bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Repair of the Unilateral Cleft Lip Nose: Completion of a Longitudinal Study
Authors: Mccomb Harold K. , Coghlan Brian A.
Published: October 2018

The first 10 consecutive unilateral cleft subjects operated on in 1975 by a technique of primary cleft nose correction, developed by the author (HKM), were reviewed at ages 10 and 18. No further nasal surgery had been performed on these cases. The anteroposterior and inferior facial appearances of each of the cases have been published for evaluation. A computer-based method of measuring nasal asymmetry was used to objectively analyze the results and compare them with normal and cleft control faces that were age matched. The results support the observation that nasal growth of the cleft side of the nose is unaffected by early primary nasal surgery and that the vertical shortening of the nose by the alar lift technique is preserved into adult life. Residual nostril asymmetry from septal deviation persists into adulthood.
Examination of Craniofacial Morphology in Children with Unilateral Cleft Lip and Palate
Authors: Öztürk Yildiz , Cura Nil
Published: October 2018

Craniofacial morphology of children with and without clefts has been reported to differ because of a combination of factors including, morphogenetic pattern, adaptive changes, and lip and palate management. The purpose of this study was to make a cephalometric evaluation of possible differences in craniofacial morphology of Turkish children with and without unilateral cleft lip and palate (UCLP). Twenty UCLP children (7 girls, 13 boys) with a mean age of 10.75 years (SD = 2.58 years) were compared with a control group of children without UCLP, who were matched for age (mean = 10.64 years, SD = 2.58 years) and sex. No patient had received orthodontic treatment. Linear and angular variables were measured from tracings of lateral cephalometric radiographs and the resulting data were evaluated statistically. Compared with children in the control group, the children in the cleft palate group demonstrated a greater flattening of the cranial base, a more retrognathic and posteriorly inclined maxilla with decreased length, a larger mandibular plane and gonial angle, larger anterior facial height, and decreased posterior and upper-posterior facial heights.
Congenital Palatal Ulcers in Newborn Infants with Cleft Lip and Palate: Diagnosis, Frequency, and Significance
Authors: Bacher Margit , Göz Gernot , Pham Thinh , Ney Thomas , Ehrenfeld Michael
Published: October 2018

Congenital decubital ulcers were found in 94% of newborn infants with unilateral cleft lip and palate in the course of a systematic study of a large cohort study (N = 52). The procedures for diagnosis, documentation, and follow-up are described. The ulceration area at birth varied over a wide range. The ulcerations were usually located in the posterior part of the vomer. Sonographic evidence supports the hypothesis that the ulcerations are caused mechanically by the motor activity of the tongue during the fetal and newborn period. The decubital ulcer disappeared in each case within 5 days following the implementation of a palatal plate.
Spectral Properties and Quantitative Evaluation of Hypernasality in Vowels
Authors: Kataoka Ryuta , Michi Ken-Ichi , Okabe Kaoru , Miura Tanetoshi , Yoshida Hiroshi
Published: October 2018

A new technique for evaluating hypernasality using an acoustic approach is presented. In a preliminary study using this technique, nasal resonance was assessed in 17 normal subjects and 16 subjects judged to be hypernasal. Analyses of the one-third-octave power spectra revealed an increase in power level between the first and second formant, and a reduction in the power level in second and third formant regions among utterances judged to be hypernasal. Factor analysis of the perceptual ratings revealed that the consensus perception of hypernasality accounted for 71% of the total variance. An additional 8% was accounted for by individual differences. Multiple regression analysis revealed a high correlation between the consensus perception of hypernasality and the variance in two acoustic-power levels, these being the power level between the first and second formant and the power level of the second and third formant regions.
Isolated Influences of Lip and Palate Surgery on Facial Growth: Comparison of Operated and Unoperated Male Adults with UCLP
Authors: Filho Leopoldino Capelozza , Normando Antonio David Correa , Da Silva Filho Omar Gabriel
Published: October 2018

Our aim was to evaluate the isolated effects of cheiloplasty and palatoplasty on dentofacial morphology. Ninety-three lateral cephalograms of white male adult patients with complete unilateral cleft lip and palate were analyzed in this study. The sample was divided into three groups according to the surgical treatment received: (1) nonoperated group (NO) — 35 patients without surgical treatment; (2) operated lip group (OL) — 23 subjects with lip closure only, (3) operated lip and palate group (OLP) — 35 individuals with both lip and palatal closure. No statistically significant differences in the cephalometric measurements between the OL and OLP groups were found. There were, however, several significant differences between these two groups (OL and OLP) and the nonoperated group (NO). Thus, the differences in dentofacial morphology in patients with unilateral cleft lip and palate, seem to be influenced principally by the surgically repaired lip. Influences of the palatal repair appeared to be minimal and statistically insignificant.
Cleft Palate Closure in the Neonate: Preliminary Report
Authors: Denk Michael J. , Magee William P.
Published: October 2018

Our recent experience with cleft palate closure in the neonatal period (within 28 days of birth) is reviewed in this study. The research involved a series of 21 neonates who presented with untreated cleft palates and underwent a modified Veau-Wardill-Kilner palate closure by a single surgeon between 1991 and 1994. The postoperative clinical follow-up ranged from 8 to 37 months (mean 18 months). All complications discussed do not seem to occur more frequently when surgery is done at this age than at an older age. Our findings demonstrate that cleft palate closure can be safely performed in the neonatal period; we do not, however, recommend that the standard approach should be changed based on this preliminary report.
Novel Stimuli for Obtaining Nasalance Measures from Young Children
Authors: Watterson Thomas , Hinton Julie , Mcfarlane Stephen
Published: October 2018

The use of novel stimuli for obtaining nasalance measures in young children was the focus of this study. The subjects were 20 children without a history of communication disorders and 20 children at risk for velopharyngeal insufficiency (VPI). Each subject recited three passages; the standard Zoo Passage, and two novel stimuli that were named the Turtle Passage and the Mouse Passage. Like the Zoo Passage, the Turtle Passage contained no normally nasal consonants. The Mouse Passage was about 11% nasal consonants, which is similar to the Rainbow Passage. Statistical analysis showed no significant difference between the mean nasalance for the Zoo Passage and the Turtle Passage for either the subjects without risk of VPI (15.4% vs 15.7%) or for those at risk (30.4% vs 28.8%). Nasalance measures for the Mouse Passage were significantly higher than for either the Zoo Passage or the Turtle Passage. Listeners rated the stimuli on a 5-point equal-appearing intervals scale. The correlation coefficient between listener judgments of hypernasality and nasalance was significant for the Zoo Passage (r = 0.70) and for the Turtle Passage (r = 0.51) but not significant for the Mouse Passage (r = 0.32). Using cut-off scores of 22% for nasalance and 2.25 for hypernasality, the sensitivity for the Zoo Passage was 0.72, and for the Turtle Passage, 0.83.
Early Palatal Changes after Initial Palatal Surgery in Children with Cleft Lip and Palate
Authors: Kramer Gem J.C. , Hoeksma Jan B. , Prahl-Andersen Birte
Published: October 2018

Early palatal growth and development after primary palatal closure was studied in children with different types of cleft lip and palate (CLP). Palatal dimensions were measured on dental casts taken at fixed ages, from 9 months to 4 years of age. The results showed that soft and hard palatal closure in one stage had a significant impeding influence on posterior sagittal palatal growth compared to closure of the soft palate only. Timing of surgery possibly had a small temporary restrictive effect on posterior transverse palatal growth and development. Type and severity of the oral cleft had a significant effect on transverse palatal development and anterior sagittal dimensions. Anterior arch width was reduced in children with a complete unilateral (U) CLP or bilateral (B) CLP. The palates of the latter children had consistently larger anterior arch depths. Compared to normal children, palates of cleft children changed anteriorly from wider at 9 months of age to narrower at 4 years of age. Arch depths were smaller in cleft children except for anterior arch depths in children with complete BCLP.
Prediction of Early Palatal Growth and Development in Children with Cleft Lip and Palate
Authors: Kramer Gem. J.C. , Hoeksma Jan B. , Prahl-Andersen Birte
Published: October 2018

With the use of multilevel modeling of longitudinal data, the relationship between the developmental status of the palate at 4 years of age and early palatal growth and development from birth to 1.5 years of age was studied. A model to predict palatal depths and widths at 4 years of age was developed and tested. The sample consisted of 130 children with cleft lip and/or palate. They were divided into three groups according to surgical treatment; (1) no palatal surgery, (2) soft palatal surgery, and (3) soft and hard palatal surgery. Results showed that in groups 1 and 2, the total arch depth at 4 years of age is strongly related to the initial arch depth at birth. No or low correlations were found between palatal depth at 4 years of age and the growth velocity at birth. The anterior arch width in groups 2 and 3 at 4 years of age appeared to be strongly related to the early growth velocity. In group 1, a moderate correlation with the palatal width and growth velocity at birth was observed. The results of the individual predictions of arch depths and arch widths were reasonable to fair. It was concluded that prediction of individual arch variables at 4 years of age is possible, although within limits. Clinically this means that extreme development can be discriminated from more average development.
Respiratory and Laryngeal Function Associated with Experimental Coupling of the Oral and Nasal Cavities
Authors: Sapienza Christine M. , Brown W.S. , Williams William N. , Wharton Paul W. , Turner Glenn E.
Published: October 2018

Three experimental openings (10 mm2, 20 mm2, 30 mm2) were placed one at a time in a man's palatal obturator at a location approximating the junction of the prepalate and the palatal shelves. The man's laryngeal and respiratory function were examined during his production of a series of CV syllables [pa] repeated at a comfortable and loud vocal intensity for each of the three experimental conditions. Two more conditions, in which the subject's obturator was not altered (no hole) and in which no obturator was worn, were also included for study. Laryngeal and respiratory function adjustments were most apparent during the 30 mm2 hole size and no obturator conditions. Laryngeal adjustment, as measured by fundamental frequency, was the most identifiable. A respiratory adjustment, which involved the expenditure of more lung volume as nasal airflow leakage increased, was also observed. These observations imply an active physiologic adjustment rather than a passive response to aberrant oronasal coupling.
Use of Standardized Video Recordings to Assess Cleft Surgery Outcome
Authors: Morrant David G. , Shaw William C.
Published: October 2018

A standardized method of video recording the nasolabial area of children with complete unilateral clefts of the lip and nose is described. Assessment of the outcome of cleft surgery using a scoring system to evaluate the video recordings was carried out by a panel of plastic surgeons familiar with the problems of secondary deformity in cleft patients. Nine features of the appearance and function of the lip and 10 features of the nose appearance were assessed in 30 children, aged 11 to 14 years, from two cleft treatment centers. The reliability of the panel ranged from poor to excellent for different features of the lip and nose. With further development this technique may be useful in quality assurance, intercenter comparisons, or outcome studies of surgical techniques.
Intranasal Tooth in a Patient with a Cleft Lip and Alveolus
Authors: Yeung K.H. , Lee K.H.
Published: October 2018

Ectopic dental eruption into the nasal cavity is a rare phenomenon with an obscure cause. A case of an early erupted intranasal tooth in a patient with a repaired cleft lip, an unrepaired cleft alveolus, and fusion of lower incisor teeth is reported. Only three similar cases of intranasal teeth in cleft patients have been reported in the literature. The unusual features in the present case are highlighted.
Teaching Model for Closure of Oronasal Fistula and Bone Grafting of the Maxilla
Authors: Cohen Mimis , Polley John W. , Figueroa Aluaro , Habakuk Susan W. , Iwamoto Cydette
Published: October 2018

Secondary bone grafting of the maxilla and closure of the residual oronasal fistula at the stage of transitional dentition has become a well-accepted treatment modality. This procedure, in conjunction with orthodontic treatment, has been incorporated into the management protocol of many cleft teams around the world in an effort to further improve functional and esthetic habilitation of patients with unilateral or bilateral clefts of the lip, alveolus, and palate.
Effect of Cuspid Positioning in the Cleft at the Time of Secondary Alveolar Bone Grafting on Eventual Graft Success
Authors: Long Ross E. , Paterno Michele , Vinson Britt
Published: October 2018

This investigation was to determine the relationship between the success of secondary alveolar bone grafting and the position of the permanent cuspid relative to the cleft at the time of grafting. In this retrospective study utilizing periapical radiographs taken on cleft patients to evaluate bone grafting results, the subjects were patients treated at the Lancaster Cleft Palate Clinic, a private institution specializing in the care of cleft patients. Sixty-seven patients (20 BCLP; 47 UCLP) were selected for this study based on availability of quality radiographs and a minimum of 6-month post-surgical follow-up. All patients underwent alveolar bone grafting (mean age, 10 years 7 months). Presurgical radiographs were taken within 3 months of the operation. Post-surgical radiographs were taken to evaluate the outcome of grafting (mean follow-up, 2 years 10 months). Radiographs were traced and digitized on a total of 86 cleft sites. Presurgically, a ratio was used to determine the amount of cuspid crown emerged through the alveolus into the cleft site relative to the anatomic cuspid-crown length. Post-surgically, ratios of bone support for the teeth mesial and distal to the cleft were established by dividing the amount of root covered by bone by the anatomic root length. Ratios expressing the height of alveolar crest relative to the cementoenamel junction (CEJ) of adjacent teeth and amount of alveolar notching relative to the mesial tooth root length were also evaluated. Linear regressions of each of the five ratios of graft outcome on the cuspid-eruption ratio were done. No significant correlations could be found between final graft success and the amount of cuspid crown exposed in the cleft at the time of grafting. Cuspid position could not be shown to be a significant factor in determining graft success.
Three-Dimensional Comparison between the Palatal Forms in Infants with Complete Unilateral Cleft Lip, Alveolus, and Palate (UCLP) with and without Hotz's Plate
Authors: Mishima Katsuaki , Sugahara Toshio , Mori Yoshihide , Sakuda Masayoshi
Published: October 2018

A three-dimensional measuring system was developed to analyze changes in palatal forms of UCLP infants. This system quantified the change of the curved surface on a palate by automatically superimposing two wireframe models obtained from casts at different stages of growth. It also analyzed the curvature of the palatal surface. This system was used to study the palates of 20 infants with unilateral cleft lip and palate (UCLP), from the first to fourth months after birth (12 with Hotz's plate and 8 without, selected at random). Both major and lesser maxillary segments without Hotz's plate remained anterior and lateral although those with Hotz's plate moved mesially during the fourth month after birth. In addition, the degrees of curvature on the palatal surfaces with Hotz's plate were less than those without Hotz's plate.
Bilaterally Involved Tessier No. 4 Cleft: Case Report
Authors: Aköz Tayfun , Erdoǧan Bülent , Görgü Metin , Kutlay Rohat , Daǧ Ferhan
Published: October 2018

Craniofacial clefts are rare among facial anomalies, with an incidence of 1.5 to 5 per 100,000 births, and 1 per 100 cases of cleft lip and palate. The Tessier No. 4 oro-ocular cleft is one of the rarest, with 33 unilateral and bilateral clefts reported in the literature. Among the bilateral clefts only 3 of 9 involved Tessier No. 4 cleft bilaterally. We report a case of bilateral Tessier No. 4 craniofacial cleft and our approach to surgical correction.
Palatal Mucoperiosteal Expansion as an Adjunct to Palatal Fistula Repair: Case Report and Review of the Literature
Authors: Van Damme Philip A. , Freihofer Hans Peter M.
Published: October 2018

Case report of conventional palatal soft-tissue expansion in an attempt at cleft palate fistula closure with a standard tissue expander. This technique may be an alternative to a tongue flap to promote closure of persistent oronasal fistula.
Biologic Responses of Autogenous Bone and Beta-tricalcium Phosphate Ceramics Transplanted into Bone Defects to Orthodontic Forces
Authors: Hossain Mohammed Zakir , Kyomen Shingo , Tanne Kazuo
Published: October 2018

This study was conducted to evaluate biologic responses of autogenous bone (particulate marrow and cancellous bone; PMCB) and beta-tricalcium phosphate ceramics (TCPC) to orthodontic stimuli. Nine dogs served as the experimental animals; three dogs underwent orthodontic tooth movement after grafting, three dogs received PMCB grafting without tooth movement, and three dogs received TCPC grafting without tooth movement. Immediately after extraction of the upper second and/or third incisors, the maxillary alveolar bone was resected bilaterally. Autogenous PMCB obtained from the iliac bone and TCPC were transplanted into each bone defect. Experimental tooth movement was initiated 2 to 4 weeks after the grafting and continued for 9 to 15 weeks. Sectional archwires with open-coil springs were used for distal movement of the upper first incisors into the extraction sites. Oxytetracycline and calcein were employed as bone markers. Sections of grafted areas including the teeth were prepared for light and fluorescence microscopy. The results revealed that both autogenous bone and TCPC presented similar adaptive changes to the original alveolar bone without any external stimuli. TCPC exhibited more prominent biodegradative responses to orthodontic force in association with new cementum formation. Root resorption was also less in the TCPC area than in the PMCB region. It Is shown that TCPC is biodegradative In nature and adaptive for remodeling during orthodontic tooth movement. This finding indicates that TCPC may be a better biocompatible alternative to autogenous bone transplanted into bone defects subjected to orthodontic tooth movement.
Intracranial and Extracranial Reduction Osteoplasty for Craniodiaphyseal Dysplasia
Authors: Sinow Jordan D. , Gruss Joseph S. , Roberts Theodore S. , Clarren Sterling K. , Graham C. Benjamin , Mouradian Wendy
Published: October 2018

Craniodiaphyseal dysplasia is a rare, sporadic form of craniotubular bone dysplasia, characterized by massive generalized hyperostosis and sclerosis, particularly of the skull and facial bones, leading to severe deformity. The clinical course is typically characterized by progressive encroachment of the craniofacial foramina and brain by the relentless deposition of bone. Compression of cranial nerves, the foramen magnum, and intracranial contents commonly leads to blindness, loss of hearing, and death. This report describes a unique case of craniodiaphyseal dysplasia manifesting with asymmetric craniofacial and axial hyperostosis. The tubular bones demonstrated the characteristic diaphyseal endostosis, undertubulation, and relative overgrowth on the involved side. Significant brain compression with signs and symptoms of increased intracranial pressure was managed successfully with decompressing craniectomy at age 12 years, enlarging the anterior and middle fossae. Calvarial thickness measured nearly 4 cm. Further calvarial, midfacial, and mandibular recontouring were performed 6 and 22 months later. Follow-up in our case indicates that close observation is mandatory to manage further progression of the disease.
Timing of Exchange of the Maxillary Deciduous and Permanent Teeth in Boys with Three Types of Orofacial Clefts
Authors: Peterka Miroslav , Peterková Renata , Likovský Zbyněk
Published: October 2018

Timing of exchange of the deciduous and permanent maxillary teeth was investigated using dental plaster casts of 163 boys with total unilateral cleft (UCLP), 82 boys with bilateral cleft (BCLP), and 97 boys with isolated cleft palate (CP). All patients were treated at the Prague Plastic Surgery Clinic. The results were compared with a control group of 294 schoolboys. To evaluate the course of eruption, the proportion of each erupted teeth in each year of age was employed. In boys with UCLP, eruption of the permanent maxillary lateral incisors and the permanent maxillary second molar was retarded on the cleft side. On the non-affected side, no delay of eruption was observed, but earlier eruption was found in the permanent maxillary canine and in the permanent maxillary first and second premolars. In boys with BCLP, the highest retardation of eruption was found in the permanent maxillary lateral incisor and in the permanent maxillary first molar. The permanent maxillary canine and both permanent maxillary premolars erupted earlier than in the control group. In boys with CP, only the permanent maxillary central incisors erupted earlier. The maxillary deciduous canines and the second molars were both lost early. We conclude that the developmental disturbances of the maxillary jaw and teeth in patients with orofacial clefts are also associated with alteration of timing of dental exchange.
Speech and Velopharyngeal Function in Children with an Open Residual Cleft in the Hard Palate, and the Influence of Temporary Covering
Authors: Lohmander-Agerskov Anette , Dotevall Hans , Lith Agneta , Söderpalm Ewa
Published: October 2018

The influence of an open residual cleft in the hard palate on speech was studied in nine children with cleft lip and palate at about 7 years of age. The subjects were treated by early repair of the velum (before 12 months of age), whereas the repair of the cleft in the hard palate was postponed until about 8 years of age. Speech and velopharyngeal function were assessed systematically with the residual cleft open and temporarily covered with an oral bandage. Listeners' judgments, the Nasal Oral RAtio Meter (NORAM), videofluoroscopy, and cephalometrics were used for the analyses. Four patients were also examined with a pressure-flow technique. Nasality registered by NORAM, nasal escape, and weak pressure consonants judged by listeners were common but decreased appreciably when the residual cleft was covered. Retracted articulation was found in four patients (44%) and glottal compensations In one (11%), with no improvement after covering.
Characterization of Cultured Rat Embryonic Palatal Mesenchymal Cells
Authors: Yano Hiroki , Yoshimoto Hiroshi , Ohtsuru Akira , Ito Masahiro , Yamashita Shunichi , Fujii Tohru
Published: October 2018

To investigate developmental palatogenesis, the establishment of palatal cell culture in vitro is preferable to eliminate several complicated biases present in the in vivo environment. We established a primary culture of rat embryonic palatal mesenchymal cells using a special technique to dissect embryonic palatal shelves, and characterized these embryonic cells by immunohistochemical analysis against histiocytic markers. Following preparation of the maxilla of 15.5-day-old rat fetuses, a midline incision of the maxilla was established while the occiput was fixed with microforceps. This procedure allowed eversion of the maxillary process and easy dissection of the palatal shelf. The technique allowed preparation of a large number of palatal shelves with no appendages using a small number of fetuses. Cells cultured with DMEM/F-12 and 10% FBS showed multi-potential nature (i.e., not only mere mesenchymal character but also neural, endothelioid, and/or myoblastoid origin were identified by immunostaining with anti-epithelium membrane antigen, keratin, vimentin, S-100 protein, factor VIII, desmin, and lysozyme antibodies, respectively). Our results demonstrated that, during several cell passages, the cultured cell gained myoblastoid characteristics in addition to a neural nature. Further in vitro studies using cultured embryonic palatal mesenchymal cells will assist in characterization of proliferation and differentiation of cells forming the palate.
Mesenchymal Cell Activity during 5-fluoro-2-deoxyuridine-lnduced Cleft Palate Formation in the Rat
Authors: Singh G. Dave , Moxham Bernard J.
Published: October 2018

Biosynthetic activity of the mesenchymal cells within the palatal shelves was determined during cleft palate formation induced by 5-fluoro-2-deoxyuridine (FUDR).The palatal shelves of 30 fetal rat heads with palatal clefts were surveyed at stages corresponding to normal palatogenesis, nucleolar organizer region (NOR) staining being employed to determine cell activity. Comparing cellular activity during normal and cleft palatogenesis, significantly lower counts were recorded for most stages of cleft formation. When anterior or posterior regions were compared, significant changes in NOR counts/cell were found at a time corresponding to the pre-elevation stage of normal palatogenesis. At a time equivalent to normal fusion, the shelves in the anterior region showed signs of recovery, but posteriorly significantly lower activity occurred throughout all stages of palate dysmorphogenesis. The depressed level of cellular activity found after treatment with FUDR may be directly or indirectly related to the abolition of an intrinsic shelf-elevation force and, subsequently, cleft palate formation.
Dental Findings in Parents of Children with Cleft Lip and Palate
Authors: Anderson Peter J. , Moss Anthony L.H.,
Published: October 2018

The incidence of dental abnormalities in the cleft lip and palate population has been reported to be much higher than in the normal population. The role of genes in the production of a cleft lip and palate, and dental anomalies is thought to be complex, with autosomal dominant, recessive, and x-linked genes all playing a role. Noncleft parents can carry some of the cleft lip and palate genes, which produce clinically subtle manifestations in their facial skeleton. The purpose of this study was to look for evidence of increased dental anomalies in the non-cleft parents of cleft lip and palate children. The dentitions of the parents of 60 children with different types of cleft lip and palate were examined prospectively to see whether or not they exhibited features found more readily in the cleft lip and palate rather than did the normal population. Their dentitions were studied to record the following dental features: congenitally missing teeth, supernumerary teeth, or morphologic changes of the crowns of the permanent teeth. The number and position of any frenal attachments were also recorded. The results of this study did not show any differences in incidence of dental anomalies from the noncleft population. There was no evidence to support the hypothesis that congenital absence of lateral incisors is a microform of cleft lip and palate. Further, these results also failed to reveal any consistent pattern in the number and position of frenal attachments.
Three-Dimensional Fetal Cephalometry
Authors: Bettega G., , Chenin M. , Sadek H., , Cinquin P. , Lebeau J. , Coulomb M. , Raphaël B.,
Published: October 2018

Craniofacial growth has been the subject of numerous studies in which different techniques have been elaborated aiming to model this dynamic phenomenon in a rational manner. One of the methods employed is cephalometric analysis applied to the fetus. Generally, however, these studies are confined to the exploration of a single spatial plane (sagittal plane), whose orientation is never defined in a rigorous and perfectly reproducible manner. Thus, none of these analyses offers a formal growth model. This has led us to propose a new method of fetal cephalometric study taking into account criteria for proper reproducible analysis: spatial exploration of the head performed through three-dimensional tomodensitometric images and precise location of landmarks and reproducibility of the orientation of each image, which is assured by reference to the vestibular orientation (based on the external semicircular canals), as has been described by Girard and Perez and further developed by Fenart. When the labyrinth is developed, this orientation does not change during the growth stages of the head, even with craniofacial deformities. This permits application of this orientation on fetuses and the superposition of images of different subjects. The methodology is presented using two normal human fetuses, and the advantages of this computerized tool are discussed.
The Goslon Yardstick Applied to a Consecutive Series of Patients with Unilateral Clefts of the Lip and Palate
Authors: Hathorn Iain , Roberts-Harry Dai , Mars Michael
Published: October 2018

First described in 1987, the Goslon yardstick has been used since as a reliable and reproducible means of measuring dental arch relationships and, therefore, the quality of facial growth. The dental study models of a group of 32 consecutively treated patients with unilateral clefts of lip and palate, from the Frenchay Hospital, Bristol, U.K., were analyzed using the Goslon yardstick. More than 50% of the sample were in the unfavorable Goslon groups IV and V. Because of these results, we at Frenchay Hospital now base our related surgical procedures on the early vomerine closure of the anterior hard palate without nasal or alveolar repair at 3 months, followed by primary hard and soft palate closure at 6 months.
Intraoral-Appliance Modification to Retract the Premaxilla in Patients with Bilateral Cleft Lip
Authors: Figueroa Alvaro A. , Reisberg David J. , Polley John W. , Cohen Mimis
Published: October 2018

Management of the protrusive premaxilla in patients with bilateral cleft lip is challenging for the reconstructive team. Several intra- and extraoral orthopedic techniques to reposition the protrusive premaxilla prior to bilateral cleft lip repair have been presented In the literature. A modification to a previously described tissue-borne palatal plate with a latex strap is presented. In the modified plate, the latex strap is replaced by an orthodontic elastomeric chain, and the chain over the prolablum is covered with soft denture liner. This appliance Is effective in retracting the premaxilla, noninvasive, easy to construct and adjust, economic, well tolerated by the patient, and accepted by the parents.
Supraperiosteal Flap Technique versus Mucoperiosteal Flap Technique in Cleft Palate Surgery
Authors: Leenstra Thomas S. , Kohama Gen-Iku , Kuijpers-Jagtman Anne M. , Freihofer Hans Peter M.
Published: October 2018

Recent animal experiments have shown that palatal repair without denudation of bone leads to a superior dento-alveolar development. The aim of this clinical study was to evaluate the peri- and postoperative course and the dento-alveolar development of the deciduous dentition in Japanese ULCP, and CP patients up to 5 years after two different types of palatal repair. One of the methods, the Kohama (1991) supraperiosteal flap technique, Is performed without denudation of the bony palate, while the other, the Wardill (1937) push-back technique, results in areas of denuded bone. It was concluded that the supraperiosteal technique can be performed successfully in approximately the same amount of time as the push-back technique. Re-epithelialization of the wound areas after supraperiosteal repair takes about 1 week, which is one third of the time associated with healing after the push-back technique. Arch depth of the deciduous dentition after the supraperiosteal technique is superior compared to the push-back technique. The question of whether or not the supraperiosteal technique produces more favorable dento-alveolar development than the mucoperiosteal technique in the permanent dentition in humans has to be elucidated in future research.
Spectral and Cepstral Properties of Vowels as a Means for Characterizing Velopharyngeal Impairment in Children
Authors: Garnier Stéphane, , Gallego Stéphane, , Collet Lionel , Berger-Vachon Christian
Published: October 2018

This study investigated spectral differences in the phonation of vowels between a group of 21 children with velopharyngeal impairment and a paired control group of 42 subjects. The speech material was composed of the isolated vowels /a/, /i/ and /u/, a sustained vowel /a/, and four vowels included in spoken words: two nasals /in/ and /on/ in “dindon,” and two orals /a/ and /o/ in “gâteau.” A bottom-up discriminant function analysis indicated that the cepstrum coefficients and the linear-FFT were the most efficient tools in the test to classify the set of children. They were superior to the results obtained with the formant-representation of the vowels. The use of a perceptive scale (barks) did not improve the results. Discrimination over the total group showed percentages lower than those obtained when boys and girls were assessed separately. The best discriminating results were obtained with the /a/ of “gâteau” for the girls and with the isolated /i/ for the boys.
Secondary Alveolar Bone Grafting — Five-Year Periodontal and Radiographic Evaluation in 100 Consecutive Cases
Authors: Tan Albert E.S. , Brogan William F. , Mccomb Harold K. , Henry Patrick J.
Published: October 2018

A prospective study of secondary alveolar bone grafting based on the Norwegian (Oslo) team approach has been conducted by the CLP Unit at the Princess Margaret Hospital for Children in Perth, Australia, since 1982. The 5-year results of 100 consecutive cases of uni- and bilateral cases are presented according to periodontal and radiographic parameters of tooth support. The vast majority of cases grafted (98%) resulted in the eventual eruption of the cleft side cuspid/lateral incisor within acceptable parameters of tooth support. The results confirm the predictability of this safe procedure when utilized within a strict clinical protocol involving the whole CLP team.
Maxillary and Mandibular Dental-Arch Dimensions and Occlusion in Bilateral Cleft Lip and Palate Patients from 3 to 17 Years of Age
Authors: Heidbuchel Kiki L.W.M. , Kuijpers-Jagtman Anne Marie
Published: October 2018

The aim of this study was to describe maxillary and mandibular dental-arch form and occlusion in bilateral cleft of the lip and palate (BCLP) from 3 to 17 years of age and to compare their characteristics with a normative sample. A sample of 22 patients with BCLP was investigated, with a noncleft control sample used for comparison. Dental-arch dimensions were studied on dental casts. A comparison between both groups was made at fixed time intervals. From 9 years of age, the cleft sample showed a significantly smaller maxillary depth. Maxillary dental-arch widths were also significantly smaller than in the control group over the whole age period. Mandibular dental-arch measurements were very similar In both groups, although smaller first-molar widths were noted in the BCLP group beginning at 12 years of age. A tendency for end-to-end occlusion was found, which became more clear with age and was most markedly in the canine region.
Differentiation between Cleft Lip with or without Cleft Palate and Isolated Cleft Palate Using Parental Cephalometric Parameters
Authors: Mossey Peter A. , Mccoll John H. , Stirrups David R.
Published: October 2018

Objective

The purpose of this study was to identify and compare lateral cephalometric measurements in noncleft parents of children with cleft palate (CP) and cleft lip (CL), and cleft lip and palate (CLP). The hypothesis was that discriminant analysis would enable identification of morphometric features that predispose to orofacial clefting and that differ for CP, CL, and CLP and are unevenly distributed within parental pairs.

Design

This was a prospective, parametric analysis.

Setting

The study was conducted by the Department of Dental Health, University of Dundee, and the Department of Statistics, University of Glasgow, Scotland.

Subjects

From a completely ascertained sample of 286 children with cleft lip and/or palate born in the West of Scotland between January 1, 1980, and December 31, 1984, a sample of 83 parents of children with nonsyndromic clefts volunteered for lateral cephalometric examination.

Methods

Thirty-seven cranial and 99 facial landmarks were identified and 37 linear, angular, and area parameters were used to describe the craniofacial skeleton. Analysis of variance was used for a three-way comparison of CL/CLP/CP, and stepwise discriminant analysis was used to determine which variables discriminate best between cleft lip with or without cleft palate [CL(P)] and isolated cleft palate (CP) parents.

Results

There were no significant differences whatsoever in the craniofacial morphology between the parents of children with CL and CLP, but differences were found between the CL(P) and CP groups. The most significant of these were in mandibular length, ramus length, mandibular area, and cranial area. Mandibular ramus length alone discriminated between the two groups in 71.4% of CP and in 62.5% of CL(P) cases, while separate analysis of fathers and mothers showed that ramus length and cranial height together reliably distinguish between mothers in 75% of CP and 80% of CL(P) cases.

Conclusions

Previous studies suggests that unaffected parents with nonsyndromic children with cleft lip and/or palate have differences in their craniofacial morphology when compared to the general population. This study indicates that these morphologic features differ for CP and CL(P).
Three-Dimensional Analysis Techniques—Part 1: Three-Dimensional Soft-Tissue Analysis of 24 Adult Cleft Palate Patients following Le Fort I Maxillary Advancement: A Preliminary Report
Authors: Mccance Andrew M. , Moss James P. , Fright W. Rick , Linney Alf D. , James David R.
Published: October 2018

The three-dimensional, facial soft-tissue changes of 24 patients with various cleft types following transpalatal Le Fort I osteotomy were measured using laser scanning techniques, radial measurements, and a color millimetric scale. There was a varying degree of midface retrusion in the different cleft groups, and a very similar pattern of retrusion over the nasal complex. Each group of patients showed a varying degree of relapse postsurgically, but there was a failure in all the cleft groups to correct the lack of nasal projection.
Three-Dimensional Analysis Techniques—Part 2: Laser Scanning: A Quantitative Three-Dimensional Soft-Tissue Analysis Using a Color-Coding System
Authors: Mccance Andrew M. , Moss James P. , Fright W. Rick , Linney Alf D. , James David R.
Published: October 2018

New methods for measuring and averaging three-dimensional soft-tissue morphology and change from laser scans using a color millimetric scale are described. The techniques were employed to measure facial differences between a group of Class I skeletal males and females. The surgical change in one patient following bimaxillary surgery is also illustrated. The combination of the laser scanning technique and the new color coding system probed to be a simple, noninvasive, effective, and easily interpreted method for measuring three-dimensional soft-tissue differences and change across the facial complex.
Three-Dimensional Analysis Techniques—Part 4: Three-Dimensional Analysis of Bone and Soft Tissue to Bone Ratio of Movements in 24 Cleft Palate Patients following Le Fort I Osteotomy: A Preliminary Report
Authors: Mccance Andrew M. , Moss James P. , Fright W. Rick , Linney Alf D. , James David R. , Coghlan Kieran , Mars Michael
Published: October 2018

The three-dimensional changes in the bone and the ratio of soft tissue to bone movement were investigated in a group of 24 cleft palate patients following Le Fort I osteotomy. CT scans were taken for each patient preoperatively and 1 year postoperatively. The scans were superimposed, radial measurements calculated, and the changes illustrated by two separate color scales. In all of the groups, there was a fairly consistent pattern of movement over the mandible. The soft tissues moved in a 1.25:1 ratio over the chin and canine regions, and reduced to 1:1 over the body. In the maxilla, there was a 1:1 movement in the midline increasing to 1.25:1 bilaterally over the alar bases for both the bilateral clefts and clefts of the secondary palate groups. In the unilateral cleft group, however, there was a greater degree of movement over the cleft than over the noncleft side.
Rhinoplasty in the Cleft Lip Patient
Authors: Nolst Trenité Gilbert J. , Paping Richard H.L. , Trenning Albert H.
Published: October 2018

Several important factors to consider in the surgical repair of the cleft lip nose are described: the importance of an adequate lip closure technique to ensure symmetry can prevent a more conspicuous deformity of the nose during growth, the consequences of secondary rhinoplasty in the growing nose in which the surgeon has to weigh the possible growth inhibition due to scar tissue against the possible functional and esthetic improvement, a systematic surgical approach in which the operative procedure is divided Into different steps, and the use of autogenous graft material. In the evaluation of 52 cleft lip patients (5 bilateral clefts, 47 complete unilateral clefts) who had undergone a secondary rhinoplasty, two specific postoperative problems were encountered: slight to moderate recurrence of the caudal septal deviation (in unilateral clefts) and restenosis of the nasal vestibule at the cleft side. Adjustment of the surgical technique and the use of a custom-made vestibulum device diminished these sequellae considerably.
Effects of Vitamin B6 on Beta-Aminoproprionitrile–Induced Palatal Cleft Formation in the Rat
Authors: Jacobsson Catharina , Granström Gösta
Published: October 2018

Objective

This study was conducted to evaluate the effects of β-aminoproprionitrile and vitamin B6 on palatal clefting.

Method

In four groups of pregnant Sprague-Dawley rats, β-aminoproprionitrile (BAPN; 600 mg/kg b.w.) was given by gavage on embryonal day 15, 7 hours to induce palatal clefts. Vitamin B6 (10 mg/kg b.w., IM) was given twice on embryonal day 14, 7 hours and on day 15, 7 hours. The possibility that the food's content of vitamin B6 affected the results was also tested. Palatal cleft formation was divided Into four different grades, ranging from no cleft formation to total cleft formation.

Results/conclusion

It was found that BAPN induces cleft palate in rat fetuses and that this defect can be prevented both in number and severity by administration of vitamin B6 before and simultaneously with BAPN.
Comparison of the Reliability of Craniofacial Anatomic Landmarks Based on Cephalometric Radiographs and Three-Dimensional CT Scans
Authors: Kragskov Jens , Bosch Carles , Gyldensted Carsten , Sindet-Pedersen Steen
Published: October 2018

Objective

Conventional cephalometry is an inexpensive and well-established method for evaluating patients with dentofacial deformities. However, patients with major deformities, and in particular asymmetric cases are difficult to evaluate by conventional cephalometry. Both two- and three-dimensional computed tomography (CT) have been proposed to alleviate some of these difficulties. Only a few studies using metallic markers have indicated 3-D CT to be a useful diagnostic method, whereas no studies have evaluated the reliability of the anatomic cephalometric points used in 3-D CT. The aim of our study therefore was to compare the reliability of anatomic cephalometric points from conventional cephalograms and 3-D CT.

Methods

Nine human dry skulls were CT scanned. In addition standard lateral and frontal cephalograms were obtained. The CT scans were 3-D image reconstructed, and the cephalometric points were recorded as x, y, and z co-ordinates by two investigators. Computerized cephalometrics were performed on the lateral and frontal cephalograms. Intra- and interindividual variations were calculated for each method and tested for statistical significance.

Results

Lateral cephalogram measures were more reliable than 3-D CT, with interobserver variations less than 1 mm for most points compared to about 2 mm for 3-D CT. Lateral cephalometrics also showed significantly less interobserver variation for six variables. This was, however, less obvious when 3-D CT was compared to frontal cephalograms. Frontal cephalometrics showed significantly less interobserver variation for three of the investigated variables.

Conclusions

For standard lateral and frontal cephalometric points, there is no evidence that 3-D CT is more reliable than the conventional cephalometric methods in normal skull, and the benefit of 3-D CT cephalometric is indicated to be in the severe asymmetric craniofacial syndrome patients, as conventional cephalometrics is known to be inferior in these cases.
Effect of Septal Perforations on Measures of Nasal Resistance
Authors: Guyette Thomas W. , Smith Bonnie E.
Published: October 2018

Objective

The purpose of this investigation was to determine the effect of septal perforations on posterior and anterior rhinomanometric measures of nasal resistance In an analog model.

Design

The data were analyzed using a repeated-measures ANOVA. Nasal resistance was the dependent variable, while type of rhinomanometry, septal perforation size, and position of resistance (proximal vs. distal) were nominal scale independent variables.

Participants

The analog model used in this study was similar to that described by Warren and Devereux (1966), except that the nasal cavities of the model were modified to create septal perforations.

Outcome Measures

The main dependent measure was nasal resistance.

Results

An important finding of this investigation was that septal perforations resulted in large differences (> 3 cm H2O/L/sec) between posterior and anterior nasal resistance values in the bilateral proximal resistor condition.

Conclusions

Anterior rhinomanometry may underestimate true nasal resistance when a septal perforation Is present, because the septal perforation prevents accurate measurement of nasopharyngeal pressure. Posterior rhinomanometric measures should accurately reflect nasal resistance despite septal perforations, because the perforation does not invalidate the estimate of nasopharyngeal pressure.
Congenital Bony Syngnathia: A Proposed Classification
Authors: Dawson Kenneth H. , Gruss Joseph S. , Myall Robert W.T.
Published: October 2018

Objective

Congenital bony syngnathia is an extremely rare condition characterized by bony fusion of the jaws. Five new cases are described and the existent literature is reviewed. A classification system is proposed and treatment recommendations based on this classification are presented.