Epidemiological Aspects of Cleft Lip and Cleft Palate

BACKGROUND A new-born baby having a cleft lip alone or a cleft lip with cleft palate is definitely painful to the parents. Such cases must be referred to a multi-disciplinary medical team having expertise in craniofacial defects. The role of a family doctor is significant in these cases as he / she is the one who can minimize the sufferings of the parents and their family members by ensuring antenatal diagnosis and extending support for the whole family post-diagnosis, during initial days of breastfeeding as well as bonding issues and also throughout an extended period of months and years of surgical interventions and speech therapies. These cleft lip and palate deformities are the most typical facial defects in children at birth. This leads to not only the altered appearance, defective speech, improper hearing, retarded growth of the baby but also deranged psychosocial well-being and disrupted social integration of the parents and family members. This article presents an overall epidemiological aspect of the said anomalies in the immense interest & benefit of all the concerned professionals. Patients with cleft lip or palate have significant problems in communication, and face difficulties with deglutition. The understanding of the anatomy and associated pathophysiology play a vital role in the management of these patients. The surgical correction remains the mainstay of treatment to date. This article describes common problems related to kids having cleft lip and palate anomalies and provides the latest surgical options available in such congenital cleft care. The genetic basis of the disease and recent advances in the developmental defects of this congenital abnormality is also discussed. In addition to physical corrections, psychological effects on the family need to be addressed at priority. The treating physician must consider the mental health of the parents. The current concepts of treatment will continue to evolve because of continuous developments in the fields of foetal surgery, genetic and tissue engineering. KEY WORDS Cleft, Lip, Palate, Aperture, Folic Acid, Congenital, Abnormality, Orofacial, Correction, Surgery

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Cárie Dentária em Indivíduos com Fissuras Labiopalatinas: Revisão de Literatura

UNICIÊNCIAS ◽

10.17921/1415-5141.2020v24n1p112-117 ◽

2021 ◽

Vol 24 (1) ◽

pp. 112-117

Author(s):

Andreza Maria Fábio Aranha ◽

Amanda Alves de Oliveira ◽

Alexandre Meireles Borba ◽

Luiz Evaristo Ricci Volpato

Keyword(s):

Oral Health ◽

Dental Caries ◽

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Public Health Practice ◽

Well Being ◽

Individualized Approach ◽

Genetic And Environmental Factors ◽

Isolated Cleft Palate

As fissuras labiopalatinas (FLP) são as malformações congênitas mais comuns da região craniofacial e apresentam diferentes fenótipos e características clínicas, que diferem entre si de acordo com as estruturas anatômicas envolvidas: fissura de lábio, fissura de lábio e palato e fissura de palato isolada. A etiologia das FLP é multifatorial e inclui fatores genéticos e ambientais. O objetivo do presente estudo foi investigar o papel das fissuras labiopalatinas na prevalência de cárie dentária por meio de uma revisão na literatura. O defeito anatômico que envolve o rebordo alveolar e/ou o palato pode resultar em agenesias dentárias, dentes supranumerários, anomalias de forma e estrutura, bem como atresia maxilar, mordidas cruzadas posteriores e apinhamentos dentários. Também, a presença da FLP pode resultar aos indivíduos problemas durante alimentação, pronúncia de alguns fonemas, audição e integração social, o que poderia afetar a qualidade de vida do indivíduo e da dinâmica familiar. Quando a saúde bucal de crianças e adolescentes com FLP foi investigada, maior retenção do biofilme microbiano nas superfícies dentárias, de inflamação gengival e maior ocorrência de cárie dentária foram observados. Para um diagnóstico e tratamento adequados, é fundamental uma abordagem multidisciplinar, individualizada, para orientação e planejamento do tratamento dos indivíduos com a malformação, desde o nascimento até a fase adulta. O conhecimento dos efeitos da FLP na saúde bucal e no bem-estar dos indivíduos e das famílias afetadas é fundamental para mudanças nas políticas públicas das práticas de saúde e redução da sobrecarga da presença da malformação congênita. Palavras-chave: Cárie Dentária. Fenda Labial. Fissura Palatina. Saúde Bucal Abstract Cleft lip and palate (CLP) are the most common congenital malformations of the craniofacial region and they present different phenotypes and clinical characteristics, which differ according to the anatomical structures involved: cleft lip, cleft lip and palate and isolated cleft palate. The etiology of CLP is multifactorial and includes genetic and environmental factors. The aim of this study was to investigate the role of cleft lip and palate in the prevalence of dental caries through a literature review. The anatomical defect involving the alveolar ridge and / or the palate can result in dental agenesis, supernumerary teeth, anomalies in shape and structure, as well as maxillary atresia, posterior cross bites and dental crowding. Also, the presence of CLP can result in problems for individuals during feeding, pronunciation of some phonemes, hearing and social integration, which could affect the individual's quality of life and family dynamics. When the oral health of children and adolescents with CLP was investigated, greater retention of microbial biofilm on dental surfaces, gingival inflammation and the occurrence of dental caries were observed. For an adequate diagnosis and treatment, a multidisciplinary and individualized approach is essential to guide and plan the treatment of individuals with the malformation, from birth to adulthood. The knowledge of the effects of FLP on oral health and on the well-being of affected individuals and families is fundamental to changes in public health practice policies and to reduce the burden of the presence of the congenital malformation. Keywords: Cleft Lip. Cleft Palate. Dental Caries. Oral Health.

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FEEDING PLATE: A BOON TO CLEFT PALATE CHILD AND MOTHER TOO - CASE REPORT

International Journal of Advanced Research ◽

10.21474/ijar01/13811 ◽

2021 ◽

Vol 9 (11) ◽

pp. 836-845

Author(s):

Manoranjan Mahakur ◽

Silpa Tarenia ◽

Louis Solaman Simon ◽

Anusuya Mishra ◽

Deepika U. ◽

...

Keyword(s):

Case Report ◽

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Family Members ◽

Chief Complaint ◽

Feeding Plate

Now a days many children are affected with cleft lip and palate due to multifactorial etiology. Among all the problems of cleft lip and palate, the most important is feeding and nutrition to the child. If a child will not be able to take mother milk after birth then definitely it will hamper the immunity and development of the baby and also it will greatly depress the psychology of mother and other family members. The aim of this article is to present a case of cleft lip and palate baby of 5 days old whose mother chief complaint was that I could not feed my child, and how he was rehabilitated with a feeding plate and made easy for the mother to feed her milk.

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Blepharophimosis, ptosis, epicanthus inversus syndrome (BPES) and cleft lip and palate. Report of two Brazilian families

Genetics and Molecular Biology ◽

10.1590/s1415-47571998000200015 ◽

1998 ◽

Vol 21 (2) ◽

pp. 259-262 ◽

Cited By ~ 1

Author(s):

N.M. Kokitsu-Nakata ◽

A. Richieri-Costa

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Family Members ◽

Clinical Signs ◽

The Other

We have evaluated a girl and a boy with the blepharophimosis, ptosis and epicanthus inversus syndrome (BPES). The girl presented cleft palate and the boy showed cleft lip and palate as additional clinical signs. Both showed familial recurrence in fourth and third generations, respectively. The other family members also presented blepharophimosis, ptosis, and epicanthus inversus, but without lip and palatal involvement. There were no additional clinical signs nor infertility in these patients. To our knowledge this is the first instance of cleft lip and palate reported as additional signs of the BPES syndrome.

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Caries in patients with cleft lip and palate, and their dental rehabilitation. Presentation of a clinical case

Mexican Journal of Medical Research ◽

10.29057/mjmr.v4i7.1849 ◽

2016 ◽

Vol 4 (7) ◽

Author(s):

Carlos E. Varela Ibáñez ◽

Diana Rivero Viveros ◽

Margarita Ibarra Navarrete

Keyword(s):

Cleft Palate ◽

Oral Hygiene ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Developmental Defects ◽

Dental Management ◽

High Prevalence ◽

Periodic Monitoring ◽

Dental Rehabilitation ◽

Bacterial Plaque

During the first three months of pregnancy, the parts of the palate and upper lip normally meet. When this union does not occur, the baby will present cleft lip and / or cleft palate. This type of malformation occurs in 1 in every 700 births. The presence of a cleft lip and cleft palate can cause various dental problems such as changes in shape, number, size, dental malposition, as well as developmental defects of enamel. Poor oral hygiene of children with cleft lip and cleft palate may contribute to the high prevalence of dental caries in these patients. We performed comprehensive dental rehabilitation of a female patient of 5 years 4 months old, diagnosed with cleft lip and cleft palate, which initially presented dental malposition, poor hygiene, and irregular shape of the arches and involvement of adjacent teeth to the slit. Strategies have been developed to prevent early childhood tooth decay, which should be considered for inclusion in the protocol of patients with cleft lip and cleft palate. We conclude that an early dental management of such patients, a periodic monitoring of bacterial plaque and instructing parents to good oral hygiene of the patients, reduce caries risk factors in this type of patients, thus favoring treatment operative success.

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Maxillary incisor enamel defects in individuals born with cleft lip/palate

PLoS ONE ◽

10.1371/journal.pone.0244506 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244506

Author(s):

Juliane R. Lavôr ◽

Rosa Helena W. Lacerda ◽

Adriana Modesto ◽

Alexandre R. Vieira

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Clinical History ◽

University Hospital ◽

Tooth Surface ◽

Maxillary Incisor ◽

Chi Square ◽

Developmental Defects ◽

Enamel Defects

Cleft lip with or without cleft palate (CLP) is considered the most frequent congenital malformations of the head and neck, with cleft individuals exhibiting more chances of presenting abnormalities such as developmental defects of enamel (DDE). Matrix metallopeptidase 2 (MMP2) is a membrane-bound protein with collagen-degrading ability and has important roles in tooth formation and mineralization. The aim of this study was to evaluate the frequency, location, severity and extent of DDE found in the maxillary incisors for groups of individuals born with CLP, as well as understanding their relationship with the cleft side. Besides, this study addresses the hypothesis that DDE can be influenced by variation in the MMP2 genes (rs9923304). Individual samples, clinical history, intraoral photographs and panoramic radiographs were obtained from 233 patients under treatment at the Cleft Lip and Palate Service of the University Hospital Lauro Wanderley at the Federal University of Paraíba. Digital images were examined by the same evaluator using the Classification of Defects According to the Modified DDE Index, and then loaded into the Image Tool software, where two measurements were made: total area of the buccal surface (SA) and the area of the DDE (DA), obtaining the percentage of the surface area affected (%SAD) (ICC = 0.99). Genomic DNA was extracted from saliva samples from 124 participants. Genotyping was carried out using TaqMan chemistry for one marker in MMP2 (rs9923304). Statistical analyses were performed by The Jamovi Project software. The Shapiro-Wilk test was applied, followed by the Student’s t-test and the Mann-Whitney test. Chi-square and Fisher’s exact tests, and odds ratio (OR) with 95% confidence interval (CI) calculations were used to determine Hardy-Weinberg equilibrium and statistically significant differences with an alpha of 0.05. No significant differences in the prevalence and extent of enamel defects were found between male and female individuals born with CLP (p = 0.058256). The frequency of individuals presenting teeth with DDE, in relation to the cleft and non-cleft side, was statistically different (p <0.001; OR = 7.15, CI: 4.674> 7.151> 10.942). However, the averages of %SAD were similar (p = 0.18). The highest means of the %SAD were found in individuals with bilateral cleft lip with or without cleft palate (BCLP) when compared to individuals with unilateral cleft lip with or without cleft palate (UCLP), for the teeth inside (IA) and outside the cleft area (OA) (p <0.001). Regardless of the cleft side, individuals with BCLP were 7.85 times more likely to have more than one third of the tooth surface affected, showing more frequently defects in the three thirds (OA: p <0.001) (IA: p = 0.03), as well as a higher frequency of more than one type of defect (OA: p = 0.000358) (IA: p = 0.008016), whereas in UCLP, defects were isolated and restricted to only one third, more frequently, the incisal third (OA: p = 0.009) (IA: p = 0.001), with greater frequency of milder defects, such as demarcated (p = 0.02) and diffuse (p = 0.008) opacities. A higher frequency of the T allele, less common, was observed in the group of CLP individuals who had all the affected teeth or at least two teeth with %SAD greater than 20% (p = 0.019843). Our results suggest that MMP2 may have a role in the cases that presented DDE and genotyping rs9923304 could serve as the basis for a genomic approach to define risks for individuals born with CLP. Frequency and severity of DDE is strongly related to the CLP phenotype, since the highest values were found for BCLP. However, the extent of the DDE is independent of its relationship with the side of the cleft.

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Perceptual Speech Outcomes After Early Primary Palatal Repair in Ugandan Patients With Cleft Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620980249 ◽

2020 ◽

pp. 105566562098024

Author(s):

Kim Bettens ◽

Laura Bruneel ◽

Cassandra Alighieri ◽

Daniel Sseremba ◽

Duncan Musasizib ◽

...

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Speech Therapy ◽

Cleft Lip And Palate ◽

Control Group ◽

English Speaking ◽

And Gender ◽

Early Primary ◽

Velopharyngeal Function ◽

Normal Speech

Objective: To provide speech outcomes of English-speaking Ugandan patients with a cleft palate with or without cleft lip (CP±L). Design: Prospective case–control study. Setting: Referral hospital for patients with cleft lip and palate in Uganda. Participants: Twenty-four English-speaking Ugandan children with a CP±L (15 boys, 9 girls, mean 8.4 years) who received palatal closure prior to 6 months of age and an age- and gender-matched control group of Ugandan children without cleft palate. Interventions: Comparison of speech outcomes of the patient and control group. Main Outcome Measures: Perceptual speech outcomes including articulation, resonance, speech understandability and acceptability, and velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary surgery. Results: Normal speech understandability was observed in 42% of the patients, and 38% were judged with normal speech acceptability. Only 16% showed compensatory articulation. Acceptable resonance was found in 71%, and 75% of the patients were judged perceptually to present with competent velopharyngeal function based on the VPC-sum. Additional speech intervention was recommended in 25% of the patients. Statistically significant differences for all these variables were still observed with the control children ( P < .05). Conclusions: Overall, acceptable speech outcomes were found after early primary palatal closure. Comparable or even better results were found in comparison with international benchmarks, especially regarding the presence of compensatory articulation. Whether this approach is transferable to Western countries is the subject for further research.

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Speech in a consecutive series of children born with cleft lip and palate with and without syndromes and/or additional malformations

BMC Pediatrics ◽

10.1186/s12887-021-02783-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kristina Klintö ◽

Maria Sporre ◽

Magnus Becker

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Consecutive Series ◽

Total Group ◽

One Stage ◽

Audio Recordings ◽

Bilateral Cleft Lip ◽

Palatal Surgery ◽

Group Comparisons

Abstract Background When evaluating speech in children with cleft palate with or without cleft lip (CP/L), children with known syndromes and/or additional malformations (CP/L+) are usually excluded. The aim of this study was to present speech outcome of a consecutive series of 5-year-olds born with CP/L, and to compare speech results of children with CP/L + and children with CP/L without known syndromes and/or additional malformations (CP/L-). Methods One hundred 5-year-olds (20 with CP/L+; 80 with CP/L-) participated. All children were treated with primary palatal surgery in one stage with the same procedure for muscle reconstruction. Three independent judges performed phonetic transcriptions and rated perceived velopharyngeal competence from audio recordings. Based on phonetic transcriptions, percent consonants correct (PCC) and percent non-oral errors were investigated. Group comparisons were performed. Results In the total group, mean PCC was 88.2 and mean percent non-oral errors 1.5. The group with bilateral cleft lip and palate (BCLP) had poorer results on both measures compared to groups with other cleft types. The average results of PCC and percent non-oral errors in the CP/L + group indicated somewhat poorer speech, but no significant differences were observed. In the CP/L + group, 25 % were judged as having incompetent velopharyngeal competence, compared to 15 % in the CP/L- group. Conclusions The results indicated relatively good speech compared to speech of children with CP/L in previous studies. Speech was poorer in many children with more extensive clefts. No significant differences in speech outcomes were observed between CP/L + and CP/L- groups.

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Solitary, non-syndromic cleft lip and/or palate A comparison between cleft lip, cleft lip and palate, and cleft palate on epidemiologic characteristics and growth

American Journal of Orthodontics and Dentofacial Orthopedics ◽

10.1016/0889-5406(89)90123-6 ◽

1989 ◽

Vol 96 (6) ◽

pp. 527

Author(s):

Alex Jacobson

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Epidemiologic Characteristics

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Repair of Recurrent Cleft Palate with Free Vastus Lateralis Muscle Flap

The Cleft Palate-Craniofacial Journal ◽

10.1597/11-008 ◽

2012 ◽

Vol 49 (2) ◽

pp. 245-248 ◽

Cited By ~ 9

Author(s):

Jose G. Christiano ◽

Amir H. Dorafshar ◽

Eduardo D. Rodriguez ◽

Richard J. Redett

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Vastus Lateralis ◽

Muscle Flap ◽

Free Flaps ◽

Vastus Lateralis Muscle ◽

Oronasal Fistula ◽

Lateralis Muscle ◽

Palate Repair

A 6-year-old girl presented with a large recalcitrant oronasal fistula after bilateral cleft lip and palate repair and numerous secondary attempts at fistula closure. Incomplete palmar arches precluded a free radial forearm flap. A free vastus lateralis muscle flap was successfully transferred. No fistula recurrence was observed at 18 months. There was no perceived thigh weakness. The surgical scar healed inconspicuously. Free flaps should no longer be considered the last resort for treatment of recalcitrant fistulas after cleft palate repair. A free vastus lateralis muscle flap is an excellent alternative, and possibly a superior option, to other previously described free flaps.

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