Cleft Type Research Articles

Co-Occurrence of Taurodontism in Nonsyndromic Cleft Lip and Palate Patients in Subset of Indian Population: A Case-Control Study Using CBCT.

The present study aimed to assess the co-occurrence of taurodontism in nonsyndromic cleft lip and palate (NSCLP) patients in a subset of Indian population using cone beam computed tomography (CBCT). The study was a retrospective case–control kinds assessing 1500 CBCT scans over a period of 2 years; 67 scans out of 1500 showed cleft lip and palate (CLP). After fulfilling the inclusion and exclusion criteria, 38 subjects out of 67 comprised the case group; 80 randomly selected subjects constituted the control group. The first and second permanent molars in both the arches (8 teeth) of each subject were assessed for the presence and severity of taurodontism using the objective criteria. Statistical analysis was done using the χ2 test. Inter and intraobserver agreement was evaluated by Kappa statistics. 71.05% subjects showed taurodontism in case group, while 45% subjects showed its presence in control group; results being significant for both the groups. However, the comparison of number of teeth with taurodontism in the 2 groups came out to be statistically insignificant. Also no significant association of taurodontism was seen with gender or the different types of cleft ( P = .437). Hypotaurodontism was the most prevalent type. There was a higher prevalence of taurodontism in both groups which had been underestimated in the previous studies. This emphasizes the significance of the use of CBCT in detection of dental anomalies which would otherwise go undetected.

Quantitative measurement of the palatal mucosa in cleft lip and palate using elastography

ABSTRACT Purpose Cleft lip and palate (CLP) are the most common congenital abnormalities in the craniofacial region. Patients with CLP usually have palatoplasty in early childhood, which causes scar tissue on the palatal mucosa. Scar tissue prevents growth of the maxilla. However, no studies have quantitatively evaluated the characteristics of the palatal mucosa. This study aimed to quantitatively evaluate the physical characteristics of the palatal mucosa after palatoplasty in patients with CLP using elastography. We also aimed to investigate the association between the physical characteristics of the palatal mucosa and the use of maxillary protraction therapy (MPA). Materials and methods We enrolled 57 patients with CLP (mean age, 20.82 ± 3.50 years) and 30 control subjects without CLP (mean age, 26.97 ± 2.09 years) and measured the stiffness of the palatal mucosa using elastography. Among the patients with CLP, we investigated the association between the use of MPA and the stiffness of the palatal mucosa. Results The palatal mucosa in patients with CLP was significantly stiffer than that in control subjects. Moreover, the palatal mucosa in the MPA group was significantly stiffer when adjusted for cleft type compared with the group with no MPA. Conclusions Our findings suggest that there are characteristic differences in the palatal mucosa between patients with CLP and subjects without CLP and between those with and without MPA use. Elastography could be a new and effective diagnostic tool in orthodontic treatment for patients with CLP.

Subphenotypes in Non-Syndromic Orofacial Cleft Patients Based on the Tooth Agenesis Code (TAC).

Background: It was the aim of this study to investigate tooth agenesis patterns, which are expressed to different subphenotypes according to the TAC method in a spectrum of non-syndromic orofacial cleft patients. Methods: A total of 183 orofacial cleft patient records were assessed for tooth agenesis and TAC patterns. The association between TAC and sex, and cleft type was examined, and logistic regression models were additionally applied. Additionally, the distribution of missing teeth by cleft type and the tooth agenesis inter-quadrant association were examined. Results: The most frequent cleft type was CLPL (n = 72; 39.3%), while the maxillary left lateral incisor was the most frequently missing tooth that was strongly dependent on the cleft type (29.5%, p < 0.001). Of the 31 TAC patterns identified, four were the most prevalent and occurred in 80.8% of the sample, while 20 TAC patterns were unique. Cleft type contrary to sex (p = 0.405) was found to play a significant role in TAC distribution (p = 0.001). The logistic regression’s results suggested that overall, neither sex nor cleft type were associated with tooth agenesis. Prevalence of tooth agenesis in each quadrant clearly depended on cleft type; and there was a strong association found between tooth agenesis in different quadrants. Conclusions: Thirty-one different subphenotypes were identified in TAC patterns. The first four TAC patterns accounted for the 80.8% of the sample’s variability while twenty of the patterns were unique. A strong association was present between TAC pattern and cleft type. No association was found between the sex of the patient, tooth agenesis and TAC patterns. Tooth agenesis depended strongly on the cleft type, and the most frequently missing tooth was the maxillary left lateral incisor. The interquadrant association for tooth agenesis found suggests a genetic link in the etiology of clefts.

The registry of congenital Cleft lip and cleft palate in Iran: Three-years pilot results and learned lessons

Introduction: Cleft lip and cleft palate are the most common maxillofacial congenital defects leading to facial deformity and complications in nutrition, respiration, and social interaction. The current study aims to report early findings of the pilot registry for congenital Cleft lip and cleft palate in Iran and discuss limitations and further goals to collect and implicate information of cleft newborn patients. Methods: A 3-year hospital-based multicenter prospective cohort study of The Congenital Cleft lip and cleft palate Registry was performed in various hospitals in Iran from 2018 to 2020. Newborns with oral clefts were included, and The type of cleft, location, geographical place, and gender of each patient were recorded. The descriptive statistics were reported as means and percentages analyzed with Fisher exact test using SPSS software ver. 22 (IBM, Chicago, US). The P-value &lt; 0.05 considered as significant. Results: From 336 registered newborns with Cleft lip and cleft palate, 40.1% were females, while 59.9% were males. The prevalence of lip cleft was 31.5%, while 17.6% have palate cleft. Also, 50.9% suffer from both cleft lip and palate simultaneously. (P-value&lt;0.05) The frequent location of clefts were bilateral Cleft lip and cleft palate with 50% of the cases (P-value&lt;0.05). Also, 28.2% and 21.8% had right-side and left side unilateral Cleft lip and cleft palate, respectively. Tabriz, Mashhad, Tehran were the most frequent location of clefts. Conclusion: Despite the primary statistics and trends presented in this study, the data quality could improve through some limited modifications. Also, the provinces with a high prevalence of congenital deformities need critical attention and provide adequate healthcare.

Epidemiology of Nonsyndromic, Orofacial Clefts in Texas: Differences by Cleft Type and Presence of Additional Defects.

To describe the current epidemiology of nonsyndromic cleft palate alone (CP) and cleft lip with or without cleft palate (CL ± P) in Texas and examine differences in the characteristics of infants with CP and CL ± P based on the presence/absence of additional defects. We used data from the Texas Birth Defects Registry, a statewide active birth defect surveillance system, from 1815 cases with CP and 5066 with CL ± P, without a syndrome diagnosis (1999-2014 deliveries). All live births in Texas were used for comparison. Poisson regression was used to calculate crude and adjusted prevalence ratios (aPR) for each characteristic, separately for each cleft subphenotype. The prevalence of CL ± P and CP in our study was estimated as 8.3 and 3.0 per 10 000 live births, respectively. After adjusting for several characteristics, several factors were associated with CL ± P, CP, or both, including infant sex and maternal race/ethnicity, age, smoking, and diabetes. There were several differences between infants with isolated versus nonisolated clefts. For example, maternal prepregnancy diabetes was associated with an increased prevalence of CL ± P (aPR 7.91, 95% confidence interval [CI]: 5.53, 11.30) and CP (aPR 3.24, 95% CI: 1.43, 7.36), but only when additional defects were present. Findings from this study provide a contemporary description of the distribution of orofacial clefts in Texas accounting for differences between isolated and nonisolated clefts. They may contribute to increasing our understanding of the etiology of CP and CL ± P.

Prevalence of malnutrition among children at primary cleft surgery: A cross-sectional analysis of a global database

BackgroundOrofacial clefts are common birth defects, affecting one newborn in every 700 live births globally. The condition requires prompt identification, feeding support, and timely surgery. While orofacial clefts benefit from a comprehensive, life-long care management in high-income countries, care provision is often lacking or inadequate in poor-resource settings. Data on the burden of orofacial clefts in children born in limited-resource settings remain scarce. The objective of this study was to estimate the prevalence of malnutrition in children using cleft surgery records collected by one large non-governmental cleft organization in low- and middle-income countries (LMICs).MethodsThe data set included clinical records of children ≤5 years who underwent primary cleft surgery between 2008 and 2018 in health care facilities across LMICs. Patients’ data included birth date, sex, weight at surgery, ethnicity, country of origin, and date of primary surgery and were analysed using descriptive statistics. The prevalence of malnutrition was estimated using weight-for-age z scores and the distribution described in relation to cleft type, sex, ethnic groups, and geography. Comparisons with prevalence estimates for underweight in children under-5 within countries were conducted using publicly available survey data.ResultsThe analysis included 602 568 children. The prevalence of underweight in children with cleft varies with the epidemiology of cleft and the timing of primary surgery, and between ethnic groups and settings. The overall prevalence of underweight at the time of primary cleft surgery was 28.6% – a figure well above the global underweight prevalence in children under-5 without cleft estimated at 13.5%. We found a positive correlation between the prevalence of underweight among children with cleft and the prevalence of underweight in the DHS program (rs = 0.6305; P < 0.0001). Within-country comparisons showed that, with only few exceptions, the prevalence of underweight was higher in children with clefts than in their peers born without clefts (P < 0.05).ConclusionsAlthough orofacial cleft is not considered to be a life-threatening condition, our findings show a high burden of malnutrition among patients accessing surgeries in LMICs. Interventions prompting early identification and appropriate feeding management of this group of vulnerable children is essential to leave no one behind in the fight against malnutrition.

Incidence of Cleft Lip with or without Cleft Palate at Yayasan Pembina Penderita Celah Bibir dan Langit-Langit (YPPCBL) in 2016-2019

&#x0D; Cleft lip with or without cleft palate is a congenital anomalies condition when a baby’s lips and/or mouth do not form properly during pregnancy. The purpose of this study was to find out the incidence of cleft lip patients with or without cleft palate registered to Yayasan Pembina Penderita Celah Bibir dan Langit-Langit (YPPCBL) Bandung, West Java in 2016-2019 based on the form of sex, age at the registry, cleft type, and area. This study was retrospective descriptive. Data were collected through the medical records periods of 2016-2019 and analyzed using Microsoft Excel 2013 and SPSS 25th. There were 933 data included in the inclusion criteria. The number of patients was at most in 2018, as many as 283 people. The most common patient is male (58,1%), the most common cleft type is left unilateral complete cleft lip and palate (18,4%), the most common patient aged 0-1 year (53,2%), the most of patients was from West Java (92,5%). In conclusion, the incidence of cleft lip with or without cleft palate in 2016-2019 tends to fluctuate with the male sex being the most. Most patient came with the best age standard for cleft management and came from West Java with left unilateral complete cleft lip and palate.&#x0D; Keywords: cleft lip; cleft palate; cleft lip and palate; incidence

Genome-wide association study of multiethnic nonsyndromic orofacial cleft families identifies novel loci specific to family and phenotypic subtypes.

Nonsyndromic orofacial clefts(OFCs) are among the most common craniofacial birth defects worldwide, and known to exhibit phenotypic and genetic heterogeneity. Cleft lip plus cleft palate (CLP) and cleft lip only (CL) are commonly combined together as one phenotype (CL/P), separately from cleft palate alone. In comparison, our study analyzes CL and CLP separately. A sample of 2218 CL and CLP cases, 4537 unaffected relatives of cases, and 2673 pure controls with no family history of OFC were selected from the Pittsburgh Orofacial Cleft (Pitt-OFC) multiethnic study.genome-wide association studieswere run for seven specific phenotypes created based on the cleft type(s) observed within these families, as well as the combined CL/P phenotype. Five novel genome-wide significant associations, 3q29 (rs62284390), 5p13.2 (rs609659), 7q22.1 (rs6465810), 19p13.3 (rs628271), and 20q13.33 (rs2427238), and nine associations (p ≤ 1.0E-05) within previously confirmed OFC loci-PAX7, IRF6, FAM49A, DCAF4L2, 8q24.21, ARID3B, NTN1, TANC2 and the WNT9B:WNT3 gene cluster-were observed. We also found that single nucleotide polymorphisms within a subset of the associated loci, both previously known and novel, differ substantially in terms of their effects across cleft- or family-specific phenotypes, indicating not only etiologic differences between CL and CLP, but also genetic heterogeneity within each of the two OFC subtypes.

Population Prevalence and Trends of Oral Clefts in Colombia: Analysis by Departments.

Determine the population prevalence and trends of cleft lip and/or palate (CL/P) by department for Colombia in the period 2009 to 2015. Prevalence study based on Individual Registry of Health Services in general population from 2009 to 2015. All people diagnosed with CL/P were included for all ages, type of diagnosis, and any type of health services in the mentioned period. The prevalence was calculated by period and point for each year, for each department and according to the type of cleft. Stationarity on time series was evaluated using (Dickey-Fuller) and (Phillips-Perron). A trend test was applied to estimate whether the increase in prevalence was significant in the period. The trend test used was a Poisson regression. A total 15 225 people with CL/P were identified, where 53.3% were men. The national period prevalence of CL/P is 3.37 per 10 000 with upward trend (prevalence ratio = 1.34, P = .05) and nonstationary behavior. The national period prevalence of cleft lip is 0.93 per 10 000, cleft palate 1.17 per 10 000, and cleft lip and palate (CLP) 1.26 per 10 000, where CLP is subclassify into unilateral CLP (0.83 per 10 000) and bilateral CLP (0.43 per 10 000). At the departmental level, the highest CL/P prevalence is Guaviare (11.2), followed by Guainía (8.4) and the lowest Quindío (0.49). In Colombia, the national period prevalence of CL/P is 3.37 per 10 000 with upward trend at national level indicates an increase in prevalence from 2009 to 2015. The 77% of the total CL/P population are infant or adolescent. Geographically, the central region has the highest availability of technologies.

Evaluation of Dimension and Bridging of Sella Turcica and Presence of Ponticulus Posticus in Individuals With and Without Cleft: A Comparative Study.

Sella turcica abnormalities such as sella turcica bridging (STB) have been observed frequently among patients with craniofacial anomalies. Ponticulus posticus (PP) is an important structure and its presence causes complications during surgeries. Due to the importance of these structures, this study aimed to evaluate the prevalence of STB, PP, and dimensions of the sella turcica in individuals with and without cleft. A cross-sectional study. Orthodontic and Radiology Departments in a public dental school, Tehran, Iran. Eighty-three lateral cephalograms of individuals with cleft and ninety-two cephalograms of class I individuals without cleft. Length, depth, and maximum anterior-posterior diameter (APD) of sella turcica, presence of STB (classified as types 1, 2, and 3), and PP. In the group with cleft, 19.3% of individuals had type I, 65.1%, type II, and 15.7%, type III STB. In the group without cleft, 15.2% had type I, 73.9%, type II, and 10.9%, type III STB. In the group with cleft, 65.1% of individuals had no PP, 24.1%, incomplete, and 10.8%, complete PP while in the group without cleft, 56.5% had no PP, 29 31.5%, incomplete, and 12%, complete PP. The sella turcica dimensions, STB, and PP prevalence were not significantly different between individuals with and without cleft. The sella turcica length and prevalence of STB and PP were not affected by age, sex, and cleft type. However, the depth and the APD were affected by age.

Comparison of stability and outcomes of surgery-first bimaxillary surgery for skeletal class III deformity between unilateral and bilateral cleft lip and palate.

Some adults with cleft lip and palate (CLP) require orthognathic surgery due to skeletal deformity. This prospective study aimed to (1) compare skeletal stability following bimaxillary surgery for correction of class III deformity between patients with unilateral CLP (UCLP) and bilateral CLP (BCLP), and (2) identify risk factors of stability. Adults with CLP and skeletal class III deformities who underwent surgery-first bimaxillary surgery were divided into two groups according to cleft type: UCLP (n = 30) and BCLP (n = 30). Skeletal stability was assessed with measures from cone beam computed tomography images of the maxilla and mandible taken before treatment, 1-week and ≥ 1 year postsurgery for translation (left/right, posterior/anterior, superior/inferior) and rotation (yaw, roll, pitch); multiple regression analysis examined risk factors. At follow-up, the maxilla moved upwards in both groups, and backwards in the UCLP group. The mandible moved forward and upward, shifted to the cleft (deviated) side, and rotated upward in both groups. The amount of surgical advancement was a risk factor for sagittal stability in the maxilla (ß = -0.14, p < 0.05). The mandible had three risk factors for sagittal stability: age (ß = -0.23, p < 0.05), surgical team (ß = -1.83, p < 0.05), and amount of surgical setback (ß = -0.32, p = 0.001). Two years after bimaxillary surgery, patients with UCLP had a higher sagittal relapse of the maxilla compared with patients with BCLP, which was due to a greater surgical advancement in the patients with UCLP. Surgery-first bimaxillary surgery results in favorable treatment outcomes for correction of cleft-related class III deformity. Severity of jaw discrepancy and surgeons should be considered in the surgical design of overcorrection.

Steroid Use in Palatoplasty: A Single Surgeon Comparative Retrospective Cohort Study.

Fistula rates in cleft palate repair vary by technique, surgeon, and institution. Although steroids are commonly used in airway surgery, many plastic surgeons are reluctant to use steroids because of concerns with wound healing. This study aims to assess outcomes and safety of steroid use in Furlow palatoplasty and determine its impact on fistula formation. A retrospective cohort study was done of all cleft palate surgeries performed by a single surgeon between 2010 and 2014. Data reviewed included demographics, type of cleft, steroid use, length of surgery, length of stay, and fistula formation rate. One hundred thirty-five patients underwent palatoplasty, of which 101 received steroids and 34 did not. The mean age was 4.6 years. A total of 42.2% of patients underwent primary palatoplasty, 48.1% underwent submucous cleft palatoplasty, and 9.7% underwent conversion palatoplasty. The overall fistula rate was 1.5% and was comparable between the 2 groups (steroids = 2.0%, no steroids = 0.0%, P = 0.558), and all occurred in primary palatoplasty patients. The average length of stay in the hospital was shorter among patients receiving steroids (steroids = 2.0 days, no steroids = 2.5 days, P < 0.05). Steroid use in cleft palate surgery appears to be safe and likely not associated with impaired wound healing or increased fistula formation. It may also shorten length of hospitalization.

Qualitative Assessment of Surgical Repair of Three Types of Unilateral Cleft Lip

Objective: To assess the effect of the three types of unilateral cleft lip (UCL) [cleft lip only, cleft lip and alveolus, and cleft lip alveolus and palate] on the outcome of the repair. Material and Methods: This study was a case series of effect of types of UCL on the outcome of the repair. Fifteen subjects each were in three UCL phenotypes groups. Evaluation of the scar, lip, and nose was done qualitatively by both parents/guardians and professionals using a modified form of the criteria described by Christofides et al. (2006). Results: In the assessment of the surgical scar, the parents found a difference between the three types of cleft in terms of texture, shape, and width of the scar and presence of columella deviation. The professional assessors, however, only found the three types of cleft to be different in the presence of alar flattening. Conclusion: Differences truly exist in the outcome of surgical repair of the three types of unilateral cleft lip, especially in the aesthetics of the nose and in the width and shape of the residual lip scar. Thus, it is important to consider this in the assessment of UCL repair because putting the subtypes together might have a negative impact on the assessment.

Primary Palatoplasty: A Comparison of Results by Various Techniques - A Retrospective Study.

Introduction:To identify a better method for primary cleft palate (CP) repairs with respect to velopharyngeal function.Materials and Methods:A retrospective, longitudinal review of medical charts of patients with congenital CP who underwent four different techniques of palatoplasty, performed by three different surgeons in the Department of Maxillofacial Surgery of the National Center for Maternal and Child Health. Nasopharyngoscopy (NPS) was used for velopharyngeal function evaluation. CP was classified according to the Veau system and the “Golding-Kushner” scale for NPS results was used for assessing the patient’s velopharyngeal function and its association with cleft types and the primary palatoplasty techniques. Pearson’s Chi-square analysis and binary logistic regression were used for statistical analysis.Results:A total of 335 patients were included in the study. The mean age at primary palate repair was 22.9 ± 13.6 months. There were 56, 42, 177, and 60 patients with Veau-I, Veau-II, Veau-III, and Veau-IV types, respectively, whereas for primary palatoplasty 65 patients underwent Furlow, 148 patients – Mongolian, 108 patients – two flap, 34 patients – von Langenbeck technique. NPS assessment of adequate velopharyngeal function was followed by Furlow’s technique in 89.4% of cases, Mongolian technique in 62.2% of cases but by “two flap” only in 48.1% and von Langenbeck in 47.1% of cases.Discussion:The Furlow and Mongolian techniques were superior for maintaining velopharyngeal function after primary palatoplasty.

Developmental defects of enamel and dental anomalies in five-year-old cleft patients

INTRODUCTION Children born with cleft lip and/or palate (CLP) have a higher prevalence of developmental defects of enamel and dental anomalies, and are at an increased risk of developing dental caries. The aim of this study was to establish the prevalence of dental anomalies and developmental defects of enamel in children born with CLP, and to assess compliance with dental prevention. METHODS Data were collected retrospectively for children who attended the five-year-old dental review clinic at the South Thames cleft service over a four-year period. Records of 162 children were analysed. RESULTS Unilateral CLP was the most common type of cleft. Two-thirds (65%) of the children in this service evaluation had developmental defects of enamel affecting the upper incisors. A third (32%) had enamel hypomineralisation. Between 90% and 100% of children over the four-year study period were registered with a dentist. Regular fluoride varnish application was received by 64% to 81% of children and toothpaste with an appropriate concentration of fluoride was used by 72% to 91% of children. CONCLUSIONS Improvements in shared care arrangements between primary dental care clinicians and specialist paediatric dentists are needed to ensure that caries risk is reduced in children born with CLP. This allows the specialist dental services to focus on the complex dental issues that are seen more frequently in CLP and often require a multidisciplinary approach.

Impact of articulation therapy on perceptual characteristics of bilabials in children with repaired cleft lip and palate

Purpose: The study's objectives were to assess the effect of articulation therapy for bilabials on SODA errors, cleft type errors (CTEs), and percentage of correct consonants-revised (PCC-R) in children with repaired cleft lip and palate. Methods: Single-subject with multiple baselines research design was used to investigate the changes in bilabials across four-time points. Four participants with repaired cleft lip and palate (RCLP) between 4 and 7.11 years were considered. For the assessment, pictures of six words were visually presented, and the participants were asked to name them. Three speech-language pathologists identified SODA errors and cleft type errors (CTE), based on which PCC-R was calculated. Participants underwent ten intensive articulation therapy sessions: phase I focused on auditory discrimination training and phase II on production training. The production training mainly focused on the phonetic placement approach, shaping the target sound, and improving the oral airflow. Results: Overall, SODA error analysis revealed substitution and distortion errors during the baseline assessment. CTE analysis indicated weak oral pressure consonant followed by a glottal stop, nasalization of voiced pressure, nasal consonants for oral pressure consonants, and voicing errors. PCC-R scores ranged from 0% to 83.33%. Assessment 4 indicated only distortion errors during SODA error analysis, weak oral pressure consonants during CTE analysis PCC-R was 100%. The obtained results indicate an improvement in the articulation placement and oral airflow; thus, the participants benefited from the intervention program.

Clinical and Hematological profile of Paediatric Patients with Cleft Lip and Palate in a Tertiary Care Hospital of Haryana, India

Introduction: Cleft lip and/ or cleft palate are the most common visible craniofacial anomalies. These patients often have feeding difficulties and recurrent infections leading to an altered immune system which can be assessed by the variations in hematological parameters. We intended to assess the clinical profile and the hematological parameters in patients with cleft lip and palate. Methods: This is a three-year cross-sectional study conducted at SGT Medical College, Gurugram, Haryana, India from January 2017 to December 2019 involving assessment of patients with cleft lip and palate who visited the paediatric unit for complete evaluation before surgery. Syndromic children or those with associated deformities were excluded .A total of 115 patients were enrolled in the study and the following information was recorded: Age, Gender and type of cleft (Cleft lip and alveolus, cleft lip, alveolus and palate, and isolated cleft palate). Hematological parameters including hemoglobin, total leukocyte count, differential leukocyte count, absolute eosinophil count, and red cell indices were evaluated and compared amongst the anatomical subtypes. Results: A total of 115 patients were included in the study, of which 66 (57.4%) were males and 49 (42.6%) were females. 57 (49.6%) had a cleft lip, alveolus, and palate, 36 (31.3%) had a cleft lip and alveolus and 22 (19.1%) had cleft palate only. Anaemia was present in 71.1% of cases. 83.4% cases of cleft lip and alveolus while81.8% of isolated cleft palate were anaemic. Microcytic hypochromic anaemia was present in 63.4% of cases while 36.6% had normocytic normochromic anaemia. The total leukocyte count was elevated in 60 children (52.2%) which was highest in cleft lip and alveolus (66%). Absolute neutrophil count was significantly high in the lip and alveolus groups.(13.9%) Absolute lymphocyte count was highest in lip and alveolus (30.56%). Absolute monocyte count and the absolute eosinophil count was low in the majority of cases. Conclusions: A large number of children with cleft lip and/ or palate are not exclusively breastfed due to anatomical deficits. They need supplemental iron to meet the demands. A standard policy to provide auxillary iron by health care professionals should be made at the first visit to the health centre because nutritional anaemia negatively affects the physical and cognitive development of a child. It also unnecessarily prolongs the date for optimum and safe surgery.

Rapid Progression of Neonatal Respiratory Distress from Laryngeal Cleft Type I: A Case Report

A one-month-old boy showed cyanosis and severe retraction on crying. He underwent diagnostic rigid bronchoscopy under general anesthesia, maintaining spontaneous ventilation. Rigid bronchoscopy revealed laryngeal cleft type I and excessive mucosa in the interarytenoid space that protruded into the subglottic area, very unusual findings in laryngeal cleft. His clinical condition quickly deteriorated and tracheotomy was performed to prevent complete airway obstruction in the few days until surgical repair of the cleft.

Quality of Life of Adopted Chinese Versus Nonadopted Dutch Children with Cleft Lip and/or Palate: A Propensity Score Matched Analysis.

ObjectiveTo examine quality of life in internationally adopted children with cleft lip and/or palate (CL/P) versus non-adopted children with CL/P.DesignCross sectional study.SettingMultidisciplinary cleft team of a secondary and tertiary hospital in the Netherlands.MethodsParents of children under the age of 8 treated by the multidisciplinary cleft team of our institutions were asked to fill out a questionnaire containing demographic and clinical data and a validated parent proxy measure of cleft-specific quality of life instrument for children aged 0–8: the CleftChild-8. Adopted children were matched to non-adopted children using propensity score matching based on sex, age, type of cleft, if palatal surgery was completed and the level of education of the parent. CleftChild-8 scores were then compared between the matched samples of adopted and non-adopted children with CL/P.Main Outcome Measure(s)Differences in (sub)domain scores of the CleftChild-8.ResultsMost median CleftChild-8 scores of the adopted children (n = 29) were slightly lower compared to the 29 matched non-adopted children. A significant difference was seen for the domain score ‘satisfaction with (operative) treatment’ and 3 of the 13 subdomain scores: ‘post-operative results’, ‘acceptance by siblings’ and ‘acceptance by family/friends’.ConclusionsBy parent report, adopted children with CL/P experienced some areas of lower quality of life when compared to non-adopted children. Members of cleft teams should be aware of the problems associated with adoption and offer additional guidance and counseling to adopted children and their parents.

The development of VdeO clefts in Chinese: A diachronic constructionist approach

Previous studies of Chinese VdeO clefts mainly focus on the function of shì and attribute the meaning of the VdeO clefts to the focus marking feature of shì without considering their functions and developments as independent constructions. This paper classifies VdeO clefts into specificational VdeO clefts (Variant1) and predicational VdeO clefts (Variant2) and analyzes the formation and development of these two types of Chinese VdeO clefts with a diachronic constructionist approach. The constructionalization of specificational VdeO clefts undergoes a series of function shifts from membership-inclusion to properties-predicating and then to value-specifying. It is the micro-step changes that finally lead to the mismatched pseudo-modifer VdeO element. The context-absorption of contrastive context is the source for the construction meaning specifying an exclusive value for the variable. In contrast, the development of predicational VdeO clefts only involves constructional changes from V-focus to VdeO-focus and then to O-focus. The change of focus is governed by the Focus-Shift Principle, according to which, the focus of a sentence tends to fall on the more complicated and specified information.