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Objective: To quantify differences in number and timing of first primary cleft lip and palate (CLP) repair procedures during the first year of the COVID-19 pandemic (1 April 2020 to 31 March 2021; 2020/2021) compared with the preceding year (1 April 2019 to 31 March 2020; 2019/2021)., Design: National observational study of administrative hospital data., Setting: National Health Service hospitals in England., Study Population: Children <5 years undergoing primary repair for an orofacial cleft Population Consensus and Surveys Classification of Interventions and Procedures-fourth revisions (OPCS-4) codes F031, F291)., Main Exposure: Procedure date (2020/2021 vs 2019/2020)., Main Outcomes: Numbers and timing (age in months) of first primary CLP procedures., Results: 1716 CLP primary repair procedures were included in the analysis. In 2020/2021, 774 CLP procedures were carried out compared with 942 in 2019/2020, a reduction of 17.8% (95% CI 9.5% to 25.4%). The reduction varied over time in 2020/2021, with no surgeries at all during the first 2 months (April and May 2020). Compared with 2019/2020, first primary lip repair procedures performed in 2020/2021 were delayed by 1.6 months on average (95% CI 0.9 to 2.2 months). Delays in primary palate repairs were smaller on average but varied across the nine geographical regions., Conclusion: There were significant reductions in the number and delays in timing of first primary CLP repair procedures in England during the first year of the pandemic, which may affect long-term outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Objectives: Adults with cleft lip and/or palate (CL/P) may report dissatisfaction with aesthetic and/or functional outcomes and express desire for further treatment. Although medical intervention can improve quality of life, surgical procedures require complex decision-making and can invoke psychological distress. The aim of this study was to gain a better understanding of ongoing treatment-related support needs by examining self-reported treatment experiences of a sample of adults born with CL/P., Design: An online, mixed-methods survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research at the University of the West of England. A total of 207 eligible responses were received. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics., Results: Although participants were satisfied with surgical and dental/orthodontic outcomes overall, many reported ongoing difficulties. Some stated they would seek further treatment while others felt conflicted about risks and benefits. Some had refused treatment, citing treatment fatigue, anxiety, and/or concerns that treatment would be unsuccessful. More than 40% of participants were unaware of their entitlement to cleft-related treatment provided by the National Health Service, and many others had experienced difficulties accessing care., Conclusions: Although advances in health care may offer opportunities for adults to improve their quality of life, treatment decisions should be weighed with the support of a clinical psychologist where available. Guidance for young adults considering future treatment is also recommended. Finally, training and resources for local practitioners may improve general awareness of CL/P services and increase access to specialist care for adults with ongoing CL/P-related concerns.

The Newcastle Surgical Training Centre Cadaveric Speech and Palate Surgery Course is an interactive and practical 1-day course for plastic surgery, ear, nose and throat surgery, and maxillofacial surgery trainees wishing to develop skills in cleft palate and speech surgery. The course is delivered by an expert faculty with delegates attending from the United Kingdom and abroad and costs £495 (US $650) to attend. This review provides information and an evaluation of the course.

Objective: In wide palatal defects, closure of the nasal layer can prove a considerable challenge. Mobilizing nasal flaps posteriorly usually facilitates soft palate closure. However, the defect is often too wide within the hard palate; hence, bilateral vomerine flaps are frequently required. Despite this, there is often a small defect in the nasal layer at the posterior septum (typically equating to the hard-soft palate junction), which has to be left to heal by secondary intention with the resulting increased risk of fistula formation and the potential deleterious long-term effect on speech due to cicatricial migration of the reconstructed levator sling anteriorly. We describe our experience in the use of the sphenoid flap to obtain tension-free primary closure of the nasal layer., Methods: A retrospective multi-center study assessing all sphenoid flap procedures undertaken at both Birmingham Children's Hospital and Great Ormond Street Hospital. Key demographic and medical data was collected pre-, peri-, and postoperatively across the 2 sites., Results: A total of 66 patients underwent the use of a sphenoid flap to aid closure of the nasal layer. The average age at time of repair was 9.7 months. More than half (55%, n = 36) were isolated cleft palates, and 35% (n = 23) were BCLPs. Forty-two percent of all patients had Robin sequence. The average cleft width was 14.4 mm. The overall fistula rate was 25.8% (n = 17)., Conclusions: We describe the operative technique, indications, and our experience in the use of the sphenoid flap in wide cleft palate repair.

Objective: To investigate the postoperative complication rates of LeFort 1 maxillary advancement surgery in cleft patients when performed by a single surgeon over a 5-year period., Design: A retrospective case note review of 79 cleft palate patients., Setting: All surgery was performed by a single oral and maxillofacial surgeon in a tertiary care center., Participants: All cleft palate patients over 17 years of age who opted for surgical correction of maxillary hypoplasia with a LeFort 1 between 2010 and 2015. Patients required full surgical and clinical records., Interventions: Complete surgical advancement of the maxilla ranging from 2.0 to 18.0 mm performed by conventional osteotomies (87%) or distraction osteogenesis (13%)., Main Outcome Measure(s): Postoperative patient- and clinician-reported complications at set-interval follow-up appointments., Results: Twenty-one patients (26.58%) reported no complications; 11 postoperative complications were identified in the remaining cohort. Temporary paresthesia of the infraorbital nerve was the most common complication (53.16%) followed by infection (13.92%). Other complications included relapse (11.39%), maxillary instability (6.33%), velopharyngeal impairment (6.33%), nasal obstruction (5.06%), chronic sinusitis (3.80%), bony dehiscence (1.27%), gingival necrosis (1.27%), partial necrosis of the maxilla (1.27%), and loss of tooth vitality (1.27%)., Conclusions: LeFort 1 maxillary advancement surgery in cleft palate patients is associated with a wide range of postoperative complications, most commonly temporary paresthesia of the infraorbital nerve. Detailed, informed consent is essential prior to surgery.

Objective: To analyse hospital admissions in the first 2 years of life among children with cleft lip and/or palate in England., Design: Analysis of national administrative data of hospital admissions., Setting: National Health Service hospitals., Patients: Patients born alive between 1997 and 2008 who underwent surgical cleft repair., Outcome Measures: Number of admissions, including the birth episode, and days spent in hospital were examined. Children were analysed according to cleft type and whether or not they had additional congenital anomalies., Results: 10 892 children were included. In their first 2 years, children without additional anomalies (n=8482) had on average 3.2 admissions and 13.2 days in hospital, which varied from 2.6 admissions and 9.2 days with cleft lip to 4.7 admissions and 19.7 days with bilateral cleft lip and palate (BCLP). Children with additional anomalies (n=2410) had on average 6.7 admissions and 51.4 days in hospital, which varied from 6.4 admissions and 48.5 days with cleft palate to 8.8 admissions and 67.5 days with BCLP. The mean number and duration of cleft-related admissions was similar in children without (1.6 admissions and 6.4 days) and in those with additional anomalies (1.5 admissions and 8.5 days). 35.2% of children without additional anomalies had at least one emergency admission, whereas the corresponding figure was 67.3% with additional anomalies., Conclusions: The burden of hospital care in the first 2 years of life varied according to cleft type and presence of additional anomalies. However, cleft-specific hospital care did not differ between children with and without additional anomalies.

Using cleft lip and palate as an exemplar, this article examines parents' decision-making for children in the context of elective treatments which aim to 'normalise' a child's function, appearance, communication or identity. Using purposive and theoretical sampling, 35 parents with children from infancy to young adulthood were recruited through a specialist cleft centre in England. Parents were interviewed in-depth between 2006 and 2008 about their beliefs and motivations in relation to treatment decision-making in this context. A grounded theory approach was used to analyse the data. Findings revealed a core category, 'doing the "right" thing', that encapsulated parents' main concern in relation to their children's treatment and highlighted several emotional, social and cultural considerations underpinning their decision-making stance. Parents fulfilled a perceived 'moral' obligation to be 'good' parents by pursuing the 'normalising' treatments, particularly surgeries, made available to their children. Such treatments were viewed as a way of facilitating their child's social inclusion and helping them reach their full potential. In order to enable their continued pursuit of treatments over the long-term, parents also constructed specialist practitioners as highly competent and particularly trustworthy. This article captures the complexities involved in parents' decision-making for children's elective 'normalising' treatments, where both functional and appearance-related concerns are involved. It suggests that social norms about parenting, physical appearance and healthcare practitioner power may significantly shape decision-making in this context, so that such choices may be viewed primarily as 'moral' rather than social. Services could support parents with such challenges, by gauging their needs for information about surgery and its likely outcomes and providing emotional/decisional support to consider all available options., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Almost 1,000 babies are born each year with some form of cleft, whether it is a palate, lip or a combination. However, with the advent of new regional cleft centres and specialist professionals caring for larger numbers of children with a cleft lip and palate, the long-term outcomes of these patients should show improvement. The nursing care on paediatric wards will make an important contribution to these outcomes. In this article, post-operative feeding, analgesia and inpatient stays following cleft palate repair are examined. In a post-palatoplasty study of 68 babies, 34 who were fed orally and 34 nasogastrically, the babies who were fed nasogastrically were more settled, needed less analgesia and were discharged earlier. The parents of these babies were more relaxed knowing their child was fed and had adequate analgesia, and nurses believed they were able to give these babies a better quality of care.

Objective: To investigate differences in size of the maxillary permanent anterior teeth and arch dimensions between individuals with repaired unilateral cleft lip and palate (UCLP) and a matched control group representing the general population., Design: Retrospective study cast review., Participants: Study casts of 30 subjects due to commence orthodontic treatment following an alveolar bone graft (ABG) were collected from the Cleft Lip and Palate Units in South Yorkshire. Thirty control subjects were collected from a previously validated control group of white individuals in South Yorkshire., Main Outcome Measures: Casts were analyzed with an image analysis system to measure the dimensions of the maxillary permanent anterior teeth, incisor chord lengths, and the intercanine and intermolar widths. The results were analyzed statistically using paired t-tests and two-way univariate analysis of variance (ANOVA)., Results: The mesiodistal widths of maxillary anterior teeth in the study group were smaller than the noncleft control group (p

Objective: To test specific standards set in the newly established cleft lip and palate service in three regions of the U.K. The standards relate to record collection and outcomes., Design: Retrospective analysis., Patients: Records of 31 children, 5 years of age, who were born in 1997 with complete unilateral clefts of lip and palate and were treated by surgeons in three regions., Main Outcome Measures: Record collection standards were measured by collecting dental study models. Outcomes were measured with the 5-Year-Old Index., Results: Of the 31 subjects, 52% had excellent and good outcomes. The 31 cases represented 62% of the total records collected., Conclusions: The three regions examined fell short of the standards set, but the outcomes were improved compared with previous national outcomes. The failings in record collection need to be rectified. This study provides baseline data for further development of cleft services within three regions.

Objective: To assess the dental arch relationships of children with a complete unilateral cleft lip and palate (UCLP), born consecutively between 1983 and 1987, who had undergone primary cleft repair in the West Yorkshire region of the United Kingdom. The treatment outcome of this UCLP sample was then compared with the results of a previously published intercenter European study., Design: A retrospective study with standardized record collection and blind assessment., Setting: Regional dental hospital providing secondary and tertiary health care to the local population., Patients: 35 UCLP patients whose primary repair had been performed within West Yorkshire., Interventions: Dental casts obtained for each subject within 12 months of their 10th birthday., Main Outcome Measures: The West Yorkshire models were randomly mixed with an anonymous sample of 115 UCLP cases from other cleft centers in the U.K. The dental arch relationships of the 10-year-old models were assessed by applying the Goslon Yardstick., Results: One-third of the West Yorkshire cleft sample were rated as belonging to Goslon group 2 (good result), another third to group 3 (fair result), and the remaining third to groups 4 and 5 (poor/very poor result). Numerically, the results were of a slightly higher standard than that previously published for other U.K. and European cleft centers but were inferior to the treatment outcome of two European centers. No statistically significant differences were found between the outcome results of the West Yorkshire group and the other cleft centers., Conclusions: These results provide useful baseline data against which progress in achieving improved treatment outcome for West Yorkshire UCLP children can be determined by future research.

The Cleft Palate Index and more recently the Craniofacial Anomalies Register--CARE--have been in operation since 1982. This paper summarises its development and plans for the future. CARE is a multi-disciplinary committee involving all specialties involved in the treatment of this group of patients. It therefore should and can be well placed to coordinate the cleft data arising from these patients.

This study examined the dento-alveolar relationships of 5-year-old children born with a unilateral cleft lip and palate with primary surgical repair performed in one of two centres (Bristol or Oslo). The Bristol sample comprised 46 sets of study models and the Oslo CLP Growth Archive provided 54 cases with a very similar sex distribution. We used a recently developed 5-year-old index to measure differences in outcome between the two centres. The Oslo sample were assessed as having up to 57 per cent in the ideal groupings (1 and 2), in the Bristol group this was only 35 per cent. Bristol had up to 46 per cent of cases assessed in the worst groups (4 and 5). The comparative figure from the Oslo group was 15 per cent. These results suggest that it is possible to detect differences in surgical outcome at 5 years of age.

Two groups of 10-year-old patients with complete unilateral clefts of the lip and palate were examined in this study. Two centers; Bristol, U.K. and Oslo, Norway, who had different treatment regimens were used. The groups comprised 40 patients from Oslo and 32 from Bristol. The groups were matched, in proportion to the size of the groups, for age, sex, and presence of Simonart's bands. In Oslo, a Millard lip repaired was performed at 3 months of age with a von Langenbeck palatal repair at 18 months, no presurgical orthopedics was employed and there was no primary nasal correction. The Bristol center also repaired the lip at 3 months with a Millard type repair but also performed a radical nasal correction at the same time. The palate was repaired at 6 months with a Veau repair, and presurgical orthopedics using a pinned arch orthopedic plate was carried out. In addition, the volume of primary repairs per surgeon was much higher in Oslo, and a much stricter treatment protocol was used compared with Bristol. Lateral cephalograms obtained within 1 year of the child's tenth birthday were digitized, and the craniofacial morphology of the two groups was compared. Significant differences in maxillary growth and soft tissue profile were noted with a much more retruded mid-face and flatter nasiolabial angle in the Bristol group. The main factors for the better results in Oslo are suggested to be the absence of presurgical orthopedics, no radical nasal correction, the high volume of operations performed per surgeon, and the stricter protocol.

The results of a postal survey in 1992 of surgeons in England and Wales undertaking primary repairs for babies born with cleft lip and palate are presented. 64 plastic surgeons undertaking primary cleft repairs were identified. The majority of cleft surgeons were low volume operators undertaking 10 or less lip repairs annually. Low volume operators were less likely to attend joint disciplinary clinics than high volume operators and those that did attended clinics with fewer specialities represented. None of the low volume operators collected standardised records for their patients. The recommendations of the Royal College of Surgeons of England for centralisation of cleft care in England and Wales on a regional basis and a minimum case-load per surgeon of 30 new cases per year are discussed.

Intercentre audit in the late 1980s revealed poorer outcomes for facial growth for British patients with cleft lip and palate than equivalent patients in northern Europe. A subsequent survey of the surgical practices in England and Wales, under the auspices of the Surgical Audit and Epidemiology Unit, revealed the widespread involvement of low-volume operators in cleft care, a tendency for low-volume operators to have an incomplete network of associated professionals, and non-standardised record keeping protocols. Recommendations for minimum standards of care for children born with cleft lip and palate were produced by a multidisciplinary steering group. A further investigation is planned to determine their validity and to provide a baseline for future audit cycles.

It is generally believed that studies of outcome for children with clefts of the lip and palate should be based on patients who are in their teens. This means that health care workers who look after these children would have to wait many years until the quality of treatment could be evaluated. In this study, significant differences between two centers, Oslo and Manchester, in facial form at the age of 5 years were detected. Based on cephalometric analysis, children from Manchester were more likely to have a retrognathic maxilla with the upper lip significantly behind the esthetic plane. An important future step may be the setting up of "reference centers" with a large archive of database information for each racial group. This would assist smaller centers in comparing their outcomes.