Long-term craniofacial morphology in young adults treated for a non-syndromal UCLP: A systematic review

Minimizing mid-facial growth impairment is one of the treatment goals in cleft lip and palate surgery. As growth of the maxilla extends into young adulthood, long-term evaluation is essential to make a comprehensive assessment of a treatment protocol. There are numerous treatment approaches for cleft lip/palate surgery, and most have the characteristic distinction between either an early or a late cleft palate closure. PRISMA guidelines were applied to explore the quality of the current literature and to identify treatment factors influencing long-term cephalometric outcomes. The literature search was conducted in Pubmed, The Cochrane Library and Embase. We included studies evaluating cephalometric outcomes (SNA and ANB values on 2D cephalograms) in UCLP patients with a mean age of 16 years and older. Studies with an inadequate description of the timing of surgery were excluded. 17 studies comprising 906 patients were selected and included for critical appraisal. Treatment protocols differed considerably among the included studies and inconsistent methodology was common. Eight studies applied a one-stage procedure, 11 studies performed a two-stage reconstruction, and five studies made use of a vomer flap. Applying a multivariate model, we did not identify any treatment factors that significantly influenced growth (SNA/ANB values), except for the method of inclusion, suggesting the presence of significant selection bias within the studies. The current literature remains inadequate for evidence-based decision making and to advise parents if an early or late palate closure leads to a more favorable maxillary outgrowth. This manuscript will propose guidelines and recommended quality criteria for future studies

Quality of life and patient satisfaction in adults treated for a cleft lip and palate: A qualitative analysis

Objective: Long-term outcomes of patients born with a cleft lip and palate (CLP) are scarcely investigated. Yet, this patient group is of particular interest, as they can provide a valuable retrospective view upon their treatment experiences and psychological adjustment. Qualitative accounts may be especially useful in understanding the patient journey. Design: The present study set out to evaluate quality of life and satisfaction with treatment in adult patients previously treated for CLP at the (Hospital). Semi-structured interviews were performed. Patients: 22 patients aged 17 years and older were asked to share their experiences of growing up with CLP, and of the treatment they received. Interviews were audio recorded and factors thought to influence psychological adjustment were identified.Results: Four main themes were identified: namely background factors, support systems, treatment factors and coping/internal factors. Each theme was described with illustrative quotes. Conclusion: This study underlines that psychological adjustment can fluctuate over time and greatly differs between individuals, even during adulthood. Psychological support should therefore be available beyond the finalization of the treatment course. Furthermore, the majority of participants stated they had wanted more psychological support as a child to facilitate resilience and to help them cope with challenges