The Cleft PalateâCraniofacial Journal is an international, interdisciplinary journal reporting on clinical and research activities in cleft lip/palate and other craniofacial anomalies, together with research in related laboratory sciences. It is the official publication of the American Cleft PalateâCraniofacial Association (ACPA). For more information, visit www.acpa-cpf.org.

The Cleft Palate–Craniofacial Journal

	In today’s connected world, surgeons and anesthesiologists have the ability to use widely available technology, such as GoPro cameras, Skype, WebEx, and Google Chat to remotely care for patients in distant countries. 

 has the ability to make clinics more efficient and reliable. A 

 examines the possibilities these tools create, and how they can assist in the diagnosing of patients in remote areas.

, researchers asked whether remote videos could be used to reliably diagnose a cleft lip or palate. Due to lack of funding in developing countries, citizens’ access to medication, medical devices, and surgeons is limited. 

, a nonprofit that provides reconstructive surgery for patients with congenital conditions, the researchers reviewed digital video evaluations of patients with oral clefts.

	At a hospital in rural Ecuador, 27 patients were evaluated for oral clefts. Researchers compared in-person and remote video assessments made by two separate craniofacial surgeons. The video was taken with an iPhone, without special lighting or camera enhancements. The surgeons who made in-person and remote evaluations nearly always agreed on how patients with a cleft lip or cleft palate should be treated. Those who assessed patients with an alveolar cleft agreed only about half of the time, likely because of the challenges of performing an oral exam via video.

Related reading: Researchers find no link between academic tests results and early oral cleft surgery

	Ultimately, more than 80 percent of the patients examined underwent oral cleft surgery. The researchers speculated that using remote video in diagnosing oral clefts among Ecuadorians could have an economic impact of roughly $7.9 million over 20 years. Worldwide, nearly 5 billion people do not have access to essential surgical care, and almost a third of all deaths and disabilities result from surgically treatable conditions.

	“We are well positioned to invent new ways to work with  technology to improve surgical outcomes,” said researcher Christopher Hughes. Among potential improvements, he listed fewer redundancies, less lost time, and more patients seen in the clinic, as well as speedier and more affordable care for patients. “If we can scale our model,” he said, “then we can change the way that children with cleft and craniofacial disorders are treated in their own country.”

	The researchers concluded that digital technology could be used to reliably diagnose cleft lips and palates, and reduce the cost to patients with oral clefts. They argue that, most importantly, digital evaluations let surgeons provide high-quality care even in remote, rural locations.

	Full text of the article “Remote Digital Preoperative Assessments for Cleft Lip and Palate May Improve Clinical and Economic Impact in Global Plastic Surgery,” The Cleft Palate–Craniofacial Journal, Vol. 54, No. 5, 2017, is now available at 

http://www.cpcjournal.org/doi/full/10.1597/15-305

Articles

The study determined that readily available technology can make clinics more efficient and reliable while providing remote care.

Study finds technology allows remote diagnosis of cleft palate patients

	Researchers have often suspected that early exposure to surgery and anesthesia is linked to cognitive impairment later in life. It has been thought that due to the timing of oral cleft surgeries, which are typically performed at an extremely young age, children with an oral cleft often experience cognitive dysfunction and academic underachievement. However, a recent study suggests that poor results on academic exams of children born with oral clefts are not related to early exposure to general anesthesia.

 recently published a study in the current issue of 

 examining this theory. Because the definite age of maximum vulnerability to general anesthesia is unknown and widely debated, it is unclear whether academic achievement among adolescents is affected by undergoing oral cleft surgery at an early age. The researchers suspected that any potential neurotoxic effect caused by extensive exposure to anesthesia at an early age would show up in poor test results in ninth-grade final exams.

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	The researchers based their study on 558 adolescents from a nationwide Danish registry who had undergone surgery for cleft lip, cleft palate, or both while young. The researchers found that 509 of the oral cleft children had been exposed to anesthesia and had undergone at least one cleft operation. They compared the level of academic achievement of the students in the registry against that of a control group.

	Although children with a cleft lip, cleft palate, or both are exposed to anesthesia early and often, the researchers found no significant difference for teens with a cleft lip or with both a cleft lip and a cleft palate when they compared their ninth-grade test scores with those of teenagers in the control group. However, students with only a cleft palate did have lower test scores than those of students in the control group. Children with a cleft palate only are generally older when surgery is performed than children with other types of clefts.

	“This finding is remarkable,” says Dr. Nicola Clausen of the research group. “Studies like the present one cannot definitely prove that anesthetic drugs do not harm developing brains. However, it can put the potential threats into perspective because other factors more importantly impact these children’s neurocognitive development.”

	The researchers concluded that oral cleft type, rather than the timing of anesthesia or number of cleft operations, is linked to poorer academic performance. Although the researchers saw no evidence in their study to suggest surgeons need to change their anesthetic methods, a neurotoxic effect due to anesthetics cannot be completely dismissed.

	The full text of the article “Oral Clefts and Academic Performance in Adolescence: The Impact of Anesthesia-Related Neurotoxicity, Timing of Surgery, and Type of Oral Clefts,” The Cleft Palate–Craniofacial Journal, Vol. 54, No. 4, 2017, is now available at 

http://www.cpcjournal.org/doi/full/10.1597/15-185

A new study suggests that poor results on academic exams of children born with oral clefts are not related to early exposure to general anesthesia.