Dudak-damak yarıklı bireylerde görülen doğumsal ve gelişimsel problemler

Dudak ve/ya damak yarıkları (DDY) kraniyofasiyal bölgenin en sık görülen doğumsal defektlerinden biridir. Yumuşak ve sert dokuları her üç boyutta etkileyen bu anomali, büyüme ve kraniyofasiyal yapıların hareketiyle dördüncü bir boyut da kazanır. Anne karnında teşhis edildiği an itibariyle başlayan, oral bölgeyle sınırlı görünüp vücudun diğer pek çok bölgesini etkileyen bu anomali hem DDY’li birey hem de aile için zorlu ve uzun bir süreçtir. Bu bireylerde sıklıkla rastlanan problemler; beslenme problemleriyle ilişkili büyüme ve gelişim anomalileri, solunum problemleri, orta kulak enfeksiyonları, konuşma ve öğrenme problemleri, normalden sapmış nazomaksiller, pterygomaksiller ve farengeal anatomi ile ilişkili problemler, maksiller sinüs oluşumunda görülen problemler ve sinüzit, dental problemler, tükürük yapısındaki farklılıklar, oral ve nazal halitozis, oral kandida kolonizasyonu, oral hijyen ve periodontal sağlıkla ilgili problemler, psikolojik ve nörolojik problemler ve DDY’nin eşlik ettiği diğer anomalilerdir. Bireyin gerek yaşamsal fonksiyonlarını gerekse de hayat kalitesini önemli ölçüde etkileyen bu problemlere yönelik doğru ve etkili bir tedavi yaklaşımı sunabilmek için hekimin görülmesi muhtemel bütün doğumsal ve gelişimsel anomalilere hâkim olması gerekir.

Congenital and developmental problems seen in patients with cleft lip and/or palate

Cleft lip and/or palate (CL/P) is one of the most frequently-seen congenital malformations of the craniofacial region. Affecting both hard and soft tissues in all 3 dimensions, CL/P achieves a fourth dimension with growth and displacement of the craniofacial structures. Although it seems to be limited with the orofacial region, it affects many other body parts and is a very compelling and lasting period starting with the prenatal diagnosis. Common problems encountered in these patients are growth and developmental anomalies associated with nutritional problems, respiratory problems, otitis media, speech and learning disorders, problems related with abnormal nasomaxillary, pterygomaxillary and pharengeal anatomies, maxillary sinus malformation and sinusitis, dental problems, differences in saliva composition, oral and nasal halitosis, oral candidiasis, problems with oral hygiene and periodontal health, psychological and neurological problems, and CL/P-accompanied anomalies. Therefore, it is mandatory to have a solid grasp of all the potential congenital and developmental anomalies affecting the CL/P patient’s quality of life besides vital functions, in order to offer an accurate and effective health service.

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Piggott RW. Organization of cleft lip and palate services. Br J Plast Surg 1992; 45: 385-387.
Goodacre T, Swan MC. Cleft lip and palate: current management. Paediatr Child Health 2008; 18: 283-292.
Wallace GH, Arellano JM, Gruner TM. Non-syndromic cleft lip and palate: Could stress be a causal factor?. Women Birth 2011; 24: 40-46.
de Vries IA, Breugem CC, van der Heul AM, Eijkemans MJ, Kon M, et al. Prevalence of feeding disorders in children with cleft palate only: a retrospective study. Clin Oral Investig 2014; 18(5): 1507-1515.
Tisza VB, Gumpertz E. The parents reaction to the birth and early care of children with cleft palate. Pediatrics 1962; 30: 86-90.
Gopinath VK, Muda WA. Assessment of growth and feeding in children with cleft lip and palate. Southeast Asian J Trop Med Public Health 2005; 36: 254-258.
Jensen B, Dahl E, Kreiborg S. Longitudinal study of body height, radius length, and skeletal maturity in Danish boys with cleft lip and palate. Scand J Dent Res 1983; 91: 473-481.
Montagnoli LC, Barbieri MA, Bettiol H, Marques IL, De Souza L. Growth impairment of children with different types of lip and palate clefts in the two years of life: a cross-sectional study. J Pediatr (Rio J) 2005; 81: 461-465.
Habel A, Sell D, Mars M. Management of cleft lip and palate. Arch Dis Child 1996; 74: 360-366.
Mcheik JN, Levard G. Growth in infants in the first two years of life after neonatal repair for unilateral cleft lip and palate. Int J Pediatr Otorhinolaryngol 2010; 74: 465-468.
Hermann NV, Kreiborg S, Darvann TA, Jensen BL, Dahl E, et al. Early craniofacial morphology and growth in children with unoperated isolated cleft palate. Cleft Palate Craniofac J 2002; 39: 604-622.
Kunkel M, Wahlmann U, Wagner W. Objective, noninvasive evaluation of velopharyngeal function in cleft and noncleft patients. Cleft Palate Craniofac J 1998; 35: 35- 39.
Wahlmam U, Kunkel M, Wagner W. Preoperative assessment of airway patency in the planning of corrective cleft nose surgery. Mund Kiefer Gesichtschir 1998; 2 (Suppl 1), 153-157.
Liao YF, Noordhoff MS, Huang CS, Chen PK, Chen NH, et al. Comparison of obstructive sleep apnea syndrome in children with cleft palate following Furlow palatoplasty or pharyngeal flap for velopharyngeal insufficiency. Cleft Palate Craniofac J 2004; 41: 152-156.
Orr WC, Levine NS, Buchanan RT. Effect of cleft palate repair and pharyngeal flap surgery on upper airway obstruction during sleep. Plast Reconstr Surg 1987; 80: 226-232.
Sirois M, Caouette-Laberge L, Spier S, Larocque Y, Egerszegi EP. Sleep apnea following a pharyngeal flap: a feared complication. Plast Reconstr Surg 1994; 93: 943- 947.
Abramson DL, Marrinan EM, Mulliken JB. Robin sequence: obstructive sleep apnea following pharyngeal flap. Cleft Palate Craniofac J 1997; 34(3): 256-260.
Liao YF, Chuang ML, Chen PK, Chen NH, Yun C, et al. Incidence and severity of obstructive sleep apnea following pharyngeal flap surgery in patients with cleft palate. Cleft Palate Craniofac J 2002; 39(3): 312-316.
Nowak KC, Weider DJ. Pediatric nocturnal enuresis secondary to airway obstruction from cleft palate repair. Clin Pediatr (Phila) 1998; 37: 653-657.
Muntz H, Wilson M, Park A, Smith M, Grimmer JF. Sleep disordered breathing and obstructive sleep apnea in the cleft population. Laryngoscope 2008; 118: 348-353.
Szabo C, Langevin K, Schoem S, Mabry K. Treatment of persistent middle ear effusion in cleft palate patients. Int J Pediatr Otorhinolaryngol 2010; 74: 874-877.
Flynn T, Moller C, Jonsson R, Lohmander A. The high prevalence of otitis media with effusion in children with cleft lip and palate as compared to children without clefts. Int J Pediatr Otorhinolaryngol 2009; 73: 1441-1446.
Maw R, Wilks J, Harvey I. Early surgery compared with watchful waiting for glue ear and effect of language development in preschool children: a randomized trial. Lancet 1999; 353: 960-963.
Taib BG, Taib AG, Swift AC, van Eeden S. Cleft lip and palate: diagnosis and management. Br J Hosp Med 2015; 76: 584-591.
Paradise JL. Long-term effects of short term hearing loss: menace or myth?. Pediatrics 1983; 71: 647-648.
Hubbard TW, Paradise JL, McWilliams BJ. Consequences of unremitting middle-ear disease in early life: otologic, audiologic, and developmental findings in children with cleft palate. N Eng J Med 1985; 312: 1529-1534.
Tengroth B, Hederstierna C, Neovius E, Flynn T. Hearing thresholds and ventilation tube treatment in children with unilateral cleft lip and palate. Int J Pediatr Otorhinolaryngol 2017; 97: 102-108.
Paradise JL, Feldman HM, Campbell TF. Effect of early or delayed insertion of tympanostomy tubes for persistent otitis media on developmental outcomes at the age of three years. N Eng J Med 2001; 344: 1179-1788.
Berkowitz S. Cleft Lip and Palate: Diagnosis and Management. 2nd ed., Berlin, Springer; 2006.
Pigott RW. Velopharyngeal (speech) disorder (VP(S)D) without overt cleft palate. Br J Plast Surg 1994; 47: 223- 229.
Loosen J van, Klooswijk AJJ, Velzen O van, Verwoerd COA. Computed tomography of the human developing anterior skull base. Eur J Radiol 1990; 10: 211-214.
Verwoerd COA, Loosen J van, Schutte HE, Verwoerd-Verhoef HL, Velzen O Van. Surgical aspects of the anatomy of the vomer in children and adults. Rhinol Suppl 1989; 9: 87-96.
Verwoerd CDA, Verwoerd-Verhoef HL. Developmental aspects of the deviated nose. Facial Plast Surg 1989; 6: 95-100.
Verwoerd CDA, Verwoerd-Verhoef HL. Rhinosurgery in children: surgical and developmental aspects. In: Nolst Trenite, GJ, ed. Rhinoplasty: A Practical Guide to Functional and Aesthetic Surgery of the Nose. Kugler, Amsterdam; 1992. p. 149-156.
McNeil CK. Orthodontic procedures in the treatment of congenital cleft palate. Dental Record 1950; 70: 126– 132.
McNeil CK. Oral and Facial Deformity. London, Sir Isaac Pitman and Sons; 1954.
Farrior TF. The cleft lip nose: an update. Fac Plast Surg 1993; 9: 241-268.
Salyer KE. Early and later treatment of unilateral cleft nasal deformity. Cleft Palate Craniofac J 1992; 29: 556- 569.
Berkowitz S. Growth of the Face with Bilateral Cleft Lip from 1 Month to 8 Years of Age. Chicago, University of Illinois Graduate School; 1959.Thesis.
Lee SH, Lee SH, Mori Y, Minami K, Park HS, et al. Evaluation of pterygomaxillary anatomy using computed tomography: Are there any structural variations in cleft patients?. J Oral Maxillofac Surg 2011; 69: 2644-2649.
Cruz AA, dos Santos AC. Blindness after Le Fort I osteotomy: A possible complication associated with pterygomaxillary separation. J Craniomaxillofac Surg 2006; 34: 210-216.
Carr RJ, Gilbert P. Isolated partial third nerve palsy following Le Fort I maxillary osteotomy in a patient with cleft lip and palate. Br J Oral Maxillofac Surg 1986; 24: 206-211.
Rajion ZA, Al-Khatib AR, Netherway DJ, Townsend GC, Anderson PJ, et al. The nasopharynx in infants with cleft lip and palate. Int J Pediatr Otorhinolaryngol 2012; 76: 227-234.
Subtelny JD. Width of nasopharynx and related anatomic structures in normal and unoperated cleft palate children. Am J Orthod 1955; 41: 889-909.
Maue-Dickson W, Dickson DR. Anatomy and physiology related to cleft palate: current research and clinical implications. Plast Reconstr Surg 1980; 65: 83-90.
Makki FM, Al-Mazrou KA. Nasopharyngeal teratoma associated with cleft palate in a newborn. Eur Arch Otorhinolaryngol 2008; 265: 1413-1415.
Levine AB, Alvarez M, Wedgwood J, Berkowitz RL, Holzman I. Contemporary management of a potentially lethal fetal anomaly: a successful perinatal approach to epignathus. Obstet Gynecol 1990; 76: 962-966.
Liang CC, Lai JP, Lui CC. Cleft palate with congenital midline teratoma. Ann Plast Surg 2003; 50: 550-554.
Haghighi K, Milles M, Cleveland D, Ziccardi V. Epignathus teratoma with bifid tongue and median glossal salivary mass: report of a case. J Oral Maxillofac Surg 2004; 62: 379-383.
Pryor SG, Lewis JE, Weaver AL, Orvidas LJ. Pediatric dermoid cysts of the head and neck. Otolaryngol Head Neck Surg 2005; 132: 938-942.
Benson RE, Fabbroni G, Russell JL. A large teratoma of the hard palate: a case report. Br J Oral Maxillofac Surg 2009; 47: 46-49.
He J, Wang Y, Zhu H, Qiu W, He Y. Nasopharyngeal teratoma associated with cleft palate in newborn: report of 2 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 211-216.
Robinson HE, Zerlin GK, Passy V. Maxillary sinus development in patients with cleft palates as compared to those with normal palates. Laryngoscope 1982; 92:183-187.
Warren DW, Trier WL, Bevin AG. Effect of restorative procedures on the nasopharyngeal airway in cleft palate. Cleft Palate J 1974; 11: 367-373.
Suzuki H, Yamaguchi T, Furukawa M. Maxillary sinus development and sinusitis in patients with cleft lip and palate. Auris Nasus Larynx 2000; 27: 253-256.
Jaffe BF, DeBlanc CB. Sinusitis in children with cleft lip and palate. Arch Otolaryngol 1971; 93: 479–482.
Ishikawa Y, Kawano M, Honjo I, Amitani R. The cause of nasal sinusitis in patients with cleft palate. Arch Otolaryngol Head Neck Surg 1989; 115: 442-446.
Finkelstein Y. Halitosis in patients with craniofacial anomalies. In: Rosenberg M, ed. Bad breath: research perspectives. Tel Aviv Israel, Ramot Publishing; 1995. p. 189-200.
Harvold E. Observations on the development of the upper jaw by harelip and cleft palate. Odont T 1947; 55: 289-305.
Weise W, Erdmann P. Anomalien der Zahnzahl and Zahnform im bleibenden Gebiss bei Lippen-Giefer-Gaumen-Spalten. Zahnaerztl Rundsch 1967; 76: 357-372.
Böhn A. Dental anomalies in harelip and cleft palate. Acta Odont Scand 1963; 21: 1-109.
Suzuki A, Nakano M, Yoshizaki K, Yasunaga A, Haruyama N, et al. A longitudinal study of the presence of dental anomalies in the primary and permanent dentitions of cleft lip and/or palate patients. Cleft Palate Craniofac J 2017; 54(3): 309-320.
Olin WH. Dental anomalies in cleft lip and cleft palate patients. Angle Orthod 1964; 34: 119-123.
Millhon JA, Stafne EC. Incidence of supernumerary and congenitally missing lateral incisor teeth in eighty-one cases of harelip and cleft palate. Am J Orthop 1941; 27:A599-A604.
Schulze C. Über milchzahnanomalien unter besonderer berficksichtigung der anomalien bei kieferspalten. Stoma 1953; 6: 201-221.
Nagai I, Fujiki Y, Fuchihata H, Yoshimoto T. Supernumerary tooth associated with cleft lip and palate. J Am Dent Assoc 1965; 70: 642-647.
Mathis H. Über die zahnfiberzahl beim menschen. Z Stomat 1935; 33: 913-920. 68.Dolder E. Zahn-Unterzahl. Schweiz Mschr Zahnheilk 1936; 46: 663-701.
Inouye M. Der zwischenkiefer, seine entstehungund der verlauf der hasencharten-kieferspalten und der schragen gesichtsspalte. Anat Hefte 1912; 45: 475-601.
Politzer G, Weizenberg J. Embryologische untersuchungen fiber die ursache der agenesie des oberen lateralen schneidezahnes. Deutsch Zahnaerztl Z 1954; 9: 1329-1343.
Hellquist R, Linder-Aronson S, Norling M, Ponten B, Stenberg T. Dental abnormalities in patients with alveolar clefts, operated upon with or without primary periosteoplasty. Eur J Orthod 1979; 1:169-180.
Kraus BS, Jordan RE, Prnzansky S. Dental abnormalities in the deciduous and permanent dentition of individuals with cleft lip and palate. J Dent Res 1966; 45: 1736- 1746.
Dixon DA. Defects of structures and formation of teeth in persons with cleft palate and the effect of reparative surgery on the dental tissues. Oral Surg 1968; 25: 435- 446.
Ranta R. A review of tooth formation in children with cleft lip and palate. Am J Orthod Dentofac Orthop 1986; 90: 11-18.
Ranta R. Comparison of tooth formation in noncleft and cleft-affected children with and without hypodontia. ASDC J Dent Child. 1982; 49: 197-199.
Menius JA, Largent MD, Vincent CJ: Skeletal development of cleft palate children as determined by hand-wrist roentgenographs: A preliminary study. Cleft Palate J 3:67-75, 1966.
Bailit HL, Doykos JD III, Swanson LT: Dental development in children with cleft palate. J Dent Res 47:664,1968.
Ranta R, Stegars T, Rintala AE. Correlations of hypodontia in children with isolated cleft palate. Cleft Palate J 1983; 20: 163-165.
Ranta R. Eruption of the premolars and canines and factors affecting it in unilateral cleft lip and palate cases. Proc Finn Dent Soc 1971; 67: 350-355.
Aizenbud D, Peri-Front Y, Nagler RM. Salivary analysis and antioxidants in cleft lip and palate children. Arch Oral Biol 2008; 53: 517-522.
Monteiro-Amado F, Montenegro Chinellato LE, Rubo de Rezende ML. Evaluation of oral and nasal halitosis parameters in patients with repaired cleft lip and/or palate. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100: 682-687.
Brennan PA, Markus AF, Flood TR, Downie IP, Uppal R. Do oral flora colonize the nasal floor of patients with oronasal fistulae?. Cleft Palate Craniofac J 2001; 38: 399-400.
Turner C, Zagirova AF, Frolova LE, Courts FJ, Williams WN. Oral health status of Russian children with unilateral cleft lip and palate. Cleft Palate Craniofac J 1998; 35: 489–494.
Cheng LL, Moor SL, Ho CT. Predisposing factors to dental caries in children with cleft lip and palate: a review and strategies for early prevention. Cleft Palate Craniofac J 2007; 44: 67-72.
Gruber W. Congenital Mangel beider Glandulae submaxillares bei einem wohlgebildeten, erwachsenen Subjects. Arch Pathol Anat 1885; cii: 9-11.
Matsuda C, Matsui Y, Ohno K, Michi K. Salivary gland aplasia with cleft lip palate: A case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87: 594-549.
Richter JL. Diagnosis and treatment of halitosis. Compend Contin Educ Dent 1996; 17: 370-376.
Richter VJ, Tonzetich J. The application of instrumental technique for the evaluation of odoriferous volatiles from saliva and breath. Arch Oral Biol 1964; 9: 47-54.
Rosenberg M, Kulkarni GV, Bosy A, McCulloch CA. Reproducibility and sensitivity of oral malodor measurements with a portable sulphide monitor. J Dent Res 1991; 70: 1436-1440.
Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis. J Periodontol 1977; 48: 13-20.
Bogdasarian RS. Halitosis. Otolaryngol Clin North Am 1986; 19: 111-117.
Rosenberg M. Clinical assessment of bad breath: current concepts. J Am Dent Assoc 1996; 127: 475-482.
Hine MK. Halitosis. J Am Dent Assoc 1957; 55: 37-46.
Bosy A. Oral malodor: philosophical and practical aspects. J Can Dent Assoc 1997; 63: 196-201.
Warren DW, Hairfield M, Dalston ET. Nasal airway impairment: the oral response in cleft palate patients. Am J Orthod Dentofacial Orthop 1991; 99: 346-353.
Jones S, Drake DJ. Case series of undetected intranasal impression material in patients with clefts. Br J Oral Maxillofac Surg. 2013; 51(3): 34-36.
Rawashdeh MA, Ayesh JAM, Darwazeh AMG. Oral candidal colonization in cleft patients as a function of age, gender, surgery, type of cleft, and oral health. J Oral Maxillofac Surg 2011; 69: 1207-1213.
Wang H, Wang Y, Chen J. Oral yeast flora and its ITS sequence diversity among a large cohort of medical students in Hainan, China. Mycopathologia 2007; 164: 65-72.
Oppenheim JJ, Biragyn A, Kwak LW. Roles of antimicrobial peptides such as defensins in innate and adaptive immunity. Ann Rheum Dis 2003; 62: 7-21.
de Almeida AL, Gonzalez MK, Greghi SL. Are teeth close to the cleft more susceptible to periodontal disease?. Cleft Palate Craniofac J 2009; 46: 161-165.
Esper LA, Sbrana MC, Ribeiro IW. Esthetic analysis of gingival components of smile and degree of satisfaction in individuals with cleft lip and palate. Cleft Palate Craniofac J 2009; 46: 381-387.
Blumberg HM, Jarvis WR, Soucie JM, Edwards JE, Patterson JE, et al. Risk factors for candidal bloodstream infections in surgical intensive care unit patients: The NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey. Clin Infect Dis 2001; 33: 177-186.
Lucas VS, Gupta R, Ololade O, Gelbier M, Roberts GJ. Dental health indices and caries associated microflora in children with unilateral cleft lip and palate. Cleft Palate Craniofac J 2000; 37: 447-452.
Quirynen M, Dewinter G, Avontroodt P, Heidbüchel K, Verdonck A, et al. A split-mouth study on periodontal and microbial parameters in children with complete unilateral cleft lip and palate. J Clin Periodontol 2003; 30: 49-56.
Kirchberg A, Treide A, Hemprich A: Investigation of caries prevalence in children with cleft lip, alveolus, and palate. J Craniomaxillofac Surg 2004; 32: 216-219.
Stec M, Szczepanska J, Pypec J, Hirschfelder U. Periodontal status and oral hygiene in two populations of cleft patients. Cleft Palate Craniofac J 2007; 44: 73-78.
Hasslof P, Twetman S. Caries prevalence in children with cleftip and palate-A systematic review of case-control studies. Int J Paediatr Dent 2007; 17: 313-319.
Pompéia Fraga de Almeida AL, Sbrana MC, Esper LA, Aguiar Greghi SL, Rodrigues Conti PC. Gingival recession in maxillary canines and central incisors of individuals with clefts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 37-45.
Bressmann T, Sader R, Ravens-Sieberer U, Zeilhofer HF, Horch HH. Quality of life research in patients with cleft lip and palate: preliminary results. Mund Kiefer Gesichtschir 1999; 3: 134-139.
Endriga MC, Kapp-Simon KA. Psychological issues in craniofacial care: state of the art. Cleft Palate Craniofac J 1999; 36: 3-11.
Kapp-Simon KA, Simon DJ, Kristovich S. Self-perception, social skills, adjustment, and inhibition in young adolescents with craniofacial anomalies. Cleft Palate Craniofac J 1992; 29: 352-356.
Broder HL, Smith FB, Strauss RP. Effects of visible and invisible orofacial defects on self-perception and adjustment across developmental eras and gender. Cleft Palate Craniofac J 1994; 31: 429-436.
McWilliams BJ, Paradise LP. Educational, occupational, and marital status of cleft palate adults. Cleft Palate J 1973; 10: 223-229.
Bremmer J. Does stress damage the brain?. Biol Psychiatry 1999; 45: 797-805.
Broder HL, Richman LC, Matheson PB. Learning disability, school achievement, and grade retention among children with cleft: a two-center study. Cleft Palate Craniofac J 1998; 35: 127-131.
Broder HL, Smith FB, Strauss RP. Effects of visible and invisible orofacial defects on self-perception and adjustment across developmental eras and gender. Cleft Palate Craniofac J 1994; 31: 429-436.
Magnotta VA, Andreasen NC, Schultz SK, Harris G, Ci -zadlo T, et al. Quantitative in vivo measurement of gyrifica -tion in the human brain: changes associated with aging. Cereb Cortex 1999; 9: 151-160.
Bronheim H, Strain JJ, Biller HF. Psychiatric aspects of head and neck surgery. Part II: body image and psychi -atric intervention. Gen Hosp Psychiatry 1991; 13: 225-232.
De Bellis MD, Baum AS, Birmaher B, Keshavan MS, Eccard CH, et al. Developmental traumatology. Part I. Bi -ological stress systems. Biol Psychiatry 1999; 45: 1259– 1270.
Teicher MH. Scars that won’t heal: the neurobiology of child abuse. Sci Am 2002; 286: 68-75.
Gould E, Reeves AJ, Graziano MS, Gross CG. Neurogenesis in the neocortex of adult primates. Science 1999; 286: 548-552.
Sapolsky R. Why stress is bad for your brain?. Scien -ce 1996; 273: 749-750.
Milerad J, Larson O, Hagberg C, Ideberg M. Associ -ated malformations in infants with cleft lip and palate: a prospective population-based study. Pediatrics 1997; 100: 180-186.
Shprintzen RJ, Siegel-Sadewitz VL, Amato J, Gold -berg RB. Anomalies associated with cleft lip, cleft palate, or both. Am J Med Genet 1985; 20: 585-595.
Lilius DP. Clefts with associated anomalies and synd -romes in Finland. Scand J Reconstr Hand Surg 1992; 26: 185-196.
Stoll C, Alembik Y, Dott B, Roth MP. Associated malformations in cases with oral clefts. Cleft Palate J 2000; 37: 41-47.