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The rise of two sub-specialties in Physical Antrhopology traces back to the Anatomy Departments of Schools of Medicine in Germany and France during the nineteenth century. The study of human diversity in bones and bodies was largely by medically-trained anatomists. There developed Medical Antropology and Dental Anthropology, employing osteometry and craniometry on the skeleton, somatometry and cephalometry on the living body. As a result cross-sectional studies gave way to longitudinal studies and X-ray techniques were added to purely mensurational procedures. In Medical Anthropology the specialties most directly concerned are pediatrics, plastic surgery, endocrinology, and orthopaedics. In Dental Anthropology the specialties most directly concerned are pedodontics, orthodontics, oral surgery, and prosthodontics. The contributions of Physical Anthropology to each is discussed.

Abstract Orofacial clefts are among the most prevalent birth defects, with severe medical and psychosocial consequences. Cleft lip with or without cleft palate (CL ± P) and cleft palate only (CPO) affect on average nearly 1/700 births worldwide. The cause of most non-syndromic cases is unknown. Maternal factors and disorders are assumed to modify the risk of orofacial clefting. In the present study, we performed a systematic review and meta-analysis to analyze the effects of maternal underweight, obesity, hypertension, diabetes, as well as smoking, and alcohol consumption on the development of orofacial clefts. As CL ± CP and CPO have distinct pathogenetic backgrounds, these cleft subtypes were assessed separately. Altogether, 5,830 studies were identified and 64 of them met the inclusion and exclusion criteria. Obesity significantly elevated the odds of clefting (OR = 1.28, CI:1.08–1.51) (ORCL±CP = 1.23, CI:1.01–1.50; ORCPO = 1.31, CI:0.97–1.77). Maternal underweight also significantly increased the odds of clefting (OR = 1.21 CI:1.06–1.38). In mothers with type 1 diabetes, the odds of cleft development were significantly elevated (OR = 1,75, CI:1.45–2.12). Essential hypertension was also associated with higher odds of developing cleft (OR = 1.55, CI:1.18–2.03). Smoking during pregnancy significantly elevated the odds of cleft development (OR = 1.55, CI:1.34–1.79) (ORCL±CP = 1.58, CI:1.36–1.83; ORCPO = 1.50, CI:1.15–1.96). Passive smoking was even more damaging than active tobacco use, but alcohol consumption had no effect. In conclusion, this study clearly showed the importance of maintaining normal maternal body weight and emphasized the importance of hypertension and type 1 diabetes care in the first months of pregnancy. It also highlighted similarnegative effects of passive and active smoking, while alcohol consumption did not seem to be a significant risk factor for cleft development. However, there is a complete lack of available studies on the interactions of these factors, which is an essential direction for improving prevention.

Abstract Non-syndromic cleft lip with/without cleft palate (nsCL/P) is one of the most common birth defects and has a multifactorial etiology. To date, over 45 loci harboring common risk variants have been identified. However, the effector genes at these loci, and the cell types that are affected by risk alleles, remain largely unknown. To address this, we combined genetic data from an nsCL/P genome-wide association study (GWAS) with single-cell RNA sequencing data obtained from the heads of unaffected human embryos. Using the recently developed single-cell disease relevance score (scDRS) approach, we identified two major cell types involved in nsCL/P development, namely the epithelium and the HAND2+ pharyngeal arches (PA). Combining scDRS with co-expression networks and differential gene expression analysis, we prioritized nsCL/P candidate genes, some of which were additionally supported by GWAS data (e.g., CTNND1, PRTG, RPL35A, RAB11FIP1, KRT19). Our results suggest that specific epithelial and PA sub-cell types are involved in nsCL/P development, and harbor a substantial fraction of the genetic risk for nsCL/P.

Objectives: Children with cleft palate may experience hearing problems, including middle ear disorders, which require careful monitoring to ensure successful treatment. To diagnose these hearing disorders, appropriate tools are necessary. While traditional single-frequency tympanometry has been commonly used as a practical tool for diagnosing middle ear problems, the effectiveness of this method has been questioned in some cases. Recently, newer tests of wideband tympanometry have been developed and may be able to provide a more comprehensive assessment of middle ear conditions in children with cleft palate. Methods: To evaluate the effectiveness of wideband tympanometry, this study analyzed 14 young children who were scheduled to undergo cleft palate repair surgery. The children’s ages ranged from 4 to 24 months. The study involved two evaluations, one before the surgery and another one month after the surgery. Different wideband absorption parameters were analyzed using the paired t test and the Wilcoxon test. Results: The analysis of statistical data regarding tympanometric parameters before and after cleft palate surgery indicated a general enhancement in the condition of the middle ear. The study found that the middle ear pressure decreased, the absorption percentage increased, and admittance increased across all five frequencies, which is consistent with our initial assumptions. Discussion: The results confirm that wideband tympanometry can be an effective approach to detecting changes in the middle ear after cleft palate repair surgery in children. The use of more sophisticated parameters and evaluations at various frequencies provides a more complete picture of the child’s middle ear condition, potentially replacing single-frequency tympanometry assessments in the future.

Objectives: This study conducts a comparative analysis of the temporal facets of velopharyngeal coarticulation in Persian-speaking adults, differentiating between subjects with and without cleft palate, across three distinct vowel contexts. Methods: The study included 14 adults who had undergone cleft palate repair, with or without cleft lip and presented moderate to severe hypernasality. Another 14 adults without cleft palate were included in the study. The age range of participants was 18 to 50 years. By utilizing the Praat software, version 6.1.50, the study obtained data for the four temporal parameters by analyzing acoustic waveforms and spectrograms within three distinct vowel contexts. The analysis included the calculation of ratios of nasalization duration to neutralize the influence of speech rate variations between the cleft palate and control groups. Results: The results revealed that adults with cleft palate exhibited significantly extended durations for the four temporal parameters compared to the control group (P

Abstract Cleft palate (CP) is a congenital condition characterized by a complex etiology and limited diagnostic and therapeutic options. In this study, we delved into the molecular mechanisms associated with retinoic acid (RA)-induced CP in Kun Ming mice. Proteomic analysis of control and RA-induced CP samples at embryonic day 15.5 revealed 25 upregulated and 19 downregulated proteins. Further analysis identified these differentially expressed proteins (DEPs) as being involved in extracellular matrix organization, actin cytoskeleton, and myosin complex. Moreover, these DEPs were found to be enriched in pathways related to motor protein activity and extracellular matrix-receptor interaction. Protein-protein interaction network analysis identified 10 hub proteins, including motor proteins and ECM-related proteins, which exhibited higher expression levels in CP compared to control tissues. These findings provide insights into the molecular mechanisms underlying CP and highlight potential targets for diagnostic and therapeutic purposes.

Introduction: According to the literature, an existing correlation is said to be present between craniocervical and craniofacial morphology. Recent studies have revealed that there are certain variations among the different forms of craniofacial patterns with respect to the morphology of the vertebrae. Since there are very few studies comparing the curvature of the cervical column in relation to the cranial base in Cleft, Class-I and Class-III individuals, this study was carried out. Aim: To provide a comprehensive comparative analysis of the curvature of the cervical vertebral column and its relationship with the cranial base in Class-I, cleft, and Class-III individuals within the Central Indian population. Materials and Methods: In this cross-sectional study conducted at the Department of Orthodontics and Dentofacial Orthopaedics at Sharad Pawar Dental College and Hospital, Sawangi (M).Wardha, Maharashtra, India, patients with skeletal Class-I, Class-III, and Unilateral Cleft Lip and Palate (UCLP) or Bilateral Cleft Lip and Palate (BCLP) in the Central India region were included. The study duration was eight months, from April 2022 to January 2023. The research involves a meticulous examination of 90 individuals, divided into three groups: Class-I individuals (n=30), cleft individuals (n=30), and Class-III individuals (n=30). A comprehensive set of radiographic and cephalometric measurements will be employed to assess cervical vertebral curvature. One-way Analysis of Variance (ANOVA) test was used for analysis. Results: With the exception of Sella-Nasion to Gonion Gnathion (SA-Go-Gn), where the p-value was 0.13, a statistically significant difference between Class-I and Class-III was seen for all angles. For Class-III cases with clefts, every angle revealed a statistically significant difference. Except for SN-Go-Gn (p=0.65), all of the angles revealed a statistically significant difference when compared to Class-I with Cleft, with a p-value

Abstract Background Surgery for pediatric cleft lip and palate repair often utilizes high-dose opioids and inhaled anesthesia, thereby causing postoperative complications such as desaturation and/or severe agitation after anesthesia. These complications are detrimental to the child and medical personnel and cause tremendous psychologic stress to parents. Our aim is to decrease these complications through dexmedetomidine, an alpha-2 receptor agonist with anxiolytic, sympatholytic, and analgetic properties. Devoid of respiratory depressant effect, it allows patients to maintain effective ventilation and reduce agitation, postoperatively. Its unique anesthetic property may shed light on providing safe anesthesia and gentle emergence to this young, vulnerable population. Case presentation A total of 21 patients of Sundanese ethnicity, aged 3 months to 8 years (9 males and 12 females), underwent cleft lip or cleft palate surgery using total intravenous dexmedetomidine. Anesthesia was induced using sevoflurane, fentanyl, and propofol, and airway was secured. Intravenous dexmedetomidine 1.5 μg/kg was administered within 10 minutes, and a maintenance dose of 1.5 μg/kg/hour was continued as the sole anesthetic maintenance agent thereafter. Hemodynamics and anesthetic depth using Patient State Index (SEDLine™ monitor, Masimo Corporation, Irvine, CA, USA) were monitored carefully throughout the surgical procedure. Dexmedetomidine did not cause any hemodynamic derangements or postoperative complications in any of our patients. We found agitation in 9.5% (2/21) of patients. Conclusion Dexmedetomidine can be used as a total intravenous anesthetic agent to maintain anesthesia and provide gentle emergence to infants and young children undergoing cleft lip and palate repair.

Abstract Background Congenital hypopituitarism (CH) and its associated syndromes, septo-optic dysplasia (SOD) and holoprosencephaly (HPE), are midline defects that cause significant morbidity for affected people. Variants in 67 genes are associated with CH, but a vast majority of CH cases lack a genetic diagnosis. Whole exome and whole genome sequencing of CH patients identifies sequence variants in genes known to cause CH, and in new candidate genes, but many of these are variants of uncertain significance (VUS). Methods The International Mouse Phenotyping Consortium (IMPC) is an effort to establish gene function by knocking-out all genes in the mouse genome and generating corresponding phenotype data. We used mouse embryonic imaging data generated by the Deciphering Mechanisms of Developmental Disorders (DMDD) project to screen 209 embryonic lethal and sub-viable knockout mouse lines for pituitary malformations. Results Of the 209 knockout mouse lines, we identified 51 that have embryonic pituitary malformations. These genes not only represent new candidates for CH, but also reveal new molecular pathways not previously associated with pituitary organogenesis. We used this list of candidate genes to mine whole exome sequencing data of a cohort of patients with CH, and we identified variants in two unrelated cases for two genes, MORC2 and SETD5, with CH and other syndromic features. Conclusions The screening and analysis of IMPC phenotyping data provide proof-of-principle that recessive lethal mouse mutants generated by the knockout mouse project are an excellent source of candidate genes for congenital hypopituitarism in children.

Objective: To evaluate the relationship between different environmental risk factors and the severity of cleft lip with/without palate (CL ± P) and cleft palate (CP) in Saudi Arabia. Methods: This was a cross-sectional national study, of government hospitals in 10 cities distributed across major regions of Saudi Arabia, from June 2020 to June 2021. All newborns with CL ± P or CP were clinically examined and evaluated for cleft phenotype severity using the LAHSHAL classification system. Various environmental factors were evaluated by interviewing parents using a validated questionnaire. The severity of CL ± P and CP was evaluated in relation to environmental factors. Results: We recruited 174 patients with non-syndromic orofacial cleft (NSOFC); 122 (70.1 %) had CL ± P and 52 (29.9 %) had CP. After adjusting the odds ratios by ordinal regression for CL ± P and logistic regression analysis for CP, environmental factors that significantly increased the severity of CL ± P were family history of NSOFC, maternal illnesses, and maternal medication use (P = 0.02, adjusted odds ratio [AOR]:2.70; P = 0.002, AOR:3.70; and P = 0.03, AOR:2.14, respectively). Folic acid supplementation in the first trimester significantly reduced the severity of CL ± P and CP (P = 0.001, AOR:0.18 and P = 0.001, AOR:0.012, respectively). Conclusion: The severity of CL ± P was affected by some maternal exposures during the 3-month pre-gestation period. Therefore, our results suggest the possibility of controlling the severity of NSOFC.

Background: Pharyngeal flap (PF) is a commonly used surgical technique in the treatment of velopharyngeal insufficiency (VPI), but it still faces limitations that have not been overcome. The present study aims to objectively analyze the results of PF combined with velar muscle repair, which aims to transform the static structure of PF into a dynamic one, addressing one of its limitations. Patients and Methods: Patients were divided into two groups based on the surgical technique: Group 1: the traditional PF group and Group 2: PF with radical intravelar veloplasty (PF-RIVVP) group. Acoustic evaluation of the velopharyngeal unit (VFU) and nasality level was conducted using a nasometry device during the preoperative period and at 1-year postoperative follow-up. Direct anatomical evaluation of the VFU was performed using a flexible fiberoptic endoscope. Student's t-test and Chi-square test were used for statistical analysis. Results: The mean preoperative nasalance score was 56.5 ± 11.0 in Group 2 and 59.9 ± 10.3 in Group 1. The postoperative mean nasalance score was 29.2 ± 3.1 in Group 2 and 35.3 ± 3.1 in Group 1. Although no statistically significant difference was observed in the mean preoperative nasalance scores, a statistically significant difference was found in the postoperative scores (P < 0.001). Furthermore, nasopharyngoscopic evaluation revealed a superior velopharyngeal movement in Group 2. Conclusion: Through the objective evaluation techniques, the present study demonstrates that PF combined with velar muscle repair provides an enhanced velopharyngeal function in the treatment of VPI compared to the traditional technique.

Surgical missions are often conducted in outreach areas where facilities are often not as advanced as in an institution. Excellent team coordination, detailed planning, and good communication are necessary for a successful outcome. Unfamiliar work environment, new acquaintances within the team, and language barriers at the mission site are some of the challenges often faced. Careful patient selection is crucial in a mission setup as most complications can be traced back to the preanaesthetic check and preoperative preparedness. We describe airway management strategies (airway assessment, mask ventilation, intubation options, and the postoperative airway plan) contrived by our anaesthesia team at one such surgical mission where four children with Pierre Robin Syndrome and incomplete cleft palate (involving posterior hard palate and complete soft palate)were successfully operated.

Recurrent oronasal fistula closure is a challenging phenomenon that has been managed with many surgical or flap techniques, such as local, regional, and distant flaps, with various modifications. Despite these options, the ideal method to repair this kind of chronic fistula has not yet been established. It is difficult to repair because recurrent surgical repairs or interventions cause this region to become more fibrotic with less vascular tissue, which considerably reduces the likelihood of closing this kind of fistula. For this reason, surgeons and researchers continue to work to overcome these obstacles by using more regional, vascular, and neighboring tissue. Classic cleft palate repair techniques use double-layered, nasal, and oral side closure and even a three-layered technique (e.g. plus levator veli palatini and tensor veli palatini muscular repair) in the soft palate region. Hence, we used partial orbicularis oris muscle with enough vascular supply to repair the nasal side and cheek mucosal flap to repair the oral side as a double-layered repair technique. Two years later, during routine patient follow-up, no complications were identified, and the patient’s satisfaction with this treatment was acceptable.

Introduction The early geneticist and psychiatrist Ernst Rüdin (1874–1952) became one of the key figures in the eugenics movement and in the German health system of the Nazi era. His connections in the international eugenics network have played an important role in the history of eugenics.

Feeding a neonate baby with a complete cleft lip and palate is a problematic pursuit because of the communication between the oral and the nasal cavity and associated problems. This present case is of a 6-day-old underweight neonate with feeding difficulties due to the cleft palate. In this case report, simple, uncomplicated steps for the fabrication of a feeding obturator are explained to aid in the proper nourishment of neonates for definite corrective procedures in the future with overall growth.

Through this research, we have presented a modified presurgical nasoalveolar molding (PNAM) device, protocol, and equipment of preoperative nasal alveolar formation techniques to improve lip, nose, alveolar, and palatal deformity in the Department of Orthodontics and Maxillo-Facial Department at the University of Prishtina. A two-week-old boy was brought to our Department of Orthodontics. The baby was diagnosed with non-syndrome bilateral complete cleft of the primary and secondary palate. After a complete examination and orthodontic therapeutic planning, precaution was taken for creating a PNAM appliance and sent to the laboratory. An intraoral molding plate was established on both sides of the separate segments of the maxilla and fixed with a mini screw to approximate the maxillary segments. Parts of the strings built in the front side activated (please check) and, together with the nasal stent, were added to correct the nose deformity. By using modified NAM to close the cleft segments, both the ones of the upper lip and the ones of the palate, we achieved the same results and reduced possible tissue damage by maintaining the conventional NAM apparatus. We used an alveolar formation plate with traction stainless steel to reduce the separate parts. Under this presurgical treatment, the cleft alveolus and palatal segments were reduced considerably. Also, the parts of the flatting nasals of the nose were set up. Through interdisciplinary work, we created a new modified NAM appliance to avoid the obstacles of the traditional NAM devices and to improve the presurgical treatment by using the benefits of the postnatal period of the child to have a more effective treatment. Despite the inability of previous studies to decide on the degree of efficacy of PNAM and the fact that scientific data is limited, we consider that our research can contribute to a better understanding of why it is essential to use PNAM and of the need to enhance the apparatus.

Introduction: Orofacial clefts are one of the most common congenital anomalies involving the craniofacial region. An isolated cleft palate is the rarest (33% of all orofacial clefts) among individuals with female predominance. Individuals born with these clefts manifest craniofacial, functional, and psychological anomalies. Sometimes, patients cannot receive the required therapies due to a lack of awareness and lack of medical access or economic factors. Untreated clefts may adversely impact the patient’s life both physically and psychologically. Case Description: This study presents a case report of a 45-year-old male with an untreated cleft palate since birth due to a low socioeconomic background, leading to several oro-dental anomalies, speech defects, and psychological and social challenges. Results: Extraoral examination revealed mild facial asymmetry, dry and incompetent lips, and underdeveloped philtrum. Intraorally, there was a cleft palate, macroglossia, soft and edematous gingiva with bleeding on probing, gingival recession, and periodontal pockets, along with various dental anomalies. Full mouth orthopantomogram showed discontinuity of the palatal line, collapsed maxillary arch, root stumps, and crowding. The final diagnosis of isolated cleft palate was made. The patient was advised for surgery regarding the cleft palate, dental treatment, speech therapy, and psychological counseling. However, the patient refused all treatments except a few dental aids due to economic difficulties. Conclusion: The present case report highlights the need for these patients to receive particular concerns. Patients must be motivated to get proper treatment at a suitable stage to prevent future complications. Cleft teams must be advised to initiate some encouraging steps in imparting treatment aids to such patients, especially in rehabilitation therapy, considering their surrounding environment, psychological makeup, socioeconomic status, and motivation. In addition, social groups should also treat these patients with a positive approach, helping them to live healthy and normal lives just like any other individual.

Non-syndromic cleft lip with or without cleft palate (NSCL/P) is the most common developmental defect that significantly affects the morphology and function of the stomatognathic system in children. The etiology of these birth defects is multifactorial, and single nucleotide polymorphisms (SNPs) in IRF6 and FGF1 have been associated with NSCL/P. This study aimed to evaluate whether SNPs in IRF6, namely rs2013162, rs642961, rs2235373, and rs34010 in FGF1, are associated with NSCL/P occurrence in the Polish population. The study included 627 participants: 209 children with NSCL/P and 418 healthy controls. DNA was isolated from saliva in the study group and from umbilical cord blood in controls. Genotyping of polymorphisms was performed using quantitative PCR. There was no statistically significant association of IRF6 gene variants with NSCL/P occurrence, although for rs2013162, AA genotype, odds ratio (OR) = 1.16 and for AC genotype, OR = 0.83; for rs642961, AA genotype, OR = 0.84 and for AG genotype, OR = 1.41; and for rs2235373, AA genotype, OR = 0.79 and for AG, OR = 0.85. In the instance of rs34010 polymorphism in FGF1, the presence of the AA genotype was statistically significant in reducing the risk of NSCL/P (OR = 0.31, p = 0.001). Genetic variation in FGF1 is an important risk marker of NSCL/P in the Polish population, which cannot be stated for the polymorphisms in the IRF6 gene.

Dental and craniofacial bone development is a highly coordinated process that is tightly controlled by genetics and influenced by complex environments. The abnormal regulation of many development-related signaling molecules may lead to abnormal tooth development, severe craniofacial bone formation disorders, and developmental deformities. Transforming growth factor-β (TGF-β) is widely expressed in vivo and participates in many cellular biological processes, showing complex regulatory roles in mammalian craniofacial bone growth and tooth development. In tooth development, abnormal TGF-β signaling can lead to the failure of tooth germ formation, and its deletion mutation can directly affect odontoblast differentiation and enamel formation defects. However, the current research on TGF-β mainly focuses on the early stage of tooth development, and a comprehensive and systematic study of TGF-β-related tooth development is lacking. TGF-β signal transduction mainly controls the development of teeth and craniofacial bone by regulating the expression of development-related molecules via the classical Smad-dependent signaling pathway. In addition, the nonclassical mitogen-activated protein kinase (MAPK) pathway also participates in this process. Abnormal TGF-β signaling may cause jaw development disorders, temporomandibular joint dysplasia and inflammation, and cleft palate. Because the specific regulatory mechanism of TGF-β in craniofacial bone development has not been fully elucidated, its specific application in the treatment of related diseases is also greatly limited. This paper describes the new research progress of TGF-β in the development of teeth, jaws, temporomandibular joints and palate as well as related diseases.

Key Clinical Message Illustrating F‐quad helix with extension arms that simultaneously expand maxillary arch and rotate its central incisor adjacent to the alveolar cleft while aligning palatally ectopic canines. Incisor rotation occurred before alveolar grafting, while canine traction was performed after alveolar grafting. The construction of this appliance is shown in detail.

Background and aims: This study was conducted to compare the effects of two compounds ropivacaine and lidocaine associated with epinephrine on the heart rate, blood pressure, and bleeding rate in children undergoing general anesthesia for the cleft palate repair surgery. Methods: In this study, 30 children candidates for cleft palate surgery who were referred to Mofid Children’s Hospital, affiliated with Shahid Beheshti University of Medical Sciences in 2021, were included by using the convenience sampling method. The patients were randomly divided into two groups. Group 1 was treated with ropivacaine and group 2 was treated with lidocaine along with epinephrine. The data were analyzed by the SPSS, version 22. Results: In total, no statistically significant difference was found between the two groups in terms of vital signs of blood pressure and heart rate in the 10 stages studied (P

Palatogenesis is a complicated and precisely balanced process in which malfunctions induce congenital cleft palate, one of the most common embryonic developmental anomaly seen in newborns. Multiple signaling pathways and transcription factors have been implicated in palatal shelves development. The purpose of this article is to review one of the most important signaling pathways that plays a critical role in secondary palate development, namely Sonic hedgehog (Shh) signaling pathway. It includes an overview of the expression patterns of members of the Hedgehog signaling pathway and the role of Shh signaling in the reciprocal epithelial-mesenchymal interactions during secondary palate development.

Objective: To develop an indigenous Caregiver Social Isolation Scale (CSIS) in Urdu for caregivers of mental and physical disorders in Pakistan. Study Design: Mixed method study. Place and Duration of Study: Department of Psychology, University of Gujrat, Pakistan, from Jan to Jun 2021. Methodology: An item pool of 48 was generated based on a thematic analysis of structured interviews with six experts and nine caregivers. The content validity was evaluated by three PhDs in Psychology and two Physicians. The reliability calculated on thirty participants for a tryout was 0.95. Item total correlation of item tool was in the acceptable range. A pilot study was done on three hundred individuals. The value of the KMO was 0.952, which showed the adequacy of the data, with the value of Bartlett’s test significant. No item was deducted. The reliability of 48 items on 300 individuals was 0.976, with two factors. First, for the validity of CSIS, data was collected from 120 individuals with standardized Ryff’s psychological well-being scale, Scale of Social Support and Delong Loneliness Scale. Second, confirmatory factor analysis was conducted on 200 caregivers of children with cleft lip and palate. Results: Exploratory factor analysis yielded two factors, mental agony and lack of social cohesion, with 48 items. Model fit indices of CFA on caregivers...... Conclusion: CSIS is a reliable and valid scale for assessing the social isolation experiences of caregivers of either mental or physical diseases in Urdu. Keywords: Cleft lip, Cleft palate, Caregiver social isolation scale, Exploratory factor analysis.

Introduction: Dermatoglyphics is the study of the characteristic ridged skin patterns on the fingertips, palms, toes, and soles of all primates, including humans. Due to this unique and unalterable nature, dermatoglyphics can be used as an excellent tool for population studies, personal identification, and morphological and genetic research. In recent years, dermatoglyphics has drawn a lot of attention in the field of dentistry, as a potential adjunct diagnostic tool in the identification of various orofacial and dental anomalies. This bibliometric analysis aimed to identify and analyse all the articles published on applications of dermatoglyphics in dentistry. Materials and Methods: A comprehensive search of bibliographic databases was performed by two independent reviewers, from October 2022 to December 2022, using medical sub-heading terms like “Dermatoglyphics”, “Dental”, and “Oral” in several combinations. All types of published studies were included in this bibliographic analysis. The articles were identified, tabulated and analysed to extract the various bibliometric details. Results: A total of 536 citations were achieved cumulatively by 57 publications included in this review. The article that received the maximum number of citations (citation=46) was by Reddy BRM et al., published in the Journal of Clinical and Diagnostic Research in year 2013. Maximum publications (n=46) originated from India. Most of the published articles were focused on application of dermatoglyphics for the diagnosis of dental caries (n=21) followed by malocclusion (n=14). Conclusion: The present bibliometric analysis identifies and analyses the most-cited articles on applications of dermatoglyphics in dentistry. The findings of this review not only provide insight into the scientific evolution in the field but also reveal trends in further research and clinical practice.

Objective: To identify the incidence of recurrent otitis media in cleft palate patients after palatoplasty and myringotomy with ventilation tube (VT) insertion in addition to identifying risk factors of recurrent otitis media with effusion (OME). Material and Methods: This retrospective cohort study was conducted from; January 2002 – December 2014. A total of 120 non- syndromic cleft palate patients were included and analyzed for risk factors contributing to recurrent otitis media with effusion. Results: In total, 77.5% of the VT slipped off at 10 months after their initial operation. The incidence of recurrent OME was 54.2% at 7 months after VT slipped off. Significant risk factors that were associated to recurrent OME included: complete cleft palate, two-stage palatoplasty and VT slip-off (p-value

While tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease among children, its first presentation in the third decade of life just after successful pregnancy outcome is extremely rare. In fact, survival of both child and mother having uncorrected TOF after noninstitutional delivery is unheard of. Herein, authors report a case of previously undiagnosed TOF associated with other midline congenital abnormalities, that is, nasal dermoid cyst and cleft palate, who presented for the first time with postpartum hemorrhage after an unsupervised home birth. To the best of our knowledge, this unique association has never been described before.

Objective: To investigate the speech sound errors and literacy skills in children with orofacial clefts (cleft palate& cleft lip and palate). Study Design: Comparative cross-sectional study. Place and Duration of Study: Centre for Clinical Psychology, University of the Punjab, Lahore, from Mar 2016 to Feb 2017. Methodology: A sample of 42 participants (cleft lip & palate: n=18 and cleft palate: n=24) was collected. Two stage sampling strategy was used. Each child was individually screened through Slosson intelligence test revised checklist of orofacial cleft and diagnostic statistical Manual-V checklist. Then children were provided with assessment measures which included demographic informational questionnaire, community developed VPI Screener, word list for articulation and phonological processes, annual status of education report (ASER) and curriculum-based measurement (Written Expression). Manual SODA (substitution, omission, distortion and addition) analysis was done to know about the type of speech sound errors. Results: Independent sample t-test was used to compare the differences of speech sound errors (52.11 ± 25.08), (47.29 ± 25.38), reading skills (3.67 ± 1.14), (3.75 ± 1.26) and writing skills (14.61 ± 13.49), (25.14 ± 29.16) in cleft lip & palate and cleft palate respectively, indicated that there were no differences; with p-value: p=0.54, 0.83, 0.13. Conclusion: Results indicated no significant differences in speech sound errors, reading, writing skills and resonance between children with cleft lip & palate and cleft palate.

Abstract The rehabilitation of the cleft requires a multidisciplinary approach involving a pediatrician, surgeon, otolaryngologist, speech therapist, orthodontist, prosthodontist, and psychologist. The present case report illustrates the rehabilitation of a 12‐day‐old neonate with a cleft palate. Since the palatal arch of the neonate was very small, a feeding spoon was innovatively modified to obtain the impression. The obturator was fabricated on the same day and delivered in one appointment.

Introduction Compensatory articulations are speech disorders due to the attempt of the individual with cleft palate/velopharyngeal dysfunction to generate intraoral pressure to produce high-pressure consonants. Speech therapy is the indicated intervention for their correction, and an intensive speech therapy meets the facilitating conditions for the correction of glottal stop articulation, which is the most common compensatory articulation. Objective To investigate the influence of an intensive speech therapy program (ISTP) to correct glottal stop articulation in the speech of individuals with cleft palate. Methods Speech recordings of 37 operated cleft palate participants of both genders (mean age = 19 years old) were rated by 3 experienced speech/language pathologists. Their task was to rate the presence and absence of glottal stops in the 6 Brazilian Portuguese occlusive consonants (p, b, t, d, k, g) distributed within several places in 6 sentences. Results Out of the 325 pretherapy target consonants rated with glottal stop, 197 (61%) remained with this error, and 128 (39%) no longer presented it. The comparison of the pre- and posttherapy results showed: a) a statical significance for the p1, p2, p3, p4, t1, k1, k2 and d6 consonants (McNemar test; p

Objective: To evaluate the speech outcomes after primary cleft palate repair in a single tertiary medical institution of Thailand. Materials and Methods: A prospective cohort study was performed. Patients who had cleft palate with/without cleft lip and underwent primary cleft palate repair were included. Speech assessment was performed using the Pittsburgh weighted speech score (PWSS) by a speech-language pathologist. Results: Forty patients (21 males and 19 females) who underwent primary cleft palate repair at Siriraj Hospital were included. The median age at the time of speech evaluation was 7 years. The median age at primary cleft palate surgery was 12 months. The predominant cleft palate type was Veau 3 (47.5%). Oronasal fistula occurred 40%. Two-flap palatoplasty and intravelar veloplasty were the most common procedures. Median PWSS was 7, in which the competence velopharyngeal mechanism was found 5%, borderline competence 10%, borderline incompetence 32.5%, and incompetence velopharyngeal mechanism 52.5%. Among the velopharyngeal incompetence group, articulation disorder was the most common disorder with median score of 3. Besides, the median scores for hypo/hyper-nasality, nasal emission, phonation, and facial grimace disorder were 1, 2, 0 and 0, respectively. There was no statistically significant association between velopharyngeal incompetence and cleft types, age at primary surgery, type of operation, the width of cleft palate and prevalence of postoperative oronasal fistula or otitis media effusion. Conclusion: Velopharyngeal incompetence has been commonly identified after cleft palate repair in our institute. The articulation disorder is the most common characteristic.

Objectives: This study aimed at investigating the effects of speech intervention on Non-Oral Cleft Speech Characteristics (NCSCs), intelligibility, and Quality of Life (QoL), as well as the relationship between speech variables and QOL-related variables in intensive speech therapy among children with cleft palate. Methods: This single-group pre-test and post-test clinical trial study was performed on 12 Persian-speaking children with cleft palate and NCSCs aged 3-7 years. For this purpose, we used 30 sessions of speech therapy and the Persian version of the Pediatric Quality of Life Inventory (PPedsQL). The pre-test and post-test assessments included perceptual assessment using the CAPS-A and QoL assessment using the Parent Proxy of the Persian version of the PPedsQL. The Wilcoxon’s test was applied to analyze group differences in the NCSCs, the intelligibility of speech, the total score of PPedsQL, physical, emotional, social, and school functions before and after providing the speech therapy. Results: The obtained results indicated that the frequency of NCSCs, the intelligibility of speech, the total score of PPedsQL, and its subscales significantly improved after the intervention (P

Background and Objectives: Cleft lip and or cleft palate (CL/P) is one of the most prevalent malformations in the head and neck region. The etiology of this malformation is multifactorial, and the incidence of clefts may be affected by ethnic, racial, geographic, and socioeconomic factors, therefore this study aimed to investigate the prevalence, risk factors of CL/P, and access to rehabilitation services for these children in the south-west of Iran. Methods: This cross-sectional study retrospectively analyzed birth data collected from hospitals (according to the International Classification of Diseases [ICD10] hospital registry code) in Shahrekord City, Iran, from 2011 to 2021. Frequency distribution and frequency of received rehabilitation services were analyzed. 76 children without this disorder were selected as a control group to evaluate the risk factors. Results: The overall prevalence was approximately 0.93 per 1000 live births. The prevalence of Cleft Lip (CL), cleft palate (CP), and Cleft Lip and Palate (CLP) were 0.17, 0.27, and 0.49, respectively. Of the 38 infants born with CL/P, 20 infants (52.63%) were boys and 18 (47.36%) were girls (P>0.05). The variables of cleft history, maternal disease, maternal medicine history, low infant weight, and child disease were significantly associated with CL/P (P

Background and Objectives: Voice assessment is one of the five universal parameters in assessing the speech ability of children with cleft palate. One of the characteristics of cleft palate children is the production of compensatory errors. This study aims to compare the acoustic characteristics of the voice, including fundamental frequency, jitter, shimmer, and average harmonic to noise ratio in cleft palate children compared to their normal peers. Methods: A total of 38 children in the age range of 48 to 60 months (17 children with cleft palate and 21 normal peers) participated in this descriptive-analytical and cross-sectional study. The children were asked to produce sustained vowels /a/ and /i/ while their speech samples were being recorded. The acoustic characteristics of the children’s voices were analyzed via the Praat software. Results: There were no statistically significant differences in acoustic parameters between the cleft palate children with and without compensatory errors. There were significant differences between children with cleft palate compared to their normal peers in the jitter averages of the vowel /a/ (P=0.05). The gender differences were found in the harmonic to noise ratio averages of the vowel /a/ between children with cleft palate (P=0.02). Conclusion: Young children with velopharyngeal insufficiency may be at risk of voice problems.

Background: Nonsyndromic craniofacial clefts are relatively common congenital malformations which could create a significant negative effect on the health status and life quality of affected individuals within the pediatric population. Multiple cleft candidate genes and their coded proteins have been described with their possible involvement during cleft formation. Some of these proteins like Homeobox Protein BarH-like 1 (BARX1), Distal-Less Homeobox 4 (DLX4), Forkhead Box E1 (FOXE1), Homeobox Protein Hox-B3 (HOXB3), and Muscle Segment Homeobox 2 (MSX2) have been associated with the formation of craniofacial clefts. Understanding the pathogenetic mechanisms of nonsyndromic craniofacial cleft formation could provide a better knowledge in cleft management and could be a possible basis for development and improvement of cleft treatment options. This study investigates the presence of BARX1, DLX4, FOXE1, HOXB3, and MSX2 positive cells by using immunohistochemistry in different types of cleft-affected tissue while determining their possible connection with cleft pathogenesis process. Materials and Methods: Craniofacial cleft tissue material was obtained during cleft-correcting surgery from patients with nonsyndromic craniofacial cleft diagnosis. Tissue material was gathered from patients who had unilateral cleft lip (n=36), bilateral cleft lip (n=13), and cleft palate (n=26). Control group (n=7) tissue material was received from individuals without any craniofacial clefts. The number of factor positive cells in the control group and patient group tissue was evaluated by using the semiquantitative counting method. Data was evaluated with the use of nonparametric statistical methods. Results: Statistically significant differences were identified between the number of BARX1, FOXE1, HOXB3, and MSX2-containing cells in controls and cleft patient groups but no statistically significant difference was found for DLX4. Statistically significant correlations between the evaluated factors were also notified in cleft patient groups. Conclusions: HOXB3 could be more associated with morphopathogenesis of unilateral cleft lip during postnatal course of the disorder. FOXE1 and BARX1 could be involved with both unilateral and bilateral cleft lip morphopathogenesis. The persistence of MSX2 in all evaluated cleft types could indicate its possible interaction within multiple cleft types. DLX4 most likely is not involved with postnatal cleft morphopathogenesis process.

Cleft lip and/or cleft palate (CL±P) in addition to the cleft palate (CP) are a category of anomalies known as orofacial clefts (OC). These anomalies are accompanied by several aesthetic and functional problems. Information on the prevalence of OC showed different values between studies worldwide. In addition, the presence of cleft lip and/or cleft palate is determined by several changes during the embryonic stage. Besides, cleft repair may lead to a significant impact on the overall aesthetic and function and could negatively affect maxillary growth on certain occasions. Therefore, having the background and knowledge on this phenomenon is essential in designing the overall treatment and obtaining outcomes that are as close to normal as possible. This article reviews the maxillary development, occurrence of cleft lip and/or palate and their prevalence, facial growth in the presence of clefts, effect of cleft repair, an overview of alveolar cleft treatment, as well as the essential information related the prevention of cleft lip and palate.

Introduction Cortisol is a hormone involved in the response to stress. Attention is a function that can change due to exposure to stress. Objectives To verify the correlation between the level of salivary cortisol and sustained auditory attention in children with cleft lip and palate, as well as to compare the results of the variables analyzed between female and male patients. Methods In total, 103 children aged 6 to 11 years, were divided into 2 groups: those with cleft lip and palate (experimental group, EG; n = 69) and the control group (CG; n = 34). The Sustained Auditory Attention Ability Test (SAAAT) and salivary cortisol levels, measured by an enzyme immunoassay kit (Salimetrics, Stage College, PA, US), were calculated and compared regarding the two groups. The statistical tests used were the Mann-Whitney test and the Spearman correlation. Results The median level of salivary cortisol was of 0.03615 µl/dL and 0.18000 µl/dL respectively for the EG and CG, with a significant difference between the groups (p = 0.000). Absence of statistical significance (total error score = 0.656; vigilance decrement = 0.051) was observed the for SAAAT among the EG (median total error score = 12.00; 25th percentile [25%] = 7.00; 75th percentile [75%] = 21.00; and vigilance decrement = 1.00; 25% = 0.00; 75% = 2.50) and the CG (median total error score = 12.00; 25% = 6.00; 75% = 24.00; and vigilance decrement = 0.00; 25% = -1.00; 75% = 2.00). Conclusion All children had median levels of salivary cortisol and scores for sustained auditory attention within normal parameters. A significant correlation between the level of salivary cortisol and the ability to sustain auditory attention was observed in children without cleft lip and palate. There were no differences regarding the SAAAT and salivary cortisol between female and male patients.

Abstract Background Epignathus is a rare, benign, congenital teratoma of the hard palate with an estimated incidence of 1 in 200,000 live births. Epignathus frequently leads to a high mortality (80–100%) due to airway obstruction in the neonatal period. Case presentation We report a case of successful management of a rare oropharyngeal teratoma in a African newborn girl who was referred to our institute with a large protruding intraoral mass, combined with cleft palate, causing some respiratory compromise. The palatal mass was removed on the fifth day after birth, and a palatoplasty performed on day 30. Conclusion Epignathus is a life-threatening condition at the time of delivery. Appropriate management begins with securing the airway, followed by complete resection of the tumor.

Introduction: Cleft lip with or without cleft palate (CLP) is one of the most common congenital defects in the orofacial region. Many factors are involved in the occurrence of cleft lip in newborns including genetic and environmental factors. The prevalence of this anomaly varies in different races and countries. Therefore, this study aimed to determine the prevalence of this disorder in newborns in Bu Ali, Hekmat, and Amir Mazandarani Hospitals in Sari, Iran, during 2004-2018. Materials and Methods: This descriptive-analytical study was carried out using information obtained from the records of patients in Imam, Hekmat, and Amir Mazandarani health centers in Sari, Iran. The number of patients with CLP was extracted from the information in the record files. Afterward, information related to infant and mother, such as gender, birth weight, maternal age, the cases of consanguine marriage, family history of CLP, history of drug use in the first trimester of pregnancy, the history of smoking and alcohol consumption were also recorded to investigate the factors related to CLP. Results: A total of 65,522 births were recorded at the three abovementioned health centers during 14 years, of which 80 infants were born with a variety of CLP anomalies. The overall CLP prevalence in this study was estimated at 1.2 per 1,000 births. It should be noted that 52.5% (n=42) and 47.5% (n=38) of these cases had CLP and CL, respectively. No cases of isolated cleft palate were observed. Furthermore, 71.3% (n=57) of all CLP cases occurred unilaterally. In total, 86.3% of the studied infants weighed over 2,500 gr at birth and 72.5% of mothers aged under 30 years at childbirth. Conclusion: Based on the obtained results, the overall prevalence of oral clefts in the studied population was 1.2 per 1,000 births and mostly occurred unilaterally.

Background and aim: Prevalence of cleft lip and palate varies across geographical location, races, and ethnic groups. The global prevalence is 1 per 700 live births. We aim to establish the prevalence, socio-demographic characteristics of patients with an orofacial cleft, and associated deformities in our locality. Materials and methods: This was a retrospective study of all the patients with cleft lip (CL), cleft palate (CP), or cleft lip/palate (CLP) managed over 12 years (2009 to 2020). A uniform Smile Train® structured interviewer-administered questionnaire completed by the Surgeons was used to obtain relevant information. Data were analyzed using SPSS version 23. Results: A total of 280 patients were managed for cleft lip and palate deformities during this period. The estimated total live births during the period were 232,168; a prevalence rate of 0.8 per 1000 live births was thus calculated. The most common type of cleft deformity in our study is CLP (61.4%), followed by isolated CP (20.7%) and then CL (17.9%). CLP was shown to be more common among males (66.1%). However, isolated CP and CL were more common among females at 67.2% and 56%. The most common associated anomalies were speech (52.8%) and growth retardation (9.6%). The least common was limb anomalies (0.7%). Conclusion: Our study has generated new knowledge of the epidemiological distribution of orofacial cleft deformities in our subregion made possible by the Smile Train® database. It will enable more comprehensive management of orofacial clefts.

Cleft lip and palate are one of the most common congenital head and neck anomalies and are seen at a frequency of 11-15%. In this study we aimed to observe airway management and intubation conditions with videolaryngoscopy in patients with cleft lip and palate. 40 patients with cleft lip and palate (Group Y) and 40 normal patients (Group N) aged between 4 months and 10 years undergoing elective surgery were included in this prospective randomized study. Mallampati Classification (MMC), Cormack-Lehane Classification (CL-S), thyromental distance (TMM) and mouth opening were evaluated to predict difficult airway. Intubation times, number of intubation attempts, heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2) and end-tidal CO2 (Et-C02) values were also recorded. Intubation times was significantly higher in Group Y than Group N. HR and MAP values measured in Group Y were found to be significantly higher than Group N at the 5th and 10th minutes (p [Med-Science 2021; 10(2.000): 520-3]

Background: Cleft lip and palate are the most common congenital malformations of the head and neck. These disorders have high economic cost for families and impose a heavy psychological burden on children. Performing early primary reconstructive surgery on cleft lip and palate is necessary to achieve the desired treatment results. The aim of this study was to evaluate the etiology of primary cleft lip and palate reconstructive surgery retardation. Methods: In this descriptive study, 516 infants referred to Tabriz Children’s Hospital and Sina Hospital to do primary cleft lip and palate reconstructive surgery from 2009 to 2014, were studied. Ages at surgery, sex, comorbidities, cause of delay in referring the patients were evaluated. SPSS version 22 was used for statistical analysis. Results: The mean age of patients at surgery was 16.20 ± 25.97 months. There was a delayed referral for primary reconstructive surgery in 27.13% of the patients. The low weight of the child for surgery (30%), late visit of the child (19.28%), and lack of awareness among parents about the time of the visit (17.85%) were the most common causes of delay of reconstructive surgery. Conclusion: Based on the findings of this study, the low weight of the child for surgery, late visit of the child, lack of parents’ awareness about the time of the visit, comorbidities, late diagnosis, and low level of socio-economic, were the most common causes of delay in referring to reconstructive surgery respectively.

BACKGROUND AND OBJECTIVE: Orofacial clefts are the most common congenital facial defect. Genetic and environmental factors play a role in their development. The prevalence of orofacial clefts in Qom province has not been studied so far. The aim of this study was to evaluate the prevalence of orofacial clefts and associated factors in infants born in Qom province during 2010-2018. METHODS: In this cross-sectional study, during nine years, the medical files of all infants with orofacial clefts and the files of their mothers in all hospitals of Qom province were examined. The files of 476 healthy infants were also evaluated to investigate the associated factors. Healthy infants were selected one number before and one after the case number of sick infants. Infant-related variables (weight, blood type, and other illnesses) and parent-related factors (age, smoking, alcohol, and medications, illness, consanguineous marriage, and number of children) were extracted through reviewing the files or telephone interview. FINDINGS: Of the 171,270 infants, 238 were found with orofacial clefts (1.39 per 1,000 births). Isolated cleft palate with 39.5% was the most common type of anomaly. Among the studied factors, the percentage of smoking in fathers in the case group (34.5%) was higher than the control group (24.2%) (p=0.004). Moreover, the history of maternal high blood pressure in the case group (7.6%) was higher than the control group (3.4%) (p=0.013). The incidence of diabetes in mothers of the case group (18.9%) was higher than the control group (8.2%) (p=0.001). CONCLUSION: The results of the study showed that the prevalence of orofacial cleft is 1.39 per 1000 births and smoking, diabetes and high blood pressure are the associated risk factors.

Postoperative fistulae are one of the most significant complications of cleft palate repair. They usually has an adverse effect on patients’ oral hygiene, speech and even mental health. There has been a wide range of rates of fistula occurrence, from 0.8%-60%, with the classification and definition of fistulae differing from one author to the next. In this paper, the definition and classification of palatal fistulae and their reconstruction method are reviewed. At present, there is a lack of a consistent definition of palatal fistulae and a classification that can fully reflect the characteristics of palatal fistula. Adjacent flap is mainly used for repairing small fistulae with an adequate amount of surrounding tissue; anteriorly based dorsal tongue flaps are a safe and reliable method for large fistulae; free flap is beneficial for refractory and complicated palatal fistulae that are difficult to repair by the local and pedicle flap; and different synthetic materials are used in multilayer repair of fistulae; among them, composite polymer membrane is highly biocompatible, promoting cell attachment and proliferation in animal models, but its security in the human body needs further research.