Cleft Palate-Craniofacial Journal最新文献

Objective: To analyze the prevalence of obstructive sleep apnea (OSA) in children aged 6 to 12 years with nonsyndromic Robin sequence (NSRS) and in those with nonsyndromic cleft palate (NSCP). All patients presented complete cleft palate (Veau II).

Design: Cross-sectional study.

Setting: Tertiary public hospital.

Patients: A total of 146 children divided into 2 groups: (1) NSRS (n = 69), (2) NSCP (n = 77).

Interventions: (1) Anthropometric assessment, dentoskeletal, and facial analysis. (2) Clinical interview with "Sleep Disturbance Scale for Children" and "Congestion Quantifier Five-Item" (CQ5); and (3) 48 patients: Type IV polysomnography.

Main outcome measures: Frequency of OSA in children with NSRS and NSCP, assessed by Type IV polysomnography.

Results: Positive scores for OSA were found in 59.42% of children with NSRS and 46.75% of those with NSCP (P > .05). Excessive daytime sleepiness was observed in 23.19% of the NSRS group and 9.01% of the NSCP group (P > .05). Positive scores for nasal obstruction were noted in 14.49% with NSRS and 20.78% of those with NSCP (P > .05). In polysomnography IV subgroups, an Oxygen Desaturation Index compatible with mild to moderate OSA was observed in 89.65% of the NSRS group and 78,94% of the NSCP group (P > .05). Also, facial and pharyngeal alterations, such as Angle Class II malocclusion, Mallampati classifications III and IV, and deep crossbite, were associated with OSA.

Conclusion: Both children with NSRS and NSCP have a high frequency of mild to moderate OSA, highlighting the need for systematic evaluation of the presence of sleep-disordered breathing in this population.

Objective: This study aims to analyze health determinants affecting patients with cleft palate, specifically examining the relationships between the Social Vulnerability Index (SVI), failure to thrive (FTT), and healthcare utilization within the initial 30 days and first year of life.

Methods: A retrospective analysis was conducted on patients with a cleft palate at a tertiary care center over an 11-year period. Data included demographics, weight percentile trends, pediatric emergency department (PED) visits, hospital admissions, SVI scores, cleft palate type, and FTT diagnoses. Statistical analyses were performed using SPSS.

Results: Social Vulnerability Index was not significantly correlated with health outcomes in cleft palate. Patients with FTT exhibited lower gestational age (P = .002) and birth (P = .005), one-month (P = .001), and one-year (P = .001) weight percentiles. FTT diagnosis was associated with increased PED visits (P = .000) and hospital admission (P = .000) in the first year of life. Early presentation to the PED was associated with increased PED visits (P = .000) and hospital admissions (P = .004) within the first year of life.

Conclusion: No direct link was found between SVI and FTT. Early hospital readmission emerged as a significant outcome, indicating increased healthcare utilization in patients that require early medical intervention. Failure to thrive significantly impacted healthcare utilization, emphasizing the importance of addressing feeding issues early in this patient population. This study contributes to understanding health disparities in cleft palate patients and highlights the need for nuanced exploration of regional factors influencing outcomes.

Velopharyngeal insufficiency (VPI) predominantly affects children with cleft palate, undermining their ability to communicate. As a result, intelligible speech generation is one of the most important outcomes following cleft palate repair. In low- and middle-income countries (LMICs), the elevated incidence of cleft palate, unavailability of speech services, and suboptimal surgical outcomes has contributed to a substantial yet poorly defined global burden of VPI. Tracking speech outcomes in LMICs is essential to assessing VPI severity and identifying patients needing care. Artificial intelligence and machine learning are well-suited to accommodate this goal.

It's interesting to note that despite clinical improvements in upper airway dimensions, the maxillary, mandibular, and mandibular body lengths remained smaller than those of controls. This finding may represent an underlying neurocristopathy, which represents a deficiency in the population of neural crest cells available in the embryonic maxillary and mandibular processes de novo. Indeed, it is known that craniofacial dimensions in infants with malformations, such as cleft palate, are often smaller when compared to non-cleft counterparts. The post-treatment decrease in the SNA angle and increase in angle SNB, which resulted in a decreased ANB angle may be associated with a "headgear effect" whereby the maxilla is dragged postero-inferiorly by the mandible, aided by gravity. To avoid this effect, proactive maxillary development might be beneficial. In fact, the concept of "catch-up growth" is also noteworthy since a developmental mechanism would need to be invoked. The authors referred to the old Functional matrix hypothesis, but the treatment effect was primarily a change in jaw position, which evoked a positive functional outcome. Thus, according to the Spatial matrix hypothesis, clinical decompensation of a dysfunctional spatial matrix leads to a cascade of events since a change in mandibular position is associated with changes in gene expression. Recently, genetic expression of Sdf1 and Foxc1 associated with histologic changes following mandibular advancement in rats has been reported as well as the effects of the PINK1/Parkin pathway on the genioglossus muscle through mandibular advancement device use in rabbits with obstructive sleep apnea. Clinically, therapeutic epigenetic changes using an orthodontic mandibular advancement device have also been reported in children.

In 2012, the James Lind Alliance (JLA) worked with individuals with cleft lip and/or palate (CL/P), their families and clinicians to identify priority areas for future research. This article reviews progress conducted in the United Kingdom in the 3 JLA priorities most closely related to Clinical Psychology. It then builds upon the original priorities to identify 4 future directions, based on contemporary literature and in-depth discussions between clinical and research experts. Finally, recommendations for next steps toward meeting these future directions are outlined, including consistent outcome measurement, engaging diverse groups of people with CL/P and embedding the principles of codesign.

Background: Paucity exists in the literature on uvular repair while documenting palatoplasty techniques for children with cleft palate.

Solution: We propose a modified approach without losing any soft tissue structures, gaining better cosmetic outcome, and possibly having functional gains postoperatively.

What we did that is new: The proposed technique provides better cosmesis for the structures postoperatively and enhances the palatoglossal arch, which may prevent the spillage of saliva to the oropharyngeal region.

Objective: The Melbourne technique for total cranial vault remodeling aims to address all aspects of scaphocephaly in sagittal craniosynostosis. These features include anterior-posterior excessive length, anteriorly displaced vertex position, frontal bossing, vertex narrowing, and occipital bulleting. This study aimed to determine the progressive cranial changes that occur following the Melbourne technique for sagittal craniosynostosis.

Design: Retrospective review of 3-dimensional images collected preoperatively and postoperatively at 3 weeks, 3 months, 1 year, and 2 years.

Setting: Tertiary care pediatric institution.

Participants: Twenty-five patients with sagittal craniosynostosis.

Interventions: The Melbourne technique for total cranial vault remodeling.

Main outcome measure(s): Head circumference, cephalic index, frontal bossing index, occipital bulleting index, vertex narrowing index, and vertex-nasion-opisthocranion (VNO) angle were evaluated.

Results: The cephalic index significantly increased postoperatively (P = .04) with a subsequent relapse at 3 months followed by progressively increased growth. The frontal bossing index significantly decreased postoperatively (P = .02) with a progressive decrease. The occipital bullet index had a relative decline postoperatively with relapse at 3 months, followed by a progressive decrease. The vertex narrowing index significantly decreased postoperatively (P < .001), with a plateau and slight relapse. The VNO angle showed a relative decline over time with a significant decrease by 1 year of age (P = .002).

Conclusions: The Melbourne technique improved the cephalic index, frontal bossing, vertex narrowing, occipital bulleting, and vertex positioning at 2 years of age. Cephalic index and occipital bulleting showed slight relapse at 3 months, followed by progressive improvement over time.

Objectives: This study compares perioperative outcomes between spring-assisted cranioplasty (SAC), distraction osteogenesis (DO) and conventional expansion in craniosynostosis surgery.

Design: Systematic review and meta-analysis.

Setting: Retrospective and prospective cohort.

Patients and participants: A comprehensive electronic search was conducted using PubMed/Medline, Scopus, Science Direct, EBSCO, Web of Science, and Cochrane Library, alongside Gray literature sources (SSRN, Scopus preprint, and MedRxiv). Publication bias was assessed and study quality was evaluated using the Newcastle Ottawa Scales (NOS).

Interventions: SAC or DO.

Main outcome measures: Blood loss and blood transfusion.

Results: Thirteen studies were included, with 7 studies comparing DO versus conventional and 6 comparing SAC vs conventional. All studies met eligibility criteria for meta-analysis, with study quality ranged from good to very good. Compared to conventional, the SAC or DO significantly reduced blood loss (MD = -190.42 mL), and blood transfusion (MD = -227.22). Additionally, SAC and DO shorten operative time (MD = -94.38 min), anesthesia duration (MD = -114.81 min), hospital stay (MD = -0.68 days), and ICU stay (MD = -1.00 days). Long-term follow-up showed a lower reoperation rate (OR = 0.20), but no significant change in cranial index at 10 years (MD = 0.06, P = .74).

Conclusions: SAC or DO result in lower perioperative complications, overall shorter durations, and reduced reoperation rates compared to conventional expansion. Standardized postoperative outcome reports are useful to classify the severity of complications and guide the future long-term treatment strategies for craniosynostosis surgery.

Objective: This study aims to estimate the geospatial distribution of cleft lip/palate (CL/P) cases in northwestern Nigeria and to estimate the prevalence and patterns of CL/P across wards.

Design: This retrospective study utilized information from health records for inpatients with CL/P. These data were analyzed via descriptive statistics. Spatial mapping involves geocoding street addresses into map coordinate system before aggregation for subsequent spatial analyses.

Setting: The center used was a nongovernmental organization clinic that manages CL/P.

Participants: All patients managed during the study period under 15 years were selected for the study, while the spatial analysis included all patients with valid addresses.

Results: A total of 1556 cases were selected, while spatial analyses mapped 928 cases. The analysis indicated over half (54.4%, n = 505 patients) lived in Kano Metropolis, whereas 45.6% (n = 423 patients) lived outside the Metropolis. CL/P prevalence correlated with the population density pattern in Kano. The prevalence of clefts was highest in Metropolis in 2008, and the Metropolis had the highest prevalence of clefts for children under 5 years of age. The significant patient and maternal factors were age (P < .001), weight (P < .001), socioeconomic status (P < .003), positive family history of cleft (P < .001), and maternal factors.

Conclusion: The GIS analysis revealed that most patients with CL/P who received treatment at the NGO lived nearby, with the greatest prevalence of clefts occurring in the Metropolis. The cost of travel may explain why those further afield do not come in for treatment or lack public awareness about the services provided at the cleft clinic.

CAAs are congenital malformations of the auricle ranging from ear underdevelopment to anotia, lacks standardized classification, impacting our outcome of different reconstruction approaches. This scoping review aimed to explore which CAA classifications are most used in current ear reconstruction practices.

We conducted a scoping review following the PRISMA guidelines, searching MEDLINE and Embase databases on November 1st, 2023. Studies on CAA reconstruction that included clear descriptions of the used classification published in the past 5 years were included. Studies were appraised using the Joanna Briggs Institute checklist.

Out of 293 screened studies, 45 met inclusion criteria, encompassing 19 case series and 5 cohort studies. Findings revealed a predominant use of the Nagata classification across rib cartilage and alloplastic material reconstructions, despite noted application inconsistencies. Other systems like Marx's, Weerda's, and Meurman's remain underutilized.

Most studies used the Nagata's classification. Its widespread use underscores the necessity for an easy to use, but standardized classification to improve surgical outcome reporting and assessment accuracy. Further investigation and standardization efforts regarding the Nagata system are recommended.