Age at Primary Cleft Lip Repair: A Potential Bellwether Indicator for Pediatric Surgery

Vanderburg, Richard; Alonso, Nivaldo; Desai, Priya; Donkor, Peter; Mossey, Peter; Stieber, Erin; Mehendale, Felicity V.

doi:10.1097/gox.0000000000003657

Cited by 9 publications

(8 citation statements)

References 24 publications

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“…(23) From China an average age of 1.8 years for lip repair and 5.9 years for palatal repair was seen in the study by Kling et al(12) These contrast with studies from developed countries were timely repair is the norm. (2,27) Reasons for late repair of clefts in developing countries and underserved areas of high income countries are reportedly multifaceted and include low socioeconomic status, lack of access to care, ignorance and lower educational status of parents of children with clefts. (28,29)…”

Section: Discussionmentioning

confidence: 99%

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: a retrospective cohort study

Michael

Olorunfemi

Olusanya

et al. 2022

Preprint

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Background: Cleft of the lip and palate is the most common craniofacial birth defect with a worldwide incidence of one in 700 live births. Early surgical repairs are aimed at improving appearance, speech, hearing, psychosocial development and avoiding impediments to social integration. Many interventions including the Smile Train partner model have been introduced to identify and perform prompt surgical procedures for the affected babies. However, little is known about the trends of the incidence and surgical procedures performed at our hospital and the relationship between the clinical characteristics of the patients and the timing of primary repairs. Objective To determine the trends in cleft surgeries, patterns of cleft surgeries and identify factors related to late primary repair at the University College Hospital, UCH, Ibadan, Nigeria. Methods A retrospective cohort study and trends analysis of babies managed for cleft lip and palate from January 2007 to January 2019 at the UCH, Ibadan was conducted. The demographic and clinical characteristics were extracted from the Smile Train enabled cleft database of the hospital. The annual trends in rate of cleft surgeries (number of cleft surgeries per 100,000 live births) was represented graphically. Chi square test and Student’s t-test were utilised to assess the association between categorical and continuous variables and delay in cleft surgery (≥12 months for lip repair, ≥18months for palatal repair). Kaplan-Meier graphs with log-rank test was used to examine the association between sociodemographic variables and the outcome (late surgery). Univariable and multivariable Cox proportional hazard regression was conducted to obtain the hazard or predictors of delayed cleft lip surgery. Stata version 17 (Statacorp, USA) statistical software was utilised for analysis Results There were 314 cleft surgeries performed over the thirteen-year period of study. The male to female ratio was 1.2:1. The mean age of the patients was 58.08 ± 99.65 months. The median age and weight of the patients were 11 (IQR:5-65) months and 8 (IQR: 5.5-16) kg respectively. Over half (n=184, 58.6 %) of the cleft surgeries were for primary repairs of the lip and a third (n=94, 29.9%) were surgeries for primary repairs of the palate. Millard’s rotation advancement flap was the commonest lip repair technique with Fishers repair introduced within two years into the end of the study. Bardachs two flap palatoplasty has replaced Von Lagenbeck palatoplasty as the commonest method of palatal repair. The prevalence of late primary cleft lip repair was about a third of the patients having primary cleft lip surgery while the prevalence of late palatal repair was more than two thirds of those who received primary palatoplasty. Compared with children who had bilateral cleft lip, children with unilateral cleft lip had a significantly increased risk of late primary repair (Adj HR: 22.4, 955 CI: 2.59 - 193.70, P-value = 0.005). Conclusion There has been a change from Von Lagenbeck palatoplasty to Bardachs two-flap palatoplasty. Intra-velar veloplasty and Fisher’s method of lip repair were introduced in later years. There was a higher risk of late primary repair in children with unilateral cleft lip.

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Section: Discussionmentioning

confidence: 99%

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: a retrospective cohort study

Michael

Olorunfemi

Olusanya

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…From China an average age of 1.8 years for lip repair and 5.9 years for palatal repair was seen in the study by Kling et al [14]. These contrast with studies from developed countries where timely repair is the norm [2,12]. Reasons for late repair of clefts in developing countries and underserved areas of high-income countries are reportedly multifaceted and include low socioeconomic status, lack of access to care, ignorance, and lower educational status of parents of children with clefts [12,29].…”

Section: Plos Onementioning

confidence: 90%

“…Cleft of the lip and palate is the most common craniofacial birth defect with a worldwide incidence of one in 700 live births [ 1 ]. This burden is higher in low- and middle-income countries with a higher number of untreated clefts [ 2 ]. Early surgical repairs are aimed at improving appearance, speech, hearing, psychosocial development and avoiding impediments to social integration [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: A retrospective cohort study

et al. 2023

View full text Add to dashboard Cite

Background Cleft of the lip and palate is the most common craniofacial birth defect with a worldwide incidence of one in 700 live births. Early surgical repairs are aimed at improving appearance, speech, hearing, psychosocial development and avoiding impediments to social integration. Many interventions including the Smile Train partner model have been introduced to identify and perform prompt surgical procedures for the affected babies. However, little is known about the trends of the incidence and surgical procedures performed at our hospital. Nothing is also known about the relationship between the clinical characteristics of the patients and the timing of primary repairs. Objective To determine the trends in cleft surgeries, patterns of cleft surgeries and identify factors related to late primary repair at the University College Hospital, UCH, Ibadan, Nigeria. Methods A retrospective cohort study and trends analysis of babies managed for cleft lip and palate from January 2007 to January 2019 at the UCH, Ibadan was conducted. The demographic and clinical characteristics were extracted from the Smile Train enabled cleft database of the hospital. The annual trends in rate of cleft surgeries (number of cleft surgeries per 100,000 live births) was represented graphically. Chi square test, Student’s t-test and Mann Whitney U were utilised to assess the association between categorical and continuous variables and delay in cleft surgery (≥12 months for lip repair, ≥18months for palatal repair). Kaplan-Meier graphs with log-rank test was used to examine the association between sociodemographic variables and the outcome (late surgery). Univariable and multivariable Cox proportional hazard regression was conducted to obtain the hazard or predictors of delayed cleft lip surgery. Stata version 17 (Statacorp, USA) statistical software was utilised for analysis. Results There were 314 cleft surgeries performed over the thirteen-year period of study. The male to female ratio was 1.2:1. The mean age of the patients was 58.08 ± 99.65 months. The median age and weight of the patients were 11 (IQR:5–65) months and 8 (IQR: 5.5–16) kg respectively. Over half (n = 184, 58.6%) of the cleft surgeries were for primary repairs of the lip and a third (n = 94, 29.9%) were surgeries for primary repairs of the palate. Millard’s rotation advancement flap was the commonest lip repair technique with Fishers repair introduced within two years into the end of the study. Bardachs two flap palatoplasty has replaced Von Langenbeck palatoplasty as the commonest method of palatal repair. The prevalence of late primary cleft lip repair was about a third of the patients having primary cleft lip surgery while the prevalence of late palatal repair was more than two thirds of those who received primary palatoplasty. Compared with children who had bilateral cleft lip, children with unilateral cleft lip had a significantly increased risk of late primary repair (Adj HR: 22.4, 955 CI: 2.59–193.70, P-value = 0.005). Conclusion There has been a change from Von Langenbeck palatoplasty to Bardachs two-flap palatoplasty. Intra-velar veloplasty and Fisher’s method of lip repair were introduced in later years. There was a higher risk of late primary repair in children with unilateral cleft lip.

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“…Patient data was obtained through Smile Train Express, a database owned and operated by Smile Train, Inc. Over 1167 hospital sites in 73 countries provide cleft-related surgical procedures supported by Smile Train, and the details of each are uploaded to Smile Train Express. 10 The 110 partner hospitals that provide speech services in local languages also upload speech assessment forms completed by trained, local personnel. Partner hospital data was obtained through a survey administered in 2019 and 2021 by Smile Train, Inc. Survey questions inquired about speech therapy providers at each partner hospital.…”

Section: Datamentioning

confidence: 99%

Predictors of Adverse Outcomes Following Cleft Palate Repair: An Analysis of Over 2500 Patients Using International Smile Train Data

Chwa

Stoehr

Gosain

2023

The Cleft Palate Craniofacial Journal

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Objective The objective of this study was to use data from Smile Train's global partner hospital network to identify patient characteristics that increase odds of fistula and postoperative speech outcomes. Design Multi-institution, retrospective review of Smile Train Express database. Setting 1110 Smile Train partner hospitals. Patients/Participants 2560 patients. Interventions N/A. Main Outcome Measure(s) Fistula occurrence, nasal emission, audible nasal emission with amplification (through a straw or tube) only, nasal rustle/turbulence, consistent nasal emission, consistent nasal emission due to velopharyngeal dysfunction, rating of resonance, rating of intelligibility, recommendation for further velopharyngeal dysfunction assessment, and follow-up velopharyngeal dysfunction surgery Results The patients were 46.6% female and 27.5% underweight by WHO standards. Average age at palatoplasty was 24.7 ± 0.5 months and at speech assessment was 6.8 ± 0.1 years. Underweight patients had higher incidence of hypernasality and decreased speech intelligibility. Palatoplasty when under 6 months or over 18 months of age had higher rates of affected nasality, intelligibility, and fistula formation. The same findings were seen in Central/South American and African patients, in addition to increased velopharyngeal dysfunction and fistula surgery compared to Asian patients. Palatoplasty technique primarily involved one-stage midline repair. Conclusions Age and nutrition status were significant predictors of speech outcomes and fistula occurrence following palatoplasty. Outcomes were also significantly impacted by location, demonstrating the need to cultivate longitudinal initiatives to reduce regional disparities. These results underscore the importance of Smile Train's continual expansion of accessible surgical intervention, nutritional support, and speech-language care.

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Age at Primary Cleft Lip Repair: A Potential Bellwether Indicator for Pediatric Surgery

Cited by 9 publications

References 24 publications

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: a retrospective cohort study

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: a retrospective cohort study

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: A retrospective cohort study

Predictors of Adverse Outcomes Following Cleft Palate Repair: An Analysis of Over 2500 Patients Using International Smile Train Data

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