Feeding Infants With Cleft Lip and/or Palate in Brazil: Suggestions to Improve Health Policy and Research.

Objective : To verify feeding resources used prior to corrective surgery among cleft babies from Brazil and to discuss suggestions to improve common feeding problems around the world. Design : Cross-sectional descriptive study conducted at eight medical centers. Participants : A total of 215 parents or guardians of cleft children. Methods : Interview based upon a prevalidated questionnaire. The chi-square test and comparison of means by analysis of variance were used; significance level adopted was 5% (P < .05). Results : Feeding guidelines were provided in the maternity unit to 53% of the families. Breast-feeding was encouraged among 80% of mothers, predominantly in the South (P = .016). However, follow-up after maternity discharge was not appropriately carried out and failure to breast-feed occurred in 78% of families. The feeding tube was used in 21%. According to families, for those who used the ordinary nipple, it was considered the best option by the majority (29%). Conclusion : Neonatal feeding in cleft babies is a global challenge. Reports about the difficulties encountered and successful experiences would be helpful to disseminate strategies and stimulate research directed at the large-scale applicability of neonatal feeding for cleft babies on public health. This study detected the need to increase professional training and emphasizes the need for public policies addressing neonatal referral to specialized care wherever possible. It also stimulates research into using an ordinary nipple as another resource for feeding cleft babies and suggests an international discussion about specific recommendations for humanized primary health care.

Estudo multicêntrico da época do diagnóstico de fendas orais / Time of diagnosis of oral clefts: a multicenter study

OBJETIVO: Determinar a época do diagnóstico de fendas orofaciais típicas em diferentes regiões brasileiras e sua influência na idade da correção cirúrgica. MÉTODO: Estudo prospectivo, descritivo e transversal realizado em centros médicos do Sudeste, Sul e Nordeste do Brasil. Fonoaudiólogos e geneticistas treinados realizaram entrevista, previamente validada, com pais de crianças afetadas. Utilizaram-se os programas Epi-Info e SPSS. Adotou-se nível de significância de 5 por cento (p < 0,05). RESULTADOS: A amostra contou com 215 entrevistas para análise: 21,9 por cento (47) aplicadas no Sudeste, 51,1 por cento (110) no Sul e 27 por cento (58) no Nordeste. A renda mensal no Sudeste foi maior (p < 0,05). A fenda labiopalatal foi encontrada em 61,4 por cento (132) dos casos, a palatal, em 20,9 por cento (45), e a labial, em 17,7 por cento (38). Em 75,3 por cento (162) dos casos, o diagnóstico ocorreu na maternidade, em 14 por cento (30), no pré-natal e, em 10,2 por cento (22), após a alta da maternidade. O Sudeste apresentou maior frequência de diagnóstico pré-natal (27,7 por cento), possivelmente relacionada ao maior poder aquisitivo e a oportunidades de investigação. Dos diagnósticos em maternidades, 74,4 por cento ocorreram no Nordeste. Entretanto, não houve diferença na comparação entre época de diagnóstico, região e idade da primeira cirurgia. CONCLUSÃO: Considerando que o diagnóstico é mais frequente em maternidades, sugere-se o treinamento das equipes de saúde desses locais, visando efetiva coordenação do atendimento inicial. Apesar da época do diagnóstico não influenciar a idade das cirurgias, ela favorece o planejamento dos cuidados neonatais e terapêuticos dos afetados.

OBJECTIVE: To determine the time of diagnosis of typical orofacial clefts in different Brazilian regions and its influence on age at surgical correction. METHOD: This was a prospective, descriptive, cross-sectional study conducted in medical centers in the Southeast, South, and Northeast of Brazil. Trained speech therapists and geneticists interviewed the parents of affected children using a previously validated questionnaire. Epi-Info and SPSS were used for data analysis. Significance level was set at 5 percent (p < 0.05). RESULTS: The sample consisted of 215 interviews conducted in the following regions: 21.9 percent (47) in the Southeast, 51.1 percent (110) in the South, and 27 percent (58) in the Northeast. Monthly family income was higher in the Southeast (p < 0.05). Cleft lip and palate were found in 61.4 percent (132) of cases, cleft palate in 20.9 percent (45), and cleft lip in 17.7 percent (38). Diagnosis occurred in the maternity ward in 75.3 percent (162) of cases, during the prenatal period in 14 percent (30), and after hospital discharge in 10.2 percent (22). The Southeast had a higher frequency of prenatal diagnosis (27.7 percent), possibly related to greater purchasing power in this region and greater availability of prenatal investigation. Of all cases diagnosed in the maternity ward, 74.4 percent occurred in the Northeast. However, no significant difference was found when comparing time of diagnosis, region, and age at first surgery. CONCLUSION: Considering that diagnosis is more common in the maternity ward, local health care teams should be trained in order to effectively improve the initial care of these patients. Although time of diagnosis did not affect age at surgery, it favors the planning of neonatal care and treatment of affected infants.

Time of diagnosis of oral clefts: a multicenter study.

OBJECTIVE: To determine the time of diagnosis of typical orofacial clefts in different Brazilian regions and its influence on age at surgical correction. METHOD: This was a prospective, descriptive, cross-sectional study conducted in medical centers in the Southeast, South, and Northeast of Brazil. Trained speech therapists and geneticists interviewed the parents of affected children using a previously validated questionnaire. Epi-Info and SPSS were used for data analysis. Significance level was set at 5% (p ≤ 0.05). RESULTS: The sample consisted of 215 interviews conducted in the following regions: 21.9% (47) in the Southeast, 51.1% (110) in the South, and 27% (58) in the Northeast. Monthly family income was higher in the Southeast (p ≤ 0.05). Cleft lip and palate were found in 61.4% (132) of cases, cleft palate in 20.9% (45), and cleft lip in 17.7% (38). Diagnosis occurred in the maternity ward in 75.3% (162) of cases, during the prenatal period in 14% (30), and after hospital discharge in 10.2% (22). The Southeast had a higher frequency of prenatal diagnosis (27.7%), possibly related to greater purchasing power in this region and greater availability of prenatal investigation. Of all cases diagnosed in the maternity ward, 74.4% occurred in the Northeast. However, no significant difference was found when comparing time of diagnosis, region, and age at first surgery. CONCLUSION: Considering that diagnosis is more common in the maternity ward, local health care teams should be trained in order to effectively improve the initial care of these patients. Although time of diagnosis did not affect age at surgery, it favors the planning of neonatal care and treatment of affected infants.

Marginal mandibulectomy in the surgical treatment of tonsil and retromolar trigone tumours.

UNLABELLED: Resection of the ascending ramus of the mandible can result in considerable functional and esthetic damage. AIM: To compare the survival rate and local and regional recurrence in marginal and segmental mandibulectomy for advanced tonsil and retromolar trigone tumours with no mandibular invasion. PLACE AND PERIOD: Reference Head & Neck Service, between October 1994 and December 2001. MATERIAL AND METHOD: 20 stage IV patients undergoing marginal mandibulectomy and 22 undergoing segmental mandibulectomy were compared. CASE STUDY: a contemporary cross-sectional cohort study. RESULTS: Of 20 patients undergoing marginal mandibulectomy, 35% died of the disease, 15% due to local recurrence, 15% due to regional recurrence and 5% due to local and regional recurrence. Of 22 patients undergoing segmentary mandibulectomy, 36,4% died of the disease, 31,8% due to local recurrence and 13,6% due to distant recurrence. The Kaplan-Meier analysis showed a 55% survival rate for the marginal mandibulectomy group, and a 45% survival rate for the segmental group (p= 0.8329). CONCLUSIONS: Analysis of the two groups showed that conservation of the ascending ramus of the mandible, even in advanced lesions with no mandibular involvement, does not increase the recurrence rate.

A mandibulectomia marginal no tratamento dos tumores de loja amigdalina e região retromolar / Marginal mandibulectomy in the surgical treatment of tonsil and retromolar trigone tumours

A ressecção do ramo ascendente da mandíbula ocasiona um déficit funcional e estético considerável. OBJETIVO: Comparar a mandibulectomia marginal e segmentar de tumores avançados de loja amigdalina e região retromolar sem envolvimento ósseo mandibular detectado no período pré-operatório, em relação à sobrevida e recidiva loco-regional. Forma de Estudo: Estudo de coorte contemporânea com corte transversal. MATERIAL E MÉTODO: Compararam-se 20 pacientes tratados com mandibulectomia marginal e 22 tratados com mandibulectomia segmentar de outubro de 1994 a dezembro de 2001 em serviço de referência em Cirurgia de Cabeça e Pescoço. RESULTADOS: Dos 20 pacientes tratados com mandibulectomia marginal, 35 por cento morreram com doença, 15 por cento por recidiva local, 15 por cento por recidiva regional e 5 por cento por recidiva loco-regional. Dos 22 pacientes tratados com mandibulectomia segmentar 45,4 por cento morreram pela doença, sendo 31,8 por cento por recidiva local e 13,6 por cento por recidiva à distância. Na análise pelo método de Kaplan-Meier o grupo tratado com mandibulectomia marginal apresentou uma taxa de 55 por cento, e o grupo tratado com ressecção segmentar 45 por cento com p= 0,8329. CONCLUSÕES: A análise dos dois grupos evidenciou que a conservação do ramo ascendente da mandíbula, mesmo em lesões avançadas, sem envolvimento mandibular, não aumenta o índice de recidiva.

Resection of the ascending ramus of the mandible can result in considerable functional and esthetic damage. AIM: To compare the survival rate and local and regional recurrence in marginal and segmental mandibulectomy for advanced tonsil and retromolar trigone tumours with no mandibular invasion. PLACE AND PERIOD: Reference Head & Neck Service, between October 1994 and December 2001. MATERIAL AND METHOD: 20 stage IV patients undergoing marginal mandibulectomy and 22 undergoing segmental mandibulectomy were compared. CASE STUDY: a contemporary cross-sectional cohort study. RESULTS: Of 20 patients undergoing marginal mandibulectomy, 35 percent died of the disease, 15 percent due to local recurrence, 15 percent due to regional recurrence and 5 percent due to local and regional recurrence. Of 22 patients undergoing segmentary mandibulectomy, 36,4 percent died of the disease, 31,8 percent due to local recurrence and 13,6 percent due to distant recurrence. The Kaplan-Meier analysis showed a 55 percent survival rate for the marginal mandibulectomy group, and a 45 percent survival rate for the segmental group (p= 0.8329). CONCLUSIONS: Analysis of the two groups showed that conservation of the ascending ramus of the mandible, even in advanced lesions with no mandibular involvement, does not increase the recurrence rate.