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Anatomical Variations in Clefts of the Lip with or without Cleft Palate  [PDF]
K. Carroll,P. A. Mossey
Plastic Surgery International , 2012, DOI: 10.1155/2012/542078
Abstract: Objective. Few orofacial cleft (OFC) studies have examined the severity of clefts of the lip or palate. This study examined associations between the severity of cleft of the lip with cleft type, laterality, and sex in four regional British Isles cleft registers whilst also looking for regional variations. Design. Retrospective analysis of cleft classification in the data contained in these four cleft registers. Sample. Three thousand and twelve patients from cleft registers based in Scotland, East England, Merseyside, and Belfast were sourced from the period 2002–2010. Submucous clefts and syndromic clefts were included whilst stillbirths, abortuses, and atypical orofacial clefts were excluded. Results. A cleft of the lip in CLP patients is more likely to be complete in males. A cleft of the lip in isolated CL patients is more likely to be complete in females. Variation in the proportion of cleft types was evident between Scotland and East England. Conclusions. Association between severity of cleft of the lip and sex was found in this study with females having a significantly greater proportion of more severe clefts of the lip (CL) and CLP males being more severe . This finding supports a fundamental difference between cleft aetiology between CL and CLP. 1. Introduction Maintaining a register of children born with orofacial clefts is recognised as important with regards to audit, research, and the planning and provision of services [1]. The use of a simple classification, such as the LAHSAL system proposed by Kriens in 1989 [2] to describe clefts is recognised as being of prime importance and allows for the accurate recording of cleft types and comparison between locations [3]. The evidence available at a global and European level indicates very significant regional variation in the birth prevalence of orofacial clefts, both cleft palate (CP) and cleft lip and palate (CLP) [4]. It is well known that the aetiology of orofacial clefts is characterised by heterogeneity and that the aetiology is polygenic multifactorial with both environmental and genetic factors contributing to nonsyndromic type [5], which comprises approximately 70% of all orofacial clefts. The increase in CP seen in some UK studies and in parts of Scandinavia may be as a result of factors associated with their northern position [6]. The proportion of CP in Sweden was shown to increase with the increase in latitude at which the comparison was carried out [7]. Several studies have shown that females are affected more often than males with regards to isolated CP [6, 8, 9]. Conversely, a
Julija Radojicic,Tatjana Tanic,Andrija Radojicic,Aleksandar Radojicic
Acta Medica Medianae , 2007,
Abstract: Lip and palate cleft (cheilognathopalatoschisis) is most often congenital defect that affects craniofacial region. It is characterized by a difficult clinical presentation.The etiology is multicausal and not yet fully understood. The examination of numerous etiological factors imposed the need to study the role of stress in the development of lip and palate cleft. This is all the more important for the socioeconomic factors that characterized our society in the last years, after bombardment, poverty, higher divorce rate, and more family violence. The aim of this paper was to establish the importance of stressful events and their role in the development of lip and palate cleft. The examination included children born from March 1999 (time of war in this area), till December 2003, as well as their mothers.The study group comprised 96 children with the lip and palate cleft anomaly, and the control one included 142 healthy children. The chosen examinees were not under the influence of other etiological factors, such as heritage. The examination was conducted using a questionnaire containing questions related to stressful situations in the first trimester of pregnancy. The questions were thus formed so as to be clear to mothers of different levels of education, without expert phrases,except in the cases where it was necessary. The statistical differences between the study and control group were determined using Pearson's χ2 test. In the first trimester, the mothers of the study group, in regard to the control group,statistically more often had fears or anxiety (p<0.01), disorganized emotional life(p<0.001), more often phychological harassment (p<0.001), and the presence of any kind of harassment (p<0.001). The presence of stress was also greater in the study group, on the significance borderline in relation to the control group.The stressful situations to which mothers of the study group were exposed are in correlation with the increase of the children with lip and palate cleft.
Psychological issues in cleft lip and cleft palate
Sousa Avinash,Devare Shibani,Ghanshani Jyoti
Journal of Indian Association of Pediatric Surgeons , 2009,
Abstract: Vocational and social issues affect rehabilitation and development of patients with cleft lip and cleft palate. However, psychological problems like lowered self esteem and difficulties in social interaction have also been noted in them. Not many pediatric reconstructive surgery teams have a psychiatrist on their panel. It is likely that psychological problems are higher in incidence than literature actually suggests. Hence it is very essential that such cases are identified by the surgical team to maximize positive outcome of surgery and rehabilitation. This study discusses psychological issues revolving around cleft lip and cleft palate along with lacunae in many psychological research studies.
Simultaneous Repair of Cleft Hard Palate by Vomer Flap along with Cleft Lip in Unilateral Complete Cleft Lip and Palate Patients  [PDF]
Kazi Md. Noor-ul Ferdous,M. Saif Ullah,M. Shajahan,M. Ashrarur Rahman Mitul,M. Kabirul Islam,Kiorsh Kumar Das,M. A. Mannan,M. Junaed Rahman,Sanjoy Biswas,A. J. M. Salek,Bijoy Krishna Das
ISRN Plastic Surgery , 2013, DOI: 10.5402/2013/954576
Abstract: The purpose of the study was to see the short-term outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP). A prospective observational study was carried out in 35 patients with unilateral complete cleft lip and palate who under-went cleft lip and cleft hard palate repair with vomer flaps simultaneously. After 3 months, cleft soft palate was repaired. During 1st and 2nd operations, the gap between cleft alveolus and posterior border of the cleft hard palate was measured. Postoperative complications, requirement of blood transfusion during the operation, and duration of operations were also recorded. Simultaneous repairs of cleft lip and closure of cleft hard palate with vomer flaps are easy to perform and are very effective for the repair of cleft lip and palate in UCLP patients. No blood transfusion was needed. Gaps of alveolar cleft and at the posterior border of hard palate were reduced remarkably, which made the closure of the soft palate easier, decreased operation time, and also decreased the chance of oronasal fistula formation. 1. Introduction Every year more than 5000 patients with cleft lip and palate are born [1]. The incidence of cleft lip and/or cleft palate in Bangladesh is 3.9 per 1000 live births [2]. Patient with cleft lip-palate usually leads a very miserable life unless surgically treated, due to the ack of social support, inadequate multidisciplinary approach to deal with the total problems, and most of the cleft patients come to the doctor only when their parents are aware or when the child had some problems like repeated respiratory tract infection, feeding difficulty, and social problems (e.g., even maternal divorce) [1]. For those reasons, we get patients of varying ages and problems like repeated ear infection, abnormal teeth eruption, permanent articular problems, and deafness. Some parents prefer cleft lip repair first irrespective of the age of the child only for aesthetic region and do not come again for cleft palate or oronasal fistula closure due to poverty, transport problem, and lack of knowledge [1, 3]. There are many procedures for the closure of the cleft lip and palate [4–7]. In unilateral complete cleft lip-palate (UCLP), if only cleft lip repaired first, it needs extensive dissection during palatoplasty, taking more time for operation and more chances of oronasal fistula formation, and if cleft palate repair is done earlier, there may be midfacial growth disturbance [8, 9]. But, after
Comparison of periodontal status among patients with cleft lip, cleft palate, and cleft lip along with a cleft in palate and alveolus  [cached]
Boloor Vinita,Thomas Biju
Journal of the Indian Society of Periodontology , 2010,
Abstract: Background and Objectives : A healthy periodontium is an important prerequisite for unhindered dentition and long-term oral health. In cleft subjects, especially in those with cleft lip, alveolus and palate (CLAP), maintenance of oral hygiene is a difficult task for the patients because of the patent oro-nasal communication. Crowding of teeth in cleft patients is a common finding, especially in those with CLAP and those with cleft palate (CP). In the case of multiple tooth-malpositions , transverse deficiency, arch length deficiency and primary cross-bite; periodontal trauma increases and is detrimental to periodontal health . According to literature, a critical periodontal situation was found in patients with CLAP. Hence a study was conducted to analyze the periodontal status of patients with cleft lip (CL); those with cleft palate; and those with cleft lip, alveolus and palate. Materials and Methods: The present study consisted of 60 cleft subjects divided into 3 groups: those with cleft lip; those with cleft palate; and those with cleft lip, alveolus and palate. Subjects with permanent dentition were selected, and the clinical examination included determination of oral hygiene status using Oral Hygiene Index - Simplified (OHI-S) index and periodontal status using community periodontal index (CPI). Results: Statistically significant increase in the periodontal disease in the CLAP group as compared with the other 2 groups, and the oral hygiene was seen to be generally poor with the CLAP group. Interpretation and Conclusion: Individuals with clefts are more prone to periodontal disease due to the presence of cleft, which causes retention of food in the defect sites and inability to maintain good oral hygiene; but the severity of periodontal disease is more if the defect is large and involving the lip, alveolus and palate.
Prevalence of Oral Habits in Children with Cleft Lip and Palate  [PDF]
Paula Caroline Barsi,Thaieny Ribeiro da Silva,Beatriz Costa,Gisele da Silva Dalben
Plastic Surgery International , 2013, DOI: 10.1155/2013/247908
Abstract: This study investigated the prevalence of oral habits in children with clefts aged three to six years, compared to a control group of children without clefts in the same age range, and compared the oral habits between children with clefts with and without palatal fistulae. The sample was composed of 110 children aged 3 to 6 years with complete unilateral cleft lip and palate and 110 children without alterations. The prevalence of oral habits and the correlation between habits and presence of fistulae (for children with clefts) were analyzed by questionnaires applied to the children caretakers. The cleft influenced the prevalence of oral habits, with lower prevalence of pacifier sucking for children with cleft lip and palate and higher prevalence for all other habits, with significant association ( ). There was no significant association between oral habits and presence of fistulae ( ). The lower prevalence of pacifier sucking and higher prevalence of other oral habits agreed with the postoperative counseling to remove the pacifier sucking habit when the child is submitted to palatoplasty, possibly representing a substitution of habits. There was no causal relationship between habits and presence of palatal fistulae. 1. Introduction The manner how children are raised is very important for their full development, general health, and inclusion or exclusion of costumes and habits. Habit is a behavior acquired by the frequent repetition or physiologic exposure with regularity [1]. Related to the mouth, it is commonly observed in children and may be harmful when excessively repeated or in more vulnerable ages. They often involve patterns of muscle contraction and may contribute to the etiology of malocclusion, because they affect the entire orofacial region. In the presence of habits, the duration of the applied force is the most critical variable to be analyzed, because the longer the duration, the greater will be the impact on the dentition, musculature, and bone structure [2]. Considerable differences are observed in the prevalence of habits throughout the world. Traditions, cultural influences, and child raising are possible factors that influence their prevalence. The prevalence of sucking habits in Brazil seems to vary between states because of differences in culture, ethnicity, and lifestyle [3]. The period of breastfeeding has been indicated as a possible cause of nonnutritive sucking habits [3]. Holanda et al. [4] stated that breastfeeding for longer than six months is considered a protective factor against the persistence of pacifier use but
Management of cleft lip and palate in adults  [cached]
Murthy Jyotsna
Indian Journal of Plastic Surgery , 2009,
Abstract: Introduction: With advancement of medical services in developed countries and awareness among the patients, it is rare to find an adult with an unoperated cleft lip and palate. However, the scenario is totally different in developing countries. Working as a part of a team in developing country, where co-coordinated team work is primitive, resources to provide treatment are very thin, public awareness of availability of treatment for this anomaly is minimal, the age of patients reaching for primary treatment varies from few days to late forties. Though the aim and aspiration is to provide holistic multidisciplinary care, the priority is getting treatment for all cleft patients. In such situation, the management of cleft lip and palate demands changes of approach, techniques and philosophy. Aims and Objectives: The deformed anatomy especially the facial bones and dentition is described. Due to well established deformities, the approach for management is individualized. The procedures and modification of procedures has been described. Results and Outcome: The outcome of the primary repair is adults certainly have less than satisfactory outcome for obvious reasons. The expected outcome and expectation of patients and families following primary surgeries in cleft lip and palate has been discussed. Though all adult patients got some improvement in speech after palate repair, achieving normal speech was difficult. The naso-labial appearance was not perfect, but well accepted by the patients and families. There are many psychosocial problems in these patients, the objective evaluation could not be done due to too many variables. However, primary repair of cleft lip and palate is justified and beneficial for the patients.
Incidence of cleft lip and palate in Tehran  [cached]
Jamilian A,Nayeri F,Babayan A
Journal of the Indian Society of Pedodontics and Preventive Dentistry , 2007,
Abstract: The purpose of this study was to assess the epidemiology and some of the possible risk factors causing oral cleft in Tehran. The study was a 7-year retrospective study from March 1998 to March 2005. Twenty-five live births with cleft lip and/or palate (CL ± P) were born between 20 March 1998 and 20 March 2005 from the total of 11,651 live births in a maternity hospital in Tehran. After recognizing the child as a cleft patient, previous and following children born were recognized as a noncleft sample. Cleft and noncleft samples were compared for variables such as gender, mother′s age, parity, consanguineous marriage and infant′s weight, and then analyzed with Chi-square. The overall incidence was 2.14 per 1000 live births. CL+ P is more prevalent, which was 52% and the least incidence was for "only cleft lip′′ patients, which was 12%. This study reveals that the incidence of oral clefts in Tehran is higher than many other countries. Consanguineous marriage and low birth weight in cleft group were significant statistically from those of noncleft group.
Influence of lip closure on alveolar cleft width in patients with cleft lip and palate
Wolfgang Eichhorn, Marco Blessmann, Oliver Vorwig, Gerd Gehrke, Rainer Schmelzle, Max Heiland
Head & Face Medicine , 2011, DOI: 10.1186/1746-160x-7-3
Abstract: A total of 44 clefts were investigated using plaster casts, 30 unilateral and 7 bilateral clefts. All infants received a passive molding plate a few days after birth. The age at the time of closure of the lip was 2.1 month in average (range 1-6 months). Plaster casts were obtained at the following stages: shortly after birth, prior to lip closure, prior to soft palate closure. We determined the width of the alveolar cleft before lip closure and prior to soft palate closure measuring the alveolar cleft width from the most lateral point of the premaxilla/anterior segment to the most medial point of the smaller segment.After lip closure 15 clefts presented with a width of 0 mm, meaning that the mucosa of the segments was almost touching one another. 19 clefts showed a width of up to 2 mm and 10 clefts were still over 2 mm wide. This means a reduction of 0% in 5 clefts, of 1-50% in 6 clefts, of 51-99% in 19 clefts, and of 100% in 14 clefts.Early lip closure reduces alveolar cleft width. In most cases our aim of a remaining cleft width of 2 mm or less can be achieved. These are promising conditions for primary alveolar bone grafting to restore the dental bony arch.The treatment of children with a cleft lip and palate remains a challenge. Beginning at birth, it is necessary to balance several aspects of treatment such as growth, esthetics, function, and psychosocial development. Especially in children with a complete bilateral cleft lip and palate, many problems remain unsolved. Apart from intrinsic tissue deficiency and anatomic aberrations, there is difficulty in restoring the orbicularis oris muscle, in creating a philtrum, and in lengthening the columella. Furthermore, benefit of early orthopedic treatment is still questioned. Unrestricted premaxillary growth also gives rise to many problems. Surgeons have not reached consensus regarding best type and timing of lip- and palatal closure. Similarly, orthodontists have not reached agreement on early management of the alv
Nursing habits in cleft lip and palate children
Cintia Magali da Silva,Beatriz Costa,Lucimara Teixeira das Neves
RSBO , 2012,
Abstract: Introduction: Cleft lip and palate anomalies are malformations that affect patients causing some alterations. These alterations can compromise maternal nursing and lead to early introduction of bottle feeding and sugar in the diet of cleft lip and palate infants, compromising their oral health and the surgical/rehabilitation process. Objective: The purpose of this study was to evaluate the nursing habits and the use of baby bottles in a group of cleft lip and palate infants. Material and methods: Two hundred and twenty nine mothers of cleft lip and palate infants in the age range from 6 to 36 months enrolled in the Hospital for Rehabilitation of Craniofacial Anomalies – USP/Bauru were interviewed. It was obtained data on family socioeconomic characteristics as well as mother educational level using the patient’s file. Using a pre-structured questionnaire accomplished always by the same interviewer, information on natural and artificial nursing pattern was obtained. Results: Only 21.4% of the mothers accomplished breastfed their babies. 98.25% of mothers used bottle feeding with milk and other sucrose liquids at one to ten times frequency. Nocturnal nursing habit was verified in 59.38% of total sample. Conclusion: Cleft lip and palate infants presented inadequate nursing habits in relation to both the content and the frequency ingestion, suggesting the need of a multidisciplinary guidance and following-up of infants during this age range.

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