Reducing delayed detection of isolated cleft palate-related deformity: a call for routine intraoral examination of newborns

Abstract Objective: To provide healthcare professional-friendly practical recommendations for early detection of cleft palate-related deformities in newborns and offer an overview of managing these high-prevalent congenital abnormalities. Source of data: PubMed, SciELO, Lilacs, Cochrane, ScienceDirect, and Scopus databases were reviewed for cleft- and diagnosis-related studies. Summary of the findings: Unfortunately, the global prevalence of delayed detection of cleft palate-related deformities remains unacceptably high, with over a quarter of cleft palates missed at birth. This delayed identification causes physical and psychological distress for patients and families, including feeding challenges and weight faltering. To improve cleft management, it is essential to adopt routine detailed, in-depth intraoral examination immediately after birth. It is recommended not only to finger-assisted palpate the intraoral structures but also to visually inspect the oral cavity from gingiva to uvula using a wooden tongue depressor and light-assisted examination. With timely diagnosis and referral to specialized care, pediatricians, nurses, speech therapists, and plastic surgeons provide life-changing treatments, including health care maintenance, anticipatory guidance, feeding support, primary surgical reconstruction, and age-and condition-specific protocols. Conclusions: Encouraging neonatologists and pediatricians, who are the first to examine new-borns, to actively investigate the intraoral region for cleft palate-related deformities is instrumental in optimizing therapeutic approaches and prioritizing age-phases in treatment. Their crucial role in early detection and referral can lead to transformative outcomes, impacting not only the future of the newborns by facilitating functional integration into society but also yielding positive effects on families and the health system.

Reducing delayed detection of isolated cleft palate-related deformity: a call for routine intraoral examination of newborns.

OBJECTIVE: To provide healthcare professional-friendly practical recommendations for early detection of cleft palate-related deformities in newborns and offer an overview of managing these high-prevalent congenital abnormalities. SOURCE OF DATA: PubMed, SciELO, Lilacs, Cochrane, ScienceDirect, and Scopus databases were reviewed for cleft- and diagnosis-related studies. SUMMARY OF THE FINDINGS: Unfortunately, the global prevalence of delayed detection of cleft palate-related deformities remains unacceptably high, with over a quarter of cleft palates missed at birth. This delayed identification causes physical and psychological distress for patients and families, including feeding challenges and weight faltering. To improve cleft management, it is essential to adopt routine detailed, in-depth intraoral examination immediately after birth. It is recommended not only to finger-assisted palpate the intraoral structures but also to visually inspect the oral cavity from gingiva to uvula using a wooden tongue depressor and light-assisted examination. With timely diagnosis and referral to specialized care, pediatricians, nurses, speech therapists, and plastic surgeons provide life-changing treatments, including health care maintenance, anticipatory guidance, feeding support, primary surgical reconstruction, and age- and condition-specific protocols. CONCLUSIONS: Encouraging neonatologists and pediatricians, who are the first to examine newborns, to actively investigate the intraoral region for cleft palate-related deformities is instrumental in optimizing therapeutic approaches and prioritizing age-phases in treatment. Their crucial role in early detection and referral can lead to transformative outcomes, impacting not only the future of the newborns by facilitating functional integration into society but also yielding positive effects on families and the health system.

Validating the Modified Small Double Opposing Z-Plasty for Palatal Lengthening in Primary Palatoplasty.

OBJECTIVE: To appraise the degree of intraoperative palatal lengthening with the modified Furlow small double-opposing Z-plasty (sDOZ). DESIGN: Retrospective single-surgeon (R.D.) study. PATIENTS: Nonsyndromic children (n = 167) with Veau types I to IV cleft palates who underwent primary sDOZ palatoplasty. INTERVENTIONS: Intraoperative measurements of palatal lengths and widths were collected using calipers, paper rulers, and metal rulers before the administration of local anesthetic solution and before the removal of the mouth gag (initial and final palatal dimensions, respectively). MAIN OUTCOME MEASURES: Assessment of the intraoperative percentage change (difference between final and initial values) in surface palatal length, straight palatal length, and soft palatal length. Bivariate and multivariate analyses were performed to identify independent predictors (sex, age at surgery, Veau, Kernahan/ Stark, and Randall classifications, widest cleft width, presence of lateral relaxing incision, type of coverage with buccal fat flap, and postoperative complications) of soft palatal lengthening. RESULTS: Surface palatal, straight palatal, and soft palatal lengths had an intraoperative increase of 8%, 14.7%, and 27.7%, respectively. The degree of intraoperative soft palatal lengthening significantly varied among Veau cleft types (I = II < III = IV). Veau type III and cleft lip/palate were independent positive predictors (P < .001) of soft palatal lengthening, while other tested variables were not correlated (P > .05) with this outcome. CONCLUSIONS: Overall intraoperative palatal lengthening occurs with the modified sDOZ palatoplasty, with differences within the spectrum of cleft palate deformity.

Buccal Fat Pad in Primary and Secondary Cleft Palate Repair: A Systematic Review of the Literature.

OBJECTIVE: To review the evidence supporting the use of buccal fat pad (BFP) in primary and secondary cleft palate repair and its short- and long- term clinical outcomes. DESIGN: Systematic review conducted by 2 independent reviewers following PRISMA guidelines. SETTING: NONE PARTICIPANTS: Articles were identified from three databases (Pubmed/Medline, Embase and Web of Science). Search terms included "cleft palate", "palatoplasty", "palate repair", "buccal fat pad". INTERVENTIONS: Use of BFP in primary and secondary cleft palatoplasty. MAIN OUTCOME MEASURES: Primary outcomes were immediate postoperative complications, postoperative fistula, and maxillary growth. Secondary outcomes were palatal length, speech, and donor site morbidity. RESULTS: Ninety-one reports were retrieved after excluding duplicates. Twenty-three studies were included (13 case series and 10 comparative studies). Overall level of evidence was low. Randomized and non-randomized studies had a high risk of bias. In primary palatoplasty, BFP was more frequently used filling lateral relaxing incisions(57.4%), or in the hard-soft palate junction and covering mucosal defects(30.1%). In these patients, post operative fistula incidence was 2.8%. Two studies found wider transverse maxillary dimensions after BFP use. No higher incidence of bleeding, infection, dehiscence, or flap necrosis was reported. In secondary palatoplasty, no recurrent fistulas were reported for patients undergoing BFP for fistula repair. CONCLUSIONS: BFP appears to be associated with a favorable impact in fistula prevention and management, as well as in transverse maxillary growth. However, there is a high heterogeneity among studies, high risk of bias and overall low quality of evidence. More high-quality research with long-term follow-up is warranted.

Thematic Analysis of Coping Strategies Used by Parents of Children with Cleft Lip and Palate in El Salvador.

OBJECTIVE: The aim of this study was to describe coping strategies used by parents of children with cleft palate with or without a cleft (CP ± L) during the early development of their children in El Salvador. DESIGN: Qualitative interviews were completed with 16 parents of children born with CP ± L who were 6 months to 6 years old. Parents were questioned about their emotions and coping during eight time periods: prenatal, birth, social interaction before the first surgery, the beginning of surgeries, social interaction after the first surgery, early childhood education (ECE), speech-language therapy, and formal education. Thematic analysis (TA) was used to identify coping strategies as conceptualized by Lazarus and Folkman (1984). RESULTS: Four major themes emerged: (a) experienced emotions related to diagnosis, (b) interpretations related to the birth of a child with a cleft, (c) seeking and experiencing cleft treatment, and (d) social interaction of the children. During prenatal and birth stages, parents used emotion-focused strategies. A few hours to a week after birth, they used problem-focused strategies, which led them in search of treatment. Some parents used avoidance strategies during periods of social interaction before surgery, ECE, and formal education. Socioeconomic challenges impacted access to speech-language therapy. Sociocultural factors, such as discrimination, religion, and folk beliefs, appeared to influence some of the coping strategies used by parents. CONCLUSIONS: Problem-focused strategies appear to be helpful in seeking surgical treatments. The emotion-focused strategy of avoidance seemed to have adverse effects in minimizing opportunities for social interaction prior to surgery and early education.

Reinforcing the Modified Double-Opposing Z-Plasty Approach Using the Pedicled Buccal Fat Flap as an Interpositional Layer for Cleft Palate Repair.

Pedicled buccal fat flaps have been adopted in primary Furlow double-opposing Z-plasty palatoplasty to reduce oronasal fistula formation or to attenuate maxillary growth disturbance. We combined both goals in a single intervention. This study describes a series of 33 modified Furlow small double-opposing Z-plasty palatoplasties reinforced with a middle layer of pedicled buccal fat flaps between the oral and nasal layers for full coverage of the dissected palatal surfaces, with rapid mucosalization of lateral relaxing incisions and no dehiscence or fistula formation.

Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible?

OBJECTIVE: An inspiring early result with no oronasal fistula formation was recently described for a modified medial incision small double-opposing Z-plasty (MIsDOZ) for treating Veau type I cleft palate. This study describes an early single-surgeon experience in applying this newly proposed surgical approach. DESIGN: Retrospective single-surgeon study. PATIENTS: Consecutive nonsyndromic patients (n = 27) with Veau I cleft palate. INTERVENTIONS: Topographic anatomical-guided MIsDOZ palatoplasty with pyramidal space dissection (releasing of the ligamentous fibers in the greater palatine neurovascular bundle and pyramidal process region, in-fracture of the pterygoid hamulus, and widening of space of Ernst) performed by a novice surgeon (RD). MEAN OUTCOME MEASURES: Age at surgery, the presence of cleft lip, palatal cleft width, use of lateral relaxing incision, and 6-month complication rate (bleeding, dehiscence, fistula, and flap necrosis). A published senior surgeon-based outcome dataset (n = 24) was retrieved for comparison purposes. RESULTS: Twenty-two (81.5%) and 5 (18.5%) patients received the medial incision only technique and lateral incision technique, respectively (P = .002). Age, presence of cleft lip, and cleft width were not associated (all P > .05) with the use of lateral incision. Comparative analysis between the novice surgeon- and senior surgeon-based datasets revealed no significant differences for sex (females: 74.1% vs 62.5%; P = .546), age (10.2 ± 1.7 vs 9.6 ± 1.2 months; P = .143), rate of lateral incision (18.5% vs 4.2%; P = .195), and postoperative complication rate (0% vs 0%). CONCLUSION: This modified DOZ palatoplasty proved to be a reproducible procedure for Veau I cleft palate closure, with reduced need for lateral incision and with no early complication.

Reconstrução de palato com malha de polipropileno e prótese acrílica para correção de fístula oronasal adquirida em cão / Palate reconstruction with polypropylene mesh and acrylic prosthesis in dog for correcton of acquired oronosal fistulae

As fístulas oronosais adquiridas são defeitos que permitem a comunicação anormal entre as cavidades oral e nasal. Inúmeras causas podem ser atribuídas à etiologia de tal defeito. O presente trabalho visa relatar o caso de um cão com fístula oronasal adquirida que foi submetido à reconstrução cirúrgica do palato com o uso de malha de polipropileno e prótese acrílica. Após estabilização do quadro clínico e remoção manual das larvas, o paciente foi encaminhado para o desbridamento cirúrgico das lesões orais e correção do defeito no palato. A palatoplastia foi realizada com o uso da malha e resina de polimetilmetacrilato autopolimerizável. A malha foi suturada sobre o defeito palatino com pontos simples separados e fio náilon 3-0 nas extremidades da ferida. Em seguida, a resina foi preparada e, ao atingir consistência adequada, foi aplicada e modelada sobre o a malha de polipropileno com o auxílio de um descolador de Molt, sendo também suturada nas bordas da fístula com pontos simples separados e fio náilon 3-0. No mesmo tempo cirúrgico foi inserida uma sonda esofágica para alimentação enteral. Devido complicações cirúrgicas no pós operatório, o paciente foi submetido a mais duas intervenções cirúrgicas para desfecho satisfatório do tratamento. Conclui-se que associação entre a tela de polipropileno e a prótese acrílica foi uma alternativa exequível para a palatoplastia em cão.

Acquired oronosal fistulae are abnormal communication between the oral and nasal cavities. A oronasal fistula can be the result of different causes, like oral myiasis. The objetctive of these paper is to report the case of a dog with acquired oronasal fistula that underwent surgical reconstruction of the palate using polypropylene mesh and acrylic prosthesis. After stabilization of the patient ́s clinical condition and mecanic removal of the larvae, the dog was referred for surgical debridement of the oral lesions and correction of the defect in the palate. Palatoplasty was performed using a mesh and polymethylmethacrylate resin. The mesh was sutured over the palatal defect with separate simple suture and 3-0 naylon thread at the ends of the wound. Then, the resin was prepared and, upon reaching adequate consistency, it was applied and shaped over the polypropylene mesh with Molt peeler. It was also sutured on the edges of the fistula with separate simple suture and 3-0 nylon suture. At the same surgical time, an esophageal tube was inserted for enteral feeding. Due to complications, the dog underwent two more surgical interventions for a satisfactory treatment outcome. It is concluded that the association between the polypropylene mesh and the acrylic prosthesis was a practical alternative for palatoplasty in dogs after oral myiasis.

Does Infant Orthopedics and Neonate Lip Surgery Influence the Occlusal Relationship in Patients With Unilateral Cleft Lip and Palate (UCLP)?

OBJECTIVE: To compare occlusal relationship in patients undergoing neonate versus conventional lip surgery (LS) with and without infant orthopedics (IO) by assessment of dental arch relationship in individuals with complete unilateral cleft lip and palate. MATERIAL AND METHODS: Three groups treated by different protocols; Group I: neonate LS (1-15 days) + IO and palatoplasty (13-31 months); Group II: LS (3-12 months) + IO and palatoplasty (15-35 months); and Group III: LS (3-6 months) without IO and palatoplasty (12-18 months). The 112 intraoral photographs of individuals of all groups, obtained between 6 and 12 years of age, were assessed by the occlusal index for intraoral photograph rating. The groups were compared by the χ2 test. The correlation between surgical timing and the scores was tested by the Spearman test (P < .05). RESULTS: Group I presented the highest percentage of score 5, group II exhibited highest percentage of score 1, and group III presented the lowest percentage of score 5 according to the χ2 test (P = .029). The Spearman correlation test revealed statistically significant difference between timing of LS and the occlusal index. The earlier the surgical timing, the higher the occlusal index (P = .019). CONCLUSIONS: Infant orthopedics has demonstrated the possibility of postponing primary plastic surgeries. Patients submitted to late lip and palate repair had the best prognosis, while patients undergoing lip repair from 1 to 15 days of life, even operating the palate later, had the worst prognosis. Neonate LS negatively influenced the occlusal relationships.

Should Cleft Surgery Always be Performed During the Matutine Time? Analysis of Early and Late Postoperative Complications in a Cleft Center.

OBJECTIVE: Surgeries performed in the afternoon schedule were discouraged by Smile Train Foundation for patients younger than 2 years. The aim of this study is to present the incidence of complications discriminating time of surgery (morning/afternoon) in a reference center in Curitiba (Brazil) during 2017. DESIGN: Retrospective study that evaluated all cleft surgeries that were performed at Assistance Center for Cleft Lip and Palate during 2017. Complications correlated with surgery period (morning/afternoon), type of surgery, and operating surgeon were studied. Statistical analysis was performed to find any association between discrete variables. SETTING: Tertiary, institutional. PARTICIPANTS: One hundred eighty-seven patients with cleft lip and/or cleft palate/cleft lip and palate, who were evaluated and submitted to surgery in the center and had less than 24 months of age, were included in the study. INTERVENTIONS: One hundred twenty-four cheiloplasties and 63 palatoplasties were performed. MAIN OUTCOME MEASURE: Incidence of complications. RESULTS: From the total of cheiloplasties, the number of complications was 2 (1.6%) and from the total of palatoplasties the number of complications was 11 (17%); 8.1% of surgeries that were performed in the morning had any complication compared to 5.1% of surgeries performed in the afternoon. Statistical analysis of discrete variables with χ2 test showed no correlation between surgery schedule and complications (χ2 = 0.62). CONCLUSION: The number of complications was not higher in the afternoon scheduled surgeries. Surgeon expertise had a statistically significant correlation with the absence of complications (χ2 = 20.57).

The first-year follow-up of a cleft lip and palate patient treated with nasoalveolar molding (NAM)

Abstract The objectives of pre-surgical orthopedics are to allow surgical repair with minimal tension of the involved tissues and less restriction to the craniofacial growth. The aim of this study was to evaluate the benefits of nasoalveolar model (NAM) as a pre-operative therapy in a patient with bilateral cleft lip and palate followed by labioplasty and palatoplasty. A 15-day-old patient underwent orthopedic treatment with NAM. After pre-operative treatment, retraction of the pre-maxilla was observed with reduction of the fissure. Due to the successful effects of NAM treatment the patient had a one-step surgery for lip correction. Six months later, due to lip pressure the fissure was further decreased. After six months, the patient underwent palatoplasty. Both surgeries contributed to the remaining closure of the fissure, which were reduced by half compared to the end of pre-operative treatment. The uses of NAM as a pre-operative treatment approached the alveolar segments, centralized the pre-maxilla, decreased the cleft palate resulting in a marked improvement of the arch and provide superior surgical results. In addition, it allows the primary repair of the patient's lip with asymmetric bilateral fissure in only one-step surgery; in consequence, it will reduce treatment morbidity and decrease cost of treatment.

Resumo Os objetivos da ortopedia pré-cirúrgica são permitir a correção cirúrgica com mínima tensão dos tecidos envolvidos e menor restrição ao crescimento craniofacial. O objetivo deste estudo foi avaliar os benefícios do modelo nasoalveolar (NAM) como terapia pré-operatória em um paciente com fissura labiopalatina bilateral seguida de labioplastia e palatoplastia. Um paciente de 15 dias de idade foi submetido a tratamento ortopédico com NAM. Após o tratamento pré-operatório, observou-se retração da pré-maxila com redução da fissura. Devido aos efeitos bem-sucedidos do tratamento com NAM, o paciente realizou a cirurgia em um único tempo cirúrgico para correção dos lábios. Seis meses após verificou-se a continuidade da redução da fissura devido à pressão labial. Após dozes meses, o paciente foi submetido à palatoplastia. Ambas as cirurgias contribuíram para o fechamento remanescente da fissura, que foram reduzidas pela metade em comparação com o final do tratamento pré-operatório. O uso do NAM como tratamento pré-operatório proporcionou a aproximação dos segmentos alveolares, centralização da pré-maxila, diminuição da fissura palatina, resultando em melhora acentuada do arco, resultando em procedimentos cirúrgicos mais eficazes. Além disso, permitiu o reparo primário do lábio do paciente com fissura bilateral assimétrica em apenas uma cirurgia; em conseqüência, reduzindo a morbidade do tratamento e diminuição dos custos do tratamento.

About a "New" Technique for Uvular Repair.

This letter is about a recent publication in the Cleft Palate Craniofacial Journal titled: "The significance of uvula after palatoplasty: A new technique to improve the aesthetic outcome" published by Elsherbiny et al (Cleft Palate Craniofacial J 2018;55(3):451-455). The authors present the use of one hemi-uvula for uvular repair during primary palatoplasty as their "new technique." The method of primary uvuloplasty using one-hemiuvula was extensively used by different surgeons in south America and presented and published in different scientific meetings and indexed scientific journals since the 90s. The original concept was described by Carlos Navarro in Perú and published by me in different scientific indexed journals and a textbook.

Reparação cirúrgica de fenda palatina em potro com a utilização de pericárdio bovino: relato de caso / Surgical correction of cleft palate in foal using bovine pericardium: case report / Corrección quirúrgica del paladar hendido en potro con pericardio bovino: reporte de un caso

Este artigo tem como objetivo relatar o caso de reparação cirúrgica de uma fenda palatina congênita em uma potra com a utilização de pericárdio bovino conservado em glicerina a 98%. Um equino, fêmea, com 6 dias de vida foi atendido em uma propriedade apresentando dificuldade de deglutição e refluxo de leite pelas narinas, o qual foi diagnosticado com fenda palatina secundária. O animal foi submetido a palatoplastia com acesso cirúrgico por bucotomia lateral, porém 5 dias após o procedimento, houve deiscência da sutura. Optou-se então pela utilização de membrana biológica para a reconstrução do palato. O acesso a cavidade bucal por bucotomia possibilitou a sutura da fenda palatina e a colocação de pericárdio bovino com adesivo tecidual de etil-cianoacrilato. A técnica utilizada mostrou-se eficiente, uma vez que o animal apresentou boa adaptação e não houve deiscência de pontos após a segunda intervenção. A utilização de pericárdio bovino mostrou-se viável nesse caso palatoplastia, visto que a não realização da reconstrução torna-se incompatível a manutenção da vida.

This paper aims to report a case of surgical repair of congenital cleft palate in foal using bovine pericardium preserved in glycerin 98%. One female horse, with 6 days of life examined at the property with difficulty swallowing and milk reflux nostrils, which was diagnosed with secondary cleft palate. The animal was subjected to palatoplasty with surgical access by bucotomia, but five days after the procedure, there was suture dehiscence. It was then decided by the use of biological membrane for the reconstruction of the palate. Access to the oral cavity by bucotomia possible suturing the cleft palate and placement of bovine pericardium with tissue adhesive the basis of ethyl-cyanoacrylate. The technique used was efficient, since the animal showed good adaptation and no dehiscence points after the second intervention. Thus demonstrating a use a viable option bovine pericardium in palatoplasty surgeries since missing the reconstruction becomes inconsistent maintenance of life.

Este artículo tiene como objetivo informar el caso de reparación quirúrgica de un paladar hendido congénito en un potro utilizando pericardio bovino preservado con glicerina 98%. Una potra de 6 días de edad fue tratada en una granja con dificultad para tragar y reflujo de leche a través de las fosas nasales, que fue diagnosticada como paladar hendido secundario. El animal se sometió a una palatoplastia con acceso quirúrgico por bucotomía lateral, pero 5 días después del procedimiento, hubo dehiscencia de sutura. Luego se decidió utilizar una membrana biológica para la reconstrucción del paladar, el acceso a la cavidad bucal por bucotomía permitió suturar el paladar hendido y colocación de pericardio bovino con adhesivo tisular de cianoacrilato de etilo. La técnica utilizada demostró ser eficiente, una vez que el animal mostró una buena adaptación y no hubo dehiscencia de puntos después de la segunda intervención. EI uso de pericardio bovino fue viable eneste caso de palatoplastia, ya que la realización de la reconstrucción se vuelve incompatible con el mantenimiento de la vida.

Reparação cirúrgica de fenda palatina em potro com a utilização de pericárdio bovino: relato de caso / Surgical correction of cleft palate in foal using bovine pericardium: case report / Corrección quirúrgica del paladar hendido en potro con pericardio bovino: reporte de un caso

Este artigo tem como objetivo relatar o caso de reparação cirúrgica de uma fenda palatina congênita em uma potra com a utilização de pericárdio bovino conservado em glicerina a 98%. Um equino, fêmea, com 6 dias de vida foi atendido em uma propriedade apresentando dificuldade de deglutição e refluxo de leite pelas narinas, o qual foi diagnosticado com fenda palatina secundária. O animal foi submetido a palatoplastia com acesso cirúrgico por bucotomia lateral, porém 5 dias após o procedimento, houve deiscência da sutura. Optou-se então pela utilização de membrana biológica para a reconstrução do palato. O acesso a cavidade bucal por bucotomia possibilitou a sutura da fenda palatina e a colocação de pericárdio bovino com adesivo tecidual de etil-cianoacrilato. A técnica utilizada mostrou-se eficiente, uma vez que o animal apresentou boa adaptação e não houve deiscência de pontos após a segunda intervenção. A utilização de pericárdio bovino mostrou-se viável nesse caso palatoplastia, visto que a não realização da reconstrução torna-se incompatível a manutenção da vida.(AU)

This paper aims to report a case of surgical repair of congenital cleft palate in foal using bovine pericardium preserved in glycerin 98%. One female horse, with 6 days of life examined at the property with difficulty swallowing and milk reflux nostrils, which was diagnosed with secondary cleft palate. The animal was subjected to palatoplasty with surgical access by bucotomia, but five days after the procedure, there was suture dehiscence. It was then decided by the use of biological membrane for the reconstruction of the palate. Access to the oral cavity by bucotomia possible suturing the cleft palate and placement of bovine pericardium with tissue adhesive the basis of ethyl-cyanoacrylate. The technique used was efficient, since the animal showed good adaptation and no dehiscence points after the second intervention. Thus demonstrating a use a viable option bovine pericardium in palatoplasty surgeries since missing the reconstruction becomes inconsistent maintenance of life.(AU)

Este artículo tiene como objetivo informar el caso de reparación quirúrgica de un paladar hendido congénito en un potro utilizando pericardio bovino preservado con glicerina 98%. Una potra de 6 días de edad fue tratada en una granja con dificultad para tragar y reflujo de leche a través de las fosas nasales, que fue diagnosticada como paladar hendido secundario. El animal se sometió a una palatoplastia con acceso quirúrgico por bucotomía lateral, pero 5 días después del procedimiento, hubo dehiscencia de sutura. Luego se decidió utilizar una membrana biológica para la reconstrucción del paladar, el acceso a la cavidad bucal por bucotomía permitió suturar el paladar hendido y colocación de pericardio bovino con adhesivo tisular de cianoacrilato de etilo. La técnica utilizada demostró ser eficiente, una vez que el animal mostró una buena adaptación y no hubo dehiscencia de puntos después de la segunda intervención. EI uso de pericardio bovino fue viable eneste caso de palatoplastia, ya que la realización de la reconstrucción se vuelve incompatible con el mantenimiento de la vida.(AU)

Respiratory Polysomnographic Findings in Patients Treated Primarily for Unilateral Cleft Lip and Palate.

Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. Obstructive sleep apnea syndrome (OSAS) is a highly prevalent but underdiagnosed disease and is frequently associated with craniofacial anomalies. There are few studies describing the sleep breathing pattern of children with CLP. This study sought to characterize the respiratory profile of 23 children with unilateral cleft lip and palate, aged 7-12 years, who had undergone cleft lip and nasal repair at age 3-4 months and palatoplasty at 12-15 months, with a particular focus on evaluating the presence of OSAS in children with CLP. Polysomnography was performed and findings were analyzed descriptively. We found a mean and median for apnea/hypopnea index (AHI) of 1.11/h (SD = 0.78) and 0.9/h, respectively. The mean obstructive apnea index (OAI) was 0.27/h (SD = 0.38) and the median, 0.1/h. Nearly 30% of patients had an AHI above 1.4 events/h. There was no significant oxyhemoglobin desaturation in the study group. In this group, the prevalence of OSAS was higher than in noncleft populations when compared to the normality values adopted. This sample of patients with unilateral cleft lip and palate exhibited an increased prevalence of OSAS during the mixed dentition stage. Although the results showed that OSAS was mild, we advise closer observation of these patients. Polysomnography is recommended for the assessment of children with airway abnormalities, to individualize the extent of treatment.

Otologic Disease Following Palatoplasty In International Cleft Palate Cohort.

OBJECTIVE: Study the prevalence of otologic disease in a pediatric post-palatoplasty population with no prior ear tube placement in resource-deprived countries and assess patient characteristics associated with these abnormal results. DESIGN: Retrospective data review. PARTICIPANTS: Ecuadorian and Chinese children identified during humanitarian cleft lip and palate repair trips with cleft palates undergoing palatoplasty from 2007 to 2010. INTERVENTIONS: Tympanometry and otoacoustic emission (OAE) testing performed following palatoplasty. Patients' parents administered surveys regarding perceived hearing deficits. MAIN OUTCOME MEASURES: Age, gender, Veau classification, follow-up time, laterality, and country of origin were evaluated for possible association with type B tympanogram, "Refer" Otoacoustic results, and presence of hearing difficulty as identified by a parent. Significant predictors were further evaluated with multivariate analysis. RESULTS: The cohorts included 237 patients (129 Ecuadorian, 108 Chinese); mean age: 3.9 years; mean follow-up: 4.2 years. Thirty-nine percent scored type B, 38% failed OAE testing, and 8% of parents noted hearing deficits. The country of origin and a younger age were identified as predictive variables regarding type B tympanogram. Follow-up time, country of origin, and bilateral OAE "Refer" results all significantly predicted parental questionnaire results. Subsequent multivariable analysis further demonstrated effect modification between the 2 variables of age at palatoplasty and country of origin when predicting type B vs type A tympanometry. CONCLUSION: Without otologic intervention, cleft palate children in resource-deprived settings suffer type B tympanometry and failed OAE results with similar to increased incidences to other studied cleft palate populations with otologic interventions available.

Palatoplastia em envelope para tratamento de prolongamento de palato mole em cão da raça pastor belga malinois: relato de caso

Prolongamento de palato é uma afecção primária em cães de raças braquicefálicas, entretanto encontra-se presente em outras raças. Promove dispneia e podem ocorrer quadros de cianose e síncope. O diagnóstico se dá por laringoscopia e o tratamento é estritamente cirúrgico, sendo a estafilectomia a técnica mais usual. Outras técnicas, como a palatoplastia em envelope, foram desenvolvidas para tratamento dessa afecção. O objetivo do estudo é relatar um caso de palatoplastia em envelope modificada para tratamento de prolongamento de palato em um cão da raça Pastor Belga Malinois, assim como sua boa recuperação pós-operatória.

Elongated soft palate is a primary affection in brachicephalic dogs, however is found to be presente in other breeds. Promotes dyspnea and may occur episodes of cianosis and syncope. Diagnosis is obtained through laryngoscopy and the treatment of this affection is strictly cirurgical, and staphylectomy is an usual technique commonly used. Other procedures, such folded flap palatoplasty, have been developed to the correction of this disease,. This study aims to report a case of a modified folded flap palatoplasty to correct a elongated soft palate in a Belgian Malinois dog, as well as its good posoperative evolution.

Palatoplastia em envelope para tratamento de prolongamento de palato mole em cão da raça pastor belga malinois: relato de caso

Prolongamento de palato é uma afecção primária em cães de raças braquicefálicas, entretanto encontra-se presente em outras raças. Promove dispneia e podem ocorrer quadros de cianose e síncope. O diagnóstico se dá por laringoscopia e o tratamento é estritamente cirúrgico, sendo a estafilectomia a técnica mais usual. Outras técnicas, como a palatoplastia em envelope, foram desenvolvidas para tratamento dessa afecção. O objetivo do estudo é relatar um caso de palatoplastia em envelope modificada para tratamento de prolongamento de palato em um cão da raça Pastor Belga Malinois, assim como sua boa recuperação pós-operatória.(AU)

Elongated soft palate is a primary affection in brachicephalic dogs, however is found to be presente in other breeds. Promotes dyspnea and may occur episodes of cianosis and syncope. Diagnosis is obtained through laryngoscopy and the treatment of this affection is strictly cirurgical, and staphylectomy is an usual technique commonly used. Other procedures, such folded flap palatoplasty, have been developed to the correction of this disease,. This study aims to report a case of a modified folded flap palatoplasty to correct a elongated soft palate in a Belgian Malinois dog, as well as its good posoperative evolution.(AU)

Risk factors leading to mucoperiosteal flap necrosis after primary palatoplasty in patents with cleft palate.

BACKGROUND: Few studies have been published reporting risk factors for flap necrosis after primary palatoplasty in patients with cleft palate. This complication is rare, and the event is a disaster for both the patient and the surgeon. This study was performed to explore the associations between different risk factors and the development of flap necrosis after primary palatoplasty in patients with cleft palate. METHODS: This is a case-control study. A 20 years retrospective analysis (1994-2015) of patients with nonsyndromic cleft palate was identified from medical records and screening day registries). Demographical and risk factor data were collected using a patient´s report, including information about age at surgery, gender, cleft palate type, and degree of severity. Odds ratios and 95% confident intervals were derived from logistic regression analysis. RESULTS: All cases with diagnoses of flap necrosis after primary palatoplasty were included in the study (48 patients) and 156 controls were considered. In multivariate analysis, female sex, age (older than 15 years), cleft type (bilateral and incomplete), and severe cleft palate index were associated with significantly increased risk for flap necrosis. CONCLUSIONS: The findings suggest that female sex, older age, cleft type (bilateral and incomplete), and severe cleft palatal index may be associated with the development of flap necrosis after primary palatoplasty in patients with cleft palate.

Effectiveness of dexmedetomidine for emergence agitation in infants undergoing palatoplasty: a randomized controlled trial / Eficácia de dexmedetomidina para o surgimento de agitação em lactentes submetidos à palatoplastia: estudo clínico randomizado

OBJECTIVES: In infants, there is a high incidence of emergence agitation (EA) after sevoflurane (Sev) anesthesia. This study aimed to test the hypothesis that dexmedetomidine (Dex) administration would reduce the incidence and severity of EA after Sev-based anesthesia in infants undergoing palatoplasty. METHODS: A prospective randomized clinical trial was conducted with 70 patients undergoing palatoplasty, aged 10-14 months. Infants were randomly allocated into two groups: Dex (n = 35) and saline (n = 35). In the Dex group, Dex (6 µg/kg/h) was administered approximately 10 min before the end of the surgery for 10 min, followed by 0.4 µg/kg/h until 5 min after extubation. In the saline group, an equivalent amount of saline was administered in a similar manner. After the surgery, patients were transferred to the postanesthetic care unit (PACU). The infant's behavior and pain were assessed with scoring system for EA (5-point rating scale) and pain scale (PS; 10-point rating scale), respectively. EA and PS were estimated at six time points (after extubation, leaving the operating room, 0, 30, 60, and 120 min after arrival in PACU). RESULTS: EA and PS scores were significantly lower in the Dex group than in the saline group from extubation to 120 min after arrival in PACU. CONCLUSIONS: Dex administration has the advantage of a reduced EA and PS without any adverse effects. Dex provided satisfactory recovery in infants undergoing palatoplasty.

OBJETIVOS: Em crianças, é elevada a incidência de surgimento de agitação (SA) em seguida à anestesia com sevoflurano (Sev). Este estudo teve como objetivo testar a hipótese de que a administração de dexmedetomidina (Dex) reduziria a incidência e a gravidade do SA após anestesia com Sev em lactentes submetidos à palatoplastia. MÉTODOS: Estudo clínico prospectivo randomizado, feito com 70 pacientes submetidos a uma palatoplastia, com 10-14 meses. As crianças foram divididas randomicamente em dois grupos: Dex (n = 35) e solução salina (n = 35). No grupo de Dex, Dex (6 µg/kg/h) foi administrada cerca de 10 minutos antes do fim da cirurgia durante 10 minutos, seguida de 0,4 µg/kg/h até 5 minutos após a extubação. No grupo de solução salina, uma quantidade equivalente de salina foi administrada com o mesmo esquema de dosagem. Após a cirurgia, os pacientes foram transferidos para a unidade de cuidados pós-anestésicos (UCPA). O comportamento e a dor dos bebês foram avaliados com um sistema de pontuação para SA (escala de classificação de 5 pontos) e com uma escala de dor (ED; escala de classificação de 10 pontos), respectivamente. SA e ED foram estimados em seis pontos cronológicos (após a extubação, ao deixar a sala de cirurgia e 0, 30, 60 e 120 minutos após a chegada à UCPA). RESULTADOS: Os escores SA e ED foram significativamente menores no grupo Dex versus grupo salina, desde a extubação até 120 minutos após a chegada à UCPA. CONCLUSÕES: A administração de Dex tem a vantagem de uma redução no SA e na ED, sem quaisquer efeitos adversos. Dex proporcionou uma recuperação satisfatória em lactentes submetidos à palatoplastia.