Primary Palate Research Articles

EVALUATION OF DERMATOGLYPHIC PATTERNS AND THEIR CORRELATION WITH SKELETAL MALOCCLUSIONS

Background and Objectives: Dermatoglyphics deals with the study of the epidermal ridges and their congurations on the ngers, palms and soles. Epidermal ridge patterns form early in fetal development and remain unchanged throughout life and play a signicant role in the diagnosis of many disorders with genetic background. As the primary palate, lip and dermal ridges develop during the same period of intrauterine life, the genetic message contained in the genome - normal or abnormal, is deciphered during this period and is also reected by dermatoglyphics. The present study was undertaken to evaluate the different dermatoglyphic patterns and their correlation with skeletal malocclusions. The study was conducted on 90 individuals divided into 3 equal groups- skeletal Methods: class I, II and III. Dermatoglyphic patterns were recorded using ink method following rolling impression technique. The dermatoglyphic data was assessed for different nger ridge patterns and total ridge count (TRC). On compar Results: ison skeletal class I group showed markedly decreased number of loops and increased total ridge count (TRC). Skeletal class II showed markedly increased number of loops and markedly decreased TRC. Skeletal class III showed markedly decreased number of arches and increased TRC. Loops were found to be the most predominant pattern in skeletal class II and III groups. The mean TRC was found to be increased in skeletal class III group and markedly decreased in skeletal class II group which was statistically signicant. Dermatoglyphics can be used as a screening tool and for early prediction of skeletal mal Conclusion: occlusion at a younger age group. Dermatoglyphics have important practical and clinical implications which can be applied for preventive and interceptive orthodontics among paediatric patients and also for parent counseling.

Cayler Syndrome with Isolated Cleft Palate: Case Report

Published on:August 2022 Journal of Young Pharmacists, 2022; 14(3):337-338 Case Report | doi:10.5530/jyp.2022.14.66 Authors: Elizabeth Jacob*, Cyril Sajan Department of Pharmacy, Sumandeep Vidyapeeth (Deemed to Be University), Vadodara, Gujarat, INDIA. Abstract: The present study was focused on assessing the clinical Isolated cleft palate is the term used when a cleft occurs only within the palate. In clinical terms it is differentiated from other clefts, affecting the primary palate because it as such doesn’t affect either the alveolar ridge or the perioral musculature. This makes the diagnosis of the cleft, by facial analysis, more challenging, since it is concealed in the palate. Cayler syndrome is an abnormal condition at birth represented by hypoplasia of the depressor angular oris muscle (HDAOM) in an addition to cardiac birth defects. A considerable range of multiple organ system anomalies are also to predicted to be present. Paediatrician must make awareness regarding this minor facial anomaly as it can be related to multiple, cardiac and internal organs abnormalities. I present to you a paediatric rare case of cleft palate which appears to be isolated, along with cayler syndrome. To my knowledge no previous report on situs inverse totalis was reported. Additionally, the patient does not have any major cardiac anomalies associated with the cayler complications.Keywords: Isolated cleft palate, Cayler syndrome, Palatoplasty, Palatogenesis, Clefting.

Impact of a Palatal Fistula After Cleft Palate Repair on Velopharyngeal Closure.

A palatal fistula is an adverse outcome of cleft palate repair. It is unknown if a palatal fistula will influence velopharyngeal closure, even after repair of the fistula. This study determines the effect of a soft palate fistula on the risk of developing velopharyngeal insufficiency. A retrospective chart review was conducted on patients who underwent primary cleft palate repair between 2000 and 2015, with complete records at 4 years of age. Fistulae involving the secondary palate following primary palatoplasty were classified as the soft or hard palate. A forced-entry multivariate logistic regression model was built to detect predictors of velopharyngeal dysfunction. Records of 329 patients were analyzed with a mean follow-up of 8.7 years. A palatal fistula was identified in 89/329 patients (27%) and 29/329 patients (9%) underwent an independent fistula repair. Of the patients with fistula, 44% were located in the hard palate only and 56% had soft palate involvement. Compared to patients without a fistula, rates of velopharyngeal dysfunction were significantly higher in patients with a fistula involving the soft palate (OR 3.875, CI: 1.964-7.648, P < .001) but not in patients with a hard palate fistula (OR 1.140, CI: 0.497-2.613, P = .757). Veau class, age at primary repair, and syndromic status were not significant predictors of VPI (0.128≤P ≤ .975). A palatal fistula involving the soft palate is a significant predictor for development of velopharyngeal dysfunction after primary palatoplasty. Surgical intervention, at the time of fistula repair, to add vascularized tissue may be indicated to prophylactically decrease the risk of velopharyngeal dysfunction.

Institutional Trends in Opioid Prescribing and Utilization after Primary Cleft Lip and Palate Repair.

Outpatient prescriptions for postoperative pain play an important role in the opioid epidemic. Prescribing guidelines are an effective target for intervention but require procedure-specific data to be successful. The aim of this study was to examine opioid prescribing patterns and pain control after primary cleft lip and palate repair at a large academic center. Children undergoing cleft lip and palate repair from April of 2018 to July of 2019 were included in a prospective cohort study. Data on discharge prescriptions, refills, and emergency room visits were obtained from the medical record. Caregivers were surveyed 7 to 21 days after surgery regarding pain control, opioid use, education exposure, storage, and disposal. Chi-square tests and one-way analysis of variance were used to examine predictors of pain control, opioid consumption, safe storage, and disposal. After screening, 59 children were included in the study. Patients were 55.8 percent male with a median age of 12 months (interquartile range, 5 to 15). Ninety percent of patients received an opioid prescription at discharge with a mean quantity of 10 doses (interquartile range, 5 to 15). Ninety-seven percent of caregivers used adjunct medication. Opioids were given for a median of 3 days (interquartile range, 2 to 6.5). Seventy-six percent of caregivers gave less opioid than prescribed. There was no association between pain control and opioid quantity ( p = 0.68). Twenty-four percent of caregivers used locked storage. Thirty-four percent of respondents with leftover medication reported disposal. Opioids are often overprescribed after cleft lip and palate repair. Providers should consider limiting prescriptions to a 3-day supply to help reduce the quantity of opioids available in the community.

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.

Whole-genome sequencing reveals de-novo mutations associated with nonsyndromic cleft lip/palate

The majority (85%) of nonsyndromic cleft lip with or without cleft palate (nsCL/P) cases occur sporadically, suggesting a role for de novo mutations (DNMs) in the etiology of nsCL/P. To identify high impact protein-altering DNMs that contribute to the risk of nsCL/P, we conducted whole-genome sequencing (WGS) analyses in 130 African case-parent trios (affected probands and unaffected parents). We identified 162 high confidence protein-altering DNMs some of which are based on available evidence, contribute to the risk of nsCL/P. These include novel protein-truncating DNMs in the ACTL6A, ARHGAP10, MINK1, TMEM5 and TTN genes; as well as missense variants in ACAN, DHRS3, DLX6, EPHB2, FKBP10, KMT2D, RECQL4, SEMA3C, SEMA4D, SHH, TP63, and TULP4. Many of these protein-altering DNMs were predicted to be pathogenic. Analysis using mouse transcriptomics data showed that some of these genes are expressed during the development of primary and secondary palate. Gene-set enrichment analysis of the protein-altering DNMs identified palatal development and neural crest migration among the few processes that were significantly enriched. These processes are directly involved in the etiopathogenesis of clefting. The analysis of the coding sequence in the WGS data provides more evidence of the opportunity for novel findings in the African genome.

Association of social and psychological aspects of quality of life and educational level of patients with different orofacial cleft.

To determine the social and psychological domains of quality of life of children with orofacial clefts in the context of different types of clefts and educational levels. The cross-sectional study was conducted at Clapp Hospital and Mayo Hospital, Lahore, Pakistan from September 1, 2020, to January 31, 2021, and comprised subjects of either gender aged 6-18 years having orofacial clefts. Data was collected using the CLEFT-Questionnaire along with a basic demographic sheet. Data was analysed using SPSS 23. Of the 80 subjects, 40(50%) each were males and females. The overall mean age was 12.41±3.39 years. A significant association of types of orofacial clefts with social function (p<0.05) and psychological function (p<0.05) was observed. The highest mean score of 27.89±3.41 and 26.11±1.76 was noted for unilateral left side cleft lip, and primary palate, respectively. No significant association of level of education with social function (p>0.05) and psychological function (p>0.05) was noted. Different types of orofacial clefts affected the psychological and social aspects of quality of life of patients differently, but the difference was not significantly correlated with the education level.

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.

Perioperative Pain Management After Primary Palate Repair: A 3-Surgeon Retrospective Study.

Pain management strategies following palatoplasty vary substantially. Despite efforts to reduce narcotic utilization, specific analgesic regimens are typically guided by surgeon preference. Our aim was to define analgesic variables that affect postoperative narcotic use and time to resumption of oral intake. This is a retrospective review from 2015 to 2018. Nonsyndromic patients undergoing primary palate repair. Analgesic variables included: local anesthetic, pterygopalatine ganglion nerve block, palatal pack, and postoperative use of ketorolac, dexamethasone, and nursing-controlled analgesia (NCA) opioid dosing. Proxy measures for pain included time to resumption of oral intake and morphine equivalence (mg/kg/h) administered. Veau phenotypes for the 111 patients included were: I (28%), II (19%), III (33%), IV (16%), and submucous (4%). Age, weight, local anesthetic, and postoperative use of ketorolac, dexamethasone, and palatal pack had no effect on either proxy measure (P > .05). Postoperative narcotic usage was significantly lower in patients who had an intraoperative suprazygomatic peripheral nerve block and significantly higher when NCA was utilized (P < .05). Neither variable had a significant impact on time to resumption of oral intake (P > .05). Several perioperative analgesic strategies lead to comparable postoperative consumption of narcotic and time to resume oral intake. The authors advise careful consideration of NCA due to the potential for increased narcotic utilization that we found in our institution. Based on our promising findings, further studies are warranted to assess risks, benefits, and costs of performing peripheral nerve blocks at the time of palatoplasty.

Congenital nasal pyriform aperture stenosis with holoproencephaly: Diagnosis and surgical management

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal nasal obstruction that clinically mimics choanal atresia. It occurs as a result of abnormal development of primary palate and maxilla, either in isolation or in association with other anomalies. Differentiation between CNSPAS and choanal atresia is critical as management approachers are quite different from one another. Diagnosis can be made clinically and with characteristics CT findings. Management options include both conservative and surgical approaches depending on the patient’s initial condition. Here is reported a case of 33 days infant who was admitted to our NICU with a working diagnosis of CNPAS after she presented with two days of fast breathing and failure to suckle, managed surgically and discharged improved.

Closing the Gap: A Systematic Review and Meta-Analysis of Enhanced Recovery After Surgery Protocols in Primary Cleft Palate Repair.

Assess the evidence for Enhanced Recovery After Surgery (ERAS) protocols in the cleft palate population. A systematic review of MEDLINE, Embase, Cochrane, and CINAHL databases for articles detailing the use of ERAS protocols in patients undergoing primary palatoplasty. New York-Presbyterian Hospital. Patients with cleft palate undergoing primary palatoplasty. Meta-analysis of reported patient outcomes in ERAS and control cohorts. Methodological quality of included studies, opioid use, postoperative length of stay (LOS), rate of return to emergency department (ED)/readmission, and postoperative complications. Following screening, 6 original articles were included; all were of Modified Downs & Black (MD&B) good or fair quality. A total of 354 and 366 were in ERAS and control cohorts, respectively. Meta-analysis of comparable ERAS studies showed a difference in LOS of 0.78 days for ERAS cohorts when compared to controls (P < .05). Additionally, ERAS patients utilized significantly less postoperative opioids than control patients (P < .05). Meta-analysis of the rate of readmission/return to ED shows no difference between ERAS and control groups (P = .59). However, the lack of standardized reporting across studies limited the power of meta-analyses. ERAS protocols for cleft palate repair offer many advantages for patients, including a significant decrease in the LOS and postoperative opioid use without elevating readmission and return to ED rates. However, this analysis was limited by the paucity of literature on the topic. Better standardization of data reporting in ERAS protocols is needed to facilitate pooled meta-analysis to analyze their effectiveness.

The use of acellular dermal matrix in palatoplasty to decrease the rate of postoperative oronasal fistula.

Different cleft palate repair techniques have been described to achieve optimum results and minimise complications. Postoperative fistulae are one of the most challenging complications after palate repair. In this clinical study, we reviewed the records of patients who underwent palatoplasty using acellular dermal matrix (ADM) as an addition to facilitate difficult cleft palate and palatal fistula closure. It was a retrospective, comparative, single-centre study, in which records of patients who underwent cleft palate surgeries between 2015 and 2018 were reviewed. Patients who underwent cleft palate or palatal fistula repair with and without ADM were included. Fischer's exact test was used to compare the two groups (primary cleft palate repair with and without ADM) in relation to the rate of fistula occurrence postoperatively. Charts of a total of 31 patients were reviewed. ADM was used in 13 patients; 8(61.5%) were primary repairs and 5(38.5%) were fistula repairs. Eighteen patients were repaired without ADM, of whom 16(88.9%) were primary cleft palate repairs and 2(11.1%) were fistula repairs. The statistical analysis showed no significant difference in fistula formation rate or recurrence in both the groups. ADM is a simple, safe, and helpful tool for augmenting cleft palate repair, mainly in relatively wide and high-tension cleft palate repairs. In our study, a trend showing decreased complications with ADM was observed. Therefore, we recommend a multi-centre study with a larger sample to assess the significance of ADM in cleft palate and palatal fistulae repair.

Buccal Fat Pad: Adjunctive Procedure for Lateral Defect Coverage following Primary Palatoplasty.

The buccal fat flap is an encapsulated mass originating from a specific fat tissue that is easily accessed and richly vascularized. The aim of this study was to report the effect of using the buccal fat flap on the oronasal fistula rate in primary palatoplasty. A case-controlled study of 94 patients who underwent primary cleft palate repair. Patients were divided into two groups: (1) two-flap palatoplasty with buccal fat flap for coverage of lateral hard palate defect and (2) conventional two-flap palatoplasty. The incidence of oronasal fistula and postoperative complications were compared between groups. Multivariate analysis was performed to determine the risk factors of oronasal fistula development. Forty-seven patients in each group demonstrated the same baseline characteristics. The buccal fat group showed a significant lower postoperative oronasal fistula rate (2.13 percent versus 21.28 percent, p = 0.008) and smaller fistula size (2 mm versus 4 mm, p = 0.049). A cleft width wider than 11.5 mm increased the odds ratio of fistula formation by 8.44-fold (p = 0.047), and the use of buccal fat protected against postoperative palatal fistula formation (OR, 0.08, p = 0.019). The use of buccal fat flaps for lateral hard palatal defect coverage in primary palatoplasty can reduce the rate of postoperative palatal fistula, especially in cases of wide palatal cleft. Therapeutic, III.

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.

Speech and swallowing function following microsurgical reconstruction of palatal defects in a series of six pediatric patients.

Reconstruction of extensive palatal defects in growing patients aims to restore speech intelligibility and swallowing function while avoiding excessive scarring formation that may cause growth disturbances in the palate and midface region. Free flaps transfer healthy, well-vascularized tissue to the defect area, and their combination with pharyngeal flaps allow for restoration of the velopharyngeal function. We examined speech and swallowing after microsurgical palate reconstruction in a series of six pediatric patients. Radial forearm free flaps were used in all cases, in combination with a superiorly based pharyngeal flap in five cases. Mean age at surgery was 10.7 years. Etiologies included recurrent oronasal fistula due to failed primary cleft palate repair (n=4), embryonal rhabdomyosarcoma of the maxilla (n=1), and inflammatory fibrous hyperplasia (n=1). Speech evaluations (with the Hirose standard and listener ratings) and swallowing assessments (based on videofluoroscopy swallowing studies and patient-reported swallowing and diet) were performed in average 44 months postoperatively. All flaps survived without major postoperative complications. Speech intelligibility was graded as "excellent" in four patients and "moderate" in two. Hypernasality and nasal obstruction were each judged as "none/minimal" in five cases and "moderate" in one case. All patients tolerated oral diet without significant nasal regurgitation. In five of six patients, the swallowing assessment showed good motion and velopharyngeal closure. Microsurgical reconstruction of extensive palatal defects using radial forearm free flap, with or without a superiorly based pharyngeal flap, is a reliable technique that can deliver substantial improvement of speech and swallowing in pediatric patients.

Primary Palatoplasty: A Comparison of Results by Various Techniques - A Retrospective Study.

Introduction:To identify a better method for primary cleft palate (CP) repairs with respect to velopharyngeal function.Materials and Methods:A retrospective, longitudinal review of medical charts of patients with congenital CP who underwent four different techniques of palatoplasty, performed by three different surgeons in the Department of Maxillofacial Surgery of the National Center for Maternal and Child Health. Nasopharyngoscopy (NPS) was used for velopharyngeal function evaluation. CP was classified according to the Veau system and the “Golding-Kushner” scale for NPS results was used for assessing the patient’s velopharyngeal function and its association with cleft types and the primary palatoplasty techniques. Pearson’s Chi-square analysis and binary logistic regression were used for statistical analysis.Results:A total of 335 patients were included in the study. The mean age at primary palate repair was 22.9 ± 13.6 months. There were 56, 42, 177, and 60 patients with Veau-I, Veau-II, Veau-III, and Veau-IV types, respectively, whereas for primary palatoplasty 65 patients underwent Furlow, 148 patients – Mongolian, 108 patients – two flap, 34 patients – von Langenbeck technique. NPS assessment of adequate velopharyngeal function was followed by Furlow’s technique in 89.4% of cases, Mongolian technique in 62.2% of cases but by “two flap” only in 48.1% and von Langenbeck in 47.1% of cases.Discussion:The Furlow and Mongolian techniques were superior for maintaining velopharyngeal function after primary palatoplasty.

PECULIARITIES OF THE HUMAN MAXILLA MORPHOGENESIS.

The aim: To find out the sources of formation and the chronological sequence of the morphogenesis of the maxilla at the early stages of human ontogenesis. Materials and methods: 14 series of consecutive histological specimens of human embryos and prefetuses (4,0-66,0 mm of parietal-coccygeal length) aged from 4 to 11 weeks of intrauterine development with the use of a complex of modern morphological methods of investigation (anthropometry, morphometry, microscopy, and 3D computer reconstruction) were studied. Results: On the basis of a complex of morphological research methods, data were obtained that made it possible to establish the general patterns of development of the human maxilla: separation of the pharyngeal apparatus (4th week), convergence and fusion of the jaw processes (5-8th weeks), formation of tooth buds (7-8th weeks), which allows considering the specified periods as critical in the formation of possible anomalies in the facial part of the skull. At the same time, a tendency of heterochrony of morphological transformations in the maxilla and maxilla was revealed. Conclusions: 1. At the beginning of the 4th week of intrauterine development, 3 pairs of pharyngeal arches are formed. Detachment of the mandibular and maxillary processes of the mandibular pharyngeal arch is planned. 2. During the 7th week of intrauterine development, the maximum convergence of the maxillary processes with the lateral and medial nasals occurs, and in embryos of 20.0 mm PCL grow with the frontal process, forming the maxilla and upper lip. During the 8th week of intrauterine development, the bone base of the jaws is modeled as a result of the increase in the size of osteogenic islands and their fusion, alveolar processes are formed. 3. During the 9-10th weeks of intrauterine development, the primary palate is formed as a result of the fusion of the palatine processes. 4. At the 11th week of intrauterine development, the bone base models both jaws. Due to the processes of histogenesis of the soft tissues of the maxillofacial apparatus, the face acquires anthropomorphic definitive human features.

Incidence of fistula after primary cleft palate repair: a 25-year assessment of one surgeon's experience.

BackgroundCleft lip and cleft palate are the most frequent congenital craniofacial deformities, with an incidence of approximately 1 per 700 people. Postoperative palatal fistula is one of the most significant long-term complications. This study investigated the incidence of postoperative palatal fistula and its predictive factors based on 25 years of experience at our hospital.MethodsWe retrospectively reviewed 636 consecutive palatal repairs performed between January 1996 and October 2020 by a single surgeon. Data from patients’ medical records regarding cleft palate repair were analyzed. The preoperative extent of the cleft was evaluated using the Veau classification system, and the cleft palate repair technique was chosen according to the extent of the cleft. SPSS version 25.0 was used for all statistical analyses, and exploratory univariate associations were investigated using the t-test.ResultsFistulas occurred in 20 of the 636 patients; thus, the incidence of palatal fistula was 3.1%. The most common fistula location was the hard palate (9/20, 45%), followed by the junction of the hard and soft palate (6/20, 30%) and the soft palate (5/20, 25%). The cleft palate repair technique significantly predicted the incidence of palatal fistula following cleft palate repair (P=0.042). Fistula incidence was significantly higher in patients who underwent surgery using the Furlow double-opposing Z-plasty technique (12.1%) than in cases where the Busan modification (3.0%) or two-flap technique (2.0%) was used.ConclusionsThe overall incidence of palatal fistulas was 3.1% in this study. Moreover, the technique of cleft palate repair predicted fistula incidence.

Racial and Ethnic Disparities in Primary Cleft Lip and Cleft Palate Repair.

To examine the impact of race/ethnicity on timing and postoperative outcomes of primary cleft lip (CL) and cleft palate (CP) repair. Cross-sectional analysis of the National Surgical Quality Improvement Program Pediatric (NSQIP-P) database from 2013 to 2018. Patients under 2 years of age who underwent primary CL or CP repair were identified in the NSQIP-P. Outcomes were the timing of surgery and 30-day readmission and reoperation rates stratified by race and ethnicity. In total, 6021 children underwent CL and 6938 underwent CP repair. Adjusted rates of CL repair over time were 10% lower in Hispanic children (95%CI: 0.84-0.96) and 38% lower for Asian children (95%CI: 0.55-0.70) compared with White infants. CP repair rates over time were 13% lower in Black (95%CI: 0.79-0.95), 17% lower in Hispanic (95%CI: 0.77-0.89), and 53% lower in Asian children (95%CI: 0.43-0.53) than in White infants. Asian patients had the highest rates of delayed surgical repair, with 19.3% not meeting American Cleft Palate-Craniofacial Association (ACPA) guidelines for CL (P < .001) and 28.2% for CP repair (P< .001). Black and Hispanic children had 80% higher odds of readmission following primary CL repair (95%CI: 1.16-2.83 and 95%CI: 1.27-2.61, respectively). This study of a national database identified several racial/ethnic disparities in primary CL and CP, with reduced receipt of cleft repair over time for non-White children. Asian patients were significantly more likely to have delayed cleft repair per ACPA guidelines. These findings underscore the need to better understand disparities in cleft repair timing and postoperative outcomes.

Split Buccal Fat Flap in Modified Furlow Palatoplasty: Surgical Technique and Early Result.

Encouraging results have been described for the use of pedicled buccal fat pad flap in primary cleft palate repair. This retrospective study describes the surgical technique and early results of a technical innovation utilizing the split buccal fat flaps in modified Furlow palatoplasty with small double-opposing Z-plasty. This technique introduces buccal fat tissue for coverage of lateral denuded palate surfaces to reduce the bone exposure and scar formation to potentially attenuate maxillary growth interference and for reinforcement of the palatal areas of high tension or with incomplete closure to decrease the risk of postoperative dehiscence and oronasal fistula formation. Consecutive nonsyndromic patients (n = 56) with cleft palate were treated with this method, all of whom demonstrated fast mucosalization of lateral palatal recipient regions within 3 weeks postoperatively and showed no fistula with 12 months' follow-up. Of 19 patients (33.9 percent) who underwent auditory-perceptual assessment, 15 (78.9 percent) had normal resonance. Surgeons could add this alternative surgical maneuver to their armamentarium during the primary palatoplasty, in which coverage of lateral surfaces and reinforcement with fat tissue in the anterior soft palate space are of paramount relevance. Therapeutic, IV.