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Background: Collection of high-quality videorecorded speech samples is essential for speech outcomes research. Solution: Cleft palate team SLPs were trained to collect standard videorecorded speech samples in the clinic setting across 20 sites in North America. Standard training and equipment was provided. What We Did That is New: Quality management procedures were developed and utilized to verify video quality and protocol adherence. Over 97% of speech samples collected by trained SLPs met defined quality standards. [ABSTRACT FROM AUTHOR]

Objective: Surgical treatment of velopharyngeal insufficiency (VPI) includes a wide array of procedures. The purpose of this study was to develop a classification for VPI procedures and to describe variations in how they are performed. Design/participants/setting/outcomes: We completed an in-depth review of the literature to develop a preliminary schema that encompassed existing VPI procedures. Forty-one cleft surgeons from twelve hospitals across the USA and Canada reviewed the schema and either confirmed that it encompassed all VPI procedures they performed or requested additions. Two surgeons then observed the conduct of the procedures by surgeons at each hospital. Standardized reports were completed with each visit to further explore the literature, refine the schema, and delineate the common and unique aspects of each surgeon's technique. Results: Procedures were divided into three groups: palate-based surgery; pharynx-based surgery; and augmentation. Palate-based operations included straight line mucosal incision with intravelar veloplasty, double-opposing Z-plasty, and palate lengthening with buccal myomucosal flaps. Many surgeons blended maneuvers from these three techniques, so a more descriptive schema was developed classifying the maneuvers employed on the oral mucosa, nasal mucosa, and muscle. Pharynx-based surgery included pharyngeal flap and sphincter pharyngoplasty, with variations in design for each. Augmentation procedures included palate and posterior wall augmentation. Conclusions: A comprehensive schema for VPI procedures was developed incorporating intentional adaptations in technique. There was substantial variation amongst surgeons in how each procedure was performed. The schema may enable more specific evaluations of surgical outcomes and exploration of the mechanisms through which these procedures improve speech. [ABSTRACT FROM AUTHOR]

Objective: To describe current postoperative management practices following cleft palate repair. Design: A survey was administered to cleft surgeons to collect information on their demographic characteristics, surgical training, surgical practice, and postoperative management preferences. Setting: Eighteen tertiary referral hospitals across the United States. Participants: Surgeons (n = 67) performing primary cleft palate repair. Results: Postoperative diet restrictions were imposed by 92% of surgeons; pureed foods were allowed at one week after surgery by 90% of surgeons; a regular diet was allowed at one month by 80% of surgeons. Elbow immobilizers and/or mittens were used by 85% of surgeons, for a median duration of two weeks. There was significant disagreement about postoperative use of bottles (61% allow), sippy cups (68% allow), pacifiers (29% allow), and antibiotics (45% prescribe). Surgeon specialty was not associated with any aspect of postoperative management (p > 0.05 for all comparisons). Surgeon years in practice, a measure of surgeon experience, was associated only with sippy cup use (p < 0.01). The hospital at which the surgeon practiced was associated with diet restrictions (p < 0.01), bottle use (p < 0.01), and use of elbow immobilizers or mittens (p < 0.01); however, many hospitals still had disagreement among their surgeons. Conclusions: Surgeons broadly agree on diet restrictions and the use of elbow immobilizers or mittens following palate repair. Almost all other aspects of postoperative management, including the type and duration of diet restriction as well as the duration of immobilizer use, are highly individualized. [ABSTRACT FROM AUTHOR]

The article focuses on presentations at ACPA's 2024 Annual Meeting, covering diverse topics such as innovative techniques for cleft rhinoplasty, novel methods for nasal aesthetic analysis, and advancements in digital workflow for nasoalveolar molding fabrication. It highlight the importance of improving surgical outcomes, enhancing preoperative planning, and leveraging technology for more effective cleft care interventions.

Objective: To present the design and methodology for an actively enrolling comparative effectiveness study of revision palatoplasty versus pharyngoplasty for the treatment of velopharyngeal insufficiency (VPI) Design: Prospective observational multicenter study Setting: Twelve hospitals across the United States and Canada Participants: Individuals who are 3–23 years of age with a history of repaired cleft palate and a diagnosis of VPI, with a total enrollment target of 528 participants Interventions: Revision palatoplasty and pharyngoplasty (either pharyngeal flap or sphincter pharyngoplasty), as selected for each participant by their treatment team Main Outcome Measure(s): The primary outcome is resolution of hypernasality, defined as the absence of consistent hypernasality as determined by blinded perceptual assessment of a standard speech sample recorded twelve months after surgery. The secondary outcome is incidence of new onset obstructive sleep apnea. Statistical analyses will use propensity score matching to control for demographics, medical history, preoperative severity of hypernasality, and preoperative imaging findings. Results: Study recruitment began February 2021. As of September 2022, 148 participants are enrolled, and 78 have undergone VPI surgery. Enrollment is projected to continue into 2025. Collection of postoperative evaluations should be completed by the end of 2026, with dissemination of results soon thereafter. Conclusions: Patients with VPI following cleft palate repair are being actively enrolled at sites across the US and Canada into a prospective observational study evaluating surgical outcomes. This study will be the largest and most comprehensive study of VPI surgery outcomes to date. [ABSTRACT FROM AUTHOR]

The article discusses the importance of multidisciplinary approaches, community support, and research findings to improve treatment and outcomes for individuals with cleft lip and palate. It highlights the positive impact of a community-based craniofacial team day, a comparative effectiveness study, and a comparison of early speech production in children with cleft palate.

Objective: To evaluate patient-reported aesthetic and psychosocial outcomes of secondary cleft lip and nose revision procedures. Design: Single-center cohort study. Setting: Tertiary care pediatric hospital. Patients/Participants: Patients who underwent secondary revision procedures for cleft lip and nasal defect (N = 42). Interventions: Patients were administered a survey during a routine postoperative clinic visit. Main Outcome Measure(s): Outcome measures were planned prior to data collection and included improvement in appearance seen in lip and nose, satisfaction with revision procedure, changes in self-confidence, likelihood to participate in social activities, and effect on teasing by peers. Results: Patients agreed that an improvement was seen in the appearance of their lip (1.93) and nose (1.98) following surgery. Overall, patients felt satisfied with the results of their revision procedure (1.76). An improvement in confidence and decrease in feelings of self-consciousness was reported. Patients were teased less by their peers and more likely to participate in social activities. Conclusions: Secondary revision procedures of the cleft lip and nasal defect provide a patient-reported improvement in appearance and a positive psychosocial impact on patient's lives. [ABSTRACT FROM AUTHOR]

The article offers information on list of the disclosures for all sessions with continuing education at ACPA's 77th Annual Meeting and disclosures have been reviewed and any relevant conflict of interests have been resolved.

Objective: This study aimed to determine whether intraoperative acetaminophen was able to decrease opioid consumption, pain scores, and length of stay while increasing oral intake in cleft palate surgery. Design/Setting/Patients: One hundred consecutive patients with cleft palate who underwent a von Langenbeck or 2-flap palatoplasty and intravelar veloplasty at a tertiary medical center by the 2 senior authors from 2010 to 2015 were reviewed. Interventions: Three intraoperative treatment groups were analyzed: intravenous (IV) acetaminophen, per rectal (PR) acetaminophen, and no acetaminophen. All patients received long-acting local anesthesia infiltration before incision. Additionally, all patients were admitted overnight and given weight-based per oral (PO) acetaminophen and oxycodone and IV morphine as needed based on pain scores. Outcomes Measured: The study outcomes included pain scores, opioid requirement, length of stay, and oral intake. Results: The treatment groups were comprised of 40 patients who received IV acetaminophen, 22 PR acetaminophen, and 35 none. Concerning demographic data, there was no statistical difference between treatment groups. There was no statistically significant difference for opioid intake, although both IV and PR acetaminophen groups had decreased pain scores (P = .029). There was no difference in oral intake (P = .13) or length of stay (P = .31) between treatment groups. Conclusion: In this study, intraoperative administration of acetaminophen was associated with decreased pain scores, but no opioid-sparing effect. As other studies have shown an opioid-sparing effect with postoperative acetaminophen, we recommend withholding the intraoperative dose and beginning therapy in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

The author discloses the financial and non-financial relationships of the contributors with the journal.

Due to the state’s recent adoption of the Interstate School Leaders Licensure Consortium standards, all leadership preparation programs are required to develop a standards-based curriculum emphasizing the principal’s responsibility to lead schools committed to student success. The Midwest State University (MSU) educational leadership faculty, which has undergone significant turnover, is faced with the dual challenge of developing collaborative working relationships among department members while revising their principal preparation program to meet the state’s upgraded requirements. The MSU faculty used this opportunity to develop a professional learning community through a series of retreats and sustained work activities throughout the academic year as they reformed their principal preparation program. [ABSTRACT FROM PUBLISHER]