bluuebunny/crossref_metadata_2025_split huggingface dataset:
Euclidean Distance Matrix Analysis of Surgical Changes in Prepubertal Craniofacial Microsomia Patients Treated with an Inverted L Osteotomy
Authors: Hay A. D. , Ayoub A. F. , Moos K. F. , Singh G. D. 
Published: October 2018

Objectives Correction of craniofacial microsomia (CFM) presents several challenges concerning the modality of surgical intervention. The aim of this study was to assess early and late surgical outcome, by undertaking Euclidean distance matrix analysis (EDMA) of CFM patients exhibiting an unilateral mandibular deformity that was surgically corrected by an inverted L osteotomy and autogenous bone graft. Design Longitudinal study. Preoperative, ≈1-year postoperative and ≈3-year postoperative assessments of 14 consecutive children (mean age 9 years) with CFM. Posteroanterior cephalographs were scanned and five homologous mandibular landmarks were digitized in triplicate (< 1% digitization error). Average mandibular geometries, scaled to an equivalent size, were generated using a generalized rotational fit program (Procrustes superimposition) and subjected to EDMA. Results The mean pre- and both postoperative mandibular configurations differed statistically (p < .01). Early postoperative improvements in mandibular form were noted; increases in length arising in the treated mandibular body (≈ 19%) and ramus (≈ 13%). Comparing early and late postoperative configurations, a decrease of ≈ 22% in the late postoperative mandibular body length was evident, but the ramus maintained steady vertical growth (≈ 7%). Comparing the preoperative and late postoperative configurations, the decrease observed in the mandibular body on the treated side was reduced to ≈ 8% while the ramus maintained good growth (≈ 20%) on that side. Conclusion Mandibular morphology is improved significantly in CFM patients surgically treated by an inverted L osteotomy, but relapse in the mandibular body is evident after ≈ 3 years. Nevertheless, ramus growth proceeds well after the surgical reconstruction.
The Effect of Vowels on Nasalance Scores
Authors: Lewis Kerry E. , Watterson Thomas , Quint Teresa 
Published: October 2018

Objective Nasalance scores were compared for nine different speech stimuli with vowel content controlled. Design The nine speech stimuli included four vowels spoken in isolation and five sentences. The four vowels were /i/, /u/, /æ/, and /a/. Four of the five sentences were loaded with High Front, High Back, Low Front, or Low Back vowels, and the fifth sentence contained a mixture of vowel types. Setting Academic and clinical craniofacial center. Subjects The subjects were 19 children with velopharyngeal dysfunction (VPD) and 19 children without history of communication disorder. Main outcome Measures The main outcome measures were the nasalance scores associated with the nine different speech stimuli for two groups of subjects. Results For the VPD group, analysis of variance procedures revealed that nasalance scores for high-vowel sentences and the mixed-vowel sentence were significantly higher than the nasalance scores for the two low-vowel sentences. This pattern was the same for the non-VPD group except for the High Back/Low Back contrast, which was not significant. In both groups, nasalance scores for sustained vowels were significantly higher for the High Front vowel /i/ than for any other vowel, and nasalance was significantly higher for the High Back vowel /u/ than for either of the Low vowels /æ/ or /a/. There was no significant difference between Low vowels. Conclusion Nasalance scores may be affected by the vowel content of the speech stimulus. This should be taken into consideration on a clinical basis and for research purposes.
What Information Do Parents of Newborns with Cleft Lip, Palate, or Both Want to Know?
Authors: Young Jennifer L. , O'Riordan Maryann , Goldstein Jeffrey A. , Robin Nathaniel H. 
Published: October 2018

Background The unexpected birth of a baby with a cleft lip and palate (CL/P) is a shocking and traumatic experience, generating anxiety for parents as well as the attendant health care team. Parents frequently leave the hospital with many unanswered questions because health care professionals do not educate them adequately. Objective To determine what information these parents felt was “critical” for them during the immediate newborn period and to determine how the “informer” was perceived during these encounters. Design Retrospective, self-administered questionnaire. Subjects and Methods Biologic parents of children with isolated CL/P aged 6 years and younger were surveyed. The questionnaire asked parents whether they remembered discussing diagnosis, prognosis, management, home care, and psychosocial issues. Parents were also asked to rank how “critical” it would have been for the “informer” to have discussed certain issues with them during this first day. Results Parents gave the highest priority to feeding and learning to identify illness in their baby; 95% wanted to be shown all normal aspects of their baby's exam, and 87% wanted to be told that the CL/P was not their fault. Usage of proper terminology to describe abnormal findings and receiving assurance that their child was not in pain were also important. Unfortunately, many parents reported that the informers did not address these issues. Conclusions Parents of newborns with CL/P want basic information in the immediate newborn period, especially regarding feeding and recognizing illness. These data suggest that informers are not adequately discussing these issues with parents.
Oral Clefts and Vitamin Supplementation
Authors: Loffredo L. C. M. , Souza J. M. P. , Freitas J. A. S. , Mossey P. A. 
Published: October 2018

Objectives The evidence linking low levels of folic acid and orofacial clefting (OFC) is presently equivocal. There is stronger evidence for the role of folic acid supplementation in protection against the occurrence and recurrence of neural tube defects. The present investigation tested the hypotheses that cleft lip, cleft palate, or both are inversely associated with maternal intake of dietary and supplemental vitamins during the periconceptional period and first 4 months of pregnancy in a Brazilian population. Design A population-based, case-control study of cleft lip with or without cleft palate (CL(P)) and isolated cleft palate (CP) in a Brazilian population. In structured interviews, case histories were taken from the mothers of a consecutive sample of 450 infants born with nonsyndromic OFC. Results Mothers who had children with CL(P) were less likely to have been supplemented during the periconceptional period. The statistical significance of the difference in prevalence of the use of supplements between mothers of patients and of controls was greater for the CL(P) group: p < .05 for CP and p < .001 for CL(P). Multivariate analysis confirmed this finding of a protective effect for both types of orofacial cleft. Conclusions The use of vitamin supplements in the first 4 months of pregnancy was suggestive of a protective effect against the occurrence of CP and CL(P) in this population. The significance of an association between multivitamin supplementation and OFC and the possible role of gene/environment interaction are discussed.
Nasalance Scores in Noncleft Individuals: Why Not Zero?
Authors: Gildersleeve-Neumann Christina E. , Dalston Rodger M. 
Published: October 2018

Objective To determine whether oral or nasal acoustic energy is primarily responsible for nonzero nasalance scores observed during the production of nonnasal sentences by individuals with normal speech. Method Sixty adults with normal speech were asked to read the Zoo passage and produce three sustained vowels, (/i/, /a/ and /u/), with and without nares occlusion. Results There was a significant decrease in nasalance scores between the unoccluded and occluded conditions for all four stimulus pairs. The mean decrease across conditions ranged from 8 (/u/) to 25 (/i/). In the unoccluded condition, the nasalance score was significantly greater for /i/ than for the other stimuli. Conclusions The findings suggest that the majority of acoustic energy detected by the nasometer's nasal microphone during the production of nonnasal utterances is the result of sound transmission through the nose. The data obtained during this investigation, coupled with information available from other studies, suggest that this may be due to transpalatal transmission. If correct, such a conclusion would have clinical implications for patients with palatal clefts, since residual structural abnormalities and scar tissue in a repaired cleft palate may increase, dampen, or in some way alter transpalatal acoustic transmission. Thus, surgical normalization of velopharyngeal port control may not be sufficient to eliminate hypernasality in all patients.
Characteristic Forms of the Upper Part of the Oral Cavity in Newborns with Isolated Cleft Palate
Authors: Ihan-Hren Nataša , Oblak Peter , Koželj Vesna 
Published: October 2018

Objective To determine the functional and morphological compensation of the lack of integrity in the upper part of the oral cavity in newborns with isolated cleft palate. Integrity of the upper part of the oral cavity is required for the effective pumping of amniotic fluid, the essential mode of nutrition in intrauterine life. The adaptation could be seen immediately after birth. Materials Plaster casts of the upper part of the oral cavity in 60 newborns with isolated cleft palate of various extent and plaster casts of the upper part of the oral cavity in 27 newborns without cleft were used. A number of surface points were identified and used for a trigonometric morphological analysis. Results The parameters of the upper part of the oral cavity in four groups of newborns with various extent of isolated cleft palate were compared with newborns without cleft palate. The results indicate a shift of the functional oral cavity into the nasal cavity and the pharynx, depending on the extent of the cleft. Conclusion The pumping activity of the tongue forms the upper part of the oral cavity and consequently the tongue moves into the nasal cavity and pharynx, depending on the extent of the cleft. In this way, effective pumping of amniotic fluid is possible despite the cleft. This is of vital importance for the fetus during intrauterine life. A poorly passable or even unpassable respiratory way is only of secondary importance during that time.
Changes in Speech following Unilateral Mandibular Distraction Osteogenesis in Patients with Hemifacial Microsomia
Authors: Guyette Thomas W. , Polley John W. , Figueroa Alvaro , Botts Jennifer , Smith Bonnie E. 
Published: October 2018

Objective The purpose of this study was to describe changes in articulation, resonance, and velopharyngeal function following mandibular distraction osteogenesis. Design This is a descriptive, post hoc study comparing the performance of patients on measures of articulation, resonance, and velopharyngeal function before and after mandibular distraction. Setting The data were collected at a tertiary health care center located in Chicago. Patients The clinical data from preoperative and postoperative evaluations of seven mandibular distraction patients were used. Outcome Measures The outcome measures were number of articulation errors, severity of hypernasality and audible nasal emission, and velopharyngeal orifice size as estimated using the pressure-flow technique. Results Immediately after distraction, 28% (2/7) experienced a temporary deterioration in articulation and 42% (3/7) experienced a deterioration in nasal resonance. But by the long-term follow-up evaluation, all had returned to their preoperative levels. Pressure-flow test results generally support the perceptual findings. Conclusions Patients being considered for mandibular distraction surgery should receive preoperative and postoperative speech evaluations and be counseled about risks for changes in their speech following surgery.
Resiliency and Success in Adults with Moebius Syndrome
Authors: Meyerson Marion D. 
Published: October 2018

Objective: This study asked selected mature individuals with Moebius syndrome to discuss the sources of strength and resiliency that allowed them to achieve professional and personal success. Design: Adults with Moebius syndrome were selected in a nonrandom manner based primarily on their affiliation with the Moebius Syndrome Foundation. Following a letter from the author describing the objective, the subjects were interviewed by telephone and were encouraged to respond at length. Participants: Eighteen adults (aged 29 to 70 years) responded. All were or had been gainfully employed in a variety of professional or vocational positions. Results: The respondents reported the following as major sources of resiliency and success: family support, faith, humor, sense of self, special skills, determination, and networking. Conclusions: The recognition and reinforcement of strengths and resiliences in younger patients may help maximize their professional and personal success as adults.
Deficits versus Strengths: Ethics and Implications for Clinical Practice and Research
Authors: Mouradian Wendy E. 
Published: October 2018

A shift in emphasis from deficits to strengths to promote health and well-being in patients with congenital and acquired craniofacial conditions (CFC) is appropriate given the chronic, “incurable” nature of CFC. Personal narratives are a valuable starting point for discovering sources of resilience. This paper explores such a shift by considering two areas of ethical concern suggested by patient narratives: informed consent and the physician-patient relationship. Both areas contain pitfalls and opportunities. The powerful emotions these patients bring with them argue for caution in medical decision making. Attention to the individual's psychosocial adjustment should always supplement surgical evaluations. Because of the inequality of the physician-patient relationship, care should be taken to use this power in positive ways. The relationship between patient and surgeon is particularly charged and may be an important source of support, information, hope, and advice for patients. The changing health care system threatens the physician-patient relationship, but the rise of alternative medicine suggests patients continue to value relationships. Relationships are critical for individuals with CFC, who experience social rejection because of the fundamental importance of face in human interactions. Future research directions should include long-term outcome studies on patients receiving modern craniofacial team care, qualitative research on resilience in patients with positive life adjustment, and development of a conceptual framework and research methodology for understanding quality of life of individuals with CFC. An emphasis upon strengths rather than defects will have implications for the structure of craniofacial teams, the care that is provided, and allocation of resources.
A Method for Three-Projection Infant Cephalometry
Authors: Hermann N. V. , Jensen B. L. , Dahl E. , Darvann T. A. , Kreiborg S. 
Published: October 2018

Objective: To assess morphology and growth in infants and children with craniofacial anomalies based on comprehensive digitization of radiographic films in three, mutually orthogonal projections. Method: The method consists of (1) acquisition of radiographic films in a highly standardized three-projection (lateral, frontal, and axial) cephalometer, (2) marking and digitization of a total of 279 anatomical landmarks in the three projections, and (3) computation and presentation (tabular and graphical) of 356 linear and angular variables describing the craniofacial morphology, including soft tissue. Computation of statistical entities describing a patient, a group of patients, the differences between patients or groups of patients was carried out. Error assessment of the method involved investigation of error distribution among a number of error sources. Duplicate digitization of radiographic films from 30 randomly selected patients, and from 10 dry skulls, was carried out to determine the errors contributed by the procedure of landmark digitization and the distribution of error among landmarks and variables, as well as between projections. Results: The average error due to landmark digitization, s(i), determined by duplicate digitization and calculated by use of Dahlberg's formula was 0.8 mm for linear variables and 1.6 degrees for angular variables. Conclusion: This method of infant cephalometry has been shown to be highly accurate and reproducible, and it adds significant new potential for, e.g., asymmetry detection, population comparison, and growth measurements compared to other cephalometric techniques due to its standardized acquisition and digitization protocol, inclusion of an axial projection, and the large number of well-defined landmarks and variables involved.
Incisive Suture (Fissure) in the Human Fetus: Radiographic and Histologic Study
Authors: Vacher Christian , Sakka Michel , Dauge Marie-Christine 
Published: October 2018

Objective: An anatomic study, in man, of the structure commonly known as the incisive suture (sutura incisiva) or incisive fissure has been performed to determine whether this structure belongs to the morphofunctional concept of a facial suture. Material: Eighteen palates of human fetuses of 9 weeks to 29 weeks after conception. Method: Anatomic, radiographic examination of the palate. Histologic study of sagittal and parasagittal sections of the palates (3 mm each). Results: The histologic aspect is that of a facial suture, with very poor vascularization. This suture is partial, limited laterally by osseous trabeculae. Conclusions: This particular suture, whose function in growth of the palatal process of the maxilla is discussed, could represent the phylogenetic vestige of the incisive-maxillary suture present in all nonhuman mammals.
Food and Drug Administration Regulation of Orthotic Cranioplasty
Authors: Littlefield Timothy R. 
Published: October 2018

Objective: To present information regarding the current federal regulation of cranial orthotics used for the treatment of deformational plagiocephaly as well as to discuss concerns raised by the Food and Drug Administration regarding the safety and effectiveness of these devices. Background: Although first introduced in 1979, the use of orthotic helmets for the treatment of deformational plagiocephaly was slow to gain acceptance. However, with the recent increase in infants presenting with this condition, numerous orthotic treatment programs have been established throughout the country. Until recently, federal regulation of this “industry” was largely ignored. Regulation: In 1995 our office was served notice that our orthosis would require clearance from the FDA. Since the FDA had never approved a medical device of this kind, clearance presented a significant challenge. However, after 3 years of providing clinical data, clearance was finally granted, and a new device category known generically as “cranial orthosis” was created. A cranial orthosis is considered to be a Class II neurology device and requires both general and special controls in order to ensure its safety and effectiveness. Summary: Orthotics used for the treatment of deformational plagiocephaly are regulated by the FDA and are considered Class II neurology devices. Submission of a premarket notification (510[k]) is required prior to placing these devices on the market.
Patterns of Body and Visceral Growth in Human Prenates with Clefts of the Lip and Palate
Authors: Spyropoulos Meropi N. , Burdi Alphonse R. 
Published: October 2018

Objective: To address the hypothesis that human prenates with birth defects such as clefts of the lip and palate show growth patterns in which body size and visceral growth are aberrant for prenatal age. Methods: Body size and organ weight measurements were derived from a cross-sectional population sample of 167 legally donated human embryos that were representative of key periods in visceral organogenesis and growth. Measurements included those of overall body size (i.e., length and weight) and weights of major organs. Data were analyzed for two comparative (age-matched) groups consisting of 120 typical-for-age “control” and 47 specimens showing the three typical cleft types. Organ weight data for the entire cleft group and for each of the three cleft subgroups were compared with those of the control group. Results: Cleft specimens showed crown-rump body sizes that were within one standard deviation of the control group. Among the entire cleft sample, each of the organ weight values was generally consistent with the organ weights observed for the age-matched control group. When organ weights for the cleft group differed from the controls, with one exception, some organs showed either increased or decreased organ weights. One remarkable exception was with lung weights, which were reduced for each of the prenates across the three cleft types. Among the three cleft groups, fetuses with cleft lip and palate showed the highest percentage of organ weight discrepancies (i.e., smaller than expected) as compared with the group with cleft palate, which showed the lowest. Conclusions: Organ weight aberrancies were observable (whether increased or reduced weights), and such aberrancies were not apparent until approximately 24 weeks (fertilization age).
Investigations of a Pressure-Sensitive Theory of Marginal Velopharyngeal Inadequacy
Authors: Karnell Michael P. , Schultz Kara , Canady John 
Published: October 2018

Purpose: This two-part project was designed to test a pressure-sensitive theory of marginal velopharyngeal inadequacy (MPVI). Specifically, are select subgroups of children with MPVI perceived as hypernasal because they fail to achieve consistent closure during vowels and semivowels while demonstrating adequate closure during pressure consonants? Methods: In part one, 36 children with cleft palate and other craniofacial anomalies were examined using a clinical assessment protocol that included nasometry and perceived ratings of hypernasal resonance. Children with nasalance percentages above threshold during low-pressure (LP) productions and below threshold for high-pressure (HP) productions were placed in one group (group 1), while children with nasalance percentages below threshold for both LP and HP sentences were placed in another (group 2). Children in the two groups were age- and sex-matched. In part two, endoscopic data were examined for 10 additional children who received nasometry, perceived hypernasal resonance scores, and videoendoscopy on the same day and who received higher mean nasalance measures during production of LP sentences than during production of HP sentences. Results: The results of part one confirmed that children in group 1 were perceived as being significantly more hypernasal than children in group 2 (meangroup 1 = 2.17, meangroup 2 = 1.50; t = 2.75, p = .01). However, results of endoscopic testing failed to demonstrate a consistent observable physiologic pattern of velopharyngeal inadequacy that would confirm the theory that some patients with MVPI are perceived as being hypernasal because of difficulty achieving velopharyngeal closure during vowels and semivowels. Conclusions: The findings provide partial support for a pressure-sensitive theory of MVPI and demonstrate the value of using both HP and LP sentences to evaluate patients with MVPI.