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Mossey PA, Lai J, Meazzini MC, Breugem C, Mark H, Mink van der Molen AB, Persson M, Davies G, Ozawa TO. Core outcomes for orofacial clefts: reconciling traditional and ICHOM minimum datasets. Eur J Orthod 2023; 45:671-679. [PMID: 37279564 PMCID: PMC10687512 DOI: 10.1093/ejo/cjad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE/DESIGN/SETTING This retrospective study sought voluntary participation from leading cleft centres from Europe and Brazil regarding core outcome measures. The results of this study would inform the debate on core outcome consensus pertaining to the European Reference Network for rare diseases (ERN CRANIO) and achieve a core outcome set for cleft care providers worldwide. INTERVENTION/METHOD Five orofacial cleft (OFC) disciplines were identified, within which all of the International Consortium of Health Outcomes Measurement (ICHOM) outcomes fall. One questionnaire was designed for each discipline and comprised 1. the relevant ICHOM's outcomes within that discipline, and 2. a series of questions targeted to clinicians. What core outcomes are currently measured and when, did these align with the ICHOM minimum, if not how did they differ, and would they recommend modified or additional outcomes?. RESULTS For some disciplines participants agreed with the ICHOM minimums but urged for earlier and more frequent intervention. Some clinicians felt that some of the ICHOM standards were compatible but that different ages were preferred and for others the ICHOM standards were acceptable but developmental stages should be preferred to absolute time points. CONCLUSION/IMPLICATIONS Core outcomes for OFC were supported in principle but there are differences between the ICHOM recommendations and the 2002 WHO global consensus. The latter are established in many centres with historical archives of OFC outcome data, and it was concluded that with some modifications ICHOM could be moulded into useful core outcomes data for inter-centre comparisons worldwide.
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Affiliation(s)
- Peter A Mossey
- Orthodontic Department, School of Dentistry, University of Dundee, Scotland, UK
| | - Jason Lai
- Orthodontic Department, School of Dentistry, University of Dundee, Scotland, UK
| | | | - Corstiaan Breugem
- Department of Plastic Reconstructive and Hand Surgery, Emma Children’s Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Mark
- Department of Plastic Surgery, Sahlgrenska University Hospital and Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Martin Persson
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Gareth Davies
- Stichting European Cleft Organisation, Rijswijk, The Netherlands
| | - Terumi Okada Ozawa
- Department of Orthodontics, Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), Bauru, Sao Paulo, Brazil
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Oechsle AL, Wiechers C, Abadie V, Abel F, Breugem C, Poets CF. Study protocol for a multicenter, multinational, observational registry of epidemiology, treatment and outcome of patients with Robin sequence. Head Face Med 2023; 19:20. [PMID: 37210548 DOI: 10.1186/s13005-023-00364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/08/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Robin sequence (RS) is a congenital condition characterized by micrognathia, glossoptosis and upper airway obstruction. Diagnosis and treatment are characterized by heterogeneity, resulting in a lack of uniformly collected data. METHODS We have set up a prospective, observational, multicenter, multinational registry aimed at obtaining routine clinical data from RS patients receiving different treatment approaches and enabling an assessment of outcomes obtained through different therapeutic approaches. Patient enrolment has started in January 2022. Disease characteristics, adverse events and complications depending on the different diagnostic and treatment approaches and their effects on neurocognition, growth, speech development and hearing outcome are evaluated using routine clinical data. In addition to characterizing the patient population and comparing outcomes achieved with different treatment approaches, the registry will evolve to focus on endpoints such as quality of life and long-term developmental status. DISCUSSION This registry will provide data on different treatment approaches collected during routine care with diverse framework conditions and will allow assessing diagnostic and therapeutic outcomes of children with RS. These data, urgently demanded by the scientific community, may contribute to refining and personalizing existing therapeutic approaches and increase knowledge about the long-term outcome of children born with this rare condition. TRIAL REGISTRATION DRKS00025365.
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Affiliation(s)
- Anna-Lisa Oechsle
- Interdisciplinary Center for Cleft Palate & Craniofacial Malformations, Department of Neonatology, Tübingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Cornelia Wiechers
- Interdisciplinary Center for Cleft Palate & Craniofacial Malformations, Department of Neonatology, Tübingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Veronique Abadie
- Department of General Pediatrics, Reference Centre for Rare Diseases 'Pierre Robin sequences and congenital sucking-swallowing troubles', Necker University Hospital, Paris University, &, France
| | - Francois Abel
- Department of Pediatric Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | - Corstiaan Breugem
- Department of Plastic Reconstructive and Hand Surgery, Emma Children's Hospital - Location AMC, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Christian F Poets
- Interdisciplinary Center for Cleft Palate & Craniofacial Malformations, Department of Neonatology, Tübingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany.
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Houkes R, Smit J, Mossey P, Don Griot P, Persson M, Neville A, Ongkosuwito E, Sitzman T, Breugem C. Classification Systems of Cleft Lip, Alveolus and Palate: Results of an International Survey. Cleft Palate Craniofac J 2023; 60:189-196. [PMID: 34812658 PMCID: PMC9843539 DOI: 10.1177/10556656211057368] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE This study aimed to identify commonly used classification systems by cleft providers around the world, including the perceived indications and limitations of each system. DESIGN A cross-sectional survey. PARTICIPANTS A total of 197 registrants from three international cleft/craniofacial meetings. INTERVENTIONS Participants were sent a web-based questionnaire concerning cleft classification systems. MAIN OUTCOME MEASURES Frequency of commonly used classification systems, their perceived indications and limitations. RESULTS A total of 197 respondents from 166 different centers completed the questionnaire. Healthcare professionals from all disciplines responded, with the most frequent respondents being plastic surgeons (38.1%), maxillofacial surgeons (28.4%) and orthodontists (23.9%). Eighteen different classification systems were in use. The most frequently used systems were the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (35.5%), LAHSHAL (34.0%), and Veau (32.5%) classification systems. Most respondents (32.5%) indicated that anatomical and morphological characteristics are essential components of a classification system. However, respondents indicated that their current classification systems lacked sufficient description of cleft extension and severity. CONCLUSIONS Great variety in the use of classification systems exists among craniofacial specialists internationally. The results recommend the usage of the LAHSHAL classification of OFCs, due to its comprehensiveness, relatively high implementation rate globally, convenience of usage and complementarity with the ICD-10 system. Moreover, it can overcome deficiencies inextricably linked to ICD-10, such as incapacity to describe laterality and clefts of the alveolus. More international exposure to the merits of using the LAHSHAL classification system would be highly recommended.
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Affiliation(s)
- Ruben Houkes
- Department of Plastic Surgery, Amsterdam University Medical Center, Emma Children’s Hospital, AZ, Amsterdam, the Netherlands
| | - Johannes Smit
- Department of Plastic Surgery, Amsterdam University Medical Center, Emma Children’s Hospital, AZ, Amsterdam, the Netherlands
- Johannes A. Smit, Department of Plastic Surgery, Amsterdam University Medical Center, Emma Children's Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Peter Mossey
- Department of Dentistry, University of Dundee Dental Hospital & School, Dundee, Scotland, UK
| | - Peter Don Griot
- Department of Plastic Surgery, Amsterdam University Medical Center, Emma Children’s Hospital, AZ, Amsterdam, the Netherlands
| | - Martin Persson
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Amanda Neville
- Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Italy
| | - Edwin Ongkosuwito
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tom Sitzman
- Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Corstiaan Breugem
- Department of Plastic Surgery, Amsterdam University Medical Center, Emma Children’s Hospital, AZ, Amsterdam, the Netherlands
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Poets CF, Abadie V, Breugem C, Wallis C, Abel F, Chalouhi C, Kruisinga F, Sorg AL, Wiechers C. Managing infants with craniofacial malformations - Where to go next? Semin Fetal Neonatal Med 2021; 26:101289. [PMID: 34548245 DOI: 10.1016/j.siny.2021.101289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Treatment of infants with craniofacial malformations, e.g. Robin sequence, is characterized by considerable heterogeneity and a lack of randomized trials to identify an optimal approach. We propose to establish an international register using a common minimal dataset that will better allow for a comparison between key determinants and outcomes in these patients. In infants, this should include an assessment of mandibular micrognathia, glossoptosis, upper airway obstruction, weight gain and mode of feeding. Later on, neurocognition, speech development, hearing and quality of life should also be included. Together, these data will help better to advice parents on which treatment to choose for their baby with a craniofacial malformation.
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Affiliation(s)
- Christian F Poets
- Interdisciplinary Center for Cleft Palate & Craniofacial Malformations and Department of Neonatology, Tübingen University Hospital, Tübingen, Germany.
| | - Veronique Abadie
- Department of General Pediatrics, Reference Center for Rare Diseases "Pierre Robin Sequences and Congenital Sucking-swallowing Troubles", Necker University Hospital, Paris University, France
| | - Corstiaan Breugem
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Emma Children's Hospital - Location AMC, University of Amsterdam, the Netherlands
| | - Colin Wallis
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | - Francois Abel
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | - Christel Chalouhi
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Emma Children's Hospital - Location AMC, University of Amsterdam, the Netherlands
| | - Frea Kruisinga
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Emma Children's Hospital - Location AMC, University of Amsterdam, the Netherlands
| | - Anna-Lisa Sorg
- Interdisciplinary Center for Cleft Palate & Craniofacial Malformations and Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Cornelia Wiechers
- Interdisciplinary Center for Cleft Palate & Craniofacial Malformations and Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
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Filip C, Impieri D, Aagenæs I, Breugem C, Høgevold HE, Særvold T, Aukner R, Lima K, Tønseth K, Abrahamsen TG. Adults with 22q11.2 deletion syndrome have a different velopharyngeal anatomy with predisposition to velopharyngeal insufficiency. J Plast Reconstr Aesthet Surg 2018; 71:524-536. [DOI: 10.1016/j.bjps.2017.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 09/08/2017] [Accepted: 09/13/2017] [Indexed: 11/27/2022]
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Smarius B, Loozen C, Manten W, Bekker M, Pistorius L, Breugem C. Accurate diagnosis of prenatal cleft lip/palate by understanding the embryology. World J Methodol 2017; 7:93-100. [PMID: 29026689 PMCID: PMC5618146 DOI: 10.5662/wjm.v7.i3.93] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/09/2017] [Accepted: 05/31/2017] [Indexed: 02/06/2023] Open
Abstract
Cleft lip with or without cleft palate (CP) is one of the most common congenital malformations. Ultrasonographers involved in the routine 20-wk ultrasound screening could encounter these malformations. The face and palate develop in a very characteristic way. For ultrasonographers involved in screening these patients it is crucial to have a thorough understanding of the embryology of the face. This could help them to make a more accurate diagnosis and save time during the ultrasound. Subsequently, the current postnatal classification will be discussed to facilitate the communication with the CP teams.
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Affiliation(s)
- Bram Smarius
- Division of Pediatric Plastic Surgery, Cleft Palate Team, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Charlotte Loozen
- Division of Pediatric Plastic Surgery, Cleft Palate Team, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Wendy Manten
- Division of Gynecology and Obstetrics, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Mireille Bekker
- Division of Gynecology and Obstetrics, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Lou Pistorius
- Division of Gynecology and Obstetrics, Stellenbosch University and Tygerberg Hospital, Cape Town 7500, South Africa
| | - Corstiaan Breugem
- Division of Pediatric Plastic Surgery, Cleft Palate Team, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
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Smarius B, Breugem C. Surgical learning curve in performing palatoplasty: A retrospective study in 200 patients. J Craniomaxillofac Surg 2015; 43:1868-74. [PMID: 26421467 DOI: 10.1016/j.jcms.2015.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/15/2015] [Accepted: 08/26/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aim of the study was to assess the influence of the experience of the surgeon on the occurrence of fistulas following palatoplasty. MATERIALS AND METHODS A retrospective review was performed of consecutive children treated between 2006 and 2013 for cleft palate by a single surgeon. Cleft palate repair was performed using the von Langenbeck technique, Furlow palatoplasty, buccal flap or Vomer flap. Data was collected for age, sex, date of birth, syndrome, adoption, cleft palate type, type of repair, cleft width, fistula occurrence and location of fistula. RESULTS A total of 276 operations were performed in 200 children (Veau I, II, III, IV). Mean age at surgery was 21.9 months (range: 6.2 months to 26 years 8.3 months). Postoperatively, palatal fistulas occurred in eight patients (4.0%), however, the incidence was 3.0% in the non-adoption group and 9.7% in the adoption population. In this study there was no statistically significant evidence of a surgical learning curve, and no significant associations between fistula rate and sex, adoption, syndrome, cleft type, cleft width, or type of repair. CONCLUSION AND CLINICAL RELEVANCE This study demonstrates a fistula formation rate of 3.0% for the non-adoption population and 9.7% for the adoption population. There was no statistically significant evidence of a learning curve during the first few years of performing cleft palate repair. No other independent risk factors for postoperative fistula formation were identified; however, the benefit of a vomer flap and subsequent reduction in fistula incidence was demonstrated.
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Affiliation(s)
- Bram Smarius
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
| | - Corstiaan Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, P.O. Box 85090, 3508 AB Utrecht, The Netherlands; Department of Plastic Surgery Meander Medical Center, 3813 TZ Amersfoort, The Netherlands
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de Graaf M, Totte J, Breugem C, van Os-Medendorp H, Pasmans S. Evaluation of the Compliance, Acceptance, and Usability of a Web-Based eHealth Intervention for Parents of Children With Infantile Hemangiomas: Usability Study. JMIR Res Protoc 2013; 2:e54. [PMID: 24345450 PMCID: PMC3875905 DOI: 10.2196/resprot.2897] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/30/2013] [Accepted: 10/30/2013] [Indexed: 11/18/2022] Open
Abstract
Background Infantile hemangiomas (IH) are common benign vascular tumors in children. Recognition and timely referral of high risk IH to specialized centers is important. This might be achieved by involving parents in the care for IH by means of an eHealth intervention. Objective The objective of our study was to evaluate parent compliance, acceptance, and usability of an open access, Web-based eHealth intervention (including e-learning and e-consult) designed to increase parents’ knowledge and (risk) evaluation of IH. Methods A cross-sectional study of parents who completed the eHealth intervention between October 2010 and November 2012 was carried out. All parents were sent a study questionnaire. Questions to evaluate compliance (to the advice given by a dermatologist during e-consultation) were asked. Acceptance and usability were evaluated by using the modified Technology Acceptance Model. Results A total of 224 parents completed the eHealth intervention and received the questionnaire, 135/224 parents responded (response rate was 60.3%). There were 128/135 questionnaires that were completed and included. A total of 110/128 (85.9%) parents were compliant to the advice of the dermatologist. There were 116.8/128 (91.3%) that perceived the eHealth intervention as useful and almost all parents (98.4%, 126/128) found the information in the e-learning clear. There were 29/128 (22.7%) that experienced technical problems. The majority of the parents (94.5%, 121/128) found the eHealth intervention reliable and most of them (98.4%, 126/128) would recommend the eHealth intervention to other parents. Noncompliant parents judged the eHealth intervention significantly less reliable compared to compliant parents (71%, 10/14 versus 97.3%, 107/110; P=.003). Conclusions Parents of children with an IH showed a high compliance (85.9%, 110/128) to the advice of the dermatologist given via our Web-based eHealth intervention. This high compliance might be positively influenced by the good acceptance and usability of the eHealth intervention and might result in timely presentation and treatment of children with high risk IH in specialized centers.
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Affiliation(s)
- Marlies de Graaf
- Wilhelmina Children's Hospital, Department of Pediatric Dermatology and Allergology, University Medical Center Utrecht, Utrecht, Netherlands.
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Breugem C, Paes E, Kon M, Mink van der Molen AB, van der Molen ABM. Bioresorbable distraction device for the treatment of airway problems for infants with Robin sequence. Clin Oral Investig 2011; 16:1325-31. [PMID: 22009183 PMCID: PMC3400032 DOI: 10.1007/s00784-011-0624-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/02/2011] [Indexed: 11/28/2022]
Abstract
Pierre Robin sequence is a well known craniofacial entity. There are numerous ways to treat the respiratory insufficiency, but sometimes surgical intervention is needed. Tracheotomy could be associated with morbidity, and distraction osteogenesis has been established as a stable method to obtain a safe airway. Distraction osteogenesis has traditionally been performed with an external device. In this manuscript we describe the feasibility of an internal bioresorbable device. Retrospective descriptive study was performed in a tertiary academic children’s hospital. After multidisciplinary team consultation, 12 consecutive patients with Robin sequence were treated with this internal distraction device. The mean age at surgery was 32 days, and the average amount of mandibular distraction was 18 mm. All patients were extubated after an average of 7.5 days after the surgery. The average length of stay in the hospital was 17 days after surgery. There were no major surgical complications. A tracheotomy was prevented in all our patients, and complications were limited. Long-term studies are needed to evaluate the influence that internal distraction has on the growth of the mandible and teeth. The internal distraction system seems safe for infants with micrognathia and has certain benefits when compared to the external distractor.
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Affiliation(s)
- Corstiaan Breugem
- Cleft Palate Team, Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, PO Box 85090, 3508 AB Utrecht, The Netherlands.
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Maarse W, Bergé SJ, Pistorius L, van Barneveld T, Kon M, Breugem C, Mink van der Molen AB. Diagnostic accuracy of transabdominal ultrasound in detecting prenatal cleft lip and palate: a systematic review. Ultrasound Obstet Gynecol 2010; 35:495-502. [PMID: 20235140 DOI: 10.1002/uog.7472] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To systematically review the diagnostic accuracy of second-trimester transabdominal ultrasound in detecting orofacial clefts in low- and high-risk populations and to compare two-dimensional (2D) with three-dimensional (3D) ultrasound techniques. METHODS MEDLINE and EMBASE were searched for articles published in English, Dutch, French or German using the keywords 'cleft' and 'ultrasound' or 'screening' or 'sonogram' and 'prenatal' or 'antenatal' or 'fetus' to identify cohort studies and randomized trials in order to assess the detection rate by prenatal ultrasound of cleft lip and palate in high-risk and low-risk pregnant women. RESULTS Of 451 citations identified, 27 met the criteria for the systematic review, 21 involving unselected low-risk populations and six involving high-risk populations. In the selected studies there was diversity in the gestational age at which the ultrasound examination was performed and there was considerable variety in the diagnostic accuracy of 2D ultrasound in the low-risk women, with prenatal detection rates ranging from 9% to 100% for cleft lip with or without cleft palate, 0% to 22% for cleft palate only and 0% to 73% for all types of cleft. 3D ultrasound in high-risk women resulted in a detection rate of 100% for cleft lip, 86% to 90% for cleft lip with palate and 0% to 89% for cleft palate only. CONCLUSIONS 2D ultrasound screening for cleft lip and palate in a low-risk population has a relatively low detection rate but is associated with few false-positive results. 3D ultrasound can achieve a reliable diagnosis, but not of cleft palate only.
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Affiliation(s)
- W Maarse
- Department of Plastic and Reconstructive Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, The Netherlands.
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Breugem C, Courtemanche D. Robin Sequence: Clearing Nosologic Confusion. Cleft Palate Craniofac J 2009. [DOI: 10.1597/08-061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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