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Biomedical subjects

A F Markus

Publications and source records attributed to A F Markus.

At least 19 recordsLinked to original sources

Speech outcome in children with cleft palate: aerophonoscope assessment of nasal emission.

The quality of speech is an important outcome measure of the success of primary surgery for clefts of the palate. A competent velopharyngeal mechanism is essential for normal speech, and disorders of resonance and nasal airflow are significant manifestations of velopharyngeal dysfunction in cleft palate subjects. The aim of this study was to determine the level of nasal emission during speech in patients with functionally repaired clefts of the palate and compare this with age and sex-matched controls. Forty-four children between the ages of 3 and 9 years were assessed for nasal emission using an Aerophonoscope. All these patients had primary functional surgery carried out at this unit by the same surgeon, and fell into three groups; complete bilateral, complete unilateral and soft palate clefts. Nasal breathing, blowing and groups of vowels and voiceless pressure consonants were assessed. There was no nasal emission in close to, or over, 90% of the patients for these parameters. The results indicate that a highly significant percentage of children with functionally repaired clefts of the palate have normal velopharyngeal function and speech, without inappropriate nasal emission. The Aerophonoscope provides an accurate, reliable and user-friendly diagnostic aid, and indeed therapeutic adjunct, to speech management in cleft palate patients.

Child

Mid-facial growth following functional cleft surgery.

The stigmata of lip and palate clefting are well recognized, but recently it has been thought that these may be exacerbated by the surgical repair. Functional repair, however, with re-establishment of muscle continuity may result in less disruption to normal facial growth. This study examines mid-facial growth in 10 consecutive children aged 6.5 years with complete unilateral cleft lip and palate who had undergone functional repair. Outcomes were compared with non-cleft children and children who had undergone non-functional surgery.

Adult

Effect of primary surgery for cleft lip and palate on mid-facial growth.

Surgery for cleft lip and palate is known to have an effect on growth and development of the mid-face. This paper studies the outcomes in 34 consecutive 10-year-old patients with unilateral cleft lip and palate. Clinical observations of the importance of both surgical technique and the influence of cranial base morphology on maxillo-mandibular position are discussed.

Cephalometry

Primary closure of the cleft alveolus: a functional approach.

The growth and development of the premaxilla in both normal and cleft lip and palate subjects is described and its relevance in surgery of the cleft alveolus discussed. Embryologically, the cleft alveolus results from failure of fusion of the median nasal and maxillary processes. Consequently, ossification centres in the premaxilla and maxilla cannot migrate and unite such that normal growth and development in the territory of the premaxillary-maxillary suture cannot occur. Functional repair of the cleft lip and soft palate encourages spontaneous alignment of the alveolar segments, facilitating the introduction of vascularized periosteum across the bony defect by gingivoperiosteoplasty. Early reconstruction in the region of the premaxillary-maxillary suture encourages a more normal development of the alveolus, particularly in the bilateral cleft subject.

Alveolar Process

Functional primary closure of cleft lip.

A technique of primary closure of the cleft lip is described. It is based on a complete understanding of the anatomy of the entire facial musculature such that it can be restored to normality and so encourage normal function and development.

Cleft Lip

Primary closure of cleft palate: a functional approach.

The role of the different zones of palatal mucosa in maxillary growth are considered and their relevance in surgery of cleft palate discussed. A method of cleft palate repair is described, based on a functional repair of the soft palate, followed by later closure of the hard palate taking into account the anatomy and physiology of the palatal mucosa.

Age Factors

Submandibular gland surgery: an audit of clinical findings, pathology and postoperative morbidity.

A series of 86 patients who underwent submandibular gland surgery were reviewed retrospectively. Of the 92 glands excised, non-neoplastic disease accounted for 96% of cases. Preoperative clinical findings were inconsistent such that early surgery should be considered for an enlarged non-tender submandibular gland. The incidence of temporary paresis of the lower branches of the facial nerve was 36% with full recovery, on average, 4 months after surgery. The low 'non-identification' approach to the submandibular gland appears to be the technique which offers the least likelihood of permanent damage to the lower branches of the facial nerve.

Adolescent

Facial balance in cleft lip and palate. I. Normal development and cleft palate.

A full understanding of balanced facial growth, based on a complete knowledge of the anatomy and physiology of the region, is essential if cleft lip and palate is to be treated successfully. The cleft abnormality is the cause of underdevelopment and subsequent loss of function. Cleft surgery must aim to restore normal anatomy and physiology with emphasis on muscle reconstruction of the lip and soft palate if normal facial development is to be achieved.

Adult

Facial balance in cleft lip and palate. II. Cleft lip and palate and secondary deformities.

The cleft abnormality is the cause of underdevelopment and subsequent loss of function. Primary cleft surgery and surgery to correct the secondary deformities of previous non-functional repair should aim to restore normal anatomy and physiology, with an emphasis on muscle reconstruction of the lip and soft palate if normal facial development is to be encouraged.

Cleft Lip

Internal derangement of the temporomandibular joint: an audit of clinical findings, arthrography and surgical treatment.

Forty seven patients who underwent double contrast video-arthrography followed by surgery for internal derangement of the temporomandibular joint were reviewed retrospectively. Of the 50 joints assessed, arthrography demonstrated 39 (78%) with irreducible meniscal displacement and 11 (22%) with reducible displacement. Clinical findings were found to be unreliable in demonstrating the degree of internal derangement: 49% of irreducible meniscal displacements presented with clicking and only 20% with loss of click. The importance of video-arthrography is emphasised. Surgery for internal derangement proved successful. It is proposed that patients who have clinical evidence suggestive of irreducible meniscal displacement and have disabling symptoms should undergo early video-arthrography and be offered surgical correction.

Adolescent

A clinical trial of Suprofen and aspirin in post-operative dental pain.

A double-blind trial comparing the analgesic efficacy of Suprofen 200 mg with aspirin 750 mg was carried out on 120 patients. There was no statistical difference between the two, though Suprofen had fewer side effects and could be used in circumstances where aspirin is contra-indicated.

Adolescent