The presurgical status of the alveolar cleft and success of secondary bone grafting.

OBJECTIVE: The primary purpose of this study was to evaluate presurgical status of the alveolar cleft site and success of secondary alveolar bone grafting. DESIGN: Thirty patient records were retrospectively reviewed. Patients selected for inclusion had isolated cleft of at least the primary palate. Patients with additional anomalies were not selected. The study population consisted of 15 female sites and 16 male cleft sites. There were two bilateral cleft lip and palate (CLP) patients and 28 unilateral CLP patients. The age at the time of the secondary alveolar bone grafting ranged from 7 years to 14 years, 4 months. SETTING: The study was conducted at the Cleft Palate Clinic at the University of Minnesota, School of Dentistry. METHOD: Presurgical radiographs taken at least 1 month prior to the secondary bone grafting and postsurgical radiographs taken at least 6 months after bone surgery were measured. Measurements included size of the cleft defect and bone support for distal and mesial teeth adjacent to the cleft. Evaluation of success was determined on the basis of postsurgical measurements of satisfactory, intermediate, and unsatisfactory outcomes. RESULTS AND CONCLUSION: The size of the cleft defect was not correlated with the success rate of the secondary alveolar bone grafting. If the amount of distal bone support for the mesial tooth was the same as those in a periodontally healthy individual, a satisfactory outcome was 5.8 times more likely. If the amount of mesial bone support for the distal tooth was the same as those in a periodontally healthy individual, the satisfactory outcome was 3.8 times more likely. Although not a primary purpose of the study, it was found that in this study population, if the patient was female, a satisfactory outcome was 3.8 times more likely.

Acquisition of linguistic and cognitive skills by children with cleft palate.

This study compared the early cognitive and linguistic development of young children with cleft palate (N = 28) to that of noncleft children (N = 29). Measures included the Mental scale of the Bayley Scales of Infant Development, the Minnesota Child Development Inventory, Mean Length of Utterance, and words acquired by 24 months. Children with cleft palate, although well within the normal range, performed significantly below the children in the control group on the Mental Scale of the Bayley Scales of Infant Development, some subscales of the Minnesota Child Development Inventory, and words acquired by 24 months. Differences observed in the cognitive development of children with and without cleft palate were verbal as opposed to nonverbal (i.e., linguistic in nature) and were related to hearing status at 12 months and velopharyngeal adequacy.

Antibiotics in irrigation solution for cataract surgery. A laboratory investigation of the pharmacological stability and bacteriological susceptibility.

PURPOSE: To evaluate the appropriateness of a prophylactic use of Gentamicin and Vancomycin in the irrigation solution for cataract surgery. METHODS: A laboratory study of the pharmacological stability and the bacteriological susceptibility of the two antibiotics and epinephrine in the irrigation solution. RESULTS: Gentamicin and Vancomycin are pharmacologically stable in concentrations above the MIC-values of most Gram positive and Gram negative bacteria without reaching toxic levels. CONCLUSION: Although it seems tempting to add Gentamicin and Vancomycin in irrigation solutions for cataract surgery, major objections to such a prophylactic use of antibiotics have been stated, specially focusing on the risk of emerging resistance to the antibiotics, and the financial implications.

Comparison of the hearing histories of children with and without cleft palate.

Aggressive otologic management has been recommended for children with cleft palate because of the almost universal occurrence of otitis media with effusion (OME) in these children and the association of OME with hearing loss and possible language, cognitive, and academic delays. In this study, 28 children with cleft palate and 29 noncleft children were seen at 3-month intervals from 9 to 30 months to compare otologic treatment and management. Hearing and middle ear function were tested at each session; information on ventilation tube placement was obtained from medical records. Ventilation tubes were placed earlier and more often in children with cleft palate, but children with cleft palates failed the hearing screening more often. The correlation between age at first tube placement and frequency of hearing screening failures was significant for the children with cleft palate, indicating that the later tubes were first placed, the poorer the child's hearing.

An approach to evaluation of velopharyngeal adequacy for speech.

The diagnosis and evaluation of velopharyngeal concerns is complex. It involves a variety of assessment techniques--both indirect, such as speech, and direct, using instrumentation to delineate how the velopharyngeal structures function. However, the most important tools we have for making decisions regarding velopharyngeal function and need for management are the speech characteristics. From thorough analysis of speech, there is much that can be learned about the status of velopharyngeal function and potential for change. The ultimate question that the speech diagnostician must attempt to answer concerns adequacy of velopharyngeal structures and function for producing acceptable speech.

The Dubowitz syndrome: a retrospective.

The purpose of the article is to update information concerning Dubowitz syndrome. A review of the literature since the disorder was originally described in 1965 is presented. In addition, case reports are presented for two siblings described in 1971 describing speech and dental development and current clinical findings. Analysis of approximately 30 cases reveals prevalence of growth failure and delayed bone age, mild microcephaly, broad forehead with sparse frontal hair, telecanthus, blepharophimosis, abnormal pinnae, broad nose, and micrognathia. Overt cleft palate or submucous cleft palate is not a prevalent finding (16%). High-pitched and hoarse voice quality appears to be a constant feature. There is the suggestion of an association with leukemia, lymphoma, and neuroblastoma. Inheritance appears clearly autosomal recessive.

Speech ratings by speech clinicians, parents and children.

Ratings of speech samples of children with cleft palate were obtained from speech clinicians in a Cleft Palate Clinic, speech clinicians in the public schools, parents of children with clefts, parents of children without clefts, children with clefts and children without clefts. Analyses of the obtained ratings suggest that nasality and articulation ratings obtained from adult groups do not differ appreciably. Correlations between ratings of nasality and articulation are interpreted as suggesting that speech clinicians are more likely to differentiate between these two variables than other listener groups.

The effects of listening conditions on speech rating obtained in a clinical setting.

The effects of listening conditions on speech ratings from trained listeners were assessed in a clinical setting. The listening conditions were: (1) while face-to-face with the patient; (2) while observing the patient through a mirror and listening via a sound system; and (3) while listening to a tape recording of the patient. Analysis of 100 patients rated under each listening condition revealed no significant condition effects for resonance and articulation judgments. Voice ratings in the face-to-face condition were different from those made in the other conditions.

The effects of feedback filtering on nasalization in normal and hypernasal speakers.

Two groups of subjects, one with normal speech and one with hypernasal speech, spoke while hearing their voices unfiltered, low-pass filtered with cut-off frequencies of 1000, 500, and 300 Hz and high-pass filtered with cut-off frequencies of 500, 1000, and 2000 Hz. Measurements of nasalization were made with a miniature accelerometer attached to the side of the subject's nose. Both groups of subjects decreased nasalization when hearing their voices low-pass filtered with a cut-off frequency of 300 Hz. This decrease was statistically significant. The results were interpreted as supporting the hypothesis that nasalization is under feedback control.