The prevalence of malnutrition in children with cleft lip and cleft palate: a case-control study

Background: Children with cleft lip and cleft palate come across lot of impediment, hurdles in society. There are several social factors which hinders the proper nourishment of CL only, CP or CLP children, so majority of them tend to suffer malnutrition due to lack of standard care especially from their parents and society. Due to even low socio-economic status, impact on growth of these children is vexatious. However potential risk of malnutrition is particularly more during early childhood. Moreover, till date there are not much significant data on malnutrition in CL only, CP or CLP children. The aim of the study was to assess the prevalence of malnutrition in non syndromic CL only, CP or CLP in south India.Methods: Anthropometric parameters weight for age z score (WAZ), height for age z score (HAZ), of children with CLP were compared with age matched controls.Results: Prevalence of PEM and stunting for cleft group were 40% and 21.3% respectively compared to 33.33% and 17.33% for the control. Differences in the underweight, and stunting between the two groups were not statistically significant (?2=2.83, p value=0.58, and ?2=1.48, p value=0.69 respectively).Conclusions: There is no statistically significant difference in the occurrence of malnutrition in children with non- syndromic cleft lip and Palate compared with control.

Morfología del velo palatino en individuos fisurados operados, y su relación con el grado de insuficiencia velo faríngea / Palate velum morphology on operated cleft palate patients and its relation with the degree of pharyngeal velum insufficiency

La fisura labio palatina corresponde a una malformación congénita, caracterizada por la interrupción en la continuidad de los tejidos. La cirugía primaria del velo del paladar permite reconstituir la morfología perdida del velo palatino, sin embargo ésta no siempre considera la devolución de la anatomía del músculo de la úvula, por lo cual, el velo operado adquiere una anatomía anómala impidiendo el cierre óptimo entre cavidad oral y nasal; esta condición se conoce con el nombre de insuficiencia velo faríngea. El objetivo de este trabajo fue asociar la morfología del velo palatino con la insuficiencia velo faríngea en individuos fisurados operados. Se realizó un estudio analítico, teniendo como unidad de muestra al velo del paladar; La muestra se seleccionó entre aquellos pacientes que cumplían con los criterios de inclusión. A los individuos seleccionados se les realizó un examen clínico y un registro fotográfico con el objetivo de clasificar la anatomía del velo del paladar. Posteriormente se les realizó una evaluación fonoaudiológica para determinar el grado de insuficiencia velo faríngea. Los datos obtenidos fueron tabulados y evaluados estadísticamente. La clasificación morfológica del velo del paladar determino que el 52% de los velos fueran clasificados como cóncavos, los velos convexos y planos se distribuyeron ambos en un 24%. Según la evaluación velo faríngea, el 12% se presentaron como insuficientes, el 52% como límite insuficiente, el 24% como límite suficiente y tan solo el 8% como suficientes. Al relacionar la morfología del velo del paladar con evaluación velo faríngea se obtuvo un p = 0,3. Existe una variabilidad tanto en la morfología del velo del paladar como en la evaluación de la insuficiencia velo faríngea en individuos fisurados operados, siendo esta ultima desfavorable. No se estableció una relación estadística entre morfología del velo del paladar y la evaluación velo faríngea.

The reason for lip and cleft palate is due to a congenital malformation characterized by the interruption in the continuity of tissue. The primary surgery of the palate velum allows us to reconstruct the lost morphology in the velum palate, however this doesn´t always consider the return of the uvula muscle anatomy, whereby the operated velum becomes an anomalous anatomy thus preventing an optimum closing between the nasal and oral cavity; this condition is known as pharyngeal velum insufficiency. The aim was to associate palate velum morphology with pharyngeal velum insufficiency on cleft palate operated patients. An analytical study was done, using the velum palate as sample; the sample was selected amongst patients who met the inclusion criteria. A photographic record and a clinical exam were done on those patients who were chosen in order to classify the anatomy of the velum palate. Subsequently a phonoaudiological evaluation was done in order to establish the degree of pharyngeal velum insufficiency. The data obtained were statistically tabulated and evaluated. The morphological classification of the palate velum determined that 52% of the vela were classified as concave; the flat and convex vela both had a 24% share each. According to the evaluation of the pharyngeal velum, 12% were shown to be insufficient, 52% as borderline insufficient, 24% as borderline sufficient, and only 8% proved to be sufficient. When relating the palate velum morphology with pharyngeal velum evaluation a p = 0.3 was obtained. There is a variability in both the palate velum morphology and in the evaluation of the pharyngeal velum insufficiency on operated cleft palate patients, with the latter shown as being unfavorable. No statistical relation was established between palate velum morphology and pharyngeal velum evaluation.

Prevalencia de malformaciones congénitas asociadas en una población de niños con fisuras del labio y del paladar en Manzanillo, Cuba / Associated malformations in children with cleft lip and cleft palate in Manzanillo, Cuba

Objetivo: determinar la prevalencia de malformaciones asociadas en una población infantil afectada por fisuras del labio y/o paladar. Material y métodos: estudio observacional, predominantemente descriptivo, sobre 128 niños con fisuras de labio y/o paladar, nacidos en el Hospital Materno Provincial "Fé del Valle" de Manzanillo, Cuba, entre 1990 y 2011. Los datos fueron registrados sistemática y prospectivamente. Las variables utilizadas fueron: sexo, color de la piel, tipo de fisura y malformaciones asociadas. La información se resumió en base a las frecuencias, a partir de las cuales se establecieron datos de asociación intervariables y se calcularon tasas específicas de prevalencia. El riesgo de malformaciones asociadas se estimó para cada tipo de fisura a partir de la medición de la razón de posibilidades (RP) y sus intervalos de confianza del 95% (IC 95%). Resultados: la prevalencia de malformaciones asociadas en estos pacientes fue del 20,3% con predominio en el sistema osteomioarticular. Las fisuras labiopalatinas presentaron el mayor riesgo de malformación asociada (RP=2,08; IC 95%:0,83 - 5,2). Conclusiones: la prevalencia de malformaciones asociadas en esta población es concordante con las variaciones reportadas para este indicador. Aparentemente, hay un riesgo mayor de comorbilidad malformativa para las fisuras labio-alveolo-palatinas.

Objective: to determinate the prevalence of associated malformations in children with cleft lip and cleft palate. Methods: observational and descriptive study performed on 128 children with cleft lip and/or palate born at the "Fé del Valle" Maternal Hospital, in Manzanillo, Cuba, between 1990 and 2011. Data were systematically and prospectively collected. The following variables were used: sex, color of skin, type of cleft and associated malformations. Information was resumed by frequencies to establish association data and estimate prevalence rates. Risk of associated malformations was estimated for each type of cleft by means of Odds ratio and its 95% confidence intervals. Results: prevalence of associated malformations in these patients was 20,3 % with predominance of osteomioarticular anomalies. Cleft lip associated to cleft palate showed the greater risk of associated malformations (OR=2,08; 95%CI: 0,83-5,2). Conclusions: the prevalence of associated malformations in this population agrees with previous reports. It seems to be more malformations associated with combined clefts.

Escape de aire nasal de fonemas oclusivos y fonemas fricativos en pacientes portadores de fisura labiovelopalatina unilateral operada / Nasal air escape during the emission of plosive and fricative phonemes in patients with operated unilateral cleft lip and palate

Objetivo: determinar si existen diferencias en el escape de aire nasal durante la emisión de fonemas oclusivos y fonemas fricativos en pacientes portadores de fisura labiovelopalatina unilateral operada. Material y método: Para la presente investigación se utilizó un instrumento llamado Aerofonoscopio IIc que capta el escape de aire nasal de los pacientes al hablar. El estudio fue realizado en 74 pacientes diagnosticados con fisura labiovelopalatina unilateral operada, con un rango de edad desde los 58 meses (4 años 10 meses) hasta los 540 meses (45 años). Para realizar el análisis comparativo se utilizó la prueba "t" student. Resultados: Se encontraron diferencias estadísticamente significativas en el porcentaje de escape de aire nasal entre fonemas fricativos (52,22 por ciento) y fonemas oclusivos (35,94 por ciento). Conclusión: Los fonemas fricativos son los más afectados en portadores de fisura labiovelopalatina. El fonema fricativo más alterado es el fonema /s/. La aerofonoscopía es un examen objetivamente válido para determinar el grado de escape nasal.

Objetive: The objetive of the present study is to determine whether or not differences in the nasal air escape during the emission of plosive and fricative phonemes in patients with unilateral cleft lip and palate exist. Methods. An aerophonoscope IIc, an instrument which captures the nasal air escape during speech, was used. The study sample comprised 74 patients diagnosed with operated unilateral cleft lip and palate. The age of the participants ranged between 58 (4 years and 10 months)and 540 months (45 years). A t-test for group comparisons was computed for the statistical analysis. Results. Statistically significant differences were found in the percentage of nasal air escape between fricative (52,22 percent) and plosive phonemes (35,94 percent). Conclusion. Fricative phonemes are the most affected ones among patients with unilateral cleft lip and palate. The most affected fricative phoneme is /s/. The aerophonoscopy is an objetive and valid test to determine the nasal air escape.

Resultados del tratamiento multidisciplinario del labio y paladar figurado unilateral / Results of multidisciplinary treatment of unilateral cleft lip and palate figurative

La historia y el estado presente de 60 pacientes de 14-22 años de edad con fisuras del labio y paladar unilateral fue evaluado por un cirujano Máxilo facial, un Ortodoncista y un Foníatra del servicio de Cirugía Máxilo facial del Hospital Carlos Manuel de Céspedes de Bayamo. Granma. Cuba. Los resultados mostraron que más de la mitad de esos pacientes tenían integro el tratamiento por uno de los especialistas. Solo 27 pacientes (16.2 por ciento) habían completado el tratamiento por los tres especialistas. Los factores que contribuyeron a este porcentaje fueron discutidos

The evaluation of the results of an interdisciplinary team for the treatment of the unilateral cleft lip and cleft palate in Maxillo-Facial surgical service from University Provincial Hospital “Carlos Manuel de Cespedes “ Bayamo, Granma, Cuba. The present state of 60 patients from 14 to 22 years old was evaluate by a maxillo facial surgeon, an orthodoncist and a pfoniatriciam. The results showed that more tham half of the patients had finished treatment by one of the specialist. Only 27 patients (16,2 percent) had completed treatment by the three specialist.The factors that contributed to this percentage was discussed

Genetic Analysis of TGFA, MTHFR, and IFR6 in Korean Patients Affected by Nonsyndromic Cleft Lip with or without Cleft Palate (CL/P)

Nonsyndromic cleft lip with or without cleft palate (CL/P) is a common craniofacial birth defect that is the result of a mixture of genetic and environmental factors. While studies have identified a number of different candidate genes and loci for the etiology of CL/P, the results have not been consistent among different ethnic groups. To study the genetic association of the candidate genes in Korean patients affected by CL/P, we genotyped 97 nonsyndromic CL/P patients and 100 control individuals using single nucleotide polymorphic markers at the MTHFR, TGFA, and IRF6 genes. We report that the T3827C marker at TGFA showed significant association with nonsyndromic CL/P, but all the other markers tested were not significantly associated with nonsyndromic CL/P in Korean patients.

Clinical Study of Cleft Lip and Cleft Palate

Incidence of congenital anomalies decreased due to decrease in birth rate and popularization of prenatal examination. But there has been relatively high incidence of congenital cleft lip and cleft palate among congenital anomalies. In spite of many studies, the cause of clefting has not been clarified yet. Purpose of this study is to investigate clinical status and etiologic factors of cleft lip and cleft palate. We reviewed clinical records of 1111 cases of cleft lip and palate patient who were treated with primary cheiloplasty and palatoplasty at Hanyang University Hospital from January, 1990 to December, 2002. Clinical analysis of these 1111 cases of cleft lip and palate patients were carried out and summarized as follows. The rate among cleft lip, cleft lip & palate, and cleft palate were 1.5:1.4:1. The rate among left side, right side, and bilateral were 2.5:1.5:1. Male versus Female was 1.3:1. In cleft palate group, the ratio was 0.7:1, conversely. 1st baby was most common in patient group. 5.9 % of patients had congenital anomalies. Medication was the most possible factor with cleft lip and palate in pregnancy. 6.4 % of patients had history of cleft lip or palate in their family trees. For the closure of cleft lip, Millard's rotation advancement method was most commonly used at about 3months of age. In cleft palate group, pushback palatoplasty was most popular method and the timing of surgery was at about 12-18 months of age. Based on the above data, it may be concluded that outbreaks of cleft are affected by multiple factors and that there is no significant difference of clinical status and treatment modalities between this and other investigations. To investigate the correlation between proposed factors and effects, prospective study method is more suitable than retrospective study like this. Good study design for data collection and appropriate control group are also required. For this purpose, I propose construction of new data collecting system and multi-center study for birth monitoring system.