Objective To determine the frequency of poor and very poor dental arch relationships in a cohort of patients with cleft lip/palate using a modified GOSLON assessment and to identify associated clinical characteristics. Design Retrospective cohort study. Setting Tertiary institutional cleft and craniofacial center. Patients and Participants Consecutive patients with cleft lip/palate who underwent alveolar bone grafting (ABG) from 2005 through 2022 and had postgraft cone-beam computed tomography (CBCT) before orthognathic surgery. Interventions ABG and post-ABG CBCT Main Outcome Measure(s) Poor and very poor dental arch relationship, defined as a modified GOSLON score of 4 or 5 on 3-dimensional reconstructed CBCT images. Results The sample included 730 patients (59.5% male) with a median age of 12 years (inter quartile range, 10-17). A modified GOSLON score of 4 or 5 was present in 495 patients (67.8%). In unadjusted analyses, cleft type and site of primary repair were associated with a poor or very poor dental arch relationship ( p < .05 for both). Conclusions In this cohort, 67.8% of patients with cleft lip/palate had a modified GOSLON score of 4 or 5, indicating poor and very poor dental arch relationship. Cleft type and site of primary cleft repair were associated with this outcome in unadjusted analyses.
Cleft lip and palate represents the most common congenital craniofacial anomaly worldwide, with low- and middle-income countries (LMICs) bearing nearly 84% of the global disease burden. Despite the instrumental role of global nongovernmental organizations (NGOs) in expanding access to cleft care across LMICs, patient databases and healthcare infrastructure remain highly fragmented across centers and organizations. Recent advances in machine learning and deep learning hold considerable promise for improving cleft care through data-driven clinical decision-making. However, privacy regulations present significant barriers to the centralized aggregation of patient data required to train robust artificial intelligence models. Federated learning (FL) offers a potential solution by enabling multiple institutions to train a shared global model without transferring raw patient data to a central server. Through mechanisms such as federated averaging, differential privacy, and homomorphic encryption, FL substantially mitigates privacy risks while producing models that perform comparably to models trained on centralized pool data. Existing implementations, most notably the Federated Tumor Segmentation initiative spanning 71 institutions across 6 continents, demonstrate the feasibility of this approach in complex healthcare settings. This narrative review proposes a potential framework for applying FL to global cleft care, outlining how existing organizational infrastructure established by prominent cleft NGOs can provide a foundation for a federated network. Five key stakeholder categories: global cleft NGOs, academic medical centers, technology partners, funding entities, and local cleft centers have been identified as essential to realizing this vision. Numerous challenges and barriers have also been identified before realizing this endeavor.
Objective The purpose of this 10-year retrospective review was to report our single-center outcomes using the posterior pharyngeal flap (PPF) horizontal split technique to treat patients with syndromic and non-syndromic velopharyngeal dysfunction (VPD). Design Retrospective review (2011-2021). Setting A tertiary pediatric institution. Patients Patients with VPD (4-21 years old). Interventions PPF surgery using the horizontal split inset technique by 2 surgeons. Main Outcome Measures Evaluated factors included demographics, VPD characteristics, and pre-operative speech evaluation. Evaluated outcomes included complications, revisional VPD surgery rates, post-operative resonance, nasometry scores, and the apnea-hypopnea index (AHI). Results Two hundred and twenty children (median age: 6.9 years) underwent surgery. The median operative time was 47 min. Most patients (95%) achieved improved resonance, with 89% achieving mild or no hypernasality. Median nasalance scores significantly decreased (pre-operative: 42, post-operative: 18). Of 137 patients who underwent a post-operative polysomnogram, 18 patients had an AHI ≥5; 2 patients with syndromic diagnoses underwent PPF takedown. Ten patients underwent revisional VPD surgery. Patients with 22qDS (22q11.2 deletion syndrome) or non-cleft VPD had an increased risk of demonstrating significant residual hypernasality requiring revisional surgery. Conclusions This simple, reproducible PPF surgical technique yields reliably improved resonance in patients with syndromic and non-syndromic VPD. Patients with 22qDS and those with non-cleft VPD may have higher odds of demonstrating residual hypernasality and needing additional surgery. Although there is low risk of flap takedown for obstructive sleep apnea (OSA), long-term airway monitoring remains essential.
Objective To evaluate the availability, content, and quality of written online information regarding the introduction of solid food to infants with cleft palate. Design Cross-sectional analysis of publicly accessible internet sources. Setting Google search engine using standardized search terms. Main Outcome Measures Content characteristics including recommended age of solid food introduction, feeding strategies, and clinical guidance. Quality was assessed using the DISCERN instrument. Results Of 56 unique sources identified, 30 met inclusion criteria. Hospital/health system resources were the most common source type (40.0%), and four sources (13.3%) cited peer-reviewed literature. Recommendations for timing of solid food introduction varied, although most sources recommended introduction at approximately 6 months (60.0%). Most sources guided nasal regurgitation (83.3%), food textures and progression (83.3%), and feeding strategies or adaptations (56.7%). The mean DISCERN score was 58.5 (SD = 23.7; median = 71; range = 16–80), with substantial variability in quality across sources. Conclusions Online information regarding solid food introduction for infants with cleft palate is variable and often lacks evidence-based guidance. Improved dissemination of standardized recommendations is needed to support caregivers and optimize feeding outcomes in this population.
BackgroundMicrotiais a congenital external ear anomaly requiring reconstruction, typically performed by plastic surgery or otolaryngology (ENT). This study examined temporal and geographic trends in specialty involvement in microtia reconstruction using the Pediatric Health Information System (PHIS) database.MethodsPHIS was queried from 2016 to 2024 for patients ≤21 years with microtia undergoing ear reconstruction. Patient characteristics, surgical specialty, and geographic region were analyzed. Adjusted temporal trends in plastic surgery versus ENT involvement were assessed using multivariable logistic regression controlling for seasonality, geography, medical complexity, acuity, and age.ResultsAmong 1176 cases, median age was 9 years; 58.5% were male, 56.6% Hispanic/Latino, and 73.0% publicly insured. Overall, 49.1% (n = 577) of reconstructions were performed by ENT, 41.3% (n = 486) by plastic surgery, and 9.6% (n = 113) by other specialties. Adjusted probability of plastic surgery versus ENT involvement remained stable from 48.6% in January 2016 to 45.7% in December 2024 (p = .755). Medical complexity was associated with greater odds of plastic surgery involvement (odds ratio (OR): 4.94, 95% confidence interval (CI): 1.54-15.85). Compared with the West, plastic surgery involvement was greater in the Midwest and South, particularly the East North Central (OR: 12.9, 95% CI: 2.1-78.9) and South Atlantic (OR: 11.9, 95% CI: 2.3-60.8) divisions.ConclusionSpecialty involvement in pediatric microtia reconstruction remained stable over time but varied geographically and by medical complexity. Findings of this study suggest regional practice patterns and workforce may influence specialty involvement.
