Associated syndromes and other genetic variations at a South African cleft lip and palate clinic

A retrospective study was done of data on all patients registered at one of the largest cleft lip and palate clinics in South Africa (n = 3174). The associated syndromes and other genetic variations [(abbreviation:) ASGV] found in the population of persons suffering from facial cleft deformities (FCD) were analysed. 832 (26.2%) cleft lip and/ or palate patients presented with ASGV. Fifty-seven different types of syndromes were recorded of which the Fairbaim-Robin appearance (FRA) (or Pierre Robin sequence) 169 (5.3%), the Demarque-van der Woude syndrome 40 (1.3%), and the holoprosencephaly sequence cases 32 (1.0%) were the three most common ones. The three most common genetic variations found in the non-syndromic patients, were heart involvement 53(1.7%), club foot 42 (1.3%) and various eye problems 39 (1.2%). The main facial cleft deformity, namely the cleft lip, alveolus and palate (CLAP), was found in 26.2% o f the ASGV-group. This particular cleft deformity was recorded at 39.7% in the FCD clinic. On the other hand, the hard and soft palate cleft (hPsP) group was found in 32.9% of patients who also had ASGV; in the total group o f patients registered at the clinic, it accounted for only 16.6%. This means that ASGV occur less commonly in the CLAP group of patients, than in the hPsP group of patients.http://www.curationis.org.zaam2013ay201

Primary surgery effect on dental arch relationships of patients born with unilateral cleft lip and palate using the GOSLON yardstick index

OBJECTIVES : To score dental arch development using the Great Ormond Street, London, and Oslo (GOSLON) yardstick index, following primary surgery in patients with a complete unilateral cleft lip and palate (UCLP), and to compare the outcome score with the GOSLON score of Cleft Care UK (CCUK) as well as with the Clinical Standards Advisory Group (CSAG), United Kingdom. METHODS : Study models of patients (average age 12 years) with a non-syndromic complete UCLP, who had been surgically treated at the University of Pretoria Facial Cleft Deformity (UPFCD) clinic. They were assessed using the GOSLON yardstick index by certified raters from the Dental School in Dundee, Scotland. The mean outcome ratings were calculated from the scoring of 27 sets of plaster models. The other scoring rounds were used to calculate intra- and inter-observer agreement using Cohen's weighted kappa and Fleiss's multi-rater kappa. RESULTS : There were strong intra- and inter-observer agreement, with a weighted kappa of 0.92. The Facial Cleft Deformity (FCD) clinic data showed a good treatment outcome with a mean GOSLON rating of 2.85 compared to a rating of 3.2 for the CSAG and 2.62 for the CCUK cohort studies. CONCLUSION : The UPFCD clinic primary surgical protocol displayed a good treatment outcome rating, in line with that of the CCUK cohort and better than the CSAG results.https://www.sada.co.za/the-sadjhj2022Maxillo-Facial and Oral SurgeryOrthodontic

Airway and feeding problems in infants with Fairbairn-Robin triad deformities

Background: The majority of patients with Pierre Robin sequence in the subdivision Fairbairn-Robin triad (FRT), are born with glossoptosis, retro-/micrognathia and cleft or agenesis of the palate leading to feeding difficulties and airway obstruction. There is limited literature on these problems, and on methods used to address them. Objectives: Community nurses in the Facial Cleft Deformity Clinic evaluate associated airway obstruction and feeding problems and devise nursing interactions to address these. This retrospective study examined the incidence of airway and feeding difficulties in the neonatal, pre-surgical period, as well as the surgical and nutritional management of these infants. Method: Retrospective records of 215 infants with FRT were examined and data on incidence, airway and feeding difficulties and surgical and nutritional management was collected. Descriptive statistics, including average and percentage values, were compiled. Results: The incidence of FRT amongst the cleft palate patients was 6.0%, with 37.7% of these having feeding difficulties. However, surgical interventions such as glossopexy (5.6%), distraction osteogenesis (0.9%) and tracheotomy (2.3%) for airway management were seldom required. Most of the infants who had upper airway obstruction and feeding problems were handled by means of suction and drinking plates, along with additional specific feeding aids. This reduced airway obstruction in 70.6%, and feeding problems in 62.4% of these infants. Conclusion: Based on this study’s finding the introduction of the suction and drinking plate and the use of specific types of feeding devices and surgical management can improve growth and development in infants with FRT

Evaluating herbivore management outcomes and associated vegetation impacts

African savannas are characterised by temporal and spatial fluxes that are linked to fluxes in herbivore populations and vegetation structure and composition. We need to be concerned about these fluxes only when management actions cause the system to shift towards a less desired state. Large herbivores are a key attribute of African savannas and are important for tourism and biodiversity. Large protected areas such as the Kruger National Park (KNP) manage for high biodiversity as the desired state, whilst private protected areas, such as those adjacent to the KNP, generally manage for high income. Biodiversity, sustainability and economic indicators are thus required to flag thresholds of potential concern (TPCs) that may result in a particular set of objectives not being achieved. In large conservation areas such as the KNP, vegetation changes that result from herbivore impact, or lack thereof, affect biodiversity and TPCs are used to indicate unacceptable change leading to a possible loss of biodiversity; in private protected areas the loss of large herbivores is seen as an important indicator of economic loss. Therefore, the first-level indicators aim to evaluate the forage available to sustain grazers without deleteriously affecting the vegetation composition, structure and basal cover. Various approaches to monitoring for these indicators were considered and the importance of the selection of sites that are representative of the intensity of herbivore use is emphasised. The most crucial step in the adaptive management process is the feedback of information to inform management decisions and enable learning. Feedback loops tend to be more efficient where the organisation’s vision is focused on, for example, economic gain, than in larger protected areas, such as the KNP, where the vision to conserve biodiversity is broader and more complex. Conservation implications: In rangeland, optimising herbivore numbers to achieve the management objectives without causing unacceptable or irreversible change in the vegetation is challenging. This manuscript explores different avenues to evaluate herbivore impact and the outcomes of management approaches that may affect vegetation