bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth Patterns in the Orbital Region: A Morphometric Study
Authors: Farkas Leslie G. , Posnick Jeffrey C. , Hreczko Tania M. , Pron Gaylene E.
Published: October 2018

Data for analysis of age-related changes in growth in the intercanthal (en–en) and biocular (ex–ex) widths were obtained from 1,594 healthy North American Caucasians in age groups from 1 to 18 years, divided equally between males and females. At 1 year, the degree of development of the intercanthal width reached 84.1%, and that of the biocular width 85.9% of adults in both sexes. The levels of growth achieved by 5 years of age rose to 93.3% in the intercanthal width and 88.1% in the biocular width, in both sexes. The average total growth increments achieved between ages 1 and 18 years were 5.2 mm in the intercanthal width and 12.5 mm in the biocular. The intercanthal width showed very little growth after 1 year of age; in contrast, the biocular width showed significantly greater growth increments both before and after 5 years of age. Rapid growth was observed between 3 and 4 years in the intercanthal width of both sexes. The age-related growth observed in the biocular width was small but continuous up to maturation time. The intercanthal width reached full maturation at 8 years in females and 11 years in males, and the biocular width at 13 years in females and 15 years in males.
Growth Patterns of the Nasolabial Region: A Morphometric Study
Authors: Farkas Leslie G. , Posnick Jeffrey C. , Hreczko Tania M. , Pron Gaylene E.
Published: October 2018

Age-related growth changes in the nasolabial region were analyzed through six measurements taken between 1 year and 18 years of age in 1,593 North American Caucasians. By 1 year of age, the length of the cutaneous portion of the upper lip and the width of the nose showed the highest levels of development compared with their adult size, 80.3 and 79.5%, respectively. By 5 years, the developmental level of the nasolabial region except nasal tip protrusion approached their maturation level. Our nasal measurements indicated that growth of the nose between 5 and 18 years was significantly greater than that of the upper lip, which revealed significantly greater growth increments between 1 and 5 years of age. The cutaneous upper lip height reached its adult size in 3-year-old females (12.7 mm) and 6-year-old males (14.4 mm). Nose width and height were fully developed in females by age 12 and in males by age 14 or 15. Rapid growth occurred in the upper lip, nose height, and nasal tip protrusion between the ages of 1 and 4 years. Knowledge of these age-related morphologic variations within the nose and upper lip may be useful in planning the time and type of reconstructive surgery and in anticipating further change in the operated regions after the surgical reconstruction.
Periodontal Status of Teeth Adjacent to Nongrafted Unilateral Alveolar Clefts
Authors: Teja Zeenat , Persson Rutger , Omnell Maj Lena
Published: October 2018

The purpose of this study was to compare the periodontal condition of teeth adjacent to the cleft with contralateral teeth in adult subjects with a nongrafted unilateral alveolar cleft. Periodontal parameters were evaluated in 18 subjects who had at least one tooth immediately adjacent to the cleft. For each tooth investigated, plaque index, gingival index, and probing depth were recorded and each tooth was assigned a mobility score. Width of attached gingiva and extent of recession was measured. Bone level was assessed using standardized magnified radiographs and a computerized digitizing system. The overall findings of this study support those of other studies and indicate that in individuals with a nongrafted alveolar cleft, teeth adjacent to the defect show signs of gingivitis but not of periodontal disease. The anatomic defect, eruption pattern, orthodontic tooth movements, and the presence of restorations appear to contribute to the reduced bone level on the central incisor adjacent to the cleft and to the presence of gingivitis.
Fetal Kleeblattschädel Cranium: Morphologic, Radiographic, and Histologic Analysis
Authors: Witt Peter D. , Hardesty Robert A. , Zuppan Craig , Rouse Glenn , Hasso Anton N. , Boyne Philip
Published: October 2018

The kleeblattschädel deformity is a rare craniofacial condition typified by its trilobed, cloverleaf skull. The pathophysiology of this process is controversial. The morphologic, radiographic, and histologic abnormalities identified in the cranial base of an 18-gestational-week fetus with kleeblattschädel skull have not been described previously. Recently, the intrauterine diagnosis of kleeblattschädel was established by serial ultrasonography and, based on this evidence, the fetus was aborted. The fetus was studied extensively. Standard radiographs and high-resolution CT scans were obtained. Three-dimensional, reformatted contour surface images were constructed from the CT scan data. The cranial base was examined grossly, radiographically, and histologically. Histologic microanatomic study concentrated on structures of the mid-sagittal cranial base from the occiput to the mid maxilla. The distorted cranial architecture in kleeblattschädel deformity has, in the past, been attributed largely to the cranial base deformity which secondarily distorts the developing brain. Our study, however, suggests that the calvarium itself may be the primary focus of abnormal events leading to synostosis. The findings in this study seem to be Inconsistent with earlier theories about the abnormal development of craniodysostoses.
Mandibular Morphology and Spatial Position in Patients with Clefts: Intrinsic or Iatrogenic?
Authors: Gabriel Da Silva Omar , David Corrêa Normando Antônio , Capelozza Leopoldino
Published: October 2018

Lateral cephalometric films of operated (Op) and non-operated (Nop) patients with cleft lip and alveolus, cleft lip and palate or cleft palate only, were compared to determine whether the shape or position of the mandible is affected by lip and/or palate surgery. The sample included 204 adult cleft patients, Caucasians of both sexes with one of the following three cleft types: complete unilateral lip and alveolus (n = 50), complete unilateral lip and palate (n = 68), and isolated palate (n = 86). The comparison involved 113 cleft patients operated at the conventional timing and 91 cleft patients who had received no surgical or orthodontic treatment. Comparison was done in order to ascertain if the surgery performed had had any influence upon mandibular growth. The results indicated that, In all three cleft types, the surgery did not induce significant changes in the mandibular growth.
A Six-Center International Study of Treatment Outcome in Patients with Clefts of the Lip and Palate: Part 1. Principles and Study Design
Authors: Shaw William C. , Asher-Mcdade Catherine , Brattström Viveca , Dahl Erik , Mcwilliam John , Mølsted Kirsten , Plint Dennis A. , Orth D. , Prahl-Andersen Birte , Semb Gunvor , The Ralph P.S.
Published: October 2018

This article describes the design of an intercenter comparative study of treatment outcome in the treatment of children with a unilateral complete cleft of the lip and palate. The rationale and aims of this study are defined and treatment schemes of the participating centers are described. The findings are presented in a series of three papers (Parts 2, 3, and 4) dealing with the comparison of craniofacial form, dental arch relationships, and nasolabial appearance. In Part 5, conclusions and general recommendations regarding future research are discussed.
A Six-Center International Study of Treatment Outcome in Patients with Clefts of the Lip and Palate: Part 4. Assessment of Nasolabial Appearance
Authors: Asher-Mcdade Catherine , Brattström Viveca , Dahl Erik , Mcwilliam John , Mølsted Kirsten , Plint Dennis A , Prahl-Andersen Birte , Semb Gunvor , Shaw William C. , The Ralph P.S.
Published: October 2018

One hundred and fifteen frontal and profile photographs of the nasolabial area of subjects with complete unilateral clefts of the lip and palate from six European centers were assessed. Four components of the nasolabial area were rated separately by a panel of judges using a five-point scale of attractiveness. The Tukey multiple comparison test showed significant differences between the centers. The relative position of the six centers in this study followed a similar pattern to their respective positions in the cephalometric and dental cast studies.
A Six-Center International Study of Treatment Outcome in Patients with Clefts of the Lip and Palate: Part 5. General Discussion and Conclusions
Authors: Shaw William C. , Dahl Erik , Asher-Mcdade Catherine , Brattström Viveca , Mars Mike , Mcwilliam John , Mølsted Kirsten , Plint Dennis A. , Prahl-Andersen Birte , Roberts Christopher , Semb Gunvor , The Ralph P.S.
Published: October 2018

Part 5 is the final part of a series of five articles reporting on an international, multicenter clinical audit of treatment outcome for complete UCLP. A number of recommendations for the methodology of future studies is made especially with respect to entry criteria, sample size, assumptions of homogeneity, and the reproducibility and validity of outcome measures. The findings of the present study regarding clinical procedures are presented tentatively, and improvement and extension of the methodology are required. It appears, however, that acceptable results can be achieved by different programs and ultimately clinical choices may be based on factors such as complexity, costs, and demands of treatment. Standardization, centralization, and the participation of high volume operators were associated with good outcomes, and nonstandardization and the participation of low volume operators with poor outcomes. Therapeutic factors associated with good outcomes were the employment of a vomer flap to close the anterior palate, and poor outcomes with primary bone grafting and with active presurgical orthopedics.
Cephalometric Analysis of Maxillofacial Morphology in Unoperated Cleft Palate Patients
Authors: Yoshida Hiroshi , Nakamura Atsushi , Michi Ken-Ichi , Go-Ming Wang , Kan Liu , Wei-Liu Qiu
Published: October 2018

This study was designed to investigate maxillofacial morphology in adolescents and adults with unrepaired cleft palate, with or without cleft lip. Twenty-two Chinese patients with unilateral cleft lip and palate (the UCLP group), and 21 Chinese with cleft palate (the CP group) were cephalometrically evaluated and classified into the five ranges established from the means and standard deviations for matched normal Chinese populations. Many subjects in both UCLP and CP groups showed an intrinsic maxillary retrusion and a steeper mandible. The others had nearly normal maxillofacial morphology. The tendency for maxillary retrusion and a steeper mandible became increasingly remarkable with age. In the long axis of upper incisors in subjects with permanent dentition, there were no UCLP subjects with labial inclination, whereas three CP subjects exhibited labial inclination.
Trends in Prosthodontic Treatment of Cleft Palate Patients at One Institution: A Twenty-One Year Review
Authors: Delgado Armando A. , Schaaf Norman G. , Emrich Lawrence
Published: October 2018

This 21-year retrospective study evaluated the trends observed in the prosthodontic treatment of 269 patients. The patients were divided into three groups. The speech aid group consisted of 203 patients and showed a significant decrease in numbers over time. The maxillary obturator group consisted of 24 patients and did not show a significant change. The infant feeding prosthesis group consisted of 42 patients and showed a significant increase in numbers. Possible reasons for the trends observed are discussed.
Pulmonary Function of Individuals with Congenital Cleft Palate
Authors: Kiemle Trindade Inge Elly , Carlos Manço José , Sergio Trindade Alceu
Published: October 2018

Ventilatory pulmonary function was investigated in 160 children and adults with repaired or unrepaired congenital cleft palate in comparison with 130 normal children and adults. Pulmonary function tests included measurement of lung volumes, of maximal voluntary ventilation (MVV) and of forced spirometry parameters: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio and mean forced expiratory flow during the middle half of FVC (FEF25–75). Patients with cleft palate demonstrated significant differences from normal individuals in some of the measurements made. Functional alterations were observed at higher frequency among adult patients with unrepaired clefts and mainly consisted of a reduction in expiratory flows and MVV. However, the deviations observed were usually discrete and probably of low Physiopathologic significance. The results permit us to conclude that, in contrast to data reported by others, subjects with congenital cleft palate have little impairment of pulmonary ventilatory function.
Phonetic and Phonologic Skills of Two-Year-Olds with Cleft Palate
Authors: Chapman Kathy L. , Hardin Mary A.
Published: October 2018

This article examines the phonetic and phonologic skills of 2-year-olds with cleft palate. Fifteen children, 10 children with cleft palate and five noncleft children, participated in the study. The children with cleft palate all received palatal surgery after 12 months of age and after the onset of meaningful speech. All subjects were video and audiotaped while interacting with their mothers during unstructured play. At least one hundred different spontaneous word productions were phonetically transcribed and analyzed for (1) percent consonants correct, (2) phonologic processes, and (3) “compensatory” articulation patterns. A comparison between the groups indicated that although the children with cleft palate exhibited more errors overall, they were similar to their noncleft peers in their phonologic process usage with two exceptions. Additionally, few “compensatory” articulation errors were noted in the speech of these children.
First-Year Mortality among Infants with Facial Clefts
Authors: Hujoel Philippe P. , Bollen Anne-Marie , Mueller Beth A.
Published: October 2018

Children born with a facial cleft are not thought to be at a greater risk for infant mortality than are those without congenital anomalies. The purpose of this study was to investigate whether the presence of a facial cleft alone or its coexistence with other anomalies increases a child's risk for dying. Birth and death certificate data from Washington State for the years 1984 to 1988 were linked for infants who died before 1 year of age. Mortality rates for different types of facial clefts and for births without noted abnormalities were compared. Relative to infants with no diagnosed abnormalities noted in the birth certificate, infants with facial clefts without other abnormalities have a 3.7 fold increased odds for dying during their first year of life. This elevated risk for dying was fairly consistent during the first year of life. When facial clefts are associated with other abnormalities there is an 82.3 fold increase in odds for mortality during the first year of life. This elevated risk is highest during the neonatal period; 77% of all deaths occurred during the first 27 days. It is concluded that infants with facial clefts with or without associated anomalies have a significantly increased mortality risk when compared to infants without any diagnosed abnormalities at birth.
Craniofacial Development in Myotonic Dystrophy
Authors: Staley Robert N. , Bishara Samir E. , Hanson James W. , Nowak Arthur J.
Published: October 2018

Anthropometric, cephalometric, and dental data from 23 subjects (12 males and 11 females) afflicted with myotonic dystrophy were compared to similar data from normal subjects who participated in the Iowa Facial Growth Study.

A two by two analysis of variance showed that myotonic subjects differed from normal subjects in headlength, head breadth, cephalic index, bizygomatic face width, nosebreadth, maxillary arch widths, palatal depth, anterior and posterior face heights, cranial base lengths, cranial base angles, and other cephalometric measures. Sex differences were observed for many of the variables. It is hoped that these findings will assist clinicians who treat patients having this disorder.
Microbiota Associated with Residual Clefts and Neighboring Teeth in Patients with Cleft Lip, Alveolus, and Palate
Authors: Mombelli Andrea , Brägger Urs , Lang Niklaus P.
Published: October 2018

Twenty patients with residual clefts or pronounced soft tissue grooves, treated for uni- or bilateral cleft lip, alveolus, and palate were included in this study. Ten patients were recalled for dental prophylaxis at regular intervals, 10 patients were not. One microbiologic sample was obtained from the cleft area and two samples from a tooth adjacent to the cleft (sites adjacent and distant to the cleft). Between the recall and the nonrecall group there were notable differences in the presence of anaerobic Gram-negative organisms. Fusobacterium spp., Prevotella melaninogenica, and P, intermedia were more often found in nonrecall patients. While rarely seen in recall patients, spirochetes and motile rods were a common feature of nonrecall patients. The putative periodontal pathogens Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were not detected in either group. The differences between the recall and the nonrecall groups were more pronounced when the respective samples from teeth were related to each other than when the samples obtained from the clefts were compared. The cleft flora was less complex irrespective of how good maintenance was and resembled the flora of teeth of well-maintained patients. Samples from clefts were never Wolinella positive, and harbored significantly less Capnocytophaga and Actinomyces viscosus than samples from dental sites.
Reproductive History of Mothers of Children with Solitary, Nonsyndromic Cleft Lip and/or Palate
Authors: Felix-Schollaart Bente , Hoeksma Jan B. , Van De Velde Jean Paul , Puyenbroek Jerôme I. , Prahl-Andersen Birte
Published: October 2018

The reproductive history was studied to evaluate if the three types of solitary, nonsyndromic clefts: cleft lip (CL), cleft lip and palate (CLP), and cleft palate (CP) are homogeneous entities. Occurrence of fetal loss, maternal health, and drug consumption of the mother during the pregnancy were compared in cases involving three types of clefts. Data was gathered from 87 children with clefts, 55 males and 32 females. Spontaneous abortions and vaginal bleeding were found to occur significantly more often in the (older) mother of a CLP child. This suggests that the factors involved in the etiology of CLP differ from the factors involved in CL and CP. Therefore, grouping of data of the three types of clefts in studies on the etiology should be avoided.
Growth Comparison between Children with Cleft Lip and/or Palate and Controls
Authors: Felix-Schollaart Bente , Hoeksma Jan B. , Prahl-Andersen Birte
Published: October 2018

General growth from birth to 2.5 years of age of 45 children with a solitary, nonsyndromic cleft lip and/or palate (CL/P) was compared to that of 50 controls. Weight, height, and head circumference were studied in relation to possible influencing factors. Growth of children with CL/P was found to be similar, to a large extent, to that of the control sample, with the exception of growth measured by height. Whereas males in the control group are generally taller than females, the reverse is seen for the CL/P group. Feeding difficulties and intestinal disorders, airway infections, and cleft restoring operations do not account for differences among the groups with CL/P and the control group as was suggested in the literature. Feeding difficulties and intestinal disorders between 12 and 18 months of age and airway infections between 0 and 3 months of age were identified as having a negative influence on growth, measured by weight and height, though not on head circumference.
Cleft Lip Repair Using Intramuscular Hydroxyzine Sedation and Local Anesthesia
Authors: Kapetansky Donald , Warren Ronald , Hawtof David
Published: October 2018

Intramuscular hydroxyzine was used alone for sedation in 18 cleft lip repairs with patients under 6 weeks of age. After injection of local anesthesia, the infants were quiet throughout the procedure. Blood pressure, pulse, respiration, and temperatures were normal throughout and the oxygen saturation remained above 94% in all cases. There were no complications noted with this series of patients and no patient required conversion to general anesthesia. Intramuscular hydroxyzine combined with local anesthesia and nerve block has been found to be a safe and effective method for cleft lip repairs in selected neonates under 6 weeks of age.
History of Cleft Lip Nasal Repair
Authors: Randall Peter
Published: October 2018

Surgery of the cleft lip nasal tip has lagged behind cleft lip surgery. In fact, in most early illustrations it was not even noted. Since the development of cosmetic rhinoplasty an endless array of techniques have been published. Unfortunately there are few studies of the gross anatomy.
Congenital Clefts of the Nose: Principles of Surgical Management
Authors: Shewmake Kris B. , Kawamoto Henry K.
Published: October 2018

Congenital clefts of the nose are rare and highly variable. Because there are few examples, standard methods for treatment do not exist. Therefore each patient must be evaluated and managed individually with respect to anatomic elements, timing, and sequence of reconstruction.
Correction of the Bilateral Cleft Lip Nasal Deformity: Evolution of a Surgical Concept
Authors: Mulliken John B.
Published: October 2018

The origin of the nasal deformity of a bilateral complete cleft lip is both primary (deformation/malformation) and secondary (postoperative distortion). This is an interim report of a personal evolution from staged correction of the bilateral cleft nasal deformity to synchronous repair of the nose and the lip and premaxillarymaxillary clefts. The anatomic concept is that, because of the maIpositioned alar cartilages, the columella only appears to be short in an infant with bilateral cleft lip. The technical stratagems to model the nose are: (1) alignment of the premaxilla and (2) anatomic placement of the alar cartilages with sculpturing of the overlying soft tissue.
Effects of Orthognathic Surgery on Nasal Form and Function in the Cleft Patient
Authors: Wolford Larry M.,
Published: October 2018

Management of common problems of nasal airway obstruction in cleft and noncleft patients by the subnasal approach through the maxillary Le Fort I osteotomy are discussed. The effects of maxillary surgical repositioning on the esthetics of the nose and upper lip are presented, as well as the sequencing and timing of orthognathic surgery and nasal reconstruction in the cleft patient. Case presentations illustrate the results of this treatment approach.
Early and Late Treatment of Unilateral Cleft Nasal Deformity
Authors: Salyer Kenneth E.
Published: October 2018

Surgical techniques have been developed to correct nasal deformity associated with unilateral cleft lip, alveolus, and palate. This deformity can be significantly corrected during the primary cleft lip repair, as performed by the technique described by the author. Secondary corrective procedures focus mostly on skeletal support and lining distortions as well as on rearrangements of lower lateral cartilages. At the final stage, esthetic appearance can be significantly improved by contour remodeling with the addition of cartilage and/or bony implants. Choice of surgical technique depends upon the severity of the deformity and the experience and proficiency of the surgeon. At the present time, correction of the nasal deformity associated with a unilateral cleft is an integral part of primary cleft lip repair and part of multidisciplinary management of cleft deformities.
Social and Psychological Effects of Major Craniofacial Deformity
Authors: Pruzinsky Thomas
Published: October 2018

This paper discusses the social and psychological experiences of patients with the most severe forms of craniofacial deformity. The paper concludes that individuals with the most severe forms of craniofacial deformities are at risk for experiencing social and psychological stress and for having their quality of life negatively impacted by the experience of having a facial deformity. Much of the stress experienced by these individuals is the result of the negative social response to their facial deformity. It is emphasized that many patients will not develop psychopathology, because of intervening personality and family factors that may ameliorate these negative social stressors. The excellent progress made in assessing, preventing, and treating the negative psychosocial impact of facial deformity is noted. Finally, in attempting to understand the impact of facial deformity on quality of life, emphasis is placed on the subjective evaluation of these factors by each individual patient and family.
A Six-Center International Study of Treatment Outcome in Patients with Clefts of the Lip and Palate: Evaluation of Maxillary Asymmetry
Authors: Mølsted Kirsten , Dahl Erik , Brattström Viveca , Mcwilliam John , Semb Gunvor
Published: October 2018

This investigation was carried out by the European Cleft Lip and Palate Research Group. The purpose of this part of the investigation was to compare and evaluate maxillary asymmetry in children born with complete unilateral cleft lip and palate treated at cleft palate centers with different surgical management. Posteroanterior radiographs from three of the six participating centers were included in the investigation. Statistically significant differences were found in the symmetry of the anterior part of the maxillary complex. Children with a primary bonegrafting procedure involved in their primary treatment procedure had a more symmetric dentoalveolar development. Children from centers with primary surgical procedures including a vomer plasty and no involvement of the alveolar process had a more asymmetric development with a tilted premaxilla and a deviating inclination of the central incisors.
Survey of Speech-Language Pathologists' Training, Experience, and Opinions on Nasopharyngoscopy
Authors: Pannbacker Mary D. , Lass Norman J. , Hansen Gregory G.R. , Mussa Ashraf M. , Robison Karen L.
Published: October 2018

A questionnaire on nasopharyngoscopy was completed by 93 speech-language pathologists randomly selected from the Directory of The American Cleft Palate-Craniofacial Association. Although the majority rated nasopharyngoscopy as important in the assessment of velopharyngeal function, and believed that it should be performed by speech-language pathologists, the majority do not perform nasopharyngoscopic examinations. Moreover, 40% had no academic preparation and 20% had no clinical experience in nasopharyngoscopy. Implications of these findings concerning exposure to nasopharyngoscopy in speech-language pathology graduate training programs and in continuing education programs for practicing speech-language pathologists are discussed.
Correction of Velopharyngeal Insufficiency by Pharyngeal Augmentation Using Autologous Cartilage: A Preliminary Report
Authors: Denny Arlen D. , Marks Susan M. , Oliff-Carneol Susan
Published: October 2018

Twenty patients with velopharyngeal insufficiency (VPI) were treated with autologous costal bone or cartilage implants. Videofluoroscopy and videonasopharyngoscopy studies were used to identify candidates for the procedure. The specific size and shape of the gap as well as an appropriate location for the implant were determined in those patients for whom videonasopharyngoscopy was used. A piece of costal bone or cartilage was implanted into a preselected site in the posterior pharynx. Speech and voice evaluation were conducted preoperatively and 8 weeks postoperatively. Hypemasality and audible nasal emissions were completely eliminated in five patients. Four patients had no postoperative change in speech quality. In the remaining patients, improvement occurred without elimination of VPI. The use of costal bone was discontinued after the ninth patient. One infection occurred with complete resorption of the costal bone graft. Resorption has not been a problem with costal cartilage. No extrusion has occurred, and there have been no infections. Overall speech improvement in this group of children (80%) compared favorably with other reports on pharyngeal augmentation. Costal cartilage appears to be a superior choice for implant material.
Phonologic Processes in Children with Cleft Palate
Authors: Chapman Kathy L.
Published: October 2018

This study examined the phonologic process usage of 3-, 4- and 5-year-old children with cleft palate. Sixty children served as subjects: 30 children with cleft palate (with or without cleft lip) and 30 noncleft palate children. The children's whole word productions were analyzed for frequency and type of phonologic process usage. Results indicated that the 3- and 4-year old children with cleft palate exhibited more instances of process usage, compared to their noncleft peers. The 5-year-old cleft and noncleft groups were similar in total instances of process usage. Further, the children with cleft palate employed common phonologic processes; however, some processes were noted more frequently in the speech of the 3-year-old children with cleft palate.
Component Approach for Partitioning Nasal Airway Resistance: Pharyngeal Flap Case Studies
Authors: Smith Bonnie E. , Guyette Thomas W.
Published: October 2018

Individuals with craniofacial anomalies often have nasal cavity and/or velopharyngeal constriction. The purpose of this clinical report was to illustrate a technique for partitioning nasal airway resistance into its nasal cavity and velo pharyngeal components. This information would be helpful in determining intervention to reduce high nasal airway resistance as well as in providing information about the outcome of corrective procedures to establish velopharyngeal competence for speech. Data from two pharyngeal flap patients seen before and after surgery were utilized in this illustration. These case studies illustrate the usefulness of component resistance measures in quantifying nasal airway patency before and after corrective surgery for velopharyngeal function.
Evaluation of Maxillary Dental Arch Form in Unilateral Clefts of Lip, Alveolus, and Palate from One Month to Four Years
Authors: Mazaheri M. , Athanasiou A.E. , Long R.E. , Kolokitha O.G.
Published: October 2018

This study evaluated the early changes of maxillary alveolar arches of operated unilateral cleft lip and palate patients. Dental casts were available at four age increments. Triangular flap cheiloplasty was carried out at an early age. Two-stage palatoplasty by vomer flap and soft palate closure took place later. Prior to lip repair, the alveolar arches were classified according to the relationship between greater and lesser segments. Almost a quarter had overlap of the alveolar segments with no contact between the alveolar ridges at the cleft site; some had no overlap with contact of the alveolar segments in the cleft region; almost a quarter had both overlap of the alveolar segments and contact; and almost half had no overlap of the segments and the alveolar ridges were not in contact at the cleft site. After lip repair, the arch relationships were examined and the percentage of patients in each of the four groups indicated a moulding effect of lip repair on the alveolar segments. This moulding effect caused the alveolar segments in most patients to be in contact at the cleft site. Most of these also had segment overlap. All patients were re-examined shortly after palatal repair. The trend for segment overlap and contact continued after palate surgery. However, when all patients were seen at age 4, percentages of patients in each group indicated that previous overlap of segments improved to a more desirable nonoverlapped relationship in approximately half of the patients. The other half continued to demonstrate arch collapse, in excess of what would be considered ideal ridge relationship.
Maxillary Arch Dimensions after Palatal Surgery and Implantation of Poly-(L-Lactic) Acid Membranes in Beagle Dogs
Authors: In De Braekt Marcel M. H. , Van Alphen Frank A.M. , Kuijpers-Jagtman Anne M. , Maltha Jaap C.
Published: October 2018

The effect of implantation of poly-(L-lactic) acid membranes after palatal surgery on dentoalveolar development was investigated. Beagle dogs were randomly assigned to four experimental groups and a control group. In the experimental groups, a soft tissue defect was created in the medial region of the palate by excising a standardized elliptical mucoperlosteal flap at 12 weeks of age. This defect was closed according to the Von Langen beck technique, leaving two areas of denuded bone. Poly-(L-lactic) acid membranes were implanted on the denuded bony areas either directly or 3 weeks after surgery. Group L and LS served as sham groups. Dental casts were made at regular intervals until 25 weeks of age, and maxillary arch dimensions were studied. Dental arch dimensions in the deciduous dentition of the experimental groups were not markedly disturbed, but after transition of teeth, mainly transversal maxillary arch dimensions in the premolar region were reduced. It was concluded that implantation of poly-(L-lactic) acid membranes after palatal surgery in Beagle dogs did not prevent iatrogenic disturbances of dentoalveolar development under conditions used in this study.
Noram–An Instrument Used in the Assessment of Hypernasality: A Clinical Investigation
Authors: Karling Jonas , Larson Ola , Leanderson Rolf , Galyas Karoly , De Serpa-Leitâo Antonio
Published: October 2018

The speech of 102 patients with complete unilateral and bilateral cleft lip and palate and 40 noncleft subjects was analysed using the NORAM (Nasal Oral Ratio Meter) instrument. The results obtained were compared with the perceptual judgments made by experienced listeners. A significant correlation was found between the NORAM values and the listener judgments. The NORAM instrument can thus be used as a complement to listener judgments in assessing hypernasality. A discussion of the acoustic and phonetic aspects of the differences between the instrumental and perceptual results is presented.
Interactive Influence of a Pharyngeal Flap and an Adenoid on Maxillofacial Growth in Cleft Lip and Palate Patients
Authors: Ren Yan-Fang , Isberg Annika , Henningsson Gunilla
Published: October 2018

The aim was to evaluate whether a large adenoid, which aids velopharyngeal function, influences facial growth and if a pharyngeal flap reinforces the effect. Forty cleft palate patients were divided into two groups: adenoid and nonadenoid. Twenty of the patients had a pharyngeal flap operation. All the patients had three cephalograms taken at the same ages over a period of 5 years. At an average age of 4.7 years, i.e., one year before any pharyngoplasty, the mandibular inclination was larger in the adenoid group. This inferioposterior mandibular position was aggravated when a flap was added and with age. The present study suggests that the nasopharyngeal space, which is indicative of nasal airway patency, is influenced by a pharyngeal flap as well as an adenoid which, in turn, influences facial growth direction in the cleft palate population. Airway variables ought to be taken into consideration when the growth effect of cleft palate treatment is evaluated.
Growth of Costochondral Fragments Transplanted from Mature to Young Isogeneic Rats
Authors: Peltomäki Timo , Rönning Olli
Published: October 2018

Experiments were carried out to determine whether growth of costochondral grafts is associated with age-related humoral factors. Rib fragments containing either short (without germinative zone) or long (with proliferative and germinativo zones) cartilaginous ends were excised from adult rats, and the sections transplanted across the interparietal suture in 10-day-old isogeneic rats. The animals with short cartilage transplants were killed 15 or 25 days later; those with long cartilage transplants 25 days postoperatively. Measurements on dry skulls with short transplants showed neurocranial width to be greater in the experimental rats than in the unoperated controls at 25 days, whereas 10 days later the difference was no longer significant. By the latter time, however, the neurocranium was significantly wider in the long cartilage group than in the other groups. It is suggested that the declining growth potential of the costal cartilages from the adult rats was reactivated when transplanted to younger animals, i.e., the growth of costochondral transplants is related to humoral factors.
Size and Form of the Cranial Base in Isolated Cleft Lip and Palate
Authors: Harris Edward F.
Published: October 2018

Most cases with cleft lip and palate (CLP) have no other obvious malformation and are termed isolated CLP. The implication is that these individuals experienced a time-specific and anatomically-localized disturbance during palatogenesis but are otherwise normal. The cranial base was studied from cephalograms in subadults with isolated CLP (n = 43) to test for alterations in size and shape. Controlling for age and gender, analyses showed no size difference, but flexure of the cranial base was significantly greater in the CLP group. Taken in conjunction with increased risks of other conditions with prenatal onsets, it appears that “isolated CLP” is a misnomer and the cleft should be viewed as an overt manifestation of a more generalized growth disturbance.
Intercanine Widening and Sagittal Effect of Maxillary Transverse Expansion in Patients with Cleft Lip and Palate during the Deciduous and Mixed Dentitions
Authors: Tindlund Rolf S. , Rygh Per , Bøe Olav E.
Published: October 2018

Since 1977 cleft lip and palate (CLP) patients with maxillary deficiency have received an interceptive orthopedic treatment consisting of (a) transverse expansion, (b) protraction, and (c) fixed retention. Ideally the treatment should be completed early enough to permit spontaneous eruption of the maxillary permanent incisors into normal occlusion without orthodontic intervention. The early transverse expansion considerably increases space so that unerupted malpositioned incisors spread out spontaneously, creating optimal conditions for eruption and root formation. Dental diagnosis in the cleft areas is made easier. Posterior crossbites in 112 CLP patients were expanded with a modified quad-helix appliance cemented with four bands in the deciduous or mixed dentition. Intercanine widening was about 3 mm per month regardless of cleft type. Several authors have claimed that transverse expansion of the upper jaw will increase sagittal overjet. Other authors have not found such an effect. The sagittal effect on the maxilla was studied in 68 CLP patients who had received transverse expansion. Analysis of the lateral cephalograms revealed no significant sagittal dentofacial maxillary treatment effects involving forward movement of maxilla, but a downward clockwise rotation of the mandible was found.
Nasal Septal Deformity in Unilateral Cleft Lip and Palate
Authors: Sandham Andrew , Murray J.A.M.
Published: October 2018

The present study is part of a larger rhinomanometric investigation to determine the type and extent of nasal septal deformity in subjects with repaired unilateral complete clefts of the lip and palate (UCLP). The cleft sample consisted of 21 subjects (mean age 16.4 years). A control group consisted of 30 subjects (mean age 13.1 years). The rhinomanometric measurements in this study have been previously reported (Sandham and Solow, 1987) and showed that bilateral nasal resistance did not differ significantly between the cleft sample and the controls. Unilateral measurements of nasal resistance showed higher valves for the cleft side than the noncleft side (p < .001). Nasal septal deformity was scored for anomaly type and severity, by direct visual observation of each nasal compartment. The results showed that nasal septal deviation occurs more frequently in subjects with cleft lip and palate than controls (p < .001). The cartilaginous nasal tip, like the maxillary nasal spine, deviated to the noncleft side because of its dependency for directional control on the maxillary crest, and it projected into the nasal aperture of the noncleft side. The most frequent deviation of the bony septum was to the cleft side, and this not only involved the valve area but also a broader area opposite the turbinates.
Primary Correction of the Unilateral Cleft Lip Nose
Authors: Sugihara Tsuneki , Yoshida Tetsunori , Igawa Hiroharu H. , Homma Ken-Ich
Published: October 2018

The details of surgical techniques for primary correction of the unilateral cleft lip nose and their results for 45 cases are reported. The technique employed an infracartilaginous incision on the affected side, thus allowing direct suturing of the alar cartilage onto the lateral cartilage. For the postoperative evaluation, the nasal form in both frontal and bottom views was scored for five items. In overall evaluation, the grades of “Good,” “Fair,” and “Poor” were derived from the total scores of five items. In the postoperative results (range of follow-up: 24 months to 84 months), 24 cases were rated “Good” (53.3%), 13 cases “Fair” (28.9%), and 8 cases “Poor” (17.8%). Thirty cases appear not to need secondary correction (66.6%). The technique is useful because the alar cartilages and lateral cartilages can be accurately sutured, and relatively stable results can be obtained.
Long-Term Results after Maxillary Advancement in Patients with Clefts
Authors: Hochban Walter , Ganß Carolina , Austermann Karl Heinz
Published: October 2018

In order to evaluate relapse tendencies after maxillary advancement, 31 patients were examined preoperatively, postoperatively, and 1 year postoperatively; 14 of whom had clefts of the lip, alveolus, and palate. Patients with maxillary deficiency were selected in a method that mere sagittal displacement was planned. Any patients with major vertical or transverse changes or additional mandibular surgery were excluded. Treatment consisted of maxillary advancement by Le Fort I osteotomy and miniplate fixation. Besides clinical examination, skeletal and dental changes were assessed cephalometrically. Results revealed a certain relapse tendency of the displacement in the noncleft group that compared favorably to the cleft group. This relapse is dependent on the amount of advancement. Despite minor differences, the two groups did not differ significantly based on maxillary advancement, so besides advancement surgery there must be another factor, cleft, to explain the different relapse tendencies between patients with and without clefts.
Masticatory Function in a Patient with Mandibular Midline Cleft
Authors: Yamaoka Minoru , Furusawa Klyofumi , Iguchi Kousei , Kumai Toshifumi , Machida Junji
Published: October 2018

Bone grafting of a midline cleft is required to allow reasonable masticatory function. However, changes in the rhythm of mastication have not been investigated before and after such bone grafting procedures. We performed bone grafting in a patient with multiple cranlofacial anomalies including a midline mandibular cleft. The patient showed a marked improvement in the rhythm of mastication after repair of the midline mandibular defect. Bone grafting proved to be an effective method for securing stable occlusion with better mandibular movement.
Age and Gender Effects on Nasal Respiratory Function in Normal Subjects
Authors: Vig Peter S. , Zajac David J.
Published: October 2018

One hundred and ninety-seven normal individuals between the ages of 5 and 73 years were evaluated to determine nasal resistance, nasal cross-sectional area, and respiratory mode during quiet breathing. Subjects were categorized into three age groups. Nasal resistance and respiratory mode were directly determined using posterior rhinomanometry and the SNORT technique, respectively. Nasal cross-sectional area was estimated using the hydrokinetic equation. Results indicated significant effects of age on all variables; significant gender differences were found for respiratory mode. Weak correlations were found between respiratory mode and nasal resistance. The results are presented as normative data on nasorespiratory characteristics to facilitate diagnostic and treatment decisions relative to individuals with normal morphology as well as to patients with craniofacial anomalies. A fundamental issue of both clinical and theoretical importance arising from the study pertains to the definitions of normality and impairment.
Nasometric Sensitivity and Specificity: A Cross-Dialect and Cross-Culture Study
Authors: Dalston Rodger M. , Neiman Gary S. , Gonzalez-Landa Gonzalo
Published: October 2018

A series of 514 patients seen at three clinics in the United States and Spain were evaluated using clinical Judgments of hypernasality, and nasometric assessment of oral-nasal resonance balance. Data from the nasometer were obtained while patients read a passage devoid of nasal consonants. Across all subjects, the Pearson correlation coefficient between the clinical and instrumental measures was 0.78. Prediction analyses revealed that maximum efficiency was obtained using a somewhat different threshold nasalance value for each of the three patient samples. When all 514 subjects were investigated as a single group, a threshold nasalance score of 28 was found to optimize identification of patients with and without clinically significant hypernasality. In that analysis, a sensitivity of 0.87, a specificity of 0.86 and an overall efficiency of 0.87 was obtained. The clinical relevance of these findings is discussed.
Dental Cast Study of Adult Patients with Untreated Unilateral Cleft Lip or Cleft Lip and Palate in Indonesia Compared with Surgically Treated Patients in the Netherlands
Authors: Spauwen Paul H.M. , Hardjowasito Widanto , Boersma Jan , Latief Benny S.
Published: October 2018

To determine differences in maxillary and dentoalveolar relationships between untreated and treated patients having unilateral clefts of the lip and alveolus (UCLA) or lip and palate (UCLP), dental cast assessments were done on 70 untreated adult indonesian patients (UCLA-I, UCLP-I) and 67 Dutch patients, surgically treated in infancy (UCLA-D, UCLP-D). The indonesian group consisted of 44 UCLA-I and 26 UCLP-I patients, and the Dutch group of 24 UCLA-D and 43 UCLP-D patients. In the UCLA-I patients, deformities occurred in that part of the dentoalveolar complex that surrounds the cleft. Lip repair in the UCLA-D group more frequently caused deformities in the incisor and buccal areas on the cleft side. In the UCLP-I patients, deformities were present in the incisor and cuspid areas on the cleft side. The buccal segments showed collapse both on the cleft and noncIeft sides. Lip and palate repair in the UCLP-D group caused significantly more deformities in the incisor, cuspid, and buccal areas up to the level of the first molars, both on the cleft and noncleft sides. Surgical treatment seems to cause maxillary and dentoalveolar deformities up to the first molars more frequently, but these are not as pronounced as one would expect: following the practiced surgical regimen, the deformities were usually mild. Negative effects of surgical intervention seem to be antagonized by the restored integrity of the lip and palate leading to orientation of maxillary parts and correction of tongue position, which in turn has a molding effect on the maxilla and mandible.