bluuebunny/crossref_metadata_2025 huggingface dataset:
Children with Cleft Lip/Palate and Mental Retardation: A Subpopulation of Cleft-Craniofacial Team Patients
Authors: Strauss Ronald P. , Broder Hillary
Published: October 2018

This study compares a subpopulation of persons with cleft lip/palate who have mental retardation (n = 56) to those with normal learning (n = 420), at a large university-based cleft-craniofacial center. Many of the patients Identified as having mental retardation in this sample have the diagnosis of isolated cleft palate (46.8%). Nearly half (46.3%) of the patients with mental retardation were found to have multiple anomalies, syndromes or associated medical findings. Common findings included cardiopulmonary defects, seizures, and deviations in head size. In this clinic population, mental retardation was found more commonly among African-American patients with clefts, than among Caucasian patients with clefts. Higher rates of facial disfiguration and impaired speech were found in patients with clefts and mental retardation. This research demonstrates that among a population of persons with cleft lip and/or cleft palate, there is a subpopulation of children who also have mental retardation. Craniofacial-cleft teams will need to develop strategies to address the special needs of this group of patients.
Suitability of the Iliac Crest as a Site for Harvest of Autogenous Bone Grafts
Authors: Canady John W. , Zeitler Deborah P. , Thompson Sue Ann , Nicholas Chris D.
Published: October 2018

Many donor sites have been advocated for obtaining cancellous bone to be used for grafting alveolar defects. Recently, some authors have suggested that the iliac crest site produced an unacceptably high degree of postoperative morbidity. Because of this morbidity, the use of other donor areas, e.g., rib, cranium, and mandible, are advocated. The iliac crest donor site for alveolar bone grafting has been common practice in our Institution for years under the assumption that little or no postoperative morbidity occurred. To investigate and document the accuracy of our assumption, the charts of the most recent 50 consecutive patients receiving alveolar bone grafts, all of which used the iliac crest as a donor site, were reviewed. Postoperative pain, numbness, infection, paralysis, or long-term disability were catalogued from the charts. In addition, a questionnaire was sent to the parents and patients requesting their perceptions of these parameters. In the cases reviewed, the average length of skin incision was 4.2 cm. The average quantity of bone harvested was 4.1 cc. The usual hospitalization time was 2–3 days. No patients experienced serious or long-term complications at the surgical donor site. Immediate postoperative complications among the 50 patients studied were limited to one hematoma, one stitch abscess, one case of swelling with pain, one erythema, and one 4-day fever accompanied by slight serosanguineous drainage. Information from the questionnaire suggests that most patients returned to full activity within 4–6 weeks. No patient reported any long-term pain or disability. We conclude that the iliac crest is a suitable site to harvest cancellous bone for use in alveolar defect grafting, and should not be rejected solely because of concerns regarding excessive morbidity.
Observations Presenting Examples of Missing Palate
Authors: Horowitz Sidney L. , Chabora Alice J. , Horowitz Sidney L.
Published: October 2018

The following “Observation” appeared (In Latin) in the Deutsche Akademie der Naturforscher Leopoldina of 1757 and to our knowledge has never been published in the English literature. We came across the report in the early 1970s while preparing the report “Cleft lip and cleft palate: one genetic system” (Chabora and Horowitz, 1974). The 1757 paper was translated by a member of the Columbia University Greek and Latin Department, but reached us too late for inclusion In our references. Forgotten for many years, the paper, and its translation, recently came to light in our files.

Christopher Jacob Trew's clear description of penetrance and expressivity in a kindred in which both cleft lip and palate and isolated cleft palate are segregating may be something of an historic curiosity at this point, but we expect that others will enjoy reading this early example of a careful and thoughtful pedigree study.
Development of a Strain of Rabbits with Congenital Simple Nonsyndromic Coronal Suture Synostosis Part II: Somatic and Craniofacial Growth Patterns
Authors: Mooney Mark P. , Losken H. Wolfgang , Siegel Michael I. , Lalikos Janice F. , Losken Albert , Burrows Annie M., , Smith Tim D.
Published: October 2018

In the March 1993 issue of The Cleft Palate-Craniofacial Journal we reported a female rabbit born in our laboratory with complete bilateral coronal suture (CS) synostosis. This follow-up study presents our attempts to breed the animal and establish a strain of craniosynostotic rabbits. The second part of this study presents longitudinal somatic and craniofacial growth data in offspring with coronal suture synostosis. Serial growth data from 72 animals were collected for the present study. The sample consisted of 11 animals (10 offspring and the original female) with complete nonsyndromic unilateral (plagiocephalic) or bilateral (brachycephalic) CS synostosis, 19 animals with partial CS synostosis, and 42 unaffected control litter mates. At 10 days of age, all animals had radiopaque amalgam markers placed on either side of the frontonasal, coronal, anterior lambdoidal, and sagittal sutures. Body weights and serial lateral and dorsoventral head radiographs were taken at 1.5 (10 days), 6, 12, and 18 weeks of age. All animals showed similar body weights at 1.5 weeks of age, while completely synostosed animals exhibited a slight (about 12%), but significantly (p < .001) lowered body weight by 18 weeks of age. Results revealed that by 1.5 weeks of age the completely synostosed animals already exhibited brachycephalic cranial vaults, mid-facial hypoplasia, and increased flattening of the cranial base compared to unaffected siblings. This pattern continued through 18 weeks of age, with the partially synostosed animals exhibiting Intermediate morphologies. Compensatory overgrowths were noted primarily at the sagittal and frontonasal sutures, especially for completely synostosed animals. Findings revealed that the craniosynostotic rabbits followed predictable compensatory craniofacial growth patterns and exhibited secondary deformities similar to those reported for cases of human coronal suture synostosis. Such findings support continued efforts at developing this model to help understand, In part, the etiopathogenesis of this condition in human populations.
Comparative Cephalometric Study of Nasal Cavity Growth Patterns in Seven Animal Models
Authors: Losken Albert , Mooney Mark P. , Siegel Michael I.
Published: October 2018

Although primates have been the craniofacial growth models of choice, recent circumstances have stimulated the search for nonprimate models. In a series of studies we have described changes in various regions of the craniofacial complex for seven commonly used animal models. The present study examined the bony nasal cavity. One hundred and forty-four serial and cross-sectional lateral head x-rays were obtained for unoperated controls from previous growth studies. The sample consisted of data from 26 rats, 21 rabbits, 21 domestic cats, 23 domestic dogs, 17 baboons, 16 rhesus monkeys, and 20 chimpanzees. Comparative human data was taken from the Bolton Standards. The samples were divided into three age categories based on dental and somatic development. Midsagittal nasal cavity measurements included length, height, shape index, and area. Analysis was based on the percent increase in measures from the Infant condition. Three major shapes were discerned at adulthood (1) vertical quadrangles (humans and cats); (2) triangles (chimpanzees, rhesus monkeys, and baboons), and (3) horizontal quadrangles (rabbits, rats, and dogs). Results showed that overall shape was best modeled by the chimpanzee and, as a nonprimate model, the laboratory cat. Rabbits and rats also showed similar percent changes for length or height dimensions at different ages, suggesting that these animals may be acceptable, inexpensive alternatives to primates in some experimental situations.
Effects of Primary Alveolar Bone Grafting on Maxillofacial Development in the Rabbit
Authors: Eppley Barry L. , Sadove A. Michael
Published: October 2018

Unilateral maxillary clefts were created In 4-week-old rabbits by removing premaxillary-maxillary sutures. Four groups, five animals per group, were formed. Control animals (Group I, no clefts) helped determine normal values for facial growth. In Group II the clefts were unrepaired. In Group III each had a rib graft harvested and placed Into the alveolar defect only. In Group IV the cleft was completely grafted with multiple ribs to the nose. At six months postoperatively skeletons of all animals were directly measured and an orthogonal coordinate analysis compared maxillary and palatal growth among groups. Greatest deviations in growth were seen when the entire cleft was grafted; shortened maxillary development and nasal deflection to the clefted side occurred. Unrepalred clefts and grafts limited to the alveolus had maxillofacial development similar to that in unoperated controls. The location of grafts In clefts in infancy appears critical to avoid retarded maxillary growth.
Electromyographic Analysis of Lip Muscle Function in Operated Cleft Subjects
Authors: Flores Genaro Katia , Trindade Alceu Sergio , Trindade Inge Elly Kiemle
Published: October 2018

EMG activity of the upper lip was measured with bipolar surface electrodes during speech and nonspeech tasks In order to assess labial function in subjects with repaired clefts. Eighteen patients between 15 and 23 years of age with repaired unilateral cleft lip (Isolated or combined with repaired cleft palate) were compared to 24 matched noncleft subjects. Data analysis demonstrated that the amplitude of action potentials of the upper lip was significantly greater In the cleft group. We hypothesize that the enhanced activity of the repaired upper lip during function may contribute to the facial growth abnormalities usually seen In the cleft population.
Ectomesenchymal Mandibular Symphysis Bone Graft: An Improvement in Alveolar Cleft Grafting?
Authors: Koole Ronald
Published: October 2018

Bone grafting the alveolar cleft in cleft lip and palate (CLP) patients is widely accepted. A traditional graft is the iliac crest. Other bone graft donor sites are briefly discussed. The ratio for an ectomesenchymal bone graft in alveolar cleft repair Is explained. Aspects of the embryology, bone graft physiology, and reports on mandibular symphysis bone grafting are discussed.
The Celluloid-Acetone-Dressing in Palatoplasty
Authors: Honigmann Klaus
Published: October 2018

The article describes an older, simple, and effective method of postoperative fixation of the palatal flaps using celluloid-acetone dressing (CAD). Veau pedicle flaps and the construction of two nasal meatuses are used for the palatoplasty. After the surgery, a wire Is round around teeth IV and V on each side: a prolene mattress suture, instead of wire, is used for infants without teeth. A celluloid-acetone paste is applied to the wire or suture over a layer of gauze and petroleum jelly. The CAD mixture hardens In less than 1 hour and is removed after 4 days by cutting the wire or suture. This method prevents the palatal flaps from descending; scar tissue is minimal, and assists In the formation of a high-arched roof of the palate. In addition, the patient feeds normally after the operation.
Hypernasality and Velopharyngeal Impairment
Authors: Warren Donald W. , Dalston Rodger M. , Mayo Robert
Published: October 2018

Although the primary cause of hypernasality is impaired velopharyngeal (VP) function, a variety of other factors influence the outcome perceived by the listener. The purpose of the current study was to assess the relationship between oral-nasal resonance balance and (1) velopharyngeal orifice area; (2) nasal airflow rate; and (3) duration of nasal airflow. The pressure-flow technique was used to estimate VP area and measure nasal airflow rate and duration. Ratings of oral-nasal balance were made on a 6-point equal-appearing interval scale. Results Indicated a moderate correlation between hypernasality rating and VP area (0.66), nasal airflow (0.61), and nasal airflow duration (0.53). Adults tended to be perceived as more hypernasal than children for a given degree of VP impairment. Finally, when the degree of VP opening was small, perceived oral-nasal resonance balance appeared to be related to duration of the opening-closing movements.
Patterns of Abnormal Myogenesis in Human Cleft Palates
Authors: Cohen Steven R. , Chen Lynn L. , Burdi Alphonse R. , Trotman Carroll-Ann
Published: October 2018

To test the hypothesis that soft palate muscles are abnormal in cleft palate, we compared soft palate morphogenesis in fetuses with cleft palate (n=4) to age-matched (n=3) and nonmatched (n=1) control specimens. The morphologic status of all soft palate and masticatory structures were classified into one of six stages based on the level of histogenesis. At 54 mm crown-rump length (CRL), the levator veli palatini (L), palatopharyngeus (PP), and palatoglossus (PG) in cleft subjects demonstrated mesenchymal condensation into myoblastic fields, lagging behind the control specimens (97 mm CRL), which displayed definitive fields of myoblasts and myotube formation. In the 175 mm and 225 mm cleft and the 170 mm and 192 mm control specimens, muscular morphology was similar and had reached its postnatal appearance for the tensor veli palatini (175 m only) and L, PP, PG (225 mm only). Muscle fiber directions were, however, disoriented and disorganized, especially close to the medial epithelial edge of the cleft. The levator veli palatini, could not be distinguished as a discrete muscle in the cleft specimens, and what we believed to be the PP and PG seemed “normal” at the level of light microscopy, but malpositioned in a superior direction. This preliminary study demonstrates for the first time that early myogenesis in cleft palates differs from normal.
Effect of Premature Sagittal Suture Closure on Craniofacial Morphology in a Prehistoric Male Hopi
Authors: Kohn Luci Ann P. , Vannier Michael W. , Marsh Jeffrey L. , Cheverud James M.
Published: October 2018

Scaphocephaly is caused by premature sagittal suture closure. It restricts medial-lateral growth of the cranial vault which appears longer and narrower than normal. We examined how this natural malformation affected morphology of the cranial base and face. A prehistoric adult male Hopi with scaphocephaly was compared to 19 normal male Hopi (Old Walpi Series, Field Museum of Natural History, Chicago, IL). Three-dimensional coordinates of 53 landmarks were recorded on the cranial vault, cranial base, and face. Finite element scaling analysis was used to test for significant differences between the scaphocephalic and normal Individuals in craniofacial morphology. Finite element scaling results indicated that scaphocephaly has a profound effect on cranial vault morphology. However, morphology of the cranial base and face were only slightly affected and, typically, are within the normal range of variation for the sample. An abnormality in the cranial base Is not associated with scaphocephaly in this individual.
Comparison of Velopharyngeal Growth Patterns between Cleft Lip and/or Palate Patients Requiring or Not Requiring Pharyngeal Flap Surgery
Authors: Mazaheri Mohammad , Athanasiou Athanasios E. , Long Ross E.
Published: October 2018

This investigation compares the patterns of velopharyngeal growth in cleft lip and/or palate patients. Those who had velopharyngeal competence and acceptable speech are compared with those who presented with velopharyngeal incompetence requiring pharyngeal flap surgery or prosthesis later. Lateral cephalograms of 30 cleft palate only (CPO), 35 unilateral cleft lip and palate (UCLP), and 20 bilateral cleft lip and palate (BCLP) children of the Lancaster Cleft Palate Clinic were studied. These records were taken at 6 month intervals during the first 2 postnatal years and annually thereafter up to 6 years of age. Soft tissue landmark points in the velopharyngeal region were digitized. Length and thickness of the soft palate and height and depth of the nasopharynx were measured. Evaluation of the growth curves of these four cephalometric variables indicated only two significant differences between children who later required pharyngeal flap surgery and those who did not. These differences were found in the growth in length of the soft palate of the CPO group and in the growth in depth of the nasopharynx of the BCLP group. Based on the present cephalometric data, it is Impossible to predict at an early age those cleft lip and/or palate patients who will later require pharyngeal flaps.
Experimental and Clinical Experience with Distraction Osteogenesis
Authors: Aronson James
Published: October 2018

G. A. Ilizarov's clinical insights and experimental biology have developed into what is known today as distraction osteogenesis. Initially used for the treatment of fractures and nonunions, his methods have proven successful for limb lengthening and bone transportation. A brief history of the development of distraction osteogenesis, definition of terms, methods, and monitoring techniques are described. The primary mechanism, intramembranous ossification, is direct bone formation in uniform gradients of mineralization from a central fibrous interzone. New bone is produced from the local host surfaces and quickly remodels to the equivalent macro and microstructure. Blood supply at the focus of distraction, dependency on a latency period, different rates, and rhythms of distraction are all tested and discussed. Data from experimental tibial lengthening in more than 125 animals (dogs, rabbits, and rats) show that distraction osteogenesis provides unlimited new bone formation that remodels at daily rates ranging from 200 to 400 μm. In over 100 clinical cases, patients ranging in age from 18 months to 49 years have regenerated bone at an average rate of 213 μm in adults and 385 μm in children. Approximately 10% of these cases required supplemental bone grafts. The article proposes that distraction osteogenesis might be successfully applied in craniofacial surgery.
Neuropsychological Development in Adolescents: Cognitive and Emotional Model for considering Risk Factors for Adolescents with Cleft
Authors: Richman Lynn C.
Published: October 2018

This article reviews neurologic, endocrinologic, and neuropsychological developments that affect our understanding of the adolescent patient. Neuroimaging and neuroradiologic techniques have assisted in identifying brain-behavior relationships and how different neuropsychological patterns result in different ways of thinking. Psychoneuroendocrinologic studies have shown that sex differences in maturation and hormonal effects on behavior need taking into account. At adolescence, the individual with a cleft or craniofacial condition may be at risk for adjustment problems due to earlier developmental events, which may affect language, behavior, and self-esteem.
Speech Assessment of Adolescents
Authors: Riski John E.
Published: October 2018

The adolescent patient provides a unique opportunity for the clinician to be both retrospective and prospective. While adolescence is a period of selective and rapid oral facial growth and dental arch development, the period of rapid speech development is long past. The adolescent patient is entering a period of quiescence and is refining and adjusting existing speech skills. During the patient's adolescence, we have the opportunity to evaluate the outcome of earlier treatment and assess the results of our management strategies and techniques. We also have the opportunity to prospectively modify and improve our treatment strategies. This Is a brief review of the experiences of one cleft palate center. Treatment goals and outcomes will be reviewed and areas that require continued refinement will be described.
Longitudinal Study of Craniofacial Growth in Subjects with Cleft Lip and Palate: From Cheiloplasty to 8 Years of Age
Authors: Han Byeong-Ju , Suzuki Akira , Tashiro Hideo
Published: October 2018

Craniofacial morphology was compared in 10 patients with unilateral cleft lip and alveolus (UCLA), 33 with complete unilateral cleft lip and palate (UCLP), and 14 patients with isolated cleft palate (CP). Serial lateral and posteroanterior cephalograms, obtained just before lip repair at 4 months or palatoplasty at 2 years, and at 4 and 8 years of age, were analyzed through comparisons with the means and growth increments of craniofacial dimensions. Facial forms at 8 years of age were compared with those of 33 noncleft subjects. Wider upper facial width before lip repair in the UCLP patients diminished slightly following surgery, but the condition persisted up to 8 years of age. Less forward growth of the maxilla was found in the subjects who received palatoplasty and a larger vertical growth increment in anterior maxilla occurred in the UCLP patients. Posterior maxillary height showed no significant differences in its growth increment among patients with clefts, but shorter posterior maxillary height in the UCLP patients continued. Linear dimensions of the mandible did not differ among cleft subjects, but a larger intercondylar width, a larger gonial angle, and a slightly retruded mandible in the CP patients and UCLP patients suggested compensation of the mandible to a wider and retroinclined nasomaxillary complex.
Precision, Repeatability, and Validation of the Localization of Cranial Landmarks Using Computed Tomography Scans
Authors: Richtsmeier Joan T. , Paik Chul H. , Elfert Peter C. , Cole Theodore M. , Dahlman Holly R.
Published: October 2018

Computed tomography (CT) has brought to the craniofacial surgeon a three-dimensional representation of internal structures. CT scans provide visualization of anatomy for preoperative planning and postoperative evaluation. Beyond visualization, however, a CT scan enables assessment of measurements useful to clinicians and basic scientists. All measurement systems used with CT require the ability to accurately locate regions of interest on the image (i.e., areas, volumes, outlines, curves, surfaces, points). This study evaluates the precision and repeatability of locating anatomic landmarks in three dimensions on CT slice images, and validates these locations using an established measurement system. The average error of landmark position is always less than 0.5 mm and for some landmarks error is negligible. Repeatability studies show that less than 2% of the total variance in our data is due to measurement inaccuracy. Although data collected from CT scans are internally consistent, validation results caution the use of CT data In combination with data collected using calipers or other direct means of measurement.
Triopia: Craniofacial Malformation with Prosencephalic Duplication
Authors: Stelnicki Eric J. , Marsh Jeffrey L. , Woolsey Thomas A. , Chee Ping Lee Benjamin , Noetzel Michael J.
Published: October 2018

A case of ocular duplication with complex craniofacial and central nervous system anomalies is described. The anomaly is termed triopia because the child's most overt and distinguishing feature was three eyes: the left orbit contained two globes with independent ocular adnexa; the right orbit contained one normal appearing and functioning globe. Computer assisted medical imaging was used to define, in vivo, the intra- and extracranial soft and hard tissue anomalies: the cerebral hemisphere ipsilateral to the ocular duplication was also duplicated. Possible bases for this anomaly include duplication of primordia for the eye and secondary prosencephalon.
Levator Veli Palatini Muscle Activity in Relation to Intraoral Air Pressure Variation in Cleft Palate Subjects
Authors: Kuehn David P. , Moon Jerald B.
Published: October 2018

A comparison of the ranges of levator veli palatini EMG activity for speech versus a nonspeech task for subjects with cleft palate was the focus of this study. EMG values are also compared with subjects without cleft palate obtained in a previous study. Hooked-wire electrodes were inserted into the levator muscle of five adult subjects with cleft palate exhibiting mild hypernasality. Intraoral air pressure was measured concurrently. A blowing task was used to determine the subject's operating range for the levator muscle. Both the nonspeech and speech tasks were designed to sample the widest possible ranges of levator EMG activity. It was found that the subjects with cleft palate used a relatively high activation level for the levator muscle during speech, in relation to their total activation range, compared with the subjects without cleft palate. Implications are discussed In relation to possible anatomic and physiologic differences for cleft palate subjects compared to normal.
Monitoring Nasal and Oral Airway Patency
Authors: Henrich Douglas E. , Hotson Suzanne , Drake Amelia F. , Warren Donald W.
Published: October 2018

The hypothesis that upper airway breathing behaviors generally follow the rules of a physiologic regulating system implies the existence of sensors that monitor the airway environment. The purpose of this study was to assess the sensitivity of the monitoring system to sudden changes in airway patency in healthy, adult subjects. An instrument capable of changing airway dimensions in about 10 ms was used to assess psychophysical recognition and physiologic responses to sudden changes in airway size. Our results indicate that psychophysical recognition of change in patency occurred at a mean constriction area of 0.31 cm2. These findings suggest that recognition of change in airway size occurs well before the airway becomes flow-limiting or severely obstructed.
Quantitative Evaluation of Craniofacial Growth in the Third Trimester Human
Authors: Michael Plavcan J. , German R. Z.
Published: October 2018

A detailed understanding of fetal craniofacial growth is necessary for understanding the mechanisms underlying the growth process and how altered growth patterns may give rise to specific craniofacial anomalies. Although descriptive studies of human fetal craniofacial growth are abundant, quantitative studies are less common; most employ only lateral cephalograms or tracings of sectioned specimens. In this study, we compared growth rates in the individual bones of the facial and basicranial regions in a large sample of spontaneously aborted, third trimester fetuses. Growth in the individual dimensions of most bones is not significantly different from isometry when compared with body weight, but comparisons of dimensions within bones show clear changes in shape. In particular, the mandible is characterized by a deepening of the corpus, probably in association with development of the teeth. The maxilla also shows a relatively rapid height increase associated with dental development. The temporal bone grows faster in superoinferior height as opposed to anteroposterior width. The lateral and inferior margins of the zygomatic bone grow faster than the orbital margin. The basioccipital bone, cited in radiographic studies as growing substantially slower than the facial region, actually changes in shape more rapidly than any other skeletal component examined in this study, with widths growing much faster than lengths. Our findings demonstrate that craniofacial development in the third trimester Is characterized by localized variation in the rate of growth within and between individual skeletal components, and that gross characterizations of regional rates of growth inadequately characterize craniofacial development.
Histomorphologic Analysis of the Soft Palate Musculature in Prenatal Cleft and Noncleft A/Jax Mice
Authors: Trotman Carroll-Ann , Hou David , Burdi Alphonse R. , Cohen Steven R. , Carlson David S.
Published: October 2018

The two specific aims of this study were as follows: to evaluate the appropriateness of the A/Jax mouse model in the investigation of the key cellular stages in prenatal soft palate morphogenesis and myogenesis; and to describe structural differences in the histomorphology of the soft palate anatomy from cleft and noncleft mice prior to, during, and after palatogenesis. Cleft-induced and control groups of A/Jax mouse embryos from timed pregnancies were harvested sequentially on gestational days 15 to 19. Embryos were weighed and staged for external body morphology. The heads were removed and fixed for light microscopy, sectioned serially in the frontal plane at 10 μm and stained with hematoxylin-eosin to characterize and compare the soft palate musculature. All observations were made at the head depth of the trigeminal ganglion in both age- and stage-matched embryos. The following findings were made: (1) the A/Jax mouse is a suitable animal model for the study of soft palate myogenesis; (2) there were no discernible morphologic differences between the soft palate muscles in cleft and noncleft A/Jax mice when viewed under light microscopy; (3) the soft palate and related muscles were identifiable as muscle fields, in both the cleft and noncleft fetuses, as early as gestational day 15 and as specific muscles at gestational day 18; (4) in both the cleft and noncleft A/Jax fetuses, the soft palate muscles appeared in a sequential anatomic fashion (the palatine aponeurosis appeared first, next the tensor palatini, and then the levator palatini muscles); and (5) in the cleft palate fetuses, both pterygoid plates were angulated and displaced laterally.
Transverse Maxillary Arch Changes with the Use of Preoperative Orthopedics in Unilateral Cleft Palate Infants
Authors: Ball Judith V. , Dibiase David D. , Sommerlad Brian C.
Published: October 2018

A retrospective clinical study, using a reflex microscope, measured arch widths, palatal shelf widths, cleft widths, and palatal shelf angulation from 26 sets of plaster models of Infants' maxillary arches at birth, and at 3 and 6 months. All infants had unilateral clefts of the lip and palate. They were treated with active preoperative orthopedics until lip repair at 3 months and with a passive plate until palate repair. Cleft width significantly decreased during these periods, due to transverse growth, along with relative flattening of the palatal shelves. Arch width contracted slightly anteriorly, but remained stable posteriorly. Preoperative orthopedics may have helped these changes by removing the effects of the tongue action and allowing unrestricted growth of the palatal shelves.
Craniosynostosis with Joint Contractures, Ear Deformity, Cleft Palate, Scoliosis, and Other Features
Authors: Iida Akihiko , Ohashi Yasushi , Ono Kazuhiro , Imai Nobuyuki , Kannari Yoji
Published: October 2018

A case of craniosynostosis with joint contractures, ear deformity, cleft palate, scoliosis, and many other features is presented. The patient's skull was round with craniosynostosis of the coronal suture. The fingers were slender and long; the finger joints were contracted. Trismus was also present. Contracture of the temporomandibular joint was suspected. The helices were flat, antihelices were minimal, and the ears protruded. Furthermore, the facial and cranial features of this patient included mild hypertelorism, ocular proptosis, short pons nasi, flat radix nasi, mild retrognathia, and small oral fissure. In the oral cavity, a relatively wide cleft extended from the soft palate to the uvula. A frontal chest radiograph revealed a mild scoliosis. Differential diagnoses are discussed in reported syndromes with craniosynostosis.
Family Focused Ethics
Authors: Aspinall Cassandra L.
Published: October 2018

It is my intent to explore the family, parent, patient, social work relationships as a focus central to the solution of ethical dilemmas. In today's environment, patient selection continues to reflect persistent patterns of biased allocation of services. The ability of a family to make a decision about medical treatment begins with an understanding of how choices regarding that treatment are shared. Without taking appropriate precautions, an increased risk arises of providing surgical procedures involving real medical risk, yet unresolved psychological trauma remains unassessed. The unrelenting questions of, When?, How?, and Why?, a family should be involved in the process of ethical decision-making, begs the inherent prejudice involved.
Accuracy of Anthropometric Measurements: Past, Present, and Future
Authors: Farkas Leslie G.
Published: October 2018

Experience, based on anthropometric examination of over 1000 children with facial syndromes and more than 2400 healthy subjects of both sexes and various ages, has led me to diverge in some points from the more usual views found in the physical anthropologic literature. The purpose of this paper is to discuss the major controversial topics associated with anthropometric measurement. These include the problems associated with formation of a representative population sample, the relative validity of longitudinal and cross-sectional studies, the interpretation of intraobserver and interobserver testings, and the questionable judgments of mensurative skill in clinical practice. The factors influencing the accuracy of anthropometric measurements, definitions of both the consistent and less reliable measurements, and the duration of validity of anthropometric normative data are also discussed.
Comparison of the Hearing Histories of Children with and without Cleft Palate
Authors: Broen Patricia A. , Moller Karlind T. , Carlstrom Jane , Doyle Shirley S. , Devers Monica , Keenan Kathleen M.
Published: October 2018

Aggressive otologic management has been recommended for children with cleft palate because of the almost universal occurrence of otitis media with effusion (OME) in these children and the association of OME with hearing loss and possible language, cognitive, and academic delays. In this study, 28 children with cleft palate and 29 noncleft children were seen at 3-month intervals from 9 to 30 months to compare otologic treatment and management. Hearing and middle ear function were tested at each session; information on ventilation tube placement was obtained from medical records. Ventilation tubes were placed earlier and more often in children with cleft palate, but children with cleft palates failed the hearing screening more often. The correlation between age at first tube placement and frequency of hearing screening failures was significant for the children with cleft palate, indicating that the later tubes were first placed, the poorer the child's hearing.
Nasalance and Nasal Area Values: Cross-Racial Study
Authors: Mayo Robert , Floyd Lisa A. , Warren Donald W. , Dalston Rodger M. , Mayo Carolyn M.
Published: October 2018

Nasometry and nasal cross-sectional area data were obtained from 80 normal male and female speakers (40 African-Americans and 40 white Americans) all of whom were over the age of 18 and spoke the Mid-Atlantic dialect of American English. The nasalance scores for readings of the Zoo Passage did not differ significantly between the groups. However, nasalance scores for readings of the Nasal Sentences were found to be significantly higher among the white speakers. The pressure-flow method was used to obtain nasal cross-sectional area values. There were no racial differences in nasal cross-sectional area. The Nasal Sentences scores were not highly correlated with nasal cross-sectional area. The clinical significance of these findings is discussed.
Studies in Cranial Suture Biology: In Vitro Cranial Suture Fusion
Authors: Bradley James P. , Levine Jamie P. , Blewett Christopher , Krummel Thomas , Mccarthy Joseph G. , Longaker Michael T.
Published: October 2018

The biology underlying craniosynostosis remains unknown. Previous studies have shown that the underlying dura mater, not the suture itself, signals a suture to fuse. The purpose of this study was to develop an in vitro model for cranial-suture fusion that would still allow for suture-dura interaction, but without the influence of tensional forces transmitted from the cranial base. This was accomplished by demonstrating that the posterior frontal mouse cranial suture, known to be the only cranial suture that fuses in vivo, fuses when plated with its dura in an organ-culture system. In such an organ-culture system, the sutures are free from both the influence of dural forces transmitted from the cranial base and from hormonal influences only available in a perfused system. For the cranial-suture fusion in vitro model study, the sagittal sutures (controls that remain patent in vivo) and posterior frontal sutures (that fuse in vivo) with the underlying dura were excised from 24-day-old euthanized mice, cut into 5 × 4 × 2-mm specimens, and cultured in a chemically defined, serum-free media. One hundred sutures were harvested at the day of sacrifice, then every 2 days thereafter until 30 days in culture, stained with H & E, and analyzed. A subsequent cranial-suture without dura in vitro study was performed in a similar fashion to the first study, but only the calvariae with the posterior frontal or sagittal sutures (without the underlying dura) were cultured. Results from the cranial-suture fusion in vitro model study showed that all sagittal sutures placed in organ culture with the underlying dura remained patent. More importantly, the posterior frontal sutures with the underlying dura, which were plated-down as patent at 24 days of age, demonstrated fusion after various growth periods in organ culture. In vitro posterior frontal mouse-suture fusion occurred in an anterior-to-posterior direction but in a delayed fashion, 4 to 7 days later than in vivo posterior frontal mouse-suture fusion. In contrast, the subsequent cranial-suture without dura in vitro study showed patency of all sutures, including the posterior frontal suture. These data from in vitro experiments indicate that: (1) mouse calvariae, sutures, and the underlying dura survive and grow in organ-culture systems for 30 days; (2) the local dura, free from external influences transmitted from the cranial base and hormones from distant sites, influences the cells of its overlying suture to cause fusion; and (3) without dura influence, all in vitro cranial sutures remained patent. By first identifying the factors involved in dural-suture signaling and then regulating these factors and their receptors, the biologic basis of suture fusion and craniosynostosis may be unraveled and used in the future to manipulate pathologic (premature) suture fusion.
Extradural Deadspace after Infant Fronto-orbital Advancement in Apert Syndrome
Authors: Moore Mark H. , Abbott Amanda H.
Published: October 2018

Infant fronto-orbital advancement is presently a management cornerstone of the craniosynostosis in Apert syndrome. This procedure is based on the premise that the expanding brain rapidly advances in support of, and to remodel, the new frontal facade. This series of infant patients with Apert syndrome undergoing fronto-orbital advancement with early postoperative computerized tomography assessment reveals a large extradural deadspace persistent through the first postoperative week, not obliterated consistently until the fourth week. Early deadspace effacement results from expansion of the prefrontal subarachnoid space, without any significant change in size or shape of the frontal brain substance or ventricles. Brain growth or expansion was particularly slow with brain shape distortions still evident at late follow-up.
Fourier Analysis of Cephalometric Shapes
Authors: Ferrario Virgilio F. , Sforza Chiarella , Poggio Carlo E. , D'addona Antonio , Taroni Alberto
Published: October 2018

Craniofacial growth and development involve both size and shape variations. Shape variations can be assessed independently from size using mathematical methods such as the Fourier series. A method for the reconstruction of outlines starting from selected landmarks and for their Fourier analysis has been developed and applied to analyze the age differences in shape in the tracings of the Bolton standards (lateral view) from 1 to 18 years of age. The size-independent shape of the Bolton standard at 18 years was larger at the chin, at the gonion, and in the anterior cranial base than the shape at 1 year of age. Conversely, the younger shape was larger in the middle part of face, corresponding roughly to the maxillary bone, than the older shape. When standardized for size, growth thus seemed to modify craniofacial shape with progressive lengthening and narrowing. This shape effect was largely overwhelmed by the very evident size increments, and it could be measured only using the proper mathematical methods.
Position of Upper Permanent Central Incisors prior to Eruption in Unilateral Cleft Lip and Palate
Authors: Šmahel Zbyněk , Tomanová Michaela , Müllerová Živa
Published: October 2018

The position and degree of eruption of permanent central incisors within the premaxilla were measured on x-ray films obtained in 102 patients with unilateral cleft lip and palate and in 52 normal individuals aged 5 years. The patients were subdivided according to sex and to the method of surgical repair (bone grafting or periosteal flap surgery). Individuals with rotated incisors were assessed separately. The results showed that maxillary depth was not significantly reduced prior to palate surgery while the alveolar process was markedly retroclined. An unerupted central upper incisor on the side of the cleft was situated more anteriorly than in controls. Because of the distortion of the alveolar process, it was retroclined and produced a deformation of the subspinal concavity. Both this deformation and the distortion of the alveolar process interfered with the measurements of maxillary depth and rendered it inadequate. The incisor on the normal side was situated more posteriorly than in controls and was less retroclined than the incisor on the affected side. The degree of eruption of Incisors on both the normal and affected sides did not differ from controls. The type of surgical repair influenced only the retroclination of the alveolar process and of the Incisors within this process. The retroclination was more marked after primary bone grafting than after periosteal flap surgery. The position and degree of eruption of rotated Incisors did not differ from nonrotated incisors, and the presence of rotated incisors was not related to the degree of the shortening of maxillary depth. There were no significant differences between males and females.
Dyspnea following Experimentally Induced Increased Nasal Airway Resistance
Authors: Warren Donald W. , Mayo Robert , Zajac David J. , Rochet A. H.
Published: October 2018

Nasal resistance (NRZ) values for healthy adults range from 1.0 to 3.5 cm H2O/L/sec. Some oral breathing tends to occur at values above 3.5. The purpose of the present study was to determine at what level of NRZ individuals sense that nasal breathing is difficult. A diaphragm was used to add four different resistance loads in random to 15 adult subjects. These loads were 5, 8, and 15 cm H2O/L/sec and a value 40% above the individual's normal NRZ. Loads were added under four conditions: normal breathing, fixed flow rate, fixed breathing rate, and fixed flow and breathing rate. The pressure-flow technique was used to measure NRZ under all conditions. The study revealed that the sensation of breathing difficulty occurred at a median resistance of 5 cm H2O/L/sec and, as subjects were constrained to maintain fixed flow and breathing rates, the magnitude of RZ, at which the sensation of dyspnea was noted, decreased. The values observed in this study support previous findings suggesting that individuals switch to some oral breathing to maintain an adequate level of upper airway resistance at values between 3.5 and 4.5 cm H2/L/sec. The findings also show that individuals attempt to minimize increases in airway resistance by modifying breathing behaviors.
Midsagittal Velar Kinematics during Production of VCV Sequences
Authors: Engelke Wilfried , Bruns Thomas , Striebeck Mark , Hoch Gerhard
Published: October 2018

We present data on velar speech movements examined by electromagnetic articulography (EMA), a tool for the study of velar kinematics. Based on investigations on 22 normal German subjects (15 male, 7 female), movement paths of the velum using a sensor positioned on the midsagittal anterior surface were recorded using a series of high and low vowel VCV utterances. Maximum velar elevation (mean = 13.5 ± 0.6 mm [SD]) with the rest position as a reference was observed during the production /iti/. The average maximum articulatory velocity of velar movements during /iti/ production was 141.0 mm/sec. Maximum movement of the velum observed during production of /ana/ averaged 7.5 ±1.1 mm. The direction of velar movement ranged between 44.6° and 50.4° relative to the bite plane registered electromagnetically. The influence of ioudness variation of sequence production is demonstrated and discussed with the literature.
Observation of Velopharyngeal Closure Patterns following Isolated Stimulation of Levator Veli Palatini and Pharyngeal Constrictor Muscles
Authors: Kogo Mikihiko , Hamaguchi Munehiro , Matsuya Tokuzo
Published: October 2018

This study, using mongrel dogs, showed the individual movements caused by the levator veli palatini muscle (LVP) and pharyngeal constrictor (PC) contraction, induced by electrical stimulation to each peripheral motor nerve. Each bilateral peripheral motor nerve of the LVP and PC muscles was isolated and stimulated electrically to induce the individual contraction of bilateral LVP and PC muscles. The movements were visualized by use of a fiberscope. Vertical movement of the middle soft palate was observed mainly at LVP contraction. Circular closure in the posterior region of the velopharynx was induced by contraction of the PC muscle. The posterior and lateral wall movements clearly occurred following PC contraction.
Prevalence of Natal/Neonatal Teeth in Cleft Lip and Palate Infants
Authors: De Almeida Cristiane Machado , Gomide Marcia Ribeiro
Published: October 2018

In the daily routine of the Hospital for Research and Rehabilitation of Cleft Lip and Palate, a high frequency of natal/neonatal teeth was observed. Therefore, this retrospective study was conducted to determine the prevalence of this anomaly in 692 patients with complete unilateral and 327 bilateral cleft lip and palate, who were less than 3 months old, without prior surgery, and registered at the Hospital from 1989 to 1994. A higher prevalence of such teeth was found in the complete bilateral cleft group (10.6%), than in the complete unilateral cleft group (2.02%). Both, however, were higher than that reported for noncleft groups. There were also different characteristics in the appearance of these teeth in cleft patients from those previously related in the literature for normal patients. The conclusion was that these differences constitute another particularity of the cleft lip and palate patient.