The nature of feeding in infants with unrepaired cleft lip and/or palate compared with healthy noncleft infants.

OBJECTIVE: Feeding difficulties are reported widely in infants with cleft lip and/ or palate. There is, however, a paucity of objective information about the feeding patterns of these infants. This study compared patterns of feeding in infants with unrepaired cleft lip and palate with healthy noncleft infants of a similar age. SETTING: North Thames Regional Cleft Centre. The noncleft cohort was recruited from West Middlesex University Hospital, a general hospital with similar demographics. PARTICIPANTS: Fifty newborn infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate who were referred to the North Thames Regional Cleft Centre participated. Parents of 20 randomly selected, noncleft infants agreed to participate. MAIN OUTCOME MEASURES: Feeding patterns were rated using the Neonatal Oral Motor Assessment Scale. Additional objective information was collected using the Great Ormond Street Measurement of Infant Feeding (Masarei et al., 2001; Masarei, 2003). RESULTS: Infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate had less efficient sucking patterns than their noncleft peers had. They used shorter sucks (mean difference, 0.30 second; p < .0005), a faster rate of sucking (mean difference, 34.20 sucks/second; p < .0005), higher suck-swallow ratios (mean difference, 1.87 sucks/swallow; p < .0005), and a greater proportion of intraoral positive pressure generation (mean difference, 45.97% positive pressure; p < .0005). CONCLUSIONS: This study demonstrated that the sucking patterns of infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate differ from those of their noncleft peers.     

A randomized control trial investigating the effect of presurgical orthopedics on feeding in infants with cleft lip and/or palate.

OBJECTIVE: To investigate the controversial assertion that presurgical orthopedics (PSO) facilitate feeding in infants with cleft lip and palate. DESIGN: Randomized control trial of 34 infants with nonsyndromic complete unilateral cleft lip and palate and 16 with cleft of the soft and at least two thirds of the hard palate. Allocation to receive presurgical orthopedics or not used minimization for parity and gender. Other aspects of care were standardized. SETTING: The North Thames Regional Cleft Centre. MAIN OUTCOME MEASURES: Measurements were made at 3 months of age (presurgery) and at 12 months of age (postsurgery). Primary outcomes were anthropometry and oral motor skills. Objective measures of sucking also were collected at 3 months using the Great Ormond Street Measure of Infant Feeding. Twenty-one infants also had videofluoroscopic assessment. RESULTS: At 1 year, all infants had normal oral motor skills and no clear pattern of anthropometric differences emerged. For both cleft groups, infants randomized to presurgical orthopedics were, on average, shorter. The presurgical orthopedics infants were, on average, lighter in the unilateral cleft and lip palate group, but heavier in the isolated cleft palate group. Infants with complete unilateral cleft and lip palate randomized to presurgical orthopedics had lower average body mass index (mean difference PSO-No PSO: -0.45 (95% confidence interval [-1.78, 0.88]), this trend was reversed among infants with isolated cleft palates (mean difference PSO-No PSO: 1.98 [-0.95, 4.91]). None of the differences were statistically significant at either age. CONCLUSIONS: Presurgical orthopedics did not improve feeding efficiency or general body growth within the first year in either group of infants.     

Feeding infants with cleft lip, cleft palate, or cleft lip and palate

In assessing 143 infants with cleft lip and palate, we found feeding problems to vary with the patients' anatomic lesion. Effective feeding techniques were identified by first assessing the infant's ability to generate negative intraoral pressure and to move the tongue against the nipple and then by matching these deficits to appropriate feeding devices.     

Immediate unrestricted feeding of infants following cleft lip and palate repair.

Postoperative feeding regimens after cleft lip and palate repair continue to be a controversial issue. This study was designed to test the feasibility of immediate unrestricted feeding after lip and palate closure with attention to operative outcome or complications. A retrospective analysis of two feeding protocols involved 80 infants with both unilateral and bilateral defects. Protocol A utilized tube and syringe feedings, and protocol B utilized unrestricted bottle or breast feedings. There were no instances of lip or palate wound complications in the unrestricted group. We conclude that immediate unrestricted feeding may be instituted safely, thus improving and simplifying postoperative management after cleft lip and/or palate repair.     

Management of an infant with cleft lip and palate with phocomelia in dental practice

Cleft lip and palate is a severe birth defect occurring approximately one in 800-1000 newborn infants. The incidence varies widely among races. Cleft lip and palate together account for approximately 50% of all cases whereas isolated cleft lip and isolated cleft palate occur in about 25% of cases. Many of these congenital anomalies appear to be genetically determined though the majority are of unknown causes or teratogenic influences. Presented here is a 3 day old infant with bilateral cleft lip and palate and phocomelia for whom a feeding obturator was made and delivered to facilitate feeding.     

Antenatal transabdominal ultrasound detection of cleft lip and palate in Western Australia from 1996 to 2003.

OBJECTIVE: To determine the frequency of detection of cleft lip with or without cleft palate and isolated cleft palate from antenatal ultrasound examinations conducted on mothers of infants born with cleft lip and/or palate and isolated cleft palate in Western Australia from 1996 to 2003. DESIGN: Review of patient records and purpose-designed questionnaire sent to parents of children born with cleft lip and/or palate and isolated cleft palate. RESULTS: There were 308 infants born with cleft lip and/or palate and isolated cleft palate in the study period. Of the 293 parents, 218 responses were available for the study (70.7%), and 2.9 +/- 1.8 SD antenatal ultrasound scans were performed on 216 women. No such scans were performed on two women. Cleft lip and/or palate was detected in 22.2% of cases. There was no detection prior to 15 weeks gestational age in the 137 women screened. Between 15 and 19 weeks gestational age, 174 scans detected 30 cases. Between 20 and 29 weeks gestational age, 84 scans detected 11 cases. Between 30 and 40 weeks gestational age, 66 scans detected 7 cases. The detection rate for bilateral cleft lip and/or palate was 44.4% and for unilateral cleft lip and/or palate, 40.6%. Detection rate for isolated cleft lip was 33.3%. Antenatal ultrasound failed to detect any infants with an isolated cleft palate (n = 95). The rate of detection of cleft lip and/or palate increased through the study period. CONCLUSIONS: The rate of detection of cleft lip and/or palate in Western Australia is comparable to that for referral centers worldwide and is increasing. The rate of detection of the various types of cleft anomalies using antenatal ultrasound ranged from 0% to 44%.     

唇腭裂患儿高级听觉中枢的MRI形态学研究

目的:通过对2岁以下唇腭裂患儿采用磁共振成像(MRI)的形态学研究方法,调查低龄唇腭裂患儿高级听觉中枢可能的结构异常。方法:选取6月～2岁唇腭裂患儿18例及年龄相匹配的正常对照组婴儿18例,分别在1.5T磁共振成像仪上扫描采集脑结构数据,运用FreeSurfer软件重建脑结构并对各部分进行测量,对2组数据采用多元协方差分析方法,进行组间比较。结果:唇腭裂组患儿的左侧大脑灰质、左侧丘脑和左侧颞上平面(听觉皮层所在区域)的体积显著小于正常对照组,左侧颞上平面的厚度也显著低于正常对照组。右侧大脑半球、右侧丘脑及脑干的体积与正常对照组无显著性差异。结论:唇腭裂患儿的高级听觉中枢可能有异于正常儿童。这种异常也许构成了其中枢性听觉处理障碍(APD)的神经生物学基础。     

Dentocraniofacial morphology of 21 patients with unilateral cleft lip and palate: a cephalometric study.

OBJECTIVE: To assess the skeletal and dental craniofacial proportions of unilateral cleft lip and palate patients who were operated upon using the Malek technique, and compare them with a normal group to highlight the effect of surgical correction on craniofacial development during growth. DESIGN: Retrospective. METHODS: The cleft palate was closed using the Malek technique in a single operation at 3 months for 11 patients (complete closure of lip and palate) and in a two-stage operation for 10 patients (soft palate at 3 months, lip and hard palate at 6 months). Comparisons were made with a normal control group. Angular and linear measurements of anterior and posterior dimensions of the upper and lower compartments of the face were measured in the 7th and 12th years. RESULTS AND CONCLUSION: No significant differences were observed between the two groups of palate technique repair, although significant differences were observed between craniofacial dimensions of normal versus cleft lip and palate patients. At a skeletal level, the maxilla and mandible were retrusive relative to the cranial base in the cleft lip and palate group. In fact, there was a backward rotation of the palatal plane with repercussions on the maxillo-mandibular complex position. Furthermore, the maxilla was shorter than in normal patients, whereas the mandible was normally shaped. The upper incisors were retroclined and they locked the lower incisors in linguoversion. There was a posterior skeletal deficit of the respiratory compartment, compensated by more marked posterior maxillary alveolar growth. Facial growth in cleft lip and palate patients followed the same pattern, but was delayed compared with normal patients.     

基于圆形分布法的广东省唇腭裂患儿受孕月份分析

目的探讨广东省唇腭裂患儿受孕月份的分布规律。 方法以2016—2017年在广东省范围内有产科资质的医疗机构内分娩的围产儿（孕28周至出生后7 d）及产妇为研究对象,将唇腭裂患儿受孕统计年度看成1个圆周,用圆形分布法对其中的先天性唇腭裂患儿的受孕时间进行聚集性分析。 结果2016—2017年广东省共监测围产儿3 748 435例,检出唇腭裂患儿5591例,其中男性患儿3137例、女性患儿2309例、性别不明或两性畸形患儿145例,排除性别不明患儿共包括唇裂1368例、腭裂913例、唇裂合并腭裂3165例。唇腭裂患儿的受孕高峰有时间聚集性（平均角 = 67.33,P<0.001）,唇腭裂患儿的受孕高峰在3月上旬。其中单纯唇裂和唇裂合并腭裂的受孕高峰时间分别是2月下旬和3月中旬,为春季;单纯腭裂的受孕高峰时间差异无统计学意义。女性唇腭裂患儿的受孕时间存在高峰,为3月份,男性患儿的受孕时间差异无统计学意义。 结论广东省唇腭裂患儿的受孕高峰有时间聚集性,单纯唇裂和唇裂合并腭裂与单纯腭裂可能有不同病因构成,女性患儿的发病更受到季节性影响,春季应加强预防唇腭裂危险因素的暴露。     

唇腭裂对低龄患儿听力影响的研究

目的：通过对2岁以下唇腭裂患儿进行术前耳科检查和听力测试,调查低龄唇腭裂患儿听力损伤的患病率。方法：选取2月-2岁唇腭裂患儿73例,分为单纯唇裂组、不完全腭裂组及完全腭裂组,术前进行耳镜检查、鼓室图、耳声发射（OAE）、听性脑干反应（ABR）等检查,并选择年龄相匹配的正常儿童61例作为对照组,进行组间比较。结果：单纯唇裂组、不完全腭裂组、完全腭裂组及正常对照组分别有18.2%、87.5%、96.3%、18.0%发生鼓膜异常,分别有9.1%、89.6%、96.3%、6.6%出现异常鼓室图,分别有34.1%、79.2%、98.1%、32.0%有OAE测试不通过,分别有6.8%、93.8%、98.1%、3.3%有ABR听阈异常。两个腭裂组在各项检查中的异常率均在统计学上显著高于单纯唇裂组和正常对照组,其中耳镜检查、鼓室图及ABR听阈检查两个腭裂组间无统计学差异。结论：低龄唇腭裂患儿听力损伤患病率较高,听力损伤与腭裂密切相关,但与腭裂类型无关。     

Sucking performance of babies with cleft conditions.

OBJECTIVE: To describe the sucking performance of bottle-fed babies with cleft conditions. PARTICIPANTS: Forty 2-week-old-babies with cleft lip (CL; n = 8), cleft palate (CP; n = 22), and cleft lip and palate (CLP; n = 10) were examined. METHODS: Suction, compression, and other sucking parameters were measured during bottle-feeding and compared to determine if they varied with cleft condition or feeding ability. RESULTS: All babies with CL and one with CLP demonstrated suction. Thirteen of 22 babies with CP demonstrated suction but only three maintained regular pressure changes over time. Between-group differences in the amplitude of suction and compression were associated with cleft condition. Cleft lip participants demonstrated the greatest amplitude of suction followed by those with CP and CLP. Cleft lip and CP participants generated similar amplitudes of compression. This was greater than their counterparts with CLP. Good feeders (n = 15) generated high levels of suction, while satisfactory (n = 15) and poor feeders (n = 10) did not generate any during bottle-feeding. CONCLUSION: Between-group differences in intra-oral pressures were confirmed when babies were examined by cleft condition. Babies with smaller clefts (i.e., CL or minor soft palate clefts) were more likely to generate normal levels of suction and compression compared to their counterparts with larger clefts. Since good feeders were more likely to have smaller clefts it was not surprising that they demonstrated higher suction pressures than babies with satisfactory or poor feeding ability. Compression values were not significantly different across the feeding ability groups. These data may inform feeding management strategies.     

新生儿完全性唇腭裂术前鼻撑和正畸治疗的临床观察

目的 观察新生儿完全性唇腭裂术前鼻撑和正畸治疗的效果。方法对38例完全性唇腭裂，通过模型测量矫治前后牙槽裂距的改变，观察治疗效果；用鼻外形的评价标准对术后患儿进行初步评价。结果经过108—152天的治疗，26例单侧完全性唇腭裂齿槽左右裂隙较矫治前平均缩小5．3mm，前后裂距较矫治前平均缩小3．5mm；鼻外形评价的优良率为76％。12例双侧完全性唇腭裂齿槽左侧裂隙平均缩小4．7mm，右侧裂隙平均缩小4．2mm，左右裂距平均扩大1．6mm，前后裂距平均缩小5．1mm，前牙槽突宽度平均增大1．2mm；鼻外形评价的优良率为66％。结论对完全性唇腭裂患者在新生儿期做术前鼻撑和正畸治疗，患儿易适应，有利鼻发育，可减小手术的难度，提高整复效果。     

Human prenatal nasal bone lengths: normal standards and length values in fetuses with cleft lip and cleft palate.

OBJECTIVE: The aim of this study was to present prenatal autopsy standards for nasal bone length in normal fetuses, as well as to compare nasal bone lengths in human fetuses with cleft lip and palate with those standards. MATERIAL AND METHODS: The material consisted of human fetuses investigated in connection with diagnosed and legally approved abortions and spontaneous abortions; 40 were normal and 26 had cleft lip and palate (7 isolated cleft lip, 12 isolated cleft palate, and 7 combined cleft lip and palate). Menstrual ages (MA) ranged from 12 to 25 weeks, crown-rump length (CRL) from 55 to 210 mm and foot length (FL) from 7 to 44 mm. All fetuses were radiographed in lateral projection, and, using these images, the nasal bone lengths were measured with a digital caliper. Regression analyses were performed. RESULTS: Standards for normal nasal bone length at different ages are expressed as menstrual age, crown-rump length, or foot length. Comparisons with normal standards showed that the isolated cleft lip group had a significantly smaller nasal bone length than the normal fetuses had. Fetuses with isolated cleft palate and fetuses with combined cleft lip and palate showed no significant deviation from normal standards. CONCLUSION: Normal nasal bone standards can contribute to information on deviations in nasal bone length for aborted fetuses with known and unknown genotypes. The differences in nasal bone lengths in fetuses with different lip and palate clefting can contribute to understanding the pathogenesis of cleft lip and palate.     

唇腭裂婴儿术前鼻牙槽骨塑形治疗后鼻孔、牙槽和腭部裂隙的变化

目的探讨鼻牙槽骨塑形器应用于完全性唇腭裂婴儿术前矫形的临床效果。方法通过对16例完全性唇腭裂婴儿进行术前鼻牙槽骨塑形矫治．记录治疗前后患侧鼻孔的宽度、高度,鼻小柱长度和上腭牙槽骨裂隙的变化,观察矫治效果。结果经过90～150d的治疗．9例双侧完全性唇腭裂婴儿和7例单侧完全性唇腭裂婴儿的鼻小柱长度和鼻孔宽度高度均有明显的改善．牙槽骨裂隙宽度和硬腭前部裂隙宽度均明显缩小。结论鼻牙槽塑形器能明显改善完全性唇腭裂婴儿的鼻翼和鼻小柱外观,减小牙槽骨和硬腭前部裂隙的宽度,有利于鼻部发育,减少手术难度,提高整复效果。     

The effect of preoperative use of an orthopedic plate on articulatory function in children with cleft lip and palate.

OBJECTIVE: To evaluate the effect of preoperative use of an orthopedic plate (OP) on postoperative articulatory function in children with cleft lip and palate. SUBJECTS: The subjects had complete unilateral or bilateral cleft lip and palate and were scheduled for a one-stage palatoplasty. MAIN OUTCOME MEASURES: Tongue movements during sucking were analyzed by ultrasonography. Postoperative articulatory behavior was also assessed at 5 years 4 months of age. RESULTS: There was an excessive downward excursion of the rear portion of the tongue during sucking regardless of the use or nonuse of the OP. This indicated that infants with cleft palate could not create negative pressure in the oral cavity, even with the OP. However, the OP appeared effective for preventing irregular movements of the tongue during sucking. The proportion of subjects obtaining excellent articulation was significantly higher in the group using the OP until palatoplasty than in the group who did not continue using the OP. The proportion of subjects with disturbed articulatory function in the latter group was comparable with that in the control group, who never used the OP. CONCLUSIONS: Continuous use of the OP up to the time of palatoplasty appeared to be effective for the postoperative articulatory function in children with complete cleft lip and palate. Inhibiting irregular movements of the tongue, the OP might assist in preventing "palatalized articulation."     

A three-dimensional computed tomographic analysis of the cervical spine in unoperated infants with cleft lip and palate.

OBJECTIVE: To investigate anatomical variations and abnormalities of cervical spine morphology in unoperated infants with cleft lip and palate. DESIGN: Retrospective cross-sectional investigation of infants born with nonsyndromic cleft lip and palate using computed tomography scans acquired for investigation of a spectrum of clinical conditions. SETTING: Computed tomography scan data were obtained from 29 unoperated cleft lip and palate infants and 12 noncleft infants of Malay origin, ages 0 to 12 months. METHODS: Observational study of cervical spine computed tomography scans. Heights of cervical vertebral bodies (C2-C7) and intervertebral spaces were measured from landmarks identified from computed tomography reformats and three-dimensional computed tomography reconstructions. Linear modeling of heights and spaces, with age as a covariate, was undertaken to identify differences between the samples. RESULTS: Anomalous features observed in the cleft lip and palate sample included short posterior arch of C1 (2/29), abnormal development of the anterior arch of C1 (2/29), and fusions of the posterior arch of C2 and C3 (2/29). No anomalies of the cervical spine were observed in the noncleft sample. Although the heights of three cervical vertebral bodies were significantly smaller and two intervertebral spaces were significantly larger in infants with cleft lip and palate compared with noncleft infants (p < .05), overall length of the cervical spine did not differ significantly between the samples. CONCLUSION: There was evidence for subtle upper spinal anomalies in the infant cleft lip and palate population. Our finding of reduced size of some cervical vertebral bodies may reflect delayed upper spinal development in infants with cleft lip and palate.     

Naso Alveolar Molding in Early Management of Cleft Lip and Palate

Cleft lip and palate is a congenital anomaly occurring at birth. This article describes about the construction of feeding plate which is also used for naso alveolar molding (NAM). The main objective of this treatment is that this procedure minimizes the extent of surgery that should be done on newborns. Two infants with unilateral and bilateral cleft lip and palate are treated by making feeding plate and which is also used for NAM. Both the infants had favorable results, better in case of unilateral cleft lip patient; we hope that it will minimize the extent of surgery and the resultant scarring.     

Mandibular morphology and spatial position in patients with clefts: intrinsic or iatrogenic?

Lateral cephalometric films of operated (Op) and non-operated (Nop) patients with cleft lip and alveolus, cleft lip and palate or cleft palate only, were compared to determine whether the shape or position of the mandible is affected by lip and/or palate surgery. The sample included 204 adult cleft patients, Caucasians of both sexes with one of the following three cleft types: complete unilateral lip and alveolus (n = 50), complete unilateral lip and palate (n = 68), and isolated palate (n = 86). The comparison involved 113 cleft patients operated at the conventional timing and 91 cleft patients who had received no surgical or orthodontic treatment. Comparison was done in order to ascertain if the surgery performed had had any influence upon mandibular growth. The results indicated that, in all three cleft types, the surgery did not induce significant changes in the mandibular growth.     

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.     

Structural birth defects associated with oral clefts in Hawaii, 1986 to 2001.

OBJECTIVE: To identify structural birth defects that occur in association with oral clefts. METHODS: Data were obtained from a birth defects registry and included all infants and fetuses with cleft palate without cleft lip or cleft lip with or without cleft palate delivered from 1986 to 2001. For 47 specific structural birth defects, rates among oral cleft cases were compared with the rates among all infants and fetuses with major birth defects, excluding those with oral clefts. RESULTS: Among cleft palate only cases, the rates were significantly higher than expected for encephalocele, microcephaly, and syndactyly. Among cases of cleft lip with or without cleft palate, the rates were significantly higher than expected for anophthalmia/microphthalmia, single ventricle, reduction deformity of upper limbs, and reduction deformity of lower limbs. When cases of cleft palate only and cleft lip with or without cleft palate were compared as to the rates for particular birth defects, the rates of the defects were either higher or lower than expected in both oral cleft categories for 38 (81%) of the defects. CONCLUSIONS: Certain birth defects were more frequently associated with oral clefts than might be expected. For the majority of defects, their patterns of association were similar between cleft palate without cleft lip and cleft lip with or without cleft palate.