Cleft Lip and Palate, Clinical and Methodological Studies

University dissertation from Department of Plastic and Reconstructive Surgery, Malmö University Hospital, SE-205 02 Malmö, Sweden

Abstract: Body dimensions of 2,936 newborns with cleft lip/palate (CLP) were compared with 2,031,140 singleton newborns between 1973 to 1992. The risk of cleft development was found to be associated with intra-uterine growth retardation - the more severe the cleft, the stronger the association. As digital photography is being increasingly applied in clinical medicine, we devised a computer software program for 'on screen' image analysis, facilitating measurement of distance, angle, and area. Methodological evaluation showed good reproducibility. Twenty-four adults operated on for isolated cleft lip underwent clinical examination combined with digital photography. The two methods proved closely correlated for both metric and discrete variables. The Millard technique for lip repair gave good results, with only slightly elongated lip on the cleft side and only minor nasal asymmetry. For CLP research and quality assurance, we created a register based on commercially available computer components. The logical arrangement of the system emphasizes its potential for easy data access and presentation. Of 66 patients operated on for isolated cleft palate assessed as adults and examined clinically regarding their speech, 44 had undergone a Langenbeck repair at age 7 months and 22 a Wardill repair at 18 months. Their speech problems persisted to some degree, mainly hypernasality, but neither method proved significantly superior. When assessed by lateral skull cephalometry, facial growth, though slightly inhibited, revealed no differences between the methods. Regarding both facial growth and speech development, neither method can be considered superior.

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