Associations between laterality of orofacial clefts and medical and academic outcomes

Abstract

Patients with oral clefts have an increased risk of other malformations, syndromes, and lower academic performance in school. Few studies have investigated if laterality of clefts is associated with medical and academic outcomes. Oral clefts have nonrandom laterality, with left-sided clefts occurring approximately twice as often as right-sided clefts. Using a retrospective study design, we examined potential associations of cleft attributes and outcomes in patients with cleft lip with or without cleft palate (CL/P) born in 2003-2010 who were treated at the Seattle Children's Craniofacial Center. The following variables were extracted from medical records: cleft type, medical history, maternal hyperglycemia, other malformations, and the need for academic support at school. We used logistic regression to examine risk of associations with outcomes of interest. Relative to patients with left-sided clefts, patients with bilateral CL/P were more likely to have a syndrome. Patients with nonsyndromic right-sided CL/P had a higher risk (OR and 95%CI: 3.5, 1.3-9.5, and 5.5, 1.9-16.0, respectively) of having other malformations and requiring academic support at school, when compared to patients with left-sided CL/P. Understanding the etiology of oral clefts is complicated, in part because both genetic and environmental factors contribute to the risk of developing a cleft. However, the different outcomes associated with cleft laterality suggest that right-sided clefts may have a distinct etiology. Using laterality to study cleft subgroups may advance our understanding of the etiology of this common birth defect.

Cognitive functioning and clinical characteristics of children with non-syndromic orofacial clefts: A case-control study

“…Psychiatric diagnoses varied across cleft subtypes and the affected side: the highest proportion of psychiatric diagnoses were observed in CLP, and bilateral-sided clefts. These observations may suggest that the more complicated clefts more likely present with psychiatric comorbidities (Pedersen et al, 2016;Gallagher et al, 2018). We did not observe psychiatric comorbidities in CPO children, which is in contrast with previous observations (Nilsson et al, 2015;Pedersen et al, 2016;Tillman et al, 2018;Gallagher and Collett, 2019).…”

Descriptive Overview of Primary Cleft Palate Surgeries in the Low- and Middle-Income Countries

“…This is also consistent with US data, revealing that left-sided clefts were 2 times as likely as right-sided clefts (Genisca et al, 2009). Interestingly, the laterality of cleft has some clinical significance in that right-sided cleft appears to be uniquely associated with other types of malformations and intellectual disability, suggesting a distinct etiology from either the left-sided or both-sided clefts (Gallagher et al, 2018). Our data show that whatever factor or multitude of factors that are responsible for causing clefts to be on one side or the other are well conserved throughout geographic regions.…”

Neurodevelopmental and Academic Outcomes in Children With Orofacial Clefts: A Systematic Review

“…Hypothesized mechanisms include functional consequences of oral clefting (eg, feeding difficulty, eustachian tube dysfunction, or speech impairment), treatment factors (eg, frequent school absences 7 ), repeated anesthesia exposures [8][9][10][11] ), and social stigma (eg, differential treatment based on appearance or speech and/or voice quality). Researchers also suggest that patients with OFCs may have structural brain differences [12][13][14] and differences in outcome depending on cleft laterality, 15,16 implying that a cleft might be a marker for aberrant brain development.…”