bluuebunny/crossref_metadata_2025_split huggingface dataset:
Velopharyngeal Function in Nonsyndromic Cleft Palate: Relevance of Surgical Technique, Age at Repair, and Cleft Type
Authors: Marrinan Eileen M. , Labrie Richard A. , Mulliken John B. 
Published: October 2018

Objective The goal of this study was to determine the relative importance of surgical technique, age at repair, and cleft type for velopharyngeal function. Design This was a retrospective study of patients operated on by two surgeons using different techniques (von Langenbeck and Veau-Wardill-Kilner [VY]) at Children's Hospital, Boston, MA. Patients We included 228 patients who were at least 4 years of age at the time of review. Patients with identifiable syndromes, nonsyndromic Robin sequence, central nervous system disorders, communicatively significant hearing loss, and inadequate speech data were excluded. Main Outcome Measure Need for a pharyngeal flap was the measure of outcome. Results Pharyngeal flap was necessary in 14% of von Langenbeck and 15% of VY repaired patients. There was a significant linear association (p = .025) between age at repair and velopharyngeal insufficiency (VPI). Patients with an attached vomer, soft cleft palate (SCP), and unilateral cleft lip/palate (UCLP) had a 10% flap rate, whereas those with an unattached vomer, hard/soft cleft palate (HSCP), and bilateral cleft lip/palate (BCLP) had a 23% flap rate (p = .03). Age at repair was critical for the unattached-vomer group (p = .03) but was not statistically significant for the attached-vomer group (p = .52). Conclusions Surgical technique was not a significant variable either in aggregate or for the Veau types. Patients in the earliest repair group (8-10 months) were the least likely to require a pharyngeal flap. Early repair was more critical for HSCP and BCLP patients. There was no correlation between velopharyngeal insufficiency and Veau hierarchy. The attached vomer/levator muscle complex may be a more important predictor of surgical success than the anatomic extent of cleft.
Learning Disability, School Achievement, and Grade Retention among Children with Cleft: A Two-Center Study
Authors: Broder Hillary L. , Richman Lynn C. , Matheson Pamela B. 
Published: October 2018

Objective This study examined the prevalence of learning disability (LD), level of school achievement; and prevalence of grade retention by type of cleft and gender at two craniofacial centers. Setting The setting included two university-based craniofacial centers. Design/Patients Participants included 84 consecutively evaluated patients from one center who were matched by cleft type, age, and gender with 84 patients evaluated at the second center. Outcomes The outcomes included learning disability, school achievement, and grade retention. Results The results revealed that 46% of subjects with cleft had LD, 47% had deficient educational progress, and 27% had repeated a grade (excluding kindergarten) in school. Males with cleft palate only (CPO) had a significantly higher rate of LD than any other subject group. Males with CPO and females with cleft lip and palate (CLP) were more likely to repeat a grade in school than were females with CPO and males with CLP. Conclusions Children with cleft are at risk for learning disability, low school achievement, and grade retention.
Nasalance Levels in the Speech of Normal Australian Children
Authors: Van Doorn Jan , Purcell Alison 
Published: October 2018

Objective Nasalance scores have been shown to depend on the regional dialect of English spoken. Australian cleft palate clinics are increasingly making use of the Nasometer as part of their evaluation of velopharyngeal inadequacy. There are, however, no normative data for Australian English available as reference information. The objective of this study, therefore, was to obtain comprehensive nasalance data for a large group of Australian children, aged 4 to 9 years, for two standard nasalance passages (Zoo Passage and Nasal Sentences) and to investigate any gender or age differences within that age range. Participants The participants were 245 children (123 female, 122 male) ranging in age from 4 years, 0 months, to 9 years, 3 months. The children were recruited from a variety of schools and preschools across the Sydney metropolitan region. The children all spoke Australian English, and their hearing, articulation skills, and speech resonance were within normal limits. Method Mean nasalance scores were obtained for two speech passages that are used as standards for Nasometer testing (Zoo Passage and Nasal Sentences). In addition, the nasalance data were analyzed for any gender and age dependence, using separate analyses of variance for each speech passage. Five consecutive age groups were used to examine age dependence (4-, 5-, 6-, 7-, and 8-year-old children). Results A mean score of 13.1 (SD, 5.9) was obtained for the Zoo Passage, and a mean of 59.6 (SD, 8.1) for the Nasal Sentences. The analysis of variance results indicated that, at a probability level of p < 0.01, there was no statistically significant age or gender dependence for either speech passage. Conclusion These normative nasalance data for children who speak Australian English will provide important reference information for clinicians who assess nasality disorders in cleft palate clinics in Australia.
Intraoral Pressure and Velopharyngeal Function
Authors: Mayo Robert , Warren Donald W. , Zajac David J. 
Published: October 2018

Objective The objective of this study was to determine the influence of velopharyngeal (VP) inadequacy on respiratory speech compensations. Design The pressure-flow technique was used to measure pressure, airflow, and timing variables associated with VP closure during the production of the initial plosive consonant /p/ in a series of the utterance “papa.” Setting The study was conducted in the speech and breathing laboratory of the UNC Craniofacial Center. Participants Eighty-two subjects with cleft lip and/or palate were assessed. The subjects were divided into two groups, those with adequate VP closure (VP size <.010 cm2) and those with inadequate VP closure (VP size >0.10 cm2). The adequate group was comprised of 62 subjects, and 20 subjects were categorized as inadequate. Results Peak intraoral pressure decreased in the inadequate group, but the difference was not significant. Nasal airflow increased (p < .01), but duration of the pressure pulse was the same for both groups. The area under the pressure curve decreased for the inadequate group (p = .04). Conclusion These data contrast with previously reported published data using /p/ in the utterance “hamper.” This suggests that phonetic context influences the compensatory response to velopharyngeal inadequacy. Additionally, while the findings are somewhat similar to studies that involved noncleft subjects whose oral airway was suddenly vented during the production of /p/, there is enough difference to suggest that learning also affects the compensatory outcome.
Scar Tissue Distribution on Palates and its Relation to Maxillary Dental Arch Form
Authors: Ishikawa Hiroyuki , Nakamura Shinji , Misaki Kouichi , Kudoh Motonori , Fukuda Hiroshi , Yoshida Shigemitsu 
Published: October 2018

Objective This study investigated the relationship between maxillary dental arch form and distribution of postsurgical scar tissue on previously denuded bone in isolated cleft palate patients. Method The palatal blood flow of 21 Japanese isolated cleft palate patients (6 males, 15 females) was examined by laser doppler flowmetry to determine the scar tissue areas. All had undergone pushback operations for palatal repair at around 18 months of age. Tissue blood flow was examined at a time ranging from 11 years, 5 months to 19 years, 9 months of age. To evaluate the maxillary dental arch form, dental casts obtained at the start of orthodontic treatment (a mean age of 8 years, 4 months) were analyzed. Results/Conclusions Scar tissue distribution in the 21 cases was classified into five types. Characteristic features in the maxillary dental arch form were found in each of the five types according to the extent of the scar tissue. It was evident that the severity of the maxillary dental arch constriction was closely related to the scar tissue distribution on palates.
Evaluation of Pharyngeal and Laryngeal Structure and Function in Patients with Oculo-Auriculo-Vertebral Spectrum
Authors: D'antonio Linda L. , Rice Reginald D. , Fink Sandra C. 
Published: October 2018

Objective This study described the occurrence and expression of pharyngeal and laryngeal anomalies in a population of patients with oculo-auriculo-vertebral spectrum (OAVS). Design Cross-sectional study using chart review, physical examination, and endoscopic evaluation of the pharynx and larynx, and perceptual and aerodynamic evaluation of speech for assessment of vocal tract function. Setting Academic tertiary referral center. Patients Chart review of 41 patients with a diagnosis of OAVS and clinical evaluation of 23 of the patients identified in the initial chart review, ranging in age from 9 months to 17 years. Main outcome Measures Data from chart review pertaining to airway and speech symptoms. Physical examination and endoscopic studies of pharyngeal and laryngeal structure and function and perceptual and aerodynamic evaluation of speech, resonance, and voice. Results Chart review showed a high occurrence of indicators of pharyngeal and laryngeal abnormalities such as velopharyngeal inadequacy and airway obstruction. Clinical evaluations documented a variety of abnormalities in pharyngeal and laryngeal structure and function as well as impairment in speech articulation, resonance, and voice. Presence and severity of pharyngeal and laryngeal abnormalities were not correlated with the severity of expression of the spectrum based on mandibular morphology. Conclusions Oculo-auriculo-vertebral spectrum appears to be associated with a high occurrence of structural and functional abnormalities of the pharynx and larynx that may contribute to increased risk of airway obstruction, communication impairment, and morbidity.
Quantitative Description of the Morphology of the Human Palate by a Mathematical Equation
Authors: Ferrario Virgilio F. , Sforza Chiarella , Schmitz Johannes H. , Colombo Anna 
Published: October 2018

Objective To derive a three-dimensional mathematical description of normal human hard tissue palatal size and shape. Methods The maxillary dental casts of 30 adolescents free from respiratory problems, who had a complete (28 teeth) permanent sound dentition with normal occlusion, were studied. The x, y, z coordinates of several standardized palatal and dental landmarks were obtained with a computerized three-dimensional digitizer. Palatal landmarks were used to derive a mathematical equation of palatal shape in the frontal and sagittal planes. Palatal width, length, frontal and sagittal heights, and sagittal slope, as well as dental arch transverse and anteroposterior dimensions, were computed. Results Neither the size nor the shape of the palate was significantly influenced by gender. Only the intercanine distance was larger (p < .025) in males than in females. Conclusions Data collected in the present investigation could represent a first database for the quantitative description of normal human palatal morphology in subjects with a complete permanent dentition.
Adverse Outcomes following Endoscopic Repair of a Fetal Cleft Lip Using an Ovine Model
Authors: Stelnicki Eric J. , Vanderwall Karen , Hoffman William Y. , Szabo Zoltan , Harrison Michael R. , Foster Rob , Longaker Michael T. 
Published: October 2018

Objective The purpose of this study was to determine if endoscopic techniques could be used to repair an epithelialized lip cleft with accuracy and with an outcome comparable to fetuses treated through an open hysterotomy. Interventions and Results In contrast to previous open fetal cleft lip repairs in the same model, none of the five fetuses reported here had a good aesthetic result. Although there was no evidence of scar histologically, the edges of the lip were poorly approximated. The epithelial lining and underlying dermis of the wound margins were notably inverted. The orbicularis oris muscle, which had been reapproximated, appeared thin and hypoplastic. Most of the vermilion elements were poorly aligned, and in one animal, there was a complete dehiscence of the repair. Conclusions In a more representative model of cleft lip that is not an acute lip wound, in utero endoscopic suture repair of the ovine lip gave a poor result using current technology. Only a meticulously performed, multilayered, open repair of a cleft appears to give a good cosmetic and functional outcome. Further studies to improve the endoscopic repair as our technology advances are therefore warranted.
Transmission of Mutans Streptococci between Mothers and Children with Cleft Lip and/or Palate
Authors: De Soet Johannes J. , Bokhout Birgitta , Buijs Jos F. , Van Loveren Cor , De Graaff Johannes , Prahl-Andersen Birte 
Published: October 2018

Objective The aim of this study was to investigate the transmission of Streptococcus mutans between children with cleft lip and/or palate and their mothers. Design Saliva samples of 21 mother-child pairs were collected and cultured on plates containing a selective growth medium for mutans streptocci. At least five separate colonies of each colony morphotype were isolated. A polymerase chain reaction (PCR) with randomly chosen primers was used to type the isolates. Results The number of morphotypes and PCR types was significantly lower in the children than in the mothers. Significant correlations were found between the number of morphotypes and PCR types, in the children as well as in the mothers. In only 38% of the mother-child pairs were the same PCR types found in mother and child. Conclusions This suggests that S. mutans had been transmitted from mother to child in one-third of the population studied. No correlations were found among the number of colony-forming units, the number of colony-colony-morphotypes, and the number of PCR types of the mothers and transmission. Similar PCR types in mother and child were found significantly more often in children who had more than one PCR type. The results indicate that transmission of S. mutans from mother to child is not frequent in children with oral cleft. This may have consequences for preventive treatment of cleft lip and/or palate children and their mothers.
Oral Health Status of Russian Children with Unilateral Cleft Lip and Palate
Authors: Turner Clara , Zagirova Asiya , Frolova Larisa , Courts Frank J. , Williams William N. 
Published: October 2018

Objective To evaluate the oral and dental health of Russian children who underwent Frolova primary palatoplasty. Design Eighty-nine children (62 boys and 27 girls; age range, 5 to 9 years) who had undergone repair of unilateral cleft lip and palate were included in this oral/dental evaluation. Factors such as stage of dentition; oral hygiene; carious, missing and restored teeth; and occlusion were recorded. Results Twenty-six of the 89 patients presented with a palatal fistula. Oral hygiene of patients without a palatal fistula was significantly better than that of patients with a fistula (p < .01). Forty-five percent of patients had eight or more decayed teeth. Significantly more patients with palatal fistulae had class II soft tissue facial profiles than those without palatal fistulae. Anterior crossbites were found in 48% of patients, unilateral posterior crossbites in 58%, and bilateral posterior crossbites in 12%. Conclusions The high percentage of poor oral hygiene and dental caries found in this group of patients is likely due to the general unavailability of dental hygiene products and the high cost of these products when available. In addition, it seems there is limited understanding by parents of the importance of dental hygiene and appropriate diet in preventing dental disease.
The Early Prenatal Diagnosis of Cleft Lip and the Decision-Making Process
Authors: Blumenfeld Zeev , Blumenfeld Israel , Bronshtein Moshe 
Published: October 2018

In 1996, Bronshtein et al. published an article entitled “Early prenatal diagnosis of cleft lip and its potential impact on the number of babies with cleft lip” in the British Journal of Oral and Maxillofacial Surgery. In this article, Bronshtein et al. revealed that, in their experience, a cleft of the lip could be identified accurately using transvaginal sonography at 13 to 16 weeks' gestation. Of interest was the observation that, in 15 cases where cleft lip was detected, the pregnancy was terminated in all but one case. The only couple that did not choose to terminate subsequently stated that they would terminate a future pregnancy if the fetus was observed prenatally to have a cleft lip. The notion of pregnancy termination for a relatively minor malformation raises a number of issues. In order to address those issues and to relate experiences in the U.S. to those reported in Israel, the following two papers were invited. In the first, Zeev Blumenfeld and colleagues update their experiences and discuss some practical, moral, and ethical issues. In the second paper, Marilyn Jones presents her perspective on the issue based on her experiences in Southern California. Readers are invited to react and respond to these two papers by submitting a letter to the editor. Readers are also encouraged to submit other issues or controversies related to the care and/or study of cleft lip and palate and craniofacial anomalies to the editor for discussion.
Nasal Deformity and Microform Cleft Lip in Parents of Patients with Cleft Lip
Authors: Sigler Alicia , Ontiveros Dolores Saavedra 
Published: October 2018

Objective To describe subtle nasal deformities and microform cleft lips in parents whose children have complete cleft lip deformities. Design Clinical analyses of three parents whose children had complete cleft lips. Subtle nasal deformities and microform cleft lips were identified. Setting An institutional general hospital: Manuel Gea González Cleft Lip and Palate Clinic in Mexico City, Mexico. Patients The study first examined the parents of all complete and incomplete cleft lip-palate patients who were seen from March 1994 to February 1997 by the authors (n = 1000). We identified three patients, each of whom had one parent who showed signs of subtle nasal deformity and microform cleft lip. Interventions None for the parents. Interventions in the children with cleft lips and palates were known. Main Outcome Measures Qualitative photographic analyses were performed. Nostril symmetry, septal deviation, nasal floor position, and orbicularis oris malinsertions were carefully examined. Results Three of the evaluated parents had one alar cartilage caudally displaced and a deviated septum. One parent's nasal floor was depressed. Two parents also had evidence of a minimal orbicularis oris muscle fissure located in the upper lip. Conclusion Genetic evaluations of children with complete and incomplete cleft lips might also include thorough evaluation of their parents. Although small in size, this study of three case histories identified nasal and lip deformities in the patients' parents.
Secondary Alveolar Bone Grafting Using Milled Cranial Bone Graft: A Retrospective Study of a Consecutive Series of 100 Patients
Authors: Denny Arlen D. , Talisman Ran , Bonawitz Steven C. 
Published: October 2018

Objective The purpose of this study was to evaluate the outcome of secondary bone grafting of alveolar clefts using milled cranial bone graft. Patients The study included a consecutive series of 100 patients who were operated on between 1986 and 1995 by a single senior surgeon. Measurements The patients were divided into four groups; (1) unilateral alveolar cleft or (2) bilateral alveolar cleft, (3) before eruption of the canine teeth or (4) after eruption. Follow-up ranged from a minimum of 12 months to 10 years, and evaluation included a physical examination, medical photography, orthodontic reports, and a panorex X-ray and/or a three-dimensional computed tomography scan of the maxilla produced using Denta-scan software. Patient outcomes were judged to be good, acceptable, or poor. Patients who developed any fistula or required regrafting were defined as poor outcomes. Results The combined good and acceptable outcomes represented 83% of the entire consecutive series. These two groups were defined as successful outcomes. In patients with unilateral and bilateral clefts who were under 12 years old, the success rate was 90% and 88%, respectively. In patients grafted following full canine eruption (>12 years old), success rate decreased to 83% in patients with unilateral and 66% in bilateral clefts, respectively. Conclusions Our results support the use of milled cranial bone graft, which produces a stable closure of the alveolar cleft with good contour and support for adjacent tooth eruption. Our data further support the conclusion by others that outcomes of early secondary grafting are superior to delayed grafting. The experience presented here, including the success rate, ease of harvesting, and minimal morbidity, makes the cranium our preferred donor site for alveolar cleft grafting.
Adaptation of Pharyngeal Wall Adduction after Pharyngeal Flap Surgery
Authors: Karling Jonas , Henningsson Gunilla , Larson Ola , Isberg Annika 
Published: October 2018

Objective The purpose of this investigation was to study lateral pharyngeal wall adduction relative to pharyngeal flaps of different widths. The hypothesis to be tested was that pharyngeal wall adduction does not increase postoperatively but may decrease due to the mechanical hindrance of a wide flap. Design In this prospective study, adaptation of lateral pharyngeal wall adduction during speech was studied relative to pharyngeal flaps of different widths utilizing videoradiography. Flap width was determined nasopharyngoscopically. Setting All patients were treated by the Stockholm Cleft Palate Team, Sweden. Patients Fifty-three patients were strictly selected by discarding conditions known to exert uncontrolled influence on velopharyngeal sphincter function. Results The results revealed a potential for adaptation of pharyngeal wall adduction to different flap widths. The magnitude and character (increase or decrease) of change in adduction was significantly correlated with the degree of preoperative adduction and with the width of the flap. In patients with limited preoperative adduction, pharyngeal wall activity increased, more in the presence of a narrow flap while less if the flap was wide. When preoperative adduction was pronounced, the postoperative activity decreased because of mechanical hindrance by the flap, and the degree of impediment was correlated to the width of the flap. Conclusion A potential for increased lateral pharyngeal wall adduction after pharyngeal flap surgery was verified, but the result cannot be interpreted as generally applicable because of the strict selection of patients.