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Contacts with these participating organizations 2. Tennison or Triangular flap method. are made months before the actual mission to give Although more exact measurements have ample time for preparations to be made. At present, to be done, this method has given us for example, we already have monthly schedules consistently good results. This is for surgical missions up to October this year. especially true in case where the superior rotation from the horizontal plane of the cupids bow is severe. It can be rightly OPERATING ROOM PROCEDURES: argued that the low triangular flap used in this method makes for an obvious lip Our procedures at the OR remain standard scar. However, we feel that in young except for some modifications adapted for other children below the age of one, the very particular situation. An example of this is the two favorable scar maturation makes the scar bed set up in the OR for faster transit and turnover almost unnoticeable. of patients. This is particularly helpful if the procedures are successively done under local anes- 3. Rose-Thomson closure. thesia. Another example is the OR information sheet. This paper is placed on the OR wall providing This method used with a Z-plasty modiquick reference on needed patient information for the fication at the mucosal side have been anesthesiologist as well as the surgeon, used with satisfactorily results in small The information sheet provides the patient's name, age, sex,hemoglabin, blood type, diagnosis, incomplete surgery to be done, weight in kg. allowable blood B. For Bilateral Cleft lips: loss, and remarks for any patient idiosyncracy. The weight in kg. is particularly helpful beacauseit is used 1. Veau IiI tecnique for computing local and general anaesthetic dosages as well as allowable blood loss (14 cc/kg). Patients The need for single stage procedure are listed in sequence by which they are to be become more compelling in outreach operated, work. This method, which we have used in most of our cases, has the advantage of being a one stage prcedure giving results CHEILOPLASTY TECHNIQUES USED: that are cosmetically acceptable. clefts. Our cheiloplasty techniques have varied from 2. Two stage procedures. case to case. Definitely, we have come along way since the "hare lip pins" of old. Among the numerous In rare instances, we have had to resort techniques described for cleft lip repair since to 2 stage procedures when the protuding _ Mirault introduced cross flap techniques in 1844, we prexamilla prevents a reasonably tension have been using the following: free closure, especially when complicated by malnutrition in the child. We A. For Unilateral Cleft lips: have used 2 successive Millard I techniques to close a bilateral 1. Milard I and II good cosmetic results. This has been used in about 80% of the cleft lip with cases. Being a "sight method " or "cut SEQUENCE OF SURGERY: as you go technique", the need for exact measurements wi_ a caliper is not The sequence of doing the surgery has become necessary making this a convenient routine. It takes about 30 to 45 minutes when done method when calipers are _navailable or under local anaesthesia (in adults and older children) when doing several cases in a short period at about an hour if done under general anesthesia of time. (from intubation to extubation of patient). 53 "-|
After intubation and the endoctracheal tube placed in the midline to avoid lip distortion, the surgeon stays at the head of the OR table for a more symmetrical view of the patient lips. 1 2 Incision lines are marked Injection of incision site with Xylo with methylene blue or caine 1% with adrenaline 1:200,000 gentian violet dilution. Done even under G.A. our experience has shown that we have been using as much as 2/3 less maintenance dose of G.A.drugs (Ethrane). This redounds to a cheaper, safer surgery and a patient who wakes up faster 3 from general anesthesia. Incisions are done first with a blade 15 for the skin then with a blade 11 for the through and through incision keeping in mind PROPER ANOTOMICAL SPATIAL RELATIONSHIPS 4 After meticulous hemostasis, suturing in 3 layers is done (mucosa, muscle, skin) using chromic 3-0 and silk 5- 5 or 6-0, The wound is cleaned and an antiseptic :solution (betadine) is applied 6 Band aid is then apllied which we feel release some of the skin tension and has some pressure dressing effect. 7 This is retained for 24 hours. The wound is cleaned of dried blood the next day and an antibiotic ointment applied. The ointment helps prevent crust Iormation. An open dressing is preferred. Antibiotics am given routinely for 9 3-5 days in areas where sterile conditions are in doubt. This means in Sutures are removed in 5-7 days most areas. by local medical personnel. 8 54
Page 2 and 3:
Iq4LIPl:qut=S TABLE OF CONTENTS NEC
Page 4 and 5:
HEAD AND NECK SURGERY - TO ADD OR N
Page 6 and 7: PRESIDENT'S PAGE The years 1989-90
Page 8 and 9: RIZAL MEDICAL CENTER DEPARTMENT OF
Page 10: muscles. Again it is likely possibl
Page 15 and 16: area measuring 4.8 x 3.7 cm extendi
Page 17 and 18: tend to recur locally, even after p
Page 20 and 21: UNIVERSITY OF THE PHILIPPINES PHILI
Page 22 and 23: The majority of patients with hyper
Page 24 and 25: mass wa uttrasonograImy. Neck explo
Page 26 and 27: Figure 2 : Parathyroid Adcnoma vs.
Page 28 and 29: E.wa_ileMassonLe_Maxilla "salt& pep
Page 30 and 31: of some clinical features as well a
Page 34 and 35: MCU HOSPITAL DEPARTMENT OF OTOLARYN
Page 37 and 38: JOSE REYES MEMORIAL MEDICAL CENTER
Page 39 and 40: nonetheless stated: "We have the im
Page 41 and 42: to the diagnostic know-how of the c
Page 43 and 44: PATIENTS & METHODS: These signs and
Page 45 and 46: Most patients in group 1 complained
Page 47 and 48: DISCUSSION: and septal deviation mi
Page 49 and 50: OSPITAL NG MAYNILA DEPARTMENT OF OT
Page 51 and 52: ..temporary relief. According to Ha
Page 53 and 54: CASE REPORT phonuclear cells. The r
Page 55: TITLE:Cleft Lip Surgeryfor Rural Fi
Page 59 and 60: BIBLIOGRAPHY Converse, J.M., Recons
Page 61 and 62: UNIVERSITY PHILIPPINE DEPARTMENT OF
Page 63 and 64: Table 3. Distribution of Organism b
Page 65 and 66: J BIBLIOGRAPHY Y MACKOWIAK, P.A., J
Page 67 and 68: Figure 3. SENSITIVITY PATTERN OF Pr
Page 69 and 70: Figure 3. Percent SENSITIVITY PATTE
Page 71 and 72: loradatine 10 mg/tabletgiven once a
Page 73 and 74: 1. Severity of Symptoms 3. Comparis
Page 75 and 76: -J;r,ceiving 40 mg of loratadine da
Page 79 and 80: : ' : _ : ::::::: : : i : ::
Page 81 and 82: These patients are new patients see
Page 83 and 84: - Table Vl Baseline Signs and Sympt
Page 85 and 86: The following Table VII will show t
Page 87 and 88: • 14.Drowsiness: None 30 2 4 10 2
Page 89 and 90: Actifed's side effect of drowsiness
Page 91 and 92: " to be packed with one type of pac
Page 93 and 94: With regard to microbiology of nasa
Page 95 and 96: TABLE 6: MANNER OF CONTROL OF REBLE
Page 97 and 98: APPENDIX C MICROBIALGROWTH POTENTIA
Page 99 and 100: EAST AVENUE MEDICAL CENTER DEPARTME
Page 101 and 102: type (20%-30% of cases) varies from
Page 103 and 104: TABLE Ii HistologicalClassification
Page 105 and 106: THE LATERAL NASAL WALL IN FILIPINOS
Page 107 and 108:
MIDDLE MEATUS: Diameter of ostium:
Page 109 and 110:
.;4".,..:'.-" ............. '---.",
Page 111 and 112:
Figure 4. Variation in the location
Page 113 and 114:
This study presents variations with
Page 115:
ACKNOWLEDGMENT The authors would li
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