Objectives: Quantitative assessment of 3-dimensional progressive changes of the maxillary geometry in unilateral cleft lip palate (UCLP) with and without nasoalveolar molding (NAM). Methods: The study was designed as a prospective 2-arm randomized controlled clinical trial conducted in parallel. Forty infants with nonsyndromic UCLP were randomly assigned into a NAM-treated group (n = 20) and non–NAM treated group (n = 20). A total of 120 laser-scanned maxillary casts were collected and blindly analyzed via a modified algorithm at T0 (initial visit; baseline), T1 (after 3 wk; first interval), and T2 (after 6 wk; second interval). The main outcome measures were the amount and rate of cleft gap changes, the midline position, and the transverse, sagittal, and vertical growth through intervals. Results: More than 50% of the cleft gap (56.42%; P < 0.001) was reduced in the first 3 wk of alveolar molding (AM). The end point of the AM was obtained in 6 wk (86.25%; P < 0.001); then, the kinks of the greater segment were noticed. The AM effect decreased as far as posterior; the anterior arch width reduced slightly (1.23%; P < 0.001), while the middle and posterior arches increased slightly (P > 0.999 and P = 0.288, respectively). The posterior arch width was the least changing and was considered a baseline, while the anterior was the pivot of the segment rotation. Both groups showed different patterns of segment rotation and sagittal growth. The non–NAM treated group showed a slight increase in cleft gap length, arch width, and midline position. Conclusion: Based on this study, it was concluded that the NAM treatment is effective in minimizing cleft severity and realigning maxillary segments without the deterioration of the transverse and vertical arch growth. Near follow-up visits are recommended to monitor the rapid gap reduction within the first 3 wk. Further trials are recommended to compare the outcomes regarding the sagittal growth to reference values ( ClinicalTrials.gov NCT03029195). Knowledge Transfer Statement: The results of this study will help clinicians understand nasoalveolar molding biomechanics that may improve the treatment outcomes for patients with unilateral cleft lip and palate. The trial data can be a valuable guide to the qualitative and quantitative predictive virtual molding in computer aided design–simulated nasoalveolar molding therapy. The modified algorithm can be used by researchers to quantify the rate, the sequence, and the direction of the maxillary segments movement in unilateral cleft lip and palate.

Autologous fat transfer is a century-old method for both aesthetic and reconstructive purposes. It is considered by many plastic surgeons the ideal body filler. The only disadvantage is its variable degree of resorption, which ranged from 45% to 80%. Various groups have studied the effects of cryo-preservation for fat storage, the advantage being that fat harvesting need only be performed once, and thereafter fat injections can be performed using stored fat as an outpatient service. This a clinical study carried out to test the aesthetic outcome of serial injection of the cryo-preserved fat cells for both aesthetic and reconstructive purposes. Methods: Clinical evaluation was performed under standardized condition for serial lipofilling between October 2003 and May 2012, and 364 autologous fat transfers were performed in 104 patients ranging in age from 18 to 69 years (mean age 34 years). Results: The postoperative clinical results favored the use of serial fat transfer because the aesthetic and structural results were stable up to 90% of the initial volume more than a year after initial transfer. Conclusion: Our data suggest that serial transfer of the cryo-preserved fat leads to better cosmetic results on the basis of outpatient service without increasing the financial burden for our patients.

Farouk (2021) Comparative study between fisher anatomical subunit approximation technique and millard rotation-advancement technique in unilateral cleft lip repair,

Cleft rhinoplasty has spurred much interest in literature because of the difficult task in obtaining a normal nasal form, function, and development. The pursuit of perfection has resulted in myriad techniques, modifications, and innovations to optimize results, but no one protocol or algorithm was proved to be completely satisfactory. Controversies still exist in timing, surgical approach, nonsurgical techniques, and outcome assessment. This article submits a humble contribution that might hopefully help in reaching consensus. Throughout a period of 18 years, 800 patients with different ages and types of clefts were managed by single surgeon using various procedures to correct their nasal deformities. These procedures included preoperative naso-alveolar molding, gingivoperiosteoplasty, primary closed or open rhinoplasty, postoperative nasal stents and nasal molding, and secondary open septorhinoplasty. The outcome was judged by panel assessment and computer-assisted anthropometry. Clinical results were satisfactory for most patients, parents, and surgeon panel. Computer-assisted anthropometry proved helpful in outcome assessment and analysis. Cleft rhinoplasty is neither optional nor separable from cleft lip repair. It requires clear perception of the complex pathogenesis and the governing dynamics of the cleft deformity. A perfect nose with no deformity is unusual, but a reasonably good result is attainable when the principles of nasal repair are fully grasped and faithfully applied.

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Background: The nose is a prime esthetic focus of the human face and it is a common site for nonmelanoma skin cancers. Esthetic reconstruction of nasal skin after tumor resection remains a problem. Beside conservative surgical excision of the skin tumor, this article presents a tactic for decreasing the size of the skin defect and optimizing its shape to facilitate reconstruction. Methods: Throughout a period of seven years, thirty-five patients with nonmelanoma cancer of nasal skin were managed by a one stage surgical operation, which entails conservative tumor resection followed by performing an esthetic rhinoplasty that remodels the nasal skeleton in order to shrink the skin defect; making it more amenable to reconstruction by adjacent skin. Results: Results were satisfactory for all patients in terms of adequate tumor resection and pleasant appearance of their noses. Conclusions: Esthetic rhinoplasty is a useful adjunctive technique in nasal oncoplastic surgery.

Recession of the midface is a relatively common condition that can have a negative impact on facial and nasal aesthetic appearance, and it poses a challenge to plastic surgeons. In cases with generalized maxillary retrusion and/or malocclusion, bone advancement surgery is required, but in localized cases, mostly seen in cleft lip patients, the quest is for an ideal material and a proper technique that would be used to augment the receding area. Throughout a period of seven years, thirty-two patients with nose and midface retrusion were managed by a construct of rib cartilage grafts designed to compensate the deficiency at the maxillary, piriform, and premaxillary areas. Results were satisfactory for most patients in terms of improved fullness of malar area, improved nasal tip projection and rotation, and improvement of upper lip. The presented technique of rib cartilage grafting is a safe and effective method for nose and midface augmentation.

Background: The inferior pedicle wise pattern breast reduction is one of the most popular techniques used. However, a major criticism of inferior pedicle technique is bottoming out of the breast and lack of upper pole fullness. This is caused by gravitational pressure of the breast parenchyma/pedicle on the inferior pole with subsequent scaphoid appearance in the upper pole and lengthening of the vertical scar. In this study, a modification of the inferior pedicle technique will be done by creation of two lateral dermal flaps alongside with the inferior pedicle, and using these flaps to suspend the pedicle to the chest wall and prevent its descent to evaluate its effect on prevention of bottoming out of the breast. Patients and Methods: This is a prospective randomized study that included 20 healthy female patients suffering from breast hypertrophy and they are candidate for reduction mammoplasty by the proposed technique. Design of skin marking for inferior pedicle breast reduction technique was carried out with the standard wise pattern with the creation of two wings (medial and lateral) at the middle of the inferior pedicle; composed of de-epithelialized dermal flaps. Buttressing these two wings to the pectoral fascia at the suitable distances would create a sort of an internal bra effect; which supports the inferior pedicle. During the follow up, the length of the vertical scar (as an indicator of bottoming out) was measured immediately postoperative and every 3 months in the follow-up period. Results: This study includes 20 female patients of an age ranged between 22-51 years old and a breast size (suprasternal notch to nipple distance) ranging from 31 to 44cm. The followup for 1-year post-operative shows change in the areola to fold distance by a ratio <1.3 in 85% of patients with patient satisfaction reaching 60%. Conclusion: From this study we concluded that the inferior pedicle suspension to pectoral fascia improve the result shape of the breast and decrease the bottoming out of the breast.