Rossell Perry, Percy Eduardo

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Rossell Perry, Percy Eduardo
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2014 - 2019132020 - 202568

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    Anatomy and Physiology
    (2024-01-01)
    Rossell Perry, Percy Eduardo  
    Cleft lip and palate is the most common congenital craniofacial disease. Multiple studies have shown that the medial nasal process remains centralized and fails to fuse with the lateral maxillary process during their development, resulting in the characteristic...
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    Is the Use of Opioids Safe after Primary Cleft Palate Repair? A Systematic Review
    (2021-01-01)
    Percy Rossell‐Perry  
    ;
    Carolina Romero-Narváez
    ;
    Ruth Rojas-Sandoval
    ;
    Paula Andrea Gómez-Henao
    ;
    Maria Pia Delgado-Jimenez
    Pharmacologic treatment of postoperative pain after cleft palate repair includes opioids and nonopioid analgesics, nerve blocks, and local anesthetic infiltration. Use of opioids in infants has concerns regarding sedation, risk of aspiration, respiratory depression, and respiratory distress. The main objective of this review was to analyze information available on the safety of the use of opioids during perioperative management of pain related to primary cleft palate repair in published studies. METHODS: A systematic review of the literature for studies published until March 2020 was performed to evaluate the safety of opioid drugs during primary cleft palate repair pain management. The authors chose the following MesH terms for this systematic review: cleft lip and palate AND opioids AND pain management. The investigators performed a systematic literature search using the Pubmed/MEDLINE, Embase, Web of Science, and Cochrane Library databases. RESULTS: After a literature search resulting in 70 identified studies, 9 were qualified for the final analysis, which included 772 patients. There was a high level of evidence in the selected studies according to the Oxford CEBM Level of Evidence classification and GRADE scale. The most common adverse event reported was postoperative nausea and vomiting (from 5% to 25%). Episodes of oxygen desaturation have been reported from 2.5% to 7.4% of the studied patients. CONCLUSION: s: Definitive conclusions about the safety of opioid drugs during primary cleft palate repair pain management cannot be drawn. Vomiting and oxygen desaturation have been associated with the use of opioids in the studied population.
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    An Innovative Method for Nasal Injury Repair after Use of Continuous Positive Airway Pressure in Newborns
    (2020-10-13)
    Percy Rossell‐Perry  
    Nasal continuous positive airway pressure is used in intensive care units as respiratory support for newborns. One of the reported complications is columellar necrosis. The mechanism seems to be the pressure generated by the prongs. The sequela is characterized by absent columella with nasal tip depression and sometimes external nasal valve obstruction. Different authors have reported this complication in their studied samples; however, treatment strategies are not well documented.1,2 Jayaratne et al.,3 in a case report, described a technique based on the principle of the Cronin columellar lengthening method. However, unnatural appearance of the nostrils and visible subnasal scars seem to be limitations of this method. Auricular chondrocutaneous composite grafts have been reported in the literature. Chang et al.4 published a case series using these grafts. The main advantages are avoidance of nasal scars and provision of tip support. However, different color and skin texture of the graft and risk of composite graft loss are reported complications of this technique. The bilateral reverse-U technique described by Tajima and Maruyama5 has been described before only for bilateral primary cleft lip nose repair. This article describes a personal surgical technique for nasal repair in patients with columellar necrosis caused by nasal continuous positive airway pressure treatment. The columella is repaired using tissues from the tip of the nose. This method is based on bilateral inverted-U incisions described by Tajima and currently used for primary bilateral cleft lip nose repair. The patient is operated on under general anesthesia. Initially, the scar tissue from the nasal septum and remaining borders of the columella is trimmed. Then, bilateral inverted-U nasal and marginal incisions are performed and finally connected, as in Figure 1.Fig. 1.: Preoperative view showing the nasal tip flap technique for columellar reconstruction.The distance from the top of the incision to the nostril rim should be the same as the length of the columellar defect (approximately 4 mm). The area of skin between these incisions (soft triangle area) is resected, as in Figure 1. The nasal flap is dissected using fine scissors at the level of the cartilages of the nose and elevated like an open rhinoplasty. The subcutaneous tissue including the nasal superficial musculoaponeurotic system and fat compartments of the nose provides volume for improvement of the nasocolumellar angle. Finally, the cutaneous flap is mobilized down and sutured to the base of the columella and the caudal septum and nostril rims using fine absorbable sutures (Fig. 2). Structural support of the repaired columella may be provided (if necessary) at later age because cartilages are too thin to be used at an early age.Fig. 2.: Postoperative view of the nasal tip flap technique for columellar reconstruction.The technique described here provides good aesthetic and functional outcomes using local tissues. [See Figure, Supplemental Digital Content 1, which shows the preoperative view of a 1-year-old patient with severe columellar injury after using nasal continuous positive airway pressure (nasal incisions in blue), https://links.lww.com/PRS/E302. See Figure, Supplemental Digital Content 2, which shows the postoperative front view of the patient after surgery illustrating cosmetic improvement of the nose after 1 year, https://links.lww.com/PRS/E303.] The main limitations of this technique are as follows: bilateral nasal soft triangle resection, lack of structural support during primary repair, and turned-up appearance of the nose. The innovative technique presented here may be useful to improve columellar appearance and external nasal valve function in patients with nasal injury caused by continuous positive airway pressure treatment. DISCLOSURE The author has no financial interest to declare in relation to the content of this article.
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    Rotational Composite Flap Technique for Primary Incomplete Cleft Nose Deformity
    (2020-06-01)
    Percy Rossell‐Perry  
    BACKGROUND: Nasal deformities accompanying unilateral incomplete cleft lip have minor skeletal and soft tissue deficiencies compared with deformities associated with unilateral complete cleft lip. Extended dissection and surgical incisions (often required for nasal deformities in complete cleft lip) are not recommended to address deformities accompanying incomplete cleft lip. The purpose of this study is to describe an innovative method involving a rotational composite flap for nasal repair in patients with unilateral cleft lip. METHODS: Since 2016, 49 consecutive patients with unilateral incomplete cleft lip have undergone primary anatomical repair of accompanying nasal deformities. The technique involves a skin incision along the marginal and intercartilaginous borders to create a V-shaped composite flap consisting of vestibular skin and alar cartilage. Rotational mobilization of the composite flap creates a triangular raw surface laterally, which is closed by advancement of the vestibular skin. RESULTS: This innovative method, which is based on the use of a rotational composite vestibular flap, achieves proper symmetry of the repaired nose. CONCLUSION: The herein described composite flap rhinoplasty is a good surgical option, which provides a good overall nasal symmetry in patients with nasal deformities accompanying unilateral incomplete cleft lip.
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    Discussion of Enhanced Recovery After Surgery Protocol for Primary Cleft Palate Repair: Improving Transition of Care
    (2020-11-04)
    Percy Rossell‐Perry  
    Post Graduate Studies School of Medicine, San Martin de Porres University, Plastic Surgery Assistant Edgardo Rebagliatti Hospital Lima, Peru. Address correspondence and reprint request to Percy Rossell-Perry, PhD, FACS, Schell St No 120 Apt 1503 Miraflores Lima 18 Peru; E-mail: [email protected], [email protected] Received 16 July, 2020 Accepted 1 August, 2020 The author reports no conflicts of interest.
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