Cleft Lip and Palate Resources on UpToDate Etiology, prenatal diagnosis, obstetrical management, and recurrence of orofacial clefts

BACKGROUND: The Furlow palatoplasty is commonly used for the correction of velopharyngeal insufficiency in cleft patients. An alternative procedure is introduced involving a single Z-plasty with overlapping intravelar veloplasty (Woo palatoplasty). This study compared the results of both techniques in the correction of velopharyngeal insufficiency.METHODS: After institutional review board approval, a retrospective chart review was performed of all patients who had undergone secondary palatoplasty for the correction of velopharyngeal insufficiency. All nonsyndromic patients with imaging data were evaluated. Data elements included preoperative and postoperative velopharyngeal gap size and perceptual speech examination results.RESULTS: Fifty-two subjects were included: 30 subjects had undergone Furlow palatoplasty and 22 underwent Woo palatoplasty. Overall, a larger proportion of Woo (95 percent) than Furlow subjects (63 percent) did not require secondary surgery (p = 0.005). However, mean presurgery closure was significantly different between groups (p = 0.042). For a more refined assessment, only those with 80 percent or greater preoperative closure were evaluated. Successful results were achieved in 67 percent (10 of 15) in Furlow and in 100 percent (19 of 19) in Woo. Again, this finding was significant (p = 0.005). Linear regression analysis suggested a significant effect of cleft type (beta = 2.3, p = 0.013) on closure after repair, with decreased closure in cases with isolated cleft palate.CONCLUSIONS: The Woo palatoplasty compared favorably with Furlow palatoplasty for correction of velopharyngeal insufficiency. The technique appears to be a viable alternative for palatal re-repair, especially in circumstances when Furlow palatoplasty cannot be performed.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. Publication type: Journal Article Source: MEDLINE Full text: Available Journal of reconstructive microsurgery at Plastic and Reconstructive Surgery Full text: Available Journal of reconstructive microsurgery at Plastic and Reconstructive Surgery 22.Title: Facial growth evaluation of complete unilateral cleft lip and palate operated patients: a cleft reference center in Paraiba, Brazil, using the "GOSLON" yardstick. Citation: Oral & Maxillofacial Surgery, December 2014, vol./is. 18/4(403-7), 1865-1550;1865-1569 (2014 Dec) Author(s): Lacerda RH, Ozawa TO, Ramos TB, Furtado PG, de Oliveira LA, de Oliveira AF Language: English Abstract: OBJECTIVES: To evaluate the surgical outcomes of patients with complete unilateral cleft lip and palate (CUCLP) operated on by a single surgeon of the cleft reference center of the Lauro Wanderley University Hospital at the Federal University of Paraiba.METHODS: Forty-four individuals' dental casts diagnosed with CUCLP, born between 1995 and 2002, mean age of 11 years, were evaluated by three calibrated orthodontic specialists and scored by the Great Ormond Street, London and Oslo (GOSLON) yardstick on two occasions. The scores were compared with those observed in other centers around the world. The Kappa test was applied to evaluate the intraand inter-examiner agreement. Descriptive statistics was applied for the GOSLON yardsticks core.RESULTS: The mean GOSLON score was 2.75. For the GOSLON yardstick, 43.2 % of the sample presented scores 1 and 2, 31.8 % had score 3, and 25 % were with scores 4 and 5. There was very good intraand inter-examiner Kappa agreement in the application of the GOSLON yardstick.CONCLUSIONS: The data suggest favorable outcomes, with 75 % of cases with no need of orthognathic surgery. The Kappa values confirmed the high reproducibility of the GOSLON yardstick. Publication type: Journal Article