IMPORTANCE This study evaluates a technique to estimate cleft severity and tissue hypoplasia in patients with cleft palate. Current classifications are limited to the morphologic characterstics of the clefts. A new classification is proposed in relation to the palatal index, which allows more individualized surgical attention for the cleft palate. OBJECTIVE To evaluate the relationship of palatal index and cleft palate repair surgical outcomes (palatal fistula and velopharyngeal insufficiency) in patients with unilateral cleft lip and palate. DESIGN, SETTING, AND PARTICIPANTS Retrospective study performed by the Outreach Surgical Center Program Lima, Lima, Perú, of surgical outcomes of 152 consecutive pediatric patients, aged 12 to 15 months, with nonsyndromic unilateral complete cleft lip and palate treated during from 2001 to 2007. Findings were obtained at 1 to 5 years' follow-up. INTERVENTIONS Palatoplasty using the 2-flap technique plus intravelar veloplasty. Palate index was measured preoperatively with the patient under general anesthesia. MAIN OUTCOMES AND MEASURES Postoperative analysis via the χ 2 test to assess the statistical significance of association between the palatal index and surgical outcomes. RESULTS Palatal fistula rates correlated directly with the cleft severity, as estimated by the palatal index (P = .01), but there was no association between postoperative velopharyngeal insufficiency and palatal index (P = .76). CONCLUSIONS AND RELEVANCE The palatal index was a good predictor of fistula development in the studied group. There was an association between the cleft severity and tissue deficiency (estimated using this index) and presence of palatal fistula. Further long-term study is needed to evaluate the relationship between the palatal index and maxillary growth. LEVEL OF EVIDENCE 4.

Objective: Evaluate simulation-based comprehensive cleft care workshops as a reproducible model for education with sustained impact. Design: Cross-sectional survey-based evaluation. Setting: Simulation-based comprehensive cleft care workshop. Participants: Total of 180 participants. Interventions: Three-day simulation-based comprehensive cleft care workshop. Main Outcome Measures: Number of workshop participants stratified by specialty, satisfaction with the workshop, satisfaction with simulation-based workshops as educational tools, impact on cleft surgery procedural confidence, short-term impact on clinical practice, medium-term impact on clinical practice. Results: The workshop included 180 participants from 5 continents. The response rate was 54.5%, with participants reporting high satisfaction with all aspects of the workshop and with simulation-based workshops as educational tools. Participants reported a significant improvement in cleft lip (33.3 ± 5.7 vs 25.7 ± 7.6; P < .001) and palate (32.4 ± 7.1 vs 23.7 ± 6.6; P < .001) surgery procedural confidence following the simulation sessions. Participants also reported a positive short-term and medium-term impact on their clinical practices. Conclusion: Simulation-based comprehensive cleft care workshops are well received by participants, lead to improved cleft surgery procedural confidence, and have a sustained positive impact on participants’ clinical practices. Future efforts should focus on evaluating and quantifying this perceived positive impact, as well reproducing these efforts in other areas of need.

Background:Secondary nose deformity after unilateral cleft lip repair is a common problem. Loss of tip projection on the cleft side of unilateral cleft lip nasal deformity can be difficult to correct due to lack of adequate support. The purpose of this study is to evaluate the surgical outcome after using V-Y-Z plasty to address unilateral cleft lip nasal deformities.Methods:A cross-sectional study of one surgeon's outcome of 58 performed primary complete unilateral cleft lip nasal deformity repairs. All these patients met the study criterion of having anthropometric measurements at the cleft and non-cleft side of the nose performed at least 1 year postoperatively.Results:Since 2012, 32 consecutive patients have undergone primary anatomical repair of the cleft nasal deformity in patients with a complete unilateral cleft. We have not found statistically significant differences between the cleft and non-cleft nostril dome height and columella length measured at least 1 year postoperatively.Conclusions:The findings suggest that the V-Y-Z plasty is a good alternative to create a more symmetric nasal tip in patients with primary unilateral cleft lip nasal deformity. Additional studies are required to evaluate functional and long-term outcomes after primary rhinoplasty in patients with unilateral cleft lip.

The Outreach Program Lima Clock Diagram classifies the severity of the cleft and affords an individualized description of cleft morphology. I have observed a direct relation between cleft severity and the number of poor outcomes in our patients.