Dental and otologic problems in cleft lip and palate patients from Northern Finland cleft associated problems
Patients with orofacial clefts must overcome problems associated with their deformity including multiple surgeries, facial scarring, speech difficulties, dental problems and hearing loss. This study considered dental and hearing problems faced by cleft lip and palate patients in Northern Finland. The research aimed to determine prevalence of dental anomalies in cleft children, assess restorative treatment need and examine dental treatment necessary under general anesthesia. Other aims were to identify middle ear problems, need for ventilation tubes (VTs) among cleft children and examine the relationship between cleft severity, palatoplasty technique and hearing outcomes in cleft children aged between 3 and 9 years. The material comprised 214 cleft patients treated at Oulu University Hospital. In the dental study 26.6% had at least one dental anomaly while 17.9% had 2 or 3, most commonly missing or supernumerary teeth. In the general anesthesia study 11.5% had a syndrome and 52.4% of those with a syndrome aged 6 years old needed restorative treatment. General anesthesia was required for dental treatment in 17.5% of cleft patients, mostly in those with a syndrome. In the middle ear study 79% had secretions in the middle ear during the study period. On average 3 VTs were placed in each patient. The prevalence of tympanic perforation was 35.9% and cholesteatoma occurred in 3.3% In the hearing study pure tone average did not significantly differ between right and left ears and was unrelated to cleft severity or palatoplasty technique. Based on the dental study the severity of clefting increased with the prevalence of dental anomalies. The general anesthesia study found that need for restorations increased with cleft severity. The presence of a syndrome increased the need for dental treatment under general anesthesia. The middle ear study found that patients with cleft lip and palate and isolated cleft palate had more extensive clefts affecting Eustachian tube function with more frequent middle ear problems requiring more VTs than isolated cleft lip patients. Continuous presence of VTs increased the prevalence of tympanic perforation and cholesteatoma. The hearing study concluded that most of the 3 to 9 year old cleft patients had normal hearing thresholds unaffected by cleft severity or palatoplasty technique.