The Cleft palate journal最新文献

Clefts of the lip and palate generally result in reduced size of the nasal airway. Procedures such as the placement of a pharyngeal flap tend to further compromise nasal breathing. The purpose of this study was to determine how size of the nasal airway affects the mode of breathing in adults with cleft lip and/or palate. A heterogeneous population of 50 adult subjects with cleft lip and/or palate was studied. Nineteen of the subjects had pharyngeal flaps. Respiratory inductive plethysmography was used in combination with an integrating pneumotachograph to measure percent nasal breathing. Pressure-flow studies were used to estimate nasal airway size. The data revealed that a majority of subjects had an airway size of less than 0.4 cm2, which constitutes impairment. Mean cross-sectional area for all subjects was 0.38 cm2 +/- 0.20 SD. Seventy percent of the subjects studied were oral breathers to some extent. A Spearman rank correlation coefficient of 0.725 (p less than 0.0001) indicated that oral-nasal breathing mode was related to airway size. Airway size in the subgroup with pharyngeal flaps was even smaller (0.31 cm2), while percent nasal breathing was lower. Mouthbreathing was observed in all subjects whose airway size was less than 0.38 cm2.

Since 1984, the Sri Lankan Cleft Lip and Palate Project has developed a large surgical and research program collecting records on over 500 subjects with unrepaired cleft lip and palate. In addition, 410 operations were performed by Project and will be followed by individual reports on facial growth and morphology, speech, surgical and anesthetic aspects, and the otologic significance of cleft palate in this issue and subsequent ones.

Through sophisticated equipment has been used to determine nasal airway resistance (Rnaw), data must be interpreted cautiously because of the variability of procedures used to obtain the measures. The present investigation was designed to determine the effects of breathing versus a speech task, using a forward versus a resting tongue carriage, and the consistency of these measures on Rnaw values. Twenty young adult females performed a noninvasive procedure for assessment of Rnaw during rest breathing and nasal/m/ sound production with and without tongue anchoring over a 2-day period. No significant differences in Rnaw were found between days or tasks. Of the tasks examined, sustained/m/production and tongue anchoring procedures proved consistent adjuncts to quiet breathing for estimation of nasal airway resistance across days and airflow rate conditions. Clinical implications for the application of these procedures are discussed.

Most, but not all, individuals with velopharyngeal inadequacy maintain consonant pressures greater than 3 cm H2O even with decreased velar resistance. The purpose of this study was to identify variables that might differentiate those who achieve adequate pressures from those who do not. Forty-four cleft lip and/or palate subjects were assessed during production of /p/ in the word "hamper." Twenty-three subjects achieved pressures greater than 3 cm H2O and 21 did not. The pressure-flow technique was used to assess velopharyngeal orifice size, nasal resistance, velar resistance, and nasal airflow during speech. Nasal cross-sectional area was measured during breathing. The data were analyzed by age and gender. Results indicate that the inability to achieve adequate consonant pressures in the presence of velopharyngeal inadequacy is more likely to occur in adults than in children. Although children are known to produce consonants at higher pressures than adults, the age disparity between groups did not account for the pressure differences. The most significant factor differentiating adequate and low pressure speakers was the magnitude of nasal plus velar resistance. This difference was consistent across age and gender.

The temporal relationship among laryngeal, velopharyngeal, and labial activity was investigated by studying the reaction times of eight normal adults. Four female and four male subjects sustained production of the nasal consonant /m/ until a computer-driven imperative tone was presented at which time they were required to say /pi/ as quickly as possible. This task was repeated 30 times for each subject. The offset of voicing at the end of the /m/ and the onset of bilabial plosive release were monitored using a commercially available Nasometer. The onset of velopharyngeal (V-P) movement toward closure and the attainment of closure were monitored using a photodetector system. Across 240 responses, the average latencies were: 146 ms for initiation of V-P movement toward closure, 224 ms for voicing offset, 280 ms for onset of V-P closure and 317 ms for onset of plosive release. The significance of these findings is discussed with respect to speech motor control and the clinical evaluation of patients with velopharyngeal impairments.

It is becoming increasingly apparent that a clinical evaluation for craniomandibular dysfunction in children is important for predicting future problems in adults. Because of the dysmorphology inherent in children with clefts, there is potential for craniomandibular dysfunction in many cases. The prevalence of craniomandibular dysfunction in white children with unilateral cleft lip or cleft lip and palate from 6 to 10 years of age was investigated. Thirty children (22 males and eight females) were examined. Craniomandibular dysfunction was detected clinically by the following criteria: mandibular movements; deflection of the mandible on opening; temporomandibular joint (TMJ) sounds; and muscle and temporomandibular joint tenderness to palpation. Information related to subjective symptoms (headaches, difficulties in opening wide, pain in the temple region, pain in opening wide, pain in chewing, and reported clicking) was collected by interview. The results showed that the prevalence of objective and subjective symptoms was 76.6 and 53.3 percent, respectively. The most frequent symptom was muscle tenderness (60 percent), followed by temporomandibular joint tenderness (26.6 percent), temporomandibular joint sounds (20 percent), and headaches (16.6 percent). Statistically significant differences by cleft type were not found in the prevalence of any objective or subjective symptom. Significant correlation was found only between temporomandibular joint tenderness and muscle tenderness. Because the overall prevalence of symptoms is shown to be high in the sample studied, routine dental examinations of patients with clefts should include an evaluation of the masticating system.

Hemifacial microsomia (HFM) is a common craniofacial disorder that is known to be etiologically heterogenous. Phenotypic differentiation of the various subgroups remains unresolved. A review of 50 patients with HFM has yielded data that may help explain different pathogenetic processes. Of particular interest is the association of facial nerve palsy, sensorineural hearing loss (SNHL), or both in a higher percentage of patients than expected. Twenty-two percent had evidence of facial palsy of varying degree. Thirty-three cases had microtia or anotia, and all instances of facial palsy were associated with auricular malformation. Sensorineural hearing loss was found in 16 percent. All patients with microtia and sensorineural hearing loss had facial palsy. Ear tags or pits were found in 21 patients, only two of whom had facial palsy. In all but one case the palsy was found on the more hypoplastic side of the face. In the single exception, both sides of the face were hypoplastic.

Computer-assisted medical imaging--transaxial computed tomography (CT) scans and three-dimensional surface reconstructions--was used to study the muscles of mastication and their osseous origins and insertions in 24 patients with untreated unilateral hemifacial microsomia (HFM). The relationship between the volume of a muscle of mastication and the shape and size of its origin and insertion in such patients varies widely. Comparison of mean volumes of specific muscles documents a statistically significant decrease among patients who have moderate to marked mandibular dysmorphology as compared with those with minimally dysmorphic mandibles. This study supports the hypothesis that the shape and size of the mandible are related to the muscles that originate and insert upon it. However, the variation among individual patients means that assumptions regarding muscle mass and, in turn, function cannot be made regarding an individual patient on the basis of osseous dysmorphology that has been demonstrated on skull radiographs alone.

Seven black children with craniofacial anomalies are reported. Holoprosencephaly and hemifacial microsomia featured prominently among the cases presented. These cases represented a large percentage of all cleft cases reported in the region served by the Port Harcourt Teaching Hospital (UPTH). The social, genetic, and surgical implications are discussed.

Nasal respiration may be assessed as part of the diagnosis and management of persons with orofacial growth disturbances. It is often evaluated by calculating nasal airway resistance. Traditional methods for measuring nasal airway resistance do not provide information about nasal cavity versus velopharyngeal resistance components. A method that partitions nasal airway resistance into its nasal cavity and velopharyngeal components would provide a localized measurement of airway obstruction useful in evaluating the effects of surgical reconstruction of the velopharynx, enlarged adenoids, adenoidectomy, and nasal cavity obstructions along the nasal airway. A modeling project is presented delineating a method for partitioning nasal airway resistance into its nasal cavity and velopharyngeal components.