Thesis (M.S.)--University of Michigan, 1997. / Includes bibliographical references.

Thesis (M.S. in oral sciences)--University of Illinois at Chicago, 1996. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (M.S.)--University of Southern California, 1999. / Includes bibliographical references.

OBJECTIVE: The goal of this study was to gather information from mothers’ of children born with orofacial clefts (OFC) in order to more accurately describe their early feeding experiences, from the time of diagnosis through the first six months of life. METHODS: We surveyed mother’s whose babies with OFC were treated at Seattle Children’s Hospital (SCH) Craniofacial Clinic and were born on or after 1/1/2013 through 12/31/2016. Survey questions were geared toward understanding overall difficulty with feeding, access to supplies for feeding, and methods and duration of any breast milk feeding. RESULTS: Eighty-two percent of mothers wanted to exclusively breastfeed for the first 16 weeks prior to the OFC diagnosis, of which 79% attempted breastfeeding and 74% attempted any breast milk feeding. Donor milk was used in 18% of mothers and 41% supplemented with formula in the delivery hospital. The majority of women were knowledgeable about facts of breastfeeding and 41% reported they received information from a lactation specialist in their delivery hospital. The level of stress reported by mothers stayed relatively the same over first 4 weeks of life and dropped by 16 weeks. The majority of women who used a breast pump pumped for 0 to 20 minutes in first week and then 0 to 30 minutes between weeks 4 to 16. Thirty percent of mothers reported receiving information specifically from a craniofacial nurse and craniofacial pediatrician before delivery and 36% reported receiving information from a craniofacial nurse and craniofacial pediatrician after their birth hospital stay. CONCLUSION: Initial study results of feeding practices, knowledge of breast milk feeding, and feeding experiences of mothers with babies born with OFCs show that most mother’s intended to exclusively breastfeed prior to their birth and that the majority of women were reasonably informed about the benefits of breastfeeding. We also found that after the delivery of their child with an OFC more mothers reported having difficulty with feeding and wanted to provide breast milk longer than they were able to do so. Once the data collection is complete the survey data will be stratified for prenatal versus postnatal diagnosis and also when a breast pump was obtained. This information and additional data will be collected from a second phase of the study, which is a medical chart abstraction to look at the child’s demographics and growth chart data for the first six months of life.

Objective: The aim of this study was to evaluate the dentoalveolar effects of rapid maxillary expansion in children with unilateral complete cleft lip and palate in comparison with non-cleft patients. Methods: The experimental group (EG) was composed of 25 patients with unilateral and complete cleft lip and palate (9 males and 15 females) with a mean age of 10.6 years. The control group (CG) comprised of 27 patients without cleft lip and palate (14 males and 13 females) with a mean age of 9.1 years. Dental models of the maxillary dental arch were obtained immediately preexpansion (T1) and 6 months post-expansion (T2) at the time of appliance removal. Digital dental models were obtained using the 3Shape R700 3D laser scanner (3Shape A/S, Copenhagen, Denmark). Transversal widths, arch perimeter, arch length, palatal depth, palatal volume, canine and posterior tooth inclination were digitally measured. Paired t-test was used to perform interphase comparisons and independent t-test to perform intergroup comparisons (p<0.05). Results: In the experimental group, the expansion produced a ignificant increase of all maxillary transverse measurements, palatal volume, arch perimeter and palatal depth while decreased the arch length. RME caused a buccal tip of posterior teeth in patients with UCLP. No differences were observed between experimental and control groups for all the measurements performed except for the intermolar distance (6-6), which showed a greater increase in patients with cleft. Conclusion: Rapid maxillary expansion showed similar dentoalveolar effects in children with UCLP and without oral clefts. / Objective: The aim of this study was to evaluate the dentoalveolar effects of rapid maxillary expansion in children with unilateral complete cleft lip and palate in comparison with non-cleft patients. Methods: The experimental group (EG) was composed of 25 patients with unilateral and complete cleft lip and palate (9 males and 15 females) with a mean age of 10.6 years. The control group (CG) comprised of 27 patients without cleft lip and palate (14 males and 13 females) with a mean age of 9.1 years. Dental models of the maxillary dental arch were obtained immediately preexpansion (T1) and 6 months post-expansion (T2) at the time of appliance removal. Digital dental models were obtained using the 3Shape R700 3D laser scanner (3Shape A/S, Copenhagen, Denmark). Transversal widths, arch perimeter, arch length, palatal depth, palatal volume, canine and posterior tooth inclination were digitally measured. Paired t-test was used to perform interphase comparisons and independent t-test to perform intergroup comparisons (p<0.05). Results: In the experimental group, the expansion produced a ignificant increase of all maxillary transverse measurements, palatal volume, arch perimeter and palatal depth while decreased the arch length. RME caused a buccal tip of posterior teeth in patients with UCLP. No differences were observed between experimental and control groups for all the measurements performed except for the intermolar distance (6-6), which showed a greater increase in patients with cleft. Conclusion: Rapid maxillary expansion showed similar dentoalveolar effects in children with UCLP and without oral clefts.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Dentistry / Master / Master of Dental Surgery

published_or_final_version / Dentistry / Master / Master of Dental Surgery

A Fissura Labiopalatina é uma doença multifatorial que tem interferência sobre a qualidade da alimentação da criança, visto que na maioria das vezes os pacientes têm dificuldades de mastigação e deglutição. O zinco está envolvido em diversos processos fisiológicos, tem importante relação com mecanismos antioxidantes, imunitários, replicação celular e de transcrição protéica. De acordo com a Organização Mundial de Saúde, o zinco é o micronutriente mais importante para o desenvolvimento corporal e cognitivo da criança. Considerando a interferência da Fissura Labiopalatina sobre a qualidade da alimentação, e a importância do zinco para o desenvolvimento da criança, este estudo se propôs a avaliar o estado nutricional relativo ao zinco de crianças de 6 a 10 anos com Fissura Labiopalatina atendidas no Centro de Atendimento Integrado ao Fissurado Labiopalatino de Curitiba - PR. Foram dosadas as concentrações de zinco plasmático, eritrocitário e urinário. A quantidade de zinco dietético foi avaliada por meio dos métodos de recordatório de 24h e três registros alimentares. Foram avaliados peso e estatura, como dados antropométricos, e comparados ao escore Z. O estudo foi do tipo casocontrole. A concentração média de zinco plasmático, eritrocitário e urinário no grupo caso foi de 83,4&#181;gZn/dL, 32,6&#181;gZn/gHb e 141,4&#181;gZn/24h, respectivamente. A concentração média de zinco plasmático, eritrocitário e urinário do grupo controle foi de 100,2&#181;gZn/dL, 34,7&#181;gZn/gHb e 373,4&#181;gZn/24h, respectivamente. Considerando os parâmetros analisados observou-se deficiência de zinco em ambos os grupos, principalmente considerando as concentrações de zinco no eritrócito e a excreção urinária para o grupo caso. No grupo controle as crianças estavam deficientes para zinco plasmático e eritrocitário 8% e 84% respectivamente. No grupo caso as crianças estavam deficientes para zinco plasmático, eritrocitário e urinário em 15%, 92% e 100%. Assim, pode-se concluir que as crianças com fissura labiopalatina estão mais sujeitas às deficiências nutricionais como o caso do zinco assim demonstrado neste estudo. / Lip and palate cleft are a multifactorial disease that has interference on the quality of children\'s nutrition, as most of the time patients have difficulty chewing and swallowing. Zinc is involved in several physiological processes, has an important relationship to antioxidant mechanisms, immune, cellular replication and transcription protein. According to World Health Organization, zinc is the most important micronutrient for body growth and cognitive development. Considering the interference of Cleft on the quality of food, and the importance of zinc for the child\'s development, this study was to assess the nutritional status of zinc in children aged 6 to 10 years treated at the Lip and Palate Cleft Integrated Center of Curitiba - PR. Were measured concentrations of plasma zinc, erythrocyte and urine. The amount of dietary zinc was assessed using the methods of three 24-hour recall and feeding records. Weight and height were evaluated as anthropometric data, and compared to the Z score. The study was a case-control study. The average concentration of plasma zinc, erythrocyte and urine in the case group was 83.4 &#181;gZn/dL, 32.6 &#181;gZn/gHb and 141,4 &#181;gZn/24h, respectively. The average concentration of plasma zinc, erythrocyte and urinary control group was 100.2 &#181;gZn/dL, 34.7 &#181;gZn/gHb and 373,4 &#181;gZn/24h respectively. Considering the parameters evaluated, we observed zinc deficiency in both groups, especially considering the zinc concentrations in erythrocytes and the urinary excretion for the group case. In the control group were zinc deficient plasma and erythrocyte 8% and 84%. In the case group were zinc deficient plasma, erythrocyte and urinary 15%, 92% and 100%. In conclusion, children aged 6 to 10 years are under risk of zinc deficiency. Whereas, children with lip and palate cleft are under higher risk of zinc deficiency comparing to control group.

Indivíduos com fissura labiopalatina frequentemente necessitam de cirurgia de avanço maxilar para correção do desequilíbrio facial e das relações oclusais. A fibrose cicatricial do lábio superior, resultante de cirurgias prévias para fechamento da fissura, impede o crescimento ósseo adequado, causando deficiência maxilar significativa. Embora diversos estudos avaliem o perfil mole de pacientes submetidos à cirurgia ortognática, a maioria não inclui em sua amostra pacientes com fissura labiopalatina. A resposta dos tecidos moles em pacientes fissurados é incerta e de difícil previsibilidade no planejamento cirúrgico, sendo um fator limitante no resultado final. No presente trabalho, a análise cefalométrica dos tecidos moles foi realizada com o objetivo de estabelecer relações entre o avanço do tecido mole e tecido duro em pacientes fissurados, além de estudar o comportamento dessas estruturas frente ao avanço maxilar. O estudo foi observacional e descritivo e contou com uma amostra de 87 pacientes fissurados tratados cirurgicamente por meio de osteotomia Le Fort I com avanço maxilar. O tempo pós-operatório mínimo para estudo foi de 6 meses. As telerradiografias com tempos operatórios distintos foram digitalizadas e o traçado cefalométrico foi realizado através do software Dolphin Imaging. Para o cálculo do avanço maxilar médio, uma ferramenta do software foi utilizada permitindo a sobreposição das telerradiografias. A amostra foi então dividida de acordo com a amplitude de movimento e os resultados em tecido mole analisados. As maiores relações tecido mole/duro foram obtidas em avanços menores ou iguais a 5,0 mm. O overjet, overbite e o comprimento do lábio superior aumentaram enquanto que o nariz diminuiu em todas as amplitudes de movimento. Não houve alteração significativa no avanço do lábio superior, independente da quantidade de avanço. Em avanços de até 5,0 mm as repercussões em tecido mole foram mínimas, manifestando-se em maiores avanços. Nenhuma correlação significativa foi encontrada entre qualquer variável estudada e o avanço maxilar. O estudo revelou uma visão geral do comportamento das estruturas do tecido mole em pacientes fissurados frente à cirurgia ortognática. Tais informações auxiliam no planejamento cirúrgico prévio e favorecem a obtenção de perfil facial condizente ao planejado. / Individuals with cleft lip and palate frequently require maxillary advancement surgery to correct facial imbalance and occlusal relationship. The scarring of upper lip, resulting from previous cleft closure surgery, inhibits proper bone growth causing significant maxillary deficiency. Although several studies evaluate the soft tissue profile in patients undergoing orthognathic surgery, most of them do not include in their sample patients with cleft lip and palate. The soft tissue response in cleft patients is uncertain and difficult to predict in surgical planning, being a limiting factor in the final result. In this study the cephalometric analysis of soft tissues was performed in order to define relationships between the advancement of soft tissue and hard tissue in cleft patients. The behavior of these structures regarding to maxillary advancement was also analyzed. The study was observational and descriptive and included a sample of 87 patients treated surgically by Le Fort I osteotomy with maxillary advancement. The minimum post-operative time to study was 6 months. Lateral cephalometric radiographs with distinct post-surgical times were scanned and cephalometric tracing was performed by Dolphin Imaging software. To calculate the average maxillary advancement, a software tool was used to allow the overlay of radiographs. Then, the sample was divided according to advancement amplitude and the results in soft tissue were analyzed. The highest soft/hard tissue ratios were obtained in advancements smaller than or equal to 5.0 mm. Overjet, overbite and upper lip length increased while the nose decreased in all advancement amplitude. There was no significant change in upper lip advancement, regardless of the measurement of maxillary advancement. In advances of up to 5.0 mm the effects in soft tissue were minimal, manifesting in greater advances. No significant correlation was found between any variable studied and the maxillary advancement. The study revealed an overview of the behavior of soft tissue structures in cleft patients undergoing to orthognathic surgery. This information supports presurgical planning and it benefits into getting the planned facial profile.