Prenatal Ultrasound Measurement of Fetal Stomach Size Is Predictive of Postnatal Development of GERD in Isolated Cleft Lip and/or Palate

2020 ◽  
pp. 105566562096871
Author(s):  
Marika Toscano ◽  
Kristen Burhans ◽  
Lauren M. Mack ◽  
Stephanie Henderson ◽  
Peter F. Koltz ◽  
...  
Keyword(s):  
Postnatal Development ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Chromosomal Abnormalities ◽  
Care Center ◽  
Tertiary Care ◽  
Surrogate Marker ◽  
Prenatal Ultrasound ◽  
Ultrasound Measurement ◽  
Control Measurement

Objective: To determine whether prenatal ultrasound measurement of fetal stomach size, as a surrogate marker of fetal swallowing, is predictive of postnatal development of gastroesophageal reflux disease (GERD) in cases of isolated cleft lip and/or palate (CL/P). Design: This is a retrospective case–control study. The outcome of interest is postnatal diagnosis of GERD in isolated CL/P. The exposure of interest is prenatal stomach size measurement by ultrasound. Setting: The study population was selected from an academic, tertiary care center between 2003 and 2011. Patients/Participants: Cases were neonates undergoing CL/P repair during the study period. Cases with other known structural or chromosomal abnormalities were excluded. Controls were contemporary, nondiabetic neonates that matched gestational age (within one week) to cases. Each case measurement was matched ∼1:2 with control measurement. Interventions: None. Main Outcome Measure: The primary outcome was difference in mean prenatal ultrasound measurement of fetal stomach size between cases and controls. We hypothesized that patients with postnatal development of GERD would have smaller mean fetal stomach size. Results: There were 32 cases including 19 patients with unilateral cleft lip and palate, 8 with unilateral cleft lip, and 4 with bilateral cleft lip and palate. Cases were noted to have smaller mean anterior–posterior and transverse fetal stomach measurements as compared to controls. This was statistically significant from 16 to 21 weeks, 25 to 27 weeks, and 28 to 36 weeks ( P < .01 for all). Conclusions: Prenatal ultrasound measurement of fetal stomach size as a surrogate marker of fetal swallowing is predictive of postnatal development of GERD in isolated CL/P.

Experiences of Canadian Parents of Young Children With Cleft Lip and/or Palate

2020 ◽  
pp. 105566562097727
Author(s):  
Eleonore E. Breuning ◽  
Rebecca J. Courtemanche ◽  
Douglas J. Courtemanche
Keyword(s):  
Health Care ◽  
Young Children ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Tertiary Care ◽  
Support Network ◽  
Tertiary Care Center ◽  
Care Needs ◽  
Care Experience

Purpose: Prior literature has described the perspectives of parents of young children with clip lip and/or palate; however, few studies have described parents’ experiences within a Canadian health care system. This study aims to better understand the experiences of parents of young children with cleft lip and/or palate seen at a Canadian tertiary care center and identify their care needs. Design: In-depth semistructured interviews. Setting: Pediatric tertiary care center. Participants: Parents of children younger than 7 years of age with cleft lip and/or palate. Results: From 14 interviews, 4 themes were identified. The diagnosis theme was associated with reactions, timing, and search for information. Key concerns within the theme of physiology and function were around feeding and speech. The health care experience theme included burden of care, peripheral hospitals and services, the cleft lip and palate clinic, and clinicians. The psychosocial theme included parents’ reactions to their child’s pain, coping strategies, family interactions, and school/day care experiences. Parents felt care could be improved by having: access to good information and community speech therapists, shorter appointment wait times, a peer support network, and increased cleft knowledge within their child’s school and peer groups. Conclusions: The experience of parents of children with cleft lip and/or palate is complex but can be organized into 4 themes. Clinics may consider suggestions offered by parents to improve care. Future work should address parents’ needs and aim to create a parent-reported quality-of-life measure specific to parents of young children with cleft lip and/or palate.

Postoperative Management of Cleft Lip and Palate Surgery

2018 ◽  
Vol 34 (06) ◽  
pp. 605-611 ◽  
Author(s):  
Ullas Raghavan ◽  
Dipesh Rao ◽  
Gautham Ullas ◽  
Vishwas Vijayadev
Keyword(s):  
Postoperative Care ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Tertiary Care ◽  
High Volume ◽  
Postoperative Management ◽  
Orofacial Clefts ◽  
Procedural Complications

AbstractCleft lip and palatal clefts are one of the most common birth defects with a global incidence of 1 in 700 live births. The majority of these orofacial clefts are nonsyndromic. However, a general screening for syndromes and other organ anomalies should always be performed as their association with orofacial clefts cannot be overlooked. With the recent progress in the knowledge of cleft repair, the procedures to correct cleft lip and palate though complex, have been simplified to allow improvisation in outcome and to achieve even better finesse of surgical result. The procedural complications and the pursuit of having near perfect esthetics and functionality, make this deformity a recipient of multiple procedures. This ensures that the patient is under the care of the treating surgeon for long term and allows the surgeon to follow-up on the result, not only to provide care but also to intercept any deviation in the desired outcome. Postoperative care of cleft lip and palate surgery is largely underdiscussed and a set of fixed guidelines will help the treating surgeon to provide the most comprehensive care to the cleft patients. The authors review the practices followed at their hospitals—a high volume cleft and craniofacial care center, a tertiary care multispeciality teaching hospital, and a community teaching and training hospital. The commonly followed practices with suitable evidence in postoperative care of these patients are enlisted here.

Etiology of Cleft Lip Lower Lip Deformity: Use of an Objective Analysis to Measure Severity

2019 ◽  
Vol 56 (10) ◽  
pp. 1333-1339 ◽  
Author(s):  
Mirte Langeveld ◽  
Richard A. Bruun ◽  
Maarten J. Koudstaal ◽  
Bonnie L. Padwa
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Case ◽  
Lower Lip ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Le Fort I ◽  
Control Study

Objective: Measure lower lip thickness and eversion in patients with cleft lip and palate (CLP) and maxillary hypoplasia. The specific aims were to (1) compare lower lip thickness/eversion in patients with CLP to noncleft controls with maxillary hypoplasia, (2) determine differences between patients with unilateral CLP (UCLP) and bilateral CLP (BCLP), and (3) document changes in the lower lip that occur with Le Fort I advancement. Design: Retrospective case–control study. Setting: Tertiary care center. Patients/Participants: Patients with available pre- and postoperative CT scans and 2D lateral photographs who had a Le Fort I advancement between 2009 and 2017. There were 32 patients with CLP (17 females; mean age 17.7 ± 1.9 years) and 33 noncleft controls (21 females; mean age 18.8 ± 2.6 years). Main Outcome Measures: Lower lip thickness and eversion. Results: Patients with CLP and maxillary hypoplasia have a significantly thicker lower lip ( P = .019) and outward rotation of the vermilion border ( P = .003) compared to noncleft controls. The lower lip was significantly thicker in patients with BCLP than in those with UCLP ( P = .035). Lower lip thickness and rotation did not change after maxillary advancement. Conclusions: Patients with CLP and maxillary hypoplasia have a thicker and more everted lower lip than noncleft controls. Patients with BCLP have a significantly thicker lower lip than those with UCLP. Strain of the lower lip musculature appears to be an important contributor to the development of the cleft lip lower lip deformity.

scholarly journals Is hormonal contraceptive risk for congenital malformation?

2019 ◽  
Vol 6 (4) ◽  
pp. 1784
Author(s):  
Prabhuswami Hiremath ◽  
R. P. Patange ◽  
J. A. Salunkhe ◽  
Vaishali R. Mohite ◽  
Prakash Naregal
Keyword(s):  
Congenital Malformation ◽  
Birth Control ◽  
Cleft Lip ◽  
Chromosomal Abnormalities ◽  
Care Center ◽  
Tertiary Care ◽  
Hormonal Contraceptives ◽  
Care Hospital ◽  
History Of ◽  
Birth Control Pills

Background: Little research is conducted in the safety of emergency contraceptives so the potential for developmental toxicity has not been evaluated.Methods: This hospital based descriptive study was conducted at tertiary care center, Krishna Hospital. Mothers who are diagnosed to have congenital birth defected fetus through antenatal examinations, delivered baby with diagnoses of congenital malformation, congenital malformed admitted neonates at Tertiary care hospital or came for reference services were assessed from September 2016 to August 2017.Results: The prevalence with number of birth, it is 1.4% and calculating with number of neonates admitted its prevalence rate is 5.3%. Overall in the hospital the prevalence noted is 0.2%. 283 mothers were diagnosed to have congenital malformation baby, among these, 264 (93.3%) mothers not had any history of birth control pills use and only 19 (6.7%) mothers stated that they used the birth control pills. Those used birth control pills in those 4 babies (1.4%) born with nervous system defects, 3 babies (1.1%) had cleft lip and cleft palate, and 2 (0.7%) babies had digestive system, musculoskeletal system and chromosomal abnormalities. Association between congenital malformation and history of Use of birth control pills shows strong association.Conclusions: The problem of conclusively proving a small increase in the incidence of rare abnormalities is very formidable. This may be due in part to the fact that the anomalies associated with hormonal contraceptives may occur primarily in those children who are predisposed genetically.

Decision-Making in Cleft-Related Surgery: A Qualitative Analysis of Patients and Caregivers

2019 ◽  
Vol 57 (2) ◽  
pp. 161-168
Author(s):  
Katelyn G. Bennett ◽  
Annie K. Patterson ◽  
Kylie Schafer ◽  
Madeleine Haase ◽  
Kavitha Ranganathan ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Thematic Analysis ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Tertiary Care ◽  
Shared Decision ◽  
Surgical Indications ◽  
Facial Difference

Objective: Preference-sensitive surgical decisions merit shared decision-making, as decision engagement can reduce decisional conflict and regret. Elective cleft-related procedures are often preference sensitive, and therefore, we sought to better understand decision-making in this population. Design: Semistructured interviews were conducted to elicit qualitative data. A hierarchical codebook was developed through an iterative process in preparation for thematic analysis. Thematic analysis was performed to examine differences between patients and caregivers. Setting: Multidisciplinary cleft clinic at a tertiary care center. Participants: Patients with cleft lip aged 8 and older (n = 31) and their caregivers (n = 31) were purposively sampled. Inability to converse in English, intellectual disability, or syndromic diagnoses resulted in exclusion. Main Outcome Measures: Preferences surrounding surgical decision-making identified during thematic analysis. Results: Mean patient age was 12.7 (standard deviation: 3.1). Most had unilateral cleft lip and palate (43.8%). Three themes emerged: Insufficient Understanding of Facial Difference and Treatment, Diversity of Surgical Indications, and Barriers to Patient Autonomy. Almost half of caregivers believed their children understood their clefts, but most of these children failed to provide information about their cleft. Although many patients and caregivers acknowledged that surgery addressed function and/or appearance, patients and caregivers exhibited differences regarding the necessity of surgery. Furthermore, a large proportion of patients believed their opinions mattered in decisions, but less than half of caregivers agreed. Conclusions: Patients with clefts desire to participate in surgical decisions but have limited understanding of their facial difference and surgical indications. Cleft surgeons must educate patients and facilitate shared decision-making.

Birth Prevalence of Orofacial Clefts in Kuwait From Hospital-Based Registration

2018 ◽  
Vol 55 (10) ◽  
pp. 1450-1455 ◽  
Author(s):  
Wasmiya A. Alhayyan ◽  
Sharat C. Pan ◽  
Fawzi M. AlQatami
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Middle Eastern ◽  
Tertiary Care ◽  
Published Data ◽  
Orofacial Clefts ◽  
Oral Cleft ◽  
Birth Prevalence ◽  
Facial Clefts

Introduction: Cleft lip and palate (CLAP) are the most common craniofacial anomalies and birth defects globally. Despite the fact that a tertiary care registry of clefts has existed in Kuwait since 2008, to date there is no published data regarding the prevalence of orofacial clefts in this population. Objective: To tabulate the pattern of orofacial clefts from tertiary care center registration during 2009 through 2014 and to estimate the prevalence and trend using population-based records. Methodology: Data from all CLAP cases (born in Kuwait) registered in the central cleft center registry of the Al-Amiri hospital, Kuwait City, Kuwait, from January 2009 to December 2014 were obtained. Data regarding the type, severity, gender as well as nationality, parental consanguinity, and associated syndrome were obtained from medical records. Birth prevalence was tabulated against the population statistics for the period obtained from the central department of statistics. Result: A total of 202 CLAP patients were recorded in the study period with a mean birth prevalence of 0.57 per 1000 live births (95% confidence interval [CI] .57 ± .23). The registry recorded 108 (53.2%) males and 94 (47.8%) females. Children born to Kuwaitis represented 53.7% of cases while those born to non-Kuwaitis represented 45.3%. The most common oral cleft was CLAP (47.3%), followed by cleft palate (30.5%), cleft lip (20.2%), and other facial clefts (2%). Other congenital anomalies were recognized in 33% of all cases. There were no statistically significant differences in oral cleft prevalence across gender or nationality. Conclusion: The prevalence of oral cleft in Kuwait appears to be similar to those of other Middle Eastern populations.

Mind the Gap: Alveolar Bone Graft Revision in the Era of Computed Tomography

2021 ◽  
pp. 105566562110026
Author(s):  
Ema Zubovic ◽  
Gary B. Skolnick ◽  
Abdullah M. Said ◽  
Richard J. Nissen ◽  
Alison K. Snyder-Warwick ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Tertiary Care ◽  
Radiographic Examination ◽  
Graft Take ◽  
Alveolar Bone Grafting ◽  
Ct Evaluation

Objective: To determine the rate of revision alveolar bone grafting (ABG) in patients with cleft lip and palate (CLP) before and after the introduction of postoperative computed tomography (CT). Design: Retrospective case–control study analyzing the incidence of revision ABG in patients with and without postoperative CT scans for graft success evaluation. Setting: Academic tertiary care pediatric hospital. Patients: Eighty-seven patients with CLP or cleft lip and alveolus treated with autologous iliac crest bone grafting for alveolar clefts over a 10-year period (January 2009 to March 2019) with minimum 6-month follow-up. Fifty patients had postoperative CT evaluation; 37 did not. Interventions: Postoperative CT to determine ABG success, versus standard clinical examination and 2-dimensional radiographs. Main Outcome Measures: Requirement for revision ABG, defined as failure of the original graft by clinical or radiographic examination. Results: Fifty-eight percent of patients underwent a postoperative CT scan at median interval of 10 months after surgery. Patients with postoperative CT evaluation had a 44% rate of revision ABG (22/50) for inadequate graft take, compared to 5% (2/37) in patients without postoperative CT ( P < .001; 95% CT, 31%-58% in the CT group, 1%-16% in the non-CT group). Conclusions: Computed tomography evaluation after ABG is associated with a significantly increased revision rate for inadequate graft take. The presence of a secondary palatal fistula at the time of original ABG is not associated with revision requirement. Lack of standardized dental and orthodontic records complicates the study of ABG outcomes and presents an area for systems-based improvement.

Reduced Socioeconomic Disparities in Cleft Care After Implementing a Cleft Nurse Navigator Program

2021 ◽  
pp. 105566562110056
Author(s):  
Connor Wagner ◽  
Carrie E. Zimmerman ◽  
Carlos Barrero ◽  
Christopher L. Kalmar ◽  
Paris Butler ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Care Center ◽  
Tertiary Care ◽  
Multidisciplinary Care ◽  
Socioeconomic Disparities ◽  
Outpatient Appointment ◽  
Nurse Navigator ◽  
Insured Patients ◽  
The Impact

Objective: To evaluate the impact of a Cleft Nurse Navigator (CNN) program on care for patients with cleft lip and cleft palate and assess the programs efficacy to reduce existing socioeconomic disparities in care. Design: Retrospective review and outcomes analysis (n = 739). Setting: Academic tertiary care center. Patients: All patients presenting with cleft lip and/or cleft palate (CL/P) born between May 2009 and November 2019 with exclusions for atypical clefts, submucous cleft palates, international adoption, and very late presentation (after 250 days of life). Interventions: Multidisciplinary care coordination program facilitated by the CNN. Main Outcome Measures: Patient age at first outpatient appointment and age at surgery, reported feeding issues, weight gain, and patient-cleft team communications. Results: After CNN implementation, median age at outpatient appointment decreased from 20 to 16 days ( P = .021), volume of patient-cleft team communications increased from 1.5 to 2.8 ( P < .001), and frequency of reported feeding concerns decreased (50% to 35%; P < .001). In the pre-CNN cohort, nonwhite and publicly insured patients experienced delays in first outpatient appointment ( P < .001), cleft lip repair ( P < .011), and cleft palate repair ( P < .019) compared to white and privately insured patients, respectively. In the post-CNN cohort, there were no significant differences in first appointment timing by race nor surgical timing on the basis of racial identity nor insurance type. Conclusions: A variety of factors lead to delays in cleft care for marginalized patient populations. These findings suggest that a CNN can reduce disparities of access and communication and improve early feeding in at-risk cohorts.

Morphological Presentation of Orofacial Clefts: An Epidemiological Study of 5004 Patients in a Tertiary Care Hospital of Central India

2021 ◽  
pp. 105566562110577
Author(s):  
Jaideep Singh Chauhan ◽  
Sarwpriya Sharma
Keyword(s):  
Cleft Palate ◽  
Epidemiological Study ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Tertiary Care ◽  
Central India ◽  
Care Hospital ◽  
Orofacial Clefts ◽  
Chi Square ◽  
The Right

Objective: To analyse the morphological presentation of orofacial clefts, gender, syndromes and systemic anomalies associated with them. Design: This was an epidemiological study performed in the patients who were registered for cleft lip and palate surgeries in our centre. The data was evaluated both retrospectively as well as prospectively. Patients/ Participants: The patients registered from November 2006 to April 2021 were studied. Out of 5276 patients, data of 5004 cases were analysed, rest 272 patients were excluded due to lack of information. Statistical analysis and Chi square test were applied. Results: Cleft deformities were more common in males than females. Cleft lip with palate was the commonest phenotype (52.2%). It was followed by isolated cleft lip (22.9%), isolated cleft palate (22.1%), rare clefts (1.62%) and syndromic clefts (1.18%). Unilateral variants were more frequent than bilateral. In unilateral, left side was more common than the right side. Among bilateral, most of the cases had premaxillary protrusion. In the present study, 3.46% of all the patients had associated anomalies affecting their other organs. Less common cleft phenotypes like microform cleft lip and submucous cleft palate ± bifid uvula showed frequency of 0.62% and 0.64% respectively. Conclusion: Thorough examination of cleft deformity should be done as it may appear as an isolated deformity or part of a syndrome and have associated systemic anomalies. This may help us to deliver comprehensive care to the patients and can prevent potential operative complications.

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