The objective of this study is to describe the role of periconceptional folic acid supplementation and assess it's potential in the prevention of foetal abnormalities, and consists of a review of the literature undertaken using an electronic and hand search. This includes research trials and methodology associated with folic acid supplementation. It is recommended that all women planning to conceive should supplement their diet with folic acid in order to prevent abnormalities in neural tube development, particularly if there is a history of a previously affected pregnancy. There is increasing evidence that folic acid supplementation may, in addition, reduce the incidence of oral facial clefting. Further research with multi-disciplinary approaches in biochemistry, genetics, gene/environment interactions, and embryology are indicated. (+info)
The incidence of cleft lip and palate deformities in the south-east of Scotland (1971-1990).
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This retrospective study reports the incidence of infants born with the cleft lip and palate anomaly within the Edinburgh Cleft Units catchment area, between 1 January, 1971, and 31 December, 1990. The importance of accurate data collection for local, regional, and national data bases is discussed with reference to the recent CSAG report on cleft lip and palate services in the UK. Five-hundred-and-two cleft lip and palate patients were identified (291 males, 211 females). The incidence is reported as 1.4 per 1000 live births (1 in 711). Twenty-five per cent of clefts affected the primary palate, 45 per cent affected the secondary palate, and the remaining 30 per cent were clefts of both the primary and secondary palate. Overall, a higher percentage of males were affected (58 per cent males to 42 per cent females). Clefts of the secondary palate, however, were more common in females (56 per cent females to 44 per cent males). Data presented in this study is similar to that previously reported from UK centres. It is suggested the accuracy of the UK cleft lip and palate data collection needs to be improved. Prospective data collection in a standardized format carried out on a national basis has to be a priority as recommended by the CSAG report. (+info)
Do you care? A national register for cleft lip and palate patients.
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The Cleft Palate Index and, more recently, the Craniofacial Anomalies Register--CARE--have been in operation since 1982. This paper summarizes its development and plans for the future. CARE is a multidisciplinary committee involving all specialties involved in the treatment of this group of patients therefore it should and can be well placed to co-ordinate the cleft data arising from these patients. (+info)
The many faces and factors of orofacial clefts.
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Orofacial clefts are congenital structural anomalies of the lip and/or palate that affect approximately 1/1000 live births. Their frequent occurrence as well as their extensive psychological, surgical, speech and dental involvement emphasize the importance of understanding the underlying causes. The etiology of orofacial clefts is complex, including multiple genetic and environmental factors. Rare forms, where they occur as one component of multiple congenital anomaly syndromes, have Mendelian or teratogenic origins; the non-syndromic forms of orofacial clefts are more common and are likely due to secondary gene-environment interactions. Recent advances in both molecular and quantitative approaches have begun to identify the genes responsible for the rare syndromic forms of cleft and have also identified both candidate genes and loci for the more common and complex non-syndromic variants. Animal models, in particular the mouse, have also contributed greatly to an understanding of these disorders. This review describes genes that are involved in orofacial clefts in humans and animal models and explores genetic approaches to identifying additional genes and gene-environment interactions that constitute the many factors of orofacial clefts. (+info)
Maternal cigarette smoking during pregnancy and risk of oral clefts in newborns.
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The results of previous epidemiologic research on the possible association between maternal smoking during pregnancy and risk of oral clefts in offspring have been inconsistent. This may be due in part to methodological limitations, including imprecise measurement of tobacco use, failure to consider etiologic heterogeneity among types of oral clefts, and confounding. This analysis, based on a large case-control study, further evaluated the effect of first trimester maternal smoking on oral facial cleft risk by examining the dose-response relationship according to specific cleft type and according to whether or not additional malformations were present. A number of factors, including dietary and supplemental folate intake and family history of clefts, were evaluated as potential confounders and effect modifiers. Data on 3,774 mothers interviewed between 1976 and 1992 by the Slone Epidemiology Unit Birth Defects Study were used. Study subjects were actively ascertained from sites in areas around Boston, Massachusetts and Philadelphia, Pennsylvania; the state of Iowa; and southeastern Ontario, Canada. Cases were infants with isolated defects--cleft lip alone (n = 334), cleft lip and palate (n = 494), or cleft palate alone (n = 244)--and infants with clefts plus (+) additional malformations: cleft lip+ (n = 58), cleft lip and palate+ (n = 140), or cleft palate+ (n = 209). Controls were infants with defects other than clefts, excluding defects possibly associated with maternal cigarette use. There were no associations with maternal smoking for any oral cleft group, except for a positive dose response among infants with cleft lip and palate+ (for light smokers, odds ratio (OR) = 1.09 (95% confidence interval (CI): 0.6, 1.9); for moderate smokers, OR = 1.84 (95% CI: 1.2, 2.9); and for heavy smokers, OR = 1.85 (95% CI: 1.0, 3.5), relative to nonsmokers). This finding may be related to the additional malformations rather than to the cleft itself. (+info)
A 5-year post-operative review of secondary alveolar bone grafting in the Yorkshire region.
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The objective of this study was to determine the quality of secondary alveolar bone grafting in the Yorkshire region, and consisted of a retrospective review of patients case notes and radiographs at five surgical units within the Yorkshire region. The subjects were 109 patients who had secondary alveolar bone grafting between 1.9.91. and 31.8.96. The quality of outcome was assessed using a four-point radiographic scale from occlusal radiographs taken at least 3 months post-operatively: Grade 1 = > 75 per cent bony in-fill, Grade 2 = 50-75 per cent bony in-fill, Grade 3 = < 50 per cent bony in-fill, and Grade 4 = no bony bridge. The radiographic assessment scale was assessed for reliability: inter-examiner weighted kappa = 0.622-0.715 and intra-examiner = 0.818-0.943. Grade 1 results were achieved in 63.2 per cent patients receiving orthodontic expansion and in 40 per cent without expansion before grafting. The four-point radiographic scale described is a useful tool in assessing alveolar bone grafting, Orthodontic expansion. (+info)
Craniofacial skeletal abnormalities in anomalous calves with clefts of the face.
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Thirteen anomalous calves with clefts of the face were morphologically examined, and craniofacial skeletons were studied in detail. According to the type and site of the cleft, four groups could be distinguished: median cleft lip and jaw (CLJ); median cleft lip, jaw, and palate (CLJP); lateral CLJ; and cleft palate (CP), including unilateral and bilateral type. Craniofacial skeletal abnormalities were observed in several bones at the roof, wall, and floor of the nasal cavity and at the boundary portion between the nasal and cranial cavities. Fissure formation at the cranial sutures, partial absence of the nasal process of the incisive bone, and opening of the bony palate were characteristic changes in median CLJ and CLJP, lateral CLJ, and CP, respectively. Furthermore, various associated changes were recognized in the median and paramedian skeletal elements of the face and other organs. The morphological changes of craniofacial skeletons with various types of clefts of the face depended on the site and degree of the cleft formation and reflected developmental errors of the facial embryonic segments. These changes would suggest disorders of the correlated development of facial processes and of other fetal organs of the face. For these conditions, etiologically hereditary cases were negative. (+info)
Popliteal pterygium syndrome: a clinical study of three families and report of linkage to the Van der Woude syndrome locus on 1q32.
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Popliteal pterygium syndrome (PPS) is a rare autosomal dominant disorder, thought to occur with an incidence of approximately 1 in 300 000 live births. The main clinical manifestations are popliteal webbing, cleft lip, cleft palate, lower lip pits, syndactyly, and genital and nail anomalies. This report describes the clinical features in two families with PPS and one isolated case, showing the range of anomalies found both within and between the families. PPS has some features in common with Van der Woude syndrome (VWS), also inherited as an autosomal dominant condition, with cleft lip/palate and, more distinctively, lower lip pits. Although the gene for VWS has not yet been identified, it has been localised to within 1.6 cM in the region 1q32-41. To determine whether PPS and VWS represent allelic forms of the same gene, three families were genotyped for markers flanking and within the critical region. A multipoint lod score of 2.7 was obtained, with no evidence of recombination, supporting the hypothesis that these two disorders are allelic. (+info)