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Análise do perfil mole facial frente ao avanço cirúrgico de maxila em pacientes com fissuras labiopalatinas / Analysis of the facial soft tissues following surgical maxillary advancement in cleft lip and palate patientsAchôa, Gustavo Lara 04 June 2008 (has links)
Objetivo: Avaliar as alterações cefalométricas induzidas em tecidos duros e moles em pacientes com fissuras transforame incisivo bilaterais (FTIB) submetidos ao avanço cirúrgico da maxila e o efeito de tal procedimento sobre o perfil mole. Modelo: Estudo retrospectivo que comparou um tempo pré-operatório imediato a outro pós-operatório mínimo de seis meses, por meio de telerradiografias cefalométricas em norma lateral e cefalometria computadorizada, de indivíduos com fissuras labiopalatinas. Local: Clínica de Odontologia, HRAC/USP. Participantes: 8 pacientes do sexo feminino e 17 do sexo masculino, entre 15 e 35 anos, com média de 20,56 anos de idade, que foram submetidos ao tratamento de reabilitação com cirurgia ortognática envolvendo avanço de maxila. Variáveis: Diferenças entre os períodos pré e pós-operatório de pontos cefalométricos definidos em maxila e perfil mole, Ângulo Naso-Labial (ANL) e distâncias representativas do comprimento (Sn-Sts) e espessura (Ls-Sts) labial superior, além das proporções da movimentação do tecido mole em relação à movimentação do tecido duro de suporte. Resultados e Conclusão: As alterações cefalométricas no sentido horizontal ocorreram em todos os pontos estudados, em tecido duro e mole; no sentido vertical, apenas os pontos Pró-nasal (Prn), Subnasal (Sn) e A\' tiveram alterações significantes; o aumento significante do ANL e Sn-Sts também foi observado. As proporções entre a movimentação óssea e a acomodação do tecido mole do perfil facial são menores que as proporções obtidas nos estudos similares em pacientes com outros tipos de fissura e pacientes sem fissuras, porém no mesmo sentido e direção. / Objective: To assess cephalometric changes in hard and soft tissues of bilateral cleft lip and palate (BCLP) patients following surgical maxillary advancement and its effect over the soft tissue profile. Design: Retrospective study which compares an immediately pre surgical to a post surgical moment, at least six months later, through cephalometric lateral radiographs and a cephalometry computer program, of individuals with cleft lip and palate. Setting: Clinic of Dentistry, HRCA/USP. Subjects: 8 women and 17 men, from 15 to 35 years old and mean age of 20.56, underwent orthognathic surgery with maxillary advancement during the rehabilitation treatment. Variables: Changes between different cephalometric landmarks from pre surgical to post surgical periods in hard and soft tissue of maxilla, Nasolabial angle (NLA) and distances representing the length (Sn-Sts) and thickness (Sts-Ls) of the upper lip, besides the ratios of soft tissue changes relative to hard tissue movements. Results and Conclusion: Horizontal cephalometric changes happened to all of the studied landmarks in both maxilla and soft tissue profile; vertically, only Pronasale (Prn), Subnasale (Sn) and A\' showed significant changes; the significant increasing of NLA and Sn-Sts also was observed. The ratios of facial profile soft tissue changes relative to bone movement were smaller than ratios observed in patients with other cleft types and patients with no clefts, however, this changes remain in the same directions.
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Estudo prospectivo das complicações respiratórias da palatoplastia primária em crianças com fissura de palato. / Prospective study of respiratory complications of primary palatoplasty in infants with cleft palateConegliam, Priscila Capelato Prado 04 October 2013 (has links)
Objetivo: Investigar a incidência de complicações respiratórias trans e pós-operatórias em crianças com fissura de palato submetidas à palatoplastia primária, com vistas à identificação de sinais e sintomas de apneia obstrutiva do sono (AOS). Modelo/Local de Execução: Estudo prospectivo realizado no Hospital de Reabilitação de Anomalias Craniofaciais. Participantes: Setenta e seis crianças não-sindrômicas, de ambos os sexos, foram divididas em dois grupos: um constituído por 56 crianças com fissura de palato (FP), idade entre 11 e 15 meses, sendo 20 com fissura de lábio e palato unilateral (FLPU), 16 com fissura de lábio e palato bilateral (FLPB), 20 com fissura de palato isolada (FPi), e, outro, controle, constituído por 20 crianças com fissura de lábio (FL), idade entre 3-13 meses. As crianças do grupo FP foram submetidas à palatoplastia primária pela técnica de von Langenbeck modificada e o grupo controle, à queiloplastia pela técnica de Millard. Variáveis: Dados referentes à história clínica e sintomas respiratórios foram levantados junto aos pais no pré-operatório (PRE), i.e., no período de 1 a 2 dias que antecederam a cirurgia primária. Foram, ainda, analisadas as complicações respiratórias observadas no transoperatório (TRANS) e em três momentos do pós-operatório: imediato (POSi), i.e., na sala de recuperação anestésica, mediato (POSm), i.e., 12 a 24 horas após a cirurgia estando o paciente ainda hospitalizado, e, tardio (POSt), i.e., 1 a 2 meses após a alta hospitalar, por contato telefônico. Com base na identificação de dificuldade respiratória, ronco e apneia durante o sono foi calculado um escore clínico (índice de Brouillette) no PRE, POSi e POSt, de modo a identificar crianças com suspeita de AOS. Resultados: A análise do índice de Brouillette mostrou aumento do escore médio, sugestivo da possível presença de AOS, apenas no POSi. Nas demais abordagens, observou-se que o grupo FP, comparativamente ao grupo controle, apresentou complicações respiratórias com frequência significantemente maior (p<0,05), particularmente no POSi. Proporção significantemente maior de crianças com FP apresentou ronco. Pausas ventilatórias no sono não foram relatadas. Conclusão: O fechamento cirúrgico do palato exerce efeito obstrutivo sobre a via aérea superior a curto prazo, em decorrência da manipulação cirúrgica, levando a sintomas respiratórios transitórios, em sua maioria. Contudo, o elevado número de relatos de ronco a longo prazo, não permite descartar a ocorrência de AOS nessa população. Estudos polissonográficos devem ser realizados para investigar em maior profundidade esta relevante questão clínica / Objective/Purpose: To investigate the incidence of trans- and postoperative respiratory complications in infants with cleft palate undergoing primary palatoplasty, in order to identify signs and symptoms of obstructive sleep apnea (OSA). Study model/Setting: Prospective study, carried out at the USP Hospital for Rehabilitation of Craniofacial Anomalies. Design/Participants: Seventy-six non-syndromic infants, both genders, were divided into two groups: CP group (56 infants with cleft palate±lip, aged 11-15 months, comprising 20 with unilateral cleft lip and palate, 16 with bilateral cleft lip and palate and 20 with isolated cleft palate), and CL control group (20 infants with cleft lip, aged 3-13 months). CP infants underwent palatoplasty using a modified von Langenbeck technique, and control infants underwent cheiloplasty using the Millard technique. Main outcome measures: Data based on parent reports of clinical history and respiratory symptoms were collected 1-2 days preoperatively (PRE). Respiratory complications were assessed during surgery (TRANS) and three times postoperatively: in the recovery room (POST1); 12-24 hours after surgery, while the patient was still hospitalized (POST2) and 1-2 months after hospital discharge, by telephone parental report (POST3). Based on the identification of breathing difficulty, snoring and breathing pauses during sleep, a clinical score was calculated (Brouillette index) at PRE, POST1 and POST3, in order to identify infants with suspected OSA. Results: Brouillette index analysis showed an increase in mean score, suggestive of OSA, only at POST1. On the other approaches, the CP group showed higher frequency of respiratory complications than the control group, (p<0.05), mainly at POST1. A significantly higher number of infants with CP presented snoring. Breathing pauses during sleep were not observed/reported. Conclusion: The surgical closure of the palate has an obstructive effect on the upper airway in the short-term due to surgical manipulation, mainly leading to transitory respiratory symptoms. However, the high number of snoring reports at the long-term, does not allow to rule out the occurrence of OSA in this population. Polysomnography studies shall be carried out to further investigate this relevant clinical issue.
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Avaliação das dimensões das fissuras labiopalatinas por meio de exame de imagem / Evaluation of cleft lip and palate dimesion through imagingSouza, Ingrid Araujo de Oliveira 24 June 2016 (has links)
As fissuras lábiopalatinas consistem em anormalidades craniofaciais congênitas comuns quando comparada as demais anomalias, que podem acometer o lábio, rebordo alveolar, palatos duro e mole, resultantes da falta de nivelamento dos processos nasais mediais entre si, e destes com os processos maxilares laterais. O tratamento deve ser realizado por meio de uma equipe multidisciplinar de especialistas. Um dos meios auxiliares mais importantes no diagnóstico da malformação são os exames de imagem, como as radiografias intra e extra bucais e as tomografias computadorizadas, para uma melhor avaliação morfológica prévia das resultando em melhorias no diagnóstico, planejamento e manejo cirúrgico dos casos, prevendo melhor prognóstico e resultado final mais satisfatório. Esta pesquisa avaliou através de radiografias periapicais de fissuras transforame incisivo unilateral a dimensão das fissuras no pré-operatório e o nível de formação óssea no pós operatório de enxerto ósseo alveolar autógeno de crista ilíaca, objetivando investigar o tamanho crítico do defeito maxilar e o nível de formação óssea, levando em consideração fatores que também influenciam na previsibilidade do resultado como a idade, presença do canino não irrompido e a ortodontia pós enxerto, para que se possa oferecer condutas terapêuticas mais adequadas. Pacientes com menos de 16 anos de idade tem seis vezes mais chances para formação de um septo ósseo intermediário com altura próximo do normal. Resultados favoráveis também foram encontrados nos casos em que o canino não havia irrompido, com 16 vezes maior a capacidade de preenchimento ósseo do defeito em até 75%. Indivíduos com início da ortodontia no período ideal, 60 a 90 dias depois do enxerto ósseo, apresentaram uma formação óssea do tipo I e II com mais de 50% de formação óssea no defeito. A altura, largura apical e o gênero da fissura alveolar são fatores que não influenciam na formação óssea. / Cleft lip and palate are common congenital craniofacial abnormalities in comparison with other anomalies. They may affect the lip, alveolar ridge and the soft and hard palate resulting from the lack of leveling of the medial nasal processes between themselves and the lateral maxilla process. The etiology is well defined: heredity involving genetic and environmental processes with a worldwide incidence of 1:700 births. The treatment should be performed by a multidisciplinary team of experts.. One of the most important exams to support the malformation diagnosis are imaging exams, such as intra/extra oral radiographs and computed tomography because they may help in pre-surgical measuring, resulting in improvement in planning and surgical management, thereby providing a good prognosis and outcome. The present research will evaluate the cleft size in the preoperative period and the bony formation after autogenous alveolar bone graft surgery of the iliac crest through periapical radiographs. The main objective is to investigate the critical size of the maxillary defect and the level of bony formation, considering factors that could also affect the final result, such as age, presence of retained canine after orthodontic grafting treatment, and finally, to suggest standard therapeutic approaches. Patients younger than 16 years old has 6 six time more chances to form a intermediary bony septum, with a height close to normal. Good results also were found in cases of unerupted canine, with bony defect filling increased until 16 times in 75%. Patients with orthodontics treatment started in the ideal period (60-90 days after bone grafting), presented a Type I and II bone formation, with more than 50% of bone defect repaired. In conclusion, the height, width and type of alveolar fissure are factors that not influenced in bone formation.
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Estudo de associação entre polimorfismo genético e os fenótipos fissura labiopalatina e agenesia dentária não sindrômicas / Study of association between a genetic polymorphism in nonsyndromic cleft lip and palate and tooth agenesis phenotypes.Lancia, Melissa 17 July 2014 (has links)
A fissura labiopalatina é a anomalia craniofacial mais comum nos seres humanos e em relação à cavidade bucal a agenesia dentária se apresenta mais prevalente em indivíduos com fissuras labiopalatinas do que na população em geral. Esses fenótipos têm sido considerados decorrentes de alterações do desenvolvimento embrionário e ocorrem como resultado da interação de fatores genéticos e ambientais, caracterizando uma etiologia multifatorial. Tem sido apontado que a função anormal de alguns genes que possuem papel na formação craniofacial e dentária poderia estar relacionada à etiologia desses fenótipos. Dentre os genes candidatos para esses fenótipos têm se destacado o MSX1 entre outros. Dessa forma, o objetivo do trabalho foi avaliar a associação entre o polimorfismo no gene MSX1 (rs12532) com os fenótipos fissura labiopalatina e agenesia dentária não sindrômicos isolados ou em associação. A amostra foi composta por 222 indivíduos divididos em 4 grupos: grupo 1, indivíduos com fissura e agenesia dentária; grupo 2, indivíduos com fissura sem agenesia dentária; grupo 3, indivíduos com agenesia dentária sem fissura e grupo 4, controle (sem agenesia e sem fissura). Foi realizada a extração do DNA genômico a partir da saliva coletada dos indivíduos. O polimorfismo no gene MSX1 (rs12532) foi estudado por meio de Reação em cadeia da Polimerase em tempo real (PCR Real Time) utilizando o ensaio Taqman (Applied Biosystems). O teste do qui-quadrado (p<0,05) e o cálculo da razão de chances (IC=95%) foram utilizados na análise estatística. O polimorfismo no gene MSX1 esteve associado aos indivíduos dos grupos com agenesia associada à fissura e agenesias isoladas, porém não houve associação para os indivíduos do grupo com fissuras isoladas. Os resultados sugerem que o polimorfismo no gene MSX1 (rs12532) exerce um papel na suscetibilidade das agenesias dentárias na população brasileira em indivíduos com e sem fissura. / Cleft lip and palate is the most common craniofacial anomaly in humans and, in relation to oral cavity, tooth agenesis is significantly more prevalent in individuals with cleft lip and palate than in the general population. Cleft lip and palate and tooth agenesis phenotypes are considered changes in embryonic development and occur as a result of interaction between environmental and genetic factors, featuring a multifactorial etiology. It has been suggested that abnormal function of some genes that have role in craniofacial and tooth formation, could be related in the etiology of these phenotypes. Among the candidate genes for these phenotypes, MSX1 has been highlighted. The aim of this study was to investigate the association between the MSX1 gene polymorphism (rs12532) with nonsyndromic cleft lip and palate and tooth agenesis phenotypes isolated or in association. The sample was comprised of 222 individuals divided into 4 groups: group 1, cleft lip and palate with tooth agenesis; group 2, cleft lip and palate without tooth agenesis; group 3, tooth agenesis without cleft and group 4, a control group without tooth agenesis or cleft. Genomic DNA extraction was performed from the saliva collected from the individuals. The MSX1 gene polymorphism (rs 12532) was studied using real time PCR, Taqman method. The chi-square (p< 0.05) and odds ratio tests (CI= 95%) were performed for statistical analyses. The MSX1 polymorphism was associated with cleft lip and palate with tooth agenesis and isolated tooth agenesis groups, but no association was found between the polymorphism and isolated cleft lip and palate group. This suggests that MSX1 gene polymorphism (rs12532) plays a role in the susceptibility for tooth agenesis in the Brazilian population with and without cleft lip and palate.
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Alterações de esmalte em incisivos e primeiros molares permanentes em pacientes com fissura de lábio e/ou palato e sem fissura / Enamel alterations on the permanent maxillary and mandibular central incisors and first molars of patients with cleft lip and/or palate and without cleftMartins, Ana Paula Moura 08 November 2007 (has links)
Objetivo: Registrar em incisivos centrais e primeiros molares superiores e inferiores permanentes de pacientes com fissura de lábio e/ou palato e sem fissura a prevalência de defeitos de esmalte e sua relação com a fissura. Modelo: Estudo transversal. Local de execução: Setor de Odontopediatria do Hospital de Reabilitação de Anomalias Craniofaciais - Universidade de São Paulo (HRAC-USP), Bauru/SP ? Brasil e na Escola Estadual, Agudos/SP ? Brasil. Participantes: 100 pacientes, regularmente matriculados no HRAC-USP, sendo 50 com fissura de lábio e palato e 50 com fissura isolada de palato e 50 pacientes sem fissura pertencentes à Escola Estadual-Agudos, de ambos os sexos, de 6 a 12 anos. Metodologia: A freqüência, a extensão e a localização das alterações de esmalte na face vestibular dos dentes foram avaliadas clinicamente, segundo o índice DDE modificado, após teste intra-examinador. Resultados: Existiu maior manifestação dos defeitos de esmalte em incisivos e molares superiores nos grupos com fissuras, com significado estatístico, quando comparados ao grupo NF. Os terços médio e cervical dos incisivos superiores nos grupos com fissura envolvendo o alvéolo, principalmente no dente do lado fissurado e os terços incisal e médio nos grupos com FP e NF foram os mais acometidos; nos incisivos inferiores e molares superiores os defeitos ocorreram mais nos três terços dentários avaliados e no molares inferiores nos terços oclusal e médio para os grupos com FP e FLP. A opacidade apresentou a maior ocorrência em todos os grupos estudados. Conclusões: Os resultados mostraram que a ocorrência de defeitos do esmalte foi comum nos incisivos e molares permanentes estudados e sua relação com a fissura é um fator clínico importante que deve ser considerado. / Objective: To record the enamel defects on permanent maxillary and mandibular central incisors and first molars of patients with cleft lip and/or palate and without cleft for detect the prevalence of the development of defects and their cleft relation. Design: Cross-sectional. Setting: Pediatric Dentistry sector, HRAC-USP and School-Agudos/SP. Participants: 100 patients registered at HRAC-USP, of which 50 with cleft lip and palate and 50 patients with cleft palate and 50 without cleft student at School-Agudos, of both genders, aged 6 to 12 years. Methods: The frequency, extent and location of enamel alterations on the buccal aspect of teeth were evaluated by the modified DDE index, after evaluation of intra-examiner agreement. Results: There was a higher demonstration of enamel defects in maxillary incisors and molars in group with cleft, with result statistically significant when was compared with group without cleft. The middle and cervical thirds of maxillary incisors on the group with complete cleft mainly of the teeth cleft side and incisal and middle thirds most affected in group cleft palate and group without cleft; the larger prevalence of enamel defects in mandibular incisors and maxillary molars was observed in three thirds of teeth and oclusal and middle thirds for mandibular molars the patients with cleft palate and cleft lip and palate. Enamel opacity was observed with greater prevalence in all studed groups. Conclusions: Results show that the occurrence of enamel defects is common in studed permanents incisor and molars and its association with cleft is an important clinical factor to be considered.
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Cleft Lip / Palate: Best Practices and Recent DevelopmentsLouw, Brenda 23 May 2017 (has links)
No description available.
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Narrative Review of the Application of the ICF-CY in Children with Cleft Lip and PalateLouw, Brenda, Acquino do Nascimento, Jacqueline, Farmer, Rachel, Hermann, A., Maximino, L. 05 May 2013 (has links)
No description available.
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Academic Preparation in Cleft Palate for Speech-Language Pathologists: Is the ICF-CY (Who, 2007) Alive and Well?Graham, Mary B., Palmer, Jackie, Louw, Brenda 12 November 2015 (has links)
The purpose of this project is to determine inclusion of the ICF-CY in CLP training curricula for SLPs. Survey research was conducted with course instructors across the nation. Results describe the application of the ICF-CY in CLP courses at the graduate level. Recommendations for including the ICF-CY framework are made.
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Young Adults with Cleft Lip and Palate: Are They Receiving Team Services?Widy, Sarah, Bisceglia, Andrea, Bradley, Emily, Kumar, Sanjana Kumari Vyda Srinivasa, McDowell, Andrea, Murr, Amanda, Nowicki, Blake, Reed, Elisha, Staples, Alexandria, Louw, Brenda 11 November 2017 (has links)
It is widely acknowledged that a team approach is preferred practice and contributes to optimizing the surgical, dental, speech and psychosocial outcomes for individuals with CLP. Young adulthood often marks the transition from child-centered interdisciplinary care to adult-centered care. There is a paucity in literature relating to the transition of care for young adults with CLP. The purpose of this survey research is therefore to explore the CLP team practices regarding young adults with CLP.
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Academic Preparation in Cleft Palate for Speech-Language Pathologists: Is the ICF-CY (Who, 2007) Alive and Well?Graham, Mary Briggs, Palmer, Jackie, Louw, Brenda 07 April 2016 (has links)
The purpose of this project is to determine inclusion of the ICF-CY in Cleft Lip and Palate (CLP) training curricula for Speech-Language Pathologists (SLPs). Survey research was conducted with CLP course instructors across the nation. Results describe the application of the ICF-CY in CLP courses at the graduate level. Recommendations for including the ICF-CY framework are made. Cleft Lip and Palate, one of the most prevalent birth defects in the US, affects 7,090 infants per year with an incidence of approximately 1 in 600 births (Center for Disease Control, 2006). SLPs require skills and competencies in assessing and treating CLP, however the academic and clinical preparation of SLPs regarding CLP remains a topic of concern. Training issues in CLP have been researched since the 1960’s (Vallino et al., 2008). Sharp and O’Gara (2014) suggested discussing training programs regarding the core learning outcomes for entry-level preparation in resonance disorders. The International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY) (WHO, 2007) provides an important, holistic framework for children with CLP. The ICF-CY’s interrelated components emphasize the factors influencing the activities and participation of children with CLP. Despite research recommending incorporation of the ICF-CY into SLP training curricula, the inclusion of the ICF-CY in CLP courses has not been explored to date as far as could be determined. The current study aimed to survey CLP graduate course instructors to describe the content of curricula and to determine the extent to which the ICF-CY is being included and applied in teaching assessment and intervention of CLP. A 35-item questionnaire was constructed to obtain information regarding academic and clinical training in the area of CLP in US graduate programs. Survey questions targeted demographic information regarding the program, course, and instructor. Survey questions also examined the inclusion of the ICF-CY framework into course content regarding assessment and intervention. The survey was administered via an online academic survey tool. The survey was distributed to the department chairs of ASHA accredited SLP graduate programs to be completed by training programs’ faculty who teach the CLP (or related) course. 61 fully completed surveys were eligible 2016 Appalachian Student Research Forum Page 101 for analysis. An item-by-item analysis was performed to describe survey results. Results showed only 23% of respondents reported teaching a course exclusively related to CLP, which confirms concerns related to Vallino et al. (2008) and other researchers. The ICF-CY does not yet appear to be fully integrated into CLP coursework and in response to the question posed by the researchers, does not appear to be alive and well in US CLP curricula. A case is made for the ICF-CY framework to be incorporated into CLP curricula to provide future SLPs a holistic perspective of children with CLP and to extend their thinking about the impact of speech impairment associated with CLP. Including the ICF-CY framework in training will facilitate collaborative inter-professional care of children with CLP. Finally, the inclusion of the ICF components and their interaction into ASHA’s most recent draft of the Scope of Practice in SpeechLanguage Pathology emphasizes the necessity of ICF inclusion in course curriculum to support provision of high-quality services.
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