Cleft Palate-Craniofacial Journal最新文献

ObjectivesThis trial was designed to test the efficacy of 2 lip taping methods in modifying the maxillary arch dimensions (MADs) of infants with bilateral cleft lip and palate (BCLP) before lip repair surgery.DesignParallel-group randomized clinical trial.SettingThe trial was conducted at 3 centers in Baghdad city.ParticipantsThirty-six nonsyndromic infants with BCLP.InterventionThe eligible infants were randomly assigned to either the first experimental group that received a conventional horizontal tape (3 M Steri strip-1/4 inch) or the second experimental group that received a custom-made tape made of Steri strips and orthodontic extra oral elastics. All of the included infants in both groups had rubber base impressions taken for them at the start of treatment (T1) and right before surgical lip repair (T2). A desktop scanner was used to scan each of the generated models, creating digital models that could be used for outcome evaluation.Main Outcomes MeasuresVirtual MAD measurements were performed by a blinded assessor on the generated digital models both before (T1) and after (T2) treatment.ResultsAt T2, both groups showed statistically significant changes in all measured MADs, with a mean difference ranging from 1.36 to 2.95 mm for the conventional taping group and from 1.46 to 7.96 mm for the custom-made one. The comparison of the 2 groups revealed both statistically and clinically significant differences with a P value <.05. The custom-made taping demonstrated more constriction in maxillary arch in terms of changes, which could provide easier surgical manipulation for the cleft parts.ConclusionLip taping appears to be an efficient technique for modifying the MADs in infants with BCLP.

ObjectiveCraniosynostosis, a condition marked by the premature fusion of one or more cranial sutures, exhibits diverse phenotypes. This study aims to advance the understanding of these phenotypes beyond the conventional 2-dimensional analysis by focusing on identifying indicators of increased intracranial pressure (ICP) such as bony thinning or irregularities in skull morphology.MethodsA retrospective review was conducted for all pediatric patients with midline craniosynostosis who presented to our tertiary academic center for evaluation. Control patients were carefully selected to match for age, sex, and weight. All computed tomography data were segmented in 3-dimensional Slicer and then delineated along with suture lines into occipital, parietal, and frontal segments. Main outcome measures included general skull shape (assessed via measures of flatness and surface area to volume ratio) and skull topography (analyzed via measures of bone thickness, surface variance, and surface standard deviation).Results and ConclusionsForty-one patients with midline craniosynostoses were identified (22 metopic and 19 sagittal). Patients with sagittal craniosynostosis had significantly angulated frontal and occipital bones, reflective of the frontal bossing and occipital bulleting commonly seen in this population, and significantly flatter parietal bones, reflective of limited growth along with the transverse axis. Interestingly, evaluation of bone topography revealed that patients with sagittal craniosynostosis had significantly higher parietal bone surface variance, reflective of gyral impressions secondary to increased ICP. In contrast, patients with metopic craniosynostosis had statistically flatter frontal bones-reflective of limited anterior brain growth caused by the fused metopic suture-with minimal impacts to parietal or occipital bones.

Cleft lip and palate are common congenital defects with multifactorial complex etiology characterized by complete or incomplete cleft of lip, alveolus, and hard and soft palate. In infants, the main problem lies in the difficulty of suckling with frequent nasal regurgitation leading to respiratory and middle ear infections. This article presents a case report of an 8-day-old female with complete cleft of hard and soft palate who was given a novel self-retentive type feeding obturator. This obturator eliminated the need for supplementary aids to help in retention and has a simple design, is cost-effective, and easy to use.

ObjectiveOur goal is to address the health literacy gap concerning cleft lip and palate using artificial intelligence (AI), specifically OpenAI's ChatGPT-4, to enhance the readability of patient educational materials (PEMs). Additionally, we aim to explore the integration of interactive educational materials into these resources.DesignA cross-sectional study.SettingWebsites of craniofacial teams approved by the American Cleft Palate-Craniofacial Association (ACPA).Patients/ParticipantsPEMs collected from these websites.InterventionsFirst, we examined the PEMs for interactive educational content such as videos, photos, case examples, and audio clips. Subsequently, we used the WebFX online readability calculator and Grammarly to evaluate the texts' readability and clarity. After that, we used ChatGPT-4 to simplify the PEM texts to a 6th-grade reading level and re-evaluated their readability and clarity.Main Outcome Measure(s)Readability levels (grade level) and clarity scores of PEMs before and after AI modification, and the presence of interactive educational content.ResultsInitial evaluations using the Flesch-Kincaid Grade Level formula showed that the texts were written at a median 9th-grade reading level. Modifications using ChatGPT-4 significantly improved readability, achieving a median 6th-grade level and enhanced clarity. Only 27% of the websites featured interactive educational content, indicating a gap in utilizing educational enhancements.ConclusionThe use of AI improved the readability and clarity of patient educational materials, aligning with recommended standards. However, the underutilization of interactive tools suggests a need for broader integration of these resources to optimize patient education and engagement.

IntroductionThere are few evidence-based practice guidelines for recalcitrant torticollis (RT), defined as torticollis that persists past 1 year of age despite conservative therapy. Available evidence recommends a combination of physical therapy (PT), occupational therapy (OT), botulinum toxin injection (BTI), and in the most severe cases, surgical release.MethodsThis is a single-center, retrospective study conducted with Institutional Review Board approval. Inclusion criteria were diagnosis of congenital muscular torticollis before 1 year old and persistence of symptoms past 1 year despite conservative treatment between January 1, 2005, and January 30, 2023. Patients with incomplete data, acquired torticollis, confounding diagnoses, or who did not receive a diagnosis or conservative therapy before 1 year of age were excluded.ResultsSeventy-seven patients met the inclusion criteria. The average age at diagnosis was 4.5 ± 2.5 months. Initial treatment consisted of PT for 61 patients (79.2%), stretching exercises for 11 patients (14.3%), and OT for 4 patients (5.2%). Regardless of timing, 74 patients in total (96.1%) received PT for an average of 13.3 ± 8.6 months. Conservative treatment modalities led to the resolution of symptoms for 40 patients (51.2%) and improvement of symptoms for 35 patients (45.5%). Two patients received at least 1 BTI which led to further improvement of symptoms. One patient underwent operative intervention which consisted of sternocleidomastoid release.ConclusionsRT is a challenging clinical entity that requires diligent multidisciplinary care. Patients who present and begin conservative therapy before 1 year of age are likely to have improvement or resolution of symptoms without more advanced therapies.

ObjectiveTo identify behaviors associated with poor caregiver-reported oral health in a population of young children with cleft palate with or without cleft lip (CP ± L).DesignObservational cross-sectional study.SettingU.S. Cleft Outcomes Research NETwork (CORNET) ConsortiumPatients/ParticipantsEight hundred thirty-four caregivers of US children with CP ± L ages 14 to 48 months who provided demographic and medical information and answered 8 items on oral health behaviors (eg, sugar-sweetened beverage intake frequency, having a regular source of dental care, toothbrushing, and fluoride exposure).Main Outcome MeasureCaregiver-reported oral health status of the child (poor/fair vs good/very good). Logistic regression models were used to generate confounder-adjusted odds ratios (OR) and evaluate associations between oral health behaviors and caregiver-reported oral health status of the child.ResultsThe mean age of children was 25.5 ± 7.5 months, 82.7% were white, and 24.1% were Hispanic/Latino. About 16.7% of caregivers reported their child's oral health as fair/poor. Children consuming 2+ servings of juice and/or sugar-sweetened beverages daily (OR: 2.18; 95% confidence interval [CI]: 1.2, 4.0; P = 0.011), those drinking bottled water (OR: 1.75; 95% CI: 1.0, 3.1; P = 0.049), and those consuming 1+ servings of meal replacement drinks daily (OR: 2.86; 95% CI: 1.2, 6.5; P = 0.015) had increased odds of fair/poor caregiver-reported child oral health.ConclusionsSugar-sweetened beverages and meal replacement drinks, as well as bottled water intake, were associated with poorer caregiver-reported oral health for children with CP ± L. Future research should focus on ways to improve beverage-related behaviors in children with CP ± L to prevent dental diseases and promote oral health.

ObjectiveWe sought to calculate the waste generated by cleft lip and palate (CL/P) procedures and to increase awareness of the environmental impact of our speciality.DesignWaste from 5 CL/P procedures was categorised into 5 streams and weighed. A carbon calculator tool was used to convert weight of waste in to estimated carbon emission over a 12-month period.SettingThe study was carried out in a university teaching hospital.Patients and ParticipantsThis was an assessment of the waste produced from 5 paediatric CL/P procedures.Main Outcome MeasuresWeight of waste produced as result of CL/P procedures, measured in kilograms (kg); weight of CO₂, measured in kg.ResultsWe found that 768.5 kg of surgical waste was generated by CL/P procedures at our centre annually. This equates to 2653 kg of CO₂.ConclusionsThis study serves as a reminder of surgeons' responsibility to oversee how the waste we produce is disposed of.

ObjectiveSecondary rhinoplasty is a frequently requested revision procedure in patients with a history of cleft lip and palate (CLP). The satisfaction of patients with the esthetic outcome of the procedure has been infrequently studied.DesignAdult patients with CLP who had undergone a secondary rhinoplasty between 2009 and 2019 were identified in a cross-sectional cohort that had filled the FACE-Q rhinoplasty module. The effect of the cleft type and the number and timing of the nasal revision surgeries were evaluated.ResultsForty participants were included, median age of 26 years (range 18-59 years). Nine (23%) participants had a history of bilateral CLP. The median time form the last nasal operation to the study was 4.5 years (range 16 days to 10 years). The participants reported being satisfied with the appearance of the nose (median score 52, interquartile range [IQR] 44-60) but the satisfaction with the appearance of the nostrils (median score 44, IQR 30-64) was below the normative value for the scale. Patients with a history of bilateral CLP reported worse satisfaction across all the aspects of health-related quality of life assessed (P < .05 for all). No association was observed between the age at the first open rhinoplasty and satisfaction with the appearance of the nose or the nostrils.ConclusionsFollowing secondary rhinoplasty, adults with CLP are, in general, satisfied with their nose but less so with nostrils. Compared to unilateral CLP, bilateral CLP is associated with a worse health-related quality of life.

ObjectiveTo evaluate the efficacy of tongue flaps in closing large palatal fistulas secondary to cleft palate repair in terms of functionality, esthetics, and donor site morbidity.DesignTertiary academic center.SettingWe report our 8-year surgical experience with tongue flaps, with our parachute suture technique in flap inset, and not using tongue fixation methods or feeding tubes.ParticipantsNineteen patients having recurrent secondary palatal fistula, post-cleft treatment were treated with anteriorly based dorsal tongue flaps.Main outcome measurePatients were evaluated for outcome in terms of flap uptake and effectiveness, correction of oronasal regurgitation, speech and nasality improvement, donor site morbidity, and esthetics.ResultsA total of 19 patients in the age range of 1.5 to 34 years were treated with anteriorly based tongue flap. Detachment of the tongue flap was observed in 1 patient. Furthermore, tongue flap necrosis was not observed in any of the patients. Nasal regurgitation was resolved completely in 15 cases (78.9%), and 2 out of 4 failed cases were due to fistula presence in a position out of flap territory. In addition, fistula persists in the case of flap detachment and another case at the location of pedicle division. Speech intelligibility and hypernasality changes were reported as noticeable improvement in 9 (47.4%) and no obvious change in 10 patients (52.6%).ConclusionUsing parachute suturing technique can facilitate successful lingual tissue inset in palatal defects with negligible remnant fistula. Moreover, avoiding tongue fixation methods and nasogastric tube-assisted feeding wasn't associated with increased flap dehiscence or suture loosening.

ObjectiveTo characterize mandibular morphology in patients with Parry-Romberg syndrome (PRS).DesignRetrospective study.SettingA craniofacial center.PatientsThirty-three patients with PRS affecting mandible.InterventionsPreoperative computed tomography data were analyzed using Mimics 26.0 (Materialise Inc.). Distances between landmarks-condyle process (Con), coronoid process (Cor), mandibular foramen (IAF), gonion (Go), and mental foramen-were measured to represent the sizes of skeletal units. Positional asymmetry was reflected by angles between lines connecting bilateral landmarks and the occlusal plane.Main outcome measure(s)Bilateral differences in unit sizes were compared. Absolute difference (Δ) > 5 mm and relative size (RS) < 80% were set to evaluate the severity of hypoplasia. Angular measurements were compared to 0° using one-sample t tests. Pearson correlation analysis was conducted to examine the relationship between onset ages and both RS and angular measurements.ResultsThe affected side's skeletal units were smaller. Severe hypoplasia was more common in the angular unit. Angles between Con-Con', Cor-Cor', IAF-IAF', and the occlusal plane were less than 0°, whereas the angle with Go-Go' was greater than 0°. Age of onset was positively correlated with the condylar unit size and the Con-Con' to occlusal plane angle.ConclusionsPatients with PRS affecting mandible exhibit smaller skeletal units on the affected side, particularly in the angular unit. Most landmarks on affected side tend to cluster toward the occlusal plane. Earlier onset of PRS correlates with more pronounced condylar asymmetry. Evaluating the severity of functional units involvement and implementing appropriate treatment should be considered.