Distribution and risk factors of cleft lip and palate on patients from a sample of Damascus hospitals - A case-control study

Abstract

This case-control study was conducted to determine the distribution of cleft lip and/or palate, its association with family history, syndromes and serous otitis media (SOM), and its relation with several risk factors. Methods: The case group comprised of 133 children born with cleft lip and/or palate, and the control was 133 noncleft children born full-term. Data was collected including age, gender, origin and risk factors for cleft lip and palate from patients' files, interviewing supervising doctors, and the patient. Data was then filled out into Excel and underwent statistical analysis using the Goodness of Fit Test and Chi-Square to determine the significance of the results. Results: Cleft lip and/or palate (CL/P) was slightly higher among males (51.9%). Combined cleft lip and palate (CLP) was the most common presentation (42.1%). Cleft lips (CL) were mostly complete cleft (51,5%) incomplete cleft comprised (41.1%), In the sample 35.4% of the cases were bilateral, 32.3% were right unilateral, 28.3% were left unilateral and 4% were median cleft. Cleft palate (CP) was mostly complete (46.6%) there were incomplete clefts (40%), and the remainder were submucosal (13.4%). Isolated CL and combined CLP were higher in males (51.6%, 62.5% respectively). Both isolated CP and Tessier anomaly were more common in females (64.7% and 58.3% respectively). consanguineous marriages accounted for 36.1% of cases. 21.8% of the sample had a firstdegree relative and 24.8% had a second degree relative born with CL/P. There were only 7 cases (0.05%) of syndromic CL/P: Down's (4), Pierre Robin's (2), and Van der Woude Syndrome (1). A relationship was found between CL/P and the risk factors: taking anticonvulsants (without specifying the drug) (p ¼ 0.025, OR ¼ 10.73 C.I. 95%), taking retinoic acid (p-value ¼ 0.049, OR ¼ 4.75 C.I. 95%), not consuming folic acid (p-value ¼ 0.00, OR ¼ 28.23 C.I. 95%), and smoking cigarettes (p-value ¼ 0.046, OR ¼ 2.00 C.I. 95%). There was no relationship with maternal alcohol consumption or maternal diabetes (p-values ¼ 0.652 and 0.210, respectively). SOM was present in 63.2% of patients with CL/P and were mostly isolated CP. Conclusion: CL/P was only slightly higher among males. The most common condition was CLP. There was higher incidence of CL/P among second-degree relatives than first degree. Down's, Pierre Robin's, and Van der Woude Syndromes may be associated with CL/P. Taking anticonvulsants, taking retinoic acid, not consuming folic acid, and smoking cigarettes all have a role in the incidence of CL/P. More than half of the sample had an associated SOM.

Epidemiological and Spatiotemporal Descriptive Analysis of Patients with Nonsyndromic Cleft Lip and/or Palate: A 12‐Year Retrospective Study in Southern Iran

“…However, the predominance of CP in our study was similar to the study conducted in northwest Iran (41%) [ 21 ], and the frequency of CLP in our study was also similar to other studies in southwestern (45.4%) [ 19 ] and northeast (50%) [ 20 ] of Iran. Additionally, our results are consistent with the studies in Syria [ 14 ] and Japan [ 37 ]. It seems that environmental factors play a critical role in the differences between the various studies [ 38 ] and different regions in our study.…”

“…Nonsyndromic CL/P comprises ~70% of the cases and is considered to be a multifactorial disorder caused by the interaction of environmental and genetic factors [ 12 , 13 ]. However, due to ethnic or regional variances, the precise cause of the nonsyndromic type is still not entirely understood [ 14 ]. Since their treatment involves intricate and multidisciplinary approaches, preventive measures through the identification of environmental risk factors are of the utmost importance [ 15 ].…”

Modifiable Risk Factors of Non-Syndromic Orofacial Clefts: A Systematic Review

“…According to most studies, the intake of folic acid or multivitamins containing folate at almost 400 mcg/day is mandatory to reduce the risk of neural tube defects and NSCL/P, not only in the first 3 months of pregnancy [ 33 , 46 ] but also during the periconceptional periods (from the time of conception to 12 weeks after conception) [ 48 ]. In other words, failing to take vitamins increases the risk of CL/P but not of CP [ 34 , 76 ]. This data may support the hypothesis that CL/P and CP appear to be genetically and embryologically distinct entities.…”

“…Finally, other drugs associated with OFCs are reported in the most recent literature, namely anticonvulsants, retinoic acid, analgesics, benzodiazepines, antidepressants, stimulants, and anti-hypertensive drugs, and drugs containing iron and folate [ 31 , 34 , 53 ].…”

“…Besides data confirming the role of genetics in the aetiology of OFCs, scientific studies and epidemiological data show that environmental risk factors (e.g., smoking, alcohol and malnutrition in pregnancy, viral infections, teratogenic pharmacological agents, folate deficiency, weight) intervene significantly in the complex embryological development determining malformation [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”