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van der Goes PAJ, Ombashi S, van Roey V, Hakelius M, Mathijssen IMJ, Mink van der Molen AB, Versnel SL. The Development of a European Multidisciplinary Cleft Lip and Palate Registry by the European Reference Network CRANIO: Experiences, Barriers, And Facilitators. J Craniofac Surg 2024:00001665-990000000-01626. [PMID: 38781427 DOI: 10.1097/scs.0000000000010314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
The European Reference Network for Rare Craniofacial Aanomalies and Ear-Nose-Throat disorders aims to improve care for patients with such afflictions, including cleft lip and palate (CL/P) across Europe. Cleft treatment remains varied throughout European centers, inhibiting meaningful comparison of treatment outcomes. To overcome these issues, a European-wide common CL/P dataset and registry was developed, facilitating standardized treatment endpoints and outcome measures for international comparison and benchmarking of CL/P centers. Questionnaires and semi-structured interviews were used to determine the set-up of the registry. Previous CL/P initiatives were analyzed to create an initial dataset, refined through consensus meetings. In total, 87 cleft specialists working in specialized CL/P centers from 16 European nations participated. Consensus on a common dataset was reached. A "Level 1" dataset, with mandatory clinical and patient-reported outcome measures, and "Level 2" dataset with additional outcome measures. Finally, 2 dashboards were developed for data dissemination. The development of the European CL/P common dataset and registry tackled challenges with resource disparities, variations in specialists within CL/P teams, regulatory differences in patient data usage, patient-reported outcome measures availability in European languages, and use of assessment tools. This study described the successful development of the European Reference Network for Rare Craniofacial Aanomalies and Ear-Nose-Throat disorders CL/P common dataset and registry. This achievement will help improve patient care and outcomes for patients with CL/P in Europe. Furthermore, this study provides useful information for initiatives with similar aims.
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Affiliation(s)
| | - Saranda Ombashi
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam
| | - Victor van Roey
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam
| | - Malin Hakelius
- Department of Plastic Surgery and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Irene M J Mathijssen
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam
| | | | - Sarah L Versnel
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam
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2
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The impact of hearing loss on speech outcomes in 5-year-old children with cleft palate ± lip: A longitudinal cohort study. Int J Pediatr Otorhinolaryngol 2021; 149:110870. [PMID: 34385041 DOI: 10.1016/j.ijporl.2021.110870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate the impact of hearing loss (using longitudinal measurements of hearing) on speech outcomes at age 5 (5 years 0 months-5 years 11 months) in children born with cleft palate ± lip. Other variables which may impact upon the speech outcomes at age 5 in this population were also investigated. METHODS A retrospective longitudinal cohort study of children, without a named syndrome, born with cleft palate ± lip, and treated at a Cleft Centre in the United Kingdom. Data collected from infancy to 5 years 11 months, included hearing test results from three specific time points (7 months-1 year 2 months [age A]; 2 years 0 months-2 years 11 months [age B]; 5 years 0 months-5 years 11 months [age C]) and speech outcome data at age 5 years (5 years 0 months-5 years 11 months). Hearing test results at each age were compared to identify how hearing changes with age. Correlations between hearing test results and speech outcomes at age 5 were analysed. RESULTS Hearing loss was frequent but predominantly mild. There were no significant correlations between speech outcomes and hearing results at any age. Mild hearing loss remained prevalent at age 5, although a significant age-related hearing improvement was found. A significant relationship between cleft type and cleft speech characteristics was found (P < .001); children with Bilateral Cleft Lip and Palate achieved the poorest articulation outcomes. CONCLUSION Although mild hearing loss was common in the cohort, there was no association between hearing loss and the speech outcomes investigated. In contrast, the type of cleft was significantly associated with the presence of cleft speech characteristics. Further longitudinal measurement of hearing is required to substantiate the findings of this study.
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3
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Peterson P, Nyberg J, Persson C, Mark H, Lohmander A. Speech Outcome and Self-Reported Communicative Ability in Young Adults Born With Unilateral Cleft Lip and Palate: Comparing Long-Term Results After 2 Different Surgical Methods for Palatal Repair. Cleft Palate Craniofac J 2021; 59:751-764. [PMID: 34263653 DOI: 10.1177/10556656211025926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare speech outcome and self-reported speech and communicative ability (SOK) in young adults treated with one-stage (OS) or two-stage (TS) palatal repair. Furthermore, to compare with normative data on individuals without cleft lip and palate and to study the relationship between patients' and experts' judgments. DESIGN A cross-sectional group comparison study with long-term follow-up. Participants: Patients born with unilateral cleft lip and palate treated at 2 cleft centers; 17 with OS at 14 months and 25 with TS, soft palate repair at 7 months and hard palate repair at 6.2 years. Pharyngeal flap surgery was performed in 53% (OS) and 24% (TS) of patients. MAIN OUTCOME MEASURE(S) Speech characteristics were blindly assessed by speech and language pathologist from audio recordings, SOK at 19 years of age. RESULTS No group differences were found. Although the occurrence of nasality symptoms was low in both groups, only 60% (OS)/65% (TS) were assessed with competent velopharyngeal function (VPC). Articulation proficiency (percentage of consonants correct [PCC]) was 91%/97%, the /s/-sound specifically 87%/91%. Good intelligibility was found in 91%/87%. Patient opinion was in agreement with norms and significantly associated with intelligibility (rs = 0.436, P < .01), PCC (rs = -0.534, P < .01), and correct /s/ (rs = -0.354, P < .05). CONCLUSIONS No differences in speech outcome were related to operation method. The low prevalence of VPC was not clearly reflected in nasality symptoms. Patient opinion was related to articulation and intelligibility. A higher burden of care in terms of pharyngeal flap surgery was seen after the OS technique.
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Affiliation(s)
- Petra Peterson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Stockholm Craniofacial Team, Medical Unit of Craniofacial Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Plastic and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jill Nyberg
- Division of Speech and Language Pathology, Department of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Christina Persson
- Division of Speech and Language Pathology, Institute of Neuroscience and Rehabilitation, Sahlgrenska Academy of Gothenburg University, Gothenburg, Sweden
| | - Hans Mark
- Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Medical Unit Speech-Language Pathology, Karolinska University Hospital, Stockholm, Sweden
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4
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Weinfeld JP, Johnels JÅ, Persson C. Prevalence of Reading Difficulties in 9- to 10-Year Old Children in Sweden Born With Cleft Palate. Cleft Palate Craniofac J 2021; 59:427-435. [PMID: 33955267 DOI: 10.1177/10556656211013236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of reading difficulties in children born with cleft palate at ages 9 and 10 in Sweden. DESIGN Using a cross-sectional design, a parental questionnaire assessing dyslexia-like reading difficulties (Short Dyslexia Scale, SDS) was administered together with separate questions regarding background data. PARTICIPANTS Families with a child born with overt cleft palate with or without cleft lip in 4 regions of Sweden. A total of 245 families were approached of which 138 families responded. Data from 136 (56%) were complete with information on cleft type and could be analyzed. RESULTS Twenty-two percent (95% CI, 15-30) of the whole study group displayed risk for dyslexic reading difficulties on the SDS corresponding to the 7th to 10th percentiles in the population. Children with cleft palate only had a significantly higher prevalence of reading difficulties (37%) compared to children with unilateral cleft palate (19%) and bilateral cleft palate (10%). The frequency of reading difficulties in participants with comorbidity was 32%. Among a subgroup with reported comorbidity in areas of attention, language, and learning problems, there was a 2.5 times higher risk of reading disability compared to participants without this reported comorbidity. CONCLUSION The prevalence of reading difficulties in the cleft palate population was higher than in the general population. Results showed that co-occurring difficulties were common in the cleft group and that reading difficulties often appear together with other, co-occurring neurodevelopmental difficulties.
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Affiliation(s)
- Justin Parry Weinfeld
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Otorhinolaryngology, Sahlgrenska University Hospital, Sweden
| | - Jakob Åsberg Johnels
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Christina Persson
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Otorhinolaryngology, Sahlgrenska University Hospital, Sweden
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Parkes W, Vilchez-Madrigal L, Cushing S, Papsin B, James A. Natural History of Tympanic Membrane Retraction in Children with Cleft Palate. J Int Adv Otol 2019; 14:250-254. [PMID: 30100539 DOI: 10.5152/iao.2018.5609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The natural history of tympanic membrane retraction is unpredictable. To obtain prognostic information for guiding surveillance and treatment, a cohort of children with retraction from cleft palate were prospectively followed for over 5 years. MATERIALS AND METHODS This was a prospective observational study at a tertiary academic institution. Children with pars tensa retraction were selected from a cohort of 143 children with cleft palate. Thirty-seven ears were assessed with otoendoscopic image capture and audiometry at a median age of 9 years and reassessed at a median follow-up interval of 6.4 years. The severity of tympanic membrane retraction in the serial images of each ear was compared by four pediatric otolaryngologists blinded to the dates of the images. RESULTS Initially, 19/37 retractions (51%) demonstrated contact with the incus and/or promontory. Follow-up images were rated as stable (n=16) or better (n=12) for 28/37 retractions (76%). Of the nine retractions that became more extensive, two developed cholesteatoma (5% of the total). No ossicular erosion developed in ears without cholesteatoma. Conductive hearing loss (4-tone average air-bone gap >25 decibels hearing level) was initially present in five ears, worsened in one, and normalized without intervention in others. No ears with initial normal hearing developed hearing loss. CONCLUSION Most tympanic membrane retractions remained stable or improved over time in this cohort of children who were at a risk of persistent eustachian tube dysfunction. Clinically significant progression occurred infrequently, justifying the conservative approach taken to manage these retractions. Such data are necessary to weigh the potential benefit of preventive intervention over observation.
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Affiliation(s)
- William Parkes
- Clinic of Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | - Sharon Cushing
- Clinic of Otolaryngology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Blake Papsin
- Clinic of Otolaryngology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adrian James
- Clinic of Otolaryngology, Hospital for Sick Children, Toronto, Ontario, Canada
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Godinho RN, Sih T, Ibiapina CDC, Oliveira MHMDF, Rezende ALDF, Tassara RV. Cleft lip and palate associated hearing loss in Brazilian children. Int J Pediatr Otorhinolaryngol 2018; 115:38-40. [PMID: 30368389 DOI: 10.1016/j.ijporl.2018.08.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/07/2018] [Accepted: 08/29/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cleft lip and palate children have chronic otitis media related to Eustachian Tube dysfunction and associated conductive hearing loss. In this group of children, communicative skill development limitations, in association with orofacial aesthetics and functional disorders, can lead to behavioral, educational and social problems. METHODS We evaluated the minimum hearing threshold and the air-bone gap (ABG) in a range from 500 to 4000 Hz for 4-14 years old cleft lip and palate children (CLPC). This cross-sectional study took place in a multiprofessional tertiary care center and involved 89 CLPC with bilateral or unilateral postforamen or transforamen malformation, divided into two groups: those aged 4-7 and 8-14 years. The hearing tests of 89 children were evaluated: 53 (group I) aged from 4 to 7 years (67.9% male) and 36 (group II) aged from 8 to 14 years (55.6% female). RESULTS The minimum hearing threshold 500-4 KHz mean (MHT 500-4 KHz) was 19.4 dB for all children. MHT 500-4 KHz was 21.2 dB and 17.5 dB respectively for the group I and group II. Both groups demonstrated a minimum hearing threshold of up to 70 dB at certain frequencies. The global ABG 500-4 KHz average was 16.6 dB (SD 12.5): 19.7 dB (SD 12.9) in group I and 13.2 dB (SD 11.1) in group II. CONCLUSION The worst hearing thresholds were found in children of 4-7 years old: 21.2 dB MHT 500-4 KHz and 19.7 ABG 500-4 KHz, what is a disadvantage for them, as the normal hearing thresholds are up to 15 dB. The children of 8-14 years old had MHT 500-4 KHz of 17.5 dB, and ABG 500-4KHZ OF 13.2 with up to 70 dB of hearing loss.
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Affiliation(s)
- Ricardo Neves Godinho
- College of Medical Sciences of Minas Gerais, Pontifical Catholic University of Minas Gerais, Brazil.
| | - Tania Sih
- Medical College of University of São Paulo, São Paulo, Brazil
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Karanth TK, Whittemore KR. Middle-ear disease in children with cleft palate. Auris Nasus Larynx 2018; 45:1143-1151. [DOI: 10.1016/j.anl.2018.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/21/2018] [Accepted: 04/25/2018] [Indexed: 10/28/2022]
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Sundell AL, Marcusson A. A comparison of orofacial profiles in 5- and 10-year-old Swedish children with and without cleft lip and/or palate. Clin Oral Investig 2018; 23:1341-1347. [PMID: 30014165 DOI: 10.1007/s00784-018-2562-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/04/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The objectives of this study were to assess orofacial profiles in 5- and 10-year-old children with cleft lip and/or palate (CL/P) compared to controls and to estimate a possible association between orofacial dysfunction and caries frequency. MATERIALS AND METHODS A total of 133 children with CL/P (77 5-year-olds and 56 10-year-olds) and 308 controls (142 5-year-olds and 166 10-year-olds) were included in the study. Orofacial function was evaluated with Nordic Orofacial Test-Screening (NOT-S), and caries were scored according to the International Caries Detection and Assessment System (ICDAS). RESULTS The total NOT-S score was higher in children with CL/P compared to controls (mean 3.2 vs 0.9, p < 0.001). The domains frequently scored in CL/P children were speech (82%), face at rest (72%), and facial expression (58%). There was a significantly positive correlation between NOT-S scores and caries frequency. CONCLUSIONS Children with CL/P have impaired orofacial function compared to controls. There seems to be a correlation between orofacial function and caries. CLINICAL RELEVANCE Impaired orofacial function seen in children with CL/P can be one of many risk factors for caries development, and it is suggested to be a part of caries risk assessment.
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Affiliation(s)
- Anna Lena Sundell
- Department of Paediatric Dentistry, Institute for Postgraduate Dental Education, Box 1030, SE-551 11, Jönköping, Sweden.
| | - Agneta Marcusson
- Dentofacial Orthopaedics, Maxillofacial Unit, Linköping University Hospital, Linköping, Sweden
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9
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Hagberg E, Flodin S, Granqvist S, Karsten A, Neovius E, Lohmander A. The Impact of Maxillary Advancement on Consonant Proficiency in Patients With Cleft Lip and Palate, Lay Listeners’ Opinion, and Patients’ Satisfaction With Speech. Cleft Palate Craniofac J 2018; 56:454-461. [DOI: 10.1177/1055665618784804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Emilie Hagberg
- Stockholm Craniofacial Team, Department of Reconstructive Plastic Surgery and Functional Area Speech Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Stina Flodin
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Svante Granqvist
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Unit of Basic Science, School of Technology and Health, KTH Royal Institute of Technology, Huddinge, Sweden
| | - Agneta Karsten
- Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
- Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erik Neovius
- Department of Reconstructive Plastic Surgery, Stockholms Craniofacial Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Functional Area Speech Language Pathology and Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
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10
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Hall A, Wills AK, Mahmoud O, Sell D, Waylen A, Grewal S, Sandy JR, Ness AR. Centre-level variation in outcomes and treatment for otitis media with effusion and hearing loss and the association of hearing loss with developmental outcomes at ages 5 and 7 years in children with non-syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 2. Orthod Craniofac Res 2018; 20 Suppl 2:8-18. [PMID: 28661080 DOI: 10.1111/ocr.12184] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To explore centre-level variation in otitis media with effusion (OME), hearing loss and treatments in children in Cleft Care UK (CCUK) and to examine the association between OME, hearing loss and developmental outcomes at 5 and 7 years. SETTING AND SAMPLE POPULATION Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK. MATERIALS AND METHODS Children had air and bone conduction audiometry at age 5. Information on grommet and hearing aid treatment was obtained from parental questionnaire and medical notes. Hearing loss at age 5 was defined as >20 dB in the better ear and history of OME and hearing loss was determined from past treatment. Children with sensorineural hearing loss were excluded. Associations were examined with speech, behaviour and self-confidence at age 5 and educational attainment at age 7. Centre variation was examined using hierarchical models and associations between hearing variables and developmental outcomes were examined using logistic regression. RESULTS There was centre-level variation in early grommet placement (variance partition coefficient (VPC) 18%, P=.001) and fitting of hearing aids (VPC 8%, P=.03). A history of OME and hearing loss was associated with poor intelligibility of speech (adjusted odds ratio=2.87, 95% CI 1.42-5.77) and aspects of educational attainment. CONCLUSIONS Hearing loss is an important determinant of poor speech and treatment variation across centres suggest management of OME and hearing loss could be improved.
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Affiliation(s)
- A Hall
- Life and Health Sciences, Aston University, Birmingham, UK.,Children's Hearing Centre, St Michael's Hospital, Bristol, UK
| | - A K Wills
- 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.,Bristol Dental School, University of Bristol, Bristol, UK
| | - O Mahmoud
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, UK.,Department of Applied Statistics, Helwan University, Cairo, Egypt
| | - D Sell
- North Thames Regional Cleft Service, Speech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - A Waylen
- Bristol Dental School, University of Bristol, Bristol, UK
| | - S Grewal
- Bristol Dental School, University of Bristol, Bristol, UK
| | - J R Sandy
- Bristol Dental School, University of Bristol, Bristol, UK
| | - A R Ness
- 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.,Bristol Dental School, University of Bristol, Bristol, UK
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Lou Q, Zhu H, Luo Y, Zhou Z, Ma L, Ma X, Fu Y. The Effects of Age at Cleft Palate Repair on Middle Ear Function and Hearing Level. Cleft Palate Craniofac J 2018; 55:753-757. [DOI: 10.1177/1055665618754632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate the age effects of cleft palate repair on middle ear function and hearing level in patients who underwent cleft palate repair at different ages by audiologic examination. Methods: Medical histories were gathered in detail, and audiologic tests (ie, tympanometry and pure tone hearing threshold) were conducted in 126 patients after palatoplasty. The patients were divided into the following 4 groups according to their ages when they underwent cleft palate repair: group I (0-3 years, 73 patients), group II (4-7 years, 29 patients), group III (8-11 years, 16 patients), and group IV (12 years and older, 8 patients). The data regarding tympanograms, hearing levels, and the average hearing thresholds of each group were analyzed using chi-square tests. Results: The prevalence of middle ear dysfunction and hearing loss in the patients who underwent palatoplasty before 3 years old (27.4% and 2.0% respectively) was significantly lower than that in patients who underwent palatopalsty at 12 years or older (75.0% and 43.7%, respectively). Linear-by-linear association revealed that the prevalences of middle ear dysfunction and hearing loss among the 4 groups were significantly different ( P < .05). Conclusions: The prevalence of middle ear dysfunction and hearing loss tended to increase with advancing age at the time of cleft palate repair. From an audiologist’s perspective, palatoplasty at an early age is very beneficial in helping children with cleft palates acquire better middle ear function and hearing level.
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Affiliation(s)
- Qun Lou
- Cleft Lip and Palate Center, Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Zhongguancun, Beijing, China
- Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongping Zhu
- Cleft Lip and Palate Center, Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Zhongguancun, Beijing, China
| | - Yi Luo
- Cleft Lip and Palate Center, Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Zhongguancun, Beijing, China
| | - Zhibo Zhou
- Cleft Lip and Palate Center, Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Zhongguancun, Beijing, China
| | - Lian Ma
- Cleft Lip and Palate Center, Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Zhongguancun, Beijing, China
| | - Xiaoran Ma
- Department of Speech and Hearing, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yuan Fu
- Cleft Lip and Palate Center, Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Zhongguancun, Beijing, China
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Persson M, Becker M, Conrad AL, Svensson H. Female and Male Differences in Academic Achievement in Individuals With Cleft: A Population-Based Register Study. Cleft Palate Craniofac J 2018; 55:196-203. [PMID: 29351028 PMCID: PMC6698897 DOI: 10.1177/1055665617726990] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The focus of this study was to determine if there is any significant difference in academic achievement for girls and boys with a cleft compared to the general population of Swedish students at graduation from compulsory school. DESIGN A retrospective population-based study using data obtained from the Swedish Medical Birth Register that was linked to the Swedish School-Grade Register. PARTICIPANTS Two hundred seventy girls and 241 boys with cleft palate (CP), 222 girls and 429 boys with cleft lip (CL), and 299 girls and 531 boys with cleft lip and palate (CLP) were compared with the compulsory school population comprising 609,397 girls and 640,007 boys. MAIN OUTCOME MEASURES (1) Odds of receiving the lowest grade and reduced odds in receiving high grades in Mathematics, English, and Swedish. (2) grade point average (GPA). RESULTS In all 3 subject grades, for boys with cleft there was no difference when compared to the male population. Girls with cleft were similar to their peers with a few exceptions. Girls with CLP had lower Math grades, and girls with CP had lower Math, English, and Swedish grades. Girls with CP and CLP achieved a significantly lower GPA in comparison to the female population and boys with CP and CL achieved lower GPAs in comparison to the male population. CONCLUSIONS This study indicates that educational outcomes for girls with cleft are more negatively affected than for boys with cleft.
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Affiliation(s)
- Martin Persson
- Kristianstad University, Kristianstad, Sweden
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Magnus Becker
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences in Malmö, University of Lund, Lund, Sweden
| | - Amy L. Conrad
- Deptartment of Pediatrics, Division Pediatric Psychology, University of Iowa Children’s Hospital, Iowa City, USA
| | - Henry Svensson
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences in Malmö, University of Lund, Lund, Sweden
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Lohmander A, Persson C, Willadsen E, Lundeborg I, Alaluusua S, Aukner R, Bau A, Boers M, Bowden M, Davies J, Emborg B, Havstam C, Hayden C, Henningsson G, Holmefjord A, Hölttä E, Kisling-Møller M, Kjøll L, Lundberg M, McAleer E, Nyberg J, Paaso M, Pedersen NH, Rasmussen T, Reisæter S, Søgaard Andersen H, Schöps A, Tørdal IB, Semb G. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 4. Speech outcomes in 5-year-olds - velopharyngeal competency and hypernasality. J Plast Surg Hand Surg 2017; 51:27-37. [PMID: 28218551 DOI: 10.1080/2000656x.2016.1254645] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIM Adequate velopharyngeal function and speech are main goals in the treatment of cleft palate. The objective was to investigate if there were differences in velopharyngeal competency (VPC) and hypernasality at age 5 years in children with unilateral cleft lip and palate (UCLP) operated on with different surgical methods for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. DESIGN Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. METHODS Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. Speech audio and video recordings of 391 children (136 girls, 255 boys) were available and perceptually analysed. The main outcome measures were VPC and hypernasality from blinded assessments. RESULTS There were no statistically significant differences between the prevalences in the arms in any of the trials. VPC: Trial 1, A: 58%, B: 61%; Trial 2, A: 57%, C: 54%; Trial 3, A: 35%, D: 51%. No hypernasality: Trial 1, A: 54%, B: 44%; Trial 2, A: 47%, C: 51%; Trial 3, A: 34%, D: 49%. CONCLUSIONS No differences were found regarding VPC and hypernasality at age 5 years after different methods for primary palatal repair. The burden of care in terms of secondary pharyngeal surgeries, number of fistulae, and speech therapy visits differed. TRIAL REGISTRATION ISRCTN29932826.
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Affiliation(s)
- Anette Lohmander
- a Division of Speech and Language Pathology , Karolinska Institutet, and Karolinska University Hospital , Stockholm , Sweden
| | - Christina Persson
- b Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Division of Speech and Language Pathology , Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Elisabeth Willadsen
- c Department of Nordic Studies and Linguistics , University of Copenhagen , Denmark
| | - Inger Lundeborg
- d Division of Speech and Language Pathology , Linköping University , Linköping , Sweden
| | - Suvi Alaluusua
- e Cleft Palate and Craniofacial Center , Helsinki University Central Hospital , Finland
| | - Ragnhild Aukner
- f Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | - Anja Bau
- g Copenhagen Cleft Palate Center , University Hospital of Copenhagen , Denmark
| | - Maria Boers
- g Copenhagen Cleft Palate Center , University Hospital of Copenhagen , Denmark
| | - Melanie Bowden
- h Department of Plastic Surgery, Greater Manchester Cleft Unit , Royal Manchester Children's Hospital , Manchester , UK
| | - Julie Davies
- h Department of Plastic Surgery, Greater Manchester Cleft Unit , Royal Manchester Children's Hospital , Manchester , UK
| | | | - Christina Havstam
- j Division of Speech and Language Pathology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Christine Hayden
- k The Royal Hospital for Sick Children , Belfast , Northern Ireland
| | - Gunilla Henningsson
- l Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | | | - Elina Hölttä
- e Cleft Palate and Craniofacial Center , Helsinki University Central Hospital , Finland
| | | | - Lillian Kjøll
- f Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | - Maria Lundberg
- l Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | - Eilish McAleer
- k The Royal Hospital for Sick Children , Belfast , Northern Ireland
| | - Jill Nyberg
- l Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | - Marjukka Paaso
- e Cleft Palate and Craniofacial Center , Helsinki University Central Hospital , Finland
| | | | | | | | | | - Antje Schöps
- g Copenhagen Cleft Palate Center , University Hospital of Copenhagen , Denmark
| | - Inger-Beate Tørdal
- f Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | - Gunvor Semb
- f Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.,n School of Dentistry , University of Manchester , Manchester , UK.,o Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
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Tengroth B, Hederstierna C, Neovius E, Flynn T. Hearing thresholds and ventilation tube treatment in children with unilateral cleft lip and palate. Int J Pediatr Otorhinolaryngol 2017; 97:102-108. [PMID: 28483218 DOI: 10.1016/j.ijporl.2017.03.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/20/2017] [Accepted: 03/26/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Children with cleft lip and palate have a high prevalence of otitis media with effusion (OME) which is often associated with a fluctuating, conductive hearing loss in the low and mid-frequencies and a risk for permanent hearing loss in the higher frequencies. Although common, there is no consensus on the treatment of OME with ventilation tubes. The aim of this study is to document if the risk for permanent hearing loss and acquired cholesteatoma increases due to treatment with ventilation tubes (VT treatments) during childhood in a group of children with cleft lip and palate. METHODS A retrospective medical chart review of 33 children (25 boys and 8 girls) born with unilateral cleft lip and palate (UCLP) was completed. Audiological data (results of hearing sensitivity tests, the total number of hearing tests, and number of VT treatments) were extracted from medical records from when the children were 4-7 and >7-10 years of age. RESULTS The hearing thresholds in the speech frequencies improved with age (p < 0,05) but a minority of the children continued to present with elevated hearing thresholds in the higher frequencies at >7-10 years of age. There were no significant correlations between number of VT treatments and hearing thresholds at >7-10 years. Four of the 33 children presented with complications: two children exhibited perforations of the ear drum (6.1%) and two children developed unilateral cholesteatoma (6.1%). CONCLUSION In the current study, the hearing sensitivity of children with cleft lip and palate improved with age. However, this improvement was not seen in the higher frequencies. Twelve percent of the children experienced complications following VT treatments. Due to these complications, it is recommended that all children with cleft palate should have routine follow-ups by an ENT doctor and audiologist. As part of the routine follow-up care, hearing assessments should be performed before and after VT treatments.
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Affiliation(s)
- Birgitta Tengroth
- Department of Audiology and Neurootology, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Christina Hederstierna
- Department of Audiology and Neurootology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Erik Neovius
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Traci Flynn
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Sweden
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Feragen KB, Aukner R, Særvold TK, Hide Ø. Speech, language, and reading skills in 10-year-old children with palatal clefts: The impact of additional conditions. JOURNAL OF COMMUNICATION DISORDERS 2017; 66:1-12. [PMID: 28292606 DOI: 10.1016/j.jcomdis.2017.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 01/19/2017] [Accepted: 03/06/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study examined speech (hypernasality and intelligibility), language, and reading skills in children with a cleft palate, specifically investigating additional conditions to the cleft, in order to differentiate challenges related to a cleft only, and challenges associated with an additional condition. DESIGN Cross-sectional data collected during routine assessments of speech and language in a centralised treatment setting. PARTICIPANTS Children born with cleft with palatal involvement from four birth cohorts (n=184), aged 10. OUTCOME MEASURES Speech: SVANTE-N; Language: Language 6-16; Reading: Word Chain Test and Reading Comprehension Test. RESULTS Descriptive analyses revealed that 123 of the children had a cleft only (66.8%), while 61 children (33.2%) had a cleft that was associated with an additional condition (syndrome, developmental difficulty, attentional difficulties). Due to close associations with the outcome variables, children with specific language impairments and dyslexia were excluded from the sample (n=14). In the total cleft sample, 33.1% had mild to severe hypernasality, and 27.9% had mild to severe intelligibility deviances. Most children with intelligibility and hypernasality scores within the normal range had a cleft without any other condition. A high number of children with developmental difficulties (63.2%) or AD/HD (45.5%) had problems with intelligibility. Hypernasality scores were also associated with developmental difficulties (58.8%), whereas most children with AD/HD had normal hypernasality scores (83.3%). As could be expected, results demonstrated that children with a cleft and an additional condition had language and reading scores below average. Children with a cleft only had language and reading scores within the normal range. Among the children with scores below average, 33.3-44.7% had no other conditions explaining difficulties with language and reading. CONCLUSIONS The findings highlight the need for routine assessments of language and reading skills, in addition to assessments of speech, in children with a cleft, in order to identify potential problems as early as possible. Study designs need to take additional difficulties into account, so that potential problems with language and reading are not ascribed the cleft diagnosis, and can be followed by appropriate treatment and interventions.
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Affiliation(s)
- Kristin Billaud Feragen
- Statped sørøst, Department of Speech and Language Disorders, Bredtvetveien 4, 0950 Oslo, Norway.
| | - Ragnhild Aukner
- Statped sørøst, Department of Speech and Language Disorders, Bredtvetveien 4, 0950 Oslo, Norway
| | - Tone K Særvold
- Statped sørøst, Department of Speech and Language Disorders, Bredtvetveien 4, 0950 Oslo, Norway
| | - Øydis Hide
- Statped sørøst, Department of Speech and Language Disorders, Bredtvetveien 4, 0950 Oslo, Norway
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16
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Klintö K, Salameh EK, Lohmander A. Phonology in Swedish-speaking 5-year-olds born with unilateral cleft lip and palate and the relationship with consonant production at 3 years of age. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 18:147-156. [PMID: 27172850 DOI: 10.3109/17549507.2015.1081287] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE At ∼3 years of age ∼50% of the children born with cleft palate present with phonological/articulatory difficulties. Differences between children with and without cleft palate have been reported to decline with age; however, the phonology in children with cleft palate at pre-school age/early school age has rarely been explored. The purpose of this study was to assess phonology in children with unilateral cleft lip and palate (UCLP) at age 5 and its relationship with performances at 3 years of age. METHOD The study included 29 children with UCLP and 20 without UCLP. Percentage correct consonants adjusted for age (PCC-A) and number of consistent phonological simplification processes were assessed from phonetic transcriptions. In addition, a descriptive analysis of phonological/articulatory processes was performed. RESULT The children with UCLP displayed significantly lower PCC-A and more phonological processes at age 5 years than peers without UCLP. The correlations between the outcomes at 3 and 5 years of age were significant. CONCLUSION Still at 5 years of age many children with cleft palate have phonological problems and it is possible to identify children at risk for impaired phonology at earlier age.
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Affiliation(s)
- Kristina Klintö
- a Otorhinolaryngology, Skåne University Hospital , Malmö , Sweden and
| | | | - Anette Lohmander
- b Division of Speech and Language Pathology , Karolinska Institutet, CLINTEC, Karolinska University Hospital , Huddinge , Stockholm , Sweden
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Smallridge J, Hall AJ, Chorbachi R, Parfect V, Persson M, Ireland AJ, Wills AK, Ness AR, Sandy JR. Functional outcomes in the Cleft Care UK study--Part 3: oral health and audiology. Orthod Craniofac Res 2015; 18 Suppl 2:25-35. [PMID: 26567853 PMCID: PMC4950029 DOI: 10.1111/ocr.12110] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare oral health and hearing outcomes from the Clinical Standards Advisory Group (CSAG, 1998) and the Cleft Care UK (CCUK, 2013) studies. SETTING AND SAMPLE POPULATION Two UK-based cross-sectional studies of 5-year-olds born with non-syndromic unilateral cleft lip and palate undertaken 15 years apart. CSAG children were treated in a dispersed model of care with low-volume operators. CCUK children were treated in a centralized, high volume operator system. MATERIALS AND METHODS Oral health data were collected using a standardized proforma. Hearing was assessed using pure tone audiometry and middle ear status by otoscopy and tympanometry. ENT and hearing history were collected from medical notes and parental report. RESULTS Oral health was assessed in 264 of 268 children (98.5%). The mean dmft was 2.3, 48% were caries free, and 44.7% had untreated caries. There was no evidence this had changed since the CSAG survey. Oral hygiene was generally good, 96% were enrolled with a dentist. Audiology was assessed in 227 of 268 children (84.7%). Forty-three per cent of children received at least one set of grommets--a 17.6% reduction compared to CSAG. Abnormal middle ear status was apparent in 50.7% of children. There was no change in hearing levels, but more children with hearing loss were managed with hearing aids. CONCLUSIONS Outcomes for dental caries and hearing were no better in CCUK than in CSAG, although there was reduced use of grommets and increased use of hearing aids. The service specifications and recommendations should be scrutinized and implemented.
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Affiliation(s)
- J Smallridge
- South Thames' Cleft Unit, Guy's and St Thomas Hospital, London, UK
- Cleft Net East Cleft Network, Addenbrooke's Hospital, Cambridge, UK
| | - A J Hall
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - R Chorbachi
- North Thames Cleft Centre, Great Ormond Street Hospital for Children and Broomfield Hospital, London, UK
| | - V Parfect
- East of England Cleft Network, Audiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Persson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - A J Ireland
- 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
| | - 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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18
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Lithovius RH, Lehtonen V, Autio TJ, Harila V, Anttonen V, Sándor GK, Ylikontiola LP. The association of cleft severity and cleft palate repair technique on hearing outcomes in children in northern Finland. J Craniomaxillofac Surg 2015; 43:1863-7. [PMID: 26421466 DOI: 10.1016/j.jcms.2015.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/29/2015] [Accepted: 08/18/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The consequences of cleft lip and palate include scaring, dental malformations, tooth misalignment, speech problems, and hearing loss. Otitis media with effusion causing hearing loss is a problem for many cleft palate patients. METHODS This study examines the association among cleft severity, palate repair technique, and hearing outcomes in children from northern Finland with clefts, aged 3-9 years. The study included 90 cleft patients who were treated at the Oulu University Hospital Cleft Lip and Palate Center between 1998 and 2011. The severity of the cleft, the surgical technique used to repair the palate, audiogram configuration data, and the need for ventilation tube placement were determined retrospectively from patient records. RESULTS Only 3.3% of cleft patients had an abnormal pure tone average hearing threshold representing abnormal hearing. Neither the surgical technique used to repair the cleft palate nor the severity of the cleft was a significant factor related to hearing loss or to the number of ventilation tubes required. Hearing improved significantly with increasing age over a span of 6 years. CONCLUSIONS Continuous follow-up with proactive placement of ventilation tubes before or at the time of palatoplasty results in hearing outcomes in cleft children that are similar to those reported in non-cleft children.
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Affiliation(s)
- Riitta H Lithovius
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Ville Lehtonen
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland; Department of Cariology, Paedodontics and Endodontology, University of Oulu, Oulu, Finland
| | - Timo J Autio
- Department of Otolaryngology, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Virpi Harila
- Department of Oral Development and Orthodontics, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Vuokko Anttonen
- Department of Cariology, Paedodontics and Endodontology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - George K Sándor
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland.
| | - Leena P Ylikontiola
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
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19
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Gładysz D, Hozyasz KK. Stem cell regenerative therapy in alveolar cleft reconstruction. Arch Oral Biol 2015; 60:1517-32. [PMID: 26263541 DOI: 10.1016/j.archoralbio.2015.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 05/23/2015] [Accepted: 07/04/2015] [Indexed: 12/17/2022]
Abstract
Achieving a successful and well-functioning reconstruction of craniofacial deformities still remains a challenge. As for now, autologous bone grafting remains the gold standard for alveolar cleft reconstruction. However, its aesthetic and functional results often remain unsatisfactory, which carries a long-term psychosocial and medical sequelae. Therefore, searching for novel therapeutic approaches is strongly indicated. With the recent advances in stem cell research, cell-based tissue engineering strategies move from the bench to the patients' bedside. Successful stem cell engineering employs a carefully selected stem cell source, a biodegradable scaffold with osteoconductive and osteoinductive properties, as well as an addition of growth factors or cytokines to enhance osteogenesis. This review highlights recent advances in mesenchymal stem cell tissue engineering, discusses animal models and case reports of stem cell enhanced bone regeneration, as well as ongoing clinical trials.
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Affiliation(s)
- Dominika Gładysz
- Department of Pediatrics, Institute of Mother and Child, Warsaw, Poland
| | - Kamil K Hozyasz
- Department of Pediatrics, Institute of Mother and Child, Warsaw, Poland.
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