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doi: 10.1597/05-184.1
The Cleft Palate-Craniofacial Journal: Vol. 44, No. 2, pp. 182–193.

A Randomized Control Trial Investigating the Effect of Presurgical Orthopedics on Feeding in Infants With Cleft Lip and/or Palate
A.G. Masarei, B.App.Sc., Ph.D., M.R.C.S.L.T.
A. Wade, B.Sc., Ph.D., C.Stat., I.L.T.M.
M. Mars, D.Sc.(Hon.), Ph.D., B.D.S., F.D.S., D.Orth., F.R.C.S.L.T.
B.C. Sommerlad, M.B., F.R.C.S.(Eng.)
D. Sell, Ph.D., M.R.C.S.L.T., F.R.C.S.L.T.

Dr. Masarei was previously Specialist Speech and Language Therapist, Great Ormond Street Hospital for Children NHS Trust, London, U.K.; Dr. Wade is Senior Lecturer in Medical Statistics, Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, U.K.; Dr. Mars is Lead Orthodontist, North Thames Regional Cleft Centre, Great Ormond Street Hospital for Children NHS Trust, London, U.K.; Dr. Sommerlad is Lead Consultant Plastic Surgeon, North Thames Regional Cleft Centre, Great Ormond Street Hospital for Children NHS Trust, London, U.K.; Dr. Sell is Lead Speech and Language Therapist, North Thames Regional Cleft Centre, Head of Speech and Language Therapy Department, Great Ormond Street Hospital for Children NHS Trust, London, U.K

Submitted November 2005; Accepted July 2006.

Objective: To investigate the controversial assertion that presurgical orthopedics (PSO) facilitate feeding in infants with cleft lip and palate.

Design: Randomized control trial of 34 infants with nonsyndromic complete unilateral cleft lip and palate and 16 with cleft of the soft and at least two thirds of the hard palate. Allocation to receive presurgical orthopedics or not used minimization for parity and gender. Other aspects of care were standardized.

Setting: The North Thames Regional Cleft Centre.

Main Outcome Measures: Measurements were made at 3 months of age (presurgery) and at 12 months of age (postsurgery). Primary outcomes were anthropometry and oral motor skills. Objective measures of sucking also were collected at 3 months using the Great Ormond Street Measure of Infant Feeding. Twenty-one infants also had videofluoroscopic assessment.

Results: At 1 year, all infants had normal oral motor skills and no clear pattern of anthropometric differences emerged. For both cleft groups, infants randomized to presurgical orthopedics were, on average, shorter. The presurgical orthopedics infants were, on average, lighter in the unilateral cleft and lip palate group, but heavier in the isolated cleft palate group. Infants with complete unilateral cleft and lip palate randomized to presurgical orthopedics had lower average body mass index (mean difference PSO-No PSO: −0.45 (95% confidence interval [−1.78, 0.88]), this trend was reversed among infants with isolated cleft palates (mean difference PSO-No PSO: 1.98 [−0.95, 4.91]). None of the differences were statistically significant at either age.

Conclusions: Presurgical orthopedics did not improve feeding efficiency or general body growth within the first year in either group of infants.

KEY WORDS:cleft lip and/or palate, feeding, infants, presurgical orthopedics

© 2007, The American Cleft Palate-Craniofacial Association