Estimate of Unmet Need for Cleft Lip and/or Palate Surgery in India

Pre-surgical Nasal Molding of a Two-Day-Old Neonate With Complete Unilateral Cleft Lip and Palate Using Passive Nasoalveolar Molding Technique: A Case Report

The occurrence of congenital deformities like cleft lip and palate is not uncommon and is often a traumatizing experience for families. The entire rehabilitation process includes frequent hospital visits and the brunt of numerous procedures. Early intervention with pre-surgical infant orthopedics facilitates better surgical outcomes and additional psychosocial benefits to the infant's family. The present clinical report addresses the pre-surgical management of a non-syndromic two-day-old female baby whose parents presented with the chief complaint of deformed lips, nose, and difficulty while feeding. The neonate had a complete left-sided cleft lip, alveolus, and cleft palate on examination. Early management with pre-surgical passive nasoalveolar molding (PNAM) has favorable outcomes, including desired upper lip, alveolus, and nose shape. Non-invasive pre-surgical intervention with PNAM reduces the severity of the deformities before the primary surgical repair, thus decreasing the overall cost of cleft care and the number of secondary revisions, thus increasing the probability of favorable outcomes.

Publishing Trends in International Humanitarian Cleft Lip and Palate Care: A Systematic Review

Background: Humanitarian outreach delivers essential cleft lip and palate (CLP) care in low- and middle-income countries. Objective: To review the literature regarding humanitarian CLP care and determine if a shift toward more sustainable care delivery is observed. Methods: A systematic review was performed on articles describing CLP repair in humanitarian settings from 1985 to 2020. Publications were categorized into trip reports, outcomes, teaching, and public health. Articles were stratified into three 12-year intervals (T1-T3) for analysis. Results: A total of 246 publications were included. Average annual publications increased 15.4-fold from T1 to T3 (p < 0.001). Among publications focused on delivering CLP-related care, descriptive trip report articles trended downward (58% in T1 vs. 42% in T3), whereas outcome-focused publications trended upward (42% in T1 vs. 58% T3). Public health research represented the greatest percentage of publications in T3 (50%). There were 22 teaching-related publications in T3 and only one in prior years. Conclusion: Research trends demonstrate a shift away from focusing solely on the number of surgical cases completed and toward more sustainable models of care delivery that address barriers to receiving longitudinal care.

Frequency of anemia and micronutrient deficiency among children with cleft lip and palate: a single-center cross-sectional study from Uttarakhand, India

Background

Children with cleft lip and/or palate can be undernourished due to feeding difficulties after birth. A vicious cycle ensues where malnutrition and low body weight precludes the child from having the corrective surgery, in the absence of which the child fails to gain weight. This study aimed to identify the proportion of malnutrition, including the deficiency of major micronutrients, namely iron, folate and vitamin B₁₂, in children with cleft lip and/or palate and thus help in finding out what nutritional interventions can improve the scenario for these children.

Methods

All children less than 5 years with cleft lip and/or cleft palate attending our institute were included. On their first visit, following were recorded: demographic data, assessment of malnutrition, investigations: complete blood count and peripheral blood film examination; serum albumin, ferritin, iron, folate, and vitamin B₁₂ levels.

Results

Eighty-one children with cleft lip and/or palate were included. Mean age was 25.37± 21.49 months (range, 3–60 months). In 53% of children suffered from moderate to severe wasting, according to World Health Organization (WHO) classification. Iron deficiency state was found in 91.6% of children. In 35.80% of children had vitamin B₁₂ deficiency and 23.45% had folate deficiency. No correlation was found between iron deficiency and the type of deformity.

Conclusion

Iron deficiency state is almost universally present in children with cleft lip and palate. Thus, iron and folic acid supplementation should be given at first contact to improve iron reserve and hematological parameters for optimum and safe surgery.

Burden of Orofacial Clefting in India, 2016: A Global Burden of Disease Approach

Background:

In the recent past, there have been inconsistent reports of India witnessing a decreasing trend in the incidence of orofacial clefts (OFC). To date, little comprehensive evidence has been published. To identify the prevalence, associated burden in terms of epidemiological parameters and to estimate the “unmet” OFC treatment needs, the present study was undertaken.

Materials and Methods:

Using the Global Burden of Diseases 2016 approach and its assumptions, an attempt was made to estimate the prevalence to quantify the burden of OFC in India as disability-adjusted life years (DALYs), years of life lost (YLL), and years lived with disability (YLD) as well as death due to OFC. The results from such an approach are presented. Using previous estimates of “unmet” OFC treatment needs, an attempt was made to estimate the current volume of “unmet” OFC treatment needs.

Results:

In the present study, it was estimated that a total of 0.033% of all Indian population suffers from OFC. In 2016, the estimated prevalence rate/100,000 was 33.27 for males, 31.01 for females, and 32.18 combined for both genders. It was estimated that for all ages, the DALYs lost were 2.05 for 100,000 males, 2.66 for females and 2.34 for both sexes. The OFC birth prevalence model revealed that the birth prevalence (as a proportion) in 2016 in India showed an odds ratio of 0.48 (1.56–1.65) and fixed factor of nonrecording 0.83 (0.15–6.63), underreporting 0.97 (0.88–1), gender 1.09 (1.02–1.16), chromosomal diagnoses included 1.22 (1.22–1.22), and stillbirth 1.22 (1.22–1.22). The total unmet cleft treatment need was estimated at 79,430 or 18.76% of the total Indian cleft population with OFC.

Conclusions:

Within the constraints of the mathematical modeling and based on all available surveys, literature, and reported data, the overall birth prevalence and the prevalence of OFC in India are presented. Till reliable data emerges, the present estimates could serve as a robust estimate of the prevalence and burden of OFC in India. The present enterprise highlights the need for well-designed, high-quality Pan-India, community-based, observational studies to accurately estimate the burden of OFC in India.