bluuebunny/crossref_metadata_2025 huggingface dataset:
Soft Tissue Response to Orthognathic Surgery in Persons with Unilateral Cleft Lip and Palate
Authors: Ewing Mark , Ross R. Bruce
Published: October 2018

Individuals with cleft lip and palate often require Orthognathic surgery to establish facial harmony and optimal occlusal function. Surgery to the skeletal components of the face can accomplish predictable alterations in jaw relations. The soft tissue response to those skeletal movements, however, is difficult to predict, as it is also for the noncIeft individual. In addition there is the variability of the repaired cleft lip. The study included 30 persons with complete unilateral cleft lip and palate, operated for midface deficiency using a Le Fort I maxillary advancement at a mean age of 18.0 years. Some relapse occurred in the immediate postoperative period, but after 1 year the mean advancement of the maxilla was 4.9 mm (best fit of anterior maxilla) and 5.6 mm (incisai edge). Both skeletal and soft tissue changes were negligible after that time. The ratio of upper lip advancement to underlying incisor advancement was 0.65 to 1. Although the lip response was highly correlated to the underlying bony movement, the variation was sufficient to preclude accurate prediction. The upper lip thinned with maxillary advancement, but this was not related to the original lip thickness. Coincident mandibular surgery had no appreciable effect on upper lip movement.
Integrated Endoscopic/Photodetector Evaluation of Velopharyngeal Function
Authors: Karnell Michael P. , Seaver Earl J.
Published: October 2018

A new integrated videoendoscopic/photodetection system, including an endoscope with an internal instrument channel used for photodetection, was applied to the evaluation of velopharyngeal closure in a subject with marginal velopharyngeal insufficiency (VPI) and in a subject with no speech disorder. Acoustic and aerodynamic speech assessments were used to establish the severity of velopharyngeal impairment in the marginal VPI patient. A light-out condition was used to establish the photodetector criterion for closure. The new system was effective for providing detailed phonetic assessment of velopharyngeal closure. Variations in degree of closure during select oral and nasal consonant productions were identified in the VPI subject but not in the normal speaking subject. The data show that important details of velopharyngeal insufficiency can be identified using the integrated endoscopic/photodetection system.
Craniofacial Morphology of Children with Williams Syndrome
Authors: Mass Eliyahu , Belostoky Leon
Published: October 2018

Facial dysmorphology is considered to be a major diagnostic feature in patients with Williams syndrome (WS). The dysmorphology is composed of soft tissue and skeletal components. In this study the skeletal component of the facial dysmorphology was examined by analyzing the lateral cephalometric radiographs of 8 children with WS. Seven anatomic areas were judged by means of the analysis of 48 cephalometric variables. Four skeletal features contributed to the facial appearance of children with WS: (1) the anterior cranial base was short, although the cranial base angle (N-S-Ba) was normal; (2) the angle of the mandibular plane was steep, although total facial height was normal; (3) despite the normal facial height, there was an unusual proportion of upper to lower anterior facial height and posterior to anterior facial height; and (4) the chin button (pogonion to N-B line) was deficient, although the mandible could not be classified as retrognathic. The common skeletal components were not dominant enough to characterize the facial dysmorphology completely.
An Aid to Nasotracheal Intubation in Orthognathic Surgery
Authors: Becker David W. , Bass Craig B. , Williams Vincent L.
Published: October 2018

An atraumatic and reliable technique of nasal intubation in patients with previous pharyngoplasty or pharyngeal flap is presented. Using the tight and smooth fit of the fluted end of a red rubber catheter over the end of a nasotracheal tube is the technique described.
Neurocranial Morphology in Mandibulofacial Dysostosis (Treacher Collins Syndrome)
Authors: Figueroa Alvaro A. , Peterson-Falzone Sally J. , Friede Hans , Begole Ellen A.
Published: October 2018

An abnormal cranial base could exert a negative influence on neurocranial development. Because patients with mandibulofacial dysostosis (MFD) present an abnormal cranial base (basilar kyphosis), a retrospective mixed longitudinal cephalometric study was designed with the purpose of ascertaining the presence of abnormalities of neurocranial form and size in this population of patients. The lateral and frontal cephalometric radiographs from 33 patients with MFD (15 males, 18 females) ranging in age from 3 years 4 months to 19 years 6 months were used. For comparison cephalometric radiographs from two samples were obtained: one from 24 children (12 male, 12 female) with repaired cleft lip only, and the other from 41 normal young adults (21 male, 21 female). All films were traced, and 9 linear, 1 angular, and 3 derived measurements were obtained from the neurocranium and cranial base. Differences between groups according to age and sex were tested with Student's t-test at the 5% level of significance. A correlation analysis between the cranial base angle and selected neurocranial variables was also conducted. The results showed that although the neurocranium in MFD had normal dimensions in length, height, and volume, it had an abnormal shape. The neurocranium had reduced length anteriorly and increased length posteriorly. The upper cranial height was decreased and the lower cranial height was increased. The difference in shape was evident during childhood and remained in adulthood. The dimensions of the anterior and posterior cranial base, as well as the cranial base angle, were smaller in MFD. A significant negative correlation was found between the cranial base angle and the lower cranial height in MFD.
Modified Coronal Incision: Distribution of Stress in the Scalp and Cranium
Authors: Akita Sadanori , Hirano Akiyoshi
Published: October 2018

Coronal incision or bitemporal incision is useful for wider visualization in craniofacial surgery. In volume-expanding surgery such as fronto-orbital advancement, however, the incisional scar in the temporal scalp is often undesirably wide and conspicuous. We modified the coronal incision to avoid the widened scar. Further, we analyzed the resulting stress distribution using the finite element method (FEM) to determine whether or not the modification we adapted was effective. The modified method of coronal scalp incision that we used for craniofacial surgery is practical and technically easy. FEM analysis showed that our method was effective in terms of mechanical strength. The simulated surgical craft model is presented and is concluded to be beneficial for further analysis in craniofacial surgery.
Obstructive Sleep Apnea Secondary to Surgery for Velopharyngeal Insufficiency
Authors: Ysunza Antonio , Garcia-Velasco Manuel , Garcia-Garcia Miguel , Haro Reyes , Valencia Matilde
Published: October 2018

The files of 585 patients who had had pharyngeal flap surgery for the correction of velopharyngeal insufficiency were reviewed. Eighteen patients, ranging in age from 6 to 16 years, showed clinical symptoms of obstructive sleep apnea syndrome. All of these cases had a Polysomnographic evaluation and videonasopharyngoscopy. Fifteen cases met the criteria for the diagnosis of obstructive sleep apnea syndrome and eventually underwent surgical treatment. A modified uvulopalatopharyngoplasty was done in 14 of the 15 cases. One patient had a prominent uvula flipping into the port of a Jackson's type pharyngoplasty, so a partial resection of the uvula was performed. Surgical treatment was successful in 14 of 15 cases, including the case with the partial uvular resection. In one case, severe sleep apnea persisted after surgery and a complete section of the flap was performed to correct the obstruction. Sizeable tonsils were found in 13 out of 15 cases, whereas flap width appeared unrelated to obstruction. Preoperative assessment of tonsillar tissue is of vital importance before pharyngeal flap surgery.
Psychotherapy for Persons with Craniofacial Deformities: Can We Treat without Theory?
Authors: Bennett M. Elizabeth , Stanton Mary L.
Published: October 2018

In recent years, increasing numbers of experts have recommended that psychological support be available for cleft children and their parents. Few cleft palate centers however offer comprehensive psychological services. This paper presents some conceptual factors which may contribute to the paucity of psychological treatments available to cleft children and their families. Shortcomings in current concepts of emotional dysfunction in cleft children are discussed, and the effects of conceptual confusion on options for psychotherapy are outlined. Suggested directions in psychotherapy research for cleft children are discussed.
High Prevalence of Cleft Lip among the Barí Indians of Western Venezuela
Authors: Ballew Carol , Beckerman Stephen J. , Lizarralde Roberto
Published: October 2018

Cleft lip with or without cleft palate (CL ± P) is of high prevalence in an isolated, inbred indigenous population of the Venezuelan rain forest: 12 contemporary probands are known in a population of 1200. CL ± P is familial in this population. One kindred contains four affected siblings and a total of eight probands. The mode of transmission of CL + P is under investigation through the collection and biological verification of genealogies and through screening for selected sequence-based polymorphisms. Polymerase chain reaction (PCR) assays were successfully applied to recover DNA from blood dried onto filter paper in the field. Eleven samples from probands and their first-degree relatives have been analyzed for DNA sequence-based polymorphisms for TGF-A and HOX7. No significant linkages for either locus were found. Evaluation of the distribution of probands in four genealogies indicates that CL ± P could be transmitted as an autosomal recessive trait in this population. We believe this is the first report of this mode of transmission for nonsyndromic CL ± P.
Peritonsillar Abscess as a Cause of Transient Velopharyngeal Insufficiency
Authors: Finkelstein Yehuda , Bar-Ziv Jacob , Nachmani Ariela , Berger Gilead , Ophir Dov
Published: October 2018

“Hot potato voice” is a characteristic sign of peritonsillar abscess and Peritonsillitis. Our findings show that the hot potato voice is the result of an underlying transient velopharyngeal insufficiency combined with muffled oral resonance. The hot potato voice should be distinguished from the muffled oral voice which can be occasionally encountered in cases of severe tonsillitis. The velopharyngeal insufficiency is the result of transient dysfunction of the palatal muscles on the affected side. Transient negative middle-ear pressure indicating eustachian tube dysfunction was found in few of the patients in whom concomitant sinusitis was also present. The clinical, nasendoscopic, and radiologic findings are analyzed and discussed. We believe that this phenomenon is valuable as a research tool for the investigation of the anatomy and physiology of the velopharyngeal valve.
Intraoperative Suction Test as a Predictor of Velopharyngeal Competence
Authors: Baker Stephan , Millard D. Ralph
Published: October 2018

A simple, inexpensive intraoperative test to estimate the probability of adequate speech development following cleft palatal or pharyngeal flap surgery is described. Its results were reviewed in 151 patients over a 10-year period. The positive predictive value of the test is 92% for not requiring further surgery and 83% for development of adequate speech. The results and their meaning are discussed.
Soft-Tissue Profile Changes during Widening and Protraction of the Maxilla in Patients with Cleft Lip and Palate Compared with Normal Growth and Development
Authors: Tindlund Rolf S. , Rygh Per
Published: October 2018

During the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP team have undergone an interceptive orthopedic treatment phase during the deciduous and mixed dentition period. The present study includes 68 patients who received maxillary transverse expansion by use of a modified quad-helix appliance and 98 cases given maxillary protraction by a facial mask. All cases were treated until an acceptable normal occlusion was attained. Lateral cephalograms were taken immediately before and after the active treatment periods. Sagittal changes of the soft-tissue profile during transverse expansion and protraction were analyzed separately for unilateral complete cleft lip and palate (UCLP) patients and bilateral complete cleft lip and palate (BCLP) patients. The soft-tissue profiles of the groups were compared to growth changes of noncleft age-matched children (NORM group). During the short period of maxillary transverse expansion (mean period, 3.5 months) no significant change of the soft-tissue profile was found, except in the protrusion of the lower lip in the BCLP group. During the period of maxillary protraction (mean periods, 12 months in the UCLP group and 15 months in the BCLP group) the soft-tissue profile improved significantly by reducing the characteristic tendency towards a concave profile in CLP patients with maxillary deficiency. Significant Increases of the sagittal maxillomandlbular lip relation (angle SS-N-SM: mean Increase, 2.5 degrees) and the Holdaway-angle (H-angle: mean increase, 3.0 degrees) were found to be similar in the UCLP and BCLP groups. However, the use of different reference lines for evaluation of treatment effects upon the soft-tissue profile resulted in conflicting findings suggesting that anteriorly situated reference lines are more suitable for the evaluation of CLP patients. Thus, the esthetic line (E.line) indicated a favorable position of the lips after treatment; the subspinale-pogonlon line (ss.pg) revealed an Improved soft-tissue profile; the soft-tissue-facial line (N.PG) showed a retruded nose and upper lip; whereas basal references such as the nasion-sella line (NSL) and the occlusal-line perpendicular (OLP) mainly showed major differences between the CLP groups and the NORM groups.
Isolated Cleft Palate in Danish Multiple Births, 1970-1990
Authors: Christensen Kaare , Andersen Poul Fogh
Published: October 2018

The etiology of most cases of Isolated cleft palate (CP) is unknown. The relative importance of genes and environment can be studied using the classical twin method but only few and potentially highly selected CP twin data are available. The present CP twin study was based on four Danish nationwide ascertainment sources of CP multiple births in the period 1970–1990. The ascertainment sources covered the time period from 15 completed weeks of pregnancy to adolescence for the older cohorts. A total of 18 CP cases in multiple births were identified; two monozygotic twin pairs of which one was concordant and eight were dizygotic, discordant twin pairs. Three cases were from two triplet sets, and four discordant twin pairs were of unknown zygosity.

The twin concordance rates suggest that genetic factors play a major role in the etiology of CP, but environmental and/or stochastic factors are probably acting as well.
Effect of Parental Factors on Social Skills of Preschool Children with Craniofacial Anomalies
Authors: Krueckeberg Suzanne M. , Kapp-Simon Kathy A.
Published: October 2018

This study investigated the parenting stress and style and the social networks of parents with preschool children with and without craniofacial anomalies (CFA), and the effect of these factors on the child's level of social skill. Fifty-two families participated In the study. No differences were found between the CFA and control groups on level of parenting stress, parenting style, or social network characteristics. However, parents with children with visible defects found their social support networks more helpful, and advocated a more nurturing parenting style. For the CFA group, parenting stress predicted child level of social skill. These results underscore the Importance of Investigating the interaction between parent and child factors.
Social Improvement after the Wilke Procedure for Excessive Drooling
Authors: Puckett Charles L. , Concannon Matthew J. , Mcnaul David , Barone Constance
Published: October 2018

The child with an excessive drooling problem often faces similar social deprivation to those with severe craniofacial malformations. Many of these children have other “strikes against them” (such as cerebral palsy) that, when coupled with drooling, isolate them from social interaction. Many methods have been employed to control drooling but surgery has been most consistently successful. The most popular of these has been the Wilke procedure or a modification of It. Several series have been reported, but a detailed correlation of mechanical success with the effects on social activity has not been reported. We reviewed a series of 23 cases of Wilke-type surgery. Analysis of the results showed a convincing Improvement in social activity after successful surgery. The Wilke procedure enjoys a relatively high rate of success In preventing excessive drooling, which seems to offer a dramatic improvement in social contact enjoyment.
Identification of Children with and without Cleft Palate from Tape-Recorded Samples of Early Vocalizations and Speech
Authors: Van Demark Duane R. , Hardin-Jones Mary A. , O'gara Mary M. , Logemann Jerilyn A. , Chapman Kathy L.
Published: October 2018

Thirty judges (5 speech pathologists, 10 mothers of children with cleft palate, and 15 mothers of noncleft children) listened to 90 tape-recorded samples of early vocalizations/speech obtained from noncleft babies and babies with cleft palate. Each sample was classified by the judges as normal or abnormal. As a group, the speech pathologists classified only 60% of the cleft samples as abnormal and 59% of the normal samples as normal. The cleft and noncleft mother groups, on the other hand, classified 37% and 25% of the cleft samples as abnormal and 59% and 73% of the normal samples as normal. Poor interjudge agreement was evident within and across the three groups of judges. The poor reliability demonstrated by the speech pathologists in identifying babies with unrepaired clefts appeared related more to a difference in interpretation of the perceptual data than an inability to hear salient information.
Syngnathia: A Report of Two Cases
Authors: Valnicek Stanley M. , Clarke Howard M.
Published: October 2018

Syngnathia is a rare anomaly involving soft tissue or bony adhesions between the maxilla and mandible. Two cases of congenital syngnathia secondary to interalveolar soft tissue synechia are presented. These children present problems with airway protection and feeding in the immediate neonatal period. Most have multiple associated anomalies requiring concurrent management. Less than 50 cases have been described, most commonly in association with popliteal pterygium syndrome. Surgical management involves division of the adhesions in the first few days of life. Depending on the severity, these patients may present formidable anesthetic challenges. The prognosis is generally favorable in cases of soft tissue adhesions with eventual restoration of normal mandibular motion and function.
Proximal Deletion of the Long Arm of Chromosome 1: [del(1)(q23–q25)]
Authors: Lo Lun-Jou , Noordhoff M. Samuel , Huang Chiung-Shing , Chen Kuo-Ting , Chen Yu-Ray
Published: October 2018

A patient with bilateral complete cleft of the lip and palate (CLP) had a proximal deletion of the long arm of chromosome 1 (1q). This rare chromosomal abnormality was characterized by pre- and postnatal growth retardation, psychomotor retardation, and specific craniofacial and other systemic anomalies. There is a high incidence of CLP in proximal 1q deletion syndrome, especially bilateral CLP. Twelve other cases reported in the literature having this deletion and associated anomalies were reviewed.
Submucous Cleft Palate with a Discontinuous Bony Deformity
Authors: Malata Charles M. , Cooter Rodney D. , Batchelor Andrew G. G.
Published: October 2018

An unusual submucous palatal cleft Is presented. In addition to the usual triad of bifid uvula, posterior bony notching, and diastasis of the velar musculature, there was a linear bony cleft involving only the maxillary component of the hard palate. The palatine bone was intact between the posterior notch and the maxillary cleft. A discontinuous palatal cleft is an extremely rare deformity and is interesting because existing theories of cleft pathogenesis do not readily explain such a defect.
Development of a Strain of Rabbits with Congenital Simple Nonsyndromic Coronal Suture Synostosis Part I: Breeding Demographics, Inheritance Pattern, and Craniofacial Anomalies
Authors: Mooney Mark P. , Wolfgang H. Losken , Siegel Michael I. , Lalikos Janice F. , Losken Albert , Smith Tim D., , Burrows Annie M.
Published: October 2018

The lack of an animal model of congenital coronal suture (CS) synostosis has prompted the widespread use of an experimental rabbit model using adhesive Immobilization of the CS. Such postnatal models have helped make significant scientific contributions but may still not fully represent all aspects of the human congenital condition. In the March 1993 issue of The Cleft Palate-Craniofacial Journal we reported a female rabbit born in our laboratory with complete bilateral CS synostosis. This follow-up study presents our attempts to breed this animal and establish a strain of cranlosynostotic rabbits. To date, we have accomplished 10 back- and intercrosses with these animals and have produced a total of 71 live offspring; 10 animals exhibited complete nonsyndromic unilateral (plagiocephalic) or bilateral (brachycephalic) CS synostotic deformities at birth, and 19 animals exhibited partial CS synostosis that showed more than 75% growth retardation across the CS (well below the 95% confidence interval for normals). Results revealed that gestational time and litter size averages were consistent with those reported for the strain, although the average litter size decreased with increased inbreeding. By 1.5 weeks of age the completely synostosed animals already exhibited brachycephalic cranial vaults and midfacial hypoplasia compared to unaffected siblings. Initial pedigree analysis suggested an autosomal dominant inheritance pattern with incomplete penetrance and variable expressivity. The development of such a congenital rabbit model may prove useful In helping to understand the etiopathogenesis of this condition In human populations.
Development of Overjet and Dentoskeletal Relations in Unilateral Cleft Lip and Palate before and during Puberty
Authors: Šmahel Zbyněk , Müllerová Živa , Škvařilová Božena , Stránská Petra
Published: October 2018

Roentgencephalometry was used for the assessment of the development of clinically important facial characteristics In complete unilateral cleft lip and palate during the prepubertal and pubertal period. Thirty-one patients aged 8 and 11 years and 30 patients aged 11 and 14 years were examined repeatedly. All of them were operated upon and orthodontically treated with the same methods. An unfavorable development of facial convexity, sagittal jaw relations, configuration of the soft profile, and of the prominence of the upper lip occurred during both periods. An improvement of overjet that was attained during the prepubertal period showed a renewed impairment during the period of puberty. The impairment was not caused by the higher facial growth rate, but was attributable to the exhaustion of the compensation and adaptation mechanisms of the dentoalveolar component of the upper Jaw produced by the preceding orthodontic therapy. The development of sagittal jaw relations and of facial rotation was not related to the Initial patterns of these characteristics, but the possibility of an improvement of the inclination of upper incisors and of overjet was influenced by their initial pattern. During the prepubertal period the development of overjet was not related to the development of sagittal jaw relations or of mandibular growth rotation, as was the case during puberty.
Coordination of Velopharyngeal Muscle Activity during Positioning of the Soft Palate
Authors: Moon Jerald B. , Smith Alice E. , Folkins John W. , Lemke Jon H. , Gartlan Michael
Published: October 2018

The relative contributions of the levator veli palatini, palatoglossus, and palatopharyngeus muscles were assessed relative to a range of positions of the velopharynx during production of the vowels [a] and [I] by four normal adult speakers. The results indicate that velopharyngeal positioning is determined by the relative contributions of the levator veli palatini, palatoglossus, and palatopharyngeus muscles. There was an increase In coefficients of determination (i.e., amount of closure level variability explained) when activity levels of all three muscles are included in the statistical model compared to activity in any one muscle analyzed independently. Both consistent and inconsistent relations among activity levels in the three velopharyngeal muscles studied were observed across speaker and vowel produced.
Health Policy and Craniofacial Care: Issues in Resource Alllocation
Authors: Strauss Ronald P.
Published: October 2018

The distribution of health care services, including craniofacial services in the United States, is examined. The U.S. has a unique health care financing and organizational system in which persons are most commonly covered by health Insurance as a benefit of their employment. Current estimates are that nearly 40 million Americans have no health insurance (Himmelsteln et al., 1992). Approximately half of the uninsured persons are in low-wage employment that does not provide health insurance benefits nor allow them to qualify for Medicaid (Pepper Commission, 1990). Personal health care costs now exceed 11% of the U.S. gross domestic product, a significantly higher percentage than that found in other Industrialized nations (Consumer Reports, 1990b). Within the current system, is health care distributed in a fair or moral manner? What are the effects of the allocation scheme? Possible changes in health care financing and delivery are examined and basic ethical and social issues associated with a changing U.S. health care delivery system are explored.
Frontonasal and Craniofrontonasal Dysplasia: Preoperative Quantitative Description of the Cranio-Orbito-Zygomatic Region Based on Computed and Conventional Tomography
Authors: Moffat Stephanie M , Posnick Jeffrey C. , Pron Gaylene E. , Armstrong Derek C.
Published: October 2018

The unoperated cranio-orbito-zygomatic complex of 18 children (mean 4.7 years) with frontonasal dysplasia (FND) and 12 children (mean 1.1 years) with craniofrontonasal dysplasia (CFND) was quantified by 15 standard measurements performed on either computed tomography scans or facial tomograms. The results were compared with age-matched control values. In the FND group, the mean anterior interorbital and mid-interorbital distances were significantly increased at 148% and 118% of normal, and in the CFND patients, at 177% and 140% of normal. Excessive medial orbital wall protrusion (mean, 145% of normal in FND and 177% in CFND), shortened zygomatic arch lengths (mean, 94% of normal In FND and 91% in CFND), and reduced cephalic lengths (mean, 96% of normal in FND and 83% in CFND) were all observed. An expanded interzygomatic buttress distance was documented only in the CFND group, at 111% of normal. The clinical presentation of craniofacial deformities such as FND and CFND can be objectively described by a numerical analysis of the bony pathology.
Three-Dimensional Evaluation of Facial Asymmetry in Cleft Lip and Palate
Authors: Ras Frank , Habets Luc L.M.H. , Van Ginkel Floris C. , Prahl-Andersen Birte
Published: October 2018

The purpose of the present study was to describe facial asymmetry in three dimensions in individuals with an operated complete unilateral cleft lip and palate (UCLP) and in individuals without craniofacial anomalies (controls). Three-dimensional coordinates for 16 bilateral and 10 midsagittal facial landmarks were determined for the UCLP group (N=49) and the control group (N=80) by means of stereophotogrammetry. The total asymmetry was measured and resolved for transverse, vertical, and sagittal components. It can be concluded that all three components are Important in studies on facial asymmetry. Individuals with UCLP show more facial asymmetry in the vertical direction than controls. They demonstrate more facial asymmetry in the region related to the cleft than controls. And, males in general demonstrate more asymmetry of the nose than females.
Prevalence of a Soft Tissue Bridge in a Sample of 2014 Patients with Complete Unilateral Clefts of the Lip and Palate
Authors: Silva Filho Omar Gabriel , Cristovâo Regina Maria , Semb Gunvor
Published: October 2018

This study examines the prevalence of a soft tissue bridge (Simonart's band) on 2014 Brazilian Caucasian patients with unilateral complete cleft lip and palate (UCLP). A soft tissue bridge occurred in 19.6% of the subjects; 94.9% of the soft tissue bands had skin coverage. The presence of soft tissue bridges was unrelated to gender and the laterality of the cleft.
Myotonic Dystrophy Revealed at Videoradiography of Deglutition and Speech in Adult Patients with Velopharyngeal Insufficiency: Presentation of Four Cases
Authors: Hillarp B. , Ekberg O. , Jacobsson S. , Nylander G. , Åberg M.
Published: October 2018

Patients with velopharyngeal insufficiency (VPI) without cleft palate, who appear for the first time in adulthood for treatment, will probably reveal a high percentage of undiagnosed myotonic dystrophy (MD). Videoradiography of deglutition and speech reveals the diagnosis. Eleven adult noncleft palate patients with VPI were studied with videoradiography of the pharynx and esophagus. Three exhibited functional radiographic manifestations of MD during deglutition and speech. The diagnosis confirmed by neurologic examination was not known or suspected prior to videoradiography. An additional patient with VPI and suspected MD displayed the same constellation of radiographic findings. Follow-up examinations confirmed the diagnosis of MD. Three of the four patients had had symptoms of VPI since childhood, but none had complaints of deglutition problems except for accidental nasal regurgitations.
Asterion Region Synostosis
Authors: Jimenez David F. , Barone Constance M. , Argamaso Ravelo V. , Goodrich James T. , Shprintzen Robert J.
Published: October 2018

Posterior plagiocephaly historically has been associated with synostosis of the lambdoid suture. The incidence, diagnosis, and modes of treatment for stenosis of the lambdoid suture remain controversial. Commonly, the lambdoid suture is found to be open both on radiographic examination and at the time of surgery. The study reports on nine patients who presented with unilateral posterior plagiocephaly and who were found to have open lambdoid sutures, but a stenosed region of the asterion. The area of Involvement included the distal-most lambdoid suture, the parietomastoid, occipitomastoid, and proximal squamosal sutures. Positional molding or torticollis was ruled out in all patients. All the patients showed progressive involvement of the skull base, including anterior shifts of the ipsilateral ear, compensatory Ipsilateral frontal bossing and malar protrusion. Stenosis of the asterion was diagnosed with three-dimensional computed tomography scans, corroborated at the time of surgery and confirmed histologically. Surgical correction Involved resection of the affected asterion and reconstruction using a bandeau-technique, barrel staves of the occipital bone and bone graft transposition. This approach provided excellent esthetic results in all patients.
Survey of 300 Chinese Cleft Palate Patients Presenting for Recall to a Dental Department in Hong Kong
Authors: Chow Tak Kun
Published: October 2018

Three hundred Chinese patients with cleft lip and/or palate were reviewed in the Dentofacial Deformities Clinic of the Department of Dentistry at the United Christian Hospital between January 1990 and January 1992. A survey was taken of patients' age, sex, type of cleft, and cleft location. The findings from this survey are compared to an original sample of 2800 cleft patients surveyed earlier.
Bipedicled Axial Cross-lip Flap for Correction of Major Vermilion Deficiency after Cleft Lip Repair
Authors: Wagner Jeffrey D. , Newman M. Haskell
Published: October 2018

Vermilion irregularities are common secondary deformities after cleft lip repair. Particularly severe In bilateral clefts, vermilion deficiency attracts considerable attention and detracts from an otherwise excellent lip repair. Minor and moderate vermilion deficits can be corrected with upper lip advancement, rotation flaps, tongue flaps, or grafts. Major defects defy correction with local flaps, because of an absolute shortage of upper-lip tissue. A technique Is described for correction of large absolute tissue deficits of the upper-lip vermilion using a bipedicled lower to upper cross-lip visor flap. A lower lip wet vermilion/mucosal flap is based bilaterally near the commissures on the coronary arteries and transferred to a releasing incision at the wet/dry vermilion border of the upper lip. The commissural pedicles are divided and inset at a second stage 10 days later to complete the transfer. The procedure provides ample bulk and lining for major upper-lip vermilion augmentation and tubercle reconstruction without disturbing the obicularis oris muscular oral sphincter. In addition it balances the lips and allows for feeding. The technique is illustrated In two patients with major upper-lip vermilion defects after repair of bilateral cleft lips.
Effect of Gamma-Irradiation on Prenatal Development of the Nasal Septal Cartilage in CD-1 Mice
Authors: Saad A. Yousef M.
Published: October 2018

The effects of gamma-rays on nasal septum development in CD-1 mouse fetuses subsequent to irradiation of their mothers were studied. Pregnant CD-1 mice exposed to 400 rads of whole body gamma-irradiation 12 days after gestation were sacrificed on day 18, post coltum. The fetuses were removed via laparotomy and analyzed. Data on head dimensions, including head height, width, and circumference were recorded. Fetal heads were then routinely prepared for histologic examination of the developing nasal septal cartilage. Analysis of data revealed significant reduction in litter size (p < .0025) and head measurements (p < .0005) of irradiated animals. Histologically, the nasal septa of Irradiated fetuses had retarded growth, were less differentiated, and smaller than those of control mice. Results suggest that gamma-irradiation has detrimental effects on litter and head sizes and may interfere with the cellular maturation process of nasal septal cartilage as well as other structures.
Electromyographic and Cephalometric Findings in Patients with Unilateral Cleft Lip and Palate after the Use of a Special Removable Appliance
Authors: Carvajal Raúl , Miralles Rodolfo , Ravera Maria José , Cauvi Doris , Manns Arturo , Carvajal Andrés
Published: October 2018

Cephalometric measurements and electromyographic analysis of the superior orbicularis oris muscle were undertaken in 13 children with unilateral cleft lip and palate with a short upper lip length who have undergone surgery in childhood. Initially, cephalometric and electromyographic records were evaluated and again after the subjects had continuously worn, for 4 months, a removable appliance specially designed to avoid the restraining effect of superior orbicularis oris muscle activity over the maxilla. Comparison between pretreatment and posttreatment cephalometric measurements showed a significant improvement in both the sagittal position of the maxilla and the dentoalveolar position. No significant changes were observed in electromyographic activity during rest or when saliva swallowing. Cephalometric changes suggest that the removable appliance used improves the growth of the maxilla.
Aerodynamic Estimates of Induced Anterior Orifice Openings in Human Subjects
Authors: Guyette Thomas W. , Smith Bonnie E. , Reisberg David J.
Published: October 2018

This study first examined the accuracy of pressure-flow area estimates of experimental openings in anterior palatal obturators of three adult subjects. Second, we evaluated pressure-flow measures of the same experimental openings using a model. Results indicated that percent error in orifice estimates was slightly higher for induced openings in human subjects (13%) versus those in the model (11%). Results for our human subjects were similar to those reported by previous investigators.
P-A Cephalometric Analysis of Nonoperated Adult Cleft Lip and Palate
Authors: Motohashi Nobuyoshi , Kuroda Takayuki , Filho Leopoldino Capelozza , De Souza Freitas José Alberto
Published: October 2018

P-A cephalometric analysis was performed on the craniofacial morphology in 88 Brazilian men with nonoperated and operated cleft lip and palate. For the comparative study, these subjects were divided into the following four groups: (1) 31 nonoperated unilateral cleft lip and palate (UCLP), (2) 24 nonoperated bilateral cleft lip and palate (BCLP), (3) 16 operated UCLP, (4) 17 operated BCLP. Thirty Brazilian men without cleft lip and palate were used as control subjects. In comparison with the control subjects, nonoperated BCLP and UCLP showed remarkable facial deformity characterized by Increased width of various facial parts. Facial morphology of surgically treated BCLP and UCLP, however, was very similar to that of noncleft subjects, apart from the Immediate cleft region. There was no remarkable difference in the facial morphology between nonoperated BCLP and UCLP, except for the cleft width and the deviation of nasal septum base, while the only significant difference between operated BCLP and UCLP was in the cleft width.
Crouzon Syndrome: Cephalometric Analysis and Evaluation of Pathogenesis
Authors: Carinci Francesco , Avantaggiato Anna , Camillo Curioni
Published: October 2018

Crouzon syndrome is a craniofaciostenosis characterized by brachycephaly, ocular proptosis, and maxillary retrusion. The hypothesis has been forwarded that an alteration in anterior cranial base synchondrosis activity is responsible for the skeleton abnormalities which are associated with this disorder. The present work was aimed at assessing this pathogenetic hypothesis. Cephalometry was used as the analysis method and care was taken in determining the three-dimensional measurements of some functional spaces (e.g., orbit, rhinopharynx, and nasal cavity). The results indicate that in Crouzon syndrome the craniofacial alterations depend not only on reduced synchondrosis activity of the anterior cranial base, but also of the posterior cranial base.
Facial Growth in Patients with Bilateral Cleft Lip and Palate: A Cephalometric Study
Authors: Heidbüchel Kiki L.W.M. , Kuijpers-Jagtman Anne Marie , Freihofer Hans Peter M.
Published: October 2018

In this study, sagittal facial growth of bilateral cleft lip and palate (BCLP) patients between 6 and 20 years of age is analyzed. The data of Nljmegen were derived from 131 lateral cephalograms taken in 21 BCLP patients who were treated In the Cleft Lip and Palate Center of the University Hospital of Nljmegen. Reported data of 90 BCLP patients treated at the Center of Oslo were used as a reference for comparison. Results of this Investigation showed mandibular growth to be similar in both centers. In the premaxillary region some differences were found: The Nljmegen patients presented a more protrusive premaxilla than those at Oslo. The upper front teeth and hence, the premaxilla, were more retroclined In the Nljmegen sample. There were also statistically significant differences in the soft tissue profile. The mean z-score was positive for the nasolabial angle and negative for the angle N'-Sn-Pg'. At 18 years of age, these differences are still apparent. In comparison with Broadbent's values of normal individuals, the SNPg-angle was smaller and the mandibular angle greater in Nljmegen and Oslo. The profiles of the BCLP patients are more convex in Nljmegen and more concave in Oslo than In the noncleft group. Finally, the different treatment strategies of the Cleft Lip and Palate Centers of Nljmegen and Oslo are compared and discussed In terms of their long-term results.
Craniofacial Morphogenesis Workshop Report
Authors: Solursh Michael , Murray Jeffrey
Published: October 2018

The following report highlights the discussions and Interaction at the workshop on craniofacial morphogenesis, sponsored by The Human Frontier Science Program, held in April 1993 at the University of Iowa. A brief summary of selected sessions is Included to exemplify the benefits of bringing together Individuals from various disciplines and backgrounds In order to establish a unified theory of craniofacial morphogenesis. The synthesis of information and experience of a wide range of approaches made the 4-day period an Invaluable experience for the participants from nine different countries.
Effect of Gamma-Irradiation on Prenatal Development of the Tongue in CD-1 Mice
Authors: Saad A. Yousef , Abdelazim Ali A. , El-Khashab Mostafa M. , Mansour Mohamed A.
Published: October 2018

Development of the tongue in murine fetuses, in which the dams were exposed to whole body γ-Irradiation (400 rads) on the 12th day postcoitum, was studied and compared with unirradiated controls. Experimental and control groups were killed on day 18 of gestation and the fetuses were removed via laparotomy. The fetal heads were excised, fixed in Bouin's solution, prepared for paraffin sectioning, and stained with hematoxylin and eosin for light microscopic examination. Histologic examination of serial coronal sections demonstrated that all of the experimental fetuses possessed malformed, poorly developed tongues, when compared to those of the control group. It was concluded that γ-irradiation has an adverse effect on tongue development in mouse fetuses.
Midline Maxillofacial Skeleton in Human Anencephalic Fetuses
Authors: Kjær Inger , Keeling Jean W. , Græm Niels
Published: October 2018

The purpose of this study was to describe the midline maxillofacial skeleton (the axial skeleton anterior to the sella turcica) in 15 human anencephalic fetuses (14-19 weeks of gestation) by radiography and histology, and to relate the findings to skeletal patterns in the remaining part of the axial skeleton. Four patterns in the maxillofacial skeleton were recognized: normal structures, slightly deformed (6 cases); cleft palate (3 cases); Incomplete nasal septum (3 cases); multilocular ethmoid cartilage (3 cases). No association was found between skeletal patterns in the different parts of the axial skeleton. The study demonstrates the existence of a developmental borderline in the anencephalic axial skeleton in the region of the sella turcica. It is presumed that this borderline indicates the boundary between skeletal tissue developed around the notochord (posterior axial skeleton) and the anterior skeletal components derived from neural crest cells.
Aerodynamic, Acoustic, and Perceptual Changes following Adenoidectomy
Authors: Andreassen Meri L. , Leeper Herbert A. , Macrae Duncan L. , Nicholson Ian R.
Published: October 2018

Fourteen children were seen prior to adenoidectomy and at 1 month, 3 months, and 6 months following surgery. On each visit, nasal airway resistance values, nasal cross-sectional area estimates, nasalance scores, and perceptual ratings of nasality were collected. These data were analyzed to identify changes that were related to the time of the test, and to the primary indication for surgery (nasal airway obstruction or recurrent infection). Results revealed significant reduction in nasal airway resistance and significant changes in nasalance following surgery. Perceptual changes were not significant. Clinical Implications of these findings are discussed.
Pre-Speech in Children with Cleft Lip and Palate or Cleft Palate Only: Phonetic Analysis Related to Morphologic and Functional Factors
Authors: Lohmander-Agerskov Anette , Söderpalm Ewa , Friede Hans , Persson Eva-Carin , Lilja Jan
Published: October 2018

Pre-speech in 35 children with clefts of the lip and palate or palate only were analyzed for place and manner of articulation. Transcriptions were made from tape recorded babbling sequences. Two children without clefts were used as reference. All of the children with clefts were treated according to a regimen of early surgical repair of the velum cleft and delayed closure of the cleft in the hard palate. The frequency of selected phonetic features was calculated. Correlations between phonetic/perceptual and functional and morphological factors were tested. Supraglottal articulation dominated among all the children Indicating a sufficient velopharyngeal mechanism. The results also showed correlations between cleft type and place of articulation. Anteriorly placed sounds (I.e., bilabial, dental, and alveolar sounds) occurred frequently among the children with cleft palate only and in the noncleft children. In children with cleft lip and palate, posteriorly placed articulations predominated. It was postulated that early intervention may have a positive effect on articulatory development.
Comparison of Tongue Position during Speech before and after Pharyngeal Flap Surgery in Hypernasal Speakers
Authors: Tanimoto Keiji , Henningsson Gunilla , Isberg Annika , Ren Yan-Fang
Published: October 2018

Tongue position was cineradiographically analyzed during speech, before and after pharyngeal flap surgery, in 19 hypernasal cleft palate speakers with acceptable articulation and in 10 noncleft reference individuals. The results showed that the position of the tongue was significantly retracted during production of the consonants (/ti/, /ki/, and /ka/) in the cleft palate speakers with VPI compared to the reference individuals. Following pharyngeal flap surgery, the position of the tongue remained different in cleft palate speakers compared to reference Individuals, although the articulation quality and resonance were evaluated to have normalized in almost all the speech samples produced by cleft palate speakers. It was suggested that the cleft palate speakers with VPI may exploit the plasticity of the speech system in order to achieve perceptually good speech, even though their tongue movements might be different from tongue movement in noncleft speakers.