Cleft Palate Patients Research Articles

Analysis of Health Determinants in Cleft Palate Patients.

This study aims to analyze health determinants affecting patients with cleft palate, specifically examining the relationships between the Social Vulnerability Index (SVI), failure to thrive (FTT), and healthcare utilization within the initial 30 days and first year of life. A retrospective analysis was conducted on patients with a cleft palate at a tertiary care center over an 11-year period. Data included demographics, weight percentile trends, pediatric emergency department (PED) visits, hospital admissions, SVI scores, cleft palate type, and FTT diagnoses. Statistical analyses were performed using SPSS. Social Vulnerability Index was not significantly correlated with health outcomes in cleft palate. Patients with FTT exhibited lower gestational age (P = .002) and birth (P = .005), one-month (P = .001), and one-year (P = .001) weight percentiles. FTT diagnosis was associated with increased PED visits (P = .000) and hospital admission (P = .000) in the first year of life. Early presentation to the PED was associated with increased PED visits (P = .000) and hospital admissions (P = .004) within the first year of life. No direct link was found between SVI and FTT. Early hospital readmission emerged as a significant outcome, indicating increased healthcare utilization in patients that require early medical intervention. Failure to thrive significantly impacted healthcare utilization, emphasizing the importance of addressing feeding issues early in this patient population. This study contributes to understanding health disparities in cleft palate patients and highlights the need for nuanced exploration of regional factors influencing outcomes.

Periodic Trends in the Incidence of Cleft Palate in a Cohort of Sri Lankan Cleft Palate Patients

Background: Over the last few decades the incidence of cleft palate has been increasing across the world. There are several genetic and environmental factors are reported to be among the causative agents of cleft palate. Theres scarcity of data with regards to the seasonality and the occurance of cleft palate among sri Lankans. Hence, the purpose of this study was to identify periodic changes in the incidence of cleft palate in a cohort of Sri Lankan population.Material & methods: Subjects (n=323) with cleft palate registered at the Regional Cleft Centre & Maxillo-Facial Department, Teaching Hospital, Karapitiya, Galle, from the 1st of January 2001 to 31st of December 2020 were included in the study. Structured interviewer based questionnaire was used to collect the information after obtaining the informed written consent.Results: Significantly higher number of cleft palate cases in this study were born in March (p = 0.008) compared with the national birth incidence while significantly lower numbers were born in October (p = 0.01). The sex ratio in the study sample was 0.71.Conclusions: The periodic trends in the incidence of cleft palate found in this preliminary study reinstated that environmental factors may have accounted for the reported seasonal variations observed in the incidence of cleft palate. Future studies are warranted to investigate the putative harmful seasonal factors that can influence the occurance of cleft palate.

Accuracy of intraoral scanners in neonates cleft anatomy.

This study investigated the accuracy of intraoral scanner (IOS) based on different image acquisition technologies in the field of presurgical-orthopedictreatment (PSOT) in neonates with cleft. Dental cast models of clinical situations representing unilateral cleft-lip-palate(UCLP), bilateral cleft-lippalate( BCLP) and cleft-palate(CP) with reference PEEK-scanbodies (Cares RC Mono-Scankörper, Straumann, Switzerland) were scanned utilizing four IOS systems: CareStream-CS3600®(CS), Medit-i500®(MD), Cerec-Omnicam®(SO), 3Shape-Trios-3®(TS). One calibrated operator made 5 scans from each model using each IOS (N=60). Reference digital impressions were obtained by an industrialgrade laboratory scanner (Sirona inEos-X5) and superimposed using best fit algorithm. The divergence measure was extracted and the scanners were compared in view of their accuracy using generalized least squares statistical models that account for variance heterogeneity. Additionally, comparative 3D analysis of scans was performed using the reverse engineering software (Geomagic-ControlX) in order to measure the discrepancy between intraoral scans and the reference scan in different anatomic regions of interest: alveolar-crest(AC), cleft(CL), palate(PL), vestibulum(VS), premaxilla(PM). The four IOS showed relevant and significant differences in estimated trueness (P<0.001) and precision (P=0.009). Among all anatomical models and analysed area of interest TS had the best accuracy (trueness: -1.57μm; precision: 9.41μm), followed by MD (trueness: - 20.63μm; precision: 29.18μm), CS (trueness: -40.43μm; precision: 16.52μm) and SO (trueness: 81.27μm; precision: 40.32μm). Impression of the maxilla in cleft lip and palate patients is challenging for the operator. Relevant and significant differences in trueness and precision were found between the four IOS. TS showed the best accuracy and was least influenced IOS under different anatomical situations.

Effect of cleft palate type and manufacturing method on feeding plate adaptation: A volumetric micro-computed tomography analysis.

Feeding plates for cleft palate patients have been used by clinicians for many years to temporarily close the oro-nasal communication until definitive treatment with surgical techniques. The current in vitro study aimed to evaluate the adaptation of the feeding plates manufactured by two different techniques for three cleft types. Feeding plates were manufactured with conventional compression molding (CM) and 3-dimensional (3D) additive manufacturing on main models representing bilateral cleft, unilateral right, and unilateral left cleft types (n=10). The 3D volumetric space between the feeding plate and the corresponding main model was measured by micro-CT to evaluate the adaptation. The adaptation of the plates was assessed based on three different measurement regions: anterior, left, and right. Repeated measure analysis of variance (ANOVA), three factorial ANOVA, and post hoc Bonferroni tests were used as statistical analysis (α=0.05). CM groups showed higher volumetric space measurements between the base and master model than 3D groups regardless of measurement region and cleft type, which refers to misfit (p˂0.05). Cleft type differed in the adaptation of 3D groups yet not in CM groups (p˂0.05). The volumetric space evaluation for the right measurement region resulted in higher values regardless of manufacturing method and cleft type (p˂0.05). Considering that 3D-printed feeding plates showed better adaptation compared to conventionally manufactured plates for all cleft types, 3D printing can be suggested as the manufacturing method of choice for feeding plates.

Effect of Probiotic Toothpaste on Enamel Mineralization and Streptococcus mutans Levels in Cleft Orthodontic Patients-A Randomized Clinical Trial.

To assess the effectiveness of probiotic and fluoride toothpaste on enamel mineralization and Streptococcus mutans levels in cleft lip and/or palate patients undergoing fixed orthodontic appliance therapy. A randomized comparative trial with a 1:1 allocation ratio. Thirty-two patients with cleft lip and/or palate undergoing fixed orthodontic appliances were recruited. Cleft lip and/or palate patients undergoing fixed orthodontic appliances were randomized into Group 1 (probiotic toothpaste) or Group 2 (fluoride toothpaste). The toothpaste was given to the patient after oral prophylaxis. The patients were advised to use the toothpaste two times a day (morning and night) for a period of 4 weeks. Enamel mineral content was assessed before intervention (T0) and after 4 weeks of intervention (T1) using DIAGNOdent. Streptococcus mutans levels were assessed after 4 weeks of intervention (T1) for both the groups using real time-polymerization chain reaction (RT-PCR). Paired t-tests and t-tests were used for intragroup and intergroup comparisons, respectively. A P-value < .05 was considered statistically significant. Both the groups showed improvement in enamel mineral content after 4 weeks of intervention. Streptococcus mutans levels in the probiotic-containing toothpaste were lesser when compared to the fluoridated toothpaste group. No statistically significant difference was found between probiotic toothpaste and fluoridated toothpaste in both the assessed parameters. Probiotic toothpaste is as effective as fluoride toothpaste in enamel remineralization. Probiotic toothpaste showed greater inhibitory effect on Streptococcus mutans than the fluoridated toothpaste.

Management of alar webbing using a CAD-CAM splint: A case report.

Alar webbing is a functional and aesthetic defect of the nasal structure noted in cleft lip and palate patients (CLP), which is thought to be due to a deficiency in nasal lining tissue. Surgical procedures have previously focused on the removal of lining or alar cartilage leading to worse post-operative defects. This case demonstrates a novel technique of releasing the tissue, followed by using a CAD-CAM splint to help mold the tissue during the healing process to better control esthetics, symmetry, and prevent relapse. The release of scarred tissue using a custom CAD-CAM stent is a promising technique that allows for symmetric healing and an overall aesthetic surgical result for patients.

Correlation between oral health knowledge and awareness and periodontal status in non-syndromic cleft lip and palate patients undergoing orthodontic treatment: a cross-sectional study

Introduction: Children and adolescents with non-syndromic cleft lip and palate (CLP) experience a higher prevalence of caries and periodontal disease compared to those without CLP. This increased prevalence is often attributed to greater plaque accumulation, which can lead to gingival inflammation and periodontal disease. This study aims to analyze the correlation between oral health knowledge and awareness and the periodontal health status of orthodontic patients with cleft lip and palate (CLP).Method: This study used a cross-sectional approach. The study population consisted of orthodontic patients with non-syndromic CLP who met the inclusion criteria. The research was conducted at the UNPAD Dental Teaching Hospital (RSGM Unpad) from March to May 2024. Twenty-seven participants with non-syndromic CLP were included in the study. A non-probability, purposive sampling technique was employed. oral health knowledge and awareness were assessed using questionnaires, while periodontal health examinations were evaluated using the Community Periodontal Index (CPI). Correlation analyses were performed using Kendall's Concordance Correlation (W). Additionally, Spearman Rank Correlation Analysis was conducted to identify the dominant variables. Results: The analysis revealed a Kendall's Concordance Correlation (W) of 0.544, which is statistically significant (p &lt; 0.0001), indicating a 54.4% relationship between the variables. The correlation between knowledge and periodontal health status in orthodontic patients with non-syndromic CLP was 11.16%, with a p-value of 0.0443 (p &lt; 0.05) and an r-value of 0.33. The correlation between awareness of oral health and periodontal health status in these patients was 19.85%, with a p-value of 0.0099 (p&lt;0.05) and an r-value of 0.45. Conclusion: There is a weak correlation between knowledge and awareness of oral health and the periodontal health status in non-syndromic CLP patients undergoing fixed orthodontic treatment.

Unilateral cleft lip and palate patients present cranial base modifications: a cross-sectional study.

The aim of this cross-sectional study was to perform a three-dimensional (3D) assessment of the cranial base of patients with unilateral cleft lip and palate (UCLP). Cone-beam computed tomography (CBCT) scans of 52 UCLP patients (21 females and 31 males; mean age, 10.0 ± 2.12 years) were compared with the scans of 72 individuals (24 females and 48 males; mean age, 11.0 ± 2.11 years) without CLP, matched by gender and age (control group, CG). The 3D Euclidean distances of anterior cranial base (N-S), posterior cranial base (S-Ba), total cranial base (N-Ba) lengths, cranial base width (Po-Po), as well as the cranial base flexure (NSBa), were measured using open-source software ITK-SNAP and 3D Slicer. Statistical analyses were carried out with the Student's t-test at a significance level of 5%. UCLP demonstrated shorter 3D distances than CG in the N-S, S-Ba, and N-Ba cranial base lengths (p < 0.001). In comparison with female CG, female UCLP had a smaller cranial base flexure (NSBa; p = 0.020). No statistically significant differences between UCLP and CG were found for the cranial base width (Po-Po). UCLP patients presented distinct morphological cranial base characteristics in comparison with CG. These results indicate that morphological and positioning changes in the maxillary bones are not solely attributable to the cleft and/or surgical procedures.

A case report of a denture for a defective jaw for a cleft lip and palate patient with oronasal fistula

A case report of a denture for a defective jaw for a cleft lip and palate patient with oronasal fistula

Evaluating quality of life changes in patients with cleft lip or palate: a mixed method pre- and postsurgical analysis in Karachi

BackgroundCleft lip and/or palate (CLP) is the most common orofacial congenital disability, presenting significant medical, psychological, and social challenges. In Pakistan, the incidence of CLP is high, estimated at one in 523 live births, but accurate data are lacking due to the absence of a birth registry. Early diagnosis and intervention are crucial for improving outcomes. This study evaluated the impact of CLP on patients’ quality of life in Karachi, comparing pre- and post-surgical phases.MethodsA sequential exploratory quantitative-qualitative mixed-methods study was conducted at two tertiary care hospitals in Karachi. In the quantitative phase, 280 patients with CLP, either awaiting or post-surgery, completed the Oral Health Impact Profile (OHIP-14) questionnaire to assess oral health-related quality of life (OHRQoL). Based on questionnaire responses, 30 participants were purposively selected for in-depth, semi-structured interviews exploring their experiences. Quantitative data were analyzed using SPSS version 25; qualitative data were analyzed thematically.ResultsQuantitative findings revealed significant gender disparities in cleft types and correction status; females had a higher prevalence of unilateral cleft lip, while males had more cleft palate cases. Dental and oral health issues significantly affected daily activities, with higher impacts in cleft palate patients. OHRQoL varied by gender, cleft type, and correction status, with those post-surgery reporting poorer OHRQoL. Qualitative analysis identified six themes: Diagnosis and Early Treatment, Challenges and Impact, Postsurgical Experiences, Support Systems, Healthcare Experiences, and Future Perspectives. Inconsistencies in psychological support, accessibility and financial burdens were presented as significant issues. Sentiment analysis highlighted varied emotions, from despair to hope and gratitude.ConclusionsCLP significantly affects patients’ quality of life in Karachi across multiple dimensions. Early diagnosis and surgical intervention are essential but often hindered by financial and accessibility issues. Psychological effects, including low self-esteem and social isolation, highlight the need for integrated mental health support. Family and community support are critical for patient resilience. A comprehensive approach addressing medical, psychological, social, and systemic factors is necessary to improve outcomes for individuals with CLP.

Smartphone-generated 3D facial images: reliable for routine assessment of the oronasal region of patients with cleft or mere convenience? A validation study

ObjectivesTo evaluate the validity and reliability of smartphone-generated three-dimensional (3D) facial images for routine evaluation of the oronasal region of patients with cleft by comparing their accuracy to that of direct anthropometry (DA) and 3dMD.Materials and methodsEighteen soft-tissue facial landmarks were manually labelled on each of the 17 (9 males and 8 females; mean age 23.3 ± 5.4 years) cleft lip and palate (CLP) patients’ faces. Two surface imaging systems, 3dMDface and Bellus3D FaceApp, were used to perform two imaging operations on each labelled face. Subsequently, 32 inter-landmark facial measurements were directly measured on the labelled faces and digitally measured on the 3D facial images. Statistical comparisons were made between smartphone-generated 3D facial images (SGI), DA, and 3dMD measurements.ResultsThe SGI measurements were slightly higher than those from DA and 3dMD, but the mean differences between inter-landmark measurements were not statistically significant across all three methods. In terms of clinical acceptability, 16% and 59% of measures showed differences of ≤ 3 mm or ≤ 5º, with good agreement between DA and SGI and 3dMD and SGI, respectively. A small systematic bias of ± 0.2 mm was observed generally among the three methods. Additionally, the mean absolute difference between the DA and SGI methods was the highest for linear measurements (1.31 ± 0.34 mm) and angular measurements (4.11 ± 0.76º).ConclusionsSGI displayed fair trueness compared to DA and 3dMD. It exhibited high accuracy in the orolabial area and specific central and flat areas within the oronasal region. Notwithstanding this, it has limited clinical applicability for assessing the entire oronasal region of patients with CLP. From a clinical application perspective, SGI should accurately encompass the entire oronasal region for optimal clinical use.Clinical relevanceSGI can be considered for macroscopic oronasal analysis or for patient education where accuracy within 3 mm and 5º may not be critical.

Artificial Intelligence for Tooth Detection in Cleft Lip and Palate Patients.

Introduction: Cleft lip and palate patients often present with unique anatomical challenges, making dental anomaly detection and numbering particularly complex. The accurate identification of teeth in these patients is crucial for effective treatment planning and long-term management. Artificial intelligence (AI) has emerged as a promising tool for enhancing diagnostic precision, yet its application in this specific patient population remains underexplored. Objectives: This study aimed to evaluate the performance of an AI-based software in detecting and numbering teeth in cleft lip and palate patients. The research focused on assessing the system's sensitivity, precision, and specificity, while identifying potential limitations in specific anatomical regions and demographic groups. Methods: A total of 100 panoramic radiographs (52 males, 48 females) from patients aged 6 to 15 years were analyzed using AI software. Sensitivity, precision, and specificity were calculated, with ground truth annotations provided by four experienced orthodontists. The AI system's performance was compared across age and gender groups, with particular attention to areas prone to misidentification. Results: The AI system demonstrated high overall sensitivity (0.98 ± 0.03) and precision (0.96 ± 0.04). No statistically significant differences were found between age groups (p > 0.05), but challenges were observed in the maxillary left region, which exhibited higher false positive and false negative rates. These findings were consistent with the prevalence of unilateral left clefts in the study population. Conclusions: The AI system was effective in detecting and numbering teeth in cleft lip and palate patients, but further refinement is required for improved accuracy in the cleft region, particularly on the left side. Addressing these limitations could enhance the clinical utility of AI in managing complex craniofacial cases.

Rehabilitation of Completely Edentulous Patient with Cleft Palate Using Neutral Zone and Palatogram Technique

Cleft lips and palates are congenital anomalies affecting the mouth and face. For fully edentulous patients with a cleft palate, crafting complete dentures is particularly challenging. These dentures, which incorporate an obturator and extend into the palate, must be meticulously designed to address issues related to appearance, speech, swallowing, and chewing. Treatment for cleft lip and palate aims to restore function, speech, and aesthetics through the use of fixed prostheses, removable prostheses, and implants. The approach should follow key principles of oral rehabilitation, including maintaining proper physiology, stability, aesthetics, hygiene, and considering patient expectations. To ensure the durability of prosthetic solutions, it is crucial to respect both the periodontal and dental tissues and the biomechanics of the prosthesis. Palatogram is an effective and straightforward technique for assessing and verifying palatal contours, which helps in addressing speech deficiencies related to affected sounds. Managing completely edentulous adults with cleft palates, particularly those who have not undergone surgical intervention, presents a significant challenge for prosthodontists. This case report explores the use of a conventional complete denture for a cleft palate patient, utilizing the palatogram technique to precisely record the palatal contours, the neutral zone technique to optimize denture stability by aligning forces in harmony with oral musculature, and monoplane teeth to reduce lateral forces and enhance denture stability. Together, these techniques aim to improve speech, mastication, and comfort, providing a functional and aesthetic prosthesis suited to the patient’s unique anatomical needs. This case demonstrates the successful rehabilitation of an edentulous cleft palate patient using a conventional complete denture with specialized techniques to address the unique anatomical and functional challenges presented. The neutral zone technique, monoplane teeth arrangement, and palatogram technique were crucial in achieving a stable, functional, and aesthetically pleasing denture. These methods helped optimize denture retention and stability, improve phonetics, and enhance masticatory efficiency, providing the patient with a significant improvement in quality of life and self-confidence. For patients unable to pursue more invasive and costly implant-supported options, such techniques offer a viable and effective solution for complete denture fabrication, allowing for functional and aesthetic rehabilitation within economical constraints.

Prevalence of hypomineralised second primary molars and molar incisor hypomineralisation in patients with cleft lip and/or palate.

This study aimed to determine the prevalence of hypomineralised second primary molars (HSPM) and molar incisor hypomineralisation (MIH) in cleft lip and/or palate (CL/P) patients. A retrospective analysis of intraoral photographs of CL/P patients was done. All patients born between 2000 and 2011, and visiting the cleft team of the Erasmus Medical Center in Rotterdam, The Netherlands, were included. Their photos were scored on the presence and severity of HSPM and MIH using criteria formulated by the European Academy of Pediatric Dentistry. The outcomes were compared with data of the general population, extracted from the Generation R study. The photos of 535 CL/P patients were evaluated. The overall prevalence of HSPM in CL/P patients was 15.2%, of MIH 12.8%. HSPM and MIH prevalence was significantly higher (both p < 0.001) compared to prevalence inthe general population. No significant differences were found in prevalence of HSPM nor of MIH in CL/P patients based on gender (p = 0.891 resp. p = 0.405), cleft type (p = 0.282, resp. p = 0.415), Pierre Robin (p = 0.837, resp. p = 0.169) or other comorbidities (p = 0.553, resp. p = 0.617). CL/P patients with HSPM were almost 3 times more likely diagnosed with MIH than CL/P patients without HSPM (OR = 2.57, p = 0.002). The prevalence of HSPM and MIH is higher in patients with CL/P than in the general population.

Modified Two-Flap Palatoplasty With Leaving Lateral Periosteum and Application of Honey Pack : A Preliminary Study

According to our experience in Ciptomangunkusumo hospital, most cleft palate patients has wide gap. It makes the epithelialization of the lateral defect takes longer time ( 3- 4 weeks). In this study, the authors propose a modified technique to the two-flap palatoplasty by not elevating the lateral part of the periosteum with the flap, and then apply honey packs to cover the lateral defects. The technique modification and additional honey-soaked dressing are expected to hasten the epithelialization rate. Twelve consecutive patients with non-syndromic cleft palate (with or without cleft lip) are included in the study. They undergo the modified two-flap palatoplasty with the lateral periosteum left behind, covering the palatal bone and the utilization of Honey pack. The rate of epithelialization is then observed every 2 days after operation until full healing is achieved. Complete epithelialization was attained within 5 days in one patient ( 2,8 mm/day), within 7 days in 8 patients (2-2,5mm/day), and within 9 days in 3 patients (2,2-2,7mm/day). There were no surgical complications, such as hemorrhage or wound infection. The fistula of the palate was not found until the defect closed. Our technique hasten the rate of epithelialization. It may prevent the maxillary growth disturbances in the future because faster healing reduces scar formation and wound contraction.

Maxillary Growth Evaluation After Cleft Palate Repair Using Goslon Criteria: Preliminary Study

Background: The goal of palatoplasty is to achieve normal maxillofacial growth, normal speech, and prevent hearing loss. Disturbance of maxillary growth may occur in cleft lip palate patients after palatoplasty. To determine how many patients later developed a disrupted maxillary growth following operations, a retrospective study was designed to evaluate patients with complete unilateral cleft lip and palate who have undergone two-flap palatoplasty.Methods:A retrospective analytic study evaluated the maxillary growth of 15 consecutive unilateral cleft lip and palate patient aged around 8-year-old treated in the Division of Plastic Surgery Cipto Mangunkusumo Hospital, Jakarta. Cephalogram and dental study models were used to assess growth. Cleft lip and palate repair were performed to all patients without alveolar bone graft or any orthodontic treatment. Result: The cephalogram shows that 53,3% of the patients developed maxillary hypoplasia post palatoplasty. Mean value of the Goslon Yardstick was 3,53 (intermediate category by Goslon criteria).No patient fell into the Goslon 1 or 5 categories. Discussion: Disturbed maxillary growth is postulated to be caused by the manipulation and suturing of the maxillary vomer, and scarring of the dentoalveoli post-surgery. Another contributing factor is the intrinsic tissue deficiency. Conclusion: Maxillary hypoplasia is a possible complication following two !ap palatopasty, affecting either anteroposterior, transversal and vertical maxillary growth. This finding needs to be proven especially after the process of growth ceased. It is highly probable that maxillary disruption is higher when the two flap palatoplasty technique leaves lateral areas of denuded bone on the maxillary tuberosity.

Antropometric Evaluation Of Gentur's Cheiloplasty Method In Unilateral Cleft Lip

Background: Cheiloplasty, the earliest surgical procedure in cleft lip and palate patient, has impact on functional and aesthetical appearance1. The Gentur’s technique is a method of cleft lip surgery that has been developed by him and has been used in RSUPN Cipto Mangunkusumo/Faculty of Medicine Universitas Indonesia2. It uses the rotation-advancement, small triangular, preventing notching concepts with some other details to overcome the wide cleft. This study was conducted to answer whether the Gentur’s technique gives symmetrical result in anthropometric measurements. Methods: Cross sectional analytic study will be taken from medical record in 14 unilateral cleft lip patients underwent cheiloplasty procedure. Direct anthropometric data before and after procedure were analyzed using SPSS17. Anthropometric data such as cupid’s bow, vertical height, horizontal height, vermillion and nostril were noted. Results: From 14 patients, we found 9 patients who underwent surgery in 3 months of age (64.3%) are mostly female (n=9, 64.3%), have complete defect (n=12, 85.8%) and left sided defect (n=8, 57.1%). Gentur’s technique is able to produce significant lip and nose symmetry (CI 95%, pvalue &lt;0.005) in cupid’s bow, vertical height, horizontal height, thickness of vermillion and nose. By doing this technique, the author is able to create good lip and nose symmetry (78.57%) even in wide defect (64.3%) and palatal collapse (57.1%). Conclusion: Gentur’s technique is able to utilize tissue deficiency to create ideal lip and nose in unilateral cleft lip repair even in patients with wide gap.

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

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.

Undernutrition in Cleft Palate Surgery: Effects on Postoperative Fistula Formation in a Tertiary Children's Hospital in Southern Africa.

Cleft palate surgery can be complicated by fistula development. It is well known that undernutrition in general leads to more postoperative complications. However, little is known about postoperative fistula development after cleft palate surgery in low- and middle-income countries (LMIC's). The aim of this study was to investigate the influence of peri-operative undernutrition on the risk of postoperative fistula formation in South African children operated on for cleft palate (CP). Three hundred thirty-seven cleft palate patients undergoing initial cleft palate repair at Red Cross War Memorial Children's Hospital were retrospectively reviewed. Undernutrition was measured as World Health Organisation (WHO) Weight-For-Age (WFA) Z-scores, postoperative fistula was noted when the patient received revision surgery for fistula after the initial repair. Longitudinal Generalized Estimation Equations (GEE) analysis was used to examine the influence of the undernutrition Z-Score on post-operative fistula formation. Our cohort had a mean Z-score of -0.873 (SD=1.6043). Among patients undergoing initial cleft palate repair, 21.9% were perioperatively underweight for age (Z-Score < -2), and 8.8% were severely underweight (Z-Score < -3). The cohort had a total symptomatic fistula rate of 19.9%. Decreasing perioperative WFA Z-Score (worsening undernutrition), predicts a significant increase in the odds of postoperative fistula (odds ratio = 1.233, P = 0.018). Worsening perioperative undernutrition in initial cleft palate surgery is associated with a significant postoperative increase in fistula formation.

Using the superiorly based pharyngeal flap to surgically manage cleft velopharyngeal insufficiency: a cohort study

Introduction: The surgical management of velopharyngeal insufficiency is traditionally guided by algorithms based on dynamic imaging, such as nasoendoscopy and video fluoroscopy. In practice, however, surgeons often favour a single surgical technique in all patients—irrespective of observed velopharyngeal closure pattern. In this study, we examine the utility of the superiorly based pharyngeal flap for correcting velopharyngeal insufficiency in a cohort of patients with varied velopharyngeal closure patterns. Methods: A retrospective cohort study was conducted of velopharyngeal insufficiency patients treated by a single surgeon at the Royal Children’s Hospital, Melbourne, between 2008 and 2015. Prior to surgery, patients underwent speech evaluation as well as nasopharyngoscopy for assessment of velopharyngeal closure pattern. Irrespective of the closure pattern observed, patients were treated using a superiorly based pharyngeal flap. Following surgery, serial evaluations for residual velopharyngeal insufficiency and surgical complications were performed. Results: A total of 18 cleft palate patients met the criteria for study inclusion. Preoperative speech evaluation revealed mild velopharyngeal insufficiency in one patient (5.6%), moderate velopharyngeal insufficiency in nine patients (50%), and severe velopharyngeal insufficiency in eight patients (44.4%). Repeat speech evaluation one year after surgery demonstrated correction of velopharyngeal insufficiency in 17 patients, representing a 94.4 per cent success rate. Furthermore, only two patients experienced postoperative snoring (11.1%). Conclusion: Consideration of velopharyngeal closure pattern is not required for effective surgical management of velopharyngeal insufficiency.