Cleft Lip and Palate Awareness Week: Highlights from the BMC Series

Last week was Cleft Lip and Palate Awareness Week 2024. In support of the initiative, the BMC Series would like to highlight some contributions from across our journals that aim to enhance our understanding and awareness of cleft lip and palate. We are also pleased to announce the launch of a new Collection in BMC Oral Health on Innovations in cleft research.

BMC Pregnancy and Childbirth – “Mine did not breastfeed”, mothers’ experiences in breastfeeding children aged 0 to 24 months with oral clefts in Uganda

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A study published in BMC Pregnancy and Childbirth explored the experiences of mothers of infants with orofacial clefts in Uganda, with the occurrence of cleft in children known to lead to feeding difficulties and malnutrition. The authors assessed the breastfeeding history of children with a cleft between 0 to 24 months old, including the use of prelacteal feeds, breast milk alternatives and feeding devices used.

Mothers of children with a cleft were invited to complete a survey and attend focus group discussions to explore their experiences of breastfeeding and the support they received. The study involved 32 mother-child pairs, with 25 mothers participating in the qualitative focus group and interviews. Participants frequently expressed difficulties with breastfeeding, with the use of cow’s milk often reported as an alternative due to the high cost of formula milk. The use of feeding devices was also frequently reported. Whilst participants indicated that family members and the hospital could provide social and feeding support, they also reported experiencing negative attitudes and social stigmatization from the community and shared concerns about their risk of anxiety and depression.

The authors conclude improved national breastfeeding guidelines and encouraging mothers to share experiences via support groups may help reduce difficulties and improve psycho-social outcomes.

BMC Oral Health Knowledge assessment on cleft lip and palate among recently graduated dentists: a cross-sectional study

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An article published in BMC Oral Health describes the development of a questionnaire to evaluate the understanding of cleft lip and palate (CLP) amongst recent dental graduates. In this study, a questionnaire to assess knowledge of CLP, early interventions, interdisciplinary care, and management options was developed and validated using three groups of subject matter experts, including orthodontists, paediatric dentists, and surgeons. The questionnaire was distributed to a cohort of graduates between the ages of 23 and 30 who were enrolled in a dental internship in Jeddah, Saudi Arabia.

The authors identified that whilst graduates demonstrated a strong understanding of how to treat and manage CLP from a dental perspective, knowledge gaps were identified in aspects of care relating to possible risk factors and post-surgical complications. Additionally, whilst graduates identified the importance of interprofessional collaboration when managing CLP, knowledge of the specific roles of specialised healthcare professionals was not expressed by participants.

The authors propose that these knowledge gaps may be addressable by developing bespoke training and practical sessions during undergraduate education.

BMC Medical Education – Utilising massive open online courses to enhance global learning dissemination in cleft lip and palate: a case report of penta helix collaboration

© Nikish Hiraman / /

Since the COVID-19 pandemic there has been an increased shift towards online and hybrid learning by higher education institutions, facilitating distance learning in undergraduate medical education. Whilst this has led to benefits such as the increased accessibility and geographical dissemination of resources and flexibility in learning options for students, online learning may be a barrier to education in regions with disparities in adequate internet access.

This study explored the outcomes of a Massive Open Online Course (MOOC) on cleft lip and palate developed for undergraduate students in Indonesia in collaboration with Smile Train.  414 out of 717 participants completed the MOOC, with course competing students providing positive feedback about the course’s content and the support they received from teachers when enrolled. Challenges identified by students included difficulties with internet access, course scheduling and that some of the topics were perceived as being too advanced, which provides feedback for further course re-assignments.

Continued development of e-learning resources for undergraduate curricula may enhance the geographical dissemination of medical education and future quality of care in low resource settings, particularly for topics with known knowledge gaps such as cleft lip and palate.

BMC Oral Health – Machine learning in 3D auto-filling alveolar cleft of CT images to assess the influence of alveolar bone grafting on the development of maxilla

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The ability to generate high-quality images is a crucial part of surgical planning, for example when performing alveolar bone grafting for unilateral cleft lip and palate. Whilst traditional two-dimensional X-rays can be used, they may lack the detail required for precise planning. Three-dimensional computed tomography (CT) scans provide a comprehensive view of facial structures for alveolar bone graft, enabling surgeons to plan the grafting procedure more accurately and assess post-surgery outcomes.

The authors of a study in BMC Oral Health describe the application of a machine learning model using 3D U-net to automatically detect morphometric changes in scans taken before and after secondary alveolar bone grafting to assess the impact on the growth and development of the maxilla post-surgery. The study involved the analysis of archived images from 32 patients who had not previously undergone surgery or orthodontic treatment. Using the improved efficiency and accuracy of the machine learning model, the authors observed differences in growth trends between the cleft and non-cleft sides of the maxilla following surgery, with secondary alveolar bone grafting appearing to have a positive effect on the length of the maxilla and alveolar ridge, but limited benefit to the height and width of the maxilla on the cleft side.

More in-depth image analysis with machine learning methods may help improve surgical outcomes and inform better treatment approaches.

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