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ORTHOPEDICS AND TRAUMATOLOGY (150 journals)                     

Showing 1 - 149 of 149 Journals sorted alphabetically
Acta Orthopaedica     Open Access   (Followers: 35)
Advances in Orthopedics     Open Access   (Followers: 10)
American Journal of Orthodontics and Dentofacial Orthopedics     Hybrid Journal   (Followers: 9)
American Journal of Orthopedics     Partially Free   (Followers: 6)
Archives of Orthopaedic and Trauma Surgery     Hybrid Journal   (Followers: 10)
Archives of Osteoporosis     Hybrid Journal   (Followers: 2)
Arthritis und Rheuma     Hybrid Journal   (Followers: 1)
Arthroplasty Today     Open Access   (Followers: 3)
Australasian Musculoskeletal Medicine     Full-text available via subscription   (Followers: 6)
BMC Musculoskeletal Disorders     Open Access   (Followers: 33)
Bone Research     Hybrid Journal   (Followers: 3)
Burns & Trauma     Open Access   (Followers: 12)
Cartilage     Hybrid Journal   (Followers: 5)
Case Reports in Orthopedic Research     Open Access   (Followers: 1)
Case Reports in Orthopedics     Open Access   (Followers: 7)
Chinese Journal of Traumatology     Open Access  
Cleft Palate-Craniofacial Journal     Hybrid Journal   (Followers: 8)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 4)
Clinical Orthopaedics and Related Research     Hybrid Journal   (Followers: 78)
Clinical Trials in Orthopedic Disorders     Open Access   (Followers: 1)
Concussion     Open Access  
Craniomaxillofacial Trauma and Reconstruction     Hybrid Journal   (Followers: 2)
Current Orthopaedic Practice     Hybrid Journal   (Followers: 14)
Current Reviews in Musculoskeletal Medicine     Open Access   (Followers: 14)
Der Orthopäde     Hybrid Journal   (Followers: 6)
Die Wirbelsäule     Hybrid Journal  
Duke Orthopedic Journal     Open Access  
East African Orthopaedic Journal     Full-text available via subscription  
Egyptian Journal of Orthopedic Research     Open Access   (Followers: 8)
Egyptian Orthopaedic Journal     Open Access   (Followers: 1)
EMC - Técnicas Quirúrgicas - Ortopedia y Traumatología     Full-text available via subscription  
EMC - Tecniche Chirurgiche - Chirurgia Ortopedica     Full-text available via subscription  
Ergonomics     Hybrid Journal   (Followers: 26)
European Journal of Orthopaedic Surgery & Traumatology     Hybrid Journal   (Followers: 9)
European Journal of Podiatry / Revista Europea de Podología     Open Access   (Followers: 1)
European Spine Journal     Hybrid Journal   (Followers: 25)
Foot & Ankle International     Hybrid Journal   (Followers: 10)
Foot & Ankle Orthopaedics     Open Access   (Followers: 5)
Gait & Posture     Hybrid Journal   (Followers: 17)
Geriatric Orthopaedic Surgery Rehabilitation     Open Access   (Followers: 5)
Global Spine Journal     Open Access   (Followers: 13)
Hip International     Hybrid Journal  
Indian Journal of Orthopaedics     Open Access   (Followers: 8)
Informationen aus Orthodontie & Kieferorthopädie     Hybrid Journal  
Injury     Hybrid Journal   (Followers: 21)
International Journal of Orthopaedic and Trauma Nursing     Hybrid Journal   (Followers: 13)
International Journal of Orthopaedic Surgery     Open Access   (Followers: 5)
International Journal of Orthopaedics     Open Access   (Followers: 2)
International Journal of Research in Orthopaedics     Open Access  
International Musculoskeletal Medicine     Hybrid Journal   (Followers: 8)
International Orthopaedics     Hybrid Journal   (Followers: 18)
JAAOS : Global Research & Reviews     Open Access   (Followers: 1)
JBJS Journal of Orthopaedics for Physician Assistants     Hybrid Journal  
JBJS Reviews     Full-text available via subscription   (Followers: 12)
JOR Spine     Open Access   (Followers: 4)
Journal de Traumatologie du Sport     Full-text available via subscription   (Followers: 2)
Journal für Mineralstoffwechsel & Muskuloskelettale Erkrankungen     Hybrid Journal  
Journal of Bone and Joint Diseases     Open Access   (Followers: 3)
Journal of Bone and Joint Infection     Open Access   (Followers: 1)
Journal of Brachial Plexus and Peripheral Nerve Injury     Open Access   (Followers: 5)
Journal of Cachexia, Sarcopenia and Muscle     Open Access   (Followers: 3)
Journal of Clinical Orthopaedics and Trauma     Hybrid Journal   (Followers: 5)
Journal of Experimental Orthopaedics     Open Access   (Followers: 8)
Journal of Hand Surgery (European Volume)     Hybrid Journal   (Followers: 46)
Journal of Head Trauma Rehabilitation     Hybrid Journal   (Followers: 19)
Journal of Musculoskeletal Research     Hybrid Journal   (Followers: 10)
Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie     Hybrid Journal   (Followers: 1)
Journal of Orthodontic Science     Open Access   (Followers: 2)
Journal of Orthopaedic & Sports Physical Therapy     Full-text available via subscription   (Followers: 77)
Journal of Orthopaedic Association of South Indian States     Open Access   (Followers: 3)
Journal of Orthopaedic Diseases and Traumatology     Open Access   (Followers: 2)
Journal of Orthopaedic Reports     Full-text available via subscription   (Followers: 12)
Journal of Orthopaedic Research     Hybrid Journal   (Followers: 29)
Journal of Orthopaedic Science     Hybrid Journal   (Followers: 4)
Journal of Orthopaedic Surgery     Open Access   (Followers: 1)
Journal of Orthopaedic Surgery and Research     Open Access   (Followers: 8)
Journal of Orthopaedic Translation     Open Access  
Journal of Orthopaedic Trauma     Hybrid Journal   (Followers: 16)
Journal of Orthopaedics     Full-text available via subscription   (Followers: 3)
Journal of Orthopaedics and Allied Sciences     Open Access   (Followers: 9)
Journal of Orthopaedics and Spine     Open Access   (Followers: 6)
Journal of Orthopaedics and Traumatology     Open Access   (Followers: 16)
Journal of Orthopaedics, Trauma and Rehabilitation     Open Access   (Followers: 6)
Journal of Orthopedics & Rheumatology     Open Access  
Journal of Orthopedics, Traumatology and Rehabilitation     Open Access   (Followers: 6)
Journal of Pediatric Orthopaedics     Hybrid Journal   (Followers: 15)
Journal of Prosthetics and Orthotics     Hybrid Journal   (Followers: 15)
Journal of Scleroderma and Related Disorders     Hybrid Journal  
Journal of the American Academy of Orthopaedic Surgeons     Hybrid Journal   (Followers: 13)
Journal of the American Podiatric Medical Association     Full-text available via subscription   (Followers: 8)
Journal of Traumatic Stress     Hybrid Journal   (Followers: 30)
Knee Surgery, Sports Traumatology, Arthroscopy     Hybrid Journal   (Followers: 29)
Multiple Sclerosis and Related Disorders     Hybrid Journal   (Followers: 10)
Musculoskeletal Care     Hybrid Journal   (Followers: 20)
Musculoskeletal Science and Practice     Hybrid Journal   (Followers: 4)
Nigerian Journal of Orthopaedics and Trauma     Open Access  
North American Spine Society Journal (NASSJ)     Open Access   (Followers: 7)
OA Orthopaedics     Open Access   (Followers: 7)
Obere Extremität     Hybrid Journal   (Followers: 1)
Open Journal of Orthopedics     Open Access   (Followers: 4)
Open Journal of Orthopedics and Rheumatology     Open Access   (Followers: 2)
Open Journal of Trauma     Open Access  
Open Orthopaedics Journal     Open Access  
Operative Orthopädie und Traumatologie     Hybrid Journal  
Operative Techniques in Orthopaedics     Full-text available via subscription   (Followers: 6)
Orthopädie & Rheuma     Full-text available via subscription  
Orthopädie und Unfallchirurgie up2date     Hybrid Journal  
Orthopaedic Journal of Sports Medicine     Open Access   (Followers: 16)
Orthopaedic Nursing     Hybrid Journal   (Followers: 12)
Orthopaedic Surgery     Open Access   (Followers: 1)
Orthopaedics & Traumatology: Surgery & Research     Full-text available via subscription   (Followers: 6)
Orthopaedics and Trauma     Full-text available via subscription   (Followers: 28)
Orthopedic Clinics of North America     Full-text available via subscription   (Followers: 5)
Orthopedic Research and Reviews     Open Access   (Followers: 6)
Orthopedic Reviews     Open Access   (Followers: 7)
Orthopedics     Full-text available via subscription   (Followers: 7)
Orthoplastic Surgery     Open Access  
Osteoarthritis and Cartilage     Full-text available via subscription   (Followers: 19)
Osteoarthritis and Cartilage Open     Open Access   (Followers: 3)
Osteologie     Hybrid Journal  
Osteoporosis and Sarcopenia     Open Access  
OTA International     Open Access  
Paediatric Orthopaedics and Related Sciences     Open Access   (Followers: 3)
Pain Management in General Practice     Full-text available via subscription   (Followers: 13)
Prosthetics and Orthotics International     Hybrid Journal   (Followers: 9)
Revista Brasileira de Ortopedia     Hybrid Journal  
Revista Chilena de Ortopedia y Traumatología / Chilean Journal of Orthopaedics and Traumatology     Open Access  
Revista Colombiana de Ortopedia y Traumatología     Full-text available via subscription  
Revista Cubana de Ortopedia y Traumatologí­a     Open Access  
Revista de la Asociación Argentina de Ortopedia y Traumatología     Open Access  
Revista Española de Cirugía Ortopédica y Traumatología     Full-text available via subscription   (Followers: 1)
Revista Portuguesa de Ortopedia e Traumatologia     Open Access  
Revue de Chirurgie Orthopédique et Traumatologique     Full-text available via subscription   (Followers: 3)
Romanian Journal of Orthopaedic Surgery and Traumatology     Open Access  
SA Orthopaedic Journal     Open Access   (Followers: 2)
SICOT-J     Open Access   (Followers: 1)
Spine     Hybrid Journal   (Followers: 75)
Spine Journal     Hybrid Journal   (Followers: 28)
Sport-Orthopädie - Sport-Traumatologie - Sports Orthopaedics and Traumatology     Full-text available via subscription   (Followers: 3)
Strategies in Trauma and Limb Reconstruction     Open Access   (Followers: 1)
Techniques in Orthopaedics     Hybrid Journal   (Followers: 6)
Therapeutic Advances in Musculoskeletal Disease     Hybrid Journal   (Followers: 5)
Trauma     Hybrid Journal   (Followers: 5)
Trauma (Travma)     Open Access  
Trauma und Berufskrankheit     Hybrid Journal  
Traumatology     Full-text available via subscription   (Followers: 1)
Traumatology and Orthopedics of Russia     Open Access   (Followers: 3)
Zeitschrift für Orthopädie und Unfallchirurgie     Hybrid Journal   (Followers: 2)
Ортопедия, травматология и протезирование     Open Access  

           

Similar Journals
Journal Cover
Cleft Palate-Craniofacial Journal
Journal Prestige (SJR): 0.757
Citation Impact (citeScore): 1
Number of Followers: 8  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1545-1569 - ISSN (Online) 1055-6656
Published by Sage Publications Homepage  [1176 journals]
  • Cephalometric Pharyngeal Morphology in Adults with Unoperated Cleft Palate

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      Authors: Congcong Cao, Deren Li, Hanwen Gong, Qian Zheng, Chao Xu, Bing Shi
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThe aim of this study was to cephalometrically evaluate the pharyngeal morphology in adults with unoperated Submucous Cleft Palate (SMCP), adults with unoperated Overt Cleft Palate (OCP), and adults without clefts.DesignThis study employed a retrospective cross-sectional design. Lateral cephalometric radiography was performed on three groups of adults: 1) 29 with unrepaired SMCP; 2) 41 with unrepaired OCP; and 3) 39 without clefts, who served as controls. One-way ANOVA and rank-sum tests were used for intergroup comparisons. P value was set at .05.ResultsThe soft palate length and the ratio of soft palate length to pharyngeal depth were significantly lower in subjects with unoperated SMCP and OCP than in non-cleft controls. Significant differences were also observed in pharyngeal depth, nasopharyngeal depth, and posterior pharyngeal wall thickness between subjects with unoperated OCP and non-cleft controls.ConclusionsPharyngeal morphology differs significantly between individuals with and without clefts, particularly in soft palate length and the ratio of soft palate length to pharyngeal depth.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-06-06T12:43:24Z
      DOI: 10.1177/10556656241260481
       
  • A Nationwide Analysis of the Impact of Cardiopulmonary Anomalies on Cleft
           Palate Surgical Outcomes

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      Authors: Eloise W. Stanton, Artur Manasyan, Idean Roohani, Katelyn Kondra, Karla Haynes, Mark M. Urata, William P. Magee, Jeffrey A. Hammoudeh
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo increase awareness and improve perioperative care of patients with cleft palate (CP) and coexisting cardiopulmonary anomalies.DesignRetrospective cohort.SettingMulti-center.Patients/ParticipantsPatients who underwent surgical repair of CP between 2012–2020 identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric Data File. Chi-squared analysis and Student's t-test were implemented to make associations between congenital heart disease (CHD) and congenital pulmonary disease (CPD) and postoperative complications. Multiple logistic regression was performed to identify associations between CP and CHD/CPD while controlling for age, gender, and ASA class. C2 values were used to assess the logistic regressions, with a significance level of 0.05 indicating statistical significance.Main Outcomes MeasuresLength of stay (LOS), perioperative complications (readmission, reoperation, reintubation, wound dehiscence, cerebrovascular accidents, and mortality).Results9 96 181 patients were identified in the database, 17 786 of whom were determined to have CP, of whom 16.0% had congenital heart defects (CHD) and 13.2% had congenital pulmonary defects (CPD). Patients with CHD and CPD were at a significantly greater risk of increased LOS and all but one operative complication rate (wound dehiscence) relative to patients with CP without a history of CHD and CPD.ConclusionThis study suggests that congenital cardiopulmonary disease is associated with increased adverse outcomes in the setting of CP repair. Thus, heightened clinical suspicion for coexisting congenital anomalies in the presence of CP should prompt referring providers to perform a comprehensive and multidisciplinary evaluation to ensure cardiopulmonary optimization prior to surgical intervention.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-06-06T12:42:26Z
      DOI: 10.1177/10556656241258525
       
  • Implementation of an Enhanced Recovery After Surgery Protocol for Cranial
           Vault Remodeling Procedures

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      Authors: Clarice A Swift, Colton J Fernstrum, Haven M Howell, John B Phillips, Rebekah B Aultman, Katherine E Baker, Clay B Thames, Gidarell C Bryant, Alexander E Velazquez, Anna G Boydstun, John M Sullivan, Michael S Lebhar, Emily E Hecox, Laura S Humphries, Ian C Hoppe
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      BackgroundEnhanced recovery after surgery (ERAS) protocols have been implemented across surgical disciplines, including cranial vault remodeling for craniosynostosis. The authors aim to describe the implementation of an ERAS protocol for cranial vault remodeling procedures performed for patients with craniosynostosis at a tertiary care hospital.DescriptionInstitutional review board approval was received. All patients undergoing a cranial remodeling procedure for craniosynostosis at the authors’ institution over a 10-year period were collected (n = 168). Patient and craniosynostosis demographics were collected as well as operative details. Primary outcome measures were intensive care unit length of stay (ICU LOS) and narcotic usage. Chi squared and independent t-tests were employed to determine significance. A significance value of 0.05 was utilized.ResultsDuring the time examined, there were 168 primary cranial vault remodeling procedures performed at the authors’ institution - all of which were included in the analysis. Use of the ERAS protocol was associated with decreased initial 24-hour morphine equivalent usage (p 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-06-06T08:16:43Z
      DOI: 10.1177/10556656241255940
       
  • Tympanostomy Tube Otorrhea: Microbiological Differences Between Children
           with and Without Cleft Palate

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      Authors: Roberto N. Solis, Kurtis Young, Oscar S. Velazquez-Castro, Nicole I. Farber, Travis T. Tollefson, Craig W. Senders, Jamie L. Funamura
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo characterize and compare microbiological profiles in tympanostomy tube otorrhea for children with and without cleft palate.DesignRetrospective cohort study.SettingPediatric otolaryngology and multidisciplinary cleft/craniofacial clinic at a single tertiary care center.PatientsChildren with and without cleft palate
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-06-06T08:09:35Z
      DOI: 10.1177/10556656241258567
       
  • Inpatient versus Outpatient Alveolar Bone Grafting: A Nationwide Cost
           Analysis

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      Authors: Idean Roohani, Dylan G. Choi, Eloise W. Stanton, Collean Trotter, Marvee Turk, Priyanka Naidu, Mark M. Urata, William P. Magee, Jeffrey A. Hammoudeh
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo compare postoperative outcomes and costs between inpatient and outpatient ABG in the United States.DesignRetrospective cohort.SettingMulti-institutional/national.Patients and ParticipantsPatients who underwent ABG (n = 6649) were identified in the National Surgical Quality Improvement Program Pediatric database from 2012–2021. Inpatient and outpatient cohorts were matched using coarsened exact matching.Main outcomes measure(s)Thirty-day readmission, reoperation, and complications. A modified Markov model was developed to estimate the cost difference between cohorts. One-way and probabilistic sensitivity analyses were performed.ResultsAfter matching, 3718 patients were included, of which 1859 patients were in each hospital-setting cohort. The inpatient cohort had significantly higher rates of reoperations (0.6% vs. 0.2%; p = 0.032) and surgical site infections (0.8% vs. 0.2%; p = 0.018). The total cost of outpatient ABG was estimated to be $10,824 vs. $20,955 for inpatient ABG, resulting in $10,131 cost savings per patient. Probabilistic sensitivity analysis revealed that all 10,000 simulations resulted in consistent cost savings for the outpatient cohort that ranged from $8000 to $24,000.ConclusionsOutpatient ABG has become increasingly more popular over the past ten years, with a majority of cases being performed in the ambulatory setting. If deemed safe for the individual patient, outpatient ABG may confer a lower risk of nosocomial complications and offer significant cost savings to the healthcare economy.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-06-06T04:39:42Z
      DOI: 10.1177/10556656241256916
       
  • A Geospatial Analysis of Barriers to Cleft Lip and Palate Care in the
           United States

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      Authors: Matthew J. Heron, Siam K. Rezwan, Katherine J. Zhu, Jordan Gornitsky, Richard J. Redett, Robin Yang
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThis study evaluates the geospatial distribution of cleft lip and/or cleft palate (CL/P) care in the United States, assesses disparities between families with and without one-hour proximity to CL/P care, and recommends interventions for improving access.DesignWe identified American Cleft Palate Craniofacial Association-approved CL/P teams and calculated a one-hour driving radius around each clinic. We then used census data to compare risk factors for developing cleft (i.e., incidence risk factors) and obstacles to care (i.e., access risk factors) between counties with and without one-hour proximity.ResultsWe identified 187 CL/P teams in 45 states. Most were in the South (n = 60, 32.0%), though children in the Middle Atlantic had the greatest access to care. Alabama, Mississippi, Tennessee, and Kentucky had the least access. Children without access were 39% more likely to have gestational tobacco exposure, 8% more likely to have gestational obesity exposure, and 28% less likely to have health insurance (p 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-06-05T08:20:17Z
      DOI: 10.1177/10556656241259883
       
  • Quantifying Sagittal Lip Changes in Patients with Bilateral Cleft Lip Post
           Abbe Flap Reconstruction

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      Authors: John N. Muller, Allison Diaz, Alexandra Verzella, David A. Staffenberg, Roberto L. Flores
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-06-05T06:56:37Z
      DOI: 10.1177/10556656241255478
       
  • Invited Review: “I’ve Just Seen a Face”

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      Authors: Kenny Ardouin
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      I've Just Seen a Face is a new resource produced by author Amy Mendillo and is designed for parents of children with cleft lip and/or palate to help them to navigate the first year of life. In this invited article, Kenny Ardouin provides an overview of the book, and offers perspective on the content contained within, including potential issues for professionals working with cleft to consider. The review ends with recommendations for likely beneficiaries of the book, as well as considerations for additional future versions of the book.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-06-04T05:45:24Z
      DOI: 10.1177/10556656241259885
       
  • A Longitudinal Investigation of Nasolabial Changes With and Without
           Revision Surgery in Patients with Non-Syndromic Unilateral Cleft Lip and
           Palate

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      Authors: Wasna Dabbagh, Destin Groff, Lexi Stauffer, Mary Newland, Alexis Lo, Andrea Hiller, Ross E Long
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo determine a baseline of anticipated change in nasolabial appearance following primary repair of unilateral cleft lip/palate and evaluate the degree to which revision surgery improves nasolabial appearance.DesignRetrospective chart review.SettingPatients treated at the Lancaster Cleft Palate Clinic interdisciplinary clinic.PatientsTwenty-three patients with complete unilateral cleft lip and palate who underwent primary surgical repair and 19 additional patients who underwent subsequent revision surgery were included.InterventionsPatients in the non-revision group underwent a Tennison-Randall triangular flap lip repair at 3mo. Patients in the revision group underwent a modification of the Nakajima straight-line repair after primary Tennison-Randall triangular flap lip repair at an average age of 141mo.Main Outcome MeasuresA modification of the Asher-McDade Aesthetic Index was utilized to evaluate Nasolabial Frontal (NLF), Nasolabial Profile (NLP), Vermillion Border (VB), and total change in appearance. Scores for patients in the revision group were evaluated before and after revision while appearance for patients without revision was evaluated at 3 distinct ages. Scores were averaged across time-points and inter-rater reliability was assessed.ResultsNasolabial appearance in the non-revision sample did not change significantly over time, except for nasal profile. Scores improved after revision surgery – NLP: 3.48 to 2.97, (p = 0.001); NLF: 3.50 to 2.95 (p = 0.001); and Total Nasolabial Score: 3.29 to 3.01 (p = 0.004), with no significant change in VB.ConclusionDecisions regarding need for nasolabial revision surgery may be made as early as 5yo with successful outcomes following secondary surgery improving appearance except for vermillion border appearance.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-05-30T09:26:38Z
      DOI: 10.1177/10556656241256706
       
  • Early Utilization of Ketorolac in Cleft Palate Repair

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      Authors: Alexandra Michalowski, Vikash Modi
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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, P = .01) and lower total opiate dosage during hospitalization (mean of 2.8 vs 9.16 morphine milligram equivalents, t = 3.37, P = .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.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-05-25T06:43:20Z
      DOI: 10.1177/10556656241250138
       
  • Crowdsourcing the Impact of Illustration in Cleft Surgery Education

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      Authors: Meagan Wu, Elizabeth B. Card, Jonathan H. Sussman, Dillan F. Villavisanis, Benjamin B. Massenburg, Jinggang J. Ng, Dominic J. Romeo, Jordan W. Swanson, Jesse A. Taylor, David W. Low
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThis study aimed to (1) assess layperson preferences for how surgical information is presented; (2) evaluate how the format of visual information relates to layperson comfort with undergoing surgery, perceptions of surgeon character traits, and beliefs about artistic skill impacting plastic surgery practice; and (3) identify sociodemographic characteristics associated with these outcomes.DesignA survey was developed in which one of five standardized sets of information depicting a unilateral cleft lip repair was presented as (1) text alone, (2) quick sketches, (3) simple drawings, (4) detailed illustrations, or (5) photographs.SettingOnline crowdsourcing platform.ParticipantsRaters aged 18 years and older from the United States.InterventionsNone.Main Outcome Measure(s)After viewing the surgical information, participants answered three sets of Likert scale questions. Ratings were averaged to produce three composite scores assessing (1) comfort with undergoing surgery (2) perceptions of surgeon character traits, and (3) beliefs about plastic surgery and artistry.ResultsFour hundred seventy-nine participants were included. Surgeon character traits score was highest among participants who viewed detailed illustrations at 4.46 ± 0.59, followed by photographs at 4.43 ± 0.54, text alone at 4.28 ± 0.59, simple drawings at 4.17 ± 0.67, and quick sketches at 4.17 ± 0.71 (p = 0.0014). Participants who viewed detailed illustrations rated surgical comfort score and plastic surgery and artistry score highest, although differences did not achieve statistical significance.ConclusionsViewing detailed cleft lip repair illustrations was significantly associated with positive perceptions of surgeon character traits. Our data help to contextualize methods of communication and education valued by the public when seeking cleft care.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-05-23T06:56:48Z
      DOI: 10.1177/10556656241257101
       
  • Gingivoperiosteoplasty in Children with Cleft Lip and Palate: The Need for
           Alveolar Bone Grafting

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      Authors: Darius Balumuka, Gwendolyn E. Daly, Kelsi Krakauer, Samantha Burch, Breanna Jedrzejewski, Alicia Johnson, Lori K. Howell, Erik M. Wolfswinkel
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThis study aimed to determine the efficacy of gingivoperiosteoplasty (GPP) in preventing alveolar bone grafting (ABG) among children with cleft lip and palate (CLP).Design/SettingRetrospective university hospital single center study.PatientsChildren with CLP treated with GPP from 2000-2015 were included. Those under eight years of age, without definitive conclusions regarding need for ABG or with incomplete data were excluded.InterventionsIncluded patients were analyzed for demographics, cleft type, age at GPP, associated cleft surgery, use of nasoalveolar molding (NAM), indication for ABG, operating surgeon and presence of residual alveolar fistula. T-tests and Fisher's exact tests were utilized for statistical analysis.Main Outcome MeasureThe need for ABG.ResultsOf the 1682 children identified with CLP, 64 underwent GPP and met inclusion criteria. 78% of patients with CLP who underwent GPP were recommended for ABG. Those who received GPP at a younger age (P = .004) and at the time of initial cleft lip repair (P = .022) were less likely to be recommended for ABG. Patients with complete CLP were more likely to be recommended for ABG than patients with cleft lip and alveolus only (P = .015). The operating surgeon impacted the likelihood of ABG (P = .004). Patient gender, race, ethnicity, laterality, and NAM were not significantly associated with recommendation for ABG.ConclusionGPP does not preclude the need for ABG. Therefore, the success of ABG after GPP and maxillary growth restriction should be analyzed further to determine if GPP is a worthwhile adjunct to ABG in cleft care.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-05-23T05:40:43Z
      DOI: 10.1177/10556656241256917
       
  • Travel Distance and Spanish-Speaking are Associated with Delays in the
           Treatment of Cleft Palate

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      Authors: Eloise W. Stanton, Danielle Rochlin, H. Peter Lorenz, Clifford C. Sheckter
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveDelayed repair of cleft palate is associated with worse speech outcomes. Social determinants of health may influence the timing of surgery; however, there are no population health investigations to evaluate factors such as travel distance, language barriers, and payer. This study sought to identify factors that may interfere with timely cleft palate repair.DesignRetrospective cohort.SettingNational/multi-center.Patients/ParticipantsAll cleft palate repairs within California were extracted from 2000–2021.Main Outcomes MeasuresThe primary outcome was age at surgical repair, which was modeled with linear regression. Covariates included race, primary language, distance from patient home to hospital, socioeconomic status, primary payer, and managed care enrollment status.Results11 260 patients underwent surgical repair of a cleft palate. Black race was associated with delayed repair (22 additional days, P = .004, 95% CI 67.00–37.7) along with Asian/Pacific-Islander race (11 additional days, P = .006, 95% CI 3.26-18.9) compared to white race. Spanish-speaking patients had significantly later cleft palate repairs by 19 days, (P 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-05-22T07:35:56Z
      DOI: 10.1177/10556656241256923
       
  • Comparison of Facial Aesthetic Evaluation Given by Patients with Cleft Lip
           and/or Palate and Professionals: A Systematic Review

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      Authors: Xin Wang, Wenying Kuang, Jianan Yan, Jingyi Xu, Xinyu Zhang, Yanping Jiang, Wenjun Yuan
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo compare the differences of facial aesthetic evaluation between patients with Cleft Lip and/or Palate (CL/P) and professionals for the treatment outcome of CL/P.DesignThis systematic review was conducted on MedLine, Web of Science, Embase and Cochrane Library databases. The Risk of Bias in Non-randomized Studies of Intervention (ROBINS-I) tool was used to evaluate the included researches.SettingNot applicable.Patients, ParticipantsPatients with CL/P and professionalsInterventionsNot applicable.Main Outcome MeasuresThe facial aesthetic evaluation of patients with CL/P and professionals.ResultsAmong the 1695 literatures retrieved, 22 articles were included, including 974 patients with CL/P and 251 professionals. The bias risk assessment on 21 articles was rated “Moderate” and only one article was rated “Serious”. Due to the high heterogeneity of the included studies, meta-analysis was not possible, so descriptive analysis was conducted. Among the included studies, two articles indicated similar views from both groups, 19 noted differences between the two groups, of which three articles indicated more positive evaluation by professionals and nine articles indicated more positive evaluation by patients.ConclusionsThe available data indicate that there is a difference between patients with CL/P and professionals in the aesthetic evaluation, but it is not clear which group is more positive. During the treatment of patients with CL/P, apart from the objective aesthetic evaluation, professionals should fully consider subjective ideas and self-assessment of patients, in order to improve the quality of life for patients.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-05-16T05:09:12Z
      DOI: 10.1177/10556656241254186
       
  • Analysis and Reporting of Randomized Trials in Cleft Palate Surgery:
           Learning from the Timing of Primary Surgery (TOPS) Trial

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      Authors: Matthew Fell, Ginette Phippen, Stephanie van Eeden, David Chong, Marc C. Swan, Simon van Eeden, John B. Carlin
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      The Timing of Primary Surgery (TOPS) trial was published August 2023 in the New England Journal of Medicine and is a milestone achievement for a study focused on cleft palate. Due to the complexity of outcome reporting in cleft and the rarity of such comparative trials, TOPS presents a useful opportunity to critically review the design, analysis and reporting strategies utilised. This perspective article focused on the inclusion of participants, the choice of the primary outcome measure and the analysis of ordinal data within the trial. Considerations for future comparative studies in cleft care are discussed.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-05-10T05:59:18Z
      DOI: 10.1177/10556656241253949
       
  • Identification of a Novel TP63 Variant in a Chinese Patient with Orofacial
           Clefts and Ectrodactyly: Case Report and Literature Review

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      Authors: Leheng Jiang, Chanyuan Jiang, Tao Song, Yongqian Wang, Nuo Si, Haidong Li, Ningbei Yin
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      The TP63 gene is essential for epithelial proliferation, differentiation, and maintenance during embryogenesis. Despite considerable clinical variability, TP63-related symptoms are characterized by ectodermal dysplasia, distal limb malformations, and orofacial clefts. We identified a novel TP63 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 TP63-related manifestations in the literature and noted different distributions of CP- and CL/P-related variants regarding p63 structural domains.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-05-09T06:48:49Z
      DOI: 10.1177/10556656241241132
       
  • Same-day Discharge for Cleft Palate Repair: A Single-Surgeon Retrospective
           Analysis

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      Authors: Allison L. Diaz, Leya Groysman, Liliana Camison, Roberto L. Flores, David A. Staffenberg
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo evaluate the safety of same-day discharge for patients undergoing primary cleft palate repairDesignSingle-surgeon retrospective reviewSettingTertiary care institutionPatients/Participants40 consecutive patients that underwent primary cleft palate repair by a single surgeon from September 2018 to June 2023InterventionsSame-day discharge versus overnight admission after primary palatoplastyMain Outcome Measures30-day readmission, reoperation, wound and all-cause complication rate and 1-year fistula incidenceResultsOf 40 total cases, 20 patients were discharged on the same calendar day and 20 patients were admitted for overnight stay following primary cleft palate repair. In the same-day discharge group, readmission incidence was 10%(n = 2), wound complication incidence was 5%(n = 1), and postoperative complication incidence was 15%(n = 3). In comparison, patients admitted overnight had a readmission incidence of 5%(n = 1, P = 1.00), wound complication incidence of 10%(n = 2, P = 1.00), and postoperative complications of 20%(n = 4, P = 1.00) No patients had 30-day reoperations or fistulas at 1 year. A higher proportion of admitted patients held a preoperative diagnosis of unilateral cleft palate and alveolus (Veau 3) as compared to patients discharged on the same day (P = .019). During the postoperative hospital course, admitted patients received significantly more oxycodone at median of 2 doses (IQR 1.00–3.75) and acetaminophen at a median of 4 doses (IQR 3.00–5.00) than patients with same-day discharge with a median of 1 dose (IQR 0.00 –1.00, P 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-05-08T06:14:06Z
      DOI: 10.1177/10556656241251932
       
  • Treatment Outcomes of Lip Taping in Patients with Non-syndromic Cleft Lip
           and/or Palate: A Systematic Review and Meta-analysis

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      Authors: Vignesh R, Ruchi Singhal, Ritu Namdev, Adarsh Kumar, Charu Dayma, Asha Rani
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo conduct a systematic review of the data in peer-reviewed medical literature and evaluate the effectiveness of lip taping as a pre-surgical naso-alveolar molding (NAM) technique in infants with cleft lip and/or palate.DesignAn electronic search of various databases for relevant studies, regardless of date, from inception to June 2023 was carried out and evaluated. After completing the electronic search and applying our inclusion/exclusion criteria, 6 studies—2 randomized control trials, 2 non-randomized studies, and 2 case series—were included. Data extraction of relevant articles was done independently by 2 authors. Quality assessment was done using the JBI prevalence critical appraisal tool and certainty of evidence was carried out by GRADE approach.Main Outcome MeasuresNasolabial Aesthetics, Dentoalveolar Relationship.ResultsA total of six studies were included in the current review. Meta-analysis was carried out, and forest plots were obtained for a single mean from the lip-taping group. 3 studies had a low risk of bias, while 3 studies displayed a serious risk of bias. Significant improvement in various outcome measures was noted with lip taping when compared with the control group although the certainty of evidence was very low.ConclusionWhen compared to no therapy, lip taping appears to ameliorate dentoalveolar measurements and nasolabial aesthetics. To increase our knowledge of lip taping, more research will be needed in the future, as there are not many studies to prove lip taping is better than other treatment approaches.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-05-07T07:17:30Z
      DOI: 10.1177/10556656241249822
       
  • Novel Technique for Median Cleft Lip Comprising the Simultaneous Formation
           of the Columella, Philtrum, and Cupid's Bow

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      Authors: Hikaru Fujito, Naritaka Kimura, Hikaru Moriyama, Syouta Matsuda, Hiroya Mihara
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-05-07T05:24:13Z
      DOI: 10.1177/10556656241253411
       
  • Incomes to Outcomes: A Global Assessment of Disparities in Cleft and
           Craniofacial Treatment

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      Authors: Connor S. Wagner, Michaela K. Hitchner, Natalie M. Plana, Carrie Z. Morales, Lauren K. Salinero, Carlos E. Barrero, Matthew E. Pontell, Scott P. Bartlett, Jesse A. Taylor, Jordan W. Swanson
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveRecent investigations focused on health equity have enumerated widespread disparities in cleft and craniofacial care. This review introduces a structured framework to aggregate findings and direct future research.DesignSystematic review was performed to identify studies assessing health disparities based on race/ethnicity, payor type, income, geography, and education in cleft and craniofacial surgery in high-income countries (HICs) and low/middle-income countries (LMICs). Case reports and systematic reviews were excluded. Meta-analysis was conducted using fixed-effect models for disparities described in three or more studies.SettingN/APatientsPatients with cleft lip/palate, craniosynostosis, craniofacial syndromes, and craniofacial trauma.InterventionsN/AResultsOne hundred forty-seven articles were included (80% cleft, 20% craniofacial; 48% HIC-based). Studies in HICs predominantly described disparities (77%,) and in LMICs focused on reducing disparities (42%). Level II-IV evidence replicated delays in cleft repair, alveolar bone grafting, and cranial vault remodeling for non-White and publicly insured patients in HICs (Grades A-B). Grade B-D evidence from LMICs suggested efficacy of community-based speech therapy and remote patient navigation programs. Meta-analysis demonstrated that Black patients underwent craniosynostosis surgery 2.8 months later than White patients (P 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-05-03T12:54:39Z
      DOI: 10.1177/10556656241249821
       
  • Posterior Positioning of Levator Veli Palatini with Intact Nasal Layer and
           Side-by-Side Bilateral Buccinator Flaps: Modified Approach for Palatal
           Lengthening

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      Authors: Mohammad Ali Hoghoughi, Hooman Kamran, Reza Shahriarirad, Maryam Salimi, Hamidreza Hosseinpour
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo introduce a modified surgical method using bilateral buccinator flaps with posterior positioning of levator veli palatini muscles to treat velopharyngeal insufficiency.DesignCross-sectional clinical studyPatientsNon-syndromic patients with velopharyngeal insufficiencyInterventionWe performed a modified surgical method using posterior positioning of levator veli palatini muscles and side-by-side bilateral buccinator flaps.Main outcome measuresPatients’ characteristics, severity of hypernasality, palatal lengthening size, and operative complications were recorded and described. The severity of hypernasality was determined by a speech therapist before and after the operation.ResultsA total of 26 non-syndromic patients, with a median age of 8.5 years, were enrolled. All patients presented with severe hypernasality. Following the operation and during the follow-up period, 12 patients showed a complete resolution of hypernasality, while 9, 3, and 2 patients exhibited mild, moderate, and severe hypernasality, respectively. In addition, the mean palatal lengthening was measured to be 25.3 ± 3.5 mm. Overall, three patients experienced partial flap loss in one flap, which was successfully repaired with a secondary intention without the development of a fistula. In five cases, complete closure of the donor sites couldn’t be achieved and thus were treated with secondary intention. Additionally, postoperative food restrictions were observed in seven cases but were resolved within one month. No other complications were noted in the remaining patients.ConclusionThis modified palatal lengthening technique results in a significant lengthening of the palate while maintaining favorable speech outcomes. Future randomized clinical trials are warranted to validate our findings.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-04-27T07:08:51Z
      DOI: 10.1177/10556656241248272
       
  • Scar Outcome in Unilateral Complete Cleft Lip Repair: A Comparative
           Analysis of Vertical Lip Lengthening Strategies Using the
           Rotation-Advancement Concept

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      Authors: Rafael Denadai, Karin Milleni Araujo, Raphael Lelis Campos, Chi-Chin Lo, Hyung Joon Seo, Nobuhiro Sato, Junior Chun-Yu Tu, Pang-Yung Chou, Lun-Jou Lo
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo assess the differences in scar outcomes between modified rotation-advancement techniques proposed by Drs. Mohler and Noordhoff, designed to address issues such as inadequate vertical lip length and scarring on the upper third of the lip in the original rotation-advancement technique.DesignRetrospective single-surgeon (RD) study.PatientsConsecutive non-syndromic children (n = 68) with unilateral complete cleft lip and palate.InterventionsModified Mohler (columellar backcut reconstructed with C flap; n = 34) and modified Noordhoff (lower, medially-created backcut reconstructed with laterally-based triangular skin flap; n = 34) repairs.Mean outcome measuresUsing 12-month postoperative frontal photographs, scar evaluations (overall and superior, middle, and inferior portions of the lip) were appraised by an assessment panel composed by independent professional and nonprofessional raters employing four validated qualitative scar assessment scales: Manchester Scar Scale, modified Scar-Rating Scale, Stony Brook Scar Evaluation Scale, and Visual Analog Scale. Quantitative computerized photogrammetric scar widths of the superior, middle, and inferior portions of the upper lip were also measured.ResultsThe modified Noordhoff method showed significantly (all P  .05) difference for the middle and lower portions. No significant difference (all P > .05) was observed for photogrammetric scar width measurements.ConclusionThe modified Noordhoff technique provided better qualitative results for unilateral complete cleft lip-related scars compared to the modified Mohler technique.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-04-22T08:29:40Z
      DOI: 10.1177/10556656241247625
       
  • 3-Dimensional Evaluation of Two PNAM Techniques (Modified Grayson &
           

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      Authors: Alisha K. H., Puneet Batra, Achint Juneja, Aditya Talwar, Stuti Mohan, S. C. Sood
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveEvaluate facial changes after Presurgical Naso-Alveolar Molding (PNAM) in unilateral cleft lip and palate (UCLP) patients treated with Modified Grayson Technique and AlignerNAM (with DynaCleft nasal elevator) using a 3D facial scan.DesignRandomised clinical trial.SettingInstitutional study. Participants: 20 UCLP patients allocated to two groups (10 patients each).InterventionsGroup A patients underwent PNAM with Modified Grayson Technique and Group B patients underwent AlignerNAM (with DynaCleft nasal elevator). Their 3D facial scans were obtained by using an iOSbased application (Bellus3D FaceApp) mounted on a novel frame. These .stl files were analysed using 3D software (GOM INSPECT) at three-time intervals; before intervention (T0), after intervention (T1) and one month after lip repair surgery (T2).Main Outcome Measure(s)Changes in facial and nasolabial morphology.ResultsBoth techniques brought significant improvement in the columellar length, nasal tip projection, columella angle, nasal tip angle and a significant reduction in cleft width. At T1, a statistically significant difference in angular and linear measurements was present in both groups. At T2, no statistically significant difference in linear parameters was observed between the two groups except for the outer lateral height of the non-cleft side, basal lateral height of the non-cleft side, and philtrum width. Similar pattern was observed in angular measurements with no statistically significant difference between the two groups except in nasolabial angle, anterior nasal base triangle III, and anterior nasal root triangle.ConclusionsAligner NAM and Modified Grayson technique are equally effective PNAM methods with similar clinical results in nasolabial morphology after lip repair surgery.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-04-22T07:40:21Z
      DOI: 10.1177/10556656241246923
       
  • Cleft Summit 2022: The Impact of a Unified Voice

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      Authors: Raj M. Vyas, Wassim Najjar, Joseph E. Losee, Ann W. Kummer, Usama S. Hamdan
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-04-17T07:49:33Z
      DOI: 10.1177/10556656241242699
       
  • A Conceptual Thematic Framework of Psychological Adjustment in Caregivers
           of Children with Craniofacial Microsomia

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      Authors: Nicola M. Stock, Bruna Costa, Jade Parnell, Alexis L. Johns, Canice E. Crerand, Kristin Billaud Feragen, Laura P. Stueckle, Angela Mills, Leanne Magee, Matthew Hotton, Melissa Tumblin, Amy Schefer, Amelia F. Drake, Carrie L. Heike
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveChildren with craniofacial microsomia (CFM) have complex healthcare needs, resulting in evaluations and interventions from infancy onward. Yet, little is understood about families’ treatment experiences or the impact of CFM on caregivers’ well-being. To address this gap, the NIH-funded ‘Craniofacial microsomia: Accelerating Research and Education (CARE)’ program sought to develop a conceptual thematic framework of caregiver adjustment to CFM.DesignCaregivers reported on their child's medical and surgical history. Narrative interviews were conducted with US caregivers (n = 62) of children aged 3-17 years with CFM. Transcripts were inductively coded and final themes and subthemes were identified.ResultsComponents of the framework included: 1) Diagnostic Experiences, including pregnancy and birth, initial emotional responses, communication about the diagnosis by healthcare providers, and information-seeking behaviors; 2) Child Health and Healthcare Experiences, including feeding, the child's physical health, burden of care, medical decision-making, surgical experiences, and the perceived quality of care; 3) Child Development, including cognition and behavior, educational provision, social experiences, and emotional well-being; and 4) Family Functioning, including parental well-being, relationships, coping strategies, and personal growth. Participants also identified a series of “high” and “low” points throughout their journey and shared their priorities for future research.ConclusionsNarrative interviews provided rich insight into caregivers’ experiences of having a child with CFM and enabled the development of a conceptual thematic framework to guide clinical care and future research. Information gathered from this study demonstrates the need to incorporate evidence-based psychological support for families into the CFM pathway from birth onward.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-04-08T07:35:17Z
      DOI: 10.1177/10556656241245284
       
  • Timing of Alveolar Bone Graft and Barriers to Care

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      Authors: Elizabeth E. Bushong, Darin Patmon, Hanna Pfershy, Cuyler Huffman, Anna Carlson, John Girotto
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThe current standard timing for alveolar bone grafting (ABG) occurs during mixed dentition, typically between the ages of six and twelve. A delay in receiving this operation is associated with an increase in graft loss and an overall thinner maxilla. This study aims to determine whether socioeconomic barriers are associated with a delay in timely ABG.DesignA retrospective analysis of patients who received ABG at our institution since 2012. Patient demographics, cleft classifications, operative details, and surgical dates were examined. A logistic regression model was created using socioeconomic variables to predict patients receiving delayed ABG. Significant variables were then included in a backwards selection logistic regression, followed by a final analysis of maximum likelihood estimates.SettingSingle-institution, primary cleft care center.Patients202 patients with cleft palates who underwent ABG.InterventionsABG.Main Outcome MeasuresTiming in which patients received ABG: standard (6-12 years) and delayed (>12 years).ResultsFemale sex was a protective factor in the timing of ABG in our initial univariate analysis (OR = 0.44; p  =  .015). Socioeconomic factors resulting in delayed presentation for ABG include median income (OR = 1.0; p  =  .018) and public insurance status (OR = 3.75; p 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-04-05T06:52:52Z
      DOI: 10.1177/10556656241242695
       
  • Alterations in Sphenoid Anatomy in Craniosynostosis: Implications for
           Fronto-Orbital Advancement

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      Authors: Gaia Santiago, Chiara Santiago, Alvin Nguyen, Akriti Choudhary, Linping Zhao, Lee W.T. Alkureishi, Pravin K. Patel, Chad A. Purnell
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveFronto-orbital advancement involves removal of the fronto-orbital bandeau. Visualization of the saw blade is lost as it passes through the fronto-orbital-sphenoid junction (FOSJ), placing the temporal lobe at risk of injury. We aim to provide a 3D analysis of the space surrounding this osteotomy to differentiate various types of craniosynostoses.DesignRetrospective cohortSettingInstitutional.PatientsThirty patients with isolated unicoronal synostosis, nonsyndromic bicoronal synostosis, metopic synostosis, Apert syndrome, Crouzon syndrome, and Muenke syndrome.InterventionsCT scans conducted between 2 months to 2 years of age were 3D reconstructed to compare craniometrics against normal controls.Main Outcome Measure(s)Craniometrics.ResultsThe mean bone thickness of the FOSJ at the level of the supraorbital rim was significantly small for the Apert, unicoronal and bicoronal groups. The mean vertical height of the middle cranial fossa from the lesser sphenoid wing was significantly greater in the unicoronal group. The mean vertical height of the tip of the temporal lobe from the lateral sphenoid ridge was greater in the unicoronal, isolated bicoronal, and Apert groups. The mean corneal protrusion beyond the lateral orbital rim was significantly greater in the Apert and unicoronal groups. The mean horizontal depth of the orbit was smallest in the Apert group. The mean vertical distance between the dacryon and the foramen cecum, and the mean volume of temporal lobe beneath the sphenoid shelf were the largest in the Apert group.ConclusionsPatients with Apert syndrome have the most unfavorable morphology of the anterior and middle cranial fossae.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-04-03T08:08:29Z
      DOI: 10.1177/10556656241245514
       
  • Barriers in Cleft Service Access in Sub-Saharan Africa: A Thematic
           Analysis of Practical Needs of Rural Families

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      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
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-04-01T07:30:14Z
      DOI: 10.1177/10556656241244976
       
  • Health-Related Quality of Life in Mexican Children and Adolescents with
           Non-Syndromic Craniosynostosis

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      Authors: Julieta Moreno-Villagómez, Miguel Castillo-Mimila, Guillermina Yáñez-Téllez, Belén Prieto-Corona, Antonio García-Méndez
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveAssess the Health-Related Quality of Life in children and adolescents with non-syndromic craniosynostosis and compare it with participants without craniosynostosis.DesignNon-experimental, cross-sectional design.SettingThe assessment was done remotely and the instrument was sent via chat or email.Patients/ ParticipantsParticipants (ages 8–17) with non-syndromic craniosynostosis (n = 27) and without craniosynostosis (n = 26).Main Outcome Measure(s)We used an adapted version for the Mexican population of the Health-Related Quality of Life Questionnaire for Children and Adolescents -KIDSCREEN-52.ResultsAll 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 (rpb = 0.48).ConclusionsChildren 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.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-29T08:08:18Z
      DOI: 10.1177/10556656241242916
       
  • ‘Suspension Palatoplasty’ – A method of surgical correction of VPI
           post Cleft Palate repair

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      Authors: Mukunda Reddy Damalachervu, Rajesh Yellinedi, A. Dharanipriya, V. Lalasa Mary, Rambabu Nuvvula
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      Objective To design the technique of ‘Suspension Palatoplasty’ for Velopharyngeal Insufficiency (VPI) post Cleft Palate (CP) based on optimal spatial positioning of palate at the time of VPI correction, by using a non-obstructive, high, midline pharyngeal flap for predictable velopharyngeal closure and normal speech. To evaluate the results of CP patients with VPI operated using the technique of ‘Suspension palatoplasty’.DesignAn ambi-spective longitudinal clinical study.SettingComprehensive cleft care clinic in a private trust hospital.Patients, ParticipantsPatients operated using the ‘Suspension Palatoplasty’ technique for VPI post CP repair between 2014 and 2018 with a minimum follow-up period of 5 years.Interventions‘Suspension Palatoplasty’ - Double Opposing Z (DOZ) plasty with palatal myoplasty is used to revise soft palate and a narrow superiorly based pharyngeal flap is used to suspend it for a dynamic velopharyngeal closure.Main outcome measureSpeech outcome and surgical complications.Results70 out of 119 studied were found to have normal speech (59%), and another 25 patients (21%) had acceptable speech. Thus 95 out of 119 patients (80%) had normal or near-normal speech and did not require any further speech therapy or surgeries. 12 patients had snoring without difficulty in breathing. One patient had symptoms suggestive of obstructive sleep apnea. Younger patients had a higher percentage of normal speech outcomes. Many of our adult patients also attained normal speech.Conclusion‘Suspension Palatoplasty’ aims to achieve normal speech with little effort. It has minimal side effects. The author has performed 403 cases to date.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-28T11:33:43Z
      DOI: 10.1177/10556656241228112
       
  • Eyeing Risks: A Critical Analysis of the Use of Periorbital Steroids in
           Fronto-orbital Advancement

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      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
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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 (P 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-28T08:22:03Z
      DOI: 10.1177/10556656241241963
       
  • Virtual Reality Simulation of Airway Management Post-Cleft Palate Surgery:
           A Model for Sustainable and Equitable Education

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      Authors: Alexandra N. Verzella, Allison L. Diaz, Matteo Laspro, Andre Alcon, Jill Schechter, Aaron Oliker, Anne Arnold, Roberto L. Flores
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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 (P 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-28T08:09:04Z
      DOI: 10.1177/10556656241241128
       
  • Elastic Chain Premaxillary Retraction Appliance Does Not Increase
           Inter-Canthal Dimension in Patients with Bilateral Cleft Lip and Palate

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      Authors: Hamad Burashed, Cory M. Resnick, Elizabeth E. Ross, John B. Mulliken, Bonnie L. Padwa
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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 (P  .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 (P  .05) and was significantly larger than normal at all time-points (P 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-22T06:48:51Z
      DOI: 10.1177/10556656241241200
       
  • Assessing Appearance, Speech, and Hearing (dis)Satisfaction in Individuals
           with Cleft Lip and/or Palate: A Contribution to General Population Norms

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      Authors: Nicola M. Stock, Bruna Costa, Paul White, Lauren Eve, Amanda J. Bates
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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 (n = 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.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-21T07:31:41Z
      DOI: 10.1177/10556656241241127
       
  • “When I was Younger, My Story Belonged to Everyone Else”:
           Co-production of Resources for Adults Living with Craniosynostosis

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      Authors: Nicola M. Stock, Bruna Costa, William Bannister, Charlotte Ashby, Nammie Matthews, Louise Hebden, Laura Melles, Zoe Hilton-Webb, Sally Smith, Kristian Kane, Lewis Carter, Anna Kearney, Katie Piggott, Charlotte Russell, Karen Wilkinson-Bell
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveDespite growing recognition that congenital craniofacial conditions have lifelong implications, psychological support for adults is currently lacking. The aim of this project was to produce a series of short films about living with craniosynostosis in adulthood, alongside a psychoeducational booklet.DesignThe resources were developed using multiple focus groups and meetings attended by researchers, patient representatives, a leading charitable organisation, an award-winning film production company, clinicians, and other experts in the field.ResultsAn online mixed-methods survey was developed based on prior work to request feedback on the acceptability and utility of the resources from the craniosynostosis community. While data collection to evaluate the resources is ongoing, preliminary results (n = 36) highlight an acceptability rating of 100%.ConclusionsThe resources developed represent a step forward in addressing the unmet information and support needs of adults with craniosynostosis and highlight the benefits of co-production in research.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-19T06:17:34Z
      DOI: 10.1177/10556656241236580
       
  • A Single Institution 19 Year Comparison of Furlow and Straight Line
           Palatoplasty Techniques in Bilateral Cleft Lip and Palate

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      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
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThis 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.DesignThis was a single-center IRB approved retrospective cohort study.SettingThis study took place at an urban tertiary academic center.Patients, ParticipantsAll 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.InterventionsA total of 1552 patients underwent palatoplasty during the study period. Of these, 192 (12.4%) met inclusion criteria with a diagnosis of BCLP.Main Outcome MeasuresPrimary outcomes of this study included rate of fistula and incidence of speech correcting surgery. Secondary outcomes included rate of surgical fistula repair.ResultsOne 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).ConclusionsThis 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.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-18T01:19:37Z
      DOI: 10.1177/10556656241239203
       
  • A 10-Year Nationwide Analysis of Risk Factors of Readmission and the
           Implications of Same-Day Discharge Following Velopharyngeal Insufficiency
           Correcting Surgery

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      Authors: Idean Roohani, Eloise Stanton, Collean Trotter, Dylan G. Choi, Sarah Alfeerawi, Pasha Shakoori, Ishani D. Premaratne, Aydin Hammoudeh, Artur Fahradyan, Mark M. Urata
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo investigate risk factors for readmission and the implications of same-day discharge for surgical management of velopharyngeal insufficiency (VPI).DesignRetrospective cohort.SettingMulti-institutional/national.Patients and ParticipantsPatients who underwent VPI-correcting surgery (n = 4479) were identified in the National Surgical Quality Improvement Program Pediatric database from 2012–2021.Main outcomes measure(s)30-day unplanned readmission.ResultsA total of 3878 (86.6%) patients were admitted inpatient following surgical intervention, while 601 (13.4%) were discharged on the same day. Thirty-day readmission rate was 1.7% across all patients. Based on multivariate logistic regression, patient factors identified as significant predictors of 30-day readmission included ASA class 4 (OR 11.22 [95% CI 1.01–124.91]; p = 0.049), steroid use (OR 7.30 [95% CI 2.22–23.97]; p = 0.001), and gastrointestinal disease (OR 2.48 [95% CI 1.22–5.00]; p = 0.012). Upon interaction analysis, patients with cardiac or neuromuscular disease who were discharged on the same day of surgery were associated with a higher readmission rate than those admitted to the hospital (cardiac disease RR 6.72 [95% CI 1.41–32.06]; p = 0.017) and (neuromuscular disease RR 12.39 [95% CI 1.64–93.59]; p = 0.015).ConclusionsApproximately 90% of VPI-correcting procedures are completed inpatient nationwide. Cardiac and/or neuromuscular disease significantly increased the patients’ readmission risk when discharged on the same day of surgery. The inpatient setting should remain the best practice as adequate resources are available to mitigate life-threatening complications.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-15T11:40:34Z
      DOI: 10.1177/10556656241233248
       
  • Feeding Management and Palate Repair Timing in Infants with Cleft Palate
           with and without Pierre Robin Sequence: A Multisite Study

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      Authors: Jessica L Williams, Kari M Lien, Richard Kirschner, Gregory Allen, Kathy Chapman
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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 (P 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-15T11:39:24Z
      DOI: 10.1177/10556656241239766
       
  • Is There Utility in Preoperative Testing of Hemoglobin Before Primary
           Cheiloplasty'

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      Authors: Aryan Shay, Megan Gaffey, Roger Roe, Alexa Robbins, Isabella Zaniletti, Adam Johnson, Larry Hartzell
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-15T11:38:44Z
      DOI: 10.1177/10556656241239510
       
  • Can MRI Replace Nasopharyngoscopy in the Evaluation of Velopharyngeal
           Insufficiency'

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      Authors: Jessica L. Williams, Jamie L. Perry, Taylor D. Snodgrass, Davinder J. Singh, M’hamed Temkit, Thomas J. Sitzman
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-15T11:38:15Z
      DOI: 10.1177/10556656241239459
       
  • Diagnostic Potential of Complementation of MRI to Prenatal Ultrasound for
           Detecting Orofacial Clefts in High-Risk Fetuses: A Network Meta-Analysis

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      Authors: Jing Zhai, Shuyan You, Zhonghua Liang, Haihua Yu, Chengfeng Zhu, Lu Han
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo compare the complementation of magnetic resonance imaging (MRI) to prenatal ultrasound (US) with prenatal US alone in detecting orofacial clefts in high-risk fetuses.DesignA network meta-analysis.SettingLiterature retrieval in PubMed, EMBASE, and Cochrane library, and meta-analysis based on STATA 14.0.PatientsFetuses were at high-risk for orofacial clefts.InterventionsPrenatal US and the complementation of MRI to prenatal US.Main outcome measuresThe pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic odds ratio (DOR), and area under the curve (AUC).ResultsThirteen studies involving 776 patients were included. Direct meta-analysis showed that the complementation of MRI to prenatal US did not differ from prenatal US in detecting orofacial clefts if the type of orofacial clefts was not distinguished. Subgroup analysis showed that the specificity of prenatal US for the detection of isolated cleft palate (CP) was lower than that of the complementation of MRI to prenatal US. Furthermore, network meta-analysis consistently suggested a comparable diagnostic value between prenatal US and the complementation of MRI to prenatal US. Moreover, subgroup analysis showed that the specificity of prenatal US was significantly lower than that of complementation of MRI to prenatal US for the detection of isolated CP.ConclusionsMRI is more accurate than ultrasound in detecting cleft palate. Therefore, MRI should be offered if there is a fetus with a possible or ultrasound diagnosis of cleft palate, especially if the evaluation of cleft palate is deemed unsatisfactory after careful evaluation of the images.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-15T11:36:16Z
      DOI: 10.1177/10556656241231119
       
  • Tranexamic Acid: Safeguarding Children with Craniosynostosis from
           Bleeding. A Review Article

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      Authors: Khildan Miftahul Firdaus, Lucky Andriyanto, Adil Jihad Muhammad, Tatang Bisri
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-14T04:44:30Z
      DOI: 10.1177/10556656241239527
       
  • A Longitudinal Analysis of Pre- and Post-Operative Dysmorphology in
           Metopic Craniosynostosis

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      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
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThe purpose of this study is to objectively quantify the degree of overcorrection in our current practice and to evaluate longitudinal morphological changes using CranioRateTM, a novel machine learning skull morphology assessment tool.  DesignRetrospective cohort study across multiple time points.SettingTertiary care children's hospital.PatientsPatients with preoperative and postoperative CT scans who underwent fronto-orbital advancement (FOA) for metopic craniosynostosis.Main Outcome MeasuresWe evaluated preoperative, postoperative, and two-year follow-up skull morphology using CranioRateTM 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.ResultsFifty-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).ConclusionsMSS 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.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-14T04:44:00Z
      DOI: 10.1177/10556656241237605
       
  • Preoperative Velopharyngeal Closure Predicts Hypernasality Outcomes of
           Secondary Furlow Double-Opposing Z-Plasty

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      Authors: Kayla Prezelski, Carolyn Kim, Jeyna Perez, Cortney Vant Slot, Alex A. Kane, James R. Seaward
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo determine if preoperative velopharyngeal closure percentage (VCP) is predictive of successful Furlow double opposing Z-plasty (DOZP) and subsequently determine the optimal velopharyngeal closure cutoff for successful DOZP.DesignRetrospective studySettingTertiary academic centerPatients110 patients with repaired cleft lip and palate having hypernasality treated with DOZPInterventionsSpeech videofluoroscopy images were used to obtain the preoperative VCP and other measurements.Main Outcome MeasuresChanges in hypernasality scores using the Cleft Audit Protocol for Speech-Augmented-Americleft Modification (CAPS-A-AM) rating system were used as the primary outcome measure. A successful DOZP was defined as a postoperative hypernasality score of ≤ 1 or an improvement of 2 or more scores from baseline. A receiver operating characteristic (ROC) curve was calculated to determine preoperative VCP cutoff.ResultsThere were 110 patients who underwent DOZP for treatment of velopharyngeal insufficiency. Of these patients, 94 (85%) had successful surgery as determined by their postoperative CAPS-A-AM hypernasality score. Preoperative VCP was a statistically significant predictor of successful DOZP (P 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-14T04:43:22Z
      DOI: 10.1177/10556656241237422
       
  • Peer Reviewer Recognition 2023

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      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.

      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-11T07:26:18Z
      DOI: 10.1177/10556656241236023
       
  • Association of Commonly Prescribed Antepartum Medications and Incidence of
           Orofacial Clefting

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      Authors: Matteo Laspro, Hilliard T. Brydges, Alexandra N. Verzella, Jill Schechter, Andre Alcon, Ashley S. Roman, Roberto L. Flores
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      BackgroundPharmacologic agents are often used in the antepartum period, however, studies on their effect on fetal development are limited. Thus, this study aims to examine the effect of commonly prescribed antepartum medications on the development of orofacial clefting.MethodsUtilizing EPIC Cosmos deidentified data from approximately 180 US institutions was queried. Patients born between January 1, 2013, to January 1, 2023, were included. Eight OC cohorts were identified. Gestational medication use was identified by medications prescribed, provider-administered, or reported use by mothers. Medications used in at least 1 in 10,000 pregnancies were included in this analysis.ResultsA total of 12 098 newborns with available maternal pharmacologic data were born with any type of orofacial clefting. Prevalence for all oral clefts, any cleft palate, and any cleft lip were 20.56, 18.10, and 10.60 per 10 000 individuals, respectively. Notable significant exposures include most anticonvulsants, such as lamotrigine (OR1.33, CI 1.10-1.62), and topiramate (OR1.35, CI 1.13-1.62), as well as nearly all SSRIs/SNRIs, including fluoxetine (OR1.34, CI 1.19-1.51), sertraline (OR1.25, CI 1.16-1.34), and citalopram (OR1.28, CI 1.11-1.47). Corticosteroids were also correlated including dexamethasone (OR1.19, CI 1.12-1.27), and betamethasone (OR1.64, CI 1.55-1.73), as were antibiotics, including amoxicillin (OR1.22, CI 1.14-1.30), doxycycline (OR1.29, CI 1.10-1.52), and nitrofuran derivatives (OR1.10, CI 1.03-1.17).ConclusionNew associations between commonly prescribed antepartum medications and orofacial clefting were found. These findings should be confirmed as causality is not assessed in this report. Practitioners should be aware of the potential increased risk associated with these medications.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-07T06:28:52Z
      DOI: 10.1177/10556656241237679
       
  • “It's On Your Shoulders Now” Transitioning from Child-to-Adult UK
           Cleft Lip/Palate Services: An Exploration of Young Adults’ Narratives

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      Authors: Danielle McWilliams, Maia Thornton, Matthew Hotton, Marc C Swan, Nicola Marie Stock
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectivesTreatment for cleft lip and/or palate (CL/P) in the United Kingdom is administered on a standardised pathway from diagnosis to early adulthood, with options to be re-referred in later life. At age 16, patients become responsible for their treatment decisions. Evidence from the wider health literature indicates this transition can be challenging and that this population may require additional support. The present study explored young people's experiences of transition to adult care in the context of CL/P services, with the aim of identifying support needs and informing future service delivery.DesignIndividual semi-structured interviews were conducted with 15 individuals with CL/P (aged 17–25 years) to explore transition experiences. Interviews lasted an average of 69 min and data were analysed using reflexive thematic analysis.ResultsFour themes, with subthemes, were identified: 1) Readiness for Transition covered feelings of preparedness and how health professionals approached transition; 2) Making Decisions as an Adult described concerns and considerations when making treatment decisions; 3) Finding and Using Support, reflected the roles of caregivers and peers in developing self-advocacy; and 4) Reflections on Transition Care offered insight into how care could be improved.ConclusionIndividuals born with CL/P may experience challenges in becoming responsible for their own care and treatment decisions. The findings of this study indicate that a dedicated transition protocol may be beneficial, such that adolescents are prepared to confidently access and manage their care into adulthood. Opportunities for improvements in transition planning and provision are discussed.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-05T12:25:32Z
      DOI: 10.1177/10556656241236006
       
  • Can Alveolar Bone Grafting Using Posterior Iliac Crest be a Day Surgery
           Procedure'

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      Authors: Alistair Varidel, Maria Ambrose, Nancy DiTullio, Taylor Fritschy, Bonnie L. Padwa, Cory M. Resnick
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      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, P = .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.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-04T10:24:51Z
      DOI: 10.1177/10556656241237419
       
  • Psychosocial Status and Self-Perception in Patients with Cleft Lip and/or
           Palate

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      Authors: Lauren K Salinero, Dominic J. Romeo, Matthew E Pontell, Leigh Friedman, Vinayak S Ahluwalia, Connor S Wagner, Carlos E Barrero, Joseph Napoli, Oksana A Jackson, David W. Low, Scott P Bartlett, Jordan Swanson, Leanne Magee, Jesse A Taylor
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo describe how the psychosocial status of patients with cleft lip and/or palate (CL/P) relates to patient-reported outcomes (PROs).DesignCross-sectional retrospective chart review.SettingTertiary care pediatric hospital.Patients/ParticipantsPatients aged 8 to 29 years attending cleft team evaluations during a 1-year period.Main Outcome MeasuresCLEFT-Q.ResultsPatients (N = 158) with isolated or syndromic CL/P and mean age 13.4 ± 3.0 years were included. Fifteen (9%) patients had siblings who also had CL/P. Of 104 patients who met with the team psychologist, psychosocial concerns were identified in 49 (47%) patients, including 25 (24%) with Attention-Deficit/Hyperactivity Disorder or behavior concerns, 28 (27%) with anxiety, and 14 (13%) with depression or mood concerns. Younger age and having siblings with cleft were associated with better PROs, while psychosocial concerns were associated with worse PROs on Speech, Psychosocial, and Face Appearance scales.ConclusionsPatient perception of cleft outcomes is linked to psychosocial factors.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-04T10:24:30Z
      DOI: 10.1177/10556656241236369
       
  • Sociodemographic Factors Predict Long-Term Attrition from
           Multidisciplinary Cleft Clinic

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      Authors: Connor S Wagner, Sarah L Barnett, Dominic Romeo, Carrie Z Morales, Lauren K Salinero, Carlos E Barrero, Matthew E Pontell, Rachel A McKenna, Nancy Folsom, Jesse A Taylor, Jordan W Swanson
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveIdentify and describe factors associated with retention and attrition of patients during longitudinal follow-up at multidisciplinary cleft clinic.DesignRetrospective cohort study.SettingSingle, tertiary care center.Patients, ParticipantsPatients born between 1995 and 2007 with a diagnosis of cleft palate with or without cleft lip attending multidisciplinary cleft clinic.InterventionsNone tested, observational study.Main Outcome Measure(s)Age at last clinical appointment with a multidisciplinary cleft team provider. Attrition was defined as absence of an outpatient appointment following 15 years of age.ResultsSix hundred seventy-eight patients were included. The average age at last appointment across the entire cohort was 13.1 years (IQR 6.6–17.2). Patients who were Black (HR 1.60, 95% CI 1.10–2.32, p = 0.014) and other races (HR 1.90, 95% CI 1.22–2.98, p = 0.004) were more likely to be lost to follow-up compared to white patients. Publicly insured patients were more likely to experience attrition than those who were privately insured (HR 1.30, 95% CI 1.03–1.65, p = 0.030). Estimated income was not significantly associated with length of follow-up (p = 0.259). Those whose residence was in the fourth quartile of driving distance from our center experienced loss to follow-up significantly more than those who lived the closest (HR 2.04, 95% CI 1.50–2.78, p 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-01T06:23:56Z
      DOI: 10.1177/10556656241234804
       
  • Suprazygomatic Maxillary Nerve Block in Palatoplasty: A Retrospective
           Cohort Study of Perioperative Outcomes in Syndromic and Non-Syndromic
           Children

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      Authors: Krystof Stanek, Walid Alrayashi, Lisa Nussbaum, Ingrid M. Ganske, Carolyn R. Rogers-Vizena
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThis study compares the impact of surgical site infiltration of local anesthesia alone to surgical site infiltration plus suprazygomatic maxillary nerve block (SMB) in non-syndromic and syndromic children undergoing primary palatoplasty.DesignRetrospective cohort study of intra- and post-operative outcomes and opioid utilization in children undergoing palatoplasty by a single surgeon.SettingUrban, academic, tertiary care children's hospital.Patients, ParticipantsChildren 24 months or younger undergoing primary palatoplasty were included (n = 102). Exclusion criteria were concurrent painful procedures, history of neonatal abstinence syndrome, and nurse-controlled analgesia (n = 30).InterventionsAll patients received epinephrine-containing local anesthetic infiltrated at the surgical site. Fifty-seven also underwent placement of ultrasound-guided SMB.Main Outcome Measure(s)Intra-operative opioid requirement, duration of anesthesia, time to wake up, post-operative opioid requirement, hypoxemic episodes, need for respiratory support, FLACC scores, and length of stay.ResultsWhen controlling for syndromic status and cleft phenotype, SMB was associated with a 57% reduction in intraoperative opioid requirements (95% CI = 15–81%, p = 0.024) but also with a 29% (∼5-min) increase in wake-up time post-surgery (95% CI = 3–50%, p = 0.048). Postoperatively, SMB was linked to a 18% reduction in hospital stay length (95% CI = 2–31%, p = 0.027) and a 88% reduction in opioid requirements within 24 h after surgery (p = 0.006). Desaturations and new respiratory support requirements were unaffected by SMB.ConclusionsCompared to surgical site infiltration of local anesthetic alone, adding SMB reduces intra- and postoperative narcotic requirements and decreases length of stay. These benefits apply to both syndromic and non-syndromic children. SMB does not meaningfully affect respiratory outcomes.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-03-01T02:09:23Z
      DOI: 10.1177/10556656241234595
       
  • Correlation between Cleft Width and Adjacent Teeth Inclination in Patients
           with Unilateral Cleft Lip and Palate Using CBCT: A Retrospective Study

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      Authors: Reham Khaled Tayyar, Tarek Z. Khattab
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectivesTo evaluate buccolingual and mesiodistal inclination of cleft-adjacent maxillary permanent central incisors (U1) and canines (U3) in patients with unilateral cleft lip and palate (UCLP) in the late mixed dentition and to investigate the correlation between the alveolar cleft width and cleft-adjacent teeth inclination using cone beam computed tomography (CBCT).DesignObservational cross-sectional retrospective study.SettingDepartment of Orthodontics, Hama University Dental School.Patients32 patients with UCLP (22 boys, 10 girls; mean age = 10.53 ± 1.51 years).Main Outcome MeasureBuccolingual and mesiodistal inclination of maxillary central incisors and canines were measured on both sides. Then, the cleft and non-cleft sides were compared using the Wilcoxon signed-rank test. Pearson's correlation was used to explore the association between the alveolar cleft width and cleft-adjacent U1 and U3 buccolingual and mesiodistal inclination.ResultsThe cleft-adjacent central incisors were significantly inclined lingually and distally compared with their non-cleft antimeres (P = .003, P 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-29T07:39:59Z
      DOI: 10.1177/10556656241236532
       
  • Two Chinese Patients of Auriculocondylar Syndrome 2: A Novel PLCB4
           Splicing Variant and 5-Year Follow-up

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      Authors: Yunting Lin, Ye Zhang, Jian Ma, Shu Liu, Yongxi Liu, Chaoxiang Yang, Chunhua Zeng, Xianqiong Luo
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveAuriculocondylar syndrome (ARCND) is a set of rare craniofacial malformations characterized by variable micrognathia, ear malformations, and mandibular condyle hypoplasia, and other accompanying features with phenotypic complexity. ARCND2 caused by pathogenic variants in the PLCB4 gene is a very rare disease with less than 50 patients reported and only 36 different variants of the PLCB4 gene recorded in HGMD. This study aims to enrich the patient resources, clinical data and mutational spectrum of ARCND2.DesignCase series study.SettingGuangzhou Women and Children's Medical Center and Guangdong Women and Children Hospital.PatientsTwo Chinese patients with ARCND2.Main Outcome MeasuresClinical, radiological and molecular findings.ResultsBoth the two patients presented with craniofacial and ear malformations, and feeding difficulties. Whole exome sequencing identified two different variants of the PLCB4 gene in these two patients with a heterozygous allele and a de novo mode of inheritance respectively. Patient 1 carried a known pathogenic c.1861C > T(p.Arg621Cys) missense variant, whereas Patient 2 had a novel c.225 + 1G > A splicing variant. Sanger sequencing confirmed the presence of PLCB4 variants in the proband and absence in the unaffected parents. These two PLCB4 variants were suggested as disease-causing candidates for these two patients. During a 5-year follow-up, Patient 2 gradually manifested crowded teeth, underweight, motor delay and intellectual disability.ConclusionsIn this study, we report two Chinese patients with ARCND2, describe their clinical and mutational features, and share a 5-year follow-up of one patient. Our study adds two additional patients to ARCND2, reveals a novel PLCB4 variant, and expands the phenotypic and genotypic spectrum.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-28T08:35:09Z
      DOI: 10.1177/10556656241234575
       
  • Three-dimensional Analysis of Maxillary Morphology in Infants with
           Unilateral Cleft Lip and Palate

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      Authors: Jie Zheng, Wenying Kuang, Shiyu Yuan, Hong He, Wenjun Yuan
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo three-dimensionally (3D) analyze the maxillary morphology of infants with unilateral cleft lip and palate (UCLP) and preliminarily classify the alveolar arch to assist in personalization of sequence therapy.DesignRetrospective study.SettingPatients with UCLP referred to outpatients’ clinic.Participants84 nonsyndromic infants with complete UCLP were recruited (58 boys, 26 girls, mean age 29.48 days).Main Outcome MeasureMorphometric analysis was conducted on 3D maxillary models. Principal component analysis (PCA) and cluster analysis were combined to classify maxillary phenotypes preliminarily. The Wilcoxon Signed Rank test and the Kruskal-Wallis test were used to compare differences between variables. A P value less than .05 was considered statistically significant.ResultsThe maxilla was divided into three types: narrow, homogenous and broad, accounting for 9.52%, 23.81% and 66.67% respectively. The alveolar cleft site (median value) was located in 61% of the total length of the alveolar arch. In the comparison of anterior and total alveolar lengths, the non-cleft side had longer alveolar bone than the affected side, a difference of approximately 2 mm. Pairwise comparisons of variables describing alveolar symmetry revealed significant differences in all subjects; whereas type C had poorer arch symmetry than types A and B, mainly in terms of anterior and overall symmetry.ConclusionsIn infants with UCLP, the maxillary alveolar arch was inherently asymmetrical with partially bone missing (about 2 mm). Significant differences in alveolar bone morphology and symmetry exist between different types of infants, with individuals with broad clefts (type C, the largest proportion) having the worst maxillary development.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-28T08:34:32Z
      DOI: 10.1177/10556656241228903
       
  • Stress and Coping Strategies in Malay Parents of Children with Cleft Lip
           and/or Palate

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      Authors: Bachok Norsa’adah, Che Ghazali Nurhazalini-Zayani, Abd Aziz Aniza, Abd Rahman Normastura, Abdullah Ahmad-Burhanudddin
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThis study was aimed at describing the level of stress and types of coping strategies used among Malay parents of children with cleft lip and/or palate (CL/P).DesignCross-sectional study.SettingA dental clinic and a general hospital.ParticipantsParents (N = 84) whose children were less than 12 years old with CL/P.MethodsSocio-demographic data and clinical characteristics of CL/P were collected. Self-administered validated Malay versions of the stress scale from the Depressive, Anxiety and Stress Scale-42 (DASS-42) and COPE Inventory questionnaires were used. Descriptive statistics and Multivariate Analysis of Covariance were used for data analysis.ResultsThe prevalence of stress among parents of children with CL/P was 21.4% [95% confidence interval (12.4, 30.4)]. The most common coping strategies were problem-focused (mean 58.15, standard deviation (SD) 7.75), followed by emotion-focused (mean 54.05, SD 4.78). The adjusted mean score for overall coping strategies was significantly different between stressed and non-stressed parents after adjustment for education, number of children, sex of child with CL/P, and cleft type [F (df) = 4.174 (3,74), P = .009]. There was a significant mean difference between stressed and non-stressed parents for avoidant coping strategies [P = .003]. Problem-focused and emotion-focused coping strategies did not differ after Bonferroni correction.ConclusionsAround a fifth of parents caring for children with CL/P experienced stress and avoidant coping strategies were more common among stressed parents. Multi-disciplinary team care should provide social support to parents of children with CL/P.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-28T07:55:40Z
      DOI: 10.1177/10556656241236011
       
  • A Case Series of Three Patients with Cleidocranial Dysplasia: Clinical
           Presentation and Diagnostic Considerations

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      Authors: Uğur Berber, Ülkü Gül Şıraz, Mustafa Yakubi, Ebru Gök, Leyla Kara, Aslihan Kiraz, Munis Dündar, Nihal Hatipoglu
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      Cleidocranial dysplasia (CCD) is a rare genetic condition that affects the bones and teeth. In our study, we presented three cases of CCD, including one with a new mutation and two with a family history. Case 1 had a unique heterozygous frameshift mutation (NM_001015051,c.762del, p.(Ser256Valfs*2)), while Case 2 and her brother (Case 3) had a common pathogenic missense mutation (NM_001015051,c.674G, p.Arg225Gln), which was also found in their father. The mutation in Case 1 was not reported before. Interestingly, the symptoms in Case 1, with the new mutation, were less severe than the other cases and the previous reports.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-28T07:55:12Z
      DOI: 10.1177/10556656241234742
       
  • Cleft Laterality Dental Arch Relationship Outcomes for Children with
           Unilateral Cleft Lip and Palate in New Zealand

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      Authors: Peter V. Fowler, H. Keall, D. Kennedy, D. Healey, J.M.D. Thompson
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectivesTo investigate cleft laterality dental arch relationship outcomes of children with non-syndromic complete unilateral cleft lip and palate (UCLP) in New Zealand.DesignA retrospective nationwide study.SettingsVirtual 3D orthodontic study models collected prior to undertaking secondary alveolar bone grafting.ParticipantsA total of 104 patients with UCLP (L = 80: R = 24).Outcome measuresFour calibrated assessors used the GOSLON Yardstick and 100 mm Visual Analogue Scale (VAS) to score the randomised models on 2 separate assessment sessions. Weighted Kappa were used to determine the intra/inter-rater reliability for the GOSLON and correlations for the VAS.ResultsIntra-rater reliability ranged from 0.57-0.88 (GOSLON) and 0.45-0.93 (VAS). Inter-rater reliability ranged from 0.62-0.86 (GOSLON) and 0.64-0.93 (VAS).GOSLON scores for the left UCLP were 31.2% for good/very good; 26.3% for fair; 42.5% for poor/very poor while the right UCLP scored 8.3% for good/very good; 37.5% for fair; 54.2% for poor/very poor. The mean VAS for left and right UCLP were 53.4 (sd 22.5) and 44.6 (sd 17.1) respectively. Neither the GOSLON nor VAS differences reached statistical significance (both P = .08).ConclusionsFrom a clinical perspective right UCLP had worse dental arch relationship outcomes, however, these differences failed to reach statistical significance. Further studies using larger sample sizes are required to determine if cleft laterality is an important consideration when investigating UCLP dental arch outcomes.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-28T07:54:41Z
      DOI: 10.1177/10556656241234599
       
  • Longitudinal Speech Outcome at 5 and 10 Years in UCLP: Influence of Speech
           Therapy and Secondary Velopharyngeal Surgery

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      Authors: C Persson, J Davies, C Havstam, H Søgaard, M Bowden, M Boers, JB Nielsen, S Alaluusua, I Lundeborg Hammarström, BK Emborg, A Sand, A Lohmander
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo investigate speech development of children aged 5 and 10 years with repaired unilateral cleft lip and palate (UCLP) and identify speech characteristics when speech proficiency is not at ‘peer level’ at 10 years. Estimate how the number of speech therapy visits are related to speech proficiency at 10 years, and what factors are predictive of whether a child's speech proficiency at 10 years is at ‘peer level’ or not.DesignLongitudinal complete datasets from the Scandcleft projectParticipants320 children from nine cleft palate teams in five countries, operated on with one out of four surgical methods.InterventionsSecondary velopharyngeal surgery (VP-surgery) and number of speech therapy visits (ST-visits), a proxy for speech intervention.Main Outcome Measures‘Peer level’ of percentage of consonants correct (PCC, > 91%) and the composite score of velopharyngeal competence (VPC-Sum, 0–1).ResultsSpeech proficiency improved, with only 23% of the participants at ‘peer level’ at 5 years, compared to 56% at 10 years. A poorer PCC score was the most sensitive marker for the 44% below ‘peer level’ at 10-year-of-age. The best predictor of ‘peer level’ speech proficiency at 10 years was speech proficiency at 5 years. A high number of ST-visits received did not improve the probability of achieving ‘peer level’ speech, and many children seemed to have received excessive amounts of ST-visits without substantial improvement.ConclusionsIt is important to strive for speech at ‘peer level’ before age 5. Criteria for speech therapy intervention and for methods used needs to be evidence-based.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-27T12:29:52Z
      DOI: 10.1177/10556656231225575
       
  • Facial Analysis of Patients with Unilateral or Bilateral Cleft Lip and
           Palate Using 3D Stereophotogrammetry

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      Authors: Vanessa Ota Nogueira, Maria Carolina Neves, Karin Neppelenbroek, Thaís Marchini Oliveira, Chiarella Sforza, Simone Soares
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectivesTo evaluate the quantitative values of linear and angular facial anthropometrics in patients with unilateral cleft lip and palate (UCLP) and compare them with those of patients with bilateral cleft lip and palate (BCLP) using three-dimensional (3D) facial imaging.DesignRetrospective, observational, and cross-sectional study.SettingHospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP).Patients/ ParticipantsIn total, 61 non-syndromic patients with CLP who underwent multidisciplinary treatment and rehabilitated with a prosthesis were enrolled and divided into those with UCLP (G1; n = 31) and those with BCLP (G2; n = 30).InterventionFacial images were captured using a 3D camera after landmarks were marked on each patient's face. The software evaluated linear and angular parameters. Statistical tests were applied. Significance was determined as P 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-26T05:29:10Z
      DOI: 10.1177/10556656241234603
       
  • Overjet in Infants: A Cross-Sectional Study

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      Authors: Mohamed El-Rabbany, Ryan Shargo, Pat Ricalde
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThe purpose of this study was to determine the normal ranges for overjet in healthy infants under 12 months of age.DesignA cross sectional study of consecutive patients below 12 months of age.SettingThe study was conducted at a private practice in Tampa, FL that specializes in pediatric craniomaxillofacial disorders.PatientsAll patients under the age 12 months were considered for entry into the study. Patients were excluded if they had temporomandibular joint pathology, sleep disordered breathing, facial trauma, or were diagnosed with a craniofacial anomaly.InterventionsMeasures of overjet, defined as the distance between the anterior surfaces of the alveolar ridges when in centric relation, were obtained.Main Outcome MeasureThe primary study outcome was the overjet of the enrolled patients.ResultsA total of 152 infants were included in this study. Of these, 51 were female, and 40 were born prematurely (ranging from 32–37 weeks of gestation). In neonates below 1 month of age, the mean overjet was 2.25 mm (95% CI 1.31–3.19). Multivariate linear regression analysis showed overjet to significantly decrease with age, at a mean rate of approximately 0.1 mm per month (coefficient of −0.09, 95% CI −1.61 to −0.02, p = 0.01). When controlling for potential confounders, average overjet was not shown to vary significantly between the sexes, with prematurity, with race, or with primary diagnosis at presentation.ConclusionThis paper establishes normative values for overjet in infants below 12 months of age.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-23T08:02:09Z
      DOI: 10.1177/10556656241235030
       
  • Presurgical Infant Orthopedic Videos on YouTube™: A Thematic
           Analysis of Caregiver Narratives

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      Authors: Raed Alrubaiaan, Bhavana Nair, Fatemeh Amir-Rad, May Aljanahi, Vijay Kumar S, Sabarinath Prasad
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveInformation regarding how caregivers cope when using presurgical infant orthopedic (PSIO) appliances is sparse. This study aimed to understand caregivers’ perspectives and experiences with contemporary PSIO treatment.DesignPSIO videos shared on the YouTube™ platform were used as the data source. Videos with caregivers were identified (n = 21) and portions with caregiver narratives were transcribed. This was followed by the application of a six-step thematic analysis as conceptualized by Braun and Clarke (2006, 2019).ResultsTwo themes were identified from the caregiver narratives in the PSIO videos. The Family Journey theme included reaction to diagnosis, choice of center, burden of care, care commitment, coping, and testimonials. The Information theme included PSIO techniques and PSIO benefits.ConclusionMultifaceted challenges and coping strategies were described by caregivers during the PSIO phase. Caregivers remained committed to treatment despite the burden of care, were motivated by an understanding of the benefits of PSIO, and customized care based on their individual strengths and needs. Study results can help providers gain an understanding of what caregivers experience outside the clinical environment.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-23T08:01:50Z
      DOI: 10.1177/10556656241233115
       
  • Occlusal Outcomes in Non-Robin Sequence Patients with Isolated Cleft
           Palate

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      Authors: Catherine Beaumont, Audrey Bellerive, Anne-Sophie Julien, Jacques E. Leclerc
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      Objectives1. To assess the skeletal class occlusion and lateral cephalometry in children with isolated cleft palates (non-Robin sequence) and 2. to identify associations between these findings and pre-palatoplasty cleft palate measurements.Study designRetrospective cohort study.SettingNorth American Institutional Tertiary Paediatric Center.PatientsOur cleft database was reviewed, and patients were included if they had an isolated cleft palate without a Robin Sequence diagnosis, had a Furlow palatoplasty and had available per operative cleft palate measurements and available lateral cephalogram between 6 and 8 years old. Thirty-two patients matched to inclusion criteria.InterventionFurlow's Palatoplasty.Main Outcome and MeasuresCleft size at palatoplasty, cephalometric measurements and skeletal occlusal classes were analysed. ANOVA was used to test the association between cephalometric measurements and occlusal classes. Results are presented as means with a 95% confidence interval. The association between cleft measurements and cephalometric parameters was tested with Spearman Correlation (rs).ResultsThe skeletal occlusal outcome at 7 years old for this series of patients was: Class I: 19%; Class II: 59% and Class III: 22%. No single cleft measurement at palatoplasty was predictive of the skeletal occlusal outcome. A larger hard palate cleft was associated with a shorter antero-posterior maxilla.ConclusionsThe skeletal occlusal class outcomes were similar to those found in a previous study in the literature. The occlusal prognosis appears to be better than in patients with Robin Sequence or with an associated cleft lip. No preoperative measurement was found to be associated with the occlusal outcome.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-23T06:09:28Z
      DOI: 10.1177/10556656241236078
       
  • Retrospective Cohort Studies in Craniofacial Outcomes Research: An
           Epidemiologist's Approach to Mitigating Bias

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      Authors: Sara Kinter, Joseph A. Delaney, Srinivas Susarla, Christy McKinney
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      Retrospective cohort studies, defined as a follow-up study in which outcome occurred prior to study onset, are common in craniofacial outcomes research and will continue to be prevalent given the increasing availability of secondary datasets and inherent prospective study limitations. However, if available data are not adequately measured, or necessary variables are absent, retrospective cohort studies can be particularly prone to bias. This brief communication aims to highlight the primary sources of bias, including measurement error, selection bias, and confounding. Each source is clearly defined, examples pertinent to craniofacial outcomes are provided, and mitigation strategies are discussed.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-23T06:08:37Z
      DOI: 10.1177/10556656241233234
       
  • Parental Stress, Infant Feeding and Well-being in Families Affected by
           Cleft Lip and/or Cleft Palate: The Impact of Early Follow-up

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      Authors: Nina Ellefsen Lindberg, Nina Margrethe Kynø, Kristin Billaud Feragen, Are Hugo Pripp, Kim Alexander Tønseth
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo document the impact of early follow-up by specialized cleft nurses (SCNs) provided to families affected by cleft lip and/or palate (CL/P) and the status of parental stress, infant feeding and well-being.DesignProspective inclusion of a control group, which only received standard care, followed by an intervention group that also received early SCN follow-up.SettingThe cleft lip and palate team at Oslo University Hospital, Norway.ParticipantsSeventy families (69 mothers and 57 fathers) distributed into an intervention group (n = 32) and a control group (n = 38).InterventionSCNs provided a consultation at the maternity ward and a follow-up conversation by phone or face-to-face at scheduled times for six months.Outcome measuresParental Stress Index (PSI), Perceived Stress Scale (PSS-14), feeding questionnaire, survey of infant diets, weight percentiles.ResultsThe mothers reported higher stress scores than the fathers, but in the control group only in the PSI parent domain at T2 and T3 (P = .007, P = .018). Infants in the intervention group used pacifiers less frequently than in the control group (55.2% vs. 81.1%, P = .023). Otherwise, no significant differences were found between the groups. Overall, the infants received less breast milk than norms.ConclusionContextual strategies for early follow-up of families affected by clefts need to be developed, with an emphasis on involving fathers and those parents reporting elevated stress and/or feeding difficulties. There is a need for diagnosis-specific guidelines about the use of pacifiers as well as collaboration between the health professionals involved to increase breastmilk feeding.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-22T06:12:55Z
      DOI: 10.1177/10556656241231524
       
  • Hearing Outcomes in Patients with Cleft Lip and Palate in a Resource
           Limited Setting

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      Authors: Kanachai Boonpiraks, Yanin Nawachartkosit, Nattayaporn Charunruengterakul, Dhave Setabutr
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo compare hearing outcomes of early versus late tympanostomy tube insertion in patients with cleft lip and palate in a resource limited settingDesignRetrospective cohort study.SettingConducted at Queen Sirikit National Institute of Child Health, a tertiary care hospital in Bangkok, Thailand.PatientsIncluded 76 patients under 18 with cleft anomalies undergoing tympanostomy tube insertion between January 2018 and July 2022, categorized into early (n = 11) and late (n = 65) tympanostomy groups.InterventionsEarly tympanostomy tube placement at ≤ 3 months old, coordinated with cleft lip repair, following failed transitory evoked otoacoustic emission (TEOAE) and Type B tympanogram. Late tympanostomy tube placement preceded by a diagnosis of middle ear effusion and typically a failed TEOAE and subsequent level of testing.Main Outcome MeasuresPrimary outcomes: normal hearing rates and age at normal hearing. Secondary outcomes: repeated tympanostomy tube placement rate, postoperative complications, and length of hospital stays.ResultsEarly tympanostomy tube placement was associated with higher rates of normal hearing (100% vs. 75%. P = .103) and significantly younger age at normal hearing (11 vs. 19 months, P = .036). Time to normal hearing was shorter in the early group. Postoperative complications, including otorrhea, occurred more frequently in the early group, but differences were not significant.ConclusionEarly tympanostomy tube insertion improves hearing outcomes in pediatric patients with cleft lip and palate, achieving normal hearing at a significantly younger age. This approach offers a valuable alternative in resource-limited settings with constrained audiological services. Further research on long-term speech outcomes and cost-effectiveness is warranted.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-21T01:23:26Z
      DOI: 10.1177/10556656241234570
       
  • Prospective Evaluation of Health-Related Quality-of-Life in Children with
           Craniosynostosis

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      Authors: Valeria Gamarra, Gregory D. Pearson, Annie Drapeau, Jonathan Pindrik, Canice E. Crerand, Ari N. Rabkin, Ibrahim Khansa
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo investigate health-related quality of life (HRQL) in children aged 2 to 7 years, who have undergone surgery for craniosynostosis.DesignCross-sectional survey.SettingA tertiary pediatric academic medical center.ParticipantsChildren with craniosynostosis who underwent surgical correction, and who were 2–7 years old at the time of the study. Children from families that did not speak English were excluded.InterventionsCaregivers were asked to fill out the Pediatric Quality of Life Inventory (PedsQL) Core Parent Report and the PedsQL Cognitive Functioning Scale.Main outcome measures PedsQL: Psychosocial Health Summary Score, Physical Health Summary Score, Total Core Score, Cognitive Functioning Scale Score. Scores range from 0 to 100, with higher scores reflecting greater QoLSubject factors: comorbidities, syndromic status, type of craniosynostosis, type of surgeryResultsThe study included 53 subjects, of whom 13.2% had a syndrome. Core and cognitive scores did not depend on presence of a syndrome or suture involved. Subjects who underwent posterior cranial distraction achieved higher Total Core Scores than subjects who underwent open vault remodeling. Among subjects with sagittal craniosynostosis, there was a tendency for higher scores among children who underwent minimally-invasive surgery compared to those who underwent open vault remodeling.ConclusionsThis study demonstrates similar HRQL among children with and without a syndrome, higher HRQL among children undergoing posterior cranial distraction than those undergoing open vault remodeling, and trends towards higher HRQL in children with sagittal craniosynostosis who underwent minimally-invasive surgery compared to those who underwent open vault remodeling.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-21T01:23:06Z
      DOI: 10.1177/10556656241234562
       
  • Online Resources for Robin Sequence; an Analysis of Readability

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      Authors: R. Browne, C.M. Hurley, S. Carr, C. de Blacam
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThe objective was to evaluate the readability of easily accessible parent-directed information concerning Robin Sequence (RS) online, compared to the American Medical Association (AMA)-recommended sixth grade (age 11-12) readability level.DesignA Google search of the term “Pierre Robin Sequence information” was performed. The first ten websites were evaluated using six commonly used readability formulas. Sample texts from three websites were ‘translated’ by the authors, with the aim of achieving a sixth grade readability level.Main outcome measuresThe following outcomes were used: Automated Readability Index (ARI), Coleman Liau Index (CLI), Gunning Fog Score, Simple Measure of Gobbledygook (SMOG), Flesch Kincaid Grade Level (FKGL), and Flesch Reading Ease (FRE) score.ResultsThe mean pooled grade level of the top 10 included websites was 12.1 (age 17-18). The overall FRE Index was 45.8, which is equivalent to a College-grade reading level. The mean grade level by each test used was: Flesch-Kincaid Grade Level 11.6 (age 16-17), Gunning Fog Score 13.3 (age 18+), SMOG 10.0 (age 14-15), Coleman-Liau Index 13.8 (age 18+), and ARI 12.0 (age 17-18). The author-translated resources achieved pooled mean grade levels of 6.3-6.5.ConclusionsParent-directed online materials concerning RS have a readability in excess of the AMA-recommended sixth grade reading level. Even though the condition is complex, more readable resources are achievable. Coproduction of parent-directed resources in association with public an patient involvement (PPI) contributors is encouraged.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-19T11:55:32Z
      DOI: 10.1177/10556656241234587
       
  • Weight Gain of Infants with Robin Sequence Treated Nonsurgically Using the
           Stanford Orthodontic Airway Plate (SOAP): 1-Year Follow-Up

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      Authors: HyeRan Choo, Alexis S. Davis, Lisa C. Bain, HyoWon Ahn
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo identify weight gain trends of infants with Robin sequence (RS) treated by the Stanford Orthodontic Airway Plate treatment (SOAP).DesignRetrospective longitudinal cohort study.SettingSingle tertiary referral hospital.PatientsEleven infants with RS treated with SOAP.InterventionsNonsurgical SOAP.Main Outcome MeasuresBody weight, Weight-for-age (WFA) Z-scores, and WFA percentiles at birth (T0), SOAP delivery (T1), SOAP graduation (T2), and 12-months old (T3).ResultsBetween T0 and T1, the weight increased but the WFA percentile decreased from 36.5% to 15.1%, and the Z-score worsened from −0.43 to −1.44. From T1 to T2, the percentile improved to 22.55% and the Z-score to −0.94. From T2 to T3, the percentile and the Z-scores further improved to 36.59% and −0.48, respectively.ConclusionsSOAP provided infants experiencing severe respiratory distress and oral feeding difficulty with an opportunity to gain weight commensurate with the WHO healthy norms without surgical intervention.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-19T11:13:49Z
      DOI: 10.1177/10556656241233239
       
  • Bilateral Cleft lip Simulation

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      Authors: Jonathan Zaga-Galante, Raymond Tse, Richard A Hopper, Anne Arnold, David M Fisher, Karen W Wong-Riff, Dale J Podolsky
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo evaluate the features, anatomic accuracy, and educational value of a high-fidelity bilateral cleft lip simulator.DesignEvaluation of the simulator by expert cleft surgeons after performing a simulated bilateral cleft lip repair.SettingThe simulator was evaluated by the surgeons during the Latin American Craniofacial Association meeting.ParticipantsEleven experienced cleft surgeons evaluated the simulator. The cleft surgeons were selected based on their availability during the meeting.InterventionsThe participants performed a simulated bilateral cleft lip repair. They were each provided with a questionnaire assessing the simulator's features, realism and value as a training tool.Main Outcome Measure (s)The main outcome measure are the scores obtained from a Likert-type questionnaire assessing the simulators features, realism and value.ResultsOverall, the surgeons agreed with the simulator's realism and anatomic accuracy (average score of 3.7 out of 5). Overall, the surgeons strongly agreed with the value of the simulator as a training tool (average score of 4.6 out of 5).ConclusionsA high-fidelity bilateral cleft lip simulator was developed that is realistic and valuable as a training tool. The simulator provides a comprehensive training platform to gain hands-on experience in bilateral cleft lip repair before operating on real patients.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-14T07:50:16Z
      DOI: 10.1177/10556656241230882
       
  • The Influence of Sidedness in Unilateral Cleft Lip and Palate on Mid
           Facial Growth at Five Years of Age

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      Authors: Matthew Fell, David Chong, Paras Parmar, Ting-Li Su, Lars Enocson, Bruce Richard
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo determine whether facial growth at five years is different for children with a left versus right sided cleft lip and palate.DesignRetrospective cohort study.SettingSeven UK regional cleft centres.PatientsPatients born between 2000-2014 with a complete unilateral cleft lip and palate (UCLP).Main Outcomes Measure5-Year-Old's Index scores.Results378 children were included. 256 (68%) had a left sided UCLP and 122 (32%) had a right sided UCLP. 5-Year-Old's index scores ranged from 1 (good) to 5 (poor). There was a higher proportion of patients getting good scores (1 and 2) in left UCLP (43%) compared to right UCLP (37%) but there was weak evidence for a difference (Adjusted summary odds ratio 1.27, 95% CI 0.87 to 1.87; P = .22).ConclusionsWhilst maxillary growth may be different for left versus right sided UCLP, definitive analysis requires older growth indices and arch forms.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-13T06:07:01Z
      DOI: 10.1177/10556656241233220
       
  • Validating the Modified Small Double Opposing Z-Plasty for Palatal
           Lengthening in Primary Palatoplasty

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      Authors: Rafael Denadai, Chi-Chin Lo, Hyung Joon Seo, Nobuhiro Sato, Dax Carlo Go Pascasio, Srinisha Murali, Junior Chun-Yu Tu, Pang-Yung Chou, Lun-Jou Lo
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo appraise the degree of intraoperative palatal lengthening with the modified Furlow small double-opposing Z-plasty (sDOZ).DesignRetrospective single-surgeon (R.D.) study.PatientsNonsyndromic children (n = 167) with Veau types I to IV cleft palates who underwent primary sDOZ palatoplasty.InterventionsIntraoperative measurements of palatal lengths and widths were collected using calipers, paper rulers, and metal rulers before the administration of local anesthetic solution and before the removal of the mouth gag (initial and final palatal dimensions, respectively).Main Outcome MeasuresAssessment of the intraoperative percentage change (difference between final and initial values) in surface palatal length, straight palatal length, and soft palatal length. Bivariate and multivariate analyses were performed to identify independent predictors (sex, age at surgery, Veau, Kernahan/ Stark, and Randall classifications, widest cleft width, presence of lateral relaxing incision, type of coverage with buccal fat flap, and postoperative complications) of soft palatal lengthening.ResultsSurface palatal, straight palatal, and soft palatal lengths had an intraoperative increase of 8%, 14.7%, and 27.7%, respectively. The degree of intraoperative soft palatal lengthening significantly varied among Veau cleft types (I = II 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-13T06:06:29Z
      DOI: 10.1177/10556656241233151
       
  • Genetic Associations of Oral Clefts in Arabs

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      Authors: Lateefa Alkharafi, Saud Alhasawi, Hisham Burezq, Alhanouf Alduraie, Muneera Alhuwais, Fatema Aldoub, Maryam Alduwaisan, Sara Aldoseri, Hala Hamdan, Nada Abdelhafez, Ashraf Mokhtar, Fawzi Alqatami, Ahmad Al-Serri, James Hartsfield, Suzanne Al-Bustan
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThis study aims to investigate genetic association between Non-syndromic Cleft lip with or without palate (NCLP) and 14 specific Single Nucleotide Polymorphism (SNPs) reported to be associated with NCLP from previous Genome Wide Association Studies (GWAS).DesignA prospective case-control study.SettingMinistry of Health (MOH) Cleft and Craniofacial Clinic and Kuwait University.Patients/ParticipantsOne hundred sixty-four NCLP patients were recruited from MOH Cleft and Craniofacial clinic, and 491 controls from the Kuwait DNA bank established at Kuwait University.InterventionsTotal gDNA was extracted from whole blood withdrawn from patients and genotyped by real time PCR. Hardy-Weinberg Equilibrium was tested, and the set p value for significance (p 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-12T05:16:05Z
      DOI: 10.1177/10556656231219433
       
  • Detecting Gene-Gene Interaction among DNA Repair Genes in Chinese
           non-Syndromic Cleft lip with or Without Palate Trios

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      Authors: Xi Chen, Zhibo Zhou, Yixin Li, Siyue Wang, Enci Xue, Xueheng Wang, Hexiang Peng, Meng Fan, Mengying Wang, Xueying Qin, Yiqun Wu, Jing Li, Hongping Zhu, Dafang Chen, Yonghua Hu, Terri H. Beaty, Tao Wu
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThe objective of this study is to investigate the gene-gene interactions associated with NSCL/P among DNA repair genes.DesignThis study included 806 NSCL/P case-parent trios from China. Quality control process was conducted for genotyped single nucleotide polymorphisms (SNPs) located in six DNA repair genes (ATR, ERCC4, RFC1, TYMS, XRCC1 and XRCC3). We tested gene-gene interactions with Cordell's method using statistical package TRIO in R software. Bonferroni corrected significance level was set as P = 4.24 × 10–4. We also test the robustness of the interactions by permutation tests.SettingNot applicable.Patients/ParticipantsA total of 806 NSCL/P case-parent trios (complete trios: 682, incomplete trios: 124) with Chinese ancestry.InterventionsNot applicable.Main Outcome Measure(s)Not applicable.ResultsA total of 118 SNPs were extracted for the interaction tests. Fourteen pairs of significant interactions were identified after Bonferroni correction, which were confirmed in permutation tests. Twelve pairs were between ATR and ERCC4 or XRCC3. The most significant interaction occurred between rs2244500 in TYMS and rs3213403 in XRCC1(P = 8.16 × 10–15).ConclusionsThe current study identified gene-gene interactions among DNA repair genes in 806 Chinese NSCL/P trios, providing additional evidence for the complicated genetic structure underlying NSCL/P. ATR, ERCC4, XRCC3, TYMS and RFC1 were suggested to be possible candidate genes for NSCL/P.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-02T06:45:21Z
      DOI: 10.1177/10556656241228124
       
  • Application of the MicroNAPS Classification for Robin Sequence

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      Authors: Cory M. Resnick, Eliot Katz, Alistair Varidel
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThe only findings consistent among infants with Robin sequence (RS) are the presence of micrognathia, glossoptosis, and upper airway obstruction (UAO). Feeding and growth dysfunction are typical. The etiopathogenesis of these findings, however, is highly variable, ranging from sporadic to syndromic causes, with widely disparate levels of severity. This heterogeneity has created inconsistency within RS literature and debate about appropriate workup and treatment. Despite several attempts at stratification, no system has been broadly adopted.DesignWe recently presented a novel classification that is summarized by the acronym MicroNAPS. Each of 5 elements is scored: Micrognathia, Nutrition, Airway, Palate, Syndrome/comorbidities, and element scores are summarized into a “stage”.ResultsTesting of this system in a sample of 100 infants from our center found it to be clinically relevant and to predict important management decisions and outcomes.ConclusionsWe herein present an interactive website (www.prscalculator.com) and printable reference card for simple application of MicroNAPS, and we advocate for this classification system to be adopted for clinical care and research.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-02-02T05:13:27Z
      DOI: 10.1177/10556656241229892
       
  • CLP-Related Information for Patients Provided by ChatGPT: Comment

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      Authors: Hinpetch Daungsupawong, Viroj Wiwanitkit
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.

      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-31T08:56:43Z
      DOI: 10.1177/10556656241229275
       
  • Cortical Bone Thickness and Morphology at the Infrazygomatic Crest Area in
           Growing Thai Patients with UCLP: A CBCT Study

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      Authors: Ploypailin Phusantisampan, Marasri Chaiworawitkul
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectivesTo determine and compare buccal cortical bone thickness and morphology (in terms of shape and height) at the infrazygomatic (IZ) crest in growing Thai patients with unilateral cleft lip and palate (UCLP) using cone-beam computed tomography (CBCT) with the ultimate goal of identifying potential sites that are suitable for the placement of miniplates.DesignProspective study.SettlingInstitutional research.PatientsTwenty-four Thai patients with non-syndromic complete UCLP with Class III skeletal discrepancy aged 10-14 years.InterventionsA total of 48 CBCT images captured the IZ crest. Five horizontal and six vertical reference planes were established in the IZ crest area.Main Outcome MeasureThe mean buccal cortical bone thickness of the cleft and non-cleft sides were 1.13 ± 0.45 mm and 1.15 ± 0.46 mm, respectively. The most frequently observed shape for the IZ crest was the external concave contour. There were no statistically significant differences in cortical bone thickness and shape distribution between the cleft and non-cleft sides. (P > .05).ResultsThe thickness of the buccal cortical bone increased anteriorly and superiorly from V + 0 and H + 0. The average height of IZ crest on the cleft side was 16.20 ± 1.59 mm and 16.78 ± 1.84 mm on the non-cleft side. Notably, significant differences were detected in terms of height between the cleft and non-cleft side and cortical bone thickness by gender (P 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-31T05:25:50Z
      DOI: 10.1177/10556656241228738
       
  • 12-Year Trends of Orofacial Clefts in the United States: Highlighting
           Racial/Ethnic Differences in Prevalence of Cleft Lip and Cleft Palate

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      Authors: Iulianna C. Taritsa, Joanna K. Ledwon, Anitesh Bajaj, Arun K. Gosain
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveDiscrepancies in prevalence among infants with orofacial clefts are public health research priorities. Our objective was to calculate updated estimated prevalence of orofacial clefts in the United States, with sub-analyses by racial/ethnic group.DesignThe National Birth Defect Prevention Network database was used to evaluate trends in cases with orofacial cleft in the United States from 2006 to 2018. Cases with cleft lip with and without cleft palate (CL ± P) and cleft palate (CP) alone were sub-stratified by racial/ethnic category. Estimated prevalence was calculated using the total live births reported in each maternal racial/ethnic group. The odds ratio (OR) was calculated to measure the strength of association between racial/ethnic group and risk of orofacial clefts.ResultsEstimated prevalence rates show that maternally-reported Native American/Alaskan Native individuals were 43.8% (p 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-31T05:25:01Z
      DOI: 10.1177/10556656241227033
       
  • What Parents of Children Born with a Cleft Lip and/or Palate Want to Know
           About the Care for their Child

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      Authors: F.A.C.J. Heijsters, M.D. van Eick, F. van Nassau, M. Bouman, Corstiaan C. Breugem, M.C. de Bruijne, M.G. Mullender, J.P.W. Don Griot
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveAdequate health information that matches the needs of care recipients is a prerequisite for patient-centered care. To facilitate the provision of tailored and timely information, it isimportant to understand the information needs of parents of children and adolescents with cleft lip and/or palate (CL/P) themselves, and in addition they were asked how they experienced the provided care-related information.DesignA cross-sectional study employing questionnaires and semi-structured interviews.SettingParticipants were recruited from a cleft palate-craniofacial care unit in a major tertiary hospital in the Netherlands.ParticipantsParticipants were parents or guardians of children with CL/P, and two adolescents with CLP. They were recruited through the outpatient clinic during multidisciplinary consultation or after clinical admission.ResultsIn total, fifty-five questionnaires were completed by parents or guardians and eleven interviews were conducted with nine parents of children with CL/P and two adolescents with CL/P. In general, participants reported to be satisfied with provided information during hospital admission or multidisciplinary cleft team consultations (mean 8.0, scale 0–10). In addition, 25.5% (n = 14) indicated that information to prepare for hospital admission was lacking (eg, practical information). Thematic qualitative analysis yielded five main information needs: 1) Clear communication during the care process, 2) Overview of the care trajectory, 3) Specific care plan information, 4) Presentation of information and 5) Guidance and support.ConclusionsOur findings emphasize the importance of gaining insights into wishes and information needs from care recipients who can provide insights in their information needs. With these findings, information provision should be redesigned to improve and to foster the further transition to family-centered care.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-19T06:54:00Z
      DOI: 10.1177/10556656241227355
       
  • Hospital Variation and Resource Use for Infants with Craniosynostosis
           Undergoing Open, Endoscopic, and Distraction Osteogenesis Surgical
           Techniques

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      Authors: Melissa D. Kanack, Mark R. Proctor, John G. Meara, Daniel M. Balkin, Jonathan Rodean, Isabel C. Stringfellow, Jay G. Berry
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      BackgroundCraniosynostosis is treated with endoscopic, open, and/or distraction surgical techniques. We assessed institutional variation in the use these techniques for craniosynostosis and compared hospital resource use.MethodsRetrospective analysis of 5249 infants age
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-19T06:53:10Z
      DOI: 10.1177/10556656241227032
       
  • Maternal Exposure to Stress During Covid-19 and Non-Syndromic Orofacial
           Clefts: A Cohort Retrospective Study

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      Authors: Heba Jafar Sabbagh, Mona Talal AlSharif, Fatma Dawood Abdulhameed, Aziza Johar Aljohar, Reema Mahdi Alhussain, Sultan Musaad Alghamdi, Najla Sulaiman Alrejaye, Latifa Yousef AlGudaibi, Bahaudbdin Ibraheem Sallout, Badi Shoaib Albaqawi, Eman Abdulbaset Alnamnakani, Lougin Khalid Brekeit, Osama Adel Basri, Manal Ibrahim Almalik, Norah Suliman Al Soqih, Ali Bakr Alshaikh, Abdullah Jameel Aburiziza, Faisal Ali Al Qahtani, Bushra Musaad Alghamdi, Asalah Khalid Alraddadi, Hadeel Hamza Khaja, Rana Abdullah Alamoudi
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThe coronavirus (COVID-19) pandemic presents an opportunity to study stress's effect on the development of non-syndromic orofacial clefts (NSOFCs). This study was aimed at assessing maternal stress exposure during the pregestational to first trimester pregnancy periods and the development of NSOFCs during a year of the COVID-19 pandemic.DesignCohort study of infants with NSOFCs and controls matched based on recruitment site and age.SettingGovernment hospitals in Saudi Arabia between November 2020 and November 2021.Main Outcome MeasuresData collection included NSOFC clinical examination and maternal stress exposure assessment using the Modified Life Events Questionnaire, the Fear of COVID-19 Scale, and a focus on the lack of pregnancy planning and a threatened miscarriage.ResultsOf the 557 infants recruited, 191 had NSOFCs. Logistic regression analysis with adjusted odds ratios (AORs) that removed the effects of confounders showed that any of the seven stressful life events (AOR:3.78, P 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-19T06:52:43Z
      DOI: 10.1177/10556656231224198
       
  • Validity of the Cleft Aesthetic Rating Scale Does Not Improve with
           Inclusion of Fixed Scores for Atypical Outcomes

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      Authors: Y. Vroom, N. S. S. Kornmann, D. G. M. Mosmuller, F. B. Niessen, J. P. W. Don Griot
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveThe Cleft Aesthetic Rating Scale (CARS) is a valid tool to assess the aesthetic outcome after unilateral cleft lip and palate (UCLP) repair. The goal of this study was to investigate whether the reliability of CARS increases by including fixed rates for atypical outcomes such as a smaller nostril, lower vermillion border or whistling deformity.Design197 patients with UCLP who underwent cleft repair were included. Three cleft experts rated the post-operative photos using the original CARS, followed by a second assessment employing the modified CARS.SettingMedisch Centrum Leeuwarden, Universitair Medisch Centrum Groningen, Radboud Universitair Medisch Centrum and Amsterdam University Medical Center.PatientsPhotographs of 16- to 25-year-old patients with repaired UCLP.InterventionsTwo separate assessments using the original and modified CARS.Main outcome measuresThe Intraclass Correlation Coefficient (ICC) was used to test inter-rater reliability of the original and modified version of the CARS.ResultsThe reported ICC for the nose scored by means of the original and modified CARS were 0.68 (95% CI 0.62-0.74) and 0.66 (95% CI 0.59-0.72) respectively. The reported ICC for the lip assessed with the original and modified CARS were 0.53 (95% CI 0.33-0.67) and 0.57 (95% CI 0.34-0.72) respectively.ConclusionsNo significant difference was found between the original and modified ICC of the nose and lip. The implementation of the fixed rates did not result in an increased reliability of the CARS. Therefore, we recommend the utilization of the original CARS.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-19T05:14:43Z
      DOI: 10.1177/10556656231221657
       
  • Management of Velopharyngeal Dysfunction (VPD) Following Cleft Palate
           Repair: A Comprehensive Decision-Making Process Based on Severity and
           Structural Deficiencies

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      Authors: Syed Altaf Hussain, Charanya Vijayakumar, Subramaniyan Balasubramanian, Sara Rahavi-Ezabadi, Vishnu Sundar, Deborah Sybil, Zaid Hussain
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo describe a comprehensive decision-making process for surgical correction of structural Velopharyngeal Dysfunction (VPD) following cleft palate repair and evaluate its efficacy.DesignRetrospective study.SettingTertiary care hospital.Patients300 consecutive patients with unilateral or bilateral cleft lip and palate (CLP) or isolated cleft palate (CP) diagnosed with clinical VPD following cleft palate repair between 2009 and 2014. Of these 206 patients had structural VPD and underwent surgical correction.InterventionsSurgical corrections were carried out according to the comprehensive two stage decision making process developed by the investigators. Step 1 of decision-making involved visualisation of the VP sphincter function by nasoendoscopy. This was followed by step 2 which involved per-operative identification of scarring, tissue loss, hypoplasia and other structural deficiencies in the soft palate and septal mucoperiosteum. The choice of operation was then made from a repertoire of interrelated and escalating surgical procedures consisting of palate revision and pharyngoplasties ranging from most anatomical to the least.Main outcome measuresEvidence of postoperative restoration of VP function on nasoendoscopy, evaluation of speech for hypernasality, understandability, acceptability and symptoms of obstructive sleep apnea.ResultsComplete VP closure was demonstrated in 94% of patients treated using this algorithm. There was significant improvement in all speech parameters (p 
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-12T08:01:27Z
      DOI: 10.1177/10556656231225573
       
  • Developmental Risk for Infants with Cleft Lip with or Without Cleft Palate
           Based on Caregiver-Proxy Reports

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      Authors: Kathleen A. Kapp-Simon, Meredith Albert, Todd C. Edwards, Salene M. Jones, Claudia Crilly Bellucci, Janine Rosenberg, Donald L. Patrick, Carrie L. Heike
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      Objectives(1) Assess caregiver-reported development in infants born with cleft lip ± alveolus (CL ± A) and cleft lip and palate (CLP); (2) determine factors associated with increased developmental risk; and (3) determine consistency of developmental risk before and after surgery for cleft lip.DesignProspective, longitudinal assessment of development. Time (T) 1, prior to lip closure; T2, 2 months post lip closure.SettingThree US craniofacial teams and online parent support groups.Participants123 total caregivers (96% mothers); 100 at T1, 92 at T2, and 69 at both T1 and T2.MeasureAges and Stages Questionnaire-3 (ASQ-3): Communication, Gross Motor, Fine Motor, Problem Solving, Personal Social Domains.ResultsAt T1 47%; at T2 42% passed all 5 Domains; 36% of infants pass all 5 Domains at both T1 and T2. Infants with CLP were at greatest risk on Communication [B = 1.449 (CI = .149-20.079), p = .038; Odds Ratio (OR) = 4.3 (CI = .923-19.650)] and Gross Motor Domains [B = 1.753 (CI = .316-20.605), p = .034; OR = 5.8 (CI = 1.162-28.671)]. Male infants were at greatest risk on Fine Motor [B = 1.542 (CI = .495-20.005), p = .009; OR = 4.7 (CI = 1.278-17.101)] and Problem Solving Domains [B = 1.200 (CI = .118-19.708), p = .044; OR = 3.3 (CI = .896-12.285)].ConclusionsBased on caregiver report, infants with CL ± A and CLP meet referral criteria at a high rate. Infants with CLP and male infants were at greatest risk. Regular developmental screening is recommended.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-10T07:57:29Z
      DOI: 10.1177/10556656231225304
       
  • Impact of Neighborhood Deprivation and Social Vulnerability on Outcomes
           and Interventions in Patients with Cleft Palate

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      Authors: Kaamya Varagur, John Murphy, Gary B. Skolnick, Sybill D. Naidoo, Lynn M. Grames, Katherine A. Dunsky, Maithilee Menezes, Alison K. Snyder-Warwick, Kamlesh B. Patel
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo examine whether neighborhood disadvantage impacts length of follow-up, interventions, and outcomes for patients with cleft palate.DesignRetrospective cohort.SettingCleft Palate Craniofacial Institute Database at St. Louis Children's Hospital.Patients/ParticipantsPatients with cleft palate following in St. Louis Children's Hospital Cleft Palate Multidisciplinary Team Clinic.InterventionsPrimary palatoplasty between 2012–2017. Patients were divided into quartiles across area deprivation index (ADI) and social vulnerability index (SVI), two validated, composite metrics of neighborhood disadvantage, to examine whether living in neighborhoods from different deprivation quartiles impacts outcomes of interest.Main Outcome MeasureFollow-up through age 5, surgeries and surgical complications, speech, developmental, and behavioral outcomesResults205 patients were included. 39% of patients belonged to the most deprived ADI quartile, while 15% belonged to the most vulnerable SVI quartile. There were no differences between ADI or SVI quartiles in number of operations received (p ≥ 0.40). Patients in the most deprived ADI quartile were significantly more likely to have speech/language concerns (OR 2.32, 95% CI [1.20–4.89], p = 0.01). Being in a more vulnerable SVI quartile was associated with developmental delay (OR 2.29, 95% CI [1.04–5.15], p = 0.04). ADI and SVI quartile did not impact risk of loss to follow-up in the isolated and combined cleft lip and palate subgroups (p ≥ 0.21).ConclusionsNeighborhood disadvantage impacts speech and developmental outcomes in patients with cleft palate despite comparable length of follow-up in multidisciplinary team clinic.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-10T07:16:49Z
      DOI: 10.1177/10556656231226070
       
  • The Use of Platelet Concentrates in the Reconstruction of the Alveolar
           Cleft Defect: A Systematic Review and Meta-Analysis

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      Authors: Mariana Vásquez-Álvarez, Qian Wang, Uriel Zapata
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveEvaluate quantitative and qualitative outputs when comparing the incidence of platelet concentrates (PCs) combined with autogenous bone grafts to an autograft control group for the reconstruction of alveolar cleft defects.DesignSystematic review and meta-analysis.Patients/ParticipantsRandomized and nonrandomized controlled clinical trials where PCs were used in the reconstruction of alveolar cleft defects.InterventionsUse of PCs in combination with autogenous bone graft in the experimental group and autogenous bone graft alone in the control group.Main Outcome Measure(s)Average bone formation and bone density were evaluated, mean differences were calculated and pooled by a meta-analysis technique. Additionally, clinical outcomes such as wound dehiscence, closure of the oronasal fistula, pain, swelling, discharges, infections, and bleeding were considered in the qualitative synthesis.ResultsAfter an evaluation of forty-nine articles, nineteen were considered for the review. The qualitative assessment of bone density, bone formation, and clinical outcomes showed no differences between groups in most of the included studies. The meta-analysis showed no statistical differences between PCs groups when compared to the control group in bone density at three months (mean difference 45.67 HU, P = .23) and six months (mean difference 48.57 HU, P = .64). Neither were statistical differences in the percentage of regenerated bone volume at six months (mean difference 6.39%, P = .15) and the volume of newly formed bone at 12 months (mean difference 0.37 mm3, P = .99).ConclusionsThere were no significant differences in terms of bone formation, bone density, and clinical outputs between groups.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-10T06:51:08Z
      DOI: 10.1177/10556656231222076
       
  • Helmet Therapy for the Management of Deformational Plagiocephaly in
           Pediatric Patients with Shunted Hydrocephalus

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      Authors: Emily A. Johnson, Gretchen M. Koller, Ryan Jafrani, Kamlesh Patel, Sybill Naidoo, Jennifer M. Strahle
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveTo evaluate the safety and efficacy of helmet therapy for deformational plagiocephaly in patients with shunted hydrocephalus.DesignRetrospective chart review.SettingInstitutional, tertiary-care hospital.PatientsAll patients at St. Louis Children's Hospital between 2014 and 2021 with shunted hydrocephalus who underwent helmet therapy for deformational plagiocephaly.InterventionsHelmet therapy.Main Outcome MeasuresCranial vault asymmetry (CVA), cranial vault asymmetry index (CVAI), and cephalic index (CI) were measured before and after completion of helmet therapy.ResultsThere were 37 patients with shunted hydrocephalus and documented deformational plagiocephaly. Twelve were managed with helmet therapy. Average age at helmeting initiation and time between shunt placement and helmeting initiation was 5.8 and 4.6 months, respectively. Average CVA, CVAI, and CI at helmeting initiation and termination was 11.6, 7.98, and 85.2, and 6.95, 4.49, and 83.7, respectively. Average duration of helmeting was 3.7 months. CVA and CVAI were significantly lower after helmeting (P = .0028 and .0021) and 11/12 patients had overall improvement in plagiocephaly.ConclusionsHelmet therapy appears to be a safe and efficacious management strategy for deformational plagiocephaly in patients with shunted hydrocephalus. Despite the occasional need for additional fittings and surveillance beyond the normal schedule, in all cases appropriately fitting helmets were achieved and no major adverse events occurred. This cohort represents a proof of principle for the safety and efficacy of helmet therapy in patients with shunted hydrocephalus. Further work in larger prospective cohorts is needed to confirm these initial findings.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-09T08:55:21Z
      DOI: 10.1177/10556656231214125
       
  • Easing the Burden on Caregivers- Applications of Artificial Intelligence
           for Physicians and Caregivers of Children with Cleft Lip and Palate

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      Authors: Sara C Chaker, Ya-Ching Hung, Mariam Saad, Michael S Golinko, Izabela A Galdyn
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveMany caregivers of children with cleft lip and palate experience a high level of anxiety throughout their child's medical and surgical care. We aim to evaluate artificial intelligence (AI) as a tool to mitigate these feelings and can aid clinicians in the development of robust pediatric educational materials for caregivers and families.DesignThirteen of the most common postoperative questions following cleft lip and/or palate repair were developed by an expert panel of senior Pediatric Plastic Surgeons and were posed to ChatGPT. Professional answers from the expert panel were provided and compared to responses from ChatGPT. A literature review was also conducted to generate a new support model for caregivers with children undergoing a surgical procedure.SettingDepartment of Pediatric Plastic Surgery at a metropolitan Children's Hospital.ParticipantsSenior Pediatric Plastic Surgeons at a metropolitan Children's Hospital.InterventionsNone.Main Outcome MeasureThe primary outcome was to determine the ability of ChatGPT to respond to common postoperative questions and to develop a model for AI assistance in family-centered perioperative care.ResultsChatGPT had a postoperative question response accuracy rate of 69% when compared with subject matter expert responses, with its greatest errors being information errors. An extensive literature search revealed that AI can assist in multiple traditional perioperative strategies to reduce caregivers and patient anxiety.ConclusionsArtificial Intelligence can help to reduce the burden of generating patient education materials as well as support caregivers in multiple aspects and perioperative care.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-05T08:15:22Z
      DOI: 10.1177/10556656231223596
       
  • Abbe Flap Division Before Two Weeks’ Time: Harmful or
           Advantageous'

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      Authors: John N. Muller, Allison Diaz, Roberto L. Flores, David A. Staffenberg
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      IntroductionThe Abbe flap is a standard intervention to treat upper lip deformities in patients with bilateral cleft lip. This two-stage procedure requires a 2 to 3-week period in which the superior and inferior lips remain connected. This study evaluates the safety of Abbe flap division and inset prior to 14 days’ time.Materials and MethodsA single institution, 8-year review of all patients with a bilateral cleft lip who underwent Abbe flap reconstruction was performed. Patients were classified into two groups: those whom division was performed 14 days or later and those with division earlier than 14 days.ResultsA total of 26 patients were identified. Patients who underwent Abbe flap division in less than 14 days (n = 10) demonstrated an average time to division of 9.7 days (range 7–13 days) with no evidence of flap loss, wound breakdown or infection. Patients who underwent Abbe flap division within 14 days or more (n = 16) demonstrated an average time to division of 15 days with four minor complications and no flap loss.ConclusionDividing the Abbe flap after the first postoperative week appears to be safe and without additional risk to flap loss or wound breakdown. A shorter time to Abbe flap division may decrease the burden of care on patients and their caregivers.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-03T09:02:38Z
      DOI: 10.1177/10556656231223615
       
  • Predicting Failure of Conservative Airway Management in Infants with Robin
           Sequence: The EARN Factors

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      Authors: Jennifer L. McGrath, Esperanza Mantilla-Rivas, Marudeen Aivaz, Monica Manrique, Md Sohel Rana, Hannah R. Crowder, Nathanael S. Oh, Gary F. Rogers, Albert K. Oh
      Abstract: The Cleft Palate Craniofacial Journal, Ahead of Print.
      ObjectiveEvaluate infants with Robin Sequence (RS) who were successfully treated with conservative airway measures alone vs. those who failed and eventually underwent surgical airway intervention after a protracted course of conservative management.DesignRetrospective review of prospectively gathered database.SettingLarge tertiary care institution.PatientsInfants diagnosed with RS (n = 122) who underwent primary airway management at a single institution from 1994–2020.Main Outcome MeasurePatient demographics, nutritional and respiratory status, laboratory values, and polysomnographic results were compared between patients who were discharged after successful conservative airway management (Group 1, n = 61) and patients that underwent surgical airway intervention after failing a prolonged course of conservative management (Group 2, n = 61). Receiver operating characteristic (ROC) curve analysis was done to assess continuous variables that may predict failure of conservative airway management.Results122 infants with RS were investigated. While several variables were significantly different between groups, the following polysomnographic EARN factors, with cut points, were identified as most predictive of failed conservative airway management: ETCO2 (max) > 49 mmHg, AHI > 16.9 events/hour, OAHI REM>25.9 events/hour, OAHI Non-REM > 23.6 events/hour.ConclusionsWe identified factors in infants with RS that were associated with severe UAO that failed to improve despite weeks of conservative airway management. Our results may expedite earlier definitive treatment of these critical patients and reduce risks for known complications of prolonged UAO.
      Citation: The Cleft Palate Craniofacial Journal
      PubDate: 2024-01-03T06:52:43Z
      DOI: 10.1177/10556656231224194
       
 
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Showing 1 - 149 of 149 Journals sorted alphabetically
Acta Orthopaedica     Open Access   (Followers: 35)
Advances in Orthopedics     Open Access   (Followers: 10)
American Journal of Orthodontics and Dentofacial Orthopedics     Hybrid Journal   (Followers: 9)
American Journal of Orthopedics     Partially Free   (Followers: 6)
Archives of Orthopaedic and Trauma Surgery     Hybrid Journal   (Followers: 10)
Archives of Osteoporosis     Hybrid Journal   (Followers: 2)
Arthritis und Rheuma     Hybrid Journal   (Followers: 1)
Arthroplasty Today     Open Access   (Followers: 3)
Australasian Musculoskeletal Medicine     Full-text available via subscription   (Followers: 6)
BMC Musculoskeletal Disorders     Open Access   (Followers: 33)
Bone Research     Hybrid Journal   (Followers: 3)
Burns & Trauma     Open Access   (Followers: 12)
Cartilage     Hybrid Journal   (Followers: 5)
Case Reports in Orthopedic Research     Open Access   (Followers: 1)
Case Reports in Orthopedics     Open Access   (Followers: 7)
Chinese Journal of Traumatology     Open Access  
Cleft Palate-Craniofacial Journal     Hybrid Journal   (Followers: 8)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 4)
Clinical Orthopaedics and Related Research     Hybrid Journal   (Followers: 78)
Clinical Trials in Orthopedic Disorders     Open Access   (Followers: 1)
Concussion     Open Access  
Craniomaxillofacial Trauma and Reconstruction     Hybrid Journal   (Followers: 2)
Current Orthopaedic Practice     Hybrid Journal   (Followers: 14)
Current Reviews in Musculoskeletal Medicine     Open Access   (Followers: 14)
Der Orthopäde     Hybrid Journal   (Followers: 6)
Die Wirbelsäule     Hybrid Journal  
Duke Orthopedic Journal     Open Access  
East African Orthopaedic Journal     Full-text available via subscription  
Egyptian Journal of Orthopedic Research     Open Access   (Followers: 8)
Egyptian Orthopaedic Journal     Open Access   (Followers: 1)
EMC - Técnicas Quirúrgicas - Ortopedia y Traumatología     Full-text available via subscription  
EMC - Tecniche Chirurgiche - Chirurgia Ortopedica     Full-text available via subscription  
Ergonomics     Hybrid Journal   (Followers: 26)
European Journal of Orthopaedic Surgery & Traumatology     Hybrid Journal   (Followers: 9)
European Journal of Podiatry / Revista Europea de Podología     Open Access   (Followers: 1)
European Spine Journal     Hybrid Journal   (Followers: 25)
Foot & Ankle International     Hybrid Journal   (Followers: 10)
Foot & Ankle Orthopaedics     Open Access   (Followers: 5)
Gait & Posture     Hybrid Journal   (Followers: 17)
Geriatric Orthopaedic Surgery Rehabilitation     Open Access   (Followers: 5)
Global Spine Journal     Open Access   (Followers: 13)
Hip International     Hybrid Journal  
Indian Journal of Orthopaedics     Open Access   (Followers: 8)
Informationen aus Orthodontie & Kieferorthopädie     Hybrid Journal  
Injury     Hybrid Journal   (Followers: 21)
International Journal of Orthopaedic and Trauma Nursing     Hybrid Journal   (Followers: 13)
International Journal of Orthopaedic Surgery     Open Access   (Followers: 5)
International Journal of Orthopaedics     Open Access   (Followers: 2)
International Journal of Research in Orthopaedics     Open Access  
International Musculoskeletal Medicine     Hybrid Journal   (Followers: 8)
International Orthopaedics     Hybrid Journal   (Followers: 18)
JAAOS : Global Research & Reviews     Open Access   (Followers: 1)
JBJS Journal of Orthopaedics for Physician Assistants     Hybrid Journal  
JBJS Reviews     Full-text available via subscription   (Followers: 12)
JOR Spine     Open Access   (Followers: 4)
Journal de Traumatologie du Sport     Full-text available via subscription   (Followers: 2)
Journal für Mineralstoffwechsel & Muskuloskelettale Erkrankungen     Hybrid Journal  
Journal of Bone and Joint Diseases     Open Access   (Followers: 3)
Journal of Bone and Joint Infection     Open Access   (Followers: 1)
Journal of Brachial Plexus and Peripheral Nerve Injury     Open Access   (Followers: 5)
Journal of Cachexia, Sarcopenia and Muscle     Open Access   (Followers: 3)
Journal of Clinical Orthopaedics and Trauma     Hybrid Journal   (Followers: 5)
Journal of Experimental Orthopaedics     Open Access   (Followers: 8)
Journal of Hand Surgery (European Volume)     Hybrid Journal   (Followers: 46)
Journal of Head Trauma Rehabilitation     Hybrid Journal   (Followers: 19)
Journal of Musculoskeletal Research     Hybrid Journal   (Followers: 10)
Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie     Hybrid Journal   (Followers: 1)
Journal of Orthodontic Science     Open Access   (Followers: 2)
Journal of Orthopaedic & Sports Physical Therapy     Full-text available via subscription   (Followers: 77)
Journal of Orthopaedic Association of South Indian States     Open Access   (Followers: 3)
Journal of Orthopaedic Diseases and Traumatology     Open Access   (Followers: 2)
Journal of Orthopaedic Reports     Full-text available via subscription   (Followers: 12)
Journal of Orthopaedic Research     Hybrid Journal   (Followers: 29)
Journal of Orthopaedic Science     Hybrid Journal   (Followers: 4)
Journal of Orthopaedic Surgery     Open Access   (Followers: 1)
Journal of Orthopaedic Surgery and Research     Open Access   (Followers: 8)
Journal of Orthopaedic Translation     Open Access  
Journal of Orthopaedic Trauma     Hybrid Journal   (Followers: 16)
Journal of Orthopaedics     Full-text available via subscription   (Followers: 3)
Journal of Orthopaedics and Allied Sciences     Open Access   (Followers: 9)
Journal of Orthopaedics and Spine     Open Access   (Followers: 6)
Journal of Orthopaedics and Traumatology     Open Access   (Followers: 16)
Journal of Orthopaedics, Trauma and Rehabilitation     Open Access   (Followers: 6)
Journal of Orthopedics & Rheumatology     Open Access  
Journal of Orthopedics, Traumatology and Rehabilitation     Open Access   (Followers: 6)
Journal of Pediatric Orthopaedics     Hybrid Journal   (Followers: 15)
Journal of Prosthetics and Orthotics     Hybrid Journal   (Followers: 15)
Journal of Scleroderma and Related Disorders     Hybrid Journal  
Journal of the American Academy of Orthopaedic Surgeons     Hybrid Journal   (Followers: 13)
Journal of the American Podiatric Medical Association     Full-text available via subscription   (Followers: 8)
Journal of Traumatic Stress     Hybrid Journal   (Followers: 30)
Knee Surgery, Sports Traumatology, Arthroscopy     Hybrid Journal   (Followers: 29)
Multiple Sclerosis and Related Disorders     Hybrid Journal   (Followers: 10)
Musculoskeletal Care     Hybrid Journal   (Followers: 20)
Musculoskeletal Science and Practice     Hybrid Journal   (Followers: 4)
Nigerian Journal of Orthopaedics and Trauma     Open Access  
North American Spine Society Journal (NASSJ)     Open Access   (Followers: 7)
OA Orthopaedics     Open Access   (Followers: 7)
Obere Extremität     Hybrid Journal   (Followers: 1)
Open Journal of Orthopedics     Open Access   (Followers: 4)
Open Journal of Orthopedics and Rheumatology     Open Access   (Followers: 2)
Open Journal of Trauma     Open Access  
Open Orthopaedics Journal     Open Access  
Operative Orthopädie und Traumatologie     Hybrid Journal  
Operative Techniques in Orthopaedics     Full-text available via subscription   (Followers: 6)
Orthopädie & Rheuma     Full-text available via subscription  
Orthopädie und Unfallchirurgie up2date     Hybrid Journal  
Orthopaedic Journal of Sports Medicine     Open Access   (Followers: 16)
Orthopaedic Nursing     Hybrid Journal   (Followers: 12)
Orthopaedic Surgery     Open Access   (Followers: 1)
Orthopaedics & Traumatology: Surgery & Research     Full-text available via subscription   (Followers: 6)
Orthopaedics and Trauma     Full-text available via subscription   (Followers: 28)
Orthopedic Clinics of North America     Full-text available via subscription   (Followers: 5)
Orthopedic Research and Reviews     Open Access   (Followers: 6)
Orthopedic Reviews     Open Access   (Followers: 7)
Orthopedics     Full-text available via subscription   (Followers: 7)
Orthoplastic Surgery     Open Access  
Osteoarthritis and Cartilage     Full-text available via subscription   (Followers: 19)
Osteoarthritis and Cartilage Open     Open Access   (Followers: 3)
Osteologie     Hybrid Journal  
Osteoporosis and Sarcopenia     Open Access  
OTA International     Open Access  
Paediatric Orthopaedics and Related Sciences     Open Access   (Followers: 3)
Pain Management in General Practice     Full-text available via subscription   (Followers: 13)
Prosthetics and Orthotics International     Hybrid Journal   (Followers: 9)
Revista Brasileira de Ortopedia     Hybrid Journal  
Revista Chilena de Ortopedia y Traumatología / Chilean Journal of Orthopaedics and Traumatology     Open Access  
Revista Colombiana de Ortopedia y Traumatología     Full-text available via subscription  
Revista Cubana de Ortopedia y Traumatologí­a     Open Access  
Revista de la Asociación Argentina de Ortopedia y Traumatología     Open Access  
Revista Española de Cirugía Ortopédica y Traumatología     Full-text available via subscription   (Followers: 1)
Revista Portuguesa de Ortopedia e Traumatologia     Open Access  
Revue de Chirurgie Orthopédique et Traumatologique     Full-text available via subscription   (Followers: 3)
Romanian Journal of Orthopaedic Surgery and Traumatology     Open Access  
SA Orthopaedic Journal     Open Access   (Followers: 2)
SICOT-J     Open Access   (Followers: 1)
Spine     Hybrid Journal   (Followers: 75)
Spine Journal     Hybrid Journal   (Followers: 28)
Sport-Orthopädie - Sport-Traumatologie - Sports Orthopaedics and Traumatology     Full-text available via subscription   (Followers: 3)
Strategies in Trauma and Limb Reconstruction     Open Access   (Followers: 1)
Techniques in Orthopaedics     Hybrid Journal   (Followers: 6)
Therapeutic Advances in Musculoskeletal Disease     Hybrid Journal   (Followers: 5)
Trauma     Hybrid Journal   (Followers: 5)
Trauma (Travma)     Open Access  
Trauma und Berufskrankheit     Hybrid Journal  
Traumatology     Full-text available via subscription   (Followers: 1)
Traumatology and Orthopedics of Russia     Open Access   (Followers: 3)
Zeitschrift für Orthopädie und Unfallchirurgie     Hybrid Journal   (Followers: 2)
Ортопедия, травматология и протезирование     Open Access  

           

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