Estudos de casos múltiplos: escolares com fissura labiopalatina no contexto da avaliação foniátrica / Multiple case studies: schoolchildren with cleft lip and palate in context of phoniatric evaluation / Múltiplesestudios de caso: escolares conlábio leporino y paladar hendido en el contexto de la evaluación foniátrica

Introdução: A foniatria tem interesse em fissura labiopalatina (FLP) devido à complexidade em aspectos de fala, linguagem e audição. Objetivo: No contexto da avaliação foniátrica em crianças escolares com fissura labiopalatina, o objetivo do estudo de múltiplos casos foi descrever a interferência de fatores clínicos no desempenho em testes da função perceptiva auditiva de linguagem, assim como a associação entre eles. Método: Trinta crianças, entre 6 anos e 2 meses e 9 anos e 11 meses, foram avaliadas pelo médico foniatra, em serviço interdisciplinar de tratamento da FLP: 13 (43%) fissura pós-forame incisivo e 17 (57%) fissura transforame incisivo. Foram descritos os fatores clínicos (incluindo tipo de fissura, idade na avaliação, sexo, condição socioeconômica, desempenho escolar, realização de fototerapia, exame audiológico e outros) e o desempenho em testes de discriminação auditiva, memória auditiva e consciência fonológica, incluindo a associação entre eles. Resultados: Não houve diferença significativa entre os grupos de fissura e médias de idade (p=0,618), sexo (p=0,431), nível socioeconômico (p=0,580) e desempenho escolar (p=0,785).A porcentagem de crianças que fez terapia é maior no grupo de fissura transforame (94,1%). Alterações nos testes: 4 crianças (13,3%) discriminação auditiva, 6 (20%) memória auditiva e 8 (26,7%) consciência fonológica. Os casos com desempenho escolar insatisfatório, mais tempo de fonoterapia e piores médias do limiar de reconhecimento de fala tiveram desempenho pior em memória auditiva e consciência fonológica. Conclusão: A avaliação foniátrica possibilitou o apontamento de fatores clínicos da fissura, que parecem, de alguma forma, interferir no desenvolvimento da linguagem destas crianças.

Introduction: Phoniatrics is interested in cleft lip and palate (CLP) due to the complexity in aspects of speech, language and hearing. Objective: In context of phoniatric evaluation in schoolchildren with CLP, the objective of multiple cases study was to describe the interference of clinical factors in the performance in tests of auditory perceptual function of language, as well as the association between them. Method: Thirty children, between 6 years and 2 months and 9 years and 11 months, were evaluated by Phoniatric doctor, in interdisciplinary treatment service for CLP: 13 (43%) cleft palate and 17 (57%) cleft lip and palate. Clinical factors (including type of cleft, age at evaluation, sex, socioeconomic status, school performance, speech therapy, audiological examination and others) and performance in tests of auditory discrimination, auditory memory and phonological awareness were described, including the association between them. Results: There was no significant difference between the cleft groups and the mean age (p = 0.618), sex (p = 0.431), socioeconomic level (p = 0.580) and school performance (p = 0.785). The percentage of children who had attended therapy is higher in cleft lip and palate group (94.1%). Changes in tests: 4 (13.3%) auditory discrimination, 6 (20%) auditory memory and 8 (26.7%) phonological awareness. The cases with unsatisfactory school performance, more speech therapy time and worse speech recognition thresholds had a worse performance in auditory memory and phonological awareness. Conclusion: The phoniatric evaluation made it possible to identify clinical factors of the cleft, which seems, in some way, to interfere in the language development of these children.

Introducción: Foniátrica está interesado en el labio leporino y paladar hendido debido a la complejidad en los aspectos del habla, el lenguaje y la audición. Objetivo: El contexto de la evaluación foniatría en escolares con labio leporino y paladar hendido, el objetivo del estudio de múltiples casos fue describir la interferencia de factores clínicos en el desempeño en las pruebas de la función auditiva perceptiva del lenguaje, así como la asociación entre ellos. Método: Treinta niños, entre 6 años y 2 meses y 9 años y 11 meses de edad, fueron evaluados por un médico foniátrico, en un centro de tratamiento interdisciplinario para labio leporino y paladar hendido: 13 (43%) paladar hendido y 17 (57%) labio leporino y paladar hendido. Se describieron y verificaron los factores clínicos (incluido el tipo de hendidura, la edad en la evaluación, el sexo, el estado socioeconómico, el rendimiento escolar, la fototerapia, el examen audiológico y otros) y el rendimiento en las pruebas de discriminación auditiva, memoria auditiva y conciencia fonológica, incluida la asociación entre ellos. Resultados: No hubo diferencias significativas entre los grupos de hendidura y la edad media (p = 0.618), sexo (p = 0.431), nivel socioeconómico (p = 0.580) y rendimiento escolar (p = 0.785). El porcentaje de niños que se sometieron a terapia es mayor en el grupo de paladar hendido y labio leporino (94.1%). Cambios en las pruebas: 4 niños (13.3%) discriminación auditiva, 6 (20%) memoria auditiva y 8 (26.7%) conciencia fonológica. Los casos con un rendimiento escolar insatisfactorio, más tiempo de terapia del habla y peores umbrales de reconocimiento del habla tuvieron un peor rendimiento en la memoria auditiva y la conciencia fonológica. Conclusión: La evaluación foniátrica permitió identificar factores clínicos de la hendidura, que de alguna manera, parece interferir en el desarrollo del lenguaje de estos niños.

3D comparison of dental arch stability in patients with and without cleft lip and palate after orthodontic/rehabilitative treatment

Abstract This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.

Fissura labiopalatina: avaliação do impacto psicológico utilizando a Escala de Autoestima de Rosenberg / Cleft lip and palate: evaluation of the psychological impact using the Rosenberg self-esteem scale

Introdução: A fissura labiopalatina é a malformação mais frequente da região da cabeça e afeta mais de 10 milhões de pessoas no mundo. O objetivo do estudo foi avaliar a autoestima em pacientes portadores de fissura labiopalatina em acompanhamento no Serviço de Cirurgia Plástica Craniomaxilofacial do Hospital de Clínicas de Porto Alegre, comparando-os com indivíduos não fissurados. Métodos: Estudo transversal contemporâneo, com 160 participantes, sendo 80 pacientes com fissura labiopalatina já submetidos a procedimentos cirúrgicos relacionados à afecção e, como grupo controle, 80 alunos e funcionários da rede pública de ensino. Um questionário para caracterizar o grupo e a escala de autoestima de Rosenberg foram utilizados para a coleta de dados. Resultados: Houve diferença significativa entre os grupos quanto ao estado civil, escolaridade e repetência escolar. Os pacientes com fissura labiopalatina apresentam níveis de autoestima menores em relação a indivíduos não afetados. Dentre eles, os subgrupos dos indivíduos com fissura bilateral, fissura completa, do gênero feminino, classe econômica D/E, baixa escolaridade, situação familiar reconstituída na infância e com resultados não satisfatórios em relação à comunicação, dentição e cicatriz de lábio também mostraram níveis de autoestima menores. Conclusão: Houve relação significativa entre fissura labiopalatina e baixa autoestima.

Introduction: Cleft lip and palate is the most frequent malformation of the head region and affects more than 10 million people worldwide. This study aims at evaluating the selfesteem in patients with cleft lip and palate and comparing that with the self-esteem of non-affected individuals during followup at the Department of Craniomaxillofacial Plastic Surgery of the Hospital de Clínicas of Porto Alegre. Methods: This is a cross-sectional, contemporary study with 160 participants, comprising 80 patients with cleft lip and palate who have already undergone surgical procedures for correcting the condition and 80 non-affected students and employees of the publicschool system as a control group. We used a questionnaire to characterize the group and the Rosenberg self-esteem scale for data collection. Results: There was a significant difference between groups in terms of marital status, schooling, and school retention. Patients with a cleft lip and palate had lower levels of self-esteem than non-affected individuals. Among them, the individuals with bilateral clefts or complete clefts; female gender; economic strata of D/E; low level of schooling; families reconstituted during childhood; and with unsatisfactory results concerning communication, dentition, and lip scar also showed lower levels of self-esteem. Conclusion: There was a significant relationship between cleft lip and palate and low self-esteem.

Avaliação do efeito imediato de exercício de trato vocal semiocluído no mecanismo velofaríngeo em cinco portadores de fissura labiopalatina: estudo piloto / Assessment of the immediate effect of a semi-occluded vocal tract exercise on velopharyngeal mechanism in five patients with cleft lip and palate: pilot study

Introdução: As fissuras labiopalatinas não sindrômicas estão incluídas entre as malformações craniofaciais severas mais frequentes na população humana. O indivíduo acometido pode apresentar alterações no mecanismo velofaríngeo, comprometendo-se assim a inteligibilidade da fala. O objetivo deste estudo foi analisar o efeito imediato do exercício de trato vocal semiocluído no mecanismo velofaríngeo de pacientes com fissura labiopalatina. Métodos: A amostra foi composta por cinco sujeitos com fissura labiopalatina reparada cirurgicamente submetidos a avaliação multidimensional, de videonasofibroscopia, análise das imagens dinâmicas por meio de software especializado e análise de fala por meio da avaliação perceptivoauditiva e parecer autorreferido. Resultados: Todos os pacientes apresentaram melhora na fala encadeada após o exercício, melhora acentuada na impressão geral da emissão e projeção vocal, maior fechamento velofaríngeo e efeito positivo na autoavaliação. Conclusão: Observou-se efeito positivo do exercício de trato vocal semiocluído quando aplicado nessa amostra.

Correlation between religiosity, spirituality and quality of life in adolescents with and without cleft lip and palate / Correlação entre religiosidade, espiritualidade e qualidade de vida em adolescentes com e sem fissura labiopalatina / Correlación entre religiosidad, espiritualidad y calidad de vida en adolescentes con y sin fisura labiopalatina

ABSTRACT Objective: to correlate spirituality and religiosity with quality of life of adolescents with and without cleft lip and palate. Methods: cross-sectional and correlational study involving two groups: case group (n = 40) and comparison group (n = 40). The Duke University Religion Index (DUREL) and the World Health Organization Quality of Life Bref were used for data collection. The Mann-Whitney, Chi-Square, Student's t-test and Pearson's correlation tests were used in the statistical analyses, with a significance level of 5% (p ≤ 0.05). Results: organizational religiosity and overall quality of life were significantly higher in the case group (p = 0.031 and p = 0.012, respectively). As for quality of life, the Environment Domain was significantly higher in the case group (p < 0.001). In the correlation between religiosity and spirituality, non-organizational religiosity had a strong correlation (r = 0.62) with organizational religiosity (p < 0.001). In the correlation of religiosity and spirituality with quality of life, only a moderate correlation between spirituality and overall quality of life was identified (r = -0.35, p = 0.026). Conclusion: there was no relationship of religiosity and spirituality with quality of life among adolescents with cleft lip and palate for most aspects evaluated.

RESUMO Objetivo: correlacionar a espirutualidade e a religiosidade com a qualidade de vida de adolescentes com e sem fissura labiopalatina. Métodos: estudo transversal e correlacional, englobando dois grupos, caso (n= 40) e comparativo (n= 40). Para a coleta de dados, utilizou-se a Escala de Religiosidade de Durel e o World Health Organization Quality of Life Bref. Para a análise estatística, os testes de Mann-Whitney, Qui-Quadrado, t-Student e de Correlação de Pearson foram utilizados, com nível de significância de 5% (p≤0,05). Resultados: a religiosidade organizacional e a qualidade de vida global foram significativamente maiores no grupo caso (p=0,031 e p=0,012, respectivamente). Referente à qualidade de vida, o Domínio Meio Ambiente foi significativamente maior no grupo caso (p<0,001). Ao se correlacionar a religiosidade e a espiritualidade, a religiosidade não organizacional apresentou forte correlação (r=0,62) com a religiosidade organizacional (p<0,001). Ao se correlacionar a religiosidade e a espiritualidade com a qualidade de vida, identificou-se somente correlação moderada entre a espiritualidade e a qualidade de vida global (r=-0,35; p=0,026). Conclusão: evidenciou-se a não existência de relação entre a religiosidade e a espiritualidade com a qualidade de vida entre adolescentes com fissura labiopalatina, para a maioria dos aspectos avaliados.

RESUMEN Objetivo: correlacionar la espiritualidad y la religiosidad a la calidad de vida de adolescentes con y sin fisura labiopalatina. Métodos: estudio transversal y correlacional, englobando dos grupos, caso (n= 40) y comparativo (n= 40). Para la recolección de datos, fueron utilizadas la Escala de Religiosidad de Durel y el World Health Organization Quality of Life Bref. Para el análisis estadístico fueron utilizados los tests de Mann-Whitney, Chi-Cuadrado, t-Student y de Correlación de Pearson, con nivel de significancia de 5% (p≤0,05). Resultados: la religiosidad organizacional y la calidad de vida global fueron significativamente mayores en el grupo caso (p=0,031 y p=0,012 respectivamente). Referente a la calidad de vida, el Dominio Medio Ambiente fue significativamente mayor en el grupo caso (p<0,001). Al correlacionarse la religiosidad y la espiritualidad, la religiosidad no organizacional presentó fuerte correlación (r=0,62) con la religiosidad organizacional (p<0,001). Al correlacionarse la religiosidad y la espiritualidad a la calidad de vida, se identificó solamente una correlación moderada entre la espiritualidad y la calidad de vida global (r=-0,35; p=0,026). Conclusión: se evidenció la no existencia de relación entre la religiosidad y la espiritualidad con la calidad de vida entre adolescentes con fisura labiopalatina, para la mayoría de los aspectos evaluados.

Quality of life and mastication in denture wearers and cleft lip and palate adults

Abstract The impact of oral rehabilitation on masticatory function and oral health-related quality of life (OHRQoL) may vary with the experience of the individual with tissue loss. Our hypothesis is that patient-centered outcomes vary among adults who have experienced large defects in the maxilla due to congenital or acquired conditions even after oral rehabilitation to restore aesthetics and function. This study compared OHRQoL, perceived masticatory ability, maximum bite force (MBF), and symptoms of pain and depression among subjects with acquired (edentulous maxilla) and congenital (cleft lip and palate) loss of oral tissues in the maxilla after dental treatment. A gender-matched sample (n = 60) of cleft lip and palate (CLP), maxillary denture wearers (DENT) and controls (CONT) was recruited. OHRQoL was assessed using OHIP-14. Chewing was evaluated through a masticatory ability questionnaire and by MBF. The RDC/TMD Axis II questionnaire was used to assess symptoms of pain and depression. Data were analyzed by Fisher's test, Kruskal Wallis test, and Spearman correlation coefficients. CLP showed higher OHIP-14 and depression scores than DENT and CONT (p < 0.05). Sub-analysis by OHIP-14 items (%FOVO) showed higher prevalence of psychological impact for CLP and of functional impacts for DENT. The number of foods difficult to chew, of food textures difficult to chew, and avoided foods were similar between CLP and DENT. OHIP-14, MBF, and depression scores showed significant correlation (p < 0.05). The results suggest that adults with treated CLP or maxillary DENT have chewing impairment and lower MBF than healthy subjects, with different psychological and functional impacts.

The maxillary lateral incisor in the rehabilitation of cleft lip and palate

Abstract Objective This study analyzed the maintenance of lateral incisors in the dental rehabilitation of individuals with cleft lip and palate. Material and Methods The study was conducted on a tertiary craniofacial center and comprised retrospective analysis of panoramic and periapical radiographs of Caucasoid individuals with non-syndromic complete unilateral cleft lip and palate, analyzing all radiographs available on the records of each individual, from the first to the last up to 12 years of age. Overall, 2,826 records were reviewed to achieve a sample of 1,000 individuals. Among these, 487 individuals presented the permanent lateral incisors on both cleft and non-cleft sides, which were included in this study. Results The results were evaluated in percentages and by descriptive statistics. The association between maintenance of the lateral incisor and timing of alveolar bone graft were analyzed by the t test. Among the 487 individuals, 265 had not completed treatment, 62 presented insufficient information, and 44 concluded the treatment elsewhere. Among the remaining 116 individuals, the lateral incisor was extracted from 88 (75.86%) of them on the cleft side (CS) and from 23 (19.83%) people on the non-cleft side (NCS). The age at accomplishment of alveolar bone graft was significantly associated with maintenance of the lateral incisor on the cleft side (p<0.01). Most extractions were indicated because of the inadequate positioning on the CS and for midline correction on the NCS. Rehabilitation was primarily completed by orthodontic movement (53 individuals on the CS and 13 individuals on the NCS). Conclusion In conclusion, the lateral incisor on the cleft side was not maintained in most individuals. Positive relationship was observed between extraction of the lateral incisor and age at accomplishment of the alveolar bone graft, suggesting the need to anticipate the initial radiographic evaluation to enhance its maintenance and reduce the procedures required for rehabilitation.

Prótesis y ortodoncia: rehabilitación de fisurado bilateral: caso clínico / Prosthesis and orthodontics: bilateral fissure repair: a clinical case

RESUMEN: El paciente fisurado labiopalatino muestra una falta de fusión de los procesos palatinos presentando una comunicación de la cavidad buconasal, anomalías de forma y/o la agenesia de los dientes cercanos a la fisura y un deficiente crecimiento sagital y transversal maxilar, esto es más complejo en la fisura bilateral, por ser el más severo de los subtipos de fisura. Se dificultan las funciones básicas como comer, hablar y relacionarse con los demás. Su tratamiento requiere del trabajo de un equipo transdisciplinario, coordinado y organizado, conformado por todos aquellos profesionales que colaboren en proporcionar un resultado integral. El objetivo de este artículo es exponer un caso clínico de rehabilitación protésica en conjunto con un tratamiento de ortodoncia en un paciente que presenta labio leporino bilateral y fisura palatina, además de una premaxila móvil, severamente extruida.

ABSTRACT: The cleft lip and palate patient is mainly characterised by the presence of an oronasal communication, malformation or agenesis of the teeth close to the cleft, and deficient sagittal and transverse growth of the maxilla. These patients require various treatments involving a multidisciplinary team, which may include a maxillofacial surgeon, an orthodontist, a speech therapist, a paediatrician, plastic surgeon, a general dentist, a prosthodontist, an ENT specialist, a psychologist, and all those professionals who can help provide functional, aesthetic and psychological improvement. This report describes a case of prosthetic rehabilitation in a patient with cleft lip and palate without alveolar bone in the cleft area, which prevented rehabilitation with an osseointegrated implant, in addition to a mobile and severely extruded pre-maxilla, which required an orthopaedic repositioning.

Orofacial clefts in Brazil and surgical rehabilitation under the Brazilian National Health System

Abstract The objective of this study was to investigate the prevalence of live births with orofacial clefts in Brazil from 2009 to 2013, according to Brazil’s federative units and regions, and correlate it with the number of corrective surgery procedures for cleft lip and palate performed through the Brazilian National Health System in the same period. The data were collected from the National Live Birth System (SINASC in Portuguese) and the Hospital Information System (SIH-SUS in Portuguese). The results showed that the average prevalence of oral clefts in the period was 5.86 per 10,000 live births, with differences observed between the federative units and the regions. The correlation between the prevalence of orofacial clefts and the number of medical procedures associated with this anomaly was statistically significant (r=0.94; p <0.001). This result indicates that greater investments are being made in areas with a higher number of cases. The relationship between supply and demand for corrective surgeries suggests that only 18.91% of the live births with orofacial clefts in this period may have received this service under the Brazilian National Health System.

3D analysis of effects of primary surgeries in cleft lip/palate children during the first two years of life

Abstract This study aimed at monitoring the maxillary growth of children with cleft lip/palate in the first two years of life, and to evaluate the effects of primary surgeries on dental arch dimensions. The sample consisted of the three-dimensional digital models of 25 subjects with unilateral complete cleft lip and palate (UCLP) and 29 subjects with isolated cleft palate (CP). Maxillary arch dimensions were measured at 3 months (before lip repair), 1 year (before palate repair), and at 2 years of age. Student’s ttest was used for comparison between the groups. Repeated measures ANOVA followed by Tukey’s test was used to compare different treatment phases in the UCLP group. Paired ttest was used to compare different treatment phases in the CP group. P<0.05 was considered statistically significant. Decreased intercanine distance and anterior arch length were observed after lip repair in UCLP. After palate repair, maxillary dimensions increased significantly, except for the intercanine distance in UCLP and the intertuberosity distance in both groups. At the time of palate repair and at two years of age, the maxillary dimensions were very similar in both groups. It can be concluded that the maxillary arches of children with UCLP and CP changed as a result of primary surgery.

Rehabilitación protésica en pacientes fisurados con fístula buconasal / Prosthetic rehabilitation in patients with cleft lip and buconasal fistula

La fisura labiopalatina consiste en la falta de fusión de los procesos palatinos y labial durante el desarrollo embrionario. Estos pacientes presentan una comunicación buconasal, alteraciones dentarias de forma, tamaño y posición, y un deficiente desarrollo del maxilar. Su tratamiento requiere un trabajo de equipo multidisciplinar, ya que afecta funciones básicas que comprometen su calidad de vida, como comer, hablar o relacionarse socialmente. Aunque la cirugía primaria soluciona mayormente esta anomalía, algunas veces persiste la comunicación entre las cavidades bucal y nasal, lo que se conoce como comunicación o fístula buconasal. Esto supone una mayor dificultad en el cierre quirúrgico, siendo a veces imposible de cerrar a través de la cirugía. En tales casos, la obturación de dicha fístula a través de una prótesis otorga una solución de bajo costo para el paciente y con resultados óptimos a corto y mediano plazo. El objetivo de este artículo es exponer casos de rehabilitación protésica en pacientes con fisura labiopalatina y fístula buconasal posterior al tratamiento quirúrgico.

Cleft lip and palate is the lack of fusion of the palatal and labial processes during embryonic development. Patients are characterised by the presence of buconasal communication, dental alterations, and poor development of the maxilla. Treatment requires multidisciplinary team work, due to the impact on basic functions such as eating, talking or interacting with other people, and even compromising their quality of life. Although primary surgery mostly solves this anomaly, sometimes communication between the oral and nasal cavity persists (called communication or buconasal fistula). This leads to greater difficulty to surgically close it, being impossible in some cases. In these cases, the closure using a prosthesis provides a low-cost solution for the patient, with an optimal result in the short and medium term. The aim of this article is to present cases of prosthetic rehabilitation in patients with cleft lip and buconasal fistula after surgical treatment.

Atención odontopediátrica del niño con fisura labio alveolo palatina / Pediatric dental care for children with cleft lip, alveolous and palate

La intervención del odontopediatra es fundamental en los primeros días de vida del niño, debido al problema de falta de succión y los trastornos que causan en la alimentación. El logro de un tratamiento eficaz en elniño fisurado dependerá del trabajo multidisciplinario y de lograr instruir y concientizar a los padres en la importancia de la permanente atención del niño, cumpliendo todos los pasos indicados por el equipo de trabajo para lograr el correcto tratamiento interdisciplinario, teniendo en cuenta además que son tratamientos muy largos con control y atención del niño afectado, prácticamente hasta la adolescencia, por parte de cada uno de los integrantes de este equipo de trabajo...

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: Institutional outcomes assessment and the role of the Laboratory of Physiology

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) Part 4: Oral Rehabilitation

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - part 3: Oral and Maxillofacial Surgery

This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 2: Pediatric Dentistry and Orthodontics

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 1: overall aspects

Cleft lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.

Feeding appliance for an infant with cleft lip and palate

Clefts of lip and palate are the most common congenital deformities involving the orofacial region. One of the immediate problems to be addressed in newborn in difficulty in feeding. Here we present a case of 4 month old infant with unilateral cleft lip and palate for whom feeding appliance was made

Occurrence of consonant production errors in liquid phonemes in children with operated cleft lip and palate

Information about the prevalence of consonant production errors, including compensatory articulations (CA), in individuals with cleft lip and palate (CLP) who speak Brazilian Portuguese is limited, particularly regarding liquid sounds. The literature primarily reports the occurrence of CA for plosive and fricative sounds, since occurrence of CAs in sounds that require higher amounts of oral air pressure is expected. While the use of CA during liquid sound production is not expected, clinical experience suggests that individuals with CLP present with inadequate backing, elevation, and anteriorization of the tongue as well as tongue clicks during production of /r/ and /l/. Objectives: Describe the occurrence of consonant error productions during liquid sounds for children with CLP; compare the occurrence between children operated with the Furlow and von Langenbeck techniques for palatoplasty; and compare the occurrence between children operated between 9-12 months and 15-18 months of age at primary palatoplasty. Material and Methods: A sample of 397 children (237 males and 160 females) with operated unilateral CLP was studied. In this group, 163 underwent palatoplasty with the Furlow procedure and 234 with the modified von Langenbeck procedure. Age at palatoplasty was between 9 and 12 months for 189 children and between 15 and 18 months for 208 children. Data about production of /l/, /r/, /R/, /λ/ and consonant clusters /l/ and /r/ were obtained from speech pathology records. Speech pathologists registered the speech findings after an auditory-perceptual evaluation of the participants at the sixth year of age. Results: The use of middorsum palatal place (MDP) of production was identified for 2 percent of the sample. Tongue anteriorization of the /l/ production was observed for 55 percent of the children. No significant difference was found related to surgical technique, but children operated earlier developed the use of the consonant cluster /r/ sooner than children operated later (p=0.040). Conclusion: We found a low occurrence of use of cleft related CA during attempts of production of liquid phonemes, and the variable age at primary palatoplasty significantly interfered with the acquisition of consonant cluster /r/.