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Sarilita E, Rafisa A, Desai P, Mossey PA. Age at primary surgery among orofacial cleft individuals in Indonesia. Orthod Craniofac Res 2024; 27 Suppl 1:62-69. [PMID: 38149758 DOI: 10.1111/ocr.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES To observe the age at primary cleft surgery among charity organizations such as Smile Train in helping Indonesia manage patients with OFC. MATERIALS AND METHODS A retrospective analysis of medical records was conducted to identify patients with orofacial clefts who underwent primary surgery between 2001 and 2021. The age at the time of surgery was recorded for each patient. Descriptive statistics were used to analyse the data and determine the average age at primary surgery. RESULTS In the period between 2001 and 2021, a total of 34 239 individuals in Indonesia underwent primary lip surgery, while 16 768 individuals received primary palatal surgery, as recorded in the Smile Train database. Notably, a significant proportion of these surgeries were classified as delayed primary repairs. Approximately 65.3% of primary lip surgeries were performed beyond the recommended timeline of 6 months of age, indicating a delay in the surgical intervention. Similarly, 67% of primary palatal surgeries were also delayed, occurring after the recommended timeline of 18 months of life. CONCLUSIONS This study provides insights into the age at primary surgery among individuals with orofacial clefts in Indonesia. The findings highlight the need for timely intervention and the importance of considering individualized treatment plans based on the specific type of orofacial cleft. Further research is warranted to explore factors influencing the age at primary surgery and their impact on treatment outcomes and long-term functional outcomes in this population.
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Affiliation(s)
- Erli Sarilita
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Anggun Rafisa
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Priya Desai
- Research and Innovation, Smile Train, New York, New York, USA
| | - Peter A Mossey
- Division of Oral Health Sciences and WHO Collaborating Centre for Oral Health & Craniofacial Anomalies, University of Dundee, Dundee, UK
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Shiva A, Soltani P, Moaddabi A, Yazdian R, Saeedi M, Mozoun Z, Esfandpour A, Rengo C, Namdar P, Spagnuolo G. In-vivo assessment of application of folinic acid and botulinum toxin A in cleft lip surgical defects. Orthod Craniofac Res 2024; 27 Suppl 1:115-121. [PMID: 38459796 DOI: 10.1111/ocr.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Folinic acid and botulinum toxin A have shown promising results in wound healing in different studies. This study aimed to compare the effects of these approaches on wound healing after simulating cleft lip surgery in rats. METHODS In this experimental animal study, after creating lip defects, 30 rats were randomly divided into three groups and received normal saline (CTL), botulinum toxin A (BOT), and folinic acid (FOL). Biopsy from the skin wounds was performed after 14- and 28-days. These samples were stained with haematoxylin and eosin and Masson trichrome staining. Finally, each pathological parameter of wound healing was rated in this study. RESULTS While the inflammatory response was not different among the study groups, fibroblast proliferation and collagen deposition were significantly higher in FOL group compared to BOT group. Moreover, both BOT and FOL facilitated epithelial healing and 14-day angiogenesis as compared with normal saline. CONCLUSIONS Improved wound healing was observed using both botulinum toxin A and folinic acid in rat animal models. However, the application of botulinum toxin A caused less fibroblast proliferation and collagen deposition which can potentially lead to less scar formation, which can be particularly important in the aesthetic zone.
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Affiliation(s)
- Atena Shiva
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Parisa Soltani
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Amirhossein Moaddabi
- Department of Oral and Maxillofacial Surgery, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rezvan Yazdian
- Department of Molecular and Cell Biology Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zohreh Mozoun
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Atefe Esfandpour
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Carlo Rengo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Parastoo Namdar
- Department of Orthodontics, Faculty of Dentistry, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Wanderley Lacerda RH, Filgueiras VM, Guedes Mendonça AC, Vieira AR. Molar-incisor hypomineralization in a cohort of individuals born with cleft lip and palate. Orthod Craniofac Res 2024; 27 Suppl 1:21-26. [PMID: 37643023 DOI: 10.1111/ocr.12708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE This study aimed to investigate the frequency of molar-incisor hypomineralization (MIH) in individuals born with cleft lip and or cleft palate. SETTINGS AND SAMPLE Three hundred eighty-six individuals born with cleft lip and/or palate before orthodontic treatment. METHODS All the individuals were submitted to a clinical examination and intraoral standardized photos. The registration of MIH was taken by two orthodontists and analysed in association with the cleft type and laterality. The Kruskal-Wallis test and the regression test were used to compare the frequency of molars and incisors affected according to cleft type and laterality, sex and age. RESULTS We found a frequency of 67.87% of MIH in the studied sample. The frequency varied from 25% (in individuals born with cleft palate) to 77% in individuals born with bilateral cleft lip and palate). The number of affected molars was statistically different depending on cleft type and laterality (P < .001- Kruskal-Wallis test). Differences were found between individuals born with unilateral cleft lip and palate and unilateral cleft lip and alveolus (P = .03), and with isolated cleft palate (P = .03), and between individuals born with bilateral cleft lip and palate and born with unilateral cleft lip and alveolus (P = .01), and cleft palate (P = .01). Sex (P = .21) and age (P = .36) had no influence on the frequency of MIH. A positive correlation was found between the number of molars affected and incisors affected (P < .001). CONCLUSION Individuals born with cleft lip and palate have a higher frequency of MIH, and the complexity of cleft type was associated with the number of affected molars.
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Affiliation(s)
| | - Vitor Marques Filgueiras
- Cleft Lip and Palate Center, University Hospital of Paraiba, Federal University of Paraiba, Paraíba, Brazil
| | | | - Alexandre Rezende Vieira
- Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ács L, Nemes B, Nagy K, Ács M, Bánhidy F, Rózsa N. Maternal factors in the origin of cleft lip/cleft palate: A population-based case-control study. Orthod Craniofac Res 2024; 27 Suppl 1:6-13. [PMID: 38010849 DOI: 10.1111/ocr.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Orofacial clefts are among the most common birth defects, with an estimated worldwide incidence of around 1.5-1.7 per 1000 live-born babies. The most frequent form of orofacial clefts is cleft lip with or without cleft palate (CL ± CP). The role of environmental factors in the development of clefts is unclear in most patients, thus the aim of this study was to estimate possible maternal risk factors in the origin of CL ± CP. MATERIALS AND METHODS 1648 CL ± CP cases, 2654 matched controls and 57 231 population controls were evaluated from The Hungarian Case-Control Surveillance of Congenital Abnormalities. Maternal factors during the critical period in cases and controls were compared. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were estimated in a multivariable conditional logistic regression model. RESULTS Among socio-demographic data, we have found significant differences between maternal employment. The proportion of unskilled mothers (6.5%) were higher in the CL ± CP group than in controls (3.5%). Medically recorded maternal anaemia, excessive vomiting and threatened abortion were associated with a higher risk of CL ± CP. An elevated risk was also found in various acute illnesses such as influenza (OR: 2.4, 95% CI: 3.0-5.8), acute bronchitis (OR: 4.5, 95% CI: 1.6-12.6) and urinary tract infections (OR: 3.5, 95% CI: 2.0-6.0). Maternal migraine and essential hypertension occurred more frequently in the mothers of cases than in controls. CONCLUSION The findings of this study suggest that maternal diseases and lifestyle factors during the first trimester play a significant role in the development of CL ± CP.
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Affiliation(s)
- Lili Ács
- Department of Paediatric Dentistry and Orthodontics, Semmelweis University Faculty of Dentistry, Budapest, Hungary
| | - Bálint Nemes
- Department of Paediatric Dentistry and Orthodontics, Semmelweis University Faculty of Dentistry, Budapest, Hungary
| | - Krisztián Nagy
- Department of Paediatrics, Semmelweis University School of Medicine, Budapest, Hungary
- OMFS-IMPATH KU Research Group, Leuven, Belgium
| | - Márton Ács
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University Faculty of Dentistry, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Ferenc Bánhidy
- Department of Obstetrics and Gynaecology, Semmelweis University School of Medicine, Budapest, Hungary
| | - Noémi Rózsa
- Department of Paediatric Dentistry and Orthodontics, Semmelweis University Faculty of Dentistry, Budapest, Hungary
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Fujito H, Kimura N, Moriyama H, Matsuda S, Mihara H. Novel Technique for Median Cleft Lip Comprising the Simultaneous Formation of the Columella, Philtrum, and Cupid's Bow. Cleft Palate Craniofac J 2024:10556656241253411. [PMID: 38711261 DOI: 10.1177/10556656241253411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
Numerous surgical techniques for median cleft lip repair have been described; however, most cause excessively sharp peaks or the collapse of Cupid's bow. We report a technique for median cleft lip repair using a mucosal skin flap and full-thickness skin graft and 15 years of follow-up. Our technique provides acceptable formation of the columella, philtrum, and the two peaks of Cupid's bow. In this paper, we cite our previously reported techniques and add new findings and discussion based on the long-term postoperative outcomes of this procedure. Advantages and disadvantages of this technique are discussed, and a possible solution to achieve a more satisfactory result is suggested. Advantages and disadvantages of this new technique are discussed, and a possible solution to achieve a more satisfactory result is suggested.
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Affiliation(s)
- Hikaru Fujito
- Department of Plastic and Reconstructive Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Naritaka Kimura
- Department of Plastic and Reconstructive Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hikaru Moriyama
- Department of Plastic and Reconstructive Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Syouta Matsuda
- Department of Plastic and Reconstructive Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hiroya Mihara
- Department of Plastic and Reconstructive Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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Gifalli M, Antonio CT, Aparecida Pezzato da Silva V, Aroteia Capone F, Capelato Prado P, Trettene ADS. Adolescents with orofacial clefts: understanding their experiences. Rev Paul Pediatr 2024; 42:e2023131. [PMID: 38716994 PMCID: PMC11073468 DOI: 10.1590/1984-0462/2024/42/2023131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/18/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To understand the experience of young people with orofacial clefts regarding life as an adolescent. METHODS Descriptive, qualitative study, developed in a Brazilian public and tertiary hospital, a reference center in the care of patients with craniofacial anomalies and related syndromes, between February and April 2019. The sample was defined by theoretical saturation. The following inclusion criteria were established: age between ten and 19 years old and having previously operated on orofacial cleft (lip and/or palate). Individuals with fissure associated with syndromes or other malformations were excluded. Data collection was performed through semi-structured interviews, which were audio recorded and transcribed in full. The trigger element was: how has it been for you to experience your adolescence? For the construction of the results, content analysis was used in the thematic modality. RESULTS Seventeen adolescents participated. From the speeches, three categories were revealed: interacting socially, feeling supported, and experiencing and facing prejudice. CONCLUSIONS The biopsychosocial and conflicting complexity that adolescents with orofacial clefts experience was noticed, as well as the importance of receiving support and establishing modalities of situational coping.
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Garrett HC, Boorer CJ, Ho K. Philtral Dermofascial Flap Reconstruction of Whistle Deformity. Cleft Palate Craniofac J 2024; 61:888-891. [PMID: 36510446 DOI: 10.1177/10556656221145057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The aim of this paper is to describe a technique that can be utilised for the targeted correction of the Whistle Deformity and accompanying upper lip subunits. All patients were post-primary cleft lip repair, either unilateral or bilateral cleft lips, with a resulting Whistle Deformity post-operatively. They all elected to undergo surgical correction of the Whistle Deformity using bilateral philtral dermofascial flaps to correct their Whistle Deformity. Post-operative clinical photographs demonstrate the results of the technique. We assessed for the resolution of the Whistle Deformity and improvement of the appearance of the upper lip subunits, including; philtral, columella, and nostril sill elements. The patients treated with this technique, with Whistle Deformities following unilateral and bilateral cleft lip repair, had satisfactory results from the procedure and recovered with no complications. We propose this is an effective method for treating up to moderate-severe Whistle deformities following both unilateral and bilateral primary cleft lip repairs.
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Affiliation(s)
- Harrison C Garrett
- Department of Plastic and Reconstructive Surgery, Sydney Children's Hospital and Prince of Wales Hospital, Sydney, Australia
| | - Catherine J Boorer
- Department of Plastic and Reconstructive Surgery, Sydney Children's Hospital and Prince of Wales Hospital, Sydney, Australia
| | - Kevin Ho
- Department of Plastic and Reconstructive Surgery, Sydney Children's Hospital and Prince of Wales Hospital, Sydney, Australia
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Kamau M, Sarna K, Guthua S, Sonigra KJ, Kimani P. Patterns of primary and secondary defects associated with non-syndromic cleft lip and palate: An epidemiological analysis in a Kenyan population. Congenit Anom (Kyoto) 2024; 64:134-142. [PMID: 38530146 DOI: 10.1111/cga.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/07/2024] [Accepted: 03/15/2024] [Indexed: 03/27/2024]
Abstract
Cleft lip and palate deformities substantially burden individuals and families, particularly in low-income communities. However, a comprehensive understanding of the patterns and distribution of these deformities in Kenya remains limited. This retrospective cross-sectional study analyzed 647 clinical records from the BelaRisu Foundation registry in Kenya, spanning 2018-2022. After meticulous record verification and data extraction, cleft pattern modeling was used to analyze each case. Data were imported to SPSS version 29.0 and descriptive statistics were calculated, which included means, ranges, frequencies, percentages, and standard deviations. Additionally, a comparative analysis between genders was conducted. The findings revealed a higher average age of presentation compared with previous studies in Kenya, along with a greater susceptibility of males to cleft lip and palate defects overall. Noteworthy disparities in case distribution across provinces were observed. Cleft lip emerged as the most observed primary defect, while palatal fistulae constituted the most frequent secondary defect. Interestingly, while some results aligned with global trends, others diverged significantly from the existing literature, warranting further exploration and investigation. These findings shed light on the unique patterns and distribution of cleft lip and palate deformities in Kenya, highlighting the need for targeted interventions and support systems.
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Affiliation(s)
- Martin Kamau
- Unit of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, Department of Dental Sciences, University of Nairobi, Nairobi, Kenya
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
- Clinical research, BelaRisu Foundation, Nairobi, Kenya
| | - Krishan Sarna
- Unit of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, Department of Dental Sciences, University of Nairobi, Nairobi, Kenya
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Symon Guthua
- Unit of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, Department of Dental Sciences, University of Nairobi, Nairobi, Kenya
| | | | - Paul Kimani
- Clinical research, BelaRisu Foundation, Nairobi, Kenya
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Robinson K, Curtis SW, Leslie EJ. The heterogeneous genetic architectures of orofacial clefts. Trends Genet 2024; 40:410-421. [PMID: 38480105 DOI: 10.1016/j.tig.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 05/09/2024]
Abstract
Orofacial clefts (OFCs) are common, affecting 1:1000 live births. OFCs occur across a phenotypic spectrum - including cleft lip (CL), cleft lip and palate (CLP), or cleft palate (CP) - and can be further subdivided based on laterality, severity, or specific structures affected. Herein we review what is known about the genetic architecture underlying each of these subtypes, considering both shared and subtype-specific risks. While there are more known genetic similarities between CL and CLP than CP, recent research supports both shared and subtype-specific genetic risk factors within and between phenotypic classifications of OFCs. Larger sample sizes and deeper phenotyping data will be of increasing importance for the discovery of novel genetic risk factors for OFCs and various subtypes going forward.
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Affiliation(s)
- Kelsey Robinson
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Sarah W Curtis
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Elizabeth J Leslie
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Lopes GDS, Guimarães L, Nascimento E, Freitas DQ, Rebello I, Medrado AP, Coletta RD, Reis SRA. Root Curvature in Non-Syndromic Oral Clefts: A Case-Control Study in a Brazilian Population. Cleft Palate Craniofac J 2024; 61:740-747. [PMID: 36475900 DOI: 10.1177/10556656221143299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study assesses the degree of root curvature in patients with non-syndromic cleft lip and/or palate (NSCL/P). DESIGN Retrospective. Case-control study. SETTING Root curvature was assessed in lower premolars and molars in 800 panoramic radiographs: 400 from patients with cleft and 400 from healthy control individuals. Root curvature was classified according to its angulation, as well as its apical, medial, or coronal localization. RESULTS The frequency of mild curvature in the NSCL/P group compared to the control group was higher in premolars especially in the left second premolar in cleft palate (OR: 6.91; 95% CI: 3.23-14.77; P < .0001). The frequency of moderate curvature in molars was significantly higher in the cleft group, with the highest risk in the right first molar in the cleft lip group (OR: 2.74; 95% CI: 1.67-4.52; P < .0001). Inclination was more frequently observed in the apical third of the root in the group with cleft, whereas for the control group, the curvature was more frequent in the medial third. In patients with cleft, the OR of curvature in the apical third was significant in premolars (left lower second premolar: Cleft lip, OR: 1.91; 95% CI: 1.04-3.52; P = .03; right lower second premolar: Cleft lip, OR: 1.91, 95% CI: 1.04-3.50; P = .03, cleft lip and palate, OR: 1.75; 95% CI: 1.12-2.73; P = .01). CONCLUSION The results of the current study indicate differences in root curvature in patients with non-syndromic cleft lip and/or palate, which should be considered during the dental treatment planning of patients.
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Affiliation(s)
| | - Laís Guimarães
- Bahiana School of Medicine and Public Health, Salvador, Brazil
| | | | - Deborah Q Freitas
- Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Alena P Medrado
- Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Ricardo D Coletta
- Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Silvia R A Reis
- Bahiana School of Medicine and Public Health, Salvador, Brazil
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Hamdan US, Garcia Garcia JA, Haddad MS, Younan RA, Melhem AM, Kantar RS, Najjar WW. Single-Stage Posterior Vomerine Ostectomy, Premaxillary Setback, Bilateral Gingivoperiosteoplasties and Primary Bilateral Cheiloplasty in Patients with Protuberant Premaxilla. J Clin Med 2024; 13:2609. [PMID: 38731138 PMCID: PMC11084371 DOI: 10.3390/jcm13092609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Various patients with complete bilateral cleft lip and palate present with a protruded premaxilla. Several techniques have been described for correctional repair of the projection with a plethora of unsatisfactory outcomes. This poses a challenge not only for the cleft team providing care but also for the patients and their respective families. Multiple patients suffer from residual deformities after inadequate primary repair, which increase surgical, financial, and psychological burden. Premaxillary setback with posterior vomerine ostectomy and complete bilateral cleft lip repair can promote alignment of the premaxilla with the maxillary prominences. To effectively address this challenging deformity, we describe a single-stage surgical technique that includes vomerine ostectomy posterior to the vomero-premaxillary suture, bilateral gingivoperiosteoplasties with complete bilateral cleft lip repair, and primary cleft rhinoplasty. Careful surgical planning is essential for adequate matching between the length of the protruded premaxilla and the extent of ostectomy. The described technique offers several advantages for the management of complete bilateral cleft lip with a projected premaxilla. It can be applied anywhere around the world and is most beneficial in underprivileged areas where patients suffer from restricted access to healthcare, absence of presurgical orthodontics and lack of sufficient resources.
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Affiliation(s)
- Usama S. Hamdan
- Global Smile Foundation, 106 Access Rd, Ste 209, Norwood, MA 02062, USA; (J.A.G.G.); (M.S.H.); (R.A.Y.); (A.M.M.); (R.S.K.); (W.W.N.)
| | - Jose A. Garcia Garcia
- Global Smile Foundation, 106 Access Rd, Ste 209, Norwood, MA 02062, USA; (J.A.G.G.); (M.S.H.); (R.A.Y.); (A.M.M.); (R.S.K.); (W.W.N.)
| | - Mario S. Haddad
- Global Smile Foundation, 106 Access Rd, Ste 209, Norwood, MA 02062, USA; (J.A.G.G.); (M.S.H.); (R.A.Y.); (A.M.M.); (R.S.K.); (W.W.N.)
- Department of General Surgery, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Robert A. Younan
- Global Smile Foundation, 106 Access Rd, Ste 209, Norwood, MA 02062, USA; (J.A.G.G.); (M.S.H.); (R.A.Y.); (A.M.M.); (R.S.K.); (W.W.N.)
- Department of General Surgery, Medical College of Georgia, Augusta, GA 30912, USA
| | - Antonio M. Melhem
- Global Smile Foundation, 106 Access Rd, Ste 209, Norwood, MA 02062, USA; (J.A.G.G.); (M.S.H.); (R.A.Y.); (A.M.M.); (R.S.K.); (W.W.N.)
- Department of General Surgery, Wyckoff Heights Medical Center, Brooklyn, NY 11237, USA
| | - Rami S. Kantar
- Global Smile Foundation, 106 Access Rd, Ste 209, Norwood, MA 02062, USA; (J.A.G.G.); (M.S.H.); (R.A.Y.); (A.M.M.); (R.S.K.); (W.W.N.)
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY 10016, USA
| | - Wassim W. Najjar
- Global Smile Foundation, 106 Access Rd, Ste 209, Norwood, MA 02062, USA; (J.A.G.G.); (M.S.H.); (R.A.Y.); (A.M.M.); (R.S.K.); (W.W.N.)
- Department of Plastic & Reconstructive Surgery, University of California, Irvine, CA 92697, USA
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Brydges HT, Laspro M, Verzella AN, Alcon A, Schechter J, Cassidy MF, Chaya BF, Iturrate E, Flores RL. Contemporary Prevalence of Oral Clefts in the US: Geographic and Socioeconomic Considerations. J Clin Med 2024; 13:2570. [PMID: 38731101 PMCID: PMC11084882 DOI: 10.3390/jcm13092570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Socio-economic status, living environments, and race have been implicated in the development of different congenital abnormalities. As orofacial clefting is the most common anomaly affecting the face, an understanding of its prevalence in the United States and its relationship with different determinants of health is paramount. Therefore, the purpose of this study is to determine the modern prevalence of oral-facial clefting in the United States and its association with different social determinants of health. Methods: Utilizing Epic Cosmos, data from approximately 180 US institutions were queried. Patients born between November 2012 and November 2022 were included. Eight orofacial clefting (OC) cohorts were identified. The Social Vulnerability Index (SVI) was used to assess social determinants of health. Results: Of the 15,697,366 patients identified, 31,216 were diagnosed with OC, resulting in a prevalence of 19.9 (95% CI: 19.7-20.1) per 10,000 live births. OC prevalence was highest among Asian (27.5 CI: 26.2-28.8) and Native American (32.8 CI: 30.4-35.2) patients and lowest among Black patients (12.96 CI: 12.5-13.4). Male and Hispanic patients exhibited higher OC prevalence than female and non-Hispanic patients. No significant differences were found among metropolitan (20.23/10,000), micropolitan (20.18/10,000), and rural populations (20.02/10,000). SVI data demonstrated that OC prevalence was positively associated with the percentage of the population below the poverty line and negatively associated with the proportion of minority language speakers. Conclusions: This study examined the largest US cohort of OC patients to date to define contemporary US prevalence, reporting a marginally higher rate than previous estimates. Multiple social determinants of health were found to be associated with OC prevalence, underscoring the importance of holistic prenatal care. These data may inform clinicians about screening and counseling of expectant families based on socio-economic factors and direct future research as it identifies potential risk factors and provides prevalence data, both of which are useful in addressing common questions related to screening and counseling.
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Affiliation(s)
- Hilliard T. Brydges
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY 10017, USA; (H.T.B.); (M.L.); (A.N.V.); (A.A.); (J.S.); (M.F.C.); (B.F.C.)
| | - Matteo Laspro
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY 10017, USA; (H.T.B.); (M.L.); (A.N.V.); (A.A.); (J.S.); (M.F.C.); (B.F.C.)
| | - Alexandra N. Verzella
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY 10017, USA; (H.T.B.); (M.L.); (A.N.V.); (A.A.); (J.S.); (M.F.C.); (B.F.C.)
| | - Andre Alcon
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY 10017, USA; (H.T.B.); (M.L.); (A.N.V.); (A.A.); (J.S.); (M.F.C.); (B.F.C.)
| | - Jill Schechter
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY 10017, USA; (H.T.B.); (M.L.); (A.N.V.); (A.A.); (J.S.); (M.F.C.); (B.F.C.)
| | - Michael F. Cassidy
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY 10017, USA; (H.T.B.); (M.L.); (A.N.V.); (A.A.); (J.S.); (M.F.C.); (B.F.C.)
| | - Bachar F. Chaya
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY 10017, USA; (H.T.B.); (M.L.); (A.N.V.); (A.A.); (J.S.); (M.F.C.); (B.F.C.)
| | - Eduardo Iturrate
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10017, USA;
| | - Roberto L. Flores
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY 10017, USA; (H.T.B.); (M.L.); (A.N.V.); (A.A.); (J.S.); (M.F.C.); (B.F.C.)
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Denadai R, Araujo KM, Campos RL, Lo CC, Seo HJ, Sato N, Tu JCY, Chou PY, Lo LJ. Scar Outcome in Unilateral Complete Cleft Lip Repair: A Comparative Analysis of Vertical Lip Lengthening Strategies Using the Rotation-Advancement Concept. Cleft Palate Craniofac J 2024:10556656241247625. [PMID: 38646778 DOI: 10.1177/10556656241247625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE To assess the differences in scar outcomes between modified rotation-advancement techniques proposed by Drs. Mohler and Noordhoff, designed to address issues such as inadequate vertical lip length and scarring on the upper third of the lip in the original rotation-advancement technique. DESIGN Retrospective single-surgeon (RD) study. PATIENTS Consecutive non-syndromic children (n = 68) with unilateral complete cleft lip and palate. INTERVENTIONS Modified Mohler (columellar backcut reconstructed with C flap; n = 34) and modified Noordhoff (lower, medially-created backcut reconstructed with laterally-based triangular skin flap; n = 34) repairs. MEAN OUTCOME MEASURES Using 12-month postoperative frontal photographs, scar evaluations (overall and superior, middle, and inferior portions of the lip) were appraised by an assessment panel composed by independent professional and nonprofessional raters employing four validated qualitative scar assessment scales: Manchester Scar Scale, modified Scar-Rating Scale, Stony Brook Scar Evaluation Scale, and Visual Analog Scale. Quantitative computerized photogrammetric scar widths of the superior, middle, and inferior portions of the upper lip were also measured. RESULTS The modified Noordhoff method showed significantly (all P < .001) better scar quality for the overall scar and superior portion of the scar in all four scales compared to the modified Mohler method, with no significant (all P > .05) difference for the middle and lower portions. No significant difference (all P > .05) was observed for photogrammetric scar width measurements. CONCLUSION The modified Noordhoff technique provided better qualitative results for unilateral complete cleft lip-related scars compared to the modified Mohler technique.
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Affiliation(s)
- Rafael Denadai
- Plastic and Cleft-Craniofacial Surgery, A&D DermePlastique, Sao Paulo, Brazil
| | | | | | - Chi-Chin Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Nobuhiro Sato
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Junior Chun-Yu Tu
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Pang-Yung Chou
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
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Tahmasebi N, Zarifian T, Ashtari A, Biglarian A. Telepractice Parent Training of Enhanced Milieu Teaching With Phonological Emphasis (EMT+PE) For Persian-Speaking Toddlers With Nonsyndromic Cleft Palate: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e54426. [PMID: 38640014 PMCID: PMC11069098 DOI: 10.2196/54426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Children born with a cleft palate with or without a cleft lip (CP/L) are at increased risk for delayed language development and speech sound disorders. Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE) is a recommended naturalistic intervention for toddlers with CP/L. The parents' role in providing naturalistic interventions is critical and they need training based on learning principles to implement these interventions. Telepractice is an appropriate method for training parents and children with various speech-related disorders. OBJECTIVE This study aims to determine and compare the effectiveness of telepractice and the parent-implemented EMT+PE intervention on language and speech measures in toddlers with CP/L with usual interventions and determine the effectiveness maintenance of the intervention. METHODS A randomized controlled trial (RCT) will assess the efficacy of telepractice and the parent-implemented EMT+PE intervention in enhancing speech and language measures in toddlers with CP/L. Eligible participants will be randomly assigned to one of 2 groups: the conventional intervention group and the EMT+PE intervention group. Participants' speech and language measures will be evaluated remotely by trained raters before and after the intervention and 2 months after the intervention. Parents of participants in the intervention group will receive 3 months of training in speech and language supportive strategies from trained therapists using telehealth fidelity scales. Parents of participants in the control group will receive the conventional speech and language intervention by cleft team therapists. Study outcomes will include language variables (mean length of utterance) and speech production variables (percent correct consonants). RESULTS The protocol was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences in February 2022. The selection process of participants, as well as training therapists and raters, commenced in January 2022, the therapy and follow-up period ended in June 2023, and pre- and postintervention assessments have been conducted. Data analysis is ongoing, and we expect to publish our results by the summer of 2024. Funding is yet to be received. CONCLUSIONS The results of this study may help us develop a speech and language intervention with a different delivery model for toddlers with CP/L, and the cleft team care can use these results in service delivery. Consistent with our hypothesis, speech and language measures are expected to improve. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54426.
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Affiliation(s)
- Neda Tahmasebi
- Department of Speech Therapy, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Talieh Zarifian
- Department of Speech Therapy, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Atieh Ashtari
- Department of Speech Therapy, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akbar Biglarian
- Department of Biostatistics and Epidemiology, Social Determinants of Health Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Baeza-Pagador A, Tejero-Martínez A, Salom-Alonso L, Camañes-Gonzalvo S, García-Sanz V, Paredes-Gallardo V. Diagnostic Methods for the Prenatal Detection of Cleft Lip and Palate: A Systematic Review. J Clin Med 2024; 13:2090. [PMID: 38610855 PMCID: PMC11012824 DOI: 10.3390/jcm13072090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/03/2024] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Accurate prenatal diagnosis of cleft lip and palate is essential to discuss severity prediction, perform appropriate parental counseling, and, at last, establish long-term treatment planning. The aim of this systematic review was to analyze the accuracy of various imaging techniques for the prenatal diagnosis of cleft lip and palate, assess the pregnancy phase for orofacial clefts diagnosis, and study the different cleft types in terms of diagnostic methods, timing, and predictability. Methods: A search of the PubMed, EMBASE, Scopus, and Web of Science databases was conducted to identify potentially relevant studies published until January 2024. The quality of the selected articles was assessed using the Newcastle-Ottawa scale for methodological quality assessment of cohort studies and the QUADAS-2 scale for diagnostic test studies. Results: A total of 18 studies met the eligibility criteria and were included in the review. The findings of this review indicate that the majority of studies showed improved diagnostic accuracy when supplementary techniques, such as 3D ultrasound or magnetic resonance imaging, were added to 2D ultrasound. Conclusions: The implementation of magnetic resonance imaging as a standard procedure could significantly improve the precision of diagnosing cleft lip and palate. Therefore, the diagnostic technique used will play a crucial role in the accuracy of the diagnosis.
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Affiliation(s)
- Ana Baeza-Pagador
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| | - Ana Tejero-Martínez
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| | - Lucas Salom-Alonso
- Department of Maxillofacial Surgery, La Fe Hospital, 46026 Valencia, Spain;
| | - Sara Camañes-Gonzalvo
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| | - Verónica García-Sanz
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| | - Vanessa Paredes-Gallardo
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
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Brugmann SA, Clouthier DE, Fantauzzo KA, Harris MP, Jeong J, Saint-Jeannet JP, Stottmann RW, Merrill AE. The society for craniofacial genetics and developmental biology 46th annual meeting. Am J Med Genet A 2024:e63615. [PMID: 38563316 DOI: 10.1002/ajmg.a.63615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
The Society for Craniofacial Genetics and Developmental Biology (SCGDB) held its 46th Annual Meeting at Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio on October 10th-12th, 2023. On the first day of the meeting, Drs. Sally Moody and Justin Cotney were each honored with the SCGDB Distinguished Scientist Awards for their exceptional contributions to the field of craniofacial biology. The following two days of the meeting featured five sessions that highlighted new discoveries in signaling and genomic mechanisms regulating craniofacial development, human genetics, translational and regenerative approaches, and clinical management of craniofacial differences. Interactive workshops on spatial transcriptomics and scientific communication, as well as a poster session facilitated meaningful interactions among the 122 attendees representing diverse career stages and research backgrounds in developmental biology and genetics, strengthened the SCGDB community.
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Affiliation(s)
- Samantha A Brugmann
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David E Clouthier
- Department of Craniofacial Biology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Katherine A Fantauzzo
- Department of Craniofacial Biology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Matthew P Harris
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Juhee Jeong
- Department of Molecular Pathobiology, New York University, College of Dentistry, New York, New York, USA
| | - Jean-Pierre Saint-Jeannet
- Department of Molecular Pathobiology, New York University, College of Dentistry, New York, New York, USA
| | - Rolf W Stottmann
- Steve and Cindy Rasmussen Institute for Genomic Medicine, Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Amy E Merrill
- Department of Biomedical Sciences, Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
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Şibar S, Doruk M, Gülşen A, Özdemir A, Tosun G, Üçüncü N. Evaluation of Orbitomalar Region Projection in Patients With Operated Cleft Lip and Palate (Cephalometric Study). Cleft Palate Craniofac J 2024; 61:545-554. [PMID: 36278686 PMCID: PMC10955793 DOI: 10.1177/10556656221133426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE The aim of this study was to compare the orbitomalar region projection in patients with cleft lip and palate (CLP) with skeletal class 1 cases. DESIGN Retrospective. SETTING Single center. PATIENTS Cephalometric data of 52 cases with unilateral CLP, 25 cases with bilateral CLP, and 60 healthy participants in skeletal class 1 without CLP were included. MAIN OUTCOME MEASURE(S) A total of 5 parameters, 3 in the orbital and 2 in the suborbital region, that determine the projection of the orbitomalar region on lateral cephalograms, and 13 parameters of the craniofacial region were evaluated. RESULTS Lateral, inferior, and anterior orbital parameters were similar between groups, while suborbital parameters were in a retrusive position in the CLP groups compared to the control group (P < .05). No significant difference was found between the CLP groups in terms of suborbital parameters. A moderate positive correlation was found between orbitomalar parameters and the anteroposterior positions of the maxilla and mandible. The lateral orbital region had a moderate negative correlation with anterior maxillary height, and the suborbital region had a negative moderate correlation with maxillary inclination. CONCLUSION Suborbital projection was more retrusive in CLP compared to the control group, but no difference was found between the CLP groups. On the other hand, the correlation between orbitomalar projection and maxillary and mandibular development was significant. The results show that there is a need for alternative treatment modalities for the suborbital region in patients with CLP.
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Affiliation(s)
- Serhat Şibar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University Hospital, Ankara, Turkey
| | - Mert Doruk
- Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University Hospital, Ankara, Turkey
| | - Ayşe Gülşen
- Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University Hospital, Ankara, Turkey
| | - Alihan Özdemir
- Department of Dentistry, Gazi University Hospital, Ankara, Turkey
| | - Gülce Tosun
- Department of Dentistry, Gazi University Hospital, Ankara, Turkey
| | - Neslihan Üçüncü
- Department of Dentistry, Gazi University Hospital, Ankara, Turkey
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Sander FH, Jørgensen DS, Jakobsen LP, Jensen AN, Lousen T, Sandager P, Sperling L, Vogel I, Petersen OB, Vedel C. Prenatal detection of orofacial clefts in Denmark from 2009 to 2018. Ultrasound Obstet Gynecol 2024; 63:507-513. [PMID: 37724632 DOI: 10.1002/uog.27488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To investigate the overall and type-specific prenatal detection rates (DRs) of orofacial clefts in a national cohort in Denmark. METHODS This study was based on data from the Danish Fetal Medicine Database and included all fetuses and children from singleton pregnancies diagnosed with an orofacial cleft prenatally and/or postnatally between 2009 and 2018. The types of cleft included unilateral, bilateral or median cleft lip (CL); unilateral, bilateral or median cleft lip with secondary cleft palate (CLP); and cleft palate (CP). The clefts were grouped as cleft lip with or without cleft palate (CL(P)) or as all clefts (including CP). All cases with discordance between prenatal and postnatal diagnoses were validated in the local patient files (Astraia). Cases without prenatal validation of the postnatal diagnosis were marked as undetected. Postnatally diagnosed cases with a strong prenatal suspicion of a cleft but without an International Classification of Diseases-10 code were registered as prenatally detected. Termination of pregnancy and intrauterine death were registered as true positives even if no autopsy could be performed. Liveborn cases with a prenatal diagnosis but without a postnatal validation were excluded. RESULTS A total of 994 cases were included in the study, of which 933 were liveborn. The prevalence of orofacial cleft was 1.6 per 1000 live births. There were no differences in the baseline characteristics between detected and undetected cases. The DR for CL(P) was 71.7% (95% CI, 64.8-78.9%), with an increase from 60.0% in 2009 to 73.0% in 2018 (P = 0.018). The type-specific DRs for the entire period were 56.4% (95% CI, 45.0-67.6%) for unilateral CL; 76.6% (95% CI, 71.7-82.9%) for unilateral CLP; 70.5% (95% CI, 52.1-87.6%) for bilateral CL; 82.3% (95% CI, 70.6-93.6%) for bilateral CLP; 0% (0/6) for median CL; 75.0% (3/4) for median CLP; and 3.3% (95% CI, 0.6-5.7%) for CP. A total of 20.9% (208/994) of the cases had associated findings, of which 33.2% (69/208) were genetic aberrations. CONCLUSIONS The DR for CL(P) has improved in Denmark over the last decade. The DR for CLP is high, with the highest DR for bilateral CLP. However, prenatal detection of CP remains a challenge. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F H Sander
- Center of Fetal Medicine, Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - D S Jørgensen
- Center of Fetal Medicine, Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - L P Jakobsen
- Department of Plastic Surgery, Breast Surgery and Burns Treatment, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - A N Jensen
- Department of Obstetrics, Aalborg University Hospital, Aalborg, Denmark
| | - T Lousen
- Department of Obstetrics, Zealand University Hospital, Roskilde, Denmark
| | - P Sandager
- Department of Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Center of Fetal Diagnostics, Aarhus University, Aarhus, Denmark
| | - L Sperling
- Department of Obstetrics, Odense University Hospital, Odense, Denmark
| | - I Vogel
- Department of Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Center of Fetal Diagnostics, Aarhus University, Aarhus, Denmark
| | - O B Petersen
- Center of Fetal Medicine, Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - C Vedel
- Center of Fetal Medicine, Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Chi H, Peng H, Zhao X, Zhou G, Shen L, Cai M. The Effectiveness of 595-nm Pulsed Dye Laser for the Treatment of Bilateral Cleft-Lip Scars in Asian Patients: A 6-Month Prospective, Randomized, Self-Controlled Trial. Adv Wound Care (New Rochelle) 2024. [PMID: 38258794 DOI: 10.1089/wound.2023.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Objective: This study is the first prospective within-patient self-controlled research seeking to investigate the safety and efficacy of 595 nm pulsed-dye laser (PDL) for the treatment of cleft-lip scars. Approach: This prospective, randomized, self-controlled study is based on the clinical records of the patients who received laser-assisted treatment due to bilateral cleft-lip scars. The bilateral scars were randomly assigned to the 595 nm PDL group with five consecutive sessions at 2-week intervals or control group in a blinded manner of evaluators, with subsequent follow-up for 6 months after the final treatment. Clinical efficacy and safety outcomes were evaluated by Vancouver Scar Scale (VSS), Patient Scar Assessment Questionnaire (PSAQ), and other objective evaluations. Results: A total of 18 patients were included. The 595 nm PDL-treated sides showed statistically significant improvement in VSS after treatment at follow-up compared with the baseline (p < 0.05). Interestingly, the 595 nm-PDL-treated side achieved significantly better improvement in scar pigmentation and pliability (p < 0.05). Though there was statistically significant difference between two groups (p < 0.05), the gap in overall PSAQ is not obvious. And comparison by area and coloring evaluation (E/M index) also suggests that the responses of scars to treatment by PDL were slightly improved (p < 0.05). Innovation and Conclusion: It is the first time to apply the 595nm PDL for cleft-lip scars. It would be a better choice for the early treatment of red scar with proliferative tendency after cleft-lip surgery.
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Affiliation(s)
- Haoshu Chi
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Hao Peng
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinran Zhao
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Guoyu Zhou
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingyue Shen
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Cai
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
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Park H, Kim H, Hwang YJ, Park SH. Poly Lactic-co-Glycolic Acid Absorbable Plate Graft for Secondary Rhinoplasty in Asian Patients with Unilateral Cleft Lip Nose Deformity. Cleft Palate Craniofac J 2024; 61:592-598. [PMID: 36604781 DOI: 10.1177/10556656221148899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION In secondary cleft lip and nasal deformity (CLND) correction, structural grafts are commonly used to control the nasal tip and restore the symmetry of the ala. However, the septal cartilage in Asians often weak and small. Biocompatible absorbable materials are alternatives to autologous grafts. This study assessed the surgical outcomes and complications of poly lactic-co-glycolic acid (PLGA) plate grafts in secondary CLND correction. METHODS This study was retrospectively analyzed for patients who underwent secondary rhinoplasty for unilateral CLND correction between March 2015 and November 2020. Using open rhinoplasty, the PLGA plate was grafted as a columellar strut. Clinical photographs taken at the initial (T0) and follow-up visits (T1: short-term, T2: long-term) were analyzed and anthropometric parameters, such as nostril height and width, dome height, and tip height, were measured. RESULTS Twenty-four patients were included in this study. The mean T1 and T2 periods were 1.0 ± 0.4 and 15.5 ± 3.1 months, respectively. The nostril height ratio increased from 0.78 ± 0.12 at T0 to 0.88 ± 0.08 at T1 and 0.86 ± 0.09 at T2 (p < 0.001; Relapse ratio -2.6 ± 6.7%). The tip height ratio increased from 0.60 ± 0.07 (T0) to 0.66 ± 0.05 (T2) (Relapse ratio -3.7 ± 3.0%). CONCLUSIONS The PLGA plate graft provided stable nasal tip projection and alar symmetry without major complications. It can be a good option for patients lacking available septal and concha cartilages or apprehensive of additional scarring.
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Affiliation(s)
- Hojin Park
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Haneul Kim
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Yong-Jae Hwang
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Seung-Ha Park
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Korea
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21
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Messias TS, Silva KCP, Silva TC, Soares S. Potential of Viruses as Environmental Etiological Factors for Non-Syndromic Orofacial Clefts. Viruses 2024; 16:511. [PMID: 38675854 PMCID: PMC11053622 DOI: 10.3390/v16040511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
In this study, we analyzed the potential of viral infections in the species Homo sapiens as environmental causes of orofacial clefts (OFCs). A scoring system was adapted for qualitatively assessing the potential of viruses to cause cleft lip and/or palate (CL/P). This assessment considered factors such as information from the literature, nucleotide and amino acid similarities, and the presence of Endogenous Viral Elements (EVEs). The analysis involved various algorithm packages within Basic Local Alignment Search Tool 2.13.0 software and databases from the National Center for Biotechnology Information and the International Committee on Taxonomy of Viruses. Twenty significant viral species using different biosynthesis strategies were identified: Human coronavirus NL63, Rio Negro virus, Alphatorquevirus homin9, Brisavirus, Cosavirus B, Torque teno mini virus 4, Bocaparvovirus primate2, Human coronavirus HKU1, Monkeypox virus, Mammarenavirus machupoense, Volepox virus, Souris mammarenavirus, Gammapapillomavirus 7, Betainfluenzavirus influenzae, Lymphocytic choriomeningitis mammarenavirus, Ledantevirus kern, Gammainfluenzavirus influenzae, Betapolyomavirus hominis, Vesiculovirus perinet, and Cytomegalovirus humanbeta5. The evident viral etiological potential in relation to CL/P varies depending on the Baltimore class to which the viral species belongs. Given the multifactorial nature of CL/P, this relationship appears to be dynamic.
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Affiliation(s)
- Thiago S. Messias
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru 17012-901, SP, Brazil; (T.S.M.); (K.C.P.S.)
| | - Kaique C. P. Silva
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru 17012-901, SP, Brazil; (T.S.M.); (K.C.P.S.)
- Faculty of Medicine, Nove de Julho University, Bauru 17011-102, SP, Brazil
| | - Thiago C. Silva
- Faculty of Architecture, Arts, Communication and Design, São Paulo State University, Bauru 17033-360, SP, Brazil;
| | - Simone Soares
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru 17012-901, SP, Brazil; (T.S.M.); (K.C.P.S.)
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, 9-75, Bauru 17012-901, SP, Brazil
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22
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Shay A, Gaffey M, Roe R, Robbins A, Zaniletti I, Johnson A, Hartzell L. Is There Utility in Preoperative Testing of Hemoglobin Before Primary Cheiloplasty? Cleft Palate Craniofac J 2024:10556656241239510. [PMID: 38490220 DOI: 10.1177/10556656241239510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To examine whether a preoperative hemoglobin of less than 10 g/dL is associated with a higher rate of perioperative complications. DESIGN Retrospective review. SETTING Tertiary academic hospital at Arkansas Children's Hospital of Little Rock, Arkansas. PATIENTS A retrospective chart review evaluated patients undergoing primary cleft lip surgery from 2012 to 2017. INTERVENTIONS No prospective intervention was performed for this study care. MAIN OUTCOME MEASURES Age, sex, medical history, weight, and perioperative complications. Hemoglobin level was collected in the preoperative area. The primary outcome was rate of perioperative complications including infection, dehiscence, return to the operating room, unplanned admission, and emergency department visit within two weeks postoperatively. RESULTS 105 patients undergoing primary cheiloplasty met inclusion criteria. Hemoglobin levels were obtained on all patients. 93.3% (n = 98) of patients had a hemoglobin of >10 g/dL before surgery, and 6.6% (n = 7) had levels <10 g/dL. 1 of 7 patients with a hemoglobin of <10 g/dL experienced a postoperative complication (Tet spell) and one patient with a hemoglobin of >10 g/dL experienced a postoperative complication (unplanned intensive care admission for respiratory distress). CONCLUSIONS Post-operative complications are rare after primary cheiloplasty in patients with low or normal hemoglobin levels. The results of this study show that a preoperative hemoglobin of <10 g/dL does not predict perioperative complications in patients undergoing primary cheiloplasty.
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Affiliation(s)
- Aryan Shay
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Megan Gaffey
- Langone Department of Otolaryngology-Head and Neck Surgery, New York University, New York City, NY, USA
| | - Roger Roe
- University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, USA
| | - Alexa Robbins
- Emory Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Adam Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Larry Hartzell
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
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McWilliams D, Thornton M, Hotton M, Swan MC, Marie Stock N. "It's On Your Shoulders Now" Transitioning from Child-to-Adult UK Cleft Lip/Palate Services: An Exploration of Young Adults' Narratives. Cleft Palate Craniofac J 2024:10556656241236006. [PMID: 38438120 DOI: 10.1177/10556656241236006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES Treatment for cleft lip and/or palate (CL/P) in the United Kingdom is administered on a standardised pathway from diagnosis to early adulthood, with options to be re-referred in later life. At age 16, patients become responsible for their treatment decisions. Evidence from the wider health literature indicates this transition can be challenging and that this population may require additional support. The present study explored young people's experiences of transition to adult care in the context of CL/P services, with the aim of identifying support needs and informing future service delivery. DESIGN Individual semi-structured interviews were conducted with 15 individuals with CL/P (aged 17-25 years) to explore transition experiences. Interviews lasted an average of 69 min and data were analysed using reflexive thematic analysis. RESULTS Four themes, with subthemes, were identified: 1) Readiness for Transition covered feelings of preparedness and how health professionals approached transition; 2) Making Decisions as an Adult described concerns and considerations when making treatment decisions; 3) Finding and Using Support, reflected the roles of caregivers and peers in developing self-advocacy; and 4) Reflections on Transition Care offered insight into how care could be improved. CONCLUSION Individuals born with CL/P may experience challenges in becoming responsible for their own care and treatment decisions. The findings of this study indicate that a dedicated transition protocol may be beneficial, such that adolescents are prepared to confidently access and manage their care into adulthood. Opportunities for improvements in transition planning and provision are discussed.
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Affiliation(s)
- Danielle McWilliams
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Maia Thornton
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Matthew Hotton
- Spires Cleft Centre, Level 2 Children's Hospital, John Radcliffe Hospital, Oxford, UK
| | - Marc C Swan
- Spires Cleft Centre, Level 2 Children's Hospital, John Radcliffe Hospital, Oxford, UK
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
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24
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Zhang Y, Zhang X, Jiang J, Xie W, Xiang D. Factors Associated With Perception of Stigma Among Parents of Children With Cleft Lip and Palate: Cross-Sectional Study. JMIR Form Res 2024; 8:e53353. [PMID: 38437002 PMCID: PMC10949127 DOI: 10.2196/53353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/10/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Parents of children with cleft lip with or without cleft palate (CL/P) often face stigmatization, which has a significant impact on their quality of life and mental health. However, to date, there is a lack of comprehensive, multicenter empirical research on parents of children with CL/P in China, particularly those with large-scale samples. OBJECTIVE This study aimed to identify major factors that contribute to the perception of stigma experienced by parents of children with CL/P. METHODS A cross-sectional survey was conducted. A total of 104 parents of children diagnosed with CL/P in 2 hospitals were selected by convenience sampling. Demographics and disease information, the Chinese Perception of Stigma Questionnaire, the Center for Epidemiological Studies Depression Scale, and the Social Anxiety Scale were used in this study. Descriptive statistics, t tests, and one-way ANOVA were used to compare the differences between participants' demographic information and perception of stigma. Multivariable linear regression was performed to assess associations between demographic factors, social anxiety, depression, and perception of stigma. RESULTS The mean scores for the dimensions of perception of stigma, depression, and social anxiety were 22.97 (SD 9.21), 38.34 (SD 8.25), and 22.86 (SD 6.69), respectively. Depression and social anxiety were positively associated with discrimination, while surgery status was a negatively associated variable. Parents with a college education or higher had significantly lower levels of perceived stigma compared to parents with a junior high school education (all P values <.05). These 4 factors explained 40.4% of the total model variance (F8=9.726; P<.001; R2=0.450; adjusted R2=0.404). CONCLUSIONS Our findings highlight a concerning trend of diminished quality of life among parents of children with CL/P. Factors such as parents' education level, surgery status, depression, and social anxiety are shown to influence the level of stigma experienced. Implementing comprehensive nursing care and providing presurgical support are effective strategies for alleviating parents' social anxiety, reducing perceived stigma, and preventing depression.
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Affiliation(s)
- Yanan Zhang
- Ophthalmology and otorhinolaryngology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Xinwen Zhang
- Ophthalmology and otorhinolaryngology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Jinzhuo Jiang
- College of Engineering, South China Agricultural University, Guangzhou, China
| | - Wanhua Xie
- Outpatient Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Daoman Xiang
- Ophthalmology and otorhinolaryngology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
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25
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Dutta S, Batra P, Raghavan S, Sharma K, Talwar A, Arora A, Srivastava A. Comparative assessment of facemask therapy with and without skeletal anchorage in growing Class III patients with unilateral cleft lip and palate (UCLP): A single-center, prospective randomized clinical trial. Spec Care Dentist 2024; 44:491-501. [PMID: 37084175 DOI: 10.1111/scd.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the maxillary protraction effect of facemask therapy with and without skeletal anchorage in growing Class III patients with unilateral cleft lip and palate (UCLP). MATERIALS AND METHODS Thirty patients (aged 9-13 years) with UCLP having a GOSLON score 3 were selected for this prospective clinical study. The patients were allocated into two groups using computer generated random number table. Group I (facemask therapy along with two I shaped miniplates, FM + MP) and Group II (facemask mask along with tooth-anchored appliance, FM). Skeletal and dental parameters were evaluated on pre- and post-treatment lateral cephalograms and pharyngeal airway on cone-beam computed tomography systems (CBCT) for assessment of the treatment changes. RESULTS Both methods proved to be effective with statistically significant improvements in skeletal and dental parameters (p < .05). Skeletal parameters (e.g., SNA, convexity-point A, ANB) with the FM + MP group showed greater change compared to those with FM group (SNA, 2.56°; convexity-point A, 1.22°; ANB, 0.35°). Significant proclination of maxillary incisors was observed in the FM group as compared to FM + MP group (U1 to NA, 5.4°; 3.37 mm). A statistically significant increase in pharyngeal airway volume was noted in both groups (p < .05). CONCLUSION While both therapies are effective in protracting the maxilla in growing patients with UCLP, the FM + MP allows for a greater skeletal correction, minimizing the dental side effects seen with FM therapy alone. Thus, FM + MP appears to be a promising adjunct in reducing the severity of Class III skeletal correction needed in patients with cleft lip and palate (CLP).
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Affiliation(s)
- Shuvadeep Dutta
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India
| | - Puneet Batra
- Department of Orthodontics and Dentofacial Orthopedics, Manav Rachna Dental College, Faridabad, Haryana, India
| | | | | | - Aditya Talwar
- Department of Orthodontics and Dentofacial Orthopedics, Manav Rachna Dental College, Faridabad, Haryana, India
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26
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Bins GP, Dourado J, Tang J, Kogan S, Runyan CM. "Primary Correction of the Cleft Nasal Septum: A Systematic Review". Cleft Palate Craniofac J 2024; 61:373-382. [PMID: 36120835 DOI: 10.1177/10556656221127539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients affected by cleft lip and palate have a characteristic nasal deformity; however, the treatment timeline varies amongst providers. There has been a shift from a more conservative approach to earlier intervention in order to allow for more normal development of the nose. Form, function, and future development all must be considered. For this reason, this investigation was undertaken to present the current literature available on the effects to all aspects of primary septoplasty in the cleft nasal deformity. An initial list of 222 papers was identified, and it was determined that 16 papers fit the inclusion criteria. Studies were included in which the initial age of operation for the majority of patients was between 3 and 12 months and in which patients underwent septal repositioning at the time of cleft lip repair. These papers were all reviewed by a single author initially, and the results recorded. All results were then verified by a second author for accuracy and completeness. Symmetry was found to be improved by primary septoplasty. Growth was not found to be impaired in any study; data was insufficient to indicate that growth was improved. Obstruction was improved as determined both by imaging, endoscopy, and patient survey. Finally, reoperation rates occurred at an acceptable rate not exceeding that of primary rhinoplasty without septoplasty. Primary septoplasty leads to better aesthetic symmetry and function of the cleft nose without impairing growth. This change is maintained into adulthood often without the need for revisionary surgery.
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Affiliation(s)
- Griffin P Bins
- Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Justin Dourado
- Department of Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - Jason Tang
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Samuel Kogan
- Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Christopher M Runyan
- Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
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27
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Stanton E, Kondra K, Jimenez C, Shakoori P, Yen S, Urata MM, Hammoudeh JA, Magee WP. Premaxillary Setback in Bilateral Cleft Lip and Palate Repair. Cleft Palate Craniofac J 2024; 61:416-421. [PMID: 36448087 DOI: 10.1177/10556656221130166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE The aim of this study is to evaluate surgical outcomes and maxillofacial growth in patients undergoing primary lip repair with or without premaxillary setback. DESIGN Retrospective review. SETTING Children's Hospital of Los Angeles, California. PATIENTS AND PARTICIPANTS Patients with bilateral cleft lip ± palate (BCLP) who underwent lip repair with or without premaxillary setback from January 1975 to September 2021. INTERVENTIONS No intervention was performed. MAIN OUTCOME MEASURE(S) Patient demographics, comorbidities, and syndromic status were obtained. Indications for premaxillary setback, incidence of midface hypoplasia, orthodontic and/or orthognathic treatments, follow-up, complications, and revisions were recorded and analyzed. Comparisons among long-term outcomes, particularly the development of midface hypoplasia were made between groups. RESULTS Thirty-one patients who underwent BCLP repair with premaxillary setback (BCLP + PS) and 31 matched control patients who underwent BCLP repair without premaxillary setback (BCLP - PS) were included. Among the 2 groups, multiple logistic regression demonstrated that when controlling for comorbidities, syndromic status, timing of lip repair, and timing of palate repair, premaxillary setback was neither significantly associated with the development of midface hypoplasia (P = .076) nor the timing of midface hypoplasia development (P = .940) in those that ultimately acquired this facial dysmorphology. CONCLUSIONS While a high incidence of midface hypoplasia was seen in both BCLP ± PS and BCLP - PS, our findings demonstrate no difference in midface hypoplasia irrespective of premaxillary setback in the setting of BCLP. Future prospective studies investigating the downstream ramifications of our suggested selection criteria for premaxillary setback are warranted.
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Affiliation(s)
- Eloise Stanton
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
| | - Katelyn Kondra
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
| | - Christian Jimenez
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
| | - Pasha Shakoori
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
| | - Stephen Yen
- Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA
| | - Mark M Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
- Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey A Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
- Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - William P Magee
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
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Dos Santos CCO, Bastos RTDRM, Normando D. Orthodontic Retainers and the Stability of the Maxillary Arch in Unilateral Cleft lip and Palate Patients: A Systematic Review. Cleft Palate Craniofac J 2024; 61:433-442. [PMID: 36444129 DOI: 10.1177/10556656221133954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE The aim of this systematic review was to elucidate the role of orthodontic retainers on the stability of compensatory orthodontic treatment in patients with unilateral cleft lip and palate. METHODS Five electronic databases (PubMed, Scopus, Web of Science, LILACS, and LIVIVO) and the grey literature (OpenGrey and Google Scholar) were investigated, according to the population, exposure, comparator, outcomes and Study design eligibility criterion. The risk of bias assessment was determined based on the Risk of Bias In Nonrandomized Studies of Exposure (ROBINS-E) and the level of evidence with the GRADE tool. RESULTS Three studies were included: two presented moderate risk of bias and one high. A moderate level of evidence revealed a mean value of 0.6 mm of intercanine relapse distance, and great variability between the data, regardless of the use or type of retention or rehabilitation. Relapse in the posterior region showed clinical significance, from -1 to -1.7 mm, especially in individuals who did not use retention, except in patients with symmetrical arches with Hawley retainer, where this value varies from -0.2 ± 0.63 mm. CONCLUSIONS Orthodontic retainers do not seem essential to prevent relapse at anterior maxillary dimensions after compensatory orthodontic treatment in patients with unilateral cleft lip and palate. Relapse in the posterior region can achieve greater clinical significance, which highlights the need for prolonged use of Hawley retainers and periodic evaluation of the stability of treatment results. Prospective studies with a longer follow-up can improve the certainty of the evidence.
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Affiliation(s)
| | | | - David Normando
- Department of Orthodontics, School of Dentistry, Federal University of Pará, Belem, Brazil
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29
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Weissbach T, Lev S, Haimov A, Massarwa A, Shamay I, Plaschkes R, Assa L, Elkan-Miller T, Weisz B, Nardini G, Armon N, Sharon R, Mazaki Tovi S, Kassif E. The Hard Palate Sweep: a multiplanar 2-dimensional sonographic method for the prenatal detection of cleft palate. Am J Obstet Gynecol 2024; 230:356.e1-356.e10. [PMID: 37741531 DOI: 10.1016/j.ajog.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Prenatal diagnosis of cleft palate is challenging. Numerous 2-dimensional and 3-dimensional methods have been proposed to assess the integrity of the fetal palate, yet detection rates remain relatively low. We propose the "Hard Palate Sweep," a novel 2-dimensional method that enables clear demonstration of the entire fetal palate throughout pregnancy, in a single sweep, avoiding acoustic shadows cast by surrounding bones. OBJECTIVE This study aimed to assess the feasibility and performance of the Hard Palate Sweep, performed throughout pregnancy. STUDY DESIGN This was a prospective cross-sectional study performed between 2018 and 2022 in pregnant patients referred for a routine or targeted anomaly scan between 13 and 40 weeks of gestation. The presence or absence of a cleft palate was determined using the "Hard Palate Sweep." This was compared with the postnatal palate integrity assessment. Test feasibility and performance indices, including sensitivity, specificity, and positive and negative predictive values were calculated. Offline clips were reviewed by 2 investigators for the assessment of inter- and intraoperator agreement, using Cohen's kappa formula. The study protocol was approved by the institutional ethics committee. All participating patients were informed and provided consent. RESULTS A total of 676 fetuses were included in the study. The Hard Palate Sweep was successfully performed in all cases, and 19 cases were determined to have a cleft palate. Of these, 13 cases were excluded because postmortem confirmation was not performed, leaving 663 cases available for analysis. Six cases determined to have a cleft palate were confirmed postnatally. In 655 of 657 cases prenatally determined to have an intact palate, this was confirmed postnatally. In the 2 remaining cases, rare forms of cleft palate were diagnosed postnatally, rendering 75% sensitivity, 100% specificity, 100% positive predictive value, and 99.7% negative predictive value for the Hard Palate Sweep (P<.001). There was complete intra- and interoperator agreement (kappa=1; P<.0001). CONCLUSION The Hard Palate Sweep is a feasible and accurate method for prenatally detecting a cleft palate. It was successfully performed in all attempted cases between 13 and 40 weeks of gestation. This method is reproducible, offering high sensitivity and specificity. Implemented routinely, the Hard Palate Sweep is expected to increase the prenatal detection of cleft palate.
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Affiliation(s)
- Tal Weissbach
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shir Lev
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adina Haimov
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abeer Massarwa
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Shamay
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Roni Plaschkes
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Assa
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Elkan-Miller
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Nardini
- Department of Plastic Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Noam Armon
- Department of Plastic and Aesthetic Surgery, Hadassah University Medical Center, Jerusalem, Israel
| | - Roni Sharon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Shali Mazaki Tovi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sahni V. Validity of Healthcare-Related Content on Digital Platforms. Cleft Palate Craniofac J 2024; 61:517. [PMID: 36205084 DOI: 10.1177/10556656221132373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
With a plethora of unverified digital content on healthcare floating around, it is imperative for organizations and stakeholders in healthcare to take effective measures in order to develop credible as well as popular sources of healthcare-related information to counter the threat of medical misinformation and its consequent catastrophic effects on the society at large. This communication brings to light some such initiatives.
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Affiliation(s)
- Vaibhav Sahni
- Unit of Periodontics, Oral Health Sciences Centre (OHSC), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Norsa'adah B, Nurhazalini-Zayani CG, Aniza AA, Normastura AR, Ahmad-Burhanudddin A. Stress and Coping Strategies in Malay Parents of Children with Cleft Lip and/or Palate. Cleft Palate Craniofac J 2024:10556656241236011. [PMID: 38414354 DOI: 10.1177/10556656241236011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE This study was aimed at describing the level of stress and types of coping strategies used among Malay parents of children with cleft lip and/or palate (CL/P). DESIGN Cross-sectional study. SETTING A dental clinic and a general hospital. PARTICIPANTS Parents (N = 84) whose children were less than 12 years old with CL/P. METHODS Socio-demographic data and clinical characteristics of CL/P were collected. Self-administered validated Malay versions of the stress scale from the Depressive, Anxiety and Stress Scale-42 (DASS-42) and COPE Inventory questionnaires were used. Descriptive statistics and Multivariate Analysis of Covariance were used for data analysis. RESULTS The prevalence of stress among parents of children with CL/P was 21.4% [95% confidence interval (12.4, 30.4)]. The most common coping strategies were problem-focused (mean 58.15, standard deviation (SD) 7.75), followed by emotion-focused (mean 54.05, SD 4.78). The adjusted mean score for overall coping strategies was significantly different between stressed and non-stressed parents after adjustment for education, number of children, sex of child with CL/P, and cleft type [F (df) = 4.174 (3,74), P = .009]. There was a significant mean difference between stressed and non-stressed parents for avoidant coping strategies [P = .003]. Problem-focused and emotion-focused coping strategies did not differ after Bonferroni correction. CONCLUSIONS Around a fifth of parents caring for children with CL/P experienced stress and avoidant coping strategies were more common among stressed parents. Multi-disciplinary team care should provide social support to parents of children with CL/P.
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Affiliation(s)
- Bachok Norsa'adah
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Che Ghazali Nurhazalini-Zayani
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Abd Aziz Aniza
- Medical Faculty, Universiti Sultan Zainal Abidin, Medical Campus, Kuala, Terengganu, Malaysia
| | - Abd Rahman Normastura
- School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
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Nogueira VO, Neves MC, Neppelenbroek K, Oliveira TM, Sforza C, Soares S. Facial Analysis of Patients with Unilateral or Bilateral Cleft Lip and Palate Using 3D Stereophotogrammetry. Cleft Palate Craniofac J 2024:10556656241234603. [PMID: 38403944 DOI: 10.1177/10556656241234603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVES To evaluate the quantitative values of linear and angular facial anthropometrics in patients with unilateral cleft lip and palate (UCLP) and compare them with those of patients with bilateral cleft lip and palate (BCLP) using three-dimensional (3D) facial imaging. DESIGN Retrospective, observational, and cross-sectional study. SETTING Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP). PATIENTS/ PARTICIPANTS In total, 61 non-syndromic patients with CLP who underwent multidisciplinary treatment and rehabilitated with a prosthesis were enrolled and divided into those with UCLP (G1; n = 31) and those with BCLP (G2; n = 30). INTERVENTION Facial images were captured using a 3D camera after landmarks were marked on each patient's face. The software evaluated linear and angular parameters. Statistical tests were applied. Significance was determined as P < 0.05. MAIN OUTCOME MEASUREMENTS Overall, 22 linear and 13 angular measurements were evaluated. RESULTS The nasal length (P = 0.08), middle third of the face (P = 0.06), base nose width (P < 0.001), nasal root width (P < 0.001), nasal tip angle (P = 0.018), philtrum width (P < 0.001), lower face width (P = 0.039) and midfacial depth (P = 0.040) were significantly higher in G2; the upper cutaneous lip height was significantly higher in G1. Sexual dimorphism was observed except for linear measurements (linear distance between the labiale superius and labiale inferius landmarks, nasal root width, and upper cutaneous lip length) and angular measurements. CONCLUSIONS G2 had a greater length and width of nose and nasal root, nasal tip angle, philtrum width, and lower face width, midfacial depth, and midface third than G1. These findings also revealed the presence of sexual dimorphism.
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Affiliation(s)
- Vanessa Ota Nogueira
- Post graduate student, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Maria Carolina Neves
- Post graduate student, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Karin Neppelenbroek
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Thaís Marchini Oliveira
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
| | - Chiarella Sforza
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Bauru, Brazil
| | - Simone Soares
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
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Lara LDS, Coletta RD, Assis Machado R, Querino Rocha de Oliveira L, Martelli Júnior H, de Almeida Reis SR, Scariot R, Evaristo Ricci Volpato L. Exploring the role of the WNT5A rs566926 polymorphism and its interactions in non-syndromic orofacial cleft: a multicenter study in Brazil. J Appl Oral Sci 2024; 32:e20230353. [PMID: 38359266 PMCID: PMC11018296 DOI: 10.1590/1678-7757-2023-0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/04/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Associations between the WNT5A rs566926 variant and non-syndromic orofacial cleft (NSOC) have been reported in different populations. OBJECTIVE This study aimed to investigate the role of the rs566926 single nucleotide polymorphism (SNP) in WNT5A and its interactions with SNPs in BMP4, FGFR1, GREM1, MMP2, and WNT3 in the occurrence of NSOC in a Brazilian population. METHODOLOGY A case-control genetic association study was carried out involving participants from four regions of Brazil, totaling 801 patients with non-syndromic cleft lip with or without cleft palate (NSCL±P), 273 patients with cleft palate only (NSCPO), and 881 health volunteers without any congenital condition (control). Applying TaqMan allelic discrimination assays, we evaluated WNT5A rs566926 in an ancestry-structured multiple logistic regression analysis, considering sex and genomic ancestry as covariates. Interactions between rs566926 and variants in genes involved in the WNT5A signaling pathway (BMP4, FGFR1, GREM1, MMP2, and WNT3) were also explored. RESULTS WNT5A rs566926 was significantly associated with an increased risk of NSCL±P, particularly due to a strong association with non-syndromic cleft lip only (NSCLO), in which the C allele increased the risk by 32% (OR: 1.32, 95% CI: 1.04-1.67, p=0.01). According to the proportions of European and African genomic ancestry, the association of rs566926 reached significant levels only in patients with European ancestry. Multiple interactions were detected between WNT5A rs566926 and BMP4 rs2071047, GREM1 rs16969681 and rs16969862, and FGFR1 rs7829058. CONCLUSION The WNT5A rs566926 polymorphism was associated with NSCL±P, particularly in individuals with NSCLO and high European ancestry. Epistatic interactions involving WNT5A rs566926 and variants in BMP4, GREM1, and FGFR1 may contribute to the risk of NSCL±P in the Brazilian population.
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Affiliation(s)
- Lorraynne Dos Santos Lara
- Universidade de Cuiabá, Programa de Pós-Graduação em Ciências Odontológicas Integradas, Faculdade de Odontologia de Cuiabá, Cuiabá, MT, Brasil
| | - Ricardo D Coletta
- Universidade Estadual de Campinas, Departamento de Diagnóstico Oral e Programa de Pós-Graduação em Biologia Buco-Dental, Faculdade de Odontologia de Piracicaba, Piracicaba, SP, Brasil
| | - Renato Assis Machado
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Programa de Pós-Graduação em Biologia Buco-Dental, Piracicaba, SP, Brasil
| | - Lilianny Querino Rocha de Oliveira
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Programa de Pós-Graduação em Biologia Buco-Dental, Piracicaba, SP, Brasil
| | - Hercílio Martelli Júnior
- Universidade Estadual de Montes Claros, Departamento de Odontologia, Clínica de Estomatologia, Montes Claros, MG, Brasil, e
| | | | - Rafaela Scariot
- Universidade Federal do Paraná, setor de Ciências da Saúde, Departamento de Estomatologia, Disciplina de Cirurgia Bucomaxilofacial, Curitiba, PR, Brasil
| | - Luiz Evaristo Ricci Volpato
- Universidade de Cuiabá, Programa de Pós-Graduação em Ciências Odontológicas Integradas, Faculdade de Odontologia de Cuiabá, Cuiabá, MT, Brasil
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Sasaki M, Togashi S, Aihara Y, Sasaki K, Shibuya Y, Oshima J, Sekido M. Long-term results of orbicularis oris muscle reconstruction in primary cleft lip repair using the "basket-weave method". Nagoya J Med Sci 2024; 86:64-71. [PMID: 38505716 PMCID: PMC10945217 DOI: 10.18999/nagjms.86.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/12/2023] [Indexed: 03/21/2024]
Abstract
The basket-weave method is an orbicularis oris muscle reconstruction method used in primary unilateral cleft lip repair. We compared the long-term results of the basket-weave method with those of a conventional method. For primary unilateral cleft lip repair, we compared the long-term results of 7 cases in which the orbicularis oris muscle was reconstructed by use of the basket-weave method, and of 7 cases in which the reconstruction was performed by use of the conventional method. The average postoperative follow-up period was 12 years and 7 months for the basket-weave method, and 11 years and 9 months for the conventional method. Using photographs of the front and elevation angle views, we evaluated the results as good if the philtrum ridge was formed on the fissure side and was almost symmetrical in height; as fair if the philtrum ridge was lower than the normal side; and as poor if the philtrum ridge had disappeared. For the basket-weave method, the results were good in 6 cases (85.7%), fair in 1 case (14.3%), and poor in 0 cases. For the conventional method, the results were good in 2 cases (28.6%), fair in 4 cases (57.1%), and poor in 1 case (14.3%). A significant difference was found between the 2 groups (Mann-Whitney U test, P = 0.0417). The philtrum ridge shape could be reconstructed by use of the basket-weave method, which gave better results in the long-term than did the conventional method for orbicularis oris muscle reconstruction in primary unilateral cleft lip repair.
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Affiliation(s)
- Masahiro Sasaki
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shinji Togashi
- Department of Plastic and Reconstructive Surgery, Shonai Amarume Hospital, Higashitagawa, Japan
| | - Yukiko Aihara
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kaoru Sasaki
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoichiro Shibuya
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Junya Oshima
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Abstract
The anatomic subunit approximation approach to unilateral cleft lip repair was developed over 20 years ago. While the underlying principles of the repair are unchanged, its description has been simplified, additional landmarks and creases have been added, and objective analysis of perioperative changes have provided better clarity regarding goals and desired alterations. We review recent insights regarding the deformity; describe the repair in a simplified manner; and link a stepwise approach to foundation-based primary rhinoplasty as a part of the avenue to creating nasolabial balance and harmony.
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Affiliation(s)
- Raymond W. Tse
- University of Washington, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
| | - David M. Fisher
- University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Chen L, Zeng N, Shi B, Huang H. Preliminary study on reliability and validity of the Chinese version of the Asher-McDade aesthetic index. Hua Xi Kou Qiang Yi Xue Za Zhi 2024; 42:97-103. [PMID: 38475957 DOI: 10.7518/hxkq.2024.2023196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVES This study aims to test the reliability and validity of the Chinese version of the Asher-McDade aesthetic index and clarify its feasibility for the postoperative outcome evaluation of cleft lip in China. METHODS The Chinese version of the Asher-McDade aesthetic index was established through translation, back translation, debugging, and pre-survey. Eighty postoperative photographs of patients with cleft lip admitted to the West China Hospital of Stomatology, Sichuan University were included. Ten healthcare professionals, including surgeons, nurses, and students, in the department of cleft lip and palate surgery finished the index to test its reliability and validity. RESULTS The Cronbach's alpha coefficient and retest reliability of this index are 0.804 and 0.895, respectively. The item-level content validity index (I-CVI) and scale-level content validity index ave-rage (S-CVI/ave) of the index are 1.000 and 0.95, respectively. For this index, the Kaiser-Meyer-Olkin (KMO) test score is 0.706, the χ2 value of Bartlett's test for the consistency of the index is 962.260 (P<0.01), and the cumulative variance contribution rate is 63.095%. CONCLUSIONS The Chinese version of the Asher-McDade aesthe-tic index has good reliability and validity and is applicable to the professional evaluation of the effect of postoperative photographs in Chinese patients with cleft lip.
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Affiliation(s)
- Lixian Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ni Zeng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Hanyao Huang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Sharma RK, Landeen KC, Ortiz A, Belcher RH, Phillips JD, Stephan SJ, Yang SF, Patel PN. National Trends of Otolaryngology Involvement in Cleft Surgical Management over 10-Years. Laryngoscope 2024; 134:671-677. [PMID: 37314217 DOI: 10.1002/lary.30812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/19/2023] [Accepted: 05/28/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Surgical management of cleft lip/palate and cleft rhinoplasty have historically been performed by plastic surgeons. No study has addressed temporal trends in cleft-associated surgeries. This study assesses trends in cleft surgical management and complications in a national database. METHODS Cross-sectional analysis of the National Surgical Quality Improvement Program Pediatric database from 2012 to 2021. Patients receiving cleft lip and/or palate repair were isolated using CPT codes. A subset receiving cleft rhinoplasty was also analyzed. The yearly proportion of otolaryngologists compared to general plastic surgeons performing surgeries was noted. Regression analysis was used to identify trends and predictors of management by OHNS. RESULTS We identified 46,618 cases of cleft repair, of which 15.6% (N = 7,255) underwent repair with otolaryngology. On univariate Pearson correlation analysis, neither cleft rhinoplasties performed by OHNS over time (R = 0.371, 95% CI -0.337 to 0.811, p = 0.2907) nor all cases (R = -0.26, -0.76 to 0.44, p = 0.465) exhibited a significant change. On multivariable regression, the operative year was not associated with being treated by otolaryngology (p = 0.826) for all cleft cases but was associated with such in cleft rhinoplasties (OR 1.04, 1.01-1.08, p = 0.024). On multivariable analysis, the operative year was correlated with a higher rate of complications overall (OR 1.04, 1.01-1.07, p = 0.002). Surgeon specialty was not associated with complication rates. CONCLUSIONS In the last 10 years, no change in the proportion of cleft lip/palate repair performed by OHNS was observed. Otolaryngologists are performing more cleft rhinoplasty but at a marginal rate. Otolaryngologists also manage more complex patients with multiple comorbidities compared to their colleagues. Complication rates have increased overall regardless of surgeon specialty, warranting further investigation. LEVEL OF EVIDENCE 3 Laryngoscope, 134:671-677, 2024.
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Affiliation(s)
- Rahul K Sharma
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Kelly C Landeen
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Alexandra Ortiz
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Ryan H Belcher
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - James D Phillips
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Scott J Stephan
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Shiayin F Yang
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Priyesh N Patel
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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Taritsa IC, Ledwon JK, Bajaj A, Gosain AK. 12-Year Trends of Orofacial Clefts in the United States: Highlighting Racial/Ethnic Differences in Prevalence of Cleft Lip and Cleft Palate. Cleft Palate Craniofac J 2024:10556656241227033. [PMID: 38291621 DOI: 10.1177/10556656241227033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE Discrepancies in prevalence among infants with orofacial clefts are public health research priorities. Our objective was to calculate updated estimated prevalence of orofacial clefts in the United States, with sub-analyses by racial/ethnic group. DESIGN The National Birth Defect Prevention Network database was used to evaluate trends in cases with orofacial cleft in the United States from 2006 to 2018. Cases with cleft lip with and without cleft palate (CL ± P) and cleft palate (CP) alone were sub-stratified by racial/ethnic category. Estimated prevalence was calculated using the total live births reported in each maternal racial/ethnic group. The odds ratio (OR) was calculated to measure the strength of association between racial/ethnic group and risk of orofacial clefts. RESULTS Estimated prevalence rates show that maternally-reported Native American/Alaskan Native individuals were 43.8% (p < 0.0001) and 36.0% (p < 0.0001) more likely to have CL ± P and CP alone, respectively, compared to maternally-reported non-Hispanic White individuals. Estimated prevalence of CL ± P in maternally-reported non-Hispanic Black individuals (OR = 0.64) and maternally-reported Asians/Pacific Islander individuals were significantly lower than in maternally-reported non-Hispanic White individuals (OR = 0.63, p < 0.0001). Estimated prevalence of CP alone was significantly lower in maternally-reported non-Hispanic Black individuals (OR = 0.64, p < 0.0001), maternally-reported Asians/Pacific Islander individuals (OR = 0.69, p < 0.0001), and maternally-reported Hispanic individuals (OR = 0.81, p < 0.0001). CONCLUSIONS Across the total population, there was no significant change in estimated orofacial cleft prevalence. However, there were significant disproportions in estimated orofacial cleft prevalence across racial/ethnic groups, which may guide further discussion among craniofacial health care providers and centers and their patients regarding differences in cleft risk factors.
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Affiliation(s)
- Iulianna C Taritsa
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joanna K Ledwon
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anitesh Bajaj
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Almoammar KA. Harnessing the Power of Artificial Intelligence in Cleft Lip and Palate: An In-Depth Analysis from Diagnosis to Treatment, a Comprehensive Review. Children (Basel) 2024; 11:140. [PMID: 38397252 PMCID: PMC10886996 DOI: 10.3390/children11020140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/25/2024]
Abstract
Cleft lip and palate (CLP) is the most common craniofacial malformation, with a range of physical, psychological, and aesthetic consequences. In this comprehensive review, our main objective is to thoroughly examine the relationship between CLP anomalies and the use of artificial intelligence (AI) in children. Additionally, we aim to explore how the integration of AI technology can bring about significant advancements in the fields of diagnosis, treatment methods, and predictive outcomes. By analyzing the existing evidence, we will highlight state-of-the-art algorithms and predictive AI models that play a crucial role in achieving precise diagnosis, susceptibility assessment, and treatment planning for children with CLP anomalies. Our focus will specifically be on the efficacy of alveolar bone graft and orthodontic interventions. The findings of this review showed that deep learning (DL) models revolutionize the diagnostic process, predict susceptibility to CLP, and enhance alveolar bone grafts and orthodontic treatment. DL models surpass human capabilities in terms of precision, and AI algorithms applied to large datasets can uncover the intricate genetic and environmental factors contributing to CLP. Additionally, Machine learning aids in preoperative planning for alveolar bone grafts and provides personalized treatment plans in orthodontic treatment. In conclusion, these advancements inspire optimism for a future where AI seamlessly integrates with CLP management, augmenting its analytical capabilities.
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Affiliation(s)
- Khalid A Almoammar
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia
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Sabbagh HJ, AlSharif MT, Abdulhameed FD, Aljohar AJ, Alhussain RM, Alghamdi SM, Alrejaye NS, AlGudaibi LY, Sallout BI, Albaqawi BS, Alnamnakani EA, Brekeit LK, Basri OA, Almalik MI, Al Soqih NS, Alshaikh AB, Aburiziza AJ, Al Qahtani FA, Alghamdi BM, Alraddadi AK, Khaja HH, Alamoudi RA. Maternal Exposure to Stress During Covid-19 and Non-Syndromic Orofacial Clefts: A Cohort Retrospective Study. Cleft Palate Craniofac J 2024:10556656231224198. [PMID: 38239006 DOI: 10.1177/10556656231224198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE The coronavirus (COVID-19) pandemic presents an opportunity to study stress's effect on the development of non-syndromic orofacial clefts (NSOFCs). This study was aimed at assessing maternal stress exposure during the pregestational to first trimester pregnancy periods and the development of NSOFCs during a year of the COVID-19 pandemic. DESIGN Cohort study of infants with NSOFCs and controls matched based on recruitment site and age. SETTING Government hospitals in Saudi Arabia between November 2020 and November 2021. MAIN OUTCOME MEASURES Data collection included NSOFC clinical examination and maternal stress exposure assessment using the Modified Life Events Questionnaire, the Fear of COVID-19 Scale, and a focus on the lack of pregnancy planning and a threatened miscarriage. RESULTS Of the 557 infants recruited, 191 had NSOFCs. Logistic regression analysis with adjusted odds ratios (AORs) that removed the effects of confounders showed that any of the seven stressful life events (AOR:3.78, P < .001) and the family histories of relatives with NSOFCs (AOR:9.73, P < .001) increased the AOR for NSOFC development. In contrast, maternal folic acid (AOR:0.56, P.010), threatened miscarriage (AOR:0.17, P = .001), fear of COVID-19 (AOR:0.83, P = .038), and suspected COVID-19 infection (AOR:0.43, P = .008) decreased the AOR for NSOFC development. CONCLUSION Along with an established risk associated with family history of birth defects, stressful life events may be a risk factor for NSOFC development. Beyond folic acid's known benefit, it may be that higher maternal health concerns contribute to increased protective health behaviors during pregnancy. Ongoing research is needed to specify the maternal risk factors for NSOFC.
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Affiliation(s)
- Heba Jafar Sabbagh
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mona Talal AlSharif
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fatma Dawood Abdulhameed
- Pediatric Surgery Department, King Salman Medical City, Maternity and Children's Hospital, Madinah, Saudi Arabia
| | - Aziza Johar Aljohar
- Consultant Pedodontist, Department of Dentistry, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Reema Mahdi Alhussain
- Pediatric Dentistry Department, Dammam Medical Complex, Eastern Province, Saudi Arabia
| | - Sultan Musaad Alghamdi
- Pediatric Dentistry Department, Bisha Dental Centre, Ministry of Health, Bisha, Saudi Arabia
| | - Najla Sulaiman Alrejaye
- Preventive Dental Science Department, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Latifa Yousef AlGudaibi
- Resident in the Saudi Board of Orthodontics and Dentofacial Orthopedics Program, King Abdulaziz Medical City, Ministry of National Guard Health Affairs; King Saud bin Abdulaziz University for Health Sciences, College of Dentistry; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Bahauddin Ibraheem Sallout
- Consultant in Obstetrics and Gynecology, Maternal Fetal Medicine, Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Badi Shoaib Albaqawi
- Consultant, Maternal Fetal Medicine, Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Lougin Khalid Brekeit
- Orthodontic Resident, Orthodontics and Dentofacial Orthopedics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Osama Adel Basri
- Craniofacial Orthodontists, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Manal Ibrahim Almalik
- Consultant Pedodontist, Dental Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Norah Suliman Al Soqih
- Department of Pediatrics, Qassim University, College of Medicine, Buraidah, Saudi Arabia
| | - Ali Bakr Alshaikh
- Resident in Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Faisal Ali Al Qahtani
- Pediatric Dentistry Department, Faculty of Dentistry, King Khalid University, Abha, Saudi Arabia
| | | | | | - Hadeel Hamza Khaja
- Center of Congenital Malformations in Fetuses and Newborns, King Salman bin Abdulaziz Medical City, Madinah, Saudi Arabia
| | - Rana Abdullah Alamoudi
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Lu Y, Zhao JJ, He P. A 12 Week Fetus with Anophthalmia, Limb Anomalies and Infratemporal Teratoma. Int J Womens Health 2024; 16:41-46. [PMID: 38222311 PMCID: PMC10788060 DOI: 10.2147/ijwh.s441452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024] Open
Abstract
Background Microphthalmia is a rare autosomal recessive condition commonly known as Waardenburg anophthalmia syndrome (WAS) or oculo-acromal formation syndrome (MIM#206920). Case Description Here, we report the case of a woman whose fetal ultrasonography at 12 weeks of pregnancy revealed multiple fetal abnormalities. These included the absence of the left upper limb, an unclear display of the right orbit, a visible maxillary space, and a round, echoless appearance measuring 4 mm in diameter in the middle of the forehead. There was also a significant echo in the sac wall. The possibility of a frontal meningocele or a proboscis-like nose was considered. The fetus was delivered with absence of the left upper limb, absence of the right eye, a cleft lip on the right side, and a milky white sac with a diameter of 5 mm on the forehead after the pregnancy was terminated at the hospital. Pathological investigation revealed a mature cystic teratoma. The conclusion was microphthalmia with limb anomalies (MLA) after missing limbs, absence of eyes, and cleft lip were input into the Online Mendelian Inheritance in Man database. The case was diagnosed with fetal microphthalmia with limb anomalies and an interfrontal teratoma. Conclusion In this case, the entire exon analysis was not conducted, and as a result, the final diagnosis remains unclear. Based exclusively on the phenotype of the induced fetus, MLA was diagnosed. It is proposed that cases satisfying the requirements for a pathological diagnosis should undergo a pathological examination to establish a definitive diagnosis.
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Affiliation(s)
- Yu Lu
- Department of Ultrasonography, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Jing-Jing Zhao
- Department of Pathology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Ping He
- Department of Ultrasonography, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
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Rihs S, Parisi L, Lauener A, Mansour F, Schnyder I, Dekany GM, La Scala GC, Katsaros C, Degen M. Reflecting the human lip in vitro: Cleft lip skin and mucosa keratinocytes keep their identities. Oral Dis 2024. [PMID: 38178623 DOI: 10.1111/odi.14844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/10/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Cell models have shown great promise as tools for research, potentially providing intriguing alternatives to animal models. However, the original tissue characteristics must be maintained in culture, a fact that is often assumed, but seldom assessed. We aimed to follow the retention of the original tissue identities of cleft lip-derived skin and mucosa keratinocytes in vitro. METHODS Cleft lip-derived keratinocytes were isolated from discarded tissue along the cleft margins during cheiloplasty. Cell identities were assessed by immunohistochemistry and quantitative real-time PCR for tissue-specific markers and compared with native lip tissue. Moreover, keratinocytes were regularly analyzed for the retention of the original tissue characteristics by the aforementioned methods as well as by differentiation assays. RESULTS The various anatomical zones of the human lip could be distinguished using a panel of differentiation and functional-based markers. Using these markers, retention of the original tissue identities could be followed and confirmed in the corresponding primary keratinocytes in culture. CONCLUSIONS Our findings promote patient-derived cells retaining their original identities as astonishing and clinically relevant in vitro tools. Such cells allow a better molecular understanding of various lip-associated pathologies as well as their modeling in vitro, including but not restricted to orofacial clefts.
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Affiliation(s)
- Silvia Rihs
- Laboratory for Oral Molecular Biology, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Ludovica Parisi
- Laboratory for Oral Molecular Biology, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Anic Lauener
- Laboratory for Oral Molecular Biology, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Farah Mansour
- Laboratory for Oral Molecular Biology, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Isabelle Schnyder
- University Clinic for Pediatric Surgery, Bern University Hospital, Bern, Switzerland
| | - Gabriela M Dekany
- University Clinic for Pediatric Surgery, Bern University Hospital, Bern, Switzerland
| | - Giorgio C La Scala
- Division of Pediatric Surgery, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Christos Katsaros
- Laboratory for Oral Molecular Biology, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Martin Degen
- Laboratory for Oral Molecular Biology, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
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43
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Muller JN, Diaz A, Flores RL, Staffenberg DA. Abbe Flap Division Before Two Weeks' Time: Harmful or Advantageous? Cleft Palate Craniofac J 2024:10556656231223615. [PMID: 38166385 DOI: 10.1177/10556656231223615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION The Abbe flap is a standard intervention to treat upper lip deformities in patients with bilateral cleft lip. This two-stage procedure requires a 2 to 3-week period in which the superior and inferior lips remain connected. This study evaluates the safety of Abbe flap division and inset prior to 14 days' time. MATERIALS AND METHODS A single institution, 8-year review of all patients with a bilateral cleft lip who underwent Abbe flap reconstruction was performed. Patients were classified into two groups: those whom division was performed 14 days or later and those with division earlier than 14 days. RESULTS A total of 26 patients were identified. Patients who underwent Abbe flap division in less than 14 days (n = 10) demonstrated an average time to division of 9.7 days (range 7-13 days) with no evidence of flap loss, wound breakdown or infection. Patients who underwent Abbe flap division within 14 days or more (n = 16) demonstrated an average time to division of 15 days with four minor complications and no flap loss. CONCLUSION Dividing the Abbe flap after the first postoperative week appears to be safe and without additional risk to flap loss or wound breakdown. A shorter time to Abbe flap division may decrease the burden of care on patients and their caregivers.
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Affiliation(s)
- John N Muller
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, 10016, USA
| | - Allison Diaz
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, 10016, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, 10016, USA
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, 10016, USA
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44
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Goich K, Schachter T. A Scoping Review: Autologous Fat Grafting to Improve Volume and Aesthetics of Cleft Lip Deformity. Cureus 2024; 16:e52632. [PMID: 38374830 PMCID: PMC10876285 DOI: 10.7759/cureus.52632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/20/2024] [Indexed: 02/21/2024] Open
Abstract
A frequent problem following cleft lip repair is insufficient lip volume and unappealing aesthetics. Autologous fat grafting is a method of improving the appearance of post-correction deformity. The aim of this review is to evaluate the effectiveness of autologous fat grafting in improving the aesthetics of cleft lip deformity. The benefits of adipose-derived stem cells (ADSCs), benefits and complications of fat grafting, timing of grafting, and harvest and transplant techniques will be examined. This review process used "PubMed" and "Google Scholar" as primary databases. Searches were performed using combinations of key terms: "Fat Graft," "Cleft Lip," "Vermillion," "Autologous Fat Transplantation," and "Adipocyte Derived Stem Cell." Reviews of reference lists for additional pertinent data were performed. Autologous fat grafting may be performed during primary repair or as a secondary correction. Statistically significant improvements in appearance were observed in some or all measured variables regardless of repair timing. Both timing options show favorable outcomes; however, there is more evidence in support of grafting as a secondary correction. Some degree of graft reabsorption will occur, lending evidence to the practice of overcorrecting to accommodate losses. Graft retention is stabilized by the 12-month mark. The presence of ADSCs within the graft aids in graft stabilization and retention. Despite a lack of longitudinal data to examine graft retention throughout a patient's lifetime, autologous fat grafting appears to be a safe and minimally invasive method of repairing deformity secondary to cleft lip repair supported by follow-up data as far as two years postoperatively with minimal reported complications.
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Affiliation(s)
- Kenneth Goich
- Medical School, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
| | - Todd Schachter
- Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, USA
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45
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Da Silva AM, De Lavôr JR, Freitas VS, Vieira AR. Risk of orofacial clefts in relation to maternal body mass index, diabetes and hypertension. J Neonatal Perinatal Med 2024; 17:41-48. [PMID: 38277306 DOI: 10.3233/npm-230118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND To investigate if maternal body mass index, diabetes and hypertension are associated with orofacial clefts. METHODS Case-control study. Information from 53,188 live births with and without orofacial cleft registered at USA Vital Statistics Natality Birth Data between 2017 and 2021. Case group consisted of all affected live births diagnosed with orofacial clefts (13,297 cases). Comparison group consisted of 39,891 live births without clefts or any other congenital malformation. Information about orofacial cleft cases were compared with the comparison group. The unadjusted and adjusted Odds Ratios were estimated to evaluate the strength of association between mother's pre-pregnancy body mass index, maternal diabetes and hypertension and orofacial cleft occurrence, assuming a p value < 0.05 and 95% confidence intervals (95% C.I.) for statistically significant differences. RESULTS Mother's pre-pregnancy body mass index, maternal diabetes and maternal hypertension are conditions associated with an increased risk of orofacial cleft development in the child (OR = 1.08, p = 0.004, 95% C.I. = 1.024-1.149; OR = 1.32, 95%, p = 0.000, 95% C.I. = 1.202-1.444; and OR = 1.35, p = 0.000, 95% C.I. = 1.239-1.484; respectively). Maternal ethnicity, sex of infant, and cigarette smoking pregnancy remained as covariates after adjustments in all logistic regression models. CONCLUSION Due to the increased prevalence of obesity, diabetes, and hypertension, and also to their association with congenital malformations, such as clefts, it is recommended that mothers planning to become pregnant to follow healthy habits, maintain healthy weight, and be screened for possible diabetes or hypertension prior to conception and early in pregnancy.
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Affiliation(s)
- A M Da Silva
- Public Health PhD Graduate Program, State University of Feira de Santana, Feira de Santana, BA, Brazil
- Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - J R De Lavôr
- Pediatric Dentistry PhD Graduate Program, State University of Pernambuco, Recife, PE, Brazil
- Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - V S Freitas
- Department of Health, State University of Feira de Santana, Feira de Santana, BA, Brazil
| | - A R Vieira
- Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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46
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Lemberger M, Peterson P, Andlin Sobocki A, Setayesh H, Karsten A. Long-term radiographic and periodontal evaluations of the bone-grafted alveolar cleft region in young adults born with a UCLP. Eur J Orthod 2024; 46:cjad064. [PMID: 37955939 PMCID: PMC10783154 DOI: 10.1093/ejo/cjad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Studies addressing the periodontal health of the teeth surrounding the bone-grafted cleft in patients born with unilateral cleft lip and palate disagree on whether periodontal health is compromised. OBJECTIVES To determine periodontal health differences between the cleft and the non-cleft sides nearly a decade after secondary alveolar bone grafting. METHODS This prospective, controlled (split-mouth design) study comprised an intraoral apical radiographic and a periodontal examination of 40 consecutive patients from one centre (n = 26 males) who had undergone bone grafting at mean age of 10.2 years (±1.6). Probing pocket depth, gingival index, gingival recession, and radiographic bone support were assessed. RESULTS No significant difference occurred in probing pocket depth between teeth at cleft and non-cleft sites (OR 1.8, P = .488). Gingival recession was present at 6.6% of all examined sites on the cleft side and at 1.7% on the non-cleft side (OR 17.3, P < .001). Gingival recession occurred most often on the buccal and disto-buccal surfaces of the central incisor on the cleft side. The gingival index was significantly higher on the cleft side (OR 8.0, P < .001). The Bergland index was I or II in most patients (87%). LIMITATIONS Recruitment of eligible patients was lengthy. CONCLUSION The teeth on the cleft side had high levels of gingival inflammation. Few pathological gingival pockets, however, were found. Shallow gingival recessions frequently occurred around the central incisor on the cleft side. Teeth in the bone-grafted cleft region generally had good bone support.
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Affiliation(s)
- Mathias Lemberger
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04 Huddinge, Sweden
- Eastman Institute, Department of Orthodontics, Public Dental Services Stockholm, Box 6031, SE-102 31 Stockholm, Sweden
| | - Petra Peterson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Plastic and Reconstructive Surgery, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Anna Andlin Sobocki
- Department of Surgical Sciences, Uppsala University and Akademiska hospital, 751 85 Uppsala, Sweden
| | - Hedieh Setayesh
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04 Huddinge, Sweden
| | - Agneta Karsten
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04 Huddinge, Sweden
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Alassaf MS, Hasubah SM, Sharbib SH, Alhammad R, Othman AA, Alsulaimani MA, Qazali AA. Assessment of Quality and Readability of Web-Based Arabic Knowledge About Cleft Lip and/or Palate: An Infodemiology Study. Cleft Palate Craniofac J 2023:10556656231223861. [PMID: 38158230 DOI: 10.1177/10556656231223861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the quality and readability of the Arabic web-based information about cleft lip and/or palate (CL/P).Materials and Method: Searching in three engines and checking eligibility for the first 300 websites. The quality of the included websites (72) was assessed using the DISCERN questionnaire, JAMA benchmarks, and HON code. The readability of the websites was assessed using three readability tests: FKGL, SMOG, and FRE. Then, data analysis was done. RESULTS All checked websites were partly related to CL/P and contained medical facts. The affiliation of most of the websites was commercial 33 (45.8%). The mean overall DISCERN score was 2.87 (± 1.61). The maximum score was not achieved by any website, and only one (1.4%) website had the minimum score. For JAMA benchmarks, the currency was the most achieved item in 39 (54.2%) websites, and none of the websites achieved the four items. Only one website had the HON code. Based on the FRE scale, the level was very easy for most of the websites 57 (79.2%). CONCLUSION The available content about CL/P is readable but with moderate to poor quality and trustfulness. Undoubtedly, there is a serious need to increase and improve the quality of the web-based Arabic population's knowledge about CL/P, especially by governmental institutions and universities. Establishing specialized websites for CL/P is also needed.
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Affiliation(s)
- Muath S Alassaf
- Department of Orthodontics and Dentofacial Orthopedics, Taibah University, Madinah, Saudi Arabia
| | - Saad M Hasubah
- Department of Dental Education, Taibah University, Madinah, Saudi Arabia
| | - Shadan H Sharbib
- Department of Dental Education, Taibah University, Madinah, Saudi Arabia
| | - Reem Alhammad
- Department of Dental Education, Taibah University, Madinah, Saudi Arabia
| | - Ahmad A Othman
- Department of Oral and Maxillofacial surgery, Taibah University, Madinah, Saudi Arabia
| | - Mahmoud A Alsulaimani
- Department of Orthodontics and Dentofacial Orthopedics, Taibah University, Madinah, Saudi Arabia
| | - Ahmad A Qazali
- Department of Prosthodontics, Taibah University, Madinah, Saudi Arabia
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48
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Francisquetti MCC, Gil-da-Silva-Lopes VL, Fett-Conte AC. How are people with orofacial clefts attended in northwest region of São Paulo state, Brazil? Genet Mol Biol 2023; 46:e20230167. [PMID: 38112488 PMCID: PMC10729311 DOI: 10.1590/1678-4685-gmb-2023-0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023] Open
Abstract
Characterization of specific birth defects is essential for conducting scientific investigations, care and therapeutic strategies. This article describes demographic, clinical and genetic aspects, risk factors and access to treatment of Brazilian patients with orofacial clefts registered in a specialized collaborative center of the Brazilian Database on Craniofacial Anomalies (BDCA). We interviewed 70 individuals with typical orofacial clefts using a standard instrument from the database and subjected them to genetic testing. The patients were grouped as syndromic and non-syndromic. The majority of individuals were of lower middle class, native ancestry and syndromic. There was a significant difference in the type of clefts regarding gender. There was no significant difference between bilateral and unilateral, between the side affected, right and left, or familial recurrence related to type of oral cleft. The risk factor familial recurrence was significantly higher among non-syndromic cases. Etiological factors were identified or suggested in 62.5% of the syndromic cases. There was a delay in diagnosis and in access to treatment in most cases. We concluded that gender, native ancestry and low family income represent risk factors. Furthermore, the distribution by cleft types and gender is similar to previous studies. The results can guide scientific investigations and care policies.
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Affiliation(s)
- Marina Cristine Cano Francisquetti
- Universidade Estadual Paulista, Instituto de Biociências, Letras e Ciências Exatas, Programa de Pós-Graduação em Biociências, São José do Rio Preto, SP, Brazil
| | | | - Agnes Cristina Fett-Conte
- Faculdade de Medicina de São José do Rio Preto, Departamento de Biologia Molecular, São José do Rio Preto, SP, Brazil
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Castejón-González AC, Reiter AM. Surgical treatment for cleft palate in dogs yields excellent outcomes despite high rates of oronasal fistula formation: a narrative review. J Am Vet Med Assoc 2023; 261:S34-S43. [PMID: 37607675 DOI: 10.2460/javma.23.06.0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023]
Abstract
Cleft palate is the most common congenital orofacial defect in dogs. Although this topic has been extensively studied in experimental dogs, current literature on clinical patients is limited to case reports and small case series studies with many individual opinions based on experience. This narrative review summarizes the literature of the last 10 years with application to clinical practice, focusing on the preparation of the patient until surgery, options for surgical management, and perioperative complications. Surgical treatment must be performed to obtain separation between the nasal/nasopharyngeal and oral/oropharyngeal passages. This will allow the dog to have independent function and reduce clinical signs associated with food, water, and other foreign material entering the respiratory tract. Surgical treatment has good to excellent outcomes when the procedure is carefully planned and appropriately executed despite the high rates of postoperative oronasal fistula reported.
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50
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Tonni G, Sepulveda W. Cleft Lip and Cleft Palate: Time to Include Orofacial Ultrasound Markers Into the First-Trimester Anatomy Scan? J Ultrasound Med 2023; 42:2905-2909. [PMID: 37551869 DOI: 10.1002/jum.16310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/09/2023]
Abstract
Orofacial clefts are one of the most common congenital malformations. The prenatal diagnosis is often made in the second trimester of pregnancy as result of ultrasound examination of the midface on coronal and axial planes. However, the diagnosis in the first trimester is elusive due to the small size of the facial structures and technical limitations present at this early gestational age. In this Commentary, we suggest the routine systematic ultrasound identification of easy-to-obtain landmarks to improve the detection of cleft lip and cleft palate in the first trimester. These include, but are not limited to, visualization of the primary palate using the coronal plane of the face looking for disruption at the base of the retronasal triangle, and visualization of the palate using the sagittal plane looking for the maxillary gap and loss of the superimposed line. Early prenatal detection of orofacial clefts would allow a more detailed search for associated chromosomal anomalies or genetic syndromes.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
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