Late results of multidisciplinary management of unilateral cleft lip and palate

A model was designed for evaluating protocol and management strategies in the multidisciplinary approach to cleft lip and palate treatment. The treatment history and present status of 45 patients 14 to 22 years of age were evaluated by a plastic surgeon, orthodontist, and speech pathologist. Results indicated that only about half of these patients had completed treatment by one of the specialties by the time they were 14 years or older. Even more surprisingly, only 7 patients (16%) had completed treatment by all three specialties by this age. Factors that may contribute to this low percentage of completed treatments are discussed.     

新生儿唇腭裂一期矫治术30例

目的 探讨新生儿唇腭裂一期修复术围手术期的安全性、可行性。方法 制订详细的手术计划，采用Onizuka法和双瓣后推法对新生儿唇腭裂行一期修复，进行围手术期新生儿全身情况监护，护理，评估，及手术效果评价等。结果 30例新生儿围手术期各项生理指标正常，与正常新生儿无明显差异，手术效果满意，有5例唇腭裂出现牙下瘘。结论 严格掌握适应证，筛选成熟新生儿，新生儿唇腭裂一期修复术是安全的可行的，手术效果良好。     

Bilateral cleft lip and palate: experience from a center with a multidisciplinary approach

The aim of this work is to analyse the global experience of a center where a pluridisciplinar approach of the child affected with a cleft lip and palate is regularly done. Since january 1980 until january 2000, a total of 36 children (8 F, 28 M) with bilateral cleft lip and palate were treated. Only 5 children were born at this hospital. The others (n = 31) were referred soon after birth (24/31) or later for treat sequels. A multidisciplinary team evaluated every case. The parameters analysed were: surgical protocol, aesthetic and speech outcome, hearing disturbance, complications and the number of secondary lip surgeries. Surgical approach consisted on a soft palate closure before 3 months follow by a bilateral cheiloplasty (6 months) and a hard palate closure before 4 years of age, in the majority of cases (24/36). The esthetical result was evaluated in 25 children and was acceptable in the great majority (22/25). 16 children were submitted to tympanic draining in order to treat their secretory otitis. Speech outcome was analysed in 27 children and was good in 23. With a follow-up of 8.4 years, 15 children (8 treated soon on this center and 7 that came for their sequels) were treated for complications. There was a media of 4.5 surgeries per children.     

Anaesthetic problems in a child with ectrodactyly, ectodermal dysplasia and cleft lip/palate

The EEC syndrome is a congenital anomaly complex associated with ectrodactyly, ectodermal dysplasia, and cleft lip and palate. We present a patient with the complete form of this syndrome who had undergone eight operations in childhood. The main problems encountered by the anaesthetists were malnutrition, difficulty with control of body temperature related to hypohidrosis and persistent infection of the respiratory tract.     

Orthodontic-surgical interaction in the management of cleft lip and palate

The orthodontist's role in the cleft palate team requires close collaboration with the surgeons and other team members. The rationale of timing and sequencing of orthodontic treatment have been discussed in the various time frames, which for convenience have been considered as follows: (1) neonatal or infant maxillary orthopedics; (2) orthodontic considerations in the primary dentition; (3) mixed dentition orthodontics to include presurgical recommendations before an alveolar bone graft and its rationale for use in selected patients; and (4) orthognathic surgery combining an orthodontic and surgical approach to the correction of dental and skeletal components of malocclusion in the permanent dentition. Speech considerations and the communicative skills of the patient with a cleft are important aspects in planning orthognathic surgery for this group of patients. Also, subsequent nose and lip revisions for cosmetic improvement must not be underestimated in the enhancement of the final result following correction of the skeletal and dental discrepancies. Provided the timing and sequencing of appropriate treatment modalities are planned in a closely coordinated, problem-oriented approach by the team members, cleft patients should currently have optimal functional and esthetic results.     

Current cleft lip and palate management in the United Kingdom

This is a report of a national survey into cleft management which was carried out in the spring of 1988. Responses were received from 45 cleft teams in England, Wales, Scotland and Northern Ireland. A summary of the results is presented covering aspects of neonatal care, presurgical orthopaedics, primary and secondary surgical procedures and orthodontic management. In a majority of centres treatment management is discussed at interdisciplinary combined clinics. A wide range of timings and techniques is used for both surgical and orthodontic therapy.     

Therapeutic approach of cleft lip and palate at Caen University Hospital

The therapeutic approach of facial cleft in Caen University Hospital depend on two teams: primary treatment by the Pediatric Plastic Unit (60 cases/year), and secondary treatment by the department of Plastic and Maxillofacial Surgery (more than 30 cases/year). The lip closure is realised before the age of one month with the Tennisson's technic. The palate closure is performed between 6 and 12 months old. Each patient is presented at a multidisciplinary consultation which include a surgeon, an orthodontist, an orthophonist, a psychologist and otologist. At about 5 years old, the orthodontic approach begins with palatal expansion with a modified quadhelix to prepare function its treatment is underwent at this age too. After the age of 9-10 years the orthodontic treatment continued on the permanent teeth. If necessary, the sequelae on maxilla, lips and nose are treated at the end of the adolescence.     

Gender differences in surgical treatment of patients with cleft lip and palate

Numerous gender-based differences in medical treatment have been recognized due to conscious or unconscious perceptions, i.e. gender bias. The aim of the present study was to investigate whether gender differences exist in the surgical treatment of patients with cleft lip and palate (CLP) anomalies. This study is a retrospective review of 235 consecutive patients with non-syndromic unilateral CLP or bilateral CLP born between 1966 and 1986. Each chart was reviewed, and 2178 surgical procedures were registered and categorized as primary surgery (primary lip, palatal and alveolar repair) or secondary surgery (aesthetic and functional revision). Different surgical procedures could be performed during the same surgical session. The number of surgeries performed was analysed and compared between genders. The results demonstrate that women with CLP received statistically significantly more secondary surgeries than men. No differences in the number of primary surgeries were identified. This study provides a gender perspective of the treatment of CLP. We identified no gender differences in primary surgery of the CLP. The standardized method of repairing the cleft is effective in preventing unjust treatment due to gender. However, we identified an indication of gender bias in cleft care regarding secondary surgeries of the nose and lip, namely, women are over-treated and/or men are under-treated. There are several possible explanations for this phenomenon, and further studies are needed.     

Speech after repair of isolated cleft palate and cleft lip and palate.

The speech of children with isolated cleft palate (CP) repaired by one surgeon has been compared with the speech of children with some form of unilateral cleft lip and palate (CLP) repaired by the same surgeon. All palate repairs included an intravelar veloplasty. We identified 57 children (5--12 years old) with cleft palates repaired in infancy, of which three patients with other medical problems were excluded. Of the 54 patients, 44 (81%) attended for review (27 CP, 17 CLP). Video recordings were analysed by two speech and language therapists, using the Cleft Audit Protocol for Speech. The CP patients had no evidence of permanent fistulas. Final speech outcomes were similar for CP and CLP patients. Intelligibility was normal in 10 (37%) CP and nine (53%) CLP patients. Mild consistent hypernasality was present in five (18.5%) CP and four (23.5%) CLP patients. No patients had moderate or severe hypernasality or nasal emission. Mild consistent hyponasality was present in five (18.5%) CP and five (29%) CLP patients. Moderate consistent hyponasality was present in one (4%) CP patient. Dysphonia was present in eight (30%) CP and seven (41%) CLP patients. Cleft-type characteristics were noted in 11 (41%) CP and nine (53%) CLP patients. No CLP patients but 10 (37%) CP patients had required a pharyngoplasty (P=0.004, Fisher's exact test). Possible reasons for this (age, cleft type, surgeon and surgery) are discussed.     

301例非综合征型唇腭裂临床资料分析

目的 研究非综合征型唇腭裂特征及各发病因素的作用.方法 对 301例非综合征型唇腭裂患者的临床资料进行详细调查与分析.结果 非综合征型唇腭裂的发生率,男性多于女性(1.59:1.00),单侧多于双侧(2.62:1.00),夏季(5～7月)出生患儿所占比例(30.56%)较大,来源于农村(75.08%) 的患儿明显多于城市(24.92%).同时,唇腭裂的发生受到多方面因素影响,尤其母亲孕早期的暴露因素非常重要.结论 唇腭裂的病因是复杂的,由遗传因素与特定的环境因素的协同作用形成.     

三种唇腭裂修复术对唇腭裂患者语音恢复影响研究

目的:探讨三种唇腭裂修复术对语音恢复的影响.方法:选择65例唇腭裂患者,随机分为反向双Z术组、咽后壁瓣成形术组、腭因肌瓣术组,观察吹水泡时间、软腭抬高角度α0、腭最高点与咽后壁的最短距离d(mm)、语音清晰.结果:三组患者术后吹水泡时间、软腭抬高角度α0、腭最高点与咽后壁的最短距离d(mm)、语音清晰度均明显优于术前(P＜0.05),组间比较无显著性特征(P＞0.05).结论:手术方式是恢复唇腭裂患者语音的最佳选择,三项检查是评价腭音闭合不全的有效手段.     

The cleft lip evaluation profile (CLEP): a new approach for postoperative nasolabial assessment in patients with unilateral cleft lip and palate

To assess the postoperative results after primary or secondary operation on unilateral cleft lip and nose, various methods have been published, in which qualitative methods are often based on the opinions of an expert panel and the quantitative methods are based on measurements of different landmarks of the lip and nose. Common problems with the present methods are the associated costs, based on the need for advanced techniques and expertise. Our cleft team now present a simplified, inexpensive, and reproducible protocol to evaluate the cosmetic and functional outcome after operations on the cleft lip and nose, together with the patients. Our protocol has been developed as a guideline to evaluate and score six variables of the lip and seven variables of the nose, including scars, projections of the lips and nose, volumes of the lip, and the alae and septum. The protocol contains series of three photographs of each of the variables that present a good postoperative result, an acceptable result, and finally a result with a clearly visible disfigurement. We also tested the reproducibility and validity of the protocol. Plastic surgeons with no knowledge of the index were approached twice and asked to assess a version with photographs in random order. The evaluation protocol is a simple and cost-effective tool for evaluation of the lip or nose, or both, among patients with repaired unilateral complete cleft lip.