bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between Cleft Size and Crossbite in Children with Cleft Palate and Unilateral Cleft Lip and Palate
Authors: Reiser Erika , Skoog Valdemar , Gerdin Bengt , Andlin-Sobocki Anna
Published: October 2018

Objective

To investigate the association between cleft size in infancy and crossbite at 5 years of age in children with cleft palate (CP) and unilateral cleft lip and palate (UCLP).

Design

Retrospective study.

Setting

University Hospital, Uppsala, Sweden.

Patients

Dental study models of 80 consecutive children, 51 children with CP and 29 children with UCLP, born between 1990 and 1999 were analyzed.

Interventions

Lip repair at 3 to 4 months in UCLP children. Primary soft palate repair at 6 to 10 months and secondary hard palate closure at 25 to 26 months of age.

Main Outcome Measures

Maxillary arch dimensions and cleft size were measured on infancy dental casts. At follow-up at 5 years, crossbite scores were registered on dental study models.

Results

The cleft dimensions in infancy showed large interindividual variation. Mean posterior cleft width was larger in UCLP children than in children with CP. The UCLP group also had significantly more crossbite at 5 years than the CP group. No significant association was noted between initial cleft size and crossbite scores at 5 years in the CP group. For the UCLP group, larger cleft widths at the level of the cuspid points were significantly associated with less anterior and posterior crossbite.

Conclusions

The findings support the hypothesis that cleft size in infancy affects early outcome with respect to crossbite in children with UCLP, but not in children with CP.
Autologous Bone Grafting with Adjunctive Use of Acellular Dermal Matrix for Alveolar Cleft Defects: Early Outcomes
Authors: Clavijo-Alvarez Julio A. , Vecchione Lisa , DeCesare Gary , Irwin Chetan , Smith Darren M. , Grunwaldt Lorelei J. , Losee Joseph E.
Published: October 2018

Background and Purpose

Alveolar bone grafting remains the standard for alveolar cleft repair. Compromised oral and/or nasal closure may impede healing and result in graft failure or persistent fistulae. Incorporating acellular dermal matrix into these repairs may protect the bone graft during mucosal healing by providing an additional layer of soft tissue coverage.

Methods

A retrospective review of alveolar bone grafts undertaken at our cleft–craniofacial center from 2005 to 2007 was performed. The use of acellular dermal matrix for nasal and/or oral lining augmentation was determined. A minimum 3 months’ follow-up was required for inclusion. Outcomes included (1) mucosal disruption, (2) time to complete mucosal healing, (3) bone graft exposure, (4) postoperative bone graft incorporation using the Chelsea scale, and (5) canine eruption through the graft site.

Results

In total, 35 patients were included. Of those, 15 patients (four girls, 11 boys; seven Veau III, eight Veau IV) received acellular dermal matrix for mucosal augmentation (five nasal, one oral, nine nasal and oral lining). Average age at surgery was 10 years (range, 9 to 16 years). Average follow-up was 23 months (range, 3 to 35 months). Mucosal disruption occurred in 20% of the acellular group and in 30% of the control group ( p = nonsignificant). Complete mucosal healing was achieved at an average of 4 weeks (range, 1 to 14 weeks) in the acellular dermal matrix group versus 4 weeks (range, 2 to 11 weeks) in the control group ( p = nonsignificant). Exposure of bone graft occurred in 0% of the acellular dermal matrix group and in 30% of the control group ( p = .016). The Chelsea scale demonstrated no significant radiographic difference in postoperative bone graft incorporation between the acellular dermal matrix and control groups. Canine eruption through the graft site was similar for both groups.

Conclusions

These data support the conclusions that using acellular dermal matrix to augment nasal/oral mucosal lining in alveolar bone grafts (1) does not increase mucosal disruption or time to complete healing, (2) prevents postoperative bone graft exposure, and (3) appears to have no negative effect on postoperative bone graft incorporation or canine eruption through the graft site.
A Study of Facial Growth in Patients with Unilateral Cleft Lip and Palate Treated by the Oslo CLP Team
Authors: Semb Gunvor
Published: October 2018

Lateral and frontal cephalometric analysis of a mixed longitudinal survey of 257 individuals with complete unilateral cleft lip and palate from the Oslo CLP Growth Archive is described. All subjects were treated and followed up by the Oslo CLP Team according to strictly defined protocols for treatment and documentation. Craniofacial form for this sample is generally similar to that reported for Caucasian children treated for this condition elsewhere.
Simonart's Band and Facial Growth in Unilateral Clefts of the Lip and Palate
Authors: Semb Gunvor , Shaw William C.
Published: October 2018

A cephalometric analysis was carried out to see if the presence of a Simonart's band at birth was associated with a detectable difference in subsequent craniofacial form. Mixed longitudinal data from 5 through 18 years of age was analyzed for 257 individuals with complete UCLP included in the Oslo CLP Growth Archive, 80 with a Simonart's band and 177 without. No major differences were detected between individuals with or without Simonart's band, though the presence of a Simonart's band was associated with a larger cranial base angle and a slightly more favorable maxillomandibular relationship. The findings are discussed in relation to embryogenesis, primary surgery, and secondary surgery. It is recommended that cephalometric studies of UCLP involving group comparisons should avoid major imbalance with respect to the proportion of individuals with a Simonart's band at birth.
Growth of the Cranial Base in Craniosynostosis
Authors: Richtsmeier Joan T. , Grausz Hannah M. , Morris G. Robert , Marsh Jeffrey L. , Vannier Michael W.
Published: October 2018

The configuration of the neurocranium has long been used as a diagnostic tool in assessing infants with abnormal head shape. In the case of craniosynostosis, a characteristic shape is caused by a constraint placed on growth of the neurocranium by prematurely closed sutures and secondary accomodation to that constraint. This investigation is a preliminary test of our hypotheses of growth of the cranial base under these constraints. Three dimensional landmark coordinate data were collected from pre-, peri-, and postoperative CT scans of eleven patients from The Cleft Palate and Craniofacial Deformities Institute, St. Louis, MO. These data were used in two sets of analytical comparisons. Comparisons of preoperative and perioperative morphology were taken to represent preoperative growth, while comparisons of perioperative to postoperative CT scans represent postoperative growth. Finite-element scaling analysis (FESA) and Euclidean distance matrix analysis (EDMA) were used to make these comparisons. Our results show that in cases involving premature closure of the metopic, sagittal, and bilateral coronal sutures, predictions about growth of the cranial base made prior to analysis prove correct. In these forms of craniosynostosis there are characteristic and consistent changes in the cranial base in both pre- and postoperative growth. Preoperative and postoperative growth in patients diagnosed with unicoronal synostosis show a greater degree of individual variability and do not follow a predictable pattern.
Syndrome Delineation Involving Orofacial Clefting
Authors: Cohen M. Michael , Bankier Agnes
Published: October 2018

A table comparing the number of syndromes with orofacial clefting for the years 1971, 1978, and 1990 is presented and discussed. Over 300 such disorders are known today. A second table is presented showing the frequency of associated anomalies with orofacial clefting. The wide range of frequencies found in various studies probably reflects the type of ascertainment. Undoubtedly, the process of syndrome delineation will further increase the number of disorders with orofacial clefting in the future.
Submucous Clefts of the Palate: How Likely are they to be Symptomatic?
Authors: Mcwilliams Betty Jane
Published: October 2018

A group of 130 patients with submucous clefts were identified from the records of the University of Pittsburgh Cleft Palate-Craniofacial Center. Many of these patients, 44 percent, remained asymptomatic into adulthood, and none required surgical intervention. A submucous cleft should be repaired in infancy only when feeding problems or unremitting ear disease is observed. The cleft should not be repaired on the theoretical basis of the potential effect of the cleft on the development of communication skills. The development of predictors that will enable professionals' valid management decisions must be developed.
Effects of Different Surgical Regimes on Nasal Asymmetry and Facial Attractiveness in Patients with Clefts of the Lip and Palate
Authors: Roberts-Harry D.P. , Evans Ruth , Hathorn I.S.
Published: October 2018

Surgery has often been blamed for the subsequent poor growth and deformity of the nasal complex in patients with cleft lip and palate. This study compares two groups of patients with unilateral clefts of the lip and palate for the effect that different surgical techniques have on nasal symmetry and facial attractiveness.
Team Acceptance of Specific Recommendations for the Treatment of VPI as Provided by Speech Pathologists
Authors: Dixon-Wood Virginia L. , Williams William N. , Seagle M. Brent
Published: October 2018

This retrospective study describes the frequency of one team's acceptance of speech pathologists' recommendations for specific secondary treatment procedures for the correction of VPI for 100 consecutive patients. In addition, assessment was made of the level of success in eliminating VPI relative to treatments utilized that were recommended by speech pathologists versus level of success when treatment other than that recommended by speech pathologists were used. For the 78 patients who received the treatment procedure recommended by speech pathologists, only 10 percent continued to demonstrate any clinically significant residual speech problem associated with VPI. However, for the 22 patients who received treatment other than that which had been recommended, 32 percent continued to demonstrate clinically significant speech problems associated with VPI. Data is presented on the success rate for correcting VPI relative to specific treatment recommendations including pharyngeal flap, palatal pushback, pharyngeal wall implant, tonsillectomy, prosthetic palatal lifts, and speech therapy.
Self-Concept of Children and Adolescents with Cleft Lip and/or Palate
Authors: Leonard Barbara J. , Brust Janny Dwyer , Abrahams George , Sielaff Bruce
Published: October 2018

The self-concept of 105 children (8 to 11 years) and adolescents (12 to 18 years) with cleft lip and/or palate (CLP) was studied using the Piers-Harris Children's Self-Concept Scale and selected demographic and medical variables. Results indicated that most (98%) of children had average or above average self-concept scores. Further analysis, however, demonstrated an interaction between age and gender: adolescent girls experienced a more negative self-concept in comparison to younger girls and adolescent boys experienced a more positive self-concept in comparison to younger boys. In addition, popularity cluster scores for all children were below the mean for the normed population. Because children with CLP have additional difficulties (i.e., facial disfigurement, speech and language deficits, multiple surgeries), professionals should intercede to prevent or interrupt negative psychosocial outcomes, particularly for adolescent girls.
Epidemiology of Oral Clefts in a Large South American Sample
Authors: Menegotto Beatriz G. , Salzano Francisco M.
Published: October 2018

A total of 849,381 newborn children were examined during the years 1967 to 1981, in 56 hospitals of eight countries, in the Latin American Collaborative Study of Congenital Malformations (ECLAMC). Of these, 741 had a cleft lip with or without a cleft palate (CL±P), yielding a global prevalence of 0.87 per thousand, and 115 had cleft palate (CP) only (frequency: 0.13 per thousand). CP frequencies by country and by year were essentially homogeneous, but those for CL±P showed heterogeneity by country (but no temporal trends). Patients thus ascertained, with matched, appropriate controls, have been subjected to a detailed epidemiologic study. For CP, only the sex ratio deviated from the control values; but for CL±P the marked divergence in sex ratio was accompanied by differences in the two series on the frequency of twin births, birth weight, neonatal survival, birth order, medicine use, and occurrence of acute or chronic illnesses during the first trimester of pregnancy. Lack of agreement of these results with previous data may be due to different types of patient ascertainment, sample sizes, and methods of analysis.
Relative Values of Various Standardized Passages in the Nasometric Assessment of Patients with Velopharyngeal Impairment
Authors: Dalston Rodger M. , Seaver Earl J.
Published: October 2018

A series of 155 patients referred for evaluation at the UNC Craniofacial Center was studied to compare nasometric performance data obtained from the Rainbow Passage to information provided when subjects read two other standardized passages (Zoo Passage and Nasal Sentences). Nasometric findings obtained using the three reading passages were compared to aerodynamic estimates of velopharyngeal area and nasal cross-sectional area as well as clinical judgments of hypernasality and hyponasality. The results suggest that the Rainbow Passage does not provide clinically relevant information that cannot be obtained using the other speech samples studied.
Combining the von Langenbeck and the Wardill-Kilner Operations in Certain Clefts of the Palate
Authors: Millard D. Ralph , Flynn William , Rao Manohar P.
Published: October 2018

The rationale for combining two standard cleft palate procedures is set forth. The circumstances in which this combination is recommended are outlined and diagrammed. By Joining the positive qualities of two established and popular methods, it is possible in certain cases to facilitate palate closure while reducing common minor complications by incorporating the good qualities of each procedure and reducing the negative.
Craniofacial Skeletal Measurements Based on Computed Tomography: Part II. Normal Values and Growth Trends
Authors: Waitzman Ariel A. , Posnick Jeffrey C. , Armstrong Derek C. , Pron Gaylene E.
Published: October 2018

Current diagnosis and surgical correction of craniofacial anomalies would benefit from accurate quantitative and standardized points of reference. A retrospective study was undertaken to define normal values for a series of craniofacial measurements and to evaluate the growth patterns of the craniofacial complex through axial computed tomography (CT). Fifteen measurements were taken from 542 CT scan series of skeletally normal subjects. The measurement values were then divided into 1 -year age categories from 1 to 17 years, and into four age groups for those under 1 year of age. The normal range and growth pattern of measurement values for the cranial vault, orbital region, and upper midface are presented. The overall size of the cranio-orbito-zygomatic skeleton reaches more than 85 percent of adult size by age 5 years. The cranial vault grows rapidly in the first year of life but growth levels off early. The upper midface grows at a slower rate in infancy, but continues to grow later in childhood and early adolescence. Knowledge of the differential growth patterns and normal measurement values in the craniofacial region will help improve diagnostic accuracy, staging of reconstruction, precision of corrective surgery, and follow-up of patients.
Videoendoscopy and Photodetection: Linearity of a New Integrated System
Authors: Covello Leonard V. , Karnell Michael P. , Seaver Earl J.
Published: October 2018

Simultaneous videoendoscopy and photodetection has potential for improving the assessment of changes in velopharyngeal (VP) movements and closure over time during speech. The purpose of this project was to examine the linearity of a new system, including a pediatric bronchoscope with an internal instrument channel through which the photodetector fiber was positioned. The results led to the conclusion that the response of the new system was linear. However, further examination Indicated that system positioning variables had important effects on the overall level of photodetector light detection. These observations confirm the Importance of monitoring and controlling the position of the endoscope-photodetector apparatus in the nasopharynx when using the system to evaluate velopharyngeal movement and closure for speech.
Respiratory Activities in Relation to Palatal Muscle Contraction
Authors: Kogo Mikihiko , Kurimoto Takuya , Koizumi Hidehiko , Nishio Juntaro , Matsuya Tokuzo
Published: October 2018

This study Investigated the activities of the tensor and levator veli palatini muscles related to respiration. During quiet breathing, no activity was observed in either muscle. With either hypercapnic or hypoxemic condition, the tensor veli palatini muscle exhibited phasic activity during inspiration. The levator veli palatini muscle showed phasic activity during expiration with hypoxemia (PaO2 < 40 mm Hg). NaCN perfused bilaterally through the carotid sinus induced these respiratory activities. The tensor veli palatini muscle was more sensitive than the levator veli palatini muscle to NaCN.
Pediatric Management of Robin Sequence
Authors: Singer Lewis , Sidoti Eugene J.
Published: October 2018

The care of infants with Robin sequence is discussed with special reference to upper airway obstruction and feeding difficulties. The use of nasopharyngeal tubes Is recommended initially to alleviate the immediate consequences of hypoxia. Modifications in feeding procedures are minor and involve enlarging the hole In the nipple and keeping the nipple and infant positioned appropriately.
Glossopexy for Upper Airway Obstruction in Robin Sequence
Authors: Argamaso Ravelo V.
Published: October 2018

A modified glossopexy is described with results of the operation in 24 patients who were specifically selected based on nasopharyngoscopic examination of the upper airway. Only patients with documented glossoptosis on endoscopy were selected for glossopexy. The procedure is designed to use two points of attachment for the tongue, one at the mandibular alveolus and the other at the lower lip. The genioglossus is also released to lengthen the tongue. All patients had resolution of their upper airway obstruction. There was only one partial dehiscence. The glossopexies were all released at the time of palate repair, usually before the first birthday.
Medical Students' Knowledge of and Exposure to Cleft Palate
Authors: Vallino Linda D. , Lass Norman J. , Pannbacker Mary , Klaiman Paula G. , Miller Patricia
Published: October 2018

To compare the knowledge and experience of medical students in 1989 with that of those surveyed in 1973, a questionnaire about the various aspects of cleft palate was completed by 209 medical students from West Virginia University and the Louisiana State University Medical Center at Shreveport and New Orleans. Results revealed that 1989 students were more familiar with the embryology of cleft palate, racial and gender differences, and intellectual and psychologic issues (p < .05). In contrast, the 1973 students were more able to define cleft palate, submucous cleft palate, and pharyngeal flap. There was no difference between the two groups of students In the amount of clinical exposure to cleft palate. These findings support the need for greater emphasis on cleft palate at the pre- and postdoctoral levels, as well as within continuing education programs. As part of current programs, the standard of practice of multidlsclplinary team management for an individual with cleft palate should be underscored.
Prevalence and Severity of Malocclusion in Children with Cleft Lip and/or Palate in Hong Kong
Authors: Tang Endarra L.K. , So Lisa L.Y.
Published: October 2018

The prevalence and severity of malocclusion among children with cleft lip and palate in Hong Kong has never been assessed or documented. A group of 20 children in the primary or early mixed dentition stages, with clefts of the lip and/or palate were assessed using the Occlusal Index. Results of this preliminary study showed that 92.3 percent of the male and 71.5 percent of the female subjects had severe malocclusion, which Implied that comprehensive orthodontic treatment at a later stage would be needed. More than half (69.2% of the male, and 57.1% of the female subjects) had syndrome F, defined as mesial molar relationship, overjet, overbite, posterior crossbite, midline diastema, and midline deviation (Summers, 1966). Therefore malocclusion problems were shown to manifest early in patients with cleft lip and/or palate, and further that it is possible to assess malocclusion prevalence and severity in early stages of dental development.
Is Nasal Airway Size a Marker for Susceptibility toward Clefting?
Authors: Liu Hui , Warren Donald W. , Drake Amelia F. , Davis Jefferson U.
Published: October 2018

Johnston and Hunter (1989) reported that in monozygotic twins discordant for cleft lip ± palate, the noncleft twins demonstrated what appeared to be a bimodal distribution of nasal cavity width. Two thirds showed reduced airway size and one third showed normal or slightly greater airway size. They suggested that the two-thirds group may represent reduced size of the medial nasal prominences and the other may represent underdevelopment of the maxillary prominence. We were particularly interested in the findings because the difference in distribution may represent differences in pathogenesis and therefore have etiologic significance. With this in mind we assessed nasal cross-sectional areas in 37 subjects with cleft lip or cleft lip ± palate using the pressure-flow technique during breathing. A group of 72 noncleft individuals served as controls. As expected, the data revealed that subjects with clefts had a significantly reduced nasal airway (p = .0001). More important, the distribution of nasal airway size in the cleft group was similar to that reported by Johnston and Hunter (1989). This comparability suggests that it may be possible to assign most cleft lip ± palate patients to a particular group. Since heredity may differ among the two groups (Chung et al., 1986), we may have a simple technique to assess the risk of occurrence for cleft lip ± palate.
Correspondence between Nasalance Scores and Listener Judgments of Hypernasality and Hyponasality
Authors: Hardin Mary A. , Van Demark D.R. , Morris Hughlett L. , Payne M. Michelle
Published: October 2018

The relationship between nasalance scores and perceptual judgments of hypernasality and hyponasality was examined for 74 subjects (51 with cleft palate and 23 noncleft controls). Twenty-nine of the 51 subjects with cleft palate had received pharyngeal flap surgery. Predictive analyses were performed to assess the sensitivity, specificity, and efficiency of the Nasometer as a screening instrument. The overall relationship between perceptual judgments of hypernasality and nasalance scores was good for the nonflap subjects when a nasalance cutoff score of 26 was used. A sensitivity coefficient of 0.67 and a specificity coefficient of 0.93 were obtained. Ninety-one percent of the nasometry-based classifications accurately reflected listener judgments of hypernasality. The correspondence between nasalance scores and clinical judgments of hyponasality was also good for the nonflap subjects when a nasalance cutoff score of 50 was used. Ninety-one percent of these classifications were consistent with the listener judgments. Efficiency of nasometry was poorer for the flap subjects.
Navigation of the Nose with Flexible Fiberoptic Endoscopy
Authors: Muntz Harlan
Published: October 2018

The introduction of flexible fiberoptics into medicine revolutionized the evaluation and treatment of velopharyngeal dysfunction. In this paper, rigid endoscopy and flexible fiberoptic scopes are discussed, including their respective advantages and disadvantages. Anesthetic and anatomic considerations relative to the endoscopic procedure are presented. Transnasal endoscopy permits documentation of static and dynamic anatomy, information that may be fundamental for the understanding and treatment of patients with velopharyngeal dysfunction.
Nasal Airway in Breathing and Speech
Authors: Warren Donald W. , Drake Amelia F. , Davis Jefferson U.
Published: October 2018

Clefts of the lip and palate frequently produce nasal deformities that tend to reduce the size of the nasal airway. Approximately 70% of the cleft population have nasal airway impairment and about 80% “mouth-breathe” to some extent. Surgical correction of nasal, palatal, and pharyngeal structures may further compromise breathing. Type of cleft appears to affect airway size, with unilateral clefts demonstrating the smallest airway. Although a pharyngeal flap may further decrease airway size, some individuals do not notice a postoperative change because of airway compromise prior to flap placement. Speech is a modified breathing behavior that uses the respiratory system to provide an energy source and involves structures within the respiratory tract to modulate this energy into meaningful sounds. The oral, nasal, and pharyngeal structures that are affected by cleft lip and palate during breathing are often compromised for speech as well. The nasal airway plays an important role in controlling speech pressures when velopharyngeal function is impaired. A “good” nose for breathing is often a “bad” nose for speech under such circumstances.
Acoustic Assessment of the Nasal Airway
Authors: Dalston Rodger M.
Published: October 2018

Instrumental assessment techniques are needed to acquire quantitative information concerning the form and function of the nasal cavity. Until recently, aerodynamic methods were virtually the only source of such information. Two additional instruments are now available that purport to provide information useful to clinicians interested in assessing nasal form and function. This paper describes both the Nasometer and the acoustic rhinometer. In addition, a more traditional measure involving acoustic analysis of nasal consonants is discussed. Both the known and potential benefits and limitations of each technique are discussed.
Anthropometric and Anthroposcopic Findings of the Nasal and Facial Region in Cleft Patients before and after Primary Lip and Palate Repair
Authors: Farkas Leslie G. , Hajniš Karel , Posnick Jeffrey C.
Published: October 2018

Two populations were studied and compared to determine the effects of cleft lip and palate surgery on the nose and face. In the first, three anthropometric measurements, two nasal and one facial, were taken before primary lip repair from infants with complete unilateral cleft lip and palate (UCLP) and with bilateral cleft lip and palate (BCLP). In the second, ten measurements were taken from the nose and face of patients surgically treated for UCLP and BCLP. The high frequency of noses disproportionately wide in relation to their height in both cleft types before primary lip repair greatly decreased after surgery. Among the residual deformities after surgery for UCLP, nostril floor width asymmetry was the most frequent, followed by columella length asymmetry, flat nasal bridge, wide soft nose, flat nasal tip, and small nasal tip protrusion. In the BCLP patients, nostril floor width asymmetry was also the most common stigma, followed by flat nasal tip, wide soft nose, columella length asymmetry, flat nasal bridge and bilaterally angled alae, and small nasal tip protrusion. A subnormally flat upper face inclination was observed in UCLP and BCLP patients. Quantitative determination of these nasal stigmata in cleft lip and palate patients who have undergone primary lip repair provides valuable information for surgical correction of the cleft soft-tissue deformities.
Fetal Cleft Lip Repair in Rabbits: Long-Term Clinical and Cephalometric Results
Authors: Kaban Leonard B. , Dodson Thomas B. , Longaker Michael T. , Stern Michael , Umeda Hironobu , Adzick Scott
Published: October 2018

We have developed a model for fetal cleft lip (CL) repair in rabbits. To date, the in utero CL procedure has been performed on 174 fetuses in 98 pregnant does. Details of the model, wound healing characteristics, and early growth results have been published previously. In this study, we report long-term clinical and cephalometric findings in 23 fetuses who underwent the fetal CL procedure, were born alive, and survived until completion of growth. The surgically created and repaired CL in fetal rabbits described here resulted in healing without scar formation. The deformity varies from an incomplete to a severe complete cleft, resembling the clinical spectrum of spontaneous clefts in humans. Cephalometric studies indicate that there were no statistically significant differences in premaxillary width, anterior maxillary length, or anterior and posterior maxillary width among control, unrepaired, and repaired animals. Documentation of this phenomenon in higher animals is necessary before the technique can be applied to humans with cleft lip.
Morphologic Effect of Preoperative Maxillofacial Orthopedics (T-Traction) on the Maxilla in Unilateral Cleft Lip and Palate Patients
Authors: Larson Margareta , Sällström Kjell-Ove , Larson Ola , Mcwilliam John , Ideberg Margareta
Published: October 2018

Sixty-eight children born with complete unilateral cleft lip and palate were studied using dental casts taken at ages 0-0,1; 0,2-0,4; and 0,5-0,6 years of age. They were all treated with preoperative maxillofacial orthopedics using an external device (T-traction). The treatment was started after the first model was taken. Dental casts were analyzed regarding the morphology of the cleft region and the maxillary segments before and after treatment. The measurements were compared with measurements on dental casts of nontreated cleft children of similar age. The results suggest that a more normal anatomy of the cleft region occurs during the first 6 months of life whether preoperative maxillofacial orthopedics (T-traction) is used or not. However, this normalized growth seems to occur faster with the T-traction.
Results of a Survey of Cleft Palate Teams concerning the Use of Nasendoscopy
Authors: D'antonio Linda L. , Achauer Bruce M. , Kam Victoria M. Vander
Published: October 2018

A national survey was conducted concerning methods used for the evaluation of velopharyngeal function with emphasis on the role of nasendoscopy. Forty-five percent of questionnaires were returned. Ninety percent of the responding teams indicated that nasendoscopy was available. Sixty-one percent agreed that endoscopy was an important clinical tool and not solely a research tool. The majority (59%) considered 3 to 5 years of age to be the youngest, appropriate age for referral. Ninety percent agreed that nasendoscopy was indicated for difficult diagnostic problems and 41% reported endoscopic studies were appropriate for all patients for whom secondary palatal management is planned. The results of this survey suggest that endoscopic assessment of velopharyngeal function is used routinely as an adjunct to the perceptual evaluation of speech and has become the standard of care among cleft palate teams for difficult diagnostic cases. However, the data also indicate that increased availability does not necessarily assure optimal use.
Speech in Unilateral and Bilateral Cleft Palate Patients from Stockholm
Authors: Karling Jonas , Larson Ola , Leanderson Rolf , Henningsson Gunilla
Published: October 2018

The speech of 84 patients with complete unilateral cleft lip and palate and 19 patients with complete bilateral cleft lip and palate was judged by professional listeners and compared with a control group of 40 noncleft subjects. The unilateral cleft group consisted of two subgroups: one group of 45 patients, who were treated with presurgicat orthopedics before primary surgery, and one group of 39 patients, who were not. The speech of the patients and the noncleft subjects was tape recorded and randomly mixed prior to listener judgments. No significant differences in articulation or resonance were found between the subgroups of unilateral cleft patients. The results also indicated that the bilateral cleft patients had poorer speech and needed more speech therapy than the unilateral cleft patients. All cleft patients were found to have poorer speech than the noncleft subjects in spite of considerable speech therapy and complementary surgical treatment. This has resulted in a change in the Stockholm approach toward earlier palatal surgery, tailormade pharyngeal flap operations, and earlier parental information and treatment of articulatory deviations.
Parents' Attitudes toward Family Involvement in Cleft Palate Treatment
Authors: Pannbacker Mary , Scheuerle Jane
Published: October 2018

Families exert a powerful influence upon their members and can be a significant resource in cleft palate treatment. The purposes of this study were to gather information about (1) the characteristics and attitudes of families whose children are treated for cleft palate; (2) the extent to which parents participate in decisions about treatment; and (3) parents' ideas about their participation. A 32-item survey questionnaire was distributed to 75 parents in Florida, Louisiana, Minnesota, and Pennsylvania. Forty-two survey forms (56%) were completed and returned for analysis. The majority of parents (57%) were satisfied with their present involvement in team treatment services; however, 36% wished for more involvement, and 7% wished for less involvement.
Maxillary Protraction: Different Effects on Facial Morphology in Unilateral and Bilateral Cleft Lip and Palate Patients
Authors: Tindlund Rolf S. , Rygh Per
Published: October 2018

Since 1977 patients with anterior/posterior crossbites in the care of the Bergen CLP team have undergone an interceptive orthopedic protraction phase during the deciduous and mixed dentition period. Eighty-seven cases with complete clefts (63 unilateral and 24 bilateral) displaying anterior crossbite (negative overjet) were treated to normal occlusion. A fixed quad-helix appliance was used in combination with a facial mask. In the unilateral complete cleft lip and palate (UCLP) group, mean age at start of treatment was 6 years 10 months and mean duration was 12 months. In the bilateral complete cleft lip and palate (BCLP) group, mean age at start of treatment was 7 years and mean duration 15 months. The protraction force was 700 g. The sagittal changes during protraction in the UCLP and BCLP groups were compared, and related to the growth changes in a group of noncleft children at the same age. Dentofacial treatment effect was different in the UCLP and BCLP groups. Significant increase of maxillary prognathism (angle s-n-ss) was found only in the UCLP group, whereas the treatment effect in the BCLP group was mainly dentoalveolar. However, after protraction there was no longer a significant difference in maxillary prognathism between the two CLP groups, and the sagittal position of the upper molars was normalized in both groups. The upper incisors remained retroclined in both groups, significantly more in the BCLP group. Increase of the upper facial height (n-sp”) and clockwise rotation of the occlusal line were significantly greater in the BCLP group. The computerized occlusal line was unsuitable as a reference standard for the evaluation of sagittal dentofacial treatment changes when the occlusal line was rotated during treatment.
Differential Growth among Components of the Palate in Rhesus Monkeys (Macaca mulatta)
Authors: King Anthony H. , Schneiderman Emet D.
Published: October 2018

To understand the etiology of maxillary hypoplasia better, which is common in individuals with cleft palate and other cranlofacial anomalies, the relative growth and contribution of the maxillary and palatine segments to enlargement of the hard palate was examined in rhesus monkeys. The purpose of the study was to identify and evaluate sites of differential growth of the palatine and maxillary segments as they contribute to the development of the midface and facial prognathism. One hundred and eight male and 107 female skulls ranging from 1.0 to 7.0 years of age were examined. Measurements of the maxillary and palatine lengths, palatal width, midface depth, canine length, and molar surface areas in the ontogenetic sample were collected. Univariate and bivariate statistics were used to describe dimensional changes and evaluate region-specific sex differences. The relative growth of palatal dimensions was evaluated using allometric analysis methods. Significant sex differences were observed (t-test, p ≤ .05) for all palatal dimensions by 4 years of age. However, proportions of the maxillary and palatine segments to overall palate length appeared to be similar throughout growth for both sexes. The results suggest that sutures of the midface, in particular the transverse palatine suture, may be important in the bony development of the palate during growth. These sutures may contribute to the overall modulation of palatal development. These findings suggest that the greater midfacial prognathism seen in adult rhesus males than in females may be associated with increased relative growth of the palatine segment during puberty, and that small growth differentials in the transverse palatine suture region can have a significant effect on the overall sagittal dimensions of the midface.
Levator Veli Palatini Muscle Activity in Relation to Intranasal Air Pressure Variation
Authors: Kuehn David P. , Moon Jerald B. , Folkins John W.
Published: October 2018

Continuous positive airway pressure (CPAP) therapy can be used to reduce hypernasality by elevating the air pressure in the nasal cavities during speech. The purpose of this study was to determine whether increased intranasal air pressure loads the major muscle of velopharyngeal closure, the levator veli palatini. Nine subjects, four with cleft palate and five without cleft palate, were studied. Electromyographic activity was measured from the levator veli palatini muscle with several levels of air pressure delivered to the nasal cavities using a commercially available CPAP instrument. It was found that levator veli palatini activity was significantly greater for the positive air pressure conditions than for the atmospheric pressure conditions for both subject groups. This indicates that the levator veli palatini muscle acts against the resistive load produced by the increased intranasal air pressure. The results support the use of CPAP therapy as a method of resistance exercise for strengthening velopharyngeal closure muscles.
Timing of Hard Palate Closure and Dental Arch Relationships in Unilateral Cleft Lip and Palate Patients: A Mixed-Longitudinal Study
Authors: Noverraz Alexis E.M. , Kuijpers-Jagtman Anne Marie , Mars Michael , Van't Hof Martin A.
Published: October 2018

In a mixed longitudinal study, dental arch relationships of 88 consecutive UCLP patients treated at the Nijmegen Cleft Palate Centre were evaluated using the Goslon Yardstick. On the basis of timing of hard palate closure, the patients were divided into four groups. Mean age of hard palate closure in group A (n = 18) was 1.5 years, in group B (n = 26) 4.6 years and in group C (n = 18) 9.4 years. In group D (n = 26, no patient older than 10 years) the hard palate was still open. Four stages of dental development were distinguished; deciduous dentition, early mixed dentition, late mixed dentition and permanent dentition. Reproducibility of scoring with the Goslon Yardstick was good for all stages of dental development. No differences in dental arch relationships were found between the four groups. In 86% of the cases, the dental arch relationships of UCLP patients treated in Nijmegen were acceptable. Pharyngeal flap surgery had minor unfavorable effects on dental arch relationships.
Social Skills of Preschoolers with and without Craniofacial Anomalies
Authors: Krueckeberg Suzanne M. , Kapp-Simon Kathy A. , Ribordy Sheila C.
Published: October 2018

The study compared the social skills of preschoolers with and without craniofacial anomalies (CFA). Fifty-two children completed self-perception and facial expression tasks and a social skills interview. Parents and teachers also rated the children's social skills. Children with CFA gave less friendly responses to hypothetical social situations and were rated as less attractive by graduate students. Girls with CFA reported above average self-perceptions. Parents and teachers rated the children with CFA as having a level of social skills equal to the children without CFA. Different factors were predictive of level of social skills for CFA and control children.
New Technique for Creating Permanent Experimental Alveolar Clefts in a Rabbit Model
Authors: Dalia El-Bokle , Smith Steven J. , Germane Nicholas , Sharawy Mohamed
Published: October 2018

Alveolar bone grafting Is an adjunctive procedure that has become increasingly popular in the rehabilitation of patients with cleft lip and palate. A histologic basis of the performance of bone grafts is required to evaluate properly different grafting materials. This, however, cannot be provided by clinical studies on humans. Therefore, an animal model with a simulated alveolar cleft is needed. A number of animal models has been previously proposed by other investigators. The problems associated with each model are presented and a surgical technique for the creation of permanent alveolar clefts in rabbits Is described. Clinical and histologic findings 6 weeks postoperatively confirm the establishment of a 1-cm wide defect with oronasal communication and healthy epithelial lining. This animal model can be efficiently used for the testing of various bone grafting materials.
Spheno-Occipital Synchondrosis in Three-Month-Old Children with Clefts of the Lip and Palate: A Radiographic Study
Authors: Mølsted Kirsten , Kjaer Inger , Dahl Erik
Published: October 2018

The literature has been focused on differences in craniofacial form and dimension in cleft lip and palate patients. No attention has been given to possible alterations in the spheno-occipital synchondrosis although the synchondrosis is regarded as an important maturity and growth center. The purpose of the present investigation was to examine if the spheno-occipital synchondrosis in children born with major complete clefts differs on lateral radiographs from that of children born with minor incomplete clefts. Fifty-seven three-month-old children with complete clefts of the lip, alveolus and palate and 42 three-month-old children with minor incomplete clefts of the lip were included In the study. The results of the comparison showed that children with complete major clefts had a broader spheno-occlpltal synchondrosis compared to children with a minor incomplete cleft of the lip, and that the distance from the superior part of the synchondrosis to the sella point was shorter in children with complete clefts. These findings could be related to a defect or a delay in maturity in the early development of the cartilaginous cranial base in children with major clefts.
Neonatal Cleft Lip Repair: The Anesthesiologist's Point of View
Authors: Van Boven Michel J. , Pendeville Philippe E. , Veyckemans Francis , Janvier Charles , Vandewalle Frédérique , Bayet Bénédicte , Vanwijck Romain , Friesen Robert H. , Veyckemans F. , Van Boven M.J. , Pendeville P.E.
Published: October 2018

Neonatal cleft lip repair is no longer an unusual procedure and several series have been published to date. We present our 3-year experience from the anesthesiologist's point of view. Preoperative evaluation, perioperative management, and postoperative problems are described. A thorough preoperative evaluation in order to exclude associated malformations (especially cardiac) and experience in neonatal anesthesia are essential for the sake of safety.
Effect of Presurgical Infant Orthopedics on Facial Esthetics in Complete Bilateral Cleft Lip and Palate
Authors: Ross R. Bruce , Macnamera M.C.
Published: October 2018

A sample of 40 teenage individuals with repalred complete bilateral cleft lip and palate, 20 of whom had received presurgical infant orthopedics, was obtained to test the effects of presurgical Infant orthopedics on facial esthetics. All subjects had surgery by the same surgeon. The age and sex distribution was approximately equal between the two groups. A panel of five judges evaluated the lip and nose esthetics from full face and profile slides and a mean panel score for each subject was derived for six individual features and three total scores. No difference in the esthetic scores between the two groups could be detected. No differences were found In the number of revisionary surgical procedures required to the lip or nose. The findings indicate that conservative presurgical orthopedics for infants with complete bilateral cleft lip and palate has no lasting effect on the esthetics of the lip and nose, and does not alter the need for subsequent revisionary surgery.
The Enigma of Cephalogenesis
Authors: Sperber Geoffrey H. , Machin Geoffrey A.
Published: October 2018

The cascade of developmental events in cephalogenesis is initiated by specific genes being transcribed and translated into polypeptides and proteins that form the structural basis of cells and tissues. These become differentiated into the complex organs of the craniofacies by the actions of signalling transducers, growth factors, and morphogens. Defects of development may be traced back through this sequence to determine the specific etiologic factors responsible for dysmorphogenesis. Molecular biology and embryology are becoming increasingly significant for clinicians.
Facial Growth and Development in Unilateral Cleft Lip and Palate during the Period of Puberty: Comparison of the Development after Periosteoplasty and after Primary Bone Grafting
Authors: Šmahel Zbyněk , Müllerová Živa
Published: October 2018

X-ray cephalometry was used in studies of facial growth and development carried out in 32 males with complete unilateral cleft lip and palate. They underwent primary periosteoplasty and were examined at the ages of 10 and 15 years. The results were compared with the development of the face In a longitudinal study of 20 males with the same type of cleft who were operated with a primary bone graft. The series with periosteoplasty showed a more marked proclination of the upper dentoalveolar component with the restoration of a positive overjet, as compared to a persistent anterior crossbite in the males with bone grafts. The lower jaw showed a larger protrusion, while individuals with bone grafts were characterized at the ages of 10 and 15 years by a larger posterior rotation of the mandible. The growth of the maxilla did not differ between series. In both series, there was a marked reduction In the growth of maxillary depth and of upper lip height, while the highest growth rate showed parameters of nasal prominence. An increasing mandibular protrusion and maxillary retrusion resulted in an impairment of sagittal jaw relations and in the flattening of the face, both of which occurred in almost all patients. The rotation of the lower jaw was not correlated with either the convexity of the face, sagittal jaw relations, or an overjet. The independence of developmental changes of selected characteristics at their initial state documented the impossibility of predicting the development of the face on the basis of a single x-ray examination at a given stage of development. Fixed appliances promoted a more marked proclination of upper incisors and the alveolar process than removable appliances, but they exerted no direct action on the other facial parameters studied.