Cleft Lip and Palate: Demographic Patterns and the Associated Communication Disorders.

PURPOSE: This study investigated demographical characteristics, health status, and associated communication disorders in patients with orofacial clefts (OFCs) in Northern Jordan. METHODS: A retrospective study of 226 cleft patients and their families was carried out between March 2012 and September 2016 at the Speech and Hearing Clinic and the Maxillofacial Center at King Abdullah University Hospital. Data were collected by interviewing patients and caregivers, having patients or caregiver to complete a questionnaire and reviewing the patient's medical records. The frequencies of OFC type, demographic, health status, and communication disorders variables were calculated. χ analysis was used to test for significance of associated demographic and communication disorders variables with OFC type. RESULTS: Results revealed higher percentage of males compared with female patients. The majority of OFC patients were born to families who lived in urban areas, obtained high school diploma or lower educational level, lived below poverty cutoff, and showed nonconsanguineous marriages. Most mothers took the prescribed pregnancy supplements. Only one-third of the families received health education and reported other incidences of OFCs. Twenty percent of the patients had other congenital anomalies, 80% experienced dysphagia prior to the cleft repair, dropped to 14% after the repair. Higher percentage of patients with isolated cleft palate and cleft lip and palate exhibited hearing loss, hypernasality, articulation and phonological disorders, and dysphagia compared with those with cleft lip only. None of the demographic variables was associated with OFC type. CONCLUSIONS: Data suggested that families who had children with OFCs displayed poor socioeconomic status and low educational level which may impede the delivery of health education by health practitioners. Increased risk of comorbid communication disorders and malformations in OFC patients must be emphasized and disseminated to health professionals involved in the management of patients with OFC.

Oral candidal colonization in cleft patients as a function of age, gender, surgery, type of cleft, and oral health.

PURPOSE: To assess the colonization rate of oral Candida species and the influence of age, gender, oral health status, number of surgeries, and type of cleft. PATIENTS AND METHODS: A prospective study of 60 patients with cleft and 60 control subjects was carried out at the Cleft Centre at King Abdullah University Hospital and the Maxillofacial Unit at Jordan University of Science and Technology between October 2007 and June 2008. Oral health was assessed using the Gingival, Plaque, and Decayed, Missing, and Filled (DMFT/dmft) indexes using World Health Organization criteria. A culture swab was obtained from the tongue and buccal and palatal mucosae. Candida albicans and other Candida species were identified using the germ tube test and the automated biochemical test panel VITEK. RESULTS: The colonization rate of Candida in patients with cleft (63.3%) was significantly higher than in healthy control subjects (18.3%). The colonization rate of Candida and the distribution of C albicans varied with age but were not significantly associated with gender in patients with cleft and healthy controls. The candidal colonization rate was highest in patients with cleft who had at least 3 surgeries (78.2%) and in patients with bilateral clefts (77.7%). Patients with cleft had a significantly poorer health status than healthy controls; however, this was not influenced by the type of the cleft or the number of surgeries. CONCLUSION: Patients with cleft had a significantly higher rate of oral candidal colonization compared with control subjects, which varied with age, type of cleft, and the number of surgical interventions. Oral health status was significantly poorer in patients with cleft.

Crown-root ratio of permanent teeth in cleft lip and palate patients.

OBJECTIVES: To determine root lengths of fully developed permanent teeth of cleft lip and palate (CLP) patients and to define their crown-root (C/R) ratios. METHOD: Crown height and root length of permanent teeth were measured from panoramic radiographs of 44 CLP patients and 37 controls. A total of 1397 teeth were measured, and C/R ratios were calculated. RESULTS: Higher C/R ratios were found in CLP patients; this was statistically significant for both maxillary and mandibular incisors and canines. Bilateral CLP subjects showed higher C/R ratios in general than unilateral CLP subjects. Roots of maxillary incisors, canines, and some other teeth were significantly shorter in CLP patients than in controls. CONCLUSIONS: CLP patients should be considered to have unfavorable C/R ratios, which could be the result of short root lengths for some teeth.

Prevalence of dental anomalies in a population of cleft lip and palate patients.

OBJECTIVE: The aim of our study was to investigate radiographically the prevalence of dental anomalies in a group of Jordanian cleft lip and/or palate subjects. DESIGN: This is a retrospective review of panoramic radiographs of 78 subjects with cleft lip and/or palate that were evaluated from their file records and investigated for possible dental anomalies. RESULTS: Dental anomalies were found frequently in cleft lip and/or palate subjects. Missing teeth were found in 66.7% of the patients; the tooth most commonly missing was the maxillary lateral incisor. Supernumerary teeth were found in 16.7% of patients; 37% had microdontia; 70.5% had taurodontism; 30.8% had transposition and/or ectopic teeth; 19.2% had dilacerations; and 30.8% had hypoplastic teeth. There was no statistically significant difference in the above anomalies' prevalence between males and females. However, it was found that subjects with bilateral cleft lip and/or palate had significantly more microdontia (p = .005), dilaceration (p = .002), and hypoplastic teeth (p = .0001) than subjects with unilateral cleft lip and/or palate. CONCLUSIONS: The prevalence of dental anomalies in cleft lip and/or palate patients was higher than what had been reported in the normal Jordanian population. This emphasizes the relation of cleft lip and/or palate to all dental anomalies studied. Although our study represents a thorough and complete description of dental anomalies present in a sample of cleft lip and/or palate subjects, larger samples are required to effectively determine the relationship of each dental anomaly with cleft type.

Crown morphologic abnormalities in the permanent dentition of patients with cleft lip and palate.

The purpose of this study was to investigate crown morphologic abnormalities in the permanent dentition of subjects with clefts and unaffected controls. This is a prospective study of 100 patients and 60 control subjects. The study was carried out at the Cleft Lip and Palate Center at the King Abdullah University Hospital and at the Maxillofacial Unit at Jordan University of Science and Technology during the period November 2003 to September 2005. Eleven kinds of crown morphology abnormalities commonly described in the permanent dentition were recorded using the Arizona State University Dental Anthropology System. There were 1525 teeth examined in 100 subjects with clefts, and 203 crown morphologic abnormalities were recorded, resulting in a mean of 2 abnormalities per individual. No significant difference between the unilateral and bilateral cleft lip and palate groups was found; however, the difference between the cleft group and the control group was highly significant. Crown morphologic abnormalities were more frequent in the maxillary cleft teeth than in the mandibular teeth and in the anterior teeth than in posterior teeth, with a statistically significant difference. The most frequently found abnormalities in subjects with clefts were peg-shaped maxillary incisors and missing hypocone, followed by excess mammelons. In conclusion, there was a significant increase in the frequency of crown morphologic abnormalities in individuals with clefts when compared with subjects without clefts. Crown morphologic abnormalities occurred throughout the entire dentition and did not follow any predictable pattern.

Congenital associated malformations in a sample of Jordanian patients with cleft lip and palate.

PURPOSE: To report the prevalence of associated congenital malformations in Jordanian subjects with oral clefts. PATIENTS AND METHODS: A retrospective study of 196 cleft patients was carried out at the Cleft Centre at King Abdullah University Hospital and Maxillofacial Unit at Jordan University of Science and Technology during the period December 2005 to September 2006. Data were collected by interviewing the parents or patients and reviewing the patient's medical records. RESULTS: Twenty-eight cleft subjects had 44 associated malformations other than cleft. Prevalence of associated congenital malformations in Jordanian cleft patients was 14.3%. Of 44 associated malformations, 20 (45.5%) affected the cardiovascular system (CVS), 7 (15.9%) affected the skeletal system, 6 (13.6%) affected the central nervous system, 4 (9.1%) affected the urogenital system, 4 (9.1%) affected the eyes, 2 (4.5%) affected the ears, and 1 (2.3%) affected the digestive system. Approximately 35.3% of these anomalies affected cleft palate subjects, while 17.4% occurred in bilateral cleft lip with or without cleft palate subjects, and 6.4% affected unilateral cleft lip with or without cleft palate subjects. The most commonly recorded anomaly was atrial septal defect (15.9%). CONCLUSIONS: Increased risk of associated malformations in children with clefts must to be highlighted and disseminated to health professionals involved in the management of children with clefts. Routine screening for other malformation, especially cardiac, skeletal, and central nervous system malformations, may need to be considered in infants with clefts, and genetic counseling seems warranted in most of these complicated cases. There should be a close liaison between the cleft team members to comprehensively cover all aspects of the cleft patient's management.

Secondary alveolar bone grafting: the dilemma of donor site selection and morbidity.

Fresh autogenous cancellous bone is ideal for secondary alveolar cleft bone grafting because it supplies living, immunocompatible bony cells that integrate fully with the maxilla and are essential for osteogenesis. Recent animal studies have shown that the dynamics of cancellous inlay bone grafts are different from those of cortical onlay bone grafts, and they refute the assumption that membranous bone grafts are superior to endochondral bone grafts because of their embryological origin. These studies prove that inlay endochondral cancellous specimens have a higher percentage increase in actual bony volume than cortical membranous and cortical endochondral inlay bone grafts. There are various donor sites for secondary alveolar cleft bone grafts. Currently the main sites for autogenous cancellous bone are iliac crest, calvarium, mandibular symphysis, and tibia. Some authors have suggested that the iliac crest donor site causes an unacceptably high degree of postoperative morbidity, but it is still the first choice for secondary alveolar cleft bone grafts and should not be rejected solely because of such concerns. Recombinant human bone morphogenetic protein-2 (rhBMP-2) is now an attractive bony substitute that promotes the differentiation of pluripotential cells into bone-forming cells that lay down new host bone in the site of the defect. Much more research and development are necessary to find a suitable carrier for rhBMP-2, and to study the properties of newly formed bone that it has induced before it can be a substitute for autogenous bone.

Outcome of secondary alveolar bone grafting before and after eruption of the canine in Jordanian patients with cleft lip and palate.

This prospective study was carried out at the Cleft Lip and Palate Centre at King Abdullah University Hospital and Maxillofacial Unit at Jordan University of Science and Technology during the period of 2000 to 2006. The sample consisted of 77 secondary alveolar bone grafts (62 patients), which were performed according to the same standardized surgical technique by a single maxillofacial surgeon. The objective was to assess the outcome of secondary alveolar bone grafting (SABG) before (early SABG) and after (late SABG) the eruption of the permanent maxillary canine in unilateral and bilateral Jordanian cleft subjects. Patients were divided into four groups: early unilateral SABG (22), late unilateral SABG (25), early bilateral SABG (8), and late bilateral SABG (7). Follow-up period ranged from 6 months to 5 years. Periapical or occlusal radiographs were used to assess the outcome of SABG. The degree of bony fill in the cleft area was assessed using the 4-point Kindelan scale. Only Grade 1 (more than 75% bony fill) cases were considered successful. Early unilateral SABG had a success rate of 90% while late unilateral SABG rate was 80%. The overall success rate of the unilateral SABG (85%) was higher than the rate for the bilateral cases (56%). Our findings support the conclusion that the outcome of early SABG is superior to late SABG. The overall success rate of SABG sample (74%) compared relatively well with other published results.

The crown size and sexual dimorphism of permanent teeth in Jordanian cleft lip and palate patients.

OBJECTIVE: To provide a detailed description of crown size dimensions in the permanent dentition of Jordanian cleft lip and palate patients and to compare the findings with those of other populations. METHOD: The mesiodistal crown diameters of the permanent teeth of 47 patients with unilateral cleft lip and palate (UCLP), 25 patients with bilateral cleft lip and palate (BCLP), and 74 controls were measured. RESULTS: The cleft group (UCLP and BCLP patients) generally demonstrated a smaller tooth size for both the maxillary and mandibular arches than did the control group. A sexual dimorphism pattern with males having larger teeth than females was observed for controls and UCLP patients. More males with BCLP had smaller teeth than did females. In the maxilla, the UCLP cleft-side teeth showed the largest percentage (4%) of sexual dimorphism, whereas the BCLP teeth achieved the highest percentage (3.4%) in the mandible. The UCLP cleft-side maxillary lateral incisors (13.2%) and BCLP mandibular canines (6%) displayed greater sexual dimorphism in crown size than did any other tooth class. CONCLUSIONS: Tooth size reduction occurred across all permanent tooth types and among early and late-forming teeth in cleft patients compared with the controls. This reduction was more pronounced in the maxillary incisor field. Males with UCLP and control males had larger teeth than did females, whereas a reversal of the normal dimorphism pattern was observed in patients with BCLP.

Mandibular fractures in Jordanians: a comparative study between young and adult patients.

BACKGROUND: There are very few reports directly comparing mandibular fractures between young and adult patients in Middle Eastern countries. AIM: To review and compare the frequency and aetiology of mandibular fractures in young and adult Jordanian patients. STUDY DESIGN: A retrospective review was made of patients' records and radiographs seen at two university-based maxillofacial units during a 10-year period between 1993 and 2002. Age, gender, aetiology, and site were analysed and compared between young and adult patients. RESULTS: In total, 703 patients (502 (71%) male and 201 (29%) female) were found with 892 mandibular fractures altogether. There were 497 (71%) adults with 676 fractures, and 206 (29%) young patients with 216 fractures. The mean age of the adults was 30 years with a male-to-female ratio of 2.5:1. The mean age of the young patients was 13 years with a male-to-female ratio of 1.5:1. The most common fracture site in adult patients was the mandibular body, whereas the condyle predominated in young patients. The most common causative factor in adults was road traffic accidents, and falls in the young. CONCLUSION: There was a similar gender distribution in both groups of Jordanian young and adult patients. However, there were differences regarding aetiology and site of fracture. The differences found in this study between adult and young patients are similar to those from other countries.

The prevalence of inflammatory and developmental odontogenic cysts in a Jordanian population: a clinicopathologic study.

OBJECTIVE: To determine the prevalence of odontogenic jaw cysts in a Jordanian population and to compare these data with previously published reports from other geographic areas. METHOD AND MATERIALS: The files on odontogenic jaw cysts treated between 1989 and 2001 in the Oral and Maxillofacial Pathology Diagnosis Service at the Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, were reviewed. Clinical and radiographic data were recorded and microscopic slides evaluated according to the most recent World Health Organization classification. Cases were analyzed with regard to age, sex, and anatomic site. RESULTS: A diagnosis of odontogenic jaw cyst was established in 654 patients, with a male-to-female ratio of 1.7:1. Radicular cyst was the most common type of odontogenic cyst found (41.7%), followed by dentigerous cysts (24.8%). The peak age affected was between the third and fifth decades. Both jaws were almost equally affected. The most common anatomic site of incidence was the maxillary incisor/canine region, followed by the mandibular molar region. CONCLUSION: This study indicates that there are some geographic differences with regard to the relative frequency, sex, and anatomic distributions of odontogenic cysts.

Transmandibular K-wire in the management of airway obstruction in Pierre Robin sequence.

The Pierre Robin sequence was first described by Pierre Robin in 1923 as a triad of micrognathia, U-shaped cleft palate, and glossoptosis. Although the problems associated with Pierre Robin sequence may be numerous, the most acute problem in affected newborns is upper airway obstruction. The causes of upper airway obstruction are heterogeneous, and treatment is controversial and may include a long stay in an intensive care setting. Most patients could be treated conservatively with prone/lateral positioning and close clinical observation. A more aggressive approach is to hold the tongue forward surgically by a lip-tongue adhesion (glossopexy) technique, and if all else fails, it might be necessary to perform a tracheostomy. The purpose of this article is to report an unconventional technique for the management of airway obstruction in Pierre Robin sequence. A transmandibular K-wire was used in two patients with Pierre Robin sequence to prevent airway obstruction. The author was not the surgeon who placed the K-wire, and in one of the patients, the K-wire was retained for 4 years before being removed by the author. Both patients had surgical intervention to manage the airway problem in the form of lip-tongue adhesion in addition to the transmandibular K-wire. In conclusion, the value of using a transmandibular K-wire in the two cases presented here could not be determined and was questionable.

Basal cell carcinoma of the maxillofacial region: site distribution and incidence rates in Arab/Jordanians, 1991 to 2000.

PURPOSE: We sought to estimate the incidence rates and disease trends for basal cell carcinoma (BCC) of the maxillofacial region in the civilian population in the north of Jordan. METHODS: A retrospective study was undertaken of all BCCs of the maxillofacial region diagnosed at the Regional Histopathology Department during the period 1991 to 2000. RESULTS: The age-adjusted rate for BCC in 1992 was 6.3:100,000, and in 2000, it was 8.8:100,000. However, several disease trends were observed during the study period. Age- and gender-specific incidence rates apparently increased during the study period. Lesions were most commonly seen on the nose, facial skin, and periorbital skin. The proportions of BCC in the various anatomic sites that were reviewed remained fairly constant over the 10-year period. CONCLUSIONS: In comparison with populations from other geographic areas, the incidence of BCC in the north of Jordan is low. Further studies are needed to identify behavioral and environmental factors that contribute to the development of BCC and to determine whether changes in diagnostic practices could account for the apparent rise in the incidence of this tumor in this population in recent years.

The surgical treatment of central giant cell granuloma of the mandible.

PURPOSE: The objective of this study was to report and evaluate our experience in the surgical treatment of mandibular central giant cell granuloma by resection without continuity defect and peripheral ostectomy. METHODS: A retrospective analysis was conducted of patients with central giant cell granuloma of the mandible who were treated between 1991 and 2000, in the Oral and Maxillofacial Surgery Unit at Jordan University of Science and Technology. A uniform surgical technique was used in all cases. The compact bone composed of the lower border of the mandible and/or posterior border of the ascending ramus, together with the nutrient periosteum attached to it, was preserved. All soft tissues in contact with or overlying the lesion and a margin of cancellous bone related to the lesion were excised. All patients were reviewed annually for a follow-up period of 1 to 9 years (mean, 3.9 years). RESULTS: Eighteen patients with central giant cell granuloma were included, (9 males and 9 females). Their age ranged from 10 to 46 years, with 89% younger than 40 years. Five (28%) lesions were in the incisor-canine region, 2 (11%) were confined to the premolar region, 4 (22%) were in the premolar-molar region, and 7 (39%) were in the molar-ramus region. All patients had aggressive central giant cell granulomas with pain, tooth mobility, and rapidly enlarging swelling. The initial diameter of lesions ranged from 2.7 to 10 cm. During the follow-up period, there was 1 case of recurrence, 2 (11%) patients had permanent lower lip paraesthesia, and no patient had obvious facial deformity. CONCLUSION: Our results suggest that resection without a continuity defect and peripheral ostectomy is a satisfactory method in the treatment of central giant cell granuloma of the mandible, with no or a very low recurrence rate and favorable postoperative function.