The Cleft palate journal最新文献

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.

Glucocorticoid-induced cleft palate (CP) has been used as an animal model for hormonal teratogenesis. In mice, the susceptibility to glucocorticoid-induced CP varies with the strain, A/J being very sensitive and C57/BL6J relatively resistant. Studies in adult and embryonic murine tissues have attempted to correlate the number of glucocorticoid receptors and CP susceptibility, with conflicting results. The relative quantities of dexamethasone receptors were now studied in established palatal and lung fibroblast cell cultures obtained from adult C57 and A/J mice. A rapidly saturable, stable binding system was demonstrated. Scatchard plots were linear indicating a single class of high affinity receptors. The glucocorticoid receptor number ranged from 6.2 x 10(-16) mole/microgram prot to 8.6 x 10(-16) mole/microgram prot, while the KD varied from 1.0 x 10(-8) M to 2.8 x 10(-8) M. The differences in receptor characteristics between murine strains were not significant (p greater than 0.05). The absence of a difference in receptor number between the two strains may reflect the limitation of fibroblast cell culture in assessing glucocorticoid binding in vivo. Alternatively, if a difference in palatal dexamethasone receptor levels between mice strains exists, it may occur only in the embryo.

The limited literature on the lateral pharyngeal recess of Rosenmüller and the various presentations of pharyngeal webbing are reviewed. Webbing across the lateral pharyngeal recess is described in 28 of 31 adults with cleft palate examined. The phenomenon has not been reported before and does not appear to be a feature of the nasopharyngeal wall in noncleft individuals.

A clinical study evaluating the use of calvarial (two different techniques of harvest) versus iliac donor bone in secondary unilateral alveolar cleft reconstruction based on clinical and radiographic assessment was conducted. Both iliac bone and the Hudson brace harvested calvarial bone resulted in high rates of radiographic evidence of osseous continuity between the maxillary segments and clinical resolution of the alveolar cleft defect. Calvarial bone obtained with the craniotome had a lower rate of success that was statistically different from the other two groups. The utilization of calvarial bone and the implications of harvest technique on graft transfer biology are discussed.

The present study addressed two questions. Does the skeletal pattern of children with cleft lip and palate who require a pharyngeal flap differ from children with similar clefts who do not? Following a pharyngeal flap does the pattern of facial development change? Skeletal form prior to pharyngeal flap was compared using cephalograms in 52 subjects with unilateral cleft lip and palate (UCLP) who subsequently received a superiorly based pharyngeal flap and 52 UCLP controls matched for sex and age. The flap group had slightly smaller maxillary length and anterior face heights and greater mandibular protrusion (p less than 0.5) before the pharyngeal flaps were done. Preoperative and five year (minimum) postoperative records were analyzed for 29 early pharyngeal flap cases and 29 matched controls. Subsequent growth demonstrated some assimilation of the flap group with the controls, but repeated measures analysis of variance failed to identify any important differences in growth after pharyngeal flap, suggesting that the superiorly based pharyngeal flap carries no systematic risk of interference with facial growth.

Latinos are expected to form the largest ethnic minority in the United States by the year 2000. Although there is considerable diversity within this group, a number of similarities prevail. Folk theories of etiology and treatment, family loyalties, attitudes toward health professionals, and hospitals appear similar across Latino subgroups. Successful treatment requires the knowledge and appreciation of cultural attitudes.

The transmission characteristics of nasal tract energy to a nasal accelerometer were evaluated in relation to nasal tract airway resistance. Ten adult speakers repeated three utterances while recordings of nasal bone vibration, as detected by miniature accelerometers, were obtained simultaneously from both sides of the nose and referenced to a common throat signal. Average nasal-to-oral accelerometry ratios recorded from the more resistant side of the nose were significantly larger in magnitude than those recorded simultaneously from the less resistant side of the nose. While accelerometer ratio waveforms from each side of the nose essentially overlapped for some subjects, others displayed unilateral variations in accelerometer output as a function of time. The anatomic and physiologic condition of the nasal passage appears to be an important variable in the detection of nasal tract acoustic energy using the accelerometric technique.