Congenital Cleft Deformity Research Articles

Unsupervised anomaly appraisal of cleft faces using a StyleGAN2-based model adaptation technique.

A novel machine learning framework that is able to consistently detect, localize, and measure the severity of human congenital cleft lip anomalies is introduced. The ultimate goal is to fill an important clinical void: to provide an objective and clinically feasible method of gauging baseline facial deformity and the change obtained through reconstructive surgical intervention. The proposed method first employs the StyleGAN2 generative adversarial network with model adaptation to produce a normalized transformation of 125 faces, and then uses a pixel-wise subtraction approach to assess the difference between all baseline images and their normalized counterparts (a proxy for severity of deformity). The pipeline of the proposed framework consists of the following steps: image preprocessing, face normalization, color transformation, heat-map generation, morphological erosion, and abnormality scoring. Heatmaps that finely discern anatomic anomalies visually corroborate the generated scores. The proposed framework is validated through computer simulations as well as by comparison of machine-generated versus human ratings of facial images. The anomaly scores yielded by the proposed computer model correlate closely with human ratings, with a calculated Pearson's r score of 0.89. The proposed pixel-wise measurement technique is shown to more closely mirror human ratings of cleft faces than two other existing, state-of-the-art image quality metrics (Learned Perceptual Image Patch Similarity and Structural Similarity Index). The proposed model may represent a new standard for objective, automated, and real-time clinical measurement of faces affected by congenital cleft deformity.

Analysis of Complications in Primary Cleft Lips and Palates Surgery

A series of retrospectively recorded patients with cleft lip and palate was uniquely investigated to demonstrate and analyze the complications after cleft repairing operations in a selected Chinese population. From January 2005 to January 2012, a selected group of 2100 patients with cleft lip and/or palate who have complete records were chosen from a large sample in the units. Complete data were retrieved, including sex, age, clinical classification, surgical modality, complications, and follow-up results. The complications were classified into 2 categories: early and long-term complications. After surgery, most patients with cleft lip remained in the hospital for 7 days and cleft palate repairs for 10 days. A standard regimen of antibiotics was administered for 3 to 5 days clinically. Of the 2100 patients, there were 1360 males and 760 females who had congenital cleft deformity with complete clinical records in the department of oral and maxillofacial surgery. The age distribution was as follows: 1600 patients in the group of 3 months to 2 years, 320 patients in the group of 2 to 10 years, 130 patients in the group of 11 to 19 years, and 50 patients in the group of older than 20 years. As to the treatment modality, cleft lips were repaired by rotation advancement method with various minor modifications or Tennison modality. The cleft palates were closed using the von Langenbeck, Veau/Wardill/Kilner, or Furlow technique. The overall complication rate was 16.8% of the patients. Of the early complications, there were 6 cases of asphyxia, 17 cases of pyrexia, 5 cases of edema of the respiratory tract, 8 cases of upper respiratory tract infection, 6 cases of bronchiolitis, 7 cases of pneumonia, 9 cases of diarrhea and vomiting, 6 cases of hemorrhage, 5 patients of odontoptosis, 11 cases of erosion of the corner of mouth, 5 cases of drowsiness, 11 cases of incision dehiscence, 9 cases of wound infection, 6 cases of palatal dehiscence/fistula, 3 cases of nostril floor breakdown, 7 cases of conjunctivitis, as well as 3 cases of mortality. The long-term complications included 30 cases of secondary lip/nasal deformity, 10 cases of dehiscence of lip, 14 cases of palatal fistula/decencies, 18 cases of hearing problem/otitis media, 21 cases of poor ventilation/snoring, 66 cases of velopharyngeal incompetence, and 58 cases of voice disorder. Complications after cleft surgery are unavoidable clinically. More attention should be paid to the etiologic factors to minimize the prevalence of complications. Mortality can be found in patients with cleft, which is a deadly complication. Problems of respiratory tract and hemorrhage should be emphasized and treated seriously.

Population-Based Study of Birth Prevalence and Factors Associated with Cleft Lip and/or Palate in Taiwan 2002–2009

BackgroundFacial cleft deformities, including cleft lip with or without cleft palate (CL/P) and cleft palate (CP), are common congenital birth anomalies, especially in Asia. This study aimed to analyze the prevalence of CL/P and CP and to identify associated factors in Taiwan.MethodsThis population-based epidemiological study retrospectively analyzed birth data obtained from the Department of Health in Taiwan for years 2002–2009. Frequency distribution, percentages and related predictors were investigated, and findings were presented by types of cleft deformities. Logistic regression analysis was performed to identify factors associated with cleft deformities.ResultsOverall prevalence of cleft deformities among 1,705,192 births was 0.1% for CL/P and 0.04% for CP over the 8-year study period. Higher prevalence of CL/P or CP was observed with multiple pregnancies, being male for CL/P, being female for CP, gestational age ≤37 weeks and lower birth weight (<1.5 kg). Both CL/P and CP were significantly associated with gestational age <37 weeks and birth weight<1.5 kg (all P <0.0001). CL/P was significantly associated with multiple parities (P = 0.0004–0.002). Male newborns and female newborns were significantly associated with CL/P and CP, respectively (both P<0.0001).ConclusionsOverall prevalence for congenital cleft deformities in study subjects was 0.1%, in keeping with high rates in Asia. Results suggest the need for awareness and early identification of those at high risk for cleft deformities, including newborns with gestational age <37 weeks, weighing <1.5 kg at birth and women with multiple parities, as a potential strategy to counter long-term adverse effects on speech and language in this population.

Interplast Italy: A 20-Year Plastic and Reconstructive Surgery Humanitarian Experience in Developing Countries

Interplast Italy is a nongovernment, nonprofit organization with the aim of providing high-quality standard reconstructive procedures, contributing to local medical and nursing education, in those countries where this is not available or where the local resources are inadequate to meet local needs. A recent debate about the real aim and the effectiveness of this kind of health support strategy in developing countries has been raised. The authors report a 20-year experience, explaining operative strategy, activities, and results, and contributing to the development and improvement of the philosophy of humanitarian missions. Since 1988, 47 missions and 5235 operations have been performed. A total of 2286 patients (43.7 percent) were younger than 18 years, and 2949 (56.3 percent) were above that age. Congenital cleft deformity was the most common diagnosis in 2415 patients (46.13 percent). Patients suffering from postburn contractures were operated on in 1956 cases (37.36 percent). The number of postburn children operated on was 922 (17.6 percent). Cooperation with local physicians is considered mandatory to guarantee adequate patient preselection, to organize the activity in situ, and to plan continuous effective work on a regular basis to build local capacity and facilitate sustainable models for health care. Furthermore, as local surgeons become interested in reconstructive surgery, continuous teaching through a multidisciplinary approach must be paramount. The activity of Interplast Italy contributed to building a plastic surgery service in Bangladesh. Combined multidisciplinary activities linked to established organizations such as the Interplast confederation are desirable to improve results. A link with structured organizations is needed to obtain financial resources to extend targets and to improve activities and outcomes.

Congenital cleft deformities in rivers state of nigeria: Is there any association with environmental pollution?

Congenital cleft deformities in rivers state of nigeria: Is there any association with environmental pollution?

Thalidomide and congenital cleft deformities

Thalidomide and congenital cleft deformities

The use of periosteum and Surgicel for bone restoration in congenital clefts of the maxilla. A clinical report and experimental investigation.

New principles are introduced for the primary repair of the maxilla in congenital cleft deformities, founded on the assumption that periosteum and bone bordering the cleft possesses normal growth potential. By periosteum to periosteum apposition all around the cleft new bone was formed. In complete clefts continuity between the segments was achieved, the premaxilla became firmly consolidated into the arch, maxillary collapse was prevented, and there was a favourable approximation within the alveolar region. Over denuded bone complete periosteal regeneration took place and appositional growth of the lateral segment was promoted.To obtain a larger volume of bone by periostealplasty it proved necessary to keep the flaps suitably separated. In maintaining the periosteal membranes in the desired position Surgicel® provided a useful scaffolding. Animal experiments demonstrated that this hemostatic material can be safely used for subperiosteal implantation. This procedure will lead to the formation of cancellous...