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Chen Y, Zhang C, Yao M, Tsauo C, Shi B, Low DW, Li C. Force Balance Reconstruction of the Orbicularis Oris in Secondary Unilateral Cleft Lip Deformity. Aesthetic Plast Surg 2024; 48:2382-2388. [PMID: 38789808 DOI: 10.1007/s00266-024-04110-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/25/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Secondary unilateral cleft lip deformities are commonly observed in patients with cleft lip and traditional surgical methods can't completely tackle this problem. The purpose of this study was to evaluate the outcomes of a novel surgical technique using force balance reconstruction of the orbicularis oris. METHODS 53 patients with secondary unilateral cleft lip deformity were included in this study, in which the orbicularis oris muscle was reconstructed symmetrically to achieve optimal force balance. Photometric 2d indexes were employed to evaluate the outcome of 27 patients, and 3d indexes for the remaining 26 patients. Aesthetic evaluation and parent-patient satisfaction surveys were also recorded. RESULTS Significant differences were found in the following: (1) LH (the lip height), LW (the lip width), D1(the vertical distance from the white roll to the vermilion bottom at the christa philtra points) and D2(the vertical distance from the christa philtra points to the facial midline) when comparing preoperative and postoperative 2D images; (2) LH, LW, D1 and D2 when comparing preoperative and follow-up 2D images; (3) RMS (root mean of square) when comparing preoperative and postoperative 3D images. Aesthetic evaluation in the follow-up period was a mean of 4.29, while parent-patient satisfaction of the overall appearance was a mean of 4.41. CONCLUSIONS The results suggest this new muscle reconstruction technique can significantly improve the surgical outcome of secondary unilateral cleft lip deformities. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."
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Affiliation(s)
- Yu Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chong Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Meilin Yao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chialing Tsauo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - David W Low
- Division of Plastic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chenghao Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Sun Y, Li Z, Qi X, Wang B, Yu N, Huang J, Ting W, Long X. Laser therapy for treating cleft lip or/and palate scarring-a systematic review and meta-analysis. Lasers Med Sci 2024; 39:160. [PMID: 38902432 PMCID: PMC11189991 DOI: 10.1007/s10103-024-04082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/12/2024] [Indexed: 06/22/2024]
Abstract
This review aims to assess the efficacy and safety of laser therapy in managing scars resulting from cleft lip and/or palate (CL/P) repair surgeries, as well as to determine the optimal timing for intervention. A systematic search was conducted across four databases using a predefined search strategy. Studies included were randomized controlled trials, non-randomized studies, and case series focusing on laser therapy for CL/P scars. Data extraction and analysis were performed using Revman Software. A total of two randomized controlled trials, four non-randomized studies, and three case series were included in the analysis. The fractional CO2 laser was the most commonly utilized type of laser. Following laser therapy, there was a significant decrease in Vancouver Scar Scale (VSS) scores by 4.05 (95% CI, 2.10-5.99). Meta-analysis revealed that laser treatment groups exhibited a significantly lower mean VSS score (1.3; 95% CI, 0.02-2.67) compared to control groups. Moreover, initiating laser therapy intervention at one month postoperatively resulted in a significantly lower VSS score compared to initiation at three months postoperatively (difference of 1.70; 95% CI, 1.33-2.08). No severe complications were reported. Laser therapy demonstrates effectiveness and safety in improving CL/P scars, with earlier intervention yielding greater benefits.
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Affiliation(s)
- Yixin Sun
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Ziming Li
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Xiaoyu Qi
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Binghan Wang
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Nanze Yu
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Jiuzuo Huang
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Wenyun Ting
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100005, China.
| | - Xiao Long
- Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100005, China.
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Roby BB, Ebert B, Zavala H, Chinnadurai S, Scott AR. Children's Visual Perception of Facial Scarring and Cleft Lip Deformity Using Eye Tracking Data. Laryngoscope 2024; 134:2726-2733. [PMID: 38214383 DOI: 10.1002/lary.31267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/15/2023] [Accepted: 10/25/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The purpose of this study is to determine children's perception of secondary cleft lip deformity (SCLD) using objective eye tracking technology and subjective responses on a survey to understand pediatric perceptions of facial scarring. DESIGN Cross-sectional study of participants aged 5-17 years old. METHODS Participants viewed images of children's faces with an eye tracking device. Sixteen images were displayed, 12 with unilateral SCLD and four with no facial scarring. Eye tracking data were obtained. Gaze samples were analyzed for areas of interest (AOIs). Immediately after viewing each image, participants answered two survey questions relating to facial asymmetry attitude toward the child pictured. For analysis, participants were divided into age groups. RESULTS A total of 259 participants were enrolled (42.5% female). Mean age was 10.5 years and 78% identified as White. In all age groups, total fixation time was greater for SCLD compared to control images. Early elementary age children spent significantly less time assessing the nose AOI compared to other groups, and also spent the least total fixation time and had the lowest visit count on all AOIs. Subjective survey questions showed similar trends with elementary age not noticing facial asymmetry compared to older age groups. CONCLUSION This study demonstrates the successful use of eye tracking technology in children as young as 5 years old. This study suggests that SCLD is perceived as less noticeable in elementary age children and becomes more noticeable to older groups. Understanding peer perception on SCLD from this study may impact decision on revision surgery for SCLD. LEVEL OF EVIDENCE IV Laryngoscope, 134:2726-2733, 2024.
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Affiliation(s)
- Brianne B Roby
- Children's Minnesota Pediatric ENT and Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Bridget Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Hanan Zavala
- Children's Minnesota Pediatric ENT and Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
| | - Siva Chinnadurai
- Children's Minnesota Pediatric ENT and Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Andrew R Scott
- Department of Otolaryngology-Head and Neck Surgery, Tufts University, Boston, Massachusetts, U.S.A
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Galarza LI, Sudduth JD, Rose AM, Moss CA, Humphries LS, Hoppe IC. The Fisher Subunit Anatomical Approach for Cleft Lip Revisions: An Evolution and Case Series. Ann Plast Surg 2024; 92:S379-S381. [PMID: 38856999 DOI: 10.1097/sap.0000000000003955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
ABSTRACT Many techniques exist to reapproximate a cleft lip but can leave unsatisfactory results with nonanatomic scars and a short upper lip, creating a need for revision. Many revisions focus on adjacent tissue transfers and realignment of landmarks, but in the senior authors' experience, recreating the defect and utilizing the Fisher repair for revision have led to aesthetically pleasing results and less noticeable scars. A database was collected that included all cleft lip revisions performed at a large, comprehensive children's hospital from October 2018 to July 2021. Inclusion criteria included any cleft patient with a cleft lip revision performed by two craniofacial surgeons. Data collected included sex, characteristics of the cleft lip, age at initial and index repair, type of initial repair, previous revisions, type of revision with any additional tissue rearrangement, and any nose repair. Sixty-five patients were included in the study for analysis. The type of initial repair was known in sixty-four cases (98%), and fifty-four were Millard repairs (83%). Twenty-two patients (33%) had a previous revision prior to their index revision. Sixty patients (92%) underwent the Fisher repair technique for their index revision and forty-six patients (70%) underwent nasal revision. In follow-up, all patients demonstrated an improvement in lip aesthetics. This study demonstrates a large subset of patients that have undergone cleft lip revision using the Fisher technique. In the senior surgeons' experience, the Fisher repair technique in the setting of cleft lip revision is an ideal way to address the shortcomings of historical repair techniques.
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Affiliation(s)
| | - Jack D Sudduth
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center
| | - Alexandra M Rose
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center
| | - Clayton A Moss
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center
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Hattori Y, Tu JCY, Chou PY, Lo LJ. Two-flap technique with interpositional dermofat graft for anterior oronasal fistula closure in patients with cleft: A case series. J Plast Reconstr Aesthet Surg 2024; 90:51-59. [PMID: 38359499 DOI: 10.1016/j.bjps.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Oronasal fistula at the anterior hard palate is one of the common sequelae after cleft surgery, and the leakage negatively affects the patient's quality of life. Although several surgical techniques have been proposed for reconstruction, it remains challenging because of the scarred regional tissue with a high rate of fistula recurrence. In this study, we present the anterior oronasal fistula repair using a two-flap technique with an interpositional dermofat graft (DFG). METHODS A retrospective review of anterior oronasal fistula repair performed by the senior author between April 2018 and August 2022 at the Craniofacial Center was conducted. Patients who underwent a fistula repair using the technique were further identified and investigated. RESULTS Thirty-four operations were performed using the technique, and 31 fistulas were completely closed, with a success rate of 91.2%. The fistula symptom improved but persisted postoperatively in 3 patients, of whom 2 patients underwent a second fistula repair using the same procedure, resulting in successful closure. Fistula recurrence was significantly correlated with fistula size (p = 0.04). The DFG was simultaneously utilized for nasal dorsum and/or vermillion reconstruction in 28 cases. CONCLUSION The two-flap technique enabled tension-free approximation, and the interpositional DFG facilitated watertight closure of the fistula, resulting in a high success rate of anterior oronasal fistula repair. The fistula closure could be combined with other revisional procedures for cleft-related deformities, where the DFG was simultaneously utilized.
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Affiliation(s)
- Yoshitsugu Hattori
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Junior Chun-Yu Tu
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pang-Yun Chou
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan.
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Parham MJ, Simpson AE, Moreno TA, Maricevich RS. Updates in Cleft Care. Semin Plast Surg 2023; 37:240-252. [PMID: 38098682 PMCID: PMC10718659 DOI: 10.1055/s-0043-1776733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Cleft lip and/or palate is a congenital malformation with a wide range of presentations, and its effective treatment necessitates sustained, comprehensive care across an affected child's life. Early diagnosis, ideally through prenatal imaging or immediately postbirth, is paramount. Access to longitudinal care and long-term follow-up with a multidisciplinary approach, led by the recommendations of the American Cleft Palate Association, is the best way to ensure optimal outcomes. Multiple specialties including plastic surgery, otolaryngology, speech therapy, orthodontists, psychologists, and audiologists all may be indicated in the care of the child. Primary repair of the lip, nose, and palate are generally conducted during infancy. Postoperative care demands meticulous oversight to detect potential complications. If necessary, revisional surgeries should be performed before the child begin primary school. As the child matures, secondary procedures like alveolar bone grafting and orthognathic surgery may be requisite. The landscape of cleft care has undergone significant transformation since early surgical correction, with treatment plans now tailored to the specific type and severity of the cleft. The purpose of this text is to outline the current standards of care in children born with cleft lip and/or palate and to highlight ongoing advancements in the field.
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Affiliation(s)
- Matthew J. Parham
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Arren E. Simpson
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Tanir A. Moreno
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Renata S. Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
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Kamal M, Möbius M, Bartella AK, Lethaus B. Perception of aesthetic features after surgical treatment of craniofacial malformations by observers of the same age: An eye-tracking study. J Craniomaxillofac Surg 2023; 51:708-715. [PMID: 37813772 DOI: 10.1016/j.jcms.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/11/2023] [Accepted: 09/30/2023] [Indexed: 10/11/2023] Open
Abstract
The aim of this study is to evaluate where exactly children and adolescents of the same group look when they interact with each other, and attempt to record and analyse the data recorded by eye-tracking technology. MATERIALS AND METHODS 60 subjects participated in the study, evenly divided into three age categories of 20 each in pre-school/primary school age (5-9 years), early adolescence (10-14 years) and late adolescence/transition to adulthood (15-19 years). Age groups were matched and categorized to be used both for creating the picture series and testing. Photographs of patients with both unilateral and bilateral cleft lip and palate were used to create the series of images which consisted of a total of 15 photos, 5 of which were photos of patients with surgically treated cleft deformity and 10 control photos with healthy faces, that were presented in random order. Using the eye-tracking module, the data on "area of first view" (area of initial attention), "area with longest view" (area of sustained attention), "time until view in this area" (time of initial attention) and "frequency of view in each area" (time of sustained attention) were calculated. RESULTS Across all groups, there was no significant difference for the individual regions for the parameters of initial attention (area of first view), while the time until first fixation of one of the AOIs (time until view in this area) was significant for all facial regions. A predictable path of the facial scan is abandoned when secondary facial deformities are present and attention is focused more on the region of an existing deformity, which are the nose and mouth regions. CONCLUSIONS There are significant differences in both male and female participants' viewing of faces with and without secondary cleft deformity. While in the age group of the younger test persons it was still the mouth region that received special attention from the male viewers, this shifted in the male test persons of the middle age group to the nose region, which was fixed significantly more often and faster. In the female participants, the mouth and nose regions were each looked at for twice as long compared to the healthy faces, making both the mouth and the nose region are in the focus of observation.
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Affiliation(s)
- Mohammad Kamal
- Department of Surgical Sciences, College of Dentistry, Health Sciences Center, Kuwait University, Safat, Kuwait.
| | - Marianne Möbius
- Department of Oral and Maxillofacial Surgery, Leipzig University Hospital, Leipzig, Germany.
| | - Alexander K Bartella
- Department of Oral and Maxillofacial Surgery, Leipzig University Hospital, Leipzig, Germany.
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery, Leipzig University Hospital, Leipzig, Germany.
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Martin SV, Van Eeden S, Swan MC. Secondary surgery techniques to optimise functional and aesthetic outcomes in orofacial clefting. Br Dent J 2023; 234:899-905. [PMID: 37349438 DOI: 10.1038/s41415-023-6001-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 06/24/2023]
Abstract
Although the goal of primary surgery is to avoid the need for secondary surgery, in a proportion of patients this is not always possible. Secondary, or revisional, surgery is frequently undertaken in patients with orofacial clefts and may present a complex and challenging problem for the multidisciplinary team. There are a broad range of functional and aesthetic issues that secondary surgery might aim to address. These include palatal fistulae (that may be symptomatic for air, fluid or food), velopharyngeal insufficiency (typically manifesting with decreased intelligibility or nasal regurgitation), suboptimal cleft lip scars (that can significantly impact upon the psychosocial wellbeing of the patient), and nasal asymmetry (that is frequently accompanied by nasal airway concerns). Unilateral and bilateral clefts are each associated with a characteristic nasal deformity that requires a tailored surgical approach. Suboptimal maxillary growth in repaired orofacial clefts may impact negatively on both appearance and function; surgical correction through orthognathic surgery can be transformational for the patient. The general dental practitioner, cleft orthodontist and restorative dentist all play a critical role in this process.
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Affiliation(s)
- Serena V Martin
- Cleft Fellow, Spires Cleft Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom
| | - Simon Van Eeden
- Consultant Cleft and Maxillofacial Surgeon, Alder Hey Children´s Hospital and Aintree University Hospital, Liverpool, L14 5AB, United Kingdom
| | - Marc C Swan
- Consultant Cleft and Plastic Surgeon, Spires Cleft Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom.
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Iglesias NJ, Williams TP, Chokshi SN, Cummins CB, Mao RMD, Mobli K, Berry A, Suzuki Y, Perez A, Radhakrishnan RS. Reviewing ACGME Plastic Surgery Fellowship Case Logs: Is Surgical Experience Increasing? J Surg Res 2022; 278:70-78. [PMID: 35594617 DOI: 10.1016/j.jss.2022.04.046] [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: 09/18/2021] [Revised: 03/26/2022] [Accepted: 04/08/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Over the last decade, there has been a 32% decrease in independent plastic surgery fellowships. The growing prevalence of 6-year integrated plastic surgery residencies, duty hour restrictions, and new subspecialty training fellowships for general surgeons have changed the training experience of plastic surgery fellows. METHODS A retrospective review of the Accreditation Council for Graduate Medical Education (ACGME) case logs for graduating fellows of independent plastic surgery fellowships in the United States was conducted from 2011 to 2019. A linear regression analysis was conducted for each case log code and category, and a 95% level of confidence was assumed (α = 0.05). RESULTS In 2011, 141 residents from 69 programs graduated with an average of 1469.7 cases. In 2019, 84 residents from 47 programs graduated with an average of 1952 cases. Index procedures significantly increased overall during the 9 y (P < 0.001). Categorical cases increased in esthetics (P < 0.001), including facelift, browlift, blepharoplasty, and more. Categorical cases increased in reconstructive surgery (P < 0.001), including treatment of deformities of the skin, lower extremities, and trunk, nerve decompression, and hand reconstruction. In breast procedures, an increase was seen in the reduction of mammoplasty, reconstruction, and treatment of other breast deformities. In head and neck procedures, an increase was seen in resection of head and neck neoplasms and secondary cleft lip repair. Decreases in procedural numbers were seen in primary cleft lip repair and hand reconstruction by primary closure. CONCLUSIONS Despite a 32% decline in the number of independent plastic surgery fellowships over the last 9 y, plastic surgery fellows are obtaining significantly more surgical experience, both in esthetic and reconstructive surgery.
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Affiliation(s)
| | - Taylor P Williams
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Shivan N Chokshi
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Claire B Cummins
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Rui-Min D Mao
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Keyan Mobli
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Andrew Berry
- Department of Plastic Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Yota Suzuki
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Alexander Perez
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
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Hartmann GC, Guimarães LK, Maggioni CG, Gasparello GG, Júnior SLM, Pithon MM, Tanaka OM. Social attractiveness perception of a cleft lip repair in an adolescent via eye-tracking. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e526-e532. [PMID: 35074565 DOI: 10.1016/j.jormas.2022.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE The present study was designed to investigate the perception of unilateral cleft lip (UCL) repair scar using an image of an adolescent and eye-tracking technology. MATERIAL AND METHODS Frontal and oblique views of an image of an adolescent with a unilateral upper lip scar result of a corrective surgery. Eighty-five laypeople respondents were divided into three groups: Group A (15-44 years of age); Group B (45-59 years of age); and Group C (≥ 60 years of age). Gaze tracking was carried out to assess the location on the image of greatest fixation, to create dot maps and to follow the trajectory of the gaze. Respondents also assessed six attention questionnaires. The answers and assessment of the VAS were compared. P-values <0.05 were considered significant in the analyses. RESULTS The central focus of the visualization was concentrated on the upper lip and the region of the nostril, followed by the eyes. Time until 1st fixation upon right lip and mouth showed differences with regard to different images. Images of the model shown in various guises including smiling or not, in a frontal or oblique views showed significant differences in VAS scoring (p<0.001). CONCLUSION The presence of a scar from the UCL repair in an adolescent was noted in the foreground by laypeople. The scar was associated with a lower degree of attractiveness, happiness, and intelligence, as well as with shyness and sympathy, although a visible scar did not influence the perception of "good hygiene habits".
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Affiliation(s)
- Giovani Ceron Hartmann
- Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; School of Life Sciences, Brazil
| | - Lara Karolina Guimarães
- Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; School of Life Sciences, Brazil
| | | | | | - Sergio Luiz Mota Júnior
- Visiting Professor of Orthodontics in Juiz de Fora Federal University, Juiz de Fora, Minas Gerais, Brazil, Private Practice
| | - Matheus Melo Pithon
- Southwest Bahia State University - UESB. Jequié, Bahia, Brazil; Diplomate of the Brazilian Board of Orthodontics - BBO, Brazil
| | - Orlando Motohiro Tanaka
- Pontifícia Universidade Católica do Paraná, Curitiba, Brazil; School of Life Sciences, Brazil; Diplomate of Brazilian Board of Orthodontics and Dentofacial Orthopedics, Postdoctoral Fellow at The Center for Advanced Dental Education at Saint Louis University, Brazil; Pontifícia Universidade Católica do Paraná - PUCPR, School of Life Sciences, R. Imaculada Conceição, 1155, CEP: 80215-901 - CURITIBA, Paraná, BRAZIL.
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Unilateral Cleft Lip Repair: Technical Maneuvers to Achieve Vermilion and Mucosal Height. Plast Reconstr Surg Glob Open 2022; 10:e4125. [PMID: 35198352 PMCID: PMC8856589 DOI: 10.1097/gox.0000000000004125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022]
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Elbaz B, Veyssière A, Boutros M, Ambroise B, Preudhomme R, Bénateau H. Correction of lip and nasal deformities in bilateral cleft operated with Le Mesurier procedure. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:322-328. [PMID: 34216817 DOI: 10.1016/j.jormas.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/12/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Bilateral cleft lip surgery recently evolved with the generalization of cheilorhinoplasty replacing cheiloplasty alone. The aim of this study was to analyze lip and nasal deformities of bilateral cleft lip operated on with the Le Mesurier procedure, and then to evaluate possible secondary surgical solutions used in our Cleft Center. PATIENTS AND METHODS We retrospectively reviewed a total of 39 patients born between 1991 and 2009 with a bilateral cleft all type included (isolated lip, lip and alveolar, associated or not with a cleft palate), all treated at the Caen University Hospital with a Le Mesurier procedure for the primary cleft lip closure. We studied population characteristics, the number of secondary surgical procedures for lip and nasal deformities. We analysed therapeutic approaches of the different secondary surgical procedures used and their morphological results. RESULTS 85% of patients needed at least one secondary surgical procedure, 28% two procedures, 15% three procedures and 8% four or more procedures. Median age at secondary surgery was 6,8. 79% had a "scar repositioning", 33% managed the vermilion, 18% a restoration of the volume of the lip, 12% a philtral tissue sacrifice, 9% a procedure on Cupid's bow, 24% a surgery for nasal tip projection, 45% a columella lengthening and 58% a reposition of the alar base. DISCUSSION Le Mesurier procedure for bilateral clefts leads to deformities that require secondary surgical procedures. We propose an algorithm to manage loop scar in this procedure.
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Affiliation(s)
- Bénédicte Elbaz
- Department of maxillofacial Surgery, Universitary Hospital of Caen, Caen 14000, France
| | - Alexis Veyssière
- Department of maxillofacial Surgery, Universitary Hospital of Caen, Caen 14000, France; Health University of Caen, Normandie, Caen 14000, France.
| | - Mariam Boutros
- Department of Anaesthesiology, Universitary Hospital of Caen, Caen 14000, France
| | - Béatrice Ambroise
- Department of maxillofacial Surgery, Universitary Hospital of Caen, Caen 14000, France
| | - Renaud Preudhomme
- Department of maxillofacial Surgery, Universitary Hospital of Caen, Caen 14000, France
| | - Hervé Bénateau
- Department of maxillofacial Surgery, Universitary Hospital of Caen, Caen 14000, France; Health University of Caen, Normandie, Caen 14000, France
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Sarrami SM, Skochdopole AJ, Ferry AM, Buchanan EP, Hollier LH, Dempsey RF. Revisional Techniques for Secondary Cleft Lip Deformities. Semin Plast Surg 2021; 35:65-71. [PMID: 34121941 DOI: 10.1055/s-0041-1728673] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Secondary deformities of repaired cleft lips are an unfortunate complication despite the meticulous approach of modern primary procedures. Most of these surgeries take place in the patient's early life and must be strategically planned to provide optimal cosmesis with minimal interventions. Depending on the level of severity, treatment of the secondary deformities ranges from noninvasive or minimally invasive techniques to complete revision cheiloplasty. Many novel topical, injectable, and laser therapies have allotted physicians more technical flexibility in treating superficial distortions. Nonetheless, surgical techniques such as diamond excision and adjacent tissue transfer remain popular and useful reconstructive modalities. Deformities involving the orbicularis oris must be completely taken down to allow full access to the muscle. Complete revision cheiloplasty requires recreation of the cleft defect and reconstruction similar to the primary repair. Due to the myriad of presentations of these secondary deformities, familiarity with the various treatments available is imperative for any cleft surgeon.
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Affiliation(s)
- Shayan M Sarrami
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Anna J Skochdopole
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Andrew M Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward P Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Larry H Hollier
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Robert F Dempsey
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
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Abstract
Cleft palate repairs often require secondary surgeries and/or revisions for a variety of reasons. The most common causes are symptomatic oronasal fistulas and velopharyngeal insufficiency. Complications from primary surgery, such as wound dehiscence, infection, and hematomas, contribute to the relatively high rate of revision surgery. Prevention of postoperative complications that may lead to fistula or velopharyngeal insufficiency is key, and many techniques have been described that have reportedly decreased the incidence of secondary surgery. Management varies depending on the nature of the fistulous defect and the type of velopharyngeal insufficiency. Numerous surgical options exist to fix this deficiency.
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Affiliation(s)
- Shirley Hu
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jared Levinson
- Department of Otolaryngology-Head and Neck Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Joseph J Rousso
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine, New York, New York
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15
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Saving Face: Patient Strategies to Reduce Stigma and Barriers to Effective Decision-Making Among Children With Cleft Lip. J Craniofac Surg 2020; 31:1608-1612. [PMID: 32371692 DOI: 10.1097/scs.0000000000006520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Facial differences associated with cleft lips are often stigmatizing and can negatively impact psychosocial development and quality of life. However, little is known regarding patients' responses to societal expectations of appearance, or how these responses may impact utilization of revision surgery. Thus, patients with cleft lips at least 8 years of age (n = 31) were purposively sampled for semi-structured interviews. After verbatim transcription, first cycle coding proceeded with a semantic approach, which revealed patterns that warranted second cycle coding. The authors utilized an eclectic coding design to capture deeper meanings in thematic analysis. Additionally, survey data from a separate study were examined to evaluate participants' interest in improving appearance. Three major themes emerged, all of which reflected a desire to "save face" when interacting with society: (1) Cultural Mantras, which included societal mottos that minimized the importance of appearance; (2) Toughening Up, wherein the participants downplayed the difficulty of having a cleft; and (3) Deflection, wherein the participants took pride in facial features unrelated to their clefts. Despite these efforts to "save face," 78% of participants expressed interest in improving their appearance in the separate survey data.In conclusion, children with cleft lips try to "save face" when interacting with society by depreciating appearance, making light of clefts, and focusing on non-cleft related features. Paradoxically, many desired improvements of their appearance in an earlier survey. Awareness of these coping strategies is critical, as they may negatively impact surgeon-patient communication and inhibit patients from expressing interest in revision surgery.
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Sitzman TJ, Carle AC, Lundberg JN, Heaton PC, Helmrath MA, Trotman CA, Britto MT. Marked Variation Exists Among Surgeons and Hospitals in the Use of Secondary Cleft Lip Surgery. Cleft Palate Craniofac J 2020; 57:198-207. [PMID: 31597471 PMCID: PMC6957675 DOI: 10.1177/1055665619880056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify child-, surgeon-, and hospital-specific factors at the time of primary cleft lip repair that are associated with the use of secondary cleft lip surgery. DESIGN Retrospective cohort study. SETTING Forty-nine pediatric hospitals. PARTICIPANTS Children who underwent cleft lip repair between 1999 and 2015. MAIN OUTCOME MEASURE Time from primary cleft lip repair to secondary lip surgery. RESULTS By 5 years after primary lip repair, 24.0% of children had undergone a secondary lip surgery. In multivariable analysis, primary lip repair before 3 months had a 1.22-fold increased hazard of secondary surgery (95% confidence interval [CI]: 1.02-1.46) compared to repair at 7 to 12 months of age, and children with multiple congenital anomalies had a 0.77-fold decreased hazard of secondary surgery (95% CI: 0.68-0.87). After adjusting for cleft type, age at repair, presence of multiple congenital anomalies, and procedure volume, there remained substantial variation in secondary surgery use among surgeons and hospitals (P < .01). For children with unilateral cleft lip repaired at 3 to 6 months of age, the predicted proportion of children undergoing secondary surgery within 5 years of primary repair ranged from 4.9% to 21.8% across surgeons and from 4.5% to 24.7% across hospitals. CONCLUSIONS There are substantial differences among surgeons and hospitals in the rates of secondary lip surgery. Further work is needed to identify causes for this variation among providers.
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Affiliation(s)
- Thomas J. Sitzman
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, AZ, USA
- Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
| | - Adam C. Carle
- Department of Pediatrics, College of Medicine, University of Cincinnati, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, USA
| | | | - Pamela C. Heaton
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Michael A. Helmrath
- Division of Pediatric and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Carroll-Ann Trotman
- Department of Orthodontics, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Maria T. Britto
- Department of Pediatrics, College of Medicine, University of Cincinnati, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Variation in the Desire for Cleft Revision Surgery among Children, Caregivers, and Surgeons. Plast Reconstr Surg 2019; 144:171-178. [PMID: 31246825 DOI: 10.1097/prs.0000000000005722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although revision surgery is part of the reconstructive process for children with cleft lip and/or cleft palate, the indications for revision vary, and the extent to which surgeons and families agree on appearance is unclear. The authors sought to understand the extent to which children with cleft lip and/or cleft palate, surgeons, caregivers, and control observers agree on satisfaction with appearance and the desire for revision. METHODS Children with cleft lip and/or cleft palate (n = 100) and their caregivers (n = 100) were surveyed regarding satisfaction with appearance using the Cleft Evaluation Profile. Surgeons (n = 10) and control observers (n = 10) rated photographs of these children using questions analogous to the Cleft Evaluation Profile. General linear model repeated measures analysis of variance were used to detect significant differences between raters, with an alpha of 0.05. RESULTS The children reported greater satisfaction with appearance across all domains compared with surgeons (nose, 7.77 versus 5.51, p < 0.001; lip, 7.94 versus 5.90, p < 0.001; maxilla, 8.16 versus 6.56, p < 0.001) and general observers (nose, 7.78 versus 6.00, p < 0.001; lip, 7.80 versus 6.12, p < 0.001; maxilla, 8.16 versus 7.40, p < 0.001). Children and caregivers expressed similar degrees of satisfaction with appearance of the lip (5.48 ± 1.69 versus 5.6 ± 1.49, p > 0.5) and maxilla (6.08 ± 1.1 versus 5.8 ± 1.2, p = 0.07). There was no significant relationship between children and surgeons in terms of the desire for revision surgery (p = 0.44). CONCLUSIONS All groups expressed differing levels of satisfaction with cleft-specific aspects of appearance. Importantly, children were more satisfied than all other groups. Care must be taken to evaluate perceptions of all stakeholders before moving forward with cleft revision surgery.
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Karp E, Scott A, Martin K, Zavala H, Chinnadurai S, Roby B. Developing an Eye-Tracking Protocol to Determine Children’s Visual Perception of Secondary Cleft Lip Deformity. Cleft Palate Craniofac J 2019; 57:321-326. [DOI: 10.1177/1055665619868332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To develop a protocol that will be used to measure children’s perception of secondary cleft lip deformity (SCLD) using objective eye-tracking technology. Design: Cross-sectional study. Data collection May and June of 2018. Setting: Single tertiary care pediatric hospital with a well-established cleft team. Participants: Participants were recruited from a general pediatric otolaryngology clinic. Sixty participants from 4 age groups (5-6, 10, 13, and 16 years) were enrolled on a voluntary basis. Intervention: Pediatric participants viewed images of children’s faces while wearing eye-tracking glasses. Ten images with unilateral SCLD and 2 control images with no facial scarring were viewed as gaze was assessed. Main Outcome and Measure: Successful gaze fixation was recorded across all age groups. Results: This article illustrates the types of data generated from glasses-based eye tracking in children. All children, regardless of age, spent more time with their gaze on a SCLD images (mean = 4.23 seconds; standard deviation [SD] = 1.41 seconds) compared to control images (mean = 3.97 seconds; SD = 1.42). Younger age groups spent less time looking at specific areas of interest in SCLD images. Conclusion: In this pilot study, we were able to successfully use eye-tracking technology in children to demonstrate gaze preference and a trend toward visual perception of SCLD changing with age. This protocol will allow for a future study, with larger and more diverse populations. Better understanding of how SCLD is perceived among children and adolescents has the potential to guide future interventions for SCLD and other facial deformities in pediatric patients.
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Affiliation(s)
- Emily Karp
- Department of Otolaryngology—Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Scott
- Department of Pediatric Otolaryngology, Tufts University, Boston, MA, USA
| | | | - Hanan Zavala
- Department of Pediatric ENT and Facial Plastic Surgery, Children’s of Minnesota, Saint Paul, MN, USA
| | - Siva Chinnadurai
- Department of Otolaryngology—Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatric ENT and Facial Plastic Surgery, Children’s of Minnesota, Saint Paul, MN, USA
| | - Brianne Roby
- Department of Otolaryngology—Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatric ENT and Facial Plastic Surgery, Children’s of Minnesota, Saint Paul, MN, USA
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Bennett KG, Patterson AK, Schafer K, Haase M, Ranganathan K, Carlozzi N, Vercler CJ, Kasten SJ, Buchman SR, Waljee JF. Decision-Making in Cleft-Related Surgery: A Qualitative Analysis of Patients and Caregivers. Cleft Palate Craniofac J 2019; 57:161-168. [PMID: 31382774 DOI: 10.1177/1055665619866552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Preference-sensitive surgical decisions merit shared decision-making, as decision engagement can reduce decisional conflict and regret. Elective cleft-related procedures are often preference sensitive, and therefore, we sought to better understand decision-making in this population. DESIGN Semistructured interviews were conducted to elicit qualitative data. A hierarchical codebook was developed through an iterative process in preparation for thematic analysis. Thematic analysis was performed to examine differences between patients and caregivers. SETTING Multidisciplinary cleft clinic at a tertiary care center. PARTICIPANTS Patients with cleft lip aged 8 and older (n = 31) and their caregivers (n = 31) were purposively sampled. Inability to converse in English, intellectual disability, or syndromic diagnoses resulted in exclusion. MAIN OUTCOME MEASURES Preferences surrounding surgical decision-making identified during thematic analysis. RESULTS Mean patient age was 12.7 (standard deviation: 3.1). Most had unilateral cleft lip and palate (43.8%). Three themes emerged: Insufficient Understanding of Facial Difference and Treatment, Diversity of Surgical Indications, and Barriers to Patient Autonomy. Almost half of caregivers believed their children understood their clefts, but most of these children failed to provide information about their cleft. Although many patients and caregivers acknowledged that surgery addressed function and/or appearance, patients and caregivers exhibited differences regarding the necessity of surgery. Furthermore, a large proportion of patients believed their opinions mattered in decisions, but less than half of caregivers agreed. CONCLUSIONS Patients with clefts desire to participate in surgical decisions but have limited understanding of their facial difference and surgical indications. Cleft surgeons must educate patients and facilitate shared decision-making.
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Affiliation(s)
- Katelyn G Bennett
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Annie K Patterson
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kylie Schafer
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Madeleine Haase
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Noelle Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | | | - Steven J Kasten
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven R Buchman
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer F Waljee
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
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Cohn JE, Nyirjesy S, Davis WJ. Repair of a Secondary Cleft Lip Deformity With the Abbé Flap in a Pediatric Patient. EAR, NOSE & THROAT JOURNAL 2019; 98:265-267. [PMID: 30935227 DOI: 10.1177/0145561319837486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jason E Cohn
- 1 Department of Otolaryngology-Facial Plastic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Sarah Nyirjesy
- 2 Drexel University College of Medicine, Philadelphia, PA, USA
| | - Wellington J Davis
- 3 Department of Plastic Surgery, St. Christopher's Hospital for Children, Philadelphia, PA, USA
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Caregiver-Reported Outcomes and Barriers to Care among Patients with Cleft Lip and Palate. Plast Reconstr Surg 2019; 142:884e-891e. [PMID: 30489528 DOI: 10.1097/prs.0000000000004987] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND For children with cleft lip and/or palate, access to care is vital for optimizing speech, appearance, and psychosocial outcomes. The authors posited that inadequate access to care negatively impacts outcomes in this population. METHODS Sixty caregivers of children with cleft lip and palate were surveyed to assess perceived barriers using the validated Barriers to Care questionnaire. The questionnaire includes 39 items divided into five subscales, with higher scores indicating fewer barriers. Caregiver-reported outcomes were assessed using the Cleft Evaluation Profile, which captures cleft-specific appearance- and speech-related outcomes. Higher scores correspond to less satisfactory outcomes. Desire for revision surgery was assessed as a binary outcome among caregivers. Multivariable regression was used to evaluate the relationship of barriers to care, caregiver-reported outcomes, and desire for revision, adjusting for clinical and demographic covariates. RESULTS Sixty percent of caregivers perceived barriers to care, and caregivers who reported poorer access to care described poorer cleft-related outcomes (r = 0.19, p = 0.024). Caregivers with poorer skills (r = 0.17, p = 0.037), expectations (r = 0.17, p = 0.045), and pragmatics (r = 0.18, p = 0.026) subscale scores were associated with worse Cleft Evaluation Profile scores. Barriers were also negatively associated with aesthetic item scores (r = 0.11, p = 0.025). Finally, caregivers reporting fewer barriers were 21.2 percent less likely to express interest in revision surgery. CONCLUSIONS Barriers to care were associated with poorer appearance-related outcomes and increased interest in revision among caregivers of cleft patients. Enhancing access to care is critical in order to effectively meet goals of care for these families.
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Epidemiology of lip and palate clefts in northwest of Iran: Prevalence, surgery complications and unrepaired patients younger than 18 years old. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Health-Related Quality of Life and the Desire for Revision Surgery Among Children With Cleft Lip and Palate. J Craniofac Surg 2017; 27:1689-1693. [PMID: 27464565 DOI: 10.1097/scs.0000000000002924] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Children with cleft lip with or without palate (CLCP) require multiple reconstructive procedures, however, little is known about their desire for surgical revision. The purpose of this study was to examine the relationship between health-related quality of life (HRQOL) and the desire for revision. METHODS The authors surveyed children with CLCP (n = 71) and their caregivers regarding general and cleft-specific HRQOL and the desire for revision surgery. The authors used logistic regression models to evaluate the relationship between HRQOL and the desire for revision stratified by age, and determined the level of agreement between caregivers and children. RESULTS In this cohort, 54.9% of children desired revision, primarily of the nose (n = 23), lip (n = 20), and dentoalveolar structures (n = 19). Children 11 years or older were more likely to desire revision than younger children (OR 3.39, 95% CI [1.19, 9.67], P <0.05). Children who reported poorer HRQOL with respect to appearance (OR 2.31, 95% CI [1.25-4.29], P = 0.008), social development (OR 0.91, 95% CI [0.84-0.99], P = 0.02), and communication (OR 0.94, 95% CI [0.89-0.99], P = 0.02) were significantly more likely to desire revision than children who reported more positive HRQOL. Caregivers' and children's desires for revision were only modestly correlated (r = 0.41). CONCLUSIONS Children with CLCP who report poorer HRQOL are more likely to desire revision than children with higher HRQOL; these differences are further magnified among older children. Given the modest correlation between patient and caregiver goals for revision, it is important to evaluate both perspectives when considering revision surgery.
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The Use of an Inferior Pennant Flap during Unilateral Cleft Lip Repair Improves Lip Height Symmetry. Plast Reconstr Surg 2015; 136:1046-1053. [PMID: 26505705 DOI: 10.1097/prs.0000000000001707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To improve the rotation of Cupid's bow and achieve sufficient vertical lip height, several variations of the Millard rotation-advancement have incorporated a small laterally based triangular flap above the cutaneous roll. This study uses three-dimensional photogrammetry to evaluate the outcomes of unilateral cleft lip repairs performed with and without pennant flaps. METHODS Three-dimensional photographs were analyzed to assess postoperative lip height asymmetry in 90 unilateral cleft lip patients (58 complete and 32 incomplete) treated between 2001 and 2012. Cleft lip repairs were performed by three pediatric cleft surgeons using different techniques. Thirty-nine of 90 procedures (43 percent) used an inferiorly placed triangular flap. All patients were photographed at least 9 months postoperatively (mean, 4.2 years). Lip height asymmetry was based on the vertical distances from the subnasale to the peaks of Cupid's bow. RESULTS Regression analysis revealed that the use of a pennant flap was a significant predictor of postoperative lip height asymmetry (β = 4.2 percent, p = 0.015). The surgeon performing the repair was also a significant factor in patients with complete cleft lips (β = 3.6 percent, p = 0.005). All three surgeons achieved greater lip height symmetry when a pennant flap was performed. CONCLUSIONS The results of unilateral cleft lip repairs are affected by both the surgeon and the surgical technique. Procedures that used a pennant flap showed better philtral height symmetry than nonpennant repairs. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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