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1.
Rev. Odontol. Araçatuba (Impr.) ; 42(2): 30-34, maio-ago. 2021. tab, graf
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1252909

RESUMO

Dentre as principais consequências da fissura labial e/ou palatina não sindrômica (FL/ PNS) estão dificuldades com fonação e autoestima, a primeira uma questão funcional e a segunda um problema social derivado não raro de contextos de bullying que, dentre outros, podem levar o indivíduo à evasão escolar. O objetivo deste estudo foi avaliar o atraso de escolaridade e a dificuldade de socialização de pacientes com FL/PNS quando comparados a uma população não afetada da mesma faixa etária de 7 a 20 anos, atendidos na Universidade José do Rosário Vellano ­UNIFENAS, campus de Alfenas. Os sujeitos foram agrupados em duas categorias de indivíduos, o grupo caso composto por indivíduos com FL/PNS em tratamento no Centro Pró-Sorriso da UNIFENAS; e o grupo controle composto por indivíduos sem FL/PNS em tratamento nas clínicas de Odontopediatria e Integrada da UNIFENAS. Os resultados demonstraram que a proporção de pacientes com FL/PNS atrasados na escola foi de quase 5 vezes maior que o número de pacientes sem fissuras (p<0,01). Constatou-se que a presença da FL/PNS pode ser o ponto de partida para outros contribuintes, com interferências psicológicas e/ou sociais, interferindo negativamente no processo de socialização (bullying) do paciente (p=0,0018). Portanto devem ser tratadas com abordagem multidisciplinar, incluindo diversos profissionais, dentre eles pedagogos, psicólogos e odontólogos(AU)


Among the main consequences of Non Syndromic Cleft Lip and Palate (NSCLP) are the difficulties with phonation and self estime, the first being a functional issue na the later being social that is derived from, not rarely, bullying contexts, that among other things, may lead na individual to school evasion. The objective of this study was to avaluate the levels of scholarity of patients with NSCLP when compared to a non affected population of the same age in individuals from 7 to 20 years old, attended the Pediatric and Integrated Pediatric Clinic of UNIFENAS, Alfenas campus. The subjects were grouped into two categories of individuals, the case group was composed of individuals with FL/PNS with treatment at the ProSmile center at UNIFENAS. The control group was composed of individuals without FL/PNS in treatment at the clinics of pediatric and integrated denistry at UNIFENAS. The results demonstrated the number of patients with FL/PNS that presented scholar delay were almost 5 times the number of patients that didn't present FL/PNS (p<0,01). The presence of NFL/PNS may be the starting point for other contributors with psychological and/or social interferences, interfering negatively with the socialization process (bullying) of the patient (p=0,0018). They should be treated with a multidisciplinary manner, including multiple professionals, among them pedagogues, psychologist and dentist(AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Evasão Escolar , Fenda Labial , Fissura Palatina , Bullying , Fonação , Socialização
2.
Trials ; 22(1): 393, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127045

RESUMO

OBJECTIVE: Bone grafting is an important surgical procedure to restore missing bone in patients with alveolar cleft lip/palate, aiming to stabilize either sides of the maxillary segments by inducing new bone formation, and in bilateral cleft cases also to stabilize the pre-maxilla. Polyphosphate (PolyP), a physiological polymer composed of orthophosphate units linked together with high-energy phosphate bonds, is a naturally existing compound in platelets which, when complexed with calcium as Ca-polyP microparticles (Ca-polyP MPs), was proven to have osteoinductive properties in preclinical studies. AIM: To evaluate the feasibility, safety, and osteoinductivity of Ca-polyP MPs as a bone-inducing graft material in humans. METHODS: This prospective non-blinded first-in-man clinical pilot study shall consist of 8 alveolar cleft patients of 13 years or older to evaluate the feasibility and safety of Ca-PolyP MPs as a bone-inducing graft material. Patients will receive Ca-polyP graft material only or Ca-polyP in combination with biphasic calcium phosphate (BCP) as a bone substitute carrier. During the trial, the participants will be investigated closely for safety parameters using radiographic imaging, regular blood tests, and physical examinations. After 6 months, a hollow drill will be used to prepare the implantation site to obtain a biopsy. The radiographic imaging will be used for clinical evaluation; the biopsy will be processed for histological/histomorphometric evaluation of bone formation. DISCUSSION: This is the first-in-man study evaluating the safety and feasibility of the polyP as well as the potential regenerative capacity of polyP using an alveolar cleft model. TRIAL REGISTRATION: Indonesian Trial Registry INA-EW74C1N . Registered on 12 June 2020.


Assuntos
Fenda Labial , Fissura Palatina , Fenda Labial/diagnóstico por imagem , Fenda Labial/cirurgia , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Humanos , Indonésia , Projetos Piloto , Polifosfatos/efeitos adversos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Medicine (Baltimore) ; 100(21): e26101, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032749

RESUMO

ABSTRACT: Mycophenolate embryopathy (MPE) is a mycophenolic acid (MPA)-induced congenital malformation with distinctive symptoms. Cleft lip/palate (CLP) is one of the most common symptoms of MPE. The aim of this study was to screen and verify hub genes involved in MPA-induced CLP and to explore the potential molecular mechanisms underlying MPE.Overlapping genes related to MPA and CLP were obtained from the GeneCards database. These genes were further analyzed via bioinformatics. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis results were visualized with the Cytoscape ClueGO plug-in. Gene protein-protein interaction (PPI) networks were constructed based on data obtained from the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database.Overall, 58 genes related to MPA and CLP were identified. The genes most relevant to MPA-induced CLP included ABCB1, COL1A1, Rac1, TGFß1, EDN1, and TP53, as well as the TP53-associated genes MDM2 and RPL5. GO analysis demonstrated gene enrichment regarding such terms as ear, mesenchymal, striated muscle, and ureteric development. KEGG analysis demonstrated gene enrichment in such pathways as the HIF-1 signaling pathway, glycosylphosphatidylinositol-anchor biosynthesis, the TNF signaling pathway, and hematopoietic stem cell development.Bioinformatic analysis was performed on the genes currently known to be associated with MPA-induced CLP pathogenesis. MPA-induced CLP is mediated by multiple ribosome stress related genes and pathways. MDM2, RPL5 and TP53 could be the main contributor in this pathogenesis, along with several other genes. ABCB1 polymorphism could be related to the probability of MPA-induced CLP.


Assuntos
Fenda Labial/genética , Fissura Palatina/genética , Ácido Micofenólico/efeitos adversos , Proteínas Proto-Oncogênicas c-mdm2/genética , Proteínas Ribossômicas/genética , Proteína Supressora de Tumor p53/genética , Fenda Labial/induzido quimicamente , Fissura Palatina/induzido quimicamente , Biologia Computacional , Conjuntos de Dados como Assunto , Redes Reguladoras de Genes/efeitos dos fármacos , Predisposição Genética para Doença , Humanos , Mapeamento de Interação de Proteínas , Mapas de Interação de Proteínas/efeitos dos fármacos , Mapas de Interação de Proteínas/genética , Ribossomos/efeitos dos fármacos , Ribossomos/metabolismo
4.
J Clin Pediatr Dent ; 45(2): 123-128, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33951163

RESUMO

Currently, the treatment protocol for cleft palate at several centers around the world involves primary lip repair around 3-4 months of age, using presurgical nasoalveolar molding, which is done soon after birth. Unfortunately, in cases where treatment is delayed, the potential for repositioning the nasoalveolar apparatus is severely limited. The purpose of this paper is to illustrate a novel use of an expansion screw appliance to aid in the faster and more efficient active molding of the premaxillary and lateral maxillary segments in infants for whom the start of PNAM therapy is delayed, without the side effects commonly seen with pin-retained active molding appliances.


Assuntos
Fenda Labial , Fissura Palatina , Parafusos Ósseos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Lactente , Moldagem Nasoalveolar , Nariz , Cuidados Pré-Operatórios
5.
J Clin Pediatr Dent ; 45(2): 140-145, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33951166

RESUMO

AIM: To compare maxillary development of individuals with unilateral cleft lip and palate (CLP) to individuals with skeletal Class I and Class III malocclusions. STUDY DESIGN: Cephalometric X-ray films from 90 patients (mean age: 13 ± 2.3 years) were used. The number of samples was determined by Power analysis and three groups consisting of 30 patients (Group 1: Skeletal Class I, Group 2: Skeletal Class III, Group 3: CLP) were formed. A total of 13 cephalometric measurements were performed using Dolphin imaging software 11.7. The Kruskal-Wallis and ANOVA tests were used to calculate the differences. The Dunn test and Bonferroni correction were used in paired group comparisons. RESULTS: SNA, Co-A, A-PTV Horizontal, Na-APog, A-Na-Pog, FH-NA, Sn'-Mx1, MxOP-TVL (p<0.001***), U6-PTV Vertical (p<0.01**), and NaBa PTV-Gn (p<0.05*) values were significantly different between the three groups. There was no significant difference in Na-ANS, FH-NPog, or Mx1 labial-ULA. SNA, Co-A, A-PTV Horizontal, Na-APog, and A-Na-Pog values between the 1st and 2nd groups and between the 1st and 3rd groups (p<0.001***) were significantly different. FH-Na-A, Sn'-Mx1, MxOP-TVL (p<0.001***), and U6-PTV vertical were different between groups 1 and 3 (p<0.01**), while FH-Na-A (p<0.001***), Sn'-Mx1, MxOP-TVL (p<0.01**), A-PTV Horizontal, and A-Na-Pog (p<0.05*) were significantly different between groups 2 and 3. CONCLUSION: Maxillary development in CLP differs from skeletal Class I but is similar to skeletal Class III. Considering the delay in maxillary development in the CLP patient, maxillary protraction and maxillary expansion are important treatment protocols in the early period.


Assuntos
Fenda Labial , Fissura Palatina , Má Oclusão Classe III de Angle , Cefalometria , Fenda Labial/diagnóstico por imagem , Fissura Palatina/diagnóstico por imagem , Humanos , Má Oclusão Classe III de Angle/diagnóstico por imagem , Maxila/diagnóstico por imagem
6.
Codas ; 33(3): e20200099, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34037161

RESUMO

PURPOSE: To compare the nasal cavity geometry of children and teenagers with cleft lip and palate and maxillary atresia by two methods: cone-beam computed tomography, considered the gold standard, and acoustic rhinometry. METHODS: Data on cone-beam computed tomography and acoustic rhinometry examinations of 17 children and teenagers with cleft lip and palate and maxillary atresia, previously obtained for orthodontic planning purposes, were evaluated prospectively. Using Dolphin Imaging 11.8 software, the nasal cavity was reconstructed by two evaluators, and the internal nasal volumes were obtained. Using rhinometry, the volumes of regions V1 and V2 were measured. The values of each examination were then compared at a significance level of 5%. RESULTS: Statistical analysis showed high intra- and inter-rater reproducibility in the cone-beam computed tomography analysis. The mean internal nasal volumes (± standard deviation) obtained using acoustic rhinometry and cone-beam computed tomography corresponded to 6.6 ± 1.9 cm3 and 8.1 ± 1.5 cm3, respectively. The difference between the examinations was 17.7%, which was considered statistically significant (p = 0.006). CONCLUSION: The nasal volumes measured via the two methods were different; that is, they presented discrepancies in the measurements. The gold standard technique identified larger volumes than acoustic rhinometry in the nasal cavity. Therefore, determining which test reflects clinical reality is an essential future step.


Assuntos
Fenda Labial , Fissura Palatina , Adolescente , Criança , Fenda Labial/diagnóstico por imagem , Fissura Palatina/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Humanos , Reprodutibilidade dos Testes , Rinometria Acústica
7.
BMC Pediatr ; 21(1): 232, 2021 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-33990187

RESUMO

BACKGROUND: Studies suggest that exposure to ambient air pollution during pregnancy may be associated with increased risks of birth defects (BDs), but conclusions have been inconsistent. This study describes the ethnic distribution of major BDs and examines the relationship between air pollution and BDs among different ethnic groups in Liuzhou city, China. METHODS: Surveillance data of infants born in 114 registered hospitals in Liuzhou in 2019 were analyzed to determine the epidemiology of BDs across five major ethnic groups. Concentrations of six air pollutants (PM2.5, PM10, SO2, CO, NO2, O3) were obtained from the Liuzhou Environmental Protection Bureau. Logistic regression was used to examine the associations between ambient air pollution exposure and risk of BDs. RESULTS: Among 32,549 infants, 635 infants had BDs, yielding a prevalence of 19.5 per 1000 perinatal infants. Dong ethnic group had the highest prevalence of BDs (2.59%), followed by Yao (2.57%), Miao (2.35%), Zhuang (2.07%), and Han (1.75%). Relative to the Han ethnic group, infants from Zhuang, Miao, Yao and Dong groups had lower risks of congenital heart disease, polydactyly, and hypospadias. The Zhuang ethnic group had higher risks of severe thalassemia, cleft lip and/or palate, and syndactyls. Overall BDs were positively correlated with air pollutants PM10 (aOR =1.14, 95% CI:1.12 ~ 2.43; aOR =1.51, 95% CI:1.13 ~ 2.03 for per 10µg/mg3 increment) and CO (aOR =1.36, 95% CI:1.14 ~ 2.48; aOR =1.75, 95% CI:1.02 ~ 3.61 for every 1 mg /m3 increment) in second and third month of pregnancy. SO2 was also significantly associated with BDs in the second month before the pregnancy (aOR = 1.31; 95% CI: 1.20 ~ 3.22) and third month of pregnancy (aOR =1.75; 95% CI:1.02 ~ 3.61). Congenital heart disease, polydactyl, cleft lip and/or palate were also significantly associated with PM10, SO2 and CO exposures. However, no significant association was found between birth defects and O3, PM2.5 and NO2 exposures (P > 0.05). CONCLUSION: This study provides a comprehensive description of ethnic differences in BDs in Southwest China and broadens the evidence of the association between air pollution exposure during gestation and BDs.


Assuntos
Poluição do Ar , Fenda Labial , Fissura Palatina , Poluição do Ar/efeitos adversos , China/epidemiologia , Grupos Étnicos , Feminino , Humanos , Lactente , Masculino , Material Particulado/efeitos adversos , Gravidez
8.
Rev Bras Enferm ; 74(2): e20200089, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34037141

RESUMO

OBJECTIVES: to identify the main doubts regarding the immediate postoperative care of patients with orofacial clefts undergoing orthognathic surgery. METHODS: cross-sectional, quantitative study, developed in a public and tertiary hospital, between November 2017 and May 2018. Data collection occurred through interviews during the preoperative nursing consultation. An instrument was used to describe doubts, which later were grouped according to the subject. RESULTS: 48 patients participated. The doubts referred to sun exposure (56%), food/mastication (48%), the relationship between intermaxillary block-breathing-vomiting (48%), oral hygiene (31%), physical activity restriction (27%), nasopharyngeal cannula, removal of surgical stitches, hospitalization time and speech/communication (23%), bleeding, cryotherapy, facial massage, aesthetic and functional results, healing, edema/ecchymosis, postoperative pain, and changes in facial sensitivity (21%). CONCLUSIONS: the doubts were related to food, the period of convalescence, care for the surgical wound, postoperative complications, and medications.


Assuntos
Fenda Labial , Fissura Palatina , Cirurgia Ortognática , Fissura Palatina/cirurgia , Estudos Transversais , Humanos , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório
9.
Facial Plast Surg ; 37(3): 340-347, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33831958

RESUMO

As facial aging occurs, aesthetic changes of the nasal tip and the senile upper lip include tip ptosis, increase in skin length, loss of vermillion height and Cupid's bow, and vertical wrinkles.Regardless of the rejuvenation procedure, the lips are not to be considered as a single anatomical entity, instead they should be placed in a strong correlation with the nose. The aim of this study is therefore to demonstrate the effectiveness of the association of primary closed rhinoplasty together with indirect subnasal lip-lifting technique.A total of 45 patients were enrolled in this study and underwent primary closed rhinoplasty with indirect subnasal lip-lifting. The result showed an overall average nasolabial angle width reduction of 10.9% and lip length shortening of 23.5%, as assessed 1 year after the surgical procedure. When comparing before and after photographs and using the Subjective Global Aesthetic Improvement Scale (sGAIS), the overall satisfaction was rated 4.4 on 5, as "much improved."The authors show that lips should not be considered as a single anatomical entity but that they indeed must be placed in a strong correlation with the nose since a droopy nasal tip is likely to be considered unattractive and is often associated with the appearance of a long nose with covered philtrum and upper lip.Tip rotation to a normal nasolabial angle width could grant a beneficial impact on overall nose aesthetics; however, it may not fully balance the midface profile as it is the "lip position-to-incisal show" ratio that defines beauty, whereas the balance among forehead, nasal tip, upper lip, and chin is what defines the contour of harmonious profiles.This is the first patient series to show that the combination of closed rhinoplasty and indirect lip-lifting is a highly effective, safe, and reliable procedure to address profile rejuvenation.


Assuntos
Fenda Labial , Rinoplastia , Estética Dentária , Humanos , Remoção , Lábio/cirurgia , Nariz/cirurgia
10.
In Vivo ; 35(3): 1451-1460, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33910822

RESUMO

BACKGROUND: We had a case in which three consecutive pregnancies resulted in birth of three children with an orofacial cleft. Their mother suffered from bronchial asthma and was treated using symbicort (corticosteroid budesonide plus bronchodilator formoterol) during her pregnancies. A hypothesis was assessed: these anti-asthmatics can induce an orofacial cleft in experimental model. MATERIALS AND METHODS: A single administration of one of five increasing doses (including therapeutically used ones) of Symbicort, budesonide or formoterol was injected into the amnion of a chick embryo on day 4 or 5 of incubation. The teratogenic/lethal effects of the anti-asthmatics were assessed on a total of 600 embryos. RESULTS: For budesonide, the teratogenic/lethal effect started at a dose 0.003 µg per embryo, for formoterol at 0.3 µg and for Symbicort 0.03 µg. Orofacial clefts and gastroschisis after exposure were found for all three anti-asthmatics. Heart septum defects occurred after exposure to formoterol. CONCLUSION: The present results support those clinical/epidemiological studies pointing out that anti-asthmatics have the potential to induce orofacial clefts, gastroschisis and heart malformations during prenatal development in human.


Assuntos
Antiasmáticos , Fenda Labial , Fissura Palatina , Gastrosquise , Administração por Inalação , Animais , Budesonida/efeitos adversos , Combinação Budesonida e Fumarato de Formoterol , Embrião de Galinha , Criança , Fenda Labial/induzido quimicamente , Fissura Palatina/induzido quimicamente , Método Duplo-Cego , Etanolaminas/efeitos adversos , Feminino , Fumarato de Formoterol/efeitos adversos , Gastrosquise/induzido quimicamente , Septos Cardíacos , Humanos , Resultado do Tratamento
11.
Rev. Odontol. Araçatuba (Impr.) ; 42(1): 44-48, jan.-abr. 2021. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1252869

RESUMO

Diversas anomalias craniofaciais acometem os seres humanos, dentre estas podem ser citadas as fissuras labiopalatinas. Ocorrem devido à mal formações congênitas e comprometem o desenvolvimento orofacial e maxilo-mandibular, gerando complicações estéticas e funcionais. O momento para abordagem cirúrgica em pacientes com deformidade deste tipo é crucial para atingir o melhor resultado. Entretanto, muitos deles não procuram atendimento ou não tem acesso aos centros especializados. A pré-maxila em portadores de fissura labiopalatina transforame bilateral, não submetidos a tratamento cirúrgico na infância, é comumente protruída, impedindo o desenvolvimento e função adequada da musculatura perioral/ Ainda, pode causar dificuldades alimentares,de fonação e, principalmente, estético. O objetivo do presente trabalho é relatar o caso de uma paciente acompanhada no serviço de cirurgia bucomaxilofacial OSID/UFBA, portadora de fissura labiopalatina, submetida à remoção de pré-maxila em idade adulta. O fechamento da fenda palatina não foi possível devido a idade da paciente e o grau de desenvolvimento do palato, tendo indicado tratamento com uso de prótese obturadora. Considera-se que quanto mais precoce e associado a uma boa técnica cirúrgica forem realizadas as intervenções primárias, menores serão as sequelas. Consequentemente, os resultados estéticos e funcionais serão mais prováveis, sendo desnecessária a remoção cirúrgica da pre-maxila(AU)


Several craniofacial anomalies affect humans and, among these, it can be cited the cleft lip and palate. These occur due to congenital malformations and compromise the orofacial and maxillo-mandibular development, causing aesthetic and functional complications. The moment of the surgical approach in patients with this type of deformities is crucial to achieve the best outcome, however, many of them do not seek care or have no access to specialized centers. The premaxilla in carries of bilateral cleft lip and palate when they are not submitted to a surgical treatment in childhood, is commonly protruding, impeding the development and function of the perioral musculature, besides difficult feeding, phonation and mainly aesthetic. The aim of this article is to report the case of a patient accompained with the Bucomaxillofacial Surgery Service from OSID / UFBA, with cleft lip and palate, submitted to pre-maxilla removal, in adulthood. The cleft palate closure was not possible due to the age of the patient and degree of development of the palate, indicating treatment with obturator prosthesis. It is considered that, the sooner and associated with a good surgical technique, primary interventions are performed, the fewer the sequelae and consequently the aesthetic and functional results, where, in most cases, surgical removal of the premaxilla will be unnecessary(AU)


Assuntos
Feminino , Adulto , Fenda Labial , Fissura Palatina , Anormalidades Craniofaciais , Alveoloplastia , Maxila/cirurgia
12.
Pediatr Dent ; 43(2): 133-139, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33892839

RESUMO

Purpose: The purpose of this study was to evaluate periodontal disease and oral biofilm in children and adolescents with cleft lip and/or palate (CLP). Methods: A total of 118 individuals aged six to 18 years, with CLP (n equals 60) and without CLP (n equals 58), were evaluated according to plaque index (PI), gingival bleeding index (BI), clinical attachment level (CAL), and probing pocket depth (PPD). Gingivitis and periodontitis were also diagnosed. Samples of subgingival oral biofilm were collected, and genomic DNA was extracted for oral microbial analysis. Aggregatibacter actinomycetemcomitans, Tannerela forsythia, Porphyromonas gingivalis, and Streptococcus oralis were identified and quantified by qPCR using Taqman primers and probes. Results: PI, BI, CAL, and PPD were statistically higher in the CLP group. Gingivitis was observed in 52 percent and 29 percent (P<0.001) and mild periodontitis was observed in 48 percent and 22 percent (P<0.001) of the CLP and control groups, respectively. When the permanent dentition group was evaluated, a greater occurrence of mild periodontitis was observed in the CLP group (P<0.001). The level of A. actinomycetemcomitans (P<0.001), P. gingivalis (P<0.001), and T. forsythia (P<0.001) was statistically higher in the subgingival biofilm of the CLP group. Conclusions: The presence of cleft lip and/or palate negatively affects oral hygiene and levels of periodontopathogens in oral biofilm. In addition, clinical and microbiological results highlight the importance of early assessment of young people with cleft lip and/or palate and the permanent dentition to prevent periodontal disease.


Assuntos
Fenda Labial , Fissura Palatina , Adolescente , Aggregatibacter actinomycetemcomitans , Estudos de Casos e Controles , Criança , Fenda Labial/complicações , Fissura Palatina/complicações , Humanos
13.
Cleft Palate Craniofac J ; 58(5): 603-611, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33840261

RESUMO

OBJECTIVE: This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics-cost-to-charge ratio (RCC) and case volume of cleft palate repair. DESIGN: Retrospective cohort study. SETTING: This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. PATIENTS AND PARTICIPANTS: Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. MAIN OUTCOME MEASURE(S): The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. RESULTS: Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; P ≤ .001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], P = .233; AOR = 0.86 [0.62-1.20], P = .386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], P = .005; AOR = 3.14 [1.80-5.58], P < .001). CONCLUSIONS: Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula.


Assuntos
Fenda Labial , Fissura Palatina , Fístula , Criança , Fissura Palatina/cirurgia , Hospitais , Humanos , Lactente , Fístula Bucal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
14.
J Indian Soc Pedod Prev Dent ; 39(1): 9-15, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33885381

RESUMO

Objective: The objective of the study is to determine the association between nonsyndromic oral clefts (OC) in children and ABO, Rh blood groups, lip, and dermatoglyphic patterns of their unaffected parents. Methods: This case-control study was conducted at a tertiary cleft center in Chennai, India, among 240 individuals comprising 80 units (40 cases and controls, respectively). Each unit (triad) was constituted by a child (0-12 years of age) either born with nonsyndromic OC (cases) or with no diagnosed congenital anomaly (control) and their unaffected parents (mother and father). ABO and Rh blood groups, specific lip print, fingerprint pattern, and palmar asymmetry were recorded for each individual. Strength of association of related factors was assessed by multivariable logistic regression reported as adjusted odds ratios and 95% confidence interval. Results: A1-positive blood group was found to be considerably higher among case mothers (14.39 [1.57-32.27]). A higher odds of OCs were observed among case mothers with whorl lip pattern (1.51 [1.16-3.17]) and radial loop pattern in fingers (1.44 [1.09-2.31]) relative to controls. In addition, palmar asymmetry was distinctively higher among case parents compared to controls (P < 0.01). Conclusion: Findings indicate that A1-positive blood group, higher frequency of whorl lip, and radial loop finger patterns in mothers and higher ulnar loop pattern in fathers and palmar asymmetry in both parents increases odds of occurrence of OC among their offspring. These identifiable traits offer potential scope for better service planning among resource-constrained disadvantaged communities in India.


Assuntos
Antígenos de Grupos Sanguíneos , Fenda Labial , Fissura Palatina , Estudos de Casos e Controles , Criança , Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Dermatoglifia , Feminino , Humanos , Índia/epidemiologia
15.
Braz Oral Res ; 35: e039, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33909861

RESUMO

The aim of this study was to evaluate the prevalence of cleft lip and/or palate (CL/P) and associated factors in patients treated at a referral service in Brazil's Midwest. Data were obtained from medical records on file between 2010 and 2017 for this epidemiologic and associational study. A descriptive analysis of the sociodemographic and clinical data was carried out, after which the data were analyzed using the chi-square test and Poisson regression with robust variance. A total of 1,696 medical records were eligible. The requests for rehabilitation were mainly for children in the early years of life, and were mostly for patients from low-income families in the state of Goiás. CL/P was more prevalent in its most severe morphological representation (cleft lip and palate), and the most frequently affected side was the left. Syndromic cleft was present in 4.1% of the cases, and the Pierre Robin sequence and Apert syndrome appeared more frequently. Adjusted multivariate Poisson regression showed an association between cleft palate and the presence of syndromes, since the prevalence was 2.33 times higher in this case than that of no syndrome. Cleft lip and palate were associated with males, whereas cleft palate was associated with females. This study highlights the importance of collecting and analyzing epidemiological data, managing health service planning, and allocating funds to assist cleft patients.


Assuntos
Fenda Labial , Fissura Palatina , Brasil/epidemiologia , Criança , Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Feminino , Humanos , Masculino , Prevalência
16.
Prog Orthod ; 22(1): 10, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33791877

RESUMO

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.


Assuntos
Fenda Labial , Fissura Palatina , Adolescente , Criança , Pré-Escolar , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estudos Transversais , Humanos , Percepção , Qualidade de Vida , Estudos Retrospectivos
17.
Artigo em Inglês | MEDLINE | ID: mdl-33805977

RESUMO

The study objective was to construct and validate a tool to assess, measure, and evaluate the barriers and obstacles that patients with orofacial clefts (OFCs), and their families, face during treatment. The Effective Accessibility and Accommodation subscale, based on the translated Primary Care Assessment Survey and Primary Care Assessment Tool scales, was used as a reference for the questionnaire. A total of 165 parents from three main cleft referral centers in Saudi Arabia were interviewed. Questionnaire content validity was conducted by calculation of a content validity index for each item (I-CVI) as well as for the total scale (S-CVI). Reliability was tested using Cronbach's alpha. Factor analysis and principal components analysis were performed to determine the factor structure of the instrument. The final questionnaire had nine items. Rating results showed both I-CVI and S-CVI scores of 1 and Cronbach's alpha was 0.86. There were three factors (geographic accessibility, appointment availability and accessibility, and scheduling-related barriers) with eigenvalues above 1.00, which collectively accounted for 73% of the variance. In conclusion, this tool is valid and reliable to evaluate accessibility and barriers to care of patients with OFCs in Saudi Arabia.


Assuntos
Fenda Labial , Fissura Palatina , Fenda Labial/epidemiologia , Humanos , Reprodutibilidade dos Testes , Arábia Saudita , Inquéritos e Questionários
18.
Artigo em Inglês | MEDLINE | ID: mdl-33925325

RESUMO

(1) Background: The etiology of orofacial cleft (OC) is not completely known but several genetic and environmental risk factors have been identified. Moreover, a knowledge gap still persists regarding neonatal characteristics. This study evaluated the effect of parental age and mothers' body mass index on the risk of having an OC child, in a matched year and sex group (cleft/healthy control). Additionally, birth data were analyzed between groups. (2) Methods: 266 individuals born between 1995 to 2015 were evaluated: 133 OC individuals (85 males/48 females) and 133 control (85 males/48 females). A logistic model was used for the independent variables. ANOVA or Kruskal-Wallis tests were used for comparison between the OC phenotypes. (3) Results: Regarding statistically significant parental related factors, the probability of having a cleft child decreases for each maternal year increase (odds ratio = 0.903) and increases for each body mass index unit (kg/m2) increase (odds ratio = 1.14). On the child data birth, for each mass unit (kg) increase, the probability of having a cleft child decrease (odds ratio = 0.435). (4) Conclusions: In this study, only maternal body mass index and maternal age found statistical differences in the risk of having a cleft child. In the children's initial data, the cleft group found a higher risk of having a lower birth weight but no relation was found regarding length and head circumference.


Assuntos
Fenda Labial , Fissura Palatina , Estudos de Casos e Controles , Criança , Fenda Labial/epidemiologia , Fenda Labial/etiologia , Fissura Palatina/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Parto , Gravidez , Fatores de Risco
19.
BMJ Open ; 11(4): e049290, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827851

RESUMO

INTRODUCTION: The craniofacial abnormalities found in infants with cleft palate (CP) decrease their airway patency and increase their risk of obstructive sleep apnoea (OSA). We hypothesise that optimising sleep position in infants with CP may improve airway patency and offer a 'low-cost, high-impact' intervention to prevent the negative impacts of OSA. Because cleft centres give inconsistent advice about sleep position: some recommend back-lying and others side-lying, we will compare these in a randomised controlled trial. METHODS AND ANALYSIS: The aim is to determine the clinical effectiveness of side-lying as compared with back-lying sleep positioning in terms of reducing oxygen desaturation resulting from OSA in 244 infants aged 3-5 weeks of age, diagnosed with an isolated CP in/by UK cleft centres. Primary outcome is the 4% Oxygen Desaturation Index measured using pulse oximetry during sleep. RESEARCH PLAN: 1. Multicentre randomised controlled trial of side-lying compared with back-lying sleep positioning in reducing oxygen desaturation resulting from OSA in infants with CP at one month of age. 2. Internal pilot questionnaire-based study to support parents and clinicians regarding study participation, seeking to identify and address any barriers to recruitment. Monitoring data from the internal pilot will be used in the final analysis. 3. Co-development of new UK recommendations with Cleft Lip and Palate Association (CLAPA) regarding sleep position for infants with CP. ETHICS AND DISSEMINATION: The study protocol has received the favourable opinion of the West Midlands-South Birmingham Research Ethics Committee. Study results will be published on affiliated webpages and in peer-reviewed publications and conference contributions. TRIAL REGISTRATION NUMBER: NCT04478201.


Assuntos
Fenda Labial , Fissura Palatina , Apneia Obstrutiva do Sono , Fenda Labial/complicações , Fissura Palatina/complicações , Humanos , Lactente , Recém-Nascido , Oxigênio , Ensaios Clínicos Controlados Aleatórios como Assunto , Sono
20.
J Prosthodont ; 30(5): 454-457, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33660377

RESUMO

The presence of a cleft lip and palate is associated with a number of complications and the oral rehabilitation for the improvement of speech, function and esthetics can involve conventional and surgical orthodontics, distraction osteogenesis, fixed and removable prosthodontics, providing obturation of open defects if required. This clinical report describes the prosthodontic management of a patient with a repaired cleft lip and palate with significant maxillary hypoplasia and primary concern of aesthetics with the use of a two-part hinged magnet retained removable prosthesis.


Assuntos
Fenda Labial , Fissura Palatina , Implantes Dentários , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estética Dentária , Humanos , Imãs , Maxila/cirurgia
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