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   2023| January-June  | Volume 10 | Issue 1  
    Online since March 14, 2023

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Stay North, Christopher Robin!
Divya Narain Upadhyaya
January-June 2023, 10(1):1-2
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Feeding interventions among cleft lip/palate infants: A systematic review and meta-synthesis
Manjubala Dash, Devi Prasad Mohapatra, Kulumina Dash, Sasmita Nayak
January-June 2023, 10(1):14-25
Cleft lip and palate (CLP) affect about one baby of every 700 newborn due to alterations in the normal development of the primary and/or secondary palate. The prevalence of clefts in India is between 27,000 and 33,000/year. Searches were undertaken in PubMed, Cochrane database, Web of Science, Scopus, and Google Scholar databases, for primary research studies that report on feeding interventions/feeding techniques/feeding methods, challenges faced by mother/care taker/health personnel as they include most of the publications in this area. Papers were independently reviewed by two authors and Thomas et al's assessment criteria checklist (2003) was used to assess the methodological quality. This systematic review was registered in PROSPERO under number CRD42020208437. The review included 25 studies: 21 quantitative, 2 qualitative, and two mixed methods study, involving 1564 infants and children (age ranging from 1 week to 5 years old) and 790 mothers of Infants with CLP from 13 countries. While comparing the efficacy of the three feeding techniques such as paladai fed, bottle fed, and spoon fed in improving the weight gain pattern the result showed mean weight gain among paladai feeding was better than the bottle or spoon-feeding. Common feeding problems observed were nasal regurgitation, vomiting, and choking, etc. Infants with cleft palate had some major challenges such as aspiration, choking, and inadequate growth. Beyond the esthetic and psychologic implications of the presence of orofacial clefts, the feeding of the child is usually the next concern of the parents and caregivers, a factor which can result in considerable stress to the mother. A prompt diagnosis, especially of a CP, and visit by the cleft team immediately after the birth so that the family can be supported and taught the skills of feeding, is essential.
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Obituary of Prof. Delaire
Joel Ferri, Tony A Markus, Srinivas Gosla Reddy
January-June 2023, 10(1):3-4
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Hearing-related problems in children with cleft palate: A single-center cross-sectional study in the sub-Himalayan population
Vishal Mago, Arush Pasricha, Hiteswar Sarma, Praveen A Jayaprakash, Madhubari Vathulya, Debarati Chattopadhyay
January-June 2023, 10(1):5-8
Purpose: Cleft palate is known to cause recurrent otitis media with hearing loss. Various studies have stated the incidence of middle ear disease in patients with cleft palate is around 90%. The anomalous position of the Eustachian tubes in patients with cleft palate leads to otitis media with effusion. If left uncorrected this leads to complications such as cholesteatoma, retraction pockets, and atelectasis leading to permanent hearing loss. In this study, we evaluated the children presenting to our institute with cleft palate for hearing-related issues. Materials and Methods: The study was conducted in our institute from January 2017 to September 2020. It was a cross-sectional study, where 45 children with cleft palate were compared with 36 children with cleft lip who were considered the control group. Hearing of all children was assessed using tympanometry, otoscopy, and brainstem evoked response audiometry (BERA). Results: About 93.3% of children in the cleft palate group had an abnormal tympanic membrane on otoscopy, whereas in the control group only 11.1% of children had an abnormal tympanic membrane on otoscopy. About 97.8% of children in the cleft palate group had a hearing threshold greater than 25 decibels, whereas only 13.9% of children in the control group had a hearing threshold of above 25 decibels. More children in the cleft palate group had an abnormal tympanogram (42.2% had a type B tympanogram and 46.7% had a type C tympanogram) compared to the control group (5.6% had a type B tympanogram and 2.8% had a type C tympanogram). Conclusion: Our study adds to the evidence that there is a high incidence of hearing impairment in children with cleft palate. Hence, we advocate that early identification by screening measures such as otoscopy, tympanometry, auditory brainstem response, and pure tone audiometry during the first visit itself in these children so that early treatment can be initiated.
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A retrospective study on clinical and epidemiological profile of nonsyndromic cleft lip and palate patients admitted in a large Comprehensive Cleft Care Centre in West Bengal, India
Nupur Saha, Mainak Das, Shabnam Zahir, Arnab Santra
January-June 2023, 10(1):9-13
Aim: The aim of this study is to observe the clinical and epidemiological profile of nonsyndromic cleft lip (CL) and/or palate patients admitted to a cleft care center in West Bengal from May 2021 to April 2022. Materials and Methods: A retrospective epidemiological study had been done by preparing a master data sheet to record the patient's data from a Comprehensive Cleft Care Centre in West Bengal. The study variables included were patient's age reporting at the hospital, type of cleft, sex distribution of patients, residential address of the parents, socioeconomic status through parents' education, occupation, and monthly income, and consanguineous marriage history of the family. Results: A total of 276 nonsyndromic cleft patients during the time period (May 2021 to April 2022) were considered. Among these, 164 were male and 112 were female patients. The mean age of patients reporting to this hospital on average was 13–18 months. CL with palate patients (62%) predominated than any other type and was mostly seen in male patients (69.59%); isolated CL (22%) cases were more in females (56.25%), whereas isolated cleft palate (16%) cases were seen more in males (62.79%); unilateral (77%) and left-sided cleft (67%) were found predominantly than bilateral cases (23%) and seen mostly in females, whereas bilateral cleft cases were more in males. Most of the patients belonged to North 24 Parganas District which is an adjacent district of Kolkata, and most of the families belonged to a low socioeconomic group, and interestingly, most of them had consanguineous marriage history (61%) with at least one generation. Conclusion: The results of this study provided that CL with palate type is more common among all types of clefts and predominantly found in males than females in West Bengal. The unilateral left-sided cleft is predominant among all other varieties. Most of the parents belonged to low socioeconomic status and are having consanguineous marriage history. We need to spread awareness among the public through ads and banners, social media, and medical free camps about the deformity of CL and/or palate and also possible preventive measures, make arrangements for free treatment among the CL and/or CL and palate population for better life of cleft patients and their parents.
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Prenatal management in clefts
Harsha Vardhan, Manju Lata Verma
January-June 2023, 10(1):26-30
Cleft lip and palate is one of the most common craniofacial anomaly. The management of this entity has led to the development of the field of craniofacial surgery. Improvement in understanding of clefts and refinement in surgical techniques have improved the life of children with clefts. However, like with all congenital anomalies, the impulse is to look earlier. Fetal management of cleft lip and palate is an attractive avenue. In this paper we explore this less travelled road, to see the advances in the field of detection of cleft lip and palate in the fetus, and to see the current state of fetal surgery for cleft lip and palate.
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Cleft palate: Part II – The concept and techniques
Partha Sadhu, Neelam Chauhan
January-June 2023, 10(1):48-53
Cleft palate is the most common craniofacial anomaly with multiple surgical options in the armamentarium of a surgeon. Following the principles and right surgical techniques can yield excellent functional results. The various techniques have gradually developed over time and each has their own peculiarities along with specific advantages and disadvantages. Here, in this article, we will be discussing a few palatoplasty techniques which have stood the test of time and are commonly performed.
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Congenital palatal fistula: Case report and review of literature
Sneha Gulati, Aditya Shivaji Yadav, Ramesh Kumar Sharma
January-June 2023, 10(1):37-39
Congenital palatal fistula (CPF) is the rarest phenotypic variation of cleft palate, commonly associated with submucous cleft palate (SCP). Isolated palatal fistula without SCP has been reported only rarely. We report here the case of a 4-year-old child, with a 10 mm × 5 mm CPF, presenting with nasal regurgitation and speech abnormalities. The patient had unilateral palatal muscular malposition without classical features of SCP. The repair was performed using turnover flaps and Bardach's two-long flap palatoplasty and intravelar veloplasty. Healing occurred without any complications.
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A novel modification of nasoalveolar molding procedure to enhance ease of use
Gaurav Pratap Singh, Gaurav Vohra
January-June 2023, 10(1):40-44
Cleft lip and palate (CLP) is one of the most common craniofacial birth defects. Its incidence varies according to race, sex and region. As ubiquitous as the condition may be, when it comes to clinical presentation, CLP manifests in a myriad of forms and varieties. The most common clinical presentation is that of a unilateral cleft lip and palate (UCLP). Management of CLP is a challenging proposition but in recent times, the results have become better owing to standardization of treatment protocol and the availability of multidisciplinary teams at specialized cleft centers worldwide. Management of CLP is initiated right from birth with parental counselling followed by presurgical infant orthopedics (PSIO). Nasoalveolar moulding (NAM) is on of the most widely accepted modalities of PSIO and is used to achieve alignment of the cleft alveolar segments into a more ideal relationship prior to the primary lip repair surgery. In its bare essence, NAM uses an acrylic molding plate with selective addition and removal of soft liner to mould the segments into a more ideal position. The molding plate is held in place with elastics which are retained by the use of adherent tapes on the cheek. The use of these tapes on a young infant often leads to tissue irritation and results in reduced compliance and treatment effect. Herein this case report we aim to highlight a novel approach of retaining the molding plate which dispenses with the need of adherent tapes. This technique has the benefit of no tissue irritation, easier application and improved compliance.
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Dermal substitute reinforced single-layer closure of the palatal fistula
Hardeep Singh, Rakesh Kumar Khazanchi
January-June 2023, 10(1):45-47
Postoperative palatal fistulas are common after surgery to correct a cleft palate. The repair is hindered by palatoplasty-related scar tissue, reduced vascularity, and restricted mobility of flaps. Surgical repair of fistulae is often effective, but recurrence is common. A 3.5-year-old boy presented with anterior palatal fistula. The presence of peri-fistulous scarring prevented two-layered closure. Nasal layer closure was achieved but not the oral layer. The dermal matrix was reinforced in a one-step procedure over the nasal layer and fixed in place using a gel foam. At 6 months, the fistula almost completely healed, with only a pinpoint track remaining that occasionally leaked into the nasal cavity. These results indicate that the application of dermal matrix is a promising technique to repair fistula with surrounding scarring, but larger, prospective trials are needed to confirm its potential benefits.
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Silver–Russell syndrome in siblings with orthodontic management
Vijaylaxmi Mendigeri, Praveen Ramdurg, Fatima Zohar Lingadalli, Sanjay Ganeshkar
January-June 2023, 10(1):31-36
Silver–Russell syndrome (SRS) is a rare congenital abnormality. The incidence ranges from 1 in 3000 to 100,000 live births. It is characterized by low birth weight, asymmetric limb, relative macrocephaly, high forehead, small triangular-shaped face with small jaws, and dental malocclusion. The etiology of SRS is still unclear, but genetic alterations and family history have been attributed. The diagnosis of SRS is mainly based on physical characteristics and appearance. This article enlightens clinical versatility in dental features of SRS in two siblings and discusses the orthodontic management for dental malocclusion in the elder one.
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