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Article
Primary Repair of Unilateral Cleft Lip Nasal Deformity

Authors: Zakaria Y.Arajy --- Ahmed A.M.Nawres**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 212-219
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:There is a growing attitude towards correcting the nasal deformity in conjunction with primary repair of cleft lip. Many studies had concluded that this repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern.OBJECTIVE:This study was conducted to document the pattern of primary unilateral cleft lip nasal repair and to evaluate the medium term outcome.METHODS:A total of 33 babies with unilateral cleft lip deformities underwent simultaneous nasal correction with their lip closure, between March of 2004 and April of 2008.Through short nostril rim incision, alar suspension to the dorsal skin at the nasion and interdomal sutures were performed primarily. Alar transfixion stitches were used to maintain the new position of the suspended cartilages.RESULTS:The average follow up periods were 3 years (ranging from 1 – 5 years).The results were assessed by 4 parameters: Nostril asymmetry, nasal dome projection, alar buckling deformity, and flaring deformity of the alar base. Eleven patients had good results, 16 patients had acceptable results, and 6 patients had poor results.CONCLUSION:Alar suspension is a relatively simple effective procedure for the primary correction of cleft lip nasal deformity. Short nostril rim incision can be relied on to access the alar dome and facilitate insertion of suspension sutures. Weather it interferes with nasal growth or not, it is necessary to have a long period of follow up to answer this question.


Article
Birth Prevalence of Cleft lip and/or Palate in Hawler City A retrospective Hospital based One year Study
معدل انتشار ولادة الشفة المشقوقة و / أو الحنك في مدينة هاولر - دراسة بأثر رجعي قائمة على سنة واحدة

Authors: Omed I. Shihab --- Muyesser A. Noori
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2009 Volume: 13 Issue: 2 Pages: 69-72
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and Objectives: The aim of this study was to report the prevalence of cleft lip and/or palate in two hospitals in Hawler city among children born from 1/1/2008 to 31/12/ 2008.Methods: In a retrospective study, birth records of 22387 children from two hospitals (Maternity and Raparin Hospitals) were used to identify all children born with cleft lip and/or palate. Information about prevalence, type of cleft, site, gender, family history, and associated anomalies were investigated.Results: The overall prevalence rate of cleft lip and palate was 0.58 per 1000 births. The prevalence of isolated cleft palate, isolated cleft lip and cleft lip and palate were 0.13, 0.09 and 0.36 per 1000 respectively. Male to female ratio was 1.6:1. Regarding the site of cleft 30.8% was on the right side, 7.7% was on the left side and 61.5% was bilateral. A positive family history was found in 15.4% of the cases and 38.5% of the cases were associated with anomalies.Conclusions: The prevalence rate of cleft lip and palate in Hawler obstetric hospitals during 2008 was lower than that reported in Asians and Europeans, and it was slightly higher than that reported in Africans. Male predominates in all types of clefts. Higher incidence of associated anomalies was observed compared with other studies in different populations.


Article
Primary Repair of Bilateral Complete Cleft Lip Nasal Deformity: Iraqi Experience
تقويــم الانف الاولي للاطفال المصابين بشق الشفه الثنائي الكامل الولادي: خبره عراقيه

Author: Ahmed A. M. Nawres
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2013 Volume: 10 Issue: 2 Pages: 325-335
Publisher: Babylon University جامعة بابل

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Abstract

Background: Simultaneous surgical correction of bilateral cleft lip nasal deformity is becoming more common. This is a major change from the conventional strategy of secondary nasal correction. Many studies had concluded that primary nasal repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern. Aim: This study was conducted to document the pattern of primary nasal repair in bilateral complete cleft lip deformity and to evaluate the medium term outcome.Method: A total of 13 babies with bilateral complete nasolabial clefts underwent simultaneous nasal correction with their lip closure. Mean age was 4 months. The study was performed between March 2006 and April 2009. Alar cartilage manipulation using combined Mulliken - Cutting retrograde nasal approach was performed for all cases.Results: The average follow up periods were 3 years (ranging from 6 months – 6 years).The results were evaluated by comparing 3 nasal anthropometric measurements with those of normal, age-matched children pre and postoperatively at 3 months and then yearly till 3 years. The selected nasal anthropometric measurements were: nasal tip projection, columellar length, and interalar distance. Nasal tip projection and columellar length were normal or near normal in 5 babies but slightly shorter than in control group in 8 babies. The interalar distance was near normal in 9 babies but moderately wider than in control group in 4 babies. In one case, partial prolabial flap necrosis occurred and was revised successfully 6 months later. In another 2 cases, a hypertrophic scar formed on the upper lip which subsided after 6 months of scar management. Over all nasal tip shapes were improved in all cases with acceptable nostrils asymmetry.Conclusions: In cases where presurgical molding is not available, a combined Mulliken-Cutting approach is advisable for obtaining a reasonable primary nasal repair in bilateral complete cleft lip deformity. It is not advisable to create a philtral dimple with a deep dermal suture at the prolabial flap as it may compromise the blood supply. Alar dome suspension stitches might be useful for further improvement of alar dome projection. A long follow-up is needed to observe nasal growth over time and detail final outcomes.

ان عملية تقويم الانف الاولي للاطفال المصابين بشق الشفه الثنائي الكامل الولادي اصبح من العمليات الاكثر شيوعا عالميا وبهذا يمثل انعطافه كبيره عن الاستراتيجيه التقليديه المتمثله بتقويم الانف ثانويا حيث ان هنالك عدة دراسات توصلت الى ان تقويم الانف اوليا لهكذا اطفال لا يؤثر على نمو غضاريف الانف بل وحتى يساعد في ارجاع الغضاريف المشوهة الي مكانها الطبيعي محسنا بذلك نمط نموها.لقد بينت هذه الدراسه الطريقه المستخدمه في تقويم الانف الاولي لثلاثه عشر طفلا ، معدل اعمارهم اربعة شهور و أجريت خلال الفترة (اذار 2006 لغايه نيسان 2009)، وقد تم استعمال طريقه (موليكان/ كاتنج) لجميع الحالات وكان معدل فترة متابعه المرضى ثلاث سنوات وقد قيمت النتائج عن طريق مقارنه ثلاثة قياسات خاصه لمنطقه الانف مع عدد مماثل من الاطفال الغير مصابين من نفس الفئة العمريه وثبتت النتائج في الجدول المبين في الدراسة.


Article
Oral health status and treatment needs among 3-12 years old children with cleft lip and/or palate in Iraq

Authors: Zainab J. Ja’far زينب جعفر --- Ban A. Salih بان علي صالح
Journal: Journal of baghdad college of dentistry مجلة كلية طب الاسنان بغداد ISSN: 16800087 Year: 2012 Volume: 24 Issue: 4 Pages: 145-151
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: This study aims to illustrate the oral health status of children with cleft lip and/or palate.Materials and methods: 233 cleft lip and/or palate Iraqi patients had participated in this study. 108(57 boys, 51 girls)within the age (3-12) years were selected from the total sample and submitted to a questionnaire and clinicalexamination. Dental caries, plaque index and gingival index, the pocket depth were recorded.Results: The mean dmfs=14.606±1.477, dmft=5.862± 0.461, the mean DMFS=2.202±0.383, DMFT=1.339± 0.195 withstatistically non significant difference among different types of cleft. The highest percentage were in need to onesurface filling (79.6%), followed by two surface filling (65.7%). The mean PI=1.663±0.051, with statistically not significantdifference among different types of cleft. The mean GI=1.211±0.038, with statistically not significant differenceamong different types of cleft. Regarding pocket depth significant differences were in the distal site of the canine,mesial, palatal and labial sites of the lateral incisor, and all the sites of the central incisor, and highly significantdifference in the distal site of the lateral incisor.Conclusion: The cleft lip and/or palate patient have major oral health problems regarding the dental caries, dentalplaque, gingival condition, pocket depth and dental treatment needs


Article
Analysis Study for Cleft Lip And / Or Palate Patients and Steps of Management in Al-Wasity Hospital

Authors: Natheer Ayed Jasem نزير عايد جاسم --- Hasaan Hameed حسن حميد
Journal: Tikrit Journal for Dental Sciences مجلة تكريت لعلوم طب الاسنان ISSN: 20731213 Year: 2016 Volume: 4 Issue: 2 Pages: 81-89
Publisher: Tikrit University جامعة تكريت

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Abstract

Cleft is defined as defect in the fusion of facial tissues alone orwith palatal processes during embryonic life causes an opening inface or roof of mouth in baby which considers as most commonanomalies visit our hospital. To analyses most important problemswhich may consider as one of the cause of cleft lip and palatepatients with steps in management of this important anomaly. Thesample involves 500 patient distributed between cleft lips only,cleft palate group and cleft lip and palate. The parent of patienttakes important field in our study since they are who answer thequestions, the study take five years from 2010 to 2015, patientscame to our hospital with age extend from few hour to 28 yearsold .the problem is very important and this first study in ourhospital . Of this study analyzed by chi-square test, the resultswere founded cleft lip group was found to be (15.6%), cleft palategroup (33.6%) and cleft lip and palate group were (50.8%). Wetake the order of patient in family found 28% of sample first inorder (highest percentage).Most patient fathers above 30 years(65%), 8.6%of them with systemic disease (40%) were smokers.Most age group of mother were younger between 16-30 years old(65.4%), previous history of cleft found in 33% of sample and(45.6 %) of mother had a history of psychological problem.Management of patient include long process therapy as early ageof patient when reach hospital to age above 20 years old whichinclude plastic surgery , orthodontic treatment and maxillofacialsurgery.


Article
Evaluation of cleft lip and palate management in Erbil
تقييم معالجة الشفة والحنك المشقوق في أربيل

Authors: Humam Sharif Ali --- Jalal Hamasalih Fattah
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2015 Volume: 19 Issue: 1 Pages: 866-873
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and Objectives: Cleft lip and palate are congenital deformities that affect the primary and secondary palates during embryogenesis. The objectives of this study was to record the pattern of presentation of cleft lip and palate in Erbil, the types of surgical procedures, the outcome and complications, hence making recommendations to ensure improved care. Methods: This is a prospective study conducted in Erbil city, in the Department of Plastic Surgery at Rezgary Teaching Hospital and Rapareen Pediatric Hospital from March 2009 to May 2013. A total of 164 patients with cleft lip/palate were included in this study. Statistical package for the social sciences (version 18) was used for data entry and analysis. Results: The age ranged from birth to 24 years. The ratio of male to female was 1.4: 1. The combined cleft lip and palate was the commonest type (87 cases, 53%). The commonest risk factor was poor family (105 cases, 64%), followed by consanguinity (97 cases, 59%). The commonest procedure for cleft lip repair was Millard (67 cases) and that for cleft palate repair was Furlow palatoplasty (57 cases). The commonest complication of cleft lip repair was wide scar (9 cases, 7.5%) mostly below one year of age. Ninety-one percent of the parents were satisfied with the children’s appearance of the lip and 86% of parents were satisfied with palatoplasty result. Conclusion: The high degree of association of consanguinity with the cleft lip and palate emphasizes the importance of education about discouraging consanguineous marriage. Millard repair is still the commonest procedure for cleft lip repair.


Article
Cleft Lip and Palate in Anbar Province
شق الشفة وفتحة اللهاة الولادية في محافظة الانبار

Author: Mohammed Kh. Al-Rawi محمد خضر الراوي
Journal: Al- Anbar Medical Journal مجلة الأنبار الطبية ISSN: PISSN: 27066207 / EISSN: 26643154 Year: 2012 Volume: 10 Issue: 2 Pages: 92-95
Publisher: University of Anbar جامعة الانبار

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Abstract

Background: Orofacial clefts are birth defects where the mouth or roof of the mouth (palate) does not grow together properly during development, Orofacial clefts include cleft lip [CL], cleft lip and palate [CLP], cleft palate [CP] alone, as well as median, lateral [transversal], oblique facial clefts(involved other parts of facial structures and classified by Tessier to 15 lines) are among the most common congenital anomalies at birth. Aim: To study the types of clefts lip and palate and its distribution in Al Anbar province. Patients and Methods: This descriptive study was carried out at Maxillofacial Unit, Ramadi Teaching Hospital from the period of August 2007 till June 2010. Result: 125 cases of clefts (of different types) were treated surgically. Children who have an orofacial cleft require several surgical procedures and complex medical treatments. The study showed that 81 of patients with cleft palate, 27 with cleft lip and 17 with cleft lip and palate.Conclusion: Increasing in number of cleft lip in female (60%). Increasing the percent of cleft palate may be related to environmental factors

الخلفية : تعتبر شقوق الوجه والفم من التشوهات الولادية الأكثر شيوعا من بين التشوهات الولادية الأخرى حيث تنمو فيه أجزاء الوجه والفم بطريقة غير منتظمة داخل الرحم يتسبب ذلك بعدم تلاصق هذه الأجزاء بطريقة نموذجية. تظهر بأشكال مختلفة تشمل شفة الأرنب وفتحة سقف الفم أو كليهما , بلأضافة إلى فتحات الوجه المائلة وصنفت إلى 15 نوع .الأهداف : البحث يهدف إلى وصف الأنواع المختلفة لفتحات الوجه والفم الولادية بالنسب المأوية في مستشفى الرمادي التعليميطريقة العمل : هذه الدراسة أجريت على 125 مريض يعانون من شفة الأرنب أو فتحة سقف الفم الولادية أو كليهما في مستشفى الرمادي التعليمي خلال الفترة من أب 2007 إلى حزيران 2010النتائج : 125 حالة لمختلف أنواع شقوق الفم والوجه الولاديه عولجت جراحيا على مراحل , الدراسة بينت أن هناك 81 حالة كانت تعاني من فتحت سقف الفم و 27 حالة من شق الشفة و 17 حالة من شق الشفة واللهاةالأستنتاجات : بينت النتائج أن هناك زيادة في عدد شق الشفة عند الإناث 60% , كما بينت أن هناك زيادة بعدد حالات فتحة سقف الفم المنسوبة غالبا إلى التأثيرات البيئية


Article
Endotracheal Intubation in Children Undergoing Cleft Lip Surgery.A Comparative Study Between Propofol and Halothane

Authors: Ali Abdulhammed M. Ali --- Atared Faraj Al-Janabe --- Raghad Ala’a Al-a’aragy
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 4 Pages: 470-476
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Endotracheal intubation is one of important step during the administration of general anesthesia. It is more so in pediatric patients with associated deformities like cleft lip and palate. Propofol, with its profound depressant effect on the airway reflexes, has a quick and smoother induction. Similarly, halothane is least expensive volatile anesthetic, sweaty to inhale and because of its safety profile.OBJECTIVE: The intubating conditions with the use of intravenous propofol is superior to inhalational halothane with oxygen for tracheal intubation without muscle relaxants in children who undergo cleft lip surgery.PATIENTS AND METHODS: In this prospective randomized study, 50 ASA I patients who where aged three to nine months, who were scheduled for cleft lips surgeries were included. Both group received halothane 3% by face mask with monitors attached [pulse oximeter , ECG ,NIBP ]. I.V line inserted ,first group(propofol group) once patients become sleepy &respiration became regular& stop movement they received 2mg/kg propofol &E.T.T attempt within 0ne min.2nd group inhalational( halothane Group) until pupil been central & constricted &E.T.T attempted within 5 min. The intubation conditions were assessed by using Steyn’s modification of the Helbo - Hansen intubating conditions score.RESULTS: The intubating conditions were better in group A than in group B. The group A patients (88%) significantly had more clinically acceptable intubating conditions than in group B(52%), (p=0.0015) . CONCLUSION: The intubating conditions with the use of intravenous propofol 2mg/kg is superior to inhalational 3% halothane with oxygen for tracheal intubation without muscle relaxants in children who undergo cleft lip surgery.


Article
Incidence of Cleft Lip and Palate in Al-Ramadi City (Descriptive Epidemiological Study)

Authors: Saria Dhakir Mahmood سارية ذاكر محمود --- Ausama A. Al-Mulla اسامة احمد الملا
Journal: Journal of baghdad college of dentistry مجلة كلية طب الاسنان بغداد ISSN: 16800087 Year: 2016 Volume: 28 Issue: 2 Pages: 139-144
Publisher: Baghdad University جامعة بغداد

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Background Birth defects are one of the causes of pediatric disability and mortality in all around the world. Data onbirth defects from population-based studies originating from developing countries are lacking. Cleft lip (CL), cleft lipand palate (CLP), and isolated cleft palate (CP), collectively termed oral clefts, occur in all races, both sexes, and allsocioeconomic groups and vary internationally (1). The main aim of this research is to establish the frequency of cleftlip and/or palate in the population of the Al-Ramadi City, and to characterize the demographic features of affectedindividuals and find possible risk factors.Materials and methods We conducted a survey of the Educational Maternal and Pediatric Hospital in Al-Ramadi city.The sample population comprised all 5100 babies born at Al-Ramadi City during the 5 months period 1 January 2013to 31 May 2013. Statistical tests used Pearson’s chi-square test, Student’s t-test and Spearman’s correlation coefficienttest according to the type of parameter tested.Results: During the study period 15 babies were born with oro-facial cleft. The overall incidence of cleft lip and palatewas 2.94 per 1000. Cleft palate was significantly more frequent in male than female babies (P = 0.81).Conclusions: A high incidence of facial clefts in this city was seen. This change may be attributed to the wars thatoccur in Iraq in the last years so increased pollutions and decreased prenatal care in the Iraqi population as part ofsocial and health-related behavior changes


Article
Congenitally missing and supernumerary teeth among a group of 3-12 years old children with cleft lip and/ or palate in Iraq

Authors: Zainab J. Ja'far --- Ban Ali Salih بان علي صالح
Journal: Journal of baghdad college of dentistry مجلة كلية طب الاسنان بغداد ISSN: 16800087 Year: 2015 Volume: 27 Issue: 2 Pages: 148-153
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: There are many congenital anomalies associated with cleft lip and/or palate. This research is to studythe prevalence of congenitally missing teeth and supernumerary teeth in this population group.Materials and Method: One hundred eight cleft lip and/or palate Iraqi patients had participated in this study (57male, 51 female), 3-12 years of age. 26 of them had orthopantomogram were within (6-12) years of age wereinspected for congenitally missing teeth and supernumerary teeth. Patients whom age range 3-5 years werechecked for the congenitally missing teeth by clinical examination with strongly insisting the teeth were not misseddue to caries or trauma.Results: There were 19(73.076%) patients with 41 congenitally missing teeth for the 26 patients within 6-12 years agegroup who were with orthopantomogram, while there were 20(37.037%) patients with 32 congenitally missing teethfor the 54 patients within 3-5 years of age who were not indicated for orthopantomogram. There were (22) patientwith (27) supernumerary teeth.Conclusion: The most frequently congenitally missing tooth was the permanent upper lateral incisor, on the otherhand the tooth most frequently noted as extra tooth was the primary lateral incisor. Majority of them were with cleftlip and palate

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