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Kauffmann P, Kolle J, Quast A, Wolfer S, Schminke B, Meyer-Marcotty P, Schliephake H. Two-stage palatal repair in non-syndromic CLP patients using anterior to posterior closure is associated with minimal need for secondary palatal surgery. Head Face Med 2024; 20:18. [PMID: 38461271 PMCID: PMC10924352 DOI: 10.1186/s13005-024-00418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/16/2024] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE The aim of the present study was to assess the need for secondary palatal corrective surgery in a concept of palate repair that uses a protocol of anterior to posterior closure of primary palate, hard palate and soft palate. METHODS A data base of patients primarily operated between 2001 and 2021 at the Craniofacial and Cleft Care Center of the University Goettingen was evaluated. Cleft lips had been repaired using Tennison Randall and Veau-Cronin procedures in conjunction with alveolar cleft repair. Cleft palate repair in CLP patients was accomplished in two steps with repair of primary palate and hard palate first using vomer flaps at the age of 10-12 months and subsequent soft palate closure using Veau/two-flap procedures 3 months later. Isolated cleft palate repair was performed in a one-stage operation using Veau/two-flap procedures. Data on age, sex, type of cleft, date and type of surgery, occurrence and location of oronasal fistulae, date and type of secondary surgery performed for correction of oronasal fistula (ONF)and / or Velophyaryngeal Insufficiency (VPI) were extracted. The rate of skeletal corrective surgery was registered as a proxy for surgery induced facial growth disturbance. RESULTS In the 195 patients with non-syndromic complete CLP evaluated, a total number of 446 operations had been performed for repair of alveolar cleft and cleft palate repair (Veau I through IV). In 1 patient (0,5%), an ONF occurred requiring secondary repair. Moreover, secondary surgery for correction of VPI was required in 1 patient (0,5%) resulting in an overall rate of 1% of secondary palatal surgery. Skeletal corrective surgery was indicated in 6 patients (19,3%) with complete CLP in the age group of 15 - 22 years (n = 31). CONCLUSIONS The presented data have shown that two-step sequential cleft palate closure of primary palate and hard palate first followed by soft palate closure has been associated with minimal rate of secondary corrective surgery for ONF and VPI at a relatively low need for surgical skeletal correction.
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Affiliation(s)
- Philipp Kauffmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany.
- Georg-August-University Goettingen, Robert-Koch-Straße 40, Goettingen, 37099, Germany.
| | - Johanna Kolle
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Anja Quast
- Department of Orthodontics, University Medical Center Goettingen, Goettingen, Germany
| | - Susanne Wolfer
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Boris Schminke
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
| | | | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
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Denadai R, Seo HJ, Go Pascasio DC, Sato N, Murali S, Lo CC, Chou PY, Lo LJ. Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible? Cleft Palate Craniofac J 2024; 61:247-257. [PMID: 36066016 DOI: 10.1177/10556656221123917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE An inspiring early result with no oronasal fistula formation was recently described for a modified medial incision small double-opposing Z-plasty (MIsDOZ) for treating Veau type I cleft palate. This study describes an early single-surgeon experience in applying this newly proposed surgical approach. DESIGN Retrospective single-surgeon study. PATIENTS Consecutive nonsyndromic patients (n = 27) with Veau I cleft palate. INTERVENTIONS Topographic anatomical-guided MIsDOZ palatoplasty with pyramidal space dissection (releasing of the ligamentous fibers in the greater palatine neurovascular bundle and pyramidal process region, in-fracture of the pterygoid hamulus, and widening of space of Ernst) performed by a novice surgeon (RD). MEAN OUTCOME MEASURES Age at surgery, the presence of cleft lip, palatal cleft width, use of lateral relaxing incision, and 6-month complication rate (bleeding, dehiscence, fistula, and flap necrosis). A published senior surgeon-based outcome dataset (n = 24) was retrieved for comparison purposes. RESULTS Twenty-two (81.5%) and 5 (18.5%) patients received the medial incision only technique and lateral incision technique, respectively (P = .002). Age, presence of cleft lip, and cleft width were not associated (all P > .05) with the use of lateral incision. Comparative analysis between the novice surgeon- and senior surgeon-based datasets revealed no significant differences for sex (females: 74.1% vs 62.5%; P = .546), age (10.2 ± 1.7 vs 9.6 ± 1.2 months; P = .143), rate of lateral incision (18.5% vs 4.2%; P = .195), and postoperative complication rate (0% vs 0%). CONCLUSION This modified DOZ palatoplasty proved to be a reproducible procedure for Veau I cleft palate closure, with reduced need for lateral incision and with no early complication.
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Affiliation(s)
- Rafael Denadai
- Plastic and Cleft-Craniofacial Surgery, A&D DermePlastique, Sao Paulo, Brazil
| | - Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dax Carlo Go Pascasio
- Section of Plastic and Reconstructive Surgery, Southern Philippines Medical Center, Davao, Philippines
| | - Nobuhiro Sato
- Department of Plastic and Reconstructive Surgery, Showa University Hospital, Tokyo, Japan
| | - Srinisha Murali
- Oral and Maxillofacial Surgery, Kumaran Clinic and Nursing Home Trichy, Tamil Nadu, India
| | - Chi-Chin Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Pang-Yung Chou
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Menon PV, Radhakrishnan V, Narayanan PV, Adenwalla HS. Learning curve in performing palatoplasty: A retrospective study. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2022. [DOI: 10.4103/jclpca.jclpca_2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sakamoto Y, Ogata H, Miyamoto J, Kishi K. The role of surgeon's learning on the outcomes of alveolar bone graft for cleft repair. J Plast Reconstr Aesthet Surg 2021; 75:1937-1941. [PMID: 34969628 DOI: 10.1016/j.bjps.2021.11.114] [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: 04/09/2020] [Revised: 05/30/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Teaching cleft repair in the operating room may not sufficiently prepare craniofacial residents to perform the procedure self-reliantly. This study aimed to assess the influence of surgeons' experience level on the operative time and graft survival ratio after alveolar bone grafts for cleft repair. SUBJECTS AND METHODS This was a retrospective review of 100 consecutive alveolar bone graft patients treated for unilateral alveolar cleft by one craniofacial surgeon between 2012 and 2019. An alveolar bone graft from the iliac bone was performed using the lateral sliding flap. Sex, age, cleft width, cleft defect volume, and operative time were recorded, and the 1-year postoperative graft survival ratio was calculated. Multiple regression analysis was performed to identify factors that affect the operative time and survival ratio. RESULTS Factors affecting the operative time were the experience level of the surgeon and the presence of a cleft palate. Factors affecting the graft survival ratio were the cleft defect volume and experience level of the surgeon. In cleft lip and alveolus, the survival ratio was constant, and the operative time stabilised after approximately 20 cases. In cleft lip and palate, more experience was required to master the technique, and the operative time and survival ratio were stabilised only after approximately 40 cases. CONCLUSION Surgeons' experience level influenced the outcomes of alveolar bone grafting. Although surgical training is currently undergoing a paradigm shift from on-the-job training to simulation-based training, clinical experience is critical to be self-sufficient.
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Affiliation(s)
- Yoshiaki Sakamoto
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ward, Tokyo, 160-8582, Japan.
| | - Hisao Ogata
- Nanpeidai Ogata Clinic, 13-1 Nanpeidai-cho, Shibuya-ku, Tokyo, 150-0036, Japan
| | - Junpei Miyamoto
- Miyamoto Plastic & Reconstructive Surgery Hospital, 2-3-22, Danbaraminami, Minami-ku, Horoshima-shi, Hiroshima, 732-0814, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ward, Tokyo, 160-8582, Japan
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Kara M, Calis M, Kara I, Kulak Kayikci ME, Gunaydin RO, Ozgur F. Comparison of speech outcomes using type 2b intravelar veloplasty or furlow double-opposing Z plasty for soft palate repair of patients with unilateral cleft lip and palate. J Craniomaxillofac Surg 2021; 49:215-222. [PMID: 33485752 DOI: 10.1016/j.jcms.2021.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/29/2020] [Accepted: 01/02/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study is to compare speech outcomes, fistula rates, and rates of secondary speech surgeries after palatoplasty using Furlow palatoplasty or type 2b intravelar veloplasty for soft palate repair. PATIENTS AND METHODS Patients with unilateral cleft lip and palate who had either Furlow palatoplasty or intravelar veloplasty for soft palate repair were retrospectively evaluated for demographic and perioperative variables and speech outcomes. Fistula rate, secondary surgical intervention for improved speech results, and findings of speech assessment were further reviewed for the patients who met the inclusion criteria. RESULTS A total of 76 patients, 36 in the Furlow palatoplasty group and 40 in the intravelar veloplasty group, were included in the study. In the speech assessment, nasalance values were statistically similar between the two groups. Also, there was no statistically significant difference between the groups in velopharyngeal motility (p = 0.103). The total rates of secondary surgeries and fistula were statistically similar between the groups (p = 0.347 and 0.105, respectively). CONCLUSION The similar outcomes of speech and surgical evaluation between the two groups make the surgeon's preference determinant in the selection of the surgical technique for soft palate repair.
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Affiliation(s)
- Murat Kara
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Cleft Lip and Palate and Craniomaxillofacial Disorders Treatment and Research Center, Ankara, Turkey
| | - Mert Calis
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Cleft Lip and Palate and Craniomaxillofacial Disorders Treatment and Research Center, Ankara, Turkey.
| | - Ilkem Kara
- Hacettepe University Faculty of Health Sciences, Department of Speech and Language Therapy, Cleft Lip and Palate and Craniomaxillofacial Disorders Treatment and Research Center, Ankara, Turkey
| | - Mavis Emel Kulak Kayikci
- Hacettepe University Faculty of Health Sciences, Department of Speech and Language Therapy, Cleft Lip and Palate and Craniomaxillofacial Disorders Treatment and Research Center, Ankara, Turkey
| | - Riza Onder Gunaydin
- Hacettepe University Faculty of Medicine, Department of Otolaryngology, Cleft Lip and Palate and Craniomaxillofacial Disorders Treatment and Research Center, Ankara, Turkey
| | - Figen Ozgur
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Cleft Lip and Palate and Craniomaxillofacial Disorders Treatment and Research Center, Ankara, Turkey
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Vandenberg K, Castle M, Qeadan F, Kraai T. Oronasal Fistula Incidence Associated With Vomer Flap Repair of Cleft Palate: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2020; 58:957-965. [PMID: 33302724 DOI: 10.1177/1055665620974562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the incidence of oronasal fistulas (ONF) associated with primary repair of the anterior palate using a single-layered, superiorly based, vomer mucoperiosteal flap. DESIGN A systematic review of MEDLINE, PubMed, Cochrane, and Web of Science databases using the keywords: "vomer flap" and "cleft palate repair" were carried out. A meta-analysis was performed using random effect modeling with stratified analysis by syndromic diagnosis, number of surgeons, and mean age. MAIN OUTCOME MEASURE(S) Incidence of ONFs. RESULTS The meta-analysis included 9 studies with a total of 464 children who met inclusion criteria. The overall ONF rate was 3.0% (95% CI: 1.0-9.0). Fistula rates were not significantly different in studies that included syndromic patients compared to studies that did not, 5.0% (95% CI: 1.0-24.0) versus 3.0% (95% CI: 1.0-6.0), respectively. There was no significant difference between studies in which there was a single surgeon versus multiple surgeons, 3.0% (95% CI: 1.0-13.0) versus 4.0% (95% CI: 1.0-8.0), respectively. Age at the time of cleft repair showed no statistically significant difference in fistula rate when comparing children with a mean age less than 12 months to those greater than 12 months, 3.0% (95% CI: 1.0-5.0) versus 5.0% (95% CI: 1.0-28.0), respectively. CONCLUSIONS The vomer flap technique in cleft palate repair appears to be associated with a low ONF rate unaffected by syndromic diagnosis, number of surgeons, or patient age at time of repair.
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Affiliation(s)
- Katherine Vandenberg
- Department of Surgery, Division of Otolaryngology Head & Neck Surgery, 1104University of New Mexico Health Sciences Centers, Albuquerque, NM, USA
| | - Michael Castle
- 1104University of New Mexico, School of Medicine, Albuquerque, NM, USA
| | - Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Tania Kraai
- Department of Surgery, Division of Otolaryngology Head & Neck Surgery, 1104University of New Mexico Health Sciences Centers, Albuquerque, NM, USA
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Tache A, Mommaerts MY. On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair. Cleft Palate Craniofac J 2019; 56:1302-1313. [DOI: 10.1177/1055665619856243] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: The aims of the study were to assess the postoperative oronasal fistula rate after 1-stage and 2-stage cleft palate repair and identify risk factors associated with its development. Design: Systematic review. Setting: Various primary cleft and craniofacial centers in the world. Patients, Participants: Syndromic and nonsyndromic cleft lip, alveolus, and palate patients who had undergone primary cleft palate surgery. Intervention: Assessment of oronasal fistula frequency and correlation with staging, timing, and technique of repair, gender, and Veau type. The results obtained in this systematic review were compared with those in previous reports. Outcome: The main outcome is represented by the occurrence of the oronasal fistula after 1-stage versus 2-stage palatoplasty. Results: The mean fistula percentage was 9.94%. In the Veau I, II, III, and IV groups, the respective fistula rates were 2%, 7.3%, 8.3%, and 12.5%. Oronasal fistula locations based on the Pittsburgh Fistula Classification System were soft palate (type II), 16.2%; soft palate–hard palate junction (type III), 29.3%; and hard palate (type IV), 37.3%. There were no statistically significant differences between 1-stage and 2-stage palatoplasty, syndromic and nonsyndromic, or male and female patients. Primary palatoplasty timing was not a significant predictor. Conclusion: Some disparities arose when comparing studies, mainly regarding location and types of clefting prone to oronasal fistulation. Interestingly, the fistula rate does not differ between 1- and 2-stage closure, and timing of the repair does not play a role.
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Affiliation(s)
- Ana Tache
- Cleft & Craniofacial Team, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Maurice Y. Mommaerts
- Cleft & Craniofacial Team, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium
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8
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Jodeh DS, Buller M, Rottgers SA. The Impact of Presurgical Infant Orthopedics on Oronasal Fistula Rates Following Cleft Repair: A Meta-Analysis. Cleft Palate Craniofac J 2018; 56:576-585. [DOI: 10.1177/1055665618806104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Presurgical infant orthopedics (PSIO) techniques were introduced to improve the outcomes achieved when treating children with complete cleft lip and palate. The effect of PSIO on the incidence of postoperative fistulae has never been reliably demonstrated. We conducted a meta-analysis to assess the effectiveness of PSIO in reducing postoperative fistulas in patients with complete cleft lip and palate. Methods: A search of the PubMed and Embase databases was performed to identify relevant articles that included primary palate repairs of patients with unilateral or bilateral complete clefts, reported the incidence of postoperative fistulae, and explicitly stated if PSIO was used. Details including author, number of subjects, use of PSIO, and fistula rate were cataloged. Results: A review of the PubMed database yielded 1135 unique citations, and Embase yielded 507 articles. Review of these yielded 15 studies, comprising 1241 children, which met inclusion criteria. The overall rate of oronasal fistula development was 7.09%. The average fistula rate for studies using PSIO was 5.93% versus 9.71% in the non-PSIO group. This difference was not statistically significant ( P = .34). Conclusions: The use of PSIO prior to cleft lip and palate repair provides multiple benefits related to facial and nasal form and is supported by a body of literature. The effect of PSIO on the incidence of postoperative fistulae has received less attention in the literature. Our meta-analysis of the available literature does not provide evidence to support the premise that the use of PSIO affects the incidence of fistulae after cleft palate repair.
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Affiliation(s)
- Diana S. Jodeh
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Mitchell Buller
- Department of Plastic Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - S. Alex Rottgers
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
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9
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Cleft Palate Repair: Description of an Approach, Its Evolution, and Analysis of Postoperative Fistulas. Plast Reconstr Surg 2018; 141:1201-1214. [PMID: 29351181 DOI: 10.1097/prs.0000000000004324] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fistulas following cleft palate repair impair speech, health, and hygiene and occur in up to 35 percent of cases. The authors detail the evolution of a surgical approach to palatoplasty; assess the rates, causes, and predictive factors of fistulas; and examine the temporal association of modifications to fistula rates. METHODS Consecutive patients (n = 146) undergoing palatoplasty during the first 6 years of practice were included. The technique of repair was based on cleft type, and a common surgical approach was used for all repairs. RESULTS The fistula rate was 2.4 percent (n = 125) after primary repair and 0 percent (n = 21) after secondary repair. All complications occurred in patients with type III or IV clefts. Cleft width and cleft-to-total palatal width ratio were associated with fistulas, whereas syndromes, age, and adoption were not. Most complications could also be attributed to technical factors. During the first 2 years, modifications were made around specific anatomical features, including periarticular bony hillocks, maxillopalatine suture, velopalatine pits, and tensor insertion. The fistula rate declined by one-half in subsequent years. CONCLUSIONS The authors describe a surgical approach to cleft palate repair, its evolution, and surgically relevant anatomy. Fistulas were associated with increasing cleft severity but could also be attributed to technical factors. A reduction in frequency and severity of fistulas was consistent with a learning curve and may in part be associated with modifications to the surgical approach. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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11
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Smarius BJA, Breugem CC. Commentary: "Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate. A systematic review". J Craniomaxillofac Surg 2017; 46:368-369. [PMID: 29287927 DOI: 10.1016/j.jcms.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 12/05/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Bram J A Smarius
- Division of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
| | - Corstiaan C Breugem
- Division of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands; Division of Plastic Surgery Meander Medical Center, 3813 TZ, Amersfoort, The Netherlands
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12
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Werker C, de Wilde H, Mink van der Molen A, Breugem C. Internationally adopted children with cleft lip and/or palate: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2017; 70:1732-1737. [DOI: 10.1016/j.bjps.2017.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 03/26/2017] [Accepted: 04/14/2017] [Indexed: 11/27/2022]
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13
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Segna E, Caruhel JB, Corre P, Picard A, Biau D, Khonsari RH. Quantitative assessment of the learning curve for cleft lip repair using LC-CUSUM. Int J Oral Maxillofac Surg 2017; 47:366-373. [PMID: 29111102 DOI: 10.1016/j.ijom.2017.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/20/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
The first step in cleft lip repair is the precise positioning of anatomical landmarks and tracing of the incisions on the patient's lip at the beginning of the procedure. The aim of this study was to evaluate progress made in learning cleft lip repair tracing using a quantitative assessment of learning curves: LC-CUSUM (learning curve - cumulative sum). Eight surgical residents were enrolled and asked to trace lip repair incisions on five cases of unilateral left cleft lip over 5 consecutive weeks. Results were compared to a reference tracing based on the positioning of nine anatomical landmarks and assessed using LC-CUSUM. Competence was defined as the accurate positioning of the nine landmarks (less than 1.4mm deviation from the reference positions, with an accepted 15% failure rate). After five tracing sessions, competence was not achieved evenly for all trainees, or for all landmarks, underlining differences in inter-individual learning ability even with similar training. However, despite an initial marked lack of theoretical and practical training in lip repair techniques, repeated drawings of cleft lip incisions allowed a satisfactory level of competence to be reached for most landmarks and most trainees. Nevertheless it was found that not all landmarks are understood by students with similar ease, and that landmark positioning reveals significant inter-individual differences. This approach allowed a global assessment of the teaching of cleft repair and will help to focus training on specific problematic points for which competence was not obtained according to the LC-CUSUM test.
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Affiliation(s)
- E Segna
- Ospedale Maggiore Policlinico di Milano, Unità Operativa di Chirurgia Maxillo-facciale e Odontostomatologia, Università di Milano-Bicocca, Milan, Italy
| | - J-B Caruhel
- Assistance Publique - Hôpitaux de Paris, Service de Chirurgie Maxillofaciale, Hôpital Universitaire Pitié-Salpêtrière, Université Paris-Descartes, Paris, France
| | - P Corre
- Centre Hospitalier Universitaire de Nantes, Université de Nantes, Nantes, France
| | - A Picard
- Assistance Publique - Hôpitaux de Paris, Service de Chirurgie Maxillofaciale et Plastique, Hôpital Necker Enfants-Malades, Université Paris-Descartes, Paris, France
| | - D Biau
- Assistance Publique - Hôpitaux de Paris, Service de Chirurgie Orthopédique, Hôpital Cochin Port-Royal, Université Paris-Descartes, Paris, France
| | - R H Khonsari
- Assistance Publique - Hôpitaux de Paris, Service de Chirurgie Maxillofaciale et Plastique, Hôpital Necker Enfants-Malades, Université Paris-Descartes, Paris, France.
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14
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Cleft Lip and Palate Repair Using a Surgical Microscope. Arch Plast Surg 2017; 44:490-495. [PMID: 29069876 PMCID: PMC5801792 DOI: 10.5999/aps.2017.01060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/14/2017] [Accepted: 08/24/2017] [Indexed: 01/27/2023] Open
Abstract
Background Cleft lip and palate repair requires a deep and small surgical field and is usually performed by surgeons wearing surgical loupes. Surgeons with loupes can obtain a wider surgical view, although headlights are required for the deepest procedures. Surgical microscopes offer comfort and a clear and magnification-adjustable surgical site that can be shared with the whole team, including observers, and easily recorded to further the education of junior surgeons. Magnification adjustments are convenient for precise procedures such as muscle dissection of the soft palate. Methods We performed a comparative investigation of 18 cleft operations that utilized either surgical loupes or microscopy. Paper-based questionnaires were completed by staff nurses to evaluate what went well and what could be improved in each procedure. The operating time, complication rate, and scores of the questionnaire responses were statistically analyzed. Results The operating time when microscopy was used was not significantly longer than when surgical loupes were utilized. The surgical field was clearly shared with surgical assistants, nurses, anesthesiologists, and students via microscope-linked monitors. Passing surgical equipment was easier when sharing the surgical view, and preoperative microscope preparation did not interfere with the duties of the staff nurses. Conclusions Surgical microscopy was demonstrated to be useful during cleft operations.
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Li F, Wang HT, Chen YY, Wu WL, Liu JY, Hao JS, Luo DY. Cleft relapse and oronasal fistula after Furlow palatoplasty in infants with cleft palate: incidence and risk factors. Int J Oral Maxillofac Surg 2016; 46:275-280. [PMID: 27769736 DOI: 10.1016/j.ijom.2016.09.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/14/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
This study was performed to investigate the incidence of and risk factors for postoperative cleft relapse and oronasal fistula after Furlow palatoplasty in infants. Sixty-two infants with cleft palate, aged 6-12 months (mean 8.25 months), who underwent cleft repair by Furlow double opposing Z-plasty between March 2012 and August 2014, were enrolled in the study. Risk factors for postoperative cleft relapse and oronasal fistula after Furlow palatoplasty were identified by logistic regression analysis. The incidence rates of cleft relapse at 1 week and oronasal fistula at 3 months after surgery were 24.2% (15/62) and 9.7% (6/62), respectively. Among all of the variables screened, only the width of the cleft was significantly associated with the incidence of postoperative cleft relapse (P=0.001) and oronasal fistula (P=0.011); the incidence rates were positively correlated with the width of the cleft when it exceeded 6.8mm and 7.5mm, respectively. Based on these findings, in order to reduce the incidence of postoperative cleft relapse and oronasal fistula, Furlow repair is not recommended for patients with wide clefts. An appropriate angle between the Z-flap incision and the central axis, use of a bilateral relaxation incision, and postoperative nursing care can help reduce the incidence of postoperative cleft relapse.
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Affiliation(s)
- F Li
- Guangzhou Women and Children's Medical Centre, Guangzhou 510623, Guangdong Province, China
| | - H-T Wang
- Guangzhou Women and Children's Medical Centre, Guangzhou 510623, Guangdong Province, China.
| | - Y-Y Chen
- Guangzhou Women and Children's Medical Centre, Guangzhou 510623, Guangdong Province, China
| | - W-L Wu
- Guangzhou Women and Children's Medical Centre, Guangzhou 510623, Guangdong Province, China
| | - J-Y Liu
- Guangzhou Women and Children's Medical Centre, Guangzhou 510623, Guangdong Province, China
| | - J-S Hao
- Guangzhou Women and Children's Medical Centre, Guangzhou 510623, Guangdong Province, China
| | - D-Y Luo
- Guangzhou Women and Children's Medical Centre, Guangzhou 510623, Guangdong Province, China
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