Cleft Palate-Craniofacial Journal最新文献

{"title":"Liposomal Bupivacaine for Additional Analgesia at Iliac Crest Donor Site in Alveolar Bone Graft Surgery: A Retrospective Pilot Study.","authors":"Daniel E Sampson, Robert Tibesar, Maria Tibesar, Mike Finch, Stacey Rabusch, Michael Raschka","doi":"10.1177/10556656251317600","DOIUrl":"https://doi.org/10.1177/10556656251317600","url":null,"abstract":"<p><p>To study postoperative pain control differences between liposomal bupivacaine (LB) and immediate-release bupivacaine (IRB) as measured by the use of narcotics after iliac crest graft harvesting for alveolar bone grafting (ABG).</p><p><p>A retrospective review was completed at a single-site pediatric stand-alone hospital of patients undergoing ABG with iliac crest bone grafting (ICBG) between May 1, 2020, through May 31, 2023.</p><p><strong>Patients, participants: </strong>Patients who underwent ABG with ICBG were split into three cohorts: LB monotherapy, IRB monotherapy, or LB with IRB.</p><p><strong>Interventions: </strong>All ABG and ICBG procedures were completed by a single surgeon who is a member of our dedicated cleft lip and palate team.</p><p><strong>Main outcome measures: </strong>The primary outcome was the difference in oral morphine equivalent (OME) requirements from the immediate postoperative time period to the time of discharge.</p><p><p>Patients treated with LB monotherapy required significantly less OME during their inpatient stay, with an average of 0.21 mg/kg ± 0.15 mg/kg in the LB group, 0.67 mg/kg ± 0.37 mg/kg in the IRB group, and 0.28 mg/kg ± 0.07 mg/kg in the LB with IRB group (<i>P</i> = .001). There was no significant difference in the total number of analgesic medication doses administered throughout the hospitalization among the three groups.</p><p><p>Utilization of LB intraoperatively may decrease the need for postoperative opioid treatment for postoperative pain control when harvesting ICB for ABG in the cleft lip and palate population compared to alternative local anesthetics.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251317600"},"PeriodicalIF":1.1,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Special Issue Introduction: Spotlight on Early-Career Researchers of the American Cleft Palate-Craniofacial Association.","authors":"Katelyn J Kotlarek, James J Cray","doi":"10.1177/10556656251316722","DOIUrl":"https://doi.org/10.1177/10556656251316722","url":null,"abstract":"<p><p>A special issue of the <i>Cleft Palate-Craniofacial Journal</i> was curated to highlight early-career researchers of the American Cleft Palate-Craniofacial Association and their innovative research contributions. This collection of 13 manuscripts, all led by early-career researcher authors of diverse disciplines and training, represents a wide variety of topics related to the science surrounding craniofacial care.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251316722"},"PeriodicalIF":1.1,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robin Sequence and Isolated Cleft Palate are Associated With a High Prevalence of Obstructive Sleep Apnea in School-Aged Children.","authors":"Fábio Luiz Banhara, Ivy Kiemle Trindade-Suedamm, Inge Elly Kiemle Trindade, Lais Mota Furtado Sena, Sergio Henrique Kiemle Trindade","doi":"10.1177/10556656251316409","DOIUrl":"https://doi.org/10.1177/10556656251316409","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the prevalence of obstructive sleep apnea (OSA) in children aged 6 to 12 years with nonsyndromic Robin sequence (NSRS) and in those with nonsyndromic cleft palate (NSCP). All patients presented complete cleft palate (Veau II).</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Tertiary public hospital.</p><p><strong>Patients: </strong>A total of 146 children divided into 2 groups: (1) NSRS (n = 69), (2) NSCP (n = 77).</p><p><strong>Interventions: </strong>(1) Anthropometric assessment, dentoskeletal, and facial analysis. (2) Clinical interview with \"Sleep Disturbance Scale for Children\" and \"Congestion Quantifier Five-Item\" (CQ5); and (3) 48 patients: Type IV polysomnography.</p><p><strong>Main outcome measures: </strong>Frequency of OSA in children with NSRS and NSCP, assessed by Type IV polysomnography.</p><p><strong>Results: </strong>Positive scores for OSA were found in 59.42% of children with NSRS and 46.75% of those with NSCP (<i>P</i> > .05). Excessive daytime sleepiness was observed in 23.19% of the NSRS group and 9.01% of the NSCP group (<i>P</i> > .05). Positive scores for nasal obstruction were noted in 14.49% with NSRS and 20.78% of those with NSCP (<i>P</i> > .05). In polysomnography IV subgroups, an Oxygen Desaturation Index compatible with mild to moderate OSA was observed in 89.65% of the NSRS group and 78,94% of the NSCP group (<i>P</i> > .05). Also, facial and pharyngeal alterations, such as Angle Class II malocclusion, Mallampati classifications III and IV, and deep crossbite, were associated with OSA.</p><p><strong>Conclusion: </strong>Both children with NSRS and NSCP have a high frequency of mild to moderate OSA, highlighting the need for systematic evaluation of the presence of sleep-disordered breathing in this population.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251316409"},"PeriodicalIF":1.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Health Determinants in Cleft Palate Patients.","authors":"Katherine E Baker, Anna G Boydstun, Mary E McMinn, Emily E Hecox, Shelley R Edwards, Savannah C Walker, Laura S Humphries, Ian C Hoppe","doi":"10.1177/10556656251316081","DOIUrl":"https://doi.org/10.1177/10556656251316081","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to analyze health determinants affecting patients with cleft palate, specifically examining the relationships between the Social Vulnerability Index (SVI), failure to thrive (FTT), and healthcare utilization within the initial 30 days and first year of life.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients with a cleft palate at a tertiary care center over an 11-year period. Data included demographics, weight percentile trends, pediatric emergency department (PED) visits, hospital admissions, SVI scores, cleft palate type, and FTT diagnoses. Statistical analyses were performed using SPSS.</p><p><strong>Results: </strong>Social Vulnerability Index was not significantly correlated with health outcomes in cleft palate. Patients with FTT exhibited lower gestational age (<i>P</i> = .002) and birth (<i>P</i> = .005), one-month (<i>P</i> = .001), and one-year (<i>P</i> = .001) weight percentiles. FTT diagnosis was associated with increased PED visits (<i>P</i> = .000) and hospital admission (<i>P</i> = .000) in the first year of life. Early presentation to the PED was associated with increased PED visits (<i>P</i> = .000) and hospital admissions (<i>P</i> = .004) within the first year of life.</p><p><strong>Conclusion: </strong>No direct link was found between SVI and FTT. Early hospital readmission emerged as a significant outcome, indicating increased healthcare utilization in patients that require early medical intervention. Failure to thrive significantly impacted healthcare utilization, emphasizing the importance of addressing feeding issues early in this patient population. This study contributes to understanding health disparities in cleft palate patients and highlights the need for nuanced exploration of regional factors influencing outcomes.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251316081"},"PeriodicalIF":1.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It's Time to Define the Global Burden of Velopharyngeal Insufficiency.","authors":"Noah Alter, Amy Stone, Maria Powell, Elisa J Gordon, Beyhan Anan, Usama Hamdan, Zhijun Yin, Matthew E Pontell","doi":"10.1177/10556656251316084","DOIUrl":"https://doi.org/10.1177/10556656251316084","url":null,"abstract":"<p><p>Velopharyngeal insufficiency (VPI) predominantly affects children with cleft palate, undermining their ability to communicate. As a result, intelligible speech generation is one of the most important outcomes following cleft palate repair. In low- and middle-income countries (LMICs), the elevated incidence of cleft palate, unavailability of speech services, and suboptimal surgical outcomes has contributed to a substantial yet poorly defined global burden of VPI. Tracking speech outcomes in LMICs is essential to assessing VPI severity and identifying patients needing care. Artificial intelligence and machine learning are well-suited to accommodate this goal.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251316084"},"PeriodicalIF":1.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Near-Normalized Maxillomandibular Relationship and Upper Airway in Infants With Robin Sequence Treated With Stanford Orthodontic Airway Plate\".","authors":"G Dave Singh","doi":"10.1177/10556656251313846","DOIUrl":"https://doi.org/10.1177/10556656251313846","url":null,"abstract":"<p><p>It's interesting to note that despite clinical improvements in upper airway dimensions, the maxillary, mandibular, and mandibular body lengths remained smaller than those of controls. This finding may represent an underlying neurocristopathy, which represents a deficiency in the population of neural crest cells available in the embryonic maxillary and mandibular processes de novo. Indeed, it is known that craniofacial dimensions in infants with malformations, such as cleft palate, are often smaller when compared to non-cleft counterparts. The post-treatment decrease in the SNA angle and increase in angle SNB, which resulted in a decreased ANB angle may be associated with a \"headgear effect\" whereby the maxilla is dragged postero-inferiorly by the mandible, aided by gravity. To avoid this effect, proactive maxillary development might be beneficial. In fact, the concept of \"catch-up growth\" is also noteworthy since a developmental mechanism would need to be invoked. The authors referred to the old Functional matrix hypothesis, but the treatment effect was primarily a change in jaw position, which evoked a positive functional outcome. Thus, according to the Spatial matrix hypothesis, clinical decompensation of a dysfunctional spatial matrix leads to a cascade of events since a change in mandibular position is associated with changes in gene expression. Recently, genetic expression of Sdf1 and Foxc1 associated with histologic changes following mandibular advancement in rats has been reported as well as the effects of the PINK1/Parkin pathway on the genioglossus muscle through mandibular advancement device use in rabbits with obstructive sleep apnea. Clinically, therapeutic epigenetic changes using an orthodontic mandibular advancement device have also been reported in children.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251313846"},"PeriodicalIF":1.1,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cleft Lip and Palate Research in the United Kingdom: Advances in Clinical Psychological Knowledge and Future Directions.","authors":"Matthew Hotton, Laura Shepherd, Nicola M Stock","doi":"10.1177/10556656251315659","DOIUrl":"https://doi.org/10.1177/10556656251315659","url":null,"abstract":"<p><p>In 2012, the James Lind Alliance (JLA) worked with individuals with cleft lip and/or palate (CL/P), their families and clinicians to identify priority areas for future research. This article reviews progress conducted in the United Kingdom in the 3 JLA priorities most closely related to Clinical Psychology. It then builds upon the original priorities to identify 4 future directions, based on contemporary literature and in-depth discussions between clinical and research experts. Finally, recommendations for next steps toward meeting these future directions are outlined, including consistent outcome measurement, engaging diverse groups of people with CL/P and embedding the principles of codesign.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251315659"},"PeriodicalIF":1.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Uvular Repair in Children Undergoing Palatoplasty.","authors":"Pritham N Shetty, Krishnamurthy Bonanthaya, Centina Rose John, Dipesh Rao","doi":"10.1177/10556656251315656","DOIUrl":"https://doi.org/10.1177/10556656251315656","url":null,"abstract":"<p><strong>Background: </strong>Paucity exists in the literature on uvular repair while documenting palatoplasty techniques for children with cleft palate.</p><p><strong>Solution: </strong>We propose a modified approach without losing any soft tissue structures, gaining better cosmetic outcome, and possibly having functional gains postoperatively.</p><p><strong>What we did that is new: </strong>The proposed technique provides better cosmesis for the structures postoperatively and enhances the palatoglossal arch, which may prevent the spillage of saliva to the oropharyngeal region.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251315656"},"PeriodicalIF":1.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-Year Progressive Cranial Changes Following the Melbourne Technique for Sagittal Craniosynostosis.","authors":"Lucas M Harrison, Kayla Prezelski, Rami R Hallac, Alex A Kane, Paymon Sanati-Mehrizy","doi":"10.1177/10556656251314966","DOIUrl":"https://doi.org/10.1177/10556656251314966","url":null,"abstract":"<p><strong>Objective: </strong>The Melbourne technique for total cranial vault remodeling aims to address all aspects of scaphocephaly in sagittal craniosynostosis. These features include anterior-posterior excessive length, anteriorly displaced vertex position, frontal bossing, vertex narrowing, and occipital bulleting. This study aimed to determine the progressive cranial changes that occur following the Melbourne technique for sagittal craniosynostosis.</p><p><strong>Design: </strong>Retrospective review of 3-dimensional images collected preoperatively and postoperatively at 3 weeks, 3 months, 1 year, and 2 years.</p><p><strong>Setting: </strong>Tertiary care pediatric institution.</p><p><strong>Participants: </strong>Twenty-five patients with sagittal craniosynostosis.</p><p><strong>Interventions: </strong>The Melbourne technique for total cranial vault remodeling.</p><p><strong>Main outcome measure(s): </strong>Head circumference, cephalic index, frontal bossing index, occipital bulleting index, vertex narrowing index, and vertex-nasion-opisthocranion (VNO) angle were evaluated.</p><p><strong>Results: </strong>The cephalic index significantly increased postoperatively (<i>P</i> = .04) with a subsequent relapse at 3 months followed by progressively increased growth. The frontal bossing index significantly decreased postoperatively (<i>P</i> = .02) with a progressive decrease. The occipital bullet index had a relative decline postoperatively with relapse at 3 months, followed by a progressive decrease. The vertex narrowing index significantly decreased postoperatively (<i>P</i> < .001), with a plateau and slight relapse. The VNO angle showed a relative decline over time with a significant decrease by 1 year of age (<i>P</i> = .002).</p><p><strong>Conclusions: </strong>The Melbourne technique improved the cephalic index, frontal bossing, vertex narrowing, occipital bulleting, and vertex positioning at 2 years of age. Cephalic index and occipital bulleting showed slight relapse at 3 months, followed by progressive improvement over time.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251314966"},"PeriodicalIF":1.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Exploratory Analysis of Early Care Differences and Risk of Post-Maxillary Advancement VPI in Individuals With Cleft Palate.","authors":"Sara Kinter, Hitesh Kapadia, Srinivas Susarla","doi":"10.1177/10556656241304215","DOIUrl":"https://doi.org/10.1177/10556656241304215","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether differences in early cleft care increase risk of velopharyngeal insufficiency (VPI) after maxillary advancement.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Large pediatric tertiary care hospital.</p><p><strong>Patients/participants: </strong>Adolescents and young adults (AYAs) with cleft palate (∓cleft lip) who underwent maxillary advancement between 2008 and 2019.</p><p><strong>Interventions/comparisons: </strong>Initial palate repair at a different institution (early care elsewhere, ECE) versus care at a single institution (consistent care, CC).</p><p><strong>Main outcome measures: </strong>Post-maxillary advancement VPI.</p><p><strong>Results: </strong>One-hundred seventy-eight AYAs underwent maxillary advancement, 74 in the ECE group and 104 in the CC group. The ECE group was more likely to be internationally adopted (34% versus 4%), to have a history of VPI surgery (54% versus 32%) and to be older at time of palate repair (mean 25 versus 16 months). Of anatomical measures, only velar length differed, with the ECE group tending to have a shorter velum (mean 26 mm versus 28 mm). Proportional odds regression revealed increased odds of post-operative VPI in the ECE group (OR 1.46, 95% CI 0.75-2.85) relative to the CC group. This relationship was stronger among those with bilateral cleft lip and palate (OR 3.29, 95% CI 0.86-13.52). For patients with history of prior VPI surgery, the odds of post-operative VPI in the ECE group was more than 3 times that in the CC group (OR 3.06, 95% CI 1.08-9.16).</p><p><strong>Conclusions: </strong>VPI after maxillary advancement is more likely among individuals who received early cleft care elsewhere compared to those who underwent all cleft operations at a single center.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656241304215"},"PeriodicalIF":1.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}