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Sundoro A, Hilmanto D, Soedjana H, Lesmana R, Harianti S. Epidemiology of cleft lip and palate charity mission surgery at Bandung Cleft Lip and Palate Center, Indonesia: a 14-year institutional review. Arch Craniofac Surg 2024; 25:62-70. [PMID: 38742332 PMCID: PMC11098759 DOI: 10.7181/acfs.2023.00416] [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: 08/30/2023] [Revised: 02/11/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The management of cleft lip and palate aims at improving the patient's aesthetic and functional outcomes. Delaying primary repair can disrupt the patient's functional status. Long-term follow-up is essential to evaluate the need for secondary repair or revision surgery. This article presents the epidemiology of cleft lip and palate, including comprehensive patient characteristics, the extent of delay, and secondary repair at our institutional center, the Bandung Cleft Lip and Palate Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia. METHODS This retrospective study aimed to determine the epidemiology and recurrence rates of cleft lip and palate at the Bandung Cleft Lip and Palate Center, Indonesia, from January 2007 to December 2021. The inclusion criteria were patients diagnosed with cleft lip and/or palate. Procedures such as labioplasty, palatoplasty, secondary lip and nasal repair, and alveolar bone grafting were performed, and data on recurrence were available. RESULTS In total, there were 3,618 patients with cleft lip and palate, with an age range of 12 months to 67 years. The mean age was 4.33 years, and the median age was 1.35 years. Males predominated over females in all cleft types (60.4%), and the cleft lip was on the left side in 1,677 patients (46.4%). Most cases were unilateral (2,531; 70.0%) and complete (2,349; 64.9%), and involved a diagnosis of cleft lip and palate (1,981; 54.8%). CONCLUSION Delayed primary labioplasty can affect daily functioning. Primary repair for patients with cleft lip and palate may be postponed due to limited awareness, socioeconomic factors, inadequate facilities, and varying adherence to treatment guidelines. Despite variations in the timing of primary cleft lip repair (not adhering to the recommended protocol), only 10% of these patients undergo reoperation. Healthcare providers should prioritize the importance of the ideal timing for primary repair in order to optimize physiological function without compromising the aesthetic results.
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Affiliation(s)
- Ali Sundoro
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Dany Hilmanto
- Department of Child Health, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Hardisiswo Soedjana
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ronny Lesmana
- Department of Physiology, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Selvy Harianti
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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2
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Liao D, Pereira N, Obayemi A, Sclafani AP. Secondary Cleft Rhinoplasty. Facial Plast Surg Clin North Am 2024; 32:43-54. [PMID: 37981415 DOI: 10.1016/j.fsc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Secondary cleft rhinoplasty remains a challenging operation that requires an understanding of the aberrant anatomy in cleft lip nasal deformity as well as the ability to adapt various techniques suited to the needs of each patient. In this article, we review some of the classically described approaches in cleft rhinoplasty and different strategies to address the nasal subunits. Presurgical adjuncts, surgical interventions before facial skeletal maturity, and patient reported outcome measures are also discussed.
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Affiliation(s)
- David Liao
- Department of Otolaryngology, Weill Cornell Medicine, 1305 York Avenue, 5th Floor, New York, NY 10021, USA
| | - Nicola Pereira
- Department of Otolaryngology, Weill Cornell Medicine, 1305 York Avenue, 5th Floor, New York, NY 10021, USA
| | - Adetokunbo Obayemi
- Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Anthony P Sclafani
- Department of Otolaryngology, Weill Cornell Medicine, 1305 York Avenue, 5th Floor, New York, NY 10021, USA.
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3
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Koh DJ, Gong JH, Sobti N, Soliman L, King V, Woo AS. The Life Cycle of Orofacial Cleft Operations. J Craniofac Surg 2023:00001665-990000000-01203. [PMID: 37973027 DOI: 10.1097/scs.0000000000009863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
Patients with cleft lip and palate must undergo various surgical interventions at appropriate times to achieve optimal outcomes. While guidelines for the timing of these operations are well known, it has not yet been described if national surgical practice reflects these recommendations. This study evaluates whether orofacial operations are performed in time frames that align with advised timing. Time-to-event analyses were performed using the 2012-2020 Pediatric National Surgical Quality Improvement Program database on the ages at time of orofacial operations. Outliers with an absolute Z-score of 3.29 or greater were excluded. Cleft lip (N=9374) and palate (N=13,735) repairs occurred earliest at mean ages of 200.99±251.12 and 655.08±694.43 days, respectively. Both operations clustered along the later end of recommended timing. 69.0% of lip versus 65.1% of palate repairs were completed within the advised age periods. Cleft lip (N=2850) and palate (N=1641) revisions occurred at a mean age of 7.73±5.02 and 7.00±4.63 years, respectively. Velopharyngeal insufficiency operations (N=3026), not including palate revision, were performed at a delayed mean age of 7.58±3.98 years, with only 27.7% of operations occurring within the recommended time frame. Finally, 75.8% of alveolar bone grafting cases (N=5481) were found to happen within the advised time period, with a mean age of 10.23±2.63 years. This study suggests that, with the exception of VPI procedures, orofacial operations reliably cluster near their recommended age periods. Nevertheless, primary lip repair, palatoplasty, and velopharyngeal insufficiency procedures had a mean age that was delayed based on advised timing.
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Affiliation(s)
- Daniel J Koh
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
- Division of Plastic and Reconstructive Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Jung Ho Gong
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Nikhil Sobti
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Luke Soliman
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Victor King
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Albert S Woo
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
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Parham MJ, Simpson AE, Moreno TA, Maricevich RS. Updates in Cleft Care. Semin Plast Surg 2023; 37:240-252. [PMID: 38098682 PMCID: PMC10718659 DOI: 10.1055/s-0043-1776733] [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: 12/17/2023]
Abstract
Cleft lip and/or palate is a congenital malformation with a wide range of presentations, and its effective treatment necessitates sustained, comprehensive care across an affected child's life. Early diagnosis, ideally through prenatal imaging or immediately postbirth, is paramount. Access to longitudinal care and long-term follow-up with a multidisciplinary approach, led by the recommendations of the American Cleft Palate Association, is the best way to ensure optimal outcomes. Multiple specialties including plastic surgery, otolaryngology, speech therapy, orthodontists, psychologists, and audiologists all may be indicated in the care of the child. Primary repair of the lip, nose, and palate are generally conducted during infancy. Postoperative care demands meticulous oversight to detect potential complications. If necessary, revisional surgeries should be performed before the child begin primary school. As the child matures, secondary procedures like alveolar bone grafting and orthognathic surgery may be requisite. The landscape of cleft care has undergone significant transformation since early surgical correction, with treatment plans now tailored to the specific type and severity of the cleft. The purpose of this text is to outline the current standards of care in children born with cleft lip and/or palate and to highlight ongoing advancements in the field.
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Affiliation(s)
- Matthew J. Parham
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Arren E. Simpson
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Tanir A. Moreno
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Renata S. Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
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5
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Miroshnychenko A, Rae C, Wong Riff K, Forrest CR, Goodacre T, Swan MC, Slator R, Goldstein J, Thoma A, Harman K, Klassen A. A Prospective Study to Examine Responsiveness and Minimally Important Differences (MIDs) for the CLEFT-Q Scales Following Three Cleft-Specific Operations. Cleft Palate Craniofac J 2023; 60:413-420. [PMID: 34904896 PMCID: PMC10018053 DOI: 10.1177/10556656211064479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The aim of this study was to examine internal responsiveness and estimate minimally important differences (MIDs) for CLEFT-Q scales. In this prospective cohort study, participants completed the CLEFT-Q appearance and health-related quality of life (HRQL) scales before and six months after cleft-related surgery. Seven cleft centres in Canada, USA and UK participated. Patients were ages 8-29 years with CL/P. Patients underwent rhinoplasty, orthognathic or cleft lip scar revision surgery. Internal responsiveness was examined using Cohen's d effect sizes (ESs) based on the following interpretation: 0.20-0.49 small, 0.50-0.79 moderate and ≥ 0.80 large. MIDs were estimated using two distribution-based approaches. Participants had a rhinoplasty (n = 31), orthognathic (n = 21) or cleft lip scar revision (n = 18) surgery. Most participants were males (56%) and aged 8-11 years (41%). Following rhinoplasty, ESs were larger for the nose (0.92, p = 0.001) and nostrils (0.94, p < 0.001) scales than for the face scale (0.51, p = 0.003). MIDs ranged between 6.2-10.4. For orthognathic surgery, larger ES was observed for the jaws scale (1.80, p < 0.001) compared with the teeth (1.16, p < 0.001), face (1.15, p = 0.001) and lips (0.94, p < 0.001) scales. MIDs ranged between 5.9-14.4. In the cleft lip scar revision sample, the largest ES was observed for the nose scale (0.76, p = 0.03), followed by lips (0.58, p = 0.009) and cleft lip scar (0.50, p = 0.043) scales. MIDs ranged between 6.4-12.3. CLEFT-Q detected change in key outcomes for three cleft-specific surgeries, providing evidence of its responsiveness. Estimated MIDs will aid in interpreting this PROM.
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Affiliation(s)
- A Miroshnychenko
- Department of Health Research Methods, Evidence and Impact,
McMaster
University, Hamilton, Canada
| | - C Rae
- Department of Health Research Methods, Evidence and Impact, and Pediatrics,
McMaster
University, Hamilton, Canada
| | - K Wong Riff
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children,
Toronto, Canada
| | - CR Forrest
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children,
Toronto, Canada
| | - T Goodacre
- Department of Plastic & Reconstructive Surgery, Oxford University Hospitals
NHS Foundation Trust, England, UK
| | - MC Swan
- Department of Plastic & Reconstructive Surgery, Oxford University Hospitals
NHS Foundation Trust, Spires Cleft Centre, John Radcliffe Hospital, England, UK
| | - R Slator
- Department of Plastic and Reconstructive Surgery, Birmingham Children's Hospital
NHS Foundation Trust, England, UK
| | - J Goldstein
- Department of Plastic Surgery, University of Pittsburgh, PA (Pitt), PA, USA
| | - A Thoma
- Division of Plastic Surgery, Department of Surgery, and Department of Health
Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - K Harman
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - A Klassen
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Anne Klassen, Department of Pediatrics, McMaster
University, (Oxon), 3N27 - 1280 Main Street West, Hamilton, Ontario, Canada.
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Sociodemographic Disparities in Access to Cleft Rhinoplasty. J Craniofac Surg 2023; 34:92-95. [PMID: 35973113 DOI: 10.1097/scs.0000000000008908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/20/2022] [Indexed: 01/11/2023] Open
Abstract
Various sociodemographic factors affect patient access to care. This study aims to assess how factors such as government-funded insurance and socioeconomic status impact the ability of adolescents with cleft lip-associated nasal deformities to access secondary rhinoplasty procedures. Patients older than 13 years old with a history of cleft lip/palate were identified in the National Inpatient Sample database from 2010 to 2012. Those who received a secondary rhinoplasty were identified using the International Classification of Diseases, Ninth Revision (ICD-9) procedural codes. A multivariate logistic regression model with post hoc analyses was performed to analyze if insurance status, socioeconomic status, and hospital-level variables impacted the likelihood of undergoing rhinoplasty. Of the 874 patients with a cleft lip/palate history, 154 (17.6%) underwent a secondary rhinoplasty. After controlling for various patient-level and hospital-level variables, living in a higher income quartile (based on zip code of residence) was an independent predictor of receiving a secondary cleft rhinoplasty (odds ratio=1.946, P =0.024). Patients had lower odds of receiving a cleft rhinoplasty if care occurred in a private, nonprofit hospital compared with a government-owned hospital (odds ratio=0.506, P =0.030). Income status plays a significant role in cleft rhinoplasty access, with patients from lower income households less likely to receive a secondary cleft rhinoplasty. Hospital-specific factors such as geographic region, bed size, urbanization, and teaching status may also create barriers for patients and their families in accessing surgical care for cleft lip nasal deformities.
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Sarrami SM, Skochdopole AJ, Ferry AM, Buchanan EP, Hollier LH, Dempsey RF. Revisional Techniques for Secondary Cleft Lip Deformities. Semin Plast Surg 2021; 35:65-71. [PMID: 34121941 DOI: 10.1055/s-0041-1728673] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Secondary deformities of repaired cleft lips are an unfortunate complication despite the meticulous approach of modern primary procedures. Most of these surgeries take place in the patient's early life and must be strategically planned to provide optimal cosmesis with minimal interventions. Depending on the level of severity, treatment of the secondary deformities ranges from noninvasive or minimally invasive techniques to complete revision cheiloplasty. Many novel topical, injectable, and laser therapies have allotted physicians more technical flexibility in treating superficial distortions. Nonetheless, surgical techniques such as diamond excision and adjacent tissue transfer remain popular and useful reconstructive modalities. Deformities involving the orbicularis oris must be completely taken down to allow full access to the muscle. Complete revision cheiloplasty requires recreation of the cleft defect and reconstruction similar to the primary repair. Due to the myriad of presentations of these secondary deformities, familiarity with the various treatments available is imperative for any cleft surgeon.
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Affiliation(s)
- Shayan M Sarrami
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Anna J Skochdopole
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Andrew M Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Edward P Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Larry H Hollier
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Robert F Dempsey
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
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Tan RA, Mulder FJ, Schwirtz RMF, Mosmuller DGM, De Vet HCW, Griot JPWD. Atypical Outcomes of Nasal and Lip Appearance After Unilateral Cleft Lip Repair: Judgment by Professionals, Patients, and Laypeople. Cleft Palate Craniofac J 2021; 58:1226-1235. [PMID: 33461321 PMCID: PMC8494007 DOI: 10.1177/1055665620982801] [Citation(s) in RCA: 1] [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 gain more insight into the assessment of “atypical” nasal and lip appearance outcomes compared to “typical” appearance outcomes after unilateral cleft lip and palate (UCLP) repair, when judged by professionals, patients with repaired UCLP, and laypeople. Design: An online survey containing 3 series of photographs with various degrees of “typical” and “atypical” nasal and lip appearance outcomes after UCLP repair was sent to 30 professionals, 30 patients with repaired UCLP, and 50 laypeople in 2 countries. Participants were instructed to rank the photographs from excellent to poor based on overall appearance. Mean rank positions of photographs were analyzed and differences in mean rank score between “typical” and “atypical” results were assessed using a T-test. Agreement of ranking between the 3 groups was assessed with an analysis of variance analysis. Setting: Amsterdam UMC, location VUmc, Netherlands and Boston Children’s Hospital, Boston, USA. Patients: Photographs of 6- to 18-year-old patients with repaired UCLP. Results: “Atypical” appearance outcomes were ranked significantly less favorably (small nostril: P = 0.00; low vermillion border: P = 0.02; whistling deformity: P = 0.00) compared to “typical” outcomes. Difference between professionals, patients and laypeople in rank positioning the photographs was not statistically significant (P = 0.89). Conclusions: Noses with a smaller nostril and lips containing a whistling deformity were perceived as poorer outcome compared to the “typical” results. Professionals, patients, and laypeople are in agreement when assessing these outcomes.
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Affiliation(s)
- Robin A Tan
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Frans J Mulder
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Roderic M F Schwirtz
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - David G M Mosmuller
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Henrica C W De Vet
- Department of Epidemiology and Data Science and the Amsterdam Public Health, Research Institute, 1209Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - J Peter W Don Griot
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
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