Incidence and Distribution of Cleft Lip and Palate and Its Correlating Factors among Madhya Pradesh Population
1Dr Rishi Thukral, 2Dr Narendra Singh Patel, 3Dr. Animesh Barodiya, 4Dr Shikhar Pratap Chauhan, 5Dr Sanad Kumar Singh Solanki, 6Dr Thiyam Nickychandra Singh
1Assistant Professor, Department Of Dentistry, Atal Bihari Vajpayee Government Medical College, Vidisha ( M.P.)
2Assistant Professor, Department of Forensic Medicine, Atal Bihari Vajpayee Government Medical College, Vidisha ( M.P.)
3Reader, Department Of OMFS, Gurugovind Singh Dental College, Burhanpur
4Assistant Professor, Department of Pediatric & Preventive Dentistry, Government College of Dentistry, Indore
5BDS, MDS, Orthodontics
6 BDS, MDS, Orthodontics Corresponding Author: Dr Animesh Barodiya
Abstract: The aim of this prospective study is to ascertain the prevalence of cleft lip and palate in the populations of Madhya Pradesh. It also illustrates several embryological aspects and hypotheses that aid in the correlation and understanding of congenital anomaly occurrence. This prospective research included 1000 patients with cleft lip and palate deformities, and the incidences and types of occurrence trends were statistically analyzed. Males have a higher incidence of Cleft lip and palate (51.9%), whereas females have a higher incidence of Cleft palate (48.1%).
Keywords: Philtrum, Congenital, Clefting, Teratogenic drugs.
Introduction: The most commonly observed congenital craniofacial abnormality is cleft of the upper lip and palate, which occurs in 1 out of every 700 births. Despite the fact that inheritance may play a significant role, cleft lip and palate is a multifactorial etiology with possible contributing factors such as chemical exposures, radiation, maternal hypoxia, teratogenic drugs, nutritional deficiencies, especially folic acid, physical obstruction, or genetic influences.
According to one popular theory, clefting occurs when multiple etiological factors combine to lift one person above the point where the fusion mechanism fails.1
Congenital deformities, such as orofacial clefts, appear at birth. Orofacial clefts form as a result of any disruption in the embryological formation, development, and growth of the orofacial zone.
There is no clear statistical study in terms of statistics relating to the incidence of cleft lip and palate in most of Indian population, but international figures are available. According to Fogh and Anderson 1942 (Denmark), the rate of cleft 1 occurrence is 1:760, according to R.H. Ivy (1963) from the state of Pennsylvania, USA.1
The incidence of cleft lip and palate in the regional population was recorded to be 1:639 in an India survey conducted at Vellore. It is now widely recognized that unilateral clefts (75%) are more frequent than bilateral clefts in cases ofprealveolar clefts (25 %). Left sided prealveolar clefts are more common than right sided clefts in unilateral prealveolar clefts. Cleft lips and palates are linked to congenital deformities in other parts of the body in around 3 to 5% of cases.
Clefts of the lip and palate account for half of all deformities. Bilateral relationships account for around a quarter of all relationships.
The aim of this study is to determine the incidences, occurrences, and distribution patterns of cleft lip and palate cases. This prospective research entails randomly selecting 1000 cases from the Madhya Pradesh populations and categorizing them according to a standard classification system,1 with the aim of evaluating the anatomical position specification and the percentage of subjects with cleft lip and palate.
Embryology:
Interaction and fusion between the maxillary processes and the median nasal process is common during the development of cleft lip and palate. The inability of LNP to make contact with MNP is the most serious issue. In the early stages of cleft, the MXP-MNP fusion remains intact, but it ruptures in 90% of cases later. The inability of the palatine shelves to fuse together causes clefts in the secondary palate. The middle portion of the nose, the philtrum (middle portion of upper lip), the middle portion of the premaxilla (four incisors), and the entire primary palate are all formed by the Medial Nasal Process. The ala of the nose is formed by the Lateral Nasal Process.The nasal septum is created by frontal prominences and is continuous with the premaxillary portion. Thus, the maxillary phase – MXP + MNP >> upper lip, 2MNP'S + 2 MXP'S
>> cheek, maxilla, zygoma, and secondary palate.
Two theories-
1. Dursy-His Theory (1931): put forth the idea that different facial processes failed to fuse. In fact, it sounded like a very plausible theory for explaining the development of different degrees of unilateral and bilateral clefts, as well as the uncommon midline upper and lower clefts. The existence of Simonart's band in an incomplete cleft lip was clarified by this. The term process refers to tissue projections that resemble fingers, while fusion implies that the projections meet, their epithelial walls vanish, and they develop together.
This has now been shown to be untrue. It is recognized that the issue is not one of processes, but rather one of localized prominence.
2. Theory of failure of mesodermal migration: Cleft palate, according to Fleischmann (1910) is the halting of the absence of the epithelial membrane, which remains intact and unpierced by the neighboring mesoderm. Victor Veau (1935) embraced this idea, which was backed up by Stark (1954). According to the mesodermal theory, the penetration of mesoderm causes a rise in the size of facial prominences as the oral and nasal cavities deepen.The bulging increases as more mesoderm reaches the region, transforming what was once a tissue wall with ectoderm on one side and endoderm on the other into prominences and grooves, depending on the amount of mesoderm between the two epithelial layers. The persistence of a groove is caused by a lack of proper mesoderm migration into a specific region. The persistent groove gives way to an existing cleft as a result of epithelial breakdown. This is the most widely held belief.
Aim of the study: To ascertain the prevalence of cleft lip and palate in the populations of Madhya Pradesh.
Methodology-
Data of cleft lip and palate patients is collected from different cleft lip and palate centers of Madhya Pradesh. The data was divided into three categories: cleft lip, cleft lip and palate, and
cleft palate alone. They were also subcategorized as
unilateral/bilateral/left/right/complete/incomplete. The total sample size chosen was 1000 people, with males accounting for 51.9 % and females for 48.1%.
The Chi-Square test was used to assess the goodness of fit of the observed data to the predicted data of occurrences, and the results are presented in table 1.
Results:
1. 291 patients out of 1000 were found to have cleft lip, accounting for 29.1% of all cases.
Unilateral cases accounted for 24.3 %, while bilateral cases accounted for 4.8 %. We divided the data into two categories in this study: site prevalences and sex prevalences.
2. Out of 1000 subjects, 53.1% had cleft lip and palate. Unilateral full cases accounted for the most patients (38%), with the right side accounting for 9.8% of the total and the left side accounting for 282 subjects. Incomplete cases accounted for 0.2 % of subjects on the right side and 1.9 % on the left. In this report, a total of 112 bilateral cases were identified, with complete and incomplete cases accounting for 10.2% and 1%, respectively.
3. Cleft palate affects 17.8% of the population, with 172 full cases recorded, with males accounting for 8.7% and females accounting for 8.5 %. Further investigation revealed that full cleft palate cases were more numerous, while incomplete palate cases constituted six subjects, with males accounting for one and females accounting for five. According to the literature, incomplete cleft palate cases are an uncommon occurrence.
The prevalence of Cleft lip and palate is 15.4 %, according to the above results.
The comparable incidences of cleft lip and palate cases account for 15.4 % of all cases, with male unilateral cleft lip accounting for 12.7 %, CLP- 20.8 %, CP- 8.8%, B/L, CL- 2.8 %, CLP -5.9 %.
According to a female population results, unilateral cleft lip accounted for 11.6 %, cleft lip and palate accounted for 20.2 %, and cleft palate accounted for 9%, while bilateral cases accounted for cleft lip 2% and cleft lip and palate 5.3 %.
Table 1: Chi-square results of the observed data to expected data of occurrences
Figure 1: Distribution of cleft lip among study subjects
Figure 2: Distribution of cleft lip and palate among study subjects
Figure 3: Distribution of cleft palate among study subjects
Discussion:
According to the study, cleft lip and palate cases affect 51.9 % of male subjects and 48.1 % of female subjects in Madhya Pradesh. Cleft lip malformation is more common in males, while cleft palate in females, with 29.1 % of 1000 subjects having unilateral cases and 24.3 % having bilateral cases.Cleft lip and palate affects 53.1 % of 1000 people, with the right side accounting for 3.8 % of cases and the left side accounting for 9.8 %. Incomplete cleft lip and palate cases were the least common, accounting for 0.2 % to 1.9 % of all cases. Cleft palates were found in 17.8% of 1000 subjects, with males accounting for 8.7% and females accounting for 8.5 %. There were no significant variations in the prevalence of cleft palates between males and females.
Conclusion:
The cases of cleft lip and palate continue to be a problem for humanity. Due to its multifactorial etiologies, precise factor identification is difficult. Based on the findings of the above study, it can be concluded that various forms of cleft abnormalities and their positions can occur in subjects of both sexes in various anatomical locations. Each form of cleft anomaly has its own distinct clinical feature that the clinician should be able to recognize and adjust the treatment plan accordingly.Despite the fact that treatment for a cleft lip and palate can take several years and require several phases of surgical intervention based on the severity of the disorder, most people
References:
1. M MTolarova, Cervenka J- classification and birth prevalence oforofacial clefts. J Craniofacial Surgery 32:7,423-427: 1998.
2. L Capelozza, SM Tanigchi – The craniofacial morphology of adultunoperated cleft lip and palate . J Craniofacial Surgery – 30:4,376-381,1993.
3. J Milerad, O Larson, C Hagberg – Associated malformations in infantswith cleft lip and palate a prospective population based study.JPaediatrics 100;2, 180-186, 1997.
4. LG Farkas, K Hajnis, JC Posnik – Anthromometric and anthroposcopicfindings of the nasal and facial region in cleft patients before and afterlip repair.J Craniofacial Surg 30;1- 12, 1993.
5. JC Murray – Clinical Genetics, Gene and environmental causes of cleftlip and palate.Wiley Online Library -2002