Various problems in the development of the child with clefts from the viewpoint of rehabilitative education]

Extensive studies and experience of many years evidence that optimal rehabilitation of the cleft patient may be achieved above all by early complex measures on the part of the sciences involved. To evaluate the efficiency of logopaedic early treatment in the cleft patient, the development of cleft children was studied during the first scholastic years, special attention being paid to their learning how to manage the written language (reading and spelling). A comparative study was undertaken in cleft children and children with normal speech at the beginning and during the third year of school education, assessing their discriminating performance in speech-motor, phonemic, visual, musical and rhythmical fields (modified Breuer-Weuffen test) and their performance in reading and spelling. The results obtained permitted to draw conclusions as to the early education of cleft patients.     

Early education of children with clefts with special regard to logopedics]

Necessity for early education: --general early education goal, contents, methods and forms of organization, --special early education--rehabilitative logopaedics goal, contents, methods and forms of organization incoherent logopaedic care coherent logopaedic care instruction of parents and co-operation with nurseries and nursery schools to realize early education. Conclusions: realization of the rehabilitative-paedagogical early education of the cleft child.     

Genealogic studies in children with clefts]

The genetic background of cleft children was studied at the Orthodontic Department of the Sofia Stomatological Faculty. A total of 149 members of 10 families were examined. The most-encountered microsymptoms were rotations of the lateral incisors and canines near the cleft. The results obtained from this, however, small number of subjects were not indicative of genetic factors.     

Biological age in children with clefts]

The skeletal and the dental maturity in a group of 189 children with cleft lip and/or cleft palate were determined by means of X-rays of the wrist joint and orthopantomogrammes. In 60 children, anthropometric determinations were also performed. 486 normal children involved in the Nijmegen growth study served as control subjects. The ages ranged from 4 to 14 years. A retardation in dental development was evidenced in boys with clefts. There was no remarkable difference in dental development between girls with clefts and girls without clefts. The progression in skeletal maturity was greater in girls with clefts than in girls without clefts. There was no remarkable difference in skeletal maturity between boys with clefts and normal boys. The determination of 10 anthropometric values revealed only a few remarkable differences between children with clefts and normal children.     

Genetic counseling of parents with children with clefts]

The elucidation of the aetiology of the individual case has proved to be of fundamental importance to the counselling interview as well as to the assessment of the risk for further affected children. Up to now, a genetic cause in the form of chromosomal or gene mutations can be assumed only if the cleft is related to a distinct syndrome. An isolated cleft obviously owes its origin to a combination of genetic and extrinsic factors. Consequently, the assessment of the risk of repetition is to a great extent based on empirical values.     

Quality of life and family functioning in children with nonsyndromic orofacial clefts at preschool ages

Children with orofacial clefts (OFC) at preschool ages may have to tolerate psychosocial disadvantages due to their altered speech and facial appearance probably affecting their quality of life (QoL) and family functioning. In 147 children with OFC aged between 5 and 6 years and their families, the QoL and family functioning were analyzed using the KINDL questionnaire for measuring health-related QoL in children and impact on family scale. The KINDL scores were lowest in the dimension self-esteem. In all dimensions, the KINDL scores of children were higher than those of the parents suggesting a superior QoL than the caregivers estimated (P<0.001). In affected families, the impact on family scale dimensions personal impact and impact on coping strategies were found highest. Families having children with isolated cleft lip or cleft lip and palate had higher impacts on coping strategies when compared with children having isolated cleft palate (P<0.041). The impact for siblings (P<0.02) was found highest in patients with cleft lip and palate. In all examined dimensions, children with OFC perceived a higher QoL than their caregivers expected. However, self-esteem seems to be problematic in all types of OFC and in both genders. Knowledge of potential impacts related to the type of cleft and the gender of the patient will probably facilitate health care professionals to identify children and families at high risk to experience a reduced QoL and may help to offer specific support and treatment strategies.     

Reading disability in children with clefts

The prevalence of reading disability was examined in 172 elementary school children with cleft lip and palate (CLP) or cleft palate only (CPO). Approximately 35 percent of the sample displayed a moderate degree of reading disability, and 17 percent of the group exhibited severe reading disability. Reading disability was more prevalent at younger ages, presumably because of peripheral speech deficits. For older children, those with CLP displayed an incidence of reading disability similar to the general population (9 percent), whereas children with CPO exhibited a much higher rate of reading disability (33 percent). There were no sex differences in the prevalence of reading disability in this sample. The study supports earlier suggestions that children with CPO may be more likely to experience general language disorders leading to long-term reading disabilities. Children with CLP appear to manifest reading problems that tend to resolve with increased age.     

Various hygienic problems in ambulatory dental surgery]

Oral surgical interventions on an outpatient basis are attended by considerable hygienic hazards. The main reasons of this, which are in part subjective and in part objective, are presented. Some typical examples show that at least minimal hygienic requirements may be met by the physician and by the patient also under apparently unfavourable conditions. An optimal solution must be aimed at, but this requires certain prerequisites as to equipment and premises. In any case, it must be called for in planning and establishing greater stomatological services that sould be preferred for this reason to single practices also from the viewpoint of hygiene. Consequently, the propagation of hospitalism and infections caused by pathogenic organisms may be controlled by strict hygienic measures also in our specialty.     

Dermatoglyphic peculiarities in children with oral clefts

In humans, the development of the primary palate and the lip is completed by the 7th week of intra uterine life and that of secondary palate by 12th week. The dermal ridges develop in relation to the volar pads, which are formed by the 6th week of gestation and reach maximum size between 12th and 13th weeks. This means that the genetic message contained in the genome--normal or abnormal is deciphered during this period and is also reflected by dermatoglyphics. Hence this study was done in order to observe the differences in dermatoglyphic patterns between the children with oral clefts and normal children and to determine the usefulness of dermatoglyphics in studying the genetic etiology of oral clefts. Dermatoglyphic data from 50 oral cleft children and 50 normal children were collected using the ink method and comparison was done between them. In the present study, we found an increase in the ulnar loop patterns on the distal phalanges of the ten fingers, an increase in the atd angle and an increase in the fluctuating asymmetry of the atd angle in the oral cleft children which indicates the degree of developmental instability of the oral cleft individual.     

Hypodontia in children with various types of clefts

The prevalence of hypodontia in children with clefts, both inside and outside the cleft region, and the possible association between the side of the cleft and the side of the missing teeth were studied using radiographs of 278 patients with cleft lip, cleft palate, or both (158 boys and 120 girls), age 5 to 18 years (mean age 10.4 years). A hypodontia prevalence of 77% (excluding third molars) was found for the total cleft sample. This was significantly higher, both statistically and clinically, than the incidence of hypodontia reported for noncleft populations, and considerably higher than the prevalence reported in other studies of children with clefts. The maxillary permanent lateral incisors were the teeth most frequently missing on the cleft side (259 teeth) followed by the maxillary (47 teeth) and mandibular (23 teeth) second premolars, in both boys and girls. The teeth that were most often missing on the noncleft side were the maxillary second premolars (12 teeth), followed by the maxillary lateral incisors (10 teeth) and mandibular second premolars (6 teeth). Hypodontia of both the maxillary lateral incisors and second premolars was found more frequently on the left side, which also has a higher frequency of clefting.     

The necessity for logopedic-orthodontic cooperation for speech and dental development in children with clefts]

Children with cheilognathopalatoschisis exhibit a peculiar specificity of speech. The present paper deals with studies on the position of the tongue at rest, the type of respiration, the functions of the lips and the position of the tongue on articulating sounds at the second site of articulation in 35 patients with cheilognathopalatoschisis. The results obtained testify to the necessity for logopaedic orthodontic co-operation.     

Prevalence of oral trauma in children with bilateral clefts

Abstract –  The main object of this study is to analyze the prevalence of oral trauma in subjects with complete bilateral clefts, with anterior projection of the premaxilla. A total of 106 children aging 6 months to 9 years were analyzed. The caretakers answered a specific questionnaire, in order to report the presence or absence of trauma to the soft and/or hard tissues of the child's mouth. Whenever there was a history of trauma, the patients were submitted to clinical examination. The prevalence of oral trauma was 53%, being 91% of soft tissue lesions, 8.9% of avulsion, 7% of luxation and 1.8% of intrusion. For the males, the prevalence was 56% and for the females it was 47%, with no statistical significance. Regarding the following aspects:period of time spent with the parents and at school, and presence or absence of siblings, no statistical difference could be found. Among the traumatized individuals, 80% aged less than 3 years by the moment of the trauma, 89% suffered the trauma at home, 75% presented lesions in the soft tissue at the premaxilla, 16% in the maxillary incisors, and 8.9% presented lesions in both structures. It was noticed that 45% of the permanent incisors that succeeded the traumatized deciduous teeth presented alterations, being 48% of structure and 52% of structure and position. The prevalence of trauma in this sample was superior to that observed in the literature, without any positive associations between the evaluated aspects. These results suggest that the projection of the premaxilla brings about a higher risk of oral trauma around this area.     

Evaluation of the limits of orthodontic treatment possibilities in surgically treated patients with clefts by means of teleradiography]

Using indices elaborated by himself for the evaluation of lateral teleradiographs, the author attempted to systematize the very divergent forms of postoperative jaw crippling in cleft patients. By substantiating the characteristics on inhibition in growth of the upper jaw, and by establishing a mandibular macrognathia, it is possible to judge of the limits of an orthodontic treatment.