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'Pai Syndrome' with anterior alveolar polyp: A variant of a rare clinical entity

Debnath KK, Kanapaty Y, Yong DJ, Chandran S, Bakri A

Med J Malaysia, 2019 Jun;74(3):229-230.
PMID: 31256179

'Pai syndrome' (PS) is a rare congenital syndrome. Presented here, a new-born baby-girl who exhibited the characteristic features of having a midline nasal (septal) polyp, an anterior alveolar process polyp, and a pericallosal lipoma associated with corpus callosum dysgenesis of the brain. Both polyps were lined with stratified-squamous epithelium. The overall features were largely consistent with those described by Pai et al., in 1987. A midline cleft-lip (with or without cleft-alveolus) is one of the most common features of the syndrome which was however absent in this case. Instead, an anterior alveolar polyp is present, which is relatively rare.

Matched MeSH terms: Cleft Lip
A New Simplified Visual Assessment Tool Describing Facial Morphotypes Observed and Desired in Asian Populations

Corduff N, Chao YY, Lam SC, Lim J, Lim TS, Lohia K, et al.

J Clin Aesthet Dermatol, 2020 Apr;13(4):23-34.
PMID: 33144908

OBJECTIVE: A group of established aesthetic physicians sought to develop treatment guidelines for assessing Asian face morphologies that reflect accurate and current beauty standards across Asia. DESIGN: Physicians completed surveys, debated, and voted on their clinical strategies and developed an alternative simplified visual tool of assessment (SVAT) that discerns between country variations in genetic and ideal morphotypes. SETTING: Electronic and paper surveys were followed by consensus debates and voting. PARTICIPANTS: Established aesthetic physicians practicing regularly on Asian patients. MEAUSUREMENTS: A clinically applicable SVAT was developed, which considered facial index, mid-face projection, upper and lower face shape, submalar contour, nose length and dorsal height, eye shape and brow shape, proportion of lips-to-lower face and ratio of upper-to-lower lip, and chin shape. RESULTS: For facial shape change, physicians always assessed the horizontal thirds, facial symmetry, and lip-chin complex profile, and also analyzed overall face shapes and Ogee curves. Criteria for creating oval-shaped faces was also defined and included treating indications, such as loss of angularity and bilateral masseter muscle hypertrophy, narrow jawlines, and longer and wider foreheads. Critical differences and similarities in country-specific aesthetic preferences, treatment requests, and considerations or strategies were uncovered, including the inadequacy of assessing overall peripheral facial shapes. CONCLUSION: This consensus establishes the assessment and treatment criteria for achieving ideal shapes for Asian patients. Specific descriptors are affected by variations; therefore, we present the visual criteria for Asian facial morphotypes. We hope that physicians new to treating Asian patients can use this clinical information to improve their practice.

Matched MeSH terms: Lip
A comparison between modified and conventional surgical techniques for surgical lip repositioning in the management of the gummy smile

Alammar A, Heshmeh O, Mounajjed R, Goodson M, Hamadah O

J Esthet Restor Dent, 2018 11;30(6):523-531.
PMID: 30412347 DOI: 10.1111/jerd.12433

AIM: The aim of this study was to evaluate and compare conventional and modified lip repositioning surgical techniques used for management of gummy smile involving hyperactive lip elevator muscles.
METHODS AND MATERIALS: A prospective study was conducted between April 2016 and May 2017. Twenty two adult patients aged 18-38 years with gummy smile ranging from 4 to 6 mm because of soft tissue disorders were included in the study. All patients were treated in the oral and maxillofacial department at Damascus University. The sample was divided into two groups of 11 patients. The first group was treated by the conventional standard technique, and the second group treated by a modified study technique. The amount of gingival display in full smile was evaluated in both groups following each intervention.
RESULTS: Both groups exhibited a statistically significant reduction in the measurement of gummy smile at month 1 and 6 postoperatively (P .05). The recent study showed a significant difference in gingival display between 3 and 6 months postoperatively in group 1, but no significant difference in group 2.
CONCLUSION: This study showed that the modified technique utilized in treating gummy smile has less relapse after surgery, shows excellent cosmesis and compared to the conventional technique, greater sustainability.
CLINICAL SIGNIFICANCE: The recent increase in demand for an esthetic smile has led to the development a modification of conventional lip repositioning for correcting gummy smile by myotomy of lip elevator muscles. This modified technique offers less relapse and greater stability post-operatively than the conventional technique.

Matched MeSH terms: Lip*; Smiling
Fulltext A neonate with ectodermal dysplasia ectrodactyly clefting syndrome and ventricular septal defect

Ram SP, Noor AR, Ariffin WA, Ariffin NA

Singapore Med J, 1994 Apr;35(2):205-7.
PMID: 7939823

A 37-week gestation male boy was born to a gravida seven para six mother by spontaneous vertex delivery at home. The baby cried at birth. On day 3 of life, he was admitted for respiratory distress. Physical examination revealed ectrodactyly, thin dry skin, anomalous tear duct with cardiomegaly. X-ray revealed absent radii, cardiomegaly and hemivertebra at L1. Echocardiogram revealed perimembranous type of ventricular septal defect. A diagnosis of Ectodermal Dysplasia Ectrodactyly Clefting Syndrome with ventricular septal defect was made. He was managed conservatively in the nursery. However, he expired on day 27 of life following short spell of fever apnoeic episode due to neonatal sepsis.

Matched MeSH terms: Cleft Lip/genetics*
Fulltext A new species of Aciconula (Amphipoda, Senticauda, Caprellidae) from Sultan Iskandar Marine Park, Malaysia

Lim JHC, Azman BAR, Othman BHR

Zookeys, 2019;859:17-29.
PMID: 31327920 DOI: 10.3897/zookeys.859.33284

A new species of caprellid, Aciconulatinggiensis (Amphipoda, Senticaudata, Caprellidae) was discovered from Pulau Tinggi, Sultan Iskandar Marine Park (SIMP), South China Sea, Malaysia. The new Malaysian species can be distinguished from the other Aciconula species by the combination of the following characters: 1. the presence of a very small suture between head and pereonite 1; 2. antenna 1 flagellum with 4 articles; 3. inner lobe of lower lip unilobed; 4. gnathopod 2 palm of propodus with a large proximal projection (stretching from the proximal margin of the palm to nearly mid-way of palm); 5. pereopods 3-4 with 2 articles (article 1 subrectangular, article 2 conical or tapering at the tip with 1 plumose seta and 2 normal setae) and; 6. pereopod 5 covered with relatively dense and long setae. An updated identification key for the five known species in the genus, including information on the respective geographical distribution and habitat, is presented.

Matched MeSH terms: Lip
Fulltext A novel technique for the management of blandin-nuhn mucocele: a case report

Kumaresan R, Karthikeyan P, Mohammed F, Thapasum Fairozekhan A

Int J Clin Pediatr Dent, 2013 Sep;6(3):201-4.
PMID: 25206223 DOI: 10.5005/jp-journals-10005-1219

Mucocele, a common benign cystic lesion of minor salivary gland and associated ducts develops following extravasation or retention of mucous material in the subepithelial tissue. Occurrence of mucocele of tongue is considered less frequent when compared to a higher incidence of mucocele in the lower lip of young patients. Different modalities of treatment, such as conventional surgical excision followed by newer techniques like cryosurgery, electrocautery have been proposed to completely remove the lesion and reduce the chances of recurrence. Herewith, we report a novel treatment technique using alginate impression material to aid in complete excision of mucocele of glands of Blandin-Nuhn. How to cite this article: Kumaresan R, Karthikeyan P, Mohammed F, Fairozekhan TA. A Novel Technique for the Management of Blandin-Nuhn Mucocele: A Case Report. Int J Clin Pediatr Dent 2013;6(3):201-204.

Matched MeSH terms: Lip
A preliminary report on one stage open tip rhinoplasty at the time of lip repair in bilateral cleft lip and palate: the Alor Setar experience

Trott JA, Mohan N

Br J Plast Surg, 1993 Apr;46(3):215-22.
PMID: 8490700

This paper is a preliminary report on a strategy to perform open tip rhinoplasty at the time of lip repair in bilateral cleft lip and palate deformity. This method was devised to suit unique socio-economic circumstances in the Malaysian centre of Alor Setar. Of 8 cases having surgery in 1991, 7 returned for follow-up with results being documented photographically. It is concluded that this aggressive approach is justified in severe bilateral cleft lip and palate deformity because of the cost effectiveness of limiting the number of interventions. Furthermore, it provides optimally orientated nasal tip anatomy and reduces the social stigma of cleft lip nose appearance from the earliest possible time in the child's development.

Matched MeSH terms: Cleft Lip/surgery*; Lip/surgery
A preliminary report on open tip rhinoplasty at the time of lip repair in unilateral cleft lip and palate: the Alor Setar experience

Trott JA, Mohan N

Br J Plast Surg, 1993 Jul;46(5):363-70.
PMID: 8369872

A method of open-tip rhinoplasty using nostril and columella rim incisions at the time of unilateral cleft lip repair is described. This preliminary report details experience gained using this technique in the Malaysian centre of Alor Setar following its introduction in September, 1991.

Matched MeSH terms: Cleft Lip/surgery*
Fulltext A retrospective clinico-statistical analysis of lip mucoceles occurrence in children below 16 years seen at a government hospital based paediatric dental clinic

Sockalingam, G.

Malaysian Dental Journal, 2007;28(1):41-44.
MyJurnal

The objective of this study is to report the occurrence, demographic and clinical findings of lip mucoceles in children. A restrospective study was conducted at the paediatric dental clinic situated at Hospital Sultanah Aminah, Johor Bahru. The period of study was 3 years beginning 2003 to 2005. Out of 1407 new cases seen over the period of study 17 (1.2%) patients presented with lip mucoceles. All lesions occurred in the lower lip. There was no sex or racial predilection. The average duration of the lesion prior to seeking treatment was 2.8 ± 2.8 months. Most patients (76.5%) first saw a medical practitioner for the problem. No spontaneous resolution of the lesions in any of the patients was noted. The preferred method of treatment of lower lip mucoceles in children is surgical excision of the involved minor salivary glands. Salivary gland mucoceles in children predominantly involve the lower lip and can be treated successfully by complete removal of the involved and associated minor salivary glands.

Matched MeSH terms: Lip
Fulltext A study of cleft lip and palate in neonates born in a large Malaysian maternity hospital over a 2-year period

Boo NY, Arshad AR

Singapore Med J, 1990 Feb;31(1):59-62.
PMID: 2333547

Out of 52,379 babies delivered in the Maternity Hospital, Kuala Lumpur, over a 2-year period, 64 were born with cleft lip and/or palates. The rate of occurrence of cleft was 1.24 per 1000 livebirths or 1.20 per 1000 deliveries. The Chinese babies had the highest incidence (1.9 per 1000 deliveries) while the Malays had the lowest (0.98 per 1000 deliveries). The most common type was unilateral cleft of the primary and secondary palates. Among the Indian babies, cleft of the secondary palate was most common. 18.8 percent of all the affected babies had positive family history of cleft. 10.9% of the mothers of affected babies had positive history of drug ingestion especially Chinese herbs during pregnancy. Associated congenital abnormalities occurred in 15.6% of the babies with cleft lip and/or palate.

Matched MeSH terms: Cleft Lip/epidemiology*
A study of the results of speech language and hearing assessment of three groups of repaired cleft palate children and adults

Abdullah S

Ann Acad Med Singap, 1988 Jul;17(3):388-91.
PMID: 3218930

The results of speech, language and hearing assessment of repaired cleft palate children and adults over a 4-year period at the Speech/Language therapy unit, Department of ENT, Faculty of Medicine, UKM are reported. The subjects were 33 incomplete cleft lip palate (ICLP), 48 unilateral complete cleft lip and palate (UCLP) and 26 bilateral complete cleft lip and palate (BCLP). Results obtained for the following assessments are reported and discussed: (i) Hearing assessment, (ii) intelligibility rate, (iii) severity of hyper-nasality and (iv) types of articulation errors and school/behaviour problems and nasal grimace. Due to subject variability in ethnicity, language and dialects and the lack of normal data, it is difficult to compare or repeat previously reported results. Assessment of intelligibility, hypernasality and articulation were conducted using the Malay language. Results obtained were compared among the three groups of subjects. The significant findings were that hypernasality, intelligibility and articulation errors were more severe in the ICLP group than in the UCLP or BCLP groups of patients. This is contrary to expectations and cannot be explained in terms of the type and/or the degree of clefting. Hence, special attention should be paid to the less overt type of cleft patients in so far as their speech assessment and rehabilitation are concerned.

Matched MeSH terms: Cleft Lip/surgery*
A three-dimensional computed tomographic analysis of the cervical spine in unoperated infants with cleft lip and palate

Rajion ZA, Townsend GC, Netherway DJ, Anderson PJ, Yusof A, Hughes T, et al.

Cleft Palate Craniofac J, 2006 Sep;43(5):513-8.
PMID: 16986980

To investigate anatomical variations and abnormalities of cervical spine morphology in unoperated infants with cleft lip and palate.

Matched MeSH terms: Cleft Lip/radiography*
Fulltext Alveolar Bone Grafting Without Closure Of Oronasal Fistula In Cleft And Palate Patient

Abdul Rahman, Z.A.

Ann Dent, 2004;11(1):-.
MyJurnal

The standard procedure for alveolar cleft closure in cleft lip and palate patients is by alveolar bone grafting (ABG) where the residual opening of oronasal fistula in the palate is also closed simultaneously. Occasionally there is a situation of soft tissue inadequacy and attempt to close the fistula at the same procedure as ABG may compromise the result of the bone graft itself. An unforeseen leakage at the closure may cause graft infection leading to failure. This article reports on a technique where alveolar bone grafting was done without closure of residual palatal fistula to provide adequate soft tissue coverage for the grafted bone. This may reduce the risk of leakage at the oral mucosal coverage of the graft . The residual palatal fistula will be closed at later stage by muco-palatal flap or tongue flap. We reported on a case of a failed ABG which was reconstructed using this technique. Various other techniques to ensure success of ABG were also discussed. Conclusion: The alveolar bone grafting without closure of oro-nasal fistula reduced the risk of failure of ABG in a wide alveolar cleft.

Matched MeSH terms: Cleft Lip
An exploratory study on speech and hearing outcomes in children with cleft lip and palate

Mohd Ibrahim H, Mohamed Yusoff FH, Ahmad K, Van Dort S

Med J Malaysia, 2015 Dec;70(6):321-5.
PMID: 26988203 MyJurnal

INTRODUCTION: Little is known about the treatment outcomes of children with cleft lip and/or palate (CLP) receiving surgical care for primary lip and palate closure in Malaysia.
OBJECTIVES: This study examined the speech and hearing status of Malay-speaking children with CLP residing in Kuala Lumpur.
METHODS: Parents whose children were between the age of 5 and 7 years were recruited via the Cleft Lip and Palate Association of Malaysia (CLAPAM) registry. Parents completed a survey and the children completed a speech and hearing assessment at the Audiology and Speech Sciences Clinic, Universiti Kebangsaan Malaysia.
OUTCOMES: Speech measures include nasality rating, nasalance scores, articulation errors and speech intelligibility rating, while hearing measures include hearing thresholds and tympanometry results for each child.
RESULTS: Out of 118 registered members who fulfilled the inclusion criteria, 21 agreed to participate in the study. The overall speech and hearing status of children in this sample were poor. Only four (19%) participants had normal speech intelligibility rating and normal hearing bilaterally. In terms of overall cleft management, only four (19%) participants were seen by a cleft team while seven (33%) had never had their hearing tested prior to this study.
CONCLUSION: Participants in this sample had poor outcomes in speech and hearing and received uncoordinated and fragmented cleft care. This finding calls for further large scale research and collaborative efforts into improving and providing centralised, multidisciplinary care for children born with CLP.

Matched MeSH terms: Cleft Lip
Fulltext An overview of indices used to measure treatment effectiveness in patients with cleft lip and palate

Haque S, Alam MK, Arshad AI

Malays J Med Sci, 2015 Jan-Feb;22(1):4-11.
PMID: 25892945 MyJurnal

In the contemporary era, the demand for orthodontic treatment is ever rising. Orthodontic treatment duration can range from a year to a few years. Our aim is to assess the available techniques of categorising treatment effectiveness in patients with cleft lip and palate (CLP) and to study their effect on improvement of treatment outcomes. The electronic databases including Medline-PUBMED, Science Direct, and ISI Web of Knowledge were searched from 1987 to 2013, and 40 311 relevant articles were found. Of these, we identified 22 articles including original articles as well as literature reviews. The different parameters and indices that are applied to speed-up orthodontic treatment outcomes in patients with CLP were identified as the GOSLON Yardstick, 5-year-old index, EUROCRAN index, Huddart Bodenham system, modified Huddart Bodenham system, GOAL Yardstick and, Bauru-Bilateral Cleft Lip and Palate Yardstick. This overview can create better awareness regarding the uses, advantages, and disadvantages of the different indices. It can enable better assessment and provide the impetus needed for a sustained upgrade in the standards of care for CLP in daily orthodontics.

Matched MeSH terms: Cleft Lip
Fulltext Anaphylactic shock following the bite of a wild Kayan slow loris (Nycticebus kayan): implications for slow loris conservation

Madani G, Nekaris KA

J Venom Anim Toxins Incl Trop Dis, 2014;20(1):43.
PMID: 25309586 DOI: 10.1186/1678-9199-20-43

BACKGROUND: Asian slow lorises (Nycticebus spp.) are one of few known venomous mammals, yet until now only one published case report has documented the impact of their venomous bite on humans. We describe the reaction of a patient to the bite of a subadult Nycticebus kayan, which occurred in the Mulu District of Sarawak in 2012.

FINDINGS: Within minutes of the bite, the patient experienced paraesthesia in the right side of the jaw, ear and right foot. By 40 minutes, swelling of the face was pronounced. The patient was admitted to Mulu National Park Health Clinic/Klinik Kesihatan Taman Mulu Tarikh, at which time he was experiencing: swollen mouth, chest pain, mild abdominal pain, nausea, numbness of the lips and mouth, shortness of breath, weakness, agitation and the sensation of pressure in the ears due to swelling. The blood pressure was 110/76, the heart ratio was 116 and oxygen saturation was 96%. The patient was treated intramuscularly with adrenaline (0.5 mL), followed by intravenous injection of hydrocortisone (400 mg) and then intravenous fluid therapy of normal saline (500 mg). By 8 h10 the next day, the patient's condition had significantly improved with no nausea, and with blood pressure and pulse rate stable.

CONCLUSIONS: A handful of anecdotes further support the real danger that slow loris bites pose to humans. As the illegal pet trade is a major factor in the decline of these threatened species, we hope that by reporting on the danger of handling these animals it may help to reduce their desirability as a pet.

Matched MeSH terms: Lip
Ankyloblepharon filiforme adnatum associated with cleft lip and palate

Raihan, S., Tg Norina, T.J., Raja Azmi, M.N.

Malaysian Journal of Paediatrics and Child Health, 2007;15(1):42-45.
MyJurnal

We report a rare case of a newborn baby girl who was delivered at 36 weeks of gestation with birth weight of 2680 grams and has ankyloblepharon filiforme adnatum with cleft lip and palate diagnosed at birth. The baby was managed with simple procedures of eyelid bands separation. We also reviewed the embryology of eyelid and its relation with ankyloblepharon formation and discussed the various syndromes and abnormality which may be associated with this eyelid abnormality. The four types of ankyloblepharon which was described by Rosenman and colleague is presented.

Matched MeSH terms: Cleft Lip
Fulltext Anthropometric characteristics of Malay nose- a pilot study

Tengku Fazrina Tengku Mohd Arif, Farah Farhana Muhamad Hanafi, Nur Wardah Hanis Abdul Razak, Narissaporn Chaiprakit, Hazmyr Abdul Wahab

ESTEEM Academic Journal, 2020;16(2):11-20.
MyJurnal

Anthropometric analysis provides the most reliable comparison of the body forms by using specific landmarks determined in respect of anatomical prominences. The knowledge of unique shape, anatomy and dimensions of the nose is very useful for surgeon undertaking its repair and reconstruction. Prosthetic rehabilitation also requires the ability to imagine the position and dimension of the nose within the facial proximity. Therefore, the access to nasal data for each
population are advantageous. The aims were to measure parameters of external nose of a Malay population and to determine the significant difference in nose value parameters between gender and age group. The direct anthropometric measurements were carried out in 86 Malay subjects within the age range of 18 to 55 years old who attended UiTM dental clinic. Nasal landmarks were
identified, and the nose parameters were measured using digital calliper. The values were expressed as mean, standard deviation and range. Nasal height, width and length of the nasal bridge were higher in male. The intercanthal width and philtrum length were statistically not significant for both genders. There were significant differences in nasal width, philtrum length, intercanthal width and outer intercommisural mouth width between the three age groups. However, the height of the nose, length of the nasal bridge and nasal index between age group were statistically not significant. The male population and the 41-55 years age group have higher nose value parameters. The most common type of nose was platyrrhine: broad. This study also suggested that Malay population have medium broad nose as the nasal index for both genders was ≤ 84.90.

Matched MeSH terms: Lip
Assessment of complete unilateral cleft lip and palate patients: Determination of factors effecting dental arch relationships

Arshad AI, Alam MK, Khamis MF

Int J Pediatr Otorhinolaryngol, 2017 Jan;92:70-74.
PMID: 28012538 DOI: 10.1016/j.ijporl.2016.11.006

OBJECTIVES: The purpose of the current study was to assess the treatment outcome of non-syndromic patients having complete unilateral cleft lip and palate (CUCLP) by using GOSLON index and to determine any association of pre and/or postnatal factors with the treatment outcome.
MATERIALS AND METHODS: One hundred and one sets of dental models of patients having CUCLP were assessed in this retrospective study. Five examiners that were blinded to case-specific information scored the dental models at two instances with an interval of two weeks to ensure memory bias elimination (5 × 101 × 2 = 1010 observations). Calibration courses were conducted prior to scoring and each examiner was provided with scoring sheets, pictures of GOSLON reference models and flowcharts explaining the scoring method.
RESULTS: According to GOSLON index, a mean (SD) GOSLON score of 3.04 (1.25) was determined. Based on treatment outcome groups, 62 patients had favorable (grade 1, 2, and 3) and 39 cases had unfavorable (grade 4 and 5) treatment outcome. Chi-square tests revealed a significant association of gender (P = 0.002), cheiloplasty (P = 0.001) and palatoplasty (P

Matched MeSH terms: Cleft Lip/surgery*
Assessment of complete unilateral cleft lip and palate treatment outcome using EUROCRAN index and associated factors

Arshad AI, Alam MK, Khamis MF

Int J Pediatr Otorhinolaryngol, 2017 Sep;100:91-95.
PMID: 28802394 DOI: 10.1016/j.ijporl.2017.06.025

OBJECTIVES: Assessment of treatment outcome is the only non-invasive approach to identify the effects of cleft lip and palate repair and modify management accordingly. Here the aim is to assess the outcome of complete unilateral cleft lip and palate (CUCLP) patients using EUROCRAN index and to check whether there are any factors associated with the treatment outcome.
MATERIALS AND METHODS: It is a retrospective cross sectional study. Dental models were collected from archives of two cleft referral centers in Pakistan. Five blinded examiners scored 101 models twice at two week interval. The primary outcome was mean EUROCRAN scores based on dental arch relationships and palatal surface morphology.
RESULTS: A mean(SD) score of 2.72 (0.76) and 2.20 (0.73) was determined based on dental arch relationships and palatal surface morphology, respectively. According to the final logistic regression model, modified Millard technique (cheiloplasty) and Veau-Wardill-Kilners' method (palatoplasty) had higher odds of producing unfavorable treatment outcome.
CONCLUSIONS: Present study determined a fair and a fair to poor treatment outcome based on dental arch relationships and palatal surface morphology, respectively. Our study suggests a significant association between treatment outcome and primary surgical techniques for lip and palate. These findings could warrant a modification of management protocols to ensure improvement in future cleft outcomes.

Matched MeSH terms: Cleft Lip/surgery*

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