Cleft Palate Craniofac. J. [JOURNAL]
Sun
200 papers
Prostaglandin-E2 Mediated Inflammatory Response and Vas-Reported Pain During Rapid Maxillary Expansion in Patients with and Without Cleft: Prospective Cohort Study.
Ramachandran N, Siva Subramanian C, Kailasam V … +1 more , Nalabothu P
Cleft Palate Craniofac J · 2026 May · PMID 42108663 · Publisher ↗
ObjectiveTo compare subjective pain perception and local inflammatory response during rapid maxillary expansion (RME) in patients with and without cleft defects.DesignProspective cohort study.SettingInstitutional clinica...
ObjectiveTo compare subjective pain perception and local inflammatory response during rapid maxillary expansion (RME) in patients with and without cleft defects.DesignProspective cohort study.SettingInstitutional clinical setting.ParticipantsSixteen patients were equally allocated to cleft and non-cleft groups (mean age: 9.5 ± 1.9 and 10.5 ± 1.2 years, respectively).InterventionsAll patients underwent tooth-borne rapid maxillary expansion using a standardised activation protocol of two turns per day (0.5 mm/day).Main Outcomes MeasuresLocal inflammatory response was assessed by measuring prostaglandin E2 (PGE2) levels, while subjective pain was evaluated using a visual analogue scale (VAS). Measurements were recorded at baseline (T0), 1 day after the first activation (T1), at 7 days (T2), 14 days (T3), and 5 days after the final activation (T4).ResultsPGE2 peaked at T1 in both groups (cleft = 91.91 ± 48.52 pg/ml, non-cleft = 95.20 ± 53.98 pg/ml), then declined through T4. The values were higher in the non-cleft group, but not significant. VAS scores were significantly higher in the non-cleft group compared to the cleft group at T1 (4.50 ± 0.76 and 3.25 ± 1.67, respectively; p = 0.021), with no significant differences at T2 and T3. By T4, pain levels were minimal in both groups. Pearson correlation demonstrated a weak association between PGE2 levels and VAS scores.ConclusionsPatients without cleft experienced higher subjective pain only after initial RME activation, while local inflammatory responses were comparable between groups throughout treatment.Clinical Trial RegistrationThe Clinical Trials Registry- India (CTRI/2024/06/068906).
Intra- and Inter-Rater Reliability and Validation of Orofacial Cleft Classification in the Cleft Collective Cohort Study.
Davies A, Sainsbury D, Cleft Multidisciplinary Collaborative … +7 more , Medina J, Russell C, Humphries K, Fitzsimons KJ, Sandy J, Deacon S, Wren Y
Cleft Palate Craniofac J · 2026 May · PMID 42108616 · Publisher ↗
ObjectiveAssess the level of agreement for classification of orofacial clefts within and between different raters and validate classifications.DesignValidation study.SettingNational longitudinal prospective cohort, Unite...
ObjectiveAssess the level of agreement for classification of orofacial clefts within and between different raters and validate classifications.DesignValidation study.SettingNational longitudinal prospective cohort, United Kingdom.ParticipantsChildren born with orofacial cleft (n=4211), recruited to the Cleft Collective between 2013 and 2024.Main outcome measuresFour cleft classifications of orofacial clefts were explored. Classification one comprised cleft lip, cleft palate, and cleft lip and palate. Classification two added laterality, classification three added sidedness and classification four added completeness using LAHSAL. Data on orofacial cleft classification were collected through seven different sources.ResultsAt least one report of cleft classification was available for 4052 Cleft Collective study children. When assessing intra-rater agreement mothers had the highest level of agreement for the simplest form of cleft classification with a Krippendorf's Alpha of 0.987. When recording LAHSAL for the same child, surgeons reported the same classification for 71% of children (Krippendorf's Alpha = 0.672). When assessing inter-rater agreement across different sources, the simplest cleft classification resulted in the highest level of agreement (Krippendorf's Alpha = 0.957) and the least agreement when using LAHSAL (Krippendorf's Alpha = 0.538).ConclusionOur study found that the more complex a cleft classification becomes the less agreement there is between sources. Differences across sources became most apparent when reporting the sidedness or completeness of a cleft. Validation of cleft classification is important for both clinical care and research. Although LAHSAL is advocated for use both clinically and in research our data show that rigorous training is essential.
Assessment of Palatal Hard and Soft Tissue Thickness for Miniscrew Placement in Patients With Unilateral Cleft Lip and Palate.
Singla R, Nagesh S, R N
Cleft Palate Craniofac J · 2026 May · PMID 42104757 · Publisher ↗
ObjectiveTo identify a safe zones in the palate for placement of temporary anchorage devices (TADs) based on hard tissue (HT) and soft tissue thickness (ST) in patients with unilateral cleft lip and palate (UCLP).DesignR...
ObjectiveTo identify a safe zones in the palate for placement of temporary anchorage devices (TADs) based on hard tissue (HT) and soft tissue thickness (ST) in patients with unilateral cleft lip and palate (UCLP).DesignRetrospective, observational.SettingTertiary care dental teaching hospital.Patients, ParticipantsForty patients with non-syndromic UCLP, including 20 left-sided (LUCLP) and 20 right-sided (RUCLP) groups, where 26 were males and 14 were females.Materials and MethodsCone beam computed tomography (CBCT) scans were analyzed using a uniform grid mapping comprising of 15 palatal zones. The HT and ST were measured at each zone. Comparisons between the genders within the groups were performed using the Mann-Whitney U-test. Comparison of the HT and ST values across the zones was done using the Kruskal-Wallis test followed by post Dunn post hoc test. The HT/ST ratio was calculated to identify optimal sites for TAD placement.ResultsStatistically significant gender-based variations and inter-zonal variations in HT and ST were observed in both LUCLP and RUCLP groups. Based on HT/ST ratios, the anterior paramedian region on the non-cleft side (zones 4 and 5 in LUCLP; zone 13 in RUCLP) demonstrated the most favorable soft-tissue to bone relationship for TAD placement.ConclusionsPatients with UCLP exhibit site-specific and gender-related variations in palatal HT and ST. The anterior paramedian region on the non-cleft side represents the most favorable location for palatal TAD placement.
Effect of Nutrition Care Process on Surgical Timing in Infants with Cleft Lip and Palate in North Karnataka, India.
Uppin KV, Powar RS, Bellad RM … +4 more , Nilgar AB, Carvalho AM, Jadinavar LR, Badanatti MB
Cleft Palate Craniofac J · 2026 May · PMID 42104755 · Publisher ↗
ObjectiveTo study the effect of nutrition care process (NCP) on cleft repair timing.DesignQuasi-experimental design.SettingTertiary care hospital with an operational cleft unit.Participants47 mothers of infants aged 0-6...
ObjectiveTo study the effect of nutrition care process (NCP) on cleft repair timing.DesignQuasi-experimental design.SettingTertiary care hospital with an operational cleft unit.Participants47 mothers of infants aged 0-6 months with cleft lip and palate who fulfilled the eligibility criteria.InterventionsDuring the baseline visit, anthropometric measurements of the infant were recorded, and World Health Organization (WHO) scores were plotted to identify their nutritional status. Nutritional education according to NCP was imparted to the mothers. In subsequent visits, growth of infants was monitored by anthropometry, education was reiterated and errors rectified. Right surgical timing was classified as on time or delayed according to age in months at surgery. Data collected were analyzed in SPSS software.Main Outcome Measure(s)Nutritional status, timely surgical readiness, educational level regarding nutrition, and feeding techniques.ResultsAmong the 47 infants, malnutrition improved from 55.3% mild, 29.8% moderate, and 14.9% severe at the first visit to 66% mild at lip surgery and 70.2% mild at palate surgery, with 68.1% and 70.2% infants respectively achieving timely surgical readiness. Infants with cleft showed consistently lower mean weights than the WHO standards at birth, lip, and palate surgery which was statistically significant (001) indicating persistent growth faltering that was more pronounced among males. Mother's education level was significantly associated with timely surgery (χ2 = 7.964, 047).ConclusionNutrition education effectively assisted infants in attaining the weight necessary for corrective surgery.
Conservative Prosthodontic Rehabilitation for Geriatric Patients With Cleft Lip and Palate, and an Edentulous Mandible: A Clinical Report.
Xue Y, Yang J, Chen W
Cleft Palate Craniofac J · 2026 May · PMID 42095567 · Publisher ↗
Cleft lip and palate affects facial esthetics, mastication, swallowing, and speech functions. We report the case of a 52-year-old woman with congenital cleft lip and palate treated using a palatal obturator prosthesis an...
Cleft lip and palate affects facial esthetics, mastication, swallowing, and speech functions. We report the case of a 52-year-old woman with congenital cleft lip and palate treated using a palatal obturator prosthesis and removable partial denture. The clinical examination revealed a residual palatal defect communicating with the nasal cavity, tooth loss, and a severely resorbed alveolar ridge. Functional and cosmetic rehabilitation was achieved using a palatal obturator prosthesis and a removable partial denture. At the 1-year follow-up, the patient was satisfied with the functional and esthetic outcomes of the prosthetic restoration, with improved psychological status and quality of life.
Incidental Exfoliation of a Natal Tooth During Impression Making for Nasoalveolar Molding in an Infant With Cleft Lip and Palate.
Koya S, Kalathingal II, Bhat HHK … +2 more , Abdurahman R, Husain A
Cleft Palate Craniofac J · 2026 May · PMID 42084531 · Publisher ↗
Nasoalveolar molding (NAM) is a standard presurgical intervention to improve feeding and nasolabial symmetry in infants with cleft lip and palate. Natal teeth are rare in this population and may complicate orthopedic car...
Nasoalveolar molding (NAM) is a standard presurgical intervention to improve feeding and nasolabial symmetry in infants with cleft lip and palate. Natal teeth are rare in this population and may complicate orthopedic care. This report describes the incidental exfoliation of a natal tooth during secondary impression making for NAM in a 2-week-old infant with unilateral cleft lip and palate. The case emphasizes the importance of careful neonatal oral examination to reduce the risk of bleeding, aspiration, and procedural complications.
Identification of , , and as Key Susceptibility Genes for Nonsyndromic Orofacial Clefts Through Insights From Syndromic Cases.
You Y, Lin YS, Jia SX … +4 more , Zhang SD, Sun JL, Shi B, Jia ZL
Cleft Palate Craniofac J · 2026 May · PMID 42080994 · Publisher ↗
ObjectiveGenome-wide association studies have identified over 80 loci associated with nonsyndromic orofacial cleft (NSOC), yet substantial heritability remains unexplained. Insights from syndromic orofacial cleft (SOC) i...
ObjectiveGenome-wide association studies have identified over 80 loci associated with nonsyndromic orofacial cleft (NSOC), yet substantial heritability remains unexplained. Insights from syndromic orofacial cleft (SOC) implicated genes could help bridge this gap.DesignA case-control association study in a Han Chinese cohort was conducted to evaluate the association between SOC-implicated genes and NSOC subtypes using association, linkage disequilibrium (LD), and haplotype analyses.SettingTertiary medical center.Patients, ParticipantsThe study included 1626 cases of non-syndromic cleft lip with or without cleft palate, 930 cases of non-syndromic cleft palate only, and 2255 controls.InterventionsPeripheral blood (cases) and umbilical cord blood (controls) were collected for DNA extraction.Main Outcome MeasuresAllelic (Pearson' s , 1 df) and genotypic (Pearson' s , 2 df) associations between SNPs and NSOC subtypes were evaluated, with odds ratios (ORs) and 95% confidence intervals (CIs). LD and sliding-window haplotype association analyses were performed in Haploview. SNPs with minor allele frequency (MAF) >0.05 and in Hardy-Weinberg equilibrium in controls were analyzed. The significance threshold was < 1.27 × 10 after Bonferroni correction.ResultsAllelic analysis identified 23 SNPs that were significantly associated with NSOC subtypes (lowest = 2.02 × 10). Genotypic analysis identified 39 significant SNPs (lowest = 1.09 × 10). Signals mapped to 7 genes. Haplotype analyses revealed a shared causal variant block at and , and allelic heterogeneity at .ConclusionsWe identified , , and as NSOC-associated genes. Using SOC genes as prior knowledge reveals loci missed by standard GWAS, offering key insights into NSOC pathogenesis.
Medial Olivocochlear Modulation in Children With Cleft Lip and Palate: Evidence From Contralateral Suppression of TEOAEs.
Yurdakul Çınar F
Cleft Palate Craniofac J · 2026 May · PMID 42080961 · Publisher ↗
ObjectiveTo investigate the potential impact of a history of cleft lip and/or palate (CL/P) on medial olivocochlear (MOC) efferent system modulation in children.DesignCross-sectional study.SettingUniversity-affiliated au...
ObjectiveTo investigate the potential impact of a history of cleft lip and/or palate (CL/P) on medial olivocochlear (MOC) efferent system modulation in children.DesignCross-sectional study.SettingUniversity-affiliated audiology research laboratory under controlled acoustic conditions.ParticipantsFifty-two children aged 9 to 15 years with typical hearing participated, including 26 children with surgically repaired, non-syndromic CL/P (CL/P group) and 26 typically developing peers (control group).InterventionMOC modulation was assessed using a dual-probe, linear-mode protocol with the Otodynamics ILO292-II system. Transient-evoked otoacoustic emissions (TEOAEs) were recorded in quiet at 1, 1.5, 2, 3, and 4 kHz using a 65 dB peSPL stimulus. Contralateral suppression of TEOAEs was subsequently measured at the same frequencies by presenting 65 dB SPL broadband noise to the contralateral ear.Main Outcome MeasuresTEOAE amplitudes and contralateral suppression amplitudes across the 1 to 4 kHz frequency range.ResultsThe CL/P group exhibited significantly reduced TEOAE amplitudes and significantly lower contralateral suppression amplitudes across the entire 1 to 4 kHz frequency range compared with the control group.ConclusionThe results suggest that typically hearing children with a history of CL/P may show subtle differences in cochlear output and MOC efferent modulation, potentially associated with early life auditory challenges. The observed MOC modulation differences may be partially influenced by reduced TEOAE amplitudes and/or reflect independent efferent regulatory mechanisms. Further investigation is required to clarify the relative contributions of these factors and their potential functional implications.
The Rise in Artificial Intelligence and Machine Learning Models to Screen for Cleft-Related Velopharyngeal Dysfunction: A Systematic Review.
Isber J, Liu W, Qu B … +8 more , Dufresne S, Stone A, Powell ME, Braun SA, Galdyn IA, Golinko MS, Yin Z, Pontell ME
Cleft Palate Craniofac J · 2026 May · PMID 42080950 · Publisher ↗
ObjectiveTo systematically review literature on the use of artificial intelligence (AI) and machine learning (ML) models for detecting velopharyngeal dysfunction (VPD) in patients with cleft palate.DesignSystematic revie...
ObjectiveTo systematically review literature on the use of artificial intelligence (AI) and machine learning (ML) models for detecting velopharyngeal dysfunction (VPD) in patients with cleft palate.DesignSystematic review conducted in accordance with PRISMA guidelines (PROSPERO CRD420251034524).SettingStudies published were identified through EMBASE, ProQuest, Google Scholar, and PubMed.ParticipantsA total of 3967 participants contributed 92,323 training samples. Internal validation included 2331 controls and 2449 VPD cases, generating 81,143 validation samples. Ages ranged from 1 to 93 years.InterventionsML models were trained on speech features such as mel frequency cepstral coefficients (MFCCs) and constant Q cepstral coefficients (CQCCs) to classify or validate VPD-related speech outcomes.Main Outcome Measure(s)Reported performance metrics included accuracy, precision, recall, F1-score, sensitivity, specificity, and Pearson correlation coefficient (PCC). External validation was assessed when reported.ResultsOf 455 screened articles, 34 met the inclusion criteria. Support vector machines were the most commonly used models (16/34, 47.1%), followed by convolutional neural networks (6/34, 17.6%) and deep neural networks (2/34, 5.9%). Across studies reporting performance metrics, midpoint estimates yielded a mean accuracy of 82.9%, precision of 86.7%, F1-score of 0.88, sensitivity of 80.5%, specificity of 82.2%, and PCC of 0.58. Only 3 studies (3/34, 8.8%) performed external validation.ConclusionsAI/ML models demonstrate promise for VPD detection with encouraging performance. Inconsistent reporting, reliance on engineered features, and limited external validation restrict generalizability. No clinically deployable model has yet been achieved.
PLANA Therapy for Infants With Bilateral Cleft Lip and Palate-Two Case Reports.
Shetye PR
Cleft Palate Craniofac J · 2026 May · PMID 42080940 · Publisher ↗
Infants with complete bilateral cleft lips and a significantly protruded premaxilla present considerable challenges for the surgeon during the primary lip and nasal reconstruction. Current presurgical infant orthopedics...
Infants with complete bilateral cleft lips and a significantly protruded premaxilla present considerable challenges for the surgeon during the primary lip and nasal reconstruction. Current presurgical infant orthopedics (PSIOs) methods to reduce cleft severity-such as lip adhesion surgery, the Latham appliance, and nasoalveolar molding-often increase the burden of care. Presurgical lip, nose alveolar approximation (PLANA) therapy offers an alternative that effectively reduces this burden. This case report describes the use of PLANA therapy in two infants with bilateral cleft lip and palate, one with mild and one with a significantly protruded premaxilla. PLANA utilizes medical adhesive lip taping and a prefabricated series of nasal silicone devices to retract the premaxilla while promoting nasal tip projection and gradual controlled columellar elongation. The combined action of hydrocolloid lip tapes and nasal devices supports early presurgical objectives and minimizes caregiver demands and prepares patients for primary reconstruction surgery. These two-case reports also address the variations in premaxillary retraction among infants with and without protruded premaxilla.
Long-term Outcomes of Porous Polyethylene Cranioplasty for Large Cranial Defects in Children: Assessment of Clinical Results and Cranial Growth.
Camison L, Dvoracek LA, Bruce MK … +5 more , Beiriger JW, Anstadt EE, Tamber MS, Goldstein JA, Losee JE
Cleft Palate Craniofac J · 2026 May · PMID 42080927 · Publisher ↗
ObjectiveTo examine long-term outcomes and cranial growth after porous polyethylene (PPE) cranioplasty for large calvarial defects in children.DesignRetrospective review.SettingTertiary pediatric hospital.PatientsPediatr...
ObjectiveTo examine long-term outcomes and cranial growth after porous polyethylene (PPE) cranioplasty for large calvarial defects in children.DesignRetrospective review.SettingTertiary pediatric hospital.PatientsPediatric patients from 2006-2023 who underwent custom PPE cranioplasty (Medpor, Stryker) for large calvarial defects (>75 cm) were identified. Twenty-six of 27 patients were included. Subset analysis was performed in 12 patients with CT scans obtained more than 5 years postcranioplasty to assess cranial growth.InterventionPPE cranioplasty.Outcome measuresPresurgical characteristics and clinical outcomes. For cranial growth, intracranial volume (ICV) and head circumference (HC) were calculated using CT at two time points.ResultsTwenty-six patients (mean age = 7.9 years; range = 2.4-21.3 years) with cranial defects averaging 152 cm (range = 75-446 cm) were included. The most common cause was traumatic brain injury (19 patients). Eighty-five percent had failed autologous cranioplasty, and 42% had prior infections. At last follow-up (mean = 6.5 years; range = 1.3-14.5 years), 25 patients had stable coverage and contour without complications. One patient required explantation because of iatrogenic causes. Growth analysis of 12 patients (mean follow-up = 9.3 years; range = 5.4-14.5 years) showed HC increased in all cases and remained within the same age-adjusted percentile range as pre-cranioplasty values. ICV increased or remained stable in 9 of 12 patients. In the remaining three patients, HC-ICV discrepancies resulted from inward calvarial thickening concurrent with intrinsic brain abnormalities.ConclusionsPPE cranioplasty appears to be safe for large cranial defects in select pediatric cases. Head circumference growth occurs over time and remains within normative ranges long term, whereas ICV changes do not always parallel HC. This growth pattern appears related to the extent of underlying brain injury rather than the reconstruction itself.
Two Decades of Craniosynostosis Surgery: Experience and Outcomes From the National Craniofacial Center in Oman.
Al Jadeedi S, Al Alawi K, Al Jubori Y … +2 more , Al Shaqsi S, Al Bulushi T
Cleft Palate Craniofac J · 2026 May · PMID 42080907 · Publisher ↗
ObjectiveTo evaluate the demographic characteristics, surgical approaches, and short- and long-term outcomes of patients undergoing craniosynostosis (CS) at a national referral center over a 20-year period.DesignRetrospe...
ObjectiveTo evaluate the demographic characteristics, surgical approaches, and short- and long-term outcomes of patients undergoing craniosynostosis (CS) at a national referral center over a 20-year period.DesignRetrospective cohort study.SettingNational Craniofacial Center, Khawlah Hospital.ParticipantsAll patients who underwent surgical correction for CS between January 2004 and December 2023 were included.InterventionsPatients were managed according to a standardized multidisciplinary institutional protocol involving craniofacial plastic surgery and neurosurgery. Surgical interventions included open cranial remodeling procedures-most commonly fronto-orbital advancement-and suturectomy.Main Outcome Measure(s)Demographic data, suture involvement, syndromic association, operative details, perioperative complications, and long-term outcomes were analyzed.ResultsA total of 124 patients were identified; 58.1% were male, and 56.5% had nonsyndromic CS. Multisuture involvement was the most common presentation (39.5%). Most patients underwent surgery between 4 and 12 months of age. Open cranial remodeling was performed in 56.5% of cases, while 11.3% underwent suturectomy. Intraoperative complications were predominantly dural injuries (41.9%), with sagittal sinus injury occurring in 2.4%. Postoperative complications included fever (48.4%) and subgaleal collection (4.8%). There was no perioperative mortality. Long-term follow-up of up to 6 years demonstrated residual cranial deformity in 28.2% and palpable fixation devices in 22.6% of patients.ConclusionsThis 20-year institutional review represents the largest national series of surgically managed CS in Khawlah Hospital. Surgical management achieved favorable outcomes with low morbidity and no mortality. Ongoing multidisciplinary collaboration remains essential to optimize long-term results.
Craniofacial Symmetry Progression Following Strip Craniectomy Versus Fronto-Orbital Advancement in Unilateral Coronal Synostosis.
Harrison LM, Hallac RR, Sanati-Mehrizy P … +2 more , Seaward JR, Kane AA
Cleft Palate Craniofac J · 2026 Apr · PMID 42029896 · Publisher ↗
Strip craniectomy (SC) and fronto-orbital advancement (FOA) are 2 techniques for the management of unilateral coronal synostosis (UCS) that differ in timing and approach. However, the tempo and extent of postoperative ch...
Strip craniectomy (SC) and fronto-orbital advancement (FOA) are 2 techniques for the management of unilateral coronal synostosis (UCS) that differ in timing and approach. However, the tempo and extent of postoperative changes in craniofacial features are less well understood. The purpose of this study is to evaluate the progression of craniofacial symmetry over time following SC or FOA in UCS.A retrospective review of 3-dimensional images obtained preoperatively and at 1- and 2-year postoperatively.Tertiary pediatric institution.Thirty-six patients with UCS and 36 control patients.Strip craniectomy with helmet or FOA.Three-dimensional craniometric asymmetry measurements.The SC group had significantly shorter operative time, less blood loss, and a shorter hospital length of stay. All craniofacial symmetry measurements significantly improved postoperatively in both groups ( < .05), except for orbital width asymmetry in the FOA group at both 1 year and 2 years postoperatively (93.63 ± 3.53%; 93.60 ± 7.41%). There was no significant difference in craniofacial asymmetry measurements between groups. The orbital width (95.15 ± 3.95%) and midface (96.12 ± 3.15%) asymmetry in the SC group remained significantly different from controls at 2 years postoperatively ( < .001; < .001). The cranial asymmetry (96.43 ± 2.63%), orbital width asymmetry (93.60 ± 7.41%), and midface asymmetry (96.53 ± 1.61%) in the FOA group remained significantly different from controls at 2 years postoperatively ( = .009; = .042; = .015).Strip craniectomy and FOA both improved craniofacial symmetry over time, though orbital width and midface differences persisted compared to controls at 2 years postoperatively. Fronto-orbital advancement also showed a persistent cranial asymmetry compared with controls.
Decision-Making at the Transition Period: Widening the Lens Around Psychosocial and Cultural Factors in Cleft Orthognathic Surgery.
Clegg H, Mastroyannopoulou K, Young E
Cleft Palate Craniofac J · 2026 Apr · PMID 42007916 · Publisher ↗
ObjectiveTo explore what factors are considered by multidisciplinary team (MDT) professionals working in cleft lip and palate services when supporting young people in their decision-making for orthognathic surgery (OS) a...
ObjectiveTo explore what factors are considered by multidisciplinary team (MDT) professionals working in cleft lip and palate services when supporting young people in their decision-making for orthognathic surgery (OS) and how professionals understand and manage ethical dilemmas that arise.DesignA qualitative design was employed in which semistructured interviews were conducted remotely with NHS staff.SettingNine participants were interviewed across four NHS cleft services in the United Kingdom.ParticipantsThe sample consisted of three Speech and Language Therapists, three Orthodontists, and three Surgeons involved in decision-making for OS.ResultsReflexive Thematic Analysis revealed three key themes and seven sub-themes:"navigating the decision-making process," "Team-Centric," and 'Health Inequalities impacting on access to cleft services. Within these themes, professionals reflected on positions of power, the MDT environment, valued contribution of different professionals, external influences impacting on shared decision-making (SDM) and barriers to accessing care.ConclusionsThe findings highlight the complex nature of balancing patient autonomy and beneficence during the decision-making process for OS while bringing awareness to factors that may pose a barrier to decision-making such as the presence of health inequalities, power dynamics and conditions of the MDT environment. The importance of optimizing the SDM environment and creating opportunities for liaison, particularly earlier in the pathway, are discussed. It is recommended that future research explores the impact of health inequalities on access to cleft care further, recognizing those that are currently disadvantaged in their treatment journey.
Reduced Orofacial Health and Esthetics, but Perception of Good Generic Health and Quality of Life in Middle-Aged Patients with UCLP.
Moi AL, Vindenes HA
Cleft Palate Craniofac J · 2026 Apr · PMID 42007914 · Publisher ↗
ObjectiveDescribe self-perceived health and quality of life in middle-aged adults with unilateral complete cleft lip and palate (UCLP).DesignQuestionnaire study.SettingMultidisciplinary care at a Norwegian university hos...
ObjectiveDescribe self-perceived health and quality of life in middle-aged adults with unilateral complete cleft lip and palate (UCLP).DesignQuestionnaire study.SettingMultidisciplinary care at a Norwegian university hospital and department of clinical dentistry.ParticipantsTwenty-one adults (37-44 years) with UCLP, operated on by the same surgeon and followed to early adulthood according to a standardized protocol.OutcomesOral-specific health, orofacial esthetics, generic health and overall quality of life. Independent variables: Coping, self-esteem, perceived social support and socio-demography.ResultsParticipants reported significantly poorer oral-specific health and lower satisfaction with orofacial esthetics than population norms. Functional limitations and difficulties related to speech and eating were most prominent. Regarding appearance, they were least satisfied with facial profile, mouth, and visible teeth. Generic health scores were comparable to norms; however, despite persistent orofacial concerns, participants reported significantly higher overall quality of life than the general population. Participants reported low avoidant coping, good self-esteem, and high perceived social support. Better oral-specific health and lower satisfaction with orofacial appearance were associated with lower avoidant coping and higher social support. Better overall quality of life was associated with being married/cohabiting, low avoidant coping, and high social support. Unemployment was linked to poorer outcomes across all health and quality of life dimensions.ConclusionsDespite persistent oral-facial health and appearance concerns, middle-aged adults with UCLP reported good generic health and high overall quality of life. Psychosocial resources, partnership and employment may buffer the impact of orofacial difficulties, underscoring the value of holistic, individualized, lifelong, and multidisciplinary follow-up.
Disparities in Appointment Attendance Among Children with Cleft Lip and Palate: A 10-Year Analysis.
Kreh CC, Kim AY, Guler M … +6 more , Manasyan A, Saker N, Turk M, Firriolo JM, Urata MM, Hammoudeh JA
Cleft Palate Craniofac J · 2026 Apr · PMID 41989057 · Publisher ↗
ObjectiveTo identify sociodemographic and clinical factors associated with missed outpatient plastic surgery appointments among children with cleft lip and palate (CLP).DesignRetrospective chart review.SettingSingle urba...
ObjectiveTo identify sociodemographic and clinical factors associated with missed outpatient plastic surgery appointments among children with cleft lip and palate (CLP).DesignRetrospective chart review.SettingSingle urban academic tertiary pediatric hospital.Patients/ParticipantsChildren with CLP who underwent cleft lip repair between 2015 and 2025. Exclusion criteria included <5 total outpatient visits during the study period or out-of-state primary residence.InterventionsNot applicable (observational). Management included routine surgical follow-up.Main Outcome Measure(s)Occurrence of ≥1 missed outpatient appointmentNo-show rate (%) among patients with any missed visit.ResultsThe cohort (n = 308) was predominantly Hispanic/Latino (55.2%), with high prevalence of public insurance (61.0%), siblings (71.4%), and household instability (40.6%). Patients attended a mean of 12.0 appointments over 5.2 years of follow-up, with 46.1% missing at least one visit. Among those with ≥1 missed appointment, the mean no-show rate was 8.4%. Hierarchical logistic regression identified Black race, household instability, siblings, and pulmonology care as being associated with appointment no-show. In hierarchical linear regression among patients with ≥1 missed visit, older age at follow-up and greater surgical burden were associated with slightly lower no-show rates, with limited contribution from sociodemographic or care coordination factors.ConclusionsDisparities in appointment attendance may be driven by household-level and clinical complexity factors. Interventions supporting families facing household instability and high caregiving demands may help reduce missed outpatient plastic surgery visits.
Piloting Patient Reported Outcome Measures in Cleft Lip and Palate Services in Aotearoa New Zealand.
Ardouin K, Stock N, Ormond T … +1 more , Macrae P
Cleft Palate Craniofac J · 2026 Apr · PMID 41983960 · Publisher ↗
ObjectiveStandardized patient-reported outcome measures (PROMs) are rarely used in cleft lip and palate (CL/P) care within New Zealand (NZ). This pilot study sought to obtain a baseline of patient-reported outcomes in NZ...
ObjectiveStandardized patient-reported outcome measures (PROMs) are rarely used in cleft lip and palate (CL/P) care within New Zealand (NZ). This pilot study sought to obtain a baseline of patient-reported outcomes in NZ and evaluate clinicians' experiences of implementing PROMs into CL/P services.DesignA mixed methods cross-sectional design using CLEFT-Q scales. Data were compared to published CL/P CLEFT-Q norms using -tests, and within-group differences were investigated. Qualitative interviews were analyzed using codebook thematic analysis.SettingFive CL/P teams in Aotearoa New Zealand.ParticipantsPatients aged 12+ years ( = 101) were recruited through the five Health NZ CL/P teams between April 2023-March 2024. Five CL/P team members responsible for recruitment participated in an interview at the conclusion of the trial.ResultsCompared with normative data, patients reported more favorable outcomes on speech distress and school function, and poorer psychological function. Speech and social function scores were aligned with CL/P norms. Patients aged 18+ reported the lowest psychological functioning and females reported the lowest social functioning. Clinicians recognized the value of PROMs, yet highlighted concerns about insufficient resourcing to administer, review, and provide follow-up.ConclusionsPsychological function is indicated as an area of concern, particularly for adults with CL/P. Routine use of PROMs would evaluate change in measures of function over time and enhance patient-centered holistic care. Greater personnel and IT resourcing would facilitate routine implementation of PROMs in CL/P teams.
An RCT Evaluating the Efficacy of Using Platelet-Rich Fibrin (PRF) with Conventional Technique of Cleft Palate Repair.
M S, Powar RS
Cleft Palate Craniofac J · 2026 Apr · PMID 41983956 · Publisher ↗
ObjectiveTo evaluate the effectiveness of platelet-rich fibrin (PRF) in the repair of cleft palate (CP), with a primary goal of reducing the occurrence of postoperative palatal fistula formation.DesignAn RCT was conducte...
ObjectiveTo evaluate the effectiveness of platelet-rich fibrin (PRF) in the repair of cleft palate (CP), with a primary goal of reducing the occurrence of postoperative palatal fistula formation.DesignAn RCT was conducted with a 1:1 allocation ratio.SettingSingle-center study conducted in the Department of Plastic & Reconstructive Surgery at a tertiary care center.Participants100 CP repair patients enrolled based on the following inclusion criteria: Non-syndromic CPAge between 1 and 3 yearsInformed consent.InterventionsParticipants were randomized using a computer-generated sequence into 2 groups ( = 50 each). The intervention group received PRF, prepared by Choukroun's method from a 5 to 7 mL blood sample, and applied during surgery. The control group underwent standard CP repair without PRF. Both groups received identical pre & postoperative care.Main OutcomesPalatal-fistula formation, wound dehiscence, and postoperative bleeding were assessed.No cases of wound dehiscence or postoperative bleeding were observed in either group.Palatal fistula occurred in 3 patients (6%) in the control group (non-PRF), while no cases were observed in the PRF group.ResultsThree palatal fistula cases were observed (3%; = 100), 0% in the PRF group ( = 50), and 6% in the non-PRF group ( = 50).ConclusionsWhile PRF appears to be safe, biologically promising, and cost-effective adjunct in CP repair; the study was inconclusive as the small number of fistula occurrence limited ability to statistically substantiate its efficacy in reducing palatal fistula.
Development and Validation of a Parent-Reported Clinical Screening Instrument for Team Care of Young Children with a Cleft: The CleftChild-8.
Bachini S, Hartendorp MJ, Visser E … +1 more , Mouës-Vink C
Cleft Palate Craniofac J · 2026 Apr · PMID 41983946 · Publisher ↗
ObjectiveThis study aimed to develop and validate a cleft-specific proxy clinical screening instrument for children up to 8 years old with orofacial clefts: the CleftChild-8. Our objective was to implement this questionn...
ObjectiveThis study aimed to develop and validate a cleft-specific proxy clinical screening instrument for children up to 8 years old with orofacial clefts: the CleftChild-8. Our objective was to implement this questionnaire as a preparatory tool for cleft team consultations, enabling early identification of patient needs, facilitating communication with caregivers, and improving the quality and efficiency of care.DesignThis was a multicenter prospective cohort study to develop an instrument to be interpreted at the item level in an iterative process with relevant domains selection, item pool generation, caregivers and expert feedback, and psychometric testing.SettingThe study took place in 5 orofacial clefts referral centers in the Netherlands.ParticipantsParticipants were parents or caregivers of children born with syndromic and nonsyndromic cleft lip and/or palate and younger than 8 years old.ResultsBetween 2023 and 2025, the CleftChild-8 working version was completed by 414 parents/caregivers. Psychometric analyses supported a four-factor structure with good to excellent internal consistency ( = 0.75-0.92) and demonstrated known-groups validity across cleft types. The final 42-item questionnaire covers feeding and dentition, otology and sleep, speech, and psychosocial functioning.ConclusionThe Cleftchild-8 is a valid instrument to support cleft consultations by prioritizing the needs of patients and their families through reviewing responses to individual items and open-ended questions. The Cleftchild-8 can assist cleft teams to efficiently identify key concerns and tailor consultations accordingly.
From Anatomy to Application: A Developmental Framework for Suprazygomatic Maxillary Nerve Block in Pediatric Palatoplasty.
Chitpitaklert P, La N, Rattanapitoon SK … +2 more , Veerasatian T, Rattanapitoon NK
Cleft Palate Craniofac J · 2026 Apr · PMID 41983944 · Publisher ↗
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