bluuebunny/crossref_metadata_2025 huggingface dataset:
Velopharyngeal Function for Speech after the Frolova Primary Palatoplasty Technique
Authors: Williams William N. , Bzoch Kenneth R. , Dixon-Wood Virginia, , Seagle M. Brent, , Nackashi John A. , Marks Ronald G. , Frolova Larisa Y. , Serova Yelena , Gonchakov Gennady V. , Scheslavsky Serguei , Shmelkova Tamara , Zagirova A.
Published: October 2018

Objective

This study was undertaken by several members of the University of Florida Craniofacial Center to assess the results of palatoplasty performed by the method devised by Larisa Y. Frolova, M.D. in 1971.

Design

The assessment was based on evaluation of each subject's speech and velopharyngeal function through perceptual measures, nasometry, and videonasendoscopy.

Setting

The study took place at the National Pediatric Center for Congenital Maxillofacial Pathology, Moscow, Russia, under the auspices and with the cooperation of Dr. Frolova, director of the program.

Subjects

One hundred twelve children (40 girls and 72 boys; age range, 4 to 10 years; mean age, 7.5 years) with repaired cleft palate who had undergone palatoplasty 2 to 4 years earlier and had no secondary surgery were randomly selected from the center's clinical files by the staff. Subjects with known conditions that could jeopardize normal speech development were excluded.

Methods

Each subject was assessed for speech and velopharyngeal function with a battery of perceptual measures and videonasendoscopy.

Results

The percentage of subjects judged to have normal resonance was 55.5%. An additional 9.5% of the subjects judged to be hyponasal increased the rate of nonhypernasal outcome to 64%.

Conclusions

The Furlow double-Z palatoplasty has had an increasing rate of success (up to 87%), whereas the Frolova technique has a success rate of only 55% to 65%.
Contraction Properties of the Superior Pharyngeal Constrictor Muscle
Authors: Ishii Shoichirou , Kogo Mikihiko , Iida Seiji , Adachi Tadafumi , Hamaguchi Munehiro , Matsuya Tokuzo
Published: October 2018

Objective

The mechanical contraction property of the superior pharyngeal constrictor (PC) muscle was analyzed and compared with the levator veli palatini (LVP) muscle.

Design

Twenty adult dogs anesthetized with sodium pentobarbital were used.

Results

The isometric contraction curves of LVP and PC were recorded after direct electric stimulation to each muscle. The contraction time of isometric twitch contraction of the superior PC muscles was 30.3 ± 5.25 msec, and the half relaxation time was 22.97 ± 5.44 msec. The summation curve was observed at a stimulus frequency above 20 Hz of a repetitive pulse stimulus frequency of 85 Hz.

Conclusions

The mechanical contraction properties of the PC muscle are similar to those of the LVP, but with more aspects that are characteristic of a fast twitch muscle.
Soft Tissue Profile Changes in Patients with Cleft Lip and Palate following Maxillary Osteotomies
Authors: Al-Waheidi E.M.H. , Harradine N.W.T. , Orth M.
Published: October 2018

Objective

To investigate the soft tissue profile changes associated with LeFort maxillary osteotomy in subjects with cleft lip and palate and the predictability of those changes.

Design

A retrospective cephalometric study. The sample comprises 28 patients with cleft lip and palate. All consecutively treated cases with satisfactory records at Frenchay Hospital, Bristol, and St. Lawrence Hospital, Chepstow, were included.

Results

Males and females showed no significant differences in their soft tissue response. The proportion of soft to hard tissue change increased progressively for points that are more inferiorly placed on the upper soft tissue profile. The horizontal change in upper incisor position was the most common significant predictor of soft tissue change but accounted for less than 50% of the variability of change for all soft tissue points. The cleft lip patients in this study did not have upper lips that were compressed as a result of the orthognathic surgery by a significantly different amount when compared with those of noncleft patients in previous studies.

Conclusions

The soft tissue response to LeFort osteototomy is similar in amount in cleft and noncleft subjects. Movement of the upper incisor tip is the best predictor of soft tissue changes, but the confidence limits of predictability are relatively wide.
Diclofenac Analgesia following Cleft Palate Surgery
Authors: Sylaidis Peter , O'neill Trevor J.
Published: October 2018

Objective

This prospective study looked at the postoperative hemorrhage risk associated with the use of diclofenac following cleft palate repair.

Patients

Twenty consecutive children (6 months to 9 years of age) requiring repair of the hard or soft palate were included.

Design and Methods

Single per rectum doses of diclofenac were given at 1 mg/kg following cleft palate repair, with additional doses every 12 hours.

Results and Conclusions

The use of the nonsteroidal anti-inflammatory drug, diclofenac, for postoperative analgesia is well established for many types of surgery. The authors find that twice daily diclofenac rectal suppositories provide very good analgesia postcleft palate repair. This, combined with supplemental oral paracetamol, obviates the need for opiates, resulting in alert infants who feed well and are suitable for early discharge.
Palatoplasty: Furlow's Double Reversing Z-Plasty versus Intravelar Veloplasty
Authors: Gunther E. , Wisser J.R. , Cohen M.A. , Brown A.S.,
Published: October 2018

Objective

To evaluate the efficacy of Furlow's double reversing z-plasty (Furlow) versus intravelar veloplasty with longitudinal closure including palatal muscle reorientation (IVV).

Design

Retrospective, single-institution, single-surgeon comparison.

Patients

One hundred nineteen consecutive cleft palate patients were enrolled; 34 syndromic and 9 language-impaired patients were removed from speech and reoperation analysis. Furlow and IVV groups were similar with respect to sex and mean age at primary repair.

Interventions

One surgeon performed all surgery and one of two speech pathologists conducted language and speech evaluations at 3 years of age without prior knowledge of the surgical technique utilized.

Outcome Measures

Outcome measures included frequency of palatal fistulae, speech abnormalities, and need for secondary pharyngoplasty procedures.

Results

Patients who had undergone IVV demonstrated a 34% higher incidence of hoarseness, nasal escape, and hypernasality at 3 years of age than did Furlow patients. These same patients likewise required significantly more secondary pharyngoplasty procedures. No significant difference was noted between fistulae frequencies.

Conclusions

These findings suggest that Furlow palatoplasty may provide a better clinical outcome than intravelar veloplasty.
Nasalance Statistics for Two Mexican Populations
Authors: Nichols Alan C.
Published: October 2018

Objectives

This study was undertaken (1) to obtain nasalance statistics for 152 Spanish-speaking normal males and females In three age groups (young children, older children, and adults) from two cities In central Mexico, (2) to determine the reliability of nasalance statistics, and (3) to test whether cities, age group, and/or gender significantly affected nasalance scores.

Design/Participants

Randomly selected volunteers, screened for normal speech and hearing, in two middle-class neighborhoods in each city particlpated.

Settings

Measures were made in private homes.

Measures

Eight nasalance measures were obtained: means, “deviations,” maxima, and minima for two sets of sentences; one set that contained no nasals (NN); and another set that included sentences containing several words with nasal sounds (N).

Results

Reliability (Cronbach's alpha) of the measures was demonstrated to be very high (0.87 to 0.95). Eight multivariate analyses of variance, one for each type of measure, were performed. Significant differences among subgroups were limited to four: (1) cities differed in their NN means, (2) age groups differed in their NN minima, (3) cities differed in their N minima, and (4) genders differed in their N minima. (Bonferroni adjusted alphas = 0.05).
Bone Grafting of Cleft Lip and Palate Patients for Placement of Endosseous Implants
Authors: Jansma Johan , Raghoebar Gerry M. , Batenburg Rutger H.K. , Stellingsma Cornelis , Van Oort Rob P.
Published: October 2018

Objective

Fixation of a prosthesis or single tooth replacement using osseointegrated implants has the potential to overcome functional and psychological inconveniences that many patients experience from such appliances. However, the dimensions of the recipient site are relatively often inadequate for implant placement. This study assessed grafting of this site with autogenous bone as a solution for the latter problem.

Methods

Ten cleft lip and palate patients had bone grafts; six had iliac crest grafts to the maxillary sinus floor (31 implants), and four had chin bone grafts to the local defect in the anterior maxilla (six implants). Implants were inserted during the grafting procedure (one patient) or after 3 months (nine patients).

Results

No inflammation of the bone grafts or the maxillary sinus occurred. One Implant was lost during the healing phase. Four single tooth restorations, one fixed bridge, and five implant-supported overdentures were made. During the follow-up, which was 47 months (range, 28 to 65 months) In the anterior maxilla group and 56 months (range, 28 to 68 months) in the posterior maxilla group, no loss of implants was observed, and all prosthetic appliances functioned well.

Conclusions

It is concluded that bone grafting followed by placement of dental Implants can serve as a reliable alternative for conventional prosthetic rehabilitation of cleft patients.
Congenital Fistulae of the lower Lip in Van der Woude Syndrome: A Histomorphological Study
Authors: Onofre Mirian Aparecida , Brosco Heli Benedito , Brosco João Urias , Taga Rumio
Published: October 2018

Objective

To evaluate a significant number of cases of fistulae of the lower lip with the light microscope in order to investigate the histological variation and to attempt to define the histopathological pattern of the lesion.

Methods

Congenital fistulae of the lower lips of 17 patients with Van der Woude syndrome were analyzed by light microscopy.

Results and Conclusion

The walls of most of the fistulae consisted of stratified nonkeratinized squamous epithelium and a lamina propria of dense connective tissue with areas of lymphohistiocytic inflammatory infiltrates. Bundles of striated muscle fibers, blood vessels, nerves, adipose tissue, and mixed acinar glands were observed. These glands surrounded the entire wall of the lesion, and their excretory ducts opened into the lumen of the fistula, explaining the clinical observation of elimination of mucous secretion through the opening of the fistula. Two microform cases of fistula were analyzed that presented only a depression in the epithelium at the site corresponding to the opening of the fistula.
The 20th Century Danish Facial Cleft Population—Epidemiological and Genetic-Epidemiological Studies
Authors: Christensen Kaare
Published: October 2018

Since Dr. Fogh-Andersen's legendary 1942 thesis, the Danish facial cleft population has been one of the most extensively studied in terms of epidemiology and genetic-epidemiology. The etiology of cleft lip and/or palate (CLP) is still largely an enigma, and different results concerning environmental and genetic risk factors are obtained in different countries and regions. This may be due to etiological heterogeneity between settings. Therefore, an in-depth studied area with an ethnically homogeneous population, such as Denmark, has provided one of the best opportunities for progress in CLP etiological research. The present review summarizes epidemiological and genetic-epidemiological studies conducted in the 20th century Danish facial cleft population. Furthermore, analyses of sex differences, time trends and seasonality for more than 7000 CLP cases born in Denmark in the period 1936 to 1987 are presented. The review also points toward the excellent opportunities for continued etiological CLP research in Denmark in the 21st century using already established resources and an on-going prospective cohort study of 100,000 pregnant women.
Mandibulofacial Dysostosis—Variability in Facial Morphology and Growth: A Long-Term Profile Roentgenographic and Roentgen Stereometric Analysis of Three Patients
Authors: Rune Bodil , Sarnäs Karl-Victor , Åberg Magnus
Published: October 2018

Objective

To monitor and compare facial morphology and growth in three individuals with variable expression of mandibulofacial dysostosis (MFD) in terms of changes in the skeletal profile and in terms of growth in the circummaxillary sutures and temporomandibular Joints (TMJs).

Design

Retrospective conventional profile roentgenography (mean age 9 to 18 years) and prospective roentgen stereometric analysis (RSA) (mean age 7 to 17 years).

Setting

Center for Craniofacial Anomalies and Department of Plastic and Reconstructive Surgery, Malmö University Hospital, Sweden.

Patients

The first three MFD patients seen by one of the authors (B.R.).

Interventions

Surgery was performed at the Department of Plastic and Reconstructive Surgery. Implants were inserted at surgery under general anesthesia. Roentgen examinations were performed in connection with continued clinical evaluations and treatment.

Main Outcome Measures

All profile roentgenograms were traced and measured by one of the authors (K.-V.S.) using a conventional point-based analysis.

Results

The more afflicted patient showed a greater total difference in profile morphology and growth from the norm and more pronounced effects of articular growth restriction. Little change in the skeletal profile was associated with considerable displacement of the Jaws.

Conclusions

The variability in MFD expression and surgical procedures in our patients is reflected less in the skeletal profile morphology and growth and more in the displacement of the jaws.
Anthropometry of Soft-Tissue Orbits in Bulgarian Newborns: Norms for Intercanthal and Biocular Widths and Length of Palpebral Fissures in 100 Boys and 100 Girls
Authors: Madjarova Ludmila M. , Madzharov Mito M. , Farkas Leslie G. , Katic Marko J.
Published: October 2018

Objective

To establish early postnatal norms for the main measurements of the soft-tissue orbits for the Slavic Bulgarian population (9 million), we measured intercanthal (en-en) and biocular width (ex-ex) and length of the palpebral fissures (ex-en) in a representative sample of newborns less than six days old.

Method

Eye measurements were taken with a sliding caliper from randomly chosen subjects by the senior author using standard anthropometric methods. Findings were compared to those published for other Caucasian ethnic groups of infants (Germans and two groups of North American Caucasians).

Results

The mean values of all three soft orbital measurements were greater in newborn Bulgarian boys than girls. Measurements of Bulgarian intercanthal width (en-en) were greater in both sexes but those of biocular width (ex-ex) and palpebral fissure length (ex-en) were less than those that have been reported for North American Caucasian infants. Bulgarian intercanthal and biocular measurements were wider than German babies in both sexes. Differences, although small, were statistically highly significant but greatly influenced by differing sample sizes and subject age among the four Caucasian populations.

Conclusion

Anthropometric differences between ethnic groups of Caucasians already exist shortly after birth. Knowledge of the soft orbital data in early stages of the postnatal development in healthy populations is essential for determination in individuals of deviations from normal data. These Bulgarian norms can be helpful in anthropometric studies of the ethnically mixed Caucasian populations of North America.
Importance of Early Recognition and Treatment of Deformational Plagiocephaly with Orthotic Cranioplasty
Authors: Kelly Kevin M. , Littlefield Timothy R. , Pomatto Jeanne K. , Ripley Catherine E. , Beals Stephen P. , Joganic Edward F.
Published: October 2018

Objectives

Infants with positional plagiocephaly often exhibit complex multistructuraI asymmetries that affect the face and skull base as well as the cranial vault. Dynamic Orthotic Cranioplasty (DOC) was developed as a nonsurgical alternative for the treatment of positional plagiocephaly. The effectiveness of DOC has been discussed elsewhere. The purpose of this study was to assess the influence of factors such as entrance age, treatment time, and initial severity on the effectiveness of correction.

Methods

The study sample consisted of 258 children with cranial vault asymmetry (CVA) treated prior to 1 year of age. In addition, 246 patients (92%) exhibited concurrent skull base (SBA) and orbitotragial depth (OTDA) asymmetries. All patients had been diagnosed with nonsynostotic plagiocephaly, did not have other contributing medical conditions, were compliant with DOC protocol, and had complete anthropometric measurements at entrance and exit from treatment.

Results

Mean age at start of treatment was 6.5 (±1.9) months (range, 2.8 to 11.0 months), with an average treatment time of 4.1 (±2.2) months. The effects of the treatment variables were analyzed using three-way analysis of variance. As expected, initial severity was significantly associated with the amount of correction (p = .0001). However, treatment time was not significant (p > .05). Most importantly, the analysis revealed that, having accounted for initial severity, entrance age had a statistically significant effect [F[1,254) = 8.36, p = .0042] on the correction of CVA. Similar results were Identified for both the SBA [F[1,254) = 5.53, p = .0195] and the OTDA [F[1,254) = 5.22, p = .0231] asymmetries.

Conclusions

These findings support clinical observations that earlier intervention results in significantly improved treatment of plagiocephaly, independent of the severity of the presenting asymmetries.
Dentocraniofacial Morphology in Parents of Children with Cleft Lip and/or Palate
Authors: Suzuki Akira , Takenoshita Yasuharu , Honda Yasuo , Matsuura Chihiro
Published: October 2018

Objective

The purpose of this study was to compare the dentocraniofacial morphology of parents of children with cleft lip and/or palate (CUP) with that of parents of children without CUP and to use the results for genetic counseling.

Participants

Twenty-five fathers and 40 mothers of Japanese children with CL/P, who also had relatives with CL/P within three generations (experimental group), and 413 pairs of parents of children without CL/P (control) were used in this study. To test the accuracy of the discriminant function, 165 subjects were added to this study (test group).

Materials and Methods

Sixty-five dental casts were measured by digital sliding calipers, and 1056 frontal and 1056 lateral cephalograms were traced, digitized, and analyzed using analysis of variance (ANOVA) and discriminant analysis.

Results

Mesiodistal tooth diameters in parents of children with CL/P did not show any differences from those in parents of children without CL/P. The parents in the experimental group showed a distinct craniofacial morphology: wider interorbital width (IO-IO′), intercoronoid process distance (Cp-Cp′), and nasal cavity width (NC-NC′) and larger anterior cranial base length (S-N) and cranial base length (N-Ba). For genetic counseling, a discriminant function was obtained using four significant ratios on ANOVA. The percentage of correct classification using this function on the pooled experimental and control subjects was 67.9.

Conclusion

The parents in the experimental group showed a special craniofacial morphology, but the results suggest that the discriminant function might not be helpful in genetic counseling.
Comparison between Two Types of Pharyngeal Flap with Regard to Configuration at Rest and Function and Speech Outcome
Authors: Karling Jonas , Henningsson Gunilla , Larson Ola , Isberg Annika
Published: October 2018

Objective

In management of hypernasality, wide pharyngeal flaps have been advocated when pharyngeal wall adduction is limited. Pharyngeal flaps merged into a transversely split velum (TS flaps) are reported to be wider than if the velum is split in the midline (MS flaps). The hypothesis to be tested was that TS flaps are wider than MS flaps and are more caudally based.

Design

In this prospective study, MS flaps were videoradiographically and nasopharyngoscopically compared with TS flaps at both rest and function. Pharyngoplasty was randomly performed by one of three surgeons and the radiographic examinations were carried out by one radiologist The speech was assessed pre- and postoperatively.

Setting

The Stockholm Cleft Palate Team, Sweden, treated all patients.

Patients

After strict selection of the patients to avoid any uncontrolled impact on velopharyngeal sphincter function, 22 patients with limited pharyngeal adduction received TS flaps and 20 patients with good adduction received MS flaps.

Results

The data failed to show any difference in location of flap base and in flap width at rest. During function, TS flaps demonstrated statistically significant widening of the flap base. TS flaps, but not MS flaps, often had a bulge that appeared to assist velopharyngeal closure in some patients. Speech evaluation revealed that both flap types corrected velopharyngeal insufficiency equally well.

Conclusions

TS flaps were not wider than MS flaps, and functional plasticity of the TS flap appeared essential for elimination of velopharyngeal insufficiency. Contribution of postoperative adaptation of the pharyngeal wall adduction remains to be clarified.
Effect of Placement of a Speech Appliance on Levator Veli Palatini Muscle Activity during Blowing
Authors: Tachimura Takashi , Nohara Kanji , Hara Hisanaga , Wada Takeshi
Published: October 2018

Objective

We have observed clinically that some speakers wearing a speech appliance for correction of velopharyngeal incompetence can blow with variable intensity without nasal air escape. This clinical finding suggests that tightness of velopharyngeal closure may be regulated in accordance with oral air pressure during blowing. The purposes of this electromyographic study were (1) to examine whether levator veli palatini muscle activity can be changed in relation to oral air pressure during blowing when the speech appliance is removed, (2) to clarify whether or not the change is related to the severity of velopharyngeal incompetence, and (3) to examine whether placement of a speech appliance can alter levator muscle activity into the equivalent of that of normal speakers during blowing.

Design

Eight patients with repaired cleft palate, who routinely wear a palatal lift prosthesis (PLP) or a hybrid speech appliance of a pharyngeal bulb and palatal lift (bulb-PLP), served as subjects. Subjects were classified into one of two groups according to their speech appliance (PLP group and bulb-PLP group). Electromyography of the levator veli palatini muscle was recorded with a speech appliance in place and then with the speech appliance removed as the subject blew through a tube at three different effort levels.

Results

In the removed condition, the change in levator activity in relation to oral air pressure was variable across subjects in the bulb-PLP group, whereas levator activity changed in relation to oral air pressure change for all subjects in the PLP group. However, levator activity changed in relation to oral air pressure with either speech appliance in place for all subjects irrespective of their speech appliance types.

Conclusion

The severity of velopharyngeal incompetence might be related in part to change in levator activity in association with oral air pressure. The effect of a speech appliance to correct velopharyngeal incompetence might consist not only of mechanical obturation of the velopharynx but also of alteration of velopharyngeal function to become similar to normal speakers. Moreover, it is likely that the velopharyngeal system could be well regulated so as to exhibit a consistent outcome of velopharyngeal function.
Perception of Middorsum Palatal Stops from the Speech of Three Children with Repaired Cleft Palate
Authors: Santelmann Lynn , Sussman Joan , Chapman Kathy
Published: October 2018

Objective

The purpose of this study was to examine listeners' perception of the middorsum palatal stop, a compensatory articulation used by individuals with repaired cleft palates.

Design

This study tested whether listeners could discriminate middorsum palatal stops from matched alveolar (/t/) and velar (/k/) stops using a two-button “change/no-change” procedure. It also explored how listeners identified the palatal stop by rating each sound on a scale of one to eight.

Participants

Twenty listeners, 10 untrained and 10 trained in general phonetics (graduate students in speech-language pathology), participated in discrimination and identification tasks during a 1-hour session in the Speech Perception Laboratory at the University of Buffalo.

Measures

Discrimination was measured using d-prime, a score based on listeners' hits, correct rejections, misses, and false alarms to the changes/no changes in the stimuli. Identification was measured by the mean rating score for each class of stops.

Results

Listeners discriminated middorsum palatal stops from alveolar and velar stops, but their ratings for the middorsum palatal stops did not differ from those for the regular stop consonants. The two groups differing in phonetic training did not perform differently.

Conclusions

Listeners can discriminate middorsum palatal stops from other stop articulations, but they did not identify them differently from alveolar and velar stop consonants. The results suggest that considerable training listening to middorsum palatal stops is necessary for listeners to be able to reliably identify them.
Sternocleidomastoid Imbalance versus Congenital Muscular Torticollis: Their Relationship to Positional Plagiocephaly
Authors: Golden Kerry A. , Beals Stephen P. , Littlereld Timothy R. , Pomatto Jeanne K.
Published: October 2018

Objective

The purpose of this study was to investigate the existence of sternocleidomastoid (SCM) imbalance in a plagiocephalic population and further clinically describe its difference, if any, from congenital muscular torticollis (CMT). If SCM imbalance is different from CMT, then the development of terminology and a differential diagnosis may allow early recognition and intervention and possible prevention of positional plagiocephaly in the first place.

Design

This was a retrospective, random review of 100 patients referred for orthotic correction of their positional plagiocephaly.

Setting

The data was collected in a private orthotic clinic and was directed by a physical therapist. The patients were seen on a weekly or biweekly basis.

Patients

Eighty-three patients diagnosed with positonal plagiocephaly that were referred for Dynamic Orthotic Cranioplasty™ during 1996 were studied.

Results

Sixty-four percent of the sample was identified as having SCM imbalance and 12% was diagnosed with CMT. There were no statistically significant differences between the characteristics of these two groups in relation to the etiological factors of positional plagiocephaly. The only observed difference was related to symptoms of the neck itself.

Conclusions

Seventy-six percent of the sample was found to have some degree of SCM dysfunction, whether it be SCM imbalance or CMT. The finding that over three quarters of our population suffers from some form of SCM dysfunction, either SCM imbalance or CMT, suggests that any degree of SCM dysfunction may act as a precursor to positional plagiocephaly and therefore should be recognized and treated at the earliest opportunity.
State of the Art in Oral and Maxillofacial Surgery: Treatment of Maxillary Hypoplasia and Anterior Palatal and Alveolar Clefts
Authors: Steinberg Barry , Padwa Bonnie L. , Boyne Philip , Kaban Leonard
Published: October 2018

As the new millennium approaches, it seems appropriate to look back at where we have been and where we are going with the care of patients with facial deformities. None of us can deny that although changes have been made, many current treatment modalities are no more than modifications of old techniques. We are, however, poised to make dramatic improvements in the management of facial abnormalities as we enter the new century and millennium.

Biotechnology, genetic manipulation, and new surgical technology will become pervasive, and perhaps we will move from “modification” of the old into a completely new era of therapeutic approaches to the care of dentofacial deformities. “Opportunities multiply as they are seized” (from Sun Tzu), and the time of opportunity is approaching.

This review will attempt to look at the state of the art in cleft care and in oral and maxillofacial surgery: where we have been and where we are going. It will be clear that there is overlap between specialties and that these overlaps will become greater as new regimens in the care of facial deformities come to the forefront.
Shape Changes in the Cleft Palate Maxilla: A Longitudinal Study
Authors: Lestrel Pete E. , Berkowitz Samuel , Takahashi Osamu
Published: October 2018

Objective

The purpose of this study was to compare the shape of the maxilla in Norma lateralis of cleft lip and palate (CLP) patients with non-CLP controls matched for sex and age. This study utilized elliptical Fourier functions to assess the presence of residual shape changes in the cleft palate maxilla after treatment, compared with controls.

Design

Longitudinal data (n = 25) were available from the Miami Craniofacial Anomalies Foundation. From these data, two samples were selected: group I (mean age and SD, 5.06 ± 1.82 years) after lip surgery and the initiation of palate surgery and group II (16.58 ± 2.42 years) well after the conclusion of surgery. Twenty-two of these patients were matched with controls (5.11 ± 1.33 and 15.91 ± 2.25 years, respectively). The maxillary outline as seen on the lateral radiograph was (1) traced, (2) fitted with a series of 48 closely placed points, (3) digitized, and (4) submitted to a specially written routine that computes elliptical Fourier functions (EFFs). These EFFs are close analogs of the bounded maxillary outline as judged by the residual or difference between the observed points and the predicted points generated by the Fourier function. Each maxillary outline was subsequently standardized for size and corrected for positioning in two-dimensional space.

Results and Conclusions

Utilizing a three-way multivariate analysis of variance, statistically significant shape differences were obtained for both young and older groups, as well as between the CLP and controls. No significant gender differences were found. Morphological differences consisted of a posterior repositioning of the nasal crest aspect in the CLP cases. These results suggest that although a clinically satisfactory treatment result was obtained, differences in maxillary shape remain.
Effect of Primary Repositioning of the Nasal Septum on Facial Growth in Unilateral Cleft Lip and Palate
Authors: Šmahel Zbynĕk , Müllerová Živa , Nejedlý Aleš
Published: October 2018

Objective

The objective of this study is to evaluate whether manipulation of the nasal septum, its release, and changing of its abnormal position in infancy has an impact on maxillary growth and facial development in patients with unilateral cleft lip and palate.

Design

Roentgencephalometric investigation.

Setting

Cleft Centre at the Clinic of Plastic Surgery, Prague.

Patients

Two consecutive groups of male patients (n = 32 and 30) with complete unilateral cleft lip and palate without associated malformations at 15 years of age.

Interventions

The patients were operated on by the same team of surgeons and by the same method (lip: Tennison and primary periosteoplasty; palate: pushback with pharyngeal flap surgery), with the exception of complete primary repositioning of the nasal septum performed only in one group.

Main outcome measures

Roentgencephalometric data of both series of patients were compared with a t-test. All measurements were performed by one investigator.

Results

Patients with primary repositioning of the nasal septum had a more favorable nasal prominence and better vertical growth of the upper and whole face in posterior height. Better growth in anterior height was only suggested; maxillary retrusion was equal in both groups.

Conclusions

Primary repositioning of the nasal septum has a favorable effect on nasal development, and it neither deteriorates nor markedly improves maxillary growth in patients with unilateral cleft lip and palate.
Half Nose with Ipsilateral Eye and Ear Anomalies and Facial Asymmetry: Report of a Case with Cephalometric Analysis and Orthodontic Treatment
Authors: Motohashi Nobuyoshi , Kuroda Takayuki , Cohen M. Michael
Published: October 2018

Objective

Unilateral nostril agenesis together with ipsilateral alterations of the eye, ear, and face make up a spectrum of anomalies. The aim of this study is to report a case in a Japanese girl, 14 years, 5 months of age. Cephalometric analysis is provided, and orthodontic treatment is discussed.

Design

Lateral and frontal cephalograms were compared to a Japanese control group. Outcome of the orthodontic treatment was evaluated by comparing cephalograms taken before and after orthodontic treatment.

Results

The lateral cephalometric analysis showed a severely hypoplastic maxilla in both sagittal and vertical dimensions, coupled with a decreased posterior cranial base. The mandibular rami were asymmetric. The frontal cephalogram showed decreased cranial width and maxillary alveolar width, together with an Increased interorbital distance.

Conclusions

Serial lateral cephalograms during the orthodontic treatment from the age of 14 to 20 years demonstrated no significant maxillary growth and some mandibular growth, coupled with labial tipping of the maxillary central incisors.
Symmetry and Morbidity Assessment of Unilateral Complete Cleft Lip Nose Corrected with or without Primary Nasal Correction
Authors: Brusse Cindy A. , Van Der Werff John F.A. , Stevens H.P. Jeroen D. , Vermeij-Keers Christl , Prahl-Andersen Birte , Van Der Meulen Jacques C. , Vaandrager J. Michiel
Published: October 2018

Objective

Unilateral complete cleft lip patients treated with or without a primary nasal correction at the time of cleft lip repair were compared to evaluate the relevance of early surgical correction of the nose by using two assessments: nasal symmetry and morbidity.

Design, Setting, Patients

The no nasal correction group (NNC, n = 19) was operated by surgeon A using the Millard technique. The primary nasal correction group (PNC, n = 9) was operated by surgeon B combining the modified Millard technique with a columellar lift and alar mobilization. Symmetry was assessed on two sets of standardized photographs at 9 years of age using a computer-assisted analysis. Both cleft groups were compared with normal controls (NC, n = 20). The computer method included area and angular measurements. Morbidity was assessed by the number of procedures on the vermilion, the lip, and/or nose for revisional surgery up to the age of 9 (NNC, n = 26; PNC, n = 12).

Results

No significant differences in symmetry were found between the NNC and PNC groups regarding the area and angular measurements. With regard to the area measurements, both cleft groups produced a significant asymmetry when compared to the NC group. Concerning the angular measurements, however, the NNC group differed significantly from the NC group, whereas such a difference could not be noted between the PNC group and NC group. With respect to morbidity, no revisional procedures were performed in the PNC group. The number of revisional procedures in the NNC group was 16 in 10 patients.

Conclusion

Results are presented that favor, up to the age of 9 years, a primary nasal correction at the time of cleft lip repair.
New Developments in Craniofacial Surgery Research
Authors: Mehrara Babak J. , Longaker Michael T.
Published: October 2018

The recent explosion in our understanding of developmental biology and genetics has enhanced our understanding of craniofacial biology. While it is not possible to summarize all new developments in craniofacial research, this article will review three areas: fetal models and surgery for craniofacial disorders, the biology of distraction osteogenesis, and the molecular mechanisms of cranial suture fusion. Numerous models of craniofacial disorders have been described, including small, short gestation and large, long gestation. The benefits and shortcomings of each are discussed. In addition, we discuss recent studies investigating the molecular mechanisms of mandibular distraction osteogenesis. Finally, we present a review of recent advances in the understanding of mechanisms of craniosynostosis, with particular emphasis on the biology of programmed cranial suture fusion in rodents.
Long-Term Effects of Nasoalveolar Molding on Three-Dimensional Nasal Shape in Unilateral Clefts
Authors: Maull Deirdre J. , Grayson Barry H. , Cutting Court B. , Brecht Larry L. , Bookstein Fred L. , Khorrambadi Deljou , Webb Jon A. , Hurwitz Dennis J.
Published: October 2018

Objective:

This objective of this study was to determine the effect of presurgical nasoalveolar molding on long-term nasal shape in complete unilateral clefts.

Design:

The study was retrospective, and the subjects were chosen at random. Nasal casts of the subjects were scanned in three dimensions. Each nose was best fit to its mirror image, and a numerical asymmetry score was determined.

Setting:

All patients were treated at the Institute of Reconstructive Plastic Surgery, NYU Medical Center, New York, New York.

Patients:

The study subjects (n = 10) were selected from a group that had undergone presurgical nasal molding in conjunction with alveolar molding. The control subjects (n = 10) were selected from a group that had undergone presurgical alveolar molding alone.

Interventions:

All subjects underwent presurgical orthopedic treatment until the age of approximately 4 months at which time the primary surgery was performed.

Main Outcome Measure:

The nasal shape following nasal molding should be more symmetrical than if molding had not been done.

Results:

The mean asymmetry index for the nasoalveolar molding group was 0.74, and the control group was 1.21. This difference was statistically significant (p < .05).

Conclusions:

Presurgical nasoalveolar molding significantly increases the symmetry of the nose. The increase in symmetry is maintained long term into early childhood. The limitations of this study include (1) asymmetry alone is not an adequate shape result in most situations, (2) the children evaluated in this study were not fully grown, and (3) the control group was not age matched.
Maxillary Growth in Patients with Clefts following Secondary Alveolar Bone Grafting
Authors: Levitt Terry , Long Ross E. , Trotman Carroll-Ann
Published: October 2018

Objective:

This investigation evaluated the effects of secondary alveolar bone grafting on subsequent maxillary growth in cleft patients.

Design:

This was a retrospective longitudinal cephalometric study. Nineteen patients who had received secondary alveolar bone grafts were matched to a control sample by sex, cleft, availability of longitudinal records, and presurgical cranial base dimensions and growth direction. All patients had at least two lateral cephalometric radiographs before surgery and two radiographs after surgery.

Setting:

The records were obtained from the Longitudinal Growth Study of the Lancaster (Pennsylvania) Cleft Palate Clinic.

Interventions:

All patients had received similar primary surgical procedures by the same surgeon, no orthopedics, and similar mixed-dentition orthodontics. Secondary alveolar bone grafting was the only surgical intervention different between the two groups.

Main outcome measures:

Six measures of maxillary sagittal and vertical growth were taken from 235 radiographs. Slopes of the regression lines for each growth dimension were compared between groups both pre- and post-surgically.

Results:

There were no significant between-group differences in maxillary sagittal or vertical growth following the grafting procedure. Anterior maxillary vertical growth rates decreased in the grafted group when their pre- and post-surgical rates were compared. Several growth trends in the postsurgical period were found to be continuations of the rates documented presurgically and unrelated to the grafting procedure.

Conclusions:

When evaluated longitudinally, maxillary growth in patients having received secondary alveolar bone grafting did not differ from a group of matched controls.
Aesthetic and Functional Outcome of Surgical and Orthodontic Correction of Bilateral Clefts of Lip, Palate, and Alveolus
Authors: Gaggl Alexander , Schultes Günter , Kärcher Hans
Published: October 2018

Objective:

To assess the aesthetic and functional long-term results of surgical and orthodontic treatment of patients with bilateral cleft lip, palate, and alveolus.

Design:

Long-term follow-up study.

Setting:

Teaching hospital in Austria.

Patients:

Twenty adult patients who had been operated on as children for bilateral cleft lip, palate, and alveolus.

Interventions:

Lateral cephalometric and model analysis. The sum of all mesiodistal tooth diameters in the maxilla and mandible were compared with standard Bolton tracings.

Main outcome measures:

Aesthetic and functional results.

Results (model analysis):

The upper arch was too wide in 12 patients and the mandibular arch was too wide in 4 patients. In 11 patients, the lateral teeth were crowded, and all had a persistent transverse space deficit and a reduction in sagittal measurements. Fifteen patients had alveolar midline displacement of the maxilla as well as of the mandible.

Results (lateral cephalometric measurements):

The lateral cephalograms showed a mean sella-nasion-A point angle of 77° and a maxillary baseline-nasion-sella line angle of 9°, indicating a tendency toward maxillary retrognathia. An anterior facial height index of 42% (compared with the standard 58%) indicated a slight reduction in midface height with consequent increase in the height of the lower face.

Conclusion:

There is specific growth impairment of the midface in adults who were treated as children for bilateral clefts of lip, palate, and alveolus. An optimal result can be achieved only by additional orthognathic surgery (Le Fort II osteotomy).
Effects of TGFβ2 on Collagen Synthesis in Cultured Normal and Wounded Fetal Mouse Palates
Authors: Thompson Sue Ann , Canady John W. , Coberly Dana M. , Sandra Alexander , Lee Chun Mee , Pang Judy C.
Published: October 2018

Objective:

It has been demonstrated in a number of models that fetal wounds heal with little or no scar. Since collagen is an integral part of the extracellular matrix in adult scar formation, we studied the synthesis and localization of collagen in an in vitro mouse palate model for fetal wound healing.

Methods:

Palates, dissected from fetal mice at 15, 16, and 17 days of gestation and from newborn mice, were cultured in medium containing serum (for 8 hours); this was followed by culture in serum-free medium (for 12 hours). One-half of the samples from each age group were wounded in the midline. All samples were placed in serum-free medium containing 20 μCl/mL 3H-proline for 8 hours. In addition, palates from 15-day gestation and from newborn mice were also incubated with transforming growth factor TGFβ2 (10 ng/mL). Palates were washed with saline, homogenized, and radioactivity was counted. Proline uptake was calculated for each sample as counts per milligram of protein and was subjected to statistical analysis (three-way analysis of variance). Samples of the homogenate were subjected to sodium dodecyl sulfate-gel electrophoresis and Western blotting in order to determine the types of collagen that were synthesized. Immunohistochemical localization of collagen types I, III, and VI was carried out on paraffin-embedded samples from each group.

Results:

There were no significant differences in proline uptake between wounded mouse palates and nonwounded mouse palates at any age, and there was no histological evidence of regeneration of the palate at the site of the wound. Proline uptake was significantly greater in untreated wounded palates at 15 days’ gestation than it was in newborns. After treatment with TGFβ2, proline uptake was significantly greater in both wounded and nonwounded palates in the newborn group and had no effect on collagen synthesis in palates from 15-day gestation animals. Collagen types I and III were localized in histological specimens using immunohistochemistry and on nitrocellulose using Western blotting. No type VI collagen was demonstrated by Western blotting, but it was localized around blood vessels and on basement membranes using immunohistochemistry.

Conclusion:

Treatment with TGFβ2 significantly increased collagen synthesis, as assessed by 3H-proline uptake, in cultured palates from newborn mice as compared with palates from untreated newborn mice and from both treated and untreated palates of 15-day gestation mice. These data suggest a differential response to TGFβ2 by mouse palates as a function of fetal development.
Children's Attitudes toward Interacting with Peers with Different Craniofacial Anomalies
Authors: Reed Julie , Robathan Magali , Hockenhull Anna , Rostill Helen , Perrett David , Lees Andie
Published: October 2018

Objective:

This study was designed to evaluate children's understanding of different craniofacial anomalies and their willingness to interact with children with such anomalies.

Design:

This was a between-measures design in which children were randomly allocated to one of three groups. Each group viewed one of three pairs of computer-generated images (nondistinctive, cleft lip, or misshapen nose) of similar-aged children.

Setting:

Participants were recruited from two city elementary schools and were interviewed at their schools.

Participants:

A total of 100 children (aged 7 to 10 years) entered the study, and complete sets of data were obtained for each child. As the majority of the children were white (n = 92), the nonwhite children (n = 8) were excluded from the data analyses.

Main Outcome Measures:

Participants were asked a number of questions to ascertain their thoughts about the image, and measures were then taken of each child's willingness to interact with the stimulus child.

Results:

There were no significant differences between the three groups. Boys were significantly more willing to interact with the stimulus images than were girls, and there was a nonsignificant trend for girls to be more likely to spontaneously mention the craniofacial anomaly. Participants gave varied explanations for the condition's causation.

Conclusions:

Boys and girls differed in their willingness to interact with unfamiliar peers with and without facial distinctions. Various explanations were given to explain causality of the anomaly. Findings lend some support to the proposal that high “background attractiveness” can overshadow the impact of a craniofacial anomaly.
Callus Distraction of the Midface in the Severely Atrophied Maxilla—A Case Report
Authors: Hierl Thomas , Hemprich Alexander
Published: October 2018

Objective:

This report introduces the possibilities of callus distraction in the extremely atrophied, edentulous midface in a cleft lip and palate patient.

Intervention:

After a subtotal Le Fort II osteotomy, tension wires were fixed to the zygomatic buttresses and frontal sinus walls by way of titanium mini-plates and mesh and connected to a rigid external distractor. Then distraction of the whole midface (1 mm/d) was performed.

Results:

Even in severe atrophy a distraction of the maxilla of 20 mm was possible. Stability has been shown for more than 5 months.

Conclusions:

Rigid external midfacial distraction may be used in difficult cases for the correction of sagittal discrepancies where conventional orthognatic surgery is likely to be insufficient. Further investigations will concentrate on the long-term outcome.