Pattern of Secondary Cleft Lip and Palate Deformities in Patients Seen in Selected Hospitals in Nairobi, Kenya.

Abstract

Study background Cleft lip and palate (CLP) deformities are the commonest congenital anomalies affecting orofacial structures, usually found in one in every 700–1000 of the new-borns worldwide. Whereas most deformities are surgically corrected, there is often residual deformity that may need additional correction. The demographics and characteristics of these secondary deformities remain largely undocumented in Kenya. Main objective Main objective was to determine the pattern of secondary CLP deformities in patients seen in selected hospitals in Nairobi, Kenya. Study design and sites This was a descriptive hospital based, cross-sectional study of patients presenting with secondary CLP deformities seen at selected hospitals in Nairobi, Kenya. Participants and method Convenience sampling technique was used. Study population consisted of patients diagnosed with CLP who had undergone at least one corrective surgery. All patients who meet the criteria for inclusion and consented to participate were enrolled to the study. Data collection Data collection was done using a questionnaire. Data collected included social and demographic characteristics of the patients, primary CLP deformities, age of the initial corrective surgeries and the secondary cleft lip and palate (SCLP6) deformities. The incidence and pattern of the secondary deformity was described and clinical photographs taken. Analysis of the data The data was analysed using SPSS 25th version. Results A total of seventy six (76) secondary cleft cases were enrolled. Forty one (41) being males and thirty five (35) females. The most common primary cleft type was the combined bilateral cleft lip and palate (BCL+P) constituting 22 (28.9%) of all cleft deformities. Of the 76 participants recruited, 69 had primary CL deformities while 7 had isolated cleft palate deformities. Of the 69, forty one (59.4%) had some form of secondary cleft deformity while twenty eight (40.6%) did not have. A total of 39 participants had had their cleft palates repaired. Thirty two (78%) had clinically observable secondary deformities while seven (22%) had no secondary deformities. Some of participants had more than one secondary cleft lip or palate deformities occurring concurrently. There was a slight male preponderance among the participants with male to female ratio of 1.2:1. Age distribution was between 5 months to 27 years with majority being below 4 years 34 (44.7%). They were from urban areas (51.3%), semi urban regions (27.6%) and rural areas (21.1%). Discussion There was a higher proportion of younger patients with mean age of 10 months which is consistent with study by Onyango JF et al (1) Kenyan studies. More than half the number of participants had secondary deformity of the lips (59.4%), this is consistent with the study by Musgrave HR et al (39) who observed that this occurrence may be due technique of repair or post-surgical complications like infection and dehiscence. Most common deformity being scarring (42.4%), a finding consistent with the preponderance of Africans to scar and keloid formation. The most common secondary cleft palate deformity was oronasal fistula in 50%. The more complex the primary deformity the more likelihood of developing secondary deformity. This is consistent with other studies (46-48) that showed the fistula formation rate to be higher in more severe degree of cleft palates. Conclusion Secondary CL +P deformity is a prevalent phenomenon that requiring proportionate attention. It should be addressed early and in a multidisciplinary manner to minimise secondary deformities