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Speech disorders related to cleft lip and palate exhibit different degrees of involvement and can occur even after primary palate repair. Hypernasality can be present as a result of velopharyngeal insufficiency, as well as nasal emission, weak pressure, articulatory errors and facial grimace, affecting speech intelligibility. Palatoplasty outcomes can be variable, and among the influencing factors are the surgical technique, the surgeon's experience, the postoperative care, and the patient/cleft characteristics. The aim of this study was to correlate speech results after primary palate repair with surgical technique and cleft characteristics, using anthropometric measurements and speech assessment in patients diagnosed with cleft lip and palate. A longitudinal, retrospective study with patients who underwent primary palatoplasty between 2015 and 2019 and still attend Craniomaxillofacial Surgery Outpatient Clinic was conducted. Patients were operated on by a single surgeon using the intravelar technique veloplasty with maximal retropositioning of the soft palate elevator muscle. Patients who underwent primary palatoplasty after 2018 had the measurements before and immediately after palatoplasty recorded: length of palate, and the distances from cleft and uvula to posterior pharyngeal wall, and uvula to adenoid. Considering the total of 39 patients, 30 (76.9%) were male, with a mean age of 20.9 months (9-53 mo). All patients had their speech recorded between ages of 60 and 120 months. Speech samples were assessed by 3 different speech pathologists experienced in cleft speech, with an intrarater and inter-rater reliability >80%. The most frequent cleft type was unilateral complete cleft lip and palate (59%). One patient had mild hyponasality, 1 isolated obligatory disorder (nasal turbulence), and 3 patients presented compensatory articulation (2 isolated and 1 also presented obligatory disorder). Only 1 patient had marginal velopharyngeal insufficiency. Postoperatively, there was a mean increase in palate length from 5.4 to 5.6 cm, and a statistically significant decrease in the distance from the uvula to the pharynx wall, with a mean of 1.7 to 1.1 cm (P<0.001). In general, patients analyzed did not have significant alterations in speech assessment, which did not allow further comparisons and correlation. Therefore, regardless of the anatomic characteristics of the palate, it is possible to achieve good results depending on the handling experience and the technique used., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Orbital fractures are high prevalent and result in several complications such as diplopia, muscular entrapment, visual impairment, and enophthalmos. The goal of orbital reconstruction is to restore orbital anatomy, volume, and globe symmetry. This case report aims to describe the use of transantral endoscopy and 3D printed model for treatment of an orbital floor fracture. A 54-year-old woman presented orbital floor fracture with diplopia and extraocular muscle entrapment. The surgical treatment was performed using a standard titanium mesh bended over 3D printed model, and transantral endoscopy to verify fracture extension and implant adaptation. The postoperative evaluation demonstrates correction of diplopia and ocular motility restriction. Computed tomography scan showed reestablishment of the orbital anatomy. The association of transantral endoscopy and 3D printed models is a feasible technique to improve orbital reconstruction.

Porous polyethylene implants have been used as an alternative in the treatment of patients with zygomatic and paranasal projections deficiency. These implants promote a facial rejuvenating effect due to the attenuation of the nasal and chin prominences. The advantages of porous polyethylene include biocompatibility, dimensional stability, easy adaptation and fixation, low complication rate, and its availability in different sizes and shapes. A 27-year-old woman presenting vertical deficiency associated with midface hypoplasia was treated with orthognathic surgery. Clockwise rotation and genioplasty were performed. In order to improve facial aesthetics, porous polyethylene implants were placed in the paranasal area, optimizing the facial contour with the correction of the midface projection.

Midface fractures usually affect the orbital cavity. This trauma may result in severe and rare consequences such as retrobulbar hemorrhage. This condition requires immediate diagnosis and early intervention to avoid blindness. The treatment usually requires evaluation of an oral and maxillofacial surgeon. This patient report aims to describe a facial trauma resulting in blindness after 4 days. An 83-year-old woman fell and hit her face on the floor. The initial evaluation only found a contusion on her left orbit, and an ophthalmologic examination was not made. After 72 hours, the patient searched for the oral and maxillofacial surgeon, showing blindness of her left eye. Despite the treatment, the vision was not recovered. Blindness can become irreversible 90 minutes after trauma, and this condition must be treated as an emergency.

Multiple myeloma (MM) is a neoplasia characterized by the proliferation of plasmacytoid cells, which produce abnormal immunoglobulins. It frequently creates local and systemic complications such as pathologic fractures and renal disease. This article reports the case of a 70-year-old man presenting a pathologic fracture of the right mandibular angle secondary to a plasmocytoma. He had a history of a previous pathologic fracture of the left mandibular angle 13 years before that was treated elsewhere, but no documentation was available. Investigation revealed the disease to be a MM and evolution led to renal failure and death. Differential diagnosis is necessary for this kind of pathologic presentation because MM presents a survival rate of 5.7% in 5 years and mandibular involvement happens in the advanced stage of the disease.