Cleft Palate-Craniofacial Journal最新文献

ObjectiveInvestigate the pre- and postoperative changes in patients with submucous cleft palate (SMCP) treated by intravelar veloplasty (IVV) with a buccinator musculomucosal flap (BMMF).DesignRetrospective case series.SettingTertiary, cleft team.Patients/ParticipantsChildren with SMCP who underwent IVV with a BMMF at Nagano Children's Hospital.Interventions: IVV with a BMMF between December 2018 and January 2022.Main outcome measuresPerceptual Japanese speech evaluation (hypernasality [HN], nasal emission, and intelligibility [IN]), amount of velopharyngeal (VP) gap, degree of soft palate elevation, amount of soft palate lengthening, VP closure pattern, additional surgery, and postoperative complications.ResultsEleven patients (four syndromic) were analyzed pre- and almost of 1 year postoperatively. Preoperative mean HN and IN scores were significantly improved (P = .0232 and P = .0313, respectively). VP gap was closed after surgery in most cases with initial VP gap <4.5 mm and good soft palate elevation. Mean soft palate lengthening with the BMMF method was 3.9 ± 1.2 mm, which was a significant increase (P = .00589). Four patients required additional surgery. We encountered no severe postoperative complications or fistula formation.ConclusionsIVV with a BMMF is considered applicable in patients with VP gap of up to 4.0 to 4.5 mm and good soft palate elevation. Our technique appears safe, with low risks of severe postoperative complications and fistula formation. Due to the limited cohort size, more cases are needed to elucidate the precise indications for the BMMF method.

ObjectiveTo evaluate the feasibility and impact of remote consecutive, in-person consecutive, and in-person simultaneous interpreter modalities on clinical workflow, patient experience, and provider experience in a multidisciplinary pediatric craniofacial clinic.DesignMixed-methods study incorporating quantitative clinical workflow and patient survey data with qualitative semi-structured interviews.SettingSingle-site multidisciplinary pediatric craniofacial clinic at an academic medical center.Patients, ParticipantsA total of 170 patients were seen during the study period: 126 (74.1%) English-speaking (for no interpreter comparison) and 44 (25.9%) Spanish-speaking using interpreter services. A total of 105 (61.8%) patients completed voluntary patient satisfaction surveys. Sixteen craniofacial providers and four Spanish-speaking interpreters participated in interviews.InterventionsLanguage interpretation was provided via three modalities: remote (audio and video) consecutive, in-person consecutive, and in-person simultaneous.Main Outcome Measure(s)Clinic cycle time and face-to-face time; patient satisfaction scores; thematic analysis of provider and interpreter interviews.ResultsClinic time and satisfaction scores did not differ significantly across modalities. Interviews revealed that in-person interpretation supported rapport, trust, and clarity, while remote interpretation posed technical and relational challenges. Simultaneous interpretation was valued for efficiency but required greater cognitive effort from interpreters. Preferences for in-person consecutive and simultaneous interpretation varied with patient and clinic needs.ConclusionsWhile quantitative outcomes showed minimal workflow differences among interpreter modalities, qualitative findings highlight important communication benefits of in-person interpretation, especially when interpreters are experienced and integrated into the care team. Tailored interpretation approaches may better promote equitable care in multidisciplinary pediatric craniofacial settings.

AimTo investigate the neuroendocrine axis in patients with arhinia, hemiarhinia, and their associated malformations.MethodsData were manually extracted from medical records at Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo (HRAC-USP) using a newly developed protocol. They were explored through a descriptive and qualitative manner. This study was approved by the HRAC-USP Ethics Committee and is part of a large research project on this topic.ResultsNine patients were included in the final sample, of which three had isolated hemiarhinia, three had hemiarhinia with additional malformations, and three were diagnosed with Bosma arhinia-microphthalmia (BAM) syndrome. Among those with isolated hemiarhinia, two presented neuroendocrine alterations (primary hypothyroidism, micropenis with bilateral cryptorchidism, and weight and height deficits). Patients with hemiarhinia and associated malformations demonstrated no clinical or laboratory evidence of neuroendocrine dysfunction. In the BAM syndrome group, two patients exhibited central hypogonadotropic dysfunction, with undetectable luteinizing hormone and follicle-stimulating hormone levels. The third patient showed no abnormalities.ConclusionsArhinia, hemiarhinia, and their associated malformations encompass a broad spectrum of manifestations that can affect multiple organs and systems, particularly the neuroendocrine system. Despite their potential impact, screening for these conditions remains poorly conducted, which may lead to underdiagnosis or delayed recognition of associated complications. Consequently, a comprehensive evaluation is essential to ensure appropriate monitoring and management of affected patients.

ObjectiveTo compare cross-linguistic auditory-perceptual nasality ratings and language-specific nasalance scores in Spanish-English bilingual children and adolescents with cleft palate.DesignRetrospective case series.SettingAcademic, tertiary pediatric hospital.ParticipantsSpanish- and English-speaking patients with cleft palate who underwent a bilingual resonance and articulation evaluation.Interventions/ComparisonsAuditory-perceptual nasality ratings versus nasalance scores.Main Outcome MeasuresCross-linguistic ratings of hypernasality, hyponasality, and audible nasal emission; mean and maximum nasalance scores for oral- and nasal-loaded stimuli in each language.ResultsEleven patients' data were analyzed (six females and five males; mean age, 11.3 years). Oral-loaded mean nasalance strongly reflected perceptual hypernasality in both languages; hyponasality ratings showed no relationship to mean nasalance with nasal-loaded stimuli in either language; and audible nasal emissions were associated with maximum nasalance in Spanish but not English. Repeated-measures analyses revealed no significant effect of phoneme context, language, or their interaction on either mean or maximum nasalance.ConclusionsOral-loaded mean nasalance measures strongly reflect perceptual hypernasality in both languages. Audible nasal emissions are significantly associated with maximum nasalance scores in Spanish only, suggesting possible language-specific perceptual and acoustic patterns. Further research is needed to determine if these conclusions hold in a larger, prospective cohort.

ObjectiveTo evaluate maxillary growth differences when buccal fat pad graft (BFP) is utilized during primary cleft palate repair, and to evaluate the need for later surgical revision of the BFP due to non-eruption of maxillary permanent molars.DesignRetrospective cohort study.SettingInstitutional hospital and clinic.PatientsPatients with CP ± L who underwent primary palatoplasty with or without BFP.InterventionsMaxillary measurements of pre-orthodontic dental models.Main outcome measureMaxillary dimensions, disruption to maxillary permanent molar eruption.ResultsPatients treated with BFP exhibited a tendency toward an increased maxillary posterior width and a more favorable maxillomandibular posterior transverse relationship (P = 0.069 and 0.072, respectively). A similar percentage of patients required maxillary expansion between the non-BFP and BFP-treated group (P = 0.103). Secondary surgical revision was recommended for 70.6% of BFPs placed due to inhibition of eruption of the maxillary permanent molars. 33.3% of BFP revisions were not combined with any other surgical procedure during the general anesthesia event.ConclusionThe use of BFP adjunctive flap during primary palatoplasty likely allows for increased transverse growth of the posterior maxilla during childhood and likely reduces the maxillomandibular posterior arch width discrepancy. However, the use of this graft does not reduce the proportion of patients who require orthodontic maxillary expansion. Patients may experience disruption of maxillary permanent molar eruption, and 70.6% of BFPs placed require secondary surgical intervention under general anesthesia to reposition the flap in late childhood.

ObjectiveTo characterize the audiological and sociodemographic profiles of children diagnosed with isolated Robin sequence (RS) and cleft palate (CP) during the first year of life. In addition, this study aimed to propose an audiological assessment protocol for early identification of hearing loss (HL) in this population.DesignRetrospective longitudinal study analyzing secondary data from medical records.SettingSpecial Care Unit at the Hospital for Rehabilitation of Craniofacial Anomalies.PatientsFifty-eight children aged 0 to 12 months diagnosed with isolated RS and CP.InterventionsNo interventions were performed.Main Outcome MeasuresAudiological assessments revealed a high prevalence of bilateral conductive HL ranging from mild to moderate severity.ResultsMost participants resided in São Paulo state and belonged to lower-upper socioeconomic backgrounds. The most frequent risk factor for early childhood HL was neonatal intensive care for more than 5 days. No statistically significant association was found between HL risk indicators and the presence of conductive HL.ConclusionsConductive HL was identified in 39.64% of children with isolated RS and CP, with a higher prevalence observed in females. The sample demonstrated no cases of permanent and disabling HL. We recommend implementing a standardized audiological assessment protocol for infants with isolated RS and CP during the first year of life, including tympanometry and air-conduction click-evoked auditory brainstem response (ABR), with bone conduction ABR and otoscopic examination performed when clinically indicated.

ObjectivesTo explore individual speech-language pathologists' (SLPs) experiences in the clinical practice of cleft palate speech/velopharyngeal dysfunction (VPD), and to identify the need for and type of (further) training necessary.DesignDescriptive and exploratory survey using QualtricsXM online platform, with subsequent in-person/Zoom Workplace platform interviews.SettingUniversity research and clinical teamParticipantsMembers of the Hong Kong Association of Speech Therapists and the Macao Association of Speech TherapistsInterventionsThe survey consisted of 39 items across 7 sections, for example, continuing professional development and assessment and treatment practices of cleft palate speech. Skip logic was applied to enhance survey efficiency and experience. Interviews were conducted in various modes.Main Outcome Measure(s)The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was used. Quantitative measures include proportions and percentages; qualitative data were summarized from the survey and subsequent interviews.Results90% reported receiving teaching in cleft palate speech/VPD ranging from 0 to 96 h (M = 12.7, SD = 15.58). Over half of respondents felt not (very) confident when undertaking assessment (61%) and treatment (54%). Lack of exposure to real clients was a key reason for low confidence levels. Almost all respondents expressed a strong need for continuing professional development in the area.ConclusionsStudy findings highlight the need for further training in cleft palate speech/VPD for SLPs in the region and emphasize the importance of continuing professional development to enhance skills and confidence in assessment and treatment, ultimately improving care and outcomes for individuals with cleft palate with or without lip.

ObjectiveThis study aimed to evaluate the accuracy of different mixed dentition period analysis methods in individuals with cleft lip and palate (CLP).DesignRetrospective comparative study.SettingDepartment of Orthodontics, Erciyes University, Turkiye.Patients/ParticipantsA total of 70 individuals aged 13 to 16 years were included in the study: 35 with CLP and 35 noncleft controls. In all individuals included in the study, all permanent teeth had erupted except for the maxillary lateral incisors, which are frequently missing in individuals with CLP.InterventionsFor formulas suggested by 8 different prediction methods (Tanaka-Johnston, Moyers 50%, Moyers 75%, Boboc, Cattaneo, Camilo, Barnabe, and Melgaço), the MD and buccolingual dimensions of incisors and molars, as well as the mesiodistal dimensions of erupted canines and premolars, were measured on the 3-dimensional dental models.Main Outcome MeasuresComparison of mean difference between actual and predicted permanent canine and premolar widths, using the control sample as a benchmark to judge model suitability in the CLP population.ResultsAll regression methods showed significant differences between predicted and actual values in the CLP group (P < .05). Boboc and Cattaneo had the fewest errors, while Tanaka-Johnston and Barnabé showed the most significant overestimation. In controls, Cattaneo was most accurate in the maxilla and Tanaka-Johnston in the mandible.ConclusionsThe Boboc and Cattaneo methods provided the most accurate predictions of permanent canine and premolar widths in patients with CLP, while the Tanaka-Johnston and Barnabé methods consistently overestimated values.

ObjectiveTo systematically review advances in surgical techniques for secondary cleft palate repair, emphasizing their impact on velopharyngeal function, speech outcomes, and the methodological validity of speech assessments used in published studies.DesignFollowing PRISMA 2021 guidelines, six electronic databases were searched for articles from January 2012 to February 2025 using MeSH terms related to secondary cleft palate repair, velopharyngeal insufficiency, palatoplasty, and speech outcomes. Eligible studies included clinical reports with ≥10 patients undergoing secondary repair. Data on surgical methods, outcomes, and complications were extracted and qualitatively synthesized due to heterogeneity across studies.SettingAll published clinical studies evaluating secondary cleft palate repair outcomes.Patients/ParticipantsIndividuals presenting with residual velopharyngeal insufficiency, recurrent fistula, or speech dysfunction following primary palatoplasty.Main Outcome MeasuresSpeech resonance and intelligibility, velopharyngeal closure rate, fistula recurrence, donor-site morbidity, and obstructive sleep apnea risk.ResultsFourteen studies met the inclusion criteria. Palate-based re-repair with Furlow double-opposing Z-plasty and buccal myomucosal flaps improved resonance and closure in small to moderate gaps. Pharyngeal flap and sphincter pharyngoplasty achieved satisfactory closure in larger defects but increased the risk of airway obstruction. However, most studies lacked validated speech protocols or controlled for articulatory errors and fistula effects, limiting confidence in the interpretation of outcomes.ConclusionsWhile secondary repairs often improve resonance and velopharyngeal competence, evidence remains constrained by heterogeneity and non-validated assessment methods. Future multicenter research integrating standardized, speech pathologist-verified protocols is essential to establish evidence-based algorithms for secondary cleft palate repair.