Presurgical Orthopedics

In young children with velo-cardio-facial syndrome (VCFS), one of the craniofacial abnormalities is cleft palate. While there are many issues that surround an unrepaired cleft palate, the most prominent issue is whether the child is able to get enough nutrition for growth and development. A child with a cleft palate has swallowing and feeding issues due to the cleft that effect the growth and development of the child. One of the strategies for addressing the feeding issues is using an orthopedic device before the child's cleft surgery.

Masarei et al. designed a study that assessed the efficacy of using a presurgical orthopedic device in children with cleft palate or cleft lip and palate. The researchers found that there was no evidence to support the use of these devices. The research study included 34 children. They all had either a cleft palate or a cleft lip and palate. These children were either fitted with an orthopedic device or they were not fitted with an orthopedic device. The criteria that the researchers used to evaluate the efficacy of the devices was the weight, height and head circumference of the children. They found that there was no statistical difference between the experimental group (with device) and the control group (without device) on these measures. This means that the benefit from the use of an orthopedic device is uncertain and may not help a child with a cleft palate get the nutrition that he/she needs. The authors of the article state that the benefits from being fitted with the orthopedic device do not counterbalance the negative aspects of using the device.

While the researchers found that there was no evidence to support the use of the devices, there were several weaknesses of the study that must be considered. One weakness in particular could call into question the implications of the results. Just over half of the children that were fitted with an orthopedic device wore it all of the time for the duration of the time between when the child was fitted for the device and when the child received the cleft palate surgery.

References

Masarei, A.G., Wade, A., Mars, M., Sommerlad, B.C., & Sell, D. (2007). A randomized control trial
     investigating the effect of presurgical orthopedics on feeding in infants with cleft lip and/or palate. The 
     Cleft Palate-Craniofacial Journal: Official Publication of the American Cleft Palate-Craniofacial 
     Association, 44(2), 182-193. doi: 10.1597/05-184.