Optic Nerve Sheath Diameter Measurement in Cleft Palate Repair
Condition: Cleft Palate
MeSH terms: Cleft Palate
Study type: Observational [Patient Registry]

Summary: 
      The aim of this study is to evaluate the effect of the Boyle-Davis mouth opener, which is
      routinely used in cleft palate surgery, on intracranial pressure by USG-guided optic nerve
      sheath diameter measurement, which is a non-invasive method with proven effectiveness and
      reliability in recent years.
    

Detailed description: 
      Non-syndromic cleft lip and / or palate is a complex congenital defect that results from
      multiple genetic and environmental factors. It is also one of the most common congenital
      malformations. Cleft defects require early surgical repair to minimize nutritional
      difficulties and ensure optimum speech function. The Boyle-Davis mouth opener used in cleft
      palate surgery consists of tongue blade, mouth opener and suspension system and is used to
      fix the endotracheal tube in the midline and provide excellent surgical vision during the
      operation. However, it can cause complications such as dental injuries, laryngospasm, and
      displacement of the tracheal tube.

      Undesirable effects such as changes in heart rate and increases in intracranial pressures may
      occur during endotracheal intubation. These hemodynamic responses are thought to be due to
      increased sympathoadrenal activity. Laryngoscopy without tracheal intubation has been shown
      to increase high catecholamine levels and blood pressure, suggesting that sympathoadrenergic
      response occurs more frequently due to stimulation of the supraglottic region. Although the
      Boyle-Davis mouth opener provides an advantage for access to the intraoral cavity, its
      insertion causes significant increases in intracranial pressure (ICP) and intraocular
      pressures by causing hemodynamic changes similar to laryngoscopy.

      In recent studies, measurement of optic nerve sheath diameter with ultrasonography, which is
      a non-invasive method, is frequently used in the detection of intracranial pressure
      increases. The optic nerve is a part of the central nervous system and is covered with a
      dural sheath. Pressure changes in the intracranial region are similar to the pressure in the
      infraorbital subarachnoid space surrounding the optic nerve. In clinical studies, it has been
      shown that changes in intracranial pressure correlate with the optic nerve sheath diameter
      measured by ultrasonography. Compared to other diagnostic methods, measurement of the
      diameter of the optic nerve sheath is an inexpensive, easy-to-apply and non-invasive method.
      In our study, we aimed to determine the intracranial pressure changes that may occur due to
      the use of mouth gag in cleft palate surgeries by measuring the optic nerve sheath diameter
      with USG, which is a non-invasive method.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients aged between 3-24 month and with an ASA physical status I-II and undergoing cleft
        palate surgery will be included to the study
      
Keywords: optic nerve sheat diameter; mouth gag; cleft palate; ultrasonography