bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic Partial Adenoidectomy for Children with Submucous Cleft Palate
Authors: Finkelstein Yehuda , Wexler David B. , Nachmani Ariela , Ophir Dov 
Published: October 2018

Objective: Children with submucous cleft palate who suffer from chronic nasal obstruction because of hypertrophic adenoids usually are not subjected to adenoidectomy because of the fear of postoperative velopharyngeal insufficiency. These patients present a therapeutic challenge because we are aware more than ever of the importance of normal nasal breathing and nocturnal respiration, especially during childhood. Our hypothesis was that transnasal endoscopic horizontal limited adenoidectomy may relieve nasal obstruction while preserving the function of the velopharyngeal valve. The objective of this study was to evaluate the efficacy of transnasal endoscopic horizontal partial adenoidectomy in patients with submucous cleft palate and adenoidal hypertrophy. Setting: Patients were either referred to the outpatient clinic of the Palate Surgery Unit (seven patients) or were patients referred to the senior author's (Y.F.) private clinic. All the patients had been operated on by this senior author (Y.F.). Patients: Ten children aged 3.5 to 13 years (six girls and four boys) with submucous cleft palate and hypertrophic adenoids were included in the study. All the patients were hyponasal and suffered nasal obstruction, loud snoring, and episodes of apnea. Interventions: Endoscopic partial adenoidectomy was accomplished to open the lower third of the choanae. Nasal breathing was achieved in all the patients, and only mild snoring remained in two patients. The hyponasality disappeared and speech intelligibility normalized. Mild hypernasality developed in two patients but was still perceived as an overall improvement in speech. Conclusions: Transnasal endoscopic horizontal partial adenoidectomy may be an effective surgical method for relief of nasal obstruction while preserving velopharyngeal valve function in patients with submucous cleft palate who suffer from obstructive adenoids.
A Local Perspective on the Initial Management of Children with Cleft Lip and Palate by Primary Care Physicians
Authors: Grow Jennifer L. , Lehman James A. 
Published: October 2018

Objective: To evaluate the frequency and referral patterns, need for continuing education, and information given to parents of children with cleft lip and palate by local primary care physicians. Study Design: A survey was sent to primary care physicians from the pediatrics, family practice, and internal medicine/pediatrics specialties in six surrounding counties of a regional craniofacial center located within northeastern Ohio with a population base of 1.5 million people. Particular aspects of care evaluated included protocols of care, information for parents, referral patterns, conferences attended, and literature read. Results: Nearly 30% of physicians had standard protocols when children are born with clefts. Eighty-seven percent of physicians referred children within 2 weeks of diagnosis, yet only 48% gave referrals to a multidisciplinary team. Physicians providing team referrals were nearly three times as likely to attend related conferences and approximately four times as likely to have a set plan at the time of diagnosis of the cleft. Forty-nine percent of physicians gave oral information, 35% gave oral and written information, and 10% did not give parents information. Ninety-four percent of physicians gave parents the option to call with concerns. Pediatricians were approximately four times as likely to attend cleft conferences and desire continuing education updates. However, family practitioners were over three times as likely to give proper referrals, compared with pediatricians. Conclusion: There is a necessity to educate local primary care physicians who manage children with cleft lip and palate regarding cleft information for parents, referral guidelines, the cleft team concept, and the role of primary physicians.
Onlay Bone Graft Augmentation for Refined Correction of Coronal Synostosis
Authors: Grant John H. , Roberts Theodore S. , Loeser John D. , Gruss Joseph S. 
Published: October 2018

Objective: The primary purpose of this study was to evaluate the long-term result of an onlay bone graft augmentation of the supraorbital ridge at the time of primary correction of coronal suture synostosis. Design: The study is a retrospective review of 62 consecutive patients treated for coronal synostosis from June 1991 through February 1997. The surgical technique utilized involved a standard bilateral fronto-orbital advancement and calvarial reshaping with the addition of an onlay bone graft in the supraorbital region. Setting: All patients were treated at a tertiary care craniofacial center. Results and Conclusion: A total of 62 patients were treated by this technique. Fifty patients underwent primary correction as infants (mean age 9.8 months). An additional 12 patients were older (mean age 8.2 years) and were treated for residual deformity having previously undergone correction by another technique. Results with follow-up as long as 7 years demonstrate stable forehead and orbital symmetry. Complications identified by chart review were minimal and not directly attributable to this modification in surgical technique.
Validity of Subjective Evaluations for the Assessment of Lip Scarring and Impairment
Authors: Ritter Kelly , Trotman Carroll-Ann , Phillips Ceib 
Published: October 2018

Objective In patients with cleft lip and palate, the aim of the study was (1) to determine and compare the level of agreement among examiners’ subjective evaluations of static and dynamic lip form; (2) assess possible bias of examiners’ subjective evaluations; and (3) determine the impact of lip scarring on an examiner's subjective assessment of dynamic lip form. Setting Patients and subjects were recruited from the University of North Carolina Cleft Lip and Palate Center and School of Dentistry. Patients, Participants Thirteen patients with unilateral cleft lip and palate and varying degrees of cleft scar severity were selected and one subject without cleft who wore artificial scars of varying severity. Interventions For the patients with cleft, a previously repaired complete cleft lip and palate. Photographs and videotape recordings were made of the patients with cleft and the subject without cleft, with and without the artifical scars, at rest and smiling. Main Outcome Measure(s) Rankings of cleft scar severity and impairment on a 6-point Likert scale by a lay and professional panel. Results Intra- and interexaminer reliability was good for the lower facial regions at rest but not during movement. Professionals gave ratings of greater severity and impairment than laypersons, and professionals agreed when rating the lower faces at rest more so than during movement. Lip scarring affected perceptions of impairment during movement by viewers in both panels. Conclusions Subjective assessments can be affected by methodological approaches, professional experience, and stimulus type. Future research should focus on establishing objective methods to evaluate patients with cleft lip and palate at rest and during function.
A Profile of the Features and Speech in Patients with Mandibulofacial Dysostosis
Authors: Vallino-Napoli Linda D. 
Published: October 2018

Purpose To present a profile of the features and speech in patients with mandibulofacial dysostosis (MFD). Data were collected on occlusion, palatal condition, hearing, resonance, voice, and articulation. Patients Thirty patients with MFD ranging in age from 1.6 to 21.0 years. Study Design Retrospective and prospective cross-sectional designs. Setting Pediatric tertiary care hospital. Results Sixty percent of the patients had an open bite. Isolated cleft palate was found in 37% with other types of cleft conditions occurring less frequently. Twenty-three percent underwent tracheostomy. All patients demonstrated hearing loss, 93% were conductive and 7% were mixed. Resonance, voice, and articulation were also affected. Seventy-seven percent had aberrant resonance including hypernasality, hyponasality, mixed hyper- and hyponasality or muffled resonance, which was found in 40% of the patients. Voice quality was abnormal in 63%. All patients had articulation errors. Although overlap between categories occurred, results showed that 60% had errors related to malocclusion, 30% demonstrated errors usually associated with velopharyngeal inadequacy and 50% had general articulatory or phonological errors that could be attributed to other causes. Conclusions The features and speech of patients with MFD are complex. The speech disorders may have multiple overlapping etiologies that require careful differential diagnosis. This is imperative to establish appropriate treatment regimens and evaluate clinical outcomes.
The Relationship between Arch Dimensions and the 5-Year Index in the Primary Dentition of Patients with Complete UCLP
Authors: Dibiase A.T. , Dibiase D.D. , Hay N.J. , Sommerlad B.C. 
Published: October 2018

Objective To compare dental arch dimensions of children in the primary dentition with repaired unilateral clefts of the lip and palate (UCLP) to a noncleft group of a similar age and determine how the dimensions of the cleft arches relate to an index of treatment outcome. Method Dental study casts of 44 5- to 6-year-olds with complete UCLP (22 boys and 22 girls) from a single center, whose primary surgery had been carried out by one surgeon, were matched for age, sex, and ethnicity with dental study casts from a longitudinal growth study. Analysis of variance was used to ascertain differences in arch dimensions between the two groups. The cleft group casts were then assessed with an established index of surgical outcome, the 5-year-old index. Spearman's rank correlation coefficient was used to see how the arch dimensions of the cleft group related to the categories of the index. Results and Conclusions Maxillary arch dimensions were significantly smaller in the cleft group than in the noncleft group, irrespective of sex (p < .05). In the mandibular arch, there was no difference between the cleft and noncleft groups (p > .05). Maxillary arch dimensions of the cleft group correlated significantly with the 5-year-old index for arch length and intercanine width (p < .05) but not intermolar width (p = .842). This would suggest that the 5-year-old index is a suitable tool for assessing the outcome of treatment in the primary dentition for anteroposterior and anterior transverse arch dimensions.
Volume and Shape of Masticatory Muscles in Patients with Hemifacial Microsomia
Authors: Takashima Mariko , Kitai Noriyuki , Murakami Shumei , Furukawa Souhei , Kreiborg Sven , Takada Kenji 
Published: October 2018

Objective To test the following hypotheses in hemifacial microsomia (HFM): (1) the volumes of the masseter, lateral and medial pterygoid, and temporal muscles are reduced on the affected versus unaffected side; (2) significant differences exist between the degrees of right-left disproportion in these four masticatory muscles; (3) circumferential shapes of the masticatory muscles are more irregular on the affected versus unaffected side; and (4) the degree of masticatory muscle right-left disproportion can be judged by the degree of ear, mandibular, or dental anomalies. Subjects and Methods Ten preadolescent patients with HFM were studied using facial photographs, dental casts, cephalometric and panoramic radiographs, and helical computed tomography scanning and three-dimensional reconstruction technique. Volumes of masseter, lateral and medial pterygoid, and temporal muscles on both sides were measured. Muscle volume disproportion was expressed as the affected/unaffected ratio. Muscle circumferential irregularity was expressed as the ratio between the total circumferential length and correspponding cross-sectional area. Results Masticatory muscle volumes were significantly smaller on the affected versus unaffected side. No significant differences were observed between the degrees of disproportion of the four masticatory muscles examined. Circumferential shapes of masticatory muscles were significantly more irregular on the affected versus unaffected side. There were no significant relationships of the degree of ear, mandibular, or dental anomalies in relation to masticatory muscle disproportion. Conclusions In HFM the masseter, lateral and medial pterygoid, and temporal muscles all have a significantly smaller volume on the affected versus unaffected side, and specific muscles were not severely affected in the present subjects. Furthermore, all four muscles showed a significantly more irregular shape on the affected versus unaffected side. Finally, the severity of masticatory muscle disproportion can probably not be judged by the degree of ear, mandibular, and dental anomalies in preadolescent patients with HFM.
Effects of Orthognathic Surgery on Speech and Breathing of Subjects with Cleft Lip and Palate: Acoustic and Aerodynamic Assessment
Authors: Trindade Inge E.K. , Yamashita Renata P. , Suguimoto Roberto M. , Mazzottini Reinaldo , Trindade Alceu S. 
Published: October 2018

Objective To evaluate the impact of orthognathic surgery on acoustic nasalance of subjects with cleft and investigate the causes of possible changes by analyzing velopharyngeal function and nasal patency. Design/Patients Nasalance was measured in 29 subjects with operated cleft palate ± lip before (PRE) and 45 days (POST1) and 9 months (POST2) after surgery, on average. In 19 of the patients, the minimum velopharyngeal (VP) and nasal cross-sectional (N) areas were also determined. Interventions Le Fort I osteotomy with maxillary advancement in combination with procedures involving the nose, maxilla, mandible or all three. Main Outcome Measures Nasalance, VP area, N area. Results We observed: (1) a significant (p < .05) increase in mean nasalance at POST1 and POST2, compared with PRE during the reading of oral sentences and nasal sentences; at POST2, high nasalance on the oral sentences was observed in 45% of the patients with normal nasalance at PRE, and 57% of patients with low nasalance on the nasal sentences at PRE no longer presented abnormal nasalance; (2) a significant increase in mean VP area at POST1; two borderline patients demonstrated deterioration of VP closure at POST2, compared with PRE; and (3) a significant increase in mean N area at POST2, with 73% of patients no longer presenting subnormal areas seen at PRE. Conclusions On a long-term basis, orthognathic surgery modifies speech nasalance of some subjects with cleft, perhaps because of an increase in internal nose size. This may also improve nasal patency for breathing.
Bilateral Superiorly Based Full-Thickness Nasolabial Island Flaps for Closure of Residual Anterior Palatal Fistulas in an Unoperated Elderly Patient
Authors: Erçöçen A.R. , Yilmaz S. , Saydam M. 
Published: October 2018

Objective Unoperated bilateral complete cleft lip and palate in an adult or elderly patient is seen rarely, and the existence of unoperated clefts is a result of unfavorable economic and social circumstances. We report an unoperated 65-year-old patient with bilateral complete cleft lip and palate and present our preference for the surgical management. Interventions Repair of the bilateral complete cleft lip and palate was successfully carried out using straight-line closure for the bilateral cleft lip and two-flap pushback palatoplasty with superiorly based lateral port control pharyngeal flap for the wide cleft palate at the first stage, and large residual anterior palatal fistulas were closed using bilateral superiorly based (retrograde flow) full-thickness nasolabial island flaps at the second stage. Conclusions To our knowledge based on a review of the literature, this is the first report of an elderly patient with bilateral complete cleft lip and palate and the first application of bilateral superiorly based (retrograde flow) full-thickness nasolabial island flaps for closure of large residual anterior palatal fistulas or alveolar clefts. The bilateral superiorly based (retrograde flow) full-thickness nasolabial island flap may be a good solution in large anterior palatal defects using unilaterally or bilaterally in a single stage with minimal donor site morbidity, in which there is not enough tissue for local repair or if previous attempts are unsuccessful.
Syngnathia and Van der Woude Syndrome: A Case Report and Literature Review
Authors: Puvabanditsin Surasak , Garrow Eugene , Sitburana Orawan , Avila Filipe M. , Nabong Marcelo Y. , Biswas Anjali 
Published: October 2018

Objective Syngnathia is a rare anomaly involving soft tissue or bony adhesions between the maxilla and mandible. We review the literature and present a case of syngnathia associated with Van der Woude syndrome. Syngnathia can have very different etiologies, but this has rarely been reported in Van der Woude syndrome. Treatment of this condition is rarely discussed in the literature because of a paucity of case reports. Results Oral adhesion (syngnathia) in our patient was caused by a mandibular to maxillary fibrous band. Surgical treatment was successful. Clinical implications and review of literature for the treatment of this rare association of syngnathia and Van der Woude syndrome are discussed.
Influence of Early Hard Palate Closure in Unilateral and Bilateral Cleft Lip and Palate on Maxillary Transverse Growth during the First Four Years of Age
Authors: Lehner Bernhard , Wiltfang Joerg , Strobel-Schwarthoff Karin , Benz Michaela , Hirschfelder Ursula , Neukam Friedrich-Wilhelm 
Published: October 2018

Objective To evaluate and compare the effects of early primary closure of the hard palate on the anterior and posterior width of the maxillary arch in children with bilateral (BCLP) and unilateral (UCLP) cleft lip and palate during the first 4 years of life. Design A retrospective, mixed-longitudinal study. Setting Cleft Palate Center of the University of Erlangen-Nuremberg. Subjects and Methods The present investigation analyzes longitudinally 42 children with UCLP and 8 children with BCLP between 1996 and 2000 with early simultaneous primary closure of lip and hard palate (4 to 5 months). Palatal arch width was measured on dental casts with a computer-controlled three-dimensional digitizing system, and their growth velocities were calculated from consecutive periods (mean follow-up 39 months). Differences in growth velocities were compared with those of 25 children with UCLP and 15 children with BCLP with delayed closure of hard palate (12 to 14 months). Results and Conclusions There was no significant difference in terms of anterior and posterior maxillary width between early and delayed closure of hard palate within the first 4 years of life.
Do the Reading Disabilities of Children with Cleft Fit into Current Models of Developmental Dyslexia?
Authors: Richman Lynn C. , Ryan Susan M. 
Published: October 2018

Objective The purpose of this study was to determine whether the reading problems of children with cleft fit models of developmental dyslexia. Design The study compared children with nonsyndromic cleft lip and palate who had reading disability (n = 46) with those who did not have reading disability (n = 46). The children were matched for age, sex, and grade. The two groups were compared (t tests) on measures of verbal expression, phonemic awareness, and rapid naming. Also, regression analyses compared the relative relationships of these variables to reading disability. Participants Children were selected from 154 patients originally screened. Results Children with reading disability scored significantly lower on rapid naming and verbal expression, with no differences found on phonemic awareness. Rapid naming was shown to have the most significant association with reading disability. Conclusion Children with nonsyndromic cleft lip and palate show symptoms similar to a naming-memory deficit model of developmental dyslexia. Reading treatment should avoid sight word approaches and focus on oral phonics treatment.
Is Isolated Palatal Anomaly an Indication to Screen for 22q11 Region Deletion?
Authors: Reish Orit , Finkelstein Yehuda , Mesterman Ronit , Nachmani Ariela , Wolach Baruch , Fejgin Moshe , Amiel Aliza 
Published: October 2018

Objective Velocardiofacial syndrome (VCFS) is the most common multiple anomaly disorder associated with palatal clefting. Cytogenetic hemizygous deletion of 22q11 region is found in 80% of patients. The frequency of 22q11 deletion in patients presenting with isolated palatal anomalies has not been fully assessed. Our objective was to determine the frequency of the deletion in patients with isolated palatal anomalies. Design Patients were referred because of velopharyngeal insufficiency because of isolated congenital palatal anomalies. Diagnosis of palatal anomalies was confirmed by videonasopharyngoscopy, multiview videofluoroscopy and cephalometry. Other clinical findings suggestive of VCFS were sought, and subjects with these characteristics were excluded from the study. Peripheral blood samples from all patients were analyzed cytogenetically utilizing fluorescent in situ hybridization for the 22q11 region. Results Thirty-eight patients aged 3 to 31 years were included in the study. Nine had cleft palate, 7 cleft lip and palate, 10 overt and 11 occult submucous cleft palate, and 1 had a deep nasopharynx. No deletion of 22q11 region was detected in any of the evaluated patients. Conclusions A routine screening for the 22q11 deletion in older children and adults presenting with an isolated palatal anomaly may not be required. Because other signs related to VCFS such as facial dysmorphism and behavioral or psychiatric disorders may evolve at an older age, young patients should be followed up and reevaluated for additional relevant symptoms that may lead to deletion evaluation. In light of the fact that the current literature is inconsistent, the relative small size of this study and the significant consequences of missed 22q11.2 deletion, more information is needed before definitive recommendations can be made.
Specific Language Impairment in Children with Velocardiofacial Syndrome: Four Case Studies
Authors: Goorhuis-Brouwer Siena M. , Dikkers Frederik G. , Robinson Peter H. , Kerstjens-Frederikse Wilhelmina S. 
Published: October 2018

Objective To describe specific language impairment in four children with velocardiofacial syndrome (VCFS). Design A descriptive, retrospective study of four cases. Setting University Hospital Groningen, tertiary clinical care. Patients Of 350 patients with cleft plate, 18 children were diagnosed with VCFS. Four children are described. Interventions In all children, cardiac and plastic surgery was carried out in the first year of life. Afterward, interventions consisted of hearing improvement, pharyngoplasty, and speech therapy. Main Outcome Inadequate and uncharacteristic development of articulation and expressive language in four children with VCFS were observed. They differed from the majority in two ways: their nonverbal IQ was in the normal range, and their language skills were below expectations for their IQ. Results Four of 18 patients with VCFS (22%) showed poor response to therapy and did not develop language in accordance with their normal learning abilities (nonverbal learning capacities and language comprehension). Persistent hypernasal resonance and severe articulation problems remained in all four children. In two children the expressive language profile was also not in agreement with the nonverbal profile: they produced only two- and three-word utterances at the age of 6.0 and 5.3 years. The other two children at the age of 6.8 and 6.4 years produced very long sentences, but they were unintelligible. Conclusions The speech and language impairment of the four children may be characterized as a phonological or verbal programming deficit syndrome and as such can be described as a specific language impairment in conjunction with VCFS.