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Al-Dourobi K, Mermod T, Doan MT, Herzog G, Broome M, El Ezzi O, de Buys Roessingh A. What We Learned from Performing the Inverse Malek Procedure to Repair Bilateral Cleft Lips and Palates: A Single-Center Retrospective Study. J Clin Med 2024; 13:1939. [PMID: 38610704 PMCID: PMC11012878 DOI: 10.3390/jcm13071939] [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: 03/05/2024] [Revised: 03/16/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This study reviews the surgical and functional outcomes of children diagnosed with a bilateral cleft lip and palate and treated by the same surgical team following specific surgical protocols 18 years after surgery and during the follow-up. Methods: Based on a single-center retrospective design, demographic and surgical data were gathered by the authors from international institutions. Most of the data were quantitative in nature, and descriptive statistical and non-parametric tests were employed for analysis. All children born with a bilateral cleft from 1982 to 2002 were considered. Children affected by a syndrome were excluded. Complications and speech results were the main items measured. Results: Thirty patients were selected; 73.3% were treated using the inverse Malek procedure, and 26.7% underwent a modified two-stage procedure. Seventy percent developed an oronasal fistula. An alveolar bone graft was performed in 83%, and 53.3% underwent Le Fort osteotomy. Thirty-six percent required a pharyngeal flap, with good speech results. The median number of times general anesthesia was used among all the interventions considered was 5.5 (4.25-6). Conclusions: This study presents the long-term results of using the inverse Malek procedure to treat children with a bilateral cleft lip and palate. It is shown that this is related to a high risk of developing a fistula, but has good long-term speech results.
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Affiliation(s)
- Karim Al-Dourobi
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.)
| | - Tessa Mermod
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.)
| | - Marie-Thérèse Doan
- Children and Adolescent Surgery Department, Multidisciplinary Consultations of Facial Cleft, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland (G.H.)
| | - Georges Herzog
- Children and Adolescent Surgery Department, Multidisciplinary Consultations of Facial Cleft, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland (G.H.)
| | - Martin Broome
- Children and Adolescent Surgery Department, Multidisciplinary Consultations of Facial Cleft, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland (G.H.)
| | - Oumama El Ezzi
- Children and Adolescent Surgery Department, Multidisciplinary Consultations of Facial Cleft, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland (G.H.)
| | - Anthony de Buys Roessingh
- Children and Adolescent Surgery Department, Multidisciplinary Consultations of Facial Cleft, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland (G.H.)
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Kauffmann P, Kolle J, Quast A, Wolfer S, Schminke B, Meyer-Marcotty P, Schliephake H. Two-stage palatal repair in non-syndromic CLP patients using anterior to posterior closure is associated with minimal need for secondary palatal surgery. Head Face Med 2024; 20:18. [PMID: 38461271 PMCID: PMC10924352 DOI: 10.1186/s13005-024-00418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/16/2024] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE The aim of the present study was to assess the need for secondary palatal corrective surgery in a concept of palate repair that uses a protocol of anterior to posterior closure of primary palate, hard palate and soft palate. METHODS A data base of patients primarily operated between 2001 and 2021 at the Craniofacial and Cleft Care Center of the University Goettingen was evaluated. Cleft lips had been repaired using Tennison Randall and Veau-Cronin procedures in conjunction with alveolar cleft repair. Cleft palate repair in CLP patients was accomplished in two steps with repair of primary palate and hard palate first using vomer flaps at the age of 10-12 months and subsequent soft palate closure using Veau/two-flap procedures 3 months later. Isolated cleft palate repair was performed in a one-stage operation using Veau/two-flap procedures. Data on age, sex, type of cleft, date and type of surgery, occurrence and location of oronasal fistulae, date and type of secondary surgery performed for correction of oronasal fistula (ONF)and / or Velophyaryngeal Insufficiency (VPI) were extracted. The rate of skeletal corrective surgery was registered as a proxy for surgery induced facial growth disturbance. RESULTS In the 195 patients with non-syndromic complete CLP evaluated, a total number of 446 operations had been performed for repair of alveolar cleft and cleft palate repair (Veau I through IV). In 1 patient (0,5%), an ONF occurred requiring secondary repair. Moreover, secondary surgery for correction of VPI was required in 1 patient (0,5%) resulting in an overall rate of 1% of secondary palatal surgery. Skeletal corrective surgery was indicated in 6 patients (19,3%) with complete CLP in the age group of 15 - 22 years (n = 31). CONCLUSIONS The presented data have shown that two-step sequential cleft palate closure of primary palate and hard palate first followed by soft palate closure has been associated with minimal rate of secondary corrective surgery for ONF and VPI at a relatively low need for surgical skeletal correction.
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Affiliation(s)
- Philipp Kauffmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany.
- Georg-August-University Goettingen, Robert-Koch-Straße 40, Goettingen, 37099, Germany.
| | - Johanna Kolle
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Anja Quast
- Department of Orthodontics, University Medical Center Goettingen, Goettingen, Germany
| | - Susanne Wolfer
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Boris Schminke
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
| | | | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
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Applebaum SA, Aronson S, Termanini KM, Gosain AK. Evidence-Based Practices in Cleft Palate Surgery. Plast Reconstr Surg 2024; 153:448e-461e. [PMID: 38266141 DOI: 10.1097/prs.0000000000011035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: (1) Understand the embryologic origins, cause, and incidence of cleft palate. (2) Review the anatomy and common classifications of cleft palate and associated defects. (3) Describe surgical techniques for palatoplasty and understand their respective indications. (4) Gain an awareness of general perioperative care considerations, timing of repair, and risk factors for and operative mitigation of complications. SUMMARY Cleft palate affects 0.1 to 1.1 per 1000 births, with a higher incidence in certain ethnic groups but affecting both sexes equally. Cleft palate may occur in isolation or in combination with cleft lip or in association with other congenital anomalies including various syndromes. The goals of cleft palate repair are to anatomically separate the oral and nasal cavities for normal feeding and improved speech and minimize the risk of oronasal fistulas, velopharyngeal dysfunction, and disruption of facial growth. This review discusses the incidence, causes, and classification of cleft palate; surgical techniques for palatoplasty and perioperative patient management; and complications of palatoplasty.
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Affiliation(s)
- Sarah A Applebaum
- From the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine
| | - Sofia Aronson
- From the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine
| | - Kareem M Termanini
- From the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine
| | - Arun K Gosain
- From the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine
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Hofman L, van Dongen JA, van Rees RCM, Jenniskens K, Haverkamp SJ, Beentjes YS, van der Molen ABM, Paes EC. Speech correcting surgery after primary palatoplasty: a systematic literature review and meta-analysis. Clin Oral Investig 2023; 28:58. [PMID: 38157017 DOI: 10.1007/s00784-023-05391-7] [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: 09/14/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES In cleft palate patients, the soft palate is commonly closed using straight-line palatoplasty, Z-palatoplasty, or palatoplasty with buccal flaps. Currently, it is unknown which surgical technique is superior regarding speech outcomes. The aim of this review is to study the incidence of speech correcting surgery (SCS) per soft palatoplasty technique and to identify variables which are associated with this outcome. MATERIALS AND METHODS A systematic literature search was carried out according to the PRISMA guidelines. Inclusion and exclusion criteria were applied to focus on the incidence of SCS after soft palatoplasty. Additional variables like surgical modification, cleft morphology, syndrome, age at palatoplasty, fistula and assessment of velopharyngeal function were reported. A modified New-Ottawa Scale (NOS) was used for quality appraisal. Pooled estimates from the meta-analysis were calculated using a random-effects model. RESULTS One thousand twenty-nine studies were found of which 54 were included in the analysis. The pooled estimate proportion of SCS after straight-line palatoplasty was 19% (95% CI 15-24), after Z-palatoplasty 6% (95% CI 4-9), and after palatoplasty with buccal flaps 7% (95% CI 4-11). CONCLUSIONS A lower SCS rate was found in patients receiving Z-palatoplasty when compared to straight-line palatoplasty. We propose a minimum set of outcome parameters which ideally should be included in future studies regarding speech outcomes after cleft palate repair. CLINICAL RELEVANCE Current literature reports highly heterogenous data regarding cleft palate repair. Our recommended set of parameters may address this inconsistency and could make intercenter comparison possible and of better quality.
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Affiliation(s)
- Lieke Hofman
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
| | - Joris A van Dongen
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | | | - Kevin Jenniskens
- Department of Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sarah J Haverkamp
- Speech and Language Therapy, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Yente S Beentjes
- Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Aebele B Mink van der Molen
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Emma C Paes
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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Elayah SA, Wu M, Al-Moraissi EA, Yin J, Sakran KA, Al-Gumaei WS, Younis H, Almagrami I, Alqadasy NE, Li Y, Shi B. Impact of relaxing incisions on maxillofacial growth following Sommerlad-Furlow modified technique in patients with isolated cleft palate: a preliminary comparative study. BMC Surg 2023; 23:358. [PMID: 37996863 PMCID: PMC10668437 DOI: 10.1186/s12893-023-02247-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE To estimate the impact of relaxing incisions on maxillofacial growth following Sommerlad-Furlow modified technique in patients with isolated cleft palate. STUDY DESIGN A Retrospective Cohort Study. METHODS A total of 90 participants, 60 patients with non-syndromic isolated soft and hard cleft palate underwent primary palatoplasty (30 patients received the Sommerlad-Furlow modified technique without relaxing incision (S.F-RI group), and 30 received Sommerlad-Furlow modified technique with relaxing (S.F+RI group) with no significant difference found between them regarding the cleft type, cleft width, and age at repair. While the other 30 were healthy noncleft participants with skeletal class I pattern as a Control group. The control group (C group) was matched with the patient groups in number, age, and sex. All participants had lateral cephalometric radiographs at least 5 years old age. The lateral cephalometric radiographs were taken with the same equipment by the same experienced radiologist while the participants were in centric occlusion and a standardized upright position, with the transporionic axis and Frankfort horizontal plane parallel to the surface of the floor. A well-trained assessor (S. Elayah) used DOLPHIN Imaging Software to trace twice to eliminate measurement errors. All the study variables were measured using stable landmarks, including 12 linear and 10 angular variants. RESULTS The mean age at collection of cephalograms was 6.03 ± 0.80 in the S.F+RI group, 5.96 ± 0.76 in the S.F-RI group, and 5.91 ± 0.87 in the C group. Regarding cranial base, the results showed no statistically significant differences between the three groups in S-N and S-N-Ba. While the S.F+R.I group had a significantly shortest S-Ba than the S.F-R.I & C groups (P = 0.01 & P < 0.01), but there was no statistically significant difference between S.F-R.I & C groups (P = 0.71). Regarding the skeletal maxilla, there was no significant difference between the S.F+R.I and S.F-R.I groups in all linear measurements (N-ANS and S-PM) except Co-A, the S.F+R.I group had significantly shorter Co-A than the S.F-R.I & C groups (P = < 0.01). While the angular measurement, S.F+R.I group had significantly less SNA angle than the S.F-R.I & C groups (P = < 0.01). Regarding mandibular bone, there were no statistically significant differences in all linear and angular mandibular measurements between the S.F+R.I and S.F-R.I.groups. Regarding intermaxillary relation, the S.F+R.I group had significant differences in Co-Gn-Co-A and ANB compared to the S.F-R.I & C groups (P = < 0.01). While there was no statistically significant difference in PP-MP between the three groups. CONCLUSION As a preliminary report, the Sommerlad-Furlow modified technique without relaxing incisions was found to have a good maxillary positioning in the face and a satisfactory intermaxillary relationship compared to the Sommerlad-Furlow modified technique with relaxing incisions.
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Affiliation(s)
- Sadam Ahmed Elayah
- State Key Laboratory of Oral Diseases & National Center for Stomatology &, National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Min Wu
- State Key Laboratory of Oral Diseases & National Center for Stomatology &, National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Thamar University, Thamar, Yemen
| | - Jiayi Yin
- State Key Laboratory of Oral Diseases & National Center for Stomatology &, National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Karim Ahmed Sakran
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Waseem Saleh Al-Gumaei
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hamza Younis
- State Key Laboratory of Oral Diseases & National Center for Stomatology &, National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ibtehal Almagrami
- Department of Orthodontics, Faculty of Dentistry, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Nadia E Alqadasy
- Department of Orthodontics, College of Dentistry, Ibn Al-Nafis University for Medical Sciences, Sana'a, Yemen
| | - Yang Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology &, National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Center for Stomatology &, National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China.
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Elayah SA, Yin J, Al-Gumaei WS, Younis H, Sakran KA, Tang Z, Mashrah MA, Lubamba GP, Wu M, Li Y, Shi B. A comparison of maxillofacial growth in Chinese children with isolated cleft palate treated with two different palatoplasty techniques without relaxing incisions: a preliminary study. BMC Oral Health 2023; 23:914. [PMID: 37996823 PMCID: PMC10668460 DOI: 10.1186/s12903-023-03588-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE To assess the maxillofacial growth of patients with isolated cleft palate following the Sommerlad-Furlow modified technique and compare it with the effect of the Sommerlad technique. STUDY DESIGN A Retrospective Cohort Study. METHODS A total of 90 participants, 60 patients with non-syndromic isolated soft and hard cleft palate (ISHCP) underwent primary palatoplasty without relaxing incision (30 patients received the Sommerlad-Furlow modified (S-F) technique and 30 received Sommerlad (S) technique). While the other 30 were healthy noncleft participants with skeletal class I pattern (C group). All participants had lateral cephalometric radiographs at least 5 years old age. All the study variables were measured by using stable landmarks, including 11 linear and 9 angular variants. RESULTS The means age at collection of cephalograms were 6.03 ± 0.80 (5-7 yrs) in the S group, 5.96 ± 0.76 (5-7 yrs) in the S-F group, and 5.91 ± 0.87 (5-7 yrs) in the C group. Regarding cranial base, the results showed that there were no statistically significant differences between the three groups in S-N and S-N-Ba. The S group had a significantly shortest S-Ba than the S-F & C groups (P = 0.01), but there was no statistically significant difference between S-F and C groups (P = 0.80). Regarding skeletal maxillary growth, the S group had significantly shorter Co-A, S- PM and significantly less SNA angle than the C group (P = < 0.01). While there was no significant difference between S-F & C groups (P = 0.42). The S group had significantly more MP-SN inclination than the C group (P = < 0.01). Regarding skeletal mandibular growth, there were no statistically significant differences in all linear and angular mandibular measurements between the three groups, except Co-Gn of the S group had a significantly shorter length than the C group (P = 0.05). Regarding intermaxillary relation, the S-F group had no significant differences in Co-Gn-Co-A and ANB as compared with the C group. The S group had significantly less ANB angle than S-F & C groups (P = 0.01 & P = < 0.01). In addition, there were no significant differences in all angular occlusal measurements between the three groups. CONCLUSION As a preliminary report, Sommerlad-Furlow modified technique showed that maxillary positioning in the face tended to be better, and the intermaxillary relationship was more satisfactory than that in Sommerlad technique when compared them in healthy noncleft participants.
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Affiliation(s)
- Sadam Ahmed Elayah
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, ChengduSichuan, 610041, China
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Jiayi Yin
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, ChengduSichuan, 610041, China
| | - Waseem Saleh Al-Gumaei
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, 610041, China
| | - Hamza Younis
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, ChengduSichuan, 610041, China
| | - Karim Ahmed Sakran
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Ziwei Tang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, 610041, China
| | - Mubarak Ahmed Mashrah
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Grace Paka Lubamba
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, ChengduSichuan, 610041, China
| | - Min Wu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, ChengduSichuan, 610041, China
| | - Yang Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, ChengduSichuan, 610041, China.
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, ChengduSichuan, 610041, China.
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Defabianis P, Guagnano R, Romano F. A Cross-Sectional Study of the Dental Arch Relationship and Palatal Morphology after Cleft Surgery in Italian Children with Unilateral Cleft and Lip Palate. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1559. [PMID: 37761520 PMCID: PMC10528838 DOI: 10.3390/children10091559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Dental arch relationships (DARs) and palatal morphology (PM) were evaluated in in non-syndromic complete unilateral cleft lip and palate (UCLP) Italian patients after surgery. Pre- and postnatal factors affecting the results were investigated. Sixty-six children with UCLP (40 boys and 26 girls, with a mean age of 10.1 ± 2.9 years), predominantly Caucasian (77%), were consecutively enrolled in this cross-sectional study. Twenty children had received a one-stage protocol consisting of an early periosteal palate surgical repair and lip closure and forty-six were submitted to a staged surgical protocol with delayed palate repair (DPR). A single clinician collected data on their medical history and carried out a dental examination. The DAR and PM were graded on dental casts according to the Eurocran index and dichotomised as favourable and unfavourable based on the treatment outcome. Multiple logistic regression analyses demonstrated that female sex (OR = 6.08, 95% CI: 1.47-25.23, p = 0.013), DPR (OR = 4.77, 95% CI: 1.14-19.93, p = 0.032) and the use of a neonatal plate (OR = 4.68, 95% CI: 1.27-17.16, p = 0.020) increased the odds of having favourable DAR, while only DPR (OR = 9.76, 95% CI: 2.40-39.71, p = 0.001) was significantly associated with a favourable PM. Based on these findings, only DPR had a significantly favourable effect on both DAR and DM in Italian children with complete UCLP.
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Affiliation(s)
- Patrizia Defabianis
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, 10126 Turin, Italy;
| | | | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, 10126 Turin, Italy;
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Maggiulli F, Hinton C, Simpson L, Gujral S, Hardwicke J, Slator R, Pigott R, Su T, Richard B. Lip symmetry following rotation advancement cleft lip repair in 5-year-old children treated by Ralph Millard and Ron Pigott. JPRAS Open 2022; 33:145-154. [PMID: 35928808 PMCID: PMC9343930 DOI: 10.1016/j.jpra.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the symmetry of the lip following Rotation-Advancement cleft lip repair by Millard and Pigott and to investigate the effect on the symmetry of cleft side and gender by using different surgical protocols. Symmetry following cleft surgery was compared to that of non-cleft children. Design Retrospective study of photographs of children aged 5 years. Setting Three decades of post-operative photographs of children treated by Millard and Pigott. Patients Eighty-nine children treated by Millard, 87 by Pigott and 91 non-cleft children. Interventions Photographs were assessed using the Symnose Computer program, a rapid semi-objective quantitative assessment of lip symmetry. Main Outcome Measure(s) Asymmetry score for each surgeon, and non-cleft children. Results There was no significant difference in the median lip % mismatch score of Millard, 36.65% and Pigott, 38.52%. Right-sided clefts showed better symmetry than left-sided clefts for Millard (p<.001). This was reversed for Pigott (P=.0121). There was a difference (P<.001) between the symmetry of the two cleft cohorts and the non-cleft children (asymmetry 19.9%), and between Millard's outcomes following different lip surgical protocols (P < .0001), but no difference between Pigott's outcomes using different palate surgical protocols (P = 0.59). Conclusions Cleft lip repair by Millard and Pigott resulted in similar lip asymmetry (37% and 39% symmetry mismatch, respectively). Lip surgical protocol and cleft side may affect lip asymmetry. Palate surgery did not affect lip asymmetry. Following cleft surgery, children were more asymmetric than non-cleft children.
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Mink van der Molen AB, van Breugel JMM, Janssen NG, Admiraal RJC, van Adrichem LNA, Bierenbroodspot F, Bittermann D, van den Boogaard MJH, Broos PH, Dijkstra-Putkamer JJM, van Gemert-Schriks MCM, Kortlever ALJ, Mouës-Vink CM, Swanenburg de Veye HFN, van Tol-Verbeek N, Vermeij-Keers C, de Wilde H, Kuijpers-Jagtman AM. Clinical Practice Guidelines on the Treatment of Patients with Cleft Lip, Alveolus, and Palate: An Executive Summary. J Clin Med 2021; 10:jcm10214813. [PMID: 34768332 PMCID: PMC8584510 DOI: 10.3390/jcm10214813] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022] Open
Abstract
Significant treatment variation exists in the Netherlands between teams treating patients with cleft lip, alveolus, and/or palate, resulting in a confusing and undesirable situation for patients, parents, and practitioners. Therefore, to optimize cleft care, clinical practice guidelines (CPGs) were developed. The aim of this report is to describe CPG development, share the main recommendations, and indicate knowledge gaps regarding cleft care. Together with patients and parents, a multidisciplinary working group of representatives from all relevant disciplines assisted by two experienced epidemiologists identified the topics to be addressed in the CPGs. Searching the Medline, Embase, and Cochrane Library databases identified 5157 articles, 60 of which remained after applying inclusion and exclusion criteria. We rated the quality of the evidence from moderate to very low. The working group formulated 71 recommendations regarding genetic testing, feeding, lip and palate closure, hearing, hypernasality, bone grafting, orthodontics, psychosocial guidance, dentistry, osteotomy versus distraction, and rhinoplasty. The final CPGs were obtained after review by all stakeholders and allow cleft teams to base their treatment on current knowledge. With high-quality evidence lacking, the need for additional high-quality studies has become apparent.
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Affiliation(s)
- Aebele B. Mink van der Molen
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.M.v.B.); (L.N.A.v.A.)
- Correspondence: ; Tel.: +31-88-7554-004
| | - Johanna M. M. van Breugel
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.M.v.B.); (L.N.A.v.A.)
| | - Nard G. Janssen
- Department Maxillo Facial Surgery and Dentistry, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (N.G.J.); (D.B.)
| | - Ronald J. C. Admiraal
- Department of Oto-Rhino-Laryngology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Leon N. A. van Adrichem
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.M.v.B.); (L.N.A.v.A.)
| | | | - Dirk Bittermann
- Department Maxillo Facial Surgery and Dentistry, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (N.G.J.); (D.B.)
| | | | - Pieter H. Broos
- Knowledge Institute of the Federation of Medical Specialists, 3528 BL Utrecht, The Netherlands; (P.H.B.); (A.L.J.K.)
| | | | | | - Andrea L. J. Kortlever
- Knowledge Institute of the Federation of Medical Specialists, 3528 BL Utrecht, The Netherlands; (P.H.B.); (A.L.J.K.)
| | - Chantal M. Mouës-Vink
- Department of Plastic and Reconstructive Surgery, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands;
| | | | | | - Christl Vermeij-Keers
- Dutch Association for Cleft Palate and Craniofacial Anomalies, 3643 AE Mijdrecht, The Netherlands;
| | - Hester de Wilde
- Department of Speech Therapy, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, Medical Faculty, University of Bern, CH-3010 Bern, Switzerland
- Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia
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Crowley JS, Friesen TL, Gabriel RA, Hsieh S, Wacenske A, Deal D, Tsai C, Lance S, Gosman AA. Speech and Audiology Outcomes After Single-Stage Versus Early 2-Stage Cleft Palate Repair. Ann Plast Surg 2021; 86:S360-S366. [PMID: 33559999 DOI: 10.1097/sap.0000000000002747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The timing and management of patients with cleft palates have been controversial. Early soft palate closure at the time of cleft lip repair followed by hard palate closure at a second stage has been hypothesized to improve speech and audiology outcomes. This study compares cleft palate patients who have undergone single-stage versus 2-stage cleft palate repairs and the outcomes on speech and hearing. METHODS A retrospective chart review identified patients with diagnosis of cleft lip with complete cleft palate who underwent either single or 2-stage repair from 2006 to 2012. Data collected included age at each surgery, necessity of further speech surgery for velopharyngeal insufficiency, frequency of tympanostomy tube placement, presence of hearing loss, and speech assessment data graded per the validated Americleft speech scale. RESULTS A total of 84 patients were identified and subdivided into groups of single-stage and 2-stage repair. The mean age at the time of single-stage palate repair was 13.3 months. For the 2-stage group, the mean ages were 4.2 and 11.8 months for the soft palate and hard palate repairs, respectively. Comparing the single-stage versus 2-stage palate repairs, there was no significant difference in all speech parameters including hypernasality, hyponasality, nasal air emission, articulation, expressive language, receptive language, speech intelligibility, and speech acceptability for both unilateral and bilateral cleft lip/palate patients. Two-stage repair was associated with increased number of tympanostomy tube placement compared with single-stage repair (relative risk, 1.74; P = 0.009), and the first set of tubes was performed at a statistically significantly younger age, 4.5 months in the 2-stage repair compared with 16.9 months in the single-stage (P = 0.012) with 87.5% performed with first stage of repair. However, there was no difference in the types, degrees of hearing loss, or the presence of at least mild conductive hearing loss at latest follow-up audiograms between the groups. CONCLUSIONS There was no significant benefit with respect to speech or hearing outcomes between single-stage and 2-stage cleft palate repairs. This advocates for surgeon and family preference in the timing of cleft palate repair.
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Affiliation(s)
| | | | | | - Sun Hsieh
- From the Division of Plastic Surgery, University of California
| | - Amanda Wacenske
- Division of Speech Pathology, Rady Children's Hospital, San Diego, CA
| | - December Deal
- Division of Speech Pathology, Rady Children's Hospital, San Diego, CA
| | - Catherine Tsai
- From the Division of Plastic Surgery, University of California
| | - Samuel Lance
- From the Division of Plastic Surgery, University of California
| | - Amanda A Gosman
- From the Division of Plastic Surgery, University of California
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Abstract
BACKGROUND A cleft team experience addressing non-syndromic cleft palate and cleft lip and palate is presented. The purpose of the present study is to compare surgical outcomes using 2 different protocols for cleft palate repair provided by a cleft team in Lima, Perú. METHODS This is a comparative study between 2 groups of patients with non-syndromic cleft palate who were operated using different surgical protocols from 1999 to 2014. One hundred twenty-four children with non-syndromic isolated cleft palate and cleft lip and palate treated from 2007 to 2014 using a surgical protocol developed by our cleft team in Lima, Perú were compared with 145 children with cleft palate and cleft lip and palate treated by the same team using different protocol from 1999 to 2007. Data collection was accomplished by evaluation of symptomatic oronasal fistulas, presence of velopharyngeal insufficiency (VPI) and postoperative complications. RESULTS Statistical significant differences were observed between the 2 groups regarding the development of flap necrosis in favor of the Lima protocol. No significant difference in palatal fistula and VPI rate between the 2 protocols was found. CONCLUSIONS The Lima Surgical Protocol for cleft palate repair is an alternative strategy which uses the strengths of different surgical techniques based on the severity of the cleft. We observed better surgical outcomes using the Lima protocol with regards to postoperative complications in patients with non-syndromic cleft palate.
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12
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Vandenberg K, Castle M, Qeadan F, Kraai T. Oronasal Fistula Incidence Associated With Vomer Flap Repair of Cleft Palate: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2020; 58:957-965. [PMID: 33302724 DOI: 10.1177/1055665620974562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the incidence of oronasal fistulas (ONF) associated with primary repair of the anterior palate using a single-layered, superiorly based, vomer mucoperiosteal flap. DESIGN A systematic review of MEDLINE, PubMed, Cochrane, and Web of Science databases using the keywords: "vomer flap" and "cleft palate repair" were carried out. A meta-analysis was performed using random effect modeling with stratified analysis by syndromic diagnosis, number of surgeons, and mean age. MAIN OUTCOME MEASURE(S) Incidence of ONFs. RESULTS The meta-analysis included 9 studies with a total of 464 children who met inclusion criteria. The overall ONF rate was 3.0% (95% CI: 1.0-9.0). Fistula rates were not significantly different in studies that included syndromic patients compared to studies that did not, 5.0% (95% CI: 1.0-24.0) versus 3.0% (95% CI: 1.0-6.0), respectively. There was no significant difference between studies in which there was a single surgeon versus multiple surgeons, 3.0% (95% CI: 1.0-13.0) versus 4.0% (95% CI: 1.0-8.0), respectively. Age at the time of cleft repair showed no statistically significant difference in fistula rate when comparing children with a mean age less than 12 months to those greater than 12 months, 3.0% (95% CI: 1.0-5.0) versus 5.0% (95% CI: 1.0-28.0), respectively. CONCLUSIONS The vomer flap technique in cleft palate repair appears to be associated with a low ONF rate unaffected by syndromic diagnosis, number of surgeons, or patient age at time of repair.
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Affiliation(s)
- Katherine Vandenberg
- Department of Surgery, Division of Otolaryngology Head & Neck Surgery, 1104University of New Mexico Health Sciences Centers, Albuquerque, NM, USA
| | - Michael Castle
- 1104University of New Mexico, School of Medicine, Albuquerque, NM, USA
| | - Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Tania Kraai
- Department of Surgery, Division of Otolaryngology Head & Neck Surgery, 1104University of New Mexico Health Sciences Centers, Albuquerque, NM, USA
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13
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Cleft Palate Repair: A Study Between Two Surgical Procedures. J Craniofac Surg 2020; 31:2280-2284. [PMID: 33136871 DOI: 10.1097/scs.0000000000006814] [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 The purpose of this study was to categorize and compare outcomes and sequels in 2 groups of patients born with unilateral and bilateral complete cleft lip/palate, having their primary cleft palate repair performed in our hospital, by the same surgical team, during 2 different periods of time, to establish which of the 2 surgical reconstructive strategies employed was more effective to decrease sequels. MATERIAL AND METHODS This is a randomized clinical trial including a total of 291, nonsyndromic patients, primary assisted in our Hospital, between 2002 and 2013, and operated by the same senior surgeon.Two groups of patients of similar characteristics were treated utilizing 2 different surgical procedures according to the considered period. Isolated palates, syndromic patients, secondary and adult cases were considered as exclusion critters. Surgical data was obtained from medical records, and clinical examinations. All the patients were cautiously evaluated by a team expert to verify results, evolution, and sequels. RESULTS Statistically significant differences in the total percentage of complications were found between both groups. Group A: 54.85% and Group B: 21.90% (P value < 0.001).Each complication was also considered by groups and estimated as follow: CONCLUSIONS:: Based on the results of our research, we can suggest the Carstens' variant plus the introduced modifications by the authors, as a useful surgical procedure to be utilized in primary complete unilateral or bilateral cleft palate repair to prevent post op common complications.
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Kearney AM, Gart MS, Brandt KE, Gosain AK. Lessons from American Board of Plastic Surgery Maintenance of Certification Tracer Data: A 16-Year Review of Clinical Practice Patterns and Evidence-Based Medicine in Cleft Palate Repair. Plast Reconstr Surg 2020; 146:371-379. [PMID: 32740590 DOI: 10.1097/prs.0000000000007018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND As a component of the Maintenance of Certification process from 2003 to 2019, the American Board of Plastic Surgery tracked 20 common plastic surgery operations. By evaluating the data collected over 16 years, the authors are able to examine the practice patterns of pediatric/craniofacial surgeons in the United States. METHODS Cumulative tracer data for cleft palate repair was reviewed as of April of 2014 and September of 2019. Evidence-based medicine articles were reviewed. Results were tabulated in three categories: pearls, or topics that were covered in both the tracer data and evidence-based medicine articles; topics that were covered by evidence-based medicine articles but not collected in the tracer data; and topics that were covered in tracer data but not addressed in evidence-based medicine articles. RESULTS Two thousand eight hundred fifty cases had been entered as of September of 2019. With respect to pearls, pushback, von Langenbeck, and Furlow repairs all declined in use, whereas intravelar veloplasty increased. For items not in the tracer, the quality of studies relating to analgesia is among the highest of all areas of study regarding cleft palate repair. In terms of variables collected by the tracer but not studied, in 2019, 41 percent of patients received more than 1 day of antibiotics. CONCLUSIONS This article provides a review of cleft palate tracer data and summarizes the research in the field. Review of the tracer data enables cleft surgeons to compare their outcomes to national norms and provides an opportunity for them to consider modifications that may enhance their practice.
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Affiliation(s)
- Aaron M Kearney
- From the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine; OrthoCarolina; and the American Board of Plastic Surgery
| | - Michael S Gart
- From the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine; OrthoCarolina; and the American Board of Plastic Surgery
| | - Keith E Brandt
- From the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine; OrthoCarolina; and the American Board of Plastic Surgery
| | - Arun K Gosain
- From the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine; OrthoCarolina; and the American Board of Plastic Surgery
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15
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Kulshrestha R, Wajid M, Singh K, Shenava S, Mathew R, Katpale S, Agarwal A. The effect of surgical correction on craniofacial growth in unilateral cleft lip and palate patients: A prospective study. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2020. [DOI: 10.4103/jclpca.jclpca_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yang AS, Richard BM, Wills AK, Mahmoud O, Sandy JR, Ness AR. Closer to the Truth on National Fistula Prevalence After Unilateral Complete Cleft Lip and Palate Repair? The Cleft Care UK Study. Cleft Palate Craniofac J 2019; 57:5-13. [DOI: 10.1177/1055665619858871] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To (1) determine the prevalence of nonperialveolar palatal fistula up to age 5 following repair of unilateral cleft lip and palate (UCLP) in the United Kingdom, (2) examine the association of palatoplasty techniques with fistula occurrence, and (3) describe the frequency of fistula repairs and their success. Design: Cross-sectional study. Setting: All 11 centralized regional cleft centers in the United Kingdom. Participants: Two hundred sixty-eight children born between 2005 and 2007 recruited by Cleft Care UK, a nationwide cross-sectional study of all 5-year-old children born with nonsyndromic UCLP. Main Outcome Measure: Nonperialveolar palatal fistula prevalence up to age 5. Results: Fistulas were found in 72 children (31.3%, 95% confidence interval: 25.4%-37.7%) and had no significant association with palate repair sequences. Twenty-four fistulas were repaired by age 5, 12 of which had data showing 10 (83.3%) successful repairs. Conclusion: The prevalence of nonperialveolar fistulas following primary palatoplasty of UCLP in the United Kingdom was higher than previously reported. This information should be part of the preoperative discussion with families. Prospective collection of the presence of fistulas will be necessary before we can associate the occurrence of fistulas with a surgeon, institution, surgical technique, or protocol of care.
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Affiliation(s)
- Arthur S. Yang
- Department of Plastic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Bruce M. Richard
- Department of Plastic Surgery, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew K. Wills
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
- Bristol Dental School, Bristol Dental Hospital, University of Bristol, Bristol, United Kingdom
| | - Osama Mahmoud
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jonathan R. Sandy
- Bristol Dental School, Bristol Dental Hospital, University of Bristol, Bristol, United Kingdom
| | - Andy R. Ness
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
- Bristol Dental School, Bristol Dental Hospital, University of Bristol, Bristol, United Kingdom
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Minatel L, Marcela de Luna Gomes J, Aparecido Araújo Lemos C, Justino de Oliveira Limírio JP, Pellizzer EP. Influence of vomer flap on craniofacial growth in patients with cleft lip and palate: A systematic review. J Craniomaxillofac Surg 2019; 47:902-908. [PMID: 30935851 DOI: 10.1016/j.jcms.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/15/2019] [Accepted: 03/11/2019] [Indexed: 11/24/2022] Open
Abstract
The aim of this review was to evaluate the impact of the vomer flap on craniofacial growth in patients with cleft lip and palate. The review was conducted according to the PRISMA checklist and is registered in the International Prospective Register of Systematic Reviews (PROSPERO - CRD42018095714). Two investigators performed the research using the PubMed/MEDLINE, Embase, and Web of Science databases for studies published until November 2018. The focused question was 'Does the vomer flap have a lesser impact on craniofacial growth in patients with cleft lip and palate?'. A total of 13 articles was selected for this review, comparing the vomer flap technique with other flap surgery techniques. The outcomes analyzed were: facial development (primary outcome); and the growth of the maxilla and mandible, occlusion, occurrence of fistula, and speech development (secondary outcomes). It was concluded that there is no difference in impact between vomer flap and the other flap surgery techniques on craniofacial development.
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Affiliation(s)
- Lurian Minatel
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Sao Paulo, Brazil.
| | - Jéssica Marcela de Luna Gomes
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Sao Paulo, Brazil
| | - Cleidiel Aparecido Araújo Lemos
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Sao Paulo, Brazil
| | | | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Sao Paulo, Brazil
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Two Methods of Cleft Palate Repair in Patients With Complete Unilateral Cleft Lip and Palate. J Craniofac Surg 2018; 29:1473-1479. [PMID: 30015742 DOI: 10.1097/scs.0000000000004769] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the surgical outcome between 2 patient groups with complete unilateral cleft lip and palate who underwent different types of palatoplasty. METHODS This is a cohort study between 2 groups of patients with complete unilateral cleft lip and palate who were operated using different surgical techniques from 2008 to 2011. About 28 patients were operated using a primary lip nose repair with vomer flap for hard palate single-layer closure and delayed soft palate repair (modified Oslo protocol) and 32 patients were operated using our protocol in Lima. Data collection was accomplished by evaluation of symptomatic oronasal fistulas, presence of velopharyngeal insufficiency and evaluation of dental arch relationships (scored using the 5-year-olds' index). RESULTS Our comparative study observed statistically significant differences between the 2 groups regarding the presence of oronasal fistulas and velopharyngeal insufficiency in favor of our palatoplasty technique. A statistically significant difference was not found in functional vestibular oronasal fistula development between the studied techniques for unilateral cleft palate repair. This comparative study did not observe significant differences in dental arch relationships between the studied techniques. CONCLUSION In this study, better surgical outcome than modified Oslo protocol regarding oronasal fistulas and velopharyngeal insufficiency on patients with complete unilateral cleft lip and palate was observed. The results arising from this study do not provide evidence that one technique is enough to obtain better functional closure of the alveolar cleft and dental arch relationship at 5 years.
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Loomans N, Decombel O, Goethals K, Mommaerts MY. Transverse Maxillary Development in Complete Cleft Patients: Comparison of 2 Treatment Strategies by Longitudinal and Cross-Sectional Model Analysis. Cleft Palate Craniofac J 2018; 56:610-618. [DOI: 10.1177/1055665618802539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: This study aimed to compare differences in the maxillary transverse dimension following cleft repair using 2 protocols involving a 2-staged palatal closure with similar timing but different techniques. Design: Retrospective study. Two matched study samples, each containing 10 patients. Setting: Cleft center A is a university hospital. Cleft Center B is a general teaching hospital. Patients: Patients with cleft lip alveolus and palate (CLAP) were matched by cleft type, gender, age, and palatal morphology at the age of 1 month. Differences in the transverse dimension were measured at 4 ages in 2 matched groups (A and B from center A and B), each including 5 patients with unilateral CLAP (UCLAP) and 5 patients with bilateral CLAP (BCLAP). Interventions: Orthodontic/orthopedic expansion treatment began at 8 and 5 years of age at centers A and B, respectively. Results: The mean intercanine distance decreased by 8 mm (standard deviation [SD] = 1.6; P = .030) in group A patients with UCLAP between 1 and 5 years (SD = 1.6; P = .030) and by 6.3 mm (SD = 3.2; P = .016) in group B patients with BCLAP. The mean intermolar distance increased by 4 mm (SD = 3.4; P = .076) in patients with BCLAP. A trend toward improved canine positioning was observed in patients with BCLAP by 12 years of age, with improvement occurring between 4 and 12 years. Conclusion: The type of palatal closure (inducing scar tissue at the bony level) and the late installment of orthodontic/orthopedic expansion probably reduced the intercanine width in bilateral complete clefts.
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Affiliation(s)
| | - Oona Decombel
- University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Klara Goethals
- Department of Comparative Physiology, Faculty of Veterinary Science, Ghent University, Ghent, Belgium
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20
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Unilateral Cleft Lip and Palate Surgical Protocols and Facial Growth Outcomes. J Craniofac Surg 2018; 29:1562-1568. [DOI: 10.1097/scs.0000000000004810] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
This study presents a systematic review of randomized controlled trials (RCTs) in cleft and craniofacial surgery. All studies reporting on RCTs in cleft and craniofacial surgery were identified on PubMed using the search terms "cleft," "velopharyngeal insufficiency," "velopharyngeal dysfunction," "nasoalveolar molding," "gingivoperiosteoplasty," "Pierre Robin sequence," "craniofacial," "craniosynostosis," "craniofacial microsomia," "hemifacial microsomia," "hypertelorism," "Le Fort," "monobloc," "distraction osteogenesis," "Treacher Collins," and "Goldenhar." Studies were excluded if they were not randomized, did not focus primarily on topics related to cleft or craniofacial surgery, included repeat publications of data, or were unavailable in English. Studies were evaluated on demographic and bibliometric data, study size, specific area of focus, and findings reported. Four hundred forty-seven unique studies were identified. One hundred eighty-three papers met inclusion criteria (115 cleft lip and palate, 65 craniofacial, and 3 spanning both disciplines). Sixty-six (36%) were dedicated to topics related to surgical techniques. There were no studies comparing current cleft lip or soft palate repair techniques and no studies on cleft rhinoplasty. The most frequently reported surgical topic was cleft palate. There were several studies on orthognathic techniques which compared distraction osteogenesis to traditional advancement. Most craniofacial operations, such as cranial vault remodeling and frontofacial advancement/distraction, were not represented. Several standard operations in cleft and craniofacial surgery are not supported by Level I evidence from randomized controlled trials. Our community should consider methods by which more RCTs can be performed, or redefine the acceptable standards of evidence to guide our clinical decisions.
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22
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Reddy RR, Reddy SG, Banala B, Bronkhorst EM, Kummer AW, Kuijpers-Jagtman AM, Bergé SJ. Placement of an antibiotic oral pack on the hard palate after primary cleft palatoplasty: a randomized controlled trial into the effect on fistula rates. Clin Oral Investig 2018; 22:1953-1958. [PMID: 29192349 PMCID: PMC5945738 DOI: 10.1007/s00784-017-2286-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study is to determine whether placement of an antibiotic oral pack on the hard palate reduces fistula rates after primary cleft palatoplasty. SUBJECTS AND METHODS This study was a parallel blocked randomized controlled trial. The study consisted of two groups of 100 patients each with non-syndromic unilateral complete cleft lip, alveolus, and hard and soft palate that underwent primary palatoplasty. Group A had an oral pack placed on the hard palate for 5 days postoperatively while group B did not. Occurrence of fistulae between both groups was tested using odds ratios (OR). RESULTS In 2% of the patients in group A, a fistula was found 6 months after palatal surgery. In contrast, in 21% of the patients in group B, a palatal fistula could be confirmed. The fistula occurrence in group A was statistically significantly lower than that in group B (OR = 0.0768, CI = [0.02 … 0.34], p < 0.001). CONCLUSION The findings of this study provide evidence that the rate of fistula formation after primary palatoplasty is significantly reduced if a pack soaked with antibiotic cream is placed on the palate postoperatively for 5 days. CLINICAL RELEVANCE The use of an antibiotic pack after cleft palate repair can be recommended to prevent occurrence of oronasal fistulae.
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Affiliation(s)
- Rajgopal R Reddy
- Cranio-maxillofacial Surgery, G.S.R. Hospital, Institute of Cranio-Maxillofacial and Facial Plastic Surgery, Vinay Nagar Colony, Saidabad, Hyderabad, India.
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands.
- GSR Institute of Craniofacial Surgery, # 17-1-383/55, Vinay Nagar Colony, IS Sadan, Saidabad, Hyderabad, 500059, India.
| | - Srinivas Gosla Reddy
- Cranio-maxillofacial Surgery, G.S.R. Hospital, Institute of Cranio-Maxillofacial and Facial Plastic Surgery, Vinay Nagar Colony, Saidabad, Hyderabad, India
| | - Bhavya Banala
- Speech and Language Therapy, G.S.R. Hospital, Institute of Cranio-Maxillofacial and Facial Plastic Surgery, Vinay Nagar Colony, Saidabad, Hyderabad, India
| | - Ewald M Bronkhorst
- Department of Cariology and Preventive Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ann W Kummer
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefaan J Bergé
- Department of Cranio-maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Effect of Relaxing Incisions on the Maxillary Growth after Primary Unilateral Cleft Palate Repair in Mild and Moderate Cases: A Randomized Clinical Trial. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1201. [PMID: 28203502 PMCID: PMC5293300 DOI: 10.1097/gox.0000000000001201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/16/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the association between the use of relaxing incisions and maxillary growth disturbance after primary palatoplasty in patients with unilateral cleft lip and palate. METHODS This is a prospective, randomized, double-blind controlled trial study with ethical committee approval between 2 groups of patients with unilateral cleft lip and palate who were operated on using the two-flap and one-flap techniques from 2008 to 2011. Two groups of patients with unilateral cleft lip and palate were operated on using the mentioned techniques by the Outreach Surgical Center Program Lima since 2008. Data collection was accomplished by evaluation of maxillary arch dimensions and dental arch relationships (scored using the 5-year-olds' index). RESULTS The mean score for the 5-year-olds' index was 2.57 for two-flap technique and 2.80 for one-flap technique without statistical significant differences (P = 0.71). Our comparative study did not find statistically significant differences in maxillary arch dimensions between the studied techniques for unilateral cleft palate repair. Good levels of agreement were observed according to the κ statistics. CONCLUSIONS The results arising from this clinical trial do not provide statistical evidence that one technique let us obtain better maxillary development than the other at 5 years. The use of relaxing incisions was not associated with maxillary growth impairment. A technique with limited relaxing incisions does not has better maxillary growth. Additional longer term study is necessary to confirm this preliminary report.
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Kaye A, Thaete K, Snell A, Chesser C, Goldak C, Huff H. Initial Nutritional Assessment of Infants With Cleft Lip and/or Palate: Interventions and Return to Birth Weight. Cleft Palate Craniofac J 2016; 54:127-136. [PMID: 26882024 DOI: 10.1597/15-163] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess and quantify cleft team practices with regard to nutritional support in the neonatal period Design : Retrospective review. SETTING Tertiary pediatric hospital. PATIENTS One hundred consecutive newborn patients with a diagnosis of cleft lip and/or cleft palate between 2009 and 2012. MAIN OUTCOME MEASURES Birth weight, cleft type, initial cleft team weight measurements, initial feeding practices, recommended nutritional interventions, and follow-up nutritional assessments. RESULTS All patients in the study were evaluated by a registered dietitian and an occupational feeding therapist. Average birth weight and average age at the first cleft team visit were similar for each cleft type: cleft lip (CL), cleft lip and palate (CLP), and cleft palate (CP). The calculated age (in days) for return to birth weight was significantly different between cleft types: CL = 13.58 days, CLP = 15.88 days, and CP = 21.93 days. Exclusive use of breast milk was 50% for patients with CL, 30.3% for patients with CLP, and 21.4% for patients with CP. Detailed nutritional interventions were made for 31 patients at the first visit: two with CL, 14 with CLP, and 15 with CP. CONCLUSIONS Distinct differences were seen in neonatal weight gain between cleft types. There was significantly greater total weight gain for patients with CL at their first visit and significantly slower return to birth weight for patients with isolated CP. Patients with CL required far fewer interventions at the initial assessment and were more likely to be provided breast milk exclusively or in combination with formula. Infants with CP were far less likely to receive any breast milk. Patients with CLP and CP required frequent nutritional interventions.
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Abstract
OBJECTIVE The aim of this cross-sectional study was to compare craniofacial growth among operated and unoperated unilateral cleft lip and palate non-syndromic subjects. MATERIALS AND METHODS A sample of 180 subjects of Indian origin was selected. Of them, 90 were operated, and 90 were unoperated complete unilateral cleft lip and palate individuals. The subjects were divided into three age groups of 3-5, 8-10, and 20-25 years comprised of 30 patients in each group. The following measurements were evaluated: Angle and length of the cranial base; maxillary spatial positioning and length; mandibular spatial positioning; morphology and length; maxillomandibular relationship. Comparative analysis of the means between the groups was performed with Student's t-test at the significance levels of 5%. The ANOVA test has been performed to test the effect of time. RESULTS No significant differences were observed between the measurements that represented the angle and length of the cranial base of unoperated and the operated patients (P>0.05). There was statistically significant decrease (P˂0.05) in the maxillary length (Co-A; 69.00 mm in 3-5 years, 68.33 mm in 8-10 years, and 67.17 mm in 20-25 years age group), and SNA angle (74.83° in 3-5 years, 74.17 ° in 8-10 years and 73.17 ° in 20-25 years age group) in operated group. No significant difference noticed on cephalometric values of the mandible, except Ar-Go-Me angle (P˂0.05), which showed vertical growth pattern in unoperated patients (132.50 ° in 3-5 years, 132.00 ° I 8-10 years and 138.33 ° in 20-25 years age group). CONCLUSION Lip and palate repair has a significant influence on the maxilla and resulting in retarded growth of maxilla, which causes midface deficiency beyond acceptable sagittal limits. The Gonial angle showed vertical growth pattern in unoperated patients, but the cranial base angle and length of unoperated and the operated patients were similar.
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Affiliation(s)
- Zuber Ahamed Naqvi
- Department of Preventive Dental Sciences-Orthodontics, College of Dentistry, Majmaah University, Zulfi, Kingdom of Saudi Arabia
| | - BM Shivalinga
- Department of Orthodontics and Dentofacial Orthopaedics, JSS Dental College and Hospital, Mysore, Karnataka, India
| | - S Ravi
- Department of Orthodontics and Dentofacial Orthopaedics, JSS Dental College and Hospital, Mysore, Karnataka, India
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Abstract
Surgical correction is central to current team-approached cleft treatment. Cleft surgeons are always concerned about the impact of their surgical maneuver on the growth of the maxilla. Hypoplastic maxilla, concaved mid-face and deformed dental arch have constantly been reported after cleft treatments. It is very hard to completely circumvent these postoperative complications by current surgical protocols. In this paper, we discussed the factors that inhibit the maxillofacial growth on cleft patients. These factors included pre-surgical intervention, the timing of cleft palate and alveolae repair, surgical design and treatment protocol. Also, we made a review about the influence on the maxillary growth in un-operated cleft patients. On the basis of previous researches, we can conclude that most of scholars express identity of views in these aspects: early palatoplasty lead to maxilla growth inhibition in all dimensions; secondary alveolar bone graft had no influence on maxilla sagittal growth; cleft lip repair inhibited maxilla sagittal length in patients with cleft lip and palate; Veau's pushback palatoplasty and Langenbeck's palatoplasty with relaxing incisions were most detrimental to growth; Furlow palatoplasty showed little detrimental effect on maxilla growth; timing of hard palate closure, instead of the sequence of hard or soft palate repair, determined the postoperative growth. Still, scholars hold controversial viewpoints in some issues, for example, un-operated clefts have normal growth potential or not, pre-surgical intervention and pharyngoplasty inhibited maxillofacial growth or not.
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Fistula incidence after primary cleft palate repair: a systematic review of the literature. Plast Reconstr Surg 2014; 134:618e-627e. [PMID: 25357056 DOI: 10.1097/prs.0000000000000548] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The development of an oronasal fistula after primary cleft palate repair has a wide variation reported in the literature. The aim of this review is to identify the reported oronasal fistula incidence to provide a benchmark for surgical practice. METHODS A systematic review was undertaken to investigate the incidence of fistula. Multiple meta-analyses were performed to pool proportions of reported fistulae, in each data set corresponding to the continent of origin of the study, type of cleft, and techniques of cleft palate repair used. RESULTS A total of 9294 patients were included from 44 studies. The overall incidence of reported fistula was 8.6 percent (95 percent CI, 6.4 to 11.1 percent). There was no significant difference in the fistula incidence corresponding to the continent of origin of each study or the repair technique used. The incidence of fistula in cleft lip-cleft palate was 17.9 percent, which was significantly higher (p = 0.03) than in cases of cleft palate alone (5.4 percent). CONCLUSIONS Palatal fistulae were more likely to occur in cases of combined cleft lip-cleft palate, compared with cleft palate alone. The authors would recommend the prospective examination and recording of all fistulae to a standardized classification scheme. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Xu X, Kwon HJ, Shi B, Zheng Q, Yin H, Li C. Influence of different palate repair protocols on facial growth in unilateral complete cleft lip and palate. J Craniomaxillofac Surg 2014; 43:43-7. [PMID: 25457468 DOI: 10.1016/j.jcms.2014.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/10/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To address the question of whether one- or two-stage palatal treatment protocol has fewer detrimental effects on craniofacial growth in patients aged 5 years with unilateral complete cleft lip and palate. MATERIALS AND METHODS Forty patients with non-syndromic unilateral complete cleft lip and palate (UCCLPs) who had received primary cleft lip repair at age 6-12 months and cleft palate repair at age 18-30 months were selected in this study. Eighteen UCCLP patients who received two-stage palate repair were selected as group 1, and 22 UCCLP patients who received one-stage palate repair were selected as group 2. The control group consisted of 20 patients with unilateral incomplete cleft lip (UICL patients) whose age and gender matched with UCCLP patients. A one-sample Kolmogorov-Smirnov test was used to analyze the nature of data distribution. Bonferroni test and Kruskal-Wallis H tests were used for multiple comparisons. RESULTS Both case groups showed reduced maxillary sagittal length (ANS-PMP, A-PM, p < 0.05) and retrusion of the maxilla (S-Ptm, p < 0.05), A point and ANS point (Ba-N-A, Ba-N-ANS, p < 0.05). Patients treated with two-stage palate repair had a reduced posterior maxillary vertical height (R-PMP, p < 0.05). CONCLUSIONS Our results indicated that maxillary sagittal length and position could be perturbed by both one- and two-stage palate repair. Vomer flap repair inhibited maxilla vertical growth. Delayed hard palate repair showed less detrimental effects on maxillary growth compared to early hard palate repair in UCCLP patients aged 5 years.
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Affiliation(s)
- Xue Xu
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, People's Republic of China.
| | - Hyuk-Jae Kwon
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry, Seoul, 120-752, Republic of Korea
| | - Bing Shi
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - Qian Zheng
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - Heng Yin
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - Chenghao Li
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, People's Republic of China.
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Early functional outcome of two surgical protocols used in the repair of complete unilateral cleft lip palate. ANNALS OF PEDIATRIC SURGERY 2014. [DOI: 10.1097/01.xps.0000452062.30697.91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rousseau P, Metzger M, Frucht S, Schupp W, Hempel M, Otten JE. Effect of lip closure on early maxillary growth in patients with cleft lip and palate. JAMA FACIAL PLAST SU 2014; 15:369-73. [PMID: 23867920 DOI: 10.1001/jamafacial.2013.335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Debate continues about the cause of midfacial growth disturbance in patients with facial clefts. OBJECTIVE To evaluate the functional effect of surgical closure of the lip before palatal closure according to the technique by Delaire on early maxillary growth in patients with complete unilateral cleft lip and palate. DESIGN, SETTING, AND PARTICIPANTS Twenty-two patients with unilateral cleft lip and palate were studied using plaster casts obtained at the time of cheilorhinoplasty and 6 months later before palatal closure. The interrupted lateral muscles were anatomically repositioned using the surgical technique by Delaire. No patients had received preoperative orthodontic treatment or a passive palatal plate. Cast analyses were performed using a digital caliper. MAIN OUTCOMES AND MEASURES Landmark positioning was performed 3 times by 2 different examiners to define intraobserver and interobserver differences. The final maxilla dimensions were recorded as the distances between the mean landmark positions. Using the t test, dimensions obtained before palatal closure were compared with dimensions obtained before lip closure. RESULTS The method allowed good reproducibility. Functional closure of the lip significantly narrowed the transverse anterior cleft areas by -2.36 mm (P < .05). Sagittal variables were increased by 1.68 mm on the nonaffected side and by 1.48 mm on the affected side (P < .05 for both). CONCLUSIONS AND RELEVANCE Functional closure according to the technique by Delaire narrows the transverse dimensions of the maxilla, while simultaneously preserving initial sagittal growth. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Pascal Rousseau
- Department of Oral, Maxillofacial, and Facial Plastic Surgery, University of Freiburg, Freiburg, Germany2Department of Plastic, Aesthetic, and Reconstructive Surgery, Centre Hospitalier Universitaire, Angers, France
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McIlvaine E, Borzabadi-Farahani A, Lane CJ, Azen SP, Yen SLK. Apriori feasibility testing of randomized clinical trial design in patients with cleft deformities and Class III malocclusion. Int J Pediatr Otorhinolaryngol 2014; 78:725-30. [PMID: 24630053 PMCID: PMC4336545 DOI: 10.1016/j.ijporl.2014.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 01/06/2014] [Accepted: 01/08/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the feasibility of randomizing treatment (surgical vs. non-surgical) for correction of a Class III malocclusion (underbite) resulting from an earlier repair of cleft lip and palate. MATERIALS AND METHODS Surveys about willingness to accept randomized treatment during adolescence were mailed to the parents of cleft lip and palate patients under the care of Children's Hospital Los Angeles between 2005 and 2010. The inclusion criteria were patients with cleft lip and palate, Class III malocclusion due to maxillary deficiency, and absence of medical and cognitive contraindications to treatment. RESULTS Out of 287 surveys, 82 (28%) were completed and returned; 47% of the subjects held a strong treatment preference (95% CI, 35-58%), while 30% were willing to accept randomization (95% CI, 20-41%). Seventy-eight percent would drop out of a randomized trial if dissatisfied with the assigned treatment (95% CI, 67-86%). The three most commonly cited reasons for being unwilling to accept random treatment assignment were 1) the desire for doctors to choose the best treatment, 2) the desire for parents to have input on treatment, and 3) the desire to correct the underbite as early as possible. CONCLUSION Based on this study, parents and patients would be unwilling to accept a randomly assigned treatment and would not remain in an assigned group if treatment did not meet expectations. This highlight the limitations associated with randomization trials involving surgical modalities and provide justification for other research models (e.g., cohort studies) to compare two treatment options when randomization is not feasible.
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Affiliation(s)
- Elizabeth McIlvaine
- Statistical Consultation and Research Center, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ali Borzabadi-Farahani
- Orthodontics, Warwick Dentistry, Warwick Medical School, University of Warwick, Coventry, UK,Formerly, Craniofacial Orthodontics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Christianne J. Lane
- Statistical Consultation and Research Center, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stanley P. Azen
- Statistical Consultation and Research Center, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stephen L.-K. Yen
- Craniofacial Orthodontics, Children's Hospital Los Angeles, Los Angeles, CA, USA,Center for Craniofacial Molecular Biology, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA,Corresponding author at: CCMB, CSA103, 2250 Alcazar St., Los Angeles, CA 90027, USA., Tel.: +1 323 442 1747; fax: +1 323 442 2981
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Maxillary reaction patterns identified by three-dimensional analysis of casts from infants with unilateral cleft lip and palate. J Orofac Orthop 2013; 74:275-86. [DOI: 10.1007/s00056-013-0153-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 12/07/2012] [Indexed: 11/26/2022]
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Al-Nawas B, Wriedt S, Reinhard J, Keilmann A, Wehrbein H, Wagner W. Influence of patient age and experience of the surgeon on early complications after surgical closure of the cleft palate--a retrospective cohort study. J Craniomaxillofac Surg 2012; 41:135-9. [PMID: 22841383 DOI: 10.1016/j.jcms.2012.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 06/04/2012] [Accepted: 06/04/2012] [Indexed: 11/26/2022] Open
Abstract
Comparative studies on timing of palatoplasty are rare. The aim of this retrospective cohort study was to compare the influence of early (<14 months) and later (>14 months) one-step closure of the soft and hard palate on early complications. All non-syndromic patients from 1999 to 2009 were included; 6-14 months n = 41 and 15-24 months n = 53. Each palatoplasty was performed as a single-step procedure using bipedicled flaps by a team of two Maxillofacial Surgeons either supervising or operating. The surgeon was rated as "non-experienced" when having performed less than 10 palatoplasties under supervision. Main outcome variable is the occurrence of residual fistula. Fistula occurred in four (4.5%) of the patients. In the multivariate model with respect to the occurrence of fistula neither age, leucocyte count, duration of surgery, nor experience of the surgeon showed a significant influence on the occurrence of a fistula. Only reduced weight contributed to a significantly higher risk of post-operative fistula. In conclusion patient age, experience of surgeon, and duration of surgery had no influence on the early outcome. High leucocyte count had a tendency for and reduced weight had a significant influence on fistula occurrence. Long-term outcome on speech development and maxillary growth have to be collected.
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Affiliation(s)
- Bilal Al-Nawas
- Oral-, Maxillofacial- and Plastic Surgery, University Medical Hospital of the J. Gutenberg UniversityMainz, Germany.
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Ferdous KMNU, Salek AJM, Islam MK, Das BK, Khan AR, Karim MS. Repair of cleft lip and simultaneous repair of cleft hard palate with vomer flap in unilateral complete cleft lip and palate: a comparative study. Pediatr Surg Int 2010; 26:995-1000. [PMID: 20842387 DOI: 10.1007/s00383-010-2643-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
UNLABELLED Repair of anterior palate after repairing the cleft lip in complete cleft lip and palate patient is sometimes very difficult. It needs wide, extensive and difficult dissection, and has later chances of wound infection, wound dehiscence, complete wound disruption, recurrent oronasal fistula formation and also maxillary hypoplasia. In this study, we compare the outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP). METHODS A prospective study was carried out in 43 patients with UCLP. In Group A, 23 patients underwent cleft lip and cleft hard palate repair with vomer flaps simultaneously, and only cleft lip repair was done in another 20 patients in Group B at the first sitting. After 3 months in both groups, repair of the cleft soft palate and cleft entire palate was done. The gaps of the cleft alveolus and posterior border of the cleft hard palate were measured during the first and second operation, and duration of operations, postoperative complications and requirement of blood transfusion during the operation were also recorded. RESULTS The procedure of simultaneous repair of cleft lip and closure of cleft hard palate with a vomer flap is easy to perform. Cleft alveolar and gap of the posterior border of the cleft hard palate were reduced remarkably. No fistula formation occurred and no blood transfusion was needed, but the procedure took some extra operating time. These were compared with simple cleft lip repair. CONCLUSION Repairs of cleft lip and simultaneous closure of cleft hard palate with vomer flaps are safe in patients with UCLP, and it makes easy the closure of the soft palate later on and decreases the chance of oronasal fistula.
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Liao YF, Prasad NKK, Chiu YT, Yun C, Chen PKT. Cleft size at the time of palate repair in complete unilateral cleft lip and palate as an indicator of maxillary growth. Int J Oral Maxillofac Surg 2010; 39:956-61. [PMID: 20637568 DOI: 10.1016/j.ijom.2010.01.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 07/26/2009] [Accepted: 01/22/2010] [Indexed: 10/19/2022]
Abstract
Cleft size at the time of palate repair might affect the difficulty of surgical repair and, thus, indirectly postoperative maxillary growth. This retrospective study aimed to determine whether a correlation existed between the cleft size at the time of palate repair and the growth of the maxilla. Maxillary dental casts of 39 infants with non-syndromic complete unilateral cleft lip and palate, taken at the time of palate repair, were used to measure cleft size. Cleft size was defined as the percentage of the total palatal area. The later growth of the maxilla was determined using lateral and postero-anterior cephalometric radiographs taken at 9 years of age. The Pearson correlation analysis was used for statistical analysis. The results showed negative correlations between cleft size and the maxillary length (PMP-ANS, PMP-A) and the maxillary protrusion (S-N-ANS, SNA). These data suggest that in patients with complete unilateral cleft lip and palate there is a significant correlation between the cleft size at the time of palate repair and the maxillary length and protrusion. Patients with a large cleft at the time of palate repair have a shorter and more retrusive maxilla than those with a small cleft by the age of 9 years.
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Affiliation(s)
- Y-F Liao
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, 199 Tung-Hwa North Road, Taipei, Taiwan.
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Holst AI, Holst S, Nkenke E, Fenner M, Hirschfelder U. Vertical and Sagittal Growth in Patients with Unilateral and Bilateral Cleft Lip and Palate—A Retrospective Cephalometric Evaluation. Cleft Palate Craniofac J 2009; 46:512-20. [DOI: 10.1597/08-041.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To investigate whether the craniofacial vertical and sagittal jaw relationship in patients with cleft lip and palate (CLP) differed from that of age-matched noncleft controls, before and after the pubertal growth spurt. Design: Retrospective observational study. Patients: The study group comprised 126 patients with CLP, subdivided according to gender and cleft type, and the control group comprised 53 age-matched skeletal class I patients. Methods: Angular and linear measurements were taken from prepubertal and postpubertal lateral cephalograms of all patients. Results: In patients with cleft lip and palate, the maxillary retrognathism became more remarkable with increasing age; whereas, the retrognathic position of the mandible became less pronounced as compared with controls. Reduced posterior midfacial height, a common prepubertal finding in patients with cleft lip and palate, was significant in postpubertal girls and young women with unilateral cleft lip and palate (p = .002). The total anterior facial height in male patients with bilateral cleft lip and palate was larger than in control patients (p = .002) after the pubertal growth spurt due to an increased anterior midfacial height. In male patients with unilateral cleft lip and palate, this finding was due to an increased anterior lower facial height (p < .001). Conclusions: Patients with cleft lip and palate treated according to a standardized treatment concept had adequate craniofacial jaw relationships after puberty. Despite a measured skeletal class I in both male and female patients with cleft lip and palate regardless of cleft type, there was a slight tendency toward a skeletal class III. Findings were similar for all groups of cleft lip and palate patients irrespective of the type of orthodontic treatment performed.
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Affiliation(s)
- Alexandra I. Holst
- University Clinic Erlangen, Dental Clinic 3–Department of Orthodontics, Erlangen, Germany
| | - Stefan Holst
- University Clinic Erlangen, Dental Clinic 3–Department of Orthodontics, Erlangen, Germany
| | - Emeka Nkenke
- University Clinic Erlangen, Dental Clinic 3–Department of Orthodontics, Erlangen, Germany
| | - Matthias Fenner
- University Clinic Erlangen, Dental Clinic 3–Department of Orthodontics, Erlangen, Germany
| | - Ursula Hirschfelder
- University Clinic Erlangen, Dental Clinic 3–Department of Orthodontics, Erlangen, Germany
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Abstract
Cleft lip and palate is one of the most common craniofacial anomalies. The surgery is not performed usually until the baby is three months of age. The anaesthesia technique is dependent on the difficulty of the airway. The anaesthetic practitioner therefore requires knowledge of the paediatric airway and of this particular anomaly and skill in the thorough preparation of the equipment used for intubating a baby for this procedure.
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Affiliation(s)
- Teresa Hardcastle
- Edge Hill University, 4th Floor, Gateway House, Piccadilly South, Manchester, M60 7LP.
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Mcheik JN, Gaudin J, Levard G. Études tomodensitométriques néonatales de l’os maxillaire dans les fentes labiopalatines unilatérales. ANN CHIR PLAST ESTH 2008; 53:430-4. [DOI: 10.1016/j.anplas.2007.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 10/16/2007] [Indexed: 10/22/2022]
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Onah II, Opara KO, Olaitan PB, Ogbonnaya IS. Cleft lip and palate repair: the experience from two West African sub-regional centres. J Plast Reconstr Aesthet Surg 2008; 61:879-82. [PMID: 17652050 DOI: 10.1016/j.bjps.2007.06.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2006] [Revised: 12/12/2006] [Accepted: 06/07/2007] [Indexed: 11/17/2022]
Abstract
Compliance with primary surgical treatment in people with cleft lip and palate is a well-known problem, especially in developing countries fraught with poverty and ignorance. Different protocols of treatment exist. In this paper, we retrospectively review a cohort from two centres, with a discussion on the outcome and its implications. The records of all patients with cleft lip and palate seen in the National Orthopaedic Hospital, Enugu, Nigeria, from January 1993 to December 1999, were sought, and all available case notes reviewed retrospectively. This included new cases seen in the period, and also cases operated during this period. Follow up took place until January 2005, when the data were collated. The records of all such patients seen at Ladoke Akintola University Teaching Hospital Osogbo, Nigeria, from September 2004 to June 2006 were also collated and analysed. During this period, 102 patients were seen (93 at Enugu and nine at Osogbo). Fifteen had isolated cleft palate, 42 had isolated cleft lip and 45 had combined cleft lip and palate. Presentation time ranged from 1 day to 43 years. The palate was not repaired in 20 people after lip repair; two patients with cleft lip and palate completely defaulted; and only one person with isolated cleft palate failed to undergo surgery in this period. Two patients in Osogbo absconded. The West African sub-region has a high drop out rate after lip repair.
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Affiliation(s)
- I I Onah
- Plastic Surgery Department, National Orthopaedic Hospital, Enugu, Nigeria.
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Evidence-Based Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2008; 66:973-86. [DOI: 10.1016/j.joms.2008.01.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 12/12/2007] [Accepted: 01/06/2008] [Indexed: 12/12/2022]
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Sharp HM, Canady JW, Ligot FAC, Hague RA, Gutierrez J, Gutierrez J. Caregiver and Patient Reported Outcomes after Repair of Cleft Lip and/or Palate in the Philippines. Cleft Palate Craniofac J 2008; 45:163-71. [DOI: 10.1597/06-230.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: To establish the feasibility of conducting outcomes research among patients treated during a medical mission and to identify the salient outcomes for patients and caregivers in one region of the Philippines. Design And Setting: Prospective structured interview conducted in or near participants’ homes on the island of Cebu, Philippines. Participants: Individuals who had surgery at least 6 months earlier within the study region were eligible. Recipients of surgery were located from surgical records and by word of mouth. Main Outcome Measures: (1) Proportion of individuals located. (2) Primary outcomes of oral cleft repair identified for the sample. Results: Of 99 people on a surgical list, 52 (53%) were located, eight were excluded (ineligible, unavailable, or inaccessible), and 44 agreed to participate in the study. Ten participants were identified via word of mouth. Seventy-five interviews were conducted (21 caregiver–patient pairs, one adolescent, and 32 caregivers of a child <7 years). Nearly all participants (99%) would encourage others to pursue surgery. Open-ended questions were coded to identify primary outcomes: improved speech (52%), improved eating (25%), social benefits (14%), and improved appearance (6%). Caregivers (50%) and patients (68%) reported that improved speech was the most important change after surgery. Conclusions: Patients and caregivers ascribe positive changes related to cleft surgery. Outcomes research requires cooperation with local professionals who can communicate effectively. These data serve to demonstrate feasibility and as a model for future studies of treatment outcomes in follow-up to international medical missions.
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Affiliation(s)
- Helen M. Sharp
- Department of Speech Pathology and Audiology, Western Michigan University, Kalamazoo, Michigan
- Department of Preventive and Community Dentistry, The University of Iowa
| | - John W. Canady
- Department of Otolaryngology–Head and Neck Surgery, Department of Surgery–Division of Plastic Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Fernando A. C. Ligot
- Department of Speech Pathology, College of Allied Medical Professions, University of the Philippines, Manila
| | - Rebecca A. Hague
- Department of Speech Pathology and Audiology, Western Michigan University, Kalamazoo, Michigan
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