bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison between Two Types of Pharyngeal Flap with Regard to Configuration at Rest and Function and Speech Outcome
Authors: Karling Jonas , Henningsson Gunilla , Larson Ola , Isberg Annika 
Published: October 2018

Objective In management of hypernasality, wide pharyngeal flaps have been advocated when pharyngeal wall adduction is limited. Pharyngeal flaps merged into a transversely split velum (TS flaps) are reported to be wider than if the velum is split in the midline (MS flaps). The hypothesis to be tested was that TS flaps are wider than MS flaps and are more caudally based. Design In this prospective study, MS flaps were videoradiographically and nasopharyngoscopically compared with TS flaps at both rest and function. Pharyngoplasty was randomly performed by one of three surgeons and the radiographic examinations were carried out by one radiologist The speech was assessed pre- and postoperatively. Setting The Stockholm Cleft Palate Team, Sweden, treated all patients. Patients After strict selection of the patients to avoid any uncontrolled impact on velopharyngeal sphincter function, 22 patients with limited pharyngeal adduction received TS flaps and 20 patients with good adduction received MS flaps. Results The data failed to show any difference in location of flap base and in flap width at rest. During function, TS flaps demonstrated statistically significant widening of the flap base. TS flaps, but not MS flaps, often had a bulge that appeared to assist velopharyngeal closure in some patients. Speech evaluation revealed that both flap types corrected velopharyngeal insufficiency equally well. Conclusions TS flaps were not wider than MS flaps, and functional plasticity of the TS flap appeared essential for elimination of velopharyngeal insufficiency. Contribution of postoperative adaptation of the pharyngeal wall adduction remains to be clarified.
Effect of Placement of a Speech Appliance on Levator Veli Palatini Muscle Activity during Blowing
Authors: Tachimura Takashi , Nohara Kanji , Hara Hisanaga , Wada Takeshi 
Published: October 2018

Objective We have observed clinically that some speakers wearing a speech appliance for correction of velopharyngeal incompetence can blow with variable intensity without nasal air escape. This clinical finding suggests that tightness of velopharyngeal closure may be regulated in accordance with oral air pressure during blowing. The purposes of this electromyographic study were (1) to examine whether levator veli palatini muscle activity can be changed in relation to oral air pressure during blowing when the speech appliance is removed, (2) to clarify whether or not the change is related to the severity of velopharyngeal incompetence, and (3) to examine whether placement of a speech appliance can alter levator muscle activity into the equivalent of that of normal speakers during blowing. Design Eight patients with repaired cleft palate, who routinely wear a palatal lift prosthesis (PLP) or a hybrid speech appliance of a pharyngeal bulb and palatal lift (bulb-PLP), served as subjects. Subjects were classified into one of two groups according to their speech appliance (PLP group and bulb-PLP group). Electromyography of the levator veli palatini muscle was recorded with a speech appliance in place and then with the speech appliance removed as the subject blew through a tube at three different effort levels. Results In the removed condition, the change in levator activity in relation to oral air pressure was variable across subjects in the bulb-PLP group, whereas levator activity changed in relation to oral air pressure change for all subjects in the PLP group. However, levator activity changed in relation to oral air pressure with either speech appliance in place for all subjects irrespective of their speech appliance types. Conclusion The severity of velopharyngeal incompetence might be related in part to change in levator activity in association with oral air pressure. The effect of a speech appliance to correct velopharyngeal incompetence might consist not only of mechanical obturation of the velopharynx but also of alteration of velopharyngeal function to become similar to normal speakers. Moreover, it is likely that the velopharyngeal system could be well regulated so as to exhibit a consistent outcome of velopharyngeal function.
Perception of Middorsum Palatal Stops from the Speech of Three Children with Repaired Cleft Palate
Authors: Santelmann Lynn , Sussman Joan , Chapman Kathy 
Published: October 2018

Objective The purpose of this study was to examine listeners' perception of the middorsum palatal stop, a compensatory articulation used by individuals with repaired cleft palates. Design This study tested whether listeners could discriminate middorsum palatal stops from matched alveolar (/t/) and velar (/k/) stops using a two-button “change/no-change” procedure. It also explored how listeners identified the palatal stop by rating each sound on a scale of one to eight. Participants Twenty listeners, 10 untrained and 10 trained in general phonetics (graduate students in speech-language pathology), participated in discrimination and identification tasks during a 1-hour session in the Speech Perception Laboratory at the University of Buffalo. Measures Discrimination was measured using d-prime, a score based on listeners' hits, correct rejections, misses, and false alarms to the changes/no changes in the stimuli. Identification was measured by the mean rating score for each class of stops. Results Listeners discriminated middorsum palatal stops from alveolar and velar stops, but their ratings for the middorsum palatal stops did not differ from those for the regular stop consonants. The two groups differing in phonetic training did not perform differently. Conclusions Listeners can discriminate middorsum palatal stops from other stop articulations, but they did not identify them differently from alveolar and velar stop consonants. The results suggest that considerable training listening to middorsum palatal stops is necessary for listeners to be able to reliably identify them.
Sternocleidomastoid Imbalance versus Congenital Muscular Torticollis: Their Relationship to Positional Plagiocephaly
Authors: Golden Kerry A. , Beals Stephen P. , Littlereld Timothy R. , Pomatto Jeanne K. 
Published: October 2018

Objective The purpose of this study was to investigate the existence of sternocleidomastoid (SCM) imbalance in a plagiocephalic population and further clinically describe its difference, if any, from congenital muscular torticollis (CMT). If SCM imbalance is different from CMT, then the development of terminology and a differential diagnosis may allow early recognition and intervention and possible prevention of positional plagiocephaly in the first place. Design This was a retrospective, random review of 100 patients referred for orthotic correction of their positional plagiocephaly. Setting The data was collected in a private orthotic clinic and was directed by a physical therapist. The patients were seen on a weekly or biweekly basis. Patients Eighty-three patients diagnosed with positonal plagiocephaly that were referred for Dynamic Orthotic Cranioplasty™ during 1996 were studied. Results Sixty-four percent of the sample was identified as having SCM imbalance and 12% was diagnosed with CMT. There were no statistically significant differences between the characteristics of these two groups in relation to the etiological factors of positional plagiocephaly. The only observed difference was related to symptoms of the neck itself. Conclusions Seventy-six percent of the sample was found to have some degree of SCM dysfunction, whether it be SCM imbalance or CMT. The finding that over three quarters of our population suffers from some form of SCM dysfunction, either SCM imbalance or CMT, suggests that any degree of SCM dysfunction may act as a precursor to positional plagiocephaly and therefore should be recognized and treated at the earliest opportunity.
State of the Art in Oral and Maxillofacial Surgery: Treatment of Maxillary Hypoplasia and Anterior Palatal and Alveolar Clefts
Authors: Steinberg Barry , Padwa Bonnie L. , Boyne Philip , Kaban Leonard 
Published: October 2018

As the new millennium approaches, it seems appropriate to look back at where we have been and where we are going with the care of patients with facial deformities. None of us can deny that although changes have been made, many current treatment modalities are no more than modifications of old techniques. We are, however, poised to make dramatic improvements in the management of facial abnormalities as we enter the new century and millennium. Biotechnology, genetic manipulation, and new surgical technology will become pervasive, and perhaps we will move from “modification” of the old into a completely new era of therapeutic approaches to the care of dentofacial deformities. “Opportunities multiply as they are seized” (from Sun Tzu), and the time of opportunity is approaching. This review will attempt to look at the state of the art in cleft care and in oral and maxillofacial surgery: where we have been and where we are going. It will be clear that there is overlap between specialties and that these overlaps will become greater as new regimens in the care of facial deformities come to the forefront.
Shape Changes in the Cleft Palate Maxilla: A Longitudinal Study
Authors: Lestrel Pete E. , Berkowitz Samuel , Takahashi Osamu 
Published: October 2018

Objective The purpose of this study was to compare the shape of the maxilla in Norma lateralis of cleft lip and palate (CLP) patients with non-CLP controls matched for sex and age. This study utilized elliptical Fourier functions to assess the presence of residual shape changes in the cleft palate maxilla after treatment, compared with controls. Design Longitudinal data (n = 25) were available from the Miami Craniofacial Anomalies Foundation. From these data, two samples were selected: group I (mean age and SD, 5.06 ± 1.82 years) after lip surgery and the initiation of palate surgery and group II (16.58 ± 2.42 years) well after the conclusion of surgery. Twenty-two of these patients were matched with controls (5.11 ± 1.33 and 15.91 ± 2.25 years, respectively). The maxillary outline as seen on the lateral radiograph was (1) traced, (2) fitted with a series of 48 closely placed points, (3) digitized, and (4) submitted to a specially written routine that computes elliptical Fourier functions (EFFs). These EFFs are close analogs of the bounded maxillary outline as judged by the residual or difference between the observed points and the predicted points generated by the Fourier function. Each maxillary outline was subsequently standardized for size and corrected for positioning in two-dimensional space. Results and Conclusions Utilizing a three-way multivariate analysis of variance, statistically significant shape differences were obtained for both young and older groups, as well as between the CLP and controls. No significant gender differences were found. Morphological differences consisted of a posterior repositioning of the nasal crest aspect in the CLP cases. These results suggest that although a clinically satisfactory treatment result was obtained, differences in maxillary shape remain.
Effect of Primary Repositioning of the Nasal Septum on Facial Growth in Unilateral Cleft Lip and Palate
Authors: Šmahel Zbynĕk , Müllerová Živa , Nejedlý Aleš 
Published: October 2018

Objective The objective of this study is to evaluate whether manipulation of the nasal septum, its release, and changing of its abnormal position in infancy has an impact on maxillary growth and facial development in patients with unilateral cleft lip and palate. Design Roentgencephalometric investigation. Setting Cleft Centre at the Clinic of Plastic Surgery, Prague. Patients Two consecutive groups of male patients (n = 32 and 30) with complete unilateral cleft lip and palate without associated malformations at 15 years of age. Interventions The patients were operated on by the same team of surgeons and by the same method (lip: Tennison and primary periosteoplasty; palate: pushback with pharyngeal flap surgery), with the exception of complete primary repositioning of the nasal septum performed only in one group. Main outcome measures Roentgencephalometric data of both series of patients were compared with a t-test. All measurements were performed by one investigator. Results Patients with primary repositioning of the nasal septum had a more favorable nasal prominence and better vertical growth of the upper and whole face in posterior height. Better growth in anterior height was only suggested; maxillary retrusion was equal in both groups. Conclusions Primary repositioning of the nasal septum has a favorable effect on nasal development, and it neither deteriorates nor markedly improves maxillary growth in patients with unilateral cleft lip and palate.
Half Nose with Ipsilateral Eye and Ear Anomalies and Facial Asymmetry: Report of a Case with Cephalometric Analysis and Orthodontic Treatment
Authors: Motohashi Nobuyoshi , Kuroda Takayuki , Cohen M. Michael 
Published: October 2018

Objective Unilateral nostril agenesis together with ipsilateral alterations of the eye, ear, and face make up a spectrum of anomalies. The aim of this study is to report a case in a Japanese girl, 14 years, 5 months of age. Cephalometric analysis is provided, and orthodontic treatment is discussed. Design Lateral and frontal cephalograms were compared to a Japanese control group. Outcome of the orthodontic treatment was evaluated by comparing cephalograms taken before and after orthodontic treatment. Results The lateral cephalometric analysis showed a severely hypoplastic maxilla in both sagittal and vertical dimensions, coupled with a decreased posterior cranial base. The mandibular rami were asymmetric. The frontal cephalogram showed decreased cranial width and maxillary alveolar width, together with an Increased interorbital distance. Conclusions Serial lateral cephalograms during the orthodontic treatment from the age of 14 to 20 years demonstrated no significant maxillary growth and some mandibular growth, coupled with labial tipping of the maxillary central incisors.
Symmetry and Morbidity Assessment of Unilateral Complete Cleft Lip Nose Corrected with or without Primary Nasal Correction
Authors: Brusse Cindy A. , Van Der Werff John F.A. , Stevens H.P. Jeroen D. , Vermeij-Keers Christl , Prahl-Andersen Birte , Van Der Meulen Jacques C. , Vaandrager J. Michiel 
Published: October 2018

Objective Unilateral complete cleft lip patients treated with or without a primary nasal correction at the time of cleft lip repair were compared to evaluate the relevance of early surgical correction of the nose by using two assessments: nasal symmetry and morbidity. Design, Setting, Patients The no nasal correction group (NNC, n = 19) was operated by surgeon A using the Millard technique. The primary nasal correction group (PNC, n = 9) was operated by surgeon B combining the modified Millard technique with a columellar lift and alar mobilization. Symmetry was assessed on two sets of standardized photographs at 9 years of age using a computer-assisted analysis. Both cleft groups were compared with normal controls (NC, n = 20). The computer method included area and angular measurements. Morbidity was assessed by the number of procedures on the vermilion, the lip, and/or nose for revisional surgery up to the age of 9 (NNC, n = 26; PNC, n = 12). Results No significant differences in symmetry were found between the NNC and PNC groups regarding the area and angular measurements. With regard to the area measurements, both cleft groups produced a significant asymmetry when compared to the NC group. Concerning the angular measurements, however, the NNC group differed significantly from the NC group, whereas such a difference could not be noted between the PNC group and NC group. With respect to morbidity, no revisional procedures were performed in the PNC group. The number of revisional procedures in the NNC group was 16 in 10 patients. Conclusion Results are presented that favor, up to the age of 9 years, a primary nasal correction at the time of cleft lip repair.
Long-Term Effects of Nasoalveolar Molding on Three-Dimensional Nasal Shape in Unilateral Clefts
Authors: Maull Deirdre J. , Grayson Barry H. , Cutting Court B. , Brecht Larry L. , Bookstein Fred L. , Khorrambadi Deljou , Webb Jon A. , Hurwitz Dennis J. 
Published: October 2018

Objective: This objective of this study was to determine the effect of presurgical nasoalveolar molding on long-term nasal shape in complete unilateral clefts. Design: The study was retrospective, and the subjects were chosen at random. Nasal casts of the subjects were scanned in three dimensions. Each nose was best fit to its mirror image, and a numerical asymmetry score was determined. Setting: All patients were treated at the Institute of Reconstructive Plastic Surgery, NYU Medical Center, New York, New York. Patients: The study subjects (n = 10) were selected from a group that had undergone presurgical nasal molding in conjunction with alveolar molding. The control subjects (n = 10) were selected from a group that had undergone presurgical alveolar molding alone. Interventions: All subjects underwent presurgical orthopedic treatment until the age of approximately 4 months at which time the primary surgery was performed. Main Outcome Measure: The nasal shape following nasal molding should be more symmetrical than if molding had not been done. Results: The mean asymmetry index for the nasoalveolar molding group was 0.74, and the control group was 1.21. This difference was statistically significant (p < .05). Conclusions: Presurgical nasoalveolar molding significantly increases the symmetry of the nose. The increase in symmetry is maintained long term into early childhood. The limitations of this study include (1) asymmetry alone is not an adequate shape result in most situations, (2) the children evaluated in this study were not fully grown, and (3) the control group was not age matched.
Maxillary Growth in Patients with Clefts following Secondary Alveolar Bone Grafting
Authors: Levitt Terry , Long Ross E. , Trotman Carroll-Ann 
Published: October 2018

Objective: This investigation evaluated the effects of secondary alveolar bone grafting on subsequent maxillary growth in cleft patients. Design: This was a retrospective longitudinal cephalometric study. Nineteen patients who had received secondary alveolar bone grafts were matched to a control sample by sex, cleft, availability of longitudinal records, and presurgical cranial base dimensions and growth direction. All patients had at least two lateral cephalometric radiographs before surgery and two radiographs after surgery. Setting: The records were obtained from the Longitudinal Growth Study of the Lancaster (Pennsylvania) Cleft Palate Clinic. Interventions: All patients had received similar primary surgical procedures by the same surgeon, no orthopedics, and similar mixed-dentition orthodontics. Secondary alveolar bone grafting was the only surgical intervention different between the two groups. Main outcome measures: Six measures of maxillary sagittal and vertical growth were taken from 235 radiographs. Slopes of the regression lines for each growth dimension were compared between groups both pre- and post-surgically. Results: There were no significant between-group differences in maxillary sagittal or vertical growth following the grafting procedure. Anterior maxillary vertical growth rates decreased in the grafted group when their pre- and post-surgical rates were compared. Several growth trends in the postsurgical period were found to be continuations of the rates documented presurgically and unrelated to the grafting procedure. Conclusions: When evaluated longitudinally, maxillary growth in patients having received secondary alveolar bone grafting did not differ from a group of matched controls.
Aesthetic and Functional Outcome of Surgical and Orthodontic Correction of Bilateral Clefts of Lip, Palate, and Alveolus
Authors: Gaggl Alexander , Schultes Günter , Kärcher Hans 
Published: October 2018

Objective: To assess the aesthetic and functional long-term results of surgical and orthodontic treatment of patients with bilateral cleft lip, palate, and alveolus. Design: Long-term follow-up study. Setting: Teaching hospital in Austria. Patients: Twenty adult patients who had been operated on as children for bilateral cleft lip, palate, and alveolus. Interventions: Lateral cephalometric and model analysis. The sum of all mesiodistal tooth diameters in the maxilla and mandible were compared with standard Bolton tracings. Main outcome measures: Aesthetic and functional results. Results (model analysis): The upper arch was too wide in 12 patients and the mandibular arch was too wide in 4 patients. In 11 patients, the lateral teeth were crowded, and all had a persistent transverse space deficit and a reduction in sagittal measurements. Fifteen patients had alveolar midline displacement of the maxilla as well as of the mandible. Results (lateral cephalometric measurements): The lateral cephalograms showed a mean sella-nasion-A point angle of 77° and a maxillary baseline-nasion-sella line angle of 9°, indicating a tendency toward maxillary retrognathia. An anterior facial height index of 42% (compared with the standard 58%) indicated a slight reduction in midface height with consequent increase in the height of the lower face. Conclusion: There is specific growth impairment of the midface in adults who were treated as children for bilateral clefts of lip, palate, and alveolus. An optimal result can be achieved only by additional orthognathic surgery (Le Fort II osteotomy).