Orofacial clefts are extremely common birth defects. Orofacial clefts affect a multitude of different areas including feeding, speech, proper tooth development, as well as personality. There are many causes associated with the many different presentations of the birth defect. There have been a multitude of different surgical procedures over time that have dealt with the complications associated with repairing the various clefts. There is no current accepted standard for orofacial cleft repair. In more recent times the focus of the various orofacial clefts procedures have gone from a major procedure where survival was the objective to a more streamline procedure with a man goal of restoring normal human anatomy. Presurgical nasoalveolar molding (PNAM) is more recent procedure that takes advantage of the malleability and rapid growth of facial tissue during the first months of life. This procedure uses a custom acrylic plate that brings the right and left halves of the cleft closer together. This procedure is currently not accepted by all because the long-term effects are unclear. The aim of this study is to point out the short term successes of the PNAM procedure, compare our results to current published studies, and suggest further study that should be completed. A case report was completed on the first five months of treatment on a bilateral cleft lip/ cleft palate case. The case report followed the patient from birth through the first cleft lip closure surgery. The notes taken at weekly appliance adjustment appointments will be reviewed for information on progress as well as behavior and parent involvement. Pictures were also reviewed in order to review progress as well as surgical procedure. After review of the appointment notes and various pictures from throughout the process it was deemed that this PNAM procedure was a success. It was found that there was an overall increase in symmetry in facial structure as well and an increase in facial tissue. After reviewing pictures of the surgical procedure it can be concluded that the overall process was made easier by the PNAM procedure. It is concluded that the PNAM procedure is extremely successful in the short term but in order to receive more concrete results more cases must be reviewed with future follow-ups in order to see consistent long-term results.

published_or_final_version / Dentistry / Master / Master of Dental Surgery

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Orientador: Ary dos Santos Pinto / Resumo: Este estudo objetivou avaliar a relação da projeção labial com diferentes inclinações de incisivos e padrões esqueléticos faciais. Foram selecionadas documentações ortodônticas de diagnóstico de 100 pré-adolescentes de 7 a 9 anos de idade e origem étnica diversa. Esta amostra foi dividida em 2 grupos equivalentes em número e gênero segundo avaliação da fotografia do perfil facial (concordância de 3 avaliadores) considerando a projeção labial, determinada pela posição dos lábios superior e inferior em relação ao mento tegumentar e região subnasal: Grupo 1: Projeção labial normal e Grupo 2: Biprojeção labial. Telerradiografias em norma lateral destas crianças foram utilizadas para a obtenção de medidas representativas da posição dos lábios, inclinações dos incisivos, padrões de crescimento facial e relação anteroposterior maxilomandibular. Os dados foram analisados quanto ao dimorfismo sexual e diferenças entre os grupos pelo test t de Student. A associação entre as medidas cefalométricas e posição labial foi verificada pelo coeficiente de correlação de Pearson. Nenhuma variável apresentou diferença quanto ao sexo. A projeção dos lábios superior e inferior mostraram fraca correlação com protrusão maxilar, moderada correlação com relação maxilomandibular, fraca correlação com inclinação dos incisivos inferiores, fraca correlação com inclinação dos incisivos superiores (lábio superior) e fraca correlação com padrão de crescimento facial (lábio inferior). Conclui-se que não existe... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The objective of this study was to evaluate the relationship of lip projection with different inclinations of incisors and skeletal facial patterns. The orthodontic documentation of 100 pre-adolescents with 7 to 9 years of age and diverse ethnic origins was selected. The sample was divided according to facial profile into Group 1, with normal lip protrusion and Group 2, with lip biprotrusion. The classification was based on the agreement of 3 evaluators who used facial profile photographs to determine the position of the upper and lower lips in relation to the soft tissue pogoniun and the subnasale region. Lateral teleradiographs of the children were used to record lip position, inclinations of the incisors, patterns of facial growth, and anteroposterior maxillomandibular relationship. Data were analyzed by sex and groups, and differences were compared with Student's t-test. The association between cephalometric measures and labial position was verified with the Pearson correlation coefficient. No difference regarding sex was found. The protrusion of the upper and lower lips showed weak correlation with maxillary protrusion, moderate correlation with maxillomandibular relationship, weak correlation with lower incisor inclination, weak correlation with upper incisors (upper lip), and weak correlation with facial growth pattern (lower lip). In conclusion, no sexual difference was found for the variables of the study; a significant correlation was found between labial protrusion... (Complete abstract click electronic access below) / Mestre

Student Number : 0204056G - MD research report - School of Oral Health Science - Faculty of Health Sciences / Evaluating facial profiles and facial balance is a continuous learning process for orthodontists. Hence, the importance of studying the intermediate and long term effects of treatment on soft tissues cannot be overemphasized. The objective of this study was to evaluate the lip changes occuring in response to tooth movement, not only immediately post-treatment but also to following the long-term monitoring when cranio-facial growth has ceased. The lip changes were measured relative to the Burstone (B-line) line. The sample was taken from the records successfully treated orthodontic cases in the Department of Orthodontics at the University of the Witwatersrand, Johannesburg. This sample comprised 18 Caucasoid females (14 extracttion, 4 non-extraction). Pre-treatment, post-treatment, and long term follow-up lateral cephalometric radiographs were evaluated. Statistical evaluation of the lips in the long term follow-up records revealed no statistically significant changes. The lips remained, relatively, in a similar position to that which had been attained immediately post-treatment. This was the case for both the extraction and non-extraction groups. The general lack of consistency in post-treatment correlations between dental variables and the soft tissue form supports the hypothesis that the soft tissues, having their own inherent architecture, respond independently. This varied response to tooth movement makes lip movement difficult to predict on a reliable basis. The concept that is better to finish the cases slightly more protrusive because the lips tend to lose elasticity with age and, as a result, become more retrusive, is therfore supported by these observations.

BACKGROUND AND SIGNIFICANCE: Almost 15% of newborns have congenital anomalies that involve the oral and craniofacial regions, but of these congenital anomalies, cleft lip and palate and craniosynostosis are the most common. It is estimated that the incidence of cleft lip and palate is 0.664 in 1000 live births. These patients commonly have skeletal imbalances of the maxillae and mandible that require surgical and orthodontic correction. Orthodontists and oral surgeons play a critical role in identifying the necessary care and ensuring that the patient receives the best quality of care possible. OBJECTIVES: The objective of the current study is to examine the prevalence of adverse effects of medical care and infectious complications in patients with cleft lip/palate undergoing facial bone repairs/orthognathic surgeries in the United States during the years 2012 to 2014. It will also examine the association between patient/hospital related factors and surgical outcomes (including adverse affects of surgery, incidence of infection, etc.) and how these surgical outcomes impact the hospital costs and length of stay in the hospital. MATERIALS AND METHODS: The Nationwide Inpatient Sample (NIS) is a 20% stratified probability sample of hospitalizations occurring in all acute care hospitals in the United States. It is part of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ) [12]. Each hospital in this sample provides information on 20% of hospitalizations occurring during the select years. Hospital stratification is based on multiple hospital-associated variables including: hospital location, geographic region, bed size, teaching status, and ownership/control. Each hospitalization is assigned a sampling weight. Patient-related variables are also provided by the hospitals. In this study, this information is used to provide a nationally representative estimate of all hospitalizations and associated outcomes in the United States from 2012-2014. RESULTS: This study includes all 1,785 patients with cleft lip/palate undergoing facial bone repair/orthognathic surgical procedures in the United States during the study period (2012-2014). These results confirm the hypothesis that there are a combination of patient and hospital related factors that contribute to the occurrence of adverse events and that the occurrence of these events is associated with substantial increases in hospital charges and length of hospital stay. CONCLUSION: These study results are a national representative sample of patients with cleft lip/palate undergoing bony facial repair and orthognathic surgery. They reflect the practice patterns and hospitalization outcomes across the United States. These results can serve as a platform for future prospective controlled studies to examine the risk factors associated with adverse effects of medical care for a wide range of surgical procedures. This information is useful for clinicians, health policy makers, and patients so that they can make informed treatment and policy decisions as well as continue to improve surgical procedures and outcomes.

Area LIP has long been considered to be heavily involved in controlling transformations of visual stimuli into oculomotor behavior, as well as being an integral part of the extensive cortico-cortical network that controls covert visual attention. Neurons in LIP have been shown to respond to shifts in spatial attention as well as changes in the reward contingencies associated with visual stimuli, leading to the hypothesis that this area is involved in the selective processing of behaviorally relevant visual stimuli. However, the effects of attentional and motivational processes on neuronal activity in LIP have not been fully dissociated from each other. In one experiment I found that changing the reward contingencies in a peripheral visual detection task sytematically modulated visual responses in LIP, and that these changes in activity were correlated with the reaction time costs of re-orienting attention. In a further experiment, I manipulated the motivational state of rhesus macaque monkeys by varying the reward value associated with successful completion of a cued reflexive saccade task, and was thus able to study the neuronal activity in LIP while attention and motivation were independently controlled and manipulated. LIP responses to visual targets showed that directed visual attention systematically increased activity in neurons coding the attended location, suggesting spatially specific selective processing of that part of the visual field. In contrast, increasing motivation multiplicatively enhanced the response to visual targets irrespective of their location, suggesting a spatially non-specific enhancement of processing. The effects of attention and motivation on LIP activity were both predictive of changes in saccadic reaction times. These results suggest that attention and motivation exert distinct influences on visual representations in LIP, but that they both contribute to the preferential processing of behaviorally relevant visual stimuli. The data thus support the hypothesis that area LIP encodes a salience map of the visual world. / Dissertation

The rotary lip seal is the most widely used dynamic seal. It is used extensively in the automotive and appliance industries. Experimentally, it is well known that the microasperities on the shaft surface can significantly affect the performance of a lip seal, even though the shaft roughness, after run-in, is much smaller than the lip roughness. In the present study, several deterministic numerical models are developed to investigate the effect of shaft surface finish on rotary lip seal behavior, through an understanding of the basic physics of lip seal operation. This project is performed in a step by step manner with gradually increasing complexity. Four models are included in this study: hydrodynamic analysis, elastohydrodynamic analysis for full film lubrication, mixed-EHL model for mixed lubrication with asperity contact, and transient dynamic mixed-EHL model for startup and shutdown processes. Those analyses allow the examination of some important seal characteristics, such as the load support sharing between hydrodynamic and contact pressure, contact and cavitation area ratio, reverse pumping rate, liftoff speed for tracing the liftoff process and average film thickness. The development of fluid, contact and cavitation areas as a result of the changing operation condition is also examined. The results of the present deterministic modeling indicate that shaft surface roughness can produce significant desirable effects on lip seal behavior. An appropriate shaft surface profile could improve the sealing ability and prevent seal failure.

Thesis(M.A.)--Case Western Reserve University, 2010 / Title from PDF (viewed on 2010-01-28) Department of Communication Sciences Includes abstract Includes bibliographical references and appendices Available online via the OhioLINK ETD Center

Lateral intraparietal area (LIP) neurons are thought to compute the decision of where to look. Specifically, their firing rate is thought to represent accumulated evidence for a decision by ramping up to a high level, the putative decision bound, before an eye movement to a given location. However, LIP neurons are also highly responsive to visual stimuli. Because all previous research put a visual stimulus (a saccadic target) in the response field (RF) location of a neuron during decision formation, it is unknown if LIP neurons can still show decision computation without this visual drive. We therefore recorded the spiking activity of LIP neurons in a conventional decision task where a monkey decides the direction of a noisy motion stimulus and indicates his decision with a saccade. On half the trials, the Choice Targets remained on for the whole trial, as is conventionally done. On the remaining trials, targets were flashed at the beginning of the trial and absent during motion-viewing. Furthermore, we recorded the activity of any neuron with an RF, instead of only neurons exhibiting persistent memory activity before an instructed saccade. This enabled us to also test the long-held assumption that only cells with persistent memory activity show decision signals. Our results show that 1) cells without persistent activity indeed show decision signals, 2) population response drops without RF stimulation (although individual neurons were affected in diverse ways), 3) distinct, repeating response “motifs” exist among cells, 4) a signal exists where neural response is lower for stronger motion strength stimuli, regardless of direction. These results prove that contrary to dogma, a neuron’s ability to show a long “memory” response is not related to an ability to accumulate evidence over time for a decision. Also, LIP firing rate cannot be interpreted as a pure decision variable because it simultaneously represents decision-irrelevant, visual stimuli. Finally, diverse, but repeating responses among cells suggest the existence of cell types in LIP. These results demonstrate that LIP acts as a bank of potentially useful signals, and raises the question of how they might be used for a decision. / text