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Kljajić M, Schölin Sahlsten J, Rizell S, Mark H. Psychological Screening Indicates That 1 in 4 Children With Cleft Lip and Palate Require Psychological Support. J Craniofac Surg 2025:00001665-990000000-02568. [PMID: 40163000 DOI: 10.1097/scs.0000000000011315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Accepted: 03/06/2025] [Indexed: 04/02/2025] Open
Abstract
Children with cleft lip and/or palate (CL/P) often experience developmental issues, including language delay, learning difficulties, and attention issues. The aim of the study was to assess potential difficulties in children with CL/P and to determine the necessity of ongoing psychological support. Eighty-two children treated for CL/P, 29 5-year-olds and 53 10-year-olds, participated together with their parents in the study. The Strengths and Difficulties Questionnaire (SDQ) was used to assess difficulties and strengths. Proxy reports were used for the 5-year-olds, while self-reports and proxy reports were utilized for the 10-year-olds. Patients who were identified as requiring further support were offered psychological interventions. Parents of 5-year-olds and 10-year-olds with CL/P estimated significantly more difficulties compared with parents of children in the normal population. Thirty-nine percent of the parents estimated that their child had minor, moderate or severe difficulties. However, 10-year-olds with CL/P didn't perceive any difference in difficulties compared with preadolescents in the normal population. The 10-year-olds estimated significantly less emotional difficulties than children in the normal population. Nevertheless, 41% of the 10-year-olds reported that they overall had difficulties, either minor or severe, in one or more areas. There were significantly moderate correlations between parental and child reports on SDQ. According to the results of the standardized psychological screenings, 25.6% of children with CL/P required additional psychological support. One in 4 children with CL/P needs psychological support. Standardized psychological interview-based follow-ups for patients with CL/P can contribute to more information regarding the patient's needs rather than only using a questionnaire.
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Affiliation(s)
- Marizela Kljajić
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery
| | - Johnna Schölin Sahlsten
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery
| | - Sara Rizell
- Clinic of Orthodontics, Public Dental Service, Region Västra Götaland
- Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Mark
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery
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Shahrul AI, Nik Mustapha NM, Ahmad MS, Kharbanda OP, Abd Rahman ANA. Development of software for collecting cleft-specific data in Malaysia. BMC Oral Health 2025; 25:333. [PMID: 40038561 PMCID: PMC11877776 DOI: 10.1186/s12903-025-05583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 01/30/2025] [Indexed: 03/06/2025] Open
Abstract
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.
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Affiliation(s)
- Al Imran Shahrul
- Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
| | - Nik Mukhriz Nik Mustapha
- Centre for Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, Universiti Teknologi MARA Sungai Buloh Campus, Selangor Branch, Jalan Hospital, Sungai Buloh, 47000, Malaysia
| | - Mas Suryalis Ahmad
- Centre for Comprehensive Care, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor Branch, Jalan Hospital, Sungai Buloh, 47000, Malaysia
| | - O P Kharbanda
- Ramaiah University of Applied Sciences (RUAS), University House, MSR Nagar, New BEL Road, Bengaluru, 560054, India
| | - Aida Nur Ashikin Abd Rahman
- Centre for Paediatric Dentistry and Orthodontic Studies, Faculty of Dentistry, Universiti Teknologi MARA Sungai Buloh Campus, Selangor Branch, Jalan Hospital, Sungai Buloh, 47000, Malaysia.
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Lendt L, Becker M, Eriksson M, Klintö K. Foreign-born 5-year-old children with cleft palate had poorer speech outcomes than their native-born peers. Acta Paediatr 2024; 113:2628-2636. [PMID: 39105692 DOI: 10.1111/apa.17385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/07/2024]
Abstract
AIM Speech difficulties are common in children with cleft palate, but research on foreign-born children is limited. This study aimed to compare speech outcomes, surgery and speech intervention in 5-year-old foreign-born and Swedish-born children with cleft palate with or without cleft lip. METHODS This retrospective study analysed data from the Swedish cleft lip and palate registry for children born between 2009 and 2016 using Pearson's Chi-squared test and binary logistic regression. RESULTS Among 160 foreign-born (106 boys, 54 girls) and 847 Swedish-born (479 boys, 368 girls) 5-year-olds, foreign-born children had significantly lower rates of sufficient velopharyngeal competence (77% vs. 86%), age-appropriate consonant production (28% vs. 60%), and speech without non-oral speech errors (70% vs. 86%). Differences remained after adjustment for cleft type, gender and additional diagnosed conditions. After further adjustments for age at completed primary palatal surgery, differences in age-appropriate consonant production and speech without non-oral speech errors remained significant. Foreign-born children underwent completed primary palatal surgery at older ages and received more secondary palatal surgery and speech intervention than Swedish-born peers. CONCLUSION Foreign-born children showed poorer speech outcomes than Swedish-born peers, despite more secondary palatal surgery and speech intervention. Age at completed primary palatal surgery could partly explain these differences.
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Affiliation(s)
- Louise Lendt
- Division of Speech Language Pathology, Phoniatrics and Audiology, Department of Clinical Sciences in Lund, Lund University, Lund, Sweden
- Division of Speech Language Pathology, Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden
| | - Magnus Becker
- Division of Surgery, Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
- Division of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Marie Eriksson
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
| | - Kristina Klintö
- Division of Speech Language Pathology, Phoniatrics and Audiology, Department of Clinical Sciences in Lund, Lund University, Lund, Sweden
- Division of Speech Language Pathology, Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden
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Sahlsten Schölin J, Mark H, Rizell S. Craniofacial Growth in Children With Unilateral Cleft Lip and Palate: Adopted From China Versus Born in Sweden. J Craniofac Surg 2024:00001665-990000000-02143. [PMID: 39509729 DOI: 10.1097/scs.0000000000010862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 10/12/2024] [Indexed: 11/15/2024] Open
Abstract
OBJECTIVE In 2005, the number of internationally adopted children (IAC) with cleft lip and palate (CLP) from China increased globally, followed by an increase in the number of surgical complications. The aim was therefore to evaluate the craniofacial growth of children with unilateral CLP adopted from China and compare with non-adopted peers (NA). METHODS Cephalograms taken at 10 and 13 were analysed for the SNA, SNB, ANB, NAPg and NSBa angles. Surgical data were extracted from the medical records. RESULTS The rate of secondary cleft-related surgery including secondary alveolar bone grafting (SABG) was higher in the IAC group than in the native groups. At age 10, the IAC exhibited higher SNB and NAPg and lower ANB values than the NA-Mod group and a similar pattern was observed at age 13. The IAC group demonstrated significantly lower SNA and ANB and higher NAPg values than the NA-Orig group at age 10. At age 13, lower SNA and ANB and higher SNB, NAPg, and NSBa values were observed in the IAC group compared with the NA-Orig group. LIMITATIONS Craniofacial growth is not finalized at age 13 years, why additional studies are needed to determine long-term outcomes. CONCLUSIONS Results from this novel study present unfavorable craniofacial growth at age 10 and 13 years of age among IAC with UCLP and indicate an increased need for future orthognathic surgery compared with NA peers.
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Affiliation(s)
- Johnna Sahlsten Schölin
- Department of Plastic Surgery, Sahlgrenska University Hospital
- Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg
| | - Hans Mark
- Department of Plastic Surgery, Sahlgrenska University Hospital
- Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg
| | - Sara Rizell
- Clinic of Orthodontics, Public Dental Service, Region Västra Götaland
- Department of Orthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sahlsten Schölin J, Hansson E, Rizell S, Lindberg J, Sandman L. Ethical Challenges for Plastic Surgery in Treating Internationally Adopted Children With Cleft Lip and Palate. J Craniofac Surg 2024; 35:1425-1431. [PMID: 38832691 DOI: 10.1097/scs.0000000000010364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/04/2024] [Indexed: 06/05/2024] Open
Abstract
A large number of children with cleft lip and palate (CLP) were adopted to Sweden in the last decade, mainly from China. Most of the children arrived with unoperated palates and at later ages than earlier years. This article aims to present an overview of ethical challenges within the practice of international adoption of children with CLP from the perspective of plastic surgery in a welfare health care system. An overview of CLP treatment is presented, followed by a normative discussion and ethical analysis using the 4 principles of Beauchamp and Childress: non-maleficence, beneficence, autonomy, and justice. The following themes and subthemes were analyzed: the search for normality and the potential challenge of being adopted and having CLP-treatment autonomy of the child and future preferences, adoptive parents' expectations of plastic surgery, the journey of the adoptee and the adoptive parents; and general issues-reconstructive possibilities and consequences of CLP in the country of origin, information to the adoptive parents, health care needs, and reconstructive possibilities for children with CLP in the receiving country. Clinical implications are discussed, and suggestions for future research are provided.
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Affiliation(s)
- Johnna Sahlsten Schölin
- Department of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg
- Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital
| | - Emma Hansson
- Department of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg
- Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital
| | - Sara Rizell
- Clinic of Orthodontics, Gothenburg
- Västra Götaland Region
| | - Jenny Lindberg
- Unit of Medical Ethics, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund
- Department of Internal Medicine, Skåne University Hospital, Malmo
| | - Lars Sandman
- Department of Health, Medicine and Caring Sciences, National Centre for Priorities in Health, Linköping University, Linköping
- Västra Götaland Region
- Borås University, Borås, Sweden
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Klintö K, Becker M. Comment on Ombashi, van der Goes, Versnel, Khonsari, van der Molen: guidance to develop a multidisciplinary, international, pediatric registry: a systematic review, Orphanet Journal of Rare diseases, 2023. Orphanet J Rare Dis 2024; 19:162. [PMID: 38632666 PMCID: PMC11022490 DOI: 10.1186/s13023-024-03123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/03/2024] [Indexed: 04/19/2024] Open
Abstract
Recently, Ombashi et al. published a systematic review aiming to identify the pitfalls in the development and implementation as well as factors influencing long-term success of a multidisciplinary, international registry for cleft care on a global scale. The purpose of this letter to the editor is to highlight that the review failed to include the Swedish quality registry for patients born with cleft lip and palate, which fulfils the inclusion criteria. The Swedish cleft lip and palate registry is multidisciplinary, has a high coverage and reporting degree, and most outcome measures have been checked for reliability and validity. It is regularly used for open comparisons between treatment centers. Several research studies have been published based on the Swedish cleft lip and palate registry, and more are ongoing. The information we provide about the Swedish cleft lip and palate registry complements and expands the information of the results reported by Ombashi et al. in their research.
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Affiliation(s)
- Kristina Klintö
- Department of Clinical Sciences in Lund, Lund University, Lund, Sweden.
- Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden.
| | - Magnus Becker
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
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