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Edwards SR, Elver AA, Frederick KB, Humphries LS, Hoppe IC. Impact of Social Vulnerability, Race, and Urbanicity on Early Nutritional Outcomes in Patients With Cleft Palate. J Craniofac Surg 2024:00001665-990000000-01970. [PMID: 39325060 DOI: 10.1097/scs.0000000000010685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/24/2024] [Indexed: 09/27/2024] Open
Abstract
Patients with cleft palate experience early feeding difficulties, resulting in increased hospital utilization due to poor nutritional status. Sociodemographic factors may impact access and outcomes for cleft patients. This study investigates the association of social vulnerability, race, and urbanicity on birth encounter metrics and failure to thrive (FTT) rates for patients with cleft palate. Retrospective data from 2013 to 2023 was queried from Cosmos, a national deidentified database from Epic electronic health record. Birth metrics, the prevalence of FTT, and MyChart activation rates were compared across sociodemographic cohorts based on (1) social vulnerability index (SVI) quartiles, (2) patient race, and (3) USDA Rural-Urban Commuting Area (RUCA) codes using χ2 or Fisher exact tests. There were 92,437 patients diagnosed with cleft palate. Birth weight was lower in socially vulnerable and Black patients (SVI 75%: 101.50±1.57 oz; SVI 25%: 106.40±1.85 oz; Black: 95.3±2.63 oz; White: 104.90±1.02 oz; Other: 104.80±2.09 oz), and length of stay was longer (SVI 75%: 21±2.39 d; SVI 25%: 15±2.18 d; Black: 22±4 d). FTT related admissions increased with SVI quartile (Q25: 0.19%; Q25-50; 0.29%, Q50-75: 0.34%; Q75: 0.47%; P<0.001). An opposite trend was observed for MyChart activation rates (P<0.001). High SVI and Black patients are susceptible to unfavorable nutritional outcomes. Access disparities, such as direct-to-provider communication systems (ie, MyChart), may contribute. Awareness of social identities, geography, and community may assist in providing individualized care in early life.
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Affiliation(s)
- Shelley R Edwards
- School of Medicine, University of Mississippi Medical Center
- Graduate Program in Neuroscience, School of Graduate Studies in Health Sciences, University of Mississippi Medical Center
| | - Ashlie A Elver
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center
| | - Keeley B Frederick
- Center for Informatics and Analytics, University of Mississippi Medical Center
| | - Laura S Humphries
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center
- Stephanie and Mitchell Morris Center for Cleft and Craniofacial Research and Innovation, Children's of Mississippi, Jackson, MS
| | - Ian C Hoppe
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center
- Stephanie and Mitchell Morris Center for Cleft and Craniofacial Research and Innovation, Children's of Mississippi, Jackson, MS
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Sajovic J, Drevenšek G, Plut A, Eberlinc A, Kosmač Vrabec M, Setnikar Lesjak A, Selič Zupančič P, Drevenšek M. Beyond the face: An interdisciplinary evaluation of satisfaction with appearance in young people with orofacial clefts. iScience 2024; 27:110738. [PMID: 39290840 PMCID: PMC11406071 DOI: 10.1016/j.isci.2024.110738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/18/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024] Open
Abstract
Orofacial clefts are the most common congenital anomaly of the face, and they significantly affect appearance. The combined effects of demographics, psychology, neurophysiology, and cleft characteristics to explain satisfaction with appearance in young people with a cleft have not yet been comprehensively studied in an interdisciplinary manner. We found that interpersonal difficulties, age, and conscientiousness were significant explanatory factors for satisfaction with appearance (tinterpersonal difficulties = -3.022, p = 0.006; tage = -3.563, p = 0.016; tconscientiousness = 4.161, p = 0.003); the model explained 50% of variance in satisfaction with appearance (R2 Adjusted = 0.504, Fvs. constant = 4.05, p = 0.00117). Furthermore, frontal alpha asymmetry was complexly intertwined with other variables, affecting the overall accuracy of the model, but explaining only 10.5% of variance in satisfaction with appearance when used as a factor alone. The results show that an interdisciplinary approach can substantially expand our understanding of the factors influencing self-perception in young people with orofacial clefts.
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Affiliation(s)
- Jakob Sajovic
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Orthodontics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Gorazd Drevenšek
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Alja Plut
- Department of Orthodontics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Andreja Eberlinc
- Department of Maxillofacial and Oral Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Manca Kosmač Vrabec
- Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, 6000 Koper, Slovenia
| | - Anina Setnikar Lesjak
- Department of Orthodontics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Polona Selič Zupančič
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Martina Drevenšek
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Orthodontics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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Asadourian P, Valenti AB, Michalowski A, Truong AY, Borys N, LaValley M, Modi V, Imahiyerobo TA. Estimated Time of Arrival: Impact of Healthcare Disparities on Access to and Outcomes of Multidisciplinary Cleft Lip and Palate Care. Cleft Palate Craniofac J 2024:10556656241259890. [PMID: 39033442 DOI: 10.1177/10556656241259890] [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: 07/23/2024] Open
Abstract
OBJECTIVE To determine the impact of sociodemographic and clinical factors on patient presentation into the cleft care pathway and determine how delayed interventions may affect post-surgical outcomes. DESIGN Retrospective study. SETTING Multidisciplinary craniofacial clinics of two university hospitals. PATIENTS, PARTICIPANT 135 patients with cleft lip and/or palate. INTERVENTIONS Primary cheiloplasty, primary palatoplasty. MAIN OUTCOME MEASURES Age at initial presentation, age at first surgery, lag time, delayed surgery, rate of return to the emergency department (ED), readmission rate, reoperations, and oronasal fistula development. RESULTS Patients referred by OBGYN who underwent cheiloplasty had an earlier age at initial presentation (p < 0.01), earlier age at first surgery (p = 0.01), and a shorter lag time (p < 0.01) compared to children from other referral pathways. African American children had an older age at first surgery (p = 0.01) and a longer lag time (p = 0.02) when compared to non-African American children. Children with syndromes had an older age at first surgery (p < 0.01) and a longer lag time (p < 0.01) than children without syndromes. Patient race, cleft type, and syndromic status increased the odds of receiving delayed surgery. Patients who received delayed palatoplasty returned to the ED at a higher rate than patients who received non-delayed palatoplasty (p = 0.02). CONCLUSIONS Our data suggest that referral source, race, and syndromic status influence the timeliness of cleft care. Surgeons should develop strong referral networks with local OBGYNs and hospitals to allow for an early entry into the cleft care pathway.
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Affiliation(s)
- Paul Asadourian
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Alyssa B Valenti
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Alexandra Michalowski
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Weill Cornell Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Albert Y Truong
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Nell Borys
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Weill Cornell Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Myles LaValley
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Vikash Modi
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Weill Cornell Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Thomas A Imahiyerobo
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
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Denadai R, Lo LJ. Reducing delayed detection of isolated cleft palate-related deformity: a call for routine intraoral examination of newborns. J Pediatr (Rio J) 2024; 100:350-359. [PMID: 38307119 PMCID: PMC11331241 DOI: 10.1016/j.jped.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE To provide healthcare professional-friendly practical recommendations for early detection of cleft palate-related deformities in newborns and offer an overview of managing these high-prevalent congenital abnormalities. SOURCE OF DATA PubMed, SciELO, Lilacs, Cochrane, ScienceDirect, and Scopus databases were reviewed for cleft- and diagnosis-related studies. SUMMARY OF THE FINDINGS Unfortunately, the global prevalence of delayed detection of cleft palate-related deformities remains unacceptably high, with over a quarter of cleft palates missed at birth. This delayed identification causes physical and psychological distress for patients and families, including feeding challenges and weight faltering. To improve cleft management, it is essential to adopt routine detailed, in-depth intraoral examination immediately after birth. It is recommended not only to finger-assisted palpate the intraoral structures but also to visually inspect the oral cavity from gingiva to uvula using a wooden tongue depressor and light-assisted examination. With timely diagnosis and referral to specialized care, pediatricians, nurses, speech therapists, and plastic surgeons provide life-changing treatments, including health care maintenance, anticipatory guidance, feeding support, primary surgical reconstruction, and age- and condition-specific protocols. CONCLUSIONS Encouraging neonatologists and pediatricians, who are the first to examine newborns, to actively investigate the intraoral region for cleft palate-related deformities is instrumental in optimizing therapeutic approaches and prioritizing age-phases in treatment. Their crucial role in early detection and referral can lead to transformative outcomes, impacting not only the future of the newborns by facilitating functional integration into society but also yielding positive effects on families and the health system.
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Affiliation(s)
- Rafael Denadai
- Centro Avançado de Cirurgia Plástica Facial, A&D DermePlastique, São Paulo, SP, Brazil; Centro Universitário Max Planck (UniMAX), Faculdade de Medicina, Indaiatuba, SP, Brazil; Chang Gung Memorial Hospital, Craniofacial Research Center, Taoyuan, Taiwan.
| | - Lun-Jou Lo
- Chang Gung Memorial Hospital, Craniofacial Research Center, Taoyuan, Taiwan; Chang Gung University, Chang Gung Memorial Hospital, Department of Plastic and Reconstructive Surgery, Taoyuan, Taiwan
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Gu B, Johns AL, Binhuwaishel L, Dass A, Sheller B, Kapadia HP, Yen SLK. Impact of protraction or orthognathic surgery for class III malocclusion on longitudinal quality of life in patients with cleft lip and palate. Orthod Craniofac Res 2024. [PMID: 38817081 DOI: 10.1111/ocr.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES This study assessed overall quality of life (QoL) over time in youth with cleft lip and palate (CLP) undergoing maxillary protraction treatment or orthognathic surgery for class III malocclusion to identify any differences in QoL based on treatment group and outcome success. MATERIALS AND METHODS A prospective longitudinal cohort study was conducted in two pediatric hospitals. The Short Form Health Survey (SF-12) measured physical and mental QoL prior to treatment, at maximal correction, at treatment completion, and at 1-year post treatment. Analyses included one-sample, two-sample, and paired t-tests and analyses of variance and covariance. RESULTS Participants (N = 91) either completed protraction (n = 53) at age 11-14 or surgery (n = 38) at age 16-21. Participants were mostly Latinx (67%) males (55%) born with unilateral CLP (81%) and there were no demographic differences between the two groups other than age. The total sample's QoL was in the average range and significantly higher than national norms. No significant differences were found in QoL-based outcome success; however, the protraction group showed a gradual physical QoL improvement over time, while the surgery group experienced a temporary drop in physical QoL postoperatively. At treatment completion, higher physical QoL was associated with higher socioeconomic status. At a year post treatment, mental QoL was significantly higher for males. CONCLUSION Both protraction and surgery appear to be acceptable treatment options in terms of overall QoL for youth with CLP. While treatment success did not impact QoL, there were some differences in physical QoL coinciding with the treatment phase as well as individual factors.
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Affiliation(s)
- Bocheng Gu
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, California, USA
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lamia Binhuwaishel
- Division of Dentistry, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Amarjit Dass
- Division of Dentistry, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Barbara Sheller
- Department of Dentistry, Seattle Children's Hospital and School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Hitesh P Kapadia
- Department of Dentistry, Seattle Children's Hospital and School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Stephen L-K Yen
- Division of Dentistry, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Kapp-Simon KA, Crilly Bellucci C, Albert M, O'Gara M, Richards S, Morgan A. The Association of Speech/Language Risk With Phonological Awareness, Rapid Naming, and Reading Ability in Children With Cleft Lip and/or Palate. Dev Neuropsychol 2024; 49:61-85. [PMID: 38414409 DOI: 10.1080/87565641.2023.2293715] [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: 08/29/2023] [Accepted: 12/02/2023] [Indexed: 02/29/2024]
Abstract
Children with cleft lip and/or palate were assessed for speech, language, phonological awareness (PA), rapid naming (RN) and reading ability using standardized instruments at baseline (T1; N = 142, Mage = 6.14 years, 51% males) and 2-year follow-up (T2; 89% retention, Mage = 8.38). Children with no speech or language risk scored higher for T1 and T2 PA, RN, and reading than children with both speech and language risk [Adjusted Mean Difference (AMD) ranged from 11.79 to 21.25]; language risk (AMD 8.37 to 13.58); and speech risk (0.51 to 6.87). No significant differences by cleft type or child sex.
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Affiliation(s)
- Kathleen A Kapp-Simon
- Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
| | | | - Meredith Albert
- Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
| | - Mary O'Gara
- Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
| | - Sarah Richards
- Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
| | - Amy Morgan
- Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
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