Cleft Palate-Craniofacial Journal最新文献

ObjectiveYoung people (YP) with a cleft lip with or without cleft palate have expressed concerns about their appearance and image-sharing on social media. This study aimed to explore and understand YP's concerns, views, and experiences regarding photographs of themselves.DesignThis was an exploratory qualitative study using photo-elicitation during semi-structured interviews conducted virtually. YP provided 3 photographs of themselves they liked and 3 they did not, which were used to facilitate discussion of their appearance, thoughts, and feelings about their photographs, and social media. Interviews were transcribed and analyzed using Reflexive Thematic Analysis.Patients/ParticipantsThirteen YP aged 16 to 20 years (mean = 17.8), 10 females and 3 males, were recruited via a UK cleft charity. Two had a cleft lip only, 9 had a unilateral cleft lip and palate, and 2 had a bilateral cleft lip and palate.ResultsFour themes were developed: (1) symmetry equals beauty, (2) controlling and curating the image presented to others, (3) acceptance with maturity, and (4) connections can promote empowerment.ConclusionsThe themes highlight the concerns that YP have with their appearance, how they present their self-image to others, and how they can become empowered to embrace their cleft condition and support others. Results suggest cleft services should integrate psychosocial screening, peer support, and appearance-focused interventions to promote confidence and resilience in young people.

ObjectiveThis pilot study explored the predictive capabilities of individual components and composite scores of the Asher-McDade Esthetic Index (AMEI) for determining the need for nasolabial revision surgery in patients with repaired complete unilateral cleft lip and palate (UCLP). Receiver operating characteristic (ROC) analysis and Youden's index were employed to assess predictive power and identify optimal thresholds, respectively.DesignSingle-center retrospective cross-sectional pilot studySettingCleft and craniofacial centerParticipantsThirty-two pre-adolescent patients with complete UCLP who underwent primary repair.InterventionsStandardized frontal and lateral facial photographs were rated by three calibrated plastic surgeons using the AMEI. Components assessed included nasal form, nasal symmetry, vermilion border, and nasolabial profile. A separate panel of three plastic surgeons determined the need for nose and/or lip surgical revision by majority vote, based on the same photographs. ROC analysis evaluated the predictive ability of individual AMEI components and composite scores, with cutoffs identified via Youden's Index.Main Outcome MeasuresThe predictive ability of AMEI for determining the need for nasolabial revision, using ROC analysis and Youden's Index.ResultsNasal symmetry demonstrated the highest predictive accuracy for nose revision, and vermilion border was the strongest predictor for lip revision. Although composite scores showed promising predictive potential, they did not surpass the predictive power of the strongest individual AMEI components.ConclusionThis pilot study provides preliminary evidence that the AMEI can serve as a useful objective tool to predict the need for revision surgery in patients with repaired UCLP.

ObjectiveTo compare the incidence of ocular abnormalities in patients with metopic craniosynostosis (MCS) treated with cranial vault reconstruction (CVR) versus endoscopic suturectomy (ESC).DesignRetrospective cohort study using the TriNetX Research Network.SettingMulti-institutional electronic health record database.Patients, ParticipantsA total of 588 pediatric patients with non-syndromic MCS (441 CVR, 147 ESC) were identified by ICD-10 and CPT codes. Propensity score matching and age adjustment were performed to reduce confounding.InterventionsSubjects underwent either CVR or ESC. Ocular and surgical complication outcomes were assessed.Main Outcome Measure(s)Primary outcome is ocular abnormalities. Secondary outcomes include surgical complications and reoperations.ResultsOcular abnormalities were present in 40.31% of MCS patients. CVR was associated with a significantly higher incidence compared to ESC (44.67% vs 27.21%; RR = 1.64; 95% CI: 1.23-2.18). CVR patients had greater rates of strabismus (15.19% vs 7.48%; RR = 2.03; 95% CI: 1.10-3.74), ametropia (29.71% vs 11.56%; RR = 2.57; 95% CI: 1.58-4.20), and astigmatism (15.87% vs 2.72%; RR = 5.84; 95% CI: 2.17-15.70). These differences remained significant after adjusting for age and matching by sex, race, and ethnicity. The ESC group showed ocular outcomes comparable to the general pediatric population.ConclusionsPatients with metopic craniosynostosis have a high rate of ocular abnormalities, and there may be a difference between those who undergo CVR versus ESC. These findings underscore the need for routine ophthalmologic surveillance and future prospective studies are needed to confirm the findings.

ObjectiveTo identify cephalometric parameters that could predict future need for orthognathic surgery (OGS) in patients with unilateral cleft lip and palate (UCLP).MethodsFinal search was conducted on July 7, 2024, across PubMed, Scopus, Embase, Web of Science, Cochrane, Ovid Medline, EBSCO, and LILACS, without any language and publication time restriction. Studies comparing surgical versus nonsurgical UCLP patients were included. Two independent reviewers screened studies, and those included were evaluated using Quality in Prognostic Studies (QUIPS) tool. Random-effects meta-analysis of various sagittal and vertical cephalometric parameters (SNA, SNB, ANB, mandibular plane angle [MPA], and lower anterior face height [%LFH]) was performed.ResultsTen studies were included in systematic review and 5 in meta-analysis. Quality in Prognostic Studies tool assessment indicated moderate risk in 6 studies, with 2 demonstrating high and low risks of bias. Meta-analysis revealed that in the 5- to 8-year age group, significant differences were observed in SNA and ANB angles between surgical and nonsurgical groups, with mean differences of 2.25° (95% confidence interval [CI] = 1.12, 3.39) and 3° (95% CI = 1.86, 4.15), respectively. In 9- to 14-year age group, significant differences were found in all 3 sagittal parameters: SNA angle difference of 2.65° (95% CI = 1.44, 3.86), SNB angle difference of 3.23° (95% CI = -4.69, -1.77), and ANB angle difference of 5.54° (95% CI = 3.66, 7.42). Vertical parameters (MPA and %LFH) were not statistically significant between groups in any age group.ConclusionCephalometric parameters could be a valuable predictive factor for determining the future need for OGS in patients with UCLP. ANB angle has been shown to be a significant predictor for distinguishing between surgical and nonsurgical patients.

ObjectiveCraniofacial conditions (CFCs) can be associated with adverse effects on quality of life (QoL). However, few studies have examined perceived benefits related to CFCs. This study described perceived benefits in an international sample of children and adolescents with CFCs and their parents.DesignSemistructured qualitative interviews were completed in English or Spanish as part of a larger study. Deductive content analysis described and quantified perceived benefits associated with CFCs.SettingInterviews were during standard visits at Rady Children's Hospital-San Diego in the USA and the Hospital Infantil de las Californias in Tijuana, Baja California, Mexico.ParticipantsPatients were ages 7 to 20 years (n = 32) with CFCs (cleft lip and/or palate, craniosynostosis, microtia, hemifacial microsomia, dermatologic conditions/neurovascular malformations, and trauma-acquired CFC), and parents (n = 71) had children ages 5 months to 23 years with CFCs. Of the total sample, there were 14 patient-parent dyads.ResultsA total of 230 benefits were identified. Of the patients (47%) and parents (73%) who identified at least 1 benefit, themes included personal growth (40%), understanding or helping others facing challenges (25%), social relationships (23%), spiritual or religious beliefs (4%), philanthropy (4%), material or external gains (3%), and personal health (1%).ConclusionsPatients with CFCs and their parents report multiple positive effects of CFCs on their QoL. These findings indicate that benefit finding is a common experience in this population and may be leveraged by clinicians to help promote positive adjustment to living with a CFC.

ObjectiveThis study aimed to use cone beam computed tomography (CBCT) scans to compare the morphometric characteristics of the greater palatine foramen (GPF) in unilateral and bilateral cleft lip/palate patients (CL/P) and non-cleft (NC) individuals.Method and materialOne hundred patients with CL/P (78 unilateral and 22 bilateral) and 100 non-cleft individuals had their GPF morphometrically assessed in CBCT images. The antero-posterior width and medio-lateral width of the GPF, the distance between the right and left GPFs, the mesio-distal location of the GPF with respect to the molar teeth, the distance between the GPF and the hamulus of the medial pterygoid plate, and the distance between the GPF and the palatine alveolar ridge were measured on these images. The Kruskal-Wallis and Chi-square tests were employed to ascertain if there were any notable disparities across the 3 groups.ResultsThe GPF's antero-posterior width and medio-lateral width, and distance from the hamulus and palatine alveolar ridge were considerably smaller in the unilateral cleft lip/palate (UCL/P) and bilateral cleft lip/palate (BCL/P) patients than in the NC individuals. However, no significant difference was observed between the BCL/P and UCL/P groups in terms of these parameters. The distance between GPFs and the location of the GPF did not exhibit any significant differences among the 3 groups.ConclusionCertain morphometric parameters of the GPF were significantly different in CL/P patients. Understanding the anatomy of this area is crucial for successful treatment of individuals with CL/P with minimal complications.

ObjectivesThe study aimed to understand parents' reactions to cleft, the manner in which they learned about its presence, and the challenges they faced in caring for their child with a view to providing healthcare professionals insights toward enhancing care delivery.DesignQualitative in-depth interviews using the grounded theory approach were carried out with 11 mothers and fathers of children with cleft lip and palate (CLP) attending a cleft speciality hospital in Chennai city, in South India.ResultsAnalysis resulted in the discovery of 5 core categories, learning about CLP-when and how, reactions and attributions to CLP, learning about and expectations from treatment, caring for a child with CLP and support systems. Feelings of shock and bewilderment when they learned of the presence of cleft in their child was reported by most parents. Poor awareness of cleft, difficulties in feeding, and concerns for the child's future were major sources of disquiet. The presence of support from family and friends and interactions with other parents of children with cleft helped them to cope better.ConclusionsThe results highlight the need for enhancing understanding of cleft among parents and strengthening them emotionally, thereby empowering them to provide effective care for their child. There is an urgent need to develop standardized information materials for parents to ensure that they have clear, consistent, and reliable information on the care of their child.

ObjectiveTo develop an artificial intelligence (AI)-based algorithm for the assessment and comparison of skeletal maturation in patients with and without cleft lip and/or palate and to detect the presence of cervical vertebral anomalies (CVAs).DesignRetrospective cohort study.SettingA university orthodontic clinic and comprehensive cleft care centers.Patients/ParticipantsIn total, 1080 cephalograms of patients with and without unilateral cleft lip and palate (UCLP) aged 6 to 18 years, without any associated syndromes, congenital disorders, or history of trauma or illness, were collected. About 960 cephalograms were assessed in the study upon elimination of poor-quality lateral cephalograms.MethodsThe MobileNet architecture using TensorFlow framework was employed to develop 2 convolutional neural network (CNN)-based AI models for automated assessment of skeletal age and detection of CVAs. Inter-rater reliability for manual cervical vertebral maturation (CVM) staging was assessed using Cohen's kappa coefficient, and intraclass correlation coefficient (ICC) was calculated. The results of each model were separately analyzed using chi-square test, and the statistical significance was tested at 5% level.ResultsThe CNN-based AI model yielded an average accuracy rate of 74.5%, with an accuracy of up to 88% for detecting skeletal maturity and an accuracy rate of 83% for detecting CVAs.ConclusionsIt can be concluded that CVM methods help detect skeletal maturity objectively in patients with UCLP and have shown delayed skeletal growth compared to patients without UCLP. CVAs were found to be more prevalent in patients with UCLP than in their non-cleft counterparts, with these findings facilitated by utilizing a novel AI algorithm.

ObjectiveTo date, there are no published studies From the Sultanate of Oman on the incidence or characteristics of craniosynostosis (CS). This is a population-based epidemiological study of the incidence of CS.MethodsThe prospective registry of the craniofacial surgery unit in Khoula Hospital was used to retrieve data on all individuals with CS treated between 2004 and 2023. The cohort was divided into four 5-year groups based on year of birth: 2004 to 2008, 2009 to 2013, 2014 to 2018, and 2019 to 2023.ResultsWe identified 312 individuals with CS. The incidence increased significantly during the study period and was 2.5 per 10 000 live births in the last 5-year period. There was a male preponderance (male/female ratio 1.5:1). Our study findings reveal a notable diversity in the trend of suture involvement, we observed a higher frequency of complex CS within our study population 35.9%. Half of the study population was nonsyndromic, accounting for 51.6%. The nonsyndromic population exhibits a higher proportion of midline suture involvement.ConclusionsThe incidence of CS increased during the study period. The majority of cases were identified as nonsyndromic. We found that multiple sutures CS were the most prevalent overall in our population. It is imperative to intensify efforts aimed at raising awareness among the general population regarding these deformities.

Objective:This study aimed to identify the predictive role of cleft type, ethnicity, adoption status, spoken language at home and parental education level on the caries risk in the primary dentition of patients with cleft lip and/or palate (CL/P). This knowledge is used to make an estimate on increased caries risk in young patients with CL/P.Design:A retrospective analysis of data concerning dental caries and basic characteristics of patients with CL/P was done. Patients were born and registered in 2016, 2017, or 2018 at the cleft team of the Erasmus Medical Center, Rotterdam, the Netherlands.Results:After Chi-square tests, the cleft type (P = .02), country of birth father (P < .001), country of birth mother (P = .002), parental educational level (P = .006), and spoken language at home (P = .002) were significantly different between 144 patients with CL/P with and without caries. Items were used in binary logistic regressions and after stepwise backward elimination resulting in most important determinants for caries in the primary dentition in patients with CL/P being: father born in another country than the Netherlands (odds ratio [OR] = 4.87, P = .001), a cleft lip alveolus and palate phenotype (OR = 3.54, P = .002), and a lower parental educational level (OR = 2.30, P = .04).Conclusion:The recommendation for the dental care professional will be to use these 3 determinants as a first prediction on future dental caries. This helps the dental professional in clinical decisions as recall intervals, referral to specialized dental care and extensiveness of caries prevention strategies and thereby improves oral health of patients born with CL/P.