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Hofman L, Paes EC, Haverkamp SJ, Jenniskens K, Mink van der Molen AB. "Long term speech outcomes after using the Sommerlad technique for primary palatoplasty: a retrospective study in the Wilhelmina Children's Hospital, Utrecht.". Clin Oral Investig 2024; 28:441. [PMID: 39046574 DOI: 10.1007/s00784-024-05828-7] [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: 05/10/2024] [Accepted: 07/13/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES After cleft lip and/or palate (CL/P) repair, children may develop velopharyngeal insufficiency (VPI) leading to speech imperfections, necessitating additional speech correcting surgery. This study examines the incidence of VPI and speech correcting surgery after Sommerlad's palatoplasty for CL/P, and its association with various clinical features. MATERIALS AND METHODS A retrospective cohort study was performed in the Wilhelmina Children's Hospital in Utrecht and child records from 380 individuals with CL/P registered from 2008 to 2017 were retrospectively reviewed. Inclusion criteria comprised the diagnosis of CL/P, primary palatoplasty according to Sommerlad's technique, and speech assessment at five years or older. Association between cleft type and width, presence of additional genetic disorders and postoperative complications (palatal dehiscence, fistula) were assessed using odds ratios and chi squared tests. RESULTS A total of 239 patients were included. The VPI rate was 52.7% (n = 126) and in 119 patients (49.8%) a speech correcting surgery was performed. Severe cleft type, as indicated by a higher Veau classification, was associated with a significant higher rate of speech correcting surgeries (p = 0.033). Significantly more speech correcting surgeries were performed in patients with a cleft width >10 mm, compared to patients with a cleft width ≤10 mm (p < 0.001). Patients with oronasal fistula underwent significantly more speech correcting surgeries than those without fistula (p = 0.004). No statistically significant difference was found in the incidence of speech correcting surgery between patients with and without genetic disorders (p = 0.890). CONCLUSIONS/CLINICAL RELEVANCE Variations in cleft morphology, cleft width and complications like oronasal fistula are associated with different speech outcomes. Future research should focus on creating a multivariable prediction model for speech correcting surgery in CL/P patients.
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Affiliation(s)
- Lieke Hofman
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, the Netherlands.
| | - Emma C Paes
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, the Netherlands
| | - Sarah J Haverkamp
- Speech and Language Therapy, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Kevin Jenniskens
- Department of Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Aebele B Mink van der Molen
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, the Netherlands
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Monte TM, Raposo-Amaral CA, Sabbag A, Gil A, Menezes PT, Raposo-Amaral CE. Speech Outcomes After Palatal Lengthening Via Double Opposing Buccinator Myomucosal Flaps. Ann Plast Surg 2024; 92:395-400. [PMID: 38527345 DOI: 10.1097/sap.0000000000003809] [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: 03/27/2024]
Abstract
BACKGROUND Palatal lengthening is becoming a first-line treatment choice for cleft patients with velopharyngeal insufficiency (VPI). As cleft palate-related surgical outcomes are age dependent, speech outcomes may be similarly affected by patient age at the time of treatment. The primary goal of this study is to determine whether there are age-related speech outcome differences when double opposing buccinator myomucosal flaps are used as part of a palatal lengthening protocol and whether these outcome differences preclude utilization of this technique for specific patient age groups. METHODS A retrospective study was performed on consecutive nonsyndromic patients with VPI who underwent treatment using double opposing buccinator myomucosal flaps at our hospital between 2014 and 2021. Patients who completed the 15-month follow-up were stratified by age. Group A aged between 2 and 7 years (n = 14), group B aged 8 and 18 years (n = 23), and group C aged older than 18 years (n = 25) were included. Standardized perceptual speech evaluations and nasopharyngoscopy were performed. Hypernasality, soft palate mobility, and lateral palatal wall mobility were assessed both preoperatively and at a 15-month postoperative interval. Complications were also recorded. The χ2 test was used for statistical comparison. RESULTS All of the age-stratified patient groups in this study showed significant improvement in hypernasality, soft palate mobility, and lateral wall mobility (P < 0.01), with no statistically significant differences between the different patient age groups. Overall speech success was achieved in 69.4% of patients. Patients in group A achieved 78.6% speech success, patients in group B achieved 78.3% speech success, and patients in group C achieved 56% speech success, with no statistically significant differences being shown regarding speech success between the different patient age groups (P > 0.05). CONCLUSIONS Regardless of age, palatal lengthening via double opposing buccinator myomucosal flaps similarly improves speech outcomes.
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Affiliation(s)
- Thais Miguel Monte
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Brazil
| | - Cesar A Raposo-Amaral
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Brazil
| | | | - André Gil
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Brazil
| | - Priscila T Menezes
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Brazil
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Esmailzade Moghimi S, Rezaei P, Sadeghi S, Feizi A, Derakhshandeh F. Outcomes of primary repair of cleft palate using sommerled intravelar veloplasty associated with velocardiofacial syndrome. Int J Pediatr Otorhinolaryngol 2024; 179:111940. [PMID: 38588634 DOI: 10.1016/j.ijporl.2024.111940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/23/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES Velocardiofacial syndrome, a prevalent microdeletion syndrome occurring in 1 in 2000-4000 live births, is marked by speech and language disorders, notably velopharyngeal dysfunction. This study investigates speech outcomes, nasometric and videofluoroscopic results before and after primary repair of cleft palate using the Sommerlad intravelar veloplasty (SIVV) technique within the Isfahan cleft care team for patients with velocardiofacial syndrome. METHODS Employing a quasi-experimental design, 19 participants with velocardiofacial syndrome, who underwent primary cleft palate repair by the Isfahan cleft care team, were included through convenience sampling. Perceptual and instrumental outcomes were assessed pre-and post-operatively. Statistical analysis encompassed paired t-tests and the non-parametric Wilcoxon signed-rank test (p < 0.05). RESULTS The study identified no statistically significant differences between pre-and post-surgical speech outcome parameters and nasalance scores. Nonetheless, a significant distinction emerged in the velopharyngeal closure ratio based on fluoroscopic evaluation (p = 0.038). CONCLUSION The efficacy of the SIVV technique in treating velopharyngeal dysfunction in velocardiofacial syndrome patients is inconclusive, demanding further research. Post-surgical speech outcomes are influenced by surgical technique, hypotonia, apraxia of speech, and surgery timing. Notably, an elevated velopharyngeal valve closure ratio, though anatomically indicative, does not exclusively predict surgical success.
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Affiliation(s)
- Sarah Esmailzade Moghimi
- Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran; Faculty of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Rezaei
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Sadeghi
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Awat Feizi
- Department of Biostatistics, Faculty of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Derakhshandeh
- Craniofacial and Cleft Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Hussain SA, Vijayakumar C, Balasubramanian S, Rahavi-Ezabadi S, Sundar V, Sybil D, Hussain Z. Management of Velopharyngeal Dysfunction (VPD) Following Cleft Palate Repair: A Comprehensive Decision-Making Process Based on Severity and Structural Deficiencies. Cleft Palate Craniofac J 2024:10556656231225573. [PMID: 38213261 DOI: 10.1177/10556656231225573] [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: 01/13/2024] Open
Abstract
OBJECTIVE To describe a comprehensive decision-making process for surgical correction of structural Velopharyngeal Dysfunction (VPD) following cleft palate repair and evaluate its efficacy. DESIGN Retrospective study. SETTING Tertiary care hospital. PATIENTS 300 consecutive patients with unilateral or bilateral cleft lip and palate (CLP) or isolated cleft palate (CP) diagnosed with clinical VPD following cleft palate repair between 2009 and 2014. Of these 206 patients had structural VPD and underwent surgical correction. INTERVENTIONS Surgical corrections were carried out according to the comprehensive two stage decision making process developed by the investigators. Step 1 of decision-making involved visualisation of the VP sphincter function by nasoendoscopy. This was followed by step 2 which involved per-operative identification of scarring, tissue loss, hypoplasia and other structural deficiencies in the soft palate and septal mucoperiosteum. The choice of operation was then made from a repertoire of interrelated and escalating surgical procedures consisting of palate revision and pharyngoplasties ranging from most anatomical to the least. MAIN OUTCOME MEASURES Evidence of postoperative restoration of VP function on nasoendoscopy, evaluation of speech for hypernasality, understandability, acceptability and symptoms of obstructive sleep apnea. RESULTS Complete VP closure was demonstrated in 94% of patients treated using this algorithm. There was significant improvement in all speech parameters (p < 0.00001). CONCLUSION Our comprehensive decision-making process is designed to effectively correct structural VPD according to the severity of structural and functional deficiencies in the soft palate and avoid over treatment.
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Affiliation(s)
- Syed Altaf Hussain
- The Cleft and Craniofacial Centre and The Department of Plastic Surgery, Sree Balaji Medical College and Rela Hospital Campus, Bharath Institute of Higher Education and Research, Chennai, 600044, India
- Smile Train, New Delhi, India
| | - Charanya Vijayakumar
- The Cleft and Craniofacial Centre and The Department of Plastic Surgery, Sree Balaji Medical College and Rela Hospital Campus, Bharath Institute of Higher Education and Research, Chennai, 600044, India
- Smile Train, New Delhi, India
| | - Subramaniyan Balasubramanian
- Smile Train, New Delhi, India
- The Cleft and Craniofacial Centre, Department of Speech Language Pathology and Audiology, Sree Balaji Medical College and Rela Hospital Campus, Bharath Institute of Higher Education and Research, Chennai, 600044, India
| | - Sara Rahavi-Ezabadi
- The Cleft and Craniofacial Centre and The Department of Plastic Surgery, Sree Balaji Medical College and Rela Hospital Campus, Bharath Institute of Higher Education and Research, Chennai, 600044, India
- Otorhinolaryngology Research Center, Otorhinolaryngology Head and Neck Surgery Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vishnu Sundar
- Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, India
| | - Deborah Sybil
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, Okhla, New Delhi 110025, India
| | - Zaid Hussain
- Post-doctoral Research Fellow, Department of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, Massachusetts, USA
- Former Research Assistant, Department of Plastic Surgery, SRMC Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, India
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Hofman L, van Dongen JA, van Rees RCM, Jenniskens K, Haverkamp SJ, Beentjes YS, van der Molen ABM, Paes EC. Speech correcting surgery after primary palatoplasty: a systematic literature review and meta-analysis. Clin Oral Investig 2023; 28:58. [PMID: 38157017 DOI: 10.1007/s00784-023-05391-7] [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: 09/14/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES In cleft palate patients, the soft palate is commonly closed using straight-line palatoplasty, Z-palatoplasty, or palatoplasty with buccal flaps. Currently, it is unknown which surgical technique is superior regarding speech outcomes. The aim of this review is to study the incidence of speech correcting surgery (SCS) per soft palatoplasty technique and to identify variables which are associated with this outcome. MATERIALS AND METHODS A systematic literature search was carried out according to the PRISMA guidelines. Inclusion and exclusion criteria were applied to focus on the incidence of SCS after soft palatoplasty. Additional variables like surgical modification, cleft morphology, syndrome, age at palatoplasty, fistula and assessment of velopharyngeal function were reported. A modified New-Ottawa Scale (NOS) was used for quality appraisal. Pooled estimates from the meta-analysis were calculated using a random-effects model. RESULTS One thousand twenty-nine studies were found of which 54 were included in the analysis. The pooled estimate proportion of SCS after straight-line palatoplasty was 19% (95% CI 15-24), after Z-palatoplasty 6% (95% CI 4-9), and after palatoplasty with buccal flaps 7% (95% CI 4-11). CONCLUSIONS A lower SCS rate was found in patients receiving Z-palatoplasty when compared to straight-line palatoplasty. We propose a minimum set of outcome parameters which ideally should be included in future studies regarding speech outcomes after cleft palate repair. CLINICAL RELEVANCE Current literature reports highly heterogenous data regarding cleft palate repair. Our recommended set of parameters may address this inconsistency and could make intercenter comparison possible and of better quality.
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Affiliation(s)
- Lieke Hofman
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
| | - Joris A van Dongen
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | | | - Kevin Jenniskens
- Department of Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sarah J Haverkamp
- Speech and Language Therapy, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Yente S Beentjes
- Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Aebele B Mink van der Molen
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Emma C Paes
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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Davis MJ, Roy MG, Burns HR, Yim N, Wilson KD, Moore EE, Buchanan EP, Monson LA. Velopharyngeal Insufficiency Following Furlow Versus Straight Line Repair With Intravelar Veloplasty: A Single-institution Experience. J Craniofac Surg 2023:00001665-990000000-01226. [PMID: 37982999 DOI: 10.1097/scs.0000000000009874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/09/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Measurements of postoperative velopharyngeal dysfunction (VPD) can be used to determine the efficacy of a palatoplasty operation. Hypernasality and audible nasal air emission are typical manifestations of VPD during speech. We aimed to longitudinally compare VPD outcomes in postpalatoplasty patients who underwent Furlow repair versus straight line repair with intravelar veloplasty (IVVP). Additionally, we examined the relationship between VPD outcomes and select pre-existing patient characteristics. METHODS Retrospective chart review was performed to identify primary palatoplasty patients treated from April 2012 to March 2021. Variables collected included gender, syndromic status, primary language, Veau cleft type, type of speech assessment, age at time of surgery, degree of hypernasality, presence of audible nasal air emission, and overall adequacy of velopharyngeal function. Pearson χ2 test and multivariable t tests were used to analyze variables. Logistic regression was used to control for statistically significant variables. RESULTS Of the 118 patients included, 38 received a Furlow procedure and 80 received a straight line with IVVP procedure. Audible nasal air emission was present in 57.3% of straight line with IVVP patients and 42.9% of Furlow patients, with no statistically significant difference between groups. Clinically significant hypernasality was present in 42.1% of straight line with IVVP patients and 22.9% of Furlow patients (P=0.05). Velopharyngeal function was classified as adequate in 63.5% of straight line with IVVP patients and 83.3% of Furlow patients (P=0.03). However, after stratifying by syndromic versus nonsyndromic status, there was no statistically significant difference between straight line with IVVP and Furlow patients for postoperative hypernasality and velopharyngeal function. CONCLUSIONS This study suggests that there are no statistically significant differences between straight line with IVVP and Furlow palatoplasty techniques regarding speech outcomes including hypernasality, audible nasal air emission, and overall VP function. Furthermore, select patient characteristics such as gender, primary language, syndromic status, age at repair, and Veau cleft type do not significantly impact postoperative speech outcomes.
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Affiliation(s)
- Matthew J Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital
| | - Michelle G Roy
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital
| | - Heather R Burns
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital
| | - Nicholas Yim
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Kristina D Wilson
- Speech, Language, and Learning, Texas Children's Hospital, Houston, TX
| | - Ellen E Moore
- Speech, Language, and Learning, Texas Children's Hospital, Houston, TX
| | - Edward P Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital
| | - Laura A Monson
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital
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Haas Junior OL, Rosa BM, Pourtaheri N, Guijarro-Martínez R, Valls-Ontañón A, Hernández-Alfaro F, de Oliveira RB, Steinbacher DM. Fat grafting in patients with cleft lip and palate: A systematic review. J Craniomaxillofac Surg 2023; 51:178-187. [PMID: 37032224 DOI: 10.1016/j.jcms.2023.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 11/17/2022] [Accepted: 01/28/2023] [Indexed: 02/03/2023] Open
Abstract
This systematic review aims to compare different fat-grafting techniques for cleft lip and palate repair. A search was conducted in PubMed, Embase, Cochrane Library, gray literature and reference lists of selected articles. A total of 25 articles were included, 12 on closure of palatal fistula and 13 on cleft lip repair. The rate of complete resolution of palatal fistula ranged from 88.6% to 100% in studies with no control group, whereas in comparative studies patients receiving a fat graft showed better outcomes than those not receiving a graft. Evidence suggests that fat grafting can be indicated for the primary and secondary repair of cleft palate, with good results. The use of dermis-fat grafts in lip repair was associated with gains in surface area (11.5%), vertical height (18.5%-27.11%), and lip projection (20%). Fat infiltration was associated with increased lip volume (6.5%), vermilion show (31.68% ± 24.03%), and lip projection (46.71% ± 31.3%). The available literature suggests that fat grafting is a promising autogenous option for palate and fistula repair and for improvement of lip projection and scar aesthetics in patients with cleft. However, to develop a guideline, further studies are needed to confirm whether one technique is superior to the other.
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de Araújo LL, Alonso N, Fukushiro AP. Treatment of Cleft Lip and Palate in the Amazon Region in Brazil: Speech Results and Sociodemographic Aspects. Cleft Palate Craniofac J 2021; 59:595-602. [PMID: 34032142 DOI: 10.1177/10556656211017791] [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: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the speech outcomes in individuals with cleft lip and palate (CLP) from the Amazon region and determine their correlation with sociodemographic factors. DESIGN Cross-sectional, prospective, single-blind study. SETTING Tertiary care institute in Manaus, Amazonas, Brazil. PATIENTS Four hundred twenty individuals with CLP, aged 4 to 57 years. MAIN OUTCOME MEASURES The samples were judged by 3 speech pathologists experienced in the speech assessment of individuals with CLP. Hypernasality was scored using a 4-point scale, being 1 = absent, 2 = mild, 3 = moderate, and 4 = severe, and the active speech symptoms were classified as absent or present. The final score for each speech symptom was reached by consensus among the 3 examiners Descriptive analysis of sociodemographic data included origin, socioeconomic status, type of cleft, surgical technique employed, the age they underwent primary and secondary palatoplasty, and palatal fistula. RESULTS Absence of hypernasality was observed in 41% of the individuals, 18% had mild, 28% moderate, and 13% severe hypernasality. Active speech symptoms were observed in 57% of the individuals. Significant correlations were found between speech outcomes and the variables such as origin, socioeconomic status, age at primary and secondary palatoplasty, and presence of fistula. CONCLUSIONS Most individuals with repaired CLP from the Amazon region presented speech disorders, characterized by hypernasality and active errors. Patients living outside the state capital, of low socioeconomic level, underwent palatoplasty late and with presence of palatal fistula tended to have the worst speech outcomes.
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Affiliation(s)
- Laryssa Lopes de Araújo
- Yaçuri da Amazônia Institute, Manaus, Brazil.,Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Nivaldo Alonso
- Department of Plastic Surgery, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Ana Paula Fukushiro
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.,Speech-Language Pathology Department, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Vu GH, Kalmar CL, Zimmerman CE, Humphries LS, Swanson JW, Bartlett SP, Taylor JA. Is Risk of Secondary Surgery for Oronasal Fistula Following Primary Cleft Palate Repair Associated With Hospital Case Volume and Cost-to-Charge Ratio? Cleft Palate Craniofac J 2021; 58:603-611. [PMID: 33840261 DOI: 10.1177/1055665620959528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics-cost-to-charge ratio (RCC) and case volume of cleft palate repair. DESIGN Retrospective cohort study. SETTING This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. PATIENTS AND PARTICIPANTS Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. MAIN OUTCOME MEASURE(S) The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. RESULTS Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; P ≤ .001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], P = .233; AOR = 0.86 [0.62-1.20], P = .386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], P = .005; AOR = 3.14 [1.80-5.58], P < .001). CONCLUSIONS Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula.
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Affiliation(s)
- Giap H Vu
- Division of Plastic and Reconstructive Surgery, 6567Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher L Kalmar
- Division of Plastic and Reconstructive Surgery, 6567Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie E Zimmerman
- Division of Plastic and Reconstructive Surgery, 6567Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura S Humphries
- Division of Plastic and Reconstructive Surgery, 6567Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic and Reconstructive Surgery, 6567Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott P Bartlett
- Division of Plastic and Reconstructive Surgery, 6567Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic and Reconstructive Surgery, 6567Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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Abdollahi Fakhim S, Nouri-Vaskeh M, Amiri F, Shahidi N. Comparison of two-flap palatoplasty plus intravelar veloplasty technique with and without double-layer Z-plasty on the soft palate length in children with cleft palate. Oral Maxillofac Surg 2020; 24:495-499. [PMID: 32653995 DOI: 10.1007/s10006-020-00884-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/07/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Velopharyngeal failure occurs as a result of a nasopharyngeal gap following inadequate velopharyngeal closure for structural or functional cause. We aimed to compare the soft palate length in two-flap palatoplasty with intravelar veloplasty (IVV) and two-flap palatoplasty with IVV plus double-layer Z-plasty combination in patients with cleft palate. METHODS This clinical trial was conducted on infants aged 9 to 12 months with cleft palate in two groups. The method of two-flap palatoplasty with IVV technique and two-flap palatoplasty with IVV plus double-layer Z-plasty was compared in terms of soft palate length which was measured during operation and short-term complications. RESULTS This study was conducted on 62 infants including 30 patients in two-flap palatoplasty with IVV group and 32 patients in two-flap palatoplasty with IVV plus double-layer Z-plasty group. The soft palate length in two-flap palatoplasty and IVV with and without Z-plasty groups before surgery was 17.56 ± 2.05 and 17.68 ± 1.88 mm, respectively (P = 0.561). After surgery, the soft palate length was significantly higher in two-flap palatoplasty with IVV plus Z-plasty group (22.43 ± 2.73 mm vs. 20.56 ± 2.42 mm) (P = 0.032). CONCLUSION The two-flap palatoplasty with IVV plus Z-plasty technique is a suitable method for increasing the palatal length in infants with cleft palate. On the other hand, the addition of Z-plasty method could increase the length of the palate. Moreover, the complications are very low and further trials for development of this method on patients with cleft palate are recommended. TRIAL REGISTRATION NUMBER (TRN) IRCT2017032423559N11.
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Affiliation(s)
- Shahin Abdollahi Fakhim
- Department of Otorhinolaryngology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Nouri-Vaskeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Faezeh Amiri
- Department of Otorhinolaryngology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nikzad Shahidi
- Department of Otorhinolaryngology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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11
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Rezaei P, Poorjavad M, Abdali H. Speech outcomes after palatal closure in 3-7-year-old children. Braz J Otorhinolaryngol 2020; 88:594-601. [PMID: 33268307 PMCID: PMC9422456 DOI: 10.1016/j.bjorl.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 08/02/2020] [Accepted: 08/22/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction One of the main goals of the team approach in management of oro-facial clefts is to help the children with cleft palate have adequate speech development. Objective The present study aimed to investigate the prevalence of articulation and resonance disorders following palate closure in children who were visited for routine examination by the Isfahan Cleft Care Team between 2011 and 2015, and to study the impact of cleft type and age at the time of palatoplasty on speech outcomes. Methods Clinical records of 180 preschool children with repaired cleft palate were reviewed. The percentage of children demonstrating hypernasality, nasal emission, nasal turbulence, and compensatory misarticulations was calculated. The relationship between cleft type and age at the time of palatal surgery, as independent variables, and speech outcomes were examined. Results 67.7 and 64.5 percent of the children demonstrated respectively moderate/severe hypernasality and nasal emission, and 71.1 percent produced compensatory misarticulations. Age at the time of palatal repair was significantly associated with compensatory misarticulations and also with moderate/severe hypernasality. The prevalence of compensatory misarticulations, significant hypernasality, nasal emission and also nasal turbulence was not significantly different in various types of cleft. Conclusions We observed a high prevalence of different speech disorders in preschool children with repaired cleft palate compared to other studies. This can be partly due to late palatal repair in the studied population. Despite many advances in cleft palate management programs in Iran, there are still many children who do not access the interdisciplinary team cares in their early childhood. We should, therefore, try to increase accessibility of appropriate and timely management services to all Iranian children with cleft lip/palate.
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Affiliation(s)
- Parisa Rezaei
- Isfahan University of Medical Sciences, Craniofacial and Cleft Research Center, Isfahan, Iran; Isfahan University of Medical Sciences, School of Rehabilitation Sciences, department of Speech Therapy, Isfahan, Iran
| | - Marziyeh Poorjavad
- Isfahan University of Medical Sciences, School of Rehabilitation Sciences, department of Speech Therapy, Isfahan, Iran.
| | - Hossein Abdali
- Isfahan University of Medical Sciences, Craniofacial and Cleft Research Center, Isfahan, Iran; Isfahan University of Medical Sciences, Department of Plastic Surgery, Isfahan, Iran
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12
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Abdel-Aziz M, Talaat A, El-Tahan AR, Kamel A, Ghandour H, Abdel-Hameed A. Pharyngeal flap for a poorly repaired cleft palate with posterior palatal defect. Int J Pediatr Otorhinolaryngol 2020; 133:109977. [PMID: 32169774 DOI: 10.1016/j.ijporl.2020.109977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Posterior palatal defect after cleft palate (CP) repair is not a rare problem, it may cause velopharyngeal insufficiency (VPI). The aim of this study was to assess the effectiveness of a superiorly-based pharyngeal flap (PF) with modification of its end to accommodate the defect in treatment of post-palatoplasty VPI. METHODS Thirteen children with VPI due to posterior palatal defect after CP repair were included in this study. PF was used in treatment of all patients, the lower end of the flap was fashioned in a V-shape to accustom the shape of the defect with peeling of its overlying mucosa to enhance wound healing. The PF was inserted deeply into a tunnel created within the defect between the oral and nasal layers of the palate. Pre- and postoperative evaluation using auditory perceptual assessment (APA), nasometric assessment and velopharyngoscopy were performed. RESULTS Significant improvement of APA and nasalance score for both oral and nasal sentences was achieved. Also, velopharyngoscopy showed complete velopharyngeal closure in all patients postoperatively. CONCLUSION A modified PF is an effective treatment for VPI caused by posterior palatal defect that may be encountered after CP repair.
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Affiliation(s)
- Mosaad Abdel-Aziz
- Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Ahmed Talaat
- Department of Otolaryngology, Suez Canal University Hospital, Ismailia, Egypt
| | | | - Ahmed Kamel
- Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hassan Ghandour
- Department of Otolaryngology (Phoniatric Unit), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Asmaa Abdel-Hameed
- Department of Otolaryngology (Phoniatric Unit), Cairo University, Cairo, Egypt
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13
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Moreau A, Charpuis-Vandenbogaerde C, Neiva-Vaz C, Sanquer E, Soupre V, Vazquez MP, Picard A, Kadlub N. Speech outcome after intravelar veloplasty. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:147-150. [PMID: 32450319 DOI: 10.1016/j.jormas.2020.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Cleft lip and palate is the main craniofacial malformation in France. Many surgical techniques had been described to restore cleft palate. In this study, we evaluate phonation in a homogeneous series of patient with isolated unilateral non-syndromic cleft lip and palate before (and after) alveolar cleft closure, operated according to our surgical protocol. METHODS We included retrospectively 71 patients with isolated non-syndromic unilateral cleft lip and palate (UCLP), operated in our department from 2009 to 2013. All patients underwent the same surgical protocol: modified Millard cheilorhinoplasty (from 5 to 9-month-old); direct hard palatal closure (from 12 to 20-month-old); alveolar cleft closure with cancellous iliac bone graft (from 4 to 6-year-old). The phonation and clinical statute were evaluated before and after alveolar cleft closure. Fistula rate and speech evaluation were recorded. RESULTS The rate of oronasal fistula was 12.7%. About phonation, 76% and 86% of patients were competent or borderline competent respectively before and after gingivoperiostoplasty. CONCLUSION This surgical protocol provided speech results in patients with isolated unilateral non-syndromic cleft lip and palate. The gingivoperiostoplasty improved the speech intelligibility.
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Affiliation(s)
- A Moreau
- Service de chirurgie maxillo-faciale et chirurgie plastique, Necker Enfants-Malades, AP-HP, 75015 Paris, France; Centre de référence fentes et malformations faciales, AP-HP, 75015 Paris, France
| | - C Charpuis-Vandenbogaerde
- Service de chirurgie maxillo-faciale et chirurgie plastique, Necker Enfants-Malades, AP-HP, 75015 Paris, France; Centre de référence fentes et malformations faciales, AP-HP, 75015 Paris, France
| | - C Neiva-Vaz
- Service de chirurgie maxillo-faciale et chirurgie plastique, Necker Enfants-Malades, AP-HP, 75015 Paris, France; Centre de référence fentes et malformations faciales, AP-HP, 75015 Paris, France
| | - E Sanquer
- Service de chirurgie maxillo-faciale et chirurgie plastique, Necker Enfants-Malades, AP-HP, 75015 Paris, France; Centre de référence fentes et malformations faciales, AP-HP, 75015 Paris, France
| | - V Soupre
- Service de chirurgie maxillo-faciale et chirurgie plastique, Necker Enfants-Malades, AP-HP, 75015 Paris, France; Centre de référence fentes et malformations faciales, AP-HP, 75015 Paris, France
| | - M P Vazquez
- Service de chirurgie maxillo-faciale et chirurgie plastique, Necker Enfants-Malades, AP-HP, 75015 Paris, France; Centre de référence fentes et malformations faciales, AP-HP, 75015 Paris, France
| | - A Picard
- Service de chirurgie maxillo-faciale et chirurgie plastique, Necker Enfants-Malades, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France; Centre de référence fentes et malformations faciales, AP-HP, 75015 Paris, France; Inserm, UMRS 1138, centre de recherche de Cordeliers, pathologie orale et moléculaire, 75006 Paris, France
| | - N Kadlub
- Service de chirurgie maxillo-faciale et chirurgie plastique, Necker Enfants-Malades, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France; Centre de référence fentes et malformations faciales, AP-HP, 75015 Paris, France; Inserm, UMRS 1138, centre de recherche de Cordeliers, pathologie orale et moléculaire, 75006 Paris, France.
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14
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Baillie L, Sell D. Benchmarking Speech, Velopharyngeal Function Outcomes and Surgical Characteristics Following the Sommerlad Protocol and Palate Repair Technique. Cleft Palate Craniofac J 2020; 57:1197-1215. [DOI: 10.1177/1055665620923925] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective: To report speech and velopharyngeal function (VPF) outcomes, and surgical characteristics, at age 5 following early complete palate closure using the Sommerlad protocol. Design: A retrospective, descriptive, cross-sectional consecutive series. Setting: A regional twin site center; a district general hospital and tertiary children’s hospital. Participants: Between 1993 and 2006, 877 participants underwent surgery; 712 (81%) were eligible for inclusion; 391 (55%) were included, 321 (45%) excluded. Thirteen percent had bilateral cleft lip and palate (CLP), 40% unilateral CLP, and 47% isolated cleft palate. Intervention: Lip and vomerine flap repair at 3 months of age (BCLP, UCLP) with soft palate closure using radical muscle dissection and retropositioning at a mean age of 6.6 months, range 4 to 23 months, as described and undertaken by Sommerlad. Outcome Measures: Velopharyngeal Composite (VPC) CAPS-A and articulation summary scores derived from analysis using the Cleft Audit Protocol for Speech-Augmented. Results: A VPC-SUM CAPS-A score of “0” was found in 97% reflecting adequate VPF; 73% had no cleft articulation difficulties. The BCLP group had the poorest articulation. Secondary speech surgery rate was 2.6% and 10.7% had fistula repair. Levator muscle quality and degree of retropositioning was associated with speech outcomes related to VPF. 2.6% had current features of VPI. Conclusions: Complete palate closure by around 6 months of age by the surgeon who described the technique led to excellent perceived VPF and very good speech outcomes at age 5, with less speech therapy and secondary speech surgery than commonly reported. These findings serve as a benchmark for the Sommerlad protocol and technique.
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Affiliation(s)
- Lauren Baillie
- Speech and Language Therapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Debbie Sell
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
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15
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Shetty KR, Ward LM, Levi JR, Grillone G. Novel treatment for mild and moderate velopharyngeal insufficiency using implantable AlloDerm for posterior pharyngeal wall augmentation and review of surgical repair techniques. Am J Otolaryngol 2019; 40:102274. [PMID: 31444004 DOI: 10.1016/j.amjoto.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Mild and moderate velopharyngeal insufficiency is a relatively common structural defect of the velopharyngeal sphincter that occurs congenitally or secondarily to various medical conditions resulting in speech inadequacy. Currently, multiple surgical methods exist to treat mild and moderate velopharyngeal insufficiency; however, the revision rates are high and the outcomes are variable. This case series describes a novel technique using implantable AlloDerm to repair the posterior pharyngeal wall to treat mild and moderate velopharyngeal insufficiency. MATERIALS AND METHODS This paper presents four patients with mild or moderate velopharyngeal insufficiency who were treated with implantable AlloDerm in the posterior pharyngeal wall at a large, safety-net hospital in New England from 2000 to 2019. Additionally, a review of surgical repair techniques for velopharyngeal insufficiency was conducted with synthesis of a qualitative overview. RESULTS There were sufficient follow-up data in three of these patients. All three reported subjective improvements in symptoms after the procedure. One patient had implant extrusion one month following the procedure with subsequent removal. CONCLUSION Ultimately, implantable AlloDerm for posterior pharyngeal wall augmentation is a useful, low risk method for treating mild to moderate velopharyngeal insufficiency.
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16
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Sell D, Seselgyte R, Prendeville N, Sadri A, Pinkstone M. Letter comments on: Time course of improvement after re-repair procedure for VPI management. J Plast Reconstr Aesthet Surg 2019; 72:2064-2094. [PMID: 31607595 DOI: 10.1016/j.bjps.2019.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Debbie Sell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID).
| | | | | | - Amir Sadri
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom
| | - Marie Pinkstone
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom
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