Surgical Repair Of Cleft Research Articles

Sociodemographic Predictors of Patient Age at Time of Cleft Lip and Palate Repair.

To identify the impact of sociodemographic and health variables on the age at which patients undergo cleft lip repair, cleft palate repair, and primary speech evaluation. A retrospective, noninterventional quality assessment, and quality improvement study was designed. This institutional study was performed at Michigan Medicine in Ann Arbor, MI. All patients born between 2011 and 2014 who received surgical cleft repair, excluded those who were adopted (n = 165). The age at which patients undergo cleft lip repair, cleft palate repair, and primary speech evaluation. Cleft lip repair was performed significantly later for patients identifying as Asian (18 weeks, P = .01), patients with Child Protective Services contact (19 weeks, P = .01), patients with a significant comorbidity (14 weeks, P = .02), and patients who underwent preliminary lip adhesion surgery (19 weeks, P < .01). Cleft palate repair was performed significantly later for patients identifying racially as Asian (19 weeks, P = .03) and other (22 weeks, P = .03). Preliminary speech and language evaluation were performed significantly later for patients identifying as black (55 weeks, P = .03) and patients diagnosed with an isolated cleft lip (71 weeks, P < .01). Timing of cleft lip, cleft palate repair, and primary speech and language evaluation are subject to variation which may be predicted by clinically accessible factors. By identifying race, Child Protective Services contact, and care variables as significant predictors of increased patient age at time of intervention, multidisciplinary cleft care teams can proactively allocate patient support resources.

Post-Surgical Repair of Cleft Scar Using Fractional CO2 Laser.

BACKGROUND:Postoperative scarring is a common cause of patients dissatisfaction. Several modalities have been developed to overcome such a problem following surgical repair. Despite precise surgical technique, still, some scars would remain over the time, mostly due to the weak formation or inadequately replaced collagen fibres in the underneath dermis especially those following unilateral or bilateral cleft lip repair surgery.AIM:of this study is to evaluate whether a 10,600 nm fractional ablative carbon dioxide (CO2) used early during the healing period would result in better postoperative scars.METHODS:In the present study six patients complained from cleft lip scars resulting from lip revision surgery. Each patient had six fractional ablative CO2 laser sessions for treatment along six months to obtain a complete collagen cycle. Vancouver Scar Scale VSS was used as a method of evaluation of the scar using 4 points scale evaluating vascularity, pliability, thickness & colour of the skin and Visual Analogue Scale VAS from (0-10) was used to assess the severity of pain as well as a survey questionnaire for the rate of patient’s satisfaction. Also, digital clinical photos assessment before&after were compared.RESULTS:Patients expressed a significantly greater degree of satisfaction with the treatment using a subjective 4-point scale. All patients observed dramatic improvement in their lip scars after FCO2 laser sessions following their surgeries with the better psychological state. The assessment was done by clinical observation according to VSS before (9.17 ± 2.2) while after (3.33 ± 1.9) with a highly significant P value <0.001 and VAS for the rate of pain & satisfaction that ranged from (8.0 ± 0.9) as well as series of photos taken before and after the procedure. No long-term complications were noted however patients complained of annoying pain during the session as well as crust formation that lasted up to 5 days after surgery. In the present study, we introduce the effectiveness of ablative fractional 10,600 nm CO2 laser for treatment of postoperative cleft lip scar after secondary surgical cleft repair rather than ablative CO2 due to its reported complications such as postoperative infection, erythema and pigmentary changes along with prolonged downtime healing. In the current study, we chose early laser treatment within the first six months before complete collagen organisation which will be easier to manage the older scars. Patients mostly complained about the pain during the session as well as dark-coloured crust formation post session that stayed from 3-5 days however they all observed a massive improvement of their scars following treatment protocol.CONCLUSION:Facial wounds sutured in layers heal in a good manner. Patients prefer early treatment with a fractional CO2 ablative laser for postoperative surgical scars. The use of a CO2 fractional laser is safe and effective also causes high patients satisfaction.

Evaluation and comparison between effects of early and late palatoplasty on the mandibular morphology and spatial position with respect to the cranial base and maxilla: A two-dimensional retrospective study

Background: This retrospective cephalometric study was designed to clarify the influence of the timing of surgical repair of cleft and its effect on mandibular growth and its position in the cleft patients which is questionable. Aim: The aim of the study was to assess the effect of timing of palate repair on the mandibular spatial position and morphology in relation to cranial base and maxilla in patients born with unilateral cleft lip and palate (UCLP) using Lateral Cephalograms. Material and Methods: This study was carried out on 20 surgically treated UCLP patients within the age group of 8–16 years. Twenty UCLP subjects were further divided into two groups (early palatal repair n = 10 and late palatal repair n = 10) according to their age at which initial hard palate repair was performed. Results: Stage of palatal repair had a significant effect on the Y-axis (P- 0.045) but there is no significant difference in the spatial position, size and morphology of mandible when compared in relation to anterior cranial base and in relation to maxilla. Conclusion: Timing of surgical repair of palate has no detrimental effects on the position and morphology of mandible in patients with unilateral cleft lip and palate.

Grommet Surgery in Children With Orofacial Clefts in England.

To assess grommet insertion practice in the first 5 years of life among children with an orofacial cleft in England. Analysis of national administrative data of hospital admissions. National Health Service hospitals, England. Patients born between 1997 and 2005 who underwent surgical cleft repair. Children receiving grommets before the age of 5 years. The proportion of children receiving grommets before the age of 5 years, the timing of the first grommet insertion, and the proportion of children having repeat grommet insertions were examined according to cleft type, the absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. The study included 8,269 children. Before the age of 5 years, 3,015 (36.5%) children received grommets. Of these, 33.2% received their first grommets at primary cleft repair and 33.3% underwent multiple grommet insertion procedures. The most common age for the first procedure was between 6 and 12 months. Children with a cleft affecting the palate were more likely to receive grommets than children with a cleft lip alone (45.5% versus 4.5%). Grommet insertion practice also varied according to year of birth, absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. Grommets practice in children with a cleft appears to vary according to their clinical characteristics. The differences in practice observed according to deprivation and region of residence need to be further explored.

The effect of early versus late palate repair on pharyngeal airway volume in patients with unilateral cleft lip and palate

Context: Timing of surgical repair of cleft and its effect on volume of pharyngeal airway have not been investigated thoroughly. Aim: The aim of the study was to assess the effect of timing of palate repair on pharyngeal airway in patients born with unilateral cleft lip and palate (UCLP) using cone beam computed tomography (CBCT). Settings and Design: The design was a retrospective study. Subjects and Methods: The study was carried out on 20 surgically treated UCLP patients and 40 normal noncleft subjects with Class I skeletal relation within the age group of 7–14 years. Twenty UCLP subjects were further divided into two groups (early palatal repair n = 11 and late palatal repair n = 9) according to their age at which initial hard palate repair was performed. Forty normal noncleft subjects were included in the control group. Results: No significant difference was found in volume of nasopharynx, oropharynx, hypopharynx, total pharyngeal volume ( P = 0.83), and minimum axial area ( P = 0.90) of the pharynx between the groups. Conclusions: Using CBCT, this study found that there was no significant difference in the pharyngeal airway between early and late hard palatal surgery.

Area and volume of the pharyngeal airway in surgically treated unilateral cleft lip and palate patient: A cone beam computed tomography study

Background: Area and volume of the pharyngeal airway in surgically treated unilateral cleft lip and palate (UCLP) patient: A cone beam computed tomography (CBCT) study. Context: Surgical repair of cleft causes restriction of maxillary growth and mid face but the effect of this reduced growth on volume of the pharyngeal airway has not been investigated thoroughly. Aims: The aim of the study was to assess the area, volume and smallest cross-sectional area of the pharyngeal airway in individuals with UCLP using CBCT and compare with age and sex matched noncleft controls. Settings and Design: Retrospective study. Materials and Methods: The study was carried out on 20 surgically treated UCLP patients and compared with 40 normal non cleft subjects with Class I skeletal relation within age group of 7-14 years. CBCT image processing and analysis were performed using Dolphin Imaging software (11.7 version premium; Dolphin Imaging and Management Solutions, Chatsworth, Calif) and volumetric rendering was done for airway analysis. Statistical Analysis Used: All statistical analyses were performed with SPSS software (version 15.0J for Windows; SPSS, Inc., Chicago, IL). An independent sample t-test was used to determine the significance of the difference between the means. Results: No significant difference was found in the area and volume of nasopharynx, oropharynx, hypopharynx, total pharyngeal volume (P = 0.86) and minimum axial area (P = 0.69) of the pharynx between the groups. Conclusions: Using CBCT, this study found that there was no significant difference in the pharyngeal area and volume between UCLP and noncleft groups. Further investigations are necessary to clarify the relationship between pharyngeal structure and airway function in patients with CLP.

The application of an external mid-face distractor using a custom made locking plate

Introduction/Aims: Surgical repair of cleft in the elderly population is controversial. Some cleft surgeons are of the opinion that the outcomes of repairing cleft in elderly patients are poor and as such, this group of patients should not be treated surgically. However, there is very little evidence in the medical literature published to support this. We report the outcomes of surgical repair of cleft in a series of elderly patients with unrepaired cleft lip and or palate. Materials/Methods: We review the South Wales experience of treating elderly patients with unoperated cleft lip and or palate. We document the presence of speech impairment, behavioral problems, depression and low self esteem due to teasing about their facial appearance and ability to communicate. Results/Statistics: our results confirm an improvement in speech, quality of life and aesthetic outcomes after surgical repair of cleft in this series of elderly patients with unrepaired cleft lip and or palate. Conclusions/Clinical Relevance: We advise the cleft team to consider surgical repair of the untreated cleft lip and or palate in the elderly population. Further research is needed to objectively detect the primary aesthetic needs of elderly patients with cleft lip and or palate, which along with the subjective needs defined by the patient, should determine the aim of the planned treatment interventions in this patient group.

Cleft Repair in the Elderly Population - the South Wales Experience

Introduction/Aims: Surgical repair of cleft in the elderly population is controversial. Some cleft surgeons are of the opinion that the outcomes of repairing cleft in elderly patients are poor and as such, this group of patients should not be treated surgically. However, there is very little evidence in the medical literature published to support this. We report the outcomes of surgical repair of cleft in a series of elderly patients with unrepaired cleft lip and or palate. Materials/Methods: We review the South Wales experience of treating elderly patients with unoperated cleft lip and or palate. We document the presence of speech impairment, behavioral problems, depression and low self esteem due to teasing about their facial appearance and ability to communicate. Results/Statistics: our results confirm an improvement in speech, quality of life and aesthetic outcomes after surgical repair of cleft in this series of elderly patients with unrepaired cleft lip and or palate. Conclusions/Clinical Relevance: We advise the cleft team to consider surgical repair of the untreated cleft lip and or palate in the elderly population. Further research is needed to objectively detect the primary aesthetic needs of elderly patients with cleft lip and or palate, which along with the subjective needs defined by the patient, should determine the aim of the planned treatment interventions in this patient group.

Centralisation of services for children with cleft lip or palate in England: a study of hospital episode statistics

BackgroundIn 1998, a process of centralisation was initiated for services for children born with a cleft lip or palate in the UK. We studied the timing of this process in England according to its impact on the number of hospitals and surgeons involved in primary surgical repairs.MethodsAll live born patients with a cleft lip and/or palate born between April 1997 and December 2008 were identified in Hospital Episode Statistics, the database of admissions to English National Health Service hospitals. Children were included if they had diagnostic codes for a cleft as well as procedure codes for a primary surgical cleft repair. Children with codes indicating additional congenital anomalies or syndromes were excluded as their additional problems could have determined when and where they were treated.ResultsWe identified 10,892 children with a cleft. 21.0% were excluded because of additional anomalies or syndromes. Of the remaining 8,606 patients, 30.4% had a surgical lip repair only, 41.7% a palate repair only, and 28.0% both a lip and palate repair. The number of hospitals that carried out these primary repairs reduced from 49 in 1997 to 13, with 11 of these performing repairs on at least 40 children born in 2008. The number of surgeons responsible for repairs reduced from 98 to 26, with 22 performing repairs on at least 20 children born in 2008. In the same period, average length of hospital stay reduced from 3.8 to 3.0 days for primary lip repairs, from 3.8 to 3.3 days for primary palate repairs, and from 4.6 to 2.6 days for combined repairs with no evidence for a change in emergency readmission rates. The speed of centralisation varied with the earliest of the nine regions completing it in 2001 and the last in 2007.ConclusionsBetween 1998 and 2007, cleft services in England were centralised. According to a survey among patients’ parents, the quality of cleft care improved in the same period. Surgical care became more consistent with current recommendations. However, key outcomes, including facial appearance and speech, can only be assessed many years after the initial surgical treatment.

Disordered sleep physiology in children presenting for primary cleft repair. Use of sleep studies results to guide preoperative respiratory intervention and plan the timing of surgical cleft repair

Disordered sleep physiology in children presenting for primary cleft repair. Use of sleep studies results to guide preoperative respiratory intervention and plan the timing of surgical cleft repair

Disordered sleep physiology in children presenting for primary cleft repair. The use of sleep study results to guide preoperative respiratory intervention and plan the timing of surgical cleft repair

Disordered sleep physiology in children presenting for primary cleft repair. The use of sleep study results to guide preoperative respiratory intervention and plan the timing of surgical cleft repair