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 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 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.

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.

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.

Escuta de crianças com fissura labiopalatina na escola / Children's listening with cleft liip and palate in the school

Introdução: Grande similaridade entre o comportamento de pacientes com fissura labiopalatina e aqueles com transtorno de processamento auditivo são relatadas por pais e professores. Objetivo: Verificar a escuta de crianças com fissura labiopalatina em seis condições de escuta. Método: Professores de 224 escolares (7 a 11 anos) com fissura completaram um questionário, visando julgar a escuta do escolar no ruído, condição ideal, com múltiplos estímulos, no silêncio, quando solicitado recordar a informação ouvida e durante longo período de escuta, comparando-o ao de outro sem fissura de mesma idade e condição de escuta. Estudo Prospectivo. Resultados: A média do julgamento (-0,08, desvio padrão de 0,27) dos alunos com fissura, realizado pelo professor, foi aproximadamente ao de "mesma dificuldade" (zero), quando comparado com o escolar sem fissura. Não foi encontrada significância estatística para qualquer uma das condições, nem para o valor total do questionário considerando os gêneros e as séries escolares. Conclusão: As características de escuta dos escolares com fissura labiopalatina foram similares ao de outro sem esta malformação craniofacial de mesma idade e condição de escuta semelhante. No ruído, quando a memória e a atenção auditiva são requeridas foram as condições mais difíceis.

Introduction: A great similarity between the patients with cleft lip and palate' behavior and those with auditory processing disorder are related by parents and professors. Objective: To verify the listening in children with cleft lip and palate in six conditions of listening. Method: Professors of 224 students (7 to 11 years old) with cleft completed a questionnaire aiming to judge the student listening in the noise, ideal condition, with multiple stimulus, in the silence, when it is solicited to remember the listened information and during a lengthy period of listening, comparing it to the other of the same age and listening condition, without cleft. A Prospective Study. Results: The mean of the trial (-0, 08, standard deviation of 0,27) of the students with cleft, performed by professor was about the "same difficulty" (zero), when compared with the student without cleft. It was not found statistical significance to anyone conditions, neither to the total value of the questionnaire, considering the gender nor the school year level. Conclusion: The listening characteristics of the students with cleft lip and palate were similar to the other without this craniofacial deformity of the same age and similar listening condition. In the noise, the conditions more difficult occurred when the memory and the auditory attention were required.

O conhecimento das gestantes sobre a síndrome da rubéola congênita / The knowledge of pregnant patients about the congenital rubella syndrome

A rubéola congênita é uma doença viral preocupante, principalmente quando acomete a gestante no primeiro trimestre gestacional. Vários estudos descrevem que a rubéola, ocorrendo precocemente na gravidez, geralmente leva a malformações congênitas variadas. A chamada Tétrade de Gregg, com alterações visuais, auditivas, cardíacas e mentais, é a mais conhecida, porém outras alterações podem ocorrer. Este trabalho mostra o grau de conhecimento das gestantes quanto aos riscos da rubéola durante a gestação e as orientações sobre o assunto recebidas do médico durante o pré-natal.

Estudo epidemiológico das fissuras labiais e palatais em Alfenas - Minas Gerais - de 1986 a 1998 / Epidemiologic study of cleft lip and palate in Alfenas - Minas Gerais - from 1986 to 1998

O objetivo do presente trabalho foi avaliar a ocorrência das fissuras labiais e palatais em recém-nascidos, no município de Alfenas, Minas Gerais. A amostra do estudo foi de 22 indivíduos portadores de fissuras labiais e palatais, nascidos no município de Alfenas, sul de Minas Gerais, entre o período de 1986 até o primeiro semestre de 1998, entre os 15.039 nascimentos registrados no referido município. As fissuras foram classificadas em labial, labiopalatal e palatal e analisadas por meio de testes não-paramétricos, observando a incidência e proporção das fissuras com relação ao sexo, número de nascimentos e a freqüência de nascimentos de pacientes fissurados ano a ano. A média de fissuras foi de 1,46 para cada 1.000 nascimentos por ano. Dos 22 indivíduos portadores de fissuras labiais e/ou palatais, 60% foram do sexo masculino e 40% do sexo feminino, sendo 19 leucodermas e 3 feodermas. Dentre as 22 fissuras, 10 foram fissuras labiais, 8 fissuras labiopalatais e 4 fissuras palatais. Verificou-se neste estudo clínico, retrospectivo, predomínio das fissuras bilaterais, comparadas com as unilaterais e maior ocorrência das fissuras labiais e labiopalatais unilaterais esquerdas no sexo masculino, ocorrendo o inverso no sexo feminino. Também se observou maior freqüência de FLP no sexo masculino e maior ocorrência de FP no sexo feminino. Fazem-se necessários mais estudos envolvendo fissuras em diferentes regiões brasileiras.

Malformações adicionais às fissuras lábio-palatais / Additional malformations in patients with oral clefts

A proposta deste trabalho foi avaliar a prevalência de malformações associadas às fissuras lábio-palatais em uma amostra brasileira, investigando quais as estruturas mais comumente afetadas e a correlação das mesmas com o tipo de fissura. Foram examinados 803 pacientes portadores de fissuras lábio-palatais sem síndrome que se matricularam no HRAC-USP no ano de 2000. Oitenta e um pacientes (10,2%) apresentavam anomalias associadas. Houve uma forte correlação entre a freqüência de anomalias associadas e o tipo de fissura lábio-palatal, com maiores prevalências para as medianas, seguidas pelas fissuras completas de lábio e palato bilaterais e pelas isoladas de palato. As alterações cardíacas e distúrbios do desenvolvimento neuropsicomotor foram as anomalias associadas às fissuras encontradas com mais freqüência, seguidas pelas alterações de membros. A prevalência relativamente alta de malformações associadas e a severidade das mesmas sugerem a necessidade de uma ampla investigação de pacientes portadores de fissuras, na busca de outras anomalias congênitas não detectadas que possam merecer intervenção precoce.

Current data on the characterization of oral clefts in Brazil.

This study aimed at investigating the current distribution of the several types of clefts among the patients receiving treatment at the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC-USP), Bauru, Brazil, for the first time during the year 2000. A total of 803 unoperated patients with cleft lip and/or palate, with or without additional malformations, with no recognizable syndromes, who came to the HRAC-USP for enrollment for treatment during the year 2000. A predominance of complete cleft lip and palate, either unilateral or bilateral, was observed (37.1%), followed by isolated cleft palate (31.7%) and isolated cleft lip (28.4%). A discrete relationship between cleft palate and the female gender was noticed (53%), and males were more affected by the other types of clefts (around 60%). The findings revealed a predominance of complete clefts of the primary and secondary palate, the treatment of which is more complex, and whose frequency is greater in males.

Current data on the characterization of oral clefts in Brazil

Foi objetivo do presente estudo investigar a distribuição atual dos vários tipos de fissuras entre pacientes que compareceram ao Hospital de Reabilitação de Anomalias Craniofaciais (HRAC-USP), Bauru, Brasil, pela primeira vez, no ano de 2000. No total, 803 pacientes não operados com fissura de lábio e/ou palato, com ou sem malformações adicionais, sem síndromes reconhecíveis, compareceram ao HRAC-USP para inscrição para tratamento durante o ano de 2000. Foi observada predominância de fissura completa de lábio e palato, unilateral ou bilateral (37,1%), seguida pela fissura de palato isolada (31,7%) e fissura de lábio isolada (28,4%). Foi notada uma relação discreta entre a fissura de palato e o gênero feminino (53%), sendo o gênero masculino mais afetado pelos outros tipos de fissuras (cerca de 60%). Os achados revelaram uma predominância de fissuras completas do palato primário e secundário, cujo tratamento é mais complexo, e uma maior ocorrência no gênero masculino.

Nasopharyngoscopy in Robin sequence: clinical and predictive value.

OBJECTIVE: To correlate nasopharyngoscopic findings with clinical manifestations during the first month of life and study the course of respiratory obstruction during the first year in infants with Robin sequence (RS). DESIGN: A longitudinal prospective study of children with RS. SETTING: Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru-SP, Brazil, 1998 to 2000. PATIENTS: Fifty-six children were studied from the age of 1 month to 12 months. INTERVENTIONS: The type of respiratory obstruction was defined by nasopharyngoscopy. Patients for whom glossoptosis was the only mechanism of respiratory obstruction were classified as having mild, moderate, or severe glossoptosis by nasopharyngoscopy and as mild, moderate, or severe cases with respect to the clinical manifestations. RESULTS: Forty-two (75%) patients showed respiratory obstruction caused by glossoptosis; seven (43.7%) of these infants with mild clinical manifestations showed moderate glossoptosis during the first month of life and five (31.3%) presented severe glossoptosis; 10 (45.5%) of the infants with severe clinical manifestations showed moderate and 11 (50.0%) severe glossoptosis. At 12 months of age, glossoptosis was mild or absent in 83.3% of the patients, moderate in 14.3% and severe in 2.4%. CONCLUSIONS: A poor correlation between the severity of glossoptosis and the severity of clinical manifestations was observed for patients with respiratory obstruction caused by glossoptosis during the first month of life, but the correlation between glossoptosis and respiratory distress according to age was statistically significant. Nasopharyngoscopy is not a good method for predicting the severity of the clinical course of respiratory obstruction caused by glossoptosis.

Condiçöes de saúde bucal e diabetes mellitus na populaçäo nipo-brasileira de Bauru-SP / Relation between oral health conditions and diabetes mellitus in a Japanese population from Bauru-SP-Brazil

Este estudo transversal foi delineado para estimar a prevalência de diabetes mellitus, intolerância à glicose e condiçöes de saúde bucal na populaçäo de origem japonesa, na faixa de 40 a 79 anos de idade, residente no município de Bauru-Brasil. Todos os indivíduos da primeira geraçäo (isseis) e uma amostra casualizada de um terço da segunda geraçäo (niseis) foram submetidos a entrevista domiciliar, totalizando 530 indivíduos. O exame clínico e teste oral de tolerância à glicose, e exame das condiçöes de saúde bucal, foram realizados no Hospital de Reabilitaçäo de Anomalias Crânio-Faciais - USP. Os dados foram processados através do programa Epi-Info, sendo que 22,9 por cento apresentaram ocorrência de diabetes mellitus (grupo I), 15,1 por cento tolerância à glicose diminuída (grupo II) e 61,9 por cento foram considerados normoglicêmicos (grupo III). O percentual de indivíduos desdentados totais foi de 45,9 por cento para a amostra e valores de 58,4 por cento, 46,7 por cento e 41,2 por cento foram verificados para os grupos I, II e III, respectivamente. Entre os indivíduos edêntulos, nenhum apresentava necessidade de confecçäo de prótese total, em contraposiçäo aos dados encontrados para a populaçäo brasileira em levantamento realizado pelo Ministério da Saúde (1986), cuja necessidade era da ordem de 8,3 por centona faixa etária de 35 a 59 anos. Pôde-se concluir que o edentulismo apresenta associaçäo significante com a ocorrência de diabetes mellitus, porém näo com a intolerância à glicose

[Relation between oral health conditions and diabetes mellitus in a japanese population from Bauru-SP-Brazil]. / Condições de saúde bucal e diabetes mellitus na população nipo-brasileira de Bauru-SP.

The aim of this cross-sectional study was to determine the oral health condition in a Japanese population aged 40 to 79, in Bauru, Brazil as well as its association with the occurrence of diabetes mellitus and impaired glucose tolerance. It involved 530 subjects, from both sexes. All persons of first generation (Issei) and a random sample of one third of second generation (Nisei) were submitted to a home interview. A clinical examination, oral glucose tolerance test, and examination of oral health conditions took place at the Hospital of Rehabilitation of Craniofacial Anomaly - USP. The data were processed by Epi-Info program and 22.9% of the individuals presented diabetes mellitus (group I), 15.1% impaired glucose tolerance (group II), and 61.9% were considered normoglycemics (group III). The percentage of edentulous subjects was 45.9% for the total sample, and values of 58.4%, 46.7%, and 41.2% were observed for groups I, II, and III, respectively. Among the edentulous subjects, no one showed necessity of making a total prothesis. These data indicate that tooth loss showed significant association with the occurrence of diabetes mellitus, but there was no significant association with glucose intolerance.