Effects of anesthesia and oral cleft types on academic achievement

ObjectiveResearch looking simultaneously at the effects of anesthesia and oral cleft types on academic achievement is scarce. Available results are contradictory: some studies suggest that anesthesia exposure is responsible for underachievement, and others that responsibility falls instead on the type of orofacial cleft. This study investigates the potential compound effects of exposure to anesthesia and orofacial cleft types on the risk of academic underachievement.DesignCentre Labio Palatin Albert Coninck, Cliniques universitaires Saint-Luc, Brussels, Belgium, nationwide register-based study.SettingBirth cohort 1995-2007.PatientsTwenty-nine children with isolated orofacial clefts exposed to anesthesia.InterventionsAverage duration of exposure to anesthesia before the Certificat d Etudes de Base (CEB) exam was 382 minutes.Main Outcome Measure(s)Scores obtained by patients at the CEB exam were compared with the scores of the 6th grade Belgian general population who passed the same exam controlling for gender, school year, year they passed the exam, medical illnesses, duration of exposure to anesthesia in minutes and socioeconomic confounders.ResultsDoubling the time of anesthesia exposure produces a 17 percentage point increase in the probability that patients will underachieve. Cleft lip reduces while cleft right-left increases the duration of anesthesia exposure relative to cleft lip palate. Results do not change when anesthesia exposure only up to 4 years and socioeconomic factors are considered.ConclusionsBoth exposure to anesthesia and different types of orofacial cleft may result in underachievement at the CEB exam.

Pregnancy Termination in the Case of an Orofacial Cleft: An Investigation of the Concept of Reproductive Autonomy

10.1177/1055665620929775 ◽

2020 ◽

Vol 57 (9) ◽

pp. 1134-1139

Author(s):

Kristien Hens ◽

Greet Hens

Keyword(s):

Pregnant Woman ◽

Cleft Lip ◽

Pregnancy Termination ◽

Clinical Information ◽

Orofacial Cleft ◽

Reproductive Autonomy ◽

Ethical Theories ◽

Cleft Lip Palate ◽

Ethical Approaches ◽

The Right

Objective: To describe ethical approaches to the issue of pregnancy termination after prenatal detection of cleft lip ± palate. Results: Gynecologists and cleft surgeons are sometimes confronted with the demand for a pregnancy termination after ultrasound detection of an isolated cleft lip/cleft palate. In this article, we discuss different ethical theories and principles that can be applied to the dilemma at hand. We formulate recommendations that will respect the right to autonomy of the pregnant woman and at the same time acknowledge that a termination of pregnancy for a cleft lip may in most cases not be the best option. Conclusion: The recognition of each person’s right to reproductive autonomy also entails that clinicians should make sure that prospective parents are provided with up-to-date and relevant clinical information.

Tomographic Pharyngeal Dimensions in Individuals with Unilateral Cleft Lip/Palate and Class III Malocclusion are Reduced When Compared with Controls

10.1597/15-124 ◽

2017 ◽

Vol 54 (5) ◽

pp. 502-508 ◽

Cited By ~ 6

Author(s):

Trindade-Suedam Ivy Kiemle ◽

Freire Lima Thiago ◽

Dominguez Campos Letícia ◽

Faria Yaedú Renato Yassutaka ◽

Filho Hugo Nary ◽

...

Keyword(s):

Cleft Lip ◽

Outcome Measure ◽

Cleft Lip And Palate ◽

Cone Beam ◽

Control Group ◽

Craniofacial Anomalies ◽

Class Iii ◽

Class Iii Malocclusion ◽

Cross Sectional ◽

Objective The objective of this study was to three-dimensionally evaluate the pharyngeal dimensions of individuals with complete nonsyndromic unilateral cleft lip and palate (UCLP) using cone beam computed tomography. Design This was a cross-sectional prospective study. Setting The study took place at the Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru-SP, Brazil. Patients and Participants The control group (CON) consisted of 23 noncleft adults with class III malocclusion, and the cleft group (UCLP) consisted of 22 individuals with UCLP and class III malocclusion. Two subgroups of individuals with class III malocclusion as a result of maxillary retrusion with (UCLP'; n = 19) and without (CON'; n = 8) clefts were also assessed. Interventions Pharyngeal volume, pharyngeal minimal cross-sectional area (CSA), location of CSA, pharyngeal length, sella-nasion-A point angle (SNA), sella-nasion-B point angle (SNB), and A point-nasion-B point angle (ANB), and body mass index were assessed using Dolphin software. Main Outcome Measure The pharyngeal dimensions of UCLP individuals are smaller when compared with controls. Results Mean pharyngeal volume (standard deviation) for the UCLP patients (20.8 [3.9] cm3) and the UCLP’ patients (20.3 [3.9] cm3) were significantly decreased when compared with the CON (28.2 [10.0] cm3) and CON’ patients (29.1 [10.2] cm3), respectively. No differences were found in the pharyngeal minimal CSA, ANB, or pharyngeal length values between groups (CON versus UCLP and CON’ versus UCLP'). CSAs were located mostly at the oropharynx, except in the UCLP’ patients, which were mainly at the hypopharynx. Mean SNA in the UCLP (76.4° [4.6°]) and UCLP’ groups (75.1 [3.1°]) were significantly smaller than those in the CON (82.8° [4.1°]) and CON’ groups (78.6° [1.2°]). SNB values were statistically smaller only for the comparison of CON versus UCLP patients. Conclusion The pharynx of individuals with UCLP and class III malocclusion is volumetrically smaller than that of individuals with class III malocclusion and no clefts.

Registry-Based Study of Prevalence of Cleft Lip/Palate in Thailand from 2012 to 2015

10.1177/1055665620987677 ◽

2021 ◽

pp. 105566562098767

Author(s):

Pornpoj Fuangtharnthip ◽

Wannapong Chonnapasatid ◽

Sasipa Thiradilok ◽

Somchai Manopatanakul ◽

Somchit Jaruratanasirikul

Keyword(s):

Staff Training ◽

Cleft Lip ◽

Outcome Measure ◽

Health Security ◽

Civil Registration ◽

Cleft Lip Palate ◽

Estimate Method ◽

Clinical Verification ◽

Pool Prevalence ◽

Very High

Objective: Two main objectives were established. First objective was to determine the prevalence of the cleft lip and/or cleft palate (CL/P) in Thailand from 2012 to 2015 using the orofacial clefts (OFCs) registry and civil registration. Second objective was to conduct a quality control of this OFC registry especially for the Birth Defects Registration (BDR). Design: Registry-based survey. Setting: Analyzing data from the Thailand National Health Security Office. Participants: Registered patients with CL/P in Thailand from 2012 to 2015. Intervention: None Main Outcome Measure: Duplicated records were verified using National Identity Number (Thai ID#) and date of birth. The prevalence of CL/P and specific phenotypes was then calculated. From this prevalence estimate method, quality assurance of the OFCs registry was possible. Results: For the main outcome, the population-weighted pool prevalence of CL/P was 2.14 per 1000 live births (95% confidence interval of 2.08-2.20). Thai ID# and expense reimbursement systems were the main factors driving this cases capturing. However, this OFCs registration still requires active case finding with clinical verification, improvement of staff training and databases networking. Conclusions: This study reported a very high CL/P prevalence of Thailand. Strengths and limitations of these OFCs registry and BDR were described.

Maternal Drug Use and Infant Cleft Lip/Palate with Special Reference to Corticoids

10.1597/02-077 ◽

2003 ◽

Vol 40 (6) ◽

pp. 624-628 ◽

Cited By ~ 65

Author(s):

Bengt Källén

Keyword(s):

Drug Use ◽

Cleft Palate ◽

Early Pregnancy ◽

Cleft Lip ◽

First Trimester ◽

Orofacial Cleft ◽

Orofacial Clefts ◽

Maternal Drug Use ◽

Median Cleft ◽

Objective To study the association between maternal drug use in early pregnancy and orofacial cleft in the infant. Design Register analysis based on prospectively collected information. Patients All delivered women in Sweden July 1, 1995, through December 31, 2001. Main outcome measure Presence of orofacial cleft in infant. Results Prospective information on maternal drug use during the first trimester, as reported in early pregnancy, was studied in 1142 infants with orofacial clefts, isolated or with other malformations, excluding chromosome anomalies. Any drug use was not associated with clefts (odds ratio [OR] = 0.98, 95% confidence interval [95% CI] = 0.85 to 1.13), with isolated clefts (OR = 0.92) with isolated median cleft palate (OR = 1.03, 95% CI = 0.79 to 1.36) or with isolated cleft lip with or without cleft palate (OR = 0.86, 95% CI = 0.71 to 1.05). Reported use of multivitamins, folic acid, or B12 was not associated with a decrease in orofacial cleft risk (OR = 1.00, 95% CI = 0.63 to 1.52). ORs above 2 were seen for some drugs: sulfasalazine, naproxen, and anticonvulsants, but only a few exposed cases occurred. An association between glucocorticoid use and infant cleft was indicated and seemed to be strongest for median cleft palate. Conclusion Maternal drug use seems to play only a small role for the origin of orofacial clefts, at least in Sweden.

Dysregulation of Rho GTPases in orofacial cleft patients-derived primary cells leads to impaired cell migration, a potential cause of cleft/lip palate development

Cells & Development ◽

10.1016/j.cdev.2021.203656 ◽

2021 ◽

Vol 165 ◽

pp. 203656

Author(s):

Mirvat El-Sibai ◽

Joelle El Hajj ◽

Maria Al Haddad ◽

Nada El Baba ◽

Mounir Al Saneh ◽

...

Keyword(s):

Cell Migration ◽

Rho Gtpases ◽

Cleft Lip ◽

Orofacial Cleft ◽

Primary Cells ◽

Palate Development ◽

Elementary School–Based Health Centers and Access to Preventive and Asthma-Related Care Among Publicly Insured Children With Asthma in Georgia

Public Health Reports ◽

10.1177/00333549211032973 ◽

2021 ◽

pp. 003335492110329

Author(s):

E. Kathleen Adams ◽

Veda C. Johnson ◽

Carol J. Hogue ◽

Daniela Franco-Montoya ◽

Peter J. Joski ◽

...

Keyword(s):

Asthma Control ◽

Health Centers ◽

Percentage Point Increase ◽

School Year ◽

School Based ◽

Point Increase ◽

Children With Asthma ◽

School Based Health Centers ◽

Publicly Insured ◽

Control Medication

Objectives We assessed the effects of 3 new elementary school–based health centers (SBHCs) in disparate Georgia communities—predominantly non-Hispanic Black semi-urban, predominantly Hispanic urban, and predominantly non-Hispanic White rural—on asthma case management among children insured by Medicaid/Children’s Health Insurance Program (CHIP). Methods We used a quasi-experimental difference-in-differences analysis to measure changes in the treatment of children with asthma, Medicaid/CHIP, and access to an SBHC (treatment, n = 193) and children in the same county without such access (control, n = 163) in school years 2011-2013 and 2013-2018. Among children with access to an SBHC (n = 193), we tested for differences between users (34%) and nonusers of SBHCs. We used International Classification of Diseases diagnosis codes, Current Procedural Terminology codes, and National Drug Codes to measure well-child visits and influenza immunization; ≥3 asthma-related visits, asthma-relief medication, asthma-control medication, and ≥2 asthma-control medications; and emergency department visits during the child–school year. Results We found an increase of about 19 ( P = .01) to 33 ( P < .001) percentage points in the probability of having ≥3 asthma-related visits per child–school year and an increase of about 22 ( P = .003) to 24 ( P < .001) percentage points in the receipt of asthma-relief medication, among users of the predominantly non-Hispanic Black and Hispanic SBHCs. We found a 19 ( P = .01) to 29 ( P < .001) percentage-point increase in receipt of asthma-control medication and a 15 ( P = .03) to 30 ( P < .001) percentage-point increase in receipt of ≥2 asthma-control medications among users. Increases were largest in the predominantly non-Hispanic Black SBHC. Conclusion Implementation and use of elementary SBHCs can increase case management and recommended medications among racial/ethnic minority and publicly insured children with asthma.

SURVIVAL OF SKIN HOMOGRAFTS EXCHANGED BETWEEN IDENTICAL TRIPLETS WITH DIFFERENT TYPES OF CLEFT LIP-PALATE DEFORMITIES

Plastic & Reconstructive Surgery ◽

10.1097/00006534-196012000-00007 ◽

1960 ◽

Vol 26 (6) ◽

pp. 622-625 ◽

Cited By ~ 1

Author(s):

LYNDON A. PEER ◽

IQBAL S. WALIA ◽

RUTH J. PULLEN

Keyword(s):

Cleft Lip ◽

Different Types ◽

Early academic achievement in children with isolated clefts: a population-based study in England

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-313777 ◽

2017 ◽

Vol 103 (4) ◽

pp. 356-362 ◽

Cited By ~ 9

Author(s):

Kate Jane Fitzsimons ◽

Lynn P Copley ◽

Efrosini Setakis ◽

Susan C Charman ◽

Scott A Deacon ◽

...

Keyword(s):

Academic Achievement ◽

Personal Development ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Hospital Admissions ◽

Surgical Techniques ◽

Population Based ◽

National Average ◽

Oral Cleft ◽

Z Scores

ObjectivesWe used national data to study differences in academic achievement between 5-year-old children with an isolated oral cleft and the general population. We also assessed differences by cleft type.MethodsChildren born in England with an oral cleft were identified in a national cleft registry. Their records were linked to databases of hospital admissions (to identify additional anomalies) and educational outcomes. Z-scores (signed number of SD actual score is above national average) were calculated to make outcome scores comparable across school years and across six assessed areas (personal development, communication and language, maths, knowledge of world, physical development andcreative development).Results2802 children without additional anomalies, 5 years old between 2006 and 2012, were included. Academic achievement was significantly below national average for all six assessed areas with z-scores ranging from −0.24 (95% CI −0.32 to −0.16) for knowledge of world to −0.31 (−0.38 to −0.23) for personal development. Differences were small with only a cleft lip but considerably larger with clefts involving the palate. 29.4% of children were documented as having special education needs (national rate 9.7%), which varied according to cleft type from 13.2% with cleft lip to 47.6% with bilateral cleft lip and palate.ConclusionsCompared with national average, 5-year-old children with an isolated oral cleft, especially those involving the palate, have significantly poorer academic achievement across all areas of learning. These outcomes reflect results of modern surgical techniques and multidisciplinary approach. Children with a cleft may benefit from extra academic support when starting school.