Birth Prevalence and Risk Factors Associated With CL/P in Thailand

Thai CLEFT-Q: Phase 1-A Pilot Study of Translation and Cultural Adaptation in Thailand

To translate and culturally adapt the original English version of the CLEFT-Q into Thai (Thai CLEFT-Q).

A pilot study.

A single tertiary referral hospital in Thailand.

Patients with cleft lip or palate (CL/P) aged between 8 and 29 years.

The CLEFT-Q was translated and culturally adapted from English into Thai using the good practice guidelines developed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Two forward translations and reconciliation, 1 back translation, and 2 sets of cognitive debriefing interviews with patients were performed to develop the Thai CLEFT-Q.

The English version of the CLEFT-Q consists of 13 scales (119 items) assessing appearance, health-related quality of life (HRQOL), and facial function. The forward translations revealed 33.6% inconsistencies. They were related to narrow meaning (2.5%) and improper (16.8%) or incorrect (14.3%) wording or phrasing of the items. After reconciliation, the back translation showed 5 inconsistencies (4.2%) with the original version. However, no changes were needed because the reconciliation version was consistent with the source version. Sixteen participants underwent cognitive debriefing interviews, which revealed a comprehensive interpretation of the Thai CLEFT-Q. Interim reports revealed fair facial appearance scores, albeit with HRQOL and facial function outcomes.

Translation and cultural adaptation of the Thai CLEFT-Q provided evidence of its transferability and equivalence with the original English version. Feasible comprehension of the Thai version was also achieved.

The Effect of Presurgical Nasoalveolar Molding on Oronasal Fistula Following Primary Palatoplasty

OBJECTIVE

Presurgical nasoalveolar molding (PNAM) is widely used in cleft care protocol. This study investigated the correlation between PNAM and oronasal fistula after primary palatoplasty.

METHODS

A case-controlled study of 80 unilateral and bilateral complete cleft palate patients who underwent cleft palate repair were enrolled. Patients were divided into 2 groups: (1) no PNAM use and (2) PNAM use. The incidence of oronasal fistula and postoperative complications were compared between groups.

RESULTS

Forty patients in each group demonstrated the same baseline characteristics. The PNAM group showed a significantly lower postoperative oronasal fistula rate (15% versus 50%, P=0.003). Palatal cleft width wider than 12.5 mm increases the odds ratio of fistula formation by 1.19-fold (P=0.037), and the PNAM protected against postoperative palatal fistula formation (odds ratio 0.20, P=0.003).

CONCLUSION

Presurgical nasoalveolar molding can reduce postoperative oronasal fistula in wide-gap Veau type III and IV cleft palate.

Environmental tobacco smoke exposure and non-syndromic orofacial cleft: Systematic review and meta-analysis

INTRODUCTION

Environmental tobacco smoke (ETS) is associated with several congenital anomalies, including non-syndromic orofacial clefts (NSOFCs). This systematic review aimed to update the literature on the association between ETS and NSOFCs.

METHODS

Four databases were searched up to March 2022, and studies that evaluated the association between ETS and NSOFCs were selected. Two authors selected the studies, extracted the data, and evaluated the risk of bias. Comparing the association of maternal exposure to ETS and active parental smoking with NSOFCs allowed for the creation of pooled effect estimates for the included studies.

RESULTS

Twenty-six studies were deemed eligible for this review, of which 14 were reported in a previous systematic review. Twenty five were case-control studies, and one was a cohort study. In total, these studies included 2142 NSOFC cases compared to 118129 controls. All meta-analyses showed an association between ETS and the risk of having a child with NSOFC, based on the cleft phenotype, risk of bias, and year of publication, with a pooled increased odds ratio of 1.80 (95% CI: 1.51-2.15). These studies had a marked heterogeneity, which decreased upon subgrouping based on the recent year of publication and the risk of bias.

CONCLUSIONS

ETS exposure was associated with more than a 1.5-fold increase in the risk of having a child with NSOFC, showing a higher odds ratio than paternal and maternal active smoking.

TRIAL REGISTRATION

The study is registered on the International Prospective Register of Systematic Reviews database # CRD42021272909.

Evaluating the Cost-Effectiveness of Plastic Surgery Based on the Satisfaction with Quality of Life and Nasolabial Appearance in Thai Preteens with Cleft Lip and Palate

Background:

Cleft Lip and Palate (CLP) negatively affect the quality of life (QoL) and nasolabial appearance, especially in preteen patients who start to be interested in their own appearance and society.

Objective:

The objective of this study is to evaluate the cost-effectiveness of plastic surgery for Thai preteen CLP patients through their satisfaction with their QoL and nasolabial appearance.

Methods:

A cross-sectional study covered purposively selected 30 samples aged between 8 and 12 years old.Their satisfaction with their QoL and appearance was reflected through an interview and a questionnaire with the cooperation of their parents as their caregivers including satisfaction with their nasolabial appearance evaluated by five experts. They compared the photos of patients’nasolabial appearance with those of normal faces of children of the same age using 5-rating scales.

Results:

General findings showed 53.3% of samples were male patients with mostly (63.3%) UCLP whose parents were mainly (73.3%) poor, so they relied on government financial supports for the treatment. Only some (15%) earned up to 5,001 to 10,000 baht per month because of their low education with just high school level. Specific findings indicated the overall satisfaction with QoL through five dimensions at average level (3.26±1.39). This was based on the satisfaction with the center services, the overall treatments, the medical additional costs, parental satisfaction with psychosocial effects including concerns about the impacts of CLP on the family ranged from high to low i.e. 4.30±0.98, 3.72±1.15, 3.70±1.14, 3.33±1.08 and 2.81±1.46 respectively. Moreover, five experts trended to be highly satisfied with patients’ nasolabial appearance by rating it from Good (53.3%) to Fair (43.43%) with only Poor (3.3%).

Conclusion:

The good cost-effectiveness of the surgery was represented through the average and high satisfaction of CLP patients with their QoL and their appearance respectively indicating the absence of disability weights for these treated CLP patients.