One-Year Treatment Outcome of Profile Changes After Transcutaneous Maxillary Distraction Osteogenesis in Growing Children With Cleft Lip and Palate

OBJECTIVE

To evaluate the long-term stability of LeFort I osteotomy followed by distraction osteogenesis with a transcutaneous rigid external device for the treatment of severe maxillary hypoplasia in patients with cleft lip and palate.

PATIENTS AND METHODS

Nine patients with cleft lip and palate underwent rigid external distraction after a LeFort I osteotomy for maxillary advancement. Lateral cephalometric films were analyzed for assessment of treatment outcome and stability in 1 month, 6 months, and 1 year after distraction.

RESULTS

Significant maxillary advancement was observed in the horizontal direction, with the anterior nasal spine (ANS) distance of the maxilla increasing by an average of 20.5 ± 5.1 mm after distraction. The ANS relapse rates in 6 months and 1 year were 8.7% and 12.8%, respectively. The mean inclination of upper incisors to the palatal plane was almost unchanged (before: 109.8° ± 6.6°; after: 108.9° ± 7.5°). The movement ratios at the nasal tip/ANS, soft tissue A point/A point, and the upper vermilion border/upper incisor edge were 0.36:1, 0.72:1, and 0.83:1, respectively.

CONCLUSION

Considerable maxillary advancement was achieved with less change of incisors inclination after distraction. Moreover, the relapse rate after 1 year was minimal. The concave facial profile was improved as well as the facial balance and aesthetics.

Salivary counts of Streptococcus mutans and Lactobacillus in patients with and without cleft lip and/or palate undergoing orthodontic treatment: A meta-analysis

OBJECTIVE

To conduct a systematic review with meta-analysis to assess if cleft lip and palate (CLP) patients undergoing orthodontic treatment have a higher colonization of Streptococcus mutans and Lactobacillus than patients without this condition.

METHODS

Five electronic databases were searched systematically. The inclusion criteria were as follows: randomized clinical trials, non-randomized, or quasi-randomized controlled trials, prospective and retrospective studies published until March, 2021; articles that evaluated S. mutans and Lactobacillus profile in patients with and without cleft lip and palate undergoing orthodontic treatment. The random-effect model was used to perform the analysis of all the data collected. Statistic heterogeneity was evaluated with I² test.

RESULTS

In this systematic review, 2 cohort studies were included. The data analysis from 160 patients revealed that patients without cleft lip and palate had 4.5 times more predisposition to oral colonization with S. mutans than CLP patients. No statistical significant difference was found between these patients for colonization with Lactobacillus.

CONCLUSIONS

Despite the limitations in the included studies, this systematic review suggested that CLP patients have a lower predisposition to oral colonization with S. mutans when compared to healthy patients.

[Pre-surgical orthopedic treatment with Hinostroza nasal retractor modification in complete unilateral palate fissure. Case report]

Complete unilateral palatine fissure affects the region of the middle facial third and individuals born with this condition have altered structures on the side where the malformation developed. The objective of the present case report was to describe a pre-surgical orthopedics alternative in a female infant of 1 month 5 days of age with complete unilateral palatine fissure diagnosed with complete unilateral left palatine fissure. The Hinostroza nasal retractor modification was placed, allowing symmetry to the affected nasal structure with respect to the unaffected side. This procedure provides good results, low cost and easy handling and should be considered as an alternative treatment in neonates born with complete unilateral palatine fissure.

Preoperative analysis of upper lip in patients with upper cleft lip/palate before lip repair

Background

The postoperative morphological appearances vary widely patients with unilateral cleft lip with or without cleft palate (UCL/P), whether it is complete or incomplete cleft. The main reason of bilateral lip asymmetry after cleft lip surgery lies in the lack of personalized measurement and design before surgery. In this study, we aim to individually investigate areas of the upper lip on cleft and non-cleft sides in patients with unilateral cleft lip with or without cleft palate (UCL/P).

Methods

Ninety-two patients with UCL/P (group 1: <1 year, group 2: 1–2 years) were included in the study. Group 1 included 37 patients with incomplete UCL/P and 29 with complete UCL/P; group 2 included 11 and 15 patients, respectively. The total area of the upper lip on the cleft side (Q8) was divided into Q3, Q4, and Q5 (further divided into a1 and a2), and the upper lip on the non-cleft side (Q7) was divided into Q2 and Q1 (further divided into A1 and A2). Area ratios between the cleft and the non-cleft sides were calculated, and certain parameters were tested for correlations with these ratios.

Results

Values of Q8/Q7 were partially overlapped between patients with complete and incomplete UCL/P. Significant correlations were noted between differences in height of the philtrum column (a–h) and the prolabial area ratio between the cleft and the non-cleft side (Q3/Q2) (P=0.032). Moreover, a significant correlation was noted between a1/A1 and the ratio of the lateral labial area between the cleft and the non-cleft side (Q5/Q1) (P=0.001).

Conclusions

The conventional classification of unilateral cleft lip as incomplete and complete does not completely and accurately reflect individual malformations. Therefore, it is necessary to analyze unilateral cleft lips individually to determine the repair technique and to predict postoperative outcomes.

Cleft Palate in Newborns Diagnosed With Prematurity

OBJECTIVE

Cleft lip and/or palate (CLP) is the most common major congenital malformation of the head and neck. Although numerous genetic features, syndromes, nutritional deficiencies, and maternal exposures have been implicated in the etiology of CLP, the impact of prematurity on the pathogenesis remains incompletely understood. This study seeks to evaluate the associations between prematurity and the development of CLP in the United States.

STUDY DESIGN

Cross-sectional.

SETTING

Academic medical center.

METHODS

The Kids' Inpatient Database (2016) was used to identify weighted in-hospital births with diagnoses of prematurity or CLP. Demographic information was obtained. Odds ratios were used to determine associations between prematurity and CLP.

RESULTS

Among patients included in our data set, 8.653% (n = 326,147) were preterm; 0.136% (n = 5115) had CLP; and 0.021% (n = 808) were preterm and had CLP. Preterm infants had 1.90 times the odds (95% CI, 1.74-2.07) of developing CLP when compared with the nonpreterm population. The binary logistic regression model accounting for possible confounding variables produced an odds ratio of 1.83 (95% CI, 1.66-2.01) for the association between prematurity and CLP.

CONCLUSION

Infants who are born preterm are more likely to have CLP than full-term infants. The current results will allow for improved risk stratification, maternal counseling, and interventions in the case of prematurity.

LEVEL OF EVIDENCE

4.

Identification of Copy Number Variation Among Nonsyndromic Cleft Lip and or Without Cleft Palate With Hypodontia: A Genome-Wide Association Study

Nonsyndromic cleft lip and or without cleft palate (NSCL/P) with the hypodontia is a common developmental abnormality in humans and animals. This study identified the genetic aberration involved in both NSCL/P and hypodontia pathogenesis. A cross-sectional study using genome-wide study copy number variation-targeted CytoScan 750K array carried out on salivary samples from 61 NSCL/P and 20 noncleft with and without hypodontia Malay subjects aged 7-13 years old. Copy number variations (CNVs) of SKI and fragile histidine triad (FHIT) were identified in NSCL/P and noncleft children using quantitative polymerase chain reaction (qPCR) as a validation analysis. Copy number calculated (CNC) for each gene determined with Applied Biosystems CopyCaller Software v2.0. The six significant CNVs included gains (12q14.3, 15q26.3, 1p36.32, and 1p36.33) and losses (3p14.2 and 4q13.2) in NSCL/P with hypodontia patients compared with the NSCL/P only. The genes located in these regions encoded LEMD3, IGF1R, TP73, SKI, FHIT, and UGT2β15. There were a significant gain and loss of both SKI and FHIT copy number in NSCL/P with hypodontia compared with the noncleft group (p < 0.05). The results supported that CNVs significantly furnish to the development of NSCL/P with hypodontia.

Opioid Prescribing Practices in Cleft Lip and Cleft Palate Reconstruction

INTRODUCTION

Currently, there is no consensus regarding the role of opioids in the management of perioperative pain in children undergoing cleft lip/palate repair.

METHOD

The present study evaluated opioid prescribing patterns of surgeon members within the American Cleft Palate-Craniofacial Association surgeons utilizing an anonymous survey.

RESULTS

Respondents performing cleft lip repair typically operate on patients 3 to 6 months of age (86%), admit patients postoperatively (82%), and discharge them on the first postoperative day (72%). Comparatively, respondents performed palatoplasty between the ages of 10 and 12 months (62%), almost always admit the patients (99%), and typically discharge on the first postoperative day (78%). Narcotics were more frequently prescribed after palatoplasty than after cleft lip repair, both for inpatients (66%; 49%) and at discharge (38%; 22%). Oxycodone was the most prescribed narcotic (39.1%; 41.4%), typically for a duration of 1 to 3 days (81.5%; 81.2%). All surgeons who reported changing their narcotic regimen (34.4% dose, 32.8% duration) after cleft lip repair, decreased both parameters from earlier to later in their career. Similarly, surgeons who changed the dose (32.2%) and duration (42.5%) of narcotics after palatoplasty, mostly decreased both parameters (96%). Additionally, physicians with >15 years of practice were less likely to prescribe opioids in comparison with colleagues with ≤15 years of experience. Ninety-two percent of respondents endorsed prescribing nonopioid analgesics after prescribing cleft surgery, most commonly acetaminophen (85.7%; 85.4%).

CONCLUSION

Cleft surgeons typically prescribe opioids to inpatients and rarely upon discharge. Changes to opioid-prescribing patterns typically involved a decreased dose and duration.

Maternal Vitamin B12 Status and Risk of Cleft Lip and Cleft Palate Birth Defects in Tamil Nadu State, India

BACKGROUND AND OBJECTIVE

The causal role of maternal nutrition in orofacial clefts is uncertain. We tested hypotheses that low maternal vitamin B₁₂ and low folate status are each associated with an increased risk of isolated cleft lip with or without cleft palate (CL±P) in a case-control study in Tamil Nadu state, India.

METHODS

Case-mothers of CL±P children (n = 47) and control-mothers of unaffected children (n = 50) were recruited an average of 1.4 years after birth of the index child and plasma vitamin B₁₂, methylmalonic acid (MMA), total homocysteine (tHcy), and folate were measured at that time. Logistic regression analyses estimated associations between nutrient biomarkers and case-control status.

RESULTS

Odds ratios (ORs) contrasting biomarker levels showed associations between case-mothers and low versus high plasma vitamin B₁₂ (OR = 2.48, 95% CI, 1.02-6.01) and high versus low plasma MMA, an indicator of poor B₁₂ status (OR = 3.65 95% CI, 1.21-11.05). Case-control status was not consistently associated with folate or tHcy levels. Low vitamin B₁₂ status, when defined by a combination of both plasma vitamin B₁₂ and MMA levels, had an even stronger association with case-mothers (OR = 6.54, 95% CI, 1.33-32.09).

CONCLUSIONS

Mothers of CL±P children in southern India were 6.5 times more likely to have poor vitamin B₁₂ status, defined by multiple biomarkers, compared to control-mothers. Further studies in populations with diverse nutritional backgrounds are required to determine whether poor maternal vitamin B₁₂ or folate levels or their interactions are causally related to CL±P.

Interdisciplinary Considerations for Nasolabial Repair During a Global Pandemic

BACKGROUND

At the declaration of the global pandemic on March 11, 2020, many hospitals and institutions developed a tiered framework for the stratification and prioritization of elective surgery. Cleft lip and palate repair was classified as low acuity, and nasoalveolar molding (NAM) clinics were closed. Anticipating the consequences of delayed cleft care and the additional burden this would cause families, we reassessed our risk-stratification and perioperative algorithms. We hypothesized we could safely optimize nasolabial repair without burdening our care systems and without increasing COVID-19-related morbidity/mortality.

METHODS

Our multidisciplinary cleft team reevaluated patient selection to maximize surgical impact. Perioperative protocols were adjusted, and COVID-19 preoperative testing was utilized before nasolabial repair and prior to suture removal under anesthesia.

RESULTS

Early in the pandemic, unilateral cleft repair was prioritized and successfully completed on 9 patients. There were no complications related to COVID-19. Nasoalveolar molding clinic was reopened after total patient volume was significantly decreased.

CONCLUSIONS

We offer an approach for surgical management of nasolabial clefts during a global pandemic. Although guidelines have suggested postponing all cleft care, we found that at our dedicated pediatric hospital with low burden of COVID-19 and adequate resources, we could follow a strategy to safely resume cleft care while decreasing burden on our patients' families and care delivery systems.

"Unexpected event": Having an infants with cleft lip and/or palate

This study aimed to determine the difficulties that the mothers of infants with a cleft lip and/or palate (CL/P) go through, the problems they encounter in this process, and how they perceive the support of healthcare professionals, families, and friends. The study used a phenomenological approach from qualitative research methods. The study sample included 18 mothers of 0 to 3-month-old infants with CL/P. The data were collected using socio-demographic information form and semi-structured interview form. The data obtained from the interviews were evaluated using content and thematic analysis approaches. On the basis of the interviews conducted with mothers of infants with CL/P, the following themes emerged: (a) "unexpected event: having an infant with CL/P," (b) "using social media," (c) "stigma," and (d) "uncertainty of long-term treatment." In this study, it was determined that mothers experienced shock, confusion, sadness, and disappointment in this process; therefore, they used social media to seek support from the families as well as conducted research on the disease that involved a lot of uncertainty due to long-term treatments. The present study can help healthcare professionals, who play a role in the care and treatment of infants with CL/P, to understand and know what mothers need in the preoperative period.

Furlow Palatoplasty: Should We Also Focus on the Size of the Nasopharynx?

OBJECTIVES

(1) To determine the incidence rate of velopharyngeal dysfunction (VPD) according to 7 speech criteria post-Furlow palatoplasty. (2) To find an anatomical measurement of the cleft palate (or combination of measurements) associated with the occurrence of VPD.

STUDY DESIGN

Retrospective cohort study.

PARTICIPANTS AND METHODS

Fifty-six patients with cleft palate ± cleft lip underwent palatoplasty with the Furlow technique at the age of 10 months. Pre-and post-palatoplasty cleft palate measurements were collected during the procedure. Three blinded speech-language pathologists (SLPs) retrospectively scored the patients from the chart data at age 4. Student t test and receiver operating characteristic curve analysis were used to evaluate the association and predictive capacity between cleft measurements and parameters (M&P) with all VPD criteria.

RESULTS

The SLPs found an incidence of VPD according to 7 criteria: hypernasality (11%), audible nasal emission (4%), nasal rustle (14%), compensatory errors (4%), impairment of speech understandability (7%), and impairment of speech acceptability (16%). The SLPs recommended a secondary surgical procedure in 5 patients (9%). A statistically significant association was found between, respectively, 17 and 5 M&P and the occurrence of compensatory errors and audible nasal emission. Our data suggest that the length of the cleft, the cleft area, and the postoperative transversal size of the nasopharynx are the best indicators of the future positivity of VPD criteria.

CONCLUSION

The size of the postoperative transverse nasopharyngeal area during the primary cleft palate procedure may become the focus of the next generation of cleft surgeons to reduce the incidence of VPD.

Orthodontic-care burden for patients with unilateral and bilateral cleft lip and palate

BACKGROUND

Cleft lip and palate (CLP) cause severe malocclusion, which requires numerous orthodontic interventions in specialized centers. There is little literature regarding the overall orthodontic burden of care for these patients.

OBJECTIVES

The aim of the study was the evaluation of orthodontic-care burden for patients treated in the Division of Facial Abnormalities at the Department of Dentofacial Orthopedics and Orthodontics of Wroclaw Medical University in Poland.

MATERIAL AND METHODS

The medical data of patients with complete unilateral and bilateral cleft lip and palate (ULCP and BLCP) who finished orthodontic treatment between 2012 and 2019 was evaluated. The duration of orthodontic treatment, the number of removable appliances, the number of kilometers traveled as well as the number of visits and surgical procedures performed were recorded. The sample was divided into 2 groups according to the World Health Organization (WHO) International Classification of Diseases (ICD-10) diagnosis codes. All data was subjected to statistical analysis.

RESULTS

For the UCLP patients (n = 54), the mean time of orthodontic treatment was 9.24 years, the mean number of orthodontic appointments was 62.91, the mean number of removable appliances was 4.12, the mean number of surgical procedures was 3.35, and the mean distance traveled to visit the center for orthodontic appointments was 5,466.95 km. For the BCLP patients (n = 19), the mean time of orthodontic treatment was 10.16 years, the mean number of orthodontic appointments was 66.26, the mean number of removable appliances was 4.12, the mean number of surgical procedures was 4.05, and the mean distance traveled to visit the center for orthodontic appointments was 3,758.23 km.

CONCLUSIONS

The orthodontic treatment of patients with UCLP and BCLP is very burdensome for the patients. However, the burden of care in the Division of Facial Abnormalities at the Department of Dentofacial Orthopedics and Orthodontics of Wroclaw Medical University in Poland is not greater than in other European countries.

Parenting Children With a Cleft Lip With or Without Palate or a Visible Infantile Hemangioma: A Cross-Sectional Study of Distress and Parenting Stress

Objective:

Parents of children with a medical condition and a visible difference can experience challenging situations. We evaluated distress and parenting stress in parents of children with a cleft lip with or without cleft palate (CL±P) or a visible infantile hemangioma (IH).

Setting:

This cross-sectional study took place in an academic medical hospital in Rotterdam, the Netherlands.

Participants:

Three-hundred nine parents (mean age = 40.30, 56.00% mothers) of children with CL±P and 91 parents (mean age = 36.40, 58.24% mothers) of children with IH.

Main Outcome Measures:

The Dutch version of the Parenting Stress Index – Short Form and the subscales Anxiety, Depression, and Hostility of the Symptom Checklist – 90.

Results:

One sample t tests and mixed linear modeling were used. On average, parents of children with CL±P and of children with IH showed significantly lower parenting stress compared to normative data. Anxiety was significantly lower in parents of children with CL±P than that in the norm group. Visibility of the condition was not related to distress or parenting stress. Child behavioral problems were positively related to parenting stress, depression, and hostility.

Conclusions:

Parents of children with CL±P and IH report less distress and parenting stress compared to the norm. On average, these parents seem well adjusted. A practical implication is to monitor parents of children with behavioral problems.

Custom-Made Nasal Retainer Using Latex Nelaton Urine Catheter After the Cheiloplasty

Nasal retainers are common tools used in managing patients with cleft lip. The significance of nasal retainer in preventing nostril collapse or stenosis to maintain a symmetrical nose after the surgical procedures is already well known. We came up with a way to create a nasal retainer using a latex nelaton catheter. Custom-made nasal retainer using latex nelaton catheter was used postoperatively on a 10-month-old infant with median cleft lip after cheiloplasty. In postoperative day 7, her nostrils were large enough for premade silicone nasal retainer to fit. She was discharged with instructions given to use the retainer for 6 months. Custom-made nasal retainer can be used as an alternative to premade nasal retainers for patients with wide columella or small nostril cavities, or who cannot afford premade retainers.

Quantification of Cytokines in Lip Tissue from Infants Affected by Congenital Cleft Lip and Palate

Cleft lip and palate are amongst the most common congenital malformations worldwide presenting with variable manifestations. Previous research has been primarily focused on the genetical aspects of its complex and multifactorial etiology. In the present study, we investigated the role of cytokines as mediators of epithelial–mesenchymal crosstalk and local site inflammation in cleft affected infants. Lip material was obtained from 12 children aged before primary dentition who suffered from orofacial clefting. The quantification of 12 cytokines (Interleukin-2,4,5,6,10,12,13,17A, Tumor Necrosis Factor-α, Interferon-γ, Transforming Growth Factor beta-1 and Granulocyte-Colony Stimulating Factor) was done using ELISA. Nonparametric Spearman Rho was used to ascertain the correlation between the expression levels of different cytokines. A significantly strong positive correlation was found between IL-2 and IFN-γ coupled with an IL4/IFN-γ ratio favoring IFN-γ. These findings indicate a shift towards the preferential activation of the Th1 differentiation pathway. Further, a pathological reduction in TGFβ-1 levels was noted, which may contribute to mucosal damage. IL-6 was more highly correlated to IFN-γ and IL-12 indicating its potential proinflammatory role in cleft affected tissues. This preferential activation of Th1 cell differentiation and consistent expression of IL-2,6,13 and TNF-α in cleft patients may indicate certain underlying mechanisms for inflammation mediation at the site of clefting.

Phenytoin Inhibits Cell Proliferation through microRNA-196a-5p in Mouse Lip Mesenchymal Cells

Cleft lip (CL) is one of the most common birth defects. It is caused by either genetic mutations or environmental factors. Recent studies suggest that environmental factors influence the expression of noncoding RNAs [e.g., microRNA (miRNA)], which can regulate the expression of genes crucial for cellular functions. In this study, we examined which miRNAs are associated with CL. Among 10 candidate miRNAs (miR-98-3p, miR-101a-3p, miR-101b-3p, miR-141-3p, miR-144-3p, miR-181a-5p, miR-196a-5p, miR-196b-5p, miR-200a-3p, and miR-710) identified through our bioinformatic analysis of CL-associated genes, overexpression of miR-181a-5p, miR-196a-5p, miR-196b-5p, and miR-710 inhibited cell proliferation through suppression of genes associated with CL in cultured mouse embryonic lip mesenchymal cells (MELM cells) and O9-1 cells, a mouse cranial neural crest cell line. In addition, we found that phenytoin, an inducer of CL, decreased cell proliferation through miR-196a-5p induction. Notably, treatment with a specific inhibitor for miR-196a-5p restored cell proliferation through normalization of expression of CL-associated genes in the cells treated with phenytoin. Taken together, our results suggest that phenytoin induces CL through miR-196a-5p induction, which suppresses the expression of CL-associated genes.

Telemedicine in International Cleft Care: A Systematic Review

BACKGROUND

Cleft lip and cleft palate (CLP) are among the world's most common congenital malformation and has a higher prevalence in developing nations due to environmental and genetic factors. Global efforts have been developed in order to prevent and treat the malformation. Telemedicine has been implemented in various humanitarian global missions with success and is currently the primary means of care due to COVID-19.

OBJECTIVE

To assess the benefits and barriers of telehealth in the care of patients with CLP through a global approach.

METHODS

Systematic review of the PubMed and Cochrane Review databases with relevant terms related to telemedicine in cleft lip and palate surgery.

RESULTS

Eight articles fit the inclusion criteria and suggested benefits with the use of telemedicine in regard to education, preoperative, and postoperative care as well as increased access to underserved populations. Barriers included connectivity and accessibility concerns.

CONCLUSION

Telehealth is a beneficial way to evaluate patients with CLP in developing countries with proper care and follow-up to reduce complications and to improve health outcomes.

A Retrospective Cohort Study to Evaluate the Association Between Types of Nonsyndromic Oral Clefts and a Child's Gender and Maternal Age

Aims

To evaluate the association between nonsyndromic cleft lip with or without cleft palate (NSCL±P) anomaly and the affected child's gender and maternal age.

Materials and Methods

Records of 141 newborns received at the orthodontic craniofacial clinic of the Jordanian Royal Rehabilitation Center between 2017 and 2019 were retrospectively analyzed. Two variables were paid attention to: child's gender and maternal age. Five cleft types were considered: unilateral CLP (right; URCLP and left; ULCLP), bilateral CLP (BCLP), isolated cleft palate (CP) and isolated cleft lip (CL). Maternal age was classified into four subgroups: "26-30" years, "31-35" years, "36-40" years, and "above 40" years. Chi-square test and multinomial logistic regression analysis were used to analyze the resultant data.

Results

A significant occurrence of the NSCL±P in females was found compared with males. The different cleft types were found to be significantly associated with the different maternal age groups investigated. The ULCLP was the most prevalent cleft type for affected children among all maternal age groups except the "31-35" group, at which the BCLP exceeded.

Conclusions

The children's gender and the maternal age have a significant impact on defining the developing oral cleft types.

Revisiting straight-line repair in unilateral complete cleft lip: a comparison with rotation-advancement repair

Rotation-advancement repair (RAR) has been the most widely used technique for unilateral cleft lip repair. We recently used a straight-line repair with medial orbicularis muscle lengthening (SLR-ml) technique, based on the hypothesis that it could minimize the postoperative scar appearance without causing s short-lip deformity when muscle reorientation is performed correctly. A retrospective cohort study was conducted on unilateral complete cleft lip patients who underwent cheiloplasty between 2009 and 2017. Two cheiloplasty techniques were compared: RAR and SLR-ml. Outcomes were evaluated by assessing follow-up photographs using three methods: (1) glance impression on a five-point scale, (2) Manchester Scar Scale, and (3) indirect anthropometry. Seventy-one patients were analysed: 41 in the RAR group (28 male, 13 female) and 30 in the SLR-ml group (15 male, 15 female). The glance impression (P=0.506) and Manchester Scar Scale (P=0.347) scores did not differ between the groups. According to the symmetry ratio (cleft side value/non-cleft side value), vertical lip height (P=0.804), horizontal lip length (P=0.881), and Cupid's bow width (P=0.122) did not differ significantly between the groups. The preoperative lip height discrepancy was not correlated with the postoperative vertical lip height. The SLR-ml method can be regarded as a successful tool for symmetric repair of unilateral cleft lip.

Validation of a novel method for canine eruption assessment in unilateral cleft lip and palate patients

Objective

The aim of this study was to propose and validate a three‐dimensional (3D) methodology for the assessment of canine eruption in patients born with unilateral cleft lip and palate (UCLP) following secondary alveolar bone graft (SABG).

Methods and Materials

A total of 10 patients (four females, six males; mean age: 8.8 years) with UCLP who underwent SABG were recruited. Pre‐ and 6‐month post‐operative cone‐beam computed tomography (CBCT) was acquired for all patients. Post‐operative data was registered onto pre‐operative data utilizing voxel‐based registration. Following superimposition, a segmentation process was applied to segment maxillary canine on both cleft and non‐cleft side. Thereafter, translational and rotational changes in canine position were assessed for both cleft and non‐cleft side by two observers.

Results

The intra‐class correlation coefficient (ICC) indicated excellent reliability (≥0.90) with inter and intra‐observer error of less than 0.05 mm. The overall ICC was found to be high for assessing both translational and rotational changes. The mean absolute inter‐ and intra‐observer difference for translational and rotational changes was found to be less than 1 mm and 3°.

Conclusion

The present method was found to be reliable proving to be clinically applicable for assessing maxillary canine eruption changes in both cleft and non‐cleft bone.

Anthropometric Outcome of Primary Unilateral Cleft Lip Repair in Indonesia

OBJECTIVE

This study aimed to measure and analyze the outcome of primary unilateral cleft lip repair.

DESIGN

Observational cohort study.

SETTING

Surabaya Cleft Lip and Palate (CLP) Center, a major referral center for the Eastern part of Indonesia, affiliated with a tertiary center.

PATIENTS, PARTICIPANTS

From 69 patients who met the inclusion criteria, we excluded 31 patients who were more than 2 years of age and were operated on by junior residents under supervision.

INTERVENTIONS

We performed anthropometric measurements of the patients on photographs taken before, immediately after, and a year after the surgery.

MAIN OUTCOME MEASURE(S)

This study measured nasal width, vertical lip height, horizontal lip length, and philtral height ratios.

RESULTS

While nasal width and philtral height ratios decreased significantly (P = .000 and P = .000, respectively) reaching symmetry immediately after surgery, the horizontal lip length, and vertical lip height ratios remained unchanged (P = .862 and P = .981, respectively). A year after surgery, the nasal width and horizontal lip length ratios increased significantly (P = .017 and P = .006, respectively), while philtral height and vertical lip height ratios remained unchanged (P = .927 and P = .138, respectively). There was no difference in the ratios based on the initial size and completeness of the cleft.

CONCLUSION

In Surabaya CLP Center, the symmetry of nasal width, philtral height, horizontal lip length, and vertical lip height were achieved by the unilateral cleft lip repair despite the initial size and completeness of the cleft.

Perioperative Management of Cleft Lip Repair: A Meta-Analysis and Clinical Practice Guideline

OBJECTIVE

Few studies have focused on perioperative management of cleft lip repair. We sought to evaluate the available data on this topic to create evidence-based clinical guidelines.

DESIGN

Systematic review, meta-analysis.

METHODS

A PubMed search was performed focusing on perioperative management of cleft lip repair. Studies were included if they included comparative data. A systematic review and meta-analysis was performed according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.

MAIN OUTCOME MEASURES

Systematic review of literature regarding wound closure, postoperative arm restraints, perioperative antibiotics, outpatient or ambulatory surgery, or feeding restrictions postoperatively.

RESULTS

Twenty-three articles met inclusion criteria after initial screening of 3103 articles. This included 8 articles on wound closure, 2 on postoperative restraints, one on perioperative antibiotics, 6 on outpatient surgery, and 6 on postoperative feeding. Meta-analysis could be performed on dehiscence rates with postoperative feeding regimen and readmission rates after outpatient versus inpatient lip repair. There were few studies with low risk of bias. Outpatient cleft lip repair does not increase readmission (odds ratio [OR]: 0.92, 95% CI: 0.28-3.07). Allowing postoperative breastfeeding or bottle-feeding does not increase dehiscence (OR: 0.61, 95% CI: 0.19-1.95). There was no evidence of publication bias.

CONCLUSION

Within the limitations of available data, there is no evidence of a clearly superior closure material. The evidence does not support use of postoperative arm restraints. The evidence does not support the use of preoperative nasal swabs for antibiotic guidance. With careful patient selection, outpatient cleft lip repair appears safe. The evidence supports immediate breastfeeding or bottle-feeding after cleft lip repair.

Clinical and Demographical Characteristics of Cleft Lip and/or Palate in the Northwest of Iran: An Analysis of 1500 Patients

OBJECTIVE

Orofacial clefts (OFCs) can occur as an isolated defect or as a manifestation of other syndromes. The current study aimed to evaluate demographic characteristics and distribution of different types of accompanying anomalies for OFCs in the northwest of Iran.

DESIGN

A retrospective cohort study.

SETTING

Tertiary pediatric hospital.

PATIENTS AND PARTICIPANTS

This study was conducted on 1500 cleft lip and/or palate patients born between July 2010 and June 2020 in the northwest of Iran.

MAIN OUTCOME MEASURES

Demographic and clinical characteristics of the children with OFCs including familial history, accompanying anomalies and syndromes, maternal passive smoking, mothers' and fathers' age, consanguineous marriage, and birth order.

RESULTS

Among 1500 patients, 441 had cleft lip, 615 had cleft palate, and 444 had cleft lip and palate. The positive family history of OFCs was found to be 20.9% to 25.4% depending on the cleft type. Accompanying anomalies were identified in 29.8% of cases. Cardiac, facial, and ear abnormalities were the most common types. Also, 2.9% were identified with syndromes and sequences. These included Pierre Robin Sequence, Velo-cardio-facial syndrome, and Down syndrome most frequently.

CONCLUSION

These findings may provide references for appropriate resources to establish and direct counseling and primary preventive projects in the northwest of Iran.

Self-Consciousness of Appearance in Chinese Patients With Cleft Lip: Validation of the Chinese Derriford Appearance Scale 59 (DAS 59) Instrument

OBJECTIVE

To develop a reliable and valid Chinese version of the Derriford Appearance Scale 59 (DAS 59) instrument for assessing the self-consciousness of appearance in Chinese patients with cleft lip.

METHODS

The original DAS 59 instrument was translated into Mandarin, back-translated, and culturally adapted among the Chinese population, following the protocol of the original DAS 59. The validation of the Chinese DAS 59 instrument was estimated on 443 adult participants including 213 subjects with a history of cleft lip with/without palate (CL/P, study group) and 230 normal subjects without facial appearance concern (control group). The reliability was estimated by Cronbach's α coefficient and Guttman's split-half coefficient. Content validity was tested using the Spearman correlation coefficient, while discriminant validity was tested by the Mann-Whitney U test.

RESULTS

The overall internal consistency of Chinese DAS 59 was excellent; Cronbach's α was 0.951 (α = 0.965 and 0.959 in the study and control groups, respectively). Further, Guttman's split-half coefficient was excellent in the study group (0.935) and control group (0.901). The validity of content was good with an acceptable correlation between all the items and domains. The construct validity through the discrimination was good with a statistically significant difference in most domains between the two groups. Patients with CL/P had more concern about the general self-consciousness and social self-consciousness of appearance. They also showed a good self-concept score.

CONCLUSION

The Chinese version of DAS 59 demonstrated acceptable reliability and good construct and discriminant validity. It can be used for the research and assessment of the psychological state and quality of life for Chinese patients with cleft lip as well as other appearance problems and concerns.

Orofacial clefts in low- and middle-income countries: A scoping review of quality and quantity of research based on literature between 2010-2019

This paper assesses the research literature on OFC in LMIC over the last decade across various geographical settings and project focus of the indexed literature. A scoping review of the indexed literature was performed using a set of predefined keywords. The articles were filtered by a ten-year time frame (2010-2019) and a strict inclusive-exclusive criterion. Two authors screened the titles/abstracts/full text of the final included papers and input the desired data (year of publication, type of publication, geographical country/region and project focus to a coded spreadsheet). Six hundred and twenty publications were inventoried from the indexed literature on OFC in LMIC settings over the 10-year period. Five hundred and eighty-three derived from single LMIC countries and 37 from multi-settings. More than half of the articles were reported from Asia (57%), then from Americas (22.8%), Africa (15.4%) and the rest from cross-regional, Europe and Oceania (4.9%). The top 3 LMIC contributors towards OFC publications were China (21.5%), Brazil (13.1%) and India (11.6%). The most discussed OFC project themes were prevalence, surgical repair, aetiology and genetics. This study helps OFC researchers, humanitarian missions and research grant funders to identify gaps in the literature on issues impacting on children and adults born with OFC, in which issues were subjected to research and which were less explored in which LMIC regions. In addition, this study offers recommendations for established OFC researchers and international research bodies to identify areas of deficiency in the literature and what information is required to support LMIC governments achieve SDGs by 2030.