Cleft Palate-Craniofacial Journal最新文献

Objective: To develop, implement, and evaluate a standardized perioperative care pathway for pediatric patients undergoing alveolar bone grafting from the anterior iliac crest.

Design: A historical control group of 40 patients was reviewed retrospectively and compared to a prospectively collected treatment group of 40 patients who were treated with the new pathway.

Setting: Tertiary-level academic pediatric hospital between 2018 and 2021.

Patients: Pediatric patients with nonsyndromic cleft lip and palate undergoing alveolar bone grafting.

Intervention: A perioperative clinical care pathway was specifically designed for patients undergoing alveolar bone grafting from the anterior iliac crest. The pathway involved standardization of perioperative care, ultrasound-guided regional anesthesia for both surgical sites, and scheduled postoperative analgesia.

Main outcome measures: (1) Length of hospital stay; (2) opioid consumption postoperatively; and (3) volume of oral intake in the first 24 h postoperatively. Data was analyzed via comparison of means (Student's t-test for continuous data and Chi-square test for categorical data) and control chart analysis.

Results: Compared to the control group, patients in the treatment group had lower mean length of stay (26.8 vs 37.8 h, p < .001), lower mean morphine consumption postoperatively (8 vs 34 mcg/kg, p = .008), and a higher proportion of patients not requiring any postoperative opioid use (80% vs 50%, p = .005).

Conclusions: Implementation of a standardized clinical care pathway for pediatric patients undergoing alveolar bone grafting from the anterior iliac crest is feasible and was associated with significant reductions in postoperative length of stay and postoperative opioid requirements.

Objective: To characterize mandibular morphology in patients with Parry-Romberg syndrome (PRS).

Design: Retrospective study.

Setting: A craniofacial center.

Patients: Thirty-three patients with PRS affecting mandible.

Interventions: Preoperative computed tomography data were analyzed using Mimics 26.0 (Materialise Inc.). Distances between landmarks-condyle process (Con), coronoid process (Cor), mandibular foramen (IAF), gonion (Go), and mental foramen-were measured to represent the sizes of skeletal units. Positional asymmetry was reflected by angles between lines connecting bilateral landmarks and the occlusal plane.

Main outcome measure(s): Bilateral differences in unit sizes were compared. Absolute difference (Δ) > 5 mm and relative size (RS) < 80% were set to evaluate the severity of hypoplasia. Angular measurements were compared to 0° using one-sample t tests. Pearson correlation analysis was conducted to examine the relationship between onset ages and both RS and angular measurements.

Results: The affected side's skeletal units were smaller. Severe hypoplasia was more common in the angular unit. Angles between Con-Con', Cor-Cor', IAF-IAF', and the occlusal plane were less than 0°, whereas the angle with Go-Go' was greater than 0°. Age of onset was positively correlated with the condylar unit size and the Con-Con' to occlusal plane angle.

Conclusions: Patients with PRS affecting mandible exhibit smaller skeletal units on the affected side, particularly in the angular unit. Most landmarks on affected side tend to cluster toward the occlusal plane. Earlier onset of PRS correlates with more pronounced condylar asymmetry. Evaluating the severity of functional units involvement and implementing appropriate treatment should be considered.

The article elucidates the management of a case of severe form of grade III hypertelorism with an intercanthal distance of 61 mm in a 4-year-old child. The management was especially challenging because of the patient's young age, degree of hypertelorism, wide cleft and simultaneous presence of 2 big (sincipital & basal) encephaloceles and a lipoma in the midline. This paper attempts to describe the attempted surgery, postoperative course and the learnings derived from its management to probably create a road-map for surgeons faced with such a challenge in future.

To 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).

Retrospective cohort study.

A university orthodontic clinic and comprehensive cleft care centers.

In 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.

The 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.

The 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.

It 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.

Common congenital malformations known as orofacial clefts include cleft lip, cleft lip and palate, and cleft palate. They present significant public health challenges globally due to their medical, psychological, and socioeconomic impacts. Genetic and environmental factors mostly influence the genesis of nonsyndromic cleft lip with or without cleft palate.

A meta-analysis was carried out to evaluate the association between IRF6 polymorphisms (rs2235371, rs2235373, and rs2235375) and NSCL/P. PubMed, Google Scholar, Scopus, and Embase were systematically searched for relevant articles. Studies meeting predefined inclusion criteria included case-control designs, genotype data, and statistical measures (odds ratios, 95% confidence intervals). Seventeen research papers were chosen based on the Newcastle-Ottawa Scale criteria for worth evaluation.

The meta-analysis included 1809 NSCL/P cases and 3164 controls from diverse populations, including Chinese Han, Brazilian, South Indian, Northeast Chinese, Uyghur, Indonesian, Vietnamese, Mesoamerican, and Iranian groups. However, in our analysis, only specific IRF6 SNPs-rs2235371 and rs2235373-showed significant associations in the allelic and dominant models, respectively, while other SNPs, including rs2235375, showed no significant association. These findings underscore the genetic heterogeneity of NSCL/P across various ethnic groups.

This meta-analysis emphasizes the complex role of IRF6 polymorphisms in the genetic susceptibility to NSCL/P. While significant associations were identified in several populations, the lack of association in others suggests that genetic factors contributing to NSCL/P vary widely. Further research is needed to elucidate additional genetic determinants and their interfaces with environmental factors in the pathogenesis of NSCL/P.

Objective: Craniosynostosis is considered a lifelong condition, yet relatively little focus has been directed toward ascertaining the information needs of Australian families. Thus, the aim of this study was to explore the information needs of Australian parents whose child has been diagnosed with nonsyndromic or syndromic craniosynostosis.

Design: Twenty-one online narrative interviews were conducted with parents of children with craniosynostosis (aged between 4 months and 20 years). Transcripts were analyzed using reflexive thematic analysis and themes were developed.

Results: Four themes were generated: (1) lots of information …. and quickly!; (2) the practicalities of hospital and surgery; (3) guidance on how to talk about my child's condition; and (4) the path is rarely clear. Parents of children with craniosynostosis discussed a range of information that was provided to them, or they would have liked to have been given, following their child's diagnosis. Parents noted that insufficient information was provided by the health system and that they faced considerable difficulties accessing credible information about their child's condition, relevant location-specific surgical options, the treatment process and outcomes.

Conclusions: Narrative interviews provided detailed insight into the information needs of Australian parents of children diagnosed with craniosynostosis. Although parents were frequently challenged by a lack of information detailing their specific treatment and support options, suggestions relevant to craniofacial providers globally were offered. Further work is now needed to develop and provide these information resources in a timely and easily accessible way.

Objective: To evaluate the efficacy of tongue flaps in closing large palatal fistulas secondary to cleft palate repair in terms of functionality, esthetics, and donor site morbidity.

Design: Tertiary academic center.

Setting: We report our 8-year surgical experience with tongue flaps, with our parachute suture technique in flap inset, and not using tongue fixation methods or feeding tubes.

Participants: Nineteen patients having recurrent secondary palatal fistula, post-cleft treatment were treated with anteriorly based dorsal tongue flaps.

Main outcome measure: Patients were evaluated for outcome in terms of flap uptake and effectiveness, correction of oronasal regurgitation, speech and nasality improvement, donor site morbidity, and esthetics.

Results: A total of 19 patients in the age range of 1.5 to 34 years were treated with anteriorly based tongue flap. Detachment of the tongue flap was observed in 1 patient. Furthermore, tongue flap necrosis was not observed in any of the patients. Nasal regurgitation was resolved completely in 15 cases (78.9%), and 2 out of 4 failed cases were due to fistula presence in a position out of flap territory. In addition, fistula persists in the case of flap detachment and another case at the location of pedicle division. Speech intelligibility and hypernasality changes were reported as noticeable improvement in 9 (47.4%) and no obvious change in 10 patients (52.6%).

Conclusion: Using parachute suturing technique can facilitate successful lingual tissue inset in palatal defects with negligible remnant fistula. Moreover, avoiding tongue fixation methods and nasogastric tube-assisted feeding wasn't associated with increased flap dehiscence or suture loosening.

Background: "Clean Cleft" (CC) is an adaptation of the Lifebox Clean Cut program, designed to reduce surgical site infections (SSIs) in cleft lip and palate repairs. It focuses on 6 key processes: hand and site decontamination, surgical linen integrity, instrument sterility, timely antibiotic use, gauze counting, and WHO Surgical Safety Checklist compliance. The study explores CC's effectiveness in reducing infections, other complications, and enhancing early recovery.

Methods: CC was piloted in 2 Ethiopian hospitals and 1 in Côte d'Ivoire, the primary public cleft care centers in each country. Baseline data were collected through direct observation in the operating room, with patients monitored postoperatively for infections and complications through daily ward visits and follow-up calls or clinic visits at 30 days. Post-intervention data were collected for 5 months. Data was captured in DHIS2 software and analyzed using SPSS version 26.

Results: The program enrolled 275 patients, with 156 during baseline and 119 post-implementation. Complications significantly dropped from 21.7% to 8.7% (P = .008), a 60% decrease. SSI rates fell from 18.1% to 8.0% (P = .03), while palatal fistulas decreased from 13.0% to 6.1% (P = .1) and wound dehiscence from 18.0% to 8.0% (P = .03). Adherence to perioperative standards improved, except for hand and skin preparation while pain management remained effective throughout the program.

Conclusion: CC improved perioperative practices, significantly reducing infections, palatal fistulas, and wound dehiscence, supporting the broader program expansion to any subspecialty.

To describe and compare the healthcare trajectories of patients with CL/P under two different income-based programs for health coverage in Colombia, known in Colombia as a health insurance regime (contributory and subsidized), in Medellín, 2021.

Non-experimental, cross-sectional questionnaire-based study.

Primary level of clinical care in Medellín, Colombia.

Twenty-eight 15- to 21-year-olds with CL/P and primary caregivers.

Individuals with CL/P answered the survey. Patients with syndromic CL/P and patients with cognitive disabilities were excluded. The calculation of the probabilistic sample was performed based on the formula for finite populations using databases from 2 health insurance companies. The analysis was descriptive and bivariate. Chi-square and Fisher tests were used to analyze the variables of interest.

Continuity of the care pathway was measured with proxy indicators: (1) access to comprehensive CL/P treatment; (2) timeliness of access to comprehensive CL/P treatment; (3) differences in access to and timeliness of comprehensive CL/P treatment between patients under both health insurance coverage.

No differences were found when comparing the healthcare trajectories of young patients with CL/P who were in both health coverage. Differences were observed in the timeliness of care for patients with CL/P under the subsidized coverage who were more economically vulnerable. Delays in care were mainly linked to administrative procedures required for orthodontic procedures, bone grafts, and maxillofacial surgeries.

Despite the health system's guarantee of equal care across income levels, differences in the timeliness of care persist for patients from lower-income families.

This study aims to report a rare complication, anisocoria (mydriasis), in a patient with cleft lip and palate in the immediate postoperative period after orthognathic surgery and discuss the literature surrounding this event. Mydriasis after orthognathic surgery may be related to the separation of the pterygoid plate from the sphenoid bone, which can injure the cranial nerves. Therefore, knowledge of possible anatomical variations of the posterior region of the maxilla becomes extremely important to minimize complications in cleft patients. The reported case highlights the management of anisocoria as a complication as well as the importance of its knowledge.