Palate Repair Surgery Research Articles

Anaphylactic reaction to tranexamic acid infusion in a six-year-old child: a case report

BackgroundTranexamic acid (TXA) is commonly considered a safe drug to mitigate bleeding during and after various surgical settings among adults and children. In recent decades, anaphylaxis induced by TXA has been increasingly reported in adults. However, among pediatrics, there are fewer reported cases.Case presentationWe report a case of a 6-year-old female who experienced anaphylaxis after receiving intravenous TXA following unilateral cleft lip and palate repair surgery. She exhibited clinical symptoms involving the cardiovascular system, respiratory system, and skin. Following the administration of epinephrine, corticosteroid, and anti-histamine, the patient’s symptoms were relieved. A few months after discharge, an intradermal test, yielded a positive result, confirming TXA as the culprit drug.ConclusionOur report emphasizes the importance of considering anaphylaxis as a potential adverse reaction to TXA in pediatric patients, showing the criticality of rapid diagnosis and appropriate management for a successful outcome.

Presurgical Reduction of the Cleft Palate: Serendipitous Benefit of the Stanford Orthodontic Airway Plate Treatment (SOAP) for Infants with Robin Sequence.

Narrowing of the palatal cleft is often observed in infants with Robin sequence (RS) treated with the Stanford Orthodontic Airway Plate treatment (SOAP) even though SOAP is utilized primarily to establish airway patency. The current study quantified dimensional changes of the cleft palate (CP) in infants with RS treated with SOAP. A retrospective chart review. Infants with RS and CP who completed SOAP and had maxillary arch models at both pre- and post-treatment time points at a single tertiary referral hospital between September 2019 and July 2023. Maxillary arch models were measured and analyzed using Bivariate statistical analysis. Seventeen infants were included in the study. The median age (min, max) was 6.7 weeks (1.1, 21.9) at pre-treatment and 26.6 weeks (18.7, 37.0) at post-treatment. The median Obstructive Apnea Hypopnea Index was 36.2 events/hour (8.1, 103.1) at pre-treatment and 4.1 events/hour (1.9, 8.6) at post-treatment. The pre-treatment width of CP decreased by an average (± standard diviation) of 6.37 mm (± 3.55, p < 0.001) at post-treatment. The ratio of the posterior cleft width to the total maxillary arch width decreased from 40% (± 9.1) at pre-treatment to 22% (± 11) at post-treatment (p < 0.001). The dimensions of CP reduced significantly during SOAP in infants with RS and CP treated for their severe upper airway obstruction. The findings highlight a potential benefit of SOAP that may contribute favorably to the palate repair surgery.

Analysis of the Management of Cleft Lip Surgery with the Characteristics of Patients with Cleft Lips or Without Cleft Palatum in Nort Sumatra

Clefts are the most common type of congenital abnormality on the face. This condition can cause medical, psychological, and social problems in individuals and&#x0D; families. Several previous studies have yielded results in the form of a large number&#x0D; of cleft sufferers who come for treatment at a late age. This can affect the outcomeof the management given. The characteristics of cleft patients in Indonesia, especially in Medan City, are still very limited. Therefore, researchers have the desire to be able to do research in this field. patients with or without cleft palate who were managed by Smile Train Indonesia together with the Horas Sehat Foundation at hospitals in North Sumatra based on:(1) type of cleft, (2) location of the cleft defect, (3) Gender, (4) Treatment time, and (5) Type of operation. design. The sample for this study was secondary data on 193 cleft patients who were managed by Smile Train Indonesia together with the Horas Sehat Foundation at hospitals in North Sumatra in the 2017 – 2022 period. palate based on the type of cleft was labiognatopalatoschizis with a total of 115 patients (59.6%), based on the location of the defect was a unilateral defect (left side) of 98 patients (50.8%), based on gender was male with a total of 130 patients (67.4%), based on the time of treatment category was the late labioplasty category with a total of 54 patients (28%), and based on the type of surgery the most was the type of primary cleft palate repair surgery with a total of 56 people (29%). from previous studies.

Ketodex versus opioid based anesthesia in cleft palate

Background &amp; objective: Cleft palate is a congenital anomaly of the palate of the infants, and it may or may not be associated with cleft lip. The only remedy is surgical repair under general anesthesia. Postoperative pain relief in cleft palate repair surgery is very important to keep the infant or child calm and pain-free. It can only be achieved by use of analgesic drugs. We compared ketodex - a combination of ketamine and dexmedetomidine, versus opioid based anesthesia in cleft palate surgery as regards postoperative respiratory depression, need for oxygenation, and the emergence agitation. Methodology: Fifty children, aged 6 months to 5 y, undergoing cleft palate surgery under general anesthesia, were randomly assigned to either ketodex group (Group KD) or opioids group (Group OP). Group KD received ketamine 1mg/kg loading dose followed by infusion @ 0.1 mg/kg/h, and dexmedetomidine loading dose 1 µg/kg followed by infusion @ 0.2 µg/kg/h], isoflurane anesthesia. Group OP received fentanyl in a loading dose of 2 µg/kg followed by infusion @ 0.5 µg/kg/h, followed by isoflurane anesthesia. Heart rate, mean blood pressure, emergence agitation, extubation time, FLACC score for pain, surgeons’ satisfaction, and the adverse effects were noted. Results: Emergence agitation score was significantly lower in Group KD compared to Group OP. FLACC score showed insignificant difference between the two groups. There was no need for opioid administration in the PACU. Three patients in Group OP desaturated and needed oxygen supply. Incidence of vomiting was significantly higher in Group OP compared to Group KD (P = 0.022). Conclusion: Ketodex used in opioid free anesthesia for cleft palate repair surgery in children provides adequate pain relief without respiratory depression, and is a good alternative of routine opioid based general anesthesia. Key words: Ketamine; Dexmedetomidine; Opioids; Anesthesia; Recovery; Cleft Palate Surgery; Pediatrics Citation: Mohamed MM, Abdelraof AF, Noser MA. Ketodex versus opioid based anesthesia in cleft palate. Anaesth. pain intensive care 2024;28(1):74-80; DOI: 10.35975/apic.v28i1.2239 Received: May 31, 2023; Reviewed: June 06, 2023; Accepted: January 02, 2024

Effect of two different doses of nalbuphine for postoperative analgesia in children with cleft palate: a randomized controlled trial

BackgroundCleft palate repair surgery may result in severe pain in the immediate postoperative period. The aim of this study is to compare the effects of different doses of nalbuphine for postoperative analgesia in children with cleft palate.MethodsFrom November 2019 to June 2021, 90 children (45 males and 45 females, age 9–20 months old, ASA class I—II) were selected for palatoplasty. They were randomly divided into three groups: the control group (Group C), the N1 group (postoperative analgesia with 0.05 mg/kg/h nalbuphine) and the N2 group (postoperative analgesia with 0.075 mg/kg/h nalbuphine). Each group had 30 cases. Nalbuphine was not continuously infused in Group C but was continuously infused in Groups N1 and N2 at rates of 0.05 mg/kg/h and 0.075 mg/kg/h, respectively, for 24 h for postoperative analgesia. The FLACC analgesia score and Ramsay Sedation score were recorded at 10 min (T1), 30 min (T2), 2 h (T3), 12 h (T4) and 24 h (T5) after the operation. Adverse reactions such as nausea, vomiting and respiratory depression were observed and recorded.ResultsCompared with those in Group C, the FLACC scores in the N1 and N2 groups decreased significantly at T1-T5 (p < 0.05); the Ramsay Sedation score in the N1 group was significantly higher at T3 and T4 (p < 0.05), and that in the N2 group was significantly higher at T1-T5 (p < 0.05). Compared with that in the N1 group, the FLACC score in the N2 group was not significantly different, and the Ramsay Sedation score increased significantly at T5 (p < 0.05).ConclusionUsing 0.05 mg/kg/h Nalbuphine continuously for 24 h for postoperative analgesia in children with cleft palate has a better effect and fewer adverse reactions.Trial registrationThis study was registered at ChiCTR1900027385 (11/11/2019).

Efficacy of intranasal administration of dexmedetomidine in combination with midazolam for sedation in infant with cleft lip and palate undergoing CT scan: a randomized controlled trial

BackgroundThere is a great challenge to sedation for infants with cleft lip and palate undergoing CT scan, because there is the younger age and no consensus on the type, dosage, and route of drug administration.ObjectiveThis study aimed to evaluate the efficacy of intranasal administration of dexmedetomidine combined with midazolam as a sedative option for infants with cleft lip and palate under imaging procedures.MethodsInfants scheduled for cleft lip and palate repair surgery were randomly assigned to the IND group (intranasal dexmedetomidine 2 µg/kg alone) and the INDM group (intranasal dexmedetomidine 2 µg/kg combined with midazolam 0.05 mg/kg). The primary outcome was the proportion of infants underwent successful computed tomography (CT) scans under intranasal sedation. The secondary outcomes included onset time and duration of sedation, recovery time, Ramsay sedation scale, hemodynamic parameters during sedation, and adverse events. Data analyses involved the unpaired t-test, the repeated-measures analysis of variance test, and the continuity correction χ2 test.ResultsOne hundred five infants were included in the analysis. The proportion of infants underwent successful CT scans under sedation was significantly greater in the INDM group than in the IND group (47 [95.9%] vs. 45 [80.4%], p = 0.016). Additionally, the INDM group had a shorter onset time and a longer duration of sedation statistically (12 [8.5, 17] min vs. 16 [12, 20] min, p = 0.001; 80 [63.6, 92.5] min vs. 68.5 [38, 89] min, p = 0.014, respectively), and their recovery time was significantly longer (43 [30, 59.5] min vs. 31.5 [20.5, 53.5] min, p = 0.006). The difference in Ramsay sedation scale values 20 min after administration was statistically significant between the groups. No statistically significant difference was found between the groups in changes in heart rate and respiratory rate.ConclusionIntranasal administration of dexmedetomidine in combination with midazolam resulted in higher sedation success in comparison with sole dexmedetomidine. However, it has a relatively prolonged duration of sedation and recovery time.Trial registrationChiCTR2100049122, Clinical trial first registration date: 21/07/2021.

Comparison of the Outcomes of Surgical Repair of Cleft Palate Performed by Modified Von Langenbeck and Bardach (Two-Flap Palatoplasty) Methods.

Cleft lip and cleft palate are one of the most common congenital craniofacial abnormalities in the skull and face. We aimed to investigate the prevalence of complications after primary cleft palate repair surgery, performed on patients referred to a children's hospital, and to use the information and results obtained from it to reduce the complications and improve the results of these surgeries. In this cross-sectional-analytical study, using a census sampling method, the medical records of 94 consecutive cleft palate patients treated in Abuzar Hospital in Ahvaz, southern Iran, in the years 2019 to 2021 were studied. The rate of postoperative complications during the first week in terms of wound opening and flap necrosis and one month later in terms of fistula formation after surgery were also extracted from the files. Ninety-four patients with congenital cleft palate (57.4% male and 42.6% female) were enrolled. The gap width in all studied patients was 14 ± 5 mm. The frequency of complications of surgical wound opening, flap necrosis, oronasal fistula and hypernasality in von Langenbeck group was 9.5%, 0.15% and 28.1% respectively, and in Bardach group was 9.5 %, 15% and 33.3% respectively. There were no significant differences between the two surgical methods in terms of postoperative complications. Besides, what is important in choosing a surgical method is the patient's clinical condition, the surgeon's experience and skill, and his choice.

Geospatial and Socioeconomic Factors Interact to Predict Management and Outcomes in Cleft Lip and Palate Surgery: A Single Institution Study of 740 Patients.

Determine interactions between geospatial and socioeconomic factors influencing cleft lip and/or cleft palate (CL/P) management and outcomes. Retrospective review and outcomes analysis (n = 740). Urban academic tertiary care center. 740 patients undergoing primary (CL/P) surgery from 2009 to 2019. Prenatal evaluation by plastic surgery, nasoalveolar molding, cleft lip adhesion, and age at CL/P surgery. Prenatal evaluation by plastic surgery was predicted by the interaction between higher patient median block group income and shorter patient distance from the care center (OR = 1.07, p = 0.022). Nasoalveolar molding was also predicted by the interaction between higher patient median block group income and shorter distance from the care center (OR = 1.28, p = 0.016), whereas cleft lip adhesion was predicted by higher patient median block group income alone (OR = 0.41, p < 0.001). Lower patient median block group income predicted later age at cleft lip (β = -67.25, p = 0.011) and cleft palate (β = -46.35, p = 0.050) repair surgery. Distance from the care center and lower median income by block group interacted to significantly predict prenatal evaluation by plastic surgery and nasoalveolar molding for patients with CL/P at a large, urban, tertiary care center. Patients living farthest from the care center who received prenatal evaluation by plastic surgery or who underwent nasoalveolar molding had higher median block group income. Future work will determine mechanisms perpetuating these barriers to care.

The Effect of Phenylephrine Nasal Drops on Surgical Bleeding in Children Underwent Cleft Palate Surgery: A Randomized Clinical Trial.

Cleft lip and palate are birth defects due to a lack of proper formation of the lip or mouth. Controlling bleeding during cleft lip and palate surgeries is very important. This study aimed to evaluate the effect of phenylephrine nasal drops on bleeding during and after cleft palate repair surgery in children. This controlled, randomized, double-blind, clinical trial was performed on 36 children aged 6 months to 2 years with cleft palate who were candidates for repair surgery. Patients were randomly divided into 2 groups of 18 patients. In the intervention group, 0.25% phenylephrine drops were poured into the nostrils, and the same amount of normal saline was poured in the control group. Changes in systolic and diastolic blood pressures, heart rate, bleeding during surgery based on the gauzes used, the volume of blood in the suction canister, and the amount of blood in the field, as well as the surgical field quality and surgeon satisfaction, were evaluated using analysis. No statistically significant difference was observed between the 2 groups in terms of age, sex, weight, heart rate, and systolic and diastolic blood pressures. The mean volume of bleeding based on the total weight of gauzes used and suctioned blood during surgery showed a statistically significant difference between the intervention and control groups (P = 0.0016). The surgeon satisfaction in terms of the surgical field quality using a 5-point Likert scale showed a significant difference between the 2 groups (P = 0.0068), as well as more satisfaction in the intervention group according to the Boezaart scale (P = 0.0043). It seems that the use of nasal phenylephrine drops in pediatric cleft palate surgeries can significantly reduce bleeding and increase the quality of the operation field. Therefore, nasal phenylephrine drops can be used to control bleeding in this type of surgery.

Comparing the effects of ropivacaine and lidocaine associated with epinephrine on the heart rate, blood pressure, and amount of bleeding in patients candidate for cleft palate repair: A randomized clinical trial

Background and aims: This study was conducted to compare the effects of two compounds ropivacaine and lidocaine associated with epinephrine on the heart rate, blood pressure, and bleeding rate in children undergoing general anesthesia for the cleft palate repair surgery. Methods: In this study, 30 children candidates for cleft palate surgery who were referred to Mofid Children’s Hospital, affiliated with Shahid Beheshti University of Medical Sciences in 2021, were included by using the convenience sampling method. The patients were randomly divided into two groups. Group 1 was treated with ropivacaine and group 2 was treated with lidocaine along with epinephrine. The data were analyzed by the SPSS, version 22. Results: In total, no statistically significant difference was found between the two groups in terms of vital signs of blood pressure and heart rate in the 10 stages studied (P&lt;0.05). There was no difference between the two groups in the trend of the changes in blood pressure (P=0.381) and heart rate (P=0.940). However, the trend of blood pressure and heart rate had significantly changed during the study in both groups individually (P&lt;0.001). The bleeding rate (suction) (P&lt;0.001) and the weight of gases used (P=0.003) in the second group were significantly higher than in the first group. Conclusion: No difference was found between the effects of ropivacaine and lidocaine combined with epinephrine on the heart rate and blood pressure in patients who were candidates for the cleft palate surgery, but the rate of bleeding (suction) in the second group was more than the first group.

P38MAPK silencing attenuates scar proliferation after cleft palate repair surgery in rats via MRTF-A/SRF pathway

Scarring is the primary factor of maxilla growth restriction among people who have undergone cleft palate repair surgery. p38 mitogen-activated protein kinase (p38MAPK) promotes fibrosis in a variety of organs. However, its role in post-surgery scarring on the hard palate has not been fully understood. This study is designed to investigate the role of p38MAPK in scar formation and maxilla growth of rats. We removed the mucosa on the hard palate of rats and applied the p38MAPK silencing adenovirus vector on it two weeks after surgery. Then the scarring tissue and maxilla growth were evaluated by histological and morphological examination. The effect of p38MAPK silencing on scarring-related genes in fibroblasts was also studied. We found that local injection of Ad-p38MAPK-1 in vivo effectively reduces the expression of p38MAPK and scarring-related proteins and weakens the impact of scarring on the width of the hard palate. Mechanistically, p38MAPK silencing inhibits the expression of α-smooth muscle actin (α-SMA) via mediating the production and nuclear localization of myocardin-related transcription factor A (MRTF-A) in fibroblasts. These results reveal a molecular pathway of scar formation involving p38MAPK/MRTF-A stimulation and support targeting p38MAPK as a potentially effective treatment for post-surgery scarring on the hard palate.

Lima Protocol for Cleft Palate Repair in Cleft and Craniofacial Centre Cipto Mangunkusumo Hospital Indonesia: A Preliminary Study

Background : The techniques of cleft palate repair has faced significant evolutions. More importantly, no surgical protocol has been significantly associated with lower incidence of post-operative complications such as fistula formation, velopharyngeal insufficiency, or speech hypernasality. As cleft width is a strong predictor of outcomes, The Lima Protocol was introduced to select suitable surgical technique based on the degree of severity measured by palatal index. This article aimed to evaluate the efficacy of the newly established Lima Protocol in lowering post-operative complications in primary cleft palate repair surgery in Cleft and Craniofacial Center, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.Case Presentation : This study is a case series featuring 6 patients with cleft palate treated with primary palatoplasty. Surgical techniques were selected based on the degree of severity measured by Palatal Index. The average age of performing primary palatoplasty was 14 months. 50% of the cases was classified as Veau 2 and the rest was Veau 3. Half of the patients fell into severe category based on Palatal Index and the other half was in moderate group. None of the patients developed fistula formation 3 months post-palatoplasty.Discussion &amp; Conclusion: We confirmed that the 1-flap technique provided adequate closure comparable with the 2-flap technique without risking mucoperiosteal flap necrosis and fistula formation. Using the strengths of different surgical techniques individualized for each case based on the palatal index and grade of severity is indisputably a practical strategy. Trials with longer follow-ups are required to widely implement The Lima Protocol.

Revision Pharyngoplasty in Cleft Palate and Velopharyngeal Insufficiency: Management and Outcomes.

Velopharyngeal insufficiency (VPI), a stigmatizing hallmark of palatal dysfunction, occurs in a wide spectrum of pediatric craniofacial conditions. The mainstays for surgical correction include palate repair and/or pharyngeal surgery. However, primary pharyngoplasty has a failure rate of 15% to 20%. Although revision pharyngoplasty may be necessary in those with persistent VPI, little is known regarding the indications for and outcomes after such procedures. The purpose of this study is to describe the authors' experience with indications for and outcomes after revision pharyngoplasty. A single-center retrospective review was performed of all patients undergoing revision pharyngoplasty between 2002 and 2019. Demographic data and Pittsburgh Weighted Speech Scores, diagnoses, comorbidities, and complications were tabulated. Two-tailed Student t test was used, and a P value of 0.05 or less was considered statistically significant. Thirty-two patients (65.6% male) met inclusion criteria for this study. The most common diagnoses included cleft palate (68.8%), submucous cleft palate (SMCP, 18.8%), and congenital VPI (6.3%, likely occult SMCP). Most patients (84.4%) underwent palatoplasty before their initial pharyngoplasty. The primary indication for initial pharyngoplasty was VPI (mean age 7.1 ± 4.6 years). The most common indication for revision pharyngoplasty (mean age 11.2 ± 5.1 years) included persistent VPI (n = 22), followed by obstructive sleep apnea (OSA) (n = 11). Persistent VPI (n = 8) and OSA (n = 6) were the most common complications after secondary pharyngoplasty. Thirteen patients (40.6%) within the revision pharyngoplasty cohort required additional surgical intervention: 4 underwent tertiary pharyngoplasty, 4 underwent takedown for OSA (n = 3) or persistent VPI (n = 1), 3 underwent takedown and conversion Furlow for persistent VPI (n = 2), OSA (n = 2) and/or flap dehiscence (n = 1), and 2 underwent palatal lengthening with buccal myomucosal flaps for persistent VPI. Of the 4 patients who required a tertiary pharyngoplasty, the mean age at repair was 6.6 ± 1.1 years and their speech scores improved from 13.5 to 2.3 after tertiary pharyngoplasty (P = 0.11). The overall speech score after completion of all procedures improved significantly from 19 to 3.3. Patients who fail primary pharyngoplasty represent a challenging population. Of patients who underwent secondary pharyngoplasty, nearly half required a tertiary procedure to achieve acceptable speech scores or resolve complications.

The Comparison of the Efficacy of Early versus Late Administration of Dexmedetomidine on Postoperative Emergence Agitation in Children Undergoing Oral Surgeries: A Randomized Clinical Trial.

Background: Emergence Agitation (EA) is a dissociated state of consciousness characterized by irritability, uncompromising stance, and inconsolability. The etiology of EA is not completely understood. Dexmedetomidine is a highly selective α2-adrenoreceptor agonist with sedative and analgesic properties, which has been used to reduce the incidence of EA. We aimed to assess the efficacy of early versus late administration of dexmedetomidine on EA in children undergoing oral surgery.Methods: A randomized, parallel, double-blind clinical trial was conducted at Mofid Children’s Hospital affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran) from November 2016 to March 2017. A total of 81 children, who underwent adenotonsillectomy or cleft palate repair surgery were enrolled in the study. Based on simple randomization, the children were assigned to two groups, namely early (group A, n=41) and late (group B, n=40) administration of dexmedetomidine. Intra-operative and postoperative hemodynamic variables, extubation time, post-anesthesia care unit (PACU) length of stay, and the scores on Ramsay sedation scale and FLACC pain scale were measured and compared. The data were analyzed using SPSS software (version 20.0), and P<0.05 were considered statistically significant.Results: The mean FLACC score was lower in the late group than in the early group (2.0±1.5 vs. 4.2±1.6, P<0.001). The mean Ramsay sedation score was higher in the late group than in the early group (3.5±1.4 vs. 1.8±0.8, P<0.001).Conclusion: Late administration of dexmedetomidine 1 µg/kg reduced the incidence of EA and PACU length of stay and improved postoperative pain management.Trial registration number: IRCT 2016122031497N1.

Visual Resources for Postoperative Care to Overcome Language and Cultural Barriers.

Visual Resources for Postoperative Care to Overcome Language and Cultural Barriers.

Comprehensive Nursing Intervention Can Reduce Postoperative Complications and Shorten Hospital Stay of Children with Cleft Lip and Palate Repair Surgery

This research aims to probe into the impact of people-oriented comprehensive nursing intervention on children with cleft lip and palate repair surgery. Totally 112 lip cleft children who underwent surgical treatment in our hospital from June 2017 to March 2019 were randomized into routine and intervention groups. Among them, 55 in the former underwent routine nursing intervention, and 57 in the latter obtained comprehensive nursing intervention additionally. The hospital stay and complications of the two groups were observed. The hospital stay and complications in the latter were less than those in the former. Comprehensive nursing intervention can reduce postoperative complications and shorten hospital stay in children with cleft lip and palate repair surgery.

Airway Management for Cleft Palate Repair Surgery in an Pediatric Patient with Pierre Robin Syndrome: A Case Report

The children with Pierre Robin Sequence (PRS) have anatomical and physiological challenges of airway management. The children with PRS have difficult airway caused by micrognathia, glossoptosis, and cleft palate. The patients’ airway management who have PRS is dificult and requires attention. Here we present a 5-year-old girl with PRS, admitted to our hospital for cleft palate repair surgery. She also had a history of traсheostomy. Otholaryngologists had to perform trachestomy for this operation. The patient had an uneventful operative and postoperative period. We wanted to discuss the difficulties of airway management of the children with PRS with this case report. Anaesthesiologists must be ready for the challenges and otholaryngologists, must also be ready to manage these difficult airways. In addition, bronchospasm and airway obstruction after extubation are very common complications, so careful postoperative monitoring should be performed.

Correlation between alveolar cleft volume and alveolar bone quality in patients with unilateral cleft lip and palate: A cone-beam computed tomography study

ObjectivesThis study aimed to determine the correlation between alveolar cleft volume and fenestration and dehiscence in the adjacent alveolar bone in patients with unilateral cleft lip and palate (UCLP) using cone-beam computed tomography (CBCT) sections. Materials and methodsIn this descriptive, cross-sectional study, CBCT scans of 68 non-syndromic patients with UCLP aged between 6 and14 years were selected. All patients were treated in Iran and had undergone lip and palate repair surgery within the first 3 to 18 months after birth. CBCT scans had been taken after orthodontic expansion and prior to alveolar bone grafting surgery. Cleft volume, fenestration and dehiscence were assessed using Mimics software. Data were analyzed using independent t-test, Kruskal-Wallis test, Spearman's correlation coefficient and logistic regression model. ResultsThe mean alveolar cleft volume was 628.66±172.84 mm3. There was a significant negative correlation between cleft volume and fenestration (P<0.001). Also, there was a significant positive correlation between cleft volume and dehiscence (P<0.001) in the adjacent bone. ConclusionThe Mimics software can be successfully used to estimate the cleft volume prior to surgical procedures in UCLP patients. The results suggest that the alveolar cleft volume can be used as an aid to assess the periodontal condition of adjacent teeth. The cleft volume has a negative and positive correlation with fenestration and dehiscence respectively.

Surgical Team Trips to Vietnam: Implementation of a Dedicated Cleft Palate Perioperative Program Improves Fistula Rates.

ReSurge International is a nongovernmental organization that organizes surgical team trips to low- and middle-income countries. Cleft palate repair is commonly performed on these trips. A comprehensive cleft care program was implemented to help reduce postoperative palatal fistula rates. A retrospective review of all patients undergoing cleft palate repair surgery with ReSurge International in Vietnam from 2013 through 2019 was performed. The cleft care program was implemented in 2018. This intervention involved preoperative education of patients and close postoperative monitoring. Critically, this program also provided closer access to providers. Subsequent follow-up was performed by a ReSurge physician. Parent-reported outcomes were assessed preoperatively and postoperatively using 5-point Likert-like survey questions. Two hundred three patients underwent cleft palate repair. The patients were older and of higher Veau classification than is usually seen in the United States. The palatal fistula rate in the preintervention group was 37.5% and 14.3% in the intervention group (P = 0.014). Patients without fistulas demonstrated improvements on parent-reported outcomes compared with those with fistulas, with food less likely to go up their nose (P < 0.001), less difficulty eating (P < 0.001), and more understandable speech (P = 0.015). Implementation of a comprehensive cleft palate program reduced postoperative fistula rates by more than 50%. Improvements in parent-reported outcomes were observed after surgery among patients without fistulas. The blueprint for improved outcomes in these more complex patients includes enhanced perioperative patient counseling, close follow-up, and maintenance of communication with patients.

The Effectiveness of the Buccal Myomucosal Flap on Speech and Surgical Outcomes in Cleft Palate: A Systematic Review

Purpose: A systematic review was conducted to assess speech and velopharyngeal competence outcomes following the buccal myomucosal flap surgical approach used for primary palatoplasty and secondary surgery for velopharyngeal insufficiency (VPI) in individuals with cleft palate. Methods: A systematic review was guided by the PRISMA guidelines. Articles were included if the patients received the surgical technique for primary cleft palate repair or secondary surgery for VPI and if the study provided detailed methods on the perceptual speech assessment or visualization of postoperative velopharyngeal anatomy. Results: A total of 1013 patients were included from 11 studies. Post-surgery, normal resonance was achieved in 77.4% of patients and no nasal air emission was reported in 54.7% of patients. An improvement in velopharyngeal closure was reported in 81.8% of patients. A variety of perceptual speech assessment scales and methods for assessing velopharyngeal competence were used in the studies. Conclusions: The review suggests that the buccal myomucosal flap procedure results in improved velopharyngeal closure as evidenced by physiologic observation and reported perceptual changes in speech intelligibility, resonance balance, and reduced nasal air emission. The development of an international, standardized method for assessing and reporting speech outcomes and velopharyngeal competency is recommended to ensure accurate comparisons between surgical techniques. Keywords: Buccal flap, systematic review, perceptual speech assessment, speech outcomes, surgical outcomes. Read more →