The Cleft palate journal最新文献

A 16-item questionnaire designed to survey opinions on the management of velopharyngeal insufficiency (VPI) was distributed to all members (N = 296) of the American Cleft Palate Association who were speech-language pathologists. Questionnaires were completed by 173 respondents (58.4 percent). There were differences of opinion among speech-language pathologists on various management issues related to VPI, including the value of instrumental assessment of VPI, the importance of oral examination of velopharyngeal function, and the effectiveness of speech therapy in the treatment of VPI. The implications of these findings for clinical training in VPI are discussed.

Detailed information about the tissue components of the soft palate is needed to construct biomechanical models that are functionally useful. Soft palates were removed from 10 adult cadavers, four males and six females. One-half of each palate was further divided into 10 blocks of equal anterior-to-posterior thickness. The face of each block was sectioned and stained using three different stains, thus providing a sample of 300 histologic slides. Each slide was carefully examined and major anatomic characteristics were noted and recorded. The results indicate that a typical adult soft palate consists of several major tissue layers including: (1) the oral aspect, which is glandular with a zone of adipose tissue located somewhat laterally; (2) the two middle layers are muscular with the more inferior layer consisting mainly of transverse levator veli palatini fibers and the overlying longitudinal layer of musculus uvulae fibers; (3) a superoanterior layer consisting of the tensor veli palatini tendon; and (4) a posteroinferior layer consisting of a mixture of tissue that is primarily glandular. The oral mucosa consists of stratified squamous epithelium with a basement membrane that is reinforced with a dense meshwork of elastic fibers. The nasal mucosa consists of pseudostratified ciliated columnar epithelium anteriorly and stratified squamous epithelium posteroinferiorly. The functional implications of these findings are discussed.

By means of a surgical expedition involving an independently financed team of surgeons, anesthetists and nurses, 410 operations were performed on 346 patients in the course of 52 operating days. This paper describes the preoperative, operative, and postoperative scenarios and how clinical practice was tailored to adapt to a new environment without compromising standards. The differences between operating on the lip and palate in the adult compared to younger children are highlighted. The clinical research implications are more evident from other papers on this topic published in this journal, but the enlightenment of working and teaching in a third world country cannot be underestimated.

This paper investigates the effects of surgery on facial growth and morphology in Sri Lankan males with unilateral cleft lip and palate who were over 13 years of age at the time of study with cephalometry and dental study models. Three separate subgroups were analyzed: those who had totally unrepaired cleft lip and palate, those who received lip repair in infancy but not palatal repair, and those who had lip and palate repair in infancy. Twenty-three healthy noncleft Sri Lankan males over 13 years formed a control group from the same racial background. The results show that subjects who had no surgery had a potential for normal maxillary growth. Subjects who have had lip repair in early infancy show relatively normal maxillary growth, but maxillary hypoplasia is common when the palate has also been repaired early.

Trigonocephaly is typically treated during the second 3 months of life by metopic suture synostectomy, orbital rim advancement, and cranioplasty. The results are generally very pleasing in nonsyndromic patients. We have not, however, seen adults with residual deformity who preceded the present basic approach to treatment first described by Hoffman and Mohr (1976). Dominguez et al (1981) described 15 individuals who improved without treatment. The question that arises is whether we are treating this congenital problem unnecessarily, particularly in nonsyndromic patients. We present a 38-year-old untreated woman who still has residual signs of the deformity seen in early childhood photographs.

The use of animal models in craniofacial biology has helped make significant contributions toward the clinical and surgical management of patients with craniofacial disorders. The present paper discusses some problems associated with choosing appropriate animal models for research in human craniofacial morphology and offers suggestions for determining the most appropriate model. Three levels of appropriate animal model choices are suggested: (1) the "generic mammalian" animal model, useful for investigating the problems of bone biology and generalized mammalian craniofacial growth mechanisms; (2) the "phylogenetically closer" animal model, useful for investigating the influence of experimental manipulations on the general primate craniofacial growth pattern; and (3) "fitting" the appropriate animal model to specific regional craniofacial growth patterns or anatomic conditions of interest. The continued, intelligent use of animal models in craniofacial investigations depends heavily on understanding and appreciating the information that can be derived from the "appropriate" animal model.

This study examines the hearing status of individuals with clefts of the palate or lip and palate without other major malformations or syndromes. A total of 1,699 audiometric records were reviewed and classified on the basis of race, gender, cleft type, age, and birth year (pre or post 1969). The results indicate that race, age, and date of birth affect the frequency of hearing loss.