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Alkharafi L, Mokhtar A, Burezq H, Almerjan D, Dashti G, Almutalaqem R, Alshammari A, Alhasawi S, Alqatami F, Geevarghese A. Seasonal, Geographic, and Ethnic Influence on the Prevalence of Orofacial Clefts in Kuwait: A Nationwide Study. Cleft Palate Craniofac J 2024; 61:1257-1265. [PMID: 36945783 DOI: 10.1177/10556656231163023] [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] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE Accurate nationwide epidemiological evidence is vital to study the seasonal, geographic, and ethnic influence on the trends of orofacial cleft prevalence in Kuwait. DESIGN Data obtained from the National Center for Health Information and Ministry of Health Hospital digital records were reviewed retrospectively to identify patients with orofacial clefts (OFC) using the ICD-10 diagnostic codes. The Jonckheere-Terpstra test was used to assess the trend of birth prevalence across the different years. The associations of types of OFC with ethnic and geographic influences were tested with chi-square or Fisher's exact tests, while the strength of that association was tested with multi-nominal logistic regression. RESULTS Birth prevalence in Kuwait ranged from 0.75-2.55 per 1000 live births (0.73- 2.73 among Kuwaitis, 0.60-3.27 among non-Kuwaitis), with no statistically significant change observed during the past 28 years. The risk of unilateral cleft lip and palate was eight times higher during summer compared to Autumn, while the risk of cleft lip and palate remained lower during winter. Jahra (OR-7.76, CI- 1.51-39.80), Farwaneya (OR-6.65, CI- 1.34-33.06), and Hawalli (OR-6.72, CI- 1.26-35.98) governorates had higher odds of bilateral cleft lip when compared to Mubarak Alkabeer. CONCLUSIONS The study outcome is an indicator to improve patient care and customize healthcare infrastructure in the Ministry of Health. It also provides insight to develop projections of future needs. Future studies should focus on understanding the factors that might be a potential contributor to the seasonal change observed in the prevalence of OFC.
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Affiliation(s)
| | - Ashraf Mokhtar
- Department of Orthodontics, Ministry of Health, Sulaibikhat, Kuwait
| | - Hisham Burezq
- Department of Plastic Surgery, Ministry of Health, Sulaibikhat, Kuwait
| | - Deemah Almerjan
- Department of Dentistry, Ministry of Health, Sulaibikhat, Kuwait
| | - Ghaidaa Dashti
- Department of Dentistry, Ministry of Health, Sulaibikhat, Kuwait
| | - Reem Almutalaqem
- Department of Dentistry, Ministry of Health, Sulaibikhat, Kuwait
| | | | - Saud Alhasawi
- Department of Orthodontics, Ministry of Health, Sulaibikhat, Kuwait
| | - Fawzi Alqatami
- Department of Orthodontics, Ministry of Health, Sulaibikhat, Kuwait
| | - Amrita Geevarghese
- Kuwait Institute for Medical Specializations, Ministry of Health, Sulaibikhat, Kuwait
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Rhodes IJ, Zhang A, Arbuiso S, Alston CC, Medina SJ, Liao M, Nthumba J, Chesang P, Hayden G, Rhodes WR, Otterburn DM. Cleft Lip and Palate Surgery at a Rural African Hospital: A 13-Year Experience From Western Kenya. J Craniofac Surg 2024; 35:1471-1474. [PMID: 38830020 DOI: 10.1097/scs.0000000000010341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Most studies on the treatment of cleft lip and palate (CLP) in low-income and middle-income countries have reported on the experience of urban centers or surgical mission trips to rural locations. There is a paucity of literature on the experience of local teams providing orofacial cleft surgery in rural Sub-Saharan Africa. This study reports the efficacy and cost-effectiveness of cleft surgery performed by an all-local team in rural Kenya. METHODS A retrospective chart review was performed on all patients who received CLP repair at Kapsowar Hospital between 2011 and 2023. Information regarding patient age, sex, cleft etiology, surgical management, and home location was retrieved. For the most recent year of study (2023), the authors performed a financial audit of all costs related to the performance of unilateral cleft lip surgery. Descriptive statistics were performed. RESULTS The authors identified 381 CLP surgeries performed on 311 patients (197 male, 63.3%). The most common etiology of the cleft was left unilateral (28.3%). The average age of primary lip repair decreased from 46.3 months in 2008 to 2009 to 20.2 months in 2022 to 2023 ( P <0.001). The average age of primary cleft palate repair decreased from 38.0 months in 2008 to 2009 to 25.3 months in 2022 to 2023 ( P <0.001). Patients traveled from 23 districts to receive treatment. Age of treatment was not different when distinguished by sex, county poverty level, or travel time from the hospital. The total costs associated with cleft lip repair was $201.6. CONCLUSIONS Adequately staffed hospitals in rural locations can meaningfully address a regional CLP backlog more cost-effectively than surgical mission trips.
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Affiliation(s)
- Isaiah J Rhodes
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Ashley Zhang
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Sophia Arbuiso
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Chase C Alston
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Samuel J Medina
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Matthew Liao
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | | | | | - Giles Hayden
- Division of Plastic Surgery, Kapsowar Hospital, Kapsowar, Kenya
| | | | - David M Otterburn
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
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Rhodes IJ, Alston CC, Zhang A, Arbuiso S, Medina SJ, Liao M, Ng JJ, Romeo D, Dahir S, Rhodes WR, Otterburn DM. The Pattern and Profile of Orofacial Clefts in Somaliland: A Review of 40 Consecutive Cleft Lip and Palate Surgical Camps. J Craniofac Surg 2024; 35:1407-1410. [PMID: 38838366 DOI: 10.1097/scs.0000000000010340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Somaliland is an autonomously run country that is not internationally recognized. As such, it has been largely excluded by global health development programs despite being the world's fourth poorest country. The purpose of this study was to provide the first known description of the pattern and clinical profile of patients with cleft lip and palate from this nation. METHODS The authors performed a retrospective chart review on all patients who received cleft lip and palate repair by a single surgeon in 40 separate surgical camps at Edna Adan University Hospital in Hargeisa, Somaliland, between 2011 and 2024. Information regarding patient age, sex, cleft etiology, surgical management, and home location was retrieved. Descriptive statistical analysis was performed. RESULTS A total of 767 patients (495 male, 64.5%) received 787 surgical procedures. The average age of primary surgery was 73.7 months. The most common chief complaint was left cleft lip with cleft palate (316, 41.2%). Males received primary surgery 19.2 months later than did females (73.7 and 54.6 mo, respectively, P <0.001). Patients residing in Hargeisa received their initial procedure an average of 17.8 months younger than those who lived elsewhere in Somaliland (62.9 and 80.7 mo, respectively, P =0.004). CONCLUSIONS In this severely economically depressed region, patients received treatment at ages that lagged far beyond recommended guidelines. Our finding of earlier treatment for females than males is rare in the literature and likely relates to cultural sex expectations. Patients from rural locations were especially vulnerable to receiving delayed treatment. Further efforts to decrease the burden of craniofacial deformities in Somaliland should be pursued in earnest.
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Affiliation(s)
- Isaiah J Rhodes
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Chase C Alston
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Ashley Zhang
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Sophia Arbuiso
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Samuel J Medina
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Matthew Liao
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Jinggang J Ng
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Dominic Romeo
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Shugri Dahir
- Division of Plastic Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - William R Rhodes
- Division of Plastic Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - David M Otterburn
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
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Mandal E, Filip C, Andersson MEM, Øgaard B. Eighteen-Year Follow-Up of 160 Consecutive Individuals Born With Unilateral Cleft Lip or Cleft Lip and Alveolus Treated by the Oslo Cleft Lip and Palate Team. Cleft Palate Craniofac J 2019; 56:853-859. [PMID: 30686058 DOI: 10.1177/1055665618820753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Describe patients born with unilateral cleft lip with or without cleft alveolus (CL±A) in relation to cleft severity and laterality, gender, associated anomalies and syndromes, number and type of lip- and nose operations, and time of alveolar bone graft (ABG) treatment in relation to dental status in cleft area. MATERIALS AND METHODS Patients included 220 children born with unilateral CL±A, born between 1988 and 1997 referred to the Oslo Cleft Lip and Palate Team. The data were collected retrospectively. All patients were followed up until 18 years of age. RESULTS Among all CL±A, 3.6% had recognized syndromes, 6.8% had associated anomalies, and in 89.6% CL±A was the only malformation. CL±A was more common, but not more severe, on the left side. Among the 160 individuals with CL±A without syndromes and associated anomalies, 66.9% had an isolated soft tissue CL, and 33.1% were diagnosed with a CL alveolus (CL+A). Male predominance was observed. Children with CL+A had more severe soft tissue clefts of the lip and underwent more lip and nose surgeries than children born with CL. The time of ABG was found to be at a younger age when the patient had a lateral incisor in the cleft area than when this tooth was missing. CONCLUSION Findings provide a reference for morphologic variations in CL±A, and insight into the surgical burden of care until the age of 18 years.
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Affiliation(s)
- Emeline Mandal
- 1 Department of Orthodontics, Faculty of Dentistry, University of Oslo, Norway
| | - Charles Filip
- 2 Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Bjørn Øgaard
- 1 Department of Orthodontics, Faculty of Dentistry, University of Oslo, Norway
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Middle ear findings and need for ventilation tubes among pediatric cleft lip and palate patients in northern Finland. J Craniomaxillofac Surg 2016; 44:460-4. [DOI: 10.1016/j.jcms.2016.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022] Open
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Lithovius RH, Lehtonen V, Autio TJ, Harila V, Anttonen V, Sándor GK, Ylikontiola LP. The association of cleft severity and cleft palate repair technique on hearing outcomes in children in northern Finland. J Craniomaxillofac Surg 2015; 43:1863-7. [PMID: 26421466 DOI: 10.1016/j.jcms.2015.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/29/2015] [Accepted: 08/18/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The consequences of cleft lip and palate include scaring, dental malformations, tooth misalignment, speech problems, and hearing loss. Otitis media with effusion causing hearing loss is a problem for many cleft palate patients. METHODS This study examines the association among cleft severity, palate repair technique, and hearing outcomes in children from northern Finland with clefts, aged 3-9 years. The study included 90 cleft patients who were treated at the Oulu University Hospital Cleft Lip and Palate Center between 1998 and 2011. The severity of the cleft, the surgical technique used to repair the palate, audiogram configuration data, and the need for ventilation tube placement were determined retrospectively from patient records. RESULTS Only 3.3% of cleft patients had an abnormal pure tone average hearing threshold representing abnormal hearing. Neither the surgical technique used to repair the cleft palate nor the severity of the cleft was a significant factor related to hearing loss or to the number of ventilation tubes required. Hearing improved significantly with increasing age over a span of 6 years. CONCLUSIONS Continuous follow-up with proactive placement of ventilation tubes before or at the time of palatoplasty results in hearing outcomes in cleft children that are similar to those reported in non-cleft children.
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Affiliation(s)
- Riitta H Lithovius
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Ville Lehtonen
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland; Department of Cariology, Paedodontics and Endodontology, University of Oulu, Oulu, Finland
| | - Timo J Autio
- Department of Otolaryngology, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Virpi Harila
- Department of Oral Development and Orthodontics, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Vuokko Anttonen
- Department of Cariology, Paedodontics and Endodontology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - George K Sándor
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland.
| | - Leena P Ylikontiola
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
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Aldhorae KA, Böhmer AC, Ludwig KU, Esmail AHA, Al-Hebshi NN, Lippke B, Gölz L, Nöthen MM, Daratsianos N, Knapp M, Jäger A, Mangold E. Nonsyndromic cleft lip with or without cleft palate in arab populations: Genetic analysis of 15 risk loci in a novel case-control sample recruited in Yemen. ACTA ACUST UNITED AC 2014; 100:307-13. [DOI: 10.1002/bdra.23221] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/17/2013] [Accepted: 01/13/2014] [Indexed: 12/16/2022]
Affiliation(s)
| | - Anne C. Böhmer
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Genomics Life and Brain Center; University of Bonn; Bonn Germany
| | - Kerstin U. Ludwig
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Genomics Life and Brain Center; University of Bonn; Bonn Germany
| | | | - Nezar Noor Al-Hebshi
- Molecular Research Laboratory Faculty of Medical Sciences; University of Science and Technology; Sana'a Yemen
| | - Bärbel Lippke
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Genomics Life and Brain Center; University of Bonn; Bonn Germany
| | - Lina Gölz
- Department of Orthodontics; University of Bonn; Bonn Germany
| | - Markus M. Nöthen
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Genomics Life and Brain Center; University of Bonn; Bonn Germany
| | | | - Michael Knapp
- Institute of Medical Biometry Informatics and Epidemiology; University of Bonn; Bonn Germany
| | - Andreas Jäger
- Department of Orthodontics; University of Bonn; Bonn Germany
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