| 2008 |
Pre and prio op Dexamethosone improves post op
recovery following cleft palate surgery |
Potter, Oxford |
| 2007 |
The Effect of Pre-Surgical Orthopaedics on Archiform
in Unilateral Cleft Lip and Palate |
Ms. N. Adali, Specialist Registrar in Orthodontics
UCLH Trust |
| 2006 |
Intra Operative Blood Loss –
Anaesthetic Type and Adrenaline Concentration |
Patrick Gillespie, Specialist Registrar in Plastic
Surgery, Addenbrookes Hospital, Cambridge |
| 2005 |
|
|
| 2004 |
Effects of the Fgfr2 Crouzon-type
Mutation on Palatal Shelf Development |
Chad Perlyn, Dept of Human Anatomy &Genetics,
University of Oxford |
| 2003 |
Assessment of Early Dental and
Facial Deformity in Repaired Unilateral Cleft Lip and Palate |
Dr A Garrahy, Glasgow Dental Hospital |
| 2002 |
Sequalae of Otitis Media with Effusion among Children
with Cleft Lip and / or Cleft Palate
|
Patrick Sheahan MB AFRCSI, Specialist Registrar in Otolaryngology, Dublin,
Ireland
|
| 2001 |
Can maxillary growth be predicted from 3-dimensional parameters of neonatal
study models in patients with unilateral Cleft Lip and Palate?
|
Ms Felicity V Mehendale, Cleft Fellow in Plastic
Surgery at Great Ormond Street Hospital for Children, London and St Andrew's
Centre for Plastic Surgery, Broomfield Hospital, Essex |
| 2000 |
The Tendons of the Levator Veli Palatini |
Ms Felicity V Mehendale, Cleft Fellow in Plastic Surgery at
Great Ormond Street Hospital for Children, London and St Andrew's Centre
for Plastic Surgery, Broomfield Hospital, Essex |
| 1999 |
The Orthodontist's contribution
to the management of Obstructive sleep Apnoea |
Mr A Johal, Senior Registrar in Orthodontics at
the Royal London Hospital |
| 1998 |
Reorganisation of Cleft services - implications of
non cleft anomalies
|
Ms Lucinda Huskisson, Senior Registrar in Paediatric
Surgery at The Children's Hospital, Birmingham |
| 1997 |
Craniofacial abnormalities in Nicosia, Cyprus, and the significance of
parental consanguinity
|
Ms Vartoukian, Dental undergraduate at King's College Dental
Institute, London |
| 1996 |
A twenty year follow-up assessment of nasal symmetry
in patients with unilateral complete Cleft Lip and Palate
|
Norma Timoney, Senior House Officer in the Department of Plastic
& Reconstructive Surgery Royal Devon & Exeter Hospital |
| 1995 |
Does the McComb primary cleft nose correction affect
nasal growth? A longitudinal study
|
Mr Brian Coghlan, Senior Registrar in Plastic
Surgery in the Yorkshire region |
| An audit of bilateral alveolar bone grafting at
Great Ormond Street Hospital 1983-1993 |
Dr Yilin Jia, Honorary Registrar in Orthodontics
at The Hospital for Sick Children, Great Ormond Street, London |
| 1994 |
Management of 100 cases of pheneme
specific nasality - a two centre audit |
Mrs Liz Albery, Speech & Language Therapist
at Frenchay Hospital, Bristol. Mrs Kim Harland, Speech & Language Therapist
at St. Andrew's Hospital, Billericay. |
| 1993 |
Growing up with a Cleft |
Ms Eileen Bradbury, Clinical Counsellor in Plastic
Surgery at Withington Hospital, Manchester and Lecturer at the University
of Manchester |
| 1992 |
The vascular basis of posterior
pharyngeal flaps |
Mr Nigel SG Mercer, Consultant Plastic Surgeon
with Frenchay Healthcare Trust, Bristol |
| 1991 |
The characteristics of pre-speech vocalisations in Cleft Palate children
|
Mrs Jane Russell, Principal Speech Therapist at Birmingham Children's
Hospital. Prepared in conjunction with Professor Pamela Grunwell
|
| 1990 |
The relationship between Intracranial pressure
and restricted skull volume in children with Craniosynostosis |
Mr Gault, Senior Registrar in Plastic Surgery at The Hospital
for Sick Children, Great Ormond Street, London. Prepared in conjunction
with B. Jones, D Marchac and D Renier |
|
2006
back to top of winners list
|
Intra Operative Blood Loss - Anaesthetic Type
and Adrenaline Concentration. An Audit
Gillespie P, Specialist Registrar in Plastic Surgery, Hall, P, Consultant
Plastic & Cleft Surgeon, Ahmad T, Consultant Plastic & Cleft Surgeon,
Sapsford D, Consultant Paediatric Anaesthetist, Smith H, Consultant Paediatric
Anaesthetist
Addenbrooke's Hospital, Cambridge
A prospective study of intraoperative blood loss for all Cleft procedures
was undertaken from January 2003 to May 2005 for 2 surgeons and their respective
anaesthetists. Local anesthetic infiltration with chirocaine (0.25% or 0.5%)
was performed in all cases with the concentration of adrenaline being determined
by the anaesthetic type -a maximum strength of 1/200,000 being used in Gaseous
Anaesthesia (GA) whereas the stronger 1/100,000 was allowed when a Total
Intravenous Anaesthetic technique (TIVA) was used. In all cases a minimum
wait of 7 minutes from injection to incision was enforced. We wanted to
determine if this made a difference to blood loss.
235 useable datasets were analysed and results fell into the following
grid.
NUMBERS MEAN BLOOD LOSS MEDIAN BLOOD LOSS
Gas TIVA Gas TIVA Gas TIVA
1/200k 97 46 31 22 15 6
1/100k 19 73 15 14 7.5 2.5
The results suggest a trend towards almost double the bleeding volume
when the weaker concentration of adrenaline is used. This seems independent
of surgeon or surgical procedure undertaken.
The study continues to enable detailed statistical analysis with larger
numbers.
|
| 2005 |
|
|
2004
back to top of winners list
|
Effects of the Fgfr2 Crouzon-type Mutation on
Palatal Shelf Development
Perlyn Chad*; Babbs Christian*; LONAI PETER^; Morriss-Kay Gillian*
*Department of Human Anatomy and Genetics University of Oxford South
Parks Road Oxford, 0X2 7AW
^Weizmann Institute of Science PO Box 26 Rehovot 76100 Israel
Introduction: The purpose of this project is to investigate the mechanisms
through which the Crouzon mutation causes palatal abnormality. The project
exploits a mouse model that has the Crouzon-type mutations Fgfr2Cys342Tyr.
Methods: Approaches used were: (1) comparative morphology; (2) cell proliferation
analysis; (3) in situ hybridisation. Histological techniques were used
for evaluating palatal sections. Cell proliferation analysis was performed
using 5’Bromodeoxyuridine (BrdU). Nuclei that took up BrdU (indicating
that they were synthesising DNA) were detected using an anti-BrdU antibody
technique. Changes in gene expression are being analyzed by in situ hybridization,
using molecular probes for markers of bone differentiation and FGFR signalling.
Results: Results from embryonic day (E)13.5-15.5 show significant morphologic
differences in palatal development in wild-type mice as compared with
heterozygote and homozygote mutants. There appears to be a pattern of
development delay by one embryonic day in the heterozygotes and two days
in the homozygotes as evidenced by orientation of palatal shelves and
degree of shelf fusion. Result of cell proliferation studies for the embryonic
day 12.5 (the time at which palatal shelf outgrowth begins) show a significantly
higher number of proliferating cells in the homozygote and heterozygote
shelves as compared to the wild-types. The effects of this are seen in
a decrease in hyaluronic acid in the mutant shelves on the following day.
This may lead to decreased osmosis within the extracellular matrix and
diminished shelf elevation. Gene expression studies, using in-situ hybridizatio,
show abnormal expression of FGFR1 and FGFR2 in the palatal shelves, which
correlates to the above findings. Conclusion: The Fgfr2Cys342Tyr mutation
leads to developmental delay of palatal shelf elevation and fusion. FGFR2
remains expressed in the mutant shelves, possibly delaying the switch
from cell proliferation to cell differentiation. As such, the necessary
factors for palatal development are not present at the appropriate embryonic
stage. Further work will be performed to examine this in more detail.
|
|
2003
back to top of winners list
|
Assessment of Early Dental and Facial Deformity in Repaired Unilateral
Cleft Lip and Palate
Objective - To assess the relationship between deformity of soft tissue
facial morphology and of the dental arches in children with repaired UCLP.
Deformity is defined as deviation from normal.
Methods - 16 healthy Caucasian children aged 3 years with repaired UCLP
and 78 matched control children were recruited.
A set of images of each child's face at rest was recorded within 6 weeks
of his or her third birthday using computerised stereophotogrammetry and
dental impressions were recorded. Analysis of facial and dental interlandmark
distances was performed. The correlation between two features of the dental
arch and one feature of soft tissue facial morphology with greatest deviation
from normal was analysed.
Results - The correlation coefficient for nasal base width and maxillary
arch cleft-affected quadrant length was 0.4 (p value 0.14) in children
with repaired UCLP. The correlation coefficient for nasal base and maxillary
arch intercanine widths was 0.28 (p value 0.32).
Conclusion - The cleft-related deformities of soft tissue morphology and
bone based dental arches are not directly related to each other.Suggested
application - Further radiation-free exploration of facial, appearance
and dental arch development in combination.
|
|
2002
back to top of winners list
|
Co-authors Alexander W Blayney Consultant in Otolaryngology, Anne McGillavery
Cleft Coordinator, Michael J Earley Consultant in Plastic Surgery all
based at The Children's Hospital, Temple Street, Dublin 1, Ireland and
Jerome N Sheahan Department of Mathematics, National University of Ireland,
Galway
The purpose of this paper is to investigate the long-term outcome of
treatment of otitis media with effusion (OME) among children with cleft
lip and/ or palate. OME is a common finding among children with cleft
palate, and concerns have been expressed regarding the possible long-term
effects of the associated hearing loss on speech and language development.
However, although treatment of OME by tympanostomy tube insertion can
reverse the hearing loss in the short-term, in the long-term, this improvement
in hearing is not maintained.
The study comprised of a retrospective review of 104 children with clefts
treated for OME at our institution. Mean duration of follow-up was 6.9
years, and mean age at latest follow-up was 9.6 years. The incidence of
chronic otitis media was 19%, and the incidence of cholesteatoma was 1.9%.
An abnormal tympanic membrane appearance was highly significantly correlated
with reduced hearing (p=0.000). Surprisingly, ears which had undergone
a greater number of previous ventilation tube insertions had a significantly
higher incidence both of abnormal tympanic membrane appearance (p=0.0071
for left ears and p=0.0003 for right ears) and of reduced hearing at long-term
follow-up (p=0.0546 for left ears and p=0.0014 for right ears).
The findings of our study would suggest that the excessive use of tympanostomy
tubes in children with OME and cleft palate may be associated with a higher
incidence of long-term tympanic membrane abnormalities and hearing loss.
We would suggest that a conservative approach to OME in children with
cleft palate is appropriate and is more likely to lead to the best long-term
outcome.
This article was accepted for publication by "Clinical Otolaryngology
and Allied Sciences" (Blackwell Science)
|
|
1999
back to top of winners list
|
Work later published as - An Investigation into
the Changes in Airway Dimension and the Efficacy of Mandibular Advancement
Appliances in Subjects with Obstructive Sleep Apnoea. Johal A, Battagel
JM, Brit J of Orthodontics Vol 26 1999 205-210 |
|
1998
back to top of winners list
|
(in conjunction with Peter Gornall, Consultant
in Paediatric Surgery) The conclusion to the study was that patients with
clefts have a large number of associated anomalies. Centres treating cleft
patients should be equipped to assess, prioritise and treat all anomalies
in cleft patients. She produced evidence to support screening for cardiac,
ophthalmic and renal anomalies. |
|
1996
back to top of winners list
|
Authors: Timoney N Smith G Pigott RW
Institution: Cleft Palate Unit, Department of Plastic Surgery, Frenchay
Hospital, Bristol, UK
Title: A 20 year audit of nose-tip symmetry in patients with unilateral
cleft lip and palate
Source: British Journal of Plastic Surgery. 54(4):294-8, 2001 Jun
Abstract: The purpose of this study was to audit the process and outcome
in terms of nasal-tip symmetry of the first 20 patients with unilateral
complete cleft lip and palate treated by the Pigott alar leapfrog primary
nasal correction in the early 1970s and followed for 20 years. Symmetry
was assessed using the Coghlan computer-based analysis of frontal and
basal views to determine the stability of the correction. The Abyholm
technique of alveolar bone grafting was performed in 12 of the 20 patients.
Various other secondary procedures have been performed on the nose tip
and septum to improve the airway or appearance. Photographs were taken
within one year of ages 5, 10, 15 and 20 years, and the lower border of
the nose, the alar domes and the nostrils were assessed. To assess the
overall change from 5 years to 20 years, both views were available for
17 patients. No significant change was found in the lower border or nostril
symmetry, but significant deterioration at the P< 0.01 level was found
on the basal view. We assessed the 10, 15 and 20 year views of all 12
patients who had undergone alveolar bone grafting to determine early and
late changes. No significant benefit was found from alveolar bone grafting
or minor secondary procedures for appearance. Consequently, our criteria
for undertaking minor adjustments to improve appearance have become more
stringent. We consider that objective reporting of appearance should become
essential in peer-reviewed journals. Copyright 2001 The British Association
of Plastic Surgeons
|
|
1995
back to top of winners list
|
The paper looked at a longitudinal series of how McCombs cases treated
only with a primary nose repair and then followed up 18 years with no
further intervention. Measurements were made of nasal symmetry at the
ages of 5, 10 and 18 looking for the overall results, as well as the affects
of growth. The results supported the McComb nose correction, a technique
that achieves good nasal symmetry of unilateral cleft lip which does not
appear to affect the growth of the nose over the 18 year study.
Work published as- McComb HK, Coghlan BA Primary repair of the unilateral
cleft lip nose: completion of a longitudinal study. Cleft Palate Craniofac
J. 1996 Jan;33(1):23-30; discussion 30-1 Department of Plastic and Maxillofacial
Surgery, Princess Margaret Hospital for Children, Perth, Western Australia.
Abstract of the paper - The first 10 consecutive unilateral cleft subjects
operated on in 1975 by a technique of primary cleft nose correction, developed
by the author (HKM), were reviewed at ages 10 and 18. No further nasal
surgery had been performed on these cases. The anteroposterior and inferior
facial appearances of each of the cases have been published for evaluation.
A computer-based method of measuring nasal asymmetry was used to objectively
analyze the results and compare them with normal and cleft control faces
that were age matched. The results support the observation that nasal
growth of the cleft side of the nose is unaffected by early primary nasal
surgery and that the vertical shortening of the nose by the alar lift
technique is preserved into adult life. Residual nostril asymmetry from
septal deviation persists into adulthood.
|
|
1994
back to top of winners list
|
Phoneme specific nasal emission occurs as nasal fricatives replace oral
fricatives or affricates when there is normal velo-pharyngeal function
for other sounds. This pattern of velopharyngeal function is sometimes
misdiagnosed and in consequence may be managed surgically or with inappropriate
management techniques.
This paper reports a review of 100 individuals using active nasal fricatives
and presenting with phoneme specific nasal emission.
The most significant retrospective finding is the presence of middle
ear hearing loss in 95% of patients. The type, frequency, timing and success
of speech and language therapy techniques used with these patients are
reported and recommendations for management given.
|
|
1992
back to top of winners list
|
Work published in the following articles:
The vascular anatomy of the pharynx, NSG Mercer and P Macarthy in Proceedings
of the Craniofacial Society of Great Britain in the British Journal of
Plastic Surgery 43. 2. 358 (1989)
The Arterial Basis of Pharyngeal Flaps, NSG Mercer and P MacCarthy in
Plastic and Reconstructive Surgery 96. 1026-1037 (1995)
The Arterial Supply of the Palate: Implications for Closure of Cleft Palates,
NSG Mercer and P MacCarthy
Plastic and Reconstructive Surgery 96. 1038-1044 (1995)
The work formed the basis of Mr Mercers Masters degree (ChM (Bristol)
1993)
|
|
1990
back to top of winners list
|
This work was published as 'Intracranial Pressure
and Intracranial Volume in Children with Craniosynostosis' by Gault DT,
Renier D, Marchac D, Jones BM in Plastic and Reconstructive Surgery September
1992 Vol 90 (3) 377 - 381
A summary of Mr Gault's presentation follows. This study looks at the relationship
between intra-cranial pressure and intra-cranial volume in children with
cranio-synostosis. When one of the coronal sutures fuses early, there is
little growth of the vault on that side. This is thought to deny the growing
brain room to develop normally. The skull affects the underlying brain and
many of these children have raised intra-cranial pressure. The rise in pressure
is slow in onset and clinical symptoms, such as headaches, are often absent.
Normal intra-cranial pressure increases with age and it is likely that the
young child's brain is especially sensitive to intra-cranial hypertension.
The life threatening rises in intra-cranial pressure seen after head injury
is not seen in these children.
At present the only satisfactory way to measure intra-cranial pressure is
to place a sensor within the skull. This requires a general anaesthetic.
If reduced intra-cranial volume is causing the rise in intra-cranial pressure
then perhaps volume measurement alone would pick out the children with intra-cranial
hypertension and thus save them an additional, albeit minor, operation to
insert the pressure sensor. This was a study of 66 children with craniosynostosis
presenting to the Hospitals for Sick Children in Paris and London. There
were 48 boys and 18 girls. Their ages ranged from 6 months to 14 years with
a mean age of 29 months. Intra-cranial pressure was recorded using the epidural
sensor in 61 children. 3 patients had their pressure measured with a Camino
Subdural bolt and in 2 cases lumbar puncture was used.
In each case an overnight record was obtained. As intra-cranial volume varies
as the child grows, the data has been examined in terms of Standard Deviation
Scores (also known as the Z score). The Z score measures the tendency of
any particular value to drift from normal, where V is the volume; V(a) is
the volume of a normal child of the same age and sex & SD(a) is the
standard deviation of a group of normal children of the same age and sex.
Those children with raised pressure had a mean Z score of -1.568 they had
a significant reduction in volume when compared to the group with normal
pressure. The reduction in volume of the borderline group was not statistically
significant.
The key question is, does reduced volume pick out the children with raised
pressure? When the children with the greatest reduction in volume were examined,
however, less than 50% had a raised pressure. Our hypothesis that volume
measurement alone would highlight the children at risk with raised pressure
was clearly not supported.
Hydrocephalus occurs in about 4% of children with craniosynostosis and is
particularly common in those with Crouzons, Aperts and Clover Leaf deformities.
This study has shown that when the intra-cranial pressure is elevated there
is a significant reduction in intra-cranial volume. A reduced intra-cranial
volume however does not reliably indicate whether the intra-cranial pressure
is elevated or not. There is, unfortunately, no short cut to direct intra-cranial
pressure measurement in these children. |
