Preoperative Alveolar Segment Position as a Predictor of Successful Gingivoperiosteoplasty in Patients with Unilateral Cleft Lip and Palate

Esenlik, Elçin; Bekisz, Jonathan M.; Gibson, Travis L.; Cutting, Court B.; Grayson, Barry H.; Flores, Roberto L.

doi:10.1097/prs.0000000000004231

Cited by 20 publications

(23 citation statements)

References 26 publications

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“…Velopharyngeal insufficiency requires highly coordinated care and clear communication between speech/language pathologists and surgeons (Ruda et al, 2012). Alveolar bone grafting and orthognathic surgery are 2 other procedures that demand strong partnerships between surgeons and dentists/orthodontists to optimize timing and outcomes (Dec et al, 2013; Esenlik et al, 2017). The observation that these procedures are predominantly performed by teams suggests that their provision is facilitated by the high levels of coordination and communication that are required by the Standards of ACPA team approval.…”

Section: Discussionmentioning

confidence: 99%

Provision and Utilization of Team- and Community-Based Operative Care for Patients With Cleft Lip/Palate in North Carolina

Shrader

Bosworth

et al. 2020

The Cleft Palate Craniofacial Journal

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Objective: To characterize operative care for cleft lip and/or palate (CL/P) based on location (ie, from American Cleft Palate Craniofacial Association [ACPA]–approved multidisciplinary teams or from community providers). Design: Cross-sectional analysis of Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery & Services Database databases for North Carolina from 2012 to 2015. Setting/Patients and Main Outcome Measures: Clinical encounters for children with CL/P undergoing operative procedures were identified, classified by location as “Team” versus “Community,” and characterized by demographic, geographic, clinical, and procedural factors. A secondary evaluation reviewed concordance of team and community practices with an ACPA guideline related to coordination of care. Results: Three teams and 39 community providers performed a total of 3010 cleft-related procedures across 2070 encounters. Teams performed 69.7% of total volume and performed the majority of cleft procedures, including cleft lip repair, palate repair, alveolar bone grafting, and correction of velopharyngeal insufficiency. Community locations principally offered myringotomy and rhinoplasty. Team care was associated with higher guideline concordance. Conclusions: American Cleft Palate Craniofacial Association –approved team-based care accounts for the majority of cleft-related care in North Carolina; however, a substantial volume of cleft-related procedures was provided by community providers, with 3 providers accounting for the vast majority of community cases.

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Section: Discussionmentioning

confidence: 99%

Provision and Utilization of Team- and Community-Based Operative Care for Patients With Cleft Lip/Palate in North Carolina

Shrader

Bosworth

et al. 2020

The Cleft Palate Craniofacial Journal

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“…Studies have reported the unfavorable growth following GPP without presurgical infant orthopedic preparation (Rintala & Ranta, 1989; Renkielska et al, 2005). In studies of patients prepared for GPP with presurgical infant orthopedics, it has been recommended that the alveolar cleft gap width should be less than 1.7 mm for a successful primary GPP procedure (Esenlik et al, 2018). In infants with bilateral cleft lip and palate, primary GPP may be considered with wider alveolar cleft gaps, as premaxilla mobility allows the surgeon to gently reposition the premaxilla to one side and perform GPP at least unilaterally (Traube et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Dental Anomalies in Patients With Unilateral Cleft Lip and Alveolus Treated With Gingivoperiosteoplasty

Gibson

Grayson

Cutting

et al. 2021

The Cleft Palate Craniofacial Journal

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Objective: To compare the prevalence of dental malformations and agenesis in patients who received or did not receive gingivoperiosteoplasty (GPP). Design: Retrospective cohort study. Patients: Review of patients born January 1, 2000, to December 31, 2007, with unilateral cleft lip and alveolus, with or without clefting of the secondary palate, who received GPP and/or secondary alveolar bone grafting (ABG). Patients were included if they had clinical images and dental radiographs available at ages 5 to 9 and 10 to 12 years. Ninety-four patients met the inclusion criteria; 46 treated with GPP, and 48 who did not receive GPP. Outcome Measures: Records were assessed for supernumerary, missing, and malformed teeth by a blinded examiner, and prevalence compared between groups using χ2 tests. Results: Cleft side lateral incisors were absent in 54% of GPP patients, compared to 50% in the no-GPP group. Two patients in the GPP group and 1 in the no-GPP group had supernumerary lateral incisors. Most lateral incisors were undersized or peg shaped in both the no-GPP (83.3%) and GPP (71.4%) groups. In the GPP group, 5 (10.9%) patients exhibited central incisor agenesis, and 3 had significant hypoplasia. In the no-GPP group, 4 (8.3%) patients exhibited central incisor agenesis, and 5 (10.5%) significant hypoplasia. These differences were not statistically significant. Conclusions: Gingivoperiosteoplasty was not associated with increased prevalence of dental malformation or agenesis. When performed appropriately, GPP is a safe treatment technique that does not increase the risk of dental anomalies.

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“…8,9 Grayson and Cutting later describe the use of NasoAlveolar Molding (NAM) as a method of passively narrowing the width between alveolar cleft segments to 1 to 2 mm followed by GPP at time of cleft lip repair. 10,11 Although good bony restoration has been demonstrated with this technique, long term growth outcomes are pending.…”

Section: Introductionmentioning

confidence: 99%

“…13 GPP can be an effective method of alveolar cleft repair in as high as 72% of patients, 14 obviating the need for secondary bone grafting. 7,11 Currently, there are no large scale studies reporting on national trends in GPP. The purpose of our study is to investigate national trends in GPP, demographics of children undergoing GPP, short term surgical outcomes, and operative time with addition of GPP when compared to cleft lip repair alone.…”

Section: Introductionmentioning

confidence: 99%

Profiling Gingivoperiosteoplasty (GPP): A Cross-Sectional Analysis Using a Nationally Validated Pediatric Surgery Database

Arias

Rochlin

Rabbani

et al. 2022

FACE

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Objective: Compare short term surgical outcomes and trends in cleft lip repair with or without gingivoperiosteoplasty (GPP). Design: Retrospective review of the ACS NSQIP-Pediatric database from 2014 to 2019. Patients: Patients between 2 and 18 months of age undergoing any initial cleft lip repair, with or without GPP, were selected via relevant CPT® codes. Main Outcome Measures: Patient demographics, comorbidities, 30-day readmissions and post-operative complications are assessed. Results: From 2014 to 2019, a total of 6269 patients were identified, of which 6.67% underwent GPP (n = 418). Patients undergoing GPP were significantly older with an average age of 9 months compared to 5 months in the non-GPP group ( P < .001). Co-morbidities were similar amongst both cohorts, although patients undergoing GPP were more likely to have a higher ASA class ( P = .006), cardiac risk factors ( P = .012) and syndromic diagnosis ( P < .001). There were no differences in 30-day short term surgical outcomes. GPP was associated with increased operative time by ~25 minutes when compared to cleft lip repair alone ( P < .001). Conclusion: GPP was not associated with increased 30-day postoperative complications, readmission, reoperation, or total length of hospital stay, and was associated with an increased operative time of 25 minutes. Children undergoing GPP were significantly older in age and were more likely to have a higher ASA class/cardiac risk factors.

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Preoperative Alveolar Segment Position as a Predictor of Successful Gingivoperiosteoplasty in Patients with Unilateral Cleft Lip and Palate

Abstract: Risk, III.

Cited by 20 publications

References 26 publications

Provision and Utilization of Team- and Community-Based Operative Care for Patients With Cleft Lip/Palate in North Carolina

Provision and Utilization of Team- and Community-Based Operative Care for Patients With Cleft Lip/Palate in North Carolina

Prevalence of Dental Anomalies in Patients With Unilateral Cleft Lip and Alveolus Treated With Gingivoperiosteoplasty

Profiling Gingivoperiosteoplasty (GPP): A Cross-Sectional Analysis Using a Nationally Validated Pediatric Surgery Database

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