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Arun K. Gosain - One of the best experts on this subject based on the ideXlab platform.

  • Evidence-based medicine: Cleft Palate
    Plastic and Reconstructive Surgery, 2013
    Co-Authors: Kyle J Chepla, Arun K. Gosain
    Abstract:

    LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Describe recent changes in treatment of Cleft Palate. 2. Compare the efficacy of different surgical treatments. 3. Assess their own knowledge of Cleft Palate repair. 4. Determine where further individual in-depth study and development are warranted. SUMMARY The Maintenance of Certification in Plastic Surgery series is designed to ensure professional development and measure continued competency within a specialty or subspecialty. The present article provides an evaluation of the interval studies regarding the management of Cleft Palate with a specific focus on craniofacial growth, speech outcomes, and obstructive sleep apnea since the last Maintenance of Certification in Plastic Surgery article on the subject published in 2010. This purpose of this article is to update plastic and craniomaxillofacial surgeons on recent changes in treatment of Cleft Palate, provide a means for accurate self-assessment, and guide further individual in-depth study and development.

  • Submucous Cleft Palate: diagnostic methods and outcomes of surgical treatment.
    Plastic and Reconstructive Surgery, 1996
    Co-Authors: Arun K. Gosain, Stephen F Conley, Susan M. Marks, David L. Larson
    Abstract:

    The following statements summarize our interpretation of the literature regarding submucous Cleft Palate: Incidence and Diagnosis of Submucous Cleft Palate 1. In surveys of classic stigmata of submucous Cleft Palate among the general population, the incidence has been reported to be 0.02 to 0.08 percent. In the larger of these series, the incidence of velopharyngeal inadequacy among patients identified to have submucous Cleft Palate was 1 to 9. The incidence of occult submucous Cleft Palate is not known, since these patients will only be detected during the evaluation of patients who present with velopharyngeal inadequacy. 2. The diagnosis of submucous Cleft Palate is made by identification of the classic stigmata on physical examination. The diagnosis of occult submucous Cleft Palate is only pursued if the patient has velopharyngeal inadequacy. 3. For consistency in evaluating and reporting data, patients with an overt Cleft of the secondary Palate that extends beyond the uvula should be reported as having a Cleft Palate, and not a submucous Cleft Palate, even if a submucous Cleft exists in a portion of the Palate anterior to the overt Cleft. 4. The true incidence of otitis media with effusion in the presence of submucous Cleft Palate has yet to be determined using a prospective study. Surgical Treatment of Velopharyngeal Inadequacy in Patients with Submucous Cleft Palate 1. The technique that has most consistently been documented to result in a significant correction of velopharyngeal inadequacy is the pharyngeal flap. There is recent evidence from one large center supporting the efficacy of the Furlow Z-plasty in selected patients with submucous Cleft Palate. Both these procedures appear to be most effective in patients with good lateral pharyngeal wall motion. 2. If a pharyngeal flap is performed as the primary procedure to act as an obturator against which the lateral pharyngeal walls appose for closure, we do not see the need for adjunctive palatal procedures. The dynamic component of velopharyngeal competence following such a pharyngeal flap consists of lateral wall motion, which is not enhanced by further surgical manipulation of the Palate. However, a pharyngeal flap may be performed as an adjunctive procedure to a palatal pushback in order to provide lining for the resultant defect in the nasal mucosa. 3. The present literature does not support "prophylactic" operations on patients who present with the physical stigmata of submucous Cleft Palate prior to reaching an age at which it can be demonstrated by perceptual speech assessment that velopharyngeal inadequacy remained refractory to speech therapy. A significant number of patients will never develop velopharyngeal inadequacy; therefore, surgery would be unnecessary. In addition, objective data regarding the outcomes of different surgical techniques cannot be gathered if patients with submucous Cleft Palate are operated on without having had velopharyngeal inadequacy documented prior to those operations. 4. In order to objectively compare the outcomes of different surgical techniques, any future studies should be prospective and utilize uniform means of assessment. As minimum criteria, these would include preoperative and postoperative perceptual speech assessments performed by a trained speech pathologist and preoperative nasopharyngoscopy and multiview videofluoroscopy. The latter two studies should be repeated postoperatively only in those patients who have persistent velopharyngeal inadequacy.

David L. Larson - One of the best experts on this subject based on the ideXlab platform.

  • Submucous Cleft Palate: diagnostic methods and outcomes of surgical treatment.
    Plastic and Reconstructive Surgery, 1996
    Co-Authors: Arun K. Gosain, Stephen F Conley, Susan M. Marks, David L. Larson
    Abstract:

    The following statements summarize our interpretation of the literature regarding submucous Cleft Palate: Incidence and Diagnosis of Submucous Cleft Palate 1. In surveys of classic stigmata of submucous Cleft Palate among the general population, the incidence has been reported to be 0.02 to 0.08 percent. In the larger of these series, the incidence of velopharyngeal inadequacy among patients identified to have submucous Cleft Palate was 1 to 9. The incidence of occult submucous Cleft Palate is not known, since these patients will only be detected during the evaluation of patients who present with velopharyngeal inadequacy. 2. The diagnosis of submucous Cleft Palate is made by identification of the classic stigmata on physical examination. The diagnosis of occult submucous Cleft Palate is only pursued if the patient has velopharyngeal inadequacy. 3. For consistency in evaluating and reporting data, patients with an overt Cleft of the secondary Palate that extends beyond the uvula should be reported as having a Cleft Palate, and not a submucous Cleft Palate, even if a submucous Cleft exists in a portion of the Palate anterior to the overt Cleft. 4. The true incidence of otitis media with effusion in the presence of submucous Cleft Palate has yet to be determined using a prospective study. Surgical Treatment of Velopharyngeal Inadequacy in Patients with Submucous Cleft Palate 1. The technique that has most consistently been documented to result in a significant correction of velopharyngeal inadequacy is the pharyngeal flap. There is recent evidence from one large center supporting the efficacy of the Furlow Z-plasty in selected patients with submucous Cleft Palate. Both these procedures appear to be most effective in patients with good lateral pharyngeal wall motion. 2. If a pharyngeal flap is performed as the primary procedure to act as an obturator against which the lateral pharyngeal walls appose for closure, we do not see the need for adjunctive palatal procedures. The dynamic component of velopharyngeal competence following such a pharyngeal flap consists of lateral wall motion, which is not enhanced by further surgical manipulation of the Palate. However, a pharyngeal flap may be performed as an adjunctive procedure to a palatal pushback in order to provide lining for the resultant defect in the nasal mucosa. 3. The present literature does not support "prophylactic" operations on patients who present with the physical stigmata of submucous Cleft Palate prior to reaching an age at which it can be demonstrated by perceptual speech assessment that velopharyngeal inadequacy remained refractory to speech therapy. A significant number of patients will never develop velopharyngeal inadequacy; therefore, surgery would be unnecessary. In addition, objective data regarding the outcomes of different surgical techniques cannot be gathered if patients with submucous Cleft Palate are operated on without having had velopharyngeal inadequacy documented prior to those operations. 4. In order to objectively compare the outcomes of different surgical techniques, any future studies should be prospective and utilize uniform means of assessment. As minimum criteria, these would include preoperative and postoperative perceptual speech assessments performed by a trained speech pathologist and preoperative nasopharyngoscopy and multiview videofluoroscopy. The latter two studies should be repeated postoperatively only in those patients who have persistent velopharyngeal inadequacy.

Stephen F Conley - One of the best experts on this subject based on the ideXlab platform.

  • Submucous Cleft Palate: diagnostic methods and outcomes of surgical treatment.
    Plastic and Reconstructive Surgery, 1996
    Co-Authors: Arun K. Gosain, Stephen F Conley, Susan M. Marks, David L. Larson
    Abstract:

    The following statements summarize our interpretation of the literature regarding submucous Cleft Palate: Incidence and Diagnosis of Submucous Cleft Palate 1. In surveys of classic stigmata of submucous Cleft Palate among the general population, the incidence has been reported to be 0.02 to 0.08 percent. In the larger of these series, the incidence of velopharyngeal inadequacy among patients identified to have submucous Cleft Palate was 1 to 9. The incidence of occult submucous Cleft Palate is not known, since these patients will only be detected during the evaluation of patients who present with velopharyngeal inadequacy. 2. The diagnosis of submucous Cleft Palate is made by identification of the classic stigmata on physical examination. The diagnosis of occult submucous Cleft Palate is only pursued if the patient has velopharyngeal inadequacy. 3. For consistency in evaluating and reporting data, patients with an overt Cleft of the secondary Palate that extends beyond the uvula should be reported as having a Cleft Palate, and not a submucous Cleft Palate, even if a submucous Cleft exists in a portion of the Palate anterior to the overt Cleft. 4. The true incidence of otitis media with effusion in the presence of submucous Cleft Palate has yet to be determined using a prospective study. Surgical Treatment of Velopharyngeal Inadequacy in Patients with Submucous Cleft Palate 1. The technique that has most consistently been documented to result in a significant correction of velopharyngeal inadequacy is the pharyngeal flap. There is recent evidence from one large center supporting the efficacy of the Furlow Z-plasty in selected patients with submucous Cleft Palate. Both these procedures appear to be most effective in patients with good lateral pharyngeal wall motion. 2. If a pharyngeal flap is performed as the primary procedure to act as an obturator against which the lateral pharyngeal walls appose for closure, we do not see the need for adjunctive palatal procedures. The dynamic component of velopharyngeal competence following such a pharyngeal flap consists of lateral wall motion, which is not enhanced by further surgical manipulation of the Palate. However, a pharyngeal flap may be performed as an adjunctive procedure to a palatal pushback in order to provide lining for the resultant defect in the nasal mucosa. 3. The present literature does not support "prophylactic" operations on patients who present with the physical stigmata of submucous Cleft Palate prior to reaching an age at which it can be demonstrated by perceptual speech assessment that velopharyngeal inadequacy remained refractory to speech therapy. A significant number of patients will never develop velopharyngeal inadequacy; therefore, surgery would be unnecessary. In addition, objective data regarding the outcomes of different surgical techniques cannot be gathered if patients with submucous Cleft Palate are operated on without having had velopharyngeal inadequacy documented prior to those operations. 4. In order to objectively compare the outcomes of different surgical techniques, any future studies should be prospective and utilize uniform means of assessment. As minimum criteria, these would include preoperative and postoperative perceptual speech assessments performed by a trained speech pathologist and preoperative nasopharyngoscopy and multiview videofluoroscopy. The latter two studies should be repeated postoperatively only in those patients who have persistent velopharyngeal inadequacy.

Susan M. Marks - One of the best experts on this subject based on the ideXlab platform.

  • Submucous Cleft Palate: diagnostic methods and outcomes of surgical treatment.
    Plastic and Reconstructive Surgery, 1996
    Co-Authors: Arun K. Gosain, Stephen F Conley, Susan M. Marks, David L. Larson
    Abstract:

    The following statements summarize our interpretation of the literature regarding submucous Cleft Palate: Incidence and Diagnosis of Submucous Cleft Palate 1. In surveys of classic stigmata of submucous Cleft Palate among the general population, the incidence has been reported to be 0.02 to 0.08 percent. In the larger of these series, the incidence of velopharyngeal inadequacy among patients identified to have submucous Cleft Palate was 1 to 9. The incidence of occult submucous Cleft Palate is not known, since these patients will only be detected during the evaluation of patients who present with velopharyngeal inadequacy. 2. The diagnosis of submucous Cleft Palate is made by identification of the classic stigmata on physical examination. The diagnosis of occult submucous Cleft Palate is only pursued if the patient has velopharyngeal inadequacy. 3. For consistency in evaluating and reporting data, patients with an overt Cleft of the secondary Palate that extends beyond the uvula should be reported as having a Cleft Palate, and not a submucous Cleft Palate, even if a submucous Cleft exists in a portion of the Palate anterior to the overt Cleft. 4. The true incidence of otitis media with effusion in the presence of submucous Cleft Palate has yet to be determined using a prospective study. Surgical Treatment of Velopharyngeal Inadequacy in Patients with Submucous Cleft Palate 1. The technique that has most consistently been documented to result in a significant correction of velopharyngeal inadequacy is the pharyngeal flap. There is recent evidence from one large center supporting the efficacy of the Furlow Z-plasty in selected patients with submucous Cleft Palate. Both these procedures appear to be most effective in patients with good lateral pharyngeal wall motion. 2. If a pharyngeal flap is performed as the primary procedure to act as an obturator against which the lateral pharyngeal walls appose for closure, we do not see the need for adjunctive palatal procedures. The dynamic component of velopharyngeal competence following such a pharyngeal flap consists of lateral wall motion, which is not enhanced by further surgical manipulation of the Palate. However, a pharyngeal flap may be performed as an adjunctive procedure to a palatal pushback in order to provide lining for the resultant defect in the nasal mucosa. 3. The present literature does not support "prophylactic" operations on patients who present with the physical stigmata of submucous Cleft Palate prior to reaching an age at which it can be demonstrated by perceptual speech assessment that velopharyngeal inadequacy remained refractory to speech therapy. A significant number of patients will never develop velopharyngeal inadequacy; therefore, surgery would be unnecessary. In addition, objective data regarding the outcomes of different surgical techniques cannot be gathered if patients with submucous Cleft Palate are operated on without having had velopharyngeal inadequacy documented prior to those operations. 4. In order to objectively compare the outcomes of different surgical techniques, any future studies should be prospective and utilize uniform means of assessment. As minimum criteria, these would include preoperative and postoperative perceptual speech assessments performed by a trained speech pathologist and preoperative nasopharyngoscopy and multiview videofluoroscopy. The latter two studies should be repeated postoperatively only in those patients who have persistent velopharyngeal inadequacy.

Jonathan Weitzman - One of the best experts on this subject based on the ideXlab platform.

  • Cleft Palate mutations
    Trends in Molecular Medicine, 2001
    Co-Authors: Jonathan Weitzman
    Abstract:

    Cleft Palate occurs with high frequency (1 in 1500 births) and leads to problems in speech, hearing and dentition. Although environmental and genetic factors have been implicated in Cleft Palate, the genetic determinates have remained elusive. Cleft Palate with ankyloglossia (CPX) is an inherited X-linked disorder and has been mapped to Xq21. Now, Philip Stanier and colleagues at Imperial College (London, UK) have identified the gene that is mutated in CPX. They found numerous mutations in the gene for T-box transcription factor TBX22. The defects include nonsense, missense and frameshift mutations suggesting complete loss of TBX22 function causes the Cleft phenotype. Their findings were published in September in Nature Genetics, together with another study, from Richard Spritz's team at the University of Colorado (Denver, CO, USA). The latter reported an association between heterozygous mutations in the PVRL1 gene and sporadic non-syndromic Cleft lip and Palate in northern Venezuela. PVRL1 encodes a cell–cell adhesion molecule that is expressed in the developing palatal epithelium. JW