Cleft Palate-Craniofacial Journal最新文献

Objective: The aim of the present research was to assess and compare the piriform aperture dimensions of subjects with a unilateral cleft lip and palate (UCLP) and those of a control group using cone-beam computed tomography (CBCT).

Design: CBCT data of 40 subjects with a complete UCLP (28 males and 12 females, with a mean age of 17.21 ± 5.75 years) and 40 CBCT images of age- and sex-matched subjects with no cleft, serving as the control group (28 males, 12 females; mean age, 17.25 ± 5.74 years) were included in the study. The maximal height and width of the piriform aperture as well as nasal bone height were measured and statistically compared between the groups.

Results: There were no significant differences in the age and sex distributions between the groups. The mean piriform aperture height was significantly lower in the UCLP group than in the control group, while the mean piriform aperture width was significantly higher in the UCLP group compared to the control group (P < .01). Furthermore, the mean bony nasal height was found to be significantly lower in the UCLP group than in the control group (P < .01).

Conclusions: According to the present findings, UCLP is associated with changes in the piriform aperture dimensions due to lower height and higher width values. These structural alterations may contribute to the functional and aesthetic nasal challenges in patients with UCLP.

The aim of this study was to investigate and compare the technical feasibility, ergonomics, and educational value of the 3D exoscope in comparison with traditional and prism loupes in cleft surgery.

A variety of cleft and pharyngeal operations were performed with the VITOM^® 3D exoscope (Karl Storz GmbH, Tuttlingen, Germany), traditional/prism loupes, and microscope. The cervical neck angulation of the operating surgeon was recorded in real-time with an inertia measurement unit system (Mbient, San Francisco, USA) and experiences of the surgeon and assistant were prospectively evaluated with 5-point Likert scales.

National Health Service, England.

Eleven patients were recruited in whom 12 procedures were performed. Two main surgeons, 3 assistant surgeons, and 3 scrub nurses were recruited into the study.

Four procedures were performed with the VITOM^® 3D exoscope, and as the comparison groups, 5 procedures were performed with normal loupes, 3 with prism loupes, and 2 were done in combination with a microscope and analyzed separately.

Neck angle measurements and feedback from surgeons, assistants, and scrub nurses.

The VITOM^® system improved surgeon ergonomics with reduced procedure time in cervical flexion when compared to the other visualization methods (versus loupes, P < .01, and prism, P < .01). The VITOM^® system also scored favorably in terms of image-related fields, ergonomics, and ease of use.

Use of the 3D exoscope in cleft surgery yielded improved experiences for both surgeons, assistants, and nurses in comparison with loupes and microscopes without increasing operating time.

Objective: This study aims to map the existing sources of evidence on perioperative care and recovery strategies for primary cleft palate repair, to identify elements that should be included in an enhanced recovery pathway (ERP), and to identify gaps in current knowledge.

Design: Scoping review.

Setting: ERPs are evidence-based, patient-centered, multimodal, perioperative care pathways designed to reduce surgical stress and improve postoperative outcomes and are increasingly being reported in the cleft lip and palate literature.

Interventions: PubMed, Embase, Cochrane, and Scopus databases were searched. Results were uploaded to Covidence systematic review software. Studies were included for analysis if they described strategies or elements for enhanced recovery following primary cleft palate repair.

Main outcome measures: ERP elements and outcome measures were recorded and collated.

Results: Forty-seven studies were included. Frequently reported topics included anesthesia, peri-operative analgesia, and parent education. There was a dearth of evidence about peri-operative nursing care. Based on the extracted data, we propose that the following elements be included in any ERP for primary cleft palate repair: preoperative parent/caregiver education; minimization of preoperative fasting time; preoperative analgesia; local anesthetic nerve blocks; perioperative antibiotics and ondansetron; postoperative non-opioid analgesia; early postoperative oral feeding and discharge planning.

Conclusions: The findings provide the framework to develop an institutional ERP for primary cleft palate repair. The positive contribution of consistent nursing care to enhanced recovery is obvious but under-investigated in the literature to date. The impact of ERPs on parent-reported outcomes also warrants further investigation.

Objective: To assess the effectiveness of probiotic and fluoride toothpaste on enamel mineralization and Streptococcus mutans levels in cleft lip and/or palate patients undergoing fixed orthodontic appliance therapy.

Design: A randomized comparative trial with a 1:1 allocation ratio.

Participants: Thirty-two patients with cleft lip and/or palate undergoing fixed orthodontic appliances were recruited.

Interventions: Cleft lip and/or palate patients undergoing fixed orthodontic appliances were randomized into Group 1 (probiotic toothpaste) or Group 2 (fluoride toothpaste). The toothpaste was given to the patient after oral prophylaxis. The patients were advised to use the toothpaste two times a day (morning and night) for a period of 4 weeks.

Main outcomes: Enamel mineral content was assessed before intervention (T0) and after 4 weeks of intervention (T1) using DIAGNOdent. Streptococcus mutans levels were assessed after 4 weeks of intervention (T1) for both the groups using real time-polymerization chain reaction (RT-PCR). Paired t-tests and t-tests were used for intragroup and intergroup comparisons, respectively. A P-value < .05 was considered statistically significant.

Results: Both the groups showed improvement in enamel mineral content after 4 weeks of intervention. Streptococcus mutans levels in the probiotic-containing toothpaste were lesser when compared to the fluoridated toothpaste group. No statistically significant difference was found between probiotic toothpaste and fluoridated toothpaste in both the assessed parameters.

Conclusions: Probiotic toothpaste is as effective as fluoride toothpaste in enamel remineralization. Probiotic toothpaste showed greater inhibitory effect on Streptococcus mutans than the fluoridated toothpaste.

ObjectiveThis study aims to assess the safety and efficacy of solely using local anesthetics for cleft lip repair and/or revision in adolescent and adult patients.DesignSystematic review.SettingClinical studies describing the use of local anesthetics in cleft lip repair procedures.Patients, ParticipantsA literature search was conducted using PubMed, Google Scholar, and Embase following the PRISMA 2020 guidelines. Inclusion criteria were studies focusing exclusively on local anesthetic techniques in adolescent or adult patients undergoing cleft lip procedures. Non-English studies, studies involving patients under the age of 10, or those undergoing cleft palate or other otolaryngological procedures were excluded. Risk of bias was addressed by using a modified Downs and Black checklist.InterventionsReview of local anesthetic use alone for adult and adolescent patients undergoing cleft lip repair or revision.Main OutcomesThe main studied outcomes were any reported general perioperative complications, the necessity of switching to general anesthesia, patients' self-reported pain during the surgery, wound dehiscence, wound infection, and the need for postoperative narcotics for pain control.ResultsThe included studies demonstrated consistent evidence supporting the sole use of local anesthesia for cleft lip repair and revision, with absence of wound dehiscence or infection. Most patients reported minimal to no pain and required no general anesthesia during the procedures.ConclusionsThe current literature supports the safety and efficacy of local anesthesia alone for cleft lip repair and revision procedures. This modality offers a promising approach in resource-limited countries where access to general anesthesia is often limited.

Objective: To describe long-term outcomes and complications following mandibular distraction osteogenesis (MDO) in a diverse patient cohort.

Design: Cross-sectional study.

Setting: Single tertiary-care pediatric center.

Patients: Forty-eight patients previously undergoing MDO with minimum 4-year follow-up.

Main outcome measures: Respiratory outcomes, feeding patterns, dental development, motor/sensory nerve function, temporo-mandibular joint function, and postsurgical scarring.

Results: Forty-six patients with a median age of 7 years were evaluated. Of 20 nonsyndromic patients, none required additional airway procedures, none required continuous positive airway pressure (CPAP) during sleep, and 19 (95%) fed exclusively by mouth. Among 26 syndromic patients, 7 (27%) required CPAP and 8 (31%) were tube fed. Permanent first molar differences were seen in the majority of subjects; patterns of damage interfering with function were more common in syndromic (13/28, 46%) compared to nonsyndromic (5/24, 21%; P = .014) subjects. MDO prior to age two was associated with more frequent and worse dental damage (P = .001). Inferior alveolar nerve and marginal mandibular nerve function were fully intact in 37 (80%) and 39 (85%) of patients, respectively. Three patients (6%), all with associated genetic syndromes, demonstrated severe nerve impairment. By the Vancouver scar scale, ≥ 80% of surgical scars were rated in the most favorable category for each quality assessed. Temporomandibular joint dysfunction was rare.

Conclusions: MDO shows highly favorable long-term respiratory, feeding, nerve, and scar outcomes in nonsyndromic patients, although permanent molar changes not precluding tooth viability are commonly seen. Patients with associated syndromes demonstrate respiratory and feeding benefits, but higher rates of dental and nerve abnormalities.

Objective: Objective measurement of pre-operative severity is important to optimize evidence-based practices given that the wide spectrum of presentation likely influences outcomes. The purpose of this study was to determine the correlation of objective measures of form with a subjective standard of cleft severity.

Design: 3D images were ranked according to severity of nasal deformity by 7 cleft surgeons so that the mean rank could be used as the severity standard.

Patients: 45 patients with unilateral cleft lip and 5 normal control subjects.

Interventions: Each image was assessed using traditional anthropometric analysis, 3D landmark displacements, and shape-based analysis to produce 81 indices for each subject.

Main outcome: The correlation of objective measurements with the clinical severity standard.

Results: Lateral deviation of subnasale from midline was the best predictor of severity (0.86). Other strongly-correlated anthropometric measurements included columellar angle, nostril width ratio, and lateral lip height ratio (0.72, 0.80, 0.79). Almost all shape-based measurements had tight correlation with the severity standard, however, dorsum deviation and point difference nasolabial symmetry were the most predictive (0.84, 0.82).

Conclusions: Quantitative measures of severity transcend cleft type and can be used to grade clinical severity. Lateral deviation of subnasale was the best measure of severity and may be used as a surrogate of uncoupled premaxillary growth; it should be recorded as an index of pre-operative severity with every cleft lip repair. The correlation of other measures evaluated clarify treatment priorities and could potentially be used to grade outcomes.

Although the value of diversity within academia and society is increasingly recognised, the role of speakers with lived experience at cleft and craniofacial conferences remains inconsistent. This perspectives article shares reflection from three academics with lived experience of cleft discussing the value of including lived experience speakers routinely within conferences and outlining common challenges and barriers to the involvement of "experts-by-experience". Key considerations and recommendations are offered to help conference organisers and delegates to make the most of the lived experience perspective, while ensuring the conference experience is positive for lived experience speakers.

To describe the long-term treatment course of bone-anchored maxillary protraction (BAMP) and evaluate orthognathic surgical indications after BAMP.

Retrospective case series.

Craniofacial/Cleft Palate Program at the Orthopaedic Institute for Children in Los Angeles, CA.

Twelve male patients with cleft palate (CP), unilateral cleft lip and palate (UCLP), or bilateral cleft lip and palate (BCLP) and Class III malocclusion treated with BAMP (mean age: 11.4 ± 2.6 years) were included.

BAMP treatment was performed by placement of bone-anchored maxillary and mandibular plates connected with intraoral Class III dental elastics or maxillary plates connected to a facemask.

We retrospectively assessed BAMP treatment variables, including age at surgery, revision surgeries, and treatment duration. The primary goal was correction to class I occlusion.

Twelve patients underwent BAMP treatment for an average of 4.4 ± 2.4 years. Two patients were corrected to class I occlusion at the time of this report. Le Fort I advancement was no longer required in two patients (16.7%), it was required for nine patients (75.0%) and was completed for one patient following BAMP treatment (8.3%).

This preliminary report demonstrated that BAMP treatment may be associated with a minimal reduction in the requirement for Le Fort I advancement at skeletal maturity. Future studies with larger sample sizes are necessary to confirm this association.

Objective: This study aims to systematically review and meta-analyze the electromyographic activity of masticatory muscles in cleft palate and non-cleft patients, and identify influencing factors.

Design: Systematic Review and Meta-analysis.

Patients and exposures: Patients with cleft lip/ palate.

Comparison: Patients without CL/P.

Main outcome measures: Electrical activity of masseter and temporalis muscles at rest and during peak activation.

Results: After a comprehensive search in MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL up to December 2022, without language or date restrictions. Eligible trials were selected based on the PECO question and assessed for bias using Cochrane's ROBINS-E tool. Eight clinical trials with 474 participants were included in the review. Then relevant data was extracted from included studies using customized forms. A random-effects meta-analysis was performed to combine the results of the studies, meta-analyses showed that CL/P patients have elevated electrical activity in the masseter (P = .01) and temporalis (P = <.01) muscles at rest compared to non-cleft control patients. During maximum bite force, cleft patients exhibited a statistically significant decrease in electrical activity in both the masseter (P = .03) and temporalis (P = <.01) muscles.

Conclusions: According to our meta-analysis, cleft patients exhibited increased resting muscle activity but decreased activity during maximum bite force, indicating reduced efficiency of masticatory muscles compared to non-cleft patients. These differences can be attributed to anatomical variations, compensatory mechanisms, and previous treatments.