One stage versus two stage cleft palate repair : implications for maxillary growth

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.

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Is a one stage or two stage cleft palate repair more beneficial in children with complete one sided cleft palate defects with respect to speech development and palatal fistula formation?

http://isrctn.com/ ◽

10.1186/isrctn17288141 ◽

2017 ◽

Author(s):

Rajgopal Reddy

Keyword(s):

Cleft Palate ◽

Speech Development ◽

Fistula Formation ◽

Two Stage ◽

Palatal Fistula ◽

One Stage ◽

Cleft Palate Repair ◽

Palate Repair

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Considerations Regarding Age at Surgery and Fistula Incidence Using One- and Two-stage Closure for Cleft Palate

Acta Medica Marisiensis ◽

10.2478/amma-2013-0069 ◽

2013 ◽

Vol 59 (6) ◽

pp. 302-305 ◽

Cited By ~ 1

Author(s):

Stoicescu Simona ◽

Enescu Dm

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Surgical Techniques ◽

Fistula Formation ◽

Two Stage ◽

One Stage ◽

Age At Surgery ◽

Cleft Palate Repair ◽

Palate Repair

Abstract Introduction: Although cleft lip and palate (CLP) is one of the most common congenital malformations, occurring in 1 in 700 live births, there is still no generally accepted treatment protocol. Numerous surgical techniques have been described for cleft palate repair; these techniques can be divided into one-stage (one operation) cleft palate repair and two-stage cleft palate closure. The aim of this study is to present our cleft palate team experience in using the two-stage cleft palate closure and the clinical outcomes in terms of oronasal fistula rate. Material and methods: A retrospective analysis was performed on medical records of 80 patients who underwent palate repair over a five-year period, from 2008 to 2012. All cleft palate patients were incorporated. Information on patient’s gender, cleft type, age at repair, one- or two-stage cleft palate repair were collected and analyzed. Results: Fifty-three (66%) and twenty-seven (34%) patients underwent two-stage and one-stage repair, respectively. According to Veau classification, more than 60% of them were Veau III and IV, associating cleft lip to cleft palate. Fistula occurred in 34% of the two-stage repairs versus 7% of one-stage repairs, with an overall incidence of 24%. Conclusions: Our study has shown that a two-stage cleft palate closure has a higher rate of fistula formation when compared with the one-stage repair. Two-stage repair is the protocol of choice in wide complete cleft lip and palate cases, while one-stage procedure is a good option for cleft palate alone, or some specific cleft lip and palate cases (narrow cleft palate, older age at surgery)

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Maxillary Growth following Atelocollagen Implantation on Mucoperiosteal Denudation of the Palatal Process in Young Rabbits: Implications for Clinical Cleft Palate Repair

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1997_034_0297_mgfaio_2.3.co_2 ◽

1997 ◽

Vol 34 (4) ◽

pp. 297-308 ◽

Cited By ~ 6

Author(s):

Masaki Fujioka ◽

Tohru Fujii

Keyword(s):

Cleft Palate ◽

Mononuclear Cells ◽

Scar Tissue ◽

Normal Mucosa ◽

Dental Arch ◽

Mineral Contents ◽

Control Side ◽

Cleft Palate Repair ◽

Palate Repair ◽

Maxillary Growth

Objective: The implantation of atelocollagen matrix on the denuded surface of palatal bone following cleft palate repair has been used because it enhances wound healing. This study was performed to determine whether the beneficial effect of atelocollagen matrix implantation on the prevention of scar tissue contraction also inhibits the scar's interference with the growth of maxillary bone. Method: Fifty New Zealand White rabbits (aged 4 weeks) underwent palatal mucoperiosteal denudation, and atelocollagen matrix was implanted on the left palatal process. The opposite side was left open as a control. Results: Histopathologically, the implantation side exhibited early infiltration of mononuclear cells and fibroblasts, and better growth of connective tissue strands and epithelium. in addition, the formation of rete ridges were seen that were similar to the normal mucosa. The bone of the atelocollagen-implanted side was covered with regenerated periosteum-like layers, but that of the control side was lined by granulation tissue, suggesting the existence of continuous inflammation on the periosteal region. When the animals reached adulthood (aged 24 weeks), the areas of scars and palatal processes, palatal shelf width, molar teeth incline, and bone mineral contents were measured and compared between sides. The atelocollagen-applied scars showed less contraction, the area and width of atelocollagen-implanted palatal processes showed more satisfactory growth, and the dental arch deformity was suppressed in comparison with the control side. Conclusions: Our results suggest that the use of atelocollagen matrix on the denuded bone surface following cleft palate repair decreases the scar's effect on maxillary growth.

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Effect of Relaxing Incisions on the Maxillary Growth after Primary Unilateral Cleft Palate Repair in Mild and Moderate Cases

Plastic & Reconstructive Surgery Global Open ◽

10.1097/gox.0000000000001201 ◽

2017 ◽

Vol 5 (1) ◽

pp. e1201 ◽

Cited By ~ 5

Author(s):

Percy Rossell-Perry ◽

Omar Cotrina-Rabanal ◽

Olga Figallo-Hudtwalcker ◽

Alicia Gonzalez-Vereau

Keyword(s):

Cleft Palate ◽

Cleft Palate Repair ◽

Palate Repair ◽

Maxillary Growth ◽

Relaxing Incisions

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Cleft palate repair by Furlow double opposing Z-plasty. II. Speech results and effects on maxillary growth.

Japanese Journal of Oral & Maxillofacial Surgery ◽

10.5794/jjoms.41.220 ◽

1995 ◽

Vol 41 (3) ◽

pp. 220-223 ◽

Cited By ~ 1

Author(s):

Kazuhiro ONO ◽

Yasushi OHASHI ◽

Yoji KANNARI ◽

Shinsaku ISONO

Keyword(s):

Cleft Palate ◽

Cleft Palate Repair ◽

Palate Repair ◽

Maxillary Growth

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Incidence of Palatal Fistula after One-Stage Palatoplasty and Factors Influencing the Fistula Occurrence

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v2i4.176 ◽

1970 ◽

Vol 2 (4) ◽

Author(s):

Nurardhilah Vityadewi ◽

Kristaninta Bangun

Keyword(s):

Body Weight ◽

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Fistula Formation ◽

Bivariate Analysis ◽

One Stage ◽

Cleft Palate Repair ◽

Hypernasal Speech ◽

Palate Repair

Background: Cleft palate repair may be compromised by a number of complications, most commonly the development of a fistula. Fistulas are related to an increased rate of hypernasal speech, articulation problems, and food or liquid regurgitation from the nose. Fistulas also tend to recur after a secondary repair to address the fistulas. This study reviews the rate of fistula in our craniofacial center after a onestage cleft palate repair; and to determine whether, cleft type, age at repair, type of cleft repair, hemoglobin level presurgery, and patients nutritional state influence the risk of fistula occurence. Patient and Method: A retrospective analysis was performed on medical records of 93 patients who underwent palate repair between January 2012 to October 2013. All consecutive cleft (lip and) palate patients are included. Bivariate analysis was performed to identify the predictors of fistula formation. Result: Ninety-three patients (50 male and 43 female) underwent one-stage palatoplasty. Cleft palate fistulas occured in 19 of 93 patients (20,4%). The age of the patients at the time of repair ranged from 9 to 144 months (mode 18 months). All palate repairs were done in one stage, using either the two flap (N=66), Wardill-Kilner (N=24), Furlow (N=2), and Langenback (N=1) techniques. No significant influence was found related between age at the time of repair (p 0.789), body weight (p 0.725), Hemoglobin value (p 0.295), and type of cleft (p 0.249) to the rate of fistula occurrence. Summary: This study found no association between , body weight, preoperative hemoglobin value, and the type of cleft to the rate of fistula following cleft palate surgery.

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