April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Zhang et al

Table 1. Patient Demographics and Interventions.

Classification (% of Subgroup)

Submucosal Cleft

CL þ A

Demographic feature

All

Veau 1

Veau 2

Veau 3

Veau 4

No. of respondents

456

34

37

106

178

92

9

Mean age, years

10.10 (4.48) 8.59 (4.59) 7.36 (3.36) 255 (55.9%) 16 (47.1%) 24 (64.9%)

10.19 (5.06)

10.09 (4.17)

11.91 (4.04)

7.89 (2.89)

Male sex

41 (38.7%)

110 (61.8%)

56 (60.9%)

8 (88.9%)

Race/ethnicity

American Indian

1 (0.2%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

1 (1.1%)

0 (0%)

Asian or Pacific Islander

102 (22.4%)

1 (2.9%) 1 (2.9%) 1 (2.9%)

4 (10.8%) 3 (8.1%) 3 (8.1%)

10 (2.8%) 3 (2.8%) 8 (7.5%) 85 (80.2%)

54 (30.3%) 17 (9.6%)

31 (33.7%)

2 (22.2%)

Black or African

29 (6.4%) 28 (6.1%)

5 (5.4%) 8 (8.7%)

0 (0%)

Hispanic

7 (3.9%)

1 (11.1%) 6 (66.7%)

White

296 (64.9%) 31 (91.2%) 27 (73.0%)

100 (56.2%)

47 (51.1%)

Extent of CL deformity Incomplete

NA NA

NA NA

NA NA

NA NA

20 (16.9%) 97 (68.6%)

22 (41.5%) 31 (58.5%)

1 (14.3%) 6 (85.7%)

Complete

Laterality Right

NA NA

NA NA

NA NA

NA NA

56 (31.5%) 122 (68.5%)

NA NA

3 (37.5%) 5 (62.5%)

Left

Intervention

Cleft lip repair surgery Cleft palate repair surgery Intermediate tip rhinoplasty

285 431

4 (11.8%)

2 (5.4%)

0 (0.0%)

178 (100.0%)

92 (100.0%) 92 (100.0%) 35 (38.0%) 10 (10.9%) 12 (13.0%) 12 (13.0%)

9 (100.0%)

18 (52.9%) 37 (100.0%) 106 (100.0%) 178 (100.0%)

0 (0%)

98 18 21 52

0 (0%) 0 (0%) 0 (0%)

0 (0%) 0 (0%) 0 (0%)

0 (0.0%) 2 (1.9%) 4 (3.8%)

60 (33.7%) 6 (3.4%) 5 (2.8%) 15 (8.4%)

3 (37.5%)

Cleft rhinoplasty

0 (0%) 0 (0%) 0 (0%)

Orthognathic procedure

Speech surgery

6 (17.6%)

2 (5.4%)

17 (16.0%)

Abbreviations: CL þ A, cleft lip with or without cleft alveolus; NA, not applicable.

trouble sleeping by 5.9 % , and trouble breathing through nose during exercise by 5.9 % .

Results Study Cohort

A total of 1028 surveys were collected from 456 individual respondents. Table 1 presents a summary of the cohort’s demo- graphic profile and surgical histories. The series included patients with submucosal cleft palate (SMCP; 7.5 % ), isolated soft cleft palate (CP; Veau 1, 8.1 % ), isolated soft and hard CP (Veau 2, 23.3 % ), unilateral cleft lip and palate (CLP; Veau 3, 39.0 % ), bilateral CLP (Veau 4, 20.2 % ), and cleft lip and alveo- lus (CL þ A; 2.0 % ). Mean age at the time of most recent follow-up was 10.10 + 4.48 years. Patients in the series had undergone 285 CL repairs, 431 CP repairs, 98 intermediate tip rhinoplasties, 18 cleft rhinoplasties, 21 orthognathic proce- dures, and 54 speech surgeries (34 posterior pharyngeal flaps, 20 sphincter pharyngoplasties). All subjects with Veau 1, 2, 3, or 4 classification had undergone CL and/or CP only repair prior to completing the surveys. Sixty-seven percent of the study cohort had at least 1 survey with composite NOSE score greater than 2. A composite score of 2 or greater indicated that the subjects had at least one “moderate problem” symptom or 2 “mild problem” symptoms. Forty-nine percent had a composite NOSE score greater than 2 at latest follow-up. “Fairly bad” or “severe” nasal congestion/ stuffiness was reported at least once by 16.4 % of subjects, nasal blockage by 9.6 % , trouble breathing through nose by 11.2 % ,

Nasal Obstruction According to Age of Respondent Table 2 presents the NOSE scores stratified into 6 brackets according to age of subject at the time of survey. There was a significant difference in the severity of symptoms reported ( P ¼ .035), with respondents aged 14 to 16 years having the highest mean composite NOSE scores (3.82 + 4.27), followed by subjects older than 17 years (3.24 + 4.08) and subjects less than 5 years (3.13 + 3.92). Figure 2 illustrates the mean com- posite NOSE score across the different age groups, for all sub- jects and phenotypic subgroups. Nasal Obstruction According to Phenotype Table 3 presents the mean scores from the most severe NOSE surveys and most recent NOSE surveys collected for each subject, stratified according to phenotype. The scores of nasal blockage symptoms differed significantly between pheno- types, when considering both the most severe NOSE surveys and the most recent NOSE surveys ( P < .050). The 9 subjects with CL þ A reported the highest mean scores (1.11 + 1.17) in the entire cohort. There was no significant difference in NOSE scores between those who had their alveolus previ- ously repaired at the time of survey (n ¼ 4) and those who

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