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PubMed2004

Approaches of South African traditional healers regarding the treatment of cleft lip and palate.

OBJECTIVE: Due to the large number of Black South Africans known to consult with traditional healers and the influential role they play in the developing world, this study investigated the approaches of a group of 15 traditional healers toward the treatment of cleft lip and palate. DESIGN: An exploratory-descriptive, qualitative research design was employed, which involved the use of standardized, semistructured interviews, conducted with the assistance of an interpreter who was fluent in several African languages. SETTING: Interviews were conducted outdoors in places in which traditional healers usually consult with their patients. These areas were in the fields close to the traditional healers' homes or under a highway bridge in the Johannesburg inner city. PARTICIPANTS: Individual interviews were conducted with 15 African traditional healers who had been practicing in their callings for at least 1 year. RESULTS: Traditional healers interviewed had treated one to six persons with a cleft lip, cleft palate, or both. Most informants believed that clefts were caused by the ancestors, spirits, and witchcraft. A variety of plant and animal products were used to treat these conditions and were augmented by spiritual resources from the ancestors. All except one healer had undergone formal training, although they had received no specific training relative to cleft lip and palate. Most participants reported referring patients to Western health care practitioners who were referred to as modern doctors but did not receive reciprocal referrals from these professionals. Patients generally consulted with traditional healers because this approach was part of their culture. CONCLUSIONS: These findings have important implications for health care professionals as well as traditional healers in terms of cross-cultural consultation, collaboration, and information sharing with regard to cleft lip and palate; the potential use of traditional healers in primary health care and education; and further research.

Adult↗

PubMed2000

Mental development in infants with cleft lip and/or palate.

OBJECTIVE: Investigated mental development in infants and toddlers with cleft lip and/or palate (CLP). DESIGN: This was a retrospective analysis of developmental scores on qualified children between 4 and 36 months of age. Cross-sectional analysis included children in four age groups (6, 12, 18, and 24 months); longitudinal analysis included children at mean age 9.1 (range = 4 to 15) months at Time 1 and 24 months (range = 16 to 36) at Time 2. PARTICIPANTS: Cross-sectional analysis included 180 children (59% male participants) in four diagnostic groups (cleft lip only [CL], cleft lip and palate [CLP], cleft palate only [CP], and Pierre Robin). The longitudinal sample included 85 children (64% male children) in the same diagnostic groups. MAIN OUTCOME MEASURES: Mental Scale (MDI) of the Bayley Scales of Infant Development. RESULTS: Mean MDIs were in the average range but decreased significantly between youngest and oldest groups in both cross-sectional (F(3,179) = 4.9, p<.01) and longitudinal samples (F(1,84) = 6.87, p<.01). There was a significant difference among cleft types (F(3,179) = 3.5, p<.025). Infants with CL obtained the highest scores, and infants with Pierre Robin Sequence obtained the lowest. Perceptual-motor development in the first year of life was predictive of developmental status at age 2. CONCLUSIONS: The number of children with CLP who may be at risk for developmental problems during the second year of life is greater than would be expected. Children at greatest risk may demonstrate early delays in acquisition of perceptual-motor skills during the first year of life.

Analysis of Variance↗

PubMed1986

Aesthetic considerations of the cleft lip operation.

The results of a cleft lip operation are checked from the anterior, the profile, and the caudal views and even if the deformities are minimal, for aesthetic reasons they should be repaired. Philtrum length, philtrum shape, philtrum depth, nasolabial triangular area, vermilion thickness, Cupid's bow peak, horizontal upper lip groove, vermilion border, alar size, depth of alar groove, nasal deviation, nostril shape, nasal tip, columella height, sill shape, columella width, and facial balance of the anterior, profile, and caudal views are used as aesthetic checkpoints for the results of a cleft lip operation. If deformities are found, the aesthetic plastic surgeon should repair them to achieve a more satisfactory result. In addition, augmentation rhinoplasty, augmentation mentoplasty, or other craniofacial surgery may be performed.

Chin↗

PubMed1988

Seasonality, incidence, and sex distribution of cleft lip and palate births in Trent Region, 1973-1982.

The birth dates of 930 children born in the Trent Region 1973-1982 with a diagnosis corresponding to cleft palate, or cleft lip with or without cleft palate, was obtained from Hospital Activity Analysis. These data were analyzed to look at the incidence of clefting, sex distribution, and seasonal variation. The results obtained show a significant peak incidence of cleft palate births in August and September, with a low incidence in March to May. Cleft lip, with or without cleft palate, shows a different seasonal trend, with peak occurrence in December and January and a low frequency in May and June. These seasonal trends may act as a pointer to the environmental factors active in the multifactorial etiology of cleft lip and cleft palate.

Cleft Lip↗

PubMed1999

[One-time operation in infant cleft lip and palate plus alveolar process].

OBJECTIVE: To improve safety and viability of one-time operation in the therapy of cleft lip and palate and cleft alveolar process. METHODS: Under the air-vein anesthesia, one-time operations were performed in 42 patients with complete cleft lip and palate plus cleft alveolar process. After rehabilitation in ICU, all patients were put into wards, and left hospital 4-7 days after operation. RESULTS: The situation during anesthesia and operation was good. There were no statistically significant changes in blood pressure, oxygen saturation of blood, heart rate and cardiac rhythm before, during and after operation. No anesthetic accident and no complication happened. The loss of blood was about 42.7 +/- 6.5 ml and the duration of operation was about 139.2 +/- 18.6 minutes. The rehabilitation was successful after operations. First intention took place in almost all patients' incisions, and palatal fistulas appeared in only 2 cases. CONCLUSION: Under the control of provisioned pediatric anesthesia and rehabilitation, one-time complete cleft lip and palate plus cleft alveolar process closure is safe and viable.

Alveolar Process↗

PubMed1984

Cleft lip nasal deformity.

The nasal deformity in the cleft lip patient is produced by the lower lateral cartilage being subluxed inferiorly and laterally, which falsely lengthens the nose on the cleft side. The columella is not short. It simply extends laterally to a dipped area in the rim of the nostril. The cleft lip nasal deformity is correctable at the time of primary lip repair by advancing the lower lateral cartilage superiorly and medially. The correction will last with the cartilage fixed to the upper lateral cartilage-septal junction, its normal position. A deficient repair will not improve. A good repair will last, will not interfere with growth of the nose, and will free the patient from years of unnecessary embarrassment . Correction of the cleft lip nasal deformity in the adult requires repositioning of the lower lateral cartilage similar to what can be and should be done in the infant.

Adolescent↗

PubMed1992

Maxillary lateral incisors of subjects with cleft lip and/or palate: Part 2.

Maxillary lateral incisors on the alveolar cleft were investigated in 431 cleft children registered in the Department of Orthodontics, Kyushu University Dental Hospital. The majority of primary maxillary lateral incisors were located on the distal side of the alveolar cleft in both unilateral cleft lip and alveolus (UCLA) and unilateral cleft lip and palate (UCLP) subjects. Permanent teeth in UCLA tend to be located distally, but in UCLP they tend to be congenitally absent (p less than .01). The majority of primary teeth had normal shapes; the majority of permanent teeth were of intermediate type or were missing congenitally. One third of the UCLA and one half of the UCLP subjects who had primary maxillary lateral incisors were not followed by permanent replacements. The location of the majority of permanent maxillary lateral incisors tallied with that of the primary ones except in four UCLA, ten UCLP, and two bilateral cleft lip and palate (BCLP) subjects. Four UCLA and ten UCLP subjects who had primary lateral incisors on the distal side were followed by their permanent successors on the mesial side. Three UCLP and one BCLP subjects had permanent maxillary lateral incisors even though they had no temporary predecessors.

Adolescent↗

PubMed2006

Distinctive cortical articulatory representation in cleft lip and palate: a preliminary functional magnetic resonance imaging study.

OBJECTIVE: To investigate cortical representation of articulation of the bilabial plosive in patients with cleft lip and palate. DESIGN: We examined cortical representation for /pa/-articulation in cleft lip and palate patients using blood oxygenation level-dependent functional magnetic resonance imaging. SUBJECTS: Data from four postsurgical adult cleft lip and palate patients were compared with those from six healthy volunteers. RESULTS: Activation foci were found in the bilateral primary sensorimotor cortex in all cleft lip and palate patients, as in the controls. The sensorimotor cortex ipsilateral to the side of cleft lip and palate showed greater activation in unilateral cleft lip and palate patients, whereas the sensorimotor cortex contralateral to the side on which cheiloplasty had been performed earlier showed greater activation in a bilateral cleft lip and palate patient. CONCLUSIONS: The results suggest that there may be an ipsilateral dominance in cortical representation during bilabial articulation to the side of the cleft in the upper lip.

Adolescent↗

PubMed1998

Premaxillary size and craniofacial growth in patients with cleft lip and palate.

BACKGROUND: Premaxillary size in individuals with cleft lip and palate is variable, ranging from a mere nubbin to a large protuberance. The purpose of this study was to evaluate the effect of premaxillary size on craniofacial growth in cleft lip and palate patients. MATERIALS AND METHODS: Premaxillary size was measured using 181 dental casts of bilateral complete cleft lip and palate (BCLP) infants. The infants had no associated systemic malformations, and were approximately one year of age. Data were obtained from the files of the Chang Gung Craniofacial Center. The mean size (mean = 19.3 mm) of the premaxilla and standard deviation (SD = 2.0 mm) were calculated. A sample of 55 subjects was divided into three groups: large premaxilla; [LP; 15 boys, 5 girls; mean age 5.2 years; premaxillary size > (19.3 + 2.0) mm; mean size 22.6 mm]; small premaxilla [SP; 15 boys, 5 girls; mean age = 5.1 years; premaxillary size < (19.3-2.0) mm; mean size = 16.5 mm] and bilateral-median facial dysplasia [B-MFD; 6 boys, 9 girls; mean age 5.1 years; mean size 10.5 mm]. They all had a bilateral cheiloplasty at about 3 months of age and palatoplasty at about one year of age. Lateral cephalograms were taken at about 5 years of age to compare the craniofacial complex among the three groups. RESULTS: The LP group tended to have a longer maxilla, longer anterior maxillary height and more protruded maxilla, producing a better interjaw relation and larger overjet. The opposite phenomena were observed in the B-MFD group, and the SP group had results between those of the LP group and the B-MFD group. CONCLUSION: BCLP patients with large premaxilla had superior maxillary growth (in depth and anterior height) as compared to those with small premaxilla.

Child↗

PubMed2000

The use of a face mask for postoperative retention in cleft lip and palate patients.

Surgical relapse in cleft lip and palate patients following Le Fort I osteotomy can be pronounced due to the presence of scar tissue from previous surgical episodes. This article reviews the literature on the use of protraction face masks. It describes the use of a face mask in the postoperative management of osteotomy patients undergoing surgery for the correction of severe skeletal Class III relationships. The management of a patient with repaired unilateral cleft lip and palate is illustrated.

Cicatrix↗

PubMed2005

Study of viridans streptococci and Staphylococcus species in cleft lip and palate patients before and after surgery.

OBJECTIVE: To determine the effect of surgery on types and colony count of Streptococcus and Staphylococcus species in cleft lip and palate (CLP) patients. DESIGN: Saliva samples were collected after the morning meal by placing a sterile cotton swab in the vestibule of the oral cavity from cleft lip and palate patients immediately preoperative and 12 weeks postoperative. Normal children were examined as a control group. Samples were cultured; Staphylococcus and Streptococcus isolates were identified and quantified. PATIENTS: Fifteen cleft lip and palate patients and 22 normal children, aged 3 to 39 months were examined. RESULTS: Streptococcus mitis biovar 1, Streptococcus salivarius and Streptococcus oralis of the viridans group of streptococci were the most commonly found in normal children, as well as in cleft lip and palate children. In the cleft lip and palate group, mean streptococcal count was 32.41 (29.80) and 46.46 (42.80) in the pre- and postoperative periods, respectively; in the normal group, the count was 20.93 (27.93) and 49.92 (34.72) at 0 week and 12 weeks, respectively. Staphylococcus aureus was the most common Staphylococcus species found in CLP patients, representing 47.4% postoperatively. In the cleft lip and palate children, mean staphylococcal count was 5.34 (8.13) and 0.56 (0.92) in the pre- and postoperative periods, respectively; in normal children, the count was 0.82 (1.98) and 0.60 (2.55) at 0 and 12 weeks, respectively. The differences were statistically significant only for the staphylococcal count between pre- and postoperative periods in children with cleft lip and palate as tested by analysis of variance (p < .05). CONCLUSIONS: Cleft lip and palate patients had more colonization by S. aureus compared with normal children, and the colony count decreased significantly following surgical repair of the cleft lip and palate.

Analysis of Variance↗

PubMed1992

Early palatal changes in complete and incomplete cleft lip and/or palate.

Early palatal development in various complete and incomplete forms of cleft lip and/or palate (CLP) was studied from birth to 3 months of age by means of dental casts. Palatal morphology (shape) and dimensions--based on reproducible reference points--were determined in a group of 128 CLP children and 68 normal children who served as controls. Substantial normal palatal growth during the first 3 months of life was observed. Round arch forms changed into oval arch forms. Growth mainly takes place in the sagittal direction (+4 mm) (transverse: +1 mm). Palates of CLP children differed significantly dependent on the type of cleft and whether the cleft was complete or incomplete. Cleft lip and alveolus children and bilateral cleft lip and palate children had more elongated palatal arches, whereas unilateral cleft lip and palate children and cleft palate children had wider palatal arches than the control group. Incomplete clefts differed from the control group in the same direction as their complete cleft forms, though less distinctly. Preoperative orthopedics used in CLP patients does not stimulate growth. On the contrary, it even restricts growth.

Cleft Lip↗

PubMed2001

Management of the cleft lip nasal deformity.

Management of the cleft lip nasal deformity offers a unique and ongoing challenge in facial plastic surgery. Although there has been no consensus regarding the optimal timing and technique for surgical repair of this deformity, the authors have found a three-tiered approach to be satisfactory. This approach involves a primary rhinoplasty performed at the time of the initial cleft lip repair to address reconstruction of the nasal floor and sill, columellar lengthening, repositioning of the alar base, and repositioning of the skin and mucosa of the lower lateral cartilage. Following alveolar bone grafting, an intermediate rhinoplasty is often performed at 6 to 10 years of age through an open approach to correct the cartilaginous lower nasal deformity. A delayed rhinoplasty is then performed in the later teenage years to correct the bony dorsal deformity and the various causes of nasal obstruction.

Cleft Lip↗

PubMed1991

Comprehensive treatment of bilateral cleft lip by multidisciplinary team approach.

Repair of bilateral cleft lip presents numerous problems, and in our opinion, it is better to begin treatment at the earliest age possible. At Fujita Health University Hospital, we utilise a multidisciplinary team approach to cleft lip. Nonsurgical correction of the nasal deformity using a nose retainer and preoperative orthodontics using a Kuwahara-modified Hotz's palatal plate begins soon after birth. Surgical repair of the lip is done within the first 2 months of life, by the time the nose, alveolus and projecting prolabium are adequately reformed. A one-stage surgical procedure, including restoration of muscle union, labial sulcus construction and nasal correction is performed. After lip repair, lip and tongue pressure are well balanced by the plate, and a good alignment of the alveolus can be achieved. A total of 27 cases of bilateral cleft lip were treated from August 1986 to October 1990. In all cases, the postoperative course was uneventful, and no complications due to early surgery were encountered.

Cleft Lip↗

PubMed2004

[Presurgical orthopedic treatment for cleft lip and palate].

INTRODUCTION: A multidisciplinary approach with several specialits allows a complete treatment for Cleft Lip and Palate. We show our experience in presurgical orthopedic treatment in these patients, their advantages, their problems and the results. MATERIAL AND METHODS: Since 1999 presurgical orthopedy has been applied to 12 patients (3 bilateral cleft lip and palate and 9 unilateral cleft lip and palate). This approach was applied when there was a long distance between the alveolar segments. A palate mould and the location of Latham's appliance have been made in the operating room under general anesthesia. The patients were controlled by the orthodoncist and Latham's appliance was removed when cleft lip was closed. RESULTS: Latham's appliance was kept for 4-7 weeks with once a week controls until the distance between the maxillary segments was less than 1 mm; in bilateral cases of cleft lip and palate the premaxilla was moved between lateral segments. Then, lip closure and nasoplasty was made and, sometimes, an obturador was placed. CONCLUSIONS: Latham's appliance permit to achieve a perfect alignment of alveolar segments decreasing the soft tissues tension and facilitating the lip surgery, thus, a better aesthetic and functional results can be achieved. A more anatomic position of palate can be made and easier future orthopedic treatments are possible.

Child, Preschool↗

PubMed1993

Median cleft lip without holoprosencephaly. Case report.

A patient with median cleft lip is reported, but the patient showed no evidence of holoprosencephaly, which was ruled out by MRI. When the neonate's head circumference is within two standard deviations of the mean and normotelorism occurs with median cleft lip, it can be assumed that the brain is not holoprosencephalic. The importance of this cannot be overemphasized because median cleft lip is commonly associated with holoprosencephaly and severe microcephaly. The mother developed overt diabetes mellitus after the patient was born. However, infants of diabetic mothers are known to be at increased risk of giving birth to infants with holoprosencephaly. Since a prediabetic woman may sometimes give birth to large and/or malformed infants before developing overt diabetes mellitus, it is intriguing to speculate that the prediabetic state might have resulted in a forme fruste of holoprosencephaly, affecting, in this case, only the face and not the brain.

Anodontia↗

PubMed2006

Survey of the patients with cleft lip and palate in China who were funded for surgery by the Smile Train Program from 2000 to 2002.

BACKGROUND: Cleft lip (CL) and cleft palate (CP) are two of the most frequent congenital malformations. Many epidemiologic studies on this deformity have been conducted worldwide, often producing inconsistent results. This study assessed epidemiology and some genetic aspects of cleft lip and palate in a Chinese sample from the Smile Train Program and to compare with other methodologically sound surveys. METHODS: The general information, family history, classification of cleft and associated malformations of 8000 CL and CP surgery patients were analyzed. RESULTS: Of the 8000 cases, 7812 had complete data. The distribution of cleft types is 17.04% with CP, 23.39% with CL and 59.58% with cleft lip and palate (CLP). Unilateral clefts were more common than bilateral, with unilateral to bilateral ratios being 10.4:1 for CL, and 3.42:1 for CLP. The overall male:female ratio was 2.01:1. Left sided defects were more common than right sided regardless of sex, 1.90:1 for CL and 1.96:1 for CLP. CLP and CL were more common in males than in females with sex ratios (SR) of 2.88:1 and 1.85:1 respectively, whereas CP was more common in females with SR of 0.76:1. Associated malformations (2.89%), involved 29 CP cases, 41 CL and 156 CLP. The frequency of associated malformations in CLP (3.35%) was higher than CL (2.24%) and CP (2.22%) (P < 0.05). Patients with CP or CLP were born less often in the winter than in the summer (P < 0.05). A history of family members having clefts occurred in 6.84% of patients. The proportion of CLP cases (7.56%) was significantly higher than that of CL cases (5.64%) (P < 0.05). CONCLUSIONS: The different types of clefts appeared in the highest proportion in CLP and lowest proportion in CP. Males are more common with CL and CLP and less common with CP. These characteristics are the same as those of other Chinese surveys but different from some European reports.

China↗

PubMed2002

[Management of cleft lip and palate by the Doctor Magalon's team in Marseille].

The goal of the treatment of patients with cleft lip and/or cleft palate was: obtain a normal appearance, a normal speech and a normal growth without severe pertubations of the quality of life. Millard technique was used to repair the cleft lip in neonatal period. Between 6 and 18 months, the palate cleft was closed by wardill-kilner technique. A gingivoperiostoplasty with osseous graft was performed between 8 and 12 years. The orthodontic treatment began at 7 years. Pharyngoplasty was necessary in several cases. Sequellae and rhinoplasty was performed at the end of the growth. The authors explained their choices.

Child↗