Traumatic cyclodialysis cleft

We describe three cases of vasa previa and review the English-language literature for all cases reported since 1980. Antenatal diagnosis was significantly associated with decreased fetal mortality (p = 0.033). A low-lying placenta is a risk factor for vasa previa, as it occurred in 81% of patients.     

Rathke's cleft cyst

Two cases of Rathke's cleft cyst which produced symptoms of compression of the optic chiasm are described. The first case has been followed for five years since the operation. No evidence of recurrence has been noticed. The prognosis after a partial removal of the cyst wall seems to be good with this lesion. In the second case, there was clinical and laboratory evidence of hypopituitarism and the CT scan revealed suggestive findings to differentiate the cyst from a pituitary adenoma.     

Midline cervical cleft

The effect of m-chlorophenylbiguanide, a selective 5-HT3 receptor agonist, on gastric antral motility was investigated in conscious dogs with a force transducer implanted chronically. m-Chlorophenylbiguanide (0.1-1 mg/kg i.v.) dose dependently enhanced antral motility in the fasted state, and the amplitude of m-chlorophenylbiguanide (1 mg/kg i.v.)-induced antral contractions reached the level of natural phase III contractions. In contrast, m-chlorophenylbiguanide reduced the amplitude of antral contractions in the fed state. A selective 5-HT3 receptor antagonist, ramosetron (0.0003-0.03 mg/kg i.v.), inhibited both effects of m-chlorophenylbiguanide. m-Chlorophenylbiguanide (1 mg/kg i.v.)-induced contractions were inhibited by atropine (0.03 or 0.1 mg/kg i.v.). These results indicate that pharmacological activation of 5-HT3 receptors has opposite effects on canine gastric antral motility in the fasted and in the fed state, being stimulatory and inhibitory, respectively. The stimulatory effect seems to be mediated mainly via the release of acetylcholine.     

Review: the Michigan cleft twin study

The combined effects of clefting of the lip and/or palate and of their surgical repair have been examined for a cross-sectional sample of 20 MZ and 25 DZ like-sexed twins discordant for clefting, in the age range of 4 to 17 years. The findings of four studies published since 1975 on that sample are explored for the primary, contiguous and pleiotropic effects of clefting. The primary effects on facial structures of repaired cleft lip appear to be minimal. However, for twins with repaired cleft of the palate (with or without cleft of the lip), the maxilla was both deficient antero-posteriorly and was positioned more posteriorly than in their non-cleft co-twins. The maxillary first molars were usually slightly less erupted in the cleft twins than in the non-cleft twins. The cleft palate only twins had larger cranial base angles than their non-cleft co-twins. A contiguous effect of the posteriorly positioned maxilla was a mandibular rotation downward and backward in the cleft palate and bilateral cleft lip and palate groups but not in the unilateral cleft lip and palate group. The slightly larger cranial base angles found for cleft palate only, although contiguous in location, are more likely pleiotropic effect. The pleiotropic effects include a deficit in height and weight for cleft subjects which appears only after puberty. Although the teeth of the cleft twins tended to be smaller than those of the non-cleft twins, the amount was not clinically significant.     

Giant Rathke cleft cyst

The preoperative diagnosis for an unusual skull base lesion was chordoma. The combination of imaging, pathologic, and surgical findings suggests the diagnosis of Rathke cyst.     

Pathology of the palatal aponeurosis in cleft palate

OBJECTIVE: The palatal aponeurosis is a controversial structure, both in terms of its anatomy and its function. This article points out a pathologic finding in the cleft palate condition that has not been previously described. DESIGN AND METHOD: By means of surgical dissections, this study demonstrates in detail that the palatal aponeurosis exists even in cleft palates, but it is disrupted, malpositioned, and folded in two layers. PATIENTS: This dissection method has been performed on more than 150 patients with cleft of the hard and soft palate, with or without cleft of the lip and alveolus. At the time of operation, the children were between 6 and 8 months of age. RESULTS: It is possible to dissect the two layers of the palatal aponeurosis, to unfold the aponeurosis, and to form a tough tendinous plane. CONCLUSION: For a functional physiologic reconstruction of the cleft palate, it is necessary not only to reconstruct the levator veli palatini and palatopharyngeus muscle slings, but also to approximate and suture the fibers of the palatal aponeurosis to the corresponding fibers of the opposite side after unfolding them in a medio-dorso-cranial direction. In this manner, a continuous palatal aponeurosis can be created, which subsequently can serve as a transmitter of the muscle forces.     

A model for the cleft lip nasal deformity

The underlying pathology of the cleft lip nasal deformity has yet to be fully realized, and cleft lip rhinoplasty continues to challenge the reconstructive surgeon. A new model is proposed, which is composed of elements that represent known anatomical structures of the nose. These structures are considered elemental to the mechanism of the primary cleft lip nasal deformity. The lobule is reduced to four arches. Five points on the skull provide foundations for these arches, which react interdependently to extrinsic forces and positional change. When certain changes are imposed on the model, predictable alterations in the configuration of the model imitate the observed deformities in the spectrum of the cleft lip nasal deformity, unilateral and bilateral, mild through severe. The model is described with illustrations, anatomic dissection, physical models, and selected clinical cases. A better understanding of the mechanisms of the cleft nasal deformities can be obtained through analysis of the model.     

Sternal cleft. Surgical treatment in the newborn

The lack of total sternal fusion without other anomalies of the chest wall is extremely rare. We present the case of one 24 h. old female, clinically asymptomatic with complete sternal cleft without other symptoms. She was operated on within the first week of life, a sternal primary suture with costal condrotomy and alternate costal suture were performed. Good thoracic stability was obtained. We agree with other authors about the need for surgical correction during the neonatal period.     

Principles of cleft nose correction

Primary synovial chondromatosis is a relatively uncommon condition. Synovial chondrosarcoma is considered to be very rare and it is not always clear whether the sarcoma develops by malignant transformation of synovial chondromatosis or whether it arises de novo. Differentiation of the two conditions on clinical and radiographic features is not possible and on histological criteria can be difficult. We report the case of a 59-year-old man who, 4 years after a synovectomy for synovial chondromatosis, developed a synovial chondrosarcoma of the hip. The literature is reviewed.     

Synaptic laminin prevents glial entry into the synaptic cleft

Presynaptic and postsynaptic membranes directly oppose each other at chemical synapses, minimizing the delay in transmitting information across the synaptic cleft. Extrasynaptic neuronal surfaces, in contrast, are almost entirely covered by processes from glial cells. The exclusion of glial cells from the synaptic cleft, and the long-term stability of synapses, presumably result in large part from the tight adhesion between presynaptic and postsynaptic elements. Here we show that there is another requirement for synaptic maintenance: glial cells of the skeletal neuromuscular synapse, Schwann cells, are actively inhibited from entering the synaptic cleft between the motor nerve terminal and the muscle fibre. One inhibitory component is laminin 11, a heterotrimeric glycoprotein that is concentrated in the synaptic cleft. Regulation of an inhibitory interaction between glial cells and synaptic cleft components may contribute to synaptic rearrangements, and loss of this inhibition may underlie the loss of synapses that results from injury to the postsynaptic cell.     

Ototoxicity of ethanol in the tympanic cleft in animals

This work was undertaken to study the ototoxicity of topically applied ethanol in quantitative terms. Using guinea pigs, ethanol was administered (1) on the round window for 10 min, (2) instilled in the middle ear cavity for 24 hours, and (3) perfused into the cochlear canal (into the scala tympani) at the rat of 10 microliter/min for 10 min. Cochlear microphonics from the electrode on the round window were recorded. The critical concentration (the maximum dilution ratio) of the ethanol that appears to be ototoxic in the experimental condition mentioned above was determined to be (1) 50%, (2) 10%, (3) 0.1% respectively. Using chinchillas, the effect of ethanol with round window application on the Endocochlear Potential (EP) was studied. Simultaneous recording of EP from the 1st and 3rd turn of the cochlea showed a more marked decline in EP in the 1st turn. 70% ethanol caused an irreversible, plateauing decline in EPO, while 35% ethanol caused a reversible decline in EP.     

Association between non-right-handedness and cleft lip with or without cleft palate in a Chinese population

The ori region of an Erwinia stewartii plasmid, pSW1200 (106 kb), has been cloned and sequenced. This region consists of a gene encoding a protein which has 91% similarity and 73% identity with the RepA protein of bacteriophage P1. The ori region also consists of eight copies of 19-bp iterons which are highly homologous to the iterons of P1. Similar to plasmid P1, pSW1200 replicon has a copy number of approximately 1. On the other hand, the copy number increases about ninefold if three of the iterons located downstream from repA gene are deleted. We also demonstrate that pGEM-5Z consisting of a copy of P1 iteron is incompatible with a pSW1200 derivative, pSW1201, suggesting that pSW1200 and P1 DNA are incompatible and both belong to the IncY group.     

Surgical treatment of unilateral alveolar cleft

In this study, 16 cases of unilateral alveolar cleft with cleft lip and palate were repaired with autografts of cancellous bone (13 cases) or hydroxyapatite (3 cases). The grafts were covered by reflected mucoperiosteal flaps and a mucosal flap from the upper lip. Twelve of the thirteen cases were followed up for 1-5 years. Nine of whom using cancellous bone had bony continuity of the maxilla and 7 cases erupted permanent maxillary canines within the area of autografts. None of the 3 cases using hydroxyapatite erupted a canine tooth. The results showed that autograft was better than hydroxyapatite in terms of maxillary canine eruption.     

Diclofenac analgesia following cleft palate surgery

OBJECTIVE: This prospective study looked at the postoperative hemorrhage risk associated with the use of diclofenac following cleft palate repair. PATIENTS: Twenty consecutive children (6 months to 9 years of age) requiring repair of the hard or soft palate were included. DESIGN AND METHODS: Single per rectum doses of diclofenac were given at 1 mg/kg following cleft palate repair, with additional doses every 12 hours. RESULTS AND CONCLUSIONS: The use of the nonsteroidal anti-inflammatory drug, diclofenac, for postoperative analgesia is well established for many types of surgery. The authors find that twice daily diclofenac rectal suppositories provide very good analgesia postcleft palate repair. This, combined with supplemental oral paracetamol, obviates the need for opiates, resulting in alert infants who feed well and are suitable for early discharge.