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Frawley G, Wilkes C, Hallett B, Chong D. Prediction of Early Postoperative Pain in Infants Undergoing Primary Cleft Palate Repair. Cleft Palate Craniofac J 2024; 61:1493-1498. [PMID: 37101364 DOI: 10.1177/10556656231172303] [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: 04/28/2023] Open
Abstract
OBJECTIVE Identification of at risk patients before surgery could facilitate improved clinical communication, care pathways and postoperative pain management. DESIGN A retrospective cohort study was performed in all infants who had undergone cleft palate repair. SETTING Tertiary Institutional. PARTICIPANTS Infants < 36 months of age who underwent primary repair of cleft palate between March 2016 and July 2022. INTERVENTION Requirement for analgesic intervention in the post operative care unit. MAIN OUTCOME MEASURE Adverse perioperative event defined as pain or distress. Secondary outcomes were the incidence of airway obstruction, hypoxemia or unplanned intensive care admission. RESULTS Two hundred and ninety one patients (14.6 months,10.1 kg weight) were included. Cleft distribution included submucous (5.2%), Veau I (23.4%), Veau 2 (38.1%), Veau 3 (24.4%), and Veau 4 (8.9%). Overall 35% of 291 infants undergoing cleft palate repair experienced pain or distress requiring opiate intervention in the first hour after surgery. Infants with a Veau 4 cleft palate had 1.8 times and Veau 2 cleft palate had 1.5 times the risk of postoperative pain compared to infants with Veau 1 cleft palate (relative risk 1.82, 95%CI 1.04-3.18 and 1.49, 95%CI 0.96-2.32 respectively). The use of bilateral above elbow arm splints was significantly associated with postoperative pain or distress (odds ratio 2.23, 95%CI 1.01-5.16). CONCLUSIONS Post operative pain requiring intervention in PACU is common despite adequate intraoperative multimodal analgesia, local anaesthesia infiltration and postoperative opiate infusions. Infants undergoing soft palate alone or submucous palate repair may require less perioperative opiates.
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Affiliation(s)
- Geoff Frawley
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital Melbourne, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute, Critical Care and Neurosciences Theme, Parkville, Australia
| | - Courtney Wilkes
- Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital, Melbourne, Australia
| | - Ben Hallett
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital Melbourne, Parkville, Australia
| | - David Chong
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital, Melbourne, Australia
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Wang Y, Zhang Z, Sun W, Song T, Yin N, Wang Y. Nasal airway resistance in patients with different degrees of operated unilateral cleft lip: Evaluation of ventilation in 112 patients. Int J Pediatr Otorhinolaryngol 2024; 183:112049. [PMID: 39053205 DOI: 10.1016/j.ijporl.2024.112049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/09/2024] [Accepted: 07/22/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE The aim of this study was to compare the nasal airway resistance between the cleft and non-cleft sides in operated unilateral cleft lip (UCL) patients with varying severities at birth, as well as to assess the differences in nasal airway resistance between UCL patients and healthy individuals. METHODS This retrospective study was conducted on 112 UCL patients who have undergone primary lip reconstructions but not advanced surgeries as the study group and 20 healthy participants as the control group between February 2023 to March 2024. The study group patients were grouped based on the severity of their cleft lip at birth, divided into occult cleft lip group, incomplete cleft lip group, and complete cleft lip group. The anterior rhinomanometry was used to evaluate nasal resistance, including unilateral effective resistances during inspiration (Reffin), expiration (Reffex), and the entire breath (ReffT), as well as unilateral vertex resistance during inspiration (VRin) and expiration (VRex). The Kolmogorov-Smirnov test was used to assess normality. Paired t-tests were utilized to analyze the differences in nasal resistance between the healthy and affected sides within the same group of patients. Student's t-test was used to analyze the differences in nasal resistance among patients with different degrees of cleft lip. A p-value of <0.05 was considered statistically significant. RESULTS The nasal resistances of the occult cleft and incomplete cleft lip groups showed no significant differences between the cleft and non-cleft sides, and were similar to the control group. However, in the complete cleft lip group, the cleft side nasal resistance was significantly higher than the non-cleft side and control group. Among the groups, the complete cleft lip group had significantly higher nasal resistances on the cleft side for Reffin, VRin, and ReffT compared to the occult cleft group. CONCLUSION Understanding the nasal resistance of different degrees of operated UCL patients can benefit clinical diagnosis and treatment. Patients with complete cleft lip have more severe nasal obstruction on the cleft side, with greater impact on inhalation than exhalation. For these patients, treatment by an otolaryngologist is recommended to improve nasal airflow.
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Affiliation(s)
- Yu Wang
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-da-chu, Beijing, 100144, China
| | - Zhilu Zhang
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-da-chu, Beijing, 100144, China
| | - Weiyi Sun
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-da-chu, Beijing, 100144, China
| | - Tao Song
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-da-chu, Beijing, 100144, China
| | - Ningbei Yin
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-da-chu, Beijing, 100144, China
| | - Yongqian Wang
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-da-chu, Beijing, 100144, China.
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Li H, Hou Y, Mou Q, Ren Z, Tao Y, Jiao Y, Huang H, Zhao H. Establishment of a novel classification system for alveolar morphology in infants with unilateral complete cleft lip and palate. Clin Oral Investig 2023; 27:7643-7650. [PMID: 37889344 PMCID: PMC10713668 DOI: 10.1007/s00784-023-05353-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES Unilateral complete cleft lip and palate (UCCLP) is one of the most severe clinical subtypes among cleft lip and palate (CLP), making repair surgery and subsequent orthodontic treatment particularly challenging. Presurgical nasoalveolar molding (PNAM) has shown conflicting and heterogeneous results in the treatment of UCCLP patients, raising questions about whether the diversity in alveolar anatomical morphology among these patients plays a role in the effectiveness of PNAM treatment. MATERIALS AND METHODS We collected 90 digital maxillary models of infants with UCCLP and performed mathematical clustering analysis, including principal component analysis (PCA), decision tree modeling, and area under the ROC Curve (AUC) analysis, to classify alveolar morphology and identify key measurements. We also conducted clinical evaluations to assess the association between the alveolar morphology and CLP treatment outcomes. RESULTS Using mathematical clustering analysis, we classified the alveolar morphology into three distinct types: average form, horizontal form, and longitudinal form. The decision tree model, AUC analysis, and comparison analysis revealed that four measurements (Trans ACG-ACL, ML length, MG length and Inc length) were essential for clustering the alveolar morphology of infants with UCCLP. Furthermore, the blinded clinical evaluation indicated that UCCLP patients with alveolar segments of horizontal form had the lowest treatment outcomes. CONCLUSION Overall, our findings establish a novel quantitative classification system for the morphology of alveolar bone in infants with UCCLP and suggest that this classification may be associated with the outcomes of CLP treatment. CLINICAL RELEVANCE The multidisciplinary CLP team should thoroughly evaluate and classify the specific alveolar morphology when administering PNAM to infants with UCCLP.
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Affiliation(s)
- Haizhen Li
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, No. 98, Xiwu Road, Xincheng District, Xi'an, Shaanxi, People's Republic of China
- Department of Orthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Yuxia Hou
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, No. 98, Xiwu Road, Xincheng District, Xi'an, Shaanxi, People's Republic of China
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Qingnan Mou
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, No. 98, Xiwu Road, Xincheng District, Xi'an, Shaanxi, People's Republic of China
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Zhanping Ren
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, No. 98, Xiwu Road, Xincheng District, Xi'an, Shaanxi, People's Republic of China
- Department of Cleft Lip and Palate Surgery, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Yongwei Tao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, No. 98, Xiwu Road, Xincheng District, Xi'an, Shaanxi, People's Republic of China
- Department of Cleft Lip and Palate Surgery, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Yuhua Jiao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, No. 98, Xiwu Road, Xincheng District, Xi'an, Shaanxi, People's Republic of China
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Huimei Huang
- Department of Nephrology, Xi'an Children's Hospital, The Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Huaxiang Zhao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, No. 98, Xiwu Road, Xincheng District, Xi'an, Shaanxi, People's Republic of China.
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
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