No abstract

Responses revealed wide discrepancy in the classification of cleft phenotypes and in the interpretation of the significance of anatomical components in the classification of a cleft lip. We discuss the difficulty in aligning classification based on unclear definition of terms and variable anatomic parameters. We highlight this issue in the face of a need for comparability in clinical evidence-based practices. To ensure precision and uniformity in cleft classification, we recommend that use of the term "Simonart's band" be abandoned while incorporating a notation of the integrity of the nasal sill into the LAHSHAL system. We propose a uniform definition of incomplete versus complete cleft lip, wherein a cleft lip will be classified as complete in the presence or absence of narrow bands of tissue present at the base of the nasal sill or more internally.

Objective: To evaluate the barriers faced by patients with nonsyndromic orofacial clefts (NSOFC) throughout their treatment course in Saudi Arabia. Design: A cross-sectional study. Setting: Eleven different governmental health care centers across Saudi Arabia. Patients: Records of pediatric patients with NSOFC. Interventions: A questionnaire with multiple validation stages was designed to assess the barriers in care of these patients through telephonic interviews with the parents or guardians of patients with NSOFC. Main Outcome Measures: We identified 3 care-barrier–related factors: (1) geographic accessibility, (2) appointment availability and accessibility, and (3) scheduling-related barriers. Results: Overall, 240 participants of both sexes, with orofacial cleft of various types and with various demographic characteristics (residence, family monthly income, and caregiver level of education) were included. The highest mean score of care barriers was reported for scheduling-related barriers. Overall, 186 individuals reported sometimes/often not receiving the required medical care for the following reasons: scheduling difficulties (89%; 37.1%), prolonged waiting room time (40%; 16.7%), and transportation difficulties (36%; 15.0%). A linear regression showed that parents cited late appointments as the main reason for patients with NSOFC not receiving adequate medical care. Care-barrier factors were significantly related to gender ( P = .035), patient age ( P < .001), place of residency ( P < .001), and caregiver’s level of education ( P = .015). Conclusions: Gaps in the health care system directly related to common care barriers need to be addressed to ensure adequate care for patients with NSOFC.

Background: Rapid Maxillary Expansion (RME) aims to re-establish balance between the widths of the jaws. It is mainly utilized to treat skeletal and dental manifestations associated with transverse maxillary constriction and to improve facial structures involving the nasal cavity. Objectives: This study aimed to investigate parents’ perceptions of breathing pattern changes after their child had undergone RME and the associated effects on sleep quality and fatigue. We also evaluated nasal cavity changes in three dimensions in six randomly selected patients. Methods: Ninety-one children aged 5-13 years with transverse maxillary deficiency and no major systemic diseases or syndromes were recruited. Their parents completed a 16-item questionnaire pre-treatment and 6 months post-treatment. The questionnaire included items pertaining to changes in (1) sleep apnea and breathing patterns, (2) sleep quality and fatigue, and (3) behavior. The cone beam computed tomography scans from six randomly chosen patients were also subjected to stereolithographic reconstruction of the midface pre-RME and post-RME. Results: Responses in the three domains exhibited good reliability. Significant improvements were observed in 59% of the items post vs. pre-RME. The overall rates of dry mouth in the morning, snoring half of the time, and heavy breathing decreased by ≥30%. The percentage change in headache in the morning, snoring loudly, and snoring half of the time was >80%. In addition, in the series of six cases, the mean difference in nasal cavity area post-RME was 4.1 mm2. Conclusion: Post-RME, parents perceived that their children exhibited improved behavior and were less fatigued during the day. Enhanced sleep quality and breathing patterns were also observed, but to a lesser extent.

The study objective was to construct and validate a tool to assess, measure, and evaluate the barriers and obstacles that patients with orofacial clefts (OFCs), and their families, face during treatment. The Effective Accessibility and Accommodation subscale, based on the translated Primary Care Assessment Survey and Primary Care Assessment Tool scales, was used as a reference for the questionnaire. A total of 165 parents from three main cleft referral centers in Saudi Arabia were interviewed. Questionnaire content validity was conducted by calculation of a content validity index for each item (I-CVI) as well as for the total scale (S-CVI). Reliability was tested using Cronbach’s alpha. Factor analysis and principal components analysis were performed to determine the factor structure of the instrument. The final questionnaire had nine items. Rating results showed both I-CVI and S-CVI scores of 1 and Cronbach’s alpha was 0.86. There were three factors (geographic accessibility, appointment availability and accessibility, and scheduling-related barriers) with eigenvalues above 1.00, which collectively accounted for 73% of the variance. In conclusion, this tool is valid and reliable to evaluate accessibility and barriers to care of patients with OFCs in Saudi Arabia.