ABSTRACT
INTRODUCTION: Chronic otitis media with effusion (OME) is a recurrent complication, usually found in cleft palate patients.Conductive hearing loss is the result of the Eustachian tube dysfunction caused by the absence of fusion and the altered insertion of the muscles of the secondary palate. It is also the consequence of an ineffective muscular reconstruction after primary cleft palate repair. METHODS: This is a cohort study to compare 4 groups of patients born with isolated cleft lip (ICL), unilateral cleft lip/palate (UCLP), bilateral cleft lip/palate (BCLP), and isolated cleft palate (ICP), received in our hospital between June 2015 to September 2017, operated by the same surgeon, using the same surgical technique and protocol.Complete cleft palate repair was performed, in average, at 10 months, and placement of ventilation tubes, if necessary, was made in the same operatory act.After palate repair, primary or secondary hearing loss was checked, joint to the connection with the type of used ventilation tubes, recurrences and complications also were considered. RESULTS: The study sample was integrated by 69 patients, 2 of 11 patients with ICL (18.18%), 30 of 34 patients with UCLP (88.23%), 17 of 19 patients with BCLP (89.47%), and 4 of 5 patients with ICP (80.00%) were diagnosed with OME requiring ventilation tubes at the time of surgery. It can be established that the average hearing loss in patients with diabolos in the postoperative period is 19.4 db and in those patients with T tubes it is 14.2 db, the difference being statistically significant (Pâ<â0.05). CONCLUSION: Hearing improvement prior to language acquisition is essential for a proper speech development. Early trans tympanic tubes implantation during cleft palate repair contributes to a correct short-term ventilation of the middle ear, being the T tubes the best option.
Subject(s)
Cleft Lip/surgery , Cleft Palate , Hearing Loss, Conductive , Middle Ear Ventilation/methods , Otitis Media with Effusion , Plastic Surgery Procedures/methods , Argentina/epidemiology , Audiometry/methods , Child , Child, Preschool , Cleft Palate/complications , Cleft Palate/diagnosis , Cleft Palate/physiopathology , Cleft Palate/surgery , Cohort Studies , Female , Hearing Loss/etiology , Hearing Loss, Conductive/diagnosis , Hearing Loss, Conductive/etiology , Humans , Infant , Male , Otitis Media with Effusion/diagnosis , Otitis Media with Effusion/etiology , Otitis Media with Effusion/physiopathology , Otitis Media with Effusion/therapy , Perioperative Period , Treatment Outcome , Tympanic Membrane/diagnostic imagingABSTRACT
Las fisuras labio-alvéolo-palatinas (FLAP) son anomalías congénitas que tienen una frecuencia estimada, mundial, de 1/500 a 1/2500 nacidos vivos y una etiología que involucra factores genéticos, ambientales. Objetivo General: Estudiar la complejidad de la rehabilitación del paciente FLAP que concurre a servicios adheridos a la Red. Metodología: la Red de Servicios de Rehabilitación de pacientes FLAP, diseñada y organizada en la primera etapa del proyecto ha proporcionado por medio de su registro epidemiológico la información básica de 970 pacientes. Resultados: La fisura de paladar con labio fisurado (Q.37) es el diagnóstico más frecuente con el 70 por ciento, la fisura de paladar (Q.35) el 17,8 por ciento y labio fisurado (Q36) 11,3 por ciento. En el 20,3 por ciento de los casos hubo malformaciones asociadas. La colocación de "placa ortopédica" y "placa con tutor nasal" fueron aplicados en el 83 por ciento de los casos. La cirugía de labio en el 60 por ciento de los casos fue realizada en tiempo y oportunidad, antes de los 6 meses de vida. En "labio unilateral" el tipo de cirugía más empleado fue de "rotación y avance" en el 40 por ciento. El 70 por ciento (32) de los casos de niños de 1 a 8 años de edad recibió "Cirugía Secundaria".
Oral clefts, in particular clefts lip and palate, are mayor birth defects with a variable prevalence ranging from 1 in 500 to 1 in 2500 newborns. Oral clefts include syndromic or isolated forms; both genes and environmental exposures are involved in their complex etiology. Objective: The objective of the present study is to organize a network of rehabilitation services of patients with FLAP. Methodology: The Network of Rehabilitation Services, designed and organized in the first phase of the project, has provided basic information of 970 patients by means of one epidemiologic register. Results: Palatal fissure with fissured lip (Q.37) is the most frequent diagnostic with 70 per cent of the cases; palatal fissure (Q35) with 17.8 per cent, and fissured lip (Q36) with 11.3 per cent. In 20.3 per cent of cases there were associated malformations. Placing of "orthopaedic plate" and "plate with nasal tutor" was applied to 83 per cent of the cases. The 60 per cent of surgery of lip was made in time and opportunity, before the 6 months of life. The most utilized method of surgery in "unilateral lip" was "rotation and advance" in 40 per cent of the cases. The 70 per cent (32) of the cases of children from 1 to 8 years old have received Secondary Surgery.
