Epidemiological, clinical and therapeutic aspects of cleft lip and palate in the Democratic Republic of Congo: about 1666 cases

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Médard, Ahuka Onalongombe, Eshete MEKONEN, Todd M. Van Ye, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3985236/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Introduction: Cleft lip and/or palate (CLP) are congenital malformations which mainly affect the upper lip and/or palate and are the most common malformations of the orofacial sphere. The objective of the present study was to describe the epidemiological, clinical and therapeutic profile of cleft lip and palate patients managed in the Democratic Republic of Congo (DRC). Material and Methods a retrospective descriptive study of 1666 patients with cleft lip and palate collected in 20 provinces of the DRC and managed between January 2017 and June 2022. The variables studied were epidemiological, anatomo-clinical and therapeutic. Results The mean age of patients seeking care was 11.6 years. The male predominance was (58.6%). A family history of CLP was found in 4.3% of cases and the association of CLP with other visible congenital malformations was identified in 1.5%. Isolated cleft lips were (66.1%) and palates (2.6%) of cases. Combinations involving cleft lip, palate and alveoli were observed respectively as following in terms of frequency: cleft lip-alveolar (15.7%), cleft lip-alveolar-palatal (10.6%) and cleft lip-palate (4.9%). The left side cleft was more common. Cheiloplasty was the most common repair procedure for cleft lip (81.4%) and the isolate palatoplasty was performed for 2.6% cleft palate. Conclusion In the DRC, CLP are common, with male predominance and often treated late. Cleft lips occur more commonly than cleft palates. Cleft lip and palate epidemiology clinical anatomy management Democratic Republic of Congo Figures Figure 1 Background Cleft lip and/or palate (CLP) are congenital malformations that primarily affect the upper lip and /or the palate. Beyond their obvious aesthetic impact, these conditions can cause a range of medical, functional and psychosocial challenges which affect individuals and their families at a number of levels. Some risk factors such as genetic, environmental and maternal have been identified to be associated with development of CLP [ 1 – 4 ]. CLP constitute a major health issue globally and are among the most common birth defects affecting approximately one in 700 births worldwide [ 1]. The prevalence of these malformations may vary between populations and geographic regions. A Chinese study conducted in Guangdong province reported a prevalence of CLP of 7.55 per 10,000 births [ 5 ] while another conducted in Beijing found a prevalence of 18.9 per 10,000 births [ 6 ]. In Uganda, the reported prevalence was 0.73 per 1000 births [ 7 ] and in Sudan it was 0.9 per 1000 births [ 8 ]. In studies published on congenital malformations in Lubumbashi (Democratic Republic of Congo [DRC]) the reported prevalence of CLP ranged from 0.65 to 0.8 per 1000 births [ 9 , 10 ]. Clinically, cleft lips are characterized by an opening in the upper lip, while cleft palates manifest as an opening in the palate. These defects can vary in size and severity, from a simple incomplete split in the lip to a complete cleft extending to involve nose, alveolus and palate. CLP may also be associated with other birth defects, such as heart defects or nervous system abnormalities [ 1 ]. Early management of CLP requires a multidisciplinary approach involving plastic surgeons, orthodontists, speech therapists and other healthcare professionals. Surgical treatment of cleft lip involves lip repair, with restoration of normal appearance and function (smiling, whistling, kissing). For cleft palates, surgery is required to close the cleft to restore the normal functions of speech, breathing and swallowing [ 1 , 11 ]. Despite the impact of CLP, there is a lack of specific data in the DRC. Epidemiological and clinical research is essential to assess the magnitude of this health problem in the country and contributes to the development of public health strategies aimed at reducing the morbidity associated with these malformations. In this perspective, the present retrospective descriptive study aims to explore the epidemiological, clinical and therapeutic aspects of cleft lip and/or palate in the DRC. By analyzing medical and surgical data collected over a specific period, this study aims to lay the foundation for a better understanding of this problem within the Congolese population, and thus contribute to the improvement of care and the quality of lives of the patients concerned. Materials and methods This is a descriptive study with retrospective data collection which took place from January 2017 to June 2022 in 20 of 26 provinces of the DRC (Table 1 ): Table 1 Distribution of patients according to recruitment provinces Province n = 1666 Percentage North Kivu 342 20.5 Kasai-Oriental 199 11.9 Kasai-Central 143 8.6 North Ubangi 124 7.4 Kongo Central 101 6.1 South Ubangi 94 5.6 Kasai 78 4.7 Lomami 73 4.4 Maniema 73 4.4 Sankuru 65 3.9 Kwango 61 3.7 South-Kivu 47 2.8 Haut-Uele 45 2.7 Kwilu 45 2.7 Tanganyika 35 2.1 Haut-Katanga 31 1.9 Équateur 20 1.2 Mai-Ndombe 20 1.2 Ituri 19 1.1 Kinshasa 14 0.8 Bas-Uele 13 0.8 Lualaba 10 0.6 Tshopo 7 0.4 Mongala 6 0.4 Haut-Lomami 1 0.1 Patients were recruited during several free campaigns of surgical repair of CLP organized by the non-governmental organization HEAL Africa in collaboration with the DRC National Ministry of Public Health planning to provide acceptable access to quality of care for the DRC population. The financial support of free campaigns was provided from the non-governmental organization Smile Train which supports free cleft repair surgery and comprehensive cleft care for children globally. The recruitment method consisted of awareness-raising periods by HEAL Africa. Messages were disseminated to the most remote corners of the country in search of patients with CLP. In the province of North Kivu, the surgical interventions took place at the HEAL Africa Hospital located in the city of Goma and at the General Reference Hospital (GRH) in Beni. In the 19 other provinces, the surgical interventions took place in the GRH of each of them. Surgical treatment covered1601 patients out of 1666 presenting with CLP. Patients came after community awareness in the sites (cities or villages) where the aforementioned hospitals. Patients with orofacial malformations were referred to the hospitals indicated above for medical evaluation and those with CLP were retained for surgical repair. All patients for surgical repair had a preanesthetic consultation and preoperative laboratory investigations. In each site, all patients were repaired by the same surgical team including a surgeon, an anesthetist and a nurse in collaboration with the local team. In each site mentioned above, the surgical campaigns took place for 1 to 4 consecutive weeks. For each campaign, the team used a well-stocked technical platform with which it traveled from the HEAL Africa hospital (HAH) in Goma. All patients aged at least three months and weighing approximately 4 kg on average were operated on for lip repair and children aged over 12 months for palatal repair. Data collection was done through a questionnaire, the data of which was collected from patient interviews, outpatient consultation registers, operating room registers, and hospitalization registers. The surgical techniques used for cleft lip were straight-line repair, Millard rotation-advancement repair and Millard-Mulliken for bilateral cleft lip repair. For the cleft palate, Von Langenbeck and Bardach repair were performed. In this study we were not able to carry out interventions on the bony gingival arch. Surgical indications for each patient were established by the surgeons. Surgical techniques used depended on the type of cleft and the expertise of the surgeon. The anesthesia was either local or general depending on the age of the patient for cleft lip repair, while all patients undergoing cleft palate repair received general anesthesia. The variables studied focused on demographic aspects (age at consultation, sex, family history of CLP), clinical aspects (types and varieties of CLP whose clinical diagnosis was based on the Lahshal classification, associated visible congenital malformations) and therapeutic and progressive (operative technique used, type of anesthesia, immediate postoperative consequences, hospital stay). Statistical analyzes were carried out using STATA 16 software. We used the entire sample to describe the epidemiological, obstetrical, clinical and therapeutic characteristics of CLP with frequencies (%) and means (with standard deviation). The study obtained approval from the Medical Ethics Committee of the University of Goma (approval number: UNIGOM/CEM/013/2022). The data was collected anonymously. The study did not present any direct, particularly lucrative benefit for the study participants. Before any surgical procedure, each patient or their guardian signed informed consent about the risks and possible complications of the surgical procedure. Results A total of 1666 patients with CLP were recorded during the study period. In Table 1 , we see that most patients were recruited in the province of North Kivu (20.5%), followed by the provinces of Kasai-Oriental (11.9%), Kasia-Central (8. 6%) and North Ubangi (7.4%). The mean age of our patients was 11.6 years (range: 3 months to 78 years). Forty-nine percent (816/1666) of our patients had consulted at the age of 5 years or less and 51% were aged over 5 years. We noted a predominance of the male sex (58.6%), with a sex ratio of 1.4. A family history of CLP was found in 72 patients (4.3%) and the association of CLP with other congenital abnormalities of various types were reported in 25 patients (1.5%) (Table 2 ). Table 2 Distribution of cases according to age, sex, family history of CLP and the presence of other congenital abnormalities. Parameter (n = 1666) Percentage Age (Years) ≤ 5 816 49.0 6–10 204 12.2 11–15 148 8.9 16–20 149 8.9 21–25 106 6.4 > 25 243 14.6 Sex Female 690 41.4 Male 976 58.6 Family history of CLP Absent 1594 95.7 Present 72 4.3 Other Obvious congenital abnormalities Absent 1641 98.5 Present 25 1.5 Figure 1 shows that clefts affect the isolated lips at (66.1%) and the palate at (2.6%). The associations involving the lips, palates and alveoli are as follows in terms of frequency: cleft lip-alveolar (15.7%), cleft lip-alveolar-palatal (10.6%), cleft lip-palate (4.9%) and alveolar-palatal clefts (0.1%). Table 3 shows the hierarchy in the frequencies of cleft types is the same for the male and female. Table 3 Distribution of cases according to variety and sex Types of clefts Sex Total (N = 1666) Female (n = 690), n (%) Male (n = 976), n (%) Cleft lip 460 (66.7) 642 (65.8) 1102 (66.1) Cleft lip and alveolus 118 (17.1) 144 (14.7) 262 (15.7) Cleft lip, alveolus & palate 68 (9.9) 108 (11.1) 176 (10.6) Cleft lip and palate 22 (3.2) 60 (6.1) 82 (4.9) Cleft palate 22 (3.2) 21 (2.1) 43 (2.6) Cleft alveolus & palate 0 (0.0) 1 (0.1) 1 (0.1) Cleft of alveolus 0 (0.0) 0 (0.0) 0 (0.0) This Table 4 shows that the left side is the most frequently affected, and that the complete type of cleft is predominant at the lip and palate level. Table 4 Description of profile of cleft lip and palate in patients (n = 1666) Parameter Lip n (%) Palate n (%) Alveolar n (%) Complete bilateral cleft 146 (8.8) 66 (4.0) 39 (2.3) Incomplete bilateral cleft 57 (3.4) 47 (2.8) 47 (2.8) Complete right cleft 302 (18.1) 40 (2.4) 35 (2.1) Incomplete right cleft 219 (13.2) 28 (1.7) 103 (6.2) Complete left cleft 500 (30.0) 61 (3.7) 51 (3.1) Incomplete left cleft 398 (23.9) 60 (3.6) 164 (9.8) No cleft 44 (2.6) 1364 (81.9) 1227 (73.7) Total 1666 (100.0) 1666 (100.0) 1666 (100.0) Of the 1666 patients examined, 1601 or 96.1% were operated on, including 88.8% for the first time. The other 65 patients were not operated on due to age less than three months, comorbidity such as cardiac or renal congenital abnormalities, and when the patient presented with severe malnutrition. Seventy-point two percent of our patients received general anesthesia and 29.8% local anesthesia. Eighty-one-point four percent of CLP underwent cheiloplasty, 16% of patient presenting CLP benefited for combined cheiloplasty and palatoplasty and 2.6% of cleft palate had palatoplasty only. The Millard technique was preferred for unilateral cleft, the straight on-line procedure was used for incomplete cleft and Mulliken for bilateral cleft. The Von Langenbeck palatoplasty was performed for incomplete cleft palate and Bardach procedure performed for complete cleft palate (Table 5 ). The average hospital stay was 2.7 days. The shortest stay was 1 day, and the longest stay 7 days. Table 5 Surgical Procedure Performed in patients with Cleft lip and Palate Variable (n = 1601) Percentage Type of anesthesia General 1125 70.2 Local 476 29.8 Surgical techniques n = 1601 Cleft lip Repair or Cheiloplasty 1303 81.4 Cleft lip Repair (Cheiloplasty) and Cleft Palate repair (Palatoplasty) 256 16.0 Cleft palate repair (Palatoplasty) 42 2.6 Discussion The epidemiological data obtained in our study on cleft lip and palate (CLP) provide important insights into the distribution of this malformation within our patient population. The mean age of 11.6 years with a variability ranging from 3 months to 78 years reflects the diversity of the stages of diagnosis and management of CLP. This variability in the mean age at the time of seeking care is in accordance with the results reported by Sangwa et al. in Lubumbashi (DRC) reporting 11.8 years [ 12 ] and by Longombe and Tshimbila in Goma (DRC) finding 9.9 years [ 13 ]. The finding that almost half of our patients presented at the age of 5 years or younger highlights the importance of early detection of CLP. This is consistent with recommendations from other studies, which emphasize the positive impact of early intervention on both functionally and aesthetically [ 14 ]. On the other hand, the significant proportion (51%) of patients aged over 5 years at the time of consultation raises questions about the factors which could contribute to a late diagnosis. Previous studies have suggested that socioeconomic barriers, limited access to health care, or lack of awareness of the malformation could influence the timing of consultation [ 15 – 17 ]. Additionally, in African communities, the birth of a malformed baby is considered a tragic event due to the religious and mystical considerations surrounding it. Children who have a cleft lip and palate at birth are often hidden by their parents for fear of stigma and discrimination and may cause divorce [ 12 , 18 ]. Understanding these factors is essential to implementing strategies to reduce the delay in making the diagnostic and improve access to care. The present study highlights a significant predominance of the male sex among patients with CLP, with a sex ratio of 1.4 in favor of male. This observation raises relevant questions about gender differences in CLP prevalence. The predominance of the male sex in our cohort is consistent with previous findings reported by several Congolese studies [ 10 , 12 , 13 , 19 ]. For example, a study conducted in Goma (DRC) revealed a male predominance of 59.2% in patients with cleft lip and palate [ 19 ]. Another study conducted in Lubumbashi (DRC) revealed a male/female ratio of 1.2:1 in patients with cleft lip and palate [ 12 ]. However, variations in sex distribution have been observed in other study populations [ 20 – 22 ]. These differences could be the result of genetic or environmental variations that merit further investigation. Genetic studies have suggested associations between certain genes involved in facial development and predisposition to CLP, but the exact understanding of the mechanisms underlying sexual predominance remains incomplete [ 23 , 24 ]. The results of the present study highlight a prevalence of family history of cleft lip and palate (CLP) among our patients, with 72 cases representing 4.3% of the total sample. In the study by Sangwa et al. [ 12 ], the presence of family history was reported at 20.7%. This observation raises intriguing questions about the potential contribution of the genetic component in the development of some cases of CLP, and it is important to explore these findings in light of the work of other investigators. Previous studies have also reported associations between CLP and positive family history, thus supporting the idea of ​​a genetic predisposition [ 10 , 25 ]. These findings support the hypothesis that genetic factors may play a critical role in the pathogenesis of CLP. Extensive genetic investigations have identified several CLP-associated genes involved in embryonic facial development. Genetic variability may contribute to the diversity in CLP prevalence in families [ 26 , 27 ]. However, it is essential to note that despite the presence of a family history, the majority of cases of CLP occur sporadically. This suggests a complex interaction between genetic and environmental factors in triggering this malformation [ 26 ]. Environmental exposures, such as nutritional factors, exposure to toxins, or other unknown factors, could also influence the risk of CLP, even in the absence of a genetic predisposition. A Chinese study reported a significant association between heavy metals and the occurrence of CLP [ 28 ]. In the present study, the identification of 25 cases (1.5%) of CLP associated with other visible malformations reinforces the idea that CLP may be part of more complex syndromes presenting a variety of anatomical abnormalities (Dixon et al., 2011; Leslie, 2017). The prevalence of these associations varies considerably depending on the populations studied, with rates reaching 21% [ 29 , 30 ], highlighting the diversity of epidemiological contexts. These differences could be influenced by genetic factors specific to each population, variations in data collection methodologies, or differences in the diagnostic criteria used. Genetic studies have identified syndromes associating CLP with other congenital malformations, highlighting underlying genetic abnormalities that influence overall embryonic development [ 31 ]. Early recognition of these associations may have important implications for clinical management, particularly in terms of planning surgical interventions, medical monitoring, and assessment of overall prognosis. As for the anatomical varieties of CLP, comparing our results with other studies, this study has similar trends regarding the predominance of cleft lips, followed by combinations of cleft lip, alveolar and palate. [ 12 , 13 , 20 ]. However, variations in specific percentages can be observed, highlighting the diversity in the anatomical presentation of CLP between different populations. The predominance of isolated cleft lip in our study is consistent with previous studies [ 12 , 13 , 20 ]. This observation suggests that cleft lips often represent the primary manifestation of the malformation. The high frequency of lip and alveolar clefts (15.7%) underlines the importance of the involvement of the lip and the alveolus in the pathogenesis of CLP. The identification of isolated cleft palates in 2.6% of patients in our study is in line with the generally lower prevalence of isolated cleft palates compared to cleft lips because they are hidden and do not attract parental attention or they simply do not want to talk about it as malformations are misinterpreted in Africa [ 13 ]. These results highlight the heterogeneity of clinical presentations of CLP and highlight the need for an individualized approach in clinical management. Complex associations between the lips, palates, and alveoli, such as cleft lip (15.7%) and cleft lip/palate (10.6%), are consistent with the expected anatomical variability in the CLP. These multiple associations reflect the diversity of abnormalities in embryonic facial development and require in-depth surgical and multidisciplinary management. Regarding the location of CLP, the observation that the left side is more frequently affected, is consistent with similar findings reported in the literature [ 12 , 13 , 21 , 32 ]. These findings could be related to specific embryonic mechanisms or environmental factors influencing the prevalence of left-sided CLP. Regarding the distribution of complete and incomplete forms of CLP, our finding that complete forms predominate at the lips and palates, while incomplete forms dominate at the alveoli, is consistent with previous observations [ 12 , 13 , 21 ]. This distribution may be linked to differences in stages of embryonic development or to specific pathogenic mechanisms in these anatomical regions. However, variations in these trends have been noted in other studies, highlighting the complexity of CLP genetics and embryonic development. Genetic and environmental factors specific to each population could influence these differences, requiring further exploration. Talking about the management of cleft lip and palate, more than 81.4% patients had cleft lip repaired according to the Straight on-line, Millard, and Mulliken techniques. In the present study, the Straight on-line technique was used for incomplete unilateral cleft lip repair, the Millard or Modified Millard technique was used to repair the complete unilateral cleft lip and the Mulliken technique for bilateral cleft repair. Studies elsewhere have described that the modified Millard technique is commonly used for cleft lip repair, particularly in the United States of America and Europe [ 33 ]. The Manchester and Mulliken techniques are best performed for bilateral labiaplasty. The advantages of the Mullikens procedure are lengthening of the columella with superior repair of the nostril [ 34 ]. A multicenter analysis carried out in Germany reported five most commonly used lip repair techniques from 37 participating centers. These were the Randall-Axhausen, Tennison, Pfeiffer, Delaire, Millard and Tennison-Randall techniques. The Millard (12/37 centers) and Tennison (14/37 centers) techniques were the most popular [ 35 ]. Gatti et al. [ 36 ] used the Tennisson-Randall and modified Millard techniques respectively to perform unilateral cleft lip surgery and the Mulliken technique was used for bilateral cleft lip. Regarding palate repair, Cubitt et al. [ 37 ] revealed that palatoplasty is more performed in developed countries than developing countries. Sub-Saharan African countries have low rates of cleft palate repair. In this study, 20.0 and 2.6% of respectively CLP and CP patients had undergone palatoplasty by practicing Von Langenbeck and Bardach techniques. When performing bilateral palatoplasty, the Bardach technique is performed more commonly where a vomer flap is applied for reconstruction [ 35 ]. Gatti et al used the Bardach or Von Langenbeck technique from the age of 6 months to repair the palate [ 36 ]. The study by Akinmoladun et al. [ 38 ] showed that Millard's rotation and advancement technique was used for lip repair in 91.2% and 63.7% used Von Langenbeck technique for palatal repair. To date, systematic reviews of the published literature have revealed no consensus on which treatment provides the best patient outcome [ 39 ]. In most cases, the surgical approach is entirely based on the personal preference of the surgeon, and most surgical centers have their own technique of choice [ 40 ]. The results of this study must be interpreted taking into account certain limitations. First, this study does not include information on the long-term outcomes of patients who underwent CLP reconstructive surgery. Follow-up over a prolonged period would have made it possible to assess the results of surgical interventions, possible complications, and the impact on quality of life. Second, this study could be subject to selection bias, because it is based on cases of cleft lip and palate identified during awareness campaigns. Patients who participated in the campaigns may not be representative of the entire population with this malformation, as some individuals may not have had access to these awareness services. Despite these limitations, this study has a number of notable strengths. First, the sample size of 1666 CLP cases represents a substantial sample size, providing an important database to describe the characteristics of this malformation. Additionally, this study provides an important perspective on the local population affected by CLP, which may have direct implications for public health policies and awareness interventions. Conclusion This retrospective descriptive study on cleft lip and/or palate in the Democratic Republic of the Congo provided essential epidemiological, clinical and therapeutic data. Late age at presentation, male predominance, and associations with other congenital malformations have been documented. Cleft lips were found to be more common than cleft palates, with complex shapes, such as cleft lip, alveolar palate, accounting for a significant proportion. The prevalence of left-sided involvement in all cleft types highlights a notable trend. Furthermore, the results indicate that the Millard technique was widely used, followed closely by the Straight-line technique. These observations highlight key elements that can guide approaches to the management of cleft lip and palate in the DRC, while emphasizing the importance of continuing to improve accessibility to care and surgical skills in this context. Abbreviations DRC Democratic Republic of the Congo CL Cleft lip CLP Cleft lip and palate CLAP Cleft Lip-Alveolar and Palate CP Cleft palate HAH Heal Africa Hospital NSCLP Non syndromic cleft lip and palate LAHSHAL Lip, Alveolar, Hard Palate, Soft Palate, Hard Palate, Alveolar, Lip UNIGOM University of Goma and GRH:General Reference Hospital. Declarations Acknowledgments: Expresses our heartfelt to Smile Train, Neil Wetzig, Olivier Mukuku, Sylvain Kwiratwiwe, Poteau Katsuva, Paluku Saruti Elvis Authors’ contributions K.K.M: Conceptualized and designed the study, collected data and approved final manuscript publication. WOS: Conceptualized and designed the study, drafted and revised the article and approved final manuscript publication. UAS, AO, ME, participate to critical revision of manuscript. TVY: Advised on the process of data collection, approved final manuscript publication and mentor in plastic surgery of cleft, PM: Conceptualized and designed the study, drafted and revised the article and approved final manuscript publication and mentor in plastic surgery of cleft. Funding This research received no external funding Availability of data and Materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics Approval and consent to participate The study was performed in accordance with the principles of the Declaration of Helsinki, and the Medical Ethics Committee of the University of Goma approved the study; reference UNIGOM/CEM/013/2022 Consent for publication Not applicable Competing interest No competing of interest References Vyas T, Gupta P, Kumar S, Gupta R, Gupta T, Singh HP. Cleft of lip and palate: A review. J Family Med Prim Care. 2020;9(6):2621–5. 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Congenital malformations and medical conditions associated with orofacial clefts in children in Burkina Faso. BMC Pediatr. 2017;17:72. Hadadi AI, Al Wohaibi D, Almtrok N, Aljahdali N, AlMeshal O, Badri M. Congenital anomalies associated with syndromic and non-syndromic cleft lip and palate. JPRAS open. 2017;14:5–15. Venkatesh R. Syndromes and anomalies associated with cleft. Indian J Plast Surg. 2009;42(SupplSuppl):S51–5. Eshete M, Gravenm PE, Topstad T, Befikadu S. The incidence of cleft lip and palate in Addis Ababa, Ethiopia. Ethiop Med J. 2011;49(1):1–5. Millard DR. The embryonic rationale for primary correction of the cleft lip and palate Annals. Roy Coll Surg Eng, 1994:76150–60. Mulliken JB. Correction of the bilateral cleft lip: Review, Revision and Reflection J. Craniofacial Surgery 2003:14(5)609 – 20. Thiele OC, Kreppel M, Dunsche A, Eckardt AM, Ehrenfeld M, Fleiner B, et al. Current concepts in cleft care: a multicenter analysis. J Cranio-Maxillofacial Surg. 2018;46(4):705–8. Gatti GL, Freda N, Giacomina A, Montemagni M, Sisti A. Cleft lip and palate repair. J Craniofac Surg. 2017;28(8):1918–24. Cubitt JJ, Hodges AM, Van Lierde KM, Swan MC. Global variation in cleft palate repairs: an analysis of 352,191 primary cleft repairs in low-to-higher-middle-income countries. Cleft Palate-Craniofacial J. 2014;51(5):553–6. Akinmoladun V, Ademola S, Ademola A. Management of cleft lip and palate in Nigeria: A survey. Niger J Clin Pract. 2017;20(11):1355–9. Shaye D. Update on outcomes research for cleft lip and palate. Curr Opin Otolaryngol Head Neck Surg. 2014;22(4):255–9. Tan SP, Greene AK, Mulliken JB. Current surgical management of bilateral cleft lip in North America. Plast Reconstr Surg. 2012;129(6):1347–55. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 04 May, 2024 Reviews received at journal 02 Apr, 2024 Reviewers agreed at journal 20 Mar, 2024 Reviewers invited by journal 20 Mar, 2024 Editor assigned by journal 20 Mar, 2024 Editor invited by journal 20 Mar, 2024 Submission checks completed at journal 15 Mar, 2024 First submitted to journal 24 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3985236","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":279975720,"identity":"c4edcd68-a632-4553-aeaf-9535e7e0db24","order_by":0,"name":"KABUYAYA K. Médard","email":"","orcid":"","institution":"University of Goma","correspondingAuthor":false,"prefix":"","firstName":"KABUYAYA","middleName":"K.","lastName":"Médard","suffix":""},{"id":279975721,"identity":"f44d1f6d-5ed9-4516-83e8-ff6972544440","order_by":1,"name":"Ahuka Onalongombe","email":"","orcid":"","institution":"Université de Kisangani","correspondingAuthor":false,"prefix":"","firstName":"Ahuka","middleName":"","lastName":"Onalongombe","suffix":""},{"id":279975722,"identity":"bf3b17fa-59f3-43b3-9a32-45bfda3aee15","order_by":2,"name":"Eshete MEKONEN","email":"","orcid":"","institution":"University of Addis Ababa","correspondingAuthor":false,"prefix":"","firstName":"Eshete","middleName":"","lastName":"MEKONEN","suffix":""},{"id":279975723,"identity":"a1be7707-6f61-4460-b227-9f2911c26db0","order_by":3,"name":"Todd M. Van Ye","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYBADORBx4AExSnmgtDFYSwIpWhIbQCRRWuzFzhh+LmyzSZ8fdvgh0BY7Od0GQrZI5xhLz2xLy914O80AqCXZ2OwAQS1pCdK8bYdzN85OAGk5kLiNCC3Jv3nb/qcbzk7/QKyW5GNAWw4kyEvnEGvL7eRj1jznkg03SOcUHEgwIMIv7LMTm2/zlNnJy89O3/zhQ4WdHEEtYMDIxsBgAFZpQIxyMPjDwCDfQLTqUTAKRsEoGGkAAH56QjANvlmyAAAAAElFTkSuQmCC","orcid":"","institution":"Plastic and Reconstructive Surgery, Center of Aesthetic and Plastic Surgery, Wisconsin, USA","correspondingAuthor":true,"prefix":"","firstName":"Todd","middleName":"M. Van","lastName":"Ye","suffix":""},{"id":279975724,"identity":"fa37a51e-0487-4802-b4d5-49207ac7f22a","order_by":4,"name":"Paul MILLICAN","email":"","orcid":"","institution":"Plastic and Reconstructive Surgery, Queensland, 4109, AUSTRALIA","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"MILLICAN","suffix":""},{"id":279975725,"identity":"4ba0cf04-cddc-47ab-a227-0a6cce1e8a04","order_by":5,"name":"Stanis O. WEMBONYAMA","email":"","orcid":"","institution":"University of Goma","correspondingAuthor":false,"prefix":"","firstName":"Stanis","middleName":"O.","lastName":"WEMBONYAMA","suffix":""},{"id":279975726,"identity":"411fbb91-4f5d-42a1-acf3-993ef6de8eb2","order_by":6,"name":"Severin UWONDA AKINJA","email":"","orcid":"","institution":"University of Mbuji Mayi","correspondingAuthor":false,"prefix":"","firstName":"Severin","middleName":"UWONDA","lastName":"AKINJA","suffix":""}],"badges":[],"createdAt":"2024-02-24 14:31:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3985236/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3985236/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53009717,"identity":"fce36a66-bbf0-4b9b-bc75-eade8d20a974","added_by":"auto","created_at":"2024-03-19 15:24:00","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":152491,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eDistribution of cases according to cleft types\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3985236/v1/c6263c882ea7a36637abc71d.jpeg"},{"id":53010982,"identity":"2fc0312c-d154-449f-ae82-99bca989cfdf","added_by":"auto","created_at":"2024-03-19 15:32:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":355869,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3985236/v1/74610512-19bc-4251-8774-cfdfac88146e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiological, clinical and therapeutic aspects of cleft lip and palate in the Democratic Republic of Congo: about 1666 cases","fulltext":[{"header":"Background","content":"\u003cp\u003eCleft lip and/or palate (CLP) are congenital malformations that primarily affect the upper lip and /or the palate. Beyond their obvious aesthetic impact, these conditions can cause a range of medical, functional and psychosocial challenges which affect individuals and their families at a number of levels. Some risk factors such as genetic, environmental and maternal have been identified to be associated with development of CLP [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCLP constitute a major health issue globally and are among the most common birth defects affecting approximately one in 700 births worldwide [ 1]. The prevalence of these malformations may vary between populations and geographic regions. A Chinese study conducted in Guangdong province reported a prevalence of CLP of 7.55 per 10,000 births [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] while another conducted in Beijing found a prevalence of 18.9 per 10,000 births [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In Uganda, the reported prevalence was 0.73 per 1000 births [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and in Sudan it was 0.9 per 1000 births [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In studies published on congenital malformations in Lubumbashi (Democratic Republic of Congo [DRC]) the reported prevalence of CLP ranged from 0.65 to 0.8 per 1000 births [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinically, cleft lips are characterized by an opening in the upper lip, while cleft palates manifest as an opening in the palate. These defects can vary in size and severity, from a simple incomplete split in the lip to a complete cleft extending to involve nose, alveolus and palate. CLP may also be associated with other birth defects, such as heart defects or nervous system abnormalities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly management of CLP requires a multidisciplinary approach involving plastic surgeons, orthodontists, speech therapists and other healthcare professionals. Surgical treatment of cleft lip involves lip repair, with restoration of normal appearance and function (smiling, whistling, kissing). For cleft palates, surgery is required to close the cleft to restore the normal functions of speech, breathing and swallowing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the impact of CLP, there is a lack of specific data in the DRC. Epidemiological and clinical research is essential to assess the magnitude of this health problem in the country and contributes to the development of public health strategies aimed at reducing the morbidity associated with these malformations.\u003c/p\u003e \u003cp\u003eIn this perspective, the present retrospective descriptive study aims to explore the epidemiological, clinical and therapeutic aspects of cleft lip and/or palate in the DRC. By analyzing medical and surgical data collected over a specific period, this study aims to lay the foundation for a better understanding of this problem within the Congolese population, and thus contribute to the improvement of care and the quality of lives of the patients concerned.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis is a descriptive study with retrospective data collection which took place from January 2017 to June 2022 in 20 of 26 provinces of the DRC (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e):\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of patients according to recruitment provinces\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvince\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;1666\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth Kivu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKasai-Oriental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKasai-Central\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth Ubangi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKongo Central\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth Ubangi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKasai\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLomami\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManiema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSankuru\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKwango\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth-Kivu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaut-Uele\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKwilu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTanganyika\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaut-Katanga\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026Eacute;quateur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMai-Ndombe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIturi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKinshasa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBas-Uele\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLualaba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTshopo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMongala\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaut-Lomami\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePatients were recruited during several free campaigns of surgical repair of CLP organized by the non-governmental organization HEAL Africa in collaboration with the DRC National Ministry of Public Health planning to provide acceptable access to quality of care for the DRC population. The financial support of free campaigns was provided from the non-governmental organization Smile Train which supports free cleft repair surgery and comprehensive cleft care for children globally. The recruitment method consisted of awareness-raising periods by HEAL Africa. Messages were disseminated to the most remote corners of the country in search of patients with CLP.\u003c/p\u003e \u003cp\u003eIn the province of North Kivu, the surgical interventions took place at the HEAL Africa Hospital located in the city of Goma and at the General Reference Hospital (GRH) in Beni. In the 19 other provinces, the surgical interventions took place in the GRH of each of them.\u003c/p\u003e \u003cp\u003eSurgical treatment covered1601 patients out of 1666 presenting with CLP. Patients came after community awareness in the sites (cities or villages) where the aforementioned hospitals. Patients with orofacial malformations were referred to the hospitals indicated above for medical evaluation and those with CLP were retained for surgical repair. All patients for surgical repair had a preanesthetic consultation and preoperative laboratory investigations. In each site, all patients were repaired by the same surgical team including a surgeon, an anesthetist and a nurse in collaboration with the local team. In each site mentioned above, the surgical campaigns took place for 1 to 4 consecutive weeks. For each campaign, the team used a well-stocked technical platform with which it traveled from the HEAL Africa hospital (HAH) in Goma. All patients aged at least three months and weighing approximately 4 kg on average were operated on for lip repair and children aged over 12 months for palatal repair.\u003c/p\u003e \u003cp\u003eData collection was done through a questionnaire, the data of which was collected from patient interviews, outpatient consultation registers, operating room registers, and hospitalization registers.\u003c/p\u003e \u003cp\u003eThe surgical techniques used for cleft lip were straight-line repair, Millard rotation-advancement repair and Millard-Mulliken for bilateral cleft lip repair. For the cleft palate, Von Langenbeck and Bardach repair were performed. In this study we were not able to carry out interventions on the bony gingival arch. Surgical indications for each patient were established by the surgeons. Surgical techniques used depended on the type of cleft and the expertise of the surgeon.\u003c/p\u003e \u003cp\u003eThe anesthesia was either local or general depending on the age of the patient for cleft lip repair, while all patients undergoing cleft palate repair received general anesthesia.\u003c/p\u003e \u003cp\u003eThe variables studied focused on demographic aspects (age at consultation, sex, family history of CLP), clinical aspects (types and varieties of CLP whose clinical diagnosis was based on the Lahshal classification, associated visible congenital malformations) and therapeutic and progressive (operative technique used, type of anesthesia, immediate postoperative consequences, hospital stay).\u003c/p\u003e \u003cp\u003eStatistical analyzes were carried out using STATA 16 software. We used the entire sample to describe the epidemiological, obstetrical, clinical and therapeutic characteristics of CLP with frequencies (%) and means (with standard deviation).\u003c/p\u003e \u003cp\u003e The study obtained approval from the Medical Ethics Committee of the University of Goma (approval number: UNIGOM/CEM/013/2022). The data was collected anonymously. The study did not present any direct, particularly lucrative benefit for the study participants. Before any surgical procedure, each patient or their guardian signed informed consent about the risks and possible complications of the surgical procedure.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 1666 patients with CLP were recorded during the study period. In Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, we see that most patients were recruited in the province of North Kivu (20.5%), followed by the provinces of Kasai-Oriental (11.9%), Kasia-Central (8. 6%) and North Ubangi (7.4%).\u003c/p\u003e \u003cp\u003eThe mean age of our patients was 11.6 years (range: 3 months to 78 years). Forty-nine percent (816/1666) of our patients had consulted at the age of 5 years or less and 51% were aged over 5 years. We noted a predominance of the male sex (58.6%), with a sex ratio of 1.4. A family history of CLP was found in 72 patients (4.3%) and the association of CLP with other congenital abnormalities of various types were reported in 25 patients (1.5%) (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of cases according to age, sex, family history of CLP and the presence of other congenital abnormalities.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1666)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (Years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e816\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e690\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily history of CLP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther Obvious congenital abnormalities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that clefts affect the isolated lips at (66.1%) and the palate at (2.6%). The associations involving the lips, palates and alveoli are as follows in terms of frequency: cleft lip-alveolar (15.7%), cleft lip-alveolar-palatal (10.6%), cleft lip-palate (4.9%) and alveolar-palatal clefts (0.1%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the hierarchy in the frequencies of cleft types is the same for the male and female.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of cases according to variety and sex\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTypes of clefts\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1666)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;690), n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;976), n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleft lip\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e460 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e642 (65.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1102 (66.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleft lip and alveolus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e262 (15.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleft lip, alveolus \u0026amp; palate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e176 (10.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleft lip and palate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82 (4.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleft palate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43 (2.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleft alveolus \u0026amp; palate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleft of alveolus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that the left side is the most frequently affected, and that the complete type of cleft is predominant at the lip and palate level.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of profile of cleft lip and palate in patients (n\u0026thinsp;=\u0026thinsp;1666)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLip\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePalate\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAlveolar\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete bilateral cleft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e146 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39 (2.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete bilateral cleft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47 (2.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete right cleft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e302 (18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35 (2.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete right cleft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e219 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e103 (6.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete left cleft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e500 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51 (3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete left cleft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e398 (23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e164 (9.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo cleft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1364 (81.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1227 (73.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1666 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1666 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1666 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf the 1666 patients examined, 1601 or 96.1% were operated on, including 88.8% for the first time. The other 65 patients were not operated on due to age less than three months, comorbidity such as cardiac or renal congenital abnormalities, and when the patient presented with severe malnutrition.\u003c/p\u003e \u003cp\u003eSeventy-point two percent of our patients received general anesthesia and 29.8% local anesthesia.\u003c/p\u003e \u003cp\u003eEighty-one-point four percent of CLP underwent cheiloplasty, 16% of patient presenting CLP benefited for combined cheiloplasty and palatoplasty and 2.6% of cleft palate had palatoplasty only. The Millard technique was preferred for unilateral cleft, the straight on-line procedure was used for incomplete cleft and Mulliken for bilateral cleft. The Von Langenbeck palatoplasty was performed for incomplete cleft palate and Bardach procedure performed for complete cleft palate (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe average hospital stay was 2.7 days. The shortest stay was 1 day, and the longest stay 7 days.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurgical Procedure Performed in patients with Cleft lip and Palate\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1601)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e70.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e29.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical techniques\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;1601\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleft lip Repair or Cheiloplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleft lip Repair (Cheiloplasty) and Cleft Palate repair (Palatoplasty)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleft palate repair (Palatoplasty)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe epidemiological data obtained in our study on cleft lip and palate (CLP) provide important insights into the distribution of this malformation within our patient population. The mean age of 11.6 years with a variability ranging from 3 months to 78 years reflects the diversity of the stages of diagnosis and management of CLP. This variability in the mean age at the time of seeking care is in accordance with the results reported by Sangwa et al. in Lubumbashi (DRC) reporting 11.8 years [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and by Longombe and Tshimbila in Goma (DRC) finding 9.9 years [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The finding that almost half of our patients presented at the age of 5 years or younger highlights the importance of early detection of CLP. This is consistent with recommendations from other studies, which emphasize the positive impact of early intervention on both functionally and aesthetically [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. On the other hand, the significant proportion (51%) of patients aged over 5 years at the time of consultation raises questions about the factors which could contribute to a late diagnosis. Previous studies have suggested that socioeconomic barriers, limited access to health care, or lack of awareness of the malformation could influence the timing of consultation [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, in African communities, the birth of a malformed baby is considered a tragic event due to the religious and mystical considerations surrounding it. Children who have a cleft lip and palate at birth are often hidden by their parents for fear of stigma and discrimination and may cause divorce [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Understanding these factors is essential to implementing strategies to reduce the delay in making the diagnostic and improve access to care.\u003c/p\u003e \u003cp\u003eThe present study highlights a significant predominance of the male sex among patients with CLP, with a sex ratio of 1.4 in favor of male. This observation raises relevant questions about gender differences in CLP prevalence. The predominance of the male sex in our cohort is consistent with previous findings reported by several Congolese studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. For example, a study conducted in Goma (DRC) revealed a male predominance of 59.2% in patients with cleft lip and palate [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Another study conducted in Lubumbashi (DRC) revealed a male/female ratio of 1.2:1 in patients with cleft lip and palate [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, variations in sex distribution have been observed in other study populations [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These differences could be the result of genetic or environmental variations that merit further investigation. Genetic studies have suggested associations between certain genes involved in facial development and predisposition to CLP, but the exact understanding of the mechanisms underlying sexual predominance remains incomplete [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results of the present study highlight a prevalence of family history of cleft lip and palate (CLP) among our patients, with 72 cases representing 4.3% of the total sample. In the study by Sangwa et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], the presence of family history was reported at 20.7%. This observation raises intriguing questions about the potential contribution of the genetic component in the development of some cases of CLP, and it is important to explore these findings in light of the work of other investigators. Previous studies have also reported associations between CLP and positive family history, thus supporting the idea of ​​a genetic predisposition [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. These findings support the hypothesis that genetic factors may play a critical role in the pathogenesis of CLP. Extensive genetic investigations have identified several CLP-associated genes involved in embryonic facial development. Genetic variability may contribute to the diversity in CLP prevalence in families [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, it is essential to note that despite the presence of a family history, the majority of cases of CLP occur sporadically. This suggests a complex interaction between genetic and environmental factors in triggering this malformation [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Environmental exposures, such as nutritional factors, exposure to toxins, or other unknown factors, could also influence the risk of CLP, even in the absence of a genetic predisposition. A Chinese study reported a significant association between heavy metals and the occurrence of CLP [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, the identification of 25 cases (1.5%) of CLP associated with other visible malformations reinforces the idea that CLP may be part of more complex syndromes presenting a variety of anatomical abnormalities (Dixon et al., 2011; Leslie, 2017). The prevalence of these associations varies considerably depending on the populations studied, with rates reaching 21% [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], highlighting the diversity of epidemiological contexts. These differences could be influenced by genetic factors specific to each population, variations in data collection methodologies, or differences in the diagnostic criteria used. Genetic studies have identified syndromes associating CLP with other congenital malformations, highlighting underlying genetic abnormalities that influence overall embryonic development [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Early recognition of these associations may have important implications for clinical management, particularly in terms of planning surgical interventions, medical monitoring, and assessment of overall prognosis.\u003c/p\u003e \u003cp\u003e As for the anatomical varieties of CLP, comparing our results with other studies, this study has similar trends regarding the predominance of cleft lips, followed by combinations of cleft lip, alveolar and palate. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, variations in specific percentages can be observed, highlighting the diversity in the anatomical presentation of CLP between different populations. The predominance of isolated cleft lip in our study is consistent with previous studies [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This observation suggests that cleft lips often represent the primary manifestation of the malformation. The high frequency of lip and alveolar clefts (15.7%) underlines the importance of the involvement of the lip and the alveolus in the pathogenesis of CLP. The identification of isolated cleft palates in 2.6% of patients in our study is in line with the generally lower prevalence of isolated cleft palates compared to cleft lips because they are hidden and do not attract parental attention or they simply do not want to talk about it as malformations are misinterpreted in Africa [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These results highlight the heterogeneity of clinical presentations of CLP and highlight the need for an individualized approach in clinical management. Complex associations between the lips, palates, and alveoli, such as cleft lip (15.7%) and cleft lip/palate (10.6%), are consistent with the expected anatomical variability in the CLP. These multiple associations reflect the diversity of abnormalities in embryonic facial development and require in-depth surgical and multidisciplinary management.\u003c/p\u003e \u003cp\u003eRegarding the location of CLP, the observation that the left side is more frequently affected, is consistent with similar findings reported in the literature [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These findings could be related to specific embryonic mechanisms or environmental factors influencing the prevalence of left-sided CLP.\u003c/p\u003e \u003cp\u003eRegarding the distribution of complete and incomplete forms of CLP, our finding that complete forms predominate at the lips and palates, while incomplete forms dominate at the alveoli, is consistent with previous observations [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This distribution may be linked to differences in stages of embryonic development or to specific pathogenic mechanisms in these anatomical regions. However, variations in these trends have been noted in other studies, highlighting the complexity of CLP genetics and embryonic development. Genetic and environmental factors specific to each population could influence these differences, requiring further exploration.\u003c/p\u003e \u003cp\u003eTalking about the management of cleft lip and palate, more than 81.4% patients had cleft lip repaired according to the Straight on-line, Millard, and Mulliken techniques. In the present study, the Straight on-line technique was used for incomplete unilateral cleft lip repair, the Millard or Modified Millard technique was used to repair the complete unilateral cleft lip and the Mulliken technique for bilateral cleft repair. Studies elsewhere have described that the modified Millard technique is commonly used for cleft lip repair, particularly in the United States of America and Europe [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The Manchester and Mulliken techniques are best performed for bilateral labiaplasty. The advantages of the Mullikens procedure are lengthening of the columella with superior repair of the nostril [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. A multicenter analysis carried out in Germany reported five most commonly used lip repair techniques from 37 participating centers. These were the Randall-Axhausen, Tennison, Pfeiffer, Delaire, Millard and Tennison-Randall techniques. The Millard (12/37 centers) and Tennison (14/37 centers) techniques were the most popular [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Gatti et al. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] used the Tennisson-Randall and modified Millard techniques respectively to perform unilateral cleft lip surgery and the Mulliken technique was used for bilateral cleft lip.\u003c/p\u003e \u003cp\u003eRegarding palate repair, Cubitt et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] revealed that palatoplasty is more performed in developed countries than developing countries. Sub-Saharan African countries have low rates of cleft palate repair. In this study, 20.0 and 2.6% of respectively CLP and CP patients had undergone palatoplasty by practicing Von Langenbeck and Bardach techniques. When performing bilateral palatoplasty, the Bardach technique is performed more commonly where a vomer flap is applied for reconstruction [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Gatti et al used the Bardach or Von Langenbeck technique from the age of 6 months to repair the palate [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The study by Akinmoladun et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] showed that Millard's rotation and advancement technique was used for lip repair in 91.2% and 63.7% used Von Langenbeck technique for palatal repair. To date, systematic reviews of the published literature have revealed no consensus on which treatment provides the best patient outcome [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In most cases, the surgical approach is entirely based on the personal preference of the surgeon, and most surgical centers have their own technique of choice [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results of this study must be interpreted taking into account certain limitations. First, this study does not include information on the long-term outcomes of patients who underwent CLP reconstructive surgery. Follow-up over a prolonged period would have made it possible to assess the results of surgical interventions, possible complications, and the impact on quality of life. Second, this study could be subject to selection bias, because it is based on cases of cleft lip and palate identified during awareness campaigns. Patients who participated in the campaigns may not be representative of the entire population with this malformation, as some individuals may not have had access to these awareness services.\u003c/p\u003e \u003cp\u003eDespite these limitations, this study has a number of notable strengths. First, the sample size of 1666 CLP cases represents a substantial sample size, providing an important database to describe the characteristics of this malformation. Additionally, this study provides an important perspective on the local population affected by CLP, which may have direct implications for public health policies and awareness interventions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis retrospective descriptive study on cleft lip and/or palate in the Democratic Republic of the Congo provided essential epidemiological, clinical and therapeutic data. Late age at presentation, male predominance, and associations with other congenital malformations have been documented. Cleft lips were found to be more common than cleft palates, with complex shapes, such as cleft lip, alveolar palate, accounting for a significant proportion. The prevalence of left-sided involvement in all cleft types highlights a notable trend. Furthermore, the results indicate that the Millard technique was widely used, followed closely by the Straight-line technique. These observations highlight key elements that can guide approaches to the management of cleft lip and palate in the DRC, while emphasizing the importance of continuing to improve accessibility to care and surgical skills in this context.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDemocratic Republic of the Congo\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCleft lip\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCLP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCleft lip and palate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCLAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCleft Lip-Alveolar and Palate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCleft palate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHAH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHeal Africa Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNSCLP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNon syndromic cleft lip and palate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLAHSHAL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLip, Alveolar, Hard Palate, Soft Palate, Hard Palate, Alveolar, Lip\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUNIGOM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUniversity of Goma and GRH:General Reference Hospital.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExpresses our heartfelt to Smile Train, Neil Wetzig, Olivier Mukuku, Sylvain Kwiratwiwe, Poteau Katsuva, Paluku Saruti Elvis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eK.K.M: Conceptualized and designed the study, collected data and approved final manuscript publication. WOS: Conceptualized and designed the study, drafted and revised the article and approved final manuscript publication. UAS, AO, ME, participate to critical revision of manuscript. TVY: Advised on the process of data collection, approved final manuscript publication and mentor in plastic surgery of cleft, PM: Conceptualized and designed the study, drafted and revised the article and approved final manuscript publication and mentor in plastic surgery of cleft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis research received no external funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and consent to participate \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was performed in accordance with the principles of the Declaration of Helsinki, and the Medical Ethics\u0026nbsp;Committee of the\u0026nbsp;University of Goma approved the study; reference UNIGOM/CEM/013/2022\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo competing of interest\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVyas T, Gupta P, Kumar S, Gupta R, Gupta T, Singh HP. 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Cleft Palate Craniofac J. 2020;57(11):1314\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStoneburner J, Munabi NCO, Nagengast ES, Williams MS, Goel P, Auslander A, Howell LK, Hammoudeh JA, Urata MM, Magee WP 3. Factors associated with delay in cleft surgery at a tertiary Children's Hospital in a Major US Metropolitan City. Cleft Palate Craniofac J. 2021;58(12):1508\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManyama M, Rolian C, Gilyoma J, et al. An assessment of orofacial clefts in Tanzania. BMC Oral Health. 2011;11:5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdollahi Fakhim S, Shahidi N, Lotfi A. Prevalence of Associated Anomalies in Cleft Lip and/or Palate Patients. Iran J Otorhinolaryngol. 2016;28(85):135\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLesmana S, Auerkari EI. Genes contributing in cleft lip and cleft palate: A literature review. J Int Dent Med Res. 2016;9:441.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMachado RA, Messetti AC, De Aquino SN, Martelli-Junior H, Swerts MSO, de Almeida Reis SR, et al. Association between genes involved in craniofacial development and nonsyndromic cleft lip and/or palate in the Brazilian population. Cleft Palate-Craniofacial J. 2016;53(5):550\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStuppia L, Capogreco M, Marzo G, La Rovere D, Antonucci I, Gatta V, et al. Genetics of syndromic and nonsyndromic cleft lip and palate. J Craniofac Surg. 2011;22(5):1722\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeslie EJ, Marazita ML. (2013, November). Genetics of cleft lip and cleft palate. In American Journal of Medical Genetics Part C: Seminars in Medical Genetics (Vol. 163, No. 4, pp. 246\u0026ndash;258).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVieira AR. Genetic and environmental factors in human cleft lip and palate. Cleft Lip Palate. 2012;16:19\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHao Y, Tian S, Jiao X, Mi N, Zhang B, Song T, et al. Association of parental environmental exposures and supplementation intake with risk of non-syndromic orofacial clefts: a case-control study in Heilongjiang Province, China. Nutrients. 2015;7:7172\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNagalo K, Ou\u0026eacute;draogo I, Laberge JM, et al. Congenital malformations and medical conditions associated with orofacial clefts in children in Burkina Faso. BMC Pediatr. 2017;17:72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHadadi AI, Al Wohaibi D, Almtrok N, Aljahdali N, AlMeshal O, Badri M. Congenital anomalies associated with syndromic and non-syndromic cleft lip and palate. JPRAS open. 2017;14:5\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenkatesh R. Syndromes and anomalies associated with cleft. Indian J Plast Surg. 2009;42(SupplSuppl):S51\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEshete M, Gravenm PE, Topstad T, Befikadu S. The incidence of cleft lip and palate in Addis Ababa, Ethiopia. Ethiop Med J. 2011;49(1):1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMillard DR. The embryonic rationale for primary correction of the cleft lip and palate Annals. Roy Coll Surg Eng, 1994:76150\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMulliken JB. Correction of the bilateral cleft lip: Review, Revision and Reflection J. Craniofacial Surgery 2003:14(5)609\u0026thinsp;\u0026ndash;\u0026thinsp;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThiele OC, Kreppel M, Dunsche A, Eckardt AM, Ehrenfeld M, Fleiner B, et al. Current concepts in cleft care: a multicenter analysis. J Cranio-Maxillofacial Surg. 2018;46(4):705\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGatti GL, Freda N, Giacomina A, Montemagni M, Sisti A. Cleft lip and palate repair. J Craniofac Surg. 2017;28(8):1918\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCubitt JJ, Hodges AM, Van Lierde KM, Swan MC. Global variation in cleft palate repairs: an analysis of 352,191 primary cleft repairs in low-to-higher-middle-income countries. Cleft Palate-Craniofacial J. 2014;51(5):553\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkinmoladun V, Ademola S, Ademola A. Management of cleft lip and palate in Nigeria: A survey. Niger J Clin Pract. 2017;20(11):1355\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaye D. Update on outcomes research for cleft lip and palate. Curr Opin Otolaryngol Head Neck Surg. 2014;22(4):255\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan SP, Greene AK, Mulliken JB. Current surgical management of bilateral cleft lip in North America. Plast Reconstr Surg. 2012;129(6):1347\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cleft lip and palate, epidemiology, clinical anatomy, management, Democratic Republic of Congo","lastPublishedDoi":"10.21203/rs.3.rs-3985236/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3985236/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eCleft lip and/or palate (CLP) are congenital malformations which mainly affect the upper lip and/or palate and are the most common malformations of the orofacial sphere. The objective of the present study was to describe the epidemiological, clinical and therapeutic profile of cleft lip and palate patients managed in the Democratic Republic of Congo (DRC).\u003c/p\u003e\u003ch2\u003eMaterial and Methods\u003c/h2\u003e \u003cp\u003ea retrospective descriptive study of 1666 patients with cleft lip and palate collected in 20 provinces of the DRC and managed between January 2017 and June 2022. The variables studied were epidemiological, anatomo-clinical and therapeutic.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age of patients seeking care was 11.6 years. The male predominance was (58.6%). A family history of CLP was found in 4.3% of cases and the association of CLP with other visible congenital malformations was identified in 1.5%. Isolated cleft lips were (66.1%) and palates (2.6%) of cases. Combinations involving cleft lip, palate and alveoli were observed respectively as following in terms of frequency: cleft lip-alveolar (15.7%), cleft lip-alveolar-palatal (10.6%) and cleft lip-palate (4.9%). The left side cleft was more common. Cheiloplasty was the most common repair procedure for cleft lip (81.4%) and the isolate palatoplasty was performed for 2.6% cleft palate.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn the DRC, CLP are common, with male predominance and often treated late. Cleft lips occur more commonly than cleft palates.\u003c/p\u003e","manuscriptTitle":"Epidemiological, clinical and therapeutic aspects of cleft lip and palate in the Democratic Republic of Congo: about 1666 cases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-19 15:23:55","doi":"10.21203/rs.3.rs-3985236/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-04T06:00:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-02T22:48:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"c195bf92-1c00-4a4c-bcdb-44108f25cb15","date":"2024-03-20T22:27:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-20T19:11:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-20T19:08:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-20T19:06:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-15T11:13:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2024-02-24T14:23:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ee6ce77-9441-4305-98d1-d74bde3f6805","owner":[],"postedDate":"March 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-05-06T10:51:23+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-19 15:23:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3985236","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3985236","identity":"rs-3985236","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}