An epidemiological study of orofacial clefts in Croatia 1988–1998

Oral flora and functional dysbiosis of cleft lip and palate patients: A scoping review

AIMS

This scoping review aimed to conduct an assessment of the current literature on specific ecological changes in the oral microbiota of individuals living with cleft lip and/or palate.

METHODS

All studies that assess oral microbiota and ecological changes distinct of individuals living with cleft lip and/or palate were included. Ovid MEDLINE and EMBASE databases were used, using planned search keywords. Included articles were grouped into cohort, cross-sectional, case-control, and retrospective reviews.

RESULTS

A total of 164 eligible title articles were recognized. Of these, 32 full-text studies were included in the present review. All the included articles were published between 1992 and 2022. These studies were two retrospective studies, two review studies, and the remaining (n = 28) were observational studies.

CONCLUSION

The oral flora of cleft lip and/or palate patients has been shown in scientific studies to have an increased frequency of potentially pathogenic fungal and bacterial colonization, particularly Candida species, Staphylococcus aureus, Lactobacili and Streptococci mutans. This may influence oral diseases and post-operative repair complications, potentially necessitating further surgical intervention.

Mothers' knowledge and experience concerning presurgical orthopedic management for infants with cleft lip and palate

OBJECTIVES:

The present study aimed to assess the level of mothers’ knowledge toward cleft lip and palate and their experience concerning presurgical orthopedic management.

MATERIALS AND METHODS:

This was a cross-sectional study where the mothers were invited to complete a self-administered validated and reliable questionnaire. The questionnaire included questions that aimed to assess mother's knowledge related to the most prevalent aspects of cleft lip and palate anomaly itself and additionally, questions associated with presurgical orthopedic treatment as an adjunct therapy. Descriptive statistics were used to define the characteristics of the study variables. Chi-square test was utilized to assess relationships between categorical variables.

RESULTS:

Totally, 145 mothers completed the survey (response rate was 73%). Forty-six (46%) of the mothers provided an incomplete or improper definition of the anomaly and 35 (24%) claimed that they know the cause of the anomaly. The majority of mothers did not identify family history as a risk factor; consanguinity was identified in 29% (n = 42). Of the total, 58 mothers (40%) agreed that dental management of CLP requires teamwork and the majority (n = 126, 87%) recognized the plastic surgeon as the most important specialist. Mothers aged 20-30 years old (n = 42, 53%), and those who are university graduates (n = 38, 48%), as well as employed mothers (n = 52, 66%) have in general a higher degree of knowledge regarding cleft lip and palate (P < 0.001). More than half of the mothers (n = 70, 57%) reported that presurgical orthopedic treatment was useful and needed for their infants.

CONCLUSIONS:

Most of the mothers reported a high level of knowledge about cleft lip and palate and they experienced the usefulness of the orthopedic appliances for their infants. However, there was uncertainty in some parts such as definition, diagnosis, causes, and risk factors for cleft lip and palate. Therefore, understanding the causes of cleft lip and palate, as well as comprehensive education concerning the essential role of the orthopedic appliances to improve cleft lip and palate are crucial for mothers to improve their infants’ quality of life.

Advantages of using toothpaste containing propolis and plant oils for gingivitis prevention and oral cavity hygiene in cleft lip/palate patients

BACKGROUND

The anti-inflammatory and antibacterial action of preparations used during oral hygiene procedures is particularly important in patients with oral cleft. Few reports have been published assessing the influence of natural products on the state of the oral cavity in patients with oral cleft. The aim of this study was to assess the effect of toothpaste containing Polish propolis and plant oils on oral cavity health in patients with oral cleft treated orthodontically.

MATERIALS AND METHODS

A total of 50 patients aged 9-16 years old (20 females, 23 males) were selected and randomly assigned into two groups. Group (A) received toothpaste with Polish propolis, tea tree oil, menthol, and rosemary oil. Group (B) received toothpaste without active ingredients (placebo). A baseline assessment was followed by an oral hygiene index (OHI, debris OHI-D, and calculus OHI-C component) and gingival bleeding index (GBI) after 35 days. The methodology of the oral condition assessment included the presence of cleft malformation as a dysmorphic of the anterior maxilla segment.

RESULTS

In group A, improvement in oral cavity hygiene assessed for incisors and molars was found (OHI-T p = 0.011). For the gingival condition, a decrease in the gingival bleeding index - total (GBI-T p = 0.002), as well as for the incisors (GBI-I p = 0.007) and molars (GBI-M p = 0.017) was found.

CONCLUSIONS

This research confirms the biological effectiveness of toothpaste with Polish propolis and plant oils. These results may be clinically useful for improving preventative oral care and for control of oral infectious diseases during orthodontic treatment in patients with oral cleft.

Development of a valid and reliable instrument for the assessment of quality of life in parents of children with clefts

PURPOSE

Orofacial clefts are the most common congenital malformations that affect craniofacial structures. Studies show that they have a major influence on psychological development of the patient, and on their families. A review of the literature showed a lack of specific questionnaires for children and their parents. This study investigated the impact of orofacial clefts in children on the quality of life of their parents. In addition, the results of the treatment and the quality of work of the health team members involved in this process were evaluated.

MATERIALS AND METHODS

For the purpose of this study, an original questionnaire was made to analyse the effect of orofacial clefts in children who had undergone surgery on the quality of life of 73 of their parents. The questionnaire consisted of 28 simple statements, which were evaluated with a 5-degree Likert scale (from 1-fully disagree to 5-fully agree), did not require any specific additional clarification, and were easy to complete.

RESULTS

Analysis of areas of the questionnaire that applied to the parents, resulted in two subscales, parental social health and child social health, which had satisfactory Cronbach's coefficients (0.907 and 0.897, respectively). However, some issues had a relatively poor coefficient of internal consistency, which justified their expulsion from the final model of the parent questionnaire.

CONCLUSION

The questionnaire developed for this study comprised two subscales concerned with the social health of parents/respondents and the social health of adolescents, as perceived by the parents. It was a valid and reliable instrument, and it showed satisfactory quality of life for parents of adolescents with clefts.

Associated Malformations in Children with Orofacial Clefts in Portugal: A 31-Year Study

Background:

Orofacial clefts are among the most common congenital craniofacial malformations and may be associated with other birth defects. However, the proportion and type of additional anomalies vary greatly between studies. This study assessed the prevalence and type of associated congenital malformations in children with orofacial clefts, who attended the largest cleft lip and palate tertiary referral center in Portugal.

Methods:

Consecutive children with orofacial clefts who attended at least 1 consultation in our Clefts Unit between 1981 and 2012 were studied. Demographic and clinical data regarding the number and type of associated malformations were retrospectively collected and analyzed.

Results:

Of the 701 patients studied, 219 (31.2%) had associated congenital malformations. These malformations were more frequent in children with cleft palate (43.4%) than in children with cleft lip and palate (27.5%) or with cleft lip only (19.4%). Within the group with associated anomalies, 73 cases (33.3%) had conditions related with known chromosomal defects, monogenic syndromes or sequences, and 146 cases (66.7%) had multiple congenital anomalies of unknown origin. From those, head and neck malformations were the most common (60.3%), followed by malformations in the cardiovascular (28.3%) and musculoskeletal systems (26%).

Conclusions:

The overall prevalence of associated malformations of nearly 1 in 3 children with orofacial clefts stressed the need for a comprehensive evaluation of these patients by a multidisciplinary cleft team. Moreover, one-third of the children had multiple congenital anomalies of known origins. Thus, early routine screening for other malformations and genetic counseling might be valuable for orofacial clefts management.

An Epidemiologic Study of Orofacial Clefts with Other Birth Defects in Victoria, Australia

Objective:

To describe the epidemiological characteristics of oral clefts occurring with other birth defects in Victoria, Australia.

Methods:

Information on infants and fetuses reported to the Victorian Birth Defects Register from 1983 to 2000 was collected. Birth defects were classified as Pierre Robin Sequence, chromosomal anomaly, nonchromosomal syndrome, single-system defect, or multiple-system defect. Pregnancy outcome and associations with selected infant and maternal features was examined.

Results:

One third of the 2022 oral clefts recorded had other birth defects. There were more overall cleft cases involving multiple systems and chromosomal anomalies than any other birth defect group. The prevalence ratio of cleft lip with or without cleft palate (CL/P) was highest among multiple-system defects and chromosomal anomalies. Perinatal mortality was high, with termination of pregnancy highest in CL/P and chromosomal anomalies and multiple-system defects. There was a nonsignificant excess of clefts among multiple births. Women ≥40 years old had a tendency toward having a child with a cleft palate and another birth defect. There was an increased likelihood that women born in the U.K. would have a baby with CL/P and another birth defect.

Conclusions:

This is among the first reports in Victoria, Australia, describing oral clefts and other birth defects and associations between infant and maternal factors. Although some findings confirmed other population-based studies, some continued to be at variance. Nonetheless, the data derived support examination of babies diagnosed with clefts for associated comorbidities.

Epidemiological Study of Orofacial Clefts among Population of Eastern Slovakia during the Period 1996-2013

BACKGROUND

Over the past 18 years, according to data from the Clinic of Plastic and Reconstructive Surgery, L. Pasteur University Hospital, there have been 493 cases of orofacial clefts (OC) reported in the area of Eastern Slovakia. The aim of this study was to map the occurrence of orofacial clefts reported in the area of Eastern Slovakia during the years 1996-2013. Also, we compared the occurrence of different types of clefts between the groups in relation to gender and ethnicity.

METHODS AND RESULTS

The statistical analysis shows relationship between variables of location and gender and gender differences in the occurrence of various types of clefts. Moreover, in comparison with another study which analyzed the years 1985-2000 (1.29/10(3) live births), there was an increase in the incidence (1.42/10(3) live births) of OC in Eastern Slovakia.

CONCLUSION

Our findings seem contradictive to similar studies which discuss ethnic differences in relation to OC. We recognize the relatively high occurrence of OC in Eastern Slovakia, and we link this phenomenon to several extrinsic factors, in particular socioeconomic status and embryotoxic factors.

Investigating Oral Microbiome Profiles in Children with Cleft Lip and Palate for Prognosis of Alveolar Bone Grafting

In this study, we sought to investigate the oral microbiota structure of children with cleft lip and palate (CLP) and explore the pre-operative oral bacterial composition related to the prognosis of alveolar bone grafting. In total, 28 patients (19 boys, 9 girls) with CLP who were scheduled to undergo alveolar bone grafting for the first time were recruited. According to the clinical examination of operative sites at the third month after the operation, the individuals were divided into a non-inflammation group (n = 15) and an inflammation group (n = 13). In all, 56 unstimulated saliva samples were collected before and after the operation. The v3-v4 hypervariable regions of the 16S rRNA gene were sequenced using an Illumina MiSeq sequencing platform. Based on the beta diversity of the operational taxonomic units (OTUs) in the inflammation and non-inflammation samples, the microbial variation in the oral cavity differed significantly between the two groups before and after the operation (P < 0.05). Analysis of the relative abundances of pre-operative OTUs revealed 26 OTUs with a relative abundance higher than 0.01%, reflecting a significant difference of the relative abundance between groups (P < 0.05). According to a principal component analysis of the pre-operative samples, the inflammation-related OTUs included Tannerella sp., Porphyromonas sp., Gemella sp., Moraxella sp., Prevotella nigrescens, and Prevotella intermedia, most of which were enriched in the inflammation group and showed a significant positive correlation. A cross-validated random forest model based on the 26 different OTUs before the operation was able to fit the post-operative status of grafted sites and yielded a good classification result. The sensitivity and specificity of this classified model were 76.9% and 86.7%, respectively. These findings show that the oral microbiota profile before alveolar bone grafting may be related to the risk of post-operative inflammation at grafted sites.

Cleft lip and palate and related factors: A 10 years study in university hospitalised patients at Mashhad--Iran

BACKGROUND

Oral-facial clefts including cleft lip and palate are the most common congenital malformations of the head and neck. Environmental factors such as maternal hormonal disorders, use of psychiatric medications, vitamin and folic acid deficiency, hypoxia, cigarette smoking and maternal obesity and overweight can affect the incidence of these disorders. In Iran, one of the associated problems is a lack of accurate statistics regarding the present status of the patients, which can cause a disturbance in the health programmes of Ministry of Health and Medical Education. The aim of this study was to report the status of 398 cases of cleft lip and palate in Sheikh and Imam Reza Hospitals of Mashhad over a 10-year period.

MATERIALS AND METHODS

This retrospective descriptive study was performed using data collection method and included the evaluation of the recorded files and completing the data forms. In this study, the file records of 398 patients referring to Mashhad Sheikh and Imam Reza (P.U.H) Hospitals were studied, from the beginning of 2002 to the end of 2011; the obtained data from the files were collected and classified.

RESULTS

The highest frequency was related to cleft palate alone (40.7%); frequencies were lower regarding the cleft lip and palate and cleft lip alone (34.41% and 24.87%, respectively). Approximately, half of the patients were from rural areas of the city and had articulation disorders. Most of the patients were the first-born children of the family and their parents were consanguineously married; about one-third of the patients had a family history of the disease.

CONCLUSION

According to the results of the present study, cleft lip is more frequent in males and cleft palate is more prevalent in females; the obtained results are consistent with the global statistics.

Risk factors involved in orofacial cleft predisposition - review

Clefts that occur in children are a special topic. Avoiding risk factors, and also an early diagnosis of cleft possibility can result in minimizing or avoiding them. If on the other hand when clefts occur they require a long-term, multistage specialized treatment. Etiology of clefts seems to be related to many factors. Factors such as genetic, environmental, geographic and even race factors are important. Identification of risk factors can lead to prevention and prophylactic behaviors in order to minimize its occurrence. Exposure to environmental factors at home and work that lead to cleft predisposition should not be disregarded. It seems that before planning a family it would be wise to consult with doctors of different specializations, especially in high-risk families with cleft history in order to analyze previous lifestyle. Clefts are very common in hereditary facial malformations and are causing a lot of other irregularities in the head and neck region. In this paper after a brief papers review authors present socio-geographic, environmental and also work place related factors that are influencing pregnant women condition and should be taken under serious consideration.

The Epidemiology of Cleft Lip and Palate in Canada, 1998 to 2007

OBJECTIVE

To examine the birth prevalence, gender distribution, and pattern of surgical intervention for clefts in Canada (1998 to 2007). Also to highlight the difficulties associated with studying the epidemiology of clefts using the current data collection mechanisms.

METHODS

Epidemiologic data acquired from the Canadian Institute for Health Information.

SETTING

Population-based study in Canada 1998 to 2007.

PATIENTS

All live births with an International Classification of Diseases (9th or 10th revision) diagnostic code for cleft palate or for cleft lip with or without cleft palate or with a surgical intervention code for repair of cleft lip or cleft palate.

MAIN OUTCOME MEASURES

Birth prevalence, gender distribution, and pattern of surgical intervention.

RESULTS

There were 3,015,325 live births in Canada (1998 to 2007). The mean birth prevalence was 0.82 per 1000 live births for cleft lip with or without cleft palate and 0.58 per 1000 live births for cleft palate. The birth prevalence of cleft lip with or without cleft palate was significantly higher in boys, with a stable boy to girl ratio of 1.75:1. Cleft palate was significantly greater in girls; however, the boy to girl ratio decreased from 0.97:1 in 1998 to 0.59:1 in 2007. The median age of repair in Canada from 1998 to 2007 was 4.7 months for cleft lip and 11.6 months for cleft palate. Thirty percent of patients underwent cleft palate repair after age 1.

CONCLUSION

The birth prevalence of cleft palate and cleft lip with or without cleft palate is stable in Canada. An increasing birth prevalence of cleft palate in girls is suggested. The timing of surgical intervention is consistent with current standards. The challenges associated with collecting these data in Canada are discussed.

A descriptive epidemiology study of cleft lip and palate in Northern Finland

OBJECTIVE

The aim of this study was to determine the incidence of cleft lip and/or cleft palate in a population uniquely from Northern Finland.

MATERIALS AND METHODS

The records of a total of 214 cleft patients treated between 1998-2011 at the Oulu Cleft Lip and Palate Center at the University of Oulu were assessed on a retrospective basis. Data regarding cleft type, sex and side of cleft was collected and analyzed. Family history of clefting was investigated.

RESULTS

Cleft palate (68.7%) was most frequently found, followed by cleft lip and palate (18.7%) and cleft lip with or without alveolus (12.6%). Cleft palate occurred more frequently in females (63.3%) and cleft lip and palate was more frequently found in males (62.5%). The left side was more frequently affected in both male and female patients. Left-sided clefts were observed in 82% of patients compared to right-sided clefts in 18%. A family history of clefting was detected in 20.1% of patients.

CONCLUSION

The incidence of clefts in Northern Finland is higher than the corresponding incidence in other European countries. Cleft palate was the most frequent cleft type and it was more frequent in females. In males, cleft lip and palate was more frequent. The left side was more frequently affected in both genders. One fifth of the patients had a family history of clefts.

Incidence of Cleft Lip and Palate in the Palestinian Territories: A Retrospective Study from the Makassed Hospital Neonatal Unit

Background

Cleft lip, with or without cleft palate (CL±P), is the most common craniofacial anomaly in newborns. The incidence of CL±P varies among different ethnic populations and is presumed to be higher in developing countries. In the Middle East, the incidence has variably been reported as 0.3 to 2.19 per 1000 live births and is generally regarded as similar to Caucasians. There is currently no literature reporting the incidence of clefting in Palestinians living in the territories. Reports from Palestinian populations in Israel and Jordan infer an incidence of 1.39 per 1000 live births. However, the reported incidence in stable populations may not reflect the actual incidence of clefting in the territories.

Methods

This is a retrospective study examining all newborn records at Makassed Maternity Hospital in Jerusalem between January 1,1986, and December 12, 1995. Data were collected by the senior author (A.D.) and interpreted by coauthors. Frequencies were established based on the number of isolated and nonisolated CL±P born during this time period.

Results

During the 10-year period from January 1, 1986, to December 12, 1995, there were 33,239 live births. Among these births, there were 35 isolated and nonisolated combined CL±P born (1.05/1000 live births).

Conclusions

Based on this limited data set from a single, tertiary referral hospital, we conclude that the prevalence rate of CL±P among a Palestinian population may be less than that reported in surrounding areas. However, more broadly based studies using nationalized birth registries are required to determine an accurate prevalence rate of CL±P among Palestinians.

Clefts of the secondary palate referred to the Oslo Cleft Team: epidemiology and cleft severity in 994 individuals

OBJECTIVE

To describe Norwegian individuals born with cleft of the secondary palate (CP) in relation to cleft severity, Pierre Robin sequence, associated anomalies, syndromes, and hypodontia and to present estimated longitudinal prevalences.

PATIENTS

Nine hundred ninety-four individuals with CP born between 1960 and 2002 referred to the Oslo Cleft Team (OCT).

METHOD

Data were collected retrospectively from the archives of the OCT.

RESULTS

Among all CP, 7.6% had recognized syndromes, 30.5% had associated anomalies, and in 61.9%, CP was the only malformation. Pierre Robin sequence was recorded in 11.7%. Female predominance was observed both in general and in each cleft severity subgroup. Of 610 individuals with CP, only 25.1% were diagnosed with a submucous cleft palate, 45.9% had a cleft of the soft palate only, and in 29%, the cleft extended into the hard palate. Among 309 individuals over the age of 10 years with CP only, hypodontia was found in 28.5%, and in individuals with Pierre Robin sequence, hypodontia was found in 44.1%. During the period 1965 to 1999, the estimated prevalence of individuals with CP in the OCT uptake area was found to be 0.59 per 1000 live births. The estimated prevalence increased slightly over time, both overall and within the cleft severity subgroups.

CONCLUSION

A large proportion of a Norwegian population with CP had syndrome or additional anomalies. The estimated prevalence of CP in this population increased slightly during the observation period.

Influence of propolis on hygiene, gingival condition, and oral microflora in patients with cleft lip and palate treated with fixed orthodontic appliances

The aim of this study was to evaluate the influence of 3% ethanol extract of propolis (EEP) on hygiene, gingival and microbiological status of oral cavity in patients with cleft lip and palate treated with fixed orthodontic appliances. The study included forty-one nonsyndromic complete unilateral of bilateral cleft lip and palate subjects with fixed appliance on at least 10 teeth. Twenty-one subjects were instructed to brush their teeth three times a day using toothpaste with propolis. Control group included twenty subjects who were asked to brush their teeth three times a day using a toothpaste without propolis. API, OPI, GI, and supragingival bacterial plaque were taken from each subject twice: baseline and after using the toothpaste for 35 days. The final examinations showed statistically significant decrease in OPI, GI, and the percentage of the Actinomyces spp. and Capnocytophaga spp. compared with baseline in propolis group subjects. The improvement in oral health in these patients confirms antibacterial, anti-inflammatory, and regenerative properties of propolis.

Anatomical Variations in Clefts of the Lip with or without Cleft Palate

Objective. Few orofacial cleft (OFC) studies have examined the severity of clefts of the lip or palate. This study examined associations between the severity of cleft of the lip with cleft type, laterality, and sex in four regional British Isles cleft registers whilst also looking for regional variations. Design. Retrospective analysis of cleft classification in the data contained in these four cleft registers. Sample. Three thousand and twelve patients from cleft registers based in Scotland, East England, Merseyside, and Belfast were sourced from the period 2002-2010. Submucous clefts and syndromic clefts were included whilst stillbirths, abortuses, and atypical orofacial clefts were excluded. Results. A cleft of the lip in CLP patients is more likely to be complete in males. A cleft of the lip in isolated CL patients is more likely to be complete in females. Variation in the proportion of cleft types was evident between Scotland and East England. Conclusions. Association between severity of cleft of the lip and sex was found in this study with females having a significantly greater proportion of more severe clefts of the lip (CL) and CLP males being more severe (P < 0.0003). This finding supports a fundamental difference between cleft aetiology between CL and CLP.

An Epidemiologic Study of Orofacial Clefts in Hamedan City, Iran: A 15-Year Study

Objective

To determine the epidemiology of cleft lip and/or palate (CL/P) in births in hospitals of Hamedan City, Iran, and to evaluate the etiologic factors that have a role in the development of these anomalies.

Design

This research was a 15-year cross-sectional study (1993 to 2008).

Participants

All infants born with CL/P during the study period comprised the study group. One thousand healthy children without cleft anomalies born in the same hospitals during the study period comprised the control group.

Results

The prevalence of CL/P was 1.016 per 1000 live births (53.4% boys and 46.6% girls). Cleft lip associated with cleft palate (CLP) was the most common type of anomaly (53.5%), followed by isolated cleft lip (CL; 28.7%) and isolated cleft palate (CP; 17.8%). Eighty-six babies (81%) had unilateral CL and 20 babies (19%) had bilateral CL. Twenty-three newborns with CL/P (17.8%) had other congenital deformities. The frequency of CL/P in parents, siblings, and relatives of newborns in study group was higher than in the control group. There was a significant difference between the study and control groups with respect to maternal drug intake, trauma, smoking, and x-ray exposure during pregnancy.

Conclusion

The birth prevalence of CL/P in Hamedan City was closer to the prevalence of CL/P in the United States and Europe than Africa and the Far East. We found that the presence of cleft in parents, siblings, and other relatives; maternal drug intake; trauma; radiation; and smoking were risk factors for cleft development in newborns.

Ten Years Recording Common Oral Clefts with a New Descriptive System

Objective

After introducing a new descriptive recording system for congenital craniofacial abnormalities in The Netherlands, common oral clefts are highlighted.

Design

Prospective observational study.

Setting

Fifteen cleft palate teams, united in the Dutch Association for Cleft Palate and Craniofacial Anomalies, registered patients from 1997 to 2006.

Patients

All unoperated patients with a common oral cleft were included.

Main Outcome Measures

Detailed information and birth prevalence rates of cleft lip/alveolus, cleft lip/alveolus and palate, and cleft palate were provided, relating referral age, gender, family history, additional congenital abnormalities, and syndrome diagnoses to these three categories.

Results

This study included 3512 patients, resulting in an overall prevalence of 16.6 per 10,000 live births. Patients showed a cleft lip/alveolus (28%), a cleft lip/alveolus and palate (39%), or a cleft palate (33%). The three categories exhibited very heterogeneous cleft types. Mean referral age was 5.8 months (median 3 weeks). Birth weight was the lowest in cleft palate patients (3238 g; p < .001 to .009). Cleft palate patients showed less positive family history concerning congenital anomalies (23%, p < .001 to .013), but more syndrome diagnoses were established in this category (24%, p < .001). Ten percent of all cleft patients showed additional abnormalities of the head and neck area, and 13% displayed congenital anomalies of other systems.

Conclusions

This new recording method allows adequate description of common oral clefts. Many cleft types exist within these three categories and should be differentiated, because they originate from different time frames and/or cell biological mechanisms during embryogenesis.

Perfil epidemiológico dos portadores de fissuras orofaciais atendidos em um Centro de Referência do Nordeste do Brasil

OBJETIVOS: descrever a frequência dos tipos de lesão dos portadores de fissura lábio-palatina, verificar a associação entre os fatores demográficos com essas lesões e identificar os fatores associados à idade em que foi realizado o primeiro atendimento médico especializado. MÉTODOS: este é um estudo do tipo série de casos, com 1216 crianças <10 anos portadoras de fissura labial e/ou palatina não sindrômica atendidas no Centro de Atenção aos Defeitos da Face do Instituto de Medicina Integral Professor Fernando Figueira no período de janeiro de 2002 a dezembro de 2005. Os dados foram obtidos de um banco de dados secundário desse Centro. RESULTADOS: observou-se um discreto predomínio do sexo masculino (57,4%) e uma maior procedência do Recife/Região Metropolitana. Cerca de metade da amostra (48,9%) encontrava-se no grupo etário >24 meses quando realizou o primeiro atendimento médico especializado. As crianças cujo primeiro atendimento especializado ocorreu antes dos 12 meses de vida procederam com maior frequência do Agreste e Sertão. Das crianças portadoras de fissura submucosa, 55% só foram atendidas após os cinco anos de idade. CONCLUSÕES: observou-se que os dados obtidos estão de acordo com os da literatura, no aspecto geral das fissuras. Necessita-se que os profissionais de saúde sejam melhor preparados para atender e diagnosticar as fissuras lábio-palatinas.

Rotation-transposition correction of nasal deformity in Tessier number 1 and 2 clefts

OBJECTIVE

To formulate a standardized procedure for repair of the nasal component of Tessier number 1 and 2 clefts.

PATIENTS AND METHODS

The procedure was performed from 1998 to 2007 in 13 patients with congenital nasal clefts of different degrees of expression corresponding to Tessier 1 and 2. The patients' ages ranged from 3 months to 28 years. There were 10 male and three female patients. In the absence of any standard published technique for these rare defects, we devised our own method, which we find uniformly applicable to all such cases. We use a composite muco-chondro-cutaneous lateral alar flap to recreate the alar rim. The resulting defect on the lateral nasal wall is then covered with a transposition flap from the dorsum. An alar rim z-plasty was added in cases where notching was evident.

RESULTS

In all cases, no problem of flap viability was encountered and all healed well with minimal scarring. The postoperative results were satisfactory and have remained stable over an average 6-month follow-up period.

CONCLUSIONS

We recommend this technique to be used for the correction of nasal deformity associated with Tessier clefts number 1 and 2. We feel that this technique is relatively simple and easily reproducible.

[Cleft lip and palate: indications for radiological postnatal explorations]

AIM

We evaluated the utility of systematic neonatal radiological explorations in 20 instances of isolated cleft lip and palate in 20 cases.

METHODS

This study included 13 infants with prenatal ultrasound diagnosis. The type of cleft and possible associated anomalies were noted. A systematic chromosomal test was done. In 7 cases, the cleft lip was noted at birth. Postnatal outcome was obtained and a clinical examination and radiological explorations were carried out.

RESULTS

For the cases with prenatal diagnosis, the chromosomal test was normal in 11 cases and we noted associated anomalies in three cases. For the cases with neonatal diagnosis, the chromosomal test was normal in 6 cases and 1 infant had associated anomalies.

CONCLUSIONS

The biological and radiological explorations can be numerous. In our study, the systematic neonatal radiological explorations did not find more elements compared with neonatal clinical examinations. The high risk of having a chromosomal anomaly in children with cleft lip requires systematic prenatal chromosomal exploration.

Birth prevalence of cleft lip and palate in Northern Ireland (1981 to 2000)

OBJECTIVE

The prevalence of cleft lip and/or palate (CL/P) in Northern Ireland (NI) was last reported for 1980 through 1990. This study was undertaken to update the prevalence of CL/P in NI for the 20-year period 1981 to 2000, to determine the pattern of prevalence, and to report the proportion of different cleft types and sex distribution.

DESIGN

Retrospective, population-based analysis.

PATIENTS/PARTICIPANTS

All live born children with CL/P in NI from 1981 to 2000 were included. A total of 750 cases were identified. Resident births outside NI, stillbirths, abortuses, and children born with atypical orofacial clefts were excluded. Those with syndromes and submucous clefts were included in the study.

RESULTS

The overall prevalence of children born with CL/P within NI for the period 1981 to 2000 was 1.47 per 1000 live births, or 1:682. This was consistent with the findings reported by other U.K. studies. There were no significant changes in the prevalence rates over any 5-year period. No significant seasonality trends were noted. Clefts of the palate only were always in the majority. More boys than girls were affected by cleft lip with or without cleft palate. There was a significant left-sided predilection for unilateral clefting of the lip.

CONCLUSIONS

There have been no significant changes in the birth prevalence of children born with CL/P or the distribution or laterality of cleft type in the NI population during the past 20 years.

Prevalence of nonsyndromic oral clefts in a reference hospital in the state of Minas Gerais, Brazil, between 2000-2005

The aim of the present study was to analyze the prevalence of nonsyndromic oral clefts in children receiving treatment at the Center for the Rehabilitation of Craniofacial Anomalies, José do Rosário Vellano University, Alfenas, MG, Brazil. All the data for the epidemiological study was retrieved from the files of 126 pediatric patients with oral clefts without any additional malformation, who came to the center for treatment between 2000 and 2005. A predominance of clefts was observed in Caucasians, and the ratio of male to female was 1.3. Males were 2.57 times more affected by cleft lip and palate (CLP) than females. CLP with a prevalence of 39.68% and isolated cleft lip (CL) with a prevalence of 38.09% were the most common anomalies, followed by isolated cleft palate (CP; 22.23%). Complete and unilateral CLP (26.19%) presented the highest prevalence, followed by incomplete and unilateral CL (23.81%). The present study presents the experience of a reference hospital in the state of Minas Gerais; however, the real prevalence of oral clefts in Brazil is still unknown. Our findings differ from those of a few previous Brazilian reports because they suggest similar prevalences of CLP and CL, and a higher prevalence of CLP in Caucasian males.

Epidemiology of cleft palate alone and cleft palate with accompanying defects

The epidemiology of cleft palate with multiple defects is often thought to be different from that of cleft palate alone, but there are few empirical data on this question. We explored this in a population-based data set created by combining data from two sources: the 1.8 million live births recorded from 1967 to 1998 in the Norwegian Birth Registry, and the two Norwegian surgical centers that repair cleft palate. Accompanying defects were identified from either source. Stratified analysis and logistic regression were used to assess relative risks by covariates. Of 1,431 babies with cleft palate, 31 % had another birth defect recorded by one or both sources. Prevalence of isolated cleft palate was steady over time, while cleft palate with other defects increased substantially. Girls had a higher risk of isolated cleft palate (relative risk 1.4; 95% confidence interval, 1.2-1.6) but not of cleft palate accompanied by other defects (1.1; 0.88-1.3). Older parents and parents who were first cousins had no increased risk of isolated cleft palate, but were twice as likely as others to have a baby with cleft palate accompanied by other defects. Risk factors differ between cases of cleft palate with and without accompanying defects.