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At least 253 records · Page 14Linked to original sources
PubMed1993

Improved patient compliance with cleft palate team regimes.

A cleft palate team's prescribed regimen requires prompt and continued compliance to meet the objectives of the clinical management and to achieve the best clinical results for the patient. In a previous study (Paynter et al., 1990), we reported an overall compliance rate of 64% for patients seen by a cleft palate team during its first 8 years of operation. After the study, changes in the team's operational procedures were made in an attempt to provide better service, improve patient compliance, and improve the efficiency of the clinic. The purposes of the current clinical investigation were to determine the degree of compliance with recommendations made by the cleft palate team for the patients seen during the four years after the implementation of the changes and to identify variables that interfered with compliance. A subject was defined as the person(s) who could best respond to questions concerning the management of the team's patient. Each subject was interviewed using a questionnaire based on the Health Belief Model (Becker et al., 1977). The mean patient compliance rate was 82%. Using Jones and Caldwell's (1981) classification, 56.7% of the patients were classified as compliers, 40% as partial compliers, and 3.3% as noncompliers. Compliance with specific recommendations ranged from 58 to 100%. No specific variable was found to interfere with compliance.

Adolescent↗
PubMed2001

Cleft palate in spondyloepiphyseal dysplasia congenita: case reports.

Cleft palate is one of the common features of spondyloepiphyseal dysplasia congenita (SEDC). However, there are few clinical data about cleft palate in SEDC. We report four patients with cleft palate and SEDC including two with overt cleft palate and two with submucous cleft palate. Our results suggested that SEDC associated with cleft palate should be treated in the same way as solitary cleft palate, and submucous cleft palate may be more common in patients with SEDC than previously appreciated.

Abnormalities, Multiple↗
PubMed1981

Functional regulator therapy for cleft palate patients.

Nine cleft lip and palate children exhibiting collapse of maxillary segments and cross-bite were treated orthodontically with the functional regulator (FR) for periods ranging from 6 to 18 months. The purpose of this investigation was to evaluate quantitatively treatment of cleft palate patients with the functional regulator and to evaluate the effect of the appliance on their speech. Cleft palate patients typically have speech, nose, and lip defects which make patient cooperation and appliance acceptance more difficult. However, patient cooperation was considered good with an average mean of 12.7 hours per day of appliance wear and a range of 5.6 to 18.2 hours. Change in interimplant dimension was measured on frontal radiographs, and dental changes were measured of serial dental casts. The resulting data indicated no significant change in maxillary width or cross-bite relationship. The functional regulator was not clinically useful in this sample when the treatment objective was primary expansion of collapsed maxillary segments in the cleft palate patient. Good speech-production skills prior to treatment will minimize the adverse effect that the FR has on speech intelligibility. A significant amount of accommodation to the appliance occurs within 1 week after insertion, but maximum improvement in speech intelligibility occurs with full-time wear of the appliance for as many hours per day as possible.

Activator Appliances↗
PubMed1986

Palatal width growth rates as the genetic determinant of cleft palate induced by vitamin A.

While many studies have demonstrated sexual dimorphism and racial variation (Mongoloid greater than Caucasian greater than Black) in the incidence of palatal clefting, only generalized statements have been made concerning the causal mechanism (eg, "genetic propensity"). The present study tests the hypothesis that the more rapid the growth rate of the width of the facial skeleton, the higher the incidence of palatal clefting, given a uniform environmental insult. Two strains of pregnant rats with differing rates of craniofacial development (Wistar-fast and Sprague-Dawley-slow) were injected prenatally with high doses of vitamin A (300,000 IU/kg) on days 10-13 gestation. Fetuses were examined at 20 d prenatally and the incidence of palatal clefting was recorded. A significantly higher (P less than .05) incidence of palatal clefting was noted in the more rapidly developing strain (66% vs 81%). These results support statements by Fraser and others who suggest that head width and palatal clefting are causally related. The "genetic propensity" in this case, then, is the rate of palatal width development.

Aging↗
PubMed1999

A technique for repair of the 'unrepairable' cleft palate.

The 'unrepairable' cleft palate may be described as one in which the width of the cleft exceeds the sum of the widths of the palatal shelves. A report of such a case is presented, and the technique used to repair the cleft using bilateral buccinator musculomucosal flaps is described. It is offered as a suggested technique for the management of such cases in the future.

Cleft Palate↗
PubMed1975

Spectrographic analysis of pain cry in neonates with cleft palate.

52 phonations of 13 cleft palate neonates were analyzed by sound spectrographic methods. 17 phonetical attributes were included in the study and the first signal after the pain stimulus was analyzed. The cries of the cleft palate infants were compared with the crying of 75 normal babies of the same age. No change in the fundamental frequency, melody type and duration of the cries was seen in association with these anatomical defects. Two of the characteristics studied, vibrato and the 'tonal pit', occurred significantly more often in cries of the cleft palate infants than in cries of the control series. The changes in the qualities seen in association with cleft palate and/or cleft lip do not mimic the abnormalities produced by brain damage.

Cleft Lip↗
PubMed1998

Measurement of palatal surface sensation by neuro-sensory tests in the postoperative cleft palate patients.

To clarify the effects of abnormal sensation on the palatal surface on speech sounds in postoperative cleft palate patients, we measured palatal surface sensation in these patients. Tactile and vibratory sensation were measured quantitatively using a SW sensemeter and a vibrometer. The obtained values were compared with those in controls. The following results were obtained. In both the postoperative cleft palate patients and controls, the sensation in the anterior region of the hard palate was more numb than that in the anterior region of the soft palate or the premolar alveolar region. The tactile sensation in the postoperative cleft palate patients was more numb than that in the controls. In particular, a marked difference was observed in the premolar alveolar mucosa. The vibratory sensation in the postoperative cleft palate patients, however, did not clearly differ from that in the controls. There was a positive correlation between the tactile sensory threshold and the vibratory sensory threshold in the controls. No association between the two thresholds was observed in the postoperative cleft palate patients. The authors concluded that the tactile sensation at premolar alveolar region in the postoperative cleft palate patients was more numb than in the controls. This abnormality may affect speech development.

Adolescent↗
PubMed1997

Maxillary growth following atelocollagen implantation on mucoperiosteal denudation of the palatal process in young rabbits: implications for clinical cleft palate repair.

OBJECTIVE: The implantation of atelocollagen matrix on the denuded surface of palatal bone following cleft palate repair has been used because it enhances wound healing. This study was performed to determine whether the beneficial effect of atelocollagen matrix implantation on the prevention of scar tissue contraction also inhibits the scar's interference with the growth of maxillary bone. METHOD: Fifty New Zealand White rabbits (aged 4 weeks) underwent palatal mucoperiosteal denudation, and etelocollagen matrix was implanted on the left palatal process. The opposite side was left open as a control. RESULTS: Histopathologically, the implantation side exhibited early infiltration of mononuclear cells and fibroblasts, and better growth of connective tissue strands and epithelium. In addition, the formation of rate ridges were seen that were similar to the normal mucosa. The bone of the atelocollagen-implanted side was covered with regenerated periosteum-like layers, but that of the control side was lined by granulation tissue, suggesting the existence of continuous inflammation on the periosteal region. When the animals reached adulthood (aged 24 weeks), the areas of scars and palatal processes, palatal shelf width, molar teeth incline, and bone mineral contents were measured and compared between sides. The atelocollagen-applied scars showed less contraction, the area and width of atelocollagen-implanted palatal processes showed more satisfactory growth, and the dental arch deformity was suppressed in comparison with the control side. CONCLUSIONS: Our results suggest that the use of atelocollagen matrix on the denuded bone surface following cleft palate repair decreases the scar's effect on maxillary growth.

Aging↗
PubMed1996

Mesenchymal cell activity during 5-fluoro-2-deoxyuridine-induced cleft palate formation in the rat.

Biosynthetic activity of the mesenchymal cells within the palatal shelves was determined during cleft palate formation induced by 5-fluoro-2-deoxyuridine (FUDR). The palatal shelves of 30 fetal rat heads with palatal clefts were surveyed at stages corresponding to normal palatogenesis, nucleolar organizer region (NOR) staining being employed to determine cell activity. Comparing cellular activity during normal and cleft palatogenesis, significantly lower counts were recorded for most stages of cleft formation. When anterior or posterior regions were compared, significant changes in NOR counts cell were found at a time corresponding to the pre-elevation stage of normal palatogenesis. At a time equivalent to normal fusion, the shelves in the anterior region showed signs of recovery, but posteriorly significantly lower activity occurred throughout all stages of palate dysmorphogenesis. The depressed level of cellular activity found after treatment with FUDR may be directly or indirectly related to the abolition of an intrinsic shelf-elevation force and, subsequently, cleft palate formation.

Analysis of Variance↗
PubMedDate not supplied

Single-word intelligibility in speakers with repaired cleft palate.

Many speakers with repaired cleft palate have reduced intelligibility, but there are limitations with current procedures for assessing intelligibility. The aim of this study was to construct a single-word intelligibility test for speakers with cleft palate. The test used a multiple-choice identification format, and was based on phonetic contrasts which are problematic for speakers with cleft palate. Fifteen Cantonese speakers with repaired cleft palate served as speakers. The intelligibility score of each speaker was calculated, based on the number of words correctly identified by eight naive listeners. The most problematic contrasts, based on mean error proportions, were place of articulation (stops and nasals), stop versus fricative, and stop versus affricate. The most robust contrasts were also determined, and physiological and language-specific interpretations offered. Single-word intelligibility could be predicted with 91% accuracy using three phonetic contrasts. The importance of an 'explanatory' intelligibility test, for focusing treatment and monitoring severity, is discussed.

Adolescent↗
PubMed1979

Stage of palate closure as one indication of "liability" to cleft palate.

A new inbred mouse strain, SW/Fr, developed from a random-bred SW stock has a 6% incidence of spontaneous cleft palate without cleft lip. SW/Fr mice close their palates comparatively late in development. After cortisone treatment, the mean of the distribution (mean time to reach palate stage 5) is shifted towards later gestational ages. There is no change in the variance of the distribution. These data lend further support to the hypothesis that cleft palate in mice may fit a model where a continuous distribution is separated into discontinuous parts by a developmental threshold, and that time of palate closure is an important component of liability to cleft palate.

Animals↗
PubMed1996

[Middle ear function in children with cleft palate].

Middle ear problems in patients with cleft palate have for a long time received insufficient attention. The present study was designed to evaluate middle ear function in 56 children with cleft palate and in a control group of 50 children without cleft palate. The age ranging between 5 and 14 years was similar in both groups. All children underwent routine otoscopic examinations of ear, nose and throat, and were also examined using the Madsen acoustic impedance audiometer. Four major parameters (static compliance, middle ear pressure, acoustic stapedius reflex and Eustachian tube function) were analyzed. It was found that the negative middle ear pressures were higher and the static compliance, which reflected the elasticity of the conducting mechanism of the middle ear, was poorer in children with cleft palate than in the controls. The proportion of children with cleft palate who showed the presence of the acoustic stapedius reflex was also lower than in the control children. Children with cleft palate have a limited ability to actively open the Eustachian tube by swallowing, as evidenced by a poor ability to equilibrate applied positive or negative middle ear pressure. A multidisciplinary approach should be adopted for the complete overall rehabilitation of children with cleft palate. Plastic surgeons to whom most of the treatment is entrusted should be concerned not only with achieving palatal function and acceptable speech, but also with the various other problems associated with cleft palate, especially those affecting the middle ear.

Abnormalities, Multiple↗
PubMed2003

[Familial cleft lip with or without coexisting cleft palate].

Etiopatology of clefts has not been explained yet. It is assumed that the cause of this defect is complex and heterogeneous. Genes which induce the incidence of cleft have not been detected too but clinical observations indicate a familial predisposition. At the Plastic Surgery Clinic of the Łódz Medical Academy, on years 1972-2001, 3180 children with cleft lip or/and palate were being treated. The group under examination consisted of 540 children with positive family histories. Two genetic groups were confirmed and each of them with a different risk of the reoccurrence of the defect. The first group--cleft lip and palate, the second group--an isolated cleft palate. A correlation between the type of cleft and a child's sex and its cleft affected parent was found. Among children of mothers with cleft lip there were 60% of boys and only 15% of girls with the same type of cleft. In mothers with cleft lip and palate the same type of cleft has been detected in 70% of boys and 18% girls. Similar results were obtained when affected fathers were taken into account. However, in case of mothers and fathers who were affected with isolated cleft palate there were significantly more girls than boys who had cleft palate. An in-depth study of cleft inheritance mechanisms will make in the future a more precise prediction of the occurrence of the defect in consecutive generations possible. Perhaps, the chance to work out cleft preventions will emerge and the gathered data will be taken advantage of in genetic counselling.

Child↗
PubMed1998

Cleft palate and craniofacial teams in the United States and Canada: a national survey of team organization and standards of care. The American Cleft Palate-Craniofacial Association (ACPA) Team Standards Committee.

OBJECTIVE: This study is the first comprehensive national survey of the organization, function, and composition of cleft palate and craniofacial teams in the U.S. and Canada. Complete descriptions of cleft and craniofacial teams are not currently provided in the literature, and this study will provide an overview for health services research and policy use. Conducted by a national organization, this study examines teams in detail using a pretested and standardized methodology. DESIGN: All known (n = 296) North American cleft palate and craniofacial teams were contacted for team listing purposes using a self-assessment method developed by an interdisciplinary committee of national stature. Team clinical leaders classified their teams into several possible categories and provided data on team care. The response rate was 83.4% (n = 247). RESULTS: The distribution of listed teams was: 105 (42.5%) cleft palate teams, 102 (41.3%) craniofacial teams (including craniofacial teams that are both cleft palate and craniofacial teams), 12 (4.9%) geographically listed teams, and 28 (11.3%) other teams (including interim cleft palate teams, low-density cleft palate teams, and evaluation and treatment review cleft palate teams). Eighty-five percent of all teams systematically collected and stored clinical data on their team's patient population in the past year. Furthermore, 50% of all teams had a quality assurance program in place to measure treatment outcomes. Other findings presented include the annual number of face-to-face team meetings; new and follow-up patient censuses; and surgical rates for initial repair of cleft lip/palate, orthognathic/osteotomy procedures, and intracranial/craniofacial procedures. CONCLUSIONS: Two of five North American teams classify themselves as having the capacity to provide both cleft palate and craniofacial care. An additional two of five teams limit their primary role to cleft palate care. Issues are raised regarding the distribution of teams, the regionalization of craniofacial services, health policy, and resource allocation.

Canada↗
PubMedDate not supplied

Evaluation of soft palate function with MRI: application to the cleft palate patient.

Magnetic resonance imaging was employed to evaluate soft palate function in four normal volunteers and four patients with surgically repaired cleft palate, using a GE Signa clinical scanner at 1.5 T and a custom designed receive coil with a sensitivity profile encompassing from the nasopharynx to the larynx. Midsagittal images were obtained using spoiled gradient recalled acquisition at steady state while the subject phonated the following sounds: (a) MMM, (b) SSS, (c) DAH, and (d) EEE. An image at rest with normal breathing was also obtained. The soft palate and its relationship to the airway and the posterior pharyngeal wall were clearly visualized in all cases. Phonation of the prescribed sounds demonstrated the normal range of soft palate motion. The images also depicted the ability of the soft palate to divert airflow to the nasopharynx. Interpretation of functional MRI may be of value in evaluation of surgical results, guidance of speech therapy, and surgical planning in the cleft palate patient. This noninvasive alternative to conventional methods of visualization provides advantages in resolution, repeatability, and patient comfort.

Adolescent↗