Background: The most incident and the most persistent complication following cleft palate repair is oronasal fi stula. Fistulas involving the soft palate may be corrected via excision and primary closure; however fi stulas of the hard palate constitue a majör challange. Aims: In this study, in order to reduce the rate of oronasal fi stula following cleft palate surgery, we present postoperative use of palatal gauze dressing. Patients and Methods: The patients were enrolled randomly into two groups as Group one and two. For group two patients, at the end of operation, an antibiotic pomade absorbed sterile gauze was fi xed at the palate with 2/0 silk sutures, under moderate pressure in order not to interfere with fl ap circulation. Results: Of the 7 fi stulas in group one, 5 were located on the hard palate and 2 on the soft palate, whereas in, 2 were located on the hard and two on the soft palate. No other complications were encountered. Conclusion: The use of an antibiotic pomade-absorbed palatal gauze, tight adherence of palatal fl aps to the underlying bone is achieved. Besides, serving as a barrier, the gauze prevents infection with food remnants and irritation with foreign bodies.
Fractures of the frontal sinus are frequently encountered injuries of maxillofacial fractures. The most common causes are traffic accidents, followed by sports-related injuries. There is still no consensus regarding the optimal management of frontal sinus fractures. The authors report a patient with depressed anterior wall fracture of the frontal sinus and superior orbital rim fracture. Reduction was performed by traction from 2 screws applied percutaneously to the depressed fragments and external fixation with an aluminum nasal splint. This technique is both minimally invasive and permits easy fixation in suitable patients.
A 35-year-old, white, 6-months pregnant woman presented to our department for hypertension. She had hypertension since 17 years. She had leg pain on excursion since 5 years. She had given birth 4 times without complications and had 2 miscarriages. Her physical examination revealed weak femoral pulses and a brachiofemoral delay. Blood pressures of right and left arm and leg were 190/110 mmHg, 140/ 90 mmHg, and 80/50 mmHg, respectively. A grade 3/6 systolic murmur was heard over the precordial and interscapular areas. The electrocardiogram was normal. Standard and Doppler echocardiographic findings revealed a coarctation of descending aorta with a maximum 84 mmHg gradient across the coarctation, which was distal to the left subclavian artery [Table/ Fig-1].MRI angiography was planned, but as the patient was pregnant and did not have serious complications nor heart failure symptoms, it was postponed to after her delivery. The patient had an uneventful pregnancy and she gave birth successfully by caesarean section without any haemodynamic complications, and the newborn was healthy. After baby's birth, the patient's blood pressure remained high. MRI angiography which was performed after birth; showed a strict coarctation of aorta (CoA) in the proximal part of the descending aorta [Table/ Fig-2]. The length of the coarctation of aorta was 14 mm, isthmus was 19 mm, smallest diameter of aortic coarctation was 6 mm, and post-coarctation aortic diameter was 28 mm.Cardiac catheterization was performed under local anaesthesia and left femoral artery and vein were cannulated. The coarctation segment could not be crossed with a 0.035 diagnostic guide wire. Therefore, a 0.014 hydrophilic guide wire was used for crossing the coarctation segment. Diagnostic multiple pores and a pigtail catheter were passed across the coarctation, over the hydrophilic guide wire. Measurements of aorta and coarctation segment were similar, as seen on MRI angiography. The maximal gradient across the coarctation was 64 mmHg. Distal part of the coarctation was minimally dilated (28 mm) [Table/ Fig-3]. Pigtail catheter was changed to a 14F, 85 cm long Mullins sheath over the 0.035 exchange guide wire. A custom made, eight-zig, 4.5 mm long CP covered stent (NuMed, Hopkinton, NY) which was loaded on a balloon in balloon (BIB) (inner balloon 12 mm × 4,5 cm, outer balloon 24 mm × 5.5 cm) was used. After attachment, the excess covering material was folded around the stent. The graft stent and balloon assembly was passed through the sheath, after checking for correct positioning. Firstly, the inner balloon was inflated and its position was rechecked by angiography and then the outer balloon was fully inflated [Table / Fig-4].Both balloons were then deflated, with the inner one being deflated first before being withdrawn through the sheath. Control aortography revealed a stent-graft in position, which covered the coarcted segment. Maximum gradient across the coarctation was 11 mmHg. The coarcted segment's diameter was increased from 6 mm to 17 mm. The proce...
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