bluuebunny/crossref_metadata_2025_split huggingface dataset:
Salvaging the Failed Pharyngoplasty: Intervention Outcome
Authors: Witt Peter D. , Myckatyn Terry , Marsh Jeffrey L. 
Published: October 2018

Objective This paper reports on the rates of failure of operations (pharyngeal flap and sphincter pharyngoplasty) performed for management of velopharyngeal dysfunction, and outcome following their revision. Design Anatomic abnormalities associated with unacceptable vocal resonance and nasal air escape following pharyngeal flap and sphincter pharyngoplasty were critiqued. The results of primary pharyngeal flap were evaluated for 65 patients, and the results of primary sphincter pharyngoplasty were evaluated for 123 patients. All patients were treated for velopharyngeal dysfunction. The definition of surgical failure was based on persistent hypernasality and/or nasal turbulence on perceptual speech evaluation, and incomplete velopharyngeal closure on instrumental evaluation, at least 3 months postoperatively. Setting All patients were evaluated and managed at the Cleft Palate and Craniofacial Deformities Institute, St. Louis Children's Hospital, a tertiary cleft care center. Patients, Participants All patients had failed surgical management initially, either with pharyngeal flap or sphincter pharyngoplasty, and all underwent repeat preoperative and postoperative perceptual speech evaluations; real-time lateral phonation fluoroscopy including still reference views; and flexible nasendoscopy of the velopharynx using standard speech protocols. Interventions Revisional surgery for both procedures consisted of either tightening of the sphincter pharyngoplasty or pharyngeal flap port(s) or reinsertion of the sphincter pharyngoplasty or pharyngeal flaps following dehiscence. Main outcome Measures The main outcome measure was normalcy of velopharyngeal function, i.e., elimination of perceptual hypernasality and instrumental evidence of complete velopharyngeal closure. The rates of pharyngeal flap failure and sphincter pharyngoplasty failure were determined for those patients requiring surgical revision. Results Thirteen of 65 patients (20%) who underwent primary pharyngeal flap required revisional surgery. Of these 13 patients, eight were managed successfully with a single revisional operation. The remaining five patients (38%) continued to exhibit velopharyngeal dysfunction and underwent a second revision consisting of tightening or augmentation of the lateral ports. Speech results were satisfactory in all patients so treated; however, hyponasality with no other airway morbidity occurred in all five. Twenty of 123 patients (16%) who underwent primary sphincter pharyngoplasty required surgical revision. Of these 20 patients, 17 were managed successfully. For both procedures, the principal cause of failure was partial or complete flap dehiscence. Conclusions Rates of primary pharyngeal flap failure are roughly equivalent to rates of primary sphincter pharyngoplasty failure. Pharyngeal flap and sphincter pharyngoplasty failures can be salvaged with revisional surgery, which can provide a velopharyngeal mechanism capable of complete closure. Revisional surgery is usually associated with denasal speech.
Branchio-Oculo-Facial Syndrome with Cleft Lip and Bilateral Dermal Thymus
Authors: Bennaceur Sélim , Buisson Thierry , Bertolus Chloé , Couly Gérard 
Published: October 2018

Objective The objective of this study was to demonstrate that the branchio-oculo-facial (BOF) syndrome is a cervicocephalic neural crest maldevelopment. Results Using an embryologic study, we linked the clinical features and the level of the neural crest deficiency. We report here two cases of BOF syndrome with a particular branchial cleft presenting as bilateral supernumerary thymus glands on the surface of the skin; one of the cases was associated with tetralogy of Fallot. One patient underwent lip reconstruction at 4 months, combined with excision of bilateral auricular pits and superior labial fistula. The other patient had a surgical correction of the tetralogy of Fallot, and at 2 months, the two stages of the lip reconstruction were performed, combined with bilateral auricular pit excision. Both patients have shown normal developmental patterns to date. Conclusion The BOF syndrome must be considered as a neurocristopathy at different levels, with a tiny mesencephalo-prosencephalic lesion and a severe rhombencephalic lesion that includes seven consecutive hindbrain segments, from rhombomere 2 to rhombomere 8.
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.
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.