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Fell M, Fitzsimons KJ, Hamilton MJ, Medina J, Butterworth S, Park MH, Van der Meulen J, Lewis S, Chong D, Russell CJ. Cleft lip Sidedness and the Association with Additional Congenital Malformations. Cleft Palate Craniofac J 2024:10556656241261918. [PMID: 38870388 DOI: 10.1177/10556656241261918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE To investigate the association between the sidedness of orofacial clefts and additional congenital malformations. DESIGN Linkage of a national registry of cleft births to national administrative data of hospital admissions. SETTING National Health Service, England. PARTICIPANTS 2007 children born with cleft lip ± alveolus (CL ± A) and 2724 with cleft lip and palate (CLP) born between 2000 and 2012. MAIN OUTCOME MEASURE The proportion of children with ICD-10 codes for additional congenital malformations by the sidedness (left, right or bilateral) of orofacial clefts. RESULTS For CL ± A phenotypes, there was no evidence for a difference in the prevalence of additional anomalies between left (22%, reference), right (22%, aOR 1.02, 95% CI 0.80 to 1.28; P = .90) and bilateral clefts (23%, aOR 1.09, 95% CI 0.75 to 1.57; P = .66). For CLP phenotypes, there was evidence of a lower prevalence of additional malformations in left (23%, reference) compared to right (32%, aOR 1.54, 95% CI 1.25 to 1.91; P < .001) and bilateral clefts (33%, aOR 1.64, 95% CI 1.35 to 1.99; P < .001). CONCLUSIONS The prevalence of additional congenital malformations was similar across sidedness subtypes with CL ± A phenotypes but was different for sidedness subtypes within CLP cases. These data support the hypothesis that CL ± A has a different underlying aetiology from CLP and that within the CLP phenotype, right sided CLP may lie closer in aetiology to bilateral CLP than it does to left sided CLP.
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Affiliation(s)
- Matthew Fell
- Spires Cleft Centre, John Radcliffe Hospital, Oxford, UK
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, UK
| | - Kate J Fitzsimons
- Cleft Registry and Audit Network, Clinical Effectiveness Unit, The Royal College of Surgeons of England, London UK
| | - Mark J Hamilton
- West of Scotland Centre for Genomic Medicine, Queen Elizabeth University Hospital, Glasgow UK
| | - Jibby Medina
- Cleft Registry and Audit Network, Clinical Effectiveness Unit, The Royal College of Surgeons of England, London UK
| | - Sophie Butterworth
- Cleft Registry and Audit Network, Clinical Effectiveness Unit, The Royal College of Surgeons of England, London UK
| | - Min Hae Park
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London UK
| | - Jan Van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London UK
| | - Sarah Lewis
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, UK
| | - David Chong
- The Royal Children's Hospital, Melbourne, Australia
| | - Craig Jh Russell
- Royal Hospital for Children, Queen Elizabeth University Hospital, Glasgow, UK
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Al-Hassani M, Fowler P, Wren Y, Leary S, Davies A. Should left- and right-sided unilateral cleft lip and palate patients be grouped together when reporting the outcomes? Orthod Craniofac Res 2024; 27 Suppl 1:49-61. [PMID: 38193240 DOI: 10.1111/ocr.12747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVES Investigate associations between cleft laterality in patients with non-syndromic unilateral cleft lip and palate (UCLP) and oral-health, dental-arch, speech, audiological, psychological and nasolabial-aesthetic outcomes. METHODS Secondary data analysis of the outcomes of 5-year-old children with non-syndromic complete UCLP identified from three studies: Cleft Collective (n = 155), Cleft Care UK (CCUK) (n = 266) and Clinical Standards Advisory Group (CSAG) study (n = 238). Outcome measures included occlusal assessment using the 5-year-old's index score, speech intelligibility rating using the CAPS-A Audit tool, audiological assessment using pure tone audiometry, nasolabial aesthetic assessment using the Asher-McDade tool, oral-health assessment using decayed, missing, filled teeth scores and parent-reported outcomes. Logistic regression with adjustment for age, sex and index-of-multiple-deprivation scores were performed. RESULTS No differences were found in patient-reported outcomes between the left and right clefts in the Cleft Collective study. From the CCUK study, right clefts had poorer speech (n = 236; 95% CI 1.09, 3.42; and P = .03) and hearing outcomes (n = 211; 95% CI 1.03, 3.43; P = .04). In the CSAG study, patients with left clefts were more likely to be teased (n = 213; 95% CI 0.26, 0.85; and P = .01). CONCLUSION Weak associations between cleft laterality, speech, hearing and psychological outcomes were found, however the findings were inconsistent across the studies. This study contributes to evidence of associations between laterality and outcomes in children born with UCLP.
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Fowler PV, Keall H, Kennedy D, Healey D, Thompson JMD. Cleft Laterality Dental Arch Relationship Outcomes for Children with Unilateral Cleft Lip and Palate in New Zealand. Cleft Palate Craniofac J 2024:10556656241234599. [PMID: 38414360 DOI: 10.1177/10556656241234599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To investigate cleft laterality dental arch relationship outcomes of children with non-syndromic complete unilateral cleft lip and palate (UCLP) in New Zealand. DESIGN A retrospective nationwide study. SETTINGS Virtual 3D orthodontic study models collected prior to undertaking secondary alveolar bone grafting. PARTICIPANTS A total of 104 patients with UCLP (L = 80: R = 24). OUTCOME MEASURES Four calibrated assessors used the GOSLON Yardstick and 100 mm Visual Analogue Scale (VAS) to score the randomised models on 2 separate assessment sessions. Weighted Kappa were used to determine the intra/inter-rater reliability for the GOSLON and correlations for the VAS. RESULTS Intra-rater reliability ranged from 0.57-0.88 (GOSLON) and 0.45-0.93 (VAS). Inter-rater reliability ranged from 0.62-0.86 (GOSLON) and 0.64-0.93 (VAS).GOSLON scores for the left UCLP were 31.2% for good/very good; 26.3% for fair; 42.5% for poor/very poor while the right UCLP scored 8.3% for good/very good; 37.5% for fair; 54.2% for poor/very poor. The mean VAS for left and right UCLP were 53.4 (sd 22.5) and 44.6 (sd 17.1) respectively. Neither the GOSLON nor VAS differences reached statistical significance (both P = .08). CONCLUSIONS From a clinical perspective right UCLP had worse dental arch relationship outcomes, however, these differences failed to reach statistical significance. Further studies using larger sample sizes are required to determine if cleft laterality is an important consideration when investigating UCLP dental arch outcomes.
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Affiliation(s)
- Peter V Fowler
- Department of Oral Sciences, University of Otago Dental School, Dunedin, New Zealand
| | - H Keall
- Formerly Hospital Dental Department, Middlemore Hospital, Auckland, New Zealand
| | - D Kennedy
- Hospital Dental Department, Middlemore Hospital, Auckland, New Zealand
| | - D Healey
- Formerly School of Dentistry, University of Queensland, Brisbane, Australia
| | - J M D Thompson
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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Fell M, Bradley D, Chadha A, Butterworth S, Davies A, Russell C, Richard B, Wren Y, Lewis S, Chong D. Sidedness in Unilateral Orofacial Clefts: A Systematic Scoping Review. Cleft Palate Craniofac J 2023:10556656231221027. [PMID: 38092732 DOI: 10.1177/10556656231221027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE An overview of the literature relating to the sidedness of unilateral cleft lip with or without cleft palate to map current knowledge on the cause and impact of directional asymmetry. DESIGN Scoping review with a systematic search of Medline and Embase from inception to May 2023. PATIENTS, PARTICIPANTS Humans born with a left or right unilateral cleft lip with or without a cleft palate. MAIN OUTCOME MEASURES Cleft sidedness as a co-occurrence, an outcome or an exposure. RESULTS Forty studies were eligible for inclusion and confirmed the predilection for the occurrence of left sided cleft lips; 12 studies reported cleft sidedness co-occurring with another phenotype, 11 studies report sidedness as an outcome and 17 studies as an exposure. Phenotypes which were reported to co-occur with either left or right sided clefts included congenital dental anomalies, handedness and additional congenital anomalies. Variables investigated as a potential cause of left or right sided clefts as an outcome included chromosomal anomalies, genetic variants and environmental factors. Outcomes investigated in relation to cleft sidedness as an exposure included facial anatomical features, facial growth, educational attainment, functional and psychological characteristics. More studies showed worse outcomes in right sided clefts versus left sided clefts than vice versa, although studies were inconsistent, and a quality assessment was not performed. CONCLUSIONS The field of cleft sidedness research is expanding and there are promising early findings to differentiate cause and outcome by sidedness of the cleft.
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Affiliation(s)
- Matthew Fell
- Spires Cleft Centre, John Radcliffe Hospital, Oxford, UK
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, UK
| | | | - Ambika Chadha
- Cleft.Net.East, University of Cambridge NHS Hospitals Trust, Cambridge, UK
- Department of Perinatal Imaging and Health, Kings College London & South Thames Cleft Service, St. Thomas Hospital, London, UK
| | - Sophie Butterworth
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Amy Davies
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, UK
| | - Craig Russell
- Cleft Care Scotland, Royal Hospital for Children, Queen Elizabeth University Hospital, Glasgow, UK
| | - Bruce Richard
- West Midlands Cleft Service, Birmingham Women and Children's Hospital, Birmingham, UK
| | - Yvonne Wren
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, UK
- Speech and language therapy research unit, North Bristol NHS Trust, Bristol, UK
| | - Sarah Lewis
- The Cleft Collective, Bristol Dental School, University of Bristol, UK
| | - David Chong
- Plastic and Maxillofacial Surgery, The Royal Children's Hospital, Melbourne, Australia
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Sándor-Bajusz KA, Dergez T, Molnár E, Hadzsiev K, Till Á, Zsigmond A, Vástyán A, Csábi G. Cognitive functioning and clinical characteristics of children with non-syndromic orofacial clefts: A case-control study. Front Psychol 2023; 14:1115304. [PMID: 36925595 PMCID: PMC10011643 DOI: 10.3389/fpsyg.2023.1115304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction The higher rate of neuropsychiatric disorders in individuals with non-syndromic orofacial clefts has been well documented by previous studies. Our goal was to identify children with non-syndromic orofacial clefts that are at risk for abnormal neurodevelopment by assessing their developmental history and present cognitive functioning. Materials and methods A single-center, case-controlled study was carried out at the Department of Pediatrics of the University of Pécs in Hungary. The study consisted of three phases including questionnaires to collect retrospective clinical data and psychometric tools to assess IQ and executive functioning. Results Forty children with non-syndromic oral clefts and 44 age-matched controls participated in the study. Apgar score at 5 min was lower for the cleft group, in addition to delays observed for potty-training and speech development. Psychiatric disorders were more common in the cleft group (15%) than in controls (4.5%), although not statistically significant with small effect size. The cleft group scored lower on the Continuous Performance Test. Subgroup analysis revealed significant associations between higher parental socio-economic status, academic, and cognitive performance in children with non-syndromic orofacial clefts. Analyzes additionally revealed significant associations between early speech and language interventions and higher scores on the Verbal Comprehension Index of the WISC-IV in these children. Discussion Children with non-syndromic orofacial clefts seem to be at risk for deficits involving the attention domain of the executive system. These children additionally present with difficulties that affect cognitive and speech development. Children with non-syndromic orofacial clefts show significant skill development and present with similar cognitive strengths as their peers. Longitudinal studies with larger sample sizes are needed to provide more conclusive evidence on cognitive deficits in children with non-syndromic orofacial clefts at risk for neurodevelopmental difficulties.
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Affiliation(s)
- Kinga Amália Sándor-Bajusz
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Medical School and Clinical Center, University of Pécs, Pécs, Hungary
| | - Tímea Dergez
- Institute of Bioanalysis, Medical School and Clinical Center, University of Pécs, Pécs, Hungary
| | - Edit Molnár
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Medical School and Clinical Center, University of Pécs, Pécs, Hungary
| | - Kinga Hadzsiev
- Department of Medical Genetics, Medical School and Clinical Center, University of Pécs, Pécs, Hungary
| | - Ágnes Till
- Department of Medical Genetics, Medical School and Clinical Center, University of Pécs, Pécs, Hungary
| | - Anna Zsigmond
- Department of Medical Genetics, Medical School and Clinical Center, University of Pécs, Pécs, Hungary
| | - Attila Vástyán
- Division of Pediatric Surgery, Department of Pediatrics, Medical School and Clinical Center, University of Pécs, Pécs, Hungary
| | - Györgyi Csábi
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Medical School and Clinical Center, University of Pécs, Pécs, Hungary
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Comparison of Presurgical Anthropometric Measures of Right and Left Complete Unilateral Cleft Lip and/or Palate. Plast Reconstr Surg 2022; 149:248e-253e. [PMID: 35077422 DOI: 10.1097/prs.0000000000008769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Left clefts occur twice as frequently as right ones. The sidedness has been suggested to influence certain outcomes. Some surgeons consider a right cleft more challenging to repair. This is often attributed to their reduced prevalence. The authors question whether this may be caused by morphologic differences. The authors' hypothesis is that there are anthropometric differences between left and right complete cleft lips. METHODS Patients with complete unilateral cleft lip, with or without cleft palate, operated on at the age of 3 to 6 months, between 2000 and 2018, by a single surgeon, were included. Eight standardized anthropometric measurements of the cleft lip, collected just before cleft lip repair, compare lip and vermillion dimensions and ratios between left and right clefts. RESULTS One hundred thirty-nine left and 80 right unilateral cleft lips were compared. A significant difference was found between left and right clefts for cleft-side to non-cleft-side ratios comparing the lateral lip element vertical heights and vermillion heights. CONCLUSIONS Patients with right cleft lips have a greater degree of lateral lip element hypoplasia, demonstrating greater deficiencies of lateral lip element vertical height and vermillion height when compared to patients with left clefts. This has clinical implications for preoperative assessment, choice of surgical technique, and postoperative and long-term outcomes.
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Grewal SS, Ponduri S, Leary SD, Wren Y, Thompson JMD, Ireland AJ, Ness AR, Sandy JR. Educational Attainment of Children Born with Unilateral Cleft Lip and Palate in the United Kingdom. Cleft Palate Craniofac J 2020; 58:587-596. [PMID: 32990032 PMCID: PMC8044616 DOI: 10.1177/1055665620959989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: This study evaluated association between functional outcomes in children born with unilateral cleft lip and palate (UCLP) and educational attainment. Design: Cleft Care UK (CCUK) was a United Kingdom (UK) wide cross-sectional study. Setting: UK Cleft Teams (data collected from all UK sites providing centralized cleft services). Patients, Participants: Five-year olds born with nonsyndromic UCLP (n = 268). Main Outcome Measure(s): National tests for educational attainment Key Stage 1 (KS1) undertaken by children at age 7 were linked to CCUK data to describe differences in educational attainment. Associations between functional outcomes and KS1 results were evaluated using regression analysis. We adjusted for birth month, gender, and an area-based measure of socioeconomic status. Results: Data were available for 205 children with UCLP. These children scored lower than national average (NA) scores across all subject areas, with a 0.62 lower score observed in the Average Point Score (APS; P = .01). There was association between being in a lower category for a cleft related outcomes and poorer KS1 results, with a trend for poorer attainment with higher numbers of poor functional outcomes. Those with 3 or more poor outcomes had a −2.26 (−3.55 to −0.97) lower APS compared to those with 0 to 1 poor outcomes. Conclusions: Children born with UCLP have poorer educational attainment at age 7 across all subject areas though differences were modest. Children with poor functional outcomes at age 5 had worse educational outcomes age 7. Improvements in functional outcomes could enhance educational outcomes.
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Affiliation(s)
- Sukhraj S Grewal
- 61139King's College London Dental Institute, London, United Kingdom
| | - Sirisha Ponduri
- Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, United Kingdom
| | - Sam D Leary
- NIHR Bristol Biomedical Research Centre Nutrition Theme, Level 3, 1980University Hospitals Bristol Education Centre, Bristol, United Kingdom
| | - Yvonne Wren
- Speech and Language, Bristol Dental School, 1980University of Bristol, Bristol, United Kingdom
| | - John M D Thompson
- Department of Obstetrics & Gynaecology, Faculty of Health Science and Medicine, 1415University of Auckland, Auckland, New Zealand
| | - Anthony J Ireland
- Orthodontics, Bristol Dental School, 1980University of Bristol, Bristol, United Kingdom
| | - Andy R Ness
- Epidemiology, NIHR Bristol Biomedical Research Centre Nutrition Theme, Level 3, 1980University Hospitals Bristol Education Centre, Bristol, United Kingdom
| | - Jonathan R Sandy
- Orthodontics, Bristol Dental School, 1980University of Bristol, Bristol, United Kingdom
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Kruse T, Mangold E, Braumann B. Impact of Maternal Smoking on Nonsyndromic Clefts: Sex-Specific Associations With Side and Laterality. Cleft Palate Craniofac J 2020; 58:181-188. [PMID: 32844678 DOI: 10.1177/1055665620951099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To compare the incidence of right-sided versus left-sided, and unilateral versus bilateral, nonsyndromic clefting in the affected offspring of smoking and nonsmoking mothers. DESIGN Self-report data on periconceptual and first trimester smoking behavior were collected from 842 mothers of children with nonsyndromic orofacial clefting. Differences in the incidence of left- versus right-sided clefts, and of unilateral versus bilateral clefts, were analyzed between the children of smoking and nonsmoking mothers. SETTING Interviews and clinical examinations took place at 8 specialist centers in Germany. PATIENTS AND PARTICIPANTS Children with nonsyndromic clefts were recruited during the course of surgical or orthodontic treatment, or within the context of the annual control consultation. Patients with cleft palate only or missing data were excluded. The final cohort comprised 842 patients (540 males and 302 females) with unilateral or bilateral clefts. The respective mothers were interviewed. MAIN OUTCOME MEASURE Side and laterality of nonsyndromic clefts were the main outcome measures. RESULTS Children of smoking mothers more often had right-sided clefts than children of nonsmoking mothers (42% right-sided clefts in children of smoking mothers vs 31% of nonsmoking mothers). Children of smoking mothers more often had bilateral clefts than children of nonsmoking mothers (35% bilateral clefts in children of smoking mothers vs 29% of nonsmoking mothers). Sex-specific analyses confirmed substantially and statistically significant associations only for girls. CONCLUSIONS The results suggest that maternal smoking is a sex-specific, exogenous determinant of laterality and side in nonsyndromic clefts.
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Affiliation(s)
- Teresa Kruse
- Department of Orthodontics, 14309University of Cologne, Cologne, Germany.,Center for Rare Diseases Cologne, 14309University of Cologne, Cologne, Germany
| | | | - Bert Braumann
- Department of Orthodontics, 14309University of Cologne, Cologne, Germany.,Center for Rare Diseases Cologne, 14309University of Cologne, Cologne, Germany
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Min JG, Khosla RK, Curtin C. Descriptive Overview of Primary Cleft Palate Surgeries in the Low- and Middle-Income Countries. Cleft Palate Craniofac J 2020; 57:984-989. [PMID: 32207319 DOI: 10.1177/1055665620911556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To increase access to high-quality and multiregional databases in global epidemiology of cleft surgeries through partnership with an NGO. DESIGN The study retrospectively analyzes 34 801 primary palate surgeries in 70+ countries from the 2016 electronic health records of an non-governmental organization (NGO). The study also utilizes the Kids' Inpatient Database to compare the epidemiology of primary cleft palate surgeries in the United States. PARTICIPANTS Patient records of those undergoing primary cleft palate surgeries only. MAIN OUTCOME MEASURES Region, age, sex, type of cleft, laterality of cleft. RESULTS Key findings show that average age of those receiving primary cleft palate surgery in the low- and middle-income countries (LMICs) was 1.95 years. The distribution of males and females receiving surgery corresponds to the US national data. More hard cleft palates were on the left side (66.18%) than the right side (33.82%), independent of gender and region. CONCLUSIONS Databases from an established NGO can be used to enhance our understanding of the disease characteristics in these regions. By increasing the information available regarding cleft surgeries in the LMIC, we hope to increase awareness of the similarities and differences in surgeries across various regions, as part of an effort to inform the goals set by Global Surgery 2030 initiative by the Lancet Commission.
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Affiliation(s)
- Jung Gi Min
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Rohit K Khosla
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Catherine Curtin
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Gil-da-Silva-Lopes V, Fontes M, dos Santos A, Appenzeller S, Fett-Conte A, Francisquetti M, Monlleó I. Syndromic Oral Clefts: Challenges of Genetic Assessment in Brazil and Suggestions to Improve Health Policies. Public Health Genomics 2019; 22:69-76. [DOI: 10.1159/000501973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/07/2019] [Indexed: 11/19/2022] Open
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Gallagher ER, Collett BR. Neurodevelopmental and Academic Outcomes in Children With Orofacial Clefts: A Systematic Review. Pediatrics 2019; 144:peds.2018-4027. [PMID: 31189616 DOI: 10.1542/peds.2018-4027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Children with orofacial clefts (OFCs) are reported to have worse neurodevelopmental outcomes than unaffected peers, although study methodologies and findings are highly variable and trends in outcomes by age remain unexplored. OBJECTIVE To examine the strength of the evidence and explore trends in neurodevelopment by age. DATA SOURCES A systematic review was conducted of studies published from January 1, 1980, through November 3, 2017. STUDY SELECTION Studies were independently screened by the authors and included in the review if they met predetermined eligibility criteria: (1) children and/or youth (<25 years) with OFCs were studied, and (2) neurodevelopmental or academic outcomes were included. DATA EXTRACTION The authors independently evaluated study quality and extracted outcome data. RESULTS Thirty-one studies involving 10 143 patients with OFCs and 2 017 360 controls met eligibility criteria. Although the quality of the studies varied, patients with OFCs consistently performed worse than their peers on neurodevelopmental and academic measures. In infancy, differences were observed on multiple developmental outcomes (eg, cognition, motor skills, and language), and in later childhood and adolescence, differences were manifest on several indicators of academic achievement (eg, use of special education services, grades, and scores on standardized measures). LIMITATIONS Heterogeneity in study designs, methods, and outcomes prevented statistical pooling and modeling for meta-analysis. CONCLUSIONS Children with OFCs exhibit neurodevelopmental and academic deficits compared with their unaffected peers. Although the nature of these deficits changes with development, differences are observed from infancy through adolescence. Clinicians should monitor neurodevelopment in children with OFCs and support them appropriately.
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Affiliation(s)
- Emily R Gallagher
- Seattle Children's Craniofacial Center and.,Division of Craniofacial Medicine, Department of Pediatrics.,University of Washington, Seattle, Washington; and.,Seattle Children's Research Institute, Seattle, Washington
| | - Brent R Collett
- Seattle Children's Craniofacial Center and.,University of Washington, Seattle, Washington; and.,Seattle Children's Research Institute, Seattle, Washington
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