title: Assessment of morbidity following insertion of fixed preoperative orthopedic appliance in infants with complete cleft lip and palate.
abstract: OBJECTIVE
  To examine physiologic and behavioral indicators of pain within the first 24 hours following insertion of the fixed presurgical orthopedic appliance (FPOA) under general anesthesia in infants with unilateral and bilateral complete cleft lip and palate.
  
  
  METHODS
  The study sample included 109 infants who had either a dentomaxillary appliance (DMA) or an elastomeric chain premaxillary retraction (ECPR) appliance. Vital signs and FLACC (Face, Legs, Activity, Cry, Consolability) scores were used to measure the outcomes.
  
  
  RESULTS
  There was an initial postoperative increase in the median heart rate. Heart rate returned to the median baseline level by 8 hours. The median systolic blood pressure increased postoperatively and remained elevated throughout the time of evaluation. The median respiratory rate remained below that at baseline throughout the study period. The highest mean change in FLACC measurements was observed approximately 2 hours postoperatively. By 3 hours postoperatively, the scores decreased.
  
  
  CONCLUSIONS
  Although there was a large individual variability, the FLACC scores became reduced after 3 hours following surgical insertion of the DMA and the ECPR appliance.
authors.affiliation: At the time of study - Cleft and Craniofacial Orthodontic Fellow at Boston Children's Hospital, Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bronkhorst
authors.affiliation: Associate Professor, Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, IA, USA. Electronic address: Veerasathpurush-Allareddy@uiowa.edu.
authors.forename: V
authors.initials: V
authors.lastname: Allareddy
authors.affiliation: Instructor, Department of Neurology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Allred
authors.affiliation: Instructor, Boston Children's Hospital, Boston, MA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Ross
authors.affiliation: Dentist-in-Chief, Emeritus and Director of Cleft and Craniofacial Orthodontics Program, Boston Children's Hospital, Boston, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Shusterman
mesh_terms: D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D017267:Dental Prosthesis Design; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009967:Orthodontic Appliances; D012189:Retrospective Studies; D016896:Treatment Outcome; D055986:Vital Signs