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Mani, Maria
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Publications (10 of 20) Show all publications
Mani, M., Saour, S., Ramsey, K., Power, K., Harris, P. & James, S. (2018). Bilateral breast reconstruction with deep inferior epigastric perforator flaps in slim patients.. Microsurgery, 38(2), 143-150
Open this publication in new window or tab >>Bilateral breast reconstruction with deep inferior epigastric perforator flaps in slim patients.
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2018 (English)In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 38, no 2, p. 143-150Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Slim women are not always considered candidates for bilateral autologous breast reconstruction. The study aims to assess the volume considerations and complications of deep inferior epigastric perforator (DIEP) flap in bilateral breast reconstruction among slim patients.

METHODS: All patients undergoing bilateral DIEP breast reconstruction at the Royal Marsden Hospital, London, September 2007-March 2015, were reviewed. Flap weight was compared to mastectomy weight (weight ratio) and complications were recorded. Subgroup analyses according to Body Mass Index (BMI) were performed.

RESULTS: One-hundred seventy patients (340 flaps) were included. There were 42 in the slim-group (BMI <25) (84 flaps), 70 in the traditional (BMI = 25.0-29.9) (140 flaps), and 58 in the obese (BMI >30) (116 flaps). There were no significant differences in reconstruction weight ratio between the slim and the traditional groups (1.04 ± 0.31 versus 0.95 ± 0.38, p = .267). When comparing the slim to obese group the ratio was lower for the obese group, inferring that a larger reconstruction was performed (p = .016). Complications was less frequent in the slim group compared to the traditional and the obese groups (31% compared to 50% and to 53% (p = .060 and p = .021, respectively). Donor-site specific complications did not differ between groups (29% 26% and 29%; p = .823 and .830, respectively).

CONCLUSION: The DIEP flaps may be a safe option for bilateral breast reconstruction among patients with BMI <25 without sacrifice in volume or increase in donor-site complications; low BMI does not in itself contraindicate bilateral DIEP breast reconstruction.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-335304 (URN)10.1002/micr.30173 (DOI)000425471500002 ()28319327 (PubMedID)
Available from: 2017-12-04 Created: 2017-12-04 Last updated: 2018-04-18Bibliographically approved
Winters, Z. E., Afzal, M., Rutherford, C., Holzner, B., Rumpold, G., da Costa Vieira, R. A., . . . King, M. T. (2018). International validation of the European Organisation for Research and Treatment of Cancer QLQ-BRECON23 quality-of-life questionnaire for women undergoing breast reconstruction.. British Journal of Surgery, 105, 209-222
Open this publication in new window or tab >>International validation of the European Organisation for Research and Treatment of Cancer QLQ-BRECON23 quality-of-life questionnaire for women undergoing breast reconstruction.
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2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, p. 209-222Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim was to carry out phase 4 international field-testing of the European Organisation for Research and Treatment of Cancer (EORTC) breast reconstruction (BRECON) module. The primary objective was finalization of its scale structure. Secondary objectives were evaluation of its reliability, validity, responsiveness, acceptability and interpretability in patients with breast cancer undergoing mastectomy and reconstruction.

METHODS: The EORTC module development guidelines were followed. Patients were recruited from 28 centres in seven countries. A prospective cohort completed the QLQ-BRECON15 before mastectomy and the QLQ-BRECON24 at 4-8 months after reconstruction. The cross-sectional cohort completed the QLQ-BRECON24 at 1-5 years after reconstruction, and repeated this 2-8 weeks later (test-retest reliability). All participants completed debriefing questionnaires.

RESULTS: A total of 438 patients were recruited, 234 in the prospective cohort and 204 in the cross-sectional cohort. A total of 414 reconstructions were immediate, with a comparable number of implants (176) and donor-site flaps (166). Control groups comprised patients who underwent two-stage implant procedures (72, 75 per cent) or delayed reconstruction (24, 25 per cent). Psychometric scale validity was supported by moderate to high item-own scale and item-total correlations (over 0·5). Questionnaire validity was confirmed by good scale-to-sample targeting, and computable scale scores exceeding 50 per cent, except nipple cosmesis (over 40 per cent). In known-group comparisons, QLQ-BRECON24 scales and items differentiated between patient groups defined by clinical criteria, such as type and timing of reconstruction, postmastectomy radiotherapy and surgical complications, with moderate effect sizes. Prospectively, sexuality and surgical side-effects scales showed significant responsiveness over time (P < 0·001). Scale reliability was supported by high Cronbach's α coefficients (over 0·7) and test-retest (intraclass correlation more than 0·8). One item (finding a well fitting bra) was excluded based on high floor/ceiling effects, poor test-retest and weak correlations in factor analysis (below 0·3), thus generating the QLQ-BRECON23 questionnaire.

CONCLUSION: The QLQ-BRECON23 is an internationally validated tool to be used alongside the EORTC QLQ-C30 (cancer) and QLQ-BR23 (breast cancer) questionnaires for evaluating quality of life and satisfaction after breast reconstruction.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-335299 (URN)10.1002/bjs.10656 (DOI)000424159800007 ()29116657 (PubMedID)
Available from: 2017-12-04 Created: 2017-12-04 Last updated: 2018-03-14Bibliographically approved
Liu, T., Freijs, C., Klein, H. J., Feinbaum, A., Svee, A., Rodriguez-Lorenzo, A., . . . Mani, M. (2018). Patients with abdominal-based free flap breast reconstruction a decade after surgery: A comprehensive long-term follow-up study. Journal of Plastic, Reconstructive & Aesthetic Surgery, 71(9), 1301-1309
Open this publication in new window or tab >>Patients with abdominal-based free flap breast reconstruction a decade after surgery: A comprehensive long-term follow-up study
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2018 (English)In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 71, no 9, p. 1301-1309Article in journal (Refereed) Published
Abstract [en]

Background: Abdominal-based free flap has increasingly become the gold standard for breast reconstruction, however long-term evidence of the aesthetic outcome and quality of life is lacking. The present study aims to gain an overview of patients with abdominal-based free flap breast reconstructions in a long-term perspective.

Methods: Seventy-five patients who received abdominal-based free flap breast reconstructions between 2000-2007 in Uppsala, Sweden were invited back for photographs, 3D imaging and questionnaires. A retrospective chart review was conducted. Patient satisfaction with appearance and quality of life were assessed using the Breast-Q questionnaire. A layman panel and a professional panel rated the aesthetic appearance of the reconstructed breast from photographs and 3D images.

Results: Fifty-five patients participated with a mean age of 52 +/- 8 years at the time of reconstruction and a mean follow-up time of 11.4 +/- 1.8 years completed the study. The majority of the patients had received unilateral (85%), delayed reconstructions (73%) with prior radiation (55%). There were 53 patients with DIEP flaps, one with free TRAM flap and one with SIEA flap. Breast-Q scores in the cohort were comparable to normative values of women without breast cancer (p < 0.001). There was a high level of agreement for the aesthetic results of the reconstructions between patient, professionals and layman panels (0.89 ICC, 95% CI: 0.83 - 0.93).

Conclusion: Abdominal-based free flap reconstructions were effective in achieving a lasting positive aesthetic result and a high quality of life in patients a decade after surgery. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Keywords
Breast reconstruction, DIEP, Autologous free tissue transfer, Breast-Q
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-364170 (URN)10.1016/j.bjps.2018.06.009 (DOI)000443019600014 ()30025757 (PubMedID)
Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2018-11-06Bibliographically approved
Svee, A., Mani, M., Sandquist, K., Audolfsson, T., Folkvaljon, Y., Isern, A. E., . . . Wärnberg, F. (2018). Survival and risk of breast cancer recurrence after breast reconstruction with deep inferior epigastric perforator flap. British Journal of Surgery, 105(11), 1446-1453
Open this publication in new window or tab >>Survival and risk of breast cancer recurrence after breast reconstruction with deep inferior epigastric perforator flap
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2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 11, p. 1446-1453Article in journal (Refereed) Published
Abstract [en]

Background: Women who undergo autologous breast reconstruction have been reported to have an increased risk of breast cancer recurrence compared with those who have mastectomy alone. It has been suggested that more extensive surgery possibly activates dormant micrometastases. The aim of this study was to evaluate whether delayed unilateral deep inferior epigastric perforator (DIEP) flap reconstruction after mastectomy increases the risk of breast cancer recurrence or affects mortality among women previously treated for breast cancer.

Methods: This was a matched retrospective cohort study including women with a previous unilateral invasive breast cancer who received a delayed DIEP flap breast reconstruction and a control cohort of individually matched women with unilateral breast cancer who underwent mastectomy but no autologous breast reconstruction. Matching criteria comprised: year of diagnosis (+/-3years), age at diagnosis (+/-5years), type of cancer and demographic region. The primary endpoints were local recurrence or distant metastasis, and overall mortality was a secondary endpoint. Absolute risk of recurrent disease and mortality was analysed, and relative risks were estimated using Cox proportional hazards analysis.

Results: There were 225 women in the DIEP cohort and 450 in the no-DIEP cohort. The median follow-up time was 125months. There was no difference in absolute risk of recurrence between the cohorts. The hazard ratio for breast cancer recurrence in DIEP versus no-DIEP cohorts was 0·76 (95 per cent c.i. 0·47 to 1·21).

Conclusion: There is no increased risk in breast cancer recurrence after delayed DIEP flap reconstruction compared with mastectomy alone. As above

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-366957 (URN)10.1002/bjs.10888 (DOI)000444672600009 ()29999520 (PubMedID)
Funder
The Breast Cancer Foundation
Available from: 2018-11-27 Created: 2018-11-27 Last updated: 2018-11-27Bibliographically approved
Morén, S., Lindestad, P. Å., Holmström, M. & Mani, M. (2018). Voice quality in adults treated for unilateral cleft lip and palate: Long-Term Follow-Up After One- or Two-Stage Palate Repair. The Cleft Palate-Craniofacial Journal, 55(8), 1103-1114
Open this publication in new window or tab >>Voice quality in adults treated for unilateral cleft lip and palate: Long-Term Follow-Up After One- or Two-Stage Palate Repair
2018 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 55, no 8, p. 1103-1114Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of the current study was to assess voice quality among adults treated for unilateral cleft lip and palate (UCLP), after 1- or 2-stage palate closure, and compare it to a noncleft control group.

Study Design: Cross-sectional study in UCLP patients with long-term follow-up and noncleft controls.

Participants: UCLP patients born 1960-1987, treated at Uppsala University Hospital, Sweden, were examined (n = 73) at a mean of 35 years after primary surgery. Forty-seven patients (64%) had been treated with 1-stage palate closure and 26 with 2-stage closure (36%). The noncleft control group consisted of 63 age-matched volunteers.

Main Outcome Measure(s): Ratings of perceptual voice characteristics from blinded voice recordings with Swedish Voice Evaluation Approach (SVEA) method. Acoustic voice analysis including pitch and spectral measures.

Results: Among the patients, the mean values for the 12 evaluated variables on a VAS scale (0 = no abnormality, 100 = maximal abnormality) ranged between 1 and 22 and the mean for all was 6 mm. Voice variables were similar between patients and controls except the total mean of all the perceptual voice variables, as well as “vocal fry”—both slightly lower among patients (P = .018 and P = .009). There was no difference in any variable between patients treated with 1-stage and 2-stage palate closure. No clear relationship was found between VPI and dysphonia.

Conclusion: The voice characteristics among adults treated for UCLP in childhood are not different from those of individuals without cleft.

Keywords
unilateral cleft lip and palate, adult, long-term, voice, palate repair
National Category
Otorhinolaryngology Surgery
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:uu:diva-340092 (URN)10.1177/1055665618764521 (DOI)000445004200007 ()29561718 (PubMedID)
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2019-06-19Bibliographically approved
Gösseringer, N., Mani, M., Cali-Cassi, L., Papadopoulos, A. & Rodriguez-Lorenzo, A. (2017). Benefits of Two or More Senior Microsurgeons Operating Simultaneously in Microsurgical Breast Reconstruction: Experience in a Swedish Medical Center. Microsurgery, 37(5), 416-420
Open this publication in new window or tab >>Benefits of Two or More Senior Microsurgeons Operating Simultaneously in Microsurgical Breast Reconstruction: Experience in a Swedish Medical Center
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2017 (English)In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 37, no 5, p. 416-420Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

The aim of this study is to evaluate how the number of senior microsurgeons, performing autologous microvascular breast reconstruction together, influences operating time and postoperative complications.

METHODS:

A retrospective study was carried out in one hundred consecutive patients who underwent unilateral delayed deep inferior epigastric perforator flap reconstruction at a single institution. All patients followed our institution's surgical protocol and were divided into groups depending on the number of senior microsurgeons that simultaneously performed the procedure. Operating time and complications were compared between the groups.

RESULTS:

Sixteen of the patients were operated by one single microsurgically trained specialist, 64 by two and 20 by three specialists. The mean operating time for the one microsurgeon's group was 286 ± 84 min, for the two-microsurgeons' group 265 ± 57 min and for the three-microsurgeons' group 251 ± 59 min. There was a trend of decreasing operating times when more microsurgeons performed surgery together, however the difference between groups was not statistically significant (P = 0.251). Total flap failure rate was 2% (2/100). Both cases occurred in the group operated by one single microsurgeon (2/16) compared with two microsurgeon's group (0/64) and three microsurgeon's group (0/20; P < 0.005).

CONCLUSIONS:

By optimising the surgical experience available during microvascular breast reconstruction, operating time can be reduced and efficiency improved. In the current setting, two microsurgically trained surgeons achieved optimal operation flow with the lowest complication rate.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-277657 (URN)10.1002/micr.30039 (DOI)000407105200010 ()26916246 (PubMedID)
Available from: 2016-02-22 Created: 2016-02-22 Last updated: 2017-11-16Bibliographically approved
Peroz, R., Holmström, M. & Mani, M. (2017). Can objective measurements of the nasal form and function represent the clinical picture in unilateral cleft lip and palate?. Journal of Plastic, Reconstructive & Aesthetic Surgery, 70(5), 653-658
Open this publication in new window or tab >>Can objective measurements of the nasal form and function represent the clinical picture in unilateral cleft lip and palate?
2017 (English)In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 70, no 5, p. 653-658Article in journal (Refereed) Published
Abstract [en]

Background: The present study aimed to evaluate the potential correlations between objective measurements of nasal function and self-assessed nasal symptoms or clinical findings at nasal examination among adults treated for unilateral cleft lip and palate (UCLP), respectively. Methods: All UCLP patients born between 1960 and 1987 (n = 109) treated at a tertiary referring center were invited. Participation rate was 76% (n = 83) at a mean of 37 years after the initial surgery. All participants completed the same study protocol including acoustic rhinometry (AR), rhinomanometry (RM), anterior rhinoscopy, and questionnaires regarding self-experienced nasal symptoms. Results: A reduced volume of the anterior nasal cavity on the operated side (measured by AR) correlated to an expressed wish by the patient to change the function of the nose. A similar correlation was seen for the minimal cross-sectional area of anterior nasal cavity on the operated side. Furthermore, correlations were found between smaller volume and area of nasal cavity and a greater frequency of nasal obstruction. No further correlations were found. Conclusion: Objective measurements partly correlate to the clinical picture among adults treated for UCLP. However, these need to be combined with findings at clinical examination and patient self-assessment to represent the complete clinical picture. (C) 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Self-assessment, Nasal function, Cleft lip and palate, Acoustic rhinometry, Rhinomanometry, Adults
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-327054 (URN)10.1016/j.bjps.2017.01.024 (DOI)000402483000013 ()28325563 (PubMedID)
Available from: 2017-08-03 Created: 2017-08-03 Last updated: 2017-08-03Bibliographically approved
Cristóbal, L., Linder, S., Lopez, B., Mani, M. & Rodriguez-Lorenzo, A. (2017). Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects: Surgical technique and clinical outcomes. Microsurgery, 37(6), 479-486
Open this publication in new window or tab >>Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects: Surgical technique and clinical outcomes
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2017 (English)In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 37, no 6, p. 479-486Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Radical tumor ablation in the periauricular area often results in extensive soft tissue defects, including facial nerve sacrifice, bone and/or dura defects. Reconstruction of these defects should aim at restoring facial reanimation, wound closure, and facial and neck contours. We present our experience using free anterolateral thigh flap (ALT) in combination with masseter nerve to facial nerve transfer in managing complex defects in the periauricular area.

METHODS: Between 2011 and 2015 six patients underwent a combined procedure of ALT flap reconstruction and masseter nerve transfer, to reconstruct extensive, post tumor resection, periauricular defects. The ALT flap was customized according to the defect. For smile restoration, the masseter nerve was transferred to the buccal branch of the facial nerve. If the facial nerve stump was preserved, interposition of nerve grafts to the zygomatic and frontal branches was performed to provide separate eye closure. The outcomes were analyzed by assessing wound closure, contour deformity, symmetry of the face, and facial nerve function.

RESULTS: There were no partial or total flap losses. Stable wound closure and adequate volume replacement in the neck was achieved in all cases, as well as good facial tonus and symmetry. The mean follow-up time of clinical outcomes was 16.8 months. Smile restoration was graded as good or excellent in four cases, moderate in one and fair in one.

CONCLUSION: Extensive periauricular defects following oncologic resection could be adequately reconstructed in a combined procedure of free ALT flap and masseter nerve transfer to the facial nerve for smile restoration.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-307767 (URN)10.1002/micr.30086 (DOI)000411186900001 ()27501201 (PubMedID)
Available from: 2016-11-21 Created: 2016-11-21 Last updated: 2019-01-25Bibliographically approved
Coelho, R., Ekberg, T., Svensson, M., Mani, M. & Rodriguez-Lorenzo, A. (2017). Reconstruction of late esophagus perforation after anterior cervical spine fusion with an adipofascial anterolateral thigh free flap: A case report.. Microsurgery, 37(6), 684-688
Open this publication in new window or tab >>Reconstruction of late esophagus perforation after anterior cervical spine fusion with an adipofascial anterolateral thigh free flap: A case report.
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2017 (English)In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 37, no 6, p. 684-688Article in journal (Refereed) Published
Abstract [en]

Reconstruction of late esophageal perforation usually requires flap surgery to achieve wound healing. However, restoring the continuity between the digestive tract and retropharyngeal space to allow for normal swallowing remains a technical challenge. In this report, we describe the use of a thin and pliable free adipofascial anterolateral thigh (ALT) flap in a 47-year-old tetraplegic man with a history of C5-C6 fracture presented with a large posterior esophagus wall perforation allowing an easier flap insetting for a successful wound closure. The postoperative course was uneventful and mucosalization of the flap was confirmed by esophagoscopy 4 weeks postsurgery. The patient tolerated normal diet and maintained normal swallowing during a follow-up of 3 years postoperatively. The adipofascial ALT flap may provide easier insetting due to the thin and pliable layer of adipofascial tissue for reconstructing large defects of the posterior wall of the esophagus by filling the retroesophageal space.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-335300 (URN)10.1002/micr.30170 (DOI)000411186900030 ()28397296 (PubMedID)
Available from: 2017-12-04 Created: 2017-12-04 Last updated: 2018-01-19Bibliographically approved
Morén, S., Mani, M., Stålhammar, L., Lindestad, P. Å. & Holmström, M. (2017). Speech in Adults Treated for Unilateral Cleft Lip and Palate: Long-Term Follow-Up After One- or Two-Stage Palate Repair. The Cleft Palate-Craniofacial Journal, 54(6), 639-649
Open this publication in new window or tab >>Speech in Adults Treated for Unilateral Cleft Lip and Palate: Long-Term Follow-Up After One- or Two-Stage Palate Repair
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2017 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 54, no 6, p. 639-649Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate speech in adults treated for unilateral cleft lip and palate with one-stage or two-stage palate closure and compare the speech of the patients with that of a noncleft control group.

DESIGN: Cross-sectional study with long-term follow-up.

PARTICIPANTS/SETTING: All unilateral cleft lip and palate patients born from 1960 to 1987 and treated at Uppsala University Hospital, Sweden, were invited (n = 109). Participation rate was 67% (n = 73) at a mean of 35 years after primary surgery. Forty-seven had been treated according to one-stage palate closure and 26 according to two-stage palate closure. Pharyngeal flap surgery had been performed in 11 of the 73 patients (15%). The noncleft control group consisted of 63 age-matched volunteers.

MAIN OUTCOME MEASURE(S): Speech-language pathologists rated perceptual speech characteristics from blinded audio recordings.

RESULTS: Among patients, seven (10%) presented with hypernasality, 12 (16%) had audible nasal emission and/or nasal turbulence, five (7%) had consonant production errors, one (2%) had glottal reinforcements/substitutions, and one (2%) had reduced intelligibility. Controls had no audible signs of velopharyngeal insufficiency and no quantifiable problems with the other speech production variables. No significant differences were identified between patients treated with one-stage and two-stage palate closure for any of the variables.

CONCLUSIONS: The prevalence of speech outcome indicative of velopharyngeal insufficiency among adult patients treated for unilateral cleft lip and palate was low but higher compared with individuals without cleft. Whether palatal closure is performed in one or two stages does not seem to affect the speech outcome at a mean age of 35 years.

Keywords
adult, cross-sectional, long-term, one-stage repair, speech outcome, two-stage repair, unilateral cleft lip and palate
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-317289 (URN)10.1597/15-037 (DOI)000413110600003 ()28140670 (PubMedID)
Available from: 2017-03-13 Created: 2017-03-13 Last updated: 2018-01-26Bibliographically approved
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