MMP16 as NSCL ± P Susceptible Gene in Western Han Chinese

OBJECTIVE

The role of MMP16 in lip development is unclear. This study aimed to identify nonsyndromic cleft lip with or without palate (NSCL ± P) susceptible loci of MMP16 in western Han Chinese.

DESIGN

We performed targeted sequencing around MMP16 combined with a 2-phase association analysis on common variants. Phase 2 association analysis was performed with NSCL ± P specific subphenotypes (NSCL and NSCLP). Then we used rare variants burden analysis and genotyping, accompanied by motif analysis.

SETTING

This study was completed in a tertiary medical center.

PATIENTS, PARTICIPANTS

Phase 1 targeted sequencing included 159 patients with NSCL ± P and 542 normal controls; phase 2 included 1626 patients with NSCL ± P (1047 NSCL and 579 NSCLP) and 2255 normal controls.

INTERVENTIONS

Venous blood samples were collected from patients and used to extract DNA.

MAIN OUTCOME MEASURES

After Bonferroni correction, phase 1 significant threshold of p-value was 4.28 × 10-5 (0.05/1167 single nucleotide polymorphisms [SNPs]), and phase 2 was .00025 (0.05/200 SNPs). Burden analysis significant threshold p-value was .05.

RESULTS

Common variants phase 1 association analysis identified 11 statistically significant SNPs (lowest p = 1.90 × 10-9, odds ratio (OR) = 0.27, 95% CI: 0.17-0.44), phase 2 replication identified 16 SNPs in NSCL ± P (lowest p = 6.26 × 10-6, OR = 0.77, 95% CI: 0.69-0.86) and 9 in NSCL (lowest p = 8.44 × 10-5, OR = 0.76, 95% CI: 0.66-0.87). Rare variants burden analysis showed no significant results, genotyping results showed they were maternally inherited.

CONCLUSIONS

Our study identified MMP16 susceptible SNPs in NSCL ± P and NSCL, emphasizing its potential role in lip development. Our study also highlighted the importance to perform association analysis with subphenotypes divided.

Relationship Between Stigma Experience and Self-Perception Related to Facial Appearance in Young Japanese Patients with Cleft lip and/or Palate

OBJECTIVE

To examine the relationship between stigma experience related to facial appearance in Japanese youths with cleft lip and/or palate (CL/P) and their self-perception.

DESIGN

A cross-sectional study.

PARTICIPANTS

Sixty-nine Japanese youths with CL/P (11-18 years old).

OUTCOME MEASURES

The participants' stigma experience in relation to facial appearance (measured with 7 single contextual scale items) and their self-perception (measured with 5 domain scores based on 30 perceptual items) were assessed using the Japanese version of the Youth Quality of Life Instrument-Facial Differences Module. Participants were categorized into high and low self-perception subgroups with a threshold of 1 standard deviation for each domain. The frequency of stigma experiences was compared between the following 2 subgroups: age, sex, cleft palate only versus other cleft, and high versus low self-perception. Correlations between the responses regarding stigma and all domain scores were examined.

RESULTS

Sixteen percent of the participants reported experiencing stigma. Hearing others say something about their face occurred significantly more frequently in youths 15 to 18 years of age than in youths 11 to 14 years of age. Stigma frequency was not found to differ by sex or cleft type. Stigma experiences were significantly more frequent for youth with higher scores across negative self-perception domains as well as higher coping skills. Significant correlations were identified between responses regarding stigma items and all domain scores (r  =  0.27-0.63, p < .05).

CONCLUSIONS

It was found that stigma experiences related to facial appearance may influence negative self-perceptions of facial differences as well as higher coping skills among Japanese youths with CL/P.

Characteristics of Orofacial Clefting in Hawai'i

Orofacial clefts are birth defects that require a multi-disciplinary approach for repair and ongoing management as there are often concomitant chronic health issues. Orofacial clefts can occur as an isolated finding, in combination with other anomalies, or as part of a genetic syndrome. When occurring as part of a genetic syndrome, the complexity of management increases and has lifelong implications for these individuals, their families, and their health care providers. Understanding factors related to the occurrence of syndromic orofacial clefting is important for birth defect research and for health care needs assessment and planning. Many research groups have addressed these issues by studying different populations and focusing on different questions. This study was a retrospective chart review of children with orofacial clefts cared for at a pediatric tertiary care center in Hawai'i to evaluate the proportion of isolated and syndromic clefts in the unique population of Hawai'i. The prevalence of syndromic and isolated clefts were then correlated with ethnicity and compared to the prevalence in other studies. Our goal was to increase knowledge about orofacial clefting in the population of Hawai'i. The proportion of isolated orofacial clefting in a population of patients with orofacial clefting cared for at a craniofacial clinic is similar to birth defect registry data for the Hawaiian Islands (59% vs 58%). Pacific Islanders in our study and prior study have a lower proportion of isolated clefts, suggesting that there are more craniofacial patients with syndromic and complex needs in this population. Further study is needed to clarify the etiologic factors.

Novel TBX22 mutations in Chinese nonsyndromic cleft lip/palate families

TBX22 is a gene which contribute to cleft lip/palate, and many mutation sites of TBX22 have been reported. However, the exact role of TBX22 mutation in Chinese nonsyndromic cleft lip/palate (NSCL/P) family was not clearly explored. In this study, we tried to investigate the profiles and effects of TBX22 mutation in Chinese NSCL/P family. Members of two Chinese NSCL/P families and 200 normal controls were enrolled in this study. Further, DNA sequence and bioinformatic analysis for TBX22 were performed. The results showed that a novel and essential splicing site mutation, IVS6-1G>C , was detected in a family with cleft palate. The bioinformatic analysis results showed that this mutation would lead to abnormal transcription or translation, followed by a loss of function of TBX22. In addition, a hemizygous missense mutation, c.874G>A (p.D292N), was first reported in another Chinese family, which may exhibit aggravated effects on the phenotypes of CL/P. Taking these findings together, this study provides a profile of TBX22 mutation in Chinese NSCL/P families, and further confirmed the important role of TBX22 in familial cases with X-linked cleft palate.

An Epidemiologic Study of Isolated Cleft Lip, Palate, or Both in Victoria, Australia from 1983 to 2000

Objective

To report the epidemiological characteristics of isolated cleft lip, cleft palate or both (CL ± P and CP) using population-based data in Victoria, Australia.

Design

Descriptive study of a cohort of children born between 1983 and 2000 notified to the Victorian Birth Defects Register by multiple ascertainment sources.

Participants

Data were collected on patients identified with CL ± P and CP without associated defects classified as live births, stillbirths, neonatal deaths, and terminated pregnancies < 20 weeks’ gestation following prenatal identification. Information was collected on sex, plurality, maternal age, and country of birth.

Results

The overall prevalence (per 10,000 pregnancies) of CL ± P was 7.8 (95% confidence interval [CI] = 7.30, 8.33; cleft lip [CL] 3.3; 95% CI = 2.97, 3.65, CL+P 4.5; 95% CI = 4.13, 4.91) and cleft palate (CP), 4.3 (95% CI = 3.89, 4.66). The prevalence of CL + P was higher among stillbirths, neonatal deaths, and terminated pregnancies than CL (without CP) and CP. Boys were at greater risk than girls for CL ± P and girls at greater risk than boys for CP. Regardless of cleft type, there was a nonsignificant excess of clefts among singleton births than multiple births and no related effects of maternal age or country of birth.

Conclusions

The prevalence of isolated CL ± P and CP in Victoria parallels other population-based studies of the same conditions. Inclusion of stillbirths, neonatal deaths, and terminations had little impact on rates. The effect of sex and plurality on cleft type is consistent with the literature, but the effects of maternal age and country of birth remain equivocal. Further studies focusing on certain ethnic groups are warranted to explain the higher rates observed.

Distribution of Orofacial Clefts and Frequent Occurrence of an Unusual Cleft Variant in the Rift Valley of Kenya

Objective:

To investigate the pattern and distribution of nonsyndromic orofacial clefts among patients in the Rift Valley region of northwestern Kenya.

Methods:

Subjects were categorized anatomically for occurrence of an atypical cleft lip variant (ACL), typical cleft lip (CL), cleft lip and palate (CLP), or cleft palate (CP), and family history of orofacial clefts. Tribal ethnicity data were obtained from both cleft and noncleft clinic attendees.

Results:

There were 194 patients with CL (52.7%), 153 with CLP (41.6%), and 21 with CP (5.7%). CL constitutes a greater fraction of orofacial clefts in the Rift Valley region than reported elsewhere in Africa, principally due to frequent occurrence of ACL (52.5% of all CL). Among noncleft clinic attendees there was a lower fraction of Bantu and larger fraction of Nilotic-Paranilotic tribal ethnicity than in Kenya overall. In contrast, among patients with orofacial clefts there was significant underrepresentation of Bantu and overrepresentation of Nilotic-Paranilotic tribes, particularly Kalenjin. Patients of Kalenjin origin had a much higher rate of positive family history of orofacial clefts than Bantu patients.

Conclusions:

There is an unusual anatomic distribution of orofacial clefts in the Kenya Rift Valley, with frequent occurrence of an atypical CL variant. Our findings indicate that Bantu tribes have lower risk of orofacial clefts than Nilotic-Paranilotic tribes, possibly due to inherited genetic differences, perhaps accounting for the relatively low prevalence of orofacial clefts through much of Africa.

Asian Oral-Facial Cleft Birth Prevalence

Objective:

To determine the clefting birth prevalence among Asian populations, specifically Chinese and Japanese, using raw counts from nonoverlapping published studies of Asian populations, and to investigate whether Asian clefting rates have been interpreted accurately as being up to twice the Caucasian rate.

Design:

A literature review of articles giving raw counts of clefting in Asian populations, primarily Japanese and Chinese.

Main Outcome Measures:

Where possible, clefts were identified by the patients’ ethnicity, country of origin, cleft type, syndromic status, and birth status.

Results:

Prevalence rates of cleft lip with or without cleft palate per 1000 live births are reported. Syndromic plus nonsyndromic cleft lip with or without cleft palate: Chinese, 1.30; Japanese, 1.34; Other Asian, 1.47; and total, 1.33. Nonsyndromic cleft lip with or without cleft palate: Chinese, 1.20; Japanese, 1.18; Other Asian, 1.22; and total, 1.19.

Conclusions:

Overall, Chinese and Japanese live birth prevalence rates for nonsyndromic cleft lip with or without cleft palate, based on the published reports of birth prevalence, are significantly lower than the oft-quoted rate of 2 per 1000 for Asians. The apparent reason for the discrepancy is that many published prevalence rates included all pregnancies (live births plus pregnancy losses) and do not distinguish between syndromic and nonsyndromic clefts or between cleft palate alone and cleft lip with or without cleft palate. These results demonstrate that it is extremely important for current population-based studies of clefts to include careful delineation of population groups, syndromes, cleft type, and birth status.

Birth Prevalence of Oral Clefting in Northern Iran

Objective:

To explore the prevalence of oral clefting in northern Iran.

Setting:

In the Dezyani hospital 37,951 live births from 1998 through 2003 were screened for oral clefts. Clinical and demographic factors of diagnosed cases, including birth date, ethnicity, type of oral cleft, parental consanguinity, and coexisting anomalies, were recorded for analysis.

Results:

The overall prevalence of oral clefting was 0.97 per 1000 live births. The prevalence of cleft lip with or without cleft palate and isolated cleft palate was 0.60 and 0.37 per 1000, respectively. The prevalence of oral clefting was 1.08 per 1000 male births and 0.86 per 1000 female births. With respect to parental ethnicity, the prevalence of oral clefting was 0.86, 0.88, and 1.47 per 1000 in Fars, Turkman, and Sistani, respectively.

Conclusions:

The prevalence of oral cleft among live births in the Dezyani hospital is similar to that reported in the previous studies for Iran and whites.

Interferon regulatory factor 6 variants affect nasolabial morphology in East Asian populations

OBJECTIVE

The interferon regulatory factor 6 gene (IRF6) is one of the most conspicuous genes among a large number of candidate risk genes for non-syndromic cleft lip with or without cleft palate, which is considered to be a multifactorial defect. Variants of IRF6 are also suggested to affect normal craniofacial variations, especially in the area of the nose and the upper lip. In the present study, we used lateral cephalograms to establish the relationship between IRF6 and sagittal nasolabial morphology in healthy East Asian subjects.

DESIGN

Genomic DNA was extracted from 215 Japanese and 226 Korean individuals, and genotyped for five IRF6 single nucleotide polymorphisms (SNPs): rs17389541, rs642961, rs2013162, rs2235371, and rs7802. These SNPs were tested by multiple regression analyses for their association with craniofacial measurements obtained from lateral cephalometrics.

RESULTS

We detected a significant association between the derived variants, rs2013162 and rs2235371 and the distances between a facial bone plane indicated by distance from Nasion and Point A (NA plane) to soft tissue landmarks; the Subalare (NA-Sbal) and the Subnasale (NA-Sn) in the sagittal plane.

CONCLUSION

Our results indicate that IRF6 variants play an important role in the normal range of variation in nasolabial soft-tissue morphology.

BMP4 rs17563 polymorphism and nonsyndromic cleft lip with or without cleft palate: A meta-analysis

BACKGROUND

Previous studies have investigated the relationship between human bone morphogenetic protein 4 gene (BMP4) rs17563 polymorphism and nonsyndromic cleft lip with or without cleft palate (NSCL/P). However, the results remained inconsistent. Therefore, we conducted a meta-analysis to assess the effect of BMP4 rs17563 polymorphism on NSCL/P.

METHODS

Electronic searches in 5 databases were conducted to select all eligible studies up to March 2017. Odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were calculated to estimate the association. Sensitivity analysis was performed to evaluate the results stability by excluding each study in turn. Publication bias was assessed by Begg funnel plots and Egger test.

RESULTS

A total of 11 case-control studies were included in the meta-analysis. The pooled frequency of the minor allele C for BMP4 rs17563 was lower in Asians (pooled frequency = 0.33, 95% CI: 0.29-0.37) than in Brazilian population (pooled frequency = 0.47, 95% CI: 0.40-0.54). The overall results showed no significant association of BMP4 rs17563 polymorphism with NSCL/P risk. However, the results turned out to be different when stratified by ethnicity. BMP4 rs17563 polymorphism was associated with a higher risk of NSCL/P among Asian ethnicity (C vs T: OR = 1.33, 95% CI: 1.02-1.73; CC vs TT: OR = 2.10, 95% CI: 1.28-3.43; CC vs TT + TC: OR = 2.16, 95% CI: 1.34-3.47) and among Caucasian population (TC vs TT: OR = 3.36, 95% CI: 2.03-5.54; TC + CC vs TT: OR = 3.71, 95% CI: 2.43-5.69). Among Brazilian population, BMP4 rs17563 polymorphism exerted a significantly protective effect on NSCL/P (C vs T: OR = 0.70, 95% CI: 0.58-0.84; CC vs TT: OR = 0.54, 95% CI: 0.33-0.88; TC vs TT: OR = 0.55, 95% CI: 0.44-0.69; TC + CC vs TT: OR = 0.56, 95% CI: 0.45-0.69).

CONCLUSION

The results suggest that the C allele of BMP4 rs17563 may be a risk factor for NSCL/P among Asians and Caucasians, and may be a protective factor for NSCL/P in Brazilian population. Future large-sample studies with appropriate designs among specific populations are warranted to evaluate the association.

Association between PAX7 and NTN1 gene polymorphisms and nonsyndromic orofacial clefts in a northern Chinese population

BACKGROUND

Nonsyndromic orofacial clefts (NSOC) are the most common orofacial congenital defect with a complex etiology. Genome-wide association studies have identified paired box protein 7 (PAX7) and netrin-1 (NTN1) as candidate susceptibility genes for NSOC in both European and Asian populations. Here, possible associations between single-nucleotide polymorphisms (SNPs) in or near PAX7 and NTN1 were investigated in relation to risk of NSOC in a northern Chinese population.

METHODS

A total of 602 individuals with NSOC and 510 controls were recruited from northern China. Polymerase chain reaction-ligation detection reactions were used to analyze 4 SNPs (rs742071, rs6659735, rs766325, and rs4920520) of PAX7 and 2 SNPs (rs9904526 and rs9788972) of NTN1. Investigations of polymorphisms and risk of NSOC were conducted by using the PLINK software.

RESULTS

NTN1 rs9788972 AG was found to be associated with an increased risk of NSOC compared to the GG homozygous genotype (OR = 1.43, 95% CI = 1.11-1.86, P = .006). When the multifactor dimensionality reduction method was applied, NTN1 rs9788972 still exhibited an increased risk for NSOC (P = .008). In contrast, SNPs in PAX7 were not associated with any increased risk of NSOC.

CONCLUSION

NTN1 rs9788972 is identified as a risk locus for NSOC susceptibility in a northern Chinese population.

The incidence of Orofacial Cleft in live births in New Zealand

AIM

To determine the incidence of orofacial cleft at birth in New Zealand over 10 years from January 2000.

METHODS

Comparison of data collected from cleft units and data held on the national minimum dataset.

RESULTS

The overall incidence of OFC in New Zealand over a 10 year period was found to be 1.79 per 1,000 live births, higher than the norm for Western society. The major reason for this increased rate was an increased rate for the Māori 2.37 per 1,000 live births, specifically related to a Cleft Palate alone rate over twice that of the European (1.54 vs 0.73 per 1,000 live births). The rate for Pacific was half way between (1.04 per 1,000 live births). The rate of Cleft Lip alone was significantly lower in both Māori and Pacific populations. Different sex ratios were also seen in relation to Cleft Lip and Cleft Lip and Palate for Māori and Pacific compared to those normally reported.

CONCLUSIONS

Māori have an increased incidence of Orofacial Cleft due to one of the highest rates of Cleft Palate alone in the world. Further aetiological studies involving genetic and environmental factors are required to elicit the reasons for this increased incidence.

Prevalence of non-syndromic orofacial clefts among Jews and Arabs, by type, site, gender and geography: a multi-center study in Israel

BACKGROUND

Orofacial clefts are the most common craniofacial congenital malformations, with significant anatomic, ethnic, racial and gender differences.

OBJECTIVES

To investigate the prevalence, distribution and characteristic features of various types of non-syndromic clefts among Israeli Jews and Arabs.

METHODS

We conducted a retrospective multi-center survey in 13 major hospitals in Israel for the period 1993-2005. To obtain the true prevalence and detailed clinical characteristics, data on liveborn infants with non-syndromic clefts were obtained from the Ministry of Health's National Birth Defect Registry and completed by chart reviews in the 13 surveyed hospitals.

RESULTS

Of 976,578 liveborn infants, 684 presented unilateral or bilateral clefts, with a prevalence of 7.00/10,000 live births; 479 were Jews and 205 were Arabs. The prevalence was higher among Arabs compared to Jews (11.12 and 6.22 per 10,000 live births in Arabs and Jews, respectively, P 0.00001). Males had higher cleft rates than females (7.69/10,000 and 6.17/10,000 live births, respectively, P = 0.05). Males had more cleft lips (P < 0.05) and cleft lips with cleft palate (P < 0.001). There was left-side predominance. Newborns of younger mothers (age < 20 years) and of older mothers (age ≥ 45 years) had higher cleft rates than those with mothers in the 20-44 year bracket (P < 0.009). Children born at or above the 5th birth order had a higher cleft rate (P < 0.001).

CONCLUSIONS

The prevalence of non-syndromic clefts was 7.00/10,000 live births. The markedly higher rate in Arabs is related to the high rate of consanguinity. Both very young and old maternal age represents a higher risk of clefts in their offspring.

[Analysis between transforming growth factor beta3 gene sfaNI polymorphism variant and non-syndromic cleft lip with or without cleft palate in people of Uygur's nationality and Han's in Xinjiang]

The present study was aimed to explore the relationship of transforming growth factor (TGF) beta3 gene SfaNI polymorphism (rs3917201 locus) and non-syndromic cleft lip with or without cleft palate (NSCL/P) in people of the Uygur's Nationality and Han's in Xinjiang, China. TGFbeta3 gene fragment including SfaNI was amplified and purified as the template of the primer extension reaction thenafter. The single base extension reaction was carried out u sing SNP specific extension primer. The products were purified and analyzed by MALDI-TOF. The test showed that there were not significantly different frequencies of AA, AG, GG genotypes and alleles between the whole NSCL/P group and the whole control group (P > 0.05). Within the Uygurs or Hans, the frequencies of genotypes between the whole NSCL/P group and the whole control group were not significantly different (P > 0.05). The distributions of the A, G alleles between the NSCL/P group and the control group were not significantly different within the Uygurs (P > 0.05), but significant different within the Hans (P < 0.05). In all the NSCL/P patients, frequencies of genotypes and alleles were not significantly different between Uygurs and Hans (P > 0.05), and not significantly different (P > 0.05) either between Uygurs and Hans in all the healthy persons. The results proved that TGFbeta3 gene SfaNI polymorphism may not be related to NSCL/P in Xinjiang Uygur people, while the occurrence of NSCL/P in Han population may be related to frequency of the A and G allele of SfaNI polymorphism.

Thymidylate synthase polymorphisms and risks of human orofacial clefts

OBJECTIVE

Underlying mechanisms are unknown by which folic acid use in early pregnancy may reduce risks of orofacial clefts. Thymidylate synthase (TYMS) is a folate-dependent enzyme that catalyzes reductive methylation of deoxyuridylate to thymidylate, thereby playing a central role in DNA synthesis and repair. We investigated two TYMS functional variants (a 28-bp tandem repeat in the promoter enhancer region of the 5'-UTR; and TYMS 1494del6 (rs16430): a 6-bp deletion in the 3'-UTR) for their risk of cleft palate (CP) and of cleft lip with/without CP (CLP). We investigated effect measure modification between these variants and maternal folate intake for cleft risk.

DESIGN

This case-control study included deliveries from July 1999 to June 2003 from select areas of California. Case groups included CLP or CP alone. Nonmalformed, liveborn controls were randomly selected. Maternal interviews provided information on vitamin use and dietary folate intake. DNA was derived from newborn bloodspots.

RESULTS

Data were available for 304 CLP cases, 123 CP cases, and 581 controls. 1496del6 variants did not appear to influence risk of CP or CLP. Homozygosity for the 28-bp VNTR variant influenced CP risk (odds ratios, OR = 1.8, 95% confidence interval, 1.1-3.1), particularly among Hispanic infants, OR 2.1 (1.0-4.6). Effect measure modification was observed between the 28-bp VNTR and combined folate intake for CP with an OR of 10.0 (1.6-60.9).

CONCLUSION

Although these findings are consistent with biological mechanisms, they were based on relatively small sample sizes and may represent false-positive discoveries. Replication is warranted in other populations.

Epidemiology of cleft lip and palate among Jews and Bedouins in the Negev

BACKGROUND

Clefts of the lip and palate are the most common significant congenital birth anomaly of the orofacial region. The condition may vary from a minor easily correctable cleft to a significant functional and cosmetic incapacitation. This is the first epidemiological study of orofacial clefts in the Negev region in Israel.

OBJECTIVES

To establish the frequency of cleft lip and palate in the population of the Negev, characterize the demographic features of affected individuals and find possible risk factors, compare the risk in two major population groups: Bedouin and Jewish in a well-defined geographic area, and determine whether there is a change overtime in the birth of babies with facial clefts.

METHODS

We conducted a retrospective survey of the Soroka Medical Center archives. The sample population comprised all 131,218 babies born at Soroka during the 11 year period 1 January 1996 to 31 December 2006. Statistical tests used Pearson's chi-square test, Student's t-test and Spearman's correlation coefficient test according to the type of parameter tested.

RESULTS

During the study period 140 babies were born with orofacial cleft. The overall incidence of cleft lip and palate was 1.067/1000. The incidence of facial clefts was 1.54/1000 among Bedouins and 0.48/1000 among Jews (P < 0.001). Cleft palate was significantly more frequent in female than male babies (P = 0.002). Over the study years we found a significant decrease in the incidence of facial clefts in the Bedouin population, with Spearman's correlation coefficient rank -0.9 (P < 0.01).

CONCLUSIONS

A significant decrease occurred in the incidence of facial clefts among Bedouin. This change may be attributed to prenatal care in the Bedouin Negev population as part of social and health-related behavior changes. The reduction in rates of congenital malformations, however, does not mean a reduction in the number of cases in a growing population. Also, with a modern western lifestyle, the expectancy and demand for reconstructive facial surgery and comprehensive care for these children are on the rise.

Association between single-nucleotide polymorphisms on chromosome 1p22 and 20q12 and nonsyndromic cleft lip with or without cleft palate: new data in Han Chinese and meta-analysis

BACKGROUND

Nonsyndromic cleft lip with or without cleft palate (NSCL/P) is a common congenital malformation associated with genetic and environmental risk factors. A recent genome-wide association study identified two novel susceptibility loci on chromosomes 1p22 and 20q12; however, conflicting results, especially for 1p22, have been reported in Han Chinese population. The aims of this study were to replicate this association with risk of NSCL/P in the southern Han Chinese population and to discern the effect of these loci by a meta-analysis.

METHODS

To this end, 305 patients with NSCL/P, 356 phenotypically normal controls, and an additional 176 case-parent trios were recruited. Four of the previously associated single nucleotide polymorphisms (SNPs) were genotyped by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Furthermore, two published datasets were combined with the present results to determine the precise roles of the loci.

RESULTS

SNPs (rs6072081, rs13041247, and rs6102085) on 20q12 were found to be strongly associated with NSCL/P (Bonferroni-corrected and χ(2) test; p values < 0.05). Subsequent analysis of the case-parent trio provided similar results. However, neither the association study nor the trio analysis supported a causative role for SNP rs560426 on 1p22 in NSCL/P susceptibility. Stratified meta- analysis combining Chinese samples supported our findings.

CONCLUSIONS

This cross-validation study confirmed the previous findings that SNPs in 20q12 are associated with NSCL/P in Han Chinese population. We further conclude that rs560426 on 1p22 might not have a major influence on susceptibility to NSCL/P in southern Han Chinese, but future studies with other Han Chinese populations are needed.

Nonsyndromic cleft lip and palate: CRISPLD genes and the folate gene pathway connection

BACKGROUND

Nonsyndromic cleft lip with or without cleft palate (NSCLP) is a common birth defect that has a multifactorial etiology. Despite having substantial genetic liability, <15% of the genetic contribution to NSCLP has been delineated. In our efforts to dissect the genetics of NSCLP, we found that variation in the CRISPLD2 (cysteine-rich secretory protein LCCL domain containing 2) gene is associated with NSCLP and that the protein is expressed in the developing murine craniofacies. In addition, we found suggestive linkage of NSCLP (LOD > 1.0) to the chromosomal region on 8q13.2-21.13 that contains the CRISPLD1 gene. The protein products of both CRISPLD1 and CRISPLD2 contain more cysteine residues than comparably sized proteins. Interestingly, the folic acid pathway produces endogenous cysteines, and variation in genes in this pathway is associated with NSCLP. Based on these observations, we hypothesized that variation in CRISPLD1 contributes to NSCLP and that both CRISPLD genes interact with each other and genes in the folic acid pathway.

METHODS

Single nucleotide polymorphisms (SNPs) in CRISPLD1 were genotyped in our non-Hispanic white and Hispanic multiplex and simplex NSCLP families.

RESULTS

There was little evidence for a role of variation for CRISPLD1 alone in NSCLP. However, interactions were detected between CRISPLD1/CRISPLD2 SNPs and variation in folate pathway genes. Altered transmission of one CRISPLD1 SNP was detected in the NHW simplex families. Importantly, interactions were detected between SNPs in CRISPLD1 and CRISPLD2 (15 interactions, 0.0031 ≤p < 0.05).

CONCLUSION

These novel findings suggest that CRISPLD1 plays a role in NSCLP through the interaction with CRISPLD2 and folate pathway genes.

Folate pathway and nonsyndromic cleft lip and palate

BACKGROUND

Nonsyndromic cleft lip with or without cleft palate (NSCLP) is a common complex birth defect. Periconceptional supplementation with folic acid, a key component in DNA synthesis and cell division, has reduced the birth prevalence of neural tube defects and may similarly reduce the birth prevalence of other complex birth defects including NSCLP. Past studies investigating the role of two common methylenetetrahydrofolate reductase (MTHFR) single-nucleotide polymorphisms (SNPs), C677T (rs1801133) and A1298C (rs1801131), in NSCLP have produced conflicting results. Most studies of folate pathway genes have been limited in scope, as few genes/SNPs have been interrogated. Here, we asked whether variations in a more comprehensive group of folate pathway genes were associated with NSCLP, and were there detectable interactions between these genes and environmental exposures?

METHODS

Fourteen folate metabolism-related genes were interrogated using 89 SNPs in multiplex and simplex non-Hispanic white and Hispanic NSCLP families.

RESULTS

Evidence for a risk association between NSCLP and SNPs in NOS3 and TYMS was detected in the non-Hispanic white group, whereas associations with MTR, BHMT2, MTHFS, and SLC19A1 were detected in the Hispanic group. Evidence for over-transmission of haplotypes and gene interactions in the methionine arm was detected.

CONCLUSIONS

These results suggest that perturbations of the genes in the folate pathway may contribute to NSCLP. There was evidence for an interaction between several SNPs and maternal smoking, and for one SNP with gender of the offspring. These results provide support for other studies that suggest that high maternal homocysteine levels may contribute to NSCLP and should be further investigated.

Antenatal determinants of oro-facial clefts in Southern Nigeria

OBJECTIVES

Cleft lip with or without cleft palate, is the most common serious congenital anomaly that affects the orofacial regions. The management and care of the cleft patient constitutes a substantial proportion of the workload of the Nigerian maxillofacial surgeon and allied specialties. Yet, there are no specific programmes targeted at this group. We believe that the findings of this study is capable of identifying useful interventions for designing programs that will lead to a reduction in the burden of orofacial cleft in Nigeria.

METHODS

It was a transverse cross-sectional study that was undertaken at the Maxillofacial Units of the University of Benin Teaching Hospital and the Central Hospital, Benin City respectively. The prevalence and antenatal determinants of cleft lip and palate were determined.

RESULTS

Cleft lip and palate were often encountered in clinical practice in Benin City with a prevalence of 1.35%. The results showed that orofacial clefts were commoner in females and that the combined unilateral cleft lip and palate was the commonest entity encountered amongst the cases. The following risk factors were associated with the risk of development of cleft lip and palate: Paternal age >40 years, maternal age >35 years, genetic/family history, low socio-economic status, alcohol consumption and indulgence in the intake of herbal medications in pregnancy.

CONCLUSION

Public health education programmes and advocacy activities geared towards raising awareness of the identified risk factors for the development of cleft lip and or cleft palate would go a long way to obviate the occurrence and reduce the burden.

Maternal factors and disparities associated with oral clefts

INTRODUCTION

The epidemiology of oral clefts continually unfolds. Researchers have not reached consensus concerning the significance of maternal smoking, weight gain, diabetes, age, and education and the risk of oral clefts. The purpose of this study was to examine these factors associated with oral clefts in the US population.

METHODS

The 2005 U.S. Natality Data File was utilized for this study. Bivariate analyses compared the characteristics of mothers of infants with and without oral clefts. Multivarlate analysis calculated adjusted odds ratios for various maternal characteristics overall and for each race/ethnic group.

RESULTS

Significant bivariate associations with oral clefts were found for maternal age, race/ethnicity, education, tobacco use, and pregnancy-associated hypertension. Multivariate models found maternal age (OR = 0.98), race/ethnicity (OR = 0.36) for non-Hispanic Blacks (OR = 0.79 for Hispanics), and tobacco use (OR = 1.66) significant after adjustment for covariates. Across all race/ethnic groups maternal age (OR = 0.98) and smoking (OR = 1.66) were significantly associated with increased risk for oral cleft (OC). Non-Hispanic Blacks and Hispanics were at lower risk for OC regardless of the presence or absence of pregnancy-associated hypertension.

CONCLUSIONS

Consistent with previous studies, maternal smoking was found to be associated with an increased risk of oral clefts. This association was significant for non-Hispanic Whites but not for non-Hispanic Blacks and Hispanics. A small inverse association was observed between maternal age, pregnancy-associated hypertension and the risk of oral clefts. This study confirms relationships found in previous studies but cannot establish causality. Further investigations of the risk factors for oral clefts would benefit from the study of gene-environment interactions.

Differences in the clinical appearances of white versus black patients with facial cleft deformities: a retrospective study of a South African clinic

OBJECTIVE

The purpose of this study was to determine the difference in prevalence of the different categories of facial cleft deformities between the white and black patients in a database of 2806 cleft cases at the University of Pretoria. No variation of clefts between these two groups has ever been compared previously. For this purpose, the clefts were classified according to the system described by Bütow in 1985.

MATERIAL AND METHODS

Records of 2806 patients attending the university's cleft lip and palate clinic, between August 1983 and February 2006, were reviewed. The study group included cleft patients with syndromic and nonsyndromic CL, CLA, CLAP, hP, hPsP, sP, COMBI clefts with or without oblique or transverse facial (or Tessier) clefts. Very few of the cases presented with speech problems only, but with no clefts. The cleft categories of cleft lip, cleft palate and cleft lip and palate, as well as their subdivisions, were analysed.

RESULTS

Of these cleft patients, 2003 were white patients and 665 were black patients; the rest were Indian, Coloured and East-Asian patients. In the black and the white population groups (n = 2668), there were more males with cleft in the white group (58.2%), but more females with clefts in the black group (54.9%). The most common cleft type generally was the cleft lip, alveolus and palate cleft (CLAP) with a 434% prevalence of white patients and 296% of black patients. The most common cleft in the black patients was the cleft palate at 435%, which was only recorded in 35.0% of the white patients. The frequency of the other orofacial clefts in decreasing order was: sP 19.4% for white and 21.2% for black; hPsP 15.2% for white and 21.2% for black; CLA 9.7% for white and 19.8% for black; CL 5.9% for white and 4.5% for black and combinations of different orofacial clefts (COMBI), 6.0% for white and 2.6% for black. The isolated hard palate cleft (hP) occurred very rarely (0.4% for white and 1.1% for black). The left side of the face was more often afflicted (left to right 51.6% to 28.5% for white; and 35.0% to 37.9% for black). In 0.5% (white) and 3.9% (black) median clefts were observed.

CONCLUSION

A retrospective study was done of 2806 facial black patients (2668 cases). There was a considerable variation between the groups of orofacial clefts occurring in the two groups.

Association between IRF6 and nonsyndromic cleft lip with or without cleft palate in four populations

PURPOSE

The interferon regulatory factor 6 (IRF6), the gene that causes van der Woude syndrome has been shown to be associated with nonsyndromic cleft lip with or without palate in several populations. This study aimed to confirm the contribution of IRF6 to cleft lip with or without palate risk in additional Asian populations.

METHODS

A set of 13 single nucleotide polymorphisms was tested for association with cleft lip with or without palate in 77 European American, 146 Taiwanese, 34 Singaporean, and 40 Korean case-parent trios using both the transmission disequilibrium test and conditional logistic regression models.

RESULTS

Evidence of linkage and association was observed among all four populations; and two specific haplotypes [GC composed of rs2235373-rs2235371 (p.V274I) and AAG of rs599021-rs2235373-rs595918] showed the most significant over- and undertransmission among Taiwanese cases (P=9x10(-6) and P=5x10(-6), respectively). The AGC/CGC diplotype composed of rs599021-rs2235373-rs2013162 showed almost a 7-fold increase in risk among the Taiwanese sample (P<10(-3)). These results confirmed the contribution of this gene to susceptibility of oral clefts across different populations; however, the specific single nucleotide polymorphisms showing statistical significance differed among ethnic groups.

CONCLUSION

The high-risk genotypes and diplotypes identified here may provide a better understanding of the etiological role of this gene in oral clefts and potential options for genetic counseling.

Epidemiological studies on the frequency of clefts in Europe and world-wide

BACKGROUND

Most textbooks present data on the various frequencies of clefts in different human "races". This was studied in more detail.

MATERIAL AND METHODS

In a major literature study the frequencies of clefting reported in more than 100 publications were studied and the following data was collected: Incidences of clefts in Mongolians, Caucasians and Negroids; relative frequencies of clefts of the primary (and secondary) palate versus that of clefts of the secondary palate (only); data on cleft location (right, left, bilateral) and on genders affected.

RESULTS

There was most confusing data on incidences in the different "races" whilst all other data was rather consistent: complete clefts (i.e. primary plus secondary palate affected) were most common with left sided ones being reported most often; males were more prone to have a cleft of the primary palate than females and females were more often affected by clefts of the secondary palate than males.

DISCUSSION

The types of data bases having been evaluated varied from report to report indicating that today's data pools are of different qualities. Regional or national registries are necessary to collect reliable data with strict definitions applied in all countries.

PVRL1 variants contribute to non-syndromic cleft lip and palate in multiple populations

Poliovirus Receptor Like-1 (PVRL1) is a member of the immunoglobulin super family that acts in the initiation and maintenance of epithelial adherens junctions and is mutated in the cleft lip and palate/ectodermal dysplasia 1 syndrome (CLPED1, OMIM #225000). In addition, a common non-sense mutation in PVRL1 was discovered more often among non-syndromic sporadic clefting cases in Northern Venezuela in a previous case-control study. The present work sought to ascertain the role of PVRL1 in the sporadic forms of orofacial clefting in multiple populations. Multiple rare and common variants from all three splice isoforms were initially ascertained by sequencing 92 Iowan and 86 Filipino cases and CEPH controls. Using a family-based analysis to examine these variants, the common glycine allele of the G361V coding variant was significantly overtransmitted among all orofacial clefting phenotypes (P = 0.005). This represented G361V genotyping from over 800 Iowan, Danish, and Filipino families. Among four rare amino acid changes found within the V1 and C1 domains, S112T and T131A were found adjacent to critical amino acid positions within the V1 variable domain, regions previously shown to mediate cell-to-cell and cell-to-virus adhesion. The T131A variant was not found in over 1,300 non-affected control samples although the alanine is found in other species. The serine of the S112T variant position is conserved across all known PVRL1 sequences. Together these data suggest that both rare and common mutations within PVRL1 make a minor contribution to disrupting the initiation and regulation of cell-to-cell adhesion and downstream morphogenesis of the embryonic face.

Cultural and religious components in Nigerian parents' perceptions of the aetiology of cleft lip and palate: implications for treatment and rehabilitation

The present study was conducted to find out the perceptions of mothers from two Nigerian ethnic groups who had children with cleft lip and palate (CLP) about the aetiology of the defect. Mothers of 16 children with CLP from the Yoruba ethnic group who attended the maxillofacial clinic of the Obafemi Awolowo University teaching hospital in southern Nigeria and 20 children with CLP from the Hausa/Fulani ethnic group who attended the maxillofacial clinic of the University of Maiduguri teaching hospital in northeastern Nigeria were interviewed over an 8-month period. We used standardised interviews including questions with ethnographic components to allow us to collect information about traditional beliefs about clefts. Interviews were recorded on tape for later analysis. Thirteen of the 16 parents from the Yoruba group attributed the aetiology of CLP to supernatural forces (evil spirits and ancestral spirits), while 16 of the 20 Hausa/Fulani parents attributed it to the "will of God". Twelve of 16 Yoruba parents had consulted traditional healers for treatment before coming to the hospital. Various plants and animal products were used to treat clefts and 10 of the Yoruba parents were referred to the hospital for further treatment by the traditional healers. Cultural and religious factors seem to have an important role in the explanations, labels and treatment that followed the birth of a child with CLP in this environment. There is a need for greater collaboration and sharing of information between modern medical practitioners and traditional healers.

Study of the PVRL1 gene in Italian nonsyndromic cleft lip patients with or without cleft palate

Nonsyndromic cleft lip with or without cleft palate (CL/P) is a complex genetic trait and little is known about its aetiology. Recent investigations on rare clefting syndromes provided interesting clues about genes involved in face development. The PVRL1 gene encodes nectin1, a cell-to-cell adhesion molecule. Mutations in its sequence have been shown to cause the rare autosomal recessive syndrome CL/P-ectodermal dysplasia syndrome (CLPED1), while heterozygosity for the mutation W185X seemed to increase the risk of non syndromic CL/P in a population from northern Venezuela. In the present study, we screened 143 Italian CL/P patients for mutations in PVRL1. Three rare sequence variants in exon 3 that create amino-acid changes were detected in a total of 7 patients. Two of these mutations were not found in a panel of 292 unaffected controls, while the third was found in two controls. This study describes new mutations that may represent genetic risk factors for CL/P. Even though a study to look at the effects of the mutations on nectin1 function was not feasible, supporting evidence was reported, thus confirming the involvement of PVRL1 in the aetiology of non-syndromic CL/P malformation.

Candidate Genes for Oral-Facial Clefts in Guatemalan Families

Nonsyndromic cleft lip +/- cleft palate (CL/P) is a complex trait of unknown etiology. Most genetic studies of CL/P define affection status in a way that ignores subtle subclinical manifestations, resulting in a potential loss of statistical power. This study investigated 10 candidate genes in 155 individuals from 25 Guatemalan CL/P families. High-resolution ultrasound images of the orbicularis oris (OO) muscle were obtained. CL/P was present in 28 family members; an additional 10 had subcutaneous OO muscle defects. Family-based association studies were performed for both narrow (CL/P only) and broad (CL/P plus OO muscle defects) definitions of affection status. PVRL1 was significantly associated under both definitions (P = 0.04, narrow; P = 0.02, broad). Association with JAG2 improved from P = 0.09 under the narrow definition to P = 0.04 under the broad definition. Broadening the oral-facial cleft phenotype to include subclinical variants may improve power in genetic studies.

Facilitating cleft palate team participation of culturally diverse families in South Africa

OBJECTIVE

The Facial Cleft Deformities Clinic, University of Pretoria, Pretoria, South Africa, provides interdisciplinary team services to patients with cleft lip and palate and craniofacial anomalies. They represent the "rainbow nation" of South Africa and reflect the multicultural and multilingual nature of the population, which poses a challenge to effective and accountable service delivery. The aim of this study was to explore some cultural variations that exist in black families that influence their participation in the team approach and to describe the assets of families that may be used to empower them and to enhance service delivery.

DESIGN

A descriptive survey research design. A questionnaire-by-interview procedure was utilized during routine visits of 35 black families to the Facial Cleft Deformities Clinic.

RESULTS

The results are discussed from an ethnographic perspective of the family and describe the knowledge base of the participants, the diagnosis and treatment of the children's cleft lip and palate, family structure and support systems, family income and education, and the geographical distribution of the participants. Implications for building family partnerships and for improving professionals' cultural competence in order to improve the quality of service delivery are presented.

CONCLUSIONS

By viewing cultural differences on a continuum, following the asset-based approach, applying knowledge based on contextually relevant research, and recognizing family uniqueness, families may be empowered to participate fully in the team approach to support their children with cleft lip and palate and craniofacial anomalies in attaining their full potential in the South African context.

Haplotype diversity in 11 candidate genes across four populations

Analysis of haplotypes based on multiple single-nucleotide polymorphisms (SNP) is becoming common for both candidate gene and fine-mapping studies. Before embarking on studies of haplotypes from genetically distinct populations, however, it is important to consider variation both in linkage disequilibrium (LD) and in haplotype frequencies within and across populations, as both vary. Such diversity will influence the choice of "tagging" SNPs for candidate gene or whole-genome association studies because some markers will not be polymorphic in all samples and some haplotypes will be poorly represented or completely absent. Here we analyze 11 genes, originally chosen as candidate genes for oral clefts, where multiple markers were genotyped on individuals from four populations. Estimated haplotype frequencies, measures of pairwise LD, and genetic diversity were computed for 135 European-Americans, 57 Chinese-Singaporeans, 45 Malay-Singaporeans, and 46 Indian-Singaporeans. Patterns of pairwise LD were compared across these four populations and haplotype frequencies were used to assess genetic variation. Although these populations are fairly similar in allele frequencies and overall patterns of LD, both haplotype frequencies and genetic diversity varied significantly across populations. Such haplotype diversity has implications for designing studies of association involving samples from genetically distinct populations.

Maternal MTHFR interacts with the offspring's BCL3 genotypes, but not with TGFA, in increasing risk to nonsyndromic cleft lip with or without cleft palate

The 677 C --> T polymorphism in the 5-10 methylenetetrahydrofolate reductase (MTHFR) gene has been associated with nonsyndromic cleft lip with or without cleft palate (CL/P) in some populations, but not others. Previous studies (ie, case-control and transmission disequilibrium tests (TDT)) in Brazilian families with CL/P have been unable to replicate this putative association. However, our group observed a lower proportion of CT heterozygotes among the mothers of CL/P probands, suggesting that the maternal genotype for this polymorphism might influence predisposition to CL/P. In order to further examine this issue, we performed a case-control study of the 677 C --> T/MTHFR polymorphism in families with CL/P ascertained in two regions of Brazil: 172 from São Paulo (SP) and 252 from Ceará (CE). The control samples included 243 individuals from SP and 401 from CE. TDT was carried out in 102 patients with CL/P and their parents. No evidence of an association was observed between the 677 C --> T/MTHFR polymorphism and CL/P using the case-control design, while borderline significance was obtained with the TDT (P=0.055). We have also looked for an interaction between maternal MTHFR genotypes and the propositi offspring's genotypes at two candidate susceptibility loci for CL/P, TGFA and BCL3. Interestingly, we observed an interaction between the maternal MTHFR and offspring's BCL3 genotypes (OR: 2.3; 95% CI: 1.1-4.8; P=0.03) but not with the offspring's TGFA genotypes. Therefore, our results reinforce the idea that the maternal MTHFR genotype plays a significant role in susceptibility to CL/P, but its teratogenic effect depends on the genotype of the offspring.

Descriptive epidemiology of oral clefts in a multiethnic population, Hawaii, 1986-2000

OBJECTIVE

To describe the relationship between oral clefts and demographic and clinical factors in Hawaii.

METHODS

Data were obtained from a birth defects registry and included all infants and fetuses with oral clefts delivered during 1986 through 2000. Subjects were categorized as total, isolated, and nonisolated cleft lip with or without cleft palate (CL+/-P) or cleft palate without cleft lip (CP).

RESULTS

There were 352 total subjects of CL+/-P and 192 total subjects of CP with corresponding rates per 10,000 live births of 12.5 for CL+/-P and 6.8 for CP. Total, isolated, and nonisolated CL+/-P rates demonstrated no clear pattern by maternal age. The total and nonisolated CP rates tended to be higher among older maternal age groups. The total CL+/-P rate was higher among Far East Asians, Pacific Islanders, and Filipinos than among whites. The total CP rate was higher among Far East Asians and Pacific Islanders than among whites, whereas the rate for Filipinos was lower than for whites. The total CL+/-P rate was substantially lower among females (rate ratio 0.62, 95% confidence interval [CI] = 0.49 to 0.77) and the total CP rate substantially higher among females (rate ratio 1.52, 95% CI = 1.13 to 2.06). Both CL+/-P and CP were more common with lower birth weight and gestational age among the total, isolated, and nonisolated groups.

CONCLUSIONS

Oral cleft risk was associated with maternal race/ethnicity, sex, birth weight, and gestational age. Although some of the observed associations were consistent with the literature, others were not.

Prevalence of nonsyndromic oral clefts in Texas: 1995-1999

Nonsyndromic cleft lip with/without cleft palate (NSCLP) and nonsyndromic cleft palate only (NSCPO) are common complex birth defects affecting 4,000 newborns annually. We undertook a descriptive study of oral clefts in Texas, focusing on the effect of folic acid fortification and Hispanic ethnicity on the prevalence of oral clefts as these factors have not previously been described. Data on 896 infants with NSCLP and NSCPO born between 1995 and 1999 in Texas were compared to all births in Texas during the same period. Prevalence odds ratios (POR) were calculated for maternal ethnicity, race, age, parity, public health region of residence, highest level of education, and infant gender. The effect of folic acid fortification on oral clefts was also examined. Compared with whites, adjusted POR were 0.97 (95% CI = 0.77-1.23) and 0.90 (95% CI 0.72-1.14) for NSCLP and 0.46 (95% CI = 0.30-0.72) and 0.62 (95% CI = 0.42-0.90) for NSCPO in foreign-born and US-born Hispanics, respectively. After fortification was implemented, the rate of NSCLP did not decrease. However, there was a 13% decrease in the prevalence of NSCPO (adjusted POR = 0.87, 95% CI = 0.68-1.15). Compared to whites, the rates in US-born and foreign-born Hispanic women were similar for NSCLP and much lower for NSCPO. The small reduction of 13% in NSCPO after folic acid fortification is imprecise and should be interpreted cautiously. Overall, it appears that folic acid fortification has had very little or no effect on the prevalence of oral clefts in infants born in Texas.

Pattern of cleft lip and palate [corrected] in Benin City, Nigeria

OBJECTIVE

To study the pattern of cleft lip and/or palate (CL/P) in Benin City, Nigeria and to compare the findings with reports from other parts of the world. The results of this study may be used to improve the welfare of affected patients.

DESIGN

A descriptive study.

SETTING

The University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria.

SUBJECTS

103 ethnic Nigerian patients with cleft lip and/or palate.

MAIN OUTCOME MEASURES

Consecutive ethnic Nigerian patients presenting with CL/P were studied. Patients' data collected included age, sex, ethnic group, type of CL/P and the laterality pattern. Descriptive statistics were generated for all the variables recorded.

RESULTS

There were 49.5% females and 50.5 % males; 95.1% were children and 4.9% were adults. The ethnic groups most often affected were Urhobo 29.1%, Bini 27.1% and Ibo 17.4%. The combined cleft lip and palate 60.2% was the commonest type of cleft. There were 28.2% patients with cleft lip only. More (7.8%) females were affected by the isolated cleft palate deformity. Twenty five patients had exceeded the time of repair. Their reasons were ignorance (36%) and financial constraints (64%)

CONCLUSION

The data from this study is consistent with studies from other parts of the world. However, a high proportion of patients did not have access to early treatment due to ignorance and financial constraints. Public enlightenment and financial assistance for the indigent patient is recommended.

The long-term speech outcome in Flemish young adults after two different types of palatoplasty

OBJECTIVE

The success of cleft palate surgery is specifically determined by the subsequent speech characteristics. There are several types of surgical techniques to repair the palate. The surgeon chooses his or her own technique according to the principles (s)he have established based on experience. The main purpose of this study is to determine and to compare the long-term speech outcome (18 years after surgery) regarding overall intelligibility, articulation, resonance, and voice after one-stage Wardill-Kilner palatoplasty or two-stage Furlow palatoplasty. The authors hypothesized that a decreased overall intelligibility, more compensatory articulation disorders, higher nasalance values and more nasality disorders would occur in the two-stage Furlow palatoplasty. Moreover, an increased risk for dysphonic symptoms, caused by the more intensive vocal tract activities, were expected in subjects with higher nasalance scores. An additional objective of this study was to compare the speech and voice characteristics with the age related normative data. Significant differences between the resonance and voice characteristics of the two techniques of palatoplasty and the normative data were hypothesized.

METHODS

Objective as well as subjective assessment techniques were used. The evaluation of the articulation included a phonetic inventory and a relational analysis in which the consonant and vowel productions were compared with target productions and analyzed for error types at the segmental level. The speech samples were perceptually judged for intelligibility and nasality. The Nasometer was used for the objective measurement of the nasalance values. The assessment of the voice included a perceptual evaluation and a determination of the Dysphonia Severity Index.

RESULTS

The subjects who received a two-stage Furlow palatoplasty showed statistically more hypernasality and higher nasalance scores in comparison with the one-stage Wardill-Kilner palatoplasty. No major differences regarding articulation and voice characteristics were found. As expected, significant differences were found between the speech intelligibility and resonance characteristics in subjects who received a palatoplasty and the normative data.

CONCLUSION

Since the subjects who received a one-stage Wardill-Kilner palatoplasty had a significantly better speech outcome it was decided in the craniofacial team of the University Hospital of Ghent that a two-stage palatoplasty would no longer be performed.

Treatment of oralfacial clefts by state-affiliated craniofacial centers and cleft palate clinics

BACKGROUND

Oralfacial clefting (OFC) disorders require expedient evaluation and treatment to obtain optimal outcome. In Florida, there is a statewide program targeted to the care of infants with OFC. We therefore sought to determine statewide referral and treatment patterns of children born with OFC identified through the Florida Birth Defects Registry.

METHODS

Using data for 1996 and 1997 and ICD-9 CM codes 749.00 - 749.25, we identified 539 OFC cases. All cases were matched with the evaluation and treatment records of the statewide Children's Medical Services' (CMS) craniofacial centers (CFC) and cleft palate clinics (CPC). The likelihood of CMS contact was examined with respect to demographic and other descriptive data characterizing the OFC cases.

RESULTS

42% (227/539) of OFC cases were evaluated at or known to the CFC or CPC. Children with cleft lip and palate were more likely to have had contact than were those with cleft lip or cleft palate alone. The CFC and CPC programs were most likely to provide evaluation between age 2 months and 3 years. Of 12 counties with occurrences of more than 15 OFC cases, 2 had significantly lower contact rates, suggesting possible problems in accessibility or reporting of services.

CONCLUSIONS

Statewide Birth Defect Registry data can be used in collaboration with statewide treatment programs to gain insight into referral patterns and provision of services. Factors influencing access to services and quality of care, though not addressed by this study, could be prospectively incorporated into such a project.

An international surgical exchange program for children with cleft lip/cleft palate in Manaus, Brazil: patient and family expectations of outcome

Increasingly, surgeons are traveling from the developed to the developing world to volunteer their services. They can often make an enormous difference in the lives of patients they serve, but they must understand that these patients exist in a sociocultural matrix in which the meaning of the condition they have and the future they face are determined by a host of factors over and above the specific surgery itself. This means that programs in which teams quickly go in and out of a country must take into account and plan for longer term follow-up by colleagues within that country as well as develop and target rehabilitation services and educational messages to ensure maximum benefits from the intervention performed. This study examines the long-term implications of a short-term surgical team intervention for pediatric patients with cleft lip/cleft palate and their families in the Amazon region of Brazil.

Genetic origins in a South American clefting population

It has been proposed that susceptibility to clefting in South America is related to Amerindian ancestry, where clefting is present at a higher frequency than in the other admixed populations (Caucasian and African) that make up the diverse racial mix of current South Americans. To clarify the genetic origins and establish a method for genetic mapping, mitochondrial DNA variation and Y-chromosome markers were studied in a South American population affected with clefting. Two-hundred and seventeen subjects and matched controls were selected through the Latin-American Collaborative Study of Congenital Malformations (ECLAMC). The case group showed a higher frequency of Native American haplogroups and a lower frequency of African haplogroups (p < 0.00001). In addition, the case group showed a much higher frequency of the specific native American haplogroup D than the control group (p < 0.00001). For the Y-chromosome markers, the case group showed a lower frequency of the African-specific marker, YAP (p = 0.002), and a higher frequency of the Native American-specific marker, DYS199 (p < 0.00001). Even though differences were found in the frequencies of the markers studied, the contribution of each founder population was similar for both groups. Results suggest a strong Native American maternal contribution and a strong Caucasian (Spanish and Portuguese) paternal contribution to the population studied. The implications of this finding include the possibility of using admixture mapping approaches to this population.

The current understanding of cleft lip malformations

Cleft lip with or without cleft palate is one of the most common congenital malformations. Epidemiology differentiates between cleft malformations connected with syndromes and the more common nonsyndromic forms not associated with other deformities. Although many syndromes with cleft lip with or without cleft palate are known, the majority of orofacial clefts are of the nonsyndromic form. These are known to be of multifactorial origin, with both environmental and genetic factors in their etiology, most of which remain to be fully investigated. Recent literature reveals that wide ethnical and racial variations in the occurrence of cleft lip and/or palate exist. The purpose of this overview is to show the current standing of research in this field. Genetics, environmental factors, and morphogenesis of the primary and secondary palate in normal development and cleft malformations are especially emphasized.

Facial clefting in an Arab town in Israel

To study the prevalence of cleft palate and cleft lip with or without cleft palate in an Israeli Arab town, questionnaires were sent to the parents of 1375 pupils in grades 1 and 2 in all seven primary schools in the town of Taibe, and 1281 responded. The information requested included data about siblings and members of the parental generation to give a total of 16 174, and the presence of consanguinity and history of exposure to medication, radiation, smoking or alcohol during pregnancy. There were four affected individuals among the index cases, of whom two had cleft palate only and two cleft lip with cleft palate, giving prevalence rates for each of these of 1.56/1000. Adding to these the number of affected siblings gave a total of 10 affected individuals; two with cleft palate only (0.39/1000) and eight with cleft lip with or without cleft palate (1.56/1000). Among the parental generation, of 16 reported affected individuals, two had cleft palate only (0.18/1000) and 14 cleft lip with or without cleft palate (1.26/1000). The overall prevalence rate for all 26 affected individuals was 1.6/1000; four of these had cleft palate only (0.24/1000) and 22 had cleft lip with or without cleft palate (1.36/1000). There were no cases whose mothers had been exposed to medication, radiation, smoking or alcohol during pregnancy. The effect of consanguinity was not significant (P < 0.92). This study shows that the prevalence of facial clefting in an Israeli Arab community is consistent with that in the general population worldwide.

Transforming growth factor alpha locus and nonsyndromic cleft lip with or without cleft palate: a reappraisal

An association between nonsyndromic cleft lip with or without cleft palate (CL +/- P) and genetic variation at the transforming growth factor alpha (TGFA) locus was originally reported in 1989. Subsequent population-based studies of this association have provided conflicting results. The present analyses were undertaken to determine if the cumulative weight of the available data convincingly supports or refutes this association. The published data were analyzed for differences in allele frequencies between Caucasian CL +/- P patients (i.e., cases) and controls, and for heterogeneity between Caucasian samples. When all data except the original report were considered, there was a statistically significant association between TGFA and CL +/- P (M.H.O.R. = 1.43; 95% C.I. 1.12-1.80). However, there was evidence of significant heterogeneity in the TGFA allele frequencies between cases, but not controls, from different studies. The data suggest that the observed heterogeneity is unlikely to be attributable to differences in the ethnic composition of the cases among the various studies but may reflect differences in the proportion of cases with bilateral lip defects and/or with positive family histories of CL +/- P. Definitive conclusions regarding the source(s) of the observed heterogeneity could not, however, be drawn on the basis of the available data. Hence, at present, the evidence regarding an association between genetic variation at the TGFA locus and CL +/- P remains inconclusive.

Oral clefts, transforming growth factor alpha gene variants, and maternal smoking: a population-based case-control study in Denmark, 1991-1994

Studies in the United States have indicated that maternal first trimester smoking and infant transforming growth factor alpha (TGFA) locus mutations are associated with non-syndromic cleft lip and/or palate (CLP) and that a synergistic effect of these two risk factors occurs. Based on a Danish case-control study of CLP, the authors studied the effects of smoking and TGFA alleles in an ethnically homogeneous setting. Interview information was obtained for mothers of 302 CLP cases (96% of eligible) and for 567 mothers of nonmalformed children (94% of eligible). Multivariate logistic regression analyses revealed that smoking was associated with a moderately increased risk of cleft lip +/- cleft palate (CL(P)) (odds ratio = 1.40, 95% confidence interval 0.99-2.00). No association between smoking and isolated cleft palate (CP) was observed. TGFA genotype was not associated with either CL(P) or CP, and no synergistic effect with smoking was observed. The "rare" TGFA allele occurred in 25% of both cases and controls compared with an average of 14% in other white control groups. Furthermore, the frequency of CLP in Scandinavia is among the highest in the world. Hence, it is possible that the previously reported association between TGFA and CLP to some degree can be attributable to confounding by ethnicity.

Racial and ethnic variations in the prevalence of orofacial clefts in California, 1983-1992

To investigate variations in the prevalence of oral cleft anomalies according to parental race and ethnicity and maternal country of birth, the authors analyzed a cohort of 2,221,755 live births and fetal deaths delivered between 1983 and 1992 to residents of California. A total of 2,329 cleft lip with or without cleft palate (CL +/- P) cases and 1,475 cleft palate alone (CP) cases were identified by the California Birth Defects Monitoring Program, a population-based registry. Compared to Whites, the prevalence of CL +/- P was lower among African Americans (prevalence ratio (PR) = 0.56, 95% confidence interval (CI) = 0.45-0.69), higher among Native Americans (PR = 1.81, CI = 1.20-2.69), and the same among the Japanese (PR = 1.07, CI = 0.62-1.82) and Chinese (PR = 0.96, CI = 0.71-1.29). The risk of CL +/- P was slightly lower among the offspring of foreign-born Chinese women relative to U.S.-born Chinese women (PR = 0.71, CI = 0.33-1.57), and slightly higher among foreign-born Filipinos relative to their U.S.-born counterparts (PR = 1.37, CI = 0.57-3.53), although confidence intervals around these risk estimates were wide owing to sparse data. For CP, lower prevalences were observed among African Americans (PR = 0.72, CI = 0.58-0.91) and Hispanics (PR = 0.77, CI = 0.67-0.87) than among Whites. The risk of CP was higher among foreign-born Filipinos compared to U.S.-born Filipinos (PR = 1.52, CI = 0.58-4.33), although the confidence interval around this estimate included unity. These prevalence variations may reflect differences in both environmental and genetic factors affecting clefting risk.

Comparative study of diagnostic measures in borderline surgical cases of unilateral cleft lip and palate and noncleft Class III malocclusions

Patients with complete unilateral cleft lip and palate present difficult growth problems. Their anteroposterior discrepancies in jaw and dentition are frequently so severe that some epidemiologic studies report the necessity of orthognathic surgery in 25% of their sample. The aims of this study were three-fold: (1) to delineate diagnostic measures in borderline surgical cases of unilateral cleft lip and palate, (2) to verify the significance of negative overjet as a measure of anteroposterior discrepancy, and (3) to compare these diagnostic measures with those of borderline surgical cases of noncleft Class III malocclusions. The sample consisted of 29 patients with unilateral cleft lip and palate and 25 noncleft Class III Korean patients (mean age, 18.69 years); all had crossbites of all four incisors. Each of their pretreatment study casts and cephalograms were analyzed. The group with unilateral cleft lip and palate was divided into two subgroups on the basis of the method of their anterior crossbite resolution; 18 subjects were treated with orthodontics alone (Cleft-NS) and 11 subjects with orthognathic surgery (Cleft-Surg). The noncleft Class III group was divided into two subgroups; 6 of the subjects were orthodontically treated (Cl III-NS), and 19 were surgically treated (Cl III-Surg). The group with unilateral cleft lip and palate showed smaller SNA and SNB angles than the noncleft Class III group, but the ANB angles and the amount of anterior crossbites showed no statistical differences. When the Cleft-NS and the Cleft-Surg groups were compared, the ANB angle and the Wits measurements were significantly different. When the Cl III-NS and Cl III-Surg groups were compared, the SNB, ANB, L1GoGn, Wits, and the crossbite showed significant differences. For borderline surgical Class III unilateral cleft lip and palate cases, ANB angle, Wits appraisal, and ABGoGn angle were critical diagnostic parameters. On the other hand, the magnitude of anterior crossbite, the negative overjet, was shown not to be a significant measure of anteroposterior discrepancy.

First year-of-life mortality among infants with oral clefts: New York State, 1983-1990

This study examined the mortality experience of children with oral clefts using the New York State Congenital Malformations Registry. Infants born in the years 1983 to 1990 to New York residents, diagnosed with an oral cleft and matched to their birth certificate were included in the analysis. Children with oral clefts were compared to a sample of live births from the years 1983 to 1990 without malformations. Children with cleft palate without additional malformations had a statistically nonsignificant adjusted risk of 1.2 when compared to children with no malformations. Children with cleft lip with or without cleft palate had a 1.1 adjusted risk. However, 35% of children with oral clefts had associated malformations and experienced much higher mortality. Children with oral clefts should be carefully evaluated for additional malformations; if none are found, their mortality appears not to be elevated.

Electropalatographic and perceptual analysis of the speech of Cantonese children with cleft palate

This study used electropalatographic and perceptual analysis to investigate the speech of two Cantonese children with repaired cleft palate. Some features of their speech, as identified from the perceptual analysis, have been previously reported as being typical of children with cleft palate. For example, fricatives and affricates were vulnerable to disruption, and obstruent sounds were judged by listeners to have posterior placement. However, some apparently language-specific characteristics were identified in the Cantonese-speaking children. First there was a relatively high incidence of initial consonant deletion, and for one subject /s/ and /f/ targets were produced as bilabial fricatives. EPG error patterns for target lingual obstruents were largely similar to those reported to occur in English- and Japanese-speaking children. In particular, broader and more posterior tongue-palate contact was observed, and intrasubject variability was noted. There was also evidence of simultaneous labial/velar and alveolar/velar constriction for labial and velar targets respectively. The clinical implications of the findings are discussed.