Search

Highlights:1. Awareness of social stigma impact on children with cleft lip and palate is lacking in various areas.2. Identifying social stigma's influence on children with cleft lip is important to help surgeons prioritize resource allocation and provide further evidence in incorporating quality of life. Abstract:Social rejection still happens to a large number of children who have cleft lip and palate. Stigma has a detrimental impact on children with cleft in the aspects of education, employment, marriage, and community acceptance, which can be exacerbated by barriers to high-quality child care. A literature study related to this topic was conducted by searching for articles from 2018 to October 2021 through three databases (i.e., PubMed, Embase, and Medline). The term used for the literature search was "cleft", which generated results that were sorted alphabetically and by relevance. This yielded 15 articles that focused on social stigma’s influence on cleft lip and palate patients. In conclusion, the articles generally reported that the awareness of social stigma impacts on children with cleft lip and palate are lacking in various areas. It is important to identify social stigma’s influence on children with cleft lip. This can help surgeons prioritize resource allocation and provide further evidence in incorporating quality of life measures into the treatment outcome assessment.

Children with orofacial clefts have a vast treatment need. Throughout life, they often overcome several physical and psychological cleft-related challenges. The burden of care due to the cleft is significant for the children, their parents, and society. More studies are needed to define cleft-related problems. The physical challenges, such as malocclusions, can be connected to the psychological difficulties that patients with clefts face. The aim of this project was to evaluate the oral health-related quality of life (OHRQoL) and dental fear among 18-year-old patients with clefts. The research also aimed to examine the cleft patients’ motivation to attend complex treatments. Another aim was to examine the maxillary arch dimensions in 6-year-old children with clefts and to compare them with the severity of the initial cleft among patients with cleft palate. The study comprised the cohort of children with cleft lip and/or palate (CLP) treated at the Oulu University Hospitals’ Cleft Lip and Palate centre. The study included 63 individuals who had turned 18 years and 89 children who were 6 years old. More than half of the 18-year-old subjects reported an impact on OHRQoL. Physical pain and psychological discomfort were the most reported domains. Good outcome, support from others, and dental care being a normal routine were the motivating factors to attend treatments. Almost 40% of the subjects reported moderate dental fear. Those with a cleft involving the lip experienced lower OHRQoL and more dental fear. Larger initial clefts resulted in shorter maxillas on the right side at 6 years of age. Maxillary growth was reduced among patients with a cleft involving the palate. The dimensions were largest for clefts involving only the lip., Tiivistelmä Halkiolapsilla on suuri hoidontarve. He kohtaavat usein lukuisia sekä fyysisiä että psyykkisiä halkioon liittyviä haasteita elämänsä aikana. Hoidon aiheuttama taakka on merkittävä lapselle itselleen, hänen vanhemmilleen ja yhteiskunnalle. Halkioon liittyvien haasteiden määrittelyä varten tarvitaan lisää tutkimustietoa. Fyysiset ongelmat, kuten purentavirheet, voivat olla yhteydessä psykologisiin haasteisiin halkiopotilailla. Tämän tutkimuksen tavoitteena oli arvioida 18-vuotiaiden halkiopotilaiden kokemaa suun terveyteen liittyvää elämänlaatua sekä hammashoitopelkoa. Tavoitteena oli myös arvioida halkiopotilaiden motivaatiota käydä läpi haasteellisia hoitoja. Lisäksi tavoitteena oli tutkia 6-vuotiaiden halkiolasten yläleuan mittoja ja niiden yhteyttä alkuperäisen halkion kokoon suulakihalkiopotilailla. Tutkimus koostui potilaista, jotka olivat olleet hoidossa Oulun halkiokeskuksessa. Tutkimuksessa oli mukana 63 osallistujaa, jotka olivat täyttäneet 18 vuotta ja 89 6-vuotiasta osallistujaa. Yli puolet 18-vuotiaista raportoi vaikutuksia suun terveyteen liittyvässä elämänlaadussa. Eniten raportoitiin fyysistä kipua sekä psykologista haittaa. Lähes 40 % osallistujista raportoi kohtalaista hammashoitopelkoa. Ne, joilla halkio ulottui huuleen, kokivat huonompaa suun terveyteen liittyvää elämänlaatua sekä enemmän hammashoitopelkoa. Halkiopotilaiden motivaatioon käydä läpi hoitoja vaikutti eniten hyvä hoitotulos ja muiden tuki sekä hammashoidon kokeminen normaalina rutiinina. Suuremmat halkiot johtivat lyhyempään yläleukaan oikealla puolella 6-vuotiailla. Yläleuan kasvu oli alentunut niillä, joilla halkio ulottui suulakeen. Suurimmat yläleuan mitat olivat potilailla, joilla halkio ulottui vain huuleen.

BackgroundChildren with isolated cleft of the lip and/or palate (iCL/P) are at a higher risk for language and reading issues. The current pilot study evaluated concurrent writing skills of children with iCL/P compared to unaffected participants with average (uAR) and impaired (uIR) reading. It was hypothesized that children with iCL/P would perform lower than age-expectations.MethodsTwenty-three males, aged 8-11 years old, were recruited through clinics, local advertisements, and state dyslexia groups (iCL/P = 7, uAR = 8, uIR = 8). Group differences on measures of cognitive processes and writing were evaluated using ANCOVA. Relationships between these measures were compared for each group through Pearson correlations.ResultsParticipants with iCL/P performed within the average range across all measures; group differences were only found for the uIR group. For those with iCL/P, writing was correlated to global cognitive skills rather than more specific skills.ConclusionsWhile this small sample of children with iCL/P demonstrated average writing skills, patterns suggest performance is related to global cognitive reasoning rather than specific cognitive processes as found in unaffected children with impaired reading. Further research is needed to better understand writing in iCL/P and the relationship to reading and cognitive processes.ImpactResearch in children with isolated cleft of the lip and/or palate (iCL/P) has demonstrated higher rates of language and reading disorders. No work has assessed written expression in children with iCL/P in over 40 years. This study is the first to evaluate elements of written expression and associated cognitive processes among children with iCL/P in comparison to unaffected children with either average or impaired reading skills. Measures of writing were within the average range for children with iCL/P and demonstrated correlation to global cognitive reasoning rather than to specific cognitive processes as found in unaffected childre

Objective: To identify the importance of the use of presurgical orthopedics in the early treatment of children with (LPH). Method: Descriptive documentary. Conclusion: The combined use of orthopedic devices such as the obturator plate plus a nasal shaper in the first 3 months of life of the neonate offers great and important benefits in: alignment of the maxillary segments, and a good structuring of the nasal ala thus facilitating surgery and restoring the lost function and harmony. Multidisciplinary treatment is of utmost importance in cleft patients, improving in several aspects such as social, emotional and self-esteem during growth. Although there is not enough evidence we can conclude that patients treated with pre-surgical orthopedics have a better surgical outcome., Objetivo: identificar la importancia del uso de ortopedia prequirúrgica en el tratamiento temprano de niños con (LPH). Método: Descriptivo documental. Conclusión: El uso combinado de aparatos ortopédicos como la placa obturadora más un modelador nasal, en los 3 primeros meses de vida del neonato ofrece grandes e importantes beneficios en: alineación de los segmentos maxilares, y una buena estructuración del ala nasal facilitando así la cirugía y devolviendo la función y armonía perdidas. El tratamiento multidisciplinario es de suma importancia en los pacientes fisurados, mejorando en varios aspectos como social, emocional y autoestima durante el crecimiento. Aunque no existe evidencia suficiente podemos concluir que los pacientes tratados con ortopedia prequirúrgica tienen un mejor resultado quirúrgico.

In Sweden, about 150-200 children annually are born with some form of cleft lip and/or palate, making it the most common facial malformation in the country. Treatment often involves one or more surgeries and the speech development is followed up by a speech pathologist from the first year of life. One of the most common speech deviation for children with a cleft palate is hypernasality, which comes from the condition velopharyngeal insufficiency (VPI), which means that the soft palate cannot close the passage between the throat and nasal cavities properly. To classify the severity of VPI and hypernasality is hard, since listeners have different internal standards. This makes it important to develop an independent method to classify the severity. This thesis studied two existing deep learning methods from another master’s thesis on new data to see if it would be able to classify the severity of VPI, which is classified on a three point scale. The methods did not work well on the new data, but could be improved a bit by better data processing and some changes in the methods. The best performance for classifying VPI was a VGGish network which gave a file-wise accuracy of 57.11 %. A method to try and classify hypernasality was investigated as well. The best method found in order to classify hypernasality, which is classified on a four point scale, was to look at the vowels and to use mel spectrograms in a Convolutional Neural Network (CNN). Nasometry data was also given and together with the mel spectrograms an accuracy of 52.38 % was reached.

Abnormalities of the lip and palate or commonly referred to as cleft lip or labioschizis, are congenital abnormalities of the gap between the right and/or left sides of the lip. Palatoschizis is the most common congenital abnormality after labioschizis with multifactorial causes and is found in every nation in the world. This congenital anomaly is ranked the third most common based on a survey conducted in 13 major hospitals in Indonesia, and the incidence of cleft lip with or without cleft palate is 1 per 700-1000 births worldwide, and Asians have the highest risk. Among the factors causing it, genetics is agreed to be the main factor. Infants die or are disabled; even mothers die during childbirth, which often occurs in pregnancies aged > 35 years and over. Giving birth at the age of > 35 years and over, babies born are susceptible to genetic disorders. This study is to report cleft lip due to high-risk pregnancy > 35 years old at regional public hospital Drs. H. Amri Tambunan, Deli Serdang, which is a type B regional hospital in North Sumatra, Indonesia. This was a descriptive analysis with the cross-sectional retrospective study by using medical records of high-risk pregnancy > 35 years old patients treated from January to December 2019. The data are presented in tabular and pie form. In this study, there were 86 samples of patients with high-risk pregnancies > 35 years, and there were 49 (56.9%) patients in this study. The highest incidence rate was congenital cleft lip in 39 (45.3%) patients. Operations on children with congenital abnormalities such as labioschizis, labiopalatoschizis, and labiopalatognatoschizis are mostly performed when children are > 3 months – 12 months old, as many as 11 (28.2%) patients while 16 (41.1%) patients do not have surgery in this research. The results of this study did not show a relationship between the age of pregnant women > 35 years with the incidence of abnormalities under the cleft lip with a p-value

In Sweden, about 150-200 children annually are born with some form of cleft lip and/or palate, making it the most common facial malformation in the country. Treatment often involves one or more surgeries and the speech development is followed up by a speech pathologist from the first year of life. One of the most common speech deviation for children with a cleft palate is hypernasality, which comes from the condition velopharyngeal insufficiency (VPI), which means that the soft palate cannot close the passage between the throat and nasal cavities properly. To classify the severity of VPI and hypernasality is hard, since listeners have different internal standards. This makes it important to develop an independent method to classify the severity. This thesis studied two existing deep learning methods from another master’s thesis on new data to see if it would be able to classify the severity of VPI, which is classified on a three point scale. The methods did not work well on the new data, but could be improved a bit by better data processing and some changes in the methods. The best performance for classifying VPI was a VGGish network which gave a file-wise accuracy of 57.11 %. A method to try and classify hypernasality was investigated as well. The best method found in order to classify hypernasality, which is classified on a four point scale, was to look at the vowels and to use mel spectrograms in a Convolutional Neural Network (CNN). Nasometry data was also given and together with the mel spectrograms an accuracy of 52.38 % was reached.

Abnormalities of the lip and palate or commonly referred to as cleft lip or labioschizis, are congenital abnormalities of the gap between the right and/or left sides of the lip. Palatoschizis is the most common congenital abnormality after labioschizis with multifactorial causes and is found in every nation in the world. This congenital anomaly is ranked the third most common based on a survey conducted in 13 major hospitals in Indonesia, and the incidence of cleft lip with or without cleft palate is 1 per 700-1000 births worldwide, and Asians have the highest risk. Among the factors causing it, genetics is agreed to be the main factor. Infants die or are disabled; even mothers die during childbirth, which often occurs in pregnancies aged > 35 years and over. Giving birth at the age of > 35 years and over, babies born are susceptible to genetic disorders. This study is to report cleft lip due to high-risk pregnancy > 35 years old at regional public hospital Drs. H. Amri Tambunan, Deli Serdang, which is a type B regional hospital in North Sumatra, Indonesia. This was a descriptive analysis with the cross-sectional retrospective study by using medical records of high-risk pregnancy > 35 years old patients treated from January to December 2019. The data are presented in tabular and pie form. In this study, there were 86 samples of patients with high-risk pregnancies > 35 years, and there were 49 (56.9%) patients in this study. The highest incidence rate was congenital cleft lip in 39 (45.3%) patients. Operations on children with congenital abnormalities such as labioschizis, labiopalatoschizis, and labiopalatognatoschizis are mostly performed when children are > 3 months – 12 months old, as many as 11 (28.2%) patients while 16 (41.1%) patients do not have surgery in this research. The results of this study did not show a relationship between the age of pregnant women > 35 years with the incidence of abnormalities under the cleft lip with a p-value

Genetic and environmental factors have been observed to influence risks for birth defects, though few studies have investigated gene-environment interactions. Our aim was to examine the interaction terms of gene variants in biotransformation enzyme pathways and air pollution exposures in relation to risk of several structural birth defects. We evaluated the role of ambient air pollutant exposure (nitrogen dioxide [NO2 ], nitrogen oxide, carbon monoxide, particulate matter <10 [PM10 ] and <2.5 [PM2.5 ] microns) during pregnancy and 104 gene variants of biotransformation enzymes from infant bloodspots or buccal cells in a California population-based case-control study in 1997-2006. Cases included cleft lip with or without cleft palate (N = 206), gastroschisis (N = 94), tetralogy of Fallot (N = 69), and dextro-transposition of the great arteries (d-TGA; N = 40) and were compared to 208 nonmalformed controls. Overall, the results were not consistent, though did highlight some associations for further investigation as indicated by Wald chi-square test p value <.1. Increased risk of cleft lip was associated with exposure to high PM10 and two CYP gene variants. High PM2.5 and the variant of SLCO1B1 was associated with increased risk of teratology of Fallot. Higher NO2 and two gene variants, CYP2A6 and SLC01B1, were associated with increased risk of d-TGA. Results for gastroschisis were inconsistent in direction and across pollutants. These exploratory results suggest that some individuals based on their genetic background may be more susceptible to the adverse effects of air pollution.

Bilateral Tessier type 4 craniofacial clefts are extremely rare and disfiguring malformations with vision-threatening ramifications. To date, there is no consensus in the literature with respect to the ideal surgical technique and management of these patients. Emergent eyelid reconstruction and additional procedures may be required to protect the cornea and avoid further ophthalmic and surgical complications. We present our experience and challenges of managing a case of bilateral Tessier type 4 clefting with an emphasis on oculoplastic considerations.

Cleft lip and/or palate (CLP) is one of the most frequently occurring birth defects, affecting approximately 1 in 700 live births. A cleft of the palate (CP) creates a communication between oral and nasal cavities, making it difficult to generate negative pressure needed for proper sucking and swallowing. Furthermore, regurgitation of milk through the nasal cavity and frequent choking contribute to feeding problems in babies with CLP that can lead to low nutritional intake if left untreated. Feeding in babies with CLP on the breast is so rarely successful that the large majority of babies with CLP are fed using specialized bottles to overcome the absence of intraoral suction—often with formula instead of breast milk. Breast milk protects against infant mortality by providing antibodies, which bolster infants’ immunity to infections, diarrhea, pneumonia, and other diseases. A breastfeeding appliance (BA) that can create enough negative pressure to draw milk into the baby’s mouth can potentially allow mothers to directly nurse their babies who have CLP. In our clinical study, we gather observational data and test the ergonomics, safety, and efficacy of this BA on lactating women. The specific aims of our project are: 1) to test the prototype BA on lactating mothers to improve product design, 2) to quantify the amount of breast milk that is able to be expressed from hand compressions using the BA, and 3) to obtain a qualitative description of the appliance’s comfortability, ease of use, and effectiveness.

Objective: This study aimed to identify commonly used classification systems by cleft providers around the world, including the perceived indications and limitations of each system. Design: A cross-sectional survey. Participants: A total of 197 registrants from three international cleft/craniofacial meetings. Interventions: Participants were sent a web-based questionnaire concerning cleft classification systems. Main outcome measures: Frequency of commonly used classification systems, their perceived indications and limitations. Results: A total of 197 respondents from 166 different centers completed the questionnaire. Healthcare professionals from all disciplines responded, with the most frequent respondents being plastic surgeons (38.1%), maxillofacial surgeons (28.4%) and orthodontists (23.9%). Eighteen different classification systems were in use. The most frequently used systems were the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (35.5%), LAHSHAL (34.0%), and Veau (32.5%) classification systems. Most respondents (32.5%) indicated that anatomical and morphological characteristics are essential components of a classification system. However, respondents indicated that their current classification systems lacked sufficient description of cleft extension and severity. Conclusions: Great variety in the use of classification systems exists among craniofacial specialists internationally. The results recommend the usage of the LAHSHAL classification of OFCs, due to its comprehensiveness, relatively high implementation rate globally, convenience of usage and complementarity with the ICD-10 system. Moreover, it can overcome deficiencies inextricably linked to ICD-10, such as incapacity to describe laterality and clefts of the alveolus. More international exposure to the merits of using the LAHSHAL classification system would be highly recommended.

Cleft lip and palate belong to the most common deformities present at birth. The condition hampers normal speech development in children, and treatment involves both surgery and regular sessions with a speech pathologist. The speech pathologist assesses the child’s speech impairment stemming from the condition on a three-point scale: "Competent", "Marginally incompetent" and "Incompetent" and the rating forms a basis for future treatment decisions. This procedure is time and resource intensive since close examination of the entire recording is necessary for an accurate aggregate rating. Furthermore, field experience is that the assigned rating for a singular recording can be biased and the ratings from different speech pathologists are inconsistent. In this thesis, deep learning methods are used to classify audio recordings of children into the three categories. The ambition of this undertaking is to rid the classification of bias and provide speech pathologists with a consistent baseline rating. Different steps in the pre-processing of speech therapy recordings are explored to transform the raw audio input into meaningful information for a neural network. The best performing network structure was a convolutional neural network model and it manages to classify recordings with a 89.76% accuracy by using Mel-spectrograms on 0.2 seconds of pre-processed audio segments. Recommendations about further work is discussed with the end goal of developing a fully automatic classifier with appropriate data gathering methods., I detta projekt föreslås en automatiserad metod för att bedöma talförmågan hos barn med läpp, käk- och gomspalt på en tregradig skala. Genom djupinlärningsmetoder uppnås en träffsäkerhet upp mot 90% vid varje enskild bedömning. Läpp, käk- och gomspalt hör till en av dem vanligaste missbildningarna som kan uppstå under graviditeten, det som händer är att ansiktets olika delar inte sammanslutits på korrekt sätt och därav lämnat en spalt i antingen läppen, käken, gommen eller flera av dem samtidigt. I Sverige föds varje år runt 200 barn med tillståndet, vilket motsvarar 1 födsel på 500. Tillståndet innebär talsvårigheter då barnet bl.a. uttalar meningar och ord med en kraftig hypernasalitet eller har svårigheter att uttala vissa konsonanter såsom /k/, /t/ och /p/ då luften lämnar via näsan p.g.a. spalten och förhindrar uppbyggnad av trycket i munnen som krävs vid korrekt uttal. Behandling innebär i de flesta fall en kombination av kirurgiska ingrepp och regelbundna träffar med en logoped för att träna upp talförmågan. Barnet träffar logopeden regelbundet och i deras sessioner får barnet säga eller upprepa vissa specifika fraser som kan påvisa grad av talsvårighet, givet läpp, käk- och gomspalt. Logopeden bedömer sedan talet på en tregradig skala som är en av faktorerna vid hänsyn till vidare behandling. Problemställningen är att den mänskliga bedömningen kräver tid och har visat sig präglas av partiskhet och varians vid bedömning av samma barn, hos olika logopeder. En automatiserad lösning skulle bli kvitt båda problemen och ge logopederna en opartisk bedömning som de kan ta hänsyn till, men även fria upp tidskrävande resurser som kan användas på annat håll vid behandlingen. Djupinlärningsmetoder har på senare tid använts med stora framgångar vid modellering av röst och tal. Det är en automatiserad lösning som givet tillgänglig data kan upptäcka skillnader mellan de tre kategorierna genom igenkänning av påvisande mönster i datan. För modelleringen finns tillgång till 1

Current methods of assessing the quality of a surgically re-paired cleft lip rely on humans scoring photographs. This is only practical for research purposes due to the resources necessary and is not used in routine audit. It has poor validity due to human subjectivity and thus low inter-rater reliability. An automatic method for aesthetic outcome assessment of cleft lip repair is required. The appearance and shape of the lips constitute the region of interest for analysis. The mouth borderline and corner points are detected using a bilateral semantic network for real-time segmentation. The bisector of the line linking the mouth corners is estimated as the vertical symmetric axis. By splitting the mouth blob into two parts, they are analyzed for similarity and a numeric score ranging from 1 to 5 is then generated. Pearson correlation coecient between automatically generated scores and human-assigned ones serves as a validation metric. A correlation of about 40% indicates a good agreement between human and computer-based assessments. However, better automatic scoring correlation of 95:9% exists between the automatically detected mouth regions and those manually drawn by human experts, the third ground truth set in scenario two. Our method has the potential to automate an outcome estimation of the aesthetics of cleft lip repair with human bias reduced, easy implementation and computational eciency.

Cleft lip is defined as a congenital anomaly of head and neck, with a higher incidence in males. The treatment par excellence is surgical intervention seeking to achieve functionality and the best aesthetic result) for this the interprofessional work is necessary, in which the speech pathologist participates on the evaluation process and therapeutic intervention in swallowing, speech and language. The objective of this narrative review was to primarily address the processes of evaluation and speech therapy intervention in children with cleft lip. For its development, a search of information in PubMed, Scopus and Lilacs databases, subsequently a critical analysis of the information was made. This narrative review proposed to make a synthesis of the history, the etiological factors and the surgical intervention processes that are performed in children with cleft lip, this allows to understand the actions and importance of the speech pathologist's work in the processes of evaluation with specific protocols that involve all areas; swallowing, language, speech, voice, hearing and speech pathologist therapy intervention in children with cleft lip, based on the evidence that allows to acknowledge positive results, being promising for this population the implementation of summer camps, El labio fisurado se define como una anomalía congénita de la cabeza y el cuello, observándose una mayor incidencia en personas del sexo masculino. El tratamiento por excelencia es la intervención quirúrgica, en la búsqueda de una adecuada funcionalidad y un buen resultado estético, para cumplir con este objetivo es necesario el trabajo interprofesional, en el cual participa el fonoaudiólogo, durante el proceso de evaluación e intervención terapéutica. El objetivo de la revisión narrativa fue abordar principalmente los procesos de evaluación e intervención fonoaudiológica en niños con labio fisurado. Para su desarrollo fue realizas una búsqueda de información en las bases de datos PubMed, Scopus y Lilacs, posteriormente fue realizado un análisis crítico de la información. La presente revisión narrativa se propone realizar un recuento sobre aspectos relacionados con la historia de la clasificación del labio fisurado, factores etiológicos, procesos de intervención quirúrgica realizada en los niños con labio fisurado, que permitan comprender el proceso de la evaluación clínica fonoaudiológica en las áreas de deglución, lenguaje, habla, voz y las propuestas de intervención terapéutica en niños con labio fisurado de acuerdo con las evidencias presentadas en la literatura.

AIMS: Orofacial clefts (OFC) are a heterogeneous group of birth defects arising in about 1.7/1000 newborns. They can occur with other congenital anomalies, including heart defects. We aim to describe a population with orofacial clefts and associated cardiac anomalies.METHODS: Retrospective study of patients attended in the Cleft Lip and Palate Multidisciplinary Group outpatient clinic at Hospital Universitario São João, Porto-Portugal. Medical records from January 1992 through December 2018 were reviewed. Patients were divided into four groups according to the Spina classification: cleft lip (CL), cleft lip and palate (CLP), isolated cleft palate (CP) and atypical cleft (AC). Further categorization included gender, affected relatives, associated congenital anomalies and syndromes.RESULTS: From the 588 patients included, 77 (13%) presented cardiac anomalies. Of those with orofacial cleft and cardiac anomalies, 53% were males and 17% had known affected relatives. CP was the most common cleft among patients with cardiac anomaly (~56%). Additional congenital anomalies were found in 89.7% of patients, namely facial defects, central nervous system, renal and skeletal malformations. A recognizable syndrome was identified in 61.5%, being Pierre-Robin the most common (n=22), followed by 22q11.2 microdeletion (n=9). Both additional congenital anomalies and recognizable syndromes were significantly more prevalent in patients with heart disease (p<0.05). The main groups of cardiac anomalies were left-to-right shunt (n=47) and right ventricular outflow tract obstruction (n=14). From these, 26 had a ventricular septal defect, 15 atrial septal defect and seven patients had tetralogy of Fallot. Five patients had dysrhythmias.CONCLUSIONS: Due to the high prevalence of cardiac anomalies in the cleft population, a routine cardiac evaluation should be performed in all these patients., INTRODUÇÃO: As fendas lábio-palatinas são um grupo heterogêneo de defeitos congênitos que ocorrem em cerca de 1,7 / 1000 recém-nascidos. Eles podem ocorrer com outras anomalias congênitas, incluindo defeitos cardíacos. O nosso objetivo é descrever uma população com fendas lábio-palatinas e anomalias cardíacas associadas.MÉTODOS: Estudo retrospectivo de doentes seguidos pelo Grupo Multidisciplinar de Fendas Lábio-Palatinas no Hospital Universitário São João, Porto-Portugal. Foram analisados os prontuários médicos de janeiro de 1992 a dezembro de 2018. Os doentes foram divididos em quatro grupos, de acordo com a classificação de Spina: fenda labial (CL), fenda labial e palatina (CLP), fenda palatina isolada (PC) e fenda atípica (CA). Outras categorizações incluíram sexo, parentes afetados, anomalias e síndromes congênitas associadas.RESULTADOS: Dos 588 pacientes incluídos, 77 (13%) apresentaram anomalias cardíacas. Daqueles com fenda e anomalias cardíacas, 53% eram do sexo masculino e 17% tinham parentes afetados. A PC foi a fenda mais comum entre os doentes com anomalia cardíaca (aproximadamente 56%). Anomalias congénitas adicionais, como defeitos faciais, malformações do sistema nervoso central, renais e esqueléticas foram encontradas em 89,7%. Síndromes foram identificadas em 61,5%, sendo Pierre-Robin a mais comum (n = 22), seguida pela microdeleção 22q11.2 (n = 9). Anomalias congénitas adicionais e a presença de uma síndrome genética foram significativamente mais prevalentes em doentes com doença cardíaca associada (p <0,05). Os principais grupos de anomalias cardíacas foram shunt da esquerda para a direita (n = 47) e obstrução da via de saída do ventrículo direito (n = 14). Destes, 26 apresentaram comunicação interventricular, 15 comunicação interauricular e sete pacientes apresentaram tetralogia de Fallot. Cinco pacientes apresentaram disritmias.CONCLUSÕES: Devido à elevada prevalência de anomalias cardíacas na população de doentes com Fenda Lábio-Palatina, acon

Objective: This study aimed to identify commonly used classification systems by cleft providers around the world, including the perceived indications and limitations of each system. Design: A cross-sectional survey. Participants: A total of 197 registrants from three international cleft/craniofacial meetings. Interventions: Participants were sent a web-based questionnaire concerning cleft classification systems. Main outcome measures: Frequency of commonly used classification systems, their perceived indications and limitations. Results: A total of 197 respondents from 166 different centers completed the questionnaire. Healthcare professionals from all disciplines responded, with the most frequent respondents being plastic surgeons (38.1%), maxillofacial surgeons (28.4%) and orthodontists (23.9%). Eighteen different classification systems were in use. The most frequently used systems were the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (35.5%), LAHSHAL (34.0%), and Veau (32.5%) classification systems. Most respondents (32.5%) indicated that anatomical and morphological characteristics are essential components of a classification system. However, respondents indicated that their current classification systems lacked sufficient description of cleft extension and severity. Conclusions: Great variety in the use of classification systems exists among craniofacial specialists internationally. The results recommend the usage of the LAHSHAL classification of OFCs, due to its comprehensiveness, relatively high implementation rate globally, convenience of usage and complementarity with the ICD-10 system. Moreover, it can overcome deficiencies inextricably linked to ICD-10, such as incapacity to describe laterality and clefts of the alveolus. More international exposure to the merits of using the LAHSHAL classification system would be highly recommended.

Objective: This study aimed to identify commonly used classification systems by cleft providers around the world, including the perceived indications and limitations of each system. Design: A cross-sectional survey. Participants: A total of 197 registrants from three international cleft/craniofacial meetings. Interventions: Participants were sent a web-based questionnaire concerning cleft classification systems. Main outcome measures: Frequency of commonly used classification systems, their perceived indications and limitations. Results: A total of 197 respondents from 166 different centers completed the questionnaire. Healthcare professionals from all disciplines responded, with the most frequent respondents being plastic surgeons (38.1%), maxillofacial surgeons (28.4%) and orthodontists (23.9%). Eighteen different classification systems were in use. The most frequently used systems were the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (35.5%), LAHSHAL (34.0%), and Veau (32.5%) classification systems. Most respondents (32.5%) indicated that anatomical and morphological characteristics are essential components of a classification system. However, respondents indicated that their current classification systems lacked sufficient description of cleft extension and severity. Conclusions: Great variety in the use of classification systems exists among craniofacial specialists internationally. The results recommend the usage of the LAHSHAL classification of OFCs, due to its comprehensiveness, relatively high implementation rate globally, convenience of usage and complementarity with the ICD-10 system. Moreover, it can overcome deficiencies inextricably linked to ICD-10, such as incapacity to describe laterality and clefts of the alveolus. More international exposure to the merits of using the LAHSHAL classification system would be highly recommended.

Cleft lip and palate belong to the most common deformities present at birth. The condition hampers normal speech development in children, and treatment involves both surgery and regular sessions with a speech pathologist. The speech pathologist assesses the child’s speech impairment stemming from the condition on a three-point scale: "Competent", "Marginally incompetent" and "Incompetent" and the rating forms a basis for future treatment decisions. This procedure is time and resource intensive since close examination of the entire recording is necessary for an accurate aggregate rating. Furthermore, field experience is that the assigned rating for a singular recording can be biased and the ratings from different speech pathologists are inconsistent. In this thesis, deep learning methods are used to classify audio recordings of children into the three categories. The ambition of this undertaking is to rid the classification of bias and provide speech pathologists with a consistent baseline rating. Different steps in the pre-processing of speech therapy recordings are explored to transform the raw audio input into meaningful information for a neural network. The best performing network structure was a convolutional neural network model and it manages to classify recordings with a 89.76% accuracy by using Mel-spectrograms on 0.2 seconds of pre-processed audio segments. Recommendations about further work is discussed with the end goal of developing a fully automatic classifier with appropriate data gathering methods., I detta projekt föreslås en automatiserad metod för att bedöma talförmågan hos barn med läpp, käk- och gomspalt på en tregradig skala. Genom djupinlärningsmetoder uppnås en träffsäkerhet upp mot 90% vid varje enskild bedömning. Läpp, käk- och gomspalt hör till en av dem vanligaste missbildningarna som kan uppstå under graviditeten, det som händer är att ansiktets olika delar inte sammanslutits på korrekt sätt och därav lämnat en spalt i antingen läppen, käken, gommen eller flera av dem samtidigt. I Sverige föds varje år runt 200 barn med tillståndet, vilket motsvarar 1 födsel på 500. Tillståndet innebär talsvårigheter då barnet bl.a. uttalar meningar och ord med en kraftig hypernasalitet eller har svårigheter att uttala vissa konsonanter såsom /k/, /t/ och /p/ då luften lämnar via näsan p.g.a. spalten och förhindrar uppbyggnad av trycket i munnen som krävs vid korrekt uttal. Behandling innebär i de flesta fall en kombination av kirurgiska ingrepp och regelbundna träffar med en logoped för att träna upp talförmågan. Barnet träffar logopeden regelbundet och i deras sessioner får barnet säga eller upprepa vissa specifika fraser som kan påvisa grad av talsvårighet, givet läpp, käk- och gomspalt. Logopeden bedömer sedan talet på en tregradig skala som är en av faktorerna vid hänsyn till vidare behandling. Problemställningen är att den mänskliga bedömningen kräver tid och har visat sig präglas av partiskhet och varians vid bedömning av samma barn, hos olika logopeder. En automatiserad lösning skulle bli kvitt båda problemen och ge logopederna en opartisk bedömning som de kan ta hänsyn till, men även fria upp tidskrävande resurser som kan användas på annat håll vid behandlingen. Djupinlärningsmetoder har på senare tid använts med stora framgångar vid modellering av röst och tal. Det är en automatiserad lösning som givet tillgänglig data kan upptäcka skillnader mellan de tre kategorierna genom igenkänning av påvisande mönster i datan. För modelleringen finns tillgång till 1

Objective: This study aimed to identify commonly used classification systems by cleft providers around the world, including the perceived indications and limitations of each system. Design: A cross-sectional survey. Participants: A total of 197 registrants from three international cleft/craniofacial meetings. Interventions: Participants were sent a web-based questionnaire concerning cleft classification systems. Main outcome measures: Frequency of commonly used classification systems, their perceived indications and limitations. Results: A total of 197 respondents from 166 different centers completed the questionnaire. Healthcare professionals from all disciplines responded, with the most frequent respondents being plastic surgeons (38.1%), maxillofacial surgeons (28.4%) and orthodontists (23.9%). Eighteen different classification systems were in use. The most frequently used systems were the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (35.5%), LAHSHAL (34.0%), and Veau (32.5%) classification systems. Most respondents (32.5%) indicated that anatomical and morphological characteristics are essential components of a classification system. However, respondents indicated that their current classification systems lacked sufficient description of cleft extension and severity. Conclusions: Great variety in the use of classification systems exists among craniofacial specialists internationally. The results recommend the usage of the LAHSHAL classification of OFCs, due to its comprehensiveness, relatively high implementation rate globally, convenience of usage and complementarity with the ICD-10 system. Moreover, it can overcome deficiencies inextricably linked to ICD-10, such as incapacity to describe laterality and clefts of the alveolus. More international exposure to the merits of using the LAHSHAL classification system would be highly recommended.

Aim: The aim of this literature study was to systematically review the scientific evidence on the most effective donor sites and/or bone substitute material for secondary alveolar cleft grafting in alveolar cleft patients. Material and method: In order to acquire a systematic and transparent reporting this literature review was conducted according to the PRISMA statement. The literature search was performed in the following four databases; PubMed, CENTRAL, Web of Science and Scopus.The quality of the included studies was assessed using the revised Cochrane Risk of Bias 2 tool (RoB 2 tool). Result: The search identified 4754 studies. Five RCT studies was included in this systematic review and assessed different donor site or bone substitute materials. Two studies showed low risk of bias and three moderate risk of bias. Only one study showed a statistically significant difference when comparing iliac bone to substitute material however all studies presented substitute materials with satisfactory results. Conclusion: According to the data from this systematic review no clear conclusion can be drawn regarding what the most effective bone donor site and/or tissue engineered bone substitute material to use in secondary bone grafts. Based on the available evidence iliac bone could still be regarded as a benchmark, but more research and RCT’s of high quality are required, especially for artificial bone substitute materials., Syfte: Syftet med denna litteraturstudie var att systematiskt granska den vetenskapliga evidensen gällande det mest effektiva bentagningsstället och/eller bensubstitutmaterialet vid sekundär bentransplantation hos patienter med käkspalt. Material och metod: För att uppnå en systematisk och transparent rapportering av denna litteraturstudie följdes PRISMA statement. Litteratursökningen gjordes i följande fyra databaser; PubMed, CENTRAL, Web of Science och Scopus. Kvaliteten av inkluderade studier granskades med hjälp av Cochrane Risk of Bias 2 tool (Rob 2 tool). Resultat: Sökningen identifierade 4754 studier. Fem RCT studier inkluderades i denna systematiska översikt vilka värderade olika bentagningsställen eller bensubstitut. Två studier bedömdes ha låg risk för bias och tre artiklar måttlig risk för bias. Endast en studie visade på en statistiskt signifikant skillnad vid jämförelse av höftben med bensubstitut däremot presenterade samtliga studier substitutmaterial med tillfredsställande resultat. Konklusion: Denna systematiska översikt visade att ingen klar slutsats kan dras gällande vilken det mest effektiva bentagningsstället eller bensubstitutsmaterialet är för sekundär bentransplantation hos patienter med käkspalt. Baserat på tillgänglig evidens kan transplantat från höftbenet fortfarande anses vara bäst lämpat men mer forskning samt RCT studier av hög kvalité erfordras, särskilt för artificiella bensubstitutmaterial.

Objective: This study aimed to identify commonly used classification systems by cleft providers around the world, including the perceived indications and limitations of each system. Design: A cross-sectional survey. Participants: A total of 197 registrants from three international cleft/craniofacial meetings. Interventions: Participants were sent a web-based questionnaire concerning cleft classification systems. Main outcome measures: Frequency of commonly used classification systems, their perceived indications and limitations. Results: A total of 197 respondents from 166 different centers completed the questionnaire. Healthcare professionals from all disciplines responded, with the most frequent respondents being plastic surgeons (38.1%), maxillofacial surgeons (28.4%) and orthodontists (23.9%). Eighteen different classification systems were in use. The most frequently used systems were the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (35.5%), LAHSHAL (34.0%), and Veau (32.5%) classification systems. Most respondents (32.5%) indicated that anatomical and morphological characteristics are essential components of a classification system. However, respondents indicated that their current classification systems lacked sufficient description of cleft extension and severity. Conclusions: Great variety in the use of classification systems exists among craniofacial specialists internationally. The results recommend the usage of the LAHSHAL classification of OFCs, due to its comprehensiveness, relatively high implementation rate globally, convenience of usage and complementarity with the ICD-10 system. Moreover, it can overcome deficiencies inextricably linked to ICD-10, such as incapacity to describe laterality and clefts of the alveolus. More international exposure to the merits of using the LAHSHAL classification system would be highly recommended.

Aim: The aim of this literature study was to systematically review the scientific evidence on the most effective donor sites and/or bone substitute material for secondary alveolar cleft grafting in alveolar cleft patients. Material and method: In order to acquire a systematic and transparent reporting this literature review was conducted according to the PRISMA statement. The literature search was performed in the following four databases; PubMed, CENTRAL, Web of Science and Scopus.The quality of the included studies was assessed using the revised Cochrane Risk of Bias 2 tool (RoB 2 tool). Result: The search identified 4754 studies. Five RCT studies was included in this systematic review and assessed different donor site or bone substitute materials. Two studies showed low risk of bias and three moderate risk of bias. Only one study showed a statistically significant difference when comparing iliac bone to substitute material however all studies presented substitute materials with satisfactory results. Conclusion: According to the data from this systematic review no clear conclusion can be drawn regarding what the most effective bone donor site and/or tissue engineered bone substitute material to use in secondary bone grafts. Based on the available evidence iliac bone could still be regarded as a benchmark, but more research and RCT’s of high quality are required, especially for artificial bone substitute materials., Syfte: Syftet med denna litteraturstudie var att systematiskt granska den vetenskapliga evidensen gällande det mest effektiva bentagningsstället och/eller bensubstitutmaterialet vid sekundär bentransplantation hos patienter med käkspalt. Material och metod: För att uppnå en systematisk och transparent rapportering av denna litteraturstudie följdes PRISMA statement. Litteratursökningen gjordes i följande fyra databaser; PubMed, CENTRAL, Web of Science och Scopus. Kvaliteten av inkluderade studier granskades med hjälp av Cochrane Risk of Bias 2 tool (Rob 2 tool). Resultat: Sökningen identifierade 4754 studier. Fem RCT studier inkluderades i denna systematiska översikt vilka värderade olika bentagningsställen eller bensubstitut. Två studier bedömdes ha låg risk för bias och tre artiklar måttlig risk för bias. Endast en studie visade på en statistiskt signifikant skillnad vid jämförelse av höftben med bensubstitut däremot presenterade samtliga studier substitutmaterial med tillfredsställande resultat. Konklusion: Denna systematiska översikt visade att ingen klar slutsats kan dras gällande vilken det mest effektiva bentagningsstället eller bensubstitutsmaterialet är för sekundär bentransplantation hos patienter med käkspalt. Baserat på tillgänglig evidens kan transplantat från höftbenet fortfarande anses vara bäst lämpat men mer forskning samt RCT studier av hög kvalité erfordras, särskilt för artificiella bensubstitutmaterial.

The aim was to cross-sectionally examine the maxillary arch dimensions in 6-year-old children with cleft lip and/or palate and to compare them with the initial cleft sizes among patients with cleft palate. The study included 89 patients with clefts treated at the Oulu University Hospital. The subjects were divided into three groups: cleft palate, cleft lip, and cleft lip and palate. Study casts were scanned, and the maxillary arch dimensions were examined using a 3D program (3Shape Orthoanalyzer, Copenhagen, Denmark). The statistical methods Student’s t-test and one-way ANOVA were used to compare the means (SD) between the groups. Spearman’s correlation coefficient was used to determine the correlation between cleft severity and maxillary dimensions. A significant difference was found between different initial cleft sizes in terms of distance between the second deciduous molar and the first incisor on the right side. The intermolar width showed a negative correlation with the initial cleft size. The dimensions were shorter for clefts affecting the palate and largest for clefts affecting only the lip. Larger clefts resulted in a shorter maxilla on the right side. Many dimensions became shorter when the initial cleft was larger. Clefts of the palate resulted in smaller maxillas.

Background: Dental fear is a prevalent phenomenon among children and adolescents globally. Aim: To investigate dental fear among 18-year-olds with cleft lip and/or palate (CLP) at their final follow-up cleft clinic visit, and to evaluate the association between dental fear and OHRQoL. Design: This cross-sectional study included the cohort of children with CLP treated at the Oulu University Hospital Cleft Lip and Palate Center, in northern Finland since 1995. A total of 62 of 64 individuals participated in this study. The validated Finnish version of the Oral Health Impact Profile (OHIP-14) was used to assess OHRQoL. Dental fear was studied using the validated Modified Dental Anxiety Scale (MDAS) and cognitive vulnerability model (CVM). Results: Almost two fifths of the participants reported moderate dental fear. Participants with cleft including lip and participants reporting impact on OHRQoL reported higher mean MDAS scores. In an unadjusted model, adolescents with cleft including lip had risk for higher dental MDAS scores compared with the ones with cleft including only palate. Conclusions: Dental fear is common among adolescents with CLP, specifically among those with clefts involving the lip. OHRQoL and dental fear seem to be associated.

Aims: To validate the Child-Oral Impact on Daily Performance (Child-OIDP) in the Hungarian language and to explore the oral health-related quality of life (OHRQoL) and associated factors among Hungarian children with cleft lip or/and palate (CLP). Methods: This cross-sectional study consists of a survey and clinical examination among conveniently selected children with CLP visiting the Pécs cleft lip and palate clinic, Pécs, Hungary. OHRQoL was assessed using the Hungarian version of Child-OIDP. Additionally, a validated structural questionnaire was used for gathering information related to oral hygiene practice. Clinical examination was done to register the dental status using ICDAS criteria, consequences of untreated dental caries (pufa), and bleeding on probing. Results were presented as proportions, means, and standard deviations (SD). Construct validity and internal reliability of the Hungarian Child-OIDP was assessed using the Pearson and Spearman’s correlation coefficients, respectively. The logistic regression model examined the association between OHRQoL and explanatory variables. Results: A total of 45 children with CLP participated in this study. The Hungarian Child-OIDP had the Cronbach’s alpha value 0.73, and the Spearman’s correlation coefficient was 0.31. The mean (SD) Child-OIDP score among the study participants was 4.4 (7.0) and three-fifths (65.9%, n = 27) of the participants reported impact in one or more items of the OHRQoL scale. Tooth brushing was more frequent among 6−10-year-olds compared to 11−16-year-olds. The proportion of those requiring restorative treatment need (DS ≥ 1) was 90.2% (n = 37), those with PUFA/pufa (score ≥ 1) was 24.4% (n = 10), and those with bleeding on probing (> 15%) was 63.4% (n = 26). Children aged 11–16 years had a higher impact on OHRQoL compared to the younger ones. Girls had a higher impact on OHRQoL compared to boys. Children with clefts involving both lip and palate had poorer OHRQoL than the rest. Th

Current methods of assessing the quality of a surgically re- paired cleft lip rely on humans scoring photographs. This is only practical for research purposes due to the resources necessary and is not used in routine audit. It has poor valid- ity due to human subjectivity and thus low inter-rater reliability. An automatic method for aesthetic outcome assessment of cleft lip repair is required. The appearance and shape of the lips constitute the region of interest for analysis. The mouth borderline and corner points are de- tected using a bilateral semantic network for real-time segmentation. The bisector of the line linking the mouth corners is estimated as the vertical symmetric axis. By splitting the mouth blob into two parts, they are analyzed for similarity and a numeric score ranging from 1 to 5 is then generated. Pearson correlation coecient between automatically gener- ated scores and human-assigned ones serves as a validation metric. A correlation of about 40% indicates a good agreement between human and computer-based assessments. However, better automatic scoring correla- tion of 95:9% exists between the automatically detected mouth regions and those manually drawn by human experts, the third ground truth set in scenario two. Our method has the potential to automate an outcome estimation of the aesthetics of cleft lip repair with human bias reduced, easy implementation and computational eciency.

[Objective] The objectives of this study were to evaluate health-related quality of life (HRQoL) in 4–7-year-old children treated for cleft lip and/or palate (CL/P) compared to healthy controls and to estimate a possible association with cleft type, gender, age, and surgical re-interventions., [Materials and methods] A total of 171 children with CL/P (mean age 5.7 years) and 186 healthy controls (mean age 5.5 years) were included in the study. Sixty-four (37.4%) children experienced both cleft lip and palate, 56 (32.8%) cleft lip only, and 51 (29.8%) cleft palate only. HRQoL in children was assessed by Kiddy-KINDL and COHIP-14 questionnaires and in parents by KINDL-p. Total score and dimensions of each questionnaire were compared between cleft children, their parents, and controls., [Results] The total scores and dimension scores of Kiddy-KINDL showed similar values between CL/P and control groups, except for “self-esteem” dimension (p = 0.036). The comparison of Kiddy-KINDL and KINDL-p showed a statistically significant total score (82.11 vs. 80.44, p = 0.047). The CL/P group presented significantly worse values with respect to controls in total score of COHIP-14 (10.53 vs 5.01, p < 0.001) and in all its dimensions., [Conclusions] Children treated for CL/P had a negative impact on HRQoL at early age compared to controls. Significant differences were found in the psychological and functional dimensions related to lip and palatal affectation, respectively. Parents reported significantly worse scores than their children. HRQoL measurement provided valuable complementary information to better inform to parents and make clinical decisions in children with CL/P at early age., [Clinical relevance] Our findings suggested that Spanish children between 4 and 7 years of age with a history of surgically treated CL/P experienced a poorer HRQoL when compared with their non-cleft peers.

Cleft lip and/or palate (CLP) is one of the most frequently occurring birth defects, affecting approximately 1 in 700 live births. A cleft of the palate (CP) creates a communication between oral and nasal cavities, making it difficult to generate negative pressure needed for proper sucking and swallowing. Furthermore, regurgitation of milk through the nasal cavity and frequent choking contribute to feeding problems in babies with CLP that can lead to low nutritional intake if left untreated. Feeding in babies with CLP on the breast is so rarely successful that the large majority of babies with CLP are fed using specialized bottles to overcome the absence of intraoral suction—often with formula instead of breast milk. Breast milk protects against infant mortality by providing antibodies, which bolster infants’ immunity to infections, diarrhea, pneumonia, and other diseases. A breastfeeding appliance (BA) that can create enough negative pressure to draw milk into the baby’s mouth can potentially allow mothers to directly nurse their babies who have CLP. In our clinical study, we gather observational data and test the ergonomics, safety, and efficacy of this BA on lactating women. The specific aims of our project are: 1) to test the prototype BA on lactating mothers to improve product design, 2) to quantify the amount of breast milk that is able to be expressed from hand compressions using the BA, and 3) to obtain a qualitative description of the appliance’s comfortability, ease of use, and effectiveness.

Objective: This study aimed to identify commonly used classification systems by cleft providers around the world, including the perceived indications and limitations of each system. Design: A cross-sectional survey. Participants: A total of 197 registrants from three international cleft/craniofacial meetings. Interventions: Participants were sent a web-based questionnaire concerning cleft classification systems. Main outcome measures: Frequency of commonly used classification systems, their perceived indications and limitations. Results: A total of 197 respondents from 166 different centers completed the questionnaire. Healthcare professionals from all disciplines responded, with the most frequent respondents being plastic surgeons (38.1%), maxillofacial surgeons (28.4%) and orthodontists (23.9%). Eighteen different classification systems were in use. The most frequently used systems were the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (35.5%), LAHSHAL (34.0%), and Veau (32.5%) classification systems. Most respondents (32.5%) indicated that anatomical and morphological characteristics are essential components of a classification system. However, respondents indicated that their current classification systems lacked sufficient description of cleft extension and severity. Conclusions: Great variety in the use of classification systems exists among craniofacial specialists internationally. The results recommend the usage of the LAHSHAL classification of OFCs, due to its comprehensiveness, relatively high implementation rate globally, convenience of usage and complementarity with the ICD-10 system. Moreover, it can overcome deficiencies inextricably linked to ICD-10, such as incapacity to describe laterality and clefts of the alveolus. More international exposure to the merits of using the LAHSHAL classification system would be highly recommended.

Introduction: This study aimed to determine if the treatment algorithm used for nonsyndromic cleft patients required alteration to manage syndromic cleft lip and/or palate patients. Methods: The records of patients managed by the Pécs Cleft Team between January 1999 and December 2015 were analyzed retrospectively. The sources of the data included clinical and genetic records. Results: A total of 607 patients were managed by the cleft team during the study. Sixteen patients (2.6%) were noted to be afflicted with a particular identifiable syndrome. Seven different genetic syndromes and one sequence were present in the study. The Pierre Robin sequence occurred most often, comprising 50% of the cohort. The treatment algorithm used in managing nonsyndromic clefts required modification in 13 of the 16 syndromic patients. Discussion: The presence of a genetic syndrome may notably affect the treatment algorithm in children born with cleft lip and/or palate. The surgical treatment of certain associated anomalies has by necessity, priority over the timing of the reconstruction of the cleft lip and/or cleft palate in syndromic patients.

During craniofacial development, defective growth and fusion of the upper lip and/or palate can cause orofacial clefts (OFCs), which are among the most common structural birth defects in humans. The developmental basis of OFCs includes morphogenesis of the upper lip, primary palate, secondary palate, and other orofacial structures, each consisting of diverse cell types originating from all three germ layers: the ectoderm, mesoderm, and endoderm. Cranial neural crest cells and orofacial epithelial cells are two major cell types that interact with various cell lineages and play key roles in orofacial development. The cellular basis of OFCs involves defective execution in any one or several of the following processes: neural crest induction, epithelial-mesenchymal transition, migration, proliferation, differentiation, apoptosis, primary cilia formation and its signaling transduction, epithelial seam formation and disappearance, periderm formation and peeling, convergence and extrusion of palatal epithelial seam cells, cell adhesion, cytoskeleton dynamics, and extracellular matrix function. The latest cellular and developmental findings may provide a basis for better understanding of the underlying genetic, epigenetic, environmental, and molecular mechanisms of OFCs.

Aim: Facial fat grafting has undergone noteworthy changes over time. Many different techniques have been followed by trying to advance the quality of the lipoaspirate and the survival of the fat graft after implantation. Methodology: The current review emphasizes the role of Adipose derived stem cells in autologous fat grafting in the maxillofacial region. Results: Fat transfer techniques have demonstrated utility in the correction of a host of deformities through soft tissue augmentation. More recently, there is evidence that fat grafts harbor stem cells, Adipose derived stem cells and that these pluripotent cells produce factors beneficial for wound healing and regeneration. This autogenous tissue may also improve scar caliber and minimize scar burden. Many researches have recently revealed that infant-derived Adipose derived stem cells are more biologically robust than those obtained from adult tissue. Conclusion: It may be inferred from the above study that fat grafting may appear to enhance the esthetic outcome in the local anatomical region of the cleft.

Aim: Facial fat grafting has undergone noteworthy changes over time. Many different techniques have been followed by trying to advance the quality of the lipoaspirate and the survival of the fat graft after implantation. Methodology: The current review emphasizes the role of Adipose derived stem cells in autologous fat grafting in the maxillofacial region. Results: Fat transfer techniques have demonstrated utility in the correction of a host of deformities through soft tissue augmentation. More recently, there is evidence that fat grafts harbor stem cells, Adipose derived stem cells and that these pluripotent cells produce factors beneficial for wound healing and regeneration. This autogenous tissue may also improve scar caliber and minimize scar burden. Many researches have recently revealed that infant-derived Adipose derived stem cells are more biologically robust than those obtained from adult tissue. Conclusion: It may be inferred from the above study that fat grafting may appear to enhance the esthetic outcome in the local anatomical region of the cleft.

Background The objective of the Swedish cleft lip and palate (CLP) registry is to promote quality control, research and improvement of treatment, by comparison of the long-term results of surgery, orthodontics and speech from all six Swedish CLP centres. The purpose of the study was to investigate the coverage and reporting degree of the Swedish CLP registry, and to describe the design of the registry and discuss questions of reliability and validity of the data included. Methods All six Swedish CLP centres participate in the registry. All children in Sweden with cleft lip and/or cleft palate, born from 2009 onwards, are included in the registry. Baseline data such as cleft type (ICD-10 diagnosis), heredity, birth weight and additional deformities and/or syndromes, as well as pre-surgical treatment, are recorded at first visit. Data on surgical treatment are recorded continuously. Treatment outcome regarding dentofacial development and speech are recorded at follow-ups at 5, 10, 16 and 19 years of age. Data on dentofacial development are also recorded 1 year after orthognathic surgery. In addition, data on babbling and speech are recorded at 18 months of age. Coverage degree and reporting degree of surgery was assessed by comparison with registrations in the Swedish Central patient registry. Reporting degree of orthodontic and speech registrations at 5 years of age was assessed by comparison with registrations at baseline. Results The average coverage degree for children born 2009 to 2018 was 95.1%. For cleft-related surgeries, the average reporting degree was 92.4%. Average reporting degree of orthodontic registrations and speech registrations at age 5 years was 92 and 97.5% respectively. Conclusion In order to achieve valid and reliable data in a healthcare quality registry, the degree of coverage and reporting needs to be high, the variables included should be limited and checked for reliability, and the professionals must calibrate themselves regularly. The Swed

The Van der Woude Syndrome is a rare anomaly that affects orofacial structures and has been insufficiently reported in Latin America; its identification can be overlooked because it is closely related to cleft lip and palate. The objective of the article is to carry out, to our knowledge, the first report in Ecuador on this Syndrome characterized by the congenital association of sinuses in the lower lips with cleft lip and palate. In the Clinic of Lip and Cleft Palate of the Catholic University of Cuenca, a 6-year-old patient with the following characteristics presented in consultation: symmetrical lip fistulas on the lower lip; Asymptomatic and with sequelae of the lip and palate fissured with extreme salivation and dripping through the lip area upon chewing. The SVW may have other important clinical findings such as: skin folds in the limbs, hypodontia, bifid uvula, hookworm, and sensorineural hearing loss, of which the patient only presented bifid uvula and lip fistulas in addition to the sequela of LPF. The main diagnosis is purely clinical, therefore, complementary diagnoses are not needed, using routine studies such as preoperative laboratory exams, plus pediatric anesthesia and cardiology evaluation. The patient had sequelae from her first LPF surgery, so she underwent a new intervention and excision of the lip fistulas without any resulting sequela. Conclusion: In a case of cleft lip and palate with lip fistulas, an inter-consultation with pediatrics should always be carried out to rule out associated syndromes and proceed to their surgical excision, to avoid discomfort during the patient's chewing and for later cosmetic purposes. The surgical technique performed was the Spindle Technique (Fistulectomy), with which the ductal path is completely eliminated and a plane closure of the lip is performed, resulting in no sequelae., El Síndrome de Van der Woude (SVW) es una anomalía infrecuente que afecta a estructuras orofaciales y ha sido insuficientemente reportada en América Latina, su identificación puede ser pasada por alto debido a que está íntimamente relacionada con labio y paladar fisurado. El objetivo del artículo es realizar según nuestro conocimiento, el primer reporte en Ecuador sobre este Síndrome que se caracteriza por la asociación congénita de senos en labios inferiores con labio leporino y paladar hendido. En la Clínica de Labio y Paladar Fisurado de la Universidad Católica de Cuenca se presentó en consulta una paciente de 6 años con las siguientes características: fístulas labiales simétricas en el labio inferior; asintomático y con secuelas de labio y paladar fisurado (LPF) con salivación extrema y goteo por la zona labial a la masticación. El SVW puede contar con otros hallazgos clínicos importantes como: pliegues cutáneos en los miembros, hipodoncia, úvula bífida, anquiloglosia y pérdida de la audición neurosensorial, de los cuales la paciente únicamente presentó úvula bífida y las fístulas labiales además de la secuela de LPF. El principal diagnóstico es meramente clínico, por lo tanto, no se necesitan diagnósticos complementarios, utilizándose los estudios de rutina como exámenes de laboratorio pre operatorios, más la valoración anestésica y cardiológica pediátrica. La paciente presentó secuelas de su primera cirugía de LPF por lo que se procedió a una nueva intervención y a la escisión de las fístulas labiales sin ningún tipo de secuela resultante. Conclusión: En un caso de Labio y Paladar Fisurado con fístulas labiales siempre se deberá realizar interconsulta con Pediatría para descartar síndromes asociados y proceder a su escisión quirúrgica, para evitar molestias durante la masticación del paciente y con fines posteriormente estéticos. La técnica quirúrgica realizada fue la Técnica en Huso (Fistulectomía), con la cual elimina de manera completa el trayecto ductal y

Purpose: Examine the birth prevalence of cleft lip with or without cleft palate (CLP), Isolated cleft lip (CL) and isolated cleft palate (CP) in Manitoba between January 1 2008 and Dec 31 2019 and to establish the burden of early childhood caries (ECC) among these children. A retrospective chart review was conducted at the Manitoba Cleft Lip and Palate Program at the Health Science Centre in Winnipeg, Manitoba. Children registered between January 1, 2008 and December 31, 2019 with or without an underlying syndrome or significant medical history were included. Data was entered into a REDCap database including the following variables: sex, date of birth, postal code, type of orofacial clefting, whether GA was required to treat ECC, oral hygiene prior to treatment under GA, age at the time of GA, cost of treatment, and the type of treatment rendered. Cumulative scores of decayed, extracted, and filled primary teeth (dmft) were also calculated. The mean birth prevalence in Manitoba from 2008-2019 was 2.46 per 1000 live births for orofacial clefting, 1.33 per 1000 live births for CLP, 0.46 per 1000 per live births for isolated CP, and 0.41 per 1000 live births for isolated CL. The orofacial clefting in Manitoba was almost 1.5 times greater than the Canadian national average. A child with any form CLP, including those who were syndromic or presented with additional medical comorbidities between 12 – 59 months were 15 times more likely to require GA to treat their ECC than a healthy child. A CLP patient who had an associated syndrome was 32 times more likely to require GA to treat ECC than their aged matched healthy counterparts, and 3.5 times more likely to require GA to treat ECC than a CLP patient who is otherwise healthy. While the birth prevalence of CLP in Manitoba was relatively stable from 2008-2019, it has increased from 2 per 1000 live births in the period of 1948-1977 to 2.46 per 1000 live births. While the rates of general anesthetic (GA) to treat ECC is sign

Background: Craniofacial morphogenesis is the result of an intricate multistep network of tightly controlled spatial and temporal signalling that involves several molecules and transcription factors organized into highly coordinated pathways. Any alteration in even one step of this delicate process can lead to congenital malformations such as cleft palate. One of the first steps in embryonal orofacial development is the migration of cells from the neural crests to the branchial arches. Next, the cells have to proliferate, differentiate, move and connect to each other in order to correctly form the palate. Cell contraction, promoted by the interaction of non-muscle myosin II and actin A, is a crucial step in morphogenesis and is regulated by ROCK1 protein. Methods: A family-based association study was carried out in order to verify whether or not genetic variants of ROCK1 were associated with non-syndromic cleft palate (nsCP). Two cohorts from Italy and Iran, a total of 189 nsCP cases and their parents were enrolled. Results: The rs35996865-G allele was under-transmitted in cases of nsCP [P =.006, odds ratio (OR) = 0.63 (95% CI 0.45-0.88)]. Conclusion: This investigation reveals for the first time data supporting a role for ROCK1 in nsCP aetiology.

Background The objective of the Swedish cleft lip and palate (CLP) registry is to promote quality control, research and improvement of treatment, by comparison of the long-term results of surgery, orthodontics and speech from all six Swedish CLP centres. The purpose of the study was to investigate the coverage and reporting degree of the Swedish CLP registry, and to describe the design of the registry and discuss questions of reliability and validity of the data included. Methods All six Swedish CLP centres participate in the registry. All children in Sweden with cleft lip and/or cleft palate, born from 2009 onwards, are included in the registry. Baseline data such as cleft type (ICD-10 diagnosis), heredity, birth weight and additional deformities and/or syndromes, as well as pre-surgical treatment, are recorded at first visit. Data on surgical treatment are recorded continuously. Treatment outcome regarding dentofacial development and speech are recorded at follow-ups at 5, 10, 16 and 19 years of age. Data on dentofacial development are also recorded 1 year after orthognathic surgery. In addition, data on babbling and speech are recorded at 18 months of age. Coverage degree and reporting degree of surgery was assessed by comparison with registrations in the Swedish Central patient registry. Reporting degree of orthodontic and speech registrations at 5 years of age was assessed by comparison with registrations at baseline. Results The average coverage degree for children born 2009 to 2018 was 95.1%. For cleft-related surgeries, the average reporting degree was 92.4%. Average reporting degree of orthodontic registrations and speech registrations at age 5 years was 92 and 97.5% respectively. Conclusion In order to achieve valid and reliable data in a healthcare quality registry, the degree of coverage and reporting needs to be high, the variables included should be limited and checked for reliability, and the professionals must calibrate themselves regularly. The Swed

Background: The objective of the Swedish cleft lip and palate (CLP) registry is to promote quality control, research and improvement of treatment, by comparison of the long-term results of surgery, orthodontics and speech from all six Swedish CLP centres. The purpose of the study was to investigate the coverage and reporting degree of the Swedish CLP registry, and to describe the design of the registry and discuss questions of reliability and validity of the data included. Methods: All six Swedish CLP centres participate in the registry. All children in Sweden with cleft lip and/or cleft palate, born from 2009 onwards, are included in the registry. Baseline data such as cleft type (ICD-10 diagnosis), heredity, birth weight and additional deformities and/or syndromes, as well as pre-surgical treatment, are recorded at first visit. Data on surgical treatment are recorded continuously. Treatment outcome regarding dentofacial development and speech are recorded at follow-ups at 5, 10, 16 and 19 years of age. Data on dentofacial development are also recorded 1 year after orthognathic surgery. In addition, data on babbling and speech are recorded at 18 months of age. Coverage degree and reporting degree of surgery was assessed by comparison with registrations in the Swedish Central patient registry. Reporting degree of orthodontic and speech registrations at 5 years of age was assessed by comparison with registrations at baseline. Results: The average coverage degree for children born 2009 to 2018 was 95.1%. For cleft-related surgeries, the average reporting degree was 92.4%. Average reporting degree of orthodontic registrations and speech registrations at age 5 years was 92 and 97.5% respectively. Conclusion: In order to achieve valid and reliable data in a healthcare quality registry, the degree of coverage and reporting needs to be high, the variables included should be limited and checked for reliability, and the professionals must calibrate themselves regularly. The

Background: The objective of the Swedish cleft lip and palate (CLP) registry is to promote quality control, research and improvement of treatment, by comparison of the long-term results of surgery, orthodontics and speech from all six Swedish CLP centres. The purpose of the study was to investigate the coverage and reporting degree of the Swedish CLP registry, and to describe the design of the registry and discuss questions of reliability and validity of the data included. Methods: All six Swedish CLP centres participate in the registry. All children in Sweden with cleft lip and/or cleft palate, born from 2009 onwards, are included in the registry. Baseline data such as cleft type (ICD-10 diagnosis), heredity, birth weight and additional deformities and/or syndromes, as well as pre-surgical treatment, are recorded at first visit. Data on surgical treatment are recorded continuously. Treatment outcome regarding dentofacial development and speech are recorded at follow-ups at 5, 10, 16 and 19 years of age. Data on dentofacial development are also recorded 1 year after orthognathic surgery. In addition, data on babbling and speech are recorded at 18 months of age. Coverage degree and reporting degree of surgery was assessed by comparison with registrations in the Swedish Central patient registry. Reporting degree of orthodontic and speech registrations at 5 years of age was assessed by comparison with registrations at baseline. Results: The average coverage degree for children born 2009 to 2018 was 95.1%. For cleft-related surgeries, the average reporting degree was 92.4%. Average reporting degree of orthodontic registrations and speech registrations at age 5 years was 92 and 97.5% respectively. Conclusion: In order to achieve valid and reliable data in a healthcare quality registry, the degree of coverage and reporting needs to be high, the variables included should be limited and checked for reliability, and the professionals must calibrate themselves regularly. The

Background: The objective of the Swedish cleft lip and palate (CLP) registry is to promote quality control, research and improvement of treatment, by comparison of the long-term results of surgery, orthodontics and speech from all six Swedish CLP centres. The purpose of the study was to investigate the coverage and reporting degree of the Swedish CLP registry, and to describe the design of the registry and discuss questions of reliability and validity of the data included. Methods: All six Swedish CLP centres participate in the registry. All children in Sweden with cleft lip and/or cleft palate, born from 2009 onwards, are included in the registry. Baseline data such as cleft type (ICD-10 diagnosis), heredity, birth weight and additional deformities and/or syndromes, as well as pre-surgical treatment, are recorded at first visit. Data on surgical treatment are recorded continuously. Treatment outcome regarding dentofacial development and speech are recorded at follow-ups at 5, 10, 16 and 19 years of age. Data on dentofacial development are also recorded 1 year after orthognathic surgery. In addition, data on babbling and speech are recorded at 18 months of age. Coverage degree and reporting degree of surgery was assessed by comparison with registrations in the Swedish Central patient registry. Reporting degree of orthodontic and speech registrations at 5 years of age was assessed by comparison with registrations at baseline. Results: The average coverage degree for children born 2009 to 2018 was 95.1%. For cleft-related surgeries, the average reporting degree was 92.4%. Average reporting degree of orthodontic registrations and speech registrations at age 5 years was 92 and 97.5% respectively. Conclusion: In order to achieve valid and reliable data in a healthcare quality registry, the degree of coverage and reporting needs to be high, the variables included should be limited and checked for reliability, and the professionals must calibrate themselves regularly. The

Background The objective of the Swedish cleft lip and palate (CLP) registry is to promote quality control, research and improvement of treatment, by comparison of the long-term results of surgery, orthodontics and speech from all six Swedish CLP centres. The purpose of the study was to investigate the coverage and reporting degree of the Swedish CLP registry, and to describe the design of the registry and discuss questions of reliability and validity of the data included. Methods All six Swedish CLP centres participate in the registry. All children in Sweden with cleft lip and/or cleft palate, born from 2009 onwards, are included in the registry. Baseline data such as cleft type (ICD-10 diagnosis), heredity, birth weight and additional deformities and/or syndromes, as well as pre-surgical treatment, are recorded at first visit. Data on surgical treatment are recorded continuously. Treatment outcome regarding dentofacial development and speech are recorded at follow-ups at 5, 10, 16 and 19 years of age. Data on dentofacial development are also recorded 1 year after orthognathic surgery. In addition, data on babbling and speech are recorded at 18 months of age. Coverage degree and reporting degree of surgery was assessed by comparison with registrations in the Swedish Central patient registry. Reporting degree of orthodontic and speech registrations at 5 years of age was assessed by comparison with registrations at baseline. Results The average coverage degree for children born 2009 to 2018 was 95.1%. For cleft-related surgeries, the average reporting degree was 92.4%. Average reporting degree of orthodontic registrations and speech registrations at age 5 years was 92 and 97.5% respectively. Conclusion In order to achieve valid and reliable data in a healthcare quality registry, the degree of coverage and reporting needs to be high, the variables included should be limited and checked for reliability, and the professionals must calibrate themselves regularly. The Swed

Background The objective of the Swedish cleft lip and palate (CLP) registry is to promote quality control, research and improvement of treatment, by comparison of the long-term results of surgery, orthodontics and speech from all six Swedish CLP centres. The purpose of the study was to investigate the coverage and reporting degree of the Swedish CLP registry, and to describe the design of the registry and discuss questions of reliability and validity of the data included. Methods All six Swedish CLP centres participate in the registry. All children in Sweden with cleft lip and/or cleft palate, born from 2009 onwards, are included in the registry. Baseline data such as cleft type (ICD-10 diagnosis), heredity, birth weight and additional deformities and/or syndromes, as well as pre-surgical treatment, are recorded at first visit. Data on surgical treatment are recorded continuously. Treatment outcome regarding dentofacial development and speech are recorded at follow-ups at 5, 10, 16 and 19 years of age. Data on dentofacial development are also recorded 1 year after orthognathic surgery. In addition, data on babbling and speech are recorded at 18 months of age. Coverage degree and reporting degree of surgery was assessed by comparison with registrations in the Swedish Central patient registry. Reporting degree of orthodontic and speech registrations at 5 years of age was assessed by comparison with registrations at baseline. Results The average coverage degree for children born 2009 to 2018 was 95.1%. For cleft-related surgeries, the average reporting degree was 92.4%. Average reporting degree of orthodontic registrations and speech registrations at age 5 years was 92 and 97.5% respectively. Conclusion In order to achieve valid and reliable data in a healthcare quality registry, the degree of coverage and reporting needs to be high, the variables included should be limited and checked for reliability, and the professionals must calibrate themselves regularly. The Swed

Background: The objective of the Swedish cleft lip and palate (CLP) registry is to promote quality control, research and improvement of treatment, by comparison of the long-term results of surgery, orthodontics and speech from all six Swedish CLP centres. The purpose of the study was to investigate the coverage and reporting degree of the Swedish CLP registry, and to describe the design of the registry and discuss questions of reliability and validity of the data included. Methods: All six Swedish CLP centres participate in the registry. All children in Sweden with cleft lip and/or cleft palate, born from 2009 onwards, are included in the registry. Baseline data such as cleft type (ICD-10 diagnosis), heredity, birth weight and additional deformities and/or syndromes, as well as pre-surgical treatment, are recorded at first visit. Data on surgical treatment are recorded continuously. Treatment outcome regarding dentofacial development and speech are recorded at follow-ups at 5, 10, 16 and 19 years of age. Data on dentofacial development are also recorded 1 year after orthognathic surgery. In addition, data on babbling and speech are recorded at 18 months of age. Coverage degree and reporting degree of surgery was assessed by comparison with registrations in the Swedish Central patient registry. Reporting degree of orthodontic and speech registrations at 5 years of age was assessed by comparison with registrations at baseline. Results: The average coverage degree for children born 2009 to 2018 was 95.1%. For cleft-related surgeries, the average reporting degree was 92.4%. Average reporting degree of orthodontic registrations and speech registrations at age 5 years was 92 and 97.5% respectively. Conclusion: In order to achieve valid and reliable data in a healthcare quality registry, the degree of coverage and reporting needs to be high, the variables included should be limited and checked for reliability, and the professionals must calibrate themselves regularly. The

The aim of this study was to determine the rate of undetected additional anomalies following a prenatal diagnosis of isolated oral cleft. Data of all infants with a prenatal diagnosis of isolated oral cleft born between 2000 and 2015 were studied retrospectively. Additional anomalies detected after birth were categorized as minor or major and included structural and chromosomal anomalies. Isolated clefts of the lip (CL), lip and alveolus (CLA) and lip, alveolus, and palate (CLAP) were diagnosed prenatally in 176 live-born infants. The type of cleft was more extensive after birth in 34/176 (19.3%) and less extensive in 16/176 (9.1%) newborns. Additional anomalies were diagnosed in 24 infants (13.6%), of which 12 (6.8%) were categorized as major. The latter included two submicroscopic chromosome anomalies and two gene mutations. Postnatal additional anomalies occurred more frequently in CLA and CLAP than in CL, and more in bilateral than in unilateral clefts. Major anomalies are still found in infants with a prenatal diagnosis of an isolated oral cleft. The prevalence of additional anomalies seems to be related to the type and bilaterality of the cleft, and this should be considered during prenatal counselling.

Purpose: Examine the birth prevalence of cleft lip with or without cleft palate (CLP), Isolated cleft lip (CL) and isolated cleft palate (CP) in Manitoba between January 1 2008 and Dec 31 2019 and to establish the burden of early childhood caries (ECC) among these children. A retrospective chart review was conducted at the Manitoba Cleft Lip and Palate Program at the Health Science Centre in Winnipeg, Manitoba. Children registered between January 1, 2008 and December 31, 2019 with or without an underlying syndrome or significant medical history were included. Data was entered into a REDCap database including the following variables: sex, date of birth, postal code, type of orofacial clefting, whether GA was required to treat ECC, oral hygiene prior to treatment under GA, age at the time of GA, cost of treatment, and the type of treatment rendered. Cumulative scores of decayed, extracted, and filled primary teeth (dmft) were also calculated. The mean birth prevalence in Manitoba from 2008-2019 was 2.46 per 1000 live births for orofacial clefting, 1.33 per 1000 live births for CLP, 0.46 per 1000 per live births for isolated CP, and 0.41 per 1000 live births for isolated CL. The orofacial clefting in Manitoba was almost 1.5 times greater than the Canadian national average. A child with any form CLP, including those who were syndromic or presented with additional medical comorbidities between 12 – 59 months were 15 times more likely to require GA to treat their ECC than a healthy child. A CLP patient who had an associated syndrome was 32 times more likely to require GA to treat ECC than their aged matched healthy counterparts, and 3.5 times more likely to require GA to treat ECC than a CLP patient who is otherwise healthy. While the birth prevalence of CLP in Manitoba was relatively stable from 2008-2019, it has increased from 2 per 1000 live births in the period of 1948-1977 to 2.46 per 1000 live births. While the rates of general anesthetic (GA) to treat ECC is sign

Background: The objective of the Swedish cleft lip and palate (CLP) registry is to promote quality control, research and improvement of treatment, by comparison of the long-term results of surgery, orthodontics and speech from all six Swedish CLP centres. The purpose of the study was to investigate the coverage and reporting degree of the Swedish CLP registry, and to describe the design of the registry and discuss questions of reliability and validity of the data included. Methods: All six Swedish CLP centres participate in the registry. All children in Sweden with cleft lip and/or cleft palate, born from 2009 onwards, are included in the registry. Baseline data such as cleft type (ICD-10 diagnosis), heredity, birth weight and additional deformities and/or syndromes, as well as pre-surgical treatment, are recorded at first visit. Data on surgical treatment are recorded continuously. Treatment outcome regarding dentofacial development and speech are recorded at follow-ups at 5, 10, 16 and 19 years of age. Data on dentofacial development are also recorded 1 year after orthognathic surgery. In addition, data on babbling and speech are recorded at 18 months of age. Coverage degree and reporting degree of surgery was assessed by comparison with registrations in the Swedish Central patient registry. Reporting degree of orthodontic and speech registrations at 5 years of age was assessed by comparison with registrations at baseline. Results: The average coverage degree for children born 2009 to 2018 was 95.1%. For cleft-related surgeries, the average reporting degree was 92.4%. Average reporting degree of orthodontic registrations and speech registrations at age 5 years was 92 and 97.5% respectively. Conclusion: In order to achieve valid and reliable data in a healthcare quality registry, the degree of coverage and reporting needs to be high, the variables included should be limited and checked for reliability, and the professionals must calibrate themselves regularly. The

Objectives: This study aimed to examine Oral Health‐related Quality of Life (OHRQoL) among patients with cleft lip with or without palate (CLP) at their final scheduled follow‐up visit at the age of 18 years. Another aim was to investigate the motivation to attend multiple follow‐up appointments and the satisfaction with care given by the cleft team using inductive qualitative analysis. Methods: This cross‐sectional study was conducted among the cohort of children born with CLP who had undergone treatment at the Oulu University Hospital Cleft Lip and Palate Centre, in northern Finland since 1995. OHRQoL was assessed using the validated Finnish version of the short form of the Oral Health Impact Profile (OHIP‐14). In addition to the OHIP‐14, two open‐ended questions were also included. These questions investigated the experience of each participant concerning their motivation to attend the Oulu University Hospital Cleft Lip and Palate Centre to receive complex treatments, and their satisfaction with care provided by the cleft team. Results were presented as proportions, means, and SD. Inductive content analysis method was performed for analysis of the open‐ended questions. Results: A total of 63 patients with CLP participated in this study. More than half of the participants had cleft palate. More than half of the participants reported an impact on OHRQoL (OHIP‐14 score ≥ 3). All the participants with bilateral cleft lip and palate, three fourths of the participants with unilateral cleft lip and palate, and half of the participants with cleft palate reported impact on OHRQoL. Inductive content analysis showed that one fourth of the participants reported a good outcome as a motivation to attend cleft center despite of complex procedures. All the participants reported their appreciation of the cleft team. Conclusions: Despite the comprehensive treatment received by the patients born with a CLP, they still experienced lower OHRQoL, especially physical pain and