Cleft Palate-Craniofacial Journal最新文献

Objective: Lip muscle reconstruction is a key strategy for cleft lip repair, but the outcome of muscle regeneration is suboptimal. The lack of relevant models restricts studies on cleft lip muscle regeneration.

Design: In this study, we developed an animal xenograft model by transplanting muscle samples from patients with cleft lip into different host sites in immunodeficient mice. The grafted muscles were harvested after 1, 2, and 5 months to investigate the temporal dynamics of myofiber growth and maturation. Comparisons were made among muscle biopsies, xenografts in the masseter (MAS) muscle of the mice, and xenografts in the tibialis anterior (TA) muscle of the mice to determine the optimal host niche.

Histological analysis of myofiber number and size, fiber type switching, innervation, and blood supply was performed to evaluate the cleft lip muscle regeneration process.

Results: The muscles from cleft lip patients underwent an active degeneration-regeneration cycle. The fiber diameter in the MAS niche was significantly larger than that in the TA niche and was comparable to the fiber diameter of the donor biopsy from which it originated. The innervation and blood supply of the muscle grafts at the MAS host site were also superior to those of the grafts at the TA host site.

Conclusions: The MAS muscles of mice provided the most favorable microenvironment for cleft lip muscle regeneration. This patient-centered xenograft model offers a platform for cleft lip muscle regeneration studies.

Timely medical care is crucial for optimal outcomes in children with cleft lip and palate. Undocumented migrant children face significant healthcare barriers. This study assesses the demographic characteristics and unmet surgical needs of undocumented children at our institution and analyzes state-level policies affecting their care.

A retrospective review was conducted at a single institution between 2023 and 2024. Medicaid and Children's Health Insurance Program policies were reviewed as of August 2024, categorizing states by immigrant child healthcare coverage.

Multidisciplinary cleft clinic in a pediatric referral center.

Ten undocumented children were included, with clinical data and immigration status collected from social work and insurance records.

Timing of initial cleft surgery, additional surgical needs, and surgical completion were assessed.

Ten undocumented children were identified, with a mean age of 7 (range 1-10) years. Eight received primary cleft surgery in their home countries, but many had unmet surgical needs, including alveolar bone grafting (n = 4), oronasal fistula closure (n = 5), and dental care (n = 3). Twelve states provide comprehensive coverage regardless of immigration status, with 2 more expected by 2025. Twenty-three states cover only certain noncitizens without a waiting period, while 14 impose a 5-year delay. Broad coverage was concentrated in the Northeast and West (P = .002), with only one US-Mexico border state included.

This study highlights barriers undocumented migrant children face in accessing cleft care, with disparities in state-funded policies potentially delaying critical interventions. Addressing these disparities is essential for equitable healthcare access.

To compare outcomes, complications, and costs between endoscopic and open surgical approaches in the management of craniosynostosis using a large national database.

Retrospective cohort study.

National Inpatient Sample database, including inpatient hospital discharge data from 2018 to 2021 across 48 states and Washington, D.C.

The present study included 1099 patients admitted with a primary diagnosis of craniosynostosis. Among them, 183 (16.6%) underwent endoscopic surgery and 916 (83.3%) underwent open surgery.

Surgical management of craniosynostosis, classified as either an endoscopic or open approach.

Length of hospital stay, total procedure costs, and rates of inpatient complications, including surgical and medical complications.

Endoscopic surgery was associated with a significantly shorter length of stay (mean 1.6 days vs 3.7 days, P < .001) and lower total costs ($ 66 815.90 vs $ 146 271.21, P < .001) compared to open procedures. It demonstrated lower rates of surgical complications (0.5% vs 7.9%, P < .001) and neurologic complications, primarily dural tears (0.5% vs 7.0%, P < .001). There were no differences in inpatient mortality between groups.

Endoscopic approaches to craniosynostosis offer advantages over open techniques, including reduced length of stay, costs, and complications. The present findings support the increasing adoption of endoscopic methods for craniosynostosis management. Future studies should assess the long-term impact on head shape durability and neurodevelopmental outcomes.

There are many barriers patients and families face in low- and middleincome countries (LMICs) to just receive the initial surgical care for their cleft lip and palate (CLP). Cleft lip/palate care encompasses much more than just the initial primary repairs, especially in the realm of otolaryngology, audiologic health, and speech language pathology. LMICs face many disparities in training and surgical care for secondary cleft surgeries, and addressing these disparities and creating solutions is paramount for the future of CLP patients globally. This editorial aims to highlight these disparities and pave a path forward with solution-based discussions.

To investigate the interdental arch relationship outcomes of 5-year-old children with unilateral cleft lip and palate (UCLP) before and after centralization of cleft services in the United Kingdom (UK) using the modified Huddart-Bodenham index (MHBI) and to investigate any differences in MHBI by cleft laterality.

Retrospective cross-sectional study.

Evaluation of three-dimensional study models of children with a complete UCLP.

All available 5-year-old orthodontic study models of participants with UCLP from the precentralization Clinical Standard Advisory Group (CSAG n = 107) and postcentralization cleft care UK (CCUK n = 195) studies. The models were also grouped by cleft laterality (left and right sided).

Differences between the interdental arch relationship outcomes were assessed using the MHBI. This index scored the buccal/palatal or labial/palatal relationships of 8 maxillary deciduous teeth with the opposing mandibular dentition. The anterior segment, buccal cleft segment, and noncleft segment scores were calculated and combined to calculate the MBHI total arch scores.

Inter and intraexaminer reliability demonstrated high levels of agreement. Statistically significant differences in the anterior segment, buccal noncleft segment, and total arch MHBI scores were found, with postcentralization CCUK performing better. Right-sided UCLP had statistically significantly better buccal cleft segments, but no differences were found for the other MBHI segments or total arch scores.

There were improved interdental arch relationships postcentralization of cleft services in the United Kingdom. Cleft laterality differences were limited to the buccal cleft segment with right-sided UCLP having better MBHI scores.

We report a case of multiple suture craniosynostosis in a patient with hypochondroplasia. The patient presented with short stature marked by a relatively long trunk and short extremities. The clinical and radiological findings were suggestive of hypochondroplasia. Additionally, craniosynostosis was identified during the evaluation, which is an unusual finding in hypochondroplasia. To further investigate, exome sequencing was performed, revealing previously reported pathogenic heterozygous variants in FGFR3 and ERF genes. Exome sequencing not only enhances the accuracy of diagnosing individual cases of genetic skeletal disorders but also contributes to the collective knowledge base, advancing future research in the field.

To ascertain the current practice in the United Kingdom with regard to the use of bite blocks and the division of the pedicles in buccinator flap surgery for velopharyngeal insufficiency. To compare the outcomes of fixed and removable bite blocks in buccinator flap surgery, in terms of the incidence of pedicle injury and patient experience.

Survey of cleft surgeons in the United Kingdom on their use of bite blocks and division of the pedicles. Retrospective cohort review of consecutive patients that underwent buccinator flap surgery at Salisbury District Hospital between January 1, 2021, and December 31, 2022, comparing the use of fixed and removable bite blocks. Survey of patients who had bite blocks fitted to understand the patient and family experience.

Cleft consultants from the United Kingdom and Ireland responded: half (11 of 22) reported using bite blocks and half reported routinely dividing the pedicles, most commonly at 4 to 6 weeks after surgery. In our cohort (19 patients), fixed bite blocks had a higher incidence of pedicle injury (33%) and difficulty eating (78%) than removable bite blocks (20% and 20%, respectively). Generally, parents/patients tolerated the presence of bite blocks and were often unaware of pedicle injury, even in cases of repeated severe biting.

There is variation in the current use of bite blocks and pedicle division following buccinator flap surgery in the United Kingdom. In compliant patients, removable bite blocks may be associated with lower complication rates but neither fixed nor removable bite blocks compromise flap integrity.

Background: The family-centered care is widely applied in pediatric nursing; however, there has been no research reflecting its extent of practice in the auricular reconstruction process for families of children with congenital microtia in China.

Objective: This study aims to understand the perspectives of parents of children with congenital microtia and nurses at auricular reconstruction centers in Beijing, China, regarding family-centered care practices and specific areas that need improvement.

Methods: The study utilized the Measure of Processes of Care (MPOC-20) and the Measure of Processes of Care for Service Providers (MPOC-SP) to survey 100 parents and 22 nurses. Scores for each dimension and item with low score (1-4 points, representing for at least 25% respondents) were statistically analyzed, indicated deficiencies in care services. The scores of parents and nurses were compared with international data.

Results: In this study, the dimension scores of the MPOC-20 ranged from 5.34 ± 1.22 (Coordinated and Comprehensive Care) to 5.57 ± 1.22 (Providing Specific Information). The dimension scores of the MPOC-SP ranged from 5.91 ± 1.08 (Showing Interpersonal Sensitivity) to 6.25 ± 1.20 (Providing General Information). Both sets of scores were higher than most previous studies, particularly in Providing General Information.

Conclusion: Parents of children with congenital microtia and nurses generally rated family-centered care practices positively. However, improvements are needed in Coordinated and Comprehensive Care and Showing Interpersonal Sensitivity. Future efforts should aim to enhance the care system for microtia by standardizing care service content, increasing auditory and psychological interventions, and strengthening long-term follow-up care.

Zygomatic implant (ZI) is considered a predictable alternative for patients with atrophic maxilla. However, regarding the case of patients with cleft lip and palate (CLP), the evidence of ZI rehabilitation remains unclear. This study aimed to evaluate the indications and clinical outcomes of rehabilitation using ZI in CLP patients. The focus question was: "What are the indications and clinical outcomes of ZI rehabilitation in patients with CLP?" Electronic and manual literature searches were performed from January 2000 to May 2024 in five databases. Clinical studies and case reports were selected. The primary outcome was the ZI survival rates. The secondary outcomes were indications, loading protocols, and complications. The extracted data were subjected to descriptive analysis. In total, 16 studies were included, 24 patients with CLP received 48 ZIs, with an average of 4.2 years of follow-up. The survival rate of ZIs was 97.9% and was mainly indicated for those with Cawood and Howell classification V and VI, with insufficient bone in the maxilla with bilateral CLP. The immediate loading was performed in 33.3% of the cases, and the prosthesis was designed according to case complexity and necessity. ZI rehabilitation appears to be a reliable and predictable solution for the patient with CLP. The immediate loading solution can be beneficial to CLP patients as it helps avoid additional treatments. However, with the inconsistently limited data, the indications cannot be only based on the existing CLP classification.

Objective: The purpose of this study was to evaluate maxillary sinus (MS) pathologies in children and adolescents with cleft lip and palate (CLP) in comparison to a sex- and age-matched control group using cone beam computed tomography (CBCT), retrospectively.

Method: CBCT images obtained between the years 2014 and 2022 from a total of 130 patients aged between 7 and 18 were considered eligible for this study. Age, sex, and the type of MS pathologies in each sinus were recorded in CLP (n = 65) and control (n = 65) groups. The MS pathologies were categorized and recorded for both right and left sinuses separately as: (1) healthy; (2) mucosal thickening >3 mm; (3) polypoidal mucosal thickening; (4) partial opacification; and (5) complete opacification. In the CLP group, the cleft type and side were also recorded. Variations of polypoidal mucosal thickenings were subcategorized as small, large, and multiple.

Results: The mean age of the 130 patients (58 female, 72 male) was calculated as 12.43 ± 3.13. Among the patients in the study and control groups, polypoidal mucosal thickening was found to be the most frequent sinus pathology (25.4%), while total opacification was found to be the least frequent (1.6%). Overall, only the number of sinuses with mucosal thickening greater than 3 mm was statistically significantly higher in the CLP than that of the control group (P < .05). In terms of cleft type and side, the frequency of the pathology based on the sinuses showed no significant difference in any of the pathology groups (P > .05).

Conclusion: Incidental findings in the oral and maxillofacial region that are detected on CBCT images of CLP patients may play an important role in the early diagnosis of MS diseases and aid in the referral for further evaluation.