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Biomedical subjects

D F Johns

Publications and source records attributed to D F Johns.

18 recordsLinked to original sources
PubMed2001

Incidence of cleft palate fistula: an institutional experience with two-stage palatal repair.

The purpose of this study was to determine the incidence of cleft palatal fistula in a series of nonsyndromic children treated at the authors' institution. This retrospective analysis of 103 patients with cleft palate treated by five surgeons between 1982 and 1995 includes 60 boys and 33 girls, whose median age was 18.4 months at the time of surgery. The median length of follow-up was 4.9 years after primary palatoplasty. Cleft palatal fistula was defined as a failure of healing or a breakdown in the primary surgical repair of the palate. Intentionally unrepaired fistulas of the primary and secondary palate were excluded. Extent of clefting was described according to the Veau classification. Statistical examination of multiple variables was performed using contingency table analysis, multivariate logistic regression, and the Wilcoxon rank sum test. The incidence of cleft palatal fistula in this series was 8.7 percent. All of these fistulas were clinically significant. The rate of fistula recurrence was 33 percent. The incidence of cleft palatal fistula when compared by Veau classification was statistically significant, with nine fistulas occurring in patients with Veau 3 and 4 clefts and no fistulas occurring in patients with Veau 1 and 2 clefts (p = 0.0441). No significant differences between patients with and without fistulas were identified with respect to operating surgeon, patient sex, patient age at palatoplasty, type of palatoplasty, and use of presurgical orthopedics or palatal expansion. All three recurrent fistulas occurred in the anterior palate, two in patients with Veau class 3 clefts and one in a patient with a Veau class 4 cleft. The low rate of clinically significant fistula was attributed to early delayed primary closure, with smaller secondary clefts allowing repair with a minimum of dissection and disruption of vascularity.

Cleft Palate↗
PubMed2000

Hearing and ultrasound-assisted liposuction: the effect on surgeon and patient.

Ultrasound-assisted liposuction has become an important tool in body-contouring surgery. Although ultrasound frequency is by definition outside the range of normal human hearing, an audible sound is heard during ultrasound-assisted liposuction. This study measured sound intensity during ultrasound-assisted liposuction performed with two commercially available systems. Sound intensity was measured at the surgeon's ear, surgical site, and patient's glabella. All measurements obtained with both machines fell within acceptable standards as defined by the Occupational Safety and Health Administration. Use of ultrasound-assisted liposuction does not pose a risk to the patient, the surgeon, or operating room personnel.

Equipment Design↗
PubMed2000

Optimal timing of cleft palate closure.

Treatment objectives for the cleft palate patient--normal speech, normal maxillofacial growth, and normal hearing--are closely related. Controversy about the timing of cleft palate surgery is directed at the need for early palatoplasty for improved speech and hearing versus delayed hard palate repair for undisturbed facial growth. This controversy as to the value of early versus delayed closure continues into the present. The authors present an updated argument regarding this controversy along with a comprehensive literature review. They also present a logical algorithm based on the literature and their personal experience.

Age Factors↗
PubMed1996

Timing of hard palatal closure: a critical long-term analysis.

The controversy about timing of cleft palate surgical procedures is focused on early palatoplasty for improved speech versus delayed hard palate repair for undisturbed facial growth. Timing and technique of palate repair are the most important influences on speech and facial growth, yet there is no consensus on the age or technique for surgery. The Oxford Cleft Palate Study was initiated to evaluate critically the long-term follow-up of 44 patients with early versus late closure of the hard palate. A multidisciplinary approach was used to determine the incidence of speech deficiencies, palatal fistulas, maxillofacial growth disturbances, and hearing abnormalities and to assess objectively the long-term effects of two different treatment modalities on the cleft palate patient. The 44 patients were selected randomly, interviewed, and examined by the multidisciplinary Oxford Cleft Palate Study team. The average age at follow-up in the early closure group was 17.0 years versus 18.2 years in the late closure group. There was a similar number of unilateral and bilateral clefts in both the early and late closure groups. The hard palate was closed in the early group at an average age of 10.8 months versus 48.6 months in the late closure group. All operative procedures in each group were performed by the same senior plastic surgery consultant. Both consultants have since retired and did not participate in the study. Each patient was evaluated by the same plastic surgeon, speech pathologist, orthodontist, and otologist. All examiners were blinded in that they were unaware of the type or timing of the surgical technique and had no prior knowledge of or access to the patient's medical records. Furthermore, none of the examiners participated in the initial care and surgery of these patients. Statistically significant greater speech deficiencies were noted with delayed hard palate closure, especially in articulation, nasal resonance, intelligibility, and substitution pattern assessment (overall intelligibility, p < 0.01). Likewise, the persistent palatal fistula rate in the late closure group was 35 percent in comparison with 5 percent for the early closure group (p <0.02). No significant differences in hearing or maxillofacial growth impairment were delineated in either group. Our data suggest that delaying hard palate closure results in significant speech impairment without a beneficial maxillofacial growth response.

Adolescent↗
PubMed1994

The self-lined superiorly based pull-through velopharyngoplasty: plastic surgery-speech pathology interaction in the management of velopharyngeal insufficiency.

We present a rationale and step-by-step description of a previously unpublished innovative surgical technique designed to overcome velopharyngeal insufficiency. This procedure maintains the anatomic integrity and physiologic function of the velopharynx by limiting interpalatal dissection and incorporates a method for flap attachment through the velum that is accessible, predictable, and versatile. The efficacy of this procedure in eliminating velopharyngeal insufficiency was evaluated by using rigorously controlled quantitative psychophysical scaling procedures of presurgical and postsurgical perceptual ratings of resonance, nasal emission, and intelligibility and instrumental acoustic analyses. The results indicated significantly better postsurgical speech outcomes by individuals treated with the pull-through velopharyngoplasty than did patients treated with other procedures designed for the secondary management of velopharyngeal insufficiency. Based on our experience with more than 150 patients, we believe that the self-lined superiorly based pull-through velopharyngoplasty represents an advancement in the surgical treatment of velopharyngeal insufficiency.

Adolescent↗
PubMed1988

Apraxia of speech: the effectiveness of a treatment regimen.

This investigation describes a treatment program for an adult patient with apraxia of speech. The program was composed of a series of physiologic (nonspeech) and phonetic (articulatory) tasks that began with oroneuromotor control activities and progressed to consonant-vowel (CV) syllable, word, and sentence drills. All activities were paced by a metronome. Detailed descriptions are provided about the (a) nature of the specific treatment steps, (b) sequence of steps followed, (c) criteria used for progression within and between steps, (d) actual number of trials and time required to reach criteria for each step, and (e) steps that were especially easy or difficult to master. A multiple probe design employed to test program efficacy revealed that (a) all tasks in the treatment program were successfully acquired, (b) control of all treatment behaviors was maintained, and (c) carry-over from treated to nontreated behaviors did not occur. Results confirmed that the program positively affected the patient's performance. Suggestions are offered outlining possible modification of the treatment steps so as to yield similar results with greater clinical efficiency.

Aphasia↗
PubMed1982

Attaining functional esophageal speech.

From the records of the Veterans Administration Hospital and the American Cancer Society, 357 patients who had undergone laryngectomy had their conditions evaluated retrospectively to see if they had acquired alaryngeal speech. Despite the efforts of highly qualified speech pathologists and the favorable implications of previous reports, only 24.4% of the entire patient population achieved functional esophageal speech. The addition of other treatment modalities did not substantially affect the results. It is concluded that if obtaining esophageal speech is the primary goal in successful rehabilitation of the alaryngeal patient, then there is a profound need to reassess the previous directions in restoration of postlaryngectomy communication.

Adult↗
PubMed1977

Evolution of the mandibular mesh implant.

Between 1960 and 1972, the Dallas Veterans Administration Hospital Maxillofacial Research Laboratory developed and made over 150 cast-mesh implants. Successive designs were ovoid, circular, and double-lumened in cross section to improve implant strength, surface area for bioattachment, and adjustability. Sleeves, collars, and bows were employed in the assembly of these implants, with an acrylic condylar head attached when indicated. In 1972, our laboratory developed a mandibular mesh tray, cast in one piece on a single sprue, with preservation of the vertically adjustable ramus. Stainless steel replaced Vitallium because of its greater malleability. Essentially, a lost-wax technique is used to cast the mesh tray. The model of a mandibular segment is duplicated as a refractory model. Mesh wax, made in our own custom-made die, is adapted to the refractory model. The unit is then sprued and invested. The wax is fired our of the mold in a gas furnace. Casting is done by the transferral of molten stainless steel from the crucible to the mold by centrifugal force in an electro-induction casting machine. Other mesh implants that have been developed are made from wire mesh, Dacron mesh, cast Ticonium, and hydroformed titanium.

Dental Implantation, Endosseous↗
PubMed1975

Some phonemic characteristics in apraxia of speech.

The articulatory performance of 13 left hemisphere-damaged adults who presented apraxia of speech was tabulated on confusion matrices and analyzed according to error pattern. Consonants were more susceptible to error than were vowels, as were consonant clusters when compared to single consonants. No significant differences existed among error percentages for the initial, medial, and final positions. When errors were analyzed according to manner of production, affricatives and fricatives were significantly more susceptible to error than all others. Analysis of errors according to place of production revealed lingua alveolar and bilabial phonemes to be significantly less impaired than all other categories. No differences were found in error percentages of voiced and unvoiced phonemes. The sequential nature of substitution errors was further analyzed by tallying and classifying errors as anticipatory (prepositioning), reiterative (postpositioning), or metathesis. Seven percent of the substitution errors in this study were sequential, with anticipatory errors outnumbering reiterative errors by a ratio of 6 to 1. Feature analysis of substitutions to determine distance from the target sound revealed that 38% of the substitutions were defective in two or more features. Some of these subjectively bore little resemblance to the target sound.

Adolescent↗
PubMedDate not supplied

Dichotic listening in adults with sensorineural hearing loss.

Digits and consonant-vowel (CV) nonsense syllables were presented dichotically to 36 normal-hearing subjects and 36 subjects with bilaterally symmetrical sensorineural hearing loss. The normal-hearing subjects performed significantly better in the recall of both digits and CV nonsense syllables, and recall decreased significantly as the degree of hearing loss increased. The expected right ear advantage was observed for the normal-hearing subjects on both tests. As a group, the hearing-loss subjects showed no significant ear preference, and ear preference did not vary significantly with the degree of hearing loss. However, individual hearing-loss subjects showed marked ear asymmetry for the dichotic digits. For both dichotic tests, individual ear preference increased as the degree of hearing loss increased. Significant but low correlations were observed between better ear speech discrimination scores for the hearing-loss subjects and the preferred ear for dichotic CV nonsense syllables.

Adult↗