The incidence of cleft lip and palate deformities in the south-east of Scotland (1971-1990).

This retrospective study reports the incidence of infants born with the cleft lip and palate anomaly within the Edinburgh Cleft Units catchment area, between 1 January, 1971, and 31 December, 1990. The importance of accurate data collection for local, regional, and national data bases is discussed with reference to the recent CSAG report on cleft lip and palate services in the UK. Five-hundred-and-two cleft lip and palate patients were identified (291 males, 211 females). The incidence is reported as 1.4 per 1000 live births (1 in 711). Twenty-five per cent of clefts affected the primary palate, 45 per cent affected the secondary palate, and the remaining 30 per cent were clefts of both the primary and secondary palate. Overall, a higher percentage of males were affected (58 per cent males to 42 per cent females). Clefts of the secondary palate, however, were more common in females (56 per cent females to 44 per cent males). Data presented in this study is similar to that previously reported from UK centres. It is suggested the accuracy of the UK cleft lip and palate data collection needs to be improved. Prospective data collection in a standardized format carried out on a national basis has to be a priority as recommended by the CSAG report.     

The Incidence of Cleft Lip and Palate in Northern Ireland from 1980–1990

Abstract

This study reports the incidence of the various types of cleft lip and/or palate drawn from a regional database of all affected children born in Northern Ireland during the period 1980–1990. The incidence of these anomalies was 1·28 per 1000 live births (1:781).

Fifty-three per cent of clefts involved the secondary palate only, 16 per cent the primary palate only, 26 per cent involved both primary and secondary palate, and 5 per cent were unconnected.

Overall, more males than females were affected and there were more males than females in the group having complete clefts. Separate clefts of lip and palate occurred exclusively in males with only one exception.

Unilateral clefts were more common on the left side.

Within the group showing complete unilateral cleft of the primary and secondary palate, left-sided clefts were more commonly male, right-sided clefts were more commonly female.

There were no statistically significant sex differences between sides in the unilateral primary palate cleft group.     

A descriptive epidemiology study of cleft lip and palate in Northern Finland

Objective. The aim of this study was to determine the incidence of cleft lip and/or cleft palate in a population uniquely from Northern Finland. Materials and methods. The records of a total of 214 cleft patients treated between 1998–2011 at the Oulu Cleft Lip and Palate Center at the University of Oulu were assessed on a retrospective basis. Data regarding cleft type, sex and side of cleft was collected and analyzed. Family history of clefting was investigated. Results. Cleft palate (68.7%) was most frequently found, followed by cleft lip and palate (18.7%) and cleft lip with or without alveolus (12.6%). Cleft palate occurred more frequently in females (63.3%) and cleft lip and palate was more frequently found in males (62.5%). The left side was more frequently affected in both male and female patients. Left-sided clefts were observed in 82% of patients compared to right-sided clefts in 18%. A family history of clefting was detected in 20.1% of patients. Conclusion. The incidence of clefts in Northern Finland is higher than the corresponding incidence in other European countries. Cleft palate was the most frequent cleft type and it was more frequent in females. In males, cleft lip and palate was more frequent. The left side was more frequently affected in both genders. One fifth of the patients had a family history of clefts.     

The distribution of clefts of the primary and secondary palates by sex, type, and location

The frequency and patterns of distribution of cleft lip, cleft lip and alveolus, cleft lip and palate, and isolated cleft palate, together with the possible association between sex, type of cleft, and affected side were studied from records of 278 individuals with clefts. These records were obtained from four cleft centers in the New York City area and constituted a racially mixed urban sample. The type of the cleft varied between sexes. Males had significantly higher rates of cleft lip and palate (p<0.0001), and females had higher rates of isolated cleft palate (p<0.0001). No sex differences were found for cleft lip or cleft lip and alveolus. Unilateral clefts of both the primary and secondary palates were found to occur over three times more frequently than bilateral clefts, and left side predominance was demonstrated.     

An audit of the Yorkshire Regional Cleft Database

This study assessed the validity of the Yorkshire regional orofacial cleft database by comparing the computer-based records with locally collated records of primary surgical events for babies born over a 2-year period (1994-1995). One-hundred-and-thirty-two infants with clefts (excluding submucous cleft palate) were identified from the latter source with an equal proportion of unilateral cleft lip/palate and isolated cleft palate births. However, only 62 per cent of cases were recorded on the database and the reporting rate of individual cleft units was highly variable (43-85 per cent). In addition, there was a significant under-reporting of both cleft lip and isolated cleft palate cases (42 and 50 per cent ascertainment, respectively). Consequently, the database figures understated the prevalence of all cleft births, but especially of these two cleft subtypes. Conversely, the relative frequency of combined cleft lip and palate cases was exaggerated. The reasons for such discrepancies and possible improvements to data collection are discussed.     

Current data on the characterization of oral clefts in Brazil

This study aimed at investigating the current distribution of the several types of clefts among the patients receiving treatment at the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC-USP), Bauru, Brazil, for the first time during the year 2000. A total of 803 unoperated patients with cleft lip and/or palate, with or without additional malformations, with no recognizable syndromes, who came to the HRAC-USP for enrollment for treatment during the year 2000. A predominance of complete cleft lip and palate, either unilateral or bilateral, was observed (37.1%), followed by isolated cleft palate (31.7%) and isolated cleft lip (28.4%). A discrete relationship between cleft palate and the female gender was noticed (53%), and males were more affected by the other types of clefts (around 60%). The findings revealed a predominance of complete clefts of the primary and secondary palate, the treatment of which is more complex, and whose frequency is greater in males.     

2002 BSPD Clinical Case Presentations, sponsored by South Yorkshire branch of BSPD

Aims. To determine the oral health of children attending a Clinical Standards Advisory Group (CSAG) audit and to assess whether this varied with the type of cleft. To record the fre-quencies of dental anomalies occurring at the site of the cleft.
Methods. Children with clefts attending the 5-, 10-, 15- and 20-year audit at Broomfield Hospital Essex over a 2-year period were examined using standardized criteria for caries experience, dental anomalies and oral hygiene status. Comparisons were made for the different cleft types.
Results. The mean DMFTat 5 years was 1·83. The DMFT for 10- and 15-year children combined was 0·64. Sixty-two percent of the children had dental anomalies in the region of the cleft. Children with cleft lip and palate had significantly more dental anomalies than cleft palate alone. Children withbilateral cleft lip and palate often had anomalies remote from the cleft.
Conclusions. Dental caries in this population of cleft children was similar to national figures. Hypodontia and hypoplasia were more common in cleft lip and palate than in cleft palate alone. Dental anomalies remote from the cleft site in bilateral clefts suggests that a field change may influence dental development.     

Cleft lip and cleft palate in Santo Domingo

The purpose of this study was to analyze the occurrence of isolated cleft lip (CL), cleft lip with cleft palate (CL + CP) and isolated cleft palate (CP) and their distribution according to sex and laterality in Santo Domingo, Dominican Republic, located in the Caribbean Archipelago. The sample consisted of 439 hospital records (204 males and 235 females) of patients attending a children's public hospital in Santo Domingo over the period of May 1973 to December 1976. Of all facial clefts, the highest percentage (36.4%) was presented by CL, followed by CP (32.1%) and CL + CP (31.4%). Of all facial clefts, males presented the highest percentage (53.5%). For both sexes, there was an equal number of cases with CL (17.54 %) but more males had CL + CP (0.20 > P0.10) and more females presented CP (P < 0.001). The left-sided defects were almost twice as common as the right-sided defects. The ratio of unilateral clefts-to-bilateral clefts was 5.4:1.     

Non-syndromic orofacial clefts in Southern Italy: pattern analysis according to gender, history of maternal smoking, folic acid intake and familial diabetes.

BACKGROUND: Genetic studies have demonstrated that non-syndromic clefts of the lip, alveolus and palate have an heterogeneous genetic background, and that environmental factors contribute to the onset of this malformation. Therefore studies on different and homogeneous populations can be useful in detecting potentially related environmental and genetic factors. PURPOSE: The aim of the present study was to evaluate whether gender, folic acid intake, family history of diabetes and/or smoking during pregnancy were associated with a specific type of cleft in a group of patients affected by non-syndromic clefts, collected from Southern Italy. MATERIAL AND METHODS: Data from one hundred and twenty-six patients were evaluated retrospectively. Each cleft was described as composed by separate antomical entities such as lip, alveolus, primary and secondary palate. None had an isolated alveolar cleft and this was used as internal control. Pattern analysis was used to detect differences in the frequencies of any possible combination of 7 types of clefting stratified according to the studied variables. Data were analysed by comparing observed proportions. RESULTS: Isolated cleft palate as well as right-sided clefts of lip, alveolus and palate were more frequent in females (p = 0.0014 and 0.0281, respectively), while left sided clefts were more frequent in males (p = 0.0359). A lack of consumption of folic acid was associated with an higher incidence of clefts of the left lip (p = 0.018), while familial diabetes was associated more often with isolated cleft palate (p = 0.0014). CONCLUSIONS: Gender-related results were comparable with those found in Northern Italy and other countries. Environmentally related results disclosed specific subclasses of clefting associated with lack of folic acid consumption and familial diabetes.     

Prevalence of orofacial clefts in Saudi Arabia and neighboring countries: A systematic review

Cleft lip and/or palate are among the most common birth defects in the world. The prevalence of these conditions varies considerably across geographic areas and ethnic groups.ObjectiveThe aim of this study was to carry out a systematic review and appraisal of the literature on the prevalence of cleft lip and/or palate in Saudi Arabia and comparable Middle Eastern countries.Materials and methodsAll published articles on orofacial clefts (OFC) in Saudi Arabia and its bordering countries in the Middle East with similar and comparable population characteristics were reviewed in July 2010.ResultsAfter reviewing the articles, only eight matched the inclusion criteria. Three studies were carried out in two regions in Saudi Arabia (Riyadh and Al-Qaseem). The other five studies were set in Dubai, Oman, and Jordan. The prevalence of cleft lip and/or palate reported in these studies varied greatly from 0.3 to 2.4 per 1000 live births. The birth prevalence of orofacial clefts in males was reported to be higher than in females. The isolated cleft palate prevalence was reported to be higher in females in most of the studies.ConclusionThe eightfold variation in the prevalence of orofacial clefts between highest and lowest prevalence is likely to be due, at least in part, to problems with ascertainment, but there may also be underlying genetic or environmental factors that require further investigation.     

Cleft lip and palate in Denmark, 1976-1981: epidemiology, variability, and early somatic development

The present investigation describes the incidence and variability of the primary cleft condition in all Danish infants born with cleft lip, cleft palate, or both, from 1976 to 1981 and analyzes general somatic growth from birth to age 22 months. Because of excellent sampling conditions in Denmark, the study material is nearly complete. Six hundred and seventy-eight infants with facial clefts were born during the period, corresponding to 1.89 per 1,000 of all newborns. Six hundred and two patients were examined--most of them twice: at 2 months and at 22 months. Material uptake included plaster casts of the upper jaw, cephalometric films in three projections, anthropometric registrations, and information from hospital charts. A detailed grading of the clefts according to severity was carried out. Sex distribution was 61% males and 39% females, of whom 34% had isolated cleft lip, 39% combined cleft lip and palate, and 27% an isolated cleft palate. Left-sided clefts were most frequent. In the combined cleft lip and palate group, 90% exhibited subtotal or total clefts, whereas the clefts were less severe in the isolated cleft lip and isolated cleft palate patients. Birth weight and length showed values close to the average for Danish newborns, but a lag was seen in infants in whom severe palatal cleft was included. The extended method of classification was suggested to select subgroups for special care.     

Centre-based statistics of cleft lip with/without alveolus and palate as well as cleft palate only patients in Aden,Yemen

ObjectiveThe purpose of the study was to report the types and patterns of cleft lip with/without cleft alveolus and palate as well as cleft palate only as seen in Aden, Yemen.Design and settingRetrospective, centre-based study conducted at the Cleft Lip and Palate Centre, Aden University, Yemen.Material and methodsStatistical evaluation of the data from all cleft patients who were registered at or referred to this centre during the years 2005–2011.ResultsA total of 1110 cleft patients were seen during the period studied (2005–2011). Amongst these there were 183 (16.48%) with a cleft lip and 144 (12.98) with a cleft of lip and alveolus, 228 (20.54%) had a cleft palate, and 555 (50%) had a combination of cleft lip, alveolus, and palate. The clefts were found more often in males than in females (56.5% boys versus 43.5% girls). This difference was statistically significant (p ≤ 0.001). Statistically significant sex differences were also noted when evaluating the various cleft types. Isolated cleft palates were found most often in females. Among the cleft palate cases there were 102 (9.2%) with a cleft soft palate only. The ages of the patients were between one day and 40 years.Two hundred and one children (18%) had a positive family history of clefts. Among the risk factors considered in this study, consanguineous marriages among cousins were found most frequently (in 48% of the cases). In contrast to this, only 10% of the mothers had reported to have been taking medication directly prior to or during the first trimester of their pregnancy. On average the mothers were neither very young nor very old.ConclusionThe prevalence rate of orofacial cleft types among this Yemeni sample was similar to prevalence rates previously reported in white Caucasians. The present study did neither find many cases with medication before, nor during, pregnancy; there were few young or very old mothers; and the incidence of positive family histories was similar to those found in other studies on clefts. However, consanguineous marriages were encountered quite often.     

The prevalence of various dental characteristics in the primary and mixed dentition in patients born with non-syndromic unilateral cleft lip with or without cleft palate

This retrospective study was carried out on consecutively collected dental casts, x-rays, and photos of 129 Swedish children who had been born with non-syndromic unilateral (U) cleft lip (CL), cleft lip and alveolus (CLA), or cleft lip and palate (CLP). The following dental characteristics were investigated in the primary and permanent dentitions: 1. the presence, eruption, position, and shape of the lateral incisor; 2. the prevalence of rotation and enamel hypoplasia of the permanent central incisor; 3. the occurrence of hypodontia outside the cleft region; and 4. the transition from the primary to the succeeding permanent lateral incisor in the cleft region. Patients with clefts involving the palate (UCLP) exhibited a high frequency of hypodontia. In patients with clefts, which did not include the palate, malformed lateral incisors were a common finding. In the primary and permanent dentition, the lateral incisor had erupted distal to the cleft in 31.8 and 24.8 per cent of the UCLA and UCLP patients, respectively. No significant pattern was seen regarding the transition from the primary to the succeeding permanent lateral incisor (P = 0.15). The central incisor was rotated in 55 per cent of the patients and this positional deviation was particularly frequent in cases where the lateral incisor was missing in the premaxilla (P < 0.05). Hypodontia outside the cleft region was recorded in 15.5 per cent of the patients. Patients with UCLP had more often crossbite than patients with a UCL or a UCLA phenotype (P < 0.001).     

Cleft lip and palate management by U.K. consultant oral and maxillofacial surgeons: a national survey.

OBJECTIVE: Following the report of the Clinical Standards Advisory Group (CSAG), a national survey of U.K. consultant oral and maxillofacial surgeons was performed to determine the current cleft lip and palate practice of this group prior to the implementation of proposed radical changes in the delivery of cleft services. The views of these surgeons regarding the proposed changes was also sought. DESIGN: An anonymous postal questionnaire sent to all 266 consultants in the U.K., which requested information on the practice of cleft surgery during a defined 1-year period (March 1997 through February 1998). It included the numbers and types of procedures performed, the involvement of multidisciplinary care, research and audit activity, and questions regarding the implementation of CSAG. RESULTS: One hundred ninety-one replies (72% response rate). Seventy-three surgeons were actively involved with mainly secondary cleft surgery. A varied number and range of procedures were undertaken, with most surgeons performing less than five of each procedure per year. Audit and research activity was 26%. The majority of both noncleft and cleft surgeons agreed with proposals made by CSAG (except for cleft osteotomy procedures). CONCLUSIONS: In the U.K. at present, there are many oral and maxillofacial surgeons performing mainly secondary cleft surgery; overall, the number of procedures performed by these surgeons per year is small. Intraspecialty referral is suggested to further improve patient outcome.     

Cleft type and Angle's classification of malocclusion in Korean cleft patients

This study was performed to investigate the contributing factors, such as cleft type, side of cleft, patient's age, and gender, associated with Angle's classification of malocclusion in Korean cleft patients. The records of 250 cleft patients (175 males, 75 females) who attended the Department of Orthodontics, Seoul National University Dental Hospital between 1988 and 1999 were examined. The percentages of subjects with cleft lip (CL), cleft lip and alveolus (CLA), cleft palate (CP), and cleft lip and palate (CLP) were 7.6, 19.2, 9.6, and 63.6, respectively. The overall distributions of unilateral and bilateral clefts were 76 and 24 per cent, respectively. The overall percentages of Class I, II, and III malocclusions were 18.5, 8.8, and 72.7. The frequency of Class III malocclusions was most prevalent in all age groups. Bivariate analysis showed that whilst gender was not significant, the type of cleft significantly influenced the development of a Class III malocclusion (P < 0.01). Using logistic regression analysis, subjects in the CP (P < 0.05) and CLP groups (P < 0.01) were 3.9 and 5.5 times more likely to have a Class III malocclusion than those in the CL group. There was, however, no statistical difference in the prevalence of a Class III malocclusion between the CL and the CLA groups (P > 0.05). When the degree of cleft involvement in the palate increased, so did the predominance of a Class III malocclusion.     

Tooth size in children with cleft lip and palate

The mesiodistal and buccolingual dimensions of primary and permanent teeth were measured in 246 children with either isolated cleft palate or complete unilateral cleft lip and palate. The primary teeth of males with clefts were reduced in their buccolingual dimension compared to the control, while in females there were reductions in the mesio-distal dimension. There were no remarkable differences in the size of the permanent teeth in males with clefts. Females with clefts had reduced buccolingual dimensions of the permanent teeth, in both jaws.     

2447例唇腭裂患者的临床资料分析

目的　了解先天性唇腭裂的患病状况及特点 ,寻找与唇腭裂发生有关的影响因素 ,为唇腭裂的预防与治疗提供依据。方法　对 1989～ 1998,10年间在原华西医科大学口腔医院颌面外科手术治疗的 2 4 4 7病例进行回顾性临床统计学分析。结果　在本组病例中 ,唇裂 6 4 8(2 6 5 % )、唇腭裂 996 (40 7% )、单纯腭裂 80 3(32 8% )。唇裂伴或不伴腭裂中 ,男多于女 (2 .14∶1) ,单纯腭裂女多于男 (0 77∶1)。单侧唇腭裂明显多于双侧 ,两者之比为 4 84∶1,其中左侧者多于右侧者 ,两者之比为 2 14∶1。有遗传史的病例占病例总数的 7 4 % ,其中唇裂伴或不伴腭裂有遗传史者占唇裂伴或不伴腭裂患者的 8 2 % ,单纯腭裂有遗传史者占单纯腭裂患者的 6 5 %。母亲怀孕前 3月经历危险因素有 95 4例 ,占 39 0 % ,其中唇裂伴或不伴腭裂者 70 0例 ,占唇裂伴或不伴腭裂患者数的 4 2 6 % ,单纯腭裂2 5 4例 ,占单纯腭裂的 31 6 %。A型和O型血患者比例高于正常人群比例 ,而B型血者比例低于正常人群比例 ,单纯唇裂出生于 4～ 6月者人数小于其他季度 ,而单纯腭裂出生于 7～ 9月者人数少于其他季度 ;19例双生子中 ,均为其中之一发病 ,无同时发病者。唇腭裂伴发畸形者共 4 1例 ,占总病例数的 1 7%。结论　本资料提示唇腭裂的发生可?     

Incidence of cleft lip and palate in the northeast of Mexico: a 10-year study

In Latin American countries, studies on the incidence of cleft lip and palate are not widely available. A 10-year retrospective study was carried out to determine the incidence of cleft lip and palate at the Autonomous University of Nuevo Leon's University Hospital. The study included data from patients who attended the plastic surgery outpatient clinic from January 1990 to December 1999. The author reviewed 10,843 files from which 376 patients were selected to identify the following variables: time of the year in which the first consultation took place, gender, birthplace, type of cleft, age of both parents, and medications taken during pregnancy. The highest incidence was found in patients aged 1 to 6 months. Ninety-four patients had a primary palate cleft; 76 had a secondary palate cleft; and 206 had primary and secondary palate clefts. The gender distribution of the 206 patients with primary and secondary clefts was 127 boys and 79 girls. The mean parent age was 29.5 years (father) and 25.7 years (mother). The incidence of cleft lip and palate in the cited hospital was 1.1:1000 births. Clefts of the left side occurred more often than of the right. Boys were affected more commonly than girls.     

Incidence of facial clefts in Cambridge, United Kingdom

The aim of this study was to determine the incidence of facial clefting in Cambridge, UK, using multiple resources of ascertainment and to relate the findings to antenatal ultrasound screening (AUS) detection rates. AUS records from an obstetric ultrasound department, post-natal records from the regional craniofacial unit, and autopsy reports of foetuses over 16 weeks' gestational age from a regional pathology department from 1993 to 1997 were retrospectively reviewed. Cross-referencing between the three data sets identified all cases of facial clefts. Of 23,577 live and stillbirths, 30 had facial clefts. AUS detected 17 of these. Sixteen of the 30 had isolated facial clefts. Others had associated anomalies, chromosomal defects, or syndromes. Percentages and confidence intervals were calculated from the above data. Twenty-one resulted in live births, seven terminations, and two foetal deaths. Overall, detection rate by AUS was 65 percent [67 percent isolated cleft lip, 93 per cent cleft lip and palate (CLP), and 22 percent isolated cleft palate], with no false positives. The incidence of facial clefts was 0.127 percent (95 percent confidence interval 0.089-0.182 percent); the incidence for isolated CLP was lower than previously reported: 0.067 percent (0.042-0.110 percent). With one exception, all terminations were in foetuses with multiple anomalies. The figures presented will enable joint CLP clinics to give parents information of termination rates. The study allows pre-pregnancy counselling of families previously affected by clefting about the reliability of AUS detection rates.     

Prevalence of nonsyndromic oral clefts in a reference hospital in the state of Minas Gerais, Brazil, between 2000-2005

The aim of the present study was to analyze the prevalence of nonsyndromic oral clefts in children receiving treatment at the Center for the Rehabilitation of Craniofacial Anomalies, José do Rosário Vellano University, Alfenas, MG, Brazil. All the data for the epidemiological study was retrieved from the files of 126 pediatric patients with oral clefts without any additional malformation, who came to the center for treatment between 2000 and 2005. A predominance of clefts was observed in Caucasians, and the ratio of male to female was 1.3. Males were 2.57 times more affected by cleft lip and palate (CLP) than females. CLP with a prevalence of 39.68% and isolated cleft lip (CL) with a prevalence of 38.09% were the most common anomalies, followed by isolated cleft palate (CP; 22.23%). Complete and unilateral CLP (26.19%) presented the highest prevalence, followed by incomplete and unilateral CL (23.81%). The present study presents the experience of a reference hospital in the state of Minas Gerais; however, the real prevalence of oral clefts in Brazil is still unknown. Our findings differ from those of a few previous Brazilian reports because they suggest similar prevalences of CLP and CL, and a higher prevalence of CLP in Caucasian males.