Differences in the clinical appearances of white versus black patients with facial cleft deformities : a retrospective study of a South African clinic

Abstract

OBJECTIVE: The purpose of this study was to determine the difference in prevalence of the different categories of facial cleft deformities between the white and black patients in a database of 2806 cleft cases at the University of Pretoria. No variation of clefts between these two groups has ever been compared previously. For this purpose, the clefts were classified according to the system described by Bütow in 1985. MATERIAL AND METHODS: Records of 2806 patients attending the university’s cleft lip and palate clinic, between August 1983 and February 2006, were reviewed. The study group included cleft patients with syndromic and nonsyndromic CL, CLA, CLAP, hP, hPsP, sP, COMBI clefts with or without oblique or transverse facial (or Tessier) clefts. Very few of the cases presented with speech problems only, but with no clefts. The cleft categories of cleft lip, cleft palate and cleft lip and palate, as well as their subdivisions, were analysed. RESULTS: Of these cleft patients, 2003 were white patients and 665 were black patients; the rest were Indian, Coloured and East-Asian patients. In the black and the white population groups (n = 2668), there were more males with cleft in the white group (58,2%), but more females with clefts in the black group (54,9%). The most common cleft type generally was the cleft lip, alveolus and palate cleft (CLAP) with a 434% prevalence of white patients and 296% of black patients. The most common cleft in the black patients was the cleft palate at 435%, which was only recorded in 35,0% of the white patients. The frequency of the other orofacial clefts in decreasing order was: sP 19,4% for white and 21,2% for black; hPsP 15,2% for white and 21,2% for black; CLA 9,7% for white and 19,8% for black; CL 5,9% for white and 4,5% for black and combinations of different orofacial clefts (COMBI), 6,0% for white and 2,6% for black. The isolated hard palate cleft (hP) occurred very rarely (0,4% for white and 1,1% for black). The left side of the face was more often afflicted (left to right 51,6% to 28,5% for white; and 35,0% to 37,9% for black). In 0,5% (white) and 3,9% (black) median clefts were observed. CONCLUSION: A retrospective study was done of 2806 facial cleft cases in order to analyse and then determine the frequency of specific clinical appearances in the white and the black patients (2668 cases). There was a considerable variation between the groups of orofacial clefts occurring in the two groups.