Cleft Palate Craniofac. J. [JOURNAL]
Sun
200 papers
Orofacial Cleft Disparities in American Indian and Alaska Native Populations: A Systematic Review and Meta-Analysis.
Kandi LA, Nguyen AT, Zhang J … +3 more , Sriram N, Galiano RD, Gosain AK
Cleft Palate Craniofac J · 2026 Feb · PMID 41739540 · Publisher ↗
ObjectiveTo evaluate the prevalence, access to care, and health outcomes of orofacial clefts (OFCs) among American Indian and Alaska Native (AI/AN) populations through a systematic review and meta-analysis.DesignSystemat...
ObjectiveTo evaluate the prevalence, access to care, and health outcomes of orofacial clefts (OFCs) among American Indian and Alaska Native (AI/AN) populations through a systematic review and meta-analysis.DesignSystematic review and meta-analysis performed in accordance with PRISMA 2020 guidelines and registered with PROSPERO (CRD420251035364).SettingUS-based population registries, hospital databases, and institutional or community-level retrospective studies involving AI/AN populations.Patients and ParticipantsAI/AN individuals with OFCs compared with non-Hispanic White patients.InterventionsPrimary cleft lip and palate repair, secondary cleft-related procedures, and multidisciplinary cleft care.Main Outcome Measure(s)Prevalence of OFCs, timing of cleft surgery, discharge disposition, access to specialists, and qualitative determinants of disparities.ResultsEighteen studies including more than 1985 AI/AN patients were identified. Meta-analysis of 5 studies estimated a pooled OFC prevalence of 15 per 10 000 live births (95% confidence interval: 5-49), with substantial heterogeneity ( = 99.8%). Individual studies reported significantly higher OFC prevalence in AI/AN populations compared to non-Hispanic Whites (odds ratio range: 1.44-2.68). Geographic maldistribution of craniofacial-trained surgeons, increased odds of nonhome discharge, and delayed cleft palate repair were consistently observed barriers. Qualitative analyses highlighted structural inequities, perceived racism, and lack of culturally responsive care as major contributors to disparities.ConclusionsAI/AN populations face a disproportionately high burden of OFCs alongside structural barriers to timely, culturally competent care. Addressing these disparities requires community-engaged, multidisciplinary interventions that improve geographic access and integrate culturally responsive approaches to care.
Risk Factors for Infection, Dehiscence, and Unplanned Reintubation Following Cleft Lip Repair.
Gharavi A, Habermann EB, Polites SF … +3 more , Mardini S, Gibreel W, Haile D
Cleft Palate Craniofac J · 2026 Feb · PMID 41739524 · Publisher ↗
ObjectiveWe sought to characterize factors associated with postoperative complications in patients undergoing primary cleft lip repair (CLR).DesignThe National Surgical Quality Improvement Program-Pediatric database was...
ObjectiveWe sought to characterize factors associated with postoperative complications in patients undergoing primary cleft lip repair (CLR).DesignThe National Surgical Quality Improvement Program-Pediatric database was queried to identify patients under 12 months old undergoing CLR using CPT codes. Multivariable analysis was conducted to characterize complications and associated comorbidities.SettingA multicenter sample.Patients/ParticipantsA total of 11 957 cases (81.9% unilateral CLR and 18.1% bilateral CLR) were identified.InterventionsNone.Main Outcomes/MeasuresThe postoperative outcomes of significance were surgical site infection (SSI), wound dehiscence, and unplanned reintubation within 30 days of CLR.ResultsThe cohort had a mean age of 4.7 ± 2.0 months and a median American Society of Anesthesiologists classification of 2. SSIs occurred in 0.6% of cases and were independently associated with bilateral cleft anatomy (OR 2.16, = .003) and longer anesthesia time (OR per minute: 1.004, = .009). Wound dehiscence occurred in 0.4% of patients and was independently associated with bilateral cleft anatomy (OR 4.03, < .001) but was associated with shorter anesthesia duration (OR per minute: 0.991, < .001). Unplanned reintubation occurred in 0.2% of cases, with these patients having significantly higher rates of multiple comorbidities.ConclusionWound dehiscence, SSI, and unplanned reintubation were rare complications following CLR. Patients with a bilateral cleft lip had increased odds of both SSI and wound dehiscence.
Levator Veli Palatini Reconstruction Using an Autologous Tendon Graft in Velopharyngeal Insufficiency: What I Do.
Hoghoughi MA, Hashemi S, Kalkateh Z
Cleft Palate Craniofac J · 2026 Feb · PMID 41739523 · Publisher ↗
BackgroundSevere velopharyngeal insufficiency following salvage surgery poses a major challenge for cleft surgeons, particularly when repeated operations have left the soft palate both shortened and densely scarred.Solut...
BackgroundSevere velopharyngeal insufficiency following salvage surgery poses a major challenge for cleft surgeons, particularly when repeated operations have left the soft palate both shortened and densely scarred.SolutionA tendon graft technique for levator veli palatini reconstruction is described, using an autologous palmaris longus (PL) or, when absent, a flexor carpi radialis (FCR) tendon graft to re-establish the muscular function necessary for velopharyngeal closure.NoveltyUnlike approaches that only address tissue deficiency, this method restores the levator sling by connecting residual muscle stumps with autologous tendon, thereby reconstituting anatomical continuity. In the present case, PL was absent, and FCR was successfully used as the graft.
Skeletal Facial Patterns in Cleft Lip and/or Palate: A Cross-Sectional Study in a Brazilian Craniofacial Center.
Seltenreich F, Verdi T, Taufer JC … +2 more , Moreira GG, Rigo L
Cleft Palate Craniofac J · 2026 Feb · PMID 41739520 · Publisher ↗
ObjectiveTo describe the demographic and clinical profile of individuals with cleft lip and/or palate (CL/P) and to analyze the association between cleft type, skeletal facial pattern, gender, and ethnicity.DesignCross-s...
ObjectiveTo describe the demographic and clinical profile of individuals with cleft lip and/or palate (CL/P) and to analyze the association between cleft type, skeletal facial pattern, gender, and ethnicity.DesignCross-sectional study.SettingDental Clinic of the Craniofacial Deformities Rehabilitation Center of Southern Brazil.PatientsFour hundred orthodontic records of patients with CL/P treated, between 2018 and 2020.Main Outcome MeasureThe variables analyzed were cleft type, gender, race/color, skeletal facial pattern, facial profile, and maxillary and mandibular positioning. Data were evaluated using frequencies and multinomial logistic regression (crude and adjusted analysis), estimating odds ratios (OR) and respective 95% confidence intervals (CI). Variables with < .10 in the crude analysis were included in the adjusted model, and those with < .05 remained in the adjusted modelResultsThe mean age was 13 years (SD ± 9.5), 64% were male, and 79.3% were white. The most prevalent cleft was unilateral transforaminal (36%). Type II facial pattern predominated (45%), with a convex profile (64%) and retrusion of the maxilla (53%) and mandible (73%). A significant association was observed between male gender and post-foraminal clefts (OR = 2.67; 95% CI 1.44-4.95) and between skeletal type III facial pattern and post-foraminal (OR = 2.90; 95% CI 1.14-7.36) and transforaminal (OR = 3.45; 95% CI 1.53-7.79) clefts.ConclusionsA high prevalence of convex facial profile, skeletal type II pattern, and maxillomandibular retrusion was observed. Male sex was associated with higher odds of post-foraminal cleft, and skeletal type III facial was associated with higher odds of post-foraminal and transforaminal clefts.
A Novel Association Between Mandibulofacial Dysostosis with Microcephaly and Congenital Diaphragmatic Hernia.
Aris KL, Kirschner RE, Hrach E … +1 more , Stone BS
Cleft Palate Craniofac J · 2026 Feb · PMID 41739502 · Publisher ↗
Mandibulofacial dysostosis with microcephaly (MFDM) is a rare craniofacial syndrome due to pathogenic variants in . Affected patients may present with cleft palate, dysmorphic craniofacial features, short stature, microc...
Mandibulofacial dysostosis with microcephaly (MFDM) is a rare craniofacial syndrome due to pathogenic variants in . Affected patients may present with cleft palate, dysmorphic craniofacial features, short stature, microcephaly, developmental delay/intellectual disability, and variable congenital anomalies. Gastrointestinal anomalies include esophageal atresia and tracheoesophageal fistula. Congenital diaphragmatic hernia (CDH) has not been previously reported. Here, we present a novel case of MFDM with CDH in a late preterm female with multiple congenital malformations observed prenatally. Postnatal genetic testing was diagnostic for a heterozygous pathogenic variant in , consistent with a diagnosis of MFDM.
The Use of Infrared Thermal Imaging for Real-Time Flap Perfusion in Revision Palatoplasty with Buccinator Myomucosal Flaps.
Tyson C, Anderson L, Hirani R … +2 more , Myers R, Grant J
Cleft Palate Craniofac J · 2026 Feb · PMID 41739500 · Publisher ↗
BackgroundInfrared thermal imaging (IRTI) provides real-time visualization of tissue perfusion and may improve outcomes in flap-based reconstructive procedures. This study evaluated the impact of IRTI on complication rat...
BackgroundInfrared thermal imaging (IRTI) provides real-time visualization of tissue perfusion and may improve outcomes in flap-based reconstructive procedures. This study evaluated the impact of IRTI on complication rates following revision palatoplasty using a buccinator myomucosal flap (BMMF).MethodsA retrospective cohort study was performed on patients who underwent revision palatoplasty with BMMF between 2021 and 2024 at a single institution. Postoperative outcomes, including partial flap loss, dehiscence, and fistula formation, were compared between cases in which IRTI was utilized and those evaluated solely by traditional clinical assessment. A brief expected-cost analysis was performed.ResultsAmong 80 cases, 20 (25%) utilized IRTI for intraoperative flap evaluation and 60 (75%) did not. The overall complication rate was significantly lower in the IRTI group compared to the non-IRTI group (10% vs. 35%; 032). Partial flap loss occurred in 5.0% of IRTI cases versus 18.3% of non-IRTI cases (139). No major complications occurred in the IRTI cohort, whereas 33.3% (7/21) of complications in the non-IRTI group required operative intervention. With conservative estimates for revision surgery, this corresponded to approximately $10,640 in savings per patient.ConclusionIntraoperative use of IRTI during revision palatoplasty with BMMF was associated with significantly lower complication rates and reduced severity of complications. By providing real-time, objective information about flap perfusion, IRTI may enhance intraoperative decision-making, improve flap viability, and reduce postoperative morbidity. These findings support IRTI as a cost-effective and noninvasive adjunct to standard clinical assessment in reconstructive surgery.
Survey of Practice Patterns of Maxillary Distraction Osteogenesis Among Craniofacial Surgeons in Patients With Cleft Lip and Palate.
McCracken M, Delfino K, Nixon A … +2 more , Manlove A, Johnson M
Cleft Palate Craniofac J · 2026 Feb · PMID 41719118 · Publisher ↗
ObjectiveWe assess current practices in treatment of maxillary hypoplasia in patients with cleft lip and palate regarding LeFort I osteotomy (LFO) and maxillary distraction osteogenesis (DO).DesignA 27-question survey wa...
ObjectiveWe assess current practices in treatment of maxillary hypoplasia in patients with cleft lip and palate regarding LeFort I osteotomy (LFO) and maxillary distraction osteogenesis (DO).DesignA 27-question survey was distributed to surgeons in the United States via email addresses obtained through the American Cleft Palate Craniofacial Association (ACPA) website, the ACPA online forum, and a surgeons group on WhatsApp.SettingResponses were recorded in the REDCap platform.Patients and ParticipantsSurgeons treating these patients in the United States were included. Surgeons outside the United States, residents, students, and those not caring for these patients were excluded.InterventionsThere were no interventions due to the nature of this study.Main Outcome MeasuresQuestions assessed specialty and experience of respondents, treatment considerations guiding practices (risks of treatment, technique, timing, pre- and post-operative assessment).ResultsFifty-three surgeons responded to the survey. Sixty-six percent would consider DO for severe maxillomandibular discrepancy, 51% for LFO. Relapse (30%), inability to adequately mobilize (47%) are concerns for LFO; vector control (34%), compliance (18.9%) for DO. At ages 16 to 20 81.1% would consider both, whereas age ages 11 to 15 49.1% would consider DO. Lag phase of <7 days (98.1%), activation at 0.6 to 1 mm/day (71.7%), consolidation of at least 10 weeks (66%) are preferred.ConclusionsSurgeons prefer DO for large maxillomandibular discrepancy and scarring from previous surgeries, note less concern for maxillary relapse with DO, but have concern for controlling vector. Surgeons prefer lag phase of <7 days, activation at 0.6 to 1 mm/day, and consolidation of ≥10 weeks.
Exploring Sleep Behavior and Language Outcomes in Children with Cleft Lip and Palate Using Data from a National Cohort Study.
van Eeden S, Knowland VCP
Cleft Palate Craniofac J · 2026 Feb · PMID 41712481 · Publisher ↗
ObjectiveTo explore the relationship between sleep behaviors and language development in children with cleft lip and palate (CP ± L).DesignCross-sectional analysis of questionnaire data from a national cohort study. All...
ObjectiveTo explore the relationship between sleep behaviors and language development in children with cleft lip and palate (CP ± L).DesignCross-sectional analysis of questionnaire data from a national cohort study. All participants were treated within a national health service specialist cleft center. 1990 questionnaires were analyzed. All cleft phenotypes, including 10.2% with Robin Sequence (RS) and 8.5% with syndromic diagnoses, were included. Sleep outcome measures from parent report included sufficient sleep in a 24-h period and reports of concern about sleep behavior. Language outcome measures included answers to the Ages and Stages Questionnaire (3rd edition) (ASQ-3).ResultsParental concern about sleep was low overall (13.0% at 18 months, 7.9% at 3 years), but higher in children with RS and syndromic diagnoses. At 3 years, parents of children with cleft palate were more likely to be concerned about sleep than those with cleft lip only (P = .009). Reports of sufficient sleep were high (>88% across all ages), but children with RS showed a decline over time. Significant positive correlations were found between sufficient sleep and language outcomes at all ages (τ = .087, P = .004 at 18 months; τ = .131, P = .002 at 3 years; τ = .445, P < .001 at 5 years). At 5 years, this association remained after controlling for confounders (r = .347, P < .001).ConclusionsSleep behaviors were associated with language development in children with CP ± L. These findings highlight the need for longitudinal and interventional studies to better understand the role of sleep on developmental outcomes in this population.
A Comparative Study of Cleft Management in Different Economic Settings: United States Versus Guatemala.
Tuchez E, Rojas Camacho JD, Patel KR … +4 more , Zhao S, Sanchez Puga R, Belcher RH, Phillips JD
Cleft Palate Craniofac J · 2026 Feb · PMID 41701000 · Publisher ↗
ObjectiveTo compare cleft lip and palate management between the USA and Guatemala, focusing on surgical timing, secondary procedures, and multidisciplinary access.DesignMulticenter, retrospective cohort study (2011-2024)...
ObjectiveTo compare cleft lip and palate management between the USA and Guatemala, focusing on surgical timing, secondary procedures, and multidisciplinary access.DesignMulticenter, retrospective cohort study (2011-2024); nonrandomized, with anonymized clinical and surgical data.SettingVanderbilt University Medical Center (USA) and Moore Pediatric Surgery Center (Guatemala). U.S. care was continuous; care in Guatemala was provided through short-term surgical missions.Patients1693 patients aged 0-21 years with cleft lip and/or palate (790 Guatemala; 903 USA). Patients with Tessier clefts or non-Guatemalan residency (for the Guatemalan cohort) were excluded.InterventionsPrimary and secondary cleft surgeries and multidisciplinary interventions.Main Outcome MeasureAge at primary surgery, cleft type, sex, secondary procedures, palatal fistula, velopharyngeal insufficiency, dental/ear interventions, and sociodemographics (Guatemala).ResultsGuatemalan patients underwent primary cleft lip and palate repairs at significantly older ages (.001) and had higher rates of palate fistula (24% vs. 7%), fistula repair (13% vs. 7%), and lip revision (15% vs. 8%) (.001). Access to multidisciplinary care was greater in the USA (myringotomy tubes: 70% vs. 10%; dental restoration: 24% vs. 17%; .001). Among Guatemalan patients, 53% lived in rural regions and traveled a mean 3.3 h to access care.ConclusionsSignificant disparities exist in cleft lip and palate management between Guatemala and the USA, marked by delayed surgical intervention beyond the optimal developmental window. Overcoming systemic, geographic, and socioeconomic barriers through integrated, sustainable, locally supported care models is critical to enhancing outcomes in resource-limited settings.
Comparison on the Success of Secondary Alveolar Bone Grafting Performed Below 12 Years and On or After 12 Years of Age for Patients With Cleft Alveolus: A Systematic Review and Meta-Analysis.
Siva R, Chaturvedula BB, Ganesan S … +1 more , Thiruvenkatachari B
Cleft Palate Craniofac J · 2026 Feb · PMID 41700995 · Publisher ↗
AimThe aim of this systematic review and meta-analysis was to compare the outcomes of secondary alveolar bone grafting (SABG) performed before and after 12 years of age in patients with nonsyndromic cleft alveolus.Method...
AimThe aim of this systematic review and meta-analysis was to compare the outcomes of secondary alveolar bone grafting (SABG) performed before and after 12 years of age in patients with nonsyndromic cleft alveolus.MethodAll relevant studies from database untill September 2024 were identified through all relevant databases. Randomized Controlled Trials (RCTs), Controlled Clinical Trials (CCTs), prospective, and retrospective studies were included.PopulationPatients with cleft alveolus who underwent SABG using iliac crest bone graft.InterventionEarly SABG performed below 12 years.ComparisonSABG performed on or after 12 years of age.Primary outcomeBone fill assessed through radiographic imaging techniques. Secondary outcomes included skeletal relationship, canine eruption, Asher-Mcdade index, Goslon yardstick index, presence of oronasal fistula, and revision surgeries. All articles were screened for the title, abstract, and full text by 2 reviewers independently and in duplicate. Risk of bias was assessed for RCT using Cochrane's risk of bias tool and the CCT was assessed using the ROBINS-I tool.ResultsOf the 3545 records identified, 9 studies met the inclusion criteria for qualitative and quantitative synthesis. Eight of the 9 included studies were rated as having moderate to serious risk of bias, and one judged as critical risk of bias. There is very low-quality evidence in favor of secondary grafting performed below 12 years of age compared to secondary grafting performed on or after 12 years.ConclusionFuture high-quality RCTs with standardized protocols are necessary to determine the most effective timing for SABG in cleft care.
Identification of Cost Categories of Cleft Care Incurred by the Parent and Child from Birth to Adulthood in the United Kingdom.
Padashi-Fard M, Thorn J, Husbands S … +1 more , Fowler P
Cleft Palate Craniofac J · 2026 Feb · PMID 41697836 · Publisher ↗
ObjectiveTo identify different cost categories incurred by the parent and child born with an orofacial cleft from birth to 20 years of age in the United Kingdom.DesignFocus groups were used to explore different cost cate...
ObjectiveTo identify different cost categories incurred by the parent and child born with an orofacial cleft from birth to 20 years of age in the United Kingdom.DesignFocus groups were used to explore different cost categories associated with cleft care based on participants' personal experiences at different stages of the cleft care pathway.Setting: Conducted online using Microsoft Teams.ParticipantsParents of children born with unilateral cleft lip and palate, bilateral cleft lip and palate, and cleft palate were recruited from the Cleft Collective UK and the Cleft Lip and Palate Association support group.InterventionsTwo focus groups were used to identify cost categories within the ages 0-10 years ( = 5) and 11-20 years ( = 4) of the cleft care pathway.Main Outcome Measure: Qualitative assessment identified hierarchical direct and indirect cost categories for each focus group.ResultsThe main direct costs incurred originated from travel, overnight accommodation, childcare, food, equipment, private treatment, and costs originating from encouraging inclusivity for the child. The main indirect costs originated from the loss of earnings due to time out of work, and time out of school for the child. Similar cost categories were identified in both focus groups.ConclusionFamilies incur numerous direct and indirect costs for cleft care from birth to adulthood. The different categories of costs identified will inform the development of quantitative instruments that will allow a better understanding of the true financial burden of cleft care for the parent and child in the United Kingdom.
Corrigendum to "Neuroendocrine Axis Investigation in Patients with Arhinia, Hemiarhinia and Associated Malformations".
Cleft Palate Craniofac J · 2026 Feb · PMID 41697799 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Impact of Socioeconomic Deprivation on Timing and Long-Term Outcomes of Cleft Surgery: A 30-Year Retrospective Analysis.
Mejia V, Patel RK, Manasyan A … +8 more , Pekcan A, Bakovic M, Vallurupalli M, Wolfe E, Valenti A, Urata MM, Magee WP, Hammoudeh JA
Cleft Palate Craniofac J · 2026 Feb · PMID 41697170 · Publisher ↗
ObjectiveTo assess the impact of neighborhood socioeconomic deprivation on the timing of cleft surgery and outcomes, including postoperative palatal fistula and velopharyngeal insufficiency (VPI).DesignRetrospective coho...
ObjectiveTo assess the impact of neighborhood socioeconomic deprivation on the timing of cleft surgery and outcomes, including postoperative palatal fistula and velopharyngeal insufficiency (VPI).DesignRetrospective cohort study.SettingSingle pediatric tertiary care center.Patients, ParticipantsA total of 702 patients who underwent cleft repair between 1995 and 2024, categorized by Area Deprivation Index (ADI) into low, medium, and high socioeconomic deprivation.InterventionsPrimary cleft lip (CL) and cleft palate (CP) repair, palatal fistula repair, and VPI surgery.Main Outcome Measure(s)Age at CL and CP repair, surgical delay (CL repair >6 months, CP repair >12 months), palatal fistula rate, time to fistula repair, and VPI surgery incidence.ResultsPatients in high-ADI areas experienced later CL (P < 0.05) and CP repairs (low ADI: 1.1 years; medium: 1.7 years; high: 1.8 years; P < 0.05). Logistic regression identified high ADI and female sex as independent predictors of CL delay (P < 0.001), while public insurance, race, greater hospital distance, and prior CL delay contributed to CP repair delays (P < 0.001). Palatal fistula rates (14.9%) were not linked to ADI, but high-ADI patients had longer times to repair (P < 0.05). Patients undergoing VPI surgery lived closer to the hospital than those not requiring repair (P < 0.05).ConclusionsHigher ADI and female sex were associated with CL repair delays, while CP repair delays correlated with public insurance, race, hospital distance, and prior CL delay. Targeted interventions are needed to improve timely cleft care.
Impact of Medicaid Expansion on State-Level Medicaid Reimbursement for Orthodontia in Patients With Cleft Lip and Palate: A Cost Analysis.
McCall RR, Elver AA, Pitre KC … +2 more , Hoppe IC, Humphries LS
Cleft Palate Craniofac J · 2026 Mar · PMID 41686721 · Publisher ↗
Examine state-level Medicaid reimbursement rates after Medicaid expansion for Phase I and II orthodontia relevant to patients with cleft lip and palate.Cross-sectional study of publicly available 2024 state Medicaid reim...
Examine state-level Medicaid reimbursement rates after Medicaid expansion for Phase I and II orthodontia relevant to patients with cleft lip and palate.Cross-sectional study of publicly available 2024 state Medicaid reimbursement rates associated with Phase I and II orthodontia. One-Way ANOVA and independent t-tests compared regional and Medicaid expansion groups.National sample of Medicaid reimbursement fee schedules.Fifty US states, including DC, utilizing fee-for-service reimbursement for Medicaid enrollees.Reimbursement Rates for CPT Code D8020 (Phase I: Limited Orthodontia, Transitional Dentition) and D8080 (Phase II: Comprehensive Orthodontia, Adolescent Dentition) were compared between regions and by Medicaid expansion status.Ten states did not adopt Medicaid Expansion (19.6%: AL, FL, GA, KS, MS, SC, TN, TX, WI, and WY). Coverage of Phase I care was low overall (58.5% of expanded and 55.6% of non-expanded states), with average reimbursement of $1080.13. More states offered Phase II coverage (87.8% of expanded and 77.8% of non-expanded states). Phase II reimbursement was higher in expansion states ($2596.73 ± $2252.59 vs non-expansion: $1266.78 ± $314.19; = .001). The South trended toward higher reimbursement for Phase II ($3224.95; = .093), followed by the West ($2902.88 ± 1327.40 vs $1413.26-$1699.10).Provider reimbursement influences access to orthodontia. Although Medicaid expansion aims to improve access for low-income families, gaps in orthodontic coverage persist. Despite higher Phase II reimbursement in Southern and expansion states, inadequate Phase I coverage and low reimbursement schedules limit provider participation, leaving low-income patients with clefts at risk for delayed or absent orthodontia and thus suboptimal outcomes.
Treatment and Long-Term Outcomes of Children with Co-Occurring Childhood Apraxia of Speech and Velopharyngeal Dysfunction.
Baas BS, Brown TM, Clark HM … +2 more , Collins DR, Cofer SA
Cleft Palate Craniofac J · 2026 Feb · PMID 41686715 · Publisher ↗
A retrospective review of multidisciplinary velopharyngeal insufficiency (VPI) Clinic records from 2010 to 2024 was completed. Inclusion criteria for the review were diagnosis of childhood apraxia of speech (CAS) and doc...
A retrospective review of multidisciplinary velopharyngeal insufficiency (VPI) Clinic records from 2010 to 2024 was completed. Inclusion criteria for the review were diagnosis of childhood apraxia of speech (CAS) and documented evaluation for velopharyngeal dysfunction (VPD). Adequacy of velopharyngeal closure and perceptual judgment of resonance were identified as primary outcome measures. Surgical interventions and speech outcomes were also described. This review identified 74 children who were diagnosed with CAS and evaluated for VPD in the VPI Clinic. For the subset (n = 50) of children who had surgical intervention, speech therapy, and long-term follow-up, all had improved velopharyngeal closure and resonance.
Construct Validity of Japanese Version of CLEFT-Q: Cleft-Specific Patient-Reported Outcomes Questionnaire.
Hikosaka M, Kobayashi S, Tamada I … +5 more , Noguchi M, Yaguchi K, Yuzuriha S, Gai R, Sugiyama M
Cleft Palate Craniofac J · 2026 Feb · PMID 41686711 · Publisher ↗
ObjectiveCLEFT-Q is a questionnaire to assess patient-reported outcomes specific to individuals with cleft. The purpose of the present study is to evaluate the construct validity of Japanese version of CLEFT-Q by evaluat...
ObjectiveCLEFT-Q is a questionnaire to assess patient-reported outcomes specific to individuals with cleft. The purpose of the present study is to evaluate the construct validity of Japanese version of CLEFT-Q by evaluating how the scores of CLEFT-Q relate to participants' subjective and clinicians' objective evaluations. Participants were asked to fill in CLEFT-Q and report whether they desired improvement or additional surgery for their cleft-related conditions and whether they attended/enjoyed going to schools. Objective evaluations were collected from clinicians.DesignProspective observational study.SettingFive institutions in Japan.ParticipantsOne hundred and eleven individuals with cleft lip, palate, and alveolus between 8 and 17 years old.Interventionsnone.Main Outcome MeasuresCLEFT-Q scores were compared to respondents' subjective and clinicians' objective evaluations.ResultsThe CLEFT-Q face, nose, nostrils, speech, distress with speech, teeth, and eating and drinking scales were significantly lower for the individuals who desired improvement or additional surgery. CLEFT-Q school and social scales were significantly lower for individuals who did not enjoy going to school. All CLEFT-Q appearance-related scales were significantly lower for individuals who were rated as having less-favorable outcomes by clinicians. The CLEFT-Q psychological scale was associated neither with respondents' subjective nor clinicians' objective evaluations.ConclusionsThis study confirmed the construct validity of the Japanese version of CLEFT-Q through hypothesis testing and known group comparisons for 12 out of 13 scales, except for the psychological scale. These findings provide a scientific basis for the use of CLEFT-Q in Japan to collect and evaluate outcomes based on patients' perspectives.
Helmet Therapy in Infants with Positional Skull Deformity: A Retrospective Study of 455 Patients from a German Tertiary Care Center.
Himmelstoß K, Lottner LM, Spoerl S … +9 more , Maurer M, Meier JK, Moralis A, Friedrich M, Ott C, Reichert TE, Ettl T, Nieberle F, Taxis J
Cleft Palate Craniofac J · 2026 Feb · PMID 41678434 · Publisher ↗
ObjectiveThis study aimed to investigate the impact of helmet therapy on changes in cranial asymmetry of infants with positional cranial deformities and to identify clinical and morphometric factors associated with treat...
ObjectiveThis study aimed to investigate the impact of helmet therapy on changes in cranial asymmetry of infants with positional cranial deformities and to identify clinical and morphometric factors associated with treatment outcome.DesignThis retrospective monocentric cohort study included 455 infants treated between 2011 and 2021.SettingData were collected using manual measurements in a tertiary care setting within the outpatient clinic of a maxillofacial surgery department in Germany.PatientsInfants with positional cranial deformities, including plagiocephaly, brachycephaly, and combined types, were included.InterventionAll patients were treated with a helmet orthosis, and data were analyzed to assess changes in cranial measurements and associated factors.Main Outcome MeasuresPredefined outcome thresholds based on cranial asymmetry reduction and prognostic factors.ResultsPlagiocephaly was the most common deformity in 332 infants. Increased ear shift (Exp(B) = 0.199; 95% CI: 0.087-0.451; 001) and large initial diagonal difference (Exp(B) = 0.518; 95% CI: 0.334-0.802; 003) were correlated to unfavorable outcome. Delayed treatment was associated with lower reduction in diagonal difference (s = -0.229001), and recognized as a negative prognostic factor (Exp(B) = 0.993; 95% CI: 0.989-0.997; 001). In contrast, a higher baseline cranial index increased the probability of success (Exp(B) = 1.057; 95% CI: 1.030-1.084; 001).ConclusionEarly diagnosis and intervention are crucial for effective treatment of cranial deformities with helmet orthosis, especially in cases with ear shift or severe initial deformation.
LIMA Protocol for Palatal Fistula Reduction and Early Postoperative Maxillary Morphology in Unilateral Cleft Lip and Palate: A Randomized Controlled Trial.
Bangun K, Gunardi AJ, Tania V … +4 more , Kreshanti P, Pancawati J, Halim J, Menna C
Cleft Palate Craniofac J · 2026 Feb · PMID 41662230 · Publisher ↗
ObjectiveCompare the incidence of palatal fistula and early postoperative maxillary morphology following cleft palate repair performed using the Lima protocol versus the Two-Flap technique.DesignThis is a double-blind ra...
ObjectiveCompare the incidence of palatal fistula and early postoperative maxillary morphology following cleft palate repair performed using the Lima protocol versus the Two-Flap technique.DesignThis is a double-blind randomized controlled trial. Participants were randomly allocated to treatment groups using a random table. All surgeries were performed by a single surgeon at a single center.SettingA national tertiary referral hospital, January 2022 to December 2024.ParticipantsInfants aged 9 months to 2 years with unilateral cleft lip and palate who had not previously undergone palatal repair. Those with a history of prior palatal surgery or refusal to participate were excluded.InterventionsParticipants underwent palatoplasty using either the Lima protocol (n = 16) or the Two-Flap technique (n = 19).Main Outcome MeasuresIncidence of palatal fistula and changes in early postoperative maxillary morphology during the first 6 months of follow-up, assessed using dental cast measurements.ResultsA total of 39 patients were enrolled, with 35 completing follow-up. Baseline characteristics were comparable between groups. Postoperative palatal fistula occurred in 11% of patients, with no significant difference between the Lima and Two-Flap groups. Early postoperative maxillary morphology parameters showed similar trajectories across groups, except for greater inter-canine width in the Lima group at 6 months ( = .017) and greater palatal length increase in the Two-Flap group between 1 and 6 months post-op ( = .018).ConclusionBoth the Lima and Two-Flap techniques demonstrated comparable efficacy in preventing fistula and preserving early postoperative maxillary morphology. These findings represent short-term outcomes, and longer follow-up is required to evaluate long-term maxillary growth.
IRF6 Gene Polymorphisms Influence the Susceptibility of Nonsyndromic Cleft Lips With or Without Palate: A MOOSE-Compliant Meta-Analysis.
Sahu R, Mishra SM, Nalabothu P … +2 more , Hussain SA, Bhaskar L
Cleft Palate Craniofac J · 2026 Feb · PMID 41662226 · Publisher ↗
ObjectiveThe present meta-analysis has been conducted with the objective of conducting a precise examination of the association between 6 gene polymorphisms and the risk of nonsyndromic cleft lip with or without palate...
ObjectiveThe present meta-analysis has been conducted with the objective of conducting a precise examination of the association between 6 gene polymorphisms and the risk of nonsyndromic cleft lip with or without palate (CL ± P) among various ethnic groups.MethodsThe meta-analysis incorporated a total of 53 published case-control studies. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were computed. A leave-1-out sensitivity analysis was conducted, in conjunction with an investigation into publication bias, under the dominant model. Subgroup analysis based on ethnicity was performed.ResultsThe rs642961 was associated with an increased risk (AA + AG vs GG; OR: 1.31; 95% CI: 1.10-1.55; < .02; = 70%), while rs2235371 significantly reduced risk (AA + AG vs GG; OR: 0.74; 95% CI: 0.60-0.92; < .007; = 75%) of CL ± P. The remaining single-nucleotide polymorphisms (rs861019, rs2013162, rs2235373, and rs2235375) were not associated with the risk of CL ± P. Subgroup analysis based on ethnicity revealed distinct ethnicity-specific effects, with rs861019 associated with increased CL ± P risk in Caucasians, rs642961 increasing risk in Asians and mixed populations, and rs2235371 reducing risk only in Caucasians.ConclusionWhile gene rs642961 and rs2235371 were found to be associated with an increased risk of CL ± P in all studies, there was suggestive evidence of ethnic-specific differences, particularly among Caucasian and Asian populations. Although this study lends further support to the notion of an association between CL ± P and the gene polymorphisms, it is clear that further studies including diverse cohorts are needed to provide fully validated, ethnic- or population-specific insights.
The Most Efficient Surgical Technique to Treat Velopharyngeal Insufficiency After Primary Cleft Palate Repair: A Systematic Review and Meta-Analysis.
Fasahat A, Omid M, Khanlar F … +1 more , Maracy M
Cleft Palate Craniofac J · 2026 Feb · PMID 41660995 · Publisher ↗
ObjectiveTo determine the most effective surgical technique for treating velopharyngeal insufficiency (VPI) following primary cleft palate repair, based on improvement in hypernasality.DesignSystematic review and meta-an...
ObjectiveTo determine the most effective surgical technique for treating velopharyngeal insufficiency (VPI) following primary cleft palate repair, based on improvement in hypernasality.DesignSystematic review and meta-analysis of published studies evaluating surgical outcomes for secondary palatoplasty.SettingIsfahan Cleft Care Team, Isfahan, Iran, conducted between 2024 and 2025.Patients/ParticipantsA total of 1774 patients with VPI across 31 studies were included. Syndromic patients and studies lacking original data were excluded.InterventionsFive surgical techniques were evaluated: pharyngeal flap, sphincter pharyngoplasty, Furlow Z-plasty, buccal flap, and buccinator flap.Main Outcome Measure(s)Improvement in hypernasality, defined as any reduction in severity assessed by speech pathologists using perceptual and instrumental tools.ResultsFurlow palatoplasty demonstrated the highest average improvement rate (85.06%), followed by pharyngeal flap (84.50%), sphincter pharyngoplasty (83.04%), buccinator flap (77.61%), and buccal flap (59.69%). Heterogeneity was high across most surgical groups ( up to 100%), indicating variability in study design and patient characteristics. Complication rates and quality of life outcomes varied, with pharyngeal flap associated with higher rates of obstructive sleep apnea in some studies.ConclusionsFurlow palatoplasty and pharyngeal flap are the most effective surgical techniques for improving hypernasality in VPI patients post-primary cleft palate repair. However, significant heterogeneity and variable complication profiles underscore the need for individualized surgical planning and further prospective research.
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