Iyad K. Al-Omari

Methods of assessment of cleft-related facial deformity: A review

Objective To review the stimulus media, measurements and scoring system, raters characteristics, and facial region used in assessment of the appearance of cleft-related deformity. Methods A review of the literature was conducted using MedLine from January 1966 to June 2003. Key orthodontic journals and The Cleft Palate–Craniofacial Journal were hand searched as well. Results Most studies used a static two-dimensional means of assessment. Direct clinical assessment, three-dimensional media, or both have been used to a lesser extent. Only one study utilized all three assessment media. Three studies, however, attempted to compare the direct clinical assessment with that obtained using two-dimensional media. Most of the studies demonstrated that appearance of the cleft-related deformity could be measured by a variety of judges. The reliability and validity of the three different media as methods of assessment have received limited attention. The facial area assessed has varied from the full face, nasolabial area, or specific features of the lip or nose. Conclusions Wide variation exists in the study design related to assessment of cleft-related deformity. An internationally agreed objective method of assessment for this facial deformity is required. A three-dimensional, rather than a two-dimensional, means of assessment should be adopted.

An appraisal of three methods of rating facial deformity in patients with repaired complete unilateral cleft lip and palate.

OBJECTIVES To evaluate the reliability of clinical assessment, two-dimensional color transparencies and three-dimensional imaging for evaluating the residual facial deformity in patients with repaired complete unilateral cleft lip and palate (UCLP) and compare the ratings of facial deformity made by health care professionals with those made by lay assessors. PATIENTS AND PARTICIPANTS Thirty-one randomly selected subjects aged 10 to 30 years with repaired complete UCLP. Five professionals and five laypersons evaluated each subjects residual cleft-related facial deformity using clinical assessment, two-dimensional color transparencies, and three-dimensional images. MAIN OUTCOME MEASURES The facial deformity of the full face, lip, nose, and midface were scored using a 5-point ordinal scale on two occasions with a 1-month interval. Intra- and interexaminer agreements were calculated from weighted kappa statistics. Bootstrap permutation tests were used to detect any differences in agreement. RESULTS Assessment of facial deformity showed good reproducibility across the three assessment media (kappa = 0.42 to 0.83, SE 0.08). Clinical assessment among lay assessors, however, was poor to moderate (kappa = 0.16 to 0.58, SE 0.07). For all assessors, there was no difference in the two nonclinical media relative to the standard clinical assessment for assessments of the full face (p =.377). For assessments of the lip or nose, transparency scores were in greater agreement with the clinical scores than were the three-dimensional assessment scores (p =.017 and.011, respectively). For rating the midface, the three-dimensional scores were in greater agreement with the clinical scores than were the color transparencies scores (p =.047). CONCLUSIONS In comparison with lay assessors, clinical assessment among professionals was more reproducible. This was not so for nonclinical media. The equivalence of using the color transparencies and three-dimensional media relative to the clinical assessment depends on the region of the face being considered.

CLEFT LIP AND PALATE IN JORDAN: BIRTH PREVALENCE RATE

Objective and Design A retrospective investigation was conducted to determine the prevalence rate of Jordanian children born with oral clefts from 1991 to 2001. Setting Hospital surgical records from two main sources were used to identify all children born with orofacial clefting. Information about date of birth, sex, cleft types, and associated major anomalies and syndromes were recorded. Results The overall prevalence rate for live births with cleft lip, cleft palate, or both was 1.39 per 1000 live births. Thirty percent of the clefts identified affected the lip, 22 percent affected the palate, and 48 percent involved the clefts of the lip and palate. In general, higher prevalence rates were found for boys than girls (55% boys versus 45% girls). There was a statistically significant sex difference between the cleft types. Clefts of the isolated palate, however, were more common in girls. Eighteen percent of patients with cleft were associated with major anomalies or syndromes. Conclusions The reported prevalence rate for orofacial clefts among Jordanians is similar to the previously reported prevalence rate in white Caucasians. Results and future recommendations are discussed.

Tooth size discrepancies among Jordanian schoolchildren

The aims of this study were to determine the tooth size discrepancies (TSD) in a representative sample of Jordanian schoolchildren and to compare TSD between genders. Dental casts of 367 (174 males and 193 females; mean age 15.5 years) Jordanian schoolchildren were selected. Anterior and overall Bolton ratios were determined using a digital calliper. Differences between genders were analyzed using a t-test. The results showed that there were no significant differences in the TSD between males and females. The percentages of subjects with more than 2 standard deviations for the anterior and overall ratios were 23.7 and 9.5, respectively.

A comparison of health-related quality of life between Jordanian and British orthognathic patients

The aim of this study was to assess health-related quality of life (HRQoL) in adult Jordanian patients referred for orthognathic treatment, and to compare this with previously published data from a British cohort. Thirty-eight Jordanians (21 females and 17 males; aged 16-31 years) who were about to commence a course of orthognathic treatment completed a generic HRQoL questionnaire [Short-Form 36 (SF-36)] and a condition-specific orthognathic quality-of-life questionnaire (OQoLQ). The questionnaires were completed prior to commencing any pre-surgical orthodontic treatment. The data were compared using the Mann-Whitney U-test for independent groups with non-normally distributed data. There were no statistically significant differences between the Jordanian males and females for any of the OQoLQ or SF-36 items; hence, the groups were combined for analysis. When comparing the OQoL data with that of the British sample, there was no statistically significant differences for three of the four domains: dentofacial aesthetics (P = 0.726), social aspects (P = 0.096), or the awareness of dentofacial aesthetics (P = 0.066). There was, however, a significant difference for oral function (P = 0.016), with the Jordanian group reporting a poorer quality of life (QoL) (mean value 10.9) than the British cohort (mean value 8.4). However, it is questionable whether this difference would be of clinical relevance. While it was not possible to directly compare the results of the SF-36 questionnaires with the same British cohort, Jordanian patients had generally lower scores, and therefore a poorer QoL, than reported in other studies. These differences may be cultural or may be due to differences in the health care systems criteria for funding, and this needs further investigation.

Oral Candida colonization in patients with fixed orthodontic appliances: The importance of some nutritional and salivary factors

We investigated the relationship between fixed orthodontic appliances and oral Candida colonization. The influence of some important nutritional and salivary factors was also investigated. These factors included: hemoglobin, vitamin B12, ferritin and folate levels, salivary flow rate, salivary pH, tobacco smoking and dietary habits. Patients enrolled in this study were adolescent patients aged 12-18 years who attended the Orthodontics Department/University of Jordan Hospital for the provision of fixed metallic orthodontic appliances. Salivary samples were collected on the first visit prior to bonding, one month and four months later. All patients were investigated for serum vitamin B12, serum ferritin, red-cell folate, complete blood count, salivary pH, and salivary flow rate. Data were obtained from the patients regarding tobacco smoking and dietary habits. We found that Candida colonization did not increase after bonding of fixed orthodontic appliances. None of the local oral factors investigated was correlated with Candida colonization. Only two systemic factors (serum vitamin B12 and red-cell folate) were significantly (P<0.05) associated with Candida colonization during the study period. It was obvious that metallic fixed orthodontic appliances did not encourage oral Candida colonization during the four months study period. On the other hand, it seems that nutritional factors like serum vitamin B12 and red-cell folate can influence oral Candida colonization more than tobacco smoking, dietary and salivary factors. Key words: