Abshact. Our experience with the treatment of 450 cleft lip and palate patients who were operated late in life is presented. Preoperative findings as to facial growth, dental occlusion, hearing, and ear disease are discussed. Final results are analysed.The type of fissure according to the accepted embryological classification (Kernahan & Stark, 1958) is presented in Table 11. Scand J Plast ReconstrSurg 8 Scand J Plast Surg Recontr Surg Hand Surg Downloaded from informahealthcare.com by Nyu Medical Center on 06/29/15 For personal use only. 8 -742913 Scand J Plast Reconstr Surg 8 Scand J Plast Surg Recontr Surg Hand Surg Downloaded from informahealthcare.com by Nyu Medical Center on 06/29/15 For personal use only.

Myofascial pain syndrome is a painful muscle condition which is defined as local or referred pain associated with hypersensitive palpable nodules in the way of that muscle and is a frequent pathology in consultations on chronic pain. Botulinum toxin is an exotoxin produced by Clostridium botulinum, of which serogroups A, B and F have clinical utility (mainly type A-Botox ® , Dysport ®). This is one of the most potent neurotoxins and is administered compassionatelly in the treatment of myofascial pain syndrome. The toxin has a beneficial analgesic effect by reducing muscle hyperactivity but recent studies suggest that this neurotoxin may also induce analgesia by non-neuromuscular actions. Its use is not without risks. Adverse effects are related to the migration of the toxin and are usually mild or moderate and transient. There have been reports of prolonged muscle weakness and diseases like myasthenia gravis or Lambert Eaton syndrome triggered by the use of the toxin. We report a case of a male patient with myofascial pain syndrome whose psoas and quadratus muscles were treated with injections of botulinum toxin. Following the improvement in clinical muscle situation, repetitive diplopia and ptosis developed and the patient was diagnosed of myasthenia gravis. We review the pathogenesis of myofascial pain syndrome and myasthenia gravis and the use of botulinum toxin and relationships between them. We conclude that a detailed history is required prior to the use of botulinum toxin on patients with muscle pathology or signs of muscle weakness.

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