bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measurement of Facial Soft Tissue Mobility in Man
Authors: Trotman Carroll-Ann , Stohler Christian S. , Johnston Lysle E. 
Published: October 2018

Objective The assessment of facial mobility is a key element in the treatment of patients with facial motor deficits. In this study, we explored the utility of a three-dimensional tracking system in the measurement of facial movements. Methods and Results First, the three-dimensional movement of potentially stable facial soft-tissue, headcap, and dental landmarks was measured with respect to a fixed space frame. Based on the assumption that the dental landmarks are stable, their motion during a series of standardized facial animations was subtracted from that of the facial and headcap landmarks to estimate their movement within the face. This residual movement was used to determine which points are relatively stable (≤1.5 mm of movement) and which are not (≥1.5 mm of movement). Headcap landmarks were found to be suitable as references during smile, cheek puff, and lip purse animations, and during talking. In contrast, skinbased landmarks were unsuitable as references because of their considerable and highly variable movement during facial animation. Second, the facial movements of patients with obvious facial deformities were compared with those of matched controls to characterize the face validity of three-dimensional tracking. In all instances, pictures that appear to be characteristic of the various functional deficits emerged. Conclusions Our results argue that tracking instrumentation is a potentially useful tool in the measurement of facial mobility.
Incidence of Cleft Lip and Palate and Risks of Additional Malformations
Authors: Hagberg Catharina , Larson Ola , Milerad Josef 
Published: October 2018

Objective and Methods Children with cleft lip and/or palate (n = 251) born between 1991 and 1995 in the county of Stockholm, Sweden, were studied with reference to incidence and rate ratios (RRs) of different types of clefts, gender, birth weight, mother's age, and length of pregnancy. Children who had clefts and additional malformations were compared with children who had clefts but no additional malformations. Results The incidence of clefts was 2.0/1000 live births, and it was higher among males than among females. The RR, an index of relative risk, was 1.58. The main groups, children with isolated cleft lip, children with cleft lip and palate, and children with isolated cleft palate, showed similar incidence values (0.6-0.7/1000 live births). Children with bilateral clefts had an incidence of 0.3/1000 live births. Additional malformations were found in approximately every sixth newborn with a cleft when children with Robin sequence were excluded. There was a tendency for newborns with bilateral clefts to have additional malformations (RR = 1.36; confidence interval = 0.74-2.49). Children with clefts and additional malformations had lower birth weight and were born earlier than children with clefts only. Conclusion Preterm cleft children with low birth weight should be screened for the presence of other birth defects.
A Cephalometric Evaluation of Craniofacial Morphology in Familial Dysautonomia
Authors: Mass Eliyahu , Brin Ilana , Belostoky Leon , Maayan Channa , Gadoth Natan 
Published: October 2018

Objective The purpose of this study was to delineate the craniofacial and dentoalveolar morphology of patients with familial dysautonomia (FD) in order to contribute to the understanding of the association between progressive sensory and autonomic neuropathy and the characteristic appearance of the dys-autonomic face. Patients The study group comprised 32 patients with FD (15 females and 17 males; mean age 10.8 years, SD 3.5 years, range 5.8-19.8 years). Design Lateral cephalograms from each patient were traced twice. The means of the two measurements were compared with homologous cephalo-metric normal values of ethnic-specific and classical norms from the literature. Results In some parameters, the craniofacial morphology of the FD group was significantly different from the classical norms. There was a pronounced retrognathism in the mandible and a steep mandibular plane angle. The skeletal features of FD patients more closely resembled those of their ethnic group, although they were more retrognathic, and the mandibular growth axis was more horizontal. The incisors of these patients were more retropositioned and retroclined than were those of their healthy counterparts. Conclusions The results suggest an insufficiency of the expected dentoal-veolar compensatory mechanism that usually helps to bridge skeletal discrepancies. It is postulated that the neuropathy is probably the important factor in the lack of this compensatory mechanism.
Median Cleft of the Lower Lip Associated with Lip Pits and Cleft of the Lip and Palate
Authors: Lekkas C. , Latief B.S. , Corputty J.E.M. 
Published: October 2018

Objective In this case report, we present an unusual combination of three congenital malformations: median cleft of the lower lip, lip pits, and unilateral cleft of the lip and palate without familial occurrence. Conclusions From an etiological point of view, this combination of malformations could have happened during the late embryogenic period. Why this combination is uncommon is not known.
Nasalance and Nasality in Low Pressure and High Pressure Speech
Authors: Watterson Thomas , Lewis Kerry E. , Deutsch Candace 
Published: October 2018

Objective This study compared nasalance measures and nasality ratings in low pressure (LP) and high pressure (HP) speech. Subjects The subjects for this study were 25 children ranging in age from 5 to 13 years. Twenty of the subjects were patients followed by a craniofacial team, and five had no history of communication disorder. Results The mean nasalance for the LP speech was 29.98% (SD, 16.16), and the mean nasalance for the HP speech was 30.28% (SD, 15.35). The mean nasality rating for the LP speech was 2.31, and the mean nasality rating for the HP speech was 2.59. Separate paired t tests revealed no significant difference between the LP or the HP speech for either the nasalance scores or the nasality ratings. The correlation coefficient between nasalance and nasality for the LP speech was r = 0.78, and for the HP speech r = 0.77. Using a cutoff of 26% for nasalance and 2.0 for nasality, Nasometer test sensitivity was 0.84 and test specificity was 0.88. Conclusions In general, clinicians may obtain valid measures of nasalance and/or ratings of nasality using either an LP stimulus or an HP stimulus. Sensitivity and specificity scores indicated that the Nasometer was reasonably accurate in distinguishing between normal and hypernasal speech samples.
Oral and Dental Health Status of Children with Cleft Lip and/or Palate
Authors: Paul Tahir , Brandt Ron S. 
Published: October 2018

Objective To ascertain the oral and dental health status of children with cleft lip and/or palate. Design Oral and dental examinations were carried out on 114 selected children with cleft lip and/or palate, using standard criteria and indices. Setting These children were examined at two cleft palate clinics in the United Kingdom. Patients All children examined were between the ages of 3 and 18 years. Results Sixty one (53.5%) of the subjects exhibited no evidence of previous caries experience, but as many as 20% exhibited active decay. The mean caries experience in the deciduous dentition (dmfs) was 2.3, and that in the permanent dentition (DMFS) was 0.9. Caries experience of the Caucasian children of the sample was lower (mean dmfs 1.9) than that of the Asian children (mean dmfs 5.5). The mean simplified debris index of the sample was 0.9, and the mean gingival bleeding index was 0.4. Children with cleft lip and palate had generally poorer oral and gingival health than those with isolated clefts of the lip or palate. Conclusion Twenty percent of the sample had active decay. These children had poor oral health in the surgically repaired anterior segment.
Spontaneous Cleft Palate in a Newborn Gorilla (Gorilla gorilla gorilla)
Authors: Siebert Joseph R. , Williams Bryan , Collins Darin , Winkler Linda A. , Swindler Daris R. 
Published: October 2018

Objective We report the first case of cleft palate in a newborn male gorilla (Gorilla gorilla gorilla). Case History and Results The full-term infant was born to clinically healthy, wild-caught parents and survived 5 days. Autopsy disclosed a unilateral cleft palate, moderate scalp hemorrhage (birth versus postnatal trauma), cerebral edema, and a sterile fibrin vegetation in the heart. The palate was also shorter and narrower than expected, and the biorbital breadth was reduced; otherwise, growth and development appeared normal. Standard cranial and intraoral radiographs and three-dimensional reconstructions of computerized tomographic (CT) scans provided thorough and noninvasive methods of studying the craniofacial complex and extracranial skeleton. By this technique, major findings were: intact premaxilla, interpremaxillary, and premaxillary/maxillary sutures; intramaxillary cleft with ipsilateral choanal atresia; mildly asymmetric inferior turbinates; and normal nasal septum and vomer. Conclusions Except for choanal atresia, cleft palate was not associated with other major craniofacial or extracranial anomalies in this case. Choanal atresia has been observed at times with cleft palate, but to our knowledge, the association has not been reported in nonhuman primates. Cleft palate, with or without cleft lip, has been recognized in a variety of nonhuman primates, including the lemur, marmoset, tamarin, squirrel monkey, and macaque. Some occurrences are spontaneous, while others are syndromic and/or arise from genetic or teratogenic influences. Each mode of presentation is poorly understood in nonhuman primates, but in this case, the absence of relevant environmental or parental history suggests that the occurrence was spontaneous. Anatomic studies of nonhuman primates are particularly valuable when they involve endangered species and will hopefully increase our understanding of the pathogenesis and etiology of congenital disorders, as well as other relationships between nonhuman primates and humans.
Etiopathogenesis of Isolated Robin Sequence
Authors: Marques Ilza Lazarini , Barbieri Marco Antonio , Bettiol Heloisa 
Published: October 2018

Objective To investigate the etiopathogenesis of isolated Robin sequence. Design A longitudinal and prospective study of children with isolated Robin sequence and no other associated syndromes or malformations. Setting The study was carried out at the Hospital de Reabilitacao de Anomalias Craniofaciais (formerly the Hospital for Research and Rehabilitation of Cleft Lip/Palate), University of São Paulo, Bauru, SP, Brazil, which provides care for patients with lip/palate lesions throughout Brazil. Patients Forty-three children were initially included in the study, seven of whom were later found to be cases of Stickler syndrome and excluded. The remaining 36 children presenting only the anomaly triad of microretrognathia, glossoptosis, and cleft palate were followed up from the first month of life to 4 years of age with repetitive clinical and ophthalmological examination. Main outcome Measure A family history of cleft lip/palate was determined on the basis of information provided by the parents and, when possible, the affected relative was submitted to physical examination. Results A family history of cleft lip/palate was observed in 27.7% of cases, one case having a younger brother with only cleft palate but no microretrognathia or glossoptosis. Six cases of isolated cleft palate and three cases of cleft lip with or without cleft palate were present in distant relatives. Complete U-shaped cleft palate (wide cleft) was the most frequent type of cleft, which was present in 75% of cases. Only one case of incomplete cleft palate was observed, but U-shaped; 25% of the patients presented complete V-shaped cleft palate. Conclusions We conclude that heredity could be a factor in the etiopathogenesis of isolated Robin sequence and suggest that cleft palate (usually complete and U-shaped) is the primary event in the determination of the triad of anomalies.
Medical Genetics on the Cleft Palate–Craniofacial Team: Understanding Parental Preference
Authors: Berk Nancy W. , Marazita Mary L. , Cooper Margaret E. 
Published: October 2018

Objective This study examined health care professionals' perceptions of parental preferences and preferences of parents of affected children (cleft lip, cleft palate, both, or other craniofacial anomaly) for prenatal testing with respect to oral-facial clefts and craniofacial anomalies. Design This was a descriptive study assessing and comparing questionnaire responses of two independent groups. Participants Healthcare professional participants comprised 570 U.S. members of the American Cleft Palate–Craniofacial Association. Parent participants comprised 97 parents of children seen at the University of Pittsburgh Cleft Palate–Craniofacial Center. Main outcome Measures A practitioner survey was developed to examine practitioner perception of parental desire for involvement, desire for knowledge, and reaction to learning of a birth defect. A parent survey was developed to correspond with the practitioner survey. Results Health professionals' perceptions of parental preferences often paralleled parental preference data. However, parental responses were found to be significantly different from practitioner perception of parental preferences on one question reflecting desire for involvement (x2 = 33.35, df=1, p = .001) and on one question reflecting desire for knowledge (x2 = 4.82, df =1, p = .03). For both questions, higher percentages of parents responded that they would want this involvement or information. Conclusions Findings are consistent with those reported In other studies of prenatal testing preferences and susceptibility. Results suggest that parents of affected children have a strong desire for information and involvement in prenatal testing and counseling decisions. Parents appear to value preparation in spite of acknowledging anxiety associated with prenatal information.
Long-Term Outcome Analysis of Two Treatment Methods for Cleft Palate: Combined Levator Retropositioning and Pharyngeal Flap versus Double-Opposing Z-Plasty
Authors: Lin Kant Y. , Goldberg David , Williams Christopher , Borowitz Kathleen , Persing John , Edgerton Milton 
Published: October 2018

Objective Two surgical techniques for repair of a cleft palate include levator retropositioning in combination with a pharyngeal flap and the Furlow double-opposing Z-plasty. This study compared morbidity and speech results from the use of these two methods in an effort to determine which was the superior technique. Design Patient records from 1986 to 1996 were retrospectively reviewed, and 10 patients with a cleft palate who underwent repair with a levator retropositioning and pharyngeal flap were compared to 14 patients who underwent a double-opposing Z-plasty repair. Postoperative complications including fistula formation, obstructive sleep apnea, and residual velopharyngeal insufficiency were recorded. Speech was assessed perceptually and through the use of nasometry. Results Both surgical techniques resulted in good speech In the majority of patients. Only two patients in the study, both In the Z-plasty group, had severe postoperative hypernasality. Two patients in the levator retropositioning and pharyngeal flap group developed severe postoperative obstructive sleep apnea, requiring additional surgery. Conclusion The levator retropositioning and pharyngeal flap technique was successful In achieving good speech results, but it also caused more serious postoperative complications when compared to the double-opposing Z-plasty technique.
Comparison of Periodontal Disease in Patients with Clefts of Palate and Patients with Unilateral Clefts of Lip, Palate, and Alveolus
Authors: Schultes Günter , Gaggl Alexander , Kärcher Hans 
Published: October 2018

Objective Long-term health of the stomatognathic system as well as esthetic aspects are the therapeutic goals in patients with orofacial clefts. The aim of this study was to analyze the periodontal condition of patients with cleft palate (CP) and cleft lip, palate, and alveolus (CLP) and to determine the differing degrees and localization of periodontal disease. Design In 30 patients with unilateral cleft lip, palate, and alveolus and 30 patients with cleft palate (CP), periodontal lesions were identified and classified according to the Community Periodontal Index of Treatment Needs (CPITN) and pathological mobility of teeth was noted. The state of oral hygiene was recorded by the Approximal Plaque Index. Results In general, poor oral hygiene was found in all patients. Patients with CLP were classified as CPITN code 0 in 0%, codes 1 and 2 in 7%, code 3 in 43%, and code 4 in 50% of cases. Patients with cleft palate showed code 0 in 0%, codes 1 and 2 in 30%, code 3 in 45%, and code 4 in 25% of cases. In this study, periodontal disease was found in patients with cleft palate to a similar extent to that in the general population, whereas patients with cleft lip, palate, and alveolus had a predisposition to deep peridontal destruction of teeth adjacent to the cleft. The registration of pathological mobility of teeth and resulting loss of attachment corresponded to the periodontal disease classification according to the CPITN. Conclusion A critical periodontal situation was found in patients with unilateral cleft lip, palate, and alveolus. In contrast, patients with cleft palate exhibited a similar periodontal situation to that found in the general population, with additional damage that may be attributed to orthodontic treatment.
The Intrajudge Reliability of the Perceptual Rating of Cleft Palate Speech before and after Pharyngeal Flap Surgery: The Effect of Judges and Speech Samples
Authors: Keuning Kornelis H.D. , Wieneke George H. , Dejonckere Philippe H. 
Published: October 2018

Objective In this pilot study, the reliabilities of the perceptual ratings of four types of speech samples by six judges, with and without expertise in evaluating cleft palate speech, were studied. Design Pre- and postoperative tape recordings of 15 patients with cleft lip and palate who had undergone a superiorly based pharyngeal flap operation were selected. Five speech-language pathologists and one oral and maxillofacial surgeon perceptually rated the following variables on separate 100-mm visual analog scales: hypernasality, audible nasal emission, intelligibility, mis-articulations associated with velopharyngeal insufficiency, voice quality, and the presence or absence of hyponasality. These six variables were rated in four types of speech samples: reading of three sentences, repeating after the speech pathologist of three sentences, 10 sentences containing the aforementioned material, and the same 10 sentences in paired comparison. All speech samples were rerated after 3 months by the same judges. Results Judges differed largely in the range they used in their rating. Intrajudge reliability of .56 to .78 was found for ratings of hypernasality. No significant differences in intrajudge reliability were found for the ratings with the different types of speech samples. The intrajudge reliability of a judge with expertise was not necessarily higher than of a judge without this expertise. Conclusions The improvement in speech is most reliably assessed with speech samples in paired comparison. A speech-language pathologist with expertise in evaluating cleft palate speech does not guarantee a high intrajudge reliability of the rating.
Acoustic Airway Profiles in Unilateral Cleft Palate Patients
Authors: Kunkel Martin , Wahlmann Ulrich , Wagner Wilfried 
Published: October 2018

Objective: This study investigates the nasal airway in unilateral cleft palate patients by means of a noninvasive, objective diagnostic method that provides topographic information about the airway profile. Design: A consecutive sample of patients was measured. Setting: Cleft palate rehabilitation center of the University of Mainz, Germany. Patients: Forty-nine subjects were investigated: 34 full-grown patients with complete unilateral cleft lip and palate and 15 controls with subjective normal nasal patency. Intervention: A transnasal series of three acoustic measurements of nasal volume was performed per nostril; measurements were taken both before and after decongestion with 0.3 mg xylometazoline per nostril. Minimum cross-sectional area, nasal volume, and decongestion capacity were calculated for both the cleft side and the contralateral side and for both nasal sides in controls. Results: Pathologic obstructions (<0.4 cm2) were detected on the cleft side in 75% of patients but were detected in only 15% of patients on the contralateral side (p < .001). The valve area of the cleft side (0.32 ± 0.2 cm2) yielded significantly (p < .001) lower cross-sectional values compared with the contralateral side (0.56 ± 0.1 cm2). Total nasal volume was determined to be 35% smaller on the cleft side (p < .001). Significantly higher decongestion capacity was verified on the cleft side, thus indicating mucosal hypertropy. Conclusion: Despite a wide range of interindividual variability, we recognized a characteristic “descending W” airway pattern in cleft palate patients. Acoustic rhinometry seems to be a powerful tool for acquiring topographic information about the individual airway profile. It has proven helpful in visualizing the location and amount of pathologic obstructions, rendering it especially useful for preoperative investigation and quality control in corrective cleft nose surgery.
Effects of Maxillary Protraction Combined with Chin-Cap Therapy in Unilateral Cleft Lip and Palate Patients
Authors: Ishikawa Hiroyuki , Kitazawa Shinichi , Iwasaki Hiroshi , Nakamura Shinji 
Published: October 2018

Objective This study investigated the treatment effects of maxillary protraction combined with chin-cap therapy in complete unilateral cleft lip and palate patients at the deciduous and early mixed dentition stages. Method Twenty-six Japanese children (10 boys and 16 girls) with complete unilateral cleft lip and palate were examined. All had undergone pushback operations for palatal repair at approximately 18 months of age. Maxillary protraction began between 5 and 7 years of age and continued for 10 to 38 months. Lateral cephalograms were used to analyze skeletal changes during the first and second years of treatment, and the relationship between pretreatment midfacial morphology and forward displacement of the maxilla during the first year was investigated. Results and Conclusions During the first year of treatment, the mean increase in the ANB angle for all cases was 2.37°. The forward displacement of the maxilla varied considerably, from 0.23 mm to 3.03 mm. The treatment response was significantly smaller in the second year, and no benefit from treatment longer than 1 year was established. The amount of maxillary forward displacement was significantly correlated with the pretreatment posterior upper facial height. Patients with smaller posterior upper facial height showed a poorer treatment response, whereas patients with a greater posterior upper facial height responded better to treatment. Individual differences in maxillary growth acceleration may be related to growth inhibition associated with post-surgical scar tissue on the palates.