Dental and prosthodontic care for patients with cleft or craniofacial conditions.

Prosthodontic treatment has a long and rich history in the care of patients with cleft lip and palate. Because of increased knowledge of craniofacial growth and development and improved surgical and orthodontic treatment, today's cleft patients receive better care and in less time. This requires less prosthetic intervention. Still, prosthetics retains an important, if somewhat diminished, place in cleft care, and the prosthodontist remains an integral member of the cleft/craniofacial habilitation team. This review presents the current state of the art in dental/prosthodontic care for patients with cleft palate and related craniofacial anomalies.

An intraoral positioning appliance for stereotactic radiotherapy.

Stereotactic radiotherapy provides the most accurate and effective therapy and protects the adjacent, normal tissues. The head must be positioned the same for all treatments. This article describes the fabrication and application of a noninvasive intraoral appliance that verifies the position of the head to deliver more accurate radiotherapy and protect the adjacent, normal tissues.

Use of a surgical positioner for bone-anchored facial prostheses.

The use of osseointegrated implants to retain facial prostheses in craniofacial rehabilitation is a reliable procedure. Proper location of the implants is critical for fabrication of a prosthesis with ideal shape and contour. The use of a positioner at time of surgery can guide placement of the implants to achieve an optimum result. The positioner is also useful as a guide to the shape of the retentive element and as a quick method for obtaining a wax pattern for the prosthesis. This article describes-the fabrication and applications of a positioner.

Intraoral-appliance modification to retract the premaxilla in patients with bilateral cleft lip.

Management of the protrusive premaxilla in patients with bilateral cleft lip is challenging for the reconstructive team. Several intra- and extraoral orthopedic techniques to reposition the protrusive premaxilla prior to bilateral cleft lip repair have been presented in the literature. A modification to a previously described tissue-borne palatal plate with a latex strap is presented. In the modified plate, the latex strap is replaced by an orthodontic elastomeric chain, and the chain over the prolabium is covered with soft denture liner. This appliance is effective in retracting the premaxilla, noninvasive, easy to construct and adjust, economic, well tolerated by the patient, and accepted by the parents.

The role of subvocalization in auditory imagery.

Five experiments explored the utility of subvocal rehearsal, and of an inner-ear/inner-voice partnership, in tasks of auditory imagery. In three tasks (reinterpreting ambiguous auditory images, parsing meaningful letter strings, scanning familiar melodies) subjects relied on a partnership between the inner ear and inner voice, one similar to the phonological loop system described in the short-term memory literature. Apparently subjects subvocally rehearsed the imagery material, which placed the material in a phonological store that allowed the imagery judgement. In a fourth task (distinguishing voiced and unvoiced consonants in imagery), subjects still subvocally rehearsed, but seemed to need no additional phonological store to respond correctly. In this case they may have consulted articulatory or kinesthetic cues instead. In a fifth experiment (making homophone judgements), subjects hardly even needed to subvocally rehearse, a result suggesting that homophone judgements rely on some direct route from print to phonology. We consider the breadth of the partnership between the inner ear and inner voice, the level that subvocal rehearsal occupies in the cognitive system, and the functional neuroanatomy of the phonological loop system.

Hygiene procedures for implant-retained facial prostheses.

Implant-retained facial prostheses offer several advantages over facial prostheses that are retained with conventional skin adhesive. However, implant-retained prostheses also require additional hygiene procedures to maintain them in good condition and to keep the implants and retentive elements free of debris and the surrounding skin healthy. This article describes additional hygiene procedures to maintain the implant-retained prostheses.

Color characterization of denture base material.

The time taken to create a more natural prosthesis by twisting a tooth, carving wax and applying a few basic colors can make a world of difference for patients wearing dental prosthesis. The technician can achieve a natural resemblance of tissue coloration in the oral cavity when these procedures are applied.

Monobloc craniomaxillofacial distraction osteogenesis in a newborn with severe craniofacial synostosis: a preliminary report.

Severe craniofacial synostosis can be a devastating problem for a newborn infant. Reasons for early surgical intervention include cranial stenosis, hydrocephalus, inadequate globe and corneal protection, compromised airway patency, and feeding problems. In this preliminary report, we describe the management of severe craniofacial synostosis in a newborn infant by means of cranial and midfacial distraction osteogenesis.

Aerodynamic estimates of induced anterior orifice openings in human subjects.

This study first examined the accuracy of pressure-flow area estimates of experimental openings in anterior palatal obturators of three adult subjects. Second, we evaluated pressure-flow measures of the same experimental openings using a model. Results indicated that percent error in orifice estimates was slightly higher for induced openings in human subjects (13%) versus those in the model (11%). Results for our human subjects were similar to those reported by previous investigators.

Audiometric evaluation of prosthetic ears: a preliminary report.

A pilot study was conducted to measure the acoustic change provided by a prosthetic ear and to determine whether this change is functionally significant. Four subjects with acquired loss of the ear were tested. Objective data confirmed that the prosthesis provided acoustic gain. This gain may be significant only for individuals with a preexisting hearing loss.

Remembering emotional events.

Recent experiments have implied that emotional arousal causes a narrowing of attention and, therefore, impoverished memory encoding. In contrast, other studies have found that emotional arousal enhances memory for all aspects of an event. We report two experiments investigating whether these differing results are due to the different retention intervals employed in past studies or to their different categorization schemes for the to-be-remembered material. Our results indicate a small role for retention interval in moderating emotion's effects on memory. However, emotion had markedly different impacts on different types of material: Emotion improved memory for gist and basic-level visual information and for plot-irrelevant details associated, both temporally and spatially, with the event's center. In contrast, emotion undermined memory for details not associated with the event's center. The mechanisms for emotion's effects are discussed.

What an image depicts depends on what an image means.

Previous research has shown that subjects visually imaging the classical ambiguous figures have great difficulty in reconstruing these images. To explain this finding, we propose that subjects' construal of their image strongly influences what is depicted in the image, leading to the inclusion of some aspects of an imaged figure and the exclusion of others. Thus, images of (supposedly) ambiguous figures may literally omit information necessary for the reconstrual. To test this claim, we asked subjects to form an image of the duck/rabbit figure, and then to compare their image to drawings that departed slightly from the original figure. We hypothesized that subjects would have a clear image of the side of the figure they understood as the "face" (the left side if the image is understood as a duck, the right side for the rabbit). Conversely, subjects would have only a vague image of the "back" of the head. Consequently, in comparing their image to test stimuli, subjects should be able to detect variations in the contour of the "face," but not in the contour of the "back" of the animal's head. These predictions were confirmed, strongly suggesting that the construal of an image does dictate what is depicted within the image.

Neither pictures nor propositions: what can we learn from a mental image?

In an earlier paper, we reported that subjects have great difficulty in finding alternative construals of their own mental images. In the present paper, we examine how subjects can nonetheless learn from their mental images. We argue that mental images, like percepts, are meaningful depictions. As such, mental images do depict appearance but are also inherently understood in a certain way, and this understanding influences the phenomenal appearance of the represented form. This, in turn, governs what the form will be seen to resemble and what the form is likely to call from memory. We report four experiments in support of this view. In each experiment, subjects are briefly shown outline shapes and asked to form a mental image of each shape. Subjects are then asked what familiar form the imaged shape resembles. Subjects routinely find target shapes in their images when the target is compatible both with the imaged geometry and with how that geometry is organized and understood. When the sought-for target is compatible with image geometry but not with how the image is understood, subjects reliably fail to find the target shape in their images.

Nasal conformer to restore facial contour.

Surgical removal of the nose may have devastating psychologic effects on the patient. This article describes the fabrication and use of a nasal conformer to restore facial contour until a definitive nasal prosthesis can be made.

Vivid memories of emotional events: the accuracy of remembered minutiae.

It has been claimed that emotional arousal causes a narrowing of attention, and, therefore, impoverished memory encoding. On this view, if details of an emotional event are reported subsequently, these details must be after-the-fact reconstructions that are open to error. Our study challenges these claims. Using a long-term (2-week), incidental learning procedure, we found that emotion promotes memory both for information central to an event and for peripheral detail. This contrasts with the results of explicit instructions to remember or to attend closely to the event, both of which seem to promote memory for the event's gist at the expense of detail. The likely mechanisms underlying these effects are discussed.

A history of facial and ocular prosthetics.

This article traces the history of facial and ocular prosthetics. Creative individuals who have made significant contributions are highlighted and the evolution of techniques and materials is presented. In view of the significance placed upon facial beauty in today's society, it becomes incumbent upon us to recognize the ingenuity and skill of those in the past to gain appreciation for the present state of the art and to provide incentive for improving facial and ocular prosthetic restorations in the future.

"Enacted" auditory images are ambiguous; "pure" auditory images are not.

Previous research indicates that visual images are inherently unambiguous. The present study extends this argument to auditory imagery. In Experiment 1, subjects were able to reinterpret an imaged ambiguous auditory figure, but covert subvocalization apparently aided this reinterpretation. When subvocalization was blocked, reinterpretations were eliminated. Experiments 2 and 3 generalize this finding to different procedures and stimuli. Experiment 4 explores further the role of subvocalization, by showing that the likelihood of reinterpreting an imaged stimulus is directly proportional to the degree of enactment allowed. We argue that subvocalization or enactment provides an internal stimulus that is subject to reinterpretation. Without enactment, the "pure" auditory image is as unambiguous as a visual image. Thus, in both visual and auditory modalities, images come into being as representations and so are inherently meaningful.