The Journal of craniofacial surgery
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Controlled Clinical Trial
Effects of preoperative local ropivacaine infiltration on postoperative pain scores in infants and small children undergoing elective cleft palate repair.
Previous data have shown that preoperative analgesia may reduce postoperative analgesic demands. The aim of the current study was to determine if preincisional ropivacaine infiltration may reduce postoperative oral pain in infants and small children undergoing elective cleft palate patients. Twenty nonsyndromic cleft palate patients were randomly divided into 2 groups. ⋯ Measurements of Children and Infants Postoperative Pain Scale scores at all the observational postoperative periods showed significantly favorable values in ropivacaine group than in control group (P < 0.05). Six patients in the control group required rescue analgesia, whereas 2 patients required analgesic therapy in the treatment group. Preemptive analgesia using ropivacaine may enhance early postoperative comfort by reducing early postoperative pain in primary cleft repair.
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Correction of craniosynostosis represents much of the workload in the pediatric designated UK craniofacial units. We reviewed recent operations as part of an ongoing unit audit cycle with outcome determined as blood use and complications or readmissions within 6 weeks of surgery. A pro forma was designed, and information from a chart search was collated on a Microsoft Excel (Microsoft, Seattle, WA) spreadsheet. ⋯ Transfusion in SC was calculated as 26 +/- 25% RCV, and 33% of patients underwent SC without transfusion. In conclusion, we show that significant reductions in blood transfusion are possible in correction of craniosynostosis both with and without the use of cell savers by application of a simple protocol. Our findings support the recommendation that all of these cases be carried out in multidisciplinary units where high patient throughput allows both maintenance of skills and completion of audit cycles.
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Neonates with Pierre Robin sequence have respiratory distress caused by glossoptosis due to microretrognathia. Numerous therapeutic maneuvers have been used to stabilize the upper airway in these patients. The purpose of this study is to document the frequency with which each of these maneuvers is used, including the newest technique of mandibular distraction osteogenesis, in a single hospital with a large obstetrical service (22,646 deliveries between July 1, 2003, and June 30, 2006). ⋯ The treatment of neonatal upper airway obstruction due to Pierre Robin sequence includes both nonsurgical and surgical interventions. Use of a therapeutic algorithm can optimize nonsurgical management and minimize the need for tracheotomy. Mandibular distraction osteogenesis is an effective treatment to avoid tracheotomy in carefully selected Pierre Robin sequence neonates.
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Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. ⋯ Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.