Parental exposures and risk of nonsyndromic orofacial clefts in offspring: A case-control study in Greece

Objective

To investigate the association between cleft lip and/or palate and nongenetic factors in Greece.

Methods

We designed a case-control study including 35 patients with nonsyndromic cleft lip and/or palate, retrospectively selected, and 35 control patients matched for prefecture of residence, prospectively selected from pediatric population hospitalized for abdominal pain or injury. Parents were interviewed about drug uptake, diseases, habits, non-occupational exposure to pollutants, and occupation. Questions covered the period from one year before until three months after conception.

Results

High-risk paternal occupations (mostly farmers) were significantly more frequent in cleft lip and/or palate than in controls (p = 0.039) and increased significantly the cleft lip and/or palate risk in offspring (OR: 3.00; 95% CI: 1.03-8.70). Maternal occupation did not correlate with cleft lip and/or palate. Parental disease, drugs uptake, hazardous habits, maternal folate supplementation and non-occupational exposure to pollutants did not correlate with cleft lip and/or palate. There was a suggestion of increased risk with maternal passive exposure to tobacco (OR: 1.81; 95% CI: 0.69-4.74) and with residential proximity to industries (OR: 1.70; 95% CI: 0.61-4.74).

Conclusions

Paternal high-risk occupations probably exert a teratogenic effect on spermatogenesis or result in maternal contamination, and deserve specific preventive policies. The relation of smoking and residential proximity to industries with occurrence of cleft lip and/or palate deserves further study.     

Cleft lip and palate treatment of 530 children over a decade in a single centre

Objective

We sought to evaluate the process of care and the outcomes of cleft lip and palate operations carried by a multidisciplinary team at a centre of craniofacial anomalies with a high patients’ volume.

Methods

A retrospective review of all cleft lips and/or palates cases treated in the centre from 1995 to 2007 was performed. Direct and long term complication rates, clinical, audiologic, speech intelligibility and dental arch assessments were analyzed.

Results

A total of 530 children have been operated this period in the centre (64 isolated cleft lip closures). A detailed presentation of the outcomes is performed in relation to the various types of cleft lip and palates. The majority of parents (70%) reported very good or excellent results 2-5 years after the lip closure with the Millard technique, although those with bilateral clefts were significantly less satisfied (P < 0.002). Forty-two percent of children with cleft palate and otitis media with effusion were self-improved 2-8 months after palate reconstruction and 83.3% of children treated with the two flaps palatoplasty technique had a rather high or very high intelligibility score. Muscles’ retropositioning had a significant effect on intelligibility (P = 0.04).

Conclusions

Children with cleft lips and palates have a variety of conditions and functional limitations even after the surgical correction of their problem that need to be evaluated and treated by several specialists. The treatment protocol utilized by the multidisciplinary team of our centre is efficient with a relative low percentage of complications and unfavorable results.     

The effect of cleft palate repair technique on hearing outcomes in children

Objective

Otitis media with effusion causing conductive hearing loss is a problem for many children with cleft palate. This study examines the association between palate repair technique and hearing outcomes in children at 3 and 6 years post-repair.

Patients and methods

Retrospective chart review of patients with all types of cleft palate that were repaired between 2001 and 2006 at a tertiary children's hospital. Exclusion criteria included sensorineural hearing loss, ossicular chain abnormalities, and ear canal abnormalities. The primary outcome was pure tone average (PTA) from 0.5 kHz to 2 kHz.

Results

69 patients (138 ears) were analyzed. 30.4% of left ears and 31.9% of right ears had an abnormal (>20 dB) PTA at 3 years; at 6 years this significantly improved to 13.0% (p = 0.008) and 15.9% (p = 0.011). Double-reverse z-plasty was associated with the lowest median PTA of 10.0 dB (p = 0.046) at 6 years. There was no difference in median PTA between children with and without comorbid diagnoses (such as Pierre Robin Sequence, arthrogryposis) at either 3 years or 6 years (p = 0.075, p = 0.331). Multivariate model showed that extent of cleft influenced technique choice (p = 0.027), but only technique choice was associated with significant differences in PTA and only at 6 years post-repair.

Conclusion

The majority of children developed normal hearing by 6 years with palatoplasty and routine tube insertion. Double reverse z-plasty was associated with the best outcome, but is not ideal for hard palate clefts. Randomized controlled trials are needed to elucidate the relationship between technique, middle ear ventilation and time to recovery, irrespective of type of cleft.     

Effect of different treatments in young children with language problems

Objective

Analysis of the relationship between treatment and improvement on language scores in children with language problems.

Design

Observational longitudinal study.

Materials and methods

123 children between 2 and 5 years of age, diagnosed as having a language problem were followed for 1 year. By means of monthly questionnaires, the form of intervention received was recorded. Language abilities were measured at baseline and after 1 year. Mixed model analysis was used to determine the relationship between improvement and language scores.

Results

During the year 119 parents returned the monthly questionnaires and four treatment groups were subsequently able to be categorized: language treatment (n = 21, 18%), surgical hearing improvement (n = 16, 13%), language treatment and surgical hearing improvement (n = 42, 35%) and a three-combination group (language treatment, surgical hearing improvement and developmental guidance, n = 40, 34%).For the four treatment groups there were no significant differences at baseline for the Language Comprehension Quotient (LCQ) (p = 0.07) and Sentence Development Quotient (SDQ) (p = 0.09). In all treatment groups the mean Sentence Development Quotient improved significantly (p = 0.001). The mean Language Comprehension Quotient did not improve in the surgical hearing improvement group (p = 0.42), but improved significantly in the language treatment group, in the language treatment and surgical hearing improvement group and in the three-combination group (p = 0.002, 0.040, 0.001).From all included children 38 children (32%) moved from an inadequate to an adequate language score.

Conclusion

All distinguished forms of treatment were effective. However, only for a proportion of the children this meant a clinical relevant improvement. For the improvement of language comprehension targeted language therapy seems essential, as children without this (children receiving surgical hearing impairment) did not improve their LCQ.     

Effects of listening ability on speaking, writing and reading skills of children who were suspected of auditory processing difficulty

Objectives

The aim of this study was to investigate the effects of listening ability on speaking, writing and reading skills of children who was suspected of auditory processing difficulty (APD).

Method

This research was conducted with 67 children in 1st or 2nd grade of primary school. The first group (Group I—control) was comprised of 41 children without APD. The second group (Group II—study group) was comprised of 26 children with APD. Listening, speaking, reading and writing skills were evaluated by Observational Rating Scale (ORS) and analyzed in both groups.

Results

Listening value of ORS in APD group was significantly lower; and, speaking, reading and writing values of ORS in APD group were significantly higher than control group (p = 0.000). It was also found that, the main effect of listening skills was on speaking in normal childs, and on writing ability in children with APD.

Conclusion

It was concluded that, for school-aged children, APD can lead to or is associated with difficulties in written language.     

The discrepancy hypothesis in children with language disorders: Does it work?

Objectives

Analysis of the relationship between verbal and nonverbal development in children with language problems.

Methods

From 134 children enrolled in a multidisciplinary diagnostic procedure in a speech and hearing clinic and diagnosed as having a language disorder, the language comprehension score (LCQ) and the nonverbal IQ score (SON-IQ) were compared.t-Tests were used to test whether the children's mean LCQ differs from their mean SON-IQ and to test whether the children with an inadequate LCQ differ from children with an adequate LCQ with respect to discrepancy. Plots inspired by Bland and Altman [18] display the measurement of mean value of verbal and nonverbal development against the discrepancy between these scores.

Results

All children had a language production problem (inadequate GDS). Out of the 57 children with an adequate language comprehension (LCQ > 80), 16 children (28%) show a discrepancy of 10 quotient points or more between their LCQ and SON-IQ. Out of the 77 children with an inadequate language comprehension (LCQ ≤ 80), 45 children (58%) show a discrepancy of 10 quotient points or more between their LCQ and their SON-IQ.There is a significant difference between the children with an adequate LCQ and an inadequate LCQ with respect to discrepancy with their SON-IQ (p = 0.013). Only in the group of children with an LCQ ≤ 80 the discrepancy is significant (p = 0.000). For the group of children with an LCQ > 80 the discrepancy is not significant (p = 0.084).

Conclusions

The discrepancy hypothesis, in our opinion, must be modified. There is not only verbal and nonverbal functioning but there is language production, language comprehension and nonverbal learning abilities. Between these three aspects discrepancies can be found.In 43% of the children there is a discrepancy between language production and language comprehension. When children also show language comprehension problems, 58% of these children show a discrepancy with nonverbal functioning.     

Post-operative bleeding is less after partial intracapsular tonsillectomy than bipolar total procedure

Objective

To compare bleeding after partial intracapsular tonsillectomy (PIT) and bipolar diathermy tonsillectomy (BDT).

Design

Retrospective chart review.

Setting

Stollery Children's Hospital, tertiary pediatric referral centre.

Patients

All children (≤17 years of age) who had tonsillectomy. Patients who had incomplete information or less than 2-weeks follow-up were excluded.

Main outcome measure

(1) Post-tonsillectomy bleeding, (2) other data collected included demographics, length of follow-up, indication(s) for surgery, other procedures performed, and co-morbidities.

Results

Over a 4.5-year period 677 patients (333 BDT, 344 PIT) were identified in our search, and 77 (38 BDT, 39 PIT) were excluded. The mean age was 7.7 ± 3.8 years in the BDT group and 6.5 ± 3.2 years in the PIT group. Sex distribution was similar in the 2 groups (chi square p = 0.61). Twenty (6.8%) BDT patients experienced post-tonsillectomy bleeding, compared to three (0.98%) of PIT patients (p = 0.0001, 95% CI 1.52-2.18, OR = 7.32). Over 3 times as many PIT patients (153) had co-morbid conditions than BDT patients (44); this was statistically significant (chi square p < 0.00001, 95% CI 1.78-2.38).

Conclusion

PIT results in significantly less post-tonsillectomy bleeding than BDT. These findings favor partial over total techniques with respect to reducing this important complication.     

Blood transfusion requirements in cleft lip surgery

Objective

Cleft lip surgery is a common procedure performed by surgeons worldwide. The aim of the study was to determine blood transfusion requirements and factors influencing blood transfusion in cleft lip surgery.

Methods

Transfusion rate in 100 consecutive patients who had cleft lip surgery was prospectively evaluated at the Lagos University Teaching Hospital, Nigeria. Data collected included age and sex of patients, type of cleft defects, type of surgery done, preoperative haematocrit, duration of surgery, amount of blood loss during surgery, the number of units of blood cross-matched and those used. Cardiovascular parameters at the point of transfusion were also recorded. Each patient was made to donate a unit of homologous blood prior to surgery.

Results

Mean estimated blood loss during surgery was 26.5 ± 47.1 ml. Most patients (92%) lost between 2 and 50 ml of blood. Mean estimated blood loss in unilateral cleft lip surgery was not significantly differently from that of bilateral cleft lip surgery (P = 0.46). Only five patients (5%) required blood transfusion. The mean blood transfused was 50.0 ± 16.9 ml. All the patients transfused had a preoperative haematocrit of <30% (23-27%). The cross-match-to-transfusion ratio for cleft surgery was 20. The transfusion index was 0.05 and overall blood-ordering quotient was 20.

Conclusion

Cleft lip surgery is a low volume blood loss surgery. Homologous blood donation prior to cleft lip surgery in patients with preoperative haematocrit of 30% or more is not necessary. For patients with preoperative haematocrit of less than 30%, type and screen of donated blood should be adequate.     

Cleft palate, retrognathia and congenital heart disease in velo-cardio-facial syndrome: A phenotype correlation study

Objective

Velo-cardio-facial syndrome (VCFS) is caused by a microdeletion of approximately 40 genes from one copy of chromosome 22. Expression of the syndrome is a variable combination of over 190 phenotypic characteristics. As of yet, little is known about how these phenotypes correlate with one another or whether there are predictable patterns of expression. Two of the most common phenotypic categories, congenital heart disease and cleft palate, have been proposed to have a common genetic relationship to the deleted T-box 1 gene (TBX1). The purpose of this study is to determine if congenital heart disease and cleft palate are correlated in a large cohort of human subjects with VCFS.

Methods

This study is a retrospective chart review including 316 Caucasian non-Hispanic subjects with FISH or CGH microarray confirmed chromosome 22q11.2 deletions. All subjects were evaluated by the interdisciplinary team at the Velo-Cardio-Facial Syndrome International Center at Upstate Medical University, Syracuse, NY. Each combination of congenital heart disease, cleft palates, and retrognathia was analyzed by Chi square or Fisher exact test.

Results

For all categories of congenital heart disease and cleft palate or retrognathia no significant associations were found, with the exception of submucous cleft palate and retrognathia (nominal p = 0.0325) and occult submucous cleft palate and retrognathia (nominal p = 0.000013).

Conclusions

Congenital heart disease and cleft palate do not appear to be correlated in human subjects with VCFS despite earlier suggestions from animal models. Possible explanations include modification of the effect of TBX1 by genes outside of the 22q11.2 region that may further influence the formation of the palate or heart, or the presence of epigenetic factors that may effect genes within the deleted region, modifying genes elsewhere, or polymorphisms on the normal copy of chromosome 22. Lastly, it is possible that TBX1 plays a role in palate formation in some species, but not in humans. In VCFS, retrognathia is caused by an obtuse angulation of the skull base. It is unknown if the correlation between retrognathia and cleft palate in VCFS indicates a developmental sequence related to skull morphology, or direct gene effects of both anomalies. Much work remains to be done to fully understand the complex relationships between phenotypic characteristics in VCFS.     

The role of audiological diagnostics in children with cleft lip & palate (CLP)

Objective

To assess the otologic and audiologic status of patients with cleft lip and palate (CLP) operated in the Department of Pediatric Surgery attached to the Advanced Pediatric Centre, Post Graduate Institute of Medical Education & Research (PGIMER), India. The main idea of carrying out this study was to know the incidence of middle ear pathologies in a group where no complaints have been noticed.

Setting

Research study was carried in Post Graduate Institute of Medical Education & Research (PGIMER) which is one of the tertiary care institutions in India.

Participants

55 children (Mch: 28; Fch: 27) in the age range of 4-13 years constituted the study group. These children were operated upon by the same surgeon (JKM) during the period 1996-1998 and were attending the speech clinics at PGIMER. None of these children/parents had complained of any ear problem and were taken up for the study to find out the middle ear pathology. The ontological and audiological evaluation was done for all the children.

Results

53 of 110 ears had normal hearing status. None of the ears had severe or profound hearing loss. The air conduction thresholds ranged from 20.2 to 29.63 dB across the frequencies whereas the bone conduction thresholds varied from 7.13 to 12.41 dB. Only 42% of the right (R) ears and 47% of the left (L) ears had a normal tympanic membrane.

Conclusion

On the basis of this finding, investigation of the benefits of early and routine follow-up for otologic and audiologic status is warranted. Patients with cleft lip and palate should have an intense and detailed otologic and audiologic follow-up to identify any ME pathology/hearing loss so that timely intervention can be taken.     

A review of malpractice cases after tonsillectomy and adenoidectomy

Objective

To examine sources of litigation following tonsillectomy and/or adenoidectomy.

Study design

Analysis of malpractice claims filed after tonsillectomy or adenoidectomy provided by 16 medical liability insurance companies.

Setting

Not applicable.

Subjects and methods

Data was obtained from 16 members of the Physician Insurers Association of America. All claims were either filed or closed between 1985 and 2006. Claims were evaluated and categorized according to the type of complication.

Results

One hundred and fifty-four claims were identified between 1985 and 2006. Six categories were created based on frequency of claims (bleeding complication n = 27 [17.5%], airway fire n = 2 [1.5%], burns n = 28 [18.2%], consent related n = 9 [5.8%], medication related n = 9 [5.8%] and residual tissue/recurrence n = 9 [5.8%]). Other less frequent claims were grouped as miscellaneous n = 70 [45.5%].

Conclusions

A significant portion of malpractice claims following tonsillectomy or adenoidectomy are related to complications not commonly discussed in the literature.     

Transforming growth factor-beta receptor type 1 (TGFBR1) is not associated with non-syndromic cleft lip with or without cleft palate in patients of Central European descent

Objective

Transforming growth factor-beta (TGF-β) type 1 receptor (also known as activin receptor-like kinase 5, ALK5) is expressed in palatal tissue during embryogenesis. Experimental studies in transgenic mice with a genetic deletion of Alk5 showed that TGF-β type 1 receptor is required for upper lip and midline fusion of the hard and soft palate. In humans, association of TGF-β type 1 receptor gene (TGFBR1) and the development of non-syndromic cleft lip with or without cleft palate (NSCL/P) had been observed in a multiethnic sample of Chinese, Philippine, Indian and Turkish families. In order to re-evaluate the relevance of these findings, we carried out a family-based association study among 218 NSCL/P families of Central European descent.

Methods

Genomic DNA was obtained from peripheral blood of 218 complete parent-offspring triads with NSCL/P. The sample comprised 14 patients with cleft lip only (CLO) and 204 patients with cleft lip and palate (CLP). Genotyping and transmission disequilibrium test (TDT) were performed on all 218 triads with a total of 17 tagging single-nucleotide polymorphisms (SNPs). We also performed testing for extended haplotypes and a log-linear model by Weinberg was used to screen parent-of-origin effects. Furthermore the use of estimates for the relative risks (RR) of Weinberg's model was obtained.

Results

TDT analysis revealed no significant transmission distortion, neither at the level of individual markers nor at the level of haplotypes. Similarly negative results were obtained when we restricted our analysis to the subgroup of patients with CLP (n = 204). Relative risk calculations (RR) of the children's and mothers’ genotypes obtained negative results, after correction of p-values for multiple testing. Likewise application of Weinberg's log-linear model did not find any evidence for parent-of-origin effects in our sample.

Conclusion

Despite the ample evidence supporting the role of TGF-β type 1 receptor as a critically important and widespread morphogenetic regulator of craniofacial development in murine models, our results do not support TGFBR1 as major risk factor for NSCL/P in patients of Central European descent.     

Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip

Introduction

The interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up.

The significance of post-operative fever following airway reconstruction

Objective

Post-operative management of children undergoing airway reconstruction has been well-described. However, many of these patients develop post-operative fevers. We conducted a retrospective review in an attempt to define the significance of post-operative fever following pediatric airway reconstruction.

Method

Retrospective analysis of 78 pediatric laryngotracheoplasties (LTPs) from May 1, 2006 - April 30, 2007 at a tertiary care pediatric hospital. Fever was defined as temperature ≥38.5. A fever was “significant” if accompanied by a positive sputum, blood or urine culture, or an elevated WBC. Chest radiograph (CXR) results and co-morbidities were examined.

Results

Forty-five percent of cases (35/78) had fever. Of those febrile, 46% (n = 16) had significant fever. Overall, 20.5% had significant fevers. Fifty-two cases were single-stage LTP (SSLTP) with 31 febrile and 26 cases were double-stage LTP (DSLTP) with 4 febrile. SSLTP cases were at a significantly greater risk for post-operative fever compared with DSLTP, 59% vs 15% respectively (p = 0.0002). 42% of febrile SSLTPs (n = 13) had significant fevers compared to 50% (n = 2) of febrile DSLTPs (Fisher's Exact p = 1.0). 81.5% of cases with CXR findings had fevers, but only 50% of these fevers were significant. Subjects with post-operative atelectasis were more likely to have a fever compared to subjects with no post-operative atelactasis (93% vs. 33% respectively, p < 0001). 30.8% of those with atelectasis had significant fever, compared to 52% of those without atelectasis (p = 0.2) and 25 of SSLTPs vs. 3.9% of DSLTPs had atelactasis (p = 0.027). No comorbidities were shown to be significant risk factors for post-operative fever.

Conclusion

Based on our review, most children undergoing LTPs will have insignificant fevers. Those children undergoing SSTLP and/or having post-operative atelectasis are at higher risk for post-operative fever. Fevers in children with double-stage procedures or all reconstruction cases with CXR findings other than atelectasis should have a thorough fever work-up.     

Is speech therapy useful as a complementary treatment for post-tonsillectomy pain?

Objectives

To evaluate the efficacy of speech therapy for relief of post-tonsillectomy pain in children.

Methods

Fifty patients who underwent tonsillectomy and were randomly divided into three groups were analyzed in this study. Groups I and II received medical and speech therapy including two different phonemes group, and Group III received only medical therapy. For Group I (20 patients) soft palate phonemes and for Group II (20 patients) lips and gingival phonemes were used. The patients who received medical treatment without speech therapy were used as the control group. Postoperative pain levels were recorded with our standard visual analog scale (VAS) forms for each patient during the postoperative 10 days. The pain score of the patients were compared statistically among the three different groups.

Results

The postoperative pain score was lower in Group I as compared to Group II (p = 0.001) and III (p = 0.045), and it was statistically significant. There was no significant difference regarding postoperative pain scores between Group II and Group III patients (p = 0.356).

Conclusion

Speech therapy may cause to strengthen the soft palate muscles and alleviate constant post-tonsillectomy pain. This therapy may be used as a complementary treatment with standard analgesics.     

Children with hearing impairment--living with cochlear implants or hearing aids

Objective

The aim of this study was to enhance knowledge about the life circumstances of children with cochlear implants or hearing aids, regarding daily functioning and attitude to the impairment.

Methods

Data were obtained from 36 children with cochlear implants and 38 children with hearing aids via study-specific questionnaires with fixed answer alternatives. The questions covered (1) usage of aids and related factors, (2) hearing in different everyday situations, (3) thoughts about the children's own hearing and others’ attitudes to it, and (4) choice of language. The data were analyzed using SPSS, and presented via the theoretical frame of the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY).

Results

Children with CI and HA functioned equally well in daily life, but there were also certain differences. Symptoms from neck and shoulders were more common among children with hearing aids than among children with cochlear implants (p < .001). Children with hearing aids used their aids significantly less often than those with cochlear implants (p < .001). The participation variables showed that children with hearing aids had significantly more hearing problems in team sports (p = .033) and outdoor activities (p = .019), in comparison to children with cochlear implants. The two groups had similar thoughts regarding their own hearing, mostly considering it not to be a problem. They also did not generally think that other people found their hearing to be a problem.

Conclusions

Children with cochlear implants and children with hearing aids have, in some aspects, equally good functioning in everyday life situations. However, certain differences were found in dimensions of functioning, regarding neck and shoulder pain, usage of aids and sign language, and hearing problems in some activities.     

Autologous fat transfer in velopharyngeal insufficiency: indications and results of a 25 procedures series

Objective

To assess the efficiency of autologous fat transfer (AFT/Coleman procedure) in the management of velopharyngeal insufficiency (VPI).

Settings

Tertiary academic center, retrospective case series over a 4 year period. Pre- and post-speech assessment by a speech pathologist using the Borel-Maisonny scale.

Patients and method

Twenty-five (25) procedures were performed on 22 patients during the considered period. Mean age at surgery was 12.4 ± 4.1 years-old. Main associated conditions were 22q11 deletion (n = 6 including 2 with cleft palate), isolated cleft palate (n = 3), and Robin sequence (n = 2).Indications were VPI grade 2a (n = 5), 2b (n = 11) and 3 (n = 6), despite prolonged speech therapy (pre-op mean duration: 4.2 years) and previous surgery (velopharyngoplasty, n = 13). Four patients had a contraindication of velopharyngoplasty (aberrant internal carotid arteries).

Results and conclusion

Fat harvesting sites were umbilicus (n = 23) and buttock (n = 2). Mean injected fat volume was 7.8 ml, in the posterior wall of the pharynx (n = 25) the soft palate (n = 15), the peritonsillar arches (n = 3), and the pre-existing flap (n = 3). Mean follow-up was 17 months. Two patients relapsed once and one patient twice, requiring additional injections. Final post-operative examination 1 year after the last procedure showed an improvement of speech in 90% of cases (grade 1, n = 2; 1/2a, n = 5; 2a n = 10; 2b, n = 5).AFT is a safe technique indicated in the primary and secondary management of VPI, with stable results on speech. However, if a complete return to normal is difficult to achieve, its simplicity allows multiple procedures in the same patient.     

The effect of saccular function on static balance ability of profound hearing-impaired children

Objective

Researches have shown that in clinical practice, balance disorders in children with congenital or early acquired severe to profound hearing loss are probable. The purposes of present study were to specify the percentage of vestibular evoked myogenic potential (VEMP) and an acoustically evoked, short latency negative response (ASNR) recordings and the relation between their presence and static balance ability and postural control of children with profound sensorineural hearing loss (SNHL).

Methods

Thirty children with profound SNHL, with an average age of 6.93 years, underwent the VEMP and auditory brainstem response (ABR) tests. Both VEMP and ABR were recorded at the threshold level through air-conduction stimulation via an insert receiver. The static balance performance of the hearing-impaired children was tested with six exercises and compared with that of 30 age- and sex-matched normal-hearing children as controls.

Results

VEMP was recorded in 53.3% of ears and ASNR in 40.0%. VEMP was revealed in all ears with ASNR, and a significant correlation was shown between their presence (p = 0.005) and also between the ASNR wave latency and P1 (p = 0.0001) and N1 (p = 0.004) wave amplitude of VEMP. There was a significant correlation between the presence of VEMP and ASNR with the performance of the children in two static balance skills, namely standing on one leg with eyes open on a line and the same practice on the balance beam (p ≤ 0.008).

Conclusion

There was a close relation between the presence of VEMP and ASNR. Additionally, when ASNR was present, the recording of VEMP could be expected. Successful performance in the static balance exercises with reduced vestibular and somatosensory inputs increased the possibility of the recording of ASNR and VEMP.     

Maxillary growth in patients with complete cleft lip and palate, operated on around 4-6 months of age

Background

The controversy about timing of cleft palate repair has been focused on early closure for improved speech versus delayed repair for enhancing maxillary growth. Early palatal repair enhances phonological development decreasing the frequency of articulation disorders associated with velopharyngeal insufficiency (VPI). In contrast, it has been described that early surgery adversely affects maxillary growth.

Objective

The purpose of this paper is to study maxillary growth in a group of cleft palate patients operated on around 4-6 months of age, and receiving further orthodontic treatment.

Materials and methods

A group of 20 cleft palate patients, who were subjected to early minimal incision palatopharyngoplasty around 4-6 months of age, were followed for a minimum of 10 years (range: 10-14 years). All patients received the same orthodontic management, starting at 4 years of age. None of the patients had orthognatic surgery or alveolar bone grafting. After orthodontic treatment, their cephalometric data were compared with a group of subjects without cleft lip and palate, matched by gender and who were within the age range of the cleft palate group.

Results

SNA, SNB, ANB, and WITS cephalometric measures were compared. A non-significant difference was found in all measurements between the two groups.

Conclusion

Early cleft palate repair enhances phonological development. Although maxillary growth is affected in cleft palate patients, appropriate orthodontic treatment can achieve normal maxillary growth as measured during adolescence.