Vocalizations of toddlers with cleft lip and palate

This study examined the early vocalizations of toddlers with cleft lip and palate. Ten toddlers, ranging in age from 12 to 14 months, served as subjects: five toddlers with cleft lip and palate and five noncleft toddlers. Samples of the toddler's spontaneous vocalizations were obtained while they interacted with their mothers during an unstructured play session. All speech-like vocalizations were transcribed, and comparisons were made between the cleft and noncleft groups for (1) size of consonant inventory, (2) type and frequency of occurrence of consonants, and (3) frequency and type of multisyllabic productions. Results indicated differences in the consonant inventories and multisyllabic productions of the two groups of toddlers.     

Velar ascent and morphological factors affecting velopharyngeal function in patients with cleft palate and noncleft controls: a cephalometric study

This study compares velar ascent and morphological factors affecting velopharyngeal function between patients with repaired cleft palate and noncleft controls from early childhood to puberty. Lateral cephalograms obtained at rest and during blowing from 61 patients with repaired unilateral cleft lip and palate (cleft group) and 82 noncleft controls (control group) were divided into four developmental stages according to age and were studied cross-sectionally. Indices of nasopharyngeal area were derived from a coordinate system and landmarks on lateral cephalograms. The cleft group had lesser velar ascent, more posterosuperior position of the posterior maxilla, shorter velar length, and lesser pharyngeal depth than did the control group. There was a strong correlation between the vertical position of the posterior maxilla and the pharyngeal depth in the cleft group. Discriminant analysis revealed that the cleft group could be discriminated from the control group primarily on the basis of pharyngeal depth, velar length, and velar ascent. Our results suggest that the posterosuperior position of the posterior maxilla in patients with repaired cleft palate, resulting in reduced pharyngeal depth, represents an effort to facilitate velopharyngeal closure by means of shorter velar length and lesser velar ascent.     

A retrospective study of hearing impairment in three groups of cleft palate patients.

Three groups of cleft palate patients were evaluated for hearing impairment and secretory otitis at age five to determine the effect of myringotomy and tube placement. Each group consisted of 23 patients (46 ears). Hearing levels and otoscopic evaluations were obtained retrospectively from medical records. Group I had had no myringotomies. Group II had myringotomies after the initial palate closure and only when deemed necessary. Group III had had myringotomies at the initial palate closure and subsequently as needed. Optimal timing for myringotomy in cleft palate patients to maximize hearing at school age could not be determined. The need for myringotomy must be determined by clinical judgement on an individual basis.     

成人腭裂患者牙弓形态的比较研究

目的 探讨腭裂畸形本身及修复术对牙弓形态发育的影响.方法 应用牙颌模型CT扫描测量系统,对比分析正常(牙合)成人、单侧完全性唇腭裂(UCLP)均已修复组以及腭裂未修复组成人患者牙弓形态特征.结果 腭裂术后组上颌牙弓各段宽度、牙弓前段长度均显著小于未手术组(P ＜ 0.01);未手术组上颌牙弓前段宽度、上下颌牙弓长度均显著小于正常组(P ＜ 0.01),而上下颌牙弓后段宽度大于正常组(P ＜ 0.001).结论 腭部裂隙对上颌牙弓发育的影响仅仅局限于牙弓前部裂隙邻近的区域,腭裂手术是造成上颌牙弓宽度缩窄的主要原因,同时也抑制了上颌牙弓前段长度发育.     

Spectral analysis of prespeech sounds (spontaneous cries) in infants with unilateral cleft lip and palate (UCLP): a pilot study.

OBJECTIVE: The objectives of the present study were: (1) to analyze the cry features of infants with cleft lip and palate (UCLP) by means of spectral analysis, (2) to describe changes of the acoustic parameters from birth until 9 months of age, and (3) to compare these data with existing cry data of infants without cleft (control group). DESIGN: The study was designed on a interdisciplinary, prospective, and longitudinal basis. SETTING: Interdisciplinary study: (1) Institute of Anthropology at the Humboldt-University, Berlin; (2) Heidelberg University Hospital: Interdisciplinary Cleft Palate and Craniofacial Center. PATIENTS AND METHOD: The cry parameters of five patients with complete unilateral cleft lip, alveolar ridge, and hard and soft palate were analyzed from birth to 9 months of age. The patients were treated with the same protocol. At the age of 24 months, sensomotor development was assessed using the KIPHARD test. Perceptual judgment of speech, performed after 36 months of life, included nasal resonance, nasal emission of air, articulation disorders, and speech intelligibility. MAIN OUTCOME MEASURE: The cry parameters of fundamental frequency (F(0)), pitch period perturbation quotient (PPQ), and cry duration (Tsam) were analyzed. RESULTS: Contrary to the expectation that laryngeal parameters are not affected by vocal tract malformations, differences of cry parameters were found between the patients with UCLP and the non-cleft group. Particularly, the F(0) and its short-time variability (PPQ) were affected. CONCLUSIONS: The preliminary results of this study showed that F(0) and PPQ of spontaneous cries are influenced in patients with UCLP, and a cry analysis might become a noninvasive tool for early detection of an at-risk status for neuromuscular development and prediction of an at-risk status for later speech and language acquisition in infants with cleft lip and palate. Future research strategies are outlined.     

The nature of feeding in infants with unrepaired cleft lip and/or palate compared with healthy noncleft infants.

OBJECTIVE: Feeding difficulties are reported widely in infants with cleft lip and/ or palate. There is, however, a paucity of objective information about the feeding patterns of these infants. This study compared patterns of feeding in infants with unrepaired cleft lip and palate with healthy noncleft infants of a similar age. SETTING: North Thames Regional Cleft Centre. The noncleft cohort was recruited from West Middlesex University Hospital, a general hospital with similar demographics. PARTICIPANTS: Fifty newborn infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate who were referred to the North Thames Regional Cleft Centre participated. Parents of 20 randomly selected, noncleft infants agreed to participate. MAIN OUTCOME MEASURES: Feeding patterns were rated using the Neonatal Oral Motor Assessment Scale. Additional objective information was collected using the Great Ormond Street Measurement of Infant Feeding (Masarei et al., 2001; Masarei, 2003). RESULTS: Infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate had less efficient sucking patterns than their noncleft peers had. They used shorter sucks (mean difference, 0.30 second; p < .0005), a faster rate of sucking (mean difference, 34.20 sucks/second; p < .0005), higher suck-swallow ratios (mean difference, 1.87 sucks/swallow; p < .0005), and a greater proportion of intraoral positive pressure generation (mean difference, 45.97% positive pressure; p < .0005). CONCLUSIONS: This study demonstrated that the sucking patterns of infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate differ from those of their noncleft peers.     

A comparative clinical study of pierre robin syndrome and isolated cleft palate

Thirty seven infants with Pierre Robin syndrome were compared with children who had isolated cleft palate. A female preponderance was seen in both groups. Skeletal II jaw relation was observed in 32% of the children with isolated cleft palate. Associated malformations such as hypertelorism and strabismus were more common in infants with Pierre Robin syndrome and also in those with isolated cleft palate combined with a skeletal II jaw relationship when compared with infants who had cleft palate with a skeletal I jaw relationship. The frequency of hypodontia also was greater in the former two groups than in the latter. Furthermore, no difference was found in the frequencies of U- and V-shaped clefts. The frequencies of near relatives with clefts were also not different between groups. Whilst it may be possible to observe from these findings an association between Pierre Robin syndrome and isolated cleft palate, it is difficult to conclude that they support any of the postulates regarding the aetiology of Pierre Robin syndrome.     

唇腭裂患者侧貌协调性医患主观评价的比较

目的比较医患对唇腭裂患者侧貌协调性主观评价的一致程度及影响评价敏感部位的异同。方法10名唇腭裂患者对150张唇腭裂患者侧位标准照的鼻尖突度、鼻上唇协调性、上下唇协调性和侧貌整体行主观等级评分。计算医患主观评价一致性、差异性及局部在整体评价中的敏感性。结果医患主观评价一致性加权Kappa值为0．408-0．508。对于鼻尖突度和侧貌整体,医生评分较患者高（P〈0．01）;对于鼻上唇协调性,患者评分较医生高（P〈0．01）。唇间角在患者整体评价三等级各组间有显著性差异。结论医患对唇腭裂患者侧貌协调性主观评价中度一致。对于鼻尖突度和侧貌整体,医生比患者认可度高;对于鼻上唇协调性,患者比医生认可度高。影响整体评价的敏感部位是上下唇协调性。     

Phonetic description of babbling in Danish toddlers born with and without unilateral cleft lip and palate.

OBJECTIVE: To investigate prelinguistic vocalization sequences of 1-year-old children with and without cleft lip and palate. DESIGN: Prospective study. PARTICIPANTS: Thirty-eight children born with unilateral cleft lip and palate and 36 control children born without clefts. The cleft children had the lip, soft palate, and posterior part of the hard palate repaired at 4 months of age. The lip was closed ad modum Millard, the nose was corrected according to McComb, and the soft palate was closed with a posteriorly based vomer flap. METHODS: Data were obtained from a clinical visit during which the baby played with the mother. Video recordings were transcribed and analyzed concerning (1) the frequency of occurrence of vocalization sequences, (2) the frequency of occurrence of contoids and vocoids, (3) the contoids' place and manner of articulation, and (4) the percentage of children who entered the canonical babbling stage. RESULTS: No significant differences were observed between the cleft and control groups concerning frequency of occurrence of vocalization sequences, contoids, or vocoids. Structural differences between the groups seem to influence the contoid inventory, with a higher frequency of occurrence of nasal contoids and a smaller frequency of occurrence of alveolar contoids in the cleft group. Canonical babbling was achieved by most children in both groups, and no significant difference was found between the groups. CONCLUSIONS: Early closure of the soft palate seems to have a positive influence on the prelinguistic development of children with cleft palate.     

Demographic and prenatal factors of patients with cleft lip and cleft palate. A pilot study

BACKGROUND: Cleft lip, or CL, and cleft palate, or CP, are common congenital abnormalities. Birth prevalence ranges from one in every 500 to 1,000 in the white population and one in every 2,000 births in the African-American population. Etiologic and genetic factors contributing to CL and CP development are unknown though extensive research has been conducted. The authors conducted this pilot study to investigate a study design that could allow for an evaluation of such etiologic factors by providing the required estimate of the projected magnitude of differences between cases and controls. METHODS: The authors obtained pregnancy history data from the mothers of 137 consecutive patients at the University of Pittsburgh Cleft Palate-Craniofacial Center. The authors investigated the differences between sex or cleft status and family history of clefts, birth order, maternal age at birth and first-trimester maternal smoking and alcohol consumption. RESULTS: None of the factors showed any significant differences by sex or cleft type (P > or = .07) in the pilot data. Power estimates ranged from 12 to 71 percent. The sample size needed to obtain power of 80 percent would be 250 for variables with two categories and 480 for variables with three categories. CONCLUSIONS: There is no evidence that the factors contribute to either sex or cleft status differences. Further investigations are needed, and they should include a larger, more diverse sample of at least 250 cases, a matched control group and a focus on mothers of newborns. CLINICAL IMPLICATIONS: This study lays the groundwork for a better understanding of the etiology of CL and CP-common birth defects that present challenges for long-term dental management.     

学龄前期与大龄腭裂患者术前辅音构音位置特点的比较研究

目的：通过对腭裂患者术前辅音状况的主观判听,对比分析学龄前期与大龄腭裂患者术前辅音构音特点,为其术后语音治疗提供更为明确的治疗方案方法将腭裂患者按照年龄分为学龄前组（4~7岁）和大龄（8~18岁）各40例,利用主观判听对音节、词组和句子进行判听评估,交叉对比分析在不同构音位置上辅音的正确率、错误类型的发生率有无差异。结果两组腭裂患者在舌尖音、舌面音、舌根音、双唇音及唇齿音的发音正确率上均有差异;除舌根音,两组腭裂患者的代偿错误率在其他构音位置均无差异;两组腭裂患者在舌尖音、舌面音及舌根音的构音位置上,省略错误率均有差异,而在双唇音及唇齿音上无差异。结论学龄前期与大龄腭裂患者术前的辅音发音情况在不同构音位置的正确率与构音障碍的发生率上存在差异,因此对预测术后的语音状况恢复有指导性作用,在进行术后语音训练时,有目的地制定不同的训练计划,使患者得到更有针对性语音训练。     

Syndromes with cleft lip and cleft palate.

A series of tables is presented as a diagnostic aid for the clinician when he confronts a patient who has a cleft lip and/or palate, together with associated anomalies. The tables provide a rapid way of sorting through the recognized syndromes with orofacial clefting in search of a possible overall diagnosis. Today, 154 such syndromes are recognized. This is more than twice as many as were known in 1971. Undoubtedly, many new syndromes with orofacial clefting will be delineated in the future.     

唇腭裂儿童与正常儿童社会心理因素的比较研究

用国内已修订过的《艾森克个性问卷（ＥＰＱ）（幼儿））》对１１３例唇裂或／和腭裂患儿及５３例正常儿童进行心理测试。结果发现，唇腭裂（ＣＬＰ）组、单纯腭裂（ＣＰ）组、单纯唇裂（ＣＬ）组患儿的个性心理发展均比正常儿童更倾向于内向不稳定，自卑、社交困难、缺乏自信。患者各组间的内倾个性无显著性差异。结果还发现，腭裂组患儿的个性与其他各组相比，表现为不稳定。从而为唇腭裂患者的综合治疗提出一些参考依据。     

Bone transplantation in cleft palate patients. A retrospective study

Bone-grafts were evaluated in 45 patients with uni- or bilateral residual alveolar clefts. In this population there were 31 unilateral clefts and 14 bilateral clefts. This makes a total of 59 bone grafts. The mean follow-up period was 5.7 years. The patients were divided into two groups. Group A (grafting prior to the eruption of the homolateral canine) and group B (grafting after the eruption of the homolateral canine). Group A consisted of 38 grafts in 30 patients and group B consisted of 21 grafts in 15 patients. The grafts were harvested from the iliac crest. The alveolar bone-height was evaluated on occlusal radiographs. Results in patients treated prior to the eruption of the homolateral canine were significantly better then in patients treated after eruption of the canine. No difference was found between unilateral or bilateral clefts. Of the 38 canines which had not erupted at the time of the grafting procedure 26 (68.4%) erupted spontaneously.     

Assessment of arch constriction in patients with bilateral cleft lip and palate and isolated cleft palate: a pilot study

The objective of this study was to test the use of the modified Huddart/Bodenham scoring system on patients with a bilateral cleft lip and palate (BCLP) or an isolated cleft palate (CP). Study models of 5- and 10-year-old patients with BCLP (n = 19) and isolated CP (n = 55) from the Cleft Services in Scotland database were scored using the system by four examiners on two separate occasions to test inter- and intraexaminer reliability. The weighted kappa statistic was used to evaluate reliability. The interexaminer reliability ranged from 0.48 to 0.74 (moderate to good agreement) for the BCLP group and 0.77 to 0.86 (good to very good agreement) for the isolated CP group. The number of study models available for the BCLP group was small due to the low incidence of this cleft group, but the scoring system was shown to be reliable when used in cleft types other than unilateral cleft lip and palate. The modified Huddart/Bodenham scoring system provides a useful tool suitable for assessing arch constriction in all types of orofacial clefting, which is objective, sensitive, and versatile.     

Cephalometric findings in two cases with unrepaired bilateral cleft lip and palate.

Two cases with unoperated bilateral cleft lip and palate were examined clinically and cephalometrically and compared to matched normals. The findings indicate a severe premaxillary skeletal protrusion which results in a maxillary-mandibular discrepancy. The maxillary incisor inclination was acceptable, while the mandibular incisors were relatively more lingually inclined in the cleft group. Surgical management of one case necessitated premaxillary resection.     

18三体腭裂小鼠上颌牙弓发育的比较形态测量学研究

目的　通过对 1 8三体伴腭裂胚鼠和正常胚鼠的上颌牙弓宽度及磨牙弓长度比较形态测量学研究 ,量化地认识该模型腭裂小鼠的上牙弓发育的特点。方法　借助计算机图象处理系统 ,分别在大体 5 2对处于相同或相近发育阶段的胎鼠腭突标本上测定了硬腭牙弓的宽度 ,并对其中 30对胎鼠颅上颌复合体冠状序列连续切片 (厚度 7μm)中牙弓宽度进行测定。进一步估算上颌磨牙弓在矢状平面的长度。对腭裂及非腭裂组进行量化的比较。结果　 1 8三体伴腭裂小鼠上牙弓宽度以较正常增宽为趋势 ,而在磨牙前区略有缩窄 ,磨牙区牙弓宽度变宽 ,呈“葫芦”样。牙弓长度则呈现明显的发育不足。结论　 1 8三体伴腭裂小鼠的上磨牙弓明显增宽 ,而其长度则明显缩短 ,即其上颌骨发育呈明显后缩畸形。