The first study of the treatment outcomes of patients with cleft lip and palate in Central Vietnam
Date
2019-07-08
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Abstract
Huule- ja/või suulaelõhe (CL/P) on maailmas üks enimesinevamaid kaasasündinud arenguanomaaliaid. CL/P esinemissagedus Vietnamis on 1/677 elussünni kohta. Kesk-Vietnamis on tavaks, et enamus CL/P patsientidest loodab rahvusvaheliste abiorganisatsioonide poolt korraldatud ravimissioonidele. Kuna need organisatsioonid ei ole kohal kogu aeg, siis toimuvad operatsioonid korrapäratult ja tavaliselt rahvusvaheliselt aktsepteeritud protokollides ettenähtud aegadest erinevalt. Rahvusvaheliste abiorganisatsioonide meeskond keskendub pigem lõhede kirurgilisele sulgemisele, mitte aga muudele ravimeetoditele. Näiteks logopeedilist- ja ortodontilist ravi rahvusvahelised abiorganisatsioonide meeskonnad ei toeta. Süsteemselt ei toimu ka patsientide lõikuste järgseid järelkontrolle. Seetõttu ei ole hinnatud ka sellise ravikorraldusega patsientide ravitulemusi.
Antud doktoritöö eesmärgiks oli hinnata nende CL/P diagnoosiga patsientide, keda on opereerinud erinevad rahvusvahelised abiorganisatsioonid, ravitulemusi Kesk-Vietnamis. Hinnati järgmisi näitajaid: hammaste tervislik seisund, nasolabiaalne esteetika, kõne kvaliteet, näo-, lõualuude ning suulae morfoloogia, lõualuude mõõdud, ülemiste hingamisteede dimensioonid, patsientide ja nende vanemate/hooldajate rahulolu, ema kogemus toimetulekuks suulõhega lapse sünni järel.
Uuring viidi läbi Hues, mis asub Kesk-Vietnamis. Kaasati 81 CL/P diagnoosiga patsienti. Hambakaariese levimust ja parodondi seisundit hinnati rahvusvahelise tervishoiuorganisatsiooni (WHO) kriteeriumite järgi. Nasolabiaalse esteetika hindamiseks kasutati kolme erinevat meetodit ja hindajateks olid erinevate erialade arstid. Kõnekvaliteet määrati nasaalsuse astme alusel kasutades Nasometer II-e. Näo- ja lõualuude piirkonna ning ülemiste hingamisteede morfoloogilised iseaärasused selgitati välja tsefalomeetrilise uuringuga. Ülalõualuu dimensioonide ja kõvasuulae morfoloogia kindlakstegemiseks kasutati digitaalseid hambamudeleid. CHASQ (Cleft Hearing, Appearance and Speech Questionnaire) küsimustik oli aluseks patsientide ja tema vanemate/hooldajate rahulolu uurimiseks. Emade kogemuse väljaselgitamiseks suulõhega lapse sünni järgselt oli kasutuses eraldi küsimustik.
Kesk-Vietnami suulõhega patsientide hulgas on väga laialt levinud hambakaaries ja gingiviit (igemepõletik). Nasolabiaalne esteetika oli rahuldav. Kõnekvaliteet oli halb, kuna rohkem kui pooltel patsientidel oli kõne hüpernasaalne. Esines Angle IIInda klassi hambumusanomaaliat. Õhuteede, ülakaare ning suulae dimensioonid olid vähenenud just lapspatsientidel. Emade suhtumine CL/P lapse sündi oli ilma suurte emotsioonideta. Nii patsiendid kui ka vanemad/hooldajad olid rahul ravitulemustega.
Vietnamis on pakiline vajadus luua rahvuslik suulõhede register, et oleks võimalik patsientide ravi koordineerida ja jälgida. Samuti on vaja luua ja kasutusele võtta patsientide jälgimise diagnostilised miinimumnõuded. Teeme ettepaneku parandada hammaste tervisega seotud protseduuride, ortodontilise ravi ja logopeedilise teenuse kättesaadavust.
Cleft lip and/or palate (CL/P) is one of the most common congenital birth defects worldwide. In Vietnam, CL/P affects about 1/677 live births per year. In Central Vietnam, most of the patients with CL/P rely on charitable operating teams to receive free treatment for their cleft. Consequently, the treatment is usually behind the optimal timetable compared to other developed countries. These charity cleft treatments have focused on surgery; other types of treatment such as speech therapy or orthodontic treatment have not been provided. Additionally, the follow-ups for these patients are usually fragmented. For these reasons, the treatment outcomes of these patients have not been investigated comprehensively. The purpose of this thesis was to evaluate the treatment outcomes of patients with CL/P in Central Vietnam who were operated on by charity operation teams. We evaluated the following treatment outcomes: oral health status, nasolabial aesthetics, speech, dentofacial morphology, maxillary arch dimensions, palatal morphology, upper airway structures, patient and their parent’s satisfaction with the cleft treatment, and maternal experiences of having a child with CL/P. The study was conducted in Hue, a city in Central Vietnam. A total of 81 patients with repaired CL/P were included in the study. Dental caries experiences and periodontal status were evaluated based on the guidelines of the World Health Organization. Nasolabial aesthetics were assessed by a panel of experienced clinicians using three different methods. The speech of the patients was assessed using the Nasometer II to obtain nasalance scores. Dentofacial morphology and upper airway structures were assessed from lateral cephalograms. Maxillary arch dimensions and palatal morphology were evaluated using digital models. The Cleft Hearing, Appearance, and Speech Questionnaire was used to investigate the satisfaction of patients and their parents with the outcomes of the cleft treatment. A different questionnaire was used to collect information about the experiences of the mother while raising a child with CL/P. Patients with repaired CL/P in Central Vietnam experienced a very high level of caries and signs of gingivitis. They had a fair appearance of nasolabial aesthetics. The speech outcomes were poor and more than half of the patients had hypernasality. Some patients had Class III malocclusion. The airway space, maxillary arch, and palatal dimensions were reduced in children. The mothers did not report any aggressive or extreme feelings about having a child with CL/P. Both patients and their parents were satisfied with the cleft treatment outcomes. This study further stresses the need to establish a national cleft registry to record, monitor, and follow-up with patients with CL/P. It is also important to establish a minimum required standard of records for each patient with CL/P. We additionally recommend improving the oral health, speech, and orthodontic treatment for patients with CL/P in Central Vietnam.
Cleft lip and/or palate (CL/P) is one of the most common congenital birth defects worldwide. In Vietnam, CL/P affects about 1/677 live births per year. In Central Vietnam, most of the patients with CL/P rely on charitable operating teams to receive free treatment for their cleft. Consequently, the treatment is usually behind the optimal timetable compared to other developed countries. These charity cleft treatments have focused on surgery; other types of treatment such as speech therapy or orthodontic treatment have not been provided. Additionally, the follow-ups for these patients are usually fragmented. For these reasons, the treatment outcomes of these patients have not been investigated comprehensively. The purpose of this thesis was to evaluate the treatment outcomes of patients with CL/P in Central Vietnam who were operated on by charity operation teams. We evaluated the following treatment outcomes: oral health status, nasolabial aesthetics, speech, dentofacial morphology, maxillary arch dimensions, palatal morphology, upper airway structures, patient and their parent’s satisfaction with the cleft treatment, and maternal experiences of having a child with CL/P. The study was conducted in Hue, a city in Central Vietnam. A total of 81 patients with repaired CL/P were included in the study. Dental caries experiences and periodontal status were evaluated based on the guidelines of the World Health Organization. Nasolabial aesthetics were assessed by a panel of experienced clinicians using three different methods. The speech of the patients was assessed using the Nasometer II to obtain nasalance scores. Dentofacial morphology and upper airway structures were assessed from lateral cephalograms. Maxillary arch dimensions and palatal morphology were evaluated using digital models. The Cleft Hearing, Appearance, and Speech Questionnaire was used to investigate the satisfaction of patients and their parents with the outcomes of the cleft treatment. A different questionnaire was used to collect information about the experiences of the mother while raising a child with CL/P. Patients with repaired CL/P in Central Vietnam experienced a very high level of caries and signs of gingivitis. They had a fair appearance of nasolabial aesthetics. The speech outcomes were poor and more than half of the patients had hypernasality. Some patients had Class III malocclusion. The airway space, maxillary arch, and palatal dimensions were reduced in children. The mothers did not report any aggressive or extreme feelings about having a child with CL/P. Both patients and their parents were satisfied with the cleft treatment outcomes. This study further stresses the need to establish a national cleft registry to record, monitor, and follow-up with patients with CL/P. It is also important to establish a minimum required standard of records for each patient with CL/P. We additionally recommend improving the oral health, speech, and orthodontic treatment for patients with CL/P in Central Vietnam.
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Keywords
suulaelõhe, huulelõhe, ravitulemused, Vietnam