Correlation between orofacial clefts and chronic serous otitis media

Author: Jolanta Lazdāne

Scientific supervisor: Gints Tomiņš MD

Introduction

• Orofacial clefts are the most common of congenital craniofacial abnormalities.

• Amount of complications depends on severity and type of cleft.

• One of common complications chronic serous otitis media.

• In order to avoid other complications it’s important to diagnose and treat chronic serous otitis media.

Methods and materials.

• Retrospectively collect and analyse data of patients with orofacial clefts who had ENT specialist consultation in the Children hearing centre of Latvia.

• Statistical analyses were performed using SPSS software

Embriology

• Development of the central face begins around the end of the fourth week of human development. Proliferation of ectomesenchyme on both sides of each placode results in the formation of the medial and lateral nasal processes.

• During the sixth and seventh weeks of development, the upper lip forms when the medial nasal processes merge with each other and with the maxillary processes of the first branchial arches. The lateral nasal processes give rise to the alae of the nose.

• The primary palate also is formed by the merger of the medial nasal processes to form the intermaxillary segment.

• The secondary palate, which makes up 90% of the hard and soft palates, is formed from the maxillary processes of the first branchialarches.

• By the eighth week, sufficient growth has occurred to allow the anterior aspects of palatal shelves to begin fusion with one another. The palatal shelves also fuse with the primary palate and the nasal septum. The fusion is completed by the twelfth week.

Causes of clefts

• Defective fusion of the medial nasal process with the maxillary process leads to cleft lip (CL).

• Likewise, failure of the palatal shelves to fuse results in cleft palate (CP).

• Frequently, CL and CP occur together. • Approximately 45% of cases are CL + CP with 30% being

CP only (CPO) and 25% being isolated CL. • The cause of CL ± CP and CPO is still being debated:

– associated with specific syndromes – major genes, minor genes, and environmental factors – Maternal alcohol consumption – Maternal cigarette smoking – anticonvulsant therapy, especially phenytoin.

Tiesser clasifficationThe classification system numbers clefts based upon their location surrounding the orbit. Numbers 0 through 7 run inferior to the orbit (facial clefts) from medial to lateral, number 8 runs on the lateral portion of the orbit, and numbers 9 through 14 run superior to the orbit from lateral to medial (cranial clefts)

Clinical presentation

• characteristic facial deformities,

• bifid uvula,

• feeding difficulties,

• nasal reflux or emission,

• hypernasal speech,

• recurrent otitis media,

• infants cannot breastfeed.

Clefts association with otitis media

• abnormal palatal muscle insertion impairs middle ear drainage.

• Th: myringotomy with ear tube placement

Results

Results.

Results.

Results.

Conclusions.

• Orofacial clefts are complex pathologies which requires multidisciplinary approach.

• It is statistically significant that congenital orofacial clefts correlate with chronic serous otitis media.

• There is no significant difference in amount of time of waiting for reconstructive surgery in male and female patients and in patients with and without chronic serous otitis media.