Biomedical subjects

H Friede

Publications and source records attributed to H Friede.

At least 37 records · Page 2Linked to original sources

PubMed1998

Use of titanium dental implants as an integrated part of a CLP protocol.

The problem of edentulousness in the cleft area of patients with cleft lip and palate was formerly resolved with a conventional fixed bridge construction, but this approach did not always prove optimal. Nowadays, in these patients the bridge can be substituted by a crown on an osseointegrated titanium implant fixture. The concept of dental rehabilitation using titanium implants has gradually merged into our routine treatment for patients with cleft lip and palate. In this report we describe our surgical technique using osseointegrated titanium implants and evaluate our result in patients with cleft lip and palate. Sixteen patients with cleft lip and palate, 11 men and five women, were divided into two groups: group 1 consisted of six patients who did not need bone grafting prior to the fixture installation, and group 2 comprised 10 patients who had additional bone grafting three months before the fixture installation. Abutments were applied six months after fixture installation. Dental crowns and fixed bridges were then constructed. All patients were seen on regular follow-up visits. Routine roentgenograms were obtained preoperatively and when the abutments were applied. Photographs were taken at these occasions and also after the prosthodontic work was completed. Of a total of 31 fixtures, all except two were osseointegrated at the time of the abutment connection, and the remaining 29 have all been functional during the observation period, giving a success rate of 93%. In group 1 all fixtures (100%) were osseointegrated. The non-integrated fixtures were found in group 2 giving a success rate of 91% in this group. The mean follow-up time after fixture installation was six years and three months, and the mean observation time with loaded fixtures was five years and six months.

Adolescent↗

PubMed1997

Residual clefts in the hard palate: correlation between cleft size and speech.

OBJECTIVE: This study was conducted to evaluate the relationship between size of residual clefts in the hard palate and speech. SUBJECTS: Fifteen 7-year-old children born with complete cleft lip and palate were investigated. METHODS: All of the children were treated according to a surgical regimen involving early soft palate repair and delayed hard palate closure. Measures were taken of the area, length, and maximal width of the residual cleft in the hard palate about a year before its closure and correlated with a perceptual judgment of several speech variables. RESULTS: Significant positive correlations were obtained between the size of the cleft and two variables: weak pressure consonants and hypernasality. Nasal escape was very common among the patients, and almost half the children had retracted palatal or velar articulation of dental stop consonants. Neither of these two variables correlated with the size of the residual cleft. CONCLUSION: Perceived oral pressure and, perhaps, resonance seem to be related to size of the opening of the residual cleft, whereas audible nasal escape and articulatory compensations are not, at least not the latter once established.

Articulation Disorders↗

PubMed1996

Bone grafting in the mixed and permanent dentition in cleft lip and palatepatients: long-term results and the role of the surgeon's experience.

This long-term study was a follow-up of 46 patients with complete unilateral cleft lip and palate treated with secondary or late secondary bone grafting. Surgeons with different degrees of experience in this procedure had operated on these patients. Morphology of the clefts prior to the grafting was assessed with regard to width of cleft, stage of eruption of permanent canine, presence or absence of permanent lateral incisor and position of permanent lateral incisor and permanent canine in the dental arch. Outcome of surgery was evaluated with regard to the amount of bleeding, flap dehiscence, alveolar bone height, and space closure in the previous cleft area. Dehiscence rate was 23% (11) and total failure rate 4% (2). Alveolar bony height in 38 patients (81%) was more than 75% of the normal alveolar bone height; in 6 cases (13%) between 50-75% bone height and in 3 subjects (6%) surgery had given less than 50% of the normal bone height. Cleft space was closed by orthodontic means in 49% of patients. Best results were obtained when bone grafting was performed prior to canine eruption. Furthermore, significantly better results regarding alveolar bone height were obtained by the more experienced surgeons.

Adolescent↗

PubMed1996

Roentgencephalometric follow-up after early osteotomies in patients with scaphocephaly.

The main objective of surgical treatment of scaphocephaly is to improve the shape of the patient's skull. Since 1989 we have used a modified pi-plasty method, and the aim of this report was to study how effective surgery had been. A sample of 25 patients was investigated. All patients were operated on during their first year of life (mean: 6 months). They had roentgencephalometric records preoperatively as well as at a follow-up at age 3 years. Certain measurements were taken from the cephalograms and compared with normative data. It was found that the average skull length had decreased from a preoperative 114% of normal to 107% at follow-up. The skull width had improved from 92% to 98% of normal. The cephalic index had improved as well but was still not within the normal range. The cephalograms were also classified according to the occurrence of digital markings. Before surgery at 6 months none had these signs, but at follow-up every second patient displayed evolution of digital markings. It was concluded that the modified pi-plasty method improves skull morphology considerably but does not completely normalize the shape of the average patient's skull. The cranial length, in particular, needs further improvement.

Cephalometry↗

PubMed1996

Dynamic cranioplasty for brachycephaly.

In craniofacial surgery, the most common techniques for treatment of brachycephaly have been either to let the forehead float on the brain or to fix it in an advanced position. Since neither of these techniques renders acceptable results with enough consistency, we have developed a different way of addressing the problem. In principle, the design of the operation is to restrict upward and transverse growth of the cranium but to allow anterior and posterior expansion. This is accomplished by producing transverse tension across the skull and letting it expand anteriorly by means of a superiorly hinged fronto-orbital flap and posteriorly by an inferiorly based occipital flap. To prevent upward expansion at the squamosal sutures when still open, these junctions are bridged with miniplates. This surgical technique has brought definite improvement to the results even in some Apert syndrome children. During a 2-year period, we have treated 14 infants with this technique and followed 10 of them with roentgencephalometry, 3 for more than 1 year, and 4 for more than 6 months. The diagnoses were the following: nonsyndromal bicoronal synostosis (4), Apert (7), bicoronal synostosis with midline cleft, Saethre-Chotzen, and Antley-Bixler (1 each). The mean age of surgery was 6.6 months (range 3 to 16 months). There were no major complications.

Acrocephalosyndactylia↗

PubMed1996

Delayed closure of the hard palate: a comparison of speech in children with open and functionally closed residual clefts.

The speech of 20 children with cleft in the hard palate that had not yet been repaired was evaluated and analysed at 7 years of age. The cleft in the hard palate was open in 14 patients and functionally closed in six. All children were born with cleft lip and palate and treated surgically according to a routine that included delayed closure of the hard palate until age 8-10 years. The soft palate was repaired at approximately 6-8 months of age. Tape recordings were used for perceptual analysis of the speech. Maxillary casts were used to assess approximate age for functional closure of the residual cleft. Speech results showed only mild hypernasality for both groups of subjects which indicates acceptable velopharyngeal function in the whole group. Children with open residual clefts had significantly more nasal escape and a higher prevalence of compensatory retracted articulation than children with functionally closed clefts. The functional closure seems to have occurred at about the age of 18-36 months. Factors which appear to facilitate narrowing of the residual cleft include the original width of the cleft, the amount of tissue in the alveolar and palatal processes, and anterior placement of a vomer flap.

Age Factors↗

PubMed1995

Abnormal craniofacial growth.

Treatment of patients with craniofacial (CF) anomalies necessitates knowledge about normal CF growth and how it deviates in the abnormal state. There are different basic types of CF anomalies and various kinds of aberrations that influence CF development. These factors might help to explain why patients display growth variations. The effect of surgery on subsequent development is significant, but the heterogeneity among patients with regards to the morphology, etiology, and pathogenesis of the anomalies could also explain certain growth results. Roentgencephalometric findings related to CF growth in three different groups of anomalies are discussed.

Cephalometry↗

PubMed1995

A longitudinal study of speech in 15 children with cleft lip and palate treated by late repair of the hard palate.

Since 1975, children with cleft lip and palate living in the western part of Sweden have been treated according to a regimen of early repair of the soft palate (at the age of 6-8 months) and late hard palate closure (at about 8-9 years of age). The present paper is a longitudinal study of 15 consecutive patients whose speech development was analysed at the mean ages (years:months) of 5:3, 7:0, 8:5, and 9:7 years. Hypernasality gradually decreased over the years whereas nasal escape almost completely ceased after closure of the residual cleft. There was no glottal articulation at any age. Despite the fact that retraction of apicodental consonants decreased in frequency with age and presumably with speech therapy, it was the main problem throughout the observation period. It was presumably caused by the residual cleft in the hard palate compensating for subnormal pressure in front of the opening to the nasal cavity.

Age Factors↗

PubMed1994

Bone grafting at the stage of mixed and permanent dentition in patients with clefts of the lip and primary palate.

Secondary bone grafting of a residual alveolar cleft has become a well established procedure. However, little attention has been paid to the benefits of these bone grafts in patients with clefts of the lip and alveolus only. This retrospective and comparative study includes 21 patients who had received a secondary or a late secondary bone grafting procedure from tibia and whose mean clinical and radiographic follow-up after the bone graft was 5.5 years. Eighteen patients treated without bone grafting served as controls. Length and width of cleft, presence or absence of permanent lateral incisor, size of nasal floor bony defect, and interdental alveolar bony height in the cleft area were investigated. The results showed that bone grafting was indicated particularly in wide clefts with missing lateral incisors. Eruption of a tooth close to the cleft was facilitated and the bony support for teeth neighboring the cleft was improved. In some cases, additional support of the alar base of the nose was achieved and closure of an oronasal fistula facilitated. A further advantage of bone grafting of clefts of the primary palate was that it might make it possible to insert a titanium implant carrying an artificial tooth in the cleft area.

Adolescent↗

PubMed1994

Pre-speech in children with cleft lip and palate or cleft palate only: phonetic analysis related to morphologic and functional factors.

Pre-speech in 35 children with clefts of the lip and palate or palate only were analyzed for place and manner of articulation. Transcriptions were made from tape recorded babbling sequences. Two children without clefts were used as reference. All of the children with clefts were treated according to a regimen of early surgical repair of the velum cleft and delayed closure of the cleft in the hard palate. The frequency of selected phonetic features was calculated. Correlations between phonetic/perceptual and functional and morphological factors were tested. Supraglottal articulation dominated among all the children indicating a sufficient velopharyngeal mechanism. The results also showed correlations between cleft type and place of articulation. Anteriorly placed sounds (i.e., bilabial, dental, and alveolar sounds) occurred frequently among the children with cleft palate only and in the noncleft children. In children with cleft lip and palate, posteriorly placed articulations predominated. It was postulated that early intervention may have a positive effect on articulatory development.

Age Factors↗

PubMed1994

Dentofacial morphology in adolescent or early adult patients with cleft lip and palate after a treatment regimen that included vomer flap surgery and pushback palatal repair.

Dentofacial morphology was evaluated in 94 adolescent or early adult patients born with unilateral or bilateral cleft lip and palate. As well as lip closure, the primary treatment included vomer flap surgery and pushback palatal repair. Roentgencephalometric measurements as well as classification of the patients into different classes of dentofacial deformity indicated development of bimaxillary retrognathia with severe midfacial deficiency in about a quarter of the cases. Our results were similar to those reported by other teams who used similar surgical regimen.

Adolescent↗

PubMed1993

Neurocranial morphology in mandibulofacial dysostosis (Treacher Collins syndrome).

An abnormal cranial base could exert a negative influence on neurocranial development. Because patients with mandibulofacial dysostosis (MFD) present an abnormal cranial base (basilar kyphosis), a retrospective mixed longitudinal cephalometric study was designed with the purpose of ascertaining the presence of abnormalities of neurocranial form and size in this population of patients. The lateral and frontal cephalometric radiographs from 33 patients with MFD (15 males, 18 females) ranging in age from 3 years 4 months to 19 years 6 months were used. For comparison cephalometric radiographs from two samples were obtained: one from 24 children (12 male, 12 female) with repaired cleft lip only, and the other from 41 normal young adults (21 male, 21 female). All films were traced, and 9 linear, 1 angular, and 3 derived measurements were obtained from the neurocranium and cranial base. Differences between groups according to age and sex were tested with Student's t-test at the 5% level of significance. A correlation analysis between the cranial base angle and selected neurocranial variables was also conducted. The results showed that although the neurocranium in MFD had normal dimensions in length, height, and volume, it had an abnormal shape. The neurocranium had reduced length anteriorly and increased length posteriorly. The upper cranial height was decreased and the lower cranial height was increased. The difference in shape was evident during childhood and remained in adulthood. The dimensions of the anterior and posterior cranial base, as well as the cranial base angle, were smaller in MFD. A significant negative correlation was found between the cranial base angle and the lower cranial height in MFD.

Adolescent↗

PubMed1993

Lip and nose morphology in patients with unilateral cleft lip and palate from four Scandinavian centres.

Sixty patients with unilateral cleft lip and palate were compared for lip and nose appearance. All patients were photographed from an anteroposterior and a basal view at 7-10 years of age. The photographic registration method was tested for validity and accuracy. Although the four groups of 15 patients each were treated according to different protocols, many similarities were found with shorter lip heights at the cleft side and inclination of the rima oris. Asymmetry of nose and retropositioning at the cleft side naris were generally seen. Significantly straighter noses were demonstrated in the group treated with a two-stage lip nose operation combined with nose plugs, and the two groups where vomer flaps were used showed the greatest deviation of the nose.

Child↗

PubMed1993

Surgical treatment of cleft palate. 27 years' experience of the Wardill-Kilner technique.

During the period 1958-1985, 230 patients with cleft palate were operated on in the Department of Plastic Surgery, University of Göteborg, Sweden. A modified push-back technique according to Wardill and Kilner was used. The children were operated on at a mean age of 13 months. They were divided into two groups, the first in which the cleft affected the velum only (n = 121) and the other in which it also affected the hard palate (n = 109). Postoperative dehiscences and fistulas occurred in 19 (8%) patients, of which 16 (15%) belonged to the group in which the cleft affected the hard palate. Only three (2%) of the 121 patients with a cleft in the soft palate only developed dehiscences. The total number of patients who had to be reoperated on because of dehiscences were 10 (4%) and palatopharyngeal flaps had to be performed in 25 patients (11%) because of speech problems.

Child↗

PubMed1993

Maxillary dental arch and occlusion in patients with repaired clefts of the secondary palate. Influence of push back palatal surgery.

Maxillary morphology and dental occlusion were studied from infancy to age 10 years in 32 patients born with isolated cleft palate. Wardill-Kilner push back repair of the palate had been done at a mean age of 7.5 months. Measurements obtained from casts of the jaws showed that the average maxillary dimensions before as well as after operation were less than those reported for children without clefts. The mean reduction was similar whether the cleft reached into the hard palate or affected the soft palate only. Preoperative anterior maxillary arch width in particular, and also distance from scar line to selected teeth seemed to influence postoperative development of the maxillary dental arch in individual patients.

Cleft Palate↗

PubMed1993

Assessment of speech in children after repair of isolated cleft palate.

The speech of 31 consecutive patients with isolated cleft palate was evaluated when they were between 10 and 14 years of age. All the children had Wardill-Kilner push-back repairs at a mean age of 7.9 months. Several speech variables were assessed by two trained listeners. In addition, an overall evaluation of the quality of the patients' speech was made by the listeners and by the patients themselves. The patients had some remaining speech problems, mainly hypernasality which was moderate or severe in 7 (23%). The prevalence of compensatory articulations was low, however (n = 4, 13%), and most patients thought that their own speech was normal or relatively normal.

Adolescent↗

PubMed1991

Craniofacial and occlusal characteristics in unilateral cleft lip and palate patients from four Scandinavian centres.

Craniofacial morphology and dental occlusion were studied at early school age in 15 consecutive patients with unilateral cleft lip and palate from each of four Scandinavian cleft centres. Treatment differed mainly in the techniques of palatal repair. Push-back closure of the palate particularly impaired maxillary development, which resulted in an increased incidence of crossbite and reduced intercanine distance when compared with patients who had been operated on by the von Langenbeck method or in whom the anterior palate had not yet been closed.

Cephalometry↗

PubMed1990

Trigonocephaly: clinical and cephalometric assessment of craniofacial morphology in operated and nontreated patients.

Craniofacial parameters were studied clinically and by cephalometry in 11 trigonocephalic patients from infancy to 4 years of age. Six of the most severe patients had surgery between 6 and 18 months of age. Analysis of morphology indicated that bony interorbital distance was reduced in patients selected for surgery and hypotelorism persisted at final examination. All patients demonstrated orbital width measurements above the mean for the norm, while orbital height was essentially normal. All but one of the patients had a variably prominent forehead bony ridge that was eliminated or reduced as a result of surgery and/or growth. However, the forehead of most patients, whether operated or not, was too narrow when compared to normal skulls. Thus, although some of the striking features of trigonocephaly are eliminated, minor characteristics of the anomaly still persevere at 4 years of age.

Cephalometry↗