Cleft Palate-Craniofacial Journal最新文献

Objective: To date, there are no published studies From the Sultanate of Oman on the incidence or characteristics of craniosynostosis (CS). This is a population-based epidemiological study of the incidence of CS.

Methods: The prospective registry of the craniofacial surgery unit in Khoula Hospital was used to retrieve data on all individuals with CS treated between 2004 and 2023. The cohort was divided into four 5-year groups based on year of birth: 2004 to 2008, 2009 to 2013, 2014 to 2018, and 2019 to 2023.

Results: We identified 312 individuals with CS. The incidence increased significantly during the study period and was 2.5 per 10 000 live births in the last 5-year period. There was a male preponderance (male/female ratio 1.5:1). Our study findings reveal a notable diversity in the trend of suture involvement, we observed a higher frequency of complex CS within our study population 35.9%. Half of the study population was nonsyndromic, accounting for 51.6%. The nonsyndromic population exhibits a higher proportion of midline suture involvement.

Conclusions: The incidence of CS increased during the study period. The majority of cases were identified as nonsyndromic. We found that multiple sutures CS were the most prevalent overall in our population. It is imperative to intensify efforts aimed at raising awareness among the general population regarding these deformities.

Objective: To assess craniofacial and upper airway growth in infants with Robin sequence (RS) during the 1^st year of life when their severe upper airway obstruction was treated non-surgically with the Stanford orthodontic airway plate treatment program (SOAP).

Design: Retrospective longitudinal cohort study comparing SOAP-treated infants with RS (treatment group) with age-matched healthy controls (HC) using computed tomography (CT).

Setting: Single tertiary referral hospital.

Patients: Twelve SOAP-treated infants with RS.

Interventions: SOAP.

Main outcome measures: Craniofacial skeletal cephalometric parameters and three-dimensional airway metrics.

Results: No infants required mandibular distraction or tracheostomy surgery after SOAP. The pre-treatment CT was acquired at the mean age (±SD) of 1.3 months (±0.7). The treatment lasted for 4.8 months (±0.9). Post-treatment CT was acquired at 12.9 months (±2.3) of age. The pre-treatment obstructive apnea hypopnea index decreased from 29.21 events/hour (±14.80) to 4.11 events/hour (±2.21) at post-treatment. The total mandibular length increased from 40.58 mm (±2.98) to 62.15 mm (±2.77) at post-treatment (p < 0.001) resulting in the growth velocity of 51.02% (±11.20) or 20.52 mm (±3.95) per year. The maxillary and mandibular lengths of the treatment group at post-treatment were shorter than those of HC although the maxillomandibular relationship was not different (p = 0.618). The upper airway volume and minimal cross-sectional area were also not different (p = 0.083, p = 0.254, respectively).

Conclusions: The maxillomandibular relationship and upper airway of the SOAP-treated infants with RS were near-normalized at post-treatment, comparable to age-matched healthy infants.

Objective: Describe surgical decision making and outcomes in a series of patients with persistent VPI after pharyngeal flap placement that were all treated with revision palatoplasty.

Design: Retrospective, case series.

Participants: Five patients with nonsyndromic cleft palate and persistent hypernasality following a pharyngeal flap. On MRI, 3 patients presented with an incohesive levator veli palatini muscle, and 4 patients had a pharyngeal flap that was below the palatal plane.

Interventions: One patient underwent straight-line intravelar veloplasty (IVVP), 2 patients underwent pharyngeal flap take-down and IVVP, and 2 patients underwent pharyngeal flap take-down and palate lengthening with buccal myomucosal flaps.

Main outcome measure: Pre- and postoperative resonance.

Results: Four of five patients (80%) achieved normal resonance 12 months postoperation.

Conclusions: Revision palatoplasty may be an effective approach for treating patients with persistent hypernasality following a pharyngeal flap. MRI may aid in surgical selection based on patient-specific anatomical findings.

Main objective: To analyze postoperative palatoplasty outcomes before and after systemic protocol changes to preferred bottle and arm immobilizer use after surgery.

Design: Retrospective, cohort study.

Setting: Urban, academic, tertiary medical center in New York City, NY.

Participants: Eighty-four patients who underwent primary palatoplasty and met inclusion criteria during 1 of 2 treatment periods, 2016 to 2017 (group A, n = 45) and 2019 to 2020 (group B, n = 39).

Interventions: Protocols were amended over the 2018 calendar year to allow for utilization of the baby's preferred bottle (vs alternative feeding methods) and hand socks (vs arm immobilizers) in the immediate postoperative period. Data was extrapolated from electronic medical records to compare surgical outcomes.

Main outcome measures: Postoperative wound complications (fistula and dehiscence) that did not resolve within 1 month, length of stay (hours), and 30-day re-admission. Nonparametric Mann-Whitney U tests and Fisher's Exact test were utilized for statistical analysis.

Results: There were no statistically significant differences between sex, age at surgery, Veau classification, or hard and soft palate surgical repair technique. Group A had a wound complication rate of 8.7% (n = 4) versus a 2.6% rate (n = 1) for group B. No patients were re-admitted to the hospital from either group. There were no statistically significant differences between groups regarding length of stay (P = .528) or wound complication (P = .366).

Conclusions: The findings from this study suggest relaxing postoperative protocols following palatoplasty to allow immediate bottle feedings and unrestricted arm use may be safe without compromise to surgical outcomes.

Autologous fat grafting for posterior pharyngeal wall augmentation has been described as a safe and effective treatment option for a subset of patients with mild to moderate velopharyngeal insufficiency (VPI). Reported complications including hyponasality and obstructive sleep apnea (OSA) are exceedingly rare. We describe the development of severe fat graft hypertrophy and subsequent OSA in a series of 3 patients several years after undergoing autologous fat grafting for VPI. All patients required revisional surgery for the removal of the engrafted fat. Although rare, OSA can result from hypertrophy of autologous fat grafted into the posterior pharyngeal wall for treatment of VPI.

Objective: Identify unbundling trends in primary palatoplasty.

Design: Retrospective study utilizing the American College of Surgeon Pediatric National Surgical Quality Improvement Program (PNSQIP).

Setting: Records available from 2016 to 2021.

Patients: All patients with primary CPT (current procedural terminology) code 42200 (palatoplasty for cleft palate, soft and/or hard palate only).

Interventions: Cohorts compared "unbundled": additional CPT code 42235 (repair of anterior palate, including vomer flap) vs. "bundled": 42200 billed alone.

Main outcome measures: Operative time, surgical specialty, and other perioperative variables.

Results: In total, 9827 had primary CPT 42200. Of these, 671 (6.8%) were unbundled. Operative time was longer in unbundled (157.08 min vs. 133.16 min; P < .001). Plastic surgeons were less likely to unbundle (6.2% vs. otolaryngology, 9.12%; P < .001).

Conclusions: Variations in primary palatoplasty billing exist. Longer operative times in unbundled cases suggest added complexity. Undervaluation of craniofacial CPT codes may contribute to non-standard billing practices.

Objective: Nasoalveolar molding (NAM) can optimize aesthetic outcomes in patients with cleft lip and palate (CLP), particularly in those with wider clefts. However, its impact on long-term postoperative sequelae such as midface hypoplasia (MFH) remains unclear. This study analyzed cephalometric data to evaluate NAM's effect on MFH in patients with complete unilateral CLP (UCLP).

Design: Systematic Review and Meta Analysis.

Patients: Included studies reported cephalometrics of patients ≥ 7 years old with repaired UCLP who underwent presurgical NAM versus no-NAM (control). Studies of bilateral cases or unoperated clefts were excluded.

Main outcome measures: Main outcomes were cephalometric angles (sella-nasion-A point (SNA), sella-nasion-B point (SNB), and A point-nasion-B point (ANB)) of patients treated with NAM vs. no-NAM.

Results: Of 2063 articles, three met inclusion criteria. Cephalometrics were reported for 171 patients (89 NAM, 82 no-NAM) at an average age of 8.5 ± 0.9 years. On pooled analysis, compared to the no-NAM cohort, the NAM cohort had insignificantly smaller SNA (78.8°±1.5° vs. 76.7°±1.5°, p = 0.169), SNB (75.5°±1.0° vs. 75.5°±1.0°, p = 0.954), and ANB (3.6°±1.4° vs. 1.23°±1.2°, p = 0.089) angles. Upon meta-analysis, compared to the no-NAM cohort, the NAM cohort had significantly smaller SNA (Mean Difference (MD) -1.96 [-3.31 to -0.61], p = 0.005) and ANB angles (MD -2.22 [-3.20 to -1.24], p < 0.001).

Conclusion: This meta-analysis revealed that patients with UCLP who underwent presurgical NAM had significantly smaller SNA and ANB angles, possibly indicating worse MFH. Before choosing NAM, clinicians should consider CLP severity, potential sagittal growth restrictions, and feasibility, particularly in low-resource settings.

Objective: Evaluate the effectiveness of a digital home monitoring program for infants with cleft palate with or without cleft lip (CP ± L), compared to monitoring through in-person clinic visits.

Design: Retrospective cohort study.

Setting: One metropolitan pediatric hospital.

Patients: Eight-eight infants with CP ± L: 41 infants received digital home monitoring and 47 infants were monitored solely through in-person visits.

Interventions: Beginning in September 2022, all infants with CP ± L were enrolled in a digital home monitoring program, in which caregivers weighed their child weekly at home and submitted those weights, along with subjective evaluations of their child's feeding, using a secure website. Submissions were monitored by the cleft team nurse coordinator.

Main outcome measures: The primary outcome was the incidence of malnutrition at 4 months of age. The secondary outcome was the average number of in-person clinic visits during the first 4 months of life.

Results: There was not a significant difference (P = .764) in the incidence of malnutrition between infants monitored in-person compared to infants in the home monitoring program (13% vs 17%). Infants in the home monitoring program had fewer in-person visits with speech-language pathology (5.4 vs 3.9; P < .001). Across groups, malnutrition was associated with Child Protective Services involvement (P = .001) and presence of a syndrome (P = .014).

Conclusions: The digital home monitoring program did not decrease the incidence of malnutrition, but it did reduce the number of speech-language pathology in-person visits. The program appears to distinguish infants who are gaining weight appropriately from those with feeding challenges, but it does not fully address the multifactorial contributors to malnutrition.

This study aimed to investigate how ear shape in adults changes with age and ethnicity among four Chinese minority groups: Buyi, Tibetan, Tu, and Salar.

We employed a combined approach using linear measurements and 2D geometric morphometrics to comprehensively assess ear shape variation.

Our findings revealed a significant effect of age on ear shape, independent of overall size. Specifically, older adults exhibited a slender helix and antihelix especially in the lower region. Interestingly, the helix showed elongation, while the antihelix became shorter, and the tragus position shifted upwards. While linear measurements increased with age, the overall size (centroid size) remained constant. Although ethnicity displayed greater variability in ear shape compared to age and size, our analysis using Principal Component Analysis and random forest models did not reveal statistically significant differences between the four ethnic groups.

This study suggests that genetic factors play a relatively minor role in shaping ear variation, similar to other cranial features.

Velopharyngeal insufficiency (VPI) is common in patients with a repaired cleft palate. 18% to 20% of patients who undergo superiorly based pharyngeal flap for VPI may require a revision procedure due to persistent hypernasality.

One solution to persistent VPI is flap revision, but there is a paucity of revision techniques described in the literature.

We present a novel technique for pharyngeal flap revision utilizing a V-to-Y procedure to tighten the lateral pharyngeal ports.