Global prevalence of cleft palate, cleft lip and cleft palate and lip: A comprehensive systematic review and meta-analysis

Diagnostic significance of combined two-dimensional ultrasound and three-dimensional tomographic ultrasound imaging for cleft palate in fetus of 11-13 + 6 weeks: a prospective study

PURPOSE

Clinical screening for cleft palate in fetus currently focuses on weeks 20-24. It has been shown that cleft palate can be detected by ultrasound in first-trimester anatomy scan, but there are no large-scale samples to validate. This study was to confirm the ability of combined two-dimensional(2D)-ultrasound and three-dimensional(3D)-tomographic ultrasound imaging (TUI) to safely detect an fetal cleft palate at 11-13 + 6 weeks via large-scale samples.

METHODS

A prospective study was designed, involving 6870 pregnant women applying 2D-ultrasound transabdominal sweeps of the fetal face in the median sagittal and coronal views of the retronasal triangle with abnormalities of the palatal line detected, followed by an axial view of the superior alveolar eminence and 3D-TUI evaluation. The endpoints were the results of the fetal facial profile assessment for delivery and induction of labor. The accuracy, sensitivity, and specificity of ultrasound for diagnosing a cleft palate at 11-13 + 6 weeks were analyzed.

RESULTS

Among 6870 fetus, a total of 43 different cleft palate types were diagnosed by 2D-ultrasound in three-sections at the 11-13 + 6 weeks, and a total of 6827 cases were diagnosed of negative for cleft palate. Of the 43 cases diagnosed of positive for cleft palate, three cases were false positives compared to endpoint results, with a correct positive predictive value of 93.0%. Of the 6827 cases diagnosed of negative for cleft palate, five cases were false negatives compared to endpoint results, with a correct negative predictive value of 99.0%. The sensitivity and specificity of 2D-ultrasound screening for cleft palate were 84.4%, and 99.9%, respectively. The 43 cases received 3D-TUI scans, and the results showed that 37 cases of cleft palate detected, with a positive predictive value of 86.0%, which was lower than that of 2D ultrasonography (93.0%) (p < 0.05).

CONCLUSION

It may be feasible and accurate to diagnose cleft palate in fetus at 11-13 + 6 weeks by using combined 2D three sections ultrasound and 3D-TUI scans.

Major allelic variants in IRF6 and the association with Non-Syndromic orofacial Clefts: Insights from a Kerala-Based Case-Control study

Orofacial clefts, are among the most common congenital defects. Previous research has consistently shown that particular IRF6 gene polymorphisms are related to nonsyndromic cleft lip with or without cleft palate (NSCL/P), which has been verified across many populations. This study aimed to investigate the role of specific IRF6 polymorphisms in nonsyndromic orofacial clefts (NSOFC) within the Kerala population. A total of 100 NSOFC cases and matched controls were genotyped for five IRF6 single nucleotide polymorphisms (SNPs): rs2235371, rs7552506, rs2235373, rs2235375, and rs2013162 using Next-Generation Sequencing. Statistical analyses (VassarStats, SNPstat, and MedCalc) and haplotype construction (Haploview) were performed to assess allelic, genotypic, and haplotype associations. Results showed that the major alleles (primarily "G" in four SNPs and "C" in rs2013162) were significantly more frequent in healthy controls, suggesting a protective effect. Conversely, minor alleles were overrepresented in NSOFC cases, indicating an elevated risk. Four SNPs (rs2235371, rs7552506, rs2235373, rs2235375) demonstrated robust protective effects under multiple inheritance models, while rs2013162 exhibited a less pronounced influence, displaying a notable protective effect only in the nonsyndromic cleft lip with palate (NSCLP) subgroup. Haplotype analysis identified G-C-G as consistently protective, whereas C-A-C and C-A-G conferred a higher risk for NSOFC. Overall, these findings underscore the importance of IRF6 variants in NSOFC etiology and suggest that considering both individual SNPs and haplotypes can enhance understanding of orofacial cleft susceptibility. Further large-scale studies are recommended to validate these associations.

Correlation Between the Initial Severity of Oral Clefts at Birth in Patients With Complete Unilateral Cleft Lip and Palate and Craniofacial Morphology, Dental Arch Relationship, and Nasolabial Aesthetics During Pre-Adolescence

STUDY OBJECTIVES

To comprehensively evaluate the correlations between the severity of oral clefts at birth and the treatment outcomes during pre-adolescence in patients with complete unilateral cleft lip and palate (CUCLP).

MATERIAL AND METHODS

Records of 21 consecutive patients with CUCLP from a cleft/craniofacial centre were obtained. All subjects were treated with nasoalveolar moulding, followed by cheiloplasty and palatoplasty. The severity was measured by anterior cleft width, anterior and posterior arch width, arch circumference and arch length on scanned plaster models taken after birth. Craniofacial morphology, dental arch relationship and nasolabial aesthetics were assessed with cephalometric measurements, GOSLON score and Asher-McDade rating (AMR), respectively. Pearson and Spearman's rank correlation tests were performed to determine correlations between initial severity parameters and the treatment outcomes.

RESULTS

Pearson correlation showed negative correlations between posterior arch width at birth and maxillary position (SNA; r = -0.573, p < 0.01), mandibular position (SNB; r = -0.452, p < 0.05) and nasal prominence (N'-UNT/SN; r = -0.478, p < 0.05). A positive correlation was also found between posterior arch width at birth and maxillary inclination (SN/ANS-PNS; r = 0.454, p < 0.05). The ratio between anterior cleft width to arch length (G-L/Arch Length) demonstrated negative correlations with soft tissue facial height ratio (N'-Sn/Sn-Me'; r = -0.470, p < 0.05) and soft tissue vertical proportions (N'-Sn/N'-Gn'; r = -0.495, p < 0.05). Spearman's rank tests revealed no significant correlation between the initial severity parameters and GOSLON score and AMR.

CONCLUSIONS

The initial severity parameters were correlated with some craniofacial characteristics but not with dental arch relationships and nasolabial aesthetics during pre-adolescence.

Fabrication of a transforming growth factor β1 functionalized silk sericin hydrogel through genetical engineering to repair alveolar bone defects in rabbit

Cleft palate is one of the most prevalent congenital craniofacial birth defects in human congenital facial anomaly. Severe cleft palate is usually accompanied by alveolar bone defects (ABDs). Growth factors (GFs) are considered as desirable opportunity to promote the craniofacial healing post the surgery. However, limited resource, susceptibility to degradation, and lack of appropriate delivery systems greatly hinder the clinic application of GFs in the ABDs repair. In this study, a transforming growth factor β1 variant (eTGF-β1) with enhanced extracellular matrix (ECM) binding efficiency was engineered to generate transgenic silkworm using the silk gland biosynthesizing system for cost effective and massive bio-synthesis of the eTGF-β1 functionalized silk fibers. The eTGF-β1 achieved a highly-efficient expression in the middle silk gland (MSG) cells of transgenic silkworm, and secretion and distribution in the sericin layer of silk fiber which accounted for approximately 5.57 ± 0.72 % of the cocoon shell weight. The eTGF-β1 functionalized silk sericin hydrogel (eTGF-β1 SH) was then fabricated with excellent mechanical and processing properties, injectability, biocompatibility, biodegradability, sustained release of eTGF-β1, and capability to promote cell proliferation, which significantly accelerated the bone defect repair particularly the osteoblast maturation and new bone formation through regulating the expressions of the bone formation-related genes in a rabbit alveolar process cleft model. This study provides a valuable strategy for future the treatments of ABDs in rabbit with cleft palate using the genetically engineered eTGF-β1 silk sericin hydrogel.

The impact of maternal stress on non-syndromic clefts: a retrospective case-control study

PURPOSE

To assess the effect of COVID-19 related maternal psychological stress (MS) in the first trimester of pregnancy on non-syndromic orofacial-clefts (NSOFCs).

METHODS

This retrospective case-control cross-sectional study included infants who were born during the COVID-19 pandemic. Sample size was determined based on differences in MS and their effect on clefts etiology. Infants were divided into two groups: cases (with NSOFCs) and controls (healthy); two controls were selected for each case, matched by gender and residence. Data was collected from mothers through phone-based questionnaires which consisted of three parts: demographics, risk factors, and maternal stress using the Life Events Questionnaire (LEQ) and Fear of COVID-19 Scale (FCV-19S). Descriptive statistics, correlations and logistic regression were done, level of significance was set at (P ≤ 0.05).

RESULTS

The final sample included 192 infants: (64 cases, 128 controls), mostly females, born full-term, with normal weight (55.2%, 72.9%, and 62.5%, respectively). Mothers ages were 19-41 years. Prevalence of NSOFCs was 1.41 birth per 1000 live births. The LEQ showed that changing residence (P = 0.012) and overall stress (P = 0.019) were significant factors for mothers in both groups. Regression analysis showed that low gestational age of the infant (P = 0.009), lack of folic acid intake during the first trimester (P = 0.037), parental consanguinity (P = 0.019) and maternal stress due to COVID-19 pandemic (P = 0.039) were risk factors for NSOFCs.

CONCLUSION

Despite limitations of reliance on self-reported MS, this study suggests that maternal stress is a risk factor for NSOFCs. More studies need to be conducted addressing MS during prenatal and perinatal periods.

Integrated Transcriptomic and Metabolomic Profiling of the Placenta in a Dexamethasone-Induced Cleft Palate Rabbit Model

BACKGROUND

Cleft palate is a congenital malformation influenced by both genetic and environmental factors. Although environmental contributors have been extensively studied, the placenta-an essential organ that mediates maternal-fetal interactions and offers protection against environmental insults-remains poorly understood in this context. This study aimed to explore transcriptomic and metabolomic alterations in the placenta following maternal exposure to corticosteroids, using a dexamethasone-induced cleft palate rabbit model.

METHODS

Untargeted metabolomics and transcriptomics analyses were conducted on placental and amniotic fluid samples from fetuses with and without dexamethasone-induced cleft palate. Histopathological examination was performed to assess structural abnormalities in the placenta.

RESULTS

The cleft palate group exhibited marked placental pathologies, including fibrosis, calcification, and necrosis. Transcriptomic analysis identified 4744 differentially expressed genes, enriched in pathways related to hormone signaling, vascular development, and inflammation. Metabolomic profiling revealed significant changes in both placenta and amniotic fluid, especially in the urea cycle, aspartate metabolism, and nicotinate and nicotinamide metabolism. The urea cycle was particularly disrupted in the cleft palate group.

CONCLUSION

These findings reveal a strong association between placental structural and functional abnormalities and cleft palate formation in the dexamethasone-induced model, offering novel insights into the potential role of the placenta in cleft palate pathogenesis.

Association of trace element levels in primary teeth and occurrence of Cleft lip and/or palate

BACKGROUND

Cleft lip and/or palate (CL/CP) are common congenital anomalies with multifactorial origins, potentially influenced by environmental factors, including multi-trace metal exposure. Primary teeth, which form in utero, offer a unique biomatrix for assessing early-life metal exposure, yet remain underexplored in CL/CP research.

OBJECTIVE

This case-control study aimed to investigate the association between multi-trace metal exposure and CL/CP occurrence by analyzing primary teeth using Inductively Coupled Plasma Mass Spectrometry (ICP-MS).

METHODS

Ethical clearance was obtained for this study, which included 30 children aged 4-12 years. Non-carious central and lateral incisors were analyzed for trace metals using ICP-MS. Demographic, socioeconomic, and nutritional data were collected via a structured proforma and environmental risk factor questionnaire.

RESULTS

A comprehensive analysis of 24 trace metals in primary teeth of CL/CP and control groups found no significant associations with 25Mg, 52Cr, 43Ca, and 56Fe, with odds ratios near 1. Lower 113 Cd concentrations were linked to CL/CP. However, the small sample size (n = 15 per group) limits conclusions on the relationship between cadmium levels and CL/CP. Maternal nutritional deficiencies (p = 0.031) and lower annual income (p = 0.001) were significantly associated with increased CL/CP prevalence, suggesting socioeconomic and dietary influences.

CONCLUSION

Exposure to 25Mg, 52Cr, 43Ca, and 56Fe showed no significant association with CL/CP risk, while lower 113 Cd levels suggested a potential link, though the small sample size limits interpretations. Further research is needed to elucidate the link between metal exposure and developmental anomalies, and to address cadmium's environmental and dietary sources to reduce CL/CP risk.

Growth Parameters in Children with Non-syndromic Cleft Lip and Palate versus Healthy Controls: A Cohort Study from Riyadh, Saudi Arabia

Background

Cleft lip and palate (CLP) can have an impact on the physical development of children; however, data from such studies is currently limited.

Objectives

To compare growth parameters between children with non-syndromic CLP and healthy controls in Saudi Arabia.

Materials and Methods

This case-control retrospective cohort study included Saudi children with CLP and age- and gender-matched healthy children (1:1) who attended a tertiary care center in Riyadh, Saudi Arabia. Growth measurements (weight, length, and head circumference) were taken at the ages of 1 year and 2 years, and the Saudi Growth Chart was used as a reference data.

Results

The study included 86 children in each group (N = 172), with 31.4% females and 68.6% males. The mean current age was 3.2 ± 1.7 years. Most patients had a unilateral CLP (96.5%). Multivariable analysis demonstrated that at the age of 1 year, compared with controls, patients with CLP had significantly lower weight (OR: 1.7, P = 0.026), weight standard deviation score (SDS) (OR: 0.4, P = 0.001), and head circumference SDS (OR: 0.8, P <0.001); however, these did not remain significant at the age of 2 years. In the early repair (age <1 year) and late repair (age ≥1 year) groups, 76.1% and 63.2% of the patients achieved catch-up growth.

Conclusion

This study found that Saudi children with cleft lip and palate had significantly lower weight and head circumference compared with healthy children in the first year of life, but catch-up growth in the second year of life, largely following surgical repair, rendered these differences to be insignificant.

Maternal Exposure to Stress During Covid-19 and Non-Syndromic Orofacial Clefts: A Cohort Retrospective Study

ObjectiveThe coronavirus (COVID-19) pandemic presents an opportunity to study stress's effect on the development of non-syndromic orofacial clefts (NSOFCs). This study was aimed at assessing maternal stress exposure during the pregestational to first trimester pregnancy periods and the development of NSOFCs during a year of the COVID-19 pandemic.DesignCohort study of infants with NSOFCs and controls matched based on recruitment site and age.SettingGovernment hospitals in Saudi Arabia between November 2020 and November 2021.Main Outcome MeasuresData collection included NSOFC clinical examination and maternal stress exposure assessment using the Modified Life Events Questionnaire, the Fear of COVID-19 Scale, and a focus on the lack of pregnancy planning and a threatened miscarriage.ResultsOf the 557 infants recruited, 191 had NSOFCs. Logistic regression analysis with adjusted odds ratios (AORs) that removed the effects of confounders showed that any of the seven stressful life events (AOR:3.78, P < .001) and the family histories of relatives with NSOFCs (AOR:9.73, P < .001) increased the AOR for NSOFC development. In contrast, maternal folic acid (AOR:0.56, P.010), threatened miscarriage (AOR:0.17, P = .001), fear of COVID-19 (AOR:0.83, P = .038), and suspected COVID-19 infection (AOR:0.43, P = .008) decreased the AOR for NSOFC development.ConclusionAlong with an established risk associated with family history of birth defects, stressful life events may be a risk factor for NSOFC development. Beyond folic acid's known benefit, it may be that higher maternal health concerns contribute to increased protective health behaviors during pregnancy. Ongoing research is needed to specify the maternal risk factors for NSOFC.

Novel Virtual Reality Simulator for Cleft Palate Surgery Training: An Assessment of Educational Feasibility and Traction Among Plastic Surgery Residents

ObjectiveTo evaluate learners' acceptance of multiuser virtual reality (VR) simulation platform while practicing the Furlow repair technique for cleft palate reconstruction.DesignNonrandomized with pre- and postsurveys.SettingTertiary care institution's Department of Surgery September 2023 through August 2024.ParticipantsTwenty plastic surgery residents from level PGY1 to PGY6 from a single institution.InterventionsMultiuser Meta Quest 2 VR simulation-based workshop with an expert surgeon demonstrating a Furlow cleft palate repair. Feedback included audio and visual.Main outcome measuresLearner confidence in using VR as a tool for surgical education, understanding of the Furlow technique, and opinion regarding the incorporation of VR into surgical and medical education. Satisfaction as measured by the Student Evaluation of Educational Quality questionnaire survey with a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree).Results20 residents participated in this study, of which 65% had previously participated in a cleft palate repair and 40% had used VR. After the simulation, trainees' confidence in using VR as a tool for surgical education, understanding of the Furlow technique, and opinion regarding the incorporation of VR into surgical and medical education significantly increased (P < .05). Trainees found the simulation stimulating (4.85 ± 0.67), interesting (4.45 ± 0.83), clear (4.60 ± 0.82), an effective teaching tool (4.75 ± 0.44) and would recommend it to others (4.90 ± 0.31). Participants reported that they would feel somewhat comfortable repeating the simulation alone (3.95 ± 1.05).ConclusionMultiuser VR-based simulation workshops can significantly increase learners' confidence and skills in the Furlow technique and promote positive opinions regarding VR as an educational tool. Learners considered this platform effective and stimulating and would recommend it as an educational tool.

Burden of orofacial clefts from 1990-2021 at global, regional, and national levels

Objectives

We aimed to study and comprehensively evaluate the burden of OFCs at global, regional, and national levels.

Methods

Based on data from the Global Burden of Disease database for 2021, we analysed the prevalence, mortality, and disability-adjusted life years (DALYs) of orofacial clefts (OFCs) from 1990-2021, categorised by sex, regions, and sociodemographic index (SDI). Numbers and age-standardised rates (ASRs) of the aforementioned indices were estimated through a systematic analysis of modelled data from the GBD 2021 study. Finally, the relationship between SDI and the epidemiological parameters of OFCs was evaluated.

Results

In 2021, the global prevalence of OFCs included 4,124,007 cases, resulting in 1,719 deaths and 408,775 DALYs. From 1990-2021, prevalence cases decreased by 40.38%, while mortality rates, and DALYs decreased by 86.08%, and 68.33%, respectively. Moreover, the ASRs for prevalence, mortality, and DALYs demonstrated a decreasing trend during the period. In 2021, the highest age-standardised prevalence rates (ASPRs) of OFCs were recorded in South Asia, North Africa, the Middle East, and Central Asia. Nationally, Palestine, Qatar, and Bangladesh reported the three highest ASPRs in 2021. A nonlinear association was observed between the ASRs of OFCs and the SDI at regional and national levels.

Conclusions

The global burden of OFCs decreased from 1990-2021. However, there is a disparity in disease burden across different regions, over 80% of the burden is borne by patients in low- and middle-income countries, the burden of OFCs remains a major public health challenge globally. Our findings will help to formulate appropriate policies to reduce the OFCs burden.

Prevalence and Incidence of Cleft Lip and/or Palate in Europe: A Scoping Review and Meta-Analysis

ObjectiveThis study synthesized and described the prevalence and incidence of cleft lip and/or palate (CL/P) reported by different studies in Europe.DesignA scoping review was designed according to the Joanna Briggs Institute methodology and an advanced search was conducted using MedLine, Science Direct, and Semantic Scholar without time or language restrictions. Two reviewers extracted data from the articles included.ParticipantsThe extracted data included specific details on the type of orofacial cleft, the European regions (Northern Europe, Western Europe, Eastern Europe, and Southern Europe).Main Outcome Measure(s)A meta-analysis was conducted with the data reported for the incidence and prevalence of CL/P.ResultsA total of 66 studies were obtained reporting from 29 European countries. According to what was obtained from the meta-analysis, a prevalence of cleft lip and palate (CLP) of 0.7/1000 95% CI: (0.6-0.7) births is reported in Europe, followed by cleft palate (CP) and cleft lip (CL) with 0.5/1000 95% CI: (0.4-0.5) and 0.3/1000 95% CI: (0.3-0.4), respectively. A total prevalence of CL/P in Europe is estimated at 1.1/1000 95% CI: (1.0-1.2) between 1950 and 2014. The incidence of CLP is reported to be 0.7/1000 95% CI: (0.6 to 0.8) followed by CP and CL with 0.5/1000 95% CI: (0.5-0.6) and 0.4/1000 95% CI: (0.3-0.4), respectively. The total incidence of CL/P in Europe is estimated at 1.6/1000 95% CI: (1.5-1.7) between 1948 and 2018.ConclusionThis review provides a description of the status of the prevalence and incidence of CL/P in Europe and its regions, and can be considered as a guide for the development of promotion and prevention programs.

Nerve block for pain management in pediatric patients undergoing cleft lip and palate repair: A systematic review and network meta-analysis

BACKGROUND

Cleft lip and palate, a common congenital anomaly, occurs in approximately 1 in every 1000-1500 births. Effective postoperative pain management in pediatric patients undergoing repair for cleft lip and palate remains a challenge. Therefore, this systematic review and network meta-analysis aimed to assess the effectiveness of nerve block in controlling postoperative pain compared to other methods in pediatric patients who underwent cleft lip and palate repair.

METHODS

This review adhered to the preferred reporting items for systematic reviews and meta-analysis guidelines. A comprehensive search was conducted across multiple databases, including Embase, MEDLINE, Cochrane, and SCOPUS, without time frame limitation.

RESULTS

A total of 8 randomized controlled trials comprising 550 patients were included. The findings of the study indicate that dexmedetomidine provided longer duration of nerve block (incremental value = 6.33, CI 95%, 1.49: 11.16) compared to the control. Thus, the probability of dexmedetomidine achieving longer nerve block is 89.98%. This was followed by fentanyl and pethidine.

CONCLUSION

This study supports the efficacy and safety of nerve blocks, particularly with dexmedetomidine, for postoperative pain management in pediatric cleft lip and palate repair. Adjuvant-enhanced nerve blocks offer extended pain relief and reduce the reliance on opioids.

Impact of Surgery on Quality of Life in Families of Children With a Cleft Lip and/or Palate: A Systematic Review

ObjectiveTo synthesize research exploring the impact of surgery on quality of life (QoL) in families of children with a cleft lip and/or palate (CL/P).DesignMedline, PsycINFO, CINAHL, and ProQuest databases were systematically searched (from database inception to July 2024) to identify studies exploring QoL in families following surgery for a child with CL/P. Studies were quality appraised using Quality Assessment for Diverse Studies criteria, and a narrative synthesis was undertaken.Main Outcome Measure: Quality of life was explored but specific measures varied across studies.Interventions: Type of surgery being investigated varied across the reviewed studies. This systematic review focussed on both functional and aesthetic surgeries throughout childhood.ResultsOf 157 identified studies, 9 were eligible for inclusion (1 mixed-methods, 1 observational, 1 qualitative, 2 cross-sectional, 4 quasi-experimental). Analysis indicated that QoL was positively impacted by surgery through reduced financial burden, increased sense of mastery/coping, and reduced social impact. However, for some families, new demands (eg, medical/dental appliances, food restrictions), intolerance of uncertainty, and adjustment to changes to their child's appearance were identified following surgery.ConclusionsThere is limited qualitative and quantitative research exploring the impact of a child's cleft surgery on family QoL. The quality of studies included in the review was variable. Supporting families accessing cleft services, especially where QoL and mental health are negatively impacted, is important. Due to the variability within and between the studies, and lack of detail relating to rationale and processes taken, the conclusions from this review are tentative. Further research is needed that addresses methodological and conceptual limitations.

Morphological Changes in Maxillary Arch Post-Cheiloplasty in Cleft Lip and Palate Infants: A Case Series

ObjectiveThis study evaluated the effectiveness of cleft lip repair in modifying maxillary arch morphology in infants with complete unilateral cleft lip and palate (cUCLP) over a 6-month period.DesignProspective case series.SettingMy Thien Hospital of Odonto-Stomatology, Ho Chi Minh City, Vietnam.ParticipantsFifteen infants with cUCLP, average age 5.07 months.InterventionAll infants underwent unilateral cleft lip repair using Fisher's technique. Maxillary arch impressions were taken before surgery and 6 months postoperatively and converted into 3D models.Main Outcome MeasuresAnalysis focused on maxillary arch dimensions in anteroposterior and transverse directions, changes in cleft width, curvature of the larger segment, and position of the proximal edge.ResultsAlveolar cleft width (GL) and anterior curvature angle (∠GIC) showed significant reductions (P < .05). Additionally, posterior arch width (TT'), maxillary arch depth (I-TT'), and anterior arch depth (I-CC') showed significant increases (P < .05), while anterior arch width (CC') remained unchanged (P = .87). Measurements demonstrated high reliability with ICC > 0.75 for all parameters.ConclusionUnilateral cleft lip repair in cUCLP infants significantly narrowed the alveolar cleft width and reduced the anterior curvature angle. Increases in posterior arch width and maxillary arch depth were also observed. These morphological changes are crucial for planning future surgical interventions to optimize outcomes.

The cranial gland system of Nasonia spp.: a link between chemical ecology, evo-devo, and descriptive taxonomy (Hymenoptera: Chalcidoidea)

Nasonia is an emerging model system for investigating the evolution of complex species-specific behavioral and morphological phenotypes. For example, the male head shape differs considerably between Nasonia Ashmead (Hymenoptera: Chalcidoidea) species. In addition, differences in courtship behaviors, and possibly influences of a male-specific aphrodisiac pheromone, contribute to interspecific prezygotic isolation. However, the possible relationships between courtship, pheromone signaling, and male head shape are unknown. Using multimodal imaging techniques, we conducted a comprehensive examination of the skeletomuscular and exocrine gland systems of the lower head region of all 4 Nasonia species and their sister genus Trichomalopsis Crawford (Hymenoptera: Chalcidoidea). This analysis reveals the presence of 3 undescribed exocrine glands in the lower head region and a unique mandibular modification, the basal mandibular carina, that might be involved in pheromone spread. We performed morphometric and volumetric analyses using 3D datasets from synchrotron X-ray microtomography and found that the size of the genomandibular gland and the corresponding basal mandibular carina correlates with both interspecific courtship length and head shape differences, indicating that this gland is a likely source of the oral aphrodisiac pheromone. These differences correlate with the prevalence of within-host mating rather than phylogenetic relatedness in Nasonia species, with increased within-host mating occurring in species with larger genomandibular glands. Our findings create an opportunity to better understand the complex gene regulatory networks underlying superficially unrelated traits and serve as a link between behavior, chemical ecology, evo-devo, and descriptive taxonomy.

Presurgical three-dimensional palatal morphology in children with different cleft types compared to healthy controls

Palatal morphology in patients with clefts can be accurately assessed during the presurgical period, providing insights into how cleft type affect palatal development. These early observations are unbiased by treatment, making them broadly applicable. This study aimed to identify differences in palatal morphology among untreated patients with various cleft types before surgery. Primary outcomes included palatal size at the occlusal plane and palatal surface area, while secondary outcomes involved palatal width, length, and premaxilla rotation. Digital impressions from 150 patients (97 males, 53 females) were grouped by cleft type: cleft lip, soft palate cleft, complete cleft palate, unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and non-cleft controls. Measurements were performed using 3D software, and statistical analysis using a generalized least squares model. Patients with BCLP had a larger palatal size due to the prominent premaxilla, but palatal surface area was similar across groups. The posterior palatal width was wider in UCLP and BCLP, while the width at the canine position was narrower in patients with isolated cleft palate. Palatal surface areas remain consistent across cleft types, indicating that surgical challenges arise from the need to cover wider clefts during repair, rather than from the management of tissue deficits.

Sulforaphane from Brassica Oleracea Induces Apoptosis in Oral Squamous Carcinoma Cells via p53 Activation and Mitochondrial Membrane Potential Dysfunction

Background/Objectives: Oral squamous cell carcinoma (OSCC) is a significant global health concern, necessitating the development of novel treatment strategies. The present study investigated the in vitro anticancer activity of sulforaphane (SFN), an isothiocyanate derived from Brassica oleracea, on the OECM-1 human oral squamous carcinoma cell line. Methods: OECM-1 cells were cultured and exposed to a range of SFN concentrations. To assess the cell viability and determine the half maximal inhibitory concentration (IC50) of SFN following 24 h of treatment, an MTT assay was performed. Apoptosis was evaluated using AO/PI staining, a TUNEL assay, Annexin V-FITC analysis, and a DNA fragmentation assay. Changes in the mitochondrial membrane potential were analyzed using a JC-1 staining assay. A Western blot assay was performed to assess the expression levels of apoptosis-associated proteins (Bax, Bcl2, caspase-3, caspase-9, PARP, Smad-4, p53, cytochrome c, and GAPDH). Cell cycle analysis was performed to validate the apoptotic findings. Results: The IC50 concentration of SFN was 5.7 µM. The apoptotic assays demonstrated an effective induction of apoptosis in the OECM-1 cells. Western blot analysis demonstrated the dose-dependent upregulation of p53, caspase-3, caspase-9, PARP, cytochrome c, and Bax and the downregulation of the anti-apoptotic proteins Bcl-2 and Smad-4 after SFN treatment. Conclusions: The data obtained indicate that SFN has significant potential to induce apoptosis in OECM-1 cells by disrupting mitochondrial function and modulating apoptotic pathways. The outcomes of our research indicate SFN's potential as a viable treatment drug for OSCC.

Skeletal, dentoalveolar and soft tissue effects of different maxillary expansion appliances in cleft lip/palate patients: A systematic review and frequentist network meta-analysis

INTRODUCTION

This study aimed to assess the available evidence regarding the skeletal, dentoalveolar, and soft tissue effects of different maxillary expansion appliances in cleft lip/palate patients.

METHODS

We assessed the effects of different maxillary expansion appliances on skeletal and dentoalveolar structures and soft tissues in cleft lip/palate patients. We searched the PubMed, Science Direct, Web of Science, Cochrane, and LILACS databases through September 2024; that investigation was augmented by a manual search. We focused on clinical trials and longitudinal studies, either retrospective or prospective. The outcomes of interest included skeletal, dentoalveolar, and soft tissue changes obtained from study models, cephalometric radiographs, or cone beam computed tomography.

RESULTS

Of the 430 screened articles, only six satisfied our eligibility criteria and were included in the quantitative synthesis. These articles exhibited a moderate overall risk of bias. None of the appliances conferred better forward skeletal maxillary movement than the hyrax. The iMini-Molars (iMini-M) was the most effective appliance for increasing maxillary skeletal width (mean: 0.89 mm [range: 0.01-1.78]), with the hyrax following closely behind. The Haas appliance exhibited the largest inter-molar distance (mean: 4.76 mm [range: 2.53-6.99]), followed by the Differential opening appliance (EDO), iMini-M, and the hyrax. The fan-type appliance was the least effective at resisting maxillary premolar tipping (14.46° [2.60-26.32]), and the iMini-premolars (iMini-P) was the most effective at reducing molar tipping (-3.54° [-6.06- -1.02]).

CONCLUSIONS

Considering the limited number of studies and moderate risk of bias, the iMini-M was the most effective appliance at increasing maxillary skeletal width compared with the hyrax; the Haas achieved the largest inter-molar distance. The fan-type appliance excelled at resisting premolar tipping, and the iMini-P offered the best control for molar tipping.

REGISTRATION

The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42023489536).

Development of software for collecting cleft-specific data in Malaysia

BACKGROUND

The World Health Organization (WHO) has recommended the development of a cleft-specific database for collecting and analyzing data on patients with cleft from birth to adulthood. However, such a database currently does not exist in Malaysia. The objective of this study was to develop a cleft lip and/or palate (CL/P) database software for Malaysia to streamline data collection and support comprehensive research to enhance outcomes of care.

METHODS

The development of the database software involves several key stages, including determining the requirements, designing the software interface, implementing the system, conducting thorough testing, and completing comprehensive documentation. The database software was mainly developed internally within the research institution. The team involved in developing the clinical database includes cleft clinicians, software developers, software designers, members of the Cleft Lip and Palate Association Malaysia (CLAPAM), and experts in database development.

RESULTS

An online and offline database software has been developed to store information on patients with CL/P in Malaysia. It is designed to be user-friendly, accommodating multiple specialties and capable of storing photographs, radiology, and three-dimensional files. Various methods have been implemented to ensure data security. Additionally, documentation including video tutorials, consent forms, and hard copy versions has been developed to complement the database.

CONCLUSION

A specialized cleft-specific database software has been successfully developed for use in Malaysia to improve data management and support CL/P patient care.

Using "Real-World Data" to Study Cleft Lip/Palate Care: An Exploration of Speech Outcomes from a Multi-Center US Learning Health Network

ObjectiveTo assess the ability of a cleft-specific multi-site learning health network registry to describe variations in cleft outcomes by cleft phenotypes, ages, and treatment centers. Observed variations were assessed for coherence with prior study findings.DesignCross-sectional analysis of prospectively collected data from 2019-2022.SettingSix cleft treatment centers collected data systematically during routine clinic appointments according to a standardized protocol.Participants714 English-speaking children and adolescents with non-syndromic cleft lip/palate.InterventionRoutine multidisciplinary care and systematic outcomes measurement by cleft teams.Outcome MeasuresSpeech outcomes included articulatory accuracy measured by Percent Consonants Correct (PCC), velopharyngeal function measured by Velopharyngeal Competence (VPC) Rating Scale (VPC-R), intelligibility measured by caregiver-reported Intelligibility in Context Scale (ICS), and two CLEFT-Q™ surveys, in which patients rate their own speech function and level of speech distress.Results12year-olds exhibited high median PCC scores (91-100%), high frequency of velopharyngeal competency (62.50-100%), and high median Speech Function (80-91) relative to younger peers parsed by phenotype. Patients with bilateral cleft lip, alveolus, and palate reported low PCC scores (51-91%) relative to peers at some ages and low frequency of velopharyngeal competency (26.67%) at 5 years. ICS scores ranged from 3.93-5.0 for all ages and phenotypes. Speech Function and Speech Distress were similar across phenotypes.ConclusionsThis exploration of speech outcomes demonstrates the current ability of the cleft-specific registry to support cleft research efforts as a source of "real-world" data. Further work is focused on developing robust methodology for hypothesis-driven research and causal inference.

Exploring the relationship between cleft type and speech outcome in 4-to-6-year-olds with non-syndromic cleft palate using different measures: A preliminary report

Cleft type affects speech outcomes, but exact relationships remain unclear as outcome measures vary. The primary aim was to investigate the relationship between cleft type and speech outcome using different measures in 4-to-6-year-olds with non-syndromic clefts. Secondary aims were to explore the relationships between (i) speech measures used; and (ii) parent perception of speech intelligibility and listener familiarity. Twenty-two pre-schoolers with clefts, plus one parent for each child, were recruited through a hospital outpatient clinic. Children with cleft lip and palate (CLP; n = 11) and those with cleft palate only (CP; n  = 11), matched on age and time of palate repair, were compared on Percentage Consonants Correct (PCC), clinician-reported speech intelligibility, and parent rating on the Intelligibility-in-Context Scale (ICS). Children with CLP had significantly lower PCC scores than children with CP (p = .020), but had no significant differences in their clinician- or parent-reported speech intelligibility. Clinician-reported speech intelligibility correlated significantly with both PCC (τ = .594, p < 0.01) and ICS (τ = .424, p  = 0.009). No significant correlation was found between PCC and ICS (τ =.197, p = 0.113). Overall, parents rated their child's intelligibility higher for familiar compared to unfamiliar communication partners (τ  = 2.325, p = 0.001, r  = .76). Cleft type is crucial for intervention planning when objective measures are employed. Speech outcomes should be evaluated at impairment, activity, and participation levels, and by different communication partners, to comprehensively evaluate communicative effectiveness.

Parental transmission effects of the IRF6 polymorphisms among Non-Syndromic Cleft Lip with or without cleft palate in Kerala case parent trios

OBJECTIVE

The purpose of this study was to evaluate the IRF6 gene polymorphisms in the etiology of the Non-syndromic Orofacial Cleft (NSOFC) population from Kerala.

DESIGN

The study included a hundred case-parent triads of NSOFC from the Kerala Population. Genomic DNA was isolated from the trios. The polymorphisms rs2235371 and rs7552506 were genotyped using polymerase chain reaction (PCR) and the Sanger sequencing method. PLINK and haploview software were used for the statistical analysis.

RESULTS

We found a substantial association of the rs2235371 (p-value = 0.0094, OR = 2.2) with NSOFC. The allelic TDT analysis 'A' allele of rs2235371 showed significant paternal transmission (p-value = 0.03, P_POO=0.506), whereas the 'C' allele of rs7552506 (p-value = 0.0094, P_POO=0.0527) showed an excess maternal transmission. The linkage disequilibrium (LD) values (D'= 0.83 and r2 =0.033) between rs2235371 and rs7552506 discovered that these two SNPs are not in strong LD. Haplotype A-G exhibited a significantly reduced risk for oral clefts (p=0.035).

CONCLUSION

The current study revealed that polymorphism rs2235371 is associated with NSOFC. The rs2235371 appears to be significant with the trait in the paternal lineage but not when considering both lineages together. On the other hand, rs7552506 shows a significant association in the maternal lineage, with the pooled analysis approaching statistical significance. This study indicates that the IRF6 gene may be a risk factor for NSOFC in the Kerala population.

Polymorphisms and dental age in non-syndromic cleft lip and palate: a cross-sectional study

BACKGROUND

Children with non-syndromic cleft lip with or without palate (CL ± P) may present alterations in dental development. The purpose of this cross-sectional study was to compare the dental age (DA) between children with and without CL ± P, and whether single nucleotide polymorphisms (SNPs) in genes encoding growth factors are associated with DA variations.

METHODS

Children aged between 5 and 14 years with and without CL ± P were recruited to participate in this study. DA was evaluated by calibrated examiners (kappa > 0.80) using the method proposed by Demirjian et al. (1973). Genomic DNA was extracted from buccal cells, and SNPs in Epidermal Growth Factor (EGF) - rs4444903 and rs2237051, Epidermal Growth Factor Receptor (EGFR) - rs2227983 -, Transforming Growth Factor Beta 1 (TGFB1) - rs1800470 and rs4803455 -, and Transforming Growth Factor Beta Receptor 2 (TGFBR2) - rs3087465 - were genotyped by real-time polymerase chain reactions using the TaqMan assay. The Student T-test was used to compare the variations in DA between the phenotypes "with CL ± P" and "without CL ± P", and the ANOVA two-way test was performed to compare the variations in DA among the genotypes (α = 0.05). A post-hoc analysis was performed using Bonferroni correction.

RESULTS

Two hundred and nine (n = 209) children (100 with CL ± P and 109 without CL ± P) with a mean chronological age of 8.66 years - standard deviation (SD) = 1.92 - were included. The group with CL ± P demonstrated a significantly delayed DA (mean=-0.23; SD = 0.71) compared to the group without CL ± P (mean=-0.01; SD = 0.88) (p = 0.049). Genotype distributions were in Hardy-Weinberg equilibrium. The SNP rs4803455 in TGFB1 was significantly associated with DA variations in children without CL ± P (p < 0.01). In the group with CL ± P, no significant differences in DA were observed among the genotypes.

CONCLUSION

Children with CL ± P presented delayed DA compared with children without CL ± P. The SNP rs4803455 in TGFB1 is associated with variations in DA in children without CL ± P.

A reliable and objective method of measuring soft tissue changes in 2D photographs after distraction osteogenesis in individuals with CL/P

Pre- and postoperative photos to assess results are widely used in plastic and reconstructive surgery, for instance, in patients with cleft lip and palate (CL/P). Evaluations are often performed by assessment panels by viewing the photos. However, these are prone to be subjective. Measurements of soft tissues in photos could be an alternative method but have not been widely used so far. Some patients with CL/P develop a retrognathic maxilla in adolescence, with ensuing Class III malocclusion. In severe cases, distraction osteogenesis (DO) of the maxilla may be indicated. The effect of DO on the facial soft tissues is sparsely reported, perhaps due to the rare procedure. The primary aim of the present study is to provide a reliable and objective method of measuring soft tissue profiles in two-dimensional digital photos. Furthermore, the study aims at assessing changes in soft tissues following DO. Fourteen patients who had undergone DO at our unit were recruited. Preoperative and postoperative photos were identified, and long-term follow-up photos were taken. Three raters performed measurements of four angles and two distances. Inter- and intra-rater reliability and soft tissue changes were analyzed statistically. Inter- and intra-rater reliability was high overall for most variables. Two angles related to facial convexity changed significantly. So did the upper lip height. Soft tissues can be measured with a high degree of accuracy, but further evaluation of the method is necessary. DO causes a favorable increase in facial convexity, and an increased upper lip height.

Epidemiologic trends of cleft lip and/or palate in Switzerland

BACKGROUND

Epidemiologic data on the number of cleft lip and/or palate (orofacial cleft (OFC)) births in Switzerland are currently sparse. However, this knowledge is essential for better understanding the etiologies underlying the various cleft phenotypes and providing expectant parents with the best possible healthcare planning and counseling.

METHODS

This is the first descriptive study to report data on the prevalence of the various cleft types, their sex, and regional distributions in Switzerland. Data for the years 1998-2021 were obtained from the Swiss Federal Statistical Office. Due to the notable initial underreporting of cleft cases from 1998 to 2006, this period was omitted from the final analyses.

RESULTS

Between 2007 and 2021, the prevalence of all Swiss OFC cases per 10,000 live births was 12.5, with a stable trend. Cleft lip was the least common anomaly. Except for cleft palate, which was more common in females, males were generally more affected by OFC than females. There was no discernible regional trend for any of the malformations, even though the prevalence differed throughout the seven Swiss regions.

CONCLUSIONS

This study presents the first descriptive epidemiologic profiles for OFCs in Switzerland and emphasizes the importance of nationwide OFC registries with an accurate and reliable reporting system for the benefit of current and future patients with clefts, their parents or caregivers, and society as a whole.

Three-dimensional analysis of facial morphology in nine-year-old children with different unilateral orofacial clefts compared to normative data

Aim

To compare three-dimensional (3D) facial morphology of various unilateral cleft subphenotypes at 9-years of age to normative data using a general face template and automatic landmarking. The secondary objective is to compare facial morphology of 9-year-old children with unilateral fusion to differentiation defects.

Methods

3D facial stereophotogrammetric images of 9-year-old unilateral cleft patients were imported into 3DMedX® for processing. All images of patients with a right sided cleft were mirrored. A regionalized general facial template was used for standardization. This template was pre-aligned to each face using five automatically determined landmarks and fitted using MeshMonk. All cleft patients were compared to an age-and gender matched normative face using distance maps and inter-surface distances (mm). Average faces were created for five groups (unilateral cleft lip, alveolus, and/or palate (UCL/A/P), fusion and differentiation defects). The selected regions for the evaluation of facial morphology were: complete face, nose, upper lip, lower lip, chin, forehead, and cheeks.

Results

A total of 86 consecutive 3D-stereophotogrammetry images were acquired for examination. No statistically significant differences were observed among the UCL, UCLA, and UCLP groups for the complete face, cheeks, chin, forehead, lower lip, and nose. However, in the upper lip region a significant difference was observed between the UCLP and UCL groups (P = 0.004, CI [-2.93 to -0.48]). Further visual examination of the distance maps indicated that more severe clefts corresponded to increased retrusion in the midface and the tip of the nose, though these differences were not statistically significant across groups. For fusion vs differentiation defects, no statistically significant differences were observed, neither for the complete face nor for any of the individual regions.

Conclusion

The findings demonstrate statistically significant differences in the upper lip region between children with UCL and those with UCLP, particularly with greater upper lip retrusion in the UCLP group. The use of color-coded distance maps revealed local variations and a trend of asymmetry in the nasal region, with increasing retrusion of the nose tip, upper lip, and cheeks correlating with the severity of the cleft. Although these trends were not statistically significant, they suggest a progressive facial retrusion pattern as cleft severity increases. For the secondary objective, no statistical differences were found between the facial morphology of children with fusion and differentiation defects, although a similar progression of maxillary retrusion was observed in the distance maps.

Parent-implemented early intervention design for improving speech and language skills among Mandarin-speaking infants and toddlers with cleft lip and/or palate

Background

Cleft lip and/or palate (CL/P) speech is a significant communication disorder with notable and enduring consequences. This study focused on developing an intervention mapping (IM)-based and parent-implemented early intervention to improve speech and language skills among infants and toddlers with CL/P in China.

Methods

An IM procedure was used to develop a parent-implemented early intervention. First, parent-child interaction problems affecting language development in infants and toddlers were identified through 132 questionnaires completed by parents of children with CL/P and 30 family videos of parent-child interactions. Second, according to the problem diagnosis, the logical model of parent-child interaction behavior change was constructed. Finally, the health outcomes were transformed into intervention goals at three levels (i.e., infants and toddlers with CL/P, parents and environment), and a set of early intervention programs were designed by integrating various intervention techniques.

Results

The diagnosis of parent-child interaction problems showed that 40.91% of parents and children often use electronic media together; in parent-child interaction, 41.67% of parents presented 'lack of waiting', 29.55% overcorrected pronunciation errors. Video analysis revealed issues in parent-child interaction, such as inadequate parental skills, ineffective interactions, and an unsuitable environment. A parent-implemented early intervention was developed, including the following specific steps: health education within the hospital, 9 days of an online reading program in WeChat groups, face-to-face standardized training workshops, and individualized video feedback therapy.

Conclusion

We have devised a parent-implemented early intervention to enhance speech and language abilities in Mandarin-speaking infants and toddlers with CL/P, overcoming the shortage of speech therapy services in China.

Parents' views and experiences of raising babies born with cleft lip and palate: a qualitative study

BACKGROUND

Parents of children born with cleft lip/palate encounter numerous challenges. This study aims to provide a deeper understanding for authorities to better support these parents by exploring the views and experiences of Iranian parents raising babies with cleft lip/palate through qualitative research.

METHODS

This qualitative study collected data through face-to-face, in-depth, semi-structured interviews. Using purposive sampling, parents of children with cleft lip/palate who visited the Department of Oral and Maxillofacial Surgery at the Children's Medical Center in Tehran, Iran, were selected. Thematic content analysis was employed to interpret the data and identify themes and subthemes.

RESULTS

From 20 interviews, six themes were identified. The diagnosis theme was associated with timing. Key concerns within the psychosocial experiences theme included initial reactions, pressure from society, the child's future in the community, hiding from family, feeling guilty about the anomaly, and couples' relationships. The challenges in childcare theme included feeding difficulties, financial challenges, and cleft treatments. The information acquisition theme included primary awareness and the importance of knowing how to care for the child. The coping theme included gaining awareness, accepting the problem as God's will and destiny, minimizing the significance of the child's cleft, and support. Parents had concerns about informing the child of his/her condition.

CONCLUSIONS

Parents of infants with cleft lip/palate feel unsupported by medical staff in feeding practices and seek improved training for staff. They propose a program to empower staff and advocate for psychological support for parents. Access to specialized baby bottles and financial support is crucial, along with establishing a parent-led community for sharing experiences.

Evaluation of the Effect of Unilateral Cleft Palate on Piriform Aperture Dimensions

OBJECTIVE

The aim of the present research was to assess and compare the piriform aperture dimensions of subjects with a unilateral cleft lip and palate (UCLP) and those of a control group using cone-beam computed tomography (CBCT).

DESIGN

CBCT data of 40 subjects with a complete UCLP (28 males and 12 females, with a mean age of 17.21 ± 5.75 years) and 40 CBCT images of age- and sex-matched subjects with no cleft, serving as the control group (28 males, 12 females; mean age, 17.25 ± 5.74 years) were included in the study. The maximal height and width of the piriform aperture as well as nasal bone height were measured and statistically compared between the groups.

RESULTS

There were no significant differences in the age and sex distributions between the groups. The mean piriform aperture height was significantly lower in the UCLP group than in the control group, while the mean piriform aperture width was significantly higher in the UCLP group compared to the control group (P < .01). Furthermore, the mean bony nasal height was found to be significantly lower in the UCLP group than in the control group (P < .01).

CONCLUSIONS

According to the present findings, UCLP is associated with changes in the piriform aperture dimensions due to lower height and higher width values. These structural alterations may contribute to the functional and aesthetic nasal challenges in patients with UCLP.

CLP-Net: an advanced artificial intelligence technique for localizing standard planes of cleft lip and palate by three-dimensional ultrasound in the first trimester

BACKGROUND

Early diagnosis of cleft lip and palate (CLP) requires a multiplane examination, demanding high technical proficiency from radiologists. Therefore, this study aims to develop and validate the first artificial intelligence (AI)-based model (CLP-Net) for fully automated multi-plane localization in three-dimensional(3D) ultrasound during the first trimester.

METHODS

This retrospective study included 418 (394 normal, 24 CLP) 3D ultrasound from 288 pregnant woman between July 2022 to October 2024 from Shenzhen Guangming District People's Hospital during the 11-13+ 6 weeks of pregnancy. 320 normal volumes were used for training and validation, while 74 normal and 24 CLP volumes were used for testing. Two experienced radiologists reviewed three standard lip and palate planes (mid sagittal, retronasal triangle, and maxillary axial planes) as ground truth (GT) and the CLP-Net was developed to locate these planes.

RESULTS

In normal test set, mean angle(± SD)° and distance(± SD)mm differences were 6.24 ± 4.83, 9.81 ± 5.48, 15.36 ± 18.14 and 0.86 ± 0.72, 1.36 ± 1.15, 1.96 ± 2.35 for MSP ± SD, RTP ± SD and MAP ± SD, NCC and SSIM were 0.931 ± 0.079, 0.819 ± 0.122, 0.781 ± 0.157 and 0.896 ± 0.058, 0.785 ± 0.076, 0.726 ± 0.088 respectively. In the CLP cases, there were 8.61 ± 5.52, 10.67 ± 5.08, 16.91 ± 17.42 and 1.03 ± 1.20, 1.17 ± 1.08, 1.34 ± 0.95 for mean angle and distance in MSP, RTP, and MAP, respectively. NCC and SSIM were 0.876 ± 0.104, 0.803 ± 0.084, 0.793 ± 0.089 and 0.841 ± 0.105, 0.812 ± 0.085, 0.764 ± 0.100, respectively. CLP-Net predictions had a highly visual acceptance rate among radiologists (MSP: 95%, RTP: 70%, MAP: 70%), with improved localization speed 15s(31.3%) for senior radiologists and 63s(38.9%) for junior radiologists.

CONCLUSIONS

CLP-Net accurately locates three planes for CLP screening, aiding radiologists and enhancing the efficiency of ultrasound examinations.

Prenatal to Adulthood: The Responsibility of the Speech-Language Pathologist on the Comprehensive Cleft Palate and Craniofacial Team

PURPOSE

Comprehensive cleft care is an important component when caring for a child with cleft palate with or without cleft lip (CP ± L). Speech-language pathologists (SLPs) serve different capacities on comprehensive cleft palate and craniofacial teams.

METHOD

This tutorial highlights the role of the SLP on the cleft palate and craniofacial team from the prenatal consultation to adulthood. This tutorial emphasizes the importance of collaboration between the cleft team SLP and other professionals on a comprehensive cleft team. Additionally, the tutorial provides education for feeding infants with CP ± L and focuses on assessment and treatment of children with CP ± L before and after the palate repair. Finally, this tutorial underscores the importance of working as part of and collaborating with interdisciplinary team members.

RESULTS

SLPs are an essential member of comprehensive cleft teams in addition to other medical providers. SLPs play a critical role on these multidisciplinary teams and are fundamental to the assessment and treatment of feeding, speech, language, and resonance disorders in children with CP ± L.

CONCLUSION

It is critical that SLPs are involved in comprehensive cleft team care from the prenatal consultation through adulthood to monitor resonance, speech, and language development and outcomes.

Microbiome and Communication Disorders: A Tutorial for Clinicians

PURPOSE

Emerging research in the field of microbiology has indicated that host-microbiota interactions play a significant role in regulating health and disease. Whereas the gut microbiome has received the most attention, distinct microbiota in other organs (mouth, larynx, and trachea) may undergo microbial shifts that impact disease states. A comprehensive understanding of microbial mechanisms and their role in communication and swallowing deficits may have downstream diagnostic and therapeutic implications.

METHOD

A literature review was completed to provide a broad overview of the microbiome, including differentiation of commensal versus pathogenic bacteria; cellular mechanisms by which bacteria interact with human cells; site-specific microbial compositional shifts in certain organs; and available reports of oral, laryngeal, and tracheal microbial dysbiosis in conditions that are associated with communication and swallowing deficits.

RESULTS/CONCLUSIONS

This review article is a valuable tutorial for clinicians, specifically introducing them to the concept of dysbiosis, with potential contributions to communication and swallowing deficits. Future research should delineate the role of specific pathogenic bacteria in disease pathogenesis to identify therapeutic targets.

Electromyographic Evaluation of Masticatory Muscle Activity in Individuals with and without Cleft Lip/Palate: A Systematic Review and Meta-analysis

OBJECTIVE

This study aims to systematically review and meta-analyze the electromyographic activity of masticatory muscles in cleft palate and non-cleft patients, and identify influencing factors.

DESIGN

Systematic Review and Meta-analysis.

PATIENTS AND EXPOSURES

Patients with cleft lip/ palate.

COMPARISON

Patients without CL/P.

MAIN OUTCOME MEASURES

Electrical activity of masseter and temporalis muscles at rest and during peak activation.

RESULTS

After a comprehensive search in MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL up to December 2022, without language or date restrictions. Eligible trials were selected based on the PECO question and assessed for bias using Cochrane's ROBINS-E tool. Eight clinical trials with 474 participants were included in the review. Then relevant data was extracted from included studies using customized forms. A random-effects meta-analysis was performed to combine the results of the studies, meta-analyses showed that CL/P patients have elevated electrical activity in the masseter (P = .01) and temporalis (P = <.01) muscles at rest compared to non-cleft control patients. During maximum bite force, cleft patients exhibited a statistically significant decrease in electrical activity in both the masseter (P = .03) and temporalis (P = <.01) muscles.

CONCLUSIONS

According to our meta-analysis, cleft patients exhibited increased resting muscle activity but decreased activity during maximum bite force, indicating reduced efficiency of masticatory muscles compared to non-cleft patients. These differences can be attributed to anatomical variations, compensatory mechanisms, and previous treatments.

Facilitators, barriers, and strategies of communication in Malaysian school-age children with non-syndromic cleft lip and palate: Results of in-depth online qualitative interviews

This study explores the perceptions of facilitators, barriers to communication and strategies in Malaysian school-aged children with non-syndromic cleft lip and palate (CL/P), parents, and teachers. Fourteen children with non-syndromic CL/P aged 7 to 12 years, their parents (n = 16), and their teachers (n = 10) were recruited via purposive sampling. Participants were selected based on resilience scores (RS-10; (Wagnild, 2015) distinguishing low (<34) from high resilience (35-40) (Wagnild, 2015). Individual in-depth interviews were conducted online and evaluated qualitatively. The analyses were conducted utilising the guidelines by Braun and Clarke (2006). Inductive thematic analysis was performed. Facilitators for communication identified by children, parents and teachers were the child's personal attributes, common interests, and helping others. Barriers that were identified were unfamiliar conversation partners, and insensitive comments or questions. Children used passive (e.g. ignored) and active (e.g. retorted, explained the condition) strategies to address social communication issues. Children with high resilience responded more actively than children with low resilience. Strategies that were described by the parents included accepting the child, empowering themselves, following the cleft management plan, and empowering the child. Teachers adopted general approaches such as giving encouragement, increasing confidence, and teaching empathy. The presence of face masks was perceived as both a facilitator and a barrier to communication. The study provides information on challenges encountered and coping mechanisms used by children with non-syndromic CL/P, their parents and their teachers. This knowledge may help the development of targeted interventions to support the communication of children with non-syndromic CL/P in school.

Exploring the Regulatory Interaction of Differentially Expressed Proteins in Cleft Palate Induced by Retinoic Acid

OBJECTIVE

This study aimed to identify novel proteins involved in retinoic acid (RA)-induced embryonic cleft palate development.

METHODS

The palate tissues of the control and RA-treated E14.5 were dissected and subjected to iTRAQ-based proteomic analysis.

RESULTS

Differential expression analysis identified 196 significantly upregulated and 149 downregulated considerably proteins in RA-induced palate tissues. Comprehensive Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis revealed the significant involvement of cytoplasmic translation, ribosome biogenesis, glycolysis/gluconeogenesis, and glutathione metabolism pathways in cleft palate pathogenesis triggered by RA. In particular, ribosome-related pathways were highly enriched, while glycolysis was disrupted. Protein-protein interaction analysis, facilitated by the STRING database, revealed a tightly interconnected network of differentially expressed proteins. Further analysis using the cytoHubba plugin in Cytoscape identified ten hub proteins, including Eif4a1, Gapdh, Eno1, Imp3, Rps20, Rps27a, Eef2, Hsp90ab1, Rpl19, and Rps16, indicating their potential roles in RA-induced cleft palate development, and thus positioning them as potential biomarkers for cleft palate.

CONCLUSION

These findings provide valuable insights into the proteomic changes associated with RA-induced cleft palate and shed light on key pathways and proteins that can contribute significantly to the pathogenesis of this congenital condition.

Oral and Maxillofacial Manifestations of Kallmann Syndrome: A Systematic Analysis of the Literature

AIMS

Kallmann syndrome (KS) is a rare genetic disorder characterized by congenital hypogonadotropic hypogonadism and varied clinical features. Despite its recognition, the oral and maxillofacial manifestations remain poorly understood. This study synthesized clinical aspects and management of KS-related oral and maxillofacial alterations.

METHODS

Searches were conducted in the PubMed, Web of Science, Scopus, Embase, and LILACS databases, supplemented by manual scrutiny and gray literature. Case series and/or case reports were included. The Joanna Briggs Institute tool was employed for critical appraisal of the studies.

RESULTS

A total of 46 studies comprising 108 cases were included. The mean age of individuals was 19.8 (±12.6) years, and there was a marked predominance of males (79.3%). Cleft lip/palate (32.7%) was the predominant oral condition, followed by high-arched palate (21.7%), and dental agenesis (19.8%). Oral treatment consisted of corrective surgery of the cleft lip and/or palate (n = 9), myoplasty (n = 1), and tooth extraction/orthodontic treatment (n = 1). Hyposmia/anosmia (71.3%) was the most frequently reported manifestation.

CONCLUSION

Early diagnosis and interdisciplinary collaboration are essential for addressing the complex nature of KS-related oral and maxillofacial alterations and improving patient outcomes. The scarcity of data on oral treatment underscores the need for additional research and clinical attention in this field.

Awareness, Knowledge, and Attitude Assessment of Cleft Lip With or Without Palate Management Among Vietnamese Dental and Medical Students: A Cross-Sectional Study

Background Cleft lip and/or palate (CL/P) are congenital malformations that require multidisciplinary treatment and in-depth knowledge for effective management, especially in countries like Vietnam, where the incidence rate is 1.4 per 1,000 live births. This study aimed to develop and validate a questionnaire to assess the awareness, knowledge, and attitudes of undergraduate medical and dental students at Hanoi Medical University, Vietnam, regarding CL/P management. Materials and methods The questionnaire was administered using Google Forms (Google LLC, USA). The study participants were 284 (55.6%) dental students and 227 (44.4%) medical students at Hanoi Medical University, Vietnam. The questionnaire comprised four sections: general information, awareness, knowledge, and attitude assessments. Results In the awareness assessment, 97.5% of students were aware of CL/P. However, 84.1% and 66.5% of medical and dental students, respectively, lacked confidence in their current knowledge. Confidence levels increased gradually from third-year to final-year students. Regarding etiology, most students believed genetic factors were the primary cause of CL/P, followed by environmental factors. The most commonly chosen treatment methods were oral, maxillofacial, and plastic surgeries. Dental students showed more interest in CL/P and felt a greater need for additional training in CL/P treatment and management than medical students. Both dental and medical students favored early intervention. However, 19.4% of students were unsure about the optimal time to begin treatment, with this uncertainty being more prevalent among medical students (26%) than among dental students (14.1%) (p<0.001). Conclusion This study emphasizes the need for improved education among undergraduate students, especially medical students, to improve CL/P management.

Evaluating quality of life changes in patients with cleft lip or palate: a mixed method pre- and postsurgical analysis in Karachi

BACKGROUND

Cleft lip and/or palate (CLP) is the most common orofacial congenital disability, presenting significant medical, psychological, and social challenges. In Pakistan, the incidence of CLP is high, estimated at one in 523 live births, but accurate data are lacking due to the absence of a birth registry. Early diagnosis and intervention are crucial for improving outcomes. This study evaluated the impact of CLP on patients' quality of life in Karachi, comparing pre- and post-surgical phases.

METHODS

A sequential exploratory quantitative-qualitative mixed-methods study was conducted at two tertiary care hospitals in Karachi. In the quantitative phase, 280 patients with CLP, either awaiting or post-surgery, completed the Oral Health Impact Profile (OHIP-14) questionnaire to assess oral health-related quality of life (OHRQoL). Based on questionnaire responses, 30 participants were purposively selected for in-depth, semi-structured interviews exploring their experiences. Quantitative data were analyzed using SPSS version 25; qualitative data were analyzed thematically.

RESULTS

Quantitative findings revealed significant gender disparities in cleft types and correction status; females had a higher prevalence of unilateral cleft lip, while males had more cleft palate cases. Dental and oral health issues significantly affected daily activities, with higher impacts in cleft palate patients. OHRQoL varied by gender, cleft type, and correction status, with those post-surgery reporting poorer OHRQoL. Qualitative analysis identified six themes: Diagnosis and Early Treatment, Challenges and Impact, Postsurgical Experiences, Support Systems, Healthcare Experiences, and Future Perspectives. Inconsistencies in psychological support, accessibility and financial burdens were presented as significant issues. Sentiment analysis highlighted varied emotions, from despair to hope and gratitude.

CONCLUSIONS

CLP significantly affects patients' quality of life in Karachi across multiple dimensions. Early diagnosis and surgical intervention are essential but often hindered by financial and accessibility issues. Psychological effects, including low self-esteem and social isolation, highlight the need for integrated mental health support. Family and community support are critical for patient resilience. A comprehensive approach addressing medical, psychological, social, and systemic factors is necessary to improve outcomes for individuals with CLP.

Genetic Mutations Leading to Dento-Maxillofacial Abnormalities in Mice: A Systematic Review

INTRODUCTION

To systematically review the available literature reporting on genetic mutations leading to dento-maxillofacial malformations in mice.

MATERIALS AND METHODS

An electronic search was performed across Embase, PubMed, Web of Science, and Scopus databases up to May 2024, targeting all in vivo studies on gene mutations causing dento-maxillofacial deformities in mice. Studies reporting oral clefts were excluded. Data collected included genetic background, sex distribution, observation times, sample sizes, interventions, affected genes, zygosity, dento-maxillofacial anomalies, and associated human syndromes. Risk of bias was evaluated using the SYRCLE tool.

RESULTS

Of 12,968 articles, 215 were included. The most common genetic background was C57BL6/J (B6) (n = 83), and knock-out was the most common intervention (n = 142). A total of 172 studies included homozygous mice. The five most studied genes were Amelx, Bmp-2, Dspp, Enam, and Runx2. Dento-alveolar anomalies were more commonly reported (n = 175) than skeletal (n = 65). Skeletal anomalies were mostly related to micrognathia (n = 14), agnathia (n = 5), dysplasia (n = 1), or reduced jaw size (n = 14). Risk of bias was moderate.

CONCLUSIONS

Key genes such as Amelx, Bmp-2, Dspp, Enam, and Runx2 implicated in dento-maxillofacial abnormalities in mice, detailing the most prevalent skeletal and dento-alveolar anomalies. These findings offer insights for developing gene therapy and diagnosing congenital malformations.

Three-dimensional assessment of mandibular asymmetry in patients with unilateral cleft lip and palate at different growth stages: a cross-sectional study

INTRODUCTION

The early diagnosis of mandibular asymmetry (MA) in patients with unilateral cleft lip and palate (UCLP) can contribute to its treatment.

OBJECTIVE

The aim of this study was to evaluate the occurrence and the extent of MA in UCLP patients at different growth stages.

METHODS

Cone-beam computed tomography (CBCT) of 47 UCLP patients were included, and divided into two groups (prepubertal stage and pubertal stage). The mandibular ramus height (Co-Go), mandibular body length (Go-Me), total mandibular length (Co-Me), gonial angle (CoGoMe), the volume of the mandibular condyles, and lateral chin deviation were evaluated. The cleft side (CS) and noncleft side (NCS) were compared using the paired t-test for dependent samples. Chin deviation and its possible association with specific sides were evaluated using the Mann-Whitney and Fisher's Exact tests, respectively. The significance level was set at 5%.

RESULTS

Comparison of CS and NCS revealed that in prepubertal stage, Co-Me was shorter (105.5 ± 5.7 mm; p = 0.036) in the CS, and that in pubertal stage, Co-Go was lower (46 ± 6 mm; p= 0.004) and Go-Me was greater (78.5 ± 5.8 mm; p = 0.026) in the CS. In both growth stages, a significant association (p< 0.05) was observed between the side to which the chin has deviated and the CS.

CONCLUSIONS

Although patients with UCLP in the prepubertal and pubertal stages presented significant measurements revealing MA, only Co-Go in the pubertal stage showed a clinically relevant difference. This specific result indicates that MA must be monitored during patients' growth.

Risk of pneumonia among children with cleft palate before and after palatoplasty: a population-based study

Pneumonia remains the primary cause of mortality among children under age 5. Cleft palate (CP) poses various challenges including velopharyngeal disfunction, potentially increasing rates of pneumonia. However, clinical evidence linking pneumonia to defect is lacking. This study aims to assess the prevalence of pneumonia and lower respiratory tract infections (LRTI) among CP patients through a population-based approach. This retrospective cohort study was conducted using medical records from Clalit Health Services in Israel, 2013-2022, encompassing population of 138,261 infants, including 166 with CP. We investigated the prevalence of pneumonia and other infectious diseases before and after palatoplasty, employing Poisson regression models adjusted for multiple demographic and clinical variables. A sibling comparison study was also conducted, analyzing 129 preoperative and 55 postoperative pairs. The preoperative analysis revealed an increased risk of pneumonia (relative risk [RR]: 5.8, 95% confidence interval (CI): 3.93-8.19), lower respiratory tract infections (LRTI) (RR: 1.55, 95% CI: 1.12-2.06), and urinary tract infections (UTI) (RR: 5.27, 95% CI: 3.23-8.03) in children with CP compared to controls. Following surgical repair, a statistically significant but reduced risk for pneumonia persisted up to 5 years (RR: 2.55, 95% CI: 1.59-3.84). Sibling comparison analyses underscored an elevated pneumonia risk compared to CP siblings preoperatively (RR: 7.07, 95% CI: 2.48-29.8). Postoperatively, the RR decreased and was no longer statistically significant (RR: 1.44, 95% CI: 0.49-4.75).

CONCLUSION

Patients with CP are at higher risk for pneumonia, and the magnitude of risk may be reduced after palatoplasty.

WHAT IS KNOWN

• Cleft palate (CP) disrupts the separation of the nasal and oral cavities, leading to food regurgitation into the nasal cavity and theoretically may lead to respiratory tract infections. • The association between CP and respiratory tract infections has yet to be assessed thoroughly.

WHAT IS NEW

• This population-based study has shown that CP is an independent risk factor for pneumonia. • The risk for pneumonia among CP patients is lowered after surgical repair of the defect.

Double Reinforcing Strategy with Perpendicular Plate of Ethmoid in Asian Secondary Unilateral Cleft Rhinoplasty: A Finite Element Analysis

BACKGROUND

Deviation and asymmetry relapse after secondary unilateral cleft rhinoplasty with septal extension graft is a common yet serious problem especially among Asian patients. Therefore, finding an effective approach to reduce deformity relapse remains a great challenge to plastic surgeons.

METHODS

In this study, authors established finite element models to simulate different nasal cartilage-corrected options and different reinforcing strategies in secondary unilateral cleft rhinoplasty. A load of 0.01N was given to the nasal tip to simulate the soft tissue pressure, while two loads of 0.5N were separately given to the anterior and posterior part of the septal extension graft to simulate the rhinoplasty condition. Maximum deformations were evaluated to make stability judgments.

RESULTS

The maximum deformation of different cartilage correction models in ascending order was: UCL deformity with septum correction, normal nasal cartilage, UCL nasal deformity, and UCL nasal deformity with lower lateral cartilage correction. When applied L-strut reinforcement graft was harvested from the perpendicular plate of the ethmoid bone, the maximum deformation of the models decreased significantly, and strong fixation of the septum could further enhance this decreasing effect.

CONCLUSIONS

Correcting the septum and lower lateral cartilage together could improve the structural stability and symmetry in secondary unilateral cleft rhinoplasty. To keep the corrected septum stable and thus reduce deformity relapse, reinforcing the L-strut with perpendicular plate of ethmoid graft while strongly anchoring the septal cartilage to the anterior nasal spine was proved to be effective in both finite element analysis and clinical observation.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anterior maxillary distraction for cleft palate associated severe hypoplastic maxillary Class III deformity during adolescence - A case report

This report chronicles the case of an adolescent female with cleft palate associated severe hypoplastic maxillary Class III deformity. Treatment involved anterior maxillary segmental distraction osteogenesis (AMSDO) in conjunction with pre-distraction and post-distraction orthodontics. Following pre-distraction orthodontics, AMSDO was performed using a customized Hyrax distractor assembly. Post-distraction orthodontics helped stabilize distraction outcomes and finalize occlusion. Post-treatment, midface deficiency and prognathic profile improved dramatically with establishment of acceptable interincisal relationship and well-balanced functionally interdigitated occlusion. Three-year follow-up showed excellent morphologic and functional stability. AMSDO is a viable modality that contributes to effective stomatological rehabilitation of patients with cleft maxillary hypoplasia.

Low-Dose Cone-Beam Computed Tomography in Swedish Pediatric Patients With Alveolar Clefts Following Alveolar Bone Grafting-A Clinical Study

OBJECTIVES

The aim of this study was to investigate whether a low-dose cone-beam computed tomography (CBCT) protocol provides diagnostically acceptable image quality for assessing bone healing after alveolar bone grafting.

MATERIAL AND METHODS

The study cohort comprised 11 patients (aged 7-14 years) with orofacial clefts who had undergone alveolar bone grafting at Skåne University Hospital in Malmö, Sweden. During the postsurgical follow-up at 6 months, each patient was assessed twice: once with a standard-dose CBCT protocol and once with a low-dose CBCT protocol, which in total corresponds to one CBCT examination made with the exposure settings recommended by the manufacturer. Among others, the assessed parameters included subjective image quality, as well as bone graft height, thickness, and integration.

RESULTS

No significant differences were found between the standard- and low-dose protocols for most parameters (p > 0.05). Exceptions included subjective image quality (one observer, p = 0.05) and confidence levels during the assessment (three observers, p = 0.01, 0.01, 0.02).

CONCLUSIONS

The low-dose protocol yielded adequate image quality for postoperative CBCT healing assessment in patients who have undergone alveolar bone grafting. However, the confidence level of observers during the assessment with the low-dose protocol was reduced. This study is registered on ClinicalTrials.gov (NCT06395077).

CLINICAL TRIAL REGISTRATION

This study is registered on ClinicalTrials.gov (NCT06395077).

CO2 laser treatment for scars after cleft lip surgery: a systematic review and meta-analysis

BACKGROUND

Current studies are controversial on the optimal treatment of postoperative scar treatment by cleft lip. Our objective is to elucidate the therapeutic effect of CO2 laser on postoperative cleft lip scar treatment.

METHODS

A systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched five electronic databases (EMBASE, PubMed, Web of Science, Cochrane Library and CNKI, from their inceptions until August 8, 2023) and independently assessed the methodological quality and bias risk of the included studies by two investigators using the Cochrane Handbook for Systematic Reviews. Quality assessment of the certainty of evidence was performed based on the Grading of Recommendations Assessment, Development, and Evaluation guidelines. Weighted mean difference of Vancouver Scar Scale were calculated to conduct meta-analysis by Stata statistical software version 14. We also estimated the pool sensitivity as well as testing the possibility of publication bias.

RESULTS

Five studies were included in this meta-analysis involving 255 subjects. Meta-analysis showed that compared with the control group, CO2 laser was more effective in treating post-cleft lip scars (WMD = 4.39, 95%CI = 0.54-8.23; Five studies with 255 participants; Low evidentiary certainty, I2 = 99.4%).

CONCLUSIONS

Patients treated with CO2 laser therapy for postoperative cleft lip scar treatment tend to have a significant therapeutic effect especially in the early stages.

TRIAL REGISTRATION

identifier CRD42023397042 (18/02/2023) [ https://www.crd.york.ac.uk/prospero/ ].

Naso-alveolar Asymmetry in Unilateral Cleft Lip and Palate Patients-CT Analysis of the Paranasal Region

Secondary deformities to the midfacial area in adolescence and adulthood are common sequelae after primary cleft lip and palate repair and lead to significant functional, aesthetic and psychosocial challenges. Treatment for patients with normal occlusion or treated malocclusion and remaining midfacial hypoplasia includes autologous and alloplastic augmentation of the maxilla. Because of the great variation of deformities, accurate evaluation is essential for appropriate treatment planning. To provide insights in the altered midfacial anatomy in cleft patients, a retrospective computed tomography morphologic analysis of the anterior projection of the maxilla in the paranasal region, soft tissue thickness, and relation of soft tissue to bony landmarks was performed in adolescent, unilateral, non-syndromic complete cleft and palate patients. The anterior projection of the maxilla was very variable with the cleft side bone surface being more anterior relative to the non-cleft side in some patients. Soft tissue thickness was not significantly different between cleft and non-cleft side. The lateral distance from the most anterior point of the maxilla to subalare was significantly smaller on the cleft side as compared with the non-cleft side. The authors' study demonstrates that in cleft lip and palate patients midfacial anatomy with regards to maxilla projection at the pyriform aperture is very variable making accurate evaluation of the bone morphology and an individualized treatment plan a prerequisite for successful correction of nasomaxillary deformities.

Information Needs of Australian Families Living with Craniosynostosis: A Qualitative Study

OBJECTIVE

Craniosynostosis is considered a lifelong condition, yet relatively little focus has been directed toward ascertaining the information needs of Australian families. Thus, the aim of this study was to explore the information needs of Australian parents whose child has been diagnosed with nonsyndromic or syndromic craniosynostosis.

DESIGN

Twenty-one online narrative interviews were conducted with parents of children with craniosynostosis (aged between 4 months and 20 years). Transcripts were analyzed using reflexive thematic analysis and themes were developed.

RESULTS

Four themes were generated: (1) lots of information …. and quickly!; (2) the practicalities of hospital and surgery; (3) guidance on how to talk about my child's condition; and (4) the path is rarely clear. Parents of children with craniosynostosis discussed a range of information that was provided to them, or they would have liked to have been given, following their child's diagnosis. Parents noted that insufficient information was provided by the health system and that they faced considerable difficulties accessing credible information about their child's condition, relevant location-specific surgical options, the treatment process and outcomes.

CONCLUSIONS

Narrative interviews provided detailed insight into the information needs of Australian parents of children diagnosed with craniosynostosis. Although parents were frequently challenged by a lack of information detailing their specific treatment and support options, suggestions relevant to craniofacial providers globally were offered. Further work is now needed to develop and provide these information resources in a timely and easily accessible way.

Normative CLEFT-Q Data From the General Dutch Population

Patient-Reported Outcome Measures (PROMs), such as the CLEFT-Q, have become essential for outcomes in patients with CL/P. Normative values of the CLEFT-Q for non-CL/P peers have not yet been established. This study aims to establish normative values for the CLEFT-Q in the general Dutch population. Dutch nationals aged 16-24 years without CL/P were recruited through an online survey. Participants completed the CLEFT-Q, excluding the lip scar and eating and drinking scales. Data were weighted based on the Dutch Central Bureau of Statistics. Normative values were calculated as means and standard deviations, stratified by sex and education category. Tobit regression models were used to analyze associations between CLEFT-Q scores and demographic variables. In total, 870 participants responded, of which 160 were excluded due to potential craniofacial anomalies. Significant variations in CLEFT-Q scores based on sex were found, with females scoring lower than males. Level of education had a modest impact on CLEFT-Q scores, with lower education having lower scores on certain scales. Age marginally influenced CLEFT-Q scores, with younger participants scoring lower than older participants. Positive correlations were found between all CLEFT-Q scales. The strongest correlation was observed between the social and school functioning scales. This study provides the first set of normative values for the CLEFT-Q in the Dutch general population. Significant differences in CLEFT-Q scores based on sex, level of education and age were found. These normative values are useful for clinicians interpreting CLEFT-Q scores and help make informed decisions.