Revista Mexicana de Ortodoncia

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board

>Journals >Revista Mexicana de Ortodoncia >Year 2018, Issue 2

Yudovich BM, Barrera AM, Gryzbowski GE, García LS, Jiménez EI, Baranda ER
Evaluation of pain perception in patients of 0-5 months of age with cleft lip and palate subjected to pre-surgical orthopedics
Rev Mex Ortodon 2018; 6 (2)

Language: Español
References: 15
Page: 83-89
PDF: 229.55 Kb.

[Full text - PDF]


Introduction: While it is considered that newborns are not able to verbalize feelings and express pain during pre-surgical orthopedic treatment, it is necessary to identify a primary measure of pain in pediatric patients with cleft lip and palate. Objective: The objective of the study was to assess pain during pre-surgical orthopaedic treatment using the FLACC scale, which assesses the expression of the face, legs, activity, scream and compression, and to determine the reliability of this scale in these patients. Material and methods: Six independent observers assessed pain through video recordings of 20 children aged 0 to 5 months during three stages or moments of time: 1. During feeding technique; 2. While taking impressions of the alveolar ridges; 3. During the placement of the pre-surgical orthopaedic appliance. This scale was scored at each stage during the procedure. During the evaluation of the impression taking and placement of the appliance the values were compared with the feeding technique using the paired Wilcoxon test. Intraclass correlation coefficients were also used to assess the reliability of the scale. Results: Statistically significant increases in scale scores were found during impression taking (p ‹ 0.000) and appliance placement (p ‹ 0.000) compared to the feeding technique. The reliability of the scale was rated as good (0.71-0.90). Conclusions: Pain was evident according to the FLACC scale during impression of the alveolar ridges and placement of the appliance prior to the patient’s cheiloplasty. In addition, the scale showed good reliability, which provides preliminary support for considering alternative or pharmacological procedures to complement the patient’s treatment.

Key words: Cleft lip and palate, FLACC scale, pain.


  1. Ahmed MM, Brecht LE, Cutting CB, Grayson BH. 2012 American Board of Pediatric Dentistry College of Diplomates annual meeting: the role of pediatric dentists in the presurgical treatment of infants with cleft lip/cleft palate utilizing nasoalveolar molding. Pediatr Dent. 2012; 34 (7): e209-214.

  2. Porter FL, Grunau RE, Anand KJ. Long-term effects of pain in infants. J Dev Behav Pediatr. 1999; 20 (4): 253-261.

  3. Byers JF, Thornley K. Cueing into infant pain. MCN Am J Matern Child Nurs. 2004; 29 (2): 84-89; quiz 90-91.

  4. Hardy W. Facilitating pain management. Adv Neonatal Care. 2011; 11 (4): 279-281.

  5. Spasojevic S, Bregun-Doronjski A. A simultaneous comparison of four neonatal pain scales in clinical settings. J Matern-Fetal Neonatal Med. 2011; 24 (4): 590-594.

  6. Manworren RC, Hynan LS. Clinical validation of FLACC: preverbal patient pain scale. Pediatr Nurs. 2003; 29 (2): 140-146.

  7. Babl FE, Crellin D, Cheng J, Sullivan TP, O’Sullivan R, Hutchinson A. The use of the faces, legs, activity, cry and consolability scale to assess procedural pain and distress in young children. Pediatr Emerg Care. 2012; 28 (12): 1281-1296.

  8. Gomez RJ, Barrowman N, Elia S, Manias E, Royle J, Harrison D. Establishing intra- and inter-rater agreement of the Face, Legs, Activity, Cry, Consolability scale for evaluating pain in toddlers during immunization. Pain Res Manag. 2013; 18 (6): e124-128.

  9. Carol A, Nickerson E. A Note on ‘a concordance correlation coefficient to evaluate reproducibility. Biometrics. 1997; 53 (4): 1503-1507.

  10. Johansson M, Kokinsky E. The COMFORT behavioural scale and the modified FLACC scale in paediatric intensive care. Nurs Crit Care. 2009; 14 (3): 122-130.

  11. Michelsson K, Sirviö P, Koivisto M, Sovijärvi A, Wasz-Höckert O. Spectrographic analysis of pain cry in neonates with cleft palate. Biol Neonate. 1975; 26 (5-6): 353-358.

  12. Malviya S, Voepel-Lewis T, Burke C, Merkel S, Tait AR. The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment. Paediatr Anaesth. 2006; 16 (3): 258-265.

  13. Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S. Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients. Am J Crit Care. 2010; 19 (1): 55-61.

  14. Voepel-Lewis T, Merkel S, Tait AR, Trzcinka A, Malviya S. The reliability and validity of the Face, Legs, Activity, Cry, Consolability observational tool as a measure of pain in children with cognitive impairment. Anesth Analg. 2002; 95 (5): 1224-1229.

  15. Willis MH, Merkel SI, Voepel-Lewis T, Malviya S. FLACC Behavioral Pain Assessment Scale: a comparison with the child’s self-report. Pediatr Nurs. 2003; 29 (3): 195-198.

>Journals >Revista Mexicana de Ortodoncia >Year 2018, Issue 2

· Journal Index 
· Links 
Copyright 2010