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1.
Cleft Palate Craniofac J ; 59(4): 453-461, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33887986

RESUMO

OBJECTIVE: This study sought to investigate the association between maxillary growth and speech outcomes for children with a repaired unilateral cleft lip and palate (UCLP) at 5 years of age. PARTICIPANTS: In all, 521 children (180 females and 341 males) with a nonsyndromic complete UCLP, born between 2007 and 2012 in England, Wales, and Northern Ireland were included in this study. OUTCOME MEASURES: Maxillary growth was analyzed using dental models scored by the 5-Year-Olds' index, and perceptual speech analyses were scored by the Cleft Audit Protocol for Speech - Augmented rating. RESULTS: Forty-one percent of the children achieved good maxillary growth (scores 1 and 2 on 5-Year-Old' index). Fifty percent of the children achieved normal speech (achieving UK speech standard 1). Maxillary growth was not found to have an impact on speech outcome when described by the 3 UK National Cleft Lip and Palate Speech Audit Outcome Standards. Analysis according to individual speech parameters showed dentalizations to be less prevalent in children with good maxillary growth compared to fair and poor growth (P = .001). The remaining speech parameters within resonance, nasal airflow, and articulation categories were not significantly associated with maxillary growth. CONCLUSION: The findings from this study suggest that children with a history of complete UCLP, who have poor maxillary growth, are not at a higher risk of having major speech errors compared to children with good or fair maxillary growth at 5 years of age.


Assuntos
Fenda Labial , Fissura Palatina , Criança , Pré-Escolar , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Feminino , Humanos , Masculino , Maxila , Fala
2.
Cleft Palate Craniofac J ; 59(5): 659-668, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34085562

RESUMO

OBJECTIVE: The mainstay of palatal repair in the United Kingdom is the intravelar veloplasty (IVVP). It is not always possible to align the oral mucosa in the midline to achieve tension-free repair. The addition of lateral relieving incisions may aid transposition of the oral mucosa to allow closure. The aim of this study was to explore cleft features that may predispose to a requirement for relieving incisions in order to allow palate closure. DESIGN: We performed a national multiinstitutional retrospective study using data from the UK Cleft Collective cohort study. PATIENTS: The study sample consisted of 474 patients who had undergone IVVP at the time of palatal closure across all 16 of the UK cleft units. RESULTS: We found strong evidence for the requirement for relieving incisions in patients with an increased degree of clefting per the Veau classification (P < .001), increasing palatal soft-edge width (P < .001) and moderate evidence of an associated use in patients with Pierre Robin sequence (P = .015). Insufficient data were available to explore the relationship between intertuberosity distance and the presence of fistula formation with the use of relieving incisions. CONCLUSIONS: The results of this study identify cleft features that increase the likelihood for requiring lateral relieving incisions to allow palatal closure. The degree to which the addition of relieving incisions to IVVP affects maxillary growth and speech outcomes is unknown. Further study is required to answer this important question.


Assuntos
Fissura Palatina , Procedimentos de Cirurgia Plástica , Insuficiência Velofaríngea , Fissura Palatina/cirurgia , Estudos de Coortes , Humanos , Lactente , Complicações Pós-Operatórias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Resultado do Tratamento , Insuficiência Velofaríngea/cirurgia
3.
Cleft Palate Craniofac J ; 58(5): 619-627, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32975452

RESUMO

AIMS: To determine reliability and predictive validity of the 5-year-olds'(5YO) Index and GOSLON Yardstick in 119 patients born with unilateral cleft lip and palate at 5, 7/8, 10, 15/16, and 19 years. METHODS: Five hundred thirty-four dental study models were appraised by 2 teams in 2 centers, twice in each center. Intrateam and interteam reliability in scoring the models was calculated using κ. Dental arch prediction rates were calculated as the proportion of models remaining in the same category (good-scores 1 and 2; fair-score 3; poor-scores 4 and 5) over time. RESULTS: Intrateam and interteam κ statistics ranged from 0.74 to 0.89 and from 0.74 to 0.81, respectively. The 5YO Index and GOSLON Yardstick at 5 years produced almost identical results. The prediction rate of 19-year-old (n = 106) outcome was >80% for those in groups 1 and 2 at 5 years, while for those in groups 4 and 5 prediction was poor (<40%). Prediction of groups 4 and 5 remained poor until 10 years when it increased to 77%. At 15/16 years prediction rate was 93% for those in groups 4 and 5. Prediction of cases in group 3 was very poor at all ages. CONCLUSIONS: These results question the predictive value of "poor" dental arch relationships before 10 years of age. However, the predictive value of "good" dental arch relationship scores over time is good in all age groups. This has implications for audit policies to predict facial growth outcomes.


Assuntos
Fenda Labial , Fissura Palatina , Adulto , Pré-Escolar , Arco Dental , Humanos , Modelos Dentários , Reprodutibilidade dos Testes , Resultado do Tratamento , Adulto Jovem
4.
Cleft Palate Craniofac J ; 57(1): 21-28, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31331191

RESUMO

OBJECTIVE: To determine whether a relationship exists between the aesthetic scores given to photographic records of the nasolabial region of patients with repaired unilateral cleft lip and palate (UCLP) and the 5-Year Olds' Index scores of study models for the same participants. DESIGN: Retrospective study. SETTING: University of Bristol Dental Hospital, United Kingdom. PARTICIPANTS: Patients with nonsyndromic UCLP previously enrolled in the Cleft Care UK (CCUK) Study. METHODS: The CCUK participants, who had both study models and photographs (frontal and worm's eye view), were identified and their records retrieved. These were rated by 2 consultants and 2 senior registrars in orthodontics. The 5-Year Olds' Index was used to score the study models, and at a separate sitting, a 5-point Likert scale was used to score the cropped frontal and worm's eye view photographs of the same children. The results were analyzed using intraclass correlation coefficients and Cohen κ. MAIN OUTCOME MEASURES: Correlation between the aesthetic scores of the photographic views and the concordant 5-Year Olds' Index scores of the study models. RESULTS: The intraclass correlation coefficient scores showed very poor agreement between the photographic views and their concordant study models. The level of inter- and intra-rater reliability was strongest when scoring the study models. CONCLUSIONS: There was no agreement between the scores given to various photographic views and their corresponding study models. Scoring the study models using the 5-Year Olds' Index was the most reliable outcome measure for this age-group.


Assuntos
Fenda Labial , Fissura Palatina , Criança , Estética Dentária , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Reino Unido
5.
Cleft Palate Craniofac J ; 56(2): 248-256, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29750571

RESUMO

OBJECTIVE: Can we reliably discriminate severity within the existing categories of the 5-Year-Olds' Index? DESIGN: Retrospective method comparison and development study. SETTING: School of Oral and Dental Science, University of Bristol. METHODS: Dental study models of 5-year-olds with unilateral cleft lip and palate (UCLP) were collected from the archives of 2 national cleft surveys (n = 351). One hundred randomly selected models were ranked to construct the modified 5-Year-Olds' Index and also scored using a visual analogue scale (VAS). Reliability testing was performed on 51 study models. Visual analogue scale scores were used to aid statistical analysis and investigate the reliability of a VAS for outcome measurement. The modified 5-Year-Olds' Index was then applied to 198 study models of 5-year-olds with UCLP. RESULTS: The modified 5-Year-Olds' Index showed excellent intra and interexaminer agreement (intraclass correlation > 0.94) and good discrimination of severity. When applied to the Cleft Care UK participants (n = 198), the modified 5-Year-Olds' Index showed good discrimination of severity within the better categories (groups 1-3) of the 5-Year-Olds' Index. Visual analogue Scale scores resulted in unacceptable variation between measurements. CONCLUSIONS: The new modified 5-Year-Olds' Index is a reliable method of assessing outcomes at 5 years of age and showed improved discriminatory power between the "better" outcome categories than the original 5-Year-Olds' Index. A VAS was found to be unsuitable for assessing outcome at 5 years of age for children with UCLP.


Assuntos
Fenda Labial , Fissura Palatina , Pré-Escolar , Arco Dental , Humanos , Modelos Dentários , Avaliação de Resultados em Cuidados de Saúde , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
6.
Cleft Palate Craniofac J ; 54(1): 80-89, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-26752135

RESUMO

OBJECTIVE: To assess grommet insertion practice in the first 5 years of life among children with an orofacial cleft in England. DESIGN: Analysis of national administrative data of hospital admissions. SETTING: National Health Service hospitals, England. PATIENTS: Patients born between 1997 and 2005 who underwent surgical cleft repair. INTERVENTION: Children receiving grommets before the age of 5 years. OUTCOME MEASURES: The proportion of children receiving grommets before the age of 5 years, the timing of the first grommet insertion, and the proportion of children having repeat grommet insertions were examined according to cleft type, the absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. RESULTS: The study included 8,269 children. Before the age of 5 years, 3,015 (36.5%) children received grommets. Of these, 33.2% received their first grommets at primary cleft repair and 33.3% underwent multiple grommet insertion procedures. The most common age for the first procedure was between 6 and 12 months. Children with a cleft affecting the palate were more likely to receive grommets than children with a cleft lip alone (45.5% versus 4.5%). Grommet insertion practice also varied according to year of birth, absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. CONCLUSION: Grommets practice in children with a cleft appears to vary according to their clinical characteristics. The differences in practice observed according to deprivation and region of residence need to be further explored.


Assuntos
Fenda Labial/complicações , Fissura Palatina/complicações , Ventilação da Orelha Média/estatística & dados numéricos , Otite Média com Derrame/etiologia , Otite Média com Derrame/prevenção & controle , Pré-Escolar , Inglaterra , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Padrões de Prática Médica/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Resultado do Tratamento
7.
J Orthod ; 44(1): 3-7, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28248619

RESUMO

OBJECTIVES: Pain is a common side effect of orthodontic treatment. An objective of this study, part of a large previously reported RCT on pain and analgesic use, was to determine the effect of anxiety on perceived pain and use of analgesia. METHODS: 1000 patients aged 11-17 years, undergoing upper and lower fixed appliance treatment in nine hospital departments were recruited into this two-arm parallel design randomised controlled trial. One arm was given sugar-free chewing gum and the other arm ibuprofen for pain relief. Neither the clinicians nor patients were blinded to assignment. In addition to recording pain experience and analgesic use for 3 days following appliance placement and first archwire change, each patient recorded their level of anxiety immediately following the fitting of the appliance and the first archwire change. RESULTS: 419 chewing gum group (84%) and 407 ibuprofen group (83%) questionnaires were returned following appliance placement, and 343 chewing gum group (70%) and 341 ibuprofen group (71%) questionnaires were returned following the first archwire change. The mean anxiety scores following fitting of the appliance and first archwire change were 2.7 (SD 2.1) and 1.6 (SD 1.8), respectively. There were weak but significant positive associations between anxiety scores and pain scores. Multi-level modelling produced a coefficient for anxiety of 0.23 (95% CI 0.17-0.28) for appliance placement, suggesting a small rise (0.23) on the 11-point pain scale for a one-point increase on the corresponding anxiety scale. Following archwire change, the corresponding coefficient was 0.32 (0.24-0.39). For ibuprofen use, again simple analyses suggested a relationship with anxiety. Multi-level logistic modelling produced an odds ratio for ibuprofen use of 1.11 (95% CI 1.07-1.15) at appliance placement and 1.21 (1.10-1.33) at the first archwire change. There was a 10-20% increase in the odds of using ibuprofen for each one-point increase on the anxiety scale. No such relationship was found between anxiety and chewing gum use. There were no adverse effects or harms reported during the trial. Approvals were granted by the Research Ethics Committee (08/H0106/139), R&D and MHRA (Eudract 2008-005522-36) and the trial was registered on the ISRCTN (79884739) and NIHR (6631) portfolios. Support was provided by the British Orthodontic Society Foundation. CONCLUSIONS: There was a weak positive correlation between anxiety reported and pain experienced following both the initial fitting of the fixed appliances and at the subsequent archwire change. Patients that were more anxious tended to take more ibuprofen for their pain relief.


Assuntos
Goma de Mascar , Ibuprofeno , Adolescente , Ansiedade , Criança , Humanos , Dor , Sociedades Odontológicas
8.
Am J Orthod Dentofacial Orthop ; 150(2): 220-7, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27476354

RESUMO

INTRODUCTION: The aim of this randomized trial was to investigate the effect of the use of a sugar-free chewing gum vs ibuprofen on reported pain in orthodontic patients. METHODS: This was a 2-arm parallel design randomized controlled trial in 9 sites in the southwest of England. Patients about to undergo orthodontic treatment with maxillary and mandibular fixed appliances were recruited and randomly allocated to an experimental chewing gum group or a control ibuprofen group. Eligibility criteria included patients undergoing fixed maxillary and mandibular appliance therapy, aged 11 to 17 years, and able to use ibuprofen and chewing gum. The primary outcome measure was pain experienced after appliance placement using a mean of 3 recordings on a scale of 0 to 10. Secondary outcome measures were pain experienced in the subsequent 3 days, pain after the first archwire change, ibuprofen use, and appliance breakages. Pain scores were recorded with a questionnaire and posted to a collection center by each patient. Randomization was by means of a central telephone service and comprised computer-generated random numbers used to generate a sequential allocation list, with permuted blocks of variable size (2 and 4) and stratified by center. Neither the clinicians nor the patients were blinded to the intervention. Patients in the control group were permitted to use ibuprofen only, and patients in the experimental group were allowed to use ibuprofen if they did not get sufficient analgesia from the chewing gum. Data were analyzed using the principle of intention to treat with multilevel modeling to reflect the structured nature of the data (scores within patient within site). RESULTS: One thousand patients were recruited and randomized in a ratio of 1:1 to the chewing gum and ibuprofen (control) groups. The male-to-female ratios were similar in the groups. The pain questionnaire response rates were good at approximately 84% and 83% after appliance placement (chewing gum group, 419; ibuprofen group, 407) and 70% and 71% after the first archwire change (chewing gum group, 343; ibuprofen group, 341). The primary outcomes were similar for the 2 groups: mean pain scores, 4.31 in the chewing gum group and 4.17 in the ibuprofen group; difference, 0.14 (95% CI, -0.13 to 0.41). There was a suggestion that the relative pain scores for the 2 groups changed over time, with the chewing gum group experiencing slightly more pain on the day of bond-up and less on the subsequent 3 days; however, the differences had no clinical importance. There were no significant differences for the period after archwire change. The reported use of ibuprofen was less in the chewing gum group than in the ibuprofen group; after appliance placement, the mean numbers of occasions that ibuprofen was used were 2.1 in the chewing gum group and 3.0 in the ibuprofen group (adjusted difference, -0.96 [95% CI, -0.75 to -1.17; P <0.001]); after archwire change, the figures were 0.8 and 1.5 occasions (difference, -0.65 [-0.44 to -0.86; P <0.001]). After appliance placement and the first archwire change, there was no clinically or statistically significant difference in appliance breakages between the chewing gum and ibuprofen groups after either bond-up (7% and 8.8%, respectively) or the first archwire change (4.2% and 5.5%, respectively). No adverse events were reported. CONCLUSIONS: The use of a sugar-free chewing gum may reduce the level of ibuprofen usage but has no clinically or statistically significant effect on bond failures. REGISTRATION: International Standard Randomised Controlled Trial Number (79884739) and National Institute of Health Research (6631) portfolios. FUNDING: This research was supported by an award by the British Orthodontic Society Foundation.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Goma de Mascar , Ibuprofeno/uso terapêutico , Braquetes Ortodônticos/efeitos adversos , Fios Ortodônticos/efeitos adversos , Manejo da Dor/métodos , Técnicas de Movimentação Dentária/instrumentação , Adolescente , Criança , Inglaterra , Falha de Equipamento , Feminino , Humanos , Masculino , Mastigação/fisiologia , Medição da Dor , Resultado do Tratamento
9.
Cochrane Database Syst Rev ; (6): CD002281, 2014 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-24934383

RESUMO

BACKGROUND: Removing dental plaque may play a key role maintaining oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this. This is an update of a Cochrane review first published in 2003, and previously updated in 2005. OBJECTIVES: To compare manual and powered toothbrushes in everyday use, by people of any age, in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost. SEARCH METHODS: We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 23 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE via OVID (1946 to 23 January 2014), EMBASE via OVID (1980 to 23 January 2014) and CINAHL via EBSCO (1980 to 23 January 2014). We searched the US National Institutes of Health Trials Register and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised controlled trials of at least four weeks of unsupervised powered toothbrushing versus manual toothbrushing for oral health in children and adults. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration. Random-effects models were used provided there were four or more studies included in the meta-analysis, otherwise fixed-effect models were used. Data were classed as short term (one to three months) and long term (greater than three months). MAIN RESULTS: Fifty-six trials met the inclusion criteria; 51 trials involving 4624 participants provided data for meta-analysis. Five trials were at low risk of bias, five at high and 46 at unclear risk of bias.There is moderate quality evidence that powered toothbrushes provide a statistically significant benefit compared with manual toothbrushes with regard to the reduction of plaque in both the short term (standardised mean difference (SMD) -0.50 (95% confidence interval (CI) -0.70 to -0.31); 40 trials, n = 2871) and long term (SMD -0.47 (95% CI -0.82 to -0.11; 14 trials, n = 978). These results correspond to an 11% reduction in plaque for the Quigley Hein index (Turesky) in the short term and 21% reduction long term. Both meta-analyses showed high levels of heterogeneity (I(2) = 83% and 86% respectively) that was not explained by the different powered toothbrush type subgroups.With regard to gingivitis, there is moderate quality evidence that powered toothbrushes again provide a statistically significant benefit when compared with manual toothbrushes both in the short term (SMD -0.43 (95% CI -0.60 to -0.25); 44 trials, n = 3345) and long term (SMD -0.21 (95% CI -0.31 to -0.12); 16 trials, n = 1645). This corresponds to a 6% and 11% reduction in gingivitis for the Löe and Silness index respectively. Both meta-analyses showed high levels of heterogeneity (I(2) = 82% and 51% respectively) that was not explained by the different powered toothbrush type subgroups.The number of trials for each type of powered toothbrush varied: side to side (10 trials), counter oscillation (five trials), rotation oscillation (27 trials), circular (two trials), ultrasonic (seven trials), ionic (four trials) and unknown (five trials). The greatest body of evidence was for rotation oscillation brushes which demonstrated a statistically significant reduction in plaque and gingivitis at both time points. AUTHORS' CONCLUSIONS: Powered toothbrushes reduce plaque and gingivitis more than manual toothbrushing in the short and long term. The clinical importance of these findings remains unclear. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and only temporary.


Assuntos
Dispositivos para o Cuidado Bucal Domiciliar/efeitos adversos , Dispositivos para o Cuidado Bucal Domiciliar/economia , Placa Dentária/prevenção & controle , Gengivite/prevenção & controle , Escovação Dentária/instrumentação , Placa Dentária/complicações , Doenças da Gengiva/prevenção & controle , Humanos , Saúde Bucal , Doenças Periodontais/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Escovação Dentária/métodos
10.
Cleft Palate Craniofac J ; 51(3): 270-3, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-23763352

RESUMO

Objective : To establish for the first time the prevalence of fistula symptoms and the effectiveness of secondary alveolar bone grafting to treat these symptoms in a single surgeon cohort in Bristol, United Kingdom. Design : Direct questioning of 233 consecutive patients with cleft before and after secondary alveolar bone grafting as to the presence of fistula symptoms. Setting : Southwest and South Wales Cleft Centre, Frenchay Hospital, Bristol, United Kingdom. Participants : Consecutive patients with cleft who were being treated for secondary alveolar bone grafting. Outcome Measure : Patients reporting presence of fistula symptoms. Data collection on cleft type (unilateral, bilateral), date of birth, and age at secondary alveolar bone grafting. Results : Of the 167 unilateral patients with cleft lip and palate and 66 patients with bilateral cleft lip and palate, 45% had symptoms of a fistula before alveolar bone grafting and 10% had symptoms of a fistula after surgery. There were no statistically significant differences between the presence of symptoms before or after secondary alveolar bone grafting between cleft types or by age at secondary alveolar bone grafting. Conclusion : This is the first study examining the rates of fistula symptoms before and after secondary alveolar bone grafting in the United Kingdom. This study used the patient-centered outcome of the presence of symptoms as a way of measuring the presence of fistulas in this group. Secondary alveolar bone grafting reduces the incidence of symptomatic fistula in this setting.


Assuntos
Enxerto de Osso Alveolar/métodos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Fístula/cirurgia , Doenças Nasais/cirurgia , Fístula Bucal/cirurgia , Medidas de Resultados Relatados pelo Paciente , Adolescente , Adulto , Criança , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação
11.
Int J Paediatr Dent ; 24(3): 200-8, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-23962045

RESUMO

BACKGROUND: Children with clefts have an increased tendency for dental anomalies and caries. AIM: To determine the pattern of hospital admissions for dental treatment during primary dentition among children with clefts. DESIGN: Cohort study based on Hospital Episode Statistics, an administrative database of all admissions to National Health Service hospitals in England. Patients born alive between 1997 and 2003 who had both a cleft diagnosis and cleft repair were included. The number of hospital admissions for surgical removal of teeth, simple extraction of teeth, and restoration of teeth before the age of seven was examined. RESULTS: Eight hundred and fifty-eight hospital admissions for dental treatment among 6551 children (<7 year) with a cleft were identified. 66.4% of admissions were primarily for caries and 95.6% involved extractions. 11.4% of children had at least one admission for dental treatment. The presence of additional anomalies, having a more severe cleft type, and living in relatively deprived areas increased the risk of hospital admission. CONCLUSIONS: Factors increasing the risk of hospital admission among cleft children should be taken into account when planning services. Efforts to reduce the number of hospital admissions should be focused on disease prevention, particularly among those most at risk of caries.


Assuntos
Fenda Labial/terapia , Fissura Palatina/terapia , Hospitalização , Admissão do Paciente , Doenças Estomatognáticas/terapia , Criança , Fenda Labial/complicações , Fissura Palatina/complicações , Estudos de Coortes , Inglaterra , Humanos , Classe Social , Doenças Estomatognáticas/complicações
12.
J Orthod ; 41(2): 128-40, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24521752

RESUMO

This article provides a summary of the main outcome measures currently available and in use within modern cleft care. The fact that there are such a diverse range, including surgical, orthodontic, dental, speech and patient satisfaction measures, is a reflection of the complex, multidisciplinary and longitudinal nature of the care provided. The use of such measures of outcome is essential in the auditing and drive for continued improvements in the standards of care for patients affected with cleft lip and palate.


Assuntos
Fenda Labial/terapia , Fissura Palatina/terapia , Avaliação de Resultados em Cuidados de Saúde , Fenda Labial/psicologia , Fenda Labial/cirurgia , Fissura Palatina/psicologia , Fissura Palatina/cirurgia , Auditoria Clínica , Humanos , Ortodontia Corretiva , Satisfação do Paciente , Fonoterapia , Padrão de Cuidado , Reino Unido
13.
Plast Reconstr Surg Glob Open ; 12(2): e5589, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38322814

RESUMO

Background: There is debate amongst surgeons regarding the use of antibiotics to prevent fistulae after palatoplasty. Prescribing should be evidence based, as antibiotic stewardship is integral to reducing antibiotic resistance. Our aim was to determine whether differing perioperative regimens affect the prevalence of postoperative fistulae. Methods: The sample comprised participants from the Cleft Collective who had undergone palatoplasty. Participants were recruited across all 16 UK cleft centers between 2013 and 2021. The exposure was perioperative antibiotic regimen prescribed at the time of palatoplasty. The primary outcome was the presence of palatal fistula. Results: Fistula data were available for 167 participants when exploring antibiotic regimen and for 159 when exploring antibiotic agent. There was no evidence to suggest a difference in fistula rate between those receiving antibiotics on induction only versus as an inpatient or up to 7 days postoperatively (χ2 = 4.57; P = 0.10). There was no evidence to suggest a difference in fistula rate between those who received co-amoxiclav and those who had an alternative antibiotic (χ2 = 0.16; P = 0.69). Postoperative fistulae increased with the extent of the cleft (χ2 = 20.39; P < 0.001). When adjusting for cleft type, no evidence of an association between antibiotic regimen and fistulae was found (inpatient antibiotics: OR 1.36; 95% confidence interval, 0.53-3.51; antibiotics up to 7 days postoperatively: OR 0.68; 95% confidence interval, 0.26-1.80). Conclusions: The choice of antibiotic and dosing regimen does not influence the formation of postoperative fistulae. These results should be supported by interventional trials.

14.
Arch Dis Child ; 108(1): 42-46, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36376018

RESUMO

OBJECTIVES: To determine the prevalence of syndromic Robin sequence (RS) in the UK and if this group of patients had an increased need for airway and feeding management compared with a non-syndromic RS cohort. DESIGN: A prospective national multicentre study of cases submitted to the Cleft Collective cohort studies. SETTING: Specialist cleft services in the UK. PATIENTS: 259 participants who fulfilled the diagnosis of RS. This group was compared with 548 participants with cleft palate only (CPO). MAIN OUTCOME MEASURES: The primary outcome measure was the presence of a syndrome in patients with RS and CPO. Secondary outcome measures included the use of airway and feeding adjuncts. RESULTS: An associated syndrome was seen in 28% of patients with RS and 14% of patients with CPO. The most common syndrome for the RS group was Stickler syndrome (27%). Syndromic status was significantly higher among patients with RS compared with those with CPO (OR 2.36, 95% CI 1.65 to 3.39; p<0.001). Patients with syndromic RS have an increased reliance on airway adjuncts compared with the patients without syndromic RS (OR 2.02, 95% CI 1.13 to 3.64; p=0.018). There was no evidence of a difference in the use of feeding adjuncts between syndromic and non-syndromic RS groups (OR 2.43, 95% CI 0.78 to 7.58; p=0.126). CONCLUSION: The presence of a syndrome has implications for management of patients with RS. Early identification of a syndrome may help prevent the consequences of a missed syndromic diagnosis. Routine ophthalmological and genetic screening for Stickler syndrome should be mandatory for all patients with RS.


Assuntos
Fissura Palatina , Síndrome de Pierre Robin , Humanos , Síndrome de Pierre Robin/complicações , Síndrome de Pierre Robin/diagnóstico , Síndrome de Pierre Robin/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Fissura Palatina/complicações , Fissura Palatina/epidemiologia , Estudos de Coortes
15.
Arch Dis Child ; 108(7): 563-568, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37068923

RESUMO

OBJECTIVES: (1) To explore differences in educational attainment between children born with isolated clefts and the general population at ages 5, 7 and 11 years; (2) to describe longitudinal changes in attainment among children with cleft through primary education. DESIGN: Analysis of Cleft Registry and Audit Network data linked to national educational outcomes. SETTING: English state schools. PATIENTS: 832 children born with isolated cleft, aged 5 years in 2006-2008. MAIN OUTCOME MEASURES: Difference in teacher-assessed attainment between children with a cleft and general population at each age, for all children and by cleft type. Percentage of children with low attainment at age 5 years who had low attainment at age 11 years, for all children and by cleft type. RESULTS: Children with a cleft had lower attainment than the general population in all subject areas (Z-score range: -0.29 (95% CI -0.36 to -0.22) to -0.22 (95% CI -0.29 to -0.14)). This difference remained consistent in size at all ages, and was larger among children with a cleft affecting the palate (cleft palate/cleft lip and palate (CP/CLP)) than those with a cleft lip (CL). Of 216 children with low attainment in any subject at age 5 years, 54.2% had low attainment in at least one subject at age 11 years. Compared with children with CL, those with CP/CLP were more likely to have persistent low attainment. CONCLUSIONS: An educational attainment gap for children born with isolated clefts is evident throughout primary education. Almost half of children with low attainment at age 5 years achieve normal attainment at age 11 years.


Assuntos
Sucesso Acadêmico , Fenda Labial , Fissura Palatina , Humanos , Criança , Pré-Escolar , Estudos de Coortes , Escolaridade
16.
BMC Health Serv Res ; 12: 148, 2012 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-22682355

RESUMO

BACKGROUND: In 1998, a process of centralisation was initiated for services for children born with a cleft lip or palate in the UK. We studied the timing of this process in England according to its impact on the number of hospitals and surgeons involved in primary surgical repairs. METHODS: All live born patients with a cleft lip and/or palate born between April 1997 and December 2008 were identified in Hospital Episode Statistics, the database of admissions to English National Health Service hospitals. Children were included if they had diagnostic codes for a cleft as well as procedure codes for a primary surgical cleft repair. Children with codes indicating additional congenital anomalies or syndromes were excluded as their additional problems could have determined when and where they were treated. RESULTS: We identified 10,892 children with a cleft. 21.0% were excluded because of additional anomalies or syndromes. Of the remaining 8,606 patients, 30.4% had a surgical lip repair only, 41.7% a palate repair only, and 28.0% both a lip and palate repair. The number of hospitals that carried out these primary repairs reduced from 49 in 1997 to 13, with 11 of these performing repairs on at least 40 children born in 2008. The number of surgeons responsible for repairs reduced from 98 to 26, with 22 performing repairs on at least 20 children born in 2008. In the same period, average length of hospital stay reduced from 3.8 to 3.0 days for primary lip repairs, from 3.8 to 3.3 days for primary palate repairs, and from 4.6 to 2.6 days for combined repairs with no evidence for a change in emergency readmission rates. The speed of centralisation varied with the earliest of the nine regions completing it in 2001 and the last in 2007. CONCLUSIONS: Between 1998 and 2007, cleft services in England were centralised. According to a survey among patients' parents, the quality of cleft care improved in the same period. Surgical care became more consistent with current recommendations. However, key outcomes, including facial appearance and speech, can only be assessed many years after the initial surgical treatment.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Hospitais Especializados/estatística & dados numéricos , Programas Médicos Regionais/estatística & dados numéricos , Cirurgia Plástica/normas , Adulto , Pré-Escolar , Fenda Labial/classificação , Fenda Labial/epidemiologia , Fissura Palatina/classificação , Fissura Palatina/epidemiologia , Aconselhamento , Inglaterra/epidemiologia , Feminino , Pesquisas sobre Atenção à Saúde , Hospitais Especializados/tendências , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Masculino , Programas Nacionais de Saúde , Relações Pais-Filho , Pais , Admissão do Paciente/estatística & dados numéricos , Cirurgia Plástica/estatística & dados numéricos
17.
Cochrane Database Syst Rev ; (6): CD008050, 2011 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-21678372

RESUMO

BACKGROUND: Secondary alveolar bone grafting has been widely used to reconstruct alveolar cleft. However, there is still some controversy. OBJECTIVES: To compare the effectiveness and safety of different secondary bone grafting methods. SEARCH STRATEGY: The final electronic and handsearches were carried out on 11 February 2011, and included the Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Chinese Biomedical Literature Database and WHO International Clinical Trials Registry Platform. All the Chinese professional journals in the oral and dental field were handsearched and conference proceedings consulted. There was no language or time restriction. SELECTION CRITERIA: Only randomized clinical trials were selected. Patients with the diagnosis of cleft lip and alveolar process only, unilateral cleft lip and palate and bilateral cleft lip and palate involving the alveolar process and greater than 5 years of age were included. DATA COLLECTION AND ANALYSIS: Two review authors extracted data and assessed the quality of included studies independently. Disagreement between the two review authors was resolved by discussion in the review team. The first authors of the included studies were contacted for additional information, if necessary. MAIN RESULTS: Two of 582 potential studies met the inclusion criteria and were included. One trial compared alveolar bone grafting using artificial materials (InFuse bone graft substitute impregnated with BMP-2) with a traditional iliac graft. The other trial investigated the application of fibrin glue to the bone graft. Both trials were small with 21 and 27 patients and were assessed as being at high risk of bias. Any apparent differences between the interventions for outcomes in either study must therefore be treated with great caution and are not highlighted here. AUTHORS' CONCLUSIONS: Due to the high level of risk of bias in the two included trials there is insufficient evidence to conclude that one intervention is superior to another.


Assuntos
Processo Alveolar/cirurgia , Transplante Ósseo/métodos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Adolescente , Aumento do Rebordo Alveolar/métodos , Proteína Morfogenética Óssea 2/uso terapêutico , Criança , Adesivo Tecidual de Fibrina/uso terapêutico , Humanos , Ílio/transplante , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Arch Dis Child ; 106(2): 154-159, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32816695

RESUMO

OBJECTIVES: To examine school absence and academic achievement among 7-year-old children with isolated orofacial clefts in England. DESIGN: Analysis of educational data linked to national cleft registry and administrative hospital data. SETTING: English state schools. PATIENTS: 3523 children with isolated clefts aged 7 years between 2006 and 2014. MAIN OUTCOME MEASURES: Annual school absence and reaching the national 'expected level' according to teacher-assessed academic achievement. RESULTS: Children with isolated clefts had higher mean annual school absence (10.5 days) than their peers in the national population (8.9 days). Total absence was higher in children with a cleft lip and palate (CLP; 11.3 days) or with a cleft palate only (CPO; 10.5 days) than in children with a cleft lip only (CLO; 9.5 days). The percentage reaching the expected academic level decreased with increasing school absence (from 77.4% (923/1192) with annual school absence ≤5 days to 43.4% (193/445) with annual school absence >20 days). However, differences in school absence did not explain that children with CPO (65.9% reaching expected level) or CLP (66.1% reaching expected level) had poorer levels of academic achievement than children with CLO (73.5% reaching expected level). Children with a cleft were twice as often recognised as having special education needs (40.5%) than their peers (21.6%). CONCLUSIONS: School absence and cleft type are both independently associated with school attainment at 7 years. Children with an isolated cleft, especially when the palate is involved, and those with high levels of school absence may benefit from increased support addressing their educational needs.


Assuntos
Absenteísmo , Sucesso Acadêmico , Fenda Labial/psicologia , Fissura Palatina/psicologia , Criança , Fenda Labial/complicações , Fissura Palatina/complicações , Bases de Dados Factuais , Inglaterra , Feminino , Hospitalização , Humanos , Masculino , Medicina Estatal
19.
Cochrane Database Syst Rev ; (12): CD004971, 2010 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-21154357

RESUMO

BACKGROUND: Powered brushes were first introduced commercially in the 1960s. A recent systematic review suggested the superiority of certain modes of powered over manual toothbrushing for plaque and gingivitis reduction. That review did not allow for direct comparison between different modes of powered toothbrush. OBJECTIVES: To compare different modes of powered toothbrushing against each other for plaque reduction and the health of the gingivae. Other factors to be assessed were calculus and stain removal, cost, dependability and adverse effects. SEARCH STRATEGY: The following databases were searched: Cochrane Oral Health Group's Trials Register (to 26 July 2010); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3); MEDLINE via OVID (1950 to 26 July 2010); EMBASE via OVID (1980 to 26 July 2010); CINAHL via EBSCO (1982 to 26 July 2010). There were no language restrictions. SELECTION CRITERIA: Trials were considered for inclusion with the following criteria: random allocation of participants; no compromised manual dexterity; unsupervised powered toothbrushing for at least 4 weeks. The primary outcomes were the plaque and gingivitis scores after powered toothbrush use during trial period. DATA COLLECTION AND ANALYSIS: Data extraction was performed independently and in duplicate. The authors of trials were contacted to provide missing data where possible. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using the random-effects model. Potential sources of heterogeneity were assessed. MAIN RESULTS: The review included data from 15 trials with 1015 participants. Due to the dearth of trials assessing the same mode of action, no definitive conclusions can be stated regarding the superiority of one mode of powered toothbrush over any other. Only minor and transient side effects were reported. Cost, dependability were not reported. AUTHORS' CONCLUSIONS: Further trials of good quality are required to establish if any mode of action has superiority over the other modes of action for powered toothbrushes.


Assuntos
Dispositivos para o Cuidado Bucal Domiciliar , Placa Dentária/prevenção & controle , Gengivite/prevenção & controle , Escovação Dentária/instrumentação , Dispositivos para o Cuidado Bucal Domiciliar/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Escovação Dentária/efeitos adversos
20.
Cleft Palate Craniofac J ; 47(4): 359-62, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20166811

RESUMO

OBJECTIVE: In 1998 the delivery of cleft care in the United Kingdom was examined by the Clinical Standards Advisory Group, the outcomes of which led to the wide restructuring of cleft services in the United Kingdom. We present a retrospective study evaluating the radiographic outcome of 53 consecutively performed alveolar bone grafts following the regional centralization of secondary alveolar bone grafting to the South West Cleft Centre between 2004 and 2006. METHODS: A retrospective audit of one surgeon's outcome of 53 consecutively performed alveolar bone grafts, assessed radiographically using the Kindelan method. RESULTS: That 94% of bone-grafted sites achieved a successful radiographic outcome compares favorably with the previously published Clinical Standards Advisory Group data of 58% with Bergland scores. CONCLUSION: The radiographic outcome for alveolar bone grafting has improved with centralization. A small number of patients are being grafted after the ideal chronological age, and this needs to be addressed throughout the region. The Kindelan assessment provides a reliable method of early assessment for alveolar bone grafting.


Assuntos
Enxerto de Osso Alveolar , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Adolescente , Criança , Fenda Labial/diagnóstico por imagem , Fissura Palatina/diagnóstico por imagem , Feminino , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido
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