Introduction: There is a wide disparity in the access to treatment facilities between developed and developing countries in cleft lip and palate (CLP) management. Factors ranging from poverty and illiteracy to paucity of healthcare services affect the patient accessing these services. Objective: Information regarding the socioeconomic and educational status of the parents of CLP patients admitted in a tertiary centre in Northern India was collected and analyzed to find any correlation between the above and the age of child at the first presentation to the hospital. Methods: Data were collected from parents of 200 consecutive patients of CLP presenting for surgery. The data set included variables such as age and sex of the child, age and literary status of the parents, household income, distance to the hospital from home, and the source of information that made them visit the hospital. Results and Conclusion: There was significant association between the age of first presentation and the literary status of the mother and father (P = −0.005 and 0.02, respectively), socioeconomic status of the family (P = −0.02), and the distance from the hospital. Other observations, though impressive, were not statistically significant. This proves the impact of socioeconomic and literary status of parents on availing access to healthcare services for their children.

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Tongue hamartoma is not a common congenital disorder. Common associations include cardiac defects and limb anomalies such as polydactyly and syndactyly. Its association with cleft palate is unusual and as such only very few cases have been reported. A 15-month-old girl who presented to us with a mass on the tongue in association with cleft of the soft palate is presented. She had cleft palate repair and incisional biopsy of the mass. Initial histology was lipoma. The mass was excised a year later and histology confirmed lipomatous harmatoma.

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Objective: This study evaluated the training module which was developed for resource workers in the community, to impart knowledge about cleft lip and/or palate (CLP) and skill to identify error patterns in speech of individuals with CLP. Design: This was a cross-sectional study. Method: This study is a part of an ongoing community based rehabilitation project conducted in a rural district of South India. A total of 47 resource workers belonging to a rural district served as participants of this study. Pre and post training measures were compared to examine the effectiveness of the training program. Knowledge about CLP and ability to identify error patterns in speech of individuals with CLP by the resource workers were measured pre and post training to examine the effectiveness of the training program. Results: There was a statistically significant improvement in the resource workers' knowledge about CLP. Resource workers were able to identify the abnormal productions but were inconsistent in categorizing the specific error patterns. Conclusions: The post training results revealed improvement in the resource worker's understanding of CLP and ability to identify speech patterns in individuals with CLP. It can be inferred that with periodic retraining, resource workers can be trained to identify speech error patterns in individuals with CLP. Trained resource workers could probably be used to provide speech services under the supervision of speech-language pathologist (SLP) in places where SLPs are not available locally to provide direct therapy.

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Introduction: The anterior iliac crest is considered the best site for harvesting autogenous bone graft for reconstruction of alveolar cleft since decades. As it is with the other sites of autogenous bone graft harvesting, anterior iliac crest also results in postoperative morbidity. The purpose of this study is to assess the associated postoperative morbidity with anterior iliac crest harvesting in the treatment of individual with alveolar clefts. Patients and Methods: A total of 92 patients with alveolar clefts were treated with autogenous bone grafting harvested from the anterior iliac crest in the duration from January 2009 to December 2014. Postoperatively, on day 1, day 7, 1^st month, 3^rd month, and 6^th month, morbidity was assessed in these patients with postoperative pain, gait disturbance, sensory disturbance, and scarring being the parameters of assessment. Results: Postoperative pain was a complaint of all the patients on day 1 which reduced to 3.26% of patients on day 7 and after 1 month revealed no patients was experiencing pain. On day 1, 69.57% of patients and 97.83% of patients complained of sensory and gait disturbances, respectively. These numbers decreased to 6.52% and 8.7%, respectively, on day 7^th, further decreasing to 2.17% and 1.09%, respectively, after 1 month. None of the patients had gait and sensory disturbances after 3 months. On scar evaluation, only one patient had a hypertrophic scar at the end of 6 months postoperatively. None of the parameters were statistically significant on completion of the 1^st, 3^rd, and 6^th month. Conclusion: Anterior iliac crest can still be continued to be considered a first option for harvesting autogenous bone graft for rehabilitation of patients with alveolar clefts as it is well tolerated by them. It has low morbidity which allows early resumption of normal activities and has a reasonable esthetic outcome.

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Context: During humanitarian cleft care mission in developing countries, a considerable noncompliance of the patient remains evident despite the provided medical support. According to the literature, social background and beliefs are some of the factors that hamper cleft management in these areas. Aims: In this study, we investigated on these impairments for a better approach to cleft care in Madagascar. Settings and Design: This is a qualitative study conducted in Clinic Ave Maria, Antsirabe, Madagascar, which interviewed parents and patients. Subjects and Methods: One adult patient and nineteen parents of a patient with cleft lip and palate (CLP) were interviewed for a qualitative study. An open-ended, closed-ended semistructured interview was conducted. Results: Analysis of the interview result and a literature discussion were performed. The most believed cause of cleft lip was supernatural forces, diet, and a curse, leading to a strong self-blame and shame inside the community. Thus, CLP is thought to be a supernatural disease, which cannot be totally healed by injection and surgery. A belief leads to a delay, denial of medical care, and/or ignorance and rejection of new explanations. Conclusions: Social background and beliefs of our Malagasy community have a considerable impact on how the patients perceive cleft deformity. These perceptions strongly influence the patient's compliance to medical care. Considering education as a part of the treatment plan during a humanitarian mission can modify the patient's attitude and improve their motivation to a better treatment outcome.

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Introduction: Alveolar bone graft surgery is of crucial importance in the cleft lip and palate patient. Adequate integration of the bone promotes dentition and esthetic of the face. The aim of this study is to evaluate the integration of the bone graft in patients with primary palate cleft. Patients and Methods: We made a retrospective analysis of medical records and plain X-ray films of 37 patients undergoing bone graft surgery in a tertiary care center. To assess the integration rate, we used the Bergland scale. Integration of alveolar bone graft evaluated with orthopantomography and relation between sex and the type of alveolar cleft surgery in the bone integration. Results: About 65% of the patients in our series were male (24). There was no statistical difference between the age, sex, and diagnosis. Mean age of the patients was 10.2 years. Successful integration (Bergland scale I and II) was achieved in 49% of the patients (Grade I: 30% and Grade II: 19%). Unfavorable integration (Bergland scale III and IV) was demonstrated in 51% of the patients, (Grade III: 43% and Grade IV: 8%). We found no difference between the integration rate and the type of alveolar graft surgery (primary, conventional secondary, and late secondary). Conclusions: Using the Bergland scale, we demonstrated 49% successful integration of the alveolar bone analyzed by two experts. Age has no impact on the integration rates in these groups of patients.

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Introduction: Cleft palate patients suffer from many comorbidities, otitis media with effusion being one of them. There is a universal consensus regarding the presence of hearing impairment in such patients. However, there are different schools of thought regarding the effect of palatal repair on hearing ability. Hence, this study was conducted to find out the effect of palatoplasty on hearing ability of children with cleft palate. Patients and Methods: Seventy-five patients with cleft palate underwent palatoplasty and were subjected to otoscopy and brainstem evoked response audiometry, preoperatively, 1 month postoperatively and 6 months postoperatively. The otoscopy and audiometry findings were statistically analyzed using Chi-square test and students unpaired t-test. Results: Ninety-two percent of patients had hearing impairment with majority of them belonging to age group <3 years. The study showed a male preponderance. Statistical analysis revealed that there was no significant difference between the preoperative and 1 month postoperative outcomes of otoscopy and audiometry. However, the values show a statistically significant improvement 6 months postoperatively. Conclusion: There is a marked association between hearing impairment and cleft palate. Moreover, this impaired hearing improves after palatoplasty in due course of time.

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Velopharyngeal insufficiency resulted from the defect in soft palate due to acquired or congenital reasons, which cause incomplete closure of the palatopharyngeal sphincter. The individual with such defect faces problem in eating, speaking, breathing as well as faces psychological trauma in society. This article presents a case report of a patient with congenital velopharyngeal defect. A definitive cast partial prosthesis with a hollow acrylic bulb obturator was planned for the patient. This case report presents a modified impression technique for making definitive obturator along with cast partial denture for better retention and stabilization of the prosthesis. The prosthesis increases the acceptance as it prevents the hypernasality; improve mastication and speech of the patient.

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Objectives: Velopharyngeal dysfunction (VPD) secondary to neuromuscular pathology is well recognized. Surgical treatment in these patients using palatoplasty or conventional sphincteric and posterior flap-based pharyngoplasty is often contraindicated as they may further weaken or aggravate already impaired musculature. We report a small case series of patients who underwent successful long-term treatment for VPD of neurogenic origin using an injectable gel polymer to augment the posterior pharyngeal wall. Design: Three patients in whom a neuromuscular condition had led to the development of VPD underwent augmentation pharyngoplasty. Speech was compared pre- and post-operatively examining hypernasality, nasal emission, and nasalance scores and patient self-evaluation of outcome. Results: All three patients had improvement in parameters measured following pharyngeal injection augmentation. One patient noticed deterioration in speech intelligibility following initial injection into the velum: the implant polymer was easily removed and later reinjected in the posterior pharynx with good effect. Conclusions: The use of gel polymer injection pharyngoplasty in the treatment of neurogenic VPD was safe, simple, well tolerated, and easily reversible. However, due to recent severe complications reported from fat augmentation pharyngoplasty, we would not recommend its routine usage.

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Objectives: The study was conducted to document the impact of the cleft of lip and palate among adults using International Classification of Functioning, Disability and Health (ICF) framework. Design: This was a cross-sectional study. Participants: A total of 32 adults with cleft lip and palate (CLP) and a matched control group of 32 adults without CLP (non-CLP [NCLP]) were included in the study. Methods: To identify a set of items from ICF framework that is relevant to adults with CLP (ICF-CLP item set) from the components of activity participation and environmental factors. Two expert teams were involved in the selection of the final set of items from both the components. Then, the item set (ICF-CLP item set) was developed in Tamil. ICF-CLP item set in Tamil was piloted on 32 adults with repaired CLP and a matched control group of adults without CLP (NCLP) group by self-administering method. Results: There was a significant difference (P = 0.000) between CLP and NCLP group, in both the components –activity participation and environmental factors. In the item-wise comparison, individuals with CLP had a greater limitation in activity, restriction in participation in the domains of communication, maintaining interpersonal interactions and relationships, employment, and major life areas. In environmental factors, the domains of support, relationship, health services, education training systems and policies, attitudes of authorities, and strangers were projected as barriers by individuals with CLP. Conclusion: This study helps us in understanding the overall impact of the cleft of lip and palate among adults in the components of activity participation and environmental factors using the ICF framework. On the other hand, the ICF-CLP item set developed is clinically relevant in identifying conditions which limit activities/participation and serve as barriers/facilitators in their environments both in CLP population as well as in normal individuals.

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