Cases reported "Cleft Palate"

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1/9. Intranasal tooth as a complication of cleft lip and alveolus in a four year old child: case report and literature review.

    Ectopic position of teeth is not rare. The presence of teeth have been reported in ovaries, testes, anterior mediastinum, and pre-sacral regions. In the maxillofacial region, teeth have been found in maxillary sinus, mandibular condyle, coronoid process, chin, nose, and even orbit. Approximately 50 cases of a tooth in the nasal cavity have been reported in literature. However, an intranasal tooth in cases of cleft lip and palate is comparatively rare. Intranasal teeth can cause problems such as nasal obstruction, chronic rhinorrhea and speech problems. Sometimes however, they are totally symptom-free. We present here an interesting case of an intranasal tooth in a four year-old-boy, who was operated on for cleft lip and alveolus at 6 months of age. The intranasal tooth did not cause any symptoms. The tooth was extracted under general anaesthesia when it was found to be very loosely attached to the nasal mucosa. The case is discussed in the light of relevant literature on intranasal teeth in cases of cleft lip and palate.
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2/9. Disruption of cleft palate repair following the use of the laryngeal mask airway.

    A 55-year-old man was admitted for routine examination of ears with insertion of grommets under general anaesthesia. At 2 years of age he had undergone successful repair of cleft lip and palate. A reinforced laryngeal mask airway was employed to maintain the airway. Postoperatively, it was evident he had suffered complete disruption of the soft palate repair, leading to velopharyngeal insufficiency with nasal regurgitation of fluids. We discuss the possible aetiology, having found no such reported injury pattern documented in the literature.
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3/9. Laryngeal mask anaesthesia for repair of cleft palate.

    A method of anaesthesia for repair of cleft palate is described. The baby had pierre robin syndrome and tracheal intubation had proved to be impossible.
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ranking = 5
keywords = anaesthesia
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4/9. Anaesthetic management of congenital fusion of the jaws in a neonate.

    Fusion of the jaws in the neonate is a very rare congenital anomaly which may be associated with other congenital defects such as aglossia, facial hemiatrophy or retrognathia. Ventilatory management for surgical separation of the fused jaws presents severe problems. In a recent case of a neonate with almost completely fused jaws requiring general anaesthesia, we used subanaesthetic doses of ketamine in combination with an insufflation technique. It took 45 minutes to reach the surgical stage of anaesthesia due to misplacement of the nasotracheal tube through an unsuspected cleft palate towards a gap between the jaws, a previously unreported combination of complications.
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ranking = 2
keywords = anaesthesia
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5/9. nicardipine: perioperative applications in children.

    nicardipine is the first intravenously administered dihydropyridine calcium channel blocker. Its primary physiological actions include vasodilatation with limited effects on the inotropic and dromotropic function of the myocardium. Several reports have documented its use in adult patients for pharmacological control of blood pressure. We present our experience with the perioperative use of nicardipine in children to treat intraoperative hypertension, as an agent for controlled hypotension during spinal fusion and LeFort I maxillary osteotomies and to treat postoperative hypertension. Dosing regimens and possible applications in paediatric anaesthesia are discussed.
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keywords = anaesthesia
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6/9. Unexpected brainstem compression following routine surgery in a child with oto-palato-digital syndrome.

    Oto-palato-digital syndrome type 1 is a rare condition with several features of concern to the anaesthetist. We report a patient who developed respiratory depression 5 h after general anaesthesia. This was subsequently found to be due to brainstem compression secondary to congenital deformities of the skull base and cervical vertebrae.
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keywords = anaesthesia
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7/9. Anaesthesia for patients with trisomy 13 (Patau's syndrome).

    Patau's syndrome (trisomy 13) is usually fatal within the first six months of life. For the few survivors, corrective surgery is only undertaken if the child has a reasonable chance of living for some time. Hence the reports of anaesthesia and surgery in the literature are rare. We describe the anaesthesia for a repair of cleft lip and palate on two children who presented to our department.
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ranking = 2
keywords = anaesthesia
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8/9. malignant hyperthermia and althesin.

    General anaesthesia with Althesin was administered on two occasions to a patient who was identified as susceptible to malignant hyperthermia, in whom there was identified familial subclinical myopathy and once in another patient suffering from arthrogryposis multiplex congenita with a history of fever associated with two previous anaesthetics. In the first patient halothane was administered by accident in association with the Althesin, but no hyperpyrexia occurred. In the second instance nitrous oxide-oxygen and halothane were associated purposely with Althesin. In none of these cases was there any rise in temperature, muscle rigor or elevation of the serum CPK level. This experience corroborates the experimental evidence of Hall, et al.10 and Harrison, who reported that Althesin prevented the onset of hyperthermia, and the clinical reports of Page and Judelman. Althesin can be assumed to be an effective anaesthetic for malignant hyperthermia susceptible patients.
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keywords = anaesthesia
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9/9. Dental mirror for difficult nasotracheal intubation.

    A patient with a previous surgical history of a cleft lip and palate repair and a pharyngeal flap pharyngoplasty was admitted for repair of mandibular prognathism. Following induction of anaesthesia, it was impossible to advance the nasotracheal tube into the oropharynx. Using a dental mirror and retrograde tracheal intubation equipment, under direct vision, the nasotracheal tube was finally advanced into the oropharynx.
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keywords = anaesthesia
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