Delayed primary palatal closure in resource-poor countries: Speech results in Ugandan older children and young adults with cleft (lip and) palate

Bruneel, Laura; Luyten, Anke; Bettens, Kim; D’haeseleer, Evelien; Dhondt, Cleo; Hodges, Andrew; Galiwango, George; Vermeersch, Hubert; Lierde, Kristiane Van

doi:10.1016/j.jcomdis.2017.06.010

Cited by 20 publications

(16 citation statements)

References 64 publications

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“…Some cleft lip and palate patients do not undergo timely surgery due to lack of knowledge of the importance of early surgery, lack of hospital access, and economic difficulties 5,6 . In 1990, Hoppenreijs 2 conducted a retrospective study of eight untreated adult cleft palate patients.…”

Section: Discussionmentioning

confidence: 99%

“…Though a cleft palate is corrected, the compensatory pattern often continues after the operation, and its treatment is very difficult 10 . According to Bruneel et al 5 , delayed palatal repair in patients older than 8 years often is insufficient to resolve nasal airflow errors, resonance abnormalities, and articulation disorders. These authors reported that speech therapy can be helpful after delayed palatoplasty.…”

Section: Discussionmentioning

confidence: 99%

“…Cleft palate surgery in adults with completed jaw growth is different from the surgery in children. Delayed hard palate closure has been reported to cause severe language problems and palatal fisula 5,11 . In 2007, Morioka et al 11 analyzed 550 cases of adult cleft lip and palate patients who had been treated over 11 years.…”

Section: Discussionmentioning

confidence: 99%

“…However, untreated adult or elderly cleft lip and palate patients are rare. Studies on delayed primary palatal closure have been performed in less-developed Asian and African countries, where access to medical care is difficult 5,6 . Most cleft lip and palate patients in South Korea are diagnosed early, even before birth, and the cleft lips and palates can be corrected through systematic treatment before adulthood.…”

Section: Introductionmentioning

confidence: 99%

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Primary repair of untreated cleft palate in an elderly patient: a case report

Lee

Kim

et al. 2021

JKAOMS

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Untreated adult or elderly cleft lip and palate patients are rarely seen, but studies on delayed primary palatal closure have been performed in the less developed Asian and African countries, where access to medical care is difficult. A 64-year-old woman visited our clinic with untreated cleft palate with a 40×20-mm-wide defect in the medial palate. Two-flap palatoplasty under general anesthesia was performed to close the cleft palate. After 1 month, the result was favorable without any complications including oronasal fistula. Cleft palate primary repair in an elderly patient is rare and has some surgical problems that are associated with a wide range of defects, but good results can be obtained if surgery is performed well with appropriate considerations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Primary repair of untreated cleft palate in an elderly patient: a case report

Lee

Kim

et al. 2021

JKAOMS

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“…Suboptimal care can have long-term effects on outcomes and on overall quality of life (Abbott et al, 2011). Delays in surgical treatments can impact appearance as well as function, since the child’s phonation, hearing, swallowing, mastication, and ventilation are all affected (Bruneel et al, 2017; Yang et al, 2019). Timely access to care can translate to improved outcomes in hearing and speech, school performance, psychosocial development, and even later employment prospects (Grollemund et al, 2010; Lorot-Marchand et al, 2015; Bell et al, 2017; Correa de Queiroz Herkrath et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic Factors That Influence the Choice to Pursue Nasoalveolar Molding: One Pediatric Hospital’s Experience

Kimia

Butler

Guajardo

et al. 2020

The Cleft Palate-Craniofacial Journal

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Objective: To identify demographic factors that influence choosing nasoalveolar molding (NAM) in the treatment of cleft lip with or without cleft palate (CL±P), and NAM treatment compliance. Design: This work is a retrospective cohort study. Setting: Tertiary pediatric hospital. Patients, Participants: One hundred forty-nine patients with a diagnosis of unilateral complete CL±P receiving treatment when NAM was offered (January 1, 2008-July 26, 2016). Main Outcome Measure(s): Demographic variables collected included race, ethnicity, ZIP code, number of caregivers, caregiver employment status, and health insurance status. Medical variables collected included diagnosis, treatment pursued, compliance with NAM, completion of NAM, and the treating cleft surgeon and orthodontist. Data were analyzed via Fisher exact tests, χ2 tests, and multivariate logistic regression to identify factors that influence the decision to pursue NAM and treatment compliance. Results: Univariate analyses identified the following significant factors predicting the pursuit of NAM: race and insurance type (both P < .001), surgeon ( P = .005), income level ( P = .009), comorbidities ( P = .015), and syndromic diagnosis ( P = .033). Driving distance trended toward significance ( P = .078). Multivariate regression analyses indicated that Asian race ( P = .047), insurance type ( P = .046), driving distance ( P = .019), and surgeon ( P = .017) were significant predictors of pursuit of NAM. Conclusions: There are disparities in patient choice of NAM at our center for children with complete cleft lip. African American patient families were less likely to pursue this intervention. A stronger understanding of the barriers that lower income and minority patients face is needed in order to better characterize disparities in cleft care.

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The Sommerlad–Furlow Modified Palatoplasty Technique: Postoperative Complications and Implicating Factors

Sakran

Alkebsi

et al. 2022

The Laryngoscope

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Objective To explore the incidence of postoperative complications and investigate the impact of preselected factors on functional and quality of life outcomes following the Sommerlad–Furlow modified palatoplasty technique. Study Design Retrospective cohort. Methods A total of 429 patients with cleft palate, who received Sommerlad–Furlow modified technique between 2011–2017 were enrolled. The postoperative complications including oronasal fistula (ONF), velopharyngeal insufficiency (VPI), and inadequate quality of life (QOL) were collected. Data of preselected factors including gender, age at palatoplasty, cleft type, cleft width, palatal width, pharyngeal cavity depth, and operation duration were also collected. Results Among 429 patients, 40.1% were males whereas 59.9% were females. The mean age at palatoplasty was 1.23 ± 0.69 (0.42–4) years, and the average cleft width was 10.15 ± 2.95 (4–27) mm. The cleft types had recorded rates of about 6.8%, 69.5%, 17.7%, and 6.1% of Veau I, II, III, and IV, respectively. The overall incidence rates of ONF, VPI, and inadequate QOL were 2.3%, 19.4%, and 31.3%, respectively. In both the univariate and multivariate analyses, the cleft type was significantly implicated in ONF formation (p = 0.023 and 0.032, respectively) whereas the velopharyngeal function was impacted by the palatoplasty age (p ˂ 0.001). The receiver operating characteristic curve indicated that age of palatoplasty ≥1.3 years (area under the curve = 0.611, p = 0.002) was the cutoff value for predicting the incidence of VPI. Conclusions The Sommerlad–Furlow modified technique appears to have appropriate postoperative outcomes, even in the wide cleft palate. The older age at palatoplasty has a major impact on the overall postoperative outcomes. Level of Evidence 4 Laryngoscope, 133:822–829, 2023

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Delayed primary palatal closure in resource-poor countries: Speech results in Ugandan older children and young adults with cleft (lip and) palate

Cited by 20 publications

References 64 publications

Primary repair of untreated cleft palate in an elderly patient: a case report

Primary repair of untreated cleft palate in an elderly patient: a case report

Sociodemographic Factors That Influence the Choice to Pursue Nasoalveolar Molding: One Pediatric Hospital’s Experience

The Sommerlad–Furlow Modified Palatoplasty Technique: Postoperative Complications and Implicating Factors

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