Search

Introduction: Orofacial cleft impacts jawbone and dental development and function, often with consequences for oral health. The first in this two-part systematic review of the literature on oral health in persons with cleft lip and/or palate focuses on periodontal parameters and composition of oral bacterial flora, while the second analyzes data on dental caries. Materials and Methods: Four databases (PubMed, Cochrane, Scopus, Web of Science) were searched for studies that compared periodontal parameters, caries index, and microbiota composition between persons with cleft lip and/or palate and healthy controls. The Newcastle–Ottawa scale and the Joanna Briggs Institute checklist were applied to evaluate study quality. Results: A total of 24 studies underwent systematic review, 18 of which entered meta-analysis. Twenty studies included a control group, while four included only persons with orofacial cleft. The first part (18 studies) compared periodontal parameters and oral microbiota. Conclusions: Meta-analysis of periodontal parameters (plaque index, gingival index, bleeding index, probing pocket depth, clinical attachment level) revealed an association between orofacial cleft and greater risk for poor oral health and periodontal disease. Good oral health relies on correct home oral hygiene and regular visits to the dentist starting at an early age. [ABSTRACT FROM AUTHOR]

Analyze contributing factors toward satisfaction after cleft lip and palate treatments in Senyum Bali Foundation. Qualitative case study, an interview with a semi-structured question from February to April 2023 by purposive sampling informants including parents, foundation staff, and plastic surgeon. Unsatisfying nose and teeth appearance due imperfect effects after surgery and requirement of more procedures. Mini model theory study that includes the appearance of the face and lips; speech and hearing; the functions of feeding, masticatory, breathing; psychosocial, quality of life, treatment cost-effectiveness, funding, health services, physician, implementing cultural contexts, surgical outcomes, and parents' feedback. [ABSTRACT FROM AUTHOR]

Background: Cleft lip and/or palate (CLP) malformation represents an important health problem in Mexico that does not cause morbidity but causes important sequelae ranging from the affectation in the child's image to functional, social, psychological, and learning problems, involving parents and the surrounding environment. Design: The present research had a descriptive and correlational cross-sectional design and was developed under a quantitative methodology. Participants: Ninety-three children, 53 (57%) male and 40 (43%) female, with a mean age of 9.6 years. Outcome Measures: The Piers–Harris self-concept scale and report card of the concluded school year were used. Results: It was found that the results of the global self-concept, as well as two of its dimensions (adjustment behavior, intellectual state), resulted to have a significant positive correlation (P < 0.01). That is, high self-concept is associated with high academic achievement, better adjustment behavior is associated with higher academic achievement and higher intellectual status is associated with high academic achievement, while other two dimensions (popularity and happiness and satisfaction) showed a low positive relationship. Conclusions: The results found in this research are relevant for the knowledge and explanation of the different psychosocial factors that are present in the socioemotional and academic development of the child with CLP and his family, being a population in Mexico little studied in terms of emotional, psychological and educational sequelae. [ABSTRACT FROM AUTHOR]

Abstract Background Depression is the most common psychological phenomenon among caregivers of children with Cleft Lip and/or Palate and affects the quality of life, treatment satisfaction, children’s self-esteem and parent–child relationship. However, Existing studies have limited explanations for the mechanisms that lead to depression in caregivers of children with Cleft Lip and/or Palate. The present study aimed to identify factors influencing depression among caregivers of children with Cleft Lip and/or Palate and to provide a reference point and new ideas for future research. Methods This cross-sectional study investigated 248 caregivers at two Cleft Lip and/or Palate treatment centers in China, spanning from April 2019 to July 2020. The diathesis-stress model was used to construct the model, and data analysis was conducted using SPSS 26.0 and AMOS 25.0. Path analysis was employed to test the hypothetical model, and the fit of the model was evaluated using Chi-Square/degree of freedom, Goodness-of-Fit Index, Normed Fit Index, Relative Fit Index, Incremental Fit Index, Tacker-Lewis Index, Comparative Fit Index and Root Mean Square Error of Approximation. Results The study found that the average level of depression among caregivers of children with Cleft Lip and/or Palate was 4.83 (4.79). Additionally, 43.5% of caregivers exhibited depressive symptoms. The fit of the modified path model was found to be satisfactory, with the following indices: Chi-Square/degree of freedom = 1.881, Goodness-of-Fit Index = 0.986, Normed Fit Index = 0.973, Relative Fit Index = 0.919, Incremental Fit Index = 0.987, Tucker-Lewis Index = 0.960, Comparative Fit Index = 0.987, and Root Mean Square Error of Approximation (RMSEA) = 0.060. The results indicated that parenting stress had the greatest direct impact on depression, followed by hope. Indirect effects on depression were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress. Conclusions This study suggests that depression in caregivers of children with Cleft Lip and/or Palate was leadingly influenced by parenting stress and hope. Strategies aimed at the key factors are expected to decrease depression.

Abstract Background Resilience refers to an individual’s ability to thrive despite adversity. Children with cleft lip and/or palate (CL/P) face numerous challenges during school age due to speech and aesthetic differences compared to typically developing (TD) children. This study aims to compare the resilience levels between Malaysian children with CL/P and TD children, utilizing the Malay-translated Resilience Scale-10 (RS-10)© ([Wagnild, Resilience scale for children (RS10) user’s guide 2015, n.d]). Results A total of 121 Malaysian children comprising 52 CL/P and 69 TD children between the ages of 7 to 12 years participated in this study. Among the children with CL/P, 49 exhibited intelligible speech with mild to moderate differences, while three had severely reduced intelligibility. Participants completed the RS-10 online with parental assistance. The total mean scores of resilience for TD and CL/P were 30.80 ± 4.28 and 33.15 ± 6.01 respectively. The t-test results showed no significant differences in resilience scores between groups and across genders. The analysis of variance showed no significant difference between age groups. Regression analysis revealed that age and group were marginally significant predictors of resilience scores. Specifically, each additional year of age was associated with a 0.47-point reduction in RS-10 scores highlighting coping difficulties associated with CL/P in older children. Conclusions The findings highlight the resilience of Malaysian children with CL/P, showing they can achieve resilience levels similar to their TD peers, particularly when speech outcomes are favourable.

Abstract Background This study aims to validate a hypothesized model of the relationships between optimism, resilience, coping, parenting stress, perceived social support, and anxiety, as well as their influencing factors and consequences among caregivers of children diagnosed with cleft lip and/or palate (CL/P). Methods A hypothesized model was proposed based on diathesis-stress theoretical model and existing literature. A convenience sample of two CL/P treatment centers in China was collected between April 2019 and July 2020. Various well-validated instruments were used to collect 248 valid data points. Descriptive statistics and correlations were computed to assess model fitness and path analysis was performed to investigate direct and indirect effects. Results The results revealed that the average level of anxiety among caregivers of children suffering from CL/P was 3.00 (0.00,6.00). The fitness of the modified path model was evaluated using various measures, including χ2/df = 1.806, GFI = 0.989, RFI = 0.916, IFI = 0.990, CFI = 0.989, TLI = 0.960, RMSEA = 0.0570. Parenting stress had the greatest direct associated with anxiety, followed by perceived social support. Moreover, indirect relations to anxiety were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress. Conclusion In summary, this work suggests that both parenting stress and perceived social support in caregivers of children suffering from CL/P are associated with anxiety. Therefore, developing effective intervention approaches targeting key factors might potentially instrumental to alleviate anxiety.

Background: Depression is the most common psychological phenomenon among caregivers of children with Cleft Lip and/or Palate and affects the quality of life, treatment satisfaction, children's self-esteem and parent–child relationship. However, Existing studies have limited explanations for the mechanisms that lead to depression in caregivers of children with Cleft Lip and/or Palate. The present study aimed to identify factors influencing depression among caregivers of children with Cleft Lip and/or Palate and to provide a reference point and new ideas for future research. Methods: This cross-sectional study investigated 248 caregivers at two Cleft Lip and/or Palate treatment centers in China, spanning from April 2019 to July 2020. The diathesis-stress model was used to construct the model, and data analysis was conducted using SPSS 26.0 and AMOS 25.0. Path analysis was employed to test the hypothetical model, and the fit of the model was evaluated using Chi-Square/degree of freedom, Goodness-of-Fit Index, Normed Fit Index, Relative Fit Index, Incremental Fit Index, Tacker-Lewis Index, Comparative Fit Index and Root Mean Square Error of Approximation. Results: The study found that the average level of depression among caregivers of children with Cleft Lip and/or Palate was 4.83 (4.79). Additionally, 43.5% of caregivers exhibited depressive symptoms. The fit of the modified path model was found to be satisfactory, with the following indices: Chi-Square/degree of freedom = 1.881, Goodness-of-Fit Index = 0.986, Normed Fit Index = 0.973, Relative Fit Index = 0.919, Incremental Fit Index = 0.987, Tucker-Lewis Index = 0.960, Comparative Fit Index = 0.987, and Root Mean Square Error of Approximation (RMSEA) = 0.060. The results indicated that parenting stress had the greatest direct impact on depression, followed by hope. Indirect effects on depression were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress. Conclusions: This study suggests that depression in caregivers of children with Cleft Lip and/or Palate was leadingly influenced by parenting stress and hope. Strategies aimed at the key factors are expected to decrease depression. [ABSTRACT FROM AUTHOR]

Background: Resilience refers to an individual's ability to thrive despite adversity. Children with cleft lip and/or palate (CL/P) face numerous challenges during school age due to speech and aesthetic differences compared to typically developing (TD) children. This study aims to compare the resilience levels between Malaysian children with CL/P and TD children, utilizing the Malay-translated Resilience Scale-10 (RS-10)© ([Wagnild, Resilience scale for children (RS10) user's guide 2015, n.d]). Results: A total of 121 Malaysian children comprising 52 CL/P and 69 TD children between the ages of 7 to 12 years participated in this study. Among the children with CL/P, 49 exhibited intelligible speech with mild to moderate differences, while three had severely reduced intelligibility. Participants completed the RS-10 online with parental assistance. The total mean scores of resilience for TD and CL/P were 30.80 ± 4.28 and 33.15 ± 6.01 respectively. The t-test results showed no significant differences in resilience scores between groups and across genders. The analysis of variance showed no significant difference between age groups. Regression analysis revealed that age and group were marginally significant predictors of resilience scores. Specifically, each additional year of age was associated with a 0.47-point reduction in RS-10 scores highlighting coping difficulties associated with CL/P in older children. Conclusions: The findings highlight the resilience of Malaysian children with CL/P, showing they can achieve resilience levels similar to their TD peers, particularly when speech outcomes are favourable. [ABSTRACT FROM AUTHOR]

BackgroundCleft lip and/or palate (CL/P) speech is a significant communication disorder with notable and enduring consequences. This study focused on developing an intervention mapping (IM)-based and parent-implemented early intervention to improve speech and language skills among infants and toddlers with CL/P in China.MethodsAn IM procedure was used to develop a parent-implemented early intervention. First, parent–child interaction problems affecting language development in infants and toddlers were identified through 132 questionnaires completed by parents of children with CL/P and 30 family videos of parent–child interactions. Second, according to the problem diagnosis, the logical model of parent–child interaction behavior change was constructed. Finally, the health outcomes were transformed into intervention goals at three levels (i.e., infants and toddlers with CL/P, parents and environment), and a set of early intervention programs were designed by integrating various intervention techniques.ResultsThe diagnosis of parent–child interaction problems showed that 40.91% of parents and children often use electronic media together; in parent–child interaction, 41.67% of parents presented ‘lack of waiting’, 29.55% overcorrected pronunciation errors. Video analysis revealed issues in parent–child interaction, such as inadequate parental skills, ineffective interactions, and an unsuitable environment. A parent-implemented early intervention was developed, including the following specific steps: health education within the hospital, 9 days of an online reading program in WeChat groups, face-to-face standardized training workshops, and individualized video feedback therapy.ConclusionWe have devised a parent-implemented early intervention to enhance speech and language abilities in Mandarin-speaking infants and toddlers with CL/P, overcoming the shortage of speech therapy services in China.

Background: The development of communication, speech and language follows three stages (development of the parent–child relationship, interactions and actual speech and language acquisition). Children born with cleft lip and/or palate are at increased risk of communicative problems while parents may be going through an emotionally difficult time. Early parent‐implemented logopaedic intervention that supports both parents and child is important. Three systematic reviews have examined the effects of early speech and language interventions, but not their structure and content. Aims: To investigate which early parent‐implemented logopaedic interventions already exist for children with cleft lip and/or palate, and to evaluate their structure, content and time of onset against the three stages of communicative development. Methods: Six databases (PubMed, Embase, Web of Science, APA PsycInfo, Cinahl and Scopus) were searched between inception and 31 March 2023 to identify published articles that reported early parent‐implemented logopaedic interventions in children with cleft lip and/or palate, aged 0 to 3 years, clearly describing the strategies used to train parents. Two authors independently assessed the eligibility of the studies. Quality assessment was conducted using the Physiotherapy Evidence Database quality assessment tool, Single‐Case Experimental Design tool and the National Institutes of Health pre‐post‐study tools. The structure and content of the interventions were analysed taking into account the needs and difficulties of both the parents and the child according to the three stages of communicative development. Main contribution: The systematic literature search identified four studies that met the inclusion criteria. Three of them had a Level of Evidence III and one study had a Level of Evidence IV. Strategies appropriate for Stage 1 of communicative development (parent–child relationship) are well represented in only one study, but the psychosocial needs of parents are currently not included in these programmes. However, research shows that parental emotional difficulties can adversely impact a child's communicative development. Strategies appropriate for Stage 2 (promoting social interactions) are better represented. However, strategies appropriate for Stage 3 (acquiring correct speech and language patterns) are most represented in all intervention programmes. Conclusions: Three out of four intervention programmes focus on Stage 3 (actual speech and language stimulation). Stage 1 is underrepresented and the psychosocial needs of parents are currently not included in existing intervention programmes. Further research is needed in close collaboration with psychologists to construct a comprehensive, longitudinal, developmentally appropriate intervention programme that equally represents the three stages of communicative development and considers the psychosocial needs of parents. WHAT THIS PAPER ADDS: What is already known on the subject: Children with cleft lip and/or palate are at increased risk of speech and language problems from birth. Parents of these children often have emotional problems following their child's diagnosis. The effectiveness of early intervention to facilitate the child's speech and language development has already been proven. Early intervention is recommended for both parents and child, but little is known about early parent‐implemented logopaedic interventions that also provide psychosocial support for parents. What this paper adds to existing knowledge: This review has shown that existing early parent‐implemented logopaedic interventions for children with cleft lip and/or palate focus mainly on facilitating responsive interactions and actual speech and language development (Stages 2 and 3 of communicative development).However, Stage 1, where the parent–child relationship develops, is currently not included, even though this stage is a prerequisite of subsequent stages. If parents are struggling with emotional problems (following their child's diagnosis) this can negatively impact their mental health, the parent–child relationship, attachment and their child's development. What are the potential or actual clinical implications of this work?: A clinical implication of the findings in this review is that more attention should be paid to Stage 1 of communicative development in early parent‐implemented logopaedic interventions. By working closely with the psychologist of the cleft (and craniofacial) team, any psychosocial needs of the parents can be included in the counselling. As a result, the parents and their child are seen and supported as a unit and the parent–child relationship can develop optimally. [ABSTRACT FROM AUTHOR]

Cleft lip and/or palate (CLP) is a congenital malformation that affects embryological formation, craniofacial growth, and development of people who have it, which is why they require a transdisciplinary team from birth for their treatment. The intervention of the stomatologist in these transdisciplinary teams is fundamental, since this treatment is longitudinal, biopsychosocial, and equitable, according to the oral-maxillary health needs of people with CLP, through different stomatological treatment protocols. [ABSTRACT FROM AUTHOR]

This case report presents a virtual treatment simulation of the orthodontic treatment and surgery-first orthognathic surgery employed to treat a patient with a repaired unilateral cleft lip and alveolus with Class III malocclusion and lower third facial asymmetry. The patient exhibited a negative overjet of 9 mm, a missing lower right second premolar, and a 5 mm gap between the upper right central and lateral incisors with midline discrepancy. The three-dimensional virtual planning began with virtual pre-surgical orthodontics, followed by the positioning of the facial bones and teeth in their ideal aesthetic and functional positions. The sequence of steps needed to achieve this outcome was then reverse-engineered and recorded using multiplatform Nemostudio software (Nemotec, Madrid, Spain), which facilitated both surgical and orthodontic planning. The treatment included a two-piece segmental maxillary osteotomy for dental space closure, a LeFort I maxillary advancement, and a mandibular setback with bilateral sagittal split osteotomy to correct the skeletal underbite and asymmetry. A novel approach was employed by pre-treating the patient for orthognathic surgeries at age 11, seven years prior to the surgery. This early phase of orthodontic treatment aligned the patient's teeth and established the dental arch form. The positions of the teeth were maintained with retainers, eliminating the need for pre-surgical orthodontics later. This early phase of treatment significantly reduced the treatment time. The use of software to predict all the necessary steps for surgery and post-surgical orthodontic tooth movements made this approach possible. Multi-step virtual planning can be a powerful tool for analyzing complex craniofacial problems that require multidisciplinary care, such as cleft lip and/or palate. [ABSTRACT FROM AUTHOR]

Objectives: After cleft lip and/or palate (CL/P) repair, children may develop velopharyngeal insufficiency (VPI) leading to speech imperfections, necessitating additional speech correcting surgery. This study examines the incidence of VPI and speech correcting surgery after Sommerlad’s palatoplasty for CL/P, and its association with various clinical features. Materials and methods: A retrospective cohort study was performed in the Wilhelmina Children’s Hospital in Utrecht and child records from 380 individuals with CL/P registered from 2008 to 2017 were retrospectively reviewed. Inclusion criteria comprised the diagnosis of CL/P, primary palatoplasty according to Sommerlad’s technique, and speech assessment at five years or older. Association between cleft type and width, presence of additional genetic disorders and postoperative complications (palatal dehiscence, fistula) were assessed using odds ratios and chi squared tests. Results: A total of 239 patients were included. The VPI rate was 52.7% (n = 126) and in 119 patients (49.8%) a speech correcting surgery was performed. Severe cleft type, as indicated by a higher Veau classification, was associated with a significant higher rate of speech correcting surgeries (p = 0.033). Significantly more speech correcting surgeries were performed in patients with a cleft width >10 mm, compared to patients with a cleft width ≤10 mm (p < 0.001). Patients with oronasal fistula underwent significantly more speech correcting surgeries than those without fistula (p = 0.004). No statistically significant difference was found in the incidence of speech correcting surgery between patients with and without genetic disorders (p = 0.890). Conclusions/clinical relevance: Variations in cleft morphology, cleft width and complications like oronasal fistula are associated with different speech outcomes. Future research should focus on creating a multivariable prediction model for speech correcting surgery in CL/P patients. [ABSTRACT FROM AUTHOR]

This study compares condylar volumetric asymmetry and facial asymmetry in patients with cleft lip and/or palate (CLP) and controls. The mandibular condyle is important to facial growth, but its role in facial asymmetry for those with CLP has not been described. Condylar volumes and mandibular asymmetry were retrospectively calculated using Mimics Version 23.0 (Materialise, Leuven, Belgium) from patients with CLP undergoing computed tomography (CT) imaging and a cohort of controls. A total of 101 participants, 60 with CLP and 41 controls, had mean condylar volumetric asymmetry of 16.4 ± 17.4 % (CLP) and 6.0 ± 4.0 % (controls) (p = 0.0002). Patients with CLP who had clinically significant chin deviation (>4 mm) had more asymmetric condyles than those without significant chin deviation (p = 0.003). The chin deviated toward the smaller condyle in patients with facial asymmetry more often than in patients without facial asymmetry (81 % vs. 62 %, p = 0.033). While controls had some degree of condylar asymmetry, it tended to be milder and not associated with facial asymmetry. There is a greater degree of condylar volumetric asymmetry in patients with CLP compared to individuals in the general population. Clinically significant facial asymmetry in CLP is associated with a higher degree of condylar asymmetry, with the facial midline deviating toward the smaller condyle. [ABSTRACT FROM AUTHOR]

Background: Cleft lip and/or palate (CL/P) is one of the most frequent craniofacial disorder which could associate with a wide range of craniofacial complication. In order to perform comprehensive care of CL/P patients, it is crucial to elucidate the link of CL/P and general clinical conditions. This study aims to elucidate the relationships between medical history of different CL/P types and infectious diseases to serve as a reference for the comprehensive care of patients with CL/P. Methods: We investigated the association between a history different types of CL/P and the risk of infectious diseases among 1-year old children in the Japan Environment and Children’s Study (JECS). Among the 104,065 registered fetal records, 92,590 eligible participants were included in the analysis. Results: The multivariable-adjusted risk ratios (95% confidence intervals) for otitis media were increased in cleft lip and palate (CLP) and cleft palate only (CPO) groups by 3.81 (2.73–5.31) and 2.27 (1.22–4.22), respectively. The prevalence of Upper respiratory inflammation (URTI) was not associated with CLP, cleft lip only, or CPO. However, analysis in all groups showed a higher risk of URTI compared with the control group (1.31 [1.04–1.66]). Conclusions: CL/P care requires additional attention to prevent airway infectious diseases such as URTI before 1 year of age. Further research is warranted to elucidate the relationship between CL/P and general medical conditions.

Background: The pathogenesis of orofacial cleft (OFC) is multifactorial, involving both genetic and non-genetic factors, the latter of which play a key role in the development of these anomalies. This paper addresses the incidence of OFC in Indonesia, with a focus on identifying and examining the distribution of contributory factors, including parental medical history, pregnancy history, and environmental influences. Methods: The study was conducted through the collection of primary data. An interdisciplinary research team from Indonesia administered a standardized questionnaire to parents who had children with OFC and who had provided informed consent. The case group comprised 133 children born with cleft lip and/or palate, and the control was 133 noncleft children born full-term. The risk factors associated with OFC anomalies were analyzed using the chi-square test and logistic regression. All statistical analyses were performed using SPSS version 25. A p-value of 0.05 or less was considered to indicate statistical significance. Results: The study comprised 138 children, of whom 82 were boys (59.4%) and 56 were girls (40.6%). Among them, 45 patients (32.6%) presented with both cleft lip and cleft palate, 25 individuals (18.1%) had a cleft palate only, and 28 patients (20.3%) had a cleft lip only. OFC was found to be significantly associated with a maternal family history of congenital birth defects (p< 0.05), complications during the first trimester (p< 0.05), consumption of local fish (p< 0.05), caffeine intake (p< 0.05), prolonged medication use (p< 0.05), immunization history (p< 0.05), passive smoking (p< 0.05), and X-ray exposure during pregnancy (p< 0.05). Conclusion: The findings indicate close relationships between the incidence of OFC and maternal medical history, prenatal factors, and environmental influences. [ABSTRACT FROM AUTHOR]

Cleft lip and/or palate anomalies (CL ± P) are the most frequent birth defects affecting the orofacial region in humans. Although their etiology remains unclear, the involvement of environmental and genetic risk factors is known. This observational study aimed to investigate how the use of crude drugs with estrogen activity influenced an animal model's ability to prevent CL ± P. A/J mice were randomly divided into six experimental groups. Five of these groups consumed a drink containing crude drug licorice root extract, with the following weights attributed to each group: 3 g in group I, 6 g in group II, 7.5 g in group III, 9 g in group IV, and 12 g in group V, whereas a control group consumed tap water. The effect of licorice extract was examined for fetal mortality and fetal orofacial cleft development compared to the control group. The rates for fetal mortality were 11.28%, 7.41%, 9.18%, 4.94%, and 7.90% in groups I, II, III, IV, and V, respectively, compared to 13.51% in the control group. There were no significant differences in the mean weight of alive fetuses in all five groups compared to the control group (0.63 ± 0.12). Group IV showed the lowest orafacial cleft occurrence of 3.20% (8 fetuses) with statistical significance (p = 0.0048) out of 268 live fetuses, whereas the control group had the occurrence of 8.75% (42 fetuses) among 480 live fetuses. Our study showed that the dried licorice root extract may reduce orofacial birth defects in experimental animal studies. [ABSTRACT FROM AUTHOR]

Background Special educational needs (SEN) provision is designed to help pupils with additional educational, behavioural or health needs; for example, pupils with cleft lip and/or palate may be offered SEN provision to improve their speech and language skills. Our aim is to contribute to the literature and assess the impact of SEN provision on health and educational outcomes for a well-defined population. Methods We will use the ECHILD database, which links educational and health records across England. Our target population consists of children identified within ECHILD to have a specific congenital anomaly: isolated cleft lip and/or palate. We will apply a trial emulation framework to reduce biases in design and analysis of observational data to investigate the causal impact of SEN provision (including none) by the start of compulsory education (Year One – age five year on entry) on the number of unplanned hospital utilisation and school absences by the end of primary education (Year Six – age ten/eleven). We will use propensity score-based estimators (inverse probability weighting (IPW) and IPW regression adjustment IPW) to compare categories of SEN provision in terms of these outcomes and to triangulate results obtained using complementary estimation methods (Naïve estimator, multivariable regression, parametric g-formula, and if possible, instrumental variables), targeting a variety of causal contrasts (average treatment effect/in the treated/in the not treated) of SEN provision. Conclusions This study will evaluate the impact of reasonable adjustments at the start of compulsory education on health and educational outcomes in the isolated cleft lip and palate population by triangulating complementary methods under a target-trial framework.

Objectives: Professionals in the United Kingdom providing care to new families affected by cleft lip and/or palate (CL/P) had to adapt to ensure families' needs were met during a time of uncertainty due to Covid-19. The aims of this study were to explore the impacts of the pandemic on CL/P care provision for new families from the perspectives of professionals working in medical and community settings along with any personal impact on professionals and their reflections on the future of CL/P care. Design: Semistructured interviews (n = 27) were completed about experiences from March 2020 to October 2020 with consultant cleft surgeons (n = 15), lead clinical nurse specialists (n = 8), and staff working at the Cleft Lip and Palate Association (n = 4). Transcripts were analyzed using inductive thematic analysis. Results: Three themes were identified: (1) the impact of Covid-19 on the provision of cleft care in the United Kingdom, including working conditions, delays to treatment, and Covid-19 policies; (2) the impact of the pandemic on professionals' mental health, including personal distress and concerns about Covid-19 exposure; and (3) reflections on the future of CL/P care, whereby professionals expressed both hope and concern about the Covid-19 recovery effort. Conclusions: The ongoing Covid-19 pandemic has impacted CL/P service delivery for new families significantly, warranting recommendations for cohesive psychological support for families in addition to a safe and resourced recovery effort. Support for professionals is also suggested, following existing evidence-based models for providers' needs that address the difficulties of working throughout challenging times. [ABSTRACT FROM AUTHOR]

In patients with clefts, the affection of other congenital malformations on the feeding is unclear. We investigated the other congenital malformations and nutritional intake of neonates with cleft lip and/or palate and examined their relationships associated with cleft type and laterality. The participants included 126 infants under treatment with a presurgical naso‐alveolar molding (PNAM) or a Hotz‐type plate. The survey items were gender, cleft type and side, presence and nature of other congenital malformations, birth weight and nutritional method at age of the fifth day. The number of infants was 36 (28.6%) of cleft lip and alveolus, 82 (65.1%) of cleft lip and palate, and 8 (6.3%) of cleft palate only. Forty‐three patients (34.1%) had other various congenital malformations. The nutritional method included oral intake in 78.6% (n = 99) of cases and tube feeding with/without oral intake in 21.4% (n = 27) of cases. The rate of tube feeding was higher for right‐sided clefts than that for left‐sided clefts. This observation was consistent with the fact that right‐sided clefts were associated with more significant other congenital malformations than those on the left‐side. The nutritional method for infants with cleft lip and/or palate was related to the presence of other congenital malformations, not to cleft laterality or oral cleft itself under early treatment with PNAM plate. These results proposed that screening the general condition is essential for neonates with right‐sided cleft lip with/without cleft palate compared to left‐sided clefts, which should be conducted immediately after birth for planning the appropriate nutritional method. [ABSTRACT FROM AUTHOR]

Non-syndromic cleft lip and/or palate (NSCL/P) is a congenital malformation with a prevalence of 1:700 births. It has a multifactorial etiology. Human craniofacial development takes place during the first 10 weeks of pregnancy. Normal craniofacial development arises from the convergence and fusion of the facial and palatal processes and involves interactions between genes that regulate cell growth, proliferation, differentiation, epithelial-to-mesenchymal transition, and apoptosis. Whole genome/exome analysis, and also genome-wide association studies give us to chance to identify the genetic factors which contribute to the development of NSCL/P. After detecting a cleft lip and/or palate on ultrasonography without associated anomalies, the patient should be evaluated in collaboration with a clinical geneticist, taking into account the many genes and environmental factors involved in NSCL/P etiopathogenesis, and a roadmap for possible genetic diagnosis should be drawn. [ABSTRACT FROM AUTHOR]

Introduction: Relevance of fetal brain magnetic resonance imaging (MRI) in cases of cleft lip and/or palate (CL/P) is still discussed to date. The aim of our study was to review the contribution of fetal brain MRI for detecting cerebral anomalies in cases of CL/P comparing antenatal data with neonatal outcomes. Methods: A retrospective multicenter study was conducted from January 2010 to October 2020 in two multidisciplinary prenatal diagnosis centers among women with a fetal ultrasound (US) diagnosis of CL/P. Prenatal imaging and genetic analysis data were collected, as well as postnatal data, including outcomes of children who had an abnormal prenatal MRI. Results: Among the 202 fetuses with a US diagnosis of CL/P, 96 underwent US and fetal brain MRI. 19 brain MRIs were found to be abnormal: 14 (73.7%) involved CL/P associated with other US abnormalities and five (26.3%) involved isolated clefts, of which four were cleft lip and alveolus and secondary palate (CLP). MRI identified severe abnormalities that changed the prognoses of 3 cases of clefts associated with other US abnormalities. In contrast, MRI found only minor abnormalities for the five isolated clefts, with no postnatal disorders found in these children. Conclusion: Fetal brain MRI should be proposed in cases of clefts associated with other anomalies or if US examination is limited by local conditions. MRI could also be discussed in cases of isolated CLP but should not be performed in cases of isolated cleft lip. [ABSTRACT FROM AUTHOR]

The most common oro-facial congenital deformity reported in live newborns is a cleft of the lip, palate, or both. The objective of this study was to the updates in management, and outcomes of cases of cleft lip and/or palate. PubMed and EBSCO Information Services will be chosen as the search databases for the publications used within the study. Topics concerning the updates in management, and outcomes of cases of cleft lip and/or palate, published in English around the world. No software will be utilized to analyze the data. The anomaly is characterized by the lack of continuity of tissues creating the lip, alveolus, and soft and hard palate. The severity ranges from a small notch in the lip to an ample fissure extending into the roof of the mouth and nose. Cases of cleft lip or cleft palate (or both) will need care from a multidisciplinary team of authorities from a 'cleft and craniofacial anomalies service'. If a cleft lip or palate was detected during pregnancy, it can also be mentioned to a cleft team before birth. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to identify the risk factors associated with nonsyndromic orofacial clefts (NSOFCs) among Saudi children., Materials and Methods: A case-control study was carried out at the Ministry of National Guard Health Affairs. Cases were children with NSOFCs who were matched by gender and year of birth to healthy controls from the same setting. Data on risk factors were collected by interviewing parents of both cases and controls using a validated questionnaire. The questionnaire consisted of the father's and mother's information and the child's information. The level of significance was set at 0.05. Odds ratio (OR) and 95% confidence intervals (CIs) were used to determine the associated risk factors with NSOFCs., Results: A total of 188 children were included (88 cases and 100 controls), with a mean age of 5.1 ± 2.3 years. Maternal fever during pregnancy was associated with a significantly higher risk of NSOFCs (OR = 3.4, 95% CI: 0.05-2.5, p < 0.05). Additionally, the presence of maternal relatives with orofacial clefts increased the risk (OR = 6.02, 95% CI: 0.43-3.16, p < 0.001), whereas the strongest predictor was paternal relatives with orofacial clefts (OR = 8.00, 95% CI: 0.41-3.75, p = 0.014). These findings are of utmost importance for the understanding and potential prevention of NSOFCs., Conclusions: The presence of paternal or maternal relatives with orofacial clefts and maternal fever during the first trimester were predictors for NSOFCs, with having affected paternal relatives being the strongest predictor., (© 2025 The Author(s). Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Analyze contributing factors toward satisfaction after cleft lip and palate treatments in Senyum Bali Foundation. Qualitative case study, an interview with a semi-structured question from February to April 2023 by purposive sampling informants including parents, foundation staff, and plastic surgeon. Unsatisfying nose and teeth appearance due imperfect effects after surgery and requirement of more procedures. Mini model theory study that includes the appearance of the face and lips; speech and hearing; the functions of feeding, masticatory, breathing; psychosocial, quality of life, treatment cost-effectiveness, funding, health services, physician, implementing cultural contexts, surgical outcomes, and parents' feedback., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Cleft lip/palate (CL/P) is considered to be the most common congenital abnormality caused by genetic and environmental factors. Certain genes related to CL/Ps have been identified and explored to determine their etiology. One of the most influential genes in the pathogenesis of CL/P is methylenetetrahydrofolate reductase (MTHFR) gene. Polymorphism of MTHFR gene impair craniofacial development during first trimester of pregnancy. This study aims to identify the single nucleotide polymorphism (SNP) C6777T of the MTHFR gene in non-syndromic CL/P patients. DNA samples were obtained from 30 non-syndromic CL/P patients. The Deoxyribonucleic acid (DNA) was amplified for Polymerase Chain Reaction (PCR) examination. Electrophoresis was performed on agarose gel to visualize PCR product, and sequencing was conducted on three specimens. The polymorphism of MTHFR C677T was examined using Restriction Fragment Length Polymorphisms (RFLP) technique. Based on analysis using restriction enzyme and bioinformatic software, cytosine was substituted into thymine in nucleotide 222 on exon 4. Valin was synthesized instead of alanine. Genotype CC was found in 22 patients (73%) and genotype CT in eight patients (73%), while the mutant homozygote TT was not found in this study. The SNP C6777T of the MTHFR gene is associated with non-syndromic CL/P. [ABSTRACT FROM AUTHOR]

Abstract Background Few reports have examined dental arch morphology (DAM) after dental implant placement in cleft patients and its actual state is unclear. Objective To analyze the presence of changes in DAM and influencing factors in cleft lip and/or palate (CLP) patients who receive implant treatment in the alveolar cleft region. Methods Subjects comprised 20 CLP patients in whom maxillary dental arch width (DAW) was evaluated before and after implant treatment based on computed tomography data. First, widths between the canines (W3), between the first premolars (W4), between the second premolars (W5), and between the first molars (W6) were measured before and after surgery. Changes in distance were analyzed using the Wilcoxon signed‐rank test, revealing a significant increase in W6. Analysis of Co‐Variance was performed with the difference in W6 after implant treatment as the response variable, and the following six items as explanatory variables: sex; cleft type; age at alveolar bone graft; time to implantation after bone grafting; number of implants; and time after completion of the observation period. Results The reduction in W6 was larger in the order of complete bilateral CLP, complete unilateral CLP, and unilateral cleft lip and alveolus, and the change decreased with an increasing number of implants. Conclusions Implant treatment of the alveolar cleft region may result in a slight reduction in width of the dental arch after treatment completion.

Abstract Background The quality of life (QoL) of children and adolescents with cleft lip/palate (CL/P) has been shown to be a predictor of good psychosocial functioning in this population group. This study aimed to measure QoL, from the patient´s perception of change produced by the different surgical and orthodontic treatments carried out since early childhood, and if gender and age are modulating the outcome variables results. Materials and methods A cross-sectional research study was carried out. The study included 60 patients with cleft lip, cleft palate, or cleft lip/palate, aged between 8 and 18, who were in orthodontic treatment and had undergone at least one surgery. They were asked to complete the Quality-of-Life Adolescent Cleft Questionnaire (QoLAdoCleft), which allows the assessment of the QoL through self-perception of improvement after surgical and orthodontic interventions. In particular, this questionnaire (administered only once), allows the evaluation of self-perception of QoL at the present time and before orthodontic and surgical treatment. This double assessment was carried out for the domains of physical, psychological, and social health. The results were analysed by looking at the interaction of gender and age. Results Statistically significant differences were found in the perception of the current QoL in comparison to the retrospective perception in all the dimensions considered. The perception of QoL improved in all cases. The results also showed a moderation of gender in the relation between perception of previous behaviour and social function and actual behaviour and social function. Conclusion The results indicated that patients perceived their quality of life had improved as a result of the treatments received, with the highest effect sizes found in the physical health domain. Specifically, the improvement in QoL in behaviour and social function tended to be influenced to a greater extent by perception of previous QoL. In this sense, personalized preventative measures from holistic and biopsychosocial approaches are necessary.

Abstract Background Cleft lip and palate(CL/P)is the most common orofacial malformation affecting one in every 700–1000 newborns worldwide. The aim of the study wasto evaluate the impact of CL/P on health- related quality of life (OHRQoL) in Sudanese children and the level of concordance between caregivers' and children and to investigate correlates of the caregivers' perceptions of OHRQoL with that of their children. Methods The sample consisted of 75 children with clefts (age range 8–16 years), (46 male, 29 female) and their caregivers' attending University of Science and Technology Dental Teaching Hospital. The children and their caregivers' were interviewed separately. The interview consisted of 38 questions adopted from the COHIP (Arabic version).The level of concordance between caregivers' and children was compared using paired t-tests and intraclass correlations. Predictive validity was assessed using Pearson correlations and linear regression analyses. Results The translated COHIP and its subscales, had Cronbach' alphas score ranged between (0.65 and 0.75) for caregivers' and children with cleft. COHIP scores for children and caregivers' were (89.41 ± 19.97) and (94.34 ± 19.52) respectively. Caregivers' and children differed significantly in the overall COHIP and oral symptoms subscale. There were high correlations between caregivers' and children ranged from (0.63 to 0.87). The correlation between all subscales was statistically significant (p = 0.05). Conclusions Caregivers' had higher perceptions of oral symptoms and overall COHIP compared to their children using the Arabic version of the COHIP. Caregiver's reports have to be considered complementary to the reports of their children themselves.

Objective: To identify and review published data on the risks associated with cleft lip and/or palate (CL/P) in lower-middle-income countries (LMICs). Design: A systematic review of literature was performed on electronic databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Literature on risks associated with CL/P in LMICs, from 2010 to 2020, were included. Results: Seventeen studies met the inclusion criteria. All studies adopted an observational study design. Biological and environmental risks were identified. Maternal and paternal age (n = 7) and low socioeconomic status (n = 5) were the most prominently associated environmental risk factors. A strong association was identified between family history of cleft (n = 7) and CL/P occurrence. Conclusion: Environmental risk factors are now being investigated more than biological risk factors in LMICs, aiding health care workers in the early identification of possible cumulative effects of risks in CL/P. Contextually relevant tools are recommended to promote early identification of at-risk infants. [ABSTRACT FROM AUTHOR]

Objectives: To identify research articles related to cleft lip and/or cleft palate (CL/P) that generated the highest online attention. Methods: Altmetric Explorer was used to identify the 100 articles with the highest Altmetric Attention Score (AAS). Descriptive and correlation statistics were performed to study the characteristics of these articles in relation to their publication data, research type and domain, number of Mendeley readers, and dimensions citations. Citation counts were extracted from Scopus and Google Scholar. Results: The median AAS for the top 100 outputs was 22 (range from 12 to 458). The outputs were mostly discussed on Twitter (median = 8; range = 0-131). Topics discussing treatment and care for patients with CL/P accounted for 38% of the articles with the highest AAS followed by etiology and risk factors (32%). The majority of articles originated from the USA (46%) followed by Europe (16%) and the United Kingdom (15%). No significant differences were observed in AAS among different study designs, topic domains, journals' ranking and impact factor, and the number of citations in Scopus and Google Scholar. Conclusions: Researchers should consider use of social platforms to disseminate their work among scholars and nonscholars. Altmetrics can be combined with traditional metrics for a more comprehensive assessment of research impact. [ABSTRACT FROM AUTHOR]

Cleft lip and/or palate (CL/P) is a most common craniofacial birth defect which has multifactorial etiology. In our study, we aimed to discover the underlying etiological gene variation in a Chinese family diagnosed as non-syndromic CL/P (NSCL/P). The blood sample of the proband and her parents were detected by whole exome sequencing. The Mendelian inheritance pattern, allele frequency, variation location, function analysis and literature search were applied to filtrate and screen the mutation. Besides, the candidates were confirmed by Sanger sequencing. We meanwhile explored the conservative analysis and protein homology simulation. As a result, a start-lost mutation c.1A > GAtg/Gtg in the Frizzled-6 (FZD6) gene predicting p.Met1 was detected. The variation has not been reported before and was predicted to be harmful. The alteration caused missing of two starting amino acids that are evolutionarily conserved for FZD6 protein. Moreover, the specific structure of the mutant protein obviously changed according to the results of the homologous model. In conclusion, the results suggest c.1A > GAtg/Gtg in the FZD6 (NM_001164616) might be the genetic etiology for non-syndromic CL/P in this pedigree. Furthermore, this finding provided new etiologic information, supplementing the evidence that FZD6 is a strong potential gene for CL/P.

Children with a history of cleft lip and/or palate (CL/P) can experience a range of difficulties such as sound articulation errors and reduced psychosocial functioning. This causes interaction with them to contain more frequent communication breakdowns than non-cleft children. The present study shows evidence of such breakdowns involving topic shifts in the interaction between parents and their repaired CL/P children. Interactional data were obtained through a series of recordings of three parent-child sets. The process is guided by the framework of Conversation Analysis (CA) while coding of topic shift adopts Crow’s typology (1983). Findings show that topic shift during interaction can indeed cause problems for children with a history of cleft, especially involving palatal cleft. Specifically, through the children’s repair initiations, the problems are manifest when a topic is introduced once the previous topic concludes, when a topic is extended and when a topic is revisited. This study shows that topic shift can potentially be a source of problems to CL/P children. Findings are useful for speech therapists, parents and teachers.

This study aimed to identify the predictive role of cleft type, ethnicity, adoption status, spoken language at home and parental education level on the caries risk in the primary dentition of patients with cleft lip and/or palate (CL/P). This knowledge is used to make an estimate on increased caries risk in young patients with CL/P., A retrospective analysis of data concerning dental caries and basic characteristics of patients with CL/P was done. Patients were born and registered in 2016, 2017, or 2018 at the cleft team of the Erasmus Medical Center, Rotterdam, the Netherlands., After Chi-square tests, the cleft type ( P  = .02), country of birth father ( P  < .001), country of birth mother ( P  = .002), parental educational level ( P  = .006), and spoken language at home ( P  = .002) were significantly different between 144 patients with CL/P with and without caries. Items were used in binary logistic regressions and after stepwise backward elimination resulting in most important determinants for caries in the primary dentition in patients with CL/P being: father born in another country than the Netherlands (odds ratio [OR]   = 4.87, P  = .001), a cleft lip alveolus and palate phenotype (OR   = 3.54, P  = .002), and a lower parental educational level (OR   = 2.30, P  = .04)., The recommendation for the dental care professional will be to use these 3 determinants as a first prediction on future dental caries. This helps the dental professional in clinical decisions as recall intervals, referral to specialized dental care and extensiveness of caries prevention strategies and thereby improves oral health of patients born with CL/P., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

ObjectivesTo preliminarily analyze factors that affected the prevalence of anxiety in Chinese patients with cleft lip and/or palate (CL/P).MethodsThe Generalized Anxiety Disorder Scale (GAD-7) was used to screen anxiety in Chinese CL/P patients. Non-CL/P individuals were also included as the control group. Sociodemographic and clinical data consisting of diagnosis, gender, only child or not, monthly household income, and current family location were collected to analyze possible factors that could affect the anxiety of this patient population.ResultsOne hundred forty-two and 78 valid questionnaires were collected from the study and control groups, respectively. The mean GAD-7 score of the study group (3.092 ± 3.381) was significantly lower than the control (3.987 ± 2.505). Moreover, the proportion of patients presenting with moderate-severe anxiety was larger in the study group than in the control group (6.6 vs. 0.0%). Statistically significant differences in GAD-7 scores were observed between the study and control groups when the patient was the only child, living in an urban area, or the monthly household income was between 1,000 and 5,000 yuan.ConclusionAlthough the severity of anxiety in Chinese CL/P patients was not severer than those without CL/P, there was a relatively high incidence of moderate-severe anxiety in CL/P patients, while the only child, current family location and the monthly household income played significant roles in affecting anxiety psychology.

Background: Resilience has become a hot spot in the field of positive psychology to study life-change events. However, there were little information on resilience among the fathers and mothers of patients with cleft lip and/or palate respectively. The present study aimed to explore and compare the level and potential influential factors associated with resilience among fathers/mothers of patients with cleft lip and/or palate in China.Method: A cross-sectional study was carried out between April 2019 and July 2020 among fathers/mothers of patients with cleft lip and/or palate in two cleft lip and/or palate treatment centers in China. Sixty Nine fathers and 179 mothers of patients with cleft lip and/or palate were interviewed with a questionnaire on demographic variables and the Resilience Scale-14 (RS-14), Herth Hope Index (HHI), Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R), Parenting Stress Index-Short Form (PSI-SF) and Coping Health Inventory for Parents (CHIP). T-test/univariate one-way ANOVA, Pearson's r, hierarchical linear regression analysis were conducted to explore the influential factors of resilience.Results: Fathers of patients with cleft lip and/or palate had a higher level of resilience (77.77 ± 14.18) than mothers (74.52 ± 14.33) though without significance. Resilience was positively associated with hope, perceived social support, optimism and coping and negatively correlated with parenting stress both in the fathers and the mothers. Hierarchical linear regression analysis showed that hope (β = 0.400, P < 0.01), coping (β = 0.281, P < 0.05), job status, medical payments (β = −0.240, P < 0.05) were found to be associated with resilience among the fathers of patients with CL/P, and all four variables in the model could explain 42.8% of the variance in resilience; Hope (β = 0.225, P < 0.05), perceived social support (β = 0.194, P < 0.05), the age of patients (β = 0.189, P < 0.05) were found to be associated with resilience among the mothers, and all three variables in the model could explain 27.6% of the variance in resilience.Conclusion: Our study showed that, in China, fathers of patients with cleft lip and/or palate had a higher level of resilience than mothers though without significance. Hope was the only communal variable strongly associated with resilience among both the fathers and the mothers; besides, coping, job status and medical payments were found to be associated with resilience among the fathers; while perceived social support and the age of patients were found to be associated with resilience among the mothers. The results suggest that enhance hope in parents of patients with cleft lip and/or palate might greatly help improve their resilience. Besides, fathers and mothers need specific intervention to prompt their resilience.

Background: Empowerment is recognized as a crucial concept in strengthening the position of parents in healthcare services. This study aimed to evaluate the validity and reliability of the Turkish Family Empowerment Scale (FES). Methods: This methodological study was conducted between January and March 2021, with 348 family members actively caring for their children in the age group of 0–18 years with cleft lip and/or palate (CL/P). The English FES was translated into Turkish using back translation and modified so that it is generic and convenient for all families. The construct validity, internal validity, internal consistency, and split‐half test reliability and responsiveness of the Turkish FES were examined. Results: The original FES structure with three factors (family, health services provided to the child and community participation) and 34 items was verified in Turkish culture. This obtained structure can explain 66% of the variance of the relevant concept. Scores of parents ranged between 34 and 170 points. Increasing scores indicated a positive significance regarding family empowerment. The Cronbach's α reliability coefficient of the scale was calculated as 0.976. Conclusion: The study findings and the goodness‐of‐fit values indicated that the FES and its Turkish version are a valid and reliable measurement instrument to be used in Turkish culture. [ABSTRACT FROM AUTHOR]

Objective: The objective of this systematic review was to evaluate the evidence regarding skeletal maturation in patients with cleft lip and/or palate (CL/P) and to investigate whether the skeletal maturation is delayed in these patients. Design: Systematic review. Methods: Electronic and manual searches of scientific literature were conducted in 4 databases (MEDLINE, Embase, Cochrane Library, and Web of Science). Cohort studies that compared the skeletal maturation of patients with CL/P with that of children without CL/P were eligible for inclusion. The quality of included cohort studies was assessed using the Newcastle-Ottawa Scale. Patients and Participants: Patients of any sex and ethnicity with CL/P and children without CL/P were included in this systematic review. Main Outcome Measures: Difference in skeletal maturation between patients with CL/P and patients without CL/P. Results: Thirteen retrospective cohort studies were included in this systematic review. Ten studies were considered of high quality and 3 were considered of general quality. The results of the included studies comparing skeletal maturation of patients with CL/P and children without CL/P were heterogeneous. Conclusion: Heterogeneity of skeletal maturation assessment methods, chronological age, sex, cleft type, and race may influence the final results of clinical studies on skeletal maturation in patients with CL/P. Overall, there is limited evidence to determine whether the skeletal maturation level of patients with CL/P is delayed compared to that of normal children. Further studies are needed to determine the skeletal maturation patterns in patients with CL/P. [ABSTRACT FROM AUTHOR]

Background: Children with clefts have high dental needs and often require a dental general anesthesia (DGA) for the management of their dentition. Objective: To assess the number of children with clefts requiring a pediatric dental consultant led DGA in the South Thames Cleft Service over a 3-year period. Design: Data were collected retrospectively over a 36-month period. Results: Sixty-five children with cleft lip and/or palate required a DGA with the South Thames Cleft Service. The average age of the child was 7 years, and the average number of teeth treated under the general anesthetic was 9. Families traveled an average of 21 miles to access their child's care, and the referral-to-treat time was on average 14 weeks. Conclusion: Results highlight the need for DGA provision for children with clefts. Cleft centers need sufficient capacity for this service to prevent long wait times, and in view of distances traveled shared, care should be implemented with local providers. [ABSTRACT FROM AUTHOR]

Objectives: To (1) survey Australian orthodontists about their involvement with a government-funded scheme for patients with clefts, the Medicare Cleft Lip and Cleft Palate Scheme (MCLCPS) and (2) investigate their attitude toward treating patients with clefts and their training in this respect. Design: A 13-question online survey was distributed to members of the Australian Society of Orthodontists. The survey gathered information regarding respondent demographics, the number of MCLCPS-eligible patients seen in the past 12 months and usual billing practices. Results: A total of 96 complete responses were obtained. About 70% of respondents had treated MCLCPS-eligible patients in the past 12 months and 55% saw between 2 and 5 patients during this time. The likelihood of treating patients with clefts increased by a factor of 4.8 (95% CI: 1.2-18.9) if practicing outside of a capital city and 1.5 times for each decade increase in orthodontist's age (95% CI: 1.0-2.2). The MCLCPS was utilized by 81% of orthodontists with 26% of these respondents accepting rebate only. Most orthodontists felt their university training could have better prepared them to treat patients with clefts. A minority of orthodontists felt that a rebate increase would make them more likely to treat these patients. Conclusions: Australian orthodontists who treat patients with clefts tend to be older and work outside of capital cities. The decision to treat these patients tends to not be financially motived. Specialty orthodontic training programs could improve the preparedness of their graduates to treat patients with clefts. [ABSTRACT FROM AUTHOR]

The oro-facial morphology is greatly affected in neonates with a cleft lip and palate. The initial evaluation of neonate’s body and maxillary arch dimensions is important for treatment planning and predicting growth in cleft patients. The objective of this study was comparative evaluation of the anthropometric and physiologic parameters of cleft and non-cleft neonates in a hospital-based set up. This cross sectional study was conducted on 88 cleft and non-cleft neonates (n = 44 in each group) aged between 0 and 30 days after obtaining approval from the institutional ethics committee and positive written informed consent from their parents. Neonates’ body weight, body length, head length, head circumference, and maxillary arch dimensions were measured. Maxillary arch dimensions were measured on dental casts with digital sliding calipers. Statistical analyses performed using the independent t-test and one-way ANOVA analysis were followed by Bonferroni correction for post-hoc comparison. The results showed statistically significant differences in birth weight (p < 0.0001), head length (p < 0.01), head circumference (p < 0.007), and maxillary arch dimensions (p < 0.0001) between cleft and non-cleft neonates. These findings suggest that cleft neonates had significant anthropometric and physiologic variations than non-cleft neonates. [ABSTRACT FROM AUTHOR]

Abstract Background Cleft lip and/or palate is among the most prevalent congenital birth defects, and negatively affects maternal psychological status and may consequently result in higher prevalence of child maltreatment. However, the association of childbirths of infants with cleft lip and/or palate with maternal emotional involvement still remains unclear. We examined the association between childbirths of infants with cleft lip and/or palate and mother-to-infant bonding, using data from the Japan Environment and Children’s Study, a nationwide birth cohort study. Methods A cross-sectional study using the jecs-an-20,180,131 dataset was performed. A total 104,065 fetuses in 15 regional centres in Japan were enrolled after obtaining informed written consent. The Mother-to-Infant Bonding Scale, a self-report scale consisting of 10 items, was used to evaluate maternal bonding at one year after childbirth. Finally, the participants consisted of 79,140 mother-infant pairs, of which 211 mothers of infants with cleft lip and/or palate were included in our analyses. Multivariable logistic regression analysis using multiple imputation for missing data was performed to calculate the odds ratio and 95% confidence interval in the estimation of the association between bonding disorders and childbirths with cleft lip and/or palate. Results No increased risk of bonding disorders was observed among all the mothers of infants with cleft lip and/or palate (odds ratio [95% confidence interval]; 0.97 [0.63–1.48], p = 0.880), however, advanced maternal age or multiple parity may adversely affect the associations between bonding disorders and cleft lip and/or palate, respectively. After stratification with a combination of maternal age and parity, a significant association of cleft lip and/or palate with bonding disorders was found only among advanced-age multiparae (odds ratio [95% confidence interval] = 2.51 [1.17–5.37], p = 0.018), but it was weakened after additional adjustment for maternal depression. Conclusions Childbirths of infants with cleft lip and/or palate may increase the risk of bonding disorders among advanced-age multiparae, possibly through maternal depression. This finding provides valuable information for the provision of multidisciplinary cleft care.

Background: Cleft lip and/or palate (CL/P) presents a rather complex challenge that requires understanding beyond biological or clinical perspective. Even though inaccuracies in speech articulation are the common consequences of CL/P, individuals with repaired CL/P are likely to experience other languageassociated issues. Studies on social interaction have generally reported the children to be passive interlocutors, despite having their surgical treatment at the early stages of life. Aims: This study aims to describe the linguistic strategies that parents employ when interacting with their repaired CL/P child. How parents allocate the next turn of speaking to their repaired CL/P child will be specifically examined. Methods & Procedures: Three parent-child pairs with each child having repaired CL/P were selected to participate in the study. Guided by the principles of Conversation Analysis, their everyday interactions in their homes were video-recorded and transcribed according to the Jefferson System of Transcription Notation (2004). The transcriptions were subsequently analysed in order to highlight the linguistic strategies. Outcomes & Results: Three main linguistic strategies are identified in the parents' turns when they allocate the next turn of speaking to their repaired CL/P child. Specifically, parents' turns are constructed through interrogative sentences in addition to using emphasis words and repeated elicitation of responses from their child. Conclusion & Implications: Parents' linguistic strategies are found to be restrictive as they limit children's active participation. Consequently, the interaction becomes asynchronous rather than synchronous, which could otherwise benefit children's language development. Findings provide information on how parents can be supported in order to foster a positive growth of the children's language development through everyday interactions. [ABSTRACT FROM AUTHOR]

The CLEFT-Q includes 12 independently functioning scales that measure appearance (face, nose, nostrils, teeth, lips, jaws), health-related quality of life (psychological, social, school, speech distress), and speech function, and an eating/drinking checklist. Previous qualitative research revealed that the CLEFT-Q has content validity in noncleft craniofacial conditions. This study aimed to examine the psychometric performance of the CLEFT-Q in an international sample of patients with a broad range of facial conditions. Data were collected between October 2016 and December 2019 from 2132 patients aged 8 to 29 years with noncleft facial conditions. Rasch measurement theory (RMT) analysis was used to examine Differential Item Function (DIF) by comparing the original CLEFT-Q sample and the new FACE-Q craniofacial sample. Reliability and validity of the scales in a combined cleft and craniofacial sample (n=4743) were examined. DIF was found for 23 CLEFT-Q items when the datasets for the two samples were compared. When items with DIF were split by sample, correlations between the original and split person locations showed that DIF had negligible impact on scale scoring (correlations ≥0.995). In the combined sample, RMT analysis led to the retention of original content for ten CLEFT-Q scales, modification of the Teeth scale, and the addition of an Eating/Drinking scale. Data obtained fit with the Rasch model for 11 scales (exception School, p=0.04). Person Separation Index and Cronbach alpha values met the criteria. The scales described in this study can be used to measure outcomes in children and young adults with cleft and noncleft craniofacial conditions. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to analyze the caries protective factors, salivary parameters, and microbial counts in high caries risk children with cleft lip and/or palate (CL/P). Design: This was a cross-sectional study. Setting: This study was conducted in a tertiary health care teaching hospital in New Delhi, India. Participants: The study was conducted in 40 children, 20 with CL/P and 20 without aged between 5 and 12 years. Methods: Children with 2 or more caries lesions in both groups were included in this study. Demographic details, dental caries of affected teeth (World Health Organization criteria for Decayed Missing Filled Teeth [WHO-DMFT] and International Caries Detection and Assessment System [ICDAS II]), caries protective factors, salivary parameters, and microbial counts were recorded by one calibrated investigator. Main Outcome Measures: Caries protective factors, salivary parameters, and microbial profile. Results: The Chi-square (χ2) test and Pearson correlation were used for statistical analysis. All the children participating in the study brushed their teeth only once in a day and consumed sweets more than twice a day. None of the children had ever received fluoride varnish. Resting saliva had a low buffering capacity in 80% of children with CL/P and 95% of children without CL/P. Microbial assessment of stimulated saliva showed that with the increases in the numbers (DMFT scores ≥4) and severity (ICDAS codes from 1-2 to 5-6) of caries lesions, both Streptococci and Lactobacilli counts were ≥105 colony-forming units/mL of saliva in the both groups. Conclusions: Children with CL/P showed limited access to caries protective measures and low buffering capacity in resting saliva, along with elevated levels of salivary Streptococci and Lactobacilli in stimulated saliva. [ABSTRACT FROM AUTHOR]

Objective: To provide comparison data on the Intelligibility in Context Scale (ICS) for a sample of 3-year-old English-speaking children born with any cleft type. Design: Questionnaire data from the Cleft Collective Cohort Study were used. Descriptive and inferential statistics were carried out to determine difference according to children's cleft type and syndromic status. Participants: A total of 412 children born with cleft lip and/or palate whose mothers had completed the ICS when their child was 3 years old. Main Outcome Measure(s): Mothers' rating of their children's intelligibility using the ICS. Results: The average ICS score for the total sample was 3.75 (sometimes-usually intelligible; standard deviation [SD] = 0.76, 95% CIs = 3.68-3.83) of a possible score of 5 (always intelligible). Children's speech was reported to be most intelligible to their mothers (mean = 4.33, SD = 0.61, 95% CIs = 4.27-4.39) and least intelligible to strangers (mean = 3.36, SD = 1.00, 95% CIs = 3.26-3.45). There was strong evidence (P <.001) for a difference in intelligibility between children with cleft lip only (n = 104, mean = 4.13, SD = 0.62, 95% CIs = 4.01-4.25) and children with any form of cleft palate (n = 308, mean = 3.63, SD = 0.76, 95% CIs = 3.52-3.71). Children born with cleft palate with or without cleft lip and an identified syndrome were rated as less intelligible (n = 63, mean = 3.28, SD = 0.85, 95% CIs = 3.06-3.49) compared to children who did not have a syndrome (n = 245, mean = 3.72, SD = 0.71, 95% CIs = 3.63-3.81). Conclusions: These results provide preliminary comparative data for clinical services using the outcome measures recommended by the International Consortium for Health Outcomes Measurement. [ABSTRACT FROM AUTHOR]

Background: Few reports have examined dental arch morphology (DAM) after dental implant placement in cleft patients and its actual state is unclear. Objective: To analyze the presence of changes in DAM and influencing factors in cleft lip and/or palate (CLP) patients who receive implant treatment in the alveolar cleft region. Methods: Subjects comprised 20 CLP patients in whom maxillary dental arch width (DAW) was evaluated before and after implant treatment based on computed tomography data. First, widths between the canines (W3), between the first premolars (W4), between the second premolars (W5), and between the first molars (W6) were measured before and after surgery. Changes in distance were analyzed using the Wilcoxon signed‐rank test, revealing a significant increase in W6. Analysis of Co‐Variance was performed with the difference in W6 after implant treatment as the response variable, and the following six items as explanatory variables: sex; cleft type; age at alveolar bone graft; time to implantation after bone grafting; number of implants; and time after completion of the observation period. Results: The reduction in W6 was larger in the order of complete bilateral CLP, complete unilateral CLP, and unilateral cleft lip and alveolus, and the change decreased with an increasing number of implants. Conclusions: Implant treatment of the alveolar cleft region may result in a slight reduction in width of the dental arch after treatment completion. [ABSTRACT FROM AUTHOR]

Purpose: Prior literature has described the perspectives of parents of young children with clip lip and/or palate; however, few studies have described parents' experiences within a Canadian health care system. This study aims to better understand the experiences of parents of young children with cleft lip and/or palate seen at a Canadian tertiary care center and identify their care needs. Design: In-depth semistructured interviews. Setting: Pediatric tertiary care center. Participants: Parents of children younger than 7 years of age with cleft lip and/or palate. Results: From 14 interviews, 4 themes were identified. The diagnosis theme was associated with reactions, timing, and search for information. Key concerns within the theme of physiology and function were around feeding and speech. The health care experience theme included burden of care, peripheral hospitals and services, the cleft lip and palate clinic, and clinicians. The psychosocial theme included parents' reactions to their child's pain, coping strategies, family interactions, and school/day care experiences. Parents felt care could be improved by having: access to good information and community speech therapists, shorter appointment wait times, a peer support network, and increased cleft knowledge within their child's school and peer groups. Conclusions: The experience of parents of children with cleft lip and/or palate is complex but can be organized into 4 themes. Clinics may consider suggestions offered by parents to improve care. Future work should address parents' needs and aim to create a parent-reported quality-of-life measure specific to parents of young children with cleft lip and/or palate. [ABSTRACT FROM AUTHOR]

Background: The quality of life (QoL) of children and adolescents with cleft lip/palate (CL/P) has been shown to be a predictor of good psychosocial functioning in this population group. This study aimed to measure QoL, from the patient´s perception of change produced by the different surgical and orthodontic treatments carried out since early childhood, and if gender and age are modulating the outcome variables results. Materials and methods: A cross-sectional research study was carried out. The study included 60 patients with cleft lip, cleft palate, or cleft lip/palate, aged between 8 and 18, who were in orthodontic treatment and had undergone at least one surgery. They were asked to complete the Quality-of-Life Adolescent Cleft Questionnaire (QoLAdoCleft), which allows the assessment of the QoL through self-perception of improvement after surgical and orthodontic interventions. In particular, this questionnaire (administered only once), allows the evaluation of self-perception of QoL at the present time and before orthodontic and surgical treatment. This double assessment was carried out for the domains of physical, psychological, and social health. The results were analysed by looking at the interaction of gender and age. Results: Statistically significant differences were found in the perception of the current QoL in comparison to the retrospective perception in all the dimensions considered. The perception of QoL improved in all cases. The results also showed a moderation of gender in the relation between perception of previous behaviour and social function and actual behaviour and social function. Conclusion: The results indicated that patients perceived their quality of life had improved as a result of the treatments received, with the highest effect sizes found in the physical health domain. Specifically, the improvement in QoL in behaviour and social function tended to be influenced to a greater extent by perception of previous QoL. In this sense, personalized preventative measures from holistic and biopsychosocial approaches are necessary. [ABSTRACT FROM AUTHOR]