Antenatal Ultrasound Detection of Cleft in Western Australia from 2003 to 2012: A Follow-Up Study

2017 ◽  
Vol 54 (3) ◽  
pp. 321-326
Author(s):  
W. Nicholls ◽  
R. Jennings ◽  
Y. Yeung ◽  
M. Walters ◽  
B. Hewitt
Keyword(s):  
Western Australia ◽  
Detection Rate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Detection Rates ◽  
Oral Clefts ◽  
Princess Margaret Hospital ◽  
Antenatal Counseling ◽  
Antenatal Detection ◽  
Isolated Cleft Palate

Aim To investigate trends in the rate of antenatal detection of cleft lip and palate (CLP) patients referred to the CLP Unit at Princess Margaret Hospital for Children in Perth, Western Australia during the period 2003-2012 and compare data with a previously published report covering the years 1996-2003. Methods This is a single-center, retrospective survey of antenatal transabdominal ultrasound screenings of mothers of infants born between July 1, 2003 and June 30, 2012 that were referred to the CLP Unit at Princess Margaret Hospital. Results Detection rates of oral clefts increased significantly when compared with outcomes reported in the same population between 1996 and 2003 ( P < .05). An overall detection rate of 71.7% (165/230) was achieved for clefts involving lip and palate. Detection of isolated cleft palate (1/99) and microform (0/8) remained elusive. Most detections (76.5%) were achieved at 15 to 20 weeks of gestational age, corresponding with routine anatomical screening. A further 16.8% were detected post-20 weeks of gestation. Scans were performed by specialist obstetricians, and sonography clinics reported a detection rate of 84.6% (55/65), whereas nonspecialist clinics reported a detection rate of only 67.1% (110/164). Conclusion The antenatal detection rates of oral clefts involving the lip have improved to the extent that the majority of mothers are now being referred to a cleft unit in Western Australia prior to the births of their children. As a result of this improvement, antenatal counseling is now a common facet of cleft management.

Antenatal Transabdominal Ultrasound Detection of Cleft Lip and Palate in Western Australia from 1996 to 2003

2006 ◽  
Vol 43 (1) ◽  
pp. 61-66 ◽  
Author(s):  
M. Hanikeri ◽  
J. Savundra ◽  
D. Gillett ◽  
M. Walters ◽  
W. McBain
Keyword(s):  
Cleft Palate ◽  
Western Australia ◽  
Gestational Age ◽  
Detection Rate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Patient Records ◽  
Antenatal Ultrasound ◽  
Bilateral Cleft Lip ◽  
Isolated Cleft Palate

Objective To determine the frequency of detection of cleft lip with or without cleft palate and isolated cleft palate from antenatal ultrasound examinations conducted on mothers of infants born with cleft lip and/or palate and isolated cleft palate in Western Australia from 1996 to 2003. Design Review of patient records and purpose-designed questionnaire sent to parents of children born with cleft lip and/or palate and isolated cleft palate. Results There were 308 infants born with cleft lip and/or palate and isolated cleft palate in the study period. Of the 293 parents, 218 responses were available for the study (70.7%), and 2.9 ± 1.8 SD antenatal ultrasound scans were performed on 216 women. No such scans were performed on two women. Cleft lip and/or palate was detected in 22.2% of cases. There was no detection prior to 15 weeks gestational age in the 137 women screened. Between 15 and 19 weeks gestational age, 174 scans detected 30 cases. Between 20 and 29 weeks gestational age, 84 scans detected 11 cases. Between 30 and 40 weeks gestational age, 66 scans detected 7 cases. The detection rate for bilateral cleft lip and/or palate was 44.4% and for unilateral cleft lip and/or palate, 40.6%. Detection rate for isolated cleft lip was 33.3%. Antenatal ultrasound failed to detect any infants with an isolated cleft palate (n = 95). The rate of detection of cleft lip and/or palate increased through the study period. Conclusions The rate of detection of cleft lip and/or palate in Western Australia is comparable to that for referral centers worldwide and is increasing. The rate of detection of the various types of cleft anomalies using antenatal ultrasound ranged from 0% to 44%.

scholarly journals Trends in Enteral Access Placement Among Patients With Oral Clefts: Evaluation of 46 617 Patient Admissions

2018 ◽  
Vol 56 (1) ◽  
pp. 21-30
Author(s):  
Thanapoom Boonipat ◽  
Nicholas S. Adams ◽  
Allen L. Shoemaker ◽  
Robert J. Mann ◽  
John W. Polley ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Enteral Feeding ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Complication Rates ◽  
Oral Clefts ◽  
Patient Admissions ◽  
Increased Risk ◽  
Enteral Access ◽  
Isolated Cleft Palate

Objective: It is well known that patients with oral clefts have challenges with feeding. Enteral feeding access, in the form of gastrostomy, is often utilized to supplement or replace oral intake. Although commonly performed, these procedures have reported complication rates as high as 83%. We intend to discover rates of enteral access in patients with oral clefts and report-related outcomes. Design: The Healthcare Cost Utilization Project Kids’ Inpatient Database from 2000 to 2012 was analyzed using patients with oral clefts and enteral access procedures. The χ2 test was used for univariate analyses of proportions, and linear regression was used to analyze trends. Multivariate logistic regression was used to analyze odds ratios. Results: Of the 46 617 patient admissions included, 14.6% had isolated cleft lip (CL), 51.7% cleft lip and palate (CLP), and 43.7% isolated cleft palate. The rates of enteral access in the oral cleft population increased from 3.7% in 2000 to 5.8% in 2012 ( P < .001). Increased rates were identified in patients with ( P = .019) and without ( P < .001) complex conditions. A significant increase in the rate of enteral access was seen in patients with CLP ( P < .001) and isolated cleft palate ( P < .001). No difference was seen in the isolated CL group ( P = .096). Patients with complex conditions were at a 4.4-fold increased risk and those admitted to urban, teaching hospitals were at a 4.7-fold risk of enteral access placement. Conclusions: The rates for enteral feeding access increased significantly from 2000 to 2012. The reasons for the increased incidence are unclear. Invasive enteral access procedures have been shown to have a multitude of complications. Careful patient selection should be done before placement of invasive enteral access.

scholarly journals Does the GOSLON yardstick predict the need for orthognathic surgery?

2018 ◽  
Vol 1 (1) ◽  
pp. 57-64
Author(s):  
Kirstin Miteff ◽  
Mark Jonathon Walters ◽  
Shahriar Raj Zaman ◽  
Wendy Nicholls ◽  
Steve Singer ◽  
...  
Keyword(s):  
Western Australia ◽  
Orthognathic Surgery ◽  
Good Predictor ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Referral Pattern ◽  
Old Patients ◽  
Princess Margaret Hospital ◽  
Dental Models ◽  
Dental Records

The ability of the GOSLON Yardstick, scored at 9 years of age, to predict the need for orthognathic surgery in a cohort of complete Unilateral Cleft Lip and Palate (UCLP) patients treated in the Cleft Lip and Palate Unit, Princess Margaret Hospital for Children, Perth, Western Australia was assessed. Sixty six consecutively treated UCLP patients with dental models at 9 years of age and details on referral for orthognathic surgery were retrieved from medical and dental records. Cephalometric appraisal at 18 year old patients was also conducted. Twenty four of sixty six patients were referred for orthognathic surgery at growth completion (36%). Referral pattern stratified by GOSLON scores at 9 years of age found that four of four patients (100%), with a GOSLON score of 5 were referred for orthognathic surgery. Eleven of fourteen patients (79%) with a GOSLON 4, four of sixteen patients (25%) with a GOSLON 3 and five of thirty two patients (15%) with a GOSLON 2 were referred. No patient recorded a GOSLON 1 at age 9. Cephalometric appraisals conducted on thirty eight subjects at age 18 significantly discriminated the referral group from the non-referral group. Of the seventeen patients referred for surgery eight fulfilled the objective cephalometric criteria for orthognathic surgery, none of the patients who were not referred for orthognathic surgery fulfilled the objective criteria. The GOSLON Yardstick was found to be a good predictor of the need for orthognathic surgery at growth completion in our unit.

scholarly journals Does the GOSLON yardstick predict the need for orthognathic surgery?

2018 ◽  
Vol 1 (1) ◽  
pp. 116-123 ◽  
Author(s):  
Kirstin Miteff ◽  
Mark Jonathon Walters ◽  
Shahriar Raj Zaman ◽  
Wendy Nicholls ◽  
Steve Singer ◽  
...  
Keyword(s):  
Western Australia ◽  
Orthognathic Surgery ◽  
Good Predictor ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Referral Pattern ◽  
Old Patients ◽  
Princess Margaret Hospital ◽  
Dental Models ◽  
Dental Records

The ability of the GOSLON Yardstick, scored at 9 years of age, to predict the need for orthognathic surgery in a cohort of complete Unilateral Cleft Lip and Palate (UCLP) patients treated in the Cleft Lip and Palate Unit, Princess Margaret Hospital for Children, Perth, Western Australia was assessed. Sixty six consecutively treated UCLP patients with dental models at 9 years of age and details on referral for orthognathic surgery were retrieved from medical and dental records. Cephalometric appraisal at 18 year old patients was also conducted. Twenty four of sixty six patients were referred for orthognathic surgery at growth completion (36%). Referral pattern stratified by GOSLON scores at 9 years of age found that four of four patients (100%), with a GOSLON score of 5 were referred for orthognathic surgery. Eleven of fourteen patients (79%) with a GOSLON 4, four of sixteen patients (25%) with a GOSLON 3 and five of thirty two patients (15%) with a GOSLON 2 were referred. No patient recorded a GOSLON 1 at age 9. Cephalometric appraisals conducted on thirty eight subjects at age 18 significantly discriminated the referral group from the non-referral group. Of the seventeen patients referred for surgery eight fulfilled the objective cephalometric criteria for orthognathic surgery, none of the patients who were not referred for orthognathic surgery fulfilled the objective criteria. The GOSLON Yardstick was found to be a good predictor of the need for orthognathic surgery at growth completion in our unit.

scholarly journals Prevalence of nonsyndromic oral clefts in a reference hospital in the state of Minas Gerais, Brazil, between 2000-2005

2007 ◽  
Vol 21 (4) ◽  
pp. 314-317 ◽  
Author(s):  
Hercílio Martelli-Junior ◽  
Letícia Vieto Porto ◽  
Daniella Reis Barbosa Martelli ◽  
Paulo Rogério Ferreti Bonan ◽  
Amanda Beatriz Freitas ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Pediatric Patients ◽  
Cleft Lip And Palate ◽  
Minas Gerais ◽  
The State ◽  
Craniofacial Anomalies ◽  
Oral Clefts ◽  
Reference Hospital ◽  
Isolated Cleft Palate ◽  
Male To Female

The aim of the present study was to analyze the prevalence of nonsyndromic oral clefts in children receiving treatment at the Center for the Rehabilitation of Craniofacial Anomalies, José do Rosário Vellano University, Alfenas, MG, Brazil. All the data for the epidemiological study was retrieved from the files of 126 pediatric patients with oral clefts without any additional malformation, who came to the center for treatment between 2000 and 2005. A predominance of clefts was observed in Caucasians, and the ratio of male to female was 1.3. Males were 2.57 times more affected by cleft lip and palate (CLP) than females. CLP with a prevalence of 39.68% and isolated cleft lip (CL) with a prevalence of 38.09% were the most common anomalies, followed by isolated cleft palate (CP; 22.23%). Complete and unilateral CLP (26.19%) presented the highest prevalence, followed by incomplete and unilateral CL (23.81%). The present study presents the experience of a reference hospital in the state of Minas Gerais; however, the real prevalence of oral clefts in Brazil is still unknown. Our findings differ from those of a few previous Brazilian reports because they suggest similar prevalences of CLP and CL, and a higher prevalence of CLP in Caucasian males.

scholarly journals Training: improving antenatal detection and outcomes of congenital heart disease

2018 ◽  
Vol 7 (4) ◽  
pp. e000276 ◽  
Author(s):  
Orhan Uzun ◽  
Julia Kennedy ◽  
Colin Davies ◽  
Anthony Goodwin ◽  
Nerys Thomas ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Detection Rate ◽  
Congenital Heart ◽  
Training Programme ◽  
Referral Rate ◽  
Cardiac Anomaly ◽  
Cardiac Ultrasound ◽  
Detection Rates ◽  
Antenatal Detection ◽  
The Uk

ObjectivesThis study describes the design, delivery and efficacy of a regional fetal cardiac ultrasound training programme. This programme aimed to improve the antenatal detection of congenital heart disease (CHD) and its effect on fetal and postnatal outcomes.Design setting and participantsThis was a prospective study that compared antenatal CHD detection rates by professionals from 13 hospitals in Wales before and after engaging in our ‘skills development programme’. Existing fetal cardiac practice and perinatal outcomes were continuously audited and progressive targets were set. The work was undertaken by the Welsh Fetal Cardiovascular Network, Antenatal Screening Wales (ASW), a superintendent sonographer and a fetal cardiologist.InterventionsA core professional network was established, engaging all stakeholders (including patients, health boards, specialist commissioners, ASW, ultrasonographers, radiologists, obstetricians, midwives and paediatricians). A cardiac educational lead (midwife, superintendent sonographer, radiologist, obstetrician, or a fetal medicine specialist) was established in each hospital. A new cardiac anomaly screening protocol (‘outflow tract view’) was created and training on the new protocol was systematically delivered at each centre. Data were prospectively collected and outcomes were continuously audited: locally by the lead fetal cardiologist; regionally by the Congenital Anomaly Register and Information Service in Wales; and nationally by the National Institute for Cardiac Outcomes and Research (NICOR) in the UK.Main outcome measuresPatient satisfaction; improvements in individual sonographer skills, confidence and competency; true positive referral rate; local hospital detection rate; national detection rate of CHD; clinical outcomes of selected cardiac abnormalities; reduction of geographical health inequality; cost efficacy.ResultsHigh levels of patient satisfaction were demonstrated and the professional skill mix in each centre was improved. The confidence and competency of sonographers was enhanced. Each centre demonstrated a reduction in the false-positive referral rate and a significant increase in cardiac anomaly detection rate. According to the latest NICOR data, since implementing the new training programme Wales has sustained its status as UK lead for CHD detection. Health outcomes of children with CHD have improved, especially in cases of transposition of the great arteries (for which no perinatal mortality has been reported since 2008). Standardised care led to reduction of geographical health inequalities with substantial cost saving to the National Health Service due to reduced false-positive referral rates. Our successful model has been adopted by other fetal anomaly screening programmes in the UK.ConclusionsAntenatal cardiac ultrasound mass training programmes can be delivered effectively with minimal impact on finite healthcare resources. Sustainably high CHD detection rates can only be achieved by empowering the regional screening workforce through continuous investment in lifelong learning activities. These should be underpinned by high quality service standards, effective care pathways, and robust clinical governance and audit practices.

Longitudinal Study on the Changes of Maxillary Arch Dimensions in Japanese Children with Cleft Lip and/or Palate: Infancy to 4 Years of Age

1995 ◽  
Vol 32 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Yasuo Honda ◽  
Akira Suzuki ◽  
Masamichi Ohishi ◽  
Hideo Tashiro
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Lateral Displacement ◽  
Growth Patterns ◽  
Posterior Displacement ◽  
Arch Width ◽  
Dental Hospital ◽  
Growth Changes ◽  
Isolated Cleft Palate ◽  
Maxillary Arch

The focus of this study was an analysis of maxillary arch growth changes prior to the time of cheiloplasty up to 4 years of age. Serial dental casts were obtained and measured in 95 children with cleft lip and palate, or both: 7 unilateral cleft lip and alveolus (CLA), 52 unilateral cleft lip and palate (UCLP), 24 bilateral cleft lip and palate (BCLP), and 12 isolated cleft palate (CP). The children were treated at the Kyushu University Dental Hospital. The results are as follows: (1) Prior to cheiloplasty, the maxillary buccal segments in the subjects with cleft lip and palate showed lateral displacement. The premaxilla in BCLP subjects was protruded. (2) Cheiloplasty influenced maxillary anterior arch width, but not posterior width. The operation caused posterior displacement of the premaxilla in BCLP subjects. (3) Palatoplasty affected the growth of the maxillary arch in the transverse and anteroposterior dimensions. (4) A variety of growth patterns observed in the patients (e.g., increasing or decreasing of the maxillary arch dimensions) suggests that maxillary arch dimensions were affected not only by surgery, but also by other individual factors such as genetic facial pattern and severity of the cleft.

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