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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 3  |  Issue : 2  |  Page : 59-62

Demographic distribution and pattern of orofacial clefts in a Nigerian Urban Hospital


1 Department of Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
2 Dental Clinic, Army Dental Hospital Bonny Camp, Lagos, Nigeria
3 Department of Dental and Maxillofacial, University of Calabar Teaching Hospital, Calabar, Nigeria

Date of Web Publication19-Mar-2019

Correspondence Address:
Dr. Benjamin Fomete
P. O. Box: 3772, Kaduna
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/archms.archms_6_19

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  Abstract 

Introduction: Clefts lip and palate are the most common deformities in the head-and-neck region. They vary in the severity of presentation from small notches in the lip to clefts that extend through the alveolar ridge in the mouth and involve the floor of the nostrils/palate. They may either occur in isolation (asyndromic) or in association with other congenital anomalies as part of a syndrome as observed. Patients and Methods: This is a retrospective clinic-based study of records of patients seen with orofacial clefts from 2009 to 2014, at the Army Dental Clinic, Bonny Cantonment, Lagos, Nigeria. Results: A total of 43 cases of cleft lip and palate of varying degrees were seen over the study period. There were slightly more males (n = 23, 53.5%) than that of females (n = 20, 46.5%). The age at presentation ranged from 4 days old to 46 years and the median age was 3 years. In terms of age distribution, patients aged 3 years and below (n = 23; 53%) were the most predominant group. This was followed by the 4–7 years (n = 6; 13.9%) age bracket. Patients aged 8–11 years, 12–15 years, and 28–31 years were equally distributed with 3 (6.9%) each. Conclusion: A significant minority of orofacial clefts patients still present in adulthood possibly due to ignorance about treatment options and poverty to access surgical treatment.

Keywords: Cleft, demographic, lip, palate, pattern


How to cite this article:
Fomete B, Adebayo ET, Osunde OD, Ahaji LE, Omobolaji I. Demographic distribution and pattern of orofacial clefts in a Nigerian Urban Hospital. Arch Med Surg 2018;3:59-62

How to cite this URL:
Fomete B, Adebayo ET, Osunde OD, Ahaji LE, Omobolaji I. Demographic distribution and pattern of orofacial clefts in a Nigerian Urban Hospital. Arch Med Surg [serial online] 2018 [cited 2019 Apr 24];3:59-62. Available from: http://www.archms.org/text.asp?2018/3/2/59/254578




  Introduction Top


Clefts lip and palate are the most common deformities in the head-and-neck region.[1],[2],[3] They vary in the severity of presentation from small notches in the lip to clefts that extend through the alveolar ridge in the mouth and involve the floor of the nostrils/palate. They may either occur in isolation (asyndromic) or in association with other congenital anomalies as part of a syndrome as observed by Fadeyibi et al.[3] There are limited reports in Africa on the epidemiology and clinical studies on cleft lip and palate (CLP), and the results of the studies suggest that CL alone is more common than either cleft palate (CP) alone or combination of CLP.[4] Isolated CL is more in females, whereas CLP is more in males.[4] Reports of birth prevalence of orofacial clefts from different African populations vary widely, from as low as 0.3/1000–1.65/1000 reported in Kenya and can even be 1/700.[5],[6] There is a variation in rates in different geographical areas and ethnic groups worldwide.[6] Studies from outside Africa, however, suggest that cases of either CP alone or combined CLP are predominant.[4] The highest incidence was found in the USA followed by Japan. Asians are at higher risk than others. African descends have the lowest incidence.[2]

Previous reports on CLP have revealed late presentation, social issues, associated anomalies, and poor follow-up visits as some of the challenges.[7] The widespread poverty in African countries predisposes pregnant women to an increased risk of nutritional deficiencies, including vitamins and folic acid deficiencies, thus leading to an increased risk of birth deformities such as CLP. Other social habits such as smoking, alcohol consumption, and the use of nonprescription medications by pregnant mothers have been reported to be associated with an increased risk of CLP.[4] Over 50% of Nigerians live with <$1/day, and this may be contributing to the 46.5 years life expectancy, in spite of a high adult literacy level of about 69.1%.[6]

Surgical techniques for appropriate treatment of CLP have developed very rapidly.[8] Several techniques have been described, and all are aimed at improving facial esthetics and function for the cleft babies and overall psychological well-being for parents of cleft children, as well as for the older cleft patient.[9],[10]

In the present study, the demographic distribution and pattern of orofacial cleft seen over a 5-year period at a Nigerian urban health-care facility are presented for comparison with previous studies.


  Patients and Methods Top


This is a retrospective clinic-based study of records of patients seen with orofacial clefts from 2009 to 2014, at the Army Dental Clinic, Bonny Cantonment, Lagos, Nigeria. Patients of all ages with congenital cleft that present at the Army Dental Clinic were recruited into the study. Patients with acquired cleft secondary to trauma were excluded from the study. Data collected included age at presentation, history of relations with similar defects, clinical details of clefts and other congenital anomaly, surgical treatment performed, history of complications, and duration of follow-up.


  Results Top


A total of 43 cases of CLP of varying degrees were seen over the study period. There were slightly more males (n = 23, 53.5%) than that of females (n = 20, 46.5%). The age at presentation ranged from 4 days old to 46 years and median age was 3 years. In terms of age distribution, patients aged 3 years and below (n = 23; 53%) were the most predominant group. This was followed by the 4–7 years (n = 6; 13.9%) age bracket. Patients aged 8–11 years, 12–15 years, and 28–31 years were equally distributed with 3 (6.9%) each. Other age groups were the 20–23 years (n = 2; 4.7%), 16–19 years (n = 1; 2.3%), 32–35 years (n = 1; 2.3%), and the 44–47 years (n = 1; 2.3%). There were more clefts on the left side (n = 17; 39.5%) than the right side (n = 8; 18.6%); bilateral cases accounted for 14 (32.5%) of the total population. The distribution of cleft types is shown in [Table 1]. Complete unilateral CL was the most common cleft type, accounting for 15 (34.9%). This was followed by complete unilateral CLP represented by 10 (23.3%). Complete bilateral CLP accounted for 7 (16.3%). The distribution according to gender was not statistically significant (P > 0.05).
Table 1: Distribution of cleft types in 43 patients

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Of the 43 cases seen, 4 (9.3%) patients had nine other craniofacial anomalies, whereas seven different body anomalies were observed in 5 (11.6%) cases. [Table 2] shows the different craniofacial and body anomalies observed in the study. All anomalies occurred singly except for undescended testes 2 (11.8%) were observed.
Table 2: Concomitant craniofacial and body anomalies seen in 17 cleft patients

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The positive family history of cleft was obtained in 7 (16.3%) of the 43 cases and the pattern of affectation of the family members is displayed in [Table 3].
Table 3: Types of cleft in family members of cleft patients

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Primary lip repair (n = 20; 46.5%) was the most common treatment carried out. Primary palate repair accounted for only 5 (11.6%) cases. Simultaneous repair of CLP was performed in five (11.6%) cases. Details of repairs carried out on the patients are shown in [Table 4]. Those not treated were not up to treatment age, were taken out of the hospital by their parents or failed to return for treatment.
Table 4: Treatment techniques of cleft patients in Lagos, Nigeria

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  Discussion Top


In this study, the distribution of the different types of clefts [Table 1] showed the preponderance of CL alone as was noted in other studies from Africa[4],[7] but disagreed with other Nigeria and Thai studies where combined CLP predominated.[3],[11] There were more males than females which is contrary to findings in Thailand and Nigeria where females were more[7],[11],[12],[13] but agreed with another Nigerian study.[10] It could be that the relatively small size of this sample favored males due to their selection for treatment by parents.

The distribution of cleft by location showed that the left side was preponderant (39.5%) than the right side (18.6%) and bilateral cleft was 32.5%. This was comparable to previous studies that, however, had lower frequency of bilateral cleft cases.[3],[7],[10],[12] The age range of patients affected with CLP as obtained in the present study lends credence to the results of earlier published works from Nigeria and other parts of Africa that some patients still present outside infancy due to ignorance, lack of access to surgical treatment, and belief in superstition.[3],[4],[7],[10]

Associated anomalies are becoming more recognized with cleft of the orofacial region, and the frequency ascertainment has improved with time.[6] CLP associated with other craniofacial anomalies or syndromic cleft [Table 3] was found in 9.3% of patients, whereas 11.6% of patients had seven different body anomalies as shown in [Table 2]. This was within the range (7.4%–75%) reported in other studies[7],[8],[10],[11] but higher than the 4.7% by Butali et al.[6] According to Jaruratanasirikul et al.,[11] there are more than 300 different nonchromosomal syndromes known to be associated with CLP. The most common such nonsyndromic clefts are holoprosencephaly and Pierre Robin sequence while Butali et al.[6] found musculoskeletal anomalies to be most frequent. In their search of the literature, they found the cardiovascular system to be most involved. The most common type of cleft defect found in syndromic cleft is CLP.[11] In this study, 5.9% presented with Pierre Robin sequence. This was similar to the finding by Nouri et al.[8]

In [Table 3], 7 (16.3%) out of the 43 patients seen had a family history of CLP, and while this was slightly lower than the 17.7% obtained in Thailand,[11] it was higher than the 4%, 10.4%, and 14% recorded in Nigeria by Ibrahim et al.[10] Butali et al.[6] and Orkar et al.,[7] respectively. The sex ratio has been reported in the literature to vary between the types of clefts,[11] boys being more likely to have CL with or without CP. In the present study, the distribution according to gender was not statistically significant (P > 0.05), even though more males were observed to be affected with CLP than females.

There are presently about 170 different protocols in the management of patients with CLP[10],[12] and the majority recommend early repair, with the completion of primary repair of the lip and palate by 2 years of age.[14] While repair of primary palate is generally accepted at 10–12 weeks, secondary palate repair has no general consensus. Some advocate 9–12 months for speech reason but others prefer after 2 years bearing the mind the risk of anesthesia and for skeletal growth of the maxilla.[10] Oronasal fistula and wound dehiscence with 5.7% each were the complications observed in this study. Ibrahim et al.[10] reported 4% wound dehiscence but 10% fistula.


  Conclusion Top


A significant minority of orofacial clefts patients still present in adulthood possibly due to ignorance about treatment options and poverty to access surgical treatment. These could be improved through universal health insurance coverage that ensures that all deliveries are in hospitals, and the provision of free surgery for congenital defects through the assistance of governments and nongovernmental agencies, as Smile train is currently doing for orofacial clefts deformities. While the gold standard for cleft care remains multispecialty care involving orthodontists, social welfare experts, geneticists, speech therapists, pediatricians, and surgeons, most of the treatment centers in Nigeria, including our center lack some of these health professionals. In addition, successful treatment for orofacial cleft should now involve evaluation of results of treatment such as appearance, speech, and need for secondary repairs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gorlin RJ, Cohen MM, Hennekam RC. Syndromes of the Head and Neck. New York: Oxford University Press; 2001.  Back to cited text no. 1
    
2.
Jamilian A, Nayeri F, Babayan A. Incidence of cleft lip and palate in Tehran. J Indian Soc Pedod Prev Dent 2007;25:174-6.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Fadeyibi IO, Adeniyi AA, Jewo PI, Saalu LC, Fasawe AA, Ademiluyi SA, et al. Current pattern of cleft lip and palate deformities in Lagos, Nigeria. Cleft Palate Craniofac J 2012;49:730-5.  Back to cited text no. 3
    
4.
Donkor P, Plange-Rhule G, Amponsah EK. A prospective survey of patients with cleft lip and palate in Kumasi. West Afr J Med 2007;26:14-6.  Back to cited text no. 4
    
5.
Butali A, Mossey PA. Epidemiology of orofacial clefts in Africa: Methodological challenges in ascertainment. Pan Afr Med J 2009;2:5.  Back to cited text no. 5
    
6.
Butali A, Adeyemo WL, Mossey PA, Olasoji HO, Onah II, Adebola A, et al. Prevalence of orofacial clefts in Nigeria. Cleft Palate Craniofac J 2014;51:320-5.  Back to cited text no. 6
    
7.
Orkar KS, Ugwu BT, Momoh JT. Cleft lip and palate: The Jos experience. East Afr Med J 2002;79:510-3.  Back to cited text no. 7
    
8.
Nouri MA, Hamad SA, Rasheed NE. Incidence of cleft lip and palate in Erbil city. Mustansiria Dent J 2010;7:106-12.  Back to cited text no. 8
    
9.
Adetayo O, Ford R, Martin M. Africa has unique and urgent barriers to cleft care: Lessons from practitioners at the pan-African congress on cleft lip and palate. Pan Afr Med J 2012;12:15.  Back to cited text no. 9
    
10.
Ibrahim A, Mshelbwala PM, Obiadazie AC, Ononiwu CN, Asuku ME, Ajike SO, et al. A descriptive study of clefts of the primary and secondary palate seen in a tertiary institution in Nigeria. Niger J Surg Res 2013;15:7-12.  Back to cited text no. 10
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11.
Jaruratanasirikul S, Chichareon V, Pattanapreechawong N, Sangsupavanich P. Cleft lip and/or palate: 10 years experience at a pediatric cleft center in Southern Thailand. Cleft Palate Craniofac J 2008;45:597-602.  Back to cited text no. 11
    
12.
Adeola DS, Ononiwu CN, Eguma SA. Cleft lip and palate in Northern Nigerian children. Ann Afr Med 2003;2:6-8.  Back to cited text no. 12
    
13.
Oladele AO, Olabanji JK, Awe OO. Adolescent and adult cleft lip and palate, in Ile-Ife, Nigeria. Niger J Clin Pract 2012;15:403-7.  Back to cited text no. 13
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14.
Butler DP, Samman N, Gollogly J. A multidisciplinary cleft palate team in the developing world: Performance and challenges. J Plast Reconstr Aesthet Surg 2011;64:1540-1.  Back to cited text no. 14
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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