Effect of hyperextension of the neck (rose position) on cerebral blood oxygenation in patients who underwent cleft palate reconstructive surgery: prospective cohort study using near-infrared spectroscopy

Objectives To facilitate the best approach during cleft palate surgery, children are positioned with hyperextension of the neck. Extensive head extension may induce intraoperative cerebral ischemia if collateral flow is insufficient. To evaluate and monitor the effect of cerebral blood flow on cerebral tissue oxygenation, near-infrared spectroscopy has proved to be a valuable method. The aim of this study was to evaluate and quantify whether hyperextension affects the cerebral tissue oxygenation in children during cleft palate surgery. Materials and methods This prospective study included children (ASA 1 and 2) under the age of 3 years old who underwent cleft palate repair at the Wilhelmina Children’s Hospital, in The Netherlands. Data were collected for date of birth, cleft type, date of cleft repair, and physiological parameters (MAP, saturation, heart rate, expiratory CO2 and O2, temperature, and cerebral blood oxygenation) during surgery. The cerebral blood oxygenation was measured with NIRS. Results Thirty-four children were included in this study. The majority of the population was male (61.8%, n = 21). The mixed model analyses showed a significant drop at time of Rose position of − 4.25 (69–74 95% CI; p < 0.001) and − 4.39 (69–74 95% CI; p < 0.001). Postoperatively, none of the children displayed any neurological disturbance. Conclusion This study suggests that hyperextension of the head during cleft palate surgery leads to a significant decrease in cerebral oxygenation. Severe cerebral desaturation events during surgery were uncommon and do not seem to be of clinical relevance in ASA 1 and 2 children. Clinical relevance There was a significant drop in cerebral oxygenation after positioning however it is not clear whether this drop is truly significant physiologically in ASA 1 and 2 patients

Carpale letsels, onderzoek naar de verzuimaspecten ten gevolge van carpale letsels in Nederland 1990-1993

Het polsgewricht vormt de verbinding tussen de onderarm en de hand. De stand van het gewricht bepaalt de stand van de hand in de ruimte en verzorgt de krachtsoverbrenging van de arrn naar de hand. Het onderdeel van de pols "waar het om draait" is de handwortel of de carpus. ... Zie: Summary

A systematic review of associated structural and chromosomal defects in oral clefts: when is prenatal genetic analysis indicated?

Background Oral clefts-comprising cleft lip (CL), cleft lip with cleft palate (CLP), and cleft palate (CP)-are being diagnosed prenatally more frequently. Consequently, the need for accurate information on the risk of associated anomalies and chromosomal defects to aid in prenatal counselling is rising. This systematic review was conducted to investigate the prenatal and postnatal prevalence of associated anomalies and chromosomal defects related to cleft category, thereby providing a basis for prenatal counselling and prenatal invasive diagnostics. Methods Online databases were searched for prenatal and postnatal studies on associated anomalies and chromosomal defects in clefts. Data from the literature were complemented with national validated data from the Dutch Oral Cleft Registry. Results Twenty studies were included: three providing prenatal data, 13 providing postnatal data, and four providing both. Data from prenatal and postnatal studies showed that the prevalence of associated anomalies was lowest in CL (0-20.0% and 7.6-41.4%, respectively). For CLP, higher frequencies were found both prenatally (39.1-66.0%) and postnatally (21.1-61.2%). Although CP was barely detectable by ultrasound, it was the category most frequently associated with accompanying defects in postnatal studies (22.2-78.3%). Chromosomal abnormalities were most frequently seen in association with additional anomalies. In the absence of associated anomalies, chromosomal defects were found prenatally in CLP (3.9%) and postnatally in CL (1.8%, 22q11.2 deletions only), CLP (1.0%) and CP (1.6%). Conclusions Prenatal counselling regarding prognosis and risk of chromosomal defects should be tailored to cleft category, and more importantly to the presence/absence of associated anomalies. Irrespective of cleft category, clinicians should advise invasive genetic testing if associated anomalies are seen prenatally. In the absence of associated anomalies, prenatal conventional karyotyping is not recommended in CL, although array comparative genomic hybridisation should be considered. In presumed isolated CLP or CP, prenatal invasive testing, preferably by array based methods, is recommende

Long-term follow-up study of patients with a unilateral complete cleft of lip, alveolus, and palate following the Utrecht treatment protocol: Dental arch relationships

Objective This study sought to evaluate long-term dental arch relationships in adults with a unilateral complete cleft lip and palate (UCLP) treated by the Utrecht protocol and to compare results with the centers from the Eurocleft study. Materials and methods Retrospective analysis of UCLP patients age 17 or older, treated by two-stage palate closure at the Wilhelmina Children's Hospital, a tertiary center for cleft surgery in Utrecht, the Netherlands. Patients were invited to the clinic for a long-term evaluation. Casts were obtained on the day of follow-up and assessed by the modified Goslon Yardstick for permanent dentition. Dental casts were scored twice by 3 different examiners. Results Intra-rater agreement varied from 0.743 to 0.844, the inter-rater agreement from 0.552 to 0.718. The mean Goslon Yardstick score was 3.3. Thirty-three percent of the patients had a Goslon score of 1 or 2, 45% had a score of 4 or 5. Conclusions The present study found unfavourable results regarding dental arch relationships after delayed hard palate closure at 3 years old. The mean Goslon Yardstick score was 3.3 (SD 1.4) and 45% of the casts were allocated to group 4 or 5 despite extensive orthodontic treatment. We observed a high number of secondary surgical interventions but no evident benefit regarding dental occlusion following the Utrecht treatment protocol, which includes a two-stage palatoplasty. Other factors than the timing of palate closure are likely of influence

Long-term follow-up study of patients with a unilateral complete cleft of lip, alveolus, and palate following the Utrecht treatment protocol:Dental arch relationships

Objective This study sought to evaluate long-term dental arch relationships in adults with a unilateral complete cleft lip and palate (UCLP) treated by the Utrecht protocol and to compare results with the centers from the Eurocleft study. Materials and methods Retrospective analysis of UCLP patients age 17 or older, treated by two-stage palate closure at the Wilhelmina Children's Hospital, a tertiary center for cleft surgery in Utrecht, the Netherlands. Patients were invited to the clinic for a long-term evaluation. Casts were obtained on the day of follow-up and assessed by the modified Goslon Yardstick for permanent dentition. Dental casts were scored twice by 3 different examiners. Results Intra-rater agreement varied from 0.743 to 0.844, the inter-rater agreement from 0.552 to 0.718. The mean Goslon Yardstick score was 3.3. Thirty-three percent of the patients had a Goslon score of 1 or 2, 45% had a score of 4 or 5. Conclusions The present study found unfavourable results regarding dental arch relationships after delayed hard palate closure at 3 years old. The mean Goslon Yardstick score was 3.3 (SD 1.4) and 45% of the casts were allocated to group 4 or 5 despite extensive orthodontic treatment. We observed a high number of secondary surgical interventions but no evident benefit regarding dental occlusion following the Utrecht treatment protocol, which includes a two-stage palatoplasty. Other factors than the timing of palate closure are likely of influence

Long-term follow-up study of young adults treated for unilateral complete cleft lip, alveolus, and palate by a treatment protocol including two-stage palatoplasty : Speech outcomes

BACKGROUND: No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). METHODS: This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. RESULTS: Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001). In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%-17% of the patients exhibited increased nasalance scores, assessed through nasometry. CONCLUSIONS: The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence