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Buj-Acosta C, Paredes-Gallardo V, Montiel-Company JM, Albaladejo A, Bellot-Arcís C. Predictive validity of the GOSLON Yardstick index in patients with unilateral cleft lip and palate: A systematic review. PLoS One 2017; 12:e0178497. [PMID: 28570588 PMCID: PMC5453533 DOI: 10.1371/journal.pone.0178497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/14/2017] [Indexed: 12/02/2022] Open
Abstract
Among the various indices developed for measuring the results of treatment in patients born with unilateral cleft lip and palate (UCLP), the GOSLON Yardstick index is the most widely used to assess the efficacy of treatment and treatment outcomes, which in UCLP cases are closely linked to jaw growth. The aim of this study was to conduct a systematic review to validate the predictability of growth using the GOSLON Yardstick in patients born with UCLP. A systematic literature review was conducted in four Internet databases: Medline, Cochrane Library, Scopus and Embase, complemented by a manual search and a further search in the databases of the leading journals that focus on this topic. An electronic search was also conducted among grey literature. The search identified a total of 131 articles. Duplicated articles were excluded and after reading titles and abstracts, any articles not related to the research objective were excluded, leaving a total of 21 texts. After reading the complete text, only three articles fulfilled the inclusion criteria. The results showed a predictive validity of between 42.2% and 64.7%, which points to a lack of evidence in the literature for the predictive validity of the GOSLON Yardstick index used in children born with UCLP.
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Affiliation(s)
- Cindy Buj-Acosta
- Orthodontics Teaching Unit, Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Vanessa Paredes-Gallardo
- Orthodontics Teaching Unit, Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
- * E-mail:
| | - José María Montiel-Company
- Preventive Teaching Unit, Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Alberto Albaladejo
- Orthodontics Department, Faculty of Dentistry, University of Salamanca, Salamanca, Spain
| | - Carlos Bellot-Arcís
- Orthodontics Teaching Unit, Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Sitzman TJ, Hossain M, Carle AC, Heaton PC, Britto MT. Variation among cleft centres in the use of secondary surgery for children with cleft palate: a retrospective cohort study. BMJ Paediatr Open 2017; 1:e000063. [PMID: 29479567 PMCID: PMC5823530 DOI: 10.1136/bmjpo-2017-000063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To test whether cleft centres vary in their use of secondary cleft palate surgery, also known as revision palate surgery, and if so to identify modifiable hospital- and surgeon-factors that are associated with use of secondary surgery. DESIGN Retrospective cohort study. SETTING Forty-three paediatric hospitals across the United States. PATIENTS Children with cleft lip and palate who underwent primary cleft palate repair from 1999 to 2013. MAIN OUTCOME MEASURES Time from primary cleft palate repair to secondary palate surgery. RESULTS We identified 4,939 children who underwent primary cleft palate repair. At ten years after primary palate repair, 44% of children had undergone secondary palate surgery. Significant variation existed among hospitals (p<0.001); the proportion of children undergoing secondary surgery by 10 years ranged from 9% to 77% across hospitals. After adjusting for patient demographics, primary palate repair before nine months of age was associated with an increased hazard of secondary palate surgery (initial hazard ratio 6.74, 95% CI 5.30-8.73). Postoperative antibiotics, surgeon procedure volume, and hospital procedure volume were not associated with time to secondary surgery (p>0.05). Of the outcome variation attributable to hospitals and surgeons, between-hospital differences accounted for 59% (p<0.001), while between-surgeon differences accounted for 41% (p<0.001). CONCLUSIONS Substantial variation in the hazard of secondary palate surgery exists depending on a child's age at primary palate repair and the hospital and surgeon performing their repair. Performing primary palate repair before nine months of age substantially increases the hazard of secondary surgery. Further research is needed to identify other factors contributing to variation in palate surgery outcomes among hospitals and surgeons.
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Affiliation(s)
- Thomas J Sitzman
- Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,James M. Anderson for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Adam C Carle
- James M. Anderson for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Pamela C Heaton
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | - Maria T Britto
- James M. Anderson for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Tsangaris E, Wong Riff KW, Goodacre T, Forrest CR, Dreise M, Sykes J, de Chalain T, Harman K, O’Mahony A, Pusic AL, Thabane L, Thoma A, Klassen AF. Establishing Content Validity of the CLEFT-Q: A New Patient-reported Outcome Instrument for Cleft Lip/Palate. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1305. [PMID: 28507866 PMCID: PMC5426885 DOI: 10.1097/gox.0000000000001305] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 03/01/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The CLEFT-Q is a new patient-reported outcome instrument designed to measure outcomes that matter to patients. The aim of this qualitative study was to establish content validity of the CLEFT-Q in patients who differ by age and culture. METHODS Patients aged between 6 and 29 years were recruited from plastic surgery clinics in Canada, India, Ireland, the Philippines, the Netherlands and the United States. Healthcare providers and other experts participated in a focus group or provided individual feedback. Input was sought on all aspects of the CLEFT-Q (item wording, instructions, and response options), and to identify missing content. Patient interviews and expert feedback took place between September 2013 and September 2014. RESULTS Sixty-nine patients and 44 experts participated. The first draft of the CLEFT-Q consisted of 163 items measuring 12 constructs. The first round of feedback identified 92 items that required revision. In total, 3 rounds of interviews, and the involvement of an artist to create pictures for 17 items, were needed to establish content validity. At the conclusion of cognitive interviews, the CLEFT-Q consisted of 13 scales (total 171 items) that measure appearance, health-related quality of life, and facial function. The mean Flesch-Kincaid readability statistic for items was 1.4 (0 to 5.2). CONCLUSION Cognitive interviews and expert review allowed us to identify items that required re-wording, re-conceptualizing, or to be removed, as well as any missing items. This process was useful for refining the CLEFT-Q scales for further testing.
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Affiliation(s)
- Elena Tsangaris
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Karen W.Y. Wong Riff
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Tim Goodacre
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Christopher R. Forrest
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Marieke Dreise
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Sykes
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Tristan de Chalain
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Karen Harman
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Aisling O’Mahony
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea L. Pusic
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Anne F. Klassen
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Plastic Surgery, Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, United Kingdom; Department of Plastic Surgery, University of Groningen, Groningen, the Netherlands; Department of Otolaryngology/Facial Plastic Surgery, UC Davis Health System, Sacramento, Calif.; Auckland Plastic Surgical Centre, Auckland, New Zealand; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Cleft Orthodontic/Prosthodontic, St. James Hospital, Dublin, Ireland; Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.; Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada; and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Pietruski P, Majak M, Debski T, Antoszewski B. A novel computer system for the evaluation of nasolabial morphology, symmetry and aesthetics after cleft lip and palate treatment. Part 1: General concept and validation. J Craniomaxillofac Surg 2017; 45:491-504. [PMID: 28238558 DOI: 10.1016/j.jcms.2017.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The need for a widely accepted method suitable for a multicentre quantitative evaluation of facial aesthetics after surgical treatment of cleft lip and palate (CLP) has been emphasized for years. The aim of this study was to validate a novel computer system 'Analyse It Doc' (A.I.D.) as a tool for objective anthropometric analysis of the nasolabial region. MATERIALS AND METHODS An indirect anthropometric analysis of facial photographs was conducted with the A.I.D. system and Adobe Photoshop/ImageJ software. Intra-rater and inter-rater reliability and the time required for the analysis were estimated separately for each method and compared. RESULTS Analysis with A.I.D. system was nearly 10-fold faster than that with the reference evaluation method. The A.I.D. system provided strong inter-rater and intra-rater correlations for linear, angular and area measurements of the nasolabial region, as well as a significantly higher accuracy and reproducibility of angular measurements in submental view. No statistically significant inter-method differences were found for other measurements. CONCLUSIONS The hereby presented novel computer system is suitable for simple, time-efficient and reliable multicenter photogrammetric analyses of the nasolabial region in CLP patients and healthy subjects.
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Affiliation(s)
- Piotr Pietruski
- Department of Plastic and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland.
| | - Marcin Majak
- Department of Systems and Computer Networks, Faculty of Electronics, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Tomasz Debski
- Department of Plastic and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland
| | - Boguslaw Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Norbert Barlicki Memorial Hospital, Lodz, Poland
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Wong Riff KWY, Tsangaris E, Goodacre T, Forrest CR, Pusic AL, Cano SJ, Klassen AF. International multiphase mixed methods study protocol to develop a cross-cultural patient-reported outcome instrument for children and young adults with cleft lip and/or palate (CLEFT-Q). BMJ Open 2017; 7:e015467. [PMID: 28077415 PMCID: PMC5253569 DOI: 10.1136/bmjopen-2016-015467] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Patient-reported outcome (PRO) instruments should be developed according to rigorous guidelines in order to provide clinically meaningful, scientifically sound measurement. Understanding the methodology behind instrument development informs the selection of the most appropriate tool. This mixed methods protocol describes the development of an internationally applicable PRO instrument, the CLEFT-Q, for evaluating outcomes of treatment for cleft lip and/or palate (CL/P). METHODS AND ANALYSIS The study includes three main phases that occur iteratively and interactively. In phase I, we determine what concepts are important to patients regarding their outcome. A conceptual framework for the CLEFT-Q is formed through a systematic review and an extensive international qualitative study. The systematic review ascertains what concepts have previously been measured in patients with CL/P. The qualitative study employs interpretive description and involves in-depth interviews with patients in high-income and lower-middle income countries. Preliminary items are generated from the qualitative data. Preliminary scales are then created for each theme in the framework. Cognitive debriefing interviews and expert clinician input are used to refine the scales in an iterative process. In phase II, the preliminary scales are administered to a large international group of patients with CL/P. The modern psychometric method of Rasch Measurement Theory analysis is employed to define the measurement characteristics. The preliminary scales are shortened based on these results. In phase III, further tests assess reliability, validity and responsiveness of the instrument. ETHICS AND DISSEMINATION The study is approved by Research Ethics Boards for each participating site. Findings from this study will be published in open access peer-reviewed journals and presented at national and international conferences. Integrated knowledge translation is employed to engage stakeholders from the outset of the study. Successful execution of the CLEFT-Q will result in an internationally applicable PRO instrument for children and young adults with CL/P.
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Affiliation(s)
- Karen W Y Wong Riff
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Elena Tsangaris
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Tim Goodacre
- Spires Cleft Center, Oxford Radcliffe Children's Hospital, Oxford, UK
| | - Christopher R Forrest
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Andrea L Pusic
- Department of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Treatment outcome after neonatal cleft lip repair in 5-year-old children with unilateral cleft lip and palate. Int J Pediatr Otorhinolaryngol 2016; 87:71-7. [PMID: 27368446 DOI: 10.1016/j.ijporl.2016.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The aim of this study was to assess speech outcomes and dental arch relationship of 5-year-old Czech patients with unilateral cleft lip and palate (UCLP) who have undergone neonatal cleft lip repair and one-stage palatal closure. METHODS AND MATERIALS Twenty-three patients with UCLP, born between 2009 and 2010, were included in the study. Three universal speech parameters (hypernasality, articulation and speech intelligibility) have been devised for speech recordings evaluation. Outcomes of dental arch relationship were evaluated by applying the GOSLON Yardstick and subsequently compared with the GOSLON outcome of other cleft centers. RESULTS Moderate hypernasality was present in most cases, the mean value for articulation and speech intelligibility was 2.07 and 1.93, respectively. The Kappa values for inter-examiner agreement for all the three speech outcomes ranged from 0.786 to 0.808. Sixty-three percent of patients were scored GOSLON 1 and 2, 26% GOSLON 3, and 10% GOSLON 4. GOSLON mean score was 2.35. Interrater agreement was very good, represented by kappa value of 0.867. CONCLUSION The treatment protocol, involving neonatal cleft lip repair and one-stage palatal repair performed up to the first year of UCLP patient's life, has shown good speech outcomes and produced very good treatment results in regard to maxillary growth, comparable with other cleft centers.
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da Silva AFR, Dutka JDCR, Amaral AMPD, Périco MDS, Pegoraro-Krook MI. Size of Velopharyngeal Structures After Primary Palatoplasty. Cleft Palate Craniofac J 2016; 54:517-522. [PMID: 27427931 DOI: 10.1597/15-207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe and compare measures of velar length, velar thickness, and depth of the nasopharynx between two groups of patients with velopharyngeal dysfunction after primary palatoplasty: one received the modified Langenbeck procedure and the other the Furlow procedure. DESIGN Comparative study involving a convenience sample of videofluoroscopic films established prospectively. SETTING Surgeries and videofluoroscopic assessments were conducted at a craniofacial center. PARTICIPANTS Exams from 90 participants were used: 27 (30%) operated with Furlow and 63 (70%) with Langenbeck. Three speech-language pathologists (SLPs) traced the images of the velopharyngeal port to determine the measures of interest. RESULTS Intrajudge agreement for the SLPs ranged between 0.85 and 0.53, while interjudge agreement ranged between 0.44 and 0.51. The overall measure of velar length was significantly larger (P = .042) for the Furlow group (mean = 26.5) than the Langenbeck group (mean = 24.2 mm). There was no significant difference in velar thickness or depth of the nasopharynx between the two procedures. Although no significant difference was found between the current findings and Subtelny's norms for length, thickness, and depth, the patients presented with an overall depth:length ratio (0.89) significantly greater than Subtelny' ratio (P = .025). CONCLUSION The findings of this study confirmed the hypothesis that patients who underwent surgery with the Furlow technique may present with significantly longer velums than patients who underwent surgery with the Langenbeck procedure. Information regarding velopharyngeal morphology was predictive of velopharyngeal dysfunction for speech for 80% of the participants and can be useful in documenting outcome of treatment.
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Caballero M, Morse JC, Halevi AE, Emodi O, Pharaon MR, Wood JS, van Aalst JA. Juvenile Swine Surgical Alveolar Cleft Model to Test Novel Autologous Stem Cell Therapies. Tissue Eng Part C Methods 2016; 21:898-908. [PMID: 25837453 DOI: 10.1089/ten.tec.2014.0646] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Reconstruction of craniofacial congenital bone defects has historically relied on autologous bone grafts. Engineered bone using mesenchymal stem cells from the umbilical cord on electrospun nanomicrofiber scaffolds offers an alternative to current treatments. This preclinical study presents the development of a juvenile swine model with a surgically created maxillary cleft defect for future testing of tissue-engineered implants for bone generation. Five-week-old pigs (n=6) underwent surgically created maxillary (alveolar) defects to determine critical-sized defect and the quality of treatment outcomes with rib, iliac crest cancellous bone, and tissue-engineered scaffolds. Pigs were sacrificed at 1 month. Computed tomography scans were obtained at days 0 and 30, at the time of euthanasia. Histological evaluation was performed on newly formed bone within the surgical defect. A 1 cm surgically created defect healed with no treatment, the 2 cm defect did not heal. A subsequently created 1.7 cm defect, physiologically similar to a congenitally occurring alveolar cleft in humans, from the central incisor to the canine, similarly did not heal. Rib graft treatment did not incorporate into adjacent normal bone; cancellous bone and the tissue-engineered graft healed the critical-sized defect. This work establishes a juvenile swine alveolar cleft model with critical-sized defect approaching 1.7 cm. Both cancellous bone and tissue engineered graft generated bridging bone formation in the surgically created alveolar cleft defect.
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Affiliation(s)
- Montserrat Caballero
- 1 Plastic Surgery, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Justin C Morse
- 2 Plastic and Reconstructive Surgery, The University of North Carolina School of Medicine , Chapel Hill, North Carolina
| | | | - Omri Emodi
- 4 Oral and Maxillofacial Surgery, Rambam Medical Center , Haifa, Israel
| | - Michael R Pharaon
- 5 Plastic Surgery, Kapiolani Hospital for Women and Children , Honolulu, Hawaii
| | - Jeyhan S Wood
- 2 Plastic and Reconstructive Surgery, The University of North Carolina School of Medicine , Chapel Hill, North Carolina
| | - John A van Aalst
- 1 Plastic Surgery, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
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Stock NM, Humphries K, Pourcain BS, Bailey M, Persson M, Ho KM, Ring S, Marsh C, Albery L, Rumsey N, Sandy J. Opportunities and Challenges in Establishing a Cohort Study: An Example from Cleft Lip/Palate Research in the United Kingdom. Cleft Palate Craniofac J 2016; 53:317-25. [DOI: 10.1597/14-306] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Cleft lip and/or palate (CL/P) is one of the most common birth conditions in the world, but little is known about its causes. Professional opinion remains divided as to which treatments may be the most beneficial for patients with CL/P, and the factors that contribute to psychological adjustment are poorly understood. The use of different methodological approaches and tools plays a key role in hampering efforts to address discrepancies within the evidence base. A new UK-wide program of research, The Cleft Collective, was established to combat many of these methodological challenges and to address some of the key research questions important to all CL/P stakeholders. Objective To describe the establishment of CL/P cohort studies in the United Kingdom and to consider the many opportunities this resource will generate. Results To date, protocols have been developed and implemented within most UK cleft teams. Biological samples, environmental information, and data pertaining to parental psychological well-being and child development are being collected successfully. Recruitment is currently on track to meet the ambitious target of approximately 9800 individuals from just more than 3000 families. Conclusions The Cleft Collective cohort studies represent a significant step forward for research in the field of CL/P. The data collected will form a comprehensive resource of information about individuals with CL/P and their families. This resource will provide the basis for many future projects and collaborations, both in the United Kingdom and around the world.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Kerry Humphries
- Faculty of Medicine and Dentistry, University of Bristol, United Kingdom
| | - Beate St Pourcain
- Faculty of Medicine and Dentistry, University of Bristol, United Kingdom
| | - Maggie Bailey
- Faculty of Medicine and Dentistry, University of Bristol, United Kingdom
| | - Martin Persson
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Karen M. Ho
- Faculty of Medicine and Dentistry, University of Bristol, United Kingdom
| | - Susan Ring
- Faculty of Medicine and Dentistry, University of Bristol, United Kingdom
| | - Cathy Marsh
- Lead Speech and Language Therapist, South West Cleft Service, University Hospitals Bristol NHS Foundation Trust, United Kingdom
| | - Liz Albery
- Lead Speech and Language Therapist, South West Cleft Service, University Hospitals Bristol NHS Foundation Trust, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Jonathan Sandy
- Faculty of Medicine and Dentistry, University of Bristol, United Kingdom
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Basal View Reference Photographs for Nasolabial Appearance Rating in Unilateral Cleft Lip and Palate. J Craniofac Surg 2016; 26:1548-50. [PMID: 26163840 DOI: 10.1097/scs.0000000000001846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The Asher-McDade system is a 5-point ordinal scale frequently used to rate the components of nasolabial appearance, including nasal form and nasal symmetry, in unilateral cleft lip and palate. Although reference photographs illustrating this scale have been identified for the frontal and right profile view, no reference photographs exist for the basal view. The aim of this study was to identify reference photographs for nasal form and nasal symmetry from the basal view to illustrate this scale and facilitate its use. Four raters assessed nasolabial appearance (form and symmetry) on basal view photographs of 50 children (average age 8 years) with a repaired cleft lip. Intraclass correlation coefficients show fair to moderate inter-rater reliability. Cronbach α indicated strong agreement between raters (0.77 nasal form; 0.78 nasal symmetry; 0.80 overall), along with low duplicate measurement error and strong internal consistency between the measures. The photographs with the highest agreement among raters were selected to illustrate each point on the 5-point scale for nasal form and for nasal symmetry, resulting in the selection of 10 reference photographs. The basal view reference photograph set developed from this study may complement existing reference photograph sets for other views and facilitate rating tasks.
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Chapman KL, Baylis A, Trost-Cardamone J, Cordero KN, Dixon A, Dobbelsteyn C, Thurmes A, Wilson K, Harding-Bell A, Sweeney T, Stoddard G, Sell D. The Americleft Speech Project: A Training and Reliability Study. Cleft Palate Craniofac J 2016; 53:93-108. [PMID: 25531738 PMCID: PMC5693235 DOI: 10.1597/14-027] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the results of two reliability studies and to assess the effect of training on interrater reliability scores. DESIGN The first study (1) examined interrater and intrarater reliability scores (weighted and unweighted kappas) and (2) compared interrater reliability scores before and after training on the use of the Cleft Audit Protocol for Speech-Augmented (CAPS-A) with British English-speaking children. The second study examined interrater and intrarater reliability on a modified version of the CAPS-A (CAPS-A Americleft Modification) with American and Canadian English-speaking children. Finally, comparisons were made between the interrater and intrarater reliability scores obtained for Study 1 and Study 2. PARTICIPANTS The participants were speech-language pathologists from the Americleft Speech Project. RESULTS In Study 1, interrater reliability scores improved for 6 of the 13 parameters following training on the CAPS-A protocol. Comparison of the reliability results for the two studies indicated lower scores for Study 2 compared with Study 1. However, this appeared to be an artifact of the kappa statistic that occurred due to insufficient variability in the reliability samples for Study 2. When percent agreement scores were also calculated, the ratings appeared similar across Study 1 and Study 2. CONCLUSION The findings of this study suggested that improvements in interrater reliability could be obtained following a program of systematic training. However, improvements were not uniform across all parameters. Acceptable levels of reliability were achieved for those parameters most important for evaluation of velopharyngeal function.
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Overview of orthodontic care for children with cleft lip and palate, 1915-2015. Am J Orthod Dentofacial Orthop 2015; 148:543-56. [DOI: 10.1016/j.ajodo.2015.07.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 11/19/2022]
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Dissaux C, Bodin F, Grollemund B, Picard A, Vazquez MP, Morand B, James I, Kauffmann I, Bruant-Rodier C. Evaluation of 5-year-old children with complete cleft lip and palate: Multicenter study. Part 1: Lip and nose aesthetic results. J Craniomaxillofac Surg 2015; 43:2085-92. [PMID: 26515264 DOI: 10.1016/j.jcms.2015.08.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/07/2015] [Accepted: 08/26/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Cleft surgery is marked by all the controversies and the multiplication of protocols, as it has been shown by the Eurocleft study. The objective of this pilot study is to start a comparison and analyzing procedure between primary surgical protocols in French centers. METHODS Four French centers with different primary surgical protocols for cleft lip and palate repair, have accepted to be involved in this retrospective study. In each center, 20 consecutive patients with complete cleft lip and palate (10 UCLP and 10 BCLP per center), non syndromic, have been evaluated at a mean age of 5 [4,6]. In this first part, the aesthetic results of nose and lip repair were assessed based on the scale established by Mortier et al. (1997). RESULTS Considering nose outcome, primary cleft repair surgery including a nasal dissection gives a statistically significant benefit in terms of septum deviation. Considering lip result, muscular dehiscence rate is significantly higher in BCLP patients with a two-stage lip closure. The centers using Millard one-stage lip closure do not have uniform results. For UCLP patients, the quality of scar is not statistically different between Skoog and Millard techniques. CONCLUSIONS Primary results based on a simple, reproducible evaluation protocol. Extension to other centers required. LEVEL OF EVIDENCE Therapeutic study. Level III/retrospective multicenter comparative study.
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Affiliation(s)
- Caroline Dissaux
- Maxillofacial and Plastic Surgery Department (Head: Prof. C. Bruant-Rodier), Cleft Competence Center, Strasbourg University Hospital, 1 place de l'hôpital, 67091 Strasbourg, France.
| | - Frédéric Bodin
- Maxillofacial and Plastic Surgery Department (Head: Prof. C. Bruant-Rodier), Cleft Competence Center, Strasbourg University Hospital, 1 place de l'hôpital, 67091 Strasbourg, France
| | - Bruno Grollemund
- Maxillofacial and Plastic Surgery Department (Head: Prof. C. Bruant-Rodier), Cleft Competence Center, Strasbourg University Hospital, 1 place de l'hôpital, 67091 Strasbourg, France
| | - Arnaud Picard
- Paediatric Maxillofacial and Plastic Surgery Department, French Cleft Reference Center, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - Marie-Paule Vazquez
- Paediatric Maxillofacial and Plastic Surgery Department, French Cleft Reference Center, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - Béatrice Morand
- Maxillofacial and Plastic Surgery Department, Cleft Competence Center, Grenoble University Hospital, Hôpital Michallon, Boulevard de la Chantourne, 38043 Grenoble, France
| | - Isabelle James
- Paediatric Plastic Surgery Department, Cleft Competence Center, Clinique du Val d'Ouest, 39 chemin de la Vernique, 69130 Ecully (Lyon), France
| | - Isabelle Kauffmann
- Maxillofacial and Plastic Surgery Department (Head: Prof. C. Bruant-Rodier), Cleft Competence Center, Strasbourg University Hospital, 1 place de l'hôpital, 67091 Strasbourg, France
| | - Catherine Bruant-Rodier
- Maxillofacial and Plastic Surgery Department (Head: Prof. C. Bruant-Rodier), Cleft Competence Center, Strasbourg University Hospital, 1 place de l'hôpital, 67091 Strasbourg, France
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The Americleft Project: Burden of Care from Secondary Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e442. [PMID: 26301131 PMCID: PMC4527616 DOI: 10.1097/gox.0000000000000415] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/08/2015] [Indexed: 11/25/2022]
Abstract
Background: The burden of care for children with cleft lip and palate extends beyond primary repair. Children may undergo multiple secondary surgeries to improve appearance or speech. The purpose of this study was to compare the use of secondary surgery between cleft centers. Methods: This retrospective cohort study included 130 children with complete unilateral cleft lip and palate treated consecutively at 4 cleft centers in North America. Data were collected on all lip, palate, and nasal surgeries. Nasolabial appearance was rated by a panel of judges using the Asher-McDade scale. Risk of secondary surgery was compared between centers using the log-rank test, and hazard ratios estimated with a Cox proportional hazards model. Results: Median follow-up was 18 years (interquartile range, 15–19). There were significant differences among centers in the risks of secondary lip surgery (P < 0.001) and secondary rhinoplasty (P < 0.001). The cumulative risk of secondary lip surgery by 10 years of age ranged from 5% to 60% among centers. The cumulative risk of secondary rhinoplasty by 20 years of age ranged from 47% to 79% among centers. No significant differences in nasolabial appearance were found between children who underwent secondary lip or nasal surgery and children who underwent only primary surgery (P > 0.10). Conclusions: Although some cleft centers were significantly more likely to perform secondary surgery, the use of secondary surgery did not achieve significantly better nasolabial appearance than what was achieved by children who underwent only primary surgery.
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Stebel A, Desmedt D, Bronkhorst E, Kuijpers MA, Fudalej PS. Rating nasolabial appearance on three-dimensional images in cleft lip and palate: a comparison with standard photographs. Eur J Orthod 2015; 38:197-201. [PMID: 25900054 DOI: 10.1093/ejo/cjv024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND/OBJECTIVE Judgement of nasolabial aesthetics in cleft lip and palate (CLP) is a vital component of assessment of treatment outcome. It is usually performed based on two-dimensional (2D) facial photographs. An increasing use of three-dimensional (3D) imaging warrants an assessment if 3D images can substitute 2D photographs during aesthetic evaluation. The aim of this study was to compare reliability of rating nasolabial appearance on 3D images and standard 2D photographs in prepubertal children. METHODS Forty subjects (age: 8.8-12) with unilateral CLP treated according to a standardized protocol, who had 2D and 3D facial images were selected. Eight lay raters assessed nasal form, nasal deviation, vermilion border, and nasolabial profile on cropped 2D and 3D images using a 100-mm visual analogue scale (VAS). Additionally, raters answer two questions: 1. Do 2D or 3D images provide more information on nasolabial aesthetics? and 2. Is aesthetic evaluation easier on 2D or 3D images? RESULTS Intrarater agreement demonstrated a better reliability of ratings performed on 3D images than 2D images (correlation coefficients for 3D images ranged from 0.733 to 0.857; for 2D images from 0.151 to 0.611). The mean scores showed, however, no difference between 2D and 3D formats (>0.05). 3D images were regarded more informative than 2D images (P = 0.001) but probably more difficult to evaluate (P = 0.06). LIMITATIONS Basal view of the nose was not assessed. CONCLUSIONS 3D images seem better than 2D images for rating nasolabial aesthetics but raters should familiarize themselves with them prior to rating.
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Affiliation(s)
- Adam Stebel
- Division of Maxillofacial Surgery, Department of Stomatology and Maxillofacial Surgery, Comenius University, Bratislava, Slovakia, Departments of
| | | | - Ewald Bronkhorst
- Community and Restorative Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Piotr S Fudalej
- Department of Orthodontics, Palacky University, Olomouc, Czech Republic, and *****Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
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Suzuki A, Sasaguri M, Hiura K, Yasunaga A, Mitsuyasu T, Kubota Y, Ninomiya T, Takenoshita Y. Can Occlusal Evaluation of Children with Unilateral Cleft Lip and Palate Help Determine Future Maxillofacial Morphology? Cleft Palate Craniofac J 2014; 51:696-706. [DOI: 10.1597/12-103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the change in occlusal evaluations from the 5-year-olds' index to the Goslon Yardstick and to compare the relationship between the evaluations and maxillofacial growth in patients with complete unilateral cleft lip and palate (UCLP). Design A prospective longitudinal study. Subjects The sample consisted of 85 patients with complete UCLP who underwent surgery from 1969 to 1994 and were treated at the Kyushu University Hospital in Fukuoka, Japan. Subjects had two serial dental casts performed at the ages of 5 and 10 years. Furthermore, each patient had lateral cephalographs taken at the age of 5 years, 76 of 85 subjects had films taken at the age of 10 years, and 54 subjects also had lateral cephalograms taken after the age of 15 years. Methods Every dental cast was evaluated by the 5-year-olds' index and the Goslon Yardstick, respectively. The lateral cephalographs were traced and digitized, and angular dimensions were calculated. Outcomes were compared using Spearman's rank-order correlation analysis and the Kruskal-Wallis analysis. Results and Conclusion Dental arch relationships were evaluated and rated as 2.96 in the 5-year-olds' index and 2.85 in the Goslon Yardstick, respectively. Both groupings showed a significant relationship, and they showed no change in 36 out of 85 subjects (42.3%), significant improvement in 30 (35.3%), and deterioration in 19 (22.3%). Two occlusal groupings and maxillofacial morphology on the cephalographs indicated that the grouping reflected the anteroposterior position of the mandible. Moreover, both groupings showed some relation to previous maxillofacial growth, but they did not show any relationship with future growth. The Goslon Yardstick may not predict maxillofacial morphology in adulthood.
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Affiliation(s)
- Akira Suzuki
- Department of Orthodontics, Kyushu University Hospital, Fukuoka, Japan
| | - Masaaki Sasaguri
- Department of Oral and Maxillofacial Surgery, Kyushu University, Fukuoka, Japan
| | | | - Atsushi Yasunaga
- Department of Orthodontics, Kyushu University Hospital, Fukuoka, Japan
| | - Takeshi Mitsuyasu
- Department of Oral and Maxillofacial Surgery, Kyushu University, Fukuoka, Japan
| | - Yasutaka Kubota
- Department of Oral and Maxillofacial Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Tomohiro Ninomiya
- Department of Oral and Maxillofacial Surgery, Kyushu University, Fukuoka, Japan
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Wang KH, Heike CL, Clarkson MD, Mejino JLV, Brinkley JF, Tse RW, Birgfeld CB, Fitzsimons DA, Cox TC. Evaluation and integration of disparate classification systems for clefts of the lip. Front Physiol 2014; 5:163. [PMID: 24860508 PMCID: PMC4030199 DOI: 10.3389/fphys.2014.00163] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/09/2014] [Indexed: 12/15/2022] Open
Abstract
Orofacial clefting is a common birth defect with wide phenotypic variability. Many systems have been developed to classify cleft patterns to facilitate diagnosis, management, surgical treatment, and research. In this review, we examine the rationale for different existing classification schemes and determine their inter-relationships, as well as strengths and deficiencies for subclassification of clefts of the lip. The various systems differ in how they describe and define attributes of cleft lip (CL) phenotypes. Application and analysis of the CL classifications reveal discrepancies that may result in errors when comparing studies that use different systems. These inconsistencies in terminology, variable levels of subclassification, and ambiguity in some descriptions may confound analyses and impede further research aimed at understanding the genetics and etiology of clefts, development of effective treatment options for patients, as well as cross-institutional comparisons of outcome measures. Identification and reconciliation of discrepancies among existing systems is the first step toward creating a common standard to allow for a more explicit interpretation that will ultimately lead to a better understanding of the causes and manifestations of phenotypic variations in clefting.
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Affiliation(s)
- Kathie H Wang
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute Seattle, WA, USA
| | - Carrie L Heike
- Center for Clinical and Translational Sciences, Seattle Children's Research Institute Seattle, WA, USA ; Seattle Children's Craniofacial Center Seattle, WA, USA ; Department of Pediatrics (Division of Craniofacial Medicine), University of Washington Seattle, WA, USA
| | - Melissa D Clarkson
- Department of Biological Structure (Structural Informatics Group), University of Washington Seattle, WA, USA ; Department of Biomedical Informatics and Medical Education, University of Washington Seattle, WA, USA
| | - Jose L V Mejino
- Department of Biological Structure (Structural Informatics Group), University of Washington Seattle, WA, USA
| | - James F Brinkley
- Department of Biological Structure (Structural Informatics Group), University of Washington Seattle, WA, USA ; Department of Biomedical Informatics and Medical Education, University of Washington Seattle, WA, USA
| | - Raymond W Tse
- Seattle Children's Craniofacial Center Seattle, WA, USA
| | | | - David A Fitzsimons
- Faculty of Medicine, The Cleft Palate Clinic, The Children's Hospital at Westmead, and Discipline of Paediatrics and Child Health, University of Sydney Sydney, NSW, Australia
| | - Timothy C Cox
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute Seattle, WA, USA ; Seattle Children's Craniofacial Center Seattle, WA, USA ; Department of Pediatrics (Division of Craniofacial Medicine), University of Washington Seattle, WA, USA ; Department of Anatomy and Developmental Biology, Monash University Clayton, VIC, Australia
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Kuijpers MAR, Chiu YT, Nada RM, Carels CEL, Fudalej PS. Three-dimensional imaging methods for quantitative analysis of facial soft tissues and skeletal morphology in patients with orofacial clefts: a systematic review. PLoS One 2014; 9:e93442. [PMID: 24710215 PMCID: PMC3977868 DOI: 10.1371/journal.pone.0093442] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/04/2014] [Indexed: 01/11/2023] Open
Abstract
Background Current guidelines for evaluating cleft palate treatments are mostly based on two-dimensional (2D) evaluation, but three-dimensional (3D) imaging methods to assess treatment outcome are steadily rising. Objective To identify 3D imaging methods for quantitative assessment of soft tissue and skeletal morphology in patients with cleft lip and palate. Data sources Literature was searched using PubMed (1948–2012), EMBASE (1980–2012), Scopus (2004–2012), Web of Science (1945–2012), and the Cochrane Library. The last search was performed September 30, 2012. Reference lists were hand searched for potentially eligible studies. There was no language restriction. Study selection We included publications using 3D imaging techniques to assess facial soft tissue or skeletal morphology in patients older than 5 years with a cleft lip with/or without cleft palate. We reviewed studies involving the facial region when at least 10 subjects in the sample size had at least one cleft type. Only primary publications were included. Data extraction Independent extraction of data and quality assessments were performed by two observers. Results Five hundred full text publications were retrieved, 144 met the inclusion criteria, with 63 high quality studies. There were differences in study designs, topics studied, patient characteristics, and success measurements; therefore, only a systematic review could be conducted. Main 3D-techniques that are used in cleft lip and palate patients are CT, CBCT, MRI, stereophotogrammetry, and laser surface scanning. These techniques are mainly used for soft tissue analysis, evaluation of bone grafting, and changes in the craniofacial skeleton. Digital dental casts are used to evaluate treatment and changes over time. Conclusion Available evidence implies that 3D imaging methods can be used for documentation of CLP patients. No data are available yet showing that 3D methods are more informative than conventional 2D methods. Further research is warranted to elucidate it. Systematic review registration International Prospective Register of Systematic Reviews, PROSPERO CRD42012002041
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Affiliation(s)
- Mette A. R. Kuijpers
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Cleft Palate Craniofacial Unit, Radboud University Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| | - Yu-Ting Chiu
- Department of Dentistry and Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Rania M. Nada
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carine E. L. Carels
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Cleft Palate Craniofacial Unit, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Piotr S. Fudalej
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern Switzerland
- Department of Orthodontics, Palacky University Olomouc, Olomouc, Czech Republic
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Sitzman TJ, Allori AC, Thorburn G. Measuring Outcomes in Cleft Lip and Palate Treatment. Clin Plast Surg 2014; 41:311-9. [DOI: 10.1016/j.cps.2013.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Heike CL, Hing AV, Aspinall CA, Bartlett SP, Birgfeld CB, Drake AF, Pimenta LA, Sie KC, Urata MM, Vivaldi D, Luquetti DV. Clinical care in craniofacial microsomia: a review of current management recommendations and opportunities to advance research. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2013; 163C:271-82. [PMID: 24132932 DOI: 10.1002/ajmg.c.31373] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Craniofacial microsomia (CFM) is a complex condition associated with microtia, mandibular hypoplasia, and preauricular tags. It is the second most common congenital facial condition treated in many craniofacial centers and requires longitudinal multidisciplinary patient care. The purpose of this article is to summarize current recommendations for clinical management and discuss opportunities to advance clinical research in CFM.
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MELLO BZF, FERNANDES VM, CARRARA CFC, MACHADO MAAM, GARIB DG, OLIVEIRA TM. Evaluation of the intercanine distance in newborns with cleft lip and palate using 3D digital casts. J Appl Oral Sci 2013; 21:437-42. [PMID: 24212990 PMCID: PMC3881848 DOI: 10.1590/1679-775720130091] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 05/26/2013] [Accepted: 08/13/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this present study was to compare, by means of 3D digital casts, the anterior transverse dimension of the dental arch of newborns with and without cleft lip and palate. MATERIAL AND METHODS The sample was composed of ninety-four children aged from 3 to 9 months divided into three study groups: Group I - children without craniofacial deformities (control group); Group II - children with unilateral cleft lip and palate; Group III - children with bilateral cleft lip and palate. Impressions were executed before lip and palate repair in patients with clefts. Dental casts were digitized using a 3D scanner linked to a computer. Measurements of the intercanine distance were measured on the digital casts. Intergroup comparisons were performed using ANOVA (p<0.05). RESULTS The results showed a mean of 36.5 mm for unilateral cleft lip and palate group, 34.8 mm for bilateral cleft lip and palate group and 27.52 mm for the control group. There was a statistically significant difference between the control group and both groups of patients with cleft lip and palate. There was no statistically significant difference between complete unilateral and bilateral cleft lip and palate groups. CONCLUSIONS Patients with complete cleft lip and palate were born with an increased anterior dimension of the maxillary dental arch compared to non cleft patients.
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Affiliation(s)
| | - Viviane Mendes FERNANDES
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São
Paulo, Bauru, SP, Brazil
| | | | | | - Daniela Gamba GARIB
- Department of Pediatric Dentistry, Orthodontics and Community Health,
Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies,
University of São Paulo, Bauru, SP, Brazil
| | - Thais Marchini OLIVEIRA
- Department of Pediatric Dentistry, Orthodontics and Community Health,
Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies,
University of São Paulo, Bauru, SP, Brazil
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Koželj V, Vegnuti M, Drevenšek M, Hortis-Dzierzbicka M, Gonzalez-Landa G, Hanstein S, Klimova I, Kobus K, Kobus-Zaleśna K, Semb G, Shaw B. Palate Dimensions in Six-Year-Old Children with Unilateral Cleft Lip and Palate: A Six-Center Study on Dental Casts. Cleft Palate Craniofac J 2012; 49:672-82. [DOI: 10.1597/10-190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To compare palatal dimensions in 6-year-old children with unilateral cleft lip and palate (UCLP) treated by different protocols with those of noncleft children. Design Retrospective intercenter outcome study. Patients Upper dental casts from 129 children with repaired UCLP and 30 controls were analyzed by the trigonometric method. Setting Six European cleft centers. Main outcome measures Sagittal, transverse, and vertical dimensions of the palate were observed. Statistics Palate variables were analyzed with descriptive methods and nonparametric tests. Regarding several various characteristics measured on a relatively small number of subjects, hierarchical, k-means clustering, and principal component analyses were used. Results Mean values of the observed dimensions for five cleft groups differed significantly from the control (p < .05). The group with one-stage closure of the cleft differed significantly from all other cleft groups in most variables (p < .05). Principal component analysis of all 159 cases identified three clusters with specific morphologic characteristics of the palate. A similar number of treated children were classified into each cluster, while all children without clefts were classified in the same cluster. The percentage of treated children from a particular group that fit this cluster ranged from 0% to 70% and increased with age at palatal closure and number of primary surgical procedures. Conclusion At 6 years of age, children with stepwise repair and hard palate closure after the age of two more frequently result in palatal dimensions of noncleft control than children with earlier palatal closure and one-stage cleft repair.
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Affiliation(s)
- Vesna Koželj
- Oral and Maxillofacial Surgery, Head of Cleft Center, Department of Maxillofacial and Oral Surgery, University Hospital, Medical Faculty, University of Ljubljana, Slovenia
| | | | - Martina Drevenšek
- Head of Orthodontic Unite, University Dental Clinic, Medical Faculty of Ljubljana, Slovenia
| | | | | | - Siiri Hanstein
- Department of Maxillofacial Surgery, North Estonia Regional Hospital, Tallinn, Estonia
| | | | | | | | - Gunvor Semb
- Craniofacial Anomalies, School of Dentistry, University of Manchester, United Kingdom, is affiliated with the Oslo Cleft Team, Department of Plastic Surgery, National Hospital, Dental Faculty, University of Oslo, Oslo
| | - Bill Shaw
- School of Dentistry, University of Manchester, Manchester, United Kingdom
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Papadopoulos MA, Koumpridou EN, Vakalis ML, Papageorgiou SN. Effectiveness of pre-surgical infant orthopedic treatment for cleft lip and palate patients: a systematic review and meta-analysis. Orthod Craniofac Res 2012; 15:207-36. [DOI: 10.1111/j.1601-6343.2012.01552.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
BACKGROUND This study was undertaken to determine contemporary surgical management of bilateral cleft lip. METHODS A survey was sent to North American cleft surgeons. Variables included number of bilateral cleft lip repairs per year, surgical specialty, and methods of nasolabial correction. The authors analyzed possible relationships between surgical specialty/volume and operative techniques. RESULTS The response rate was 40 percent (241 of 600). Annual bilateral nasolabial repairs per surgeon were as follows: zero to two, 30 percent; three to five, 46 percent; and six or more, 25 percent. For bilateral complete cleft lip, dentofacial orthopedics was used by 71 percent of respondents; synchronous closure was most commonly performed (88 percent); infrequent techniques were preliminary labial adhesions (11 percent) and staged labial closure (1 percent); and 50 percent undertook primary nasal repair. One half of respondents used nostril splinting following primary or secondary nasal correction. For bilateral incomplete cleft lip, 90 percent of surgeons performed synchronous labial repair and 36 percent did primary nasal correction. For both complete and incomplete bilateral cleft lips, high-volume surgeons were more likely to excise prolabial vermilion and use lateral vermilion-mucosal flaps to form the median tubercle. For bilateral asymmetrical cleft lip, 85 percent of surgeons practiced synchronous labial repair and 54 percent used dentofacial orthopedics on the complete side. CONCLUSIONS Synchronous repair was the most frequent method for bilateral cleft lip; one-half of surgeons practiced primary nasal correction. There were no associations between surgical specialty/volume and operative principles or techniques for bilateral nasolabial repair, except for construction of the median tubercle.
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Dogan S, Semb G, Erbay E, Alcan T, Uzel A, Kocadereli I, Shaw WC. Dental arch relationships in Turkish patients with complete unilateral cleft lip and palate born between 1976 and 1990: a comparison with eurocleft. Cleft Palate Craniofac J 2012; 51:70-5. [PMID: 22849640 DOI: 10.1597/11-304r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the dental arch relationships of Turkish patients with complete unilateral cleft lip and palate (UCLP) with the results reported for participants in the Eurocleft study. PATIENTS Study models of 109 patients with complete UCLP from five university clinics in Turkey were evaluated (clinic A = 25 patients, clinic B = 23 patients, clinic C = 20 patients, clinic D = 21 patients, and clinic E = 20 patients). The mean age of the patient cohort was nine years old (range = 8-11 years old), and the cohort was born between 1976 and 1990. METHODS The examiners rated the three-dimensional (3D) models using the GOSLON Yardstick. The scores were compared with those from the Eurocleft centers: E1(B), E2(E), E3(A), E4(F), E5(C), and E6(D). Intra- and interexaminer agreements were evaluated using weighted kappa statistics. RESULTS The mean GOSLON scores for the Turkish clinics were as follows: clinic A = 3.16, clinic B = 3.13, clinic C = 3.25, clinic D = 3.67, and clinic E = 3.70. Scores for three of the Turkish clinics (A, B, and C) were significantly worse than the scores for the three best Eurocleft centers, E1(B), E2(E), and E3(A) (P < .001, P < .001, and P < .05, respectively). Scores for two of the Turkish clinics (D and E) were similar to those for Eurocleft center E6(D) but worse than the scores for the other Eurocleft centers (P < .01, P < .001, respectively). CONCLUSIONS This was the first study in which three-dimensional models were used to derive scores to compare with those of the Eurocleft centers. According to the results of analysis of 109 3D models, 50.4 % of the patients in Turkey were classified as GOSLON score 4 and 5. This may have been attributable to poor surgical procedures, low-volume surgeons, and the decentralized treatment approach in Turkey between 1985 and 2000. Further research is needed to assess the situation in Turkey in more recent years.
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