scholarly journals Comparing Plastic Surgery and Otolaryngology Management in Cleft Care: An Analysis of 4,999 Cases

2017 ◽  
Vol 10 (4) ◽  
pp. 271-277 ◽  
Author(s):  
Kevin T. Jubbal ◽  
Dmitry Zavlin ◽  
Shola Olorunnipa ◽  
Anthony Echo ◽  
Edward P. Buchanan ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
The United States ◽  
Surgical Approaches ◽  
Nasal Reconstruction ◽  
Improvement Program ◽  
Primary Specialty ◽  
Significant Difference ◽  
Procedure Type

Care for patients with cleft lip and palate is best managed by a craniofacial team consisting of a variety of specialists, including surgeons, who are generally plastic surgeons or otolaryngologists trained in the United States. The goal of this study was to compare the surgical approaches and management algorithms of cleft lip, cleft palate, and nasal reconstruction between plastic surgeons and otolaryngologists. We performed a retrospective analysis of the American College of Surgeons’ National Surgical Quality Improvement Program Pediatric database between 2012 and 2014 to identify patients undergoing primary repair of cleft lip, cleft palate, and associated rhinoplasty. Two cohorts based on primary specialty, plastic surgeons and otolaryngologists, were compared in relation to patient characteristics, 30-day postoperative outcomes, procedure type, and intraoperative variables. Plastic surgeons performed the majority of surgical repairs, with 85.5% ( n = 1,472) of cleft lip, 79.3% ( n = 2,179) of cleft palate, and 87.9% ( n = 465) of rhinoplasty procedures. There was no difference in the age of primary cleft lip repair or rhinoplasty. However, plastic surgeons performed primary cleft palate repair earlier than otolaryngologists ( p = 0.03). Procedure type varied between the specialties. In rhinoplasty, otolaryngologists were more likely to use septal or ear cartilage, whereas plastic surgeons preferred rib cartilage. Results were similar, with no statistically significant difference in terms of mortality, reoperation, readmission, or complications. Significant variation exists in the treatment of cleft lip and palate based on specialty service with regard to procedure timing and type. However, short-term rates of mortality, wound occurrence, reoperation, readmission, and surgical or medical complications remain similar.

Comprehension of Online Educational Material Regarding Orofacial Clefts

2019 ◽  
Vol 56 (9) ◽  
pp. 1206-1212
Author(s):  
Diana S. Jodeh ◽  
Aleshia J. Pringle ◽  
S. Alex Rottgers
Keyword(s):  
Web Sites ◽  
Web Site ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
The United States ◽  
Educational Material ◽  
Reading Level ◽  
Significant Difference ◽  
The Mean ◽  
American Society

Background:Cleft lip and palate are among the common birth defects in the United States. Management is complex and may be difficult for parents and patients to understand. The goal of this study was to evaluate the readability of online educational material provided by the American Society of Plastic Surgeons (ASPS) and the American Cleft Palate-Craniofacial Association (ACPA) websites regarding cleft lip and palate and to assess parents’ comprehension.Methods:Parents of children younger than 10 years of age presenting to the plastic and reconstructive surgery clinic at Johns Hopkins All Children’s Hospital for conditions other than cleft lip and palate were recruited for participation. Parents were given the literature published on the ASPS and ACPA web sites to review and were asked to complete a 5-question test specifically targeted to the content of the passage they reviewed. We tested the readability of the 2 online passages using Readability Studio software (Oleander Software Solutions Ltd).Results:Sixty parents completed the study. Across all groups, the mean score was 4.35 of a possible 5. The mean score was 4.4 for the ASPS web site and 4.29 for the ACPA web site. Fifty-three percent of participants answered all questions correctly. No significant difference in scores was noted between web sites ( P = .48).Conclusions:Despite containing content of varying reading-level difficulty, the literature posted on the ACPA and ASPS web sites concerning cleft lip and palate conveyed information equally well to the target parent demographic with high levels of comprehension.

scholarly journals Evaluation of Eustachian tube function in patients of cleft palate and effects of palatoplasty on these findings

2021 ◽  
Vol 7 (9) ◽  
pp. 1473
Author(s):  
Lalit Kochar ◽  
Deepak V. Chauhan ◽  
S. P. Bajaj ◽  
Akash Juneja
Keyword(s):  
Cleft Palate ◽  
Eustachian Tube ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Hospital ◽  
Eustachian Tube Function ◽  
Significant Difference ◽  
Tube Function ◽  
Isolated Cleft Palate ◽  
Palatal Surgery

<p class="abstract"><strong>Background:</strong> Isolated cleft palate and cleft palate and cleft lip patients have poor Eustachian tube function which results in hearing impairment that too in the speech formative years. Aim of study was to evaluate tympanometric findings in patient of cleft palate and effect of palatoplasty on both short term and long term postoperatively.</p><p class="abstract"><strong>Methods:</strong> The subjects consisted of patients attending the cleft lip and palate clinic. This was a combined clinic consisting of department of plastic surgery, department of ENT and department of dental surgery held every month at a tertiary care hospital in Delhi. Study consisted of three groups of patients namely preoperative group, postoperative group and pre-postoperative group.</p><p class="abstract"><strong>Results:</strong> No significant difference was observed in tympanometric abnormalities in cases of combined cleft lip and palate as compared to isolated cleft palate. After age of 5 months once changes of OME has set in there was no significant change in middle ear findings irrespective of palatal repair.</p><p class="abstract"><strong>Conclusions:</strong> There is a very high prevalence of otitis media with effusion in these patients. The changes do resolve spontaneously after age of seven, this perhaps is due to combined effect, growth, development and l maturity of Eustachian tube and palatal surgery rather than palatal surgery alone.</p><p> </p>

scholarly journals Scandcleft Project Trial 2—Comparison of Speech Outcome in 1- and 2-Stage Palatal Closure in 5-Year-Olds With UCLP

2019 ◽  
Vol 57 (4) ◽  
pp. 458-469
Author(s):  
Inger Lundeborg Hammarström ◽  
Jill Nyberg ◽  
Suvi Alaluusua ◽  
Jorma Rautio ◽  
Erik Neovius ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Burden Of Treatment ◽  
Hearing Thresholds ◽  
Significant Difference ◽  
Age Appropriate ◽  
Velopharyngeal Function

Objective: To investigate in-depth speech results in the Scandcleft Trial 2 with comparisons between surgical protocols and centers and with benchmarks from peers without cleft palate. Design: A prospective randomized clinical trial. Setting: Two Swedish and one Finnish Cleft Palate center. Participants: One hundred twelve participants were 5-years-old born with unilateral cleft lip and palate randomized to either lip repair and soft palate closure at 4 months and hard palate closure at 12 months or lip repair at 3 to 4 months (Arm A), or a closure of both the soft and hard palate at 12 months (Arm C). Main Outcome Measures: A composite measure dichotomized into velopharyngeal competency (VPC) or velopharyngeal incompetency (VPI), overall assessment of velopharyngeal function (VPC-Rate), percentage of consonants correct (PCC score), and consonant errors. In addition, number of speech therapy visits, average hearing thresholds, and secondary surgeries were documented to assess burden of treatment. Results: Across the trial, 53.5% demonstrated VPC and 46.5% VPI with no significant differences between arms or centers. In total, 27% reached age-appropriate PCC scores with no statistically significant difference between the arms. The Finnish center had significantly higher PCC scores, the Swedish centers had higher percentages of oral consonant errors. Number of speech therapy visits was significantly higher in the Finnish center. Conclusion: At age 5, poor speech outcomes with some differences between participating centers were seen but could not be attributed to surgical protocol. As one center had very few participants, the results from that center should be interpreted with caution.

scholarly journals Kajian faktor-faktor yang berhubungan dengan skor nasalance pada pasien celah palatum

2016 ◽  
Vol 45 (2) ◽  
pp. 131
Author(s):  
Duhita Yassi ◽  
Dini Widiarni ◽  
Tri Juda Airlangga ◽  
Lestaria Aryanti ◽  
Muchtarudin Mansyur
Keyword(s):  
Cleft Palate ◽  
Otitis Media ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Otitis Media With Effusion ◽  
Group Analysis ◽  
Cross Sectional ◽  
Purposive Sampling ◽  
Significant Difference ◽  
The Mean

Latar belakang: Celah bibir dan palatum merupakan kelainan proses pertumbuhan area orofasial yang menimbulkan permasalahan kompleks. Penelitian ini menitikberatkan permasalahanyang terkait dengan fungsi bicara. Tujuan: Penelitian ini melaporkan gambaran skor nasalance padacelah palatum, hubungan antara skor nasalance percontoh celah palatum dan tanpa celah palatum sertafaktor-faktor yang berhubungan dengan skor nasalance. Metode: Desain penelitian adalah comparativecross sectional. Pengambilan percontoh dilakukan dengan purposive sampling. Dilakukan wawancara,pengisian kuesioner, pemeriksaan THT, audiometri, timpanometri, nasoendoskopi, dan nasometri.Hasil: Didapatkan gambaran rerata skor nasalance percontoh celah palatum. Terdapat  perbedaanbermakna antara skor nasalance percontoh celah palatum dan tanpa celah palatum pada Uji Gajah danUji Hantu (p<0,001). Pada analisis multivariat secara keseluruhan faktor-faktor yang berhubungandengan skor nasalance (adenoid, otitis media efusi, serta gangguan pendengaran) dan keberadaancelah palatum berpengaruh secara signifikan terhadap skor nasalance untuk semua uji nasalance(p<0,05) pada pengujian terhadap kedua kelompok percontoh. Bila dilihat secara parsial faktor adenoidberpengaruh secara signifikan terhadap skor semua uji nasalance baik pada analisis kedua kelompokpercontoh maupun pada percontoh celah palatum saja. Kesimpulan: Rerata skor nasalance kelompokcelah palatum lebih tinggi daripada kelompok tanpa celah palatum. Didapatkan peran faktor yangberpengaruh terhadap skor nasalance, khususnya adenoid. Diperlukan penelitian lebih lanjut terhadappercontoh sesudah operasi sehingga bisa dijadikan sebagai evaluasi terhadap keberhasilan tindakan. Kata kunci: celah palatum, skor nasalance, tonsil, adenoid, otitis media efusi, gangguan pendengaran ABSTRACTBackground: Cleft lip and palate is an orofacial malformation and associated with many problems. This study concerned in speech problem in cleft palate patients. Purpose: This study reportednasalance score in cleft palate patients, the correlation between nasalance score in cleft palate and noncleft palate groups and also some factors related with nasalance score in cleft palate patients. Methods:The design of this study was comparative cross sectional, with purposive sampling. Data was collectedwith interview, questioner apllication, ENT examination, audiometry, tympanometry, nasoendoscopy,and nasometry. Results: The result of this study reported the mean of nasalance score in cleft palatepatients. There was significant difference in nasalance score between cleft palate and non cleft palatepatients in Uji Gajah and Uji Hantu (p>0,05). In multivariate analysis, in general the factors relatedwith nasalance score (adenoid, otitis media with effusion, and hearing loss) and cleft palate  itself weresignificantly correlated with nasalance score in all nasalance test (p<0,05) in both groups analysis butno signifficant correlation in cleft palate group analysis. Partially, adenoid  was significantly correlated in both group analysis and cleft palate group analysis. Conclusion: The mean of nasalance score incleft palate group was higher than non cleft group. Some factors in this study, especially adenoid had corelations with nasalance score. It needs further study to evaluate the nasalance score patients withcleft palate after surgery to compare the results. Keywords: cleft palate, nasalance score, tonsil, adenoid, otitis media with effusion, hearing disturbance

Outcomes in Pharyngoplasty: A 10-Year Experience

2006 ◽  
Vol 43 (2) ◽  
pp. 222-225 ◽  
Author(s):  
Landon S. Pryor ◽  
James Lehman ◽  
Michael G. Parker ◽  
Anna Schmidt ◽  
Lynn Fox ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Revisional Surgery ◽  
Retrospective Chart Review ◽  
Surgical Revision ◽  
Velopharyngeal Insufficiency ◽  
Significant Difference ◽  
Potential Risk Factors ◽  
Palate Repair

Objective The outcomes of 61 patients who underwent a pharyngoplasty for velopharyngeal insufficiency were reviewed to determine potential risk factors for reoperation. Design This was a retrospective chart review of 61 consecutive patients over approximately 10 years (1993 to 2003). Variables analyzed included gender, cleft type, age at the time of pharyngoplasty, length of time between palate repair and pharyngoplasty, and associated syndromes. Participants Of the 61 patients, 20 (34%) had a unilateral cleft lip and palate, 5 (8%) had a bilateral cleft lip and palate, 13 (21%) had an isolated cleft palate, 7 (11%) had a submucous cleft palate, and 16 (26%) were diagnosed with noncleft velopharyngeal insufficiency. Results Of the 61 patients, 10 (16%) required surgical revision. No statistically significant difference was found among gender, cleft type, age at the time of pharyngoplasty, the length of time between palate repair and pharyngoplasty, and associated congenital syndromes, with respect to the need for surgical revision (p > .05). Of the surgical revisions, 50% (5) were performed for a pharyngoplasty that was placed too low. Conclusions Because 50% of the pharyngoplasty revisions had evidence of poor velopharyngeal closure and associated hypernasality resulting from low placement of the sphincter, the pharyngoplasty needs to be placed at a high level to reduce the risk for revisional surgery. The pharyngoplasty is a good operation for velopharyngeal insufficiency with an overall success rate of 84% (51 of 61) after one operation and greater than 98% (60 of 61) after two operations.

Race-Based Differences in the Utilization and Timing of Secondary Cleft Procedures in the United States

2021 ◽  
pp. 105566562110471
Author(s):  
Connor J. Peck ◽  
Navid Pourtaheri ◽  
Yassmin Parsaei ◽  
Arvind U. Gowda ◽  
Jenny Yang ◽  
...  
Keyword(s):  
United States ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
The United States ◽  
Improvement Program ◽  
Alveolar Bone Grafting ◽  
Secondary Procedures ◽  
Cleft Rhinoplasty ◽  
Race Ethnicity

Objective: Secondary procedures optimize outcomes following cleft lip and palate (CL/P) repair. We analyzed the association between race and the utilization and timing of revisionary/secondary cleft surgeries in the United States. Primary CL/P repair, revisions, and secondary procedures—cleft rhinoplasty, speech surgery, and alveolar bone grafting (ABG)—performed from 2014–2018 were identified from the Pediatric National Surgical Quality Improvement Program (NSQIP) database. Utilization estimates were derived via univariable and multivariable logistic regression. A Kruskal-Wallis rank-sum test and multivariable linear regression were used to assess differences in timing for each procedure cohort. The primary outcome measures were the odds of a patient being a certain race/ethnicity, and the age at which patients of different race/ethnicity receive surgery. There were 23 780 procedures analyzed. After controlling for sex, diagnosis, and functional status, there were significant differences in utilization estimates across procedure groups. Primarily, utilization was lowest in patient who were Black for cleft rhinoplasty (OR = 0.70, P = .023), ABG (OR = 0.44, P < .001) and speech surgery (OR = 0.57, P = .012), and highest in patients who were Asian patients in all surgery cohorts (OR 2.05-4.43). Timing of surgery also varied by race, although differences were minimal. Conclusions Estimates of utilization and timing of secondary cleft procedures varied by race, particularly among patients who were Black (poor utilization) or Asian (high utilization). Further studies should identify the causes and implications of underutilized and/or delayed cleft care.

scholarly journals The prevalence of malnutrition in children with cleft lip and cleft palate: a case-control study

2019 ◽  
Vol 6 (2) ◽  
pp. 445
Author(s):  
Shashidhar V. ◽  
Sharanabasappa S. Dhanwadkar ◽  
Ashwini Kumari N. B. ◽  
Ravikumar Kurle ◽  
Rakesh A. Navale
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Economic Status ◽  
P Value ◽  
Z Score ◽  
Anthropometric Parameters ◽  
Significant Difference ◽  
Height For Age ◽  
Weight For Age

Background: Children with cleft lip and cleft palate come across lot of impediment, hurdles in society. There are several social factors which hinders the proper nourishment of CL only, CP or CLP children, so majority of them tend to suffer malnutrition due to lack of standard care especially from their parents and society. Due to even low socio-economic status, impact on growth of these children is vexatious. However potential risk of malnutrition is particularly more during early childhood. Moreover, till date there are not much significant data on malnutrition in CL only, CP or CLP children. The aim of the study was to assess the prevalence of malnutrition in non syndromic CL only, CP or CLP in south India.Methods: Anthropometric parameters weight for age z score (WAZ), height for age z score (HAZ), of children with CLP were compared with age matched controls.Results: Prevalence of PEM and stunting for cleft group were 40% and 21.3% respectively compared to 33.33% and 17.33% for the control. Differences in the underweight, and stunting between the two groups were not statistically significant (χ2=2.83, p value=0.58, and χ2=1.48, p value=0.69 respectively).Conclusions: There is no statistically significant difference in the occurrence of malnutrition in children with non- syndromic cleft lip and Palate compared with control.

Relationship of Velopharyngeal Insufficiency With Face Mask Therapy in Patients With Cleft Lip and Palate

2019 ◽  
Vol 57 (1) ◽  
pp. 118-122 ◽  
Author(s):  
Narmin Helal ◽  
Matthew Ford ◽  
Osama Basri ◽  
Lindsay Schuster ◽  
Brian Martin ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Pediatric Patients ◽  
Cleft Lip And Palate ◽  
Face Mask ◽  
The United States ◽  
Velopharyngeal Insufficiency ◽  
Patient Counseling ◽  
Maxillary Protraction ◽  
Increased Risk

Objective: To determine whether orthodontic/dentofacial orthopedic maxillary protraction face mask therapy induces changes in velopharyngeal functioning in a cohort of pediatric patients having cleft palate with or without cleft lip. Design: Retrospective chart review. Setting: A children’s hospital in the United States. Participants: Forty-three pediatric patients with cleft palate, with or without cleft lip, syndromic or with isolated clefts, who received face mask therapy from January 2009 to April 2016. Intervention: Clinical data were extracted for review and analysis from medical records obtained from the Cleft Database/Research Registry (CDB-RR). Main Outcome Measures: Pittsburgh Weighted Speech Scores (PWSS) before and after therapy. Results: There was a significant increase in PWSS after face mask therapy for patients with a PWSS score of 0 prior to treatment. Patients with PWSS >0 before treatment remained largely stable after face mask therapy. Maxillary advancement was not significantly associated with change in PWSS or fistula presence/absence. Conclusions: There is an increased risk of velopharyngeal insufficiency with maxillary protraction face mask treatment in patients with cleft palate. Patient counseling and obtaining consent regarding speech changes during treatment are recommended.

Analysis of the candidate genes responsible for non-syndromic cleft lip and palate in Japanese people

2000 ◽  
Vol 99 (2) ◽  
pp. 105-111 ◽  
Author(s):  
Atsuko TANABE ◽  
Shigeru TAKETANI ◽  
Yoko ENDO-ICHIKAWA ◽  
Rikio TOKUNAGA ◽  
Yutaka OGAWA ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Candidate Genes ◽  
Cleft Lip ◽  
Transforming Growth Factor ◽  
Cleft Lip And Palate ◽  
Control Group ◽  
Case Group ◽  
Coding Region ◽  
Transforming Growth Factor Α ◽  
Significant Difference

In order to assess the association of alleles for candidate genes with non-syndromic cleft lip and palate, DNA samples from 43 Japanese patients were compared with those from 73 control subjects with respect to the genes encoding transforming growth factor α (TGFα), TGFβ and γ-aminobutyric acid type A receptor β3 (GABRB3). The restriction fragment length polymorphisms of the 3′-non-coding region of the TGFα gene K-primer region were observed after digestion with NcoI and HinfI. Allele 4 was the most common among cases of cleft lip with or without cleft palate, whereas allele 2 was the most common among controls. A significant difference was found in this region between groups with cleft lip (with or without cleft palate) and controls (χ2 = 10.190; P = 0.017). Three alleles of the TGFβ2 gene were tested, and allele 2 was the most common in both cases and controls. The proportion of allele 2 in the case group was greater than that in the control group, showing a significant difference between cases of cleft lip (with or without cleft palate) and controls (χ2 = 19.208; P < 0.0001). No significant differences in variants of TGFβ3 or GABRB3 between case and control populations were observed. Thus it is concluded that TGF genes play a role in craniofacial development, and that alleles of TGFα or/and TGFβ2 are associated with cleft lip and cleft palate in Japanese populations.

Clonidine as an Adjuvant to Bupivacaine for Suprazygomatic Maxillary Nerve Blocks in Cleft lip and Palate Repair: A Randomized, Prospective, Double-Blind Study

2020 ◽  
pp. 105566562096414
Author(s):  
Gaston Echaniz Barbero ◽  
Marcos de Miguel ◽  
Plinio Sierra ◽  
Glenn Merritt ◽  
Pranjal Bora ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Blind Study ◽  
Double Blind Study ◽  
Emergence Agitation ◽  
Nerve Blocks ◽  
Double Blind ◽  
Maxillary Nerve ◽  
Significant Difference

Objectives: Does clonidine, as adjuvant to bupivacaine for suprazygomatic maxillary nerve blocks, reduce emergence agitation in patients undergoing cleft lip and cleft palate surgery? Design: Randomized, controlled, and double-blind study. Setting: Guwahati Comprehensive Cleft Care Center, Guwahati (Assam, India). Participants: A total of 124 patients; with a median age of 5 years in the clonidine group (CLG) and 7 years in the control group (CG), who underwent cleft lip or cleft palate surgery were included. Exclusion criteria included lack of consent from patients or their guardians, allergy to local anesthetics, coagulation disorders, local infection at the puncture site before performing the block, and language difficulties or cognitive disorders. Interventions: Patients were randomized into 2 groups to receive bilateral suprazygomatic maxillary nerve blocks with either a bupivacaine/clonidine mixture for the CLG or bupivacaine alone in the CG. Main Outcome Measure: The primary end point was the incidence of emergence agitation. Results: There was a statistically significant difference in the incidence of emergence agitation (30.2% in the CG compared to 15.2% in the CLG; difference of incidences: 15%, 95% CI: 0.1-30.1). The percentage of patients requiring intraoperative Fentanyl was lower in the CLG (10.6% compared to 26.4%; difference of incidences: 15.8%, 95% CI: 1.8-29). No other differences were observed. Further research in a more typically aged children population undergoing cleft surgery is needed. Conclusions: The use of clonidine as an adjuvant to bupivacaine in maxillary nerve block reduces the incidence of emergence agitation and intraoperative opioid consumption without hemodynamic or sedative side effects in patients undergoing cleft lip and palate surgery.

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