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Semb G, Enemark H, Friede H, Paulin G, Lilja J, Rautio J, Andersen M, Åbyholm F, Lohmander A, Shaw W, Mølsted K, Heliövaara A, Bolund S, Hukki J, Vindenes H, Davenport P, Arctander K, Larson O, Berggren A, Whitby D, Leonard A, Neovius E, Elander A, Willadsen E, Bannister RP, Bradbury E, Henningsson G, Persson C, Eyres P, Emborg B, Kisling-Møller M, Küseler A, Granhof Black B, Schöps A, Bau A, Boers M, Andersen HS, Jeppesen K, Marxen D, Paaso M, Hölttä E, Alaluusua S, Turunen L, Humerinta K, Elfving-Little U, Tørdal IB, Kjøll L, Aukner R, Hide Ø, Feragen KB, Rønning E, Skaare P, Brinck E, Semmingsen AM, Lindberg N, Bowden M, Davies J, Mooney J, Bellardie H, Schofield N, Nyberg J, Lundberg M, Karsten ALA, Larson M, Holmefjord A, Reisæter S, Pedersen NH, Rasmussen T, Tindlund R, Sæle P, Blomhoff R, Jacobsen G, Havstam C, Rizell S, Enocson L, Hagberg C, Najar Chalien M, Paganini A, Lundeborg I, Marcusson A, Mjönes AB, Gustavsson A, Hayden C, McAleer E, Slevan E, Gregg T, Worthington H. A Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management. J Plast Surg Hand Surg 2017; 51:2-13. [PMID: 28218559 DOI: 10.1080/2000656x.2016.1263202] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project. METHOD Ten established national or regional cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3-4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes. RESULTS Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years. CONCLUSION The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series. TRIAL REGISTRATION ISRCTN29932826.
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Affiliation(s)
- Gunvor Semb
- a Division of Dentistry, University of Manchester , Manchester , UK.,b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.,c Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | | | - Hans Friede
- e Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Gunnar Paulin
- f Department of Dentofacial Orthopedics , University Hospital , Linköping , Sweden
| | - Jan Lilja
- g Department of Plastic Surgery , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Jorma Rautio
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Mikael Andersen
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Frank Åbyholm
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Anette Lohmander
- j Division of Speech and Language Pathology , Karolinska Institute, and Karolinska University Hospital , Stockholm , Sweden
| | - William Shaw
- a Division of Dentistry, University of Manchester , Manchester , UK
| | - Kirsten Mølsted
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Arja Heliövaara
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Stig Bolund
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Jyri Hukki
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Hallvard Vindenes
- k Centre for Cleft Lip and Palate, Bergen University Hospital Haukeland , Bergen , Norway
| | - Peter Davenport
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Kjartan Arctander
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Ola Larson
- m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | - Anders Berggren
- n Department of Plastic Surgery , University Hospital , Linköping , Sweden
| | - David Whitby
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Alan Leonard
- o The Royal Hospital for Sick Children , Belfast , N. Ireland
| | - Erik Neovius
- m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | - Anna Elander
- g Department of Plastic Surgery , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Elisabeth Willadsen
- p Department of Nordic Studies and Linguistics , University of Copenhagen , Denmark
| | - R Patricia Bannister
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | | | - Gunilla Henningsson
- m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | - Christina Persson
- r Institute of Neuroscience and Physiology, Speech and Language Pathology Unit , Sahlgrenska Academy, University of Gothenburg , Sweden.,s Division for Speech and Language Pathology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Philip Eyres
- a Division of Dentistry, University of Manchester , Manchester , UK
| | | | | | - Annelise Küseler
- a Division of Dentistry, University of Manchester , Manchester , UK
| | | | - Antje Schöps
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Anja Bau
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Maria Boers
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | | | - Karin Jeppesen
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Dorte Marxen
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Marjukka Paaso
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Elina Hölttä
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Suvi Alaluusua
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Leena Turunen
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Kirsti Humerinta
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Ulla Elfving-Little
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Inger Beate Tørdal
- c Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | - Lillian Kjøll
- c Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | - Ragnhild Aukner
- c Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | - Øydis Hide
- c Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | | | - Elisabeth Rønning
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Pål Skaare
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Eli Brinck
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Ann-Magritt Semmingsen
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Nina Lindberg
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Melanie Bowden
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Julie Davies
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Jeanette Mooney
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Haydn Bellardie
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Nina Schofield
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Jill Nyberg
- m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | - Maria Lundberg
- m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | | | - Margareta Larson
- u Eastman Institute, Stockholms Läns Landsting , Stockholm , Sweden
| | | | | | | | | | - Rolf Tindlund
- w Dental School, University of Bergen , Bergen , Norway
| | - Paul Sæle
- x Oral Health Center of Expertise/Western Norway , Bergen , Norway
| | - Reidunn Blomhoff
- k Centre for Cleft Lip and Palate, Bergen University Hospital Haukeland , Bergen , Norway
| | - Gry Jacobsen
- k Centre for Cleft Lip and Palate, Bergen University Hospital Haukeland , Bergen , Norway
| | - Christina Havstam
- s Division for Speech and Language Pathology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Sara Rizell
- e Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Lars Enocson
- e Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Catharina Hagberg
- e Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Midia Najar Chalien
- e Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Anna Paganini
- g Department of Plastic Surgery , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Inger Lundeborg
- y Division of Speech and Language Pathology , Linköping University , Linköping , Sweden
| | - Agneta Marcusson
- f Department of Dentofacial Orthopedics , University Hospital , Linköping , Sweden
| | - Anna-Britta Mjönes
- n Department of Plastic Surgery , University Hospital , Linköping , Sweden
| | - Annica Gustavsson
- f Department of Dentofacial Orthopedics , University Hospital , Linköping , Sweden
| | | | - Eilish McAleer
- o The Royal Hospital for Sick Children , Belfast , N. Ireland
| | - Emma Slevan
- o The Royal Hospital for Sick Children , Belfast , N. Ireland
| | - Terry Gregg
- o The Royal Hospital for Sick Children , Belfast , N. Ireland
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