Magnus Becker

Academic achievement in individuals with cleft: a population-based register study.

Objective The focus of this study was to determine whether there were any significant differences in academic achievement between students with a cleft and the general population of Swedish students at the typical time of graduation from compulsory school (usually 16 years of age). Design A retrospective population-based study. Data were obtained from the Swedish Medical Birth Register for the years 1973 through 1986 and were linked to the Swedish School–Grade Register. Participants A total of 511 individuals with cleft palate (CP), 651 individuals with cleft lip (CL), and 830 individuals with cleft lip and palate (CLP) were compared with a control group consisting of 1,249,404 individuals. Main Outcome Measures (1) Not receiving school leaving certificate; (2) odds of receiving lowest grade and reduced odds of receiving a high grade in the following subjects: (a) Mathematics, (b) English, (c) Swedish, (d) Physical Education, and (e) grade point average (GPA). Results The group with cleft had higher odds of not receiving leaving certificates in comparison with the general population. They also had higher odds of receiving the lowest grade and/or reduced odds of receiving a high grade in the subjects analyzed together, with strong evidence of lower GPA in comparison with the general population. Individuals with CP were affected the most, followed by individuals with CLP; least affected were individuals with CL. Conclusion This study clearly indicates that adolescents with cleft lip and/or palate in Sweden experience significant deficits in their educational achievements in compulsory school.

Birth weight, body length, and cranial circumference in newborns with cleft lip or palate

OBJECTIVE This paper reports on birth weight, body length, body mass index, and cranial circumference at birth of infants with cleft lip and/or palate born between 1973 and 1992. METHODS Data were obtained from two nationwide Swedish health registries. Infants with syndromes, twins, and infants with immigrant parentage were excluded from the study. Comparisons were made with all singleton births with the same exclusion criteria (n = 2,031,140). RESULTS The body dimensions of infants with isolated cleft lip (n = 865) were found not to differ from those of control subjects, but infants with isolated cleft palate (n = 811) or cleft lip and palate (n = 1139) were found to be lighter and shorter than control subjects. Also, infants with the Pierre Robin sequence (n = 121) had a tendency to be lighter and shorter than control subjects, but these differences did not reach statistical significance despite the large study population.

Otitis media and feeding with breast milk of children with cleft palate

The purpose of the present study was to analyse the incidence of acute and secretory otitis media (OM), and feeding with breast milk, and the use of a grommet in children with a cleft palate (CP/CLP) or cleft lip (CL), compared with controls. A total of 84 children between 6 and 10 years of age were studied. The CP/CLP group consisted of 48 children with an isolated cleft palate ( n = 28), or a cleft lip and palate ( n = 20). The CL group consisted of 15 children with an isolated cleft lip. The controls were 21 children without clefts. Children with CP/CLP had acute OM significantly more often than children without clefts (43/48 compared with 10/21), and secretory OM (40/48 compared with 4/21), despite the use of grommets. CP/CLP children were breast fed for a mean of 2.8 months (range 0-13), compared with 3.6 months (0-12) for CL, and 7.5 (0-24) months for controls. There was a significant correlation during the first 18 months of life between longer duration of feeding with breast milk and a lower incidence of acute and secretory OM in the three study groups combined. The incidence of otitis media was not affected by care in a day centre, having a sibling attending a day care centre, or by the familys medical history. Despite cleft repair and early treatment with grommets, both secretory and acute OM are common among children with cleft palate, presumably as a result of their eustachian tube dysfunction. The present study suggests that premature cessation of feeding with breast milk may contribute to an increased incidence of acute and secretory OM.

Von Langenbeck or Wardill procedures for primary palatal repair in patients with isolated cleft palate--speech results

Sixty-six patients operated on for isolated cleft palate were evaluated as adults, and their speech was assessed clinically. Forty-four had undergone a von Langenbeck repair at the age of 7 months and 22 a Wardill repair at the age of 18 months. Speech was judged subjectively by the patients themselves, and perceptual assessment was made by three speech pathologists. The remaining speech problems, mainly hypernasality, were moderate or severe in 7 (16%) of the patients in the von Langenbeck group, and in 7 (32%) in the Wardill group. On the other hand, the patients in the Wardill group had fewer fistulas closed, and fewer velopharyngoplasties. There were no significant differences between the two methods regarding speech in adulthood. The Wardill method produced significantly more scar tissue clinically, which carries the potential risk of inhibition of facial growth. The present speech results will therefore be weighed against the outcome of maxillofacial growth for these patients.Sixty-six patients operated on for isolated cleft palate were evaluated as adults, and their speech was assessed clinically. Forty-four had undergone a von Langenbeck repair at the age of 7 months and 22 a Wardill repair at the age of 18 months. Speech was judged subjectively by the patients themselves, and perceptual assessment was made by three speech pathologists. The remaining speech problems, mainly hypernasality, were moderate or severe in 7 (16%) of the patients in the von Langenbeck group, and in 7 (32%) in the Wardill group. On the other hand, the patients in the Wardill group had fewer fistulas closed, and fewer velopharyngoplasties. There were no significant differences between the two methods regarding speech in adulthood. The Wardill method produced significantly more scar tissue clinically, which carries the potential risk of inhibition of facial growth. The present speech results will therefore be weighed against the outcome of maxillofacial growth for these patients.

Adopted children with cleft lip or palate, or both, require special needs cleft surgery.

Abstract In recent years adoption of children with cleft lip, with or without cleft palate (CLP), and other birth defects has become more common. The aim of the present study was to describe the characteristics and initial care and treatment of adopted children with CLP. A total of 25 children were referred to our department between 2008 and 2010, 7 (28%) of whom had bilateral CLP and 16 (64%) had unilateral CLP. Two children had atypical clefts. Twenty of the patients (80%) had been operated on with a lip plasty in China before adoption. Most patients (n = 14) was seen by the cleft team within two months of arrival, and 13 were operated on within a month of the first visit at our department. In total, 22 primary palatoplasties, 6 lip plasties, and 1 lip adhesion were done. There were 5 fistulas (14%) three months after the palatoplasty. On arrival, 11 (44%) of the children were carriers of methicillin-resistant Staphylococcus aureus (MRSA). Adoption of children with CLP creates new challenges for the cleft teams, as we no longer have control over the overall treatment plan as regards preoperative and surgical treatment and timing of the operations. The patients are also often carriers of resistant bacteria, which create nursing challenges. In cases where the child is older than a year and has not been operated on, we advocate that the palatoplasty, or combined lip plasty and palatoplasty, is always given priority so that speech development is not compromised.

Low rate of fistula formation after Sommerlad palatoplasty with or without lateral incisions: An analysis of risk factors for formation of fistulas after palatoplasty.

The aim of palate repair is to restore normal eating and drinking function and normal speech development and still maintain undisturbed facial growth. The repair should be performed with a low frequency of complications. A number of factors are thought to contribute to the formation of fistulas after palatoplasty; they include patient factors and treatment issues. The aim of this study was to review all patients operated on with palatoplasties according to Sommerlad in our clinic, examine the fistula frequency and analyse risk factors for the development of fistulas after palate repair. During the study period, 175 patients were operated on with palatoplasties according to Sommerlad by the senior cleft surgeon. The group included 150 native patients and 25 adopted children. In the native population, seven patients developed fistulas and the fistula frequency was thus 5%. In the non-native group four patients developed fistulas, which gave a fistula frequency of 16%. In conclusion, the fistula frequency after Sommerlad repair of cleft palate is low in our material and few patients need fistula repair. The liberal usage of Langenbeck flaps might give a lower fistula rate. The most common place for fistulas is the junction of the soft and hard palate. No clear difference could be seen between different types of clefts. Syndromes and associated malformation seem to play a small role in the formation of fistulas. The fistula frequency in the non-native population is higher. A number of factors are different in the non-native population.

Analysis of complications after repair of hypospadias

We have reviewed 184 patients after repair of primary hypospadias. They were operated on and followed-up according to a standard protocol, and the senior author (HS) participated in all operations. The patients were reconstructed using a Byars two-stage procedure (n=102) or a Scuderi (n=29) or Mathieu (n=41) single-stage procedure. The rest (n=12) just had a removal of the chordee with realignment of the skin. Complications recorded were haematomas, postoperative infections, malfunction of catheter, urinary retention, fistulas, and strictures. Thirty-eight complications developed in 26 patients and the overall incidence of fistula was 22 in 18 patients (10%). Our findings suggest that the most decisive risk factor for complications is the severity of the primary malformation, because a severe malformation per se is difficult to treat as it requires a long reconstruction; in addition the curvature, shortage of tissue, and extensive surgery generally require a staged reconstruction in these cases. Other factors seem to be of much lesser importance.

Clinical Examination Compared with Morphometry of Digital Photographs for Evaluation of Repaired Cleft Lips

Twenty-four adult patients who had been operated on as infants for isolated cleft lip underwent clinical examination combined with photographic documentation using a digital camera. The same predetermined protocol comprising 20 variables describing nasolabial appearance was used for both the clinical examination and the computerised evaluation of the images. The correlation between the two methods is described in the present study. The results obtained with the two methods agreed closely. For metric variables the mean coefficient of correlation was 0.73 and when all measurements were combined, it reached 0.98. Likewise, discrete variables showed a close correlation, with a mean kappa value of 0.72. Variables related to muscular dynamics of the lip can for obvious reasons not be judged from photographs. However, the computerised photographic evaluation was able to detect more precisely even minor angular deviations of the nose and to measure areas such as the areas of the nostrils. We conclude that morphometry of digital photographs is a new valuable clinical tool for the assessment of the nasolabial appearance in patients with cleft lip and palate.

Speech results in adult Swedish patients born with unilateral complete cleft lip and palate.

Sixty-one adult patients (34 men and 27 women) who were operated on for unilateral complete cleft lip and palate (UCLP) were followed up from 1996–2001 by clinical investigation, perceptual speech analysis, and self-estimation of quality of speech. Thirty-four had had a von Langenbeck repair at the age of 8 months (L-8 group), and 27 a Wardill repair at the age of 18 months (W-18 group). Statistical comparisons were made by univariate and multiple logistic regression analyses. The L-8 group had a slightly better general outcome but at the expense of a greater incidence of velopharyngeal flaps. There was no significant difference in hypernasality, being 7/34 (21%) of the patients in the L-8 group, compared with 9/27 (33%) in the W-18 group. Compared with findings reported previously of patients with isolated cleft palate (CP) who were treated and investigated under the same circumstances, the speech outcome in the group with UCLP was found to be significantly better.

General intellectual capacity of young men with cleft lip with or without cleft palate and cleft palate alone

We report on the general intellectual capacity of men around 17–19 years of age and with cleft lip either with or without cleft palate (CLP) or cleft palate alone. Data were obtained from the Swedish National Service enrolment register for the years 1991–1997, about 335 individuals with CLP and 88 with cleft palate alone, who were compared with a control group consisting of 272 879 people. Those with CLP showed no significant differences compared with the control group. The group with cleft palate alone had significantly lower general intellectual scores than the control group.