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DEMOGRAPHIC PROFILE OF CLEFT LIP and PALATE PATIENTS.

Byline: ABDUL HAFEEZ SHAIKH, MUHAMMAD WASIM IBRAHIM, GULZAR BUKHARI and MUHAMMAD TAQI

ABSTRACT

Cleft lip and palate are one of the most common developmental deformities seen in oral and maxillofacial surgery clinics. It is generally associated with problems which include not only cosmetic and dental abnormalities but also facial growth difficulties.

The aim of this study was to provide a basic demographic profile of the cleft lip and palate deformity with references to age, sex and cleft type in children from birth onwards reporting to Armed Forces Institute of Dentistry, Rawalpindi, which can serve as a mean of establishing data important for the diagnosis, treatment and counselling of patient/parents with cleft lip and cleft palate. This survey was undertaken at outpatient department of oral and maxillofacial surgery, Armed Forces Institute of Dentistry, Rawalpindi. The patients were selected according to convenience non-probability sampling technique. Total 100 participants were selected by age range from birth to 6 years. In this study out of total 100 patients an increased number of male patients were observed with cleft lip and palate abnormality (51%). However, female dominance is observed in a complete cleft of the secondary palate (49%).

Key Words: Cleft lip, Cleft Palate, Demographic profile, Primary and secondary palate.

INTRODUCTION

Cleft lip and palate are one of the most common developmental deformities seen in oral and maxillofacial surgery clinics. It is generally associated with problems which include not only cosmetic and dental abnormalities but also facial growth difficulties.1 Cleft lip and palate are the fourth most common birth defect of the face.2 Both genetic and environmental influences are considered to cause cleft lip and palate. Causes of cleft are not completely known in fact there does not appear to be a single factor that contributes to all clefts. Most scientist's belief that cleft is multifactorial and it occurs due to the combination of genetic and environmental factors.3

Persistent high position of tongue, increase facial width, overall reduction in the facial mesenchyme, alcohol and drug abuse, lack of vitamins (especially folic acid) during first week of pregnancy, maternal age and diabetes mellitus in the mother, all appear to be related to the occurrence of facial clefts.4-5

Numerous studies have been performed worldwide to see the demographic profile of cleft lip and palate deformities. In case of Pakistan, a study conducted in Northern Pakistan reports that cleft of lip is more frequent compared to the combine cleft lip and palate deformities. Moreover, boys are more commonly affected by the cleft lip and cleft lip with palate, in case of girl's isolated cleft palate are more predominant.6 Another study conducted in Liaquat University of Medical and Health Sciences, Jamshoro, concluded that cleft lip and palate is more common in males than females and unilateral clefts are more common on the left side.7

The aim of this study was to provide a basic demographic profile of the cleft palate deformity with references to age, sex and cleft type in children from birth onwards reporting to Armed Forces Institute of Dentistry, Rawalpindi, which can serve as a mean of establishing data important for the diagnosis, treatment and counselling of patients/parents with cleft lip and cleft palate.

METHODOLOGY

This survey was undertaken at outpatient department of oral and maxillofacial surgery, Armed Forces Institute of Dentistry, Rawalpindi. The patients were selected according to convenience non-probability sampling technique. Total 100 participants were selected by age range from birth to 6 years. All patients and caretakers were briefed on the objectives of the study and signed consent was taken. Participants with recognizable syndromes and patients undergone any type of surgical correction procedure were excluded, except for patients with a median cleft lip or median cleft lip or palate, which are very rare and usually occur with some syndromes.

The oral examination was carried out with the patient seated in the dental chair. Examination include evaluation of cleft and its extension to determine the anatomical structures affected by the cleft. The examination was performed by the trained physician under good lighting. The intraoral examination was performed by using a mouth mirror. All clefts were characterized precisely as possible and classified as complete or incomplete and unilateral or bilateral. The cleft profile was classified according to the method describe by the Kernahan and Starke classification.8 The statistical analysis was performed by using SPSS 17. Frequencies and percentages were presented for gender, age and cleft type.

TABLE 1: DISTRIBUTION OF SUBJECTS ACCORDING TO AGE AND GENDER

Gender###Male (%)###Female (%)###Total

Mean (S.D)###2.53 (1.72)###3.41(1.60)###2.95(1.49)

Birth-1 year###21(43.1)###10(20.4)###31

2 Year###8(15.7)###4(8.2)###12

3 Year###5(9.8)###10(20.4)###15

4 Year###11(19.6)###9(18.4)###20

5 Year###0###14(28.6)###14

6 Year###6(11.8)###2(4.1)###08

Total###51###49###100

TABLE 2: DISTRIBUTION OF SUBJECTS ACCORDING TO GENDER AND CLEFT TYPES

Cleft type###Male###Female###Total

Bilateral complete Cleft of primary and secondary###Count###5###3###8

palate###% within cleft###62.5%###37.5%###100.0%

Unilateral complete cleft of primary and secondary###Count###23###17###40

palate###% within cleft###57.5%###42.5%###100.0%

Complete cleft secondary palate###Count###10###19###29

###% within cleft###34.5%###65.5%###100.0%

Incomplete cleft of secondary palate###Count###1###1###2

###% within cleft###50.0%###50.0%###100.0%

Complete cleft primary palate###Count###9###6###15

###% within cleft###60.0%###40.0%###100.0%

Incomplete cleft primary palate###Count###3###3###6

###% within cleft###50.0%###50.0%###100.0%

Total###Count###51###49###100

###% within cleft###51.0%###49.0%###100.0%

RESULTS

In this study out of total 100 patients an increased number of male patients were observed, 51 males compared to 49 females with an age range from birth to 6 years as showed in Table 1. In all categories of cleft male dominance is observed except a complete cleft of the secondary palate as showed in Table 2.

DISCUSSION

In the present study, a total of 100 cases of different types of cleft lip and palate were examined. The age of presentation ranged from birth to 6 years. The age groups under study in some of the previous studies were 1 day to 26 years, and 10 months to 11 years.9

However, they did not specify the commonly affected age group. In this study, the subjects of 1 year of age are most commonly affected with cleft lip and palate. On the other hand, among females the subjects of 5 years of age are most commonly affected.

The male to female ratio in this study is almost 1:1 which is consistent with the study conducted in Saudi Arabia with a male to female ratio of 1:3.10 The present study showed increased number of male patient were observed, 51 males compared to 49 females. This finding was verified by the description of many investigators.11

However, there are studies reporting higher trend of cleft condition in females.12 In our study the frequency of isolated clefts are more common in females. This is consistent with several studies such as Pavri and Forrest13, Dai et al.,14 and Goenjian et al.,.15

The most frequent type of the cleft was the unilateral complete cleft of the primary and secondary palate. The frequency of unilateral clefts is more common in this study. The similar trend was also observed in some studies where unilateral clefts were more common than bilateral, with unilateral-to-bilateral ratio of 10:1.1 Several studies emphasized that statistics on the prevalence of these clefts and their clinical outcome are essential for the progress of research, clinical audit and planning of clinical services and specialist training. Moreover, it is important that such statistics are based on valid and accurate data. In order to find incidence of oral clefts, accurate data of congenital anomalies must be maintained by the government agencies and that data should range from individual unit's record to the national register.

Registration of the cleft patients should be made compulsory rather than on voluntary basis, involving government, semi-government and private sector. Such an authentic and valid data collection is being implemented in certain developed countries. In Pakistan, however, no such system is in place and calculating incidence of the clefts in Pakistani population is not possible as such11. On that basis, the aim of this study was to provide a basic demographic profile of the cleft lip and palate deformity with references to age, sex and cleft type in children from birth onwards reporting to Armed Forces Institute of Dentistry, Rawalpindi, which can serve as a mean of establishing data important for the diagnosis, treatment and counselling of patient/parents with cleft lip and cleft palate.

CONCLUSION

In conclusion, non-syndromic cleft deformities of the palate affect the male population more than females, with the cleft lip in association with cleft palate being the most frequent anomaly. Further research is required to delineate the information regarding the cleft deformity.

REFERENCES

1) Suleiman AM, Hamzah ST, Abusalab MA, Samaan KT. Prevalence of cleft lip and palate in a hospital-based population in the Sudan. International Journal of Paediatric Dentistry. 2005: 1;15(3):185-89.

2) Abdulah N, Samsudin AR, Sadiq LN, Ayub M. Dental anomalies And Facial Profile abnormality Of The Non-Syndromic Cleft Lip and Palate Children In Kelantan. Malaysian Journal Of Medical Sciences. 2004;2(2):41-51.

3) Ellis E III. Management of patients with orofacial clefts. In: Peterson J L, Ellis E III, Hupp J R, Tucker M R. Contemprorary Oral and Maxillofacial Surgery. 4th ed. St. louis USA: Mosby Publication 2003; 623-45.

4) Carinci F, Rullo R, Farina A, Morano D, Festa VM, Mazzarella N, del Viscovo D, Carls PF, Becchetti A, Gombos F. Non-syndromic orofacial clefts in Southern Italy: pattern analysis according to gender, history of maternal smoking, folic acid intake and familial diabetes. Journal of Cranio-Maxillofacial Surgery. 2005 Apr 30;33(2):91-94.

5) Sipek, A., Gregor, V., Horacek, J., and Masatova, D. (2002). [Facial clefts from 1961 to 2000--incidence, prenatal diagnosis and prevalence by maternal age]. Ceska gynekologie/Ceska lekarska spolecnost J. Ev. Purkyne, 67(5), 260-67.

6) Elahi MM, Jackson IT, Elahi O, Khan AH, Mubarak F, Tariq GB, Mitra A. Epidemiology of cleft lip and cleft palate in Pakistan. Plastic and reconstructive surgery. 2004;113(6):1548-55.

7) Kumar M. A 21 years perspective of Cleft Lip and Palate and outcome of surgical procedures at Jamshoro. Pakistan. J Liaquat Uni Med Health Sci. 2003;2(1):3-6.

8) Kernahan DA, Stark RB. A new classification for cleft lip and cleft palate. Plastic and Reconstructive Surgery. 1958:1;22(5):435-41.

9) Dvivedi J, Dvivedi S. A clinical and demographic profile of the cleft lip and palate in Sub-Himalayan India: A hospital-based study. Indian Journal of Plastic Surgery. 2012:1;45(1):115.

10) Aljohar A, Ravichandran K, Subhani S. Pattern of cleft lip and palate in hospital-based population in Saudi Arabia: retrospective study. The Cleft Palate-Craniofacial Journal. 2008: 45(6):592-96.

11) Raffat A. Proportions of oral clefts in patients visiting the cleft center of children's hospital and institute of child health Lahore: A five year study (2000-2005). Pakistan Oral and Dent. Jr. 25 (1) June 2005:40-46.

12) Shah SY, Rahman ZA, Mirani SA, Shaikh MI, Khattak MN, Sahito MA. Demographic data on the characterization of oral clefts in Malaysia. Pakistan Oral and Dental Journal. 2015 Mar 1;35(1):108-10.

13) Pavri S, Forrest CR. Demographics of orofacial clefts in Canada from 2002 to 2008. The Cleft Palate-Craniofacial Journal. 2013;50(2):224-30.

14) Dai L, Zhu J, Mao M, Li Y, Deng Y, Wang Y, Liang J, Tang L, Wang H, Kilfoy BA, Zheng T. Time trends in oral clefts in Chinese new borns: data from the Chinese National Birth Defects Monitoring Network. Birth Defects Research Part A: Clinical and Molecular Teratology. 2010: 1;88(1):41-47.

15) Goenjian HA, Chiu ES, Alexander ME, St. Hilaire H, Moses M. Incidence of cleft pathology in greater new orleans before and after hurricane katrina. The Cleft Palate-Craniofacial Journal. 2011;48(6):757-61.

16) Zhou QJ, Shi B, Shi ZD, Zheng Q, Wang Y. Survey of the patients with cleft lip and palate in China who were funded for surgery by the Smile Train Program from 2000 to 2002. Chinese medical journal. 2006;119(20):1695-700.
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Publication:Pakistan Oral and Dental Journal
Article Type:Report
Geographic Code:9PAKI
Date:Mar 31, 2017
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