Showing papers in "The Cleft Palate-Craniofacial Journal in 2008"

Universal parameters for reporting speech outcomes in individuals with cleft palate.

Abstract: Objective:To achieve consistency and uniformity in reporting speech outcomes in individuals born with cleft palate with or without cleft lip using perceptual parameters that characterize their speech production behavior regardless of the language or languages spoken. Design:A working group of six individuals experienced in speech and cleft palate was formed to develop a system of universal parameters for reporting speech outcomes in individuals born with cleft palate. The system was adopted in conjunction with a workshop held in Washington, D.C., that was devoted to developing the universal system. The system, which was refined further following the workshop, involves a three-stage plan consisting of (1) evaluation, (2) mapping, and (3) reporting. The current report focuses primarily on the third stage, reporting speech outcomes. Results:A set of five universal speech parameters has been devised for the reporting stage. These consist of (1) hypernasality, (2) hyponasality, (3) audible nasal air e...

Validity and reliability of craniofacial anthropometric measurement of 3D digital photogrammetric images.

Abstract: Background: Direct anthropometry performed during a patient examination is the standard technique for quantifying craniofacial dysmorphology, as well as for surgical planning and outcome assessment. Several new technologies have been designed to computerize anthropometric measurements, including three-dimensional (3D) digital photogrammetry. These digital systems have the advantage of acquiring patient craniofacial surface images quickly and noninvasively. Before morphometry using digital photogrammetry can be applied in clinical and research practice, it must be assessed against direct anthropometry. Objective: To evaluate the validity and reliability of facial anthropometric linear distances imaged by 3D digital photogrammetry with respect to direct anthropometry. Design, Setting, Participants, Measures: Standard craniofacial distances were directly measured twice on 20 normal adult volunteers. Craniofacial surfaces were also imaged using the 3dMDface digital photogrammetry system, and distance...

Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: an audit of 211 children born between 1990 and 2004.

Abstract: Objective: We present an audit of primary cleft palate surgery at our unit, including rates of oronasal fistula development, speech outcomes, and rates of velopharyngeal insufficiency requiring secondary surgery. Design: A retrospective study of patients with all cleft palate types, born between January 1990 and December 2004, who underwent primary palatoplasty at Middlemore Hospital, Auckland, New Zealand. Patients: The study included 211 patients, collectively operated on by five different surgeons. Results: The overall rate of true fistula development was 12.8% over a mean follow-up period of 4 years 10 months. The incidence of true fistulae that required surgical repair was 8.1%. Fistula rates were higher for more severe degrees of clefting but were not affected by gender or type of surgical repair. Overall, 31.8% of the study population had some degree of hypernasality following primary palatoplasty. Secondary surgery for velopharyngeal insufficiency was required in 13.3% of patients. Follow...

Prevalence of Abnormalities in Dental Structure, Position, and Eruption Pattern in a Population of Unilateral and Bilateral Cleft Lip and Palate Patients:

Abstract: Objective: To evaluate the dental characteristics of patients subjected to a protocol that included early secondary gingivoalveoloplasty (ESGAP). Design: Panoramic radiographs of 87 patients with unilateral cleft lip and palate (UCLP) and 29 with bilateral cleft lip and palate (BCLP) were evaluated. Missing and supernumerary teeth were also quantified on the cleft and noncleft side and in the maxilla and mandible. Crown and root malformations and tooth rotations were quantified. A subsample in permanent dentition was extrapolated to analyze canine eruption patterns. Results: A total of 48.8% of the UCLP patients presented with missing permanent lateral incisors in the cleft area and 6.1% contralaterally. A total of 4.9% presented with missing second maxillary premolars on the cleft site and 1.2% contralaterally. A total of 7.3% presented with supernumerary lateral incisors, and 45% of the BCLP cleft sites presented with missing lateral incisors, while 25% of the cleft sites presented second maxil...

Timing of Palatal Surgery and Speech Outcome

Abstract: Objective: To examine the impact of age and lexical status at the time of primary palatal surgery on speech outcome of preschoolers with cleft palate. Participants: Forty children (33 to 42 months) with nonsyndromic cleft palate participated in the study. Twenty children (Group 1) were less lexically advanced and younger (mean age = 11 months) and 20 children (Group 2) were more lexically advanced and older (mean age = 15 months) when palatal surgery was performed. Main Outcome Measures: Samples of the children's spontaneous speech were compared on 11 speech production measures (e.g., size of consonant inventory, total consonants correct, % correct for manner of articulation categories, compensatory articulation usage, etc.). Next, listeners rated a 30-second sample of each child's connected speech for articulation proficiency and hypernasality, separately, using direct magnitude estimation (DME). Results: Group differences were noted for 4 of the 11 speech production measures. Children in Gr...

Dental anomalies as part of the cleft spectrum.

Abstract: Objective: The aim of this study was to determine subphenotypes of clefts based on tooth development. Dental phenotypes (tooth agenesis, supernumerary and impacted teeth, transposition, and structural anomalies) outside the cleft area in the permanent dentition of oral cleft individuals were investigated. Design: Evaluation of dental records of cleft patients. Setting: National Museum of Health and Medicine, Washington, D.C. Patients, Participants: A collection of dental casts, radiographic and clinical records of 146 patients with oral clefts was evaluated. Main Outcome Measure: Association of dental anomalies with preferential subtypes of clefts. Results: Forty-seven individuals (32.19%) presented at least one dental anomaly outside the cleft area. Individuals with complete cleft lip and palate (CLP) presented more dental anomalies than individuals with incomplete CLP (p = .04). Cleft palate individuals presented more dental anomalies than CLP individuals (p = .048). Maxillary lateral incis...

A longitudinal study of speech production in Swedish children with unilateral cleft lip and palate and two-stage palatal repair.

Abstract: Objective:To describe speech production longitudinally in a group of children with unilateral cleft lip and palate (UCLP). Participants:Twenty consecutive children with UCLP and nine age-matched children without clefts in a comparison group. Intervention: A two-stage palatal repair procedure with soft palate closure at 6 months and hard palate repair at 3 to 4 years. Main Outcome Measures:Percent correct consonants (PCC), percent correct places (PCP), and percent correct manners (PCM) at 3, 5, and 7 years of age. Cleft speech errors at the same ages. Previously collected data on number of consonant tokens, consonant types, frequency of occurrence of places and manners of articulation at 18 months. Results:PCC and PCP were significantly lower in the UCLP group than in the comparison group at all ages. Number of consonant types and frequency of occurrence of dental plosives at 18 months correlated significantly with PCC at age 3. A high frequency of velar plosives at 18 months correlated significan...

Early Intervention for Speech Impairment in Children With Cleft Palate

Abstract: Objective:This study explored the effectiveness of a parent-implemented, focused stimulation program on the speech characteristics of children younger than 3 years with cleft lip and palate. The research questions included the following: (1) Can parents be trained to deliver an early intervention (EI) program for children with cleft palate? (2) Does a parent-implemented EI program result in positive changes in speech characteristics? Participants:Ten mother-child pairs in which the child had cleft lip and palate (CLP) and 10 mother-child pairs in which the child did not have a cleft (NCLP). The children ranged in age from 14 to 36 months of age and were matched between the CLP and the NCLP groups for vocabulary size, age, and socioeconomic status. Main Outcome Measures:Group differences (CLP and the NCLP) for preintervention and postintervention language and speech measures were compared. Results:The results of this study showed that the mothers could be trained to deliver the intervention reliab...

Clinical outcomes of the Furlow Z-plasty for primary cleft palate repair.

Abstract: Objective: To review the clinical outcomes following the Furlow Z-plasty for primary cleft palate repair. The primary objective was to determine if the presence of an associated sequence or syndrome (i.e., Pierre Robin sequence), age at palate repair, cleft type, or surgeon experience influenced speech outcomes after a Furlow Z-plasty. Design: The outcomes of 140 patients who underwent palate repair were analyzed retrospectively. Speech evaluations were performed to score the severity of hypernasality, nasal escape, articulation errors, and velopharyngeal insufficiency. Results: The mean age at latest evaluation was 4 years 9 months (age range 2 years old to 12 years old and 4 months). Of the 140 patients, 83% had no evidence of hypernasality, 91% had no presence of nasal escape, and 69% had no articulation errors. Overall, 84% of patients had no evidence of velopharyngeal insufficiency. Secondary posterior pharyngeal flap to correct velopharyngeal insufficiency was required in only 2.1% of patie...

A new grading of Pierre Robin sequence.

Abstract: Objective: Pierre Robin sequence (PRS) involves the triad of micrognathia, glossoptosis, and cleft palate. Neonates with PRS suffer from two problems—airway obstruction and feeding difficulties—but the severity of these problems varies greatly. The resultant varying definitions of PRS have resulted in inconsistent management of those babies given the diagnosis. This in turn makes comparison of published data and communication between clinicians difficult. Historically at Birmingham Children's Hospital, the cleft team only identified babies presenting with cleft palate and severe respiratory distress as “true” PRS. These babies were admitted to the high-dependency neonatal ward for airway assessment and management. Babies with a mild degree of respiratory obstruction but who were managed successfully at home were not classified as having PRS despite needing considerable input from the Cleft Clinical Nurse Specialist. A system of classifying babies with PRS based on the severity of their symptoms a...

Characteristics of 2733 cases diagnosed with deformational plagiocephaly and changes in risk factors over time.

Abstract: Objectives: To describe infant and maternal characteristics among infants with plagiocephaly and to quantify time trends in potential risk factors for plagiocephaly. Design: Case-only study. We described the characteristics of individuals born between 1987 and 2002. We also compared characteristics of individuals born from 1987 through 1990, before the American Academy of Pediatrics 1992 sleep-position recommendations, with those of individuals born from 1991 to 2002. Setting: Children's Craniofacial Center at Children's Hospital and Regional Medical Center in Seattle, Washington. Participants: Subjects included 2733 infants diagnosed with deformational plagiocephaly or brachycephaly before 18 months of age who were born from 1987 to 2002. Main Outcome Measure: Descriptive statistics, odds ratios, and 95% confidence intervals. Results: Among individuals born from 1991 to 2002, 91.6% had occipital-only flattening, 17.2% were brachycephalic, 67.7% were boys, and 9.9% were multiple birth infants. As...

Canine Eruption in Patients With Complete Cleft Lip and Palate

Abstract: Objective:To describe erupting maxillary canine positions in patients with bone-grafted alveolar clefts. Sample:The sample consisted of 101 cleft sites from patients with complete unilateral or bilateral cleft lip and palate who had early (≤9 years) or late (>9 years) secondary alveolar bone grafts. Methods:Canine position was assessed using panoramic radiographs taken before and after alveolar bone grafts. Vertical canine positions were assessed using the long axis of the maxillary permanent canine relative to a 90° vertical reference line. Lateral canine positions were defined using the relationship between the canine tip and the midplane of the lateral incisor root. Anomalous lateral incisors were recorded. Statistical analysis included Student's t tests and chi-square tests. Results:Patients with alveolar clefts had a 20-fold increased risk for canine impaction, based on erupting canine positions. Abnormal vertical canine positions decreased following early and late alveolar bone grafts (p < ...

Long-term treatment effectiveness of molding helmet therapy in the correction of posterior deformational plagiocephaly: A five-year follow-up

Abstract: Objective: To evaluate the long-term effectiveness of helmet therapy in the correction of deformational plagiocephaly and to assess the early occlusal abnormalities seen in these patients. Design: A prospective study with blinded measurements. Patients: Twenty-eight patients with deformational plagiocephaly who were treated with molding helmet therapy with at least 5 years of follow-up. Interventions: The average length of molding helmet treatment was 6.2 months. At the time of this follow-up evaluation, the mean interval since completing the molding helmet therapy was 5.6 years. Main Outcome Measures: Anthropometric measurements of cranial asymmetry included cranial vault asymmetry (CVA), orbitotragial depth asymmetry (OTDA), and cranial base asymmetry (CBA). A dental examination was also performed. Results: At the completion of therapy, the most improvement was seen in the measurement of CBA, followed by CVA and OTDA. However, in evaluating the long-term stability of molding treatment, OTDA ten...

Morphologic and management characteristics of individuals with unilateral cleft lip and palate who required maxillary advancement.

Abstract: Objective:To delineate factors that may contribute to maxillary hypoplasia requiring maxillary advancement surgery in individuals with nonsyndromic unilateral cleft lip and palate (UCLP). Methods:This retrospective, longitudinal study used lateral cephalometric radiographs and chart reviews of 16 nonsyndromic UCLP individuals who underwent Le Fort I maxillary advancement and 16 controls matched for cleft type, age, and gender. Cephalometric measurements were made at three time points (T1, T2, and T3): mean ages of 10.7, 13.3, and 15.8 years for the Le Fort group and 10.11, 12.9, and 15.7 years, respectively, for the control group. Information regarding team care, timing and number of surgical procedures, and number of congenitally missing teeth were determined from clinical records. Results:The Le Fort group had significant maxillary hypoplasia at all time points compared to the UCLP controls, indicated by midface length measurements, ANB and Wit's analysis (p < .001). The Le Fort group had twice...

Preferential associations between oral clefts and other major congenital anomalies.

Abstract: Objectives: To identify preferential associations between oral clefts (CL = cleft lip only, CLP = cleft lip with cleft palate, CP = cleft palate) and nonoral cleft anomalies, to interpret them on clinical grounds, and, based on the patterns of associated defects, to establish whether CL and CLP are different conditions. Design And Settings: Included were 1416 cleft cases (CL = 131, CLP = 565, CP = 720), among 8304 live- and stillborn infants with multiple congenital anomalies, from 6,559,028 births reported to the International Clearinghouse for Birth Defects Surveillance and Research by 15 registries between 1994 and 2004. Rates of associated anomalies were established, and multinomial logistic regressions applied to identify significant associations. Results: Positive associations with clefts were observed for only a few defects, among which anencephaly, encephaloceles, club feet, and ear anomalies were the most outstanding. Anomalies negatively associated with clefts included conge...

Effect of infant orthopedics on facial appearance of toddlers with complete unilateral cleft lip and palate (Dutchcleft)

Abstract: Objective: To evaluate the effect of infant orthopedics (IO) on facial appearance of 54 patients with unilateral cleft lip and palate (UCLP), aged 4 and 6 years. Design: Prospective two-arm randomized controlled clinical trial in three Cleft Palate Centers in the Netherlands (Dutchcleft-trial). Interventions: Patients were divided randomly into two groups. Half of the patients (IO+) had a plate until surgical closure of the soft palate at the age of ± 52 weeks; the other half (IO-) received no intervention. Main outcome measures: Facial appearance at 4 and 6 years of age assessed on full face photographs and photographs showing only nose and mouth. Ratings were performed on a VAS-scale by professionals and laymen. Results: At 4 years of age the full face pictures of IO+ children were scored to be more attractive than those of IO- children. However, this difference had disappeared at 6 years of age. At the age of 6, only professionals saw a significant difference on nasolabial photographs between IO+ and IO-. Regression analysis showed a minor effect of occlusion, lip revision, or type of nose reconstruction on the esthetic results. Conclusions: IO had a positive effect on full facial appearance of UCLP children at the age of 4 years, but at the age of 6, only professionals saw a positive effect of IO on the nasolabial photographs. This is irrelevant for UCLP patients since they deal with laymen in their daily life.

Pattern of Cleft Lip and Palate in Hospital-Based Population in Saudi Arabia: Retrospective Study

Abstract: Objective: To report the patterns of cleft lip and/or cleft palate in Saudi Arabia from data collected at a tertiary care hospital. Design and Setting: King Faisal Specialist Hospital and Research Center, Riyadh. Patients: All the cleft lip and/or cleft palate patients registered in the Cleft Lip/Palate and Craniofacial Anomalies Registry from June 1999 to December 2005. Results: Retrospectively, 807 cases of cleft lip and/or palate were registered. There were 451 boys and 356 girls. Cleft lip and palate was more common (387) than isolated cleft palate (294) and isolated cleft lip (122). Boys predominated in cleft lip and palate and cleft lip; whereas, girls predominated in isolated cleft palate, with boy to girl ratios of 1.6:1, 1.2:1, and 0.9:1 for cleft lip and/or palate, isolated cleft lip, and isolated cleft palate, respectively. The Riyadh region had more cases (32.0%) than the Asir (15.6%) and Eastern (14.6%) regions. Parents of 439 individuals had consanguineous marriages. A positive fami...

Quality assurance guidelines for surgical outreach programs: a 20-year experience.

Abstract: Numerous American volunteer organizations travel throughout the developing world, providing surgical services to those in need. Medical staff who undertake such missions must contend with the realities inherent to providing healthcare abroad. Inadequate medical facilities and equipment, coupled with a short mission duration and the lack of substantial integration with the local medical community, greatly increase the risk of unnecessary medical complications. At present, there is no definitive set of quality assurance guidelines for the surgical outreach community. This report draws on 20 years of outreach experience to recommend a set of quality assurance guidelines for surgical outreach missions.

A study of speech, language, hearing, and dentition in children with cleft lip only.

Abstract: Objective: To examine the prevalence of speech, language, hearing, and dental problems in children with an initial diagnosis of isolated cleft lip only (CL), for which evidence-based practice can be developed. Design: Retrospective chart review of 95 patients with cleft lip (age range, 2.8 to 3.7 years; mean, 3.1 years). Results: Speech and language impairment was documented in 13% and 18% of the patients, respectively. Thirty-three percent of the children presented with middle ear effusion. Thirteen percent had abnormal hearing. With one exception, the type and degree of hearing loss was a mild conductive loss most often attributed to the presence of effusion. Dental and/or occlusal anomalies were documented in 62% of the patients. A supernumerary tooth was the most frequently occurring dental anomaly and crossbite the most frequently occurring occlusal anomaly. Two children had a submucous cleft palate. Resonance was abnormal in 5% of the children. Conclusion: Children with an initial diagnosis...

DNA methylation changes during cleft palate formation induced by retinoic acid in mice.

Abstract: Objectives: The aim of this study was to analyze epigenetic (specifically, DNA methylation) participation in the mechanisms of cleft palate only induced by maternal exposure to all-trans retinoic acid in mice. Design: Cleft palate only was induced in fetuses by maternal exposure to all-trans retinoic acid. Their secondary palates were excised for analysis. Cytosine extension assay and restriction landmark genomic scanning were performed to analyze DNA methylation status. The expression levels of the DNA methyltransferases were examined by real-time reverse transcriptase–polymerase chain reaction. Results: Using cytosine extension assay, on gestation day 14.5, the status of DNA methylation within CpG islands and in global DNA was decreased significantly in all-trans retinoic acid–treated groups compared with the controls (p < .01 and p < .05). In the controls, the status within CpG islands on gestation day 14.5 was significantly increased compared with gestation days 13.5 and 18.5 (p < .01). Using...

The Continuing Multidisciplinary Needs of Adult Patients with Cleft Lip and/or Palate:

Abstract: Objective: Babies born with cleft lip and/or palate are followed-up throughout their growth in childhood During adulthood, they may require further functional and/or aesthetic treatment Adult multidisciplinary cleft clinics have been in place in the West Midlands, UK since June 2000 The aim of this study was to review the number and nature of problems these adult patients had and the types of treatment they required Design: All adult patients seen in 2004 were identified Case notes were reviewed for patient epidemiology, problems at initial presentation, and interventions carried out until their last clinic visit in 2004 Results: In 2004, there were 145 patients seen in the adult cleft clinic Of those, 55 patients attended as part of their continuing care Ninety were newly referred as adults to the cleft service Patients ranged in age from 15 to 70 years and had, on average, three clinical problems each One hundred and sixteen patients were listed for surgery of varying types, nine pa

Dental anomalies of number in the permanent dentition of patients with bilateral cleft lip: radiographic study.

Abstract: Objective: To radiographically evaluate the prevalence of dental anomalies in patients with complete and incomplete bilateral cleft lip, comparing the prevalence of anomalies between genders and cleft types. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (HRAC/USP), Bauru, Sao Paulo, Brazil. Participants: 150 randomly selected panoramic radiographs of individuals with complete or incomplete bilateral cleft lip; patient age 12 to 25 years (mean age 13.8 years). Results: Data were statistically analyzed to compare the possible association between presence of hypodontia and supernumerary teeth, according to gender and cleft type. Among the 150 patients evaluated, 80 (53.3%) were male and 70 (46.6%) were female. Since no statistically significant difference was found in hypodontia between genders, data were grouped for analysis, revealing prevalence of 31.6% for complete clefts and 26.8% for incomplete clefts. Concerning supernumerary teeth, the prevalence for...

Folate and clefts of the lip and palate--a U.K.-based case-control study: Part I: Dietary and supplemental folate.

Abstract: Objectives: We sought to determine the associations between nonsyndromic cleft lip with or without cleft palate (CL−P) and cleft palate only (CP) and maternal intake of dietary folate and supplemental folic acid, in an area where the prevalence at birth of neural tube defects has been high and flour is not fortified with folic acid. Methods: Interviews regarding periconceptional dietary intake and supplement use were completed with the mothers of 112 CL−P cases, 78 CP cases, and 248 unaffected infants. The data were analyzed by logistic regression methods. Results: There was no overall association between CL−P and CP and either energy-adjusted total folate intake or supplemental folic acid use, irrespective of dosage. Conclusion: Overall, higher intakes of total folate do not appear to prevent oral clefts in this population.

Sella Turcica Morphology and Dimensions in Cleft Subjects

Abstract: Objectives: Evaluate sella turcica morphology, calculate its size in cleft subjects, and compare it with noncleft subjects Materials: Lateral cephalometric radiographs of 95 cleft and 190 noncleft individuals Radiographs were divided into two groups by age: 11 to 14 years of age, 15 years and above Main Outcome Measures: The morphology of the sella turcica was categorized into six shapes; whereas, the size of the sella turcica was measured in terms of length, depth, and diameter in millimeters Results: The sella turcica was abnormal in shape in the majority of cleft subjects when compared with noncleft subjects (p = 0000), more so in subjects with unilateral cleft lip and palate and bilateral cleft lip and palate (p = 0000, p = 020, respectively) Depth of sella turcica was smaller in unilateral cleft lip and palate subjects (p = 037) A smaller sella turcica size (length, depth, diameter) was evident in cleft subjects as compared with noncleft subjects (p = 037, p = 004, p

Seasonal variation and regional distribution of cleft lip and palate in Zambia.

Abstract: Objective: To assess variations in seasonality and regional distribution of orofacial clefts in babies born in Zambia. Design: A retrospective chart review was done using records of all cleft procedures performed by the only plastic surgeon in Zambia (G.J.). Delivery data from the University Teaching Hospital (UTH) were also examined to estimate the birth prevalence of orofacial clefts (55,108 live births between 2001 and 2005). Patients: All cleft patients operated in Zambia from 2000 to 2006 (413 patients). Results: A low birth prevalence of clefts (1/4239 live births) was found using UTH delivery data. Surgical data showed no difference for the frequency of one gender over another overall (M:F ratio is 1.04; p = .70). More bilateral clefts occurred in cleft lip and palate (CLP) patients than in cleft lip (CL) patients (p < .01), and more unilateral left-sided clefts occurred in CL than in CLP patients (p = .03). The data reflected seasonal variation in month of birth of cleft lip with or w...

Hospitalization, breast-milk feeding, and growth in infants with cleft palate and cleft lip and palate born in Denmark.

Abstract: Objective: To evaluate if the duration of postpartum hospitalization, duration of breast-milk feeding, and growth during the first year of life in infants with cleft lip and palate (CLP) and cleft palate (CP) are comparable to infants without facial clefts. Design: Prospective data collection using a registration chart developed by the authors. Setting: Special health care of infants with CLP/CP born in Denmark. Participants: All mature infants with CLP/CP born in 2003 and 2004 were included. Of 165 infants, 115 participated in the study. Intervention: In Denmark, parents of children with CLP/CP receive counseling. This counseling is managed by specially trained health visitors/nurses and is initiated at birth. The counseling seeks to support parents' confidence in having an infant with CLP/CP and to initiate a relationship between the infant and the parents. Main Outcome Measures: Duration of postpartum hospitalization, duration of breast-milk feeding, and weight and length at birth, 5 months of...

Long-term effects of pharyngeal flaps on the upper airways of subjects with velopharyngeal insufficiency.

Abstract: Objectives: To investigate the long-term effects of pharyngeal flap surgery (PFS) on nasal and nasopharyngeal dimensions of patients with velopharyngeal insufficiency (VPI) and to correlate the findings with the onset of respiratory complaints after surgery. Design/Participants: Prospective study in 58 nonsyndromic patients with repaired cleft palate and VPI, evaluated 2 days before and 5 months (POST1) and 1 year (POST2) after PFS, on average. Patients were divided into two groups: one consisting of patients with postoperative respiratory complaints (RC group) and the other without complaints (NRC group). Interventions: Superiorly based PFS. Main Outcome Measures: Respiratory complaints (self reports of mouth breathing, snoring, and other sleep obstructive events) assessed at POST1 and POST2, and minimum nasal (NCSA) and nasopharyngeal (NPA) cross-sectional areas assessed by rhinomanometry at POST2. Results: Respiratory complaints were reported by 55% and 36% of the patients evaluated at POST1 a...

Presurgical orthopedics and satisfaction in motherhood: a randomized clinical trial (Dutchcleft).

Abstract: Objective: To study the effect of infant orthopedics on satisfaction in motherhood. Design: Prospective two-arm randomized controlled trial in parallel with three participating academic cleft palate centers. Treatment allocation was concealed and was performed by means of a computerized balanced allocation method. Setting: Cleft palate centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. Patients: Two groups of infants with complete unilateral cleft lip and palate and no other malformations. Interventions: Group IO+ (n = 27) wore passive maxillary plates during the first year of life, group IO− (n = 27) did not. Main Outcome Measure(s): Mean satisfaction scores were obtained from completed questionnaires at 6, 24, and 58 weeks of age. A 4-point scale was used (1 = very satisfactory to 4 = very unsatisfactory). Results: The range of the mean scores for the individual items on the questionnaires for both groups ranged between 1.1 and 2.4. No differences were found between groups....

Oral health-related quality of life of children with craniofacial conditions.

Abstract: Objective: Evaluation of the Dutch Child Oral Health Impact Profile (COHIP), assessing the level of concordance between parents and children. The internal consistency and the predictive validity of the COHIP for self-reported general health were examined. Methods: Sample size was 35 pairs of parents and children age 11 to 14 with craniofacial conditions. Cronbach alphas were calculated and the level of concordance between parents and children was studied using t tests and intraclass correlations. Predictive validity was assessed using Pearson correlations and linear regression analyses. Results: The COHIP and its subscales, except for one, had satisfactory to high Cronbach alphas (.59 to .94). Parents and children did not differ significantly. Correlations between parents and children were high (.62 to .91). Only "Oral symptoms" proved to be a significant predictor of general health, but only in the parent sample. Conclusions: In spite of the high level of concordance found, proxy reports have to be considered complementary to the reports of the children themselves. The Dutch version of the COHIP performs adequately, but could use some further psychometric evaluation and revision. It does not seem advisable to use the subscales separately as predictors in the same regression model, since they are strongly intercorrelated. For use in craniofacial patients, further validation is needed on a larger sample and some items need to be revised or removed. Finally, given the small number of cases, conclusions must be drawn with caution.