The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association最新文献

{"title":"Primary Cleft Lip Repair in Adults Under Local Anesthesia.","authors":"Bijoy Krishna Das,&nbsp;Satyajit Dhar","doi":"10.1177/10556656211051577","DOIUrl":"https://doi.org/10.1177/10556656211051577","url":null,"abstract":"<p><strong>Objective: </strong>There are many adults with cleft lip deformities in developing countries. This is due to the lack of public awareness, social stigma, distance from the health center, and parents' financial condition. Lip repair under local anesthesia is safe, cost-effective and would be beneficial for the underprivileged population.</p><p><strong>Design: </strong>A retrospective cohort study with follow-up of 1 to 8 years.</p><p><strong>Setting: </strong>Academic Hospital.</p><p><strong>Patients/participants: </strong>Cleft lip repair was performed in 252 patients of age more than 12 years from 2012 to 2019. Patients with cleft palate, cardiopulmonary disease, who did not consent for the procedure while awake were excluded.</p><p><strong>Interventions: </strong>Cleft lip surgery done under local anesthesia.</p><p><strong>Main outcome measures: </strong>Outcome measures were patients' self-satisfaction and comments of peer.</p><p><strong>Results: </strong>Two hundred fifty-two primary cleft lip operations were done in 168 male and 84 female patients. The mean age was 23.62 years, and the mean weight was 49.66 kg. Unilateral was 227<b>,</b> Bilateral cleft lip 25. The postoperative period was uneventful. No case of wound dehiscence or wound infection was observed. Patients were discharged on the same day, except the ones who traveled a long distance.</p><p><strong>Conclusion: </strong>Cleft lip repair in adults under local anesthesia is safe and cost-effective.</p>","PeriodicalId":520794,"journal":{"name":"The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association","volume":" ","pages":"1477-1481"},"PeriodicalIF":1.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39690390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Follow-up of Unilateral Cleft lip and Palate: Incidence of Speech-Correcting Surgeries and Fistula Formation.","authors":"Charlotta Gustafsson,&nbsp;Arja Heliövaara,&nbsp;Junnu Leikola","doi":"10.1177/10556656211055641","DOIUrl":"https://doi.org/10.1177/10556656211055641","url":null,"abstract":"<p><strong>Objective: </strong>The ideal surgical protocol and technique for primary closure of unilateral cleft lip and palate (UCLP) are unclear, and the development of velopharyngeal insufficiency and fistulae following primary repair is common. This study aimed to determine the long-term surgical burden of care in terms of secondary surgeries, defined as speech-correcting surgeries (SCSs) and fistula repair, in a UCLP population, and to compare outcomes of various surgical protocols.</p><p><strong>Design: </strong>Retrospective, single-center review.</p><p><strong>Participants: </strong>The study comprised 290 nonsyndromic children with complete UCLP. Different surgical protocols entailing both single-stage and 2-stage approaches were compared, and the surgical outcome was analyzed at the time of alveolar bone grafting (ABG) and post ABG.</p><p><strong>Results: </strong>Altogether 110 children (37.9%) underwent secondary surgery by the time of ABG. Of the total population 25.9% (n  =  75) had undergone SCS and 17.2% (n  =  50) had undergone fistula repair. The respective incidences at follow-up (post ABG) were 30.3% (n  =  88) and 18.9% (n  =  55). Median age at ABG was 9.8 years and at follow-up was 16.3 years. No significant difference emerged in terms of secondary surgeries between the techniques and protocols applied at primary repair. However, some differences occurred regarding the location of fistulae; the single-stage procedure had more anterior fistula repairs, particularly connected to a perialveolar fistula.</p><p><strong>Conclusions: </strong>Although the outcome differences between the surgical protocols were small, indicating that none of the treatment protocols was clearly superior to another, attention was drawn to the favorable outcomes of the single-stage protocol.</p>","PeriodicalId":520794,"journal":{"name":"The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association","volume":" ","pages":"1537-1545"},"PeriodicalIF":1.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9585542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39693509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life of Adopted Chinese Versus Nonadopted Dutch Children with Cleft Lip and/or Palate: A Propensity Score Matched Analysis.","authors":"Martinus M van Veen,&nbsp;Bente A van den Berge,&nbsp;Chantal M Mouës-Vink","doi":"10.1177/10556656211050795","DOIUrl":"https://doi.org/10.1177/10556656211050795","url":null,"abstract":"<p><strong>Objective: </strong>To examine quality of life in internationally adopted children with cleft lip and/or palate (CL/P) versus non-adopted children with CL/P.</p><p><strong>Design: </strong>Cross sectional study.</p><p><strong>Setting: </strong>Multidisciplinary cleft team of a secondary and tertiary hospital in the Netherlands.</p><p><strong>Methods: </strong>Parents of children under the age of 8 treated by the multidisciplinary cleft team of our institutions were asked to fill out a questionnaire containing demographic and clinical data and a validated parent proxy measure of cleft-specific quality of life instrument for children aged 0-8: the CleftChild-8. Adopted children were matched to non-adopted children using propensity score matching based on sex, age, type of cleft, if palatal surgery was completed and the level of education of the parent. CleftChild-8 scores were then compared between the matched samples of adopted and non-adopted children with CL/P.</p><p><strong>Main outcome measure(s): </strong>Differences in (sub)domain scores of the CleftChild-8.</p><p><strong>Results: </strong>Most median CleftChild-8 scores of the adopted children (n = 29) were slightly lower compared to the 29 matched non-adopted children. A significant difference was seen for the domain score 'satisfaction with (operative) treatment' and 3 of the 13 subdomain scores: 'post-operative results', 'acceptance by siblings' and 'acceptance by family/friends'.</p><p><strong>Conclusions: </strong>By parent report, adopted children with CL/P experienced some areas of lower quality of life when compared to non-adopted children. Members of cleft teams should be aware of the problems associated with adoption and offer additional guidance and counseling to adopted children and their parents.</p>","PeriodicalId":520794,"journal":{"name":"The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association","volume":" ","pages":"1502-1508"},"PeriodicalIF":1.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9585539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39696397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of Feeding Interventions for Infants with Cleft Palate.","authors":"Cameron Penny,&nbsp;Connor McGuire,&nbsp;Michael Bezuhly","doi":"10.1177/10556656211051216","DOIUrl":"https://doi.org/10.1177/10556656211051216","url":null,"abstract":"<p><strong>Objective: </strong>Various devices and techniques have been proposed to reduce feeding difficulties experienced by infants with cleft palate. The aim of this review is to identify and assess the scope and quality of evidence for these interventions.</p><p><strong>Methods: </strong>A systematic review of published literature evaluating feeding interventions for infants with cleft palate (with or without cleft lip) from database inception to 2021 was conducted using Preferred Reporting Items for Systematic Reviews guidelines. Quality appraisal of included studies was conducted using a methodological index for nonrandomized studies, Cochrane, or a measurement tool to assess systematic reviews 2 instruments, according to study type.</p><p><strong>Results: </strong>Fourteen studies met inclusion criteria, with the majority (71%) of studies consisting of second-level evidence. Included interventions were specialty bottles (21%), alternative feeding delivery systems (14%), obturators (14%), and educational programs (14%). Specialty bottles and palatal obturators did not appear to offer any substantial growth advantages compared to traditional bottles or no intervention, respectively. Designated education programs for the mothers of infants with clefts had a positive impact on infant growth.</p><p><strong>Conclusions: </strong>Overall evidence evaluating feeding interventions for infants with cleft palate was moderate to low. While it does not appear that specialized feeding delivery systems or palatal obturators significantly improve growth in infants with clefts compared to children without cleft conditions, education programs do appear to be beneficial.</p>","PeriodicalId":520794,"journal":{"name":"The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association","volume":" ","pages":"1527-1536"},"PeriodicalIF":1.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39826335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between SNPs in 1q32.2 and NSCL ± <i>P</i> in Han Chinese Population.","authors":"Bin Yin,&nbsp;Jia-Yu Shi,&nbsp;Bing Shi,&nbsp;Qian Zheng,&nbsp;Zhong-Lin Jia","doi":"10.1177/10556656211052837","DOIUrl":"https://doi.org/10.1177/10556656211052837","url":null,"abstract":"<p><strong>Objectives: </strong>Non-syndromic cleft lip with or without cleft palate (NSCL ± <i>P</i>) is one of the most common birth malformations. Currently, numerous susceptibility SNPs have been reported by GWA studies, however, the replications of them among NSCL ± <i>P</i> from Han Chinese were very limited.</p><p><strong>Design: </strong>In this study, we selected 16 SNPs around 1q32.2 based on the published GWA studies and replicated them among 302 trios with NSCL ± <i>P</i> from Han Chinese Population. The genotypic data was analyzed with FBAT, PLINK and R package.</p><p><strong>Setting: </strong>The study was conducted in a tertiary medical center.</p><p><strong>Patients, participants: </strong>302 patients with CL ± <i>P</i> and their parents.</p><p><strong>Main outcome measures: </strong>To ascertain the genetic variants in 1q32.2 in patients with CL ± <i>P</i> in Han Chinese Population.</p><p><strong>Interventions: </strong>Blood samples were collected.</p><p><strong>Results: </strong>We found T allele (<i>Z</i> = 4.26, <i>p</i> = 0.00002) and T/T homozygotes (<i>Z</i> = 4.4, <i>p</i> = 0.000011) at rs12063989 was significantly over-transmitted among non-syndromic cleft lip with or without cleft palate (NSCL ± <i>P</i>).</p><p><strong>Conclusions: </strong>We found rs12063989 exhibited significant association with the occurrence of NSCL ± <i>P</i>, which would provide new evidence for the future study in the etiology of NSCL ± <i>P</i>.</p>","PeriodicalId":520794,"journal":{"name":"The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association","volume":" ","pages":"1520-1526"},"PeriodicalIF":1.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39839188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tissue Augmenting Palatoplasty for the Treatment of Velopharyngeal Insufficiency.","authors":"Erin E Anstadt,&nbsp;Madeleine K Bruce,&nbsp;Matthew Ford,&nbsp;Noel Jabbour,&nbsp;Miles J Pfaff,&nbsp;Michael Bykowski,&nbsp;Jesse A Goldstein,&nbsp;Joseph E Losee","doi":"10.1177/10556656211053761","DOIUrl":"https://doi.org/10.1177/10556656211053761","url":null,"abstract":"<p><strong>Purpose: </strong>Persistent velopharyngeal insufficiency (VPI) following primary palatoplasty remains a difficult problem to treat. This study evaluates speech outcomes following revision palatoplasty with tissue augmentation using buccal myomucosal flaps (BMF) as an alternative to pharyngoplasty for patients with VPI.</p><p><strong>Methods: </strong>A retrospective single-center review of revision palatoplasty with tissue augmentation at a tertiary pediatric hospital Cleft-Craniofacial Center between January 2017 and March 2021 was conducted. Patients with a history of previous palatoplasty, a diagnosis of persistent or recurrent VPI, and comprehensive pre- and postoperative speech evaluations who underwent revision palatoplasty with BMF were included.</p><p><strong>Results: </strong>Twenty patients met inclusion criteria (35% female, 20% syndromic). Mean age at the time of revision palatoplasty with BMF was 9.7 years. Preoperatively, all patients had stigmatizing speech and received the recommendation for speech surgery; the mean Pittsburgh Weighted Speech Score (PWSS) was 14.3 ± 4.9. The mean postoperative PWSS at the most recent assessment was 4.2 ± 2.3, representing a statistically significant improvement from preoperative scores (<i>P </i>< .001). Mean follow-up time was 8.9 months. Following revision palatoplasty with BMF, only one patient has received the recommendation for further speech surgery. No complications were noted.</p><p><strong>Conclusion: </strong>In patients with VPI following primary palatoplasty, revision palatoplasty with tissue augmentation offers an alternative to pharyngoplasty. This approach preserves dynamic velopharyngeal function, improves speech outcomes, and should be considered an option when treating patients with post-primary palatoplasty VPI.</p>","PeriodicalId":520794,"journal":{"name":"The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association","volume":" ","pages":"1461-1468"},"PeriodicalIF":1.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39740110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial Experiences That Support Positive Self-Concept in Children with Cleft Lip and Palate Adopted From China.","authors":"S A Everhart,&nbsp;K M Cochran,&nbsp;N H Lambrou,&nbsp;W H Davies,&nbsp;P K Marik","doi":"10.1177/10556656211051222","DOIUrl":"https://doi.org/10.1177/10556656211051222","url":null,"abstract":"<p><strong>Objective: </strong>Existing psychosocial research offers little information on the unique challenges and strengths of children adopted from China with cleft lip and/or palate (CL/P). The present study aimed to understand biopsychosocial factors that support positive self-concept in this population.</p><p><strong>Design: </strong>Qualitative, semistructured interviews were conducted with children and their parents. Interpretive phenomenological analysis of transcribed interviews was utilized for data analysis.</p><p><strong>Setting: </strong>Participants were recruited in an outpatient, pediatric multidisciplinary cleft clinic during a standard team visit.</p><p><strong>Patients, participants: </strong>Participants were ages 8 to 12 years with a diagnosis of isolated cleft lip-palate who were internationally adopted from China before the age of 2 years and English-speaking. Participants also included English-speaking parents.</p><p><strong>Results: </strong>Themes reflecting data from the child and parent subsamples include: (1) child's characteristics, (2) family strengths, (3) adoption identity, (4) cultural identity, (5) coping with a cleft, and (6) social factors. Additional 2 to 3 subthemes were identified for the parent and child subsamples within each broader theme.</p><p><strong>Conclusions: </strong>Findings from this sample suggested factors supporting positive self-concept included pride and self-efficacy in activities, family support, instilment of family values, strategies for coping with a cleft, family belonging, cultural exposure, and normalization of differences. Medical providers can support patients and families by providing education on surgeries, CL/P sequelae and outcomes, and pediatric medical stress. Mental health providers can screen for social and emotional challenges and provide psychoeducation on racial/ethnic socialization, identity development, and coping.</p>","PeriodicalId":520794,"journal":{"name":"The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association","volume":" ","pages":"1509-1519"},"PeriodicalIF":1.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9676477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39801690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Panorama of Cleft Lip and Palate Live Birth in Brazil: Follow-up of a 10-Year Period and Inequalities in the Health System.","authors":"Raquel S Silva,&nbsp;Soraia Macari,&nbsp;Thiago R Dos Santos,&nbsp;Marcos A F Werneck,&nbsp;Rafaela da Silveira Pinto","doi":"10.1177/10556656211050004","DOIUrl":"https://doi.org/10.1177/10556656211050004","url":null,"abstract":"<p><strong>Objective: </strong>To provide the prevalence and an overview of cleft lip and palate (CL/P) in the period of 2008 to 2017, as well as the profile of care provided for this condition in Brazil.</p><p><strong>Design: </strong>Cross-sectional study of epidemiological character.</p><p><strong>Setting: </strong>Brazilian government website.</p><p><strong>Participants: </strong>National Live Birth and Hospital Information System.</p><p><strong>Intervention: </strong>Organization of the end databases and performance-based statistical analysis.</p><p><strong>Main outcome measure(s): </strong>Analysis of the prevalence of CL/P in newborns, sociodemographic condition of the mothers, surgical procedures and hospitalizations, and specialized hospitals in Brazil within a 10-year period.</p><p><strong>Results: </strong>The average prevalence of CL/P in Brazil was ∼52 children per 100 000 live births in the covered period, corresponding to 1 per 1924 newborns. The presence of cleft was associated with preterm birth, being underweight, and the male gender. The highest prevalence was found in the South region, while the lowest was found in the Northeast region, with increasing rates in the North region of Brazil. The states with the highest prevalence were not those with a great number of hospitalizations and surgical procedures for live births with CL/P.</p><p><strong>Conclusion: </strong>In the 10-year study period, the prevalence of CL/P was 0.52 newborns per 1000 live births, a result which differs among the states of Brazil. The need to reinforce the national monitoring of the prevalence and surgical procedures of cleft patients have also emphasized the need to improve public medical care for CL/P subjects.</p>","PeriodicalId":520794,"journal":{"name":"The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association","volume":" ","pages":"1490-1501"},"PeriodicalIF":1.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39720091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Maxillary Dentoalveolar Changes in Children with Unilateral Cleft Lip and Palate After Palatal Repair: A Pilot Study.","authors":"Shreepriya Singhania,&nbsp;Nandlal Bhojraj","doi":"10.1177/10556656211053765","DOIUrl":"https://doi.org/10.1177/10556656211053765","url":null,"abstract":"<p><strong>Objective: </strong>To assess early maxillary dentoalveolar changes in children with unilateral cleft lip and palate (UCLP) up to 6 months after palatoplasty.</p><p><strong>Design: </strong>Pilot study.</p><p><strong>Patients and participants: </strong>Eight children with UCLP at the age of 18 to 30 months, who were awaiting palatal repair, were included.</p><p><strong>Interventions: </strong>All participants with repaired lip were scheduled for palatal repair between 18 and 24 months by Bardach's technique.</p><p><strong>Main outcome measure(s): </strong>Arch widths, arch depths, and arch perimeter was measured on 32 dental casts of 8 participants at 4 time points: just prior to palatal repair (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after palatal repair. Manual method using digital vernier caliper (Zhart, India) was used for model analysis. Intraexaminer reliability was also assessed.</p><p><strong>Results: </strong>Only one examiner assessed all the dental casts after blinding. There was a significant decrease in the intercanine width (29.75 ± 1.98 mm at T1 to 26.42 ± 1.67 mm at T4; <i>P</i> < .001) and anterior arch depth (9.86 ± 1.07 mm at T1 to 8.29 ± 1.51 mm at T4; <i>P</i> < .001). Growth occurred in intertuberosity width (38.18 ± 1.40 mm at T1 to 39.76 ± 1.09 mm at T4; <i>P</i> < .001) and total arch depth (24.36 ± 1.21 mm at T1 to 26.79 ± 1.04 mm; <i>P</i> < .001) over 6 months post-surgery.</p><p><strong>Conclusions: </strong>There was growth restriction in the anterior part of the palate, whereas the posterior region continued to grow after palatal repair. These changes were observable even in the early months after palatoplasty.</p>","PeriodicalId":520794,"journal":{"name":"The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association","volume":" ","pages":"1546-1554"},"PeriodicalIF":1.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39649952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Complication Following Cleft Lip and Palate Surgery in a Low-Resource Setting: A Prospective Outcomes Study in Nicaragua.","authors":"Marco A Swanson,&nbsp;Allyn Auslander,&nbsp;Tatiana Morales,&nbsp;Breanna Jedrzejewski,&nbsp;William P Magee,&nbsp;Armando Siu,&nbsp;Ruben Ayala,&nbsp;Jordan W Swanson","doi":"10.1177/10556656211046810","DOIUrl":"https://doi.org/10.1177/10556656211046810","url":null,"abstract":"<p><strong>Background: </strong>Higher rates of postoperative complication following cleft lip or palate repair have been documented in low resource settings, but their causes remain unclear. This study sought to delineate patient, surgeon, and care environment factors in cleft complications in a low-income country.</p><p><strong>Design: </strong>Prospective outcomes study.</p><p><strong>Setting: </strong>Comprehensive Cleft Care Center.</p><p><strong>Patients: </strong>Candidate patients presenting for cleft lip or palate repair or revision.</p><p><strong>Interventions: </strong>Patient anthropometric, nutritional, environmental and peri- and post-operative care factors were collected. Post-operative evaluation occurred at standard 1-week and 2-month postoperative intervals.</p><p><strong>Main outcome measures: </strong>Complication was defined as fistula, dehiscence and/or infection.</p><p><strong>Results: </strong>Among 408 patients enrolled, 380 (93%) underwent surgery, of which 208 (55%) underwent lip repair (124) or revision (84), and 178 (47%) underwent palate repair (96) or revision (82). 322 (85%) were evaluated 1 week and 166 (44%) 2 months postoperatively. 50(16%) complications were identified, including: 25(8%) fistulas, 24(7%) dehiscences, 17(5%) infections. Mid-upper arm circumference (MUAC) ≤12.5 cm was associated with dehiscence after primary lip repair (OR = 28, p = 0.02). Leukocytosis ≥11,500 on pre-operative evaluation was associated with dehiscence (OR = 2.51, p = 0.04) or palate revision fistula (OR = 64, p < 0.001). Surgeons who performed fewer previous-year palate repairs had higher likelihood of palate complications, (OR = 3.03, p = 0.01) although there was no difference in complication rate with years of surgeon experience or duration of surgery.</p><p><strong>Conclusions: </strong>Multiple patient, surgeon, and perioperative factors are associated with higher rates of complication in a low-resource setting, and are potentially modifiable to reduce complications following cleft surgery.</p>","PeriodicalId":520794,"journal":{"name":"The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association","volume":" ","pages":"1452-1460"},"PeriodicalIF":1.1,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39524838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}