scholarly journals Closing the Loop on Centralization of Cleft Care in the United Kingdom

2017 ◽  
Vol 55 (2) ◽  
pp. 248-251 ◽  
Author(s):  
Andrew R. Ness ◽  
Andrew R. Wills ◽  
Andrea Waylen ◽  
Jackie Smallridge ◽  
Amanda J. Hall ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Previous Survey ◽  
Main Outcome Measure ◽  
The United Kingdom ◽  
Closing The Loop ◽  
Clinical Measures ◽  
The Impact

Objective: We highlight a major study that investigated the impact of reconfigured cleft care in the United Kingdom some 15 years after centralization. We argue that centralization as an intervention has a major impact on outcomes. Setting: Audit clinics held in Cleft Centers in the United Kingdom. Patients, Participants: Five-year-olds born between April 1, 2005, and March 31, 2007, with nonsyndromic unilateral cleft lip and palate. Interventions: Centralization of cleft care. Main Outcome Measure(s): We collected routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) in a very similar way to a previous survey. Results: We identified 359 eligible children and recruited 268 (74.7%) to the study. Overall, their outcomes were better post-centralization. There have been marked improvements in dentoalveolar arch relationships and in speech whereas the prevalence of dental caries and hearing loss are unchanged. Conclusions: Centralized cleft care has changed UK outcomes considerably and there is no argument for returning to a dispersed model of treatment.

scholarly journals Closer to the Truth on National Fistula Prevalence After Unilateral Complete Cleft Lip and Palate Repair? The Cleft Care UK Study

2019 ◽  
Vol 57 (1) ◽  
pp. 5-13
Author(s):  
Arthur S. Yang ◽  
Bruce M. Richard ◽  
Andrew K. Wills ◽  
Osama Mahmoud ◽  
Jonathan R. Sandy ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Palatal Fistula ◽  
The United Kingdom ◽  
Palate Repair

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.

scholarly journals Centralization of Cleft Lip and Palate Services in the United Kingdom

2018 ◽  
Vol 55 (5) ◽  
pp. 676-681 ◽  
Author(s):  
Nicola Marie Stock ◽  
Hamza Anwar ◽  
Jonathan R. Sandy ◽  
Nichola Rumsey
Keyword(s):  
United Kingdom ◽  
Large Scale ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Patient Centered ◽  
Delivery Of Care ◽  
Emotional Challenges ◽  
The United Kingdom ◽  
Specialist Services ◽  
The Impact

Background: Since the implementation of centralized services in the United Kingdom for those affected by cleft lip and/or palate (CL/P), several studies have investigated the impact of service rationalization on the delivery of care. While large-scale quantitative studies have demonstrated improvements in a range of patient outcomes, and smaller studies have reported on the benefits and challenges of centralization from the views of health professionals, little research has attempted to capture the patient perspective. Furthermore, few studies have investigated the views of adult “returners” who have undergone treatment both pre- and postcentralization. Methods: Qualitative data relevant to the subject of this article were extracted from 2 previous larger studies carried out between January 2013 and March 2014. A total of 16 adults born with CL/P contributed data to the current study. These data were subjected to inductive thematic analysis. Results: The findings suggest that centralization of CL/P services has considerably enhanced the patient experience. Specifically, the overall standard and coordination of care has improved, service delivery has become more patient centered, and access to professional psychological support and peer support has greatly improved patients’ capacity to cope with the associated emotional challenges. Conclusions: The data collected provide additional insight into the impact of centralization from the perspective of a largely unexplored patient population. In combination with other literature, these findings are also relevant to future efforts to centralize other specialist services around the world.

Skeletal and Dental Correction and Stability Following LeFort I Advancement in Patients With Cleft Lip and Palate With Mild, Moderate, and Severe Maxillary Hypoplasia

2021 ◽  
pp. 105566562199610
Author(s):  
Buddhathida Wangsrimongkol ◽  
Roberto L. Flores ◽  
David A. Staffenberg ◽  
Eduardo D. Rodriguez ◽  
Pradip. R. Shetye
Keyword(s):  
Retrospective Study ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Inclusion Criteria ◽  
Maxillary Hypoplasia ◽  
Main Outcome Measure ◽  
Lateral Cephalograms

Objective: This study evaluates skeletal and dental outcomes of LeFort I advancement surgery in patients with cleft lip and palate (CLP) with varying degrees of maxillary skeletal hypoplasia. Design: Retrospective study. Method: Lateral cephalograms were digitized at preoperative (T1), immediately postoperative (T2), and 1-year follow-up (T3) and compared to untreated unaffected controls. Based on the severity of cleft maxillary hypoplasia, the sample was divided into 3 groups using Wits analysis: mild: ≤0 to ≥−5 mm; moderate: <−5 to >−10 mm; and severe: ≤−10 mm. Participants: Fifty-one patients with nonsyndromic CLP with hypoplastic maxilla who met inclusion criteria. Intervention: LeFort I advancement. Main Outcome Measure: Skeletal and dental stability post-LeFort I surgery at a 1-year follow-up. Results: At T2, LeFort I surgery produced an average correction of maxillary hypoplasia by 6.4 ± 0.6, 8.1 ± 0.4, and 10.7 ± 0.8 mm in the mild, moderate, and severe groups, respectively. There was a mean relapse of 1 to 1.5 mm observed in all groups. At T3, no statistically significant differences were observed between the surgical groups and controls at angle Sella, Nasion, A point (SNA), A point, Nasion, B point (ANB), and overjet outcome measures. Conclusions: LeFort I advancement produces a stable correction in mild, moderate, and severe skeletal maxillary hypoplasia. Overcorrection is recommended in all patients with CLP to compensate for the expected postsurgical skeletal relapse.

Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 4: Outcome Comparisons, Training, and Conclusions

2001 ◽  
Vol 38 (1) ◽  
pp. 38-43 ◽  
Author(s):  
David Bearn ◽  
Sue Mildinhall ◽  
Terrie Murphy ◽  
John J. Murray ◽  
Debbie Sell ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Dental Health ◽  
Parent Satisfaction ◽  
Advisory Group ◽  
Dental Arch ◽  
The United Kingdom ◽  
Alveolar Bone Grafting

Objective A critical appraisal of cleft care in the United Kingdom. Design Retrospective comparative study. Setting All National Health Service cleft centers in the United Kingdom. Patients/Participants Children born with unilateral complete clefts of the lip and palate between April 1, 1982, and March 31, 1984 (12-year-olds), and April 1, 1989, and March 31, 1991 (5-year-olds). Newly appointed and senior cleft clinicians. Main Outcome Measures Skeletal pattern, dental arch relationship, success of alveolar bone grafting, dental health, facial appearance, oral health status, patient/parent satisfaction. Conclusions This paper highlights the poor outcomes for the fragmented cleft care in the United Kingdom, compared with European centers. There is an urgent need for a review of structure, organization, and training.

Should Cleft Surgery Always be Performed During the Matutine Time? Analysis of Early and Late Postoperative Complications in a Cleft Center

2020 ◽  
Vol 57 (11) ◽  
pp. 1332-1335
Author(s):  
Daniel Velez Restrepo ◽  
Marilson Hideki Sato ◽  
Fernanda Saturnino Cardoso ◽  
Renato da Silva Freitas
Keyword(s):  
Statistical Analysis ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Discrete Variables ◽  
Time Analysis ◽  
Main Outcome Measure ◽  
Operating Surgeon ◽  
Type Of Surgery ◽  
Cleft Surgery

Objective: Surgeries performed in the afternoon schedule were discouraged by Smile Train Foundation for patients younger than 2 years. The aim of this study is to present the incidence of complications discriminating time of surgery (morning/afternoon) in a reference center in Curitiba (Brazil) during 2017. Design: Retrospective study that evaluated all cleft surgeries that were performed at Assistance Center for Cleft Lip and Palate during 2017. Complications correlated with surgery period (morning/afternoon), type of surgery, and operating surgeon were studied. Statistical analysis was performed to find any association between discrete variables. Setting: Tertiary, institutional Participants: One hundred eighty-seven patients with cleft lip and/or cleft palate/cleft lip and palate, who were evaluated and submitted to surgery in the center and had less than 24 months of age, were included in the study. Interventions: One hundred twenty-four cheiloplasties and 63 palatoplasties were performed. Main Outcome Measure: Incidence of complications. Results: From the total of cheiloplasties, the number of complications was 2 (1.6%) and from the total of palatoplasties the number of complications was 11 (17%); 8.1% of surgeries that were performed in the morning had any complication compared to 5.1% of surgeries performed in the afternoon. Statistical analysis of discrete variables with χ2 test showed no correlation between surgery schedule and complications (χ2 = 0.62). Conclusion: The number of complications was not higher in the afternoon scheduled surgeries. Surgeon expertise had a statistically significant correlation with the absence of complications (χ2 = 20.57).

scholarly journals The Cleft Multidisciplinary Collaborative: Establishing a Network to Support Cleft Lip and Palate Research in the United Kingdom

2018 ◽  
Vol 56 (4) ◽  
pp. 502-507 ◽  
Author(s):  
David C. G. Sainsbury ◽  
Amy Davies ◽  
Yvonne Wren ◽  
Lucy Southby ◽  
Ambika Chadha ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
The United Kingdom

Facial and Nasolabial Aesthetics of Complete UCLP Submitted to 2-Stage Palate Repair With Vomer Flap

2018 ◽  
Vol 55 (9) ◽  
pp. 1211-1217
Author(s):  
Terumi Okada Ozawa ◽  
Luciana Lais Savero Reis ◽  
Renata Mayumi Kato ◽  
Diógenes Laercio Rocha ◽  
Renata Sathler ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Mixed Dentition ◽  
Single Center ◽  
Facial Profile ◽  
Main Outcome Measure ◽  
Kappa Test ◽  
Palate Repair ◽  
Vomer Flap

Objective: To evaluate the aesthetics of nasolabial appearance and facial profile of children with unilateral cleft lip and palate (UCLP) submitted to 2-stage palate repair with vomerine flap. Design: Retrospective. Setting: Single center. Patients: Forty patients with UCLP, mean age of 7.81 years of both sexes, rehabilitated at a single center by 1 plastic surgeon. Interventions: Lip and anterior palate repair with nasal alar repositioning was performed at 3 to 6 months of age by Millard technique and vomer flap, respectively. Posterior palate was repaired at 18 months by Von Langenbeck technique. Main Outcome Measure(s): Four cropped digital facial photographs of each patient were evaluated by 3 orthodontists to score the nasolabial aesthetics and profile. Frequencies of each score as well means and medians were calculated. Kappa test was used for evaluating inter- and intrarater reproducibility. Results: The nasal form and deviation was scored as good/very good in 70%, fair in 22.5%, and poor in 7.5% of the sample. The nasal–subnasal aesthetic was considered good/very good in 55%, fair in 30%, and poor in 15% of the sample. The lip vermilion border and the white part of surgical scar aesthetics were good/very good in 77.5% and 80%, fair in 17.5% for both categories, and poor in 5% and 2.5% of the cases, respectively. In all, 67.5% showed convex facial profile, 20% was straight, and 12.5% was concave profile. Conclusions: Two-stage palatoplasty presented an adequate aesthetical results for the majority of patients with UCLP in the mixed dentition.

Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 3: Speech Outcomes

2001 ◽  
Vol 38 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Debbie Sell ◽  
Pamela Grunwell ◽  
Sue Mildinhall ◽  
Terrie Murphy ◽  
Tremaine A. O. Cornish ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Age Groups ◽  
Advisory Group ◽  
Cross Sectional ◽  
The United Kingdom ◽  
Severe Degree ◽  
Therapy Intervention

Objective To summarize speech outcomes in children born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom. Design Prospective descriptive study on a cross-sectional sample of children. Patients/Participants Data were collected for 238 5-year-olds (born between April 1, 1989, and March 31, 1991) and 218 12-year-olds (born between April 1, 1982, and March 31, 1984) with complete UCLP. Main Outcomes Ratings of intelligibility, nasality, “speech cleft type characteristics” and speech therapy intervention. Conclusions Nineteen percent of 5-year-olds and 4% of 12-year-olds were judged to be impossible to understand or just intelligible to strangers. Thirty-four percent of 5-year-olds and 17% of 12-year-olds had at least one serious error of consonant production. Eighteen percent of 5-year-olds and 12-year-olds had consistent hypernasality of mild, moderate, or severe degree. Approximately two-thirds of both age groups had undergone speech therapy.

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