Palate Repair Research Articles

Evaluation of Postoperative Outcomes Following Early and Late Palate Repair: A Preclinical Study.

To quantitatively assess the impact of early versus late surgical intervention on midfacial growth using a mouse model. A full-thickness mucoperiosteal flap surgery was performed on newborn (P17) mice and on neonatal (P30) mice. High-resolution micro-computed tomographic imaging coupled with histomorphometric analyses was used to assess craniomaxillofacial growth. Histology and immunohistochemical analyses were used to assess cellular and molecular responses postsurgery. Early surgical intervention at P17 resulted in significant midfacial growth arrest, with pronounced maxillary hypoplasia. Histomorphometric analyses revealed significant (P < 0.05) growth disruptions in the mid-palatal suture complex, including premature removal of the cartilaginous growth plate and its replacement by bone. In the suture itself, cell proliferation was significantly reduced (P < 0.05) compared with controls. The same surgical intervention performed in mice at P30 did not lead to significant midfacial growth arrest. Early surgical intervention in a mouse model mirrors the adverse growth outcomes in children undergoing early cleft repair. Molecular and cellular observations accompanying this midfacial growth arrest may inform therapeutic strategies to mitigate midfacial growth disturbances in patients and highlight the need for refined surgical techniques to minimize adverse growth outcomes.

Considerations in dental local anaesthesia for the patient with cleft lip and palate

Patients who have had a history of surgical repair of cleft lip and palate can often develop scar tissue post-operatively that can make it more difficult for dentists to achieve sufficient local anaesthesia. In addition, the presence of a cleft can result in anatomical variation of nerve supply to the maxillary region, which can result in further complications for achieving sufficient anaesthesia. This article reviews the anatomical variations that can occur, and posits a technique to allow for more predictable and successful local anaesthesia in this cohort of patients. CPD/Clinical Relevance: GDPs may have difficulty in achieving sufficient local anaesthesia for patients with a cleft lip and palate.

Cleft Lip and Palate Correction: The Utah Protocol.

Cleft repair remains a contentious issue in craniofacial surgery, especially regarding the optimal timing and techniques. This study aims to present our institutions' current protocol for cleft lip and palate repair, including alveolar bone grafting (ABG). A total of 17 patients (20 clefts) treated with the latest protocol from 2016 to 2023 were evaluated. Demographic and clinical data were obtained from electronic charts. The protocol includes lip repair at 3 months, soft palate repair at 1 year, and hard palate closure with concurrent ABG at 2 years. Mean graft height and thickness scores were 2.3 and 2.2, respectively. Three clefts showed scores marginally below the threshold for thickness, potentially requiring regrafting. Malocclusion was minimal with no significant crossbites or velopharyngeal insufficiency. Our modified protocol, emphasizing early hard palate closure with ABG, yields satisfactory outcomes in terms of graft height and thickness. Although long-term follow-up is warranted, our approach seems safe and efficient, potentially improving outcomes compared with traditional methods.

Hearing, speech, and language outcomes in school-aged children after cleft palate repair.

Following primary cleft palate repair, individuals face a heightened risk of hearing problems, particularly conductive hearing loss, compensatory articulation disorders (CADs), resonance disorders, delayed speech and language development, and voice disorders. This study aimed to investigate the prevalence and impact of these challenges in children with cleft palate with or without cleft lip (CP± L). This cross-sectional study included 38 children with CP± L aged 5 to 13 years. A comprehensive evaluation involved audiological assessments (audiograms, tympanograms) by an audiologist and speech-language pathology assessments (Thai Speech Parameters for Patients with Cleft Palate, Articulation Screening Test) by speech-language pathologists. The prevalence of hearing loss affected 27.63% of participants (21 out of 76 ears) and majority of cases involved conductive hearing loss. Velar substitution was the most common CAD, followed by nasalized voiced pressure consonants, phoneme-specific nasal air emission, and pharyngeal substitution. A moderate correlation was found between these CAD patterns and hypernasality at the word, sentence, and screening levels (r= 0.44, p< 0.01; r= 0.43, p< 0.01; and r= 0.40, p= 0.01). For summary, the most common type of hearing loss was conductive hearing loss. The predominant CAD pattern was velar substitution. The protocol could be designed to enhance early improvement in hearing and articulation, thereby supporting academic achievement and long-term quality of life.

A Realistic Ingeniously Designed Cleft Palate Simulator for Training of Residents: Bridging the Gap Between Theory and Practice.

Cleft palate is a congenital deformity that presents significant challenges in surgical correction. Proper training with an educational model for can greatly enhance the learning curve and improve patient outcomes. This article discusses the development and evaluation of an economical cleft palate model designed to enhance surgical skills and confidence among residents. The model was constructed using dental casts, acrylic resin, foam sheets, double-sided adhesives, infant feeding tubes, and red dye. Tertiary care center. Surgical residents. The assembly time and material costs were recorded. To evaluate its effectiveness, participants' feedbacks were collected and analyzed. The cleft palate model was produced at a cost of 250 INR per unit, with assembly taking approximately 15 minutes. Overall, 32 residents completed the simulation exercise of cleft surgery on the model. Participants gave the model an average score of 4 (±0.60) for realistic anatomical appearance, 3.5 (±1.3) for replicating the tactile nature of human tissue. Anatomical accuracy and ability to manipulate tissue and perform suturing received a rating of 3.4 (±1.1) and 3.7 (±0.81), respectively. The model's value as a training tool scored 4.4 (±0.51), with an overall satisfaction rating of 4.6 (±0.22) among residents. Our cleft palate model offers an economical, practical, and accessible solution for surgical training. This model is a viable alternative to more complex and expensive training tools and potentially enhancing the training of healthcare professionals in cleft palate repair.

A Case of Multiple Tongue Hamartomas with Cleft Palate: 7 Years of Follow-Up.

Hamartoma is a congenital benign lesion commonly found in the lungs, kidneys, colon, and other regions, but it is seldom seen in the oral cavity. Multiple hamartoma occurrences in the tongue are particularly rare. This article describes a 7-day-old female infant with multiple tongue tumors and a cleft palate, who had difficulty feeding and subsequently underwent tumor removal under general anesthesia. Nine months later, a cleft palate repair was performed. No genetic abnormalities were detected in the genetic testing. After the tumor removal, follow-ups were conducted every year to observe any recurrence of the tumors, the morphology and function of the tongue, and any systemic abnormalities. After 7 years of follow-up, there was no recurrence of the tumors, and the morphology and function of the tongue were normal, with no systemic diseases found. It is crucial to conduct multidisciplinary consultations for children diagnosed with multiple tongue hamartomas and to monitor their overall development while addressing oral lesions.

Repair of Cleft Palate in Adult Patients; Impact of Speech Therapy Following Surgical Intervention in Africa

Repair of Cleft Palate in Adult Patients; Impact of Speech Therapy Following Surgical Intervention in Africa

Accelerating Oral Wound Healing Using Bilayer Biomaterial Delivery of FTY720 Immunotherapy.

Orofacial clefts are the most common congenital craniofacial anomaly. Adverse healing following cleft palate repair can lead to oronasal fistula (ONF), a persistent connection between the oral and nasal cavities. Although human allograft tissues are currently the gold standard for ONF repair, these methods carry risks of infection and rejection, often requiring surgical revision. Immunoregenerative therapies present a novel alternative approach to harness the body's immune response and enhance the wound healing environment. An FDA-approved immunomodulatory drug, FTY720, is repurposed to reduce lymphocyte egress and induce immune cell fate switching toward pro-regenerative phenotypes. In this study, a bilayer biomaterial system is engineered using Tegaderm to secure and control the delivery of FTY720-nanofiber scaffolds (FTY720-NF). The release kinetics of the bilayer FTY720-NF is optimized to maintain drug release for up to 7 days, ensuring safe transdermal absorption and tissue biodistribution. The comprehensive immunophenotyping results demonstrate a regenerative state transition in hybrid immune cells recruited to the wound site. Further, histological evaluations reveal a significant ONF closure in mice by day 7 following bilayer FTY720-NF implantation. These findings demonstrate the utility of immunomodulatory strategies for oral wound healing, better positing the field to develop more efficacious treatment options in pediatric patients.

Worth the Pain? Comparing Pain Scores in Primary Furlow Palatoplasty With and Without Buccal Flap Augmentation.

Pain following primary palatoplasty can adversely affect nutritional and quality of life following primary palatoplasty. The incorporation of buccal flaps during primary cleft palate (CP) repair provides additional tissue to reduce the risk of velopharyngeal insufficiency, though the additional donor site may alter pain levels in the postoperative period. This study sought to compare postoperative pain levels in patients undergoing primary CP repair with or without buccal flaps. A single-institution, retrospective cohort study. An academic children's hospital with an affiliated comprehensive cleft care team. Patients age 18 months or less with cleft palate undergoing primary palatoplasty from 2016 to 2021 were included. Patients were stratified by the number of buccal flaps utilized during repair. Primary outcome was 24-h postoperative pain score, measured using the FLACC pain scale. Secondary outcome was 24-h postoperative narcotic use, measured in morphine milligram equivalents (MME). A total of 106 patients (53 without buccal flaps, 53 with 1 + buccal flaps) were included. There was no significant difference in postoperative pain scores between the groups (p > 0.9). Both groups had similar postoperative narcotic utilization (p = 0.8). This study demonstrates no significant difference in postoperative pain levels or narcotic utilization between patients undergoing primary Furlow palatoplasty with or without buccal flaps. This information can help address parental concerns regarding pain in the context of a larger donor site for patients undergoing primary palatoplasty with buccal flaps. Larger, multi-institutional randomized trials are needed to confirm these findings.

Speech Outcome Audit for Cleft Lip and Palate Patient Population Correlated With Veau Cleft Type, Surgical Repair Technique, and Patient Age

Objective: The objective of this study is to determine speech outcome differences for specific palate repair techniques and correlate these data with patient age at the time of operation. Methods: A retrospective study was conducted on a cohort of consecutive nonsyndromic patients who underwent cleft lip and/or palate repair at the authors' hospital between 2010 and 2020. Only those patients who participated in at least 4 years of follow-up accompanied by audio-video recording were included. The patient cohort was divided into 2 age groups, between 1 year and 2 years of age versus older than 2 years of age. Standardized perceptual speech evaluations and nasopharyngoscopy were performed by the authors' team to detect the presence of velopharyngeal insufficiency. Results: A total of 481 patients were initially evaluated, and 323 of these patients met all inclusion criteria and were subsequently selected for this study. One hundred seventy-two patients (n = 172) underwent palatal surgery using the Bardach 2-flap palatoplasty technique, 47 patients (n = 47) underwent repair through the von Langenbeck palatoplasty technique, 78 patients (n = 78) underwent repair through Veau-Wardill-Killner palatoplasty technique, and 26 patients (n = 26) underwent repair through double-opposing Z-plasty palatoplasty. The rate of residual velopharyngeal insufficiency was statistically similar among all palatoplasty techniques. A comparison between these two age groups revealed that patients younger than 2 years of age showed higher speech outcome success. Conclusion: High rates of speech success are achieved for patients younger than 2 years of age. Speech outcomes success is maximized by proper technique selection in relation to cleft type.

A Comparative Effectiveness Study of Speech and Surgical Outcomes: Study Overview.

To provide an overview of the Cleft Outcomes Research NETwork (CORNET) and the CORNET Speech and Surgery study. The study is (1) comparing speech outcomes and fistula rate between two common palate repair techniques, straight-line closure with intra-velar veloplasty (IVVP) and Furlow Double-Opposing Z-palatoplasty (Furlow Z-plasty); (2) summarizing practice variation in the utilization of early intervention speech-language (EI-SL) services; and (3) exploring the association between EI-SL services and speech outcomes. Prospective, longitudinal, observational, comparative effectiveness, multi-center. Twenty sites across the United States. One thousand two hundred forty-seven children with cleft palate with or without cleft lip (CP ± L). Children with submucous cleft palate or bilateral sensorineural severe to profound hearing loss were excluded from participation. Straight-line closure with IVVP or Furlow Z-plasty based on each surgeon's standard clinical protocol. The primary study outcome is perceptual ratings of hypernasality judged from speech samples collected at 3 years of age. Secondary outcomes are fistula rate, measures of speech production, and quality of life. The statistical analyses will include generalized estimating equations with propensity score weighting to address potential confounders. Recruitment was completed in February 2023; 80% of children have been retained to date. Five hundred sixty two children have completed their final 3-year speech assessment. Final study activities will end in early 2025. This study addresses long-standing questions related to the effectiveness of the two most common palatoplasty approaches and describes CORNET which provides an infrastructure that will streamline future studies in all areas of cleft care.

Prenatal Opioid Exposure Effect on Cleft Palate Repair Recovery.

Prenatal Opioid Exposure Effect on Cleft Palate Repair Recovery.

Clinical Outcomes after Cleft Palate Repair at a Major Referral Hospital in Addis Ababa, Ethiopia

Background: The two most common complications after primary palatoplasty are oronasal fistula and velopharyngeal insufficiency (VPI). To the best of our knowledge, there have been no studies examining postpalatoplasty speech outcomes in Ethiopia. Methods: A hospital-based retrospective cross sectional study design was used. A total of 149 patient records were reviewed, and 103 patients fulfilled all the inclusion criteria. These 103 cleft lip and palate patients who had undergone cleft palate repair at Yekatit 12 Hospital Medical College and who had undergone long-term speech assessment with the speech therapy department from January 2019 to December 2021 were included in this study. The bivariate/multivariate logistic regression was used to compare between different groups of patients, with the level of significance set at a P value of less than 0.05. Results: Moderate and severe hypernasality was seen in 45.7% of patients. Age at time of palatal surgery has significant association with incidence of hypernasality (P = 0.01). The type of cleft, sex of the patient, and type of surgery had no significant association with incidence of hypernasality. Oronasal fistula was seen in 25% of patients, with Pittsburgh type VI being the most common (40%). Conclusions: There is a high rate of VPI and oronasal fistula in this cohort of patients who underwent palatoplasty at Yekatit 12 Hospital. One of the factors for higher complication rate was older age at time of surgery. Therefore, patient education and strengthening the cleft care with training are paramount to ensure better results.

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.

Different Surgical Approaches to the Treatment of Cleft Palate Fistulae as Perceived by Cleft Surgeons.

Palatal fistulas after palatoplasty could pose difficulties for both patients and surgeons. Numerous surgical approaches are available to treat palatal fistulas. In this manuscript, we investigate surgical treatment options for palatal fistula repair looking at the different anatomical locations, and we create a summary of surgical approaches to facilitate the decision-making process for palatal fistulae repair. In this cross-sectional survey, nine anonymized patient cases with palatal fistulae that differed in severity and anatomical location were presented to participants from the International Cleft Master Course in Amsterdam about "Palatal Fistulas". Participants were invited to participate in this survey. A total of 141 participants reported their preferred surgical treatment options for fistula repair at different anatomical locations. We created different options for fistula treatment, catalogued by fistula location. This overview gives the surgeon possible approaches for each location. If the soft palate is involved, this overview underscores the importance of including velopharyngeal insufficiency management into the fistula repair. For hard palate involvement, our overview lists techniques available for nasal lining repair and for oral lining repair in each region. We provide a comprehensive overview of potential surgical approaches to repair palatal fistulae. This inventory of techniques is grouped per location to support surgeons in their decision-making process when confronted with a palatal fistula.

A 37-year follow-up after Skoog lip repair of unilateral cleft lip and palate: what is the long-term verdict on lip appearance by different panels?

BackgroundThe study examined long-term lip appearance after Skoog’s lip repair in unilateral cleft, lip, and palate (UCLP) patients. To include different views, three different panels respectively, rated level of lip appearance and desire for improvement. The secondary aim was to investigate the correlation between the self-reported satisfaction of UCLP patients and controls with the panel assessments.MethodsCropped frontal photographs of the lips of 74 UCLP-treated individuals and 61 non-cleft individuals were assessed twice by three panels of five cleft surgeons (Professional panel), nine laymen (Layman panel), and five individuals with CLP (Cleft panel) using a web-based platform, at a mean follow-up of 37 years post-lip surgery.ResultsAll three panels rated the lip appearance of UCLP patients worse than that of the controls (p < 0.001). The Professional panel reported higher satisfaction levels and less desire to change lip appearance than the Layman and Cleft panels. Intra-rater agreements were, in general, moderate in the Professional panel ICC (0.57–0.82) and Laymen panel ICC (0.63–0.73) and poor in the Cleft panel ICC (0.21–0.36). The inter-rater agreement was, in general, poor in all panels. No significant correlation was found between the patient’s Self-assessments and any of the panel assessments.ConclusionsAll panels’ rated lip appearance of adults born with UCLP treated with Skoog’s technique as worse than that of non-cleft controls. The study highlights a significant discrepancy between the Professional panel’s more favorable assessment and the more critical views of the laymen and cleft panels, contradicting the initial hypothesis of uniform perception across panels. The lack of correlation between patient self-assessment and panel assessments underscores the subjective nature of lip satisfaction, emphasizing the need for personalized patient care strategies in CLP treatment outcomes.Level of evidenceNot gradable.

Correlation of Velopharyngeal Score in Nasoendoscopy with Perceptual Speech Intelligibility of Patients with Cleft Palate

Background and Objective: One of the challenges patients with cleft palate face is the production of intelligible speech. Though instrumental assessment of velopharyngeal function is required, there is a need to correlate the results obtained with speech outcome. The objective of this study is to correlate the Golding-Kushner scale scoring system for velopharyngeal defects as observed on nasoendoscopy with patients’ speech intelligibility. Method: The design is an observational cross-sectional study conducted from December 2022 to May 2023. This study was carried out at the orofacial cleft clinic of a tertiary hospital. Participants: The study included English-speaking patients with cleft palate who had palatorrhaphy done at least 6 months before recruitment. Intervention: Speech intelligibility was measured using a simple analog scale that ranged from 0 to 5 (0—worst speech intelligibility possible, 5—best speech intelligibility). The Golding-Kushner scale is used to measure gap size (defect) in nasoendoscopy. Main outcome measures: The primary outcome is to correlate the score of speech intelligibility with the Golding-Kushner score during nasoendoscopy. Results: A total of 40 people participated in the study, with a median age of 11 years (IQR: 6.25-21.75 years). There is a moderately negative correlation between velopharyngeal gap size and speech intelligibility (correlation coefficient = −0.6, P &lt; .01). Only the size of the size of the gap is a significant predictor of speech intelligibility after cleft palate repair. Conclusion: There is a significant, moderate correlation between velopharyngeal gap size and speech intelligibility.

An Assessment of Adverse Events in Patients with 22q11.2 Deletion Syndrome Undergoing Palatoplasty: An Analysis of the NSQIP Pediatric Database.

The National Surgical Quality Improvement Program (NSQIP) Pediatric database has been used to identify factors related to adverse surgical outcomes in pediatric and craniofacial surgical procedures. Focusing on a historically "higher-risk" population, our aim was to assess the impact of demographics, comorbidities, and 22q11.2 deletion syndrome (22QDS) diagnosis on 30-day postoperative complications in patients undergoing primary palatoplasty. We used the 2012-2020 NSQIP Pediatric database to identify patients ≤3 years with and without 22q11.2 deletion syndrome who underwent primary palatoplasty. Demographics, comorbidities, and perioperative characteristics were compared between those with and without 22QDS. Logistic regression was used to determine if children with 22QDS were more likely to experience a 30-day postoperative complication or readmission. There were 10,745 patients ≤3 years old who underwent primary palatoplasty; 83 (0.8%) of whom had 22QDS and 10,662 (99.8%) did not. Children with 22QDS were older when they underwent primary palatoplasty and more likely to have comorbidities. A total of 513 patients (4.8%) experienced a postoperative complication within 30 days and 255 were readmitted (2.4%). Of the 513, 8 (9.6%) had a 22QDS diagnosis and 505 (4.7%) did not. A diagnosis of 22QDS was not a significant independent risk factor for a complication (adjusted odds ratio (aOR) = 1.13; 95% confidence interval (CI): 0.50-2.54) or readmission (aOR = 1.74; 95% CI: 0.74-4.13) within 30 days. This study found that the diagnosis of 22QDS was not an independent predictor of post-palatoplasty complication risk, and in fact 30-day complications are rare for those patients undergoing cleft palate repair, even among those patients with 22QDS.

Serous otitis media as a cause for language delay following cleft palate repair—A case-control study

Background and Objectives: Serous otitis media (SOM), also called otitis media with effusion (OME) or glue ear, is a collection of non-purulent fluid within the middle ear space. Children with cleft palate are more prone to develop this condition. This is caused by impaired eustachian tube function in cleft palate. They may present with hearing loss, delayed speech, and language development or poor social behavior. This is a significant cause of conductive hearing loss in the early speech-forming years of their life. Even after an early surgical repair of palate, speech and language defects are frequently identified during regular postoperative follow-up by speech-language pathologists. When identified, the approach to language delay varies across healthcare systems and includes watchful waiting, providing hearing aids to early otological intervention. The primary objective was to compare the incidence of SOM in children with and without language delay following surgical correction of cleft palate. Materials and Methods: A case-control study involving 63 patients was conducted in a tertiary care hospital with a high-volume cleft lip and palate center from June 2022 to March 2023. Thirty children with language delay were identified and grouped as cases and 33 children without language delay as controls. Tympanogram was conducted after the detailed otoscopic examination. Those with Jerger types B and C were diagnosed with SOM. The incidence of SOM in each group was compared statistically. Results: About 70% of cases and 87.9% of controls had SOM. There is no positive correlation between the incidence of SOM and language delay (P-value &gt; 0.05). Conclusion: SOM cannot be identified as a causal factor for language delay after cleft palate surgery.

Characterization of Friction within a Novel 3 mm Wristed Robotic Instrument

Surgical robotic tools are being developed for a variety of surgical procedures that are executed within small workspaces. Novel designs of miniaturized cable-actuated surgical tools for cleft palate repair have previously been developed. However, the behavior and significance of friction within these tools are largely unknown. A study was conducted to investigate the friction in a pulleyless 3 mm diameter wristed instrument. The wrist utilizes cable guide channels that allow for miniaturization at the cost of increased friction. An experimental rig was developed to measure friction within the wrist link mechanism when the tool is positioned at various pitch angles. A strong relationship between the cable tension and the tool’s pitch angle was found as a result of friction. The cable tension increased as the pitch angle approached extreme values (percent increases in the cable tension of 33% and 67.3% at a pitch of 90° and −90°, respectively). However, the resultant cable tension was below the failure strength of the cable, indicating that the design is feasible. The results of this study would be useful to those considering the design of miniature robotic surgical tools that are cable-driven. Significant tool reduction can be achieved by employing static guide channels for the cables, forgoing the use of additional moving components like pulleys while maintaining cable tension well within its break strength. Future work in the design and optimization of novel miniaturized wrist mechanisms should consider frictional effects and their impact on mechanism function.