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Relational development in children with cleft lip and palate: influence of the waiting period prior to the first surgical intervention and parental psychological perceptions of the abnormality
Bruno Grollemund, Antoine Guedeney, Marie-Paule Vazquez, Arnaud Picard, Véronique Soupre, Philippe Pellerin, Etienne Simon, Michel Velten, Caroline Dissaux, Isabelle Kauffmann, Catherine Bruant-Rodier, Anne Danion-Grilliat
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-65
Abstract: The main hypothesis is that the longer the time-lapse before the first surgicalintervention, the more likely are the psychological perceptions of the parents to affect the harmonious development of their child. Parents and children are seen twice, when the child is 4 months (T0) and when the child is one year old (T1). At these two times, the psychological state of the child and his/her relational abilities are assessed by a specially trained professional, and self-administered questionnaires measuring factors liable to affect child–parent relationships are issued to the parents. The Alarme Détresse BéBé score for the child and the Parenting Stress Index score for the parents, measured when the child reaches one year, will be used as the main criteria to compare children with early surgery to children with late surgery, and those where the diagnosis was obtained prior to birth with those receiving it at birth.The mental and psychological dimensions relating to the abnormality and its correction will be analysed for the parents (the importance of prenatal diagnosis, relational development with the child, self-image, quality of life) and also, for the first time, for the child (distress, withdrawal). In an ethical perspective, the different time lapses until surgery in the different protocols and their effects will be analysed, so as to serve as a reference for improving the quality of information during the waiting period, and the quality of support provided for parents and children by the healthcare team before the first surgical intervention.ClinicalTrials.gov Identifier: NCT00993993.Cleft lip with or without cleft palate (CLP), or cleft palate alone (CP) are the most frequent cranio-facial malformations in humans. The prevalence in France is 1/700 births, but incidence varies according to geographical origins from 1/300 births for Asians to 1/2500 births among Africans [1-3]. Two clinical forms are generally distinguished: CP, and unilateral or bilateral CLP which
The importance of multi-professional, interdisciplinary care in rehabilitation and health promotion directed at patients with cleft lip/palate
Lorenzzoni, Daniela;Carcereri, Daniela Lemos;Locks, Arno;
Revista Odonto Ciência , 2010, DOI: 10.1590/S1980-65232010000200018
Abstract: cleft lip/palate is the one of the most prevalent congenital craniofacial deformities. according to data from the brazilian institute of statistics and studies carried out at the craniofacial anomaly rehabilitation hospital in bauru/sp, cleft lip/palate occurs in one out of every 650 births in brazil. cleft lip/palate may result in impairments that stigmatize the individual and have an impact on health, emotions and social interaction. treatment requires children with cleft lip/palate to be monitored from birth to young adulthood in order to avoid further functional, aesthetic and psychological impact. the present literature review offers reflections on the organization of the work process of multi-professional, interdisciplinary care in rehabilitation and health promotion directed at patients with cleft lip/palate. there are gaps in the integration between the specialties that make up the three levels of care in the brazilian public health care system and there is a need for the government to ensure reference and counter-reference services.
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.
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.
Etiology, classification, diagnosis and treatment of cleft lip and palate.
Sofia Mavroudi,Leda Rekopoulou,Nikolaos A. Papadopulos,Moschos A. Papadopoulos
Hellenic Orthodontic Review , 2007,
Abstract: Cleft lip and palate constitutes one of the most common congenital anomalies. This paper attempts a contemporary literature review concerning the etiology, classification and diagnosis of clefts of the lip, alveolus, soft and hard palate. Clefts of the lip, alveolus and palate are entities of varied etiology that may be genetically determined. However, their manifestation is also influenced by environmental factors during pregnancy. Today, clefting may be diagnosed at the beginning of the 2nd gestational trimester through advanced techniques of prenatal control. This paper also discusses aspects of normal facial development and cleft pathogenesis. Furthermore, the major parameters of cleft treatment recommended by the American Cleft Palate-Craniofacial Association are presented comprehensively. In conclusion, long-term follow up of patients in specialized centers by experienced inter-disciplinary teams is of particularly importance for the best possible management of these patients.
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.
Cleft lip and palate in northern Nigerian children
DS Adeola, CN Ononiwu, SA Eguma
Annals of African Medicine , 2003,
Abstract: Background: Cleft lip and palate are congenital abnormalities often seen and managed early in life in the developed world. The current approach to management is a multidisciplinary one. In this part of the world however, patients present at a later age and are managed by a single specialist. Methods: A retrospective review of children with cleft lip and palate seen and managed over a 10- year period was done using data obtained from patients' case folders. Results: Five hundred children were treated over the ten-year period. 56.8% of patients treated presented with cleft lip alone while 43.2% had both cleft lip and palate. More males than females presented with cleft lip alone while more females had both cleft lip and palate. 59.3% of the patients were less than one year of age. There was a positive family history of cleft lip and palate in 5.5% of patients. Malnutrition, anaemia, convulsion, ear infection, diarrhoea, malaria fever, upper respiratory tract infection and skin rashes were often seen in these patients at first visit. All patients were managed by maxillofacial surgeons and anaesthetists. There was no involvement of the orthopaedic and plastic surgeon, orthodontist or speech therapist in patients' management. Conclusion: Though management of cleft lip and palate was successful within our limits, there is need to increase public awareness of the treatment possibilities available and to adopt a team approach to management in order to improve treatment outcome.
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