Cleft Palate-Craniofacial Journal最新文献

ObjectiveTo investigate the impact of sociodemographic factors on the surgical management and outcomes of patients with non-syndromic craniosynostosis, with a focus on delays in diagnosis and intervention.DesignRetrospective cohort study.SettingTertiary pediatric hospital.PatientsThree hundred seventy-three non-syndromic patients who underwent primary craniosynostosis surgery between 2013 and 2023.Main Outcome MeasuresPrimary outcomes included age at first specialty appointment, age at diagnosis, age at surgery, and type of surgery (CVR, open cranial vault remodeling; or ES + HT, endoscopic suturectomy + helmet therapy). Secondary outcomes included postoperative complications, need for additional craniofacial procedures, and length of hospital stay.ResultsPatients undergoing CVR were older at the time of specialty appointments (median 6.6 vs. 1.9 months, P < 0.001), diagnosis (median 8.1 vs. 2.1 months, P < 0.001), and surgery (median 11.3 vs. 2.9 months, P < 0.001) compared to those undergoing ES + HT. When controlling procedure type and sociodemographic variables, private insurance was a predictor of earlier diagnosis (β=-3.06, 95% CI [-5.97, -0.16], P = 0.039) and earlier surgical intervention (β=-3.55, 95% CI [-6.67, -0.42], P = 0.026). Independent predictors of longer hospital stay included Hispanic ethnicity (β=0.45, 95% CI [0.03, 0.87], P = 0.035) and higher national Area Deprivation Index (ADI) score (β=0.014, 95% CI [0.008, 0.021], P < 0.001). After multivariable adjustment, complication rates and the need for additional craniofacial procedures did not differ significantly between ES + HT and CVR.ConclusionPatients with public insurance were more likely to experience a delay in diagnosis and, consequently, underwent a more invasive CVR procedure than privately insured patients. Hispanic ethnicity and higher ADI were associated with longer hospitalizations.

ObjectiveTo evaluate bone development in patients with alveolar clefts and permanent dentition treated with alveolar bone graft supplemented with stromal vascular fraction (SVF).DesignClinical, prospective, randomized.LocationSingle tertiary care institution.PatientsEighteen participants with unilateral alveolar cleft and permanent dentition were included. Patients with other comorbidities were excluded.InterventionThe control group underwent alveolar bone grafting (ABG) using iliac crest bone, while the experimental group underwent the same treatment, supplemented with SVF. Adipose tissue was collected by abdominal liposuction, and the SVF was processed using mechanical methods (decantation, microfragmentation, and filtration).Main Outcome MeasurementBone formation and bone graft integration rate in alveolar cleft at 6 months postsurgery using 3-dimensional tomographic methods and density measurements.ResultsThe amount of bone graft correlated with an improvement in the relationship between the cleft and noncleft sides (R = 0.78, P < .001) and an improvement in alveolar cleft density (R = 0.69, P = .005), but did not correlate with the graft integration rate. The experimental group showed larger cleft sizes (0.83 × 1.74 cm³, P = .021) and older patients (17.35 × 27.6 years, P = .002), and did not differ in terms of bone development variables when compared to the control group.ConclusionABG supplemented with SVF showed statistically similar bone development results, but with a better trend than conventional ABG. Additionally, the studied groups had asymmetric pre-existing characteristics, with greater severity in the experimental group. A larger study will be necessary to mitigate preoperative characteristic differences and to more accurately compare the results between the methods.

BackgroundThe present study compared the central auditory processing abilities using electrophysiological tests in children with non-syndromic cleft lip and palate (NSCLP) and their age-matched control group.MethodThirty children aged 7 to 15 years were recruited for the study. Participants were divided into 2 groups. The clinical group (children with NSCLP) comprised 15 children, while the control group (craniofacially typical peers) comprised 15 children with normal hearing sensitivity and auditory processing skills. Electrophysiological tests, including auditory brainstem responses (ABR), binaural interaction component (BIC) of ABR, auditory late latency responses (ALLR), and P300 were assessed.ResultsThe results showed deviant responses in ABR, BIC, and ALLR in children with NSCLP compared to craniofacially typical counterparts. However, no significant difference was observed in P300 between the two groups.ConclusionChildren with NSCLP may be at a higher risk of central auditory processing disorder due to their abnormal neural transmission in the auditory nervous system. Also, assessing auditory processing abilities in children with NSCLP should include electrophysiological tests in the test battery for additional information regarding neural transmission.

ObjectiveThis study analyzes indications and outcomes of premaxillary setback (PS) and presents an algorithm for its use in patients with bilateral cleft lip and/or palate (BCL ± P).DesignRetrospective review.SettingChildren's Hospital Los Angeles.Patients, ParticipantsA retrospective review was conducted evaluating patients with BCL ± P undergoing lip repair from 2003-2023. Patients were categorized as undergoing repair with (BCL + PS) or without (BCL-PS) simultaneous PS. Presurgical nasoalveolar molding (NAM), indications for PS, timing of surgery, and complications were collected.InterventionsBCL with PS, BCL + PS.Main Outcome Measures(s)Primary outcomes included rates of postoperative complications and revision surgeries. Secondary outcome was the need for orthognathic surgery to correct midface hypoplasia in patients at least 14 years old at their most recent follow-up.ResultsOf 1193 patients, 262 met inclusion criteria. One hundred forty-nine patients (56.9%) were referred for NAM. Fifty-one patients (19.5%) underwent PS during primary BCL repair. Patients who failed repositioning of the premaxilla following presurgical NAM (n = 12) were not candidates for NAM (n = 31) or presented late with a protruding premaxilla (n = 8, 12.977 ± 8.196 months) underwent PS. Median age at surgery was 4.29 months. Complications included wound dehiscence (n = 3) and abscess formation (n = 2). No premaxillary necrosis occurred. Overall revision rates were 9.9%. Of 41 patients over 14 years old, 53.6% needed orthognathic surgery. BCL + PS had comparable rates of wound dehiscence (2.0% vs 4.0%; P = .790), lip revisions (7.8% vs 10.4%; P = .770), and orthognathic surgery (50.0% vs 56.3%; P > .999).ConclusionPS is a safe and effective method to facilitate BCL repair in patients who are not candidates for NAM.

ObjectiveTo investigate the association between clinical, biomechanical, and psychosocial factors and smiling behavior in individuals with treated unilateral cleft lip with or without cleft palate (UCL ± P) compared to non-cleft controls.DesignMulticenter observational study in New Zealand.ParticipantsIndividuals aged ≥15 (N = 42) comprised 2 study groups: a UCL ± P group (N = 21) and a non-cleft control group (N = 21).MethodsParticipants viewed an amusing video while their facial expressions were recorded. Smile features were automatically detected via software. A clinical outcome, nasolabial esthetics, was scored using the Asher-McDade system. Perioral biomechanical properties were measured via myotonometry. Smile Esthetics-related Quality of Life (SERQoL), Orofacial Esthetics Scale (OES), and personality (IPIP-NEO-60) questionnaires were completed.ResultsSmile features and personality traits did not differ between the groups. Participants with UCL ± P exhibited higher stiffness (+44.2%; Cohen's d = 1.6) and tone (+22.6%; Cohen's d = 1.9) at the cleft scar site, and higher decrement (or lower elasticity, +8.5%; Cohen's d = 0.8) adjacent to the scar. Nasolabial esthetics and elasticity of the scar correlated with the duration of smiles and relative smile time (-0.50 < R < -0.44; p < .05). Participants in the UCL ± P group had lower scores for the OES and higher impacts on SERQoL for social contacts and dental self-confidence.ConclusionsAdolescents and adults with UCL ± P exhibit similar smile behavior as their cleft-free peers-at least in non-social settings. Nasolabial esthetics and perioral biomechanical properties are associated with propensity to smile. UCL ± P is negatively associated with smile-related quality of life and an individual's perception of their facial appearance.

This is a correspondence on published article on health literacy on cleft lip and cleft palate. Issues on current problem and future directions are discussed.

ObjectiveTo describe and compare the healthcare trajectories of patients with CL/P under two different income-based programs for health coverage in Colombia, known in Colombia as a health insurance regime (contributory and subsidized), in Medellín, 2021.DesignNon-experimental, cross-sectional questionnaire-based study.SettingPrimary level of clinical care in Medellín, Colombia.ParticipantsTwenty-eight 15- to 21-year-olds with CL/P and primary caregivers.InterventionsIndividuals with CL/P answered the survey. Patients with syndromic CL/P and patients with cognitive disabilities were excluded. The calculation of the probabilistic sample was performed based on the formula for finite populations using databases from 2 health insurance companies. The analysis was descriptive and bivariate. Chi-square and Fisher tests were used to analyze the variables of interest.Main Outcome MeasureContinuity of the care pathway was measured with proxy indicators: (1) access to comprehensive CL/P treatment; (2) timeliness of access to comprehensive CL/P treatment; (3) differences in access to and timeliness of comprehensive CL/P treatment between patients under both health insurance coverage.ResultsNo differences were found when comparing the healthcare trajectories of young patients with CL/P who were in both health coverage. Differences were observed in the timeliness of care for patients with CL/P under the subsidized coverage who were more economically vulnerable. Delays in care were mainly linked to administrative procedures required for orthodontic procedures, bone grafts, and maxillofacial surgeries.ConclusionDespite the health system's guarantee of equal care across income levels, differences in the timeliness of care persist for patients from lower-income families.

ObjectiveTo establish the effect of cleft palate repair on hearing outcomes in children with glue ear and conductive hearing loss undergoing elective primary palatoplasty.MethodsA 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.ResultsA 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.ConclusionsThis 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.

A true median cleft is an extremely rare congenital anomaly characterized by a midline vertical cleft and various deformities, also known as Tessier number 0 cleft. Here we report a case of a 5-year-old Asian boy with true median cleft associated with sinus tracts in the nasal septum, a phenomenon not previously reported in the literature. The tracts were identified as the cause of recurrent infections around the oral vestibule and upper lip. The tracts were resected successfully, and postoperative progress has been satisfactory. We discuss the importance of preoperative image evaluations and the selection of a suitable surgical approach.

ObjectiveDermoid cyst (DC) is a congenital cyst with the potential to have intracranial extension (ICE). This study aims to evaluate the imaging yield and surgical outcomes of nasal, medial brow, forehead, and scalp DCs.DesignRetrospective review of craniofacial DCs treated at our institution between 1992 and 2024.ResultsA total of 117 patients (57 females) were included. The median age at cyst detection and removal were 4.8 months (IQR 3.6-9.6) and 1.8 years (IQR 0.9-5.3), respectively. In 42 patients, parents have noticed the presence of the cyst immediately after birth. Cyst wall rupture during surgical removal was reported in 15.4%. The median follow-up time was 1.3 months (IQR 0.5-12.2). Three patients experienced recurrence. No postoperative complication was reported. The regions with the highest prevalence of ICE were the forehead, frontotemporal scalp, and nasal region. The lateral frontal/temporal scalp had a 33.3% rate of ICE. Midline forehead/scalp lesions demonstrated a higher risk of ICE compared to their lateral equivalents (54.5% vs 17.5%, P = .03). The sensitivity and specificity of magnetic resonance imaging (MRI) were 100% and 95.7%, while for computed tomography (CT scans) were 72.7% and 96.5%. The Area Under the Curve for MRI was 0.978, and for CT was 0.846. The sensitivity and specificity of ultrasound were 50% and 100%.ConclusionsMidline forehead/scalp DCs are more prone to extend intracranially than lateral DCs. MRI had a higher sensitivity and specificity than CT scans in detecting ICE. Routine screening imaging should be considered in midline forehead/scalp, lateral frontal/temporal, and nasal DCs.