Objective: Cleft lip repair is undertaken in the U.K between the age of 3-6 months according to the “OSLO” protocol. During the COVID19 pandemic all cleft surgical activity was suspended leading to a backlog. With the return of surgical activity, we were operating on children much older than we normally would. This meant that the children were a lot more mobile, traumatising their lip repairs due to an increase in incidents of falls. We would like to present the impact of delays in cleft lip repairs at our centre, due to the COVID-19 pandemic. Patients and Methods: A retrospective review of patients undergoing primary cleft lip repair was performed for patients between 2020-2022 Aug (COVID19 pandemic). To compare the outcomes, we also collected data from patients operated between 2018 and 2019. The Fisher exact test was used to explore statistical difference in surgical outcomes between the two groups of cleft lip patients. Results: During the pandemic 100% of the patients undergoing primary lip repair were over the age of 6 months compared to 16% (8/50) in the pre-pandemic group. In the pandemic group, the parents of 12 children (21%) reported an incident causing trauma to the lip repair. The p value using the Fisher exact test was 0.0037, which was significant at p< 0.05 confirming a higher incidence of falls in older children. Conclusions: We conclude from this study that cleft lip surgery performed in older children has the potential to cause significant and unwanted complications.

Comprehensive rehabilitation of cleft lip and palate (CLP) necessitates a meticulously coordinated, multidisciplinary approach due to the complexity of skeletal and dental anomalies involved. This report outlines the phased management of a growing female patient presenting with unilateral CLP and congenital absence of the upper left lateral incisor. Treatment involved a sequence of orthodontic and surgical interventions including maxillary expansion with a quad-helix appliance, secondary alveolar bone grafting, canine mesialization through a tooth-borne distractor, mandibular repositioning through the inferior subapical osteotomy, genioplasty, and secondary rhinoplasty. At the 5-year follow-up, both functional and esthetic outcomes remained stable underscoring the efficacy of the interdisciplinary treatment strategy.

Background: Cleft lip and palate (CLP) is a prevalent congenital malformation in Mexico, affecting a significant portion of the population. It is associated with a range of psychological and mental health issues, in addition to physical sequelae, making it a complex and multifaceted condition. Materials and Method: The present research was meticulously developed using a robust quantitative methodology and an exploratory cross-sectional design. This approach was chosen to provide a comprehensive understanding of the mental health status of children with CLP in Mexico. Participants: The sample consisted of 93 children with a mean age of 9.6 years, 53 (57%) males and 40 (43%) females. Outcome Measures: The Brief Screening and Diagnostic Questionnaire (CBTD), designed to identify possible mental health problems in children and adolescents, was used. Results: It was found that 63.44% of the sample did not have serious mental health problems, but there were changes in the children’s behavior; 21.5% were likely to have uncomplicated mental health problems, and 15.1% were likely to have complicated mental health problems. Conclusions: The findings underscore the need for more comprehensive research focusing on the mental health of children with CLP. A larger and more diverse participant population is essential to provide conclusive data on the psychological sequelae of CLP, thereby enhancing our understanding and improving the care for these children.

Context: Cleft lip and palate (CLP) are congenital anomalies that vary in occurrence by geography. There are less data on the demographic and clinical profiles of familial cleft lip and/or palate cases in India. Aim: The aim of this study was to analyze the demographic and clinical profiles of familial cleft lip and/or palate cases in high-volume cleft center in Telangana, India. Settings and Design: This was a retrospective descriptive study with a population-specific setting. Subjects and Methods: After ethical clearance, this retrospective analysis was carried out at the GSR Institute of Craniofacial Surgery, a high-volume cleft center. Data from 4000 medical records spanning 4 years indicated 55 families with nonsyndromic familial cleft lip and/or palate cases. These 55 familial cases provided data on demographic and clinical characteristics such as socioeconomic level, consanguinity, CLP type, laterality, and gender distribution. They were entered into an Excel spreadsheet. Statistical Analyses Used: Descriptive and inferential statistics were used for statistical analysis. Results: Nonsyndromic familial cleft lip and/or palate cases increased significantly between 2020 and 2024 before declining in 2024. Consanguinity was common in 32.7% of households. The frequency of any clefts was higher in the lower socioeconomic class. The frequency of left and right unilateral complete cleft lip was seen in 16.4% and 5.5%, cleft palate was seen in 18.2%, and unilateral right-side CLP was seen in 23.6%, with male predominance. Conclusions: The present study found a male majority among familial cleft lip and/or palate instances, with right unilateral complete cleft being the most common. Consanguinity and low socioeconomic status were prevalent among affected families. A significant rise in cleft cases was observed in recent years, though this may reflect increased outreach efforts rather than a true increase in incidence. The growing frequency of cleft lip and/or palate in recent years, particularly the differences in our findings, shows that geographical variables may play a role.

Congenital palatal fistula is a rare anomaly. We are reporting a rare case of congenital palatal fistula with a submucous cleft palate successfully operated on with satisfactory functional results. A 14-year-old male presented to us with a palatal fistula with submucous cleft palate since birth. The child was born by full-term normal vaginal delivery at a hospital in a rural area with normal birth weight, antenatal, and postnatal period were uneventful. His complaints were nasal regurgitation and hypernasal speech and recurrent episodes of secretory otitis media. A detailed video nasopharyngoscopy was done. On intraoral examination, fistula of 7 cm by 4 cm in the midline involving palatine bone of hard palate and anterior part of soft palate suggestive of congenital fistula with aberrant insertion of palatal muscles and bifid uvula-Calnan’s triad suggestive of submucous cleft palate. Veau–Wardill–Kilner V-Y pushback palatoplasty (oxford technique) with three-layer closure was performed. Three-layer closure (nasal mucosal layer, palatal muscular layer, and Oral mucosal layer) was achieved without tension, and the hook of the Hamulus was also fractured. The patient was discharged on postoperative day 5, tolerating adequate oral intake. At 2 months was found to have well-healed palate and had attained good velopharyngeal function (on video nasopharyngoscopy). Hypernasality in speech also improved with speech therapy at 1 year of follow-up. Although very few cases of congenital fistula of palate have been reported, the incidence appears to be high. Any child presenting with speech abnormalities and velopharyngeal insufficiency should be thoroughly investigated for the presence of submucous cleft palate. These patients need to be referred to well-equipped centers so that they are repaired at the earliest before speech develops and have better speech outcomes. The general population needs to be made aware of the pros and cons of the surgery and the consequences of delaying the surgery.

Background: Speech intelligibility is a critical challenge for individuals with orofacial clefts, as effective communication is essential for cognitive and social development. Children with orofacial clefts often experience difficulties in speech production, particularly with high-pressure consonants, due to anatomical differences and related conditions. Early and accurate identification of speech intelligibility deficits beyond age norms is crucial for timely intervention. Early intervention and psychoeducational support are commonly advocated as strategies to enhance speech intelligibility in this population. However, there is a scarcity of research on the predictive outcomes of these interventions in LMICs such as Nigeria, necessitating this study. Aims and Objectives: To determine the predictive outcomes of early intervention and psychoeducational support on speech intelligibility among children with orofacial clefts in low- and middle-income countries (LMICs), with a focus on South-western Nigeria. Materials and Methods: This research adopted a descriptive survey of the correlational type, utilizing self-structured and adapted questionnaires for data collection. Results: The findings revealed a positive moderate relationship between early intervention and speech intelligibility of persons with orofacial clefts (r = 0.458, n = 106, p (.000) < 0.05) and no significant relationship between psychoeducational support and speech intelligibility of persons with orofacial clefts (r = .101, n = 106, p (.301) > .05). The research also identified variables such as socio-economic status and time of repair as predictors of speech intelligibility of the respondents. Conclusion: These results highlight the need for further research to explore additional factors influencing speech outcomes in individuals with orofacial clefts within this context.

Introduction: Cleft palate is a very common congenital defect that disrupts velopharyngeal closure leading to some complications such as velopharyngeal insufficiency (VPI) and hypernasality. After initial surgical repair, about 20%–30% continue to have persistent VPI requiring additional surgical procedures. This study evaluates the outcome of intravelar veloplasty in conjunction with the posterior tonsillar pillar flap to elongate the palate, improve the competence of the velopharynx, and reduce hypernasality. Materials and Methods: This was a prospective clinical trial conducted from 2018 to 2019 at Al-Zahra Hospital, Isfahan, Iran. A total of 40 patients with persistent VPI following cleft palate repair underwent intravelar veloplasty for the reconstruction of the levator veli palatini muscle sling under general anesthesia. This procedure was then followed by posterior pillar flap mobilization for palatal lengthening. In this study, preoperative and postoperative outcomes were assessed regarding velopharyngeal adequacy by measuring gap and assessing speech through satisfaction scores using videofluoroscopy. Results: At 1-year follow-up, 62.5% of patients showed adequate velopharyngeal closure, with significant gap measures improvement, as evidenced by P < 0.001. Younger age groups (<10 years) had better results than the older ones with P = 0.019. The satisfaction score ranked highest in patients at 7.2 ± 0.82, followed by expert panels at 6.33 ± 0.8, then surgeons at 6.55 ± 0.93. There were no significant differences according to gender or cleft type. Conclusion: The combined intravelar veloplasty and posterior pillar flap technique considerably improves the palatal length, velopharyngeal closure, and hypernasality in patients with persistent VPI, particularly in carefully selected cases. Larger studies with longer follow-up are needed to confirm these findings and overcome study limitations.

Presurgical nasoalveolar molding (PNAM) is a key intervention in the management of cleft lip and palate deformities, aiming to optimize soft tissue and cartilaginous anatomy prior to surgical repair. However, conventional devices such as the Grayson nasal stent can be cumbersome, interfere with feeding, and are often poorly tolerated in bilateral cleft lip and palate (BCLP) patients. This report describes the successful use of a novel bilateral modified indigenous nasal elevator (BMINE) appliance in a neonate with BCLP. The infant, presenting with severe columellar shortening, nasal dome collapse, and a protrusive premaxilla, was managed using a phase-wise protocol: PNAM with BMINE, followed by lip repair and rhinoplasty at 3 months, and planned palatal repair at 15–18 months. The BMINE appliance, fabricated using 19-gauge stainless steel wire and heat-cure acrylic, provided patient-specific, calibrated traction to the alar domes. Its pull-type mechanism allowed columella centralization, nasal dome elevation, and effective nasal cartilage molding, without interfering with feeding or requiring invasive fixation. Over the course of treatment, the intersegmental gap reduced from 11 mm to 2.5 mm. Columellar angle improved from 115° to 91°, and nasal symmetry and alar dome projection were restored. Postoperative assessment confirmed improved nasal contour, lip esthetics, and arch form. The appliance continued to be used postoperatively, with periodic modifications to accommodate facial growth, thereby preserving surgical outcomes. The BMINE appliance offers a low-cost, customizable, and noninvasive alternative to conventional NAM techniques in BCLP patients. Its bilateral design, ease of fabrication, and calibrated force application make it a valuable adjunct for cleft teams, particularly in resource-constrained settings. Further studies are warranted to evaluate its long-term outcomes and scalability.

Background: Stem cells from human exfoliated deciduous teeth (SHED) have been considered a promising resource for regenerative medicine due to the ease of obtainment, noninvasive collection, and availability of deciduous teeth. Aims and Objectives: This study compared the characterization of SHED between children with and without cleft lip and palate (CLP), aiming at analyzing whether autologous SHED can be considered an option to be used as an alternative in the reconstruction of alveolar clefts in individuals with CLP. Materials and Methods: Dental pulp tissues were obtained from 6 healthy deciduous teeth at the exfoliation stage, from donors aged between 4 and 12 years, and divided into the control group and cleft group. The dental pulp cells obtained in the primary culture were immunophenotypically analyzed. Cells that showed positive for expressions of the cell surface markers and negative for were collected. The cells were submitted to multilineage differentiation and morphologically analyzed. The immunophenotypic difference between the groups was analyzed using Student’s t test, with a significance level of 5% (P < 0.05). Results: Plastic adhesion was demonstrated and high levels of mesenchymal stem cell (MSC) markers were identified in both groups, with positive expression of CD105, CD73, and CD90 (≥95% positive) and absence of hematopoietic lineage markers CD45, CD34, CD11b, CD19, and HLA RD (≤2% positive). Pulp cells demonstrated capacity for adipogenic, osteogenic, and chondrogenic differentiation. The morphological analysis identified a slightly smaller nucleus and decreased proliferative capacity in the cleft group. There was a statistically significant difference (P = 0.042) in the comparison of the cells obtained after immunophenotypic analysis between the groups. After validating the standard criteria for defining multipotent MSCs in both groups, the isolation and characterization of SHED were confirmed in all samples. Conclusion: SHED characterization of both groups was similar. These results suggest that SHED of children with CLP may be considered an option for future investigations on the autologous use of cells for therapeutic intervention.