Inequitable Access to Timely Cleft Palate Surgery in Low‐ and Middle‐Income Countries

Carlson, Lucas C.; Hatcher, Kristin Ward; Tomberg, Lindsay; Kabetu, Charles; Ayala, Ruben; Burg, Richard Vander

doi:10.1007/s00268-015-3374-0

Cited by 33 publications

(29 citation statements)

References 42 publications

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“…This is especially remarkable since median age at palatoplasty in the late palatoplasty group (15.5 months) is only a few months later than the ages at palatoplasty in the standard group (11-13 months). In comparison, other studies have defined late palatoplasty as occurring after 18 (Haapanen and Rantala, 1992; Nyström and Ranta, 1994; Pasick et al, 2014; Follmar et al, 2015) or 24 months (Guneren et al, 2015; Carlson et al, 2016; Menegueti et al, 2017), 4 to 7 years (Rohrich et al, 1996; Stancheva et al, 2015), or even 10 years of age (Murthy et al, 2010; Schönmeyr et al, 2015). Although this tentatively point to benefits of a relatively earlier palatal closure, the association between late palatoplasty and speech/language delays is not proof of causation.…”

Section: Discussionmentioning

confidence: 99%

“…As with the literature regarding maxillofacial growth, several considerations complicate the interpretation of the literature examining the impact of timing of palatoplasty on speech and language outcomes. First, variability in criteria used to define “early” and “late” palatoplasty exists, with early age for simultaneous soft and hard palate repair ranging from 3 months (Kaplan, 1981) to 6 months (Ysunza et al, 1998; Kirschner et al, 2000) to 24 months (Yang et al, 2013), and late age ranging from >12 months (Randall et al, 1986; Yang et al, 2019) to >18 months (Pasick et al, 2014) to >2 years (Zhao et al, 2012; Guneren et al, 2015; Carlson et al, 2016; Menegueti et al, 2017), depending on the study. Further variability is introduced by studies examining staged closure of the soft and hard palate (Cosman and Falk, 1980; Randall et al, 1983; Kirschner et al, 2000; Holland et al, 2007; Yamanishi et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

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The Association Between Age at Palatoplasty and Speech and Language Outcomes in Children With Cleft Palate: An Observational Chart Review Study

Shaffer

Ford

Losee

et al. 2019

The Cleft Palate Craniofacial Journal

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Objective: To determine whether timing of palatoplasty (early, standard, or late) is associated with speech and language outcomes in children with cleft palate. Design: Retrospective case series. Setting: Tertiary care children’s hospital. Participants: Records from 733 children born between 2005 and 2015 and treated at the Cleft Craniofacial Clinic of a tertiary children’s hospital were retrospectively reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, syndromes, staged palatoplasty, and introduction to clinic after 12 months of age. Data from 232 children with cleft palate ± cleft lip were analyzed. Interventions: Palatoplasty. Main Outcome Measures: Speech/language delays and disorders at 20 months and 5 years of age based on formal hospital or community-based testing or screening evaluation in the Cleft Craniofacial Clinic; additional speech surgery. Results: Median age at palatoplasty was 12.6 months (range: 8.8-21.9 months). Age at palatoplasty was classified as early (<11 months, n = 28), standard (11-13 months, n = 158), or late (>13 months, n = 46). Late palatoplasty was associated with increased odds of speech/language delays and speech therapy at 20 months, and language delays at 5 years, compared with standard or early palatoplasty ( P < .05 for all comparisons). However, speech sound production disorders, velopharyngeal incompetence, tube replacement, and hearing loss were not significantly associated with age at palatoplasty. Conclusions: Late palatoplasty may be associated with short- and long-term delays in speech/language development. Future studies with standardized surgical technique/timing and outcome measures are required to more definitively describe the impact of age at palatoplasty on speech/language development.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Association Between Age at Palatoplasty and Speech and Language Outcomes in Children With Cleft Palate: An Observational Chart Review Study

Shaffer

Ford

Losee

et al. 2019

The Cleft Palate Craniofacial Journal

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“…Another limitation is that our patient population is older than the recommended age for these types of surgeries. This limitation reflects that a high degree of inequity in access to surgery exists between regions, with a delayed access to cleft surgery, particularly in low- and lower middle-income countries (Cubitt et al, 2014; Carlson et al, 2016). Unfortunately, the number of patients ≤1 is small and this sample is not sufficiently powered to detect a difference between groups.…”

Section: Discussionmentioning

confidence: 99%

Clonidine as an Adjuvant to Bupivacaine for Suprazygomatic Maxillary Nerve Blocks in Cleft lip and Palate Repair: A Randomized, Prospective, Double-Blind Study

Barbero

Miguel

Sierra

et al. 2020

The Cleft Palate Craniofacial Journal

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Objectives: Does clonidine, as adjuvant to bupivacaine for suprazygomatic maxillary nerve blocks, reduce emergence agitation in patients undergoing cleft lip and cleft palate surgery? Design: Randomized, controlled, and double-blind study. Setting: Guwahati Comprehensive Cleft Care Center, Guwahati (Assam, India). Participants: A total of 124 patients; with a median age of 5 years in the clonidine group (CLG) and 7 years in the control group (CG), who underwent cleft lip or cleft palate surgery were included. Exclusion criteria included lack of consent from patients or their guardians, allergy to local anesthetics, coagulation disorders, local infection at the puncture site before performing the block, and language difficulties or cognitive disorders. Interventions: Patients were randomized into 2 groups to receive bilateral suprazygomatic maxillary nerve blocks with either a bupivacaine/clonidine mixture for the CLG or bupivacaine alone in the CG. Main Outcome Measure: The primary end point was the incidence of emergence agitation. Results: There was a statistically significant difference in the incidence of emergence agitation (30.2% in the CG compared to 15.2% in the CLG; difference of incidences: 15%, 95% CI: 0.1-30.1). The percentage of patients requiring intraoperative Fentanyl was lower in the CLG (10.6% compared to 26.4%; difference of incidences: 15.8%, 95% CI: 1.8-29). No other differences were observed. Further research in a more typically aged children population undergoing cleft surgery is needed. Conclusions: The use of clonidine as an adjuvant to bupivacaine in maxillary nerve block reduces the incidence of emergence agitation and intraoperative opioid consumption without hemodynamic or sedative side effects in patients undergoing cleft lip and palate surgery.

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“…Carlson et al (2016a) collected data of age during primary palatal repair in 11 LMIC in which the median age was ranged from 13.35 to 66.41 months 12 . There is a direct correlation between delayed access to primary cleft palate surgery and low national income status in LMIC 12 . Higashi et al (2015) analysed Global Burden of Disease 2012 Study.…”

Section: Discussionmentioning

confidence: 99%

Orofacial clefts in low‐ and middle‐income countries: A scoping review of quality and quantity of research based on literature between 2010‐2019

Sarilita

Setiawan

Mossey

2020

Orthod Craniofacial Res

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Structured Abstract This paper assesses the research literature on OFC in LMIC over the last decade across various geographical settings and project focus of the indexed literature. A scoping review of the indexed literature was performed using a set of predefined keywords. The articles were filtered by a ten‐year time frame (2010‐2019) and a strict inclusive‐exclusive criterion. Two authors screened the titles/abstracts/full text of the final included papers and input the desired data (year of publication, type of publication, geographical country/region and project focus to a coded spreadsheet). Six hundred and twenty publications were inventoried from the indexed literature on OFC in LMIC settings over the 10‐year period. Five hundred and eighty‐three derived from single LMIC countries and 37 from multi‐settings. More than half of the articles were reported from Asia (57%), then from Americas (22.8%), Africa (15.4%) and the rest from cross‐regional, Europe and Oceania (4.9%). The top 3 LMIC contributors towards OFC publications were China (21.5%), Brazil (13.1%) and India (11.6%). The most discussed OFC project themes were prevalence, surgical repair, aetiology and genetics. This study helps OFC researchers, humanitarian missions and research grant funders to identify gaps in the literature on issues impacting on children and adults born with OFC, in which issues were subjected to research and which were less explored in which LMIC regions. In addition, this study offers recommendations for established OFC researchers and international research bodies to identify areas of deficiency in the literature and what information is required to support LMIC governments achieve SDGs by 2030.

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Inequitable Access to Timely Cleft Palate Surgery in Low‐ and Middle‐Income Countries

Cited by 33 publications

References 42 publications

The Association Between Age at Palatoplasty and Speech and Language Outcomes in Children With Cleft Palate: An Observational Chart Review Study

The Association Between Age at Palatoplasty and Speech and Language Outcomes in Children With Cleft Palate: An Observational Chart Review Study

Clonidine as an Adjuvant to Bupivacaine for Suprazygomatic Maxillary Nerve Blocks in Cleft lip and Palate Repair: A Randomized, Prospective, Double-Blind Study

Orofacial clefts in low‐ and middle‐income countries: A scoping review of quality and quantity of research based on literature between 2010‐2019

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