Electromyographic Comparison of Lips and Jaw Muscles between Children With Competent and Incompetent Lips: A Cross Sectional Study.

OBJECTIVE: This cross-sectional study evaluates the electromyographic (EMG) activity of lips and anterior temporalis muscles of children with competent or incompetent lips. STUDY DESIGN: Forty children were classified clinically according to their lip competence into two groups of 20 each: 1) competent lips group (CLG), and 2) incompetent lips group (ILG). Surface EMG activity of the superior orbicularis oris (SOO), inferior orbicularis oris (IOO), and anterior temporalis (AT) muscles was recorded with the children seated in the upright position during the following tasks: 1) at rest; 2) speaking; 3) swallowing; 4) puffing out the cheeks. RESULTS: ILG showed lower EMG activity than CLG in the SOO and IOO muscles at rest, similar activity in both muscles during speaking, similar activity in the SOO muscle and lower in the IOO during swallowing. ILG showed significantly higher activity than CLG in both muscles while puffing out the cheeks. In the AT muscle, ILG showed lower activity than CLG at rest, during speaking and swallowing, whereas activity was similar while puffing out the cheeks. CONCLUSION: The difference in EMG activity recorded in children with incompetent lips and with competent lips suggests that the status of their musculature could affect the position and stability of their upper/lower anterior teeth.

Chiari malformation Type I surgery in pediatric patients. Part 1: validation of an ICD-9-CM code search algorithm.

OBJECTIVE Administrative billing data may facilitate large-scale assessments of treatment outcomes for pediatric Chiari malformation Type I (CM-I). Validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code algorithms for identifying CM-I surgery are critical prerequisites for such studies but are currently only available for adults. The objective of this study was to validate two ICD-9-CM code algorithms using hospital billing data to identify pediatric patients undergoing CM-I decompression surgery. METHODS The authors retrospectively analyzed the validity of two ICD-9-CM code algorithms for identifying pediatric CM-I decompression surgery performed at 3 academic medical centers between 2001 and 2013. Algorithm 1 included any discharge diagnosis code of 348.4 (CM-I), as well as a procedure code of 01.24 (cranial decompression) or 03.09 (spinal decompression or laminectomy). Algorithm 2 restricted this group to the subset of patients with a primary discharge diagnosis of 348.4. The positive predictive value (PPV) and sensitivity of each algorithm were calculated. RESULTS Among 625 first-time admissions identified by Algorithm 1, the overall PPV for CM-I decompression was 92%. Among the 581 admissions identified by Algorithm 2, the PPV was 97%. The PPV for Algorithm 1 was lower in one center (84%) compared with the other centers (93%-94%), whereas the PPV of Algorithm 2 remained high (96%-98%) across all subgroups. The sensitivity of Algorithms 1 (91%) and 2 (89%) was very good and remained so across subgroups (82%-97%). CONCLUSIONS An ICD-9-CM algorithm requiring a primary diagnosis of CM-I has excellent PPV and very good sensitivity for identifying CM-I decompression surgery in pediatric patients. These results establish a basis for utilizing administrative billing data to assess pediatric CM-I treatment outcomes.