Research Archive

This qualitative study explored the psychological experience of adults born with cleft lip and/or palate (CL/P) making decisions about appearance-altering lip and/or nose surgery. Twelve adults (aged 20-61) who had decided to pursue, were deciding about, or had recently undergone such surgery took part in semi-structured interviews at a UK regional cleft service. The findings describe this decision as often the person's first opportunity to make an independent surgical choice about their own appearance, shaped by past experiences of cleft-related care and social feedback. The authors highlight the importance of psychological support during this decision-making process.

This narrative review summarises the ongoing functional, aesthetic and psychosocial challenges faced by adults living with cleft lip and palate (CL/P) after childhood treatment. Many adults continue to experience speech difficulties, hearing loss from chronic eustachian tube dysfunction, nasal airway obstruction and dentofacial abnormalities that may require orthognathic surgery, together with higher rates of depression, anxiety and social stigma. Satisfaction with surgical outcomes varies by cleft type, with bilateral clefts associated with lower satisfaction and more revision procedures, while strong family and community support appear protective.

This survey-based study by the Nordic Pediatric Neurosurgery Network examined current management of craniosynostosis across all 11 treatment centres in the Nordic region (28 million inhabitants), with a 100% response rate. Despite advances in diagnostics, minimally invasive techniques and computer-assisted planning, the survey found marked heterogeneity in organizational structures, preferred surgical techniques for isolated sagittal synostosis (ranging from minimally invasive suturectomy with helmet therapy to open cranial vault remodeling), and follow-up routines, including variable use of neurocognitive testing and patient-reported outcome measures.

This case-control study compared 3D mandibular morphometrics on head CT scans between 25 neonates with severe non-syndromic Pierre Robin sequence (mean age 15 days) who required mandibular distraction osteogenesis and 25 age-matched controls. Severe micrognathia was characterised by a mandible that is wide and short front-to-back relative to its height; intercondylar distance, intergonial distance, pogonion-interdental distance, ramus height and ramus-height-to-body-length ratio were larger, while intercondylar angle and body length were smaller than in controls, providing normative 3D data for assessing micrognathia in neonates.

This pilot retrospective cohort study used head and neck MRI to quantify asymmetry of the levator veli palatini (LVP) muscle in 20 children with craniofacial microsomia (CFM), three of whom (15%) had velopharyngeal insufficiency (VPI). Significant left-right asymmetry was found in LVP length, thickness and angle of origin. Greater differences in total LVP length between the more- and less-affected sides were associated with lower VPI prevalence, greater pharyngeal depth predicted higher VPI prevalence, and increased midline LVP thickness was associated with lower VPI prevalence, suggesting a role for soft-tissue variation in velopharyngeal function.

This study describes nine fetal craniosynostosis cases with an established genetic cause (six with Apert syndrome, three with Pfeiffer syndrome), characterised clinically, radiologically and molecularly. Four Apert and two Pfeiffer cases were diagnosed prenatally by ultrasonography, while the remaining cases were identified postmortem. Common prenatal findings included polyhydramnios, a high flat forehead and syndactyly; the authors note that proptosis, frontal bossing and trigonocephaly are key prenatal indicators, but their absence, especially alongside systemic anomalies, can make diagnosis challenging.

This systematic review and meta-analysis evaluated 9 studies on presurgical nasoalveolar moulding (NAM) combined with cheiloplasty in infants with cleft lip and/or palate, comparing nasal symmetry outcomes between infants treated with NAM plus cheiloplasty and those treated with cheiloplasty alone. Electronic searches were performed across 6 databases. Overall, the pooled results support a positive effect of NAM treatment on nasal symmetry, although the quality and comparability of the individual included studies varied.

In this pilot randomised controlled trial, 14 infants with unilateral cleft lip undergoing Fisher anatomic subunit repair were randomised to receive either a custom, digitally fabricated nasal conformer worn for three months after surgery, or no conformer. Digital anthropometric measurements at 6 months postoperatively (alar width, alar base width, columella length, nasal tip projection, columellar angle, nostril height/width ratio) showed little change in the conformer group but significant change across nearly all measurements in the control group, with significantly better nasal symmetry in the conformer group.

This qualitative interview study explored how 16 adults born with cleft lip and/or palate experienced orthognathic (jaw-correcting) surgery. For many, surgery was a transformative process that went beyond functional and aesthetic correction, fostering greater self-confidence and social ease over time. However, empowerment was neither universal nor immediate, and some reported neutral or context-dependent outcomes.

Using data from 8045 children up to 36 months of age undergoing craniosynostosis surgery, the authors developed machine-learning models to predict perioperative blood transfusion risk and volume. The models achieved moderate predictive accuracy (AUC 0.77 for transfusion risk). Such tools could support individualized blood-product planning and selective use of cell salvage, but external validation is needed before clinical use.

This study compared speech intelligibility and perceived listening effort between children (aged 4-12) with syndromic and non-syndromic cleft palate, using 52 naive listeners. Children with syndromic clefts were significantly less intelligible and required substantially greater listening effort. The authors suggest that listening effort could serve as a complementary outcome measure and help flag previously undiagnosed syndromic cases.

This UK study describes the first development stage of the West Midlands Assessment of Speech-Preschool (WAS-P), a speech assessment designed specifically for 3-year-olds with cleft palate with or without cleft lip. Two age-appropriate speech samples were piloted with 20 children with clefts and 5 without. Both samples proved feasible and were judged suitable for routine clinical use, enabling standardised comparison of speech outcomes across cleft units.

This systematic review of 13 studies synthesized patient-reported psychosocial outcomes of velopharyngeal insufficiency (VPI) treatment after cleft palate repair, using the VELO and PedsQL instruments. Children with cleft-related VPI showed a substantial psychosocial burden before surgery, with evidence of improvement afterwards, particularly on VELO. However, longitudinal data were sparse and reporting inconsistent, so more standardised outcome reporting is needed.

This retrospective cohort study analyzed 676 patients with submucous cleft palate treated between 2008 and 2025. Palatal morphology correlated with velopharyngeal function, but younger age at surgery was the single most important predictor of achieving velopharyngeal competence, with the odds of an unfavourable outcome rising about 9% per additional year. Early diagnosis and timely intervention were the most critical factors for good speech outcomes.

This study compared perioperative outcomes for sagittal craniosynostosis (scaphocephaly) in children operated before 6 months versus after 7 months of age by the same surgeon. Younger patients had significantly shorter anaesthesia and surgery times and less blood loss and transfusion, while hospital stay did not differ. Early surgery before 6 months of age offered clear perioperative advantages.

Using serial measurements from 6694 infants treated with cranial-orthosis (helmet) therapy for deformational plagiocephaly and/or brachycephaly, the authors developed a machine-learning model to forecast head-shape changes during treatment. The model predicted final cranial asymmetry and cranial index with high accuracy. Such a tool could aid clinical decision-making and parental counselling, though further study is needed.

This 3D retrospective study assessed upper-airway changes after mandibular distraction osteogenesis and/or orthognathic surgery in 40 patients with hemifacial microsomia (16 children, 24 adults). Airway volume and cross-sectional area increased significantly after surgery in both groups, with reduced asymmetry. The findings suggest these procedures can improve upper-airway structure, supporting airway analysis in surgical planning.

This prospective study followed 30 patients with unilateral complete cleft lip and palate and moderate-to-severe midface deficiency treated with bone-anchored maxillary protraction (BAMP) for 18 months, with follow-up at least 5 years later. About 46% avoided orthognathic surgery, and results in this non-surgical subgroup remained stable long-term. A hyperdivergent growth pattern and more severe negative overjet predicted the eventual need for surgery.

The Timing of Primary Surgery (TOPS) trial was published August 2023 in the New England Journal of Medicine. This perspective article reviews the design and analysis of the trial, which compared palate closure at 6 months versus 12 months of age. After 5 years, speech differences were measurable but clinically modest.

This systematic review (2014-2024) investigates how different surgical techniques influence speech outcomes in children with cleft palate. Early closure of the hard palate was linked to improved consonant articulation. However, surgical technique and subsequent speech therapy substantially modulate these outcomes. No single protocol showed uniform superiority.

Systematic review and meta-analysis comparing the Oslo protocol and delayed hard palate closure protocols in 4,831 UCLP patients. Oslo protocol showed favourable speech outcomes at 5 years; DHPCP showed better midfacial growth at 12 years. No overall superior protocol was identified.

SARPE (surgically assisted rapid palatal expansion) is performed to address transverse maxillary hypoplasia in patients with cleft and craniofacial diagnoses. This study analyses outcomes in patients with cleft lip and palate, craniosynostosis, and other craniofacial diagnoses undergoing SARPE.

This systematic review and meta-analysis compared three UCLP treatment protocols: one-stage palatoplasty (OSPP), Oslo protocol, and delayed hard palate closure (DHPCP) in 6,463 patients across 162 studies. VPI incidence was significantly higher in Oslo (24%) versus DHPCP (9%), with OSPP intermediate (14%). Oronasal fistula rates were lower for OSPP and Oslo. Overall, OSPP and Oslo are favoured over DHPCP.

Systematic review and meta-analysis of 1,774 VPI patients across 31 studies comparing five surgical techniques: pharyngeal flap, sphincter pharyngoplasty, Furlow Z-plasty, buccal flap, and buccinator flap. Furlow palatoplasty showed the highest average improvement rate (85%), followed by pharyngeal flap (84.5%). Pharyngeal flap was associated with higher obstructive sleep apnea rates.

Systematic review and meta-analysis comparing the risk of obstructive sleep apnea (OSA) following pharyngeal flap versus non-pharyngeal flap VPI procedures (751 subjects, 4 studies). Pharyngeal flap use was associated with a significantly greater risk of OSA (pooled risk ratio 2.45). Palatal lengthening procedures had a significantly lower OSA risk.

Retrospective study of 109 patients with cleft lip comparing patient-reported outcomes (CLEFT-Q) in those who did or did not undergo primary rhinoplasty at time of lip repair. Primary rhinoplasty was associated with improved self-perception of nasal appearance in school-aged children (CLEFT-Q nose score 75 vs 57). Patients without primary rhinoplasty were significantly more likely to undergo secondary rhinoplasty later.

Systematic review and meta-analysis of 65 studies (4,337 records screened) on primary rhinoplasty effectiveness in cleft lip. Primary rhinoplasty was significantly more effective than cleft repair alone (RR 1.87). Success rate 73.6% for unilateral, 88% for bilateral cases. Only 14% required additional surgeries for unilateral deformities.

Reliability study of speech variables in the Swedish quality registry for cleft lip and palate. 121 ten-year-olds with CLP assessed by 6 independent raters. Excellent reliability for percentage of consonants correct (ICC 0.93) and non-oral errors (ICC 0.80). Findings support use of standardised speech assessment in clinical quality registers.