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Summary En coup de sabre deformity (ECDS) is a form of localized scleroderma in the frontoparietal region caused by progressive subcutaneous tissue atrophy and bony defect. Although ECDS involves two layers, skin/subcutaneous tissue and bone, the existing literature mainly focuses only on treating the skin/subcutaneous tissue layer. In this case series, we aimed to propose a novel approach that includes the combined use of fat grafting and demineralized bone matrix (DBM). Four patients with ECDS deformity, operated between February 2016 and October 2018, were retrospectively evaluated. All the patients were treated with the novel approach. Patients were evaluated with localized scleroderma scale and computed tomography (CT) scan in the preoperative period and at the annual follow-up. We observed remarkable improvement in the localized scleroderma scale including appearance, palpation, and size scores in all patients at the annual follow-up. CT scans at the annual follow-up revealed new callus formation at the bony defect area in all patients. Reinforcing fat grafting with DBM could promote healing of the bony and skin/subcutaneous tissue defects associated with ECDS.

Introduction: Children with cleft palate exhibit differences in the 4 temporal components of nasalization (nasal onset and offset intervals, nasal consonant duration, and total speech duration), with various patterns having been noted based on different languages. Thus, the current study aimed to examine the temporal aspects of velopharyngeal closure in children with and without cleft palate; this is the first study to do so in the Turkish language. Methods: This study evaluated and compared the 4 temporal characteristics of velopharyngeal closure in children (aged 6–10 years) with (n = 28) and without (n = 28) cleft palate using nonword consonant and vowel speech samples, including the bilabial nasal-to-stop combination /mp/ and the velar nasal-to-stop combination /ηk/. Acoustic data were recorded using a nasometer, after which acoustic waveforms were examined to determine the 4 temporal components of nasalization. Flexible nasoendoscopy was then used to evaluate velopharyngeal closure patterns. Results: With regard to the 4 closure patterns, significant differences in the nasal offset interval (F4–25 = 10.213, p = 0.04; p < 0.05) and the nasal consonant duration ratio (F4–25 = 12.987, p = 0.02; p < 0.05) were observed for only /ampa/. The coronal closure pattern showed the longest closure duration (0.74 s). Children with cleft palate showed prolonged temporal parameters in all 4 characteristics, reflecting oral-nasal resonance imbalances. In particular, the low vowel sound /a/ was significantly more prolonged than the high vowel sounds /i/ and /u/. Conclusions: The examined temporal parameters offer more accurate characterizations of velopharygeal closure, thereby allowing more accurate clinical assessments and more appropriate treatment procedures. Children with cleft palate showed longer nasalization durations compared to those without the same. Thus, the degree of hypernasality in children with cleft palate may affect the temporal aspects of nasalization.

Objective: To explore parenting stress and factors affecting the mothers of infants with cleft lip and/or palate (CL/P) in Turkey. Design and Participants: The study compared mothers of infants born with CL/P (n = 90) with mothers of healthy infants (n = 90). Mothers completed the data collection form, the Parenting Stress Index-Short Form, and the Multidimensional Scale of Perceived Social Support. Results: Mothers of infants born with CL/P had higher mean parenting stress scores than the control mothers. A significant negative relationship was found between social support and parenting stress for mothers of infants born with CL/P but was not related for control mothers. Among mothers with an infant with CL/P, the mean parenting stress scores were higher for mothers preoperatively than mothers responding postoperatively. Among mothers with an infant with a cleft, higher stress was found for diagnosis after birth, not breastfeeding, feeding difficulties, lack of fathers’ support, perceived difficult infant temperament, blame, anger, and concern for the future. Conclusion: Parenting stress was higher and social support was lower for mothers of infants with a cleft. Treatment teams can design interventions aimed at factors related to stress, such as addressing feeding issues, teaching coping skills, and linking to social support.

Purpose To determine the purpose of the parents of infants with cleft lip and/or palate (CL/P) for using Facebook, how they share for the audience and what kind of information they search for. Design and methods The results of the study were analyzed using qualitative and quantitative methodologies. Data were collected for one major social media platform (Facebook) from public accounts dedicated to CL/P. The former involved thematic and word count analysis for online posts on the Facebook platform, while the latter employed descriptive statistics. Results Facebook has a total of 8 group accounts and 7695 users in Turkey. Among the 702 posts analyzed, “requesting information” was found to be the most commonly encountered theme (55.4%). This study, it was determined that especially parents of infants with CL/P need information about surgery. The “announcement” was mentioned in only 3.3% of all posts. Our text analysis of 17.134 words mentioned in posts revealed that the most common word was surgery (6.6%). Conclusions The current study provides a comprehensive reference to the role of social media in CL/P. Practice implications In the near future, analysis of patients' and public knowledge and perception of surgery will be an important next step in building greater awareness of its role in the management of CL/P.

Purpose The purpose of this study was to evaluate the speech results of posterior pharyngeal wall augmentation (PPWA) with fat grafting both in the early and late postoperative period, and to clarify the impact of the procedure concomitant with speech therapy. Materials and methods This is a prospective case-control study. The study involved 87 cleft palate ± cleft lip patients with velopharyngeal insufficiency (VPI) who has been treated with PPWA. Patients were separated into two groups according to age; the first group consisted of 49 pediatric participants between 6 and 12 years of age and the second group consisted of 38 adolescent participants between 13 and 18 years of age. Preoperative velopharyngeal function and articulation were compared postoperatively at the following time points: the 3rd month, 12th month, 18th month and 24th month. The velopharyngeal function was evaluated with regards to the velopharyngeal closure type and velopharyngeal closure amount, by using the pediatric flexible nasoendoscopy and the nasometer methods. In the nasometer evaluation, nasalance sores were measured by using nonsense syllables and meaningful sentences. The Ankara Articulation Test (AAT) (Ege et al., 2004) was used to detect compensatory articulation products secondary to VPI. Consonant production error types and frequencies were determined according the guidelines stated in the study of Hardin-Jones et al. (2009). These were Pharyngeal Fricatives – Posterior Nasal Fricatives/Stop Production, Glottal Stop Production, Middorsum Palatal Stop Production, Nasal Frictional Production, Posterior Nasal Frictional Production/Phoneme Specific Nasal Emission, use of Nasal Consonants for Oral Consonants, and Replacement of Trills. All the participants received concurrent speech therapy four times, twice in the post-operative period between 1 and 3 months and twice between 3 and 6 months. Results PPWA improved the speech performance from the 18th month to 24th month of the postoperative period. AAT assessment of the first group after 24 months comparing the post-PPWA with the preoperative data showed a highly significant decrease with regard to compensatory production errors and hypernasality; however, in the second group, the same comparison revealed a highly significant decrease in regard to the degree of hypernasality and a significant difference in terms of glottal articulation and pharyngealization of fricatives. A circular closure pattern was observed in 17 individuals with cleft palate at a rate of 70.6%. Conclusion PPWA with concurrent speech therapy is an acceptable surgical method to correct VPI and to improve speech performance.

Objective: To compare the prevalence of increased risk of obstructive sleep apnea (OSA) in children with and without cleft lip and/or palate using a previously validated questionnaire and to examine the clinical and demographic variables that may lead to increased OSA risk. Design: Prospective, cross-sectional study. Participants: One hundred fifty-five cleft lip palate and 155 noncleft children between 2 and 18 years old. Interventions: The Pediatric Sleep Questionnaire (PSQ): Sleep Related Breathing Disorder Scale was used for screening of increased OSA risk. Age, body mass index (BMI), gender, breast-feeding, and bottle-feeding durations were recorded for all patients. Cleft type, lip and palate operation times, nasoalveolar molding, or nutrition plaque usage was documented for the cleft lip palate group. Pearson χ2 or Fisher exact test was used for the evaluation of the qualitative variables and independent samples t test or Mann Whitney U test for quantitative variables. P < .05 was accepted as statistically significant. Results: The mean ages were 7.52 ± 3.91 and 7.50 ± 3.89 years for cleft lip palate and control groups, respectively. No significant differences were observed between the groups for age, gender, or BMI. Breast-feeding duration was significantly higher, and bottle-feeding duration was lower in the control group ( P < .05). Mean PSQ score was significantly higher in cleft lip palate group (0.18 ± 0.12) than in control group (0.13 ± 0.1, P < .001); and prevalence of increased OSA risk was significantly higher in patients with both cleft lip and palate ( P = .020). Conclusions: Positive OSA screening ratio of children with cleft lip and palate (12.2%) was significantly higher than the controls (4.5%).

Purpose The aim of the study is to compare long term otoscopic and audiological findings of cleft palate patients with or without early grommet insertion. Methods Cleft palate patients followed-up in Hacettepe University between 2008 and 2013 were included in the study. Age, gender, cleft types and palate surgery data, grommet tube insertion history and otological – audiological evaluations of the patients were recorded. Patients were evaluated in three groups according to grommet insertion history: A-early routine grommet insertion, B-grommet insertion during follow-up, C-no grommet insertion. Otological and audiological findings were compared. Results There were 154 patients in the study, with a median age of 7.7 years. There were 67 patients in group A (43.5%), 22 patients in group B (14.3%) and 65 patients in group C (42.2%). OME was identified significantly higher in group A and normal otoscopic examination findings were higher in group C. Complications showed a higher rate than other otoscopic findings in group B patients. There was no significant difference for any frequencies in between the groups in terms of mean air-bone gap (ABG) values. There were 20 grade I, 25 grade II, 77 grade III and 32 grade IV patients in the study according to the Veau classification. Conclusion Prophylactic grommet insertion may not be applied as some cleft palate patients with no OME. Wait and see protocol can be recommended for these patients, and they should be followed-up up closely to avoid complications. If the effusion does not recover or tympanic membrane changes occur in follow-up, grommet insertion should be considered.

The aim was to investigate the effects of glottal stop productions (GS) on voice in children with cleft palate using multidimensional voice assessment methods.This is a prospective case-control study.Children with repaired cleft palate (n = 34) who did not have any vocal fold lesions were separated into two groups based on the results of the articulation test. The glottal stop group (GSG) consisted of 17 children who had GS. The control group (CG) consisted of an equal number of age- and gender-matched children who did not have GS. The voice evaluation protocol included acoustic analysis, Pediatric Voice Handicap Index (pVHI), and perceptual analysis (Grade, Roughness, Breathiness, Asthenia, Strain method). The velopharyngeal statuses of the groups were compared using the nasopharyngoscopy and the nasometer.The total pVHI score and the subscales of the pVHI were found to be significantly higher in the GSG. The F0, jitter, and shimmer were found to be numerically higher in the GSG with the difference being statistically significant in jitter (P 0.05). Audioperceptual analysis revealed a difference in overall voice quality and roughness between the groups. Greater incidence of significant velopharyngeal insufficiency and higher nasalance scores were found in the GSG (P 0.05).These results may indicate that the vocal quality characteristics of children with GS differ from children who do not have this type of production. It is suggested that children with cleft palate who have GS should receive a comprehensive speech and language pathology intervention including voice therapy techniques.

The technique of tissue expansion in pediatric patients is described and complications seen in a series of 44 patients are analyzed. It is concluded that tissue expanders in children proved to be a well-tolerated and valuable reconstructive method for soft-tissue deficiencies of the scalp, face, trunk, and extremities.