Evaluation of primary surgical outcomes in New Zealand patients with unilateral clefts of the lip and palate

Jack, Hannah C.; Antoun, Joseph S.; Fowler, Peter V.

doi:10.2478/aoj-2011-0005

Abstract

Objective: To evaluate and compare the primary surgical outcomes of complete unilateral cleft lip and palate (UCLP) patients in two New Zealand cleft care centres.

Methods: This is a retrospective study of two providers of cleft care in New Zealand: Centre A in the North Island and Centre B in the South Island of New Zealand. Pre-orthodontic study models were evaluated from 28 UCLP patients from Centre A with primary surgical repairs performed between 1987–1999 and 31 UCLP patients from Centre B with primary surgical repairs performed between 1984–2000. Dental arch relationships were measured using the Goslon Yardstick. A Goslon score of 1 is considered to be an excellent outcome, whereas a score of 5 is a very poor treatment outcome.

Results: Intra- (Kappa: 0.84 – 0.93) and inter-examiner (Kappa: 0.63 – 0.69) reliabilities revealed good to very good agreement between examiners using the Goslon Yardstick. The mean Goslon score for Centre A was 3.5, with no cases in Group 1, five cases in Group 2 (17.9 per cent), nine cases in Group 3 (32.1 per cent), 11 cases in Group 4 (39.3 per cent) and three cases in Group 5 (10.7 per cent). The mean score for Centre B was 3.1, with one case in Group 1 (3.2 per cent), nine cases in Group 2 (29.0 per cent), eight cases in Group 3 (25.8 per cent), 11 cases in Group 4 (35.5 per cent) and two cases in Group 5 (6.5 per cent). There were no statistically significant differences between the two centres (p > 0.05).

Conclusions: The outcome scores from the two cleft centres, based on historic records, were disappointing and higher than expected. It is recommended that a review of primary surgical protocols be implemented to ensure outcomes comparable with international standards. The results provide useful benchmarks for future comparisons of treatment.

References

Shaw WC, Asher-McDade C, Brattström V, Dahl E, McWilliam J, Mølsted K et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 1. Principles and study design. Cleft Palate Craniofac J 1992;29:393–7.
Search in Google Scholar Back to article
Sandy J, Williams A, Mildinhall S, Murphy T, Bearn D, Shaw B et al. The Clinical Standards Advisory Group (CSAG) cleft lip and palate study. Br J Orthod 1998;25: 21–30.
Search in Google Scholar Back to article
Semb G, Brattström V, Mølsted K, Prahl-Andersen B, Shaw WC. The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 1: introduction and treatment experience. Cleft Palate Craniofac J 2005;42:64–8.
Search in Google Scholar Back to article
Mars M, Plint DA, Houston WJB, Bergland O, Semb G. The Goslon Yardstick: a new system of assessing dental arch relationships in children with unilateral clefts of the lip and palate. Cleft Palate Craniofac J 1987;24:314–22.
Search in Google Scholar Back to article
Huddart AG, Bodenham RS. The evaluation of arch form and occlusion in unilateral cleft palate subjects. Cleft Palate J 1972;9:194–209.
Search in Google Scholar Back to article
Mossey PA, Clark JD, Gray D. Preliminary investigation of a modified Huddart/Bodenham scoring system for assessment of maxillary arch constriction in unilateral cleft lip and palate subjects. Eur J Orthod 2003;25:251–7.
Search in Google Scholar Back to article
Mars M, Asher-McDade C, Brattström V, Dahl E, Mølsted K, McWilliam J et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 3. Dental arch relationships. Cleft Palate Craniofac J 1992;29:405–8.
Search in Google Scholar Back to article
Mølsted K, Brattström V, Prahl-Andersen B, Shaw WC, Semb G. The Eurocleft study: intercenter study of treatment outcome in patients with complete lip and palate. Part 3: dental arch relationships. Cleft Palate Craniofac J 2005; 42:78–82.
Search in Google Scholar Back to article
Hathorn I, Roberts-Harry D, Mars M. The Goslon Yardstick applied to a consecutive series of patients with unilateral clefts of the lip and palate. Cleft Palate Craniofac J 1996;33: 494–6.
Search in Google Scholar Back to article
Morris DO, Roberts-Harry D, Mars M. Dental arch relationships in Yorkshire children with unilateral cleft lip and palate. Cleft Palate Craniofac J 2000;37:453–62.
Search in Google Scholar Back to article
Hanify JA, Metcalf P, Nobbs CL, Worsley KJ. Congenital malformations in the newborn in Northland: 1966–1977. NZ Med J 1980;92:245–8.
Search in Google Scholar Back to article
Chapman CJ. Ethnic differences in the incidence of cleft lip and palate in Auckland, 1960–1976. NZ Med J 1983;96: 327–9.
Search in Google Scholar Back to article
Fowler P, Esson I. Non-syndromal orofacial clefts in the Canterbury/West Coast region, 1960–2000. NZ Dent J 2005;101:72–4.
Search in Google Scholar Back to article
Derijcke A, Eerens A, Carels C. The incidence of oral clefts: a review. Br J Oral Maxillofac Surg 1996;34:488–94.
Search in Google Scholar Back to article
Gregg T, Boyd D, Richardson A. The incidence of cleft lip and palate in Northern Ireland from 1980–1990. Br J Orthod 1994;21:387–92.
Search in Google Scholar Back to article
Altman DG. Statistics in medical journals: developments in the 1980s. Stat Med 1991;10:1897–913.
Search in Google Scholar Back to article
Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 1977;33:363–74.
Search in Google Scholar Back to article
Williams AC, Bearn D, Mildinhall C, Murphy T, Sell D, Shaw WC et al. Cleft lip and palate care in the United Kingdom – the Clinical Standards Advisory Group (CSAG) Study. Part 2: Dentofacial outcomes and patient satisfaction. Cleft Palate Craniofac J 2001;38:24–9.
Search in Google Scholar Back to article
Susami T, Ogihara Y, Matsuzaki M, Sakiyama M, Takato T, Shaw WC et al. Assessment of dental arch relationships in Japanese patients with unilateral cleft lip and palate. Cleft Palate Craniofac J 2006;43:96–102.
Search in Google Scholar Back to article
Zreaqat M, Hassan R, Halim AS. Dentoalveolar relationships of Malay children with unilateral cleft lip and palate. Cleft Palate Craniofac J 2009;46:326–30.
Search in Google Scholar Back to article

Evaluation of primary surgical outcomes in New Zealand patients with unilateral clefts of the lip and palate

Abstract

Paradigm

My account