Comparison of Codeine Phosphate and Morphine Sulphate in Infants Undergoing Cleft Palate Repair

2007 ◽  
Vol 44 (5) ◽  
pp. 528-531 ◽  
Author(s):  
S. Fenlon ◽  
N. Somerville
Keyword(s):  
Cleft Palate ◽  
Analgesic Effect ◽  
Outcome Measure ◽  
Codeine Phosphate ◽  
Double Blind ◽  
Pain Scores ◽  
Significant Difference ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Clinically Significant

Objective: To ascertain the quality of analgesia provided by morphine in comparison to codeine. Design: The study is a prospective, randomized, double-blind trial of analgesic effect employing validated pain scores. Patients: Infants having primary cleft palate repair with informed parental consent to enter the study. Interventions: Infants received one of two analgesics intraoperatively for immediate postoperative pain relief. Morphine was given by intravenous injection and codeine by the intramuscular route. Main Outcome Measure: Pain scores in the immediate postoperative period for 2 hours following surgery; this outcome measure was decided prior to data collection. Results: The pain score and other outcome measures were all blinded. Measurements are all evident from the nature of the results. Conclusions: There was no clinically significant difference observed in the analgesic effect of either drug on the two groups studied.

Is Risk of Secondary Surgery for Oronasal Fistula Following Primary Cleft Palate Repair Associated With Hospital Case Volume and Cost-to-Charge Ratio?

2021 ◽  
Vol 58 (5) ◽  
pp. 603-611
Author(s):  
Giap H. Vu ◽  
Christopher L. Kalmar ◽  
Carrie E. Zimmerman ◽  
Laura S. Humphries ◽  
Jordan W. Swanson ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Outcome Measure ◽  
Charge Ratio ◽  
Fistula Repair ◽  
Case Volume ◽  
Secondary Surgery ◽  
Hospital Case ◽  
Oronasal Fistula ◽  
Cleft Palate Repair ◽  
Palate Repair

Objective: This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics—cost-to-charge ratio (RCC) and case volume of cleft palate repair. Design: Retrospective cohort study. Setting: This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. Patients and Participants: Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. Main Outcome Measure(s): The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. Results: Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; P ≤ .001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], P = .233; AOR = 0.86 [0.62-1.20], P = .386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], P = .005; AOR = 3.14 [1.80-5.58], P < .001). Conclusions: Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula.

Tympanoplasty Results in Patients with Cleft Palate: An Age- and Procedure-Matched Comparison of Preliminary Results with Patients without Cleft Palate

2002 ◽  
Vol 126 (5) ◽  
pp. 518-523 ◽  
Author(s):  
Edward Gardner ◽  
John L. Dornhoffer
Keyword(s):  
Cleft Palate ◽  
Published Data ◽  
Otologic Surgery ◽  
Significant Difference ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Poor Outcomes ◽  
Matched Comparison ◽  
And Control ◽  
Palate Patient

OBJECTIVE: Because of continued eustachian tube abnormalities, the presence of a cleft palate repair has been thought to be associated with poor outcomes after tympanoplastic surgery. However, little published data exist regarding the results of major otologic surgery in patients with cleft palate. The objective of this study was to review our results of otologic surgery in these patients and compare results with those of age- and procedure-matched controls. METHODS: Our otologic database was used to identify patients with a repaired cleft palate who underwent otologic surgery between March 1994 and December 1999. Two control patients were identified for each cleft palate patient. Results of hearing, graft take, and need for postoperative pressure-equalizing tubes were compared. RESULTS: No significant difference existed between patients with a repaired cleft palate and control patients with regard to postoperative air-bone gap ( P = 0.6805), graft survival rate ( P = 1.00), and need for postoperative intubation ( P = 0.457). CONCLUSION: Results in patients with cleft palate appear to be similar to those in patients without cleft palate.

Risk of Malocclusion Among Patients Undergoing Single-Stage Versus Two-Stage Cleft Palate Repair

2022 ◽  
pp. 105566562110449
Author(s):  
Hilary McCrary ◽  
Vanessa Torrecillas ◽  
Sarah Hatch Pollard ◽  
Dave S. Collingridge ◽  
Duane Yamashiro ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Outcome Measure ◽  
Single Stage ◽  
Stage Versus ◽  
Class Iii ◽  
Class Iii Malocclusion ◽  
Two Stage ◽  
Increased Risk ◽  
Cleft Palate Repair ◽  
Palate Repair

Objective Evaluate impact of single-stage versus staged palate repair on the risk of developing malocclusion among patients with cleft palate (CP). Design Retrospective cohort study 2000–2016 Setting Academic, tertiary children’s hospital. Patients Patients undergoing CP repair between 1999–2015. Interventions CP repair, categorized as either single-stage or staged. Main Outcome Measure Time to development of Class III malocclusion. Results 967 patients were included; 60.1% had a two-stage CP repair, and 39.9% had single-stage. Malocclusion was diagnosed in 28.2% of patients. In the model examining all patients at ≤5 years ( n = 659), patients who were not white had a higher risk of malocclusion (HR 2.46, p = 0.004) and staged repair was not protective against malocclusion (HR 0.98, p = 0.91). In all patients >5 years ( n = 411), higher Veau classification and more recent year of birth were significantly associated with higher hazard rates ( p < 0.05). Two-staged repair was not protective against developing malocclusion (HR 0.86, p = 0.60). In the model examining patients with staged repair ≤5 years old ( n = 414), higher age at hard palate closure was associated with reduced malocclusion risk (HR 0.67, p < 0.001) and patients who were not white had increased risk (HR 2.56, p = 0.01). In patients with staged repair >5 years old, more recent birth year may be associated with a higher risk of malocclusion (HR 1.06, p = 0.06) while syndrome may be associated with lower risk of malocclusion diagnosis (HR 0.46, p = 0.07). Conclusion Our data suggests that staged CP repair is not protective against developing Class III malocclusion.

scholarly journals The Use of Postoperative Restraints in Children after Cleft Lip or Cleft Palate Repair: A Preliminary Report

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Jennifer Huth ◽  
J. Dayne Petersen ◽  
James A. Lehman
Keyword(s):  
Postoperative Complications ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Suture Line ◽  
Convenience Sample ◽  
Study Results ◽  
Significant Difference ◽  
Cleft Lip Palate ◽  
Cleft Palate Repair ◽  
Palate Repair

Purpose. This study examines whether the use of elbow restraints after cleft lip/palate repair has a relationship to postoperative complications. Methods. A comparative descriptive design was used to study a convenience sample of children undergoing repair of cleft lip/palate at Akron Children’s Hospital with Institutional Review Board approval. The children were randomized into intervention or control groups with use of elbow restraints considered the intervention. The study consists of two arms; one examined children after cleft lip repair, the second examined children after cleft palate repair. Repairs were performed by a single surgeon. Data collected included age, comorbidities, patient discomfort measured by pain score, frequency and duration of pain medications, use of pacifier or finger/thumb sucking, and postoperative complications including disruption of the suture line. Results. With 47 post palate repair patients and 47 post cleft repair patients, there is no significant difference () in the occurrence of postoperative complications. Conclusions. Study results provide prospective evidence to support postoperative observation of children by surgery staff and family following cleft lip or cleft palate repair without the use of elbow restraints. Clinicians should reevaluate the use of elbow restraints after cleft lip/palate repair based on the belief restraints prevent postoperative complications.

scholarly journals Bilateral Suprazygomatic Maxillary Nerve Block for Cleft Palate Repair in Children

2014 ◽  
Vol 120 (6) ◽  
pp. 1362-1369 ◽  
Author(s):  
Julien Chiono ◽  
Olivier Raux ◽  
Sophie Bringuier ◽  
Chrystelle Sola ◽  
Michèle Bigorre ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Nerve Block ◽  
Isotonic Saline ◽  
Saline Group ◽  
Morphine Consumption ◽  
Maxillary Nerve ◽  
Pain Scores ◽  
Cleft Palate Repair ◽  
Maxillary Nerve Block ◽  
Palate Repair

Abstract Background: The authors investigated the efficacy of bilateral suprazygomatic maxillary nerve block (SMB) for postoperative pain relief in infants undergoing cleft palate repair. Methods: In this prospective, double-blind, single-site, randomized, and parallel-arm controlled trial, 60 children were assigned to undergo bilateral SMB with general anesthesia with either 0.15 ml/kg of 0.2% ropivacaine (Ropi group) or 0.15 ml/kg of isotonic saline (Saline group) on each side. The primary endpoint was total postoperative morphine consumption at 48 h. Pain scores and respiratory- and SMB-related complications were noted. Results: The overall dose of intravenous morphine after 48 h (mean [95% CI]) was lower in the Ropi group compared with that in the Saline group (104.3 [68.9 to 139.6] vs. 205.2 [130.7 to 279.7] μg/kg; P = 0.033). Continuous morphine infusion was less frequent in the Ropi group compared with that in the Saline group (1 patient [3.6%] vs. 9 patients [31%]; P = 0.006). Three patients in the Saline group had an episode of oxygen desaturation requiring oxygen therapy. There were no technical failures or immediate complications of the SMB. Intraoperative hemodynamic parameters, doses of sufentanil, pain scores, and postoperative hydroxyzine requirements were not different between the two groups. Conclusion: Bilateral SMB is an easy regional anesthesia technique that reduces total morphine consumption at 48 h after cleft palate repair in children and the use of continuous infusion of morphine and may decrease postoperative respiratory complications.

Oronasal Fistula Incidence Associated With Vomer Flap Repair of Cleft Palate: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 105566562097456
Author(s):  
Katherine Vandenberg ◽  
Michael Castle ◽  
Fares Qeadan ◽  
Tania Kraai
Keyword(s):  
Systematic Review ◽  
Cleft Palate ◽  
Meta Analysis ◽  
Random Effect ◽  
Oronasal Fistula ◽  
Significant Difference ◽  
Cleft Palate Repair ◽  
Syndromic Diagnosis ◽  
Palate Repair ◽  
Vomer Flap

Objectives: To determine the incidence of oronasal fistulas (ONF) associated with primary repair of the anterior palate using a single-layered, superiorly based, vomer mucoperiosteal flap. Design: A systematic review of MEDLINE, PubMed, Cochrane, and Web of Science databases using the keywords: “vomer flap” and “cleft palate repair” were carried out. A meta-analysis was performed using random effect modeling with stratified analysis by syndromic diagnosis, number of surgeons, and mean age. Main Outcome Measure(s): Incidence of ONFs. Results: The meta-analysis included 9 studies with a total of 464 children who met inclusion criteria. The overall ONF rate was 3.0% (95% CI: 1.0-9.0). Fistula rates were not significantly different in studies that included syndromic patients compared to studies that did not, 5.0% (95% CI: 1.0-24.0) versus 3.0% (95% CI: 1.0-6.0), respectively. There was no significant difference between studies in which there was a single surgeon versus multiple surgeons, 3.0% (95% CI: 1.0-13.0) versus 4.0% (95% CI: 1.0-8.0), respectively. Age at the time of cleft repair showed no statistically significant difference in fistula rate when comparing children with a mean age less than 12 months to those greater than 12 months, 3.0% (95% CI: 1.0-5.0) versus 5.0% (95% CI: 1.0-28.0), respectively. Conclusions: The vomer flap technique in cleft palate repair appears to be associated with a low ONF rate unaffected by syndromic diagnosis, number of surgeons, or patient age at time of repair.

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