The Cleft palate journal最新文献

Absorbed doses of radiation were measured by thermoluminescent dosimeters (TLDs) using a skull phantom during simulated cinefluorographic and videofluorographic examination of velopharyngeal function in frontal and lateral projections. Dosages to the thyroid gland, the parotid gland, the pituitary gland, and ocular lens were measured. Radiation dosage was found to be approximately 10 times less for videofluoroscopy when compared with that of cinefluoroscopy. In addition, precautionary measures were found to reduce further the exposure of radiation-sensitive tissues. Head fixation and shielding resulted in dose reduction for both video- and cinefluoroscopy. Pulsing exposure for cinefluoroscopy also reduced the dosage.

Proplast I was used as posterior pharyngeal wall implant to correct velopharyngeal insufficiency (VPI) in 26 patients. Specific criteria were followed in patient selection. Follow-up ranged from 4 months to 124 months. Postoperatively, 18 patients had elimination of VPI and three patients had minimal residual VPI. Four patients lost the implants secondary to infection with residual VPI. One patient had significant residual VPI without the loss of the implant. Based on long-term follow-up, no migration of the implant was seen and there was no detectable effect on subsequent facial growth. Predictably better results were achieved with younger patients in whom smaller implants were used. Conclusions from this study indicate that Proplast I is an acceptable pharyngeal wall implant material to correct VPI when the specific criteria are met and good surgical technique is used.

Predictions about the temporal sequencing (i.e., primacy) and causal relationships between various midfacial growth components, as suggested by two midfacial growth models (functional matrix and septal traction), were examined in the present study. The relationships between quantitative changes in the nasal septum, nasal airway, nasolabial musculature, and premaxilla of 15 normal human fetal specimens, ranging in age from 12 to 20 weeks postmenstrual age, were assessed using the multivariate technique of path analysis. Path analysis results revealed that the causal sequence of variables proposed by the septal-traction model explained more of the variance in premaxillary size (87 percent goodness-of-fit) than did the sequence of variables proposed by the functional matrix model (65 percent goodness-of-fit). These results suggest that the septal-traction model may be a more parsimonious and primary explanation of early human fetal midfacial growth than the functional matrix model. Path analysis results also reiterate the observed complex developmental relationships within the fetal labioseptopremaxillary region, knowledge of which may be important in the surgical management of infants with complete cleft.

On October 14 to 17, 1987, a meeting entitled "State of the Art Conference: Multidisciplinary Management of Cleft Lip and Palate" was held in Iowa City. The major purpose of the conference was to review the available knowledge concerning management of unilateral cleft lip and palate from the perspectives of surgery, speech-language pathology, and orthodontics. The closing feature of the conference was the identification of issues for future research. Participants identified issues of high priority that were then discussed by the entire conference faculty. This paper reports the summary of that discussion and the recommendations of the Conference.

Many methods have been described for correction of the "whistling lip" deformity, a possible sequela of bilateral cleft lip repair. A technique is described that utilizes medially based deepithelialized mucosal-submucosal flaps to augment the central tubercle and to reduce lateral lip fullness. This technique is also useful for certain mucosal contour defects that follow unilateral cleft lip repair. Indications for applying this technique and its advantages, compared with other procedures, are described.

This study compares self-concept scores on the Primary Self-Concept Inventory (PSCI) of 58 7-year-old children. The experimental groups included the three following subgroups: those with visible defects (cleft lip), mixed visible and invisible defects (cleft lip and palate), and invisible defects (cleft palate). The control consisted of first grade students with no physical defects. Significant differences between the subjects with clefts and controls were found. Children with cleft lip and palate (visible and invisible defects) demonstrated the lowest self-concept scores. These test results suggest that early primary school age children experience significant stigma. Therefore, early evaluation of psychosocial stress factors for children with clefts is suggested. School personnel can contribute to addressing self-concept concerns of children with defects. Suggestions for further research are presented.

Ratings and drawings of multi-view videofluoroscopy and nasopharyngoscopic studies of the velopharyngeal valve in 25 subjects with velopharyngeal insufficiency (VPI) were compared. The videofluoroscopic projections assessed were lateral, base, and Towne views. The Towne view was visually compared with flexible fiber optic nasopharyngoscopic studies in the same subjects. The Towne view was found to compare well with nasopharyngoscopic examination, and lateral view alone was found to be inadequate for the description of velopharyngeal movements.

In this personal essay, presented as the keynote address at the inaugural meeting of the Australasian Cleft Palate Association, the author provides an overview of what many might call "the state-of-the-art." But beyond that, the author also plots direction to our efforts so our science can progress.