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Téblick S, Ruymaekers M, Van de Casteele E, Boudewyns A, Nadjmi N. The effect of soft palate reconstruction with the da Vinci robot on middle ear function in children: an observational study. Int J Oral Maxillofac Surg 2023:S0901-5027(23)00045-0. [PMID: 36914451 DOI: 10.1016/j.ijom.2023.02.006] [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: 08/08/2022] [Revised: 02/11/2023] [Accepted: 02/24/2023] [Indexed: 03/13/2023]
Abstract
Cleft palate is associated with a high prevalence of middle ear dysfunction, even after palatal repair. The aim of this study was to evaluate the effects of robot-enhanced soft palate closure on middle ear functioning. This retrospective study compared two patient groups after soft palate closure with a modified Furlow double-opposing Z-palatoplasty technique. Dissection of the palatal musculature was performed using a da Vinci robot in one group and manually in the other. Outcome parameters were otitis media with effusion (OME), tympanostomy tube use, and hearing loss during 2 years of follow-up. At 2 years post-surgery, the percentage of children with OME had reduced significantly to 30% in the manual group and 10% in the robot group. The need for ventilation tubes (VTs) decreased significantly over time, with fewer children in the robot group (41%) than those in the manual group (91%) needing new VTs during postoperative follow-up (P = 0.026). The number of children presenting without OME and VTs increased significantly over time, with a faster increase in the robot group at 1 year post-surgery (P = 0.009). Regarding hearing loss, significantly lower hearing thresholds were recorded in the robot group from 7 to 18 months postoperatively. To conclude, beneficial effects of robot-enhanced surgery were recorded, suggesting a faster recovery when the soft palate was reconstructed using the da Vinci robot.
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Affiliation(s)
- S Téblick
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Craniomaxillofacial Surgery, Antwerp University Hospital, Edegem, Belgium.
| | - M Ruymaekers
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - E Van de Casteele
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Craniomaxillofacial Surgery, Antwerp University Hospital, Edegem, Belgium; Department of Maxillofacial Surgery, ZMACK, AZ MONICA Antwerp, Antwerp, Belgium; All for Research vzw, Antwerp, Belgium
| | - A Boudewyns
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - N Nadjmi
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Craniomaxillofacial Surgery, Antwerp University Hospital, Edegem, Belgium; Department of Maxillofacial Surgery, ZMACK, AZ MONICA Antwerp, Antwerp, Belgium; OMFS Program, University of Antwerp, Antwerp, Belgium
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Joos U, Markus AF, Schuon R. Functional cleft palate surgery. J Oral Biol Craniofac Res 2023; 13:290-298. [PMID: 36911175 PMCID: PMC9996444 DOI: 10.1016/j.jobcr.2023.02.003] [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: 12/06/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023] Open
Abstract
Cleft lip and palate (CLP) as a dislocation malformation confronts parents with a malformation of their child that could not be more central and visible: the face. In addition to the stigmatizing appearance, however, in cases of a CLP, food intake, physiological breathing, speech and hearing are also affected. In this paper, the principles of morphofunctional surgical reconstruction of the cleft palate are presented. With the closure of the palate, and restoration of the anatomy, a situation is achieved enabling nasal respiration, normal or near normal speech without nasality, improved ventilation of the middle ear, normal oral functions with coordinated interaction of the tongue with the hard and soft palate important for the oral and pharyngeal phases of feeding. With the establishment of physiological function, in the early phases of the infant and toddler, these activities initiate essential growth stimulation, leading to normalisation of facial and cranial growth. If these functional considerations are disregarded during primary closure, lifelong impairment of one or more of the abovementioned processes often follows. In many cases, despite secondary surgery and revision, it might not be possible to correct and achieve the best possible outcomes, especially if critical stages of development and growth have been missed or there has been significant tissue loss due to resection of existing tissue while primary surgery. This paper describes functional surgical methods and reviews long term, over many decades, results of children with cleft palate.
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Affiliation(s)
- Ulrich Joos
- International Medical College, University Duisburg, Essen, Germany
| | - Anthony F. Markus
- Emeritus Consultant Maxillofacial Surgeon, Poole Hospital, United Kingdom
| | - Robert Schuon
- Department of Otorhinolaryngology, Hannover Medical School, Germany
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Nachmani A, Biadsee A, Masalha M, Kassem F. Compensatory Articulation Errors in Patients With Velopharyngeal Dysfunction and Palatal Anomalies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2518-2539. [PMID: 35858260 DOI: 10.1044/2022_jslhr-21-00679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The aim of this study was to assess the frequency and types of compensatory articulations (CAs) in nonsyndromic patients with velopharyngeal dysfunction (VPD) and various palatal anomalies and to determine the relationship between the frequency of CAs, type of palatal anomaly, and phonological errors. METHOD A total of 783 nonsyndromic, Hebrew-speaking patients with VPD and various palatal anomalies (cleft lip and palate [CLP], cleft palate [CP], submucous CP [SMCP], occult submucous CP [OSMCP], or non-CP) were studied retrospectively. Perceptual VPD tests, including articulation and phonological assessment, were conducted. CAs were described as below the level of the defect in the vocal tract (abnormal backing of oral targets to post-uvular place) or in front of it within the oral cavity (palatalization) and at the velopharyngeal port. RESULTS Among 783 patients, 213 (27.2%) had CAs. Most CAs (18.4%) occurred below the level of the defect, followed by CAs at the velopharyngeal port (12.0%) or in front of it (4.9%). No differences were found in the frequency of CAs between patients with CP (47.8%) or CLP (52.6%) and between those with non-CP (13.6%) or OSMCP (14.7%). SMCP patients had lower frequency of CAs (29.8%) than CP (p = .003) and CLP (p = .002) patients but higher frequency than OSMCP (p = .002) and non-CP (p = .002) patients did. Among the 783 patients, 247 (31.5%) had phonological errors. A higher frequency of phonological errors was found in patients with CAs (55.4%) compared to those without (22.6%) and in all palatal anomaly groups except CLP (31.4% vs. 23.9%). CONCLUSIONS CAs in nonsyndromic patients with VPD remained relatively high in all age groups, up to adulthood. CAs are influenced by inadequate velar length following palatal repair, as well as by oral structural abnormalities, whereas poor muscle function due to OSMCP and/or abnormal size and/or shape of nasopharynx has less influence. Errors produced in front of the velopharyngeal port are influenced by the structural anomaly of CLP. This information may contribute to general phonetic and phonological theories and genetic investigations about CP anomalies.
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Affiliation(s)
- Ariela Nachmani
- Faculty of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ameen Biadsee
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Muhamed Masalha
- Department of Otolaryngology-Head and Neck Surgery, Emek Medical Center, Afula, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Firas Kassem
- Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
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Singhania S, Bhojraj N. Early Maxillary Dentoalveolar Changes in Children with Unilateral Cleft Lip and Palate After Palatal Repair: A Pilot Study. Cleft Palate Craniofac J 2021; 59:1546-1554. [PMID: 34812086 DOI: 10.1177/10556656211053765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess early maxillary dentoalveolar changes in children with unilateral cleft lip and palate (UCLP) up to 6 months after palatoplasty. DESIGN Pilot study. PATIENTS AND PARTICIPANTS Eight children with UCLP at the age of 18 to 30 months, who were awaiting palatal repair, were included. INTERVENTIONS All participants with repaired lip were scheduled for palatal repair between 18 and 24 months by Bardach's technique. MAIN OUTCOME MEASURE(S) Arch widths, arch depths, and arch perimeter was measured on 32 dental casts of 8 participants at 4 time points: just prior to palatal repair (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after palatal repair. Manual method using digital vernier caliper (Zhart, India) was used for model analysis. Intraexaminer reliability was also assessed. RESULTS Only one examiner assessed all the dental casts after blinding. There was a significant decrease in the intercanine width (29.75 ± 1.98 mm at T1 to 26.42 ± 1.67 mm at T4; P < .001) and anterior arch depth (9.86 ± 1.07 mm at T1 to 8.29 ± 1.51 mm at T4; P < .001). Growth occurred in intertuberosity width (38.18 ± 1.40 mm at T1 to 39.76 ± 1.09 mm at T4; P < .001) and total arch depth (24.36 ± 1.21 mm at T1 to 26.79 ± 1.04 mm; P < .001) over 6 months post-surgery. CONCLUSIONS There was growth restriction in the anterior part of the palate, whereas the posterior region continued to grow after palatal repair. These changes were observable even in the early months after palatoplasty.
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Affiliation(s)
- Shreepriya Singhania
- 29240JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Nandlal Bhojraj
- 29240JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
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The impact of hearing loss on speech outcomes in 5-year-old children with cleft palate ± lip: A longitudinal cohort study. Int J Pediatr Otorhinolaryngol 2021; 149:110870. [PMID: 34385041 DOI: 10.1016/j.ijporl.2021.110870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate the impact of hearing loss (using longitudinal measurements of hearing) on speech outcomes at age 5 (5 years 0 months-5 years 11 months) in children born with cleft palate ± lip. Other variables which may impact upon the speech outcomes at age 5 in this population were also investigated. METHODS A retrospective longitudinal cohort study of children, without a named syndrome, born with cleft palate ± lip, and treated at a Cleft Centre in the United Kingdom. Data collected from infancy to 5 years 11 months, included hearing test results from three specific time points (7 months-1 year 2 months [age A]; 2 years 0 months-2 years 11 months [age B]; 5 years 0 months-5 years 11 months [age C]) and speech outcome data at age 5 years (5 years 0 months-5 years 11 months). Hearing test results at each age were compared to identify how hearing changes with age. Correlations between hearing test results and speech outcomes at age 5 were analysed. RESULTS Hearing loss was frequent but predominantly mild. There were no significant correlations between speech outcomes and hearing results at any age. Mild hearing loss remained prevalent at age 5, although a significant age-related hearing improvement was found. A significant relationship between cleft type and cleft speech characteristics was found (P < .001); children with Bilateral Cleft Lip and Palate achieved the poorest articulation outcomes. CONCLUSION Although mild hearing loss was common in the cohort, there was no association between hearing loss and the speech outcomes investigated. In contrast, the type of cleft was significantly associated with the presence of cleft speech characteristics. Further longitudinal measurement of hearing is required to substantiate the findings of this study.
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Effect of Nonradical Intravelar Veloplasty in Patients With Unilateral Cleft Lip and Palate: A Comparative Study and Systematic Review. J Craniofac Surg 2021; 32:1999-2004. [PMID: 33534327 DOI: 10.1097/scs.0000000000007481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare 2 techniques used for primary muscular repair and perform a systematic review of the literature to evaluate the effects of radical intravelar veloplasty (IVV) on nonsyndromic unilateral cleft lip and palate. METHODS This is an ambispective study between 2 groups of patients with unilateral cleft lip and palate who were operated using a radical and conservative form of IVV in Lima Peru. Data collection was accomplished by evaluation of speech development and middle ear function of the patients. A systematic review of the literature for studies published until June 2020 to evaluate the effect using the radical IVV in patients with cleft lip and palate. RESULTS Our comparative study did not find statistically significant differences in speech development between the studied techniques for unilateral cleft palate repair. Increased number of ear tube placements have been observed in the group treated with radical form of IVV. After systematic literature searching, 10 identified studies were qualified for the final analysis, which included 1367 patients. The overall study quality according to Oxford CEBM and GRADE scale was low. CONCLUSIONS The results arising from this study provides statistical evidence that one technique let us obtain better speech outcomes. A technique with conservative IVV has statistical significant fewer rate of middle ear disorders after primary cleft palate repair. Based on available scientific evidence, definitive conclusions about the effectiveness of radical IVV on velopharyngeal and middle ear function cannot be drawn.
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An Observational Study to Evaluate Association Between Velopharyngeal Anatomy and Speech Outcomes in Adult Patients With Severe Velopharyngeal Insufficiency. J Craniofac Surg 2021; 32:2753-2757. [PMID: 34238870 DOI: 10.1097/scs.0000000000007853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE By measuring velopharyngeal structure and evaluating speech intelligibility, to explore and observe the association between velopharyngeal anatomy and speech outcomes in these patients. METHODS Thirty-one adult patients with velopharyngeal insufficiency after the primary palatoplasty aged 18 to 35 years (mean 22.03 years) were enrolled as the study group. The patients had significant hypernasality and audible nasal emission. The degree of velopharyngeal closure assessed by electronic nasopharyngeal fiberoptic endoscopy was grade III. Cephalometric analysis was performed on lateral cephalograms to measure velopharyngeal structure, including hard palate length (ANS-PNS), velar length (PNS-U), pharyngeal depth (PNS-PPW), and oropharyngeal airway space (U-MPW). Their speech intelligibility was evaluated through the Mandarin Chinese speech intelligibility test, and each speech sample was examined by 2 speech and language pathologists. The results were assessed with the SPSS 23.0 software package, and regression analysis was used to examine the relationship between velopharyngeal structure and speech outcomes. RESULTS A significant negative correlation was confirmed between speech intelligibility and pharyngeal depth. Pharyngeal depth also showed a linear relationship with speech intelligibility, and there was no significant correlation between speech intelligibility and other measures (hard palate length, velar length, oropharyngeal airway space). CONCLUSIONS In the velopharyngeal anatomy, only pharyngeal depth was associated with speech intelligibility in adult patients with severe velopharyngeal insufficiency, this is consistent with our clinical observation. It suggests that appropriate reduction of pharyngeal depth during palatopharyngoplasty may have a good effect on the speech recovery in patients with cleft palate and patients with velopharyngeal insufficiency after palatorrhaphy.
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Rezaei P, Poorjavad M, Abdali H. Speech outcomes after palatal closure in 3-7-year-old children. Braz J Otorhinolaryngol 2020; 88:594-601. [PMID: 33268307 PMCID: PMC9422456 DOI: 10.1016/j.bjorl.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 08/02/2020] [Accepted: 08/22/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction One of the main goals of the team approach in management of oro-facial clefts is to help the children with cleft palate have adequate speech development. Objective The present study aimed to investigate the prevalence of articulation and resonance disorders following palate closure in children who were visited for routine examination by the Isfahan Cleft Care Team between 2011 and 2015, and to study the impact of cleft type and age at the time of palatoplasty on speech outcomes. Methods Clinical records of 180 preschool children with repaired cleft palate were reviewed. The percentage of children demonstrating hypernasality, nasal emission, nasal turbulence, and compensatory misarticulations was calculated. The relationship between cleft type and age at the time of palatal surgery, as independent variables, and speech outcomes were examined. Results 67.7 and 64.5 percent of the children demonstrated respectively moderate/severe hypernasality and nasal emission, and 71.1 percent produced compensatory misarticulations. Age at the time of palatal repair was significantly associated with compensatory misarticulations and also with moderate/severe hypernasality. The prevalence of compensatory misarticulations, significant hypernasality, nasal emission and also nasal turbulence was not significantly different in various types of cleft. Conclusions We observed a high prevalence of different speech disorders in preschool children with repaired cleft palate compared to other studies. This can be partly due to late palatal repair in the studied population. Despite many advances in cleft palate management programs in Iran, there are still many children who do not access the interdisciplinary team cares in their early childhood. We should, therefore, try to increase accessibility of appropriate and timely management services to all Iranian children with cleft lip/palate.
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Affiliation(s)
- Parisa Rezaei
- Isfahan University of Medical Sciences, Craniofacial and Cleft Research Center, Isfahan, Iran; Isfahan University of Medical Sciences, School of Rehabilitation Sciences, department of Speech Therapy, Isfahan, Iran
| | - Marziyeh Poorjavad
- Isfahan University of Medical Sciences, School of Rehabilitation Sciences, department of Speech Therapy, Isfahan, Iran.
| | - Hossein Abdali
- Isfahan University of Medical Sciences, Craniofacial and Cleft Research Center, Isfahan, Iran; Isfahan University of Medical Sciences, Department of Plastic Surgery, Isfahan, Iran
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Bates A, Forrester-Jones R, McCarthy M. Specialist hospital treatment and care as reported by children with intellectual disabilities and a cleft lip and/or palate, their parents and healthcare professionals. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:283-295. [PMID: 31578815 DOI: 10.1111/jar.12672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 07/26/2019] [Accepted: 08/29/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Research into hospital treatment and care of children with intellectual disabilities is extremely limited, but available literature points to difficulties. Some children have a co-occurring condition alongside an intellectual disability which requires ongoing treatment, such as a cleft lip/palate. To date, their experiences remain untapped. METHOD Semi-structured interviews with 23 participants; five children with intellectual disabilities (aged 11-16), their parents (n = 9) and nine healthcare professionals working in cleft care. Thematic analysis determined patterns across the data. RESULTS Three key themes were found: struggles (stress and distress, and power imbalance), tensions (perceived levels of choice and control in decision making, lack of training around intellectual disability assumptions and jargon) and good practice (appropriate communication and information, and tailored treatment). CONCLUSION Good practice was evident, but was ad hoc. Individualized treatment and communication based upon children's needs are required as is further investigation into general anaesthetic induction for children with intellectual disabilities.
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Affiliation(s)
- Amanda Bates
- Centre for Health Services Studies, University of Kent, Canterbury, UK
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Téblick S, Ruymaekers M, Van de Casteele E, Nadjmi N. Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review. J Oral Maxillofac Surg 2019; 77:405.e1-405.e15. [DOI: 10.1016/j.joms.2018.09.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 12/01/2022]
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Humanitarian Activities of Interplast Turkiye: 6 Years of Experience in Uzbekistan for Surgical Treatment of Cleft Patients and Related Secondary Deformities. Ann Plast Surg 2018; 77:494-498. [PMID: 27070687 DOI: 10.1097/sap.0000000000000821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cleft lip and palate (CL/P) is one of the leading congenital deformities among the world. Children born with CL/P experience problems with feeding, speech, hearing, and dentition. In developed countries, CL/P patients are receiving optimal health care involving multidisciplinary team approach and staged surgical operations, whereas in developing countries, there is severe shortage of both medical and financial sources. To overcome these limitations, humanitarian surgical missions are essential. The aim of this article is to share our experience of humanitarian surgical mission in Uzbekistan consisting of 6 consecutive visits between 2009 and 2014. The series of these humanitarian activities consisting of 6 consecutive visits was organized by the cooperation of Interplast Turkiye and governmental Turkish Coordination and Cooperation Agency. After initial evaluation, triage at the initial setting and prompt anesthesia evaluation among many more of them, 529 patients mostly with cleft, craniofacial, or congenital deformities were operated. The success of this type of mission is not solely based on the expertise of the team members, but also meticulous planning, patient selection, good coordination with the local colleagues and communication. At this point, caregivers attending from a culturally close and similar language-spoken countries will certainly have more advantages in achieving a mission. Volunteer surgical missions for congenital deformities can be an important relief for this burden in developing countries. Nevertheless, training the native surgeons and supporting the plastic surgery foundations in these countries are as important as providing the necessary health care by such humanitarian missions.
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Brunnegård K, Lohmander A. A Cross-Sectional Study of Speech in 10-Year-Old Children with Cleft Palate: Results and Issues of Rater Reliability. Cleft Palate Craniofac J 2017; 44:33-44. [PMID: 17214536 DOI: 10.1597/05-164] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: To describe speech based on perceptual evaluation in a group of 10-year-old children with cleft palate. A secondary aim was to investigate the reliability of speech-language pathologists’ perceptual assessment of cleft palate speech. Design: Retrospective cross-sectional study in children with cleft palate. External raters made assessments from randomized speech recordings. Subjects: Thirty-eight children with unilateral cleft lip and palate (UCLP) or cleft palate only (CPO) and 10 children in a comparison group. Main Outcome Measures: Ratings of hypernasality, hyponasality, audible nasal air leakage, weak pressure consonants, and articulation. Exact agreement and weighted kappa values were used for reliability. Results: Hypernasality was found in 25% of children with a cleft of the soft palate (CSP), 33% of children with a cleft of the hard and soft palate (CHSP), and 67% of children with a UCLP. Similar results were found for audible nasal air leakage. Articulation errors were found in 6% of the CHSP group and 25% of the UCLP group, whereas no child in the CSP group had articulation errors. The reliability was moderate to good for different variables, with lowest values for hypernasality. Conclusions: Speech results in this series seem less satisfactory than those reported in other published international studies, but it is difficult to draw any certain conclusions about speech results because of large methodological differences. Further developments to ensure high reliability of perceptual ratings of speech are called for.
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Bruneel L, Luyten A, Bettens K, D'haeseleer E, Dhondt C, Hodges A, Galiwango G, Vermeersch H, Van Lierde K. Delayed primary palatal closure in resource-poor countries: Speech results in Ugandan older children and young adults with cleft (lip and) palate. JOURNAL OF COMMUNICATION DISORDERS 2017; 69:1-14. [PMID: 28675808 DOI: 10.1016/j.jcomdis.2017.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 06/07/2023]
Abstract
AIMS Unrepaired clefts still regularly occur in resource-poor countries as a result of limited health-care access. The purpose of the present study was to report resonance, airflow and articulation characteristics following delayed (≥8years) primary palatal closure. METHODS Fifteen Ugandan participants with cleft (lip and) palate (CP±L) were included as well as 15 age- and gender-matched Ugandan subjects without clefts. Palatal closure was performed at a mean age of 15;10 years using the Sommerlad technique. Speech evaluations were carried out on a single occasion postoperatively (mean age: 18;10 years). Resonance and nasal airflow were perceptually evaluated and detailed phonetic and phonological assessments were carried out. Additionally, nasalance values were determined. RESULTS Nasal emission occurred postoperatively in only 27% (4/15) of the patients, whereas resonance disorders and articulation errors were prevalent in 87% (13/15) of the patient group. Compared with the control group, a significantly higher prevalence of hypernasality and significantly higher nasalance values for all oral and oronasal speech samples were obtained in the CP±L group. Moreover, significantly smaller consonant inventories and significantly more phonetic and phonological disorders were observed. CONCLUSIONS Delayed palatal repair (≥8years) seems to be insufficient to eliminate nasal airflow errors, resonance abnormalities, and articulation disorders. In order to prevent patients' late presentation at specialized centers, the availability of high quality surgical cleft palate treatment should increase as well as people's awareness of the possibility and importance of early surgical intervention. Moreover, speech therapy following delayed palatal closure would be beneficial. Furthermore, a standardized and validated protocol for speech assessment in future studies is advocated.
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Affiliation(s)
- Laura Bruneel
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
| | - Anke Luyten
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
| | - Kim Bettens
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
| | - Evelien D'haeseleer
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
| | - Cleo Dhondt
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium.
| | - Andrew Hodges
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda.
| | - George Galiwango
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda.
| | - Hubert Vermeersch
- Ghent University, Department of Head and Neck Surgery, De Pintelaan 185 2P2, 9000 Gent, Belgium.
| | - Kristiane Van Lierde
- Ghent University, Department of Speech, Language, and Hearing Sciences, De Pintelaan 185 2P1, 9000 Gent, Belgium; University of Pretoria, Faculty of Humanities, Department of Speech-Language Pathology and Audiology, Lynnwood Road Hillcrest, Pretoria, South Africa.
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Wroblewska-Seniuk K, Greczka G, Dabrowski P, Szyfter W, Mazela J. The results of newborn hearing screening by means of transient otoacoustic emissions - has anything changed over 10 years? Int J Pediatr Otorhinolaryngol 2017; 96:4-10. [PMID: 28390612 DOI: 10.1016/j.ijporl.2017.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Universal newborn hearing screening (UNHS) has become the standard of care in many countries. The aim of this study was to evaluate the results of UNHS after ten years of the program in Poland and to compare them with the results of 2003. METHODS In the study, we analyze the results of UNHS in the University Hospital in Poznan, Poland. Between 01.01.2013 and 31.12.2013, 6827 children were examined by means of otoacoustic emissions. RESULTS Risk factors (RF) were identified in 772 (11.3%) newborns, which is significantly less than 10 years ago (p < 0.05). The most frequent RF were: ototoxic medications, treatment in neonatal intensive care unit (NICU) and prematurity < 33 weeks of gestation. In 2003, the most frequent were ototoxic medications and prematurity, less frequent was treatment in NICU and more common was low Apgar score. In 51 (6.6%) newborns with RF, the result of OAE was positive either unilaterally or bilaterally. In infants without RF the result was positive unilaterally in 22 (0.4%) and bilaterally in 14 (0.2%) patients. These results are significantly lower than in our former study. The relative risk of positive result was the highest in infants with complex congenital anomalies (RR = 44.99), craniofacial anomalies (RR = 17.46) and mechanical ventilation for > 5 days (RR = 10.69). In our previous study, the highest RR of positive test results was in infants with family history, congenital malformations and low Apgar score. We found that most predictive as to the final diagnosis was bilaterally positive OAE test. In most patients, the second check confirmed the diagnosis, independently of RF. The number of false positive tests at the 1st level of screening is significantly lower now than 10 years ago, probably due to better staff training. CONCLUSIONS Long term monitoring and the appropriate management of hearing deficit in children is essential. UNHS seems to be the most efficient way of finding children who require treatment of hearing impairment. The prevalence of most risk factors of hearing deficit has significantly changed over the years. The number of false positive results has significantly decreased over the years thanks to better staff training.
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Affiliation(s)
- Katarzyna Wroblewska-Seniuk
- Department of Newborns' Infectious Diseases, Poznan University of Medical Sciences, ul. Polna 33, 60-535 Poznań, Poland.
| | - Grazyna Greczka
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355 Poznań, Poland
| | - Piotr Dabrowski
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355 Poznań, Poland
| | - Witold Szyfter
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355 Poznań, Poland
| | - Jan Mazela
- Department of Newborns' Infectious Diseases, Poznan University of Medical Sciences, ul. Polna 33, 60-535 Poznań, Poland
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An alternative clinical approach to achieve greater anterior than posterior maxillary expansion in cleft lip and palate patients. J Craniofac Surg 2015; 25:e523-6. [PMID: 25347603 DOI: 10.1097/scs.0000000000001037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cleft lip and palate patients commonly present maxillary constriction, particularly in the anterior region. The aim of this case report was to describe an alternative clinical approach that used a smaller Hyrax screw unconventionally positioned to achieve greater anterior than posterior expansion in patients with complete unilateral cleft lip and palate. The idea presented here is to take advantage of a reduced dimension screw to position it anteriorly. When only anterior expansion was needed (patient 1), the appliance was soldered to the first premolar bands and associated to a transpalatal arch cemented to the first molars. However, when overall expansion was required (patient 2), the screw was positioned anteriorly, but soldered to the first molar bands. Intercanine, premolar, and first molar widths were measured on dental casts with a digital caliper. Pre-expansion and postexpansion radiographs and tomographies were also evaluated. A significant anterior expansion and no intermolar width increase were registered in the first patient. Although patient 2 also presented a greater anterior than posterior expansion, a noteworthy expansion occurred at the molar region. The alternative approach to expand the maxilla in cleft patients reported here caused greater anterior than posterior expansion when the Mini-Hyrax was associated to a transpalatal arch, and its reduced dimension also minimized discomfort and facilitated hygiene.
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Abstract
Development of normal speech is the primary goal of successful palatoplasty. The purpose of this study was to determine the importance of the contribution of vomer flap to palatoplasty procedure for speech function. Eighty-one children who underwent 2 flap palatoplasty procedures for cleft palate repair between 2002 and 2010 were retrospectively reviewed in 3 groups. Group 1 underwent palatoplasty without contribution of vomer flap. Group 2 underwent palatoplasty with standard dissection of vomer flap, whereas group 3 underwent palatoplasty with extended dissection of vomer flap. Speech function of the patients was evaluated using objective assessment tools such as nasopharyngoscopy and nasometer. Eighty-one children who underwent 2 flap palatoplasty were included in this study. The mean age at palatoplasty was 10.17 months, and mean length of follow-up was 72.33 months. For most syllables, patients repaired using extended vomer flap demonstrated lower nasalance scores. Nasopharyngoscopic examination revealed velopharyngeal motility in 24 patients (80%) in group 1 and in 20 (83.3%) and 23 (85.2%) patients in groups 2 and 3, respectively (P = 0.930). In velopharyngeal closure, there were only 5 patients (18.5%) in group 3, whereas there were 6 patients (25.0%) for group 2 and 10 patients (33.3%) for group 1 with no closure (P = 0.311). Although most optimum results were observed in the group with extended dissection of the vomer flap, contribution of the extended vomer flap to the repair of the soft palate did not lead to significantly better speech results.
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Vos B, Senterre C, Lagasse R, Levêque A. Newborn hearing screening programme in Belgium: a consensus recommendation on risk factors. BMC Pediatr 2015; 15:160. [PMID: 26475713 PMCID: PMC4609128 DOI: 10.1186/s12887-015-0479-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/08/2015] [Indexed: 01/08/2023] Open
Abstract
Background Understanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium. Methods A literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting). Results Congenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a ‘high’ level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a ‘moderate’ level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from ‘very low’ to ‘low’ levels, and ototoxic drugs were evidenced as ‘very low’. Possible explanations for these ‘very low’ and ‘low’ levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss. Conclusions We revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0479-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bénédicte Vos
- Research Center Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. .,Research Center Health Policy and Systems - International Health, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. .,Centre d'Epidémiologie Périnatale (CEpiP), Route de Lennik 808, Brussels, 1070, Belgium.
| | - Christelle Senterre
- Research Center Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium.
| | - Raphaël Lagasse
- Research Center Health Policy and Systems - International Health, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium.
| | | | - Alain Levêque
- Research Center Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. .,Research Center Health Policy and Systems - International Health, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. .,Centre d'Epidémiologie Périnatale (CEpiP), Route de Lennik 808, Brussels, 1070, Belgium.
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Lithovius RH, Lehtonen V, Autio TJ, Harila V, Anttonen V, Sándor GK, Ylikontiola LP. The association of cleft severity and cleft palate repair technique on hearing outcomes in children in northern Finland. J Craniomaxillofac Surg 2015; 43:1863-7. [PMID: 26421466 DOI: 10.1016/j.jcms.2015.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/29/2015] [Accepted: 08/18/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The consequences of cleft lip and palate include scaring, dental malformations, tooth misalignment, speech problems, and hearing loss. Otitis media with effusion causing hearing loss is a problem for many cleft palate patients. METHODS This study examines the association among cleft severity, palate repair technique, and hearing outcomes in children from northern Finland with clefts, aged 3-9 years. The study included 90 cleft patients who were treated at the Oulu University Hospital Cleft Lip and Palate Center between 1998 and 2011. The severity of the cleft, the surgical technique used to repair the palate, audiogram configuration data, and the need for ventilation tube placement were determined retrospectively from patient records. RESULTS Only 3.3% of cleft patients had an abnormal pure tone average hearing threshold representing abnormal hearing. Neither the surgical technique used to repair the cleft palate nor the severity of the cleft was a significant factor related to hearing loss or to the number of ventilation tubes required. Hearing improved significantly with increasing age over a span of 6 years. CONCLUSIONS Continuous follow-up with proactive placement of ventilation tubes before or at the time of palatoplasty results in hearing outcomes in cleft children that are similar to those reported in non-cleft children.
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Affiliation(s)
- Riitta H Lithovius
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Ville Lehtonen
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland; Department of Cariology, Paedodontics and Endodontology, University of Oulu, Oulu, Finland
| | - Timo J Autio
- Department of Otolaryngology, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Virpi Harila
- Department of Oral Development and Orthodontics, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Vuokko Anttonen
- Department of Cariology, Paedodontics and Endodontology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - George K Sándor
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland.
| | - Leena P Ylikontiola
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
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Smith CB, Walker K, Badawi N, Waters KA, MacLean JE. Impact of sleep and breathing in infancy on outcomes at three years of age for children with cleft lip and/or palate. Sleep 2014; 37:919-25. [PMID: 24790270 DOI: 10.5665/sleep.3660] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the relationship between sleep disordered breathing (SDB) in early infancy and outcomes at 3 years of age in children with cleft lip and/or palate (CL/P). DESIGN Observational follow-up study. SETTING Multidisciplinary CL/P clinic, tertiary centre. PARTICIPANTS Children with CL/P who participated in a study of sleep and breathing in infancy. MEASUREMENTS AND RESULTS The families of 52 children were approached for this follow-up study. The children underwent neurocognitive (Bayley Scales of Infant and Toddler Development, Third Edition; BSID-III), quality of life (Infant/Toddler Quality of Life Questionnaire; ITQOL), and growth assessments at 3 years. The families of 33 children (66%) completed follow-up at 36.7 ± 1.4 months. The apnea-hypopnea index (AHI) in infancy was 23.9 ± 18.0 events/h. Mean group BSID-III scores fell within the standardized normal range (10 ± 3) for all domains; however, language scores were lower than control children. Quality of life scores and growth parameter z-scores were similar to published control data. PSG variables in infancy showed significant relationships with outcomes at 3 years of age; lower percentage of AS/REM sleep was associated with lower cognition score; more obstructive events were associated with lower global behavior ITQOL score; and higher number of respiratory events in infancy was associated with lower weight z-score. CONCLUSION Neurocognition, quality of life, and growth measures from children with CL/P fall within a normal range; however, scores in the language domain are lower than controls. Sleep and respiratory elements of SDB in infancy appear to modify these outcomes at 3 years of age.
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Affiliation(s)
- Courtney B Smith
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia ; Medical Program, University of New South, Sydney, NSW, Australia
| | - Karen Walker
- Discipline of Paediatrics & Child Health, University of Sydney, Sydney, NSW, Australia ; Neonatal Intensive Care Unit, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Nadia Badawi
- Discipline of Paediatrics & Child Health, University of Sydney, Sydney, NSW, Australia ; Neonatal Intensive Care Unit, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Karen A Waters
- Discipline of Paediatrics & Child Health, University of Sydney, Sydney, NSW, Australia ; Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Joanna E MacLean
- Department of Pediatrics & The Women & Children's Research Institute, University of Alberta, Edmonton, AB, Canada ; Discipline of Paediatrics & Child Health, University of Sydney, Sydney, NSW, Australia ; Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
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Leclerc JE, Godbout A, Arteau-Gauthier I, Lacour S, Abel K, McConnell ÉM. We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients. Laryngoscope 2013; 124:561-9. [DOI: 10.1002/lary.24200] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 03/20/2013] [Accepted: 04/22/2013] [Indexed: 11/10/2022]
Affiliation(s)
| | - Audrey Godbout
- Department of Otolaryngology-Head and Neck Surgery; Laval University; Quebec City Quebec Canada
| | | | - Sophie Lacour
- Department of Speech-Language Pathology; Quebec University Hospital Center; Quebec City Quebec Canada
| | - Kati Abel
- Department of Speech-Language Pathology; Quebec University Hospital Center; Quebec City Quebec Canada
| | - Élisa-Maude McConnell
- Department of Speech-Language Pathology; Quebec University Hospital Center; Quebec City Quebec Canada
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Annigeri VM, Mahajan JK, Nagarkar A, Singh SP. Outcome analysis of palatoplasty in various types of cleft palate. J Indian Assoc Pediatr Surg 2012; 17:157-61. [PMID: 23243367 PMCID: PMC3518993 DOI: 10.4103/0971-9261.102333] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS To analyse the factors affecting clinical and functional outcome of Veau-Wardill-Kilner palatoplasty in various types of cleft palate. MATERIALS AND METHODS Demographic data were retrieved from case records and a detailed speech, language and hearing and an orthodontic analysis were carried out prospectively. RESULTS Mean age at operation was 2.7 years; whereas mean age at the time of evaluation was 6 years. Most of the patients (43.3%, 13/30) had a bilateral cleft lip and palate. The postoperative fistula had developed in 31% (4/13) of the patients with bilateral clefts and in 17% (1/6) and 9% (1/11) of the patients with left unilateral and isolated cleft palate respectively (P<0.05). Eight per cent (2/24) of the patients operated before 2 years of age developed a fistula as compared to 66.6% (4/6) of the patients who had undergone a repair after 2 years of age (P<0.01). Severe speech abnormality was seen in 33.4% of the patients having postoperative fistula as compared to 16.6% of non-fistula patients (P<0.05). Derangement of speech was found in 66.6% of the patients who had undergone surgery after the age of 2 years as compared to the patients (13%, 3/24) undergoing correction before 2 years of age (P<0.05). Hearing loss was seen most commonly in patients with bilateral cleft palate as compared to the other varieties (P>0.05). Tympanic membrane (TM) abnormalities were also more common in bilateral cleft patients (P<0.05). Mean maxillary arch length, arch circumference and maxillary inter-canine and inter-molar width were significantly reduced as compared to the control group (P<0.001). CONCLUSIONS Socially acceptable quality of speech can be achieved in more than 85% of the patients. The postoperative fistula is associated with poor speech; bilateral cleft and older age being the risk factors for fistula formation. Many patients require audiological surveillance even when asymptomatic. Maxillary growth is impaired in all the patients despite early surgery.
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Affiliation(s)
- Venkatesh M Annigeri
- Department of Paediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Schuster M, Maier A, Bocklet T, Nkenke E, Holst A, Eysholdt U, Stelzle F. Automatically evaluated degree of intelligibility of children with different cleft type from preschool and elementary school measured by automatic speech recognition. Int J Pediatr Otorhinolaryngol 2012; 76:362-9. [PMID: 22236457 DOI: 10.1016/j.ijporl.2011.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 12/09/2011] [Accepted: 12/10/2011] [Indexed: 10/14/2022]
Affiliation(s)
- Maria Schuster
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Ludwig-Maximilians-University Munich, Marchioninstrasse 15, D-81377, Munich, Germany.
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The use of buccal fat pad (BFP) as a pedicled graft in cleft palate surgery. Int J Oral Maxillofac Surg 2011; 40:685-9. [DOI: 10.1016/j.ijom.2011.02.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 12/29/2010] [Accepted: 02/22/2011] [Indexed: 11/23/2022]
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Vomopalatoplasty: a novel procedure to reduce velopharyngeal distance in cleft palate repair. J Craniofac Surg 2010; 21:526-8. [PMID: 20489456 DOI: 10.1097/scs.0b013e3181d0240a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite numerous improvements in the palatoplasty procedure, speech dysfunction tends to develop in many patients, requiring another surgery. In addition, vomer flaps have been used in palatoplasty in various shapes and on purposes. Nonetheless, they have been used mostly to cover the defect in wide and complete type of cleft palate. We introduce the vomopalatoplasty procedure that uses a vomer flap to reduce the nasopharyngeal space in incomplete or submucous type of cleft palate patients.The mucoperiosteal flaps on the nasal and oral sides were elevated by the conventional palatoplasty procedure, which subsequently elevated the bilateral vomer flaps to the posterior edge of vomer. Then, the vomer flap was sutured with the mucoperiosteal flap of the nasal side to the anterior half of the soft palate, and thus, the soft palate was fixed in more posterosuperior direction than in conventional palatoplasty. For patients whose junction of vomer and hard palate had to be exposed, a part of the bone at the bifid posterior nasal spine of the hard palate may be removed sometimes.Ostectomy of the bifid posterior nasal spine or the posterior end of the hard palate was performed in 11 patients. Another 12 patients did not need ostectomy. After the surgery, the surgical wounds healed well in all patients without any major complications such as dehiscence or loss of flap.Our vomopalatoplasty is easy to perform, and the procedure could be combined to the conventional palatoplasty procedure. Thus, we consider vomopalatoplasty as a useful procedure that could reduce the nasopharyngeal space in patients with incomplete or submucous type of cleft palate.
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Da Silva DP, Collares MVM, Da Costa SS. Effects of Velopharyngeal Dysfunction on Middle Ear of Repaired Cleft Palate Patients. Cleft Palate Craniofac J 2010; 47:225-33. [DOI: 10.1597/09-008.1] [Citation(s) in RCA: 7] [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 Cleft palates are strongly associated with the development of otitis media due to the anatomic and functional defect of the soft palate musculature and the associated alterations of velopharyngeal muscle insertion on tubal cartilage, or even intrinsic alterations of the cartilage, which affects eustachian tube function. This study will assess velopharyngeal muscle adequacy after palatoplasty through videonasoendoscopy and verify if there is a correlation with otologic status. Design Transversal study. Setting Otorhinolaryngology and cleft palate outpatient service of the Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil. Patients Seventy-three patients with cleft palate or cleft lip and palate between the ages of 6 and 12 years who had already undergone palatoplasty. Interventions Videonasoendoscopy for evaluation of velopharyngeal function and videotoscopy to assess middle ear status. Main Outcome Measures Severity scale for videonasoendoscopic and videotoscopic findings. Results There was no significant correlation between the videonasoendoscopic and the videotoscopic scores in the population studied. Discussion and Conclusions Intrinsic defects of the eustachian tube cartilage and of the insertion of the velopharyngeal muscles seem to contribute to the evolution of otitis media in patients with cleft palate, in addition to the actual defect of the soft palate. There was no correlation between the severity of the otoscopic findings and the degree of velopharyngeal dysfunction.
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Affiliation(s)
- Daniela Preto Da Silva
- Universidade Federal do Rio Grande do Sul, Member of the Craniofacial Surgery Group of Hospital de Clinicas de Porto Alegre, Fellowship on Otology and Cochlear Implants of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcus Vinicius Martins Collares
- Craniomaxillofacial Surgery, Universidade Federal do Rio Grande do Sul, Head of the Craniofacial Surgery Group of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Sady Selaimen Da Costa
- Otorhinolaryngology, Universidade Federal do Rio Grande do Sul, Head of the Chronic Otitis Media Center of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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Farzaneh F, Becker M, Peterson AM, Svensson H. Speech results in adult Swedish patients born with bilateral complete cleft lip and palate. ACTA ACUST UNITED AC 2009; 43:207-13. [DOI: 10.1080/02844310903040722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
BACKGROUND Cleft palate is the most common congenital deformity of the face. It could affect speech acquisition, resulting in articulation errors that could persist into adulthood. Electropalatography (EPG) has been used in speech therapy with individuals who have articulation problems that are unresponsive to "standard treatment" procedures. OBJECTIVES To determine the effectiveness of speech intervention using electropalatography (EPG) for treating articulation errors in individuals with repaired cleft palate. SEARCH STRATEGY The following databases were searched: CENTRAL 2008 (Issue1), MEDLINE 1966 to March 2008, EMBASE 1974 to March 2008, CINAHL 1982 to March 2008, PsycINFO 1967 to March 2008 and eight other databases. We handsearched Clinical Linguistics and Phonetics (1987 to 2008, Issue 2), Cleft Palate Journal/ Cleft Palate-Craniofacial Journal (1980 to 2008, Issue 1), and the International Journal of Language and Communication Disorders (1980 to 2008, Issue 1). We searched the EPG bibliography (Gibbon 2007). We reviewed reference lists of relevant articles and approached researchers to identify other possible published and unpublished studies. SELECTION CRITERIA Randomised controlled studies comparing EPG intervention to no treatment, delayed treatment, "standard treatment", or alternative treatment techniques for managing articulation problems associated with cleft palate in children or adults. DATA COLLECTION AND ANALYSIS One author searched the titles and abstracts and assessed trial quality. A second author checked judgements; disagreement was resolved through discussion. Three authors were available to examine any potential trials for possible inclusion in the review. MAIN RESULTS One trial using parallel design met the inclusion criteria of this review; no meta-analysis was performed. The study reported that fewer therapy sessions were needed to achieve the treatment goals for the EPG therapy and frication display method (N = 2), followed by EPG therapy (N = 2) and "standard treatment" (N = 2). AUTHORS' CONCLUSIONS The included trial was a small-scaled study and there were serious limitations in the design and methodology (e.g. allocation concealment was unclear, blinding of outcome assessor(s) was not ensured, few quantitative outcome measures were used, and the results were not reported as planned). Therefore, the current evidence supporting the efficacy of EPG is not strong and there remains a need for high-quality randomised controlled trials to be undertaken in this area.
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Affiliation(s)
- Alice S‐Y Lee
- University College CorkDepartment of Speech and Hearing SciencesBrookfield Health Sciences ComplexCollege RoadCorkIreland
| | - James Law
- Queen Margaret UniversityCentre for Integrated Healthcare ResearchMusselburghEdinburghScotlandUKEH21 6UU
| | - Fiona E. Gibbon
- University College CorkDepartment of Speech and Hearing SciencesBrookfield Health Sciences ComplexCollege RoadCorkIreland
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Cleft lip and palate treatment of 530 children over a decade in a single centre. Int J Pediatr Otorhinolaryngol 2009; 73:993-7. [PMID: 19443049 DOI: 10.1016/j.ijporl.2009.03.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 03/26/2009] [Accepted: 03/28/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to evaluate the process of care and the outcomes of cleft lip and palate operations carried by a multidisciplinary team at a centre of craniofacial anomalies with a high patients' volume. METHODS A retrospective review of all cleft lips and/or palates cases treated in the centre from 1995 to 2007 was performed. Direct and long term complication rates, clinical, audiologic, speech intelligibility and dental arch assessments were analyzed. RESULTS A total of 530 children have been operated this period in the centre (64 isolated cleft lip closures). A detailed presentation of the outcomes is performed in relation to the various types of cleft lip and palates. The majority of parents (70%) reported very good or excellent results 2-5 years after the lip closure with the Millard technique, although those with bilateral clefts were significantly less satisfied (P<0.002). Forty-two percent of children with cleft palate and otitis media with effusion were self-improved 2-8 months after palate reconstruction and 83.3% of children treated with the two flaps palatoplasty technique had a rather high or very high intelligibility score. Muscles' retropositioning had a significant effect on intelligibility (P=0.04). CONCLUSIONS Children with cleft lips and palates have a variety of conditions and functional limitations even after the surgical correction of their problem that need to be evaluated and treated by several specialists. The treatment protocol utilized by the multidisciplinary team of our centre is efficient with a relative low percentage of complications and unfavorable results.
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White RN, Hawkins HL, Alemi VP, Warner C. Soft palate hypoplasia and concurrent middle ear pathology in six dogs. J Small Anim Pract 2009; 50:364-72. [DOI: 10.1111/j.1748-5827.2009.00742.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ruiter JS, Korsten-Meijer AGW, Goorhuis-Brouwer SM. Communicative abilities in toddlers and in early school age children with cleft palate. Int J Pediatr Otorhinolaryngol 2009; 73:693-8. [PMID: 19211158 DOI: 10.1016/j.ijporl.2009.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 01/05/2009] [Accepted: 01/06/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Evaluation of improvement in communicative abilities in children with nonsyndromic cleft palate. METHODS Longitudinal retrospective case history study. Out of 117 children with cleft lip and/or cleft palate born in 1998, 1999 and 2000 and enrolled in the cleft palate team of the University Medical Centre Groningen (UMCG), 63 children were included in the study; 29 (46%) boys and 34 (54%) girls. From these 63 Dutch speaking children communicative abilities were measured when toddlers and at early school age. Cleft types were cleft lip with or without cleft alveolus (CL+/-A; n=10, 5%), unilateral cleft lip and palate (UCLP; n=23, 37%), bilateral cleft lip and palate (BCLP; n=9, 14%) and isolated cleft palate (CP; n=21, 33%). The percentage of problems in language comprehension, language production, articulation, hearing and hypernasality, present when toddlers, were compared with the percentage of problems found at early school age. The treatments executed were also analysed. RESULTS Except for hearing problems, problems in all other communicative fields improved significantly. In the total group language comprehension problems decreased from 23% to 2% (p=0.00), language production problems from 21% to 6% (p=0.01), articulation problems from 57% to 25% (p=0.00) and hypernasality from 38% to 10% (p=0.04). Hearing problems appeared more difficult to treat effectively, they decreased from 42% to 31% (p=0.29). Children with BCLP appeared to have the most problems, followed by children with UCLP and then children with CP. Children with CL+/-A show the least problems. In the intervening period, often a combination of treatments was performed. Pharyngoplasty appeared to be very successful in treating hypernasality, with a success rate of 86%. CONCLUSIONS At early school age, in children with clefts, speech and language problems were significantly improved following a multidisciplinary approach to treatment and resemble their peers without clefts. Hearing problems were more difficult to treat.
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Affiliation(s)
- Jolien S Ruiter
- Department of Clinical Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Boscariol M, André KD, Feniman MR. Crianças com fissura isolada de palato: desempenho nos testes de processamento auditivo. ACTA ACUST UNITED AC 2009. [DOI: 10.1590/s0034-72992009000200009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Muitas crianças com transtorno de processamento auditivo têm uma prevalência alta de otite média, alteração na orelha média de grande ocorrência na população com fissura labiopalatina. OBJETIVO: Verificar o desempenho de crianças com fissura isolada de palato (FP) em testes do processamento auditivo. Estudo prospectivo. MATERIAL E MÉTODO: Vinte crianças (7 a 11 anos) com FP foram submetidas aos testes de localização sonora (LS), memória para sons verbais (MSSV) e não-verbais em seqüência (MSSNV), Fusão Auditiva-Revisado (AFT-R), Teste Pediátrico de Inteligibilidade de Fala/Sentenças Sintéticas (PSI/SSI), Dissílabos alternados (SSW) e Dicótico de dígitos (DD). O desempenho das crianças nos testes foi classificado em ruim e bom. RESULTADOS: Não houve diferença estatística entre os gêneros e orelhas. Os valores médios obtidos foram 2,16, 2,42, 4,37, 60,50ms, de 40,71 a 67,33%, 96,25 a 99,38%, 73,55 a 73,88% e 58,38 a 65,47%, respectivamente, para os testes MSSNV, MSSV, LS, AFT-R, PSI/SSI com mensagem competitiva ipsilateral (PSI/SSIMCI) e contralateral (PSI/SSI/MCC), DD e SSW. CONCLUSÃO: Uma alta porcentagem de crianças demonstrou seus piores desempenhos nos testes AFT-R, DD, SSW e no teste PSI/SSIMCI. Os melhores desempenhos ocorreram nos testes de localização sonora, memória seqüencial para sons não verbais e verbais e para PSI/SSIMCC.
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Boscariol M, André KD, Feniman MR. Cleft palate children: performance in auditory processing tests. Braz J Otorhinolaryngol 2009; 75:213-20. [PMID: 19575106 PMCID: PMC9450609 DOI: 10.1016/s1808-8694(15)30780-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 04/15/2008] [Indexed: 11/29/2022] Open
Abstract
Many children with auditory processing disorders have a high prevalence of otitis media, a middle ear alterations greatly prevalent in children with palatine and lip clefts. Aim to check the performance of children with palate cleft alone (PC) in auditory processing tests. Prospective study. Materials and Methods twenty children (7 to 11 years) with CP were submitted to sound location tests (SL), memory for verbal sounds (MSSV) and non verbal sounds in sequence (MSSNV), Revised auditory fusion (AFT-R), Pediatric test of speech intelligibility/synthetic sentences (PSI/SSI), alternate disyllables (SSW) and digit dichotic (DD). The children performances in the tests were classified in bad and good. Results there was no statistically significant difference between genders and ears. The average values obtained were 2.16, 2.42, 4.37, 60.50ms; 40.71 to 67.33%; 96.25 to 99.38%; 73.55 to 73.88% and 58.38 to 65.47% respectively for the MSSNV, MSSV, LS, AFT-R, PSI/SSI tests with ipsilateral (PSI/SSIMCI) and contralateral (PSI/SSI/MCC) competitive message, DD and SSW tests. Conclusion a high percentage of children showed worse results in the AFT-R, DD, SSW tests and in the PSI/SSIMCI tests. The best performances happened in the sound location tests, verbal and non-verbal sounds for sequential memory and for PSI/SSIMCC tests.
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Polzer I, Breitsprecher L, Winter K, Biffar R. Videoendoscopic, speech and hearing in cleft palate children after levator-palatopharyngeus surgery according to Kriens. J Craniomaxillofac Surg 2006; 34 Suppl 2:52-6. [PMID: 17071392 DOI: 10.1016/s1010-5182(06)60012-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION The importance of the soft palate is greater than its dimension. Velopharyngeal muscles have diverse functions. The goal of this study was to clarify the efficacy of levator-palatopharyngeus surgery according to Kriens. MATERIAL AND METHODS Retrospective follow-up of 22 cleft patients operated at the Department of Oral and Maxillo-Facial and Plastic Surgery at the University of Greifswald between 1994 to 2001, within the context of primary closure of the palate. A questionnaire evaluated parents' opinion of postoperative results of treatment. Speech, videoendoscopics and hearing findings were analyzed. RESULTS Parents assessed success of the treatment as adequate to very good. More than a half of the patients had perfect or very usable colloquial speech. Speech findings of patients with palatal clefts (CP) were significantly better than those of patients with clefts of lip, alveolus and palate (CLAP) (p = 0.043). Velopharyngeal closure pattern with highest prevalence was the coronal closure type. Subjects with CLAP were much more likely to have poor velopharyngeal closure (VPI > 2 mm(2); 58%) than those with a CP (12%). More than 75% of the patients showed normal hearing results in the audiogram. CONCLUSION Levator-palatopharyngeus surgery according to Kriens seems to be effective in exact reconstruction of velar muscle sling, improving velopharyngeal structure and function.
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Affiliation(s)
- Ines Polzer
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany.
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