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Background: Fistulas following cleft palate repair impair speech, health, and hygiene and occur in up to 35 percent of cases. The authors detail the evolution of a surgical approach to palatoplasty; assess the rates, causes, and predictive factors of fistulas; and examine the temporal association of modifications to fistula rates., Methods: Consecutive patients (n = 146) undergoing palatoplasty during the first 6 years of practice were included. The technique of repair was based on cleft type, and a common surgical approach was used for all repairs., Results: The fistula rate was 2.4 percent (n = 125) after primary repair and 0 percent (n = 21) after secondary repair. All complications occurred in patients with type III or IV clefts. Cleft width and cleft-to-total palatal width ratio were associated with fistulas, whereas syndromes, age, and adoption were not. Most complications could also be attributed to technical factors. During the first 2 years, modifications were made around specific anatomical features, including periarticular bony hillocks, maxillopalatine suture, velopalatine pits, and tensor insertion. The fistula rate declined by one-half in subsequent years., Conclusions: The authors describe a surgical approach to cleft palate repair, its evolution, and surgically relevant anatomy. Fistulas were associated with increasing cleft severity but could also be attributed to technical factors. A reduction in frequency and severity of fistulas was consistent with a learning curve and may in part be associated with modifications to the surgical approach., Clinical Question/level of Evidence: Therapeutic, IV.

Objective: This study compares speech and surgical outcomes in internationally adopted and nonadopted patients undergoing cleft palate repair, and examines the influence of age at initial palatoplasty., Design: Retrospective cohort study setting: Tertiary Care Children's Hospital., Patients: 70 international adoptees and 211 nonadoptees with Veau type III and IV clefts (without associated syndrome) repaired at our institution., Outcome Measures: Outcomes included VPI, compensatory misarticulations, intelligibility, nasal air emission, oronasal fistula, and secondary speech surgery. Speech evaluations completed near 5 years of age were gathered from a prospectively collected database., Results: Adoptees underwent palatoplasty 5.2 months after arrival, a mean of 10.4 months later than nonadoptees. Adoptees were significantly more likely to develop moderate/severe VPI and trended toward more frequent need for secondary speech surgery. Oronasal fistula occurred at similar rates. Increased age at initial palatoplasty was a significant predictor of moderate to severe VPI, and need for secondary speech surgery., Conclusions: International adoptees undergo palatoplasty 10.4 months later than nonadoptees and are significantly more likely to develop moderate/severe VPI, with a trend toward increased secondary speech surgery. An association between treatment delay and moderate/severe VPI and secondary speech surgery has been demonstrated. While a causal relationship between delayed repair and inferior outcomes in international adoptees has not been proven, this data suggests that surgical intervention upon unrepaired cleft palates soon after adoption may be beneficial. The opportunity for a change in practice exists, as half of the 10.4-month relative delay in palate repair occurs postadoption.

Backgrounds: The success rate of the surgical repair of palatal fistula after palatoplasty is often unsatisfactory. This study is a review of 15 years of single surgeon's experience with the evolution of a reliable surgical technique with high success rate., Methods: This is a retrospective chart review of consecutive cleft cases undergoing repair of palatal fistula from 2000 to 2015. The study included 37 consecutive fistula repair cases with wide elevation and mobilization of the palatal tissues and nasal and oral layer repair. Group 1 (n = 20) were treated earlier in the study using either midline, von Langenbeck, or 2-flap palatoplasty with 3-layer suturing. Group 2 (n = 17) were treated through a Dorrance-type incision and additional repair of the oral periosteum for a total of 4-layer suturing., Results: The overall fistula closure rate was 94.6% (90% in group 1 and 100% in group 2). The difference in outcome between the 2 groups was statistically insignificant (P > 0.05). Most patients (83.8%) had concomitant velar muscle retropositioning for treatment of velopharyngeal incompetence., Conclusions: Fistula repair using wide mobilization of the entire palate through previous repair incisions and multilamellar suturing technique has a very low fistula recurrence rate. Addition of the fourth layer of suturing and the use of a Dorrance-type incision further improves the outcome. This approach provides wide tissue release and access to tissue layers for better repair and tension-free closure. Combining intravelar veloplasty with fistula repair is safe and allows management of the fistula and its possible consequences on palatal function in a single procedure.

Nasal septal surgery is one of the most common otolaryngology procedures performed, with rare occurrences of major postoperative complications. Oronasal fistula is a rare complication of septal surgery, with only few cases being reported in the literature. It is commonly caused by a congenital cleft palate, cleft palate surgery, traumatic injuries, infections, or neoplasms; however, it does not usually occur post-septal surgery. Here, we report the case of a 55-year-old male who presented with a symptomatic oronasal fistula post-septoplasty. Unlike other reported cases, there were no features of underlying palatal pathologies, and no previous history of other nasal or oral procedures. We described a multilayer surgical closure technique that was utilized in this case, with no recurrence seen during a 6-month follow-up period. Additionally, we reviewed the other 3 reported cases of this complication, and discussed the possible etiology in this case.

Introduction: Fistula formation following closure of palatal clefts remains a difficult clinical complication. A significant recurrence rate has also been reported following attempted closure. We present our results of fistula closure augmented with Bio-Gide(®), a purified porcine collagen membrane designed to promote guided tissue regeneration., Methods: We reviewed the records of 263 patients operated between 1993 and 2011 for closure of palatal fistula. The patients selected comprised 61 who underwent fistula closure augmented with Bio-Gide and 202 with other techniques in the absence of Bio-Gide. We reviewed the age at surgery, sex, location of fistula, cleft type and outcome. Operation success was defined as an asymptomatic patient along with visible confirmation of closure of the fistula., Results: The overall fistula closure rate was 75% in the Bio-Gide group and 63% in the non-Bio-Gide group (p = 0.070) and 86% versus 61% in the unilateral cleft palate patients (p = 0.027)., Discussion: Bio-Gide has improved the success rate in fistula closure in this study. Using this technique, fistula closure can be performed as a day case procedure and does not need to transgress any original suture lines; an additional advantage is that this procedure does not require harvesting of any autologous tissue to augment the repair., (Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Intranasal foreign bodies arising from dental clinical practice, especially in patients with cleft lip and palate (CLP) occur rarely and are very scarce in the literature. This article reports an unusual case of a dental impression material presenting as a foreign body in the nasal cavity of an adult with repaired CLP who presented for dental prosthetic rehabilitation. To our knowledge, this is only the second report presenting nasal foreign body in a cleft patient arising due to a dental impression procedure.

A 31-year-old woman presented with a large oro-nasal communication (ONC), loss of vomer and significant nasal cartilage and nose deformity. Physical examination of the patient revealed a typical midline destructive lesion (MDL) with nasal septum and hard/soft palate perforation with a friable granular surface and a large amount of necrotic tissues. Medical history was unremarkable and the patient denied previous local trauma, including surgical procedures or drug assumption. Pathological examination revealed the presence of necrosis and chronic inflammation. MDLs have numerous etiologies. Signs and symptoms of MDLs can be similar and an accurate diagnosis may be elusive. We hereby present detailed clinicopathological findings., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: Oral cutaneous sinus tracts (OCSTs) of dental origin are often initially misdiagnosed and inappropriately treated. Accurate diagnosis is especially important in cases of bisphosphonate (BP) therapy because extraction may lead to a risk of osteonecrosis. A case report of misdiagnosis related to a tooth with a vertical root fracture in an oncologic patient treated with BPs is reported here., Methods: In 2011, a 75-year-old woman was examined at the oral medicine clinic because of pain and swelling of the left submandibular area. The patient's medical history included oral and intravenous BP therapy because she was diagnosed with metastatic breast cancer and left maxillary stage 1 antiresorptive agent-induced osteonecrosis of the jaw. The lower left odontogenic region showed no signs or symptoms, and no apical pathosis was observed on imaging. Although antibiotics were applied, clinical symptoms worsened and an OCST appeared. Intravenous antibiotic treatment was pursued. Biopsy and direct smear from fistula were not conclusive. A diagnosis of a nonexposed variant of stage 3 antiresorptive agent-induced osteonecrosis of the jaw was established., Results: Symptoms resolved after 2 weeks of antibiotic treatment and reappeared a month later. Endodontic examination revealed that the origin of the OCST was tooth no. 18 caused by a vertical root fracture, and the tooth was extracted. The patient was scheduled for routine checkups because of the fact that osteonecrosis may occur in intravenous BP-treated patients., Conclusions: Early correct diagnosis can prevent unnecessary and ineffective antibiotic therapy and surgical intervention, which is not recommended in intravenous BP cases., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: A tooth is said to be ectopic if it is malpositioned either due to congenital factors or displaced due to pathological lesions. The incidence of osteomyelitis of condyle has a rare occurrence, very few cases have been reported, either their etiology is unknown or is due to hematogenous spread or a tuberculous focus. This particular case may be a rare of its kind, as recent literature did not reveal any case where an ectopic mandibular third molar led to osteomyelitis of the condyle., Case Report: This report presents a unique case where an ectopically placed mandibular third molar led to extraoral sinus and scar formation below the ear lobule with osteomyelitis of the mandibular condyle and proposes various indications for its removal along with literature review., Discussion: Ectopic eruption of a tooth into the dental environment is common, whereas ectopic eruption of tooth in other sites is rare. The exact etiology of ectopic eruption of mandibular third molar in condyle is a rare occurrence and to the best of our knowledge, only 14 cases have been reported in the literature. Management of such cases should be meticulously planned after ruling out various local as well as systemic factors as an underlying cause for osteomyelitis and on the basis of the position and type of ectopic tooth and related potential trauma which could be caused by surgical intervention with less morbidity., Conclusion: This particular case may be the unique of its kind, as recent literature did not reveal any case where an ectopic mandibular third molar led to osteomyelitis of the condyle. Diagnosis and management in such cases deserve very special attention to rule out various local and systemic causes which can cause osteomyelitis to affect very unusual site like mandibular condyle. The aim of surgical intervention should be to cause minimum morbidity without affecting the functional efficiency of the mandibular condyle. In this report, we also have proposed the indications for surgical intervention to remove ectopically erupted teeth.

Unlabelled: An infected cyst, associated with a supernumerary fourth molar in the ascending ramus of the mandible, presented with parotid swelling, trismus and pain. It was managed as a parotid infection but recurred and a draining pre-auricular sinus developed, which was thought to be a parotid fistula. This was managed by cautery, followed by excision of the fistula, both of which were unsuccessful. Following this, further investigations revealed that the cause of the facial sinus was in fact a cyst associated with a mandibular fourth molar in the posterior ascending ramus. The tooth was extracted, via a pre-auricular extra-oral approach, under general anaesthetic., Clinical Relevance: This case shows how a dental panoramic radiograph can be extremely helpful at ruling out certain pathology. It also demonstrates how the symptoms of an infection arising from a tooth in the ramus may be misdiagnosed as salivary gland pathology.

Background: Cocaine snorting may cause significant local ischemic necrosis and the destruction of nasal and midfacial bones and soft tissues, leading to the development of a syndrome called cocaine-induced midline destructive lesion. A review of the English-language literature reveals only a few articles describing the treatment of hard and/or soft palatal perforation related to cocaine inhalation. Described here are 4 patients with a history of cocaine abuse showing palatal lesions., Materials and Methods: From 2010 to 2013, a total of 4 patients affected by cocaine-related midline destructive lesions were referred to our department. They all presented signs of a cocaine-induced midline destructive lesion. They showed wide midfacial destruction involving the nasal septum as well as the hard and soft palates causing an ample oronasal communication., Results: In 3 patients, oronasal communication has been treated successfully using a personal technique based on a partially de-epithelialized forearm free flap. The fourth patient had been treated only with local debridement because, when she came to our attention, her abusive habits were still unsolved., Discussion: Different surgical options have been reported such as local, regional, and free flaps for hard and soft palate reconstruction. However, because of an unpredictable vascularization of the palatal tissues and owing to the scarceness of the local soft tissues, local flaps are at high risk for partial and complete failure. The transfer of free vascularized tissue, however, seems to be the most reliable and logical solution for medium- to large-sized fistulas. Among the various free flaps, we choose the radial forearm type because of the pedicle length and the flap thickness.

Unlabelled: Hydatid cysts of the head and neck are rare, even in regions where echinococcal infestation is endemic. Although complications, like cyst rupture and infection, may occur, an external fistula is extremely rare. This study examined a case of hydatid cyst that had fistulized in the right submandibular region of the oral cavity, which eroded the mandible., Case Report: A 45 year-old female patient visited our clinic with complaints of a discharge that left a bad taste in her mouth that persisted for 1 month and a painless swelling in the right submandibular region that had slowly expanded over the past 5 months. A physical examination revealed a cystic mass located in the right submandibular region that had fistulized in the oral cavity. The results were consistent with a hydatid cyst. We performed submandibular gland exeresis and a marginal mandibulectomy to excise the hydatid cyst together with the fistulous tract.

This article describes the clinical case of a patient, a 13-year-old boy, in whom the appearance of patent nasopalatine ducts was noted after having a rapid maxillary expansion performed. To confirm this finding, inspection and radiographic examination were performed in which gutta-percha cones were used as contrast. The patient related no symptoms or discomfort due to the ducts. The patient was followed up for a period of 6 months, during which he was instructed as regards correct cleaning to prevent the accumulation of food and infection.

Introduction: Florid cemento-osseous dysplasia is a benign and rare tumor of the jaws. It is more commonly seen in middle-aged black women. Most cases are asymptomatic and are found during routine radiographic examination., Observations: We report two complicated cases of florid cemento-osseous dysplasia, one with facial deformity and the other with chronic osteitis., Discussion: The diagnosis of florid cemento-osseous dysplasia is based on clinical and radiological features. The lesions are commonly bilateral and symmetrical., (Copyright © 2011. Published by Elsevier Masson SAS.)

Introduction: Maxillary sinus osteomas are rare benign tumours with a poorly documented clinical evolution. Their craniofacial localization may be part of a syndrome. We report a case of maxillary sinus osteoma associated to a mucocele and a cyst probably of dental origin, with no sign of associated Gardner syndrome., Case Report: A 52-year-old woman consulted for chronic maxillary sinusitis and an oral vestibular fistula. The CT-scan suggested a mucocele with reactive bone formation. Macroscopically, a pediculated bone tumour was found next to a mucocele, and to a cyst probably of dental origin. The anatomopathological examination led to a diagnosis of cancellous osteoma., Discussion: Several hypotheses have been made on the etiology of sinus osteomas. When identified, screening for Gardner's syndrome should be implemented because of the associated risk for colic malignancy., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Nasal septoplasty is a common and low-risk procedure performed very frequently in plastic surgery as well as in otorhinolaryngology. The development of a palatal perforation following a nasal septoplasty procedure is a very rare event with only a few cases reported in the literature. A patient with palatal fistula formation after septoplasty procedure is presented here, who was later on diagnosed with submucous cleft palate during the repair of the palatal fistula., (Copyright 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Rhabdomyosarcoma is a rare soft tissue tumor that was found incidentally in a repaired cleft palate oronasal fistula of a 3-year-old boy. This situation has yet to be reported in the literature. During this fistula repair, a small piece of tissue was sent for routine pathology, which showed embryonal rhabdomyosarcoma. A literature review as well as diagnostic and treatment algorithms are discussed concerning management of this rare malignancy. Also, routine pathology should be reviewed carefully because unsuspected tissues may have pathologic findings that dramatically affect patient diagnosis and management.

We report the case of a 25-year-old man with defects in the nasal septum and maxillopalatine bone and an oronasal fistula., (2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

A 15-year-old white female sought our institution complaining of a chirping noise during speech and swallowing. The noise was spontaneous, perceptible, and enhanced when hard suction on the anterior palate was performed. The patient reported no trauma, infection, or other clinical feature related to the noise. Clinical examination showed 2 small grooves on both sides of the midline, lateral to the incisive papilla. The left groove was visually deeper. Careful probing with a gutta-percha cone revealed the existence of a communication on this side extending from the mouth to the nasal cavity, which was confirmed clinically and radiographically. Probing was not possible on the right side. The diagnosis was unilateral patent nasopalatine duct, which was surgically treated. We report here a new case of patent nasopalatine duct and also present a review of the pertinent literature.

Background: Foreign body removal in children is very common in the daily routine of an otolaryngologist but reports of oronasal foreign bodies and their management are rare., Method: The case note of a 5-year-old female child presenting with an oronasal foreign body following a domestic accident was retrieved and studied and followed up., Result: a 5-year-old female child with an oronasal foreign body which created an oronasal fistula that was closed with local palatal mucoperiosteal-lined flaps. The patient defaulted following treatment, a common practice by patients in our society., Conclusion: This report highlights the occurrence of this rare condition, its management and the need to put measures in place to prevent domestic accidents especially for those most at risk.

Parotid gland tuberculosis is rare and may present in different clinical forms. We present three cases of tuberculosis of the parotid gland that presented to us with different clinico-pathological appearances. The cases were diagnosed on the basis of histopathological evaluation and fine needle aspiration cytology. All the patients responded to four-drug antitubercular chemotherapy.

Unlabelled: Dentistry has recently recognized the practicality and benefits of treating damaged and diseased oral tissues under high magnification levels. Initially, enhanced vision was more-or-less restricted to the use of prescription bifocals, awkward magnifying loops, and heavy cumbersome telephoto glasses; the microscope drew little interest and was quickly viewed as another useless and expensive dental gadget. However, owing to the very nature and demands of the therapy, endodontists were quick to accept and adopt this technology, and the manufacturers were quick to adapt and market their surgical microscopes to the endodontic office. Since acceptance leads to progression, we are currently witnessing manufacturers adapting the microscopic and other magnifying lenses to other areas of dentistry. However, choosing and purchasing a microscope involves a great number of issues, including the adequacy of one's present vision, the type of practice conducted, the demands one places on the quality of his or her dentistry, and the amount of time and expense one wishes to devote to becoming competent in using magnification. In addition, one must become familiar with what the different levels of magnification offer, what different depths and widths of field meet their normal practice needs, the amount of space required for the equipment, and whether the investment is cost effective. This article details all of the benefits as well as the difficulties encountered when embarking on a magnification journey., Clinical Significance: The art of dentistry is based on precision. The human naked eye is capable of distinguishing fine detail, but it is no match for what can be accomplished when an image is sharpened and enlarged. The microscope and other forms of magnification fill that need, especially for accomplishing endodontic procedures.

Eight families with the combination of cleft lip and/or cleft palate plus lower lip pits including their microforms were examined with the aim of characterization of microsymptoms. Hypodontia as a further symptom was also taken into consideration. Each of the symptoms was also noted separately in relatives of the patients and are to be considered as a genetic equivalent of the complete form of the autosomal-dominant inherited Van der Woude's syndrome. Knowledge of the variable expression of the basic gene is crucial for risk assessment in family counselling and also for distinguishing from clefts of other genesis with lower recurrence risk.

Oroantral and oronasal fistulas present with a broad range of causation, size, duration, and extent of infection involving the nose and paranasal sinuses. Accurate diagnosis of the extent of the disease with appropriate radiographic evaluation will guide the surgeon to select an approach that addresses all of the infected sites. When significant sinus disease is found, an endoscopic approach to restoring drainage in all of the involved sinuses can promote predictably successful closure of oroantral and oronasal fistulas. The multispecialty team approach to this disease, with the concomitant management of the sinusitis and fistula closure, is a significant advance in the successful management of this chronic condition.

Background: Congenital lip fistulas are very rare and may occur alone or in combination with oral clefts and other dysontogenetic malformations. The etiology of congenital lip fistulas is not yet known., Patient and Method: We present a 7-year-old boy with recurrent infections of bilateral congenital fistulas of the lower lip. There were no associated congenital anomalies and a negative family history. An elliptical excision of the fistulas under microscopic control gave satisfactory functional and esthetic results. There was no recurrence two years after surgery., Conclusion: Since the possibility of additional severe malformations exists for the patient and the patient's children patients should undergo careful ENT and pediatric assessment, and genetic counselling should be considered. In order to achieve good functional and esthetic results, the corrective operation must be planned carefully taking into consideration important surgical principles.

This paper presented a conservative technique for biopsy of periapical lesions. The case report demonstrated the insertion of a flexible microsurgical biopsy forceps through a labial sinus tract into a lesion for removal of specimens for histopathological evaluation. This limited tissue removal seemed to induce a change from a cyst to a granuloma, as well as stimulate a degree of repair.

We considered these cases of odontogenic cysts of the maxillary sinus. One of them complicated with an oroantral fistula. The aim of our paper is to consider the origine, the radiology and the surgery of those items.