April 2020 HSC Section 4 - Plastic and Reconstructive Problems

The Cleft Palate-Craniofacial Journal 56(2)

Table 2. Results According to Age.

NOSE Score, mean (SD)

Composite Congestion Blockage Nose Breathing Sleeping

Exercise

All subjects (number of surveys) <5 years (228)

3.13 (3.92) 2.39 (2.97) 2.37 (3.06) 2.84 (3.59) 3.82 (4.27) 3.24 (4.08) 2.61 (3.95) 1.73 (2.11) 2.46 (2.76) 3.38 (3.94) 3.76 (4.47) 4.50 (5.46) 3.58 (3.67) 2.51 (2.99) 2.44 (3.06) 3.27 (3.86) 4.41 (4.48) 2.12 (2.03) 3.61 (4.75) 3.11 (3.87) 2.22 (3.60) 1.94 (2.82) 2.97 (3.61) 2.43 (2.44) .035 a .054 .043 a

1.25 (1.16) 1.08 (1.04) 0.94 (1.05) 0.96 (1.05) 1.00 (1.06) 0.85 (1.03) 1.03 (1.10) 0.80 (0.82) 1.06 (1.06) 1.13 (1.08) 1.05 (1.10) 1.17 (1.31) 1.48 (1.18) 1.12 (1.03) 0.99 (1.05) 0.98 (1.08) 1.13 (1.09) 0.65 (0.70) 1.39 (1.20) 1.48 (1.28) 0.69 (1.04) 0.82 (1.01) 0.72 (0.92) 0.57 (0.65) .016 a .685 .011 a

0.52 (0.94) 0.38 (0.80) 0.41 (0.82) 0.55 (0.99) 0.72 (1.10) 0.55 (1.00) 0.32 (0.70) 0.25 (0.55) 0.30 (0.69) 0.69 (1.10) 0.68 (1.23) 0.83 (1.31) 0.72 (1.08) 0.45 (0.86) 0.52 (0.90) 0.60 (1.04) 1.02 (1.18) 0.35 (0.61) 0.67 (1.08) 0.43 (0.98) 0.43 (0.89) 0.37 (0.81) 0.31 (0.54) 0.29 (0.61) .039 a .054 .022 a

0.68 (1.05) 0.50 (0.85) 0.52 (0.89) 0.61 (1.03) 0.90 (1.20) 0.78 (1.21) 0.53 (0.99) 0.33 (0.59) 0.53 (0.86) 0.62 (1.07) 0.98 (1.21) 1.17 (1.43) 0.82 (1.10) 0.54 (0.88) 0.48 (0.87) 0.78 (1.11) 1.00 (1.25) 0.41 (0.71) 0.72 (1.18) 0.70 (1.09) 0.59 (1.00) 0.43 (0.89) 0.66 (1.11) 0.57 (1.16) .032 a .005 a .042 a

0.45 (0.90) 0.20 (0.67) 0.21 (0.61) 0.21 (0.61) 0.27 (0.68) 0.24 (0.63) 0.26 (0.68) 0.45 (0.93) 0.52 (0.86) 0.70 (1.13) 0.55 (1.10) 0.55 (1.14) 0.47 (0.97) 0.22 (0.72) 0.20 (0.59) 0.15 (0.41) 0.34 (0.69) 0.23 (0.63) 0.49 (0.94) 0.46 (0.97) 0.57 (0.93) 0.49 (0.96) 0.75 (1.36) 0.67 (1.34) 0.43 (0.78) 0.15 (0.50) 0.19 (0.63) 0.21 (0.59) 0.20 (0.62) 0.25 (0.63) 0.27 (0.66) 0.62 (1.09) 0.54 (0.81) 0.78 (1.13) 0.47 (0.87) 0.24 (0.56) 0.50 (1.10) 0.33 (1.03) 0.24 (0.57) 0.26 (0.85) 0.27 (0.73) 0.24 (0.66) 0.08 (0.34) 0.24 (0.66) 0.41 (0.87) 0.83 (1.31) 0.29 (0.83) 0.71 (1.27) <.001 a <.001 a .088 .061 <.001 a <.001 a

5-7 years (252) 8-10 years (231) 11-13 years (150) 14-16 years (112)

>17 years (55)

P value

Submucosal cleft, Veau 1,2 (number of surveys) <5 years (111)

5-7 years (95) 8-10 years (83) 11-13 years (39) 14-16 years (37) >17 years (24)

P value

Veau 3 (number of surveys) <5 years (96)

5-7 years (107) 8-10 years (91) 11-13 years (60) 14-16 years (46) >17 years (17)

P value

Veau 4 (number of surveys) <5 years (18)

5-7 years (46) 8-10 years (49) 11-13 years (49) 14-16 years (29) >17 years (14)

.003 a

.008 a

P value

.085

.761

.738

.312

Isolated CL (number of surveys) <5 years (3)

5.00 (5.57) 6.50 (3.87) 1.63 (2.77) 1.50 (2.12)

1.67 (1.53) 2.25 (0.96) 0.50 (0.76) 0.50 (0.71)

1.33 (1.53) 1.25 (1.50) 0.25 (0.71) 1.00 (1.41)

1.00 (1.00) 1.50 (1.00) 0.24 (0.71) 0.00 (0.00)

0.33 (0.58) 0.67 (1.15) 0.50 (1.00) 1.00 (1.15) 0.50 (1.07) 0.13 (0.35) 0.00 (0.00) 0.00 (0.00)

5-7 years (4) 8-10 years (8) 11-13 years (2)

P value

.194

.079

.330

.096

.916

.348

Abbreviation: CL, cleft lip. a Indicating statistical significance ( p value <0.05)

had not (n ¼ 5; P > .050). Among subjects with CP, those with unilateral CLP (Veau 3, 0.89 + 1.18) reported the highest mean nasal blockage scores, compared to subjects with bilat- eral CLP (Veau 4, 0.62 + 1.01) and subjects with no CL deformity (SMCP, Veau 1, Veau 2). When all 1028 surveys collected were aggregated (which included multiple surveys per subject from different annual visits), the difference in nasal blockage was still statistically different across phenoty- pic groups ( P < .001). Given that the phenotypic groups differed significantly in mean age, subanalyses were performed to assess the younger (9 ¼ years and younger) and older subjects (10 years and older) separately. In both groups, nasal blockage symptoms differed

significantly with regard to phenotypic classification ( P < .050), with the CL þ A cohort having the highest mean scores, followed by the Veau 3 and Veau 4 cohorts. Figure 3 illustrates the distribution of nasal blockage sever- ity, stratified by phenotype. A total of 12.3 % of Veau 3 subjects reported that nasal blockage was a “severe” or “fairly bad” problem, compared to 8.7 % of Veau 4 subjects, 6.8 % of Veau 1 and 2 subjects, and 2.9 % of SMCP subjects. A total of 66 % of Veau 4 subjects reported that nasal blockage was “not a problem,” compared to 55 % of Veau 3 subjects. Finally, when considering the most severe NOSE survey collected, there was a trend of subjects who had complete uni- lateral CL + P deformities reporting higher NOSE scores (4.41

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