Facial clefting is one of the most common birth defects and having a child born with this defect can be a devastating experience for parents and family members. Until recently, repair of cleft lip and palate deformities was deferred until the infant had reached 10 weeks of age, 10 pounds in weight, and a hemoglobin level of 10 gm per 100 mL. This criteria eliminated neonates 28 days of age or younger from the possibility of early repair. Waiting until these criteria were achieved often caused problems with parent-infant bonding and infant growth and development. Advances in neonatology and pediatric anesthesia now have made it possible to perform cleft surgery during the neonatal period. This article discusses the anatomy and embryology of cleft deformities and how cleft repair surgery now can be performed on the neonate.
The treatment of nasal hemangiomas continues to be controversial. The authors' experience with early surgical treatment of nasal hemangiomas is presented. This retrospective study includes 11 patients. Surgical intervention consisted of excision of the nasal hemangioma and reconstruction by local tissue transfer or rearrangement. Age at surgery ranged from 10 months to 6.5 years (mean age, 2.2 years). All patients have acceptable nasal contour and have demonstrated excellent nasal growth. The authors' experience demonstrates that early surgical intervention is an acceptable alternative for the management of nasal hemangiomas.
Our recent experience with cleft palate closure in the neonatal period (within 28 days of birth) is reviewed in this study. The research involved a series of 21 neonates who presented with untreated cleft palates and underwent a modified Veau-Wardill-Kilner palate closure by a single surgeon between 1991 and 1994. The postoperative clinical follow-up ranged from 8 to 37 months (mean 18 months). All complications discussed do not seem to occur more frequently when surgery is done at this age than at an older age. Our findings demonstrate that cleft palate closure can be safely performed in the neonatal period; we do not, however, recommend that the standard approach should be changed based on this preliminary report.
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