{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T02:09:46Z","timestamp":1789524586195,"version":"build-2803163510"},"reference-count":46,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"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":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to introduce a classification scheme and treatment algorithm for Submucous Cleft Palate (SMCP) to improve surgical outcomes and standardize patient management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective review of patients presenting with SMCP was conducted, categorizing them according to the proposed classification scheme based on the extent of the zona pellucida and palatal length. Tailored surgical interventions were implemented for each category.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>CLAPP Hospital, Lahore, Pakistan, from 2015 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients\/Participants<\/jats:title>\n                    <jats:p>\n                      252 patients with SMCP were identified (\n                      <jats:italic toggle=\"yes\">M<\/jats:italic>\n                      <jats:sub>age<\/jats:sub>\n                      \u2009=\u20098.29 years; 52.8% male, 47.2% female). Patients with other cleft variants were excluded.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>The classification scheme categorized patients into three types based on the extent of the zona pellucida and further stratified them by palatal length. Surgical interventions included midline incisions, modified and standard Von Langenbeck techniques, and adjunctive palatal lengthening or pharyngeal flaps for patients with inadequate palatal length.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Speech was assessed pre- and post-operatively using a modified Ann Kummer Speech Evaluation Protocol. Post-operative complications, including fistula formation, were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Significant speech improvement was observed, with 89.9% of patients improving from moderate\/severe hypernasality to mild hypernasality. Patients receiving a pharyngeal flap exhibited a significant improvement in speech (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u2009.001) compared to those who did not. Fistulas were observed in 8.7% of cases, consistent with rates reported in the literature.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The proposed classification scheme and treatment algorithm show promise in providing a practical framework for SMCP management. This framework will help standardize the management of patients with SMCP and improve postoperative outcomes in these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656251341093","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T18:37:30Z","timestamp":1747679850000},"page":"1431-1443","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["CLAPP Classification Scheme and Treatment Algorithm for Submucous Cleft Palate"],"prefix":"10.1177","volume":"63","author":[{"given":"Muhammad","family":"Daiem","sequence":"first","affiliation":[{"name":"CLAPP Hospital, Lahore, Pakistan"},{"name":"Operation Smile Incorporated, Virginia Beach, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farrukh","family":"Aslam Khalid","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, King Edward Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvee","family":"Turk","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Mustehsan","family":"Bashir","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, King Edward Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Azam","sequence":"additional","affiliation":[{"name":"CLAPP Hospital, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3587-7489","authenticated-orcid":false,"given":"Corstiaan","family":"Breugem","sequence":"additional","affiliation":[{"name":"Division of Plastic &amp; Reconstructive Surgery, Amsterdam UMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7995-7256","authenticated-orcid":false,"given":"David","family":"Low","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8156-9922","authenticated-orcid":false,"given":"Renato","family":"da Silva Freitas","sequence":"additional","affiliation":[{"name":"Plastic Surgery Unit, Hospital de Clinicas of Federal University of Parana, Curitiba, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nauman Ahmad","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Services Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3615-3586","authenticated-orcid":false,"given":"Ghulam Qadir","family":"Fayyaz","sequence":"additional","affiliation":[{"name":"CLAPP Hospital, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"issue":"7","key":"e_1_3_4_2_2","first-page":"64","article-title":"Submucous cleft palate","volume":"7","author":"Stewart JM","year":"1971","unstructured":"Stewart JM, Ott ME, Lagace R. 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