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Late detection of cleft palate
K H Hanny1, I A C de Vries2, S J Haverkamp3
1Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Insights
Late diagnosis of cleft palate only (CPO) is common, impacting development. Early detection, especially for severe clefts, is crucial. Healthcare professionals need enhanced intra-oral examination awareness to improve CPO diagnosis rates.
Area of Science:
- Pediatric Congenital Malformations
- Craniofacial Surgery
- Speech and Hearing Sciences
Background:
- Cleft palate only (CPO) is a frequent congenital anomaly impacting feeding, speech, hearing, and development.
- Submucous clefts are particularly prone to underdiagnosis due to detection challenges, with literature indicating diagnoses as late as 4.9 years on average.
- Late diagnosis of CPO can lead to significant feeding, growth, speech, and hearing impairments.
Purpose of the Study:
- To retrospectively determine the age of diagnosis for Cleft Palate Only (CPO).
- To investigate the correlation between the presence of syndromes and other factors with the age of CPO diagnosis.
- To identify factors influencing the timeliness of CPO diagnosis.
Main Methods:
- Retrospective analysis of Cleft Palate Only (CPO) cases diagnosed between 1997 and 2014.
- Statistical analysis including Kaplan-Meier survival analyses to assess diagnosis timing.
- Correlation analysis to evaluate the impact of syndromes and cleft severity on diagnosis age.
Main Results:
- The mean age of diagnosis for CPO was 1 year and 4 months, with 37.3% diagnosed after 30 days and 24.8% after 12 months.
- Submucous clefts were diagnosed significantly later, with 89.3% detected after 30 days (p=.000).
- Earlier diagnoses were associated with increased cleft severity (grades 1-4) and the presence of associated disorders.
Conclusions:
- Cleft Palate Only (CPO) is frequently diagnosed late, potentially delaying necessary interventions.
- Healthcare professionals, including midwives and pediatricians, require heightened awareness and improved intra-oral examination techniques for early CPO detection.
- Thorough visual and manual palatal inspections are recommended to improve the detection rates of all cleft types, particularly submucous clefts.
Abstract:
Cleft palate only (CPO) is a common congenital malformation, and most patients are diagnosed within the first weeks after birth. Late diagnosis of the cleft palate (CP) could initially result in feeding and growth impairment, and subsequently speech and hearing problems later in life. The purpose of this study is to retrospectively investigate (1) at which age CPO is diagnosed and (2) how the presence of syndromes and other factors relate to the age at diagnosis. The mean age of all children at our centre with CPO included between 1997 and 2014 at diagnosis (n = 271) was 1 year and 4 months. In all, 24.8% (n = 67) was older than 12 months when diagnosed, and 37.3% (n = 101) of all children had been diagnosed >30 days. These findings remain valid when a cut-off point of 14 days is used (44.3% late). Moreover, the grade of the cleft was a determining factor for successful diagnosis; submucous clefts were detected much later on average (89.3% > 30 days; p = .000). Similar results were found using Kaplan-Meier survival analyses.
Conclusion:
CPO is often diagnosed late. Patients diagnosed ≤30 days after birth more often presented with an associated disorder. Early diagnoses became more frequent as the severity of the cleft increased (grades 1-4). Professionals should perform more thorough intra-oral investigations, including manual palpations and visual inspections of the palate; they should be made more aware of the frequent accompanying symptoms.
What Is Known:
The presence of cleft palate only (CPO) is known to negatively affect feeding, hearing, speech and (social) development. Submucous clefts are often underdiagnosed due to their difficulty to detect. As far as we know the literature shows that symptomatic submucous CPs are often diagnosed at an average age of 4.9 years.
What Is New:
37.3% respectively of all children with CPO were diagnosed relatively late (>30 days after birth), 24.8% was older than 12 months when diagnosed. Mean age of all children with CPO was 1 year and 4 months. We conclude that midwives and pediatricians should perform more through intra-oral investigations of all new-borns, including both a manual palpation, als well a visual inspection of the palate.
