Palate Treatment Research Articles

Interactive influence of a pharyngeal flap and an adenoid on maxillofacial growth in cleft lip and palate patients.

The aim was to evaluate whether a large adenoid, which aids velopharyngeal function, influences facial growth and if a pharyngeal flap reinforces the effect. Forty cleft palate patients were divided into two groups: adenoid and nonadenoid. Twenty of the patients had a pharyngeal flap operation. All the patients had three cephalograms taken at the same ages over a period of 5 years. At an average age of 4.7 years, i.e., one year before any pharyngoplasty, the mandibular inclination was larger in the adenoid group. This inferioposterior mandibular position was aggravated when a flap was added and with age. The present study suggests that the nasopharyngeal space, which is indicative of nasal airway patency, is influenced by a pharyngeal flap as well as an adenoid which, in turn, influences facial growth direction in the cleft palate population. Airway variables ought to be taken into consideration when the growth effect of cleft palate treatment is evaluated.

Interactive Influence of a Pharyngeal Flap and an Adenoid on Maxillofacial Growth in Cleft Lip and Palate Patients

The aim was to evaluate whether a large adenoid, which aids velopharyngeal function, influences facial growth and if a pharyngeal flap reinforces the effect. Forty cleft palate patients were divided into two groups: adenoid and nonadenoid. Twenty of the patients had a pharyngeal flap operation. All the patients had three cephalograms taken at the same ages over a period of 5 years. At an average age of 4.7 years, i.e., one year before any pharyngoplasty, the mandibular inclination was larger in the adenoid group. This inferioposterior mandibular position was aggravated when a flap was added and with age. The present study suggests that the nasopharyngeal space, which is indicative of nasal airway patency, is influenced by a pharyngeal flap as well as an adenoid which, in turn, influences facial growth direction in the cleft palate population. Airway variables ought to be taken into consideration when the growth effect of cleft palate treatment is evaluated.

Parents' Attitudes toward Family Involvement in Cleft Palate Treatment

Parents' Attitudes toward Family Involvement in Cleft Palate Treatment

Parents' attitudes toward family involvement in cleft palate treatment.

Families exert a powerful influence upon their members and can be a significant resource in cleft palate treatment. The purposes of this study were to gather information about (1) the characteristics and attitudes of families whose children are treated for cleft palate; (2) the extent to which parents participate in decisions about treatment; and (3) parents' ideas about their participation. A 32-item survey questionnaire was distributed to 75 parents in Florida, Louisiana, Minnesota, and Pennsylvania. Forty-two survey forms (56%) were completed and returned for analysis. The majority of parents (57%) were satisfied with their present involvement in team treatment services; however, 36% wished for more involvement, and 7% wished for less involvement.

Evaluation of Unilateral Cleft Lip and Palate Treatment: Long Term Results

Fifty-seven consecutive complete unilateral cleft lip and palate patients were followed longitudinally from birth to 21 years of age. All patients were operated with the same primary surgical procedures. Reevaluation at age 21 with respect to speech, dental condition, need for secondary surgery, and skeletal and soft tissue facial growth was completed. Speech results indicated that 13 patients (23 percent) had required a pharyngeal flap, and that at age 21 only one patient still had unacceptable speech. The majority of patients had slight speech disturbances related to articulation and voice quality. Fifty-one patients had acceptable occlusion following orthodontic treatment, twenty-two patients (39 percent) without need for prosthodontic treatment of the cleft area. Secondary surgery for correction of nasal deformities was required for fifty-two patients. Growth analysis demonstrated deficiency in growth; however, normal and acceptable profiles were obtained in 50/57 of the patients.

Evaluation of Unilateral Cleft Lip and Palate Treatment: Long Term Results

Evaluation of Unilateral Cleft Lip and Palate Treatment: Long Term Results

History and Perspective of Cleft Palate Treatment

History and Perspective of Cleft Palate Treatment

A Review of Unilateral Cleft Lip and Palate Surgery*

ABSTRACT Operative techniques for unilateral cleft lip and palate have undergone continuous development, with improvement and modification, during the last three decades. The author's operation began with Tennison's method and gradually changed into a narrower and long triangular flap method. The edge of the orbicularis oris muscle on the cleft side is tucked under the center of the philtral dimple to obtain muscles linkage and a philtral ridge on the affected side. The longitudinal line is sutured with meticulous subcuticular stitches using 6–0 Nylon, resulting in a neat scar.Relationship between vertical height of lip and width of triangular flap was examined in follow‐up studies. Flap width increased rapidly for one year after surgery and then slowed down to a pace proportionate with lip height. Although ratio of flap width to height increased from 27% to 40%, the balance of both sides of the lip did not, as had been thought might be possible, change. Correction of the cleft lip nose by the triangular flap method is rather difficult. It is considered natural for many surgeons to prefer a combination of the rotation‐advancement flap and small triangular flap.Much remains to be discussed regarding cleft palate treatment. Author prefers closure of the hard palate using a vomer flap in the primary cleft lip operation because the most effective push‐back of the palate, without fistulae, is achieved. Underdevelopment of lip and maxilla should be evaluated from many aspects, and with a long‐term view.

The design, fabrication, and use of a full-coverage bonded rapid maxillary expansion appliance

A detailed design and step-by-step construction of a bandless indirectly fabricated and bonded rapid maxillary expansion appliance are presented. Four case reports demonstrate the use of the appliance in routine correction of posterior crossbite; in simultaneous correction of anterior crossbite, especially useful in cleft palate treatment; in combination with maxillary protraction; and in pre-expansion osteotomy cases. Various modifications of the basic appliance make it useful in treating a variety of orthodontic problems. Three of the cases reported have tantalum bone markers for enhanced ascertainment of orthopedic effect.

Late results of multidisciplinary management of unilateral cleft lip and palate.

A model was designed for evaluating protocol and management strategies in the multidisciplinary approach to cleft lip and palate treatment. The treatment history and present status of 45 patients 14 to 22 years of age were evaluated by a plastic surgeon, orthodontist, and speech pathologist. Results indicated that only about half of these patients had completed treatment by one of the specialties by the time they were 14 years or older. Even more surprisingly, only 7 patients (16%) had completed treatment by all three specialties by this age. Factors that may contribute to this low percentage of completed treatments are discussed.

A follow-up study of cleft lip and palate patients treated with orthodontics, secondary bone grafting, and prosthetic rehabilitation.

The purpose of this study was to evaluate the significance of secondary bone grafting in cleft palate treatment. The investigation included a clinical, a biometrical, and a radiographic follow-up of the occlusion, the craniofacial morphology and the function of the masticatory system. The total material of secondary bone grafting cases during the period of 1958–68 consisted of 125 patients. For the final examination, 93 of them were present. The treatment plan was: (1) orthodontic treatment, (2) bone grafting, (3) retention treatment, (4) prosthetic reconstruction of lost teeth. 58 bridges were inserted. The mean age of the patients at the time of bone grafting was 20 years and the mean lag between the bone grafting procedure and the final check-up was 7 1/2 years. Besides bone grafting, 43 palatopharyngeal flap-operations were carried out. At the final check-up, none of the patients wear any obturator. Besides these operations 7 osteotomies of the lower jaw were carried out. The frequence of crossbites was reduced from 94 to 31%. Open bites were present in 6 cases while the remaining cases exhibited normal overjet and overbite. A slight degree of relapse after the orthodontic expansion treatment was noted; thus, in 12 cases, one or two teeth relapsed to crossbite occlusion. The jaw function was fairly normal in all cases studied. The chewing ability was reduced in 9 cases, though the average number of tooth contact-pairs increased, from 5.9 prior to orthodontic treatment to 11.4 at the final examination. The cephalometric part of the investigation indicated that the average patient had a more retrognathic type of face with steeper mandibular and nasal planes than are reported for non-clefts. The bone grafting procedure was successful in 96% of the cases, as evaluated from radiographs. The reorganisation of the average bone graft was completed within 3 to 6 months. This clinical and radiographic investigation revealed that bone grafting of the alveolar process and the palate did normalise and stabilize the maxilla in practically all instances. Thus the method used had prevented relapse after orthodontic treatment in the great majority of cases and the definitive prosthetic rehabilitation could be carried out using the same principles as in non-cleft cases.

The present state of cleft lip and palate treatment at the Department of Plastic Surgery in Prague

The present state of cleft lip and palate treatment at the Department of Plastic Surgery in Prague

A personal construct theory and treatment of stuttering

RELATIVELY fluent people often find it hard to understand how it is possible for someone to speak in a way that is so obviously distressing to the speaker and disturbing to the listener. For the speaker and the listener the better way of communicating is by fluent and not disfluent or stuttered speech. Why then do people go on behaving in such an inefficient way? The answer has been sought for centuries. Because of its involuntary nature, the vast majority of theories have attributed its origin to some organic defect. In the twelfth century, stuttering was said to be caused by convulsions, or ulcers and infections of the tongue. As treatment always stems from theory, remedies included the application of embrocations and the production of blisters on the tongue [l]. Francis Bacon [2] thought that the cause of stuttering lay in “the Refrigeration of the Tongue” and suggested the highly palatable treatment of drinking wine “because it heateth”. Variations on these themes were proposed and practiced throughout the ensuing centuries until, in the nineteenth century, not only were the tongues of stutterers being pierced with red-hot needles, but hypoglossal nerves were being severed. One surgeon even made his name by excising a triangular wedge at the root of the tongue to cure muscular spasm [3]; of the some 260 stutterers who underwent this operation, many died and it was finally abandoned. The most remarkable aspect of these theories and their resulting therapies is their diversity. Even to-day there is no generally accepted theory or treatment. However, one significant development that occurred in the nineteenth century was the suggestion that there might be a psychological component in stuttering [4], thus getting away from the concentration upon the speech apparatus itself. As with all new directions of thought, there was a tendency to go to extremes. Psychoanalytic theorists had a field day, and even now one finds such statements as:

A report on maxillary orthopedics in cleft palate treatment

The maxillofacial anomaly known as cleft lip and palate usually includes dental malocclusion and occasionally gross disturbances in jaw relationships. Although these problems are usually not severe in a young child, they tend to worsen as the child grows older. A great deal of recent clinical evidence points out the need for maxillary orthopedic treatment by the dentist as a member of the cleft-palate team. This early phase of treatment from the dental standpoint gives the plastic surgeon practical reasons for delaying closure of the soft and hard structures involved in facial clefts. Although a section of the vomer bone might have to be removed, maxillary orthopedics may forever remove the need for such radical treatment as resection of the premaxilla. Expansion of the maxillary segments shortly after birth may eliminate previous indecisions or faulty treatment plans. Also, maxillary orthopedics provides good segment alignment prior to the grafting procedures. The use of soft acrylic resin in the deeply undermined clefts gives maximum retention of these restorations prior to the eruption of teeth and makes this treatment plan almost universally acceptable.

Prosthodontics in cleft palate treatment and research

A mutual restraint and understanding within the professional team are necessary if the patient with oral-facial-speech difficulties is to gain full benefit of treatment. The repair of a cleft of the palate in most patients is a surgical challenge. However, there are some situations in which a prosthesis is the treatment of choice. Greater knowledge of the nature of the cleft palate defect through research and the use of better diagnostic tools has made possible better service for patients with a cleft palate. A prosthodontist engaged in treating oral-facial-speech handicapped people should be thoroughly familiar with: (1) the anatomic and physiologic deviations of the region involved, and (2) the basic principles involved in prosthetic dentistry, and (3) he should be willing to acquire further knowledge in this field.

Congenital cleft lip and palate treatment plan

The prosthodontic treatment plan is one phase of a team effort that is comprehensive and long range in scope. An attempt is made to correlate all information related to the patient's problem in order to arrive at the best solution. Treatment is based on the premise that the burden of responsibility for therapy may shift to other disciplines at any time.

Secondary surgical procedures in cleft palate treatment

Three case reports illustrate the results obtained by coordinated treatment in the rehabilitation of older cleft palate patients for whom earlier treatment was incomplete or inadequate. Three case reports illustrate the results obtained by coordinated treatment in the rehabilitation of older cleft palate patients for whom earlier treatment was incomplete or inadequate.

The Development of Latin -gn- in Southern Italy

In southern Italy the group -gnshows a labial development which has generally been treated either as the result of the epenthesis of the velar vowel u or as the vocalization of the g. But in all cases this labialization has been considered characteristic of some southern dialects as opposed to a palatal treatment in others, and not as an extensive change which once covered all southern Italy and has given way later to a northern development in many cases but remains sufficiently widespread to indicate a general treatment which was not confined to single dialects. Previous conceptions of the situation in southern Italy can be summarized as follows. Meyer-Liibke' says that a velar vowel replaces g in southeastern Italy and that in Campobasso the g of -gnbecomes a spirant. Bertoni2 says that in the extreme south of Italy -gnbecomes un, elsewhere (Apulia, northern Calabria, Abruzzi, and Naples) jn. The intermediate stages are: -gunand -gin-, thus *agunu *avunu *a(v)unu aunu and *aginu *ajinu ajno. Merlo3 writes that as in Abruzzi and Apulia so in Naples and Calabria there exist only two developments for Lat. -gn-: -jnand -yn-, which, he believes, are the result of a very ancient epenthesis of i in the one case, u in the other. Similar explanations have been given for -gr-.4 M. Bartoli first pointed out that a labial treatment of -gnwas very extensive in southern Italy and is to be connected with the Balkan treatment. 'La Scuola vecchia crede che il b sardo di battoro abbia un' origine indipendente da quella del p rumeno di patru, e che anche tra i riflessi labiali di -gnnell' Italia meridionale (pugl. cal. dunu, liun -a, pugl. livana, cal. dmunu: agnus, lignum e quelli del Balcano interceda una concordanza illusoria.'5 Previously, in Das Dal-