Preface

Chapter 8 **Cleft Lip and Palate in the Dog: Medical and**

Enio Moura and Cláudia Turra Pimpão

**Genetic Aspects 143**

**VI** Contents

Back in the 1990s in the beautiful city of Jeddah, under the umbrella of the unique Faculty of Dentistry at King Abdulaziz University, I started spending some elective time in different hospitals in the city as a dental student trying to understand the difficult subject, oral and maxillofacial surgery. At that time, none of the internet programs were available in order to help a dental student to watch the meaning of cleft surgery, orthognathics, facial trauma, or dental implant by a simple click at any of the video media available nowadays. This made me very confused and yet curious to understand those topics and worried about the idea of entering the operating room (OR) to watch all the scary scenes that our former amazing teachers used to show us in the lecture halls. I did not imagine that only a couple of years later we had the chance to go through the experience at some of the popular health-care centers in the city. However, I was still confused about that specialty, and hence I had to take the decision of traveling to the USA to go through the experience again during summer vacation, hoping to get more answers to what I was looking for. Thereafter, a big part of the picture was uncovered, and I learned my valuable lesson; the medical service is like a fourdish meal that can only be designed by a chef. And that's where I fell in love with the field; I could always be the chef tailoring what is best to be served.

The field of cleft lip and palate is one of the areas in the medical practice that can show vari‐ able regimes according to different factors such as the general society understanding, access to specialized health care, manpower, resources, expertise, patient and parent compliance about oral hygiene, cleft grafting techniques, research evidence, and genetic advancement. One or more of the former can change the *recipe*.

During the process of exploring the recipe between Jeddah, Abha, and Montreal (Canada), I was lucky to meet a lot of amazing mentors in the field of oral and maxillofacial surgery : Dr. Edward Ellis III, Dr. Johan Ryneke, and Dr. Eric Dierks at international conference in Riyadh, Saudi Arabia. At that time, I was already involved deeply in a busy multidisciplina‐ ry practice. However, meeting those famous teachers took us into an amazing talk we en‐ joyed having over dinner about the concept of designing care. The impressive part was that each one of those amazing surgeons was practicing in a different region including the USA, South Africa, and Canada. And, I guess by the time we reached desert, we agreed about the general concept of health care, "being a chef is the key of success."

In "Designing Strategies for Cleft Lip and Palate Care" it was aimed to link the epidemiolo‐ gy from different areas in the world with the interspecialty surgical care and the future ge‐ netic research projects. The objective is to concisely discuss the methodology of interspecialty care and stimulate future ideas for prophylactically managing or preventing such deformities. I am confident that one day the surgical interventions that bombard the patients from the day of newborn delivery and throughout the years of youth should be significantly decreased based on the genetic prophylactic intervention, probably.

I hope that the book can reach out easily to students, residents, practitioners, and research‐ ers in the field to give them a different prospect of understating cleft lip and palate deformi‐ ties and stimulating novel ideas to manage the patients all over the world. And hereby, I as an editor to the book acknowledge all the contributors' effort that was provided to put this work together.

#### **Acknowledgment**

I am very grateful to **Professor Abdulrahman Bin Obaid Alyoubi**, the respectful president of King Abdulaziz University in Jeddah City, Saudi Arabia, for his extraordinary support to science, manpower, and the society.

A special gratitude to the administration at the Faculty of Dentistry, Dean, Professor Abdul‐ ghani Mira, and the respectful vice deans for their continuous help toward education, clini‐ cal care, and research: Dr. Moath Attar, Dr. Rayan Kayyal, Dr. Ayman Darrab, and Dr. Sahar Bukhari.

A warm appreciation to my colleagues and friends Dr. Ahmad Saeed Jan, head of the Oral Maxillofacial Surgery Department, and Dr. Abeer Abdulrahman Alnuwaiser, head of the In‐ ternship Training Program, for their ongoing support to accomplish this project among oth‐ ers in King Abdulaziz University.

I can never thank enough all my family members, my father Ahmad Jawad Almasri, mother Fatima Abduljawad, friends, colleagues, nurses, and the secretarial office members. You all are the power of life, thank you!

> **Dr. Mazen Ahmad Almasri, BDS, MSc, FRCD(c), Dipl ABOMS** Consultant/Assistant Professor of Oral and Maxillofacial Surgery Faculty of Dentistry, King Abdulaziz University Jeddah City, Saudi Arabia

**Epidemiology of Cleft Lip and Palate Care**

patients from the day of newborn delivery and throughout the years of youth should be

I hope that the book can reach out easily to students, residents, practitioners, and research‐ ers in the field to give them a different prospect of understating cleft lip and palate deformi‐ ties and stimulating novel ideas to manage the patients all over the world. And hereby, I as an editor to the book acknowledge all the contributors' effort that was provided to put this

I am very grateful to **Professor Abdulrahman Bin Obaid Alyoubi**, the respectful president of King Abdulaziz University in Jeddah City, Saudi Arabia, for his extraordinary support to

A special gratitude to the administration at the Faculty of Dentistry, Dean, Professor Abdul‐ ghani Mira, and the respectful vice deans for their continuous help toward education, clini‐ cal care, and research: Dr. Moath Attar, Dr. Rayan Kayyal, Dr. Ayman Darrab, and Dr. Sahar

A warm appreciation to my colleagues and friends Dr. Ahmad Saeed Jan, head of the Oral Maxillofacial Surgery Department, and Dr. Abeer Abdulrahman Alnuwaiser, head of the In‐ ternship Training Program, for their ongoing support to accomplish this project among oth‐

I can never thank enough all my family members, my father Ahmad Jawad Almasri, mother Fatima Abduljawad, friends, colleagues, nurses, and the secretarial office members. You all

> **Dr. Mazen Ahmad Almasri, BDS, MSc, FRCD(c), Dipl ABOMS** Consultant/Assistant Professor of Oral and Maxillofacial Surgery

> > Faculty of Dentistry, King Abdulaziz University

Jeddah City, Saudi Arabia

significantly decreased based on the genetic prophylactic intervention, probably.

work together.

VIII Preface

Bukhari.

**Acknowledgment**

science, manpower, and the society.

ers in King Abdulaziz University.

are the power of life, thank you!

**Chapter 1 Provisional chapter**

#### **Epidemiology of Cleft Lip and Palate Epidemiology of Cleft Lip and Palate**

Mairaj K. Ahmed, Anthony H. Bui and Mairaj K. Ahmed, Anthony H. Bui and

Emanuela Taioli Emanuela Taioli

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/67165

#### **Abstract**

Orofacial cleft (OFC) anomalies are amongst the most common congenital anomalies and the most common craniofacial anomalies. Despite their poorly characterized etiologies, cases of OFC are usually grouped by epidemiological studies as cleft lip, with or without cleft palate (CL/P), and cleft palate alone (CPO). Incidence of CL/P and CPO differs according to gender and ancestry and may vary widely across studies. Cases of OFC are characterized as either "syndromic" or "nonsyndromic," with further classification of nonsyndromic cases into isolated cases and cases that present with additional malformations. The genetic bases for many syndromic cases of OFC have been previously elucidated. Genetic associations have been described for nonsyndromic OFC as well. Importantly, etiology of OFC is known to involve interaction between genetic and environmental factors, including maternal nutrition and exposure to teratogenic agents. Furthermore, evidence points toward epigenetic as well as genetic factors influencing OFC etiology. Recent studies have begun to explore the association between CL/P and cancer. These studies report higher incidence of cancer among patients with CL/P and their family members as well as identification of common genetic markers mediating this increased risk, although much remains unknown about this link.

**Keywords:** cleft, epidemiology, etiology, genetics, epigenetics, environmental risk factors, cancer
