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Primary surgical correction of the cleft lip nasal deformity is routinely performed at the Craniofacial Center at Chang Gung Memorial Hospital. Over time, however, there is a tendency for the lower lateral cartilage to retain its memory and, subsequently, recreate the preoperative nasal deformity. Therefore, it is current practice to use a nostril retainer for a period of at least 6 months to maintain the corrected position of the nose. The aim of this study was to qualitatively assess the benefit of postoperative nasal splinting in the primary management of unilateral cleft nasal deformity. Data from two groups of 30 patients with complete unilateral cleft lips each were retrospectively collected and analyzed. The first group served as a control (no nasal splints), and the second group used the nasal retainer compliantly for at least 6 months postoperatively. All patients had their primary lip repair at 3 months of age. A photographic evaluation of the results when the patients were between 5 and 8 years of age was conducted. The parameters used to assess the nasal outcome were nostril symmetry, alar cartilage slump, alar base level, and columella tilt. The first scores were based on residual nasal deformity, and the second set were based on overall appearance. It was found that the mean scores of residual nasal deformity for all four parameters in patients who used the nasal stent were statistically better than the scores of patients who did not (p values ranged from 0.0001 to 0.005). The overall appearance scores for the four parameters in the patients who used the nasal stent after surgery were also statistically better than the scores for those who did not (p values ranged from 0.0001 to 0.01). The results show that postoperative nasal splinting in the primary management of the unilateral cleft nasal deformity serves to preserve and maintain the corrected position of the nose after primary lip and nasal correction, resulting in a significantly improved aesthetic result. Therefore, it is recommended that all patients undergoing primary correction of complete unilateral cleft deformity use the nasal retainer postoperatively for a period of at least 6 months.

Autogenous bone graft of an alveolar cleft area has the following advantages: (1) assistance in the closure of buccoalveolar oronasal fistula; (2) provision of bony support for unerupted teeth and teeth adjacent to the cleft; (3) formation of a continuous alveolar ridge to facilitate orthodontic correction of malocclusion; (4) supporting the nostril floor and alar base to improve nasal aesthetics. It has been well accepted in most craniofacial centers as routine procedure in cleft lip and palate rehabilitation. A new surgical technique for alveolar bone grafting has been introduced to the Chang Gung Craniofacial Center since July 1991. It provided a good exposure of the alveolar cleft, primary closure of the fistula and adequate volume of bone graft. A review of 27 consecutive alveolar bone grafting procedures performed in unilateral cleft lip and palate patients from July 1991 to June 1992 was presented. Patients have been followed up for at least 6 months. The alveolar bone graft was evaluated clinically and radiologically at one week, six months and one year after the surgery. The preliminary results indicated that the new surgical technique produced less chance of recurrent fistula, good postoperative gingival height, and improvement of nasal aesthetics. Based on the results of this new study we strongly advocate the use of this new surgical technique.

In order to achieve a better speech result while eliminating the possible adverse effect to midfacial growth, a Furlow palatoplasty has been used for primary palatal repair as well as correction of velopharyngeal insufficiency in 54 patients since 1985. There were four oronasal fistulae in the 35 patients who received the procedure for primary palatal repair. These four patients were earlier cases in the series. There was no fistula in the patients operated on after July 1989. Among the 28 patients who had postoperative speech assessment, only two patients had velopharyngeal insufficiency (VPI). These unfavorable results were due to an inappropriate patient selection. For the 19 patients who received a Furlow palatoplasty for the correction of VPI, the results were also encouraging. The unfavorable results were also caused by incorrect patients selection. With increasing experience, the results of this technique should continue to improve.

Thirty-six patients with 72 metacarpal and phalangeal fractures with associated injuries to the neurovascular bundle, tendon, soft tissue, or bone following acute complex hand injury were treated with miniature plates and screws and reconstruction of the disrupted and missing structures. The results were judged according to the criteria of the American Society for Surgery of the Hand. The overall results were good in 46.3%, fair in 32.2%, and poor in 21.5%. Although traditional wiring techniques are certainly useful in complex hand injuries, internal osteosynthesis with miniature plates and screws has definite indications in cases requiring stable and rigid internal fixation.

Submucous cleft palate (SMCP) is a subgroup of cleft palate which is often unawared by general practitioners. The diagnostic triad of (1) bifid uvula, (2) translucent zone in soft palate and (3) bony notch in the posterior edge of the hard palate can be variable in their severity among each patient. Some patients with SMCP will have speech problems with velopharyngeal insufficiency (VPI) and/or articulation errors. Patients will also have middle ear effusion as in an overt cleft palate. Surgical treatment is indicated in the presence of VPI or recurrent otitis media. There are controversies on the timing and type of surgical intervention. This study was the first part of an ongoing study on SMCP. It was a retrospective review of the SMCP patients treated before June 1988 to compare the results among different age groups and surgical procedures. It was found that neither age nor type of surgery was a determinant for a satisfactory correction of VPI. Unless the patient had recurrent otitis media, surgery should not be performed before having a thorough speech evaluation including perceptual assessment and instrumental assessment. The type of surgery should be decided according to the findings from the instrumental assessment.

The loss of function of the metacarpophalangeal joint is a significant disability. Simultaneous reconstruction of the soft tissue, extensor mechanism, joint, and flexor tendon in a complex hand injury is difficult and challenging. Free vascularized autogenous toe joint transplantation is a useful technique that provides not only joint replacement but also the soft tissue, extensor mechanism, and flexor tendon in more severe complex hand injuries. Two patients underwent immediate, free vascularized metatarsophalangeal joint transfer of the second toe to replace the long and ring finger metacarpophalangeal joint in acute complex hand injuries. The follow-up results at 16 months and 8 months postoperatively are presented.

A simple and useful method is described for resurfacing a distal phalanx of the degloved thumb with twin neurovascular island flaps from the ulnar and radial aspects of the middle and ring fingers respectively. It provides protective sensation and an acceptable cosmetic result.

Reconstruction with free flaps for the lower leg in the presence of venous thrombosis or venous hypertension has a high risk of failure. We describe the use of the contralateral leg for venous drainage through a pedicled skin bridge containing a tributary of the long saphenous vein. The recipient artery was a main artery of the ipsilateral leg. Two weeks later, once there was a well-established venous communication between flap and recipient site, the venous bridge was divided. Because the arterial inflow to the flap was not interrupted by the division of the skin bridge, the flap has good viability and good resistance to infection or ulceration 3 years later.