Evaluation of a Sample of Patients With Unilateral Cleft Lip and Palate Treated With a Two-Stage Protocol

Abstract

The aim of this paper was to assess growth, speech, and aesthetic results at the completion of growth in patients with unilateral cleft lip and palate treated with the 2 stages Milan surgical protocol. Craniofacial growth was evaluated with cephalometric analysis and a theoretical need for orthognathic surgery. Nasolabial appearance was qualitatively assessed using the Asher McDade Aesthetic Index. Speech was assessed using the Gos.Sp.Ass ’98 modified for Italian language scoring system. Burden of care was recorded in terms of number of secondary surgical procedures. All of the patients were treated and evaluated at San Paolo Hospital, Smile House, Milan. Fifty-two consecutive patients treated by the same surgeon were recalled, 12 patients did not come for assessment. The first surgical step (average age of 6 months) was cheilorhinoplasty (Millard modified Delaire technique) and soft palate rapair (Pigott). The second step (average age of 35 months) was hard palate and alveolar repair performed simultaneously with an early secondary gengivo alveolo plasty. Fifty-six percent of the patients did not need further surgery after the 2-stage surgery protocol. The 2-stage surgical protocol of Milano, Smile House, seems to be effective for treatment of unilateral cleft lip and palate, with good results in terms of speech, labial appearance, and alveolar cleft management. Nevertheless, maxillary growth was moderately impaired by the protocol.

Speech Outcome and Self-Reported Communicative Ability in Young Adults Born With Unilateral Cleft Lip and Palate: Comparing Long-Term Results After 2 Different Surgical Methods for Palatal Repair

“…The velopharyngeal flap rate was significantly higher in the OS group (53%) compared to the TS group (24%). The TS group had a flap rate which is comparable to that of other similar studies (Farzaneh et al, 2008; Havstam et al, 2008; Lohmander et al, 2012; Morén et al, 2017; Brusati et al, 2018). However, the flap rate in the OS group was very high and even higher than the earlier presented rate of 43% in 69 children with UCLP at 10 years of age, also operated on in Stockholm with OS protocol including MIT (Nyberg et al, 2014).…”

“…Hence, in addition to establishing a reliable basis for the procedure and timing of surgical intervention in cleft care, it is also necessary to build knowledge of what matters to the affected individual to better tailor and guide the treatment (Neumann & Romonath, 2012). However, the burden of care must also be considered in terms of the multidisciplinary intervention, including surgical protocols, when reporting on the long-term outcome (Semb et al, 2005; Brusati et al, 2018), especially as it has been demonstrated that more operations during at-risk periods may result in long-term consequences and decreased quality of life (Potemra et al, 2020).…”

“…Ideally, long-term follow-up should be done after the patients reach adulthood, when the growth of the anatomical region affected by the cleft is completed (Morén et al, 2017). To date, 9 published studies have evaluated speech in adult patients born with cleft lip and/or palate (CL/P) conducted according to the recommendations of Sell (2005), that is, based on audio-recorded material with blinded perceptual speech assessments and reported listener reliability (Karling et al, 1993; Becker et al, 2000; Van Lierde et al, 2004; Farzaneh et al, 2008; Havstam et al, 2008; Farzaneh et al, 2009; Lohmander et al, 2012; Morén et al, 2017; Brusati et al, 2018). Seven of these studies were performed on Swedish-speaking patients, 1 on Italian-speaking patients, and 1 on Flemish-speaking patients.…”

“…Four of the studies compared speech outcome after 2 different surgical protocols (Van Lierde et al, 2004; Farzaneh et al, 2008; Farzaneh et al, 2009; Morén et al, 2017), 3 reported on patients’ own opinions about their speech (Becker et al, 2000; Farzaneh et al, 2008; Farzaneh et al, 2009) and 1 compared experts’ and patients’ own assessments (Havstam et al, 2008). One study reported on the results after 1 protocol only (Brusati et al, 2018). Other researchers have reported on patients’ satisfaction with their speech and communicative skills (Noar, 1991; Strauss et al, 1988 Klassen et al, 2018; Nicholls et al, 2018), but very few have compared patients’ self-estimated speech quality with that of a control group born without a cleft (Olsson and Rutgersson, 2009; Stiernman et al, 2021).…”

Clase esqueletal e inclinación dental en pacientes con labio y paladar hendido

“…En un estudio realizado previamente a la cirugía en pacientes con labio y paladar hendido unilateral evaluaron el ángulo ANB, se sugirió la formación de una retrusión del maxilar de manera concordante con el presente estudio, aunque discrepa con respecto al tipo de análisis propuesto. (16) Los resultados obtenidos permitieron establecer la inexistencia de diferencias significativas entre ambos grupos con respecto a la inclinación del incisivo inferior; lo que coincidió con los (17) .Aunque, los métodos diagnósticos fueron diferentes, también encontraron una mayor protrusión en el grupo experimental en el incisivo inferior, a diferencia de lo reportado por Corbo et al (13) con respeto a esa variable.…”