Orofacial Clefts: Genetics of Cleft Lip and Palate

Mortality in Cleft Lip and Palate Patients: A Systematic Review and Meta-analysis

Background

Cleft lip and/or palate (CLP) represents one of the most common congenital anomalies among live births globally. Morbidity associated with CLP is well documented in the literature and stratified through measures such as disability-adjusted life years. However, a paucity of literature details mortality rates among different subgroups of patients with CLP.

Methods

A meta-analysis was performed using preferred reporting items for systematic reviews and meta-analysis guidelines. Included studies reported on mortality rates of patients with CLP in a liveborn cohort. Studies that reported only intraoperative mortality, included fetal mortality, or included non-CLP conditions in mortality rates were excluded. Meta-analysis was performed through subgroup analysis using random-effects models.

Results

Twenty-one studies were included. Mortality rates ranged from 1.22% to 19.8% between studies. Patients with isolated cleft lip had lower odds of mortality compared with CLP (odds ratio [OR] = 0.28 [0.14, 0.56], P = 0.005) or isolated palate (OR = 0.34 [0.24, 0.48], P = 0.0005). Increased odds of mortality were found in patients with comorbidities (OR = 19.79 [11.37, 34.43], P < 0.0001) compared with otherwise healthy CLP patients. Across age groups, neonates (0-28 d) had the highest mortality rate (0.7%-19.8%) followed by infants (0.2%-6.6%), both with P values less than 0.05.

Conclusions

Mortality rates in patients with CLP are higher for those with an additional comorbidity or younger age (<1 y). Further studies stratifying data by cleft phenotype and age are required to better understand factors that contribute to CLP mortality.

The Global, Regional, and National Patterns of Change in the Burden of Orofacial Clefts, 1990-2021: An Analysis of the Global Burden of Disease Study 2021 and Forward-Looking Forecast

OBJECTIVE

Orofacial clefts (OFCs) are the most common congenital craniofacial anomalies worldwide. However, data on the burden and trends of this disease remains limited.

METHODS

This study utilizes data from the 2021 Global Burden of Disease study to analyze the prevalence, incidence, and disability-adjusted life years from 1990 to 2021 at global, regional, and national levels, along with age-standardized rates and the average annual percentage change. In addition, the authors examine these global trends by age, gender, and Sociodemographic Index (SDI). Frontier analysis was employed to visually illustrate each country's or region's potential to reduce the burden based on its development level. Finally, the authors used the autoregressive integrated moving average model to forecast future trends in disease burden from 2022 to 2036.

RESULTS

The study shows that, despite a 24.79% decline in incidence from 1990 to 2021, the global number of OFC cases has increased by 3.96%. The incidence of OFCs varies significantly across regions, with the highest incidence in Central Asia. The OFC burden is negatively correlated with SDI, indicating that higher socio-economic development is associated with a lower disease burden. Gender differences show a slightly higher incidence in males, while age-specific data indicate that the highest burden occurs in the first year of life. This study also identifies countries with the greatest disease burden disparities, particularly in low-income regions such as Afghanistan and Cambodia. Projections indicate a continued decline in global OFC incidence and case numbers from 2022 to 2036.

CONCLUSION

The findings highlight the need for targeted interventions, especially in low-income and middle-income countries, to address inequalities in access to health care.

The burden and care of orofacial cleft in Rwanda: a scoping review

BACKGROUND

Orofacial clefts (OFCs) are among the most common congenital anomalies accounting for over 4.6 million cases globally. In many developing nations, OFCs are associated with significant morbidity and a heightened risk of infant mortality due to barriers to accessing multidisciplinary care. This scoping review aims to identify knowledge gaps, establish research agendas, and inform decision-making for policy redirection in Rwanda regarding OFCs.

METHODS

The design and reportage of this scoping review were based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Following the search of eleven electronic databases, all retrieved articles were imported into the Rayyan web application where deduplication of literature was done. One hundred and fourteen articles were obtained from the literature search. After screening and deduplication, six articles were included in the scoping review for data charting, collation, and summarization.

RESULTS

Rwanda faces a substantial burden of OFCs, with prevalence rates ranging from 12.1 to 34.2% across its provinces. The scarcity of specialists who treat OFCs highlights a significant disparity in healthcare access. The prevalence of OFCs varies among demographics and age groups, with a higher incidence in males compared to females. This review also addresses the clinical management of OFCs in Rwanda, highlighting a low retention rate among patients receiving care.

CONCLUSION

This review highlights the need for targeted interventions in OFC care in Rwanda, including the early detection of associated anomalies, enhanced prenatal management, and improved access to specialized treatment facilities, particularly for patients with concomitant malformations. Policymakers and stakeholders must implement strategies to increase the number of specialists supporting individuals with OFCs and ensure high retention rates in OFC care. Further, OFC-related studies with representative sample sizes and advanced research designs are required to address the information gap and better inform Rwandan health policy.

Personal and Cultural Perceptions About Orofacial Clefts in the Democratic Republic of the Congo

ObjectiveThis study aims to explore the personal and cultural perceptions of participants from the Democratic Republic of the Congo (DRC) regarding the etiology and management of orofacial clefts (OFCs).DesignCross-sectional descriptive study.SettingDRC across 19 provinces.Main Outcome Measure(s)Perceptions regarding knowledge of the causes and treatment for OFCs were gathered through surveys in structured interviews.ResultsA total of 710 adults participated (360 women, 350 men), with 51.27% living in urban areas. Most participants (41.1%) were ages 20 to 29 years, with a mean age of 32.5 ± 7.8 years, were married (68.3%), and had secondary education (66.9%). The majority of participants (80.8%) had seen someone with OFC. Personal opinions about OFC etiology included not knowing the cause (33.8%), congenital/hereditary factors (20.8%), God's will (15.6%), evil spirits or witchcraft (10.7%), and disease (9.9%). Similarly, cultural perceptions mostly cited uncertainty (37.9%), evil spirits (19.2%), God's will (13.1%), and congenital/hereditary factors (13.0%). A majority of participants (75.8%) recommended medical care for OFC, which did not vary based on participants' sex, age, residence, marital status, educational level, or religion.ConclusionA range of personal and cultural perceptions were reported about OFCs in the DRC, with many respondents unsure of the cause and most recommending surgery across sociodemographic backgrounds. These insights can help develop culturally appropriate interventions to raise awareness, reduce stigma, and improve the management of OFCs.

Sasa veitchii Extract Mitigates Mycophenolate Mofetil-Induced Human Palatal Cell Proliferation Inhibition by Downregulating microRNA-4680-3p

Cleft palate is a common birth defect worldwide and is caused by both genetic and environmental factors. Intrauterine drug exposure is one of the environmental factors that can induce cleft palate. Mycophenolate mofetil (MPM) is an immunosuppressant drug with teratogenic effects, including cleft palate. However, the research on MPM-induced cleft palate remains limited. Sasa veitchii extract (SE), a medical plant extract, is commercially available in Asia and has been reported to show effectiveness against oral diseases. The purpose of the present study is to evaluate whether SE protects against MPM-induced immunosuppression in human embryonic palatal mesenchymal (HEPM) cells. Cell viability and G1 phase-related cell cycle markers were assessed by co-treatment with MPM and SE. Furthermore, we quantified cleft palate-associated miRNA levels and the expression of its downstream genes. MPM treatment reduced cell viability in a concentration-dependent manner. Co-treatment with SE alleviated MPM-induced inhibition of HEPM cell proliferation. Additionally, SE reduced MPM-induced miR-4680-3p upregulation and the downregulation of its downstream genes (ERBB2 and JADE1). These results suggest that SE alleviated MPM-induced cell proliferation inhibition through modulating miR-4680-3p expression.

Rhinoplasty for Patients with Cleft Lip-Palate: Functional and Aesthetic Concerns

Cleft lip and palate, the most common congenital orofacial anomalies, result in complex nasal deformities due to deficient bony maxilla, dentoalveolar arch, teeth, and soft tissues. This article explores nasal deformities in patients with cleft lip and palate, surgical techniques and considerations in cleft rhinoplasty, particularly focusing on nasal valves in both unilateral and bilateral cases. Unilateral cleft lip deformities include asymmetry of the nasal tip, flattened nostril, and displaced caudal septum, while bilateral cleft lip deformities present a wider and flatter nose with complex nasal features.

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

Objectives

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

Methods

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

Results

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

Conclusions

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

5'tiRNA-35-GlyTCC-3 and 5'tiRNA-33-CysGCA-11 target BMP6, CUL1 and SPR of non-syndromic cleft palate

BACKGROUND

tsRNAs are novel small non-coding RNAs that play important regulatory roles in gene expression, translation, transcription, and epigenetic modification through proteins or mRNAs and may be therapeutic targets for certain diseases. The etiology of non-syndromic cleft palate-only is complex and the pathogenesis is poorly understood, non-coding RNAs play important roles in its development.

METHODS

The tsRNAs of patients with simple cleft palate were compared with healthy individuals using small RNA microarray, bioinformatic analysis, quantitative real-time transcription polymerase chain reaction, and the effects measured using immunohistochemical staining.

RESULTS

Seventy-nine tsRNAs were upregulated and fifty-four tsRNAs were downregulated in patients with simple cleft palate compared with healthy individuals, among which the expression of 5'tiRNA-35-GlyTCC-3 and 5'tiRNA-33-CysGCA-11 was markedly different and was involved in key signaling pathways related to the development of the palate, such as the cell cycle, cAMP signaling pathway, BMP signal transduction, folate biosynthesis, and other key signaling pathways that determine anatomical structure occurrence, regulate gene expression during development, influence epigenetics, and other biological processes, its target genes include BMP6, CUL1 and SPR.

CONCLUSION

5'tiRNA-35-GlyTCC-3 and 5'tiRNA-33-CysGCA-11 are closely associated with non-syndromic cleft palate development and are expected to be potential new targets for diagnosis and treatment.

Cleft Palate Induced by Mycophenolate Mofetil Is Associated with miR-4680-3p and let-7c-5p in Human Palate Cells

Background/Objectives: Cleft palate is a birth defect associated with environmental and genetic factors. Disturbance of microRNAs (miRNAs) and exposure to medicinal agents during pregnancy can cause cleft palate. Although an association between medicine-induced cleft palate and miRNAs has been suggested, it remains to be fully elucidated. This study aimed to clarify the molecular mechanism underlying mycophenolate mofetil (MPM)-induced inhibition of cell proliferation and miRNA expression in human embryonic palatal mesenchymal (HEPM) cells. Methods: Cell viability, apoptosis, and cell cycle-related markers were evaluated 48 h after MPM treatment. In addition, miRNA levels and expression of their downstream genes were measured, and a rescue experiment was performed using miR-4680-3p and/or let-7c-5p inhibitors. Results: MPM dose-dependently reduced HEPM cell viability. Additionally, MPM treatment suppressed cyclin-D1, cyclin E1, cyclin-dependent kinase (CDK)-2, and CDK6 expression in HEPM cells. Furthermore, MPM upregulated miR-4680-3p and let-7c-5p expression and downregulated the downstream genes of each miRNA. Moreover, miR-4680-3p and/or let-7c-5p inhibitors alleviated MPM-induced inhibition of cell proliferation. Conclusions: These results suggest that MPM-induced cleft palate is associated with miR-4680-3p and let-7c-5p expression in HEPM cells.

Exploring the Utility of ChatGPT in Cleft Lip Repair Education

Background/Objectives: The evolving capabilities of large language models, such as generative pre-trained transformers (ChatGPT), offer new avenues for disseminating health information online. These models, trained on extensive datasets, are designed to deliver customized responses to user queries. However, as these outputs are unsupervised, understanding their quality and accuracy is essential to gauge their reliability for potential applications in healthcare. This study evaluates responses generated by ChatGPT addressing common patient concerns and questions about cleft lip repair. Methods: Ten commonly asked questions about cleft lip repair procedures were selected from the American Society of Plastic Surgeons' patient information resources. These questions were input as ChatGPT prompts and five board-certified plastic surgeons assessed the generated responses on quality of content, clarity, relevance, and trustworthiness, using a 4-point Likert scale. Readability was evaluated using the Flesch reading ease score (FRES) and the Flesch-Kincaid grade level (FKGL). Results: ChatGPT responses scored an aggregated mean rating of 2.9 out of 4 across all evaluation criteria. Clarity and content quality received the highest ratings (3.1 ± 0.6), while trustworthiness had the lowest rating (2.7 ± 0.6). Readability metrics revealed a mean FRES of 44.35 and a FKGL of 10.87, corresponding to approximately a 10th-grade literacy standard. None of the responses contained grossly inaccurate or potentially harmful medical information but lacked citations. Conclusions: ChatGPT demonstrates potential as a supplementary tool for patient education in cleft lip management by delivering generally accurate, relevant, and understandable information. Despite the value that AI-powered tools can provide to clinicians and patients, the lack of human oversight underscores the importance of user awareness regarding its limitations.

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSION

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

Prevalence and Correlation of Lip Shapes and Arch Forms in Primary Dentition of Children between 3-6 Years of Age: A Cross-sectional Study

Aims and background

The study of the morphology of soft tissues as well as hard tissues of the orofacial region holds prime importance. A very less information is known about the lips (soft tissues) and maxillo-mandibular arches (hard tissue structures) in primary dentition. Henceforth, there is a need to classify, find the prevalence and correlation of various lip shapes, and arch forms in primary dentition.

Materials and methods

A total of 135 children aged 3-6 years were assessed over a period of 6 months. Lip shapes were classified into three major types: type I (arched upper lip), type II (flat upper lip), and type III (atypical cases). The arch forms were classified into ovoid, square-shaped, and tapered. The data was analyzed using Chi-squared test.

Results

The prevalence of lip shapes includes: type Ib (43.70%), type IIb (34.07%), type IIa (14.07%), type Ia (7.41%), and type III (0.74%). Arch form prevalence for maxilla, ovoid (79.26%), tapered (16.30%), and square (4.44%) shaped arch form while for mandible, ovoid (57.04%), square (36.30%), and tapered (6.67%) arch form.

Conclusion

The most prevalent lip shapes were type Ib followed by type IIb and the most common arch form was ovoid followed by tapered for maxilla and square for mandible. There was no significant correlation found between lip shapes and arch forms in primary dentition.

Clinical significance

The knowledge of lip shapes in primary dentition would aid in rehabilitation of the abnormalities like cleft lip, electrical burns, etc., while the information on arch forms will support the fabrication of prefabricated appliances, correction of alveolar defects, etc.

How to cite this article

Anadeo P, Saxena A, Chauhan SP, et al. Prevalence and Correlation of Lip Shapes and Arch Forms in Primary Dentition of Children between 3-6 Years of Age: A Cross-sectional Study. Int J Clin Pediatr Dent 2024;17(12):1418-1422.

Elucidating tobacco smoke-induced craniofacial deformities: Biomarker and MAPK signaling dysregulation unraveled by cross-species multi-omics analysis

Tobacco smoke (TS), particularly secondhand and thirdhand smoke, poses a pervasive and intractable environmental hazard that promotes teratogenesis and the progression of craniofacial malformations, although the underlying mechanisms remain elusive. Using zebrafish larvae as a model, our research demonstrated a correlation between the increasing concentration of cigarette smoke extract (CSE) and the severity of craniofacial malformations, supported by Alcian blue staining and histological assessments. Through a combined mRNA-miRNA analysis and quantitative real-time PCR, we identified miR-96-5p, miR-152, miR-125b-2-3p, and miR-181a-3-3p as pivotal biomarkers in craniofacial cartilage development. Functional analyses revealed their association with the MAPK signaling pathway, oxidative stress (OS), and cell development, highlighting MAPK as a crucial mediator. Single-cell transcriptomics further disclosed aberrant MAPK activation in mesenchymal cells. Subsequent investigations in human embryonic palatal mesenchymal (HEPM) cells confirmed similar patterns of growth inhibition, apoptosis, and OS, and emphasized the cross-species consistency of these biomarkers and the over-activation of the MAPK signaling pathway. A comprehensive tri-omics analysis of HEPM cells identified pivotal genes, proteins, and metabolites within the MAPK pathway. This groundbreaking cross-species multi-omics study unveils novel biomarkers and MAPK pathway perturbations linked to TS-induced craniofacial developmental toxicity, promoting innovative clinical prediction, diagnosis, and interventional strategies to tackle TS-induced craniofacial malformations.

Prenatal exposure to antibiotics and the risk of orofacial clefts: a protocol for a systematic review and meta-analysis

INTRODUCTION

Orofacial clefts (OFCs), including cleft lip, cleft palate and combined cleft lip and palate, are among the most common craniofacial malformations in newborns and present significant healthcare challenges. Emerging evidence has raised concerns regarding the potential impact of prenatal exposure to antibiotics on fetal development. Antibiotics prescribed during pregnancy-particularly those that cross the placental barrier-may pose teratogenic risks. Previous studies investigating the association between prenatal antibiotic exposure and the risk of OFCs have yielded inconsistent results. However, no studies have yet attempted to summarise this evidence, highlighting the need for a comprehensive evaluation. This report describes a systematic review and meta-analysis protocol to retrospectively analyse the relationship between prenatal antibiotic exposure and the risk of developing OFCs, focusing on the role of antibiotic type and timing of exposure. The results of such a review will hopefully provide a comprehensive synthesis of the available evidence, helping to inform clinical practice and guide patient counselling regarding the use of antibiotics during pregnancy.

METHODS AND ANALYSIS

The planned systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines to ensure a comprehensive and systematic approach to summarising the available evidence on the topic. This study will include longitudinal cohort studies, case-control studies, and interventional trials that investigate the association between prenatal antibiotic exposure and OFCs. The search strategy will cover major databases, including CINAHL, Cochrane Library, ClinicalTrials.gov, EMBASE, PubMed, Scopus and Web of Science, using tailored search terms. A team of independent assessors will screen article titles, abstracts and full texts. Any discrepancies will be resolved through discussions. Quality assessment will use the Newcastle-Ottawa Scale and Grading of Recommendations Assessment, Development and Evaluation criteria. Data extraction will focus on the study characteristics, participant details, exposure specifics and outcome measures. A random-effects meta-analysis will aggregate summary effect sizes, and heterogeneity will be assessed using I2 and Q statistics.

ETHICS AND DISSEMINATION

Ethical approval is not required for this systematic review, as it relies on already published data. The findings will be disseminated through peer-reviewed journals and conference presentations, providing critical insights into clinical practice and public health policies regarding antibiotic use during pregnancy.

PROSPERO REGISTRATION NUMBER

CRD42024565064.

Underreporting, Prevalence, and Epidemiological Trends of Orofacial Clefts in the Brazilian Amazon Region

Cleft lip and palate are the most common congenital anomalies of the cranial segment worldwide. Particularly in low-income and middle-income countries, these conditions are associated with increased morbidity and mortality, socioeconomic challenges, and considerable psychological and social integration difficulties for affected individuals. This study aims to evaluate the epidemiological profile of patients with these conditions treated at a newly established specialized center in the Brazilian Amazonian Region. Data were extracted from medical records at a Reference Service for Clefts and Craniofacial Anomalies in the north of Brazil, covering the period from 2016 to 2020. These were compared with data from the official epidemiological health portal of the Brazilian Ministry of Health. The study recorded a total of 852 patients, with males comprising 54.4%. The predominant type of cleft was the transforaminal cleft, which accounted for 69.4% of cases, followed by postforamen clefts at 17.3%. The left side was more frequently affected in 63% of the cases. The primary surgical intervention performed was cheiloplasty, representing 39.5% of all procedures. Notably, 52% of the patients were from the interior regions of the state. The 2019 DataSUS data indicated a prevalence of cleft lip and palate in the State of Pará of 4.26 per 10,000 live births. However, data from this single specialized hospital showed a higher prevalence of 7.58 per 10,000 live births. These results may reflect underreporting of the number of cases reported in national official data sets.

Perception, attitude, and opinion of parents of cleft lip and palate patients treated with nasoalveolar molding (NAM): A cross-sectional questionnaire study

BACKGROUND

The main goal of the nasoalveolar molding (NAM) is to mitigate the initial severity of the cleft, facilitating the subsequent surgical procedures. Nevertheless, the use of the appliance entails high stress levels for families.

AIM

The aim of this study was to assess the perceptions, attitudes, and opinions of parents whose cleft-affected children underwent treatment using the NAM technique.

DESIGN

A cross-sectional questionnaire study was conducted on a cohort of relatives of infants born with cleft lip and palate who were treated with the NAM appliance. The parents completed a 59-item questionnaire that had been previously validated.

RESULTS

The initial cohort consisted of 104 families. The level of satisfaction was high, and there was a direct correlation with early diagnosis. Satisfaction levels varied depending on the cleft type, with a decrease in cases of bilateral presentation. Satisfaction was influenced by the newborns' adaptation and the absence of complications. Parents who exhibited lower levels of satisfaction contemplated terminating the treatment.

CONCLUSIONS

Parents expressed high satisfaction with NAM treatment, due to effective management and understanding. Bilateral clefts and delayed diagnosis can significantly impact satisfaction. These results emphasize the importance of personalized approaches to address challenges in NAM treatment, particularly in instances of bilateral clefts and delayed diagnoses.

Spatiotemporal characteristics of eustachian tube development in C57BL/6 mice: Correlation between morphological and functional maturation

BACKGROUND

The eustachian tube (ET), a critical conduit connecting the middle ear and nasopharynx, is essential for normal middle ear function. However, it remains one of the least understood anatomical structures due to its complexity and the challenges of in vitro manipulation. Historically, these challenges have hindered research into the morphology and function development of the ET. This study elucidates the spatiotemporal relationship of ET morpho-functional maturation in mice, identifying key periods and factors that lay the theoretical foundation for exploring the molecular mechanisms of ET-related diseases.

RESULTS

We comprehensively characterized the ET development in C57BL/6 mice from embryonic day (E) 12.5 to postnatal day (P) 30, focusing on the development of cilia, secretory cells, surrounding glands, and macrophages. Immunostaining identified the localization and secretion patterns of the mucins Muc5b and Muc5ac within the ET. Additionally, using improved ET function assessment tools, we evaluated the developmental features of ET mucociliary clearance and ventilation functions.

CONCLUSIONS

In C57BL/6 mice, E16.5 marks a critical period for middle ear cavity and ET formation. Muc5b plays a foundational role during early stages, while Muc5ac enhances function in later stages. During P7-11, despite morphological maturity, ET function remains underdeveloped but continues to improve with growth.

Do Tunisian children with unilateral cleft lip and palate differ from normal individuals in dental maturity? A pilot study

INTRODUCTION

Cleft lip and palate (CLP) is the most common congenital malformation of the head and neck. Children with CLP often exhibit dental anomalies.

AIM

To evaluate the dental age (DA) of unilateral CLP in Tunisian children.

METHODS

This was a cross-sectional study carried out in the department of pediatric dentistry at the University Hospital La Rabta, Tunis. Patients aged between 5 and 14 years, with no other congenital anomalies or syndromes in the craniofacial region other than CLP, were included. The patients' chronological ages were first calculated in years and months. DA was assessed in panoramic radiographs using Demirjian's method. The score of each stage is allocated, and the sum of the scores provides an evaluation of the subject's dental maturity.

RESULTS

Fifty-three patients were included in the present study. No difference was observed between the two groups regarding the dental age. A strong and positive correlation between the DA and the chronological age in the two groups was observed (r=0.826). Estimated regression showed that chronological age alone explained 57,4% (r2=0.574) of the dental age variation in the study group and 64.5% (r2=0.645) in the control group.

CONCLUSION

For dental management, CLP children should have the same approach in orthodontics and pediatric dentistry as individuals without clefts, with a focus on the individualization of diagnosis and treatment planning.

Timely Access for Orofacial Cleft Repairs in a Brazilian Amazon Center

Orofacial clefts are the most common congenital craniofacial anomalies worldwide, and if not managed in a timely manner, can lead to significant complications. We aim to examine surgical timing at one of the few cleft care centers in the North region of Brazil since its foundation in 2016. This retrospective, descriptive study analyzed medical records from 2016 to 2023. We calculated the age at surgery for each time period and each primary surgery performed. We also evaluated the number of procedures performed outside the recommended age. Of the 1439 procedures performed from 2016 to 2023, 713 procedures met our inclusion criteria. Among these, 66.67% (n=188) of primary cheiloplasties, 67.80% (n=40) of primary lip adhesions, and 54.57% (n=203) of palatoplasties were performed outside the recommended time frame. Of the surgeries performed, 45.16% (n=322) were between 2016 and 2019, while 54.84% (n=391) were from 2020 to 2023. Considering procedures performed within the ideal recommended age groups, only 32.92% (n=106) were done between 2016 and 2019, in contrast to 45.01% (n=176) between 2020 and 2023. In conclusion, since the inception of the specialized center, there has been an increase in surgical volume and an improvement in their timing. However, many surgeries are still being conducted outside the recommended time frame.

Congenital diaphragmatic hernia and cleft lip and palate: looking for a common genetic etiology

PURPOSE

Congenital diaphragmatic hernia (CDH) and cleft lip and/or palate (CL/P) are inborn closure defects. Genetic factors in and outcomes for patients with both anomalies (CDH+CL/P) remain unclear. We aimed to investigate associated genetic aberrations, prevalence of, and outcomes for, CDH+CL/P.

METHODS

Data from Congenital Diaphragmatic Hernia Study Group (CDHSG) registry were collected. CL/P prevalence in CDH patients was determined. Genetic abnormalities and additional malformations in CDH+CL/P were explored. Patient characteristics and outcomes were compared between CDH+CL/P and isolated CDH (CDH-) using Fisher's Exact Test for categorical, and t-test or Mann-Whitney U-test for continuous, data. p < 0.05 was considered statistically significant.

RESULTS

Genetic anomalies in CDH+CL/P included trisomy 13, 8p23.1 deletion, and Wolf-Hirschhorn syndrome (4p16.3 deletion). CL/P prevalence in CDH was 0.7%. CDH+CL/P had lower survival rates than CDH-, a nearly fourfold risk of death within 7 days, were less supported with extracorporeal life support (ECLS), had higher non-repair rates, and survivors had longer length of hospital stay.

CONCLUSION

Genetic anomalies, e.g. trisomy 13, 8p23.1 deletion, and Wolf-Hirschhorn syndrome, are seen in patients with the combination of CDH and orofacial clefts. CL/P in CDH patients is rare and associated with poorer outcomes compared to CDH-, influenced by goals of care decision-making.

Socioeconomic Deprivation Detrimentally Influences Language Outcomes in Toddlers With Cleft Palate

PURPOSE

The purpose of this study was to examine the influence of socioeconomic deprivation on language and developmental outcomes in toddlers with cleft palate with or without cleft lip (CP ± L). Other factors known to influence language outcomes were also considered, including home language history, history of hearing problems, syndromic diagnoses, and sex.

METHOD

A multicenter, cross-sectional study design was conducted. Data for 566 16-month-old toddlers with CP ± L were collected from 17 outpatient cleft palate clinics located throughout the United States. Outcome measures included the MacArthur-Bates Communicative Development Inventories, LENA Developmental Snapshot, age at first word as reported by the caregiver, and the Ages and Stages Questionnaires-Third Edition (ASQ-3). Multivariable linear or logistic regression was used to determine the influence of socioeconomic deprivation, as measured by the Area Deprivation Index, on language and developmental outcomes.

RESULTS

Greater socioeconomic deprivation significantly predicted poorer language outcomes in toddlers with CP ± L, including receptive vocabulary words (p = .02), expressive vocabulary words (p = .02), and late-developing gestures (p = .02). Additionally, toddlers from less affluent neighborhoods produced their first words significantly later than their counterparts living in more affluent areas (p < .01). Lower maternal education levels predicted significantly increased risk for problem solving delays (p < .01), and patients with subsidized insurance were at significantly increased risk for personal-social delays on the ASQ-3 (p < .01).

CONCLUSIONS

Children with CP ± L are susceptible to developmental delays associated with socioeconomic deprivation. These findings have implications for identifying a child's individual risk factors for developmental language disorders when conducting speech-language assessments. Future study should examine how inequities in care can be mitigated and addressed.

Investigating Single Nucleotide Polymorphisms in the Etiology of Cleft Lip and Cleft Palate in the Polish Population

Cleft lip and/or palate (CL/P) are the most common congenital anomalies in the craniofacial region, leading to morphological and functional disruptions in the facial region. Their etiology involves genetic and environmental factors, with genetics playing a crucial role. This study aimed to investigate the association of four single nucleotide polymorphisms (SNPs)-rs987525, rs590223, rs522616, and rs4714384-with CL/P in the Polish population. We analyzed DNA samples from 209 individuals with CL/P and 418 healthy controls. The impact of SNPs on the presence of CL/P was assessed using multivariate logistic regression. Significant associations were found with rs987525. Specifically, the AC genotype was linked to an increased CL/P risk (odds ratio [OR] = 1.95, 95% confidence interval [CI]: 1.34-2.83, p < 0.001), while the CC genotype was associated with a decreased risk (OR = 0.46, 95% CI: 0.32-0.67, p < 0.001). Rs4714384 was also significant, with the CT genotype correlated with a reduced risk of CL/P (OR = 0.66, 95% CI: 0.46-0.94, p = 0.011). SNPs rs590223 and rs522616 did not show statistically significant associations. These results underscore the role of rs987525 and rs4714384 in influencing CL/P risk and suggest the utility of genetic screening in understanding CL/P etiology.

Prenatal Diagnosis of Cleft Lip and Palate: A Retrospective Study

Cleft lip and/or palate are prevalent congenital anomalies. Early and accurate diagnosis allows proper case management. The Objective: This retrospective cohort study aimed to investigate the association between cleft lip and palate and other congenital anomalies. Methods: This study analyzed 17 pregnancies prenatally diagnosed with cleft lip and palate. The investigations consisted of ultrasound examination, fetal karyotyping through amniocentesis, and family tree analysis. In the presence of an abnormal fetal karyotype, the parental karyotype was also indicated. Results: Of the 17 cases identified, 9 (52.94%) were syndromic and 8 (47.06%) were non-syndromic. The genetic syndromes identified in association with cleft lip and palate in this study included translocation syndrome (one case), Patau syndrome, trisomy 13 (seven cases), and Edwards syndrome, mosaic trisomy 18 (one case). Conclusions: A comprehensive approach ensures a thorough assessment and accurate diagnosis. Early detection and a multidisciplinary approach allow appropriate case management.

The Frequency of Risk Factors for Cleft Lip and Palate in Mexico: A Systematic Review

BACKGROUND

Cleft lip and palate is an anomaly that affects both women and men. It is considered to be among the most frequent congenital abnormalities and is related to modifications in chromosomal DNA and multiple genetic alterations. This anomaly can also be associated with various environmental factors, such as tobacco and alcohol consumption, medication use, and exposure to different environmental and industrial toxic substances. The objective of this study was to document the frequency of risk factors related to cleft lip and palate through a systematic review of Mexican studies.

METHODS

In this systematic review, a bibliographic search was conducted following PRISMA guidelines in the databases Scielo, ScienceDirect, PubMed, and EBSCO. Keywords related to cleft lip and palate, epidemiology, and risk factors were used. In all, 3 independent reviewers (J.A.S.L., S.L.V., and N.M.F.) selected and evaluated a total of 17 articles included in this analysis, achieving a coefficient of κ = 0.84.

RESULTS

The analysis revealed that the highest frequency of conducted studies was in the State of Mexico. The most common risk factors identified were environmental, pharmacological, consumption habits, and gynecological factors.

CONCLUSIONS

Identifying the main risk factors for cleft lip and palate in the Mexican population will enable the implementation of preventive measures aimed at reducing exposure to these factors. Additionally, early intervention can improve the quality of life for individuals affected by this condition.

Assessment of Parental Risk Factors Involved in Orofacial Clefts in Hail, Saudi Arabia: A Retrospective Cohort Study

Background Orofacial clefts are congenital anomalies affecting the development of the oral and facial structures, influenced by genetic and environmental factors. The prevalence of orofacial clefts varies globally, necessitating region-specific studies to understand contributing factors. Orofacial clefts are among the most common congenital defects affecting the head and neck, underscoring the importance of investigating paternal and maternal influences on their development to enhance awareness and understanding of potential contributing factors. Therefore, this research aimed to investigate parental risk factors contributing to the development of orofacial clefts.  Methods A retrospective cohort study was conducted at the Oral and Maxillofacial Department of King Khaled Hospital, Hail, Saudi Arabia, involving 40 parents of children born between 2019 and 2023 with orofacial clefts. Data collection included interviewer-administered questionnaires with parents addressing demographic information, pregnancy details, parental medical history, and postoperative outcomes. Statistical analysis utilized descriptive statistics, chi-square tests, Fisher's exact test, and linear regression, with significance defined as p<0.05. Results The study had a gender distribution of 19 males (47.5%) and 21 females (52.5%) among orofacial cleft cases (p<0.75), with cleft palate (13 cases, 32.5%) and cleft lip (11 cases, 27.5%) being the most prevalent anomalies (p<0.05). Maternal supplementation rates were high, with 34 mothers (85%, p<0.05) taking folic acid and 36 mothers (90%, p<0.05) taking iron, yet orofacial clefts incidence persisted. Paternal risk factors such as tobacco use were reported by 19 fathers (47.5%, p<0.05), and familial history of orofacial clefts was noted in nine cases (22.5%, p<0.05). Postoperative outcomes indicated varying levels of functional recovery and satisfaction. Conclusion This study explored the complex origins of orofacial clefts, emphasizing genetic and environmental influences. The findings suggest a potential paternal risk factor. The study highlights the need for further investigation into genetic mechanisms and the development of effective prevention strategies.

Testing Reported Associations of Gene Variants with Non-Syndromic Orofacial Clefts in the Polish Population

Orofacial clefts (OFCs) are the second most common birth defect worldwide. The etiology of OFCs involves complex interactions between genetics and environment. Advances in genomic technologies have identified gene variants associated with OFCs. This study aimed to investigate whether selected SNPs in the MYH9, MTHFR, MAFB, and SUMO1 genes influence the occurrence of non-syndromic OFCs in the Polish population. The study included 209 individuals with non-syndromic OFCs and 418 healthy controls. Saliva and umbilical cord blood samples were collected for DNA extraction. Four SNPs in the MYH9, MTHFR, MAFB, and SUMO1 genes were genotyped using real-time PCR-based TaqMan assays. Statistical analysis was performed using logistic regression to assess the association between SNPs and OFCs. A significant association was found between the rs7078 CC polymorphism and OFCs (OR = 3.22, CI 1.68-6.17, p < 0.001). No significant associations were identified for the rs1081131, rs13041247, and rs3769817 polymorphisms. The research indicates that the rs7078 polymorphism significantly influences the occurrence of orofacial cleft palate in the Polish population, whereas the rs3769817, rs1801131, and rs13041247 SNPs do not show such a correlation.

[Gene-gene/gene-environment interaction of transforming growth factor-β signaling pathway and the risk of non-syndromic oral clefts]

OBJECTIVE

To explore the association between polymorphisms of transforming growth factor-β (TGF-β) signaling pathway and non-syndromic cleft lip with or without cleft palate (NSCL/P) among Asian populations, while considering gene-gene interaction and gene-environment interaction.

METHODS

A total of 1 038 Asian NSCL/P case-parent trios were ascertained from an international consortium, which conducted a genome-wide association study using a case-parent trio design to investigate the genes affec-ting risk to NSCL/P. After stringent quality control measures, 343 single nucleotide polymorphism (SNP) spanning across 10 pivotal genes in the TGF-β signaling pathway were selected from the original genome-wide association study(GWAS) dataset for further analysis. The transmission disequilibrium test (TDT) was used to test for SNP effects. The conditional Logistic regression models were used to test for gene-gene interaction and gene-environment interaction. Environmental factors collected for the study included smoking during pregnancy, passive smoking during pregnancy, alcohol intake during pregnancy, and vitamin use during pregnancy. Due to the low rates of exposure to smoking during pregnancy and alcohol consumption during pregnancy (<3%), only the interaction between maternal smoking during pregnancy and multivitamin supplementation during pregnancy was analyzed. The threshold for statistical significance was rigorously set at P =1.46×10-4, applying Bonferroni correction to account for multiple testing.

RESULTS

A total of 23 SNPs in 4 genes yielded nominal association with NSCL/P (P<0.05), but none of these associations was statistically significant after Bonferroni' s multiple test correction. However, there were 6 pairs of SNPs rs4939874 (SMAD2) and rs1864615 (TGFBR2), rs2796813 (TGFB2) and rs2132298 (TGFBR2), rs4147358 (SMAD3) and rs1346907 (TGFBR2), rs4939874 (SMAD2) and rs1019855 (TGFBR2), rs4939874 (SMAD2) and rs12490466 (TGFBR2), rs2009112 (TGFB2) and rs4075748 (TGFBR2) showed statistically significant SNP-SNP interaction (P<1.46×10-4). In contrast, the analysis of gene-environment interactions did not yield any significant results after being corrected by multiple testing.

CONCLUSION

The comprehensive evaluation of SNP associations and interactions within the TGF-β signaling pathway did not yield any direct associations with NSCL/P risk in Asian populations. However, the significant gene-gene interactions identified suggest that the genetic architecture influencing NSCL/P risk may involve interactions between genes within the TGF-β signaling pathway. These findings underscore the necessity for further investigations to unravel these results and further explore the underlying biological mechanisms.

The heterogeneous genetic architectures of orofacial clefts

Orofacial clefts (OFCs) are common, affecting 1:1000 live births. OFCs occur across a phenotypic spectrum - including cleft lip (CL), cleft lip and palate (CLP), or cleft palate (CP) - and can be further subdivided based on laterality, severity, or specific structures affected. Herein we review what is known about the genetic architecture underlying each of these subtypes, considering both shared and subtype-specific risks. While there are more known genetic similarities between CL and CLP than CP, recent research supports both shared and subtype-specific genetic risk factors within and between phenotypic classifications of OFCs. Larger sample sizes and deeper phenotyping data will be of increasing importance for the discovery of novel genetic risk factors for OFCs and various subtypes going forward.

Research on Cleft Lip and Palate: What Is New?

Craniofacial development begins during the fourth week of intrauterine life (IUL) [...].

Association between IRF6, TP63, GREM1 Gene Polymorphisms and Non-Syndromic Orofacial Cleft Phenotypes in Vietnamese Population: A Case-Control and Family-Based Study

This study aims to identify potential variants in the TP63-IRF6 pathway and GREM1 for the etiology of non-syndromic orofacial cleft (NSOFC) among the Vietnamese population. By collecting 527 case-parent trios and 527 control samples, we conducted a stratified analysis based on different NSOFC phenotypes, using allelic, dominant, recessive and over-dominant models for case-control analyses, and family-based association tests for case-parent trios. Haplotype and linkage disequilibrium analyses were also conducted. IRF6 rs2235375 showed a significant association with an increased risk for non-syndromic cleft lip and palate (NSCLP) and cleft lip with or without cleft palate (NSCL/P) in the G allele, with pallele values of 0.0018 and 0.0003, respectively. Due to the recessive model (p = 0.0011) for the NSCL/P group, the reduced frequency of the GG genotype of rs2235375 was associated with a protective effect against NSCL/P. Additionally, offspring who inherited the G allele at rs2235375 had a 1.34-fold increased risk of NSCL/P compared to the C allele holders. IRF6 rs846810 and a G-G haplotype at rs2235375-rs846810 of IRF6 impacted NSCL/P, with p-values of 0.0015 and 0.0003, respectively. In conclusion, our study provided additional evidence for the association of IRF6 rs2235375 with NSCLP and NSCL/P. We also identified IRF6 rs846810 as a novel marker associated with NSCL/P, and haplotypes G-G and C-A at rs2235375-rs846810 of IRF6 associated with NSOFC.