Cleft Palate-Craniofacial Journal最新文献

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.

ObjectivesTo assess surgical instrument usage in cleft lip (CL) and cleft palate (CP) surgery and create an optimized surgical tray with an associated cost-savings analysis.DesignProspective, observational study.SettingSingle institution, 6-month prospective review.Patients/ParticipantsA total of 10 primary CL surgeries and 10 primary CP surgeries were included in this study.InterventionComplete lists of surgical instruments utilized in CL and CP surgeries were collected.Main Outcome Measurements:Utilization fractions (UFs) were calculated as the percentages of average used instruments to averaged opened instruments per case. New optimized CL and CP surgical trays were idealized by removing instruments not used in at least 20% of cases, and a cost analysis was performed to identify potential savings. Calculation of annual potential savings was also conducted based on institutional caseload.ResultsThe average instrument UFs were 26.0% for CL and 22.6% for CP. The estimated costs were $33.15 to $290.29 for the original CL surgical tray and $10.20 to $63.80 for the optimized tray. For CP, the original tray's cost was estimated at $38.25 to $319.00, and the optimized tray at $9.18 to $57.42. This demonstrates a cost reduction of $22.95 to $226.49 for CL and $29.07 to 261.58 for CP.ConclusionsThe idealized surgical instrument tray could contribute to reducing healthcare expenditures and promoting operating room efficiency, patient safety, and environmentally friendlier operating theaters.

The article elucidates the management of a case of severe form of grade III hypertelorism with an intercanthal distance of 61 mm in a 4-year-old child. The management was especially challenging because of the patient's young age, degree of hypertelorism, wide cleft and simultaneous presence of 2 big (sincipital & basal) encephaloceles and a lipoma in the midline. This paper attempts to describe the attempted surgery, postoperative course and the learnings derived from its management to probably create a road-map for surgeons faced with such a challenge in future.

ObjectiveTo identify morphosyntax and lexical ability predictors in children with repaired cleft palate (CP) with or without cleft lip (CP ± L).DesignProspective longitudinal cohort study.SettingMultisite institutional.ParticipantsEighty-eight toddlers with nonsyndromic CP ± L.ProceduresParticipants' parents completed the MacArthur-Bates Communicative Development Inventories (CDI) Words and Gestures and background information questionnaires at 16-month visits. They also recorded 2 to 4 hours of their child's vocalizations/words using Language Environmental Analysis (LENA™) recorders. Recordings were analyzed for the number and type of consonants produced. At 24-month visits, parents completed the CDI Words and Sentences.Main Outcome MeasuresMean utterance length of the child's three longest utterances (M3L) and expressive vocabulary reported on the CDI Words and Sentences.ResultsThe results showed significant associations for vocabulary and M3L at 24 months with maternal education level (MEL), total consonants, stop consonants, CDI words produced, and CDI words understood at 16 months. Additionally, vocabulary and the area deprivation index were significantly correlated. Age at palatoplasty, cleft Veau classification, Pierre Robin Sequence, preterm birth, and family history of speech-language delay/disorder were not significantly associated with M3L or vocabulary. Linear regression indicated that MEL, stop consonant production, and CDI words understood at 16 months significantly predicted expressive vocabulary and M3L at 24 months.ConclusionStop consonant production remained a significant predictor of expressive vocabulary and morphosyntax skills, after controlling for other factors. These findings suggest early intervention targeting stop production should promote expressive language skills. Children's stop consonant inventory should be closely monitored following palatoplasty.