Spectrographic measures of the speech of young children with cleft lip and cleft palate.

Twenty-two consecutive children with repaired cleft lip and/or palate [isolated cleft lip (CL) 6, isolated cleft palate (CP) 7, unilateral cleft lip and palate (UCLP) 7, and bilateral cleft lip and palate 2] with a mean age of 27 months underwent spectrographic measures of tape-recorded speech (DSP Sona-Graph digital unit). Controls were 22 age- and sex-matched noncleft children. Data analyzed included (1) the Spanish vocalic variables [a, i, u, e, o]: first formant, second formant, duration, and context; (2) obstruent variables [p, t, k]: burst, voice onset time, and duration, and (3) nasal variables [m]: first formant, second formant, and duration. Statistically significant differences were observed between the CL group and the control group in the first formant of [e] and in the increase of the frequency of the [t] burst. Comparison between UCLP and controls showed differences in the second formant of [a], in the first formant of [o], and in the second formant of [o]. These results suggest a small but significant influence of either the cleft lip or its repair on lip rounding for [o] and [u]. In addition, tongue position differences were most likely responsible for the differences seen with [a] and [e]. Spectrographic differences in the current patients did not contribute to meaningful differences in speech sound development. Individualized care (orthodontics, surgery, speech therapy) in children with cleft lip and/or palate attended at specialized craniofacial units contributes to normalization of speech development.

[Mammaplasty in adolescent girls]. / Mastoplastia en la adolescente.

The aim of this work is to analyze the experience in our pediatric center on the surgical management of mammary malformation in teenagers. We have reviewed or mammaplasty cases until 1999 (n = 24). We have divided them in two groups: augmentation (A) and reduction (R) mammaplasty. The analyzed parameters were: ethiology, associated pathology, surgical approach, aesthetic results and complications. Group A (n = 14; 17 implants). The surgical indication was moderate-severe mammary hypoplasia with psychological repercussion. Associated pathology: thoracic malformation (n = 13) and psychiatric pathology (n = 2). The surgical approach was submammary in 6 cases, videoassisted transaxillary in 4 and iterative on thoracic scar in 3. All the implants were located at the subglandular space. No major complications were found and the cosmetic results were good, with only one reoperation because of asymmetry. Group R (n = 10). Surgery was indicated because of bilateral puberal mammary hipertrophy in all cases. Associated pathology: obesity (n = 3), psychiatric and behaviour disorders (n = 3), scoliosis (n = 2), and one case of isosexual precocious puberty. In all cases but one the Strömbeck mammaplasty was performed. We used the Lejour technique in this single case. The cosmetic results were good, except for 2 cases of hypertrophic scar. The only complication was a wound infection that healed well.

Mastoplastia en la adolescente / Mammaplasty in female adolescente

El objetivo de este trabajo es analizar la experiencia de nuestro centro pediátrico en el tratamiento de las malformaciones mamarias en las adolescentes. Hemos revisado los casos de mastoplastia hasta el año 1999 (n = 24). Se han dividido en dos grupos: mastoplastia de aumento (A) y de reducción (R). Se analizan los parámetros: etiología, patología asociada, técnica empleada, resultados estéticos y complicaciones. Grupo A (n = 14; 17 implantes). En todos ellos la hipoplasia mamaria moderada-severa con repercusión psicológica fue la indicación. Patología asociada: malformaciones torácicas (n =13) y patología psiquiátrica (n = 2). La vía de abordaje fue submamaria en 6 casos, axilar videoasistida en 4 e iterativa sobre cicatriz torácica en 3. Todas las prótesis se situaron en el espacio retromamario. No se encontró ninguna complicación mayor y se obtuvo un buen resultado estético, reinterviniendo un solo caso por asimetría. Grupo R (n = 10). La indicación fue en todos los casos la hipertrofia mamaria puberal bilateral. Patología asociada: obesidad (n = 3), trastornos psiquiátricos y de conducta (n = 3), escoliosis (n = 2), y un caso de pubertad precoz isosexual. En todos los casos excepto uno (en que se empleó la técnica de Lejour) se practicó una mastoplastia de Strómbeck. El resultado estético fue bueno, presentando dos casos cicatrización hipertrófica. La única complicación fue una infección de herida que evolucionó favorablemente. (AU)

[Bilateral cleft lip and palate: experience from a center with a multidisciplinary approach]. / Fisura labiopalatina bilateral: experiencia de un centro con abordaje multidisciplinar.

The aim of this work is to analyse the global experience of a center where a pluridisciplinar approach of the child affected with a cleft lip and palate is regularly done. Since january 1980 until january 2000, a total of 36 children (8 F, 28 M) with bilateral cleft lip and palate were treated. Only 5 children were born at this hospital. The others (n = 31) were referred soon after birth (24/31) or later for treat sequels. A multidisciplinary team evaluated every case. The parameters analysed were: surgical protocol, aesthetic and speech outcome, hearing disturbance, complications and the number of secondary lip surgeries. Surgical approach consisted on a soft palate closure before 3 months follow by a bilateral cheiloplasty (6 months) and a hard palate closure before 4 years of age, in the majority of cases (24/36). The esthetical result was evaluated in 25 children and was acceptable in the great majority (22/25). 16 children were submitted to tympanic draining in order to treat their secretory otitis. Speech outcome was analysed in 27 children and was good in 23. With a follow-up of 8.4 years, 15 children (8 treated soon on this center and 7 that came for their sequels) were treated for complications. There was a media of 4.5 surgeries per children.

Fisura labiopalatina bilateral: experiencia de un centro con abordaje multidisciplinar / Bilateral cleft lip and palate: experience of a center with multidisciplinary approach

El objetivo de este trabajo es analizar la experiencia de un centro donde se hace un abordaje multidisciplinar del niño con fisura labiopalatina. Desde enero de 1980 hasta enero del 2000 se han intervenido 36 niños (8F, 28M) con fisura labiopalatina bilateral. Sólo 5 niños han nacido en el hospital y los restantes (n=31) fueron remitidos tras el nacimiento (n=24/31) o para tratar secuelas (n=7/31). Todos los casos fueron desde su ingreso valorados por un equipo pluridisciplinar. Los parámetros analizados han sido: protocolo quirúrgico utilizado, resultado estético, resultado de la voz y del habla, audición, complicaciones y número de cirugía efectuadas. El tratamiento consistió en una estafilorrafia precoz hacia los 3 meses, seguida de una queiloplastia bilateral (6 meses) y después una uranorrafia hacia los 4 años en la mayoría de los casos (24/36). El resultado estético fue evaluado en 25 niños y fue satisfactorio en la mayoría (22/25). Dieciseis niños fueron sometidos a drenaje timpánico para tratamiento de su otitis serosa. El resultado logopédico fue analizado en 27 casos y fue bueno en 23. Con un tiempo de seguimiento medio de 8,4 años, 15 niños (8 propios y los 7 que vinieron para tratamiento de secuelas) han sido tratados de complicaciones. La media de intervenciones por paciente fue de 4,5 (AU)

Elongación ósea progresiva del área máxilo-facial: Distracción mandibular / Progressive osseous lengthening of the maxilofacial área: Mandibular distraction

La creación de hueso nuevo en el área máxilo-facial es actualmente posible gracias a la técnica de distracción ósea. Entre enero de 1997 y marzo de 1999 hemos efectuado 20 distracciones del área máxilo-facial de las que 15 corresponden a distracciones mandibulares. Presentamos nuestra experiencia en esta nueva técnica que hemos efectuado en 10 pacientes (5 unilaterales y 5 bilaterales). Se trata de 7 varones y 3 mujeres con edades comprendidas entre los 2 y 14 años, afectos de microsomia hemifacial, síndrome de Goldenhar: 3; retrognatia con maloclusión severa: 4; asimetría facial por anomalías de la ATM: 2; y asimetría facial: 1.La elongatión se pudo conseguir en todos los casos. La mejoría no fue sólo ósea, sino que existió también una ganancia y remodelación de los tejidos blandos de la cara. La distracción mandibular constituye un tratamiento precoz en las anomalías del área máxilo-facial con evidentes ventajas para los pacientes en crecimiento (AU)

Anquilosis de la articulación temporomandibular (ATM) en la edad pediátrica* / Temporomandibular joint (TMJ) ankylosis in children

La anquilosis de la ATM es un proceso degenerativo que implica una limitación de la apertura bucal. En los niños, esta patología produce graves asimetrías faciales, así como trastornos en la alimentación y más raramente obstrucción de la vía aérea. Las causas más frecuentes son los traumatismos, infecciones, enfermedades inflamatorias, aunque también puede ser congénita. El diagnóstico suele ser clínico, siendo la TAC y la RNM las dos exploraciones complementarias de elección. El tratamiento es quirúrgico, mediante la resección en bloque de la articulación y la posterior reconstrucción. Se han revisado todos aquellos pacientes afectos de anquilosis de la ATM que han requerido tratamiento quirúrgico en nuestro centro. Se han analizado los siguientes parámetros: edad, sexo, etiología, técnica quirúrgica, apertural bucal pre y postratamiento (AU)

[Progressive bone elongation of the maxillo-facial area: mandibular distraction]. / Elongación ósea progresiva del área máxilo-facial: distracción mandibular.

Thanks to the distraction osteogenesis technique, it is nowadays possible to create new bone in the facial area. Between january 1997 and march 1999 we have performed 20 such procedures, from which 15 were mandibular. We present our experience in 10 patients with this new technique, 5 unilateral and 5 bilateral. Those were 7 boys and 3 girls, aged 2 to 14 years, affected with hemifacial microsomia, Goldenhar syndrome: 3; retrognatism with severe malocclusion: 4; facial assimetry due temporomandibular joint abnormalities: 2; and facial assimetry: 1. The proposed elongation was achieved in all cases. There was not only a skeletal improvement, but also growth and remodeling of the facial soft tissues. Distraction osteogenesis is the early treatment of the mandibulofacial deformities and offers a great deal of advantages to the growing patient.

[Temporomandibular joint ankylosis (TMA) in children]. / Anquilosis de la articulación temporomandibular (ATM) en la edad pediátrica.

Temporomandibular joint (TMJ) ankylosis is a degenerative disease that produces a limitation of mouth opening. In children, TMJ ankylosis usually presents with facial asymmetry, difficulty in feeding and rarely upper way obstruction. Ankylosis is commonly associated with trauma, infections, systemic and congenital diseases. Diagnosis must be clinical, being CT scan and magnetic resonance imaging (MRI) the most important methods to evaluate this disease. The treatment of TMJ ankylosis requires excision of the involved structures and reconstruction. We present our experience in treatment of the temporomandibular joint ankylosis. We have analysed the following parameters: age, sex, etiology, surgical technique, pre and postoperative oral opening.

[The profile surgery. Mandibular osteotomies]. / Cirugía del perfil. Osteotomía mandibular.

During the years 1987-1994, 31 mandibular osteotomies have been performed in 25 patients, 15 had mandibular alteration alone, 10 of them with prognatism, 2 with microretrognatia and 3 with chin hipoplasia. The other 10 had a combined maxillary-mandibular alteration with hipoplasia and maxillary retrussion. The preoperative work-up included cephalometric and dental study, and a cast model was done to asses the theoretical benefic of the osteotomy. All these patients underwent orthodontic treatment before and after surgery. The results have been good or very good in 96% of the cases. The ortognatic surgery offers significant aesthetic and functional improvement to these patients.

[Treatment of fronto-orbital malformations associated with craniostenosis]. / Tratamiento de las malformaciones fronto-orbitarias ligadas a craneostenosis.

From 1977 to 1982, 13 children affected by craniostenosis involving the supraorbital ridge were treated by surgery and subsequently followed up. Six cases of plagiocephaly, one of brachycephaly, three of Apert's syndrome, and three cases of Crouzon's disease were operated on, employing in seven cases classical lineal craniectomies, an in six other, craniotomies with advancement and remodelling. The results obtained are discussed in terms of functional and cosmetic improvement, the therapeutic criterion being in terms corresponding with the gravity of the malformation and the age at which the surgical operation was carried out.