Secondary surgery in cleft lip and palate care

2009 ◽  
Vol 5 (4) ◽  
pp. 212-214
Author(s):  
Fiona Grist
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Secondary Surgery

Greater Palatal Cleft Width Predicts an Increased Risk for Unfavorable Outcomes in Cleft Palate Repair

2021 ◽  
pp. 105566562110295
Author(s):  
Åsa C. Okhiria ◽  
Fatemeh Jabbari ◽  
Malin M. Hakelius ◽  
Monica M. Blom Johansson ◽  
Daniel J. Nowinski
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Hospital ◽  
Velopharyngeal Insufficiency ◽  
Secondary Surgery ◽  
Increased Risk ◽  
Cleft Palate Repair ◽  
The Impact ◽  
Nasal Emission

Objective: To investigate the impact of cleft width and cleft type on the need for secondary surgery and velopharyngeal competence from a longitudinal perspective. Design: Retrospective, longitudinal study. Setting: A single multidisciplinary craniofacial team at a university hospital. Patients: Consecutive patients with unilateral or bilateral cleft lip and palate and cleft palate only (n = 313) born from 1984 to 2002, treated with 2-stage palatal surgery, were reviewed. A total of 213 patients were included. Main Outcome Measures: The impact of initial cleft width and cleft type on secondary surgery. Assessment of hypernasality, audible nasal emission, and glottal articulation from routine follow-ups from 3 to 16 years of age. The assessments were compared with reassessments of 10% of the recordings. Results: Cleft width, but not cleft type, predicted the need for secondary surgery, either due to palatal dehiscence or velopharyngeal insufficiency. The distribution of cleft width between the scale steps on a 4-point scale for hypernasality and audible nasal emission differed significantly at 5 years of age but not at any other age. Presence of glottal articulation differed significantly at 3 and 5 years of age. No differences between cleft types were seen at any age for any speech variable. Conclusions: Cleft width emerged as a predictor of the need for secondary surgery as well as more deviance in speech variables related to velopharyngeal competence during the preschool years. Cleft type was not related to the need for secondary surgery nor speech outcome at any age.

scholarly journals Five-Fold Variation Among Surgeons and Hospitals in the Use of Secondary Palate Surgery

2018 ◽  
Vol 56 (5) ◽  
pp. 586-594 ◽  
Author(s):  
Thomas J. Sitzman ◽  
Adam C. Carle ◽  
Pamela C. Heaton ◽  
Michael A. Helmrath ◽  
Maria T. Britto
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Primary Repair ◽  
Multivariable Analysis ◽  
Secondary Surgery ◽  
Secondary Palate ◽  
Primary Palate ◽  
Cleft Palate Repair ◽  
Palate Repair

Objective: To identify child-, surgeon- and hospital-specific factors at the time of primary cleft palate repair that are associated with the use of secondary palate surgery. Design: Retrospective cohort study. Setting: Forty-nine pediatric hospitals. Participants: Children who underwent cleft palate repair between 1998 and 2015. Main Outcome Measure: Time from primary cleft palate repair to secondary palate surgery. Results: By 5 years after the primary palate repair, 27.5% of children had undergone secondary palate surgery. In multivariable analysis, cleft type and age at primary palate repair were both associated with secondary surgery ( P < .01). Children with unilateral cleft lip and palate had a 1.69-fold increased hazard of secondary surgery (95% confidence interval [CI]: 1.54-1.85) compared to children with cleft palate alone. Primary palate repair before 9 months had a 3.99-fold increased hazard of secondary surgery (95% CI: 3.39-4.07) compared to repair at 16 to 24 months of age. After adjusting for cleft type, age at repair, and procedure volume, there remained substantial variation in secondary surgery use among surgeons and hospitals ( P < .01). For children with isolated cleft palate, the predicted proportion of children undergoing secondary surgery within 5 years of primary repair ranged from 8.5% to 46.0% across surgeons and 9.1% to 49.4% across hospitals. Conclusions: There are substantial differences among surgeons and hospitals in the rates of secondary palate surgery. Further work is needed to identify causes for this variation among providers and develop interventions to reduce the need for secondary surgery.

scholarly journals Active Presurgical Infant Orthopedics for Unilateral Cleft Lip and Palate

2018 ◽  
Vol 55 (5) ◽  
pp. 639-648 ◽  
Author(s):  
Michelle Kornbluth ◽  
Richard E. Campbell ◽  
John Daskalogiannakis ◽  
Elizabeth J. Ross ◽  
Patricia H. Glick ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Dental Arch ◽  
Secondary Surgery ◽  
Early Revision ◽  
Nasoalveolar Molding ◽  
Cephalometric Measurements ◽  
Dental Arch Relationship ◽  
Infant Orthopedics

Objective: To compare dental arch relationship, craniofacial form, and nasolabial aesthetic outcomes among cleft centers using distinct methods of presurgical infant orthopedics (PSIO). Design: Retrospective cohort study. Setting: Four cleft centers in North America. Patients: One hundred ninety-one children with repaired complete unilateral cleft lip and palate (CUCLP). Main Outcome Measures: Dental arch relationship was assessed using the GOSLON Yardstick. Craniofacial form was assessed by 12 cephalometric measurements. Nasolabial aesthetics were assessed using the Asher-McDade system. Assessments were performed between 6 and 12 years of age. Results: The center that used no PSIO achieved the most favorable dental arch relationship and maxillomandibular relationship, with a median GOSLON score of 2.3 ( P < .01) and an ANB angle of 5.1° ( P < .05). The proportion of children assigned a GOSLON score of 4 or 5, predictive of the need for orthognathic surgery in adolescence, was 16% at the center that used no PSIO and no secondary surgery, compared to 76% at the centers that used the Latham appliance and early secondary lip and nose surgery ( P < .01). The center that used no PSIO and no secondary surgery achieved significantly less favorable nasolabial aesthetic outcomes than the centers using Latham appliance or nasoalveolar molding (NAM) ( P < .01). Conclusions: Effects of active PSIO are multifaceted and intertwined with use of revision surgery. In our study, centers using either the Latham appliance combined with early revision surgery or the NAM appliance without revision surgery achieved better nasolabial aesthetic outcomes but worse maxillary growth, compared to a center using no PSIO and secondary surgery.

Secondary surgery in cleft lip and palate

2021 ◽  
pp. 767-776
Author(s):  
Peter D. Hodgkinson
Keyword(s):  
Surgical Procedures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Clinical Psychologist ◽  
Facial Growth ◽  
Secondary Surgery ◽  
Primary Surgery ◽  
Facial Surgery ◽  
Maxillary Surgery

Secondary surgery in patients with cleft lip and palate should be undertaken within a cleft multidisciplinary team where such expertise is available. A clinical psychologist can identify issues related (or unrelated) to the cleft and aid in establishing appropriate patient expectations if surgery is contemplated. The requirements of patients considering secondary cleft surgery are more similar to the needs of patients undergoing primary surgery than they are to other non-cleft facial surgery patients. Secondary surgical procedures appropriate to cleft lip and palate patients include revisional lip surgery, adjunctive alveolar or maxillary surgery, orthognathic surgery, revisional nasal surgery, and adjunctive facial procedures. These procedures tend to be performed once facial growth is complete and may need to be coordinated with other interventions, including orthodontics and speech assessment. Surgical procedures should be correctly sequenced and a long-term plan made in conjunction with the patient.

Treating Velopharyngeal Inadequacy Using Bilateral Buccal Flap Revision Palatoplasty

2019 ◽  
Vol 4 (5) ◽  
pp. 878-892
Author(s):  
Joseph A. Napoli ◽  
Linda D. Vallino
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
A Priori ◽  
Sufficient Evidence ◽  
Obstructive Sleep ◽  
Before And After ◽  
Buccal Flap

Purpose The 2 most commonly used operations to treat velopharyngeal inadequacy (VPI) are superiorly based pharyngeal flap and sphincter pharyngoplasty, both of which may result in hyponasal speech and airway obstruction. The purpose of this article is to (a) describe the bilateral buccal flap revision palatoplasty (BBFRP) as an alternative technique to manage VPI while minimizing these risks and (b) conduct a systematic review of the evidence of BBFRP on speech and other clinical outcomes. A report comparing the speech of a child with hypernasality before and after BBFRP is presented. Method A review of databases was conducted for studies of buccal flaps to treat VPI. Using the principles of a systematic review, the articles were read, and data were abstracted for study characteristics that were developed a priori. With respect to the case report, speech and instrumental data from a child with repaired cleft lip and palate and hypernasal speech were collected and analyzed before and after surgery. Results Eight articles were included in the analysis. The results were positive, and the evidence is in favor of BBFRP in improving velopharyngeal function, while minimizing the risk of hyponasal speech and obstructive sleep apnea. Before surgery, the child's speech was characterized by moderate hypernasality, and after surgery, it was judged to be within normal limits. Conclusion Based on clinical experience and results from the systematic review, there is sufficient evidence that the buccal flap is effective in improving resonance and minimizing obstructive sleep apnea. We recommend BBFRP as another approach in selected patients to manage VPI. Supplemental Material https://doi.org/10.23641/asha.9919352

Orthodontic Management Of The Cleft Lip And Palate Patient

1993 ◽  
Vol 20 (4) ◽  
pp. 733-753 ◽  
Author(s):  
Alvaro A. Figueroa ◽  
John W. Polley ◽  
Mimis Cohen
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Palate Patient
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