show that Millard method and derived are taken as a whole effective, even if the number of secondary surgery and supplementary adjustments was sizeable (87%). The postoperative abnormalities concerning red lip (discontinuity, mucous excess) were frequent (53%), but easily correctable. The secondary surgeries were mainly for minor touch up of lip (46%), second time palate surgeries (53%), and rhinoplasties (40%)., Conclusion: Progress in anesthesia and reanimation allowed us to assure an early management of clefts. The absence of incorrigible after-effects by a secondary surgery of the first-operated patients encouraged the team to continue in this way.

The aim was to examine the bony maxillary structures by computed tomographic measurements in newborns with unilateral cleft lip and palate before cheiloplasty. Analysis of maxillary bone was performed and size parameters were measured by computed-tomographic analysis in 12 infants with unilateral cleft lip and palate. We compared the bony maxillary length and the bony maxillary width between the cleft side and the healthy side. For eight patients, the bony maxillary length was different between the cleft side and the healthy side. For three patients, the bony maxillary width was different between the incisor alveolar structure in the cleft side and the healthy side. For six patients, the bony maxillary width was different between the canine alveolar structure in the cleft side and the healthy side. We noted an asymmetry without hypoplasy in bony maxillary structure in newborns before cheiloplasty. The data can serve as the starting point for a control and later evaluation on the efficiency of different therapeutic approaches of alveolar and maxillary development in children with cleft lip and palate.

Introduction: Cleft lip and palate (CLP) patients often present with a class III malocclusion in connection with a three dimensional maxillary hypoplasia. Twenty-five to 60% of these patients require a maxillary advancement. Two solutions are possible: orthognathic surgery and maxillary distraction. The purpose of this study was to evaluate the complications of the maxillary distraction in CLP patients., Materials and Methods: Data was collected from the records of patients treated at our Surgery Unit between 2000 and 2007. Among the eight patients (four male and four female), five presented a bilateral CLP, two a unilateral CLP and one a unilateral cleft lip associated to a soft palate cleft. The average age at surgery was 17 years old. All had a Le Fort I osteotomy with a pterygomaxillary disjunction. The first two patients had external distractors and the six following internal ones. After a seven-day latency, activation was led to the rate of 1mm per day twice. The period of consolidation was four months on average. The maxillary advancement varied between 7 and 19 mm with an average of 12.6mm. The average follow-up was four years., Results: We encountered difficulties and/or complications in seven patients: one intraoperatively haemorrhage, one avulsion of a tooth fixed at the pterygoid process during the osteotomy, three device failures, two cases of significant pains during activation, one dissociation of the dental anchorage of an external system, two labial ulcerations and one maxillary sinusitis by migration of the 18., Discussion: Difficulties of maxillary distraction in CLP patients are very frequent. The majority is related to the distractors and did not interfere with the final result. But this frequency must be taken into account in the indication and in the choice of the material. Two types of complications can occur during distraction: those related to the osteotomy and those related to the material. The complications related to the osteotomy are in connection with the cicatricial ground of the CLP. They are not specific of the distraction. We especially managed complications related to the material. The social benefit of the internal distractors is undeniable, but the design of certain models must be reexamined to improve their tolerance.

Usually, the nasal sequels of unilateral cleft patient are just considered as an esthetic problem to be addressed after the growth spurt of adolescence. This very narrow vision has led the cleft lip and palate treatment to a deadend. Actually, nasal sequels are the worst in terms of consequence on facial growth. 75% of complete unilateral cleft children are more oral than nasal breathers. Today, we know about the bad consequences of oral breathing on facial growth. It is not surprising to observe a high rate of small maxilla with cleft maxilla scars. In the fetus, the unilateral cleft nose deformities are well explained by the rupture of the facial envelope and the ventilatory dynamics of the amniotic fluid. Every step of the primary treatment threatens the nasal air way patency, whether when repairing lip and nose, suturing the hard palate that is the floor of the nose, or closing the alveolar cleft which controls the width of the piriform aperture. The functional and esthetic nasal sequels reflect the initial deformity, but are also the surgeon's skill and protocol choice. Before undertaking treatment, we must analyze the deformity at every level. Usually, the best option is to reopen the cleft completely to perform a combined revision of the lip, nose, and alveolar cleft after an adequate anterior maxillary expansion. If nasal breathing is necessary for an adequate facial growth, 25 years of experience showed us that it was very difficult to erase the cortical imprint of an early oral breathing pattern. So it is essential to establish a normal nasal breathing mode at the initial surgery. When the initial surgery is efficient and/or the secondary repair is successful, the final esthetic rhinoplasty, when indicated, is just performed for the sake of harmonization, with a classic internal approach and a few refinements.

Primary nasal deformity is characterized by apparent prolabio-columellar skin shortness due to alar cartilage dislocation worsened by lack of muscular support. The secondary deformation retains part of the initial deformity, sometimes even worsened by the primary lip repair. Multiple surgical lengthening techniques were used in nasal defect correction, suggesting both technical complexity and unsatisfactory results. Indeed, columellar insufficiency has more to do with abnormal columello-apical skin distribution due to alar mispositioning than an effective lack of skin. Secondary correction by open rhinoplasty allowing careful cartilage reconstruction of the nose tip seems to be widely accepted. However, the nasal defect can be limited by performing a primary intervention focusing on two principles: columellar lengthening by early alar repositioning and simultaneous lip and nose repair.

Children born with labial-alveolar-velopalatine clefts must be managed by multidisciplinary teams in order to decrease the frequency and the importance of sequels, by implementing a true therapeutic strategy. It is indeed easier to avoid a secondary deformation than to correct it. Labial sequels are often associated to nasal sequels, and are managed in a single surgical intervention, with total revision of the cheilorhinoplasty. Some less important labial deformities can be corrected without total and simultaneous revision of the lip-nose complex. The goal of correction is functional and aesthetic, and the choice of the moment depends mainly on the psychological impact of the deformation for the child, and his motivation for reoperation.

Maxillary hypoplasia is a common sequel in cleft lip and palate deformities. After primary surgery to close lip and palate, patients routinely need extensive treatment particularly orthodontic management. With this type of approach, maxillary hypoplasia is less frequent and severe and subsequent orthognathic surgery is efficient in most cases. Without the proper management maxillary hypoplasia may be severe and patients will need a modified management and specific revision. At the end of maxillar growth, the first aim of treatment is to achieve continuity of the maxillary arch with gingivoperiosteoplasty. The transversal insufficiency can then be treated by distraction osteogenesis. Orthodontic treatment should leave place for missing teeth.