| 1. |
- Nicholls, Wendy, et al.
(författare)
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Adult-Specific life outcomes of cleft lip and palate in a Western Australian cohort
- 2018
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Ingår i: The Cleft Palate-Craniofacial Journal. - 1055-6656 .- 1545-1569. ; 55:10, s. 1419-1429
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: People with a cleft of the lip and/or palate (CL/P) differ from their peers due to their facial appearance, hearing and speech difficulties, and the significant time spent attending appointments and recovering from surgical interventions. These differences may impact life outcomes including occupation, income, education, relationships, psychosocial health issues, and lifestyle choices.METHODOLOGY: A self-administered questionnaire was posted to 338 former and current patients of the Cleft Lip and Palate Unit of Princess Margaret Hospital (PMH), Perth, Western Australia.RESULTS: Completed questionnaires were returned by 158 former and current patients. In comparison to the Australian Bureau of Statistics, study participants attained equivalent highest education levels, full-time annual income levels, occupational categories, employment rates, and home ownership levels. They did not marry later and demonstrated positive health-related lifestyle behaviors. However independent living was significantly delayed, and the number of romantic relationships, marriages, and children was lower, with separation/divorce rates also being lower. A key finding was that 78% of participants self-reported that they experienced at least 1 psychosocial health issue and more than half experienced anxiety and/or depression.CONCLUSION: When comparing the sociological outcomes for the study participants, the psychosocial outcomes were the areas of most concern. Further investigation is required to determine the causes for the high self-reported rates of anxiety and/or depression found in this study.
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| 2. |
- Nicholls, Wendy, et al.
(författare)
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The psychosocial impact of cleft in a Western Australian cohort across 3 age groups
- 2019
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Ingår i: The Cleft Palate-Craniofacial Journal. - 1055-6656 .- 1545-1569. ; 56:2, s. 210-221
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:: Management of a cleft of the lip and/or palate (CL/P) involves a multidisciplinary team approach lasting from birth to potentially postskeletal maturity. This condition is complex, with both medical and psychosocial implications that may place individuals with a cleft at higher risk of developing psychosocial problems.METHODOLOGY:: A self-administered questionnaire was completed by a sample from the Western Australian cleft population comprising 3 age groups: child (n = 100), adolescent (n = 101), and adult (n = 158).RESULTS:: Public speaking, being photographed, special relationships, and participation in school were identified as the areas most impacted by having a cleft. Hearing and speech were reported to have a higher importance than facial and dental appearance. Participants rated support given to them by their parents as the most important, with high ratings for treatment providers. For teasing, the impact of cleft was significantly higher among participants with cleft lip and palate for both the adolescent and adult age groups. There was little significant difference by gender across the variables, which suggests that males are just as likely to require support as females.CONCLUSION:: The impact of a cleft across multiple psychosocial domains needs to be recognized and addressed as part of craniofacial team care across age groups.
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| 3. |
- Allori, AC, et al.
(författare)
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A Standard Set of Outcome Measures for the Comprehensive Appraisal of Cleft Care
- 2017
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Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1545-1569. ; 54:5, s. 540-554
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Tidskriftsartikel (refereegranskat)abstract
- Care of the patient with cleft lip and/or palate remains complex. Prior attempts at aggregating data to study the effectiveness of specific interventions or overall treatment protocols have been hindered by a lack of data standards. There exists a critical need to better define the outcomes- particularly those that matter most to patients and their families-and to standardize the methods by which these outcomes will be measured. This report summarizes the recommendations of an international, multidisciplinary working group with regard to which outcomes a typical cleft team could track, how those outcomes could be measured and recorded, and what strategies may be employed to sustainably implement a system for prospective data collection. It is only by agreeing on a common, standard set of outcome measures for the comprehensive appraisal of cleft care that intercenter comparisons can become possible. This is important for quality-improvement endeavors, comparative effectiveness research, and value-based health-care reform.
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| 4. |
- Hagberg, Emilie, et al.
(författare)
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The Impact of Maxillary Advancement on Consonant Proficiency in Patients With Cleft Lip and Palate, Lay Listeners' Opinion, and Patients' Satisfaction With Speech
- 2019
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Ingår i: The Cleft Palate-Craniofacial Journal. - : NLM (Medline). - 1055-6656 .- 1545-1569. ; 56:4, s. 454-461
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study investigates the impact of maxillary advancement (Le Fort Iosteotomy) on consonant proficiency in patients with cleft lip and palate (CLP) and explores how these patients and lay people perceive their speech 1 year post Le Fort I osteotomy. Design: Retrospective group study before and after treatment. Participants: All patients with CLP who had undergone Le Fort I osteotomy for maxillary retrognathia between 2007 and 2010 at Karolinska University Hospital, Sweden (n = 21). Six patients were excluded due to additional malformations and missing data. Two experienced speech and language pathologists assessed consonant proficiency, and speech accuracy was determined by lay listeners from pre- and postoperative standardized audio recordings. The patients' satisfaction with speech postoperatively was collected from medical records. Main Outcome Measures: Percentage of oral consonants correct and acoustic analysis of /s/, lay listeners' opinion, and patients' satisfaction with speech. Results: One year postoperation, 11 of the 15 patients had improved articulation, especially on the /s/-sound, without speech intervention. The mean percentage of oral consonants correct before treatment (82%) was significantly improved later (95%; P > .01). This assessment was supported by the patients' satisfaction with speech. However, lay listeners' opinion on accuracy was inconsistent. Length of maxillary advancement or change in occlusion did not correlate with change in articulation. Conclusion: Maxillary advancement performed to normalize occlusion and facial profile improved consonant proficiency in patients with CLP 1 year postoperation. Lay listeners' and patients' perceptions of speech need further exploration.
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| 5. |
- Jabbari, Fatima, et al.
(författare)
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Optimization of Dental Status Improves Long-Term Outcome After Alveolar Bone Grafting in Unilateral Cleft Lip and Palate
- 2015
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Ingår i: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 52:2, s. 210-218
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Tidskriftsartikel (refereegranskat)abstract
- Objective : To evaluate the importance of dental status for long-term outcome after alveolar bone grafting in patients with unilateral cleft lip and palate. Design : Retrospective longitudinal study. Setting : Cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. Patients : A total of 67 consecutive patients with unilateral complete cleft lip and palate. Interventions : Secondary alveolar bone grafting, prior to the eruption of the permanent canine, was performed at the average age of 10.0 years (range, 8.5 to 12.0 years). Main Outcome Measures : Alveolar bone height was evaluated with the modified Bergland index at 1 and 10 years after surgery. Results : Of the patients, 97% had modified Bergland index grade I and the remaining 3% had modified Bergland index grade II at 1 year after surgery. At 10 years' follow-up, 43% showed modified Bergland index grade I; 55%, modified Bergland index grade II; and 2% (one patient), modified Bergland index grade III. The degree of dental anomalies in the cleft area, such as enamel hypoplasia, incisor rotation, incisor inclination, canine inclination, and oral hygiene registered preoperatively, all correlated negatively to the modified Bergland index at 10 years after surgery. Enamel hypoplasia (ρ = 0.70195, P < .0001), followed by canine inclination (ρ = 0.55429, P < .0001), showed the strongest correlation to reduced bone height in the cleft area. Conclusions : In patients with unilateral cleft lip and palate, excellent results from secondary alveolar bone grafting in terms of bone height in the alveolar cleft tend to decrease with time. This seems to be correlated with factors that might to some extent be treated preoperatively through adequate planning and execution of the orthodontic treatment.
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| 6. |
- Jabbari, Fatima, et al.
(författare)
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Secondary Alveolar Bone Grafting in Patients Born With Unilateral Cleft Lip and Palate : A 20-Year Follow-up
- 2018
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Ingår i: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 55:2, s. 173-179
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To identify factors of oral health important for the final outcome, after secondary alveolar bone grafting in patients born with unilateral cleft lip and palate and compare occlusal radiographs with cone beam computed tomography (CBCT) in assessment of alveolar bone height. Design: Observational follow-up study. Setting: Cleft Lip and Palate Team, Craniofacial Center, Uppsala University Hospital, Sweden. Patients: 40 nonsyndromic, Caucasian patients with unilateral complete cleft lip and palate. Interventions: Clinical examination, CBCT, and occlusal radiographs. Main Outcome Measurements: Alveolar bone height was evaluated according to Bergland index at a 20-year follow-up. Results: The alveolar bone height in the cleft area was significantly reduced compared to a previously reported 10-year follow-up in the same cohort by total (P = .045) and by subgroup with dental restoration (P = .0078). This was positively correlated with the gingival bleeding index (GBI) (r = 0.51, P = .0008) and presence of dental restorations in the cleft area (r = 0.45, P = .0170). There was no difference in the Bergland index generated from scoring the alveolar bone height on occlusal radiographs as with the equivalent index on CBCT. Conclusion: Patients rehabilitated with complex dental restoration seems to be at higher risk for progression of bone loss in the cleft area. Supportive periodontal therapy should be implemented after complex dental restorations in cleft patients. Conventional occlusal radiographs provide an adequate image for evaluating postoperative bone height in clinical follow-up.
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| 7. |
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| 8. |
- Langeveld, M, et al.
(författare)
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Etiology of Cleft Lip Lower Lip Deformity: Use of an Objective Analysis to Measure Severity
- 2019
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Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1545-1569. ; 56:10, s. 1333-1339
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Tidskriftsartikel (refereegranskat)abstract
- Measure lower lip thickness and eversion in patients with cleft lip and palate (CLP) and maxillary hypoplasia. The specific aims were to (1) compare lower lip thickness/eversion in patients with CLP to noncleft controls with maxillary hypoplasia, (2) determine differences between patients with unilateral CLP (UCLP) and bilateral CLP (BCLP), and (3) document changes in the lower lip that occur with Le Fort I advancement. Design: Retrospective case–control study. Setting: Tertiary care center. Patients/Participants: Patients with available pre- and postoperative CT scans and 2D lateral photographs who had a Le Fort I advancement between 2009 and 2017. There were 32 patients with CLP (17 females; mean age 17.7 ± 1.9 years) and 33 noncleft controls (21 females; mean age 18.8 ± 2.6 years). Main Outcome Measures: Lower lip thickness and eversion. Results: Patients with CLP and maxillary hypoplasia have a significantly thicker lower lip ( P = .019) and outward rotation of the vermilion border ( P = .003) compared to noncleft controls. The lower lip was significantly thicker in patients with BCLP than in those with UCLP ( P = .035). Lower lip thickness and rotation did not change after maxillary advancement. Conclusions: Patients with CLP and maxillary hypoplasia have a thicker and more everted lower lip than noncleft controls. Patients with BCLP have a significantly thicker lower lip than those with UCLP. Strain of the lower lip musculature appears to be an important contributor to the development of the cleft lip lower lip deformity.
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| 9. |
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| 10. |
- Malmenholt, A, et al.
(författare)
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Orofacial Function, Articulation Proficiency, and Intelligibility in 5-Year-Old Children Born With Cleft Lip and Palate
- 2019
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Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1545-1569. ; 56:3, s. 321-330
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Tidskriftsartikel (refereegranskat)abstract
- To explore and describe orofacial function in 5-year-old children born with clefts affecting the palate and to investigate potential relationship with articulation proficiency and intelligibility. Design: A prospective cohort study of 88 consecutive patients born with cleft lip and palate (CLP) between July 2009 and June 2011. Participants: Excluding internationally adopted children and children with no speech production resulted in 52 children with different cleft types and additional malformations, examined at age 5. Data on orofacial function were available for 43 children. Outcome Measures: Screening of orofacial function resulted in a profile and a total score, narrow phonetic transcription of test consonants produced a percentage of consonants correct (PCC) score, and ratings of intelligibility by speech and language pathologists (SLPs) and by parents gave 2 estimates. Inter- and intra-transcriber agreement was calculated. Results: Orofacial dysfunction was found in 37% of children, with results not significantly different between cleft types but significantly more frequent than in children born without CLP. Age-appropriate articulation proficiency was found in 39%, 49% presented below −2 standard deviations. Just above 50% had good intelligibility and were always understood by different communication partners according to both SLP and parent ratings. No significant correlation was found between orofacial dysfunction and PCC or intelligibility. Conclusions: Orofacial dysfunction was not found to be an explanatory factor for speech outcome in children born with CLP.
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| 11. |
- Morén, Staffan, et al.
(författare)
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Speech in Adults Treated for Unilateral Cleft Lip and Palate : Long-Term Follow-Up After One- or Two-Stage Palate Repair
- 2017
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Ingår i: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 54:6, s. 639-649
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate speech in adults treated for unilateral cleft lip and palate with one-stage or two-stage palate closure and compare the speech of the patients with that of a noncleft control group.DESIGN: Cross-sectional study with long-term follow-up.PARTICIPANTS/SETTING: All unilateral cleft lip and palate patients born from 1960 to 1987 and treated at Uppsala University Hospital, Sweden, were invited (n = 109). Participation rate was 67% (n = 73) at a mean of 35 years after primary surgery. Forty-seven had been treated according to one-stage palate closure and 26 according to two-stage palate closure. Pharyngeal flap surgery had been performed in 11 of the 73 patients (15%). The noncleft control group consisted of 63 age-matched volunteers.MAIN OUTCOME MEASURE(S): Speech-language pathologists rated perceptual speech characteristics from blinded audio recordings.RESULTS: Among patients, seven (10%) presented with hypernasality, 12 (16%) had audible nasal emission and/or nasal turbulence, five (7%) had consonant production errors, one (2%) had glottal reinforcements/substitutions, and one (2%) had reduced intelligibility. Controls had no audible signs of velopharyngeal insufficiency and no quantifiable problems with the other speech production variables. No significant differences were identified between patients treated with one-stage and two-stage palate closure for any of the variables.CONCLUSIONS: The prevalence of speech outcome indicative of velopharyngeal insufficiency among adult patients treated for unilateral cleft lip and palate was low but higher compared with individuals without cleft. Whether palatal closure is performed in one or two stages does not seem to affect the speech outcome at a mean age of 35 years.
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| 12. |
- Morén, Staffan, et al.
(författare)
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Voice quality in adults treated for unilateral cleft lip and palate : Long-Term Follow-Up After One- or Two-Stage Palate Repair
- 2018
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Ingår i: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 55:8, s. 1103-1114
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of the current study was to assess voice quality among adults treated for unilateral cleft lip and palate (UCLP), after 1- or 2-stage palate closure, and compare it to a noncleft control group.Study Design: Cross-sectional study in UCLP patients with long-term follow-up and noncleft controls.Participants: UCLP patients born 1960-1987, treated at Uppsala University Hospital, Sweden, were examined (n = 73) at a mean of 35 years after primary surgery. Forty-seven patients (64%) had been treated with 1-stage palate closure and 26 with 2-stage closure (36%). The noncleft control group consisted of 63 age-matched volunteers.Main Outcome Measure(s): Ratings of perceptual voice characteristics from blinded voice recordings with Swedish Voice Evaluation Approach (SVEA) method. Acoustic voice analysis including pitch and spectral measures.Results: Among the patients, the mean values for the 12 evaluated variables on a VAS scale (0 = no abnormality, 100 = maximal abnormality) ranged between 1 and 22 and the mean for all was 6 mm. Voice variables were similar between patients and controls except the total mean of all the perceptual voice variables, as well as “vocal fry”—both slightly lower among patients (P = .018 and P = .009). There was no difference in any variable between patients treated with 1-stage and 2-stage palate closure. No clear relationship was found between VPI and dysphonia.Conclusion: The voice characteristics among adults treated for UCLP in childhood are not different from those of individuals without cleft.
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| 13. |
- Nyberg, Jill, et al.
(författare)
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Speech in 10-year-olds born with cleft lip and palate: What do peers say?
- 2016
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Ingår i: Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 53, s. 516-526
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Tidskriftsartikel (refereegranskat)abstract
- © Copyright 2016 American Cleft Palate - Craniofacial Association. Objective: The aim of this study was to explore how 10-year-olds describe speech and communicative participation in children born with unilateral cleft lip and palate in their own words, whether they perceive signs of velopharyngeal insufficiency (VPI) and articulation errors of different degrees, and if so, which terminology they use. Methods/Participants: Nineteen 10-year-olds participated in three focus group interviews where they listened to 10 to 12 speech samples with different types of cleft speech characteristics assessed by speech and language pathologists (SLPs) and described what they heard. The interviews were transcribed and analyzed with qualitative content analysis. Results: The analysis resulted in three interlinked categories encompassing different aspects of speech, personality, and social implications: descriptions of speech, thoughts on causes and consequences, and emotional reactions and associations. Each category contains four subcategories exemplified with quotes from the children's statements. More pronounced signs of VPI were perceived but referred to in terms relevant to 10-year-olds. Articulatory difficulties, even minor ones, were noted. Peers reflected on the risk to teasing and bullying and on how children with impaired speech might experience their situation. The SLPs and peers did not agree on minor signs of VPI, but they were unanimous in their analysis of clinically normal and more severely impaired speech. Conclusions: Articulatory impairments may be more important to treat than minor signs of VPI based on what peers say.
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| 14. |
- Paciello Yamashita, Renata, et al.
(författare)
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Reliability of Hypernasality Rating : Comparison of 3 Different Methods for Perceptual Assessment
- 2018
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Ingår i: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 55:8, s. 1060-1071
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare reliability in auditory-perceptual assessment of hypernasality for 3 different methods and to explore the influence of language background.Design: Comparative methodological study. Participants and Materials: Audio recordings of 5-year-old Swedish-speaking children with repaired cleft lip and palate consisting of 73 stimuli of 9 nonnasal single-word strings in 3 different randomized orders. Four experienced speech-language pathologists (2 native speakers of Brazilian-Portuguese and 2 native speakers of Swedish) participated as listeners. After individual training, each listener performed the hypernasality rating task. Each order of stimuli was analyzed individually using the 2-step, VISOR and Borg centiMax scale methods.Main Outcome Measures: Comparison of intra- and inter-rater reliability, and consistency for each method within language of the listener and between listener languages (Swedish and Brazilian-Portuguese).Results: Good to excellent intra-rater reliability was found within each listener for all methods, 2-step:kappa = 0.59-0.93; VISOR: intraclass correlation coefficient (ICC) = 0.80-0.99; Borg centiMax (cM) scale: ICC = 0.80-1.00. The highest inter-rater reliability was demonstrated for VISOR (ICC = 0.60-0.90) and Borg cM-scale (ICC = 0.40-0.80). High consistency within each method was found with the highest for the Borg cM scale (ICC = 0.89-0.91). There was a significant difference in the ratings between the Swedish and the Brazilian listeners for all methods.Conclusions: The category-ratio scale Borg cM was considered most reliable in the assessment of hypernasality. Language background of Brazilian-Portuguese listeners influenced the perceptual ratings of hypernasality in Swedish speech samples, despite their experience in perceptual assessment of cleft palate speech disorders.
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| 15. |
- Parikakis, K, et al.
(författare)
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Facial Growth at 5 and 10 Years After Veau-Wardill-Kilner Versus Minimal-Incision Technique Repair of Isolated Cleft Palate
- 2018
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Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1545-1569. ; 55:1, s. 79-87
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Tidskriftsartikel (refereegranskat)abstract
- To compare the Veau-Wardill-Kilner technique with the Minimal-Incision technique repair of isolated clefts of the hard and soft palate regarding facial growth at 5 and 10 years of age. Design: Retrospective study of lateral cephalograms. Setting: Hospital and university based. Patients: A consecutive series of 145 Caucasian nonsyndromic children born with isolated cleft palate between 1980 and 1996 were studied. Children with Pierre Robin sequence (PRS) were included in the study. The patients were divided into 4 groups: 2 groups regarding surgical technique and 2 groups regarding cleft length. Intervention: Veau-Wardill-Kilner or Minimal-Incision palatoplasty. Main Outcome Measures: Eleven skeletal and 1 soft tissue measurement were evaluated from lateral cephalograms taken at 5 and 10 years of age. Results: Only minor differences in cephalometric morphology were found between the Veau-Wardill-Kilner technique group and the Minimal-Incision technique group. Similar results were found independent of cleft length or the inclusion of PRS in the sample. Conclusion: The craniofacial cephalometric morphology at 5 and 10 years of age in patients with isolated cleft palate is similar between the Veau-Wardill-Kilner and the Minimal-Incision technique group.
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| 16. |
- Persson, Martin, et al.
(författare)
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Female and male differences in academic achievement in individuals with cleft : A population-based register study
- 2018
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Ingår i: Cleft Palate - Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 55:2, s. 196-203
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The focus of this study was to determine if there is any significant difference in academic achievement for girls and boys with a cleft compared to the general population of Swedish students at graduation from compulsory school. Design: A retrospective population-based study using data obtained from the Swedish Medical Birth Register that was linked to the Swedish School–Grade Register. Participants: Two hundred seventy girls and 241 boys with cleft palate (CP), 222 girls and 429 boys with cleft lip (CL), and 299 girls and 531 boys with cleft lip and palate (CLP) were compared with the compulsory school population comprising 609,397 girls and 640,007 boys. Main Outcome Measures: (1) Odds of receiving the lowest grade and reduced odds in receiving high grades in Mathematics, English, and Swedish. (2) grade point average (GPA). Results: In all 3 subject grades, for boys with cleft there was no difference when compared to the male population. Girls with cleft were similar to their peers with a few exceptions. Girls with CLP had lower Math grades, and girls with CP had lower Math, English, and Swedish grades. Girls with CP and CLP achieved a significantly lower GPA in comparison to the female population and boys with CP and CL achieved lower GPAs in comparison to the male population. Conclusions: This study indicates that educational outcomes for girls with cleft are more negatively affected than for boys with cleft.
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| 17. |
- Peterson, P, et al.
(författare)
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Mean GOSLON Yardstick Scores After 3 Different Treatment Protocols-A Long-term Study of Patients With Unilateral Cleft Lip and Palate
- 2019
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Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1545-1569. ; 56:2, s. 236-247
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Tidskriftsartikel (refereegranskat)abstract
- (1) To evaluate dental arch relationships, with the Great Ormond Street, London and Oslo (GOSLON) Yardstick, of participants with Unilateral cleft lip and palate (UCLP) and treated with 1-stage palatal closure with 3 different surgical protocols (2) to compare the mean GOSLON ratings with other CLP centers. Design: Retrospective study of medical charts and dental models. Setting: Karolinska University Hospital, Stockholm, Sweden. Participants: Eighty-seven patients with UCLP operated with 1-stage palatal repair. Thirty-five were operated with Veau-Wardill-Kilner (VWK) technique 1975 to 1986, 31 with minimal incision technique (MIT) from 1987 to 1997, and 21 according to MIT with muscle reconstruction (MITmr) 1998 to 2004. Interventions: Dental casts at ages 5 (n = 87), 7 to 8 (n = 27), 10 (n = 81), 16 (n = 61), and 19 (n = 35) years were rated by 10 assessors with the GOSLON Yardstick. Information of other interventions was retrieved from patients’ charts. Main outcome measures: Mean GOSLON ratings. Results: A total of 82% of the participants were rated as having excellent to satisfactory outcome. Weighted κ statistics for the 10 assessors was good for inter-rater agreement and good/very good for intra-rater agreement. Conclusions: The mean GOSLON score in the Stockholm overall material at age 10 was 2.67. The VWK technique resulted in a greater need of orthognathic surgery than the MIT ( P < .01). The MITmr did not produce better dental arch relationships than MIT at age 5 ( P < .05). The best dental arch relationships were found in the MIT group at 10 years, mean 2.58, which is not significantly different from other centers with excellent outcome except Gothenburg and Vienna.
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| 18. |
- Schönmeyr, Björn, et al.
(författare)
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Surgical complications in 1408 primary cleft palate repairs operated at a single center in Guwahati, Assam, India
- 2016
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Ingår i: The Cleft Palate - Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 53:3, s. 278-282
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyze surgical complications after primary cleft palate repair in a setting with limited resources. Patients and Design: A total of 1608 consecutive cleft palate repairs with 1408 follow-ups, operated upon between 2011 and 2013, were reviewed retrospectively through medical records. Patients were 10 months to 50 years old at the time of surgery, with a median age of 9 years. Setting: Guwahati Comprehensive Cleft Care Center, Guwahati, India. Intervention: Primary cleft palate repair. Main Outcome Measures: Postoperative complications in terms of necrosis, dehiscence, fistula, infection, and "hanging palate" were assessed, as was perioperative bleeding. Logistic regression was used with complication (yes/no) as the binary dependent variable and with age, cleft type, and surgeon (visiting/long-term) as covariates. Results: The overall incidence of postoperative complications was 16.9% with a fistula rate of 13.6%. The incidence of perioperative bleeding was 1.8%. Logistic regression analysis identified cleft severity (P ≤.001) and visiting surgeon (P ≤.01) as factors related to the incidence of postoperative complications. Age at surgery was related to both the incidence of postoperative complications (P ≤.001) and perioperative bleeding (P ≤.05). Conclusion: Due to increased risks of surgical complications, older patients with complete clefts should only be operated upon after careful consideration. In addition, these patients should be assigned to surgeons experienced with this cleft type.
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| 19. |
- Sundell, A. L., et al.
(författare)
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Salivary Cortisol Rhythms in Children With Cleft Lip and/or Palate: A Case-Control Study
- 2018
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Ingår i: Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1545-1569 .- 1055-6656. ; 55:8, s. 1072-1080
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Knowledge about the stress response in children with cleft lip and/or palate (CUP) is sparse and the association between the stress response and health-related quality of life (HRQoL) is unknown. Consequently, investigations on the influence of CUP on the stress response alone and its association with HRQoL are of importance. The purpose was to determine whether salivary cortisol concentration in children with CL/P differs from that in children without clefts (controls) and whether there are any differences in salivary cortisol concentrations between ages, gender, and type of cleft. Furthermore, the final aim was to determine the correlation between salivary cortisol concentration and HRQoL. Participants: Ninety-one 5- and 10-year-old children with CUP and 180 age-matched controls. Main Outcome Measures: Salivary samples were collected on 2 mornings and 1 evening for each child. Samples were analyzed using a commercial competitive radioimmunoassay and HRQoL was assessed using the KIDSCREEN-52. Results: Salivary cortisol concentrations were similar in children with CL/P and controls. There was no difference in salivary cortisol concentrations between children with different types of cleft. There was no correlation between cortisol concentration and HRQoL. Conclusion: Five- and 10-year-old children with corrected CUP seemed not to be more stressed than controls, and there were no correlation to HRQoL. The HRQoL levels - were comparable to that of a European norm population.
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| 20. |
- Willadsen, Elisabeth, et al.
(författare)
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Scandcleft Project, Trial 1: Comparison of Speech Outcome in Relation to Timing of Hard Palate Closure in 5-Year-Olds With UCLP.
- 2019
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Ingår i: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association. - : SAGE Publications. - 1545-1569. ; 56:10, s. 1276-1286
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Tidskriftsartikel (refereegranskat)abstract
- To compare in-depth speech results in Scandcleft Trial 1 as well as reference data from peers without cleft palate (CP).A prospective randomized clinical trial.A Danish and a Swedish CP center.143 of 148 randomized 5-year-olds with unilateral cleft lip and palate. All received lip and velum closure at 4 months, and hard palate closure at 12 months (arm A) or 36 months (arm B).A composite measure based on velopharyngeal competence (VPC) or velopharyngeal incompetence (VPI), an overall assessment of VPC from connected speech (VPC-Rate), Percentage of Consonants Correct (PCC-score), and consonant errors. Speech therapy visits, average hearing thresholds, and secondary pharyngeal surgeries documented burden of treatment.Across the trial, 61.5% demonstrated VPC and 38.5% VPI. Twenty-two percent of participants achieved age appropriate PCC-scores. There were no statistically significant differences between arms or centers for these measures. In the Danish center, arm B: achieved lower PCC-scores (P = .01); obtained PCC-scores without s-errors below 79% (P = .002); produced ≥3 active oral cleft speech characteristics (P = .004) than arm A. In both centers, arm B attended more speech visits.At age 5, differences between centers and treatment arms were not statistically significant for VPC/VPI, but consonant proficiency differed between treatment arms in the Danish center. Poor speech outcomes were seen for both treatment arms. Variations between centers were observed. As the Swedish center had few participants, intercenter comparisons should be interpreted with caution.
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| 21. |
- Nicholls, W., et al.
(författare)
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Adult narratives of the psychosocial impact of cleft in a Western Australian cohort
- 2019
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Ingår i: Cleft Palate Craniofac J. - 1545-1569 (Electronic) 1055-6656 (Linking) ; 56:3, s. 373-382
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Living with a cleft condition involves many years of multidisciplinary therapy, treatment, and surgical intervention. This complex process may have both physical and psychosocial long-term impacts. There is limited evidence of the psychosocial impact of cleft on individuals in Australia. AIM: To obtain an understanding of the adult patient perception of having a cleft and explore the impact of the condition on their lives. DESIGN: Qualitative methodologies at one case study site in Western Australia. Population of Interest: Adults with a cleft lip and/or palate (CL/P) who had received treatment at Princess Margaret Hospital, the only treatment center for cleft in Western Australia. METHODOLOGY: Individual in-depth semi-structured qualitative interviews were conducted and recorded and transcribed for analysis. RESULTS: Fifteen adults with a CL/P. Two main themes were identified: lived experience (with 3 subthemes: normality, support networks, and impacts in later life) and advice to others. The majority of participants reported social rejection and isolation, which occurred mostly at school and in some instances at home, but did not often last into adulthood. The greatest protective factor was the support of family and friends, which if missing during their childhood, was desired and appreciated in adulthood. CONCLUSION: Adults with CL/P may require psychosocial support from their cleft team including referral to clinicians in adult services. There is also the need for earlier psychological interventions and social programs to support those with appearance-related social difficulties.
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| 22. |
- Nicholls, W., et al.
(författare)
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Body esteem in a Western Australian cleft lip and/or palate cohort across 3 age groups
- 2018
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Ingår i: Cleft Palate Craniofac J. - 1545-1569 (Electronic) 1055-6656 (Linking) ; 55:4, s. 487-498
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To determine if patients with cleft lip and/or palate (CL/P) from a Western Australian (WA) cohort were more dissatisfied with their body esteem than a normative non-cleft cohort, and identify demographic variables that may have significant associations with body esteem. DESIGN: Questionnaire study using the Body-Esteem Scale (BES) and Cleft Research Questionnaire (CRQ). PARTICIPANTS: Self-selected participants from a Western Australian CL/P population across 3 age groups (n=359). MAIN OUTCOME MEASURES: The BES is comprised of 3 factors: BE-Appearance, BE-Weight and BE-Attribution. Study mean BES factor scores were compared to normative non-cleft scores. Regression analysis was used to determine significant associations within each age group between BES factor scores and CRQ variables of: gender, self-reported body weight category, cleft type and importance of facial appearance rating. RESULTS: Study mean BE-Attribution scores were significantly lower than the normative scores and significantly lower than the mean BE-Appearance and BE-Weight factor scores within the same age groups of this study. Having a cleft type of lip and palate, being overweight, and placing a high importance on facial appearance had significant negative associations with BES scores. Maintaining a normal body weight and placing a lower level of importance on facial appearance had significant positive associations. Gender had no significant associations. CONCLUSION: In this study, the attribution aspect of body esteem had a greater negative impact on patients than their appearance and body weight. This has important implications for clinical treatment and support of patients.
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| 23. |
- Norman, A., et al.
(författare)
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The effectiveness of psychosocial intervention for individuals with cleft lip and/or palate
- 2015
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Ingår i: Cleft Palate Craniofac J. - 1545-1569 (Electronic) 1055-6656 (Linking) ; 52:3, s. 301-10
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this review was to assess the effectiveness of different psychological interventions for children and adults with cleft lip and/or palate and their parents. DESIGN: We searched six databases including MEDLINE and EMBASE to June 2013 and checked bibliographies. We included research that evaluated any psychological intervention in studies in which at least 90% of the participants had cleft lip and/or palate or were parents of those with cleft lip and/or palate. Studies containing less than 90% were excluded unless they reported results separately for those with cleft lip and/or palate, or raw data were available upon request from the authors. Inclusion assessment, data extraction, and risk of bias assessment were carried out independently by two reviewers. RESULTS: Seven studies were identified as inclusions, with only two studies being included in the full data analysis (one of which failed to meet the full inclusion criteria). The five remaining studies were included only in a narrative synthesis because data were available for people or parents of those with cleft lip and/or palate only. This highlights a distinct dearth of research into psychological intervention within the field of cleft lip and/or palate. CONCLUSIONS: The review found no evidence to support any specific intervention. Key uncertainties need to be identified and addressed. Adequately powered, methodologically rigorous randomized controlled trials are needed to provide a secure evidence base for psychological intervention techniques in participants with cleft lip and/or palate and their parents.
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| 24. |
- Persson, Martin, 1971-, et al.
(författare)
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Female and male differences in academic achievement in individuals with cleft : a population-based register study
- 2018
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Ingår i: Cleft Palate Craniofac J. - 1545-1569 (Electronic) 1055-6656 (Linking) ; 55:2, s. 196-203
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The focus of this study was to determine if there is any significant difference in academic achievement for girls and boys with a cleft compared to the general population of Swedish students at graduation from compulsory school. DESIGN: A retrospective population-based study using data obtained from the Swedish Medical Birth Register that was linked to the Swedish School-Grade Register. PARTICIPANTS: Two hundred seventy girls and 241 boys with cleft palate (CP), 222 girls and 429 boys with cleft lip (CL), and 299 girls and 531 boys with cleft lip and palate (CLP) were compared with the compulsory school population comprising 609,397 girls and 640,007 boys. MAIN OUTCOME MEASURES: (1) Odds of receiving the lowest grade and reduced odds in receiving high grades in Mathematics, English, and Swedish. (2) grade point average (GPA). RESULTS: In all 3 subject grades, for boys with cleft there was no difference when compared to the male population. Girls with cleft were similar to their peers with a few exceptions. Girls with CLP had lower Math grades, and girls with CP had lower Math, English, and Swedish grades. Girls with CP and CLP achieved a significantly lower GPA in comparison to the female population and boys with CP and CL achieved lower GPAs in comparison to the male population. CONCLUSIONS: This study indicates that educational outcomes for girls with cleft are more negatively affected than for boys with cleft.
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| 25. |
- Scott, J. K., et al.
(författare)
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Perceptions of team members working in cleft services in the United Kingdom : a pilot study
- 2015
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Ingår i: Cleft Palate Craniofac J. - 1545-1569 (Electronic) 1055-6656 (Linking) ; 52:1, s. e1-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cleft care provision in the United Kingdom has been centralized over the past 15 years to improve outcomes for children born with cleft lip and palate. However, to date, there have been no investigations to examine how well these multidisciplinary teams are performing. METHODS: In this pilot study, a cross-sectional questionnaire surveyed members of all health care specialties working to provide cleft care in 11 services across the United Kingdom. Team members were asked to complete the Team Work Assessment (TWA) to investigate perceptions of team working in cleft services. The TWA comprises 55 items measuring seven constructs: team foundation, function, performance and skills, team climate and atmosphere, team leadership, and team identity; individual constructs were also aggregated to provide an overall TWA score. Items were measured using five-point Likert-type scales and were converted into percentage agreement for analysis. RESULTS: Responses were received from members of every cleft team. Ninety-nine of 138 cleft team questionnaires (71.7%) were returned and analyzed. The median (interquartile range) percentage of maximum possible score across teams was 75.5% (70.8, 88.2) for the sum of all items. Team performance and team identity were viewed most positively, with 82.0% (75.0, 88.2) and 88.4% (82.2, 91.4), respectively. Team foundation and leadership were viewed least positively with 79.0% (72.6, 84.6) and 76.6% (70.6, 85.4), respectively. CONCLUSIONS: Cleft team members perceive that their teams work well, but there are variations in response according to construct.
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| 26. |
- Stock, N. M., et al.
(författare)
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Opportunities and challenges in establishing a cohort study : an example from cleft lip/palate research in the United Kingdom
- 2016
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Ingår i: Cleft Palate Craniofac J. - 1545-1569 (Electronic) 1055-6656 (Linking) ; 53:3, s. 317-25
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cleft lip and/or palate (CL/P) is one of the most common birth conditions in the world, but little is known about its causes. Professional opinion remains divided as to which treatments may be the most beneficial for patients with CL/P, and the factors that contribute to psychological adjustment are poorly understood. The use of different methodological approaches and tools plays a key role in hampering efforts to address discrepancies within the evidence base. A new UK-wide program of research, The Cleft Collective, was established to combat many of these methodological challenges and to address some of the key research questions important to all CL/P stakeholders. OBJECTIVE: To describe the establishment of CL/P cohort studies in the United Kingdom and to consider the many opportunities this resource will generate. RESULTS: To date, protocols have been developed and implemented within most UK cleft teams. Biological samples, environmental information, and data pertaining to parental psychological well-being and child development are being collected successfully. Recruitment is currently on track to meet the ambitious target of approximately 9800 individuals from just more than 3000 families. CONCLUSIONS: The Cleft Collective cohort studies represent a significant step forward for research in the field of CL/P. The data collected will form a comprehensive resource of information about individuals with CL/P and their families. This resource will provide the basis for many future projects and collaborations, both in the United Kingdom and around the world.
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