Cleft Palate-Craniofacial Journal最新文献

{"title":"A Longitudinal Analysis of Pre- and Post-Operative Dysmorphology in Metopic Craniosynostosis.","authors":"Justin W Beiriger, Wenzheng Tao, Zhazira Irgebay, John Smetona, Lucas Dvoracek, Nicolás M Kass, Angel Dixon, Casey Zhang, Meeti Mehta, Ross Whitaker, Jesse A Goldstein","doi":"10.1177/10556656241237605","DOIUrl":"10.1177/10556656241237605","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study is to objectively quantify the degree of overcorrection in our current practice and to evaluate longitudinal morphological changes using CranioRate^TM, a novel machine learning skull morphology assessment tool.  Design:Retrospective cohort study across multiple time points.</p><p><strong>Setting: </strong>Tertiary care children's hospital.</p><p><strong>Patients: </strong>Patients with preoperative and postoperative CT scans who underwent fronto-orbital advancement (FOA) for metopic craniosynostosis.</p><p><strong>Main outcome measures: </strong>We evaluated preoperative, postoperative, and two-year follow-up skull morphology using CranioRate^TM to generate a Metopic Severity Score (MSS), a measure of degree of metopic dysmorphology, and Cranial Morphology Deviation (CMD) score, a measure of deviation from normal skull morphology.</p><p><strong>Results: </strong>Fifty-five patients were included, average age at surgery was 1.3 years. Sixteen patients underwent follow-up CT imaging at an average of 3.1 years. Preoperative MSS was 6.3 ± 2.5 (CMD 199.0 ± 39.1), immediate postoperative MSS was -2.0 ± 1.9 (CMD 208.0 ± 27.1), and longitudinal MSS was 1.3 ± 1.1 (CMD 179.8 ± 28.1). MSS approached normal at two-year follow-up (defined as MSS = 0). There was a significant relationship between preoperative MSS and follow-up MSS (R²= 0.70).</p><p><strong>Conclusions: </strong>MSS quantifies overcorrection and normalization of head shape, as patients with negative values were less \"metopic\" than normal postoperatively and approached 0 at 2-year follow-up. CMD worsened postoperatively due to postoperative bony changes associated with surgical displacements following FOA. All patients had similar postoperative metopic dysmorphology, with no significant association with preoperative severity. More severe patients had worse longitudinal dysmorphology, reinforcing that regression to the metopic shape is a postoperative risk which increases with preoperative severity.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1144-1150"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133042","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":"Assessing Appearance, Speech, and Hearing (dis)Satisfaction in Individuals with Cleft Lip and/or Palate: A Contribution to General Population Norms.","authors":"Nicola M Stock, Bruna Costa, Paul White, Lauren Eve, Amanda J Bates","doi":"10.1177/10556656241241127","DOIUrl":"10.1177/10556656241241127","url":null,"abstract":"<p><p>BackgroundIndividuals with cleft lip and/or palate (CL/P) may grow up with a visible facial difference, alongside speech and/or hearing challenges. Self-perceptions are stronger predictors of psychosocial adjustment than objective assessments, highlighting the importance of patient-reported outcome measures. Previously titled the Satisfaction with Appearance (SwA) questionnaire, the Cleft Hearing, Appearance and Speech Questionnaire (CHASQ) has been used in several countries to assess patient satisfaction, guide clinical decision-making, and conduct craniofacial research, but has lacked general population norms from which to draw comparisons. The aim of this study was to contribute to the development of norms by utilising existing data collected in the United Kingdom (UK) in 2004 using the original SwA.MethodsSwA data collected from school pupils (<i>n</i> = 761) aged 10-16 years were analysed across age and gender.ResultsHair, Eyes and Ears received the highest ratings, while Teeth received the lowest ratings. Those who were younger, and those who were male, generally rated their appearance more favourably. Thresholds are proposed to identify young people in need of clinical monitoring (10%) and intervention (5%).DiscussionThis study supports the potential of the CHASQ as a clinically useful outcome measure and research tool with the ability to identify appearance concerns in relation to specific facial features, as well as overall appearance satisfaction in young people with and without CL/P. Further validation of its use in the CL/P population and other patient groups, as well as countries outside the UK would add additional weight to the CHASQ's utility.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1201-1209"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177349","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":"Early Utilization of Ketorolac in Cleft Palate Repair.","authors":"Alexandra Michalowski, Vikash Modi","doi":"10.1177/10556656241250138","DOIUrl":"10.1177/10556656241250138","url":null,"abstract":"<p><p>ObjectiveTo determine the effect of ketorolac on opiate requirement and hospital length of stay after palatoplasty.DesignThis was a retrospective chart review.SettingThis study was completed at an urban tertiary medical center.PatientsThose who underwent palatoplasty with a pediatric otolaryngologist between 2010-2020.InterventionsIncorporation of standing Ketorolac into the immediate post-operative pain regimen.Main outcome measuresT-test analysis was performed to determine whether initiation of ketorolac within 24 h post-palatoplasty was correlated with shorter length hospitalization or reduced opiate requirement.ResultsA total of 55 pediatric subjects (49.1% female) were included in this study. Average age at time of surgery was 13 months (range 9.9-33.9 months). On two tailed t-test, use of ketorolac within the first 24 h after palatoplasty was associated with shorter length of stay (mean of 1.68 vs 2.57 days, t = 2.58, <i>P</i> = .01) and lower total opiate dosage during hospitalization (mean of 2.8 vs 9.16 morphine milligram equivalents, t = 3.37, <i>P</i> = .001).ConclusionsAmong patients undergoing palatoplasty, there is a significant relationship between the early utilization of ketorolac and decreased length of hospitalization as well as decreased opiate requirement. This has important consequences to help improve pain control with reduced opiates requirement as well as length of stay. Future prospective studies can help elicit the causative effect of Ketorolac on these parameters and can investigate whether use of Ketorolac has an effect on long term recovery and post-discharge opiate requirements as well.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1103-1106"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094507","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":"Novel Technique for Median Cleft Lip Comprising the Simultaneous Formation of the Columella, Philtrum, and Cupid's Bow.","authors":"Hikaru Fujito, Naritaka Kimura, Hikaru Moriyama, Syouta Matsuda, Hiroya Mihara","doi":"10.1177/10556656241253411","DOIUrl":"10.1177/10556656241253411","url":null,"abstract":"<p><p>Numerous surgical techniques for median cleft lip repair have been described; however, most cause excessively sharp peaks or the collapse of Cupid's bow. We report a technique for median cleft lip repair using a mucosal skin flap and full-thickness skin graft and 15 years of follow-up. Our technique provides acceptable formation of the columella, philtrum, and the two peaks of Cupid's bow. In this paper, we cite our previously reported techniques and add new findings and discussion based on the long-term postoperative outcomes of this procedure. Advantages and disadvantages of this technique are discussed, and a possible solution to achieve a more satisfactory result is suggested. Advantages and disadvantages of this new technique are discussed, and a possible solution to achieve a more satisfactory result is suggested.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1257-1262"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858758","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 Summit 2022: The Impact of a Unified Voice.","authors":"Raj M Vyas, Wassim Najjar, Joseph E Losee, Ann W Kummer, Usama S Hamdan","doi":"10.1177/10556656241242699","DOIUrl":"10.1177/10556656241242699","url":null,"abstract":"<p><p>ObjectiveThe inaugural Cleft Summit aimed to unite experts and foster interdisciplinary collaboration, seeking a collective understanding of velopharyngeal insufficiency (VPI) management.DesignAn interactive debate and conversation between a multidisciplinary cleft care team on VPI managementSettingA two-hour discussion within a four-day comprehensive cleft care workshop (CCCW).ParticipantsThirty-two global leaders from various cleft disciplinesInterventionsCleft Summit that allows for meaningful interdisciplinary collaboration and knowledge exchange.Main Outcome MeasuresAbility to reach consensus on a unified statement for VPI management.ResultsParticipants agreed that a patient with significant VPI and a dynamic velum should first receive a surgery that lengthens the velum to optimize patient outcome. A global, multicenter prospective study should be done to test this hypothesis.ConclusionThe 1st Cleft Summit successfully distilled global expertise into actionable best-practice guidelines through iterative discussions, fostering interdisciplinary collaboration and paving the way for a transformative multi-center prospective study on VPI care.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1268-1270"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860603","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":"Tranexamic Acid: Safeguarding Children with Craniosynostosis from Bleeding. A Review Article.","authors":"Khildan Miftahul Firdaus, Lucky Andriyanto, Adil Jihad Muhammad, Tatang Bisri","doi":"10.1177/10556656241239527","DOIUrl":"10.1177/10556656241239527","url":null,"abstract":"<p><p>Craniosynostosis is a congenital condition characterized by the premature closure of one or more sutures in the skull after birth, often necessitating urgent surgical intervention. Nevertheless, cranial vault reconstruction surgery can cause rapid and massive blood loss. This procedure requires a blood transfusion, which entails potential hazards. In addition, the hemostatic system in children differs significantly from that in adults, resulting in increased bleeding during surgical procedures. We conducted a comprehensive literature review in the PubMed, Scopus, and Web of Science databases, referring to their inception for studies on the use of tranexamic acid in pediatric craniosynostosis surgery. Selection criteria were based on the relevance of tranexamic acid, its clinical efficacy, and its safety profile in pediatric populations. Authoritative reviews were considered to ensure a comprehensive synthesis of current knowledge and practice trends in the field. We determined that a low loading dose of 10 mg/kg followed by a maintenance dose of 5 mg/kg/h is as effective as a high dose of 50 mg/kg followed by a maintenance dose of 10 mg/kg/h of tranexamic acid when administered after induction of anesthesia through skin closure and can reduce blood loss by up to 72% and total packed red blood cell transfusion by up to 85%. No difference in safety profile is observed. We concluded that a low dose of tranexamic acid, administered as a loading dose followed by a maintenance dose, is beneficial and safe for reducing blood loss and transfusion following craniosynostosis surgery.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1249-1256"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132987","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":"Can MRI Replace Nasopharyngoscopy in the Evaluation of Velopharyngeal Insufficiency?","authors":"Jessica L Williams, Jamie L Perry, Taylor D Snodgrass, Davinder J Singh, M'hamed Temkit, Thomas J Sitzman","doi":"10.1177/10556656241239459","DOIUrl":"10.1177/10556656241239459","url":null,"abstract":"<p><p>ObjectiveTo investigate whether flexible nasopharyngoscopy, when performed in addition to magnetic resonance imaging (MRI), influences the type of surgery selected or success of surgery in patients with velopharyngeal insufficiency (VPI).DesignCohort study.SettingA metropolitan children's hospital.PatientsPatients with non-syndromic, repaired cleft palate presenting for management of VPI.InterventionsMRI and nasopharyngoscopy or MRI alone for preoperative imaging of the velopharyngeal mechanism.Main Outcome Measures(1) Surgical selection and (2) resolution of hypernasality. All speech, MRI, and nasopharyngoscopy measurements were performed by raters blinded to patients' medical and surgical history.ResultsOf the 25 patients referred for nasopharyngoscopy, 76% completed the exam. Of the 41 patients referred for MRI, the scan was successfully completed by 98% of patients. Completion of nasopharyngoscopy was significantly (p=0.01) lower than MRI. Surgical selection did not significantly differ (p=0.73) between the group receiving MRI and nasopharyngoscopy and the group receiving MRI alone, nor was there a significant difference between these groups in the proportion of patients achieving resolution of hypernasality postoperatively (p=0.63). Percent total velopharyngeal closure assessments on nasopharyngoscopy and MRI were strongly correlated (r=0.73).ConclusionsIn patients receiving MRI as part of their preoperative VPI evaluation, the addition of nasopharyngoscopy did not result in a difference in surgical selection or resolution of hypernasality. Routine inclusion of nasopharyngoscopy may not be necessary for the evaluation of velopharyngeal anatomy when MRI is available.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1093-1102"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11401959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-Related Quality of Life in Mexican Children and Adolescents with Non-Syndromic Craniosynostosis.","authors":"Julieta Moreno-Villagómez, Miguel Castillo-Mimila, Guillermina Yáñez-Téllez, Belén Prieto-Corona, Antonio García-Méndez","doi":"10.1177/10556656241242916","DOIUrl":"10.1177/10556656241242916","url":null,"abstract":"<p><strong>Objective: </strong>Assess the Health-Related Quality of Life in children and adolescents with non-syndromic craniosynostosis and compare it with participants without craniosynostosis.</p><p><strong>Design: </strong>Non-experimental, cross-sectional design.</p><p><strong>Setting: </strong>The assessment was done remotely and the instrument was sent via chat or email.Patients/ Participants:Participants (ages 8-17) with non-syndromic craniosynostosis (n = 27) and without craniosynostosis (n = 26).</p><p><strong>Main outcome measure(s): </strong>We used an adapted version for the Mexican population of the Health-Related Quality of Life Questionnaire for Children and Adolescents -KIDSCREEN-52.</p><p><strong>Results: </strong>All scores were in the average clinical range and both groups scored similarly in all domains except those with craniosynostosis were significantly lower in the Social Support and Peers domain (r_pb= 0.48).</p><p><strong>Conclusions: </strong>Children and adolescents with non-syndromic craniosynostosis reported similar Health-Related Quality of Life as the control group, except for the Social Support domain, which should be investigated in future studies.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1271-1274"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Sagittal Lip Changes in Patients with Bilateral Cleft Lip Post Abbe Flap Reconstruction.","authors":"John N Muller, Allison Diaz, Alexandra Verzella, David A Staffenberg, Roberto L Flores","doi":"10.1177/10556656241255478","DOIUrl":"10.1177/10556656241255478","url":null,"abstract":"<p><p>ObjectivesTo objectively quantify results of sagittal lip changes following Abbe flap reconstruction in patients with bilateral cleft lip.DesignRetrospective, observational study.SettingSingle institution, 8-year retrospective review.Patients/ParticipantsIn total, 17 patients with bilateral cleft lip that underwent Abbe flap reconstruction were included in this study.InterventionPatients had lateral photographs taken prior to Abbe flap reconstruction and at least 8 months post-Abbe flap.Main Outcome MeasurementsVegter's index, Sushner's S2 line and Burstone's B line reference lines were used for evaluation of sagittal lip changes. Wilcoxon signed rank tests were used in analysis.ResultsThe mean pre-Abbe flap upper to lower lip ratio, defined as Vegter's Lip Index, was 0.906 compared to a mean of 0.946 following Abbe flap reconstruction. The mean upper to lower lip ratio for Sushner's S2 and Burstone's B line exhibited an increase in upper lip sagittal projection from -0.164 to 1.459 and 0.259 to 0.957, respectively (P < 0.001).ConclusionsThis study quantifies sagittal changes to upper and lower lip position after Abbe flap reconstruction. These findings may aid in operative planning and patient/caregiver expectations during counseling.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1107-1113"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248907","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":"Is There Utility in Preoperative Testing of Hemoglobin Before Primary Cheiloplasty?","authors":"Aryan Shay, Megan Gaffey, Roger Roe, Alexa Robbins, Isabella Zaniletti, Adam Johnson, Larry Hartzell","doi":"10.1177/10556656241239510","DOIUrl":"10.1177/10556656241239510","url":null,"abstract":"<p><p>ObjectiveTo examine whether a preoperative hemoglobin of less than 10 g/dL is associated with a higher rate of perioperative complications.DesignRetrospective review.SettingTertiary academic hospital at Arkansas Children's Hospital of Little Rock, Arkansas.PatientsA retrospective chart review evaluated patients undergoing primary cleft lip surgery from 2012 to 2017.InterventionsNo prospective intervention was performed for this study care.Main Outcome MeasuresAge, sex, medical history, weight, and perioperative complications. Hemoglobin level was collected in the preoperative area. The primary outcome was rate of perioperative complications including infection, dehiscence, return to the operating room, unplanned admission, and emergency department visit within two weeks postoperatively.Results105 patients undergoing primary cheiloplasty met inclusion criteria. Hemoglobin levels were obtained on all patients. 93.3% (n = 98) of patients had a hemoglobin of >10 g/dL before surgery, and 6.6% (n = 7) had levels <10 g/dL. 1 of 7 patients with a hemoglobin of <10 g/dL experienced a postoperative complication (Tet spell) and one patient with a hemoglobin of >10 g/dL experienced a postoperative complication (unplanned intensive care admission for respiratory distress).ConclusionsPost-operative complications are rare after primary cheiloplasty in patients with low or normal hemoglobin levels. The results of this study show that a preoperative hemoglobin of <10 g/dL does not predict perioperative complications in patients undergoing primary cheiloplasty.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1175-1179"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137330","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}