The standard approach to management of high imperforate anus is colostomy in the newborn period followed by posterior saggital anorectoplasty (PSARP) at 6 to 12 months of age. The purpose of this study was to determine whether a one-stage repair by primary PSARP in the newborn period could be performed without clear determent to the patient’s functional result. Totally 30 newborns with high imperforate anus who underwent primary PSARP without colostomy were studied retrospectively. All cases were studied by sonography, echocardiography, lower vertebra X-ray and finally routine blood and urine laboratory tests. Incontinence was defined as fecal soiling at least twice a day, and patients requiring more than office dilatation were described to have stricture formation. All patients recovered well and were followed for periods ranging from 1.5 to 10 years. There were 3 cases of postoperative wound infection, but no anastomotic dehiscence, stricture formation and fistula recurrence were seen. In cases of constipation and fecal incontinence there were associated anomalies such as sacral dysplasia, kidney dysplasia, ventricular septal defect and vesicoureteral reflux. There were no complications in other cases. The most important factor is patient selection, and one-stage PSARP spares the patient the morbidity of additional surgeries in the standard multistage approach for high imperforate anus. These preliminary results suggest that one-stage PSARP is a safe and viable approach to the management of high imperforate anus without clear determent to future bowel function.

Background: Posterior sagittal anorectoplasty (PSARP) is the newest and most-widely-used technique for correction of anorectal malformations (ARMs). In the present investigation, the functional outcomes of PSARP and also the relationship between the complications and the sacral ratio (SR) have been studied. Methods: The study group included 49 patients (25 males and 24 females) with ARMs, operated on by the PSARP technique during 1995 – 1999. The patients had been followed up for at least 4 years. Those with mental retardation were not included in this retrospective study. For objective evaluation of the sacrum, the SR was calculated in all of the patients. Results: In the female patients, rectovestibular fistula (46%) and in the males, perineal fistula and imperforate anus without fistula, each with equal frequency (28%) were the most common anomalies. The mean SR in the study group was 0.72 + 0.04. SR was 0.67 + 0.03 among patients who had associated urogenital anomalies, 0.69 + 0.04 in patients suffering from soiling, and 0.67 + 0.02 in patients who had postoperative fecal incontinence. The most common complication following PSARP was soiling (44.9%) and then constipation and fecal incontinence in order of frequency. None of the cases developed urinary incontinence or other urinary complications after PSARP. Seventy-three percent of the patients had voluntary bowel movements (VBMs) and 51% were totally continent. Conclusion: Although the PSARP has a negligible complication rate, the success and outcome of the surgical correction in view of the bowel function depend on the development of the sacral nerves. SR reflects the sacral bone development and can be easily calculated by a pelvic AP film. Considering the lower SR in patients suffering from postoperative soling and fecal incontinence, in comparison to the normal group (0.77), SR could be used as a prognostic index to predict the probability of achieving total continence following PSARP.

Anorectal malformation is one of the congenital diseases with incidence of 3 to 5 in 1000 live births, with a wide range of clinical manifestation from anterior displacement of anus to more severe anomaly with common channel in perineum for defecation and urination and vaginal interoitus. To rule out any variations in operation procedure, all the patients were operated by one surgeon. The results showed 90% success in fecal continence, which is favorable comparable with previous abdominosacral technique. Although now-adays abdominosacral approach is not used, most of the patients underwent this operation suffered from incontinence. In our study, soiling was observed in 8% of our patients. Furthermore, there was neither stricture, following the compete dilatation programme, nor other common complications such as fever.

Background: Fecal incontinence after repair of imperfoate anus is one of the major complications of the anorectoplasty surgery in children. Mental and emotinal distress of fecal incontinence can be problematic and therefore appropriate surgical management is essential. Rectal mislocation is a common cause of fecal incotinence after anorctoplasty in patients with imperfoate anus. Complete mislocation of the rectum is a term used when the rectum is totally displaced from the anal sphincter and partial mislocation is refered mostly to the partial defect of the anal sphincter. Surgical treatment of complete and partial mislocation of the anorectum may lead to fecal continence. The aim of this research was to evaluate the cause of the fecal incontinency and the therapeutic outcome of it in patients operated for imperforate anus and mislocation of the anorectum after anorectoplasey.Methods: The study was of descriptive and retrospective type. Eleven patients(7 boys, 4 girls) with mean age of 4.5 years who had fecal incontinence after anorectoplasty were evaluated. The diagnosis of fecal incontinence was based on EMG, MRI, and endoanal sonograply. The author used muscle stimulator under general anesthesia as a final assessment for drawing sphincter mapping to identify the location of the defect of anal sphincter. Two patients had complete mislocotion and 9 had partial mislocation of the sphincter muscle. Four patients had surgical repair without colostomy and 7 underwent repair together with colostomy. In 2 patients with complete mislocation, fecal incontinence was treated with anorectum relocation. Nine patients who had sphincter muscle defect (partial mislocation) underwent sphincter repair.Results: Out of 11 patients, nine had adequate control of their bowel movenment (were continent). Meanwhile two patients (6 and 11 years old) had occasional(2 to 3 times/week)involuntary gas passing (for 8 and 48 months after operation, respectively) which was treated medically with Dimethicone. Biofeedback therapy was also taught to enhance anal-sphincter muscle function. All patients had good social inteaction and and their behavior showed a high level of self confidence.Conclusion: Most of sphincter defects occur at 6 and 12 o'clock in lithotomy position. So pediatric surgeons have to operate carefully an anal sphincter repair during anorectoplasty procedure.

Purpose: The prognosis for patients with ophthalmomyiasis interna posterior is variable. In many patients the larva remains in the eye for years without inducing inflammationor loss of vision. Sometimes, the migratinglarva involvesthe macula or optic nerve and results in permanent visual loss or blindness.Methods: Our patient was referred secondary to decreased visual acuity in her left eye because of recurrent uveitis resistent to anti-inflammatory drugs. We found panuveitis with a subluxated lens. Pars plana deep vitrectomyand lensectomy was done and the larva was removed. Two days laterwe found localized inferior peripheral retipal detachment with multiple holes. Repeat vitrectomy, scleral buckling and endolaser photocoagulation was done.Results: Clinical examination 6 weeks later revealed visual acuity of 2/10 in the left eye.Conclusion: We suggest early removal of larva to prevent damage and visual loss in cases of ophthalmomyiasis interna posterior.

Background: Optimal surgical management of the neonate with imperforate anus (IA) depends on determining accurate location of sphincter muscle complex, pouch of rectum and rectourinary fistula. We aimed to investigate a novel minimally invasive technique of anorectoplasty assisted by intraoperative sonography pull-through for repair of anorectal malformation and rectourinary fistula. Materials and Methods: Eight male patients with anorectal malformation and IA underwent formation of a diverting colostomy within 48 hours after birth. These patients had anorectoplasty about 6-8 weeks postoperatively. A urinary catheter was inserted per urethra into the bladder and sonography of perineum was carried out under general anesthesia. The neoanus was reconstructed by suturing the pulled-through anorectum to the anal sphincter muscle complex and the skin using absorbable 4/0 sutures. Results: In all cases, the distance of pouch of rectum to the skin was 15-18 mm and entrance of the guide wire to fistula was 6-7 mm. Of eight patients 6 had removal of urinary catheter after two days, and 2 patients after 10 days because the fistula was not closed. The median range of hospital stay was 2. 12 days and follow-up was 30 days. We calibrate all of patients with size 12F dilators. Patients were followed up at one week and one month postoperatively, and all had defecation frequency of 3-5 times a day. There were no complications. Conclusion Intra-operative sonography guided pulled-through anorectoplasty (ISPA) is a novel and safe technique for surgical treatment of IA and rectourethral fistula. ISPA is a minimally invasive approach, which preserves the external anal sphincter muscle complex with good functional outcome.

Introduction: One of the most difficult procedures in orthodontics is the treatment of skeletal open bite. This malocclusion is characterized by back ward rotation of mandible, an obtuse gonial angle, an increased anterior facial height, and a E long face appearance. The treatment strategy of skeletal open bite has been mainly based on vertical growth inhibition, forward autorotation of mandible, and intrusion of posterior dent alveolar structures. Early treatment of this malocclusion is of great interest because the therapeutic approach is functional before growth has been completed and is surgical afterwards. Posterior bite-blocks are one of the functional appliances which are commonly used. The purpose of this study was to evaluate the effect of spring loaded posterior occlusal bite block (SLPOBB) on dento-facial structures in patients with skeletal open bite. Materials & Methods: In this clinical trial study, our sample group consisted of 23 skeletal open bite subjects (9 males and 14 females) having a mean age of 9.8, treated by SLPOBB until the open bite was completely dissolved and a favorable overjet was achieved. Cephalometric tracing was carried out on the lateral cephalograms taken prior to and after treatment. The data were analyzed using paired t-test to determine significant changes (a=0.05).Results: Skeletal changes: A statistically significant increase in SNB, ArGoGn, mandible length, anterior facial height, UFH, LFH, and posterior facial height was found.Decrease in ANB, Palatal plane/MeGo, SArGo, SNGoAr, and Y-Axis was also significant. Dental changes: The results revealed a significant increase in Upperl/Palatal plane height, Lower1/GoMe height & Upper 6/Palatal plane height and a decrease in Lower1/GoMe angle. Conclusion: SLPOBB was found to be effective in treatment of skeletal open bite by: 1) A significant decrease of mandibular posterior angles, an increase of posterior facial height, and upward and forward rotation of mandible. 2) Intrusion of mandibular first molars. 3) Extrusion of anterior dentoalveolar height, and lingual inclination of lower incisors.

Introduction: Among several cephalometric analyses used in orthodontics. Done of them could present all diagnostic and interpretative features. The aim of this study is to apply a simple and convenient approach which could enable the orthodontists to gain maximum information from it.Materials and Methods: Cephalograms of 58 adults patient (40 femals and 18males) with mean age of 15 years and 4 months, were used for analysis. After tracing, the relationship between mandibular plane and the most inferior point of posterior cranial fosse was assessed.Results: The data revealed that:- SNA and SNB were less than norms which was not significant. - In patients with normal facial height, extension of mandibular plane lay lower to posterior cranial fosse and the mean distance was 6.84 mm. - Mp-Ar-NAngle was 42°to 55°(49 ± 6) that was 2° less than Norms.Conclusion: Extension of mandibular plane to posterior cranial fosse or lower, shows that there is a failure in vertical growth.