Background
Wide palatal defects remain a challenge to the plastic surgeon. The authors present a new method for closure of a wide Veau class II cleft palate in which anterior palatal closure was achieved by use of a bipedicled mucoperiosteal anterior palatal flap.


Methods
Two patients with wide Veau class II cleft palatal defects underwent palatoplasty with difficulty in closing the anterior palate. A novel technique was employed for tension-free closure.


Results
A tension-free closure in the midline was achieved with a bipedicled mucoperiosteal anterior palatal flap.


Conclusions
This novel technique can assist with closure of the anterior-most portion of hard palatal defects.

Bipedicled Palatoplasty for Closure of Wide Veau Class II Anterior Palatal Defect: A Case Series.

Skin lesions of the face, trunk, and extremities are commonly seen in the pediatric population. Although most of these lesions are benign, they can be locally destructive or interfere with normal development. Recognition and diagnosis of these lesions allow for timely workup and referral; treatment, if needed; and facilitation of parental discussions. The purpose of this article is to review common pediatric skin and soft-tissue lesions-or "lumps, bumps, and birthmarks"-to assist with diagnosis, workup, and guidelines for referral to pediatric plastic surgery. [Pediatr Ann. 2023;52(1):e23-e30.].

A Review on Lumps, Bumps, and Birthmarks: When and Why to Refer.

PURPOSE: Craniofacial microsomia (CFM) repre-sents a spectrum of craniofacial malformation, ranging from isolated microtia to underdevelopment of the mandible, maxilla, orbit, facial soft tissue

PC17. Implementation of an Enhanced Recovery after Surgery Protocol for Cleft Palate Repair

Retrospective observational study. The purpose of this publication is to address the absence of literature detailing respiratory management in patients with syndromic craniosynostosis and obstructive sleep apnea during the immediate postoperative interval following LeFort III advancement with placement of distraction hardware but prior to sufficient midface advancement. After IRB approval, the investigators retrospectively selected candidates for inclusion in this case series. The sample was composed of four patients ranging from 10 to 19 years of age undergoing LeFort III midface advancement during a one-year span at a single tertiary care center. All operations were performed by a single surgeon. Three of the selected patients suffered significant obstructive sleep apnea necessitating the operation, as determined by polysomnography. One patient experienced persistent apnea postoperatively requiring prolonged ICU level care. Three of the four patients had severe OSA diagnosed by polysomnography with a median AHI of 28.3. Two of the three patients with preoperative OSA experienced no untoward respiratory compromise in the immediate postoperative period; one required nightly oxygen tent and the other required no supplemental oxygen. Patient 1 experienced significant postoperative respiratory distress with nightly apneic episodes and desaturations requiring supplemental oxygen and frequent stimulation. The present study suggests that early involvement of sleep medicine and management of patient expectations is vital. Extremely close postoperative monitoring in the ICU is necessary. Future studies are needed to protocolize perioperative management of obstructive sleep apnea in patients undergoing LeFort III osteotomy prior to initiation and completion of midface advancement.

Perioperative Management of Obstructive Sleep Apnea in Patients With Syndromic Craniosynostosis Undergoing LeFort III Osteotomy With Distraction: A Case Series

SP27. Mandibular Distraction in Patients with Pierre Robin Sequence: A Multi-surgeon Experience

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