Individualized erlanger KS-impression trays for infants with cleft lip and palate.

OBJECTIVE: The use of individualized impression trays is required when taking impressions of the maxilla in infants with cleft lip and palate. Custom trays made of plastic such as polymethylmethacrylate, as well as generic, full-arch infant metal trays, have been used up to now. Given the increasing incidence of infectious diseases, the ability to sterilize impression trays for infants with cleft lip and palate is mandatory. Polymethylmethacrylate impression trays are altered in shape and consistency when autoclaved during the sterilization process. Therefore, they have to be fabricated afresh at regular intervals. METHODS: Based on modified mold patterns of the available plastic trays, 44 pieces were sorted into four groups of 11 trays in ascending order of size. On these plaster casts, which served as the male part of the template, a 1-mm layer of sheet wax was applied. An optimized ergonomic wax handle was then fitted to the wax plate. Realization in a chromium-cobalt-molybdenum alloy was performed according to the lost wax principle. CONCLUSIONS: The sterilizable Erlangen KS-Impression tray (Erlanger KS-Abformlöffel®) is now available in 11 sizes for each of four basic forms. They meet current hygiene guidelines. They can be recommended for routine use when taking impressions in infants with any form of cleft lip and palate without complications.

Evaluation of speech disorders in children with cleft lip and palate.

BACKGROUND: We investigated the reliability of nasopharyngoscopy and auditory perception, two common clinical methods employed in examining the speech pathology of children with cleft lip and palate. PATIENTS AND METHODS: Nasopharyngoscopy was performed to assess velopharyngeal closure function and nasopharyngeal morphology. The auditory examination evaluated nasality and other speech disorders such as articulatory tension, shift in articulation, and sigmatism. The study was based on the audio and video recordings of twelve patients (9.5 +/- 0.5 years) after surgical rehabilitation of their cleft lip and palate. The speech sample consisted of reading a standardized sequence of words. The recordings were analyzed by several examiners with different experience in the evaluation procedure at two time-points. Inter-rater and intra-rater reliability was determined by Cohen's Kappa coefficient and by estimation of the 95% intervals of confidence. RESULTS: Analysis of the visual and auditory-perceptual findings by the experienced raters was highly reliable. However, the less experienced raters' results showed greater variability, as did morphological evaluation in both groups. Comparison between visual and auditory evaluations concerning hypernasality resulted in little correlation. CONCLUSIONS: These two subjective methods of evaluation are recommended because of their high reliability with experienced raters. Our results suggest that "experience" is an essential criterion in determining the structural quality of the morphological and functional assessment of typical speech pathologies in children with cleft lip and palate. In addition, the data demonstrate the necessity of special multidisciplinary rehabilitation teams in so-called cleft centers.

Influence of early hard palate closure in unilateral and bilateral cleft lip and palate on maxillary transverse growth during the first four years of age.

OBJECTIVE: To evaluate and compare the effects of early primary closure of the hard palate on the anterior and posterior width of the maxillary arch in children with bilateral (BCLP) and unilateral (UCLP) cleft lip and palate during the first 4 years of life. DESIGN: A retrospective, mixed-longitudinal study. SETTING: Cleft Palate Center of the University of Erlangen-Nuremberg. SUBJECTS AND METHODS: The present investigation analyzes longitudinally 42 children with UCLP and 8 children with BCLP between 1996 and 2000 with early simultaneous primary closure of lip and hard palate (4 to 5 months). Palatal arch width was measured on dental casts with a computer-controlled three-dimensional digitizing system, and their growth velocities were calculated from consecutive periods (mean follow-up 39 months). Differences in growth velocities were compared with those of 25 children with UCLP and 15 children with BCLP with delayed closure of hard palate (12 to 14 months). RESULTS AND CONCLUSIONS: There was no significant difference in terms of anterior and posterior maxillary width between early and delayed closure of hard palate within the first 4 years of life.