Browsing by Author "Shakya, Pramila"
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Publication Anterior Palatal Fistula Closure with Tongue Flap(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Goit, Bipulesh; Singh, Sunil Kumar; Thapa, Swosti; Pradhan, Leeza; Shakya, PramilaAbstract: Palatal fistula is an abnormal oronasal communication with incidence of 4% to 35% and recurrence up to 25%. Repairing large palatal fistula can be technically challenging. Anteriorly based tongue flap may be the flap of choice for recurrent and symptomatic anterior palatal fistula. A case of bilateral complete cleft lip, alveolus and palate with residual anterior palatal fistula was successfully managed with anteriorly based tongue flap. Postoperative care included liquid diet, oral hygiene and flap division after 2 weeks. Wound healing was satisfactory and uneventful. No flap loss, speech impairment, taste disturbance or functional tongue morbidity was noted. The tongue flap is a highly reliable flap with reported success rates of 85% to 95.5% in management of palatal fistula. Based on our experience, tongue can be considered a good option and highly recommended for the closure of large & recurrent palatal fistula.Publication Pedicled Buccal Fat Pad versus Conventional Gelfoam in Management of Lateral Palatal Defect Healing After Primary Palatoplasty(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Singh, Sunil Kumar; Goit, Bipulesh; Thapa, Swosti; Pradhan, Leeza; Shakya, PramilaAbstract: Introduction: Delayed mucosalization of lateral palatal defects following palatoplasty may increase postoperative pain, discomfort, and risk of complications. The pedicled buccal fat pad has been used as a biological dressing to enhance intraoral wound healing; however, systematic evaluation following palatoplasty remains limited. This study aimed to evaluate mucosalization time of buccal fat pad-covered lateral palatal defects and compare outcomes with conventional management. Methods: An observational study was conducted at Kirtipur Hospital, Nepal, from August 2025 to January 2026. Thirty non-syndromic cleft palate patients undergoing primary palatoplasty were enrolled consecutively and divided into two groups: Group A (n=15), managed with purified gelatin (Gelfoam), and Group B (n=15), managed with pedicled buccal fat pad coverage. Postoperative pain, cheek swelling, operative duration, and time to complete mucosalization were assessed. Data were analyzed using descriptive statistics, chi-square test, and independent t-test. Results: Baseline demographic characteristics, defect size, and operative duration were comparable between groups. Mean time to complete mucosalization was significantly shorter in the BFP group (2.20 ± 0.41 weeks) than the conventional group (4.00 ± 1.07 weeks; p<0.05). Postoperative pain on the day of surgery was significantly lower in the BFP group, while no postoperative bleeding was observed. Transient cheek swelling in some BFP cases resolved spontaneously. Conclusion: The pedicled buccal fat pad significantly accelerates mucosalization of lateral palatal defects and reduces early postoperative pain without adding substantial operative time. It is a safe and effective adjunct in cleft palate reconstruction.Publication Prevalence of Dental Anomalies in the Patient with Cleft Lip and Palate Visiting a Tertiary Care Hospital(Nepal Medical Association, 2020) Pradhan, Leeza; Shakya, Pramila; Thapa, Swosti; Nakarmi, Kiran Kishor; Maharjan, Anjana; Sagtani, Reshu Agrawal; Rai, Shankar ManAbstract Introduction: Dental anomaly is one of the major problems in a child born with cleft lip and palate. These anomalies have deleterious effects on the dentition leading to aesthetic problems, impairment of mastication andimproper phonation. The aim of our study was to find out the prevalence of dental anomalies in patient with cleft lip and/or palate radiographically. Methods: A descriptive cross-sectional study was conducted from the 208 radiographs, collected by the convenience samplingtechnique with cleft lip and/or palate in Department of Burns, Plastic and Reconstructive Surgery, Nepal Cleft and Burn Centre, Kirtipur Hospital from January 2017 to July 2019.Ethical clearance for the study was obtained from Institutional Review Committee. Demographic data were collected and radiographs were evaluated for possible dental anomalies. Data obtained were entered and analysed in Statistical Package for Social Sciences version 23. Results: Dental anomalies were highly prevalent among cleft lip and palate patients with at least one anomaly present in 188 (90.4%) of patients with male 120 (57.4%) presenting more anomalies than female 88 (42.6%) population. The most common anomaly was dental agenesis 161 (77.9%). The prevalence of positional anomaly, morphological anomaly and supernumerary teeth were found to be 54 (26%), 33 (15.9%) and 20 (10%) respectively. Lateral incisor showed the highest incidence of agenesis among all other missing teeth 223 (65.2%). Conclusions: The prevalence of dental anomalies among patients with cleft lip and/or palate was found to be high. Tooth agenesis was the most common anomaly observed in the study with lateral incisor having the highest incidence of agenesis. Keywords: cleft lip and palate; dental anomalies; panoramic radiograph.Publication Radiographic Assessment of Secondary Autogenous Bone Grafting in Alveolar Cleft Patient at Kirtipur Hospital(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Goit, Bipulesh; Singh, Sunil Kumar; Thapa, Swosti; Pradhan, Leeza; Shakya, PramilaAbstract: Introduction: Alveolar bone graft is the procedure to fill the gap in the gum with bone so the teeth and jaw can grow normally. It is an integral part and most commonly performed procedure in cleft patients. The study is aimed to evaluate the outcomes of secondary alveolar bone grafting through bone fill at alveolar defect site using 2- dimensional radiographs. Methods: We conducted a single center prospective cohort study at Kirtipur Hospital, Nepal from July 1st, 2025 to December 30th, 2025. Patients who underwent alveolar bone graft were evaluated for outcome of grafting through bone fill seen on intra oral radiographs using Kindelan score grading at 3-4 months post operatively. Outcomes were dichotomized as successful (Kindelan score 1–2) and failure (Kindelan score 3–4). Results: We had a total of 16 cases with 6 males (37.5%) and 10 female (62.5%) patients who had a median age 15.5 years (IQR 11.5, 18). Radiographic success as defined by Kindelan score 1–2 was achieved in 12 cases (75.0%) and failure in 4 cases (25%) with no statistically significant association between sex and radiographic success (p = 0.234). There was good to excellent intra-observer agreement (ICC = 0.89 & 0.96 for observer 1 & 2) and excellent inter-observer reliability (ICC = 0.96). Conclusion: Secondary autogenous alveolar bone grafting demonstrated favorable early radiographic outcomes, with 75% of patients achieving satisfactory bone fill at 3–4 months postoperatively. The Kindelan scoring system proved to be a reliable and reproducible method for radiographic evaluationPublication Use of a Buccinator Myomucosal Flap for Wide Recurrent Palatal Fistula Repair(Public Health Concern Trust-Nepal (phect-NEPAL), 2025) Singh, Sunil Kumar; Goit, Bipulesh; Thapa, Swosti; Pradhan, Leeza; Shakya, PramilaAbstract: Palatal fistula is a common and challenging complication following cleft palate repair, particularly in recurrent cases with scarred local tissues. The buccinator myomucosal flap (BMMF) provides a well-vascularized regional option for fistula closure. We report a 17-year-old male with a wide recurrent palatal fistula following multiple cleft palate surgeries. The defect, extending from the hard–soft palate junction to the pre-alveolar region, was reconstructed using a posteriorly based unilateral BMMF after nasal layer closure. The flap provided adequate reach and tension-free oral lining. Postoperative recovery was uneventful, with minimal donor-site morbidity. At four-year follow-up, the patient demonstrated stable fistula closure, healthy mucosalization, and no functional complications.