Change in Prevalence of Orofacial Clefts in California between 1987 and 2010.

INTRODUCTION: To extend the knowledge base about possible prevalence declines of specific orofacial cleft phenotypes, here we examine prevalence in a population base from California over a two-decade period among numerous race/ethnic groups. METHODS: This population-based study used vital statistics and birth defects registry data. Its population involved all births (~1.5 million births) in central California counties from 1987 to 2010. Orofacial clefts were defined as cleft lip with or without cleft palate (CLP, n=1766), and cleft palate (CP, n=922) only. The slope of prevalence of each cleft phenotype over the period 1987-2010 was estimated using weighted least squares regression. RESULTS: Birth prevalence of CLP was 121/100,000 live births, and 63/100,000 live births for CP. The slope for CLP decreased by 1.2 (slope: -1.2; 95% CI: -1.9, -0.5), and for CP by 0.7 (slope: -0.7; 95% CI: -1.7, 0.2) for CP. Stratification by race/ethnicity or infant sex did not demonstrate a statistical difference in slopes. CONCLUSIONS: We observed a decline in the prevalence in CLP in all ethnic groups, however did not observe the same amount of decline in CP, perhaps due to antenatal screening.

Malthus Mysterious Orofacial Cleft Correction.

Thomas Malthus (1766-1834), distinguished English professor, is the father of modern demography and the most famous harelip carrier of history. Much is known of his orofacial cleft but nothing regarding its mysterious surgical correction. An 1833 portrait of Malthus by John Linnell, finished when he considered himself "handsome enough," for sitting does not show any upper lip scar. When this surgery took place? Although technically feasible in the 19th century, surgery of cleft lip and palate was complicated. Malthus would not risk his life to have his orofacial disability corrected shortly before his death. Linnell cunningly dissimulated his deformity.

Tessier 3 Cleft in a Pre-Hispanic Anthropomorphic Figurine in El Salvador, Central America.

In 1976, Paul Tessier provided a numerical classification system for rare facial clefts, numbered from 0 to 14. The Tessier 3 cleft is a rare facial cleft extending from the philtrum of the upper lip through the wing of the nostril, and reaches the medial canthus of the eye. The aim of this document was to describe a pre-Hispanic anthropomorphic figurine dating from the classic period (200 A.D.-900 A.D.), which has a Tessier 3 cleft. We also discuss the documented pre-Hispanic beliefs about facial clefts.

Classification of Cleft Lip/Palate: Then and Now.

Cleft lip and/or palate (CL/P) is phenotypically diverse, making classification difficult. This article explores the evolution of ideas regarding CL/P classification and includes the schemes described by Davis and Ritchie (1922) , Brophy (1923) , Veau (1931) , Fogh-Andersen (1943), Kernahan and Stark (1958) , Harkins et al. (1962) , Broadbent et al. (1968), Spina (1973) , and others. Based on these systems, a longhand structured form is proposed for describing CL/P in a way that is clear, comprehensive, and consistent. A complementary shorthand notation is also described to improve the utility and convenience of this structured form.

Prevalence of cleft lip and/or palate in children from Lodz between years 1981-2010.

Congenital malformations constitute a serious problem of both medical and social nature. Cleft lip and/or palate represent the most common congenital anomaly of the face that is why it is essential to know the real frequency of the described phenomenon. The aim of this paper is to determine the frequency of cleft lip and/or palate and the types of malformations that occurred in Lodz city between the years 1981-2010. Our clinic has been carrying on the studies concerning the incidence of cleft lip and/or palate since 1981. The Polish Registry of Congenital Malformations has been operating in Poland since 1 April 1997. The team has managed to obtain data, from the Registry, concerning the total number of all live born infants and the number of children with cleft lip and/or palate, who were born in Lodz, between 1998 and 2010. In years 1981-2010, 319 children, in 210 952 live born infants, were born with cleft lip and/or palate in Lodz. The isolated cleft palate was observed more frequently in girls and the unilateral cleft of lip and palate in boys. In all three decades palate clefts are more common whereas bilateral lip, alveolus and palate clefts are more infrequent. A small tendency to decrease in actual cleft lip and/or palate frequency among children, in the period of 30 years, is observed in Lodz. Over the years it has still been observed that the isolated cleft palate is the most common type of defect.

Overview of orthodontic care for children with cleft lip and palate, 1915-2015.

The purpose of this article is to review and discuss the advances in the management of children born with cleft lip and palate (CLP) as it has evolved over the past 100 years. This overview is based on articles published in the American Journal of Orthodontics, which frequently changed its name, over the past century. Additionally, other journals will be cited as craniofacial anomalies became recognized during the 20th century and the biologic basis became refined, with the new discipline of genetics replacing the term hereditary and its connotations of eugenics. The Human Genome Project, completed in 2003, has now provided an understanding of syndromic and nonsyndromic CLP that has led to advances in the diagnosis and treatment of CLP in the 21st century. These evolving concepts will be discussed in an overview of the types of procedures published from 1915 to 2015 and the major transition in the mid-20th century from multiple uncoordinated interventions from various specialists to a coordinated team approach in which the orthodontist has a specific role in the timing and sequencing of interdisciplinary treatment goals. Major technologic advancements in treatment modalities and the contemporary approach to the health-related quality of life of the patient and the caregiver have resulted in their participation in treatment options and decisions. The requirement of informed consent reflects the legal doctrine that now emphasizes the ethical imperative of greater respect for patient autonomy in the decision-making process. The orthodontist no longer makes decisions alone, but rather with the team and the patient or the caregiver.

Cleft and Craniofacial Care in Palestine: Breaking From the Cycle of the Past.

The history of cleft care in the Palestinian territories has largely been sporadic and dependent on foreign practitioners. This article discusses the recent history and the current status of cleft care in Palestine, including the quality of training among Palestinian cleft practitioners and limitations in operating room capacity. The discussion concludes with a future model of cleft care that focuses on carefully crafted programs to train surgeons (this is broadly applicable to other disciplines involved in cleft care), working in partnership with a designated National Cleft Organization, operationalized within a centrally located and accessible Cleft Center.

Heinrich von Pfalzpaint, Pioneer of Arm Flap Nasal Reconstruction in 1460, More Than a Century Before Tagliacozzi.

Heinrich von Pfalzpaint (circa 1415-1465) was a Bavarian military surgeon of the Teutonic Order who treated more than 4000 casualties during the siege of Marienberg Fortress (1454-1457). In 1460, he reported "How to create a new nose if it has been chopped off and the dogs have eaten it" in his treatise on wound care Bündt-Ertznei. He used opium-soaked sponges for anesthesia, described the surgical extraction of bullets and cleft lip repair. Pfalzpaint would have been the first author to describe nasal reconstruction in Europe if his treatise had not been lost. Only 5 copies of his manuscript existed. One was rediscovered and printed in 1868. Pfalzpaint's technique for nasal reconstruction was performed in 2 stages using an undelayed skin flap from the upper arm, which was sutured to the nasal defect and the arm was bandaged to the head. After 8 to 10 days, he divided the pedicle; inset the flap; and fashioned the nasal dorsum, alae, and columella. Tagliacozzi described arm flap nasal reconstruction more than a century later in 1597. He used delayed skin flaps, with at least 6 operative stages over 4 months. Pfalzpaint was ahead of his time regarding his knowledge of wounds, insistence on surgical cleanliness, and his technically easier arm flap rhinoplasty, compared with Tagliacozzi. Pfalzpaint, who is rarely referenced in the literature, should be remembered as a great pioneer of reconstructive surgery in Europe.

Cranio-facial clefts in pre-hispanic America.

Among the representations of congenital malformations in Moche ceramic art, cranio-facial clefts have been portrayed in pottery found in Moche burials. These pottery vessels were used as domestic items during lifetime and funerary offerings upon death. The aim of this study was to examine archeological evidence for representations of cranio-facial cleft malformations in Moche vessels. Pottery depicting malformations of the midface in Moche collections in Lima-Peru were studied. The malformations portrayed on pottery were analyzed using the Tessier classification. Photographs were authorized by the Larco Museo.Three vessels were observed to have median cranio-facial dysraphia in association with midline cleft of the lower lip with cleft of the mandible. ML001489 portrays a median cranio-facial dysraphia with an orbital cleft and a midline cleft of the lower lip extending to the mandible. ML001514 represents a median facial dysraphia in association with an orbital facial cleft and a vertical orbital dystopia. ML001491 illustrates a median facial cleft with a soft tissue cleft. Three cases of midline, orbital and lateral facial clefts have been portrayed in Moche full-figure portrait vessels. They represent the earliest registries of congenital cranio-facial malformations in ancient Peru.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: a historical perspective.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital defect of the Müllerian ducts characterized by uterovaginal agenesis and underdeveloped female genital organs. This paper is a tribute to the contributors of this condition - August Franz Joseph Karl Mayer, Karl Freiherr von Rokitansky, Hermann Küster and Georges André Hauser. In addition to their contributions, we have discussed findings and reports of similar defects from other important scientists (Hippocrates, Albucasis, etc.) dating as far back as 460B.C. We have also discussed the disease types and different classification systems including VCUAM and AFS/ASRM among others. Even with several surgical and non-surgical treatment options, there are still many questions that remain unanswered and very little is known about the etiology or genetic predisposition of this condition.

Harvey Cushing's Contributions to Plastic Surgery: Bilateral Cleft Lip Repair.

Harvey Cushing has been deemed by many as the neurosurgeon of the 20th century. Cushing's unknown contributions to the field of plastic and reconstructive surgery were only recently reported. Further review of his teaching and operative records, brought from Johns Hopkins to Yale University, revealed an unpublished case of bilateral cleft lip repair that he performed. In this article, we present in detail this comprehensive case and describe, with the help of his personal teaching notes and illustrations, how Cushing combined methods from world-renowned surgeons to approach bilateral cleft lip deformities.

Scope of Western surgical techniques to correct cleft lip and palate prior to the 18th century.

OBJECTIVES: To present the state of knowledge and surgical practice concerning cleft lip and palate leading to the modern era. DESIGN: Bibliographical review. SETTING: Analysis of the scientific medical, surgical, and odontological literature from the 16th to 18th centuries. RESULTS: Texts and art confirm the existence of cleft lip and palate from antiquity in all cultures; however, the first certain references in Western scientific literature did not appear until the works of Celsus (ca. 25 BC to AD 50) and Galen (AD 129 to 200). Indications for cleft lip surgery appear in the Middle Ages with Albucasis (936 to 1013) and Yperman (1260 to 1332). From the Renaissance period onward, and with the invention of the printing press, numerous authors described their own surgical methods. CONCLUSIONS: Given the limitations imposed by pain and infection, the authors of the Modern Age focus on correcting the functional and esthetic defect of the lip with techniques that do not differ greatly from those described in the Middle Ages. The treatment for cleft palate was limited to the creation of "obturators" and surgery for cleft palate was not possible until the 19th century.

Gustav Simon's band and the evolution of labial adhesion.

"Simonart's band" is an eponymic misnomer. In the mid-19th century, Pierre-Joseph Simonart described congenital bands in the limb, not in the lip. Shortly thereafter, Gustav Simon reported preliminary closure of bilateral cleft lip and thus deserves credit for labial adhesion (Simon's band). Labial adhesion was rediscovered 100 years later; however, with increasing use of infant-dentofacial orthopedics, its popularity has declined in many centers. The authors continue to use this procedure before formal repair of unilateral complete cleft lip/palate, unilateral complete cleft lip and alveolus, severe unilateral incomplete cleft lip, and bilateral asymmetrical cleft lip (on the complete side). Bilateral labial adhesion may also have a preparatory role in double cleft lip whenever dentofacial orthopedic manipulation is unavailable or unsuccessful.

Military medical advances resulting from the conflict in Korea, Part II: Historic clinical accomplishments.

Throughout the recorded history of civilization, there has been armed conflict. Warfare has been associated with advances in care for the wounded. Many of these advances when shown effective on the battlefield become incorporated into civilian health care. It is a laboratory where there is unfortunately much clinical material and presents opportunity for the creative, curious, and innovative. This article reviews the medical advances that resulted from the Korean War. There were notable advances in neurosurgery, vascular surgery, and plastic surgery. Tools from prior wars were rediscovered, dusted off, and used to stop combat losses from psychiatric trauma. A treatment was developed for cleft lip by a plastic surgeon, thus giving hope to young lives. War is a disruptive, destructive, and harrowing experience--but can lead to improvements in care for the wounded and these developments can improve the lives of people everywhere.

Cleft lip-cleft palate closure: the unknown contributions of Harvey Cushing.

BACKGROUND: The development of surgical repair of cleft lip-cleft palate closure has been well documented in the literature. However, the contributions of an unlikely pioneer, Harvey Cushing, in the development of cleft lip-cleft palate closure have been to date unknown. METHODS: Patient surgical records from 1896 to 1912 at The Johns Hopkins Hospital documenting Harvey Cushing's cases were reviewed. RESULTS: Three cases of Cushing's surgical closure of cleft lip-cleft palate, using a variety of techniques, are described and placed into historical context in the development of cleft lip-cleft palate surgery. CONCLUSIONS: Harvey Cushing's contributions to the field of plastic and reconstructive surgery have largely remained unknown. The cases reported here illustrate the early work of this pioneering surgeon in the area of cleft lip-cleft palate surgery.

Bone regeneration and periosteoplasty: a 250-year-long history.

BACKGROUND: Since antiquity, many attempts have been carried out and a number of theories proposed to explain the process that leads to bone regeneration. Through manifold experiments, several authors tried to understand and subsequently to control the physiological events that enable bone healing. Between the 18th and 19th centuries something changed. Although the scientific world was initially skeptical, a new idea emerged in the field of bone surgery. It principally concerned the necessity to perform amputations and resections leaving intact the periosteum to obtain new bone formation. MATERIALS AND METHODS: With this article we emphasize the contribution of many authors in the development of knowledge about the osteogenic properties of the periosteum. In particular we focus on the experiences of unknown Italian authors Michele Troja and Bernardino Larghi, consider well-recognized scientific personalities such as Leopold Ollier and Bernhard von Langenbeck, and reach a milestone of plastic surgery with Tord Skoog and his description of periosteoplasty. CONCLUSION: Various surgical approaches have been proposed to provide optimal care for patients with cleft lip and palate disorders. Among several treatment options, periosteoplasty is one of the choices to correct maxillary clefts. Highlighting difficulties and successes of many authors in demonstrating osteogenic properties of periosteum, this paper describes how periosteoplasty performed in maxillary cleft restoration capitalizes on what has been discovered during a 250-year-long history.