ABSTRACT
Objective: The multifactorial etiology of cleft can be due to environmental factors or genetic factors or combination of both. Many studies were conducted to detect the epidemiology of the clefts and the genetic factors causing clefts. There is no or very less studies conducted in India to identify the risk of pesticidal exposure in occurrence of nonsyndromic clefts. The present study is to investigate the risk of parental pesticidal exposure in causing clefts in the craniofacial region. Methods: The case-control study included 179 cases of cleft in the craniofacial region and 200 healthy controls matched for age and gender. The data were collected in the proforma from the study group in the departments of plastic surgery, Obstetrics and Gynaecology, and Paediatrics of Vydehi Institute of Medical Sciences and Research Centre. Result: Majority (55.3%) of the parents from the cleft group were exposed to pesticides but only 4.5% parents of the control group were exposed which is statistically significant (p=0.001). Compared to other cleft group, more parents of cleft lip palate exposed to pesticides was also significant (p=0.041).The cleft cases which were exposed to pesticides (86%) were from the rural area and the controls which were not exposed (79%) were from the urban area and is statistically significant (p<0.001). Conclusion: Parental pesticidal exposure is a risk factor for clefts in the craniofacial region. Among all the clefts, the risk is increased for the cleft lip palate.
ABSTRACT
Background: Sacrum is a large triangular bone formed by fusion of five sacral vertebrae. The opening present at the caudal end of sacral canal is known as sacral hiatus and is formed due to the failure of fusion of lamina of fifth sacral vertebra. Objective of current study was to study the anatomical variations of dorsal wall of sacrum in order to clarify the structural variations of sacral hiatus and surrounding structures for improving the reliability of caudal epidural block Methods: The present study was done on 50 male and 50 female dry human sacra after calculating the sacral indices and sexing of sacra. The dorsal wall of sacrum was studied with respect to composition of sacrum, level of sacral hiatus, deficiencies and apertures in the bony dorsal wall and also for the presence and absence of sacral cornua. Results: The level of apex of sacral hiatus can vary from upper part of S2 to lower part of S5. The most common position was at S4 (64%). Elongated sacral hiatus at the level of S2 was present in 4% of cases. Sacrum had normal 5 segments in 70% of cases, 4 segmented sacra were observed in 4% of cases, sacralization of 5th lumbar vertebra in 7%, coccygeal ankylosis in 19% of cases. Less extensive apertures in the bony dorsal wall of sacral canal were observed in 29% of sacra. Conclusion: The dorsal wall of sacrum has anatomical variations. Understanding these variations may improve the reliability and success of caudal epidural anesthesia.