A Multicenter Outcomes Assessment of Five-Year-Old Patients with Unilateral Cleft Lip and Palate

2006 ◽  
Vol 43 (3) ◽  
pp. 253-258 ◽  
Author(s):  
Wanda Flinn ◽  
Ross E. Long ◽  
Giovanna Garattini ◽  
Gunvor Semb
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Primary Repair ◽  
Dental Arch ◽  
University Hospitals ◽  
Free Standing ◽  
Chi Square ◽  
Old Patients ◽  
Palate Repair ◽  
Presurgical Orthopedics

Objective Compare 5-year-old dental arch relationships of patients from three centers with differing primary protocols. Design Retrospective study of treatment outcomes using blinded evaluation of dental study casts. Setting Three major cleft-craniofacial centers; one (center A) is a free-standing institution, and two (centers B and C) are university hospitals. Patients 118 (A = 41; B = 33; C = 44) consecutively treated 5-year-old patients with complete, nonsyndromic unilateral cleft lip and palate. Interventions Centers A and C completed primary repair without presurgical orthopedics by 18 months (center A in three surgeries and center C in two surgeries). Center B used passive presurgical orthopedics with lip/soft palate repair at 6 months and gingivo-alveoloplasty/hard palate repair at 18 to 36 months. Main Outcome Measure Averaged ratings of dental casts using the 5-year yardstick were computed for each patient. The Wilcoxon two-sample test was used to compare means; a chi-square test was used to compare distributions. Results Intra- and interexaminer reliability tests showed excellent reliability (>.90). Mean scores were not significantly different. Distribution of scores differed significantly. Center A had the highest percentage of good scores and the lowest percentage of poor scores (72% versus 6.5%), followed by center B (63% versus 6.6%) and center C (59% versus 16.3%). Conclusions Centers A and B had comparable scores and completely different protocols in surgical technique, timing, sequencing, and nonuse/use of appliances. Center C's results were slightly lower than those of 1 and 3, but the center had the protocol with the least burden of treatment (only two surgeries, without use of appliances).

A Comparison of Craniofacial Form in Northern Irish Children with Unilateral Cleft Lip and Palate Treated with Different Primary Surgical Techniques

2004 ◽  
Vol 41 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Chris D. Johnston ◽  
Alan G. Leonard ◽  
Donald J. Burden ◽  
Patrick F. McSherry
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Primary Repair ◽  
Statistical Significance ◽  
Surgical Techniques ◽  
Dental Arch ◽  
Soft Tissue Profile ◽  
Palate Repair ◽  
The Difference

Objective The quality of outcomes in patients with unilateral cleft lip and palate (UCLP) was compared between two senior plastic surgeons. One surgeon carried out a one-stage Wardill-Kilner palate repair. The other surgeon employed a vomer flap hard palate repair followed by a von Langenbeck soft palate closure (Oslo protocol). Design Retrospective analysis. Patients Thirty-four children (mean age 9.7 years) born with complete skeletal UCLP in Northern Ireland from 1983 to 1991 who received primary repair surgery from one of the two surgeons. Main Outcome Measures Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system. Results Twenty-nine of the 34 subjects had good or satisfactory arch relationships. Comparison between the surgeons revealed that the Wardill-Kilner group had a greater proportion of Goslon grades of greater than 3, indicating poor arch relationships. However, this difference failed to reach statistical significance. There were no significant cephalometric differences between patients treated by the two surgeons. Conclusions Although the difference was not statistically significant, the highest proportion of patients likely to require orthognathic surgery was found in those treated using the Wardill-Kilner technique.

Orthodontic characteristics of maxillary arch deficiency in 5-year-old patients undergoing unilateral cleft lip and palate repair with and without early gingivoplasty

2010 ◽  
Vol 38 (3) ◽  
pp. 155-159 ◽  
Author(s):  
Anna Wojtaszek-Slominska ◽  
Alicja Renkielska ◽  
Marek Dobke ◽  
Amanda Gosman ◽  
Wojciech Slominski
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Old Patients ◽  
Palate Repair ◽  
Maxillary Arch

Dental Arch Relationships following Palatoplasty for Cleft Lip and Palate Repair

2011 ◽  
Vol 91 (1) ◽  
pp. 47-51 ◽  
Author(s):  
P. Fudalej ◽  
C. Katsaros ◽  
Z. Dudkiewicz ◽  
B. Offert ◽  
W. Piwowar ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Dental Arch ◽  
Palate Repair

Treatment Outcome of Bangladeshi UCLP Patients Based on Both Phenotype and Postnatal Treatment Factors using Modified Huddart Bodenham (mHB) Index

2018 ◽  
Vol 55 (7) ◽  
pp. 966-973 ◽  
Author(s):  
Sanjida Haque ◽  
Mohammad Khursheed Alam ◽  
Mohd Fadhli Khamis
Keyword(s):  
Regression Analysis ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Dental Arch ◽  
Kappa Statistics ◽  
Class Iii ◽  
Chi Square ◽  
Positive History ◽  
Postnatal Treatment ◽  
History Of

Objective: To evaluate the dental arch relationship (DAR) of nonsyndromic unilateral cleft lip and palate (UCLP) and to explore the various phenotype and postnatal treatment factors that are responsible for poor DAR. Design: Retrospective study. Setting: School of Dental Science, Universiti Sains Malaysia. Subjects: Eighty-four Bangladeshi children with nonsyndromic UCLP who received cheiloplasty and palatoplasty. Main Outcome Measures: Dental models were taken at 5 to 12 years of age (man: 7.69), and dental arch relationships were assessed using modified Huddart/Bodenham index (mHB) by two raters. Kappa statistics was used to evaluate the intra- and interexaminer agreements, chi-square was used to assess the associations, and logistic regression analysis was used to explore the responsible factors that affect DAR. Results: The total mHB score (mean [SD]) was −8.261 (7.115). Intra- and interagreement was very good. Using crude and stepwise backward regression analysis, significant association was found between positive history of class III (P = .025, P = .030, respectively) and unfavorable DAR. Complete UCLP (P = .003) was also significantly correlated with unfavorable DAR. Conclusion: This multivariate study suggested complete type of UCLP and positive history of class III had a significantly unfavorable effect on the DAR.

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 A status report on management of cleft lip and palate in India

2010 ◽  
Vol 43 (01) ◽  
pp. 066-075 ◽  
Author(s):  
A. Gopalakrishna ◽  
Karoon Agrawal
Keyword(s):  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Interdisciplinary Approach ◽  
Personal Communication ◽  
Status Report ◽  
Microsoft Excel ◽  
Palate Repair ◽  
Video Fluoroscopy ◽  
Presurgical Orthopedics

ABSTRACT Introduction: This national survey on the management of cleft lip and palate (CLP) in India is the first of its kind. Objective: To collect basic data on the management of patients with CLP in India for further evaluation. Materials and Methods: A proforma was designed and sent to all the surgeons treating CLP in India. It was publicized through internet, emails, post and through personal communication. Subjects: 293 cleft surgeons representing 112 centers responded to the questionnaire. Most of the forms were filled up by personal interview. Results: The cleft workload of the participating centers is between 10 and 2000 surgeries annually. These centers collectively perform 32,500–34,700 primary and secondary cleft surgeries every year. The responses were analyzed using Microsoft excel and 112 as the sample size. Most surgeons are repairing cleft lip between 3-6 months and cleft palate between 6 months to 1 year. Millard and Tennison repairs form the mainstay of lip repair. Multiple techniques are used for palate repair. Presurgical orthopedics, lip adhesion, nasendoscopy, speech therapy, video-fluoroscopy and orthognathic surgery were not always available and in some cases not availed of even when available. Conclusion: Management of CLP differs in India. Primary surgical practices are almost similar to other studies. There is a lack of interdisciplinary approach in majority of the centers, and hence, there is a need for better interaction amongst the specialists. A more comprehensive study with an improved questionnaire would be desirable.

Palate Height: Another Indicator of Surgical Outcome in Unilateral Cleft Lip and Palate?

2002 ◽  
Vol 39 (3) ◽  
pp. 308-311 ◽  
Author(s):  
Om P. Kharbanda ◽  
William C. Shaw ◽  
Helen Worthington
Keyword(s):  
Outcome Measures ◽  
Surgical Outcome ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Primary Repair ◽  
Surgical Care ◽  
Dental Arch ◽  
Anterior Arch ◽  
Retrospective Comparison ◽  
Maxillary Arch

Objective: To determine whether palate height and maxillary arch depth are systematically related to the surgical center at which primary repair in unilateral cleft lip and palate (UCLP) was carried out. Design: A retrospective comparison based on study casts of consecutive cases of UCLP obtained at age 9 years from six different centers. The observer who conducted measurements was blinded to the source of individual records. Setting: The patients whose records were analyzed received all their surgical care in a national health service setting in six different northern European centers and regions. Patients: Patients were consecutively treated Caucasian children with non-syndromic complete UCLP born in the period 1976 to 1979. Main Outcome Measures: The main outcome measures for the original study were craniofacial form, dental arch relationships, nasolabial appearance, and speech. This report focuses on measurements of anterior maxillary arch depth and palate height. Results: Anterior arch depth and anterior palate height showed some variation among the centers. There was a tendency for anterior arch depth and palate height to also be reduced at centers at which patients showed unfavorable dental arch relationships. Conclusions: Anterior arch depth and palate height might be considered in future studies of surgical outcome and in their possible relationship to problems of articulation.

Results of Randomized Controlled Trial of Soft Palate First versus Hard Palate First Repair in Unilateral Complete Cleft Lip and Palate

2006 ◽  
Vol 43 (3) ◽  
pp. 329-338 ◽  
Author(s):  
Bruce Richard ◽  
Joyce Russell ◽  
Siobhan McMahon ◽  
Ron Pigott
Keyword(s):  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Primary Repair ◽  
Controlled Trial ◽  
Facial Growth ◽  
Cleft Closure ◽  
Palate Repair ◽  
Intercanine Distance

Objective To compare the outcomes for primary repair of unilateral cleft lip and palate, operating on the soft palate first versus the hard palate first. Design Randomized controlled trial. Setting The Regional Cleft Service of West Nepal. Patients Forty-seven consecutive patients with nonsyndromic unilateral cleft lip and palate, of whom 37 were assessed 4 to 6 years after completing primary surgical repair. Interventions Primary repair of unilateral cleft lip and palate by two differing sequences: (1) soft palate repair, with hard palate and lip repair 3 months later; and (2) lip and hard palate repair, followed by the soft palate repair 3 months later. Main Outcome Measures Analysis of dental study models, weight gain, and speech recordings. Results Four to 7 years after completing the cleft closure, there was no significant difference in facial growth between the two types of repair sequencing. Completing posterior repair first had no effect on anterior alveolar gap width. It narrowed the hard palate gap by reducing the intercanine distance. Anterior repair dramatically closed the anterior alveolar gap, and narrowed the intercanine distance. Comparing anterior alveolar gap width with age at first presentation demonstrated that there was no spontaneous narrowing of the cleft in older children. Completing posterior closure first had a weight gain advantage over anterior closure first. Improved oropharyngeal closure, and thus swallowing, is the likely explanation. Conclusion Changing the sequencing of cleft closure has no demonstrable difference in facial growth at 4 to 7 years after completion of the primary surgery.

scholarly journals Atypical Outcomes of Nasal and Lip Appearance After Unilateral Cleft Lip Repair: Judgment by Professionals, Patients, and Laypeople

2021 ◽  
pp. 105566562098280
Author(s):  
Robin A. Tan ◽  
Frans J. Mulder ◽  
Roderic M. F. Schwirtz ◽  
David G. M. Mosmuller ◽  
Henrica C. W. De Vet ◽  
...  
Keyword(s):  
Analysis Of Variance ◽  
Online Survey ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Old Patients ◽  
Rank Score ◽  
Cleft Lip Repair ◽  
Typical Appearance ◽  
Unilateral Cleft Lip Repair ◽  
Insight Into

Objective: To gain more insight into the assessment of “atypical” nasal and lip appearance outcomes compared to “typical” appearance outcomes after unilateral cleft lip and palate (UCLP) repair, when judged by professionals, patients with repaired UCLP, and laypeople. Design: An online survey containing 3 series of photographs with various degrees of “typical” and “atypical” nasal and lip appearance outcomes after UCLP repair was sent to 30 professionals, 30 patients with repaired UCLP, and 50 laypeople in 2 countries. Participants were instructed to rank the photographs from excellent to poor based on overall appearance. Mean rank positions of photographs were analyzed and differences in mean rank score between “typical” and “atypical” results were assessed using a T-test. Agreement of ranking between the 3 groups was assessed with an analysis of variance analysis. Setting: Amsterdam UMC, location VUmc, Netherlands and Boston Children’s Hospital, Boston, USA. Patients: Photographs of 6- to 18-year-old patients with repaired UCLP. Results: “Atypical” appearance outcomes were ranked significantly less favorably (small nostril: P = 0.00; low vermillion border: P = 0.02; whistling deformity: P = 0.00) compared to “typical” outcomes. Difference between professionals, patients and laypeople in rank positioning the photographs was not statistically significant ( P = 0.89). Conclusions: Noses with a smaller nostril and lips containing a whistling deformity were perceived as poorer outcome compared to the “typical” results. Professionals, patients, and laypeople are in agreement when assessing these outcomes.

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