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Beaumont C, Bellerive A, Julien AS, Leclerc JE. Occlusal Outcomes in Non-Robin Sequence Patients with Isolated Cleft Palate. Cleft Palate Craniofac J 2024:10556656241236078. [PMID: 38389267 DOI: 10.1177/10556656241236078] [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: 02/24/2024] Open
Abstract
OBJECTIVES 1. To assess the skeletal class occlusion and lateral cephalometry in children with isolated cleft palates (non-Robin sequence) and 2. to identify associations between these findings and pre-palatoplasty cleft palate measurements. STUDY DESIGN Retrospective cohort study. SETTING North American Institutional Tertiary Paediatric Center. PATIENTS Our cleft database was reviewed, and patients were included if they had an isolated cleft palate without a Robin Sequence diagnosis, had a Furlow palatoplasty and had available per operative cleft palate measurements and available lateral cephalogram between 6 and 8 years old. Thirty-two patients matched to inclusion criteria. INTERVENTION Furlow's Palatoplasty. MAIN OUTCOME AND MEASURES Cleft size at palatoplasty, cephalometric measurements and skeletal occlusal classes were analysed. ANOVA was used to test the association between cephalometric measurements and occlusal classes. Results are presented as means with a 95% confidence interval. The association between cleft measurements and cephalometric parameters was tested with Spearman Correlation (rs). RESULTS The skeletal occlusal outcome at 7 years old for this series of patients was: Class I: 19%; Class II: 59% and Class III: 22%. No single cleft measurement at palatoplasty was predictive of the skeletal occlusal outcome. A larger hard palate cleft was associated with a shorter antero-posterior maxilla. CONCLUSIONS The skeletal occlusal class outcomes were similar to those found in a previous study in the literature. The occlusal prognosis appears to be better than in patients with Robin Sequence or with an associated cleft lip. No preoperative measurement was found to be associated with the occlusal outcome.
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Affiliation(s)
- Catherine Beaumont
- Department of Otolaryngology - Head and Neck Surgery, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | | | - Anne-Sophie Julien
- Department of Mathematics and Statistic, Pavillon Alexandre-Vachon, Université Laval, Quebec City, QC, Canada
| | - Jacques E Leclerc
- Department of Otolaryngology-Head and Neck Surgery, Centre hospitalier universitaire de Québec - Université Laval, Quebec City, QC, Canada
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Huang RS, Mihalache A, Wong Riff KWY. Cleft lip and/or palate mortality trends in the USA: a retrospective population-based study. BMJ Paediatr Open 2024; 8:e002305. [PMID: 38242631 PMCID: PMC10806517 DOI: 10.1136/bmjpo-2023-002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Cleft lip and/or palate (CL/P) is one of the most common congenital anomalies worldwide. Although CL/P management may require a series of interventions, mortality resulting from CL/P alone is rare. This study aims to examine recent trends of CL/P mortality rates in the USA. METHODS A retrospective population-based study was conducted using official US birth and death certificate data from the Centers for Disease Control and Prevention from 2000 to 2019. Annual mortality rates per 1000 births with CL/P were calculated across sex and racial groups. Multivariable logistic regression models estimated the effects of sex and race on the risk of mortality with CL/P, and linear regression models were used to examine temporal changes in mortality rate across sex and race. RESULTS From 2000 to 2019, 1119 deaths occurred in patients with documented CL/P, for an overall incidence of 20.3 deaths per 1000 births with CL/P (95% CI 18.9 to 22.8). Of these, Patau syndrome was the listed cause of death in 167 cases (14.9%). Black individuals (OR 1.93, 95% CI 1.85 to 2.01), Hispanic (1.54, 1.49 to 1.58) and American Indian individuals (1.28, 1.20 to 1.35) were at a greater risk of CL/P mortality compared with white individuals. Additionally, females were also at a greater risk (1.35, 1.21 to 1.49). A significant upward trend in CL/P mortality was observed in Hispanic (r2=0.70, p<0.01) and American Indian individuals (r2=0.81, p<0.01) from 2000 to 2019. CONCLUSIONS Cleft birth and mortality surveillance is essential in healthcare and prevention planning. Future studies are required to understand the differences in CL/P mortality rates across various sociodemographic groups.
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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Mihalache
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen W Y Wong Riff
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
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Malic CC, Lam M, Donelle J, Richard L, Vigod S, Benchimol EI. The burden of psychiatric disorders associated with orofacial cleft pathology among children in Ontario, Canada. J Plast Reconstr Aesthet Surg 2023; 84:422-431. [PMID: 37406373 DOI: 10.1016/j.bjps.2023.06.019] [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] [Received: 01/26/2021] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Individuals with orofacial cleft (OFC) may be at a higher risk of developing psychiatric disorders (PD) than the general population. We determined the risk of psychiatric diagnoses in children with OFC in Canada. METHODS This population-based retrospective cohort study used health administrative data from the province of Ontario, Canada. Children with OFC who were born between April 1, 1994, and March 31, 2017, in Ontario were matched to five non-OFC children based on sex, date of birth, and mother's age. We determined the rate of events and time-to-event for first diagnosis of PD in children aged ≥ 3 years (y), and for intellectual developmental delay (IDD) from birth. Risk factors for PD and IDD were assessed using 1-way ANOVA for means, Kruskal-Wallis for medians, and the χ2 test for categorical variables. OUTCOMES There were 3051 children with OFC (matched to 15,255 controls), of whom 2515 patients with OFC (12,575 controls) had a complete follow-up to the third birthday. Children with OFC were more likely to have PD than controls (54.90 vs. 43.28 per 1000 patient-years, P < .001), with a mean age to first diagnosis of 8.6 ± 4.2 y. The cleft palate group had the highest risk (HR 1.33, 95% CI 1.18-1.49). Children with OFC also had a higher risk of IDD than non-OFC children (27.78 vs. 3.46 per 1000 patient-years, p < .001). INTERPRETATION Children born with OFC in Ontario had a higher risk of psychiatric diagnosis and IDD compared to controls. Further research is also required to better understand the predictors of variation in risk, including geographic location and the presence of congenital abnormalities, and identify potential areas for intervention. EVIDENCE RATING SCALE FOR PROGNOSTIC/RISK STUDIES Level II.
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Affiliation(s)
- Claudia C Malic
- Department of Surgery, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada.
| | | | - Jessy Donelle
- ICES uOttawa, The Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Simone Vigod
- Division of Equity, Gender and Population, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Canada; ICES, Toronto, Ontario, Canada
| | - Eric I Benchimol
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada; ICES, Toronto, Canada
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4
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Abdul Mohsen M, El Husseiny Saafan AM, El-Basiouny MS, ElTagy GH, ElBarbary MAM, Ragab M, Emara D. Evaluating the Effect of Low Power Diode Laser 806 nm on the Healing of Unilateral Cleft Lip Scar: An Open-Label Comparative Study. Cleft Palate Craniofac J 2023; 60:21-26. [PMID: 34786978 DOI: 10.1177/10556656211053536] [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: 12/16/2022] Open
Abstract
OBJECTIVE To investigate the effect of laser bio-modulation irradiation therapy on the scar after surgical correction of unilateral cleft lip. DESIGN a comparative, open-label study. SETTING we conducted the study in a university based tertiary hospital that recruited early wound healers of unilateral cleft lip correction. PATIENTS Eighty patients were divided into two groups: In study's group, patients undergo laser bio-modulation irradiation (n = 60); in the control group, patients were followed-up without intervention (n = 20). INTERVENTION In the study's group, patients underwent low-power diode Laser with wavelength of 806 nm and power of 100 mw. MAIN OUTCOME The change in the scar of cleft lip patients, which was assessed by clinical examination and ultrasound. RESULTS The median pigmentation score was significantly lower in the laser group (median = 1; IQR = 1-2) than the control group (median 2; IQR 1-3), with p-value of <0.001. Likewise, the median height score was significantly lower in the laser group (median = 1; IQR = 1-1) than the control group (median 1.5; IQR 1.5-2), with p-value of 0.001. The median pliability score was significantly lower in the laser group (median = 1; IQR = 1-1) than the control group (median 2.5; IQR 1-3), with p-value of <0.001. Finally, the median vascularity score was significantly lower in the laser group (median = 1; IQR = 1-1) than the control group (median 1.5; IQR 1-2), with p-value of <0.001. CONCLUSION laser bio-modulation irradiation therapy demonstrates a potential efficacy in managing the hypertrophic scars after surgical repair of unilateral cleft lip.
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Affiliation(s)
| | | | - Mahmoud S El-Basiouny
- General and Plastic Surgery in 531223National Institute of Laser Enhanced Science, 63526Cairo University, Cairo, Egypt
| | - Gamal Hassan ElTagy
- General Surgery Departement, Pediatric Surgery Unit, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | | | - Moutaz Ragab
- General Surgery Departement, Pediatric Surgery Unit, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Dawlat Emara
- Plastic Surgery Department, Faculty of Medicine, 63526Cairo University, Cairo, Egypt
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Ponton E, Courtemanche R, Singh TK, Duffy D, Courtemanche DJ, Loock C. Assessing the Social Determinants of Health and Adverse Childhood Experiences in Patients Attending a Children's Hospital Cleft Palate-Craniofacial Program. Cleft Palate Craniofac J 2021; 59:1482-1489. [PMID: 34730452 PMCID: PMC9585543 DOI: 10.1177/10556656211048742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aimed to describe the social determinants of health (SDoH) for patients receiving multidisciplinary team care in a Cleft Palate-Craniofacial program, develop responsive and consistent processes to include trauma-informed psychosocial histories, promote discussions about additional "non-medical" factors influencing health and surgical outcomes, and demonstrate that these activities are feasible in the context of multidisciplinary patient-provider interactions. Single-site, cross-sectional study using a questionnaire. Participants were recruited from a provincial quaternary care Cleft Palate-Craniofacial program at British Columbia Children's Hospital in Vancouver, BC, Canada. 290 families completed the questionnaire. 34% of families experience significant barriers to accessing primary health care, 51% struggle financially, and 11% scored four or more on the Adverse Childhood Experiences scale. Furthermore, 47% reported not having adequate social support in their lives, and 5% reported not feeling resilient at the time of the survey. Patients with cleft and craniofacial anomalies have complex needs that extend beyond the surgical and medical care they receive. It is critical that all Cleft and Craniofacial teams incorporate social histories into their clinic workflow and be responsive to these additional needs. Discussions surrounding SDoH and adversity are welcomed by families; being involved in the care and decision-making plans is highly valued. Healthcare providers can and should ask about SDoH and advocate for universal access to responsive, site-based, social work support for their patients.
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Affiliation(s)
- Ethan Ponton
- Office of Pediatric Surgical Evaluation and Innovation, 12358British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopaedics, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca Courtemanche
- Department of Surgery, 8166University of British Columbia, Vancouver, British Columbia, Canada.,Division of Plastic Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Tanjot K Singh
- Department of Pediatrics, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Damian Duffy
- Office of Pediatric Surgical Evaluation and Innovation, 12358British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatric Surgery, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas J Courtemanche
- Department of Surgery, 8166University of British Columbia, Vancouver, British Columbia, Canada.,Division of Plastic Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Christine Loock
- Department of Pediatrics, 8166University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatrics, 37210British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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Impact of Parental Consanguinity on the Frequency of Orofacial Clefts in Jordan. J Craniofac Surg 2021; 33:e203-e206. [PMID: 34669683 DOI: 10.1097/scs.0000000000008294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Orofacial clefts (OFCs) are the most common craniofacial congenital anomalies, and its prevalence is highest among Asian populations. The aim of this retrospective case-control study is to evaluate the effect of parental consanguinity on the frequency of OFCs at Jordan University Hospital over a 15-year-period. The study group consists of all patients with OFCs presented to the major tertiary referral center in Jordan during the last 15 years, along with age and gender-matched controls. The authors analyzed the risk of different predictors, including consanguinity, on the development of OFCs, both cleft lip with or without cleft palate (CL/P) and cleft palate only. A total of 332 participants were included in this study, with a mean age of 74.36 (±48.75) months. The authors included 129 (38.9%) OFCs, and 203 (61.1%) controls. The percentage of parental consanguinity among OFCs group was 41.1%, compared to only 24.1% for controls, a difference that was statistically significant (P = 0.001). On logistic regression analysis, the authors found that parental consanguinity is a significant predictor for the occurrence of OFCs (P = 0.007), where people with consanguineous marriage have 2 times higher risk (odds ratio of 0.504, with 95% confidence interval 0.306-0.830) to have offspring with OFCs. Moreover, lower birth weight babies are also significantly more associated with OFCs (P = 0.014), with an odds ratio of 1.819 (95% confidence interval 1.131 2.926). Among the Jordanian population, the authors found that consanguinity and lower birth weight were the only variables significantly associated with the development of OFCs.
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Global prevalence of cleft palate, cleft lip and cleft palate and lip: A comprehensive systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:110-120. [PMID: 34033944 DOI: 10.1016/j.jormas.2021.05.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Birth defect is widely used as a term for congenital anomalies. Children with cleft lip and palate may have serious speech, hearing, nutrition, and mental and social development disorders; therefore, this study was designed to determine the overall prevalence of cleft palate, lip, and cleft palate through systematic review and meta-analysis. METHODS In this study, systematic review and meta-analysis of data from studies on the prevalence of cleft lip and palate in Scopus, Embase, Magiran, Web of Science (WoS), PubMed and Science Direct databases were extracted between January 2000 and June 2020. In order to perform the analysis of qualified studies, the model of random effects was used and the inconsistency of studies with I2 index was investigated. Data analysis was performed with Comprehensive Meta-Analysis software (Version 2). RESULTS According to the results of the present study on cleft palate, the total number of samples entered in the study in 59 studies were 21,088,517 individuals, the prevalence of cleft palate based on the meta-analysis of the reviewed studies in every 1000 live births was obtained 0.33 (95% CI: 0.28-0.38). In the case of cleft lip, the total number of samples entered in the 57 reviewed studies were 17,907,569 individuals. The prevalence of cleft lip obtained based on the meta-analysis of the reviewed studies was 0.3 in every 1000 live births (95% CI: 0.26-0.34), and in the case of cleft lip and palate, the total number of samples entered in the 55 reviewed studies was 17,894,673. The prevalence of cleft lip and palate based on the meta-analysis of the studies reviewed in each 1000 live births was 0.45 (95% CI: 0.38-0.52). CONCLUSION Due to the high prevalence of oral clefts such as cleft palate, cleft lip, and cleft lip and palate; health system policymakers need to take precautionary measures to reduce the number of patients, as well as diagnostic and therapeutic measures to reduce the effects of this disorder in children.
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James O, Adekunle AA, Adamson OO, Agbogidi OF, Adeyemo WL, Butali A, Ladeinde AL, Ogunlewe MO. Management of Orofacial Cleft in Nigeria - A Retrospective Study. Ann Maxillofac Surg 2020; 10:434-438. [PMID: 33708591 PMCID: PMC7943976 DOI: 10.4103/ams.ams_104_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Orofacial clefts (OFCs) are among the most common craniofacial developmental abnormalities worldwide and a significant cause of childhood morbidity and mortality. This study aimed to identify patterns of patient presentation, treatment approaches, and changes in our overall cleft care service between 2007 and 2019. Methods and Methodology A retrospective review of patients managed at a tertiary health facility in Nigeria of all OFC cases operated between 2007 and 2019 was done using the postintervention data retrieved from the Smile Train database. Data of all OFC cases operated within the period were analyzed using the Statistical Package for the Social Sciences. Descriptive statistics were performed using the Statistical Package for the Social Sciences version 20.0. Results A total number of 740 OFC surgeries were performed in 565 patients, consisting of 269 females (48.2%) and 289 males (51.8%). The majority (63%) of the patients presented before the age of 2 years. Thirty-seven percent presented with cleft lip and alveolus, 27.1% with cleft palate only, and 36.7% with cleft lip, alveolus, and palate. Primary cleft lip repair was the most performed surgery (n = 320, 43.2%), the mean age at repair was 2.1 years. Since 2017, additional services such as speech therapy, mixed dentition orthodontics, and nutritional support were added to services provided to our cleft patients. Fifteen patients have undergone speech assessment and three have completed speech treatment. Eight patients have undergone mixed dentition stage orthodontic treatment. Discussion Our services have evolved from simply providing surgical care to comprehensive care with a multidisciplinary team approach and provision of a wide range of services including nutritional counseling, pediatric care, orthodontic services, and speech therapy. We believe these will improve the overall well-being of our patients while we continue to improve on services based on clinical research outcomes.
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Affiliation(s)
- Olutayo James
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Adegbayi Adeola Adekunle
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Olawale Olatubosun Adamson
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Olushola Failat Agbogidi
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, University of Iowa, Iowa City, IA, USA
| | - Akinola L Ladeinde
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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Almeida MSC, Lacerda RHW, Leal KB, Figueiredo CHMDC, Santiago BM, Vieira AR. Analysis of permanent second molar development in children born with cleft lip and palate. J Appl Oral Sci 2020; 28:e20190628. [PMID: 32520078 PMCID: PMC7299560 DOI: 10.1590/1678-7757-2019-0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/21/2020] [Accepted: 04/04/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The study of dental development in individuals born with cleft lip and palate (CLP) serves to determine when orthodontic intervention should start. To evaluate the permanent second molar development in children born with cleft lip and palate according to Demirjian's and Nolla's methods. METHODOLOGY Out of a total of 513 digital panoramic radiographs, 113 pairs of children aged 3 to 16 years were selected. The exams were from children born with or without cleft lip and palate, of the same sex, with an age difference of up to 30 days. The images were analyzed by three examiners and reliability was checked through intra-examiner agreement by the Kappa test. The data were analyzed by Wilcoxon's and Mann-Whitney tests according to each dataset. RESULTS The findings indicated delayed development of the permanent second molars in children with CLP (P<0.001). The development of the right permanent second molar was delayed compared to the left molar in children with CLP. Moreover, mandibular teeth showed significantly earlier development than maxillary teeth in both the case and control groups. There was no significant difference in the development of permanent second molars between sexes. CONCLUSION Children with CLP presented delay in the development of permanent second molars.
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Affiliation(s)
| | | | | | | | | | - Alexandre Rezende Vieira
- Universidade Federal da Paraíba , João Pessoa , Paraíba , Brasil
- University of Pittsburgh , Pittsburgh , Pennsylvania , United States of America
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Malic CC, Lam M, Donelle J, Richard L, Vigod SN, Benchimol EI. Incidence, Risk Factors, and Mortality Associated With Orofacial Cleft Among Children in Ontario, Canada. JAMA Netw Open 2020; 3:e1921036. [PMID: 32049294 DOI: 10.1001/jamanetworkopen.2019.21036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Orofacial cleft (OFC) is one of the most common congenital malformations, with a wide variation in incidence worldwide. However, population-based studies on the incidence of OFC in North America are lacking. OBJECTIVES To examine the incidence of OFC in Ontario, Canada, and to compare risk factors and mortality associated with children with OFC vs children without OFC. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used health administrative data from the province of Ontario, Canada. Children with OFC who were born from April 1, 1994, to March 31, 2017, in Ontario were each matched to 5 children without OFC based on sex, date of birth (±30 days), and mother's age (±5 years). Analyses were conducted from September 2018 to January 2019. EXPOSURES Children born with OFC. MAIN OUTCOMES AND MEASURES Incidence of OFC over time and regional variation. Risk factors for OFC were assessed using 1-way analysis of variance for means, Kruskal-Wallis for medians, and χ2 tests for categorical variables. Adjusted Cox regression models were used to assess mortality. RESULTS From 1994 to 2017, 3262 children were born with OFC in Ontario, Canada, and they were matched to 15 222 children born without OFC. Incidence of OFC in Ontario was 1.12 cases per 1000 live births, with wide geographic variation and a lower incidence from 2004 to 2017 compared with 1994 to 2003 (1.02 vs 1.13 cases per 1000 live births; P = .002), especially for the subgroup with cleft palate (0.52 vs 0.44 cases per 1000 live births; P = .006). Children with OFC, compared with children without OFC, were more likely to be born prematurely (406 children [13.3%] vs 1086 children [7.1%]; P < .001; standardized difference, 0.21) and had lower mean (SD) birth weight (3215.3 [687.6] g vs 3382.6 [580.0] g; P < .001; standardized difference, 0.26). The mortality rate among children with OFC was higher than among matched children without OFC (hazard ratio, 10.60; 95% CI, 7.79-14.44; P < .001). When mortality was adjusted for the presence of congenital or chromosomal anomalies, the risk of death was not significantly different between children with OFC and those without OFC (hazard ratio, 1.35; 95% CI, 0.73-2.72). CONCLUSIONS AND RELEVANCE These findings suggest that incidence of OFC In Ontario, Canada, decreased from 1994 to 2017. Mortality in children with OFC was high, especially in the first 2 years of life, and was predominantly associated with the presence of other congenital or chromosomal anomalies. Further research is required to better understand the causes of wide geographical variations of OFC incidence and improve the survival of these patients.
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Affiliation(s)
- Claudia C Malic
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Jessy Donelle
- ICES uOttawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Simone N Vigod
- Division of Equity, Gender and Population, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's Mental Health Research, Women's College Hospital and Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Eric I Benchimol
- ICES uOttawa, Ottawa, Ontario, Canada
- Department of Pediatrics, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Health Information Technology Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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Surgical, Speech, and Audiologic Outcomes in Patients With Orofacial Cleft and Van der Woude Syndrome. J Craniofac Surg 2019; 30:1484-1487. [PMID: 31299749 DOI: 10.1097/scs.0000000000005590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the surgical, speech, and audiologic outcomes in patients with Van der Woude syndrome (VWS) and compare them to patients with nonsyndromic cleft palate with or without cleft lip (NS-CP ± L) treated at the same institution. DESIGN Retrospective chart review. SETTING A single children's hospital at a major academic institution. PATIENTS The records of 18 patients with VWS who had been treated at a single institution from 1989 to 2017 have been retrospectively examined. Thirty-eight patients with NS-CP ± L who were also treated at the same institution during that same time frame were selected to closely match sex and date of birth. MAIN OUTCOME MEASURES Demographic, clinical, surgical, and speech pathology data were gathered from medical charts. RESULT By age 4, 88% of subjects with VWS and 76% of subjects with NS-CP ± L (P = 0.732) had been, or were actively involved in, speech therapy. By age 10, 100% of remaining subjects with VWS and 58% of remaining subjects with NS-CP ± L remained involved in speech therapy (P = 0.027).About 33% of patients with VWS and 16% of patients with NS-CP ± L had a secondary procedure for velopharyngeal dysfunction (VPD) (P = 0.171). CONCLUSION The VWS group had more than twice the rate of secondary procedures for VPD repair, and a higher rate of continuing involvement for speech therapy at age 10. No differences were found in the rate of participation in speech therapy at or by age 4.
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Flowers H, Bérubé D, Ebrahimipour M, Perrier MF, Moloci S, Skoretz S. Swallowing behaviours and feeding environment in relation to communication development from early infancy to 6 years of age: a scoping review protocol. BMJ Open 2019; 9:e028850. [PMID: 31427327 PMCID: PMC6701691 DOI: 10.1136/bmjopen-2018-028850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Understanding the influences of early swallowing function and feeding environment on the development of communication will enhance prevention and intervention initiatives for young children. This scoping review will help elucidate key elements affecting the developmental trajectory of communicative systems, typically robust and well-developed by formal school entry. We aim to (1) map the current state of the literature in a growing field of interest that has the potential to advance knowledge translation, (2) identify existing gaps and (3) provide research direction for future investigations surrounding feeding-swallowing functions and environment that support or forestall communication development in young children. METHODS AND ANALYSIS We are proposing a scoping review to identify the breadth and depth of the existing literature regarding swallowing-feeding functions and environment relative to the onset and progression of communicative behaviours from infancy to 6 (<6;0) years of age. Our protocol delineates rigorous methods according to Arskey and O'Malley's framework and includes elaborations by Levac and colleagues. We will search the literature based on 10 databases, 17 peer-reviewed journals, 4 conference proceedings and 6 grey literature sources. Two authors will independently screen abstracts and review full articles, remaining blind to each other's results. A third author will contribute to resolving any discrepant results from both the abstract and article review. Subsequently, we will extract data and chart information from accepted articles using a pre-established data collection form. We will stratify results according to healthy versus impaired swallowing-feeding functions and communication development. ETHICS AND DISSEMINATION Our scoping review does not require ethical approval. We will disseminate our final study results through international and national conference presentations, publication in a peer-reviewed journal and knowledge translation activities with stakeholders.
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Affiliation(s)
- Heather Flowers
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Institut du savoir - A Knowledge Institute, Montfort Hospital, Ottawa, Ontario, Canada
| | - Daniel Bérubé
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Mona Ebrahimipour
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- In-patient Rehabilitation, Elisabeth-Bruyere Hospital, Ottawa, Ontario, Canada
| | - Marie-France Perrier
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- In-patient Rehabilitation, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sarah Moloci
- In-patient Medical Units, Hopital Montfort, Ottawa, Ontario, Canada
| | - Stacey Skoretz
- School of Audiology and Speech Sciences, The University of British Columbia, Vancouver, Ontario, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Ontario, Canada
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SOUSA GFTD, RONCALLI AG. Orofacial clefts in Brazil and surgical rehabilitation under the Brazilian National Health System. Braz Oral Res 2017; 31:e23. [DOI: 10.1590/1807-3107bor-2017.vol31.0023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 02/24/2017] [Indexed: 11/22/2022] Open
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Wu D, Mandal S, Choi A, Anderson A, Prochazkova M, Perry H, Gil-Da-Silva-Lopes VL, Lao R, Wan E, Tang PLF, Kwok PY, Klein O, Zhuan B, Slavotinek AM. DLX4 is associated with orofacial clefting and abnormal jaw development. Hum Mol Genet 2015; 24:4340-52. [PMID: 25954033 DOI: 10.1093/hmg/ddv167] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/05/2015] [Indexed: 01/10/2023] Open
Abstract
Cleft lip and/or palate (CL/P) are common structural birth defects in humans. We used exome sequencing to study a patient with bilateral CL/P and identified a single nucleotide deletion in the patient and her similarly affected son—c.546_546delG, predicting p.Gln183Argfs*57 in the Distal-less 4 (DLX4) gene. The sequence variant was absent from databases, predicted to be deleterious and was verified by Sanger sequencing. In mammals, there are three Dlx homeobox clusters with closely located gene pairs (Dlx1/Dlx2, Dlx3/Dlx4, Dlx5/Dlx6). In situ hybridization showed that Dlx4 was expressed in the mesenchyme of the murine palatal shelves at E12.5, prior to palate closure. Wild-type human DLX4, but not mutant DLX4_c.546delG, could activate two murine Dlx conserved regulatory elements, implying that the mutation caused haploinsufficiency. We showed that reduced DLX4 expression after short interfering RNA treatment in a human cell line resulted in significant up-regulation of DLX3, DLX5 and DLX6, with reduced expression of DLX2 and significant up-regulation of BMP4, although the increased BMP4 expression was demonstrated only in HeLa cells. We used antisense morpholino oligonucleotides to target the orthologous Danio rerio gene, dlx4b, and found reduced cranial size and abnormal cartilaginous elements. We sequenced DLX4 in 155 patients with non-syndromic CL/P and CP, but observed no sequence variants. From the published literature, Dlx1/Dlx2 double homozygous null mice and Dlx5 homozygous null mice both have clefts of the secondary palate. This first finding of a DLX4 mutation in a family with CL/P establishes DLX4 as a potential cause of human clefts.
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Affiliation(s)
- Di Wu
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Shyamali Mandal
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Alex Choi
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, USA
| | - August Anderson
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Michaela Prochazkova
- Division of Craniofacial Anomalies, Department of Orofacial Sciences, University of California, San Francisco, San Francisco, CA, USA, Laboratory of Transgenic Models of Diseases, Institute of Molecular Genetics of the ASCR, v. v.i., Prague, Czech Republic, Program in Craniofacial Biology, University of California, San Francisco, San Francisco, CA 94114, USA
| | - Hazel Perry
- Division of Craniofacial Anomalies, Department of Orofacial Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Richard Lao
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, USA and
| | - Eunice Wan
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, USA and
| | - Paul Ling-Fung Tang
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, USA and
| | - Pui-yan Kwok
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, USA and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Ophir Klein
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, USA, Division of Craniofacial Anomalies, Department of Orofacial Sciences, University of California, San Francisco, San Francisco, CA, USA, Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA, Program in Craniofacial Biology, University of California, San Francisco, San Francisco, CA 94114, USA
| | - Bian Zhuan
- Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, China
| | - Anne M Slavotinek
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, USA, Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA,
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Loozen CS, Maarse W, Manten GTR, Pistorius L, Breugem CC. The accuracy of prenatal ultrasound in determining the type of orofacial cleft. Prenat Diagn 2015; 35:652-5. [DOI: 10.1002/pd.4582] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/14/2015] [Accepted: 02/17/2015] [Indexed: 11/12/2022]
Affiliation(s)
- C. S. Loozen
- Division of pediatric plastic surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - W. Maarse
- Division of pediatric plastic surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - G. T. R. Manten
- Department of Obstetrics and Gynecology; University Medical Center Utrecht; Utrecht The Netherlands
| | - L. Pistorius
- Department of Obstetrics and Gynecology; University Medical Center Utrecht; Utrecht The Netherlands
| | - C. C. Breugem
- Division of pediatric plastic surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
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Mooney MP, Cooper GM, Marazita ML. Cleft Palate-Craniofacial Journal 50th anniversary editorial board commentary: anatomy, basic sciences, and genetics--then and now. Cleft Palate Craniofac J 2014; 51:253-6. [PMID: 24617328 DOI: 10.1597/14-022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To celebrate the 50th year of the Cleft Palate-Craniofacial Journal we look back to where we started in 1964 and where we are now, and we speculate about directions for the future in a "Then and Now" editorial series. This editorial examines changing trends and perspectives in anatomical, basic science, and genetic studies published in this 50-year interval. In volume 1 there were 45 total papers, seven (16%) of which were peer-reviewed basic science and genetic articles published: four in anatomy, three in craniofacial biology, and none in genetics. In contrast, in volume 50, of 113 articles there were 47 (42%) peer-reviewed basic science and genetic articles published: 30 in anatomy, five in craniofacial biology, and 12 in genetics. Topical analysis of published manuscripts then and now reveal that similar topics in anatomy and craniofacial biology are still being researched today (e.g., phenotypic variability, optimal timing of surgery, presurgical orthopedics, bone grafting); whereas, most of the more recent papers use advanced technology to address old questions. In contrast, genetic publications have clearly increased in frequency during the last 50 years, which parallels advances in the field during this time. However, all of us have noticed that the more "cutting-edge" papers in these areas are not being submitted for publication to the journal, but instead to discipline-specific journals. Concerted efforts are therefore indicated to attract and publish these cutting-edge papers in order to keep the Cleft Palate-Craniofacial Journal in the forefront of orofacial cleft and craniofacial anomaly research and to provide a valuable service to American Cleft Palate-Craniofacial Association members.
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Mirfazeli A, Kaviany N, Hosseinpour KR, Golalipour MJ. Incidence of cleft lip and palate in gorgan - northern iran: an epidemiological study. Oman Med J 2012; 27:461-4. [PMID: 23226815 DOI: 10.5001/omj.2012.110] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 10/03/2012] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Cleft lip with or without cleft palate is the most common orofacial congenital anomaly among live births. This study was carried out to determine the incidence rate of oral clefting in Gorgan, Northern Iran during 2004-2009. METHODS This descriptive hospital-based study was performed on 35,009 live newborns in Dezyani Hospital in Gorgan, Northern Iran during 2004-2009. All newborns were screened for oral clefts. Data including birth date, gender, type of oral clefts, parents' consanguinity, parental ethnicity and presence of other congenital anomalies were recorded for analysis. RESULT The overall incidence rate of oral clefts during this 6-year period was 1.05 per 1000, or 1 per 946 live births. The incidence of cleft lip and isolated cleft palate was 0.08 and 0.37 per 1,000 live births, respectively. The ratio for different cleft types was 1:7:4 (CL: CLP: CP). The incidence of oral clefting was 1.2 per 1,000 male births and 0.86 per 1,000 female births (RR=1.40; 95% CI: 0.73-2.71). According to parental ethnicity, the incidence of oral clefting was 0.7, 1.7 and 1.26 per 1,000 in Native Fars, Turkman and Sistani, respectively. The relative risk for oral clefting in Turkman to native Fars group was 2.56 (p<0.02). In this study, 56.7% of clefts were CL+P, 8.1% were CL and 35.1% of cases were CP. CP was more common among girls (54%) than among boys (46%) but CL was more common among boys. CONCLUSION The results showed that the incidence of oral clefts in the study population as being 1.05 per 1,000 live births, which has increased from 0.97 per 1,000 live births reported in an earlier study in this area.
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Affiliation(s)
- Arezou Mirfazeli
- Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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