Intraoral air pressure discrimination under conditions of partial and complete resistance.

This study assessed a sample of normal-speaking individuals' ability to discriminate differences in their self-generated intraoral air pressures. Two conditions were employed: (1) open tube in which subjects had to sustain an expiratory breath stream to maintain the target pressure, and (2) closed tube in which there was complete resistance to the subjects' breath stream. Analysis of variance revealed no significant difference (p > 0.05) in subjects' ability to discriminate differences in their self-generated intraoral air pressure as a function of open or closed tube conditions. However, subjects' discrimination scores significantly increased (p < 0.05) as the standard pressure was increased.

Submucous cleft palate: a 10-year series.

Twenty-nine consecutive patients with submucous cleft palate were treated at the University of Florida during the 10-year period from 1986 to 1996. Twenty-seven patients were available for speech follow-up. The evaluation of these patients and rationale for treatment are discussed. The largest subgroup of patients were treated with the Furlow Z-plasty palatoplasty, which yielded a successful outcome in 15 of 18 patients, or 83%. The overall success rate was 96%. The Furlow Z-plasty palatoplasty was noted to have a very high rate of success for patients with velopharyngeal gaps of 8 mm or less, and less likelihood of success when the velopharyngeal gap exceeded 8 mm.

Velopharyngeal function for speech after the Frolova primary palatoplasty technique.

OBJECTIVE: This study was undertaken by several members of the University of Florida Craniofacial Center to assess the results of palatoplasty performed by the method devised by Larisa Y. Frolova, M.D. in 1971. DESIGN: The assessment was based on evaluation of each subject's speech and velopharyngeal function through perceptual measures, nasometry, and video-nasendoscopy. SETTING: The study took place at the National Pediatric Center for Congenital Maxillofacial Pathology, Moscow, Russia, under the auspices and with the cooperation of Dr. Frolova, director of the program. SUBJECTS: One hundred twelve children (40 girls and 72 boys; age range, 4 to 10 years; mean age, 7.5 years) with repaired cleft palate who had undergone palatoplasty 2 to 4 years earlier and had no secondary surgery were randomly selected from the center's clinical files by the staff. Subjects with known conditions that could jeopardize normal speech development were excluded. METHODS: Each subject was assessed for speech and velopharyngeal function with a battery of perceptual measures and videonasendoscopy. RESULTS: The percentage of subjects judged to have normal resonance was 55.5%. An additional 9.5% of the subjects judged to be hyponasal increased the rate of nonhypernasal outcome to 64%. CONCLUSIONS: The Furlow double-Z palatoplasty has had an increasing rate of success (up to 87%), whereas the Frolova technique has a success rate of only 55% to 65%.

Oral health status of Russian children with unilateral cleft lip and palate.

OBJECTIVE: To evaluate the oral and dental health of Russian children who underwent Frolova primary palatoplasty. DESIGN: Eighty-nine children (62 boys and 27 girls; age range, 5 to 9 years) who had undergone repair of unilateral cleft lip and palate were included in this oral/dental evaluation. Factors such as stage of dentition; oral hygiene; carious, missing and restored teeth; and occlusion were recorded. RESULTS: Twenty-six of the 89 patients presented with a palatal fistula. Oral hygiene of patients without a palatal fistula was significantly better than that of patients with a fistula (p < .01). Forty-five percent of patients had eight or more decayed teeth. Significantly more patients with palatal fistulae had class II soft tissue facial profiles than those without palatal fistulae. Anterior crossbites were found in 48% of patients, unilateral posterior crossbites in 58%, and bilateral posterior crossbites in 12%. CONCLUSIONS: The high percentage of poor oral hygiene and dental caries found in this group of patients is likely due to the general unavailability of dental hygiene products and the high cost of these products when available. In addition, it seems there is limited understanding by parents of the importance of dental hygiene and appropriate diet in preventing dental disease.

Otologic and audiologic status of Russian children with cleft lip and palate.

OBJECTIVE: In this study, researchers evaluated the otologic and audiologic status of 112 children with repaired cleft lip and palate who had received primary palatal repair by means of Frolova palatoplasty, a surgical technique developed by Dr. Larisa Y. Frolova, founder and director of the National Pediatric Center for Congenital Maxillofacial Pathology, Moscow, Russia. DESIGN: Results of hearing thresholds and tympanograms for these Russian children were compared with data previously reported from a group of 48 children and adults with repaired cleft lip and palate at the University of Florida Craniofacial Center, Gainesville, Florida. RESULTS: There were no substantial differences in hearing thresholds between the two groups, which was surprising in view of the vast differences between middle ear management techniques used in Russia and the United States. CONCLUSIONS: Considering these findings and the growing body of literature favoring a more conservative approach to the management of middle ear effusion in infants with cleft lip and palate, a reexamination of otologic strategies in the United States seems advisable.

Stature of Russian children with isolated cleft lip and palate.

OBJECTIVE: To evaluate the stature of Russian children with cleft lip and palate (CLP). DESIGN: One hundred twelve Russian children predominantly with repaired unilateral CLP 4 through 10 years of age underwent studies including height measurement, physical examinations, and record review. Children with health concerns that could affect growth were excluded. U.S. growth data from the National Center for Health Statistics (NCHS) and Russian parental heights were used in the absence of Russian growth norms. RESULTS: Based on U.S. norms, the distribution curve for heights for the Russian children was largely confined to the +1 to -1 standard deviation (SD) range. Sixty-two percent of the Russian children had heights below the 50th percentile for American female and male children of the same age. The proportion of children found outside the +1 to -1 SD range approximated the proportion expected statistically for the general population, with 14.4% < -1 SD (16th percentile) and 12% > +1 SD (84th percentile). A total of 3.6% of the children ranked below the third percentile, which is close to the expected 3%. Russian parents' (n = 209) mean heights were 0.5 SD below NCHS's 50th percentile values for adults. CONCLUSION: These results indicate that there is no increased risk of true short stature in 4- to 10-year-old Russian children with repaired CLP.

A methodology report of a randomized prospective clinical trial to assess velopharyngeal function for speech following palatal surgery.

Cleft lip and palate occurs in approximately 1 in every 750 live human births, making it one of the most common congenital malformations. Surgical closure of the palatal cleft does not always result in a velopharyngeal port capable of supporting normal speech. The University of Florida (UF), in collaboration with the University of São Paulo (USP), is engaging in a 5-year prospective, randomized controlled study to compare velopharyngeal function for speech outcomes between patients undergoing palatoplasty for complete unilateral cleft lip and palate performed using the von Langenbeck procedure with intravelar velarplasty and those receiving the Furlow double-reversing Z-plasty palatoplasty. The von Langenbeck procedure was selected as the time-tested standard against which the Furlow procedure could be judged. The Furlow procedure, a relatively new operation, has been reported to yield substantially higher rates of velopharyngeal competency for speech than have most other reported series and theoretically should result in less disturbance to midfacial growth. A total of 608 patients will be entered into one of two age categories. Inclusion of two age groups will allow a comparison of results between patients having surgery before 1 year of age (9-12 months) and patients undergoing surgery at approximately 1.5 years of age (15-18 months). Speech data will be collected and will be available for definitive analysis throughout the last 3 years of the study. Collection of preliminary growth data will require more than 5 years; growth analysis is anticipated to continue until all patients have reached maturity. The Hospital for Research and Rehabilitation of Patients with Cleft Lip and Palate at the University of São Paulo (USP-HPRLLP) in Bauru, Brazil, is uniquely situated for conducting this study. The well-equipped and modern facilities are staffed by well-trained specialists representing all disciplines in cleft-palate management. In addition, an already existing social services network throughout Brazil will ensure excellent follow-up of study cases. The clinical caseload at this institution currently exceeds 22,000, and more than 1200 new cases are added annually. This project represents a unique opportunity to obtain prospective data from a large number of subjects while controlling the variables that have traditionally plagued cleft-palate studies. This study is designed to determine which of the two proposed surgical procedures is superior in constructing a velum capable of affecting velopharyngeal competency for the development of normal speech.

Prevalence of 22q11 region deletions in patients with velopharyngeal insufficiency.

Velo-cardio-facial syndrome, DiGeorge syndrome, conotruncal anomaly face syndrome, tetralogy of Fallot, and pulmonary atresia with ventricular septal defect are all associated with hemizygosity of 22q11. While the prevalence of the deletions in these phenotypes has been studied, the frequency of deletions in patients presenting with velopharyngeal insufficiency (VPI) is unknown. We performed fluorescence in situ hybridization for locus D22S75 within the 22q11 region on 23 patients with VPI (age range 5-42 years) followed in the Craniofacial Clinic at the University of Florida. The VPI occurred either as a condition of unknown cause (n=16) or as a condition remaining following primary cleft palate surgery (n=7). Six of sixteen patients with VPI of unknown cause and one of seven with VPI following surgery had a deletion in the region. This study documents a high frequency of 22q11 deletions in those presenting with VPI unrelated to overt cleft palate surgery and suggests that deletion testing should be considered in patients with VPI.

Respiratory and laryngeal function associated with experimental coupling of the oral and nasal cavities.

Three experimental openings (10 mm2, 20 mm2, 30 mm2) were placed one at a time in a man's palatal obturator at a location approximating the junction of the prepalate and the palatal shelves. The man's laryngeal and respiratory function were examined during his production of a series of CV syllables [pa] repeated at a comfortable and loud vocal intensity for each of the three experimental conditions. Two more conditions, in which the subject's obturator was not altered (no hole) and in which no obturator was worn, were also included for study. Laryngeal and respiratory function adjustments were most apparent during the 30 mm2 hole size and no obturator conditions. Laryngeal adjustment, as measured by fundamental frequency, was the most identifiable. A respiratory adjustment, which involved the expenditure of more lung volume as nasal airflow leakage increased, was also observed. These observations imply an active physiologic adjustment rather than a passive response to aberrant oronasal coupling.

Systemic lupus erythematosus, rheumatoid arthritis and HLA phenotypes in Jamaicans.

The HLA phenotypes were investigated in 30 Jamaican patients with Systemic Lupus Erythematosus (SLE), 30 with Rheumatoid Arthritis (RA) and 40 healthy controls. HLA phenotypes were determined by the microcytoxicity technique, using commercially prepared typing trays. In this study, the HLA phenotypic associations with SLE (HLA-B14, RR 4.3: HLA-A28, RR 4.3) were not statistically significant. However, a statistically significant lack of HLA-A9 (p < 0.01; CP < 0.1) was observed in SLE patients compared to healthy controls. In RA patients, a statistically significant association was noted with HLA-A2 (RR 5.1; CP < 0.01). No HLA class II associations were noted with SLE. Class II associations with RA did not achieve statistical significance but included those previously established in other populations. The preliminary data obtained from this study indicate differences in the patterns of HLA phenotypes in Jamaican patients with SLE and RA compared to those observed in such patients elsewhere. Further studies involving larger groups of patients and typing at the serological, cellular and molecular levels are clearly warranted.

Systemic lupus erythematosus, rheumatoid arthritis and HLA phenotypes in Jamaicans

The HLA phenotypes were investigated in 30 Jamaican patients with systemic lupus erythematosus (SLE), 30 with rheumatoid arthritis (RA) an d forty healthy controls. HLA phenotypes were determined by the microcytotoxicity technique, using commercially prepared typing trays. In this study, the HLA phenotypic associations with SLE (HLA-B14, RR 4.3: HLA-A28, RR 4.3) were not statiscally significant. However, a statistically significant lack of HLA-A9 (p<0.01;CP<0.1) was observed in SLE patients compared to healthy controls. In RA patients, a statistically significant associations was noted with HLA-A2 (RR5.1; CP<0.01). No HLA class 11 associations were noted with SLE. Class 11 associations with RA did not achieve statistical significance but included those previously established in other populations. The preliminary data obtained from this study indicate differences in the patterns of HLA phenotypes in Jamaican patients with SLE and RA compared to those observed in such patients elsewhere. Further studies involving larger groups of patients and typing at the serological, cellular and molecular levels are clearly warranted

Systemic lupus erythematosus, rheumatoid arthritis and HLA phenotypes in Jamaicans

The HLA phenotypes were investigated in 30 Jamaican patients with systemic lupus erythematosus (SLE), 30 with rheumatoid arthritis (RA) an d forty healthy controls. HLA phenotypes were determined by the microcytotoxicity technique, using commercially prepared typing trays. In this study, the HLA phenotypic associations with SLE (HLA-B14, RR 4.3: HLA-A28, RR 4.3) were not statiscally significant. However, a statistically significant lack of HLA-A9 (p<0.01;CP<0.1) was observed in SLE patients compared to healthy controls. In RA patients, a statistically significant associations was noted with HLA-A2 (RR5.1; CP<0.01). No HLA class 11 associations were noted with SLE. Class 11 associations with RA did not achieve statistical significance but included those previously established in other populations. The preliminary data obtained from this study indicate differences in the patterns of HLA phenotypes in Jamaican patients with SLE and RA compared to those observed in such patients elsewhere. Further studies involving larger groups of patients and typing at the serological, cellular and molecular levels are clearly warranted (AU)

Level of accuracy and degree of precision in attempting to maintain steady levels of biting force.

The primary purpose of this study was to assess the level of accuracy (bias) and degree of precision for a group of 24 normal subjects attempting to maintain a constant biting force at levels of 100 gm, 500 gm, 1000 gm and 2000 gm for a period of 10 s each. Accuracy is defined as the difference between subjects' actual level of biting force and the target value they were trying to achieve. Precision is the level or range of variability demonstrated by the subjects while attempting to bite with a constant level of force. Subjects' performance relative to accuracy and precision was also compared when using the central incisors vs. the first permanent molars. Assessment of bite force was measured using a specially designed strain gauge scale which permitted subjects to visually monitor when their biting force equalled a preset resistance. Each subject was instructed to bite on the end of a plastic sheathed steel beam with enough force to activate the indicator needle on the voltage meter to its central position and to try to maintain a constant level of biting force (by attempting to keep the indicator needle steady in its central position). No significant (P > 0.05) differences were found in mean accuracy in bite force for gender or specific teeth used in the biting task. However, a significant difference (P < 0.0001) in mean accuracy in bite force was found to exist between the target levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Human pinch-force discrimination.

Pinch-sustaining tasks such as holding a pencil, fork, or key require the exertion of different levels of force. There is little information concerning normal subjects' ability to discriminate differences in their pinching force, so the purpose of this study was to evaluate the ability of 24 normal young women to discriminate differences in their self-generated isometric tip and lateral pinching force. Resistance forces of 10, 25, 50, and 75% of known normal maximum pinching force were selected as standards. Subjects were presented a series of paired resistance settings of which the first resistance in each pair was the standard and the second resistance a comparator of some greater amount. This procedure of paired comparisons was continued until subjects' threshold of discrimination between two pinching forces was established. The results indicated that subjects' pinch-force discrimination at the standard of 50% of reported maximum pinching force was significantly better for the tip condition than for the lateral condition. This study has described an instrumentation and the methodology for assessing individuals' ability to discriminate differences in their pinching force at submaximal levels.

Team acceptance of specific recommendations for the treatment of VPI as provided by speech pathologists.

This retrospective study describes the frequency of one team's acceptance of speech pathologists' recommendations for specific secondary treatment procedures for the correction of VPI for 100 consecutive patients. In addition, assessment was made of the level of success in eliminating VPI relative to treatments utilized that were recommended by speech pathologists versus level of success when treatment other than that recommended by speech pathologists were used. For the 78 patients who received the treatment procedure recommended by speech pathologists, only 10 percent continued to demonstrate any clinically significant residual speech problem associated with VPI. However, for the 22 patients who received treatment other than that which had been recommended, 32 percent continued to demonstrate clinically significant speech problems associated with VPI. Data is presented on the success rate for correcting VPI relative to specific treatment recommendations including pharyngeal flap, palatal pushback, pharyngeal wall implant, tonsillectomy, prosthetic palatal lifts, and speech therapy.

Fluoroscopy and nasoendoscopy in designing palatal lift prostheses.

Prosthodontists frequently provide prostheses for the management of speech disorders related to palatopharyngeal dysfunction. Optimal prosthetic management of the palatopharyngeal port requires close interaction between the prosthodontist and speech pathologist in the use of videofluoroscopy and videonasoendoscopy for design, placement, and modification of the prosthesis. Function of the palatopharyngeal port during production of controlled samples of connected speech can be observed from multiview fluoroscopy, including lateral and frontal projections. Like fluoroscopy, nasoendoscopy can be used to observe and record function of the palatopharyngeal port during speech. This article provides an overview of the procedures suggested for diagnosing palatopharyngeal disorders. A method for designing and placing a prosthesis to aid in obturating the nasopharynx is also suggested.

Human bite force discrimination using specific maxillary and mandibular teeth.

The purpose of this study was to determine whether performance differences existed in subjects' self-generated bite force discrimination ability using maxillary and mandibular central incisors, canines, premolars and first molars. Two separate studies were conducted: (i) to assess whether performance differences existed in subjects' bite force discrimination ability using central incisors and premolars; (ii) to compare subjects' performance on bite force discrimination using central incisors, canines and first molars. Assessment of bite force was measured using a specially designed strain gauge scale allowing subjects to visually monitor when their biting force equalled a preset resistance. Resistance forces of 500, 1000 and 3000 g were selected as standards. Subjects were presented with a series of paired resistance settings, one at a time, the first of each pair being the standard and the second being the comparator setting of a predetermined amount. This paired-comparisons procedure was continued until the subjects' difference limen (DL) value (the threshold of discrimination between two forces) could be established. The first study revealed no significant (P greater than 0.05) overall difference in subjects' bite force discrimination ability relative to specific teeth. In contrast, in the second study a significant difference (P less than 0.05) was identified in subjects' performance relative to specific teeth; subjects' performed better using central incisors compared to first molars. In both studies, subjects' performance was significantly better (P less than 0.05) using the 500 g standard compared to the 3000 g standard in the first study, and compared to the 1000 g standard in the second study. No significant differences (P greater than 0.05) were observed between the performance of males and females in either study.

The effect of experimental anesthetization of the temporomandibular joint superior cavity on bite force discrimination.

The purpose of this study was to determine whether bilateral experimental sensory impairment of the temporomandibular joints (TMJs), as induced by injecting 1.5 ml of two percent mepivacaine into the superior cavity of the TMJs would alter the subject's ability to discriminate among differences in their bite force. Assessment of bite force was measured isometrically, using the strain gauge scale, and isotonically, using the mechanical swing beam scale. Resistance forces of 500 and 1000 gms were selected as standards. For each task, subjects were given a series of paired resistance settings, one at a time, the first of each pair being the standard resistance and the second being a comparator resistance of some greater amount. Subjects reported whether biting against the comparator resistance was equal to, greater than, or less than the standard resistance. This procedure of paired comparisons was continued until the subject's threshold of discrimination (difference limen value) between two biting forces was established. The results revealed that the subject's ability to discriminate differences in their bite force, either isometrically or isotonically, was not significantly (p greater than 0.05) affected following anesthetization of the superior cavity of the TMJs. These findings suggest that the sensory receptors within the TMJ capsules are not significantly involved in the detection of forces that play a role in monitoring biting force.

Bilabial compression force discrimination by human subjects.

This study examined and compared bilabial compression force difference limen (DL) values (the minimally perceivable difference between two compression forces) for a group of twenty normal-speaking female subjects (mean age, 25 years) under conditions with and without the teeth clenched. In addition, measures of maximum bilabial compression force under conditions with and without the teeth clenched were obtained. Mean DL values obtained against a standard of 100 gm were 36 gm for the clenched condition and 38 gm with no clenching. Discrimination performance under these two conditions was not significantly different (P greater than 0.05). Mean maximum bilabial compression force was 411 gm with the teeth clenched and 568 gm without clenching. This difference in performance was significant (P less than 0.01). This study provides initial normal data against which individuals with labial sensorimotor dysfunction can be compared.

Effect of mouth opening on bite-force discrimination.

The purpose of this study was to determine whether different extents of mouth opening affect normal subjects' (N = 24; 12 women, 12 men) ability to discriminate differences in their interincisor bite force. Three mouth openings were selected including 50, 70, and 90 percent of maximum opening for each subject. Bite force was measured using a specially designed strain gauge scale which permitted subjects to monitor visually when their biting force equalled a preset resistance. Resistance forces of 500 and 1000 gm. were selected as standards. The procedure involved the use of a modified method of constant stimuli in which each subject was presented with a series of paired resistance settings, one at a time--the first resistance setting being the standard and the second resistance was the comparator. This paired-comparisons procedure was continued until the subjects' difference limen (DL) value (the threshold of discrimination between two forces) could be established. An analysis of variance yielded no significant differences in subjects' ability to discriminate bite force as a function of mouth opening.