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 mu g/kg vs 0.29 mu g/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.

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.

Abstract 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.

Editor—Orofacial clefts, both cleft lip with or without palate and isolated cleft palate, are considered one of the most common congenital malformations. The overall prevalence of orofacial clefts is about 1 in 700 live births. 1 Mossey P.A. Modell B. Epidemiology of oral clefts 2012: an international perspective. Front Oral Biol. 2012; 16: 1-18 Crossref PubMed Scopus (63) Google Scholar Cleft centres worldwide have their own treatment protocols and timing for primary surgeries. 2 Shaw W.C. Semb G. Nelson P. et al. The eurocleft project 1996–2000: overview. J Craniomaxillofac Surg. 2001; 29: 131-140 Crossref PubMed Scopus (233) Google Scholar In the Cleft Center of the University Hospital Brno (UHB) in the Czech Republic, about 80 newborns with orofacial cleft are taken into care per year. Cleft lip surgery is performed from the second day of life, and cleft palate surgery is recommended from the seventh month of life. 3 Košková O. Vokurková J. Vokurka J. et al. Treatment outcome after neonatal cleft lip repair in 5-year-old children with unilateral cleft lip and palate. Int J Pediatr Otorhinolaryngol. 2016; 87: 71-77 Crossref PubMed Scopus (8) Google Scholar

Cilem teto knihy je instruovat lekaře, jake naroky ma splňovat soucasna předoperacni připrava, nastinit organizaci provozu centralnich operacnich salů velkých nemocnic, ukazat soucasnou operativu s důrazem na nove operacni techniky u nejcastějsich výkonů a osvětlit anesteziologicke praktiky v sirsich souvislostech vztažených ke zdravotnimu stavu pacienta před operaci. Kniha uvadi do souvislosti i nutnost intenzivni pooperacni pece u některých nemocných a osvětluje požadavky, se kterými pacient přichazi zpět do ambulance po propustěni z nemocnice.