Pub Date : 2024-06-17DOI: 10.1177/10556656241261838
Melanie Bakovic, Lilliana Starsiak, Spencer Bennett, Ryan McCaffrey, Esperanza Mantilla-Rivas, Monica Manrique, Gary F Rogers, Albert K Oh
Objective: Disparities in insurance and socioeconomic status (SES) may impact surgical management and subsequent postoperative outcomes for patients with craniosynostosis. This systematic review summarizes the evidence on possible differences in surgical care, including procedure type, age at surgery, and differences in surgical outcomes such as complications, length of hospital stay, and child development based on SES.
Design: The databases Scopus, PubMed, and CINAHL were searched between May and July 2022. Following PICO criteria, studies included focused on patients diagnosed with craniosynostosis; corrective surgery for craniosynostosis; comparison of insurance, income, or zip code; and surgical management of postoperative outcomes.
Results: The initial search yielded 724 articles. After three stages of screening, 13 studies were included. Assessed outcomes included: type of procedure (6 articles), age at time of surgery (3 articles), post-operative complications (3 articles), referral delay (2 articles), length of stay (2 articles), hospital costs (2 articles), and child development (1 article). Of the studies with significant results, insurance type was the main SES variable of comparison. While some findings were mixed, these studies indicated that patients with public medical insurance were more likely to experience a delay in referral, undergo an open rather than minimally-invasive procedure, and have more complications, longer hospitalization, and higher medical charges.
Conclusions: This study demonstrated that SES may be associated with several differences in the management of patients with craniosynostosis. Further investigation into the impact of SES on the management of patients with craniosynostosis is warranted to identify possible interventions that may improve overall care.
{"title":"Socioeconomic Influence on Surgical Management and Outcomes in Patients with Craniosynostosis - A Systematic Review.","authors":"Melanie Bakovic, Lilliana Starsiak, Spencer Bennett, Ryan McCaffrey, Esperanza Mantilla-Rivas, Monica Manrique, Gary F Rogers, Albert K Oh","doi":"10.1177/10556656241261838","DOIUrl":"https://doi.org/10.1177/10556656241261838","url":null,"abstract":"<p><strong>Objective: </strong>Disparities in insurance and socioeconomic status (SES) may impact surgical management and subsequent postoperative outcomes for patients with craniosynostosis. This systematic review summarizes the evidence on possible differences in surgical care, including procedure type, age at surgery, and differences in surgical outcomes such as complications, length of hospital stay, and child development based on SES.</p><p><strong>Design: </strong>The databases Scopus, PubMed, and CINAHL were searched between May and July 2022. Following PICO criteria, studies included focused on patients diagnosed with craniosynostosis; corrective surgery for craniosynostosis; comparison of insurance, income, or zip code; and surgical management of postoperative outcomes.</p><p><strong>Results: </strong>The initial search yielded 724 articles. After three stages of screening, 13 studies were included. Assessed outcomes included: type of procedure (6 articles), age at time of surgery (3 articles), post-operative complications (3 articles), referral delay (2 articles), length of stay (2 articles), hospital costs (2 articles), and child development (1 article). Of the studies with significant results, insurance type was the main SES variable of comparison. While some findings were mixed, these studies indicated that patients with public medical insurance were more likely to experience a delay in referral, undergo an open rather than minimally-invasive procedure, and have more complications, longer hospitalization, and higher medical charges.</p><p><strong>Conclusions: </strong>This study demonstrated that SES may be associated with several differences in the management of patients with craniosynostosis. Further investigation into the impact of SES on the management of patients with craniosynostosis is warranted to identify possible interventions that may improve overall care.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-17DOI: 10.1177/10556656241261846
Jin-Woo Kim, Alison Wan, Jun-Young Kim, HyeRan Choo
Objective: Narrowing of the palatal cleft is often observed in infants with Robin sequence (RS) treated with the Stanford Orthodontic Airway Plate treatment (SOAP) even though SOAP is utilized primarily to establish airway patency. The current study quantified dimensional changes of the cleft palate (CP) in infants with RS treated with SOAP.
Design: A retrospective chart review.
Patients: Infants with RS and CP who completed SOAP and had maxillary arch models at both pre- and post-treatment time points at a single tertiary referral hospital between September 2019 and July 2023.
Setting and outcome measure: Maxillary arch models were measured and analyzed using Bivariate statistical analysis.
Results: Seventeen infants were included in the study. The median age (min, max) was 6.7 weeks (1.1, 21.9) at pre-treatment and 26.6 weeks (18.7, 37.0) at post-treatment. The median Obstructive Apnea Hypopnea Index was 36.2 events/hour (8.1, 103.1) at pre-treatment and 4.1 events/hour (1.9, 8.6) at post-treatment. The pre-treatment width of CP decreased by an average (± standard diviation) of 6.37 mm (± 3.55, p < 0.001) at post-treatment. The ratio of the posterior cleft width to the total maxillary arch width decreased from 40% (± 9.1) at pre-treatment to 22% (± 11) at post-treatment (p < 0.001).
Conclusion: The dimensions of CP reduced significantly during SOAP in infants with RS and CP treated for their severe upper airway obstruction. The findings highlight a potential benefit of SOAP that may contribute favorably to the palate repair surgery.
{"title":"Presurgical Reduction of the Cleft Palate: Serendipitous Benefit of the Stanford Orthodontic Airway Plate Treatment (SOAP) for Infants with Robin Sequence.","authors":"Jin-Woo Kim, Alison Wan, Jun-Young Kim, HyeRan Choo","doi":"10.1177/10556656241261846","DOIUrl":"https://doi.org/10.1177/10556656241261846","url":null,"abstract":"<p><strong>Objective: </strong>Narrowing of the palatal cleft is often observed in infants with Robin sequence (RS) treated with the Stanford Orthodontic Airway Plate treatment (SOAP) even though SOAP is utilized primarily to establish airway patency. The current study quantified dimensional changes of the cleft palate (CP) in infants with RS treated with SOAP.</p><p><strong>Design: </strong>A retrospective chart review.</p><p><strong>Patients: </strong>Infants with RS and CP who completed SOAP and had maxillary arch models at both pre- and post-treatment time points at a single tertiary referral hospital between September 2019 and July 2023.</p><p><strong>Setting and outcome measure: </strong>Maxillary arch models were measured and analyzed using Bivariate statistical analysis.</p><p><strong>Results: </strong>Seventeen infants were included in the study. The median age (min, max) was 6.7 weeks (1.1, 21.9) at pre-treatment and 26.6 weeks (18.7, 37.0) at post-treatment. The median Obstructive Apnea Hypopnea Index was 36.2 events/hour (8.1, 103.1) at pre-treatment and 4.1 events/hour (1.9, 8.6) at post-treatment. The pre-treatment width of CP decreased by an average (± standard diviation) of 6.37 mm (± 3.55, p < 0.001) at post-treatment. The ratio of the posterior cleft width to the total maxillary arch width decreased from 40% (± 9.1) at pre-treatment to 22% (± 11) at post-treatment (p < 0.001).</p><p><strong>Conclusion: </strong>The dimensions of CP reduced significantly during SOAP in infants with RS and CP treated for their severe upper airway obstruction. The findings highlight a potential benefit of SOAP that may contribute favorably to the palate repair surgery.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-13DOI: 10.1177/10556656241261918
Matthew Fell, Kate J Fitzsimons, Mark J Hamilton, Jibby Medina, Sophie Butterworth, Min Hae Park, Jan Van der Meulen, Sarah Lewis, David Chong, Craig Jh Russell
Objective: To investigate the association between the sidedness of orofacial clefts and additional congenital malformations.
Design: Linkage of a national registry of cleft births to national administrative data of hospital admissions.
Setting: National Health Service, England.
Participants: 2007 children born with cleft lip ± alveolus (CL ± A) and 2724 with cleft lip and palate (CLP) born between 2000 and 2012.
Main outcome measure: The proportion of children with ICD-10 codes for additional congenital malformations by the sidedness (left, right or bilateral) of orofacial clefts.
Results: For CL ± A phenotypes, there was no evidence for a difference in the prevalence of additional anomalies between left (22%, reference), right (22%, aOR 1.02, 95% CI 0.80 to 1.28; P = .90) and bilateral clefts (23%, aOR 1.09, 95% CI 0.75 to 1.57; P = .66). For CLP phenotypes, there was evidence of a lower prevalence of additional malformations in left (23%, reference) compared to right (32%, aOR 1.54, 95% CI 1.25 to 1.91; P < .001) and bilateral clefts (33%, aOR 1.64, 95% CI 1.35 to 1.99; P < .001).
Conclusions: The prevalence of additional congenital malformations was similar across sidedness subtypes with CL ± A phenotypes but was different for sidedness subtypes within CLP cases. These data support the hypothesis that CL ± A has a different underlying aetiology from CLP and that within the CLP phenotype, right sided CLP may lie closer in aetiology to bilateral CLP than it does to left sided CLP.
目的调查口面裂的偏侧性与其他先天性畸形之间的关联:设计:将全国唇裂出生登记与全国入院管理数据进行关联:主要结果测量指标:根据面裂的偏侧(左侧、右侧或双侧),患有ICD-10编码额外先天畸形的儿童比例:对于 CL ± A 表型,没有证据表明左侧(22%,参考值)、右侧(22%,aOR 1.02,95% CI 0.80 至 1.28;P = .90)和双侧(23%,aOR 1.09,95% CI 0.75 至 1.57;P = .66)额外畸形的发生率存在差异。就 CLP 表型而言,有证据表明左侧(23%,参考值)额外畸形的发生率低于右侧(32%,aOR 1.54,95% CI 1.25 至 1.91;P P 结论:不同侧位亚型的CL±A表型的额外先天畸形发生率相似,但CLP病例中不同侧位亚型的额外先天畸形发生率不同。这些数据支持以下假设:CL±A 的潜在病因与 CLP 不同,在 CLP 表型中,右侧 CLP 的病因可能更接近于双侧 CLP,而不是左侧 CLP。
{"title":"Cleft lip Sidedness and the Association with Additional Congenital Malformations.","authors":"Matthew Fell, Kate J Fitzsimons, Mark J Hamilton, Jibby Medina, Sophie Butterworth, Min Hae Park, Jan Van der Meulen, Sarah Lewis, David Chong, Craig Jh Russell","doi":"10.1177/10556656241261918","DOIUrl":"https://doi.org/10.1177/10556656241261918","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between the sidedness of orofacial clefts and additional congenital malformations.</p><p><strong>Design: </strong>Linkage of a national registry of cleft births to national administrative data of hospital admissions.</p><p><strong>Setting: </strong>National Health Service, England.</p><p><strong>Participants: </strong>2007 children born with cleft lip ± alveolus (CL ± A) and 2724 with cleft lip and palate (CLP) born between 2000 and 2012.</p><p><strong>Main outcome measure: </strong>The proportion of children with ICD-10 codes for additional congenital malformations by the sidedness (left, right or bilateral) of orofacial clefts.</p><p><strong>Results: </strong>For CL ± A phenotypes, there was no evidence for a difference in the prevalence of additional anomalies between left (22%, reference), right (22%, aOR 1.02, 95% CI 0.80 to 1.28; <i>P</i> = .90) and bilateral clefts (23%, aOR 1.09, 95% CI 0.75 to 1.57; <i>P</i> = .66). For CLP phenotypes, there was evidence of a lower prevalence of additional malformations in left (23%, reference) compared to right (32%, aOR 1.54, 95% CI 1.25 to 1.91; <i>P</i> < .001) and bilateral clefts (33%, aOR 1.64, 95% CI 1.35 to 1.99; <i>P</i> < .001).</p><p><strong>Conclusions: </strong>The prevalence of additional congenital malformations was similar across sidedness subtypes with CL ± A phenotypes but was different for sidedness subtypes within CLP cases. These data support the hypothesis that CL ± A has a different underlying aetiology from CLP and that within the CLP phenotype, right sided CLP may lie closer in aetiology to bilateral CLP than it does to left sided CLP.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-11DOI: 10.1177/10556656241261839
Mehr A Sazgar, Amir A Sazgar
Background: Tessier No. 0 cleft, characterized by a bifid nose, significantly impacts facial development, imposing significant psychological and financial burdens on patients. Correction lacks consensus due to varied presentations and limited documentation of surgical treatments, notably in adults.
Solution: Loco-regional soft tissue flaps can address minor deformities, but establishing a robust skeletal framework is often crucial for permanent correction.
Innovation: This article introduces a novel and effective approach through reconstructive septorhinoplasty for addressing this anomaly.
{"title":"Reconstructive Septorhinoplasty for Surgical Correction of Tessier's No. 0 Cleft in Adult Patients.","authors":"Mehr A Sazgar, Amir A Sazgar","doi":"10.1177/10556656241261839","DOIUrl":"https://doi.org/10.1177/10556656241261839","url":null,"abstract":"<p><strong>Background: </strong>Tessier No. 0 cleft, characterized by a bifid nose, significantly impacts facial development, imposing significant psychological and financial burdens on patients. Correction lacks consensus due to varied presentations and limited documentation of surgical treatments, notably in adults.</p><p><strong>Solution: </strong>Loco-regional soft tissue flaps can address minor deformities, but establishing a robust skeletal framework is often crucial for permanent correction.</p><p><strong>Innovation: </strong>This article introduces a novel and effective approach through reconstructive septorhinoplasty for addressing this anomaly.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-11DOI: 10.1177/10556656241261908
Daphane Anishya, Shweta Nagesh
Objectives: To assess and compare the deviating nasal cephalometric parameters of patients with unilateral cleft lip and palate (UCLP) with a control group. The study also aims to correlate the deviating cephalometric parameters with two aesthetic scoring systems.
Design: A retrospective study.
Setting: Dental college and hospital.
Participants: Pre-treatment lateral cephalograms and extra oral photographs of 20 adult patients with repaired UCLP presenting for orthodontic treatment. 20 patients with age and type of malocclusion matched control were selected.
Main outcome: The nasal cephalometric parameters of patients with UCLP and a control group were compared. The nasolabial region of patients with cleft lip and palate (CLP) was scored using Asher McDade Aesthetic Index (AMAI) and Cleft Aesthetic Rating Scale (CARS). The scoring was done by six different groups assessors to study their perception of the nasolabial region. Correlation between cephalometric parameters and the aesthetic scores was done.
Results: The study found significant differences in nasal length (P = .003) and depth (P < .001) between UCLP and the non-cleft control group. In the aesthetic assessment, orthodontist gave the least scores, while layman group scored the highest. The CARS nose aesthetic scores showed statistically significant high, negative correlation with the nasal length (P = .01).
Conclusion: The cephalometric parameters and the aesthetic indices can be aid the orthodontists in the assessment of nasolabial aesthetics and additionally refer for further definitive rhinoplasty to improve the patient's overall facial aesthetics.
研究目的评估并比较单侧唇腭裂(UCLP)患者与对照组的鼻部偏差头形测量参数。研究还旨在将偏离的头形测量参数与两种美学评分系统进行关联:设计:回顾性研究:地点:牙医学院和医院:20名接受正畸治疗的修复性UCLP成人患者的治疗前侧头影和口外照片。选取 20 名年龄和错颌畸形类型相匹配的患者作为对照:主要结果:比较了 UCLP 患者和对照组的鼻头测量参数。使用阿舍-麦克戴德美学指数(AMAI)和唇腭裂美学评分量表(CARS)对唇腭裂患者的鼻唇部进行评分。评分由六组不同的评估人员完成,以研究他们对鼻唇沟区域的感知。头测量参数与美学评分之间存在相关性:研究发现鼻长度(P = .003)和深度(P P = .01)存在明显差异:结论:头测量参数和美学指数可帮助正畸医生评估鼻唇美学,并进一步转诊进行明确的鼻整形手术,以改善患者的整体面部美学。
{"title":"Assessment of Nasal Aesthetic Parameters in Patients with Unilateral Cleft Lip and Palate - A Retrospective Study.","authors":"Daphane Anishya, Shweta Nagesh","doi":"10.1177/10556656241261908","DOIUrl":"https://doi.org/10.1177/10556656241261908","url":null,"abstract":"<p><strong>Objectives: </strong>To assess and compare the deviating nasal cephalometric parameters of patients with unilateral cleft lip and palate (UCLP) with a control group. The study also aims to correlate the deviating cephalometric parameters with two aesthetic scoring systems.</p><p><strong>Design: </strong>A retrospective study.</p><p><strong>Setting: </strong>Dental college and hospital.</p><p><strong>Participants: </strong>Pre-treatment lateral cephalograms and extra oral photographs of 20 adult patients with repaired UCLP presenting for orthodontic treatment. 20 patients with age and type of malocclusion matched control were selected.</p><p><strong>Main outcome: </strong>The nasal cephalometric parameters of patients with UCLP and a control group were compared. The nasolabial region of patients with cleft lip and palate (CLP) was scored using Asher McDade Aesthetic Index (AMAI) and Cleft Aesthetic Rating Scale (CARS). The scoring was done by six different groups assessors to study their perception of the nasolabial region. Correlation between cephalometric parameters and the aesthetic scores was done.</p><p><strong>Results: </strong>The study found significant differences in nasal length (<i>P</i> = .003) and depth (<i>P</i> < .001) between UCLP and the non-cleft control group. In the aesthetic assessment, orthodontist gave the least scores, while layman group scored the highest. The CARS nose aesthetic scores showed statistically significant high, negative correlation with the nasal length (<i>P</i> = .01).</p><p><strong>Conclusion: </strong>The cephalometric parameters and the aesthetic indices can be aid the orthodontists in the assessment of nasolabial aesthetics and additionally refer for further definitive rhinoplasty to improve the patient's overall facial aesthetics.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-11DOI: 10.1177/10556656241258687
Kayla Prezelski, Daniel Villarreal Acha, Tuong-Vi Cindy Ngo, Caitlin Wilson, Vania Thrasher, Kandi Trevino, Cortney Van't Slot, Rami R Hallac, James R Seaward, Alex A Kane
Objective: A Growth and Feeding Clinic (GFC) focused on early intervention around feeding routines in patients with cleft lip and/or palate (CL/P) was implemented.
Design: This study assessed the effect of preoperative feeding interventions provided by the GFC.
Setting: Tertiary academic center.
Methods: This study evaluated patients with CL/P who were cared for by the GFC and a control group of patients with CL/P. Weight-for-age (WFA) Z-score of less than -2.00 was used as a cutoff to classify patients who were underweight during the preoperative period.
Main outcome measure: The number of underweight patients who were able to reach normal weight by the time of their cleft lip repair was used as the primary outcome measure.
Results: Within both the GFC and control groups, 25% of patients with CL/P were underweight as determined by WFA Z-score. GFC patients who were underweight received more clinic visits (P < .001) and GFC interventions (P < .001) compared to GFC patients who were normal weight. At the time of cleft lip surgery, 64.1% of GFC underweight patients were normal weight compared to 31.8% of control group underweight patients (P = .0187).
Conclusion: This study showed that multidisciplinary care provided by the GFC was able to target preoperative nutritional interventions to the highest-risk patients, resulting in double the percentage of patients who were of normal weight at the time of their cleft lip repair. These results provide objective proof supporting the assertion that multidisciplinary team care of the infant with cleft leads to measurable improvement in outcomes.
目标:开设生长与喂养门诊(GFC):唇裂和/或腭裂(CL/P)患者的生长与喂养门诊(GFC)侧重于围绕喂养常规进行早期干预:本研究评估了 GFC 提供的术前喂养干预的效果:地点:三级学术中心:本研究评估了由GFC护理的CL/P患者和对照组CL/P患者。主要结果测量指标:以在唇裂修复时体重达到正常值的体重不足患者人数作为主要结果测量指标:结果:在 GFC 组和对照组中,25% 的 CL/P 患者体重不足(以 WFA Z 分数为准)。体重不足的 GFC 患者接受的门诊就诊次数更多(P P = .0187):这项研究表明,GFC 提供的多学科护理能够针对风险最高的患者进行术前营养干预,从而使唇裂修复时体重正常的患者比例增加了一倍。这些结果为多学科团队护理唇裂婴儿可显著改善疗效的论断提供了客观证明。
{"title":"A Dedicated Multidisciplinary Growth and Feeding Clinic for Infants with Cleft Lip and/or Palate Demonstrates Need for Intervention.","authors":"Kayla Prezelski, Daniel Villarreal Acha, Tuong-Vi Cindy Ngo, Caitlin Wilson, Vania Thrasher, Kandi Trevino, Cortney Van't Slot, Rami R Hallac, James R Seaward, Alex A Kane","doi":"10.1177/10556656241258687","DOIUrl":"https://doi.org/10.1177/10556656241258687","url":null,"abstract":"<p><strong>Objective: </strong>A Growth and Feeding Clinic (GFC) focused on early intervention around feeding routines in patients with cleft lip and/or palate (CL/P) was implemented.</p><p><strong>Design: </strong>This study assessed the effect of preoperative feeding interventions provided by the GFC.</p><p><strong>Setting: </strong>Tertiary academic center.</p><p><strong>Methods: </strong>This study evaluated patients with CL/P who were cared for by the GFC and a control group of patients with CL/P. Weight-for-age (WFA) Z-score of less than -2.00 was used as a cutoff to classify patients who were underweight during the preoperative period.</p><p><strong>Main outcome measure: </strong>The number of underweight patients who were able to reach normal weight by the time of their cleft lip repair was used as the primary outcome measure.</p><p><strong>Results: </strong>Within both the GFC and control groups, 25% of patients with CL/P were underweight as determined by WFA Z-score. GFC patients who were underweight received more clinic visits (<i>P</i> < .001) and GFC interventions (<i>P</i> < .001) compared to GFC patients who were normal weight. At the time of cleft lip surgery, 64.1% of GFC underweight patients were normal weight compared to 31.8% of control group underweight patients (<i>P</i> = .0187).</p><p><strong>Conclusion: </strong>This study showed that multidisciplinary care provided by the GFC was able to target preoperative nutritional interventions to the highest-risk patients, resulting in double the percentage of patients who were of normal weight at the time of their cleft lip repair. These results provide objective proof supporting the assertion that multidisciplinary team care of the infant with cleft leads to measurable improvement in outcomes.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-06DOI: 10.1177/10556656241255940
Clarice A Swift, Colton J Fernstrum, Haven M Howell, John B Phillips, Rebekah B Aultman, Katherine E Baker, Clay B Thames, Gidarell C Bryant, Alexander E Velazquez, Anna G Boydstun, John M Sullivan, Michael S Lebhar, Emily E Hecox, Laura S Humphries, Ian C Hoppe
Background: Enhanced recovery after surgery (ERAS) protocols have been implemented across surgical disciplines, including cranial vault remodeling for craniosynostosis. The authors aim to describe the implementation of an ERAS protocol for cranial vault remodeling procedures performed for patients with craniosynostosis at a tertiary care hospital.
Description: Institutional review board approval was received. All patients undergoing a cranial remodeling procedure for craniosynostosis at the authors' institution over a 10-year period were collected (n = 168). Patient and craniosynostosis demographics were collected as well as operative details. Primary outcome measures were intensive care unit length of stay (ICU LOS) and narcotic usage. Chi squared and independent t-tests were employed to determine significance. A significance value of 0.05 was utilized.
Results: During the time examined, there were 168 primary cranial vault remodeling procedures performed at the authors' institution - all of which were included in the analysis. Use of the ERAS protocol was associated with decreased initial 24-hour morphine equivalent usage (p < 0.01) and decreased total morphine equivalent usage (p < 0.01). Patients using the ERAS protocol experienced a shorter ICU LOS (p < 0.01), but the total hospital length of stay was unchanged.
Conclusion: This study reiterates the benefit of developing and implementing an ERAS protocol for patients undergoing cranial vault remodeling procedures. The protocol resulted in an overall decreased ICU LOS and a decrease in narcotic use. This has implications for ways to maximize hospital reimbursement for these procedures, as well as potentially improve outcomes.
{"title":"Implementation of an Enhanced Recovery After Surgery Protocol for Cranial Vault Remodeling Procedures.","authors":"Clarice A Swift, Colton J Fernstrum, Haven M Howell, John B Phillips, Rebekah B Aultman, Katherine E Baker, Clay B Thames, Gidarell C Bryant, Alexander E Velazquez, Anna G Boydstun, John M Sullivan, Michael S Lebhar, Emily E Hecox, Laura S Humphries, Ian C Hoppe","doi":"10.1177/10556656241255940","DOIUrl":"https://doi.org/10.1177/10556656241255940","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) protocols have been implemented across surgical disciplines, including cranial vault remodeling for craniosynostosis. The authors aim to describe the implementation of an ERAS protocol for cranial vault remodeling procedures performed for patients with craniosynostosis at a tertiary care hospital.</p><p><strong>Description: </strong>Institutional review board approval was received. All patients undergoing a cranial remodeling procedure for craniosynostosis at the authors' institution over a 10-year period were collected (n = 168). Patient and craniosynostosis demographics were collected as well as operative details. Primary outcome measures were intensive care unit length of stay (ICU LOS) and narcotic usage. Chi squared and independent t-tests were employed to determine significance. A significance value of 0.05 was utilized.</p><p><strong>Results: </strong>During the time examined, there were 168 primary cranial vault remodeling procedures performed at the authors' institution - all of which were included in the analysis. Use of the ERAS protocol was associated with decreased initial 24-hour morphine equivalent usage (p < 0.01) and decreased total morphine equivalent usage (p < 0.01). Patients using the ERAS protocol experienced a shorter ICU LOS (p < 0.01), but the total hospital length of stay was unchanged.</p><p><strong>Conclusion: </strong>This study reiterates the benefit of developing and implementing an ERAS protocol for patients undergoing cranial vault remodeling procedures. The protocol resulted in an overall decreased ICU LOS and a decrease in narcotic use. This has implications for ways to maximize hospital reimbursement for these procedures, as well as potentially improve outcomes.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-06DOI: 10.1177/10556656241258567
Roberto N Solis, Kurtis Young, Oscar S Velazquez-Castro, Nicole I Farber, Travis T Tollefson, Craig W Senders, Jamie L Funamura
Objective: To characterize and compare microbiological profiles in tympanostomy tube otorrhea for children with and without cleft palate.
Design: Retrospective cohort study.
Setting: Pediatric otolaryngology and multidisciplinary cleft/craniofacial clinic at a single tertiary care center.
Patients: Children with and without cleft palate <18 years of age who underwent tympanostomy tube placement between 2017-2021.
Main outcome measures: Otopathogen profiles and antibiotic resistance patterns in ear culture specimens obtained in children presenting for treatment of recalcitrant post-tympanostomy tube otorrhea.
Results: Of the 886 children with tympanostomy tubes placed between 2017-2021, 345 (38.9%) had clinically significant otorrhea defined as requiring at least one otolaryngology visit for treatment. Children with cleft palate had higher rates of otorrhea (50.0% versus 35.7%; P < .01). In the 128 cultures obtained, Staphylococcus aureus was the most common organism in both groups present in 39.8% of cultures; 49% were methicillin-resistant (MRSA). Pseudomonas aeruginosa was also frequently isolated (20.0% versus 23.4%, P = .69) in children with and without cleft palate. Collectively, fluoroquinolone resistance was observed in 68.6% and 27.6% of the S. aureus and P. aeruginosa isolates, respectively, however, no differences in fluoroquinolone resistance were observed between cleft and non-cleft cohorts. Corynebacterium species were isolated more frequently in children with cleft palate (26.7% versus 6.1%, P < .01), a finding of unclear significance.
Conclusions: Recalcitrant post-tympanostomy tube otorrhea is more common in children with cleft palate. MRSA was the most common isolate, which was commonly resistant to first-line fluoroquinolone therapy.
{"title":"Tympanostomy Tube Otorrhea: Microbiological Differences Between Children with and Without Cleft Palate.","authors":"Roberto N Solis, Kurtis Young, Oscar S Velazquez-Castro, Nicole I Farber, Travis T Tollefson, Craig W Senders, Jamie L Funamura","doi":"10.1177/10556656241258567","DOIUrl":"https://doi.org/10.1177/10556656241258567","url":null,"abstract":"<p><strong>Objective: </strong>To characterize and compare microbiological profiles in tympanostomy tube otorrhea for children with and without cleft palate.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Pediatric otolaryngology and multidisciplinary cleft/craniofacial clinic at a single tertiary care center.</p><p><strong>Patients: </strong>Children with and without cleft palate <18 years of age who underwent tympanostomy tube placement between 2017-2021.</p><p><strong>Main outcome measures: </strong>Otopathogen profiles and antibiotic resistance patterns in ear culture specimens obtained in children presenting for treatment of recalcitrant post-tympanostomy tube otorrhea.</p><p><strong>Results: </strong>Of the 886 children with tympanostomy tubes placed between 2017-2021, 345 (38.9%) had clinically significant otorrhea defined as requiring at least one otolaryngology visit for treatment. Children with cleft palate had higher rates of otorrhea (50.0% versus 35.7%; <i>P</i> < .01). In the 128 cultures obtained, <i>Staphylococcus aureus</i> was the most common organism in both groups present in 39.8% of cultures; 49% were methicillin-resistant (<i>MRSA)</i>. <i>Pseudomonas aeruginosa</i> was also frequently isolated (20.0% versus 23.4%, <i>P</i> = .69) in children with and without cleft palate. Collectively, fluoroquinolone resistance was observed in 68.6% and 27.6% of the <i>S. aureus</i> and <i>P. aeruginosa</i> isolates, respectively, however, no differences in fluoroquinolone resistance were observed between cleft and non-cleft cohorts. <i>Corynebacterium</i> species were isolated more frequently in children with cleft palate (26.7% versus 6.1%, <i>P</i> < .01), a finding of unclear significance.</p><p><strong>Conclusions: </strong>Recalcitrant post-tympanostomy tube otorrhea is more common in children with cleft palate. <i>MRSA</i> was the most common isolate, which was commonly resistant to first-line fluoroquinolone therapy.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.1177/10556656241260481
Congcong Cao, Deren Li, Hanwen Gong, Qian Zheng, Chao Xu, Bing Shi
Objective: The aim of this study was to cephalometrically evaluate the pharyngeal morphology in adults with unoperated Submucous Cleft Palate (SMCP), adults with unoperated Overt Cleft Palate (OCP), and adults without clefts.
Design: This study employed a retrospective cross-sectional design. Lateral cephalometric radiography was performed on three groups of adults: 1) 29 with unrepaired SMCP; 2) 41 with unrepaired OCP; and 3) 39 without clefts, who served as controls. One-way ANOVA and rank-sum tests were used for intergroup comparisons. P value was set at .05.
Results: The soft palate length and the ratio of soft palate length to pharyngeal depth were significantly lower in subjects with unoperated SMCP and OCP than in non-cleft controls. Significant differences were also observed in pharyngeal depth, nasopharyngeal depth, and posterior pharyngeal wall thickness between subjects with unoperated OCP and non-cleft controls.
Conclusions: Pharyngeal morphology differs significantly between individuals with and without clefts, particularly in soft palate length and the ratio of soft palate length to pharyngeal depth.
{"title":"Cephalometric Pharyngeal Morphology in Adults with Unoperated Cleft Palate.","authors":"Congcong Cao, Deren Li, Hanwen Gong, Qian Zheng, Chao Xu, Bing Shi","doi":"10.1177/10556656241260481","DOIUrl":"https://doi.org/10.1177/10556656241260481","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to cephalometrically evaluate the pharyngeal morphology in adults with unoperated Submucous Cleft Palate (SMCP), adults with unoperated Overt Cleft Palate (OCP), and adults without clefts.</p><p><strong>Design: </strong>This study employed a retrospective cross-sectional design. Lateral cephalometric radiography was performed on three groups of adults: 1) 29 with unrepaired SMCP; 2) 41 with unrepaired OCP; and 3) 39 without clefts, who served as controls. One-way ANOVA and rank-sum tests were used for intergroup comparisons. <i>P</i> value was set at .05.</p><p><strong>Results: </strong>The soft palate length and the ratio of soft palate length to pharyngeal depth were significantly lower in subjects with unoperated SMCP and OCP than in non-cleft controls. Significant differences were also observed in pharyngeal depth, nasopharyngeal depth, and posterior pharyngeal wall thickness between subjects with unoperated OCP and non-cleft controls.</p><p><strong>Conclusions: </strong>Pharyngeal morphology differs significantly between individuals with and without clefts, particularly in soft palate length and the ratio of soft palate length to pharyngeal depth.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.1177/10556656241259883
Matthew J Heron, Siam K Rezwan, Katherine J Zhu, Jordan Gornitsky, Richard J Redett, Robin Yang
Objective: This study evaluates the geospatial distribution of cleft lip and/or cleft palate (CL/P) care in the United States, assesses disparities between families with and without one-hour proximity to CL/P care, and recommends interventions for improving access.
Design: We identified American Cleft Palate Craniofacial Association-approved CL/P teams and calculated a one-hour driving radius around each clinic. We then used census data to compare risk factors for developing cleft (i.e., incidence risk factors) and obstacles to care (i.e., access risk factors) between counties with and without one-hour proximity.
Results: We identified 187 CL/P teams in 45 states. Most were in the South (n = 60, 32.0%), though children in the Middle Atlantic had the greatest access to care. Alabama, Mississippi, Tennessee, and Kentucky had the least access. Children without access were 39% more likely to have gestational tobacco exposure, 8% more likely to have gestational obesity exposure, and 28% less likely to have health insurance (p < 0.01). Children without access in the South were 29% more likely to have a low birth weight and 46% more likely to be living below the poverty line (p < 0.01). Children with access were twice as likely to live in immigrant families and 7-times more likely to speak English as a second language.
Conclusions: Pronounced disparities affect patients with and without one-hour access to CL/P care. Interventions should address care costs for patients living furthest without access and language barriers for patients with access that speak English as a second language.
{"title":"A Geospatial Analysis of Barriers to Cleft Lip and Palate Care in the United States.","authors":"Matthew J Heron, Siam K Rezwan, Katherine J Zhu, Jordan Gornitsky, Richard J Redett, Robin Yang","doi":"10.1177/10556656241259883","DOIUrl":"https://doi.org/10.1177/10556656241259883","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the geospatial distribution of cleft lip and/or cleft palate (CL/P) care in the United States, assesses disparities between families with and without one-hour proximity to CL/P care, and recommends interventions for improving access.</p><p><strong>Design: </strong>We identified American Cleft Palate Craniofacial Association-approved CL/P teams and calculated a one-hour driving radius around each clinic. We then used census data to compare risk factors for developing cleft (i.e., incidence risk factors) and obstacles to care (i.e., access risk factors) between counties with and without one-hour proximity.</p><p><strong>Results: </strong>We identified 187 CL/P teams in 45 states. Most were in the South (n = 60, 32.0%), though children in the Middle Atlantic had the greatest access to care. Alabama, Mississippi, Tennessee, and Kentucky had the least access. Children without access were 39% more likely to have gestational tobacco exposure, 8% more likely to have gestational obesity exposure, and 28% less likely to have health insurance (p < 0.01). Children without access in the South were 29% more likely to have a low birth weight and 46% more likely to be living below the poverty line (p < 0.01). Children with access were twice as likely to live in immigrant families and 7-times more likely to speak English as a second language.</p><p><strong>Conclusions: </strong>Pronounced disparities affect patients with and without one-hour access to CL/P care. Interventions should address care costs for patients living furthest without access and language barriers for patients with access that speak English as a second language.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}