Postoperative Management of Cleft Lip and Palate Surgery

2018 ◽  
Vol 34 (06) ◽  
pp. 605-611 ◽  
Author(s):  
Ullas Raghavan ◽  
Dipesh Rao ◽  
Gautham Ullas ◽  
Vishwas Vijayadev
Keyword(s):  
Postoperative Care ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Tertiary Care ◽  
High Volume ◽  
Postoperative Management ◽  
Orofacial Clefts ◽  
Procedural Complications

AbstractCleft lip and palatal clefts are one of the most common birth defects with a global incidence of 1 in 700 live births. The majority of these orofacial clefts are nonsyndromic. However, a general screening for syndromes and other organ anomalies should always be performed as their association with orofacial clefts cannot be overlooked. With the recent progress in the knowledge of cleft repair, the procedures to correct cleft lip and palate though complex, have been simplified to allow improvisation in outcome and to achieve even better finesse of surgical result. The procedural complications and the pursuit of having near perfect esthetics and functionality, make this deformity a recipient of multiple procedures. This ensures that the patient is under the care of the treating surgeon for long term and allows the surgeon to follow-up on the result, not only to provide care but also to intercept any deviation in the desired outcome. Postoperative care of cleft lip and palate surgery is largely underdiscussed and a set of fixed guidelines will help the treating surgeon to provide the most comprehensive care to the cleft patients. The authors review the practices followed at their hospitals—a high volume cleft and craniofacial care center, a tertiary care multispeciality teaching hospital, and a community teaching and training hospital. The commonly followed practices with suitable evidence in postoperative care of these patients are enlisted here.

Birth Prevalence of Orofacial Clefts in Kuwait From Hospital-Based Registration

2018 ◽  
Vol 55 (10) ◽  
pp. 1450-1455 ◽  
Author(s):  
Wasmiya A. Alhayyan ◽  
Sharat C. Pan ◽  
Fawzi M. AlQatami
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Middle Eastern ◽  
Tertiary Care ◽  
Published Data ◽  
Orofacial Clefts ◽  
Oral Cleft ◽  
Birth Prevalence ◽  
Facial Clefts

Introduction: Cleft lip and palate (CLAP) are the most common craniofacial anomalies and birth defects globally. Despite the fact that a tertiary care registry of clefts has existed in Kuwait since 2008, to date there is no published data regarding the prevalence of orofacial clefts in this population. Objective: To tabulate the pattern of orofacial clefts from tertiary care center registration during 2009 through 2014 and to estimate the prevalence and trend using population-based records. Methodology: Data from all CLAP cases (born in Kuwait) registered in the central cleft center registry of the Al-Amiri hospital, Kuwait City, Kuwait, from January 2009 to December 2014 were obtained. Data regarding the type, severity, gender as well as nationality, parental consanguinity, and associated syndrome were obtained from medical records. Birth prevalence was tabulated against the population statistics for the period obtained from the central department of statistics. Result: A total of 202 CLAP patients were recorded in the study period with a mean birth prevalence of 0.57 per 1000 live births (95% confidence interval [CI] .57 ± .23). The registry recorded 108 (53.2%) males and 94 (47.8%) females. Children born to Kuwaitis represented 53.7% of cases while those born to non-Kuwaitis represented 45.3%. The most common oral cleft was CLAP (47.3%), followed by cleft palate (30.5%), cleft lip (20.2%), and other facial clefts (2%). Other congenital anomalies were recognized in 33% of all cases. There were no statistically significant differences in oral cleft prevalence across gender or nationality. Conclusion: The prevalence of oral cleft in Kuwait appears to be similar to those of other Middle Eastern populations.

Morphological Presentation of Orofacial Clefts: An Epidemiological Study of 5004 Patients in a Tertiary Care Hospital of Central India

2021 ◽  
pp. 105566562110577
Author(s):  
Jaideep Singh Chauhan ◽  
Sarwpriya Sharma
Keyword(s):  
Cleft Palate ◽  
Epidemiological Study ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Tertiary Care ◽  
Central India ◽  
Care Hospital ◽  
Orofacial Clefts ◽  
Chi Square ◽  
The Right

Objective: To analyse the morphological presentation of orofacial clefts, gender, syndromes and systemic anomalies associated with them. Design: This was an epidemiological study performed in the patients who were registered for cleft lip and palate surgeries in our centre. The data was evaluated both retrospectively as well as prospectively. Patients/ Participants: The patients registered from November 2006 to April 2021 were studied. Out of 5276 patients, data of 5004 cases were analysed, rest 272 patients were excluded due to lack of information. Statistical analysis and Chi square test were applied. Results: Cleft deformities were more common in males than females. Cleft lip with palate was the commonest phenotype (52.2%). It was followed by isolated cleft lip (22.9%), isolated cleft palate (22.1%), rare clefts (1.62%) and syndromic clefts (1.18%). Unilateral variants were more frequent than bilateral. In unilateral, left side was more common than the right side. Among bilateral, most of the cases had premaxillary protrusion. In the present study, 3.46% of all the patients had associated anomalies affecting their other organs. Less common cleft phenotypes like microform cleft lip and submucous cleft palate ± bifid uvula showed frequency of 0.62% and 0.64% respectively. Conclusion: Thorough examination of cleft deformity should be done as it may appear as an isolated deformity or part of a syndrome and have associated systemic anomalies. This may help us to deliver comprehensive care to the patients and can prevent potential operative complications.

Experiences of Canadian Parents of Young Children With Cleft Lip and/or Palate

2020 ◽  
pp. 105566562097727
Author(s):  
Eleonore E. Breuning ◽  
Rebecca J. Courtemanche ◽  
Douglas J. Courtemanche
Keyword(s):  
Health Care ◽  
Young Children ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Tertiary Care ◽  
Support Network ◽  
Tertiary Care Center ◽  
Care Needs ◽  
Care Experience

Purpose: Prior literature has described the perspectives of parents of young children with clip lip and/or palate; however, few studies have described parents’ experiences within a Canadian health care system. This study aims to better understand the experiences of parents of young children with cleft lip and/or palate seen at a Canadian tertiary care center and identify their care needs. Design: In-depth semistructured interviews. Setting: Pediatric tertiary care center. Participants: Parents of children younger than 7 years of age with cleft lip and/or palate. Results: From 14 interviews, 4 themes were identified. The diagnosis theme was associated with reactions, timing, and search for information. Key concerns within the theme of physiology and function were around feeding and speech. The health care experience theme included burden of care, peripheral hospitals and services, the cleft lip and palate clinic, and clinicians. The psychosocial theme included parents’ reactions to their child’s pain, coping strategies, family interactions, and school/day care experiences. Parents felt care could be improved by having: access to good information and community speech therapists, shorter appointment wait times, a peer support network, and increased cleft knowledge within their child’s school and peer groups. Conclusions: The experience of parents of children with cleft lip and/or palate is complex but can be organized into 4 themes. Clinics may consider suggestions offered by parents to improve care. Future work should address parents’ needs and aim to create a parent-reported quality-of-life measure specific to parents of young children with cleft lip and/or palate.

Etiology of Cleft Lip Lower Lip Deformity: Use of an Objective Analysis to Measure Severity

2019 ◽  
Vol 56 (10) ◽  
pp. 1333-1339 ◽  
Author(s):  
Mirte Langeveld ◽  
Richard A. Bruun ◽  
Maarten J. Koudstaal ◽  
Bonnie L. Padwa
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Case ◽  
Lower Lip ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Le Fort I ◽  
Control Study

Objective: Measure lower lip thickness and eversion in patients with cleft lip and palate (CLP) and maxillary hypoplasia. The specific aims were to (1) compare lower lip thickness/eversion in patients with CLP to noncleft controls with maxillary hypoplasia, (2) determine differences between patients with unilateral CLP (UCLP) and bilateral CLP (BCLP), and (3) document changes in the lower lip that occur with Le Fort I advancement. Design: Retrospective case–control study. Setting: Tertiary care center. Patients/Participants: Patients with available pre- and postoperative CT scans and 2D lateral photographs who had a Le Fort I advancement between 2009 and 2017. There were 32 patients with CLP (17 females; mean age 17.7 ± 1.9 years) and 33 noncleft controls (21 females; mean age 18.8 ± 2.6 years). Main Outcome Measures: Lower lip thickness and eversion. Results: Patients with CLP and maxillary hypoplasia have a significantly thicker lower lip ( P = .019) and outward rotation of the vermilion border ( P = .003) compared to noncleft controls. The lower lip was significantly thicker in patients with BCLP than in those with UCLP ( P = .035). Lower lip thickness and rotation did not change after maxillary advancement. Conclusions: Patients with CLP and maxillary hypoplasia have a thicker and more everted lower lip than noncleft controls. Patients with BCLP have a significantly thicker lower lip than those with UCLP. Strain of the lower lip musculature appears to be an important contributor to the development of the cleft lip lower lip deformity.

Decision-Making in Cleft-Related Surgery: A Qualitative Analysis of Patients and Caregivers

2019 ◽  
Vol 57 (2) ◽  
pp. 161-168
Author(s):  
Katelyn G. Bennett ◽  
Annie K. Patterson ◽  
Kylie Schafer ◽  
Madeleine Haase ◽  
Kavitha Ranganathan ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Thematic Analysis ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Tertiary Care ◽  
Shared Decision ◽  
Surgical Indications ◽  
Facial Difference

Objective: Preference-sensitive surgical decisions merit shared decision-making, as decision engagement can reduce decisional conflict and regret. Elective cleft-related procedures are often preference sensitive, and therefore, we sought to better understand decision-making in this population. Design: Semistructured interviews were conducted to elicit qualitative data. A hierarchical codebook was developed through an iterative process in preparation for thematic analysis. Thematic analysis was performed to examine differences between patients and caregivers. Setting: Multidisciplinary cleft clinic at a tertiary care center. Participants: Patients with cleft lip aged 8 and older (n = 31) and their caregivers (n = 31) were purposively sampled. Inability to converse in English, intellectual disability, or syndromic diagnoses resulted in exclusion. Main Outcome Measures: Preferences surrounding surgical decision-making identified during thematic analysis. Results: Mean patient age was 12.7 (standard deviation: 3.1). Most had unilateral cleft lip and palate (43.8%). Three themes emerged: Insufficient Understanding of Facial Difference and Treatment, Diversity of Surgical Indications, and Barriers to Patient Autonomy. Almost half of caregivers believed their children understood their clefts, but most of these children failed to provide information about their cleft. Although many patients and caregivers acknowledged that surgery addressed function and/or appearance, patients and caregivers exhibited differences regarding the necessity of surgery. Furthermore, a large proportion of patients believed their opinions mattered in decisions, but less than half of caregivers agreed. Conclusions: Patients with clefts desire to participate in surgical decisions but have limited understanding of their facial difference and surgical indications. Cleft surgeons must educate patients and facilitate shared decision-making.

Occlusal Outcome of Orthodontic Treatment for Patients With Complete Cleft Lip and Palate

2021 ◽  
pp. 105566562199611
Author(s):  
Daniel Stonehouse-Smith ◽  
Aida N.A. Abd Rahman ◽  
Jeanette Mooney ◽  
Haydn Bellardie
Keyword(s):  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Time ◽  
Peer Assessment ◽  
Tertiary Care ◽  
Standard Of Care ◽  
High Volume ◽  
Retrospective Assessment ◽  
Par Index

Aim: To assess occlusal outcomes of orthodontic treatment for patients with complete cleft lip and palate. Design: Retrospective assessment using the Peer Assessment Rating (PAR) index. Setting: Consecutive patients treated by one consultant orthodontist at a tertiary care cleft center. Participants: One hundred twenty-seven patients with either complete unilateral cleft lip and palate (UCLP) or bilateral cleft lip and palate (BCLP) consecutively treated with fixed appliances. Intervention: Fixed orthodontic appliance treatment and orthognathic surgery when required. Outcomes: The PAR index assessment was carried out by a calibrated-independent assessor. Treatment duration, the number of patient visits, and data on dental anomalies were drawn from patient records and radiographs. Results: One hundred two patients’ study models were assessed after exclusions. Mean start PAR score for UCLP (n = 71) was 43.9 (95% CI, 41.2-46.6, SD 11.5), with a mean score reduction of 84.3% (95% CI, 81.9-86.7, SD 10.1). The UCLP mean treatment time was 23.7 months with 20.1 appointments. Mean start PAR score for BCLP (n = 31) was 43.4 (95% CI, 39.2-47.6, SD 11.4), with a mean score reduction of 80.9% (95% CI, 76.3-85.5, SD 12.5). The BCLP mean treatment time was 27.8 months with 20.5 appointments. Conclusion: These results compare well with other outcome reports, including those for patients without a cleft, and reflect the standard of care provided by an experienced cleft orthodontist. As with high-volume surgeons, orthodontic treatment for this high need group is favorable when provided by a high-volume orthodontist. These findings may be used for comparative audit with similar units providing cleft care.

Prenatal Ultrasound Measurement of Fetal Stomach Size Is Predictive of Postnatal Development of GERD in Isolated Cleft Lip and/or Palate

2020 ◽  
pp. 105566562096871
Author(s):  
Marika Toscano ◽  
Kristen Burhans ◽  
Lauren M. Mack ◽  
Stephanie Henderson ◽  
Peter F. Koltz ◽  
...  
Keyword(s):  
Postnatal Development ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Chromosomal Abnormalities ◽  
Care Center ◽  
Tertiary Care ◽  
Surrogate Marker ◽  
Prenatal Ultrasound ◽  
Ultrasound Measurement ◽  
Control Measurement

Objective: To determine whether prenatal ultrasound measurement of fetal stomach size, as a surrogate marker of fetal swallowing, is predictive of postnatal development of gastroesophageal reflux disease (GERD) in cases of isolated cleft lip and/or palate (CL/P). Design: This is a retrospective case–control study. The outcome of interest is postnatal diagnosis of GERD in isolated CL/P. The exposure of interest is prenatal stomach size measurement by ultrasound. Setting: The study population was selected from an academic, tertiary care center between 2003 and 2011. Patients/Participants: Cases were neonates undergoing CL/P repair during the study period. Cases with other known structural or chromosomal abnormalities were excluded. Controls were contemporary, nondiabetic neonates that matched gestational age (within one week) to cases. Each case measurement was matched ∼1:2 with control measurement. Interventions: None. Main Outcome Measure: The primary outcome was difference in mean prenatal ultrasound measurement of fetal stomach size between cases and controls. We hypothesized that patients with postnatal development of GERD would have smaller mean fetal stomach size. Results: There were 32 cases including 19 patients with unilateral cleft lip and palate, 8 with unilateral cleft lip, and 4 with bilateral cleft lip and palate. Cases were noted to have smaller mean anterior–posterior and transverse fetal stomach measurements as compared to controls. This was statistically significant from 16 to 21 weeks, 25 to 27 weeks, and 28 to 36 weeks ( P < .01 for all). Conclusions: Prenatal ultrasound measurement of fetal stomach size as a surrogate marker of fetal swallowing is predictive of postnatal development of GERD in isolated CL/P.

scholarly journals Continuous Multidisciplinary Care for Patients With Orofacial Clefts—Should the Follow-up Interval Depend on the Cleft Entity?

2021 ◽  
pp. 105566562110352
Author(s):  
Anna K. Sander ◽  
Elisabeth Grau ◽  
Anita Kloss-Brandstätter ◽  
Rüdiger Zimmerer ◽  
Michael Neuhaus ◽  
...  
Keyword(s):  
Soft Palate ◽  
Cleft Lip ◽  
Care Center ◽  
Tertiary Care ◽  
Growth Period ◽  
Multidisciplinary Care ◽  
Treatment Needs ◽  
Orofacial Clefts ◽  
Treatment Demand

Objective The multidisciplinary follow-up of patients with cleft lip with or without palate (CL/P) is organized differently in specialized centers worldwide. The aim of this study was to evaluate the different treatment needs of patients with different manifestations of CL/P and to potentially adapt the frequency and timing of checkup examinations accordingly. Design We retrospectively analyzed the data of all patients attending the CL/P consultation hour at a tertiary care center between June 2005 and August 2020 ( n = 1126). We defined 3 groups of cleft entities: (1) isolated clefts of lip or lip and alveolus (CL/A), (2) isolated clefts of the hard and/or soft palate, and (3) complete clefts of lip, alveolus and palate (CLP). Timing and type of therapy recommendations given by the specialists of different disciplines were analyzed for statistical differences. Results Patients with CLP made up the largest group ( n = 537), followed by patients with cleft of the soft palate ( n = 371) and CL ± A ( n = 218). There were significant differences between the groups with regard to type and frequency of treatment recommendations. A therapy was recommended in a high proportion of examinations in all groups at all ages. Conclusion Although there are differences between cleft entities, the treatment need of patients with orofacial clefts is generally high during the growth period. Patients with CL/A showed a similarly high treatment demand and should be monitored closely. A close follow-up for patients with diagnosis of CL/P is crucial and measures should be taken to increase participation in follow-up appointments.

Objective Assessment of the Nasal Airway in Unilateral Cleft Lip and Palate - a Long-term Study

2009 ◽  
pp. 091202121239062
Author(s):  
Maria Mani ◽  
Staffan Morén ◽  
Ornolfur Thorvardsson ◽  
Olafur Jakobsson ◽  
Valdemar Skoog ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Objective Assessment ◽  
Nasal Airway ◽  
Term Study ◽  
Long Term Study
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