The effect of 1-stage versus 2-stage palate repair on facial growth in patients with cleft lip and palate: a review

Yang, I-Ying; Liao, Yu‐Fang

doi:10.1016/j.ijom.2010.04.053

Cited by 38 publications

(20 citation statements)

References 24 publications

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“…This can be quantified as a reduced frequency of Le Fort I type osteotomy advancements after the secondary growth spurt. Due to the heterogeneity of published articles, Yang and Liao (2010) concluded that there is no evidence to support one technique over the other regarding anteroposterior jaw relationships. Others suggest that early 1-stage palatoplasty might improve speech results (Chapman et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

“…According to Yang and Liao (2010), patients treated by the senior surgeon had fewer fistulas than those treated by the resident (trainee) surgeon (2% vs 11%). Rintala and Haapanen (1995) reported a 36% fistula rate in a resident group compared to 33% in a specialist group, but the difference in the reoperation rates of specialists and residents was statistically significant.…”

Section: Discussionmentioning

confidence: 99%

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On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair

Tache

Mommaerts

2019

The Cleft Palate-Craniofacial Journal

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Objective: The aims of the study were to assess the postoperative oronasal fistula rate after 1-stage and 2-stage cleft palate repair and identify risk factors associated with its development. Design: Systematic review. Setting: Various primary cleft and craniofacial centers in the world. Patients, Participants: Syndromic and nonsyndromic cleft lip, alveolus, and palate patients who had undergone primary cleft palate surgery. Intervention: Assessment of oronasal fistula frequency and correlation with staging, timing, and technique of repair, gender, and Veau type. The results obtained in this systematic review were compared with those in previous reports. Outcome: The main outcome is represented by the occurrence of the oronasal fistula after 1-stage versus 2-stage palatoplasty. Results: The mean fistula percentage was 9.94%. In the Veau I, II, III, and IV groups, the respective fistula rates were 2%, 7.3%, 8.3%, and 12.5%. Oronasal fistula locations based on the Pittsburgh Fistula Classification System were soft palate (type II), 16.2%; soft palate–hard palate junction (type III), 29.3%; and hard palate (type IV), 37.3%. There were no statistically significant differences between 1-stage and 2-stage palatoplasty, syndromic and nonsyndromic, or male and female patients. Primary palatoplasty timing was not a significant predictor. Conclusion: Some disparities arose when comparing studies, mainly regarding location and types of clefting prone to oronasal fistulation. Interestingly, the fistula rate does not differ between 1- and 2-stage closure, and timing of the repair does not play a role.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair

Tache

Mommaerts

2019

The Cleft Palate-Craniofacial Journal

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“…4 Relationship between Goslon Yardstick scores depending on palatoplasty method used and selection of protraction facemask in patients with UCLP delay in the closure of the hard palate may affect pronunciation and intelligence 2,3,15,30,31) . Numerous studies have cited results regarding assessment of growth and function, but a definitive answer has yet to emerge 9,13,14,19,27,33) . In addition, orthodontic treatment in patients with UCLP can be presumed to involve greater complexity than in those without.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Orthodontic Treatment Plan and Goslon Yardstick Assessment in Japanese Patients with Unilateral Cleft Lip and Palate: One-stage vs. Two-stage Palatoplasty

Ishii¹,

Sakamoto²,

Ishikawa³

et al. 2016

Bull. Tokyo Dent. Coll.

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The present study targeted patients with unilateral cleft lip and palate (UCLP) undergoing either one - (Wardill technique) or two-stage palatoplasty (Perko technique). Correlations between Goslon Yardstick scores and orthodontic appliances used and whether an osteotomy was performed were investigated. No differences were observed between the two types of palatoplasty in terms of Goslon Yardstick scores. A palatal expander and protraction facemask were used in Phase I of orthodontic treatment. The palatal expander was selected for most patients with UCLP in Phase I, regardless of the surgical technique used. A protraction facemask was used in patients undergoing the Wardill procedure who had a Goslon Yardstick score placing them in Group 3 or 4. In contrast, a protraction facemask was used in patients undergoing the Perko procedure who had a Goslon Yardstick score placing them in Group 4. No significant differences were observed in the Goslon Yardstick scores yielded by either type of procedure. The Goslon Yardstick score in relation to whether an osteotomy was performed in Phase II as part of orthodontic treatment was determined, focusing on the relationship between that score and the palatoplasty method used. A protraction facemask was used in patients undergoing the Perko procedure, which eliminated the need for an osteotomy at a future date. However, a protraction facemask was also used in patients undergoing the Wardill option, and those patients were likely to require an osteotomy. In other words, the results suggest that the type of palatoplasty selected will determine the effectiveness of any orthodontic appliances used.

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“…One technique that may affect the risk of developing a fistula is 2-stage palate repair or delayed hard palate closure, here referred to as 2-stage surgery. Although the primary reason for 2-stage surgery is to minimize the risk of maxillary hypoplasia (Yang and Liao, 2010), a difference in the risk of fistula development may contribute to surgical decision-making. Further, understanding the risk reduction that may be associated with single- or 2-stage surgery would also be of value in shared decision-making with parents.…”

Section: Introductionmentioning

confidence: 99%

Oronasal Fistula Risk After Palate Repair

Pollard

Skirko

Dance

et al. 2020

The Cleft Palate-Craniofacial Journal

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Objective: To assess risk factors for oronasal fistula, including 2-stage palate repair. Design: Retrospective analysis. Setting: Tertiary children’s hospital. Patients: Patients with non-submucosal cleft palate whose entire cleft repair was completed at the study hospital between 2005 and 2013 with postsurgical follow-up. Interventions: Hierarchical binary logistic regression assessed predictive value of variables for fistula. Variables tested for inclusion were 2 stage repair, Veau classification, sex, age at surgery 1, age at surgery 2, surgeon volume, surgeon, insurance status, socioeconomic status, and syndrome. Variables were added to the model in order of significance and retained if significant at a .05 level. Main Outcome Measure: Postoperative fistula. Results: Of 584 palate repairs, 505 (87%) had follow-up, with an overall fistula rate of 10.1% (n = 51). Among single-stage repairs (n = 211), the fistula rate was 6.7%; it was 12.6% in 2-stage repairs (n = 294, P = .03). In the final model utilizing both single-stage and 2-stage patient data, significant predictors of fistula were 2-stage repair (odds ratio [OR]: 2.5, P = .012), surgeon volume, and surgeon. When examining only single-stage patients, higher surgeon volume was protective against fistula. In the model examining 2-stage patients, surgeon and age at hard palate repair were significant; older age at hard palate closure was protective for fistula, with an OR of 0.82 ( P = .046) for each additional 6 months in age at repair. Conclusions: Two-stage surgery, surgeon, and surgeon volume were significant predictors of fistula occurrence in all children, and older age at hard palate repair was protective in those with 2-stage repair.

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The effect of 1-stage versus 2-stage palate repair on facial growth in patients with cleft lip and palate: a review

Cited by 38 publications

References 24 publications

On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair

On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair

Relationship between Orthodontic Treatment Plan and Goslon Yardstick Assessment in Japanese Patients with Unilateral Cleft Lip and Palate: One-stage vs. Two-stage Palatoplasty

Oronasal Fistula Risk After Palate Repair

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