bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beyond Easy Answers: The Plastic Surgeon and Prenatal Diagnosis
Authors: Matthews Martha S. 
Published: October 2018

Objective To explore how plastic surgeons handle the issue of prenatal diagnosis of cleft lip and palate. Design Mail survey. Participants The plastic surgeon listed as team contact in the team directory of the American Cleft Palate–Craniofacial Association was identified. In cases in which a plastic surgeon was not listed as a team contact, the first plastic surgeon listed as a team member was identified. A total of 211 surgeons were contacted. Intervention Each surgeon was mailed a survey asking for his/her experience in prenatal diagnosis for cleft conditions. Ethical issues concerning the surgeon's personal beliefs about abortion and the potential influence of the surgeon's presentation of information were explored. Results A 50% response rate was obtained. Eighty-five percent of respondents were experienced in prenatal counseling; 92% offer consults on a routine basis. Ninety-six percent indicated they did so because they felt it was helpful to families. Treatment (98%), appearance of clefts (96%), cleft etiology (94%), and associated problems (40%) were discussed most commonly. Termination was rarely discussed (5%). Of those who had not met with a family, 82% said they had never been asked to do so. Most respondents felt families sought consultation for information and rarely sought consultation to decide on abortion. The majority felt their personal beliefs about abortion did not influence their willingness to meet with parents. The majority of surgeons in both groups felt it was ethical to give an opinion on pregnancy termination if asked (55% of experienced surgeons, 44% of inexperienced surgeons); however, a significantly larger number of the surgeons who had not met with a family were unsure of their opinion. Conclusions Prenatal counseling of parents of a fetus with cleft lip/palate is common among plastic surgeons. There is uniformity in the information discussed. There is no agreement among surgeons about the ethical issues of pregnancy termination and the surgeon's role in that discussion.
Dealing with the Prenatal Diagnosis of Clefting: A Parent's Perspective
Authors: Aspinall Cassandra L. 
Published: October 2018

Objectives Prenatal testing and information is available on an increasing basis for a variety of reasons. There are conflicting standards of care in the delivery of this type of evaluation and even more confusion around access to such services. As physicians and patients evaluate which tests will generate useful information with acceptable levels of risk, the rules of the game constantly shift. Presenting the situation from the viewpoints of both a professional and a parent, issues revolving around uncertainty and reassurance are evaluated. A description of the personal experience of the impact of the discovery of a cleft prenatally is provided. Conclusions Finally, efforts are made to raise questions about our motivations behind conducting prenatal testing and also developing some suggestions about how to support families better in our regular clinical work. A challenge is made to providers and patients to do more work prior to examination to explore how the unexpected will be handled. The dilemma about how to facilitate informed consent through full disclosure without overwhelming the patient is also discussed.
Use of U.S. Birth Certificate Data to Estimate the Risk of Maternal Cigarette Smoking for Oral Clefting
Authors: Wyszynski Diego F. , Wu Tianxia 
Published: October 2018

Objective The purpose of this study was to evaluate the relationship between maternal cigarette smoking and the risk of having an offspring with an oral cleft. Design This was a large population-based, matched case-control study derived from the United States Natality database for 1997. Subjects The sample consisted of 2029 cases with nonsyndromic oral clefts and 4050 nonmalformed controls. Controls were matched to cases on mother's and father's race and child's sex, county of birth, and month of birth. This sample was selected from a total of 3,093,821 births in the United States, which represents 80% of all births in this country during 1997. Results The association between maternal cigarette smoking and oral clefts in the offspring was close to the null (odds ratio 1.16; 95% confidence interval (CI) 1.01 to 1.33; one-sided Fisher exact testp = .0207). The comparison and pooling of results to those of a similar study that used the U.S. Natality database for 1996 resulted in a common Mantel-Haenszel odds ratio of 1.33 (95% CI 1.21 to 1.46). The dose-response analysis was slightly significant for all levels of maternal smoking. Conclusion This large study confirms that smoking during pregnancy is only a minor risk factor for oral clefting in the offspring.
Craniofacial Anthropometry in a Turkish Population
Authors: Evereklioglu Cem , Doganay Selim , Er Hamdi , Gunduz Abuzer , Tercan Mustafa , Balat Ayse , Cumurcu Tongabay 
Published: October 2018

Objective To present norms and demonstrate the anthropometric variations in fronto-occipital circumference, inner and outer canthal distances, near and distant [far] anatomical interpupillary distance, canthal index, and circumference-interorbital index across age and sex in urban Turkish subjects. Participants Three thousand four hundred forty-eight subjects (1852 male, 1596 female) aged 7 to 40 years were included in this study. Methods Three age groups were studied: children aged 7 to 15 years, young adults aged 16 to 25 years, and adults aged 26 to 40 years. Mean values for each measured parameter were determined at each age between 7 and 25 years. Subjects were also divided into nine age subgroups to observe the change of each parameter with advancing age. Results The fronto-occipital circumference and outer canthal distance of males was significantly (p < .001) wider than females in all age groups. The near and distant interpupillary distances of male subjects were, on average, wider than the female subjects with greater differences with advancing age. Across all subjects aged 7 to 40 years, the mean of all measured parameters and calculated indexes of men and boys was significantly different from girls and women (p < .001). The mean for interpupillary distances in our study in both sexes were found to be similar to Arabian, Hong Kong, and British children; larger than those of Chinese, Black, Indian, and Caucasians; and smaller than those of Mexican children and a mixed European population. Conclusion This study clearly shows the anthropometric variation for fronto-occipital circumference, inner canthal distance, outer canthal distance, near and distant interpupillary distance, canthal index, and circumference-interorbital index with age. These developmental data and the normal values of these measurements in healthy subjects are useful for dysmorphologists in the early identification of some craniofacial syndromes, hyper- and hypotelorism, and congenital or posttraumatic telecanthus and of planning surgical intervention. We suggest that the comparison of craniofacial dimensions of a patient must be performed with normal standards specific for age as well as sex and race.
A New Scale to Assess Radiographic Success of Secondary Alveolar Bone Grafts
Authors: Witherow H. , Cox S. , Jones E. , Carr R. , Waterhouse N. 
Published: October 2018

Objectives: To propose a new scale for evaluating the position of the bone graft within the cleft and assess its inter- and intraobserver reliability. Design: Sixty-six patients (70 cleft sites) over a 14-year period were assessed, 90% of patients retrospectively and 10% prospectively. The radiographs were reviewed by two clinicians in controlled conditions twice, with 1 week between assessments. Both clinicians were blind to patient identity. Outcome measures: A new scale subdividing the position of the bone into one of six categories was used. The radiographs were also assessed using the Bergland scale. Results: Using the Bergland scale, 62.9% of the cleft sites were type I, 21.4% type II, 4.3% type III, and 5.7% type IV. It was not possible to assess 5.7% of the clefts with this scale because the canine was unerupted. Using the Chelsea alveolar bone graft scale, 58% were category A, 20% B, 7% C, 3% D, 3% E, and 9% F. Conclusions: The above scale can be used to determine accurately the position of bone within the cleft site. It can be used in the mixed dentition prior to eruption of the canine. It demonstrated moderate to substantial inter- and intraobserver reliability and offers several advantages, compared with other scales.
Upper Lip Fistulas: Three New Cases
Authors: Sancho M. A. , Albert A. , Cusi V. , Grande C. , Aguilar C. , Morales L. 
Published: October 2018

Objective We present three new cases of congenital upper lip fistula. Two of them were located in the philtrum midline, one of which was associated to a double maxillary frenulum, a medial lip cleft, and a medial cleft of the primitive palate. The other was located in the left side of the vermilion. All three patients had clear fluid discharge through the fistulous orifice without pain. Two of them had a history of recurrent swelling of the philtrum area. Conclusions A simple surgical excision is the treatment of choice in these cases, in which the anatomy is preserved; this fact is more consistent with a completed but aberrant development than with focal dysgenesis.
Fibroblast Growth Factor 2 Induces Increased Calvarial Osteoblast Proliferation and Cranial Suture Fusion
Authors: Moursi Amr M. , Winnard Phillip L. , Winnard Alissa V. , Rubenstrunk John M. , Mooney Mark P. 
Published: October 2018

Objective: Craniosynostosis has been associated with fibroblast growth factors (FGFs) and their receptors. The purpose of this study was to quantitatively determine the effect of FGF2 on rat calvarial osteoblasts and a rat cranial suture formation model. Design: Fetal rat calvarial osteoblasts were cultured with and without FGF2. Cell attachment and proliferation was determined by alamarBlue dye assay and cell morphology by toluidine-blue staining. In rat calvarial organ culture, postnatal day 15 rat calvariae with dura mater were placed in serum-free media with and without FGF2. A unique quantitative analysis of suture fusion was developed by obtaining measurements of suture bridging in histological serial sections at progressive stages of fusion. Results: Attachment for cells treated with FGF2 was similar to control. In contrast, proliferation was higher for cells treated with FGF2 while maintaining an osteoblastic morphology. After 5 days in organ culture, FGF2-treated posterior frontal sutures showed a dramatic increase in fusion, compared with untreated controls. This increased fusion was maintained throughout days 7 and 10 in culture. Also, fusion was enhanced on the dural side of the suture, as is normally observed in vivo, and the normal tissue architecture was maintained. Conclusions: These results indicate that FGF2 can promote rat osteoblast attachment and normal cell morphology as well as induce cell proliferation. In calvarial organ culture, FGF2 treatment produced an enhanced suture fusion. These results provide further support for a critical role for FGF2 in cranial suture development. These studies also present a new quantitative approach to evaluating the effect of suture-perturbing growth factors on cranial suture fusion.
Seventeen-Year Follow-Up of a Patient with Median Cleft of the Lower Lip, Mandible, and Tongue with Flexion Contracture: A Case Report
Authors: Ishii Masatoshi , Ishii Yoshimasa , Moriyama Takashi , Enomoto Shoji , Ono Toaki , Ohyama Kimie , Kuroda Takayuki 
Published: October 2018

Purpose: We present a 17-year follow-up of an unusual patient with median cleft of the lower lip, mandible, and tongue with a flexion contracture. Conclusion: Timing of the mandibular reconstruction needs to take into account growth of the mandible and masticatory function. In this case, fixation of the mandible performed at the age of 6 years 6 months and reconstruction carried out at 7 years 8 months of age resulted in satisfactory occlusion and masticatory function.
Microsurgical Tissue Transfer for Rehabilitation of the Patient with Cleft Lip and Palate
Authors: Eufinger Harald , Machtens Egbert 
Published: October 2018

Objective: Three case reports of microsurgically revascularized tissue transfer for secondary closure of complex oronasal fistulae in cleft lip and palate patients are reported. One scapular and two radial forearm flaps were used in that respect; the scapular flap was transferred without a skin paddle and was left for secondary epithelialization whereas iliac crest bone was transplanted in the two patients with the forearm flaps in a further surgical step. Conclusions: These microsurgical flaps represent solutions in selected cases of oronasal fistulae in patients with cleft lip and palate with extensive scarring, large defects, or both. Alternative free flaps of the vast spectrum available today, however, also deserve consideration.
The Treatment of Hemimandibular Hyperplasia Preserving Enlarged Condylar Head
Authors: Sugawara Yasushi , Hirabayashi Shin-Ichi , Susami Takafumi , Hiyama Shigetoshi 
Published: October 2018

Objective To present a case of hemimandibular hyperplasia (HH) treated with orthognathic surgery that preserves the condyle without disturbing mandibular function. Methods A 27-year-old woman with HH was treated with orthognathic surgery preserving the enlarged condylar head. Radiographic examination showed typical enlargement of the right condyle, elongation of the right ascending ramus and mandibular body, and tilted occlusal plane. A mandibular sagittal split osteotomy on the unaffected side and subcondylar ramus osteotomy on the affected side, Le Fort I wedge osteotomy to relevel the tilted occlusal plane, and contouring of the lower mandibular margin were performed. Results Excellent results in the full-face appearance and occlusion were obtained. There was no change in the size of the reserved condylar head 4 years postoperatively. In a series of examinations of jaw function with electromyography, mandibular kinesiography, and computer-aided diagnostic axiography, more favorable findings were obtained postoperatively. Conclusions In a case of HH without abnormally high growth activity, orthognathic surgery preserving hypertrophic condyle produced functional improvement in addition to good occlusal and aesthetic outcomes.
Speech Development of Children with Cleft Palate before and after Palatal Surgery
Authors: Jones Courtney E. , Chapman Kathy L. , Hardin-Jones Mary A. 
Published: October 2018

Objective This study examined the speech production abilities of children with cleft palate before and after palate repair. Participants Twenty-eight children participated in the study, 14 with cleft palate and 14 without clefts matched for age, gender, and mothers’ educational level. Main Outcome Measures Comparisons were made between the children with cleft palate before and after surgery for canonical babbling ratios, size of consonant inventories, place and manner characteristics, and early developing sounds [p, b, t, d, k, g, m, n, η]. Also, comparisons were made between the children with cleft palate and their peers without clefts at postsurgery/17 months for the measures described above. Results Paired ttests revealed differences in pre- and postsurgery performance of the children with cleft palate for production of canonical syllables and size of consonant inventories. Although no significant differences were noted for place and manner features, production of oral stops doubled from the time before surgery to that after surgery. Specifically, production of the bilabial stop [b] showed significant change over time. Results of independent t tests indicated no difference between groups for production of canonical syllables and size of consonant inventories at 17 months. However, significant group differences were noted for production of stops, oral stops, nasals, glides, and alveolars. The children without clefts produced more stops, oral stops, and alveolars. In contrast, more nasals and glides were seen in the vocalizations of the children with cleft palate. Conclusions Children with cleft palate made gains in production of canonical syllables and size of consonant inventories postsurgery; however, they continued to show deficits in production of stops and alveolar place features.
Comparison of Nasalance Scores Obtained from the Nasometer and the NasalView
Authors: Lewis Kerry E. , Watterson Thomas 
Published: October 2018

Objective Nasalance scores obtained from the Nasometer and the Nasal-View were compared for five different sentences. Design Vowel content was controlled in the design of the five stimulus sentences. One sentence was loaded with high-front vowels, one with high-back vowels, one with low-front vowels, one with low-back vowels, and one contained a mixture of vowel types. Subjects The subjects were 50 elementary school children ranging from kindergarten to sixth grade. Each subject was a native speaker of English, had no history of adenoidectomy, and was not currently enrolled in speech therapy services. Main Outcome Measures The main outcome measures were the nasalance scores obtained from the Nasometer and the NasalView for each of the five sentences. Results There was a significant difference in the nasalance scores between the Nasometer and the NasalView for four of the five stimuli, but not all differences were in the same direction. For two stimuli, the Nasometer scores were significantly higher, and for two stimuli the NasalView scores were higher. Bivariate correlations between nasalance scores for individual stimuli were in the good range for the Nasometer but poor for the NasalView. Conclusion Speech stimuli weighted with different vowel types are differentially affected by the different acoustical filtering used in the Nasometer versus the NasalView. Nasalance scores obtained with the NasalView were qualitatively and quantitatively different from those obtained with the Nasometer. This suggests that the two machines provide different information, and the scores are not interchangeable.
Importance of Soft Tissue for Skeletal Stability in Maxillary Advancement in Patients with Cleft Lip and Palate
Authors: Baumann Arnulf , Sinko Klaus 
Published: October 2018

Objective Assessment of stability of the advanced maxilla after two-jaw surgery and Le Fort I osteotomy in patients with cleft palate based on soft tissue planning. Subjects Between 1995 and 1998, 15 patients with cleft lip and palate deformities underwent advancement of a retruded maxilla, without insertion of additional bone grafts. Eleven patients had bimaxillary osteotomies and four patients only a Le Fort I osteotomy. Relapse of the maxilla in horizontal and vertical dimensions was evaluated by cephalometric analysis after a clinical follow-up of at least 2 years. Results In the bimaxillary osteotomies, horizontal advancement was an average 4 mm at point A. After 2 years, there was an additional advancement of point A of an average of 0.7 mm. In the mandible, a relapse of 0.8 mm was seen after an average setback of 3.9 mm. In the four patients with Le Fort I osteotomy, point A was advanced by 3.8 mm and the relapse after 2 years was 0.9 mm. Vertical elongation at point A resulted in relapse in both groups. Impaction of the maxilla led to further impaction as well. Conclusion Cephalometric soft tissue analysis demonstrates the need for a two-jaw surgery, not only in severe maxillary hypoplasia. Alteration of soft tissue to functional harmony and three-dimensional correction of the maxillomandibular complex are easier to perform in a two-jaw procedure. It results in a more stable horizontal skeletal position of the maxilla.
Chromosome 17: Gene Mapping Studies of Cleft Lip with or without Cleft Palate in Chinese Families
Authors: Peanchitlertkajorn Supakit , Cooper Margaret E. , Liu You-E , Field L. Leigh , Marazita Mary L. 
Published: October 2018

Objective Involvement of loci on chromosome 17, including retinoic acid receptor alpha (RARA) in nonsyndromic oral clefts has been reported in Caucasian populations, although never investigated in Asian populations. The purpose of the present study was to investigate several loci on chromosome 17, including RARA, in Chinese families. Participants Thirty-six multiplex families (310 individuals), ascertained through nonsyndromic cleft lip with or without cleft palate surgical probands from hospitals in Shanghai, China, participated in the present study. There were 23 families whose probands had cleft lip and cleft palate (CLP) and 13 with cleft lip alone (CL). Results Seventeen markers, spanning chromosome 17 and about 10 cM apart were assessed. Logarithm of odds ratio (LOD) scores (two point and multipoint), model-free linkage analyses, and allelic association tests (transmission/disequilibrium, Fisher's exact tests, and chi-square) were performed on the total family sample, families with CLP probands (CLP subgroup), and families with CL probands (CL subgroup). LOD scores from the two-point analyses were inconclusive. Multipoint analyses rejected linkage except for a few regions in the CL subgroup. However, positive results were found using the model-free linkage and association methods (p < .05). The markers with positive results varied across the CL and CLP subgroups. However, the RARA region and loci nearby yielded consistently positive results. Conclusion Genetic variation within the RARA locus or nearby appears to be involved in the pathogenesis of nonsyndromic oral clefts in this population. Furthermore, based on the differing pattern of results in the CL versus CLP subgroups, it appears that the formation of CL and CLP is because of either differing alleles at the same genetic locus or different but related (and/or linked) genes that modify the severity and expression of oral clefting.
A Survey of Cleft Lip and Palate Management Taught in Training Programs in Korea
Authors: Lee Taik Jong , Kim Sang Tae 
Published: October 2018

Objective A national survey was conducted to obtain an overall view of the status, assess changes in trends of cleft management, and study new categories of interest. Method Questionnaires were sent to 90 chief residents of all Korean institutes with plastic surgery training programs. Results Forty-eight respondents returned completed questionnaires. The results were: (1) the most common unilateral cleft lip repair method used is the rotation-advancement technique (100%); (2) 73% of respondents correct cleft lip nasal deformity at preschool age; (3) the Millard technique is the most common management in bilateral cleft lip repair (65%); (4) in the management of protruding premaxilla, 44% of the respondents choose presurgical orthopedics; (5) the usual cleft palate repairs are the pushback (64%) and double-opposing Z-plasty (43%) in complete cleft palates and the double-opposing Z-plasty (75%) and pushback (36%) comprised the common techniques in incomplete cases; (6) 86% of responding programs perform alveolar cleft repairs during the period of mixed dentition; the most common treatment of velopharyngeal incompetence is pharyngeal flap (71%); and (8) the interdisciplinary team approach is practiced by 64% of respondents. Conclusions Many changes were noted since a previous 1995 survey. We hope that this study provides the necessary information needed for the eventual establishment of standard cleft management in Korea.
Case Report: Cleft Palate Closure in 18-Month-Old Female with Epidermolysis Bullosa
Authors: Cooper Jason , Seung-Jun O , Thaller Seth R. 
Published: October 2018

Objective In a patient with epidermolysis bullosa and cleft palate, perioperative guidelines and surgical management can be unclear. This case report illustrates the occurrence of a skin anomaly often associated with potentially significant morbidity and a cleft palate. Perioperative guidelines to successfully manage the cleft palate closure in these patients are presented.