The Cleft palate journal最新文献

A major goal of the treatment of cleft lip and palate is to improve the esthetic acceptability of the face. It is assumed that an improved esthetic appearance is associated with significant psychosocial benefits, but there is almost no empiric support for this assumption. Researchers have been hindered in the study of this problem because scales to measure severity of facial impairment of clefts have not been available; however, standard scales of facial impairment have been developed for occlusal traits, orthognathic structure, and facial attractiveness. The purpose of this paper is to describe selected theoretic and methodologic approaches to scaling the esthetic acceptability of various facial characteristics and to discuss how these methods have been applied to the study of relationships between facial morphology and psychosocial variables. It is argued that these approaches may be useful, as models for the development of scales of severity of cleft impairment, to clinicians and researchers who are interested in the treatment of facial clefts.

The postsurgical psychological status of 25 craniofacial patients, 6 through 16 years of age, was studied using self, teacher, and parent report measures. In contrast to earlier reports of more positive adjustment following corrective surgery, the present study identified several concerns for craniofacial patients, including low self-esteem, impaired peer relationships, and greater dependency on significant adults. Problems were more clearly identified using projective techniques rather than self-report measures. The findings suggest that many children having craniofacial surgery should have supportive psychotherapeutic services. Variables were explored relative to psychosocial functioning. Although few significant correlations were demonstrated, positive psychological adjustment was found to be related to greater physical attractiveness, lower parental stress, and younger age.

Cycle-to-cycle variations in voice fundamental frequency (jitter) and amplitude (shimmer) were derived by electroglottography for 10 children with velopharyngeal insufficiency (VPI). Jitter was found to be positively correlated with ratings of perceived nasality, whereas shimmer was found to be positively correlated with ratings of perceived hoarseness. Theoretic implications for a regulatory model of speech aerodynamics are discussed. Additionally, clinical applications, in terms of using electroglottography as a supplemental assessment procedure, are suggested.

Oral health was studied in 49 children aged 5 or 6 years old with clefts of the lip and/or palate (CL(P] and 49 healthy controls matched for sex and age. The results showed a statistically significant increase in the prevalence and activity of caries in CL(P) children. The mean number of decayed and filled surfaces in the CL(P) group was 7.0 compared with 3.9 in the control group (p less than 0.05). The most evident difference between the two groups was found in the number of decayed proximal surfaces. The mean number of decayed proximal surfaces in the CL(P) group was 2.5, as compared with 0.9 in the control group (p less than 0.001). There were no significant differences in the caries prevalence and activity in children with clefts that involves the alveolus compared with those of children with isolated clefts of the lip or palate. The CL(P) children also exhibited a significant increase (p greater than 0.01) in the number of gingival units with gingivitis. Other dental abnormalities included an increased frequency of enamel hypomineralization (p less than 0.05), supernumerary teeth (p less than 0.01), unilateral crossbite (p less than 0.001), mesial terminal plane (p less than 0.01), and crowding (p less than 0.001). The results show that the CL(P) children must be considered as a group with an increased caries risk and should therefore be subjected to an additional preventive program.

The classification by Tessier of rare craniofacial clefts brought, for the surgeon, order to a previously confusing array of anatomic and developmental descriptions. An ordered two-dimensional categorization of severe clefting malformations evolved from his clinical, radiologic, and surgical observations. The purpose of this paper is to report a complete series of facial clefts studied with computed tomography (CT) and three-dimensional reconstruction. The CT analysis supports some, but contradicts other, hypotheses and speculations presented by Tessier. The CT data reveal the scale of the reconstructive challenge and allow the assessment of our therapeutic interventions.

Flexible fiberoptic nasopharyngoscopy (FFN) has become a popular clinical tool for evaluating velopharyngeal function. The literature contains numerous reports of FFN methodology and findings. However, there are few published reports that address clinical rating and reporting schemes or that evaluate viewer reliability. This study was designed to evaluate the reliability of visual perceptual ratings of FFN video images for assessing velopharyngeal structure and function in a clinical population. Ninety-five videotaped clinical evaluations were presented to and judged by three expert raters and nine novice raters from the fields of speech pathology, otolaryngology, and plastic surgery, using a standard rating form. A clinical rating scheme was used for quantifying perceptual judgments of velopharyngeal activity. Results suggest that videotaped FFN evaluations may be rated reliably, that expert raters working as a group are more reliable than novice raters working individually, and that the 125 evaluations presented without feedback are insufficient to improve the novices' reliability. The combined auditory and visual perceptual evaluation inherent in FFN may be its most significant asset for both clinical and research applications.

Randomized videotaped samples of conversational speech recorded preoperatively and 6 months postoperatively in 15 patients with Down syndrome who had undergone facial reconstruction were studied. The videotapes were rated by 34 normal adolescent students for appearance, friendliness, intelligence, and speech. In addition, the opinions of the patients' parents regarding their child's appearance and speech were surveyed. Results indicated that, although most parents reported improvements in their child's speech and appearance, independent raters could not readily discern improvement in any of the four areas studied. The use of videotape recordings to assess improvements in these traits after surgery in children with Down syndrome has not been previously reported.