Cleft Palate-Craniofacial Journal最新文献

ObjectiveThis study aimed to investigate the impact of helmet therapy on changes in cranial asymmetry of infants with positional cranial deformities and to identify clinical and morphometric factors associated with treatment outcome.DesignThis retrospective monocentric cohort study included 455 infants treated between 2011 and 2021.SettingData were collected using manual measurements in a tertiary care setting within the outpatient clinic of a maxillofacial surgery department in Germany.PatientsInfants with positional cranial deformities, including plagiocephaly, brachycephaly, and combined types, were included.InterventionAll patients were treated with a helmet orthosis, and data were analyzed to assess changes in cranial measurements and associated factors.Main Outcome MeasuresPredefined outcome thresholds based on cranial asymmetry reduction and prognostic factors.ResultsPlagiocephaly was the most common deformity in 332 infants. Increased ear shift (Exp(B) = 0.199; 95% CI: 0.087-0.451; p ≤ .001) and large initial diagonal difference (Exp(B) = 0.518; 95% CI: 0.334-0.802; p = .003) were correlated to unfavorable outcome. Delayed treatment was associated with lower reduction in diagonal difference (rs = -0.229; p ≤ .001), and recognized as a negative prognostic factor (Exp(B) = 0.993; 95% CI: 0.989-0.997; p ≤ .001). In contrast, a higher baseline cranial index increased the probability of success (Exp(B) = 1.057; 95% CI: 1.030-1.084; p ≤ .001).ConclusionEarly diagnosis and intervention are crucial for effective treatment of cranial deformities with helmet orthosis, especially in cases with ear shift or severe initial deformation.

ObjectiveThe present meta-analysis has been conducted with the objective of conducting a precise examination of the association between 6 IRF6 gene polymorphisms and the risk of nonsyndromic cleft lip with or without palate (CL ± P) among various ethnic groups.MethodsThe meta-analysis incorporated a total of 53 published case-control studies. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were computed. A leave-1-out sensitivity analysis was conducted, in conjunction with an investigation into publication bias, under the dominant model. Subgroup analysis based on ethnicity was performed.ResultsThe rs642961 was associated with an increased risk (AA + AG vs GG; OR: 1.31; 95% CI: 1.10-1.55; P < .02; I² = 70%), while rs2235371 significantly reduced risk (AA + AG vs GG; OR: 0.74; 95% CI: 0.60-0.92; P < .007; I² = 75%) of CL ± P. The remaining single-nucleotide polymorphisms (rs861019, rs2013162, rs2235373, and rs2235375) were not associated with the risk of CL ± P. Subgroup analysis based on ethnicity revealed distinct ethnicity-specific effects, with rs861019 associated with increased CL ± P risk in Caucasians, rs642961 increasing risk in Asians and mixed populations, and rs2235371 reducing risk only in Caucasians.ConclusionWhile IRF6 gene rs642961 and rs2235371 were found to be associated with an increased risk of CL ± P in all studies, there was suggestive evidence of ethnic-specific differences, particularly among Caucasian and Asian populations. Although this study lends further support to the notion of an association between CL ± P and the IRF6 gene polymorphisms, it is clear that further studies including diverse cohorts are needed to provide fully validated, ethnic- or population-specific insights.

ObjectiveTo determine the most effective surgical technique for treating velopharyngeal insufficiency (VPI) following primary cleft palate repair, based on improvement in hypernasality.DesignSystematic review and meta-analysis of published studies evaluating surgical outcomes for secondary palatoplasty.SettingIsfahan Cleft Care Team, Isfahan, Iran, conducted between 2024 and 2025.Patients/ParticipantsA total of 1774 patients with VPI across 31 studies were included. Syndromic patients and studies lacking original data were excluded.InterventionsFive surgical techniques were evaluated: pharyngeal flap, sphincter pharyngoplasty, Furlow Z-plasty, buccal flap, and buccinator flap.Main Outcome Measure(s)Improvement in hypernasality, defined as any reduction in severity assessed by speech pathologists using perceptual and instrumental tools.ResultsFurlow palatoplasty demonstrated the highest average improvement rate (85.06%), followed by pharyngeal flap (84.50%), sphincter pharyngoplasty (83.04%), buccinator flap (77.61%), and buccal flap (59.69%). Heterogeneity was high across most surgical groups (I² up to 100%), indicating variability in study design and patient characteristics. Complication rates and quality of life outcomes varied, with pharyngeal flap associated with higher rates of obstructive sleep apnea in some studies.ConclusionsFurlow palatoplasty and pharyngeal flap are the most effective surgical techniques for improving hypernasality in VPI patients post-primary cleft palate repair. However, significant heterogeneity and variable complication profiles underscore the need for individualized surgical planning and further prospective research.

ObjectiveCompare the incidence of palatal fistula and early postoperative maxillary morphology following cleft palate repair performed using the Lima protocol versus the Two-Flap technique.DesignThis is a double-blind randomized controlled trial. Participants were randomly allocated to treatment groups using a random table. All surgeries were performed by a single surgeon at a single center.SettingA national tertiary referral hospital, January 2022 to December 2024.ParticipantsInfants aged 9 months to 2 years with unilateral cleft lip and palate who had not previously undergone palatal repair. Those with a history of prior palatal surgery or refusal to participate were excluded.InterventionsParticipants underwent palatoplasty using either the Lima protocol (n = 16) or the Two-Flap technique (n = 19).Main Outcome MeasuresIncidence of palatal fistula and changes in early postoperative maxillary morphology during the first 6 months of follow-up, assessed using dental cast measurements.ResultsA total of 39 patients were enrolled, with 35 completing follow-up. Baseline characteristics were comparable between groups. Postoperative palatal fistula occurred in 11% of patients, with no significant difference between the Lima and Two-Flap groups. Early postoperative maxillary morphology parameters showed similar trajectories across groups, except for greater inter-canine width in the Lima group at 6 months (P = .017) and greater palatal length increase in the Two-Flap group between 1 and 6 months post-op (P = .018).ConclusionBoth the Lima and Two-Flap techniques demonstrated comparable efficacy in preventing fistula and preserving early postoperative maxillary morphology. These findings represent short-term outcomes, and longer follow-up is required to evaluate long-term maxillary growth.

ObjectivesTo evaluate the effect of rapid maxillary expansion (RME) on nasopharyngeal dimensions in children with unilateral cleft lip and palate (UCLP).DesignA prospective case-series longitudinal study.SettingOrthodontic Department, School of Dental Sciences.ParticipantsForty-eight children (30 males and 18 females) aged 8 to 10 years old with UCLP who had maxillary transverse constriction and need maxillary expansion.InterventionRME followed by retention phase.Main outcomeChanges in 3-dimensional nasopharyngeal parameters after RME using cephalometric radiographs and cone-beam computed tomography (CBCT).ResultsThe CBCT analysis revealed that the nasal cavity increased by 1907 mm³ (P < .001), the nasopharynx (NP) increased by 707 mm³ (P = .027), the minimum cross-sectional area increased by 29.98 mm² (P < .001), and the distance between the right and left maxillary sinuses increased by 7.98 mm (P < .001), although the change in the sinus volume was insignificant (P > .05). Cephalometric measurements revealed a statistically significant inferior dislocation of the maxilla after treatment (S-S1, P = .024; N-ANS, P = .017), increase in the inferior anterior and posterior facial height (S-Go, P = .017; ANS-Me, P = .041; N-Me, P = .020).ConclusionRME treatment increased some nasopharyngeal dimensions in children with UCLP and maxillary constriction.

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.