Showing papers in "The Cleft Palate-Craniofacial Journal in 1998"
TL;DR: In this series of 20 alveolar cleft sites treated with presurgical orthopedics and GPP, 60% did not need a secondaryAlveolar bone graft in the mixed dentition.
Abstract: Objective: The purpose of this study was to evaluate if narrowing and approximation of the alveolar cleft through presurgical alveolar molding followed by gingivoperiosteoplasty (GPP) at the time of lip repair reduces the need for a bone-grafting procedure. Design: This was a retrospective blind study of patients with unilateral or bilateral alveolar clefts who underwent presurgical infant alveolar molding and GPP by a single surgeon. Alveolar bone formation was assessed prior to the eruption of the maxillary lateral incisor or canine by clinical examination, panoramic and periapical radiographs, and/or a dental CT scan. The criterion for bone grafting was inadequate bone stock to permit the eruption and maintenance of the permanent dentition. Setting: This study was performed at the Institute of Reconstructive Plastic Surgery by the members of the Cleft Palate Team. Patients:All patients with unilateral (n = 16) or bilateral (n = 2) alveolar clefts who underwent presurgical infant alveolar moldi...
206 citations
TL;DR: Preterm cleft children with low birth weight should be screened for the presence of other birth defects, and children with clefts and additional malformations had lower birth weight and were born earlier than children with Clefts only.
Abstract: Objective and Methods: Children with cleft lip and/or palate (n = 251) born between 1991 and 1995 in the county of Stockholm, Sweden, were studied with reference to incidence and rate ratios (RRs) of different types of clefts, gender, birth weight, mother's age, and length of pregnancy. Children who had clefts and additional malformations were compared with children who had clefts but no additional malformations. Results: The incidence of clefts was 2.0/1000 live births, and it was higher among males than among females. The RR, an index of relative risk, was 1.58. The main groups, children with isolated cleft lip, children with cleft lip and palate, and children with isolated cleft palate, showed similar incidence values (0.6–0.7/1000 live births). Children with bilateral clefts had an incidence of 0.3/1000 live births. Additional malformations were found in approximately every sixth newborn with a cleft when children with Robin sequence were excluded. There was a tendency for newborns with bilat...
195 citations
TL;DR: The attached vomer/levator muscle complex may be a more important predictor of surgical success than the anatomic extent of cleft, and age at repair was more critical for HSCP and BCLP patients.
Abstract: 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...
173 citations
TL;DR: Most children with nonsyndromic craniosynostosis obtain developmental quotients within the normal range in infancy, and rates of retardation may increase relative to normative expectations as children mature.
Abstract: Objective: This study examined the global intellectual development and presence/absence of learning disorders in children with nonsyndromic metopic, sagittal, and unilateral coronal synostosis who had early surgery (under 1 year of age), late surgery (over 1 year of age), or no surgery to correct the synostosis across three time periods. Design: The design was longitudinal. Children were assessed at initial team evaluation, 1 year after surgery or initial evaluation if surgery was not performed, and annually thereafter. Participants: Participants included 84 consecutively evaluated patients. Seventy-two children were evaluated at Time 1 (T1), 8 months; 57 at Time 2 (T2), 21 months; and 39 at Time 3 (T3), 50 months. Data on learning disorders or mental retardation were available on 34 children who were school age. Main Outcome Measures: The Mental Development Index from the Bayley Scales of Infant Development was the main outcome measure for T1 and T2. The General Cognitive Index from the McCarthy...
147 citations
TL;DR: Children with cleft are at risk for learning disability, low school achievement, and grade retention, and males with Cleft palate only had a significantly higher rate of LD than any other subject group.
Abstract: 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 tan 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 ...
142 citations
TL;DR: The incidence of increased intracranial pressure in children with single-suture craniosynostosis is reviewed, and a rational treatment plan including multidisciplinary team management is recommended.
Abstract: In this paper, we review the incidence of increased intracranial pressure in children with single-suture craniosynostosis. The major studies in this area are presented, along with their limitations. A rational treatment plan including multidisciplinary team management is recommended. All patients with proven synostosis should be followed closely, whether or not surgery is chosen. Continued clinical and basic science research are necessary to further clarify the ramifications of asymptomatic elevations of intracranial pressure in these patients.
124 citations
TL;DR: 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 dentitions in UCLP patients.
Abstract: 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 distributio...
115 citations
TL;DR: 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.
Abstract: 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 s...
112 citations
TL;DR: The digitizer can assess the coordinates of facial landmarks with sufficient precision, and reliable measurements can be obtained.
Abstract: Objective: In this investigation, the precision of a commercial three-dimensional digitizer in the detection of facial landmarks in human adults was assessed. Methods: Fifty landmarks were identified and marked on the faces of five men, on five women, and on a stone cast of the face of one man. For each subject, the three-dimensional coordinates of the landmarks were obtained twice using an electromagnetic three-dimensional digitizer, and the duplicate digitizations were superimposed using common orientations and centers of gravity. Metric differences between homologous landmarks were assessed, and Dahlberg's error was computed. Results: For both men and women, the error was 1.05% of the nasion–mid-tragion distance, while for the cast, it was 0.9%. When the duplicate digitizations were used to mathematically reconstruct the faces, and several distances, angles, volumes, and surfaces were computed, more than 80% of the measurements had coefficients of variation lower than 1%. Conclusions: The digi...
101 citations
TL;DR: Sensitivity and specificity scores indicated that the Nasometer was reasonably accurate in distinguishing between normal and hypernasal speech samples in low pressure (LP) and high pressure (HP) speech.
Abstract: Objective: This study compared nasalance measures and nasality ratings in low pressure (LP) and high pressure (HP) speech. Subjects: The subjects for this study were 25 children ranging in age from 5 to 13 years. Twenty of the subjects were patients followed by a craniofacial team, and five had no history of communication disorder. Results: The mean nasalance for the LP speech was 29.98% (SD, 16.16), and the mean nasalance for the HP speech was 30.28% (SD, 15.35). The mean nasality rating for the LP speech was 2.31, and the mean nasality rating for the HP speech was 2.59. Separate paired t tests revealed no significant difference between the LP or the HP speech for either the nasalance scores or the nasality ratings. The correlation coefficient between nasalance and nasality for the LP speech was r = 0.78, and for the HP speech r = 0.77. Using a cutoff of 26% for nasalance and 2.0 for nasality, Nasometer test sensitivity was 0.84 and test specificity was 0.88. Conclusions: In general, clinicians ...
81 citations
TL;DR: The correct differential diagnosis of an abnormal head shape in an infant or a child is vital to the management of this common condition and special emphasis has been placed on posterior plagiocephaly, in the light of recent evidence demonstrating that lambdoid synostosis has been overdiagnosed.
Abstract: The correct differential diagnosis of an abnormal head shape in an infant or a child is vital to the management of this common condition. Establishing the presence of craniosynostosis, which warrants surgical correction, versus nonsynostotic causes of head deformity, which do not, is not always straightforward. This paper deals with three groups of abnormal head shape that may cause diagnostic confusion: the spectrum of metopic synostosis; the dolichocephaly of prematurity versus sagittal synostosis; and the differential diagnosis of plagiocephaly. Special emphasis has been placed on the problem of posterior plagiocephaly, in the light of recent evidence demonstrating that lambdoid synostosis has been overdiagnosed. Metopic synostosis presents as a wide spectrum of severity. Although only severe forms of the disorder are corrected surgically, all cases should be monitored for evidence of developmental problems. The dolichocephalic head shape of preterm infants is nonsynostotic in origin and is ma...
TL;DR: In a gross anatomic study of 20 sides in 16 human head specimens, the tensor veli palatini, the dilatator tubae, and the Tensor tympani muscles were studied, the bulk of the Dilatator Tubae remained distinct from the tenser veliPalatini despite a connective tissue alliance and intermingling of some muscle fibers.
Abstract: In a gross anatomic study of 20 sides in 16 human head specimens, the tensor veli palatini, the dilatator tubae, and the tensor tympani muscles were studied. The tensor veli palatini was observed to insert onto the anterior one-third of the pterygoid hamulus, whereas the dilatator tubae rounded the middle one-third of the pterygoid hamulus without an insertion. Thus, the dilatator tubae, not the tensor veli palatini, could serve to tense the anterior velum. An insertion from the superior pharyngeal constrictor muscle onto the posterior one-third of the hamulus could provide a curbing function for the dilatator tubae muscle. Adipose tissue, located at the hamulus, could provide lubrication for the tendinous fibers of the dilatator tubae as they round the hamulus. The dilatator tubae was observed to attach to the hook of the eustachian tube and is accepted as the tubal dilator. Observed on 13 of 20 sides in 11 specimens, the bulk of the dilatator tubae remained distinct from the tensor veli palatini despite a connective tissue alliance and intermingling of some muscle fibers. On 5 of 20 sides in 5 specimens, fibers of the dilatator tubae intermingled extensively with the tensor veli palatini. Of the 20 dilatator tubae muscles dissected, 2 were observed to be deficient. The tensor veli palatini was observed to be continuous with the tensor tympani. Full color versions of the figures are available at the following website: http://www.shc.uiowa.edu/papers/tensor/.
TL;DR: Preliminary evidence is provided for a gene-nutrient interaction in risk of clefting among infants with uncommon TGFa genotypes and whose mothers did not use multivitamins periconceptionally.
Abstract: Objective: We previously demonstrated a strong association between periconceptional maternal cigarette smoking, infant transforming growth factor-alpha (TGFa) genotype, and risk of orofacial clefts. Because serum folate may be decreased by cigarette smoking and because maternal periconceptional use of multivitamins containing folic acid has been associated with a reduced risk of clefting, we explored whether a potential relation existed between infant TGFa genotype, maternal multivitamin use, and risk of orofacial cleft phenotypes. Design: Data were derived from a population-based case-control study of fetuses and live-born infants among a cohort of 1987 to 1989 California births (n = 548,844). Information concerning periconceptional multivitamin use was obtained via telephone interviews with mothers of 731 (84.7% of eligible) orofacial cleft case infants, and of 734 (78.2%) nonmalformed control infants. DNA was obtained from newborn screening bloodspots and genotyped for the Taq1 polymorphism of...
TL;DR: The adult CLP patients had poorer oral hygiene and more gingivitis, but there is no conclusive evidence that they have a higher risk of developing periodontal disease.
Abstract: A review of the studies of the caries prevalence and periodontal health of patients with cleft lip and palate (CLP) revealed that only five investigations of caries prevalence in CLP patients included children. One reported that CLP children did not have a higher caries prevalence in the permanent dentition, whereas more recent studies have reported a higher caries prevalence in both the primary and permanent dentitions of CLP children than in those of noncleft children. However, there is wide variation in the teeth examined and the method of presenting data on caries prevalence. Six papers have reported on the periodontal health of adult CLP patients, and only one has done so on that of children. The adult CLP patients had poorer oral hygiene and more gingivitis, but there is no conclusive evidence that they have a higher risk of developing periodontal disease. No data on the oral hygiene of CLP children were available, but it has been emphasized that they have significantly more gingivitis than noncleft children, especially in the maxillary anterior teeth.
TL;DR: Two of five North American teams classify themselves as having the capacity to provide both cleft palate and craniofacial care, and an additional two of five teams limit their primary role tocleft palate care.
Abstract: Objective: This study is the first comprehensive national survey of the organization, function, and composition of cleft palate and craniofacial teams in the U.S. and Canada. Complete descriptions of cleft and craniofacial teams are not currently provided in the literature, and this study will provide an overview for health services research and policy use. Conducted by a national organization, this study examines teams in detail using a pretested and standardized methodology. Design: All known (n = 296) North American cleft palate and craniofacial teams were contacted for team listing purposes using a self-assessment method developed by an interdisciplinary committee of national stature. Team clinical leaders classified their teams into several possible categories and provided data on team care. The response rate was 83.4% (n = 247). Results: The distribution of listed teams was: 105 (42.5%) cleft palate teams, 102 (41.3%) craniofacial teams (including craniofacial teams that are both cleft pala...
TL;DR: Children with cleft lip and palate had generally poorer oral and gingival health than those with isolated clefts of the lip or palate.
Abstract: Objective: To ascertain the oral and dental health status of children with cleft lip and/or palate. Design: Oral and dental examinations were carried out on 114 selected children with cleft lip and/or palate, using standard criteria and indices. Setting: These children were examined at two cleft palate clinics in the United Kingdom. Patients: All children examined were between the ages of 3 and 18 years. Results: Sixty one (53.5%) of the subjects exhibited no evidence of previous caries experience, but as many as 20% exhibited active decay. The mean caries experience in the deciduous dentition (dmfs) was 2.3, and that in the permanent dentition (DMFS) was 0.9. Caries experience of the Caucasian children of the sample was lower (mean dmfs 1.9) than that of the Asian children (mean dmfs 5.5). The mean simplified debris index of the sample was 0.9, and the mean gingival bleeding index was 0.4. Children with cleft lip and palate had generally poorer oral and gingival health than those with isolated c...
TL;DR: It is suggested that Furlow palatoplasty may provide a better clinical outcome than intravelar veloplasty in patients with cleft palate problems.
Abstract: Objective: To evaluate the efficacy of Furlow's double reversing z-plasty (Furlow) versus intravelar veloplasty with longitudinal closure including palatal muscle reorientation (IVV). Design: Retrospective, single-institution, single-surgeon comparison. Patients: One hundred nineteen consecutive cleft palate patients were enrolled; 34 syndromic and 9 language-impaired patients were removed from speech and reoperation analysis. Furlow and IVV groups were similar with respect to sex and mean age at primary repair. Interventions: One surgeon performed all surgery and one of two speech pathologists conducted language and speech evaluations at 3 years of age without prior knowledge of the surgical technique utilized. Outcome Measures: Outcome measures included frequency of palatal fistulae, speech abnormalities, and need for secondary pharyngoplasty procedures. Results: Patients who had undergone IVV demonstrated a 34% higher incidence of hoarseness, nasal escape, and hypernasality at 3 years of age t...
TL;DR: It is suggested that cleft palate (usually complete and U-shaped) is the primary event in the determination of the triad of anomalies and heredity could be a factor in the etiopathogenesis of isolated Robin sequence.
Abstract: Objective: To investigate the etiopathogenesis of isolated Robin sequence. Design: A longitudinal and prospective study of children with isolated Robin sequence and no other associated syndromes or malformations. Setting: The study was carried out at the Hospital de Reabilitacao de Anomalias Craniofaciais (formerly the Hospital for Research and Rehabilitation of Cleft Lip/Palate), University of Sao Paulo, Bauru, SP, Brazil, which provides care for patients with lip/palate lesions throughout Brazil. Patients: Forty-three children were initially included in the study, seven of whom were later found to be cases of Stickler syndrome and excluded. The remaining 36 children presenting only the anomaly triad of microretrognathia, glossoptosis, and cleft palate were followed up from the first month of life to 4 years of age with repetitive clinical and ophthalmological examination. Main Outcome Measure: A family history of cleft lip/palate was determined on the basis of information provided by the parent...
TL;DR: It was evident that the severity of the maxillary dental arch constriction was closely related to the scar tissue distribution on palates.
Abstract: 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 constr...
TL;DR: These findings confirm that in subjects with unoperated BCLP, the initial characteristics of the cleft malformation persist during growth.
Abstract: Objective: This report is a retrospective study that compares the craniofacial morphology of adult subjects with unoperated bilateral complete cleft lip and palate (BCLP) with that of a noncleft group. Methods: The study was performed on standardized lateral cephalograms obtained at the Hospital for Research and Rehabilitation of cleft Lip and Palate, University of Sao Paulo, Brazil. The research group consisted of 28 subjects (20 males, 8 females) with unoperated BCLP, ranging in age from 15 to 41 years. The control group was matched to the cleft group with regard to gender and age. The findings were analyzed on the basis of the two-way analysis of variance (ANOVA) for cleft and gender. Results: The most striking difference between the groups was the extremely prominent premaxilla in the cleft group that gave the BCLP face a very convex profile. The mandible exhibited a vertical growth pattern that resulted in a steep mandibular plane, an obtuse gonial angle and a long lower face height. The pos...
TL;DR: The combination of a clinical trial and an economic evaluation makes it possible to relate effects to costs involved in treatment alternatives to determine the cost-effectiveness of presurgical orthopedic treatment (PSOT).
Abstract: 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...
TL;DR: Birth weight, body length, body mass index, and cranial circumference at birth of infants with cleft lip and/or palate born between 1973 and 1992 are reported on.
Abstract: OBJECTIVE: This paper reports on birth weight, body length, body mass index, and cranial circumference at birth of infants with cleft lip and/or palate born between 1973 and 1992. METHODS: Data were obtained from two nationwide Swedish health registries. Infants with syndromes, twins, and infants with immigrant parentage were excluded from the study. Comparisons were made with all singleton births with the same exclusion criteria (n = 2,031,140). RESULTS: The body dimensions of infants with isolated cleft lip (n = 865) were found not to differ from those of control subjects, but infants with isolated cleft palate (n = 811) or cleft lip and palate (n = 1139) were found to be lighter and shorter than control subjects. Also, infants with the Pierre Robin sequence (n = 121) had a tendency to be lighter and shorter than control subjects, but these differences did not reach statistical significance despite the large study population. (Less)
TL;DR: The present method of three-dimensional tracking has the potential to detect and characterize a range of clinically significant functional deficits and found good agreement between instrument rankings based on the data from these landmarks and the panel rankings.
Abstract: Objective: (1) To determine which facial landmarks show the greatest movement during specific facial animations and (2) to determine the sensitivity of our instrument in using these landmarks to detect putatively abnormal facial movements. Design: Movements of an array of skin-based landmarks on five healthy human subjects (2 men and 3 women; mean age, 27.6 years; range, 26 to 29 years) were observed during the execution of specific facial animations. To investigate the instrument sensitivity, we analyzed facial movements during maximal smile animations in six patients with different types of functional problems. In parallel, a panel was asked to view video recordings of the patients and to rate the degree of motor impairment. Comparisons were made between the panel scores and those of the measurement instrument. Results: Specific regions of the face display movement that is representative of specific animations. During the smile animation, landmarks on the mid- and lower facial regions demonstra...
TL;DR: The results argue that tracking instrumentation is a potentially useful tool in the measurement of facial mobility.
Abstract: Objective: The assessment of facial mobility is a key element in the treatment of patients with facial motor deficits. In this study, we explored the utility of a three-dimensional tracking system in the measurement of facial movements. Methods and Results: First, the three-dimensional movement of potentially stable facial soft-tissue, headcap, and dental landmarks was measured with respect to a fixed space frame. Based on the assumption that the dental landmarks are stable, their motion during a series of standardized facial animations was subtracted from that of the facial and headcap landmarks to estimate their movement within the face. This residual movement was used to determine which points are relatively stable (≤1.5 mm of movement) and which are not (≥1.5 mm of movement). Headcap landmarks were found to be suitable as references during smile, cheek puff, and lip purse animations, and during talking. In contrast, skin-based landmarks were unsuitable as references because of their considera...
TL;DR: Rates of primary pharyngeal flap failure are roughly equivalent to rates of primary sphincter pharyngoplasty failure, and revisions can be salvaged with revisional surgery, which can provide a velopharyngeAl mechanism capable of complete closure.
Abstract: Objective: This paper reports on the rates of failure of operations (pharyngeal flap and sphincter pharyngoplasty) performed for management of velopharyngeal dysfunction, and outcome following their revision. Design: Anatomic abnormalities associated with unacceptable vocal resonance and nasal air escape following pharyngeal flap and sphincter pharyngoplasty were critiqued. The results of primary pharyngeal flap were evaluated for 65 patients, and the results of primary sphincter pharyngoplasty were evaluated for 123 patients. All patients were treated for velopharyngeal dysfunction. The definition of surgical failure was based on persistent hypernasality and/or nasal turbulence on perceptual speech evaluation, and incomplete velopharyngeal closure on instrumental evaluation, at least 3 months postoperatively. Setting: All patients were evaluated and managed at the cleft Palate and Craniofacial Deformities Institute, St. Louis Children's Hospital, a tertiary cleft care center. Patients, Participa...
TL;DR: Children with cleft lip and palate may show a less assertive style of Conversational participation, at least during the preschool years, and 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.
Abstract: 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 non-cleft 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 ...
TL;DR: 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.
Abstract: 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 fou...
TL;DR: Children should be followed for many years following craniosynostosis repair with cranial, neurologic, and possibly funduscopic examinations as well as head circumference measurements to detect delayed closure of cranial sutures.
Abstract: ObjectiveIncreased intracranial pressure, frequently associated with closure of multiple cranial sutures, has been reported to occur in 36% of cases following correction of syndromal craniosynostos...
TL;DR: This surgical procedure for premaxillary repositioning in combination with two-stage alveolar bone grafting is highly effective, because it ensures the blood supply to the premaxilla and minimizes the potential for surgical failure.
Abstract: Objective: This paper introduces a surgical technique for premaxillary repositioning in combination with two-stage alveolar bone grafting for the correction of the premaxillary deformity of patients with bilateral cleft lip and palate (BCLP). The paper also reports on two patients with BCLP who underwent this surgical management. Surgical Procedure: The operation is usually performed when the patient is 8 to 14 years of age. In the first stage of surgery, the side more accessible to the septo-premaxillary junction is selected, and an osteotomy of the premaxilla and unilateral alveolar bone grafting are performed. Approximately 4 to 12 months after the first stage of surgery, contralateral alveolar bone grafting is carried out. Conclusion: We have found that this surgical procedure is highly effective, because it ensures the blood supply to the premaxilla and minimizes the potential for surgical failure. Moreover, it affords wide exposure of the premaxillary bone surface, facilitating sufficient b...