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Romero-Narvaez C, Lin LO, Kirschner RE. Buccal Fat Pad in Primary and Secondary Cleft Palate Repair: A Systematic Review of the Literature. Cleft Palate Craniofac J 2023:10556656231206238. [PMID: 37853550 DOI: 10.1177/10556656231206238] [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: 10/20/2023] Open
Abstract
OBJECTIVE To review the evidence supporting the use of buccal fat pad (BFP) in primary and secondary cleft palate repair and its short- and long- term clinical outcomes. DESIGN Systematic review conducted by 2 independent reviewers following PRISMA guidelines. SETTING: NONE PARTICIPANTS Articles were identified from three databases (Pubmed/Medline, Embase and Web of Science). Search terms included "cleft palate", "palatoplasty", "palate repair", "buccal fat pad". INTERVENTIONS Use of BFP in primary and secondary cleft palatoplasty. MAIN OUTCOME MEASURES Primary outcomes were immediate postoperative complications, postoperative fistula, and maxillary growth. Secondary outcomes were palatal length, speech, and donor site morbidity. RESULTS Ninety-one reports were retrieved after excluding duplicates. Twenty-three studies were included (13 case series and 10 comparative studies). Overall level of evidence was low. Randomized and non-randomized studies had a high risk of bias. In primary palatoplasty, BFP was more frequently used filling lateral relaxing incisions(57.4%), or in the hard-soft palate junction and covering mucosal defects(30.1%). In these patients, post operative fistula incidence was 2.8%. Two studies found wider transverse maxillary dimensions after BFP use. No higher incidence of bleeding, infection, dehiscence, or flap necrosis was reported. In secondary palatoplasty, no recurrent fistulas were reported for patients undergoing BFP for fistula repair. CONCLUSIONS BFP appears to be associated with a favorable impact in fistula prevention and management, as well as in transverse maxillary growth. However, there is a high heterogeneity among studies, high risk of bias and overall low quality of evidence. More high-quality research with long-term follow-up is warranted.
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Affiliation(s)
- Carolina Romero-Narvaez
- Plastic and Reconstructive Surgery Service, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Lawrence O Lin
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Richard E Kirschner
- Plastic and Reconstructive Surgery Service, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
- Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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Yoshida H, Takahashi M, Yamaguchi T, Takizawa H, Takakaze M, Maki K. Comparison of Maxillofacial Morphology Between Modified Furlow's and Modified two-Flap Palatoplasty in Orofacial Clefts During the Primary Dentition Period. Cleft Palate Craniofac J 2023; 60:1313-1320. [PMID: 35673253 DOI: 10.1177/10556656221104374] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the effect of two palatoplasty procedures, modified Furlow's palatoplasty (F procedure) and modified two-flap palatoplasty (T procedure), on the maxillofacial morphology of unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) during the primary dentition period. DESIGN Retrospective cohort study. SETTING Department of Orthodontics, School of Dentistry, Showa University. PARTICIPANTS We enrolled 106 pediatric patients (63 boys, 43 girls; aged 4.43 ± 0.34 years) with non-syndromic orofacial clefts who underwent cheiloplasty and palatoplasty. INTERVENTIONS Patients were divided into four groups according to cleft type (BCLP or UCLP) and palatoplasty procedure type (F or T procedure). MAIN OUTCOME MEASURES Maxillofacial morphology was assessed by examining parameters on lateral cephalograms. RESULTS Multiple comparisons revealed significant differences among N-A, N-ANS, and ANS-PNS distances and SNA and ANB angles among the groups. There were significant differences in N-A, N-ANS, ANS-PNS, SNA, and SNB among the UCLP and BCLP groups. The calculated effect sizes were all within 0.3-0.5. The statistical power was as follows: N-A, 86.41%; N-ANS, 79.77%; ANS-PNS, 97.49%; SNA, 96.88%; and ANB, 99.25%. CONCLUSIONS Although UCLP and BCLP both exhibited differences in craniofacial distances and angles, the procedure type (either F or T procedure) had no significant effect on the maxillofacial morphology (as determined by lateral cephalograms). However, to rule out additional bias, patient-specific factors should be considered that may be affected by maxillofacial development when deciding surgical approaches.
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Affiliation(s)
- Hiroshi Yoshida
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Masahiro Takahashi
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Tetsutaro Yamaguchi
- Department of Oral Interdisciplinary Medicine, Division of Orthodontics, Graduate School of Dentistry, Kanagawa Dental University, Kanagawa, Japan
| | - Hideomi Takizawa
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Momoko Takakaze
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Koutaro Maki
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
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Petrova T, Brudnicki A, Kotova M, Urbanova W, Dubovska I, Polackova P, Voborna I, Fudalej PS. The Slavcleft: A Three-Center Study of the Outcome of Treatment of Cleft Lip and Palate Considering Palatal Shape. J Clin Med 2023; 12:5985. [PMID: 37762926 PMCID: PMC10531518 DOI: 10.3390/jcm12185985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/26/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
The degree of deviation of palatal shape from the norm may reflect facial growth disturbance in cleft lip and palate (CLP). The objective of this study was to compare the palatal morphology in children treated with different surgical protocols. Palatal shape was assessed with geometric morphometrics (GM) including Procrustes superimposition, principal component analysis (PCA), and permutation tests with 10,000 permutations, in 24 children treated with two-stage repair with a late palatoplasty (Prague group; mean age at assessment 8.9 years), 16 children after two-stage repair with early palatoplasty (Bratislava group; mean age 8.2 years), and 53 children treated with a one-stage repair (Warsaw group, mean age 10.3 years). The non-cleft control group comprised 60 children at 8.6 years. The first five principal components (PCs) accounted for a minimum of 5% of the total shape variability (65.9% in total). The Procrustes distance was largest for the Prague vs. Control pair and smallest for the Prague vs. Bratislava pair. Nonetheless, all intergroup differences were statistically significant (p < 0.01). One can conclude that variations in palatal shape roughly correspond to cephalometric and dental arch relationship findings from prior research. Among the children who underwent a one-stage repair of the complete cleft, their palatal morphology most closely resembled that of the non-cleft controls. Conversely, children who received late palatoplasty exhibited the greatest degree of deviation.
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Affiliation(s)
- Tereza Petrova
- Department of Stomatology, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, 10034 Prague, Czech Republic
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, 77900 Olomouc, Czech Republic
| | - Andrzej Brudnicki
- Department of Pediatric Surgery, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Magdalena Kotova
- Department of Stomatology, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, 10034 Prague, Czech Republic
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, 77900 Olomouc, Czech Republic
- Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Wanda Urbanova
- Department of Stomatology, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, 10034 Prague, Czech Republic
- Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Ivana Dubovska
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, 77900 Olomouc, Czech Republic
| | - Petra Polackova
- Department of Stomatology, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, 10034 Prague, Czech Republic
| | - Iva Voborna
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, 77900 Olomouc, Czech Republic
| | - Piotr S. Fudalej
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, 77900 Olomouc, Czech Republic
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, 3012 Bern, Switzerland
- Department of Orthodontics, Jagiellonian University Cracow, 31-155 Krakow, Poland
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Felício Carvalho Carrara C, Jorge PK, Costa B, Machado MAAM, Oliveira TM, da Silva Dalben G. Customized Tray for Impression Taking in Children With Cleft Lip and Palate. Cleft Palate Craniofac J 2023; 60:1168-1171. [PMID: 35466698 DOI: 10.1177/10556656221095713] [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] [Indexed: 11/17/2022] Open
Abstract
The assessment of rehabilitation outcomes requires a patient documentation protocol, including records obtained at standardized ages, to compare different types of surgeries, their effects, as well as between different rehabilitation centers. The aim of this paper was to present proper trays for babies with different types of cleft lip and palate, which are used in the outpatient routine at Hospital of Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP). The customized trays are made with self-curing acrylic resin. The tray must have suitable depth to copy the buccal sulcus, and wax is usually applied to contour the tray edge, and the adjustment of the tray to the fornix, making the tray specific for each child. The impression precludes the utilization of dental casts for diagnosis, treatment plan, and research measurements. In the clinical practice at HRAC-USP, it was observed that customized trays increased the quality of impression, accurately reproducing anatomical features of dental arches of babies with oral clefts.
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Affiliation(s)
- Cleide Felício Carvalho Carrara
- Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Paula Karine Jorge
- Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Beatriz Costa
- Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Thais Marchini Oliveira
- Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Gisele da Silva Dalben
- Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
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Kamata M, Sakamoto Y, Ogata H, Sakamoto T, Ishii T, Kishi K. Influence of Lip Revision Surgery on Facial Growth in Patients With A Cleft Lip. J Craniofac Surg 2023; 34:1203-1206. [PMID: 36727767 DOI: 10.1097/scs.0000000000009191] [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: 03/07/2022] [Accepted: 10/10/2022] [Indexed: 02/03/2023] Open
Abstract
Although patients with cleft lip and palate often present with poor maxillary growth because of intrinsic and iatrogenic factors, the surgical influence of lip revision surgery, palatal fistula repair, and pharyngeal flap procedures remains uncertain in contrast to that of primary cleft lip repair and palatoplasty. Therefore, this study aimed to reveal factors inhibiting maxillary growth and inducing later orthognathic surgery. A retrospective analysis was conducted on the data of patients with cleft lip and palate who underwent a series of treatments at Keio University Hospital from 1990 to 2000. We collected data on patient sex, cleft type, number and timing of lip revision surgery, the incidence of palatal fistulae, history of pharyngeal flap procedures, and timing of a repeat bone graft, and reviewed whether these patients underwent orthognathic surgery later in life. Multivariate analysis was conducted using binary logistic regression to extract factors affecting later orthognathic surgery. A total of 52 patients were included in this study. Results showed that revision surgery conducted more than twice was the highest statistically significant predictor of later orthognathic surgery in patients with a cleft lip and palate ( P <0.05, odds ratio=43.3), followed by palatal fistula occurrence after cleft palate repair ( P <0.05, odds ratio=22.3). Therefore, primary surgical procedure is most important for these patients.
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Affiliation(s)
- Masafumi Kamata
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo , Japan
| | - Yoshiaki Sakamoto
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo , Japan
| | | | - Teruo Sakamoto
- Department of Orthodontics, Tokyo Dental College, Chiba, Japan
| | - Takenobu Ishii
- Department of Orthodontics, Tokyo Dental College, Chiba, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo , Japan
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Willadsen E, Jørgensen LD, Alaluusua S, Pedersen NH, Nielsen JB, Hölttä E, Hide Ø, Hayden C, Havstam C, Hammarström IL, Davies J, Boers M, Andersen HS, Aukner R, Jackson Morris D, Nielsen SF, Semb G, Lohmander A, Persson C. Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: Speech proficiency at 10 years of age. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:892-909. [PMID: 36541222 DOI: 10.1111/1460-6984.12830] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/21/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND & AIM To assess consonant proficiency and velopharyngeal function in 10-year-old children born with unilateral cleft lip and palate (UCLP) within the Scandcleft project. METHODS & PROCEDURES Three parallel group, randomized, clinical trials were undertaken as an international multicentre study by nine cleft teams in five countries. Three different surgical protocols for primary palate repair (Arm B-Lip and soft palate closure at 3-4 months, hard palate closure at 36 months, Arm C-Lip closure at 3-4 months, hard and soft palate closure at 12 months, and Arm D-Lip closure at 3-4 months combined with a single-layer closure of the hard palate using a vomer flap, soft palate closure at 12 months) were tested against a common procedure (Arm A-Lip and soft palate closure at 3-4 months followed by hard palate closure at 12 months) in the total cohort of 431 children born with a non-syndromic UCLP. Speech audio and video recordings of 399 children were available and perceptually analysed. Percentage of consonants correct (PCC) from a naming test, an overall rating of velopharyngeal competence (VPC) (VPC-Rate), and a composite measure (VPC-Sum) were reported. OUTCOMES & RESULTS The mean levels of consonant proficiency (PCC score) in the trial arms were 86-92% and between 58% and 83% of the children had VPC (VPC-Sum). Only 50-73% of the participants had a consonant proficiency level with their peers. Girls performed better throughout. Long delay of the hard palate repair (Arm B) indicated lower PCC and simultaneous hard and soft palate closure higher (Arm C). However, the proportion of participants with primary VPC (not including velopharyngeal surgeries) was highest in Arm B (68%) and lowest in Arm C (47%). CONCLUSIONS & IMPLICATIONS The speech outcome in terms of PCC and VPC was low across the trials. The different protocols had their pros and cons and there is no obvious evidence to recommend any of the protocols as superior. Aspects other than primary surgical method, such as time after velopharyngeal surgery, surgical experience, hearing level, language difficulties and speech therapy, need to be thoroughly reviewed for a better understanding of what has affected speech outcome at 10 years. WHAT THIS PAPER ADDS What is already known on the subject Speech outcomes at 10 years of age in children treated for UCLP are sparse and contradictory. Previous studies have examined speech outcomes and the relationship with surgical intervention in 5-year-olds. What this study adds to the existing knowledge Speech outcomes based on standardized assessment in a large group of 10-year-old children born with UCLP and surgically treated according to different protocols are presented. While speech therapy had been provided, a large proportion of the children across treatment protocols still needed further speech therapy. What are the potential or actual clinical implications of this work? Aspects other than surgery and speech function might add to the understanding of what affects speech outcome. Effective speech therapy should be available for children in addition to primary surgical repair of the cleft and secondary surgeries if needed.
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Affiliation(s)
- E Willadsen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - L D Jørgensen
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - S Alaluusua
- Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | - E Hölttä
- Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Ø Hide
- Department of Speech and Language Disorders, Statped sørøst, Oslo, Norway
| | - C Hayden
- The Royal Hospital for Sick Children, Belfast, UK
| | - C Havstam
- Region Västra Götaland, Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - I L Hammarström
- Division of Speech and Language Pathology, Linköping University, Linköping, Sweden
| | - J Davies
- Greater Manchester Cleft Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - M Boers
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - H S Andersen
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - R Aukner
- Department of Speech and Language Disorders, Statped sørøst, Oslo, Norway
| | - D Jackson Morris
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - S F Nielsen
- Copenhagen Business School, Center for Statistics, Copenhagen, Denmark
| | - G Semb
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - A Lohmander
- Division of Speech and Language Pathology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - C Persson
- Region Västra Götaland, Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Huang H, Li J, Li C, Yin H, Wu M, Wang Y, Li Y, Yang C, Zeng N, Zheng Q, Shi B. Sommerlad-Furlow modified palatoplasty: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00058-6. [PMID: 37164835 DOI: 10.1016/j.jcms.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 03/27/2023] [Accepted: 04/08/2023] [Indexed: 05/12/2023] Open
Abstract
The purpose of this study was to introduce the surgical process of Sommerlad-Furlow modified (S-F) palatoplasty and compare its surgical and functional outcomes with conventional Sommerlad (S) palatoplasty. Patients with non-syndromic cleft palate who had undergone either S-F palatoplasty or S palatoplasty were retrospectively reviewed. Data on the outcomes of velopharyngeal function and postsurgical palatal fistula incidence were collected for all patients. Data for preselected factors, including gender, age at palatoplasty, and cleft type, were also collected. Chi-square tests were conducted. 1254 patients were included. The postsurgical velopharyngeal competence (VPC) rate after S-F palatoplasty was significantly higher than after S palatoplasty (total, 70.5% vs 57.9%, p < 0.0001; age ≤ 1, 87.0% vs 69.2%, p < 0.0001; 1 < age ≤ 2, 78.3% vs 69.3%, p = 0.0479). With regard to different types of cleft palate, the postsurgical VPC rates after S-F palatoplasty were all significantly higher than for S palatoplasty in all patients younger than 2 years of age (complete cleft palate, 78.7% vs 62.4%, p = 0.0016; hard and soft palate cleft, 84.4% vs 74.8%, p = 0.0172; submucosal cleft and soft palate cleft, 96.6% vs 68.4%, p = 0.0114). The postoperative fistula rate after S-F palatoplasty was 4.3%. This modified palatoplasty technique provided adequate cleft palate closure, with satisfactory speech outcomes and low fistula rates, while older age at palatoplasty may affect the postsurgical outcomes. Within the limitations of the study it seems that the Sommerlad-Furlow modified technique is an option for cleft palate repair.
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Affiliation(s)
- Hanyao Huang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jingtao Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Chenghao Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Heng Yin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Min Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yan Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yang Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Chao Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Ni Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Qian Zheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases and Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China.
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Fujimoto Y, Tanaka S, Otsuki K, Yamanishi T, Isomura E, Yokota Y, Kogo M. Labial Vestibular Flap Closure of the Cleft Palate Is Advantageous for Maxillary Development. Cleft Palate Craniofac J 2023; 60:233-242. [PMID: 35043724 DOI: 10.1177/10556656211065944] [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] [Indexed: 01/18/2023] Open
Abstract
Objective: Using labial vestibular flap was performed to close the primary alveolar and hard palate cleft at the second stage of early 2-stage closure surgery for unilateral cleft lip and palate for minimizing the damage to the maxillary periosteum. We analyzed maxillary development to clarify the influence of cleft palate surgery. Design: Retrospective longitudinal study in 5 years after primary palatal closure. Setting: Institutional study Patients: Study subjects included 214 patients with nonsyndromic complete unilateral cleft lip and palate who were consecutively treated in our clinic. Main Outcome: We used a 3D dental model scanner to assess maxillary development in patients aged 3 months to 5 years after using either the conventional pushback method (PB) (51 cases) or 2-stage closure (Local palatal flap closure: LF [67 cases] and Labial vestibular flap closure: VF [96 cases]). Results: Comparing the measurement results, the major axis of maxilla, width, intercanine distance, and intermolar distance was significantly larger in the LF group compared to the PB group. After the age of 3, the cleft side of VF group had grown significantly to compare with LF group in width. It was also confirmed that the inserted labial mucosal flap itself grew. Enlargement of the labial mucosal flap was observed at all sites except the canine. Conclusion: Good maxillary growth occurred in the following order: VF groups > LF group > PB group. Poor growth was correlated with the extent of periosteal damage during surgery and the degree of postoperative bone surface exposure.
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Affiliation(s)
- Yukari Fujimoto
- 136081st Department of Oral and Maxillofacial Surgery, 314275Osaka University Graduate School of Dentistry, Suita, Japan
| | - Susumu Tanaka
- 136081st Department of Oral and Maxillofacial Surgery, 314275Osaka University Graduate School of Dentistry, Suita, Japan
| | - Koichi Otsuki
- 136081st Department of Oral and Maxillofacial Surgery, 314275Osaka University Graduate School of Dentistry, Suita, Japan
| | - Tadashi Yamanishi
- 136081st Department of Oral and Maxillofacial Surgery, 314275Osaka University Graduate School of Dentistry, Suita, Japan
| | - Emiko Isomura
- 136081st Department of Oral and Maxillofacial Surgery, 314275Osaka University Graduate School of Dentistry, Suita, Japan
| | - Yusuke Yokota
- 136081st Department of Oral and Maxillofacial Surgery, 314275Osaka University Graduate School of Dentistry, Suita, Japan
| | - Mikihiko Kogo
- 136081st Department of Oral and Maxillofacial Surgery, 314275Osaka University Graduate School of Dentistry, Suita, Japan
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Bschorer F, Hornig L, Schön G, Bschorer R. Speech assessment following microsurgical soft palate repair. J Craniomaxillofac Surg 2023; 51:199-204. [PMID: 36878754 DOI: 10.1016/j.jcms.2023.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 11/01/2022] [Accepted: 01/22/2023] [Indexed: 01/26/2023] Open
Abstract
The aim of this study was to analyze speech intelligibility of children, who had undergone microsurgical soft palate repair according to Sommerlad. Cleft palate patients were treated by closure of the soft palate according to Sommerlad at about 6 months of age. At the age of 11, their speech was evaluated through automatic speech recognition. Word recognition rate (WR) was used as the outcome parameter of automatic speech recognition. To validate automatic speech results, an institute for speech therapy evaluated the speech samples for perceptual intelligibility. The results of this study group were compared to an age-matched control group. A total of 61 children were evaluated in this study, 29 in the study group and 32 in the control group. Study group patients had a lower word recognition rate (mean 43.03, SD 12.31) compared to the control group (mean 49.98, SD 12.54, p = 0.033). The magnitude of the difference was considered small (95% CI of the difference 0.6-13.3). The study group patients received significantly lower scores in the perceptual evaluation (mean 1.82, SD 0.58) compared to the control group mean (mean 1.51, SD 0.48, p = 0.028). Again, the magnitude of the difference was small (95% CI of the difference 0.03-0.57). Within the limitations of the study it seems that microsurgical soft palate repair according to Sommerlad at the age of 6 months might be a relevant alternative to other well established surgical techniques.
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Affiliation(s)
- Frizzi Bschorer
- Department of Oral and Maxillofacial Surgery, Helios Kliniken Schwerin, Wismarsche Straße 393-397, 19049, Schwerin, Germany; Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Rostock University Medical Center, Schillingallee 35, 18057, Rostock, Germany.
| | - Lena Hornig
- ISBA University of Cooperative Education, Ziegelseestr. 1, 19055, Schwerin, Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, Eppendorf University Hospital, University of Hamburg, Martinistr. 52, D-20246, Hamburg, Germany
| | - Reinhard Bschorer
- Department of Oral and Maxillofacial Surgery, Helios Kliniken Schwerin, Wismarsche Straße 393-397, 19049, Schwerin, Germany; MKG-Praxis Am Stadthafen, Schliemannstraße 18, 19055, Schwerin, Germany
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10
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Fan X, Liu W, Nie J, Chen X, Dong Y, Lu Y. Comparison of velopharyngeal morphology of two palatoplasty techniques in patients with hard and soft cleft palate. Front Surg 2023; 9:1080955. [PMID: 36684272 PMCID: PMC9852632 DOI: 10.3389/fsurg.2022.1080955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose The study aims to compare the velopharyngeal morphology of hard and soft cleft palate (HSCP) patients after Furlow and Sommerlad palatoplasty. Patients and methods A total of 51 patients (20 cases in Furlow palatoplasty group, 16 cases in Sommerlad palatoplasty group and 15 normal children in the control group) were included in our study. Velopharyngeal function and speech outcomes of patients with HSCP who had either Furlow palatoplasty or Sommerlad palatoplasty for cleft palate repair were evaluated by perceptual speech assessment (PSA), lateral cephalometric radiographs and nasopharyngoscopy. To assess velopharyngeal morphology of patients treated with two techqiques, we analyzed measurements such as velar length, pharyngeal depth, and the Adequate ratio (the ratio of velar length to pharyngeal depth). Furthermore, skeletal landmarks including cranial base, cervical vertebrae, posterior nasal spine which were defined as the pharyngeal triangle were measured. Finally, the position of the point U relative to the pharyngeal triangle were compared. Results Velopharyngeal closure (VPC) rate in Furlow palatoplasty group accounted for 90%, while that in Sommerlad palatoplasty group was 81.3%. PSA of the former group was significantly better than that of the latter group (P < 0.05). Velar length, pharyngeal depth and the Adequate ratio (1.37 ± 0.14 vs. 1.41 ± 0.15) were comparable between the Furlow group and control group (P > 0.05), while Sommerlad group had a shorter velar length, deeper pharyngeal depth and a smaller Adequate ratio (1.20 ± 0.18) compared to the above two groups (P < 0.05). Furhermore, the point U of Sommerlad group in the pharyngeal triangle was higher than that of the other two groups. Conclusions In the treatment modality of patients with HSCP, both Furlow palatoplasty and Sommerlad palatoplasty seem to be effective. Furlow palatoplasty appears to have velopharyngeal morphology similar to normal control group., while Sommerlad group shows a shorter velar length, deeper pharyngeal depth and a smaller Adequate ratio.
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Affiliation(s)
- Xiaofen Fan
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weilong Liu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jiancun Nie
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaoxuan Chen
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yingchun Dong
- Department of Oral Anesthesiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China,Correspondence: Yong Lu Yingchun Dong
| | - Yong Lu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China,Correspondence: Yong Lu Yingchun Dong
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11
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Wang Y, Yang F, Liu W, Fan X, Lu Y. Evaluation of the effect of a resorbable membrane on the closure of palatal fistulas. Front Surg 2023; 10:1134934. [PMID: 36925507 PMCID: PMC10011083 DOI: 10.3389/fsurg.2023.1134934] [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: 12/31/2022] [Accepted: 02/03/2023] [Indexed: 03/08/2023] Open
Abstract
Purpose A palatal fistula following the closure of palatal clefts remains a difficult clinical complication. Surgical treatment of fistulas is often complicated, with high recurrence rates. We present our results of fistula closure augmented with GTR, a resorbable membrane designed to promote guided tissue regeneration. Methods We reviewed the records of 75 patients operated on between 2008 and 2022 for closure of the palatal fistula. The patients included 24 who underwent fistula closure augmented with GTR and 51 who underwent fistula closure with other techniques. We reviewed the age at surgery, sex, fistula location, and outcome. Operation success was defined as an asymptomatic patient with a healed fistula on clinical examination. Results The overall fistula closure rate was 79.1% in the GTR group and 76.5% in the non-GTR group(p = 0.79). Discussion The success rate of fistula closure in the GTR group is comparable to that in the non-GTR group in this study. An additional advantage is that this procedure does not require harvesting any autologous tissue and reduces tissue damage in the long term.
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Affiliation(s)
- Yufeng Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fangling Yang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weilong Liu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaofen Fan
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yong Lu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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12
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Huokuna J, Loimaranta V, Laine MA, Svedström-Oristo AL. Adverse effects of orthodontic forces on dental pulp. Appearance and character. A systematic review. Acta Odontol Scand 2022; 81:267-277. [PMID: 36436210 DOI: 10.1080/00016357.2022.2137232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To comprehensively assess recent data on the effects of orthodontic forces on the dental pulp and to critically evaluate, whether any of the changes are permanent. MATERIALS AND METHODS Articles published between 2/2009 and 2/2022 were searched electronically on the PubMed, EMBASE and SCOPUS databases. The initial search retrieved 780 publications and, applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 33 relevant articles were identified. Twenty articles fulfilled the requirements for high (n = 1) or moderate (n = 19) methodological quality and were included. All assessments were made independently by three researchers. RESULTS Orthodontic forces appeared to cause a reduction in pulpal blood flow and a reduction in tooth sensibility, as indicated by increased response thresholds and increased amounts of negative responses to tooth sensibility tests. In addition, there were increases in the expression or activity levels of enzymes and neuropeptides associated with hypoxia and inflammation. Fibrotic tissue formation in the pulp was also reported. CONCLUSIONS Except for some histological and morphological alterations, the observed pulpal changes were in most cases only temporary, appearing within days of initiating the treatment and usually lasting for weeks. There were no clear signs of permanent damage.
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Affiliation(s)
- Jukka Huokuna
- Institute of Dentistry, University of Turku, Turku, Finland
| | | | - Merja A. Laine
- Institute of Dentistry, University of Turku, Turku, Finland
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13
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Craniofacial Growth at Age 6–11 Years after One-Stage Cleft Lip and Palate Repair: A Retrospective Comparative Study with Historical Controls. CHILDREN 2022; 9:children9081228. [PMID: 36010118 PMCID: PMC9406322 DOI: 10.3390/children9081228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
Background: Primary alveolar bone grafting inhibits craniofacial growth. However, its effect on craniofacial growth in one-stage cleft lip and palate protocols is unknown. This study investigated whether primary alveolar bone grafting performed during one-stage unilateral cleft lip and palate repair negatively affects growth up to 6–11 years old. Methods: The craniofacial growth, dental arch relationship and palatal morphology at 6–11 years old in children with unilateral cleft lip and palate were compared retrospectively. Two cohorts after a one-stage protocol without (Group A) and with (Group B) primary bone grafting at the same center were compared. Further, cephalometric measurements for growth were compared with an external cohort of a one-stage protocol and a heathy control. Results: Group A comprised 16 patients assessed at 6.8 years (SD 0.83), and Group B comprised 15 patients assessed at 9 years (SD 2.0). Cephalometric measurements indicated similar sagittal maxillary growth deficits and a significant deviation in maxillary inclination in both groups compared to the healthy group. Moderate to severe changes in palatal morphology were observed in 70% of the members in both groups. Conclusion: Omitting primary alveolar bone grafting under the one-stage protocol with two-flap palatoplasty studied did not improve growth at 6–11 years. The results implicate two-flap palatoplasty with secondary healing as having greater adverse effects on growth than primary alveolar bone grafting. Dental and palatal morphology was considerably compromised regardless of primary alveolar bone grafting.
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14
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Favorable Transverse Maxillary Development after Covering the Lateral Raw Surfaces with Buccal Fat Flaps in Modified Furlow Palatoplasty: A 3D Imaging-Assisted Long-Term Comparative Outcome Study. Plast Reconstr Surg 2022; 150:396e-405e. [PMID: 35687419 DOI: 10.1097/prs.0000000000009353] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The pedicled buccal fat flap has recently been applied to cover the lateral raw surfaces during palatoplasty as an attempt to mitigate scar-induced transverse maxillary constriction during growth, but with no formal long-term comparative analysis. This 3D imaging-assisted study assessed its impact on posterior transverse maxillary development. METHODS Cone beam computerized tomography scans from patients with unilateral cleft lip, alveolus and palate who received buccal fat flap (buccal fat group; n=22) or Surgicel (Surgicel group; n=32) for covering lateral raw surfaces during modified Furlow palatoplasty at 9-10 months old and had reached 9 years old were retrieved for analysis. Patients with unilateral cleft lip and alveolus (non-palatoplasty group; n=24) were also included for comparison. Using 3D maxillary image models, linear (U6T-MSP and U6J-MSP) and area measurements were calculated for cleft and non-cleft posterior maxillary sides as well as for total posterior transverse maxillary dimension. RESULTS The buccal fat group had significantly (all p<0.05) wider dimensions compared with the Surgicel group for all transverse maxillary measurements on both the cleft and non-cleft sides, with exception for U6J-MSP and posterior palatal area parameters on the cleft side (p>0.05). The buccal fat group had significantly (all p<0.05) wider total transverse maxillary dimensions compared with Surgicel and non-palatoplasty groups. CONCLUSION Covering the lateral raw surfaces with buccal fat flaps resulted in less posterior transverse maxillary constriction compared with the Surgicel-based covering procedure.
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15
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Speech in Adults Treated for Unilateral Cleft Lip and Palate as Rated by Naïve Listeners, Speech-Language Pathologists and Patients. J Plast Reconstr Aesthet Surg 2022; 75:3804-3812. [DOI: 10.1016/j.bjps.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 03/30/2022] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
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Simultaneous Closure of the Cleft Alveolus and Hard Palate with Concomitant Bone Grafting. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4099. [PMID: 35169529 PMCID: PMC8830839 DOI: 10.1097/gox.0000000000004099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022]
Abstract
Cleft repair has been in constant evolution since its inception. Conventional repair of the cleft hard palate involves closure of nasal and oral mucosa without bony reconstitution. In many instances, this approach is adequate, but, particularly in complete clefts, the lack of bony support can lead to collapse of the maxillary arch, dental crowding, and posterior cross-bite. To address these shortcomings, our institution performs a two-staged palatoplasty with concomitant bone grafting of the alveolus and hard palate in the second stage. A retrospective review of children who underwent a two-staged palatoplasty at our institution was performed. These patients’ records and images were reviewed for complications and changes in maxillary morphology. Fourteen patients with complete clefts had a two-staged palatoplasty with bone grafting in the second stage. The mean age at surgery was 37.5 months, and the mean follow-up was 16 months. One patient had resorption of the alveolar bone graft requiring additional bone grafting. The remaining patients were without complications and had good consolidation of the bone graft on follow-up imaging. Our early results support that there is a low complication rate (7% regrafting) in those patients who underwent bone grafting at the time of cleft palate repair with early evidence of bony consolidation on imaging and clinical examination. Wide exposure during the repair allows complete grafting of the maxillary bony deficit, which is not possible with traditional alveolar cleft repair and may alleviate the shortcoming of soft-tissue closure only. Future study is necessary to determine long-term outcomes.
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Jargaldavaa E, Gongorjav A, Badral B, Lkhamsuren K, Ichinkhorloo N. Primary palatoplasty: A comparison of results by various techniques - A retrospective study. Ann Maxillofac Surg 2022; 12:27-32. [PMID: 36199461 PMCID: PMC9527831 DOI: 10.4103/ams.ams_62_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/23/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction: To identify a better method for primary cleft palate (CP) repairs with respect to velopharyngeal function. Materials and Methods: A retrospective, longitudinal review of medical charts of patients with congenital CP who underwent four different techniques of palatoplasty, performed by three different surgeons in the Department of Maxillofacial Surgery of the National Center for Maternal and Child Health. Nasopharyngoscopy (NPS) was used for velopharyngeal function evaluation. CP was classified according to the Veau system and the “Golding-Kushner” scale for NPS results was used for assessing the patient’s velopharyngeal function and its association with cleft types and the primary palatoplasty techniques. Pearson’s Chi-square analysis and binary logistic regression were used for statistical analysis. Results: A total of 335 patients were included in the study. The mean age at primary palate repair was 22.9 ± 13.6 months. There were 56, 42, 177, and 60 patients with Veau-I, Veau-II, Veau-III, and Veau-IV types, respectively, whereas for primary palatoplasty 65 patients underwent Furlow, 148 patients – Mongolian, 108 patients – two flap, 34 patients – von Langenbeck technique. NPS assessment of adequate velopharyngeal function was followed by Furlow’s technique in 89.4% of cases, Mongolian technique in 62.2% of cases but by “two flap” only in 48.1% and von Langenbeck in 47.1% of cases. Discussion: The Furlow and Mongolian techniques were superior for maintaining velopharyngeal function after primary palatoplasty.
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18
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Singhania S, Bhojraj N. Early Maxillary Dentoalveolar Changes in Children with Unilateral Cleft Lip and Palate After Palatal Repair: A Pilot Study. Cleft Palate Craniofac J 2021; 59:1546-1554. [PMID: 34812086 DOI: 10.1177/10556656211053765] [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: 11/16/2022] Open
Abstract
OBJECTIVE To assess early maxillary dentoalveolar changes in children with unilateral cleft lip and palate (UCLP) up to 6 months after palatoplasty. DESIGN Pilot study. PATIENTS AND PARTICIPANTS Eight children with UCLP at the age of 18 to 30 months, who were awaiting palatal repair, were included. INTERVENTIONS All participants with repaired lip were scheduled for palatal repair between 18 and 24 months by Bardach's technique. MAIN OUTCOME MEASURE(S) Arch widths, arch depths, and arch perimeter was measured on 32 dental casts of 8 participants at 4 time points: just prior to palatal repair (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after palatal repair. Manual method using digital vernier caliper (Zhart, India) was used for model analysis. Intraexaminer reliability was also assessed. RESULTS Only one examiner assessed all the dental casts after blinding. There was a significant decrease in the intercanine width (29.75 ± 1.98 mm at T1 to 26.42 ± 1.67 mm at T4; P < .001) and anterior arch depth (9.86 ± 1.07 mm at T1 to 8.29 ± 1.51 mm at T4; P < .001). Growth occurred in intertuberosity width (38.18 ± 1.40 mm at T1 to 39.76 ± 1.09 mm at T4; P < .001) and total arch depth (24.36 ± 1.21 mm at T1 to 26.79 ± 1.04 mm; P < .001) over 6 months post-surgery. CONCLUSIONS There was growth restriction in the anterior part of the palate, whereas the posterior region continued to grow after palatal repair. These changes were observable even in the early months after palatoplasty.
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Affiliation(s)
- Shreepriya Singhania
- 29240JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Nandlal Bhojraj
- 29240JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
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Falzoni MMM, Ambrosio ECP, Jorge PK, Sforza C, de Menezes M, de Carvalho Carrara CF, Valarelli FP, Soares S, Machado MAAM, Oliveira TM. 3D morphometric evaluation of the dental arches in children with cleft lip and palate submitted to different surgical techniques. Clin Oral Investig 2021; 26:1975-1983. [PMID: 34665341 DOI: 10.1007/s00784-021-04177-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to compare dimensional alterations of dental arches in children with unilateral complete cleft lip and palate before and after different techniques of primary plastic surgeries. MATERIALS AND METHODS The sample was divided into two groups: group 1-cheiloplasty by Millard's technique and one-stage palatoplasty by von Langenbeck's technique; group 2-cheiloplasty by Millard's technique and two-stage palatoplasty: anterior palatoplasty by Hans Pichler's technique and posterior palatoplasty by Sommerlad's technique. Dental arches were evaluated before (T1), after the first phase (T2), and 1 year after the second phase (T3) of primary surgeries. Linear measurements and palatal area were assessed. To analyze the method's error, interclass correlation coefficient was applied. ANOVA (followed by Tukey test), dependent, and independent t-test were used (p < 0.05). RESULTS At T1, the intertuberosity distance was statistically greater in G2 (p = 0.004). At T2, the anterior length of the dental arch was statistically greater in G2 (p = 0.025), while the area of the smaller palatal segment (p = 0.001), cleft area (p = 0.014), and total area (p = 0.002) were statistically smaller in G2. At T3, the intertuberosity distance was statistically greater in G2 (p = 0.017). CONCLUSION This study suggests that cheiloplasty and one-stage palatoplasty resulted in smaller growth of maxilla than cheiloplasty and two-stage palatoplasty in the linear measurements (T-T' and I-CC') and total area of the dental arches. CLINICAL RELEVANCE Surgical protocols need to be evaluated to verify their effects aiming at improving the clinical practice of the interdisciplinary team, determining new parameters for the rehabilitation of individuals with cleft lip and palate.
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Affiliation(s)
- Maiara Miyuki Matsui Falzoni
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Eloá Cristina Passucci Ambrosio
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Paula Karine Jorge
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Chiarella Sforza
- Department of Biomedical Sciences for Health, Functional Anatomy Research Center (FARC), Faculty of Medicine and Surgery, Universita' Degli Studi Di Milano, Milan, Italy
| | - Márcio de Menezes
- Department of Restorative Dentistry, School of Health Science, State University of Amazonas, Manaus, Brazil
| | | | | | - Simone Soares
- Department of Prosthodontics, School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Thais Marchini Oliveira
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, São Paulo, 17012-901, Brazil.
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20
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Single Stage Cleft Lip and Palate Repair In Toddlers: Retrospective Review of Feasibility and Operative Experience. J Craniofac Surg 2021; 33:413-417. [PMID: 34519704 PMCID: PMC8865211 DOI: 10.1097/scs.0000000000008108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In children with cleft lip and palate (CLP), we aimed to compare a single-stage surgery group or all in one (AIO) approach with a 2-stage surgery group (2-SSG) of 18 and 12 toddlers, respectively. A retrospective review of 30 patients with CLP was conducted between 2007 and 2019. All in one procedure was performed at 12 to 24 months and 2-SSG patients had lip and primary nasal correction at 3 to 9 months, followed by palatoplasty and myringotomies at 12 to 16 months. In the AIO group, 13 (72.2%) patients had unilateral CLP, while 5 (27.8%) had bilateral CLP, which is comparable to the 2-SSG who had 8 (66.7%) unilateral CLP, 3 (25%) bilateral CLP, and 1 (8.3%) incomplete CL with submucous CP. The 2-SSG had a 30 minutes longer cumulative operative time and increased blood loss that was not statistically significant (P = 0.149 and 0.219, respectively). The AIO group had a slightly longer intubation (0.67 versus 0.33 day) and pediatric intensive care unit admission duration of 1.72 versus 1.67 days, (P = 0.427, 0.927), respectively. Total hospitalization time was significantly shorter with the AIO (8 versus 10.67 days, P = 0.016). The duration of postoperative pediatric intensive care unit and need for supplemental oxygen were higher in the AIO (38.9% versus 8.3%, P = 0.064). The “AIO” approach of lip, nasal, and palate surgery from 12 to 24 months completes early surgical care in a single operation. However, based on our review, this protocol must be selective; children with comorbidities or syndromes are advised to be exempted and operated in stages.
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Abstract
PURPOSE OF REVIEW The aim of this article is to present the current opinion on the prevention and management of oronasal fistulas in cleft palate patients. RECENT FINDINGS Though cleft palate repair has seen numerous modifications and improvements, oronasal fistulas remain one of the most common complications of palatoplasty. There are various techniques available for preventing and managing this complication. SUMMARY Oronasal fistulas can be minimized by employing proper principles for palatoplasty. Once a fistula occurs, the repair technique should be appropriate for the fistula type. Oronasal fistula classifications, various repair techniques, tissue adjuncts, and biomaterials used in both the primary palate repair and oronasal fistula repair are discussed in this review.
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Affiliation(s)
- Florence Othieno
- Department of Otolaryngology - Head and Neck Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
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22
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Crowley JS, Friesen TL, Gabriel RA, Hsieh S, Wacenske A, Deal D, Tsai C, Lance S, Gosman AA. Speech and Audiology Outcomes After Single-Stage Versus Early 2-Stage Cleft Palate Repair. Ann Plast Surg 2021; 86:S360-S366. [PMID: 33559999 DOI: 10.1097/sap.0000000000002747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The timing and management of patients with cleft palates have been controversial. Early soft palate closure at the time of cleft lip repair followed by hard palate closure at a second stage has been hypothesized to improve speech and audiology outcomes. This study compares cleft palate patients who have undergone single-stage versus 2-stage cleft palate repairs and the outcomes on speech and hearing. METHODS A retrospective chart review identified patients with diagnosis of cleft lip with complete cleft palate who underwent either single or 2-stage repair from 2006 to 2012. Data collected included age at each surgery, necessity of further speech surgery for velopharyngeal insufficiency, frequency of tympanostomy tube placement, presence of hearing loss, and speech assessment data graded per the validated Americleft speech scale. RESULTS A total of 84 patients were identified and subdivided into groups of single-stage and 2-stage repair. The mean age at the time of single-stage palate repair was 13.3 months. For the 2-stage group, the mean ages were 4.2 and 11.8 months for the soft palate and hard palate repairs, respectively. Comparing the single-stage versus 2-stage palate repairs, there was no significant difference in all speech parameters including hypernasality, hyponasality, nasal air emission, articulation, expressive language, receptive language, speech intelligibility, and speech acceptability for both unilateral and bilateral cleft lip/palate patients. Two-stage repair was associated with increased number of tympanostomy tube placement compared with single-stage repair (relative risk, 1.74; P = 0.009), and the first set of tubes was performed at a statistically significantly younger age, 4.5 months in the 2-stage repair compared with 16.9 months in the single-stage (P = 0.012) with 87.5% performed with first stage of repair. However, there was no difference in the types, degrees of hearing loss, or the presence of at least mild conductive hearing loss at latest follow-up audiograms between the groups. CONCLUSIONS There was no significant benefit with respect to speech or hearing outcomes between single-stage and 2-stage cleft palate repairs. This advocates for surgeon and family preference in the timing of cleft palate repair.
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Affiliation(s)
| | | | | | - Sun Hsieh
- From the Division of Plastic Surgery, University of California
| | - Amanda Wacenske
- Division of Speech Pathology, Rady Children's Hospital, San Diego, CA
| | - December Deal
- Division of Speech Pathology, Rady Children's Hospital, San Diego, CA
| | - Catherine Tsai
- From the Division of Plastic Surgery, University of California
| | - Samuel Lance
- From the Division of Plastic Surgery, University of California
| | - Amanda A Gosman
- From the Division of Plastic Surgery, University of California
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23
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Kato J, Mikoya T, Ito Y, Sato Y, Uematsu S, Kodama Y, Susami T, Yamanishi T, Takagi R. Dental Arch Relationship Outcomes Following 2-Stage Palatoplasty for Japanese Patients With Complete Unilateral Cleft Lip and Palate: A 3-Center Study. Cleft Palate Craniofac J 2021; 59:355-364. [PMID: 33910394 DOI: 10.1177/10556656211010606] [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: 11/17/2022] Open
Abstract
OBJECTIVE To compare dental arch relationship outcomes following 3 different 2-stage palatal repair protocols. DESIGN Retrospective, cross sectional. SETTING Three cleft palate centers (A, B, C) in Japan. PATIENTS Ninety (A: 39, B: 26, C: 25) consecutively treated Japanese patients with complete unilateral cleft lip and palate. INTERVENTIONS In A, the soft palate and the posterior half of the hard palate were repaired at a mean age of 1 year 7 months. In B, the soft palate and hard palate were closed separately at a mean age of 1 year 6 months and 5 years 8 months, respectively. In C, the soft palate and hard palate were closed at a mean age of 1 year and 1 year 5 months, respectively. MAIN OUTCOME MEASURES Dental arch relationships were assessed using the 5-Year-Olds' (5-Y) index by 5 raters and the Huddart/Bodenham (HB) index by 2 raters. RESULTS Intra- and inter-rater reliabilities showed substantial or almost perfect agreement for the 5-Y and HB ratings. No significant differences in mean values and distributions of 5-Y scores were found among the 3 centers. The mean HB index scores of molars on the minor segment were significantly smaller in C than those in A and B (P < .05). CONCLUSIONS There were no significant differences in dental arch relationships at 5 years among the times and techniques of hard palate closure. However, further analysis of the possible influence of infant cleft size as a covariable on a larger sample size is needed.
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Affiliation(s)
- Junya Kato
- Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Tadashi Mikoya
- Center for Advanced Oral Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Yumi Ito
- Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshiaki Sato
- Department of Orthodontics, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Setsuko Uematsu
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yasumitsu Kodama
- Division of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takafumi Susami
- Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, University of Tokyo Hospital, Tokyo, Japan
| | - Tadashi Yamanishi
- Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Ritsuo Takagi
- Division of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Fell M, Medina J, Fitzsimons K, Seifert M, Roberts A, Russell C, Deacon S. The Relationship Between Maxillary Growth and Speech in Children With a Unilateral Cleft Lip and Palate at 5 Years of Age. Cleft Palate Craniofac J 2021; 59:453-461. [PMID: 33887986 DOI: 10.1177/10556656211010620] [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: 11/17/2022] Open
Abstract
OBJECTIVE This study sought to investigate the association between maxillary growth and speech outcomes for children with a repaired unilateral cleft lip and palate (UCLP) at 5 years of age. PARTICIPANTS In all, 521 children (180 females and 341 males) with a nonsyndromic complete UCLP, born between 2007 and 2012 in England, Wales, and Northern Ireland were included in this study. OUTCOME MEASURES Maxillary growth was analyzed using dental models scored by the 5-Year-Olds' index, and perceptual speech analyses were scored by the Cleft Audit Protocol for Speech - Augmented rating. RESULTS Forty-one percent of the children achieved good maxillary growth (scores 1 and 2 on 5-Year-Old' index). Fifty percent of the children achieved normal speech (achieving UK speech standard 1). Maxillary growth was not found to have an impact on speech outcome when described by the 3 UK National Cleft Lip and Palate Speech Audit Outcome Standards. Analysis according to individual speech parameters showed dentalizations to be less prevalent in children with good maxillary growth compared to fair and poor growth (P = .001). The remaining speech parameters within resonance, nasal airflow, and articulation categories were not significantly associated with maxillary growth. CONCLUSION The findings from this study suggest that children with a history of complete UCLP, who have poor maxillary growth, are not at a higher risk of having major speech errors compared to children with good or fair maxillary growth at 5 years of age.
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Affiliation(s)
- Matthew Fell
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Jibby Medina
- Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom
| | - Kate Fitzsimons
- Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom
| | - Miriam Seifert
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Anne Roberts
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Craig Russell
- Royal Hospital for Children, Glasgow, United Kingdom
| | - Scott Deacon
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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Li Y, Wu M, Yang C, Tsauo C, Li C, Liu R, Zheng Q, Shi B, Low DW, Li CH. Evaluation of fistula rates in three cleft palate techniques without relaxing incisions. J Craniomaxillofac Surg 2021; 49:456-461. [PMID: 33581960 DOI: 10.1016/j.jcms.2021.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/25/2020] [Accepted: 01/31/2021] [Indexed: 10/22/2022] Open
Abstract
The aim of the present study was to investigate the incidence of postoperative fistula formation from a hybrid cleft palate repair compared to that from two well-established techniques. We performed a modified technique, Sommerlad-Furlow (SF), which combined the repositioning of the levator veli palatini muscles as described by Sommerlad with the double opposing Z-plasty of Furlow to lengthen the soft palate. A retrospective cohort study was conducted to evaluate patients who underwent cleft palate repair utilizing SF, Sommerlad, or Furlow techniques with the incidence of palatal fistula as the target endpoint. A total of 1,164 patients were included in the present study and underwent the following techniques: 603 cases with SF, 244 cases with Furlow, and 317 cases with Sommerlad. In addition to not requiring relaxing incisions, SF advantages included a consistently lower fistula rate compared to that of the Sommerlad technique, as well as the lowest fistula rate in patients with both hard and soft palate clefts without a cleft lip (OR:2.62 95% CI: 1.35, 5.09). However, the differences among the three techniques did not reach statistical significance in terms of a bilateral or unilateral cleft lip/palate, or in patients with a soft palate only or a submucosal cleft palate(OR: 2.22,95% CI:0.77, 6.37). Based on the results of our study, the Somerlad-Furlow technique should be preferred whenever possible.
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Affiliation(s)
- Yuanyuan Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Min Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Chao Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Chialing Tsauo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Chen Li
- Department of Health Statistics, School of Preventive Medicine, Fourth Military Medical University, Changlexilu Road #169, Shaanxi, 710032, China
| | - Renkai Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Qian Zheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - David W Low
- Division of Plastic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Cheng-Hao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Maxillofacial Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, China.
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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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Bettens K, Bruneel L, Alighieri C, Sseremba D, Musasizib D, Ojok I, Hodges A, Galiwango G, Adriaansen A, D'haeseleer E, Vermeersch H, Van Lierde K. Perceptual Speech Outcomes After Early Primary Palatal Repair in Ugandan Patients With Cleft Palate. Cleft Palate Craniofac J 2020; 58:999-1011. [PMID: 33380217 DOI: 10.1177/1055665620980249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To provide speech outcomes of English-speaking Ugandan patients with a cleft palate with or without cleft lip (CP±L). DESIGN Prospective case-control study. SETTING Referral hospital for patients with cleft lip and palate in Uganda. PARTICIPANTS Twenty-four English-speaking Ugandan children with a CP±L (15 boys, 9 girls, mean 8.4 years) who received palatal closure prior to 6 months of age and an age- and gender-matched control group of Ugandan children without cleft palate. INTERVENTIONS Comparison of speech outcomes of the patient and control group. MAIN OUTCOME MEASURES Perceptual speech outcomes including articulation, resonance, speech understandability and acceptability, and velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary surgery. RESULTS Normal speech understandability was observed in 42% of the patients, and 38% were judged with normal speech acceptability. Only 16% showed compensatory articulation. Acceptable resonance was found in 71%, and 75% of the patients were judged perceptually to present with competent velopharyngeal function based on the VPC-sum. Additional speech intervention was recommended in 25% of the patients. Statistically significant differences for all these variables were still observed with the control children (P < .05). CONCLUSIONS Overall, acceptable speech outcomes were found after early primary palatal closure. Comparable or even better results were found in comparison with international benchmarks, especially regarding the presence of compensatory articulation. Whether this approach is transferable to Western countries is the subject for further research.
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Affiliation(s)
- Kim Bettens
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Daniel Sseremba
- Speech-Language Pathologist, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Duncan Musasizib
- Speech-Language Pathologist, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Isaac Ojok
- Speech-Language Pathologist, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Andrew Hodges
- Plastic and Reconstructive Surgeon, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - George Galiwango
- Plastic and Reconstructive Surgeon, Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Anke Adriaansen
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
| | - Hubert Vermeersch
- Department of Head and Skin, 26656Ghent University, Ghent, Belgium.,Department of Plastic Surgery, 26656Ghent University Hospital, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), 26656Ghent University, Ghent, Belgium
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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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Pollard SH, Skirko JR, Dance D, Reinemer H, Yamashiro D, Lyon NF, Collingridge DS. Oronasal Fistula Risk After Palate Repair. Cleft Palate Craniofac J 2020; 58:35-41. [PMID: 32573252 DOI: 10.1177/1055665620931707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To assess risk factors for oronasal fistula, including 2-stage palate repair. DESIGN Retrospective analysis. SETTING Tertiary children's hospital. PATIENTS Patients with non-submucosal cleft palate whose entire cleft repair was completed at the study hospital between 2005 and 2013 with postsurgical follow-up. INTERVENTIONS Hierarchical binary logistic regression assessed predictive value of variables for fistula. Variables tested for inclusion were 2 stage repair, Veau classification, sex, age at surgery 1, age at surgery 2, surgeon volume, surgeon, insurance status, socioeconomic status, and syndrome. Variables were added to the model in order of significance and retained if significant at a .05 level. MAIN OUTCOME MEASURE Postoperative fistula. RESULTS Of 584 palate repairs, 505 (87%) had follow-up, with an overall fistula rate of 10.1% (n = 51). Among single-stage repairs (n = 211), the fistula rate was 6.7%; it was 12.6% in 2-stage repairs (n = 294, P = .03). In the final model utilizing both single-stage and 2-stage patient data, significant predictors of fistula were 2-stage repair (odds ratio [OR]: 2.5, P = .012), surgeon volume, and surgeon. When examining only single-stage patients, higher surgeon volume was protective against fistula. In the model examining 2-stage patients, surgeon and age at hard palate repair were significant; older age at hard palate closure was protective for fistula, with an OR of 0.82 (P = .046) for each additional 6 months in age at repair. CONCLUSIONS Two-stage surgery, surgeon, and surgeon volume were significant predictors of fistula occurrence in all children, and older age at hard palate repair was protective in those with 2-stage repair.
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Affiliation(s)
- Sarah Hatch Pollard
- Division of Pediatric Otolaryngology-Head & Neck Surgery, 7060University of Utah and Primary Children's Hospital, Salt Lake City, USA
| | - Jonathan R Skirko
- Division of Pediatric Otolaryngology-Head & Neck Surgery, 7060University of Utah and Primary Children's Hospital, Salt Lake City, USA
| | - Dallin Dance
- Pediatric Dentistry, Dance Dentistry for Kids, Coeur d'Alene, Idaho
| | - Hans Reinemer
- Pediatric Dentistry, 23188Primary Children's Medical Center, Salt Lake City, UT, USA
| | - Duane Yamashiro
- Division of Plastic Surgery, 7060University of Utah, Salt Lake City, USA
| | - Natalee F Lyon
- Cleft Craniofacial Program, Primary Children's Medical Center, Salt Lake City, UT, USA
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Optimizing speech outcomes for cleft palate. Curr Opin Otolaryngol Head Neck Surg 2020; 28:206-211. [PMID: 32520757 DOI: 10.1097/moo.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cleft lip with or without palate is one of the most common pediatric birth anomalies. Patients with cleft palate often have speech difficulties from underlying anatomical defects that can persist after surgery. This significantly impacts child development. There is a lack of evidence exploring, which surgical techniques optimize speech outcomes. The purpose of this update is to report on recent literature investigating how to optimize speech outcomes for cleft palate. RECENT FINDINGS The two-flap palatoplasty with intravelar veloplasty (IVVP) and Furlow double-opposing Z-plasty has the strongest evidence for optimizing speech. One-stage palatal repair is favored at 10-14 months of age, while delays are associated with significant speech deficits. For postoperative speech deficits, there is no significant difference between the pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation. Surgical management should be guided by closure pattern and velopharyngeal gap but few studies stratify by these characteristics. SUMMARY According to recent evidence, the two-flap palatoplasty with IVVP and Furlow palatoplasty result in the best speech. The pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation are all viable techniques to correct residual velopharyngeal insufficiency. Future research should focus on incorporating standardized measures and more robust study designs.
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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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Azouz V, Ng M, Patel N, Murthy AS. Low incidence of maxillary hypoplasia in isolated cleft palate. Maxillofac Plast Reconstr Surg 2020; 42:8. [PMID: 32206667 PMCID: PMC7083977 DOI: 10.1186/s40902-020-00252-9] [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: 02/13/2020] [Accepted: 03/11/2020] [Indexed: 12/03/2022] Open
Abstract
Background The cause of maxillary growth restriction in patients with cleft lip and palate remains controversial. While studies have investigated the effects surgical technique and timing have on maxillary growth, few focus on patients with isolated cleft palate (ICP). The purpose of this study was to determine the impact palate repair and its associated complications may have on maxillary growth. Methods A retrospective chart review of ICP patients who underwent palatoplasty from 1962 to 1999 at Akron Children’s Hospital was performed. Patient demographics, Veau type, age at primary repair, closure technique, presence of fistula or velopharyngeal insufficiency (VPI), number of palatal operations, maxillary hypoplasia (MH) frequency, and follow-up were recorded. Exclusion criteria included patients with cleft lip, submucous cleft, or syndromes. Results Twenty-nine non-syndromic ICP patients were identified; 62% (n = 18) had Veau type 1 and 38% (n = 11) had Veau type 2. All patients underwent 2-flap or Furlow palatoplasty with mobilization of mucoperiosteal flaps. Vomerine flaps were used in all Veau 2 cleft palate closures. Palatoplasty was performed at a mean age of 19.9 ± 8.2 months. Average follow-up was 209 ± 66.5 months. The rate of VPI was 59% (n = 17) and the rate of oronasal fistula was 14% (n = 4). Conclusions There was a low incidence of MH despite complications after initial palate closure. Our results seem to suggest that age at palate closure, type of cleft palate, and type of surgical technique may not be associated with MH. Additionally, subsequent procedures and complications after primary palatoplasty such as VPI and palatal fistula may not restrict maxillary growth.
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Affiliation(s)
- Vitali Azouz
- 1Department of Surgery, Summa Health System, 55Arch Street, Suite 2F, Akron, OH 44304-1423 USA
| | - Marilyn Ng
- 2Plastic, Reconstructive and Hand Surgery, Northwell Health-Staten Island University Hospital, Staten Island, NY USA
| | - Niyant Patel
- 3Plastic & Reconstructive Surgery, Akron Children's Hospital, Akron, OH USA
| | - Ananth S Murthy
- 3Plastic & Reconstructive Surgery, Akron Children's Hospital, Akron, OH USA
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Persson C, Pedersen NH, Hayden C, Bowden M, Aukner R, Vindenes HA, Åbyholm F, Withby D, Willadsen E, Lohmander A. Scandcleft Project Trial 3: Comparison of Speech Outcomes in Relation to Sequence in 2-Stage Palatal Repair Procedures in 5-Year-Olds With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2020; 57:352-363. [PMID: 31928085 DOI: 10.1177/1055665619896637] [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
OBJECTIVE To compare speech outcome following different sequencing of hard and soft palate closure between arms and centers within trial 3 and compare results to peers without cleft palate. DESIGN A prospective randomized clinical trial. SETTING Two Norwegian and 2 British centers. PARTICIPANTS One hundred thirty-six 5-year-olds with unilateral cleft lip and palate were randomized to either lip and soft palate closure at 3 to 4 months and hard palate closure at 12 months (arm A) or lip and hard palate closure at 3 to 4 months and soft palate closure at 12 months (arm D). MAIN OUTCOME MEASURES A composite measure of velopharyngeal competence (VPC), overall assessment of VPC from connected speech (VPC-Rate). Percentage of consonants correct (PCC), active cleft speech characteristics (CSCs), subdivided by oral retracted and nonoral errors, and developmental speech characteristics (DSCs). RESULTS Across the trial, 47% had VPC, with no statistically significant difference between arms within or across centers. Thirty-eight percent achieved a PCC score of >90%, with no difference between arms or centers. In one center, significantly more children in arm A produced ≥3 active CSCs (P < .05). Across centers, there was a statistically significant difference in active CSCs (arm D), oral retracted CSCs (arm D), and DSCs (arms A and D). CONCLUSIONS Less than half of the 5-year-olds achieved VPC and around one-third achieved age-appropriate PCC scores. Cleft speech characteristics were more common in arm A, but outcomes varied within and across centers. Thus, outcome of the same surgical method can vary substantially across centers.
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Affiliation(s)
- Christina Persson
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Speech and Language Pathology/ENT, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Melanie Bowden
- Greater Manchester Cleft Unit, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Ragnhild Aukner
- Department of Speech and Language Disorders, Statped sørøst, Oslo, Norway
| | - Hallvard A Vindenes
- Center for Cleft Lip and Palate, Bergen University Hospital Haukeland, Bergen, Norway
| | - Frank Åbyholm
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - David Withby
- Greater Manchester Cleft Unit, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Elisabeth Willadsen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - Anette Lohmander
- Division of Speech and Language Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Seo HJ, Denadai R, Pascasio DCG, Lo LJ. Modified double-opposing Z-plasty for patients with Veau I cleft palate: Are lateral relaxing incisions necessary? Medicine (Baltimore) 2019; 98:e18392. [PMID: 31852156 PMCID: PMC6922361 DOI: 10.1097/md.0000000000018392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Low fistula rate and a satisfactory speech outcome were previously reported by adopting a modified Furlow palatoplasty using small double-opposing Z-plasty (DOZ). The purposes of this study were to (1) describe the technical standardization of further modification of this small DOZ using the medial incision (MIDOZ) approach for Veau I cleft repair; (2) assess the early postoperative outcomes of a single surgeon's experience using this technique; and (3) evaluate the temporal association of this standardization with the necessity of lateral relaxing incisions.A prospective study (n = 24) was performed consecutively to non-syndromic patients with Veau I cleft palate who underwent MIDOZ approach. Patients with similar characteristics who underwent small DOZ were included as a retrospective group (n = 25) to control for the potential effect of the standardization of surgical maneuvers (including the hamulus fracture) on the rate of lateral relaxing incisions. Six-month complication rate was collected.No postoperative complications, such as bleeding, flap necrosis, dehiscence or fistula were observed. The prospective group had a significantly (all P < .05) higher rate of hamulus fractures (n = 48, 100%) and a lower rate of lateral relaxing incisions (n = 1, 2%) than the retrospective group (n = 16, 32%; n = 26, 52%).This technical standardization for performing palatoplasty using MIDOZ approach provided adequate Veau I cleft palate closure, without fistula formation, and with a low need of lateral relaxing incisions.
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Affiliation(s)
- Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- Department of Plastic and Reconstructive Surgery, Pusan National University Hospital, Busan, Korea
| | - Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Dax Carlo Go Pascasio
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Hammarström IL, Nyberg J, Alaluusua S, Rautio J, Neovius E, Berggren A, Persson C, Willadsen E, Lohmander A. Scandcleft Project Trial 2-Comparison of Speech Outcome in 1- and 2-Stage Palatal Closure in 5-Year-Olds With UCLP. Cleft Palate Craniofac J 2019; 57:458-469. [PMID: 31746642 DOI: 10.1177/1055665619888316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate in-depth speech results in the Scandcleft Trial 2 with comparisons between surgical protocols and centers and with benchmarks from peers without cleft palate. DESIGN A prospective randomized clinical trial. SETTING Two Swedish and one Finnish Cleft Palate center. PARTICIPANTS One hundred twelve participants were 5-years-old born with unilateral cleft lip and palate randomized to either lip repair and soft palate closure at 4 months and hard palate closure at 12 months or lip repair at 3 to 4 months (Arm A), or a closure of both the soft and hard palate at 12 months (Arm C). MAIN OUTCOME MEASURES A composite measure dichotomized into velopharyngeal competency (VPC) or velopharyngeal incompetency (VPI), overall assessment of velopharyngeal function (VPC-Rate), percentage of consonants correct (PCC score), and consonant errors. In addition, number of speech therapy visits, average hearing thresholds, and secondary surgeries were documented to assess burden of treatment. RESULTS Across the trial, 53.5% demonstrated VPC and 46.5% VPI with no significant differences between arms or centers. In total, 27% reached age-appropriate PCC scores with no statistically significant difference between the arms. The Finnish center had significantly higher PCC scores, the Swedish centers had higher percentages of oral consonant errors. Number of speech therapy visits was significantly higher in the Finnish center. CONCLUSION At age 5, poor speech outcomes with some differences between participating centers were seen but could not be attributed to surgical protocol. As one center had very few participants, the results from that center should be interpreted with caution.
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Affiliation(s)
| | - Jill Nyberg
- Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Suvi Alaluusua
- Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Jorma Rautio
- Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Erik Neovius
- Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Berggren
- Department of Plastic Surgery, University Hospital, Linköping, Sweden
| | - Christina Persson
- Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
| | - Elisabeth Willadsen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Denmark
| | - Anette Lohmander
- Division of Speech and Language Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Shaffer AD, Ford MD, Losee JE, Goldstein J, Costello BJ, Grunwaldt LJ, Jabbour N. The Association Between Age at Palatoplasty and Speech and Language Outcomes in Children With Cleft Palate: An Observational Chart Review Study. Cleft Palate Craniofac J 2019; 57:148-160. [DOI: 10.1177/1055665619882566] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective:To determine whether timing of palatoplasty (early, standard, or late) is associated with speech and language outcomes in children with cleft palate.Design:Retrospective case series.Setting:Tertiary care children’s hospital.Participants:Records from 733 children born between 2005 and 2015 and treated at the Cleft Craniofacial Clinic of a tertiary children’s hospital were retrospectively reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, syndromes, staged palatoplasty, and introduction to clinic after 12 months of age. Data from 232 children with cleft palate ± cleft lip were analyzed.Interventions:Palatoplasty.Main Outcome Measures:Speech/language delays and disorders at 20 months and 5 years of age based on formal hospital or community-based testing or screening evaluation in the Cleft Craniofacial Clinic; additional speech surgery.Results:Median age at palatoplasty was 12.6 months (range: 8.8-21.9 months). Age at palatoplasty was classified as early (<11 months, n = 28), standard (11-13 months, n = 158), or late (>13 months, n = 46). Late palatoplasty was associated with increased odds of speech/language delays and speech therapy at 20 months, and language delays at 5 years, compared with standard or early palatoplasty ( P < .05 for all comparisons). However, speech sound production disorders, velopharyngeal incompetence, tube replacement, and hearing loss were not significantly associated with age at palatoplasty.Conclusions:Late palatoplasty may be associated with short- and long-term delays in speech/language development. Future studies with standardized surgical technique/timing and outcome measures are required to more definitively describe the impact of age at palatoplasty on speech/language development.
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Affiliation(s)
- Amber D. Shaffer
- Division of Pediatric Otolaryngology, UPMC Children’s Hospital of Pittsburgh, PA, USA
| | - Matthew D. Ford
- Cleft Craniofacial Center, UPMC Children’s Hospital of Pittsburgh, PA, USA
| | - Joseph E. Losee
- Division of Pediatric Plastic Surgery, UPMC Children’s Hospital of Pittsburgh, PA, USA
| | - Jesse Goldstein
- Division of Pediatric Plastic Surgery, UPMC Children’s Hospital of Pittsburgh, PA, USA
| | - Bernard J. Costello
- Division of Pediatric Oral and Maxillofacial Surgery, UPMC Children’s Hospital of Pittsburgh, PA, USA
| | - Lorelei J. Grunwaldt
- Division of Pediatric Plastic Surgery, UPMC Children’s Hospital of Pittsburgh, PA, USA
| | - Noel Jabbour
- Division of Pediatric Otolaryngology, UPMC Children’s Hospital of Pittsburgh, PA, USA
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Botticelli S, Küseler A, Mølsted K, Andersen HS, Boers M, Shoeps A, Emborg BK, Kisling-Møller M, Pedersen TK, Andersen M, Willadsen E. Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2019; 57:420-429. [DOI: 10.1177/1055665619874143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair. Design: Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft). Setting: Tertiary health care. One surgical center. Patients and Methods: One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months). Main outcome measurements: Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency. Results: No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate “cleft size at tuberosity level” was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = −.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99). Conclusions: Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.
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Affiliation(s)
- Susanna Botticelli
- Section of Orthodontics, Aarhus University, Denmark
- Cleft Lip and Palate Center, IKH, Region Midt, Aarhus, Denmark
| | - Annelise Küseler
- Section of Orthodontics, Aarhus University, Denmark
- Cleft Lip and Palate Center, IKH, Region Midt, Aarhus, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark
| | - Kirsten Mølsted
- Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark
| | | | - Maria Boers
- Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark
| | - Antje Shoeps
- Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark
| | | | | | - Thomas Klit Pedersen
- Section of Orthodontics, Aarhus University, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark
| | - Mikael Andersen
- Department of Plastic Surgery and Burns Treatment, University Hospital of Copenhagen, Denmark
| | - Elisabeth Willadsen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Denmark
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Sun XC, Zhang ZB, Wang H, Li JH, Ma X, Xia HF. Comparison of three surgical models of bone tissue defects in cleft palate in rabbits. Int J Pediatr Otorhinolaryngol 2019; 124:164-172. [PMID: 31200319 DOI: 10.1016/j.ijporl.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Cleft palate is one of the most common craniofacial birth defects in the maxillofacial region. There is an urgent need in tissue regeneration research to establish animal models that faithfully mimic human diseases. Here, we compared three surgical models of bone tissue defects in cleft palate in rabbits in order to screen for the biomaterials that induced optimal bone regeneration. DESIGN Rabbits were used to establish the models of hard palate cleft, alveolar cleft, and alveolar process cleft. Eight weeks following surgery, bone tissue self-healing capacity was estimated by macroscopic appearance and calculating the area of defective bone tissue. The dimensions of the upper jaw in left and right sides were measured at zero and eight weeks. RESULTS Bone defects in three types of cleft palate models were made at the positions of the hard palate, alveoli and alveolar process. After 8 weeks, when the hard palate was partially excised, it underwent self-healing. When the hard palate was completely excised, it underwent partial self-healing. However, in the models of alveolar cleft and alveolar process cleft, there was no significant self-healing in the bone tissues. The dimensions of the upper jaw in left and right sides were no significant differences in three types of cleft palate models. CONCLUSIONS Bone defects in the alveolar and alveolar process clefts exhibit a diminished capability for self-healing. This study may provide valuable information for the screening of materials that induce bone regeneration.
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Affiliation(s)
- Xue-Cheng Sun
- Reproductive and Genetic Center of National Research Institute for Family Planning, Beijing, 100081, China; Graduate Schools, Peking Union Medical College, Beijing, 100730,China
| | - Ze-Biao Zhang
- Reproductive and Genetic Center of National Research Institute for Family Planning, Beijing, 100081, China
| | - Hu Wang
- Reproductive and Genetic Center of National Research Institute for Family Planning, Beijing, 100081, China; Graduate Schools, Peking Union Medical College, Beijing, 100730,China
| | - Jian-Hui Li
- Reproductive and Genetic Center of National Research Institute for Family Planning, Beijing, 100081, China; Graduate Schools, Peking Union Medical College, Beijing, 100730,China
| | - Xu Ma
- Reproductive and Genetic Center of National Research Institute for Family Planning, Beijing, 100081, China; Graduate Schools, Peking Union Medical College, Beijing, 100730,China.
| | - Hong-Fei Xia
- Reproductive and Genetic Center of National Research Institute for Family Planning, Beijing, 100081, China; Graduate Schools, Peking Union Medical College, Beijing, 100730,China.
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Outcomes of Primary Palatoplasty: An Analysis Using the Pediatric Health Information System Database. Plast Reconstr Surg 2019; 143:533-539. [PMID: 30688897 DOI: 10.1097/prs.0000000000005210] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous attempts at reporting oronasal fistula development and secondary speech surgery following cleft palate surgery have been limited to single-center case series. This limitation can be overcome by querying large databases created by health care governing bodies or health care alliances. The authors examined the effect of cleft type and demographic variables on the clinical outcomes. METHODS Data from the Pediatric Health Information System database were queried for patients, aged 6 to 18 months, who had undergone primary palatoplasty between 2004 and 2009. Subsequent repair of an oronasal fistula and/or secondary speech surgery between 2004 and 2015 was identified by procedure codes. Logistic regression models were used to assess the associations between cleft type with oronasal fistula and with secondary speech surgery. RESULTS Seven thousand three hundred twenty-five patients were identified, and 6.4 percent (n = 468) had a subsequent repair of an oronasal fistula and 18.5 percent (n = 1355) had a secondary speech operation. Adjusted for age, sex, and race, patients with cleft lip and palate have increased odds of oronasal fistula (OR, 5.60; 95 percent CI, 4.44 to 7.07) and secondary speech surgery (OR, 2.32; 95 percent CI, 2.05 to 2.63). CONCLUSIONS Using a large, multi-institution billing database, the authors were able to estimate the prevalence of oronasal fistula and surgically treated velopharyngeal insufficiency following primary palatoplasty in the United States. In addition, the authors demonstrated that patients with isolated cleft palate develop fewer oronasal fistulas and require less secondary speech surgery than patients with cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Effect of One-Stage versus Two-Stage Palatoplasty on Hypernasality and Fistula Formation in Children with Complete Unilateral Cleft Lip and Palate: A Randomized Controlled Trial. Plast Reconstr Surg 2018; 142:42e-50e. [PMID: 29652768 DOI: 10.1097/prs.0000000000004486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Is one-stage or two-stage palatoplasty more effective for preventing fistula formation and hypernasality in patients with complete unilateral cleft lip and palate? METHODS This parallel blocked randomized controlled trial included 100 patients with nonsyndromic complete unilateral cleft lip and palate with a repaired cleft lip, divided into two equal groups. Group A had one-stage palatoplasty patients at age 12 to 13 months while group B had two-stage palatoplasty patients with soft palatoplasty at age 12 to 13 months and hard palatoplasty at age 24 to 25 months. Presence of a fistula was tested clinically at 3 years and speech was tested using nasometry and perceptual analyses at 6 years. Group C consisted of noncleft controls (n = 20, age 6 years) for speech using nasometry. Fistula rates, hypernasality ratings, and nasalance scores were compared between groups A and B. Nasometry recordings of groups A and B were compared with control group C. RESULTS There was no difference in fistula rates between groups A and B (p = 0.409; 95 percent CI, 0.365 to 11.9). Mean nasalance scores of group A showed higher nasalance than group B (p = 0.006; 95 percent CI, 1.16 to 6.53). Perceptual analysis showed no difference between groups A and B (p = 0.837 and p = 1.000). Group A showed higher mean nasalance than group C (p = 0.837 and p = 1.000), whereas group B showed no difference (p = 0.088; 95 percent CI, -0.14 to 2.02). CONCLUSIONS There was no difference in fistula rates between groups. Nasalance was slightly higher in patients in the one-stage palatoplasty group than two-stage palatoplasty group, but the difference was not clinically significant. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Mommaerts MY, Gundlach KK, Tache A. "Flip-over flap" in two-stage cleft palate repair. J Craniomaxillofac Surg 2018; 47:143-148. [PMID: 30471935 DOI: 10.1016/j.jcms.2018.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/01/2018] [Accepted: 10/30/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study served to evaluate a two-stage concept in cleft palate repair, including key use of a triangular hinge ("flip-over") flap, in order to prevent palatal fistulae. It uses data from a prospective registry established in 1991. MATERIALS AND METHODS The concept entails Furlow soft palate repair (at 1 year of age) and hard palate closure (at 4 years) by a three-pronged approach [paring of the edges with or without postero-lateral relaxing incisions, peninsula (Veau) flap(s)], plus a triangular hinge flap. The latter is elevated from the oral layer of the already-repaired soft palate, stays based anteriorly, and is flipped over to close the posterior nasal layer defect. The case series is compared with data from the literature. RESULTS The palatal fistula rate for Veau II to IV types (two-stage surgeries) was 4.3%. The overall fistula rate in the cleft population (Veau I-IV) was 2.9%. Meta-analyses describe 4.9 and 8.6% on average. There was no difference between sample A in which the flip-over flaps were used only when modified Veau flaps were indicated (until 2006) and sample B in which it was used regardless of the technique of hard palate closure applied (2006-2018). The fistula rate decreased to zero after 2010, which may reflect also an influence of other factors such as the interpositioning of a collagen membrane and also of improved surgical judgment. CONCLUSIONS Using a flip-over flap in two-stage cleft palate repair may contribute to prevent fistula formation at the hard/soft palate junction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Maurice Y Mommaerts
- European Face Centre (Head: Prof. Dr. mult. Maurice Y. Mommaerts), Cleft & Craniofacial Team, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium.
| | - Karsten Kh Gundlach
- Department of Oral and Maxillofacial Plastic Surgery (Chair: Prof. Dr. Bernhard Frerich), Rostock University, Rostock, Germany
| | - Ana Tache
- European Face Centre (Head: Prof. Dr. mult. Maurice Y. Mommaerts), Cleft & Craniofacial Team, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium
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Eriguchi M, Watanabe A, Suga K, Nakano Y, Sakamoto T, Sueishi K, Uchiyama T. Growth of Palate in Unilateral Cleft Lip and Palate Patients Undergoing Two-stage Palatoplasty and Orthodontic Treatment. THE BULLETIN OF TOKYO DENTAL COLLEGE 2018; 59:183-191. [PMID: 30224612 DOI: 10.2209/tdcpublication.2017-0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to investigate the long-term effects of two-stage palatoplasty on the morphology of the maxillary alveolar arch and occlusion using plaster models of the maxilla and mandible obtained from patients with unilateral complete cleft lip and palate who also underwent orthodontic treatment. A total of 20 patients undergoing two-stage palatoplasty by Perko's method (Group T) were enrolled. Plaster models of the maxilla and mandible were obtained from each patient at Time 1, on commencement of orthodontic treatment in the mixed dentition period; at Time 2, on that of orthodontic treatment in the permanent dentition period; and at Time 3, on completion of active orthodontic treatment. Analysis of occlusion and morphological analysis were performed using a 3-dimensional measuring system. The results were compared with 15 patients who underwent one-stage palatoplasty by the push-back method using a mucoperiosteal flap (Group P). Alveolar morphology and the relationship between the maxilla and mandible were satisfactory in Group T. The palates in Group T were deeper and larger than those in Group P. Alveolar collapse in Group T was milder, and impairment of the alveolar morphology less notable than in Group P, as surgical invasion to the anterior alveolar region was avoided during the palatal growth period. These results suggest that two-stage palatoplasty is advantageous for jaw development.
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Affiliation(s)
- Masashi Eriguchi
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College
| | - Akira Watanabe
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College
| | - Kenichirou Suga
- Tochigi Medical Center, Department of Dentistry & Oral Surgery & Pediatric Dentistry
| | - Youko Nakano
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College
| | | | | | - Takeshi Uchiyama
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College
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