Background: Cleft lip and/or palate (CL/P) is a complex, heterogeneous disorder which occurs due to the interplay between environmental and biological risk factors. Individuals in lower-middle-income countries (LMICs) are exposed to a multitude of risk factors resulting in a greater occurrence of CL/P. Research and knowledge of which risk factors are associated with CL/P in LMICs may aid health care professionals such as speech-language therapists in low-income countries in the early identification of at-risk infants. Objective: To identify and review published data on the risks associated with CL/P in LMICs. Design: A systematic review of literature was performed on electronic databases using the PRISMA-P. Literature on risks associated with CL/P in LMICs, from 2010 to 2020 was included. Results: Seventeen studies met the inclusion criteria. All studies adopted an observational study design. Biological and environmental risks were identified. Maternal and paternal age (n=7) and low socioeconomic status (n=5) were the most prominently associated environmental risk factors. Regarding biological risk factors, a strong association was identified between family history of cleft (n=7) and CL/P occurrence. Conclusion: Environmental risk factors are now being investigated more than biological risk factors in LMICs, hindering health care workers in the early identification (EI) of the possible cumulative effects of risks in CL/P. Contextually-relevant tools are recommended to promote the EI of at-risk infants. / Dissertation (MA (Speech-Language Pathology))--University of Pretoria, 2021. / Speech-Language Pathology and Audiology / MA (Speech-Language Pathology) / Unrestricted

Indiana University-Purdue University Indianapolis (IUPUI) / This investigation examined the relationship of the self-concept of children with cleft lip and palate to the self-concept of non-cleft children. Fifty cleft lip and palate children between the ages of eight and 18 were individually matched by age, sex and race with 50 non-cleft children. Each child was given the Piers-Harris Children's Self-Concept Scale. Children with clefts, regardless of sex, reported significantly lower global self-concept than non-cleft subjects (p < .005). Further significant differences between cleft and non-cleft subjects were found in five of six cluster scores. These included: behavior (p < .05), school status (p < .05), popularity (p < .05), happiness and satisfaction (p < .001), and physical attributes and appearance (p < .001). A significant effect (p < .01), was found on the popularity score, with cleft males feeling less popular than their non-cleft peers. A significant effect was also found on the anxiety score, with cleft females reporting significantly more anxiety (p < .01) than their non-cleft peers. A questionnaire was completed by the parents of the cleft and non-cleft subjects evaluating their child's relationship with family, peers and progress in school. In general, parents of both groups reported positive ratings of their child's social interactions. Parents of cleft. . subjects reported more negative responses than the parents of non-cleft subjects concerning the teasing the child experiences because of his/her facial appearance (p < .05) and the effect that the child's facial appearance had on progress in school (p < .05).

This study examined the impact of several noise conditions on speech articulator movements during a sentence repetition task. Sixty participants in three age groups ranging from 20 to 70 repeated a sentence under five noise conditions. Lower lip movements during production of a target sentence were used to compute the spatiotemporal index (STI). It was hypothesized that STI would be lower (indicating greater stability) in the silent baseline condition. There were changes in speech production under several of the noise conditions. The duration for the 1-talker condition was significantly shorter when compared to the silent condition, which could be due to the impact of the 1-talker noise on the attention of the speaker. The peak velocity of a selected closing gesture increased in all of the noise conditions compared to silence. It could be speculated that the repetitive and predictable nature of the speaking task allowed participants to easily filter out the noise while automatically increasing the velocity of lip movements, and consequently, the rate of speech. The STI in the pink noise and 6-talker conditions was lower than in the silent condition, which may be interpreted to reflect a steadier manner of speech production. This could be due to the fact that in the 6-speaker noise condition, the overall effect was more similar to continuous noise, and thus potentially less distracting than hearing a single speaker talking. The count of velocity peaks was unexpectedly lower in the noise conditions compared to speech in silence, suggesting a smoother pattern of articulator movement. The repetitiveness of the task may not require a high level of self-monitoring, resulting in speech output that was more automatic in the noise conditions. With the presentation of noise during a speaking task, the intensity increased due to the Lombard effect in all of the noise conditions. People communicate in noisy environments every day, and an increased understanding of the effects of noise on speech would have value from both theoretical and clinical perspectives.

Indiana University-Purdue University Indianapolis (IUPUI) / The question of growth attenuation of the maxillary complex arises in connection with primary osteoplasty procedure. The deficiencies associated with the development of the jaws in unilateral complete cleft lip and palate (UCLP) children is an ongoing problem in terms of growth inhibition and orthodontic treatment. Retardation of growth can be attributed to intrinsic cleft factors and/or associated with the treatment of the cleft condition. In this study, the extent of such deficiency, if any, was investigated by assessing arch length, arch width, arch symmetry and inter-arch harmony. Seventeen orthodontic casts of UCLP children (mean age 7 years 11 months) were obtained. All were treated with a primary osteoplasty at James Whitcomb Riley Hospital for Children at Indianapolis, Indiana. The sample was compared to an age and sex matched non-cleft control group (n=38). None of the subjects had undergone orthodontic treatment beyond infant maxillary orthopedics. Anatomic landmarks were identified and digitized by means of optical electronics. The data were automatically fed into a computer which executed preprogrammed data manipulation algorithms. Significant (p<0.05) inhibition of growth has taken place in the maxillary arches of the UCLP group in both anteroposterior and transverse directions. lntercanine width (ICW) was reduced on average by 7.6 mm (23.6 percent) while the intermolar width (IMW) was shortened by 3.9 mm (7.8 percent). Sagittal growth was retarded by 5.5 mm (17.4 percent). A gradient of "normalization" originating at a point of surgical insult was observed anteroposteriorly in the transverse maxillary dimension. In the mandible, ICW was retarded by 2.0 mm (7.8 percent) while IMW and A-P growth vectors were not significantly affected. This investigation also revealed significant (p = 0.0001) differences in the size of the maxillary anterior palatal area (cleft mean = 83.5 mm2, non-cleft mean = 133.9 mm2). These findings lead to the conclusion that primary osteoplasty may contribute to maxillary growth attenuation with concomitant mandibular compensatory growth patterns.

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Background: The management of cleft lip and/or palate (CL/P) includes multidisciplinary care beginning in infancy and continuing through to adulthood. Outcomes of cleft care have been difficult to measure because of the subjective nature of evaluating concepts such as appearance and speech. Including the patient perspective in outcome evaluation through the use of a patient-reported outcome (PRO) measure would provide a more accurate reflection of a patient’s status. The overall objective of this thesis is to show that through adherence to rigorous methods of development, a PRO measure can provide clinically meaningful outcome evaluation in cleft care. Methods: The first paper uses the qualitative method of interpretive description to define a conceptual framework to guide the development of a PRO measure for patients with CL/P, the CLEFT-Q. The second paper describes the protocol for the entire development of the CLEFT-Q. The third paper analyzes the results of the cross-sectional field-test of the CLEFT-Q scales to determine whether or not the CLEFT-Q is able to detect differences between specific cleft types. Results: The qualitative study included 138 patients with CL/P from six countries. The final conceptual framework contained thirteen concepts within the domains of appearance, facial function, and health-related quality of life. The second paper details the process of designing the CLEFT-Q scales. The field-test included 2,434 patients from thirty sites in twelve countries, and CLEFT-Q scores were found to vary with cleft type for all scales. Conclusions: PRO measures need to be rigorously designed in order to provide scientifically sound, clinically meaningful measurement. The CLEFT-Q is able to detect differences between patients with various cleft types, and will be a useful tool to provide the patient perspective in future outcome evaluation in cleft care. / Thesis / Doctor of Philosophy (PhD) / Measuring outcomes of treatment for cleft lip and/or palate (CL/P) should include the patient perspective. The objective of this thesis is to show that through rigorous methods of development, a patient-reported outcome (PRO) measure, the CLEFT-Q, can provide clinically meaningful evaluation of outcomes. First, 136 patients with CL/P from six countries were interviewed to learn what concepts related to having a cleft or its treatment are important to them. A conceptual framework was developed that informed the CLEFT-Q scales. Describing the methodology behind developing the CLEFT-Q then served to inform and engage members of the community. A field-test of the CLEFT-Q scales showed that in a sample of 2,434 patients with CL/P from twelve countries, CLEFT-Q outcomes varied in patients with different types of CL/P. The CLEFT-Q can be used to provide rigorous measurement of PROs in patients with CL/P in the future.

Surgical closure of cleft palate improves function and esthetics but affects facial growth. The effect depends on age of the patient at the time for surgery. The study aimed to compare early versus late closure of the hard palate and its effect on dental arch relationship at the age of five for patients born with unilateral cleft lip and palate (UCLP). The study included 40 non-syndromic, Caucasian children with UCLP. All patients had their surgeries performed by the regional cleft-team at University Hospital of Umeå, Sweden, according to the protocol for treatment of UCLP. The patients were divided into early closure (operation age: approximately 2 years, n = 20) and late closure (operation age 4 - 8 years, n = 20). Dental arch relationships were analyzed on dental casts (n = 36) or clinical photos (n = 4) taken at the age of five using the modified Huddart and Bodenham (mHB) scoring system. The results showed that there was significant difference (P = 0.035) in mHB total score between early closure (median - 6.69) and late closure (median - 3.63). Children who had an early closure of the hard palate had a statistically significant lower mHB total score, and hence worse dental arch relationship compared to children with a late closure.

O presente estudo tem o objetivo de verificar os efeitos das cirurgias primárias sobre os arcos dentários de crianças com fissura completa de lábio e palato unilateral submetidas a dois diferentes protocolos cirúrgicos, Spina + Von Langenbeck (Grupo 1) e Millard + Von Langenbeck (Grupo 2), considerando também a presença ou ausência de bandeleta de Simonart. Para a avaliação da relação interarcos foi utilizado o Índice de Atack em uma amostra de 145 modelos de gesso obtidos aos 5 a 6 anos de idade. Nos resultados relativos aos protocolos cirúrgicos a comparação dos escores agrupados demonstrou maior ocorrência de índices 4 e 5 (42%) para ambos os grupos, com índices oclusais médios de 3,22 para o Grupo 1 e 3,12 para o Grupo 2. Houve maior prevalência de índices 4 e 5 tanto para os pacientes com bandeleta (53%) como sem bandeleta (39%), que apresentaram índices oclusais médios de 3,41 e 3,11, respectivamente. A avaliação individual do protocolo cirúrgico Spina + Von Langenbeck, considerando a presença de bandeleta, demonstrou maior porcentagem de índice 3, para os pacientes com bandeleta (42%) e índices 4 e 5 para os sem bandeleta (44%), com índices oclusais médios de 3,0 e 3,27, respectivamente. Para o protocolo de Millard + Von Langenbeck, o grupo com bandeleta apresentou acentuada maioria de índices 4 e 5 (76%) enquanto que no grupo sem bandeleta prevaleceu índices 1 e 2 (50%), com índices oclusais médios de 3,88 e 2,71, respectivamente, com diferença estatisticamente significativa entre eles (p=0,001). Na amostra estudada a avaliação dos protocolos cirúrgicos e da presença de bandeleta, de acordo com os valores dos índices oclusais, demonstrou que a maioria dos casos apresentou uma pobre relação entre os arcos, com prognóstico de tratamento ortodôntico-cirúrgico. / This study analyzed the effects of primary surgeries on the dental arches of children with complete unilateral cleft lip and palate submitted to two different surgical protocols, Spina + Von Langenbeck (Group 1) and Millard + Von Langenbeck (Group 2), also considering the presence or absence of a Simonarts band. The interarch relationship was assessed by the Atack index on a sample of 145 dental casts obtained at 5 to 6 years of age. In results related to the surgical protocols, the comparison of grouped scores revealed higher occurrence of scores 4 and 5 (42%) for both groups, with mean occlusal scores of 3.22 for Group 1 and 3.12 for Group 2. There was higher prevalence of scores 4 and 5 both for patients with band (53%) and without band (39%), who presented mean occlusal scores of 3.41 and 3.11, respectively. Individual analysis of the surgical protocol Spina + Von Langenbeck, considering the presence of a Simonarts band, demonstrated higher percentage of score 3 for patients with band (42%) and scores 4 and 5 for patients without band (44%), with mean occlusal scores of 3.0 and 3.27, respectively. Concerning the protocol Millard + Von Langenbeck, the group with band exhibited great majority of scores 4 and 5 (76%), while the group without band had predominance of scores 1 and 2 (50%), with mean occlusal scores of 3.88 and 2.71, respectively, with statistically significant difference between them (p=0.001). In the present study sample, evaluation of the surgical protocols and presence of a Simonarts band according to the values of occlusal scores demonstrated that most cases presented poor interarch relationship, thereby with prognosis for orthodontic-surgical treatment.