Due to issues of limited substances and expensive cost of wound treatment, topical insulin and simvastatin are being developed due to benefits including easy to find and applicable in every health center. Topical insulin can be used in treating diabetic patient’s wound. Simvastatin contributed in wound healing process by increasing angiogenesis and lymphangiogenesis. This experimental study is using randomized post test only control design in male Wistar mice, divided in 5 treatment groups with 9 mice each : carboxymethylcellulose sodium gel, short acting insulin topical gel, long acting insulin topical gel, simvastatin topical 2% gel, and simvastatin 3% topical gel. A full thickness wound was made randomly and observed in 5 days, followed with wound biopsy and analyzing using histopathological specimen measuring the epithelial thickness, fibroblast proliferation and collagen density from each group. Long acting insulin topical gel has the highest average rate of epithelial proliferation and fibroblast proliferation. In simvastatin 3% topical gel has the highest level of collagen density level among other groups. This study showed long acting insulin topical gel significantly has better outcome than other groups.
Background: When indicated, velopharyngeal insufficiency (VPI) is treated with pharyngoplasty with consideration of patient’s age. Several studies have evaluated the relationship between age at surgery and speech outcome. The best results regarding reduction of open nasality were obtained when surgeries were performed around age of 5 to 6 years and operative complications were also less frequent in the younger age group than in older patients. Pre-operative assessment such as nasopharyngoscopy and/or videofluoroscopy gives surgeons a chance to estimate flap dimension to correct the defect causing the VPI. Moreover, velopharyngoplasty proceeded with speech therapy yields better recovery.Case History : A seriously neglected case of cleft lip and palate was reported. A 24 years old female underwent two palatorrhaphy at age 13 and 14 years old, which were far beyond the recommended age of 10 – 12 months. The resulting hypernasality was further worsened by absence of speech therapy which should have been followed from age 1 – 4 years old. On presentation, this patient requested to have immediate orthognatic surgery to repair his severe type 3 facial profile and malocclusion, a procedure which he underwent worsening the VPI. We decided to surgically correct the VPI. Nasoendoscopic assessment revealed he had an antero-posterior velopharyngeal closure problem which indicated a pharyngoplasty using a superiorlybased pharyngeal flap. Three months post-operatively his speech was re-evaluated by a speech therapist and nasoendoscopically. Despite imperfectness, significant improvement was achieved.Conclusion : Pharyngoplasty could still be reliable to a certain extent as a correction treatment of VPI in a seriously neglected case. A posterior pharyngeal flap helped this patient to recover significant speech capacity.
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