TOTAL CARE OF CHILDREN WITH CLEFT LIP AND CLEFT PALATE

Although some aspects of the management of a child with a cleft lip or cleft palate or both are controversial, it is generally agreed that the best possible care of these youngsters involves the co-operation of a multi-professional group including at least a surgeon, dentist, speech therapist, pediatrician, orthodontist, and the parents as well. It is not necessary for the group to be centralized in location, although this is helpful to the patient. However, each member of a group must be aware of the potentialities and procedures of the other members and should have a knowledge of the terminology and basic principles of the other disciplines represented. As his duties of total care are ever present and continuous, the pediatrician is in a strategic position to help the parents to understand and to implement the consecutive phases of therapy in the home. The rationale and a general description of one type of cleft lip—cleft palate program as it is carried out at the Children's Medical Center in Boston is presented. During the last 15 years, 2,635 operations for closure of the lip and palate have been performed in the Plastic Surgery Unit. The authors' policy is to repair a cleft lip at 6 to 8 weeks of age and to repair the palate within the first 2 years of life, preferably at about 14 months of age. Included is a summary of a study made at this Center to evaluate the long-range results of early palatal closure and over-all care of a group of 164 children operated upon between the years of 1942 and 1952. The conclusions of this study corroborate the authors' previous clinical impression that the results of early palatal closure have been so satisfactory that continuation of the policy seems warranted. Supportive care is described in some detail because of the authors' wish to emphasize its importance and to provide for the pediatrician a practical guide which long experience has proven to be successful.

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Cleft lip and cleft palate

AccessScience ◽

10.1036/1097-8542.140200 ◽

2015 ◽

Keyword(s):

Cleft Palate ◽

Cleft Lip

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Evaluation and Treatment Planning for Patients with Cleft Lip and Cleft Palate

Clinics in Plastic Surgery ◽

10.1016/s0094-1298(20)31639-4 ◽

1985 ◽

Vol 12 (4) ◽

pp. 553-572

Author(s):

William C. Trier

Keyword(s):

Cleft Palate ◽

Treatment Planning ◽

Cleft Lip

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Australian Orthodontists Utilization and Attitude Toward a Government Funded Cleft Scheme

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665621989125 ◽

2021 ◽

pp. 105566562198912

Author(s):

Morgan Wishney ◽

Aziz Sahu-Khan ◽

Peter Petocz ◽

M. Ali Darendeliler ◽

Alexandra K. Papadopoulou

Keyword(s):

Cleft Palate ◽

Online Survey ◽

Cleft Lip ◽

Training Programs ◽

Capital City ◽

Australian Society ◽

Capital Cities ◽

The Past ◽

Orthodontic Training ◽

University Training

Objectives: To (1) survey Australian orthodontists about their involvement with a government-funded scheme for patients with clefts, the Medicare Cleft Lip and Cleft Palate Scheme (MCLCPS) and (2) investigate their attitude toward treating patients with clefts and their training in this respect. Design: A 13-question online survey was distributed to members of the Australian Society of Orthodontists. The survey gathered information regarding respondent demographics, the number of MCLCPS-eligible patients seen in the past 12 months and usual billing practices. Results: A total of 96 complete responses were obtained. About 70% of respondents had treated MCLCPS-eligible patients in the past 12 months and 55% saw between 2 and 5 patients during this time. The likelihood of treating patients with clefts increased by a factor of 4.8 (95% CI: 1.2-18.9) if practicing outside of a capital city and 1.5 times for each decade increase in orthodontist’s age (95% CI: 1.0-2.2). The MCLCPS was utilized by 81% of orthodontists with 26% of these respondents accepting rebate only. Most orthodontists felt their university training could have better prepared them to treat patients with clefts. A minority of orthodontists felt that a rebate increase would make them more likely to treat these patients. Conclusions: Australian orthodontists who treat patients with clefts tend to be older and work outside of capital cities. The decision to treat these patients tends to not be financially motived. Specialty orthodontic training programs could improve the preparedness of their graduates to treat patients with clefts.

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Prevalence of Reading Difficulties in 9- to 10-Year Old Children in Sweden Born With Cleft Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211013236 ◽

2021 ◽

pp. 105566562110132

Author(s):

Justin Parry Weinfeld ◽

Jakob Åsberg Johnels ◽

Christina Persson

Keyword(s):

General Population ◽

Cleft Palate ◽

Cleft Lip ◽

Reading Difficulties ◽

Learning Problems ◽

Study Group ◽

Cross Sectional ◽

Parental Questionnaire ◽

Background Data ◽

Cross Sectional Design

Objective: To investigate the prevalence of reading difficulties in children born with cleft palate at ages 9 and 10 in Sweden. Design: Using a cross-sectional design, a parental questionnaire assessing dyslexia-like reading difficulties (Short Dyslexia Scale, SDS) was administered together with separate questions regarding background data. Participants: Families with a child born with overt cleft palate with or without cleft lip in 4 regions of Sweden. A total of 245 families were approached of which 138 families responded. Data from 136 (56%) were complete with information on cleft type and could be analyzed. Results: Twenty-two percent (95% CI, 15-30) of the whole study group displayed risk for dyslexic reading difficulties on the SDS corresponding to the 7th to 10th percentiles in the population. Children with cleft palate only had a significantly higher prevalence of reading difficulties (37%) compared to children with unilateral cleft palate (19%) and bilateral cleft palate (10%). The frequency of reading difficulties in participants with comorbidity was 32%. Among a subgroup with reported comorbidity in areas of attention, language, and learning problems, there was a 2.5 times higher risk of reading disability compared to participants without this reported comorbidity. Conclusion: The prevalence of reading difficulties in the cleft palate population was higher than in the general population. Results showed that co-occurring difficulties were common in the cleft group and that reading difficulties often appear together with other, co-occurring neurodevelopmental difficulties.

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Maternal Vitamin B12 Status and Risk of Cleft Lip and Cleft Palate Birth Defects in Tamil Nadu State, India

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665621998394 ◽

2021 ◽

Vol 58 (5) ◽

pp. 567-576

Author(s):

Ronald G. Munger ◽

Rajarajeswari Kuppuswamy ◽

Jyotsna Murthy ◽

Kalpana Balakrishnan ◽

Gurusamy Thangavel ◽

...

Keyword(s):

Cleft Palate ◽

Tamil Nadu ◽

Cleft Lip ◽

Maternal Nutrition ◽

Case Control ◽

Vitamin B ◽

Plasma Vitamin ◽

Maternal Vitamin ◽

Increased Risk ◽

Tamil Nadu State

Background and Objective: The causal role of maternal nutrition in orofacial clefts is uncertain. We tested hypotheses that low maternal vitamin B12 and low folate status are each associated with an increased risk of isolated cleft lip with or without cleft palate (CL±P) in a case–control study in Tamil Nadu state, India. Methods: Case-mothers of CL±P children (n = 47) and control-mothers of unaffected children (n = 50) were recruited an average of 1.4 years after birth of the index child and plasma vitamin B12, methylmalonic acid (MMA), total homocysteine (tHcy), and folate were measured at that time. Logistic regression analyses estimated associations between nutrient biomarkers and case–control status. Results: Odds ratios (ORs) contrasting biomarker levels showed associations between case-mothers and low versus high plasma vitamin B12 (OR = 2.48, 95% CI, 1.02-6.01) and high versus low plasma MMA, an indicator of poor B12 status (OR = 3.65 95% CI, 1.21-11.05). Case–control status was not consistently associated with folate or tHcy levels. Low vitamin B12 status, when defined by a combination of both plasma vitamin B12 and MMA levels, had an even stronger association with case-mothers (OR = 6.54, 95% CI, 1.33-32.09). Conclusions: Mothers of CL±P children in southern India were 6.5 times more likely to have poor vitamin B12 status, defined by multiple biomarkers, compared to control-mothers. Further studies in populations with diverse nutritional backgrounds are required to determine whether poor maternal vitamin B12 or folate levels or their interactions are causally related to CL±P.

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The efficacy of transnasal palatal transillumination for the diagnosis of submucous cleft palate

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00093-9 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Yasir S. Jamal ◽

Sabah S. Moshref ◽

Abeer M. Baamir ◽

Mazin O. Kurdi ◽

Doaa Y. Jamal

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Diagnostic Techniques ◽

Lateral Release ◽

Feeding Difficulties ◽

Presenting Symptoms ◽

Submucous Cleft Palate ◽

Cheap Method ◽

Operative Findings ◽

Simple Repair

Abstract Background Submucous cleft palate (SMCP) is a congenital abnormality with various clinical and anatomical features. Submucous cleft pathologies may be unrecognized during routine examinations. Current diagnostic techniques are constrained and unrevealing in presurgical patients. This prospective study aimed to evaluate transnasal palatal transillumination technique in diagnosis of SMCP at our institute hospital, during period from 2005-2020. Patients and methods Twenty-one cases with SMCP were recruited with age range from 2-60 months. Transnasal palatal transillumination with controllable light intensity endoscope used to evaluate SMCP and cases were photo and video recorded. Results In this study, 21 cases (13 males and 8 females) with SMCP were detected or confirmed by intranasal transnasal palatal transillumination. Frequency of SMCP patients at our institute was 3.39%. All patients presented with symptomatic complaints at diagnosis time, apart from 5 patients (23.8%) were diagnosed during cleft lip repair operations. Presenting symptoms were hypernasality (23.8%), delayed speech (23.8%), perforated palate with nasal escape of milk and food (14.3%), feeding difficulties (14.3%), and otitis media (4.8%). During intra-oral examination, all cases had a bifid uvula accompanied SMCP. Submucous cleft palate appeared as thin palate with central lucency. According to operative findings, operations done for repair were mostly two long palatal flaps (n = 13, 61.9%), von Langenbeck (n = 5, 23.8%), simple repair with lateral release incisions (n = 2, 9.6%), and simple repair without lateral release incision (n = 1, 4.8%). Conclusions Intraoperative assessment of submucous cleft palate with transnasal palatal transillumination is easy and cheap method to avoid missing cases of SMCP.

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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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