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Gong SW, Hung P, Obinero CG, Barrera J, Jiang ZY, Greives MR, Huang Z. Effect of palatoplasty technique on otologic outcomes in children with cleft palate. Am J Otolaryngol 2025; 46:104610. [PMID: 40107158 DOI: 10.1016/j.amjoto.2025.104610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2024] [Accepted: 03/08/2025] [Indexed: 03/22/2025]
Abstract
BACKGROUND In patients with cleft palate (CP), the impact of primary palatoplasty technique on otologic outcomes remains a major point of contention. While some studies report improved outcomes after certain techniques of palatal repair, there is a lack of consensus on the most effective procedure. OBJECTIVE We sought to characterize the effects of primary palatoplasty technique on otologic outcomes in children with CP. METHODS A single institution retrospective review of patients with CP who underwent primary palatoplasty (straight-line repair or Furlow Z-plasty) was performed. Primary outcomes of interest included time to placement of T-tubes, number of tympanostomy tube placements, tympanic membrane (TM) perforation, and 3-year and 6-year postoperative hearing thresholds. RESULTS A total of 140 patients were included in this study. The mean number of tympanostomy tube placements in the straight-line repair group (1.93 ± 1.28) was significantly higher than in the Furlow Z-plasty group (1.42 ± 1.03, p = 0.03). Median time from primary palate repair to T-tube placement was 38.93 (IQR 33.03) months. Higher birth weight (p < 0.01) and multiple tympanostomy tube placements (p < 0.05) were associated with longer time to T-tube placement. T-tube replacement was associated with a 16.9 times higher likelihood of TM perforation (p < 0.05). The median PTA significantly improved from 16.25 (IQR 7) dB at 3 years to 11.00 (IQR 5.25) dB at 6 years (p < 0.01). CONCLUSIONS Furlow palatoplasty technique was associated with fewer number of tympanostomy tube placements; however, palatoplasty technique did not significantly impact time to T-tube placement, TM perforation, or hearing outcomes. There were no significant differences in long-term hearing outcomes between patients who underwent Furlow Z-plasty and those who had straight-line repair. Most patients achieved normal hearing thresholds by 6 years after primary palatoplasty and tympanostomy tube placement. These are important considerations to discuss when counseling patients' families on surgical management of CP and otologic outcomes.
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Affiliation(s)
- Shaina W Gong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Paul Hung
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Chioma G Obinero
- Division of Plastic Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jose Barrera
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Zi Yang Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Matthew R Greives
- Division of Plastic Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Zhen Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States.
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Prosak OL, Du J, Gao L, Patel KR, Zhao S, Braun S, Golinko M, Phillips JD, Belcher RH. Does Palatoplasty Technique Impact Resolution of Eustachian Tube Dysfunction? Cleft Palate Craniofac J 2025; 62:179-187. [PMID: 39782704 PMCID: PMC11909771 DOI: 10.1177/10556656241308347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025] Open
Abstract
ObjectiveTo determine whether palatoplasty technique affects the resolution of eustachian tube dysfunction and postoperative speech outcomes in children with cleft palate (CP).DesignRetrospective cohort.SettingMultidisciplinary cleft and craniofacial clinic at a tertiary care center.PatientsSeventy-three patients with nonsyndromic CP who underwent palatoplasty between 2005 and 2019. Inclusion criteria included soft palate repair with Furlow technique or intravelar veloplasty (IVV) and Veau classifications I-III.InterventionsEither Furlow or IVV repair was performed based on the surgeon's clinical judgment. All patients had bilateral ear tubes placed prior to or at the time of palate repair, with postpalatoplasty ear tubes placed at the ENT surgeon's discretion. Patients received routine follow-up care for over 5 years. Data were analyzed with Wilcoxon tests, χ2 tests, and negative binomial regression.Main Outcome MeasuresNumber of postpalatoplasty ear tubes placed, rates of velopharyngeal insufficiency, and speech surgery after palatoplasty in each group.ResultsFurlow repair patients required a similar number of postpalatoplasty ear tubes (P = .321) and underwent additional sets at similar rates compared to those who underwent IVV repair. Negative binomial regression found no covariates (age, race, Veau, repair type, speech surgery, fistula repair) that predicted additional ear tube requirements.ConclusionFurlow repair patients required postpalatoplasty ear tubes at a similar rate compared to IVV repair patients. While the palatoplasty techniques differ, patients may still need the same amount of time for resolution of their eustachian tube dysfunction.
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Affiliation(s)
- Olivia L. Prosak
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Du
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lily Gao
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kalpnaben R. Patel
- Surgical Outcomes Center for Kids (SOCKS), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shilin Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephan Braun
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Golinko
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James D. Phillips
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pediatric Otolaryngology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Ryan H. Belcher
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Pediatric Otolaryngology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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Prathanee B, Buakanok N, Pumnum T, Thanawirattananit P. Hearing, speech, and language outcomes in school-aged children after cleft palate repair. Arch Craniofac Surg 2024; 25:230-239. [PMID: 39501732 PMCID: PMC11540486 DOI: 10.7181/acfs.2024.00395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 09/03/2024] [Accepted: 09/28/2024] [Indexed: 11/08/2024] Open
Abstract
BACKGROUND Following primary cleft palate repair, individuals face a heightened risk of hearing problems, particularly conductive hearing loss, compensatory articulation disorders (CADs), resonance disorders, delayed speech and language development, and voice disorders. This study aimed to investigate the prevalence and impact of these challenges in children with cleft palate with or without cleft lip (CP± L). METHODS This cross-sectional study included 38 children with CP± L aged 5 to 13 years. A comprehensive evaluation involved audiological assessments (audiograms, tympanograms) by an audiologist and speech-language pathology assessments (Thai Speech Parameters for Patients with Cleft Palate, Articulation Screening Test) by speech-language pathologists. RESULTS The prevalence of hearing loss affected 27.63% of participants (21 out of 76 ears) and majority of cases involved conductive hearing loss. Velar substitution was the most common CAD, followed by nasalized voiced pressure consonants, phoneme-specific nasal air emission, and pharyngeal substitution. A moderate correlation was found between these CAD patterns and hypernasality at the word, sentence, and screening levels (r= 0.44, p< 0.01; r= 0.43, p< 0.01; and r= 0.40, p= 0.01). CONCLUSION For summary, the most common type of hearing loss was conductive hearing loss. The predominant CAD pattern was velar substitution. The protocol could be designed to enhance early improvement in hearing and articulation, thereby supporting academic achievement and long-term quality of life.
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Affiliation(s)
- Benjamas Prathanee
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Netra Buakanok
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Tawitree Pumnum
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Panida Thanawirattananit
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Kazemi T, Nabavizadeh SS, Nadjmi N, Ahmadkhani A, Ghaemmaghami P, Kafaei A, Faramarzi A. The relationship between cleft palate repair technique and audiological outcomes: A retrospective cohort study. Laryngoscope Investig Otolaryngol 2024; 9:e1237. [PMID: 38525123 PMCID: PMC10960244 DOI: 10.1002/lio2.1237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/15/2024] [Accepted: 03/03/2024] [Indexed: 03/26/2024] Open
Abstract
Objective Otitis media with effusion is common in children with cleft palates. This study aimed to investigate the link between palatal closure techniques and audiological outcomes. Methods In this retrospective-prospective cohort study, we examined the relationship between palate repair techniques and hearing outcomes in children with cleft palates. From 2017 to 2022, 190 ears of 95 cleft patients were studied at the Cleft Lip and Palate Department of Shiraz University of Medical Sciences. Variables assessed included the surgical technique, cleft severity, auditory brainstem response (ABR) threshold, and tympanometry configuration. Results The mean ABR improved from a prepalatoplasty value of 39.51(11.62) decibels (dB) to a postpalatoplasty mean of 26.61(11.60) dB (Cohen's d: 1.12 [95% CI; 0.90-1.34]). Initially, 87.9% of the studied ears exhibited abnormal tympanometry, but this significantly decreased to 47% postsurgery (risk ratio: 4.43 [95% CI; 1.20-16.43]). When compared with Sommerlad intravelar veloplasty, the Nadjmi modified Furlow palatoplasty was associated with a notably lower mean ABR (β: -6.58 [95% CI: -10.43 to -2.73], p-value = .001) and a reduced frequency of abnormal tympanometry (odds ratio [OR]: -1.10; 95% CI: -1.85 to -0.36, p-value = .004). Factors like prepalatoplasty ABR, cleft palate severity, gender, and syndromic did not confound these findings. Conclusions Although the Nadjmi modified Furlow palatoplasty showed better results, our findings indicate a significant improvement in ABR and tympanometry outcomes for both techniques. Future randomized controlled trials are suggested to confirm the influence of palatal closure techniques on audiological outcomes. Level of Evidence 3b.
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Affiliation(s)
- Tayebeh Kazemi
- Department of Otolaryngology, Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Sara S. Nabavizadeh
- Department of Otolaryngology, Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Nasser Nadjmi
- Department of Cranio‐Maxillofacial SurgeryAntwerp University HospitalEdegemBelgium
- Department of Maxillofacial SurgeryZMACK, AZ MONICA AntwerpAntwerpBelgium
| | - Alireza Ahmadkhani
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Parvin Ghaemmaghami
- Department of Biostatistics, School of nursing and midwifery, Shiraz University of Medical SciencesShirazIran
| | - Ardavan Kafaei
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Ali Faramarzi
- Department of Otolaryngology, Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
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Montenegro de Andrade ÉJ, Toledo Teixeira da Silveira I, Marinho Barcellos B, Reis de Araújo Carvalho L, Faria Yaedú RY. Fracture patterns in cleft orthognathic surgery. a cross-sectional study. REVISTA CIENTÍFICA ODONTOLÓGICA 2024; 12:e194. [PMID: 39119124 PMCID: PMC11304855 DOI: 10.21142/2523-2754-1202-2024-194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/16/2024] [Indexed: 08/10/2024] Open
Abstract
Objective This study aims to identify fracture patterns on the lingual aspect of the mandible following Bilateral Sagittal Osteotomy of the Mandibular Ramus and correlate these patterns with mandibular anatomical characteristics in patients with cleft lip and palate. Methods Two hundred cone beam CT scans were analyzed, with 100 scans in the preoperative period to assess mandibular anatomy and 100 in the postoperative period to evaluate the course of fractures on the lingual surface after surgery. Results Statistical analysis revealed no correlation between the depth of the mandibular fossa and the type of fracture after bilateral sagittal osteotomy. Similarly, there was no association between the height and angle of the mandibular body and the type of fracture. The most common fracture type observed was the type 3 pattern, characterized by a line running through the mandibular canal. Furthermore, no relationship was identified between the studied anatomical aspects and the occurrence of undesired fractures. Conclusions The anatomical data presented in this study can assist surgeons in selecting the safest surgical techniques and optimal osteotomy sites, particularly in patients with cleft lip and palate.
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Affiliation(s)
- Ércio Júnior Montenegro de Andrade
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP). Bauru, Brazil. , , Universidade de São Paulo Hospital for Rehabilitation of Craniofacial Anomalies University of São Paulo (HRAC/USP) Bauru Brazil
| | - Isabela Toledo Teixeira da Silveira
- Faculty of Dentistry of Bauru, University of São Paulo, Department of Surgery, Stomatology, Pathology and Radiology. Bauru, Brazil. , Universidade de São Paulo Faculty of Dentistry of Bauru University of São Paulo Department of Surgery, Stomatology, Pathology and Radiology Bauru Brazil
| | - Bhárbara Marinho Barcellos
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP). Bauru, Brazil. , , Universidade de São Paulo Hospital for Rehabilitation of Craniofacial Anomalies University of São Paulo (HRAC/USP) Bauru Brazil
| | - Luciano Reis de Araújo Carvalho
- Faculty of Dentistry of Bauru, University of São Paulo, Department of Surgery, Stomatology, Pathology and Radiology. Bauru, Brazil. , Universidade de São Paulo Faculty of Dentistry of Bauru University of São Paulo Department of Surgery, Stomatology, Pathology and Radiology Bauru Brazil
| | - Renato Yassutaka Faria Yaedú
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP). Bauru, Brazil. , , Universidade de São Paulo Hospital for Rehabilitation of Craniofacial Anomalies University of São Paulo (HRAC/USP) Bauru Brazil
- Faculty of Dentistry of Bauru, University of São Paulo, Department of Surgery, Stomatology, Pathology and Radiology. Bauru, Brazil. , Universidade de São Paulo Faculty of Dentistry of Bauru University of São Paulo Department of Surgery, Stomatology, Pathology and Radiology Bauru Brazil
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Kitaya S, Suzuki J, Ikeda R, Sato A, Adachi M, Shirakura M, Kobayashi Y, Shirakura S, Suzuki Y, Imai Y, Katori Y. Impact of palatoplasty techniques on tympanic membrane findings and hearing prognosis in children with cleft palate. Int J Pediatr Otorhinolaryngol 2023; 174:111747. [PMID: 37820571 DOI: 10.1016/j.ijporl.2023.111747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Children with cleft palate (CP) are at high risk of developing otitis media with effusion (OME) due to Eustachian tube (ET) dysfunction. Palatoplasty has been reported to decrease the frequency of middle ear disease and improve ET function, and although various techniques have been developed, there is no consensus on the differences in the impact of different techniques on the middle ear. The purpose of this study was to determine the differential effects of palatoplasty on middle ear function and hearing. METHODS We performed a retrospective observational survey of pediatric patients who underwent palatoplasty for CP between June 2010 and October 2018 at Tohoku University Hospital. Cases were divided into three groups depending on the palatoplasty procedures performed: the push-back palatoplasty group, the two-flap palatoplasty group, and the Furlow double-opposing Z-plasty group. We examined the differences in clinical characteristics between patients who underwent each procedure. The primary outcome variable was tympanic membrane (TM) findings, and the secondary outcome was hearing test results. RESULTS Children who underwent the two-flap palatoplasty had a higher tympanostomy tube (TT) insertion rate and a higher total number of TT insertions than those who underwent the Furlow double-opposing Z-plasty or the push-back palatoplasty. The TM retraction rate tended to be lower in the Furlow double-opposing Z-plasty group than in the push-back palatoplasty group or the two-flap palatoplasty group. The hearing test results at the last visit were not significantly different among the three groups. CONCLUSIONS Children who underwent the two-flap palatoplasty had a higher rate of TT insertions, potentially increasing the risk of TM perforation. In contrast, the Furlow double-opposing Z-plasty group had a lower tendency for TM regression, possibly due to improved ET function and reduced incidence of OME. It is important to understand the advantages and disadvantages of each technique before selecting one suitable for the child's cleft and arch width. Additionally, it is important to conduct regular follow-up of TM findings and hearing test results even after palatoplasty.
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Affiliation(s)
- Shiori Kitaya
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Jun Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University, School of Medicine, Shiwa, Iwate, Japan
| | - Akimitsu Sato
- Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mika Adachi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masayuki Shirakura
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yuta Kobayashi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shiho Shirakura
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yuka Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoshimichi Imai
- Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Martin HL, Poehlein ER, Allori AC, Marcus JR, Cheng J, Lee H, Raynor EM. Relevance of cleft palatal width in short-term otologic outcomes. Int J Pediatr Otorhinolaryngol 2023; 171:111647. [PMID: 37429111 DOI: 10.1016/j.ijporl.2023.111647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/21/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Children with cleft palate are at increased risk for Eustachian tube dysfunction (ETD) and conductive hearing loss from chronic otitis media. While it has been proposed that the severity of ETD is related to the severity of cleft palate, data are lacking to support this hypothesis. An improved understanding of the relevance of cleft width may have prognostic value that could inform decisions on the timing of tympanostomy tube placement and choice of tympanostomy tube design. The objective of this study was to assess severity of ETD in children with narrow, moderate, and wide cleft palate, with examination of hearing outcomes, number of tympanostomy procedures, and incidence of otologic complications. METHODS Retrospective chart review was conducted on 58 patients with primary palatoplasty performed at a single academic medical center from January 1, 2016-December 31, 2019. The primary outcome was the number of otologic procedures performed after the initial palatoplasty. Secondary outcomes included audiometric findings, number of tympanostomy tube placements, presence of effusion at the time of myringotomy, and occurrence of any postoperative otologic complication. Outcomes were compared for patients with narrow (<10 mm), moderate (10-15 mm), and wide (>15 mm) cleft palate. Analysis included consideration of cleft palatal morphology (Veau I - IV), presence of Robin sequence or syndromes, and risk factors for otitis media. RESULTS Patients with moderate and wide cleft palate underwent higher mean numbers of otologic procedures [narrow: 1.3 (95% confidence interval [CI] 0.9, 1.7); moderate: 1.6 (95% CI 1.1, 2.1); wide: 1.8 (95% CI 1.2, 2.4)]. Moderate and wide cleft palate were less likely to have normal hearing after their first tympanostomy (narrow: 50%, 10/20; moderate: 25%, 6/24; wide: 36%, 5/14). Patients with a wide cleft palate had a shorter median time between first and second tympanostomy procedures (median, IQR; narrow: 27.0, 20.8-35.7; moderate 20.4, 16.3-25.9; wide 17.3, 11.5-23.4). CONCLUSION Our findings suggest that patients with wider cleft palate may be more susceptible to severe ETD. Further large-scale study may help to allow for more informed and personalized clinical decision making for management of cleft palate, incorporating cleft width for prognosis of risks for persistent middle ear dysfunction.
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Affiliation(s)
- H L Martin
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3805, 27710, Durham, NC, USA.
| | - E R Poehlein
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, 27710, Durham, NC, USA.
| | - A C Allori
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3974, 27710, Durham, NC, USA.
| | - J R Marcus
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3974, 27710, Durham, NC, USA.
| | - J Cheng
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3805, 27710, Durham, NC, USA.
| | - H Lee
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, 27710, Durham, NC, USA.
| | - E M Raynor
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3805, 27710, Durham, NC, USA.
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Shi D, Zhou L, Shang Y, Zhao J. Impact of a Modified Restoration of Tensor Veli Palatini on Hearing and Middle Ear Function in Cleft Palate Children-a Retrospective Study. J Craniofac Surg 2023; 34:e259-e263. [PMID: 36728970 PMCID: PMC10128907 DOI: 10.1097/scs.0000000000009148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/26/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Many children with cleft palate also exhibit hearing loss and middle ear dysfunction, which could last for years. There are still arguments on how to treat this problem. This study aimed to evaluate the impact of a modified restoration of tensor veli palatine (TVP) on hearing and middle ear function in the cleft palate children. METHODS This retrospective study was completed using records of the cleft palate children who received surgery in Peking Union Medical College Hospital from May 2013 to December 2020. They were divided into 2 groups: Group 1: children who received cleft palate surgery without specific restoration of TVP; Group 2: children who received palate surgery with a specific TVP restoration technique. Perioperative information was collected. The conductive auditory brainstem response and the 226-Hz tympanometry before and after the cleft surgery were compared intragroup and intergroup. RESULTS Totally 42 children were included in this study, 21 children in each group. There were no significant differences considering clinical characteristics between the 2 groups. The modified TVP restoration didn't increase operation time or complication compared with no TVP restoration. Statistically, neither the auditory brainstem response air conduction hearing thresholds nor the 226-Hz tympanometry results had significant differences between the 2 groups after the surgery. CONCLUSIONS This modified restoration of TVP was not time-consuming and did not increase complications. The beneficial effect of the modified TVP restoration on the hearing or the middle ear function of cleft palate children was uncertain around 6 months after surgery compared with no restoration.
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Affiliation(s)
| | | | - Yingying Shang
- Otorhinolaryngology, Peking Union Medical College Hospital, CAMS and PUMC, Beijing, China
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Jeon S, Choe G, Oh J, Kim SW, Park MK, Chung JH. The Impact of Lateral Relaxing Incision on Middle Ear Function in Cleft Palate Repair. J Craniofac Surg 2023; 34:e277-e281. [PMID: 36872493 DOI: 10.1097/scs.0000000000009206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/05/2022] [Indexed: 03/07/2023] Open
Abstract
Children with cleft palate are susceptible to otitis media with effusion. This study aimed to investigate the effect of lateral relaxing incision (RI) on middle ear function in cleft palate patients who underwent palatoplasty using double-opposing Z-plasty (DOZ). This is a retrospective study of patients who underwent bilateral ventilation tube insertion concurrently with DOZ, wherein RI was selectively performed on the right side of the palate (Rt-RI group) or not (No-RI group). The frequency of VTI, duration of the first ventilation tube retention, and hearing outcomes at the last follow-up were reviewed. Outcomes were compared using the χ 2 test and t test. A total of 126 treated ears from 63 non-syndromic children (18 male, 45 female) with cleft palate were reviewed. The mean age at surgery was 15.8±6.17 months. There were no significant differences in the frequency of ventilation tube insertion between the right and left ears within the Rt-RI group or between the Rt-RI and no-RI groups in the right ear. Subgroup analysis for ventilation tube retention time, auditory brainstem response thresholds, and air-conduction pure tone averages showed no significant differences. In the DOZ, the use of RI had no significant effects on middle ear outcomes during 3 years of follow-up. Relaxing incision seems to be safe without concern for middle ear function in children with cleft palate.
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Affiliation(s)
- Sungmi Jeon
- Division of Pediatric Plastic Surgery, Seoul National University Children's Hospital
| | - Goun Choe
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Jayoung Oh
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Suk Wha Kim
- Department of Plastic Surgery, CHA Bundang Medical Center, Gyeonggi-do
- Medical Big Data Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Moo Kyun Park
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Jee Hyeok Chung
- Division of Pediatric Plastic Surgery, Seoul National University Children's Hospital
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Corcoran M, Karki S, Ylikontiola L, Lithovius R, Sándor GK, Harila V. Maxillary Arch Dimensions in 6-Year-Old Cleft Children in Northern Finland: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147432. [PMID: 34299883 PMCID: PMC8304168 DOI: 10.3390/ijerph18147432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
The aim was to cross-sectionally examine the maxillary arch dimensions in 6-year-old children with cleft lip and/or palate and to compare them with the initial cleft sizes among patients with cleft palate. The study included 89 patients with clefts treated at the Oulu University Hospital. The subjects were divided into three groups: cleft palate, cleft lip, and cleft lip and palate. Study casts were scanned, and the maxillary arch dimensions were examined using a 3D program (3Shape Orthoanalyzer, Copenhagen, Denmark). The statistical methods Student's t-test and one-way ANOVA were used to compare the means (SD) between the groups. Spearman's correlation coefficient was used to determine the correlation between cleft severity and maxillary dimensions. A significant difference was found between different initial cleft sizes in terms of distance between the second deciduous molar and the first incisor on the right side. The intermolar width showed a negative correlation with the initial cleft size. The dimensions were shorter for clefts affecting the palate and largest for clefts affecting only the lip. Larger clefts resulted in a shorter maxilla on the right side. Many dimensions became shorter when the initial cleft was larger. Clefts of the palate resulted in smaller maxillas.
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Affiliation(s)
- Mirjami Corcoran
- Research Unit of Oral Health Sciences, University of Oulu, 90220 Oulu, Finland; (S.K.); (L.Y.); (R.L.); (G.K.S.); (V.H.)
- Correspondence:
| | - Saujanya Karki
- Research Unit of Oral Health Sciences, University of Oulu, 90220 Oulu, Finland; (S.K.); (L.Y.); (R.L.); (G.K.S.); (V.H.)
| | - Leena Ylikontiola
- Research Unit of Oral Health Sciences, University of Oulu, 90220 Oulu, Finland; (S.K.); (L.Y.); (R.L.); (G.K.S.); (V.H.)
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, 90220 Oulu, Finland
| | - Riitta Lithovius
- Research Unit of Oral Health Sciences, University of Oulu, 90220 Oulu, Finland; (S.K.); (L.Y.); (R.L.); (G.K.S.); (V.H.)
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, 90220 Oulu, Finland
| | - George K. Sándor
- Research Unit of Oral Health Sciences, University of Oulu, 90220 Oulu, Finland; (S.K.); (L.Y.); (R.L.); (G.K.S.); (V.H.)
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, 90220 Oulu, Finland
| | - Virpi Harila
- Research Unit of Oral Health Sciences, University of Oulu, 90220 Oulu, Finland; (S.K.); (L.Y.); (R.L.); (G.K.S.); (V.H.)
- Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, 90220 Oulu, Finland
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Surface Electromyography as a Method for Diagnosing Muscle Function in Patients with Congenital Maxillofacial Abnormalities. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:8846920. [PMID: 33029337 PMCID: PMC7527883 DOI: 10.1155/2020/8846920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022]
Abstract
Electromyography (EMG) is the most objective and reliable method available for imaging muscle function and efficiency, which is done by identifying their electrical potentials. In global surface electromyography (sEMG), surface electrodes are located on the surface of the skin, and it detects superimposed motor unit action potentials from many muscle fibers. sEMG is widely used in orthodontics and maxillofacial orthopaedics to diagnose and treat temporomandibular disorders (TMD) in patients, assess stomatognathic system dysfunctions in patients with malocclusions, and monitor orthodontic therapies. Information regarding muscle sEMG activity in subjects with congenital maxillofacial abnormalities is limited. For this reason, the aim of this review is to discuss the usefulness of surface electromyography as a method for diagnosing muscle function in patients with congenital malformations of the maxillofacial region. Original papers on this subject, published in English between 1995 until 2020, are located in the MEDLINE/PubMed database.
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McAndrew L. Parental Judgement of Hearing Loss in Infants With Cleft Palate. Cleft Palate Craniofac J 2020; 57:886-894. [PMID: 32013560 DOI: 10.1177/1055665619899743] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate whether reported parental concern is supported by hearing assessment findings in children with cleft palate. To describe this population by examining the relationship between cleft type, middle ear status, and hearing loss. DESIGN Retrospective consecutive case note review. SETTING Tertiary institutional regional cleft center. PATIENTS Consecutive cases of 194 babies born with cleft palate and referred to the specialist center from January 2009 and December 2013. Following exclusions, data from 155 infants were included for analysis. INTERVENTIONS Documented parental concern in ear, nose and throat (ENT) and speech and language therapy case notes were compared to hearing assessment findings. Findings from otoscopic examination, tympanometry, and hearing assessment were analyzed with respect to cleft type. RESULTS Parental concern is not always accurately reflected by objective assessment particularly when no concern is reported. Analysis of the cohort examined suggests that cleft type is not related to middle ear findings or hearing. CONCLUSIONS It is helpful to be aware of parental concern and clinicians should consider that parental reports may not be accurately reflected by test results. As cleft type was not found to substantially influence middle ear status or hearing it is not recommended to adapt speech and language advice offered to families according to cleft type. Follow-up studies to increase participant numbers would support a statistical analysis.
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Affiliation(s)
- Lucy McAndrew
- Spires Cleft Centre Oxford, Level 2, Children's Hospital, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom
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13
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Prognostic Factors for Hearing Outcomes in Children with Cleft Lip and Palate. Plast Reconstr Surg 2019; 143:368e-374e. [DOI: 10.1097/prs.0000000000005219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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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: 3.0] [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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Garcia-Vaquero C, Mir C, Graterol D, Ortiz N, Rochera-Villach MI, LLeonart ME, Lorente J. Otologic, audiometric and speech findings in patients undergoing surgery for cleft palate. BMC Pediatr 2018; 18:350. [PMID: 30409226 PMCID: PMC6225714 DOI: 10.1186/s12887-018-1312-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 10/16/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Although considerable progress has been made in the last 30 years in the treatment of cleft palate (CP), a multidisciplinary approach combining examinations by a paediatrician, maxillofacial surgeon, otolaryngologist and speech and language pathologist followed by surgical operation is still required. In this work, we performed an observational cross-sectional study to determine whether the CP grade or number of ventilation tubes received was associated with tympanic membrane abnormalities, hearing loss or speech outcomes. METHODS Otologic, audiometric, tympanometric and speech evaluations were performed in a cohort of 121 patients (children > 6 years) who underwent an operation for CP at the Vall d'Hebron Hospital, Barcelona from 2000 to 2014. RESULTS The most and least frequent CP types evaluated according to the Veau grade were type III (55.37%) and I (8.26%), respectively. A normal appearance of the membrane was observed in 58% individuals, of whom 55% never underwent ventilation ear tube insertion. No statistically significant associations were identified between the CP type and number of surgeries for insertion of tubes (p = 0.820). The degree of hearing loss (p = 0.616), maximum impedance (p = 0.800) and tympanic membrane abnormalities indicative of chronic otitis media (COM) (p = 0.505) among examined patients revealed no statistically significant association with the grade of CP. However, an association was identified between hypernasality and the grade of CP (p = 0.053), COM (p = 0.000), hearing loss (p = 0.000) and number of inserted ventilation tubes. CONCLUSION Although the placement of tympanic ventilation tubes has been accompanied by an increased rate of COM, it is still important to assess whether this is a result of the number of ventilation tubes inserted or it is intrinsic to the natural history of middle ear inflammatory disease of such patients. Our results do not support improvements in speech, hearing, or tympanic membrane abnormalities with more aggressive management of COM with tympanostomy tubes.
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Affiliation(s)
- Cristina Garcia-Vaquero
- Otolaryngology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Cristina Mir
- Biomedical Research in Cancer Stem Cells, Vall d'Hebron Research Institute, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Domingo Graterol
- Otolaryngology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Nuria Ortiz
- Otolaryngology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Maria Isabel Rochera-Villach
- Otolaryngology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Matilde E LLeonart
- Biomedical Research in Cancer Stem Cells, Vall d'Hebron Research Institute, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Juan Lorente
- Otolaryngology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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Electromyographic Analysis of Masticatory Muscles in Cleft Lip and Palate Children with Pain-Related Temporomandibular Disorders. Pain Res Manag 2018; 2018:4182843. [PMID: 29861801 PMCID: PMC5971269 DOI: 10.1155/2018/4182843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/16/2018] [Accepted: 04/12/2018] [Indexed: 11/17/2022]
Abstract
Aim The aim of this study was to assess the electrical activity of temporalis and masseter muscles in children with cleft lip and palate (CLP) and pain-related temporomandibular disorders (TMD-P). Methods The sample consisted of 31 CLP patients with a TMD-P (mean age 9.5 ± 1.8 years) and 32 CLP subjects with no TMD (mean age 9.2 ± 1.7 years). The children were assessed for the presence of temporomandibular disorders (TMD) using Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD). Electromyographical (EMG) recordings were performed using a DAB-Bluetooth Instrument (Zebris Medical GmbH, Germany) in the mandibular rest position and during maximum voluntary contraction (MVC). Results The rest activity of the temporalis and masseter muscles was significantly higher in TMD-P group compared with non-TMD children. A significant decrease in temporalis muscle activity during MVC was observed in TMD-P patients. There was a significant increase in the Asymmetry Index for temporalis and masseter muscle rest activity in the TMD-P group. Conclusion Cleft children diagnosed with TMD-P have altered masticatory muscle activity, and this can affect their muscle function.
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Electromyographic analysis of superior orbicularis oris muscle function in children surgically treated for unilateral complete cleft lip and palate. J Craniomaxillofac Surg 2017; 45:1547-1551. [PMID: 28736109 DOI: 10.1016/j.jcms.2017.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 05/17/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The aim of this study was to assess the electrical activity of the superior orbicularis oris muscle in children surgically treated for unilateral complete cleft lip and palate (UCCLP). MATERIAL AND METHODS The sample comprised 45 patients 6.38-12.68 years of age with UCCLP and 40 subjects 6.61-11.71 years of age with no clefts. Electromyographical (EMG) recordings were taken with a DAB-Bluetooth Instrument (Zebris Medical GmbH, Germany) in the rest position and during saliva swallowing, lip protrusion and reciprocal compression of the lips, as well as while producing the phonemes /p/, /b/, and /m/ combined with the vowel /a/. RESULTS The electrical activity of the upper lip during saliva swallowing and lip compression was significantly greater in the cleft group. Similar resting level activity was observed in both groups. During the production of the /p/, /b/, and /m/ phonemes combined with the vowel /a/ the results showed no significant differences in the EMG activity between children with UCCLP and noncleft subjects. CONCLUSION Patients with UCCLP have abnormal upper lip function characterized by increased activity of the superior orbicularis oris muscle during saliva swallowing and lip compression, and this may affect facial morphology.
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