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Biomedical subjects

A Heliövaara

Publications and source records attributed to A Heliövaara.

17 recordsLinked to original sources
PubMed2006

Craniofacial cephalometric morphology in children with CATCH 22 syndrome.

OBJECTIVES: To evaluate cephalometrically the craniofacial, pharyngeal and cervical morphology in children with CATCH 22, and to compare and quantify the findings with age- and sex-matched controls. DESIGN: A retrospective case-control study. SETTING AND SAMPLE POPULATION: Forty-one children (20 girls) with CATCH 22 were compared with age- and sex-matched controls from lateral cephalograms taken at the mean age of 8.5 years (range 5.8-12.9). The deletion of 22q11 was verified by fluorescence in situ hybridization techniques. Thirteen of the children with CATCH 22 had palatal clefts. OUTCOME MEASURE: Linear and angular measurements were obtained from lateral cephalograms. A Student's t-test and a paired Student's t-test were used in the statistical analysis. Standard deviation scores (SDS) were calculated to quantify the variation. RESULTS: Children with CATCH 22 had obtuse cranial base angles and long anterior cranial bases. Their faces were long with increased facial convexity. The maxillae were long but both jaws were retrognathic and the lower jaws posteriorly diverged. The pharynges were wide in the nasopharyngeal area and narrow in the hypopharyngeal area. The development of the hyoid bones was delayed, and hyoid bone and atlas lengths were reduced. The morphology of the children with CATCH 22 with and without a palatal cleft was similar. Despite several statistically significant differences between the children with CATCH 22 and the controls, the SDS did not exceed +/-2 for any of the measurements. CONCLUSION: Children with CATCH 22 have several minor distinctive morphological features in the craniofacial, pharyngeal, and cervical areas.

Abnormalities, Multiple↗
PubMed2002

Skeletal stability of Le Fort I osteotomy in patients with isolated cleft palate and bilateral cleft lip and palate.

The skeletal stability of Le Fort I osteotomy was evaluated retrospectively in 14 patients with isolated cleft palate (CP, mean age 27.2 years) and 11 patients with bilateral cleft lip and palate (BCLP, mean age 23.7 years). The osteotomy was fixed with titanium plates and the osteotomy gap was grafted with autologous bone. Neither intermaxillary fixation nor occlusal splints were used postoperatively. Skeletal stability was analysed both horizontally and vertically by cephalograms taken shortly before operation, immediately afterwards, and at six months and at one year postoperatively. In the CP group the mean maxillary horizontal advancement (point A) was 4.7 mm (range 0.3-7.8) and the mean vertical lengthening 3.6 mm (range 0.7-6.1). One year postoperatively the mean relapse was 8.5% (0.4 mm) horizontally and 16.7% (0.6 mm) vertically. In the BCLP group the mean horizontal advancement was 5.3 mm (range 0.2-10.7) and the mean vertical lengthening 7.3 mm (range 0.6-11.8). The mean postoperative relapse was 9.4% (0.5 mm) horizontally and 17.8% (1.3 mm) vertically. The skeletal stability and relapse were similar in both cleft types although BCLP patients had more residual cleft problems and their mean surgical advancement was greater. There was great individual variation.

Adolescent↗
PubMed2001

Skeletal stability of Le Fort I osteotomy in patients with unilateral cleft lip and palate.

The skeletal stability of Le Fort I osteotomy was evaluated cephalometrically in 40 consecutive patients with unilateral cleft lip and palate (UCLP) (27 male and 13 female) who were operated on between 1987-1995. Their mean age at the time of operation was 23.7 years (range 16.3-40.4). The one-piece Le Fort I osteotomy was fixed with titanium plates and the osteotomy line was bone-grafted. Neither intermaxillary fixation nor occlusal splints were used postoperatively. Skeletal stability was analysed both horizontally and vertically on cephalograms taken shortly before operation, immediately afterwards, and at six months and at one year postoperatively. The mean maxillary advancement (point A) during the Le Fort I was 3.9 mm (range 0-8.9) and mean vertical lengthening 4.5 mm (range -0.6-10.5). One year postoperatively the mean maxillary horizontal relapse was 20.5% (0.8 mm, range 0-3.7) whereas the mean vertical relapse was 22.2% (1 mm, range 0-5.7). The vertical relapse reduced from 38% to 8.3% between 1987 and 1995, and there was a positive correlation between the amount of maxillary advancement and relapse both horizontally and vertically.

Adolescent↗
PubMed2001

Changes in soft tissue thickness after Le Fort I osteotomy in different cleft types.

The soft tissue thickness before and after Le Fort I osteotomy was evaluated in 46 cleft patients. The sample consisted of 10 patients with isolated cleft palate (CP, mean age 25.5 years); 10 patients with bilateral cleft lip and palate (BCLP, mean age 21.7 years); and 26 patients with unilateral cleft lip and palate (UCLP, mean age 22.9 years). Patients with bimaxillary surgery, simultaneous rhinoplasty, or V-Y plasty of the upper lip were excluded. Soft tissue changes were analyzed by cephalograms taken shortly before surgery and at 6 months postoperatively. Horizontal advancement varied from 4.1 mm in the UCLP group to 5 mm in the BCLP group. The vertical lengthening varied from 3.7 mm in the CP group to 7.2 mm in the BCLP group. In all cleft types, thinning of the subnasal area, superior labial sulcus, and upper lip (anterior nasal spine-subnasale, point A-soft tissue point A, and prosthion-labrale superius) took place. Significant thinning of the upper lip occurred in the UCLP and BCLP patients. Surgical changes of the lower lip and mandibular area were small and insignificant. There were significant differences in soft tissue thicknesses between different types of clefts. The subnasal area and superior labial sulcus were significantly thicker in the CP group than in the BCLP or UCLP groups, both pre- and postoperatively. The upper lip was thickest in the BCLP group preoperatively but thickest in the CP group postoperatively. The upper lip was thinnest in the UCLP group both before and after the operation.

Adolescent↗
PubMed2000

Soft tissue profile changes after Le Fort I osteotomy in UCLP patients.

The changes in soft tissue profile after Le Fort I osteotomy were evaluated cephalometrically in 38 consecutive UCLP patients (25 males, 13 females) operated on between 1987 and 1995. Mean age at operation was 23.5 years. The one-piece Le Fort I osteotomy was fixed with titanium plates and the osteotomy site was bone grafted. Neither intermaxillary fixation nor occlusal splints were used postoperatively. Soft tissue changes were analyzed both horizontally and vertically by cephalograms taken shortly before surgery, 6 months and 1 year postoperatively. The mean maxillary skeletal advancement (point A) during surgery was 3.8 mm and mean vertical lengthening 4.4 mm. One year postoperatively the horizontal change in the upper lip profile (point a) was 80% of the skeletal change. Vertically, the soft tissue change in the upper lip was smaller 40%, but increased significantly (to 58%) if V-Y plasty was used. The V-Y plasty also increased the anteroposterior thickness of the upper lip. No significant soft tissue changes were observed between 6 months and 1 year postoperatively.

Adolescent↗
PubMed1998

Occurrence of dental consonant misarticulations in different cleft types.

To study the occurrence and type of misarticulations in dental consonants /r/, /s/ and /l/ 280 (115 girls, 165 boys) 6-year-old cleft children were examined by 1 of the 2 experienced speech pathologists of the cleft team. The patients included 82 children with isolated cleft palate (CP), 82 with cleft lip with (34) or without (48) cleft alveolus [CL(A)], 85 with unilateral cleft lip and palate (UCLP) and 31 with bilateral cleft lip and palate (BCLP). CP children were first divided into subgroups; there were 17 children with soft palate cleft, 49 with partial and 16 with complete hard palate cleft. All patients were native Finnish speakers, and had normal hearing, no known syndrome or associated anomalies possibly affecting speech or psychomotor retardation. The results showed that the occurrence and severity as well as the number of errors of all studied sounds separately or grouped increased with the severity of the cleft being constantly greatest in the BCLP group and lowest in the CL(A) group. Altogether 44% of the patients misarticulated at least one studied sound; 41% distorted and 5% substituted, and 2% both distorted and substituted. The /r/ sound was misarticulated by 36%, the /s/ sound by 23%, and the /l/ sound by 18% of the patients. Boys tend to have more problems in producing the studied sounds correctly.

Articulation Disorders↗
PubMed1997

Velopharyngeal function in cleft patients undergoing maxillary advancement.

Maxillary advancement may result in movement of the posterior border of the hard palate with its soft palate attachment, which may cause impairment of velopharyngeal (VP) function. We examined VP function before and after Le Fort I osteotomy in 15 cleft lip and palate patients. The extent of maxillary advancement was measured by means of standard cephalometric radiographs taken before and after the operation. VP function was evaluated in terms of perceptual speech assessments, pressure-flow data and nasalance scores preoperatively and 2, 6 and 12 months after the operation. The results showed that maxillary advancement resulted in impairment of VP function in 4 (27%) of the patients.

Adolescent↗
PubMed1997

Craniofacial morphology in young adults with the Pierre Robin sequence and isolated cleft palate.

The craniofacial morphology of 30 young adults with the Pierre Robin sequence, aged 17.0-27.1 years (mean, 20.8), was analyzed and compared with the craniofacial morphology of 116 young adults with isolated cleft palate, aged 16.9-20.6 years (mean, 18.8). All patients had been examined and operated on at the Cleft Center, Department of Plastic Surgery, Helsinki University Central Hospital. The skeletal dimensions of patients with Pierre Robin sequence differed from those of patients with isolated cleft palate by the shorter posterior cranial base, maxilla, and mandibular ramus. The mandible was also more retruded and more posteriorly rotated, and the soft tissue profile more convex in Pierre Robin sequence patients. In the pharyngeal area, the lower sagittal depth of the pharynx was significantly shorter and the hyoid bone position more inferior in those with Pierre Robin sequence than in those with isolated cleft palate.

Adolescent↗
PubMed1994

One-stage closure of isolated cleft palate with the Veau-Wardill-Kilner V to Y pushback procedure or the Cronin modification. IV. Cephalometric comparison of transverse dentofacial morphology.

The transverse dentofacial morphology of 116 consecutive patients with isolated cleft palate was studied by PA-headfilms at 17-20 years of age. One-stage soft and hard palate closure had been carried out at the mean age of 1.8 years using the Veau-Wardill-Kilner or the Cronin mucoperiosteal palatal V-Y pushback technique. In multivariate statistical analyses no significant findings were observed with regard to craniofacial measurements and operation method, additional palate operations, cleft extent at birth or associated minor anomalies. The effect of sex was consistently in the same direction with males having larger values. The bizygomatic width (Zydx-Zysin) was greater for those who had familial disposition for clefts. No asymmetries were detected.

Adolescent↗
PubMed1994

Growth in children with Pierre Robin sequence and isolated cleft palate.

Postnatal height and weight growth were assessed in 50 children (20 boys) with Pierre Robin sequence and in 58 children (27 boys) with isolated cleft palate, born in 1967-86. The height and weight measurements from birth to 12 years were collected retrospectively from child health centers and schools. The current Finnish relative weight and SD scores for height were used for growth assessment. The birth size of children with Pierre Robin sequence did not differ from those with isolated cleft palate or from healthy children, on the basis of Finnish norms. During the first year after birth, children with Pierre Robin sequence were shorter and lighter than those with isolated cleft palate but later caught up with them and the Finnish norms. Children with Pierre Robin sequence born prematurely or with associated anomalies showed more deficient growth.

Body Height↗
PubMed1994

One-stage closure of isolated cleft palate with the Veau-Wardill-Kilner V to Y pushback procedure or the Cronin modification. II. Height, weight and comparison of dental arches.

The body height and weight, and sizes of dental arches in 116 patients with isolated cleft palate were evaluated at 16.9-20.6 years of age. One-stage closure of the soft and hard palate had been done at a mean age of 1.8 years using the Veau-Wardill-Kilner or the Cronin mucoperiosteal palatal V-Y pushback technique. The height attained in both the boys (177.6 cm) and the girls (165.7 cm) was similar to that in the general adult population, even though half of the boys had not reached their final height. The median relative weight for height and sex was 6%. There were no significant differences in dental arch measurements depending on the method of operation but the more palatal operations done the shorter the maxillary and mandibular dental arch widths. The extent of cleft made a significant difference, larger clefts having narrower palatal intercanine widths. Dental arch dimensions were consistently larger in boys than in girls.

Adolescent↗
PubMed1993

One-stage closure of isolated cleft palate with the Veau-Wardill-Kilner V-Y push-back method or the Cronin modification. Cephalometric comparison of nasopharynx.

The craniofacial structure of 116 consecutive patients with isolated cleft palate was studied by lateral cephalograms at 17-20 years of age. One-stage soft- and hard-palate closure had been done with the Veau-Wardill-Kilner or the Cronin mucoperiosteal palatal V-Y push-back method at the mean age of 1.8 years. The patients treated with the Veau-Wardill-Kilner method showed larger sagittal depths of the bony nasopharynx and nasopharyngeal airway but smaller thickness of the soft tissue on the posterior nasopharyngeal wall. The sagittal depth of the nasopharyngeal airway was larger in patients who had had secondary palatal operations. The effect of sex was significant, males having larger dimensions.

Cephalometry↗
PubMed1993

One-stage closure of isolated cleft palate with the Veau-Wardill-Kilner V to Y pushback procedure or the Cronin modification. III. Comparison of lateral craniofacial morphology.

The craniofacial morphology of 116 consecutive patients with isolated cleft palate was studied by means of lateral cephalograms at 17 to 20 years of age. One-stage hard- and soft-palate closure had been carried out at the mean age of 1.8 years by using the Veau-Wardill-Kilner or the Cronin mucoperiosteal palatal V-Y pushback technique. In the Veau-Wardill-Kilner group the cranial base was longer, the cranial base angle was larger, and the mandible longer and its ramus higher but less backward rotated. The patients with originally the most extensive clefts showed the most marked deviations in craniofacial morphology at adult age.

Adolescent↗
PubMed1993

One-stage closure of isolated cleft palate with the Veau-Wardill-Kilner V to Y pushback procedure or the Cronin modification. I. Comparison of operative results.

The long term operative results of one-stage closure of isolated cleft palate with either the Veau-Wardill-Kilner V to Y pushback procedure or the Cronin modification were evaluated and compared retrospectively. A total of 116 consecutive patients with isolated cleft palate who had been operated on at the age of 18-24 months were followed up until 17-20 years of age. Twenty-four of the patients needed one or more additional operations on the palate, mainly pharyngeal flaps (20%) and repair of fistulas (10%). There was no significant difference in the number of patients who needed further operations, either between the two different operations or between the sexes, but the patients who presented with the most extensive clefts required the most operations.

Adolescent↗
PubMed1991

Hypernasality and the nasopharyngeal space. A cephalometric study.

In the present study cephalometric measurements reflecting the nasopharyngeal space were traced on lateral cephalometric X-rays in 59 young adults with an isolated cleft palate. The distribution of the measurements AD1-PNS, AD2-PNS, AD1-BA, AD2-SO and PNS-BA and the magnitude of the hypernasality were analyzed with the ANOVA procedure and Duncan's multiple range test. The degree of hypernasality was assessed in terms of the hypernasality index. The results showed that AD1-PNS and AD2-PNS measurements were significantly related to the hypernasality index at the risk level of 0.03 and 0.05 per cent, respectively. The patients with the shortest sagittal depth of the nasopharynx had normal resonance in their speech, while the patients with the longest measurements demonstrated hypernasality. The thickness of the posterior pharyngeal wall in terms of AD2-SO was not clearly significant for speech, although the patients with the longest measurements tended to speak without hypernasal resonance. The other cephalometric measurements, i.e. AD1-BA and PNS-BA were not significantly related to the occurrence of hypernasality. It was concluded that the cephalometric measurements reflecting nasopharyngeal space are correlated with the occurrence of hypernasality, but the relationship is by no means simple and linear, and therefore it requires further study.

Adolescent↗
PubMedDate not supplied

Associations between lateral cephalometric dimensions and misarticulations of Finnish dental consonants in cleft lip/palate children.

The purpose of this study was to examine the associations between lateral cephalometric variables and the misarticulation of /r/, /s/ and /l/ sound in cleft lip/palate children. The subjects were 134 Finnish-speaking 6-year-old boys with isolated cleft palate (CP, n = 33), unilateral (n = 44), bilateral (BCLP, n = 19) cleft lip and cleft lip/alveolus (n = 38); /r/, /s/ and /l/ distortions were obtained from original hospital records which were based on perceptual speech follow-ups performed by experienced speech pathologists. Cephalometric measurement points were determined from standardized lateral roentgen cephalograms and traced twice by a computer-connected digitizer. The data were entered into a microcomputer and analysed by NCSS 6.0 for Windows using appropriate tests. The results revealed new significant associations between cephalometric measurements and misarticulations, especially that of the /r/ sound in CP and BCLP groups. Children with /r/ distortion had upward rotation of the mandible, maxillary protrusion and a higher position of the hyoid bone in the CP group. In the BLCP group, on the contrary, the mandible had downward rotation, mandibular retrusion and narrower nasopharyngeal port. The /s/ and /l/ sounds were less clearly associated with craniofacial morphology. The anteroposterior relationship of the maxilla and the mandible did not have any association with dentoalveolar misarticulations, instead, the systematic vertical, particularly posterior relationship of the jaws seems to be associated with /r/ sound production in CP and BCLP boys.

Articulation Disorders↗