Nascidos vivos com fissura de lábio e/ou palato: as contribuições da fonoaudiologia para o Sinasc

Orofacial clefts associated with cardiac anomalies

AIMS: Orofacial clefts (OFC) are a heterogeneous group of birth defects arising in about 1.7/1000 newborns. They can occur with other congenital anomalies, including heart defects. We aim to describe a population with orofacial clefts and associated cardiac anomalies.METHODS: Retrospective study of patients attended in the Cleft Lip and Palate Multidisciplinary Group outpatient clinic at Hospital Universitario São João, Porto-Portugal. Medical records from January 1992 through December 2018 were reviewed. Patients were divided into four groups according to the Spina classification: cleft lip (CL), cleft lip and palate (CLP), isolated cleft palate (CP) and atypical cleft (AC). Further categorization included gender, affected relatives, associated congenital anomalies and syndromes.RESULTS: From the 588 patients included, 77 (13%) presented cardiac anomalies. Of those with orofacial cleft and cardiac anomalies, 53% were males and 17% had known affected relatives. CP was the most common cleft among patients with cardiac anomaly (~56%). Additional congenital anomalies were found in 89.7% of patients, namely facial defects, central nervous system, renal and skeletal malformations. A recognizable syndrome was identified in 61.5%, being Pierre-Robin the most common (n=22), followed by 22q11.2 microdeletion (n=9). Both additional congenital anomalies and recognizable syndromes were significantly more prevalent in patients with heart disease (p<0.05). The main groups of cardiac anomalies were left-to-right shunt (n=47) and right ventricular outflow tract obstruction (n=14). From these, 26 had a ventricular septal defect, 15 atrial septal defect and seven patients had tetralogy of Fallot. Five patients had dysrhythmias.CONCLUSIONS: Due to the high prevalence of cardiac anomalies in the cleft population, a routine cardiac evaluation should be performed in all these patients.

Symptoms of dysphagia in children with cleft lip and/or palate pre- and post-surgical correction

PURPOSE

Determine the occurrence of dysphagia symptoms in children with cleft lip and/or palate (CLP) pre- and post-surgical correction.

METHODS

Quantitative observational cross-sectional study. Existence of clef lip and/or palate without association with other syndromes was the study inclusion and/or exclusion criterion. Parents and/or legal guardians responded to a recall questionnaire on the identification of occurrence of coughing, choking, vomiting, and nasal escape pre- and postoperatively and whether these symptoms disappeared after surgical correction. The study was approved by the Research Ethics Committee of the aforementioned Institution under protocol no. 1573164.

RESULTS

The sample comprised 23 children with mean age of 48 months, mostly male and with unilateral trans-foramen incisor clefts. Statistically significant difference was observed between the pre- and post-surgical periods regarding the presence of dysphagia symptoms.

CONCLUSION

Surgical treatment of patients with cleft lip and/or palate proved to be a resource to prevent the occurrence of dysphagia symptoms when associated with adequate intervention chronology.