Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 2. Surgical results

Rautio, Jorma; Andersen, Mikael; Bolund, S.; Hukki, Jyri; Vindenes, Hallvard; Davenport, Peter; Arctander, Kjartan; Larson, Ola; Berggren, Anders; Åbyholm, Frank; Whitby, David; Leonard, Alan G.; Lilja, Jan; Neovius, Erik; Elander, Anna; Heliövaara, Arja; Eyres, Phil; Semb, Gunvor

doi:10.1080/2000656x.2016.1254646

Cited by 70 publications

(82 citation statements)

References 12 publications

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“…In addition, all participants had velar closure around 4 months of age according to the same surgical protocol that was performed by one of two surgeons (Rautio et al . ). This means that the reported differences in speech outcomes between groups can most probably not be explained by a difference in hearing between the two groups, but it may likely influence speech outcomes in some individuals.…”

Section: Discussionmentioning

confidence: 97%

“…The surgeons had experience with a similar procedure before initiation of the trial, and the same surgical procedures were used in both arms as only the timing of hard palate repair differed (Rautio et al . ).…”

Section: Methodsmentioning

confidence: 97%

“…Recently, results from an international randomized controlled trial (RCT), the Scandcleft Trials, showed that surgeons’ level of experience with a surgical procedure influenced results with a strong surgical learning curve with the use of new techniques (see Rautio et al . for a discussion).…”

Section: Introductionmentioning

confidence: 99%

“…From a survey of cleft care in the UK, Bearn et al (2001) reported surgical skill as a main factor in achieving good speech outcomes with better results from highversus low-volume operators. Recently, results from an international randomized controlled trial (RCT), the Scandcleft Trials, showed that surgeons' level of experience with a surgical procedure influenced results with a strong surgical learning curve with the use of new techniques (see Rautio et al 2017 for a discussion).…”

Section: Introductionmentioning

confidence: 99%

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Influence of timing of delayed hard palate closure on articulation skills in 3‐year‐old Danish children with unilateral cleft lip and palate

Willadsen

Boers²,

Schöps³

et al. 2017

Intl J Lang & Comm Disor

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Background: Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. Aims: To assess the influence of different timing of hard palate closure in a two-stage procedure on articulation skills in 3-year-olds born with unilateral cleft lip and palate (UCLP). Secondary aims were to compare results with peers without CP, and to investigate if there are gender differences in articulation skills. Furthermore, burden of treatment was to be estimated in terms of secondary surgery, hearing and speech therapy. Methods & Procedures:A randomized controlled trial (RCT). Early hard palate closure (EHPC) at 12 months versus late hard palate closure (LHPC) at 36 months in a two-stage procedure was tested in a cohort of 126 Danish-speaking children born with non-syndromic UCLP. All participants had the lip and soft palate closed around 4 months of age. Audio and video recordings of a naming test were available from 113 children (32 girls and 81 boys) and were transcribed phonetically. Recordings were obtained prior to hard palate closure in the LHPC group. The main outcome measures were percentage consonants correct adjusted (PCC-A) and consonant errors from blinded assessments. Results from 36 Danish-speaking children without CP obtained previously by Willadsen in 2012 were used for comparison. Outcomes & Results: Children with EHPC produced significantly more target consonants correctly (83%) than children with LHPC (48%; p < .001). In addition, children with LHPC produced significantly more active cleft speech characteristics than children with EHPC (p < .001). Boys achieved significantly lower PCC-A scores than girls (p = .04) and produced significantly more consonant errors than girls (p = .02). No significant differences were found between groups regarding burden of treatment. The control group performed significantly better than the EHPC and LHPC groups on all compared variables.

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of timing of delayed hard palate closure on articulation skills in 3‐year‐old Danish children with unilateral cleft lip and palate

Willadsen

Boers²,

Schöps³

et al. 2017

Intl J Lang & Comm Disor

Self Cite

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“…Patients were then randomized for hard palate closure at 12 (EHPC) or 36 months (DHPC). Inclusion criteria, randomization method and trial design have been reported by Semb and co‐authors, and the surgical technique described in detail by Rautio et al Surgery was performed by two senior high‐volume surgeons (more than 50 cleft newborns' primary surgeries/year), calibrated according the Scandcleft protocol.…”

Section: Methodsmentioning

confidence: 99%

Palatal morphology in unilateral cleft lip and palate patients: Association with infant cleft dimensions and timing of hard palate repair

Botticelli

Küseler

Mølsted

et al. 2019

Orthod Craniofacial Res

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Objectives To assess the impact of cleft severity and timing of hard palate repair on palatal dimensions in unilateral cleft lip and palate (UCLP) children. Setting and sample population Single‐centre analysis within a multicenter RCT of primary surgery; 122 UCLP randomized to early hard palate closure (EHPC) at 12 months or delayed hard palate closure (DHPC) at 36 months; 28 frequency‐matched controls. Methods Linear measurements of palatal height, width and length were performed on 116 digital models of UCLP subjects (8.21 years, SD = 0.53) and 28 models of non‐cleft individuals (8.44 years SD = 0.72). Cleft dimensions at infancy (mean 1.8 months) were considered. In a pilot study, shell‐to‐shell distances between the 3D cleft palate objects and a reference mesh were calculated and differences between the groups assessed. Morphological differences were visualized using colour mapping. Results Compared to controls, UCLP subjects presented a higher palate at the level of the anterior scar (P = 0.002), but generally a lower palate in the middle region (P < 0.001). Comparing UCLP subgroups, the DHPC subjects showed a flatter palate posteriorly (P = 0.048) and the EHPC group exhibited more transversal constriction (P = 0.003 at M1 level). 3D analysis revealed a shallower palate in the DHPC group both in the middle (P = 0.002) and the posterior part (P = 0.008). Anterior cleft severity correlated negatively with palatal height (P = 0.01). Conclusions Unilateral cleft lip and palate palates differ from controls in width and height. DHPC may represent an advantage for the transversal dimension, but a disadvantage for palatal height. Infant cleft dimensions partially explain differences in palatal height.

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Other Complications

Rossell-Perry

2022

Atlas of Non-Desirable Outcomes in Cleft Lip and Palate Surgery

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Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 2. Surgical results

Abstract: ISRCTN29932826.

Cited by 70 publications

References 12 publications

Influence of timing of delayed hard palate closure on articulation skills in 3‐year‐old Danish children with unilateral cleft lip and palate

Influence of timing of delayed hard palate closure on articulation skills in 3‐year‐old Danish children with unilateral cleft lip and palate

Palatal morphology in unilateral cleft lip and palate patients: Association with infant cleft dimensions and timing of hard palate repair

Other Complications

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