Cleft Palate-Craniofacial Journal最新文献

{"title":"A Single Institution 19 Year Comparison of Furlow and Straight Line Palatoplasty Techniques in Bilateral Cleft Lip and Palate.","authors":"Collean Trotter, Dylan G Choi, Idean Roohani, Sarah Alfeerawi, Priyanka Naidu, Pasha Shakoori, Artur Fahradyan, Jessica A Lee, William P Magee, Mark M Urata, Jeffrey A Hammoudeh","doi":"10.1177/10556656241239203","DOIUrl":"10.1177/10556656241239203","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to compare patients' speech correcting surgery and fistula rates between the Furlow and Straight Line (SLR) palatoplasty techniques when combined with greater palatine flaps for complete bilateral cleft lip and palate (BCLP) repair.</p><p><strong>Design: </strong>This was a single-center IRB approved retrospective cohort study.</p><p><strong>Setting: </strong>This study took place at an urban tertiary academic center.</p><p><strong>Patients, participants: </strong>All patients with BCLP anomalies that underwent repair between January 2003 and August 2022 were included. Patients with index operations at an outside institution or incomplete medical charting were excluded.</p><p><strong>Interventions: </strong>A total of 1552 patients underwent palatoplasty during the study period. Of these, 192 (12.4%) met inclusion criteria with a diagnosis of BCLP.</p><p><strong>Main outcome measures: </strong>Primary outcomes of this study included rate of fistula and incidence of speech correcting surgery. Secondary outcomes included rate of surgical fistula repair.</p><p><strong>Results: </strong>One hundred patients underwent SLR (52.1%) and 92 Furlow repair (47.9%). There was no significant difference in fistula rates between the SLR and Furlow repair cohorts (20.7% vs. 15.0%; p = 0.403). However, SLR was associated with lower rates of speech correcting surgery when compared to the Furlow repair (12.5% vs. 29.6%; p = 0.011).</p><p><strong>Conclusions: </strong>This study compares the effect of Furlow and SLR on speech outcomes and fistula rates in patients with BCLP. Our findings suggest that SLR resulted in an almost three times lower rate of velopharyngeal dysfunction requiring surgical intervention in patients with BCLP, while fistula rates remained similar.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1134-1143"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144468","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":"Eyeing Risks: A Critical Analysis of the Use of Periorbital Steroids in Fronto-orbital Advancement.","authors":"Daniel Y Cho, Jessica D Blum, Nicole Kurnik, Jordan W Swanson, Srinivas M Susarla, Jesse A Taylor, Richard A Hopper, Scott Bartlett, Craig B Birgfeld","doi":"10.1177/10556656241241963","DOIUrl":"10.1177/10556656241241963","url":null,"abstract":"<p><p>ObjectiveTo evaluate the outcomes associated with two techniques of periorbital steroid administration in bilateral fronto-orbital advancement (FOA).DesignMulti-institutional retrospective chart reviewSettingTwo high volume, tertiary US craniofacial centersPatients, ParticipantsPatients who underwent FOA between 2012 and 2021InterventionsPatients were divided into three cohorts based on method of steroid administration. Groups GEL and INJ represent those who received steroids in the form of triamcinolone soaked gelfoam or direct injection of dilute triamcinolone to the frontal/periorbital region, respectively. Group NON did not receive any periorbital steroids.Main Outcome Measure(s)Peri-operative outcomes including hospital length of stay and complications were evaluated based on method of periorbital steroid administration. Variables predictive of infectious complications were assessed using stepwise logistic regression.ResultsFour hundred and twelve patients were included in our sample (INJ:249, GEL:87, NON:76). Patients in the INJ group had a higher ASA class (<i>P</i> < .001) while patients in the NON group were significantly more likely to be syndromic (<i>P</i> < .001) and have multisuture craniosynostosis (<i>P</i> < .001). Rate of infectious complications for each cohort were NON: 2.6%, INJ: 4.4%, and GEL: 10.3%. There was no significant difference between groups in hospital length of stay (<i>P</i> = .654) or rate of post-operative infectious complications (<i>P</i> = .061). Increased ASA class (<i>P</i> = .021), increased length of stay (<i>P</i> = .016), and increased intraoperative narcotics (<i>P</i> = .011) were independent predictors of infectious complications.ConclusionsWe identified a dose-dependent relationship between periorbital steroids and rate of postoperative infections, with key contributions from ASA class, hospital length of stay, and dose of intraoperative narcotics.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1210-1218"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307597","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":"Elastic Chain Premaxillary Retraction Appliance Does Not Increase Inter-Canthal Dimension in Patients with Bilateral Cleft Lip and Palate.","authors":"Hamad Burashed, Cory M Resnick, Elizabeth E Ross, John B Mulliken, Bonnie L Padwa","doi":"10.1177/10556656241241200","DOIUrl":"10.1177/10556656241241200","url":null,"abstract":"<p><p>ObjectiveTo determine if the elastic chain premaxillary retraction (ECPR) appliance increases inter-medial and inter-lateral canthal dimension in patients with bilateral complete cleft lip and palate (BCLP).DesignRetrospective cohort study.SettingSpecialized tertiary care facility.Patients, Participants126 patients with BCLP; 75 had ECPR, 51 had no pre-surgical manipulation.InterventionsThree-dimensional facial photographs were obtained prior to insertion of appliance (T0), post-appliance therapy prior to appliance removal/labial repair (T1), and several months after labial repair (T2) for a longitudinal ECPR group, and were obtained after age 4 years (T3) for a non-longitudinal ECPR group and for the non-ECPR group.Main Outcome MeasuresInter-medial and inter-lateral canthal dimension (en-en, ex-ex) was determined for all groups/time-points. Measurements were compared between groups and to norms.ResultsThe mean en-en and ex-ex was 32.6 ± 3.2 mm and 84.4 ± 6.3 mm for the ECPR group and 33.5 ± 3.1 mm and 86.7 ± 7.2 mm for the non-ECPR group at T3. Inter-medial and inter-lateral canthal dimensions were significantly greater than normal (<i>P</i> < .05) in both groups; there was no significant difference between groups (<i>P</i> > .05). The mean en-en and ex-ex for the Longitudinal ECPR group was 27.5 ± 2.4 mm and 66.7 ± 3.7 mm at T0, 29.6 ± 2.4 mm and 70.4 ± 2.9 mm at T1, and 29.2 ± 2.3 mm and 72.3 ± 3.8 mm at T2. en-en and ex-ex increased significantly from T0-T1 (<i>P</i> < .05), decreased at T2 (<i>P</i> > .05) and was significantly larger than normal at all time-points (<i>P</i> < .05).ConclusionsInter-medial and inter-lateral canthal dimension increased after ECPR but returned to baseline growth trajectory. These dimensions were above normal at all time-points. There was no difference between those that did and did not have dentofacial orthopedic manipulation.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1195-1200"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186104","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":"Barriers in Cleft Service Access in Sub-Saharan Africa: A Thematic Analysis of Practical Needs of Rural Families.","authors":"Abdurrazaq Olanrewaju Taiwo, Uta Lehmann, Vera Scott, Isah Shafi'u, Suleman Gusau Lawal, Usamatu Abdulmajid, Ramat Oyebummi Braimah, Adebayo Aremu Ibikunle, Abdullahi Bello Abubakar, Bala Mujtaba, Mike Eghosa Ogbeide, Suwaiba Labbo-Jadadi, Olufemi Ibrahim Adigun, Bruno Oludare Ile-Ogedengbe","doi":"10.1177/10556656241244976","DOIUrl":"10.1177/10556656241244976","url":null,"abstract":"<p><p>ObjectiveTo explore the experiences and perceptions of barriers of parents and family members of patients with cleft lip and palate in accessing cleft services in remote northwest Nigeria.DesignFace-to-face semi-structured audio recorded interviews were used to obtained qualitative textual data. Thematic analysis using interpretative descriptive techniques was employed to understand the participants' lived experiences with barriers and accessibility to cleft services.SettingParticipants were from Sokoto, Kebbi and Zamfara states in remote northwest, Nigeria.ParticipantsConsisted of 22 caregivers (17 parents and 5 extended family members) were purposively sampled between 2017 and 2020Main outcome measuresBarriers experienced while accessing cleft services were identified during thematic analysis.ResultOver three quarter of the respondents had patients with both cleft lip and palate and without any previous family history (n = 20). About two-thirds of the participants (n = 15) were females. Most of the interviews were conducted before the surgeries (n = 15).Five themes emergedlack of information, financial difficulty, misrepresentation from health workers, multiple transportation and previous disappointment.ConclusionsAreas of poor awareness, misinformation from primary health care workers, financial hurdles, multiple transportation logistics and others were identified. Aggressive broadcasting of information through radio, timely treatment and collaboration with influential religious leaders were emphasized. Support, grants and subsidies from government and voluntary agencies are encouraged to mitigate the huge out of pocket cost of cleft care in the region.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1219-1227"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337438","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":"Identification of a Novel TP63 Variant in a Chinese Patient with Orofacial Clefts and Ectrodactyly: Case Report and Literature Review.","authors":"Leheng Jiang, Chanyuan Jiang, Tao Song, Yongqian Wang, Nuo Si, Haidong Li, Ningbei Yin","doi":"10.1177/10556656241241132","DOIUrl":"10.1177/10556656241241132","url":null,"abstract":"<p><p>The TP63 gene is essential for epithelial proliferation, differentiation, and maintenance during embryogenesis. Despite considerable clinical variability, <i>TP63</i>-related symptoms are characterized by ectodermal dysplasia, distal limb malformations, and orofacial clefts. We identified a novel <i>TP63</i> variant (c.619A > G, p.K207E) in a seven-month-old Chinese patient with orofacial clefts and ectrodactyly but no evident signs of ectodermal dysplasia. This phenotype was rarely reported before. We summarized the presence of the three main <i>TP63</i>-related manifestations in the literature and noted different distributions of CP- and CL/P-related variants regarding p63 structural domains.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1263-1267"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892596","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":"Feeding Management and Palate Repair Timing in Infants with Cleft Palate with and without Pierre Robin Sequence: A Multisite Study.","authors":"Jessica L Williams, Kari M Lien, Richard Kirschner, Gregory Allen, Kathy Chapman","doi":"10.1177/10556656241239766","DOIUrl":"10.1177/10556656241239766","url":null,"abstract":"<p><p>ObjectivesCompare the feeding management practices in infants with cleft palate with and without Pierre Robin sequence (PRS) and determine if specific feeding difficulties or interventions predict delayed palate repair.DesignRetrospective cross-sectional study.SettingSeventeen cleft palate teams contributed data.Patients414 infants were included in this study: 268 infants with cleft palate only and 146 infants with cleft palate and PRS.ProceduresData were collected via parent interview and electronic health records.Main Outcome MeasuresOutcomes for the primary objective included categorical data for: history of poor growth, feeding therapy, milk fortification, use of enteral feeding, and feeding difficulties. The outcome for the secondary objective was age in months at primary palate repair.ResultsInfants with PRS had a significantly higher prevalence of feeding difficulties (81% versus 61%) and poor growth (29% versus 15%) compared to infants with cleft palate only. Infants with PRS received all feeding interventions-including feeding therapy, milk fortification, and enteral feeding-at a significantly higher frequency. Infants with PRS underwent primary palate repair at a mean age of 13.55 months (SD = 3.29) which was significantly (<i>P</i> < .00001) later than infants with cleft palate only who underwent palate repair at a mean age of 12.05 months (SD = 2.36). Predictors of delayed palate repair included diagnosis of PRS as well as Hispanic ethnicity and a history of poor growth.ConclusionsThese findings can be used to establish clinical directives focused on providing early, multimodal feeding interventions to promote optimal growth and timely palate repair for infants with PRS.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1180-1189"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11401965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137329","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":"Can Alveolar Bone Grafting Using Posterior Iliac Crest be a Day Surgery Procedure?","authors":"Alistair Varidel, Maria Ambrose, Nancy DiTullio, Taylor Fritschy, Bonnie L Padwa, Cory M Resnick","doi":"10.1177/10556656241237419","DOIUrl":"10.1177/10556656241237419","url":null,"abstract":"<p><p>ObjectiveThe purpose of this study was to determine if patients undergoing alveolar bone grafting (ABG) can be discharged home on the day of surgery safely and with high satisfaction.DesignThis is a prospective cohort study of patients who underwent ABG over a 6-month period (August 2022 to February 2023). Medical records were reviewed, and postoperative surveys were provided to assess patient/family experience.SettingTertiary care free-standing pediatric hospital.Patients and ParticipantsParticipants who had ABG using iliac marrow from the posterior iliac crest.InterventionsSubjects were assigned to overnight admission (ON) or day surgery (DS) based on hospital bed capacity.Main Outcome MeasuresMain outcome measures were postoperative medical events and satisfaction with discharge timing.Results41 participants were included: ON, n = 20 (48.8%); DS, n = 21 (51.2%), and there were no differences between groups in any predictor variable. There were no postoperative medical events. Overall, families reported comfort managing pain, nausea, bleeding, hydration, and nutrition after discharge. Most (83.3% of the DS group and 69.2% of the ON group, <i>P</i> = .644) reported satisfaction with the discharge timing they received, despite this being driven by hospital rather than patient factors. Reasons for some families preferring longer admission included fluid management (n = 2), anxiety about postoperative swelling (n = 2), and a long drive home (n = 1). For the ON group, 16.7% would have preferred same-day discharge.ConclusionsSame day discharge is safe and well-received in appropriately selected patients who undergo ABG using posterior iliac crest. Perioperative patient/family education is essential.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1151-1155"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140023002","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":"Virtual Reality Simulation of Airway Management Post-Cleft Palate Surgery: A Model for Sustainable and Equitable Education.","authors":"Alexandra N Verzella, Allison L Diaz, Matteo Laspro, Andre Alcon, Jill Schechter, Aaron Oliker, Anne Arnold, Roberto L Flores","doi":"10.1177/10556656241241128","DOIUrl":"10.1177/10556656241241128","url":null,"abstract":"<p><p>BackgroundThe effectiveness of virtual-reality (VR) simulation-based training in cleft surgery has not been tested. The purpose of this study was to evaluate learners' acceptance of VR simulation in airway management of a pediatric patient post-cleft palate repair.MethodsThis VR simulation was developed through collaboration between BioDigital and Smile Train. 26 medical students from a single institution completed 10 min of standardized VR training and 5 min of standardized discussion about airway management post-cleft palate repair. They spent 4-8 min in the VR simulation with guidance from a cleft surgery expert. Participants completed pre- and post-surveys evaluating confidence in using VR as an educational tool, understanding of airway management, and opinions on VR in surgical education. Satisfaction was evaluated using a modified Student Evaluation of Educational Quality questionnaire and scored on a 5-point Likert scale. Wilcoxon signed-rank tests were performed to evaluate responses.ResultsThere was a significant increase in respondents' confidence using VR as an educational tool and understanding of airway management post-cleft palate repair after the simulation (<i>P</i> < .001). Respondents' opinions on incorporating VR in surgical education started high and did not change significantly post-simulation. Participants were satisfied with VR-based simulation and reported it was stimulating (4.31 ± 0.88), increased interest (3.77 ± 1.21), enhanced learning (4.12 ± 1.05), was clear (4.15 ± 0.97), was effective in teaching (4.08 ± 0.81), and would recommend the simulation (4.2 ± 1.04).ConclusionVR-based simulation can significantly increase learners' confidence and skills in airway management post-cleft palate repair. Learners find VR to be effective and recommend its incorporation in surgical education.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"1156-1163"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307599","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":"Quantifying Sagittal Craniosynostosis Severity: A Machine Learning Approach With CranioRate.","authors":"Wenzheng Tao, Tobi J Somorin, Janina Kueper, Angel Dixon, Nicolas Kass, Nawazish Khan, Krithika Iyer, Jake Wagoner, Ashley Rogers, Ross Whitaker, Shireen Elhabian, Jesse A Goldstein","doi":"10.1177/10556656251347366","DOIUrl":"https://doi.org/10.1177/10556656251347366","url":null,"abstract":"<p><p>ObjectiveTo develop and validate machine learning (ML) models for objective and comprehensive quantification of sagittal craniosynostosis (SCS) severity, enhancing clinical assessment, management, and research.DesignA cross-sectional study that combined the analysis of computed tomography (CT) scans and expert ratings.SettingThe study was conducted at a children's hospital and a major computer imaging institution. Our survey collected expert ratings from participating surgeons.ParticipantsThe study included 195 patients with nonsyndromic SCS, 221 patients with nonsyndromic metopic craniosynostosis (CS), and 178 age-matched controls. Fifty-four craniofacial surgeons participated in rating 20 patients head CT scans.InterventionsComputed tomography scans for cranial morphology assessment and a radiographic diagnosis of nonsyndromic SCS.Main OutcomesAccuracy of the proposed Sagittal Severity Score (SSS) in predicting expert ratings compared to cephalic index (CI). Secondary outcomes compared Likert ratings with SCS status, the predictive power of skull-based versus skin-based landmarks, and assessments of an unsupervised ML model, the Cranial Morphology Deviation (CMD), as an alternative without ratings.ResultsThe SSS achieved significantly higher accuracy in predicting expert responses than CI (<i>P</i> < .05). Likert ratings outperformed SCS status in supervising ML models to quantify within-group variations. Skin-based landmarks demonstrated equivalent predictive power as skull landmarks (<i>P</i> < .05, threshold 0.02). The CMD demonstrated a strong correlation with the SSS (Pearson coefficient: 0.92, Spearman coefficient: 0.90, <i>P</i> < .01).ConclusionsThe SSS and CMD can provide accurate, consistent, and comprehensive quantification of SCS severity. Implementing these data-driven ML models can significantly advance CS care through standardized assessments, enhanced precision, and informed surgical planning.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251347366"},"PeriodicalIF":1.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508997","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":"Disparities in Insurance Coverage of Cleft Lip and Palate: A Comparative Analysis of State Healthcare Policies and Legal Frameworks.","authors":"Yasmine Ibrahim, Sumun Khetpal, Wayne Ozaki","doi":"10.1177/10556656251351437","DOIUrl":"https://doi.org/10.1177/10556656251351437","url":null,"abstract":"<p><p>Nonsyndromic cleft lip with or without cleft palate (CL/P) is a prevalent congenital anomaly worldwide that poses significant health challenges. Currently, the United States lacks a unified approach to CL/P coverage. This article explores the U.S. medical-legal framework surrounding CL/P, identified via the PubMed, Google Scholar, Lexis, and Westlaw databases. It examines the Affordable Care Act, the Health Insurance Portability and Accountability Act, and state-level variations in CL/P coverage. The findings suggest a need for legal reform to ensure equitable access for patients with CL/P across the United States.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251351437"},"PeriodicalIF":1.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508996","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}