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  • 1.
    Bannister, Patricia
    et al.
    Dental School, University of Manchester, Manchester, UK.
    Lindberg, Nina
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Jeppesen, Karin
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Copenhagen, Denmark.
    Elfving-Little, Ulla
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland.
    Semmingsen, Ann-Margritt
    Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
    Paganini, Anna
    Department of Plastic Surgery, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Gustavsson, Annica
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Slevin, Emma
    Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK.
    Jacobsen, Gry
    Center for Cleft Lip and Palate, Haukeland University Hospital, Bergen, Norway.
    Eyres, Phil
    Dental School, University of Manchester, Manchester, UK.
    Semb, Gunvor
    Dental School, University of Manchester, Manchester, UK;Department of Plastic and Reconstructive Surgery, Oslo University of Hospital Rikshospitalet and Statped, Sørøst, Hospital Oslo, Norway.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 3. Descriptive study of postoperative nursing care following first stage cleft closure.2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, 6 p.21-26 p.Article in journal (Refereed)
    Abstract [en]

    Background:Cleft lip and palate is one of the most common congenital anomalies requiring surgical treatment in children, normally commenced in the first year of life. Following the initiation of a group of multicentre surgical trials of primary surgery, variations in postoperative recovery and management became apparent. An agreement was made for a nurse-led survey in eight surgical centres to document postoperative care and recovery. Materials and methods:A postoperative recovery clinical report form was developed to capture relevant data for the children participating in the four arms of the trials. This included the age and weight at admission, the postoperative recovery setting, pain management, postoperative feeding, post-operative complications, and length of hospital stay. Results:Four hundred and three nursing forms from the first surgical procedure were returned for analysis. Differences in important aspects of care such as postoperative analgesia and postoperative feeding were evident. Postoperative care was influenced by local custom and practice, as little firm clinical evidence exists to guide optimal management. Conclusion:Postoperative recovery may play a significant role in the future selection of surgical protocols, and future trials need to consider cross-study site training to familiarise nurses, prior to any changes in surgical methods. Trial registration:ISRCTN29932826. [ABSTRACT FROM AUTHOR]

  • 2.
    Billaud Feragen, Kristin
    et al.
    Oslo University Hospital, Norway; Statped Sorost, Norway.
    Semb, Gunvor
    University of Manchester, England; National Hospital Norway, Norway.
    Heliovaara, Arja
    University of Helsinki, Finland.
    Lohmander, Anette
    Karolinska Institute, Sweden.
    Johannessen, Emma Christine
    Statped Sorost, Norway.
    Boysen, Betty Marie
    University of Copenhagen Hospital, Denmark.
    Havstam, Christina
    Sahlgrens University Hospital, Sweden.
    Lundeborg, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Nyberg, Jill
    Karolinska University Hospital, Sweden.
    Pedersen, Nina-Helen
    Statped Vest, Norway.
    Bogh-Nielsen, Joan
    Cleft Palate Centre, Denmark.
    Eyres, Philip
    University of Manchester, England.
    Bradbury, Eileen
    Private Practice, Manchester, UK.
    Rumsey, Nichola
    University of West England, England.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 10. Parental perceptions of appearance and treatment outcomes in their 5-year-old child2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, 81-87 p.Article in journal (Refereed)
    Abstract [en]

    Background and aim: Few studies have explored childrens emotional and behavioural reactions to cleft surgery and treatment-related stress. The objective was to investigate parents evaluations of appearance and treatment outcomes in their 5-year-old child with unilateral cleft lip and palate (UCLP), and their perceptions of how their child was coping with treatment, comparing this information with recorded postsurgical complications.Design: Three parallel group randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK.Methods: Three different surgical procedures for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. A total of 356 parents completed the Scandcleft Parent Questionnaire, and 346 parents completed the Cleft Evaluation Profile.Results: The results indicated that the majority of parents were satisfied with cleft-related features of their childs appearance. Further, most children coped well with treatment according to their parents. Nevertheless, 17.5% of the children showed minor or short-term reactions after treatment experiences, and 2% had major or lasting difficulties. There were no significant relationships between parent perceptions of treatment-related problems and the occurrence of post-surgical medical complications.Conclusions: Most parents reported satisfaction with their childs appearance. However, treatment-related problems were described in some children, urging cleft centres to be aware of potential negative emotional and behavioural reactions to treatment in some young children, with a view to preventing the development of more severe treatment-related anxiety.

  • 3.
    Bjerså, Kristofer
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Biorserud, Christina
    Institute Clin Science, Sweden.
    Fagevik Olsen, Monika
    Institute Clin Science, Sweden; University of Gothenburg, Sweden.
    Therapeutic ultrasound treatment for excessive skin on the upper arms due to extensive weight loss after bariatric surgery: A single blind, randomised, controlled trial2015In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 49, no 6, 353-357 p.Article in journal (Refereed)
    Abstract [en]

    Background: Excessive skin is a side-effect of massive weight loss. The only evidence-based treatment for excessive skin is plastic surgery. Non-invasive treatments, therefore, need to be evaluated. The aim of this study was to investigate effects of therapeutic ultrasound treatment on excess skin on the upper arms after bariatric surgery. Method: Fourteen patients were randomised to receive five treatments, each lasting for 30 minutes with active ultrasound treatment by CellsonicTM (Cellsonic Ltd) on one arm. The other arm served as control. The effect was evaluated objectively by measuring arm volume, circumference, and ptosis, and subjectively by a questionnaire where the patients assessed the effect of the treatment and amount and/or discomfort of the excess skin. Result: No statistical differences were observed in the objectively measured variables. Some patients reported perceived effects and a majority reported positive experiences of the treatment. No side-effects were reported. Conclusion: This study could not find any objectively measured effect of ultrasound treatment on excessive skin after bariatric surgery. However, participants experienced relief of symptoms associated with excess skin, such as pain, looseness, and decreased skin burst, which indicates that ultrasonic treatment of patients with excessive skin should be further investigated.

  • 4.
    Feragen, Kristin, Billaud
    et al.
    Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway.
    Rumsey, Nichola
    Centre for Appearance Research, University of the West of England, Bristol, UK.
    Heliövaara, Arja
    Department of Plastic Surgery, Cleft Palate and Craniofacial Centre, Helsinki University Central Hospital, Helsinki, Finland.
    Boysen, Betty, Marie
    Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Denmark.
    Johannessen, Emma Christine
    Department of Speech and Language Disorders, Statped Sørøst, Oslo, Norway.
    Havstam, Christina
    Division of Speech and Language Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Marcusson, Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Nyberg, Jill
    Division of Speech and Language Pathology, Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden.
    Pedersen, Nina-Helen
    Department of Speech and Language Disorders, Statped Vest, Bergen, Norway.
    Bogh-Nielsen, Joan
    Cleft Palate Centre, Aarhus, Denmark.
    Eyres, Philip
    Dental School, University of Manchester, Manchester, UK.
    Bradbury, Eileen
    Private Practice, Manchester, UK.
    Semb, Gunvor
    Dental School, University of Manchester, Manchester, UK; Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and Palate: 9. Parental report of social and emotional experiences related to their 5-year-old child's cleft diagnosis2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, 8 p.73-80 p.Article in journal (Refereed)
    Abstract [en]

    Background and aim:Parents of children with a cleft lip and palate may be emotionally affected by the child’s diagnosis. Their experiences and perceptions are important when evaluating the complexity of satisfactory treatment outcomes. The objective was to examine parents’ social and emotional experiences related to their child’s cleft diagnosis, and their perceptions of the child’s adjustment to living with a visible difference. Design:International multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. Methods:A cohort of 448 children born with a non-syndromic UCLP were included. A total of 356 parents completed the Scandcleft Parent Questionnaire. Results:The majority of parents experienced practical and emotional support from family, friends, and health professionals. Nevertheless, parents had to cope with other people’s reactions to the cleft, experiences that were described as ranging from hurtful to neutral and/or positive. According to parents, 39% of the children had experienced cleft-related comments and/or teasing. More than half of the parents reported specific worries related to their child’s future. Conclusion:While the majority of the parents experienced positive support and coped well with the child’s diagnosis, some parents were at risk for psychological and emotional challenges that should be identified by the cleft team. To optimise outcomes and the child’s adjustment, these parents should be offered psychological support when necessary. Trial registration:ISRCTN29932826. [ABSTRACT FROM AUTHOR]

  • 5.
    Heliövaara, Arja
    et al.
    Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland.
    Küseler, Annelise
    Cleft Palate Center, Aarhus, Denmark.
    Skaare, Pål
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Shaw, William
    Dental School, University of Manchester, Manchester, UK.
    Mølsted, Kirsten
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark.
    Karsten, Agneta
    Division of Orthodontics, Department of Dental Medicine, Stockholm Craniofacial Team, Karolinska Institutet, Stockholm, Sweden.
    Brinck, Eli
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Rizell,, Sara
    Orthodontic clinic, University Clinics of Odontology Gothenburg, Sweden.
    Marcusson, Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Sæle, Paul
    Oral Health Center of Excellence/Western Norway, Bergen, Norway.
    Hurmerinta, Kirsti
    Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland;.
    Rønning, Elisabeth
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Najar Chalien, Midia
    Orthodontic clinic, University Clinics of Odontology Gothenburg, Sweden.
    Bellardie,, Haydn
    Greater Manchester Cleft Unit, Royal Manchester Children’s Hospital, Manchester, UK.
    Mooney,, Jeanette
    Greater Manchester Cleft Unit, Royal Manchester Children’s Hospital, Manchester, UK.
    Eyres, Phil
    Dental School, University of Manchester, Manchester, UK.
    Semb, Gunvor
    Dental School, University of Manchester, Manchester, UK;Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet and Statped Sørøst, Oslo, Norway.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 6. Dental arch relationships in 5 year-olds.2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, 6 p.52-57 p.Article in journal (Refereed)
    Abstract [en]

    Background and aim:Good dentofacial growth is a major goal in the treatment of unilateral cleft lip and palate (UCLP). The aim was to evaluate dental arch relationships at age 5 years after four different protocols of primary surgery for UCLP. Design:Three parallel randomised clinical trials were undertaken as an international multi-centre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. Methods:Three different surgical procedures for primary palatal repair (Arms B, C, D) were tested against a common procedure (Arm A) in the total cohort of 448 children born with non-syndromic UCLP. Study models of 418 patients (273 boys) at the mean age of 5.1 years (range = 4.8–7.0) were available. Dental arch relationships were assessed using the 5-year index by a blinded panel of 16 orthodontists. Kappa statistics were calculated to assess reliability. The trials were tested statistically witht-and Chi-square tests. Results:Good-to-very good levels of intra- and interrater reliability were obtained (0.71–0.94 and 0.70–0.87). Comparisons within each trial showed no statistically significant differences in the mean 5-year index scores or their distributions between the common method and the local team protocol. The mean index scores varied from 2.52 (Trial 2, Arm C) to 2.94 (Trial 3, Arm D). Conclusion:The results of the three trials do not provide statistical evidence that one technique is better than the others. Further analysis of the possible influence of individual surgical skill and learning curve are being pursued in this dataset. Trial registration:ISRCTN29932826. [ABSTRACT FROM AUTHOR]

  • 6.
    Jarefors, Erik
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Hansson, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Functional outcome in 17 patients whose mandibles were reconstructed with free fibular flaps2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 3, 178-181 p.Article in journal (Refereed)
    Abstract [en]

    Objective: The vascularised free fibular flap is considered to be a reliable choice for reconstruction of oromandibular defects, especially after resection of malignant tumours in the area. This study evaluates the functional outcome of this method.

    Method: From January 2001 - May 2014, 37 patients were treated at the University Hospital of Linköping using the free fibular flap. The authors present the results from 17. This study reviewed their records and used the University of Washington Quality-of-Life questionnaire (UW-QoL), the Head and Neck Performance Status Scale (PSS), and interviews to assess their outcome.

    Results and conclusions: Functional evaluation showed a significant decrease in chewing (16 out of 17 patients), appearance (n = 10), salivation (n = 6), sensitivity in the mouth and skin (n = 16), occlusive problems in the mouth (n = 13), and range of mouth opening (n = 12). The remaining domains showed acceptable results, although most of them probably could not compare with the preoperative function. Out of 17 patients, six had to adjust their eating in public significantly, three thought their activity to be considerably restricted and two their recreation to be notably diminished. Common postoperative complications were infections or fistula in the mandible (n = 6), partial or complete rejection of the cutaneous flap (n = 4), and rupture of some of the sutures (n = 3). Nine patients required at least one more operation to repair defects, and six required a new soft tissue flap.

  • 7.
    Karsten, Agneta
    et al.
    Stockholm Craniofacial Team, Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Marcusson, Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Hurmerinta, Kirsti
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland.
    Heliövaara, Arja
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland.
    Küseler,, Annelise
    Cleft Palate Center, Aarhus, Denmark.
    Skaare, Pål
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway.
    Bellardie, Haydn
    Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Childrens’ Hospital, Manchester, UK.
    Rønning, Elisabeth
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway.
    Shaw, William
    Dental School, University of Manchester, Manchester, UK.
    Mølsted, Kirsten
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Copenhagen, Denmark.
    Sæle, Paul
    Oral Health Center of Expertise/Western Norway, Bergen, Norway.
    Brinck, Eli
    Oral Health Center of Expertise/Western Norway, Bergen, Norway.
    Rizell, Sara
    Department of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Najal Chalier, Midia
    Department of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Eyres, Philip
    Dental School, University of Manchester, Manchester, UK.
    Semb, Gunvor
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway; Dental School, University of Manchester, Manchester, UK.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 7. Occlusion in 5 year-olds according to the Huddart and Bodenham index.2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, 6 p.58-63 p.Article in journal (Refereed)
    Abstract [en]

    Background and aim:Good dentofacial development and good occlusion are main goals in the treatment of UCLP. The aim was to evaluate dental occlusion at age 5 years with the Huddart and Bodenham index after four different protocols of primary surgery for UCLP. Design:Three parallel randomised controlled trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. Methods:Three different surgical procedures for primary palatal repair (Arms B, C, and D) were tested against a common procedure (Arm A) in the total cohort of 448 children born with non-syndromic UCLP. Dental casts of 418 patients (272 boys, 146 girls), at the mean age of 5.1 years (range =4.7–6.9) were blindly assessed by 10 orthodontists with the original Huddart and Bodenham index. The main outcome measure was dental occlusion. Results:The inter- and intra-examiner reliability was good-to-excellent (0.61–0.94; 0.66–1.0, respectively). The mean total scores (+2 to −18) varied from −5.56 (Trial 2C) to −7.21 (Trial 3D). The mean anterior scores (+2 to −6) varied from −1.66 (Trial 2C) to −2.56 (Trial 3A). The mean posterior cleft-side scores (0 to −6) varied from −3.24 (Trial 3A) to −3.82 (Trial 3D) and the mean non-cleft-side scores (0 to −6) varied from −0.60 (Trial 2C) to −1.30 (Trial 3A); however, no significant differences were found within the trials. Conclusion:There was no statistical evidence of a difference in occlusion between the two surgical methods in each trial. Trial registration:ISRCTN29932826. [ABSTRACT FROM AUTHOR]

  • 8.
    Lohmander, Anette
    et al.
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Persson, Christina
    University of Gothenburg, Sweden.
    Willadsen, Elisabeth
    University of Copenhagen, Denmark.
    Lundeborg, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Alaluusua, Suvi
    University of Helsinki, Finland.
    Aukner, Ragnhild
    Statped Sorost, Norway.
    Bau, Anja
    University of Copenhagen Hospital, Denmark.
    Boers, Maria
    University of Copenhagen Hospital, Denmark.
    Bowden, Melanie
    Royal Manchester Childrens Hospital, England.
    Davies, Julie
    Royal Manchester Childrens Hospital, England.
    Emborg, Berit
    Cleft Palate Centre, Denmark.
    Havstam, Christina
    Sahlgrens University Hospital, Sweden.
    Hayden, Christine
    Royal Hospital Sick Children, North Ireland.
    Henningsson, Gunilla
    Karolinska University Hospital, Sweden.
    Holmefjord, Anders
    Statped Vest, Norway.
    Hölttä, Elina
    University of Helsinki, Finland.
    Kisling-Moller, Mia
    Cleft Palate Centre, Denmark.
    Kjoll, Lillian
    Statped Sorost, Norway.
    Lundberg, Maria
    Karolinska University Hospital, Sweden.
    McAleer, Eilish
    Royal Hospital Sick Children, North Ireland.
    Nyberg, Jill
    Karolinska University Hospital, Sweden.
    Paaso, Marjukka
    University of Helsinki, Finland.
    Pedersen, Nina Helen
    Statped Vest, Norway.
    Rasmussen, Therese
    Statped Vest, Norway.
    Reisaeter, Sigvor
    Statped Vest, Norway.
    Sogaard Andersen, Helene
    University of Copenhagen Hospital, Denmark.
    Schoeps, Antje
    University of Copenhagen Hospital, Denmark.
    Tordal, Inger-Beate
    Statped Sorost, Norway.
    Semb, Gunvor
    Statped Sorost, Norway; University of Manchester, England; National Hospital Norway, Norway.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 4. Speech outcomes in 5-year-olds - velopharyngeal competency and hypernasality2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, 27-37 p.Article in journal (Refereed)
    Abstract [en]

    Background and aim: Adequate velopharyngeal function and speech are main goals in the treatment of cleft palate. The objective was to investigate if there were differences in velopharyngeal competency (VPC) and hypernasality at age 5 years in children with unilateral cleft lip and palate (UCLP) operated on with different surgical methods for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. Design: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. Methods: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. Speech audio and video recordings of 391 children (136 girls, 255 boys) were available and perceptually analysed. The main outcome measures were VPC and hypernasality from blinded assessments. Results: There were no statistically significant differences between the prevalences in the arms in any of the trials. VPC: Trial 1, A: 58%, B: 61%; Trial 2, A: 57%, C: 54%; Trial 3, A: 35%, D: 51%. No hypernasality: Trial 1, A: 54%, B: 44%; Trial 2, A: 47%, C: 51%; Trial 3, A: 34%, D: 49%. Conclusions: No differences were found regarding VPC and hypernasality at age 5 years after different methods for primary palatal repair. The burden of care in terms of secondary pharyngeal surgeries, number of fistulae, and speech therapy visits differed.

  • 9.
    Lönnqvist, Susanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Emanuelsson, Peter
    Karolinska Institute, Sweden.
    Kratz, Gunnar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Influence of acidic pH on keratinocyte function and re-epithelialisation of human in vitro wounds2015In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 49, no 6, 346-352 p.Article in journal (Refereed)
    Abstract [en]

    Background: Chronic wounds are one of the greatest challenges for the healthcare system. Today, a plethora of dressings are used in the treatment of these wounds, each with specific influence on the wound environment. Due to differences in the permeability of the dressings the use will result in differences in the pH balance in the wound bed. However, little is known about how changes in the pH in the wound environment affect the different phases of the healing process. Aim: The aim of the present study was to investigate the effects of acidic pH on the regeneration phase by studying keratinocyte function in vitro and re-epithelialisation in an in vitro model of human skin. Results:In vitro assays showed reduced viability and migration rates in human keratinocytes when pH was lowered. Real time PCR revealed differential expression of genes related to wound healing and environmental impairment. Tissue culture showed no re-epithelialisation of wounds subjected to pH 5.0 and moderate re-epithelialisation at pH 6.0, compared to controls at pH 7.4. Conclusion: The results indicate that lowering pH down to pH 5.0 in wounds is counterproductive in aspect of keratinocyte function which is crucial for successful wound healing.

  • 10.
    Mølsted, Kirsten
    et al.
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Copenhagen, Denmark.
    Humerinta, Kirsti
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland.
    Küseler,, Annelise
    Cleft Palate Center, Aarhus, Denmark.
    Skaare, Pål
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway.
    Bellardie, Haydn
    Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Childrens Hospital, Manchester, UK.
    Shaw, William
    Dental School, University of Manchester, Manchester, UK.
    Karsten, Agneta
    Stockholm Craniofacial Team, Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Kåre Sæle, Paul
    Oral Health Center of Expertise/Western Norway, Bergen, Norway.
    Rizell, Sara
    Department of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Marcusson, Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Eyres, Philip
    Greater Manchester Cleft Lip and Palate Unit, Royal Manchester Childrens Hospital, Manchester, UK.
    Semb, Gunvor
    Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway;(4);Dental School, University of Manchester, Manchester, UK;(6);Statped Sørøst, Oslo, Norway.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 8. Assessing naso-labial appearance in 5-year-olds - a preliminary study2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, 9 p.64-72 p.Article in journal (Refereed)
    Abstract [en]

    Background and aim:Facial appearance is one of the most relevant measures of success in cleft lip and palate treatment. The aim was to assess nasolabial appearance at 5 years of age in all children in the project. In this part of the project the local protocol for lip closure continued to be used because the primary lip and nose operations were not part of the randomisation. The great majority of the surgeons used Millard’s technique together with McComb’s technique for the nose. One center used Tennison-Randalls technique and in one center the centers own technique as well as nose plugs were used. Methods:Three hundred and fifty-nine children participated in this part of the project. Standardised photos according to a specific protocol developed for the Scandcleft project were taken. Only the nasolabial area was shown, the surrounding facial features were masked. Three components were scored using a 5-point ordinal scale. A new developed Scandcleft Yardstick was used. Results:The reliability of the method was tested using the weighted kappa statistics. Both the interrater and intrarater reliability scores were good to very good. There were statistically significant differences between the three trials. Conclusion:The Millard procedure combined with McComb technique had been used in the majority of the cases in all three trials. There were statistically significant differences between the three trials concerning upper lip, nasal form, and cleft side profile. Trial registration:ISRCTN29932826. [ABSTRACT FROM AUTHOR]

  • 11.
    Rautio, Jorma
    et al.
    Helsinki University Hospital, Finland.
    Andersen, Mikael
    University of Copenhagen Hospital, Denmark.
    Bolund, Stig
    University of Copenhagen Hospital, Denmark.
    Hukki, Jyri
    Helsinki University Hospital, Finland.
    Vindenes, Hallvard
    University of Bergen, Norway.
    Davenport, Peter
    Royal Manchester Childrens Hospital, England.
    Arctander, Kjartan
    Rikshosp Oslo, Norway.
    Larson, Ola
    Karolinska University Hospital, Sweden.
    Berggren, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Abyholm, Frank
    Rikshosp Oslo, Norway.
    Whitby, David
    Royal Manchester Childrens Hospital, England.
    Leonard, Alan
    Royal Hospital Sick Children, North Ireland.
    Lilja, Jan
    University of Gothenburg, Sweden.
    Neovius, Erik
    Karolinska University Hospital, Sweden.
    Elander, Anna
    University of Gothenburg, Sweden.
    Heliovaara, Arja
    Helsinki University Hospital, Finland.
    Eyres, Phil
    University of Manchester, England.
    Semb, Gunvor
    University of Manchester, England; National Hospital Norway, Norway.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 2. Surgical results2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, 14-20 p.Article in journal (Refereed)
    Abstract [en]

    Background: Longstanding uncertainty surrounds the selection of surgical protocols for unilateral cleft lip and palate, and randomised trials have only rarely been performed. The Scandcleft Project consists of three trials commenced in 1997 involving ten centres in Denmark, Finland, Norway, Sweden, and the UK. Three groups of centres tested a newly-defined common technique for palatal repair (Arm A) against their local protocols (Arms B, C, D). Arm A was familiar to most of the surgeons in Trial 1, but not to the surgeons in the other Trials. Aim: To evaluate surgical events and complications of the 448 (293 boys, 155 girls) patients with complete unilateral cleft lip and palate (UCLP) enrolled in the three trials. Method: The three trials were carried out in parallel in adherence with a fully developed, ethically approved protocol. Operative time, bleeding, complications, and major dehiscence during and after both primary surgeries were recorded by the surgeon. Rates of fistula and surgery for velopharyngeal incompetence (VPI) were assessed until the youngest patient of the study had reached the age of 9 years. Pearson Chi-square statistical analysis was used to compare the outcomes. Results: No significant differences in bleeding, infection, anaesthetic complications or length of hospital stay between the different arms were found for Trial 1. However, in Trials 2 and 3 there were more airway problems in Arm A than with the traditional local protocols (Arms C or D). In Trial 3 fistula and VPI surgery rates were also higher in Arm A. Conclusions: The results do not provide statistical evidence that any technique is better than others, but indicate that surgery was more problematic for surgeons who were still gaining experience with an unfamiliar surgical protocol.

  • 12.
    Rubensson, Carin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Ydreborg, Karin
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Boren, Linda
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Karlander, Lars-Erik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Flexor tendon repair after rupture caused by volar plate fixation of the distal radius2015In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 49, no 2, 112-115 p.Article in journal (Refereed)
    Abstract [en]

    Volar plate fixation of unstable fractures of the distal radius is preferred by a majority of surgeons today. One known complication is the rupture of flexor tendons. The aim of this paper is to present flexor tendon ruptures after volar plate fixation analysing the clinical outcome after tendon surgery, aetiology, and methods of prevention. Seventeen consecutive ruptures in 14 patients were included. The incidence was 1.4%. Three patients declined tendon surgery. Eleven patients were treated with a free tendon graft. Only two patients showed excellent results regarding mobility in the thumb and/or fingers. Analysis of radiographs demonstrated sub-optimal placement of plate or screws in all cases. Rupture of a flexor tendon is a serious complication where the functional outcome after surgical reconstruction is uncertain. Early removal of the plate when the placement is sub-optimal or when local volar tenderness appears would probably prevent many ruptures.

  • 13.
    Semb, Gunvor
    et al.
    Division of Dentistry, University of Manchester , Manchester , UK; Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway; Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway..
    Enemark, Hans
    Cleft Palate Center , Aarhus , Denmark.
    Friede, Hans
    Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Paulin, Gunnar
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Lilja, Jan
    Department of Plastic Surgery , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Rautio, Jorma
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Andersen, Mikael
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Åbyholm, Frank
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Lohmander, Anette
    Division of Speech and Language Pathology , Karolinska Institute, and Karolinska University Hospital , Stockholm , Sweden.
    Shaw, William
    Division of Dentistry, University of Manchester , Manchester , UK.
    Mølsted, Kirsten
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Heliövaara, Arja
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Bolund, Stig
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Hukki, Jyri
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Vindenes, Hallvard
    Centre for Cleft Lip and Palate, Bergen University Hospital Haukeland , Bergen , Norway.
    Davenport, Peter
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Arctander, Kjartan
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Larson, Ola
    Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.
    Berggren, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Whitby, David
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Leonard, Alan
    The Royal Hospital for Sick Children , Belfast , N. Ireland.
    Neovius, Erik
    Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.
    Elander, Anna
    Department of Plastic Surgery , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Willadsen, Elisabeth
    Department of Nordic Studies and Linguistics , University of Copenhagen , Denmark.
    Bannister, R. Patricia
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Bradbury, Eileen
    Private Practitioner , Manchester , UK.
    Henningsson, Gunilla
    Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.
    Persson, Christina
    Institute of Neuroscience and Physiology, Speech and Language; Division for Speech and Language Pathology , Sahlgrenska University Hospital , Gothenburg , Sweden Pathology Unit , Sahlgrenska Academy, University of Gothenburg , Sweden; .
    Eyres, Philip
    Division of Dentistry, University of Manchester , Manchester , UK.
    Emborg, Berit
    Cleft Palate Center , Aarhus , Denmark.
    Kisling-Møller, Mia
    Division of Dentistry, University of Manchester , Manchester , UK.
    Küseler, Annelise
    Division of Dentistry, University of Manchester , Manchester , UK.
    Granhof Black, Birthe
    Division of Dentistry, University of Manchester , Manchester , UK.
    Schöps, Antje
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Bau, Anja
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Boers, Maria
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Søgaard Andersen, Helene
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Jeppesen, Karin
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Marxen, Dorte
    Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark.
    Paaso, Marjukka
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Hölttä, Elina
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Alaluusua, Suvi
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Turunen, Leena
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Humerinta, Kirsti
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Elfving-Little, Ulla
    Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland.
    Tørdal, Inger Beate
    Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.
    Kjøll, Lillian
    Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.
    Aukner, Ragnhild
    Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.
    Hide, Øydis
    Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.
    Feragen, Kristin Billaud
    Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway.
    Rønning, Elisabeth
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Skaare, Pål
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Brinck, Eli
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Semmingsen, Ann-Magritt
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Lindberg, Nina
    Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.
    Bowden, Melanie
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Davies, Julie
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Mooney, Jeanette
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Bellardie, Haydn
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Schofield, Nina
    Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK.
    Nyberg, Jill
    Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.
    Lundberg, Maria
    Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden.
    Linder-Aronson Karsten, Agneta
    Stockholm Craniofacial Team, Department of Dental Medicine , Karolinska Institute , Stockholm , Sweden.
    Larson, Margareta
    Eastman Institute, Stockholms Läns Landsting , Stockholm , Sweden.
    Holmefjord, Anders
    Statped vest , Bergen , Norway.
    Reisæter, Sigvor
    Statped vest , Bergen , Norway.
    Pedersen, Nina-Helen
    Statped vest , Bergen , Norway.
    Rasmussen, Therese
    Statped vest , Bergen , Norway.
    Tindlund, Rolf
    Dental School, University of Bergen , Bergen , Norway.
    Sæle, Paul
    Oral Health Center of Expertise/Western Norway , Bergen , Norway.
    Blomhoff, Reidunn
    Centre for Cleft Lip and Palate, Bergen University Hospital Haukeland , Bergen , Norway.
    Jacobsen, Gry
    Centre for Cleft Lip and Palate, Bergen University Hospital Haukeland , Bergen , Norway.
    Havstam, Christina
    Division for Speech and Language Pathology , Sahlgrenska University Hospital , Gothenburg , Sweden.
    Rizell, Sara
    Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Enocson, Lars
    Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Hagberg, Catharina
    Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Najar Chalien, Midia
    Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Paganini, Anna
    Department of Plastic Surgery , Sahlgrenska Academy, University of Gothenburg , Sweden.
    Lundeborg, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Marcusson, Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Mjönes, Anna-Britta
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Gustavsson, Annica
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Hayden, Christine
    The Royal Hospital for Sick Children , Belfast , N. Ireland.
    McAleer, Eilish
    The Royal Hospital for Sick Children , Belfast , N. Ireland.
    Slevan, Emma
    The Royal Hospital for Sick Children , Belfast , N. Ireland.
    Gregg, Terry
    The Royal Hospital for Sick Children , Belfast , N. Ireland.
    Worthington, Helen
    Division of Dentistry, University of Manchester , Manchester , UK.
    A Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management.2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, 2-13 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project.

    METHOD: Ten established national or regional cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3-4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes.

    RESULTS: Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years.

    CONCLUSION: The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series.

    TRIAL REGISTRATION: ISRCTN29932826.

  • 14.
    Willadsen, Elisabeth
    et al.
    University of Copenhagen, Denmark.
    Lohmander, Anette
    Karolinska University Hospital, Sweden.
    Persson, Christina
    Sahlgrens University Hospital, Sweden; University of Gothenburg, Sweden.
    Lundeborg, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Alaluusua, Suvi
    University of Helsinki, Finland.
    Aukner, Ragnhild
    Statped Sorost, Norway.
    Bau, Anja
    University of Copenhagen Hospital, Denmark.
    Boers, Maria
    University of Copenhagen Hospital, Denmark.
    Bowden, Melanie
    Royal Manchester Childrens Hospital, England.
    Davies, Julie
    Royal Manchester Childrens Hospital, England.
    Emborg, Berit
    Cleft Palate Centre, Denmark.
    Havstam, Christina
    Sahlgrens University Hospital, Sweden.
    Hayden, Christine
    Royal Hospital Sick Children, North Ireland.
    Henningsson, Gunilla
    Karolinska University Hospital, Sweden.
    Holmefjord, Anders
    Statped Vest, Norway.
    Hölttä, Elina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Kisling-Moller, Mia
    Cleft Palate Centre, Denmark.
    Kjoll, Lillian
    Statped Sorost, Norway.
    Lundberg, Maria
    Karolinska University Hospital, Sweden.
    McAleer, Eilish
    Royal Hospital Sick Children, North Ireland.
    Nyberg, Jill
    Karolinska University Hospital, Sweden.
    Paaso, Marjukka
    University of Helsinki, Finland.
    Helen Pedersen, Nina
    Statped Vest, Norway.
    Rasmussen, Therese
    Statped Vest, Norway.
    Reisaeter, Sigvor
    Statped Vest, Norway.
    Sogaard Andersen, Helene
    University of Copenhagen Hospital, Denmark.
    Schops, Antje
    University of Copenhagen Hospital, Denmark.
    Tordal, Inger-Beate
    Statped Sorost, Norway.
    Semb, Gunvor
    Statped Sorost, Norway; University of Manchester, England; National Hospital Norway, Norway.
    Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 5. Speech outcomes in 5-year-olds - consonant proficiency and errors2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 1, 38-51 p.Article in journal (Refereed)
    Abstract [en]

    Background and aim: Normal articulation before school start is a main objective in cleft palate treatment. The aim was to investigate if differences exist in consonant proficiency at age 5 years between children with unilateral cleft lip and palate (UCLP) randomised to different surgical protocols for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. Design: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Norway, Sweden, and the UK. Methods: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with non-syndromic UCLP. Speech audio- and video-recordings of 391 children (136 girls and 255 boys) were available and transcribed phonetically. The main outcome measure was Percent Consonants Correct (PCC) from blinded assessments. Results: In Trial 1, arm A showed statistically significant higher PCC scores (82%) than arm B (78%) (p=.045). No significant differences were found between prevalences in Trial 2, A: 79%, C: 82%; or Trial 3, A: 80%, D: 85%. Across all trials, girls achieved better PCC scores, excluding s-errors, than boys (91.0% and 87.5%, respectively) (p=.01). Conclusions: PCC scores were higher in arm A than B in Trial 1, whereas no differences were found between arms in Trials 2 or 3. The burden of care in terms of secondary pharyngeal surgeries, number of fistulae, and speech therapy visits differed.

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