Change in Prevalence of Orofacial Clefts in California between 1987 and 2010.

INTRODUCTION: To extend the knowledge base about possible prevalence declines of specific orofacial cleft phenotypes, here we examine prevalence in a population base from California over a two-decade period among numerous race/ethnic groups. METHODS: This population-based study used vital statistics and birth defects registry data. Its population involved all births (~1.5 million births) in central California counties from 1987 to 2010. Orofacial clefts were defined as cleft lip with or without cleft palate (CLP, n=1766), and cleft palate (CP, n=922) only. The slope of prevalence of each cleft phenotype over the period 1987-2010 was estimated using weighted least squares regression. RESULTS: Birth prevalence of CLP was 121/100,000 live births, and 63/100,000 live births for CP. The slope for CLP decreased by 1.2 (slope: -1.2; 95% CI: -1.9, -0.5), and for CP by 0.7 (slope: -0.7; 95% CI: -1.7, 0.2) for CP. Stratification by race/ethnicity or infant sex did not demonstrate a statistical difference in slopes. CONCLUSIONS: We observed a decline in the prevalence in CLP in all ethnic groups, however did not observe the same amount of decline in CP, perhaps due to antenatal screening.

Malthus Mysterious Orofacial Cleft Correction.

Thomas Malthus (1766-1834), distinguished English professor, is the father of modern demography and the most famous harelip carrier of history. Much is known of his orofacial cleft but nothing regarding its mysterious surgical correction. An 1833 portrait of Malthus by John Linnell, finished when he considered himself "handsome enough," for sitting does not show any upper lip scar. When this surgery took place? Although technically feasible in the 19th century, surgery of cleft lip and palate was complicated. Malthus would not risk his life to have his orofacial disability corrected shortly before his death. Linnell cunningly dissimulated his deformity.

Tessier 3 Cleft in a Pre-Hispanic Anthropomorphic Figurine in El Salvador, Central America.

In 1976, Paul Tessier provided a numerical classification system for rare facial clefts, numbered from 0 to 14. The Tessier 3 cleft is a rare facial cleft extending from the philtrum of the upper lip through the wing of the nostril, and reaches the medial canthus of the eye. The aim of this document was to describe a pre-Hispanic anthropomorphic figurine dating from the classic period (200 A.D.-900 A.D.), which has a Tessier 3 cleft. We also discuss the documented pre-Hispanic beliefs about facial clefts.

Classification of Cleft Lip/Palate: Then and Now.

Cleft lip and/or palate (CL/P) is phenotypically diverse, making classification difficult. This article explores the evolution of ideas regarding CL/P classification and includes the schemes described by Davis and Ritchie (1922) , Brophy (1923) , Veau (1931) , Fogh-Andersen (1943), Kernahan and Stark (1958) , Harkins et al. (1962) , Broadbent et al. (1968), Spina (1973) , and others. Based on these systems, a longhand structured form is proposed for describing CL/P in a way that is clear, comprehensive, and consistent. A complementary shorthand notation is also described to improve the utility and convenience of this structured form.

Prevalence of cleft lip and/or palate in children from Lodz between years 1981-2010.

Congenital malformations constitute a serious problem of both medical and social nature. Cleft lip and/or palate represent the most common congenital anomaly of the face that is why it is essential to know the real frequency of the described phenomenon. The aim of this paper is to determine the frequency of cleft lip and/or palate and the types of malformations that occurred in Lodz city between the years 1981-2010. Our clinic has been carrying on the studies concerning the incidence of cleft lip and/or palate since 1981. The Polish Registry of Congenital Malformations has been operating in Poland since 1 April 1997. The team has managed to obtain data, from the Registry, concerning the total number of all live born infants and the number of children with cleft lip and/or palate, who were born in Lodz, between 1998 and 2010. In years 1981-2010, 319 children, in 210 952 live born infants, were born with cleft lip and/or palate in Lodz. The isolated cleft palate was observed more frequently in girls and the unilateral cleft of lip and palate in boys. In all three decades palate clefts are more common whereas bilateral lip, alveolus and palate clefts are more infrequent. A small tendency to decrease in actual cleft lip and/or palate frequency among children, in the period of 30 years, is observed in Lodz. Over the years it has still been observed that the isolated cleft palate is the most common type of defect.

Cleft and Craniofacial Care in Palestine: Breaking From the Cycle of the Past.

The history of cleft care in the Palestinian territories has largely been sporadic and dependent on foreign practitioners. This article discusses the recent history and the current status of cleft care in Palestine, including the quality of training among Palestinian cleft practitioners and limitations in operating room capacity. The discussion concludes with a future model of cleft care that focuses on carefully crafted programs to train surgeons (this is broadly applicable to other disciplines involved in cleft care), working in partnership with a designated National Cleft Organization, operationalized within a centrally located and accessible Cleft Center.

Overview of orthodontic care for children with cleft lip and palate, 1915-2015.

The purpose of this article is to review and discuss the advances in the management of children born with cleft lip and palate (CLP) as it has evolved over the past 100 years. This overview is based on articles published in the American Journal of Orthodontics, which frequently changed its name, over the past century. Additionally, other journals will be cited as craniofacial anomalies became recognized during the 20th century and the biologic basis became refined, with the new discipline of genetics replacing the term hereditary and its connotations of eugenics. The Human Genome Project, completed in 2003, has now provided an understanding of syndromic and nonsyndromic CLP that has led to advances in the diagnosis and treatment of CLP in the 21st century. These evolving concepts will be discussed in an overview of the types of procedures published from 1915 to 2015 and the major transition in the mid-20th century from multiple uncoordinated interventions from various specialists to a coordinated team approach in which the orthodontist has a specific role in the timing and sequencing of interdisciplinary treatment goals. Major technologic advancements in treatment modalities and the contemporary approach to the health-related quality of life of the patient and the caregiver have resulted in their participation in treatment options and decisions. The requirement of informed consent reflects the legal doctrine that now emphasizes the ethical imperative of greater respect for patient autonomy in the decision-making process. The orthodontist no longer makes decisions alone, but rather with the team and the patient or the caregiver.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: a historical perspective.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital defect of the Müllerian ducts characterized by uterovaginal agenesis and underdeveloped female genital organs. This paper is a tribute to the contributors of this condition - August Franz Joseph Karl Mayer, Karl Freiherr von Rokitansky, Hermann Küster and Georges André Hauser. In addition to their contributions, we have discussed findings and reports of similar defects from other important scientists (Hippocrates, Albucasis, etc.) dating as far back as 460B.C. We have also discussed the disease types and different classification systems including VCUAM and AFS/ASRM among others. Even with several surgical and non-surgical treatment options, there are still many questions that remain unanswered and very little is known about the etiology or genetic predisposition of this condition.

Professor David Poswillo CBE (1927-2003): Skilled oral and maxillofacial surgeon, influential scientist, teacher and adviser.

David Poswillo trained at Otago University Dental School, Dunedin, New Zealand (BDS) and the Royal College of Surgeons of England (FDSRCS). His great interest became the genesis and repair of cleft lip and palate and, in addition to clinical work, he undertook an experimental study of the embryology of cleft palate in pregnant rats exposed to three teratogenic agents. The microscopic work was carried out in his garden shed in Christchurch. His groundbreaking work on amniotic puncture at a critical period came to international notice and he was given the first Chair in Teratology of the Royal College of Surgeons. In experimental studies he showed that thalidomide induced focal haemorrhage in the developing embryo. Poswillo was also Consultant Oral Surgeon at Queen Victoria Hospital, East Grinstead and his skills as surgeon and teacher attracted numerous trainee surgeons. He was Professor of Oral Surgery in Adelaide and then in London. Poswillo was Chairman of two advisory committees whose lucid reports on anaesthesia, sedation and resuscitation in dentistry (Poswillo Report) and on tobacco and health were far-reaching and influential. David Poswillo had immense energy and enthusiasm and is remembered by many for his personal interest and stimulating guidance.

Scope of Western surgical techniques to correct cleft lip and palate prior to the 18th century.

OBJECTIVES: To present the state of knowledge and surgical practice concerning cleft lip and palate leading to the modern era. DESIGN: Bibliographical review. SETTING: Analysis of the scientific medical, surgical, and odontological literature from the 16th to 18th centuries. RESULTS: Texts and art confirm the existence of cleft lip and palate from antiquity in all cultures; however, the first certain references in Western scientific literature did not appear until the works of Celsus (ca. 25 BC to AD 50) and Galen (AD 129 to 200). Indications for cleft lip surgery appear in the Middle Ages with Albucasis (936 to 1013) and Yperman (1260 to 1332). From the Renaissance period onward, and with the invention of the printing press, numerous authors described their own surgical methods. CONCLUSIONS: Given the limitations imposed by pain and infection, the authors of the Modern Age focus on correcting the functional and esthetic defect of the lip with techniques that do not differ greatly from those described in the Middle Ages. The treatment for cleft palate was limited to the creation of "obturators" and surgery for cleft palate was not possible until the 19th century.

Philibert Joseph Roux (1780-1854).

Philibert Joseph Roux (1780-1854), a French surgeon, was a student and friend of Marie Xavier François Bichat, the father of modern pathology and histology. He was assigned as a surgeon to the Hôpital Beaujon (1806), the Hôpital de la Charité (1810) and to Hôtel-Dieu de Paris (1835), where he succeeded to Guillaume Dupuyrten, a French anatomist, as a Chief Surgeon. Roux is best known for having performed the surgical repair of a cleft palate and for having been the first surgeon to stitch a ruptured female perineum. His contribution to surgery has also included the publication of Quarante années de pratique chirurgicale. Roux was awarded the grade of Chevalier of the National Order of the legion of Honor and that of Officer. He also served as a President of the Academy of Sciences. He died of a stroke on 3 March 1854.

Cleft lip-cleft palate closure: the unknown contributions of Harvey Cushing.

BACKGROUND: The development of surgical repair of cleft lip-cleft palate closure has been well documented in the literature. However, the contributions of an unlikely pioneer, Harvey Cushing, in the development of cleft lip-cleft palate closure have been to date unknown. METHODS: Patient surgical records from 1896 to 1912 at The Johns Hopkins Hospital documenting Harvey Cushing's cases were reviewed. RESULTS: Three cases of Cushing's surgical closure of cleft lip-cleft palate, using a variety of techniques, are described and placed into historical context in the development of cleft lip-cleft palate surgery. CONCLUSIONS: Harvey Cushing's contributions to the field of plastic and reconstructive surgery have largely remained unknown. The cases reported here illustrate the early work of this pioneering surgeon in the area of cleft lip-cleft palate surgery.

John Stephenson's cleft palate.

An account of the history surrounding the first successful surgical repair of a cleft palate, with excerpts from the patient's narrative.

Bone regeneration and periosteoplasty: a 250-year-long history.

BACKGROUND: Since antiquity, many attempts have been carried out and a number of theories proposed to explain the process that leads to bone regeneration. Through manifold experiments, several authors tried to understand and subsequently to control the physiological events that enable bone healing. Between the 18th and 19th centuries something changed. Although the scientific world was initially skeptical, a new idea emerged in the field of bone surgery. It principally concerned the necessity to perform amputations and resections leaving intact the periosteum to obtain new bone formation. MATERIALS AND METHODS: With this article we emphasize the contribution of many authors in the development of knowledge about the osteogenic properties of the periosteum. In particular we focus on the experiences of unknown Italian authors Michele Troja and Bernardino Larghi, consider well-recognized scientific personalities such as Leopold Ollier and Bernhard von Langenbeck, and reach a milestone of plastic surgery with Tord Skoog and his description of periosteoplasty. CONCLUSION: Various surgical approaches have been proposed to provide optimal care for patients with cleft lip and palate disorders. Among several treatment options, periosteoplasty is one of the choices to correct maxillary clefts. Highlighting difficulties and successes of many authors in demonstrating osteogenic properties of periosteum, this paper describes how periosteoplasty performed in maxillary cleft restoration capitalizes on what has been discovered during a 250-year-long history.

Orthodontics in 3 millennia. Chapter 14: surgical adjuncts to orthodontics.

Around 1970, after overcoming obstacles related to anesthesia, infection, and blood supply, orthognathic surgeons come into their own. The history of cleft lip and palate treatment has a much earlier beginning because a deformed infant evokes a strong desire to intervene. Angle's belief that orthodontists can grow bone finally came to fruition with the advent of distraction osteogenesis, which developed from the limb-lengthening procedures of Ilizaroff in Russia. Now distraction osteogenesis has replaced osteotomies in many applications.