Structured AbstractObjectives: To explore centre-level variation in otitis media with effusion (OME), hearing loss and treatments in children in Cleft Care UK (CCUK) and to examine the association between OME, hearing loss and developmental outcomes at 5 and 7 years.Setting and Sample Population: Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK. Materials and Methods:Children had air and bone conduction audiometry at age 5.Information on grommet and hearing aid treatment was obtained from parental questionnaire and medical notes. Hearing loss at age 5 was defined as >20 dB in the better ear and history of OME and hearing loss was determined from past treatment. Children with sensorineural hearing loss were excluded. Associations were examined with speech, behaviour and self-confidence at age 5 and educational attainment at age 7.Centre variation was examined using hierarchical models and associations between hearing variables and developmental outcomes were examined using logistic regression.Results: There was centre-level variation in early grommet placement (variance partition coefficient (VPC) 18%, P=.001) and fitting of hearing aids (VPC 8%, P=.03). A history of OME and hearing loss was associated with poor intelligibility of speech (adjusted odds ratio=2.87, 95% CI 1.42-5.77) and aspects of educational attainment. Conclusions:Hearing loss is an important determinant of poor speech and treatment variation across centres suggest management of OME and hearing loss could be improved. K E Y W O R D Scentralization, developmental outcomes, hearing loss, unilateral cleft lip and palateThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Objective: This study evaluated association between functional outcomes in children born with unilateral cleft lip and palate (UCLP) and educational attainment. Design: Cleft Care UK (CCUK) was a United Kingdom (UK) wide cross-sectional study. Setting: UK Cleft Teams (data collected from all UK sites providing centralized cleft services). Patients, Participants: Five-year olds born with nonsyndromic UCLP (n = 268). Main Outcome Measure(s): National tests for educational attainment Key Stage 1 (KS1) undertaken by children at age 7 were linked to CCUK data to describe differences in educational attainment. Associations between functional outcomes and KS1 results were evaluated using regression analysis. We adjusted for birth month, gender, and an area-based measure of socioeconomic status. Results: Data were available for 205 children with UCLP. These children scored lower than national average (NA) scores across all subject areas, with a 0.62 lower score observed in the Average Point Score (APS; P = .01). There was association between being in a lower category for a cleft related outcomes and poorer KS1 results, with a trend for poorer attainment with higher numbers of poor functional outcomes. Those with 3 or more poor outcomes had a −2.26 (−3.55 to −0.97) lower APS compared to those with 0 to 1 poor outcomes. Conclusions: Children born with UCLP have poorer educational attainment at age 7 across all subject areas though differences were modest. Children with poor functional outcomes at age 5 had worse educational outcomes age 7. Improvements in functional outcomes could enhance educational outcomes.

Pain is a common side-effect of orthodontic treatment. The aetiology of orthodontic pain, pain pathways and pain management will be described. CPD/Clinical Relevance: An understanding of the cause and subsequent management of orthodontic pain is essential for any orthodontist in order to improve patient co-operation and satisfaction with treatment.

The incidence of permanent canines failing to erupt in the mandible is not as common, and, therefore, not as well reported, as that in the maxilla. Mandibular canines have important functional and aesthetic purposes and knowledge of this uncommon condition is essential for those involved with the management of these cases. This article explores the aetiology, assessment and treatment options available to manage this condition, using examples from treated cases within our department. CPD/Clinical Relevance: An understanding of the aetiology, assessment and various treatment options available to manage impacted and transmigrated mandibular canines will inform better treatment planning.