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Adopted children with cleft lip and/or palate: a unique and growing population.
Plast Reconstr Surg. 2014 Aug; 134(2):283e-293e.PR

Abstract

BACKGROUND

Standard clinical pathways are well established for children with cleft lip and/or palate. Treatment of internationally adopted children differs because of the late age at presentation, a newly evolving child-family relationship, and variable extent and quality of previous treatment.

METHODS

The authors characterized the presentation and treatment patterns of all internationally adopted children with clefts at their institution between 1997 and 2011.

RESULTS

Among 1841 children with clefts, 216 (12 percent) were internationally adopted: 78 percent had cleft lip and palate, 18 percent had cleft lip, and 4 percent had cleft palate. Patients originated predominantly from China (80 percent). Median age at presentation was 31 months, and the rate of new presentations increased five-fold during the study period. Eighty-two percent presented with prior cheiloplasty, and revision was recommended for 64 percent of them. Thirty-seven percent of patients had prior palatoplasty, of which 34 percent presented with a palatal fistula. Secondary palatoplasty/pharyngoplasty was performed more frequently for patients who underwent primary palatoplasty before adoption than after adoption (95 percent CI, 0.20 to 0.77). Overall, adoptees required secondary surgery more often than nonadoptees (49 percent versus 28 percent) regardless of where their primary surgery was performed. Changes in adoptee growth indices suggested improvements in systemic health following adoption.

CONCLUSIONS

Internationally adopted children with clefts have unique treatment challenges. Children with unrepaired clefts undergo surgery late, and children with prior repairs frequently undergo revision. Compared with nonadoptees, adoptees require more revisions and have a higher fistula rate. Further detailed study is important to optimize care.

Authors+Show Affiliations

Seattle, Wash.; and Dallas, Texas From the Craniofacial Center, Seattle Children's Hospital; the Division of Plastic Surgery, Department of Surgery, University of Washington; and the Department of Plastic Surgery, University of Texas Southwestern.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

25068349

Citation

Swanson, Jordan W., et al. "Adopted Children With Cleft Lip And/or Palate: a Unique and Growing Population." Plastic and Reconstructive Surgery, vol. 134, no. 2, 2014, pp. 283e-293e.
Swanson JW, Smartt JM, Saltzman BS, et al. Adopted children with cleft lip and/or palate: a unique and growing population. Plast Reconstr Surg. 2014;134(2):283e-293e.
Swanson, J. W., Smartt, J. M., Saltzman, B. S., Birgfeld, C. B., Hopper, R. A., Gruss, J. S., & Tse, R. (2014). Adopted children with cleft lip and/or palate: a unique and growing population. Plastic and Reconstructive Surgery, 134(2), 283e-293e. https://doi.org/10.1097/PRS.0000000000000391
Swanson JW, et al. Adopted Children With Cleft Lip And/or Palate: a Unique and Growing Population. Plast Reconstr Surg. 2014;134(2):283e-293e. PubMed PMID: 25068349.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adopted children with cleft lip and/or palate: a unique and growing population. AU - Swanson,Jordan W, AU - Smartt,James M,Jr AU - Saltzman,Babette S, AU - Birgfeld,Craig B, AU - Hopper,Richard A, AU - Gruss,Joseph S, AU - Tse,Raymond, PY - 2014/7/29/entrez PY - 2014/7/30/pubmed PY - 2014/10/17/medline SP - 283e EP - 293e JF - Plastic and reconstructive surgery JO - Plast. Reconstr. Surg. VL - 134 IS - 2 N2 - BACKGROUND: Standard clinical pathways are well established for children with cleft lip and/or palate. Treatment of internationally adopted children differs because of the late age at presentation, a newly evolving child-family relationship, and variable extent and quality of previous treatment. METHODS: The authors characterized the presentation and treatment patterns of all internationally adopted children with clefts at their institution between 1997 and 2011. RESULTS: Among 1841 children with clefts, 216 (12 percent) were internationally adopted: 78 percent had cleft lip and palate, 18 percent had cleft lip, and 4 percent had cleft palate. Patients originated predominantly from China (80 percent). Median age at presentation was 31 months, and the rate of new presentations increased five-fold during the study period. Eighty-two percent presented with prior cheiloplasty, and revision was recommended for 64 percent of them. Thirty-seven percent of patients had prior palatoplasty, of which 34 percent presented with a palatal fistula. Secondary palatoplasty/pharyngoplasty was performed more frequently for patients who underwent primary palatoplasty before adoption than after adoption (95 percent CI, 0.20 to 0.77). Overall, adoptees required secondary surgery more often than nonadoptees (49 percent versus 28 percent) regardless of where their primary surgery was performed. Changes in adoptee growth indices suggested improvements in systemic health following adoption. CONCLUSIONS: Internationally adopted children with clefts have unique treatment challenges. Children with unrepaired clefts undergo surgery late, and children with prior repairs frequently undergo revision. Compared with nonadoptees, adoptees require more revisions and have a higher fistula rate. Further detailed study is important to optimize care. SN - 1529-4242 UR - https://www.unboundmedicine.com/medline/citation/25068349/Adopted_children_with_cleft_lip_and/or_palate:_a_unique_and_growing_population_ L2 - http://Insights.ovid.com/pubmed?pmid=25068349 DB - PRIME DP - Unbound Medicine ER -