Cleft Cases Research Articles

Periodic Trends in the Incidence of Cleft Palate in a Cohort of Sri Lankan Cleft Palate Patients

Background: Over the last few decades the incidence of cleft palate has been increasing across the world. There are several genetic and environmental factors are reported to be among the causative agents of cleft palate. Theres scarcity of data with regards to the seasonality and the occurance of cleft palate among sri Lankans. Hence, the purpose of this study was to identify periodic changes in the incidence of cleft palate in a cohort of Sri Lankan population.Material & methods: Subjects (n=323) with cleft palate registered at the Regional Cleft Centre & Maxillo-Facial Department, Teaching Hospital, Karapitiya, Galle, from the 1st of January 2001 to 31st of December 2020 were included in the study. Structured interviewer based questionnaire was used to collect the information after obtaining the informed written consent.Results: Significantly higher number of cleft palate cases in this study were born in March (p = 0.008) compared with the national birth incidence while significantly lower numbers were born in October (p = 0.01). The sex ratio in the study sample was 0.71.Conclusions: The periodic trends in the incidence of cleft palate found in this preliminary study reinstated that environmental factors may have accounted for the reported seasonal variations observed in the incidence of cleft palate. Future studies are warranted to investigate the putative harmful seasonal factors that can influence the occurance of cleft palate.

Epidemiologic trends of cleft lip and/or palate in Switzerland

BackgroundEpidemiologic data on the number of cleft lip and/or palate (orofacial cleft (OFC)) births in Switzerland are currently sparse. However, this knowledge is essential for better understanding the etiologies underlying the various cleft phenotypes and providing expectant parents with the best possible healthcare planning and counseling.MethodsThis is the first descriptive study to report data on the prevalence of the various cleft types, their sex, and regional distributions in Switzerland. Data for the years 1998–2021 were obtained from the Swiss Federal Statistical Office. Due to the notable initial underreporting of cleft cases from 1998 to 2006, this period was omitted from the final analyses.ResultsBetween 2007 and 2021, the prevalence of all Swiss OFC cases per 10,000 live births was 12.5, with a stable trend. Cleft lip was the least common anomaly. Except for cleft palate, which was more common in females, males were generally more affected by OFC than females. There was no discernible regional trend for any of the malformations, even though the prevalence differed throughout the seven Swiss regions.ConclusionsThis study presents the first descriptive epidemiologic profiles for OFCs in Switzerland and emphasizes the importance of nationwide OFC registries with an accurate and reliable reporting system for the benefit of current and future patients with clefts, their parents or caregivers, and society as a whole.

Evaluating quality of life changes in patients with cleft lip or palate: a mixed method pre- and postsurgical analysis in Karachi

BackgroundCleft lip and/or palate (CLP) is the most common orofacial congenital disability, presenting significant medical, psychological, and social challenges. In Pakistan, the incidence of CLP is high, estimated at one in 523 live births, but accurate data are lacking due to the absence of a birth registry. Early diagnosis and intervention are crucial for improving outcomes. This study evaluated the impact of CLP on patients’ quality of life in Karachi, comparing pre- and post-surgical phases.MethodsA sequential exploratory quantitative-qualitative mixed-methods study was conducted at two tertiary care hospitals in Karachi. In the quantitative phase, 280 patients with CLP, either awaiting or post-surgery, completed the Oral Health Impact Profile (OHIP-14) questionnaire to assess oral health-related quality of life (OHRQoL). Based on questionnaire responses, 30 participants were purposively selected for in-depth, semi-structured interviews exploring their experiences. Quantitative data were analyzed using SPSS version 25; qualitative data were analyzed thematically.ResultsQuantitative findings revealed significant gender disparities in cleft types and correction status; females had a higher prevalence of unilateral cleft lip, while males had more cleft palate cases. Dental and oral health issues significantly affected daily activities, with higher impacts in cleft palate patients. OHRQoL varied by gender, cleft type, and correction status, with those post-surgery reporting poorer OHRQoL. Qualitative analysis identified six themes: Diagnosis and Early Treatment, Challenges and Impact, Postsurgical Experiences, Support Systems, Healthcare Experiences, and Future Perspectives. Inconsistencies in psychological support, accessibility and financial burdens were presented as significant issues. Sentiment analysis highlighted varied emotions, from despair to hope and gratitude.ConclusionsCLP significantly affects patients’ quality of life in Karachi across multiple dimensions. Early diagnosis and surgical intervention are essential but often hindered by financial and accessibility issues. Psychological effects, including low self-esteem and social isolation, highlight the need for integrated mental health support. Family and community support are critical for patient resilience. A comprehensive approach addressing medical, psychological, social, and systemic factors is necessary to improve outcomes for individuals with CLP.

Epidemiology of Orofacial Clefts: A Spatio-Temporal Descriptive Analysis in Tripoli, Libya, 2017-2021

Orofacial clefts are the most common congenital anomalies affecting the orofacial region. An abnormal facial development causes this congenital deformity during gestation; its aetiology is multifactorial. It is crucial to understand the prevalence of craniofacial anomalies in each community to determine the size of the problem, enhance the life standards for the patients, and assess the efficacy of interventions. In this study, we aimed to provide a picture of the prevalence of orofacial clefts in Tripoli, Libya. Also, it provides a useful reference for cleft-type distribution with their etiological risk factors. The data was collected from the archives of cleft babies referred to major specialized hospitals in Tripoli, Libya, from 2017 to 2021. Variables were collected and analyzed, including data related to cleft cases and their parents. During the study period, the incidence of orofacial clefts was 1.06 per 1,000 live births. The prevalence of cleft lip was 38.3%, cleft palate was 42.2%, and cleft lip with palate was 19.6%. The results showed that 2017 had the highest incidence rate, reaching 32.2%, while it was 8.3% in 2021. The prevalence was generally higher among males than females, at a difference rate of 3.47%. A history of folic acid deficiency and unsupervised drug intake during pregnancy was noted (58.3% and 61.7%, respectively). In addition, the higher prevalence was more common among mothers older than 34. Moreover, it has observed that 46.8% of patients` fathers were smokers. The study concluded that the incidence of cleft defects in Tripoli, Libya, was relatively low, and the role of the predisposing factors in increasing the incidence of cleft deformity remains uncertain. Further studies are recommended to find out the root cause.

Dental Anomalies in Children with Unilateral and Bilateral Cleft Lip and Palate

Background: Dental anomalies is common feature of cleft lip and palate cases. Clefting is not an isolated condition but rather part of a broader spectrum of malformations involving both facial structures and tooth developmentObjective: To determine and compare the frequency of dental anomalies among children with unilateral and bilateral cleft palateMaterials and Methods: This cross-sectional descriptive study was conducted at the outpatient department of Bacha Khan Dental College, Mardan, involving 82 participants aged 4 to 20 years. Patient history, clinical examination, and panoramic radiographs were employed to identify common dental anomalies, like lateral incisor agenesis, supernumerary teeth, peg-shaped lateral incisor, lateral incisor microdontia, agenesis of the maxillary second premolar, and enamel hypoplasia. The Chi-square test was used to compare dental anomalies between unilateral and bilateral cleft palate cases, with the significance level set at p < 0.05.Results: The age was 12.12 ± 5.21 years, with a gender distribution of 28 (34.15%) females and 54 (65.85%) males. Unilateral cleft palate (n=56, 68.29%) was more common than bilateral (n=26, 31.71%). The frequency of dental anomalies included 37.80% exhibiting lateral incisor agenesis, 21.95% supernumerary teeth, 17.07% peg-shaped lateral incisor, 17.07% lateral incisor microdontia, 20.73% agenesis of the second premolar, and 9.76% clinical enamel hypoplasia. No statistical significant difference was found for all dental anomalies between unilateral and bilateral cleft palate (p>0.05).Conclusion: Dental anomalies are quite prevalent in both unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients. Importantly, no statistically significant differences were observed between these two groups.Keywords: Bilateral, Cleft lip and palate, Dental anomalies, Unilateral.

Residential Environment and Parental Lifestyle as Risk Factors of The Co-Occurrence of Cleft Lip and Palate Birth Defect Cases in Indonesia

Cleft lip and palate (CLP) are multifactorial birth defects, and the etiology behind their occurrence remains insufficiently understood. This case-control study aimed to investigate the association between residential environmental factors, parental lifestyle, and the risk of CLP in Indonesia. A total of 213 participants from 14 provinces were selected using stratified random sampling. Multivariable logistic regression was employed to determine the odds ratios (ORs) with 95% confidence intervals (CIs) for each risk factor. The study identified significant associations between several residential environmental factors and CLP. Proper kitchen ventilation was found to be protective (OR = 0.245, 95% CI: 0.096–0.624, p = 0.003), while proximity to industrial sites significantly increased the risk (OR = 3.595, 95% CI: 1.029–12.558, p = 0.045). Additionally, using treated drinking water showed a protective effect (OR = 0.39, 95% CI: 0.16–0.95, p = 0.038), whereas concerns about water sources displayed a marginally significant risk increase (OR = 2.841, 95% CI: 0.876–9.211, p = 0.082). Regarding parental lifestyle factors, maternal active smoking exhibited a marginal protective association (OR = 0.052, 95% CI: 0.002–1.09, p = 0.057), while paternal passive smoking presented a marginally significant risk (OR = 2.309, 95% CI: 0.897–5.942, p = 0.083). Furthermore, paternal radiation exposure was associated with an elevated risk of CLP (OR = 3.489, 95% CI: 0.828–14.703, p = 0.089). These findings highlight the need for targeted public health interventions to mitigate environmental exposures and promote safer parental lifestyle behaviors in Indonesia.

Case report: Two cases of Cleft rhinoplasty

The correction of cleft lip nose deformity remains a great challenge for any cleft surgeon. The nose is a prominent part of the face, and any cleft lip repair directs the beholders’ eyes from the deformed lip to the deformed nose, Controversies exist on the timing of rhinoplasty in cleft lip patients and is categorized as primary rhinoplasty performed at the time of cleft lip repair, intermediate rhinoplasty at the age of 5–11 years and definitive rhinoplasty. This article presents two cases of unilateral nasal cleft in two adults treated by secondary rhinoplasty using an open technique. The primary deformity is an imbalance between abnormal muscle insertion and maxillary skeletal hypoplasia. The general characteristics of this deformity are a very short columella, downward rotation of the tip and diminished nasal projection, and treatment of this depressed and hypoplastic bony scaffolding is the secret to successful secondary rhinoplasty. Proponents of delayed nasal repair suggest that altering the cartilages in early nasal repair at the time of lip repair would complicate future corrective nasal surgeries if the primary repair would prove unsatisfactory. However, we know that repositioning the wing cartilage at the same time as closing the lip respects nasal growth by using a rigorous technique and control of scars The aim of cleft lip rhinoplasty is both aesthetic and functional: to obtain a normal nose with nasal breathing.

Columellar lengthening with V-Y advancement flap in aesthetic rhinoplasty

Achieving a harmonious nasal shape requires balance from the frontal, lateral, and basal views. A short columella can lead to inadequate tip projection and drooping. While various methods have been used to lengthen a short columella in cleft lip and palate cases, adapting these techniques for aesthetic surgery presents challenges. This report outlines the design and surgical considerations for this issue. Ten patients with a short columella at risk of skin resistance or retraction were evaluated. The V-Y flap technique was employed, featuring a V-shaped design starting at the midpoint between the columellar footplate and the lowest point of the nostril sill. Standard techniques included a columellar graft to prevent narrowing. The rhomboid flap was trimmed and sutured in place. Results showed that the V-Y flap provided adequate tip projection, reduced columellar flaring, and improved nostril shape. Scarring was comparable to an inverted-V incision, with improvements in the columellar base and philtrum and high patient satisfaction. The technique effectively addressed tip projection challenges in patients with short columella.

The Efficacy of Naso-Alveolar Molding on Premaxilla Pushback and Dentoalveolar Changes in Patients With Bilateral Cleft Lip and Palate.

To evaluate the extent of naso-alveolar molding (NAM) in pushing the premaxilla posteriorly in patients with bilateral cleft lip and palate (BCLP). Naso-alveolar molding application in cleft lip and palate cases bridges the cleft gap and increases nasal tip projection. In BCLP, NAM potentially mobilizes the premaxilla posteriorly to allow tension-free primary lip closure. However, some patients with BCLP with NAM history still necessitate osteotomy during labioplasty, questioning the efficacy of NAM for BCLP management. This single-center retrospective study was conducted using medical records of nonsyndromic patients with BCLP. Twenty-six patients with BCLP were enrolled over a 5-year period with a history of NAM application before primary labioplasty. The changes in premaxilla width (P), anterior arch width (A), posterior arch width (R), and anteroposterior projection of the premaxilla (P'-A') were statistically analyzed at 2 time points: (1) at the start of NAM application (T1) and (2) after completion of NAM before surgery (T2). The average age at NAM initiation was 46.2 ± 40.4 days, and the average duration of NAM usage was 125.14 ± 62.94 days. A and P-A showed significant differences between T1 and T2 (P < 0.0001), whereas the rest did not show significant differences in value following NAM application (P > 0.05). Naso-alveolar molding successfully pushed back the premaxilla portion about 4.68 ± 2.83mm on average. Naso-alveolar molding can push back the premaxillary protrusion up to 5mm, which can serve as a cutoff point for the consideration of combined modalities. Prenatal diagnosis, counseling, and cleft education should be the benchmark in cleft centers to improve overall patient outcomes.

Septal Extension Spreader Graft Combined With Warped Alar Batten Graft for Improvement of Nasal Tip and Alar Asymmetry in Adult Cleft Lip Nasal Deformity.

This paper presents the findings of an observational study involving 38 patients to evaluate the application of a surgical technique utilizing an autologous costal cartilage scaffold for correcting nasal tip and alar asymmetry in unilateral cleft lip-nasal deformity. Nasal septum extension spreader grafts (SEG) and warped alar batten grafts, both made from autologous costal cartilage, were utilized in open rhinoplasty procedures. The warped alar batten graft was fixed to the caudal end of the SEG, with the lower lateral cartilage on the cleft side suspended to the free part of the newly created warped alar batten graft to lift the collapsed nasal alar further. Measurements of nasal tip height, nostril height, and the intersection angle of the nasal sill and alar (α) were taken before and after surgery, comparing the ratios between the normal and cleft sides. Patients were followed up for 2.5 to 5.5 years, with all cases showing successful healing and no complications. Postoperative improvements in nasal tip and nostril asymmetries were significant, with statistically significant changes observed in nasal tip height, nostril height, and the intersection angle of nasal sill and alar (α) ( P <0.05). The combined use of SEG and warped alar batten graft, both crafted from autologous costal cartilage, effectively corrected nasal tip and alar asymmetry in adult cleft lip nasal deformity cases.

Assessment of Parental Risk Factors Involved in Orofacial Clefts in Hail, Saudi Arabia: A Retrospective Cohort Study.

Background Orofacial clefts are congenital anomalies affecting the development of the oral and facial structures, influenced by genetic and environmental factors. The prevalence of orofacial clefts varies globally, necessitating region-specific studies to understand contributing factors.Orofacial clefts are among the most common congenital defects affecting the head and neck, underscoring the importance of investigating paternal and maternal influences on their development to enhance awareness and understanding of potential contributing factors.Therefore, this research aimed to investigate parental risk factors contributing to the development of orofacial clefts. Methods A retrospective cohort study was conducted at the Oral and Maxillofacial Department of King Khaled Hospital,Hail, Saudi Arabia, involving 40 parents of children born between 2019 and 2023 with orofacial clefts. Data collection included interviewer-administered questionnaires with parents addressing demographic information, pregnancy details, parental medical history, and postoperative outcomes. Statistical analysis utilized descriptive statistics, chi-square tests, Fisher's exact test, and linear regression, with significance defined as p<0.05. Results The study had a gender distribution of 19 males (47.5%) and 21 females (52.5%) among orofacial cleft cases (p<0.75), with cleft palate (13 cases, 32.5%) and cleft lip (11 cases, 27.5%) being the most prevalent anomalies (p<0.05). Maternal supplementation rates were high, with 34 mothers (85%, p<0.05) taking folic acid and 36 mothers (90%, p<0.05) taking iron, yet orofacial clefts incidence persisted. Paternal risk factors such as tobacco use were reported by 19 fathers (47.5%, p<0.05), and familial history of orofacial clefts was noted in nine cases (22.5%, p<0.05). Postoperative outcomes indicated varying levels of functional recovery and satisfaction. Conclusion This study explored the complex origins of orofacial clefts, emphasizing genetic and environmental influences. The findings suggest a potential paternal risk factor. The study highlights the need for further investigation into genetic mechanisms and the development of effective prevention strategies.

High incidence and geographic distribution of cleft palate cases in Finland are associated with a regulatory variant in IRF6.

In Finland the frequency of isolated cleft palate (CP) is higher than that of isolated cleft lip with or without cleft palate (CL/P). This trend contrasts to that in other European countries but its genetic underpinnings are unknown. We performed a genome-wide association study for orofacial clefts, which include CL/P and CP, in the Finnish population. We identified rs570516915, a single nucleotide polymorphism that is highly enriched in Finns and Estonians, as being strongly associated with CP ( P = 5.25 × 10 -34 , OR = 8.65, 95% CI 6.11-12.25), but not with CL/P ( P = 7.2 × 10 -5 ), with genome-wide significance. The risk allele frequency of rs570516915 parallels the regional variation of CP prevalence in Finland, and the association was replicated in independent cohorts of CP cases from Finland ( P = 8.82 × 10 -28 ) and Estonia ( P = 1.25 × 10 -5 ). The risk allele of rs570516915 disrupts a conserved binding site for the transcription factor IRF6 within a previously characterized enhancer upstream of the IRF6 gene. Through reporter assay experiments we found that the risk allele of rs570516915 diminishes the enhancer activity. Oral epithelial cells derived from CRISPR-Cas9 edited induced pluripotent stem cells demonstrate that the CP-associated allele of rs570516915 concomitantly decreases the binding of IRF6 and the expression level of IRF6 , suggesting impaired IRF6 autoregulation as a molecular mechanism underlying the risk for CP.

Optimization of orofacial cleft imaging protocols using device-specific low-dose cone-beam computed tomography.

The aim of this study was to present optimized device-specific low-dose cone-beam computed tomography (CBCT) protocols with sufficient image quality for pre-surgical diagnostics and three-dimensional (3D) modelling of cleft defects. Six paediatric skulls were acquired, and an artificial bony cleft was created. A high-resolution CBCT scan acted as a reference standard (Accuitomo 170, Morita, Kyoto, Japan) for comparing eight low-dose protocols of Newtom VGi-evo (QR Verona, Cefla, Verona, Italy), which included Eco and Regular protocols with different field of views (FOVs). Delineation of lamina dura, cementoenamel junction (CEJ), trabecular bone and bony bridge were assessed. A 3D model of the defect was also evaluated. The dose area product of low-dose protocols ranged from 31 to 254 mGy*cm2. Despite the dose difference of up to eight times between applied protocols, trabecular bone and CEJ exhibited appropriate image quality in all scans. However, Regular small FOV protocols (5 × 5 and 8 × 5 cm2), for both lamina dura and bony bridge, demonstrated a significant improvement in image quality compared to Eco FOV counterparts. Based on 3D defect analysis, no significant difference existed between low-dose protocols and the reference standard. The findings highlight the possibility of achieving a considerable reduction (up to eight times) in the radiation dose using low-dose CBCT protocols while maintaining sufficient image quality for assessing anatomical structures and 3D modelling in cleft cases.

Risk of orofacial clefts in relation to maternal body mass index, diabetes and hypertension.

To investigate if maternal body mass index, diabetes and hypertension are associated with orofacial clefts. Case-control study. Information from 53,188 live births with and without orofacial cleft registered at USA Vital Statistics Natality Birth Data between 2017 and 2021. Case group consisted of all affected live births diagnosed with orofacial clefts (13,297 cases). Comparison group consisted of 39,891 live births without clefts or any other congenital malformation. Information about orofacial cleft cases were compared with the comparison group. The unadjusted and adjusted Odds Ratios were estimated to evaluate the strength of association between mother's pre-pregnancy body mass index, maternal diabetes and hypertension and orofacial cleft occurrence, assuming a p value < 0.05 and 95% confidence intervals (95% C.I.) for statistically significant differences. Mother's pre-pregnancy body mass index, maternal diabetes and maternal hypertension are conditions associated with an increased risk of orofacial cleft development in the child (OR = 1.08, p = 0.004, 95% C.I. = 1.024-1.149; OR = 1.32, 95%, p = 0.000, 95% C.I. = 1.202-1.444; and OR = 1.35, p = 0.000, 95% C.I. = 1.239-1.484; respectively). Maternal ethnicity, sex of infant, and cigarette smoking pregnancy remained as covariates after adjustments in all logistic regression models. Due to the increased prevalence of obesity, diabetes, and hypertension, and also to their association with congenital malformations, such as clefts, it is recommended that mothers planning to become pregnant to follow healthy habits, maintain healthy weight, and be screened for possible diabetes or hypertension prior to conception and early in pregnancy.

A retro-prospective study\' of cleft palatal fistulas: An analy\'sis of prevalence, cause and location in C) perated cleft lip and palate cases

One of the expected outcomes of palate repair is to achieve complete partition between nasal and oral cavity in addition to good speech. Any failure of achieving complete structural integrity of palate is labelled as an oronasal (palatal) fistula with persistent passage between oral and nasal cavity, it can occur at the anterior, posterior or mid palatal region The aim of the study is to assess prevalence of palatal fistula, cause of palatal fistula, location of palatal fistula and to derive a more relevant surgical technique. A retro-prospective study was conducted in operated cleft patients who showed presence of palatal fistula between the age group of 9 months to 7 years. The data collected included age, sex and type of cleft defecttype, width of cleft palatetype of surgery performed, size of fistula, location of fistula, duration of fistula formationpostoperatively 8 palatal fistula were included. The fistula was located mostly at the anterior palatal region (50%) and secondly at the mid palatal region (38%). The occurrence of fistula in operated cleft lip and palate cases was noted mostly after V-Y pushback palatoplasty followed by Von Langenbeck Among the surgical techniques used for palatoplasty, the Von Langenbeck is proven to be superior than V-Y pushback palatoplasty in accordance with the occurrence of palatal fistula. The anterior palate fistulas were the most common type in the study.

The Impact of Participating in Surgical Trips to Low Income, Low Resource Countries on Professional Development of Plastic Surgery Trainees

Title: The impact of participating in surgical trips to low income, low resource countries on professional development of plastic surgery trainees. Objective: Global health initiatives have increased in popularity in recent years, yet international surgical volunteerism remains controversial. Though many U.S. residencies incorporate global health initiatives, there is no standardization of the role that surgical volunteerism plays in resident education. Our goal was to evaluate the impact of surgical volunteerism on former plastic surgery trainees during and after residency. Methods: An electronic survey was distributed to 35 graduates of the plastic surgery residency program at the University of Minnesota between 1991 and 2019. The survey included 28 yes/no questions and free responses. The response rate was 100% (n = 35). Results: 34 of 35 former graduates (97.1%) participated in at least one international surgical trip during residency. All participants had exposure to cleft surgery, and 82.4% reported a predominance of cleft cases. 23.5% of graduates have continued to perform cleft surgery as part of their practice, and 47.1% have continued to embark on surgical trips post-residency. Participants reported that volunteering on international surgical trips have made them more adaptable in the operating room (91.2%), gave them a better understanding of the challenges of poverty (97.1%), and helped them to provide better care for marginalized patients in low resource settings (70.6%). One hundred percent of participants reported that international surgical trips were an important part of their residency training (n = 34). Conclusions: International surgical volunteer work can provide an invaluable experience during training, and they should be offered by plastic surgery residency programs. Supporting resident involvement in surgical trips can have long term ramifications in their careers and commitment to helping the underserved.

Craniofacial Surgery in a Low-Resource Setting: The Successes, Challenges, and Prospects

Background:Craniofacial Trauma and Anomalies affect a substantial proportion of the global society, especially those in the low-and middle-income countries (LMICs). The literature stresses the concept of a team approach for craniofacial surgery and the need for the interaction of many specialists to provide optimal care for the patient. Craniofacial surgery is practiced mainly in the advanced countries of Europe and America. This report describes the establishment of craniofacial care in an African country. It reports on 6-year early outcomes of craniofacial surgery in a low-resourced country, counting the successes, challenges, and prospects. Methods: The establishment of an international collaboration that facilitated the training in craniofacial surgery is described. A 6-year retrospective review of craniofacial surgery cases managed by the Multidisciplinary Cleft and Craniofacial team at the Komfo Anokye Teaching Hospital (KATH) was done from January 2016 to December 2022. Results: Two Ghanaian surgeons were trained in Alabama, USA (a maxillofacial surgeon and a neurosurgeon), then returned to Kumasi to begin a Craniofacial practice with the help of the craniofacial team in Children of Alabama Birmingham Al, USA. A total of 646 procedures were performed (616 cases of orofacial cleft, 20 cases of craniofacial anomalies, and 10 cases of craniofacial trauma involving the cranial vault or base of the skull). Ninety percent of the cases were cleft lip and palate, with the remainder being a mixture of isolated and syndromic craniosynostosis, craniofacial trauma, encephalocele, and craniofacial fibrous dysplasia. Conclusion: The Commonest craniofacial procedure performed was cleft lip and palate repair. Other surgeries were for the repair of velopharyngeal incompetence (VPI) and atypical facial clefts. Complex craniosynostosis and encephaloceles are also now being repaired at KATH. The foundation for a sub-regional center of excellence in cleft and craniofacial surgery is being laid in Ghana at KATH.

Epidemiological Profile of Cleft Lip and Palate Cases in A Libyan Neonatal Unit at Al Wahda Teaching Hospital, Derna: A Comprehensive Analysis

Aim. This study aims to assess the prevalence and associated risk factors of Cleft lip and palate (CLP) among neonates in Derna, Libya, over a six-year period from 2016 to 2021. Methods. This retrospective observational study analysed data from the neonatal unit registry at Al Wahda teaching hospital in Derna, Libya. The study population comprised neonates admitted to the hospital from 2016 to 2021. Inclusion criteria specified Libyan neonates diagnosed with CLP, while exclusion criteria excluded stillbirths and non-Libyan neonates. Data analysis involved calculating incidence rates, descriptive statistics, and subgroup analyses to identify demographic characteristics and associated risk factors. Results. Out of 2,887 neonatal records reviewed, 10 cases of cleft lip ± palate (CL±P) were identified, yielding an overall incidence rate of 0.6 cases per 1000 live births. The majority of cases (50%) presented with both cleft lip and palate, followed by cleft palate only (40%) and cleft lip only (10%). Demographic analysis revealed a higher prevalence among females (60%), full-term neonates (80%), neonates from larger families of more than 6 children (50%), and those with birth weights between 2.5 and 4 kg (70%). Left-sided clefts were more common (90%) than right-sided clefts (10%). Potential risk factors included maternal history of abortion (20%), irregular pregnancy follow-up (90%), and gestational diabetes (10%). Conclusion. This study provides insights into the prevalence and associated risk factors of cleft lip ± palate (CL±P) among neonates in Derna, Libya. The findings underscore the importance of comprehensive prenatal care and public health interventions to address modifiable risk factors and reduce the incidence of cleft lip ± palate in affected populations. Further research is needed to explore additional factors contributing to cleft anomaly occurrence and outcomes.

Characteristics of Charity Cleft Patients in Haulussy General Hospital 2017-2019

Cleft lip and palate is a common congenital disorder with an incidence of 1 per 300 live births of Asian descent. There is a lack of cleft epidemiological data due to the absence of plastic surgeons, patients were referred to other provinces or enlisted to charity programs. This paper aims to evaluate the characteristics of our cleft patients at Haulussy General Hospital, Ambon, Maluku from 2017 – 2019. This is a retrospective study of 69 patients treated at Haulussy General Hospital, Ambon, Maluku, charity program from 2017 – 2019. Age, gender, diagnosis, procedure, and nutritional status were collected. 52% of patients are male with a median age of 4 years (range: 3 months – 34 years). The most common diagnosis was complete cleft palate (n=19), and the rarest was microform cleft lip (n=1). Complete cleft lip is more common in males, while isolated cleft palate is more common in females. The median age for primary lip repair, lip revision, and primary palate repair/revision was 1 year, 4.5 years, and 8 years, consecutively. Among 32 patients assessed for nutritional status, 22% were malnourished (19% were underweight, and 3% were severely underweight). Lip repair was done in 28 patients, palate repair in 36 patients, and lip or palate revision in 16 patients. The main techniques used were Lazy S and von Langenbeck.This retrospective study at Haulussy General Hospital from 2017 to 2019 highlights predominant cleft cases and malnutrition among patients. The findings emphasize the importance of tailored interventions and comprehensive care for individuals with cleft lip and/or palate.

The prevalence of dental agenesis among children with cleft lip and palate patients in Lahore, Pakistan.

This retrospective, cross-sectional analytical study investigated the incidence of tooth agenesis in cleft lip and palate (CLP) patients. Cone Beam Computed Tomography (CBCT) radiographs of the CLP children were examined for congenitally missing teeth. This study was conducted at three radiology centers in Lahore, namely, the Pakistan Jinnah MRI and Body Scan Centre, the University of Lahore Radiology Centres, and Fatima Memorial Hospital, from September 2021 to August 2022. The CLP patients were divided into four groups based on the location of the cleft: Cleft Lip and Palate Right (CLPR), Cleft Lip and Palate Left (CLPL), Bilateral Cleft (CLPB), and Midline Cleft (CLPM), inside and outside the cleft region. Two-way ANOVA was employed to compare the means of agenesis. Tukey's test was utilized to ascertain where the difference lies. The significance level was set at p ≤ 0.05. Moreover, a significant number of missing teeth were found inside the cleft. This study observed the CLPL (42.3%) and CLPR (13.6%) types more in number. Maxillary first premolars were found more missing outside the cleft region in CLPL and CLPB types. Although CLPB and CLPM types revealed a pattern of missing teeth, only a few cases were found in this study. Moreover, mean tooth agenesis was highest (4.5 SD.71) in the CLPM group, followed up by CLPB (2.75 SD 2.49), CLPR (1.23 SD 1.27), and CLPL Group (1.15 SD 1.12). Unilateral cleft lip and palate patients reported significant agenesis patttern compared to bilateral and median cleft cases.