Parental Perceptions Following Cleft Lip Repair in Their Children.

OBJECTIVE: Cleft lip (CL) repair at 3 months is chosen mostly out of convention and offers minimal functional benefit. Potentially, a better cosmetic outcome is possible by delaying repair. This study examines parental perceptions around repair at 3 months to determine if current guidelines are appropriate. DESIGN: Retrospective cross-sectional survey. SETTING: Tertiary-care institution. PARTICIPANTS: Parents of children with CL ±â€ŠP under age 6 years who underwent CL repair from 2004 to 2011 at our center were surveyed (n = 64). Response rate was 61% (n = 37). METHODS: Open-ended survey asked about various aspects of parental perceptions before and after repair. Qualitative data analysis is used to interpret survey responses. STATISTICS: Fisher exact test using contingency tables to identify statistically significant results. RESULTS: Nearly all (36/37) parents felt repair was important, citing reasons such as feeding, speech, and appearance. Most (28/37) felt surgery would fix the problem. A portion of parents (15/37) would delay repair if better aesthetics were possible later, but most would not (20/37). Most parents were satisfied with repair quality (33/37). On average, repair did not impact parent-child bonding, and eliminated negative interactions with strangers that parents found distressing. CONCLUSIONS: Arguably, positive parental perceptions of their child's condition reflect favorably on the child's well-being, and may outweigh any future aesthetic benefit. Therefore, current recommendations should be upheld. However, given that some parents would consider delaying repair, they could be offered this option. Future efforts should examine cultural factors, and aesthetic and developmental outcomes of repair at different ages to determine optimal repair timing.

Stapedial synkinesis causing change in hearing threshold with facial motion.

OBJECTIVE: Synkinetic facial movement after facial nerve regeneration is a well-documented phenomenon. Rarely, patients recovering from facial nerve injury report feelings of auditory ringing, fullness, and a sensation of ear tightness as a result of stapedial muscle involvement. It is exceedingly rare for such synkinesis to produce perceivable changes in hearing threshold. We report a unique case of stapedial synkinesis causing pure-tone changes in hearing threshold with activation of the facial musculature. PATIENT: A single patient is presented who developed stapedial synkinesis after suboccipital resection of a unilateral acoustic neuroma. RESULTS: Despite facial nerve sparing, surgery resulted in House-Brackmann grade V/VI right facial nerve paralysis that improved to Grade III/VI after 7 months. Synkinesis developed that caused eye closure with puckering of the lips. Puckering of the lips likewise caused decreased hearing in the right ear, corresponding to a measured decrease of 10 dB in the PTA. Over the next several months, facial motion continued to improve, and hearing changes became less bothersome, so no intervention was undertaken. CONCLUSION: The changes presented in the hearing threshold fit within the classically described 15-dB attenuation provided by the stapedial reflex. Although no intervention was undertaken in this particular case, some patients with unremitting stapedial synkinesis might benefit from sectioning of the stapedial muscle. Thus, consideration should be made for audiometric evaluation with and without facial muscle contraction in the evaluation of individuals with synkinetic facial movement.