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As a child approaches adulthood, many transitions take place; physically and psychosocially. There are new roles and responsibilities. For the young adult with cleft lip and palate (CLP), one of the most significant transitions is moving from the pediatric interdisciplinary team to the adult-centered health care system. There is a shift in focus from the cleft itself and clinician-reported outcomes to patient self-report about the perceived impact of the cleft on quality of life. Transition also befalls the parents and team providers who, through the course of some 18 years, were active participants in the young person's care. Their roles, too, have changed. The International Classification of Functioning, Disability, and Health (ICF; World Health Organization, 2001, 2004) is a conceptual framework for considering the totality of the cleft by addressing the interaction between the person and their personal and social environment. This model is suitably applicable to the transition of care of the young adult with CLP. In this paper, we propose an evidence-based person-centered delivery model of care using the concepts of the ICF to facilitate the transition of care for this population. A case example is presented highlighting the use of these concepts for the speech-language pathologist.

Cleft lip with or without cleft palate (CLP) is an ongoing public health issue across the globe, and in the United States. The estimated number of babies born each year in the United States with cleft palate (CP) is about 2,650, while CLP affects approximately 4,440 babies. The purpose of this quantitative cross-sectional study was to determine if there is a relationship between CLP and maternal characteristics such as reproductive history (advanced maternal age, maternal obesity, prenatal visits, month prenatal care began, number of pregnancies, gestational age at birth, assisted reproductive technology used, gestational diabetes, and hypertension), socioeconomic status of the mother (marital status, education, mother's race, payment source for delivery, and place where birth occurred), and admission to the Neonatal Intensive Care Unit (NICU) in U.S. hospitals from January 2016 to December 2016. The epidemiological triad theory served as the study's framework. A secondary dataset from the National Vital Statistics System was used for this study. Logistic regression was used to test the hypothesized associations. Results indicated that many maternal characteristics such as mother's age (p = .000), maternal obesity (p = .020), number of prenatal visits (p = .001), total birth order (p = .001), gestational age at birth (p = .000), gestational diabetes (p = .002), and gestational hypertension (p = .032), mother's education (p = .000), marital status (p = .018), race (p = .000), and admission to NICU (p = .000) were significantly associated with CLP. Results of this study may help health care professionals identify the determinants of the risk of CLP so as to design and implement effective CLP preventive measures among United States populations that are disproportionately affected by this condition.

Läpp-, käk och gomspalt (LKG) kan medföra svårigheter med tal, artikulation och röst. Enligt tidigare forskning har vuxna individer behandlade för LKG liknande förekomst av röstavvikelser som kontrollpersoner utan spalt. Syftet med denna studie var att undersöka grad av röstavvikelser hos vuxna patienter behandlade för enkelsidig LKG och kartlägga eventuella samband mellan röstavvikelser och kirurgiska metoder för gomslutning, kön och operation med eller utan svalglambå samt jämföra röstresultat med data från individer utan LKG. Sjuttio patienter behandlade för enkelsidig genomgående LKG deltog i studien, varav 45 patienter hade opererats med gomslutning i en seans och 25 patienter hade opererats i två seanser. Elva av patienterna i patientgruppen hade genomgått svalglambåoperation. I studien ingick även en åldersmatchad kontrollgrupp med 63 individer utan LKG. Röstinspelningar utvärderades med perceptuell röstbedömning med Stockholm Voice Evaluation Approach (SVEA) av två erfarna logopeder. Skattning skedde individuellt av randomiserade och blindade inspelningar. Inter- och intrabedömarreliabilitet beräknades. Grad av avvikelse i röstkvalité var ca. 5/100 i patientgrupp och kontrollgrupp vilket är lägre jämfört med tidigare studier. “Knarr” fanns lägre i patientgruppen i jämförelse med kontrollgrupp. Skattningar av övriga röstparametrar skiljde sig inte mellan patientgrupp och kontrollgrupp. Patienter opererade med gomslutning i en eller två seanser hade inga skillnader i röstparametrar. Enstaka små skillnader fanns mellan könen. Ingen skillnad fanns mellan patienter som genomgått svalglambåoperation och de som inte gjort det. / Cleft lip and palate (CLP) may cause impairments in speech, articulation and voice. Treatment of patients with CLP include different types of palatoplasty. Recent studies have found a comparable prevalence rate of dysphonia in adult patients treated for CLP and controls without cleft. The purpose of this study was to investigate the rate of dysphonic deviation in adult patients treated for unilateral CLP and determine, if any, the relationship between voice quality outcome and differences in surgical procedures, gender, palatoplasty with or without pharyngeal flap surgery and compare the voice characteristics with age related normative data. Seventy patients treated for unilateral CLP with one- or two-stage palatoplasty participated in this study, of which 45 patientshad undergone one-stage palatoplasty and 25 patients two-stage palatoplasty. Eleven ofthe patients had also undergone pharyngeal flap surgery. Data from an age matched non-cleft group consisted of 63 participants. Sound recordings of participants' voices were perceptually assessed by two speech-language pathologists. Individual ratings of randomized and blinded sound recordings were performed. Inter- and intra-raterreliability was calculated. The study showed a lower degree of dysphonia in patients treated for unilateral CLP than earlier studies. Among patients treated for unilateral CLP and the non-cleft group, a degree of approximately 5/100 voice quality deviation was found. ”Vocal fry” was found significantly lower in patients treated for CLP than the non-cleft group. Measures of voice parameters did not differ significantly between patients and non-cleft groups. Patients that had undergone palatoplasty in one or two stages showed no significant differences in voice parameters. Minor statistical significance was found in a few of the measured voice parameters as related to gender. Between patients that had undergone pharyngeal flap surgery and those that had not no differences were found.

Darbe nagrinėjamas kompleksinės pagalbos vaikams su įgimtais lūpos ir / ar gomurio nesuaugimais vertinimas tėvų požiūriu. Atlikta teorinė vaikų, turinčių įgimtą lūpos, alveolinės ataugos, gomurio nesuaugimus pagrindinių aspektų analizė. Tyrimo tikslas - ištirti tėvų požiūrį apie medicininės ir logopedinės pagalbos teikimą vaikams, turintiems įgimtų lūpos, alveolinės ataugos ir/ar gomurio nesuaugimų. Darbe aprašytos kompleksinės pagalbos vaikams su įgimtais lūpos ir / ar gomurio nesuaugimais strategijos, išnagrinėti logopedinės pagalbos ypatumai dirbant su tokiais vaikais. Panaudotas anketinės apklausos metodas, interviu ir atlikta statistinė duomenų analizė. Tyrime dalyvavo 105 tėvai, auginantys vaikus su įgimtais lūpos ir / ar gomurio nesuaugimais: 97 šeimos dalyvavo anketinėje apklausoje ir 8 – interviu. Svarbiausios empirinio tyrimo išvados: 1. Vaikams, turintiems lūpos, alveolinės ataugos ir gomurio nesuaugimų, reikalinga kompleksinė įvairių sričių specialistų pagalba. Tokiems vaikams pagalba teikiama iki 18 m. amžiaus. Visame šiame procese labai svarbu komandinis specialistų darbas ir aktyvus bendradarbiavimas su vaiko šeima. 2. Tėvų, auginančių vaikus su įgimtais lūpos, alveolinės ataugos ir/ar gomurio nesuaugimais, nuomonė apie teikiamą pagalbą jų vaikams yra skirtinga ir prieštaringa. Pagalbos suteikimo informacijos sklaida šeimoms, auginančioms vaikus su lūpos ir/ar gomurio nesuaugimais nėra tiek pakankama mažuose Lietuvos miesteliuose, kiek didžiuosiuose miestuose... [toliau žr. visą tekstą] / In this work, the approach to professional help for children with congenital cleft lip and / or palate was evaluated from the parents’ perspective. There was carried out the theoretical analysis of the main aspects related to children with congenital cleft lip, alveolus and palate. Aim of the study – to research parents’ opinion about the treatment and logopedic help support for children with congenital cleft lip, alveolus and palate. In the work, the strategies of professional help for children with congenital cleft lip and / or palate are described, and the peculiarities of logopedic help in work with such children are researched. It was used the method of questionnaire, interview, and it was performed the analysis of statistical data. In the study, there were involved 105 parents having children with congenital cleft lip and / or palate: 97 questionnaire respondents and 8 interview participants. The main conclusions of the empirical study: 1. For children with congenital cleft lip and / or palate, the complex course for rehabilitation of functions is applied until the age of 18 years. In order to achieve good results, the teamwork of surgeon, orthodontist, speech therapist with other specialists in cooperation together with children parents is useful. 2. The opinion of parents, having children with congenital cleft lip and / or palate, is different and contradictory in terms of the professional help for their children; it was revealed that there is a lack of information... [to full text]

O propósito do presente estudo foi comparar as variações das dimensões lineares dos arcos dentários de pacientes com fissura labiopalatina após o tratamento ortodôntico e protético com prótese parcial fixa e pacientes sem fissura labiopalatina imediatamente após a ortodontia e pelo menos um ano após a remoção do aparelho ortodôntico. Este estudo longitudinal retrospectivo, foi composto por uma amostra de 70 modelos digitais, dos quais 30 modelos eram de pacientes com fissura labiopalatina unilateral completa, que receberam uma prótese parcial fixa na região da fissura (n=15), grupo fissura (GF); e 40 modelos de pacientes sem fissura labiopalatina (n=20), grupo controle (GC); com idade entre 18 e 30 anos. Os modelos foram obtidos em dois tempos: (T1) término do tratamento ortodôntico, e (T2) pelo menos 1 ano após a reabilitação protética (GF); e (T1) término do tratamento ortodôntico e (T2) pelo menos um ano após remoção do aparelho ortodôntico (GC). As medidas das dimensões dos arcos dentários foram realizadas diretamente nas imagens escaneadas, por meio do Scanner 3Shapes R700TM e mensuradas pelo Software Appliance Designer. As dimensões avaliadas foram: distância inter-caninos, distância inter-1os. pré-molares, distância inter-molares, e comprimento incisivo-molar. Um examinador previamente calibrado e treinado realizou as avaliações. Foram realizadas comparações entre os grupos, em tempos distintos (T1 e T2); e na diferença entre T2 e T1 nos grupos (GF e GC); utilizando o teste T ou de Mann- Whitney, com um nível de significância de 5% (p<0.05). Houve diferença estatística (p=0,005) no valor da variação de T2-T1 na distância inter-caninos com aumento da distância no GF e diminuição no GC. Na variação da distância inter-prémolar o GF apresentou diminuição do valor e o GC mostrou aumento, com diferença estatisticamente significativa (p=0,008). Nos demais parâmetros (inter-molar e incisivo molar) não houve diferença estatística. Não houve estabilidade no GC na distância inter-caninos e observou-se estabilidade no GF, não houve estabilidade no GF na distância inter-pré molar e houve estabilidade no GC. A Prótese Parcial Fixa estabiliza os resultados obtidos com a ortodontia. / The aim of the present study was to compare the linear dimensions of dental arches of patients with cleft lip and palate following orthodontic and prosthetic treatment with fixed partial denture and patients without cleft lip and palate immediately after orthodontics and at least one year after removal of the orthodontic appliance. This retrospective longitudinal study consisted of a sample of 70 digital models, of which 30 models were from patients with complete unilateral cleft lip and palate, who received a fixed partial prosthesis in the cleft region (n = 15), cleft lip and palate group (CLPG); and 40 patient models without cleft lip and palate (n = 20), control group (CG); aged between 18 and 30 years. The models were obtained in two stages: (T1) end of orthodontic treatment, and (T2) at least 1 year after prosthetic rehabilitation (CLPG); and (T1) end of orthodontic treatment and (T2) at least one year after removal of the orthodontic appliance (CG). Measurements of the dimensions of the dental arches were performed directly on the scanned images, using the 3Shape\'s R700TM Scanner and measured by the Appliance Designer Software. The dimensions evaluated were: inter-canine distance, inter-1st premolars distance, intermolar distance, and incisormolar length. A pre-calibrated and trained examiner performed the assessments. Comparisons were made between the groups at different times (T1 and T2); and in the difference between T2 and T1 in the groups (CLPG and CG); using the T or Mann- Whitney test, with a significance level of 5% (p <0.05). There was a statistical difference (p = 0.005) in the value of the T2-T1 variation in the intercanine distance with increase in the ClG distance and decrease in the CG. In the interprémolar distance variation the ClG presented a decrease in value and the CG showed an increase, with a statistically significant difference (p = 0.008). In the other parameters (intermolar and molar incisors) there was no statistical difference. There was not stability in the CG in the intercanine distance and there was stability in the CLPG, there was stability in the CG in the inter-pre-molar distance and there was no stability in the CLPG. Partial Fixed Prosthesis stabilizes the results obtained with orthodontics.

Estudos recentes demonstram que a incidência de fissura lábio-palatina é de 1.4 a 1.5 por 1.000 nascimentos vivos1. Pelo senso do IBGE de 2000, temos um número aproximado de 4.500 casos novos de pacientes portadores de fissuras lábio-palatinas a cada ano em nosso país. Com a maior aceitação e interação social pela recuperação estética, a preocupação com o aspecto funcional tornou-se ainda mais evidente. No convívio social, a comunicação através da voz/fala é uma das ferramentas fundamentais para o desenvolvimento pessoal. Nos pacientes com fissura palatina (FP), malformação do esfíncter velofaringeano, esta dinâmica está comprometida2. A palatoplastia é o tratamento indicado para a correção da fissura palatina. A busca pela técnica que proporcione melhores resultados é um objetivo permanente. É óbvio que a melhor análise da eficácia de uma técnica de palatoplastia é a fonação. Entretanto, outros fatores são importantes, como o reposicionamento anatômico das estruturas e a reprodutibilidade. O objetivo deste trabalho é o de comparar morfometricamente o reposicionamento conseguido por três técnicas cirúrgicas diferentes de palatoplastia através de medidas intraoperatórias e pós-operatórias imediatas. Tais procedimentos foram realizados em 30 pacientes portadores de fissura lábiopalatina unilateral, com idades que variavam entre 12 e 24 meses, sem cirurgias prévias em palato mole, sem outras co-morbidades. Todos os pacientes foram operados por um mesmo cirurgião e foram divididos em três grupos: Grupo I - Técnica de Furlow; Grupo II - Técnica de Veau-Wardil-Kilner com veloplastia; e Grupo III - Técnica de Veau-Wardil-Kilner com veloplastia e plástica em Z na mucosa nasal. Duas destas técnicas (GI e GII) são consagradas pelo uso, e a terceira (GIII) é uma modificação destas sugerida pelo autor. Nas medidas realizadas, observou-se que as três técnicas alongam o palato, com uma tendência maior no Grupo III. O conjunto muscular é mais retroposicionado nos pacientes do Grupo III. O índice de complicações foi maior nos pacientes operados pela técnica de Furlow. Os achados clínicos perioperatórios e morfométricos deste estudo sugerem que a técnica VW- K+B+Z é uma alternativa viável e promissora para o tratamento da fissura palatina. A avaliação fonológica destes pacientes em longo prazo será a resposta final para a sua aplicabilidade clínica. / Recent studies have demonstrated that the incidence of cleft lip and palate is that of 1.4 to 1.5 in 1000 live births. According to the 2000 IBGE (Brazilian Institute of Geography and Statistics) census, we have approximate 4.500 new cases of cleft lip and palate in our country each year. The concern with the functional aspect has become more evident with the greater acceptance and social interaction resulting from aesthetic restoration. Oral communication is a fundamental tool for social interaction and personal development. Patients suffering from cleft palate (CP) or malformation of the velopharyngealsphincter cannot properly benefit from this tool. Palatoplasty is the treatment recommended for the correction of palate. The search for a technique which produces better results is a constant objective. It is obvious that the best analysis of the effectiveness of a palatoplasty technique is speech itself. However, other factors are also important, such as the anatomical repositioning of the structures and reproductibility. The purpose of this study is to carry out a morphological contrast of the repositioning resulting from three different palatoplasty surgical techniques, by means of intra-surgical measurements and immediate post-surgical measurements. Such procedures were carried out in 30 patients suffering from unilateral cleft lip and palate, ranging from 12 to 24 months old, who had not been subjected to previous surgery to the soft palate, and who did not suffer from any other abnormalities. All the patients were operated by the same surgeon, and were divided into three groups: Group I – Furlow’s Technique; Group II – Veau-Wardil-Kilner Technique with veloplasty, and Group III – Veau- Wardil-Kilner Technique with veloplasty and Z plasty on the nasal mucosa. Two of the techniques (GI and GII) are well known, and the third (GIII) is a variation of such techniques by the author of this study. The measurements carried out demonstrated that all three surgical techniques extend the palate, with a greater prolongation tendency in Group III. The muscular network was more extensively retro-positioned in the patients in Group III. The rate of complications was greater in the patients who were operated with the use of Furlow’s technique. The perisurgical and morphometric clinical findings in this study suggest that the VW- K+B+Z technique presents itself as a promising and feasible alternative for the treatment of cleft lip and palate. The long term phonological evaluation of such patients shall be the final evidence for its clinical applicability.

Introdução: Uma série de aspectos diagnósticos e terapêuticos relacionados à Sequência de Robin (SR) não possuem definição clara na literatura, conforme demonstrado em revisão sistemática presente nesta tese. Essas áreas de incerteza envolvem os métodos de classificação do grau de glossoptose por meio da endoscopia de via aérea (EVA), a associação com manifestações clínicas e a avaliação polissonográfica. Objetivos: Avaliar, a partir de um estudo transversal aninhado em uma coorte, a associação entre duas classificações de glossoptose e a severidade dos sintomas em pacientes com SR, além de determinar a acurácia dessas classificações na determinação de pacientes com maior gravidade clínica. Avaliar a associação entre parâmetros de polissonografia e graus de gravidade de manifestações clínicas. Métodos: Os pacientes com diagnóstico de SR tiveram suas manifestações clínicas classificadas conforme Cole et al. Foram submetidos à endoscopia do sono e as imagens foram classificadas de acordo com Yellon e De Sousa et al por pesquisador cegado. Os pacientes que não necessitavam de suporte ventilatório foram submetidos à polissonografia. Resultados: Os resultados obtidos foram apresentados em quatro trabalhos: Artigo 1, aceito para publicação: revisão sistemática; Artigo 2, publicado: Associação entre classificação endoscópica da glossoptose e manifestação clínica grave: neste trabalho, um total de 58 pacientes foram incluídos. A probabilidade de apresentar sintomas graves conforme classificado por Cole et al foi maior nos pacientes Yellon grau 3 (68,4%, P=0,012) e de Sousa et al moderado e grave (61,5% e 62,5%, respectivamente, P=0,015) do que nos graus mais leves de obstrução; Artigo 3, submetido: Performance diagnóstica das classificações endoscópicas: neste trabalho foram incluídos 80 pacientes. A sensibilidade (Y: 56.2% x S: 28.1%, P<0.001) e a especificidade (Y: 85.4% x S: 93.8%, P=0.038) na identificação de sintomas clínicos graves foram estatisticamente diferentes entre as classificações de Yellon e de Sousa et al. Calculou-se a Razão de Chances Diagnóstica para Yellon (RCD: 7,53 95%CI 4.15-10.90) e de Sousa (RCD: 5,87 95%CI 1.86-9.87). As diferenças encontradas não foram significativas (P=0,92); Artigo 4, submetido: Associação entre parâmetros polissonográficos e as manifestações clínicas conforme Cole et al. Determinou-se a Razão de Chances para cada variação nos seguintes parâmetros: índice de dessaturação (1.27; 1.07-1.51; R2=19.8%; P=0.006), índice de apneia e hipopneia (1.13; 1.01-1.26; R2=12.5%; P=0.02), média de saturação de oxigênio (0.16; 0.05-0.52; R2=22.6%; P=0.002), nadir de saturação (0.73; 0.56- 0.96; R2=10.0%; P=0.02), porcentagem de tempo com saturação menor que 90% (9.49; 1.63- 55.31, R2=37.6%; P=0.012) e porcentagem de tempo com obstrução (2.5; 1.31-4.76; R2=25.1%; P=0.006). Conclusões: As alterações na EVA estão associadas com a gravidade das manifestações clínicas. Ao se aprofundar a abordagem de análise sob uma perspectiva diagnóstica, demonstrou-se que as classificações de Yellon e de Sousa et al possuem uma baixa sensibilidade, porém uma alta especificidade. A porcentagem do tempo com saturação menor que 90%, porcentagem do tempo apresentando obstrução e média de saturação de oxigênio durante o sono foram os parâmetros polissonográficos com a maior associação com as manifestações clínicas. Assim, recomenda-se que a avaliação endoscópica da via aérea em pacientes portadores de SR seja realizada com intuito de estratificar a gravidade, mas não para triagem diagnóstica. Da mesma forma, recomenda-se que os parâmetros acima destacados da polissonografia, sejam especialmente considerados no acompanhamento desses pacientes. / Introduction: Several diagnostic and therapeutic aspects concerning Robin Sequence (RS) are not clearly defined in medical literature, as demonstrated in a systematic review included in this thesis. These areas of uncertainty comprehend methods of glossoptosis degree classification, its association with clinical manifestations and polysomnographic evaluation. Objectives: A cohort nested cross-sectional study was done to evaluate the association of two different glossoptosis classifications with symptom severity in RS patients, while determining its accuracy for the identification of severely symptomatic patients. The study also aimed to evaluate the association between polysomnographic parameters and clinical symptom severity. Methods: RS patients had their clinical manifestations classified according to Cole et al. They were also examined with flexible fiberoptic laryngoscopy (FFL) and recordings were classified according to Yellon and De Sousa et al classifications by a blinded researcher. Those patients not needing ventilator support underwent polysomnographic testing. Results: Overall results were divided into four distinct articles: Article 1, accepted for publication: systematic review; Article 2, published: Association between glossoptosis endoscopic classification and severe clinical manifestations: in this article, a total of 58 patients were enrolled. The probability of presenting severe clinical findings according to Cole et al classification was higher in patients classified as Yellon grade 3 (68.4%, P=0.012) and De Sousa et al moderate or severe levels (61.5% and 62.5%, respectively, P=0.015) than in milder degrees of obstruction. Article 3, submitted: Diagnostic performance of endoscopic classifications: in this article, additional 22 patients were enrolled, summing up 80 patients. The sensitivity (Y: 56.2% x S: 28.1%, P<0.001) and specificity (Y: 85.4% x S: 93.8%, P=0.038) in the identification of severe clinical symptoms were statistically different between classifications of Yellon and De Sousa et al. A Diagnostic Odds Ratio was computed for Yellon (DOR: 7.53 95%CI 4.15-10.90) and De Sousa et al (DOR: 5.87 95%CI 1.86-9.87). No relevant differences were found between them (P=0.92). Article 4: submitted: Association between polysomnographic parameters and obstructive airway symptoms: odds ratios for severe clinical findings were computed for the variation of polysomnographic parameters: Dessaturation Index (1.27; 1.07-1.51; R2=19.8%; P=0.006), Apnea/Hypopnea Index - AIH - (1.13; 1.01-1.26; R2=12.5%; P=0.02), Sleep Mean Oxygen Saturation (0.16; 0.05-0.52; R2=22.6%; P=0.002), Oxygen Saturation Nadir (0.73; 0.56-0.96; R2=10.0%; P=0.02), Percentage of time under oxygen saturation of 90% (9.49; 1.63-55.31, R2=37.6%; P=0.012) and Percentage of Time Presenting Obstruction (2.5; 1.31-4.76; R2=25.1%; P=0.006). Conclusions: FFL findings seem to have a fair association with the severity of clinical manifestations. However, this association was found to be probably a major influence of a high specificity, while observed sensitivity was less than would be desirable for diagnostic purposes. Percentage of time under 90% oxygen saturation, percentage of time with obstruction and mean oxygen saturation during sleep were the most associated parameters with clinical manifestations. Therefore, based on these findings, we would argue that airway endoscopic examination in RS patients should be approached aiming at clinical severity stratification, rather than for screening purposes. Also, we would recommend that those aforementioned parameters from polysomnography should be specifically addressed in the follow up of this peculiar group of patients.

As fissuras palatinas são problemas frequentes na rotina hospitalar em humanos assim como nos animais. Nas últimas décadas, diferentes técnicas cirúrgicas foram empregadas para a correção dos defeitos palatinos, entretanto, não possuem uma eficácia satisfatória em fendas que apresentam um grande defeito ósseo. Através do exposto acima, buscam-se novas alternativas para a reconstrução de fendas palatinas, sendo a engenharia de tecidos uma alternativa de tratamento para tal afecção. Este estudo possui a finalidade de avaliar a utilização da tela de polipropileno acrescida com MSC (células-tronco mesenquimais) e selante de fibrina em um modelo experimental de correção de fenda palatina em suínos, avaliando-se a cicatrização de tecido mucoso e ósseo do palato duro. Com isso, objetiva-se desenvolver uma nova técnica de reconstrução de fendas palatinas baseada na engenharia de tecidos. O estudo foi desenvolvido em duas etapas, uma in vitro e outra in vivo. O projeto in vitro avaliou duas técnicas de cultivo de MSC em diferentes placas de cultura, utilizando dois tipos de telas de polipropileno (macroporosa e microporosa) durante um período de quinze dias, para obter as melhores condições de interação entre a tela e as células. Em todas as formas de cultivo houve aderências das MSC, entretanto, o melhor protocolo foi na tela microporosa no período de sete dias de cultivo e em placas sem metacrilato. Para o estudo in vivo, foram utilizados 12 suínos, distribuídos em quatro grupos de igual número: grupo que utilizou somente tela de polipropileno (GT); tela de polipropileno associada à MSC e selante de fibrina (GTCF); tela de polipropileno e MSC (GTC); tela de polipropileno e selante de fibrina (GTF). Em todos os animais foi realizada a fenda palatina e colocação do enxerto conforme cada grupo. Os suínos foram avaliados quanto à presença de inflamação, cicatrização e deiscência de sutura no implante do palato. Após quinze dias os animais foram eutanasiados e os palatos avaliados por histologia pela coloração de HE e Picrosirius Red. A tela de polipropileno associada com MSC demonstrou ser melhor, entre os demais protocolos estudados neste trabalho, para correção de fenda palatina. Forneceu completa cicatrização óssea e da mucosa oral e nasal em um período de quinze dias, demonstrando ser uma nova técnica segura e eficaz, possuindo um potencial significativo para correção de fenda palatina. / Cleft palates are common problems in the hospital routine in humans and animals. In recent decades, different surgical techniques were employed for the correction of palatal defects, however, do not have a satisfactory efficacy in cracks that have a large bone defect. Through the above, seek new alternatives for the reconstruction of cleft palates, and tissue engineering an alternative treatment for this condition. This study has the purpose of evaluating the use of enhanced polypropylene mesh with MSC (mesenchymal stem cell) and fibrin sealant in an experimental model of cleft palate repair in pigs, assessing the healing of mucosal tissue and bone of the hard palate. Thus, the objective is to develop a new technique for reconstruction of cleft palates based on tissue engineering. The study was conducted in two stages, one in vitro and another in vivo. The project in vitro evaluated two MSC cultivation techniques in different culture plates using two types of polypropylene meshes (macroporous and microporous) over a period of fifteen days, to get the best conditions for interaction between the screen and the cells. In all forms of cultivation were MSC adhesions; however the best protocol was the microporous screen in the seven days of culture plates and without methacrylate. For the in vivo study, we used 12 pigs, divided into four equal groups: group using only polypropylene mesh (GT); polypropylene mesh associated with MSC and fibrin sealant (GTCF); polypropylene mesh associated with MSC (GTC); polypropylene mesh and fibrin sealant (GTF). In all animals was performed cleft palate and graft placement as each group. The pigs were evaluated for the presence of inflammation, scarring and wound dehiscence in the palatal implant. After fifteen days the animals were euthanized and palates assessed by histology staining by HE and Sirius Red. The polypropylene mesh associated with MSC proved to be the best, among others protocols studied in this work, to cleft palate correction. Provided complete bone healing and oral and nasal mucosa in a period of fifteen days, proving to be a new safe and effective technique, having a significant potential for cleft palate correction.

Estudos recentes demonstram que a incidência de fissura lábio-palatina é de 1.4 a 1.5 por 1.000 nascimentos vivos1. Pelo senso do IBGE de 2000, temos um número aproximado de 4.500 casos novos de pacientes portadores de fissuras lábio-palatinas a cada ano em nosso país. Com a maior aceitação e interação social pela recuperação estética, a preocupação com o aspecto funcional tornou-se ainda mais evidente. No convívio social, a comunicação através da voz/fala é uma das ferramentas fundamentais para o desenvolvimento pessoal. Nos pacientes com fissura palatina (FP), malformação do esfíncter velofaringeano, esta dinâmica está comprometida2. A palatoplastia é o tratamento indicado para a correção da fissura palatina. A busca pela técnica que proporcione melhores resultados é um objetivo permanente. É óbvio que a melhor análise da eficácia de uma técnica de palatoplastia é a fonação. Entretanto, outros fatores são importantes, como o reposicionamento anatômico das estruturas e a reprodutibilidade. O objetivo deste trabalho é o de comparar morfometricamente o reposicionamento conseguido por três técnicas cirúrgicas diferentes de palatoplastia através de medidas intraoperatórias e pós-operatórias imediatas. Tais procedimentos foram realizados em 30 pacientes portadores de fissura lábiopalatina unilateral, com idades que variavam entre 12 e 24 meses, sem cirurgias prévias em palato mole, sem outras co-morbidades. Todos os pacientes foram operados por um mesmo cirurgião e foram divididos em três grupos: Grupo I - Técnica de Furlow; Grupo II - Técnica de Veau-Wardil-Kilner com veloplastia; e Grupo III - Técnica de Veau-Wardil-Kilner com veloplastia e plástica em Z na mucosa nasal. Duas destas técnicas (GI e GII) são consagradas pelo uso, e a terceira (GIII) é uma modificação destas sugerida pelo autor. Nas medidas realizadas, observou-se que as três técnicas alongam o palato, com uma tendência maior no Grupo III. O conjunto muscular é mais retroposicionado nos pacientes do Grupo III. O índice de complicações foi maior nos pacientes operados pela técnica de Furlow. Os achados clínicos perioperatórios e morfométricos deste estudo sugerem que a técnica VW- K+B+Z é uma alternativa viável e promissora para o tratamento da fissura palatina. A avaliação fonológica destes pacientes em longo prazo será a resposta final para a sua aplicabilidade clínica. / Recent studies have demonstrated that the incidence of cleft lip and palate is that of 1.4 to 1.5 in 1000 live births. According to the 2000 IBGE (Brazilian Institute of Geography and Statistics) census, we have approximate 4.500 new cases of cleft lip and palate in our country each year. The concern with the functional aspect has become more evident with the greater acceptance and social interaction resulting from aesthetic restoration. Oral communication is a fundamental tool for social interaction and personal development. Patients suffering from cleft palate (CP) or malformation of the velopharyngealsphincter cannot properly benefit from this tool. Palatoplasty is the treatment recommended for the correction of palate. The search for a technique which produces better results is a constant objective. It is obvious that the best analysis of the effectiveness of a palatoplasty technique is speech itself. However, other factors are also important, such as the anatomical repositioning of the structures and reproductibility. The purpose of this study is to carry out a morphological contrast of the repositioning resulting from three different palatoplasty surgical techniques, by means of intra-surgical measurements and immediate post-surgical measurements. Such procedures were carried out in 30 patients suffering from unilateral cleft lip and palate, ranging from 12 to 24 months old, who had not been subjected to previous surgery to the soft palate, and who did not suffer from any other abnormalities. All the patients were operated by the same surgeon, and were divided into three groups: Group I – Furlow’s Technique; Group II – Veau-Wardil-Kilner Technique with veloplasty, and Group III – Veau- Wardil-Kilner Technique with veloplasty and Z plasty on the nasal mucosa. Two of the techniques (GI and GII) are well known, and the third (GIII) is a variation of such techniques by the author of this study. The measurements carried out demonstrated that all three surgical techniques extend the palate, with a greater prolongation tendency in Group III. The muscular network was more extensively retro-positioned in the patients in Group III. The rate of complications was greater in the patients who were operated with the use of Furlow’s technique. The perisurgical and morphometric clinical findings in this study suggest that the VW- K+B+Z technique presents itself as a promising and feasible alternative for the treatment of cleft lip and palate. The long term phonological evaluation of such patients shall be the final evidence for its clinical applicability.