The incidence of congenital anomalies associated with cleft palate/cleft lip and palate in neonates in the Konya region, Turkey

Congenital cardiac anomalies in non-syndromic cleft lip and cleft palate patients: A systematic review and meta-analysis

The aim was to establish a specific and definite connection between non-syndromic orofacial cleft patients and associated congenital heart disease (CHD). Following PRISMA guidelines, selective databases were searched for data collection. Studies showing a definite association of CHD with orofacial cleft were included, and studies non-specific of the association of orofacial cleft with CHD were excluded. Data extraction criteria were study design, frequency of CHD in overall non-syndromic orofacial cleft and in specific cleft type, and most prevalent congenital cardiac anomaly. DerSimonian Laird random effects model was used to estimate the pooled proportion of CHD, along with corresponding 95% confidence intervals (CIs) for each measure. Publication bias was assessed using Fail-Safe N analysis and the Rosenthel approach. Of a total of 182 articles searched, only 30 studies were assessed. The overall pooled estimate of the proportion of CHD in total cleft lips/palates was 16% (95% CI: 13-19). The odds of developing CHD in cleft palates was 4.08 times more as compared to cleft lips with 95% CIs of 3.86-4.33, and 1.65 more as compared to cleft lips and palates both with 95% CI of 1.52-1.68. We affirm the upsurging prevalence of CHD in non-syndromic cleft children and vehemently propose that it is of utmost importance to inculcate it in practice and policy-making to screen all non-syndromic orofacial cleft children for congenital cardiac anomaly. This study was registered on PROSPERO (ID no. CRD42023391597) on February 24, 2023.

Morphological Presentation of Orofacial Clefts: An Epidemiological Study of 5004 Patients in a Tertiary Care Hospital of Central India

To analyse the morphological presentation of orofacial clefts, gender, syndromes and systemic anomalies associated with them.

This was an epidemiological study performed in the patients who were registered for cleft lip and palate surgeries in our centre. The data was evaluated both retrospectively as well as prospectively.

The patients registered from November 2006 to April 2021 were studied. Out of 5276 patients, data of 5004 cases were analysed, rest 272 patients were excluded due to lack of information. Statistical analysis and Chi square test were applied.

Cleft deformities were more common in males than females. Cleft lip with palate was the commonest phenotype (52.2%). It was followed by isolated cleft lip (22.9%), isolated cleft palate (22.1%), rare clefts (1.62%) and syndromic clefts (1.18%). Unilateral variants were more frequent than bilateral. In unilateral, left side was more common than the right side. Among bilateral, most of the cases had premaxillary protrusion. In the present study, 3.46% of all the patients had associated anomalies affecting their other organs. Less common cleft phenotypes like microform cleft lip and submucous cleft palate ± bifid uvula showed frequency of 0.62% and 0.64% respectively.

Thorough examination of cleft deformity should be done as it may appear as an isolated deformity or part of a syndrome and have associated systemic anomalies. This may help us to deliver comprehensive care to the patients and can prevent potential operative complications.

An investigation into nutritional methods at the fifth day after birth of infants in association with cleft type and laterality

In patients with clefts, the affection of other congenital malformations on the feeding is unclear. We investigated the other congenital malformations and nutritional intake of neonates with cleft lip and/or palate and examined their relationships associated with cleft type and laterality. The participants included 126 infants under treatment with a presurgical naso-alveolar molding (PNAM) or a Hotz-type plate. The survey items were gender, cleft type and side, presence and nature of other congenital malformations, birth weight and nutritional method at age of the fifth day. The number of infants was 36 (28.6%) of cleft lip and alveolus, 82 (65.1%) of cleft lip and palate, and 8 (6.3%) of cleft palate only. Forty-three patients (34.1%) had other various congenital malformations. The nutritional method included oral intake in 78.6% (n = 99) of cases and tube feeding with/without oral intake in 21.4% (n = 27) of cases. The rate of tube feeding was higher for right-sided clefts than that for left-sided clefts. This observation was consistent with the fact that right-sided clefts were associated with more significant other congenital malformations than those on the left-side. The nutritional method for infants with cleft lip and/or palate was related to the presence of other congenital malformations, not to cleft laterality or oral cleft itself under early treatment with PNAM plate. These results proposed that screening the general condition is essential for neonates with right-sided cleft lip with/without cleft palate compared to left-sided clefts, which should be conducted immediately after birth for planning the appropriate nutritional method.

Dental anomalies in non-syndromic orofacial clefts: a clinical approach

Orofacial clefts (OC) represent some of the most common congenital malformations and affect multiple structures in the craniofacial region. There are a wide range of morphological OC types within the spectrum of both non-syndromic OC (NSOC) and syndromic OC, including cleft lip (CL); cleft lip and palate (CLP) and cleft palate (CP). Here, we describe the most frequent dental anomalies seen in the permanent dentition of individuals with NSOC, comparing them between the three main cleft types (CL, CLP, CP). We present these findings from the perspective of prevalence relating to each anomaly, as well as the clinical characteristics and potential impact in the rehabilitation process. The investigation of dental anomalies associated with NSOC is important, helping to expand the phenotypic characterization of NSOC, improve initial diagnostics and establish appropriate rehabilitation and counseling.

The characteristics and perioperative outcomes of children with orofacial clefts managed at an academic hospital in Johannesburg, South Africa

Background

Orofacial clefts (OFCs) are the commonest congenital anomalies of the head and neck. Their aetiology is multifactorial, and prevalence has a geographical variation. This study sought to describe OFC cases that presented for surgery.

Objectives

The study aimed to describe the preoperative characteristics, concomitant congenital anomalies and perioperative outcomes of children presenting for cleft repair surgery over a 5-year period at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).

Methods

A retrospective descriptive record review for children under the age of 14 years who presented for cleft repair surgery at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) during a 5-year period, from 1 January 2014 to 31 December 2018. Descriptive and comparative statistics were used to report the results.

Results

A total of 175 records were included in the study. The median (IQR) age was 11 (6—27) months, with a predominance of males 98 (56%). Most of the children had cleft lip and palate (CLP) 71(41%). The prevalence of concomitant congenital anomalies was 22%, emanating mostly from head and neck congenital anomalies. Nine syndromes were identified in 15 children with syndromic clefts. Twenty-nine percent of children were underweight for age. There were 25 anaesthetic related complications, commonly airway related. Six children with complex multiple congenital anomalies were admitted in the intensive care unit postoperatively. No mortalities were recorded.

Conclusion

Majority of children with orofacial clefts underwent cleft repair surgery without serious complications and intensive care unit admission. Only six children were diagnosed with significant anomalies needing intensive care management.

Are Dental Maturation, Skeletal Maturation, and Chronological Age Associated With Complete Cleft Lip and Palate?

OBJECTIVE

The relationship between dental and skeletal development levels was determined in individuals with cleft lip and palate and a control group comprising individuals without cleft lip and palate.

DESIGN

Retrospective, cross-sectional study.

SETTING

A university clinic specializing in orthodontic and pedodontic care.

PATIENTS

A total of 198 patients with cleft lip and palate (99 females, 11.66 ± 2.36 years; 99 males, 12.44 ± 2.33 years) and 198 patients without cleft lip and palate (99 females, 11.88 ± 2.26 years; 99 males, 12.99 ± 2.25 years).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

The Demirjian method and cervical vertebra maturation method were used to evaluate panoramic and lateral cephalometric radiographs, respectively. The Fishman maturation predictors were determined from hand-wrist radiographs.

RESULTS

Statistically significant correlations were found between the chronological age and the dental age in both the groups (P < .05). Significant correlations between skeletal maturation indicators and dental maturation indicators were observed in both groups and sexes (P < .05), with a stronger correlation among teeth with incomplete dental maturation. Dental age was found to be significantly lower (female, P = .001; male, P = .001) in individuals with cleft lip and palate (female, 11.71 ± 2.58 years; male, 12.51 ± 2.62 years) compared to those in the control group (female, 12.95 ± 2.47 years; male, 13.64 ± 2.37 years).

CONCLUSIONS

A high correlation between the results of the evaluated radiographic methods and chronological age supports their use for accurate age estimation in the patients with cleft lip and palate.

Parenting Stress in Turkish Mothers of Infants With Cleft Lip and/or Palate

Objective:

To explore parenting stress and factors affecting the mothers of infants with cleft lip and/or palate (CL/P) in Turkey.

Design and Participants:

The study compared mothers of infants born with CL/P (n = 90) with mothers of healthy infants (n = 90). Mothers completed the data collection form, the Parenting Stress Index-Short Form, and the Multidimensional Scale of Perceived Social Support.

Results:

Mothers of infants born with CL/P had higher mean parenting stress scores than the control mothers. A significant negative relationship was found between social support and parenting stress for mothers of infants born with CL/P but was not related for control mothers. Among mothers with an infant with CL/P, the mean parenting stress scores were higher for mothers preoperatively than mothers responding postoperatively. Among mothers with an infant with a cleft, higher stress was found for diagnosis after birth, not breastfeeding, feeding difficulties, lack of fathers’ support, perceived difficult infant temperament, blame, anger, and concern for the future.

Conclusion:

Parenting stress was higher and social support was lower for mothers of infants with a cleft. Treatment teams can design interventions aimed at factors related to stress, such as addressing feeding issues, teaching coping skills, and linking to social support.

The Prevalence of Cleft Lip and Palate Patients: A Single-Center Experience for 17 Years

Objective

The aim of the present study was to report the prevalence of cleft lip and palate (CLP), isolated cleft palate (CP), isolated cleft lip (CL), and median cleft (MC) applied in Marmara University School of Dentistry, Department of Orthodontics.

Methods

There were 1058 patients who applied to the center between 2000 and 2017. A total of 1026 patients were included in the study. Files, models, and photographs were evaluated. The patients were divided into six groups: unilateral right or left CLP, bilateral CLP, isolated CP, isolated CL, and MC. The prevalence was identified according to cleft type, side, gender, age, and application year.

Results

The most common type was unilateral CLP (44.3%), which was observed more on the left side (28.9%), followed by CP (28.7%). MC had a minimum ratio (0.3%) between cleft types. Males were more prone to have unilateral CLP (right side, 64.6%) and bilateral CLP (64.1%), whereas females were more prone to have CP (59.9%). The greatest number of applications was recorded in 2004, and the patients mostly applied in the neonatal period (64.9%). The ratios of complete cleft cases in all types of clefts were statistically significantly higher.

Conclusion

Unilateral CLP was the most common cleft type and seen more on the left side. While males were affected more by CLP, isolated CP was seen more in females than in males.

Cardiovascular abnormalities in patients with oral cleft: a clinical-electrocardiographic-echocardiographic study

OBJECTIVES

The present study aims to describe the clinical, electrocardiographic, and echocardiographic cardiological findings in a group of patients with oral clefts.

METHODS

This is a prospective cross-sectional study on 70 children (age range from 13 days to 19 years) with oral clefts who attended the multidisciplinary program of a university hospital from March 2013 to September 2014. The patients were evaluated by a pediatric cardiologist and underwent detailed anamnesis, physical examination, electrocardiogram, and echocardiogram.

RESULTS

Sixty percent of the patients were male; 55.7% presented with cleft lip and palate, and 40.0% presented with health complaints. Comorbidities were found in 44.3%. Relevant pregnancy, neonatal, family and personal antecedents were present in 55.7%, 27.1%, 67.2%, and 24.3% of the patients, respectively. Regarding the antecedents, 15.2% of the patients presented with a cardiac murmur, 49.0% with a familial risk of developing plurimetabolic syndrome, and 6% with family antecedents of rheumatic fever. Electrocardiographic evaluation showed one case of atrioventricular block. Echocardiograms were abnormal in 35.7% of the exams, including 5 cases of mitral valve prolapse - one of which was diagnosed with rheumatic heart disease.

CONCLUSION

The finding of a family risk of developing plurimetabolic syndrome and a diagnosis of rheumatic heart disease indicates that patients with oral clefts may be more prone to developing acquired heart disease. Thus, our findings highlight the importance of anamnesis and methodological triangulation (clinical-electrocardiographic-echocardiographic) in the investigation of patients with oral clefts and emphasize that cardiological follow-up to evaluate acquired and/or rhythm heart diseases is necessary. This strategy permits comorbidity prevention and individualized planned treatment.

Does the visibility of a congenital anomaly affect maternal-infant attachment levels?

PURPOSE

To determine whether congenital anomaly visibility affects maternal-infant attachment levels.

DESIGN AND METHODS

The study population consisted of mothers who had infants with cleft lip/palate or congenital heart anomalies who were receiving treatment in a university hospital. The data were collected using the Structured Questionnaire Form and the Maternal Attachment Inventory.

RESULTS

Statistically significant differences in maternal-infant attachment levels were observed between infants with cleft lips/palates and healthy infants and between infants with congenital heart anomalies and healthy infants.

PRACTICE IMPLICATIONS

It is important to apply appropriate nursing interventions for these mothers during the postpartum period.

Diagnostic implications of associated defects in patients with typical orofacial clefts

OBJECTIVES

To describe prevalence of associated defects and clinical-genetic characteristics of patients with typical orofacial clefts seen at a reference genetic service.

METHODS

Descriptive study conducted between September of 2009 and July of 2014. Two experienced dysmorphologists personally collected and coded clinical data using a validated, standard multicenter protocol. Syndromic cases were defined by the presence of four or more minor defects, one or more major defects, or recognition of a specific syndrome. Fisher's exact and Kruskal-Wallis tests were used for statistics.

RESULTS

Among 141 subjects, associated defects were found in 133 (93%), and 84 (59.5%) were assigned as syndromic. Cleft palate was statistically associated with a greater number of minor defects (p<0.0012) and syndromic assignment (p<0.001). Syndromic group was associated with low birth weight (p<0.04) and less access to surgical treatment (p<0.002). There was no statistical difference between syndromic and non-syndromic groups regarding gender (p<0.55), maternal age of 35 years and above (p<0.50), alcohol (p<0.50) and tobacco consumption (p<0.11), consanguinity (p<0.59), recurrence (p<0.08), average number of pregnancies (p<0.32), and offspring (p<0.35).

CONCLUSIONS

There is a lack of information on syndromic clefts. The classification system for phenotype assignment adopted in this study has facilitated recognition of high prevalence of associated defects and syndromic cases. This system may be a useful strategy to gather homogeneous samples, to elect appropriate technologies for etiologic and genotype-phenotype approaches, and to assist with multiprofessional care and genetic counseling.

The Impact of Congenital Cardiovascular Malformations on the Assessment and Surgical Management of Infants with Cleft Lip and/or Palate

Objective

The purpose of this study was to assess the cardiac evaluation of cleft lip and/or palate patients, characterize their cardiovascular malformations, and determine the impact of cardiovascular malformations on surgical management.

Design

A single-institution retrospective study of 329 consecutive cleft patients was performed. Cardiovascular malformations were categorized according to involvement of cardiac septa, vasculature, and valves. Their impact on the need for cardiac surgery, timing of cleft repair, need for subacute bacterial endocarditis (SBE) prophylaxis, and the perioperative experience was evaluated.

Results

Ten percent (33/329) of cleft patients had a cardiovascular malformation, and 3% underwent cardiac surgery prior to cleft repair. Malformations of the septa, vasculature, and valves were present in 9%, 6%, and 2% of cleft infants, respectively. Murmur as a sign of structural cardiovascular disease was 79% sensitive and 97% specific. Cleft palate repair was delayed by 2 months in patients with a cardiovascular malformation ( P = .001). Subacute bacterial endocarditis prophylaxis was recommended, not recommended, or not specified by cardiology in 18%, 33%, and 48% of cleft patients with a cardiovascular malformation, respectively. Postoperative stay and surgical complications were not associated with cardiovascular malformation.

Conclusions

Even in the absence of a murmur, echocardiographic screening should be considered in infants with nonspecific signs of cardiovascular disease. Greater awareness of the guidelines for SBE prophylaxis is needed. Most cleft patients with a cardiovascular malformation do not require cardiac surgery and do not experience an increased rate of complications associated with cleft surgery.

A survey of congenital heart disease and other organic malformations associated with different types of orofacial clefts in Eastern China

BACKGROUND

A high incidence of orofacial clefts is reported in China, but no data has shown the relation between cleft types and the incidence of other defects so far. The aim of this study is to assess the incidence of congenital heart diseases and other organic defects associated with different types of orofacial clefts.

METHODOLOGY AND PRINCIPAL FINDINGS

All children with orofacial clefts, which were sought out from the Health Information System of Shanghai Ninth People's Hospital between 1(st) Jan 2009 and 30(th) Dec 2011, were enrolled in this study. All subjects underwent a thorough examination and grouped by the cleft phenotype. The numbers and types of other organic defects were recorded and analyzed statistically using SPSS 17.0. Of 2180 cases reported as having orofacial clefts, 657 (30.1%) had other congenital abnormalities, which were significantly more common in cleft palate (47.9% (329/687)) than that in cleft lip (10.6% (80/755)) or cleft lip and palate (33.6% (248/738)) (P<0.01). In subgroups, unilateral cleft lip and palate had a statistically higher incidence of associated abnormalities than bilateral cleft lip and palate (P<0.01). The most common malformation was congenital heart disease, which counted 45.1% (296/657) of all malformations. Disorders of the central nervous system (14.3%(94/657)) and Skeletal anomalies (13.1%(86/657)) were also frequently associated. Additionally, the most common defect in heart was atrial septal defect, which was 39.7% (118/296) of all congenital heart diseases.

CONCLUSIONS AND SIGNIFICANCE

As the high incidence of heart defects and other organic abnormalities in the children with cleft palate in Eastern China, special attention should be paid to them and echocardiography should be a proposed examination in the evaluation of children with cleft palate before any surgical correction being executed.