Browsing by Author "Singh, Sunil Kumar"
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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 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 Small Cell Lung Carcinoma with Pancoast Syndrome: A Case Report(Nepal Medical Association, 2022) Limbu, Sion Hangma; Bhatta, Narendra; Mishra, Deebya Raj; Acharya, Achyut Bhakta; Verma, Avatar; Shahi, Rejina; Katuwal, Srijan; Singh, Sunil KumarAbstract: Small cell lung cancer mostly arises centrally in the large bronchi. The literature search revealed very limited cases of small cell lung cancer arising at the upper part of the pulmonary sulcus near the thoracic inlet as superior sulcus tumor and also manifesting with typical Pancoast syndrome. We report a case of a 71 years old male patient, presenting with features of Pancoast syndrome including Horner’s syndrome with completed three cycles of chemotherapy resulting in partial response which concludes that small cell lung carcinoma has to be considered despite the clinical findings like pancoast syndrome.Publication 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.