Clefts Of Secondary Palate Research Articles

Secondary cleft palate correction with 3D-printed thermoplastic polyurethane film – a case report

Cleft palate is an oronasal communication that can affect the area comprehending the lips and the soft palate. Its clinical signs vary depending on the degree of the defect and the age of the animal, ranging from nasal secretion, coughing, sneezing, halitosis, respiratory difficulty, aspiration pneumonia, and loss of body condition. Its diagnosis is based on inspection of the oral cavity and imaging tests. Palatal defects must be surgically corrected as quickly as possible, using mucosal flaps, grafts, or implants. A desire to evolve alternative treatments for cleft palates drives the search for ways to manufacture customized pieces. 3D printing and biomaterials have enhanced in detail and applicability; combined with design tools and imaging exams, they allow for the making of precise implants and anatomical models for the planning and execution of surgical procedures. This report describes the case of a female, mixed-breed feline treated at a veterinary clinic; it was diagnosed with secondary cleft palate, had a history of falling, and underwent previous palatoplasties with recurrence. A surgical reintervention was performed to implant a 3D-printed TPU film to close its secondary cleft palate.

Spatial Multi-omics Reveals the Role of the Wnt Modulator, Dkk2, in Palatogenesis'.

Multiple genetic and environmental etiologies contribute to the pathogenesis of cleft palate, which is the most common of the inherited disorders of the craniofacial complex. Insights into the molecular mechanisms regulating osteogenic differentiation and patterning in the palate during embryogenesis are limited and needed for the development of innovative diagnostics and cures. This study used the Pax9-/- mouse model with a consistent phenotype of cleft secondary palate to investigate the role of Pax9 in the process of palatal osteogenesis. Although prior research has identified the upregulation of Wnt pathway modulators Dkk1 and Dkk2 in Pax9-/- palate mesenchyme, limitations of spatial resolution and technology restricted a more robust analysis. Here, data from single-nucleus transcriptomics and chromatin accessibility assays validated by in situ highly multiplex targeted single-cell spatial profiling technology suggest a distinct relationship between Pax9+ and osteogenic populations. Loss of Pax9 results in spatially restricted osteogenic domains bounded by Dkk2, which normally interfaces with Pax9 in the mesenchyme. Moreover, the loss of Pax9 leads to a disruption in the normal osteodifferentiaion of palatal osteogenic mesenchymal cells. These results suggest that Pax9-dependent Wnt signaling modulators influence osteogenic programming during palate formation, potentially contributing to the observed cleft palate phenotype.

Global Research Trends and Focuses on Pierre Robin Sequence From 1992 to 2023: A Bibliometric Analysis of the Past 3 Decades.

There is currently a lack of scientific bibliometric analyses in the field of Pierre Robin sequence (PRS). Pierre Robin sequence is known for its clinical triad of micrognathia, glossoptosis, airway obstruction, and possible secondary cleft palate. These defects can lead to upper airway obstruction, sleep apnea, feeding difficulties, affect an individual's growth and development, education level, and in severe cases can be life-threatening. Through analysis of literature retrieved from the Web of Science Core Collection (WoSCC) database using Results Analysis and Citation Report and Citespace software, 933 original articles and reviews were included after manual screening. The overall trend for the number of annual publications and citations was increasing. On the basis of the analysis, airway evaluation and treatment, mandibular distraction osteogenesis (MDO), as well as descriptions of PRS characteristics have been the focus of research in this field. In addition, with advances in new technologies such as gene sequencing and expanding understanding of diseases among researchers, research on genetics and etiology related to PRS has become a growing trend.

Improving labial and nasal outcome in a secondary bilateral cleft lip and palate patient using the Mulliken method of repair

Improving labial and nasal outcome in a secondary bilateral cleft lip and palate patient using the Mulliken method of repair

Buccal Fat Pad in Primary and Secondary Cleft Palate Repair: A Systematic Review of the Literature.

To review the evidence supporting the use of buccal fat pad (BFP) in primary and secondary cleft palate repair and its short- and long- term clinical outcomes. Systematic review conducted by 2 independent reviewers following PRISMA guidelines. Articles were identified from three databases (Pubmed/Medline, Embase and Web of Science). Search terms included "cleft palate", "palatoplasty", "palate repair", "buccal fat pad". Use of BFP in primary and secondary cleft palatoplasty. Primary outcomes were immediate postoperative complications, postoperative fistula, and maxillary growth. Secondary outcomes were palatal length, speech, and donor site morbidity. Ninety-one reports were retrieved after excluding duplicates. Twenty-three studies were included (13 case series and 10 comparative studies). Overall level of evidence was low. Randomized and non-randomized studies had a high risk of bias. In primary palatoplasty, BFP was more frequently used filling lateral relaxing incisions(57.4%), or in the hard-soft palate junction and covering mucosal defects(30.1%). In these patients, post operative fistula incidence was 2.8%. Two studies found wider transverse maxillary dimensions after BFP use. No higher incidence of bleeding, infection, dehiscence, or flap necrosis was reported. In secondary palatoplasty, no recurrent fistulas were reported for patients undergoing BFP for fistula repair. BFP appears to be associated with a favorable impact in fistula prevention and management, as well as in transverse maxillary growth. However, there is a high heterogeneity among studies, high risk of bias and overall low quality of evidence. More high-quality research with long-term follow-up is warranted.

The spontaneous mouse mutant low set ears (Lse) is caused by tandem duplication of Fgf3 and Fgf4.

The external ear develops from an organized convergence of ventrally migrating neural crest cells into the first and second branchial arches. Defects in external ear position are often symptomatic of complex syndromes such as Apert, Treacher-Collins, and Crouzon Syndrome. The low set ears (Lse) spontaneous mouse mutant is characterized by the dominant inheritance of a ventrally shifted external ear position and an abnormal external auditory meatus (EAM). We identified the causative mutation as a 148Kb tandem duplication on Chromosome 7, which includes the entire coding sequences of Fgf3 and Fgf4. Duplications of FGF3 and FGF4 occur in 11q duplication syndrome in humans and are associated with craniofacial anomalies, among other features. Intercrosses of Lse-affected mice revealed perinatal lethality in homozygotes, and Lse/Lse embryos display additional phenotypes including polydactyly, abnormal eye morphology, and cleft secondary palate. The duplication results in increased Fgf3 and Fgf4 expression in the branchial arches and additional discrete domains in the developing embryo. This ectopic overexpression resulted in functional FGF signaling, demonstrated by increased Spry2 and Etv5 expression in overlapping domains of the developing arches. Finally, a genetic interaction between Fgf3/4 overexpression and Twist1, a regulator of skull suture development, resulted in perinatal lethality, cleft palate, and polydactyly in compound heterozygotes. These data indicate a role for Fgf3 and Fgf4 in external ear and palate development and provide a novel mouse model for further interrogation of the biological consequences of human FGF3/4 duplication.

D11. Who’s Performing Primary and Secondary Cleft Palate Surgery? A Scope of Care Analysis Over Time

D11. Who’s Performing Primary and Secondary Cleft Palate Surgery? A Scope of Care Analysis Over Time

Single Oral Z-Plasty: A Clinical Validation of a Technique for Palatal Lengthening in Primary and Secondary Cleft Palate Repair.

In cleft palate repair, palate length is associated with improved speech outcomes. Although direct closure offers poor palatal lengthening, use of two opposing Z-plasties may reorient palatal musculature and lengthen the velum. The authors previously described a novel overlapping intravelar veloplasty to achieve longitudinal closure of the nasal mucosa with a single oral Z-plasty (1ZP), lengthening the palate in cadaver studies. This study aims to corroborate this finding in clinical cases. A retrospective comparative study of patients with a cleft palate was conducted. Patients underwent cleft palate closure with 1ZP or intravelar veloplasty with straight-line closure. Preoperative and postoperative measurements of the palate along four dimensions were recorded. Analysis was conducted on preoperative and postoperative measurements within and between groups using the Mann-Whitney-Wilcoxon or chi-square test. Eighty-five patients were included (1ZP, n = 65; straight-line closure, n = 20). 1ZP increased soft palate length (SPL) by 33% ( P < 0.001) and total palate length (TPL) by 10% ( P < 0.001). Primary 1ZP increased SPL by 33% ( P < 0.001) and TPL by 10% ( P < 0.001). Secondary 1ZP increased SPL by 28% ( P < 0.001) and TPL by 8% ( P < 0.001). When comparing between primary and secondary 1ZP, 1ZP was equal with regard to percentage lengthening in SPL ( P > 0.9) and TPL ( P > 0.3). When compared with straight-line closure, 1ZP showed superior percentage lengthening in SPL ( P < 0.001) and TPL ( P = 0.038). 1ZP results in a statistically significant increase in palate length in both primary and secondary cleft palate repair. This technique provides an effective alternative in patients for whom 2ZP is not feasible. Therapeutic, III.

The Reality of Commercial Payer-Negotiated Rates in Cleft Lip and Palate Repair.

Commercial payer-negotiated rates for cleft lip and palate surgery have not been evaluated on a national scale. The aim of this study was to characterize commercial rates for cleft care, both in terms of nationwide variation and in relation to Medicaid rates. A cross-sectional analysis was performed of 2021 hospital pricing data from Turquoise Health, a data service platform that aggregates hospital price disclosures. The data were queried by CPT code to identify 20 cleft surgical services. Within- and across-hospital ratios were calculated per CPT code to quantify commercial rate variation. Generalized linear models were used to assess the relationship between median commercial rate and facility-level variables and between commercial and Medicaid rates. There were 80,710 unique commercial rates from 792 hospitals. Within-hospital ratios for commercial rates ranged from 2.0 to 2.9 and across-hospital ratios ranged from 5.4 to 13.7. Median commercial rates per facility were higher than Medicaid rates for primary cleft lip and palate repair ($5492.20 versus $1739.00), secondary cleft lip and palate repair ($5429.10 versus $1917.00), and cleft rhinoplasty ($6001.00 versus $1917.00; P < 0.001). Lower commercial rates were associated with hospitals that were smaller ( P < 0.001), safety-net ( P < 0.001), and nonprofit ( P < 0.001). Medicaid rate was positively associated with commercial rate ( P < 0.001). Commercial rates for cleft surgical care demonstrated marked variation within and across hospitals, and were lower for small, safety-net, or nonprofit hospitals. Lower Medicaid rates were not associated with higher commercial rates, suggesting that hospitals did not use cost-shifting to compensate for budget shortfalls resulting from poor Medicaid reimbursement.

A Review of the Use of Buccal Fat Pad in Cleft Palate Repair.

To review the available evidence on the use of the Buccal Fat Pad in primary and secondary Cleft Palate repair. This is a narrative review. A computerized literature search was conducted for articles published till February 2022 using the Mesh phrases buccal fat pad AND cleft palate, Bichat's Fat pad AND cleft palate, buccal fat pad OR Bichats Fat pad AND cleft palate. A total of 35 articles were included in this review based on the set eligibility criteria. Most of the studies were retrospective case reviews (n = 16, 45.7%), and the aggregate number of patients from all included studies was 666. Reported uses of the buccal fat pad (BFP) in association with cleft palate repair include the closure of central cleft palate defect and nasal floor in primary cleft palate repair, oronasal fistula repair following primary repair of cleft palate, and closure of relieving incision defect in primary repair of cleft palate. Complications reported were 24 cases of Oronasal Fistula (ONF), 2 dehiscences, and 4 transient mucosal defects. The high success rate, vascularity, ease of tissue harvest, and low donor site morbidity all support its use as an adjunct flap in cleft palate repair, especially in the closure of wide palatal clefts, to prevent post-palatal repair fistula, wound contracture, and subsequently velopharyngeal insufficiency and possibly midface hypoplasia.

The Utility of the Ultrasound “Superimposed-Line” Sign at the Junction of the Vomer and Maxilla in First-Trimester Screening for Fetal Cleft Palate: A Case-Control Study

Introduction: The current retrospective case-control study evaluates the diagnostic value of screening for a fetal cleft palate by using the ultra-sound-based observation of the “superimposed-line” sign appearing at the junction of the vomer and maxilla in the first trimester of pregnancy. Methods: Retrospective analyses were performed of ultrasonographic images of nuchal translucency obtained during the first trimester of pregnancy (11–13⁺⁶ weeks) from 45 fetuses with a cleft palate later confirmed following parturition or induced labor (cases) and 4,500 normal fetuses confirmed after parturition (controls). Ultrasonographic features of the “superimposed-line” sign were observed and recorded, and between-group comparisons were performed. Results: The “superimposed-line” sign was absent in 39 cases (86.67%), including 4 (8.89%) with simple secondary hard palate cleft and 35 (77.78%) with secondary hard palate cleft complicated by a primary cleft palate. The “superimposed-line” sign was shown in 6 cases (13.33%), including 2 (4.44%) with a simple secondary soft palate cleft, 1 (2.22%) with a simple secondary bifid uvula, and 3 (6.67%) with a simple primary cleft palate. Among the 4,500 controls, 31 fetuses showed an absence of the “superimposed-line” sign (0.69%) and 4,469 showed the “superimposed-line” sign (99.31%). The between-group difference was significant (p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive values of the “superimposed-line” sign in the first trimester of pregnancy for predicting fetal cleft palate were 86.67% (39/45), 99.31% (4,469/4,500), 55.71% (39/70), and 99.86% (4,469/4,475), respectively. Conclusion: The “superimposed-line” sign did not appear in fetuses with secondary hard palate cleft and primary cleft palate only when a secondary hard palate cleft is present. The sign appeared in normal fetuses and those with a simple primary cleft palate, simple secondary soft palate cleft, or a simple secondary bifid uvula. Based on these results, we propose that the “superimposed-line” sign in the mid-sagittal plane of the fetal face in the first trimester of pregnancy (11–13⁺⁶ weeks) is an important tool in screening for fetal cleft palate, especially secondary hard palate cleft.

An Acoustic Analysis of Cleft Palate Speech before and after Pharyngoplasty: A Case Report

The purpose of the primary cleft palate surgery is to recover the anatomical structure, securefunctions such as speaking and swallowing, and induce the growth of the right maxillaryface. VPI(Velopharyngeal Inadequacy) may occur after the primary cleft palate surgery,and the purpose of the secondary surgery performed at this time is to improve VPI andthereby increase clarity and communication efficiency. Videofluoroscopic examinationand endoscopic nasopharynx examination can be performed to confirm the improvementof VPI after secondary surgery, and acoustic evaluation using a test device and perceptualexamination by speech and language pathologists(SLP) can be performed to evaluate speechsounds. Acoustic analysis using assessment instruments is useful because it can proveclinical diagnosis by experts, identify fine voice problems and their causes, and quantify theseverity of speech problems. Nevertheless, there are not many researches that can presentacoustic analysis for cleft palate speech and provide meaningful statistical data. Through thecase of an adult who improved velopharyngeal functions after secondary cleft palate surgery,this report can introduce specific examples of acoustic analysis of cleft palate speech andprovide the chances to review the usefulness and availability of acoustic analysis.

Anencephaly, Bifid Tongue, and Cleft Palate in a Pomeranian Dog: GFAP and NeuN Immunoreactivities.

Anencephaly is a congenital disease manifesting with the absence of the brain due to the failure of the cranial part of the neural tube to close during the embryonic stage. The disease may be accompanied by other anomalies and usually results in premature death. A stillborn puppy of a 2-year-old female Pomeranian dog is examined in this case. The lack of brain tissue and accompanying abnormal skull formation was noted macroscopically. The eyes were protruding out of their normal position (exophthalmos), and a bifid tongue together with a secondary cleft palate was present. On serial sections stained with Haematoxylin-Eosin, only the medulla spinalis among the central nervous system structures could be inspected microscopically. Immunohistochemistry staining revealed GFAP immunoreactivity in the astrocytic glial cells. NeuN immunoreactivity was detected in the neurons in the medulla spinalis and spinal ganglions. Incomplete retinal layers were observed on the eye sections stained with Haematoxylin-Eosin and NeuN. The case was concluded to be coherent with skull and nervous system congenital malformations rarely observed in dogs. To the best of our knowledge, this represents the first description of a dog with anencephaly, bifid tongue and cleft palate.

Multiple congenital malformations arise from somatic mosaicism for constitutively active Pik3ca signaling.

Recurrent missense mutations of the PIK3CA oncogene are among the most frequent drivers of human cancers. These often lead to constitutive activation of its product p110α, a phosphatidylinositol 3-kinase (PI3K) catalytic subunit. In addition to causing a broad range of cancers, the H1047R mutation is also found in affected tissues of a distinct set of congenital tumors and malformations. Collectively termed PIK3CA-related disorders (PRDs), these lead to overgrowth of brain, adipose, connective and musculoskeletal tissues and/or blood and lymphatic vessel components. Vascular malformations are frequently observed in PRD, due to cell-autonomous activation of PI3K signaling within endothelial cells. These, like most muscle, connective tissue and bone, are derived from the embryonic mesoderm. However, important organ systems affected in PRDs are neuroectodermal derivatives. To further examine their development, we drove the most common post-zygotic activating mutation of Pik3ca in neural crest and related embryonic lineages. Outcomes included macrocephaly, cleft secondary palate and more subtle skull anomalies. Surprisingly, Pik3ca-mutant subpopulations of neural crest origin were also associated with widespread cephalic vascular anomalies. Mesectodermal neural crest is a major source of non-endothelial connective tissue in the head, but not the body. To examine the response of vascular connective tissues of the body to constitutive Pik3ca activity during development, we expressed the mutation by way of an Egr2 (Krox20) Cre driver. Lineage tracing led us to observe new lineages that had normally once expressed Krox20 and that may be co-opted in pathogenesis, including vascular pericytes and perimysial fibroblasts. Finally, Schwann cell precursors having transcribed either Krox20 or Sox10 and induced to express constitutively active PI3K were associated with vascular and other tumors. These murine phenotypes may aid discovery of new candidate human PRDs affecting craniofacial and vascular smooth muscle development as well as the reciprocal paracrine signaling mechanisms leading to tissue overgrowth.

A treatment algorithm for secondary cleft palate repair based on age and preoperative velopharyngeal closure ratio

This study aimed to find a surgical treatment algorithm for secondary velopharyngeal insufficiency (VPI), with Furlow palatoplasty or posterior pharyngeal flap (PPF), balancing speaking and breathing. Non-syndromic cleft palate patients with secondary VPI who underwent Furlow palatoplasty or PPF were reviewed. A multinomial logistic regression model was employed to estimate the association between preoperative variables and surgical outcomes. A series of multinomial logistic regression models was utilized to determine the cut-off value of the significant predictors for subgroup comparison. In total, 203 patients were enrolled, with 73 receiving Furlow palatoplasty and 130 receiving PPF. The surgical outcomes of the two techniques were significantly different (p = 0.005). Age was a significant predictor in all intragroup comparative analyses. Preoperative VCR was associated with postoperative velopharyngeal function in patients undergoing Furlow palatoplasty (p = 0.042). The best cut-off values were an age of 13 years and a VCR of 70%. Surgical outcomes in both group B (age <13, VCR <70%; p = 0.017) and group C (age ≥13, VCR ≥70%; p = 0.003) differed significantly between the two surgical techniques. Within the limitations of the study, it is seems that in patients aging <13 years and with a VCR of ≥70%, Furlow palatoplasty should be preferred whenever appropriate to receive adequate velopharyngeal function.

Assessment Of Hearing Threshold Among Post Repaired Cleft Palate Patients In Korle-Bu Teaching Hospital, Ghana

Objective: The aim of the study was to assess the hearing threshold in patients with repaired cleft palate and to determine the degree of hearing loss in various types of cleft palate.Methods: This was a cross-sectional study which was conducted on 97 consenting patients with clinical diagnosis of repaired cleft palate at the Plastic and Reconstructive surgery unit, Korle Bu Teaching Hospital. The hearing loss threshold levels in the rightand left cleft palates were then compared using Chisquare test of independence.Results: A total of 97 participants who had cleft palate were seen that is 194 ears were examined. Most of patients had cleft of secondary palate (n=65, 67.0%), only one participant had cleft of primary palate only (1.0%) and the rest had cleft of both primary andsecondary palate (n=31, 32.0%). The age range of patients in this study was between the ages of 6 years to 12 years with a mean (±SD) age of 7.43 (3.85) and the male to female ratio was 1:1. Out of the total ear examined, 76 were mild conductive hearing loss and 95 ears had abnormal tympanogram. The overall prevalence rate for the abnormal tympanograms (B, C1, C2) in both ears is 49%. Therewas no statistically significant association between the level of hearing loss and the type of cleft palate for the left ear and the right ear respectively as well as the association between the type of tympanogram and the type of cleft palate for the left ear and the right ear respectively (p&gt;0.05).Conclusion: Prevalence rate of hearing loss among post repaired cleft palate subjects is 33%. This hearing loss is usually mild conductive hearing loss only. Mild conductive hearing loss and abnormal tympanogram was common between the ages of 6-8yearsirrespective of the type of cleft palate.

Discerning a Potential Link between MEMO1’s Role in Vascular, Bone, and Craniofacial Development

Embryonic development of craniofacial structures requires the tight integration of multiple tissues and cell‐types. For example, the intersection of neural crest derived mesenchyme with mesoderm derived endothelium (i.e., vasculature) is necessary for craniofacial bone development and mineralization. Despite craniofacial anomalies being the 2nd leading congenital anomaly worldwide, our understanding of how these tissues interact is limited.Through a forward genetic screen, we previously identified a novel role for the protein encoded by the gene mediator of ERBB2‐driven cell motility 1 (Memo1) in craniofacial development. Global loss of Memo1 resulted in a range of defects, including hypo‐mineralization of the craniofacial skeleton, fully penetrant cleft secondary palate, coupled with widespread vascular abnormalities. Interestingly, while neural crest cell specific deletion of Memo1 recapitulated some aspects of global loss of Memo1, several defects were less apparent—suggesting MEMO1 functions in tissues outside the neural crest during craniofacial development. Further, molecular profiling of craniofacial elements in global Memo1mutants identified significantly altered Vegfa expression, coupled with disrupted vascular development, relative to controls. Based on these observations, along with Memo1’s semi‐ubiquitous expression during development, we hypothesized that MEMO1 functions within the endothelial derived vasculature and this function is necessary for proper craniofacial development.To test this hypothesis, we have generated a Memo1 endothelial specific mouse knock‐out model. Similar to Memo1 global knock‐outs, and in contrast to Memo1 neural crest knock‐outs and controls, Memo1 endothelial knock‐outs develop vascular hemorrhaging and edema with variable penetrance. Vascular defects are accompanied by gross alterations to craniofacial shape. We are currently utilizing µCT, cell sorting coupled with gene expression profiling, and ex vivo ‘sprouting’ assays to quantify the impact endothelial loss of Memo1 has on craniofacial bone development and mineralization, MEMO1’s molecular role in craniofacial endothelial cells, and MEMO1’s functional role in endothelial cells, respectively.Overall, in addition to MEMO1’s neural crest cell specific role, our findings extend MEMO1’s function into an additional cell‐type, endothelial cells, during craniofacial development. These data illuminate the molecular pathology for how disrupted neural crest or endothelial cells may lead to human craniofacial disorders.

Out-of-Pocket Costs and Provider Payments in Cleft Lip and Palate Repair.

As healthcare spending within the United States grows, payers have attempted to curb spending through higher cost sharing for patients. For families attempting to balance financial obligations with their children's surgical needs, high cost sharing could place families in difficult situations, deciding between life-altering surgery and bankruptcy. We aim to investigate trends in patient cost sharing and provider payments for cleft lip and palate repair. The IBM® MarketScan® Commercial Database was queried to extract patients younger than 18 years who underwent primary or secondary cleft lip and/or palate repair from 2007 to 2016. Financial variables included gross payments to the provider (facility and/or physician), net payment as reported by the carrier, coordination of benefits and other savings, and the beneficiary contribution, which consisted of patients' coinsurance, copay, and deductible payments. Linear regression was used to evaluate trends in payments over time. Poisson regression was used to trend the proportion of patients with a nonzero beneficiary contribution. All financial values were adjusted to 2016 dollars per the consumer price index to account for inflation. The sample included 6268 cleft lip and 9118 cleft palate repair episodes. Total provider payments increased significantly from 2007 to 2016 for patients undergoing cleft lip (median, $2527.33 vs $5116.30, P 0.008) and palate ($1766.13 vs $3511.70, P < 0.001) repair. Beneficiary contribution also increased significantly for both cleft lip ($155.75 vs $193.31, P < 0.001) and palate ($124.37 vs $183.22, P < 0.001) repair, driven by an increase in deductibles ( P < 0.002). The proportion of cleft palate patients with a nonzero beneficiary contribution increased yearly by 1.6% ( P = 0.002). Higher provider payments and beneficiary contributions were found in the Northeast ( P < 0.001) and South ( P < 0.011), respectively, for both cleft lip and palate repair. The US national data demonstrate that for commercially insured patients with cleft lip and/or palate, there has been a trend toward higher patient cost sharing, most pronounced in the South. This suggests that patients are bearing an increased cost burden while provider payments are simultaneously accelerating. Additional studies are needed to understand the impact of increased cost sharing on parents' decision to pursue cleft lip and/or palate repair for their children.

Evaluation of patients after different types of secondary cleft palate repair.

The aim of this retrospective study was to evaluate results of four different surgical approaches to palatoplasty and to demonstrate which type showed the lowest number of cases with the need for secondary surgeries. The results of 227 patients who underwent cleft palate surgical repair over a 13-year period (2000-2012) were included. The incidence rates of oronasal fistula, velopharyngeal insufficiency with the need of pharyngeal flap and pharyngoplasty were examined. The need for revision surgery was found in 48 patients (21.1 %). A significantly higher rate of cases with the need for secondary correction was found in patients with a complete cleft (44 %) as compared to patients with incomplete cleft palate (9.8 %). A higher percentage for additional surgery was noted after the Bardach procedure (50 %) as opposed to the lower revision rate after Veau-Wardill-Kilner (22.8 %) and Furlow (17.6 %). After the von Langenbeck procedure, the need for revision eventuated only in 5.5 % of cases. It is important to mention that there were no significant differences in the incidence of secondary surgery between the patients with cleft palate with or without the presence of Pierre Robin sequence. Neither there was observed a significant difference in the incidence of additional surgery between male and female patients. However, a higher need for pharyngeal flap was noted in the female group (Tab. 8, Ref. 38). Keywords: complications after palatoplasty, cleft repair techniques, Pierre Robin sequence, pharyngeal flap.

Orthognathic Surgery Rate in Cleft Care.

To determine the true need for orthognathic surgery in patients with repaired cleft lip and/or palate (CL/P) at a high-volume craniofacial center. An institutional retrospective review of patients with CL/P born between 1975 and 2008 was performed. Patients with adequate documentation reflecting cleft care who were ≥ 18 years at the time of last craniofacial/dentistry follow-up were included. Patients with non-paramedian clefts or a comorbid craniofacial syndrome were excluded. Primary outcome variable was the total proportion of patients with CL/P who either underwent or were referred for orthognathic surgery Le Fort I (LF1) to correct midface hypoplasia. Secondary outcome variables were associations between cleft phenotype, midface hypoplasia severity, and number of cleft related surgeries with the eventual LF1 referral/recipiency. One hundred seventy-seven patients with CL/P met inclusion criteria. A total of 90/177 (51%) patients underwent corrective LF1; however, 110/177 (62%) of patients were referred for surgery. Patients with secondary cleft palate involvement were referred for and underwent LF1 at significantly greater rates than those without secondary palate involvement (referred: 65% versus 13%, P = 0.001; underwent: 55% versus 0%, P < 0.001). Patients with bilateral cleft lip/palate were referred for and underwent LF1 at significantly higher rates than those with unilateral cleft lip/palate (referred: 71.0% versus 50.4%, P= 0.04; underwent: 84% versus 71%, P = 0.02). Number of secondary palate surgeries was positively correlated with increased LF1 referral (P = 0.02) but not LF1 recipiency (P = 0.15). The incidence of orthognathic surgery redundant in patients with repaired CL/P was 51% at our institution, marginally above the higher end of previously reported rates. However, this number is an underrepresentation of the true requirement for LF1 as 62% of patients were referred for surgical intervention of midface hypoplasia. This distinction should be considered when counseling families.