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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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Scarmagnani RH, Lohmander A, Salgado MH, Fukushiro AP, Trindade IEK, Yamashita RP. Models for Predicting Velopharyngeal Competence Based on Speech and Resonance Errors and Velopharyngeal Area Estimation. Cleft Palate Craniofac J 2024; 61:965-975. [PMID: 36594481 DOI: 10.1177/10556656221149516] [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: 01/04/2023] Open
Abstract
OBJECTIVE To develop tools for predicting velopharyngeal competence (VPC) based on auditory-perceptual assessment and its correlation with objective measures of velopharyngeal orifice area. DESIGN Methodological study. PARTICIPANTS AND METHODS Sixty-two patients with repaired cleft palate, aged 6 to 45 years, underwent aerodynamic evaluation by means of the pressure-flow technique and audiovisual recording of speech samples. Three experienced speech-language pathologists analysed the speech samples by rating the following resonance, visual, and speech variables: hypernasality, audible nasal air emission, nasal turbulence, weak pressure consonants, facial grimacing, active nonoral errors, and overall velopharyngeal competence. The correlation between the perceptual speech variables and velopharyngeal orifice area estimates was analysed with Spearman's correlation coefficient. Two statistical models (discriminant and exploratory) were used to predict VPC based on the orifice area estimates. Sensitivity and specificity analyses were performed to verify the clinical applicability of the models. RESULTS There was a strong correlation between VPC (based on the orifice area estimates) and each speech variable. Both models showed 88.7% accuracy in predicting VPC. The sensitivity and specificity for the discriminant model were 92.3% and 97.2%, respectively, and 96.2% and 94.4% for the exploratory model. CONCLUSION Two predictor models based on ratings of resonance, visual, and speech variables and a simple calculation of a composite variable, SOMA (Eng. "sum"), were developed and found to be efficient in predicting VPC defined by orifice estimates categories based on aerodynamic measurements. Both tools may contribute to the diagnosis of velopharyngeal dysfunction in clinical practice.
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Affiliation(s)
- Rafaeli Higa Scarmagnani
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Speech-Language Pathology Unit, Karolinska University Hospital, Stockholm, Sweden
| | | | - Ana Paula Fukushiro
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
- Department of Speech and Hearing Pathology, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Inge Elly Kiemle Trindade
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
- Department of Speech and Hearing Pathology, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Renata Paciello Yamashita
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
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3
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Dunworth K, Sharif-Askary B, Grames L, Jones C, Kern J, Nyswonger-Sugg J, Suárez A, Thompson K, Ching J, Golden B, Merrill C, Nguyen P, Patel K, Rogers-Vizena CR, Rottgers SA, Skolnick GB, Allori AC. Using "Real-World Data" to Study Cleft Lip/Palate Care: An Exploration of Speech Outcomes from a Multi-Center US Learning Health Network. Cleft Palate Craniofac J 2023:10556656231207469. [PMID: 37844605 DOI: 10.1177/10556656231207469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE To assess the ability of a cleft-specific multi-site learning health network registry to describe variations in cleft outcomes by cleft phenotypes, ages, and treatment centers. Observed variations were assessed for coherence with prior study findings. DESIGN Cross-sectional analysis of prospectively collected data from 2019-2022. SETTING Six cleft treatment centers collected data systematically during routine clinic appointments according to a standardized protocol. PARTICIPANTS 714 English-speaking children and adolescents with non-syndromic cleft lip/palate. INTERVENTION Routine multidisciplinary care and systematic outcomes measurement by cleft teams. OUTCOME MEASURES Speech outcomes included articulatory accuracy measured by Percent Consonants Correct (PCC), velopharyngeal function measured by Velopharyngeal Competence (VPC) Rating Scale (VPC-R), intelligibility measured by caregiver-reported Intelligibility in Context Scale (ICS), and two CLEFT-Q™ surveys, in which patients rate their own speech function and level of speech distress. RESULTS 12year-olds exhibited high median PCC scores (91-100%), high frequency of velopharyngeal competency (62.50-100%), and high median Speech Function (80-91) relative to younger peers parsed by phenotype. Patients with bilateral cleft lip, alveolus, and palate reported low PCC scores (51-91%) relative to peers at some ages and low frequency of velopharyngeal competency (26.67%) at 5 years. ICS scores ranged from 3.93-5.0 for all ages and phenotypes. Speech Function and Speech Distress were similar across phenotypes. CONCLUSIONS This exploration of speech outcomes demonstrates the current ability of the cleft-specific registry to support cleft research efforts as a source of "real-world" data. Further work is focused on developing robust methodology for hypothesis-driven research and causal inference.
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Affiliation(s)
- Kristina Dunworth
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Banafsheh Sharif-Askary
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Lynn Grames
- Cleft Palate and Craniofacial Institute, St. Louis Children's Hospital, St. Louis, USA
| | - Carlee Jones
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Jennifer Kern
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Jillian Nyswonger-Sugg
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Arthur Suárez
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Karen Thompson
- Cleft Lip and Palate Program/Craniofacial Program, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Jessica Ching
- University of Florida Craniofacial Center, University of Florida, Gainesville, FL, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Brent Golden
- Pediatric Cleft Lip and Palate Surgery Program, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Corinne Merrill
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Phuong Nguyen
- Division of Plastic Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kamlesh Patel
- Cleft Palate and Craniofacial Institute, St. Louis Children's Hospital, St. Louis, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Carolyn R Rogers-Vizena
- Cleft Lip and Palate Program/Craniofacial Program, Boston Children's Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - S Alex Rottgers
- Cleft and Craniofacial Center, Johns Hopkins Children's Center, Baltimore, MD, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Alexander C Allori
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
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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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5
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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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6
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Frederick R, Hogan AC, Seabolt N, Stocks RMS. An Ideal Multidisciplinary Cleft Lip and Cleft Palate Care Team. Oral Dis 2022; 28:1412-1417. [DOI: 10.1111/odi.14213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Robert Frederick
- Department of Otolaryngology College of Medicine University of Tennessee Health Science Center 910 Madison Avenue Ste 430 Memphis TN 38163 USA
| | - Amy Claire Hogan
- LeBonheur Children’s Inpatient Rehabilitation Services 848 Adams Avenue Memphis TN 38103 USA
| | - Natalie Seabolt
- College of Nursing University of Tennessee 874 Union Avenue Memphis TN 38163 USA
| | - Rose Mary S. Stocks
- Department of Otolaryngology College of Medicine University of Tennessee Health Science Center 910 Madison Avenue Ste 430 Memphis TN 38163 USA
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7
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Molyneaux C, Sherriff M, Wren Y, Ireland A, Sandy J. Changes in the Transverse Dimension of the Maxillary Arch of 5-Year-Olds Born With UCLP Since the Introduction of Nationwide Guidance. Cleft Palate Craniofac J 2021; 59:1064-1071. [PMID: 34282648 PMCID: PMC9272515 DOI: 10.1177/10556656211028511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: To determine whether the transverse dimensions of the maxillary arch of
5-year-old children with unilateral cleft lip and palate (UCLP) have changed
following centralization of cleft services in the United Kingdom. Design: Retrospective cross-sectional study. Setting: Digital analysis of UCLP maxillary dental casts. Participants: All available maxillary dental casts from 5-year-old participants of the
Clinical Standards Advisory Group (CSAG, N = 114) and Cleft Care UK (CCUK, N
= 175) studies. Interventions: Quantitative measurements of the intercanine width (ICW), intermolar width
(IMW), and the distance from the midline to the greater and lesser side
canine (GC/LC) and greater side and lesser side second primary molar
(GE/LE). Degree measurements of the greater and lesser arch form angles,
arch length, anterior palatal depth (APD), and posterior palatal depth were
also measured. Main outcome: Differences between the transverse dimensions of the maxillary arch for the
CSAG and CCUK cohorts. Results: In 5 (ICW, IMW, LC, LE, and APD) of the 11 measurements, there was a
statistically significant difference between the CSAG and CCUK cohorts. In
all of these, the CCUK values were greater than CSAG. Conclusions: There have been small but positive improvements for the transverse maxillary
dimensions since centralization of the UK cleft service.
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8
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Al Awaji NN, Almudaiheem AA, Mortada EM. Assessment of caregivers' perspectives regarding speech-language services in Saudi Arabia during COVID-19. PLoS One 2021; 16:e0253441. [PMID: 34157033 PMCID: PMC8219133 DOI: 10.1371/journal.pone.0253441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 06/06/2021] [Indexed: 12/01/2022] Open
Abstract
Background As a consequence of stay-at-home and other lockdown measures, such as social distancing, all health care service provisions during the COVID-19 pandemic have been affected, including the provision of speech therapy. Telehealth services can play a major role in maintaining access to health care, help speech and language pathologists (SLPs) overcome physical barriers by providing patients and caregivers with access to health care, and limit the discontinuity of patient care. To have a better understanding of the changes that have occurred in these services during COVID-19, this research was conducted to explore the nature and current situation of speech-language services in Saudi Arabia based on caregivers’ perspectives. It also investigated whether changes have occurred in these services during the COVID-19 lockdown. The study also determined the perception of caregivers in delivering SLS sessions remotely. Method A cross-sectional study was conducted with 385 caregivers in Saudi Arabia. An online survey asked whether children were experiencing any SLS problems and if they had received any intervention. The survey also assessed the perception of changes in service during the COVID-19 lockdown and the perceptions, acceptance, and willingness of the caregivers to deliver telehealth speech services in Saudi Arabia. Results About 50% of the respondents had or were suspected to have a child with SLS problems, and just over half of them had accessed SLS services. Most of the respondents reported suspension of therapy sessions as a response to the COVID-19 pandemic. While the respondents had little experience using telehealth prior to the pandemic, they generally showed a willingness to use telehealth in therapy sessions, expressing a preference for video calls over other options. Conclusion The study revealed that SLS services in Saudi Arabia are limited and that accessing these services is challenging. Alternative service delivery using remote services could help caregivers overcome such challenges. When telehealth was introduced as an option for service delivery, the caregivers showed welcoming responses, particularly with video calls.
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Affiliation(s)
- Nisreen Naser Al Awaji
- Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- * E-mail:
| | - Alanoud A. Almudaiheem
- King Abdullah Specialized Children Hospital-King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Eman M. Mortada
- Health Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Community, Environmental & Occupational Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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9
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Grewal SS, Ponduri S, Leary SD, Wren Y, Thompson JMD, Ireland AJ, Ness AR, Sandy JR. Educational Attainment of Children Born with Unilateral Cleft Lip and Palate in the United Kingdom. Cleft Palate Craniofac J 2020; 58:587-596. [PMID: 32990032 PMCID: PMC8044616 DOI: 10.1177/1055665620959989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: This study evaluated association between functional outcomes in children born with unilateral cleft lip and palate (UCLP) and educational attainment. Design: Cleft Care UK (CCUK) was a United Kingdom (UK) wide cross-sectional study. Setting: UK Cleft Teams (data collected from all UK sites providing centralized cleft services). Patients, Participants: Five-year olds born with nonsyndromic UCLP (n = 268). Main Outcome Measure(s): National tests for educational attainment Key Stage 1 (KS1) undertaken by children at age 7 were linked to CCUK data to describe differences in educational attainment. Associations between functional outcomes and KS1 results were evaluated using regression analysis. We adjusted for birth month, gender, and an area-based measure of socioeconomic status. Results: Data were available for 205 children with UCLP. These children scored lower than national average (NA) scores across all subject areas, with a 0.62 lower score observed in the Average Point Score (APS; P = .01). There was association between being in a lower category for a cleft related outcomes and poorer KS1 results, with a trend for poorer attainment with higher numbers of poor functional outcomes. Those with 3 or more poor outcomes had a −2.26 (−3.55 to −0.97) lower APS compared to those with 0 to 1 poor outcomes. Conclusions: Children born with UCLP have poorer educational attainment at age 7 across all subject areas though differences were modest. Children with poor functional outcomes at age 5 had worse educational outcomes age 7. Improvements in functional outcomes could enhance educational outcomes.
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Affiliation(s)
- Sukhraj S Grewal
- 61139King's College London Dental Institute, London, United Kingdom
| | - Sirisha Ponduri
- Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, United Kingdom
| | - Sam D Leary
- NIHR Bristol Biomedical Research Centre Nutrition Theme, Level 3, 1980University Hospitals Bristol Education Centre, Bristol, United Kingdom
| | - Yvonne Wren
- Speech and Language, Bristol Dental School, 1980University of Bristol, Bristol, United Kingdom
| | - John M D Thompson
- Department of Obstetrics & Gynaecology, Faculty of Health Science and Medicine, 1415University of Auckland, Auckland, New Zealand
| | - Anthony J Ireland
- Orthodontics, Bristol Dental School, 1980University of Bristol, Bristol, United Kingdom
| | - Andy R Ness
- Epidemiology, NIHR Bristol Biomedical Research Centre Nutrition Theme, Level 3, 1980University Hospitals Bristol Education Centre, Bristol, United Kingdom
| | - Jonathan R Sandy
- Orthodontics, Bristol Dental School, 1980University of Bristol, Bristol, United Kingdom
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10
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Setabutr D, Sathavornmanee T, Jitpakdee P, Nudchawong S, Krergmatukorn P. The Trend of Cleft Care at a Children's Referral Center in Thailand. Cleft Palate Craniofac J 2020; 57:1100-1104. [PMID: 32452240 DOI: 10.1177/1055665620922103] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the trend in cleft care at a major children's referral center in Bangkok, Thailand. STUDY DESIGN Retrospective chart review. PATIENTS AND METHODS A review of 129 patients under 18 years of age who had underwent care by the senior author for cleft treatment between January 2015 and October 2017 was done. The impact of varying factors on patient care was analyzed. We compare our demographics and treatment timeline to that of previously published literature in more developed countries. SETTING Tertiary care medical center. RESULTS One hundred and two patient charts were reviewed with 53% male patients. Most patients had both cleft lip and cleft palate, 44%. Cleft lips most commonly were complete and occurred on the left side. In all, 77.4% of clefts were nonsyndromic. On average, primary cleft lip surgery was delayed being performed about 11 months of age. Sixteen percent of patients were treated with an obturator, while 11 patients had nasoalveolar molding use. Hearing screenings occurred on average at around 6 months of age. Abnormal tympanograms were evident in 32% of individuals. There was a significant difference in timing of surgery for patients who lived a distance greater than 30 kilometers from the hospital versus those from the Bangkok metropolis (P < .05). CONCLUSION Reviewing data from a high-volume referral center in Thailand reveals mild variance with regard to cleft care timing compared to published literature from the developed world. Distance traveled was found to impact timing of surgery.
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Affiliation(s)
- Dhave Setabutr
- Department of Otolaryngology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.,Department of Otolaryngology, Queen Sirikit National Institutes of Health, Bangkok, Thailand
| | - Thanakrit Sathavornmanee
- Department of Otolaryngology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.,Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Polpatt Jitpakdee
- Department of Otolaryngology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.,Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Songphon Nudchawong
- Department of Otolaryngology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Penpak Krergmatukorn
- Department of Plastic Surgery, Queen Sirikit National Institute of Children's Health, Bangkok, Thailand
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11
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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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12
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Lee TVN, Ireland AJ, Atack NE, Deacon SA, Jones TEM, Matharu J, Wills A, Al-Ghatam R, Richard BM, Ness AR, Sandy JR. Is There a Correlation Between Nasolabial Appearance and Dentoalveolar Relationships in Patients With Repaired Unilateral Cleft Lip and Palate? Cleft Palate Craniofac J 2019; 57:21-28. [PMID: 31331191 DOI: 10.1177/1055665619862145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine whether a relationship exists between the aesthetic scores given to photographic records of the nasolabial region of patients with repaired unilateral cleft lip and palate (UCLP) and the 5-Year Olds' Index scores of study models for the same participants. DESIGN Retrospective study. SETTING University of Bristol Dental Hospital, United Kingdom. PARTICIPANTS Patients with nonsyndromic UCLP previously enrolled in the Cleft Care UK (CCUK) Study. METHODS The CCUK participants, who had both study models and photographs (frontal and worm's eye view), were identified and their records retrieved. These were rated by 2 consultants and 2 senior registrars in orthodontics. The 5-Year Olds' Index was used to score the study models, and at a separate sitting, a 5-point Likert scale was used to score the cropped frontal and worm's eye view photographs of the same children. The results were analyzed using intraclass correlation coefficients and Cohen κ. MAIN OUTCOME MEASURES Correlation between the aesthetic scores of the photographic views and the concordant 5-Year Olds' Index scores of the study models. RESULTS The intraclass correlation coefficient scores showed very poor agreement between the photographic views and their concordant study models. The level of inter- and intra-rater reliability was strongest when scoring the study models. CONCLUSIONS There was no agreement between the scores given to various photographic views and their corresponding study models. Scoring the study models using the 5-Year Olds' Index was the most reliable outcome measure for this age-group.
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Affiliation(s)
- Tara V N Lee
- University of Bristol Dental Hospital, Bristol, United Kingdom.,Royal United Hospitals, Bath, United Kingdom
| | - Anthony J Ireland
- University of Bristol Dental Hospital, Bristol, United Kingdom.,Royal United Hospitals, Bath, United Kingdom
| | - Nikki E Atack
- University of Bristol Dental Hospital, Bristol, United Kingdom.,Musgrove Park Hospital, Taunton, United Kingdom
| | - Scott A Deacon
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | | | | | - Rana Al-Ghatam
- Dental and Maxillofacial Centre, Royal Medical Services, Bahrain Defence Force, West Riffa, Kingdom of Bahrain
| | | | - Andy R Ness
- NIHR Biomedical Research Unit, University Hospitals Bristol NHS Foundation Trust Education and Research Centre, Bristol, United Kingdom
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13
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Yang AS, Richard BM, Wills AK, Mahmoud O, Sandy JR, Ness AR. Closer to the Truth on National Fistula Prevalence After Unilateral Complete Cleft Lip and Palate Repair? The Cleft Care UK Study. Cleft Palate Craniofac J 2019; 57:5-13. [DOI: 10.1177/1055665619858871] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To (1) determine the prevalence of nonperialveolar palatal fistula up to age 5 following repair of unilateral cleft lip and palate (UCLP) in the United Kingdom, (2) examine the association of palatoplasty techniques with fistula occurrence, and (3) describe the frequency of fistula repairs and their success. Design: Cross-sectional study. Setting: All 11 centralized regional cleft centers in the United Kingdom. Participants: Two hundred sixty-eight children born between 2005 and 2007 recruited by Cleft Care UK, a nationwide cross-sectional study of all 5-year-old children born with nonsyndromic UCLP. Main Outcome Measure: Nonperialveolar palatal fistula prevalence up to age 5. Results: Fistulas were found in 72 children (31.3%, 95% confidence interval: 25.4%-37.7%) and had no significant association with palate repair sequences. Twenty-four fistulas were repaired by age 5, 12 of which had data showing 10 (83.3%) successful repairs. Conclusion: The prevalence of nonperialveolar fistulas following primary palatoplasty of UCLP in the United Kingdom was higher than previously reported. This information should be part of the preoperative discussion with families. Prospective collection of the presence of fistulas will be necessary before we can associate the occurrence of fistulas with a surgeon, institution, surgical technique, or protocol of care.
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Affiliation(s)
- Arthur S. Yang
- Department of Plastic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Bruce M. Richard
- Department of Plastic Surgery, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew K. Wills
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
- Bristol Dental School, Bristol Dental Hospital, University of Bristol, Bristol, United Kingdom
| | - Osama Mahmoud
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jonathan R. Sandy
- Bristol Dental School, Bristol Dental Hospital, University of Bristol, Bristol, United Kingdom
| | - Andy R. Ness
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
- Bristol Dental School, Bristol Dental Hospital, University of Bristol, Bristol, United Kingdom
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14
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Abstract
This short review is an opportunity to focus on significant positive changes for those children born with some form of oro-facial clefting and who are treated in a centralised service within the National Health Service (NHS). There has also been an opportunity to provide a focus for research as part of this service model. Orthodontists have played a key role in all aspects of this and will continue to be central to further improvements in caring for cleft children.
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15
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Kornmann NSS, Tan RA, Mulder FJ, Hardwicke JT, Richard BM, Pigott BB, Pigott RW. Defining the Aesthetic Range of Normal Symmetry for Lip and Nose Features in 5-Year-Old Children Using the Computer-Based Program SymNose. Cleft Palate Craniofac J 2018; 56:799-805. [PMID: 30463424 PMCID: PMC6604244 DOI: 10.1177/1055665618813236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: To provide a normal comparison group against which to judge symmetry results after
cleft surgery and to introduce the thin lip correction (TLC) feature in SymNose. A
lip–aspect ratio algorithm has been added to the latest version of SymNose to compensate
for the higher degree of overlap in thicker lips when compared to thin lips. Design: Retrospective analysis of symmetry in healthy participants, using the computer-based
program SymNose on both anteroposterior (AP) and base view images. Photographs of 91
noncleft children were traced twice by 3 independent investigators experienced with
SymNose. Participants: Five-year-old healthy participants from a local state school in Tavistock (West Devon,
United Kingdom). Main Outcome Measure: Asymmetry expressed as the perimeter mismatch percentage for nose and lip features on
AP view images and for nose features on base view images. Results: The perimeter mismatch reference range for the nose (AP view) was 2.65% to 30.91%, for
the lip 2.13% to 15.44%, for the nose (base view) 1.69% to 14.84%, for the nostrils
4.68% to 26.6%, and for the width–height ratio 1.15% to 1.80%. The perimeter mismatch
percentage for the lip without TLC was significantly higher compared to the perimeter
mismatch percentage with TLC (P < .001). Conclusion: This article provides a noncleft reference range for all perimeters drawn from SymNose
against which to compare results after cleft surgery at 5 years of age. Furthermore, it
shows the importance of correcting for variance in lip volume per child.
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Affiliation(s)
- Nirvana S S Kornmann
- 1 West Midlands Cleft Lip and Palate Service, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom.,2 Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Robin A Tan
- 2 Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Frans J Mulder
- 2 Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Joseph T Hardwicke
- 1 West Midlands Cleft Lip and Palate Service, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Bruce M Richard
- 1 West Midlands Cleft Lip and Palate Service, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Ronald W Pigott
- 4 Department of Plastic Surgery, Frenchay Hospital, Bristol, United Kingdom
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16
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Thierens LA, Lewyllie A, Temmerman L, De Roo NM, Verdonck A, Cadenas de Llano Perula M, Willems G, De Pauw GA. A retrospective intercenter comparison of two surgical protocols through the dental arch relationship of 5- to 6-year-old unilateral cleft patients. Clin Oral Investig 2018; 23:1777-1784. [PMID: 30171346 DOI: 10.1007/s00784-018-2601-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The objectives of this retrospective equivalence trial were to assess the dental arch relationship of 5- to 6-year-old patients with unilateral cleft lip and palate (UCLP) treated in two specialized cleft centers with a different surgical protocol using the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system, and to determine the correlation between these two scoring indices. MATERIALS AND METHODS The dental arch relationship of seventy-three 5- to 6-year-old patients with complete UCLP was evaluated on plaster casts using the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system. The sagittal occlusion, overbite, and overjet were also recorded. Inter- and intra-examiner agreement was determined using Intraclass Correlation Coefficients. RESULTS A good to very good inter- and intra-examiner agreement was found. No significant mean difference in outcome based on the 5-Year-Olds' Index, the modified Huddart/Bodenham scoring system, overjet, or overbite was detected. For mean difference in sagittal occlusion, the hypothesis that both centers are clinically equivalent was confirmed. A strong negative correlation (rs = - 0.832) between the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system was found. CONCLUSIONS The dental arch relationship of 5- to 6-year-old unilateral cleft patients treated in two Belgian cleft centers is clinically equivalent based on sagittal occlusion, despite substantial differences in their treatment protocol. Clinical equivalence for other parameters was not confirmed. There is a strong correlation between the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system. CLINICAL RELEVANCE A well-implemented treatment protocol for cleft patients is of the utmost importance, but case load and skill of the surgeon are also important factors for the quality of the results.
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Affiliation(s)
- Laurent Am Thierens
- Oral Health Sciences, Department of Orthodontics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium. .,Centre for Congenital Facial Anomalies, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Arianne Lewyllie
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Liesbeth Temmerman
- Oral Health Sciences, Department of Orthodontics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Noëmi Mc De Roo
- Oral Health Sciences, Department of Orthodontics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - An Verdonck
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.,Leuven Cleft Lip and Palate Team, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Maria Cadenas de Llano Perula
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.,Leuven Cleft Lip and Palate Team, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Guy Willems
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Guy Am De Pauw
- Oral Health Sciences, Department of Orthodontics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.,Centre for Congenital Facial Anomalies, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
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17
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Mittal TK, Ireland AJ, Atack NE, Leary SD, Russell JI, Deacon SA, Ness AR, Sandy JR. Outcome Measures in UCLP: The Modified 5-Year-Olds'-Index-Development and Reliability. Cleft Palate Craniofac J 2018; 56:248-256. [PMID: 29750571 DOI: 10.1177/1055665618774018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Can we reliably discriminate severity within the existing categories of the 5-Year-Olds' Index? DESIGN Retrospective method comparison and development study. SETTING School of Oral and Dental Science, University of Bristol. METHODS Dental study models of 5-year-olds with unilateral cleft lip and palate (UCLP) were collected from the archives of 2 national cleft surveys (n = 351). One hundred randomly selected models were ranked to construct the modified 5-Year-Olds' Index and also scored using a visual analogue scale (VAS). Reliability testing was performed on 51 study models. Visual analogue scale scores were used to aid statistical analysis and investigate the reliability of a VAS for outcome measurement. The modified 5-Year-Olds' Index was then applied to 198 study models of 5-year-olds with UCLP. RESULTS The modified 5-Year-Olds' Index showed excellent intra and interexaminer agreement (intraclass correlation > 0.94) and good discrimination of severity. When applied to the Cleft Care UK participants (n = 198), the modified 5-Year-Olds' Index showed good discrimination of severity within the better categories (groups 1-3) of the 5-Year-Olds' Index. Visual analogue Scale scores resulted in unacceptable variation between measurements. CONCLUSIONS The new modified 5-Year-Olds' Index is a reliable method of assessing outcomes at 5 years of age and showed improved discriminatory power between the "better" outcome categories than the original 5-Year-Olds' Index. A VAS was found to be unsuitable for assessing outcome at 5 years of age for children with UCLP.
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Affiliation(s)
- Tarun K Mittal
- 1 Derriford Hospital, Crownhill, Plymouth, United Kingdom
| | | | - Nikki E Atack
- 2 Dental School, University of Bristol, Bristol, United Kingdom.,3 Musgrove Park Hospital, Taunton, United Kingdom
| | - Sam D Leary
- 2 Dental School, University of Bristol, Bristol, United Kingdom
| | - Joyce I Russell
- 4 Alder Hey Children's Foundation Trust, Liverpool, United Kingdom
| | - Scott A Deacon
- 5 South West Cleft Service, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Andy R Ness
- 2 Dental School, University of Bristol, Bristol, United Kingdom.,6 University Hospitals Bristol, Bristol, United Kingdom
| | - Jonathan R Sandy
- 2 Dental School, University of Bristol, Bristol, United Kingdom.,6 University Hospitals Bristol, Bristol, United Kingdom
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18
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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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19
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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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20
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Ness AR, Wills AK, Waylen A, Al-Ghatam R, Jones TEM, Preston R, Ireland AJ, Persson M, Smallridge J, Hall AJ, Sell D, Sandy JR. Centralization of cleft care in the UK. Part 6: a tale of two studies. Orthod Craniofac Res 2018; 18 Suppl 2:56-62. [PMID: 26567856 PMCID: PMC4670710 DOI: 10.1111/ocr.12111] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 11/30/2022]
Abstract
Objectives We summarize and critique the methodology and outcomes from a substantial study which has investigated the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after the UK government started to implement the centralization of cleft care in response to an earlier survey in 1998, the Clinical Standards Advisory Group (CSAG). Setting and Sample Population A UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Data were collected from children born in the UK with a unilateral cleft lip and palate between 1 April 2005 and 31 March 2007. Materials and Methods We discuss and contextualize the outcomes from speech recordings, hearing, photographs, models, oral health and psychosocial factors in the current study. We refer to the earlier survey and other relevant studies. Results We present arguments for centralization of cleft care in healthcare systems, and we evidence this with improvements seen over a period of 15 years in the UK. We also make recommendations on how future audit and research may configure. Conclusions Outcomes for children with a unilateral cleft lip and palate have improved after the introduction of a centralized multidisciplinary service, and other countries may benefit from this model. Predictors of early outcomes are still needed, and repeated cross-sectional studies, larger longitudinal studies and adequately powered trials are required to create a research-led evidence-based (centralized) service.
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Affiliation(s)
- 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.,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 Waylen
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - 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.,Musgrove Park Hospital, Taunton, UK
| | - R Preston
- Cleft Lip and Palate Association, London, UK
| | - A J Ireland
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - M Persson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - 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.,Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - D Sell
- 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
| | - J R Sandy
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
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21
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Ness AR, Wills AR, Waylen A, Smallridge J, Hall AJ, Sell D, Sandy JR. Closing the Loop on Centralization of Cleft Care in the United Kingdom. Cleft Palate Craniofac J 2017; 55:248-251. [DOI: 10.1177/1055665617736779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: We highlight a major study that investigated the impact of reconfigured cleft care in the United Kingdom some 15 years after centralization. We argue that centralization as an intervention has a major impact on outcomes. Setting: Audit clinics held in Cleft Centers in the United Kingdom. Patients, Participants: Five-year-olds born between April 1, 2005, and March 31, 2007, with nonsyndromic unilateral cleft lip and palate. Interventions: Centralization of cleft care. Main Outcome Measure(s): We collected routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) in a very similar way to a previous survey. Results: We identified 359 eligible children and recruited 268 (74.7%) to the study. Overall, their outcomes were better post-centralization. There have been marked improvements in dentoalveolar arch relationships and in speech whereas the prevalence of dental caries and hearing loss are unchanged. Conclusions: Centralized cleft care has changed UK outcomes considerably and there is no argument for returning to a dispersed model of treatment.
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Affiliation(s)
- Andrew R. Ness
- Biomedical Research Unit in Nutrition, Diet and Lifestyle, National Institute for Health Research, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Andrew R. Wills
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Andrea Waylen
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Jackie Smallridge
- Cleft Net East Cleft Network, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Amanda J. Hall
- Children's Hearing Centre, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Debbie 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
| | - Jonathan R. Sandy
- Dean of Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
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22
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Sell D, Southby L, Wren Y, Wills AK, Hall A, Mahmoud O, Waylen A, Sandy JR, Ness AR. Centre-level variation in speech outcome and interventions, and factors associated with poor speech outcomes in 5-year-old children with non-syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 4. Orthod Craniofac Res 2017; 20 Suppl 2:27-39. [DOI: 10.1111/ocr.12186] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- 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
| | - L. Southby
- School of Social and Community Medicine; University of Bristol; Clifton Bristol UK
- Cleft.NET.East; Cambridge University Hospitals NHS Foundation Trust; Addenbrooke's Hospital; Cambridge UK
| | - Y. Wren
- Bristol Dental School; University of Bristol; Bristol UK
- Bristol Speech & Language Therapy Research Unit; North Bristol NHS Trust; Southmead Hospital; Bristol UK
| | - A. K. Wills
- Bristol Dental School; 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
| | - A. Hall
- Life and Health Sciences; Aston University; Birmingham UK
- Children's Hearing Centre; St Michael's Hospital; Bristol UK
| | - O. Mahmoud
- School of Social and Community Medicine; University of Bristol; Clifton Bristol UK
- Department of Applied Statistics; Helwan University; Cairo Egypt
| | - A. Waylen
- Bristol Dental School; University of Bristol; Bristol UK
| | - J. R. Sandy
- Bristol Dental School; University of Bristol; Bristol UK
| | - A. R. Ness
- Bristol Dental School; 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
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23
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Smallridge J, Wills AK, Mahmoud O, Chong A, Clark V, Collard M, Sandy JR, Ness AR. Centre-level variation in dental treatment and oral health and individual- and area-level predictors of oral health in 5-year-old children with non-syndromic unilateral cleft lip and palate: the Cleft Care UK study. Part 3. Orthod Craniofac Res 2017; 20 Suppl 2:19-26. [DOI: 10.1111/ocr.12185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- J. Smallridge
- Cleft.NET.East; Cambridge University Hospitals NHS Foundation trust, Addenbrooke's Hospital; Cambridge UK
| | - A. K. Wills
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle; 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; Bristol UK
- Department of Applied Statistics; Helwan University; Cairo Egypt
| | - A. Chong
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle; University Hospitals Bristol NHS Foundation Trust and the University of Bristol; Bristol UK
| | - V. Clark
- West Midlands Regional Centre for Cleft Lip and Palate; Birmingham Children's Hospital; Birmingham 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; 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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Ness AR, Wills AK, Mahmoud O, Hall A, Sell D, Smallridge J, Southby L, Stokes D, Toms S, Waylen A, Wren Y, Sandy JR. Centre-level variation in treatment and outcomes and predictors of outcomes in 5-year-old children with non-syndromic unilateral cleft lip treated within a centralized service: the Cleft Care UK study. Part 6: summary and implications. Orthod Craniofac Res 2017; 20 Suppl 2:48-51. [DOI: 10.1111/ocr.12188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/27/2022]
Affiliation(s)
- A. R. Ness
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle; The University Hospitals Bristol NHS Foundation Trust and the University of Bristol; Bristol UK
- Bristol Dental School; University of Bristol; Bristol UK
| | - A. K. Wills
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle; 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; Bristol UK
- Department of Applied Statistics; Helwan University; Cairo Egypt
| | - A. Hall
- Life and Health Sciences; Aston University; Birmingham UK
- Children's Hearing Centre; St Michael's Hospital; Bristol UK
| | - D. Sell
- North Thames Regional Cleft Service, Speech and Language Therapy Department; Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID); Great Ormond Street Hospital NHS Foundation Trust; London UK
| | - J. Smallridge
- Cleft.NET. East; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital; Cambridge UK
| | - L. Southby
- School of Social and Community Medicine; University of Bristol; Bristol UK
- Cleft.NET. East; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital; Cambridge UK
| | - D. Stokes
- Cleft Lip and Palate Association; London UK
| | - S. Toms
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle; The University Hospitals Bristol NHS Foundation Trust and the University of Bristol; Bristol UK
| | - A. Waylen
- Bristol Dental School; University of Bristol; Bristol UK
| | - Y. Wren
- Bristol Dental School; University of Bristol; Bristol UK
- Bristol Speech & Language Therapy Research Unit; North Bristol NHS Trust, Southmead Hospital; Bristol UK
| | - J. R. Sandy
- Bristol Dental School; University of Bristol; Bristol UK
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Wills AK, Mahmoud O, Hall A, Sell D, Smallridge J, Southby L, Toms S, Waylen A, Wren Y, Ness AR, Sandy JR. Centre-level variation of treatment and outcome in 5-year-old children with non-syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 1: Methodology and results for dento-facial outcomes. Orthod Craniofac Res 2017; 20 Suppl 2:1-7. [PMID: 28661082 PMCID: PMC5836895 DOI: 10.1111/ocr.12183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Outline methods used to describe centre-level variation in treatment and outcome in children in the Cleft Care UK (CCUK) study. Report centre-level variation in dento-facial outcomes. SETTING AND SAMPLE POPULATION Two hundred and sixty-eight five-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP). MATERIALS AND METHODS Between January 2011 and December 2012, data were collected on a comprehensive range of outcomes. Child facial appearance and symmetry were assessed using photographic pictures. Dental arch relationships were assessed from standardized dental study models. Hierarchical statistical models were used to predict overall means and the variance partition coefficient (VPC)-a measure of amount of variation in treatment or outcome explained by the centre. RESULTS Data on dento-alveolar arch relationships and facial appearance were available on 197 and 252 children, respectively. The median age of the children was 5.5 years, and 68% were boys. Variation was described across 13 centres. There was no evidence of centre-level variation in good or poor dento-alveolar arch relationships with a VPC of 4% and 3%, respectively. Similarly, there was no evidence of centre-level variation in good or poor facial appearance with a VPC of 2% and 5%, respectively. CONCLUSIONS There was no evidence of centre-level variation for dento-facial outcomes although this study only had the power to detect large variation between sites.
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Affiliation(s)
- A. K. Wills
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and LifestyleThe University Hospitals Bristol NHS Foundation Trust and the University of BristolBristolUK
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - O. Mahmoud
- School of Social and Community MedicineUniversity of BristolBristolUK
- Department of Applied StatisticsHelwan UniversityCairoEgypt
| | - A. Hall
- Life and Health SciencesAston UniversityBirminghamUK
- Children’s Hearing CentreSt Michael’s HospitalBristolUK
| | - D. Sell
- North Thames Regional Cleft Service, Speech and Language Therapy DepartmentCentre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID)Great Ormond Street Hospital NHS Foundation TrustLondonUK
| | - J. Smallridge
- Cleft Net East Cleft NetworkAddenbrooke's HospitalCambridgeUK
| | - L. Southby
- Bristol Speech Language Therapy Research UnitNorth Bristol NHS TrustBristolUK
| | - S. Toms
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and LifestyleThe University Hospitals Bristol NHS Foundation Trust and the University of BristolBristolUK
| | - A. Waylen
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - Y. Wren
- Bristol Dental SchoolUniversity of BristolBristolUK
- Bristol Speech Language Therapy Research UnitNorth Bristol NHS TrustBristolUK
| | - A. R. Ness
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and LifestyleThe University Hospitals Bristol NHS Foundation Trust and the University of BristolBristolUK
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - J. R. Sandy
- Bristol Dental SchoolUniversity of BristolBristolUK
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Waylen A, Mahmoud O, Wills AK, Sell D, Sandy JR, Ness AR. Centre-level variation in behaviour and the predictors of behaviour in 5-year-old children with non-syndromic unilateral cleft lip: The Cleft Care UK study. Part 5. Orthod Craniofac Res 2017; 20 Suppl 2:40-47. [PMID: 28661083 PMCID: PMC5836977 DOI: 10.1111/ocr.12187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aims of this study were to describe child behavioural and psychosocial outcomes associated with appearance and speech in the Cleft Care UK (CCUK) study. We also wanted to explore centre-level variation in child outcomes and investigate individual predictors of such outcomes. SETTING AND SAMPLE POPULATION Two hundred and sixty-eight five-year-old children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK. MATERIALS AND METHODS Parents completed the Strengths and Difficulties questionnaire (SDQ) and reported their own perceptions of the child's self-confidence. Child facial appearance and symmetry were assessed using photographs, and intelligibility of speech was derived from audio-visual speech recordings. Centre-level variation in behavioural and psychosocial outcomes was examined using hierarchical models, and associations with clinical outcomes were examined using logit regression models. RESULTS Children with UCLP had a higher hyperactive difficulty score than the general population. For boys, the average score was 4.5 vs 4.1 (P=.03), and for girls, the average score was 3.8 vs 3.1 (P=.008). There was no evidence of centre-level variation for behaviour or parental perceptions of the child's self-confidence. There is no evidence of associations between self-confidence and SDQ scores and either facial appearance or behaviour. CONCLUSIONS Children born with UCLP have higher levels of behaviour problems than the general population.
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Affiliation(s)
- A. Waylen
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - O. Mahmoud
- School of Social and Community MedicineUniversity of BristolBristolUK
- Department of Applied StatisticsHelwan UniversityCairoEgypt
| | - A. K. Wills
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - D. Sell
- North Thames Regional Cleft ServiceSpeech 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 TrustLondonUK
| | - J. R. Sandy
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - A. R. Ness
- Bristol Dental SchoolUniversity of BristolBristolUK
- National Institute for Health Research (NIHR) Biomedical Research Unit in NutritionDiet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of BristolBristolUK
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Lewis CW, Jacob LS, Lehmann CU, Krol D, Gereige R, Karp J, Fisher-Owens S, Braun P, Jacob L, Segura A. The Primary Care Pediatrician and the Care of Children With Cleft Lip and/or Cleft Palate. Pediatrics 2017; 139:peds.2017-0628. [PMID: 28557774 DOI: 10.1542/peds.2017-0628] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Orofacial clefts, specifically cleft lip and/or cleft palate (CL/P), are among the most common congenital anomalies. CL/P vary in their location and severity and comprise 3 overarching groups: cleft lip (CL), cleft lip with cleft palate (CLP), and cleft palate alone (CP). CL/P may be associated with one of many syndromes that could further complicate a child's needs. Care of patients with CL/P spans prenatal diagnosis into adulthood. The appropriate timing and order of specific cleft-related care are important factors for optimizing outcomes; however, care should be individualized to meet the specific needs of each patient and family. Children with CL/P should receive their specialty cleft-related care from a multidisciplinary cleft or craniofacial team with sufficient patient and surgical volume to promote successful outcomes. The primary care pediatrician at the child's medical home has an essential role in making a timely diagnosis and referral; providing ongoing health care maintenance, anticipatory guidance, and acute care; and functioning as an advocate for the patient and a liaison between the family and the craniofacial/cleft team. This document provides background on CL/P and multidisciplinary team care, information about typical timing and order of cleft-related care, and recommendations for cleft/craniofacial teams and primary care pediatricians in the care of children with CL/P.
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Affiliation(s)
- Charlotte W. Lewis
- Division of General Pediatrics and Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, Washington
| | - Lisa S. Jacob
- Georgetown Pediatric Dentistry and Orthodontics, Georgetown, Texas; and
| | - Christoph U. Lehmann
- Departments of Biomedical Informatics and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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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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Sell D, Mildinhall S, Albery L, Wills AK, Sandy JR, Ness AR. The Cleft Care UK study. Part 4: perceptual speech outcomes. Orthod Craniofac Res 2015; 18 Suppl 2:36-46. [PMID: 26567854 PMCID: PMC4670716 DOI: 10.1111/ocr.12112] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [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: 11/26/2022]
Abstract
OBJECTIVES To describe the perceptual speech outcomes from the Cleft Care UK (CCUK) study and compare them to the 1998 Clinical Standards Advisory Group (CSAG) audit. SETTING AND SAMPLE POPULATION A cross-sectional study of 248 children born with complete unilateral cleft lip and palate, between 1 April 2005 and 31 March 2007 who underwent speech assessment. MATERIALS AND METHODS Centre-based specialist speech and language therapists (SLT) took speech audio-video recordings according to nationally agreed guidelines. Two independent listeners undertook the perceptual analysis using the CAPS-A Audit tool. Intra- and inter-rater reliability were tested. RESULTS For each speech parameter of intelligibility/distinctiveness, hypernasality, palatal/palatalization, backed to velar/uvular, glottal, weak and nasalized consonants, and nasal realizations, there was strong evidence that speech outcomes were better in the CCUK children compared to CSAG children. The parameters which did not show improvement were nasal emission, nasal turbulence, hyponasality and lateral/lateralization. CONCLUSION These results suggest that centralization of cleft care into high volume centres has resulted in improvements in UK speech outcomes in five-year-olds with unilateral cleft lip and palate. This may be associated with the development of a specialized workforce. Nevertheless, there still remains a group of children with significant difficulties at school entry.
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Affiliation(s)
- D Sell
- 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 TrustLondon, UK
| | - S Mildinhall
- Previously South Thames Cleft Service, Guys and St Thomas’ NHS Foundation Trust HospitalLondon, UK
| | - L Albery
- University Hospitals Bristol NHS Trust, Cleft Lip and Palate TeamBristol, UK
| | - A K Wills
- School of Oral and Dental Sciences, University of BristolBristol, UK
| | - J R Sandy
- School of Oral and Dental Sciences, University of BristolBristol, UK
| | - A R Ness
- School of Oral and Dental Sciences, University of BristolBristol, 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 BristolBristol, UK
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