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Meazzini MC, Demonte LP, Parravicini F, Biglioli F, Autelitano L, Balbo N. Prospective study of nasal growth in bilateral cleft lip and palate patients after naso-alveolar moulding and primary columella lengthening compared to controls at 5, 10 and 20 years. Orthod Craniofac Res 2024; 27 Suppl 1:70-79. [PMID: 38284309 DOI: 10.1111/ocr.12761] [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: 04/27/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION A short columella, wide nostrils and a flat nasal tip are common features in patients with bilateral complete cleft lip and palate (BCLP). The objective of this study was to evaluate nasal morphology during growth in patients treated with naso-alveolar moulding (NAM) and primary surgical columella lengthening (PCL) compared with matched non-cleft individuals. STUDY DESIGN Prospective longitudinal case-control study. PARTICIPANTS AND METHODS Thirty-four consecutively treated BCLP patients at 5 and 10 years and at the end of growth (19.7 ± 2.0 years) were compared through normalized photogrammetry to a control of 34 age and sex-matched non-cleft individuals. Regression Models for Panel Data assessed how nasal measurements were influenced by surgery, age and gender. RESULTS Nasal protrusion was equal to non-cleft controls at all ages. Length of the columella was also comparable to controls at 5 and 10 years, but significantly shorter at the end of growth. Inter-alar and nasal tip width and nasolabial angle were significantly wider than controls at all ages: More than 60% of the patients have asked for correction of the nasal width, but no early surgery for columella lengthening was needed. CONCLUSIONS NAM and PCL have provided a nasal projection close to that of non-cleft individuals until adulthood, while length of the columella was physiological at 5 and 10, but shorter than controls at age 20. Width of the nasal tip and width of the alar bases were significantly wider than the controls and eventually required secondary nasal width correction in over two thirds of the sample.
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Affiliation(s)
- Maria Costanza Meazzini
- Department of Maxillo-Facial Surgery, Regional Center for CLP, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
- Department of Maxillo-Facial Surgery, San Gerardo Hospital, Monza, Italy
| | - Leonardo Paolo Demonte
- Department of Orthodontics, San Raffaele Hospital, University Vita-Salute, Milano, Italy
| | - Francesca Parravicini
- Department of Orthodontics, Policlinico Hospital, University of Milano, Milano, Italy
| | - Federico Biglioli
- Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - Luca Autelitano
- Department of Maxillo-Facial Surgery, Regional Center for CLP, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - Nicoletta Balbo
- Department of Social and Political Sciences, Dondena Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milano, Italy
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Wright M, Cortina-Borja M, Knowles R, Urquhart DS. Global birth prevalence of Robin sequence in live-born infants: a systematic review and meta-analysis. Eur Respir Rev 2023; 32:230133. [PMID: 38056889 DOI: 10.1183/16000617.0133-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/16/2023] [Indexed: 12/08/2023] Open
Abstract
Robin sequence (RS), a congenital disorder of jaw maldevelopment and glossoptosis, poses a substantial healthcare burden and has long-term health implications if airway obstruction is suboptimally treated. This study describes the global birth prevalence of RS and investigates whether prevalence estimates differ by geographical location, ethnicity or study data source (registry versus non-registry data). The protocol was prospectively registered with PROSPERO.Databases were searched using keywords and subject terms for "Robin sequence", "epidemiology", "incidence" and "birth prevalence". Meta-analysis was performed fitting random effects models with arcsine transformation.From 34 eligible studies (n=2722 RS cases), pooled birth prevalence was 9.5 per 100 000 live births (95% CI 7.1-12.1) with statistical heterogeneity. One third of studies provided a case definition for RS and numerous definitions were used. A total of 22 countries were represented, predominantly from European populations (53% of studies). There was a trend towards higher birth prevalence in European populations and lower prevalence from registry-based studies. Only two studies reported ethnicity.This study indicates that RS occurs globally. To investigate geographical differences in prevalence, additional studies from non-European populations and reporting of ethnicity are needed. Heterogeneity of estimates may be due to variable diagnostic criteria and ascertainment methods. Recently published consensus diagnostic criteria may reduce heterogeneity among future studies.
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Affiliation(s)
- Marie Wright
- Division of Respiratory Medicine, BC Children's Hospital, Vancouver, BC, Canada
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rachel Knowles
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
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Okhiria Å, Persson C, Johansson MB, Hakelius M, Nowinski D. Longitudinal data on speech outcomes in internationally adopted children compared with non-adopted children with cleft lip and palate. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1440-1453. [PMID: 36929536 DOI: 10.1111/1460-6984.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND At the beginning of the 21st century, international adoptions of children with cleft lip and/or palate increased dramatically in Sweden. Many children arrived partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. To date, the speech development of internationally adopted (IA) children has been described up to age 7-8 years, but later development remains unstudied. AIMS To investigate speech development between ages 5 and 10 years in children born with cleft lip and palate (CLP) adopted from China and to compare them with non-adopted (NA) children with CLP. A secondary aim was to compare the frequencies of secondary palatal surgery and number of visits to a speech and language pathologist (SLP) between the groups. METHODS & PROCEDURES In a longitudinal study, 23 IA children from China were included and matched with 23 NA children born in Sweden. Experienced SLPs blindly reassessed audio recordings from routine follow-ups at ages 5 and 10 years. Velopharyngeal function (VPF) was assessed with the composite score for velopharyngeal competence (VPC-Sum) for single words and rated on a three-point scale (VPC-Rate) in sentence repetition. Target sounds in words and sentences were phonetically transcribed. Per cent correct consonants (PCC) were calculated at word and sentence levels. For in-depth analyses, articulation errors were divided into cleft speech characteristics (CSCs), developmental speech characteristics (DSCs) and s-errors. Information on secondary palatal surgery and number of visits to an SLP was collected. OUTCOMES & RESULTS VPF differed significantly between the groups at both ages when assessed with VPC-Sum, but not with VPC-Rate. Regardless of the method for assessing VPF, a similar proportion in both groups had incompetent VPF but fewer IA than NA children had competent VPF at both ages. IA children had lower PCC at both ages at both word and sentence levels. More IA children had CSCs, DSCs and s-errors at age 5 years, and CSCs and s-errors at age 10. The development of PCC was significant in both groups between ages 5 and 10 years. The proportion of children receiving secondary palatal surgery did not differ significantly between the groups, nor did number of SLP visits. CONCLUSIONS & IMPLICATIONS CSCs were more persistent in IA children than in NA children at age 10 years. Interventions should target both cleft and DSCs, be comprehensive and continue past the pre-school years. WHAT THIS PAPER ADDS What is already known on this subject At the beginning of the 21st century, IA children with cleft lip and/or palate arrived in Sweden partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. Studies up to age 7-8 years show that adopted children, compared with NA peers, have poorer articulation skills, demonstrate both cleft-related and developmental articulation errors, and are more likely to have velopharyngeal incompetence. Several studies also report that adopted children more often require secondary palatal surgery due to fistulas, dehiscence or velopharyngeal incompetence compared with NA peers. What this paper adds to existing knowledge This longitudinal study provides additional knowledge based on longer follow-ups than previous studies. It shows that the proportion of children assessed to have incompetent VPF was similar among IA and NA children. It was no significant difference between the groups regarding the proportion that received secondary palatal surgery. However, fewer IA children were assessed to have a competent VPF. Developmental articulation errors have ceased in most IA and all NA children at age 10 years, but significantly more adopted children than NA children still have cleft-related articulation errors. What are the potential or actual clinical implications of this work? Speech and language therapy should target both cleft-related and developmental articulation errors. When needed, treatment must be initiated early, comprehensive, and continued past the pre-school years, not least for adopted children.
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Affiliation(s)
- Åsa Okhiria
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Christina Persson
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Monica Blom Johansson
- Department of Public Health and Caring Sciences, Speech and Language Pathology, Uppsala University, Uppsala, Sweden
| | - Malin Hakelius
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Daniel Nowinski
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
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Stoll C, Alembik Y, Roth MP. Co-occurring anomalies in congenital oral clefts. Am J Med Genet A 2022; 188:1700-1715. [PMID: 35179301 DOI: 10.1002/ajmg.a.62689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/11/2022] [Accepted: 01/22/2022] [Indexed: 11/07/2022]
Abstract
Oral clefts (OCs) are frequently co-occurring with other non-OC congenital anomalies. The types and the prevalence of anomalies co-occurring with OCs vary in the reported studies. The aims of this report were to study the types and the prevalence of the anomalies co-occurring with OCs in a well-defined population. The types and the prevalence of anomalies co-occurring in cases with OCs were ascertained in all terminations of pregnancy, stillbirths, and live births in 387,067 births occurring consecutively during the period 1979-2007 in the area covered by our registry of congenital anomalies which is population based, 789 cases of OCs were registered during the study period with a prevalence of 20.4 per 10,000 births, 39.5% of the cases had associated non-OC anomalies. Associated anomalies were more common in cases with cleft palate (52.4%) than in cases with cleft lip and palate (37.3%) and in cases with cleft lip only (16.8%). Chromosomal abnormalities were present in 94 (11.9%) cases including 27 trisomies 13, 15 trisomies 18, 12 22 q11.2 deletion, and 40 other chromosomal abnormalities. Nonchromosomal recognizable conditions were diagnosed in 38 cases (4.8%) including syndromes, associations, spectrums and sequences. Multiple congenital anomalies (MCAs) were present in 180 cases (22.8%). The most frequent MCA were in the musculoskeletal system (16.7%), the central nervous system (15.0%), the urogenital system (13.7%), the cardiovascular system (8.6%), and the digestive system (6.6%). The high prevalence of associated anomalies justifies a thorough screening for other congenital anomalies in cases with OCs.
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Affiliation(s)
- Claude Stoll
- Genetique Medicale, Faculte de Medecine, Strasbourg, France
| | - Yves Alembik
- Genetique Medicale, Faculte de Medecine, Strasbourg, France
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Kumar Ps P, S Dhull K, G L, Singh N. Incidence and Demographic Patterns of Orofacial Clefts in Mysuru, Karnataka, India: A Hospital-based Study. Int J Clin Pediatr Dent 2018; 11:371-374. [PMID: 30787548 PMCID: PMC6379536 DOI: 10.5005/jp-journals-10005-1542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/16/2018] [Indexed: 11/23/2022] Open
Abstract
Objective The study was conducted to know the incidence and trends of orofacial clefts between 1st January 2011 and 31st August 2016 in Mysuru, Karnataka; and to describe the demographic patterns. Materials and methods This is a retrospective, hospital-based study. Data were retrieved from multiple sources like Parturition books, Neonatal intensive care unit records, baby and mothers case records archived in medical records department of Cheluvamba Hospital, a Tertiary Care Government Hospital, attached to Mysore Medical College and Research Institute, Mysore, Karnataka, between 1 January 2011 and 31 August 2016. All subjects with CL ± P were included in the study. Data were collected using semi-structured proforma, designed based on the review of the literature. Prior to the study, approval of the Institutional Ethics Committee was obtained. Collected data were subjected to descriptive statistical analysis using SPSS version 21 (SPSS Inc.). Results A total of 59 children with CL ± P were born between 1 January 2011 and 31 August 2016 among 77667 births (Male: 36,625; Females: 41042). Hence the incidence of orofacial clefts in this hospital was 0.76/1000 births/year. Incidence in boys was 0.71/1000 births and in girls it was 0.78/1000 births (p < 0.7). Distribution of CL ± P showed that cleft lip with palate were more prevalent, which was 64.4%. 54.2% of the female child had clefts. Pierre-Robin syndrome was the most common associated malformation. Conclusion This study indicates that CL ± P are the most common types of orofacial clefts. Adequate ante-natal history in birth records is not been given critical importance, with lack of parental counseling. Public awareness regarding the early diagnosis of orofacial clefts, follow up, surgery and dental therapy is required. How to cite this article: Kumar PSP, Dhull KS, Lakshmikantha G, Singh N, Incidence and Demographic Patterns of Orofacial Clefts in Mysuru, Karnataka, India: A Hospital-based Study. Int J Clin Pediatr Dent, 2018;11(5):371-374.
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Affiliation(s)
- Praveen Kumar Ps
- Associate Professor, Department of Dentistry, Mysore Medical College and Research Institute, Mysuru, Karnataka, India
| | - Kanika S Dhull
- Reader, Department of Pedodontics and Preventive Dentistry, Kalinga Institute of Dental Sciences, KIIT University, Odisha, India
| | - Lakshmikantha G
- Assistant Professor, Department of Obstetrics and Gynaecology, Mysore Medical College and Research Institute, Mysuru, Karnataka, India
| | - Nikita Singh
- Postgraduate Student, Department of Obstetrics and Gynaecology, Mysore Medical College and Research Institute, Mysuru, Karnataka, India
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Electromyographic Activity of the Masseter and Temporal Muscles in Patients With Nonsyndromic Complete Unilateral Cleft Lip and Palate: 2-Stage Versus 1-Stage Palate Repair. J Craniofac Surg 2018; 29:1463-1468. [PMID: 29762320 DOI: 10.1097/scs.0000000000004587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess the electromyographic activity of the masseter and temporal muscles in cleft patients who underwent 1-stage palate repair versus 2-stage palate repair. METHODS Thirty-two patients with nonsyndromic complete unilateral cleft lip and palate operated by 2 different protocols for palate repair, 1-stage (group 1, n = 16) versus 2-stage with delayed hard palate closure (group 2, n = 16) were available in the retrospective longitudinal study. Standardized electromyographic records of the masseter and anterior portion of temporal muscles were obtained with 2 repetitions during mastication and rest. RESULTS No statistically significant (all P > 0.05) differences were observed in the electromyographic data between the groups 1 and 2. CONCLUSION There were similar electromyographic activity of masseter and temporal muscles during mastication and at rest after 1- and 2-stage palate closure.
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Paganini A, Hörfelt C, Mark H. Gender differences in surgical treatment of patients with cleft lip and palate. J Plast Surg Hand Surg 2017; 52:106-110. [PMID: 28708467 DOI: 10.1080/2000656x.2017.1348951] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Numerous gender-based differences in medical treatment have been recognized due to conscious or unconscious perceptions, i.e. gender bias. The aim of the present study was to investigate whether gender differences exist in the surgical treatment of patients with cleft lip and palate (CLP) anomalies. This study is a retrospective review of 235 consecutive patients with non-syndromic unilateral CLP or bilateral CLP born between 1966 and 1986. Each chart was reviewed, and 2178 surgical procedures were registered and categorized as primary surgery (primary lip, palatal and alveolar repair) or secondary surgery (aesthetic and functional revision). Different surgical procedures could be performed during the same surgical session. The number of surgeries performed was analysed and compared between genders. The results demonstrate that women with CLP received statistically significantly more secondary surgeries than men. No differences in the number of primary surgeries were identified. This study provides a gender perspective of the treatment of CLP. We identified no gender differences in primary surgery of the CLP. The standardized method of repairing the cleft is effective in preventing unjust treatment due to gender. However, we identified an indication of gender bias in cleft care regarding secondary surgeries of the nose and lip, namely, women are over-treated and/or men are under-treated. There are several possible explanations for this phenomenon, and further studies are needed.
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Affiliation(s)
- Anna Paganini
- a Department of Plastic Surgery, Institute for Clinical Sciences, Sahlgrenska Academy , Göteborg University, Sahlgrenska University Hospital , Göteborg , Sweden
| | - Camilla Hörfelt
- a Department of Plastic Surgery, Institute for Clinical Sciences, Sahlgrenska Academy , Göteborg University, Sahlgrenska University Hospital , Göteborg , Sweden
| | - Hans Mark
- a Department of Plastic Surgery, Institute for Clinical Sciences, Sahlgrenska Academy , Göteborg University, Sahlgrenska University Hospital , Göteborg , Sweden
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Almotairy N, Pegelow M. Dental age comparison in patients born with unilateral cleft lip and palate to a control sample using Demirjian and Willems methods. Eur J Orthod 2017; 40:74-81. [DOI: 10.1093/ejo/cjx031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Nyberg J, Neovius E, Lohmander A. Speech outcomes at 5 and 10 years of age after one-stage palatal repair with muscle reconstruction in children born with isolated cleft palate. J Plast Surg Hand Surg 2017; 52:20-29. [DOI: 10.1080/2000656x.2017.1316282] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jill Nyberg
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Functional Area Speech & Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Neovius
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anette Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Functional Area Speech & Language Pathology, Karolinska University Hospital, Stockholm, Sweden
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Rodman RE, Tatum S. Controversies in the Management of Patients with Cleft Lip and Palate. Facial Plast Surg Clin North Am 2016; 24:255-64. [DOI: 10.1016/j.fsc.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Almuhizi Y, Leser A, Pegelow M. Correlation between the modified Huddart and Bodenham index and the GOSLON yardstick for assessing occlusal characteristics at 5 and 10 years of age in individuals born with unilateral cleft lip and palate. Eur J Orthod 2016; 38:359-65. [DOI: 10.1093/ejo/cjw046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Sundman H, Flynn T, Tengroth B, Lohmander A. ABR thresholds in infants born with CLP and OME and infants with OME. Int J Pediatr Otorhinolaryngol 2016; 81:21-5. [PMID: 26810283 DOI: 10.1016/j.ijporl.2015.11.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 11/02/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to investigate and compare auditory brainstem response (ABR) thresholds related to otitis media with effusion (OME) in infants with and without cleft palate and/or lip (CP±L). METHODS Forty-seven infants with CP±L and 67 infants with OME participated in the study. Hearing thresholds of ears of infants with OME were compared between groups and within the group with CP±L. RESULTS Infants with CP±L and OME presented with similar hearing thresholds as infants with OME and not CP±L. Within the cleft group, infants with isolated cleft palate and OME demonstrated significantly higher hearing thresholds than infants with unilateral cleft lip and palate and OME. CONCLUSION A high prevalence of infants with CP±L present with OME early in life. Hearing thresholds of these infants are similar to infants without CP±L, but with OME. The ear status and hearing thresholds of infants with CP±L needs to be monitored to be able to provide the best access to hearing in order to fully allow speech and language development.
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Affiliation(s)
- H Sundman
- Hearing and Balance Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - T Flynn
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - B Tengroth
- Hearing and Balance Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - A Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Sundell AL, Ullbro C, Marcusson A, Twetman S. Comparing caries risk profiles between 5- and 10- year-old children with cleft lip and/or palate and non-cleft controls. BMC Oral Health 2015. [PMID: 26208495 PMCID: PMC4514989 DOI: 10.1186/s12903-015-0067-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have suggested that children with oral clefts may have higher caries prevalence in comparison with non-cleft controls but the relative importance of the potential risk factors is not clear. The aim of this study was to compare the caries risk profiles in a group of cleft lip and/or palate (CL(P)) children with non-cleft controls in the same age using a computerized caries risk assessment model. METHODS The study group consisted of 133 children with CL(P) (77 subjects aged 5 years and 56 aged 10 years) and 297 non-cleft controls (133 aged 5 years and 164 aged 10 years). A questionnaire was used to collect data concerning the child's oral hygiene routines, dietary habits and fluoride exposure. Oral hygiene was assessed using Quigley-Hein plaque Index and the caries prevalence and frequency was scored according to the International Caries Detection and Assessment System. Whole saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rate. The risk factors and risk profiles were compared between the groups with aid of Cariogram and the estimated risk for future caries was categorized as "high" or "low". RESULTS Children with CL(P) (the entire study group) had significantly higher counts of salivary lactobacilli (p < 0.05) and displayed less good oral hygiene (p < 0.05). More 10-year-old children in the CL(P) group had low secretion rate but this difference was not significant. The average chance to avoid caries ranged from 59 to 67% but there were no significant differences between the groups. The odds of being categorized with high caries risk in the CL(P) group was significantly elevated (OR = 1.89; 95% CI = 1.25-2.86). In both groups, children in the high risk category had a higher caries experience than those with low risk. CONCLUSION Children with CL(P) displayed increased odds of being categorized at high caries risk with impaired oral hygiene and elevated salivary lactobacilli counts as most influential factors. The results suggest that a caries risk assessment model should be applied in the routine CL(P) care as a basis for the clinical decision-making and implementation of primary and secondary caries prevention.
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Affiliation(s)
- Anna Lena Sundell
- Department of Pediatric Dentistry, Institute for Postgraduate Dental Education, Box 1030, SE, 551 11, Jönköping, Sweden.
| | - Christer Ullbro
- Institute for Clinical Dentistry, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Agneta Marcusson
- Department of Dentofacial Orthopedics, Maxillofacial Unit, Linköping University Hospital, Linköping, Sweden.
| | - Svante Twetman
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Seifeldin SA. Is alveolar cleft reconstruction still controversial? (Review of literature). Saudi Dent J 2015; 28:3-11. [PMID: 26792963 PMCID: PMC4688438 DOI: 10.1016/j.sdentj.2015.01.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/15/2014] [Accepted: 01/27/2015] [Indexed: 11/18/2022] Open
Abstract
Cleft lip and palate (CL/P) is a frequent congenital malformation that manifests in several varieties including unilateral or bilateral and complete or incomplete. Alveolar cleft reconstruction remains controversial with regard to timing, graft materials, surgical techniques, and methods of evaluation. Many studies have been conducted addressing these points to develop an acceptable universal protocol for managing CL/P. The primary goal of alveolar cleft reconstruction in CL/P patients is to provide a bony bridge at the cleft site that allows maxillary arch continuity, oronasal fistula repair, eruption of the permanent dentition into the newly formed bone, enhances nasal symmetry through providing alar base support, orthodontic movement and placement of osseointegrated implants when indicated. Other goals include improving speech, improvement of periodontal conditions, establishing better oral hygiene, and limiting growth disturbances. In order to rehabilitate oral function in CL/P patients alveolar bone grafting is necessary. Secondary bone grafting is the most widely accepted method for treating alveolar clefts. Autogenous bone graft is the primary source for reconstructing alveolar cleft defects and is currently the preferred grafting material.
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Affiliation(s)
- Sameh A. Seifeldin
- Corresponding author at: 11545, Riyadh- B.O. 60169, Riyadh, Saudi Arabia. Tel.: +966 506944359; fax: +966 14678548.
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Paes EC, van Nunen DPF, Basart H, Don Griot JPW, van Hagen JM, van der Horst CMAM, van den Boogaard MJH, Breugem CC. Birth prevalence of Robin sequence in the Netherlands from 2000-2010: a retrospective population-based study in a large Dutch cohort and review of the literature. Am J Med Genet A 2015; 167A:1972-82. [DOI: 10.1002/ajmg.a.37150] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/24/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Emma C. Paes
- Department of Plastic; Reconstructive and Hand Surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - Daan P. F. van Nunen
- Department of Plastic; Reconstructive and Hand Surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - Hanneke Basart
- Department of Plastic; Reconstructive and Hand Surgery; Academic Medical Hospital; Amsterdam The Netherlands
| | - J. Peter W. Don Griot
- Department of Plastic; Reconstructive and Hand Surgery; VU Medical Center; Amsterdam The Netherlands
| | | | | | | | - Corstiaan C. Breugem
- Department of Plastic; Reconstructive and Hand Surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
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Sundell AL, Nilsson AK, Ullbro C, Twetman S, Marcusson A. Caries prevalence and enamel defects in 5- and 10-year-old children with cleft lip and/or palate: A case-control study. Acta Odontol Scand 2015; 74:90-5. [PMID: 25972142 DOI: 10.3109/00016357.2015.1044562] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls. MATERIALS AND METHODS The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization. RESULTS The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p < 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p < 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected. CONCLUSIONS Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.
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Affiliation(s)
- Anna Lena Sundell
- a 1 Department of Pediatric Dentistry, The Institute for Postgraduate Dental Education , Jönköping, Sweden
| | - Anna-Karin Nilsson
- a 1 Department of Pediatric Dentistry, The Institute for Postgraduate Dental Education , Jönköping, Sweden
| | - Christer Ullbro
- b 2 Institute for Clinical Dentistry, UiT The Arctic University of Norway , Tromsø, Norway
| | - Svante Twetman
- c 3 Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen, Denmark
| | - Agneta Marcusson
- d 4 Department of Dentofacial Orthopedics, Maxillofacial Unit, Linköping University Hospital , Linköping, Sweden
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Kim JH, Lee IH, Lee SM, Yang BE, Park IY. Distraction osteogenesis and orthognathic surgery for a patient with unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop 2015; 147:381-93. [PMID: 25726406 DOI: 10.1016/j.ajodo.2014.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 03/01/2014] [Accepted: 03/01/2014] [Indexed: 11/18/2022]
Abstract
Maxillary deficiency is a common feature in patients with repaired cleft lip and palate. Orthognathic surgery has been the conventional approach for the management of cleft-related maxillary hypoplasia. However, for patients with a severe maxillary deficiency, orthognathic surgery alone has many disadvantages, such as high relapse rates of 25% to 40%, instability, limited amount of advancement, and a highly invasive surgical technique. As an alternative treatment method, distraction osteogenesis has been used successfully in the distraction of the mandible, the maxilla, the entire midface, and the orbits as well as the cranial bones, with stable outcomes. The type of distraction device, either external or internal, can be chosen based on the surgical goals set for the patient. In this study, we report on the use of a rigid external distraction device for maxillary advancement in a 22-year-old woman with a repaired unilateral cleft lip and palate and severe maxillary hypoplasia. After the distraction osteogenesis, 2-jaw surgery was performed to correct the maxillary yaw deviation and the mandibular prognathism.
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Affiliation(s)
- Ji Hyun Kim
- Resident, Department of Orthodontics, Hallym Sacred Heart Hospital, Anyang, Korea
| | - Il Hong Lee
- Resident, Department of Orthodontics, Hallym Sacred Heart Hospital, Anyang, Korea
| | - Sang Min Lee
- Assistant professor, Department of Orthodontics, School of dentistry, Dankook University, Cheonan, Korea
| | - Byoung Eun Yang
- Associate professor, Department of Oral and Maxillofacial Surgery, Hallym Sacred Heart Hospital, Anyang, Korea
| | - In Young Park
- Clinical assistant professor, Department of Orthodontics, Hallym Sacred Heart Hospital, Anyang, Korea.
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Conway JC, Taub PJ, Kling R, Oberoi K, Doucette J, Jabs EW. Ten-year experience of more than 35,000 orofacial clefts in Africa. BMC Pediatr 2015; 15:8. [PMID: 25884320 PMCID: PMC4342189 DOI: 10.1186/s12887-015-0328-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical correction of orofacial clefts greatly mitigates negative outcomes. However, access to reconstructive surgery is limited in developing countries. The present study reviews epidemiological data from a single charitable organization, Smile Train, with a database of surgical cases from 33 African countries from 2001-2011. METHODS Demographic and clinical patient data were collected from questionnaires completed by the participating surgeons. These data were recorded in Excel, analyzed using SPSS and compared with previously reported data. RESULTS Questionnaires were completed for 36,384 patients by 389 African surgeons. The distribution of clefts was: 34.44% clefts of the lip (CL), 58.87% clefts of the lip and palate (CLP), and 6.69% clefts of the palate only (CP). The male to female ratio was 1.46:1, and the unilateral: bilateral ratio 2.93:1, with left-sided predominance 1.69:1. Associated anomalies were found in 4.18% of patients. The most frequent surgeries included primary lip/nose repairs, unilateral (68.36%) and bilateral (11.84%). There was seasonal variation in the frequency of oral cleft births with the highest in January and lowest by December. The average age at surgery was 9.34 years and increased in countries with lower gross domestic products. The average hospital stay was 4.5 days. The reported complication rate was 1.92%. CONCLUSIONS With the exception of cleft palates, results follow trends of worldwide epidemiologic reports of 25% CL, 50% CLP, and 25% CP, 2:1 unilateral:bilateral and left:right ratios, and male predominance. Fewer than expected patients, especially females, presented with isolated cleft palates, suggesting that limitations in economic resources and cultural aesthetics of the obvious lip deformity may outweigh functional concerns and access to treatment for females. A fewer than expected associated anomalies suggests either true ethnic variation, or that more severely-affected patients are not presenting for treatment. The epidemiology of orofacial clefting in Africa has been difficult to assess due to the diversity of the continent and the considerable variation among study designs. The large sample size of the data collected provides a basis for further study of the epidemiology of orofacial clefting in Africa.
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Affiliation(s)
- Julia C Conway
- Department of Pediatrics at Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1497, New York, NY, 10029, USA.
| | - Peter J Taub
- Department of Pediatrics at Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1497, New York, NY, 10029, USA. .,Department of Surgery at Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Dentistry at Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Rochelle Kling
- State University of New York Downstate Medical School, Brooklyn, NY, USA.
| | - Kurun Oberoi
- Johns Hopkins University Medical School, Baltimore, MD, USA.
| | - John Doucette
- Department of Preventive Medicine at Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Ethylin Wang Jabs
- Department of Pediatrics at Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1497, New York, NY, 10029, USA. .,Department of Genetics and Genomic Sciences at Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Developmental and Regenerative Biology at Icahn School of Medicine at Mount Sinai, New York, New York, USA, New York, NY, USA.
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Bautzer APD, Guedes ZCF. Verification of the therapeutic process in cleft patients. Codas 2014; 26:457-63. [DOI: 10.1590/2317-1782/20140000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/09/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: This study was conducted to verify the origin of a longer or even failed therapeutic process in patients with cleft lip and palate as to its difficulty. METHODS: Eighteen children undergoing therapeutic process were observed for at least 6 months and divided into two groups: presenting isolated cleft lip and palate (group I) and having been diagnosed by a Speech-Language Pathologist with reading and writing disorders, with manifestation of phonological awareness deficit (group II). Two tests were applied for the evaluation of speech and language: ABFW Language Test for Young Children (phonology) and Phonological Awareness: Instrument of Sequential Assessment (CONFIAS). RESULTS: Group I presented higher percentages in ABFW test than group II, except in the "simplification of consonant cluster" and "plosive devoicing" variables. It was also observed that, in the process of omission, group I hardly omits the vibrant consonant, as observed in group II. At the syllable level of CONFIAS, the percentages observed in group I tended to be higher than in group II, with the exception of the following tasks: "medial syllable," "production of rhyme," and "exclusion." At the phoneme level, the percentages observed in group II tended to be higher than in group I, with the exception of the following tasks: "starts with given sound," "exclusion," "synthesis," and "segmentation." No significant difference was observed between percentage distributions in groups I and II (p>0.118). CONCLUSIONS: The differences found between groups I and II, although not statistically significant, may suggest that the presence of malformation hinders speech and language acquisition and development and prolongs the therapeutic process if directive interventions are not carried out, including phonological awareness therapy.
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Prigge L, van Schoor AN, Bosman MC, Bosenberg AT. Clinical anatomy of the maxillary nerve block in pediatric patients. Paediatr Anaesth 2014; 24:1120-6. [PMID: 25040918 DOI: 10.1111/pan.12480] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anatomical landmarks in children are mostly extrapolated from studies in adults. Despite this, complex regional anesthetic procedures are frequently performed on pediatric patients. Sophisticated imaging techniques are available but the exact position, course and/or relationships of the structures are best understood with appropriate anatomical dissections. Maxillary nerve blocks are being used for peri-operative analgesia after cleft palate repair in infants. However, the best approach for blocking the maxillary nerve in pediatric patients has yet to be established. OBJECTIVE To determine the best approach for blocking the maxillary nerve within the pterygopalatine fossa. METHODS In an attempt to define an optimal approach for maxillary nerve block in this age group three approaches were simulated and compared on 10 dried pediatric skulls as well as 30 dissected pediatric cadavers. The needle course, including depth and angles, to block the maxillary nerve, as it exits the skull at the foramen rotundum within the pterygopalatine fossa, was measured and compared. Two groups were studied: Group 1 consisted of skulls and cadavers of neonates (0-28 days after birth) and Group 2 consisted of skulls and cadavers from 28 days to 1 year after birth. RESULTS No statistically significant difference (P > 0.05) was found between the left and right side of each skull or cadaver. Only technique B, the suprazygomatic approach from the frontozygomatic angle towards the pterygopalatine fossa, exhibited no statistical significance (P > 0.05) when other measurements made on the skulls and cadavers were compared. Technique A, a suprazygomatic approach from the midpoint on the lateral border of the orbit, as well as technique C, an infrazygomatic approach with an entry at a point on a vertical line extending along the lateral orbit wall, showed statistical significant differences when measurements of the skulls and cadavers were compared. CONCLUSIONS On the basis of these findings technique B produces the most consistent data for age groups 1 and 2 and supports the clinical findings recently reported.
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Affiliation(s)
- Lané Prigge
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Anatomy, School of Pathology and Pre-Clinical Sciences, Faculty of Health Sciences, University of Limpopo (Medunsa Campus), Ga-Rankuwa, South Africa
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Kesande T, Muwazi LM, Bataringaya A, Rwenyonyi CM. Prevalence, pattern and perceptions of cleft lip and cleft palate among children born in two hospitals in Kisoro District, Uganda. BMC Oral Health 2014; 14:104. [PMID: 25135242 PMCID: PMC4139140 DOI: 10.1186/1472-6831-14-104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cleft lip with or without cleft palate is one of the most common congenital anomalies that affect the oro-facial region. The aim of the study was to determine the period prevalence, pattern and perceptions of cleft lip and cleft palate in children born between 2005 and 2010 in two hospitals in Kisoro District, Uganda. METHODS The study involved a retrospective review of medical records of mothers who delivered live babies between January 2005 and December 2010 in Kisoro Hospital and St. Francis Hospital, Mutolere in Kisoro District. Key informant interviews of mothers (n = 20) of the children with cleft lip and/or clip palate and selected medical staff (n = 24) of the two hospitals were carried out. The data were analysed using descriptive statistics. RESULTS Over the 6 year period, 25,985 mothers delivered live babies in Kisoro Hospital (n = 13,199) and St. Francis Hospital, Mutolere (n = 12,786) with 20 babies having oro-facial clefts. The overall period prevalence of the clefts was 0.77/1,000 live births. Sixty percent (n = 12) of children had combined cleft lip and palate and the same proportion had clefts on the left side of the face. More boys were affected than girls: 13 versus 7. About 45% of mothers were hurt on realizing that they had delivered a child with an oro-facial cleft. Forty percent of mothers indicated that a child with oro-facial cleft was regarded as an outcast. About 91.7% (n = 22) of the medical staff reported that these children were not accepted in their communities. Surgical intervention and psychosocial support were the management modalities advocated for by most respondents. CONCLUSION/RECOMMENDATIONS The period prevalence of combined cleft lip and palate in two hospitals in Kisoro District was comparable to some findings elsewhere. Cleft lip and cleft palate are a medical and psychosocial problem in Kisoro District that calls for sensitization and counseling of the families and communities of the affected children. The policy makers need to strategically plan for provision of rehabilitation with feeding obturators to facilitate easy feeding to gain weight before surgical intervention of the affected children.
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Affiliation(s)
- Teopista Kesande
- Department of Oral and Maxillofacial Surgery, Mulago Hospital, P.O. Box 7071, Kampala, Uganda
| | - Louis Mugambe Muwazi
- Department of Dentistry, School of Health Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Aisha Bataringaya
- Department of Dentistry, School of Health Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Charles Mugisha Rwenyonyi
- Department of Dentistry, School of Health Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Genetics of cleft lip and/or cleft palate: Association with other common anomalies. Eur J Med Genet 2014; 57:381-93. [DOI: 10.1016/j.ejmg.2014.04.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/03/2014] [Indexed: 12/16/2022]
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Lithovius RH, Ylikontiola LP, Harila V, Sándor GK. A descriptive epidemiology study of cleft lip and palate in Northern Finland. Acta Odontol Scand 2014; 72:372-5. [PMID: 24255959 DOI: 10.3109/00016357.2013.840737] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine the incidence of cleft lip and/or cleft palate in a population uniquely from Northern Finland. MATERIALS AND METHODS The records of a total of 214 cleft patients treated between 1998-2011 at the Oulu Cleft Lip and Palate Center at the University of Oulu were assessed on a retrospective basis. Data regarding cleft type, sex and side of cleft was collected and analyzed. Family history of clefting was investigated. RESULTS Cleft palate (68.7%) was most frequently found, followed by cleft lip and palate (18.7%) and cleft lip with or without alveolus (12.6%). Cleft palate occurred more frequently in females (63.3%) and cleft lip and palate was more frequently found in males (62.5%). The left side was more frequently affected in both male and female patients. Left-sided clefts were observed in 82% of patients compared to right-sided clefts in 18%. A family history of clefting was detected in 20.1% of patients. CONCLUSION The incidence of clefts in Northern Finland is higher than the corresponding incidence in other European countries. Cleft palate was the most frequent cleft type and it was more frequent in females. In males, cleft lip and palate was more frequent. The left side was more frequently affected in both genders. One fifth of the patients had a family history of clefts.
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Affiliation(s)
- Riitta H Lithovius
- Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Oulu Cleft Lip and Palate Center, Oulu University Hospital , Oulu , Finland
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Figueiredo RF, Figueiredo N, Feguri A, Bieski I, Mello R, Espinosa M, Damazo AS. The role of the folic acid to the prevention of orofacial cleft: an epidemiological study. Oral Dis 2014; 21:240-7. [PMID: 24828118 DOI: 10.1111/odi.12256] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 04/06/2014] [Accepted: 04/27/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Orofacial clefts (OFCs) have complex and multifactorial etiologies. Periconceptional folic acid supplementation can significantly reduce the risk of OFC. OBJECTIVE To evaluate the role of folate and other factors in preventing OFC by analyzing the health and socio-demographic data collected from a population sample. METHODS Retrospective case-control study in which mothers with children with or without OFC were evaluated for the following main parameters: nutritional factors, socio-demographic characteristics, pregnancy and family history, use of folate, and counseling by healthcare professionals. RESULTS Socio-epidemiological analysis of the 80 participants, 40 in the case group and 40 in the control group, found a significant impact on the risk of OFC related to economic and educational status. The mothers who had a diet rich in vegetables and white meat had a lower risk of having children with OFC. A short interval between pregnancies, subsequent pregnancy while still breastfeeding, and family history also increased risk of OFC. CONCLUSIONS Limited family planning, diet low in folate, and inadequate use of folate during the periconceptional period and during the first trimester of pregnancy were demonstrated a potential correlation with a high incidence of OFC in this study.
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Affiliation(s)
- R F Figueiredo
- Post-Graduation in Health Science, Medical School, Federal University of Mato Grosso, Cuiaba, MT, Brazil; Cuiaba Emergency Hospital, Cuiaba, MT, Brazil
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Hassan WA, Lees CC. Facial cleft detected: Is the palate normal? Best Pract Res Clin Obstet Gynaecol 2014; 28:379-89. [DOI: 10.1016/j.bpobgyn.2014.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
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Klintö K, Olsson M, Flynn T, Svensson H, Lohmander A. Phonology in Swedish-speaking 3-year-olds born with cleft lip and palate and the relationship with consonant production at 18 months. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2014; 49:240-254. [PMID: 24180229 DOI: 10.1111/1460-6984.12068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Approximately 50% of children born with cleft palate present speech difficulties around 3 years of age, and several studies report on persisting phonological problems after palatal closure. However, studies on early phonology related to cleft palate are few and have so far mainly been carried out on English-speaking children. Studies on phonology related to cleft palate in languages other than English are also warranted. AIMS To assess phonology in Swedish-speaking children born with and without unilateral cleft lip and palate (UCLP) at 3 years of age, and to identify variables at 18 months that are associated with restricted phonology at age 3 years. METHODS & PROCEDURES Eighteen consecutive children born with UCLP and 20 children without cleft lip and palate were included. Transcriptions of audio recordings at 18 months and 3 years were used. Per cent correct consonants adjusted for age (PCC-A), the number of established phonemes, and phonological simplification processes at 3 years were assessed and compared with different aspects of consonant inventory at 18 months. OUTCOMES & RESULTS PCC-A, the number of established phonemes, and the total number of phonological processes differed significantly at 3 years between the two groups. Total number of oral consonants, oral stops, dental/alveolar oral stops and number of different oral stops at 18 months correlated significantly with PCC-A at 3 years in the UCLP group. CONCLUSIONS & IMPLICATIONS As a group, children born with UCLP displayed deviant phonology at 3 years compared with peers without cleft lip and palate. Measures of oral consonant and stop production at 18 months might be possible predictors for phonology at 3 years in children born with cleft palate.
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Affiliation(s)
- Kristina Klintö
- Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden
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DeVolder I, Richman L, Conrad AL, Magnotta V, Nopoulos P. Abnormal cerebellar structure is dependent on phenotype of isolated cleft of the lip and/or palate. THE CEREBELLUM 2013; 12:236-44. [PMID: 23055082 DOI: 10.1007/s12311-012-0418-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Isolated cleft lip and/or palate (ICLP) is one of the most common congenital birth defects in the USA, affecting roughly 1 in 600 births annually. Along with the facial deformity, this population has been found to have abnormal neurodevelopment and gross structural abnormalities in the brain, particularly within the cerebellum. The current study examined cerebellar structure within the two primary subtypes of ICLP: cleft lip with/without cleft palate (CL/P) and cleft palate alone (CPO). A large sample of 107 subjects aged 7 to 27 years with ICLP was compared to 127 healthy controls. Samples were separated by sex. Brain structure was obtained via magnetic resonance imaging. For males, after controlling for intracranial volume, cerebellum volume was significantly lower in the ICLP group (F = 12.351, p = 0.001). Regionally in the cerebellum, males with ICLP had proportionally larger anterior lobes (F = 4.022, p = 0.047) and smaller superior posterior lobes (F = 5.686, p = 0.019). CL/P males showed only a reduction in overall cerebellum volume, with no regional changes. CPO males showed only regional changes, with no reduction in overall volume. Females with ICLP showed no overall or regional cerebellar abnormalities. However, females with CPO did have significantly lower cerebellum volumes than controls. The results reveal both global and regional cerebellar abnormalities within subjects with ICLP. They also establish the existence of abnormal cerebellar morphologies that are dependent on cleft subtype as well as sex. This lends further support to the claim that CL/P and CPO are distinct conditions.
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Affiliation(s)
- Ian DeVolder
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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Souza J, Raskin S. Clinical and epidemiological study of orofacial clefts. J Pediatr (Rio J) 2013; 89:137-44. [PMID: 23642423 DOI: 10.1016/j.jped.2013.03.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 10/03/2012] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Cleft lip with or without cleft palate (CL±P) or cleft palate (CP) are groups of malformations named orofacial clefts (OC), which are the second leading cause of birth defects. This study aimed to analyze clinical and epidemiological features of Brazilian patients with OC, studying cases treated in the reference center of the state of Paraná (PR). METHODS 2,356 charts were reviewed and 1,838 were evaluated by the same clinical geneticist. Data were collected in the reference center, and compared with those of the Health Department of the state of Paraná. Clinical characteristics, presence of other anomalies, and birth prevalence were evaluated. RESULTS 389 (21.2%) patients had CP, 437 (23.8%) had cleft lip (CL), and 1,012 (55%) had cleft lip and palate (CLP). Syndromic OC were identified in 15.3% of patients, 10.4% of patients with CL±P, and 33.9% of patients with CP. Common additional anomalies were: central nervous system, limbs, cardiovascular, and musculoskeletal defects. The number of syndromic cases was lower when clinical evaluation was performed by other medical specialists when compared to that of the clinical geneticist. Birth prevalence was 1/1,010 live births. Lack of notification with the national birth registry was observed in 49.9% of CL±P. The present data suggests a decrease of 18.52% in the prevalence of non-syndromic OC after folic acid fortification in Brazil. CONCLUSION Better understanding of clinical and epidemiological aspects of OC is crucial to improve the understanding of pathogenesis, promote preventive strategies, and guide clinical care, including the presence of clinical geneticists in the multidisciplinary team for OC treatment.
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Affiliation(s)
- Josiane Souza
- Programa de Pós-graduação em Ciências da Saúde PPGCS, Centro de Ciências Biológicas e da Saúde CCBS, Pontifícia Universidade Católica do Paraná PUCPR, Curitiba, PR, Brazil.
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Yáñez-Vico RM, Iglesias-Linares A, Gómez-Mendo I, Torres-Lagares D, González-Moles MÁ, Gutierrez-Pérez JL, Solano-Reina E. A descriptive epidemiologic study of cleft lip and palate in Spain. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:S1-4. [DOI: 10.1016/j.tripleo.2011.07.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 05/24/2011] [Accepted: 07/26/2011] [Indexed: 11/29/2022]
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Doray B, Badila-Timbolschi D, Schaefer E, Fattori D, Monga B, Dott B, Favre R, Kohler M, Nisand I, Viville B, Kauffmann I, Bruant-Rodier C, Grollemund B, Rinkenbach R, Astruc D, Gasser B, Lindner V, Marcellin L, Flori E, Girard-Lemaire F, Dollfus H. Épidémiologie des fentes labio-palatines : expérience du Registre de malformations congénitales d’Alsace entre 1995 et 2006. Arch Pediatr 2012; 19:1021-9. [DOI: 10.1016/j.arcped.2012.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 05/25/2012] [Accepted: 07/04/2012] [Indexed: 11/15/2022]
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Altunhan H, Annagür A, Konak M, Ertuğrul S, Örs R, Koç H. The incidence of congenital anomalies associated with cleft palate/cleft lip and palate in neonates in the Konya region, Turkey. Br J Oral Maxillofac Surg 2012; 50:541-4. [DOI: 10.1016/j.bjoms.2011.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 08/03/2011] [Indexed: 11/26/2022]
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Longombe AO, Tshimbila Kabangu JMV. [The epidemiological approach of clefts lip and palate in the eastern of Democratic Republic of Congo]. ANN CHIR PLAST ESTH 2012; 57:245-9. [PMID: 22465425 DOI: 10.1016/j.anplas.2012.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study aims to present the epidemiological profile of clefts lip/palate observed in the eastern of Democratic Republic of Congo (DRC) from January 2002 to May 2004, period of civil wars. METHOD It is a retrospective study realized at Doctors on Call for service Learning Center (DOCS LC) in Goma/DRC concerning 89 cases of cleft lip/palate operated during the same period. The data processing was facilitated by the software package SPSS 17.0 installed in the IT center of DOCS. RESULTS The average age of the consultation is 9.9 years with extreme of zero and 42 years. Both sexes are concerned: 50.6% of male and 49.4% of female. The more cleft extends from the superior lip to the palate through the alveolus, the more the frequency of the various types of clefts lips/palate decreases: 59.6% (simple clefts lip), 37.1% (labio-alveolar clefts), and 2.2% (cleft palate). The left incomplete cleft lip variety represents 33.7% of all varieties. Most of clefts lips/palate come from the first to the fifth pregnancy with a peak of frequency (19.1%) in the second pregnancy. No family history about congenital deformation was found from 97% of our patients. CONCLUSION The epidemiology of cleft lip/palate in our area would be more connected to environmental factors than genetics: no family history of congenital deformation was seen for most of our patients during this period of civil war.
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Affiliation(s)
- A O Longombe
- Université de Kisangani, Doctors On Call for Service Medical Center, Goma, République Démocratique du Congo
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Abstract
Distraction osteogenesis (DO) has become a mainstream surgical technique for patients with jaw deformities. The aim of this study was to report the use of internal DO in the treatment of maxillary hypoplasia in a patient with cleft lip and palate. The case illustrates a 17-year-old boy with class III malocclusion, maxillary deficiency, and cleft lip and palate. Because the patient was experiencing severe hypernasality, it was decided to treat him by DO. The treatment process began by mounting a hyrax in the upper jaw for lateral expansion. A second hyrax was mounted in a way to create anteroposterior expansion. One day after the second hyrax application, the patient underwent a modified Le Fort I osteotomy. He was instructed to turn the screws twice per day for 12 days. The treatment was continued by means of a conventional face mask for 2 months. After 16 months of active treatment, favorable correction of the skeletal problem was observed. The S-N-A angle increased by 5 degrees, and patient's hypernasality was comprehensively improved.
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Paranaíba LMR, Miranda RTD, Ribeiro LA, Barros LMD, Martelli-Júnior H. Frequency of congenital craniofacial malformations in a Brazilian Reference Center. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2011. [DOI: 10.1590/s1415-790x2011000100014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To evaluate the frequency of craniofacial anomalies in patients treated at a Brazilian Reference Center for craniofacial deformities. METHOD: Retrospective epidemiological study evaluating the clinical records of 1,142 patients: 656 (57.4%) male and 486 (42.6%) female, between 1992 and 2008. RESULTS: Among birth defects, non-syndromic cleft lip and/or palate were the most frequent ones (778 cases; 68.1%), followed by single or multiple congenital anomalies without cleft lip and/or palate (240 cases; 21%), recognized syndromes or sequences (56 cases; 5%), syndromes with orofacial cleft as a component (41 cases; 3.5%), and orofacial clefts in association with systemic malformations (27 cases; 2.4%). CONCLUSIONS: Non-syndromic cleft lip and/or palate was the congenital defect most frequently identified, although, isolated anomalies and syndromes involving craniofacial structures were quite frequent. Furthermore, the need for studies to identify the frequency and risk factors associated with craniofacial anomalies in the Brazilian population is emphasized in order to plan comprehensive strategies and integrated actions for the development of preventive programs and treatment.
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Maternal cigarette smoking and the associated risk of having a child with orofacial clefts in China: a case-control study. J Craniomaxillofac Surg 2010; 39:313-8. [PMID: 20832329 DOI: 10.1016/j.jcms.2010.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 05/01/2010] [Accepted: 07/21/2010] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We investigated whether maternal and paternal cigarette smoking during early pregnancy could increase the risk of delivering an infant with an orofacial cleft. METHODS A case-control study was carried out in China. 304 infants born with an isolated nonsyndromic oral cleft and 453 non-malformed controls were recruited as participants and their exposure to smoke plus family history data were collected. RESULTS The relative odds ratios of maternal smoking to cause an orofacial cleft in infant increased for 3.30 (95% CI, 1.17-9.33) in CLO and 3.12 (95% CI, 1.24-7.84) in CLP from 1 to 10 cigarettes per day before pregnancy. The unadjusted odds ratio is 3.64 (95% CI, 1.01-13.19) and the adjusted OR is 7.00 (95% CI, 1.44-34.13) in CLO from 1 to 10 cigarettes during the first trimester. Paternal smoking in the periconceptional period was strongly associated with all subtypes of CLP. The association with medium ETS (2-6h) at home or at work was strongest for infants with all OFCs in the periconceptional period from 1 month before pregnancy through the end of the first trimester. CONCLUSION This study confirmed the modest association between maternal smoking and orofacial clefts.
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Escoffié-Ramírez M, Medina-Solís CE, Pontigo-Loyola AP, Acuña-González G, Casanova-Rosado JF, Colome-Ruiz GE. Asociación de labio y/o paladar hendido con variables de posición socioeconómica: un estudio de casos y controles. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2010. [DOI: 10.1590/s1519-38292010000300005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVOS: determinar la asociación entre variables indicadoras de posición socioeconómica y la presencia de labio y/o paladar hendido no sindrómico (L/PH). MÉTODOS: se realizó un estudio de casos y controles en el que se incluyeron 110 casos con L/PH pareados por edad y sexo con 220 controles, seleccionados de la clínica del Hospital Niño DIF de Hidalgo, México. A través de un cuestionario se recogió una serie de variables relacionadas con la posición socio-económica. Utilizando el análisis de componentes principales (correlación policórica) se combinaron las variables relacionadas entre sí y se construyeron diversas variables indicadoras de posición socioeconómica; nivel socioeconómico (características de la vivienda), índice de bienestar (posesiones de bienes/ enseres del hogar), escolaridad de los padres (años de estudio), seguridad social (derechohabiencia), e indigenismo (hablar alguna lengua indígena por alguno de los padres). El análisis bivariado se realizó con regresión logística condicionada. RESULTADOS: el 90.9% de los pacientes presentó labio + paladar hendido al mismo tiempo, ya sea uni o bilateral. El tipo de defecto mas común fue el labio y paladar hendido izquierdo (33.6%). Resultaron asociadas a L/PH las variables: índice de bienestar (comparado con el peor quintil: 2do OR=0.46; p=0.030, 3er OR=0.39; p=0.015, 4to OR=0.30; p=0.002, 5to OR=0.27; p=0.001), nivel socioeconómico (comparado con el mejor tercil: 2do OR=0.46; p=0.004, 3er OR=0.18; p<0.001), escolaridad del padre (OR=0.86; p<0.001), y escolaridad de la madre (OR=0.84; p<0.001). CONCLUSIONES: este estudio demuestra la existencia de desigualdades socioeconómicas en salud bucal, observándose que los sujetos de menor posición socioeconómica presentan mayor riesgo de tener L/PH.
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McHeik JN, Levard G. Growth in infants in the first two years of life after neonatal repair for unilateral cleft lip and palate. Int J Pediatr Otorhinolaryngol 2010; 74:465-8. [PMID: 20207020 DOI: 10.1016/j.ijporl.2010.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 01/21/2010] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the growth during the first two years of life in infants after unilateral cleft lip and palate neonatal repair. METHOD All mature infants with nonsyndromic unilateral cleft lip and palate (NSUCLP) born between 2004 and 2007 were included. Information concerning growth was collected. Weight and length at birth, 6, 12, 18 and 24 months of age measurements and data regarding feeding were obtained. RESULTS Weight and length at birth, 6, 12, 18 and 24 months of age were identical with reference curve values. Children with NSUCLP showed a normal growth at two years. The weight curves lie between 5th and the 50th percentile for girls and between 10th and higher than the 97th percentile for boys. The height curves lie between -1 Standard Deviation and +1 Standard Deviation for girls and 0 and +2 Standard Deviation for boys. CONCLUSION Feeding difficulties are reported in infants with cleft lip and/or palate CLP/CP. However, the growth in children with NSUCLP and after neonatal cleft lip repair is identical with reference curve values.
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Affiliation(s)
- Jiad N McHeik
- Chirurgie Pédiatrique, Centre Hospitalier Universitaire, Cité Hospitalière de La Milétrie, Hôpital Jean-Bernard - BP 577, 86021 Poitiers Cedex, France.
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Chetpakdeechit W, Mohlin B, Persson C, Hagberg C. Cleft extension and risks of other birth defects in children with isolated cleft palate. Acta Odontol Scand 2010; 68:86-90. [PMID: 19878042 DOI: 10.3109/00016350903258003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To study the risks of having other birth defects in children born with an isolated cleft palate (iCP) when the length of the cleft was taken into account. The hypothesis was that a newborn with an extensive cleft lesion may have an increased risk of other birth defects compared to a child with a less extensive cleft of the palate. MATERIAL AND METHODS All Caucasian children with iCP born between 1975 and 2005 in the southwestern region of Sweden were included. Data were collected from standardized medical records and the length of the cleft was checked on the pre-surgical dental cast for each child. RESULTS A total of 343 children were born with an iCP. The incidence was 0.64/1000 live births. Thirty-four percent of children with either a total or partial iCP had other birth defects. The risk was 1.7 times higher for a total compared to a partial iCP. The two most common birth defects were congenital heart disease and intellectual disability. Ear problems related to infections were registered in 43% of cases. Fifteen percent of the children had the Pierre Robin sequence, which was analyzed as a separate variable and not included as a birth defect. CONCLUSIONS The length of the iCP was found to influence the risk of having another birth defect as the total palatal clefts were more often combined with other birth defects compared to partial clefts. Careful medical check-ups are important for newborns with iCP since they have increased risks of other birth defects.
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Affiliation(s)
- Woranuch Chetpakdeechit
- Department of Orthodontics, Institute of Odontology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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Havstam C, Lohmander A, Dahlgren Sandberg A, Elander A. Speech and satisfaction with outcome of treatment in young adults with unilateral or bilateral complete clefts. ACTA ACUST UNITED AC 2009; 42:182-9. [DOI: 10.1080/02844310802055102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chetpakdeechit W, Hallberg U, Hagberg C, Mohlin B. Social life aspects of young adults with cleft lip and palate: grounded theory approach. Acta Odontol Scand 2009; 67:122-8. [PMID: 19148835 DOI: 10.1080/00016350902720888] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The findings of many questionnaire and inventory studies suggest that people with cleft lip and/or palate report a decreased quality of life. Common problems include dissatisfaction with the external appearance of the lips and nose, speech problems, depression, and anxiety. This qualitative study aimed to explore the subjective perceptions and values of young adults with clefts, particularly with regard to their social lives. MATERIAL AND METHODS Twelve persons participated in an in-depth interview. Among those, seven had a repaired isolated cleft palate involving only the hard/soft palate. Five had a repaired bilateral cleft lip and palate that had been a continuous lesion of the lip, the alveolar process, and the palate. A grounded theory approach was used to conduct and analyze the interviews. RESULTS The study revealed seven important categories--hoping to be like other people, being treated differently from others, experiencing deviation from others, regarding oneself as being different from others, lack of recognition, low self-esteem, and receiving recognition from significant others--with hoping to be like other people as the core category. CONCLUSION Young adults with either cleft lip and palate or isolated cleft palate who received recognition from significant others reported increased self-esteem and greater ability to cope with their social lives.
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Abstract
We describe our experience of working in plastic and reconstructive surgery in Uganda over the last 10 years. There is a high burden of disease, a health system that is under resourced, and few qualified physicians to provide healthcare for a principally rural population. Training the physicians of the future is essential. Prevention and early wound management needs to be emphasized for traumatic injuries including burns. Subsidized up-country visits by trained specialists with the appropriate equipment are required to provide a service for the rural poor. There appears to be a high mortality rate in babies with unrepaired cleft palate, probably due to feeding difficulties in an environment where intercurrent illness is common. We now offer nutritional support with early combined cleft lip and palate repair in these babies, a practice that has a high success rate and may be suited to other specialist units in the developing world.
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Rawashdeh MA, Jawdat Abu-Hawas B. Congenital Associated Malformations in a Sample of Jordanian Patients With Cleft Lip and Palate. J Oral Maxillofac Surg 2008; 66:2035-41. [DOI: 10.1016/j.joms.2008.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Revised: 10/15/2007] [Accepted: 01/01/2008] [Indexed: 10/21/2022]
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McHeik JN, Gaudin J, Levard G. [Cleft lip and palate: indications for radiological postnatal explorations]. Arch Pediatr 2008; 15:1388-92. [PMID: 18722755 DOI: 10.1016/j.arcped.2008.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 04/05/2008] [Accepted: 06/25/2008] [Indexed: 11/16/2022]
Abstract
AIM We evaluated the utility of systematic neonatal radiological explorations in 20 instances of isolated cleft lip and palate in 20 cases. METHODS This study included 13 infants with prenatal ultrasound diagnosis. The type of cleft and possible associated anomalies were noted. A systematic chromosomal test was done. In 7 cases, the cleft lip was noted at birth. Postnatal outcome was obtained and a clinical examination and radiological explorations were carried out. RESULTS For the cases with prenatal diagnosis, the chromosomal test was normal in 11 cases and we noted associated anomalies in three cases. For the cases with neonatal diagnosis, the chromosomal test was normal in 6 cases and 1 infant had associated anomalies. CONCLUSIONS The biological and radiological explorations can be numerous. In our study, the systematic neonatal radiological explorations did not find more elements compared with neonatal clinical examinations. The high risk of having a chromosomal anomaly in children with cleft lip requires systematic prenatal chromosomal exploration.
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Affiliation(s)
- J N McHeik
- Service de chirurgie pédiatrique, hôpital Jean-Bernard, CHU de Poitier, cité hospitalière de la Milétrie, Poitiers cedex, France.
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Abstract
INTRODUCTION Epidemiological information gathered through birth defects surveillance is an important adjunct to carrying out clinical and aetiological research. Information on the incidence in the population, causative risk factors and providing baseline data prior to intervention are all important elements. Under the auspices of the World Health Organisation, it was agreed that a global registry and database on craniofacial anomalies should be created and this, the International Database on Craniofacial Anomalies (ICDFA) was designed to gather information on craniofacial abnormalities from existing birth defects registries and databases around the world to become a resource underpinning research. There are currently 62 registries covering 2 million births per year contributing to a database along with information on the size and type of studies used to collect the information, any variation in ascertainment and on the inclusion of syndromes and associated abnormalities. GENERATION OF HYPOTHESES From the epidemiological data collected it is possible to carry out meta-analysis and to search for trends and consistencies in the data that enable hypothesis to be generated. Issues such as geographical distribution, ethnicity, gender, associated abnormalities and clefts in stillbirths can all be examined in a meta-analytical approach. Collection of information on risk factors such as maternal illnesses, medications, lifestyle factors, nutrition and perhaps occupational exposures enables investigation into environmental contribution to causality and genetic predisposition. A range of techniques are currently being used to identify new candidate genes and ultimately it will be necessary to test genetic and environmental hypothesis in the context of human population studies. CONCLUSIONS It is only by consistency of association between different populations with different gene pools and maternal exposures, lifestyles, nutrition etc that conclusive evidence regarding causality will be found. It is therefore essential, and a major objective of the WHO that international multicentre collaborative studies are setup to gather the appropriate evidence and improve knowledge and the cause of birth defects in general and orofacial clefts in particular, with the ultimate humanitarian and scientific objective of the WHO being primary prevention. CLINICAL UTILITY AND IMPLICATIONS This IDCFA project fulfils three basic objectives namely to enable global surveillance of CFA; to create online access to those who wish to contribute to the IDCFA, and to develop an online directory of resources on craniofacial anomalies for the support of research and improving quality of care. The next steps for IPDTOC are to expand the number of participating registries and to actively collect data on other craniofacial birth defects.
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Affiliation(s)
- Peter Mossey
- University of Dundee, Dental Hospital & School, Dundee, Scotland, UK.
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Hasslöf P, Twetman S. Caries prevalence in children with cleft lip and palate--a systematic review of case-control studies. Int J Paediatr Dent 2007; 17:313-9. [PMID: 17683319 DOI: 10.1111/j.1365-263x.2007.00847.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To conduct a systematic review of literature in order to examine the evidence of an increased prevalence of dental caries in children with cleft lip and palate (CLP). METHODS A search of the PubMed database was conducted through May 2006. Sex- and age-matched case-control studies with noncavitated and manifest caries lesions as endpoint were targeted (n = 6). The studies were assessed independently by two reviewers and scored A-C according to predetermined criteria for methodology and performance. RESULTS Significantly more caries in CLP children were reported in two of the four studies in the permanent dentition and in three out of four publications dealing with primary teeth. None of the articles were, however, assessed with the highest grade 'A' and the level of evidence was therefore based on three papers graded 'B'. There was a tendency towards higher caries scores in preschool children, but as conflicting results were revealed, the evidence that children with CLP exhibit more caries than noncleft controls was inconclusive. CONCLUSION This systematic review of literature was unable to find firm evidence for the assumption that CLP children have an increased prevalence of dental caries.
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Affiliation(s)
- Pamela Hasslöf
- Department of Odontology, Pediatic Dentistry, Faculty of Medicine, Umeå University, Umeå, Sweden
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Nunes LMN, Queluz DDP, Pereira AC. Prevalência de fissuras labiopalatais no município de Campos dos Goytacazes-RJ, 1999-2004. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2007. [DOI: 10.1590/s1415-790x2007000100012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi determinar a prevalência de fissuras labiopalatais no município de Campos dos Goytacazes-RJ, Brasil, em crianças nascidas entre 01/01/1999 e 31/12/2004. Foram considerados a faixa etária, tipo de fissura, sexo e raça da criança, além do estado civil, grau de escolaridade e procedência da mãe do portador na época do parto. Deste modo, foram verificados os prontuários de pacientes inscritos em serviços de referência em tratamento de anomalias craniofaciais, com o objetivo de selecionar os nascidos e/ou domiciliados no município de Campos dos Goytacazes. Após seleção inicial, foi realizada busca no Sistema de Informações sobre Nascidos Vivos (SINASC), definindo o universo do estudo, a saber: nascidos vivos entre 1999 e 2004, cujas mães eram residentes em Campos dos Goytacazes. Neste período, o número de nascidos no município, por residência da mãe, foi de 46.707, dos quais 63 possuíam algum tipo de fissura labiopalatal, representando uma prevalência de 1,35 casos por 1000 nascidos vivos. A análise dos dados revelou que 55,6% dos pacientes eram do sexo masculino. Os tipos de fissuras mais encontrados foram o de lábio e palato e o de palato isolado (34,9% cada). Embora a raça branca tenha representado 61,3% dos indivíduos estudados, o percentual de casos por raça não diferiu estatisticamente em relação à distribuição de nascidos na população. Com relação à mãe do portador, a maior parte das mães era solteira ou casada, possuindo como característica o baixo grau de escolaridade.
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Suleiman AM, Hamzah ST, Abusalab MA, Samaan KT. Prevalence of cleft lip and palate in a hospital-based population in the Sudan. Int J Paediatr Dent 2005; 15:185-9. [PMID: 15854114 DOI: 10.1111/j.1365-263x.2005.00626.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Cleft lip and palate represents one of the most common developmental deformities seen in oral surgery clinics. It is usually associated with problems which include not only cosmetic and dental abnormalities, but also speech, hearing and facial growth difficulties. OBJECTIVES The purpose of the present study was to determine the prevalence of cleft lip and palate in births taking place in hospitals in the Sudan. METHODS The records of 15,890 Sudanese new-borns delivered at three hospitals during the period from 1997 to 2000 were examined. RESULTS Thirteen cases of cleft lip and palate were found, demonstrating a prevalence of 0.9 per 1000. There were more girls than boys, with a male:female ratio of 3:10. Fifty-four per cent of the cases had cleft lip with cleft palate, 30% had only cleft palate and the remaining 16% had cleft lip alone. CONCLUSIONS The present study was confined to hospital-based births in one city, and the true incidence of cleft lip and/or palate in the Sudan is not yet known. Findings differ from reports from other countries in terms of suggesting a higher incidence in girls.
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Affiliation(s)
- A M Suleiman
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan.
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Magdalenić-Mestrović M, Bagatin M. An epidemiological study of orofacial clefts in Croatia 1988–1998. J Craniomaxillofac Surg 2005; 33:85-90. [PMID: 15804585 DOI: 10.1016/j.jcms.2005.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Accepted: 11/17/2004] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The objective of this epidemiological study was to assess the incidence at birth of orofacial clefts in Croatia. AIM The aim of the present study was to analyse the character and incidence of orofacial clefts in Croatia and to compare the data with reports from other countries. MATERIAL AND METHODS All the material for the epidemiological study was retrieved from the documented files from all the neonatal units and hospitals in Croatia providing surgical treatment. RESULTS A total of 525,298 livebirths were documented during 11 years (1988-1998); 903 among them with orofacial clefts, 24 (2.7%) of them twins. Sixty (6.6%) infants died between birth and the age of 6 months. The incidence of orofacial clefts during the study period was 1.71 per thousand. When eliminating syndromic clefts, the incidence of non-syndromic clefts was 1.56 per thousand. Analysis of cleft lip with or without cleft palate (CL+/-P) and isolated cleft palate only (CP) revealed their incidence to be 1.05 and 0.66 per 1000, respectively. Of all types of clefting, CL and CLA was found in 17.2%, CL+/-P in 43.9%, CP in 38.2% and atypical facial clefts (AFC) in 0.8% of children. Left-sided clefts were most common (51%), followed by bilateral (30.5%) and right-sided (18.5%) clefts. The male to female ratio was 1.3. CL+/-P predominated in male and CP in female children. In 220 cases (24.4%) orofacial clefts were either associated with other anomalies or the clefts occurred as one feature of a syndrome. CONCLUSION Data obtained from different sources yielded a cleft incidence of 1.71 per 1000 in Croatia. There were no differences in the incidences of orofacial clefts in comparison with similar data from other European countries.
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Campbell S, Lees C, Moscoso G, Hall P. Ultrasound antenatal diagnosis of cleft palate by a new technique: the 3D "reverse face" view. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:12-18. [PMID: 15619313 DOI: 10.1002/uog.1819] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the clinical value of a novel three-dimensional (3D) ultrasound technique, the reverse face view (3D RF view), in the antenatal categorization of facial clefting and in particular clefting of the hard palate. METHODS Eight cases of suspected orofacial clefting were examined by 3D surface rendering. The fetal lips and alveolar ridge were examined in the frontal plane and the face was then rotated through 180 degrees on the vertical axis to examine the secondary palate by the 3D RF view. RESULTS In each case described, we were able to visualize the fetal face, lips and palate and make an antenatal diagnosis as to whether the palate was affected. In all cases, the antenatal diagnosis was subsequently confirmed. In one case with a left-sided cleft in the lips and alveolar ridge and an intact hard palate, the correct diagnosis was made but a cleft in the soft palate was missed. CONCLUSION Although clefts of the lips and alveolar ridge are readily diagnosed on high-quality antenatal ultrasound, visualization of the fetal palate using existing techniques is unreliable. In the patients described here, the 3D RF technique allowed relatively straightforward assessment of the fetal palate with a high degree of accuracy.
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Affiliation(s)
- S Campbell
- Create Health Clinic, 103-105 Harley Street, Imperial College, London W1G 6AJ, UK.
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