A Challenging Period After Repair: Etiology and Follow-Up Rates of the Patients With Cleft Lip and Palate in Intensive Care Unit

Kara, Murat; Çalış, Mert; Kesici, Selman; Canbay, Özgür; Bayrakçı, Benan; Özgür, Figen

doi:10.1097/scs.0000000000007797

Cited by 3 publications

(2 citation statements)

References 34 publications

(100 reference statements)

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“…CL and CP repairs are associated with increased complications compared to other pediatric otolaryngologic procedures in the United States, 35,36 which our data corroborated. These complications relate to high‐tension closures and the moist, high bacterial colonization of the mouth 35,37 .…”

Section: Discussionsupporting

confidence: 79%

Pediatric Otolaryngology Short‐Term Mission Outcomes at a Surgical Mission Hospital in Guatemala

Richard

Sanchez²,

Amado³

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveThe frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low‐ and middle‐income country missions‐based surgery center in Guatemala City, Guatemala, and identify factors that influence surgical outcomes.Study DesignRetrospective cohort study.SettingGuatemalan surgery center is called the Moore Center.MethodsPediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses.Results A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% “other” surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty‐nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p < .001) and had a higher ASA classification (p < .001) than the 89% who did attend. Sixty‐nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p < .001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation.ConclusionThis surgical center models effective surgical care in low‐resource areas. Complications and follow‐up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair.

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Section: Discussionsupporting

confidence: 79%

Pediatric Otolaryngology Short‐Term Mission Outcomes at a Surgical Mission Hospital in Guatemala

Richard

Sanchez²,

Amado³

et al. 2023

Otolaryngol.--head neck surg.

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“…Furthermore, an investigation extending to the use of glucocorticoids, including "methylprednisolone" and "dexamethasone, " as well as β2-Agonist agents such as "Salbutamol, " frequently administered as bronchodilators in the intensive care unit for postoperative airway issues, is needed. These medications serve various roles in managing upper and lower airway obstructions (Table 1), and their potential effects on wound healing require careful consideration [5].…”

Section: Introductionmentioning

confidence: 99%

Effects of anemia and peri-operative medication on wound healing in cleft lip and palate patients

Üstün,

Menkü Özdemir,

Özgür

2024

Acta Medica

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Introduction: Wound healing complications among cleft lip and palate patients pose risks of additional surgeries, reduced scar quality, and increased patient morbidity. This literature review aims to explore the impact of anemia and drug usage associated with respiratory complications, frequently encountered in these patients, on wound healing. Materials and Method: We conducted an extensive literature search without time constraints using PubMed and Google Scholar databases. The investigation into the effects of anemia and medications on wound healing was divided into three stages. The first stage examined the general effects of anemia and medications on wound healing. The second and final stages assessed wound healing in craniofacial and cleft lip/palate surgeries, respectively. Results: Preoperative anemia exerts no substantial influence on wound healing unless hemoglobin levels drop below 5 g/dl. No studies reported detrimental effects of glucocorticoids on wound healing. The impact of salbutamol use on wound healing remains controversial, while data regarding ipratropium usage are insufficient. Conclusion: Severe anemia is the only significant concern for wound healing, necessitating transfusion or improvement in anemia. It appears that short-term use of glucocorticoids after surgery does not have a negative effect on wound healing.It is worth noting that salbutamol and ipratropium usage may have detrimental effects, and while complete avoidance may not be feasible, their potential impact on wound healing should be considered.

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Impact of endocrine disorders associated with cleft lip and palate

Çavuşoğlu,

Boynuyoğun,

Erek

et al. 2024

Turk J Pediatr

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Background. Any impediment to the development of midline structures i.e. hypothalamus, pituitary and oral cavity may cause anatomical and functional issues. We aimed to determine the association of endocrine disorders with anatomic defects of midline structures i.e. cleft types and syndromes, as well as their impact on postoperative intensive care unit (ICU) admissions and complications. Methods. A total of 6000 patients from the Cleft Lip and/or Palate (CLP) Treatment Center between September 2014 - February 2022 were included. Patients with physical findings or biochemistry that may indicate endocrine disorders were examined by the Division of Pediatric Endocrinology. Data concerning sex, operation age, cleft types, coexisting endocrine disorders, syndromes, echocardiography, postoperative complications as well as postoperative intensive care unit (ICU) admissions were recorded. Results. The study group consisted of 78 patients with endocrine disorders, with a mean follow-up time of 59±7 months. One hundred and nine CLP operations were performed. The most common endocrine disorders coexisting in CLP patients were hypothyroidism (44.8%) and growth hormone (GH) deficiency (14.1%). Of the patients, 29.4% had genetic syndromes. The median age of operation in patients with endocrine disorders was 5 months (Q1-Q3: 4-8 months) for cleft lip and 15 months (Q1-Q3: 12-20 months) for cleft palate repair. Of the patients with CLP and endocrine disorders, 24% required postoperative ICU admission. Age of operation and ICU admission rates were higher compared to the general population of patients with CLP in our center (p<0.01). Conclusions. Endocrine disorders, particularly hypothyroidism and GH deficiency, are frequent in CLP. Furthermore, our data suggest that endocrine disorders may complicate the postoperative course. Thus, investigation of these problems is crucial for appropriate treatment as well as adopting measures to successfully manage the postoperative course.

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A Challenging Period After Repair: Etiology and Follow-Up Rates of the Patients With Cleft Lip and Palate in Intensive Care Unit

Abstract: Supplemental Digital Content is available in the text

Cited by 3 publications

References 34 publications

Pediatric Otolaryngology Short‐Term Mission Outcomes at a Surgical Mission Hospital in Guatemala

Pediatric Otolaryngology Short‐Term Mission Outcomes at a Surgical Mission Hospital in Guatemala

Effects of anemia and peri-operative medication on wound healing in cleft lip and palate patients

Impact of endocrine disorders associated with cleft lip and palate

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