The respondents were significantly less knowledgeable about the impact of depression on patients' responses to periodontal treatment than about the effect of anxiety and stress. Given the evidence concerning the relationships among depression, pain, pain medication use, and wound healing, it is important to educate periodontists about the role of anxiety and stress and the significance of depression on their patients' responses to periodontal therapy.

Psychosocial factors (i.e., anxiety, depression, stress, and well-being) can affect the patients' quality of life on the day of periodontal treatment and the pain experience and medications used after surgical and non-surgical periodontal therapy (4-week period). Patient-provider communication should address the role of these factors in the treatment process.

Objective: The purpose of this study was to examine the surgical impact of the pedicled buccal fat pad (BFP) flap on the levator veli palatini (LVP) muscle and surrounding velopharyngeal (VP) anatomy following primary palatoplasty using magnetic resonance imaging (MRI). Design: Observational, prospective. Setting: MRI studies were completed at 3 different facilities. All participants with BFP flap were operated on by the same surgeon. Participants: Five pediatric participants with cleft palate with or without cleft lip (CP±L) who underwent primary palatoplasty with BFP flap placement. Comparison groups consisted of 10 participants: 5 with CP±L who did not receive the BFP flap and 5 healthy controls. Interventions: All participants underwent nonsedated MRI 2 to 5 years postoperatively. Main Outcomes and Measures: Anatomical measures of the velopharynx and LVP among the 3 participant groups. Results: Median values were significantly different among groups for velar length ( P = .042), effective velar length ( P = .048), effective VP ratio ( P = .046), LVP length ( P = .021), extravelar LVP length ( P = .009), and LVP origin–origin distance ( P = .030). Post hoc analysis revealed a statistically significant difference between the BFP and traditional repair groups for effective VP ratio ( P = .040), extravelar LVP length ( P = .033), and LVP length ( P = .022). Conclusions: This study provides preliminary support that the BFP flap creates a longer velum, with increased distance between the posterior hard palate and the LVP, and a larger effective VP ratio compared to traditional surgical techniques. Future research is needed to determine whether this procedure provides a more favorable mechanism for VP closure.

Congenital midline cervical cleft (CMCC) is a rare congenital difference. Accurate diagnosis is important to ensure appropriate treatment. CMCC results in both functional and esthetic concerns addressed by surgical management. While the majority of reported CMCC cases have been treated with a z-plasty, the best method of repair has been debated in the literature. The authors present a case of CMCC and review of the literature.

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