Restoring the integrity of the external nose presents a complex surgical challenge due to its three-dimensional structure and subunit divisions. The most frequent causes of nasal defects include basal or squamous cell carcinoma, animal bites and trauma. The reconstruction approach varies depending on factors such as the defect’s size, the affected subunit of the nose, the condition and quality of the surrounding tissues and the surgeon’s expertise. Commonly employed surgical techniques for nasal reconstruction include the forehead flap, nasolabial flap, Rieger flap, bilobed flap, and free autologous skin graft. We present a clinical case of a patient with a full-thickness nasal alar defect who underwent three-layer reconstruction with a combination of an inverted skin flap- for the internal lining, a conchal graft to substitute the missing alar cartilage and a forehead flap for external coverage. One of the challenges of nasal reconstruction surgery is to restore a full-thickness defect, especially the internal nasal lining. We offer a different perspective on this problem, showcasing considerable advantages, as there are limited literature data on this method.

Background: Restoring the integrity of the lower eyelid presents a complex surgical challenge due to its lamellar structure and the high risk of complications. Among these, ectropion is the most frequent and troublesome outcome. Objective: This study aims to present a case of lower eyelid reconstruction following the excision of squamous cell carcinoma using Mohs micrographic surgery combined with the Mustardé cheek rotation flap technique, highlighting its advantages, limitations, and applicability in elderly patients. Case presentation: A 93-year-old female patient with right lower eyelid squamous cell carcinoma underwent Mohs micrographic surgery. The resulting defect was reconstructed using a Mustardé cheek rotation flap, chosen for its suitability in patients with adequate skin laxity. Patient-specific risk factors, including advanced age, a history of ischemic stroke, and class II heart failure (NYHA classification), were considered in the surgical planning stage. Results: The Mustardé cheek rotation flap provided a reliable closure with a favorable esthetic outcome and inconspicuous scarring, aligned with natural anatomical margins. The technique was technically straightforward in this patient owing to age-related skin laxity. No major postoperative complications were observed. Conclusions: The Mustardé cheek rotation flap represents a safe and effective reconstructive option for elderly patients with lower eyelid defects following tumor excision. This case illustrates the esthetic and functional benefits of the technique while emphasizing the need to tailor reconstruction strategies to patient comorbidities and defect characteristics.

Introduction: An original software platform was developed as a partnership between a Parent Organization (www.ALA-BG.org) and a Cleft Center (Medical University Hospital of Plovdiv, Bulgaria). Methods: The software platform enables both the multidisciplinary team and patients to access and update the information referring to certain treatment stages, the treatment plan and the outcome of a stage in a patient's treatment. The information includes data provided by different specialists involved in the multidisciplinary treatment who work at different geographical locations by using the Internet and the original software platform in conformity with the confidentiality and personal data protection requirements. The patient and family are in charge of their own personal data. The patient specifies which specialists can have access and what they may access. All specialists can add their notes and data (text, audio, pictures, video and PDF files) into the patients database. Results: In 2014 the funding for DFA has stopped and ALA receive the rights to develop the database DFA in an Electronic Medical Record, www.emrfa.org. EMRFA was put into operation in 2015, and in 2017 all target functionalities in the system were completed. More than 800 patients are included and the following of the patients have improved substantially. Conclusion: EMRFA can be easily translated into another language and modified for multidisciplinary treatment of other disorders; furthermore, there is a provision for connection and information exchange with other electronic medical records.

Cleft lip with or without cleft palate is the most common congenital malformation of the head and neck. Children with cleft anomalies may experience a multitude of physical and developmental challenges. Psychosocial and emotional concerns of the patients and their families can also occur. As such, comprehensive care for the patient with cleft lip and/or palate requires an interdisciplinary team. This article describes epidemiology, embryo-logical developmental processes, known environmental and genetic risk factors, and their interaction, the assessment and current treatment recommendations for children born with cleft lip and/or cleft palate. We review the commonly used surgical techniques for repair, clinical outcomes and complications. Throughout the discussion, we share our experience and identify areas for future study with the focus on cleft palate management.

Changes in outcomes during growth and subsequent treatment require not only a multidisciplinary approach but also a system enabling the follow-up of the patients. We present our ten years of experience with an innovative web-based platform that follows around 1500 patients born with facial anomalies on a national level. The degree of the full follow-up can be measured by the number of patients that drop out and the number of patients that have global assessment scores at a fixed period of age. At our actual level of integration of the filters, reminders, and statistics the level of coverage of the outcomes is between 18 to 39% based on the global assessment scores in different periods of age. Even if we had organized several pieces of training for parents in the last three years it is evident that we should improve in future the clarity of our messages in leaflets, training, and websites.

Background: Cleft lip with or without cleft palate (CL ± P) is a common congenital anomaly requiring a multidisciplinary team approach from birth into adulthood. Many patients undergo multiple secondary procedures on the lip, nose, and alveolus, representing a substantial long-term “burden of care” for families and health systems. The relationship between preoperative cleft severity and the cumulative number of surgical interventions into late adolescence remains insufficiently characterized. Methods: A retrospective cohort study was conducted on 166 patients with cleft lip ± cleft palate treated at a single tertiary cleft center. All patients underwent primary cheiloplasty, with or without concomitant gingivoperiosteoplasty (GPP), and had follow-up extending to a mean age of 18 years. Preoperative nasolabial deformity was graded into four categories (mild, moderate, severe, and very severe) using standardized photographic assessment. The primary outcome was the total number of cleft-related surgical interventions on the lip, nose, and alveolus, including the primary operation and all subsequent corrective procedures. Associations between preoperative severity and surgery counts were analyzed using the Kruskal–Wallis test and Bonferroni-adjusted pairwise comparisons. Results: All 166 patients underwent a primary procedure, either cheiloplasty alone (n = 86; 51.8%) or cheiloplasty combined with GPP (n = 80; 48.2%). A second surgical intervention was performed in 111 patients (66.8%), yielding 138 procedures, most commonly GPP with bone grafting (n = 54), corrective cheiloplasty (n = 48), GPP without graft (n = 23), and rhinoplasty (n = 12). A third intervention was performed in 48 patients (28.9%; 70 procedures), predominantly rhinoplasty and additional cheiloplasties, and a fourth intervention in 13 patients (7.8%; 17 procedures), mostly staged rhinoplasty and lip revisions. Overall, 56 patients (33.7%) had only one (primary) operation, 50 (30.1%) had two, 27 (16.3%) had three, 18 (10.8%) had four, 13 (7.8%) had five, and one patient (0.6%) had six surgical interventions. The total number of operations differed significantly across severity grades (Kruskal–Wallis p < 0.001). Patients with mild and moderate severity had significantly fewer surgeries than those with severe or very severe deformities (all p ≤ 0.023), whereas differences between mild vs. moderate and severe vs. very severe were not significant. Conclusions: In this cohort of patients with cleft lip followed to a mean age of 18 years, two-thirds required at least one secondary procedure, and nearly one-fifth underwent four or more surgeries. Higher preoperative severity was strongly associated with greater surgical burden, particularly when comparing mild or moderate deformities to severe and very severe clefts. These findings underline the importance of preoperative severity assessment for family counseling, expectation management, and the design of treatment protocols aimed at minimizing the long-term burden of care while preserving functional and esthetic outcomes.