Journal of Postgraduate Medicine, Education and Research

Register      Login

VOLUME 56 , ISSUE 1 ( January-March, 2022 ) > List of Articles

Original Article

Epidemiology of Cleft Lip and Palate among Infants Born in Chandigarh

Dara Singh, Satinder P Singh, Ashok Utreja, Ashok Jena, Sanjeev Verma, Raj K Verma

Keywords : Cleft lip and palate, Epidemiology, Incidence

Citation Information : Singh D, Singh S P, Utreja A, Jena A, Verma S, Verma RK. Epidemiology of Cleft Lip and Palate among Infants Born in Chandigarh. J Postgrad Med Edu Res 2022; 56 (1):13-20.

DOI: 10.5005/jp-journals-10028-1550

License: CC BY-NC 4.0

Published Online: 19-02-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim and objective: To determine the incidence of cleft deformity in Chandigarh by monitoring the total live births occurring at different birth facilities. Materials and methods: This cross-sectional study was carried out at all birth facilities of UT, Chandigarh during the period between 1st January 2009 and 31st December 2010. Total 35 birth facilities, 6 government hospitals, and 29 private nursing homes were included in the study. This epidemiological study was based on monitoring of all the live births and recorded the incidence of type of cleft deformity, associated congenital malformations, birth order, family history, detection, and diagnosis with ultrasonography and folic acid intake during pregnancy. Results: Forty eight babies with different types of cleft deformities were born with an incidence of 0.97/1,000 live births. Group- 1, group- 1(A), group- 2, and group- 3 (as per Balakrishnan classification) and miscellaneous group included eight (16.66%), 10 (20.84%), 13 (27.08%), 14 (29.16%) newborns, and three (6.26%) newborns (one with subcutaneous cleft and palate while two with midline cleft deformity of face), respectively. The frequency of cleft deformity was significantly more among males except isolated cleft palate group which showed equal distribution. About 15 (46.87%) newborns had cleft deformity on left side, 10 (31.25%) on right side while seven (21.87%) had bilateral cleft deformity. The overall percentage of subjects of cleft with associated major anomalies or syndromes was 22%. Conclusion: The incidence of cleft deformity in Chandigarh region was found to be 0.97/1,000 live births. The frequency of cleft deformity was more among males as compared to females except isolated cleft palate group which showed equal distribution. The laterality of the cleft deformity was more on left side followed by right side and then bilateral. Improved training to radiologists and gynecologists could increase the detection rates of orofacial clefts during pregnancy.


HTML PDF Share
  1. Gorlin RJ, Cervenka J, Hannekam R: Syndromes of head and neck, 4th edition. New York, Oxford: Oxford University Press; 2001.
  2. Tolarova MM, Mosby T, Pastor L, et al. Prevention of cleft lip and palate–the plan of today, the goal for the future. Paper no. 114, 2nd World Cleft Congress, Munich; 2002 September 15–19.
  3. Wyszynski DF. Cleft lip and palate: From origin to treatment. Oxford: Oxford University Press; 2002. p. 548.
  4. Felix-Schollaert B, Prahl-Andersen B, Puyenbroek JI, et al. De incidentie van cheilognathopalatoschisis in Nederland. Tijdschr Kindergeneeskd 1986;54(3):90–95.
  5. Calzolari E, Milan M, Cavazzuti GB, et al. Epidemiological and genetic study of 200 cases of oral cleft in Emilia Romagna region of Northern Italy. Teratology 1988;38(6):559–564. DOI: 10.1002/tera.1420380603
  6. Stoll C, Alembik Y, Dott B, et al. Epidemiological and genetic study in 207 cases of oral clefts in Alsace, north-eastern France. J Med Genet 1991;28(5):325–329. DOI: 10.1136/jmg.28.5.325
  7. Fogh-Andersen P. Inheritance of hare lip and cleft palate. Copenhagen: Nyt Nordisk Forlag; 1942.
  8. Jensen BL, Kreiborg S, Dahl E, et al. Cleft lip and palate in Denmark, 1976–1981: epidemiology, variability, and early somatic development. Cleft Palate J 1988;25(3):258–269.
  9. Moller P. Cleft lip and palate. An epidemiologic and genetic study of cleft lip and palate in Iceland. Arch Oral Biol 1965;10:407–420.
  10. Abyholm FE. Cleft lip and palate in Norway. Plast Reconstr Surg 1978;12(1):29–43. DOI: 10.3109/0284431780901047
  11. Rintal A, Stegar T. Increasing incidence of clefts in Finland: reliability of hospital records and central register of congenital malformations. Scand J Plast Reconstr Surg 1982;16(1):35–40. DOI: 10.3109/02844318209006568
  12. Hagberg C, Larson O, Milerad J. Incidence of cleft lip and palate and risk of additional malformations. Cleft Palate-Craniofac J 1997;35(1):40–45. DOI: 10.1597/1545-1569_1998_035_0040_ioclap_2.3.co_2
  13. Coupland MA, Coupland AI. Seasonality, incidence, and sex distribution of cleft lip and palate births in trent region, 1973–1982. Cleft Palate J 1988;25(1):33–37.
  14. Singh M, Jawadi M H, Arya L S, et al. Congenital malformations at birth among live-born infants in Afghanistan – a prospective study. Ind J Pediat 1982; 49(398):331–335. DOI: 10.1007/BF02834416
  15. Jakobsen PL. Occurrence of cleft lip and palate in Faroe islands and Greenland from 1950 to 1999. Cleft Palate-Craniofac J 2003;40(4): 426–430. DOI: 10.1597/1545-1569_2003_040_0426_ooclap_2.0.co_2
  16. Mestrovic MM, Bagatin M. An epidemiological study of orofacial clefts in Croatia 1988–1998. J Cranio–Maxillofac Surg 2005;33(2):85–90. DOI: 10.1016/j.jcms.2005.01.002
  17. Cooper ME, Ratay JS, Marazita ML. Asian oral-facial cleft birth prevalence. Cleft Palate-Craniofac J 2006;43(5):580–589. DOI: 10.1597/05-167
  18. Singh M, Sharma NK. Spectrum of congenital malformation in newborn. Ind J Pediat 1980;47:239–244. DOI: 10.1007/BF02758201
  19. Saifullah S, Chandra RK, Pathak IC, et al. Congenital malformation in newborn: a prospective longitudinal study. A preliminary report on 1000 consecutive births. Ind Pediat 1967;4(6):251–261.
  20. Ghosh S, Bali L. Congenital malformations in the newborn. Ind J Child Health 1963;12:448–452.
  21. Kolah PJ, Master PA, Sanghvi LD. Congenital malformations and perinatal mortality in Bombay. Am J Obs and Gynec 1967;97:400–406.
  22. Aiyar RR, Agarwal JR. Observation in the Newborn: s study of 10,000 consecutive live births. Ind Pediat 1969;6(11):729–742.
  23. Mital VK, Grewal RS. Congenital anomalies in neonates. Ind J Pediat 1969;36:356–365.
  24. Gupta BM, Mathur HC, Sharda DC. A study of congenital malformations in central Rajasthan (Ajmer). Archives Child Health 1971;13:30–36.
  25. Sharma B, Bajpai PC, Sharma NL. Some observations on congenital malformations. Ind J Pediat 1972;39(296):286–292. DOI: 10.1007/BF02755419
  26. Tibrewala NS, Pai PM. Congenital malformations in the newborn. Ind J Pediat 1974;11(6):403–407.
  27. Reddy SG, Reddy RR, Bronkhorst EM, et al. Incidence of cleft lip and palate in the state of Andhra Pradesh, South India. Indian J Plast Surg 2010;43(2):184–9. DOI: 10.4103/0970-0358.73443
  28. Goravalinagappa JP, Nashi HK. Congenital malformations in a study of 2398 consecutive births. Ind J Med Res 1979;69:140–146.
  29. Kulshrestha R, Upadhaya P, Nath LM. Congenital malformations in live born infants in a rural community. Ind Pediat 1983;20(1):45–49.
  30. Choudhury A, Talukder G, Sharma A. Neonatal congenital malformations in Calcutta. Ind Pediat 1984;21(5):399–407.
  31. Choudhury AR, Mukherjee M, Sharma A, et al. Study of 1,26,266 consecutive births for major congenital defects. Ind J Pediat 1989;56(4):493–499. DOI: 10.1007/BF02722422
  32. Chaturvedi P, Banerjee KS. Spectrum of congenital malformations in the newborns from rural Maharashtra. Ind J Pediat 1989;56(4):501–507. DOI: 10.1007/BF02722424
  33. Balakrishnan C. Indian classification of cleft lip and palate. Indian J Plast Surg 1975;8:23–24.
  34. Kalle SM. History of Nagpur plastic, reconstructive and maxillofacial surgery unit: 1st plastic surgery department in India. Indian J Plastic Surg 2003;36(2):134–137. DOI: 10.1055/s-00042863
  35. Azaz B, Koyoumdjisky-Kaye E. Incidence of clefts in Israel. Cleft Palate-Craniofac J 1967;4:227–233.
  36. Tolarova MM, Cervenka J. Classification and birth prevalence of orofacial clefts. Am J Med Genet 1998;75(2):126–137.
  37. Fraser FC. The genetics of cleft lip and cleft palate. Am J Hum Genet 1970;22:336–352.
  38. McMahon B, McKeown T. The birth prevalence of harelip and palate related to birth rank and maternal age. Am J Hum Genet 1953;5(2):176–183.
  39. Bonaiti C, Briard ML, Feingold J. An epidemiological and genetic study of facial clefting in France: epidemiology and frequency in relatives. J Med Genet 1982;19(1):8–15. DOI: 10.1136/jmg.19.1.8
  40. Gregg T, Boyd D, Richardson A. The birth prevalence of cleft lip and palate in Northern Ireland from 1980–1990. Br J Orthod 1994;21(4):387–392. DOI: 10.1179/bjo.21.4.387
  41. Kozelj V. Epidemiology of orofacial clefts in Slovenia, 1973–1993: comparison of the incidence in six European countries. J Craniomaxillofac Surg 1996;24(6):378–382. DOI: 10.1016/s1010-5182(96)80040-0
  42. Czeizel AE. First 25 years of the Hungarian Congenital Abnormality Registry. Teratology 1997;55(5):299–305. DOI: 10.1002/(sici)1096-9926(199705)55:5<299::aid-tera1>3.0.co;2-v
  43. Gilmore SI, Hofman SM. Clefts in Wisconsin: incidence and related factors. Cleft Palate J 1966;3:186–199.
  44. Niswander JD, Adams MS. Oral clefts in the American Indians. Public Health Rep 1967;82(9):807–812.
  45. Lowry RB, Trimble BK. Incidence rates for cleft lip and palate in British Columbia 1952–71 for North American Indian, Japanese, Chinese and total populations: secular trends over twenty years. Teratology 1977;16(3):277–283. DOI: 10.1002/tera.1420160306
  46. Fraser GR, Calnan JS. Cleft lip and palate: seasonal incidence, birth weight, birth rank, sex, site, associated malformations and parental age. Arch Dis Child 1961;36(188):420–423. DOI: 10.1136/adc.36.188.420
  47. Altemus LA. The incidence of cleft lip and palate among North American Negroes. Cleft Palate J 1966;3:357–361.
  48. Iregbulem LM. The incidence of cleft lip and palate in Nigeria. Cleft Palate J 1982;19(3):201–205.
  49. Srivastava A, Bang RL. Facial clefting in Kuwait and England: a comparative study. Br J Plast Surg 1990;43(4):457–462. DOI: 10.1016/0007-1226(90)90013-p
  50. Neel JV. A study of major congenital defects in Japanese infants. Am J Hum Genet 1958;10(4):398–445.
  51. Koguchi H. Population data on cleft lip and cleft palate in the Japanese In Melnick M, Bixler D, Shields ED (eds): “Etiology of Cleft Lip and Cleft Palate,” New York: A.R. Liss. 1980;297–323.
  52. Saxen I, Lahti A. Cleft lip and palate in Finland: incidence, secular, seasonal, and geographical variations. Teratology 1973;9(2):217–224. DOI: 10.1002/tera.1420090213
  53. Will AL, Parsons RW. Characteristics of new patients at Illinois cleft palate teams. Cleft palate-Craniofac J 1991;28(4):378–384. DOI: 10.1597/1545-1569_1991_028_0378_conpai_2.3.co_2
  54. Murray JC, Hirsch SD, Buetow KH, et al. Clinical and epidemiologic studies of cleft lip and palate in the Philippines. Cleft Palate-Craniofac J 1997;34(1):7–10. DOI: 10.1597/1545-1569_1997_034_0007_caesoc_2.3.co_2
  55. Taher AA. Cleft lip and palate in Tehran. Cleft Palate-Craniofac J 1992;29(1):15–16. DOI: 10.1597/1545-1569_1992_029_0015_clapit_2.3.co_2
  56. Menegotto BG, Salzano FM. Epidemiology of oral clefts in a large south America sample. Cleft Palate-Craniofac J 1991;28(4):371–377. DOI: 10.1597/1545-1569_1991_028_0373_eoocia_2.3.co_2
  57. Omari FA, Omari IK. Cleft lip and palate in Jordan: birth prevalence rate. Cleft Palate-Craniofac J 2004;41(6):609–612. DOI: 10.1597/03-034.1
  58. Druschel CM, Hughes JP, Olsen CL. First year of life mortality among infants with oral clefts: New York state, 1983–1990. Cleft Palate-Craniofac J 1996;33(5):400–405. DOI: 10.1597/1545-1569_1996_033_0400_fyolma_2.3.co_2
  59. Vallino-Napoli LD, Riley MM, Halliday J. An epidemiologic study of isolated cleft lip, palate, or both in Victoria, Australia From 1983 to 2000. Cleft Palate-Craniofac J 2004;41(2):185–194. DOI: 10.1597/02-076
  60. Gregg TA, Leonard AG, Hayden C, et al. Birth prevalence of cleft lip and palate in Northern Ireland (1981–2000). Cleft Palate-Craniofac J 2008;45(2):141–146. DOI: 10.1597/06-045.1
  61. Elliott RF, Jovic G, Beveridge M. Seasonal variation and regional distribution of cleft lip and palate in Zambia. Cleft Palate Craniofac J 2008;45(5):533–538. DOI: 10.1597/07-086.1
  62. Mcleod NM, Urioste ML, Saeed NR. Birth prevalence of cleft lip and palate in Sucre, Bolivia. Cleft Palate-Craniofac J 2004;41(2):195–198. DOI: 10.1597/02-116
  63. Spirtz RA, Arnold TD, Buonocore S, et al. Distribution of orofacial clefts and frequent occurrence of an unusual cleft variant in the Rift valley of Kenya. Cleft Palate-Craniofac J 2007;44(4):374–377. DOI: 10.1597/06-136.1
  64. Aljohar A, Ravichandran K, Subhani S. Pattern of cleft lip and palate in hospital based population in Saudi Arabia: retrospective study. Cleft Palate-Craniofac J 2008;45(6):592–596. DOI: 10.1597/06-246.1
  65. Onyango JF, Noah S. Pattern of the clefts of the lip and palate managed over a three year period at a Nairobi hospital in Kenya. East Afr Med J 2005;82(12):649–651. DOI: 10.4314/eamj.v82i12.9371
  66. Clark JD, Mossey PA, Sharp L, et al. Socioeconomic status and orofacial clefts in Scotland, 1989 to 1998. Cleft Palate Craniofac J 2003;40(5):481–485. DOI: 10.1597/1545-1569_2003_040_0481_ssaoci_2.0.co_2
  67. Calzolari E, Bianchi F, Rubini M, et al. Epidemiology of cleft palate in Europe: implications for genetic research. Cleft Palate-Craniofac J 2004;41(3):244–249. DOI: 10.1597/02-074.1
  68. Johnston MC, Bronsky PT. Prenatal craniofacial development, new insight on normal and abnormal mechanism. Crit Rev Oral Biol Med 1995;6(1):368–422. DOI: 10.1177/10454411950060010301
  69. Tal Y, Dar H, Winter ST, et al. Frequency of cleft lip and palate in Northern Israel. Isr J Med Sci 1974;10:515–518.
  70. Czeizel A, Tusnady G. An epidemiologic study of cleft lip with or without cleft palate and posterior cleft palate in Hungary. Hum Hered 1972;21(1):17–38. DOI: 10.1159/000152380
  71. Trestven VE. Incidence of cleft lip and palate in Montana Indians. J Speech Hear Dis 1963;28:52. DOI: 10.1044/jshd.2801.52
  72. Yi NN, Yeow VK, Lee ST. Epidemiology of cleft lip and palate in Singapore a 10 year hospital-based study. Ann Acad Med Singapore 1999;28(5):655–659.
  73. Akker A, Hoeksma JB, Prahl Andersen B. Schisis in Nederland. De vraagnaarbehandeling van schisispatientenNed Tijdschr THK 1987;94(3):520–525.
  74. Rank BK, Thomson JA. Cleft lip and palate in Tasmania. Med J Aust 1960;47(2):681–689.
  75. Meskin LH, Pruzansky S, Gullen WH. An epidemiologic study of factors related to the extent of facial clefts. Cleft Palate J 1968;5:23–29. DOI: 10.1016/0002-9416(71)90192-8
  76. Henriksson TG. Cleft Lip and Palate in Sweden. Uppsala: Institute for Medical Genetics of the University of Uppsala, Thesis; 1971.
  77. Ingalls TH, Taube IE, Klingberg MA. Cleft lip and cleft palate: epidemiologic considerations. Plast Reconstr Surg 1964;34:1–10. DOI: 10.1097/00006534-196407000-00001
  78. Hay S, Barbano H. Independent effects of maternal age and birth order on the incidence of selected congenital malformations. Teratology 1972;6(3):271–279 DOI: 10.1002/tera.1420060304
  79. Robert E, Kallen B, Harris J. The epidemiology of orofacial clefts. 1. Some general epidemiological characteristics. J Craniofac Genet Dev Biol 1996;16(4):234–241.
  80. Spry CC, Nugent MAC. Some epidemiological aspects of clefts of the primary and secondary palate in South Australia, 1949–1968. Aust Dent J 1975;20(4):250–256. DOI: 10.1111/J.1834-7819.1975.TB05056.X
  81. Mulinare J, Erickson JD, James LM, et al. Does periconceptional use of multivitamins reduce the occurrence of birth defects? Am J Epidemiol 1995;41:3–4.
  82. Schorah CJ, Wild J. Fortified foods and folate intake in women of child-bearing age. Lancet 1993;341(10):1417–1419. DOI: 10.1016/0140-6736(93)90991-o
  83. Stoll C, Dott B, Alembik Y, et al. Evaluation of prenatal diagnosis of cleft lip/palate by fetal ultrasonographic examination. Ann Genet 2000;43(1):11–14. DOI: 10.1016/s0003-3995(00)00011-3
  84. Grandjean H, Larroque D, Levi S. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus study. Am J Obstet Gynecol 1999;181(2):446–454. DOI: 10.1016/s0002-9378(99)70577-6
  85. Climenti M, Tenconi R, Bianchi F, et al. Evaluation of prenatal diagnosis of cleft lip with and without cleft palate and cleft palate by ultrasound: experience from 20 European registries. Prenat Diagn 2000;20(11):870–875.
  86. Bronshtein M, Blumenfeld I, Blumenfeld Z. Early prenatal diagnosis of cleft lip and its potential impact on the number of babies with cleft lip. Br J Oral Maxillofac Surg 1996;34(6):486–487. DOI: 10.1016/s0266-4356(96)90241-7
  87. Sohan K, Freer M, Mercer N, et al. Prenatal detection of facial clefts. Fetal Diagn Ther 2001;16(4):196–199. DOI: 10.1159/000053908
  88. Johnson DD, Pretorius DH, Budorick NE, et al. Fetal lip and primary palate: three-dimensional versus two-dimensional US. Radiology 2000;217(1):236–239. DOI: 10.1148/radiology.217.1.r00oc18236
  89. Borker AS, Mathur AK, Mahaluxmivalas S. Epidemiology of facial clefts in the central province of Saudi Arabia. Br J Plast Surg 1993;46(8): 673–675. DOI: 10.1016/0007-1226(93)90198-k
  90. Lilius DP. Clefts with associated anomalies and syndromes in Finland. Scand J Plast Reconstr Surg Hand Surg 1992;26(2):185–196. DOI: 10.3109/02844319209016011
  91. Knox G, Braithwaite F. Cleft lips and palates in Northumberland and Durham. Arch Dis Child 1963;38(197):66–70. DOI: 10.1136/adc.38.197.66
  92. Stark R. Cleft Palate: a Multidiscipline Approach. New York: Harper & Row; 1968.
  93. Fogh-Andersen P. Epidemiology and etiology of clefts. In: Bergsma D, ed. Third Conference on the Clinical Delineation of Birth Defects. Baltimore: Williams and Wilkins 1971:50–53.
  94. Shprintzen RJ, Siegel-Sadewitz VL, Amato J, et al. Anomalies associated with cleft lip, cleft palate, or both. Am J Med Genet 1985;20(4):585–595. DOI: 10.1002/ajmg.1320200404
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.