ObjectiveAssess if velopharyngeal gap size during speech is associated with consonant accuracy and whether hypernasality severity and compensatory misarticulation errors (CMAs) mediate this relationship.DesignCross-sectional.SettingMetropolitan hospital.ParticipantsEighty-one patients undergoing assessment for velopharyngeal insufficiency (VPI).Assessment(s)Each patient completed a preoperative magnetic resonance imaging protocol during sustained /i/ production and a perceptual speech evaluation. Velopharyngeal gap size was measured in millimeters. Hypernasality was rated using the Cleft Audit Protocol for Speech-Augmented-Americleft Modification. Percent consonants correct (PCC) and percent of CMAs used were derived from transcriptions of the American English sentence or phrase sample.Main Outcome Measure(s)A generalized structural equation model was used to examine whether velopharyngeal gap size is associated with PCC indirectly through hypernasality severity and CMA use.ResultsLarger velopharyngeal gap sizes were associated with more severe hypernasality (P < .001), greater hypernasality severity was associated with increased CMA use (P < .001), and greater CMA use was associated with lower PCC (P < .001). Velopharyngeal gap size was not directly associated with PCC (P = .400). However, the full indirect pathway from gap size to PCC through hypernasality severity and CMA use was significant (P = .001); gap size was significantly associated with PCC when accounting for both direct and indirect pathways combined (P = .005).ConclusionsThese findings suggest hypernasality severity is the key mediator between gap size and speech accuracy. Patients with more severe hypernasality may benefit from timely surgical remediation of VPI to increase overall consonant accuracy.

ObjectiveTo investigate in field of view (FOV) reduction in cone-beam computed tomography (CBCT) examinations of patients with bilateral alveolar clefts for dose reduction and potential missed information of dental anomalies.DesignRetrospective cohort study.SettingDepartment of Oral and Maxillofacial Radiology, Falu lasarett, Sweden.Patients36 patients (24 males and 12 females) with bilateral alveolar clefts, with 70 CBCT examinations performed before and after alveolar bone grafting exposed between 2016 and 2020. All examinations had a FOV of 80 × 50 mm.InterventionsTwo reduced-FOV protocols were measured: a larger preoperative protocol including upper canines and the anterior maxilla, and a smaller postoperative protocol depicting the cleft areas.Main Outcome MeasureSuggested FOV dimensions for clinical use before and after bone graft.ResultsThe suggested preoperative protocol (65 × 45 mm) resulted in an estimated 27% reduction in radiation dose, whereas the postoperative protocol (35 × 35 mm) achieved a 62% reduction compared with the original FOV. Incidental findings were detected in 80% of the suggested preoperative protocol and in none of the suggested postoperative protocols.ConclusionThe suggested FOV reduction protocols for CBCT may substantially reduce radiation exposure while maintaining essential information. A preoperative FOV of 65 × 45 mm and a postoperative FOV of 35 × 35 mm are suggested for CBCT of bilateral alveolar clefts.

ObjectiveTo evaluate whether preoperative anthropometric measures and feeding-related variables are associated with readmission following primary palatoplasty.DesignRetrospective cohort studySettingTertiary pediatric craniofacial center.ParticipantsInfants undergoing primary palatoplasty between 2015 and 2022 with documented weight-for-age (WAZ) and height-for-age (HAZ) z scores.Main Outcome MeasuresReadmission within 30 days of primary palatoplasty. Multivariable logistic regression evaluated associations with anthropometric, demographic, and feeding-related covariates.ResultsAmong 282 patients, 43 (15.2%) experienced 30-day readmission. Higher WAZ was associated with increased odds of readmission (OR: 1.87; 95% CI: 1.23-2.84; p = .003), whereas higher HAZ was associated with decreased odds (OR: 0.66; 95% CI: 0.49-0.90; p = .009). Concentrated formula use was also associated with increased odds (OR: 2.92; 95% CI: 1.18-7.19; p = .020). These associations persisted among patients without a syndromic diagnosis. Nutrition- or feeding-related concerns accounted for 19 of 43 readmissions (44.2%) and higher WAZ and lower HAZ remained associated with this outcome.ConclusionsHigher WAZ, lower HAZ, and concentrated formula use were associated with readmission following primary palatoplasty with similar anthropometric associations observed among patients without a syndromic diagnosis and for nutrition- or feeding-related readmissions. Anthropometric variables should be interpreted alongside the feeding and nutritional support required during surgical preparation and may help identify patients requiring closer perioperative feeding surveillance.

ObjectiveCleft lip and/or palate (CL/P) are common congenital craniofacial anomalies associated with functional and psychosocial challenges. As social media platforms continue to expand, they increasingly influence perceptions of facial appearance, stigma, and social support among individuals with CL/P.DesignLiterature review and narrative synthesis of studies examine social media use and psychosocial experiences among individuals with CL/P and their families. A literature search was conducted across PubMed, Medline, Cochrane, Clarivate Web of Science, and ScienceDirect for studies published between January 2015 and October 2025. Studies examining social media use among individuals with CL/P, caregivers, or families were included. Eligible articles explored psychosocial experiences related to platforms such as Instagram, TikTok, YouTube, Facebook, Snapchat, and online support communities. Risk of bias was evaluated using the Mixed Methods Appraisal Tool.Main Outcome MeasureThe impact of social media on self-awareness, stigma, and psychosocial experiences among individuals with CL/P and their families.ResultsAfter screening and eligibility assessment, 55 studies were included in the final synthesis. Social media was found to have both beneficial and detrimental effects. Appearance-focused platforms may contribute to social comparison, body image concerns, and experiences of stigma, particularly among adolescents. Online communities and support groups provide opportunities for peer support, information sharing, and advocacy, helping reduce isolation and improve coping among patients and families.ConclusionWhile certain platforms may exacerbate stigma and body image concerns, online support networks offer meaningful opportunities for connection, education, and empowerment.

ObjectiveAlveolar bone grafting in individuals with cleft lip and/or palate is typically performed using the iliac crest as the donor site. Platelet-rich fibrin is a concentrate rich in growth factors that can promote bone formation. This review evaluates the effect of using this concentrate along with alveolar bone grafts on bone formation in people with cleft lip and/or palate.DesignThis systematic review was conducted following the PRISMA guidelines, and PubMed (MEDLINE), Scopus, Embase, and Web of Science were searched with appropriate search terms. Data were exported to EndNote Online, and duplicates were removed. After screening, full-text articles were retrieved, and only those meeting the inclusion criteria were further assessed. Data were extracted, and the methodological quality of the articles was appraised using the Cochrane Risk of Bias tool.SettingNot applicable.PatientsIndividuals with cleft lip and/or palate.InterventionsAlveolar bone grafting using the iliac crest.Main outcome measureDetails on volume, percentage of newly formed bone, density, height, and width of the bone over time in the cleft lip and/or palate.ResultsOf 116 articles retrieved from the databases, 5 were included in the review. All studies indicated better outcomes when using platelet-rich fibrin with the graft, although the results were not always statistically significant. Methodological concerns were noted across all studies.ConclusionPlatelet-rich fibrin may enhance bone formation at the alveolar cleft site when used with iliac crest grafts. However, more rigorous long-term studies and clinical trials are needed to obtain definitive evidence.

ObjectiveTo analyze the association between Medicaid provider reimbursement for cleft lip and palate (CL/P) procedures and state-level economic factors.DesignCross-sectional study of publicly available 2025 state Medicaid provider reimbursement rates associated with CL/P procedures. Statistical analysis compared provider reimbursement and demographic factors.SettingNational sample of Medicaid reimbursement fee schedules.ParticipantsFifty U.S. states utilizing fee-for-service reimbursement.Main Outcome Measure(s)Reimbursement Rates for D8020 (Phase I: Limited Orthodontia, Transitional Dentition) and D8080 (Phase II: Comprehensive Orthodontia, Adolescent Dentition), CPT 42210 (Palatoplasty for Cleft Palate with Bone Graft), Pediatric Population of Medicaid and Children's Health Insurance Program.ResultsD8080 reimbursement was negatively correlated with pediatric Medicaid enrollment (r = -0.375, p = 0.014). Multivariate linear regression predicted D8080 reimbursement, explaining 46.9% of variance (adjusted R[2] = 0.41). Higher reimbursement was associated with higher cost of living (β = 0.39, p = 0.007), poverty (β = 0.51, p < 0.001), and Medicaid expansion (β = 0.27, p = 0.041), but lower in states with greater pediatric enrollment (β = -0.53, p < 0.001).ConclusionsMedicaid provider reimbursement for comprehensive orthodontic treatment is independently associated with state socioeconomic characteristics. Reimbursement decreased with higher enrollment. This trend may further limit provider availability for low-income families with existing barriers in access to care. These findings suggest that Medicaid reimbursement may not adequately scale with pediatric beneficiary demand, potentially limiting access to multidisciplinary treatment.

ObjectiveTo explore the utility of velopharyngeal MRI in contributing additional diagnostic information for patients with velopharyngeal insufficiency (VPI) of unknown etiology.DesignRetrospective cohort study.SettingTertiary children's hospital.ParticipantsChildren with clinically significant VPI without a confirmed etiology.InterventionsStandardized perceptual speech assessment with nasometry, non-sedated MRI, and multidisciplinary review for treatment planning.Main Outcome MeasuresMRI-informed etiologic classification, anatomic and functional contributors to VPI, and management recommendations.ResultsAmong 89 children, six (6.7%) presented with clinically significant VPI of unknown etiology on routine examination. MRI identified occult submucous cleft palate or atypical levator veli palatini morphology in five (83.3%) and adenoid-supported VP closure in three (50%). Involution was expected to unmask increased pharyngeal depth in two (33.3%). MRI supported patient-specific recommendations for speech therapy, surgical interventions, and longitudinal monitoring.ConclusionsMRI provided clinically meaningful diagnostic information beyond routine examination and informed management decisions for children with VPI.

ObjectiveTo evaluate mandibular condylar trabecular bone structure in individuals with cleft lip and palate (CLP) using cone-beam computed tomography (CBCT)-based fractal analysis.DesignRetrospective imaging study.SettingDepartmental dentomaxillofacial radiology archive.Patients, ParticipantsCBCT images of 33 individuals with CLP (11 right-sided unilateral, 16 left-sided unilateral, and 6 bilateral clefts) and 38 individuals without CLP with a comparable age distribution were analyzed.InterventionsNot applicable.Main Outcome Measure(s)Fractal dimension (FD) values of the right and left mandibular condyles measured on standardized coronal, sagittal, and axial CBCT sections. Intra- and interobserver agreement were assessed with intraclass correlation coefficients.ResultsIntra- and interobserver agreement was excellent (ICC > 0.90). FD values tended to be lower in individuals with CLP than in individuals without CLP. After Benjamini-Hochberg false discovery rate correction for multiple comparisons, only the between-group difference in the left sagittal plane remained statistically significant (FDR-adjusted p = .018). No significant group-by-side interaction was observed in the coronal, sagittal, or axial planes (all FDR-adjusted p > .05). In individuals with unilateral CLP, no significant ipsilateral-contralateral differences in condylar FD were observed.ConclusionsIndividuals with CLP tended to show lower mandibular condylar FD values than individuals without CLP; however, the between-group difference did not differ significantly between the right and left sides. These findings suggest that CLP may be associated with radiographically detectable differences in condylar trabecular bone complexity. Larger longitudinal studies are needed to clarify the clinical and functional relevance of these findings.

Cleft lip deformity is the most common birth defect, characterized by failure of the union of the medial nasal process and maxillary prominence. A variable range of cleft lips could be unilateral or bilateral, complete or incomplete, cleft lip with or without cleft palate. Diagnosis of a cleft lip is typically made through clinical examinations. Surgical repair is the ultimate management of cleft lips, which restores their normal appearance. Repairing a cleft lip could be associated with certain complications, including infection, dehiscence, notching, and post-op hypertrophic scarring. Nevertheless, infection can occur after cleft lip repair surgery, but infection with Serratia marcescens is typically uncommon.

ObjectiveTo compare the temporomandibular joint (TMJ) health, occlusal load distribution, masticatory efficiency and masticatory muscle function in patients with unilateral cleft lip and palate (UCLP) against age- and gender-matched noncleft controls, using a multimodal assessment approach.DesignA cross-sectional comparative study.SettingsAll measurements were performed by 2 calibrated examiners.PatientsIn total, 19 UCLP patients (Group 1) and 19 noncleft controls (Group 2).Main Outcome MeasureOcclusal load distribution was evaluated using computerised occlusal analysis (T-Scan). Surface electromyography (sEMG) of the anterior temporalis and masseter muscles was recorded at rest, during chewing and at maximum voluntary clenching (MVC). Masticatory efficiency was assessed using colorimetric analysis, and TMJ function was evaluated using joint vibration analysis (JVA).ResultsOcclusal timing parameters were comparable between groups. During maximum bite force (MBF), Group 1 demonstrated significantly lower MBF on the cleft side (38.64 ± 7.00%) than Group 2 (51.48 ± 4.63%). At MVC, normalised sEMG activity was significantly higher bilaterally in Group 1 compared with controls for both muscles. Masticatory efficiency was significantly reduced in Group 1 (optical density 0.42 ± 0.15 vs 0.76 ± 0.15). JVA showed significantly elevated noncleft-side total integral in Group 1 versus Group 2, and integral <300 Hz on the noncleft side, while the significantly elevated integral >300 Hz on the noncleft side also persisted.ConclusionUCLP patients exhibit significant occlusal force asymmetry, reduced masticatory efficiency and a task-dependent pattern of masticatory muscle recruitment. TMJ vibrational alterations were predominantly of low frequency, suggestive of structurally forced load redistribution and neuromuscular compensation.

ObjectiveTo identify susceptibility loci for nonsyndromic cleft lip and/or palate with cleft alveolus involvement and to elucidate subtype-specific regulatory mechanisms in a Chinese population.DesignSubtype-stratified case-control targeted association analysis.SettingTertiary medical center for orofacial cleft treatment in western China.Patients, ParticipantsA total of 3009 unrelated Chinese individuals from two previously generated Genome-wide association study datasets, comprising 445 cases with cleft lip extending through the alveolus without palatal involvement (CLCA), 309 cases with cleft lip and palate extending through the alveolus (CLPCA), and 754 combined CL/P with cleft alveolus (CL/PCA) cases, along with unaffected controls.InterventionsNot applicable.Main Outcome Measure(s)Single nucleotide polymorphisms associations with CLCA, CLPCA, and combined CL/PCA phenotypes at Bonferroni-corrected significance (P < 3.65 × 10[-6]), with functional annotation integrating ENCODE chromatin states, Hi-C interactions, and GTEx eQTL data.ResultsThree SNPs (rs10863790, rs2064163, rs4880224) reached study-wide significance in the combined CL/PCA and CLCA subgroups but not in CLPCA. rs10863790 showed the highest population attributable risk in CLCA (29.63%). All three variants overlap NHEK-active enhancers and regulate craniofacial development genes (IRF6, UTP25, TRAF3IP3, BNIP3, JAKMIP3, PPP2R2D) through chromatin looping, pluripotency factor binding, and FOX family transcription factor recruitment.ConclusionsThese findings reveal pronounced genetic heterogeneity between CLCA and CLPCA subtypes, underscoring the necessity of subtype-stratified approaches for precision medicine in orofacial cleft management.

ObjectiveTo compare microtia-derived chondrocytes (MCs) with costal cartilage-derived chondrocytes (CCs) and determine whether costal cartilage harvest location influences chondrocyte proliferative and chondrogenic potential for auricular cartilage tissue engineering.DesignExperimental laboratory study using native tissue analysis and in vitro cell culture.SettingSingle-center laboratory study.PatientsNative auricular and costal cartilage samples were collected from four paired pediatric patients undergoing autologous microtia reconstruction.Interventions: MCs and costal chondrocytes isolated from proximal/osteochondral (PCs), distal/sternal (DCs), and medial costal (CCs) regions, were expanded in normal cell culture and 3D pellet culture.Main Outcome MeasuresType II collagen, glycosaminoglycans, total collagen, proteoglycans, and Ki67 were evaluated via immunohistochemistry (IHC). Cell proliferation was measured using cell counting kit-8 (CCK8), and gene expression of chondrogenic, osteogenic, and proliferative markers was analyzed in monolayer and 3D pellet cultures.ResultsNative microtia and costal cartilage demonstrated similar type II collagen and proteoglycan content across regions. Native microtia tissue showed greater Ki67 staining than medial and proximal costal cartilage (p < 0.05 and p < 0.01, respectively), whereas glycosaminoglycan staining was greater in costal cartilage (p < 0.05). In normal cell culture, all cell types demonstrated similar proliferative activity. In 3D pellet culture, PCs had higher Ki67 staining than DCs and MCs (p < 0.01). In CC pellet cultures, Ki67 and COL2A1 expression was increased.ConclusionCostal CCs demonstrated distinct chondrogenic characteristics based on harvest site. These findings support a more targeted utilization of costal CCs for auricular cartilage tissue engineering.

People with facial differences (FD) experience unique manifestations of stigma, possibly contributing to the high variability in whether they identify as disabled. Three levels of identity specificity can describe how much people with FDs identify with: having a diagnosis, having an FD identity, and having a disability. Critical consciousness, which refers to awareness of and action against injustice, may help mitigate stigma and impact identity.ObjectiveThis study examined associations between demographics, identities, critical consciousness, and life satisfaction.Participants & DesignAdults with FDs were recruited through social media and FD organizations to complete a cross-sectional online questionnaire.Main Outcome & MeasuresThree open-ended questions, Disability Personal Identity Scale, Critical Consciousness Scale, and Satisfaction with Life Scale were completed. Qualitative content analysis described how they learned about the term FD and thoughts about identifying with having a disability. Multiple regressions described relationships between each identity and critical consciousness as well as identities with life satisfaction.ResultsParticipants (N = 60) were mostly white (81%) women (80%) with a college education (88%). All participants self-categorized as having an FD and 59% self-categorized as disabled. Themes of disability identification depended on: health and medical treatment, comparisons to "normal" life, impacts on social/public interactions, and the less frequent societal attitudes. Identifying with their diagnosis and higher education were associated with higher critical consciousness. Study variables were not associated with life satisfaction.ConclusionsGreater awareness of identities and utilizing the term 'FD' in healthcare settings may help to connect more people to FD community.

ObjectiveTo evaluate the face, content and construct validity of a low-cost unilateral cleft lip trainer through a multicentre trainee-trainer workshop.DesignProspective multicentre validation study.SettingThree accredited plastic surgery training centres.Patients/ParticipantsSixty-two plastic surgery residents participated in standardised simulation workshops.InterventionsParticipants underwent lectures, video demonstrations and supervised practice of unilateral cleft lip repair using the low-cost simulator. Pre- and post-workshop questionnaires assessed self-reported knowledge and procedural understanding. Participants rated the model for face and content validity using a 5-point Likert scale. Faculty assessed simulator-based performance using a 10-point checklist.Main Outcome Measure(s)Face validity, content validity, construct validity, pre- and post-workshop knowledge scores, repair time, suture-line integrity and lip-height symmetry.ResultsKnowledge scores increased from 55% to 87%, with significant improvement in chronological recall of repair steps (P < .001). Face validity exceeded 90% across anatomical and procedural domains, with teaching usefulness rated highest (98%). Content validity was strongly supported, with 99% of participants recommending curriculum integration. Construct validity demonstrated significant discrimination between first-, second- and third-year residents, with mean performance scores of 7.1, 8.4 and 9.6, respectively (P < .001). Repair times decreased with increasing training level, while senior trainees achieved superior repair quality.ConclusionsThe low-cost unilateral cleft lip trainer demonstrated favourable face, content and construct validity within a structured workshop setting. Its affordability and reproducibility support its use as an adjunct for procedural rehearsal and assessment in plastic surgery training.

ObjectiveTo determine the demographic distribution, anatomical patterns and associated complications of orofacial clefts (OFCs) at a major tertiary referral centre in Ghana.DesignA retrospective cross-sectional review of patient records.SettingThe Cleft Centre of the Oral and Maxillofacial Surgery Department, a tertiary Institution in West Africa.Patients/participantsRecords of all patients managed for OFCs between January 2017 and December 2019. After exclusions for incomplete data, 189 patients were included.InterventionsNot applicable (observational study).Main outcome measure(s)Primary outcomes were frequencies and percentages of cleft types (cleft lip with or without cleft alveolus [CL ± A], cleft lip and palate [CLP], cleft palate only [CPO]), laterality, completeness and associated complications/anomalies.ResultsOf 189 patients, 101 (53.4%) were male and 88 (46.6%) were female. The median age at presentation was 4 months. CL ± A was most common (38.6%, n = 73), followed by CLP (34.9%, n = 66) and CPO (26.5%, n = 50). Unilateral clefts (79.5%) and left-sided defects (60.3%) predominated. Feeding difficulties were the most frequent complication (59.1% of 93 patients with complications). Associated anomalies were present in 36 patients (19.0%).ConclusionsOFCs present a significant burden at this tertiary centre. Determining patterns of cleft phenotypes informs surgical timing and type, highlighting the need for policies to allocate resources for multidisciplinary care.