MANAGEMENT OF THE PATIENT WITH CLEFT LIP AND CLEFT PALATE

PEDIATRICS ◽  
1957 ◽  
Vol 20 (4) ◽  
pp. 573-583
Author(s):  
Donald W. MacCollum ◽  
Sylvia Onesti Richardson
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Medical Center ◽  
The Other ◽  
Clinical Impression ◽  
General Description ◽  
Basic Principles ◽  
Total Care ◽  
Speech Therapist ◽  
Strategic Position

Although some aspects of the management of a child with a cleft lip or cleft palate or both are controversial, it is generally agreed that the best possible care of these youngsters involves the co-operation of a multi-professional group including at least a surgeon, dentist, speech therapist, pediatrician, orthodontist, and the parents as well. It is not necessary for the group to be centralized in location, although this is helpful to the patient. However, each member of a group must be aware of the potentialities and procedures of the other members and should have a knowledge of the terminology and basic principles of the other disciplines represented. As his duties of total care are ever present and continuous, the pediatrician is in a strategic position to help the parents to understand and to implement the consecutive phases of therapy in the home. The rationale and a general description of one type of cleft lip—cleft palate program as it is carried out at the Children's Medical Center in Boston is presented. During the last 15 years, 2,635 operations for closure of the lip and palate have been performed in the Plastic Surgery Unit. The authors' policy is to repair a cleft lip at 6 to 8 weeks of age and to repair the palate within the first 2 years of life, preferably at about 14 months of age. Included is a summary of a study made at this Center to evaluate the long-range results of early palatal closure and over-all care of a group of 164 children operated upon between the years of 1942 and 1952. The conclusions of this study corroborate the authors' previous clinical impression that the results of early palatal closure have been so satisfactory that continuation of the policy seems warranted. Supportive care is described in some detail because of the authors' wish to emphasize its importance and to provide for the pediatrician a practical guide which long experience has proven to be successful.

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.

Infant Orthopedics Has No Effect on Maxillary Arch Dimensions in the Deciduous Dentition of Children with Complete Unilateral Cleft Lip and Palate (Dutchcleft)

2006 ◽  
Vol 43 (6) ◽  
pp. 665-672 ◽  
Author(s):  
Catharina A. M. Bongaarts ◽  
Martin A. van't Hof ◽  
Birte Prahl-Andersen ◽  
Iris V. Dirks ◽  
Anne M. Kuijpers-Jagtman
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Vertical Position ◽  
Controlled Clinical Trial ◽  
Deciduous Dentition ◽  
Surgical Closure ◽  
Infant Orthopedics ◽  
Maxillary Arch

Objective: Evaluation of the effect of infant orthopedics on maxillary arch dimensions in the deciduous dentition in patients with unilateral cleft lip and palate. Design: Prospective two-arm randomized controlled clinical trial with three participating cleft palate centers. Setting: Cleft palate centers of the Radboud University Nijmegen Medical Center, Academic Center of Dentistry Amsterdam, and University Medical Center Rotterdam, the Netherlands. Patients: Children with complete unilateral cleft lip and palate (n = 54) were included. Interventions: Patients were randomly divided into two groups. Half of the patients (IO+) had a presurgical orthopedic plate until surgical closure of the soft palate at the age of 52 weeks; the other half (IO−) did not undergo presurgical orthopedics. Mean outcome measures: Maxillary arch dimensions were assessed on dental casts at 4 and 6 years of age with measurements for arch width, arch depth, arch length, arch form, and the vertical position of the lesser segment. Contact and collapse were assessed also. Results: There were no clinically significant differences found between IO+ and IO− for any of the variables. Conclusions: Infant orthopedics had no observable effect on the maxillary arch dimensions or on the contact and collapse scores in the deciduous dentition at the ages of 4 and 6 years. Considering the Dutchcleft results to date, there is no need to perform infant orthopedics for unilateral cleft lip and palate patients.

Reorganization of Craniofacial/Cleft Care Delivery: The Massachusetts Experience

1993 ◽  
Vol 30 (3) ◽  
pp. 333-336
Author(s):  
Gregory L. Borah ◽  
Nancy Hagberg ◽  
Carolyn Jakubiak ◽  
Jean Temple
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Care Delivery ◽  
Medical Center ◽  
Radical Change ◽  
The State ◽  
Direct Care ◽  
Block Grant ◽  
Coordinated Care ◽  
Team Members

Until 1989, the Commonwealth of Massachusetts operated a mandated care program known as Services for Handicapped Children (SHC) for children with cleft lip/palate or craniofacial anomalies. During the mid 1980s, the federal government reduced its block grant funds and encouraged the Commonwealth of Massachusetts to develop Project SERVE to address this changing fiscal reality. The principal outcome of Project SERVE was the recommendation that the SHC direct care programs, Including all craniofacial and cleft palate clinics, should be dismantled over a number of years. However, due to the economic recession, all government funding was suddenly withdrawn from cleft palate teams and the state-run SHC clinics were abruptly dissolved. To treat patients left without coordinated care, former team members reassembled and began a new craniofacial team based at the University of Massachusetts Medical Center. Difficulties with the transition of the clinic included recruiting and retaining team members; remuneration procedures for team members; maintenance of patient records previously kept by the state; coordination of clinical/clerical responsibilities; identifying a physical locale to hold the clinics; and solicitation of referring health care provider referrals and follow-up. All these issues required specific interventions that are presented in this paper. Project SERVE, begun under federal auspices, In the Commonwealth of Massachusetts, has recently been promoted as a model for a new and improved approach to the management of cleft palate and craniofacial care delivery nationwide. Awareness of the potential for abrupt, radical change in funding for federally mandated cleft/craniofacial care is essential, and a successful transition to a medical center-based model is possible using the procedures established at our center.

The Prevalence of Apraxia Characteristics in Patients with Velocardiofacial Syndrome as Compared with Other Cleft Populations

2007 ◽  
Vol 44 (2) ◽  
pp. 175-181 ◽  
Author(s):  
Ann W. Kummer ◽  
Linda Lee ◽  
Lindsay Schaadt Stutz ◽  
Adam Maroney ◽  
Jennifer Weidenbach Brandt
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Velocardiofacial Syndrome ◽  
High Prevalence ◽  
History Of ◽  
Oral Motor Function ◽  
A Prospective Study ◽  
Abnormal Brain

Objective: The purpose of this study was to assess the oral-motor function of children with a history of cleft lip and palate, cleft palate only, velocardiofacial syndrome, and children with normal oral structures to determine if children with velocardiofacial syndrome have more apraxia characteristics than the other populations have. Design: The Apraxia Profile (Hickman, 1997) was administered to all participants in a prospective study. Setting: The investigation was conducted at Cincinnati Children's Hospital Medical Center. Participants: In this study, 10 children with cleft lip and palate, 10 with cleft palate only, 7 with velocardiofacial syndrome, and 47 with normal structures were tested. Results: This study revealed that when compared with children with normal structures, children with cleft lip and palate did not demonstrate significant apraxia characteristics, children with cleft palate only demonstrated some apraxia characteristics, and children with velocardiofacial syndrome demonstrated the most apraxia characteristics. Conclusions: There appears to be a high prevalence of apraxia characteristics in the speech of patients with velocardiofacial syndrome. This information has implications for the type of treatment recommended. Further investigation is warranted with a larger patient population and a focus on the association of abnormal brain structure with apraxia in this population.

scholarly journals On randomised trials of surgical timings for cleft palate repair

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Selena Young ◽  
Seng Teik Lee ◽  
David Machin ◽  
Say Beng Tan ◽  
Qingshu Lu
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Meta Analysis ◽  
The Other ◽  
International Strategy ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Different Ages ◽  
Palatal Surgery

Background: In this article we review randomised controlled trials (RCTs) comparing palatal surgery at different ages to examine their design features and quantify their conclusions. Method: A literature search of RCTs comparing surgical timings for cleft palate and/or lip repair from 1 January 2004 to 31 December 2013 was undertaken. This supplements an earlier systematic review of 62 RCTs in cleft lip and palate from 1 January 2004 to 31 December 2013 in English using the Cochrane Central Register of Controlled Trials, MEDLINE® and EMBASE with key words ‘cleft lip’ or ‘cleft palate’. Results: Four RCTs were identified, each comparing palate surgery at different lower (six, nine and 12 months) and upper (12, 18 and 36 months) ages with velopharyngeal competence (VPC) also at different ages (three, four, more than four or five years). These surgical and assessment age differences prevent a synthesis using meta-analysis techniques. Nevertheless, three RCTs indicate that VP function is more impaired with later surgery. Two ask questions about the type of surgery; one suggests that VPC is greater with Furlow palatoplasty than von Langenbeck surgery and the other that one technique appears to have better VPC at six months and the other at 12 months. Conclusion: The role of the timing of palatal surgery with respect to VPC remains unclear. We propose an international strategy that is designed to establish the optimal age for palatal surgery in infants requiring palate and/or lip repair.

scholarly journals Blepharophimosis, ptosis, epicanthus inversus syndrome (BPES) and cleft lip and palate. Report of two Brazilian families

1998 ◽  
Vol 21 (2) ◽  
pp. 259-262 ◽  
Author(s):  
N.M. Kokitsu-Nakata ◽  
A. Richieri-Costa
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Family Members ◽  
Clinical Signs ◽  
The Other

We have evaluated a girl and a boy with the blepharophimosis, ptosis and epicanthus inversus syndrome (BPES). The girl presented cleft palate and the boy showed cleft lip and palate as additional clinical signs. Both showed familial recurrence in fourth and third generations, respectively. The other family members also presented blepharophimosis, ptosis, and epicanthus inversus, but without lip and palatal involvement. There were no additional clinical signs nor infertility in these patients. To our knowledge this is the first instance of cleft lip and palate reported as additional signs of the BPES syndrome.

scholarly journals Feeding Appliance for an Infant with Cleft Palate: A Case Report

2021 ◽  
Vol 6 (4) ◽  
pp. 71-75
Author(s):  
Hilal Ahmad Hela ◽  
Shazana Nazir ◽  
Mehvash Qazi
Keyword(s):  
Case Report ◽  
Environmental Factors ◽  
Cleft Palate ◽  
Cleft Lip ◽  
The Other ◽  
Nutritional Deficiencies ◽  
Chromosomal Disorders ◽  
The Face ◽  
Feeding Plate ◽  
Proper Weight

The cleft palate is a ‘‘congenital defect of the middle third of the face that occurs when an oro-nasal communication is present between the palate and the base of the nose. Single genes, chromosomal disorders or environmental factors may cause clefts. The other possible causes are hormonal imbalances, nutritional deficiencies, infections, radiation during pregnancy, alcohol or cigarette consumption, the ingestion of other teratogenic substances by the mother, and heredity. Immediate problems to be addressed in a new born with this defect would be to aid in suckling and swallowing other problems associated later would be difficulty in speech, altered appearance, many dental problems and psychological problems. Feeding plate (obturator) rehabilitates the oro-nasal gap and helps in feeding and in reduction of airway problems, frequent infections and regurgitations. This paper presents a case report of an infant with cleft palate (Veau II) in whom a feeding plate was delivered, with a simple impression method, which helped the infant feed and restores the proper weight required for cleft palate reconstructive surgery in future. Keywords: Cleft Lip, Cleft Palate, Infant, Obturator

Infant-Driven Feeding Systems: Do They “Normalize” the Feeding Experience of Infants With Cleft Palate?

2021 ◽  
pp. 105566562098435
Author(s):  
Lauren L. Madhoun ◽  
Meghan O’Brien ◽  
Adriane L. Baylis
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bottle Feeding ◽  
Control Group ◽  
Cross Sectional ◽  
Level 1 ◽  
Level 2 ◽  
Feeding Systems

Objective: To examine feeding skills of infants with cleft palate with or without cleft lip (CP±L) using infant-driven feeding systems compared to healthy controls on standard bottles. Design: Cross-sectional cohort. Setting: Large pediatric academic medical center in the Midwestern United States. Participants: Infants with CP±L (n = 15) using the Dr. Brown’s Specialty Feeding System and typically developing infants without CP±L (n = 15) using the Dr. Brown’s Natural Flow Original or Options bottles. Main Outcome Measure(s): Bottle-feeding proficiency, duration, milk transfer, and signs of feeding difficulty. Results: Five-minute feeding proficiency differed significantly between groups with the control group taking 45% of the feed compared to 16% for the CP±L group on level 1 ( P < .001) and 30% on level 2 ( P < .001) nipples. Proportion of milk transfer was 96% ± 7% for controls and 75% ± 24% for the CP±L group ( P = .013). Feeding duration (minutes) differed between the control group (13 ± 3) and the CP±L groups on each nipple level (level 1: 29 ± 16; P = .003; level 2: 32 ± 11; P = .001). Milk transfer rate (mL/min) was 9 ± 3 for control infants compared to 3 ± 1 for infants with CP±L on level 1 ( P < .001) and 5 ± 1 on level 2 ( P = .007). Coughing occurred in 40% of infants with CP±L and 27% of controls. Conclusions: Even when using specialty bottles, infants with CP±L differ from noncleft infants in feeding proficiency, duration, and overall intake.

Association Between SNPs in 1q32.2 and NSCL ± P in Han Chinese Population

2021 ◽  
pp. 105566562110528
Author(s):  
Bin Yin ◽  
Jia-Yu Shi ◽  
Bing Shi ◽  
Qian Zheng ◽  
Zhong-Lin Jia
Keyword(s):  
Cleft Palate ◽  
Genetic Variants ◽  
Chinese Population ◽  
Cleft Lip ◽  
Medical Center ◽  
R Package ◽  
Han Chinese ◽  
Han Chinese Population ◽  
New Evidence ◽  
Gwa Studies

Objectives Non-syndromic cleft lip with or without cleft palate (NSCL ±  P) is one of the most common birth malformations. Currently, numerous susceptibility SNPs have been reported by GWA studies, however, the replications of them among NSCL ±  P from Han Chinese were very limited. Design In this study, we selected 16 SNPs around 1q32.2 based on the published GWA studies and replicated them among 302 trios with NSCL ±  P from Han Chinese Population. The genotypic data was analyzed with FBAT, PLINK and R package. Setting The study was conducted in a tertiary medical center. Patients, participants 302 patients with CL ±  P and their parents. Main outcome measures To ascertain the genetic variants in 1q32.2 in patients with CL ±  P in Han Chinese Population. Interventions Blood samples were collected. Results We found T allele ( Z = 4.26, p = 0.00002) and T/T homozygotes ( Z = 4.4, p = 0.000011) at rs12063989 was significantly over-transmitted among non-syndromic cleft lip with or without cleft palate (NSCL ±  P). Conclusions We found rs12063989 exhibited significant association with the occurrence of NSCL ±  P, which would provide new evidence for the future study in the etiology of NSCL ±  P.

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