bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distribution Patterns of Primary and Permanent Dentition in Children with Unilateral Complete Cleft Lip and Palate
Authors: Tsai Tzong-Ping , Huang Chiung-Shing , Huang Chuan-Chuan , See Lai-Chu 
Published: October 2018

Objective To investigate the distribution patterns of primary and permanent teeth in the cleft area and the numerical variation in teeth in unilateral complete cleft lip and palate (UCLP) patients. Design A survey of the dentition in UCLP patients. Setting Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan. Patients 137 UCLP patients who met the following criteria: (1) have had at least one panoramic film taken, (2) the first panoramic film illustrates either primary or early mixed dentition. Evaluation of both permanent and primary dentition was available in 91 cases. Main Outcome Measures Two evaluators performed independent evaluations of number and distribution of teeth in UCLP patients. The hypothesis that there are two odontogenic origins for maxillary lateral incisors was proposed to explain the occurrence of distribution patterns of dentition in the cleft area and to explain differences between primary and permanent dentition in UCLP patients. Results Four distribution patterns in the cleft area were identified in both the primary and the permanent dentition. In the primary dentition, placement of the lateral incisor distal to the alveolar cleft was the predominant pattern (pattern y, 82.4%), followed by absence of the cleft side maxillary lateral incisor (pattern ab, 9.9%), presence of one tooth on each side of the alveolar cleft (pattern xy, 5.5%), and placement of the lateral incisor mesial to the alveolar cleft (pattern x, 2.2%). In the permanent dentition, the most common pattern was the absence of the maxillary lateral incisor on the cleft side (pattern AB, 51.8%), followed by lateral incisor placement distal to the alveolar cleft (pattern Y, 46%), lateral incisor placement mesial to the alveolar cleft (pattern X, 1.5%) and the presence of one tooth on each side of the alveolar cleft (pattern XY, 0.7%). The discrepancy between the distribution patterns of primary dentition and permanent dentition successors is 57.1%. Variations in tooth number in both primary and permanent dentition of UCLP patients occurred most often in the cleft area. Abnormalities in the number of teeth (hypodontia or hyper-dontia) outside the cleft area were more common in the permanent dentition than in the primary dentition (24.1% versus 4.4%). Conclusions Four distribution patterns in the cleft area were identified in both sets of dentition. Our findings of distribution patterns in UCLP patients support the hypothesis that there may be two odontogenic origins for maxillary lateral incisors. Clinicians involved in managing the dentition of UCLP patients should consider the high frequency of numerical variation both in and outside the cleft area before starting dental treatment.
Characteristics of Jaw Growth in Cleidocranial Dysplasia
Authors: Ishii Kazuhiro , Nielsen Ib Leth , Vargervik Karin 
Published: October 2018

Objective The purpose of this pilot study was to assess craniofacial morphology in young and adult individuals with cleidocranial dysplasia (CCD). Design Craniofacial morphology in young individuals (primary dentition) and in young adults was compared with control data using ratios and angles obtained from lateral head films. Setting The CCD individuals were referred to the Center for Craniofacial Anomalies for diagnostic workup and treatment recommendations. Subjects The sample consisted of 14 Caucasians. The inclusion criterion for the young, prepubertal group (A) was complete primary dentition, and for the adult, postpubertal group (B), the eruption of all four first molars was required. Interventions No treatment other than extraction or surgical removal of selected primary or supernumerary teeth was performed. Results Both groups showed significantly smaller anterior upper face height compared with controls. Group B subjects demonstrated significantly smaller face height values than the controls in the A point-nasion-B point (ANB) angle, facial axis, mandibular plane angle, palatal plane/mandibular plane angle, and gonial angle. No significant differences were found between group A individuals and the controls for these measurements. The older group had shorter anterior lower face height compared with both anterior upper face height and posterior lower face height. Conclusions Whereas young CCD subjects showed relatively normal jaw proportions and morphology of the mandible, older CCD individuals tended to have short lower face height, acute gonial angle, anterior inclination of the mandible, and mandibular prognathism. These differences can be attributed to pronounced horizontal mandibular growth resulting from lack of vertical maxillary growth and impaired eruption of permanent teeth.
Temporal Characteristics of Velopharyngeal Function in Children
Authors: Leeper Herbert A. , Tissington M. Lynn , Munhall Kevin G. 
Published: October 2018

Objective This investigation was designed to examine the performance of children with normal speech on temporal aspects of aerodynamic tasks related to velopharyngeal closure. Design The investigation was a descriptive evaluation of variability in aerodynamic features related to velopharyngeal function during multiple repetitions of the word “hamper.” Setting Children without speech or velopharyngeal difficulties were seen in an experimental laboratory setting for the evaluation procedures. Participants Twenty-seven subjects were recruited for the experiment. Three subjects were rejected because of behavioral difficulties, and the remaining 24 subjects were subdivided into 4 groups of 6 children (3 males and 3 females) aged 3, 6, 9, and 12 years. The children, who were from local schools and day care centers, volunteered to participate in the experiment. All of the children had age-appropriate speech, language, and hearing abilities, as determined by screening tests administered by one of the examiners (L.T.). Main Outcome Measures Mean and variability of pressure-flow measures of peak intraoral air pressure and peak nasal airflow and the temporal measures accompanying each air pressure or airflow pulse were evaluated for the age groups of children examined in the experiment. Results The aerodynamic procedures employed to evaluate velopharyngeal closure during speech were reliable for use with young children. There was a numerical trend toward decreased duration of the temporal parameters with increasing age. Thus, children demonstrated durational values similar to those previously reported for normal-speaking adults. In general, peak oral air pressure and nasal airflow values were like those of previous investigations and demonstrated low variability across all age groups of children tested. Conclusions The data from the present investigation provide a preliminary base for comparison of temporal features of velopharyngeal closure for the aerodynamic evaluation of children with impaired velopharyngeal function.
Short-term Cost-effectiveness Analysis of Presurgical Orthopedic Treatment in Children with Complete Unilateral Cleft Lip and Palate
Authors: Severens Johan L. , Prahl Charlotte , Kuijpers-Jagtman Anne M. , Prahl-Andersen Birte 
Published: October 2018

Objective The aim of this article was to investigate cost-effectiveness in cleft palate treatment using cost-effectiveness of presurgical orthopedic treatment (PSOT) as an example. Design A three-center randomized clinical trial compared PSOT with non-PSOT for children with unilateral cleft lip and palate (UCLP, n=52). Patients The inclusion criteria for the trial were: complete UCLP, no other malformations, born at term, both parents Caucasian, trial entrance preferably within 2 weeks after birth, and informed consent by the parents. Interventions PSOT was performed by means of a passive plate according to Hotz and Gnoinski. Main Outcome Measure The short-term cost-effectiveness of PSOT was based on the time taken for the surgical lip closure procedure. Medical and nonmedical costs until surgical lip closure at 18 weeks of age were analyzed. Results The durations of the surgical lip closure procedures did not differ significantly (57.2 minutes for PSOT and 56.4 minutes for non-PSOT). The mean medical cost for PSOT treatment was US$852. The non-PSOT treatment group had a significantly different mean medical cost (US$304). Mean travel costs and indirect nonmedical costs were US$128 and US$231 for PSOT and US$79 and US$130 for non-PSOT, respectively. Conclusions The combination of a clinical trial and an economic evaluation makes it possible to relate effects to costs involved in treatment alternatives. Longer-term costs and effects will be incorporated into an extended cost-effectiveness analysis to determine the cost-effectiveness of PSOT.
Location and Distribution of Epithelial Pearls and Tooth Buds in Human Fetuses with Cleft Lip and Palate
Authors: Arnold W.H. , Rezwani T. , Baric I. 
Published: October 2018

Objective The purpose of this study was to establish the location and distribution of epithelial pearls and tooth buds in cleft palate fetuses, relative to the time of palate fusion. Design The facial skeletal structures, dental laminae, tooth buds, and epithelial pearls were examined in seven spontaneously aborted human fetuses, of which five had unilateral or bilateral cleft lip and palate or cleft palate. The sectioned fetuses were reconstructed by 3D-computer technology. Results Epithelial pearls were found in four of the investigated cases, of which one was a control specimen. They were located at the margins of the palatal shelves. In the cleft lip and palate cases, the cleft was found in the premaxilla between the first and second incisor tooth. The premaxilla was found to be hypoplastic in both bilateral cleft lip and palate cases and was totally absent in the unilateral cleft lip and palate case. The maxilla was hypoplastic in one case with unilateral cleft lip and palate. In all other specimens, it was developed symmetrically. Conclusions The results indicate that cleft lip and palate development may occur after the fusion of the frontonasal prominence with the maxillary prominence and the palatal shelves, as well as a nonfusion of the palatal shelves in the secondary palate.
HONC Measures in 4- to 6-Year-Old Children
Authors: Mra Zan , Sussman Joan E. , Fenwick Julie 
Published: October 2018

Objective To collect normative data using Horii's Oral Nasal Coupling Index (HONC) from 4- to 6-year-old children without cleft palate to be used in the evaluation of young children with cleft palate. In addition, to determine whether HONC values in children are similar to those of adults and thus show that the HONC ratio successfully normalizes nasal accelerometric signals across age, gender, and vocal intensity. Design Measurement of accelerometric and acoustic signals from novel nasal and nonnasal utterances, which the children repeated after the experimenter. Measurements also included four sustained [m] productions, which were used to calibrate correction factors used to equate nasal and oral signals during a sustained [m] production. Setting Laboratory at a state university. Participants Ten girls and 10 boys, aged 4 to 6 years, with normal speech, language, and hearing. Results Differences of 13 dB (HONC) were found to separate nasal from nonnasal sentences. No significant difference in HONC score was found across gender for nasal/nonnasal sentences and [m] productions. The correction factors generated during [m] calibration procedures did not differ between girls and boys. Conclusions Horii Oral Nasal Coupling Index differences between nasal and nonnasal utterances appear to be valid and reliable measures in both children and adults for detection of disorders of nasal resonance.
Conversational Skills of Preschool and School-Age Children with Cleft Lip and Palate
Authors: Chapman Kathy L. , Graham Karen Tecco , Gooch Janet , Visconti Colleen 
Published: October 2018

Objective The purpose of this study was to examine the conversational skills of preschool and school-age children with cleft lip and palate. Design The children were audio- and videotaped during interactions with an unfamiliar adult. In addition, standardized measures of speech and language were administered, and ratings of resonance were obtained. Comparisons were made between the children with cleft lip and palate and their same-age peers on measures of conversational participation and a standardized test of pragmatic skills. Participants Participants were 20 children with unilateral cleft lip and palate (10 preschoolers and 10 school-age children) recruited from the Craniofacial Team at Rainbow Babies and Children's Hospital, Cleveland (OH) and 20 noncleft peers matched for gender, age, and socioeconomic status. Main outcome Measures Separate comparisons were made for the preschool children with cleft lip and palate and their noncleft peers, and the school-age children with cleft lip and palate and their noncleft peers on eight measures of conversational assertiveness/responsiveness and the standardized tests of pragmatics. Next, each child with cleft lip and palate was classified for level of conversational participation. Results Paired t tests revealed no significant differences between the preschool and school-age children with cleft lip and palate and their noncleft peers in level of conversational participation. However, individual child comparisons revealed less assertive profiles of conversational participation for 50% of the preschool and 20% of the school-age children with cleft lip and palate. Conclusions Children with cleft lip and palate may show a less assertive style of conversational participation, at least during the preschool years. Therefore, craniofacial team evaluations should include examination of conversational competency, particularly for children who are demonstrating difficulty with other aspects of speech, language, or social development.
Psychosocial Adjustment in Twin Pairs with and without Hemifacial Microsomia
Authors: Maris Catherine L. , Endriga Marya C. , Omnell M. Lena , Speltz Matthew L. 
Published: October 2018

Objective To compare the psychosocial adjustment of children with and without hemifacial microsomia (HFM). Design This cross-sectional pilot study investigated psychosocial adjustment of twin pairs in which one twin was affected with HFM and the other was unimpaired. Data were analyzed using paired t tests. Setting The dental medicine clinic of a large urban children's hospital, serving a multistats area. Participants Participants were six twin pairs aged 9 to 15 years and their parents. Data were also collected from classroom teachers. Main outcome Measures Outcome measures included: the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), the Coopersmith Self-Esteem Inventory (SEI), and a structured self-concept interview (the Self-Interview). Results Children with HFM had significantly higher CBCL and TRF total behavior problem scores and lower SEI general self-esteem scores than their unimpaired twins. No differences were found in CBCL competence scores. Interview data revealed concerns among the HFM group related to appearance, negative social responses, and fear of hospital procedures. Children also reported positive aspects of coping with HFM. Conclusions The results of this study suggest that, similar to other craniofacial conditions, HFM is associated with an elevated risk for childhood psychosocial difficulties. Replication of specific findings with a larger sample is needed. Multicenter, collaborative studies are a crucial next step for this field.
A Finite Element Model of the Soft Palate
Authors: Berry David A. , Moon Jerald B. , Kuehn David P. 
Published: October 2018

Objective As a step toward better understanding of normal and abnormal velar control, a finite element model of the soft palate was developed. Design A static two-dimensional midsagittal model of the velum was given physical dimensions to match that of a 10-year-old boy. Biomechanical properties of the tissues were inferred based on previous histologic studies. Velar movements were induced by the influence of three extrinisic velar muscles: the levator veli palatini, the palatoglossus, and the palatopharyngeus, which were simulated as external forces acting on the velar model. Results and Conclusions Velopharyngeal opened and closed positions were simulated as well as a variety of intermediate steps between the two configurations. Velopharyngeal closure was also simulated in a manner appropriate for both high and low vowels. Future extensions of the model will incorporate the muscles as an intrinsic component of the model and will include a full time-dependent implementation, including inertial effects. Future studies will compare model predictions with experimental data from the laboratory, including both kinematic data and velopharyngeal closure forces.
Brain Growth Rates in Craniosynostotic Rabbits
Authors: Cooper Gregory M. , Mooney Mark P. , Burrows Annie M. , Smith Timothy D. , Dechant Jason , Losken H. Wolfgang , Marsh Jeffrey L. , Siegel Michael I. 
Published: October 2018

Objective It has been suggested that abnormal brain morphology or growth rates may be a primary causal factor of craniosynostosis due, in part, to a lack of normal growth stretch and tension at the suturai margins. The purpose of the present study was to quantify cerebral hemisphere morphology and growth in a rabbit model of nonsyndromic coronal suture synostosis to determine whether cerebral dysmorphology is primary or secondary to synostosis in this model. Design Fifty-seven brains (114 hemispheres) were examined from 40 normal control rabbits and 17 rabbits with bilateral coronal suture synostosis ranging in age from 25 to 450 days postconception (synostosis occurs at approximately 23 days postconception in this model). The calvariae were removed, the brains were fixed in 10% paraformaldehyde, and in situ bilateral measurements of cerebral hemisphere length and cerebral hemisphere width were obtained using a Wild microscope with a camera lucida attachment and digital caliper. Regression analysis was used to compare cerebral cortex growth rates by age between the two groups. Results Cerebral hemisphere width and cerebral index regression line slopes had similar y intercepts (23 day postconception) with significantly (p < .05) diverging slopes over time. Normal rabbits increased more rapidly than synostosed rabbits. No significant (p > .05) differences were noted in regression line slopes between groups for cerebral hemisphere length by age or length by width. Conclusions Cerebral dysmorphologies are probably a compensatory, secondary (postsynostotic) event and not a primary causal factor of craniosynostosis in this rabbit model of human familial, nonsyndromic coronal suture synostosis.
The Efficacy of Perioperative Steroid Therapy in Pediatric Primary Palatoplasty
Authors: Senders Craig W. , Di Stephen M. , Brodie Hilary A. , Emery Brian E. , Sykes Jonathan M. 
Published: October 2018

Objective To determine if perioperative steroid therapy benefits pediatric primary palatoplasty patients. Design A prospective, double-blind, randomized trial with a placebo control. Setting An academic medical center. Patients Forty-five children undergoing primary repair of their cleft palate between 1989 and 1996 who were under the age of 48 months and without developmental delay or any associated syndrome. Interventions Intravenous dexamethasone sodium phosphate (0.25 mg/kg) or a placebo (5% dextrose in water) immediately preoperatively and once every 8 hours for two doses postoperatively. Main outcome measures Postoperative airway distress, fever, oral fluid intake, discharge eligibility, and palatal fistula formation. Results Perioperative steroid therapy significantly reduced the incidence of postoperative airway distress (p = .05) and postoperative fever (p = .02); postoperative oral fluid intake, discharge eligibility, and palatal fistula formation were not significantly affected. Conclusions Perioperative steroids effectively lower the risk of postoperative airway distress and postoperative fever in children undergoing the primary repair of their cleft palate. This finding favors a customary role for perioperative steroid therapy in pediatric primary palatoplasty.
A Multicenter Retrospective 3D Study of Serial Complete Unilateral Cleft Lip and Palate and Complete Bilateral Cleft Lip and Palate Casts to Evaluate Treatment: Part 1—The Participating Institutions and Research Aims
Authors: Berkowitz Samuel 
Published: October 2018

Objective: To compare the multicenter retrospective and prospective spaciotemporal (4D) serial analyses of complete unilateral (CUCLP) and complete bilateral (CBCLP) cleft lip and palate casts that had undergone different treatment procedures. The involved institutions are Miami Craniofacial Anomalies Foundation, South Florida Cleft Palate Clinic; University Hospital of Nijmegen Cleft Palate Center; Free University of Amsterdam Cleft Palate Center; Academic Hospital (Dijkzigt/Sophia) Rotterdam Cleft Palate Center; Center for Craniofacial Anomalies, University of Illinois College of Medicine; Cleft Palate Center, Sahigrenska University Hospital, Göteborg, Sweden; and Children's Memorial Medical Center, Northwestern University Cleft Palate Institute. Design: Using serial casts of the upper jaw and an electromechanical digitizer with special CadCam software (CadKey), the occlusal relationships and morphometric palatal growth changes that occur under the influence of presurgical orthopedics and various surgical procedures will be studied. It is anticipated that 3D geometric data extracted from serial casts will identify the important geometric palatal parameters present before cleft surgical closure, which will supply objective criteria for establishing a scientific basis for improved surgical therapy. This research study will test three hypotheses: (1) Conservative (varying the timing of surgical cleft closure according to the size of the cleft space) lip and palatal surgery will permit “catch-up” palatal growth and normalize palatal growth and development. (2) The amount of mucoperiosteal tissue relative to the size of the cleft space is important in determining the timing of palatal surgery, as it influences the degree of scarring and ultimately the palate's adult size and form. (3) Presurgical orthopedics (the use of appliances soon after birth) can stimulate palatal growth beyond its normal growth potential. Results: In a previous project and again after reviewing the data already collected during the first year of this study, it has been shown that incremental changes in size of palatal segments in CUCLP and CBCLP cases prior to surgery vary slightly. The CBCLP cases grow slightly faster than CUCLP cases before surgery, but growth of the CBCLP cases decreases in acceleration after surgery. Reasons for these differences will be determined when more cases are analyzed and subjected to biostatistical analysis.