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.
ObjectiveTo evaluate associations between Sleep Disturbance Scale for Children (SDSC) findings and polysomnographic parameters and the diagnostic performance of its Sleep Breathing Disorders (SBD) and Excessive Daytime Sleepiness (EDS) subscales for identifying obstructive sleep apnea (OSA) in children with non-syndromic cleft conditions.DesignProspective, analytical, cross-sectional diagnostic study.SettingTertiary craniofacial referral center.Patients, ParticipantsChildren aged 3 years 8 months to 13 years with non-syndromic cleft lip and palate or isolated cleft palate. Forty-two underwent polysomnography; 38 had valid recordings and 37 had complete paired questionnaire and polysomnographic data.Main Outcome Measure(s)Associations between SDSC scores and polysomnographic parameters; sensitivity, specificity, predictive values, and accuracy of the SBD and EDS subscales for identifying PSG-defined OSA (apnea-hypopnea index ≥1 event/h).ResultsOSA was identified in 27 of 38 participants (71.1%) with valid recordings and was predominantly mild. SDSC total and subscale scores were not significantly correlated with polysomnographic parameters. The SBD subscale had sensitivity of 38.5% and specificity of 72.7%; the EDS subscale had sensitivity of 23.1% and specificity of 54.5%.ConclusionsSDSC findings showed limited agreement with polysomnography, and the SBD and EDS subscales could not reliably identify or exclude OSA. The SDSC may complement clinical assessment by characterizing caregiver-reported symptoms, but polysomnography remains necessary for objective diagnosis and severity classification.
ObjectiveThis meta-analysis characterized variability in the posterior vault distraction osteogenesis (PVDO) distraction protocol and outcome reporting and explored study-level associations between distraction parameters and postoperative complications.MethodsThis PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant systematic review and meta-analysis included pediatric PVDO studies from PubMed, Ovid MEDLINE, and EMBASE (June 12, 2025). Studies underwent quality assessment and data extraction, with pooled proportions calculated using a random-effects model.ResultsEleven studies including 479 patients were analyzed. Median distraction distance and activation phase duration were 26.3 mm and 25.4 days, respectively; median latency and consolidation phase durations were 3.1 and 94.5 days, respectively. The pooled complication rate was 44.3% (95% confidence interval (CI): 31%-57%; I2 = 86%, p < .0001). Weighted logistic regression showed that a higher mean distraction velocity (MDV) was associated with lower rates of dermatologic complications (p = .027). Weighted linear regression showed that longer activation phases significantly increased skin complications (p = .025) and device failures (p = .040). Distraction distance was not significantly associated with postoperative complications in weighted linear regression modeling.ConclusionsThis review revealed substantial variation in the distraction protocol and patient outcome reporting. While MDV and distraction distance showed weak or inconsistent associations with complications, activation phase duration showed the most consistent study-level associations with postoperative outcomes. However, divergent trends between models, substantial heterogeneity, and reliance on cohort-level averages limit the ability to establish definitive relationships between distraction parameters and complications; these findings should not be used to guide clinical practice. Future studies reporting patient-level distraction protocols, subsequent protocol modifications, and postoperative outcomes are needed to support more robust risk modeling.
