Complete bilateral cleft lip and palate are one of the most severe forms of orofacial deformities. This is why their rehabilitation represents a special challenge to the interdisciplinary treatment team. The ideal procedure of treatment is still today an object of controversial discussions and the aim of many investigations. Especially the right moment for the repair of the hard palate is disputed. Thereby an undisturbed development of speech contrasts to an inhibition of growth because of resulting scar tissue. To evaluate the advantages and disadvantages of several treatment concepts the analysis of plaster models has been proved to be a suitable method. In this study the maxillary morphology of cleft patients with deciduous dentition was analysed following the investigations of KRAUSE (2005) that are concerning the infant situation. Thereby it was focused on the vertical development to which item only a few studies exist until now. The patients were treated following two different concepts with early or late closure of the palate respectively, which were compared. Additionally a comparison to a group of non cleft children was made. The group of investigation derived from the archive of the “Zentrum für Mund-, Kiefer-, Gesichtschirurgie” of the University of Leipzig including models of 16 patients at the average age of 4 years and 2 months of it. The therapy of all patients was done according to the same concept which included a similar closure of the lip at an average age of 5 months after an early orthodontic treatment according to HOTZ. The closure of the palate took place at the age of 10 up to 14 which was long before the time of investigation. They were compared to a reference group of 21 cleft patients of the former “Wolfgang-Rosenthal-Klinik” in Thallwitz. The average age in this group was 4 years and 8 months. These patients underwent the same procedure as well without an orthodontic treatment and with a two-phase lip closure at the age between 4 and 6 months. The repair of the palate was made only after our point of investigation. The control group of non cleft children finally originated in a collection of the former head of the orthodontic and prosthetic compartment of the University of Leipzig Prof. Dr. Kleeberg including models of 34 patients. Also these subjects had a complete deciduous dentition. However, the exact age could not be determined. All plaster casts were measured three-dimensionally with the reflex-microscope. As reference points served special points of the mucosal surface defined by ASHLEY-MONTAGU and SILLMAN as well as by MAZAHERI. To enable vertical measurements a plane of reference was constructed with the help of the tuberosity points and the half intercanine distance. The results showed clear differences between the two cleft groups as well as to the non cleft control group. Thereby it had to be discriminated between the results of the orthodontic treatment and the lip closure and those caused by the early or late repair of the palate respectively. Considering the vertical development especially the latter became obvious. So the segmental ends of the reference group showed a more pronounced cranial collapse than those of the group of investigation what is probably due to the late closure of the palate. However the premaxilla of the group of investigation was obviously more caudal situated so the incisal point showed a significant difference to the non cleft controls. On the contrary there were greater differences within the reference group regarding the vertical position of the premaxilla which was also more rotated than in the group of investigation. Probably because of the two-phase lip closure the right end of the premaxilla was more cranial located so the vertical distance between the alveolar segment and the premaxilla was greater on the left side. Furthermore the incisal point showed a greater deviation from the midline than it was in the group of investigation what is probably also due to the two-phase lip closure. The smallest deviation from the midline was found in the control group. In transversal direction there was a similar unfavorable relation between anterior and posterior arch width in both cleft groups, what became obvious with a significant smaller segmental angle than it was in the non cleft group. This was caused by a significant smaller anterior arch width in the group of investigation whereas the posterior arch width was almost normal. This was probably due to the early orthodontic treatment and the simultaneous lip closure as well as to the early palatal closure. In contrast the anterior arch width of the reference group showed hardly any differences but the posterior width was significant greater than in the control group. This development may have been caused by the late palatal repair allowing an unimpeded growth to take place. Finally the evaluation of the sagittal relations revealed a greater arch length in the cleft groups than in the control group. The greatest distance became again obvious in the reference group. For this difference was already measured in infancy one can presume that the closure of palate did not have a great influence on that development but the orthodontic treatment did. In summary it can be concluded that the time of palatal closure is mainly relevant concerning the vertical development but also in regard of the intertuberosity width. Thus the results of this study suggest a more favorable effect of an early closure of the palate. To verify these results further studies especially after palatal closure in the reference group are necessary. Furthermore a vertical measurement related to the cranium would be suitable.

Complete bilateral cleft lip and palate are one of the most severe forms of orofacial deformities. This is why their rehabilitation represents a special challenge to the interdisciplinary treatment team. The ideal procedure of treatment is still today an object of controversial discussions and the aim of many investigations. Especially the right moment for the repair of the hard palate is disputed. Thereby an undisturbed development of speech contrasts to an inhibition of growth because of resulting scar tissue. To evaluate the advantages and disadvantages of several treatment concepts the analysis of plaster models has been proved to be a suitable method. In this study the maxillary morphology of cleft patients with deciduous dentition was analysed following the investigations of KRAUSE (2005) that are concerning the infant situation. Thereby it was focused on the vertical development to which item only a few studies exist until now. The patients were treated following two different concepts with early or late closure of the palate respectively, which were compared. Additionally a comparison to a group of non cleft children was made. The group of investigation derived from the archive of the “Zentrum für Mund-, Kiefer-, Gesichtschirurgie” of the University of Leipzig including models of 16 patients at the average age of 4 years and 2 months of it. The therapy of all patients was done according to the same concept which included a similar closure of the lip at an average age of 5 months after an early orthodontic treatment according to HOTZ. The closure of the palate took place at the age of 10 up to 14 which was long before the time of investigation. They were compared to a reference group of 21 cleft patients of the former “Wolfgang-Rosenthal-Klinik” in Thallwitz. The average age in this group was 4 years and 8 months. These patients underwent the same procedure as well without an orthodontic treatment and with a two-phase lip closure at the age between 4 and 6 months. The repair of the palate was made only after our point of investigation. The control group of non cleft children finally originated in a collection of the former head of the orthodontic and prosthetic compartment of the University of Leipzig Prof. Dr. Kleeberg including models of 34 patients. Also these subjects had a complete deciduous dentition. However, the exact age could not be determined. All plaster casts were measured three-dimensionally with the reflex-microscope. As reference points served special points of the mucosal surface defined by ASHLEY-MONTAGU and SILLMAN as well as by MAZAHERI. To enable vertical measurements a plane of reference was constructed with the help of the tuberosity points and the half intercanine distance. The results showed clear differences between the two cleft groups as well as to the non cleft control group. Thereby it had to be discriminated between the results of the orthodontic treatment and the lip closure and those caused by the early or late repair of the palate respectively. Considering the vertical development especially the latter became obvious. So the segmental ends of the reference group showed a more pronounced cranial collapse than those of the group of investigation what is probably due to the late closure of the palate. However the premaxilla of the group of investigation was obviously more caudal situated so the incisal point showed a significant difference to the non cleft controls. On the contrary there were greater differences within the reference group regarding the vertical position of the premaxilla which was also more rotated than in the group of investigation. Probably because of the two-phase lip closure the right end of the premaxilla was more cranial located so the vertical distance between the alveolar segment and the premaxilla was greater on the left side. Furthermore the incisal point showed a greater deviation from the midline than it was in the group of investigation what is probably also due to the two-phase lip closure. The smallest deviation from the midline was found in the control group. In transversal direction there was a similar unfavorable relation between anterior and posterior arch width in both cleft groups, what became obvious with a significant smaller segmental angle than it was in the non cleft group. This was caused by a significant smaller anterior arch width in the group of investigation whereas the posterior arch width was almost normal. This was probably due to the early orthodontic treatment and the simultaneous lip closure as well as to the early palatal closure. In contrast the anterior arch width of the reference group showed hardly any differences but the posterior width was significant greater than in the control group. This development may have been caused by the late palatal repair allowing an unimpeded growth to take place. Finally the evaluation of the sagittal relations revealed a greater arch length in the cleft groups than in the control group. The greatest distance became again obvious in the reference group. For this difference was already measured in infancy one can presume that the closure of palate did not have a great influence on that development but the orthodontic treatment did. In summary it can be concluded that the time of palatal closure is mainly relevant concerning the vertical development but also in regard of the intertuberosity width. Thus the results of this study suggest a more favorable effect of an early closure of the palate. To verify these results further studies especially after palatal closure in the reference group are necessary. Furthermore a vertical measurement related to the cranium would be suitable.

Bereits in frühen Phasen der Sprachentwicklung sind bei Kindern mit Spaltbildungen im Vergleich zu Kindern ohne Spaltbildungen Abweichungen beobachtet worden. In der Fachliteratur sind allerdings meist nur undifferenzierte Aussagen über den frühen strukturellen Verlauf zu finden. Daher wurde eine Untersuchung an 100 Kindern mit Spaltbildungen im Alter von 0-1;6 Jahren durchgeführt. Untersuchungsgegenstand waren die kindlichen Vokalisationen in der 1.Lallphase, der 2.Lallphase (prälinguistische Phase) und der Phase des Sprechbeginns (frühe linguistische Phase). Die Analyse umfaßte phonetische Parameter, den aktiven Wortschatz sowie die Silben- und Wortstrukturen. Die Auswertung ergab hinsichtlich des temporalen Verlaufs beim überwiegenden Teil der Probanden keine Unterschiede, hinsichtlich des strukturellen Verlaufs jedoch deutliche, typisch-spezifische Unterschiede im Vergleich zu altersgleichen Kindern ohne Spaltbildungen. / Even at the earliest stages, differences in speech development can be observed between children with cleft palate and those without cleft palate. One finds, however, only undifferentiated statements in the scientific literature on the early structural and linguistic phases. We therefore undertook an investigation of 100 children with cleft palate between the ages of 0 and 1;6 years. The subjects of the investigation were the children s vocalizations during the first and second babbling phases (prelinguistic phase) and during the onset of speech (early linguistic phase). The analysis included phonetic parameters and active vocabulary, as well as syllable and word structures. Our results showed no differences among the majority of the cildren, in terms of temporal development, and only typical-specific differences in structural development, in comparison with children of the same age without cleft palate.

Bereits im frühen Kindesalter zeigen Kinder mit Spaltbildungen im Vergleich zu Kindern ohne Spaltbildungen eine veränderte Sprachentwicklung. Untersucht wurden die Möglichkeiten einer von Geburt ansetzenden Sprachförderung von Kindern mit Spaltbildung unter intensiver Zusammenarbeit mit den Eltern im Hinblick auf eine physiologische Sprachentwicklung. Innerhalb der Arbeit wurde ein sprachliches Frühförderkonzept für Kinder mit Lippen-, Kiefer-, Gaumenspalte (LKG) für die Zeit der ersten zwei Lebensjahre entwickelt und mit sieben Kindern mit LKG (Untersuchungsgruppe) in Form von Hausbesuchen erprobt. Im Alter von zwei Jahren wurde die Sprachentwicklung dieser Kinder mit sieben Kindern ohne Spaltbildung (Vergleichsgruppe) verglichen. Für die Auswertung der Untersuchungen kamen die Testverfahren ELFRA-1, ELFRA-2 und SETK-2 sowie eine informelle Prüfung des Lautbestandes zum Einsatz. Die Ergebnisse bestätigten bei fünf Kindern der Untersuchungsgruppe Unterschiede im sprachlichen Entwicklungsverlauf, die sich in Tendenzen zu Sprachentwicklungsrückständen bzw. Auffälligkeiten auf phonetisch-phonologischer Ebene niederschlugen. Deutlichere Hinweise auf Symptome der Gaumenspaltensprache gab es nur bei zwei Probanden. Zwei Kinder der Untersuchungsgruppe zeigten eine altersgerechte sprachliche Entwicklung. Möglicherweise sind diese positiven Ergebnisse auch auf die frühe sprachtherapeutische Förderung zurückzuführen. Zukünftig müsste die Wirksamkeit frühsprachlicher Förderkonzepte anhand von größeren Probandengruppen und längerem Förderzeitraum untersucht werden. / Even in the earliest stages of speech and language development children with cleft lip and palate show differences compared to children without clefts. This study focussed on encouraging early speech development of children with cleft lip and palate and investigated an intensive cooperation between speech pathologist and parents straight after birth up to the age of two years. An early intervention speech program was developed for the first two years of life and tried out on seven children with cleft lip and palate (research group). At the age of two the speech and language development of these children was compared to seven children without clefts (control group). For the time of the investigation the speech pathologist visited the families at home on a regular basis. Evaluation was done with the help of the following instruments: parent questionnaire ELFRA-1, ELFRA-2, language test SETK-2 and an informal screening of the childrens’ sound inventory. The results show differences in speech development in five children with clefts that are reflected in tendencies for delayed speech development and decreased phonological abilities. However, only two children of the research group showed distinctive signs of cleft palate speech. Two children of this group even had speech and language outcomes without pathological findings. Tentatively, these positive results may also be attributed to the effects of the early speech intervention. In future, the effectivity of such programs must be evaluated by researching larger groups of children over a longer period of time.