Cleft Palate-Craniofacial Journal最新文献

ObjectivesCharacterize the upper airways (UAW) in individuals with syndromic craniosynostosis (SCS) using computed tomography scans and correlate with the airflow dynamics and craniofacial pattern.DesignObservational, cross-sectional study.SettingTertiary craniofacial center.IndividualsTwenty-nine individuals were included, divided in 2 groups: CON (n = 19; 21.2 ± 3.7 y), individuals with no craniofacial anomalies and no UAW morphological alterations, and SCS (n = 10; 22.1 ± 5.1 y) individuals with SCS prior to maxillomandibular surgery.InterventionsVolume (V, cm³) and minimal cross-sectional area (mCSA, mm²) was calculated (Mimics, Belgium). Computational fluid dynamics (ANSYS, EUA) was performed and flow (F, L/min), pressure (P, Pa), and resistance (R, Pa/[L/min]) were calculated. Cephalometric analysis (SNA[^o]), ANB[^o], Ba-S-N[^o]) was also assessed (Dolphin Imaging, USA).Main OutcomeThe morphophysiology of the UAW in SCS individuals was severely impaired compared with the CON group.ResultsThe SCS group exhibited significant volumetric reduction in the total UAW (-29%), nasal cavity (-21%), and pharynx (-37%) compared with the CON group. The mCSA was 57% smaller in the SCS group. CFD simulations demonstrated decreased flow (-9%), increased pressure (136%), and resistance (156%) in the SCS group. UAW resistance presented a strong positive correlation with mCSA (CON: r = 0.77 / SCS: r = 0.88). Cephalometric findings revealed significant differences between CON and SCS, with the SCS group exhibiting values outside the normal range.ConclusionThe UAW of individuals with SCS was anatomically and functionally impaired, suggesting a significant risk for obstructive sleep apnea.

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.MethodsCC 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.ResultsThe 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.ConclusionCC improved perioperative practices, significantly reducing infections, palatal fistulas, and wound dehiscence, supporting the broader program expansion to any subspecialty.

ObjectiveCraniosynostosis 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.DesignTwenty-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.ResultsFour 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.ConclusionsNarrative 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.

ObjectiveThis study sought to understand cleft team clinician experiences of transitioning patients from pediatric to adult cleft care services in New Zealand.DesignThe qualitative study conducted 4 interviews and 4 focus groups with Cleft Team clinicians either in person or over Zoom. Data were analyzed using inductive thematic analysis to identify themes.ParticipantsTwelve Cleft Team clinicians from 4 Health New Zealand cleft services.ResultsPatients are treated by the same clinicians both before and after transition, however, changes at age 16 include gaining treatment decision-making autonomy, inpatient stays within general plastic surgery wards, and evolving life experiences outside of the hospital. Clinicians reported unmet psychosocial needs of patients and their families, and difficulties experienced by patients returning to cleft services as adults. The development of peer support networks between adolescents and young adults who have experiences of cleft care is also recommended.ConclusionsOngoing cleft care provision and expansion of services are recommended. Furthermore, future studies to understand patients' perspectives of transition are paramount, and incorporating patient voice into any proposed interventions is essential. Potential supports for families of patients with a cleft should also be further investigated, and the application of international standards would promote increased consistency and collaboration between the practice of Cleft Team clinicians around the world.

ObjectiveThe 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.DesignA 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.SettingNational Health Service, England.Patients, ParticipantsEleven patients were recruited in whom 12 procedures were performed. Two main surgeons, 3 assistant surgeons, and 3 scrub nurses were recruited into the study.InterventionsFour 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.Main Outcome Measure(s)Neck angle measurements and feedback from surgeons, assistants, and scrub nurses.ResultsThe 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.ConclusionUse 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.

ObjectiveTo analyze speech outcomes and cleft shape changes in children diagnosed with Robin sequence (RS) treated with a customized pre-epiglottic baton plate (PEBP).DesignSingle-surgeon retrospective analysis.SettingTertiary care institution.Patients and ParticipantsTwenty-five patients with RS who were treated with PEBP and primary cleft palate repair between 2010 and 2019.InterventionsPostnatal use of a PEBP.Main Outcome MeasuresSpeech assessment at the age of 3.5 to 4.5 years documenting hypernasality, nasal emission, nasal turbulence, voice quality, and consonant production, and analysis of digitally scanned cast models before and after the use of PEBP to quantify changes in cleft shape and width.ResultsThe study cohort (N = 25) consisted of 19 patients with hard and soft cleft palates and 6 patients with soft cleft palate only and postnatal use of PEBP. The mean reduction in cleft width following PEBP treatment prior to cleft palate repair in 19 infants with hard and soft cleft palates was 41.30% (standard deviation, 13.25). Speech assessments were conducted at a mean age of 48.5 months in all 25 children treated with PEBP. Most children presented with absent or mild hypernasality (96%), a rate of 8% of nasal emission and 4% of nasal turbulence was found. The most frequent findings were articulation errors in 14 children (56%), of whom 2 presented with cleft-type characteristics.ConclusionsChildren with RS and cleft palate treated with PEBP demonstrated a narrowing of the cleft palate prior to a timely surgical repair, and favorable speech outcomes already at a young age during childhood.

ObjectiveThe goal of this study is to provide an overview of the current clinical practices of cleft teams affiliated to the Dutch Association for Cleft Palate (CP) and Craniofacial anomalies in the Netherlands and in Belgium, with regards to the placement of ventilation tubes in young children with CP.DesignCross-sectional survey.SettingMulticenter study, Oral Cleft Referral Centers of the Netherlands and Belgium.Patients, ParticipantsEar-nose-throat (ENT) surgeons, plastic surgeons, and language speech pathologists.InterventionsOnline survey.Main Outcome Measure(s)The survey questions covered the following topics: audiology assessment before palatoplasty, ventilation tube insertion (VTI) timing, postoperative follow-up visits.ResultsResponse rate per center was 100% (11/11 cleft centers), for a total of 21 cleft specialists (44%). Most centers (n = 7/11) establish VTI indication before palatoplasty by means of audiology assessment combined with ENT surgeon examination. Most centers combine VTI with palatoplasty (n = 9/11), and schedule a routine follow-up 2 to 3 months after surgery (n = 7/11).ConclusionsAlthough no standardized national or international protocols exist for the diagnosis and treatment of otitis media with effusion in children with CP, most Dutch and both Belgian cleft centers have independently developed local protocols that are largely aligned. Formalizing these into a unified written protocol represents an important next step toward optimizing and standardizing care for this patient population.

ObjectiveTo identify factors associated with repeated ventilation tube insertion (VTI) in children with cleft palate (CP) who developed otitis media with effusion (OME) before 6 years of age, and to construct a practical risk prediction scoring system.DesignRetrospective cohort study.SettingTertiary care academic hospital.ParticipantsMedical records of 127 children with CP who underwent both myringotomy with VTI and palatoplasty between 2007 and 2023 were reviewed. Patients were classified into single VTI (n = 55) and repeated VTI (n = 72) groups.InterventionsAll participants received myringotomy with VTI as standard OME management. Palatoplasty techniques included intravelar veloplasty and double-opposing Z-plasty, with or without hamulus fracture.Outcome MeasuresTen potential risk factors were evaluated, including craniofacial syndromes, premyringotomy hearing level, acute otitis media history, cleft type and gap width, middle ear fluid type, tympanic membrane (TM) retraction, surgeon level, palatoplasty technique, and hamulus fracture. Logistic regression was used to develop a predictive scoring system.ResultsMultivariate analysis identified thick middle ear fluid (odds ratio (OR) 3.18, P = .008), TM retraction (OR 4.06, P = .043), and premyringotomy hearing level >40 dB (OR 3.50, P = .010) as independent predictors of repeat VTI. A 0 to 4 point scoring system showed acceptable discrimination (area under the curve = 0.732).ConclusionChildren with TM retraction, thick middle ear fluid, or hearing loss >40 dB are at higher risk for repeated VTI. This scoring system supports early identification, caregiver counseling, and closer follow-up to optimize middle ear outcomes.

ObjectiveTo evaluate the effectiveness of cyanoacrylate tissue adhesives versus conventional sutures for skin closure in primary cleft lip repair, focusing on esthetic, clinical, and patient-centered outcomes.DesignSystematic review and meta-analysis of randomized controlled trials and comparative observational studies.SettingMulticenter data synthesis including studies from the United States, the United Kingdom, India, Nigeria, and the Netherlands.Patients, ParticipantsA total of 442 patients undergoing primary cleft lip repair, with 402 contributing extractable outcome data.InterventionsEpidermal closure using tissue adhesives (octyl-2-cyanoacrylate, iso-amyl cyanoacrylate, or octyl-2-cyanoacrylate with polyester mesh tape) compared with fine nonabsorbable sutures (nylon, Prolene, or Monocryl).Main Outcome Measure(s)Esthetic scar quality, wound complications, parental satisfaction, operative time, and scar-related secondary parameters (eg, white roll alignment, hypertrophic scarring).ResultsEight studies met inclusion criteria, of which 2 were randomized controlled trials. Meta-analysis showed no significant difference in esthetic outcomes between adhesives and sutures (SMD -0.05, 95 % confidence interval [95% CI] [-0.28 to 0.18]; I² = 12%). Complication rates were comparable (RR 0.93, 95% CI [0.41-2.11]). Operative time was consistently shorter with adhesives, reducing closure by 5 to 7 min per case. Parental satisfaction was uniformly higher in adhesive groups. Evidence certainty was graded moderate for esthetic outcomes and wound complications, and low for operative time and satisfaction.ConclusionsTissue adhesives provide equivalent esthetic and complication outcomes to sutures in cleft lip repair, with added advantages of faster closure and improved parental satisfaction. Incorporating adhesives into cleft protocols may enhance efficiency and patient-centered care, though further high-quality trials with long-term follow-up are warranted.