[Primary "swallowing" function in relation to cleft type after 18 years of interdisciplinary therapy]. / Primärfunktion "Schlucken" in Abhängigkeit von der Spaltform nach 18-jähriger interdisziplinärer Therapie.

PURPOSE: The aim of today's interdisciplinary treatment of clefts is complete aesthetic and functional rehabilitation of the patient. But is it possible to also achieve a physiological swallowing pattern? MATERIAL AND METHODS: At the Rostock cleft center patients are treated by an interdisciplinary approach from their day of birth until their 18th year of life. Tongue position during swallowing was investigated in 117 consecutive patients. They were assigned to four groups. The control group consisted of 197 age-matched patients receiving non-cleft orthodontic treatment. RESULTS: Patients with clefts of only the primary or only the secondary palate achieved physiological swallowing in 87% or 88% of cases at the age of 18. Of the unilateral CLP cases, 74% also had a physiological swallowing pattern, but in patients with bilateral complete clefts this pattern could be observed in only 46%. In comparison, 95% of non-cleft patients achieved a physiological swallowing pattern following orthodontic and speech treatment at the age of 18. The so-called anterior swallowing pattern was the pathological pattern found most often in cleft and non-cleft patients. CONCLUSION: In most cleft patients interdisciplinary treatment leads to a physiological swallowing pattern. Only patients with bilateral clefts of lip and palate have a critical prognosis. They need special care and attention.

[Wavy incision of the soft palate. Modification of intravelar veloplasty]. / Wellenschnitt am weichen Gaumen. Modifikation der intravelaren Veloplastik.

PURPOSE: The problem with primary soft palate repair is shortness of the soft palate and a soft tissue deficit in this region. The authors introduce a modification of the intravelar veloplasty allowing lengthening of the soft palate at the time of primary closure. METHODS: The "soft palate wavy incision procedure" combines a wavy or undulating type of incision at the velar cleft margins with intravelar veloplasty. In 12 patients with complete clefts of the palate, postoperative breathing and speech was analyzed 3 years later. The investigator did not know whether a modification of the common procedure had been performed in these patients or not. RESULTS: It was found that the soft palate wavy line procedure is easy to perform and closure in three layers is possible even in wide clefts of the soft palate. No postoperative fistula was observed. An average lengthening of the soft palate of about 56% (24-83%) was achieved, measured immediately at the end of surgery. Three years later the patients have good speech results following this technique. CONCLUSIONS: Experience has shown that the soft palate wavy incision procedure is straightforward, safe, and easy. It seems that this technique leads to better results than classic intravelar veloplasty. This paper is only a first report, and further investigations are necessary.

[Wavy incisions for soft palate repair]. / Wellenschnitt am weichen Gaumen : Modifikation der intravelaren Veloplastik.

Purpose. The problem with primary soft palate repair is shortness of the soft palate and a soft tissue deficit in this region. The authors introduce a modification of the intravelar veloplasty allowing lengthening of the soft palate at the time of primary closure. Methods. The "soft palate wavy incision procedure" combines a wavy or undulating type of incision at the velar cleft margins with intravelar veloplasty. In 12 patients with complete clefts of the palate, postoperative breathing and speech was analyzed 3 years later. The investigator did not know whether a modification of the common procedure had been performed in these patients or not. Results. It was found that the soft palate wavy line procedure is easy to perform and closure in three layers is possible even in wide clefts of the soft palate. No postoperative fistula was observed. An average lengthening of the soft palate of about 56% (24-83%) was achieved, measured immediately at the end of surgery. Three years later the patients have good speech results following this technique. Conclusions. Experience has shown that the soft palate wavy incision procedure is straightforward, safe, and easy. It seems that this technique leads to better results than classic intravelar veloplasty. This paper is only a first report, and further investigations are necessary.

[The late results following velopharyngoplasty. A data comparison of the 2 cleft centers of Hamburg and Rostock]. / Spätergebnisse nach Velopharyngoplastik. Datenvergleich der zwei Spaltzentren Hamburg und Rostock.

Speech results were evaluated in 349 patients following velopharyngoplasty in all cases according to Sanvenero-Rosselli. Velopharyngoplasty was performed several years after palatoplasty in either the Rostock or the Hamburg cleft centers. Comparison of the data revealed that the outcome after velopharyngoplasty in relation to speech was more or less the same in the patients from both centers. In 90% of the patients with clefts of the lip, alveolus, and palate, and in over 90% of those patients with only cleft palates, voice sound was at a level between 1 and 2 on a scale to 3 and on average levels of 1.46 and 1.53 were achieved. These results document that the surgery, when combined with close interdisciplinary team work with the speech therapist, culminated in the successful rehabilitation of cleft patients at both cleft centers.

[Public health measures in homes for the aged and nursing homes]. / Hygiene in Alten- und Pflegeheimen.

It was the purpose of this study to give a survey of standards of hygiene in homes for the aged as well as nursing homes and to find out whether there is any need of appropriate training measures. Furthermore, we tried to compile a brief standard of assessment that should enable public health officers to draw up a standardised documentation of inspections. Four homes of the aged or nursing homes were chosen. At a cursory inspection two of them seemed properly run, whereas the other two showed certain deficiencies. Using a questionnaire that covered 11 fields of interest each home was registered 5-fold at intervals of 6 weeks and once again 22 months later. 3 training courses were held at one home of each type (properly run, less properly run). Urine analyses served as indicators for the success of these courses. The most important and relevant points of each field of hygiene were chosen to compile a short schedule of assessment. By means of the detailed questionnaire it was possible to register completely the standard of hygiene and to check on the nursing of the patient. Inspections alone improved the standards of hygiene of those homes where no training courses had been held (homes B and C). With the other two homes the attitude towards hygiene improved even if the staff was less motivated (less properly run home D, trained). When the regular inspection and training measures had been interrupted for a longer time, the standards of hygiene were maintained only partially in some areas of interest.(ABSTRACT TRUNCATED AT 250 WORDS)

[The necessity for logopedic-orthodontic cooperation for speech and dental development in children with clefts]. / Die Notwendigkeit der logopädisch-kieferorthopädischen Zusammenarbeit für die Sprach- und Gebissentwicklung bei Spaltträgern.

Children with cheilognathopalatoschisis exhibit a peculiar specificity of speech. The present paper deals with studies on the position of the tongue at rest, the type of respiration, the functions of the lips and the position of the tongue on articulating sounds at the second site of articulation in 35 patients with cheilognathopalatoschisis. The results obtained testify to the necessity for logopaedic orthodontic co-operation.

[Etiology and rehabilitation of lip, jaw, palate and velum clefts]. / Zur Atiologie und Rehabilitation der Lippen-, Kiefer-, Gaumen-, Segelspalten.

The heredity rate among the patients treated by the authors (527 cases) was 14.4 percent. Most of the schistases were caused by exogenic noxae. Of 271 children affected, 83.1 percent entered school at the normal age and 14.7 percent later, whereas 2.2 percent were found not educable. A total of 88.5 percent went to ordinary schools and 9.2 percent to special schools. At the elementary stage 10 children (6.1 percent) had to repeat a year once. The most important task in rehabilitation is the full social integration of patients, and special attention must be devoted to the early recognition of developmental disturbances and their treatment through specific advancement measures.

[Group treatment of children with speech disorders]. / Die Gruppenbetreuung sprachgestörter Kinder

Group instruction of children with speech disorders due to clefts has certain advantages over individual instruction. These advantages ares presented from the viewpoint of logopaedia and corroborated by experience with 77 children treated up to now. More rapid and better speech rehabilitation associated with a decrease in indication for speech-improving surgical interventions are the outstanding results of group instruction. It comprises early instruction, rehabilitative logopaedia (courses and individual instruction) and after-care with directives for the parents, and concerns the age groups 0-3, 3-6 (7) and 6 (7)-18 years.