Trigeminal somatosensory evoked magnetic fields to tactile stimulation.

OBJECTIVE: To characterise the activation of the contra- and ipsilateral primary somatosensory cortex (SI) after tactile stimulation of the face. METHODS: Trigeminal somatosensory evoked magnetic fields (TSEFs) were recorded after tactile stimulation of the lower lip, cheek, chin and forehead in 11 healthy subjects. The responses were determined visually from the waveforms and modelled with equivalent current dipoles (ECDs). RESULTS: Contralateral SI responses were evoked in all subjects after lip stimulation, and in 91% and 64% after right and left cheek, 73% and 82% after chin and 64% and 27% after forehead stimulation. The responses usually showed an early double-peak wave pattern, the underlying sources localising to the SI. In addition, altogether 37 ipsilateral SI responses were evoked in eight subjects. Fourteen of these responses were amenable to ECD modelling and localised to ipsilateral SI. CONCLUSIONS: Tactile stimulation of the lip area reliably activates the contralateral SI in normal subjects, but the success rate for other trigeminal areas is lower. Ipsilateral responses can be present after stimulation of any of the trigeminal branches in normal subjects. SIGNIFICANCE: Recording of TSEFs after tactile stimulation of particularly the lip area provides a non-invasive technique to study the function of the trigeminal nerve.

Serum lipid fatty acids and temporal processing acuity in children with oral clefts.

We investigated the relation between a biological factor (fatty acids, FA) and a cognitive processing speed factor (temporal processing acuity, TPA) that are both suggested to relate to neuronal and cognitive functioning. Blood samples of 49 ten-year-old children with oral clefts were collected for FA analysis in serum triglycerides, cholesteryl esters, and phospholipids on the same day as they performed behavioral TPA tasks (simultaneity/nonsimultaneity judgments) in several perceptual modalities (visual, auditory, tactile, audiotactile, visuotactile, and audiovisual). This population has larger than expected variation in the relevant cognitive measures (TPA, learning ability, and intelligence). Sequential regression analyses (adjusted for age, gender, and cleft type) showed that saturated FAs were not generally associated with TPA. Monounsaturated erucic and nervonic acids were inversely related with TPA. Of the polyunsaturated fatty acids, eicosapentaenoic and docosahexaenoic acids were positively associated with TPA, whereas gamma-linolenic acid was inversely related to TPA. In summary, we found significant relations between a biological (certain FAs) and a cognitive factor (TPA).

Serum lipid fatty acids, phonological processing, and reading in children with oral clefts.

Reading skill is suggested to be related to phonological processing ability and polyunsaturated fatty acids (PUFAs). Here we investigated whether fatty acids (FAs) are related to phonological processing, whether the relations between PUFAs and reading generalize to other FAs, whether these relations are mediated by phonological processing, and whether relations of FAs are specific for language-related functions. Blood samples of 49 ten-year-old children with oral clefts were collected for FA proportion analysis in serum cholesteryl esters and phospholipids. On the same day, they performed tasks of phonological processing, reading, and both verbal and nonverbal intelligence. Sequential regression analyses (adjusted for age, gender, and cleft type) showed that phonological processing was inversely related to myristic acid in phospholipids and positively related to eicosapentaenoic acid in cholesteryl esters. Reading was inversely related to palmitoleic and gammalinolenic acids in phospholipids. The relations between FAs and reading were not mediated by phonological processing and FAs related only to language-related functions.

Associations between lateral cephalometric dimensions and misarticulations of Finnish dental consonants in cleft lip/palate children.

The purpose of this study was to examine the associations between lateral cephalometric variables and the misarticulation of /r/, /s/ and /l/ sound in cleft lip/palate children. The subjects were 134 Finnish-speaking 6-year-old boys with isolated cleft palate (CP, n = 33), unilateral (n = 44), bilateral (BCLP, n = 19) cleft lip and cleft lip/alveolus (n = 38); /r/, /s/ and /l/ distortions were obtained from original hospital records which were based on perceptual speech follow-ups performed by experienced speech pathologists. Cephalometric measurement points were determined from standardized lateral roentgen cephalograms and traced twice by a computer-connected digitizer. The data were entered into a microcomputer and analysed by NCSS 6.0 for Windows using appropriate tests. The results revealed new significant associations between cephalometric measurements and misarticulations, especially that of the /r/ sound in CP and BCLP groups. Children with /r/ distortion had upward rotation of the mandible, maxillary protrusion and a higher position of the hyoid bone in the CP group. In the BLCP group, on the contrary, the mandible had downward rotation, mandibular retrusion and narrower nasopharyngeal port. The /s/ and /l/ sounds were less clearly associated with craniofacial morphology. The anteroposterior relationship of the maxilla and the mandible did not have any association with dentoalveolar misarticulations, instead, the systematic vertical, particularly posterior relationship of the jaws seems to be associated with /r/ sound production in CP and BCLP boys.

Association between velopharyngeal function and dental-consonant misarticulations in children with cleft lip/palate.

We studied the association between velopharyngeal function and misarticulation of the dental consonants /r/, /s/ and /l/ in children with cleft lip/palate. We assessed 278 6-year-old Finnish-speaking non-syndromic children (115 girls, 163 boys) with isolated cleft palate (n= 81), cleft lip/alveolus (n= 82) or unilateral (n= 84) or bilateral (n= 31) cleft lip and palate. Auditory analysis of speech and velopharyngeal function, the presence of fistulae, previous velopharyngoplasty and speech therapy, as well as surgical technique and timing of primary palatal surgery were obtained from the hospital records. The misarticulations of the sounds /r/, /s/ and /l/ were evaluated in spontaneous speech by two experienced speech pathologists from the cleft team. Velopharyngeal function was categorised, on the basis of the effect on speech, into competent, marginal incompetent and obvious incompetent. Nasal grimace and distortions due to palatal fistulae were registered. The results indicated that velopharyngeal function was not significantly associated with misarticulation of any of the sounds /r/, /s/ and /l/ or their combinations in any cleft groups. The technique and timing of primary palatal surgery, the presence of fistulae and previous pharyngoplasty were not associated with misarticulations. On the basis of these results we conclude that dental-consonant misarticulations occur independently of velopharyngeal function, primary palatal surgical technique and timing of palatoplasty.

Comparisons of speech aerodynamics and lateral craniofacial cephalometrics in cleft lip and palate patients with and without Finnish /r/-sound distortion.

To study the associations between the articulation of the Finnish /r/ sound and dentofacial and pharyngeal lateral cephalometric morphology and speech physiology, 18 (12 females, 6 males) young adult cleft patients' /r/ sound was analysed auditorily by 3 speech experts. Laryngeal resistance (LARE), the smallest nasal cross-sectional area (NASA), nasal resistance (NASAR) and velopharyngeal orifice area (VEPA) were measured with pressure flow technique, and 31 points were identified from the lateral cephalograms to landmark the skeletal structure, pharyngeal airway diameters, and position of the hyoid bone. The present results showed no significant differences in lateral cephalometric skeletal, nasopharyngeal, oropharyngeal or hypopharyngeal morphology between subjects with and without /r/-sound distortion. There were no significant correlations either between /r/ distortions and NASA, NASAR or VEPA. An anteriorly positioned hyoid bone was significantly associated with decreased LARE and /r/ distortion. LARE was significantly lower in subjects with /r/ distortion.

Velopharyngeal function from the age of three to eight years in cleft palate patients.

The purpose of this investigation was to study changes of velopharyngeal function between the ages of 3 and 8 years. The subjects were 65 (30 girls and 35 boys) Finnish-speaking non-syndromic children with isolated cleft palate (CP, n = 35) and with unilateral cleft lip and palate (UCLP, n = 30) operated primarily at the age of 1.0-2.0 years. Before the age of 8 years, 16 children required velopharyngoplasty (VPP, ad modum Hoenig). The children were followed up for speech at the age of 3, 6 and 8 years. The perceptual speech characteristics nasal air emission, hypernasality, weakness of pressure consonants and compensatory articulations were registered. Indications for a velopharyngeal flap (by VPP) were identified on the basis of perceptual speech characteristics and confirmed by instrumental examinations. The results indicated that the method and timing of primary palatoplasty and sex did not correlate with the quality of velopharyngeal function. It was good both in children treated conservatively or with VPP at the age of 8 years. The children with a flap required speech therapy significantly more often than other children. No child with VPP and only 12% of the children without VPP had simultaneous nasal air emissions and hypernasality. Compensatory articulation was completely eliminated and weakness of pressure consonants was diagnosed only in 1 child without VPP. The CP children required significantly more often a velopharyngeal flap than the UCLP children. In conclusion, the CP and UCLP children develop a similar velopharyngeal function but in a different way.

Changes in Finnish dental consonant articulation in cleft lip/palate children between 6 and 8 years of age.

The aim of this study was to clarify changes in the occurrence of misarticulations of dental consonants /r/, /s/ and /l/ between 6 and 8 years of age in cleft-affected Finnish children and to compare the effects of gender and to estimate if spacing due to changing of maxillary incisors could explain changes in articulation of these sounds. The subjects were 133 (47 girls, 86 boys) Finnish-speaking non-syndromic children with isolated cleft palate (n = 34), cleft lip/alveolus (n = 49), unilateral (n = 33), and bilateral (n = 17) cleft lip and palate. The results showed that there were no statistically significant differences between genders according to changes in articulation abilities by the age of 8 years. Eighty-one percent of the subjects with misarticulations at the age of 6 years still misarticulated at 8 years of age, and 16% of the subjects without misarticulations at the age of 6 years misarticulated at the age of 8 years; /s/ and /l/ misarticulations were eliminated more often than /r/ errors. New misarticulations were diagnosed at the age of 8 years in the same way in the groups with (14%) and without (16%) misarticulations at the age of 6 years. Dental arch spacing due to changing of maxillary incisors does not seem to explain new misarticulations of /r/, /s/ and /l/ sounds estimated at the age of 8 years.

Dysfunction of the auditory cortex persists in infants with certain cleft types.

Language and learning disabilities occur in almost half of individuals with oral clefts. The characteristics of these cognitive dysfunctions vary according to the cleft type, and the mechanisms underlying the relation between cleft type, cognitive dysfunction, and cleft-caused middle-ear disease are unknown. This study investigates preattentive auditory discrimination, which plays a significant role in language acquisition and usage, in infants with different cleft types. A mismatch negativity (MMN) component of brain evoked potentials, which indexes preconscious sound discrimination, and brain responses to rare sine-wave tones were recorded in 12 healthy infants and 32 infants with oral clefts at the ages of 0 and 6 months. Infants with clefts were subdivided into two categories: those with cleft lip and palate (CLP) (n=11 at birth, n=6 at the age of 6 months) and those with cleft palate only (CPO) (n=17 at birth, n=8 at the age of 6 months). At both ages, brain responses to rare sounds tended to be smaller in both cleft subgroups than in healthy peers. However, in the latency range of 300 to 500 ms, the MMN was significantly smaller in infants with CPO. In infants with CLP, the MMN was comparable to that of healthy infants. Differences in auditory discrimination between infants with CLP and CPO, as reflected by MMN, were detectable at birth and persisted into later infancy. This pattern parallels known behavioural differences between children with these cleft types. Brain responses to rare sounds, in contrast, had no differentiative power with respect to the cleft type.

Cortical auditory dysfunction in children with oral clefts: relation with cleft type.

OBJECTIVE: Up to 46% of individuals with oral clefts suffer from language-learning disabilities. The degree of these disabilities varies according to cleft type. The pathogenesis of cognitive malfunctioning or its relationship with cleft type is not known. We investigated persistence of auditory short-term memory (STM) that is implicitly involved in language-specific perception in children with clefts, grouped using fine-graded cleft classification. METHODS: Cortical evoked potentials were recorded in 78 children with non-syndromic oral clefts and in 32 healthy peers. A mismatch negativity (MMN) potential that indexes preattentive detection of change in auditory input was obtained in response to tone sounds. In order to test durability of short-term memory traces, sounds were presented with three stimulation rates. RESULTS: With slowest stimulation, MMN amplitudes were reduced in cleft children as compared to the healthy peers (P < 0.00065). Only cleft-lip children did not significantly differ from controls. Among isolated palatal clefts, the more posteriorly delimited the cleft was, the smaller was the amplitude of MMN. MMNs of smallest amplitudes were obtained in the subgroup of complete unilateral cleft of lip and palate. CONCLUSIONS: Reduced MMN amplitudes, found in cleft children, imply deficiency in auditory STM trace maintenance. This dysfunction is likely to contribute to their language and learning disabilities. The MMN diminution with shorter/more posterior clefts suggests that differences in auditory cortex function are one of the underlying mechanisms of the cleft type-malcogniton association.

Associations between dental occlusion and misarticulations of Finnish dental consonants in cleft lip/palate children.

The purpose of this study was to examine whether malocclusions in terms of crossbites, large maxillary overjet, and deep bite are related to the articulatory problems with the Finnish dental consonants /r/, /s/ and /l/ in different cleft types and gender. The subjects were 260 (108 girls, 152 boys) 6-yr-old Finnish-speaking non-syndromic children with isolated cleft palate (CP, n = 79), cleft lip/alveolus (CL(A), n = 76), unilateral (UCLP, n = 78), and bilateral (BCLP, n = 27) cleft lip and palate. Occlusal anomalies were evaluated from dental plaster casts, and speech was analyzed by two speech pathologists with a high reliability. Altogether, 43% of patients misarticulated at least one of the studied sounds, and had crossbites significantly more often (73%) than subjects with correct /r/, /s/ and /l/ production (45%). Posterior crossbites were significantly associated with defective articulation, whereas anterior crossbite alone, large maxillary overjet, or deep bite were not. It was concluded that occlusal abnormalities in terms of posterior crossbites should be considered as a risk factor for correct dental consonant articulation in cleft-affected subjects.

Brain dysfunction in neonates with cleft palate revealed by the mismatch negativity.

OBJECTIVES: Our recent studies have demonstrated that the brain's automatic change-detection response, the mismatch negativity (MMN) of the event-related brain potential (ERP), is significantly attenuated in school-age children with CATCH syndrome and in children of the same age with cleft palate but without the CATCH syndrome. Among other problems, various kinds of learning difficulties are commonly reported in these patient groups. The present study aimed at investigating whether the MMN is attenuated already in newborns with cleft palate compared with healthy controls. METHODS: Stimuli of 1000 Hz were presented frequently and 1100 Hz infrequently to 9 neonates with cleft palate and to 8 healthy controls. Infrequent 1100 Hz stimuli elicited a prominent MMN in all of the healthy children, but only in 3 of the 9 infants with cleft palate. RESULTS: A significant difference in the mean amplitudes of responses to deviant tones between the healthy and cleft palate neonates was found. CONCLUSIONS: MMN may indicate brain dysfunctions long before they have manifested themselves in cognitive disabilities, which would enable one to identify the infants with an elevated risk and to start their rehabilitation much earlier than before.

The association between dental arch dimensions and occurrence of Finnish dental consonant misarticulations in cleft lip/palate children.

The aim of this study was to examine whether maxillary and mandibular dental arch width, length, and palatal height dimensions are associated with the occurrence of misarticulations (phonetic or phonologic errors) in the dental consonants /r/, /s/, and /1/ in different cleft types and sexes. The subjects were 263 (109 girls, 154 boys) 6-year-old Finnish-speaking non-syndromic children with isolated cleft palate (CP, n=79), deft lip/alveolus (CL(A), n=77), unilateral (UCLP, n=80), and bilateral (BCLP, n=27) cleft lip and palate. Dental plaster casts were measured by two authors using the technique of Moorrees, and auditive speech was analyzed with high reliability by two speech pathologists. The results showed that the occurrence of misarticulations increased and dental arch dimensions decreased with the severity of the cleft. Narrower and shorter maxillary arches as well as shallower palates were related to problems with the studied dental consonants. Mandibular arch dimensions were not related to the misarticulations. However, statistical analysis did not reveal significant differences in dental arch dimensions between subjects with and without misarticulations when they were compared separately for different cleft types. The etiology of clefting per se--isolated deft palate versus cleft lip with or without deft palate--did not seem to explain the associations between dental arch dimensions and the studied misarticulations.

Mismatch negativity (MMN) as an index of auditory sensory memory deficit in cleft-palate and CATCH syndrome children.

Our recent study demonstrated with the brain's automatic change-detection response, the mismatch negativity (MMN) of the event-related potentials (ERPs), that the duration of auditory sensory memory is significantly shorter in school-age children with CATCH syndrome than in healthy age-matched controls. One of the characteristic symptoms of this syndrome, caused by a microdelection in chromosome 22, is cleft palate. The most common problems in these children, however, are learning difficulties and, according to our results, it is likely that these problems are not due to the dysmorphology of peripheral speech mechanisms only but are also caused by CNS dysfunctions. In the present study we show with MMN that auditory sensory memory is also shortened in school-age children with cleft palate but without the CATCH syndrome. It has been shown in previous studies with neuropsychological tests that although children with cleft palate have language and learning-related problems these difficulties are usually less severe than those of CATCH children. Likewise the present study demonstrates that the auditory sensory memory trace seems to decay more rapidly in CATCH children than in children with cleft palate.

Occurrence of dental consonant misarticulations in different cleft types.

To study the occurrence and type of misarticulations in dental consonants /r/, /s/ and /l/ 280 (115 girls, 165 boys) 6-year-old cleft children were examined by 1 of the 2 experienced speech pathologists of the cleft team. The patients included 82 children with isolated cleft palate (CP), 82 with cleft lip with (34) or without (48) cleft alveolus [CL(A)], 85 with unilateral cleft lip and palate (UCLP) and 31 with bilateral cleft lip and palate (BCLP). CP children were first divided into subgroups; there were 17 children with soft palate cleft, 49 with partial and 16 with complete hard palate cleft. All patients were native Finnish speakers, and had normal hearing, no known syndrome or associated anomalies possibly affecting speech or psychomotor retardation. The results showed that the occurrence and severity as well as the number of errors of all studied sounds separately or grouped increased with the severity of the cleft being constantly greatest in the BCLP group and lowest in the CL(A) group. Altogether 44% of the patients misarticulated at least one studied sound; 41% distorted and 5% substituted, and 2% both distorted and substituted. The /r/ sound was misarticulated by 36%, the /s/ sound by 23%, and the /l/ sound by 18% of the patients. Boys tend to have more problems in producing the studied sounds correctly.

Correlation between speech outcome and cephalometric dimensions in patients with diastrophic dysplasia.

Diastrophic dysplasia (DTD) is a recessively inherited form of osteochondrodysplasia, presenting with disproportionate short stature and multiple orthopedic problems. The clinical oral manifestations include either cleft palate or submucous cleft palate in at least half of the patients. Histological studies have shown alterations in growth plate, articular, laryngeal, tracheal, and ear cartilages. Mutations in the DTDST gene, which codes for the sulphate transporter membrane protein, are responsible for the disease. Thirty-three patients were studied for speech characteristics and their correlation with cephalometric dimensions. Hyponasality was observed in 13 and misarticulation of /R/, /S/, or /L/ sounds in 17 of the 33 patients. Neither of these correlated with the occurrence of palatal deformities. Hyponasality was atypical and did not correlate with the obtained nasalance scores. Cephalometric measurements reflecting the size of the orofacial area of the vocal tract were short in the DTD patients compared with those in the healthy controls. The specific speech characteristics in DTD probably result from both the altered size and shape of the vocal tract and the structural and functional abnormalities of the laryngeal and tracheal cartilages.

The first neurophysiological evidence for cognitive brain dysfunctions in children with CATCH.

CATCH syndrome, caused by a microdelection in chromosome 22, is characterized by cleft palate and cardiac anomalies. The majority of these children also have learning difficulties or speech and language deficits. These problems are often due to the dysmorphology of the articulatory system. In the present study, the duration of auditory sensory memory, which is of central importance to speech perception and understanding, was investigated. As a research method we used mismatch negativity (MMN), an attention independent event-related potential, which provides an objective electrical index of auditory sensory memory. The present data suggest that the duration of this memory span is considerably shorter in 6-10-year-old children with CATCH than in healthy controls. Thus, the language-related problems encountered in children suffering from CATCH syndrome are likely to be caused also by CNS dysfunctions.

Velopharyngeal function in association with artificial obstruction of the nose: a videonasendoscopic study.

Artificial obstruction of the nose can make the nasal cavity a cul-de-sac resonator, which has clearly audible consequences. The present study compares videonasendoscopic views of the velopharyngeal mechanism in test words uttered with the nose open and obstructed in 20 subjects with a Pierre Robin sequence and in 6 subjects without this sequence. A velopharyngeal flap was constructed on 12 subjects. Videonasendoscopic findings were assessed by 3 judges with acceptable agreement. The results indicated that impairment of velopharyngeal function occurred significantly more often in subjects with a velopharyngeal flap. This was attributed to aerodynamic reasons. Clinical implications of the results are discussed.

Velopharyngeal function in cleft patients undergoing maxillary advancement.

Maxillary advancement may result in movement of the posterior border of the hard palate with its soft palate attachment, which may cause impairment of velopharyngeal (VP) function. We examined VP function before and after Le Fort I osteotomy in 15 cleft lip and palate patients. The extent of maxillary advancement was measured by means of standard cephalometric radiographs taken before and after the operation. VP function was evaluated in terms of perceptual speech assessments, pressure-flow data and nasalance scores preoperatively and 2, 6 and 12 months after the operation. The results showed that maxillary advancement resulted in impairment of VP function in 4 (27%) of the patients.