Unilateral Cleft Lip And Palate Subjects Research Articles

An Investigation of Three-Dimensional Maxillary Arch Morphometry of Children With Unilateral Cleft Lip and Palate.

The aim of this study was to evaluate the effects of multiple factors (congenital and postnatal treatment factors) on the treatment outcome by assessing the maxillary arch dimension of children with unilateral cleft lip and palate (UCLP). Eighty-five Pakistani children with UCLP were taken who received cheiloplasty and palatoplasty. Laser scanned 3D digital models of UCLP subjects were prepared before any orthodontic treatment and bone grafting at 7.69 ± 2.46 (mean ± standard deviation) years of age. Inter-canine width (ICW), inter-molar width (IMW), and arch depth (AD) measurements of maxillary arch were measured with Mimics software. Multiple linear regression analyses were used to evaluate the association between congenital factors (age, gender, UCLP side, family history of cleft) and postnatal treatment factors (techniques of cheiloplasty and techniques of palatoplasty) with maxillary arch dimensions (ICW, IMW, and AD). P value was set at 5%. The mean (standard deviation) dimensions of ICW, IMW, and AD are 26.7 (5.70) mm, 43.3 (4.66) mm, and 27.1 (5.26) mm, respectively. There is no significant association found between multiple factors and maxillary arch dimensions. This regression analysis shows no significant association between multiple factors and MAD in this sample.

A prospective cohort study on the effects of RME in the mandibular dentition of cleft subjects

PurposeRapid maxillary expansion (RME) is the most frequent orthopedic procedure in cleft subjects. However, little is known about its effects on the mandible. The aim of this study was to investigate the spontaneous response of the mandibular teeth following RME. MethodsThis prospective cohort study was carried out with a sample of thirty participants with unilateral cleft lip and palate (UCLP), 8–15 years old, who had transverse maxillary deficiency. Two participants were excluded. They were allocated into three groups: G1 (n = 10), G2 (n = 10), and G3 (n = 8). G1 was treated with a Fan-type expander; G2 with an iMini expander; and G3 with a Hyrax expander. Measurements were performed in Cone Beam CT scans obtained before treatment (T1) and 3 months post-expansion (T2). The primary outcomes were buccolingual inclination of mandibular first molars and canines, and intercanine and intermolar width at different levels. ResultsDental changes were significant (P < 0.05) for intercanine width, increasing in G1 and G2, and for intermolar width, increasing in G2 and G3. There were no significant differences among groups (P > 0.05). ConclusionRME in UCLP subjects performed with these expanders may lead to significant spontaneous changes in both anterior and posterior region of the mandible.

Effects of Multiple Factors on Treatment Outcome in the Three-Dimensional Maxillary Arch Morphometry of Children With Unilateral Cleft Lip and Palate.

Studies have claimed that the maxillary arch dimension of unilateral cleft lip and palate (UCLP) patient is significantly smaller than normal patient. Multiple factors (both congenital and post natal treatment factors) are believed to have an impact on the treatment outcome (maxillary arch retardation) of UCLP patient. The aim of this study was to evaluate the effects of multiple factors on the treatment outcome by assessing the maxillary arch dimension of UCLP Children. Eighty-five Malaysian UCLP children were taken who received cheiloplasty and palatoplasty. Laser scanned 3D digital models of UCLP subjects were prepared before any orthodontic treatment and bone grafting at 7.69 ± 2.46 (mean± SD) years of age. Intercanine width (ICW), intermolar width (IMW), and arch depth (AD) measurements of maxillary arch were measured with Mimics software. Multiple linear regression analyses were used to evaluate the association between multiple factors (gender, UCLP type, UCLP side, family history of cleft, family history of class III malocclusion, techniques of cheiloplasty, and techniques of palatoplasty) and maxillary arch dimensions (ICW, IMW, and AD). P value was set at 5%. Significant association was found between 2 techniques of cheiloplasty and ICW (P = 0.001) and also between 2 techniques of palatoplasty and ICW (P = 0.046) of maxilla. No significant association observed in IMW and AD in relation to all other factors. Modified Millard techniques of Cheiloplasty and Bardach technique of palatoplasty had unfavorable effect on the treatment outcome by assessing the maxillary arch dimension (ICW) using laser scanned 3D digital models in Malaysian UCLP children.

Palatal volume estimation in operated unilateral and bilateral cleft lip and palate subjects using digital study models.

To quantify and compare palatal volume of operated unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) subjects. This cross-sectional study was conducted on 85 study models comprising of 40 operated UCLP subjects (UG; mean age 10.33±1.76years), 25 operated BCLP subjects (BG; mean age 10.44±1.92years) and 20 non-cleft controls (C; mean age 12.90±1.68years). The study models were scanned using 3D scanner and palatal volume assessment done using 3-matic software. Kruskal-Wallis test for palatal volume and one-way ANOVA for intercanine (IC), interpremolar (IPM) and intermolar (IM) width comparison were used. Pearson correlation was done between IM, IPM, and IC width, and palatal volume for three groups. The control group sample was evaluated by two observers to evaluate the interobserver reliability. The median palatal volume of C, UG and BG groups was 5814.31mm3 , 2452.34mm3 and 1688.39mm3 , respectively. Significantly smaller palatal volume was found in UG and BG compared to control. Significant difference was seen in IC width between three groups. The IM, IPM and IC width with palatal volume in UG and IM width with palatal volume in BG group showed significant correlation. The ICC showed excellent agreement (>0.9) between observers. Palatal volume of UG and BG groups was smaller by 57.82% and 71.1%, respectively, compared to controls. Improving IPM width in UG and IM width in BG seems to have more impact in correction of palatal volume.

Three-dimensional facial development of children with unilateral cleft lip and palate during the first year of life in comparison with normative average faces.

BackgroundStereophotogrammetry can be used to study facial morphology in both healthy individuals as well as subjects with orofacial clefts because it shows good reliability, ability to capture images rapidly, archival capabilities, and high resolution, and does not require ionizing radiation. This study aimed to compare the three-dimensional (3D) facial morphology of infants born with unilateral cleft lip and palate (UCLP) with an age-matched normative 3D average face before and after primary closure of the lip and soft palate.MethodsThirty infants with a non-syndromic complete unilateral cleft lip, alveolus, and palate participated in the study. Three-dimensional images were acquired at 3, 6, 9, and 12 months of age. All subjects were treated according to the primary surgical protocol consisting of surgical closure of the lip and the soft palate at 6 months of age. Three-dimensional images of UCLP patients at 3, 6 (pre-treatment), 9, and 12 months of age were superimposed on normative datasets of average facial morphology using the children’s reference frame. Distance maps of the complete 3D facial surface and the nose, upper lip, chin, forehead, and cheek regions were developed.ResultsAssessments of the facial morphology of UCLP and control subjects by using color-distance maps showed large differences in the upper lip region at the location of the cleft defect and an asymmetry at the nostrils at 3 and 6 months of age. At 9 months of age, the labial symmetry was completely restored although the tip of the nose towards the unaffected side showed some remnant asymmetry. At 12 months of age, the symmetry of the nose improved, with only some remnant asymmetry noted on both sides of the nasal tip. At all ages, the mandibular and chin regions of the UCLP patients were 2.5–5 mm posterior to those in the average controls.ConclusionIn patients with UCLP deviations from the normative average 3D facial morphology of age-matched control subjects existed for the upper lip, nose, and even the forehead before lip and soft palate closure was performed. Compared to the controls symmetry in the upper lip was restored, and the shape of the upper lip showed less variation after primary lip and soft palate closure. At this early age, retrusion of the soft-tissue mandible and chin, however, seems to be developing already.

Palatal morphology in unilateral cleft lip and palate patients: Association with infant cleft dimensions and timing of hard palate repair.

To assess the impact of cleft severity and timing of hard palate repair on palatal dimensions in unilateral cleft lip and palate (UCLP) children. Single-centre analysis within a multicenter RCT of primary surgery; 122 UCLP randomized to early hard palate closure (EHPC) at 12months or delayed hard palate closure (DHPC) at 36months; 28 frequency-matched controls. Linear measurements of palatal height, width and length were performed on 116 digital models of UCLP subjects (8.21years, SD=0.53) and 28 models of non-cleft individuals (8.44years SD=0.72). Cleft dimensions at infancy (mean 1.8months) were considered. In a pilot study, shell-to-shell distances between the 3D cleft palate objects and a reference mesh were calculated and differences between the groups assessed. Morphological differences were visualized using colour mapping. Compared to controls, UCLP subjects presented a higher palate at the level of the anterior scar (P=0.002), but generally a lower palate in the middle region (P<0.001). Comparing UCLP subgroups, the DHPC subjects showed a flatter palate posteriorly (P=0.048) and the EHPC group exhibited more transversal constriction (P=0.003 at M1 level). 3D analysis revealed a shallower palate in the DHPC group both in the middle (P=0.002) and the posterior part (P=0.008). Anterior cleft severity correlated negatively with palatal height (P=0.01). Unilateral cleft lip and palate palates differ from controls in width and height. DHPC may represent an advantage for the transversal dimension, but a disadvantage for palatal height. Infant cleft dimensions partially explain differences in palatal height.

Evaluation and comparison between effects of early and late palatoplasty on the mandibular morphology and spatial position with respect to the cranial base and maxilla: A two-dimensional retrospective study

Background: This retrospective cephalometric study was designed to clarify the influence of the timing of surgical repair of cleft and its effect on mandibular growth and its position in the cleft patients which is questionable. Aim: The aim of the study was to assess the effect of timing of palate repair on the mandibular spatial position and morphology in relation to cranial base and maxilla in patients born with unilateral cleft lip and palate (UCLP) using Lateral Cephalograms. Material and Methods: This study was carried out on 20 surgically treated UCLP patients within the age group of 8–16 years. Twenty UCLP subjects were further divided into two groups (early palatal repair n = 10 and late palatal repair n = 10) according to their age at which initial hard palate repair was performed. Results: Stage of palatal repair had a significant effect on the Y-axis (P- 0.045) but there is no significant difference in the spatial position, size and morphology of mandible when compared in relation to anterior cranial base and in relation to maxilla. Conclusion: Timing of surgical repair of palate has no detrimental effects on the position and morphology of mandible in patients with unilateral cleft lip and palate.

Three-dimensional evaluation of the maxillary arch and palate in unilateral cleft lip and palate subjects using digital dental casts.

To assess arch width, palatal surface area, and volume in surgically treated unilateral cleft lip and palate (UCLP) in mixed dentition children in comparison with non-cleft lip and palate (NCLP) children using a 3D laser scanning. 38 subjects (Caucasian origin), 5.63-11.9 years of age (mean, 9.33 ± 1.67 years), were included. 19 in each group (UCLP and NCLP). Digital dental casts were obtained using a 3 Shape R700 laser scanner. Intercanine and intermolar widths (cusp and gingival levels), palatal surface area and volume were measured. An independent sample Student's t-test and an ANOVA were undertaken with significance level set as P < 0.05. Intercanine widths at the cusp (5.60 mm; P < 0.001) and at the gingival level (3.11 mm; P = 0.014), palatal area (141.5 mm2; P = 0.009) and volume (890.7 mm3; P = 0.029) were significantly lower in the UCLP compared to the control group. A smaller part of the subjects was in late mixed dentition phase. To overcome this limitation a matched control group was used. In seven subjects with UCLP, some teeth were missing, which might have had an influence on the dental measurements. However, these subjects could not be excluded because eliminating more severely affected subjects, would have introduced bias. Three-dimensional evaluation of the maxillary arch and palate highlighted significant differences between UCLP and non-UCLP subjects in mixed dentition phase, suggesting that orthopaedic maxillary expansion is advisable in UCLP.

Evaluation of mandibular hard and soft tissues in cleft patients.

The aim of this study was to compare the mandibular hard and soft tissue measurements of unilateral and bilateral cleft lip and palate patients with non-cleft individuals. The study sample comprised of lateral cephalograms of 45 subjects. Sample included 15 non-cleft (NC), 15 unilateral cleft lip and palate (UCLP) and 15 bilateral cleft lip and palate (BCLP) cases whose age were between 15 to 17. 1 angular 13 linear measurements were carried out using Arnett and Gunson soft tissue cephalometric analysis and 4 angular measurements were calculated with Steiner Analysis. Mandibular incisor inclinations relative to the occlusal plane (Md1-Md OP) were significantly greater and mandibular incisor projections (Md1-TVL) were significantly retrusive in cleft subjects (p<0.05). Projection values pertaining to lower lip anterior (LLA-TVL), soft tissue B point (B'-TVL), and soft tissue pogonion (Pog'-TVL) were significantly deficient as well in cleft patients (p<0.05). Sagittal position of the maxilla (SNA) (p<0.001) and intermaxillary relation of the jaws (ANB) were significantly deficient in UCLP subjects (p<0.05) and BCLP individuals (p<0.01). LLA-TVL and B'-TVL correlated with SNB in cleft patients (p<0.05). Decreased lower lip and chin projection values suggest that mandibular region of cleft patients should be taken into account in forming the treatment plan to improve the esthetic outcome of orthodontic and plastic surgery interventions.

Evaluation of skeletal maturation in individuals with cleft lip and palate

Abstract Objectives The assessment of hand-wrist films to identify skeletal maturation stage is a commonly used method for the determination of the status of a growing patient. However, there is limited information available regarding skeletal growth evaluation in subjects with a unilateral cleft lip and palate (UCLP). Therefore, the current study aimed to examine skeletal and chronological ages in subjects with a UCLP for comparison with those of a non-cleft control group to derive clinical guidelines. Methods Hand-wrist films of 45 UCLP subjects (24 male, 21 female) and 45 Angle Class I orthodontic patients (17 male, 28 female) were evaluated. Skeletal age was assessed by comparing ossification events with standard radiographs illustrated in the Greulich-Pyle atlas and recording based on the best match of maturity criteria. Results A high correlation coefficient was observed between skeletal and chronological ages in the overall study sample (p &lt; 0.01) (N = 90). Skeletal age (11.4 years) was delayed in the UCLP group when compared with chronological age (12.3 years), although the difference between the two was statistically insignificant. Skeletal age (13.6 years) was similar to chronological age in the control group (13.1 years). Conclusions The discrepancy between chronological and skeletal age was greater in UCLP subjects compared with controls. Given that the skeletal age of male and female UCLP subjects was delayed in comparison with their chronological ages, it is of particular importance that hand-wrist films should be used instead of chronological age to assess the growth status of UCLP subjects.

The effect of early versus late palate repair on pharyngeal airway volume in patients with unilateral cleft lip and palate

Context: Timing of surgical repair of cleft and its effect on volume of pharyngeal airway have not been investigated thoroughly. Aim: The aim of the study was to assess the effect of timing of palate repair on pharyngeal airway in patients born with unilateral cleft lip and palate (UCLP) using cone beam computed tomography (CBCT). Settings and Design: The design was a retrospective study. Subjects and Methods: The study was carried out on 20 surgically treated UCLP patients and 40 normal noncleft subjects with Class I skeletal relation within the age group of 7–14 years. Twenty UCLP subjects were further divided into two groups (early palatal repair n = 11 and late palatal repair n = 9) according to their age at which initial hard palate repair was performed. Forty normal noncleft subjects were included in the control group. Results: No significant difference was found in volume of nasopharynx, oropharynx, hypopharynx, total pharyngeal volume ( P = 0.83), and minimum axial area ( P = 0.90) of the pharynx between the groups. Conclusions: Using CBCT, this study found that there was no significant difference in the pharyngeal airway between early and late hard palatal surgery.

Is missing maxillary lateral incisor in complete cleft lip and palate a product of genetics or local environment?

To test the null hypothesis: Subjects with isolated complete unilateral cleft lip and palate (UCLP) show no differences in overall frequency of tooth agenesis (hypodontia), comparing a subsample with cleft-side maxillary lateral incisor (MxI2) agenesis to a subsample without cleft-side MxI2 agenesis. Findings could clarify the origins of cleft-side MxI2 agenesis. Tooth agenesis was identified from dental radiographs of 141 subjects with UCLP. The UCLP cohort was segregated into four categories according to the status and location of MxI2 in the region of the unilateral cleft: group M: subjects with one tooth, located on the mesial side of the alveolar cleft; group D: subjects with one tooth, located on the distal side of the alveolar cleft; group MD: subjects with two teeth present, one mesial and one distal to the cleft; and group ABS: subjects with lateral incisor absent (agenesis) in the cleft area. The null hypothesis was rejected. Among UCLP subjects, there was a twofold increase (P < .0008) in overall frequency of tooth agenesis outside the cleft region in a subsample with cleft-side MxI2 agenesis (ABS), compared to a subsample presenting with no agenesis of the cleft-side MxI2 (M+D+MD). Cleft-side MxI2 agenesis in CLP subjects appears to be largely a genetically controlled anomaly associated with cleft development, rather than a collateral environmental consequence of the adjacent cleft defect, since increased hypodontia involving multiple missing teeth observed remote from a cleft clearly has a significant genetic basis.

Crown-root ratio of permanent teeth in cleft lip and palate patients

To determine root lengths of fully developed permanent teeth of cleft lip and palate (CLP) patients and to define their crown-root (C/R) ratios. Crown height and root length of permanent teeth were measured from panoramic radiographs of 44 CLP patients and 37 controls. A total of 1397 teeth were measured, and C/R ratios were calculated. Higher C/R ratios were found in CLP patients; this was statistically significant for both maxillary and mandibular incisors and canines. Bilateral CLP subjects showed higher C/R ratios in general than unilateral CLP subjects. Roots of maxillary incisors, canines, and some other teeth were significantly shorter in CLP patients than in controls. CLP patients should be considered to have unfavorable C/R ratios, which could be the result of short root lengths for some teeth.

Characterization of the Maxillary Complex in Unilateral Cleft Lip and Palate Using Cone-Beam Computed Tomography

Deficiencies in maxillary growth have often been implicated in suboptimal results of cleft lip and palate therapy. Cone-beam computed tomography provides an opportunity to look at the dimensions of the maxillary complex in three dimensions in a way that is not possible with lateral cephalograms or dental models. The purposes of this preliminary study were to outline a new set of 18 cone-beam computed tomographic measurements, apply them to 6 patients with unilateral cleft lip and palate (UCLP), and contrast them to a comparable sample of 7 normal young adults. The patients with UCLP were treated with a single protocol by a single surgeon and orthodontist. The 18 measurements had a mean intrarater reliability of 0.95 and ranged from 0.40 to 2.23 for the individual measurements. The mean interrater reliability was 1.01 and ranged from 0.40 to 2.45 for the individual measurements. Significant differences between the patients with UCLP and control subjects (combined sex samples) were found in palate length, anterior palate thickness, overall sagittal maxillary length, and premaxillary height (Mann-Whitney U tests, P <or= 0.037). The body of the maxilla and its heights appear less affected. These methods and preliminary findings lay the groundwork for larger scale and prospective studies that evaluate such dimensional data in conjunction with positional data and other vital outcomes of cleft lip and palate therapy such as speech and occlusion.

Maxillary Anterior Tooth Size and Arch Dimensions in Unilateral Cleft Lip and Palate

To investigate differences in size of the maxillary permanent anterior teeth and arch dimensions between individuals with repaired unilateral cleft lip and palate (UCLP) and a matched control group representing the general population. Retrospective study cast review. Study casts of 30 subjects due to commence orthodontic treatment following an alveolar bone graft (ABG) were collected from the Cleft Lip and Palate Units in South Yorkshire. Thirty control subjects were collected from a previously validated control group of white individuals in South Yorkshire. Casts were analyzed with an image analysis system to measure the dimensions of the maxillary permanent anterior teeth, incisor chord lengths, and the intercanine and intermolar widths. The results were analyzed statistically using paired t-tests and two-way univariate analysis of variance (ANOVA). The mesiodistal widths of maxillary anterior teeth in the study group were smaller than the noncleft control group (p <or= .01). The dimensions of the cleft side maxillary incisors and incisor chord length were smaller (p <or= .05 and p <or= .01 respectively) compared with the noncleft side. The study group maxillary cleft side incisor chord length and maxillary intercanine width were narrower than the control group (p <or= .0001). (1) Anterior teeth are smaller mesiodistally in individuals with UCLP. (2) Maxillary incisors are smaller on the cleft side than the noncleft side. (3) UCLP subjects had smaller maxillary cleft side incisor chord lengths and intercanine widths than the control group despite pre-ABG expansion.

Active versus passive cleft-type speech characteristics.

Cleft palate speech is generally described in terms of nasal resonance, nasal emission and compensatory articulations. A longitudinal study of children at different stages of surgical treatment revealed a distinction between passive and active cleft-type speech characteristics whereby passive characteristics were thought to be the product of structural abnormality or dysfunction and active characteristics were specific articulatory gestures replacing intended consonants. Passive and active patterns of articulation are described and defined in the context of three longitudinal studies of subjects who were at various stages of two different surgical regimes: five bilateral cleft lip and palate (BCLP) subjects aged 1;6-4;6, 12 mixed unilateral cleft lip and palate (UCLP) and BCLP subjects aged 4;6-7;6 and nine mixed UCLP and BCLP subjects aged 9;0-11;0. Reference is also made to data from 12 mixed cleft-type subjects aged 13;0 who had been treated with different surgical timing regimes. Comparison is made between the incidence of active versus passive processes in relation to oral structure. At age 4;6 speech samples taken from BCLP subjects who had been treated with 1-stage versus 2-stage palate repair all evidenced both active and passive processes. The lack of differentiation in speech results irrespective of their current surgical status, i.e. completely repaired palates versus residual cleft of the hard palate, was unexpected. Cleft-type processes in completely repaired subjects might be accounted for by the inevitable anterior defect following repair of a bilateral cleft. Older subjects with structural defects also evidenced more cleft-type processes. The relevance of distinguishing between active and passive processes is underlined by consideration of the effects of structural changes following surgery. The effect of surgery on seven subjects' speech is discussed using the active/passive distinction. Active cleft-type characteristics did not change as a direct result of surgery, whereas passive characteristics were largely eliminated following surgery. A specific distinction is made between active and passive nasal fricatives, with the implication that active nasal fricatives may not be affected by surgical intervention, whereas passive nasal fricatives may be eliminated by surgery. Accurate distinction between active and passive patterns of articulation may serve to identify those cleft-type speech error patterns most likely to respond to surgical intervention. Indications from this study are that active cleft-type characteristics require destabilization in a course of speech and language therapy before the potential benefits of surgery can be properly assessed. An analytical protocol for the interpretation of speech samples is presented and some therapy strategies are proposed for active and passive processes.

A new index for assessing surgical outcome in unilateral cleft lip and palate subjects aged five: reproducibility and validity.

This study assessed the reproducibility, reliability, and predictive validity of a previously developed index by the authors for assessing surgical outcome in unilateral cleft lip and palate (UCLP) children aged 5. Sixty randomly selected study models of 5- to 6-year-old complete UCLP subjects were obtained and the index was used to assess their surgical outcomes. Assessment of these study models using the new index demonstrated excellent intra-examiner agreement. The inter-examiner agreement was shown to be good. The corresponding longitudinal models at 16 to 18 years of 54 of the initial 5- to 6-year-old sample were also acquired. These subjects had undergone orthodontic treatment but not orthognathic surgery. The need for osteotomy amongst these models was assessed. Between 13% and 18% (depending on examiner) of 5-year-olds' models were scored in the groups likely to require orthognathic surgery. In the corresponding 16- to 18-year-olds' models, 9% were assessed as likely to benefit from an osteotomy. However, on an individual basis, it was not possible to predict future growth from study models at age 5. This study has provided a reliable and reproducible index for assessing the outcome of surgery in UCLP subjects earlier than indices already available. True validation of the index was not possible but it appears that it relies on face validity.

A new Index for Assessing Surgical Outcome in Unilateral Cleft Lip and Palate Subjects Aged Five: Reproducibility and Validity

This study assessed the reproducibility, reliability, and predictive validity of a previously developed index by the authors for assessing surgical outcome in unilateral cleft lip and palate (UCLP) children aged 5.Sixty randomly selected study models of 5- to 6-year-old complete UCLP subjects were obtained and the index was used to assess their surgical outcomes.Assessment of these study models using the new index demonstrated excellent intra-examiner agreement. The inter-examiner agreement was shown to be good. The corresponding longitudinal models at 16 to 18 years of 54 of the initial 5- to 6-year-old sample were also acquired. These subjects had undergone orthodontic treatment but not orthognathic surgery. The need for osteotomy amongst these models was assessed. Between 13% and 18% (depending on examiner) of 5-year-olds' models were scored in the groups likely to require orthognathic surgery. In the corresponding 16- to 18-year-olds' models, 9% were assessed as likely to benefit from an osteotomy. However, on an individual basis, it was not possible to predict future growth from study models at age 5.This study has provided a reliable and reproducible index for assessing the outcome of surgery in UCLP subjects earlier than indices already available. True validation of the index was not possible but it appears that it relies on face validity.

Active versus passive cleft‐type speech characteristics: implications for surgery and therapy

ABSTRACT Cleft palate speech is generally characterised by hypernasality and compensatory articulations. A longitudinal study of children at different stages of surgical treatment revealed a distinction between passive and active cleft‐type speech characteristics as described by Hutters and Brondsted (1987). Passive characteristics are the product, not of disordered articulatory patterns, but of structural abnormality or dysfunction. Active characteristics are alternative articulatory gestures which function in place of intended consonants. Passive and active patterns of articulation will be described and defined in the context of three longitudinal studies: five bilateral left lip and palate (BCLP) subjects aged, 1;6‐4;6; 12 mixed unilateral cleft lip and palate (UCLP) and BCLP subjects aged 4;6–7;6 and nine mixed UCLP and BCLP subjects aged 9;0–11;0. The effects of surgery on the speech of seven subjects will be discussed using the active/passive distinction. Active cleft‐type characteristics did not change as a direct result of surgery, whereas passive characteristics were largely eliminated following surgery. This distinction between active and passive patterns of articulation can serve to identify those cleft‐type speech error patterns most likely to respond to surgical intervention. Indications from this study are that active cleft‐type characteristics require destabilisation in a course of speech and language therapy before the potential benefits of surgery can be properly assessed.

Relationship between cleft severity and dentocraniofacial morphology in Japanese subjects with isolated cleft palate and complete unilateral cleft lip and palate.

Relationships between the width of the palatal cleft measured at palatoplasty and the craniofacial morphology or the occlusal conditions present at approximately 4 years of age were studied in 25 cleft palate (CP) and 39 complete unilateral cleft lip and palate (UCLP) subjects treated at the Dental Clinic of Kyushu University. Posteroanterior cephalograms and dental casts showed that the width of the palatal cleft was significantly correlated with wider upper facial width and posterior dental arch width in UCLP, but not in CP subjects. Cleft width was not significantly correlated with the buccolingual occlusal relationship in either subject type. The anterior occlusal relationship in UCLP was not as good as in CP subjects. On lateral cephalograms, the width of the palatal cleft was significantly correlated with vertical hypoplasia of the upper face in UCLP, but not in CP subjects. The cleft palate width appears to be related to the lateral displacement and the retardation of the downward and forward growth of the nasomaxillary complex in UCLP subjects.