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Fell M, Davies A, Davies A, Chummun S, Cobb ARM, Moar K, Wren Y. Current Surgical Practice for Children Born with a Cleft lip and/or Palate in the United Kingdom. Cleft Palate Craniofac J 2022; 60:679-688. [PMID: 35199604 DOI: 10.1177/10556656221078151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study describes primary surgical reconstructions performed for children born with a cleft lip and/or palate (CL ± P) in the United Kingdom (UK). DESIGN Data forms completed at the time of surgery included details on timing, technique, and adjuncts used during the operative period. Demographic data on participants were validated via parental questionnaires. SETTING Data were obtained from the Cleft Collective, a national longitudinal cohort study. PATIENTS Between 2015 and 2021, 1782 Cleft Collective surgical forms were included, relating to the primary reconstructions of 1514 individual children. RESULTS The median age at primary cheiloplasty was 4.3 months. Unilateral cleft lips (UCL) were reconstructed with an anatomical subunit approximation technique in 53%, whereas bilateral cleft lips (BCL) were reconstructed with a broader range of eponymous techniques. Clefts of the soft palate were reconstructed at a median age of 10.3 months with an intravelar veloplasty in 94% cases. Clefts of the hard palate were reconstructed with a vomer flap in 84% cases in a bimodal age distribution, relating to reconstruction carried out simultaneously with either lip or soft palate reconstruction. Antibiotics were used in 96% of cases, with an at-induction-only regimen used more commonly for cheiloplasties (P < .001) and a 5 to 7-day postoperative regime used more commonly for soft palatoplasties (P < .001). Perioperative steroids were used more commonly in palatoplasties than cheiloplasties (P < .001) but tranexamic acid use was equivalent (P = .73). CONCLUSIONS This study contributes to our understanding of current cleft surgical pathways in the UK and will provide a baseline for analysis of the effectiveness of utilized protocols.
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Affiliation(s)
- Matthew Fell
- The Cleft Collective, 156596University of Bristol, Bristol, UK
| | - Alex Davies
- South West Cleft Service, University Hospital Bristol and Weston, Bristol, UK
| | - Amy Davies
- The Cleft Collective, 156596University of Bristol, Bristol, UK
| | - Shaheel Chummun
- South West Cleft Service, University Hospital Bristol and Weston, Bristol, UK
| | - Alistair R M Cobb
- South West Cleft Service, University Hospital Bristol and Weston, Bristol, UK
| | - Kanwalraj Moar
- East of England Cleft Lip and Palate Service, 89744Addenbrookes Hospital, Cambridge, UK
| | - Yvonne Wren
- South West Cleft Service, University Hospital Bristol and Weston, Bristol, UK
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Fell M, Russell C, Medina J, Gillgrass T, Chummun S, Cobb ARM, Sandy J, Wren Y, Wills A, Lewis SJ. The impact of changing cigarette smoking habits and smoke-free legislation on orofacial cleft incidence in the United Kingdom: Evidence from two time-series studies. PLoS One 2021; 16:e0259820. [PMID: 34818369 PMCID: PMC8612573 DOI: 10.1371/journal.pone.0259820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Both active and passive cigarette smoking have previously been associated with orofacial cleft aetiology. We aimed to analyse the impact of declining active smoking prevalence and the implementation of smoke-free legislation on the incidence of children born with a cleft lip and/or palate within the United Kingdom. METHODS AND FINDINGS We conducted regression analysis using national administrative data in the United Kingdom between 2000-2018. The main outcome measure was orofacial cleft incidence, reported annually for England, Wales and Northern Ireland and separately for Scotland. First, we conducted an ecological study with longitudinal time-series analysis using smoking prevalence data for females over 16 years of age. Second, we used a natural experiment design with interrupted time-series analysis to assess the impact of smoke-free legislation. Over the study period, the annual incidence of orofacial cleft per 10,000 live births ranged from 14.2-16.2 in England, Wales and Northern Ireland and 13.4-18.8 in Scotland. The proportion of active smokers amongst females in the United Kingdom declined by 37% during the study period. Adjusted regression analysis did not show a correlation between the proportion of active smokers and orofacial cleft incidence in either dataset, although we were unable to exclude a modest effect of the magnitude seen in individual-level observational studies. The data in England, Wales and Northern Ireland suggested an 8% reduction in orofacial cleft incidence (RR 0.92, 95%CI 0.85 to 0.99; P = 0.024) following the implementation of smoke-free legislation. In Scotland, there was weak evidence for an increase in orofacial cleft incidence following smoke-free legislation (RR 1.16, 95%CI 0.94 to 1.44; P = 0.173). CONCLUSIONS These two ecological studies offer a novel insight into the influence of smoking in orofacial cleft aetiology, adding to the evidence base from individual-level studies. Our results suggest that smoke-free legislation may have reduced orofacial cleft incidence in England, Wales and Northern Ireland.
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Affiliation(s)
- Matthew Fell
- Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Craig Russell
- Scottish Cleft Service, Royal Hospital for Children, Glasgow, United Kingdom
| | - Jibby Medina
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Toby Gillgrass
- Scottish Cleft Service, Royal Hospital for Children, Glasgow, United Kingdom
| | - Shaheel Chummun
- South West Cleft Service, University Hospitals Bristol and Weston NHS Trust, Bristol, United Kingdom
| | - Alistair R. M. Cobb
- South West Cleft Service, University Hospitals Bristol and Weston NHS Trust, Bristol, United Kingdom
| | - Jonathan Sandy
- Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Yvonne Wren
- Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Andrew Wills
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Sarah J. Lewis
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
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Valk RVD, Magill S, Pellatt A, Ahmadi-Lari N, Hall SP, Cobb ARM, Walker TWM. Tessier 30 Facial Clefts-A Literature Review of 72 Cases (1996-2020), Suggested Treatment Protocol, Outcome Measures, Minimum Dataset for Future Case Reports, and Registries. Cleft Palate Craniofac J 2021; 59:644-651. [PMID: 34192974 DOI: 10.1177/10556656211019237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Tessier 30 facial cleft is a rare anomaly presenting in the soft and hard tissues over the central lower face. Owing to the rarity of cases and difficulty of treatment, there is no universally accepted surgical management strategy. The last comprehensive literature review of Tessier 30 clefts was in 1996. This report aims to update the literature to inform decision-making on treating Tessier 30 cases. METHODOLOGY A literature search was performed. PubMed, SCOPUS, and OVID databases were searched. A total of 72 cases in 51 articles were analyzed, looking at demographics, extent of cleft, parent health, family history, procedures, follow-up, existence of other anomalies, and stages of repair. RESULTS Surgeons are increasingly choosing to repair Tessier 30 defects in one rather than multiple stages. Of the 72 cases studied, only 31 had documented the completed repair of the cleft. All completed soft tissue only defects were repaired in 1 stage of repair (n = 11). Where both soft tissue and mandible was involved (n = 20), 55% (n = 11) had undergone 1-stage repair to address the Tessier 30 cleft. DISCUSSION We argue that a single-stage approach is preferable to multistage. Primary mucogingivoperiosteoplasty should be undertaken in children at the time of management of the soft tissue cleft. The timing of this procedure should be in the latter half of the first year of life, as this is when mandibular symphyseal fusion normally occurs. We have suggested a treatment protocol and we hope that future case reports use our minimum data set.
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Affiliation(s)
- Ruben van der Valk
- Department of Oral & Maxillofacial Surgery, King's College Hospital, London
| | - Stephen Magill
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - Annie Pellatt
- Department of Oral & Maxillofacial Surgery, Bristol Children's Hospital, Dental Hospital & Royal Infirmary, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Nazanin Ahmadi-Lari
- Department of Orthodontics Kingston Hospital NHS Foundation Trust & Guys & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon P Hall
- Academic Centre for Primary Care, University of Bristol, United Kingdom
| | - Alistair R M Cobb
- South West Cleft Service, Bristol Royal Infirmary, Dental Hospital & Children's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Tom W M Walker
- Bristol Royal Infirmary, Dental Hospital & Children's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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Davies A, Davies A, Wren Y, Deacon S, Cobb ARM, Chummun S. Exploring the Relationship Between Palatal Cleft Type and Width With the Use of Relieving Incisions in Primary Repair. Cleft Palate Craniofac J 2021; 59:659-668. [PMID: 34085562 DOI: 10.1177/10556656211019616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The mainstay of palatal repair in the United Kingdom is the intravelar veloplasty (IVVP). It is not always possible to align the oral mucosa in the midline to achieve tension-free repair. The addition of lateral relieving incisions may aid transposition of the oral mucosa to allow closure. The aim of this study was to explore cleft features that may predispose to a requirement for relieving incisions in order to allow palate closure. DESIGN We performed a national multiinstitutional retrospective study using data from the UK Cleft Collective cohort study. PATIENTS The study sample consisted of 474 patients who had undergone IVVP at the time of palatal closure across all 16 of the UK cleft units. RESULTS We found strong evidence for the requirement for relieving incisions in patients with an increased degree of clefting per the Veau classification (P < .001), increasing palatal soft-edge width (P < .001) and moderate evidence of an associated use in patients with Pierre Robin sequence (P = .015). Insufficient data were available to explore the relationship between intertuberosity distance and the presence of fistula formation with the use of relieving incisions. CONCLUSIONS The results of this study identify cleft features that increase the likelihood for requiring lateral relieving incisions to allow palatal closure. The degree to which the addition of relieving incisions to IVVP affects maxillary growth and speech outcomes is unknown. Further study is required to answer this important question.
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Affiliation(s)
- Alex Davies
- South West Cleft Service, 1980University of Bristol Dental Hospital, Bristol, United Kingdom
| | - Amy Davies
- The Cleft Collective, 1980University of Bristol, Bristol, United Kingdom
| | - Yvonne Wren
- The Cleft Collective, 1980University of Bristol, Bristol, United Kingdom
| | - Scott Deacon
- South West Cleft Service, 1980University of Bristol Dental Hospital, Bristol, United Kingdom
| | - Alistair R M Cobb
- South West Cleft Service, 1980University of Bristol Dental Hospital, Bristol, United Kingdom
| | - Shaheel Chummun
- South West Cleft Service, 1980University of Bristol Dental Hospital, Bristol, United Kingdom
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Adenwalla SF, Cobb ARM. Hirji S Adenwalla. Assoc Med J 2020. [DOI: 10.1136/bmj.m2592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kelly R, Cereceda-Monteoliva N, Frezzini C, Walker TWM, Cobb ARM, Ayliffe P. Rose-trellis periosteal release in oral mucosal advancement flaps in pigs. Br J Oral Maxillofac Surg 2020; 58:542-545. [PMID: 32245578 DOI: 10.1016/j.bjoms.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 02/10/2020] [Indexed: 11/16/2022]
Abstract
The aims of this study were to find out whether scoring in a rose-trellis pattern improved the stretch of mucoperiosteal flaps more than conventional scoring in the horizontal plane, and to consider its application in the closure of oroantral communications. Sixteen sections of cadaveric porcine buccal mucoperiosteum were removed from the molar region of the maxilla and mandible. A three-sided flap was raised in the subperiosteal plane, excised, and pinned to a cork board with the periosteal side facing upwards. Eight samples were scored in the horizontal plane (control) using lines perpendicular to the line of simulated advancement, and eight in a rose-trellis or criss-cross pattern. Scoring using a rose-trellis pattern yielded a mean increase in stretch of 24.3% (p=0.0003) when compared with the conventional method. Buccal advancement flaps are widely used to close oroantral communications, and scoring of the mucoperiosteum facilitates the stretching of the tissue over the defect. To be successful, defects should be fully closed to prevent contamination, and closure should be tension-free. In this study, scoring in a rose-trellis pattern increased the stretch of the tissue sample more than scoring in the horizontal plane. The rose-trellis technique therefore could aid the effective closure of oroantral communications.
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Affiliation(s)
- R Kelly
- Oral & Maxillofacial Surgery, Great Western Hospital, Swindon.
| | - N Cereceda-Monteoliva
- Oral & Maxillofacial Surgery, Bristol Royal Infirmary, University Hospitals Bristol, NHS Foundation Trust, Bristol
| | - C Frezzini
- Oral & Maxillofacial Surgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Glossop Road, Sheffield
| | - T W M Walker
- Oral & Maxillofacial Surgery, Department of Oral & Maxillofacial Surgery, Bristol Royal Infirmary, Dental Hospital & Children's Hospital, University Hospitals Bristol, NHS Foundation Trust, Bristol
| | - A R M Cobb
- South West Cleft Service, Bristol Dental Hospital, Bristol
| | - P Ayliffe
- King Edward VII Hospital, Beaumont Street, London
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Walker TWM, Ahmadi-Lari N, Pellatt A, Cobb ARM. Tessier 30 Median Mandibular Hard and Soft Tissue Cleft, One-Stage Reconstruction Using a Template-Guided Resorbable “U”-Shaped Plate. Cleft Palate Craniofac J 2019; 56:1249-1252. [PMID: 30971098 DOI: 10.1177/1055665619841149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Midline clefts of the lower lip, tongue, and mandible are a rare type of facial cleft classified as “Tessier 30.” We present the case of a female patient with an isolated Tessier 30 facial cleft affecting the tongue, lower lip, and mandibular symphysis with ankyloglossia. This was reconstructed with a template-guided resorbable “U”-shaped plate at 10 months of age. The procedure was carried out in one stage, which avoided the need for a repeat general anesthetic for the patient. We had a successful outcome with normal dental eruption and we believe such an approach could be considered as a relevant treatment modality for future cases.
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Affiliation(s)
- Tom W. M. Walker
- Oral & Maxillofacial Surgery, Bristol Dental Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin Street, Bristol, United Kingdom
| | - Nazanin Ahmadi-Lari
- Oral & Maxillofacial Surgery, Bristol Dental Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin Street, Bristol, United Kingdom
| | - Annie Pellatt
- Oral & Maxillofacial Surgery, Bristol Dental Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin Street, Bristol, United Kingdom
| | - Alistair R. M. Cobb
- South West UK Cleft Lip & Palate Service, Lower Maudlin Street, Bristol, United Kingdom
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8
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Al-Ghatam R, Jones TEM, Ireland AJ, Atack NE, Chawla O, Deacon S, Albery L, Cobb ARM, Cadogan J, Leary S, Waylen A, Wills AK, Richard B, Bella H, Ness AR, Sandy JR. Structural outcomes in the Cleft Care UK study. Part 2: dento-facial outcomes. Orthod Craniofac Res 2018; 18 Suppl 2:14-24. [PMID: 26567852 PMCID: PMC4670707 DOI: 10.1111/ocr.12109] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare facial appearance and dento-alveolar relationship outcomes from the CSAG (1998) and CCUK (2013) studies. SETTING AND SAMPLE POPULATION Five-year-olds born with non-syndromic unilateral cleft lip and palate. Those in the original CSAG were treated in a dispersed model of care with low-volume operators. Those in CCUK were treated in a more centralized, high-volume operator model. MATERIALS AND METHODS We compared facial appearance using frontal view photographs (252 CCUK, 239 CSAG) and dental relationships using study models (198 CCUK, 223 CSAG). Facial appearance was scored by a panel of six assessors using a standardized and validated outcome tool. Dento-alveolar relationships were scored by two assessors using the 5-Year-Olds' Index. Ordinal regression was used to compare results between surveys. RESULTS Excellent or good facial appearance was seen in 36.2% of CCUK compared with 31.9% in CSAG. In CCUK, 21.6% were rated as having poor or very poor facial appearance compared with 27.6% in CSAG. The percentage rated as having excellent or good dento-alveolar relationships was 53.0% in CCUK compared with 29.6% in CSAG. In CCUK, 19.2% were rated as having poor or very poor dento-alveolar relationships compared to 36.3% in CSAG. The odds ratios for improved outcome in CCUK compared to CSAG were 1.43 (95% CI 1.03, 1.97) for facial appearance and 2.29 (95% CI 1.47, 3.55) for dento-alveolar relationships. CONCLUSIONS Facial and dento-alveolar outcomes were better in CCUK children compared to those in CSAG.
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Affiliation(s)
- R Al-Ghatam
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - T E M Jones
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A J Ireland
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - N E Atack
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - O Chawla
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - S Deacon
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK.,South West Cleft Team, University Hospitals Bristol NHS Trust, Cleft Lip and Palate Team, Bristol, UK
| | - L Albery
- South West Cleft Team, University Hospitals Bristol NHS Trust, Cleft Lip and Palate Team, Bristol, UK
| | - A R M Cobb
- South West Cleft Team, University Hospitals Bristol NHS Trust, Cleft Lip and Palate Team, Bristol, UK
| | - J Cadogan
- South West Cleft Team, University Hospitals Bristol NHS Trust, Cleft Lip and Palate Team, Bristol, UK
| | - S Leary
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A Waylen
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A K Wills
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - B Richard
- Birmingham Children's Hospital NHS Trust, Birmingham, UK
| | - H Bella
- Birmingham Children's Hospital NHS Trust, Birmingham, UK
| | - A R Ness
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - J R Sandy
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
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Cobb ARM, Vourvachis M, Ahmed J, Wyatt M, Dunaway D, Hayward R. Aberrant facial flushing following monobloc fronto-facial distraction. J Craniomaxillofac Surg 2015; 43:1511-5. [PMID: 26293186 DOI: 10.1016/j.jcms.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with syndromic forms of craniosynostosis may experience functional problems such as raised intracranial pressure, proptosis, obstructive sleep apnoea and failure to thrive. The monobloc fronto-facial advancement with osteogenic distraction is increasingly used to correct these functional problems in one procedure as well as improve appearance. The authors report the phenomenon of post operative aberrant facial flushing - an unusual and previously unreported complication of the procedure. METHODS The case notes of 80 consecutive patients undergoing fronto-facial advancement by distraction using the rigid external distraction device (RED) were reviewed for features of aberrant facial flushing. RESULTS Four out of eighty individuals developed facial flushing after monobloc fronto-facial distraction using the rigid external distractor (RED) frame. All were female with Crouzon or Pfeiffer syndromes causing the severe functional problems for which they underwent the surgery. They were aged 6-8 years. Following removal of the frame, they developed intermittent but severe facial flushing. The flushing spontaneously settled in three patients after up to four years but persists in the other child seven years after her surgery. CONCLUSION Aberrant facial flushing is a rare but significant complication of monobloc fronto-facial surgery. It occurred in 4 of our 80 (5%) patients. The skull base osteotomies essential for the procedure are made anterior to the pterygopalatine ganglion and it is our contention that damage from these was responsible for a neuropraxia of its efferent nerve branches. A review of the autonomic control of the facial vascular system suggests that the phenomenon is due to an unequal process of recovery that leaves the cutaneous vasodilating parasympathetic or beta-adrenergic innervation relatively unopposed - a situation that persists until with time a normal balance of autonomic input is achieved.
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Affiliation(s)
- Alistair R M Cobb
- Department of Oral & Maxillofacial Surgery, United Hospitals Bristol NHS Trust, Bristol, UK.
| | - Michael Vourvachis
- Craniofacial Service, Great Ormond Street Hospital for Children, London, UK
| | - Jahangir Ahmed
- Department of Otolaryngology, Royal London Hospital, London, UK
| | - Michelle Wyatt
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London, UK
| | - David Dunaway
- Craniofacial Service, Great Ormond Street Hospital for Children, London, UK
| | - Richard Hayward
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, UK
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Green B, Nikkhah D, Cobb ARM, Dunaway DJ. Craniofacial disorders that have phenotypic overlap with Treacher Collins syndrome. J Plast Reconstr Aesthet Surg 2013; 66:e234-5. [PMID: 23664577 DOI: 10.1016/j.bjps.2013.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 04/06/2013] [Indexed: 11/16/2022]
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Green B, Cobb ARM. Re: Learning anatomy--a pain in the neck? Br J Oral Maxillofac Surg 2013; 51:463. [PMID: 23601835 DOI: 10.1016/j.bjoms.2013.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/19/2013] [Indexed: 11/26/2022]
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Abstract
A case is presented of a 14-year-old female undergoing orthodontic fixed appliance treatment who presented with right facial swelling in the parotid region. An initial diagnosis of acute infective parotitis was made by her primary care clinician. However, after clinical examination and ultrasonographic imaging, a diagnosis of salivary stasis secondary to inflammatory occlusion of Stensen's ductal orifice was made. The ductal orifice had been traumatized by the adjacent orthodontic appliance. This has not been described before in the literature. The differential diagnosis of parotid enlargement in children is discussed.
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Green B, Cobb ARM, Hopper C. Photodynamic therapy in the management of lesions of the head and neck. Br J Oral Maxillofac Surg 2012; 51:283-7. [PMID: 23245464 DOI: 10.1016/j.bjoms.2012.11.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
Abstract
Photodynamic therapy (PDT) is a promising and effective treatment for lesions of the head and neck. It uses illumination with light of a specific wavelength, which activates a photosensitising drug in the presence of oxygen. It can be used in combination with other treatments or on its own, and results in the cellular destruction of the lesion through a free-radical process. Photosensitisers can be applied topically or given systemically depending on the lesion being treated. Results indicate that PDT is an effective adjunct to standard conventional treatments. We review its use.
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Affiliation(s)
- Ben Green
- King's College London School of Medicine, Guy's Campus, London Bridge, London, UK.
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Cobb ARM, Lloyd TE, Dunaway DJ. Bone sutures--prevention of vertical height gain in midface distraction during callus formation. Br J Oral Maxillofac Surg 2012; 50:682. [PMID: 22818044 DOI: 10.1016/j.bjoms.2012.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 06/29/2012] [Indexed: 10/28/2022]
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Cobb ARM, Moore M. Split plate technique in the fixation of remodelled cranial bones in infants. Br J Oral Maxillofac Surg 2012; 51:271-2. [PMID: 22766269 DOI: 10.1016/j.bjoms.2012.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 06/06/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Alistair R M Cobb
- South Thames Cleft Service, Guys and St Thomas's Hospitals NHS Trust, London, United Kingdom.
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Cobb ARM, Kowalski C, Lloyd TW. Pneumocephalus--late cause of neurological deterioration after craniomaxillofacial trauma. Br J Oral Maxillofac Surg 2012; 51:e188-9. [PMID: 22739206 DOI: 10.1016/j.bjoms.2012.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/25/2012] [Indexed: 11/19/2022]
Abstract
We report a case of pneumocephalus, which is an unusual cause of late deterioration of the level of consciousness after craniomaxillofacial trauma.
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Affiliation(s)
- Alistair R M Cobb
- South Thames Cleft Service, Guys and St Thomas' Hospitals NHS Trust, London, UK.
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Joshi R, Cobb ARM, Wilson P, Bailey BMW. Lingual cyst lined by respiratory and gastric epithelium in a neonate. Br J Oral Maxillofac Surg 2012; 51:173-5. [PMID: 22554694 DOI: 10.1016/j.bjoms.2012.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
Abstract
Congenital oral cysts of foregut origin include bronchogenic, enteric, and oesophageal cysts, and they are much rarer than the well described dermoid, epidermoid, and thyroglossal cysts. The exact aetiology is poorly understood, but they are thought to arise from misplaced embryonic rests of the primitive foregut. The presentation of cysts lined by respiratory or gastrointestinal epithelium in the oral cavity is unusual. There have been previous reports of bronchogenic or gastrointestinal epithelium-lined lingual cysts, but few report both features occurring within the same cyst. In view of the scarcity of such reports, we present the case of a lesion on the ventral surface of the tongue of a newborn boy. On removal it was found to be a cyst lined by immature squamous, respiratory, and gastric body epithelium.
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Affiliation(s)
- Rajnish Joshi
- Maxillofacial Unit, St Georges Hospital NHS Trust, London, United Kingdom
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Abstract
In children, differences in the properties and proportions of bone in the craniofacial skeleton and the lack of development of the paranasal sinuses result in orbital fractures that present differently from those in adults. Facial growth may be disturbed by such injuries and also by surgical intervention, which should therefore be as conservative as possible. However, urgent operation is needed to prevent irreversible changes when fractures of the orbital floor involve entrapped muscle. We present an approach to such injuries.
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Affiliation(s)
- Alistair R M Cobb
- Craniofacial Centre, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
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Cobb ARM, Ghali S, Dunaway DJ. Butterfly reconstruction of the anterior scalp hairline using bilaterally apposing STA island flaps. J Plast Reconstr Aesthet Surg 2012; 65:e213-6. [PMID: 22465596 DOI: 10.1016/j.bjps.2012.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 03/05/2012] [Indexed: 11/26/2022]
Abstract
Traditional methods of reconstruction of the hair-bearing scalp can provide incorrect directional hair growth and may require secondary procedures to complete. We present a case of reconstruction of the anterior hairline after tumour resection in an infant. Lessons learned from the case have led to a novel method for a single stage reconstruction of the anterior hairline using pedicled superficial artery flaps.
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Affiliation(s)
- Alistair R M Cobb
- Craniofacial Centre, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.
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Ahmad F, Cobb ARM, Mills C, Jones BM, Hayward RD, Dunaway DJ. Frontofacial Monobloc Distraction in the Very Young. Plast Reconstr Surg 2012; 129:488e-497e. [DOI: 10.1097/prs.0b013e3182412820] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Cobb ARM, Sebire NJ, Anderson J, Dunaway D. Congenital malignant rhabdoid tumor of the scalp. J Craniomaxillofac Surg 2011; 40:e258-60. [PMID: 22079123 DOI: 10.1016/j.jcms.2011.10.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 10/05/2011] [Accepted: 10/07/2011] [Indexed: 10/15/2022] Open
Abstract
BACKGROUND Malignant rhabdoid tumors (MRT) are rare but aggressive tumors presenting in the pediatric population. First thought a variant of Wilms' tumor in the kidney, it is recognized as presenting at renal, central nervous system and other extra-renal primary sites. It is uniformly of very poor prognosis, however. CASE REPORT AND DISCUSSION We present a case of congenital MRT of the scalp, which we believe to be the first described at this site. The clinical and histopathological features of the tumor are discussed in light of the current literature on MRT at other sites. The bleak prognosis at this site appears to be no different from others - the child succumbed at 10 months old despite surgical resection and initial excellent response to chemotherapy. CONCLUSION Malignant rhabdoid tumor has a very poor prognosis and needs to be considered in the differential diagnosis of similar lesions by clinicians involved in pediatric head and neck care.
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Affiliation(s)
- Alistair R M Cobb
- Craniofacial Centre, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.
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Cobb ARM, Murthy R, Cousin GCS, El-Rasheed A, Toma A, Uddin J, Manisali M. Silent sinus syndrome. Br J Oral Maxillofac Surg 2011; 50:e81-5. [PMID: 22051178 DOI: 10.1016/j.bjoms.2011.10.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 10/05/2011] [Indexed: 11/16/2022]
Abstract
Silent sinus syndrome is defined as a spontaneous and progressive enophthalmos and hypoglobus with hypoplasia of the maxillary sinus and resorption of the orbital floor. It is caused by atelectasis of the maxillary sinus in the presence of ipsilateral chronic hypoventilation of the sinus. The problem may be idiopathic, but the term is now also used to describe cases that follow operation or trauma. We describe three cases, each with a different aetiology, and discuss the clinical and radiographic evaluation of the condition, theories regarding its pathophysiology, and surgical correction.
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Affiliation(s)
- Alistair R M Cobb
- Craniofacial Centre, Great Ormond Street Hospital for Children, London, UK.
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Cobb ARM, Walsh S, Lee NJ, Kumar M, Bailey BMW. The addition of a locking plate to a modified transbuccal retractor confers increased stability and easier soft tissue control in the application of miniplates in the management of mandibular angle fractures. Br J Oral Maxillofac Surg 2007; 46:247-248. [PMID: 17905490 DOI: 10.1016/j.bjoms.2007.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2007] [Indexed: 10/22/2022]
Affiliation(s)
- A R M Cobb
- Department of Oral and Maxillofacial Surgery, Maxillofacial Unit, St. Georges Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK.
| | - S Walsh
- Department of Oral and Maxillofacial Surgery, Maxillofacial Unit, St. Georges Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - N J Lee
- Department of Oral and Maxillofacial Surgery, Maxillofacial Unit, St. Georges Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - M Kumar
- Department of Oral and Maxillofacial Surgery, Maxillofacial Unit, St. Georges Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - B M W Bailey
- Department of Oral and Maxillofacial Surgery, Maxillofacial Unit, St. Georges Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
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Liyanage SH, Gupte CM, Cobb ARM. Skeletal tuberculosis. J R Soc Med 2003. [PMID: 12949215 PMCID: PMC539619 DOI: 10.1258/jrsm.96.9.474-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Chinmay M Gupte
- Department of Orthopaedics, Ealing Hospital, Southall, UB1 3HW, UK
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Liyanage SH, Gupte CM, Cobb ARM. Skeletal Tuberculosis. Med Chir Trans 2003; 96:474. [PMID: 12949215 PMCID: PMC539619 DOI: 10.1177/014107680309600927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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