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Denadai R, Seo HJ, Go Pascasio DC, Sato N, Murali S, Lo CC, Chou PY, Lo LJ. Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible? Cleft Palate Craniofac J 2024; 61:247-257. [PMID: 36066016 DOI: 10.1177/10556656221123917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE An inspiring early result with no oronasal fistula formation was recently described for a modified medial incision small double-opposing Z-plasty (MIsDOZ) for treating Veau type I cleft palate. This study describes an early single-surgeon experience in applying this newly proposed surgical approach. DESIGN Retrospective single-surgeon study. PATIENTS Consecutive nonsyndromic patients (n = 27) with Veau I cleft palate. INTERVENTIONS Topographic anatomical-guided MIsDOZ palatoplasty with pyramidal space dissection (releasing of the ligamentous fibers in the greater palatine neurovascular bundle and pyramidal process region, in-fracture of the pterygoid hamulus, and widening of space of Ernst) performed by a novice surgeon (RD). MEAN OUTCOME MEASURES Age at surgery, the presence of cleft lip, palatal cleft width, use of lateral relaxing incision, and 6-month complication rate (bleeding, dehiscence, fistula, and flap necrosis). A published senior surgeon-based outcome dataset (n = 24) was retrieved for comparison purposes. RESULTS Twenty-two (81.5%) and 5 (18.5%) patients received the medial incision only technique and lateral incision technique, respectively (P = .002). Age, presence of cleft lip, and cleft width were not associated (all P > .05) with the use of lateral incision. Comparative analysis between the novice surgeon- and senior surgeon-based datasets revealed no significant differences for sex (females: 74.1% vs 62.5%; P = .546), age (10.2 ± 1.7 vs 9.6 ± 1.2 months; P = .143), rate of lateral incision (18.5% vs 4.2%; P = .195), and postoperative complication rate (0% vs 0%). CONCLUSION This modified DOZ palatoplasty proved to be a reproducible procedure for Veau I cleft palate closure, with reduced need for lateral incision and with no early complication.
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Affiliation(s)
- Rafael Denadai
- Plastic and Cleft-Craniofacial Surgery, A&D DermePlastique, Sao Paulo, Brazil
| | - Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dax Carlo Go Pascasio
- Section of Plastic and Reconstructive Surgery, Southern Philippines Medical Center, Davao, Philippines
| | - Nobuhiro Sato
- Department of Plastic and Reconstructive Surgery, Showa University Hospital, Tokyo, Japan
| | - Srinisha Murali
- Oral and Maxillofacial Surgery, Kumaran Clinic and Nursing Home Trichy, Tamil Nadu, India
| | - Chi-Chin Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Pang-Yung Chou
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Torres PTIC, Luisa MSPPM, Peralta PPEC, Robertson PJP, Montalva MDFM, Figueroa DDSÁA, Mejía DDSML, Moreno MDAS, Martínez MSMD, Aguilera MDA, Arreguín MDJC, Dosal MDMRP, Saavedra MSMDLPA, Granados MSA. Developing core outcome set for anthropometric evaluation for presurgical infant orthopedics for unilateral cleft lip and palate: e- Delphi consensus. J Plast Reconstr Aesthet Surg 2022; 75:3795-3803. [DOI: 10.1016/j.bjps.2022.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 04/11/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
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Chonnapasatid W, Viwattanatipa N, Manopatanakul S, Jaruratanasirikul S. Thai Universal Health Care Coverage scheme promotes the accessibility to cleft lip/palate treatment: the result of cleft care provision assessment using modified Geographic Information System. BMC Health Serv Res 2022; 22:416. [PMID: 35351111 PMCID: PMC8966314 DOI: 10.1186/s12913-022-07784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study assessed the cleft lip/palate (CL/P) healthcare provision using data from the Thailand National Health Security Office from fiscal years 2012-2016. METHODS Four national databases of Thailand comprising 1) admitted patient visit, 2) non-admitted patient visit, 3) birth defects registry and 4) civil registration databases were analyzed. All duplicate records were removed by a matching process using national identity number and date of birth prior to data extraction. Modified Geographic Information System was also used to compare each provincial patients with CL/P of Thailand to the number of provincial live births with CL/P. RESULTS The results showed that the number of live births with CL/P during this period was 7,775 cases (1,555 cases/fiscal year). While the number of cases with CL/P registered under the Universal Health Care Coverage with hospital stay was 6,715 (86.37%), 927 cases (11.92%) visited hospitals without a stay, and the remaining 133 cases (1.71%) never visited any hospital. Modified Geographic Information System result showed that the provincial CL/P healthcare was relatively well-balanced with the provincial live births with CL/P (r = 0.92, p < 0.05). Moreover, provinces with CL/P tertiary care centers attracted more patients from the surrounding provinces. CONCLUSION This study showed that the percentage of patients with CL/P receiving hospital treatment was 98. The Thai Universal Health Care Coverage scheme has promoted the accessibility to CL/P treatment. In order to achieve the best possible comprehensive cleft care coverage, periodical assessment and improvement of the function and accuracy of the national database registry are recommended.
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Affiliation(s)
- Wannapong Chonnapasatid
- Samutprakan Provincial Public Health Office, Mueang Samutprakan District, 20 Phoem Toem 2 Alley, Samutprakan, 10270, Thailand
| | - Nita Viwattanatipa
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, 6 Yothi Street, Ratchthewi, Bangkok, 10400, Thailand
| | - Somchai Manopatanakul
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, 6 Yothi Street, Ratchthewi, Bangkok, 10400, Thailand.
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Lips and noses in 10-year old patients with repaired complete unilateral clefts of lip, alveolus, and palate. A prospective three-centre study of the Baltic Cleft Network. J Craniomaxillofac Surg 2021; 50:246-253. [PMID: 34961665 DOI: 10.1016/j.jcms.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/06/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022] Open
Abstract
This multicenter study aimed at comparing different techniques of lip and nose repair with or without NAM and primary anterior rhinoplasty in pre-adolescent children. Patients with unilateral clefts of lip, alveolus, and palate who had undergone cleft lip and nose repair were evaluated in a prospective three-centre study using standardized monochromatic, cropped photographs. Four cleft surgeons evaluated the aesthetics of the central part of the face when the patients had reached age ten years. Seventy-six sets of photographs out of 87 patients were evaluated. The overall ratings of lips and noses did not differ much between centres. However, noses of centres 1 (mean 0.74; SD 0.57) and 2 (mean 0.76; SD 0.60) had been rated better than centre 3 (mean 1.32; SD 0.78; p = 0.0078), especially "Deformation of upper part of nostril rim or poor position of alar cartilage". Centre 3 had produced better looking scars (mean 0.33; SD 0.48); p = 0.0036. Within the limitations of the study it seems that NAM and primary anterior rhinoplasty including postoperative nasal stents should be performed whenever possible in order to achieve a favorable shape of the nose and to reduce the need for secondary corrective surgery.
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Alighieri C, Bettens K, Bruneel L, D'haeseleer E, Van Gaever E, Van Lierde K. Reliability of Outcome Measures to Assess Consonant Proficiency Following Cleft Palate Speech Intervention: The Percentage of Consonants Correct Metric and the Probe Scoring System. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1811-1828. [PMID: 33970671 DOI: 10.1044/2021_jslhr-20-00628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This study compared the inter- and intrarater reliability of the percentage of consonants correct (PCC) metrics and the probe scoring system between an experienced and a less experienced rater and between two experienced raters. In addition, these outcome measures' ability to reflect changes following speech intervention was measured. Method During Phase 1, two raters (Rater 1 with 5 years of experience in cleft-related speech disorders and Rater 2 with limited experience in cleft-related speech disorders) independently assessed 134 speech samples at the word and sentence levels, which were collected on different data points before, during, and following a cleft palate speech intervention. During Phase 2, a third rater (with 8 years of experience) analyzed 34 speech samples. The percentage of consonants correct-revised, the percentage of correct places and manners, and probe scores at the word and sentence levels were measured. Results Poor-to-moderate interreliability between Raters 1 and 2 was found due to differences in error classification. Interrater reliability between Raters 1 and 3 was very good for both the PCC metrics and the probe scores. The interrater reliability for the amount of targets elicited was lower compared to the interrater reliability for the amount of targets correct. The probe scoring system demonstrated a greater ability to detect changes toward the correct production of the target consonant compared to the PCC metrics. Conclusions Having an experience with the assessment of cleft-related speech disorders is a crucial factor to gain reliable results. The interrater reliability for the PCC metrics and the probe scoring system between two experienced raters did not differ, suggesting that both outcome measures can be used in cleft palate speech intervention studies. Despite the ability of the probe scoring system to detect changes, further research should provide insight in the benefits of this system both for research and clinical purposes.
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Affiliation(s)
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | | | - Ellen Van Gaever
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Ghent University, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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Sullivan ZC, Van Eeden S, McMahon S, Edwards Z, Flannigan N, Seshu M, Dominguez-Gonzalez S. Identifying associations between dental arch relationship scores, relative deprivation and other cleft audit outcomes. Part 1. Orthod Craniofac Res 2021; 25:82-95. [PMID: 33998764 DOI: 10.1111/ocr.12495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/05/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess whether dental arch relationship scores are associated with speech, audiological and psychology outcomes in patients with complete unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). SETTING AND SAMPLE POPULATION One hundred 5-year-old children with non-syndromic complete UCLP and forty-two 5-year-olds with non-syndromic complete BCLP from the United Kingdom. MATERIAL AND METHODS Data were collected from five-year audit clinics for dental arch relationships, speech, hearing and psychology outcomes. Associations were assessed between ordinal prognostic covariates and the dental arch relationship outcome using a Cochrane-Armitage test for trend and comparisons with binary prognostic covariates using chi-square/Fisher's exact test. This was extended to assess associations between five-year audit outcomes and a measure of deprivation. RESULTS There was no evidence of associations between dental arch relationships and outcomes for audiology and speech. Individual domain analysis of the psychology outcomes within the UCLP cohort reported a poor outcome for Pro-social score to be associated with a poor 5-year-old index score (P = .018). For the BCLP sample, a good outcome for the BCLP Deciduous Dentition Yardstick was associated with a good conduct score (P = .01). CONCLUSION There was no association with the 5-year-old index/BCLP Deciduous Dentition Yardstick score and outcomes reported for audiology and speech. For the UCLP and BCLP cohorts, a poor dental arch relationship outcome may be associated with issues with some aspects of psychological well-being, associated with peer interactions and conduct. The deprivation index of samples had no association with the outcomes assessed.
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Affiliation(s)
| | | | | | - Zoe Edwards
- Alder Hey Hospital Children's Hospital, Liverpool, UK
| | - Norah Flannigan
- Orthodontic Department, Liverpool University Dental Hospital, Liverpool, UK
| | - Madhavi Seshu
- Alder Hey Hospital Children's Hospital, Liverpool, UK
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Nibbio A, Ruffenach L, Bruant-Rodier C, Robert E, Bodin F, Dissaux C. [Shape and aesthetic outcome evaluation of transposed umbilicus according to four surgical procedures]. ANN CHIR PLAST ESTH 2020; 66:52-61. [PMID: 33223366 DOI: 10.1016/j.anplas.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In abdominal plastic surgery, umbilicus is frequently transposed, generating scars and shapes variating with the techniques used. Various umbilical transposition techniques have been described, all of them attempt to reproduce the "ideal" umbilicus. This study aimed to define the shape and the aesthetic results obtained with four different surgical procedures, in order to choose an "ideal" umbilical transposition technique. PATIENTS AND METHODS This retrospective study analyzed the characteristics of transposed umbilicus, in 50 patients who had undergone abdominal dermolipectomy for aesthetic reason, after a loss of weight or in breast reconstruction by Deep-Inferior-Epigastric-Perforator. Four surgical procedures were chosen, which differed by their counter-incision shape in the abdominal flap (Y, inverted Y, de-epidermized round with horizontal incision or U), and the deep points position of umbilical docking (along a horizontal or vertical axis). Shape and depth were evaluated by a panel of experts. The global assessment was based on a double evaluation, by the surgical jury and the patients themselves. RESULTS The counter-incision type determined the umbilicus shape: triangular for the Y (60%) or inverted-Y (41%), round for the U (52%) and vertical oval (67%) or round (32%) for the de-epidermized circle. The deep points position influenced the umbilicus axis. Regarding the appreciation, the de-epidermized circle had the best results for surgeons in a significant way, and for patients (respectively 72% and 100% satisfied), followed by the inverted-Y (57% and 92%) and Y techniques (55% and 89%) and at last the U (50 and 75%). CONCLUSION Horizontal counter incision in a de-epidermized round, with two anchoring points on a vertical axis, generates vertical oval or round shaped umbilicus, considered attractive in the literature, and giving the highest aesthetic satisfaction for both surgeons and patients.
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Affiliation(s)
- A Nibbio
- Service de chirurgie plastique, esthétique, reconstructrice et maxillo-faciale, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| | - L Ruffenach
- Service de chirurgie plastique, esthétique, reconstructrice et maxillo-faciale, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - C Bruant-Rodier
- Service de chirurgie plastique, esthétique, reconstructrice et maxillo-faciale, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - E Robert
- Service de chirurgie sénologique, plastique, reconstructrice et esthétique, hopitaux civils de Colmar, 39, avenue de la Liberté, 68024 Colmar cedex, France
| | - F Bodin
- Service de chirurgie plastique, esthétique, reconstructrice et maxillo-faciale, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - C Dissaux
- Service de chirurgie plastique, esthétique, reconstructrice et maxillo-faciale, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
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Raveendran M. Simulation-Based Training Models for Cleft Palate Repair: A Systematic Review. Cleft Palate Craniofac J 2019; 57:506-511. [DOI: 10.1177/1055665619877768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: Simulation-based training is a relatively new inclusion to surgical training curricula, with promises of achieving increased competency while maximizing patient safety. Cleft palate, which contributes significantly to the global burden of surgically treatable diseases, is a challenging repair to learn due to the high level of skill and dexterity required, delicate oral tissues, and limited space of an infant oral cavity. Simulation training can allow cleft palate education to move from an observational to a competency-based learning. Hence, this systematic review presents the models described in the literature that simulate cleft palate repair. Design: The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search of the MEDLINE and Cochrane databases was performed. Qualitative data were extracted, and the models were stratified based on their anatomical fidelity and realism, forming the basis of the curriculum. Results: The database search returned 3261 articles. Twelve articles were considered eligible for inclusion. The anatomical fidelity, human tissue likeness, evidence of improved outcomes, and cost are discussed. Conclusions: Cleft palate is a globally significant birth defect and its repair is a difficult procedure to learn. This review presents the 12 models of cleft palate described in the literature, highlighting the advances and gaps in current cleft palate simulation.
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Affiliation(s)
- Maria Raveendran
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Bruneel L, Bettens K, De Bodt M, D’haeseleer E, Thijs Z, Roche N, Van Lierde K. Stages in the Development and Validation of a Belgian Dutch Outcome Tool for the Perceptual Evaluation of Speech in Patients With Cleft Palate. Cleft Palate Craniofac J 2019; 57:43-54. [DOI: 10.1177/1055665619862726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective:To develop and validate a Belgian Dutch outcome tool for the perceptual evaluation of speech in patients with cleft palate.Setting:Cleft palate team in a tertiary university hospital.Methods:The tool was based on the Cleft Audit Protocol for Speech–Augmented (John et al., 2006; Sell et al., 2009), with adaptations to some of the speech variables and the structured listening protocol. Following a preliminary listening experiment in phase 1, the tool was optimized. In the second phase, a listening experiment with 4 experienced listeners was set up to assess face validity, inter- and intrarater reliability and criterion validity.Results:Results of phase 1 indicated good to very good inter- and intrarater reliability for the majority of the speech variables, good discriminant validity, and varying sensitivity and specificity based on a comparison with nasalance values and the Nasality Severity Index 2.0 (criterion validity). Results of phase 2 showed good to very good interrater reliability for 5 of the 14 variables and good intrarater reliability in 3 of the 4 experienced listeners. Sensitivity and specificity were sufficient, except the specificity of the hypernasality judgments in comparison with the nasalance values of the oral text. Overall, listeners positively judged the face validity of the tool.Conclusion:The 2-phase evaluation indicated varying validity and reliability results. Future studies will aim to optimize validity and reliability of the developed tool based on adaptations to the listening protocol, the addition of speech variables, and the inclusion of a more elaborate training.
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Affiliation(s)
- Laura Bruneel
- Department of Rehabilitation Sciences, Language, and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Language, and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Marc De Bodt
- Department of Rehabilitation Sciences, Language, and Hearing Sciences, Ghent University, Ghent, Belgium
- Department of ENT, Head and Neck Surgery and Communication Disorders, Antwerp University, Wilrijk, Belgium
| | - Evelien D’haeseleer
- Department of Rehabilitation Sciences, Language, and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Zoë Thijs
- Department of Rehabilitation Sciences, Language, and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Nathalie Roche
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Language, and Hearing Sciences, Ghent University, Ghent, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
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Ben Bouhjar N, Kleinheinz J, Dirksen D, Berssenbrügge P, Runte C, Wermker K. Facial and midfacial symmetry in cleft patients: Comparison to non-cleft children and influence of the primary treatment concept. J Craniomaxillofac Surg 2019; 47:741-749. [PMID: 30777738 DOI: 10.1016/j.jcms.2019.01.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/12/2018] [Accepted: 01/29/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Patients with cleft lip, alveolus and palate (CLAP) may suffer from marked asymmetry with an impact on attractiveness and psychosocial aspects. The aim of this study was to assess symmetry in CLAP patients compared to non-cleft controls of similar age with regard to cleft type and treatment concept. MATERIALS AND METHODS In CLAP patients with different cleft forms and in healthy non-cleft subjects (control group) a three-dimensional stereophotogrammetric face scan was performed and an objective 3D asymmetry index (AI) was calculated for the whole face, the midface, the upper lip and the nose. RESULTS In total, 305 patients were included: 140 CLAP patients (90 male, 50 female, mean age 9.9 ± 3.6 years) and 165 controls (87 male, 78 female, mean age 8.7 ± 2.1 years). In general, CLAP patients showed significantly higher asymmetry than controls, with the most severe asymmetry found in unilateral complete CLAP. Patients treated according to an actual concept considering reconstruction of all affected muscular systems had a significant lower and more favourable AI than patients not treated according to this concept (p < 0.05). CONCLUSION An adequate treatment concept is essential to achieve better results concerning symmetry in CLAP, but symmetry values of healthy non-cleft controls are not reached.
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Affiliation(s)
| | - Johannes Kleinheinz
- University Hospital Münster, Department of Cranio-Maxillofacial Surgery, Waldeyerstraße 30, 48149, Muenster, Germany
| | - Dieter Dirksen
- University Hospital Münster, Department of Prosthetic Dentistry and Biomaterials, Waldeyerstraße 30, 48149, Muenster, Germany
| | - Philipp Berssenbrügge
- University Hospital Münster, Department of Prosthetic Dentistry and Biomaterials, Waldeyerstraße 30, 48149, Muenster, Germany
| | - Christoph Runte
- University Hospital Münster, Department of Prosthetic Dentistry and Biomaterials, Waldeyerstraße 30, 48149, Muenster, Germany
| | - Kai Wermker
- Klinikum Osnabrueck, Department of Oral and Cranio-Maxillofacial Surgery, Am Finkenhuegel 1, 49076, Osnabrueck, Germany.
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Boonipat T, Brazile TL, Darwish OA, Montana P, Fleming KK, Stotland MA. Measuring visual attention to faces with cleft deformity. J Plast Reconstr Aesthet Surg 2018; 72:982-989. [PMID: 30598394 DOI: 10.1016/j.bjps.2018.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/06/2018] [Accepted: 12/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Limited data are available regarding observers' visual attention to faces with congenital difference. We implemented eye tracking technology to examine this issue, as it pertains particularly to faces with cleft deformity. METHOD Four hundred three observers assessed 273 clinical images, while their eye movements were unobtrusively tracked using an infrared sensor. Forty-one facial images of the repaired cleft lip, 137 images of other facial conditions, and 95 images of matched controls were assessed. Twenty facial regions of interest ("lookzones") were considered for all images observed. A separate cohort of 720 raters evaluated the images for attractiveness. Observer and image demographic information was collected. Visual fixation counts and durations were computed across all 20 lookzones for all images. The effect of a variety of variables on lookzone fixation was analyzed using factorial ANOVA testing. RESULTS Cleft-repaired faces were rated as less attractive and drew observers' attention preferentially to the affected upper lip lookzone (p<.001). Images rated as less attractive garnered greater visual attention in the cleft-affected lookzones (p<.001). The eye tracking methodology demonstrated exquisite sensitivity to laterality of cleft deformity (p<.001). Individuals reporting a personal or a family history of facial deformity fixated more on the perioral region of cleft-repaired faces than did naïve observers (p<.001). CONCLUSION These findings highlight the utility of eye tracking measures for understanding critical variables that influence the visual processing of faces with cleft deformity. The data may provide analytical tools for assessing surgical outcome and direct priority setting during surgeons' conversations with patients.
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Affiliation(s)
| | - Tiffany L Brazile
- Medical Student, Geisel School of Medicine at Dartmouth, Hanover, NH
| | | | - Philip Montana
- Medical Student, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Kevin K Fleming
- Chair, Department of Psychology and Education, Norwich University, Northfield, VT
| | - Mitchell A Stotland
- Chief, Plastic and Craniofacial Surgery, Sidra Medicine and Weill Cornell Medical College-Qatar, Doha, Qatar.
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12
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Parikakis KA, Larson O, Larson M, Karsten A. Minimal incision palatoplasty with or without muscle reconstruction in patients with isolated cleft palate: a cast and medical records analysis. Eur J Orthod 2018; 40:504-511. [PMID: 29253093 DOI: 10.1093/ejo/cjx090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives To compare the minimal incision (MI) technique with the minimal incision including muscle reconstruction (MMI) technique regarding surgical complications and dentoalveolar status at 5 years of age. Subjects and method A consecutive series of 202 Caucasian non-syndromic children (apart from Pierre Robin Sequence) born with isolated cleft palate between 1987 and 2007 and treated with MI (n = 78) or MMI (n = 102) palatoplasty at a mean age of 12.7 (SD = 1.43) months in Stockholm. Twenty-two patients did not fulfill the inclusion criteria. The patients were divided into two subgroups: clefts within the soft palate only (small cleft, n = 50) and clefts within the hard and soft palate (big cleft, n = 130). Dental relations, structure of the palatal mucosa, and height of the palatal vault at 5 (mean age 5.3, range: 4.4-6.9) years of age were studied using plaster models. Time for surgery, blood loss, complications in the immediate postoperative period, frequency of fistulas, and additional pharyngeal flap surgery were evaluated. Student's t-test, chi-square test and 95 per cent confidence intervals were calculated. Results MMI compared to MI technique result in statistically significant increased operation time, less need for pharyngeal flap surgery, and to shallower palatal vault. Big clefts result in statistically significant increased operation time and need for pharyngeal flap surgery. Dental relations were the same in all groups. Limitations Retrospective single centre study, limited sample size, more than one surgeon. Conclusions The muscle reconstruction results in a reduced subsequent need for pharyngeal flap surgery, but to shallower palatal vault and demand for almost double operation time. The dental relations were the same in all groups.
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Affiliation(s)
- Konstantinos A Parikakis
- Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Stockholm Craniofacial Team, Karolinska Institutet, Stockholm, Sweden
| | - Ola Larson
- Stockholm Craniofacial Team, Karolinska Institutet, Stockholm, Sweden.,Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Larson
- Stockholm Craniofacial Team, Karolinska Institutet, Stockholm, Sweden.,Department of Orthodontics, Section for Jaw Orthopedics, Eastman Institute, Stockholm, Sweden
| | - Agneta Karsten
- Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Stockholm Craniofacial Team, Karolinska Institutet, Stockholm, Sweden
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Unilateral Cleft Lip and Palate Surgical Protocols and Facial Growth Outcomes. J Craniofac Surg 2018; 29:1562-1568. [DOI: 10.1097/scs.0000000000004810] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Tsangaris E, Wong Riff KWY, Dreise M, Stiernman M, Kaur MN, Piplani B, Aydin A, Moh’d Kharashgah GN, Stotland MA, Thabane L, Thoma A, Klassen AF. Translation and cultural adaptation of the CLEFT-Q into Arabic, Dutch, Hindi, Swedish, and Turkish. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1445-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Bittar PG, Carlson AR, Mabie-DeRuyter A, Marcus JR, Allori AC. Implementation of a Standardized Data-Collection System for Comprehensive Appraisal of Cleft Care. Cleft Palate Craniofac J 2018; 55:1382-1390. [PMID: 29561717 DOI: 10.1177/1055665618764952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Our objective is to describe the process of adapting a conceptual framework into a practical toolkit for one cleft team. DESIGN This is a single-arm implementation study in a single institution. SETTING Implementation took place at a mid-sized multidisciplinary clinic for patients with cleft lip and/or palate (CL/P) from urban/suburban and rural areas across North Carolina and neighboring states. PARTICIPANTS Eligible participants were patients with CL/P from English-speaking families. Sixty patients entered and finished the study. INTERVENTIONS The implementation of a prospective data collection system based on the International Consortium for Health Outcomes Measurement (ICHOM) standard set of outcome measures for CL/P was accomplished in multiple stages. Patient- and clinician-reported forms and protocols for gathering data were created. Team members were trained and the system was tested; finally, the system was deployed. MAIN OUTCOME MEASURES Success was appraised using the RE-AIM framework to assess reach, effectiveness, adoption, implementation, and maintenance. RESULTS Ninety-eight percent of patients and all team members agreed to participate. Ninety-four percent of required data were captured. Adaptations to friction points were made; specifically, visible reminders were affixed to charts, primary clinicians were required to assume data entry responsibility, and e-mail reminders were instituted. Development cost was US$7707; average time cost per clinician was 21 min/wk. CONCLUSIONS Conceptual frameworks for outcomes studies must be tailored to their environments; otherwise, they cannot be practically implemented and sustained. We present this process for a cleft team using the ICHOM standard set. The process may help other teams implement the standard set or other conceptual frameworks.
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Affiliation(s)
| | - Anna R Carlson
- 2 Division of Plastic, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Hospital, Durham, NC, USA
| | - Ann Mabie-DeRuyter
- 3 Division of Otolaryngology and Communication Sciences, Department of Surgery, Duke University Hospital; Durham, NC, USA.,4 Duke Cleft and Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
| | - Jeffrey R Marcus
- 2 Division of Plastic, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Hospital, Durham, NC, USA.,4 Duke Cleft and Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
| | - Alexander C Allori
- 2 Division of Plastic, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Hospital, Durham, NC, USA.,4 Duke Cleft and Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
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Prospective, Double-Blind Evaluation of Umbilicoplasty Techniques Using Conventional and Crowdsourcing Methods. Plast Reconstr Surg 2017; 140:1151-1162. [DOI: 10.1097/prs.0000000000003839] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Tsangaris E, Riff KWYW, Vargas F, Aguilera MP, Alarcón MM, Cazalla AA, Thabane L, Thoma A, Klassen AF. Translation and cultural adaptation of the CLEFT-Q for use in Colombia, Chile, and Spain. Health Qual Life Outcomes 2017; 15:228. [PMID: 29179776 PMCID: PMC5704495 DOI: 10.1186/s12955-017-0805-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 11/20/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cleft lip and/or palate (CL/P) is a common congenital craniofacial anomaly that may negatively affect an individual's appearance, health-related quality of life, or speech. In Spain, Colombia, and Chile the overall prevalence of CL/P ranges from 0.53 to 1.59 cases per 1000 live births. Currently, there is no patient-reported outcome (PRO) instrument that is specific for patients with CL/P. The CLEFT-Q is a new PRO instrument developed to measure outcomes of treatment in patients 8 to 29 years of age with CL/P. The aim of this study was to translate and culturally adapt the CLEFT-Q for use in Colombia, Chile, and Spain. METHODS The CLEFT-Q was translated from English to 3 Spanish language varieties (Colombian, Chilean, and Spanish (Spain)) and Catalan. Translation and cultural adaptation guidelines set forth by the International Society for Pharmacoeconomics and Outcomes Research were followed. RESULTS The field- test version of the CLEFT-Q consisted of 13 scales (total 154 items) measuring appearance, health-related quality of life, and facial function. Forward translations revealed 10 (7%) items that were difficult to translate into Chilean, and back translations identified 34 (22%) and 21 (13%) items whose meaning differed from the English version in at least 1 of the 3 Spanish varieties and Catalan respectively. Twenty-one participants took part in cognitive debriefing interviews. Participants were recruited from plastic surgery centres in Bogotá, Colombia (n = 4), Santiago, Chile (n = 7), and Barcelona, Spain (n = 10). Most participants were males (n = 14, 67%) and were diagnosed with CL/P (n = 17, 81%). Participants reported difficulty understanding 1 item in the Colombian, 1 item in the Spanish (Spain), and 11 items from the Catalan version. Comparison of the 3 Spanish varieties revealed 61 (40%) of the 154 items whose wording differed across the 3 Spanish versions. CONCLUSION Translation and cultural adaptation processes provided evidence of transferability of the CLEFT-Q scales into 3 Spanish varieties and Catalan, as semantic, idiomatic, experiential, and conceptual equivalence of the items, instructions, and response options were achieved.
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Affiliation(s)
- Elena Tsangaris
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8 Canada
| | - Karen W. Y. Wong Riff
- Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario M5G 1X8 Canada
| | - Federico Vargas
- Fundación Operación Sonrisa Colombia, Bogotá, 110221 Colombia
| | | | | | - Asteria Albert Cazalla
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Barcelona, 08950 Barcelona, Spain
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8 Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario L8P 3A9 Canada
| | - Anne F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario L8S 4K1 Canada
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18
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Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Understand the components of unilateral and bilateral cleft lip nasal deformity. 2. Assess the deformity. 3. Design a treatment plan for secondary correction of cleft lip nasal deformity. 4. Discuss methods for managing suboptimal outcomes. SUMMARY Correction of cleft lip nasal deformity has been addressed in this Maintenance of Certification/Continuing Medical Education series a number of times-a testament to the complexity of the topic. In this addition to the series, the authors provide a principle-based approach toward management of unilateral and bilateral cleft lip nasal deformity with an emphasis on timing intervention, role for intermediate correction, and methods for cleft rhinoplasty after completion of nasal growth.
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Allori AC, Kelley T, Meara JG, Albert A, Bonanthaya K, Chapman K, Cunningham M, Daskalogiannakis J, De Gier H, Heggie AA, Hernandez C, Jackson O, Jones Y, Kangesu L, Koudstaal MJ, Kuchhal R, Lohmander A, Long RE, Magee L, Monson L, Rose E, Sitzman TJ, Taylor JA, Thorburn G, Van Eeden S, Williams C, Wirthlin JO, Wong KW. A Standard Set of Outcome Measures for the Comprehensive Appraisal of Cleft Care. Cleft Palate Craniofac J 2017; 54:540-554. [DOI: 10.1597/15-292] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Care of the patient with cleft lip and/or palate remains complex. Prior attempts at aggregating data to study the effectiveness of specific interventions or overall treatment protocols have been hindered by a lack of data standards. There exists a critical need to better define the outcomes- particularly those that matter most to patients and their families-and to standardize the methods by which these outcomes will be measured. This report summarizes the recommendations of an international, multidisciplinary working group with regard to which outcomes a typical cleft team could track, how those outcomes could be measured and recorded, and what strategies may be employed to sustainably implement a system for prospective data collection. It is only by agreeing on a common, standard set of outcome measures for the comprehensive appraisal of cleft care that intercenter comparisons can become possible. This is important for quality-improvement endeavors, comparative effectiveness research, and value-based health-care reform.
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Affiliation(s)
- Alexander C. Allori
- Division of Plastic, Maxillofacial & Oral Surgery, Duke Children's Hospital & Health Center, Durham, North Carolina
| | - Thomas Kelley
- Business Development & Partnerships, International Consortium for Health Outcomes Measurement, Boston, Massachusetts
| | - John G. Meara
- Department of Plastic & Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Asteria Albert
- Department of Pediatric Surgery, Hospital Sant Joan de Deu, Barcelona, Spain
| | | | - Kathy Chapman
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah
| | - Michael Cunningham
- Division of Craniofacial Medicine, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - John Daskalogiannakis
- Department of Orthodontics, Hospital for Sick Children, University of Toronto, Toronto, Canada, and Member, Task Force on Americleft, American Cleft Palate-Craniofacial Association, Lancaster, Pennsylvania
| | - Henriette De Gier
- Department of Otolaryngology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Andrew A. Heggie
- Department of Plastic & Maxillofacial Surgery, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | | | - Oksana Jackson
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yin Jones
- Cleft Lip & Palate Association, London, England
| | - Loshan Kangesu
- North Thames Cleft Centre, London, United Kingdom, and Consultant Surgeon, St. Andrews Centre of Plastic Surgery, Broomfield Hospital Chelmsford, Essex, United Kingdom
| | - Maarten J. Koudstaal
- Department of Oral & Maxillofacial Surgery, Dutch Craniofacial Centre, Sophia's Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden, and Professor, Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Ross E. Long
- Lancaster Cleft/Craniofacial Program, Lancaster, Pennsylvania; Professor, Department of Orthodontics, Albert Einstein Medical Center, Philadelphia, Pennsylvania, and Task Force on Americleft, American Cleft Palate-Craniofacial Association, Lancaster, Pennsylvania
| | - Leanne Magee
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Laura Monson
- Department of Plastic Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Elizabeth Rose
- Department of Otolaryngology, Royal Children's Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Thomas J. Sitzman
- Department of Plastic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Jesse A. Taylor
- Division of Plastic & Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Guy Thorburn
- North Thames Cleft Centre, London, United Kingdom
| | - Simon Van Eeden
- Northwest, North Wales, and Isle of Man Cleft Network, Liverpool, England
| | | | - John O. Wirthlin
- Department of Plastic Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Karen W. Wong
- Division of Plastic & Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Campbell A, Restrepo C, Deshpande G, Tredway C, Bernstein SM, Patzer R, Wendby L, Schonmeyr B. Validation of a Unilateral Cleft Lip Surgical Outcomes Evaluation Scale for Surgeons and Laypersons. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1472. [PMID: 29062644 PMCID: PMC5640349 DOI: 10.1097/gox.0000000000001472] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/11/2017] [Indexed: 10/31/2022]
Abstract
BACKGROUND A standardized evaluation tool is needed for the assessment of surgical outcomes in cleft lip surgery. Current scales for evaluating unilateral cleft lip/nose (UCL/N) aesthetic outcomes are limited in their reliability, ease of use, and application. The Unilateral Cleft Lip Surgical Outcomes Evaluation (UCL SOE) scale measures symmetry of 4 components and sums these for a total score. The purpose of this study was to validate the SOE as a reliable tool for use by both surgeons and laypersons. METHODS Twenty participants (9 surgeons and 12 laypeople) used the SOE to evaluate 25 sets of randomly selected presurgical and postsurgical standardized photographs of UCL/N patients. Interrater reliability for surgeon and laypeople was determined using an intraclass correlation coefficient (ICC). RESULTS Individual surgeons and laypeople both reached an ICC in the "fair to good" range (ICC = 0.42 and 0.59, respectively). Averaging 2 evaluators in the surgeon group improved the ICC to 0.58 and in the laypeople group to 0.74, respectively. Averaging 3 evaluators increased the ICC for surgeons to the "good" range (ICC = 0.71) and the ICC for laypeople to the "very good" range (ICC = 0.82). CONCLUSIONS Surgeon and layperson raters can reliably use the SOE to assess the aesthetics results after surgical repair of UCL/N, and improved reliability and reproducibility is achieved by averaging the scores of multiple reviewers.
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Affiliation(s)
- Alex Campbell
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Carolina Restrepo
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Gaurav Deshpande
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Caroline Tredway
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Sarah M. Bernstein
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Rachel Patzer
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Lisa Wendby
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Bjorn Schonmeyr
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
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Bruneel L, Van Lierde K, Bettens K, Corthals P, Van Poel E, De Groote E, Keppler H. Health-related quality of life in patients with cleft palate: Validity and reliability of the VPI Effects on Life Outcomes (VELO) questionnaire translated to Dutch. Int J Pediatr Otorhinolaryngol 2017; 98:91-96. [PMID: 28583513 DOI: 10.1016/j.ijporl.2017.04.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Disease-specific health-related quality of life (HRQOL) questionnaires provide the clinician with important information regarding the impact of the disease on functioning and well-being. For patients with velopharyngeal insufficiency (VPI), the VPI Effects on Life Outcomes (VELO) questionnaire was developed and validated in English by Skirko et al. (2012). However, a valid and reliable Dutch translation of this questionnaire is not available yet. METHODS The English questionnaire was translated to Dutch following a forward-backward translation procedure. A linguistic validation and the evaluation of the internal consistency (Cronbach's α) of this Dutch version were performed based on the responses of 39 parents of patients with cleft (lip and) palate (mean age: 6.8 years) (parent report) and the responses of 14 patients older than 8 years (mean age: 9.5 years) (child report). Additionally, the concurrent validity was assessed by comparing the scores on the parent report to those on the pediatric voice handicap index. Furthermore, the validity of the parent proxy assessment and the relationship between age and responses on the VELO questionnaire were investigated. Based on the responses of an age and gender matched control group without cleft palate, the discriminant validity was evaluated. RESULTS The parent report was easy to complete for all parents. Nine of the fourteen (64%) patients were able to complete the child report independently. The median scores on the parent report and the child report were 82.7 and 95.1 respectively. The patient group had a significantly worse perception of HRQOL compared to the control group (p < 0.001; p = 0.029). There were no significant differences between the responses of the parent and their child's (p = 0.345). A significant positive correlation was found between the score on the parent report and the age of the patients (p = 0.001). Furthermore, a significant negative correlation was found between the parent report and the P-VHI (p < 0.001). Cronbach's α was 0.955 and 0.817 for the parent report and the child report respectively. CONCLUSION The Dutch VELO questionnaire is a valid, reliable and user-friendly tool that provides important information about HRQOL in patients with cleft (lip and) palate.
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Affiliation(s)
- Laura Bruneel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.
| | - Kristiane Van Lierde
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Kim Bettens
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Paul Corthals
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Faculty of Education, Health and Social Work, University College Ghent, Belgium
| | - Esther Van Poel
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Evelien De Groote
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
| | - Hannah Keppler
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
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Crowdsourcing as a Novel Method to Evaluate Aesthetic Outcomes of Treatment for Unilateral Cleft Lip. Plast Reconstr Surg 2017; 138:864-874. [PMID: 27673519 DOI: 10.1097/prs.0000000000002545] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lack of convenient and reliable methods to grade aesthetic outcomes limits the ability to study results and optimize treatment of unilateral cleft lip. Crowdsourcing methods solicit contributions from a large group to achieve a greater task. The authors hypothesized that crowdsourcing could be used to reliably grade aesthetic outcomes of unilateral cleft lip. METHODS Fifty deidentified photographs of 8- to 10-year-old subjects (46 with unilateral cleft lip and four controls) were assembled. Outcomes were assessed using multiple pairwise comparisons that produced a rank order (Elo rank) of nasal appearance and, on a separate survey, by Asher-McDade ratings. Both surveys were repeated to assess reliability. A group of expert surgeons repeated the same tasks on a smaller subset of photographs. RESULTS The authors obtained 2500 and 1900 anonymous, layperson evaluations by means of crowdsourcing on each Elo rank and Asher-McDade survey, respectively. Elo rank and Asher-McDade scores were highly reproducible (correlation coefficients, 0.87 and 0.98), and crowd evaluations agreed with those by expert surgeons (0.980 and 0.96 for Elo rank and Asher-McDade score, respectively). Crowdsourcing surveys were completed within 9 hours, whereas the expert surgeons required 3 months. On further analysis of their cleft subject sample set, the authors found that greater initial cleft severity was associated with worse aesthetic outcome. CONCLUSIONS Outcomes assessed by crowds were reliable and correlated well with expert assessments. Crowdsourcing allows acquisition of massive numbers of layperson assessments on an unprecedented scale, and is a convenient, rapid, and reliable means of assessing aesthetic outcome of treatment for unilateral cleft lip. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, IV.
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Kappen IFPM, Bittermann GKP, Bitterman D, Mink van der Molen AB, Shaw W, Breugem CC. Long-term follow-up study of patients with a unilateral complete cleft of lip, alveolus, and palate following the Utrecht treatment protocol: Dental arch relationships. J Craniomaxillofac Surg 2017; 45:649-654. [DOI: 10.1016/j.jcms.2017.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/08/2016] [Accepted: 01/26/2017] [Indexed: 11/29/2022] Open
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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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Pietruski P, Majak M, Pawlowska E, Skiba A, Antoszewski B. A novel computer system for the evaluation of nasolabial morphology, symmetry and aesthetics after cleft lip and palate treatment. Part 2: Comparative anthropometric analysis of patients with repaired unilateral complete cleft lip and palate and healthy individuals. J Craniomaxillofac Surg 2017; 45:505-514. [PMID: 28258919 DOI: 10.1016/j.jcms.2017.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The aim of this study was to use a novel system, 'Analyse It Doc' (A.I.D.) for a complex anthropometric analysis of the nasolabial region in patients with repaired unilateral complete cleft lip and palate and in healthy individuals. MATERIALS AND METHODS A set of standardized facial photographs in frontal, lateral and submental view have been taken in 50 non-cleft controls (mean age 20.6 years) and 42 patients with repaired unilateral complete cleft and palate (mean age 19.57 years). Then, based on linear, angular and area measurements taken from the digital photographs with the aid of the A.I.D. system, a photogrammetric analysis of intergroup differences in nasolabial morphology and symmetry was conducted. RESULTS Patients with cleft lip and palate differed from the controls in terms of more than half of analysed angular measurements and proportion indices derived from linear and area measurements of the nasolabial region. CONCLUSIONS The findings presented herein imply that despite primary surgical repair, patients with unilateral complete cleft lip and palate still show some degree of nasolabial dysmorphology. Furthermore, the study demonstrated that the novel computer system is suitable for a reliable, simple and time-efficient anthropometric analysis in a clinical setting.
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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
| | | | - Adam Skiba
- Department of Orthodontics, Medical University of Lodz, Lodz, Poland
| | - Boguslaw Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Norbert Barlicki Memorial Hospital, Lodz, Poland
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Photographic Measurements Partially Correlate to Nasal Function and Appearance among Adult Cleft Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e720. [PMID: 27579244 PMCID: PMC4995719 DOI: 10.1097/gox.0000000000000728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 03/23/2016] [Indexed: 11/29/2022]
Abstract
Background: Unilateral cleft lip and palate (UCLP) affects nasal function and appearance. There is a lack of objective measurements to evaluate these features. This study analyzes whether objective measurements on photographs correlate with nasal function and/or appearance among adults treated for UCLP. Methods: All patients with UCLP born from 1960 to 1987 treated at the Uppsala University Hospital were invited (n = 109). Participation rate was 68% (n = 74); mean follow-up was 35 years. An age-matched control group (n = 61) underwent the same tests. Nostril area, nasal tip deviation angle, and width of the nostril were measured on photographs and were compared with functional tests and with appearance as assessed by self-assessment questionnaire, professional panel, or laymen panel. Results: The photographically measured nostril area correlated with nasal volume (acoustic rhinometry) among UCLP patients, both cleft side and noncleft side, and controls (0.331, P = 0.005; 0.338, P = 0.004; and 0.420, P < 0.001, respectively). For the patients’ noncleft side and controls, the area correlated inversely with airflow resistance at inspiration (noncleft side: −0.245, P = 0.043; controls: −0.226, P = 0.013). Laymen assessment of nasal appearance correlated with width ratio of the patients (0.27, P = 0.022) and with nasal tip deviation angle and area ratio of the controls (0.26, P = 0.041, and 0.31, P = 0.015, respectively). Conclusions: Photographic measurements correlate partially with both functional tests of the nose and panel ratings of appearance. No correlation was found with self-assessment of appearance. Evaluation of photographs needs to be combined with patient-reported outcome measures to be a valuable endpoint of nasal appearance.
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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: 22] [Impact Index Per Article: 2.4] [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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