Os objetivos do presente estudo foram: 1) mensurar e descrever as medidas de extensão e espessura do véu palatino e da profundidade da nasofaringe em indivíduos com fissura transforame unilateral operada (FTU) que apresentavam disfunção velofaríngea (DVF); 2) calcular e descrever a razão entre a profundidade da nasofaringe e a extensão do véu palatino; 3) comparar as medidas encontradas para os indivíduos deste estudo com as normas descritas por SUBTELNY (1957); 4) comparar as medidas encontradas entre os sexos masculino e feminino; 5) comparar as medidas encontradas para os indivíduos que receberam palatoplastia com procedimento de Furlow (FW) com as medidas daqueles que receberam procedimento de Von Langenbeck (VL); 6) correlacionar as medidas encontradas com as idades dos indivíduos. A casuística foi constituída de 30 indivíduos com FTU e DVF, sendo 15 meninas e 15 meninos, com média de idade de 6 anos e 11 meses. Desses 30, 10 tiveram o palato operado pela técnica de FW e 20 pela de VL, entre as idades de 9 e 18 meses. Para definição da conduta para correção da DVF, todos os indivíduos foram submetidos ao exame de videofluoroscopia. Uma imagem em tomada lateral do MVF em repouso fisiológico foi selecionada e editada em um DVD para análise e mensuração das estruturas velofaríngeas de interesse. Três fonoaudiólogas experientes em videofluoroscopia realizaram as mensurações. Os resultados indicaram média de 27,4 mm para as medidas de extensão do véu palatino, de 9,7 mm para as de espessura do véu palatino, de 22,7 mm para as de profundidade da nasofaringe e de 0,86 para a razão entre a profundidade da nasofaringe e a extensão do véu palatino. Comparando os resultados do presente estudo com os de Subtelny (1957) diferença significante foi encontrada para as medidas da espessura do véu palatino, da profundidade da nasofaringe e da razão entre a profundidade da nasofaringe e a extensão do véu palatino. Os resultados também demonstraram diferença significante entre a média das medidas de extensão do véu palatino nos sexos masculino e feminino. Não houve diferença significante entre a média das medidas das estruturas avaliadas para os indivíduos operados pela técnica de FW nem pelos operados pela VL. Não houve correlação significante entre a variável idade e as medidas obtidas. / The objectives of the present study were: 1) to measure and to describe length and thickness of the velum and depth of nasopharynx for individuals with unilateral operated cleft lip and palate (UCLP) with velopharyngeal dysfunction (VPD); 2) to calculate and describe the depth of nasopharynx to velar length ratio (D/L); 3) to compare measures found for the individuals in this study with the norms described by Subtelny (1957) for normal individuals; 4) to compare the measures between males and females; 5) to compare the measures between individuals who received palatoplasty with the Furlow (FW) procedure to those who received the Von Langenbeck (VL) procedure; 6) correlate measures between different ages. The sample included 30 individuals with UCLP and VPD, 15 girls and 15 boys, with mean age of 6y11m. Ten individuals had palatoplasty with FW procedure and 20 with VL, between the ages of 9 and 18 months. For identifying best procedure for correcting VPD all individuals were submitted to videofluoroscopy assessment. A lateral view of the velopharyngeal mechanism during rest was selected and edited into a DVD, for analysis and measurement of the velopharyngeal structures of interest. Three speech-language pathologists experienced in videofluoroscopic assessment obtained all measures studied. The results revealed a mean velar length of 27.4 mm; mean velar thickness of 9.7 mm; mean depth of nasopharynx of 22.7 mm; D/L of 0.86. Comparing these results to Subtelny\'s (1957) a significant difference was found for measures of velar thickness, depth of nasopharynx velar length and D/L. Significant difference was found between males and females only for velar length. No significant differences were found between different techniques for palatoplasty. There was no significant correlation between age and the measurements obtained.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-10-04T20:52:05Z No. of bitstreams: 1 PERFIL CL?NICO-EPIDEMIOL?G ICO DOS PORTADORES DE FISSURAS .pdf: 1130964 bytes, checksum: 116e81d06957864f0fed433876117d0f (MD5) / Made available in DSpace on 2016-10-04T20:52:05Z (GMT). No. of bitstreams: 1 PERFIL CL?NICO-EPIDEMIOL?G ICO DOS PORTADORES DE FISSURAS .pdf: 1130964 bytes, checksum: 116e81d06957864f0fed433876117d0f (MD5) Previous issue date: 2014-11-20 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / PURPOSE: Describe the clinical and epidemiological profile of patients with congenital orofacial clefts, residents in the state of Bahia, seen at Anomalies Rehabilitation Center Craniofacial Hospital Santo Antonio in the 2008-2013 period. METHOD: This is an observational and descriptive epidemiological study. The study included patients with orofacial clefts, nonsyndromic, of both sexes and without limitation of age. A simple random sample consisted of 319 records. Information was obtained on sociodemographic profile of the carrier and mother, medication use during pregnancy, clinical and surgical aspects cracks, family history of malformations and consanguinity of the parents. Data were analyzed descriptively using the Statistical Package for Social Sciences version 17.0 on you, where frequency measurements were obtained, mean and standard deviation. RESULTS: It was observed that 51.1% of patients with orofacial clefts were female, 46.2% were in the age group of one year and 54.4% were from the urban area. Most mothers was in the age group between 16 to 25 years during pregnancy and reported medication use in 59.2% of cases, especially vitamins and antibiotic. The cleft transforamen was the most diagnosed (34.4%). At the time of the service registration, it was observed that 90.5% of the subjects had not yet performed the surgical treatment. Family history of cleft was observed in 29.8% of cases and only 7.1% of cases were reported consanguinity between parents. CONCLUSIONS: A slight prevalence of oral clefts was observed in females, less than a year and living in an urban area. Mothers found themselves outside the age range considered risk during pregnancy and were using medication as vitamins and antibiotics that stage. Greater proportion of patients had cleft incisive trans type and have not undergone previous surgical treatment. Family history of orofacial clefts and relations of consanguinity in some of the cases studied was found. / OBJETIVO: Descrever o perfil cl?nico-epidemiol?gico dos portadores de fissuras orofaciais cong?nitas, residentes no estado da Bahia, atendidos no Centro de Reabilita??o de Anomalias Craniofaciais do Hospital Santo Ant?nio, no per?odo de 2008 a 2013. M?TODO: Trata-se de um estudo epidemiol?gico observacional e descritivo. Participaram do estudo portadores de fissuras orofaciais, n?o sindr?micos, de ambos os sexos e sem limita??o de faixa et?ria. A amostra aleat?ria simples foi composta de 319 prontu?rios. Foram obtidas informa??es sobre o perfil sociodemogr?fico do portador e da m?e, uso de medicamentos durante a gesta??o, aspectos cl?nicos e cir?rgicos relacionados as fissuras, hist?rico familiar da malforma??o e consanguinidade dos pais. Os dados foram analisados descritivamente com o uso do Statistical Package for te Social Sciences na vers?o 17.0, onde foram obtidas medidas de frequ?ncia, m?dia e desvio padr?o. RESULTADOS: Observou-se que 51,1% dos portadores de fissuras orofaciais eram do sexo feminino, 46,2% encontravam-se na faixa et?ria menor de um ano e 54,4% eram procedentes na zona urbana. A maioria das m?es encontrava-se na faixa et?ria entre 16 a 25 anos durante o per?odo gestacional e relataram uso de medica??o em 59,2% dos casos, especialmente vitaminas e antibi?ticos. A fissura transforame incisivo foi a mais diagnosticada (34,4%). No momento de cadastro ao servi?o, observou-se que 90,5% dos indiv?duos ainda n?o haviam realizado tratamento cir?rgico. A hist?ria familiar de fissura foi observada em 29,8% dos casos estudados e em apenas 7,1% dos casos foi reportado consanguinidade entre os pais. CONCLUS?ES: Uma leve predomin?ncia de fissuras orofaciais foi observada em indiv?duos do sexo feminino, menores de um ano e residentes em ?rea urbana. As m?es encontravam-se fora da faixa et?ria considerada de risco durante o per?odo gestacional e faziam uso de medica??o como vitaminas e antibi?ticos nessa fase. A maior parcela dos portadores apresentava fissura do tipo transforame incisivo e n?o foram submetidos a tratamento cir?rgico pr?vio. Foi encontrado hist?rico familiar de fissuras orofaciais e rela??es de consanguinidade em alguns dos casos estudados.

It is widely acknowledged that a team approach is preferred practice and contributes to optimizing the surgical, dental, speech and psychosocial outcomes for individuals with cleft lip and palate (CLP).Young adulthood often marks the transition from child-centered interdisciplinary care to adult-centered care. There is a paucity in literature relating to the transition of care for young adults with CLP. The purpose of this survey research is therefore to explore the CLP team practices regarding young adults with CLP. An exploratory, descriptive design with quantitative analysis was used to explore what services are provided by CLP teams to young adults with CLP. An exploratory design was deemed appropriate due tolimited research available on the provision of team services for young adults with CLP. An online survey was used as the method of data collection to determine the number of teams providing services to this population, the types of services provided, and the perceived needs of young adults receiving CLP team services. 71 participants of (18.4%) responded to the survey. The low response rate is typical of survey research, despite three invitations to participate. However, the topic elicited global responses, from North America, South America, Europe, Asia and Australia, which is indicative of the importance of transition of care for young adults with CLP. 46 Participants responded to the question regarding their perceived needs of young adults with CLP. It appears that the characteristics of young adults with CLP (i.e., appearance, self-acceptance, social attitudes, social experiences, employment, starting a family, hearing and speech) are perceived to occur universally and that concerns about appearance is most frequent, followed by speech were important needs recognized by the teams. 56% of teams that responded to that they discharge young adults between 18-22 years, which confirms the expected results. However, an unexpected finding is that 37% of team’s complete treatment or never discharge patients. 35.5% of the respondents described the services provided, which existed of plastic and reconstructive surgery (98%), oral and maxilla facial surgery (86%), orthodontics (90%) and speech therapy (78%) with 50% indicating that they also provided other services. This confirms the perceptions of the needs of young adults with CLP since the high frequency of surgery and orthodontics address the concerns regarding appearance and speech therapy addresses the frequently perceived concern regarding speech. Continued team care is crucial for young adults with CLP to address their adult needs and improve their QoL.The results from this survey research will increase awareness of the importance of the transition from child to adult team care. Recommendations for further research will be discussed.

Die vorliegende Arbeit befasst sich mit der dreidimensionalen Untersuchung und Beschreibung der Oberkiefermorphologie von isolierten Gaumenspalten im ersten Lebensjahr. Hierzu wurden Oberkieferabformungen von nicht-syndromalen isolierten Gaumenspalten und Säuglingen mit Pierre-Robin-Sequenz bis zum operativen Gaumenspaltverschluss miteinander verglichen. Zusätzlich erfolgte die Gegenüberstellung einer gesunden Kontrollgruppe. Bei den Robin-Patienten waren eine signifikant vergrößerte anteriore Zahnbogenlänge, sowie eine verstärkte posteriore Zahnbogenbreite nachweisbar. Im Vergleich zu dieser tendenziell parabelförmigen Zahnbogenform, wiesen die isolierten Gaumenspalten einen eher u-förmigen Zahnbogen auf. Setzt man die Ergebnisse aus den Untersuchungsgruppen ins Verhältnis zur Zahnbogenform eines gesunden Säuglings, ergeben sich teilweise ganz andere Tendenzen. Die untersuchten Säuglinge weisen gegenüber der gesunden Population im gesamten ersten Lebensjahr eine signifikant verbreiterte posteriore Zahnbogenbreite auf. Zudem zeigen beide Gruppen im Vergleich zu der gesunden Kontrollgruppe ein deutliches Längendefizit im anterioren Bereich. Dieses Defizit führt zum Ende des ersten Lebensjahres zu einem zunehmenden Wachstumsrückstand der Gesamtzahnbogenlänge.:1 EINLEITUNG 3 2 LITERATURÜBERSICHT 5 2.1 Prä- und postnatale Entwicklung des Oberkiefers 5 2.1.1 Embryonale Entwicklung und Morphogenese des Oberkieferkomplexes 5 2.1.2 Entwicklungsstörungen 6 2.1.3 Spezialfall Pierre-Robin-Sequenz 7 2.1.4 Inzidenz und Äthiologie von Lippen-Kiefer-Gaumenspalten 8 2.2 Modellanalysen des Oberkiefers von Säuglingen und Kleinkindern 9 2.2.1 Zweidimensionale Methoden 9 2.2.2 Dreidimensionale Methoden 11 2.3 Moderne Therapiekonzepte 17 2.3.1 Besondere Bedeutung der prächirurgischen Therapie 18 2.3.2 Einfluss der kieferorthopädischen Primärbehandlung 20 3 FRAGESTELLUNG 22 4 MATERIAL UND METHODE 23 4.1 Fallauswahl und Beschreibung 23 4.1.1 Untersuchungsgruppen 23 4.1.2 Kontrollgruppe 25 4.2 Beschreibung der Messmethode 25 4.2.1 Auswahl der Messpunkte 25 4.2.2 Auswahl der Messstrecken und Hilfskonstruktionen 27 4.2.3 Erläuterung der Messinstrumente 28 4.3 Elektronische Datenverarbeitung 30 4.3.1 Mathematische Analyse der 3D-Koordinaten 30 4.3.2 Statistische Datenverarbeitung 32 4.4 statistische Auswertung 32 4.4.1 Mittelwertdarstellung 32 4.4.2 Mittelwertvergleiche 32 4.5 Messfehlerbetrachtung 34 5 ERGEBNISSE 36 5.1 Test auf Normalverteilung 36 5.2 Querschnittsanalyse 36 5.3 Longitudinale Betrachtung 41 5.3.1 Der Friedman-Test 48 5.3.2 Wilcoxon-Test 49 5.3.3 Der Mann-Whitney-Test 51 5.4 Vergleich mit der Kontrollgruppe 59 5.5 Korrelation 64 6 DISKUSSION 66 6.1 Fallzusammensetzung und Methode 66 6.2 Diskussion der Messwerte 68 6.3 Beantwortung der Fragestellung 74 6.4 Klinische Schlussfolgerungen 75 7 ZUSAMMENFASSUNG 76 8 LITERATURVERZEICHNIS 79 9 ANHANG 89 9.1 Tabellenverzeichnis 89 9.2 Abbildungsverzeichnis 91 9.3 Formelverzeichnis 93

Orofacial clefts (OFCs) are among the most common structural birth defects and a public health problem. Several studies suggest that maternal obesity pre-existing diabetes mellitus (DM), and the underlying metabolic abnormalities, may be involved in the pathogenesis of cleft lip (CL) and cleft palate (CP) birth defects. Although hypertension and gestational diabetes mellitus (GDM) have been associated in a few studies with congenital birth defects, studies examining the risk associated with OFCs are limited. The overall objective of this dissertation was to examine the association between maternal obesity, DM, GDM, and hypertension and the risk of OFCs in case-control studies. Analyses of data from an international consortium revealed that maternal obesity (pre-pregnancy BMI >30), compared to normal weight (18.525), was associated with an increased risk of cleft palate with or without cleft lip (CP/L) (adjusted odds ratio (aOR) =1.13 [95% confidence intervals (CI) 1.01-1.25]). We also found a marginal association between maternal underweight and CP/L (1.0 [reference]; aOR=1.14 [0.97-1.34]. CL only was not associated with maternal bodyweight. Interestingly, among college-graduates, there was no increased risk of CP, but mothers with less than a completed college education had an increased risk of CP for underweight and obesity. Investigation of the Utah OFC data provided evidence that maternal GDM is significantly associated with isolated (aOR=2.63 [1.30-5.34]) and non-isolated clefts (aOR=2.66 [1.02-6.97]). Maternal hypertension is significantly associated with non-isolated clefts (aOR=6.56 [2.18-19.77]). We found a further elevated risk of OFCs among GDM mothers and those with hypertension who were also obese. The analyses of data from an international consortium revealed significant associations between maternal diabetes and the risk of OFCs. The estimated relative risk of DM for isolated OFCs was 1.33 [1.14-1.54] and was slightly higher for multiple OFCs (aOR=1.86 [1.44-2.40]). Diabetic mothers with abnormal body-mass-index had an increased risk for having inborn with OFCs. Throughout the dissertation, we demonstrated the extent in which maternal obesity, pre-existing DM, GDM, and maternal hypertension may increase the risk of OFC birth defects. The results highlight the need for pre-conceptional program planning for the prevention of OFCs with screening for abnormal glucose tolerance and hypertension.

Indiana University-Purdue University Indianapolis (IUPUI) / The Riley Children's Hospital Craniofacial Anomalies Team rigorously follows a treatment protocol developed by Dr. Sheldon Rosenstein for the treatment of cleft lip and palate patients. Rosenstein's protocol incorporates primary bone grafting and alveolar molding appliances for cleft lip and palate patients. While other cleft lip and palate treatment centers utilize alveolar molding appliances, there remains debate concerning the efficacy of primary bone grafting. The principal detraction of primary bone grafting is the concern that such early surgical treatment affects maxillary and craniofacial growth and development. The purpose of this retrospective study was to analyze post-treatment lateral head plates and dental casts of cleft lip and palate circumpubertal patients treated in infancy at Riley Hospital in Indianapolis by the Craniofacial Team following Rosenstein's protocol. The hypothesis was that primary alveolar bone grafting in conjunction with the use of alveolar molding appliances contributes to the early stabilization of the alveolar segments, and produces no statistically significant difference in craniofacial development among primary bone grafted patients and nongrafted patients. The dental arch dimensions of the nongrafted patients (control group) consisted of the same data utilized by Moorrees in his study of the dentition of the growing child. The dental arch dimensions of nongrafted cleft patients consisted of the same data utilized by Athanasiou in his study of the dentition of cleft patients treated surgically without bone grafting. Of the eight measurements made by the three examiners, six demonstrated excellent interexaminer agreement, one demonstrated moderate interexaminer agreement, and one demonstrated poor interexaminer agreement. The arch width and length for the grafted group was significantly smaller (p < .05, Student's t-test) than the normal group in all measures except for the mandibular canine width. The arch width and length for the grafted group was not significantly different (p < .05, Student's t-test) than the nongrafted group, except for the maxillary molar width where the grafted group was smaller than the nongrafted group. The cephalometric values of the Riley group were compared against a nongrafted group, an early primary grafted group, and the Bolton standard values cited in Rosenstein's study. The Bolton standard values were used as the control group. This study found the cephalometric values of the Riley experimental group (treated following Rosenstein's protocol) to be of no statistically significant difference (p < .05, Students t-test) when compared with cephalometric values of the nongrafted and primary alveolar grafted groups cited in Rosenstein's 1982 study. The cephalometric values of the Riley experimental group were less than the cephalometric values of the nonclefted patients (Bolton standard control group) cited in Rosenstein's 1982 study. Interexaminer agreement ranged from poor to good with the poorest agreement among the linear values of ANS/PNS and GO/ME. The intraclass correlation coefficient values for SNA,m ANB, and SNB ranged from fair to moderate. The Riley cephalometric values were equal or slightly better than Rosenstein's grafted and nongrafted groups. Though smaller than the control group, the Riley cephalometric values were of no statistical significance (p < .05, Students t-test) when compared with the same parameters cited in Rosenstein's study. Although these findings infer that the patients treated following Rosenstein's protocol demonstrate some degree of craniofacial growth attenuation when compared with nonclefted patients (Bolton standard control group), the Riley patients showed no worse growth attenuation than similar patients treated without Rosenstein's protocol for primary alveolar grafting. The hypothesis of this thesis was that Rosenstein's protocol was viable and non-detrimental when compared with other treatment regimens. The results of this study support the hypothesis that Rosenstein's surgical protocol is not a contributing factor in craniofacial growth attenuation among cleft lip and palate patients.

No description available.

This document only includes an excerpt of the corresponding thesis or dissertation. To request a digital scan of the full text, please contact the Ruth Lilly Medical Library's Interlibrary Loan Department (rlmlill@iu.edu).

This study investigated changes in vocabulary and speech production in response to storybooks embedded with specialized language prompts and speech recasts. Six children received intervention, 3 with cleft palate (CLP), displaying speech-language delays, and 3 with nonclefts, each 12-24 months of age. A multiple baseline design across behaviors was implemented by a clinician. Results indicated all children increased use of target vocabulary and production of stop consonants, while reducing compensatory articulation errors. Generalization of targets to a picture-naming task, a free-play task, and to the home was observed. Effect sizes were moderate-to-high. Children with CLP required more sessions to achieve criterion. Analysis of 20-minute language samples, collected pre- and post-intervention, showed that both groups increased their vocabulary and speech measures.

No description available.