Long-Term Follow-up of Unilateral Cleft lip and Palate: Incidence of Speech-Correcting Surgeries and Fistula Formation

2021 ◽  
pp. 105566562110556
Author(s):  
Charlotta Gustafsson ◽  
Arja Heliövaara ◽  
Junnu Leikola
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Primary Repair ◽  
Single Stage ◽  
Velopharyngeal Insufficiency ◽  
Fistula Formation ◽  
Fistula Repair ◽  
Alveolar Bone Grafting

Objective The ideal surgical protocol and technique for primary closure of unilateral cleft lip and palate (UCLP) are unclear, and the development of velopharyngeal insufficiency and fistulae following primary repair is common. This study aimed to determine the long-term surgical burden of care in terms of secondary surgeries, defined as speech-correcting surgeries (SCSs) and fistula repair, in a UCLP population, and to compare outcomes of various surgical protocols. Design Retrospective, single-center review. Participants The study comprised 290 nonsyndromic children with complete UCLP. Different surgical protocols entailing both single-stage and 2-stage approaches were compared, and the surgical outcome was analyzed at the time of alveolar bone grafting (ABG) and post ABG. Results Altogether 110 children (37.9%) underwent secondary surgery by the time of ABG. Of the total population 25.9% (n  =  75) had undergone SCS and 17.2% (n  =  50) had undergone fistula repair. The respective incidences at follow-up (post ABG) were 30.3% (n  =  88) and 18.9% (n  =  55). Median age at ABG was 9.8 years and at follow-up was 16.3 years. No significant difference emerged in terms of secondary surgeries between the techniques and protocols applied at primary repair. However, some differences occurred regarding the location of fistulae; the single-stage procedure had more anterior fistula repairs, particularly connected to a perialveolar fistula. Conclusions Although the outcome differences between the surgical protocols were small, indicating that none of the treatment protocols was clearly superior to another, attention was drawn to the favorable outcomes of the single-stage protocol.

Speech in Adults Treated for Unilateral Cleft Lip and Palate: Long-Term Follow-Up after One- or Two-Stage Palate Repair

2017 ◽  
Vol 54 (6) ◽  
pp. 639-649 ◽  
Author(s):  
Staffan Morén ◽  
Maria Mani ◽  
Stålhammar Lilian ◽  
Per Åke Lindestad ◽  
Mats Holmström
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Velopharyngeal Insufficiency ◽  
Control Group ◽  
Two Stage ◽  
One Stage ◽  
Long Term Follow Up

Objective To evaluate speech in adults treated for unilateral cleft lip and palate with one-stage or two-stage palate closure and compare the speech of the patients with that of a noncleft control group. Design Cross-sectional study with long-term follow-up. Participants/Setting All unilateral cleft lip and palate patients born from 1960 to 1987 and treated at Uppsala University Hospital, Sweden, were invited (n = 109). Participation rate was 67% (n = 73) at a mean of 35 years after primary surgery. Forty-seven had been treated according to one-stage palate closure and 26 according to two-stage palate closure. Pharyngeal flap surgery had been performed in 11 of the 73 patients (15%). The noncleft control group consisted of 63 age-matched volunteers. Main Outcome Measure(s) Speech-language pathologists rated perceptual speech characteristics from blinded audio recordings. Results Among patients, seven (10%) presented with hypernasality, 12 (16%) had audible nasal emission and/or nasal turbulence, five (7%) had consonant production errors, one (2%) had glottal reinforcements/substitutions, and one (2%) had reduced intelligibility. Controls had no audible signs of velopharyngeal insufficiency and no quantifiable problems with the other speech production variables. No significant differences were identified between patients treated with one-stage and two-stage palate closure for any of the variables. Conclusions The prevalence of speech outcome indicative of velopharyngeal insufficiency among adult patients treated for unilateral cleft lip and palate was low but higher compared with individuals without cleft. Whether palatal closure is performed in one or two stages does not seem to affect the speech outcome at a mean age of 35 years.

Repair of Protruding Bilateral Cleft Lip and Palate With Staged Premaxilla Setback Osteotomy, Cheiloplasty, and Palatoplasty in Trisomy 17p Patient: A Review of Syndromic Clinical Characteristic

2021 ◽  
pp. 105566562110698
Author(s):  
Kristaninta Bangun ◽  
Jessica Halim ◽  
Vika Tania
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Chromosome 17 ◽  
Long Term Effects ◽  
Surgical Strategies ◽  
Increased Risk ◽  
The Cost

Chromosome 17 duplication is correlated with an increased risk of developmental delay, birth defects, and intellectual disability. Here, we reported a female patient with trisomy 17 on the whole short arm with bilateral complete cleft lip and palate (BCLP). This study will review the surgical strategies to reconstruct the protruding premaxillary segment, cleft lip, and palate in trisomy 17p patient. The patient had heterozygous pathogenic duplication of chromosomal region chr17:526-18777088 on almost the entire short arm of chromosome 17. Beside the commonly found features of trisomy 17p, the patient also presented with BCLP with a prominent premaxillary portion. Premaxillary setback surgery was first performed concomitantly with cheiloplasty. The ostectomy was performed posterior to the vomero-premaxillary suture (VPS). The premaxilla was firmly adhered to the lateral segment and the viability of philtral flap was not compromised. Two-flap palatoplasty with modified intravelar veloplasty (IVV) was performed 4 months after. Successful positioning of the premaxilla segment, satisfactory lip aesthetics, and vital palatal flap was obtained from premaxillary setback, primary cheiloplasty, and subsequent palatoplasty in our trisomy 17p patient presenting with BLCP. Postoperative premaxillary stability and patency of the philtral and palatal flap were achieved. Longer follow-up is needed to evaluate the long-term effects of our surgical techniques on inhibition of midfacial growth. However, the benefits that the patient received from the surgery in improving feeding capacity and facial appearance early in life outweigh the cost of possible maxillary retrusion.

Long-Term Otologic and Audiometric Outcomes in Patients with Cleft Palate

2017 ◽  
Vol 157 (4) ◽  
pp. 676-682 ◽  
Author(s):  
Terence E. Imbery ◽  
Lindsay B. Sobin ◽  
Emily Commesso ◽  
Lindsey Koester ◽  
Sherard A. Tatum ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Closure Rate ◽  
Pressure Equalization

Objective Describe longitudinal audiometric and otologic outcomes in patients with cleft palates. Study Design Case series with chart review. Setting Single academic medical center. Methods Charts of 564 patients with a diagnosis of cleft palate (59% syndromic etiology, 41% nonsyndromic) from 1998 to 2014 were reviewed. Patients without at least 1 audiometric follow-up were excluded from analysis. Patient demographics, surgeries, audiometric tests, and otologic data were recorded for 352 patients. Results Forty-five percent had isolated cleft palates, 34% had unilateral cleft lip and palate, and 21% had bilateral cleft lip and palate. Patients were followed for a mean of 50.3 months with a mean of 3.2 separate audiograms performed. Patients received a mean of 2.93 pressure equalization tubes. Increased number of pressure equalization tubes was not associated with incidence of cholesteatoma, which was identified in only 4 patients. Nine patients underwent eventual tympanoplasty with an 89% closure rate. Analysis of mean air-bone gap by cleft type did not reveal significant differences ( P = .08), but conductive losses and abnormal tympanometry persisted into teenage years. Conclusions Patients with cleft palates have eustachian tube dysfunction, which, in our cohort, resulted in persistent conductive hearing loss, highlighting the importance of long-term follow-up. Cholesteatoma incidence was low and not associated with number of tubes, which at our institution were placed prophylactically. Tympanoplasty was successful in those with persistent perforations.

WITHDRAWN—Administrative Duplicate Publication: Voice Quality in Adults Treated for Unilateral Cleft Lip and Palate: Long-term Follow-up After 1- or 2-Stage Palate Repair

2018 ◽  
Vol 55 (5) ◽  
pp. 758-768 ◽  
Author(s):  
Staffan Morén ◽  
Per Åke Lindestad ◽  
Mats Holmström ◽  
Maria Mani
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Voice Quality ◽  
Two Stage ◽  
Duplicate Publication ◽  
Long Term Follow Up ◽  
Palate Repair

Morén, S., Lindestad, P. Å., Holmström, M., & Mani, M. (2018). Voice Quality in Adults Treated for Unilateral Cleft Lip and Palate: Long-term Follow-up After 1- or 2-Stage Palate Repair. The Cleft Palate-Craniofacial Journal, 55(5), 758–768. DOI: 10.1177/1055665618754946 Article withdrawn by publisher. Due to an administrative error, this article was accidentally published in Volume 55 Issue 5 as well as Volume 55 Issue 8 of publishing year 2018 with different DOIs and different page numbers. The incorrect version of the article with DOI: 10.1177/1055665618754946 has been replaced with this correction notice. The correct and citable version of the article remains: Morén, S., Lindestad, P. Å., Holmström, M., & Mani, M. (2018). Voice Quality in Adults Treated for Unilateral Cleft Lip and Palate: Long-Term Follow-Up After One- or Two-Stage Palate Repair. The Cleft Palate-Craniofacial Journal, 55(8), 1103–1114. DOI: 10.1177/1055665618764521

scholarly journals Long term follow up study of survival associated with cleft lip and palate at birth

BMJ ◽  
2004 ◽  
Vol 328 (7453) ◽  
pp. 1405 ◽  
Author(s):  
Kaare Christensen ◽  
Knud Juel ◽  
Anne Maria Herskind ◽  
Jeffrey C Murray
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Follow Up Study ◽  
Long Term Follow Up

scholarly journals The First-Year Follow-Up of a Cleft Lip and Palate Patient Treated With Nasoalveolar Molding (NAM)

2020 ◽  
Vol 31 (2) ◽  
pp. 190-196
Author(s):  
Nathália Viegas de Oliveira ◽  
Gabriel Antônio Anjos Tou ◽  
Raquel Souto Silva ◽  
Sérgio Edriane Rezende ◽  
Henrique Pretti ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Primary Repair ◽  
Operative Therapy ◽  
First Year ◽  
Treatment Morbidity ◽  
One Step ◽  
Nasoalveolar Molding

Abstract The objectives of pre-surgical orthopedics are to allow surgical repair with minimal tension of the involved tissues and less restriction to the craniofacial growth. The aim of this study was to evaluate the benefits of nasoalveolar model (NAM) as a pre-operative therapy in a patient with bilateral cleft lip and palate followed by labioplasty and palatoplasty. A 15-day-old patient underwent orthopedic treatment with NAM. After pre-operative treatment, retraction of the pre-maxilla was observed with reduction of the fissure. Due to the successful effects of NAM treatment the patient had a one-step surgery for lip correction. Six months later, due to lip pressure the fissure was further decreased. After six months, the patient underwent palatoplasty. Both surgeries contributed to the remaining closure of the fissure, which were reduced by half compared to the end of pre-operative treatment. The uses of NAM as a pre-operative treatment approached the alveolar segments, centralized the pre-maxilla, decreased the cleft palate resulting in a marked improvement of the arch and provide superior surgical results. In addition, it allows the primary repair of the patient’s lip with asymmetric bilateral fissure in only one-step surgery; in consequence, it will reduce treatment morbidity and decrease cost of treatment.

Sign in / Sign up

Export Citation Format

Share Document