{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:50:30Z","timestamp":1789055430991,"version":"build-2803163510"},"reference-count":42,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2022,6,20]],"date-time":"2022-06-20T00:00:00Z","timestamp":1655683200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2022,6,20]],"date-time":"2022-06-20T00:00:00Z","timestamp":1655683200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>\n                      <jats:italic toggle=\"yes\">Introduction<\/jats:italic>\n                    <\/jats:title>\n                    <jats:p>While bilateral cleft lip and palate (BCLP) constitutes a clinical challenge for the whole cleft team, the ideal surgical protocol remains obscure. This study presents the long-term burden of care in terms of secondary surgeries, defined as fistula repair and speech-correcting surgeries (SCS), in a single center. Outcomes of two surgical protocols utilized over the years were also compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>\n                      <jats:italic toggle=\"yes\">Material and Methods<\/jats:italic>\n                    <\/jats:title>\n                    <jats:p>A retrospective single-center analysis of 81 non-syndromic children with complete BCLP born between 1990 and 2010. Two surgical protocols comprising single-stage and two-stage (delayed hard palate closure) procedures were compared. Outcome was analyzed at the time of alveolar bone grafting (ABG) and post-ABG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>\n                      <jats:italic toggle=\"yes\">Results<\/jats:italic>\n                    <\/jats:title>\n                    <jats:p>Altogether 54 children (66.7%) had underwent secondary surgery by the time of bilateral ABG. At this point, 38.3% (n = 31) of patients had received SCS and 49.4% (n\u2009=\u200940) had undergone fistula repair. The corresponding incidences at the end of follow-up were 46.9% (n\u2009=\u200938) and 53.1% (n\u2009=\u200943). No significant difference emerged in SCS incidence between the 2 protocols; however, prior to ABG the single-stage protocol had a significantly lower need for fistula repair. Regarding the location of fistulas, some differences were observed, with the single-stage procedure more associated with anterior fistulas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>\n                      <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>\n                    <\/jats:title>\n                    <jats:p>BCLP has a high surgical burden of care in terms of secondary surgeries, defined as SCS and fistula repair. In our experience, the single-stage protocol, particularly the two-flap technique, offers better results in the management of BCLP than the two-stage approach with a short delay in hard palate closure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656221102816","type":"journal-article","created":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T01:12:06Z","timestamp":1655773926000},"page":"1241-1249","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["Long-term Follow-up of Bilateral Cleft Lip and Palate: Incidence of Speech-Correcting Surgeries and Fistula Formation"],"prefix":"10.1177","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9527-4180","authenticated-orcid":false,"given":"Charlotta","family":"Gustafsson","sequence":"first","affiliation":[{"name":"Cleft and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8064-3484","authenticated-orcid":false,"given":"Arja","family":"Heli\u00f6vaara","sequence":"additional","affiliation":[{"name":"Cleft and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorma","family":"Rautio","sequence":"additional","affiliation":[{"name":"Cleft and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junnu","family":"Leikola","sequence":"additional","affiliation":[{"name":"Cleft and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,6,20]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1071-0949(06)80034-X"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31821e6f92"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001665-200409000-00020"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000548"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211055641"},{"key":"e_1_3_2_7_2","doi-asserted-by":"crossref","unstructured":"Millard DRJr. Closure of bilateral cleft lip and elongation of columella by two operations in infancy. Plast Reconstr Surg. 1971;47(4):324\u2013331.","DOI":"10.1097\/00006534-197104000-00004"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-194609000-00005"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-198801000-00006"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3109\/02844319409015981"},{"key":"e_1_3_2_11_2","first-page":"205","article-title":"Die uranoplastik mittelst ablosung des mucoes-periostalen gaumenuberzuges","volume":"2","author":"Von Langenbeck B","year":"1861","unstructured":"Von Langenbeck B. Die uranoplastik mittelst ablosung des mucoes-periostalen gaumenuberzuges. Arch Klin Chir. 1861;2:205\u2013287.","journal-title":"Arch Klin Chir"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/2000656X.2016.1254646"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665618760889"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198678060-00002"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1597\/06-204.1"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569_1998_035_0095_vfincp_2.3.co_2"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0b013e318192801b"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1597\/14-127"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665619829388"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665620923925"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-021-02783-0"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1597\/09-069"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1597\/16-179"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1597\/11-190"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2019.01.053"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211026861"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000007514"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2013.12.010"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665617735102"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2013.12.005"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199608000-00005"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000258518.81309.70"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.5999\/aps.2017.44.3.202"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1080\/2000656X.2016.1254647"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1597\/09-120"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1080\/2000656X.2016.1194280"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1080\/2000656X.2016.1254645"},{"issue":"4","key":"e_1_3_2_38_2","first-page":"1285","article-title":"Early hard palate closure using a vomer flap in unilateral cleft lip and palate: effects on cleft width","volume":"18","author":"de Jong JP","year":"2014","unstructured":"de Jong JP, Breugem CC. Early hard palate closure using a vomer flap in unilateral cleft lip and palate: effects on cleft width. Clin Oral Investig. 2014;18(4):1285\u20131290.","journal-title":"Clin Oral Investig"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2015.03.033"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000004769"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-013-1084-2"},{"key":"e_1_3_2_42_2","doi-asserted-by":"crossref","unstructured":"Heli\u00f6vaara A Leikola J Hukki J. Craniofacial cephalometric morphology and later need for orthognathic surgery in 6-year-old children with bilateral cleft lip and palate. Cleft Palate Craniofac J. 2013;50(2):e35-40.","DOI":"10.1597\/11-262.1"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1597\/08-249_1"}],"container-title":["The Cleft Palate Craniofacial Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656221102816","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10556656221102816","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656221102816","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T16:22:04Z","timestamp":1777393324000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10556656221102816"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,20]]},"references-count":42,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1177\/10556656221102816"],"URL":"https:\/\/doi.org\/10.1177\/10556656221102816","relation":{},"ISSN":["1055-6656","1545-1569"],"issn-type":[{"value":"1055-6656","type":"print"},{"value":"1545-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,20]]}}}