BSAPS Journal

Van der Woude Syndrome (VWS) is an uncommon autosomal dominant disorder that affects embryologic facial development and is characterized by two labial pits in the lower lip and is usually associated with cleft lip and cleft palate. Congenital lip pits are frequently associated with cleft lip and/or cleft palate in VWS; nevertheless, lip pits may be the only symptom in this condition. The prevalence of VWS is about 1 in 35,000 to 100,000 births and accounting for 2% of all cases with cleft lips and palates.

A 10-year-old boy presented with bilateral pits on the lower lip, one on either side of the midpoint. There was evidence of maxillary hypoplasia and he also presented with bilateral accessory auricles. Additional deformities such as cleft lip or palate were not present. The patient’s parents were eager for aesthetic correction. The lower lip pits with their tracts were excised under general anaesthesia. Wound healing and aesthetic outcome was satisfactory. Histopathological examination revealed fibrous tract, squamous epithelisation and fibres of skeletal muscle. 

Autologous fat grafting is widely used in breast augmentation and reconstructive breast surgery. Coleman has detailed the fat grafting surgical procedure. After centrifugation and refining, the fat is melted through small parts using blunt infiltration cannulas. With each cannula removal, the grafted tissue is deposited in tiny aliquots. To obtain an aesthetically acceptable breast shape, fat should be stacked into multiple layers from the chest wall to the skin. However, if not conducted properly, autogenous lipotransfer can result in problems such as fat necrosis, calcification, the creation of encapsulated fatty lumps (cystic lesions), lymphadenopathy, deformity of breast contouring, hypersensitive breasts, and itchy nipples. Six months after autologous fat grafting for breast augmentation elsewhere, a 36-year-old female patient came with several palpable cystic lesions, disturbed breast contouring, asymmetry, heightened sensitivity, and discomfort upon palpation. The patient had ultrasound and MRI screening, which showed of several bilateral cysts in the breast tissue. The big lesions were surgically removed, and the specimens were sent for pathology and cytology evaluation. Breast augmentation with silicone implants was performed a few months after surgical excision of these lesions and after symptoms decreased. It was possible to obtain an aesthetically acceptable outcome while also relieving the patient's initial symptoms. Evidence Level: Level II: Evidence derived from well-designed controlled studies that were not randomised therapeutic Study. 

Background: Poland's syndrome is an uncommon congenital abnormality characterized by unilateral lack of the pectoralis major muscle, ipsilateral brachysyndactyly, and is occasionally linked with other anterior chest wall deformities.

Case Report: A 28-year-old woman with marked hypoplasia of the right breast without any malformation of the right upper limb since birth was studied. Reconstruction was done with pedicled Latissimus Dorsi myocutaneous flap and silicone implant along with contralateral mastopexy to manage this case. The current literature on the topic is also reviewed.

Conclusion: The surgical method with combined autologous pedicled Latissimus Dorsi myocutaneous flap with implant is a reliable technique for breast reconstruction and can deliver an excellent outcome in long term in selected cases of Poland’s syndrome. 

Background: Earlobes play a vital role in the overall aesthetics of the ear and face. There are several forms of congenital auricular abnormalities. Multiple procedures for repairing the cleft earlobe have been proposed. These procedures aim to restore the ear's natural look and shape for aesthetic and social purposes.

Objective: The aim of the study is to discuss the technique used in the department of Plastic and Aesthetic Surgery at Bangladesh Specialized Hospital, Dhaka, for the repair of cleft earlobe.

Methods: A prospective study was carried out on the procedure used to repair cleft ear lobe in our hospital. We present 20 patients with congenital left earlobes.

Result: Gross disparity of the two sides of the cleft was minimised while restoring the anatomical curve of the earlobe. Skin grafts were not used. Visible scar was minimal and almost imperceptible.

Conclusion: This simple technique has the advantage of being easy to perform and at the same time provide good aesthetic results. 

Introduction: Evaluation of the surgical outcomes of frontalis brow suspension surgery and supra maximal levator resection in ptosis with poor levator function.

Methodology:  A cross-sectional, observational study from 2011 to 2018 comprising 60 patients with ptosis with levator function were divided into two groups. Patients in group A underwent supra maximal levator resection and in group B underwent frontalis brow suspension with different suspension materials. All the patients were operated upon by a single surgeon. The post operative results were deducted as Excellent (difference of MRD I with fellow eye < 1mm), Good (difference of MRD I with fellow eye 1 ≤ 2 mm) and Poor (difference of MRD I with fellow eye ≥ 2 mm).

Results: Outcome of group A; 66.67% excellent, 26.67% good and 6.67% poor. On the other hand, 46.67% were excellent, 13.33% were good and 40% were poor in group B. Deterioration occurred in both groups at 24 months. In group A it was 6.66% and in group B it was 20%. Both the groups had some complications. 6.66% under correction in group A and 40% in group B. 6.6% overcorrection and 6.6% lid notching in group A; none in Group B. Exposure keratopathy occurred 13.33% in group A and 20% in group B. Stitch granuloma occurred in 13.33% in group B whereas none in group A. All the complications were dealt with. 2 patients from group A and 6 patients from group B needed revision surgery with excellent to good results. 6 patients from group B did not undergo revision surgery as the degree of asymmetry was acceptable to the patient party. Exposure keratopathy was successfully treated with lubricants and ointments. 02 patient from group B needed extended frost suture for exposure keratopathy. Inter group difference was insignificant (p>0.05)  

Conclusion: Correction of ptosis with poor levator function being challenging, surgeons opt different techniques. Frontalis brow suspension being the most preferred method. Supra maximal levator resection is a newer technique that negates the use of suspension material with good postoperative outcome.

Glomus tumor is an uncommon condition that accounts for about 1% of all soft tissue tumors in the body. Glomus tumor is well known for its unusual presentation and long-standing symptoms due to delay in diagnosis. Authors have presented the clinical behavior and treatment of 6 patients with subungual soft tissue mass. Following surgical excision, all patients were cured of symptoms and at the end of follow up, no recurrence occurred; post operative nail deformity was insignificant.

Introduction: Breast augmentation also called augmentation mammoplasty is used to increase breast size usually by using silicone implants. It involves placing breast implants under the breast tissue or chest muscle. Subfascial breast augmentation was pioneered by Dr. Ruth Graf in Brazil. There are studies which indicates that sub facial breast augmentation is better than the other techniques commonly used. Regular silicone breast implants are the most popularly used by the plastic surgeons, as they feel and look more real and natural.

Aim of the study: The aim of the study was to evaluate the outcome of the subfascial breast augmentation surgery with silicone implants.

Methods: It is a retrospective study that was conducted with 15 patients enrolled in the department of Plastic & Aesthetic surgery from January 2018 to January 2021.

Result: Among the study population (N=15), the mean age of the samples was 28.67±SD, and the maximum and the minimum age of the study population were 36 and 18 respectively. Four study population 4(26.67%) were actresses and models, One-fifth of the study population 3(20%) were housewives, one-fourth 4(26.67%) of the study population were jobholders, and four 4(26.67%) were students. 80% of the study population underwent this surgery to improve body image and the rest of 20% of the study population were keen on breast augmentation surgery to improve their self-confidence. No complication was observed during the postoperative period and follow-up at three month, six months and at 1 year.

Conclusion: Subfascial breast augmentation provides natural results with adequate implant coverage, especially in the upper pole. So, palpability and visibility is minimized; and animation movement of the implant can be avoided. The morbidity and pain associated with the procedure is minimal and the recovery is rapid.