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Objective Assessment of Nasal Airway in Unilateral Cleft Lip and Palate: a Long-term Study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
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2010 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 47, no 3, 217-224 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To objectively evaluate the nasal function in adults operated on for unilateral cleft lip and palate with one-stage or two-stage palate closure. DESIGN: The population consists of all unilateral cleft lip and palate patients born from 1960 to 1987 and treated at the Cleft Lip and Palate Center, Uppsala University Hospital, Sweden. The patients were treated according to the same protocol except for palate closure, which was performed in one stage until 1977 and in two stages thereafter. Eighty-three patients participated. Mean follow-up time after primary surgery was 32 years. An age-matched control group underwent the same examinations. MAIN OUTCOME MEASURES: Nasal minimum cross-sectional area (cm(2)) and volume (cm(3)) were assessed (acoustic rhinometry). Airflow resistance (Pa s/cm(3)) (rhinomanometry), peak inspiratory flow (L/min) (peak nasal inspiratory flow), and number of identified odors (Scandinavian Odor Identification Test) were determined. RESULTS: The cleft side of unilateral cleft lip and palate patients had significantly lower values for all parameters compared with controls (p < .001). No difference was found between one-stage and two-stage procedures in values for the cleft side. However, the nasal area and volume of the noncleft side were significantly larger in patients who underwent one-stage as compared with two-stage procedures (p < .05). CONCLUSION: The nasal airway of unilateral cleft lip and palate patients demonstrates a wide range of impairments that can be quantified by objective measurements. However, the measurements used did not differentiate between patients operated on with the one-stage and two-stage procedures except for values of the noncleft side.

Place, publisher, year, edition, pages
2010. Vol. 47, no 3, 217-224 p.
Keyword [en]
Cleft, Airways
National Category
Surgery
Research subject
Plastic Surgery
Identifiers
URN: urn:nbn:se:uu:diva-122571DOI: 10.1597/09-057.1ISI: 000277435400001PubMedID: 20426672OAI: oai:DiVA.org:uu-122571DiVA: diva2:310599
Available from: 2010-04-14 Created: 2010-04-14 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Unilateral Cleft Lip and Palate: Quality of Life and Nasal Form and Function among Adults
Open this publication in new window or tab >>Unilateral Cleft Lip and Palate: Quality of Life and Nasal Form and Function among Adults
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Unilateral cleft lip and palate (UCLP) is a craniofacial malformation with functional and aesthetical impact on the face and the upper airways. The aims of the current thesis were to evaluate Quality of life (QoL) in adults treated for UCLP  (I), to objectively evaluate nasal form and function and to search for possible differences in residual nasal deformity and impairment of function between patients operated according to one-stage and two-stage palate closure (II) as well as to evaluate the relationship between professional and lay rating and patient satisfaction with nasolabial appearance (III) and to identify factors associated with lower levels of QoL and less satisfaction with nasal appearance among adults treated for UCLP (IV).

Analyses of data from a homogenous population of UCLP patients treated at Uppsala University Hospital form the basis of this thesis. The mean follow-up time after primary surgery was 35 years (20-47 years) and participation rate was 79% (n=86). An age and gender matched control group of 68 people without clefts were evaluated according to the same protocol. The evaluation protocol included the Short Form 36 questionnaire (SF-36), rhinomanometry, acoustic rhinometry, odor test, peak nasal inspiratory flow test and photographies of faces. For the SF-36 data, age- and gender-matched norm data of 1385 people from the Swedish population were used.

Unilateral cleft lip and palate affected QoL differently depending on gender and age of the patient. Younger patients were affected more negatively than older patients in several subscales. However, except for lower values in the Mental Health subscale, QoL was similar among UCLP patients and norm data. Objectively measured nasal function was extensively affected among adults treated for UCLP. No difference in impairment of nasal function was found between one-stage and two-stage palate closure protocols on the cleft side. Judgment of nasolabial appearance differed between professionals, lay people and patients. Large infant cleft width was associated with less satisfaction with nasal appearance and male gender was associated with lower levels of mental QoL. Correlation between high nasal breathing resistance and low levels of physical QoL was found. In conclusion, this thesis provides a platform for future research for optimal evaluation of cleft treatment outcome.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 73 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 558
Keyword
unilateral cleft lip and palate, quality of life, SF-36, nasal function, nasal breathing, nasolabial appearance, cleft width, long-term results
National Category
Surgery
Research subject
Plastic Surgery
Identifiers
urn:nbn:se:uu:diva-122574 (URN)978-91-554-7799-8 (ISBN)
Public defence
2010-06-11, Skoogsalen, Uppsala University Hospital, entrance 79, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2010-04-29 Created: 2010-04-14 Last updated: 2010-05-18

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