A descriptive epidemiology study of oral cleft in sergipe, Brazil

Epidemiologic Characteristics, Time Trend, and Seasonality of Orofacial Clefts in São Paulo State, Brazil. 2008-2019

OBJECTIVE

To characterize the epidemiology, identify trends in prevalence, seasonality, and risk factors for orofacial clefts (OFC), selecting the São Paulo state (SPS) population database.

DESIGN

A population-based study to estimate the OFC prevalence trends in recent years, stratified by maternal age and SPS geographical clusters.

SETTING

All live births (LB) with OFC in SPS from 2008-2019.

PATIENTS

5342 cases of OFC among 7 301 636 LB.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

OFC prevalence trends, annual percent change (APC) with a 95% confidence interval, and seasonality.

RESULTS

We found an OFC prevalence of 7.3/10 000LB in SPS, Brazil. Among all the cases, the majority were male (57.1%), Caucasian (65.4%), 77.8% born at term, 75.8% weight >2500 g, 97.1% singleton, and 63.9% of births were by cesarean section. From 2008-2019, SPS presented a stationary OFC prevalence trend; in São Paulo city, the highest APC was observed (0.05%); the maternal age group with the highest OFC prevalence rate was ≥35 years (9.2/10 000LB). We identified the existence of seasonal variation based on the conception date in the final months of the year, corresponding to the spring season (P < .001).

CONCLUSION

OFC had a stationary prevalence trend in recent years, with the highest prevalence in the Central North Cluster and ≥35 years maternal age group. Seasonality was observed in the spring season, and congenital malformation of lips was the most common associated pathology. This population-based study is the first to summarize the current epidemiology of OFC in SPS.

Population Prevalence and Trends of Oral Clefts in Colombia: Analysis by Departments

Determine the population prevalence and trends of cleft lip and/or palate (CL/P) by department for Colombia in the period 2009 to 2015.

Prevalence study based on Individual Registry of Health Services in general population from 2009 to 2015. All people diagnosed with CL/P were included for all ages, type of diagnosis, and any type of health services in the mentioned period. The prevalence was calculated by period and point for each year, for each department and according to the type of cleft. Stationarity on time series was evaluated using (Dickey-Fuller) and (Phillips-Perron). A trend test was applied to estimate whether the increase in prevalence was significant in the period. The trend test used was a Poisson regression.

A total 15 225 people with CL/P were identified, where 53.3% were men. The national period prevalence of CL/P is 3.37 per 10 000 with upward trend (prevalence ratio = 1.34, P = .05) and nonstationary behavior. The national period prevalence of cleft lip is 0.93 per 10 000, cleft palate 1.17 per 10 000, and cleft lip and palate (CLP) 1.26 per 10 000, where CLP is subclassify into unilateral CLP (0.83 per 10 000) and bilateral CLP (0.43 per 10 000). At the departmental level, the highest CL/P prevalence is Guaviare (11.2), followed by Guainía (8.4) and the lowest Quindío (0.49).

In Colombia, the national period prevalence of CL/P is 3.37 per 10 000 with upward trend at national level indicates an increase in prevalence from 2009 to 2015. The 77% of the total CL/P population are infant or adolescent. Geographically, the central region has the highest availability of technologies.

Prevalence of cleft lip and palate and associated factors in Brazil's Midwest: a single-center study

The aim of this study was to evaluate the prevalence of cleft lip and/or palate (CL/P) and associated factors in patients treated at a referral service in Brazil's Midwest. Data were obtained from medical records on file between 2010 and 2017 for this epidemiologic and associational study. A descriptive analysis of the sociodemographic and clinical data was carried out, after which the data were analyzed using the chi-square test and Poisson regression with robust variance. A total of 1,696 medical records were eligible. The requests for rehabilitation were mainly for children in the early years of life, and were mostly for patients from low-income families in the state of Goiás. CL/P was more prevalent in its most severe morphological representation (cleft lip and palate), and the most frequently affected side was the left. Syndromic cleft was present in 4.1% of the cases, and the Pierre Robin sequence and Apert syndrome appeared more frequently. Adjusted multivariate Poisson regression showed an association between cleft palate and the presence of syndromes, since the prevalence was 2.33 times higher in this case than that of no syndrome. Cleft lip and palate were associated with males, whereas cleft palate was associated with females. This study highlights the importance of collecting and analyzing epidemiological data, managing health service planning, and allocating funds to assist cleft patients.

Investigating the use of ultrasonography for the antenatal diagnosis of structural congenital anomalies in low-income and middle-income countries: a systematic review

BACKGROUND

Congenital anomalies are the fifth leading cause of under-5 mortality globally. The greatest burden is faced by those in low/middle-income countries (LMICs), where over 95% of deaths occur. Many of these deaths may be preventable through antenatal diagnosis and early intervention. This systematic literature review investigates the use of antenatal ultrasound to diagnose congenital anomalies and improve the health outcomes of infants in LMICs.

METHODS

A systematic literature review was conducted using three search strings: (1) structural congenital anomalies; (2) LMICs; and (3) antenatal diagnosis. The search was conducted on the following databases: Medline, Embase, PubMed and the Cochrane Library. Title, abstract and full-text screening was undertaken in duplicate by two reviewers independently. Consensus among the wider authorship was sought for discrepancies. The primary analysis focused on the availability and effectiveness of antenatal ultrasound for diagnosing structural congenital anomalies. Secondary outcomes included neonatal morbidity and mortality, termination rates, referral rates for further antenatal care and training level of the ultrasonographer. Relevant policy data were sought.

RESULTS

The search produced 4062 articles; 97 were included in the review. The median percentage of women receiving an antenatal ultrasound examination was 50.0% in African studies and 90.7% in Asian studies (range 6.8%-98.8%). Median detection rates were: 16.7% Africa, 34.3% South America, 34.7% Asia and 47.3% Europe (range 0%-100%). The training level of the ultrasound provider may affect detection rates. Four articles compared morbidity and mortality outcomes, with inconclusive results. Significant variations in termination rates were found (0%-98.3%). No articles addressed referral rates.

CONCLUSION

Antenatal detection of congenital anomalies remains highly variable across LMICs and is particularly low in sub-Saharan Africa. Further research is required to investigate the role of antenatal diagnosis for improving survival from congenital anomalies in LMICs.

PROSPERO REGISTRATION NUMBER

CRD42019105620.

Temporal Muscle Flap as a Treatment of an Extensive Cleft Palate in an Adult Patient

For the management of cleft palate, the surgical approach has been suggested at an early stage even in childhood, varying in the number of interventions. Once the interventions are not performed at appropriate times, such as sequences that may accompany specific psychological, functional, and aesthetic effects. Since it has been indicated, temporal muscle flap is a technique with satisfactory results for a resolution of extensive clef palate in adult patients. The purpose of this paper is reporting a case of temporal muscle flap in the soft and hard palate of an adult with a reconstruction of the donor area with a titanium mesh. A 37 year old male patient with cleft lip/palate, complained of difficulty in speech, chewing, swallowing, and breathing. Clinically, it was observed oroantral communication in the region of the hard and soft palate, with a previous cheiloplasty. A temporal rotation was planned to close the fissure for the treatment. The modified coronal approach was used. Temporal muscle traction and its interposition in the palate region were performed through the tunneling technique, and mass suturing was performed. After 3 years, he presented satisfactory results, with the improvement of the quality of life, as well as the area of exposure. In conclusion, since it has been indicated, temporal muscle flap is a technique with satisfactory results for a resolution of extensive cleft palate in adult patients.

Symptoms of dysphagia in children with cleft lip and/or palate pre- and post-surgical correction

PURPOSE

Determine the occurrence of dysphagia symptoms in children with cleft lip and/or palate (CLP) pre- and post-surgical correction.

METHODS

Quantitative observational cross-sectional study. Existence of clef lip and/or palate without association with other syndromes was the study inclusion and/or exclusion criterion. Parents and/or legal guardians responded to a recall questionnaire on the identification of occurrence of coughing, choking, vomiting, and nasal escape pre- and postoperatively and whether these symptoms disappeared after surgical correction. The study was approved by the Research Ethics Committee of the aforementioned Institution under protocol no. 1573164.

RESULTS

The sample comprised 23 children with mean age of 48 months, mostly male and with unilateral trans-foramen incisor clefts. Statistically significant difference was observed between the pre- and post-surgical periods regarding the presence of dysphagia symptoms.

CONCLUSION

Surgical treatment of patients with cleft lip and/or palate proved to be a resource to prevent the occurrence of dysphagia symptoms when associated with adequate intervention chronology.