Rozštěpy rtu a patra patří mezi nejčastější vrozené vady obličeje. Léčba rozštěpů je centralizovaná, multioborová a podílí se na ní plastický chirurg, ortodontista, anesteziolog, klinický logoped a další profese. Incidence rozštěpů rtu a patra zůstává stále přibližně stejná, mění se však přístup k jejich léčbě. Mezi moderní postupy léčby se stále více přidává 3D tisk a léčebné a výukové možnosti s ním spojené.
Cleft lip and cleft palate are among the most common congenital defects of the head. The treatment of clefts is centralized, multidisciplinary, and involves a plastic surgeon, orthodontist, anesthesiologist, clinical speech therapist, and other specialists. While the incidence of cleft lip and cleft palate remains approximately unchanged, the approach to their treatment is evolving. Modern treatment methods increasingly include 3D printing and the associated therapeutic and educational possibilities.
- MeSH
- 3D tisk MeSH
- lidé MeSH
- obturátory patra MeSH
- rozštěp patra * chirurgie diagnostické zobrazování MeSH
- rozštěp rtu * chirurgie diagnostické zobrazování MeSH
- zákroky plastické chirurgie MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND: Ring 18 chromosome is a rare chromosomal aberration associated with a wide range of symptoms affecting all organ systems. One possible symptom associated with this condition is an orofacial cleft. However, to date, there are very few reported cases where the cleft has been surgically treated. CASE DESCRIPTION: In our case study, we present a female patient with Ring 18 chromosome who underwent cleft palate surgery at 14 months of age. Subsequently, a reoperation of the palate was necessary due to wound dehiscence. For the secondary reconstruction of the palate, the acellular dermal matrix (ADM) MatriDerm® was used to improve healing. The cleft palate surgery progressively improved her ability to take in food, allowing a transition from nasogastric tube feeding to oral intake. RESULTS: This is only the fourth reported case of a child with Ring 18 chromosome undergoing surgical correction of an orofacial cleft. Additionally, it is one of the first cases where an ADM MatriDerm® was used in the surgical correction of a cleft palate. In this study, we also present a comprehensive literature review, providing an overview of the various symptoms associated with this syndrome. CONCLUSION: Cleft palate surgery had a very positive effect on improving food intake in the patient with Ring 18 chromosome. The use of an acellular dermal matrix during the secondary cleft palate surgery led to improved healing and a good outcome.
- MeSH
- kojenec MeSH
- kruhové chromozomy * MeSH
- lidé MeSH
- lidské chromozomy, pár 18 genetika MeSH
- rozštěp patra * genetika chirurgie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
OBJECTIVES: This study evaluated maxillary growth and dental arch relationships at 5 and 10 years of age in patients with unilateral cleft lip and palate (UCLP) who underwent early cleft lip and palate surgery. METHODS: 28 patients with UCLP who underwent cleft lip surgery in neonatal age and cleft palate surgery at average age of 7 months without orthodontic treatment (intervention group) were measured for intercanine and intermolar distances and for dental arch length. These measurements were compared with those of 30 healthy participants in a control group. Dental arch relationships in the intervention group were evaluated by 5-YO index at 5 years and the GOSLON Yardstick score at 10 years of patients' age. RESULTS: Patients in the intervention group had significantly shorter mean intercanine distance and arch length than control patients at both 5 and 10 years of age (p<.001 for all). There were no significant differences in intermolar distance at both 5 (p = .945) and 10 years (p = .105) of patients' age. The average 5YO index increased from 2.46 to an average GOSLON 10-year score of 2.89 in intervention group. CONCLUSION: Intercanine distance and dental arch length of patients with UCLP are significantly reduced at 5 and 10 years after early cleft lip and palate surgeries compared to the healthy population. Dental arch relationships at 5 and 10 years of patients with UCLP show comparable outcomes to those reported by other cleft centers. CLINICAL SIGNIFICANCE: This study evaluates maxillary growth in UCLP patients 5 and 10 years of age who underwent early primary lip and palate surgery.
- MeSH
- dítě MeSH
- lidé MeSH
- maxila * chirurgie růst a vývoj MeSH
- maxilofaciální vývoj MeSH
- předškolní dítě MeSH
- průřezové studie MeSH
- rozštěp patra * chirurgie MeSH
- rozštěp rtu * chirurgie MeSH
- studie případů a kontrol MeSH
- zubní oblouk * růst a vývoj patologie chirurgie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- dítě MeSH
- lidé MeSH
- rizikové faktory MeSH
- rozštěp patra * chirurgie komplikace MeSH
- rozštěp rtu * chirurgie komplikace MeSH
- stupeň závažnosti nemoci * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Orofacial clefts are the most common congenital abnormalities. Cleft lip reconstruction is performed mostly in 3 months of life including the neonatal period. The consumption of opioids during anesthesia is one of the monitored parameters of anesthesia safety. We investigated the effect of using an infraorbital nerve block for reducing opioid consumption during cleft lip surgery in neonates. PATIENTS/METHODS: Overall, 100 patients who underwent primary cleft lip surgery in neonatal age between 2018 and 2021 were included in the study. The primary outcome was to compare opioid requirements during cleft lip surgery with and without using regional anesthesia. Secondary outcomes included a first oral intake from surgery between neonates with and without regional anesthesia and complications rate of infraorbital nerve block. RESULTS: Data from 100 patients (46 patients with and 64 without regional anesthesia) were retrospectively analyzed and classified into two groups according to whether regional anesthesia during neonatal cleft lip surgery had been performed or not. The use of infraorbital block was found to be positively correlated with lower doses of opioids used during the general anesthesia for the surgery (mean 0.48 μg/kg vs 0.29 μg/kg, p < 0.05). The postoperative course was evaluated based on the interval from surgery to first oral intake which was statistically insignificant shorter (p = 0.16) in the group of patients using regional anesthesia. No complications were recorded in the group of patients with regional anesthesia. CONCLUSIONS: Regional anesthesia is associated with reduced opioid consumption during anesthesia thereby increasing the safety of anesthesia in neonates. GOV IDENTIFIER: NCT06067854https://clinicaltrials.gov/study/NCT06067854?cond=NCT06067854&rank=1.
- MeSH
- lidé MeSH
- nervová blokáda * metody MeSH
- novorozenec MeSH
- opioidní analgetika * terapeutické užití MeSH
- pooperační bolest farmakoterapie prevence a kontrola MeSH
- retrospektivní studie MeSH
- rozštěp patra * chirurgie MeSH
- rozštěp rtu * chirurgie MeSH
- svodná anestezie * metody MeSH
- zákroky plastické chirurgie metody škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
This was a prospective cohort study of eighteen patients with large and debilitating vascular malformations with one or more major systemic complications. In all patients, we discovered activating alterations in either TEK or PIK3CA. Based on these findings, targeted treatment using the PI3K inhibitor alpelisib was started with regular check-ups, therapy duration varied from 6 to 31 months. In all patients, marked improvement in quality of life was observed. We observed radiological improvement in fourteen patients (two of them being on combination with either propranolol or sirolimus), stable disease in 2 patients. For 2 patients, an MRI scan was not available as they were shortly on treatment, however, a clinically visible response in size reduction or structure regression, together with pain relief was observed. In patients with elevated D-dimer levels before alpelisib administration, a major improvement was noted, suggesting its biomarker role. We observed overall very good tolerance of the treatment, documenting a single patient with grade 3 hyperglycemia. Patients with size reduction were offered local therapies wherever possible. Our report presents a promising approach for the treatment of VMs harboring different targetable TEK and PIK3CA gene mutations with a low toxicity profile and high efficacy.
- MeSH
- 3D tisk MeSH
- design s pomocí počítače MeSH
- dítě MeSH
- lidé MeSH
- pilotní projekty MeSH
- rozštěp patra * MeSH
- rozštěp rtu * MeSH
- zajištění dýchacích cest MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- dopisy MeSH
- Publikační typ
- abstrakt z konference MeSH
Úvod: Traumatická ztráta palce ruky je vážné zranění ovlivňující schopnost pacienta pracovat a účastnit se každodenních činností. Hlavním cílem plastického chirurga je obnovit úchop ruky, často mikrochirurgickými metodami. Pacienti by však měli být informováni o všech následcích odběru tkáně. Cílem studie bylo posoudit dopad na došlap donorské nohy a na chůzi u pacientů, kteří podstoupili rekonstrukci palce ruky technikou twisted-toe modifikovanou Kempným. Materiál a metody: Studie se zúčastnilo 12 pacientů: všichni utrpěli ztrátu palce ruky mezi lety 2003 a 2011 a pro rekonstrukci byla použita technika twisted-toe. Byly hodnoceny změny v rozložení tlaku na chodidla a zatížení kloubů dolních končetin. Výsledky: Rozdíly mezi celkovým maximálním plantárním tlakem, integrálem tlakového času, kontaktní plochou a maximální silou mezi postiženou a nepostiženou končetinou; byly však zjištěny statisticky významné rozdíly v kinetických parametrech a momenteh předního kotníků a kolene. Závěr: Funkčnost donorské končetiny a anatomické postižení byly hodnoceny pomocí pedobarografických systémů a 3D analýzy chůze. Nejvýznamnější nálezy byly zaznamenány v rozdílné distribuci plantárního tlaku (zvýšený tlak v I., IV. a V. metatarzální oblasti) a přetížení mediálního kompartmentu kolenního kloubu. Proto by pro pacienty po rekonstrukci palce technikou twisted-toe mohlo být jako prevence osteoartrózy prospěšné nošení individuálně přizpůsobených vložek do bot.
Background: Traumatic thumb loss is a serious injury affecting patient´s ability to work and participate in activities of daily life. The main goal for a plastic surgeon is to restore hand grip, often by microsurgical methods. However, patients should be informed of all effects associated with tissue harvesting. The aim of the study was to assess the impact on donor foot and gait cycle in patients who have undergone thumb reconstruction using twisted-toe technique modified by Kempný. Material and methods: Twelve patients participated in the study: all suffered a thumb loss between the years 2003 and 2011 and the twisted-toe technique for thumb reconstruction was utilized. The changes in foot pressure distribution and lower extremity joint loading were evaluated. Results: The differences in total maximal plantar pressure, pressure time integral, contact area, and maximum force between the affected and non-affected foot were statistically significant (P ≤ 0.1). No significant differences of temporal gait parameters between the affected and non-affected extremity were observed; however, statistically significant differences in kinetics parameters, frontal ankle and knee moments were detected. Conclusion: Donor limb functionality and anatomical disability were assessed using pedobarography systems and 3D-gait analysis. The recorded differences in plantar pressure distribution (increased pressure in I., IV. and V. metatarsal areas) and overload of the medial compartment of the knee joint were the most significant findings. Therefore, wearing individually adapted shoe insoles as prevention of osteoarthrosis might be beneficial for patients after thumb reconstruction by a twisted-toe technique.
- Klíčová slova
- pedobarografie,
- MeSH
- analýza chůze přístrojové vybavení MeSH
- lidé MeSH
- palec nohy * transplantace MeSH
- palec ruky * transplantace MeSH
- pooperační komplikace MeSH
- pooperační období MeSH
- posturální rovnováha MeSH
- traumatická amputace chirurgie MeSH
- zákroky plastické chirurgie MeSH
- zatížení muskuloskeletálního systému MeSH
- zobrazování trojrozměrné metody MeSH
- Check Tag
- lidé MeSH
Poleptání kůže, ať kyselinou nebo zásadou, patří ke stále častějším pracovním úrazům. Látek, které způsobují poruchu integrity kožního krytu, je nepřeberné množství. Epoxidová pryskyřice, jejíž používání v řadě průmyslových odvětví je dlouhodobě na vzestupu, se i dnes řadí svým výskytem mezi raritní původce kožních postižení. Nízký epidemiologický výskyt je však v kontrastu s možnou mírou postižení. I zde se ukazuje, že jedno z největších úskalí postižení kůže chemikáliemi je jejich dlouhodobá absorpce měkkými tkáněmi. Pokud se úraz a následná léčba navíc zkomplikují nespecifickou hypersenzitivní reakcí při vrozené predispozicí jedince, může se zprvu banální ambulantní rána změnit v dlouhodobě se nehojící defekt vedoucí až k ústavní péči spojené se systémovou léčbou.
Chemical burns represent a frequent cause of an occupational injury. Numerous chemical substances, such as epoxy resin as we reported on in this article, could potentially cause skin damage or, moreover, systemic toxicity. There is an increasing trend in use of epoxy resin in different kinds of industry. Nevertheless, a minimum of occupational diseases are effected by epoxy resin, however, this could be in contrast with the possible severity of the disease. Chemical substances penetrate the human skin and are absorbed by soft tissues for the long time resulting into a major damage of the skin. In this publication we present a case of a chemical burn caused by the epoxy resin and complicated by a severe nonspecific hypersensitive reaction requiring a hospital care and systemic treatment.
- MeSH
- chemické popálení * MeSH
- dospělí MeSH
- dráždivá dermatitida MeSH
- kontaktní dermatitida MeSH
- lidé MeSH
- syntetické pryskyřice * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
