Cleft Palate-Craniofacial Journal最新文献

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.

ObjectiveTo compare weight gain in infants with PRS treated with nonsurgical orthodontic airway plate (OAP) or surgical mandibular distraction osteogenesis (MDO).DesignRetrospective cohort study.SettingSingle tertiary-care pediatric center.PatientsNeonates and infants with PRS at a single institution from 2016 to 2023.InterventionsNonsurgical OAP or surgical MDO, with or without gastrostomy tube (GT) placement.Main Outcome MeasuresWeight, weight-for-age (WFA) percentile, and WFA Z-score were analyzed at four timepoints: at birth (T0), start of treatment (T1), end of treatment (T2), and end of observation (T3, approximately 12 months of age). Fisher's exact, two-tailed paired t-test, and mixed effect models were used to compare groups.ResultsTwenty OAP-treated and sixteen MDO-treated infants with two MDO-Subgroups based on oral feeds status at T3. There were no differences in comorbidities between groups. GT was inserted in no infants in OAP and nine infants in MDO. The hospital stay and total treatment duration were 13.1 days (± 4.8) and 4.3 months (± 0.98) in OAP and 20.8 days (± 11.2) and 4.6 months (± 0.99) in MDO, respectively. There was no difference in weight parameters between OAP and MDO at any time point. All infants in OAP achieved full oral feeds significantly earlier than MDO (p < .001).ConclusionsWeight gain in infants with PRS treated with either OAP alone or MDO ± GT at a single institution was similar during the first year of life.

BackgroundCleft lip and palate are the most common congenital craniofacial anomalies. There are several classifications of cleft lip and palate that have been proposed over the years; however, only a few have found clinical application. We presented classification of a cleft lip and palate that is comprehensive and uniform, and it can precisely define the vast majority of the clefts.MethodsFive hundred and twenty-one consecutive patients underwent their primary surgical procedure for cleft lip and palate deformities. These intraoperative diagnoses were translated into abbreviated diagnoses based on the classification that we presented. In this paper, we compared the accuracy of preoperative diagnoses with that of intraoperative diagnoses according to the well-known classification of cleft lip and palate that we presented.ResultsA total of 343 cleft lip surgeries and 413 palatoplasty surgeries were performed on 521 patients. The isolated cleft palate was the most common type of cleft in our group of patients. Associated anomalies occurred in 16% of patients with clefts of the lip and palate. In our study, 18% of patients had an inaccurate preoperative diagnosis. The intraoperative diagnoses were more accurate compared to preoperative diagnoses. The simplicity and comprehensibility of the proposed classification were shown through the comparison of preoperative, intraoperative, and diagnostic information presented by this classification.ConclusionThe classification of cleft lip and palate that we presented is clear, easy to understand, and can be a successful tool in studying the epidemiology of clefts.

ObjectiveTo compare the 2-year post-treatment stability of vertical and transverse dimensions in orthodontic patients with non-syndromic cleft lip and palate (CLP) versus non-cleft controls (NC).DesignRetrospective comparative study.Patients/ParticipantsTwenty-eight patients divided into CLP (n = 14) and NC (n = 14) groups matched for age and sex.InterventionsOrthodontic fixed appliance therapy followed by removable vacuum-formed retainers.Main Outcome MeasuresVertical changes were assessed with lateral cephalograms, and transverse relationships were analyzed using the Modified Huddart-Bodenham (MHB) Index. Intragroup changes (T0-T1) were analyzed with paired t-tests and intergroup differences with unpaired t-tests (P < .05).ResultsAt 2-year post-treatment, the cleft group showed significant reductions in anterior facial height (-1.06 ± 0.59 mm, P < .001), U1-NF (-0.31 ± 0.48 mm, P = .01), L1-MP (-0.54 ± 0.63 mm, P = .004), and U6-NF (-0.66 ± 0.70 mm, P < .001). Transverse relapse was evident at the incisors (-0.36 ± 0.50, P = .006), molars (-0.43 ± 0.51, P = .002), and in total scores (-0.29 ± 0.47, P = .007). The NC group showed minimal changes (P > .05).ConclusionsPatients with CLP demonstrate greater vertical and transverse orthodontic relapse 2-year post-treatment compared to non-cleft patients. These findings underscore the necessity for potential permanent retention protocols tailored to the unique anatomical and physiological challenges of the cleft population.

ObjectiveThe 2^nd Cleft Summit aimed to understand what policies and actions various cleft-centered non-governmental organizations (NGOs) can adopt to achieve sustainable, patient-centered, interdisciplinary cleft care.DesignA Summit of global leaders in interdisciplinary cleft care.SettingA two-hour discussion within a three-and-a-half-day International Comprehensive Cleft Care Workshop (CCCW).ParticipantsTwenty-eight global leaders from various cleft-focused specialties.InterventionsThe Second Cleft Summit was held to collaboratively improve understanding among global cleft leaders regarding the role and responsibility of NGOs to provide sustainable interdisciplinary cleft care.Main Outcome MeasuresThe summit's primary objective was to explore and develop strategies to strengthen interdisciplinary cleft care, particularly in resource-limited settings.ResultsParticipants agreed on the need to shift NGO focus toward interdisciplinary, patient-centered care that extends beyond a single program to include long-term follow-up. They also strongly encouraged empowering on-site medical providers and teams through bidirectional education (lectures, case discussions) and capacity-building (workshops, simulation). Health system strengthening emerged as a uniformly viable pathway to ensuring sustainable care delivery while diminishing the footprint of international NGOs.ConclusionThe summit emphasized the need for systemic strengthening of the health delivery infrastructure alongside education and capacity-building. Whenever feasible, NGOs should collaborate with local governments and regional stakeholders through a bidirectional exchange of knowledge and skills.

ObjectiveDevelop and apply novel data visualization techniques to analyze longitudinal cleft surgical care and to identify patterns in treatment timing and procedural burden across 2 cleft teams.DesignRetrospective cohort study of operative data using novel data visualization methods.SettingTwo cleft teams in the United States.Patients and ParticipantsPatients with cleft lip and/or palate with operative clinical encounters between 2018 and 2023. Team A had 228 patients and team B had 355.InterventionsVisualization of primary cleft-related surgical procedures which were cleft lip and palate repair, fistula repair, alveolar bone grafting, correction of velopharyngeal insufficiency, orthognathic surgery, and rhinoplasty.Main Outcome Measure(s)Visual interpretation of surgical timing, frequency, volume, and distribution using novel timelines, stacked-bar charts, and ridgeplots.ResultsTimeline visualizations clarified procedural sequencing and highlighted variation in treatment timing by team and phenotype but were too dense for interpretation for a large volume of patients. Stacked-bar charts illustrated procedural volume but lacked temporal insight. Ridgeplots demonstrated both timing of procedures and aggregate team volume.ConclusionsIndividual patient timelines can effectively depict deviation from "ideal" care protocols, but aggregate data may be best depicted by a ridgeplot. These tools may support quality improvement initiatives by transforming raw data into actionable insights and enhancing multidisciplinary team reflection.

ObjectiveTo determine if increased food security (FS) reduces mortality, prevalence, and disability in patients with orofacial clefts (OFCs).DesignEcological study.SettingA total of 204 countries and territories in the Global Burden of Disease Study and FS data from 113 countries from the Global Food Security Index.Patients, ParticipantsDeidentified country-level data on patients with OFCs <4 years old from years 2012 to 2019.InterventionsNone.Main Outcome MeasureNumber of deaths from OFCs, prevalence of OFCs, and disability adjusted life years (DALYs) from OFCs per 100,000 people.ResultsOf 113 countries with data from 2012 to 2019, regression showed a 13.8% decreased rate of death (incidence rate ratio 0.862 [95% confidence interval (CI) 0.852, 0.871]) and 74.9% higher odds of nondeath (odds ratio 1.749 [95% CI 1.106, 2.786]) with a 1-point increase in FS score. A linear relationship was demonstrated between FS and prevalence of OFCs (β -18.5 [95% CI -34.8, -2.3]) and DALYs from OFCs (β -43.1 [95% CI -62.6, -23.5]) with a 1-point increase in FS score as well. The greatest reductions in mortality and DALYs were seen in children <1 year whereas reductions in prevalence were seen in children 2-4 years, attributed to decreases in late presentations.ConclusionOur study shows higher FS is associated with reduced deaths from OFCs, prevalence of OFCs, and DALYs from OFCs. We hope our study validates efforts by nutritional programs led by OFC teams and provides evidence for further support.