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Likitkulthanaporn A, Boonpratham S, Honglertnapakul Y, Saengfai NN, Chaweewannakorn C, Jongkhum N, Peanchitlertkajorn S. Effects of nasoalveolar molding on nasolabial aesthetics in patients with cleft lip and palate during pre-adolescence: A systematic review and meta-analysis of retrospective studies. Orthod Craniofac Res 2024; 27:350-363. [PMID: 38288677 DOI: 10.1111/ocr.12762] [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] [Received: 10/21/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 05/08/2024]
Abstract
This study aims to analyze long-term effects of nasoalveolar molding (NAM) as a part of cleft primary management protocols on nasolabial aesthetics for patients with non-syndromic cleft lip and palate by conducting a systematic review and meta-analysis. Six electronic databases and two journals were searched up to July 2023. Studies comparing nasolabial outcomes between NAM and non-NAM protocols were selected for further analysis. Nasolabial aesthetics were the outcome of interest. Data extraction, methodological quality assessment, risk of bias assessment, meta-analysis and subgroup analysis were performed. Seven retrospective cohort studies were selected for a qualitative review and four for a quantitative analysis. The risk of bias assessment was moderate for most studies. Only studies utilizing the Asher-McDade rating (AMR) were included for meta-analyses. The protocols with NAM exhibited a significantly lower AMR score for vermillion border than other protocols. AMR scores for nasal form and nasal symmetry from protocols with NAM were significantly lower than protocols without any pre-surgical infant orthopaedics (PSIO) but not significantly different from protocols with other PSIO techniques. The AMR score for nasolabial profile from protocols with NAM was not significantly different from other protocols. However, subgroup analysis demonstrated that protocol combining NAM and primary rhinoplasty significantly lowered AMR scores for nasal form, nasal symmetry and nasolabial profile. For patients with unilateral cleft lip with or without palate (UCLP), this study found that a protocol combining NAM and primary rhinoplasty improved nasolabial outcomes while a protocol with NAM alone offered only limited benefits. For patients with BCLP, the available evidence remains inconclusive. Performing NAM in combination with primary rhinoplasty improves nasolabial aesthetics in patients with UCLP. PROSPERO (CRD4202128384).
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Affiliation(s)
| | - Supatchai Boonpratham
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | | | | | - Nannapat Jongkhum
- Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Fell M, Chadha A, van Eeden S. Are NHS cleft services in England ready for delegation to integrated care systems? Br Dent J 2024; 236:443-446. [PMID: 38519672 DOI: 10.1038/s41415-024-7172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/03/2023] [Accepted: 10/13/2023] [Indexed: 03/25/2024]
Abstract
Cleft care services in the UK have been nationally funded since centralisation 25 years ago and during this time have been able to demonstrate improved clinical outcomes. Integrated care systems have been introduced into legislature as part of the Health Care Act of 2022 and will be responsible for the paradigm shift of allocating funds on a regional basis for cleft care services in England from 2024. The proposed population-based funding formulas present an opportunity to improve current inequities in cleft care, including access to speech therapy and adult services. However, the regional footprint of integrated care systems does not align with that of the centralised cleft service system and represents a threat to the standardised patient-centred care that has taken two decades to build. Awareness needs to be raised so that cleft care providers can proactively adapt to this mandatory change to service funding to ensure that clinical standards are maintained and continue to improve.
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Affiliation(s)
- Matthew Fell
- Cleft Collective, University of Bristol, UK; Spires Cleft Centre, Oxford and Salisbury, UK.
| | - Ambika Chadha
- Cleft.Net.East, Addenbrookes Hospital, Cambridge University NHS Hospitals Trust, UK; Department of Perinatal Imaging, King´s College London, UK
| | - Simon van Eeden
- Alder Hey Children´s and Aintree University Hospitals, Liverpool, UK
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Berman S, Sharp GC, Lewis SJ, Blakey R, Davies A, Humphries K, Wren Y, Sandy JR, Stergiakouli E. Prevalence and Factors Associated with Behavioral Problems in 5-Year-Old Children Born with Cleft Lip and/or Palate from the Cleft Collective. Cleft Palate Craniofac J 2024; 61:40-51. [PMID: 36083151 PMCID: PMC10676624 DOI: 10.1177/10556656221119684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the UK prevalence of behavioral problems in 5-year-old children born with isolated or syndromic cleft lip and/or palate (CL/P) compared to the general population and identify potentially associated factors. DESIGN Observational study using questionnaire data from the Cleft Collective 5-Year-Old Cohort study and three general population samples. MAIN OUTCOME MEASURE The Strengths and Difficulties Questionnaire (SDQ). PARTICIPANTS Mothers of children (age: 4.9-6.8 years) born with CL/P (n = 325). UK general population cohorts for SDQ scores were: Millennium Cohort Study (MCS) (n = 12 511), Office of National Statistics (ONS) normative school-age SDQ data (n = 5855), and Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 9386). RESULTS By maternal report, 14.2% of children born with CL/P were above clinical cut-off for behavioral problems, which was more likely than in general population samples: 7.5% of MCS (OR = 2.05 [1.49-2.82], P < 0.001), 9.8% of ONS (OR = 1.52 [1.10-2.09], P = 0.008), and 6.6% of ALSPAC (OR = 2.34 [1.70-3.24], P < 0.001). Children in the Cleft Collective had higher odds for hyperactivity, emotional and peer problems, and less prosocial behaviors. Maternal stress, lower maternal health-related quality of life and family functioning, receiving government income support, and maternal smoking showed evidence of association (OR range: 4.41-10.13) with behavioral problems, along with maternal relationship status, younger age, and lower education (OR range: 2.34-3.73). CONCLUSIONS Findings suggest elevated levels of behavioral problems in children born with CL/P compared to the general population with several associated maternal factors similar to the general population.
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Affiliation(s)
- Samantha Berman
- Cleft Collective, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Gemma C. Sharp
- Cleft Collective, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Sarah J. Lewis
- Cleft Collective, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Rachel Blakey
- Population Health Sciences, Bristol Medical School, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Amy Davies
- Cleft Collective, University of Bristol, Bristol, UK
| | | | - Yvonne Wren
- Cleft Collective, University of Bristol, Bristol, UK
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, UK
| | | | - Evie Stergiakouli
- Cleft Collective, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Van der Straeten C, Verbeke J, Alighieri C, Bettens K, Van Beveren E, Bruneel L, Van Lierde K. Treatment Outcomes of Interdisciplinary Care on Speech and Health-Related Quality of Life Outcomes in Adults With Cleft Palate. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2654-2675. [PMID: 37844623 DOI: 10.1044/2023_ajslp-23-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
PURPOSE Individuals born with a cleft palate with or without a cleft lip (CP ± L) often experience functional, aesthetic, and psychosocial consequences well into adulthood. This study aimed to investigate outcomes of speech and health-related quality of life (HRQoL) in adults with a CP ± L who received interdisciplinary cleft care at the Ghent University Hospital using valid, reliable, and condition-specific instruments. METHOD Thirteen Belgian Dutch-speaking participants with a CP ± L with a mean age of 25.4 years (SD = 5.1, range: 20-33 years) and an age- and gender-matched control group of 13 participants without a CP ± L with a mean age of 25.2 years (SD = 4.8, range: 20-32 years) were included in this study. Speech characteristics were evaluated perceptually and instrumentally. HRQoL was assessed through standardized patient-reported outcome measures. Outcomes were compared with those of the control group and to normative data where available. RESULTS Participants with a CP ± L in this sample demonstrated significantly lower speech acceptability (p < .001) and higher rates of hypernasality (p = .015) and nasal turbulence (p = .005) than the control group. They showed significantly higher satisfaction with appearance of the cleft scar compared with norms of adults with a CP ± L (p = .047). No other differences in speech characteristics, sociodemographics, or HRQoL were found between participants with and without a CP ± L. CONCLUSIONS The reduced speech acceptability and the presence of resonance and nasal airflow disorders may indicate the need for standardized long-term outcome measurement and interdisciplinary follow-up for speech characteristics and velopharyngeal insufficiency in young and middle adulthood in future clinical practice. Additional research is necessary to further substantiate these findings and to determine predictors for these continuing complications in adults with a CP ± L. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24243901.
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Affiliation(s)
- Charis Van der Straeten
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Jolien Verbeke
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Ellen Van Beveren
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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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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Mason KN, Kotlarek KJ. Where is the Care? Identifying the Impact of Rurality on SLP Caseloads and Treatment Decisions for Children with Cleft Palate. Cleft Palate Craniofac J 2023:10556656231189940. [PMID: 37488965 PMCID: PMC10805969 DOI: 10.1177/10556656231189940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
Challenges providing cleft/craniofacial care in rural communities are often reported, leading to disparities in resources available to clinicians. The purpose of this study was to identify the impact of rurality on caseloads and practice patterns of speech-language pathologists (SLPs) regarding speech and velopharyngeal function for children with cleft lip and/or palate (CL/P). A national, survey of US-based SLPs (N = 359 respondents) investigated resources, comfort level, caseloads, and practice patterns for children with CL/P. Sub-county classifications that delineated levels of rurality were utilized. Descriptive statistics and chi-square analyses were conducted to determine the impact of population density on assessment and referral decisions. Nearly 83% of SLPs reported providing care for a child with CL/P and 41.4% of these SLPs reported five or more children with CL/P on caseload throughout their career. There were no significant differences in rurality of practice setting and the likelihood of treating a child with CL/P. Significant differences were present between rural, town, suburban, and metropolitan-based SLPs regarding available resources (p = 0.035). SLPs in rural settings reported feeling uncomfortable treating children with CL/P compared to those in metropolitan settings (p = 0.02). Distance to the cleft/craniofacial team and comfort levels impacted referral decisions. Most SLPs report having children with CL/P on caseload regardless of practice location. Rurality impacted assessment and referral decisions, especially surrounding access to resources and comfort levels engaging in team care. Findings have implications for developing support systems and reducing barriers for rural SLPs working with children born with CL/P.
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Affiliation(s)
- Kazlin N. Mason
- Department of Human Services, University of Virginia, Charlottesville, VA, 22903
| | - Katelyn J. Kotlarek
- Division of Communication Disorders, University of Wyoming, Laramie, WY, 82071
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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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Martin SV, Swan MC. An essential overview of orofacial clefting. Br Dent J 2023; 234:937-942. [PMID: 37349450 DOI: 10.1038/s41415-023-6000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 06/24/2023]
Abstract
An appreciation of the embryologic development of the face is essential to understanding the anatomic variation observed in this phenotypically broad condition. Embryologically, the nose, lip and palate are separated into the primary and secondary palate, which are divided anatomically by the incisive foramen. The epidemiology of orofacial clefting is reviewed together with the contemporaneous cleft classification systems that enable comparisons to be made between international centres for audit and research purposes. A detailed examination of the clinical anatomy of the lip and palate informs the surgical priorities for the primary reconstruction of both form and function. The pathophysiology of the submucous cleft palate is also explored. The seismic impact of the 1998 Clinical Standards Advisory Group report on the organisation of UK cleft care provision is outlined. The importance of the Cleft Registry and Audit Network database in auditing UK cleft outcomes is highlighted. The potential for the Cleft Collective study to establish the causes of clefting, the optimal treatment protocols, and the impact of cleft on patients is tremendously exciting for all health care professionals involved in the management of this challenging congenital deformity.
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Affiliation(s)
- Serena V Martin
- Cleft Fellow, Spires Cleft Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom
| | - Marc C Swan
- Consultant Cleft and Plastic Surgeon, Spires Cleft Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom.
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Phippen G. Articulating the issues: speech assessment and intervention in cleft lip and palate. Br Dent J 2023; 234:912-917. [PMID: 37349440 DOI: 10.1038/s41415-023-5954-y] [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: 11/13/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
This paper describes the impact of cleft lip and palate on speech. It provides an overview for the dental clinician of the key issues affecting speech development and clarity. The paper summarises the complex speech mechanism and cleft-related factors that affect speech, including palatal, dental and occlusal anomalies. It outlines the framework for speech assessment throughout the cleft pathway and provides a description of cleft speech disorder, as well as describing treatment approaches for cleft speech and velopharyngeal dysfunction.This is followed by a spotlight on speech prosthetics for treating nasal speech, with an emphasis on joint management by the Speech and Language Therapist and Consultant in Restorative Dentistry. This includes the core multidisciplinary approach, clinician and patient-reported outcome measures, and brief discussion of national developments in this area.The importance of multidisciplinary cleft care is highlighted and, within this, the essential interaction between speech and dental clinicians in providing routine care, as well as in delivering a highly specialist speech prosthetics service.
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Affiliation(s)
- Ginette Phippen
- Lead Speech & Language Therapist, The Spires Cleft Centre, Salisbury NHS Foundation Trust/Oxford University Hospitals NHS Foundation Trust, United Kingdom.
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10
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Mossey PA. Global perspectives in orofacial cleft management and research. Br Dent J 2023; 234:953-957. [PMID: 37349453 DOI: 10.1038/s41415-023-5993-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/24/2023]
Abstract
Orofacial clefts (OFCs) refer to clefts of the lip and palate, a heterogeneous group of relatively common congenital conditions that can cause mortality and significant disability if untreated, and residual morbidity even when treated with multidisciplinary care. Contemporary challenges in the field include: lack of awareness of OFCs in remote, rural and impoverished populations; uncertainties due to lack of surveillance and data gathering infrastructure; inequitable access to care in some parts of the world; and lack of political will combined with lack of capacity to prioritise research.OFCs present clinically as either syndromic or non-syndromic, with the latter either being isolated or in conjunction with other malformations; however, many registries still do not differentiate between these fundamentally different entities and lump a spectrum of cleft types and sub-phenotypes together. This has implications for treatment, research and ultimately, quality improvement.This paper deals with the challenges in contemporary management in terms of care and the prospects and possibilities for primary prevention of non-syndromic clefts. In terms of management and optimal care, there are also challenges in the provision of multi-disciplinary treatment and management of the consequences of being born with OFCs, such as dental caries, malocclusion and psychosocial adjustment.
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Affiliation(s)
- Peter A Mossey
- Professor of Craniofacial Development and Associate Dean for Internationalisation, Dundee University Dental School, 1 Park Place, Dundee, DD1 4HR, Scotland, United Kingdom.
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11
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Park MH, Fitzsimons KJ, Deacon S, Medina J, Wahedally MAH, Butterworth S, Russell C, van der Meulen JH. Longitudinal educational attainment among children with isolated oral cleft: a cohort study. Arch Dis Child 2023:archdischild-2023-325310. [PMID: 37068923 DOI: 10.1136/archdischild-2023-325310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/27/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES (1) To explore differences in educational attainment between children born with isolated clefts and the general population at ages 5, 7 and 11 years; (2) to describe longitudinal changes in attainment among children with cleft through primary education. DESIGN Analysis of Cleft Registry and Audit Network data linked to national educational outcomes. SETTING English state schools. PATIENTS 832 children born with isolated cleft, aged 5 years in 2006-2008. MAIN OUTCOME MEASURES Difference in teacher-assessed attainment between children with a cleft and general population at each age, for all children and by cleft type. Percentage of children with low attainment at age 5 years who had low attainment at age 11 years, for all children and by cleft type. RESULTS Children with a cleft had lower attainment than the general population in all subject areas (Z-score range: -0.29 (95% CI -0.36 to -0.22) to -0.22 (95% CI -0.29 to -0.14)). This difference remained consistent in size at all ages, and was larger among children with a cleft affecting the palate (cleft palate/cleft lip and palate (CP/CLP)) than those with a cleft lip (CL). Of 216 children with low attainment in any subject at age 5 years, 54.2% had low attainment in at least one subject at age 11 years. Compared with children with CL, those with CP/CLP were more likely to have persistent low attainment. CONCLUSIONS An educational attainment gap for children born with isolated clefts is evident throughout primary education. Almost half of children with low attainment at age 5 years achieve normal attainment at age 11 years.
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Affiliation(s)
- Min Hae Park
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kate J Fitzsimons
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Scott Deacon
- South West Cleft Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | | | - Sophie Butterworth
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Craig Russell
- Royal Hospital for Children, Queen Elizabeth University Hospital Campus, Glasgow, UK
| | - Jan H van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
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12
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Costa B, McWilliams D, Blighe S, Hudson N, Hotton M, Swan MC, Stock NM. Isolation, Uncertainty and Treatment Delays: Parents' Experiences of Having a Baby with Cleft Lip/Palate During the Covid-19 Pandemic. Cleft Palate Craniofac J 2023; 60:82-92. [PMID: 34841909 PMCID: PMC9218610 DOI: 10.1177/10556656211055006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Previous literature finds that having a child with a cleft lip and/or palate (CL/P) may pose social and emotional challenges for parents. For parents of children born during the Covid-19 pandemic, such challenges may be heightened. Further, novel demands brought about by the pandemic could have caused additional hardships. The aim of this study was to describe the impact of the pandemic on new parents through qualitative exploration of their experiences. DESIGN Semi-structured interviews were conducted with 14 parents of children born in the United Kingdom with CL/P between January and June 2020, around the start of the pandemic. Data were analysed using inductive thematic analysis. RESULTS Three themes, with sub-themes, were identified. The first theme, "Changes to Healthcare: The Impact of Restrictions and Reduced Contact", discussed the impact of the pandemic on perinatal care, the care received from the specialist CL/P teams, and parents' experiences of virtual consultations. The second theme, "Family Functioning During the Pandemic", covered parental anxiety, fathers' experiences, and social support. The third theme, "Surgical Prioritisation: Delays and Uncertainty", addressed changes to surgical protocols, coping with uncertainty, complications associated with delayed surgery, and how parents created positive meaning from this period. CONCLUSIONS A range of increased and additional psychosocial impacts for parents were identified, along with several coping strategies, utilization of social support, and the positive aspects of their experiences. As the pandemic continues, close monitoring of families affected by CL/P remains imperative, particularly for those at risk of emotional distress.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of
England, Bristol, UK,Nicola Marie Stock, Associate Professor in
Psychology, Centre for Appearance Research, University of the West of England,
Bristol, United Kingdom.
| | - Danielle McWilliams
- Centre for Appearance Research, University of the West of
England, Bristol, UK
| | - Sabrina Blighe
- Spires Cleft Centre, Level 2 Children's
Hospital, John Radcliffe Hospital, Oxford, UK
| | - Nichola Hudson
- Spires Cleft Centre, Salisbury District
Hospital, Salisbury, UK
| | - Matthew Hotton
- Spires Cleft Centre, Level 2 Children's
Hospital, John Radcliffe Hospital, Oxford, UK
| | - Marc C Swan
- Spires Cleft Centre, Children's
Hospital, John Radcliffe Hospital, Oxford, UK
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13
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Francisco I, Antonarakis GS, Caramelo F, Paula AB, Marto CM, Carrilho E, Fernandes MH, Vale F. Current Treatment of Cleft Patients in Europe from a Provider Perspective: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710638. [PMID: 36078357 PMCID: PMC9518109 DOI: 10.3390/ijerph191710638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 05/27/2023]
Abstract
The latest Eurocleft study reported several discrepancies in cleft care. Since then, no critical assessment has been performed. This study aimed to better understand the main strengths and inefficiencies of cleft care within Europe. The Google documents platform was used to create an online survey to investigate several aspects, i.e., provider characteristics, patient profile, services offered, and treatment protocols and complications. Descriptive statistics were calculated. The association between categorical variables was performed using Fisher's exact test. The significance level chosen was 0.05. A total of 69 individuals from 23 European countries completed the survey. Centralized care was the preferred system, and the majority of the countries have an association for cleft patients and professionals (53.6%). The largest percentage of patients was seen in the university hospital environment (Fisher's exact test p < 0.001). The majority of responders (98.6%) reported that an orthodontist was involved in cleft treatment, and 56.5% of them spend 76-100% of their time treating these patients. Despite cleft care having been reconfigured in Europe, a better consensus among the various centers regarding provider characteristics, services offered, and treatment protocols is still required. There is a need for better coordination between clinicians and national/international regulatory bodies.
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Affiliation(s)
- Inês Francisco
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
| | - Gregory S. Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Francisco Caramelo
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
| | - Anabela Baptista Paula
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Carlos Miguel Marto
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Eunice Carrilho
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Maria Helena Fernandes
- Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
- LAQV/REQUIMTE, University of Porto, 4160-007 Porto, Portugal
| | - Francisco Vale
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal
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14
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Saikia A, Muthu M, Orenuga OO, Mossey P, Ousehal L, Yan S, Campodonico M, England R, Taylor S, Sheeran P. Systematic Review of Clinical Practice Guidelines for Oral Health in Children With Cleft Lip and Palate. Cleft Palate Craniofac J 2022; 59:800-814. [PMID: 34159833 PMCID: PMC9121521 DOI: 10.1177/10556656211025189] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Clinical practice guidelines (CPGs) exist to present recommendations and policies aimed at optimizing the oral health of children and adolescents born with cleft lip and/or palate. The aim of this review is to identify and assess the scope, quality, adequacy, and consistency of CPGs related to oral health in children and adolescents with clefts, along with reporting any differences and shortcomings. METHODS A systematic review of the literature of CPGs following Preferred Reporting Items for Systematic Reviews guidelines was conducted. Assessment of selected CPGs was performed using the Appraisal of Guidelines for Research & Evaluation II methodological quality instrument. RESULTS Only 7 CPGs fulfilled the criteria. Of these, 4 were from the American Cleft Palate-Craniofacial Association, and 1 each from the American Academy of Pediatrics, the Academy of Breastfeeding Medicine, and the American Academy of Pediatric Dentistry. The lowest overall mean scores were in the domain "Rigor of Development" (mean 29.58%, SD 17.11), revealing lower quality in methodology of the guideline. The domain "Clarity of Presentation" (mean 73.80%, SD 7.87) revealed the best score. CONCLUSIONS Our review results reveal a lack of integrated high-quality CPGs that can be used as universal guidelines by health workers in a range of disciplines for improving oral health in children and adolescents with cleft problems.
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Affiliation(s)
- Ankita Saikia
- Consulting Pediatric Dental Surgeon, Pedo Planet Children Dental
Centre, Porur, Chennai, Tamilnadu, India
| | - M.S. Muthu
- Centre for Early Childhood Caries Research (CECCRe), Faculty of
Dental Sciences, Department of Pediatric Dentistry, Sri Ramachandra Institute of
Higher Education and Research, Porur, Chennai, Tamilnadu, India
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman
University, United Arab Emirates
| | - Omolola O. Orenuga
- Department of Child Dental Health, College of Medicine University of
Lagos, University Teaching Hospital, Lagos, Nigeria
| | - Peter Mossey
- School of Dentistry, University of Dundee, Dundee, United
Kingdom
| | - Lahcen Ousehal
- Department of Orthodontics , University of Casablanca, Morocco
| | - Si Yan
- Department of Preventive Dentistry, Peking University, Beijing,
People’s Republic of China
| | | | | | - Sean Taylor
- FDI World Dental Federation, Geneva, Switzerland
| | - Pamela Sheeran
- Strategic Programs and Partnerships, Comprehensive Cleft Care,
Smile Train, NY, USA
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15
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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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16
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McWilliams D, Costa B, Blighe S, Swan MC, Hotton M, Hudson N, Stock NM. The Impact of the Covid-19 Pandemic on Cleft Lip and Palate Service Delivery for New Families in the United Kingdom: Medical and Community Service Provider Perspectives. Cleft Palate Craniofac J 2022; 60:551-561. [PMID: 35195455 PMCID: PMC9218609 DOI: 10.1177/10556656221074870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Professionals in the United Kingdom providing care to new families affected by cleft lip and/or palate (CL/P) had to adapt to ensure families' needs were met during a time of uncertainty due to Covid-19. The aims of this study were to explore the impacts of the pandemic on CL/P care provision for new families from the perspectives of professionals working in medical and community settings along with any personal impact on professionals and their reflections on the future of CL/P care. DESIGN Semistructured interviews (n = 27) were completed about experiences from March 2020 to October 2020 with consultant cleft surgeons (n = 15), lead clinical nurse specialists (n = 8), and staff working at the Cleft Lip and Palate Association (n = 4). Transcripts were analyzed using inductive thematic analysis. RESULTS Three themes were identified: (1) the impact of Covid-19 on the provision of cleft care in the United Kingdom, including working conditions, delays to treatment, and Covid-19 policies; (2) the impact of the pandemic on professionals' mental health, including personal distress and concerns about Covid-19 exposure; and (3) reflections on the future of CL/P care, whereby professionals expressed both hope and concern about the Covid-19 recovery effort. CONCLUSIONS The ongoing Covid-19 pandemic has impacted CL/P service delivery for new families significantly, warranting recommendations for cohesive psychological support for families in addition to a safe and resourced recovery effort. Support for professionals is also suggested, following existing evidence-based models for providers' needs that address the difficulties of working throughout challenging times.
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Affiliation(s)
- Danielle McWilliams
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
| | - Sabrina Blighe
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Marc C Swan
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Matthew Hotton
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Nichola Hudson
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
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17
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Batra P, Sybil D, Izhar A, Batra P, Thiruvenkatachari B. Standard of Care for Patients With Cleft Lip and Palate in India-A Questionnaire-Based Study. Cleft Palate Craniofac J 2022; 60:536-543. [PMID: 35099313 DOI: 10.1177/10556656221074212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A national survey of cleft teams was undertaken to evaluate the current standard of care for patients with cleft lip and palate (CLP) in India as a part of Cleft Care India study. This was a cross-sectional questionnaire-based study. Cleft teams across India attending the 19th Annual Conference of the Indian Society of Cleft Lip and Palate were invited to complete the questionnaire. The questionnaire consisted of 18 questions that included demographics, institutional details, patient protocols, surgical technique, rehabilitation facilities, and accessibility. The data are descriptively reported. A total of 112 centers completed the survey. Nongovernment organizations funded 87% of the cleft centers and 8% did not receive any funding. Only 39% of the centers had centralized cleft services providing multidisciplinary care. Speech therapy was provided either onsite or through referral at 90% of the centers, whereas audiology was provided only at 4% of centers. Feeding advice was routinely provided in 52% of centers. Millard technique was the most preferred technique for unilateral cleft lip repair (66%). The 2-flap technique (37%) and pharyngeal flap (48%) were the most common surgeries for cleft palate and pharyngoplasty, respectively. Although 54% of centers reported their patients to be interested in comprehensive care, 43% reported that their patients only wanted surgical correction. There is wide diversity in access to cleft care and clinical practices across centers in India. Further work is needed to evaluate the quality of care by assessing outcomes of centers treating patients with CLP.
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Affiliation(s)
- Panchali Batra
- Faculty of Dentistry, 28849Jamia Millia Islamia University, New Delhi, India
| | - Deborah Sybil
- Faculty of Dentistry, 28849Jamia Millia Islamia University, New Delhi, India
| | - Arisha Izhar
- Faculty of Dentistry, 28849Jamia Millia Islamia University, New Delhi, India
| | - Puneet Batra
- 29873Manav Rachna Dental College (Faculty of Dental Sciences), Manav Rachna International Institute of Research and Studies (MRIIRS), Faridabad, India
| | - Badri Thiruvenkatachari
- School of Dentistry, 5292University of Manchester, Manchester, UK.,Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Pallikaranai, Chennai, India
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18
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The impact of COVID-19 on cleft services in Great Britain & Northern Ireland. J Plast Reconstr Aesthet Surg 2021; 75:1689-1695. [PMID: 34991972 DOI: 10.1016/j.bjps.2021.11.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/03/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Cleft lip and/or palate is the most common craniofacial anomaly and occurs in 1 in 650 to 700 live births in the United Kingdom (UK). The majority of cleft surgery is elective, and as a result, almost all cleft surgery was suspended across the UK in March 2020 during the first national lockdown. The UK has centralised regional Cleft Services which all use the same agreed target-age standards for primary surgery including lip and palate repairs. The coronavirus disease-2019 (COVID-19) response has caused a delay in carrying out procedures. The severity of this delay depends on the impact of COVID-19 on local trusts and R-value within that region. As the country goes through the second and third wave, the impact could be long lasting, and we aimed to quantify it so that the data could be used to guide service prioritisation in the NHS and help future workforce planning. METHODS An online survey was designed based on the cleft quality dashboard indicators and circulated nationally to all nine cleft regions in the UK. The survey was divided into three main headings: • Duration of suspended cleft services • Quantification of the impact on delayed in surgery/services • Changes needed to restart surgery/services RESULTS: We obtained a 60% response rate with five completed surveys from five out of nine regions. All regions reported that they suspended their cleft services in March 2020 around the time of the first wave and the first national lockdown. There has been an impact on delayed surgical and clinical interventions for cleft patients. Regions were affected differently with some on an exponential waiting list growth projection, whereas other teams are on track to recover from the backlog within 7-22 weeks. There has been an impact on the allied health professionals' services within the cleft multidisciplinary team. The cleft nurses' 24-h reviews, Speech And Language Therapy (SALT), and psychology maintained service delivery in some format. Patient-facing services such as audiology and dentistry were significantly disrupted and continue to experience delays due to reduced capacity. CONCLUSIONS Various regions have seen a varied impact from COVID-19 on their services, from all cleft regions there seems to be an impact on achieving surgery within the national target age. The adverse effect of the COVID-19 impact is unlikely to be known for a few years to come; however, the data are a useful guide when supporting the allocation of resources within the healthcare setting. A prospective long-term study is required to assess the impact of COVID-19 on cleft surgery, follow-up, assess access to allied health professional MDT clinics, and long-term complications.
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19
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Reddy RR, Reddy SG, Pandey A, Banala B, Bronkhorst EM, Kuijpers-Jagtman AM. Effect of antibiotic pack on hard palate after fistula closure on nasal airflow and reoccurrence rate. J Oral Biol Craniofac Res 2021; 12:27-32. [PMID: 34745861 DOI: 10.1016/j.jobcr.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/31/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022] Open
Abstract
This parallel blocked randomized controlled trial was done in two groups of 30 patients each to determine if placement of an antibiotic oral pack on the hard palate after hard palatal fistula repair reduces nasal air emission and fistula re-occurrence. Group A had an oral pack on the hard palate for 5 days post-operatively while group B did not. In group A, percentage of nasal air emission was tested using nasometry with and without pack. Paired t-tests were performed to compare nasal emissions for patients with and without pack. Recurrence of fistulas after 6 months between group A and B was tested using odds ratio. Effect of nasal air emission on fistula rates was tested using paired t-tests. There was a significant increase (p < 0.0001) in nasal emission after removal of the pack in group A. Fistula re-occurrence tended to be higher in group B (no pack) than group A but this was not significant (p = 0.242). There was no correlation between nasal air emission and fistula rates. In patients with recurrent fistulae, placement of an oral pack after fistula repair diminishes nasal air emission. Whether this has an impact on re-occurrence of fistulae needs to be investigated further.
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Affiliation(s)
- Rajgopal R Reddy
- Cranio-maxillofacial Surgery, G.S.R. Hospital, Institute of Cranio-Maxillofacial and Facial Plastic Surgery, Vinay Nagar Colony, Saidabad, Hyderabad, India
| | - Srinivas Gosla Reddy
- Cranio-maxillofacial Surgery, G.S.R. Hospital, Institute of Cranio-Maxillofacial and Facial Plastic Surgery, Vinay Nagar Colony, Saidabad, Hyderabad, India
| | - Avni Pandey
- G.S.R. Hospital, Institute of Cranio-Maxillofacial and Facial Plastic Surgery, Vinay Nagar Colony, Saidabad, Hyderabad, India
| | - Bhavya Banala
- Speech and Language Therapy,G.S.R. Hospital, Institute of Cranio-Maxillofacial and Facial Plastic Surgery, Vinay Nagar Colony, Saidabad, Hyderabad, India
| | - Ewald M Bronkhorst
- Department of Cariology and Preventive Dentistry, Radboud University Medical Center, Nijmegen, the Netherlands
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20
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Patel M, Vaidyanathan M, Bhujel N. Clefts and Dental General Anesthesia: The South Thames Experience. Cleft Palate Craniofac J 2021; 59:66-71. [PMID: 33618553 DOI: 10.1177/1055665621995044] [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
BACKGROUND Children with clefts have high dental needs and often require a dental general anesthesia (DGA) for the management of their dentition. OBJECTIVE To assess the number of children with clefts requiring a pediatric dental consultant led DGA in the South Thames Cleft Service over a 3-year period. DESIGN Data were collected retrospectively over a 36-month period. RESULTS Sixty-five children with cleft lip and/or palate required a DGA with the South Thames Cleft Service. The average age of the child was 7 years, and the average number of teeth treated under the general anesthetic was 9. Families traveled an average of 21 miles to access their child's care, and the referral-to-treat time was on average 14 weeks. CONCLUSION Results highlight the need for DGA provision for children with clefts. Cleft centers need sufficient capacity for this service to prevent long wait times, and in view of distances traveled shared, care should be implemented with local providers.
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Affiliation(s)
- Maalini Patel
- Consultant in Paediatric Dentistry, King's College Hospital NHS Foundation Trust, London, UK
| | - Mina Vaidyanathan
- Consultant in Paediatric Dentistry, South Thames Cleft Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nabina Bhujel
- Consultant in Paediatric Dentistry, South Thames Cleft Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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21
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Torrecillas V, Pollard SH, McCrary H, Taylor HM, Palmer A, Meier J, Muntz H, Skirko JR. Management of Velopharyngeal Insufficiency in Cleft Patients With and Without Multidisciplinary Team Care. Cleft Palate Craniofac J 2020; 58:479-488. [PMID: 33016110 DOI: 10.1177/1055665620954063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the effect of an American Cleft Palate-Craniofacial Association (ACPA)-approved multidisciplinary team on velopharyngeal insufficiency (VPI) diagnosis and treatment. DESIGN Retrospective cohort setting; tertiary children's hospital patients; children with cleft palate repair identified through procedure codes. MAIN OUTCOME MEASURES Velopharyngeal insufficiency diagnosis was assigned based on surgeon or team assessment. Age at diagnosis and surgery was recorded. Difference in age and rate of VPI diagnosis and surgery was analyzed with t test. Multivariate linear and logistic regression adjusted for confounding variables. RESULTS Nine hundred forty patients were included with 71.5% cared for by an ACPA-approved multidisciplinary team. More (38.8% ) team care patients were found to have a diagnosis of VPI in comparison to 10% in independent care (P < .001). Team care was associated with an almost 6-fold increase in VPI diagnosis (P < .001). Team care was associated with a higher proportion of speech surgery (21% vs 10%, P < .001). Among children receiving team care, each visit was associated with 25% increased odds of being diagnosed with VPI (P < .001) and 20% increased odds of receiving speech surgery (P < .001). Age at VPI diagnosis and speech surgery were similar between groups (P = .55 and .29). DISCUSSION Team care was associated with more accurate detection of VPI, resulting in more VPI speech therapy visits and surgical management. A higher number of team visits were similarly associated. CONCLUSION Further studies of the clinical implication of timely and accurate VPI diagnosis, including quality of life assessments, are recommended to provide stronger guidance on team visit and evaluation planning.
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Affiliation(s)
- Vanessa Torrecillas
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sarah Hatch Pollard
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Hilary McCrary
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Helene M Taylor
- Intermountain Primary Children's Hospital, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alexandra Palmer
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeremy Meier
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Harlan Muntz
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jonathan R Skirko
- Division of Otolaryngology, University of Utah, 7060The University of Utah School of Medicine, Salt Lake City, UT, USA
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22
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Weidler EM, Britto MT, Sitzman TJ. Facilitators and Barriers to Implementing Standardized Outcome Measurement for Children With Cleft Lip and Palate. Cleft Palate Craniofac J 2020; 58:7-18. [PMID: 32662298 DOI: 10.1177/1055665620940187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Identify facilitators and barriers to implementing standardized outcome measurement in cleft care. DESIGN Cross-sectional, qualitative study. SETTING/PARTICIPANTS Participants included 24 providers and staff from a large, multidisciplinary cleft team in the southwest United States, 5 caregivers of children with cleft palate (with or without cleft lip) treated by this team, and 3 experts involved in implementing a cleft-specific standardized outcome measurement in the United Kingdom. INTERVENTIONS Semistructured, qualitative interviews were conducted exploring perceived facilitators and barriers to implementing standardized outcome measurement in cleft care. Interviews were audio-recorded, transcribed, and analyzed for content. The Consolidated Framework for Implementation Research was used to guide the interviews and analysis. The analysis focused on the characteristics of standardized outcome measurement that directly influence its adoption. RESULTS Participants identified both facilitators and barriers to implementing standardized outcome measurement. Facilitators included the strength and quality of evidence supporting improvements in cleft care delivery following implementation of standardized outcome measurement and the relative advantage of standardized outcome measurement over continuing the status quo. Barriers included the difficulty adapting standardized outcome measurement to meet local context and patient-specific needs and the complexity of implementing standardized outcome measurement. CONCLUSIONS Providers, staff, and caregivers involved in cleft care perceive multiple benefits from standardized outcome measurement, while also recognizing substantial barriers to its implementation. Results from this study can be used to guide development of an implementation strategy for standardized outcome measurement that builds upon perceived strengths of the intervention and reduces perceived barriers.
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Affiliation(s)
- Erica M Weidler
- Department of Clinical Research, Phoenix Children's Hospital, AZ, USA
| | - Maria T Britto
- Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH, USA
| | - Thomas J Sitzman
- Division of Plastic Surgery, Phoenix Children's Hospital, AZ, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
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23
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Baillie L, Sell D. Benchmarking Speech, Velopharyngeal Function Outcomes and Surgical Characteristics Following the Sommerlad Protocol and Palate Repair Technique. Cleft Palate Craniofac J 2020; 57:1197-1215. [DOI: 10.1177/1055665620923925] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective: To report speech and velopharyngeal function (VPF) outcomes, and surgical characteristics, at age 5 following early complete palate closure using the Sommerlad protocol. Design: A retrospective, descriptive, cross-sectional consecutive series. Setting: A regional twin site center; a district general hospital and tertiary children’s hospital. Participants: Between 1993 and 2006, 877 participants underwent surgery; 712 (81%) were eligible for inclusion; 391 (55%) were included, 321 (45%) excluded. Thirteen percent had bilateral cleft lip and palate (CLP), 40% unilateral CLP, and 47% isolated cleft palate. Intervention: Lip and vomerine flap repair at 3 months of age (BCLP, UCLP) with soft palate closure using radical muscle dissection and retropositioning at a mean age of 6.6 months, range 4 to 23 months, as described and undertaken by Sommerlad. Outcome Measures: Velopharyngeal Composite (VPC) CAPS-A and articulation summary scores derived from analysis using the Cleft Audit Protocol for Speech-Augmented. Results: A VPC-SUM CAPS-A score of “0” was found in 97% reflecting adequate VPF; 73% had no cleft articulation difficulties. The BCLP group had the poorest articulation. Secondary speech surgery rate was 2.6% and 10.7% had fistula repair. Levator muscle quality and degree of retropositioning was associated with speech outcomes related to VPF. 2.6% had current features of VPI. Conclusions: Complete palate closure by around 6 months of age by the surgeon who described the technique led to excellent perceived VPF and very good speech outcomes at age 5, with less speech therapy and secondary speech surgery than commonly reported. These findings serve as a benchmark for the Sommerlad protocol and technique.
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Affiliation(s)
- Lauren Baillie
- Speech and Language Therapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Debbie Sell
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
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24
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Latif A, Kuijpers MAR, Rachwalski M, Latief BS, Kuijpers-Jagtman AM, Fudalej PS. Morphological variability in unrepaired bilateral clefts with and without cleft palate evaluated with geometric morphometrics. J Anat 2019; 236:425-433. [PMID: 31792971 DOI: 10.1111/joa.13118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 11/29/2022] Open
Abstract
In subjects with orofacial clefts, there is an unresolved controversy on the effect of congenital maxillary growth deficiency vs. the effect of surgical intervention on the outcome of treatment. Intrinsic growth impairment in subjects with orofacial clefts can be studied by comparing facial morphology of subjects with untreated cleft and unaffected individuals of the same ethnic background. Bilateral cleft lip and palate is the most severe and least prevalent form of the orofacial cleft. The aim of this study was to compare facial morphology in subjects with unrepaired complete bilateral clefts and unaffected controls using geometric morphometrics. Lateral cephalograms of 39 Indonesian subjects with unrepaired bilateral complete cleft lip and alveolus (mean age: 24 years), or unrepaired bilateral complete cleft lip, alveolus, and palate (mean age: 20.6 years) and 50 age and ethnically matched controls without a cleft (25 males, 25 females, mean age: 21.2 years) were digitized and traced and shape variability was explored using principal component analysis, while differences between groups and genders were evaluated with canonical variate analysis. Individuals with clefts had a more pronounced premaxilla than controls. Principal component analysis showed that facial variation in subjects with clefts occurred in the anteroposterior direction, whereas in controls it was mostly in the vertical direction. Regression analysis with group, sex, and age as covariates and principal components from 1 to 6 as dependent variables demonstrated a very limited effect of the covariates on the facial shape variability (only 11.6% of the variability was explained by the model). Differences between cleft and non-cleft subjects in the direction of facial variability suggest that individuals with bilateral clefts can have an intrinsic growth impairment affecting facial morphology later in life.
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Affiliation(s)
- Abdul Latif
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Mette A R Kuijpers
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Rachwalski
- Department of Maxillofacial and Plastic Surgery, National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Benny S Latief
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Anne Marie Kuijpers-Jagtman
- Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia.,Department of Orthodontics, University Medical Center Groningen, Groningen, The Netherlands
| | - Piotr S Fudalej
- Department of Orthodontics, Jagiellonian University in Krakow, Krakow, Poland.,Department of Orthodontics, Institute of Dentistry and Oral Sciences, Palacky University Olomouc, Olomouc, Czech Republic
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25
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The dental health of cleft patients attending the 18-month-old clinic at a specialised cleft centre. Br Dent J 2019; 227:199-202. [DOI: 10.1038/s41415-019-0608-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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26
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Brons S, Meulstee JW, Loonen TG, Nada RM, Kuijpers MA, Bronkhorst EM, Bergé SJ, Maal TJ, Kuijpers-Jagtman AM. Three-dimensional facial development of children with unilateral cleft lip and palate during the first year of life in comparison with normative average faces. PeerJ 2019; 7:e7302. [PMID: 31392092 PMCID: PMC6677122 DOI: 10.7717/peerj.7302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Stereophotogrammetry can be used to study facial morphology in both healthy individuals as well as subjects with orofacial clefts because it shows good reliability, ability to capture images rapidly, archival capabilities, and high resolution, and does not require ionizing radiation. This study aimed to compare the three-dimensional (3D) facial morphology of infants born with unilateral cleft lip and palate (UCLP) with an age-matched normative 3D average face before and after primary closure of the lip and soft palate. METHODS Thirty infants with a non-syndromic complete unilateral cleft lip, alveolus, and palate participated in the study. Three-dimensional images were acquired at 3, 6, 9, and 12 months of age. All subjects were treated according to the primary surgical protocol consisting of surgical closure of the lip and the soft palate at 6 months of age. Three-dimensional images of UCLP patients at 3, 6 (pre-treatment), 9, and 12 months of age were superimposed on normative datasets of average facial morphology using the children's reference frame. Distance maps of the complete 3D facial surface and the nose, upper lip, chin, forehead, and cheek regions were developed. RESULTS Assessments of the facial morphology of UCLP and control subjects by using color-distance maps showed large differences in the upper lip region at the location of the cleft defect and an asymmetry at the nostrils at 3 and 6 months of age. At 9 months of age, the labial symmetry was completely restored although the tip of the nose towards the unaffected side showed some remnant asymmetry. At 12 months of age, the symmetry of the nose improved, with only some remnant asymmetry noted on both sides of the nasal tip. At all ages, the mandibular and chin regions of the UCLP patients were 2.5-5 mm posterior to those in the average controls. CONCLUSION In patients with UCLP deviations from the normative average 3D facial morphology of age-matched control subjects existed for the upper lip, nose, and even the forehead before lip and soft palate closure was performed. Compared to the controls symmetry in the upper lip was restored, and the shape of the upper lip showed less variation after primary lip and soft palate closure. At this early age, retrusion of the soft-tissue mandible and chin, however, seems to be developing already.
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Affiliation(s)
- Sander Brons
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jene W. Meulstee
- Department of Oral and Maxillofacial Surgery, Radboudumc 3D Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tom G.J. Loonen
- Department of Oral and Maxillofacial Surgery, Radboudumc 3D Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rania M. Nada
- Faculty of Dentistry, Kuwait University, Kuwait City, Kuwait
| | - Mette A.R. Kuijpers
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ewald M. Bronkhorst
- Department of Dentistry, Section of Preventive and Curative Dentistry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Stefaan J. Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Thomas J.J. Maal
- Department of Oral and Maxillofacial Surgery, Radboudumc 3D Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
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27
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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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28
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Fowler PV, Keall H, Kennedy D, Healey D, Thompson JMD. Dental arch relationship outcomes for children with complete unilateral and complete bilateral cleft lip and palate in New Zealand. Orthod Craniofac Res 2019; 22:147-152. [PMID: 30742737 DOI: 10.1111/ocr.12300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate dental arch relationships of patients with complete unilateral and complete bilateral cleft lip and palate (CUCLP/CBCLP) in New Zealand. SETTING AND SAMPLE POPULATION Retrospective nationwide observational outcomes study involving 100 CUCLP and 32 CBCLP non-syndromic patients. MATERIAL AND METHODS Four calibrated assessors, blinded to the origin of the randomized digital models, used the GOSLON (UCLP) and the Bauru-BCLP (BCLP) Yardsticks and a 100 mm visual analogue scale (VAS) (UCLP&BCLP) to assess dental arch relationships. Weighted Kappa statistics were used to determine the intra- and inter-rater reliability for the GOSLON/Bauru-BCLP Yardsticks and correlations for the VAS. RESULTS Intra-rater reliability ranged from 0.57 to 0.88 (GOSLON), 0.62-0.84 (Bauru-BCLP) and 0.45-0.93 (VAS). Inter-rater reliability ranged from 0.62 to 0.86, (GOSLON), 0.48-0.75 (Bauru-BCLP) and 0.64-0.93 (VAS). Of the 100 CUCLP models, 46% had poor/very poor, 28% fair and 26% had good/very good dental arch relationships. Of the 32 CBCLP models, 37.5% were poor/very poor, 40.6% fair and 21.9% had good/very good dental arch relationships. The mean CUCLP VAS score was 50.5 mm (SD 19.9 mm) whilst the mean CBCLP VAS score was 40.0 mm (SD 22.0 mm) and both showed a strong relationship with their respective Yardstick scorings. CONCLUSION The dental arch relationships of children in New Zealand with CUCLP are similar to those centres in the Eurocleft and Americleft studies which had less favourable outcomes. Those with CBCLP are inferior to those reported elsewhere. Continued monitoring will allow for tracking of improvement in outcomes.
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Affiliation(s)
- Peter V Fowler
- Hospital Dental Department, Christchurch Hospital, Christchurch, New Zealand.,Department of Paediatrics, Child and Youth Health, Faculty of Health Science and Medicine, University of Auckland, Auckland, New Zealand
| | - Heather Keall
- Hospital Dental Department, Middlemore Hospital, Auckland, New Zealand
| | - Dan Kennedy
- Hospital Dental Department, Middlemore Hospital, Auckland, New Zealand
| | - David Healey
- School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
| | - John M D Thompson
- Department of Paediatrics, Child and Youth Health, Faculty of Health Science and Medicine, University of Auckland, Auckland, New Zealand.,Department of Obstetrics & Gynaecology, Faculty of Health Science and Medicine, University of Auckland, Auckland, New Zealand
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29
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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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30
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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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31
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Fitzsimons KJ, Copley LP, Setakis E, Charman SC, Deacon SA, Dearden L, van der Meulen JH. Early academic achievement in children with isolated clefts: a population-based study in England. Arch Dis Child 2018; 103:356-362. [PMID: 29097368 PMCID: PMC5890634 DOI: 10.1136/archdischild-2017-313777] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/28/2017] [Accepted: 09/13/2017] [Indexed: 12/04/2022]
Abstract
OBJECTIVES We used national data to study differences in academic achievement between 5-year-old children with an isolated oral cleft and the general population. We also assessed differences by cleft type. METHODS Children born in England with an oral cleft were identified in a national cleft registry. Their records were linked to databases of hospital admissions (to identify additional anomalies) and educational outcomes. Z-scores (signed number of SD actual score is above national average) were calculated to make outcome scores comparable across school years and across six assessed areas (personal development, communication and language, maths, knowledge of world, physical development andcreative development). RESULTS 2802 children without additional anomalies, 5 years old between 2006 and 2012, were included. Academic achievement was significantly below national average for all six assessed areas with z-scores ranging from -0.24 (95% CI -0.32 to -0.16) for knowledge of world to -0.31 (-0.38 to -0.23) for personal development. Differences were small with only a cleft lip but considerably larger with clefts involving the palate. 29.4% of children were documented as having special education needs (national rate 9.7%), which varied according to cleft type from 13.2% with cleft lip to 47.6% with bilateral cleft lip and palate. CONCLUSIONS Compared with national average, 5-year-old children with an isolated oral cleft, especially those involving the palate, have significantly poorer academic achievement across all areas of learning. These outcomes reflect results of modern surgical techniques and multidisciplinary approach. Children with a cleft may benefit from extra academic support when starting school.
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Affiliation(s)
| | - Lynn P Copley
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Efrosini Setakis
- UCL Institute of Education, University College London, London, UK
| | - Susan C Charman
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK,Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Scott A Deacon
- University Hospitals Bristol NHS Foundation Trust, London, UK
| | - Lorraine Dearden
- UCL Institute of Education, University College London, London, UK
| | - Jan H van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK,Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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32
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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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33
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Elledge R, Attard A, Green J, Lowe D, Rogers S, Sidebottom A, Speculand B. UK temporomandibular joint replacement database: a report on one-year outcomes. Br J Oral Maxillofac Surg 2017; 55:927-931. [DOI: 10.1016/j.bjoms.2017.08.361] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/21/2017] [Indexed: 11/17/2022]
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34
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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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35
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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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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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38
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Funding in facial palsy. J Plast Reconstr Aesthet Surg 2016; 69:1526-1527. [DOI: 10.1016/j.bjps.2016.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/13/2016] [Accepted: 08/22/2016] [Indexed: 11/24/2022]
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Scheffer MC, Guilloux AGA, Matijasevich A, Massenburg BB, Saluja S, Alonso N. The state of the surgical workforce in Brazil. Surgery 2016; 161:556-561. [PMID: 28341282 DOI: 10.1016/j.surg.2016.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND A critical insufficiency of surgeons, anesthesiologists, and obstetricians exists around the world, leaving billions of people without access to safe operative care. The distribution of the surgical workforce in Brazil, however, is poorly described and rarely assessed. Though the surgical workforce is only one element in the surgical system, this study aimed to map and characterize the distribution of the surgical workforce in Brazil in order to stimulate discussion on future surgical policy reforms. METHODS The distribution of the surgical workforce was extracted from the Brazilian Federal Medical Board registry as of July 2014. Included in the surgical workforce were surgeons, anesthesiologists, and obstetricians. RESULTS There are 95,169 surgeons, anesthesiologists, and obstetricians in the surgical workforce of Brazil, creating a surgical workforce density of 46.55/100,000 population. This varies from 20.21/100,000 population in the North Region up to 60.32/100,000 population in the South Region. A total of 75.2% of the surgical workforce is located in the 100 biggest cities in Brazil, where only 40.4% of the population lives. The average age of a physician in the surgical workforce is 46.6 years. Women make up 30.0% of the surgical workforce, 15.8% of surgeons, 36.6% of anesthesiologists, and 53.8% of obstetricians and gynecologists. CONCLUSION Brazil has a substantial surgical workforce, but inequalities in its distribution are concerning. There is an urgent need for increased surgeons, anesthesiologists, and obstetricians in states like Pará, Amapá, and Maranhão. Female surgeons and anesthesiologists are particularly lacking in the surgical workforce, and incentives to recruit these physicians are necessary. Government policies and leadership from health organizations are required to ensure that the surgical workforce will be more evenly distributed in the future.
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Affiliation(s)
- Mário C Scheffer
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Benjamin B Massenburg
- Icahn School of Medicine at Mount Sinai, New York, NY; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
| | - Saurabh Saluja
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Nivaldo Alonso
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Urbanova W, Klimova I, Brudnicki A, Polackova P, Kroupova D, Dubovska I, Rachwalski M, Fudalej PS. The Slav-cleft: A three-center study of the outcome of treatment of cleft lip and palate. Part 1: Craniofacial morphology. J Craniomaxillofac Surg 2016; 44:1767-1776. [PMID: 27663676 DOI: 10.1016/j.jcms.2016.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/25/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022] Open
Abstract
Results of a comparison of the outcomes of treatment of cleft lip and palate can be affected by growth characteristics of populations from which subjects with the clefts are derived. Moreover, conventional cephalometric techniques used in cleft studies for analysis of facial morphology provide only a partial description of shape and are confounded by biases regarding the reference structures. In this retrospective comparison, craniofacial morphology of preadolescent patients with unilateral cleft lip and palate treated in Warsaw (n = 35, age = 10.6 years, SD = 1.2), Prague (n = 38, age = 11.6 years, SD = 1.4), and Bratislava (n = 26, age = 10.5 years, SD = 1.6) were evaluated on cephalograms with the cephalometric method used in the Eurocleft study and geometric morphometrics. We found that patients treated in Warsaw showed slightly more favorable outcomes than in Prague and Bratislava. The differences were related primarily to the position of maxillary alveolar process, cranial base, mandibular angle, and soft tissues. Although no association between a component of treatment protocol and the outcome was found, it is possible that organizational factors such as participation of high-volume, experienced surgeons contributed to these results.
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Affiliation(s)
- Wanda Urbanova
- Department of Orthodontics and Cleft Anomalies, Dental Clinic, 3rd Medical Faculty, Charles University, Faculty Hospital Royal Vineard, Šrobárova 50, 100 34 Prague 10, Czech Republic
| | - Irena Klimova
- Cleft Center, Clinic of Plastic and Reconstructive Surgery, Comenius University, Pažítková ul. č. 4, 821 01 Bratislava, Slovakia
| | - Andrzej Brudnicki
- Department of Pediatric Surgery, Institute of Mother and Child, Kasprzaka Str. 17a, 01-211 Warsaw, Poland
| | - Petra Polackova
- Department of Orthodontics and Cleft Anomalies, Dental Clinic, 3rd Medical Faculty, Charles University, Faculty Hospital Royal Vineard, Šrobárova 50, 100 34 Prague 10, Czech Republic
| | - Daniela Kroupova
- Cleft Center, Clinic of Plastic and Reconstructive Surgery, Comenius University, Pažítková ul. č. 4, 821 01 Bratislava, Slovakia
| | - Ivana Dubovska
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacky University Olomouc, Palackého 12, 779 00 Olomouc, Czech Republic
| | - Martin Rachwalski
- Department of Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Straße 62, 50937 Köln, Germany
| | - Piotr Stanislaw Fudalej
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacky University Olomouc, Palackého 12, 779 00 Olomouc, Czech Republic; Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland.
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