Cleft Palate-Craniofacial Journal最新文献

ObjectiveExplore barriers and prioritize supports that could increase breast milk feeding (BMF) rates.DesignSurvey study.SettingTertiary children's hospital.Patients, Participants204 mothers [102 with child with cleft palate (CP), 102 with child with intact palate], ages 0-3 years old.InterventionsSurvey questions about older sibling feeding history, maternal education, and breastfeeding/breast milk pumping experience.Main Outcome Measure(s)Differences in survey responses between groups; associations between socioeconomic (SES) proxies and BMF.ResultsMedian child age at survey completion was 17.7 months (range 9 days-3.9 years). Direct breastfeeding was less common in the group with CP (46.1% vs. 73.5%, P < .001), who were also more frequently advised against breastfeeding (34.0% vs. 10.9%, P < .001) and more often formula fed (94.1% vs. 85.3%, P = .04). Despite this, the control and CP groups had equal initiation of BMF (77.5%), with no significant difference in median duration (1.0 vs. 1.5 months). Sustained BMF to 6 months was seen in 23.1% of CP group and 28.9% of controls. In the CP group, postnatal counseling (odds ratio [OR] 21.8, P < .001), receiving a breast pump (OR 40.8, P < .001), family support (OR 7.44, P < .001), prior experience with BMF (OR 11.4, P < .001), and maternal education (OR 4.30, P = .006) increased the odds of BMF. Proxies of higher SES were associated with longer BMF in the CP group but not controls (all P < .02).ConclusionsTargeted supports for mothers of children with CP such as integrating early feeding specialists and education on pump retrieval are vital to decrease the barriers to sustained BMF.

A 6-day-old girl presented with bilateral macrostomia, micrognathia, and a complex cleft palate consisting of a midline submucous cleft, left lateral submucous cleft, and a right lateral cleft with partial soft-palate agenesis. Owing to Pierre Robin Sequence, surgery was deferred until airway stability. Bilateral macrostomia repair was performed at 12 months, followed by one-stage correction of all palatal clefts at 17 months using a right buccal myomucosal flap for oral lining. Rare clefts variably labeled as oblique clefts or soft-palate agenesis should be uniformly termed "lateral cleft palate."

ObjectiveTo evaluate the safety of immediate postoperative single-dose ketorolac after primary palatoplasty (PP) and assess its efficacy in reducing opioid use and improving other recovery metrics.DesignProspective cohort with historical controls.SettingTertiary pediatric hospital.Patients, ParticipantsTwo hundred forty-nine patients who underwent PP between 2009 and 2023.InterventionsFollowing institutional implementation of routine ketorolac use after PP, 124 patients who received an immediate postoperative single dose of IV ketorolac (median 0.5 mg/kg) were compared with 125 patients who did not receive ketorolac.Main Outcome MeasuresSafety outcomes included significant bleeding, supplemental oxygen requirements, and 30-day postoperative complications. Efficacy outcomes were assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, postoperative opioid use, time to first oral intake, and antiemetic use.ResultsNo significant differences were observed between groups regarding the minimal rates of postoperative bleeding, need for supplemental oxygen, or other adverse events. Postoperative FLACC scale was significantly lower in the ketorolac group during the first postoperative hour (adjusted difference: 0.54, 95% CI: 0.04-1.03, P = .033) and hours 1 to 3 (adjusted difference: 0.44, 95% CI: 0.02-0.85, P = .039). The ketorolac group also had lower total opioid use during hospitalization, earlier initiation of oral intake, and shorter length of stay, though these differences were not significant after multivariable adjustment.ConclusionsImmediate postoperative single-dose ketorolac after PP is associated with improved early postoperative pain control without increasing complication rates. Other observed potential benefits deserve further attention.

ObjectiveTo evaluate the validity, reliability, and usability of a newly digitized GOSLON Yardstick model set for unilateral cleft lip and palate (UCLP) outcome assessment. It was hypothesized that digital ratings would demonstrate reliability comparable to traditional plaster models and support consistent outcome comparisons across centers.DesignRetrospective secondary analysis of dental casts. Raters were blinded to patient and institutional identity. Calibration sessions were held prior to assessment. Reliability, workload, and usability were evaluated using validated instruments.SettingOne craniofacial center.ParticipantsThirty-eight Caucasian UCLP patients in mixed dentition, with primary surgical care at a single institution. Seven orthodontic residents (novices) and 5 craniofacial orthodontists (experts) completed all ratings.InterventionsPlaster casts were digitized using a 3Shape TRIOS scanner and uploaded to Sketchfab. Novices rated both formats across 2 sessions post-calibration. Experts completed 2 digital-only sessions after virtual calibration.Main Outcome MeasuresIntra- and inter-rater reliability (Cohen's kappa), GOSLON score distribution, task workload (NASA-TLX), and system usability (SUS).ResultsDigital GOSLON ratings showed moderate-to-high reliability (expert kappa: 0.82-0.86; novice: 0.75-0.81). No significant differences were found between plaster and digital scores for novices. Experts assigned more GOSLON 3 scores; novices assigned more GOSLON 4 (P < .001). Experts preferred digital models; novices preferred plaster. Workload and usability scores were acceptable across both groups.ConclusionsEven though calibration remains critical for novice raters, the Digital GOSLON is a reliable tool for outcomes assessment and may facilitate inter-center comparisons.

ObjectiveThis scoping review aimed to identify patient-reported outcome (PRO) and proxy-report outcome (ProxRO) measures administered to children under 8 years of age with cleft lip and/or palate (CL/P) and to describe the age at which proxy or self-report measures were used.DesignScoping ReviewSettingWhen children are unable to self-report, PROs and ProxROs can be used. The age at which proxy-report is appropriate has not been described in patients with CL/P.Patients, ParticipantsChildren born with CL/P.InterventionsOvid MEDLINE, EMBASE, PsycINFO, the Cochrane Register, and Web of Science were searched from inception until July 2024. Title and abstract screening, full text review, and data extraction were done independently in duplicate. Measures were categorized as PROs, ProxROs, or "MultiROs," where both caregivers and children responded. A narrative synthesis was performed to describe the identified measures.Main Outcome MeasuresPRO or ProxRO measures in children with CL/P less than 8 years old.ResultsOf 7001 publications identified, 57 studies met the inclusion criteria. Fifty-six measures were identified, of which 43 had at least 1 published psychometric property. Thirteen studies used ad hoc measures. Most measures were not condition-specific to CL/P. ProxROs were more commonly utilized than PROs. Parent-proxy tools were used from birth to 8 years, while self-report was used in patients as young as 3 years old.ConclusionsThere is a paucity of cleft-specific ProxRO measures that assess outcomes of cleft care in patients under 8 years of age. Work to develop and validate ProxRO measures for CL/P is needed.

IntroductionThe vomer flap is a versatile surgical technique used in cleft palate repair, primarily to reconstruct the nasal layer of the hard palate. Its implementation has gained renewed interest due to its anatomical advantages and potential for reducing postoperative complications, especially oronasal fistulas.ObjectiveThis narrative review aims to evaluate the historical evolution, technical variations, clinical indications, outcomes, and limitations of the vomer flap in both unilateral and bilateral cleft palate repair.MethodsA systematic literature search was conducted across PubMed, Embase, and Cochrane Library databases, including studies published from 1981 to April 2024. Articles were selected based on relevance to vomer flap use in cleft surgery, focusing on surgical outcomes, functional results, complication rates, and long-term effects on maxillary growth.ResultsThree main techniques were identified for unilateral clefts: cephalically based, caudally based, and open-book vomer flaps. For bilateral clefts, cephalically based and open-book configurations demonstrated superior anatomical adaptation and lower fistula rates compared to caudally based flaps. The vomer flap is particularly advantageous in early repairs and wide clefts, with evidence suggesting a minimal adverse effect on maxillary development. However, high variability in technique and outcome reporting limits comparability.ConclusionThe vomer flap remains a valuable tool in cleft palate repair, offering a balance between surgical efficacy and preservation of growth potential. It's appropriate application, based on cleft morphology and surgical objectives, can enhance functional and aesthetic outcomes. Further prospective studies are needed to standardize technique and validate long-term benefits.

ObjectiveTo evaluate skeletal outcomes of the Alt-RAMEC protocol with facemask therapy compared with conventional rapid maxillary expansion (RME) in patients with cleft lip and/or palate.DesignSystematic review and meta-analysis.SettingData from international databases (PubMed, Embase, Scopus, Web of Science, CENTRAL, clinical trials registers, and Google Scholar) were analyzed.Patients/ParticipantsFour studies involving approximately 136 patients with cleft lip and/or palate met inclusion criteria.InterventionsAlternate RME and Constriction (Alt-RAMEC) followed by facemask protraction versus conventional expansion protocols.Main Outcome Measure(s)Cephalometric skeletal parameters (SNA, SNB, and ANB) and maxillary advancement.ResultsAlt-RAMEC with facemask produced a greater increase in SNA compared with controls (SMD 1.04; 95% CI 0.60-1.49; I² = 0%), while SNB changes were non-significant. ANB changes were variable across studies (I² = 96%). Certainty of evidence was moderate for SNA and low for SNB.ConclusionsAlt-RAMEC combined with facemask therapy may yield greater anterior maxillary displacement in cleft lip and palate patients than conventional RME protocols, though evidence remains limited. Standardized multicenter studies with long-term follow-up are needed.

ObjectiveTo evaluate the incidence and characteristics of secondary synostosis following spring-mediated cranioplasty (SMC) for nonsyndromic sagittal craniosynostosis.DesignRetrospective cohort study.SettingSingle tertiary pediatric hospital.Patients/ParticipantsTen patients with isolated sagittal craniosynostosis who underwent primary SMC between 2021 and 2023. Patients with syndromic diagnoses or prior cranial surgery were excluded.InterventionsSMC was performed using 2 to 3 stainless-steel springs following sagittal strip craniectomy. Springs were typically removed 3 to 4 months postoperatively. Follow-up included review of clinical photographs, radiographs, and operative records.Main Outcome MeasuresChange in cephalic index (CI) from preoperative to postoperative assessment and occurrence of secondary suture fusion, particularly coronal synostosis.ResultsMean age at surgery was 4 months (range, 3-6 months). Mean CI improved from 68.5 to 79 following expansion. Three patients (30%) developed left unicoronal synostosis (UCS) during the perioperative period prior to spring removal. One patient required secondary coronal suturectomy for significant frontal asymmetry, while 2 were observed without intervention.ConclusionsSecondary synostosis, particularly UCS, may represent an underrecognized sequela of SMC. Altered biomechanical forces or asymmetric cranial remodeling during distraction may contribute to this finding. Larger, multicenter studies with longitudinal imaging are warranted to determine incidence, risk factors, and preventive strategies.

ObjectiveThis study compares perioperative outcomes of three operative approaches for metopic craniosynostosis: spring-assisted cranioplasty (SAC), strip craniectomy (SC), and fronto-orbital advancement (FOA).DesignRetrospective cohort study.SettingSingle-institution.PatientsPatients with metopic craniosynostosis treated 2021 to 2024.InterventionsSC, FOA, SAC.Main Outcome Measure(s)Perioperative data including blood loss, anesthesia duration, operative duration, hospital length of stay. For SAC, metrics for placement and removal were combined.ResultsSix patients underwent SAC, seven SC, and seven FOA at 4.77 (±1.22), 3.42 (±.46), and 11.38 (±3.65) months, respectively. FOA exhibited increased blood loss (median [IQR]; 200 mL [162.5, 250]), anesthesia time (328.86 min ±49.65) and operative time (230.86 min ±45.38) compared to SC (40 [20, 57.5]; P < .005; 153.29 ± 32.2; P < .001; 70.43 ± 20.11; P < .001) and SAC (50 [40,75]; P < .012; 254.17 ± 32.81; P < .012; 131 ± 24.5; P < .0010).ConclusionsSAC for metopic craniosynostosis has lower blood loss, shorter operative time, and shorter anesthesia time in comparison to FOA. Total hospital stay duration required for SAC (including spring placement and removal procedures) is similar to FOA and greater than SC. Perioperative metrics for SAC are favorable or comparable relative to current standard-of-care procedures.

ObjectiveThis systematic review and meta-analysis aim to evaluate the prevalence of dental anomalies in primary versus permanent dentition among individuals with non-syndromic cleft lip and palate (CLP) and to elucidate the differences in these anomalies between the two dentitions.MethodsA comprehensive literature search was conducted across PubMed, LILACS, Web of Science, EMBASE, and Scopus. Studies included were those assessing dental anomalies in patients with CLP, with data on both primary and permanent dentition. The review adhered to PRISMA guidelines and included data extraction, risk of bias assessment, and meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was utilized to evaluate the quality of evidence.ResultsSeven retrospective cohort studies met the inclusion criteria. The pooled prevalence of hyperdontia was higher in primary dentition (25%) compared to permanent dentition (12%), while hypodontia was more prevalent in permanent dentition (32%) than in primary dentition (12%). Patients with BCLP exhibited a greater prevalence of hypodontia in permanent dentition. Significant heterogeneity was observed across studies in terms of methodologies and sample sizes.ConclusionDental anomalies in patients with CLP differ between primary and permanent dentition, with hyperdontia being more prevalent in primary dentition and hypodontia in permanent dentition. Variations in prevalence and types of anomalies between patients with UCLP and BCLP highlight the need for standardized diagnostic protocols. Future research should address methodological inconsistencies to improve the robustness of findings.