RESUMO
INTRODUCTION: The early diagnosis of mandibular asymmetry (MA) in patients with unilateral cleft lip and palate (UCLP) can contribute to its treatment. OBJECTIVE: The aim of this study was to evaluate the occurrence and the extent of MA in UCLP patients at different growth stages. METHODS: Cone-beam computed tomography (CBCT) of 47 UCLP patients were included, and divided into two groups (prepubertal stage and pubertal stage). The mandibular ramus height (Co-Go), mandibular body length (Go-Me), total mandibular length (Co-Me), gonial angle (CoGoMe), the volume of the mandibular condyles, and lateral chin deviation were evaluated. The cleft side (CS) and noncleft side (NCS) were compared using the paired t-test for dependent samples. Chin deviation and its possible association with specific sides were evaluated using the Mann-Whitney and Fisher's Exact tests, respectively. The significance level was set at 5%. RESULTS: Comparison of CS and NCS revealed that in prepubertal stage, Co-Me was shorter (105.5 ± 5.7 mm; p = 0.036) in the CS, and that in pubertal stage, Co-Go was lower (46 ± 6 mm; p= 0.004) and Go-Me was greater (78.5 ± 5.8 mm; p = 0.026) in the CS. In both growth stages, a significant association (p< 0.05) was observed between the side to which the chin has deviated and the CS. CONCLUSIONS: Although patients with UCLP in the prepubertal and pubertal stages presented significant measurements revealing MA, only Co-Go in the pubertal stage showed a clinically relevant difference. This specific result indicates that MA must be monitored during patients' growth.
Assuntos
Fenda Labial , Fissura Palatina , Tomografia Computadorizada de Feixe Cônico , Assimetria Facial , Imageamento Tridimensional , Mandíbula , Humanos , Fenda Labial/diagnóstico por imagem , Fenda Labial/fisiopatologia , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/fisiopatologia , Estudos Transversais , Criança , Feminino , Masculino , Mandíbula/crescimento & desenvolvimento , Mandíbula/diagnóstico por imagem , Adolescente , Assimetria Facial/diagnóstico por imagem , Imageamento Tridimensional/métodos , Puberdade/fisiologia , Queixo/diagnóstico por imagem , Queixo/crescimento & desenvolvimento , CefalometriaRESUMO
Cleft lip and palate (CLP) represent the most frequently reported congenital anomaly affecting the craniofacial region. The aim of this study was to assess the output (in number of procedures) of the Brazilian hospitals accredited for the treatment of CLP patients, examine the referral flow of patients requiring this type of care, and ascertain the adequacy of the corresponding infrastructure of these healthcare facilities. Methodologically, the study used an observational, cross-sectional, and ecological design. Output data, categorized by state and macro-region, and patient referral flow records were accessible through the Outpatient Information System (SIA, in its Portuguese acronym) and the Hospital Information System (SIH, in Portuguese), respectively. Infrastructure assessment relied on data sourced from the National Register of Health Establishments (CNES, in Portuguese). Analysis encompassed data from 28 accredited hospitals. Concerning output metrics, the state of São Paulo ranked first in the number of procedures conducted. The establishments exhibiting the lowest output performance comprised six hospitals located in the Southeast region and two in the Center-West region. Examination of patient referral flow corroborated the concentration of procedures predominantly conducted in the Southeast, notably within São Paulo state. Infrastructure evaluation encompassed the following categories: physical facilities, diagnostic and therapeutic support services, equipment, and comprehensive multidisciplinary care services. The data showed that roughly 61% of the hospitals surveyed possessed less than half of the recommended items. The primary deficiency identified pertained to inadequacies in equipment availability. Conversely, the best outcomes were associated with diagnostic and therapeutic support services. It was concluded that enhancing hospital infrastructure is imperative for the amelioration of care provision to patients with CLP across all Brazilian states.
Assuntos
Fenda Labial , Fissura Palatina , Brasil , Fenda Labial/terapia , Humanos , Fissura Palatina/terapia , Estudos Transversais , Encaminhamento e Consulta/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Sistemas de Informação Hospitalar/estatística & dados numéricos , Sistemas de Informação Hospitalar/organização & administração , Atenção à Saúde/estatística & dados numéricos , Atenção à Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/estatística & dados numéricosRESUMO
OBJECTIVE: To understand the multidisciplinary care provided to children with cleft lip and palate and their families. METHOD: Descriptive, exploratory and qualitative study, based on the theoretical-philosophical framework of Family-Centered Care, conducted with professionals from the multidisciplinary team of an association supporting individuals with cleft lip and palate. The data were processed using the Iramuteq® software and systematized using Similarity Analysis. The study was approved by the Ethics Committee under opinion no. 4,095,950. RESULTS: Twelve professionals participated, in which the guiding thread for the construction of the classes was the link between the words: Child, Family, Treatment and Difficulty and the alignment with the principles of the Family-Centered Care philosophy, resulting in the following classes: 1. Portrait of assistance from the multidisciplinary team in caring for children and their families (Assistance and Monitoring); 2. Challenges experienced by the team in caring for children and their families (Barriers); and 3. Exercising their (essential) role as a member of the multidisciplinary team (Impact). CONCLUSION: Professionals who care for children with cleft lip and palate and their families encounter barriers during care. However, they provide support to family members and work collaboratively, from the perspective of family-centered care involving participation, dignity, respect, and information sharing.
Assuntos
Fenda Labial , Fissura Palatina , Equipe de Assistência ao Paciente , Fenda Labial/terapia , Fissura Palatina/terapia , Humanos , Criança , Pesquisa Qualitativa , Família/psicologia , Feminino , Assistência Centrada no Paciente , Masculino , Relações Profissional-Família , Saúde da FamíliaRESUMO
OBJECTIVE: Cleft lip and palate are the most common congenital malformations in the craniofacial region, occurring at a rate of 1:700 births in Brazil. These conditions lead to functional impacts on patients, such as changes in breathing, teeth, speech, chewing, swallowing and sucking. Treatment begins with primary surgeries, including lip and palate repair, which aim to reconstruct the soft tissues. Secondary alveolar bone grafting (SABG) reconstructs the bone defect in the cleft region, with the main goal of supplying bone tissue to the cleft region and restore the continuity of the alveolar process. To measure the changes in cross-sectional areas (CSAs) and nasal volume in patients and their impact on the nasal cavity (NC) in the two-month postoperative period (PO2M). METHODOLOGY: This study included 15 patients with complete unilateral cleft lip and palate (U/CLP) indicated for alveolar bone grafting (ABG). Cone beam computed tomography scans obtained prior to SABG and at PO2M were compared. Nasal volumes and CSAs were measured by marking the masks delimiting the nasal cavity on CT scans using Mimics™ software. RESULTS: NC volumes (total, right and left sides) were statistically lower at PO2M in patients with left-sided UCLP. In right-sided UCLP, these volumes were only significant for the total NC and left NC. The CSAs of the internal nasal valve in both groups showed significantly lower values compared to the preoperative period (p≤0.05). CONCLUSION: In the short term, alveolar bone graft surgery reduces the volume of nasal cavities and the cross-sectional areas of the right and left internal nasal valve as a whole, not only the cleft area where the graft material was placed.
Assuntos
Enxerto de Osso Alveolar , Fenda Labial , Fissura Palatina , Tomografia Computadorizada de Feixe Cônico , Cavidade Nasal , Humanos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Enxerto de Osso Alveolar/métodos , Feminino , Masculino , Resultado do Tratamento , Cavidade Nasal/cirurgia , Criança , Estatísticas não Paramétricas , Fatores de Tempo , Valores de Referência , Adolescente , Período Pós-Operatório , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: Given prior craniofacial research reporting higher risk for negative social interactions, this study aimed to explore experiences of stigma described by children with cleft lip and/or palate (CL/P). DESIGN: Qualitative interviews were conducted with children in three sessions (totaling 90-180â min) using creative activities in their homes and/or and walking interviews in their neighborhood. Interview transcriptions were interpreted primarily with thematic analysis following theoretical frameworks of the stigmatization process and self-stigma concept. SETTING: Participants were recruited through Operation Smile Colombia. Interviews took place at children's homes and neighborhoods within three Colombian regions (Boyacá, Bogotá and Cundinamarca). PARTICIPANTS: Children (N = 12) with CL/P aged between 6-12 years were interviewed. RESULTS: Themes fit within the stigmatization process, starting with labeling and stereotyping, such as a range of mockery, and group separation by peers highlighting their not belonging and being socially 'other'. Status loss themes included negative appraisals of cleft-related differences and being perceived as 'ill' and 'imperfect'. Social exclusion themes reflected limited social interactions and loneliness. Self-stigma themes included shame about speaking with peers and anticipation of negative social interactions. CONCLUSIONS: The study results suggest that the process of stigmatization and self-stigma adversely affect social interactions for children with a cleft in multiple ways. Healthcare practitioners and policy makers can help address the potential consequences of stigma by implementing interventions at micro, meso and macro levels.
Assuntos
Fenda Labial , Fissura Palatina , Entrevistas como Assunto , Estigma Social , Humanos , Fissura Palatina/psicologia , Fenda Labial/psicologia , Criança , Colômbia , Masculino , Feminino , Pesquisa Qualitativa , Estereotipagem , AutoimagemRESUMO
OBJECTIVE: To evaluate the correlation between religiosity and alcohol use among adolescents with orofacial clefts. METHODS: Cross-sectional study, developed in a Brazilian public and tertiary hospital, between December 2021 and March 2022. Data collection was hybrid, and three instruments were used: Sociodemographic Questionnaire, Durel Religiosity Scale, and the Alcohol Use Disorders Identification Test. For statistical analysis, the following tests were used: χ2, Fisher's Exact, Mann-Whitney and Spearman's Correlation Coefficient, in addition to analyses of linear correlation strength and bivariate logistic regression. The significance level adopted for all tests was 5% (p≤0.05). RESULTS: 370 adolescents participated, with a mean age of 15.2 years (±1.8). Among them, 23 (5.4%) used alcohol riskly or harmfully, being more frequent among male adolescents (p=0.001), those of mixed race (p=0.046), attending high school (p=0.011), with no religion (p<0.001), or who did not attend religious services (p<0.001). Levels of organizational, non-organizational and intrinsic religiosity were significantly lower among adolescents with risky or harmful alcohol use (p=0.005; p<0.001 and p=0.002, respectively). There was a moderate correlation between risky or harmful alcohol use and non-organizational (r=0.31; p=0.002) and intrinsic (r=0.36; p<0.001) religiosity. Male adolescents (p<0.001; OR=6.58), closest in age to 18 years (p<0.001; OR=1.37), and non-practitioners of religion (p<0.001; OR=6. 48) presented higher odds of risky or harmful alcohol use. CONCLUSIONS: Adolescents with higher levels of organizational and intrinsic religiosity used less alcohol, while males, closest in age to 18 years, and non-practitioners of religion presented higher odds of using alcohol riskly or harmfully.
Assuntos
Fenda Labial , Fissura Palatina , Humanos , Adolescente , Masculino , Estudos Transversais , Feminino , Brasil/epidemiologia , Fenda Labial/psicologia , Fenda Labial/epidemiologia , Fissura Palatina/psicologia , Fissura Palatina/epidemiologia , Religião , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Inquéritos e Questionários , Consumo de Álcool por Menores/psicologia , Consumo de Álcool por Menores/estatística & dados numéricosRESUMO
The goal of this study was to digitally evaluate the development of maxillary dental arches of children with unilateral cleft lip and palate treated with one- and two-stage palatal closure. One hundred and sixty-eight digitized dental models of cheiloplasty and one-stage palatoplasty (G1) and cheiloplasty and two-stage palatoplasty (G2) were evaluated at preoperative time 1 (T1), preoperative time 2 (T2), and postoperative (T3). The following surface distances were evaluated: across surface distance; cleft widths anterior (P-P') and posterior (U-U') cleft widths, intercanine width (C-C'), and intertuberosity width (T-T'); smallest (P'-T') and largest (P-T) segment lengths; and smallest (C'-D') and largest (C-D) segment cleft depths. In G1, P-P', U-U', and C-C' reduced at T2, unlike P'-T' (P<0.05). P-T and C'-D' distances increased at T3 (P<0.05), while C-D increased at all stages (P<0.001). In G2, U-U' and C-C' reduced at T2 (P<0.05), while P'-T', P-T, C'-D', and C-D' increased at T3 (P<0.001). In an intergroup analysis of growth rate, G2 showed higher growth percentages compared to G1, in which C'-D' was significant (P=0.038). Furthermore, C'-D' presented a coefficient of determination of 0.076 (P=0.039). In conclusion, dental arch development is influenced by the rehabilitation protocol. However, in the sample evaluated, the comparison suggested that individuals whose palate was operated on in two stages had the most favorable palatal growth.
Assuntos
Fenda Labial , Fissura Palatina , Arco Dental , Humanos , Fissura Palatina/cirurgia , Feminino , Masculino , Fenda Labial/cirurgia , Arco Dental/cirurgia , Arco Dental/crescimento & desenvolvimento , Criança , Procedimentos de Cirurgia Plástica/métodos , Pré-Escolar , Resultado do Tratamento , Modelos DentáriosRESUMO
Patients with orofacial clefts are more likely to develop oral fungal diseases due to anatomo-physiological changes and surgical rehabilitation treatment. This case-series study evaluated the genetic diversity and dynamics of oral colonization and spread of C. albicans and C. tropicalis in four patients with orofacial clefts, from the time of hospital admission, perioperative and outpatient follow-up, with specialized physician. Candida biotypes previously identified by CHROMagar Candida and PCR methods were studied by MALDI-TOF MS assays and clustering analyses. Possible correlations with pathogenicity characteristics were observed, including production of hydrolytic exoenzymes and the antifungal sensitivity profiles. Amphotericin B-sensitive and fluconazole-resistant (low frequency) C. tropicalis and C. albicans, including clinically compatible MIC of nystatin, were found in the oral cavity of these patients. Clusters of isolates revealed phenomena of (i) elimination in the operative phase, (ii) maintenance or (iii) acquisition of oral C. tropicalis in the perioperative period and specialized outpatient and medical follow-up. For C. albicans, these phenomena included (i) elimination in the operative phase, (ii) acquisition in the operative phase and propagation from the hospital environment, and (iii) maintenance during hospitalization and operative phase. Amphotericin B and nystatin were shown to be effective in cases of clinical treatment and/or prophylaxis, especially considering the pre-existence of fluconazole-resistant strains. This study confirmed the phenomena of septic maintenance, septic neocolonization and septic elimination involving the opportunistic pathogens. MALDI-TOF MS associated with clustering analysis may assist the monitoring of clinical isolates or groups of epidemiologically important microbial strains in the hospital setting.
Assuntos
Anfotericina B , Antifúngicos , Candida albicans , Candida tropicalis , Farmacorresistência Fúngica , Genótipo , Testes de Sensibilidade Microbiana , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Humanos , Candida tropicalis/efeitos dos fármacos , Candida tropicalis/isolamento & purificação , Candida tropicalis/genética , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candida albicans/genética , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Anfotericina B/farmacologia , Anfotericina B/uso terapêutico , Masculino , Feminino , Boca/microbiologia , Criança , Fluconazol/farmacologia , Fluconazol/uso terapêutico , Candidíase Bucal/microbiologia , Nistatina/farmacologia , Nistatina/uso terapêutico , Técnicas de Tipagem Micológica , Fissura Palatina/cirurgia , Fenda Labial/cirurgia , Adolescente , Análise por Conglomerados , Pré-EscolarAssuntos
Fenda Labial , Fissura Palatina , Humanos , Fenda Labial/genética , Fissura Palatina/genética , CriançaAssuntos
Fenda Labial , Fissura Palatina , Adulto , Humanos , Cefalometria , Fenda Labial/terapia , Fenda Labial/complicações , Fissura Palatina/complicações , Fissura Palatina/terapia , Ortodontia Corretiva/métodos , Planejamento de Assistência ao Paciente , Técnicas de Movimentação Dentária/instrumentação , Técnicas de Movimentação Dentária/métodosRESUMO
Orofacial clefts are the most common congenital craniofacial anomalies worldwide, and if not managed in a timely manner, can lead to significant complications. We aim to examine surgical timing at one of the few cleft care centers in the North region of Brazil since its foundation in 2016. This retrospective, descriptive study analyzed medical records from 2016 to 2023. We calculated the age at surgery for each time period and each primary surgery performed. We also evaluated the number of procedures performed outside the recommended age. Of the 1439 procedures performed from 2016 to 2023, 713 procedures met our inclusion criteria. Among these, 66.67% (n=188) of primary cheiloplasties, 67.80% (n=40) of primary lip adhesions, and 54.57% (n=203) of palatoplasties were performed outside the recommended time frame. Of the surgeries performed, 45.16% (n=322) were between 2016 and 2019, while 54.84% (n=391) were from 2020 to 2023. Considering procedures performed within the ideal recommended age groups, only 32.92% (n=106) were done between 2016 and 2019, in contrast to 45.01% (n=176) between 2020 and 2023. In conclusion, since the inception of the specialized center, there has been an increase in surgical volume and an improvement in their timing. However, many surgeries are still being conducted outside the recommended time frame.
Assuntos
Fenda Labial , Fissura Palatina , Procedimentos de Cirurgia Plástica , Humanos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Brasil , Estudos Retrospectivos , Lactente , Feminino , Masculino , Pré-Escolar , Procedimentos de Cirurgia Plástica/métodos , Criança , Adolescente , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Recém-NascidoRESUMO
BACKGROUND: Orofacial clefts (OFCs) are among the most common birth defects (BD). In 2008, a series of improvements began in the Costa Rican Birth Defect Register Center (CREC). We aim to explore trends between 1996 and 2021. METHODS: A trend analysis of OFCs from 1996 to 2021 and a descriptive analysis of OFCs from 2010 to 2021 were performed based on data from the CREC, the national BD surveillance system. Prevalence at birth was calculated according to the type: cleft palate (CP), cleft lip with or without CP (CL ± P), and presentation (isolated, multiple non-syndromic, or syndromes). We used joinpoint regression to identify if a significant change in trend occurred; the average annual percent change (AAPC) was determined. Marginal means and prevalence ratios by subperiod (1996-2009 as referent and 2010-2021) were estimated using Poisson regression and compared using Wald's chi-square tests (α ≤.05). RESULTS: We found a significant AAPC for OFCs prevalence of +1.4: +0.6 for isolated, +2.9 for multiple non-syndromic, and +7.7 for syndromes (p < .05). When comparing the OFC's prevalence of the subperiod 2010-2021 (11.86 per 10,000) with 1996-2009 (9.36 per 10,000) the prevalence ratio was 1.3 (p < .01): 1.1 (p < .05) for isolated, 1.6 (p < .01) for multiple non-syndromic, and 3.3 (p < .01) for syndromes. The prevalence of OFCs from 2010 to 2021 was 9.1 for CL ± P and 2.8 for CP. Seventy-one percent of the OFCs were isolated, 22% multiple non-syndromic, and 7% syndromes. CONCLUSION: The trend in OFCs' prevalence is toward increasing, mainly due to improvements in the surveillance system.
Assuntos
Fenda Labial , Fissura Palatina , Costa Rica/epidemiologia , Humanos , Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Prevalência , Feminino , Masculino , Sistema de Registros , Recém-Nascido , Vigilância da População/métodosRESUMO
OBJECTIVE: To use the bibliographic data of publications regarding the association between orofacial cleft (OC) and cancer to examine the implications of publication growth, co-citation, co-words, and authorship networks using bibliometric indicators and network visualization. METHODS: Bibliometric study analyzed documents related to the association between OC and cancer. Data were obtained in October 2023 from the Scopus, Pubmed, Web of Science. The search strategy was developed, and data obtained were imported into R ("bibliometrix") for analysis. Results: 70 documents were found from 1977 to 2023. Most were journal articles (90.0%) designed as case-control studies (42.8%). American Journal of Epidemiology was the most relevant source. The most cited document was Frebourg T, et al. (2006). Vieira A, Martelli-Junior were the most cited author. Most authors were affiliated to Brazil (University of Montes Claros) and United States (University of Pittsburgh). Research in this thematic has included children and adults of both sexes. Research trend points to gastric cancer, leukemia and breast cancer as the most investigated cancers in association to OC. CONCLUSION: This bibliometric analysis helps fill research gaps regarding the knowledge of the relationship between OC and cancer, providing some clues for selecting future research in this topic.
Analysis of publications regarding the association between orofacial cleft and cancer highlighted: The majority of publications as journal articles (90.0%) designed as casecontrol studies (42.8%).American Journal of Epidemiology was the most relevant source.The most global cited documents were Frebourg T, et al. (2006).Vieira A, Martelli-Junior was the top author of the published literature and the most local cited author.Most of the authors were mainly affiliated to Universities from Brazil (University of Montes Claros) and United States (University of Pittsburgh).Motor themes of study include genetic association studies, investigating single nucleotides polymorphisms shared by OC and cancer types.Research in this thematic has included children and adults of both sexes. Research trend points to gastric cancer, leukemia and breast cancer as the most investigated cancers in association to OC.
Assuntos
Bibliometria , Fenda Labial , Fissura Palatina , Neoplasias , Humanos , Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Neoplasias/epidemiologia , Pesquisa Biomédica/tendênciasRESUMO
INTRODUCTION: The complete bilateral cleft lip and palate (BCLP) divides the maxillary arch into three segments, separated from each other, resulting in abnormal growth of the alveolar arch. This study evaluated the maxillary arch dimensions in BCLP and compared them with neonates without craniofacial anomalies. METHODS: This retrospective study was conducted in a tertiary cleft centre. Sixty-six neonates aged 0-5 months were divided into two groups: cleft group-children with BCLP (23 boys and 18 girls) and control group-children without craniofacial deformities (15 boys and 10 girls). The dental models were processed by a 3D scanner. Landmarks were marked to achieve inter-canine distance, inter-tuberosity distance and arch length measurements. t-Tests were used for intergroup comparisons (p < .05). RESULTS: The maxillary cleft arch was demonstrated to be wider and longer in the posterior region compared to the control group. The inter-canine distance did not present differences between the cleft and controls. The inter-canine distance of the control group was the only measurement influenced by the variable sex. CONCLUSIONS: The cleft significantly interfered with the arch posterior width and arch sagittal length, making them larger. There was no statistical difference in the measurements between sex in the cleft group.
Assuntos
Fenda Labial , Fissura Palatina , Arco Dental , Maxila , Humanos , Fenda Labial/patologia , Fenda Labial/diagnóstico por imagem , Fissura Palatina/patologia , Fissura Palatina/diagnóstico por imagem , Masculino , Feminino , Maxila/patologia , Maxila/crescimento & desenvolvimento , Estudos Retrospectivos , Arco Dental/patologia , Arco Dental/diagnóstico por imagem , Lactente , Recém-Nascido , Modelos Dentários , Imageamento Tridimensional/métodos , Cefalometria , Estudos de Casos e Controles , Pontos de Referência Anatômicos/patologiaRESUMO
OBJECTIVES: Oronasal fistulas are common sequelae following cleft lip and palate surgery and can significantly impact a patient's quality of life. They result from various factors, including surgical techniques, tissue management, and patient-specific factors. This case report explores the modern approach to oronasal fistula closure using periodontal plastic surgery principles. MATERIALS AND METHODS: The report presents two cases of patients with oronasal fistulas due to previous maxillofacial surgical intervention. These patients underwent microsurgical procedures that involved partial flap thickness preparation of the fistula areas, the use of connective tissue grafts from the palate, and meticulous suturing techniques to ensure graft integrity. The procedures were performed in stages, and postoperative care was provided. RESULTS: Both cases demonstrated successful fistula closure and graft survival. The patients reported improvements in breathing, speech, aesthetics, and quality of life. The second case also included guided bone regeneration and implant placement. CONCLUSIONS: Oronasal fistulas resulting from maxillofacial surgery can be effectively treated using periodontal plastic surgery techniques, significantly improving patients' quality of life and aesthetic outcomes. This approach represents a valuable addition to the existing repertoire of oronasal fistula closure methods.
Assuntos
Fissura Palatina , Fístula Bucal , Procedimentos de Cirurgia Plástica , Humanos , Fístula Bucal/cirurgia , Fístula Bucal/etiologia , Procedimentos de Cirurgia Plástica/métodos , Fissura Palatina/cirurgia , Feminino , Masculino , Doenças Nasais/cirurgia , Retalhos Cirúrgicos/transplante , Fenda Labial/cirurgia , Qualidade de Vida , Adulto , Resultado do TratamentoRESUMO
This study aimed to assess and quantify the morphologic characteristics of the lips and the lower third of the face in cleft and noncleft patients, utilizing three-dimensional (3D) stereophotogrammetry. Sixty patients were included in the study, comprising 30 unilateral cleft lip and palate patients (G1, 24 female, 6 male; aged 20 to 60 y, mean age 44.0±12.0 y) and 30 noncleft patients (G2, 23 female, 7 male; aged 20 to 59 y, mean age 43.5±12.0 y). Anthropometric landmarks were identified on the facial surface. Three-dimensional stereophotogrammetry was employed to capture images. Statistical analysis was conducted to compare the groups, with a significance level set at 0.05. The comparative analysis revealed statistically significant differences in 5 linear and 6 angular measurements. Linear measurements such as philtrum width, upper and lower cutaneous lip height, mandibular ramus length, and midfacial depth exhibited significant differences between cleft and noncleft patients. Similarly, angular measurements, including upper lip angle, Cupid's bow angle, lower/medium face convexity, lip seal, nasolabial angle, and left gonial angle, displayed statistically significant disparities. These findings underscore the ongoing surgical challenges in the comprehensive rehabilitation of patients with clefts, highlighting the critical need for continued advancements in treatment strategies.
Assuntos
Pontos de Referência Anatômicos , Fenda Labial , Fissura Palatina , Imageamento Tridimensional , Lábio , Fotogrametria , Humanos , Fenda Labial/cirurgia , Fenda Labial/diagnóstico por imagem , Fenda Labial/patologia , Fotogrametria/métodos , Feminino , Masculino , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Fissura Palatina/patologia , Lábio/diagnóstico por imagem , Lábio/patologia , Imageamento Tridimensional/métodos , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Estudos de Casos e ControlesRESUMO
OBJECTIVE: The current study delves into the accessibility of genetic evaluations for individuals with orofacial clefts (OC), comparing data between genetics and treatment centers across Brazil. METHODS: This cross-sectional retrospective study analyzed primary data from 1463 OC individuals registered in the Brazilian Database of Craniofacial Anomalies (BDCA) between 2008 and 2018 without age or sex selection. Diagnostic exam results stemming from research projects until 2023 were considered. RESULTS: Of the 1463 individuals with typical OC, 987 were non-syndromic, 462 were syndromic (SOC), 10 presented atypical forms, and three were not specified OC cases. The average age for accessing laboratory diagnosis was 8.5 years among SOC individuals. Notably, more SOC cases were registered in genetics centers than treatment and rehabilitation centers (37.1 % vs. 29 %, p = 0.0015). Those originating from genetics centers accessed diagnosis at an average age of 7.3 years, while those from treatment and rehabilitation centers experienced delays with an average age of 10.7 years (p = 0.0581). CONCLUSIONS: Irrespective of the center of origin, the data highlight delayed diagnosis and challenges in accessing genetic tests for the syndromic group. Given the widespread reliance on the public health system by most of the Brazilian population, disseminating this data can significantly contribute to shaping an informed perspective on healthcare access. These insights can improve public policies tailored to the unique needs of individuals with OC.
Assuntos
Fenda Labial , Fissura Palatina , Testes Genéticos , Acessibilidade aos Serviços de Saúde , Humanos , Brasil , Estudos Transversais , Estudos Retrospectivos , Feminino , Masculino , Criança , Fenda Labial/genética , Fissura Palatina/genética , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Pré-Escolar , Adolescente , LactenteRESUMO
OBJECTIVE: To assess whether there is an association between an individual's sex and social judgements made by lay persons regarding untreated cleft lip. MATERIALS AND METHODS: Lay individuals over 18 years old were recruited through an application to respond online to two questionnaires: a sociodemographic survey and the Brazilian Version of Lay Persons' Social Judgements about Cleft-lip Scale (B-LSojCleft-S). B-LSojCleft-S comprises 14 items evaluating social judgements made by laypersons concerning different types of untreated cleft lips in teenagers. The 14 items are linked to 8 images featuring untreated cleft lips and 1 image without a cleft (control). Higher scores represented more favourable social judgements. Independent samples t-test, paired, and multiple linear regression were conducted (P < 0.05). The study assessed judgements of untreated cleft lips in male and female adolescents using the B-LSojCleft-S. RESULTS: The mean age of the 217 participants was 37.78 ± 12.39 years, predominantly women (72.7%), married (47.7%), with a monthly income below three minimum wages (35.6%) in the majority of cases. Significantly higher social judgement scores were observed in the control group (no cleft) compared to any type of cleft (P < 0.001), with similar scores obtained for the same types of clefts with female or male images (P > 0.05). The participant's sex is associated with social judgement scores (F [1, 214] = 6.318, P = 0.013; adjusted R2 = 0.024), with females making more favourable judgements than males (P < 0.05). CONCLUSIONS: Individuals with cleft lips receive more negative social judgement scores, regardless of their own sex. Women make better social judgements than men.
Assuntos
Fenda Labial , Julgamento , Humanos , Fenda Labial/psicologia , Feminino , Masculino , Estudos Transversais , Adulto , Fatores Sexuais , Adolescente , Brasil , Percepção Social , Inquéritos e QuestionáriosRESUMO
PURPOSE: Patients with cleft lip/palate need an interdisciplinary approach. Delays in the care of these patients and difficulties in accessing health services have been reported in different low-, middle-, and high-income countries. This study aimed to characterize worldwide publications on access to cleft lip and palate health treatment. METHODS: Databases were selected systematically and searched until July 2021. The review process followed standard methods for systematic reviews. The study quality was evaluated using the Strengthening the Reporting of Observational studies in Epidemiology guidelines for observational studies. RESULTS: A total of 289 publications were identified using our search strategy. After reviewing the titles and reading the abstracts and full text, 16 studies met the inclusion criteria in the review. In one study, financial difficulties obtained the attention of the professionals who attended to cleft lip/palate patients. Ethnic disparities, problems in transportation, and long distances between users and health centers were found. Additionally, there was misinformation about treatment and follow-up among the caregivers of patients with cleft lip/palate. CONCLUSION: When reviewing the literature on access to health services for patients with cleft lip/palate, barriers were reported in access to information, physical access to care centers, financial resources to cover expenses for treatment, and opportunities in care.