bluuebunny/crossref_metadata_2025_split huggingface dataset:
Standardized Facial Photography of Cleft Patients: Just Fit the Grid?
Authors: Vegter Florine , Hage J. Joris 
Published: October 2018

Objective The objective results of craniofacial surgery are usually evaluated by comparing pre- and postoperative photographs. To allow for optimal comparison, these photographs should be of constant and reproducible lay-out and quality. For this, various techniques to standardize photography have been suggested. Design, Setting, and Patients A review of the literature on standardization of medical photography is presented. The advantages and disadvantages of standardizing techniques are evaluated. The difficulty to achieve standardization in cleft patients is illustrated using clinical photographs. Our personal protocol is presented as it tries to optimize comparability of photographs. Results Use of a grid or cephalostat will not lead to comparable photographs in cleft patients. Personal protocols also have shortcomings, but they offer reproducible and comparable results. A personal effort of the photographer is essential to adjust any allegedly standardizing protocol to the individual patient. Conclusion Photographs are only as good as the photographer. True standardization of facial photographs is a utopia in cleft patients.
Abnormal Brain Morphology in Patients with Isolated Cleft Lip, Cleft Palate, or Both: A Preliminary Analysis
Authors: Nopoulos Peg , Berg Stephanie , Canady John , Richman Lynn , Van Demark Duane , Andreasen Nancy C. 
Published: October 2018

Objective The aim of this study was to determine whether adult men with cleft lip and palate (CLP) have aberrant cerebral morphology. Design Brain morphology of 14 adult men with isolated CLP were analyzed and compared with 14 healthy controls matched for sex, age, and parental socioeconomic status. Setting The research took place at a large, tertiary care hospital, with participation on an outpatient basis. Participants The 14 males with CLP were recruited from a large cleft lip and palate registry, while their 14 matched controls were selected from a registry of healthy volunteers collected via the Mental Health Clinical Research Center. Results The males with CLP have significantly smaller cerebellar size (p = .04), significantly larger frontal lobes (p = .02), and significantly smaller temporal and occipital lobes (p = .02; p = .009, respectively). No significant difference in gray/white matter ratios or laterality were found. Conclusions Adult males with CLP have a significantly different pattern of brain morphology, compared with healthy controls, which is most likely due to aberrant cerebral development. This study highlights the complex interaction and interdependence of craniofacial and cerebral development.
Dental Health Indices and Caries Associated Microflora in Children with Unilateral Cleft Lip and Palate
Authors: Lucas Victoria S. , Gupta Ragini , Ololade Olubenga , Gelbier Marilyn , Roberts Graham J. 
Published: October 2018

Objective To investigate the dental health and caries related microflora of children with unilateral cleft lip and palate. Study Group Sixty children with unilateral cleft lip and palate and matched controls. Outcome Measures The decayed, missing, and filled teeth and surfaces in both the deciduous and permanent dentitions. The presence of developmental defects and plaque and gingivitis scores were also recorded. Plaque was collected from 25 of the children and their matched controls from three different sites, which were (1) the first approximal site distal to the cleft, (2) a contralateral anterior site, and (3) a remote site. It was cultured for Streptococcus mutansand lactobacilli. Plaque was collected from two sites in the matched controls. Results There was no significant difference in the caries, plaque, and gingivitis scores between the children with cleft palate and the controls. A greater number of enamel opacities were recorded in the control group, and there was a higher prevalence of enamel discoloration in the children with cleft lip and palate. There was no significant difference in the proportion of S. mutanso r lactobacilli at the cleft site, compared with the unaffected site in the study group, although there was an anterior-posterior gradient in the proportion of S. mutans. There was no significant association between the stagnation area at the cleft site and the bacteria associated with dental caries.
Pressure-Flow Characteristics of /m/ and /p/ Production in Speakers without Cleft Palate: Developmental Findings
Authors: Zajac David J. 
Published: October 2018

Objective The purpose of this study was to describe the pressure-flow characteristics of a large sample of speakers without cleft palate ranging in age from early childhood to young adulthood. Method Speakers consisted of 223 children, teens, and adults without cleft palate categorized into five age groups: 6 through 8 years, 9 through 10, 11 through 12, 13 through 16, and 18 through 37 years. Speakers produced the syllables /mi/, /pi/, and /pA/, the word “hamper,” and the sentence “Peep into the hamper.” The pressure-flow method was used to determine oral air pressure, nasal airflow, and estimates of velopharyngeal (VP) orifice size associated with /m/ and /p/ production. Descriptive statistics were computed for each age group and speech sample. Analysis of variance (ANOVA) procedures were used to determine the effects of age, sex, and production level (word versus sentence) on the aerodynamic variables. Results ANOVA procedures indicated significant main effects (p < .01) of age on most of the aerodynamic variables during production of /m/ and /p/. No significant main effects or interactions involving sex were found for any variable. Regardless of age, approximately 95% to 99% of the speakers exhibited airtight VP closure during /p/ at syllable level, depending upon the selected nasal airflow criterion. ANOVA procedures also indicated significant main effects of production level (word versus sentence) on each of the aerodynamic variables during the /mp/ sequence. These effects appeared to be related to speaking rate. Conclusions The study suggests that speakers without cleft palate exhibit essentially complete VP closure during production of oral pressure consonants in isolated syllables, and developmental aspects of speech aerodynamics be considered during pressure-flow testing.
Effect of Placement of a Speech Appliance on Levator Veli Palatini Muscle Activity during Speech
Authors: Tachimura Takashi , Nohara Kanji , Wada Takeshi 
Published: October 2018

Objective The purposes of this electromyographic study were to examine whether levator veli palatini muscle activity during speech can be changed with placement of a speech appliance and to clarify whether or not the change is related to the type of speech appliance used. Design Electromyography (EMG) was performed during production of speech samples in two conditions: with placement and with removal of a speech appliance. Speech samples were the vowel /ω/ and consonant-vowel (ω) syllables, including nasal, plosive, fricative, and affricate consonants. Setting Division for Oral-Facial Disorders, Faculty of Dentistry, Osaka University Dental Hospital, Japan. Participants Subjects were six patients with repaired cleft palate and velopharyngeal inadequacy (VPI); three routinely wore a palatal lift prosthesis to correct borderline VPI, and the other three wore a speech appliance hybrid that consisted of a pharyngeal bulb and a palatal lift. Interventions Each patient was asked to produce each speech sample in both conditions of placement and removal of their respective appliances. Main outcome Measures Smoothed EMG signals of the levator veli palatini muscle were recorded with and without the appliance during five repetitions of each speech sample. The average value of peak smoothed levator EMG was compared between placement and removal conditions for all subjects and between the two subject groups in each experimental condition. Results With a speech appliance in place, the range of levator activity was distributed in a portion lower than that in the removed condition for subjects in both appliance groups. In addition, the intervals were smaller in the placement condition than in the removed condition. Conclusion A speech appliance may prevent hypernasality, nasal emission of air, or both associated with VPI because of mechanical obturation of the velopharynx and an alteration in velopharyngeal function.
Velopharyngeal Closure Pattern Exerted by Contraction of the Pharyngeal Constrictor Muscle in Dogs
Authors: Tanaka Susumu , Kogo Mikihiko , Hamaguchi Munehiro , Matsuya Tokuzo 
Published: October 2018

Objective This study was performed to investigate aspects of velopharyngeal closure demonstrated by movements of the parapharyngeal wall under various physiological conditions and especially the stimulation of several intrapneumonal receptors. Materials and Methods Fifteen mongrel dogs were anesthetized and a nasopharyngeal fiberscope was inserted from the oronasal fistula at the center of the hard palate, with the tip fixed around the choana. Mechanical and chemical stimulation was applied, and ongoing velopharyngeal movements were observed. In each case examined, the muscle nerve located under the bilateral levator veli palatini (LVP) was severed. Results Two different closure patterns were recognized between rebreathing and deglutition. Chemical stimulation of the pulmonary irritant receptor and type-J receptor induced a sphincteric tight closure of the velopharynx but only a weak inward movement of the lateral pharyngeal wall at lung inflation. Conclusion The movements of the parapharyngeal wall, mainly represented by the pharyngeal constrictor muscle's contraction, are facilitated as a sphincteric velopharyngeal closure under reflexive movements such as deglutition or gagging.
The Effect of Hamulus Fracture on the outcome of Palatoplasty: A Preliminary Report of a Prospective, Alternating Study
Authors: Kane Alex A. , Lo Lun-Jou , Yen Ben-Dong , Chen Yu-Ray , Noordhoff M. Samuel 
Published: October 2018

Objective To determine whether, in performing palatoplasty, fracture of the pterygoid hamulus is beneficial, detrimental, or neutral with respect to intraoperative and perioperative complications, hearing outcome, and speech outcome. Design Prospective, alternating. Setting Institutional, tertiary cleft palate center, Chang Gung Memorial Hospital, Taipei, Taiwan. Participants A total of 173 patients enrolled in the study, of whom 161 had charts available for analysis. Interventions During the performance of palatoplasty, 85 patients received hamulus fracture and 76 patients did not. All palatoplasties were performed by the same surgeon. Main outcome Measures (1) Surgical outcomes, including patient demographic data, palatoplasty type and duration, blood loss, incidences of oronasal fistulae, temporary mucosal dehiscence, and postoperative bleeding; (2) otolaryngological outcomes, including hearing results as judged by auditory brainstem response testing, myringotomy tube data describing rates of tube extrusion, and culture results from sampled effusions; and (3) preliminary speech outcomes as described by judgments of overall velopharyngeal function from perceptual speech samples. Results No statistically significant differences in any of the measured surgical, otolaryngological, or preliminary speech outcomes were found between the groups who did and did not receive hamulus fracture. Conclusions On the basis of these results, we are unable to advocate the performance of hamulus fracture as an operative maneuver during the performance of primary palatoplasty. The historical rationale and theoretical advantage of this maneuver have not been demonstrated here nor have any detrimental effects of the maneuver been measured.
Video-Imaging Assessment of Nasal Morphology in Individuals with Complete Unilateral Cleft Lip and Palate
Authors: Russell K.A. , Waldman S.D. , Lee J.M. 
Published: October 2018

Objective The purpose of this study was to develop a video-imaging mathematical method to assess nostril morphology. Design This retrospective study involved two age-matched groups: 28 subjects with complete unilateral cleft lip and palate (CUCLP) and 19 noncleft controls. Nose casts were reproducibly oriented in a jig such that the casts could be rotated about the coronal axis. Video images of the nostrils were captured and then analyzed for area, perimeter, centroid, principal axis, moments about the major and minor axes (I11, I22), anisometry, bulkiness, lateral offset, internostril angle, and rotational angle. Results All parameters identified nostril asymmetry in both groups. The results of the analyses using anisometry, I11, and I22 showed that, in both groups, one nostril was rounder and one was more elliptical. This asymmetry, however, differed between the two groups, and the difference was primarily based on the degree of ellipticity of the nostrils. Maximum dimension, perimeter, lateral offset, I11, and I22 were more asymmetric in the cleft group. In the control group, the right nostril was more elliptical and had a greater perimeter, and the leftside nostril had a greater bulkiness (enfolding). Conclusions The method developed was validated for assessment of nasal morphology in cleft and noncleft samples. Nostril morphology was asymmetric in both groups but more asymmetric in the cleft group than the control group. The dominant influence of the cleft resulted in more elliptical noncleft nostrils and greater nostril shape asymmetry in the cleft group. The validated video-imaging method can now be used to assess the efficacy of treatment on nasal morphology.
Cranial Base and Facial Skeleton Asymmetries in Individuals with Unilateral Cleft Lip and Palate
Authors: Kyrkanides Stephanos , Klambani Mavra , Subtelny J. Daniel 
Published: October 2018

Objective Individuals with unilateral cleft lip and palate (UCLP) manifest a plethora of phenotypic characteristics, including asymmetric development of the middle and lower facial skeleton. The purpose of this study was to retrospectively investigate the development of cranial base asymmetries in patients with UCLP noted on posteroanterior cephalometric radiographs. Methods Thirty individuals with UCLP and 64 controls participated in this study. Medial and lateral cranial base asymmetries were analyzed on frontal cephalometric radiographs relative to three developmental stages. Furthermore, the development of horizontal and vertical lower facial asymmetry in these patients with UCLP was assessed in relation to cranial base, nasomaxillary, and dentoalveolar structures. Results Individuals with UCLP demonstrated cranial base asymmetries that did not significantly differ from individuals without cleft. In addition, lower facial asymmetry in patients with UCLP correlated with horizontal lower facial and dentoalveolar asymmetries but not with cranial base or nasomaxillary structures. Conclusions No significant vertical cranial base asymmetries were detected in patients with UCLP. Horizontal lower facial asymmetry appeared to develop in close relation to the vertical asymmetries of mandibular fossae and dentoalveolus.
The Load-Displacement Characteristics of Neonatal Rat Cranial Sutures
Authors: Mclaughlin E. , Zhang Y. , Pashley D. , Borke J. , Yu J. 
Published: October 2018

Objective Recently several centers have attempted to distract the craniofacial skeleton in infants with craniosynostosis. To effectively achieve this goal, we must first understand the normal sutural response to tensile forces. The objective of this study was to determine the load-displacement characteristics of neonatal rat sutures. Methods Thirty cranial sutures were harvested from 1-week-old Wistar rats (10 each coronal, posterior frontal, and sagittal). The width of the harvested bone-suture-bone construct was standardized to 4 mm. The specimens, kept moist, were mounted fresh and distracted at 10 μm/sec until rupture using a Vitrodyne V1000 universal tester. Standard load-displacement curves were constructed. The stiffness, defined as tensile force/change in suture length, and the ultimate stress, defined as tensile force at suture rupture/cross sectional area, were calculated. Results These sutures demonstrated classical viscoelastic behavior. During the elastic phase, they elongated approximately 1 μm for every 1 g of force (104 N/m). The ultimate tensile stress was approximately 4 MN/m2. The estimated mean elastic modulus was 10 megapascals. The posterior frontal sutures were significantly less stiff than the other two sutures (Kruskal-Wallis nonparametric analysis of variance, p = .0023). The difference in the ultimate stress was also significant (p = .0201). Conclusions This study provides data regarding the basic mechanical behavior of neonatal cranial sutures in a mammalian system.
Factors Related to Relapse after Le Fort I Maxillary Advancement Osteotomy in Patients with Cleft Lip and Palate
Authors: Hirano Akiyoshi , Suzuki Hiroyuki 
Published: October 2018

Objective To identify factors associated with relapse after maxillary advancement in cleft lip and palate patient. Subjects Seventy-one cleft lip and palate patients underwent Le Fort I maxillary advancement osteotomy between 1988 and 1998, and 58 patients (42 unilateral cleft and 16 bilateral cleft) with complete data were investigated for relapse by clinical and cephalometric analysis. The clinical follow-up period ranged from 1.5 to 8.5 years (mean 2.5 years). Results Horizontal advancement averaged 6.9 mm. There was a significant correlation between surgical movement and postoperative relapse in both the horizontal and vertical planes. In vertical repositioning, 15 patients had maxillary intrusion and 31 had inferior repositioning. There was a significant difference between the intrusion group and the inferior repositioning group. There was a significant correlation between surgical and postoperative rotation regardless of the direction. Other factors were evaluated by the horizontal relapse rate. Type of cleft and the rate of relapse were statistically associated. A relapse was more likely to occur in patients with bilateral cleft. There were no significant associations with the rate of relapse in type of operations or previous alveolar bone grafting. There was no significant correlation between the rate of relapse and the number of missing anterior teeth, postoperative overbite and overjet, and age at operation. Four of 71 patients experienced major relapse, and 3 of them underwent jaw surgery again. Conclusions Based on clinical and cephalometric analysis, two-jaw surgery should be performed in cases of severe maxillary hypoplasia, and overcorrection may be useful in inferior repositioning or surgical rotation. Special attention should be paid to the patient with bilateral cleft, multiple missing teeth, or shallow postoperative overbite.
Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 2: Dentofacial Outcomes and Patient Satisfaction
Authors: Williams Alison C. , Bearn David , Mildinhall Sue , Murphy Terrie , Sell Debbie , Shaw William C. , Murray John J. , Sandy Jonathan R. 
Published: October 2018

Objective To describe facial development and appearance, quality of bone grafts, oral health, and patient/parent satisfaction, with clinical outcome, for children in two age cohorts born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom. Design Cross-sectional outcome study. Setting Fifty National Health Service cleft centers. Participants Children born with complete UCLP between April 1, 1982, and March 31, 1984, (12-year-olds) and April 1, 1989, and March 31, 1991 (5-year-olds). Data were collected for 239 5-year-olds and 218 12-year-olds. The parents of these children were also interviewed to determine levels of satisfaction with care received. Main Outcome Measures Skeletal pattern, dental arch relationship, success of alveolar bone grafting, facial appearance, oral health status, and patient/parent satisfaction. Results Nearly 40% of 5- and 12-year-olds had poor dental arch relations, and 70% of 12-year-olds had midface retrusion. Fifteen percent of 12-year-olds had not received an alveolar bone graft, and only 58% of bone grafts that had been undertaken were successful. Twenty percent of 12-year-olds and 40% of 5-year-olds had untreated dental caries. Less than one-third of subjects had a good facial appearance as judged by a panel of experts. Levels of patient and parent satisfaction were generally high. Conclusion A rigorous evaluation of cleft care in the United Kingdom reveals disappointing outcomes.
Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 3: Speech Outcomes
Authors: Sell Debbie , Grunwell Pamela , Mildinhall Sue , Murphy Terrie , Cornish Tremaine A. O. , Bearn David , Shaw William C. , Murray John J. , Williams Alison C. , Sandy Jonathan R. 
Published: October 2018

Objective To summarize speech outcomes in children born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom. Design Prospective descriptive study on a cross-sectional sample of children. Patients/Participants Data were collected for 238 5-year-olds (born between April 1, 1989, and March 31, 1991) and 218 12-year-olds (born between April 1, 1982, and March 31, 1984) with complete UCLP. Main Outcomes Ratings of intelligibility, nasality, “speech cleft type characteristics” and speech therapy intervention. Conclusions Nineteen percent of 5-year-olds and 4% of 12-year-olds were judged to be impossible to understand or just intelligible to strangers. Thirty-four percent of 5-year-olds and 17% of 12-year-olds had at least one serious error of consonant production. Eighteen percent of 5-year-olds and 12-year-olds had consistent hypernasality of mild, moderate, or severe degree. Approximately two-thirds of both age groups had undergone speech therapy.
Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 4: Outcome Comparisons, Training, and Conclusions
Authors: Bearn David , Mildinhall Sue , Murphy Terrie , Murray John J. , Sell Debbie , Shaw William C. , Williams Alison C. , Sandy Jonathan R. 
Published: October 2018

Objective A critical appraisal of cleft care in the United Kingdom. Design Retrospective comparative study. Setting All National Health Service cleft centers in the United Kingdom. Patients/Participants Children born with unilateral complete clefts of the lip and palate between April 1, 1982, and March 31, 1984 (12-year-olds), and April 1, 1989, and March 31, 1991 (5-year-olds). Newly appointed and senior cleft clinicians. Main Outcome Measures Skeletal pattern, dental arch relationship, success of alveolar bone grafting, dental health, facial appearance, oral health status, patient/parent satisfaction. Conclusions This paper highlights the poor outcomes for the fragmented cleft care in the United Kingdom, compared with European centers. There is an urgent need for a review of structure, organization, and training.