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MANAGEMENT In considering the management of this vast range of heteroge neous congenital abnormalities it is very di ffi cult to generalise about management protocols. The vast majority of manage ment is delivered by multidisciplinary teams (MDTs) within spec...

Management in early childhood (1–12 years) In early childhood management should be aimed at dealing with functional problems – airway obstruction, speech and feeding issues – but there is an increasing imperative for surgery to address the appearance of the c...

Management in infancy (0–12 months) At this age treatment falls into two categories: that directed at - major functional issues as for neonatal care and that directed at skull surgery in cases of craniosynostosis. same; however, there is the possibility of s...

Neonatal management In the neonatal period management is aimed at addressing the urgent issues relating to the airway , breathing, eye protection and establishing feeding. In many of the craniofacial conditions the airway can be a ff ected and may be fully or ...

Orthodontic treatment Children with cleft lip and alveolar involvement will often benefit from orthodontic treatment. Orthodontic treatment is commonly carried out in two phases: 1 Mixed dentition (8–10 years): to prepare the alveolar cleft for ABG (see Alveola...

Orthognathic surgery Impaired growth of the midface (maxilla) is a consequence of a number of factors, which are poorly understood. Genetic factors as well as local factors following primary surgery may be involved. Elective maxillary advancement or bimaxill...

PRINCIPLES OF CLEFT SURGERY The ultimate aim in cleft lip and palate management is to facilitate normal development and well-being. In seeking this, surgical repair is aimed at producing normal anatomy in the lip, nose and palate. Essentially , oral and dental...

SECONDARY/REVISION SURGERY These procedures are undertaken to improve aesthetics and/ or function. They may be considered as procedures that were unplanned at the time of primary surgery . Specific examples are as follows.

SUMMARY Cleft care has been the subject of significant reorganisation in recent years. Coordinated care is provided in most countries by MDTs. Specific training pathways exist in many countries for cleft surgery . Better collection and collation of outcome dat...

Surgical techniques Much debate and variation exist across the world in the timing and techniques employed in cleft repair. All have the common aims stated above. Restoration of form and function can be achieved using many of these protocols, but the followi...

The cleft multidisciplinary team and primary management The cleft team Modern cleft services rely on well-coordinated patient path - ways. The pathways and protocols may vary from country to country but the aims of treatment are consistent. Care is with cleft...

maturity Airway and other functional issues are usually stabilised by - this time and interventions are aimed at optimising the overall appearance. The transition from primary school to secondary school is often a period of distress for patients with visible ...

Acute otitis media Acute otitis media (AOM) is one of the most common child - hood illnesses with a peak incidence between 6 and 18 months of age. It has occurred in 70% of children by the age of 2 and in 90% by the age of 6. It is characterised by purulen...

Acute rhinosinusitis ARS is thought to result from bacterial superinfection of virally damaged mucosa. The commonest bacteria involved are S. /uni00A0 pneumoniae , H. influenzae and Moraxella catarrhalis . Upper dental sepsis may also predispose to acute maxill...

Balance disorders V ertigo is the hallucination of movement. Benign paroxysmal positional vertigo Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. It is caused by otoliths (calcium carbonate crystals) most commonly within the p...

Benign tumours Simple papillomas or viral warts can grow inside the nasal vestibule. They can be confused with carcinomas and are best excised for histological diagnosis. Osteomas of the nasal skeleton are not uncommon and are often detected on radiology as ...

CONDITIONS OF THE EXTERNAL EAR Congenital anomalies The external and middle ear originate from the first and second branchial arches, but the cochlea is neuroectodermal in origin. An individual can have a congenital abnormality of the pinna and middle ear with ...

CONDITIONS OF THE EXTERNAL EAR Congenital anomalies The external and middle ear originate from the first and second branchial arches, but the cochlea is neuroectodermal in origin. An individual can have a congenital abnormality of the pinna and middle ear with ...