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).

Thesis (Ph. D.)--Texas State University-San Marcos, 2007. / Vita. Includes bibliographical references (leaves 111-129).

Thesis (Ph.D.) - University of Glasgow, 2008. / Ph.D. thesis submitted to the Faculty of Information and Mathematical Sciences, Department of Statistics, University of Glasgow, 2008. Includes bibliographical references. Print version also available.

Thesis (M.S.)--University of Wyoming, 2007. / Title from PDF title page (viewed on June 11, 2009). Includes bibliographical references (p. 44-51).

Thesis (doctoral)--Katholieke Universiteit te Nijmegen, 1988. / Text in English with a summary in Dutch. "Een wetenschappelijke proeve op het gebied van geneeskunde en tandheelkunde." Includes bibliographical references.

Thesis (doctoral)--Katholieke Universiteit te Nijmegen, 1988. / Text in English with a summary in Dutch. "Een wetenschappelijke proeve op het gebied van geneeskunde en tandheelkunde." 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.

Introdução: A palatoplastia é o procedimento cirúrgico que visa à reconstrução do palato duro e/ou mole. Atualmente dispomos de diferentes técnicas que buscam o maior alongamento do palato mole junto à parede nasofaríngea para contribuir no funcionamento adequado do esfíncter velofaríngeo (EVF). Falhas no seu fechamento ocasionam disfunções na fala. Objetivo: Comparar os achados das avaliações perceptivo-auditiva e instrumental em pacientes com fissura labiopalatina operados mediante três técnicas distintas de palatoplastia. Métodos: A presente pesquisa realizou duas avaliações (perceptivo-auditiva e instrumental). Os dados foram obtidos de 26 pacientes, com aproximadamente 8 anos de pós-operatório, do total de 30 participantes de um ensaio clínico randomizado, cujos métodos foram descritos por Fróes Filho (2003). Os pacientes na época da cirurgia foram divididos em três grupos distintos com 10 participantes em cada um. O presente estudo avaliou: 10 pacientes da Técnica de Furlow, 7 pacientes da Técnica de Veau-Wardill-Kilner+Braithwaite e 9 pacientes da Técnica Znasal. Todos pacientes foram submetidos à avaliação perceptivo-auditiva por meio de gravação de fala. Também foi realizada a avaliação instrumental por meio do exame de videonasoendoscopia. A interpretação de ambos os procedimentos foi realizada separadamente por três fonoaudiólogas experientes, cegadas quanto ao tipo de técnica de palatoplastia. Para o julgamento perceptivo-auditivo considerou-se a presença ou ausência de hipernasalidade; grau de hipernasalidade segundo uma escala de severidade; presença ou ausência de distúrbio articulatório compensatório; presença ou ausência de emissão de ar nasal audível. Na avaliação instrumental foi estimado clinicamente o tamanho do gap do esfíncter velofaríngeo de acordo com uma escala de severidade. Resultados: As técnicas de Furlow e V-W-K+B apresentaram aproximadamente o dobro de hipernasalidade quando comparadas com a técnica Znasal, porém sem significância estatística. Houve menor ocorrência de Distúrbio Articulatório Compensatório e Emissão de Ar nasal Audível em todas as técnicas. Na avaliação instrumental, observou-se maior ocorrência de sujeitos sem gap na técnica Znasal em relação as demais. Conclusão: não foi encontrada diferença estatisticamente significativa entre as técnicas de palatoplastia nas duas avaliações. / Introduction: The palatoplasty is a surgical procedure aimed at the reconstruction of hard palate and / or soft. Currently we have different techniques that seek the greatest sling of the soft palate near the nasopharyngeal wall to contribute to the proper velopharyngeal sphincter functioning. Failures to its closure cause speech disorders. Objective: To compare the findings of auditory perceptual and instrumental evaluations in patients with cleft lip and palate surgery by three different techniques of palatoplasty. Method: The present research made two assessments (auditory perceptual and instrumental). The data were obtained from 26 patients, after approximately 8 years of post-operative, in a total of 30 subjects of a randomized clinical trial, whose methods were described by Fróes Filho (2003). The patients at the time of surgery were divided into three groups with 10 participants in each. This study evaluated: 10 patients in the Furlow technique, 7 patients of the Veau-Kilner-Wardill + Braithwaite technique and 9 patients in the Wardill-Kilner-Veau Braithwaite + Zetaplasty technique. All of them were submitted to perceptual assessment through their recording audio speech. It was also performed the instrumental evaluation through the videonasoendoscopy. The interpretation of both procedures was performed separately by three experienced speechlanguage pathologists blind on the type of palatoplasty technique. For the perceptual-auditory judgment, it was evaluated the presence or absence of hypernasality; degree of hypernasality using a scale of severity, presence or absence of compensatory articulation disorder, presence or absence of audible nasal air emission in all the techiniques. On the instrumental evaluation, it was clinically estimated the gap size of the velopharyngeal sphincter according to a severity scale. Results: The Furlow techniques and V-W-K+B presented approximately twice more of hipernasality when compared with the technique Znasal, however without statistical significant. There was a low occurrence of compensatory articulation disorder and emission of audible nasal air. In the instrumental assessment, it was seen more often subjects without gap in the Znasal technique comparing it to the others.Conclusion: It was not found statistically significant difference between palatoplasty techniques in the two assessments.

Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-04-23T17:02:51Z No. of bitstreams: 1 Dissertacao Eugenio Leite.pdf: 1280278 bytes, checksum: f23be710eb7acbb9dbe2cb1e282c5193 (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-05-08T12:12:19Z (GMT) No. of bitstreams: 1 Dissertacao Eugenio Leite.pdf: 1280278 bytes, checksum: f23be710eb7acbb9dbe2cb1e282c5193 (MD5) / Made available in DSpace on 2013-05-08T12:12:19Z (GMT). No. of bitstreams: 1 Dissertacao Eugenio Leite.pdf: 1280278 bytes, checksum: f23be710eb7acbb9dbe2cb1e282c5193 (MD5) Previous issue date: 2006 / A fenda alveolar é um distúrbio congênito que afeta crianças em todas as partes do mundo, trazendo comprometimentos funcional, estético e social. Diversos estudos têm avaliado as diferentes técnicas cirúrgicas para a reabilitação destes pacientes, sendo que a maioria utiliza critérios clínicos ou a radiografia convencional para analisar seu resultado terapêutico. Este trabalho teve como objetivo avaliar longitudinalmente o enxerto de crista ilíaca no tratamento de fenda alveolar unilateral, empregando análises quantitativas do tecido ósseo em radiografias digitalizadas. A amostra foi constituída por dez (10) indivíduos (seis (6) do gênero masculino e quatro (4) do gênero feminino), com idade entre 5 e 15 anos, operados por um mesmo cirurgião, no Hospital Santo Antônio (HSA) – Obras Sociais Irmã Dulce (OSID) (SSA-BA), utilizando a crista ilíaca como área doadora dos enxertos. Foram obtidas radiografias periapicais pré e pós-operatórias imediatas e tardias, que foram digitalizadas e corrigidas no programa Photoshop®, e posteriormente analisadas no programa ImageTool®. Os resultados mostraram que a técnica utilizada preencheu adequadamente a área da fenda e que este preenchimento manteve-se estável no pós-operatório tardio. / Salvador

Introdução: O esfíncter velofaríngeo é uma região anatômica de ação esfinctérica com capacidade de interromper a comunicação entre a cavidade oral e nasal. Não se sabe se a intensidade de emissão vocal influencia nessa ação. O seu fechamento é atingido elevando-se e retraindo-se o palato mole e, ao mesmo tempo, constringindo as paredes da nasofaringe. Objetivo: Correlacionar a intensidade vocal com o fechamento do esfíncter velofaríngeo em sujeitos sem queixa de disfunção velofaríngea e sujeitos portadores de fissura labiopalatina. Métodos: Trata-se de um estudo transversal, comparativo e contemporâneo. Amostra de 16 sujeitos para o grupo controle e 16 sujeitos para o grupo caso. Os pacientes foram submetidos a uma avaliação instrumental posteriormente sendo analisada por um software e um breve levantamento da história clínica do paciente. Resultados: No grupo controle a média de idade foi de 27,6 anos e para o grupo de casos a média foi de 15,6 anos. Os casos apresentaram intensidades mais elevadas nas frases fricativa habitual e fraca quando comparados com os controles. Não houve concordância na análise da avaliação instrumental entre os avaliadores e o software. Independente da intensidade em que as frases foram emitidas o software apontou padrão semelhante de fechamento. Conclusão: O software apontou padrão semelhante de fechamento para as três intensidades. Não houve concordância entre os três avaliadores e o padrão de fechamento. Nos grupos estudados não houve correlação estatisticamente significativa entre a intensidade de fala e o grau de fechamento do esfíncter velofaríngeo. / Introduction: The velopharyngeal sphincter is a portion of the muscle of the palatopharyngeal arch that is capable of separating the oral cavity from the nasal cavity. It has not been determined yet whether voice intensity has an influence on this capacity. Velopharyngeal sphincter closure is accomplished by elevating and retracting the soft palate at the same time as the nasopharyngeal walls are constricted. Objective: To correlate voice intensity with velopharyngeal sphincter closure in individuals without velopharyngeal dysfunction and patients with cleft lip and palate. Methods: We conducted a cross-sectional, comparative, and contemporary study. The sample consisted of 16 individuals in the control group and 16 individuals in the study group. Patients underwent instrumental assessment, which was subsequently analyzed using a computer program, and a brief medical history of the patient. Results: The mean age of the control group was 27.6 years, whereas the mean age of the case group was 15.6 years. Cases showed higher voice intensity in regular and weak fricative sentences when compared with controls. There was no agreement on the analysis of the instrumental assessment between the assessors and the computer program. Regardless of voice intensity, the computer program demonstrated similar closure pattern. Conclusion: The computer program showed similar closure pattern for the three levels of intensity. There was no agreement between the three assessors and the closure pattern determined by the computer program. There was no statistically significant correlation between voice intensity and degree of velopharyngeal sphincter closure.