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Thiruvenkatachari B, Bonanthaya K, Kuijpers Jagtman AM, Sandler J, Powar RS, Hussain SA, Subramaniyan B, Bhola N, Bhat HK, Ramachandra V, Jayakumar S, Batra P, Chakkaravarthi S, Thailavathy V, Prathap M, Elumalai T, Nambiar K, Vijayakumar C, Mahajan RK, Sood SC, Kahlon SS, Bijapur S, Kamble RH, Keluskar KM, Nilgar A, Khan FA, Das D, Sridhar S, Buch A, Kumar S, Mohanraj R, Listl S, Chopra S, Jadhav V, Arora A, Valiya C, Pattamata M. A multi-centric, single-blinded, randomized, parallel-group study to evaluate the effectiveness of nasoalveolar moulding treatment in non-syndromic patients with complete unilateral cleft lip, alveolus and palate (NAMUC study): a study protocol for a randomized controlled trial. Trials 2024; 25:453. [PMID: 38965585 PMCID: PMC11223389 DOI: 10.1186/s13063-024-08229-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: 05/25/2024] [Accepted: 06/04/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Cleft lip and palate (CLP) are among the most common congenital anomaly that affects up to 33,000 newborns in India every year. Nasoalveolar moulding (NAM) is a non-surgical treatment performed between 0 and 6 months of age to reduce the cleft and improve nasal aesthetics prior to lip surgery. The NAM treatment has been a controversial treatment option with 51% of the cleft teams in Europe, 37% of teams in the USA and 25 of cleft teams in India adopting this methodology. This treatment adds to the already existing high burden of care for these patients. Furthermore, the supporting evidence for this technique is limited with no high-quality long-term clinical trials available on the effectiveness of this treatment. METHOD The NAMUC study is an investigator-initiated, multi-centre, single-blinded randomized controlled trial with a parallel group design. The study will compare the effectiveness of NAM treatment provided prior to lip surgery against the no-treatment control group in 274 patients with non-syndromic unilateral complete cleft lip and palate. The primary endpoint of the trial is the nasolabial aesthetics measured using the Asher McDade index at 5 years of age. The secondary outcomes include dentofacial development, speech, hearing, cost-effectiveness, quality of life, patient perception, feeding and intangible benefits. Randomization will be carried out via central online system and stratified based on cleft width, birth weight and clinical trial site. DISCUSSION We expect the results from this study on the effectiveness of treatment with NAM appliance in the long term along with the cost-effectiveness evaluation can eliminate the dilemma and differences in clinical care across the globe. TRIAL REGISTRATION ClinicalTrials.gov CTRI/2022/11/047426 (Clinical Trials Registry India). Registered on 18 November 2022. The first patient was recruited on 11 December 2022. CTR India does not pick up on Google search with just the trial number. The following steps have to be carried out to pick up. How to search: ( https://ctri.nic.in/Clinicaltrials/advsearch.php -use the search boxes by entering the following details: Interventional trial > November 2022 > NAMUC).
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Affiliation(s)
- Badri Thiruvenkatachari
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India.
| | | | - Anne Marie Kuijpers Jagtman
- Department of Orthodontics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern, Bern, Switzerland
| | - Jonathan Sandler
- Chesterfield Royal Hospital, Chesterfield Royal Hospital NHS Foundation Trust, Calow, England
| | - Rajesh S Powar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Syed Altaf Hussain
- Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India
| | - B Subramaniyan
- Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India
| | - Nitin Bhola
- Shri Sharad Pawar Dental College and Hospital (SPDC), Wardha, Maharashtra, India
| | - Hari Kishore Bhat
- Yenepoya University: Yenepoya (Deemed to Be University), Mangaluru, Karnataka, India
| | | | | | - Puneet Batra
- Manav Rachna Dental College, Faridabad, Haryana, India
| | - Subhiksha Chakkaravarthi
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - V Thailavathy
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - Manoj Prathap
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - Thulasiram Elumalai
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - Karthika Nambiar
- Cleft and Craniofacial Department, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Velachery Main Road, Chennai, Tamil Nadu, 600100, India
| | - Charanya Vijayakumar
- Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India
| | | | | | | | | | | | - K M Keluskar
- Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education & Research, Belagavi, India
| | - Amit Nilgar
- Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education & Research, Belagavi, India
| | - Faizan Ahmed Khan
- Yenepoya University: Yenepoya (Deemed to Be University), Mangaluru, Karnataka, India
| | | | - Swetha Sridhar
- Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chrompet, Chennai, India
| | | | | | | | - Stefan Listl
- Heidelberg University BIOMS: Universitat Heidelberg Bioquant, Heidelberg, Germany
| | | | - Vikrant Jadhav
- Shri Sharad Pawar Dental College and Hospital (SPDC), Wardha, Maharashtra, India
| | - Anika Arora
- Manav Rachna Dental College, Faridabad, Haryana, India
| | | | - Madhuri Pattamata
- Radboud Universiteit Nijmegen: Radboud Universiteit, Nijmegen, The Netherlands
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Al-Hassani M, Fowler P, Wren Y, Leary S, Davies A. Should left- and right-sided unilateral cleft lip and palate patients be grouped together when reporting the outcomes? Orthod Craniofac Res 2024; 27 Suppl 1:49-61. [PMID: 38193240 DOI: 10.1111/ocr.12747] [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] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVES Investigate associations between cleft laterality in patients with non-syndromic unilateral cleft lip and palate (UCLP) and oral-health, dental-arch, speech, audiological, psychological and nasolabial-aesthetic outcomes. METHODS Secondary data analysis of the outcomes of 5-year-old children with non-syndromic complete UCLP identified from three studies: Cleft Collective (n = 155), Cleft Care UK (CCUK) (n = 266) and Clinical Standards Advisory Group (CSAG) study (n = 238). Outcome measures included occlusal assessment using the 5-year-old's index score, speech intelligibility rating using the CAPS-A Audit tool, audiological assessment using pure tone audiometry, nasolabial aesthetic assessment using the Asher-McDade tool, oral-health assessment using decayed, missing, filled teeth scores and parent-reported outcomes. Logistic regression with adjustment for age, sex and index-of-multiple-deprivation scores were performed. RESULTS No differences were found in patient-reported outcomes between the left and right clefts in the Cleft Collective study. From the CCUK study, right clefts had poorer speech (n = 236; 95% CI 1.09, 3.42; and P = .03) and hearing outcomes (n = 211; 95% CI 1.03, 3.43; P = .04). In the CSAG study, patients with left clefts were more likely to be teased (n = 213; 95% CI 0.26, 0.85; and P = .01). CONCLUSION Weak associations between cleft laterality, speech, hearing and psychological outcomes were found, however the findings were inconsistent across the studies. This study contributes to evidence of associations between laterality and outcomes in children born with UCLP.
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Goodwin JW, Hopkins L, Conrad AL. White matter tract integrity in isolated oral clefts: relationship to cognition and reading skills. Child Neuropsychol 2024:1-22. [PMID: 38501945 PMCID: PMC11411015 DOI: 10.1080/09297049.2024.2330725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/09/2024] [Indexed: 03/20/2024]
Abstract
Children with isolated cleft of the lip and/or palate (iCL/P) have been shown to be at risk for impaired reading ability. Structural and functional neuroimaging studies have revealed subtle morphological and functional abnormalities correlated to cognition and reading ability. However, the integrity of white matter tracts and their potential relationship to reading performance in iCL/P is under-studied. The purpose of the present study was to evaluate white matter integrity related to cognition and reading skills among participants with and without iCL/P. Data from two cross-sectional, case/control studies with similar neuropsychological batteries and diffusion tensor imaging (DTI) protocols were combined. The final sample included 210 participants (ages 7 to 27 years). Group and sex differences in fractional anisotropy (FA) values were examined between participants with (n = 105) and without (n = 105) iCL/P. Potential associations between FA values and age, cognition, and reading skills were also evaluated separately by group and sex. Sex effects were prominent in association and projection fibers, and effects of cleft status were found in association fibers and cerebellar regions, with isolated associations to reading skills. Findings provide preliminary understanding of microstructural associations to cognitive and reading performance among children, adolescents, and young adults with iCL/P.
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Affiliation(s)
- Jon Willie Goodwin
- Department of Counseling, Clinical and School Psychology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Lauren Hopkins
- Department of Psychiatry, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA, USA
| | - Amy Lynn Conrad
- Stead Family Department of Pediatrics, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA, USA
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Fell M, Chadha A, van Eeden S. Are NHS cleft services in England ready for delegation to integrated care systems? Br Dent J 2024; 236:443-446. [PMID: 38519672 DOI: 10.1038/s41415-024-7172-7] [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: 08/13/2023] [Revised: 10/03/2023] [Accepted: 10/13/2023] [Indexed: 03/25/2024]
Abstract
Cleft care services in the UK have been nationally funded since centralisation 25 years ago and during this time have been able to demonstrate improved clinical outcomes. Integrated care systems have been introduced into legislature as part of the Health Care Act of 2022 and will be responsible for the paradigm shift of allocating funds on a regional basis for cleft care services in England from 2024. The proposed population-based funding formulas present an opportunity to improve current inequities in cleft care, including access to speech therapy and adult services. However, the regional footprint of integrated care systems does not align with that of the centralised cleft service system and represents a threat to the standardised patient-centred care that has taken two decades to build. Awareness needs to be raised so that cleft care providers can proactively adapt to this mandatory change to service funding to ensure that clinical standards are maintained and continue to improve.
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Affiliation(s)
- Matthew Fell
- Cleft Collective, University of Bristol, UK; Spires Cleft Centre, Oxford and Salisbury, UK.
| | - Ambika Chadha
- Cleft.Net.East, Addenbrookes Hospital, Cambridge University NHS Hospitals Trust, UK; Department of Perinatal Imaging, King´s College London, UK
| | - Simon van Eeden
- Alder Hey Children´s and Aintree University Hospitals, Liverpool, UK
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Cleft and Craniofacial Surgery. J Oral Maxillofac Surg 2023; 81:E120-E146. [PMID: 37833020 DOI: 10.1016/j.joms.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Paul NR, Rolland SL. Characteristics of orthognathic multidisciplinary team clinics in England. Part 2: A qualitative study. J Orthod 2023; 50:296-302. [PMID: 36994796 PMCID: PMC10469473 DOI: 10.1177/14653125231165069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE The aim of the study was to explore the orthodontist's perspective of the strengths and weaknesses of their current multidisciplinary team (MDT) design for orthognathic treatment. PARTICIPANTS AND METHODS This was a qualitative study using online interviews of orthodontic consultants across England. The data were analysed using thematic analysis. This was the second part of a two-part study, where the first part, an online questionnaire survey, identified the variation in design of orthognathic MDTs across England and was the source of the 19 participants for this study. RESULTS Seven themes were identified that influenced the design of orthognathic MDTs across England. Close working relationship with the team, access to closed surgery space to conduct the MDT and access to 3D planning were identified as definite strengths of some MDT clinics. Lack of a team psychologist and long waiting lists were identified as weaknesses of some orthognathic MDTs. Teaching and training within MDT clinics were highlighted as a strength of MDTs where surgery spaces were not restricted due to the pandemic. Finally, there was general agreement about revising the orthognathic minimum dataset for records collection as it was not thought to be in the patient's best interest. CONCLUSION This study was able to identify key areas considered to be determinants of a successful orthognathic MDT design from the orthodontic consultant's perspective. Orthodontic consultants across England prioritised the need for a psychologist in the orthognathic MDT to improve the effectiveness of these clinics.
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Affiliation(s)
- Ninu R Paul
- Department of Orthodontics, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah L Rolland
- Department of Orthodontics, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Martin SV, Swan MC. An essential overview of orofacial clefting. Br Dent J 2023; 234:937-942. [PMID: 37349450 DOI: 10.1038/s41415-023-6000-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 06/24/2023]
Abstract
An appreciation of the embryologic development of the face is essential to understanding the anatomic variation observed in this phenotypically broad condition. Embryologically, the nose, lip and palate are separated into the primary and secondary palate, which are divided anatomically by the incisive foramen. The epidemiology of orofacial clefting is reviewed together with the contemporaneous cleft classification systems that enable comparisons to be made between international centres for audit and research purposes. A detailed examination of the clinical anatomy of the lip and palate informs the surgical priorities for the primary reconstruction of both form and function. The pathophysiology of the submucous cleft palate is also explored. The seismic impact of the 1998 Clinical Standards Advisory Group report on the organisation of UK cleft care provision is outlined. The importance of the Cleft Registry and Audit Network database in auditing UK cleft outcomes is highlighted. The potential for the Cleft Collective study to establish the causes of clefting, the optimal treatment protocols, and the impact of cleft on patients is tremendously exciting for all health care professionals involved in the management of this challenging congenital deformity.
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Affiliation(s)
- Serena V Martin
- Cleft Fellow, Spires Cleft Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom
| | - Marc C Swan
- Consultant Cleft and Plastic Surgeon, Spires Cleft Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom.
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Dudding T, Martin S, Popat S. An introduction to the UK care pathway for children born with a cleft of the lip and/or palate. Br Dent J 2023; 234:943-946. [PMID: 37349451 PMCID: PMC10287563 DOI: 10.1038/s41415-023-5998-z] [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: 03/29/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/24/2023]
Abstract
Cleft lip and/or palate includes a spectrum of congenital disorders affecting union on the lip, alveolus, hard and/or soft palate. The management of children born with an orofacial cleft requires a complex process from a multidisciplinary team (MDT) to restore form and function. Since the Clinical Standards Advisory Group (CSAG) report in 1998, the UK has reformed and restructured cleft services to improve the outcomes for children born with a cleft.The spectrum of cleft conditions, the members of the MDT and a chronological description of the stages of cleft management from diagnosis to adulthood are described using a clinical example. This paper forms the introduction to a series of more detailed papers which span all major aspects of cleft management. The papers will cover the following topics: dental anomalies; associated medical conditions among children; orthodontic management of patients; speech assessment and intervention; role of the clinical psychologist; challenges for the paediatric dentist; genetics and orofacial clefts; surgery - primary and secondary; restorative dentistry; and global perspectives.
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Affiliation(s)
- Tom Dudding
- Bristol Dental School, University of Bristol, Bristol, UK; The Spires Cleft Centre, John Radcliffe Hospital, Oxford, United Kingdom.
| | - Serena Martin
- The Spires Cleft Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Sandip Popat
- The Spires Cleft Centre, John Radcliffe Hospital, Oxford, United Kingdom
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Mossey PA. Global perspectives in orofacial cleft management and research. Br Dent J 2023; 234:953-957. [PMID: 37349453 DOI: 10.1038/s41415-023-5993-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/24/2023]
Abstract
Orofacial clefts (OFCs) refer to clefts of the lip and palate, a heterogeneous group of relatively common congenital conditions that can cause mortality and significant disability if untreated, and residual morbidity even when treated with multidisciplinary care. Contemporary challenges in the field include: lack of awareness of OFCs in remote, rural and impoverished populations; uncertainties due to lack of surveillance and data gathering infrastructure; inequitable access to care in some parts of the world; and lack of political will combined with lack of capacity to prioritise research.OFCs present clinically as either syndromic or non-syndromic, with the latter either being isolated or in conjunction with other malformations; however, many registries still do not differentiate between these fundamentally different entities and lump a spectrum of cleft types and sub-phenotypes together. This has implications for treatment, research and ultimately, quality improvement.This paper deals with the challenges in contemporary management in terms of care and the prospects and possibilities for primary prevention of non-syndromic clefts. In terms of management and optimal care, there are also challenges in the provision of multi-disciplinary treatment and management of the consequences of being born with OFCs, such as dental caries, malocclusion and psychosocial adjustment.
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Affiliation(s)
- Peter A Mossey
- Professor of Craniofacial Development and Associate Dean for Internationalisation, Dundee University Dental School, 1 Park Place, Dundee, DD1 4HR, Scotland, United Kingdom.
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May J, Smallridge J, Collard M, Vaidyanathan M, Bhujel N. Challenges for dental care of the paediatric patient born with cleft lip and/or palate. Br Dent J 2023; 234:867-871. [PMID: 37349433 DOI: 10.1038/s41415-023-5995-2] [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: 02/03/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 06/24/2023]
Abstract
This paper forms part of a series on the management of patients with cleft lip and/or palate (CLP). Children with CLP have a higher incidence of dental caries and dental anomalies. This paper explains the important roles of both the general dental practitioner and specialist paediatric dentist on the cleft team in managing these children alongside the multidisciplinary team.
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Affiliation(s)
- Joanna May
- North West North Wales Cleft Network, Alder Hey Children´s Hospital, Liverpool, United Kingdom.
| | | | - Mechelle Collard
- South West South Wales Cleft Network, Cardiff, Wales, United Kingdom
| | | | - Nabina Bhujel
- Evelina London Cleft Service, London, United Kingdom
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Stepp WH, Stein EJ, Canfarotta MW, Wood J, Vandoros E, Stein M, Daniel R, Shockley WW, Clark JM, Drake AF. Body Dysmorphic Disorder in Adult Patients With an Orofacial Cleft: An Unseen Psychological Burden. Laryngoscope 2023; 133:818-821. [PMID: 36054769 DOI: 10.1002/lary.30378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/14/2022] [Accepted: 08/12/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Facial dysmorphic disorder (FDD), a variant of body dysmorphic disorder, occurs when individuals are preoccupied with perceived defects in their facial appearance. Cleft lip and/or palate (CL/P) requires many clinical interventions and has significant psychological impacts on a patient's perception of appearance. This study identified psychological burdens related to living as an adult with CL/P and characterizes the degree of FDD symptoms in an adult craniofacial population. METHODS This was a prospective, single-center, cross-sectional case-control study using semi-structured interviews and symptom assessments at a university-based craniofacial center. Patients without CL/P undergoing non-cosmetic facial surgery were recruited as controls (n = 20). Patients with an orofacial cleft (n = 30) were recruited from medical and dental providers at the University of North Carolina. Body Dysmorphic Disorder-Yale Brown Obsessive Compulsive Scale (BBD-YBOCS) scores were collected from a control population and patients with CL/P to assess FDD severity. RESULTS Demographic factors such age, biological sex, and ethnicity had no significant impact on FDD symptom scores. Patient with CL/P were more likely to have significant FDD symptoms (BDD-YBOCS greater than 16) than patients without CL/P (OR 10.5, CI95 2.7-41.1), and had a mean difference in FDD symptoms scores of 10.04 (p < 0.0001; CI95 5.5-14.6). Patients with CL/P seen by a mental health provider in the past 3 months had 3-fold lower overall FDD symptom scores (OR 0.081; CI95 0.0085-0.77). CONCLUSIONS Adults with CL/P would benefit from treatment for cleft-specific needs and psychological support as they face unique stressors related to their appearance, including an increase in FDD-associated symptoms. This study emphasizes the importance of recognizing psychological symptoms and providing ongoing multidisciplinary care to adults with CL/P. LEVEL OF EVIDENCE 3; Individual case-control study Laryngoscope, 133:818-821, 2023.
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Affiliation(s)
- Wesley H Stepp
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Eva J Stein
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Michael W Canfarotta
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Jeyhan Wood
- University of North Carolina Craniofacial Center, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A.,Department of Surgery, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Eva Vandoros
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Margot Stein
- University of North Carolina Craniofacial Center, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A
| | - Renie Daniel
- University of North Carolina Craniofacial Center, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A.,Department of Oral and Maxillofacial Surgery, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A
| | - William W Shockley
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Joseph Madison Clark
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Amelia F Drake
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A.,University of North Carolina Craniofacial Center, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A
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Butterworth S, Hodgkinson EL, Stock NM, Sainsbury DCG, Hodgkinson PD. Evolution of Cleft Lip and Palate Surgical Training in the UK: A Qualitative Study. Cleft Palate Craniofac J 2023; 60:197-210. [PMID: 34786999 DOI: 10.1177/10556656211058443] [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
BACKGROUND Although the United Kingdom (UK) cleft surgeons follow a similar training pathway, and cleft centers adhere to similar protocols regarding the timing of palate surgery and surgical technique, speech outcomes still vary between centers. OBJECTIVE To explore the training experiences of consultant cleft lip and palate (CL/P) surgeons, performing a Sommerlad radical intravelar veloplasty (IVVP) and their approach to teaching others. DESIGN An exploratory, qualitative approach was adopted to understand the views of UK cleft surgeons performing a Sommerlad radical IVVP and discuss what was important during training and upon qualifying as a consultant. METHOD A semi-structured interview schedule was designed, interviews were conducted in-person or via videoconferencing, depending on preference and availability, with interested surgeons. The interviews were recorded, transcribed, and checked for accuracy. Analysis involved inductive thematic analysis. RESULTS Fourteen cleft consultants from the UK participated (3F:11M). Seven of the consultants were trained in plastic surgery and four in maxillofacial surgery. Seven themes were identified from the thematic analysis. Three themes, namely Learning to perform palate repair, Teaching others to perform palate repair, and Ongoing learning as a consultant are discussed. CONCLUSIONS Cleft palate repair is clearly a technically challenging procedure to learn and teach with the potential to cause harm if performed incorrectly. Positive changes have been made to improve exposure to palate surgery, encourage practice away from the patient, and increase supervised practical experience. The role of colleagues in providing mentorship and support appears invaluable. We provide some simple recommendations that may improve the training experience and ensure parity for all trainees.
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Affiliation(s)
- Sophie Butterworth
- 5983Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Emma L Hodgkinson
- 5983Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - David C G Sainsbury
- 5983Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Peter D Hodgkinson
- 5983Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Sainsbury DCG, Butterworth S, Fell M, Humphries K, Mehendale F, Richard B. Towards breaking down cleft data silos to improve clinical research and patient outcomes. BRITISH MEDICAL JOURNAL 2022. [DOI: 10.1136/bmj.o1799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Secondary Alveolar Bone Grafting in Patients with Unilateral and Bilateral Complete Cleft Lip and Palate: A Single-Institution Outcomes Evaluation Using Three-Dimensional Cone Beam Computed Tomography. Plast Reconstr Surg 2022; 149:1404-1411. [PMID: 35613289 DOI: 10.1097/prs.0000000000009142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Secondary alveolar bone grafting of autologous bone from the iliac crest is a widely accepted modality for repair of residual alveolar cleft in patients with mixed dentition with previously repaired complete cleft lip and palate. There remains debate regarding surgical timing and preoperative, perioperative, and postoperative management of these cases. METHODS This retrospective study reviewed patient demographic information in addition to preoperative, perioperative, and postoperative course to evaluate how patient and practice factors impact graft outcomes as assessed by three-dimensional cone beam computed tomographic evaluation at the 6-month postoperative visit. RESULTS On univariate analysis, age at operation older than 9 years, history of oronasal fistula, history of cleft lip or palate revision, and history of international adoption were all found to significantly increase likelihood of graft failure (p < 0.05). On multivariate analysis, age older than 9 years was found to be the single most significant predictor of graft failure (p < 0.05). There was no significant difference in graft outcomes between patients with unilateral or bilateral cleft lip and palate, and no single variable was found to significantly correlate to increased complication rates. The graft success rate overall of the authors' practice was 86.2 percent, with a complication rate of 7.7 percent. CONCLUSIONS Secondary alveolar bone grafting is an integral part of the cleft lip and palate surgical treatment series; this study identified several outcome predictors for both graft failure and adverse events, the most significant of which was age at operation. Although the mixed dentition phase often extends to 12 years of age, it is recommended that bone grafting be performed before 9 years of age to optimize outcomes. CLINICAL QUESTIONS/LEVEL OF EVIDENCE Risk, III.
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15
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Nicholas R, Heinze Z, Papavasiliou T, Fiadeiro R, Atherton D, Timoney N, Echlin K. Educational Impact of a Novel Cleft Palate Surgical Simulator: Improvement in Surgical Trainees’ Knowledge and Confidence. J Plast Reconstr Aesthet Surg 2022; 75:3817-3825. [DOI: 10.1016/j.bjps.2022.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/01/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022]
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16
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McWilliams D, Costa B, Blighe S, Swan MC, Hotton M, Hudson N, Stock NM. The Impact of the Covid-19 Pandemic on Cleft Lip and Palate Service Delivery for New Families in the United Kingdom: Medical and Community Service Provider Perspectives. Cleft Palate Craniofac J 2022; 60:551-561. [PMID: 35195455 PMCID: PMC9218609 DOI: 10.1177/10556656221074870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Professionals in the United Kingdom providing care to new families affected by cleft lip and/or palate (CL/P) had to adapt to ensure families' needs were met during a time of uncertainty due to Covid-19. The aims of this study were to explore the impacts of the pandemic on CL/P care provision for new families from the perspectives of professionals working in medical and community settings along with any personal impact on professionals and their reflections on the future of CL/P care. DESIGN Semistructured interviews (n = 27) were completed about experiences from March 2020 to October 2020 with consultant cleft surgeons (n = 15), lead clinical nurse specialists (n = 8), and staff working at the Cleft Lip and Palate Association (n = 4). Transcripts were analyzed using inductive thematic analysis. RESULTS Three themes were identified: (1) the impact of Covid-19 on the provision of cleft care in the United Kingdom, including working conditions, delays to treatment, and Covid-19 policies; (2) the impact of the pandemic on professionals' mental health, including personal distress and concerns about Covid-19 exposure; and (3) reflections on the future of CL/P care, whereby professionals expressed both hope and concern about the Covid-19 recovery effort. CONCLUSIONS The ongoing Covid-19 pandemic has impacted CL/P service delivery for new families significantly, warranting recommendations for cohesive psychological support for families in addition to a safe and resourced recovery effort. Support for professionals is also suggested, following existing evidence-based models for providers' needs that address the difficulties of working throughout challenging times.
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Affiliation(s)
- Danielle McWilliams
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
| | - Sabrina Blighe
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Marc C Swan
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Matthew Hotton
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Nichola Hudson
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
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17
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Fell M, Russell C, Medina J, Gillgrass T, Chummun S, Cobb ARM, Sandy J, Wren Y, Wills A, Lewis SJ. The impact of changing cigarette smoking habits and smoke-free legislation on orofacial cleft incidence in the United Kingdom: Evidence from two time-series studies. PLoS One 2021; 16:e0259820. [PMID: 34818369 PMCID: PMC8612573 DOI: 10.1371/journal.pone.0259820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Both active and passive cigarette smoking have previously been associated with orofacial cleft aetiology. We aimed to analyse the impact of declining active smoking prevalence and the implementation of smoke-free legislation on the incidence of children born with a cleft lip and/or palate within the United Kingdom. METHODS AND FINDINGS We conducted regression analysis using national administrative data in the United Kingdom between 2000-2018. The main outcome measure was orofacial cleft incidence, reported annually for England, Wales and Northern Ireland and separately for Scotland. First, we conducted an ecological study with longitudinal time-series analysis using smoking prevalence data for females over 16 years of age. Second, we used a natural experiment design with interrupted time-series analysis to assess the impact of smoke-free legislation. Over the study period, the annual incidence of orofacial cleft per 10,000 live births ranged from 14.2-16.2 in England, Wales and Northern Ireland and 13.4-18.8 in Scotland. The proportion of active smokers amongst females in the United Kingdom declined by 37% during the study period. Adjusted regression analysis did not show a correlation between the proportion of active smokers and orofacial cleft incidence in either dataset, although we were unable to exclude a modest effect of the magnitude seen in individual-level observational studies. The data in England, Wales and Northern Ireland suggested an 8% reduction in orofacial cleft incidence (RR 0.92, 95%CI 0.85 to 0.99; P = 0.024) following the implementation of smoke-free legislation. In Scotland, there was weak evidence for an increase in orofacial cleft incidence following smoke-free legislation (RR 1.16, 95%CI 0.94 to 1.44; P = 0.173). CONCLUSIONS These two ecological studies offer a novel insight into the influence of smoking in orofacial cleft aetiology, adding to the evidence base from individual-level studies. Our results suggest that smoke-free legislation may have reduced orofacial cleft incidence in England, Wales and Northern Ireland.
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Affiliation(s)
- Matthew Fell
- Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Craig Russell
- Scottish Cleft Service, Royal Hospital for Children, Glasgow, United Kingdom
| | - Jibby Medina
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Toby Gillgrass
- Scottish Cleft Service, Royal Hospital for Children, Glasgow, United Kingdom
| | - Shaheel Chummun
- South West Cleft Service, University Hospitals Bristol and Weston NHS Trust, Bristol, United Kingdom
| | - Alistair R. M. Cobb
- South West Cleft Service, University Hospitals Bristol and Weston NHS Trust, Bristol, United Kingdom
| | - Jonathan Sandy
- Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Yvonne Wren
- Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Andrew Wills
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Sarah J. Lewis
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
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18
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Stonehouse-Smith D, Beale V, Bellardie H. Radiographic outcome of secondary alveolar bone grafting in patients with alveolar clefts. Orthod Craniofac Res 2021; 25:128-133. [PMID: 34101345 DOI: 10.1111/ocr.12508] [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: 05/10/2021] [Revised: 05/29/2021] [Accepted: 06/03/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the outcome of secondary alveolar bone grafting (SABG) in a series of consecutive patients with clefts involving the alveolus. DESIGN AND SETTING Retrospective cohort study of consecutive operations performed between June 2011 and September 2016 by a single surgeon at a single United Kingdom cleft center. PARTICIPANTS A total of 160 patients with a cleft/s involving the alveolus, inclusive of syndromic patients and those with atypical facial clefts. INTERVENTIONS A standard protocol involved an oral hygiene program, pre-surgical orthodontics where necessary and autologous bone grafting from the iliac crest. MAIN OUTCOME MEASURE(S) The Kindelan bone-fill index was used to evaluate success using occlusal radiographs. Weighted Cohen's kappa coefficient was used as a measure of intra- and inter-rater agreement. Fisher's exact test was used to examine the effects of type of cleft, pre-surgical orthodontics or age at time of SABG on radiographic outcome. RESULTS There were 200 SABGs assessed. Mean age at time of SABG was 9.1 years old (SD 1.1) with 99% (n = 198) of grafts deemed successful. There were two failures where re-graft was performed successfully during the study period. A grade 1 outcome was achieved for 92.5% (n = 185) of grafts and this did not appear to be affected by type of cleft (P = .290), pre-surgical orthodontics (P = .380) or age at time of SABG (P = .081). CONCLUSIONS The high success rate reported in this study supports the favorable outcomes of a high-volume cleft surgeon. These findings can be used for comparative audit with similar units providing cleft care.
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Affiliation(s)
- Daniel Stonehouse-Smith
- Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK.,Department of Orthodontics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Victoria Beale
- Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Haydn Bellardie
- Cleft Lip and Palate Unit, Royal Manchester Children's Hospital, Manchester, UK.,Faculty of Dentistry, Department of Orthodontics, University of the Western Cape, Cape Town, South Africa
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19
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Sullivan ZC, Van Eeden S, May J, Flannigan N, Seshu M, Dominguez-Gonzalez S. Identifying associations between dental arch relationship scores, relative deprivation and other cleft audit outcomes. Part 2. Orthod Craniofac Res 2021; 25:103-111. [PMID: 34056824 DOI: 10.1111/ocr.12504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
Identify associations between dental arch relationship scores, oral health status and deprivation index in patients with complete unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). Ninety-two 5-year-old children with non-syndromic complete UCLP and thirty-nine 5-year-old children with non-syndromic complete BCLP from the United Kingdom. Data were collected from the 5-year audit outcomes submitted to the Cleft Registry and Audit Network (CRANE). The index of multiple deprivation (IMD) and Welsh index of deprivation were used to assess a relative measure of deprivation. Comparisons of 5-year-old index/BCLP Deciduous Dentition Yardstick outcome against IMD and dmft are performed using multivariable linear regression models. Both UCLP and BCLP had a high percentage of children with dmft >0 (47% and 49%, respectively). The mean dmft for the UCLP cohort was 2.8 and 2.6 for the BCLP cohort. In the UCLP group, a poorer 5-year-old index was associated with an increased dmft score (P = .023) and higher level of deprivation (P = .010). In the BCLP group, there was no significant associations between BCLP Deciduous Dentition Yardstick, dmft and IMD. A poorer dental arch relationship outcome may be associated with higher level of area deprivation and oral health status, in children with UCLP. Those with a poor outcome for the 5-year-old Index are more likely to have increased caries experience.
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Affiliation(s)
| | | | - Joanna May
- Alder Hey Hospital Children's Hospital, Liverpool, UK
| | - Norah Flannigan
- Orthodontic department, Liverpool University Dental Hospital, Liverpool, UK
| | - Madhavi Seshu
- Alder Hey Hospital Children's Hospital, Liverpool, UK
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20
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Thomson RM, Jovic T, Drake D, O'Neill T. Nasolabial appearance of bilateral cleft lip repair at five years of age. Comparing techniques of modified advancement-rotation (Delaire) with Manchester repair: a retrospective cohort study. Br J Oral Maxillofac Surg 2021; 59:1214-1219. [PMID: 34312000 DOI: 10.1016/j.bjoms.2021.04.004] [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: 01/19/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Abstract
The techniques used to repair bilateral cleft lip have evolved over time, yet little data exist to compare outcomes using the various techniques. The aim of this study was to retrospectively evaluate and compare the aesthetic outcomes of two types of complete bilateral cleft repair: advancement rotation and a historic cohort repaired with the Manchester technique. A total of 32 consecutive patients who had complete repair of bilateral cleft lips were identified retrospectively from our centre using inpatient records. The first 16 (born between 1994 and 2005) underwent the Manchester repair, the second 16 (born between 2006 and 2010) a Delaire modified advancement rotation technique. Standardised photographs were taken at five years post repair and cropped to isolate the nasolabial component. Appearance outcomes were assessed by 20 members of the cleft and plastic surgery team, who were each asked to rate all 32 images using the Asher-McDade five-point scale. A chi squared test was used to determine whether there was a statistically significant difference in cleft scores between the two approaches. There was a mean (SD) of 2.8 (1.02) in the advancement rotation group and a mean (SD) of 3.1 (1.07) in the Manchester group. There was a statistically significant difference in the distribution of scores in the advancement rotation group compared with the Manchester group, with lower scores (better results) in the advancement rotation group (p=0.003). This study demonstrates that the advancement rotation technique for the repair of bilateral cleft lip defects resulted in a superior nasolabial appearance when directly compared with the Manchester repair at 5 years of age.
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Affiliation(s)
- R M Thomson
- The Welsh Centre for Cleft Lip & Palate, Morriston Hospital Swansea, UK.
| | - T Jovic
- The Welsh Centre for Cleft Lip & Palate, Morriston Hospital Swansea, UK
| | - D Drake
- Royal Hospital for Children, Cleft Care Scotland, Glasgow
| | - T O'Neill
- The Welsh Centre for Cleft Lip & Palate, Morriston Hospital Swansea, UK
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21
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Palatal growth changes in newborns with unilateral and bilateral cleft lip and palate from birth until 12 months after early neonatal cheiloplasty using morphometric assessment. Clin Oral Investig 2021; 25:3809-3821. [PMID: 33409695 DOI: 10.1007/s00784-020-03711-9] [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: 07/13/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare palatal growth changes in infants with complete unilateral (UCLP) or bilateral (BCLP) cleft lip and palate during the first year of life. MATERIALS AND METHODS Upper dental arches of 68 neonates with UCLP and BCLP were evaluated using 2D and 3D morphometry based on dental casts obtained in two age categories (T0 before early neonatal cheiloplasty-UCLP 4 ± 3 days, BCLP 6 ± 5 days; T1 before palatoplasty-UCLP 10 ± 2 months, BCLP 12 ± 3 months). RESULTS Intensive palatal growth was manifested in both directions of the palate. Palatal growth in the anterior direction was not restricted, despite the intercanine (CC´) and anterior (LL´) widths being significantly narrowed in the BCLP group (CC´ p = 0.019, LL´ p = 0.009). The posterior dental arches were significantly enlarged (UCLP p ≤ 0.001; BCLP p ≤ 0.001). The negative effect of cleft severity on palatal length was not confirmed (p = 0.802). Variability of the palate was immense mainly in BCLP infants (T0); however, it decreased in both cleft types, confirming the formative effect of palatal growth leading to alveolar cleft closure (UCLP p ≤ 0.001; BCLP p = 0.006 on the right, 0.005 on the left). CONCLUSIONS Both analyzed cleft groups (UCLP, BCLP) grew favorably during the first year of life, and the palatal growth was not limited in any direction. CLINICAL RELEVANCE Geometric morphometry allowed a comprehensive analysis of the palate, which can contribute to the improvement of surgical methods.
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22
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Harrison CJ, Tyler MPH, Rodrigues JN. Value-based plastic surgery. J Plast Reconstr Aesthet Surg 2020; 73:2106-2110. [PMID: 32859568 PMCID: PMC7438207 DOI: 10.1016/j.bjps.2020.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/01/2020] [Indexed: 11/22/2022]
Abstract
This editorial explores value in relation to plastic surgery and strategies that have been suggested to deliver value-based healthcare. We consider how value is measured, accounting for patient outcomes and experiences, costs and equity, and describe strategies that might improve value, such as outcome-based reimbursement, reporting transparency and high volume specialist centres.
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Affiliation(s)
- Conrad J Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Old Road, Headington, Oxford OX3 7LD, United Kingdom.
| | - Michael P H Tyler
- Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom
| | - Jeremy N Rodrigues
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Old Road, Headington, Oxford OX3 7LD, United Kingdom; Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom
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23
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Thomson RM, Azzopardi E, Drake D. Validating the Asher-McDade score to assess facial aesthetic outcomes in 22 consecutive complete bilateral cleft lip repairs. Br J Oral Maxillofac Surg 2020; 59:375-379. [PMID: 33349494 DOI: 10.1016/j.bjoms.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Most scoring systems used to assess facial aesthetics in cleft patients tend to lack consistency, and the absence of an internationally agreed system makes comparison challenging. The most widely used and validated tool is the five-point Asher-McDade index. We note that there are currently no reports (to our knowledge) of its use for scoring outcomes after bilateral cleft lip repair. To validate it for this use, the aim was to describe the outcomes of 22 consecutive bilateral cleft lip repairs assessed using this scale. A retrospective review was undertaken of 22 consecutive patients with bilateral cleft lip repairs performed at our centre. Each patient underwent bilateral advancement rotation repair with a vomer flap on one side at three months followed by repair of the remaining hard palate and an intravelar veloplasty three months later. Standardised photographs were taken five years after repair and were cropped to isolate the nasolabial component. Eleven members of the cleft multidisciplinary team were asked to rate each image on a five-point Likert scale. Statistical analysis was performed using a two-way ANOVA test and intraclass correlation coefficient to interrogate intraobserver and interobserver variance. A total of 22 consecutive patients with complete bilateral cleft lips were photographed. The overall mean (range) score for the repairs was 3.2 (4.3 - 1.8). Two-way ANOVA demonstrated that inter-rater variability accounted for just over 10% (11.23% of the total variance, p < 0.0001). As predicted, the single biggest factor affecting score variability was the patient's appearance, which accounted for 44.51% of the total variance between scores (p < 0.0001). Intraobserver variance was not found to be significant, accounting for 0.33% of the total variance (p = 0.0006). We demonstrate that the Asher-McDade scoring system is a valid tool to use when assessing bilateral cleft lip repairs. Variance in the patient's score was significantly related to a true difference in appearance, with only a small percentage of differences being due to intraobserver and interobserver variation.
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Affiliation(s)
- R M Thomson
- The Welsh Centre for Cleft Lip & Palate, Morriston Hospital Swansea, UK.
| | | | - D Drake
- Cleft Care Scotland, Royal Hospital for Children, Glasgow
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24
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Martin S, McBride M, McGarry K, Hill C. Burden of cleft surgery—a 21-year follow-up of patients with cleft lip and palate. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Slator R, Perisanidou LI, Waylen A, Sandy J, Ness A, Wills AK. Range and timing of surgery, and surgical sequences used, in primary repair of complete unilateral cleft lip and palate: The Cleft Care UK study. Orthod Craniofac Res 2020; 23:166-173. [DOI: 10.1111/ocr.12355] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/19/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Rona Slator
- West Midlands Cleft Service Birmingham Children’s Hospital Birmingham UK
| | | | - Andrea Waylen
- Bristol Dental School University of Bristol Bristol UK
| | | | - Andy Ness
- Bristol Dental School University of Bristol Bristol UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol Bristol UK
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26
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Gallagher N. A general dental practitioner's role in treating patients with a cleft lip and/or palate. Br Dent J 2020; 228:19-21. [DOI: 10.1038/s41415-019-1116-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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27
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Gee C, Maskell J, Newcombe P, Kimble R, Williamson H. Opening a Pandora's Box that can't be salvaged: Health professionals' perceptions of appearance-related care in an Australian pediatric specialist hospital. Body Image 2019; 31:1-12. [PMID: 31465991 DOI: 10.1016/j.bodyim.2019.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 11/19/2022]
Abstract
Many children and young people struggle adjusting to the psychosocial consequences (e.g., body dissatisfaction, social anxiety, and stigmatisation) of visible differences (or disfigurement). As appearance-affecting conditions often require specialist multidisciplinary team care, health professionals are in a unique position to offer psychosocial support and intervention. However, there is a dearth of literature on how appearance-related concerns are managed in pediatric hospital settings. Sixteen Australian specialist health professionals participated in semi-structured qualitative interviews to address this gap. Interviews explored current appearance-related psychosocial service provision, barriers in accessing appearance-related care, and perceptions of online platforms to deliver specialist support and intervention. Thematic analysis demonstrated four themes: We can do it better, Capability versus availability, Online generation, and Putting appearance on the agenda. This research highlighted the potential value of online platforms to increase accessibility to specialist appearance-related care, the need for more psychosocial resources to be integrated into appearance-related specialities, prioritising the development of low to medium appearance-related support and intervention, increasing the appearance-related knowledge of health professionals and families, and the need for more holistic approaches in routine care.
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Affiliation(s)
- Caroline Gee
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Level 7, 62 Graham Street, South Brisbane, Queensland, 4101, Australia.
| | - Jessica Maskell
- Gold Coast University Hospital, Social Work Department, 1 Hospital Boulevard, Southport, Queensland, 4217, Australia.
| | - Peter Newcombe
- Institute for Teaching and Learning Innovation, Level 3, Building 17, Staff House Road, The University of Queensland, St Lucia, Queensland, 4072, Australia.
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Level 7, 62 Graham Street, South Brisbane, Queensland, 4101, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Level 5, 501 Stanley Street, South Brisbane, Queensland, 4101, Australia.
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Bristol, BS16 1QY, United Kingdom.
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28
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Steinberg B, Caccamese J, Costello BJ, Woerner J. Cleft and Craniofacial Surgery. J Oral Maxillofac Surg 2019; 75:e126-e150. [PMID: 28728728 DOI: 10.1016/j.joms.2017.04.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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29
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Fowler PV, Al-Ani AH, Thompson JMD. Bone fill following secondary alveolar bone grafting for children with cleft of the alveolus in New Zealand. Orthod Craniofac Res 2019; 22:153-158. [PMID: 30811844 DOI: 10.1111/ocr.12305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/30/2019] [Accepted: 02/16/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the amount of bone fill post-secondary alveolar bone grafting for children with cleft in New Zealand. SETTINGS AND SAMPLE POPULATION Retrospective analysis of post-operative intra-oral periapical and upper anterior occlusal radiographs of 45 grafted sites where all grafting was undertaken within the New Zealand public hospital service. MATERIALS AND METHODS A modified Kindelan Index and a 100 mm visual analogue scale (VAS) were used to assess the amount of bone fill using intra-oral radiographs by 4 orthodontists experienced in cleft care and who were blind to the patient's identity. Fourteen duplicated radiographs were randomly selected and added to the sample for reliability assessment. RESULTS The Kindelan Index rated 37.8% Grade 1 (Good), 31.1% rated Grade 2 (Satisfactory), 22.2% rated Grade 3 (Unsatisfactory) and 8.9% Grade 4 (Failure), a combined unsatisfactory/failure rate of 31.1%. The average VAS score was 50 mm ± 24 mm, and there was a strong relationship between Kindelan and VAS assessments. Those patients aged 10-11 years had significantly better outcomes using both assessments compared to those aged <10 and >11. The VAS assessment found that higher caseload surgeons had better outcomes, although the difference was of borderline statistical significance (mean VAS 56 mm vs 44 mm P = 0.07). CONCLUSIONS Contemporary secondary alveolar bone grafting bone fill outcomes in New Zealand are poor when compared to contemporary international studies. These findings indicate a review of secondary bone grafting is required to improve outcomes for New Zealand children with cleft.
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Affiliation(s)
- Peter V Fowler
- Hospital Dental Services, Christchurch Hospital, Christchurch, New Zealand.,Faculty of Medical and Health Sciences, Department of Paediatrics Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Azza H Al-Ani
- Faculty of Dentistry, Orthodontic Department, University of Otago, Dunedin, New Zealand
| | - John M D Thompson
- Faculty of Medical and Health Sciences, Department of Paediatrics Child and Youth Health, University of Auckland, Auckland, New Zealand.,Faculty of Medical and Health Sciences, Department of Obstetrics & Gynaecology, University of Auckland, Auckland, New Zealand
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Stock NM, Sharratt ND, Heath J, Nankivell D, Martindale A, Ridley M, Ahmed A, McMullin A, Cunniffe C. Falling through the gap: Dental treatment experiences of patients affected by cleft lip and/or palate. Br Dent J 2018; 225:218-222. [PMID: 30072784 DOI: 10.1038/sj.bdj.2018.542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/09/2022]
Abstract
Introduction In the UK, one in 600–700 infants is born with a cleft lip and/or palate (CL/P). Previous research has identified patients with CL/P to be at high risk of long-term oral health issues. Yet, few of these patients are currently accessing community dental care. Aims To assess patients' dental treatment experiences and their suggestions for improving services. Materials and methods Five focus groups were conducted with 24 adults with CL/P. Thematic analysis was performed on the data. Results Participants perceived local dental practitioners to lack knowledge about CL/P and its treatment. Consequently, some participants had stopped visiting a dental practice altogether. Participants were also largely unaware of the specialist CL/P services they are entitled to. Discussion Suggestions are made for the integration of improved training and resources for local dental practitioners. Closer communication between specialist cleft teams and local dental practitioners could also help to bridge the gap in knowledge and improve patients' engagement with dental services. The tertiary sector has a crucial role to play in empowering patients to take more control of their oral health and dental treatment.
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Affiliation(s)
- N M Stock
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - N D Sharratt
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - J Heath
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - D Nankivell
- Cleft Lip and Palate Association, London, EC1V 7LQ, United Kingdom
| | - A Martindale
- Cleft Lip and Palate Association, London, EC1V 7LQ, United Kingdom
| | - M Ridley
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - A Ahmed
- University of Liverpool School of Dentistry, Liverpool, L69 7ZX, United Kingdom
| | - A McMullin
- Cleft Lip & Palate Orthodontics, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - C Cunniffe
- Cleft Lip and Palate Association, London, EC1V 7LQ, United Kingdom
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Al-Ghatam R, Jones TEM, Ireland AJ, Atack NE, Chawla O, Deacon S, Albery L, Cobb ARM, Cadogan J, Leary S, Waylen A, Wills AK, Richard B, Bella H, Ness AR, Sandy JR. Structural outcomes in the Cleft Care UK study. Part 2: dento-facial outcomes. Orthod Craniofac Res 2018; 18 Suppl 2:14-24. [PMID: 26567852 PMCID: PMC4670707 DOI: 10.1111/ocr.12109] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare facial appearance and dento-alveolar relationship outcomes from the CSAG (1998) and CCUK (2013) studies. SETTING AND SAMPLE POPULATION Five-year-olds born with non-syndromic unilateral cleft lip and palate. Those in the original CSAG were treated in a dispersed model of care with low-volume operators. Those in CCUK were treated in a more centralized, high-volume operator model. MATERIALS AND METHODS We compared facial appearance using frontal view photographs (252 CCUK, 239 CSAG) and dental relationships using study models (198 CCUK, 223 CSAG). Facial appearance was scored by a panel of six assessors using a standardized and validated outcome tool. Dento-alveolar relationships were scored by two assessors using the 5-Year-Olds' Index. Ordinal regression was used to compare results between surveys. RESULTS Excellent or good facial appearance was seen in 36.2% of CCUK compared with 31.9% in CSAG. In CCUK, 21.6% were rated as having poor or very poor facial appearance compared with 27.6% in CSAG. The percentage rated as having excellent or good dento-alveolar relationships was 53.0% in CCUK compared with 29.6% in CSAG. In CCUK, 19.2% were rated as having poor or very poor dento-alveolar relationships compared to 36.3% in CSAG. The odds ratios for improved outcome in CCUK compared to CSAG were 1.43 (95% CI 1.03, 1.97) for facial appearance and 2.29 (95% CI 1.47, 3.55) for dento-alveolar relationships. CONCLUSIONS Facial and dento-alveolar outcomes were better in CCUK children compared to those in CSAG.
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Affiliation(s)
- R Al-Ghatam
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - T E M Jones
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A J Ireland
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - N E Atack
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - O Chawla
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - S Deacon
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK.,South West Cleft Team, University Hospitals Bristol NHS Trust, Cleft Lip and Palate Team, Bristol, UK
| | - L Albery
- South West Cleft Team, University Hospitals Bristol NHS Trust, Cleft Lip and Palate Team, Bristol, UK
| | - A R M Cobb
- South West Cleft Team, University Hospitals Bristol NHS Trust, Cleft Lip and Palate Team, Bristol, UK
| | - J Cadogan
- South West Cleft Team, University Hospitals Bristol NHS Trust, Cleft Lip and Palate Team, Bristol, UK
| | - S Leary
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A Waylen
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A K Wills
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - B Richard
- Birmingham Children's Hospital NHS Trust, Birmingham, UK
| | - H Bella
- Birmingham Children's Hospital NHS Trust, Birmingham, UK
| | - A R Ness
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - J R Sandy
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
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Zucchelli F, Rumsey N, Humphries K, Bennett R, Davies A, Sandy J, Stock NM. Recruiting to cohort studies in specialist healthcare services: Lessons learned from clinical research nurses in UK cleft services. J Clin Nurs 2018; 27:e787-e797. [DOI: 10.1111/jocn.14188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Fabio Zucchelli
- Centre for Appearance Research; University of the West of England (UWE); Bristol UK
| | - Nichola Rumsey
- Centre for Appearance Research; University of the West of England (UWE); Bristol UK
- The Cleft Collective; School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - Kerry Humphries
- The Cleft Collective; School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - Rhiannon Bennett
- The Cleft Collective; School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - Amy Davies
- The Cleft Collective; School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - Jonathan Sandy
- The Cleft Collective; School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - Nicola Marie Stock
- Centre for Appearance Research; University of the West of England (UWE); Bristol UK
- The Cleft Collective; School of Oral and Dental Sciences; University of Bristol; Bristol UK
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Campbell A, Restrepo C, Deshpande G, Tredway C, Bernstein SM, Patzer R, Wendby L, Schonmeyr B. Validation of a Unilateral Cleft Lip Surgical Outcomes Evaluation Scale for Surgeons and Laypersons. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1472. [PMID: 29062644 PMCID: PMC5640349 DOI: 10.1097/gox.0000000000001472] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/11/2017] [Indexed: 10/31/2022]
Abstract
BACKGROUND A standardized evaluation tool is needed for the assessment of surgical outcomes in cleft lip surgery. Current scales for evaluating unilateral cleft lip/nose (UCL/N) aesthetic outcomes are limited in their reliability, ease of use, and application. The Unilateral Cleft Lip Surgical Outcomes Evaluation (UCL SOE) scale measures symmetry of 4 components and sums these for a total score. The purpose of this study was to validate the SOE as a reliable tool for use by both surgeons and laypersons. METHODS Twenty participants (9 surgeons and 12 laypeople) used the SOE to evaluate 25 sets of randomly selected presurgical and postsurgical standardized photographs of UCL/N patients. Interrater reliability for surgeon and laypeople was determined using an intraclass correlation coefficient (ICC). RESULTS Individual surgeons and laypeople both reached an ICC in the "fair to good" range (ICC = 0.42 and 0.59, respectively). Averaging 2 evaluators in the surgeon group improved the ICC to 0.58 and in the laypeople group to 0.74, respectively. Averaging 3 evaluators increased the ICC for surgeons to the "good" range (ICC = 0.71) and the ICC for laypeople to the "very good" range (ICC = 0.82). CONCLUSIONS Surgeon and layperson raters can reliably use the SOE to assess the aesthetics results after surgical repair of UCL/N, and improved reliability and reproducibility is achieved by averaging the scores of multiple reviewers.
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Affiliation(s)
- Alex Campbell
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Carolina Restrepo
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Gaurav Deshpande
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Caroline Tredway
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Sarah M. Bernstein
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Rachel Patzer
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Lisa Wendby
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Bjorn Schonmeyr
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; Department of Epidemiology, Emory University School of Medicine, Atlanta, Ga.; Department of Surgery, Emory University School of Medicine, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
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Campbell A, Restrepo C, Deshpande G, Bernstein SM, Tredway C, Wendby L, Schonmeyr B. Validation of the Unilateral Cleft Lip Severity Index for Surgeons and Laypersons. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1479. [PMID: 29062648 PMCID: PMC5640353 DOI: 10.1097/gox.0000000000001479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/11/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Severity of the primary unilateral cleft lip/nose deformity (UCL/N) is postulated to play a key role in postoperative complications, aesthetic result, and need for secondary surgery. There is no validated and widely accepted classification scheme of initial cleft severity. The purpose of this study was to validate the Unilateral Cleft Lip Cleft Severity Index as a reliable tool for evaluating presurgical UCL/N deformity by both surgeons and laypersons. METHODS Twenty-five participants (10 surgeons and 15 laypeople) evaluated 25 sets of randomly selected presurgical standardized photographs of UCL/N patients. Each participant rated patients on a scale of 1-4 using the Cleft Severity Index. Interrater reliability for surgeons, laypersons, and all participants was determined using an intraclass correlation coefficient. Histograms and regression analysis were performed to compare average ratings between groups. RESULTS Interrater reliability for all groups was classified as "very good" determined by intraclass correlation coefficients of 0.837 (laymen), 0.885 (surgeons), and 0.848 (all participants). These results indicate that there was a high degree of interrater across all 3 groups and that both surgeons and laypersons can reliability rate cleft severity using the Cleft Severity Index. CONCLUSIONS This study validates the use of the Cleft Severity Index by both surgeons and laypersons as a reliable tool for evaluating the degree of presurgical severity of patients with UCL/N. The Unilateral Cleft Lip Cleft Severity Index can thus serve as a reproducible and reliable grading system for primary UCL/N deformity and to categorize patients for future outcomes studies.
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Affiliation(s)
- Alex Campbell
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Carolina Restrepo
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Gaurav Deshpande
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Sarah M. Bernstein
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Caroline Tredway
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Lisa Wendby
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
| | - Bjorn Schonmeyr
- From Operation Smile, Virginia Beach, Va.; Plastic Surgery, Penn State Hershey, Hershey, Pa.; MGM Dental College and Hospital, Navi Mumbai, India; School of Medicine, Emory University, Atlanta, Ga.; and Plastic Surgery, Skane University Hospital, Malmo, Sweden
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Development of an implementation intention-based intervention to change children's and parent-carers' behaviour. Pilot Feasibility Stud 2017; 4:20. [PMID: 28725453 PMCID: PMC5513026 DOI: 10.1186/s40814-017-0171-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 07/05/2017] [Indexed: 01/17/2023] Open
Abstract
Background Implementation intentions enable individuals to translate good intentions into action. Parents and children can find maintaining oral health difficult, as evidenced by the presence of tooth decay. This is a common condition in children in spite of being preventable through the use of regular tooth brushing, fluoride protection and avoiding sugar intake. Even when parents and children are positive about looking after the teeth, they can face challenges in maintaining consistent habits. The aim of this paper is to describe the design of a video animation to teach parents and children how to use implementation intentions to establish new habits to improve oral health, applied in this case, to parents and children with cleft lip and/or palate (CLP). Methods Evidence from a qualitative study of parents’ and children’s knowledge, beliefs and behaviour informed the design of an animation forming part of an intervention for children and parents using implementation intentions. The user views generated a set of guiding principles to determine the style and content of a teaching video, whilst an animation designer translated the key messages of implementation intention into images and characters appealing and meaningful to the target audience of children and parents. Results A team of researchers, an animation designer and a script writer designed a 2-min video as a teaching tool for children and parents. The team drafted and iteratively refined the content and visuals, with guidance from an advisory group and informal discussions with children in the target age group and their parents. Planning, consulting, designing and production of the animation spanned a total of 20 weeks. The video explains how to formulate ‘if-then’ plans using the voices of a boy and his mother in a conversation, with examples from oral health to illustrate how to enact intentions. It is available via digital media and designed to be delivered by dental care practitioners. The effectiveness of the intervention will be evaluated as part of a feasibility study. Conclusion The current study describes the development of an intervention mediated through an animation tutorial that enables children and parents to devise ‘if-then’ plans to improve oral health as a collaborative endeavour between parents and children. The animation uses examples from oral health, but we believe there is scope for exploring application of the intervention to other areas of behaviour.
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Alzain I, Batwa W, Cash A, Murshid ZA. Presurgical cleft lip and palate orthopedics: an overview. Clin Cosmet Investig Dent 2017; 9:53-59. [PMID: 28615974 PMCID: PMC5459959 DOI: 10.2147/ccide.s129598] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with cleft lip and/or palate go through a lifelong journey of multidisciplinary care, starting from before birth and extending until adulthood. Presurgical orthopedic (PSO) treatment is one of the earliest stages of this care plan. In this paper we provide a review of the PSO treatment. This review should help general and specialist dentists to better understand the cleft patient care path and to be able to answer patient queries more efficiently. The objectives of this paper were to review the basic principles of PSO treatment, the various types of techniques used in this therapy, and the protocol followed, and to critically evaluate the advantages and disadvantages of some of these techniques. In conclusion, we believe that PSO treatment, specifically nasoalveolar molding, does help to approximate the segments of the cleft maxilla and does reduce the intersegment space in readiness for the surgical closure of cleft sites. However, what we remain unable to prove equivocally at this point is whether the reduction in the dimensions of the cleft presurgically and the manipulation of the nasal complex benefit our patients in the long term.
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Affiliation(s)
| | - Waeil Batwa
- Orthodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alex Cash
- Cleft Lip and Palate Orthodontics, Queen Victoria NHS Foundation Trust, South Thames Cleft Service, London, UK
| | - Zuhair A Murshid
- Orthodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Gupta A, Chowdhury R, Haring RS, Leinbach LI, Petrone J, Spitzer MJ, Schneider EB. Length of Stay and Cost in Patients Undergoing Orthognathic Surgery: Does Surgeon Volume Matter? J Oral Maxillofac Surg 2017; 75:1948-1957. [PMID: 28576668 DOI: 10.1016/j.joms.2017.04.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/11/2017] [Accepted: 04/18/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE The relations among procedure-specific annual surgeon volume, hospital length of stay (LOS), and hospital costs for patients undergoing the 2 most common orthognathic surgical (OGS) procedures, segmental osteoplasty or osteotomy of the maxilla (SOM) or open osteoplasty or osteotomy of the mandibular ramus (SOMR), are not known. The authors hypothesized that treatment by high-volume surgeons would be associated with decreased LOS and costs. MATERIALS AND METHODS All patients 8 to 64 years old who underwent elective SOM or SOMR were selected from the 2001 to 2009 Nationwide Inpatient Sample. Patients with missing vital status or payment mode status or who underwent more than 1 OGS procedure during the index hospitalization were excluded. Based on year- and procedure-specific annual surgeon volumes, the highest (highest quartile) and lowest (lowest quartile) procedure volume surgeon groups were compared. Multivariable logistic regression was used to study the relation between surgeon volume and extended patient LOS (defined as LOS ≥ 75th percentile). Generalized linear models with a log-link and gamma distribution were used to examine the association between surgeon volume and hospital costs. Models were adjusted for patient- and hospital-level factors and type of procedure (SOM or SOMR). Analysis was weighted to represent national-level estimates and an α value of 0.05 was used for all comparisons. RESULTS After weighting to the population level, 8,062 patients were included for study. Most were white (80.6%), female (61.4%), and privately insured (84.6%). Mean age was 26 years (standard deviation, 0.38 yr). After adjusting for potential confounders, patients treated by high-volume surgeons showed 40% lower odds of extended LOS (odds ratio = 0.60; 95% confidence interval [CI], 0.38-0.95; P = .032) and incurred substantially lower costs (-$1,484.74; 95% CI, -2,782.76 to -185.58; P = .025) compared with patients treated by low-volume surgeons. CONCLUSION These findings suggest that regionalization of patients to high-volume surgeons for OGS procedures could decrease LOS and incurred costs.
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Affiliation(s)
- Avni Gupta
- Senior Research Assistant, Center for Surgery and Public Health, Harvard Medical School, Harvard School of Public Health, Brigham and Women's Hospital, Boston, MA
| | - Ritam Chowdhury
- Research Associate, Center for Surgery and Public Health, Harvard Medical School, Harvard School of Public Health, Brigham and Women's Hospital, Boston, MA
| | - R Sterling Haring
- Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Leah I Leinbach
- Assistant Professor of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - John Petrone
- Program Director of Dental Residency, Assistant Professor of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Martin J Spitzer
- Associate Professor, Department of Oral and Maxillofacial Plastic Surgery, University Hospital of Bonn, Bonn, Germany
| | - Eric B Schneider
- Director of Quantitative Science, Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Johns Hopkins School of Medicine, Baltimore, MD.
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Oh TS, Park JS, Choi JW, Kwon SM, Koh KS. Risk factor analysis of bone resorption following secondary alveolar bone grafting using three-dimensional computed tomography. J Plast Reconstr Aesthet Surg 2015; 69:487-92. [PMID: 26718845 DOI: 10.1016/j.bjps.2015.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 09/15/2015] [Accepted: 11/04/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND/AIM The purpose of this study is to analyze the risk factors for bone resorption following secondary bone grafting in the alveolar cleft, using three-dimensional (3D) computed tomography (CT) based on surgical simulation software (SimPlant OMS, Materialise Dental, Leuven, Belgium). METHODS We reviewed the secondary alveolar bone grafts performed by a single surgeon between January 2005 and January 2014. A total of 40 patients with unilateral alveolar cleft were included in this study. The grafted alveolar bone was measured using surgical simulation software. In order to validate the measurement, each data set was measured by three different analysts and the inter- and intraobserver variabilities were calculated. A total of eight risk factors for grafted bone survival, including patient age, sex, body mass index (BMI), palatal fistula, amount of grafted bone, dental appliance, canine or incisor eruption, and preoperative upper respiratory tract infection, were evaluated using the linear mixed model and Mann-Whitney test. RESULTS The average alveolar defect size was 4.98 cc and the average graft survival was 67.5%. The inter- and intraobserver variabilities of simulation software were 0.758 and 0.915, respectively. Among the risk factors, only dental appliance (p = 0.02) and canine eruption (p = 0.041) were significantly correlated with graft survival. Other risk factors, including the amount of grafted bone, did not show a significant relationship with graft survival. CONCLUSION Measurement of an alveolar bone defect using a simulation program based on 3D CT is reliable and reproducible. Secondary bone grafting survival was significantly correlated with canine eruption and dental appliance in the alveolar cleft.
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Affiliation(s)
- Tae Suk Oh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Joo Seok Park
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | | | - Kyung S Koh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.
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Effect of Hospital Volume on Outcomes of Surgery for Cleft Lip and Palate. J Oral Maxillofac Surg 2015; 73:2219-24. [DOI: 10.1016/j.joms.2015.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/01/2015] [Accepted: 04/04/2015] [Indexed: 11/22/2022]
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Jones T, Al-Ghatam R, Atack N, Deacon S, Power R, Albery L, Ireland T, Sandy J. A review of outcome measures used in cleft care. J Orthod 2013; 41:128-40. [DOI: 10.1179/1465313313y.0000000086] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Reliability, completeness and accuracy of cleft subphenotyping as recorded on the CLEFTSiS (Cleft Service in Scotland) electronic patient record. Surgeon 2013; 11:313-8. [DOI: 10.1016/j.surge.2013.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/02/2013] [Accepted: 05/08/2013] [Indexed: 11/23/2022]
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An investigation into infant feeding in children born with a cleft lip and/or palate in the West of Scotland. Eur Arch Paediatr Dent 2012; 12:250-5. [DOI: 10.1007/bf03262817] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The timing of repair of a cleft lip continues to be debated. One of the reasons for delaying operation has been the belief that there is an increased risk of anaesthesia during the neonatal period. As a contribution to this debate we have analysed the anaesthetic and surgical complications of neonatal cleft lip repair undertaken at a single centre. We made a retrospective study of 99 babies consecutively referred for repair of cleft lip over a five-year period (January 1995-December 1999). In contrast to other series, all babies were considered for neonatal surgery and no exclusion criteria were set. All repairs were undertaken within 28 days of birth (median 4); the median gestational age was 40 weeks (range 34-42) and median birth weight of 3300 g (range 1500-4600 g). Perianaesthetic complications included one case of hypoxia presumably as a result of transitional circulation, one reintubation for poor respiratory effort in a premature baby, and five cases of nasal obstruction, three of which required a nasal stent. All recovered without long-term effects. There were significantly more surgical complications with bilateral repairs than with unilateral (p < 0.03). Breast feeding was achieved in 54 babies by the time of discharge. We found no evidence that neonatal repair of cleft lip is unsafe. Paediatric anaesthetic and intensive care support within a specialised centre are necessary, and close postoperative monitoring is required, with attention to the nasal airway.
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Affiliation(s)
- Paul A Harris
- Department of Reconstructive and Plastic Surgery, St. George’s Healthcare NHS Trust,London, UK
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Locke M, Bishop K. An assessment of the contribution of UK specialists in restorative dentistry to cleft lip and palate services. Br Dent J 2011; 210:E20. [DOI: 10.1038/sj.bdj.2011.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2010] [Indexed: 11/09/2022]
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Revington PJ, McNamara C, Mukarram S, Perera E, Shah HV, Deacon SA. Alveolar bone grafting: results of a national outcome study. Ann R Coll Surg Engl 2010; 92:643-6. [PMID: 20615302 DOI: 10.1308/003588410x12699663904790] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In 1998, the Clinical Standards Advisory Group (CSAG) report demonstrated a successful radiographic outcome of 58%, for alveolar bone grafting, from 157 cases of unilateral cleft lip and palate (UCLP) in children aged 12 years. No further national studies have assessed the current level of radiographic outcome following the re-organisation of cleft services since the recommendations from the CSAG report. PATIENTS AND METHODS In 2008, radiographic images were requested for alveolar bone grafts performed in calendar year 2006 from each of the now established UK cleft centres. A sample of 206 patients with 235 grafted sites was scored by a panel of trained assessors, following a calibration exercise, using a modified Kindelan index. Inter- and intra-observer variation was assessed. RESULTS The overall radiographic success rate for the 2006 images assessed was 85%. There was no statistical difference for radiographic success between centres or surgeons or cleft type when defined as either a bilateral or unilateral alveolar defect for a patient. CONCLUSIONS Alveolar bone grafting appears to have improved radiographic outcomes when compared with the CSAG report following the re-organisation of surgical services for children with cleft lip and/or palate.
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Affiliation(s)
- Peter J Revington
- Department of Maxillofacial Surgery, North Bristol NHS Trust, Bristol, UK
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Parbatani R, Williams AC, Ireland AJ, Sandy JR. The process of orthognathic care in an NHS region. Ann R Coll Surg Engl 2009; 92:34-9. [PMID: 19887023 DOI: 10.1308/003588410x12518836438723] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate, within an NHS region, the process of care and the standard of record keeping for orthognathic patients. PATIENTS AND METHODS A retrospective analysis of the medical records of 372 patients who underwent orthognathic surgery between 1 January 1995 and 31 April 2000 in the South West Region of the UK. RESULTS Most patients underwent joint orthodontic and maxillofacial planning and had third molars extracted under general anaesthesia prior to orthognathic surgery. There was a significant difference in the median operation times and length of stay for bimaxillary surgery (4 h/4 days) compared with single jaw surgery (2 h/3 days; P < 0.001). Just over 15% of patients required removal of internal fixation plates after surgery, with nearly 90% of these requiring a further episode of general anaesthesia. The level of record keeping and patient review was variable with no regional standardisation. CONCLUSIONS This study is evidence of a generally acceptable standard in the process of care, which was found to follow international and national practices. However, at the time of the study there was no regional protocol for patient records or patient review, highlighting the need for the establishment of a regional database.
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Hasslöf P, Twetman S. Caries prevalence in children with cleft lip and palate--a systematic review of case-control studies. Int J Paediatr Dent 2007; 17:313-9. [PMID: 17683319 DOI: 10.1111/j.1365-263x.2007.00847.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To conduct a systematic review of literature in order to examine the evidence of an increased prevalence of dental caries in children with cleft lip and palate (CLP). METHODS A search of the PubMed database was conducted through May 2006. Sex- and age-matched case-control studies with noncavitated and manifest caries lesions as endpoint were targeted (n = 6). The studies were assessed independently by two reviewers and scored A-C according to predetermined criteria for methodology and performance. RESULTS Significantly more caries in CLP children were reported in two of the four studies in the permanent dentition and in three out of four publications dealing with primary teeth. None of the articles were, however, assessed with the highest grade 'A' and the level of evidence was therefore based on three papers graded 'B'. There was a tendency towards higher caries scores in preschool children, but as conflicting results were revealed, the evidence that children with CLP exhibit more caries than noncleft controls was inconclusive. CONCLUSION This systematic review of literature was unable to find firm evidence for the assumption that CLP children have an increased prevalence of dental caries.
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Affiliation(s)
- Pamela Hasslöf
- Department of Odontology, Pediatic Dentistry, Faculty of Medicine, Umeå University, Umeå, Sweden
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Deacon S, Bessant P, Russell JI, Hathorn I. What are the occlusal outcomes for unilateral cleft lip and palate patients? A national project in the UK. Br Dent J 2007; 203:E18. [PMID: 17728793 DOI: 10.1038/bdj.2007.807] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2007] [Indexed: 11/08/2022]
Abstract
AIM This national project assessed the orthodontic outcome for unilateral cleft lip and palate (UCLP) patients in the UK. METHOD Six consecutively treated fixed appliance cases where orthognathic surgery was not undertaken were assessed using the peer assessment rating (PAR) index on orthodontic study models. These cases were submitted by NHS consultant orthodontists undertaking treatment on patients with cleft lip and/or palate. SETTING UK NHS consultant-led hospital service. RESULTS The mean reduction in PAR score was 69% + or - 22. The mean start PAR score was 41 + or - 11. The mean end of treatment PAR was 12 + or - 9. The proportion of cases where the score was worse or no different was 7.5%. CONCLUSION The mean percentage PAR reduction compares well with other national projects looking at outcome from patients treated in the hospital service. The mean PAR reduction could be used as a benchmark for outcome in UCLP orthodontic treatments in future audit projects and the annual consultant appraisal process.
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Affiliation(s)
- S Deacon
- South West Cleft Unit, Frenchay Hospital, Bristol, England BS16 1LE
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