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      The Impact of the COVID-19 Pandemic on Cleft Care

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          Abstract

          Background:

          The COVID-19 pandemic had multiple effects on the provision of health care, including the suspension of elective and nonessential surgeries. The objective of this study was to determine the early effect of the COVID-19 pandemic on the surgical care of patients with cleft lip and/or palate at a high-volume cleft center.

          Methods:

          A retrospective comparative cohort study of patients with cleft lip and/or palate undergoing lip adhesion, cleft lip and nose repair, and palatoplasty before and during the pandemic was conducted. There were 50 patients in the prepandemic cohort and 53 in the pandemic cohort.

          Results:

          Mean age at lip adhesion was 3.1 ± 1.1 months prepandemic (n = 8) and 3.5 ± 2.5 months in the pandemic cohort (n = 8) ( P = 0.75). One lip adhesion was delayed by 1.6 months. Mean age at cleft lip and nose repair was 6.6 ± 1.9 months prepandemic (n = 23) and 8.0 ± 2.1 months in the pandemic cohort (n = 23) ( P = 0.03). Six pandemic cleft lip and nose repairs were delayed; the mean delay was 2.6 ± 1.8 months. The mean age at palatoplasty was 13.9 ± 2.2 months prepandemic (n = 26) and 14.1 ± 2.9 months in the pandemic cohort (n = 26) ( P = 0.79). Seven pandemic palatoplasties were delayed; the mean delay was 3.3 ± 1.4 months.

          Conclusions:

          The COVID-19 pandemic caused delays at each stage of repair for cleft lip and/or palate-related procedures; however, only cleft lip and nose repair were significantly affected. This study emphasizes the importance of remaining vigilant regarding the care of this vulnerable population during this challenging time.

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          Most cited references24

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          Elective surgery cancellations due to the COVID ‐19 pandemic: global predictive modelling to inform surgical recovery plans

          Background The COVID‐19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID‐19. Methods A global expert‐response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian beta‐regression model was used to estimate 12‐week cancellation rates for 190 countries. Elective surgical case‐mix data, stratified by specialty and indication (cancer versus benign surgery), was determined. This case‐mix was applied to country‐level surgical volumes. The 12‐week cancellation rates were then applied to these figures to calculate total cancelled operations. Results The best estimate was that 28,404,603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID‐19 (2,367,050 operations per week). Most would be operations for benign disease (90.2%, 25,638,922/28,404,603). The overall 12‐week cancellation rate would be 72.3%. Globally, 81.7% (25,638,921/31,378,062) of benign surgery, 37.7% (2,324,069/6,162,311) of cancer surgery, and 25.4% (441,611/1,735,483) of elective Caesarean sections would be cancelled or postponed. If countries increase their normal surgical volume by 20% post‐pandemic, it would take a median 45 weeks to clear the backlog of operations resulting from COVID‐19 disruption. Conclusions A very large number of operations will be cancelled or postponed due to disruption caused by COVID‐19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to safely restore surgical activity. This article is protected by copyright. All rights reserved.
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            Cleft Lip and Palate

            Orofacial clefts are common congenital malformations with genetic and environmental risk factors. In the perinatal period, feeding and nutrition can be a challenge and the need for specialized feeders is common. Lip taping and nasoalveolar molding are early interventions that can be used to preoperatively modify cleft defects to enhance surgical outcomes. Multiple techniques are available for repair of orofacial clefts and choice of technique depends on cleft extent and surgeon preference. After definitive repair, children remain at increased risk for middle ear disease, velopharyngeal dysfunction, and malocclusion and require ongoing follow-up with a multidisciplinary team.
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              Coping strategies and social support in the family impact of cleft lip and palate and parents' adjustment and psychological distress.

              To examine the role of parents' coping strategies and social support in the family impact of cleft lip and palate (CLP) and levels of adjustment and psychological distress and to investigate whether a child's age, type of cleft, or other reported medical problems influenced such outcomes. A cross-sectional study. One hundred three parents of children or young adults with CLP recruited from families attending a multidisciplinary cleft lip and palate clinic. Family impact, psychological distress, and positive adjustment were assessed using validated psychological questionnaires. Findings indicated that while there were many impacts of a child's CLP, negative outcomes (family impact, psychological distress) were not high. In contrast, parents reported high levels of positive adjustment or stress-related growth as a result of their child's condition. Participants also reported high levels of social support and relied more on the use of approach rather than avoidance-oriented coping strategies. Having more support from friends and family was associated with less negative family impact, lower psychological distress, and better adjustment. Greater use of approach coping was associated with more positive adjustment; whereas, avoidant coping was associated with a greater family impact and more psychological distress. Having a younger child and/or a child with medical problems in addition to CLP was associated with a greater impact on the family. How parents cope with their child's condition and the levels of support received may have implications for caregivers, the family unit, and the delivery of more family-oriented CLP services.
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                Author and article information

                Journal
                Plast Reconstr Surg Glob Open
                Plast Reconstr Surg Glob Open
                GOX
                Plastic and Reconstructive Surgery Global Open
                Lippincott Williams & Wilkins (Hagerstown, MD )
                2169-7574
                April 2021
                28 April 2021
                : 9
                : 4
                : e3587
                Affiliations
                From the [* ]Children’s Hospital/ of Pittsburgh of UPMC, Pittsburgh, Pa.
                []University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, Pa.
                Author notes
                Jesse A. Goldstein, MD, University of Pittsburgh Department of Plastic Surgery, One Children’s Hospital Drive, 4401 Penn Avenue, Floor 3, #3533, Pittsburgh, PA 15224, E-mail: jesse.goldstein@ 123456chp.edu
                Article
                00044
                10.1097/GOX.0000000000003587
                8081485
                33936921
                4262b6a0-ea37-4adc-94f9-ea773c7bd494
                Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 14 January 2021
                : 25 March 2021
                Categories
                Pediatric/Craniofacial
                Original Article
                Custom metadata
                TRUE

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