Functional results of patients with cleft palate between 1993 and 2006 in Moravia I – Epidemiology and surgical results
Authors:
Z. Dvořák 1,2; T. Mrázek 2; J. Vokurková 3,4; T. Výška 2; J. Veselý 1,2
Authors‘ workplace:
Lékařská fakulta Masarykovy Univerzity, Brno
1; Klinika plastické a estetické chirurgie FN U sv. Anny, Brno
2; Oddělení dětské plastické chirurgie KDCHOT, FN Brno
3; Klinika popálenin a plastické chirurgie, FN Brno
4
Published in:
Čes-slov Pediat 2019; 74 (6): 315-327.
Category:
Original Papers
Overview
Objective: To evaluate the results of palatal reconstruction in children with cleft palate based on the therapeutic results of the multidisciplinary team of the Cleft center at the Department of Plastic and Aesthetic Surgery of St. Anna’s Faculty Hospital in Brno (KPECH) focusing on epidemiological data and results of surgical control.
Methods: The basic set consisted of 919 cleft patients operated from January 1, 1993 to December 31, 2006 at KPECH, 20 children had an atypical cleft, 899 children had a typical cleft. An epidemiological analysis of the set has been carried out. The 688 children of the set were operated with a cleft palate. Timing, type of surgery, surgical and postoperative complications were monitored. The function of the velopharyngeal closure was evaluated in 561 of these patients.
Results: Female gender for cleft palate (55.7%) and male gender in other cleft types (67.4–69.5%) as well as the predisposition of left-sided clefts have been confirmed. The palatal reconstruction was performed most often between 10–15 months of life (median 13 months). From surgical methods, the Furlow’s method was used in 288 children, two-flap palatoplasty with intravelar veloplasty (IVV) in 268 children and without IVV in 133 patients. Early complications occurred in ¼ of patients (most commonly serious rhinitis and postoperative febrile), palatal perforations were observed in 6.7% of patients. The 16.2% of patients were reoperated for velofaryngeal dysfunction.
Conclusion: From the epidemiological point of view, the patient population has all characteristics of the Central European population of cleft patients. Based on the results of surgical examinations, Furlow’s method had the best results in patients with the isolated cleft palate, and two-flap palatoplasty with IVV had the best results in patients with the cleft lip and palate.
Keywords:
cleft lip – cleft palate – orofacial cleft – velofaryngeal insufficiency – reconstructive surgery
Sources
1. Vokurková J, Elstnerová L, Lukášová O, Hufová I. The development of neonatal care and evaluation of the first five years experience in surgery of cleft lip in the neonatal period. Čes-sov Pediat 2011; 66 (6): 356–362.
2. Borský J, Tvrdek M, Kozák J, et al. Our first experience with primary lip repair in newborns with cleft lip and palate. Acta Chir Plast 2007; 49 (4): 83–87.
3. Dvořák Z, Veselý J, Konvičková E, et al. Standardy multidisciplinární péče o dítě s rozštěpem obličeje. Čes-slov Pediat 2009; 64 (5): 236–241.
4. Denk MJ, Magee WP. Cleft palate closure in the neonate: preliminary report. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 1996; 33 (1): 57–61; discussion 62–66.
5. Riski JE, DeLong E. Articulation development in children with cleft lip/palate. Cleft Palate J 1984; 21 (2): 57–64.
6. Dorf DS, Curtin JW. Early cleft palate repair and speech outcome. Plast Reconstr Surg 1982; 70 (1): 74–81.
7. Chapman KL, Hardin MA. Phonetic and phonologic skills of two-year-olds with cleft palate. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 1992; 29 (5): 435–443.
8. Heidbüchel KL, Kuijpers-Jagtman AM, Freihofer HP. Facial growth in patients with bilateral cleft lip and palate: a cephalometric study. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 1994; 31 (3): 210–216.
9. Kramer GJ, Hoeksma JB, Prahl-Andersen B. Prediction of early palatal growth and development in children with cleft lip and palate. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 1996; 33 (2): 112–117.
10. Semb G. A study of facial growth in patients with bilateral cleft lip and palate treated by the Oslo CLP Team. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 1991; 28 (1): 22–39; discussion 46-48.
11. Kotova M, Urbanova W, Sukop A, et al. Dentoalveolar arch dimensions in UCLP boys after neonatal cheiloplasty or after lip surgery at the age of 3 or 6 months. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 29th January 2019; doi: 10.1177/1055665618824835
12. Motohashi N, Kuroda T, Capelozza Filho L, Freitas JA. P-A cephalometric analysis of nonoperated adult cleft lip and palate. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc1994; 31 (3): 193–200.
13. Ross RB. Facial growth in cleft lip and palate. In: McCarthy JG (ed). Plastic Surgery. 4th ed. Philadelphia: W. B. Saunders Company, 1990: 2553–2558.
14. Bardach J. Salyer & Bardach’s Atlas of Craniofacial & Cleft Surgery (Vol. 2). 1st ed. Philadelphia, New York: Lippincott Williams & Wilkins, 1999: 1–854.
15. Raol N, Hartnick CJ. Furlow double-opposing z-plasty. Adv Otorhinolaryngol 2015; 76: 67–73.
16. Gart MS, Gosain AK. Surgical management of velopharyngeal insufficiency. Clin Plast Surg 2014; 41 (2): 253–270.
17. Loney RW, Bloem TJ. Velopharyngeal dysfunction: recommendations for use of nomenclature. Cleft Palate J 1987; 24 (4): 334–335.
18. Trost-Cardamone JE. Coming to terms with VPI: a response to Loney and Bloem. Cleft Palate J 1989; 26 (1): 68–70.
19. Gosain AK, Chim H, Sweeney WM. Double-opposing Z-plasty for secondary surgical management of velopharyngeal insufficiency following primary Furlow palatoplasty. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 2018; 55 (5): 706–710.
20. Sloan GM, Zajac DJ. Velofaryngeal dysfunction. In: Mathes SJ (ed). Pediatric Plastic Surgery. 2nd ed. Philadelphia, Pa: Saunders Elsevier, 2006: 311–337.
21. Zdravotnická ročenka České republiky – ÚZIS ČR, 24. červen 2018. Dostupné z: http://www.uzis.cz/katalog/rocenky/zdravotnicka-rocenka-ceske-republiky.
22. Lukáš J, Diblík P, Voska P. Poranění obličeje: z pohledu otorinolaryngologa, oftalmologa a maxilofaciálního chirurga. Praha: Grada Publishing, 2001.
23. Fiala M, Košková O, Vokurková J, Bartošková J. Cleft lip and palate – principles of primary care and aftercare. Pediatr Praxi 2017; 18 (5): 297–299.
24. Tolarová MM, Cervenka J. Classification and birth prevalence of orofacial clefts. Am J Med Genet 1998; 75 (2): 126–137.
25. International Centre for Birth Defects, EUROCAT, World Health Organization, Human Genetics Programme. World Atlas of Birth Defects. Switzerland, Geneva: Human Genetics Programme, Management of Noncommunicable Diseases, World Health Organization, 2003.
26. Klásková O. Incidence of cleft lip and palate in Bohemia. Rozhl Chir 1974 Mar; 53 (3): 147–50.
27. Peterka M, Peterkova R, Likovsky Z, et al. Incidence of orofacial clefts in Bohemia (Czech Republic) in 1964–1992. Acta Chir Plast 1995; 37 (4): 122–126.
28. Peterka M, Peterková R, Tvrdek M, et al. Significant differences in the incidence of orofacial clefts in fifty-two Czech districts between 1983 and 1997. Acta Chir Plast 2000; 42 (4): 124–129.
29. Šípek A, Gregor V, Horáček J. Birth defects in the Czech Republic in the period 1961–2005 – Mean incidences. Ceska Gynekol 2007; 72 (3): 185–191.
30. Milan M, Astolfi G, Volpato S, et al. 766 cases of oral cleft in Italy. Data from Emilia Romagna (IMER) and Northeast Italy (NEI) registers. Eur J Epidemiol 1994; 10 (3): 317–324.
31. Cornel MC, Spreen JA, Meijer I, et al. Some epidemiological data on oral clefts in the northern Netherlands, 1981–1988. J Cranio-Maxillo-fac Surg Off Publ Eur Assoc Cranio-Maxillo-fac Surg1992; 20 (4): 147–152.
32. Hagberg C, Larson O, Milerad J. Incidence of cleft lip and palate and risks of additional malformations. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 1998; 35 (1): 40–45.
33. Stoll C, Alembik Y, Dott B, Roth MP. Associated malformations in cases with oral clefts. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 2000; 37 (1): 41–47.
34. Jensen BL, Kreiborg S, Dahl E, Fogh-Andersen P. Cleft lip and palate in Denmark, 1976–1981: epidemiology, variability, and early somatic development. Cleft Palate J 1988; 25 (3): 258–269.
35. Kozelj V. Epidemiology of orofacial clefts in Slovenia, 1973–1993: comparison of the incidence in six European countries. J Cranio-Maxillo-fac Surg Off Publ Eur Assoc Cranio-Maxillo-fac Surg 1996; 24 (6): 378–382.
36. Cooper ME, Stone RA, Liu Y, et al. Descriptive epidemiology of nonsyndromic cleft lip with or without cleft palate in Shanghai, China, from 1980 to 1989. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 2000; 37 (3): 274–280.
37. Rajabian MH, Sherkat M. An epidemiologic study of oral clefts in Iran: analysis of 1,669 cases. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 2000; 37 (2): 191–196.
38. Christensen K, Fogh-Andersen P. Etiological subgroups in non-syndromic isolated cleft palate. A genetic-epidemiological study of 52 Danish birth cohorts. Clin Genet 1994; 46 (5): 329–335.
39. Natsume N, Kawai T, Kohama G, et al. Incidence of cleft lip or palate in 303738 Japanese babies born between 1994 and 1995. Br J Oral Maxillofac Surg 2000; 38 (6): 605–607.
40. Jones MC. Facial clefting. Etiology and developmental pathogenesis. Clin Plast Surg 1993; 20 (4): 599–606.
41. Rohrich RJ, Byrd HS. Optimal timing of cleft palate closure. Speech, facial growth, and hearing considerations. Clin Plast Surg 1990; 17 (1): 27–36.
42. Kokavec R. Chirurgická liečba rázštěpov pery a podnebí. Habilitačná práca. Bratislava: LF Univerzity Komenského, 2004: 1–84.
43. Spauwen PH, Goorhuis-Brouwer SM, Schutte HK. Cleft palate repair: Furlow versus von Langenbeck. J Cranio-Maxillo-fac Surg Off Publ Eur Assoc Cranio-Maxillo-fac Surg 1992; 20 (1): 18–20.
44. Gunther E, Wisser JR, Cohen MA, Brown AS. Palatoplasty: Furlow’s double reversing Z-plasty versus intravelar veloplasty. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 1998; 35 (6): 546–549.
45. Vokurková J. Rozštěpové vady obličeje. Disertační práce. Brno: LF Masarykovy univerzity, 2000: 1–75.
46. Pantaloni M, Hollier R. Cleft palate and velopharyneal incompetence. Sel Read Plast Surg 2001; 9 (23): 1–39.
47. Cohen SR, Kalinowski J, LaRossa D, Randall P. Cleft palate fistulas: a multivariate statistical analysis of prevalence, etiology, and surgical management. Plast Reconstr Surg 1991; 87 (6): 1041–1047.
48. Košková O, Vokurková J, Baslík V, Horník P. Skryté vady patra jako příčina velofaryngeální insuficience. Pediatr Praxi 2016; 17 (5): 296–298.
49. Roberts TM, Brown BS. Evaluation of a modified sphincter pharyngoplasty in the treatment of speech problems due to palatal insufficiency. Ann Plast Surg 1983; 10 (3): 209–213.
50. Moss AL, Pigott RW, Albery EH. Hynes pharyngoplasty revisited. Plast Reconstr Surg 1987; 79 (3): 346–355.
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Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
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