Evaluation of cleft lip and palate management in Erbil
Keywords:Cleft lip, Cleft palate, Palatal fistula
AbstractBackground and Objectives: Cleft lip and palate are congenital deformities that affect the primary and secondary palates during embryogenesis. The objectives of this study was to record the pattern of presentation of cleft lip and palate in Erbil, the types of surgical procedures, the outcome and complications, hence making recommendations to ensure improved care. Methods: This is a prospective study conducted in Erbil city, in the Department of Plastic Surgery at Rezgary Teaching Hospital and Rapareen Pediatric Hospital from March 2009 to May 2013. A total of 164 patients with cleft lip/palate were included in this study. Statistical package for the social sciences (version 18) was used for data entry and analysis. Results: The age ranged from birth to 24 years. The ratio of male to female was 1.4: 1. The combined cleft lip and palate was the commonest type (87 cases, 53%). The commonest risk factor was poor family (105 cases, 64%), followed by consanguinity (97 cases, 59%). The commonest procedure for cleft lip repair was Millard (67 cases) and that for cleft palate repair was Furlow palatoplasty (57 cases). The commonest complication of cleft lip repair was wide scar (9 cases, 7.5%) mostly below one year of age. Ninety-one percent of the parents were satisfied with the children’s appearance of the lip and 86% of parents were satisfied with palatoplasty result. Conclusion: The high degree of association of consanguinity with the cleft lip and palate emphasizes the importance of education about discouraging consanguineous marriage. Millard repair is still the commonest procedure for cleft lip repair.
Olasoji O, Ukiri E, Yahaya A. Incidence and aetiology of oral clefts: a review. Afr J Med Sci 2005; 34:1–7.
Flora L, Margareta B, Ricky W. A multidisciplinary team approach on cleft lip and palate management. Hong Kong Dent J 2007; 4:38-45.
Hopper R, Cutting C, Grayson B. Cleft lip and palate. Charles Thorn. Grabb and Smiths Plastic surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. P.201-25.
Molina S, Vico Y, Iglesias L, Mendoza M, Reina S. Current concepts on the effect of environmental factors on cleft lip and palate. Int J Oral Maxillofac Surg 2013; 42:177–84.
Hodges A. Combined early cleft lip and palate repair in children under 10 months, a series of 106 patients. JPRAS 2010; 63:1813-9.
Noordhoff S, Chen P. Unilateral chieloplasty. Mathes S. Mathes plastic surgery. 2nd ed. Philadelphia, Saunders- Elsevier; 2006. P. 176-87.
Sadove M, Van A, Culp A. Cleft palate repair: art and issues. Clin Plastic Surg 2004; 31:231-41.
Yamanishi T, Nishio J, Kohara H, Hirano H, Sako M, Yamanishi Y, et al. Effect on maxillary arch development of early 2-stage palatoplasty by modified Furlow technique and conventional 1-stage palatoplasty in children with complete unilateral cleft lip and palate. J Oral Maxillofac Surg 2009; 67:2210-6.
Posnick C. Cleft lip and palate: infancy through adolescence. Posnick C. Craniofacial and maxillofacial surgery in children and young adults. 1st ed. Philadelphia, Saunders; 2000..P..50-62.
Bellis H, Wohlgemuth B. The incidence of cleft lip and palate deformities in the south-east of Scotland. Br J Orthod 1999; 26:121-5.
McLeod M, Urioste L, Saeed R. Birth prevalence of cleft lip and palate in Sucre, Bolivia. Cleft Palate Craniofac J 2004; 41:195–8.
Spritz A, Arnold D, Buonocore S. Distribution of orofacial clefts and frequent occurrence of an unusual cleft variant in the Rift Valley of Kenya. Cleft Palate Craniofac J 2007; 44:374-7.
Andrews M, Johnston D, Fletcher J. Cleft lip with or without cleft palate: effect of family history on reproductive planning, surgical timing, and parental stress. Cleft Palate Craniofac J 1998; 35:52-7.
Mohammad E, Ian J, Omer E, Ayesha K, Fatima M, Gul T. Epidimiology of cleftlip and cleft palate in Pakistan. Plast Reconstr Surg J 2004; 113(6):1548-55.
Ravichandran K, Shoukri M, Aljohar A, Shazia S, Al-Twaijri Y, Al Jarba I. Consanguinity and occurrence of cleft lip/palate: a hospital-based registry study in Riyadh. Am J Med Genet A 2012; 158A:541-6.
Aziza A, Kandasamy R, Shazia S. Pattern of craniofacial anomalies seen in a tertiary care hospital in Saudi Arabia. Ann Saudi Med 2011; 31:488-93.
Khan M, Ullah H, Naz S, Ullah T, Khan H, Tahir M. Pattern of cleft lip and cleft palate in Northern Pakistan. Arch Clin Exp Surg 2012; 1(2):63-70
Johnson Y, Little J. Folate intake, markers of folate status and oral clefts: is the evidence converging? Int J Epidemiol 2008; 37: 1041–58.
Botto D, Erickson D, Mulinare J, Lynberg C, Liu Y. Maternal fever, multivitamin use, and selected birth defects: evidence of interaction? Epidemiology 2002; 13:485-8.
Habib Z. Factors determining occurrence of cleft lip cleft palate. Surg Gynecol Obstet 1978; 146:105-10.
Harville E, Wilcox A, Lie R. Epidemiology of cleft palate alone and cleft palate with accompanying defects. Eur J Epidemiol 2007; 22:389-95.
Santiago P, Grayson B, Cutting C. Reduced need for alveolar bone grafting by presurgical orthopedics and gingivoperiosteoplasty. Cleft Palate Craniofac J 1998; 1:35.
Bongaarts A, Prahl B, Bronkhorst M. Effect of infant orthopedics on facial appearance of toddlers with complete unilateral cleft lip and palate (Dutchcleft). Cleft palate craniofac J 2008; 45(4):407-13.
Slade P, Emerson J, Freedlander E. A longitudinal comparison of the psychological impact on mothers of neonatal and 3 month repair of cleft lip. Br J Plast Surg 1999; 52(1):1-5.
Mcheik N, Sfalli P, Bondonny M. Early repair for infants with cleft lip and nose. Int J Pediatr Otorhinolaryngol 2006; 70(10):1785–90.
Goodacre E, Hentges F, Moss L. Does repairing a cleft lip neonatally have any effect on the longer-term attractiveness of the repair? Cleft Palate Craniofac J 2004; 41(6):603–8.
Chapman L, Hardin A, Goldstein A. Timing of palatal surgery and speech outcome. Cleft Palate Craniofac J 2008; 45(3):297.
Pigott W, Albery H, Hathorn S. A comparison of three methods of repairing the hard palate. Cleft Palate Craniofac J 2002; 39:383.
Salyer E, Sng W, Sperry E. Two-flap palatoplasty: 20-year experience and evolution of a surgical technique. Plast Reconstr Surg 2006; 118:193.
Williams N, Seagle B, Nackashi J. Amethodology report of a randomized prospective trial to assess velopharyngeal function for speech following palatal surgery. Control Clin Trials 1998; 19:297.
Helling R, Dev R, Garza J. Low fistula rate in palatal clefts closed with the Furlow technique using decellularized dermis. PRS 2006;117(7): 2361–5.
Noorchashm N, Duda R, Ford M. Conversion Furlow palatoplasty: salvage of speech after straight-line palatoplasty and incomplete intravelarveloplasty. Ann Plast Surg 2006; 56:505.
Anke L, Evelien D, Dorte B, Andrew H, George G. Parental satisfaction in Ugandan children with cleft lip and palate following synchronous lip and palatal repair. J Commu Disorders; 2013 (In press).
Munz S, Edwards S, Inglehart M. Oral health-related quality of life, and satisfaction with treatment and treatment outcomes of adolescents/young adults with cleft lip/palate: an exploration. Int J Oral Maxillofac Surg 2011; 40:790-6.
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