The inferior turbinates are important anatomical nasal structures that provide warmth, humidification, and filtration of the inspired air to provide optimal conditioning for lung function. Besides these well-established basic functions, the turbinates are also important in immune function as the interface between the airway and the environment. Proper functioning of the inferior turbinates relies on an intact autonomic system, which maintains homeostasis within the nasal cavity. The autonomic nervous system innervates the submucosal glands and the vasculature within the inferior turbinate, resulting in control of major turbinate functions: nasal secretions, nasal patency, and amount of warmth and humidification provided. This thesis will summarize the normal and abnormal autonomic processes that contribute to the inferior turbinate as an autonomic organ.

The wide variation in infant maxillary morphology and cleft size of children with unilateral cleft lip and palate (UCLP) and isolated cleft palate (CP) raise concerns about their possible influences on treatment outcome. The studies in this thesis aimed to investigate the relation between cleft size in infancy and crossbite at 5 years of age (Paper I); the impact of primary surgery on cleft size and maxillary arch dimensions from infancy to 5 years of age (Paper II); associations between cleft size, maxillary arch dimensions and facial growth in both UCLP and CP children (Paper III); and, to evaluate the relation between infant cleft size and nasal airway size and function in adults treated for UCLP (Paper IV). In homogenously treated groups of children with UCLP and CP, dental casts were used to measure cleft size and maxillary arch dimensions from infancy up to 5 years of age, and for crossbite recording at 5 years. Serial lateral cephalometric radiographs taken between 5 and 19 years of age in the same groups were used to study facial growth. Nasal airway size and function were evaluated by acoustic rhinometry, rhinomanometry, peak nasal inspiratory flow and odour test in a group of adults treated for UCLP. The main findings were: crossbite was a frequent malocclusion at 5 years of age in children with UCLP and large cleft widths at the level of the cuspid points in infancy were associated with less anterior and posterior crossbite in this group (Paper I). Cleft widths decreased after lip closure and/or soft palate closure in both UCLP and CP children. Initially, UCLP children had wider maxillary arch dimensions, but after hard palate closure, the transverse growth was reduced, and at 5 years, they had smaller maxillary arch widths than CP children had (Paper II). Maxillary arch depths and cleft widths in infancy were correlated with maxillary protrusion and sagittal jaw relationships in both UCLP and CP children (Paper III), but cleft width in infancy was not correlated with nasal airway size and function in adults treated for UCLP (Paper IV).

Introdução O espelho de Glatzel (EG) é correntemente utilizado em consultórios fonoaudiológicos para a avaliação rápida da permeabilidade nasal. O mesmo foi descrito inicialmente em 1898 por Zwaardemaker. Porém, estudos de validação inexistem na literatura. Este estudo teve por objetivos verificar a reprodutibilidade do EG e a correlação intra-sujeito entre área de condensação e percepção subjetiva de permeabilidade nasal. Material e Métodos Vinte e cinco sujeitos foram avaliados com o EG por cinco minutos consecutivos (475 medidas por sujeito); cada meia hora por quatro horas; cada dia no início da tarde, por cinco dias e toda a quinta-feira por cinco semanas consecutivas. Utilizou-se uma escala análoga visual para avaliar a percepção de respiração nos períodos de horas, dias e semanas. Resultados O coeficiente de correlação total (área direita mais esquerda) encontrado entre área de condensação e percepção subjetiva foi de r=0,04 (p=0,3761). No lado esquerdo foi de r=0,08 (p=0,0984) e no lado direito de r=0,05 (p=0,2862). Os coeficientes de variação unilaterais medianos foram menores que 15% e os totais menores que 12%, independente do intervalo de tempo entre teste e re-teste. Conclusão Não se evidenciou correlação significativa entre a percepção subjetiva e a área de condensação nasal. A variabilidade unilateral foi maior do que quando considerados os valores totais (direito mais esquerdo) e não houve diferença na variabilidade das medidas de área de condensação nasal nos diferentes momentos do tempo. / Objective The Glatzel mirror (Gm) is used at speech therapy offices for a prompt evaluation of the nasal patency. It has been described in 1898 by Zwaardemarker. However, there is no literature of validation studies. This study aimed the verification of the reproducibility of the Gm and the correlation between the condensation area and the subjective perception of nasal patency. Methods Twenty-five individuals were evaluated for five consecutive minutes (475 measurements per individual), every half-an-hour during four hours, every day, in the beginning of the afternoon, for five days, and every Thursday during five consecutive weeks. A visual analog scale was used to evaluate the breathing perception within the hour, day and week periods. Results The coefficient of correlation between the subjective perception of the nasal patency and the condensation area of the right and left areas sumed was r=0.04 (p=0.3761). The left was r=0.08 (p=0.0984) and the right was r=0.05 (p=0.2862). The medium unilateral and total coefficients of variation were, respectivelly, less then 15% and 12%, independently of the interval of test-retest timing. Conclusion No significant correlation has been noticed between the subjective perception and the nasal condensation area. The unilateral variability was higher than the total values (right + left) and there was no difference in the variability of nasal condensation areas on different moments in time.

Introdução O espelho de Glatzel (EG) é correntemente utilizado em consultórios fonoaudiológicos para a avaliação rápida da permeabilidade nasal. O mesmo foi descrito inicialmente em 1898 por Zwaardemaker. Porém, estudos de validação inexistem na literatura. Este estudo teve por objetivos verificar a reprodutibilidade do EG e a correlação intra-sujeito entre área de condensação e percepção subjetiva de permeabilidade nasal. Material e Métodos Vinte e cinco sujeitos foram avaliados com o EG por cinco minutos consecutivos (475 medidas por sujeito); cada meia hora por quatro horas; cada dia no início da tarde, por cinco dias e toda a quinta-feira por cinco semanas consecutivas. Utilizou-se uma escala análoga visual para avaliar a percepção de respiração nos períodos de horas, dias e semanas. Resultados O coeficiente de correlação total (área direita mais esquerda) encontrado entre área de condensação e percepção subjetiva foi de r=0,04 (p=0,3761). No lado esquerdo foi de r=0,08 (p=0,0984) e no lado direito de r=0,05 (p=0,2862). Os coeficientes de variação unilaterais medianos foram menores que 15% e os totais menores que 12%, independente do intervalo de tempo entre teste e re-teste. Conclusão Não se evidenciou correlação significativa entre a percepção subjetiva e a área de condensação nasal. A variabilidade unilateral foi maior do que quando considerados os valores totais (direito mais esquerdo) e não houve diferença na variabilidade das medidas de área de condensação nasal nos diferentes momentos do tempo. / Objective The Glatzel mirror (Gm) is used at speech therapy offices for a prompt evaluation of the nasal patency. It has been described in 1898 by Zwaardemarker. However, there is no literature of validation studies. This study aimed the verification of the reproducibility of the Gm and the correlation between the condensation area and the subjective perception of nasal patency. Methods Twenty-five individuals were evaluated for five consecutive minutes (475 measurements per individual), every half-an-hour during four hours, every day, in the beginning of the afternoon, for five days, and every Thursday during five consecutive weeks. A visual analog scale was used to evaluate the breathing perception within the hour, day and week periods. Results The coefficient of correlation between the subjective perception of the nasal patency and the condensation area of the right and left areas sumed was r=0.04 (p=0.3761). The left was r=0.08 (p=0.0984) and the right was r=0.05 (p=0.2862). The medium unilateral and total coefficients of variation were, respectivelly, less then 15% and 12%, independently of the interval of test-retest timing. Conclusion No significant correlation has been noticed between the subjective perception and the nasal condensation area. The unilateral variability was higher than the total values (right + left) and there was no difference in the variability of nasal condensation areas on different moments in time.

Introdução O espelho de Glatzel (EG) é correntemente utilizado em consultórios fonoaudiológicos para a avaliação rápida da permeabilidade nasal. O mesmo foi descrito inicialmente em 1898 por Zwaardemaker. Porém, estudos de validação inexistem na literatura. Este estudo teve por objetivos verificar a reprodutibilidade do EG e a correlação intra-sujeito entre área de condensação e percepção subjetiva de permeabilidade nasal. Material e Métodos Vinte e cinco sujeitos foram avaliados com o EG por cinco minutos consecutivos (475 medidas por sujeito); cada meia hora por quatro horas; cada dia no início da tarde, por cinco dias e toda a quinta-feira por cinco semanas consecutivas. Utilizou-se uma escala análoga visual para avaliar a percepção de respiração nos períodos de horas, dias e semanas. Resultados O coeficiente de correlação total (área direita mais esquerda) encontrado entre área de condensação e percepção subjetiva foi de r=0,04 (p=0,3761). No lado esquerdo foi de r=0,08 (p=0,0984) e no lado direito de r=0,05 (p=0,2862). Os coeficientes de variação unilaterais medianos foram menores que 15% e os totais menores que 12%, independente do intervalo de tempo entre teste e re-teste. Conclusão Não se evidenciou correlação significativa entre a percepção subjetiva e a área de condensação nasal. A variabilidade unilateral foi maior do que quando considerados os valores totais (direito mais esquerdo) e não houve diferença na variabilidade das medidas de área de condensação nasal nos diferentes momentos do tempo. / Objective The Glatzel mirror (Gm) is used at speech therapy offices for a prompt evaluation of the nasal patency. It has been described in 1898 by Zwaardemarker. However, there is no literature of validation studies. This study aimed the verification of the reproducibility of the Gm and the correlation between the condensation area and the subjective perception of nasal patency. Methods Twenty-five individuals were evaluated for five consecutive minutes (475 measurements per individual), every half-an-hour during four hours, every day, in the beginning of the afternoon, for five days, and every Thursday during five consecutive weeks. A visual analog scale was used to evaluate the breathing perception within the hour, day and week periods. Results The coefficient of correlation between the subjective perception of the nasal patency and the condensation area of the right and left areas sumed was r=0.04 (p=0.3761). The left was r=0.08 (p=0.0984) and the right was r=0.05 (p=0.2862). The medium unilateral and total coefficients of variation were, respectivelly, less then 15% and 12%, independently of the interval of test-retest timing. Conclusion No significant correlation has been noticed between the subjective perception and the nasal condensation area. The unilateral variability was higher than the total values (right + left) and there was no difference in the variability of nasal condensation areas on different moments in time.

Unilateral cleft lip and palate (UCLP) is a craniofacial malformation with functional and aesthetical impact on the face and the upper airways. The aims of the current thesis were to evaluate Quality of life (QoL) in adults treated for UCLP  (I), to objectively evaluate nasal form and function and to search for possible differences in residual nasal deformity and impairment of function between patients operated according to one-stage and two-stage palate closure (II) as well as to evaluate the relationship between professional and lay rating and patient satisfaction with nasolabial appearance (III) and to identify factors associated with lower levels of QoL and less satisfaction with nasal appearance among adults treated for UCLP (IV). Analyses of data from a homogenous population of UCLP patients treated at Uppsala University Hospital form the basis of this thesis. The mean follow-up time after primary surgery was 35 years (20-47 years) and participation rate was 79% (n=86). An age and gender matched control group of 68 people without clefts were evaluated according to the same protocol. The evaluation protocol included the Short Form 36 questionnaire (SF-36), rhinomanometry, acoustic rhinometry, odor test, peak nasal inspiratory flow test and photographies of faces. For the SF-36 data, age- and gender-matched norm data of 1385 people from the Swedish population were used. Unilateral cleft lip and palate affected QoL differently depending on gender and age of the patient. Younger patients were affected more negatively than older patients in several subscales. However, except for lower values in the Mental Health subscale, QoL was similar among UCLP patients and norm data. Objectively measured nasal function was extensively affected among adults treated for UCLP. No difference in impairment of nasal function was found between one-stage and two-stage palate closure protocols on the cleft side. Judgment of nasolabial appearance differed between professionals, lay people and patients. Large infant cleft width was associated with less satisfaction with nasal appearance and male gender was associated with lower levels of mental QoL. Correlation between high nasal breathing resistance and low levels of physical QoL was found. In conclusion, this thesis provides a platform for future research for optimal evaluation of cleft treatment outcome.