A prospective, longitudinal study of feeding skills in a cohort of babies with cleft conditions.

OBJECTIVE: To examine the natural history of feeding skills in babies with clefts and identify risk factors and predictors of poor feeding. PARTICIPANTS: Sixty-two babies with clefts were examined at 2 weeks, 3 months, and 14 months of age. MAIN OUTCOME MEASURES: Feeding ability, oral motor function, and feeding efficiency were assessed. Univariate analyses were used to determine whether oral motor function and sequelae varied according to feeding ability or cleft condition. Multivariable logistic regressions were used to determine risk factors for poor feeding. RESULTS: Poor feeding skills were detected in one third of newborns. The prevalence of poor feeding reduced to 19% at 3 months of age and 15% at 14 months of age. Oral motor dysfunction and sequelae (particularly nasal regurgitation) were more commonly observed in babies with poor feeding skills irrespective of comorbidity. The main risk factor for poor feeding was a diagnosis of syndrome or Pierre Robin sequence (PRS). At 2 weeks of age, babies with syndrome or PRS were 15 times more likely to have poor feeding skills than their nonsyndromic counterparts. When syndrome or PRS was controlled for, babies with cleft palate and cleft lip and palate were equally likely to have poor feeding skills. Parental report of feeding efficiency was predictive of poor feeding in young babies. CONCLUSIONS: Poor feeding skills are relatively common in newborns with cleft palate and cleft lip and palate. Treatment for feeding problems may be needed beyond the first year of life, especially for babies born with PRS or a syndrome.     

The impact of cleft type on early vocal development in babies with cleft palate.

OBJECTIVE: The purpose of the present investigation was to examine the impact of cleft type on early sound development in children with cleft palate (with or without cleft lip). PARTICIPANTS: The participants included 53 babies with unrepaired cleft palate aged 8 to 10 months. Thirty-five babies had cleft lip and palate (CLP) and 18 had cleft palate only (CPO). MAIN OUTCOME MEASURES: Spontaneous vocalizations of the CLP and CPO groups were compared to determine whether differences were evident in canonical babbling, size of consonant inventory as well as place and manner of consonant production, and frequency of vocalization. RESULTS: Student's t tests revealed no significant differences between the groups in canonical babbling, size of consonant inventory, place and manner of consonant production, or frequency of vocalization. However, there was a trend for babies in the CPO group to produce fewer compensatory stop consonants and more anterior place features. In addition, a larger percentage of children in the CPO group had entered the canonical babbling stage at the time of this study. CONCLUSIONS: In general, the findings of this study suggested that cleft type does not appear to play a significant role in early consonant development for babies with cleft palate. Additional study using a larger CPO group is recommended to further investigate the trend toward better performance noted in this group.     

Breast-feeding and sugar intake in babies with cleft lip and palate.

OBJECTIVE: To investigate the pattern of breast-feeding and sugar intake among babies with cleft lip and palate. PARTICIPANTS: Caretakers of 200 babies with cleft lip and palate enrolled at the Hospital for Rehabilitation of Craniofacial Anomalies, University of S?o Paulo, Bauru, Brazil. RESULTS: A low prevalence of breast-feeding was found. The most reported reason was the sucking inability of the baby. Complete cleft lip and palate was the primary cause affecting sucking. The first contact with sugar occurred mainly through the baby bottle with milk during the first month of life. For nutritional supplement, the children were given sugar and fruit juices in the bottle. CONCLUSIONS: It was observed that dietary habits in babies with cleft lip and palate are more risky. This highlights the role played by early education and constant oral hygiene follow-up for prevention in these patients.     

The impact of early palatal obturation on consonant development in babies with unrepaired cleft palate.

OBJECTIVE: The purpose of this investigation was to determine whether palatal obturators enhance consonant development during babbling for babies with unrepaired cleft palate. PARTICIPANTS: Fourteen babies with cleft palate who had worn anterior palatal obturators prior to palatal surgery were matched to 14 unobturated babies according to cleft type, sex, and age at time of presurgical evaluation. MAIN OUTCOME MEASURES: Spontaneous vocalizations of the obturated and unobturated groups were compared to determine whether differences were evident in size of consonant inventory as well as place and manner of consonant production. RESULTS: Paired t tests revealed no significant differences between the groups in size of consonant inventory or place and manner of consonant production. There was a trend for babies in the obturated group to produce more glottal consonants. CONCLUSIONS: In general, the findings of this study suggested that palatal obturators do not appear to facilitate production of anterior palatal consonants during babbling.     

Sucking efficiency of early orthopaedic plate and teats in infants with cleft lip and palate

Intraoral negative pressure during bottle feeding with two kinds of teats (a regular Nuk and a cleft Nuk) was measured in 7 infants with cleft lip and palate, 8 infants with cleft palate, 2 infants with cleft lip, 4 infants with operated cleft lip and palate and 7 normal infants. Infants with cleft lip and palate or cleft palate were unable to generate negative pressure before cleft lip and palate closure. The presence or absence of an early orthopaedic plate did not make any difference. In infants with unoperated cleft lip and with operated cleft lip and palate, peak negative pressure during feeding differed little from that of normal infants.     

Incidence of cleft lip and cleft palate in 39,696 Japanese babies born during 1983

To estimate the incidence of cleft lip and/or cleft palate among the Japanese, 39,696 Japanese babies born during the period from January 1, 1983 to December 31, 1983, were investigated. It was found that 65 babies (0.163%) had these abnormalities, and that the ratio of the birth of such babies was approximately one per 611 in the population. Of the 65 affected babies, 41.3% presented cleft lip (CL), 46.0% cleft lip and palate (CL/P), and 12.7% cleft palate (CP). These results suggest that the incidence of CL/P in the Japanese is higher than that observed among other races.     

Dental and prosthodontic care for patients with cleft or craniofacial conditions.

Prosthodontic treatment has a long and rich history in the care of patients with cleft lip and palate. Because of increased knowledge of craniofacial growth and development and improved surgical and orthodontic treatment, today's cleft patients receive better care and in less time. This requires less prosthetic intervention. Still, prosthetics retains an important, if somewhat diminished, place in cleft care, and the prosthodontist remains an integral member of the cleft/craniofacial habilitation team. This review presents the current state of the art in dental/prosthodontic care for patients with cleft palate and related craniofacial anomalies.     

Syndromes with cleft lip and cleft palate.

A series of tables is presented as a diagnostic aid for the clinician when he confronts a patient who has a cleft lip and/or palate, together with associated anomalies. The tables provide a rapid way of sorting through the recognized syndromes with orofacial clefting in search of a possible overall diagnosis. Today, 154 such syndromes are recognized. This is more than twice as many as were known in 1971. Undoubtedly, many new syndromes with orofacial clefting will be delineated in the future.     

Periodontal conditions in adult patients with cleft lip, alveolus, and palate.

The present study assessed the progression rate of periodontal disease over 8 years in a group of 52 adult patients with various forms of cleft lip, alveolus, and palate considered at risk for progression of periodontal disease. Of special interest was the evaluation of periodontal disease progression at sites adjacent to cleft regions compared to changes found at control sites not directly affected by such defects. High incidences of generalized plaque accumulation and bleeding on probing were noted at both examinations in 1979 and 1987. A mean apical shift of the clinical attachment level amounting to 0.2 mm had occurred over the 8-year observation period. A slight apical displacement of the mesial and distal mean crestal alveolar bone was also noted. The rate of progression of periodontal disease over the 8 years was not found to be different at statistically significant levels at cleft sites compared to control sites. However, the results of this study documented that the cumulative periodontal destruction at 26 to 28 years of age was statistically significant and more pronounced at cleft sites as revealed by greater probing pocket depth and loss of clinical attachment. The differences between test and control sites amounted to 0.3 and 0.4 mm respectively for probing depth and 0.6 mm for loss of clinical attachment. In addition, the discrepancy between alveolar bone height and the levels of the clinical attachment at cleft sites demonstrated the presence of a long supracrestal connective tissue attachment adjacent to cleft defects. Therefore, the alveolar bone height as visualized in radiographs at such sites was considered an unreliable diagnostic tool for the assessment of the degree of periodontal destruction.     

Incidence of cleft lip or palate in 303738 Japanese babies born between 1994 and 1995

To investigate the incidence of cleft lip or palate or both (CLP) in Japan, 303738 babies born in 1532 institutions between 1994 and 1995 were examined and 437 (0.14%) were found to have abnormalities. Of these babies, 32.1% had cleft lip, 43.3% had cleft lip and palate, and 24.8% had cleft palate (Table 2). These results show that the incidence of cleft lip and palate has declined compared with the period from 1981 to 1982.     

Craniofacial variability in parents of children with cleft lip and cleft palate.

The purpose of this study was to determine whether there are variations in the craniofacial morphology between parents of children with non-syndromic cleft lip and palate and normal controls with no history of cleft in the families in a Saudi sample. Frontal skull radiographs were obtained from a study group consisting of 40 couples, who have a child with cleft deformity and control group of 32 males and 35 females, who have no history of clefts in the family. A total of 18 landmarks were digitized for each individual by a custom made computer program. T-test, logistic regression analysis were applied to the data. Significant findings were obtained for both males and females of the affected children. The males displayed wider nasal cavity and a narrower maxillary width with asymmetry of the face. Females showed smaller facial dimension as a whole, and asymmetry of the face.     

Bilateral asymmetry in Chinese families with cleft lip with or without cleft palate.

OBJECTIVE: To determine if Chinese individuals with nonsyndromic cleft lip with or without cleft palate (CL/P) display more bilateral asymmetry than do their unaffected relatives. DESIGN/SUBJECTS: A case-control study of 313 individuals with CL/P from Shanghai, China, with 201 unaffected relatives as controls. METHODS: Size-adjusted asymmetry scores were defined by data on middle-finger length, palm length, palpebral fissure width, and ear length. Case-control comparisons used a multivariate repeated measures analysis of variance, paired t tests, and the Wilcoxon signed rank test. RESULTS: The ear-length measure showed a significant increase in fluctuating asymmetry (FA) in individuals with CL/P compared with their unaffected relatives, which was most pronounced in the female cleft lip and palate subgroup (p = .04). No other measures showed any increase in FA. CONCLUSION: Evidence was found for increased FA, as measured by overall ear length, in Chinese individuals with nonsyndromic CL/P, compared with their unaffected family members. The use of bilateral measurements other than dermatoglyphics may prove to be a valuable means of assessing overall developmental stability in individuals with developmental malformations and in their families.     

A videoradiographic investigation of the position of the tongue prior to palatal repair in babies with cleft lip and palate

Lateral videoradiography was carried out on nine babies, seven with clefts and two without, at rest and while feeding with a barium mixture. No discernible difference was found in tongue movement or position between the cleft and noncleft babies, nor did the presence or absence of a presurgical plate make any difference.     

Human tooth-size asymmetry in cleft lip with or without cleft palate.

Failure of corresponding teeth on the right and left sides to form as exact mirror images of each other is an expression of imprecise developmental control. Levels of tooth-size asymmetry can therefore be used to quantify developmental instability in different regions of the dentition. Mesiodistal and buccolingual diameters of deciduous and permanent teeth were measured to the nearest 0.1 mm on serial plaster models of 77 patients with cleft lip with or without a cleft of the palate, and 63 control non-cleft orthodontic patients. In the cleft group as a whole, there were abnormally high levels of tooth-size asymmetry but, although most marked in the upper lateral incisor region, these were neither restricted to the vicinity of the cleft nor to the upper jaw. Thus, in addition to major local disturbances related to the malformation itself, it appears that tooth-size asymmetry results from a generally high level of developmental instability throughout cleft lip/palate dentitions. This generalized developmental instability may be to some extent under genetic control, as cases with positive family histories showed some signs of greater asymmetry than those with negative family histories.     

A left transverse facial cleft with a median cleft of the lower jaw.

OBJECTIVE: A 13-day-old girl with a left transverse facial cleft and a median defect of the lower jaw is reported in detail. Left macrostomia was repaired using a W-plasty technique, and preauricular appendages were excised. The median defect of the mandible demonstrated by computed tomography scan on the first examination had disappeared at 1 year of age. CONCLUSION: Congenital clefts of the mandible can fuse at a later stage; thus, it is necessary to wait to treat the mandibular defect until the infant is slightly older.     

Oral health of individuals with cleft lip, cleft palate, or both.

OBJECTIVE: To evaluate the oral health of children with cleft lip and palate. DESIGN: DMFT (dmft) and DMFS (dmfs) were calculated on the basis of visual examination. Periodontal disease was assessed by classical clinical parameters: volume gain, bleeding, probing depth, loss of insertion, gingival recession. and calculus. PATIENTS: Seventy-eight individuals aged 1 to 32 years took part in the study. RESULTS: The dmft was 2.91 (+/- 3.99) in the 1- to 5-year-old age group and 2.77 (+/- 3.15) in the 6- to 12-year-old group. The DMFT averages for the age groups of 6 to 12 years, 13 to 18 years, and 19 to 32 years were 1.87 (+/- 1.78), 6.46 (+/- 3.11), and 13.62 (+/- 6.51), respectively. A total of 5.3% of individuals presented a healthy periodontium, and 86.6% presented with gingivitis and 8% presented with periodontitis. CONCLUSIONS: The dental and periodontal condition of individuals with cleft lip and palate was similar to the general population in the region in which this study was conducted. Good preventive measures should result in improved oral health similar to the general population and should be emphasized.     

Nasal deformity and microform cleft lip in parents of patients with cleft lip.

OBJECTIVE: To describe subtle nasal deformities and microform cleft lips in parents whose children have complete cleft lip deformities. DESIGN: Clinical analyses of three parents whose children had complete cleft lips. Subtle nasal deformities and microform cleft lips were identified. SETTING: An institutional general hospital: Manuel Gea González Cleft Lip and Palate Clinic in Mexico City, Mexico. PATIENTS: The study first examined the parents of all complete and incomplete cleft lip-palate patients who were seen from March 1994 to February 1997 by the authors (n = 1000). We identified three patients, each of whom had one parent who showed signs of subtle nasal deformity and microform cleft lip. INTERVENTIONS: None for the parents. Interventions in the children with cleft lips and palates were known. MAIN OUTCOME MEASURES: Qualitative photographic analyses were performed. Nostril symmetry, septal deviation, nasal floor position, and orbicularis oris malinsertions were carefully examined. RESULTS: Three of the evaluated parents had one alar cartilage caudally displaced and a deviated septum. One parent's nasal floor was depressed. Two parents also had evidence of a minimal orbicularis oris muscle fissure located in the upper lip. CONCLUSION: Genetic evaluations of children with complete and incomplete cleft lips might also include thorough evaluation of their parents. Although small in size, this study of three case histories identified nasal and lip deformities in the patients' parents.