Shashank Chauhan

Background: Orofacial clefts are among the most common congenital anomalies worldwide, affecting approximately 1 in 700 live births. Despite surgical repair, most children require long‐term speech therapy; parental perspectives on accessing and continuing this therapy remain poorly documented in Low resource contexts. Objective: To explore the facilitators and barriers influencing access to and continuation of speech therapy for children with CP within the low resource context. Methods: A qualitative descriptive design was employed. Semi‐structured interviews were conducted with 32 caregivers (15 mothers, 17 fathers) of children with non‐syndromic cleft palate (all post‐palate repair) at a tertiary cleft care centre, (November 2023–July 2025). Purposive sampling ensured variation in child age, urban/rural residence, and therapy status. Sixteen interviews were conducted in‐person (mean duration 20 min) and 16 by telephone (mean duration 18 min) by a single Speech‐Language Pathologist interviewer. All interviews were conducted in Hindi. Data were analysed using Braun and Clarke's (2006) six‐phase reflexive thematic analysis by two independent coders. Member‐checking was conducted with six purposively selected participants to validate findings. Results: Four themes were identified: (1) Information deficit as a barrier—28/32 (87.5%) caregivers reported inadequate guidance at diagnosis or post‐surgery (mean importance 4.5 ± 0.8); (2) Structural, geographic, and financial barriers—20/32 (62.5%) reported challenges attending therapy (mean importance 3.8 ± 0.9), with a distinct urban/rural pattern; (3) Perceived therapy outcomes as a facilitator—all 32 participants discussed visible speech progress as the primary motivator for continuation (mean importance 4.7 ± 0.6); and (4) Social, emotional, and cultural impact—22/32 (68.8%) described stigma, psychosocial burden, and protective family support (mean importance 4.2 ± 0.7). Conclusion: Continuity of speech therapy is contingent on timely information, accessible care models, and empowered family engagement. Structured information at diagnosis, teletherapy, community rehabilitation worker models, and parent‐implemented home programmes represent actionable, context‐appropriate solutions. WHAT THIS STUDY ADDS: What is already known on this subject Existing research on cleft palate (CP) in low‐ and middle‐income countries (LMICs), highlights significant barriers to speech therapy access, such as limited local SLP providers, financial constraints, long travel distances, and resource shortages. Studies document high unmet needs for rehabilitative care, delayed intervention, and caregiver concerns about speech outcomes, social impacts, and information gaps at diagnosis. Qualitative work from LMICs has explored general parental experiences, psychosocial challenges, and treatment pathways, but caregiver perspectives specifically on facilitators and barriers to initiating and continuing speech therapy remain limited. What this study adds to existing knowledge This qualitative study provides novel, in‐depth insights from 32 LMICs caregivers on facilitators and barriers to accessing and continuing speech therapy for children with non‐syndromic cleft palate in a high‐burden LMIC setting. Using reflexive thematic analysis, it identifies four key themes: information deficits delaying early engagement; structural/geographic/financial barriers with urban‐rural contrasts; perceived therapy benefits as the main continuation driver; and broader social/emotional/cultural impacts. It offers the first detailed, context‐specific exploration of these issues from a tertiary centre perspective. What are the potential or actual clinical implications of this study? Findings underscore the need for improved information delivery at diagnosis to promote early SLP referral and engagement. Clinicians should address urban‐rural disparities through targeted strategies, such as telepractice or community outreach for geographic/financial barriers. Emphasizing observable therapy benefits may enhance continuation rates. Recommendations include multidisciplinary training for non‐specialists, culturally sensitive guidance, policy support for affordable SLP services, and community programs to reduce stigma and emotional burden—ultimately improving access, adherence, and outcomes in resource‐constrained LMIC settings. PRACTITIONER POINTS: Information deficits at diagnosis are a major barrier to early speech therapy engagement for children with cleft palate in LMICs—clinicians should prioritize clear, timely education. Structural and geographic barriers differ markedly between urban and rural caregivers; telepractice and community outreach may improve access and continuation. Perceived positive therapy outcomes strongly facilitate ongoing attendance—emphasizing observable benefits can enhance adherence in resource‐limited settings.

Angioleiomyoma is an uncommon benign vascular smooth muscle tumor, representing <1% of soft-tissue neoplasms in the upper extremity. Its rarity, variable symptoms, and nonspecific imaging features frequently lead to misdiagnosis, with lesions mimicking ganglion cysts, giant cell tumor of tendon sheath, schwannoma, leiomyosarcoma, or glomus tumor. Multidisciplinary radiology review plays a key role in evaluating such indeterminate hand masses. A 57-year-old male presented with a gradually enlarging, painless palmar swelling. Magnetic Resonance Imaging revealed a well-defined, heterogeneously T2-hyperintense subcutaneous lesion with intramuscular extension, tendon encasement, and involvement of the radial digital nerve—features that generated a broad differential at the institutional radiology conference. Surgical exploration showed an encapsulated tumor encasing several digital nerve fibers, which were repaired following en bloc excision. Histopathology demonstrated smooth muscle bundles around thick-walled vessels with myxoid change but no atypia. The presence of myxoid stroma and neurovascular encasement raised concern for neurogenic and other spindle-cell lesions, necessitating targeted immunohistochemistry (IHC). Smooth muscle actin and Desmin positivity with S-100 and Pan-TRK negativity confirmed angioleiomyoma. This case illustrates the diagnostic complexity of palmar angioleiomyoma, driven by clinical ambiguity, nondiagnostic imaging, myxoid stromal change, and unusual neurovascular involvement. Accurate diagnosis requires thoughtful integration of clinical, radiologic, intraoperative, and histopathologic findings. Focused IHC is essential to differentiate angioleiomyoma from its mimics and to guide appropriate management.

Wound management represents one of the most intricate and evolving challenges in modern clinical practice. With the rising incidence of diabetes, vascular disease, and an ageing population, the burden of chronic wounds has grown substantially, demanding both scientific insight and practical strategies. Against this backdrop, Dr. Arun Bal's Clinical Insights into Wound Healing—An Atlas offers a timely and authoritative contribution, combining foundational knowledge with clinical pragmatism and rich visual documentation. The book opens with a clear emphasis that a wound is not merely a break in the skin but a dynamic pathological state influenced by multiple systemic and local factors. The preface highlights the pressing clinical realities—delayed healing, recurrent infections, impaired vascularization, and the high risk of chronicity if acute wounds are mismanaged. By framing wound care as both a biological process and a public health priority, the author immediately underscores the relevance of this atlas to contemporary medical practice. The text is logically organized into four distinct sections: A defining strength of this atlas lies in its visual presentation. The carefully curated photographs and illustrations not only reinforce the textual content but also serve as a clinical repository, capturing the complexity and variability of real-world wounds. The language remains clear, concise, and free of unnecessary jargon, making it accessible to a broad readership ranging from students to senior clinicians. In summary, Clinical Insights into Wound Healing—An Atlas is more than a reference text—it is a practical companion that bridges the gap between theoretical science and everyday practice. The dedication, tenacity, perseverance, and hard work required in bringing out this book by Dr. Bal are commendable. The contribution by the editorial team of Mind's Lab Publishing is commended for its extraordinary and timely contribution. They have provided color photographs and plentiful tables with flow diagrams that give clear demonstrations of many important points. Mind's Lab Publishing has also done a remarkable job in producing this beautiful hardbound book with an appealing book cover and glossy ivory pages, offering a perfect contrast. This atlas deserves a place in every surgical library and wound care unit. It will serve not only as a quick reference for practicing clinicians but also as an invaluable teaching tool for residents and young doctors. Dr. Arun Bal has made a lasting contribution to the field of wound care by capturing the essence of wound healing and translating it into clinical guidance. Article published online: 10 October 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

Introduction: Palate development involves a genetic regulation through a complex molecular mechanism that may be disrupted by environmental factors, resulting in impaired fusion and cleft palate formation. An encounter with a case of cleft palate due to dorsal tongue hamartoma prompted us to perform this systematic review. Objective: To review the clinical profile and management approach for a case with cleft palate and tongue hamartoma. Design: A systematic literature search was conducted using keywords related to cleft palate and tongue hamartoma in PubMed, Scopus, MEDLINE, and Scielo databases through December 2021, with no time or language restrictions. Patients, Participants: Studies reporting patients with cleft palate and tongue hamartoma were included. Main outcome measure(s): Information related to clinical profile, diagnostic tests, histopathology, management, and outcomes were extracted. Fourteen relevant publications were identified with 16 cases reported so far. Among them, thirteen patients were females (81.25%), and 3 were males (18.75%). The age of presentation varied from birth to 19 years. Oral-facial-digital syndrome (type II) was the most commonly associated syndrome. Congenital tongue hamartoma with cleft palate is a rare presentation, which can present as an isolated entity or part of a syndrome. Genetic evaluation is warranted, particularly for multiple hamartomatous lesions. The preferred treatment is immediate excision of hamartoma while following a standard timeline for palatoplasty.

The first part of this review article emphasized correct nomenclature, classification systems, and imaging algorithm of vascular anomalies. The second part of the review discusses the individual entities, highlighting the characteristic clinico-radiological features of the commonly encountered ones. A step-wise algorithmic approach is also proposed for the evaluation of a suspected case of vascular anomaly.

Separation of total vertical craniopagus with shared venous sinuses poses multiple challenges. Provision of soft-tissue cover to the exposed brains at the time of total separation is one of them, due to the large size of the defect and paucity of local tissues. Staged separation of twins is advised with partial venous and parenchymal disconnection in the first stage and total separation in the second stage. Tissue expanders are inserted in the first stage, and second stage planned to coincide with the period of adequate expansion. In the child being reported, emergency second stage was done due to the deteriorating general condition of the children. Left with inadequate expanded skin, the critical defect in a twin was managed with bilateral trapezius myocutaneous flaps. High ionotropic support of the postoperative period resulted in superficial necrosis of the flap, which was managed by debridement, allograft application and autograft later. Both twins had well-healed wounds by 3 months.

Objective: The aim of the study was to analyze the caries protective factors, salivary parameters, and microbial counts in high caries risk children with cleft lip and/or palate (CL/P). Design: This was a cross-sectional study. Setting: This study was conducted in a tertiary health care teaching hospital in New Delhi, India. Participants: The study was conducted in 40 children, 20 with CL/P and 20 without aged between 5 and 12 years. Methods: Children with 2 or more caries lesions in both groups were included in this study. Demographic details, dental caries of affected teeth (World Health Organization criteria for Decayed Missing Filled Teeth [WHO-DMFT] and International Caries Detection and Assessment System [ICDAS II]), caries protective factors, salivary parameters, and microbial counts were recorded by one calibrated investigator. Main Outcome Measures: Caries protective factors, salivary parameters, and microbial profile. Results: The Chi-square (χ²) test and Pearson correlation were used for statistical analysis. All the children participating in the study brushed their teeth only once in a day and consumed sweets more than twice a day. None of the children had ever received fluoride varnish. Resting saliva had a low buffering capacity in 80% of children with CL/P and 95% of children without CL/P. Microbial assessment of stimulated saliva showed that with the increases in the numbers (DMFT scores ≥4) and severity (ICDAS codes from 1-2 to 5-6) of caries lesions, both Streptococci and Lactobacilli counts were ≥10⁵ colony-forming units/mL of saliva in the both groups. Conclusions: Children with CL/P showed limited access to caries protective measures and low buffering capacity in resting saliva, along with elevated levels of salivary Streptococci and Lactobacilli in stimulated saliva.