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1.
J. Health Biol. Sci. (Online) ; 10(1): 1-4, 01/jan./2022. ilus
Artigo em Inglês | LILACS | ID: biblio-1370925

RESUMO

Introduction: orofacial clefts are common congenital malformations with an important social, psychological, and economic impact. The treatment of this condition may include different surgical procedures that previously require an adequate oral condition. Case report: we report a case of dental treatment before palatoplasty in a male patient of 17 years-old with bilateral cleft lip and palate and lesion in the jugal mucosa. Final considerations: the adequacy of the oral environment is a fundamental step in the treatment of patients with orofacial clefts and aims to restore oral health regardless of the degree of complexity of the dental treatment through the reduction of the pathogenic microbiota, elimination of retentive niches, instructions on diet and adequate oral hygiene and constant patient motivation.


Objetivos: as fissuras orofaciais são malformações congênitas comuns, com importante impacto social, psicológico e econômico. O tratamento dessa condição pode incluir vários procedimentos cirúrgicos que requerem previamente uma adequada condição bucal. Relato de caso: Relatamos o caso de tratamento odontológico prévio a palatoplastia em um paciente do gênero masculino de 17 anos de idade, com fissura transforame incisivo bilateral e lesão em mucosa jugal. Considerações finais: A adequação do meio bucal é uma etapa fundamental no tratamento de pacientes com fissuras orofaciais e visa restabelecer a saúde bucal independente do grau de complexidade do tratamento odontológico por meio da redução da microbiota patogênica, eliminação de nichos retentivos, orientações sobre dieta e higiene bucal adequada e motivação constante do paciente.


Assuntos
Fissura Palatina , Higiene Bucal , Palato , Fenda Labial , Cissus , Cárie Dentária , Fissura , Reabilitação Bucal
2.
Braz. j. oral sci ; 21: e226343, jan.-dez. 2022. ilus
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1393030

RESUMO

Aim: to evaluate the surgical effects of two rehabilitation protocols on dental arch occlusion of 5-year-old children with or without cleft lip and palate. Methods: this is a retrospective longitudinal study the sample comprised 45 digitized dental casts divided into followed groups: Group 1 (G1) ­ children who underwent to cheiloplasty (Millard technique) at 3 months and to one-stage palatoplasty (von Langenbeck technique) at 12 months; Group 2 (G2) ­ children who underwent to cheiloplasty (Millard technique) and two-stage palatoplasty (Hans Pichler technique for hard palate closure) at 3 months and at 12 months to soft palate closure (Sommerlad technique); and Group 3 (G3) ­ children without craniofacial anomalies. Linear measurements, area, and occlusion were evaluated by stereophotogrammetry software. Shapiro-Wilk test was used to verify normality. ANOVA followed by posthoc Tukey test and Kruskal-Wallis followed by posthoc Dunn tests were used to compared groups. Results: For the measures intercanine distance (C-C'), anterior length of dental arch (I-CC'), and total length of the dental arch (I­MM'), there were statistical differences between G1x G3 and G2xG3, the mean was smaller for G1 and G2. No statistically significant differences occurred in the intermolar distance and in the dental arch area among groups. The occlusion analysis revealed significant difference in the comparison of the three groups (p=0.0004). Conclusion: The surgical effects of two rehabilitation protocols affected the occlusion and the development of the anterior region of the maxilla of children with oral clefts when compared to children without oral clefts.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Cirurgia Bucal , Protocolos Clínicos , Fenda Labial , Fissura Palatina , Arco Dental , Oclusão Dentária
3.
J Craniofac Surg ; 33(6): 1709-1713, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36054887

RESUMO

OBJECTIVE: Perform a systematic review assessing the efficacy of enhanced recovery after surgery (ERAS) protocols for cleft palate repair. Primary outcomes included hospital length of stay, readmission rates, and postoperative narcotic use. Secondary outcomes included complications, time to initial postoperative oral intake, and pain scores. DATA SOURCES: Cohort and randomized studies of ERAS protocols pertaining to cleft palate repair were identified by systematic review of Medline, Scopus, Embase, and grey literature. REVIEW METHODS: Data extracted included patient demographics, clinical care protocols, complication rates, postoperative narcotic use, time to initial postoperative oral intake, hospital length of stay, family satisfaction, and 30-day readmission. Meta-analysis was used to compare outcomes between patients enrolled in ERAS protocols versus those in conventional care pathways. RESULTS: Eight hundred sixty-five articles were screened, and 5 studies met full inclusion criteria. A total of 425 patients were included. Patients in ERAS protocols saw a mean reduction of - 23.96 hours in length of stay compared to controls (95% confidence interval [CI]: - 26.4, - 20.6). Patients in ERAS protocols also had decreased total morphine consumption (mean difference [MD]: - 3.88 mg; CI: - 4.31, - 3.45), and decreased time to first initial feed compared to controls (MD: - 3.88 hours; CI: - 4.3, - 3.5). There was no difference in readmission rates or complication rates between ERAS and control groups. CONCLUSIONS: ERAS protocols have seen limited use in pediatric patients. The present study sought to assess the impact of ERAS protocols following primary palatoplasty. Our results indicate decreased hospital length of stay, postoperative opioid consumption, and time to feeding, without increasing readmission rates or complication rates.


Assuntos
Fissura Palatina , Recuperação Pós-Cirúrgica Melhorada , Analgésicos Opioides/uso terapêutico , Criança , Fissura Palatina/cirurgia , Humanos , Tempo de Internação , Readmissão do Paciente , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório
4.
J Craniofac Surg ; 33(6): 1869-1874, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36054892

RESUMO

BACKGROUND: Patients with alveolar cleft unrepaired suffer from nasal deformities of different magnitude. Bone and cartilage grafts are harvested through several incisions. In this study, we present a method to simultaneously correct nasal deformities and repair alveolar cleft using grafts from the nasal septum. PATIENTS AND METHODS: All 6 patients with unilateral cleft lip and palate have alveolar cleft unrepaired combined with nasal deformity. Computed tomography scans and 3-dimensional-printed models of vomer and ethmoid bone were used for the purpose of preoperative design and for assessing the magnitude of deformity. Grafts of bone and cartilage from deviated septum were harvested by septoplasty through which dorsum deviation was corrected. Bone grafts from vomer and ethmoid were then fixed to the prepared alveolar cleft to repair the defect and elevate the alar base. Septal cartilage was adjusted into different shapes of grafts and deformities of nasal tip, nostrils, and columella were then corrected by rhinoplasty to restore the symmetry of the nose. RESULTS: Symmetry of nostrils was improved. The height of alar base on the cleft side was elevated to the level close to the noncleft side. Deviation of the septum, nasal dorsum, and columella was corrected. Projection of the nasal tip was adjusted to facial midline. Midface aesthetics was generally improved. CONCLUSION: Application of septal grafts reduce the number of incisions. One-stage repair of alveolar cleft and nasal deformities, with the aid of digital design, improves the postoperative experience and the general outcome of the surgery.


Assuntos
Fenda Labial , Fissura Palatina , Doenças Nasais , Rinoplastia , Cartilagem/transplante , Fenda Labial/diagnóstico por imagem , Fenda Labial/cirurgia , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Estética Dentária , Osso Etmoide/cirurgia , Humanos , Septo Nasal/cirurgia , Septo Nasal/transplante , Nariz/anormalidades , Nariz/cirurgia , Doenças Nasais/cirurgia , Rinoplastia/métodos , Resultado do Tratamento , Vômer/cirurgia
5.
Am J Orthod Dentofacial Orthop ; 162(3): 403-409, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36049869

RESUMO

INTRODUCTION: Presurgical infant orthopedics was introduced as an interceptive approach for treating cleft lip and/or palate (CLP). This study aimed to evaluate the intraoral digital impression technique as a viable alternative to conventional impression in infants with unilateral CLP. METHODS: Trios 3-Shape scanner (3Shape, Copenhagen, Denmark) was used for intraoral scanning of the infants' maxillary arches to provide a direct digital scan (DDS). In addition, conventional impressions of the same patients were taken in a hospital setting, and the resultant stone models were digitized using the same scanner to create an indirect digital scan (IDS). Both scans (DDS and IDS) were exported in stereolithography format, and the resultant stereolithography files were imported into computer-assisted-design software (Exocad DentalCAD; exocad GmbH, Darmstadt, Germany) for 3-dimensional surface model superimposition. Differences between the 2 surfaces were quantified in millimeters and visually displayed by a color map. RESULTS: Three-dimensional surface model superimposition of the DDS and IDS scans showed an excellent agreement between both approaches, in which differences ranged from 0.01 mm to 0.1 mm CONCLUSIONS: Intraoral direct digital impression in infants with unilateral CLP is a safe, accurate, and time-efficient technique, which can be a viable alternative to conventional impression. This will aid in overcoming the challenges and complications that are frequently associated with using conventional impressions in infants with unilateral CLP, thus reducing the burden of care not only on the patients' families but also on the care providers.


Assuntos
Fenda Labial , Fissura Palatina , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Desenho Assistido por Computador , Técnica de Moldagem Odontológica , Humanos , Imageamento Tridimensional/métodos , Lactente , Modelos Dentários
6.
Stem Cell Res Ther ; 13(1): 469, 2022 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-36076255

RESUMO

BACKGROUND: Regularly discarded lip tissue obtained from corrective surgeries to close the cleft lip represents an easily accessible and rich source for the isolation of primary fibroblasts. Primary fibroblasts have been described to show compelling similarities to mesenchymal stem cells (MSCs). Hence, cleft lip and palate (CLP) lip-derived fibroblasts could be thought as an intriguing cell source for personalized regenerative therapies in CLP-affected patients. METHODS: Initially, we thoroughly characterized the fibroblastic nature of the lip-derived mesenchymal outgrowths by molecular and functional assays. Next, we compared their phenotype and genotype to that of bone marrow-mesenchymal stem cells (BM-MSCs) and of human lung-derived fibroblasts WI38, by assessing their morphology, surface marker expression, trilineage differentiation potential, colony-forming (CFU) capacity, and immunomodulation property. Finally, to better decipher the heterogeneity of our CLP cultures, we performed a single cell clonal analysis and tested expanded clones for surface marker expression, as well as osteogenic and CFU potential. RESULTS: We identified intriguingly similar phenotypic and genotypic properties between CLP lip fibroblasts and BM-MSCs, which makes them distinct from WI38. Furthermore, our own data in combination with the complex anatomy of the lip tissue indicated heterogeneity in our CLP cultures. Using a clonal analysis, we discovered single cell-derived clones with increased levels of the MSC markers CD106 and CD146 and clones with variabilities in their commitment to differentiate into bone-forming cells and in their potential to form single cell-derived colonies. However, we were not able to gain clones possessing superior MSC-like capacities when compared to the heterogeneous parental CLP population. Additionally, all clones could still generate contractile forces and retained robust levels of the fibroblast specific marker FSP1, which was not detectable in BM-MSCs. CONCLUSIONS: Our results suggest that we isolate heterogeneous populations of fibroblasts from discarded CLP lip tissue, which show a prominently multipotent character in their entirety avoiding the need for elaborate subpopulation selections in vitro. These findings suggest that CLP lip fibroblasts might be a novel potential cell source for personalized regenerative medicine of clinical benefit for CLP patients.


Assuntos
Fenda Labial , Fissura Palatina , Células-Tronco Mesenquimais , Células da Medula Óssea , Diferenciação Celular , Células Cultivadas , Fenda Labial/genética , Fenda Labial/metabolismo , Fissura Palatina/genética , Fibroblastos , Humanos , Células-Tronco Mesenquimais/metabolismo
7.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 57(9): 899-906, 2022 Sep 09.
Artigo em Chinês | MEDLINE | ID: mdl-36097935

RESUMO

Objective: To analyze the morphological changes of gray matter in clefts lip and palate (CLP) children using voxel-based morphometric (VBM) and surface-based morphometric (SBM) methods. So as to provide a reference for the neural mechanism of cleft palate speech disorder (CPSD) in CLP population. Methods: A total of 29 CLP children with CPSD who were admitted to Department of Oral & Maxillofacial Plastic & Tramuma Surgery, Capital Medical University School of Stomatology from January 2017 to January 2022 were selected (CLP group), including 9 males and 20 females, aged (9.6±3.2) years (5-17 years old). During the same period, 33 healthy children (healthy control group) were recruited in Beijing Children's Hospital, including 9 males and 24 females, aged (9.6±2.4) years (5-16 years). Results: There were no significant differences in age and gender between the healthy control group and the CLP group (t=-0.07, P=0.944; χ2=0.11, P=0.745). Compared with the healthy control group, the left inferior temporal gyrus, right inferior parietal angular gyrus, and left upper cerebellar gray matter volume in the CLP group were significantly decreased (P<0.05), and the volume of the right medial superior frontal gyrus was significantly increased (P<0.05). The left inferior frontal gyrus insula and the right insula cortical thickness of the subjects in the CLP group were significantly thinner [family-wise error rate (FWER) correction, P=0.035]. The right hemisphere cingulate gyrus isthmus sulcus index increased in the CLP group (FWER correction, P=0.040). Conclusions: CLP children with speech disorder have multiple language-related brain regions with reduced gray matter (GM) volume, decreased cortical thickness, and increased gyrificaition index. The abnormal changes in GM morphology in these brain regions may be related to the characteristics of cleft palate speech disorder in the CLP population.


Assuntos
Fissura Palatina , Substância Cinzenta , Adolescente , Encéfalo , Criança , Pré-Escolar , Feminino , Substância Cinzenta/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Fala
8.
J Clin Pediatr Dent ; 46(4): 299-306, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-36099229

RESUMO

BACKGROUND: The setback of having a child with cleft lip and palate deeply affects the parents psychology. The Pre Surgical Infant Orthopaedics(PSIO) is a promising procedure for improvement in facial morphology prior to primary lip repair. OBJECTIVE: The current study examines the perception of effects of PSIO procedures on the facial appearance of newborns with cleft lip/palate by their mothers and finds its correlation if any, with the change in psychosocial status of the mothers. STUDY DESIGN: The mothers of 50 infants(0-6 months) born with cleft lip/palate rated the nasal morphology, extent of cleft defect and overall facial morphology on a Likert's scale before and after PSIO procedure. This was correlated with changes in mother's depression, anxiety and stress levels by using the validated Hindi-version of Depression Anxiety and Stress scale(DASS-42) index before and after PSIO. RESULTS: The mothers reported a significant improvement in all the morphological parameters for their infants with PSIO which correlated well with significant reduction in the DASS scores from 22.54(severe) to 7.10(normal) for depression, 20.64(extremely severe) to 6.46(normal) for anxiety and 24.7(severe) to 8.4(normal) for stress. CONCLUSIONS: The changes in facial morphology by PSIO procedures are well perceived by mothers and significantly improves their depression, anxiety and stress levels.


Assuntos
Fenda Labial , Fissura Palatina , Ortopedia , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Percepção
9.
Artigo em Inglês | MEDLINE | ID: mdl-36078357

RESUMO

The latest Eurocleft study reported several discrepancies in cleft care. Since then, no critical assessment has been performed. This study aimed to better understand the main strengths and inefficiencies of cleft care within Europe. The Google documents platform was used to create an online survey to investigate several aspects, i.e., provider characteristics, patient profile, services offered, and treatment protocols and complications. Descriptive statistics were calculated. The association between categorical variables was performed using Fisher's exact test. The significance level chosen was 0.05. A total of 69 individuals from 23 European countries completed the survey. Centralized care was the preferred system, and the majority of the countries have an association for cleft patients and professionals (53.6%). The largest percentage of patients was seen in the university hospital environment (Fisher's exact test p < 0.001). The majority of responders (98.6%) reported that an orthodontist was involved in cleft treatment, and 56.5% of them spend 76-100% of their time treating these patients. Despite cleft care having been reconfigured in Europe, a better consensus among the various centers regarding provider characteristics, services offered, and treatment protocols is still required. There is a need for better coordination between clinicians and national/international regulatory bodies.


Assuntos
Fenda Labial , Fissura Palatina , Procedimentos Cirúrgicos Bucais , Fenda Labial/epidemiologia , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estudos Transversais , Europa (Continente) , Humanos , Procedimentos Cirúrgicos Bucais/métodos
10.
Artigo em Inglês | MEDLINE | ID: mdl-36078576

RESUMO

OBJECTIVE: The objective of this systematic review was (a) to explore the current clinical applications of AI/ML (Artificial intelligence and Machine learning) techniques in diagnosis and treatment prediction in children with CLP (Cleft lip and palate), (b) to create a qualitative summary of results of the studies retrieved. MATERIALS AND METHODS: An electronic search was carried out using databases such as PubMed, Scopus, and the Web of Science Core Collection. Two reviewers searched the databases separately and concurrently. The initial search was conducted on 6 July 2021. The publishing period was unrestricted; however, the search was limited to articles involving human participants and published in English. Combinations of Medical Subject Headings (MeSH) phrases and free text terms were used as search keywords in each database. The following data was taken from the methods and results sections of the selected papers: The amount of AI training datasets utilized to train the intelligent system, as well as their conditional properties; Unilateral CLP, Bilateral CLP, Unilateral Cleft lip and alveolus, Unilateral cleft lip, Hypernasality, Dental characteristics, and sagittal jaw relationship in children with CLP are among the problems studied. RESULTS: Based on the predefined search strings with accompanying database keywords, a total of 44 articles were found in Scopus, PubMed, and Web of Science search results. After reading the full articles, 12 papers were included for systematic analysis. CONCLUSIONS: Artificial intelligence provides an advanced technology that can be employed in AI-enabled computerized programming software for accurate landmark detection, rapid digital cephalometric analysis, clinical decision-making, and treatment prediction. In children with corrected unilateral cleft lip and palate, ML can help detect cephalometric predictors of future need for orthognathic surgery.


Assuntos
Fenda Labial , Fissura Palatina , Inteligência Artificial , Criança , Fenda Labial/diagnóstico , Fenda Labial/cirurgia , Fissura Palatina/diagnóstico , Fissura Palatina/cirurgia , Humanos , Aprendizado de Máquina
11.
Afr J Paediatr Surg ; 19(4): 268-270, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36018213

RESUMO

The Cleft Q, a patient-reported outcome measure, has been adopted by the International Consortium for Health Outcome measurement as a valid tool for the measurement of outcomes following intervention on a patient with a cleft. It is scarcely used in sub-Saharan Africa. We report our first experience with the Cleft Q in measuring the outcomes following palatoplasty in an African adult female with a Veau type II defect. The Cleft Q was able to demonstrate improved scores across all domains measured. There is however a need for further validation of the Cleft Q in our setting.


Assuntos
Fissura Palatina , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Feminino , Humanos , Lactente , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Resultado do Tratamento
12.
Folia Med (Plovdiv) ; 64(4): 697-700, 2022 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-36045461

RESUMO

It is assumed that most cleft lip and palate are due to a combination of genetic and environmental factors (maternal diseases, smoking, alcohol intake, infections, and ionizing treatment) that alter morphogenesis. Treatment of these cases begins from birth to adulthood and requires a number of interventions depending on the period of development of the maxillofacial area and teeth.We present the case of a patient with unilateral cleft lip and palate. Surgery and orthodontic treatment were carried out subsequently, and then a metal-ceramic bridge was made to correct the defect. In the course of the treatment, we made decisions that were determined by the available space.The construction restored the dentition, the aesthetics, speech, and masticatory functions of the patient. The treatment of such defects requires good collaboration between individual specialists in order to achieve optimally good results. We believe that in such cases of crucial importance is the contribution of a prosthetic dentistry expert since surgical and orthodontic treatments alone are insufficient to achieve complete recovery and rehabilitation of patients.


Assuntos
Fenda Labial , Fissura Palatina , Adulto , Fenda Labial/cirurgia , Fissura Palatina/reabilitação , Fissura Palatina/cirurgia , Estética , Humanos
13.
J Craniofac Surg ; 33(5): 1388-1393, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36041139

RESUMO

OBJECTIVE: Comparison of speech outcomes in 2 similar groups of "wide" cleft palate. One received a Furlow double-opposing Z- plasty (FZP) versus a group (non-FZP) that received only a muscle release at the second stage after both received a soft palate mucosal adhesion (SPA) at the first stage. METHODS: Retrospective review. Thirty-three patients (non-FZP) versus 29 patients (FZP) between 2010 and 2016. Both groups had SPA at approximately 6 months of age. After 12 months, an FZP with hard palate closure was performed in the FZP group. in the non-FZP group, only the muscle was released from the posterior palatal shelves with hard palate closure. Speech and velopharyngeal insufficiency (VPi) were determined clinically and by videofluoroscopy. RESULTS: The FZP group (15 M: 14 F) with Veau (III = 14; IV = 5; II = 10) had a mean palate length (MPL) of 20.5 mm and mean palate width (MPW) of 11.2 mm at 8.3 months. MPW decreased to 7 mm after 20.7 months. 21% (n = 6) had fistulae. 14% (n = 4) (all males) had VPI. Their MPL was 16.3 mm. The mean follow-up was 5.5 years. In the non-FZP group, (18 M: 15 F) with Veau (III = 22; IV = 7; II = 4), the MPL was 20.5 mm and MPW was 11 mm at 8.4 months. MPW decreased to 6.5 mm after 12.5 months (P = 0.006). The fistula rate was 18% (n = 6). 24% (n = 8) predominantly male (87%) had VPI (P = 0.432). Their MPL was 17 mm; the mean follow-up was 4.7 years. CONCLUSIONS: SPA as a first stage performed in "wide" cleft palate narrows the subsequent hard palate repair and with a muscle release, may be adequate in some patients.


Assuntos
Fissura Palatina , Fístula , Procedimentos Cirúrgicos Reconstrutivos , Insuficiência Velofaríngea , Fissura Palatina/cirurgia , Feminino , Humanos , Masculino , Músculos , Palato Duro , Palato Mole/cirurgia , Estudos Retrospectivos , Aderências Teciduais , Resultado do Tratamento , Insuficiência Velofaríngea/cirurgia
14.
Medicine (Baltimore) ; 101(31): e29383, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35945732

RESUMO

This study's objective was to compare the total and outside the cleft prevalence of dental anomalies (DA) between patients with cleft lip and palate (CLP) and a control group. This retrospective cross-sectional study was done under a case-control design. The case group consisted of 192 non-syndromic patients with complete CLP, while the control group included 411 patients. All subjects had orthopantomography, intra, and extraoral photographs. The prevalence of dental agenesis, supernumerary teeth, impacted teeth, dental transposition, and microdontia were compared using a chi-squared test (P < .05). Next, a second test was made, but only the anomalies outside the cleft were considered for this study. Total prevalence was 89.1% for cases, and 20.9% for controls (P < .01). The prevalence of each DA was significantly higher for the case group. In the analysis of DAs outside the cleft, the total prevalence was still significantly associated (P < .01); however, only dental agenesis was statistically significant (P < .01). Further analysis found that a high rate of upper premolar absence (P < .01) could explain this event. Patients with CLP have a higher prevalence of DAs compared to controls. After considering only the DAs outside the cleft, the total prevalence remains significantly higher. However, this phenomenon is explained mainly by the elevated prevalence of upper premolars' agenesis. This study's results suggest that environmental factors are behind the high prevalence of DAs in subjects with CLP.


Assuntos
Fenda Labial , Fissura Palatina , Anormalidades Dentárias , Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Estudos Transversais , Humanos , Prevalência , Estudos Retrospectivos , Anormalidades Dentárias/epidemiologia
15.
Int J Oral Sci ; 14(1): 43, 2022 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-36008388

RESUMO

Genome-wide association studies (GWASs) are the most widely used method to identify genetic risk loci associated with orofacial clefts (OFC). However, despite the increasing size of cohort, GWASs are still insufficient to detect all the heritability, suggesting there are more associations under the current stringent statistical threshold. In this study, we obtained an integrated epigenomic dataset based on the chromatin conformation of a human oral epithelial cell line (HIOEC) using RNA-seq, ATAC-seq, H3K27ac ChIP-seq, and DLO Hi-C. Presumably, this epigenomic dataset could reveal the missing functional variants located in the oral epithelial cell active enhancers/promoters along with their risk target genes, despite relatively less-stringent statistical association with OFC. Taken a non-syndromic cleft palate only (NSCPO) GWAS data of the Chinese Han population as an example, 3664 SNPs that cannot reach the strict significance threshold were subjected to this functional identification pipeline. In total, 254 potential risk SNPs residing in active cis-regulatory elements interacting with 1 718 promoters of oral epithelium-expressed genes were screened. Gapped k-mer machine learning based on enhancers interacting with epithelium-expressed genes along with in vivo and in vitro reporter assays were employed as functional validation. Among all the potential SNPs, we chose and confirmed that the risk alleles of rs560789 and rs174570 reduced the epithelial-specific enhancer activity by preventing the binding of transcription factors related to epithelial development. In summary, we established chromatin conformation datasets of human oral epithelial cells and provided a framework for testing and understanding how regulatory variants impart risk for clefts.


Assuntos
Fenda Labial , Fissura Palatina , Cromatina , Fenda Labial/genética , Fissura Palatina/genética , Epitélio , Estudo de Associação Genômica Ampla , Humanos
16.
Paediatr Anaesth ; 32(10): 1104-1112, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35929340

RESUMO

BACKGROUND: Children undergoing cleft palate repair present challenges to postoperative management due to several factors that can complicate recovery. Utilization of multimodal analgesic protocols can improve outcomes in this population. We report experience designing and implementing an enhanced recovery after surgery (ERAS) pathway for cleft palate repair to optimize postoperative recovery. AIMS: The primary aim was to implement an ERAS pathway with >70% bundle adherence to achieve a 30% reduction in postoperative opioid consumption within 12 months. Our secondary aims assessed intraoperative opioid consumption, length of stay, timeliness of oral intake, and respiratory recovery. METHODS: A multidisciplinary team of perioperative providers developed an ERAS pathway for cleft palate patients. Key drivers included patient and provider education, formal pathway creation and implementation, multimodal pain therapy, and target-based care. Interventions included maxillary nerve blockade and enhanced intra- and postoperative medication regimens. Outcomes were displayed as statistical process control charts. RESULTS: Pathway compliance was 77.0%. Patients during the intervention period (n = 39) experienced a 49% reduction in postoperative opioid consumption (p < .0001) relative to our historical cohort (n = 63), with a mean difference of -0.33 ± 0.11 mg/kg (95% CI -0.55 to -0.12 mg/kg). Intraoperative opioid consumption was reduced by 36% (p = .002), with a mean difference of -0.27 ± 0.09 mg/kg (95% CI -0.45 to -0.09 mg/kg). Additionally, patients in the intervention group had a 45% reduction in time to first oral intake (p = .02) relative to our historical cohort, with a mean difference of -3.81 ± 1.56 h (95% CI -6.9 to -0.70). There was no difference in PACU or hospital length of stay, but there was a significant reduction in variance of all secondary outcomes. CONCLUSION: Opioid reduction and improved timeliness of oral intake is possible with an ERAS protocol for cleft palate repair, but our protocol did not alter PACU or hospital length of stay.


Assuntos
Fissura Palatina , Analgésicos Opioides/uso terapêutico , Criança , Fissura Palatina/complicações , Fissura Palatina/cirurgia , Humanos , Tempo de Internação , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Melhoria de Qualidade , Estudos Retrospectivos
18.
J Nepal Health Res Counc ; 20(1): 154-159, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35945869

RESUMO

BACKGROUND: Speech therapy is important for ideal functional outcome after cleft palate surgery. Nationwide lockdown due to outbreak of COVID-19 in Nepal restricted the ability of patients to travel to nearby outreach centers for regular speech therapy. The objectives were to assess the feasibility and challenges of conducting online speech therapy with postpalatoplasty children during COVID-19 pandemic; and evaluate the ways to overcome them. METHODS: Patients with cleft palate surgery done at least 3 months prior were given online speech therapy. Feasibility, advantages and challenges of online speech therapy were evaluated through interviewing the guardians and speech therapy providers. RESULTS: A total of 89 patients were included in the study. Only 11.2% had secondary palatine procedures. Almost all the children (97.8%) had face to face speech therapy prior to study period. Best use of time, use of audiovisual aid, no need to travel and rapid progress were the most commonly perceived strengths of online speech therapy. The most frequent challenges were internet connectivity, unclear voice, lack of direct interaction and unstable power supply. Recommended ways to improve online speech therapy were cited as better internet connectivity, having a fixed schedule and availing free or affordable Wifi. CONCLUSIONS: Despite the challenges, online speech therapy provided us with a way to reach out to the cleft palate children when face-to-face therapy was not possible due to COVID-19 pandemic. We see its role even during non-pandemic situations for the children who are unable to visit the speech therapy centers.


Assuntos
COVID-19 , Fissura Palatina , COVID-19/epidemiologia , Criança , Fissura Palatina/epidemiologia , Fissura Palatina/cirurgia , Controle de Doenças Transmissíveis , Humanos , Nepal/epidemiologia , Pandemias , Fonoterapia , Resultado do Tratamento
19.
Int J Pediatr Otorhinolaryngol ; 161: 111289, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35987131

RESUMO

OBJECTIVE: To investigate the prevalence of middle ear cholesteatoma in children with Turner syndrome (TS) as compared to the general population using a large database. METHODS: The TriNetx Analytics Network, a federated health research network that aggregates the de-identified electronic health record data of over 78 million patients across the United States, was queried for patients 18 years old or younger with TS. Patients in this group with any occurrence of a diagnosed middle ear cholesteatoma were recorded and reported. RESULTS: Out of 3,682 children 18 years old or younger with diagnosed TS, 1.47% (95% CI: 1.10%-1.91%) had a history of middle ear cholesteatoma. Out of 12,836,624 children 18 years or younger without TS, 0.09% (95% CI: 0.09%-0.09%) had a history of diagnosed middle ear cholesteatoma. The relative risk for middle ear cholesteatoma in children with TS was 16.74 (95% CI: 12.84-21.83). The relative risk for diagnosed cleft palate among children with TS was 8.56 (95% CI: 6.67-10.98) which, because of the Eustachian tube dysfunction in this population, may contribute to the cholesteatoma risk. CONCLUSION: The rate of diagnosed middle ear cholesteatoma was found to be 16 times higher in patients with Turner syndrome versus children without Turner syndrome. Of studies examining middle ear cholesteatoma in children with TS, the present study has the largest sample size thus providing reliable evidence for prevalence in this population. Clinical monitoring for cholesteatoma should be especially rigorous and frequent in this population.


Assuntos
Colesteatoma da Orelha Média , Colesteatoma , Fissura Palatina , Síndrome de Turner , Adolescente , Criança , Colesteatoma/complicações , Colesteatoma da Orelha Média/diagnóstico , Fissura Palatina/complicações , Humanos , Prevalência , Estudos Retrospectivos , Síndrome de Turner/complicações , Síndrome de Turner/epidemiologia
20.
J Speech Lang Hear Res ; 65(9): 3365-3376, 2022 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-36001858

RESUMO

PURPOSE: Limited quantitative data exist regarding growth of the velopharynx within the first 2 years of life. The purpose of this study was to (a) quantify changes in velopharyngeal structures due to growth during the first 2 years of life, (b) examine the impact of sex and race within this age range, and (c) provide normative measures for comparison to individuals with cleft palate. METHOD/DESCRIPTION: A retrospective chart review was completed of all patients up to 24 months of age that underwent magnetic resonance imaging of the head for medical necessity within the past 18 months using a three-dimensional fluid-attenuated inversion recovery sequence. Measurements of the velopharynx were obtained from 200 scans consistent with previous literature. Participants were divided into five groups based on corrected age for comparison. Variables of interest included adenoid depth, angle of origin, effective velopharyngeal ratio, effective velar length, levator veli palatini length, origin-origin distance, pharyngeal depth, sagittal angle, velopharyngeal ratio, velar insertion distance, velar length, and velar thickness. RESULTS: Velopharyngeal dimensions were significantly different among corrected age groups after controlling for sex and race. Regarding age, analyses revealed significant differences in all variables of interest except effective velopharyngeal ratio. Regarding sex, significant differences were observed for angle of origin, effective velopharyngeal ratio, effective velar length, levator veli palatini muscle length, and velar insertion distance. Regarding race, a significant difference was only observed for angle of origin. CONCLUSIONS: Results of this study demonstrate growth of velopharyngeal anatomy in normative infants with race and sex effects apparent in children up to 24 months of age. Variable growth trends were observed among different velopharyngeal measures.


Assuntos
Fissura Palatina , Músculos Palatinos , Criança , Humanos , Lactente , Imageamento por Ressonância Magnética/métodos , Palato Mole/fisiologia , Faringe/diagnóstico por imagem , Faringe/fisiologia , Estudos Retrospectivos
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