Cleft Palate-Craniofacial Journal最新文献

Objective: To establish the effect of cleft palate repair on hearing outcomes in children with glue ear and conductive hearing loss undergoing elective primary palatoplasty.

Methods: A retrospective chart review of all patients who underwent cleft palate repair (isolated cleft palate [CPO], unilateral cleft lip and palate [UCLP], and bilateral CLP [BCLP]) between 2020 and 2022 in a single institution. Patient demographic data and cleft type were recorded. Statistical analysis was performed on pre and postoperative audiology reports.

Results: A total of 42 children (20 males, 22 females) had cleft palate repair within the study period. The mean age at primary repair was 15.2 months (range: 8-33 months). Seven of the 42 children were syndromic and 4 had Pierre Robin sequence. Preoperatively, 36 patients (86%) were diagnosed with conductive hearing loss. A single patient had hearing aids preoperatively due to severe hearing loss. One patient had grommets inserted at the time of palatoplasty. Postoperatively, all 42 patients attended their follow-up audiology appointments (100%); 20 patients (48%) had improved hearing levels, 18 (43%) had similar hearing levels, and 4 (9%) had worse hearing levels. When stratified by cleft type (25 CPO, 9 BCLP, and 8 UCLP) no difference was noted. Four patients required hearing aids postoperatively.

Conclusions: This study confirms that primary cleft palate repair has a positive impact on audiology outcomes in patients with cleft. These findings suggest that primary cleft palate repair may improve hearing at an early stage, possibly by contributing proactively to restoring eustachian tube function and normalizing middle ear ventilation before glue ear and associated conductive hearing loss improve with patient maturity.

Objective: To evaluate the effectiveness and parental satisfaction of an at-home weight reporting system for the maintenance of weight stability in infants with cleft lip and/or palate (CLP).

Design: A prospective cohort of infants with CLP was provided an at-home scale to track weekly weights compared to a retrospective cohort of infants with CLP that underwent standard weight checks at routine healthcare appointments.

Setting: Tertiary care pediatric hospital.

Patients/participants: Infants from 0 to 3 months of age who presented to a large midwestern Cleft Clinic with a diagnosis of CLP without a secondary major birth difference.

Interventions: "Weigh Easy" at-home scale and reporting system.

Main outcome measure(s): Weight loss or plateau.

Results: Infants enrolled in the prospective cohort (n = 25) were significantly less likely to have a destabilizing weight loss compared to the retrospective cohort (n = 131) (OR = 0.09, 95% CI = 0.01-0.60, P = .001 at 30 g/day; OR = 0.15, 95% CI = 0.04-0.60, P = .001 at 25 g/day; OR = 0.24, 95% CI = 0.09-0.61, P = .002 at 20 g/day). Over at least 90 days of data collection, the prospective group had a median of 12 weight changes compared to 4 in the retrospective cohort (P < .001). The Parent Satisfaction Survey (n = 17) revealed 94.1% preferred to weigh their child at home with the Weigh Easy Scale compared to commuting to a publicly available scale and 88.2% would recommend the "Weigh Easy" scale to their friends and family.

Conclusions: Providing parents of infants with CLP with the "Weigh Easy" scale identifies feeding and nutritional needs more quickly than standard weight checks.

Objective: To compare the reliability of different digitizing methods not only among themselves but also with direct measurements from facial plaster models of unoperated cleft babies.

Design: Single-center retrospective study.

Setting: The study consisted facial models of babies with unilateral (UCLP, n = 65) and bilateral (BCLP, n = 65) cleft lip and palate from the archives of the Department of Orthodontics, Marmara University, Istanbul, Turkey. Those models were digitized using Medit i600, iTero Element 2 (Align Technology), and E3 3Shape scanning devices. A digital caliper with a 0.03 precision (INSIZE Digital Caliper) was used for manual measurements on plaster models. 3Shape Ortho Analyzer software was used for digital measurements.

Results: All scanning methods were reliable and compatible with a rate of 90% or more compared to manual measurements. The E3 3Shape device showed the lowest deviations (UCLP, between 0.04 and 0.11 mm; BCLP, between 0.04 and 0.25 mm) from manual measurements. In the UCLP group, Medit i600 presented the highest deviation (0.15-0.58 mm) whereas Itero Element 2 showed the highest deviation in the BCLP group (0.16-0.46 mm). Although there were statistically significant differences in the deviations of digital measurements, the values were still within clinically acceptable limits.

Conclusion: Intraoral scanners were less reliable in topographic measurements, especially in cases with increased depth. Although the highest compatible results were found with E3 3Shape model scanner, iTero Element 2 and Medit i600 were promising and advisable for digitizing and archiving the plaster models of babies with cleft lip and palate.

To study postoperative pain control differences between liposomal bupivacaine (LB) and immediate-release bupivacaine (IRB) as measured by the use of narcotics after iliac crest graft harvesting for alveolar bone grafting (ABG).

A retrospective review was completed at a single-site pediatric stand-alone hospital of patients undergoing ABG with iliac crest bone grafting (ICBG) between May 1, 2020, through May 31, 2023.

Patients, participants: Patients who underwent ABG with ICBG were split into three cohorts: LB monotherapy, IRB monotherapy, or LB with IRB.

Interventions: All ABG and ICBG procedures were completed by a single surgeon who is a member of our dedicated cleft lip and palate team.

Main outcome measures: The primary outcome was the difference in oral morphine equivalent (OME) requirements from the immediate postoperative time period to the time of discharge.

Patients treated with LB monotherapy required significantly less OME during their inpatient stay, with an average of 0.21 mg/kg ± 0.15 mg/kg in the LB group, 0.67 mg/kg ± 0.37 mg/kg in the IRB group, and 0.28 mg/kg ± 0.07 mg/kg in the LB with IRB group (P = .001). There was no significant difference in the total number of analgesic medication doses administered throughout the hospitalization among the three groups.

Utilization of LB intraoperatively may decrease the need for postoperative opioid treatment for postoperative pain control when harvesting ICB for ABG in the cleft lip and palate population compared to alternative local anesthetics.

A special issue of the Cleft Palate-Craniofacial Journal was curated to highlight early-career researchers of the American Cleft Palate-Craniofacial Association and their innovative research contributions. This collection of 13 manuscripts, all led by early-career researcher authors of diverse disciplines and training, represents a wide variety of topics related to the science surrounding craniofacial care.

Objective: To analyze the prevalence of obstructive sleep apnea (OSA) in children aged 6 to 12 years with nonsyndromic Robin sequence (NSRS) and in those with nonsyndromic cleft palate (NSCP). All patients presented complete cleft palate (Veau II).

Design: Cross-sectional study.

Setting: Tertiary public hospital.

Patients: A total of 146 children divided into 2 groups: (1) NSRS (n = 69), (2) NSCP (n = 77).

Interventions: (1) Anthropometric assessment, dentoskeletal, and facial analysis. (2) Clinical interview with "Sleep Disturbance Scale for Children" and "Congestion Quantifier Five-Item" (CQ5); and (3) 48 patients: Type IV polysomnography.

Main outcome measures: Frequency of OSA in children with NSRS and NSCP, assessed by Type IV polysomnography.

Results: Positive scores for OSA were found in 59.42% of children with NSRS and 46.75% of those with NSCP (P > .05). Excessive daytime sleepiness was observed in 23.19% of the NSRS group and 9.01% of the NSCP group (P > .05). Positive scores for nasal obstruction were noted in 14.49% with NSRS and 20.78% of those with NSCP (P > .05). In polysomnography IV subgroups, an Oxygen Desaturation Index compatible with mild to moderate OSA was observed in 89.65% of the NSRS group and 78,94% of the NSCP group (P > .05). Also, facial and pharyngeal alterations, such as Angle Class II malocclusion, Mallampati classifications III and IV, and deep crossbite, were associated with OSA.

Conclusion: Both children with NSRS and NSCP have a high frequency of mild to moderate OSA, highlighting the need for systematic evaluation of the presence of sleep-disordered breathing in this population.

Objective: This study aims to analyze health determinants affecting patients with cleft palate, specifically examining the relationships between the Social Vulnerability Index (SVI), failure to thrive (FTT), and healthcare utilization within the initial 30 days and first year of life.

Methods: A retrospective analysis was conducted on patients with a cleft palate at a tertiary care center over an 11-year period. Data included demographics, weight percentile trends, pediatric emergency department (PED) visits, hospital admissions, SVI scores, cleft palate type, and FTT diagnoses. Statistical analyses were performed using SPSS.

Results: Social Vulnerability Index was not significantly correlated with health outcomes in cleft palate. Patients with FTT exhibited lower gestational age (P = .002) and birth (P = .005), one-month (P = .001), and one-year (P = .001) weight percentiles. FTT diagnosis was associated with increased PED visits (P = .000) and hospital admission (P = .000) in the first year of life. Early presentation to the PED was associated with increased PED visits (P = .000) and hospital admissions (P = .004) within the first year of life.

Conclusion: No direct link was found between SVI and FTT. Early hospital readmission emerged as a significant outcome, indicating increased healthcare utilization in patients that require early medical intervention. Failure to thrive significantly impacted healthcare utilization, emphasizing the importance of addressing feeding issues early in this patient population. This study contributes to understanding health disparities in cleft palate patients and highlights the need for nuanced exploration of regional factors influencing outcomes.

Velopharyngeal insufficiency (VPI) predominantly affects children with cleft palate, undermining their ability to communicate. As a result, intelligible speech generation is one of the most important outcomes following cleft palate repair. In low- and middle-income countries (LMICs), the elevated incidence of cleft palate, unavailability of speech services, and suboptimal surgical outcomes has contributed to a substantial yet poorly defined global burden of VPI. Tracking speech outcomes in LMICs is essential to assessing VPI severity and identifying patients needing care. Artificial intelligence and machine learning are well-suited to accommodate this goal.

It's interesting to note that despite clinical improvements in upper airway dimensions, the maxillary, mandibular, and mandibular body lengths remained smaller than those of controls. This finding may represent an underlying neurocristopathy, which represents a deficiency in the population of neural crest cells available in the embryonic maxillary and mandibular processes de novo. Indeed, it is known that craniofacial dimensions in infants with malformations, such as cleft palate, are often smaller when compared to non-cleft counterparts. The post-treatment decrease in the SNA angle and increase in angle SNB, which resulted in a decreased ANB angle may be associated with a "headgear effect" whereby the maxilla is dragged postero-inferiorly by the mandible, aided by gravity. To avoid this effect, proactive maxillary development might be beneficial. In fact, the concept of "catch-up growth" is also noteworthy since a developmental mechanism would need to be invoked. The authors referred to the old Functional matrix hypothesis, but the treatment effect was primarily a change in jaw position, which evoked a positive functional outcome. Thus, according to the Spatial matrix hypothesis, clinical decompensation of a dysfunctional spatial matrix leads to a cascade of events since a change in mandibular position is associated with changes in gene expression. Recently, genetic expression of Sdf1 and Foxc1 associated with histologic changes following mandibular advancement in rats has been reported as well as the effects of the PINK1/Parkin pathway on the genioglossus muscle through mandibular advancement device use in rabbits with obstructive sleep apnea. Clinically, therapeutic epigenetic changes using an orthodontic mandibular advancement device have also been reported in children.