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The Smile Index: Part 3. A Simple, Prognostic Severity Scale for Unilateral Cleft Palate. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3870. [PMID: 34703715 PMCID: PMC8542126 DOI: 10.1097/gox.0000000000003870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
Background Unilateral cleft palates have a large spectrum of variability. Key morphologic factors such as cleft width and palatal length are not represented in current classification systems. Palate length and velopharyngeal port size are clinically linked to speech outcomes, as the soft palate must close the posterior pharynx for proper phonation. This study investigates the relationship between objective preoperative measures and postoperative velopharyngeal port size, to define a reproducible severity scale. Methods Surgical data were prospectively collected from unilateral cleft palate patients in Morocco, Bolivia, Vietnam, and Madagascar. Key measurements were cleft width and palate width at the hard-soft palate junction, alveolar cleft width, vertical alveolar discrepancy, velopharyngeal port size. Cleft width ratio (CWR) was defined as the width of the cleft at the hard-soft junction, divided by the palate width. Results Seventy-six patients were evaluated. Thirty-one had complete clefts and average age at surgical repair was 2.9 years. Mean CWR was 0.50 ± 0.12. Palate length was increased by an average of 2.2 mm (11%) after palatoplasty. Multivariate analysis determined greater CWR and larger preoperative velopharyngeal ports were significantly correlated with a smaller percent change in palate length after palatoplasty (P < 0.01). Conclusions A wider palatal cleft decreases the surgeon's ability to decrease velopharyngeal port size through palatoplasty. Given the ease of measurement even in low-resource settings, CWR may be a valuable tool for setting expectations for speech results, modifying surgical technique, and correlating future speech outcomes in evidence-based cleft care.
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Biomechanical behavior of an alveolar graft under maxillary therapies. Biomech Model Mechanobiol 2021; 20:1519-1532. [PMID: 33893875 DOI: 10.1007/s10237-021-01460-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
Cleft lip and palate is a congenital defect that affects the oral cavity. Depending on its severity, alveolar graft surgery and maxillary orthopedic therapies must be carried out as a part of the treatment. It is widely accepted that the therapies should be performed before grafting. Nevertheless, some authors have suggested that mechanical stimuli such as those from the maxillary therapies could improve the success rate of the graft. The aim of this study is to computationally determine the effect of maxillary therapies loads on the biomechanical response of an alveolar graft with different degrees of ossification. We also explore how the transverse width of the cleft affects the graft behavior and compare results with a non-cleft skull. Results suggest that stresses increase within the graft as it ossifies and are greater if maxillary expansion therapy is applied. This has consequences in the bone remodeling processes that are necessary for the graft osseointegration. Maxillary orthopedic therapies after graft surgery could be considered as a part of the treatment since they seem to act as a positive extra stimulus that can benefit the graft.
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Leclerc JE, Gilbert F, McConnell ÉM, Beaudoin E, Bouchard J, Simonyan D. Furlow Palatoplasty: Should We Also Focus on the Size of the Nasopharynx? Cleft Palate Craniofac J 2021; 58:1348-1360. [PMID: 33631972 DOI: 10.1177/1055665620987684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES (1) To determine the incidence rate of velopharyngeal dysfunction (VPD) according to 7 speech criteria post-Furlow palatoplasty. (2) To find an anatomical measurement of the cleft palate (or combination of measurements) associated with the occurrence of VPD. STUDY DESIGN Retrospective cohort study. PARTICIPANTS AND METHODS Fifty-six patients with cleft palate ± cleft lip underwent palatoplasty with the Furlow technique at the age of 10 months. Pre-and post-palatoplasty cleft palate measurements were collected during the procedure. Three blinded speech-language pathologists (SLPs) retrospectively scored the patients from the chart data at age 4. Student t test and receiver operating characteristic curve analysis were used to evaluate the association and predictive capacity between cleft measurements and parameters (M&P) with all VPD criteria. RESULTS The SLPs found an incidence of VPD according to 7 criteria: hypernasality (11%), audible nasal emission (4%), nasal rustle (14%), compensatory errors (4%), impairment of speech understandability (7%), and impairment of speech acceptability (16%). The SLPs recommended a secondary surgical procedure in 5 patients (9%). A statistically significant association was found between, respectively, 17 and 5 M&P and the occurrence of compensatory errors and audible nasal emission. Our data suggest that the length of the cleft, the cleft area, and the postoperative transversal size of the nasopharynx are the best indicators of the future positivity of VPD criteria. CONCLUSION The size of the postoperative transverse nasopharyngeal area during the primary cleft palate procedure may become the focus of the next generation of cleft surgeons to reduce the incidence of VPD.
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Affiliation(s)
- Jacques E Leclerc
- Department of Otolaryngology-Head and Neck Surgery, Centre hospitalier universitaire de Quebec - Université Laval, Quebec, Canada
| | - Francis Gilbert
- Department of Otolaryngology-Head and Neck Surgery, Université Laval, Quebec, Canada
| | - Élisa-Maude McConnell
- Department of Speech-Language Pathology, Centre hospitalier universitaire de Québec-Université Laval, Quebec, Canada
| | - Ericka Beaudoin
- Department of Speech-Language Pathology, Centre hospitalier universitaire de Québec-Université Laval, Quebec, Canada
| | - Johanie Bouchard
- Department of Speech-Language Pathology, Centre hospitalier universitaire de Québec-Université Laval, Quebec, Canada
| | - David Simonyan
- Statistical and Clinical Research Platform, Centre hospitalier universitaire de Quebec Research Center-Université Laval, Quebec, Canada
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Long-term Speech Outcomes of Cleft Palate Repair in Robin Sequence versus Isolated Cleft Palate. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3351. [PMID: 33564582 PMCID: PMC7859383 DOI: 10.1097/gox.0000000000003351] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 12/28/2022]
Abstract
Supplemental Digital Content is available in the text. Whether treatment of cleft palate (CP) associated with Robin sequence (RS) should attain outcomes similar to those of isolated cleft palate (ICP) remains unknown. This study compares treatment and outcomes in both conditions and delineates predictors of long-term outcome.
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Complications and the Need for Long-Term Follow-Up after Secondary Speech Surgery: A National and Longitudinal Claims Analysis. Plast Reconstr Surg 2021; 146:1340-1346. [PMID: 33234965 DOI: 10.1097/prs.0000000000007339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although most patients attain normal speech after cleft palate repair, up to 20 percent require secondary speech surgery. Despite the frequency of these procedures, complications and rates of subsequent revisions of secondary speech surgery after all procedure types have never been reviewed using national, longitudinal data. METHODS The authors examined insurance claims from Clinformatics Data Mart between 2001 and 2017. Cases were categorized as palatalprocedures (i.e., palatoplasty, revision palatoplasty, secondary lengthening, palatal island flap) or pharyngeal procedures (i.e., pharyngeal flap, dynamic sphincter pharyngoplasty) (n = 846). Continuous enrollment from 180 days before to 30 days after surgery was required. Patients were excluded if they underwent palatoplasty, or any surgery at less than 3 years of age, without a speech diagnosis. Outcomes included 30-day complications and rates of subsequent revision secondary speech surgery. Multivariable logistic regression was used to evaluate the relationship between procedure type and complications. RESULTS In this cohort, 52.5 percent underwent pharyngeal procedures, and 47.5 percent underwent palatal procedures. Complications occurred in 10.9 percent of patients and included respiratory complications (4.0 percent), bleeding (1.2 percent), dehiscence (3.6 percent), and critical care episodes (3.0 percent). There was no difference in complications between procedure types (OR, 0.87; 95 percent CI, 0.56 to 1.37; p = 0.56). The subsequent revision rate was 12.7 percent, but was 21.7 percent in patients with 3 years of postoperative enrollment. CONCLUSIONS Although complication rates were comparable to those in recent literature, rates of subsequent revisions of secondary speech procedures were high in patients with longer postoperative enrollment. Thus, these patients merit prolonged follow-up, as velopharyngeal dysfunction may recur over time. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Liu CX, Li JT, Zheng Q, Guo CL, Yin H. [Factors affecting the postoperative velopharyngeal function among aged patients with cleft palate]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:626-630. [PMID: 31875441 DOI: 10.7518/hxkq.2019.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the prognostic factors affecting the primary surgical management of aged patients with cleft palate. METHODS This study reviewed aged patients with cleft palate who received Furlow palatoplasty (surgical age≥5 years) at the cleft center at West China Hospital of Stomatology from 2009 to 2014. The study retrieved intraoperative mea-surements, including velar length, pharyngeal depth, cleft width, maxillary width, cleft palate index, and palatopharyngeal ratio. Speech evaluation results at follow-up at least a year after surgery were also obtained. Logistic regression and retrospec-tive analyses were performed to identify correlative prognostic factors. RESULTS One hundred and thirty-one patients were included (70 males and 61 females). Dichotomy logistic regression analysis revealed that pharyngeal depth was the only mea-surement considerably associated with postoperative velopharyngeal function. Pharyngeal depth deeper than 16 mm indicated high risk of postoperative velopharyngeal insufficiency. CONCLUSIONS Pharyn-geal depth is a significant prognostic factor for the primary surgical management of aged patients with cleft palate. Pharyn-goplasty might be considered when planning the primary management of aged patients.
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Affiliation(s)
- Chu-Xian Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jing-Tao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Qian Zheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Chun-Li Guo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Heng Yin
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Cheng X, Bo Z, Yin H, Yang K, Li J, Shi B. Age and Preoperative Velar Closure Ratio Are Significantly Associated With Surgical Outcome of Furlow Double-Opposing Z-Plasty in Palatal Re-Repair. J Oral Maxillofac Surg 2019; 78:431-439. [PMID: 31654644 DOI: 10.1016/j.joms.2019.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE The patient selection criteria for Furlow double-opposing Z-plasty in palatal re-repair remain obscure. This study investigated whether patients' preoperative characteristics significantly affected the surgical outcome of Furlow double-opposing Z-plasty in palatal re-repair. MATERIALS AND METHODS We designed and implemented a case-control study nested in a cohort, which could be divided into 2 stages. In the first stage, a retrospective cohort study was performed to collect basic information and the preoperative status of the patients who would undergo Furlow double-opposing Z-plasty to correct velopharyngeal insufficiency after primary cleft palate repair. Eight predictor variables were included: age, gender, primary surgical technique, velopharyngeal closure pattern, velar movement, lateral pharyngeal wall movement, levator muscle orientation, and preoperative velar closure ratio. The outcome variable was postoperative velopharyngeal function described as velopharyngeal competence or velopharyngeal insufficiency. In the second stage, a case-control analysis was performed to explore the potential factors affecting the surgical outcome. Univariate and multivariate analyses were applied to examine the relationship between the predictor variables and surgical outcome. RESULTS The sample was composed of 83 patients and resulted in 54 velopharyngeal competence outcomes and 29 velopharyngeal insufficiency outcomes after surgery. Two predictors showed statistical significance: age and preoperative velar closure ratio. The possibility of postoperative velopharyngeal insufficiency in patients older than 14.5 years was 6 times higher than that in patients younger than 14.5 years. The possibility of postoperative velopharyngeal insufficiency in patients with preoperative velar closure ratios of 0.9 or greater was one fifth that in patients with preoperative velar closure ratios between 0.8 and less than 0.9. CONCLUSIONS The results of this study suggest that age and preoperative velar closure ratio are significantly associated with postoperative velopharyngeal insufficiency. Age was a risk factor in achieving good surgical outcomes, and the preoperative velar closure ratio remained a protective factor.
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Affiliation(s)
- Xu Cheng
- Chief Resident, State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhenyan Bo
- Medical Statistician, Department of Pharmacy, Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Heng Yin
- Associate Professor, State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ke Yang
- Oral Surgery Resident, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Jingtao Li
- Associate Professor, State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- Department Head and Professor, State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Preoperative Planning and Simulation in Patients With Cleft Palate Using Intraoral Three-Dimensional Scanning and Printing. J Craniofac Surg 2019; 30:2245-2248. [DOI: 10.1097/scs.0000000000005983] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Botticelli S, Küseler A, Mølsted K, Andersen HS, Boers M, Shoeps A, Emborg BK, Kisling-Møller M, Pedersen TK, Andersen M, Willadsen E. Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2019; 57:420-429. [DOI: 10.1177/1055665619874143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair. Design: Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft). Setting: Tertiary health care. One surgical center. Patients and Methods: One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months). Main outcome measurements: Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency. Results: No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate “cleft size at tuberosity level” was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = −.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99). Conclusions: Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.
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Affiliation(s)
- Susanna Botticelli
- Section of Orthodontics, Aarhus University, Denmark
- Cleft Lip and Palate Center, IKH, Region Midt, Aarhus, Denmark
| | - Annelise Küseler
- Section of Orthodontics, Aarhus University, Denmark
- Cleft Lip and Palate Center, IKH, Region Midt, Aarhus, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark
| | - Kirsten Mølsted
- Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark
| | | | - Maria Boers
- Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark
| | - Antje Shoeps
- Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark
| | | | | | - Thomas Klit Pedersen
- Section of Orthodontics, Aarhus University, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark
| | - Mikael Andersen
- Department of Plastic Surgery and Burns Treatment, University Hospital of Copenhagen, Denmark
| | - Elisabeth Willadsen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Denmark
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Smyth AG, Wu J. Cleft Palate Outcomes and Prognostic Impact of Palatal Fistula on Subsequent Velopharyngeal Function—A Retrospective Cohort Study. Cleft Palate Craniofac J 2019; 56:1008-1012. [DOI: 10.1177/1055665619829388] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To assess outcomes from cleft palate repair and define the level of impact of palatal fistula on subsequent velopharyngeal function. Design: A retrospective cohort study. Setting: A regional specialist cleft lip and palate center within United Kingdom. Patients, Participants: Nonsyndromic infants born between 2002 and 2009 undergoing cleft palate primary surgery by a single surgeon with audited outcomes at 5 years of age. Four hundred ten infants underwent cleft palate surgery within this period and 271 infants met the inclusion criteria. Interventions: Cleft palate repair including levator palati muscle repositioning with or without lateral palatal release. Main Outcome Measures: Postoperative fistula development and velopharyngeal function at 5 years of age. Results: Lateral palatal incisions were required in 57% (156/271) of all cases. The fistula rate was 10.3% (28/271). Adequate palatal function with no significant velopharyngeal insufficiency (VPI) was achieved in 79% of patients (213/271) after primary surgery only. Palatal fistula was significantly associated with subsequent VPI (risk ratio = 3.03, 95% confidence interval: 1.95-4.69; P < .001). The rate of VPI increased from 18% to 54% when healing was complicated by fistula. Bilateral cleft lip and palate (BCLP) repair complicated by fistula had the highest incidence of VPI (71%). Conclusions: Cleft palate repair with levator muscle repositioning is an effective procedure with good outcomes. The prognostic impact of palatal fistula on subsequent velopharyngeal function is defined with a highly significant 3-fold increase in VPI. Early repair of palatal fistula should be considered, particularly for large fistula and in BCLP cases.
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Affiliation(s)
- Alistair G. Smyth
- Northern and Yorkshire Cleft Lip and Palate Service, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Jianhua Wu
- Dental Translational and Clinical Research Unit, School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
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Georgievska-Jancheska T. The Relationship between the Type of Cleft and Nasal Air Emission in Speech of Children with Cleft Palate or Cleft Lip and Palate. Open Access Maced J Med Sci 2019; 7:352-357. [PMID: 30834000 PMCID: PMC6390167 DOI: 10.3889/oamjms.2019.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: Cleft palate, due to damage of the soft palate, leads to dysfunction, i.e., inappropriate closure of the velopharynx during speech production, thus resulting in velopharyngeal insufficiency which characterises with hypernasal speech and nasal air loss/emission during speech production. AIM: To establish the relationship between the type of cleft according to the Veau classification and the degree of nasal air emission in the speech of patients with cleft using auditory-visual perceptual assessment procedures. MATERIAL AND METHODS: A group of 40 patients with irregular speech aged 4 to 7, out of which 20 with cleft palate or cleft lip and palate, participated in the research. The Veau classification was used to classify the cleft severity, while an indirect instrumental examination was conducted with the See-Scape instrument to detect nasal air emission during the speech. RESULTS: The respondents with cleft palate or cleft lip and palate of higher Veau class had a greater degree of nasal air emission during the speech. There is a positive, statistically significant correlation between the results obtained with the Veau classification of cleft lip and palate, and the degree of nasal air emission. The value of Spearman’s coefficient of correlation is R = 0.46, and the calculated p-value is p = 0.04. CONCLUSION: A more severe cleft type is associated with an increased degree of nasal air emission during the speech, and vice versa.
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Affiliation(s)
- Tatjana Georgievska-Jancheska
- Center for Rehabilitation of Hearing, Speech and Voice, Faculty of Medicine, University Ss. Cyril and Methodius of Skopje, Skopje, Republic of Macedonia
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Jodeh DS, Buller M, Rottgers SA. The Impact of Presurgical Infant Orthopedics on Oronasal Fistula Rates Following Cleft Repair: A Meta-Analysis. Cleft Palate Craniofac J 2018; 56:576-585. [DOI: 10.1177/1055665618806104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Presurgical infant orthopedics (PSIO) techniques were introduced to improve the outcomes achieved when treating children with complete cleft lip and palate. The effect of PSIO on the incidence of postoperative fistulae has never been reliably demonstrated. We conducted a meta-analysis to assess the effectiveness of PSIO in reducing postoperative fistulas in patients with complete cleft lip and palate. Methods: A search of the PubMed and Embase databases was performed to identify relevant articles that included primary palate repairs of patients with unilateral or bilateral complete clefts, reported the incidence of postoperative fistulae, and explicitly stated if PSIO was used. Details including author, number of subjects, use of PSIO, and fistula rate were cataloged. Results: A review of the PubMed database yielded 1135 unique citations, and Embase yielded 507 articles. Review of these yielded 15 studies, comprising 1241 children, which met inclusion criteria. The overall rate of oronasal fistula development was 7.09%. The average fistula rate for studies using PSIO was 5.93% versus 9.71% in the non-PSIO group. This difference was not statistically significant ( P = .34). Conclusions: The use of PSIO prior to cleft lip and palate repair provides multiple benefits related to facial and nasal form and is supported by a body of literature. The effect of PSIO on the incidence of postoperative fistulae has received less attention in the literature. Our meta-analysis of the available literature does not provide evidence to support the premise that the use of PSIO affects the incidence of fistulae after cleft palate repair.
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Affiliation(s)
- Diana S. Jodeh
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Mitchell Buller
- Department of Plastic Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - S. Alex Rottgers
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
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14
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Elsherbiny A, Mazeed AS. Comprehensive and reliable classification system for primary diagnosis of cleft lip and palate. J Craniomaxillofac Surg 2017; 45:1010-1017. [DOI: 10.1016/j.jcms.2017.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/27/2016] [Accepted: 03/20/2017] [Indexed: 11/25/2022] Open
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15
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Lambert A, Piché M, Leclerc JE. Detailed Cleft Measurements: A Comparison between Isolated Cleft Palates and Cleft Palates Associated with Cleft Lips. Cleft Palate Craniofac J 2016; 53:309-16. [DOI: 10.1597/14-255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To determine whether there are differences in the anatomical cleft measurements between patients with isolated cleft palate (CP) with or without Pierre Robin sequence (PR) and those with cleft lip and palate (CLP). Design Prospective case series. Setting Tertiary care university-based medical center. Patients From 1993 to 2012, CP and CLP patients were prospectively enrolled in a database. Main Outcome Measures Several anatomical cleft parameters were recorded with precise measurements at the time of palatoplasty under general anesthesia. Results One hundred twenty-five patients were included in our study: 50 patients in the CP without PR group, 87 patients in the CP with or without PR (CPPR) group, and 38 patients in the CLP group. Patients in the CLP group had increased values for the following parameters compared to patients with CP and patients with CPPR: nasopharyngeal depth ( P = .02 and P = .01, respectively); cleft width at posterior hard palate border ( P < .001 and P < .001); width of the dental arch ( P < .001 and P < .001); and total cleft length ( P < 01 and P < .001). For cleft width at the soft palate level, there was a significant difference between the CP and CLP groups ( P = .005). We found no statistically significant differences between the groups (CLP versus CP and CPPR, respectively) for the length of the soft palate ( P = .74, P = .21) or for the length of the hard palate ( P = .19, P = .08). Conclusion There are significant differences in cleft and palate measurements between CLP and CP patients that may be useful to predict the occurrence of velopharyngeal insufficiency or other complications.
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Affiliation(s)
| | - Marilou Piché
- Head & Neck Surgery, Laval University, Quebec City, Canada
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Discussion: Outcomes of Cleft Palate Repair in Patients with Pierre Robin Sequence: A Matched Case-Control Study. Plast Reconstr Surg 2016; 137:936-937. [PMID: 26910676 DOI: 10.1097/prs.0000000000002015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Jiang C, Whitehill TL, McPherson B, Ng ML. Consonant accuracy in Mandarin-speaking children with repaired cleft palate. Int J Pediatr Otorhinolaryngol 2015; 79:2270-6. [PMID: 26564617 DOI: 10.1016/j.ijporl.2015.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/16/2015] [Accepted: 10/17/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the consonant production of Chinese-speaking cleft palate children with perceived hypernasal resonance (PHR) after palatoplasty and those with perceived normal resonance (PNR), and to assess the possible influence of language on articulation. SETTING Two hospital cleft lip and palate centers in mainland China. PARTICIPANTS Thirty-one speakers were allocated into two groups based on perceptual judgment results of their resonance provided by three speech therapists: one group with PNR (n=20, average age=9.3 years), and another group with PHR (n=11, average age=8.3 years). All participants had no known hearing or cognitive deficits. INTERVENTION Articulation was evaluated using two Mandarin Chinese assessment tools, the Putonghua Segmental Phonology Test and the Deep Test for Cleft Palate Speakers in Putonghua. Speaker consonant accuracy was evaluated by two experienced speech therapists. RESULTS Compared to individuals with PNR, the PHR group exhibited more difficulties on production of unaspirated consonants, including/b/,/t/,/k/,/ts/,/tʂ/ and/tɕ/, than for aspirated consonants. CONCLUSION The distinctive feature of aspiration in Mandarin phonology brought a language specific pattern to consonant production among those speakers with PHR after primary palatal closure.
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Affiliation(s)
- Chenghui Jiang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University; Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China; Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, Hong Kong.
| | - Tara L Whitehill
- Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, Hong Kong
| | - Bradley McPherson
- Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, Hong Kong
| | - Manwa L Ng
- Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, Hong Kong
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Smarius B, Breugem C. Surgical learning curve in performing palatoplasty: A retrospective study in 200 patients. J Craniomaxillofac Surg 2015; 43:1868-74. [PMID: 26421467 DOI: 10.1016/j.jcms.2015.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/15/2015] [Accepted: 08/26/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aim of the study was to assess the influence of the experience of the surgeon on the occurrence of fistulas following palatoplasty. MATERIALS AND METHODS A retrospective review was performed of consecutive children treated between 2006 and 2013 for cleft palate by a single surgeon. Cleft palate repair was performed using the von Langenbeck technique, Furlow palatoplasty, buccal flap or Vomer flap. Data was collected for age, sex, date of birth, syndrome, adoption, cleft palate type, type of repair, cleft width, fistula occurrence and location of fistula. RESULTS A total of 276 operations were performed in 200 children (Veau I, II, III, IV). Mean age at surgery was 21.9 months (range: 6.2 months to 26 years 8.3 months). Postoperatively, palatal fistulas occurred in eight patients (4.0%), however, the incidence was 3.0% in the non-adoption group and 9.7% in the adoption population. In this study there was no statistically significant evidence of a surgical learning curve, and no significant associations between fistula rate and sex, adoption, syndrome, cleft type, cleft width, or type of repair. CONCLUSION AND CLINICAL RELEVANCE This study demonstrates a fistula formation rate of 3.0% for the non-adoption population and 9.7% for the adoption population. There was no statistically significant evidence of a learning curve during the first few years of performing cleft palate repair. No other independent risk factors for postoperative fistula formation were identified; however, the benefit of a vomer flap and subsequent reduction in fistula incidence was demonstrated.
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Affiliation(s)
- Bram Smarius
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
| | - Corstiaan Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, P.O. Box 85090, 3508 AB Utrecht, The Netherlands; Department of Plastic Surgery Meander Medical Center, 3813 TZ Amersfoort, The Netherlands
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