Ear, nose and voice problems in children with orofacial clefts.

The purpose of this study was to compare the prevalence of ear, nose and particularly voice problems in groups of children with cleft palate (CP) and with unilateral cleft lip, alveolus and palate (UCLP). On the basis of history, regular otorhinolaryngological examinations and hearing tests, the prevalence of different pathologies was assessed in 80 CP children (35 boys and 45 girls) and 73 UCLP children (47 boys and 26 girls). Ear pathology was reported in 53.8 per cent of CP children and in 58.9 per cent of UCLP children. Nasal breathing was impaired in 14 CP (17.5 per cent) and 36 UCLP (49.3 per cent) children. Dysphonia was detected in 12.5 per cent of CP and 12.3 per cent of UCLP children. In 9.2 per cent of all cleft children, functional voice disorder caused a hoarse voice. Two-thirds of cleft children with functional dysphonia had protracted hearing loss. Therefore, ENT specialists must take an active role early in the treatment of children with clefts.

Characteristic forms of the upper part of the oral cavity in newborns with isolated cleft palate.

OBJECTIVE: To determine the functional and morphological compensation of the lack of integrity in the upper part of the oral cavity in newborns with isolated cleft palate. Integrity of the upper part of the oral cavity is required for the effective pumping of amniotic fluid, the essential mode of nutrition in intrauterine life. The adaptation could be seen immediately after birth. MATERIALS: Plaster casts of the upper part of the oral cavity in 60 newborns with isolated cleft palate of various extent and plaster casts of the upper part of the oral cavity in 27 newborns without cleft were used. A number of surface points were identified and used for a trigonometric morphological analysis. RESULTS: The parameters of the upper part of the oral cavity in four groups of newborns with various extent of isolated cleft palate were compared with newborns without cleft palate. The results indicate a shift of the functional oral cavity into the nasal cavity and the pharynx, depending on the extent of the cleft. CONCLUSION: The pumping activity of the tongue forms the upper part of the oral cavity and consequently the tongue moves into the nasal cavity and pharynx, depending on the extent of the cleft. In this way, effective pumping of amniotic fluid is possible despite the cleft. This is of vital importance for the fetus during intrauterine life. A poorly passable or even unpassable respiratory way is only of secondary importance during that time.

Time series analysis of births of children with orofacial clefts.

Observation of the dates when children with orofacial clefts were born, gives the impression that they were born in clusters, between which there were intervals of different duration. An analysis was therefore undertaken of the period between 1972 to 1997 when 1112 such children were born. For diagnostic checking of stationarity of the time series the Box-Ljung test was used. Since it was found that the time series was stationary, analysis of autocorrelation function was performed. The results confirmed the impression that children with clefts are born in clusters, between which there are gaps of different duration. This suggests that the birth of a child with a cleft is not a random and independent event.

Immune response in chronic periapical parodonititis.

The purpose of our study was to investigate the immune response in chronical periapical parodontitis (CPP) by using multidisciplinary approach. 30 CPP samples were obtained after surgical removal--apicoectomy. Each CPP sample was examined by histological, bacteriological and flow cytometrical (FC) analysis of lymphocytes infiltrating CPP samples. Ten percent of bacteriological samples were sterile, others had significant aerobic and anaerobic growth. We used pathohistologic and microbiologic findings and compared them to the results of immunological analysis. By FC we found a significant increase in proportions of T lymphocytes expressing interleukin-2 receptors and ICAM-1 compared to peripheral blood lymphocytes. Proportions of T helper cells that produce interferon-gama (IFN-gamma) was higher in CPP samples predominantly colonized by anaerobic bacteria. There were no differences in IL-4 expression by T cells in both groups (anaerobic and streptococcal). Among anaerobic CPP samples differences in proportion of T cells that express IL-2 receptors expression was also found between samples colonised by P. acnes and Bacteroides sp. Oral streptococci cause relatively limited tissue destruction and induce Th2 type of immune response accompanied by non-cytotoxic inflammatory reaction. On the contrary, anaerobic bacteria induce Th1 type of immune response that cause more severe inflammatory reaction (type 4) of hypersensitivity that damage the tissue by the action of cytotoxic T cell activation.

The basis for presurgical orthopedic treatment of infants with unilateral complete cleft lip and palate.

OBJECTIVE: The purpose of this study was to describe the posttreatment morphology of the upper part of the oral cavity of complete unilateral cleft lip and palate (UCLP) patients and to compare it to noncleft contemporaries. Patients were treated according to a protocol designed to keep a proper resting posture of the oral cavity. DESIGN: Retrospective study on dental casts. SETTING: The study was performed at a maxillofacial center serving a population of 2 million inhabitants. Data for noncleft subjects are the result of a longitudinal study at the same institution. PATIENTS: Twenty-one Caucasian UCLP patients (13 males, 8 females) aged 5 to 9 years with no other congenital anomalies and no postoperative orthodontic treatment. INTERVENTIONS: Each patient received 5 to 6 months of preoperative orthopedics with a passive plate and external nonelastic strapping with definitive lip repair at age 5 to 7 months, soft palate repair at 11 to 15 months, and hard palate repair with mucoperiosteal closure of the alveolus at 30 to 36 months. Each patient was compared to the mean values obtained from a longitudinal study of a group of 25 healthy noncleft children of the same ethnic group (11 males, 14 females). RESULTS: Analysis of dental casts indicated that 16 patients had a width, depth, and length of the alveolar arch in the range of the mean normal values minus two standard deviations. Their analyzed palates were flatter than normal. Six of 21 children had too small an alveolar arch for their ages, and they did not acquire a correct posture of the oral cavity. CONCLUSION: The results indicate that the upper part of the oral cavity of UCLP patients can reach the dimensions of noncleft contemporaries despite surgery.

Changes produced by presurgical orthopedic treatment before cheiloplasty in cleft lip and palate patients.

OBJECTIVE: The purpose of this study was to test the hypothesis that, with the use of preoperative treatment, the dimensions of the upper part of the oral cavity of an infant with unilateral cleft lip and palate (UCLP) become more similar to those of a noncleft infant. DESIGN: This was a retrospective study of upper dental casts taken at birth and prior to lip repair at 6 months of age. A treated group, an untreated group, and a group of noncleft contemporaries were compared cross-sectionally and longitudinally. Models were analyzed by the trigonometric method. SETTING: The study was performed at a maxillofacial center servicing a population of two million. PARTICIPANTS: The treated group consisted of 24 babies born after 1990 with UCLP that started presurgical treatment within 20 days of life. The untreated group consisted of 25 randomly selected UCLP casts taken at birth and 25 casts taken just before lip surgery. The noncleft group consisted of 25 full-term infants whose mothers participated in the longitudinal growth study. All participants belonged to the same ethnic group. INTERVENTIONS: Presurgical treatment consisted of the babies constantly wearing a thin, passive acrylic plate mimicking the normal palate and a slim adhesive tape fixed to the lip segments to bring them slightly together. RESULTS: The upper oral cavity in a newborn with UCLP was significantly larger than in a noncleft infant, the only exception being in the sagittal dimension. After presurgical treatment, the upper oral cavity was remodeled and slightly enlarged; there was a lesser difference from the noncleft at 6 months than at birth. The cleft in the alveolus reduced significantly, and the position of the incisive point improved. The group without presurgical treatment had no remodeling, and the growth dynamics were similar to the noncleft so that the dimensional differences from the normal remained the same as at birth. CONCLUSION: The morphological characteristics of the upper part of the mouth change if the functional conditions in the oral cavity are changed. Infants with presurgical orthopedics become more similar to noncleft contemporaries than those without presurgical orthopedics.

Inflammatory dentigerous cysts of children treated by tooth extraction and decompression--report of four cases.

Inflammatory dentigerous cysts are only found in the mixed dentition. The four cases presented here illustrate the uncomplicated behavior of these cysts when properly treated. By extracting the infected primary teeth, opening the cyst and ensuring continuous drainage, it is possible to achieve spontaneous eruption of the involved permanent teeth into the dental arch even if they are badly dislocated. Simultaneous with the eruption of the permanent teeth, ossification of the bony defect can take place. The reparatory process is completed in one to two years.

Epidemiology of orofacial clefts in Slovenia, 1973-1993: comparison of the incidence in six European countries.

For over 40 years, all children with orofacial clefts in Slovenia have been treated at the Department of Maxillofacial Surgery in Ljubljana, which maintains a register of these anomalies. Since 1987, clefts have also been registered within the framework of the perinatal Information System. An analysis of patients included in each of the two sources showed that an estimated 3.5% of cases were missing from the Cleft Register of the Department of Maxillofacial Surgery and 15% from the Perinatal Registry. The incidence of clefts in the period 1973-1993 was 1.64 per 1000 live births, with an increasing trend of 0.02 per year. Considerable differences were established among different geographic regions of Slovenia. Comparison with the data for Finland, Denmark, Hungary, Poland and Bohemia revealed some synchronicity of fluctuations in the incidence of clefting in these countries. The last two observations suggest that exogenous factors of two types play a part in the aetiology of orofacial clefts: some are limited in their action to a small geographical area, while others exert their influence simultaneously in areas several thousand kilometers apart.

[Measurement of adrenalin concentrations in the blood of children after local infiltration before surgical corrections of clefts]. / Merjenje koncentracije adrenalina v krvi otrok pri lokalni apliaciji pred operacijo shize.

Blood concentrations of epinephrine were measured after local infiltration of epinephrine and procaine in children, undergoing surgical corrections of lip and palate clefts. Local anaesthesia was combined with general intravenous anaesthesia. Cardio-circulatory parameters were changing moderately in spite of enormous elevations of epinephrine serum levels. Monitoring of vital signs is obligatory with this combined method.