bluuebunny/crossref_metadata_2025 huggingface dataset:
Pressure-Flow Characteristics of /m/ and /p/ Production in Speakers without Cleft Palate: Developmental Findings
Authors: Zajac David J.
Published: October 2018

Objective

The purpose of this study was to describe the pressure-flow characteristics of a large sample of speakers without cleft palate ranging in age from early childhood to young adulthood.

Method

Speakers consisted of 223 children, teens, and adults without cleft palate categorized into five age groups: 6 through 8 years, 9 through 10, 11 through 12, 13 through 16, and 18 through 37 years. Speakers produced the syllables /mi/, /pi/, and /pA/, the word “hamper,” and the sentence “Peep into the hamper.” The pressure-flow method was used to determine oral air pressure, nasal airflow, and estimates of velopharyngeal (VP) orifice size associated with /m/ and /p/ production. Descriptive statistics were computed for each age group and speech sample. Analysis of variance (ANOVA) procedures were used to determine the effects of age, sex, and production level (word versus sentence) on the aerodynamic variables.

Results

ANOVA procedures indicated significant main effects (p < .01) of age on most of the aerodynamic variables during production of /m/ and /p/. No significant main effects or interactions involving sex were found for any variable. Regardless of age, approximately 95% to 99% of the speakers exhibited airtight VP closure during /p/ at syllable level, depending upon the selected nasal airflow criterion. ANOVA procedures also indicated significant main effects of production level (word versus sentence) on each of the aerodynamic variables during the /mp/ sequence. These effects appeared to be related to speaking rate.

Conclusions

The study suggests that speakers without cleft palate exhibit essentially complete VP closure during production of oral pressure consonants in isolated syllables, and developmental aspects of speech aerodynamics be considered during pressure-flow testing.
Effect of Placement of a Speech Appliance on Levator Veli Palatini Muscle Activity during Speech
Authors: Tachimura Takashi , Nohara Kanji , Wada Takeshi
Published: October 2018

Objective

The purposes of this electromyographic study were to examine whether levator veli palatini muscle activity during speech can be changed with placement of a speech appliance and to clarify whether or not the change is related to the type of speech appliance used.

Design

Electromyography (EMG) was performed during production of speech samples in two conditions: with placement and with removal of a speech appliance. Speech samples were the vowel /ω/ and consonant-vowel (ω) syllables, including nasal, plosive, fricative, and affricate consonants.

Setting

Division for Oral-Facial Disorders, Faculty of Dentistry, Osaka University Dental Hospital, Japan.

Participants

Subjects were six patients with repaired cleft palate and velopharyngeal inadequacy (VPI); three routinely wore a palatal lift prosthesis to correct borderline VPI, and the other three wore a speech appliance hybrid that consisted of a pharyngeal bulb and a palatal lift.

Interventions

Each patient was asked to produce each speech sample in both conditions of placement and removal of their respective appliances.

Main outcome Measures

Smoothed EMG signals of the levator veli palatini muscle were recorded with and without the appliance during five repetitions of each speech sample. The average value of peak smoothed levator EMG was compared between placement and removal conditions for all subjects and between the two subject groups in each experimental condition.

Results

With a speech appliance in place, the range of levator activity was distributed in a portion lower than that in the removed condition for subjects in both appliance groups. In addition, the intervals were smaller in the placement condition than in the removed condition.

Conclusion

A speech appliance may prevent hypernasality, nasal emission of air, or both associated with VPI because of mechanical obturation of the velopharynx and an alteration in velopharyngeal function.
Velopharyngeal Closure Pattern Exerted by Contraction of the Pharyngeal Constrictor Muscle in Dogs
Authors: Tanaka Susumu , Kogo Mikihiko , Hamaguchi Munehiro , Matsuya Tokuzo
Published: October 2018

Objective

This study was performed to investigate aspects of velopharyngeal closure demonstrated by movements of the parapharyngeal wall under various physiological conditions and especially the stimulation of several intrapneumonal receptors.

Materials and Methods

Fifteen mongrel dogs were anesthetized and a nasopharyngeal fiberscope was inserted from the oronasal fistula at the center of the hard palate, with the tip fixed around the choana. Mechanical and chemical stimulation was applied, and ongoing velopharyngeal movements were observed. In each case examined, the muscle nerve located under the bilateral levator veli palatini (LVP) was severed.

Results

Two different closure patterns were recognized between rebreathing and deglutition. Chemical stimulation of the pulmonary irritant receptor and type-J receptor induced a sphincteric tight closure of the velopharynx but only a weak inward movement of the lateral pharyngeal wall at lung inflation.

Conclusion

The movements of the parapharyngeal wall, mainly represented by the pharyngeal constrictor muscle's contraction, are facilitated as a sphincteric velopharyngeal closure under reflexive movements such as deglutition or gagging.
The Effect of Hamulus Fracture on the outcome of Palatoplasty: A Preliminary Report of a Prospective, Alternating Study
Authors: Kane Alex A. , Lo Lun-Jou , Yen Ben-Dong , Chen Yu-Ray , Noordhoff M. Samuel
Published: October 2018

Objective

To determine whether, in performing palatoplasty, fracture of the pterygoid hamulus is beneficial, detrimental, or neutral with respect to intraoperative and perioperative complications, hearing outcome, and speech outcome.

Design

Prospective, alternating.

Setting

Institutional, tertiary cleft palate center, Chang Gung Memorial Hospital, Taipei, Taiwan.

Participants

A total of 173 patients enrolled in the study, of whom 161 had charts available for analysis.

Interventions

During the performance of palatoplasty, 85 patients received hamulus fracture and 76 patients did not. All palatoplasties were performed by the same surgeon.

Main outcome Measures

(1) Surgical outcomes, including patient demographic data, palatoplasty type and duration, blood loss, incidences of oronasal fistulae, temporary mucosal dehiscence, and postoperative bleeding; (2) otolaryngological outcomes, including hearing results as judged by auditory brainstem response testing, myringotomy tube data describing rates of tube extrusion, and culture results from sampled effusions; and (3) preliminary speech outcomes as described by judgments of overall velopharyngeal function from perceptual speech samples.

Results

No statistically significant differences in any of the measured surgical, otolaryngological, or preliminary speech outcomes were found between the groups who did and did not receive hamulus fracture.

Conclusions

On the basis of these results, we are unable to advocate the performance of hamulus fracture as an operative maneuver during the performance of primary palatoplasty. The historical rationale and theoretical advantage of this maneuver have not been demonstrated here nor have any detrimental effects of the maneuver been measured.
Growth and Development in Patients with Untreated Clefts
Authors: Will Leslie A.
Published: October 2018

Motivated by the observation that individuals with clefts of the lip and palate exhibit different facial growth than those individuals without facial clefts, many studies have assessed dentofacial morphology in order to understand these differing growth patterns. This review addresses current understanding of facial growth in patients with untreated clefts, drawing broad conclusions about the state of the art, and presents a challenge for cleft care in the future.
Dental and Prosthodontic Care for Patients with Cleft or Craniofacial Conditions
Authors: Reisberg David J.
Published: October 2018

Prosthodontic treatment has a long and rich history in the care of patients with cleft lip and palate. Because of increased knowledge of craniofacial growth and development and improved surgical and orthodontic treatment, today's cleft patients receive better care and in less time. This requires less prosthetic intervention. Still, prosthetics retains an important, if somewhat diminished, place in cleft care, and the prosthodontist remains an integral member of the cleft/craniofacial habilitation team. This review presents the current state of the art in dental/prosthodontic care for patients with cleft palate and related craniofacial anomalies.
Video-Imaging Assessment of Nasal Morphology in Individuals with Complete Unilateral Cleft Lip and Palate
Authors: Russell K.A. , Waldman S.D. , Lee J.M.
Published: October 2018

Objective

The purpose of this study was to develop a video-imaging mathematical method to assess nostril morphology.

Design

This retrospective study involved two age-matched groups: 28 subjects with complete unilateral cleft lip and palate (CUCLP) and 19 noncleft controls. Nose casts were reproducibly oriented in a jig such that the casts could be rotated about the coronal axis. Video images of the nostrils were captured and then analyzed for area, perimeter, centroid, principal axis, moments about the major and minor axes (I11, I22), anisometry, bulkiness, lateral offset, internostril angle, and rotational angle.

Results

All parameters identified nostril asymmetry in both groups. The results of the analyses using anisometry, I11, and I22 showed that, in both groups, one nostril was rounder and one was more elliptical. This asymmetry, however, differed between the two groups, and the difference was primarily based on the degree of ellipticity of the nostrils. Maximum dimension, perimeter, lateral offset, I11, and I22 were more asymmetric in the cleft group. In the control group, the right nostril was more elliptical and had a greater perimeter, and the leftside nostril had a greater bulkiness (enfolding).

Conclusions

The method developed was validated for assessment of nasal morphology in cleft and noncleft samples. Nostril morphology was asymmetric in both groups but more asymmetric in the cleft group than the control group. The dominant influence of the cleft resulted in more elliptical noncleft nostrils and greater nostril shape asymmetry in the cleft group. The validated video-imaging method can now be used to assess the efficacy of treatment on nasal morphology.
Cranial Base and Facial Skeleton Asymmetries in Individuals with Unilateral Cleft Lip and Palate
Authors: Kyrkanides Stephanos , Klambani Mavra , Subtelny J. Daniel
Published: October 2018

Objective

Individuals with unilateral cleft lip and palate (UCLP) manifest a plethora of phenotypic characteristics, including asymmetric development of the middle and lower facial skeleton. The purpose of this study was to retrospectively investigate the development of cranial base asymmetries in patients with UCLP noted on posteroanterior cephalometric radiographs.

Methods

Thirty individuals with UCLP and 64 controls participated in this study. Medial and lateral cranial base asymmetries were analyzed on frontal cephalometric radiographs relative to three developmental stages. Furthermore, the development of horizontal and vertical lower facial asymmetry in these patients with UCLP was assessed in relation to cranial base, nasomaxillary, and dentoalveolar structures.

Results

Individuals with UCLP demonstrated cranial base asymmetries that did not significantly differ from individuals without cleft. In addition, lower facial asymmetry in patients with UCLP correlated with horizontal lower facial and dentoalveolar asymmetries but not with cranial base or nasomaxillary structures.

Conclusions

No significant vertical cranial base asymmetries were detected in patients with UCLP. Horizontal lower facial asymmetry appeared to develop in close relation to the vertical asymmetries of mandibular fossae and dentoalveolus.
The Load-Displacement Characteristics of Neonatal Rat Cranial Sutures
Authors: Mclaughlin E. , Zhang Y. , Pashley D. , Borke J. , Yu J.
Published: October 2018

Objective

Recently several centers have attempted to distract the craniofacial skeleton in infants with craniosynostosis. To effectively achieve this goal, we must first understand the normal sutural response to tensile forces. The objective of this study was to determine the load-displacement characteristics of neonatal rat sutures.

Methods

Thirty cranial sutures were harvested from 1-week-old Wistar rats (10 each coronal, posterior frontal, and sagittal). The width of the harvested bone-suture-bone construct was standardized to 4 mm. The specimens, kept moist, were mounted fresh and distracted at 10 μm/sec until rupture using a Vitrodyne V1000 universal tester. Standard load-displacement curves were constructed. The stiffness, defined as tensile force/change in suture length, and the ultimate stress, defined as tensile force at suture rupture/cross sectional area, were calculated.

Results

These sutures demonstrated classical viscoelastic behavior. During the elastic phase, they elongated approximately 1 μm for every 1 g of force (104 N/m). The ultimate tensile stress was approximately 4 MN/m2. The estimated mean elastic modulus was 10 megapascals. The posterior frontal sutures were significantly less stiff than the other two sutures (Kruskal-Wallis nonparametric analysis of variance, p = .0023). The difference in the ultimate stress was also significant (p = .0201).

Conclusions

This study provides data regarding the basic mechanical behavior of neonatal cranial sutures in a mammalian system.
Factors Related to Relapse after Le Fort I Maxillary Advancement Osteotomy in Patients with Cleft Lip and Palate
Authors: Hirano Akiyoshi , Suzuki Hiroyuki
Published: October 2018

Objective

To identify factors associated with relapse after maxillary advancement in cleft lip and palate patient.

Subjects

Seventy-one cleft lip and palate patients underwent Le Fort I maxillary advancement osteotomy between 1988 and 1998, and 58 patients (42 unilateral cleft and 16 bilateral cleft) with complete data were investigated for relapse by clinical and cephalometric analysis. The clinical follow-up period ranged from 1.5 to 8.5 years (mean 2.5 years).

Results

Horizontal advancement averaged 6.9 mm. There was a significant correlation between surgical movement and postoperative relapse in both the horizontal and vertical planes. In vertical repositioning, 15 patients had maxillary intrusion and 31 had inferior repositioning. There was a significant difference between the intrusion group and the inferior repositioning group. There was a significant correlation between surgical and postoperative rotation regardless of the direction. Other factors were evaluated by the horizontal relapse rate. Type of cleft and the rate of relapse were statistically associated. A relapse was more likely to occur in patients with bilateral cleft. There were no significant associations with the rate of relapse in type of operations or previous alveolar bone grafting. There was no significant correlation between the rate of relapse and the number of missing anterior teeth, postoperative overbite and overjet, and age at operation. Four of 71 patients experienced major relapse, and 3 of them underwent jaw surgery again.

Conclusions

Based on clinical and cephalometric analysis, two-jaw surgery should be performed in cases of severe maxillary hypoplasia, and overcorrection may be useful in inferior repositioning or surgical rotation. Special attention should be paid to the patient with bilateral cleft, multiple missing teeth, or shallow postoperative overbite.
Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 2: Dentofacial Outcomes and Patient Satisfaction
Authors: Williams Alison C. , Bearn David , Mildinhall Sue , Murphy Terrie , Sell Debbie , Shaw William C. , Murray John J. , Sandy Jonathan R.
Published: October 2018

Objective

To describe facial development and appearance, quality of bone grafts, oral health, and patient/parent satisfaction, with clinical outcome, for children in two age cohorts born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom.

Design

Cross-sectional outcome study.

Setting

Fifty National Health Service cleft centers.

Participants

Children born with complete UCLP between April 1, 1982, and March 31, 1984, (12-year-olds) and April 1, 1989, and March 31, 1991 (5-year-olds). Data were collected for 239 5-year-olds and 218 12-year-olds. The parents of these children were also interviewed to determine levels of satisfaction with care received.

Main Outcome Measures

Skeletal pattern, dental arch relationship, success of alveolar bone grafting, facial appearance, oral health status, and patient/parent satisfaction.

Results

Nearly 40% of 5- and 12-year-olds had poor dental arch relations, and 70% of 12-year-olds had midface retrusion. Fifteen percent of 12-year-olds had not received an alveolar bone graft, and only 58% of bone grafts that had been undertaken were successful. Twenty percent of 12-year-olds and 40% of 5-year-olds had untreated dental caries. Less than one-third of subjects had a good facial appearance as judged by a panel of experts. Levels of patient and parent satisfaction were generally high.

Conclusion

A rigorous evaluation of cleft care in the United Kingdom reveals disappointing outcomes.
Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 3: Speech Outcomes
Authors: Sell Debbie , Grunwell Pamela , Mildinhall Sue , Murphy Terrie , Cornish Tremaine A. O. , Bearn David , Shaw William C. , Murray John J. , Williams Alison C. , Sandy Jonathan R.
Published: October 2018

Objective

To summarize speech outcomes in children born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom.

Design

Prospective descriptive study on a cross-sectional sample of children.

Patients/Participants

Data were collected for 238 5-year-olds (born between April 1, 1989, and March 31, 1991) and 218 12-year-olds (born between April 1, 1982, and March 31, 1984) with complete UCLP.

Main Outcomes

Ratings of intelligibility, nasality, “speech cleft type characteristics” and speech therapy intervention.

Conclusions

Nineteen percent of 5-year-olds and 4% of 12-year-olds were judged to be impossible to understand or just intelligible to strangers. Thirty-four percent of 5-year-olds and 17% of 12-year-olds had at least one serious error of consonant production. Eighteen percent of 5-year-olds and 12-year-olds had consistent hypernasality of mild, moderate, or severe degree. Approximately two-thirds of both age groups had undergone speech therapy.
Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 4: Outcome Comparisons, Training, and Conclusions
Authors: Bearn David , Mildinhall Sue , Murphy Terrie , Murray John J. , Sell Debbie , Shaw William C. , Williams Alison C. , Sandy Jonathan R.
Published: October 2018

Objective

A critical appraisal of cleft care in the United Kingdom.

Design

Retrospective comparative study.

Setting

All National Health Service cleft centers in the United Kingdom.

Patients/Participants

Children born with unilateral complete clefts of the lip and palate between April 1, 1982, and March 31, 1984 (12-year-olds), and April 1, 1989, and March 31, 1991 (5-year-olds). Newly appointed and senior cleft clinicians.

Main Outcome Measures

Skeletal pattern, dental arch relationship, success of alveolar bone grafting, dental health, facial appearance, oral health status, patient/parent satisfaction.

Conclusions

This paper highlights the poor outcomes for the fragmented cleft care in the United Kingdom, compared with European centers. There is an urgent need for a review of structure, organization, and training.
Cleft Lip and Palate Management by U.K. Consultant Oral and Maxillofacial Surgeons: A National Survey
Authors: Brennan P. A. , Macey-Dare L. V. , Flood T. R. , Markus A. F. , Uppal R.
Published: October 2018

Objective

Following the report of the Clinical Standards Advisory Group (CSAG), a national survey of U.K. consultant oral and maxillofacial surgeons was performed to determine the current cleft lip and palate practice of this group prior to the implementation of proposed radical changes in the delivery of cleft services. The views of these surgeons regarding the proposed changes was also sought.

Design

An anonymous postal questionnaire sent to all 266 consultants in the U.K., which requested information on the practice of cleft surgery during a defined 1-year period (March 1997 through February 1998). It included the numbers and types of procedures performed, the involvement of multidisciplinary care, research and audit activity, and questions regarding the implementation of CSAG.

Results

One hundred ninety-one replies (72% response rate). Seventy-three surgeons were actively involved with mainly secondary cleft surgery. A varied number and range of procedures were undertaken, with most surgeons performing less than five of each procedure per year. Audit and research activity was 26%. The majority of both noncleft and cleft surgeons agreed with proposals made by CSAG (except for cleft osteotomy procedures).

Conclusions

In the U.K. at present, there are many oral and maxillofacial surgeons performing mainly secondary cleft surgery; overall, the number of procedures performed by these surgeons per year is small. Intraspecialty referral is suggested to further improve patient outcome.
Comparison between the Palatal Configurations in Complete and Incomplete Unilateral Cleft Lip and Palate Infants under 18 Months of Age
Authors: Mishima Katsuaki , Mori Yoshihide , Sugahara Toshio , Sakuda Masayoshi
Published: October 2018

Objective

The purpose of this study was to examine the three-dimensional characteristics of the palatal configurations in incomplete unilateral cleft lip and palate (UCLP) patients and to determine whether there are differences in the effect of early orthopedic treatment between complete and incomplete UCLP patients.

Design

Eight infants with incomplete UCLP and 12 infants with complete UCLP, selected at random, wore Hotz plates, and 8 other infants with complete UCLP did not. Palatal impressions were taken of these patients immediately after birth and at 1, 2, 3, 4 (just before cheiloplasty), 6, and 18 months of age (just before palatoplasty). Using our measuring system, the palatal casts were measured and compared three-dimensionally.

Results and Conclusions

The palate of the incomplete UCLP patients measured immediately after birth, compared with complete UCLP, showed: (1) smaller posterior arch width; (2) sagittal arch length did not differ; (3) incisal point was located more mesially; (4) the gap between the alveolar arch forms of the major and minor segments was smaller; and (5) the curvature of the palatal surface forward the nasal cavity in the minor segment was less. At 18 months of age, the following characteristics could be observed: (1) the difference observed at birth in the posterior arch width between the incomplete and complete UCLP infants vanished; (2) a significant difference in the location of the incisal point was observed only between the incomplete UCLP infants and the complete UCLP infants with a Hotz plate; and (3) the curvature was less in the incomplete UCLP infants than in the complete UCLP infants. Furthermore, the morphological change of the palatal surface was less in the incomplete UCLP infants than in the complete UCLP infants. This suggested that any influence of the Hotz appliance might be less in incomplete UCLP than in complete UCLP.
Reliability of Listener Transcriptions of Compensatory Articulations
Authors: Gooch Janet L. , Hardin-Jones Mary , Chapman Kathy L. , Trost-Cardamone Judith E. , Sussman Joan
Published: October 2018

Objective

This study examined the ability of speech-language pathologists to transcribe compensatory articulation errors.

Design

Speech-language pathologists phonetically transcribed audiorecordings of 130 monosyllabic words, 70 of which contained compensatory articulations.

Participants

The participants for this study were two groups of 10 speech-language pathologists. Group I included speech-language pathologists who were experienced in evaluating children with cleft palate, and group II speech-language pathologists were not.

Results

Marked variability was evident across listeners, with percentages of agreement ranging from 19 to 71 (mean agreement = 41%). The experienced listeners performed significantly better on the transcription task than the inexperienced listeners, but poor interjudge agreement was evident across both groups.

Conclusions

The results of this study suggest that speech-language pathologists may differ in their understanding of the auditory perceptual characteristics of compensatory articulations. The results underscore the need for increased training and standardization of transcription procedures.
Different Cleft Conditions, Facial Appearance, and Speech: Relationship to Psychological Variables
Authors: Millard Tom , Richman Lynn C.
Published: October 2018

Objective

The purpose of this investigation was to study the adjustment and learning characteristics of children with different types of clefts. The hypotheses were that there may be different relationships among cleft variables (speech and appearance) according to the cleft types.

Design

The study compared three cleft groups on behavior rating, anxiety scales, depression scales, and self-perception (analyses of variance) and examined the influence of facial and speech ratings on self-perception (multiple regression analyses).

Setting

All patients were treated at a university hospital cleft palate clinic.

Patients

Sixty-five children aged 8 years to 17 years were selected based on nonsyndromic cleft (unilateral cleft lip and palate [ULP], bilateral cleft lip and palate [BLP], and cleft palate only [CPO]) and no significant neurological condition or hearing loss.

Results

The findings indicated children with CPO showed greater problems with parent- and teacher-reported depression, anxiety, and learning related to speech than children with ULP or BLP. The later two groups showed fewer problems and a greater relationship of problem to facial appearance. The children with ULP self-reported lower levels of depression than the other two groups.

Conclusions

Children with cleft show relatively good overall adjustment, but some problems appear related to speech and facial appearance. Subgroups may need to be studied separately.
An Electropalatographic Investigation of Middorsum Palatal Stops in an Adult with Repaired Cleft Palate
Authors: Gibbon Fiona E. , Crampin Lisa B.
Published: October 2018

Objective

Middorsum palatal stops are compensatory articulations that occur relatively frequently in cleft palate speech. This study used electropalatographic (EPG) and acoustic data to investigate /t/ and /k/ targets produced as middorsum palatal stops ([c]) by an adult with an articulation disorder associated with a repaired cleft palate.

Results

Two novel observations were made from the instrumental data. First, although /t/ and /k/ targets were judged by phonetically trained listeners as homophonous (i.e., both produced as [c]), the EPG data revealed that the place of articulation for the [c] produced for /t/ was more anterior than the place of articulation for the [c] produced for /k/. Second, production of palatal stops involved lateral release followed by a variable period of lateral friction. Measurements made from the instrumental data quantified the temporal extent of lateral friction during the aspiration period.

Conclusions

These observations merit further systematic investigation in cleft palate speech, and the procedures reported in this study are considered appropriate for such future research.
Mandibular Bone Graft Material for Reconstruction of Alveolar Cleft Defects: Long-Term Results
Authors: Enemark Hans , Jensen John , Bosch Carles
Published: October 2018

Objective

To analyze the long-term effect of mandibular bone as donor material in bone grafting of the alveolar process defect in patients with unilateral cleft lip and palate (UCLP), compared with iliac crest cancellous bone.

Method

During a 7-year period, 101 UCLP patients were bone grafted, 57 cases with iliac crest cancellous bone and 44 with mandibular symphyseal bone. The long-term results with an observation time of more than 4 years were analyzed with respect to marginal bone level and dental and gingival condition in the grafted area. Complications were recorded.

Results

The bone level in the grafted area was satisfactory in both groups. Impaction of cleft-side canines was found in 35% of the patients in both groups. Patients with agenesis of the cleft side lateral incisor had significantly more impacted canines, compared with patients with a cleft-side lateral situated in the lesser maxillary segment, probably due to the fact that the lateral incisors help in guiding the canine down through the grafted area. The number of complications was scarce, although both groups demonstrated some gingival retraction with a longer crown length at the cleft side central incisor.

Conclusion

The findings of this study have changed our strategy in bone grafting. Timing of orthodontic treatment and bone grafting has been more varied depending on the position and presence of teeth in the cleft area. Bone grafting of the alveolar process is not just a local treatment of a bony defect, but in respect to the burden of treatment, bone grafting of the alveolar process has to be planned in accordance with orthodontic treatment and maxillofacial growth.
Presurgical Nasoalveolar Orthopedic Molding in Primary Correction of the Nose, Lip, and Alveolus of Infants Born with Unilateral and Bilateral Clefts
Authors: Grayson Barry H. , Cutting Court B.
Published: October 2018

This addendum to the “State of the Art Dental Treatment of Predental and Infant Patients With Clefts and Craniofacial Anomalies,” by Prahl-Andersen (Cleft Palate Craniofac J. 2000;37:528–532), offers an extended perspective on this controversial subject. This article reviews the role of combined nasal and alveolar (nasoalveolar) molding in the primary correction of the nose, lip, and alveolus of infants born with unilateral and bilateral clefts. The background of presurgical nasoalveolar orthopedic molding, the technique, and the literature are presented. The proposed benefits of treatment from the traditional techniques of presurgical orthopedics have been shown to be unsubstantiated (Kuijpers-Jagtman and Prahl, 1996). A close comparison of the proposed benefits of earlier forms of presurgical orthopedics, along with those of the current technique of nasoalveolar molding, is presented.
Changes in Speech following Maxillary Distraction Osteogenesis
Authors: Guyette Thomas W. , Polley John W. , Figueroa Alvaro , Smith Bonnie E.
Published: October 2018

Objective:

The purpose of this study was to describe changes in articulation and velopharyngeal function following maxillary distraction osteogenesis.

Design:

This is a descriptive, post hoc clinical report comparing the performance of patients before and after maxillary distraction. The independent variable was maxillary distraction while the dependent variables were resonance, articulation errors, and velopharyngeal function.

Setting:

The data were collected at a tertiary health care center in Chicago.

Patients:

The data from pre- and postoperative evaluations of 18 maxillary distraction patients were used.

Outcome Measures:

The outcome measures were severity of hypernasality and hyponasality, velopharyngeal orifice size as estimated using the pressure-flow technique, and number and type of articulation errors.

Results:

At the long-term follow-up, 16.7% exhibited a significant increase in hypernasality. Seventy-five percent of patients with preoperative hyponasality experienced improved nasal resonance. Articulation improved in 67% of patients by the 1-year follow-up.

Conclusions:

In a predominately cleft palate population, the risk for velopharyngeal insufficiency following maxillary distraction is similar to the risk observed in Le Fort I maxillary advancement. Patients being considered for maxillary distraction surgery should receive pre- and postoperative speech evaluations and be counseled about risks for changes in their speech.
Facing up to Stigma: Workplace and Personal Strategies
Authors: Kelton Robert W.
Published: October 2018

This paper examines some of the influences that contribute to health, life success, and resiliency in persons with craniofacial conditions. Those influences are examined from the perspective of the author, a 50-year-old man with cleft palate, right microtia, and hemifacial microsomia. A biosketch describes the author as one example of someone with craniofacial conditions who has also achieved significant personal and professional success. Central to that success were the influences of health care providers and parents as well as other people with craniofacial conditions. Specific attention is given to the benefits of a team approach to the care of patients with craniofacial conditions; the role of health care professionals in fostering the optimism that can mobilize the family for action; the importance of acknowledging the intransigence of stigma in our culture; the value of practical advice that affected individuals can offer one another.
Using Psychological Assessment and Therapeutic Strategies to Enhance Well-Being
Authors: Broder Hillary L.
Published: October 2018

Objective:

To provide an overview of the psychological assessment; results from studies examining psychological issues among individuals with craniofacial anomalies (CFA) and other chronic conditions; resilience; and therapeutic strategies to enhance psychological well-being.

Conclusions:

The literature on chronic conditions and findings from studies with people having CFA and their families demonstrate a range of effective adaptation patterns and strategies to enhance issues having an impact on quality of life.
Three-Dimensional Z-Plasty in the Correction of the Unilateral Cleft Lip Nasal Deformity
Authors: Han Sanghoon , Choi Moon Su
Published: October 2018

Objective:

Numerous methods have been introduced for correction of the cleft lip nasal deformities, but no single procedure has given sufficiently satisfactory results to provide a surgical standard. Much effort has been put on restoring cartilaginous structures using alar cartilage modification and suspension. But even after the cartilage framework is repositioned well, redundant alar webbing is still unsightly and frequently conspicuous. This paper presents a procedure combining the usual open rhinoplasty technique and three-dimensional Z-plasty in an external approach to remove the alar web and to lengthen the columella at the same time.

Methods:

Open rhinoplasty was performed in 26 consecutive patients with unilateral cleft lip nasal deformity from 1991 to 1996. We used an open rhinoplasty approach, which is a combination of the usual infracartilaginous incision on the noncleft side and a small triangular flap on the cleft side.

Results and Conclusions:

This external rhinoplasty incision can provide a wide surgical field for the handling of the whole cartilage framework. The three-dimensional Z-plasty utilizing redundant alar skin not only removes the alar web but also helps lengthen the columella and provides soft tissue to the nasal vestibule. This technique is easy, and the postoperative result is very consistent. Our open rhinoplasty approach has several advantages and can be a useful approach in the correction of the unilateral cleft lip nasal deformity.
Airway Obstruction Due to a Rudimentary Premaxilla in Holoprosencephaly
Authors: Mehendale Felicity V. , Sommerlad Brian C.
Published: October 2018

Objective:

We present two infants with holoprosencephaly and clefts of the primary palate, who developed nasal airway obstruction due to a previously undocumented cause: a ball-valve–like action of a rudimentary premaxilla, which was extremely mobile on a soft tissue stalk. In such patients, the importance of intranasal examination to identify a rudimentary premaxilla, in order to preserve it, and if necessary, surgically stabilize it, is illustrated.
Facial Reconstruction on the Abnormal Skull Model of a Living Patient
Authors: van der Wal Karel G. H. , Neave Richard A. H. , van der Biezen Jan J. , van der Kuijl Bart
Published: October 2018

Objective:

The concept of using a skull as the armature upon which to reconstruct a face has been understood for many years. The objective of this study was to blindly test this technique by using a skull that was reconstructed from the computed tomography (CT) scans of a living 48-year-old man.

Design:

The patient had a bilateral cleft lip, alveolus, and palate. A model of the complete skull produced by a computer-controlled milling machine that used data from the CT scans was used for the reconstruction. Surgery was then performed, and new dental prostheses were also constructed. After surgery, a second model of the relevant part of the skull was made and the reconstruction modified accordingly.

Conclusion:

Despite having no information about the patient apart from that which could be gleaned from the model skull, the reconstructions demonstrate the approximate appearance of the face before and after surgery. Even without the extra information routinely available in forensic cases, a face broadly similar to that of the living patient could be achieved.
Long-Term Evidence for Favorable Midfacial Growth after Delayed Hard Palate Repair in UCLP Patients
Authors: Friede Hans , Enemark Hans
Published: October 2018

Objective:

To investigate whether delayed hard palate repair resulted in better midfacial growth in the long term than previously achieved with “conventional” surgical methods of palatal closure.

Design and Setting:

Long-term cephalometric data from patients with unilateral cleft lip and palate were available from two Scandinavian cleft centers. The patients had been treated by different regimens, particularly regarding the method and timing of palatal surgery. Patients were analyzed retrospectively, and one investigator digitized all radiographs.

Patients:

Thirty consecutively treated subjects from each center, with cephalograms taken at three comparable stages between 10 and 16 years of age.

Results and Conclusions:

Patients whose hard palates were repaired late (early soft palate closure followed by delayed hard palate repair at the stage of mixed dentition) had significantly better midfacial development than patients in whom the hard palate was operated on early with a vomer flap, and then during the second year of life, the soft palate was repaired with a push-back procedure. As the growth advantage in the delayed hard palate repair group was accomplished without impeding long-term speech development, the delayed repair regimen proved to be a good alternative in surgical treatment of patients with unilateral cleft lip and palate.
Facial Attractiveness and Facial Impairment Ratings in Children with Craniofacial Malformations
Authors: Okkerse Jolanda M. E. , Beemer Frits A. , Cordia-de Haan Marjanne , Heineman-de Boer Josien A. , Mellenbergh Gideon J. , Wolters Wim H. G.
Published: October 2018

Objective:

This study examined (1) the effects of type of malformation, sex of ratee, and sex of rater on facial attractiveness and facial impairment ratings, and (2) the reliability of judgments on facial attractiveness and facial impairment and the association between these two constructs.

Setting:

A university hospital for children.

Participants:

Raters were eight volunteers from the student population in a university, four men and four women.

Main Outcome Measures:

Raters judged frontal and lateral view slides of children with various types of craniofacial malformations both on a 5-point facial attractiveness scale and on a 5-point facial impairment scale.

Results:

Main effects were found for type of malformation, sex of ratee, and sex of rater. No interaction effects were found among type of malformation, sex of ratee, and sex of rater. Interrater reliability was moderate to high, both for attractiveness ratings and for impairment ratings. The correlation between facial attractiveness and facial impairment was also moderate to high.

Conclusions:

Both condition parameters (type of malformation) as well as social parameters (sex of rater and sex of ratee) seem to influence judgments on attractiveness and impairment. Facial attractiveness and facial impairment can be rated reliably in children with (cerebro)craniofacial dysplasias. Raters consider these concepts to be very similar but not identical.
Is it Possible to Prevent Cleft Palate by Prenatal Administration of Folic Acid? An Experimental Study
Authors: Bienengräber Volker , Malek Fathi A. , Möritz Klaus-Uwe , Fanghänel Jochen , Gundlach Karsten K. H. , Weingärtner Jens
Published: October 2018

Objective:

In this study, folic acid was tested for its antiteratogenic effects on experimentally induced cleft palate in animals.

Design:

Eleven pregnant Lew 1 A dams (75 fetuses) received 200 mg/kg procarbazine via gastric tubing on postconception (p.c.) day 14 to induce a cleft palate (CP); seven of the pregnant dams (45 fetuses) were additionally given 4 mg/kg folic acid subcutaneously from the 14th to the 17th day p.c. As a control group, three more pregnant dams (24 fetuses) were not treated with the drugs mentioned above. All fetuses were delivered by Caesarian section on day 20 p.c.

Outcomes measured:

All fetuses were weighed and examined macroscopically with a stereomicroscope. Each fetal head was cut into 35 frontal sections and scrutinized histologically.

Results:

None of the control fetuses (n = 24) exhibited a cleft. Without folate administration, 90% of the fetuses (27 of 30) that received procarbazine exhibited a CP. After additional prenatal folate administration, this rate remained virtually unchanged (91%; 41 of 45). However, the proportion of complete (total) CP (4%) was significantly (p < .0001) lower than in the group without folate (53%). Cleft-associated microgenia and microglossia were also significantly less frequent when folate was administered prenatally: microgenia was reduced by 22% (p = .029) and microglossia by 24% (p = .032).

Conclusions:

On the basis of these results, folate has a partial ameliorating effect on the teratogenicity of procarbazine given to pregnant rats. Additional studies are necessary on the effect of folate in different species, also taking cleft lip and CP into consideration.
Do Oral Flora Colonize the Nasal Floor of Patients with Oronasal Fistulae?
Authors: Brennan Peter A. , Markus Anthony F. , Flood Timothy R. , Downie Ian P. , Uppal Rajvinder
Published: October 2018

Objective:

To determine if oral bacteria colonize the cleft nasal floor in patients with unilateral oronasal fistula when compared with the unaffected nasal floor and whether the results obtained would be of benefit in assessing oronasal fistulae in the clinic.

Design:

Prospective study of 26 patients with cleft palate and unilateral oronasal fistula. Microbiological culture swabs were taken from the mouth and nasal floors of patients. The unaffected nasal floor was used as a control. Bacterial isolates were identified and compared in the laboratory by a senior microbiologist.

Main Outcomes Measure:

A significant growth of oral bacteria from the cleft nasal floor when compared with the unaffected nasal floor.

Results:

Four patients were excluded because no growth was found on any culture plate. In the remaining 22 cases, a light growth of oral flora was found in the cleft nasal floor in only 3 patients. No statistical correlation between culture of oral bacteria and the cleft nasal floor could be found (p = .12).

Conclusions:

The relative lack of colonization of the cleft nasal floor by oral bacteria may reflect poor transmission of bacteria through the fistula, competition with commensal nasal flora, or an inability of oral bacteria to survive in a saliva-depleted area. The investigation is not helpful in the assessment of oronasal fistulae in the clinic.
Complete Agenesis of the Soft Palate
Authors: Ascherman Jeffrey A. , Jones Valerie A. , Manduley Robert A. , Yeboa Kwame
Published: October 2018

Objective:

This report documents the physical characteristics and treatment of a patient with the extremely rare finding of complete agenesis of the soft palate. The posterior hard palate cleft and soft palate agenesis were treated with a palatal pushback procedure.
Phenotypic and Molecular Analyses of A/WySn Mice
Authors: Gong Siew-Ging
Published: October 2018

Objective:

Since its first description, the A strain of mice have been utilized extensively as models to study the processes involved in clefting of the midfacial region. Of the A substrains, the A/WySn has a spontaneous rate of clefting of the lip of about 20% to 30%. The A/WySn mouse model was utilized in this study to analyze and compare the phenotypic and molecular changes in the midfacial region of embryos with and without cleft.

Results:

Scanning electron microscopy and skeletal and cartilage preparations of newborn A/WySn pups showed the presence of bilateral and unilateral clefts of the lips and the disruption of the skeletal and cartilaginous components of the mice with clefts of the lip. The expression of the msx1 homeobox gene was analyzed by whole mount in situ hybridization of A/WySn embryos at different stages of midfacial development. The results showed that there was misregulation of the expression of the msx1 gene in embryos with cleft, with a persistence of expression in the distal growing tips of the midfacial processes and in areas that have fused in normal embryos without cleft.

Conclusions:

Although the genetic defect in A/WySn mice is not known, a possible candidate gene has been mapped to a corresponding human chromosome carrying retinoic acid receptor α, and there exists a possibility that msx1 is in the same genetic pathway affected by the mutation of the gene in A/WySn.
Pure Ectodermal Dysplasia: Retrospective Study of 16 Cases and Literature Review
Authors: Ruhin B. , Martinot V. , Lafforgue P. , Catteau B. , Manouvrier-Hanu S. , Ferri J.
Published: October 2018

Objective:

To review the possible craniomaxillofacial deformative consequences associated with ectodermal dysplasias and embryonic malformations, which include dental ageneses.

Setting:

Oral and Maxillofacial Surgery Department, University Hospital, Lille, France.

Patients:

Sixteen patients (seven boys and nine girls, aged 4 to 34 years) with pure ectodermal dysplasia (no ectodermal dysplasia syndromes).

Interventions:

All patients had a clinical examination. Seven (two boys and five girls, aged 4 to 25 years) had undergone plaster casts and radiographic and Delaire's cephalometric studies before being treated.

Main Outcome Measures:

All patients had tooth ageneses (from hypodontia to anodontia), associated with cutaneous dyshidrosis and hair and nail dystrophy. Most of them had a short face, with an unusual facial concavity, a maxillary retrusion, and a relative mandibular protrusion.

Management Results and Discussion:

Depending on their ages and their orthopedic abnormalities, patients underwent either dental or prosthodontic, orthodontic, orthopedic, orthognathic, or implant treatment. So as not to interfere with the growth pattern, we preferred to reserve implant and orthognathic surgery for full-grown cases.

Conclusions:

Oral and maxillofacial surgeons must undertake a comprehensive approach to these patients to improve their dental, masticatory, growing, and orthognathic conditions.