Birte Prahl-Andersen

A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 4. Assessment of nasolabial appearance

One hundred and fifteen frontal and profile photographs of the nasolabial area of subjects with complete unilateral clefts of the lip and palate from six European centers were assessed. Four components of the nasolabial area were rated separately by a panel of judges using a five-point scale of attractiveness. The Tukey multiple comparison test showed significant differences between the centers. The relative position of the six centers in this study followed a similar pattern to their respective positions in the cephalometric and dental cast studies.

A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 5. General discussion and conclusions

Part 5 is the final part of a series of five articles reporting on an international, multicenter clinical audit of treatment outcome for complete UCLP. A number of recommendations for the methodology of future studies is made especially with respect to entry criteria, sample size, assumptions of homogeneity, and the reproducibility and validity of outcome measures. The findings of the present study regarding clinical procedures are presented tentatively, and improvement and extension of the methodology are required. It appears, however, that acceptable results can be achieved by different programs and ultimately clinical choices may be based on factors such as complexity, costs, and demands of treatment. Standardization, centralization, and the participation of high volume operators were associated with good outcomes, and nonstandardization and the participation of low volume operators with poor outcomes. Therapeutic factors associated with good outcomes were the employment of a vomer flap to close the anterior palate, and poor outcomes with primary bone grafting and with active presurgical orthopedics.

A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 3. Dental Arch Relationships

One hundred and forty-nine dental casts of subjects with complete unilateral clefts of the lip and palate from six European cleft palate centers were assessed by means of the Goslon Yardstick. The Yardstick proved capable of discriminating between the quality of the dental arch relationships between the six centers. Two centers showed especially poor results. Three centers obtained satisfactory results although differing surgical techniques were used in these centers. One of the centers showing satisfactory dental arch relationships employed a more complex and expensive treatment program than the other two centers, which both used simpler centralized treatment regimens.

A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 1. Principles and study design

This article describes the design of an intercenter comparative study of treatment outcome in the treatment of children with a unilateral complete cleft of the lip and palate. The rationale and aims of this study are defined and treatment schemes of the participating centers are described. The findings are presented in a series of three papers (Parts 2, 3, and 4) dealing with the comparison of craniofacial form, dental arch relationships, and nasolabial appearance. In Part 5, conclusions and general recommendations regarding future research are discussed.

A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 2. Craniofacial form and soft tissue profile.

The craniofacial morphology and the soft tissue profile were evaluated in this part of the intercenter study of the European Cleft Lip and Palate Research Group. The sample was comprised of cephalometric x-rays of the full cohort of 151 cases from the six European cleft palate centers. The facial morphology in complete unilateral cleft lip and palate patients was evaluated by means of roentgen cephalometry. Approximately 25 consecutive cases from each of six European cleft palate centers were compared. Only one center showed notable and consistent differences from the others. A contributing factor for these differences may be an inconsistent treatment regimen with many surgeons involved. Analysis of the soft tissue profile between the centers showed more pronounced differences than analysis of the skeletal profile. The treatment outcome in centers with more complex or expensive programs was no better than those centers using simpler management approaches.

The eurocleft study : Intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 2: Craniofacial form and nasolabial appearance

Objective To compare craniofacial morphology and nasolabial appearance up to age 17 in individuals with repaired complete unilateral cleft lip and palate (UCLP) treated at five European centers. Design Longitudinal cohort study. Setting Multidisciplinary cleft services in Northern Europe. Subjects 127 consecutively treated individuals with repaired complete UCLP. Main outcome measures Cephalometric variables, 14 angular and 2 ratio variables, and panel ratings of nasolabial appearance, 4 variables. Results The results revealed that at ages 12 and 17, two centers had a flatter profile (gs-sn-pgs) and retrognathic maxilla (sss-ns-sms). Additionally, one of the two centers had increased lower face height. Ratings of nasolabial appearance showed more similarity between the centers. Conclusion The results confirm that systematic differences in craniofacial morphology and nasolabial appearance may occur between different cleft centers, but do not allow specific caused factors to be identified.

The Eurocleft Study: Intercenter Study of Treatment Outcome in Patients With Complete Cleft Lip and Palate. Part 3: Dental Arch Relationships

Objective To compare dental arch relationships up to age 17 in individuals with complete unilateral cleft lip and palate (UCLP) treated at five European centers. Design Longitudinal cohort study, where results were previously reported at 9 years and follow-up measurements were obtained for 12 and 17 years. Setting Multidisciplinary cleft services in Northern Europe. Subjects 127 consecutively treated individuals with repaired UCLP. Main outcome measure Panel rating of dental arch relationship. Results The results revealed that at 17 years of age three of the centers had better ratings in dental arch relationship (means scores: 1.7, 1.9, and 2.2, respectively) than the other two centers (3.3, 3.4) at statistically significant levels (p < .01 to p < .001). Conclusion The results confirm that systematic differences in dental arch relationships may occur between different cleft centers, but do not allow specific causal factors to be identified.

The Eurocleft Study: Intercenter Study of Treatment Outcome in Patients With Complete Cleft Lip and Palate. Part 5: Discussion and Conclusions

Objective To review the lessons learned from a longitudinal intercenter comparison study. Design Longitudinal cohort study. Setting Multidisciplinary cleft services in Northern Europe. Subjects Individuals with repaired complete unilateral cleft lip and palate. Main Outcomes Measures The first four papers in this series report amount of treatment, cephalometric form, nasolabial appearance, dental arch relationship, patient/parent satisfaction. This paper considers the consistency of outcome at the five centers over time, and other relationships between outcomes. Results Some outcomes measured in childhood can be predictive over time. The amount of treatment does not correlate with the quality of clinical outcome. Conclusions Measurement of clinical outcome in childhood is an important and valid form of clinical audit. Intercenter studies are more informative than single center reports, and will have an important future role in cleft care.

The Eurocleft Study: Intercenter Study of Treatment Outcome in Patients With Complete Cleft Lip and Palate. Part 4: Relationship Among Treatment Outcome, Patient/Parent Satisfaction, and the Burden of Care

Objective To assess patient/parent satisfaction with the treatment they had received from their respective teams, and to explore interrelationships between satisfaction, objectively rated outcome, and the burden of care. Design This study reports cross-sectional data as part of the overall longitudinal cohort study reported in the other four papers of this series. Setting Multidisciplinary cleft services in Northern Europe. Subjects 127 consecutively treated 17-year-olds with repaired complete unilateral cleft lip and palate and their parents. Main Outcome Measure Patient/parent satisfaction. Results Generally, there was a high level of patient/parent satisfaction. There were no relationships among satisfaction, objectively rated outcomes, and the amount of care. Conclusions This study highlights various challenges involved in questionnaire surveys into patient/parent satisfaction, and underlines the need for collective efforts to improve our understanding of this issue.

The Eurocleft study: Intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 1: Introduction and treatment experience

Objective To calculate the amount of treatment and associated travel experienced by five groups of patients treated at different centers. (This data is related to outcomes and patient/parent satisfaction in subsequent papers in this series). Design A longitudinal cohort study where results were previously reported at 9 years and follow-up measurements were obtained for 12 and 17 years. Setting Multidisciplinary cleft services in Northern Europe. Subjects 127 consecutively treated individuals with repaired unilateral complete cleft lip and palate. Main Outcome Measures Numbers of surgeries and outpatient visits, number of visits, and treatment duration for early orthopedics and orthodontic treatment, associated travel time and difficulties. Results The mean number of operations per center ranged from 3.5 to 6; length of orthodontic treatment from 3.3 to 8.5 years, and attendance from 49 to 94 visits; and for early orthopedics, 0 to 15 months of treatment, 0 to 17 visits, and 0 to 146 days in hospital. Conclusion Protocols for the management of complete unilateral cleft lip and palate can vary dramatically in the burden of treatment imposed.