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Tio PAE, Rooijers W, de Gier HHW, Poldermans HG, Koudstaal MJ, Caron CJJM. Velopharyngeal insufficiency, speech, and language impairment in craniofacial microsomia: a scoping review. Br J Oral Maxillofac Surg 2024; 62:30-37. [PMID: 38057178 DOI: 10.1016/j.bjoms.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 12/08/2023]
Abstract
This review provides a comprehensive overview of the literature on velopharyngeal insufficiency, associated anomalies, and speech/language impairment in patients with craniofacial microsomia (CFM). A systematic search of the literature was conducted to identify records on VPI and speech impairment in CFM from their inception until September 2022 within the databases Embase, PubMed, MEDLINE, Ovid, CINAHL EBSCO, Web of Science, Cochrane, and Google Scholar. Seventeen articles were included, analysing 1,253 patients. Velopharyngeal insufficiency results in hypernasality can lead to speech impairment. The reported prevalence of both velopharyngeal insufficiency and hypernasality ranged between 12.5% and 55%, while the reported prevalence of speech impairment in patients with CFM varied between 35.4% and 74%. Language problems were reported in 37% to 50% of patients. Speech therapy was documented in 45.5% to 59.6% of patients, while surgical treatment for velopharyngeal insufficiency consisted of pharyngeal flap surgery or pharyngoplasty and was reported in 31.6% to 100%. Cleft lip and/or palate was reported in 10% to 100% of patients with CFM; these patients were found to have worse speech results than those without cleft lip and/or palate. No consensus was found on patient characteristics associated with an increased risk of velopharyngeal insufficiency and speech/language impairment. Although velopharyngeal insufficiency is a less commonly reported characteristic of CFM than other malformations, it can cause speech impairment, which may contribute to delayed language development in patients with CFM. Therefore, timely recognition and treatment of speech impairment is essential.
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Affiliation(s)
- Pauline A E Tio
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands.
| | - Wietse Rooijers
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Henriëtte H W de Gier
- Department of Otorhinolaryngology, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Henriëtte G Poldermans
- Speech and Language Centre, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Maarten J Koudstaal
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Cornelia J J M Caron
- The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands
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Three-Dimensional Morphology and Configuration Analyses of the Craniovertebral Junction in Children with Hemifacial Microsomia. Spine (Phila Pa 1976) 2022; 47:817-824. [PMID: 35193998 DOI: 10.1097/brs.0000000000004346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Observational and morphological study with three-dimensional (3D) computed tomography (CT) analysis. OBJECTIVE To discover the morphology and configuration deformities of craniovertebral junction (CVJ) and upper cervical spine in children with unilateral hemifacial microsomia (HFM). To determine whether there are specific HFM patients who are at higher risk of certain cervical vertebral anomaly. SUMMARY OF BACKGROUND DATA The evaluation for cervical vertebrae anomaly in HFM children, especially in CVJ region, is underreported. METHODS Eighty-eight unilateral HFM children (64 males, 24 females) with four Pruzansky-Kaban types (I, Ila, Ilb, and III) underwent cranial and cervical CT scanning from skull to C5 in neutral position. The 3D morphology and configuration of the occipital condyle, atlas, and axis, etc. were evaluated on the presence of deformed detailed structures of CVJ region. RESULTS No C1 deformation was found in type I group. Six (14.3%) type Ila cases, seven (33.3%) type IIb cases, and six (37.5%) type Ill cases had lateral masses asymmetry of C1 (P < 0.05). Five (55.6%) type I cases, 17 (40.5%) type Ila cases, 12 (57.1%) type Ilb cases, and 10 (62.5%) type Ill cases had C2 anomaly (P > 0.05). The incidence rate of C1-C2 instability for four groups were 33.3% (type I), 33.3% (type IIa), 33.3% (type IIb), and 31.3% (type Ill), respectively (P > 0.05). CONCLUSION For HFM children, the incidence of C1 deformation increased from type I to type Ill. The probability of C2 anomaly and C1-C2 instability in children with different types of HFM is nearly the same. The craniovertebral junction of every HFM child must be monitored carefully for C1-C2 instability before any surgical procedure to avoid atlantoaxial dislocation and spinal cord injury.Level of Evidence: N/A.
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Feeding and swallowing outcomes following mandibular distraction osteogenesis: an analysis of 22 non-isolated paediatric cases. Int J Oral Maxillofac Surg 2021; 51:892-899. [PMID: 34952774 DOI: 10.1016/j.ijom.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/02/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022]
Abstract
Patients with mandibular hypoplasia and upper airway obstruction are at an increased risk of feeding and swallowing difficulties. Little has been described regarding these outcomes following mandibular distraction. The aim of this study was to evaluate the effect of mandibular distraction on feeding and swallowing function. A retrospective study was performed on 22 patients with non-isolated mandibular hypoplasia and severe upper airway obstruction treated with mandibular distraction. Median age at first mandibular distraction was 3.1 years (interquartile range 2.3-6.0 years) and the median follow-up time was 3.5 years (interquartile range 2.0-9.4 years). Prior to mandibular distraction, feeding difficulties were present in 18 patients. Swallowing difficulties were present in 20 patients, all of whom had problems in the oral phase of swallowing, while 11 patients had additional problems in the pharyngeal phase. Following mandibular distraction, at the time of follow-up, feeding difficulties persisted in 13 patients. Swallowing difficulties in the oral phase remained present in all 20 patients, while pharyngeal phase problems persisted in seven patients. In conclusion, feeding and swallowing difficulties are highly prevalent in non-isolated patients and often persist following mandibular distraction. Moreover, these can be the reason that decannulation cannot be accomplished. Hence, awareness and close follow-up by a specialized speech therapist is of paramount importance.
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Bergamini LL, Spineli-Silva S, Félix TM, Gil-da-Silva-Lopes VL, Vieira TP, Ribeiro EM, Xavier AC, Lustosa-Mendes E, Fontes MÍB, Monlleó IL. Craniofacial microsomia: Reflections on diagnosis and severity assessment based on a series of cases. Congenit Anom (Kyoto) 2021; 61:148-158. [PMID: 33900643 DOI: 10.1111/cga.12422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/29/2021] [Accepted: 03/22/2021] [Indexed: 12/22/2022]
Abstract
This study aims to discuss diagnostic criteria and severity assessment for craniofacial microsomia (CFM). A series of 61 patients with diverse CFM phenotypes had their clinical data collected by experienced dysmorphologists using a single protocol. Genetic abnormalities were searched through karyotype and chromosomal microarray analysis. Sex ratio, prenatal risk factors, and recurrence rate corroborated the literature. Despite the wide variability of clinical findings, ear disruption was universal. Eight patients were assigned as syndromic, four of whom had demonstrable genetic alterations. The majority of patients (67.2%) fulfilled four known diagnostic criteria, while 9.8% fulfilled one of them. Data strengthened disruptions of the ear and deafness as a semiotically valuable sign in CFM. Facial impairment should consider asymmetry as a mild expression of microsomia. Spinal and cardiac anomalies, microcephaly, and developmental delay were prevalent among extra craniofacial features and should be screened before planning treatment and follow up. The severity index was able to recognize the less and the most affected patients. However, it was not useful to support therapeutic decisions and prognosis in the clinical scenario due to syndromic and non-syndromic phenotypes overlapping. These issues make contemporary the debate on diagnostic methods and disease severity assessment for CFM. They also impact care and etiopathogenetic studies.
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Affiliation(s)
- Luna Lira Bergamini
- Faculty of Medicine, Federal University of Alagoas (UFAL), Maceió, Alagoas, Brazil
| | - Samira Spineli-Silva
- Department of Translational Medicine, Medical Genetics and Genomic Medicine, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Têmis Maria Félix
- Medical Genetics Service, Clinical Hospital of Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Vera L Gil-da-Silva-Lopes
- Department of Translational Medicine, Medical Genetics and Genomic Medicine, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Tarsis P Vieira
- Department of Translational Medicine, Medical Genetics and Genomic Medicine, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Erlane Marques Ribeiro
- Medical Genetics Service, Children's Hospital Albert Sabin (HIAS), Fortaleza, Ceará, Brazil
| | - Ana Carolina Xavier
- Center for Research and Rehabilitation of Lip and Palate Lesions, Prefeito Luiz Gomes Center, Joinville, Santa Catarina, Brazil
| | | | | | - Isabella L Monlleó
- Faculty of Medicine, Federal University of Alagoas (UFAL), Maceió, Alagoas, Brazil.,Clinical Genetics Service, University Hospital, Federal University of Alagoas (UFAL), Maceió, Alagoas, Brazil
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顾 伟, 樊 悦, 霍 红, 陈 晓. [Obstructive sleep apnea in microtia children with maxillofacial dysostosis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:371-379. [PMID: 33794641 PMCID: PMC10128449 DOI: 10.13201/j.issn.2096-7993.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Indexed: 06/12/2023]
Abstract
Children with microtia are often associated with maxillofacial dysostosis, such as Treacher Collins syndrome, Goldenhar syndrome, and Nager syndrome, and they are prone to suffer from obstructive sleep apnea(OSA). Obstruction widely occurred in the upper airway is the main mechanism of OSA in these children, and dysplasia of the pharynx and neurodevelopmental abnormalities may also participate. Early diagnosis requires symptom screening and polysomnography. Imaging techniques and endoscopy can be adopted to fully assess the upper airway status to guide further treatment. According to the child's condition and the main obstruction site, treatment methods include maxillofacial deformity correction, continuous positive pressure ventilation and tracheotomy. OSA in microtia children with maxillofacial dysostosis needs to be identified and treated in time to reduce the adverse effects on the growth and development of children.
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Affiliation(s)
- 伟 顾
- 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
| | - 悦 樊
- 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
| | - 红 霍
- 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
| | - 晓巍 陈
- 中国医学科学院 北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
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Collett BR, Wallace ER, Kapp-Simon KA, Johns AL, Drake AF, Heike CL, Kinter S, Luquetti DV, Magee L, Norton S, Sie K, Speltz ML. Cognitive, Motor, and Language Development of Preschool Children With Craniofacial Microsomia. Cleft Palate Craniofac J 2020; 58:1169-1177. [PMID: 33322943 DOI: 10.1177/1055665620980223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine neurodevelopment in preschool-aged children with craniofacial microsomia (CFM) relative to unaffected peers. DESIGN Multisite, longitudinal cohort study. SETTING Tertiary care centers in the United States. PARTICIPANTS We included 92 children with CFM ("cases") through craniofacial centers and clinics. Seventy-six children without CFM (controls) were included from pediatric practices and community advertisements. This study reports on outcomes assessed when participants were an average age of 38.4 months (SD = 1.9). MAIN OUTCOME MEASURES We assessed cognitive and motor skills using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), and language function using subtests from the Clinical Evaluation of Language Fundamentals-Preschool, second edition (CELF-P2). RESULTS Case-control differences were negligible for Bayley-III cognitive (effect sizes [ES] = -0.06, P = .72) and motor outcomes (ES = -0.19, P = .25). Cases scored lower than controls on most scales of the CELF-P2 (ES = -0.58 to -0.20, P = .01 to .26). Frequency counts for "developmental delay" (ie, one or more scores > 1 SD below the normative mean) were higher for cases (39%) than controls (15%); however, the adjusted odds ratio = 1.73 (P = 0.21) was not significant. Case-control differences were most evident in children with microtia or other combinations of CFM-related facial features. CONCLUSIONS Cognitive and motor scores were similar for preschool-aged children with and without CFM. However, children with CFM scored lower than controls on language measures. We recommend early monitoring of language to identify preschoolers with CFM who could benefit from intervention.
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Affiliation(s)
- Brent R Collett
- Department of Psychiatry and Behavioral Sciences, 7284University of Washington, Seattle, WA, USA
| | - Erin R Wallace
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kathleen A Kapp-Simon
- Department of Surgery, University of Illinois at Chicago and 24183Shriners Hospitals for Children, Chicago, IL, USA
| | - Alexis L Johns
- Clinical Pediatrics, 5150Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, 2331University of North Carolina, Chapel Hill, NC, USA
| | - Carrie L Heike
- Division of Craniofacial Medicine, Department of Pediatrics, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Sara Kinter
- Seattle Children's Craniofacial Center, Seattle, WA, USA
| | - Daniela V Luquetti
- Division of Craniofacial Medicine, Department of Pediatrics, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Leanne Magee
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Norton
- Department of Otolaryngology, 7284University of Washington, Seattle, WA, USA
| | - Kathleen Sie
- Department of Otolaryngology, 7284University of Washington, Seattle, WA, USA
| | - Matthew L Speltz
- Department of Psychiatry and Behavioral Sciences, 7284University of Washington, Seattle, WA, USA
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Collett BR, Chapman K, Wallace ER, Kinter SL, Heike CL, Speltz ML, Werler M. Speech, Language, and Communication Skills of Adolescents With Craniofacial Microsomia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1571-1581. [PMID: 31580699 PMCID: PMC7251598 DOI: 10.1044/2019_ajslp-19-0089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
Purpose Youth with craniofacial microsomia (CFM) have anomalies and comorbidities that increase their risk for speech, language, and communication deficits. We examined these outcomes in youth with and without CFM and explored differences as a function of CFM phenotype and hearing status. Method Participants included youth ages 11-17 years with CFM (n = 107) and demographically similar controls (n = 306). We assessed speech intelligibility, articulation, receptive and expressive language, and parent and teacher report measures of communication. Hearing status was also screened at the study visit. Group differences were estimated using linear regression analyses with standardized effect sizes (ES) adjusted for demographic characteristics (adjusted ES) or negative binomial regression. Results Youth with CFM scored lower than unaffected peers on most measures of intelligibility, articulation, expressive language, and parent- and-teacher-rated communication. Differences were most pronounced among participants with CFM who had mandibular hypoplasia plus microtia (adjusted ES = -1.15 to -0.18). Group differences were larger in youth with CFM who failed the hearing screen (adjusted ES = -0.73 to 0.07) than in those who passed the hearing screen (adjusted ES = -0.34 to 0.27). Conclusions Youth with CFM, particularly those with mandibular hypoplasia plus microtia and/or hearing loss, should be closely monitored for speech and language concerns. Further research is needed to identify the specific needs of youth with CFM as well as to document the course of speech and language development in children with CFM.
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Affiliation(s)
- Brent R Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, WA
| | - Kathy Chapman
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Erin R Wallace
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | | | | | - Matthew L Speltz
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, WA
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Abstract
Clinicians use different diagnostic terms for patients with underdevelopment of facial features arising from the embryonic first and second pharyngeal arches, including first and second branchial arch syndrome, otomandibular dysostosis, oculoauriculovertebral syndrome, and hemifacial microsomia. Craniofacial microsomia has become the preferred term. Although no diagnostic criteria for craniofacial microsomia exist, most patients have a degree of underdevelopment of the mandible, maxilla, ear, orbit, facial soft tissue, and/or facial nerve. These anomalies can affect feeding, compromise the airway, alter facial movement, disrupt hearing, and alter facial appearance.
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Affiliation(s)
- Craig Birgfeld
- Pediatric Plastic and Craniofacial Surgery, Seattle Children's Hospital, 4800 Sand Point Way, M/S OB.9.520, PO Box 5371, Seattle, WA 98105, USA.
| | - Carrie Heike
- Craniofacial Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way, M/S OB.9.528, PO Box 5371, Seattle, WA 98105, USA
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Luquetti DV, Speltz ML, Wallace ER, Siebold B, Collett BR, Drake AF, Johns AL, Kapp-Simon KA, Kinter SL, Leroux BG, Magee L, Norton S, Sie K, Heike CL. Methods and Challenges in a Cohort Study of Infants and Toddlers With Craniofacial Microsomia: The Clock Study. Cleft Palate Craniofac J 2019; 56:877-889. [PMID: 30621445 DOI: 10.1177/1055665618821014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The Craniofacial microsomia: Longitudinal Outcomes in Children pre-Kindergarten (CLOCK) study is a longitudinal cohort study of neurobehavioral outcomes in infants and toddlers with craniofacial microsomia (CFM). In this article, we review the data collection and methods used to characterize this complex condition and describe the demographic and clinical characteristics of the cohort. SETTING Craniofacial and otolaryngology clinics at 5 study sites. PARTICIPANTS Infants with CFM and unaffected infants (controls) ages 12 to 24 months were recruited from the same geographical regions and followed to age 36 to 48 months. METHODS Phenotypic, neurodevelopmental, and facial expression assessments were completed during the first and third waves of data collection (time 1 and time 3, respectively). Medical history data were taken at both of these time points and during an intermediate parent phone interview (time 2). RESULTS Our cohort includes 108 cases and 84 controls. Most cases and controls identified as white and 55% of cases and 37% of controls identified as Hispanic. Nearly all cases had microtia (95%) and 59% had mandibular hypoplasia. Cases received extensive clinical care in infancy, with 59% receiving care in a craniofacial clinic and 28% experiencing at least one surgery. Study visits were completed at a study site (92%) or at the participant's home (8%). CONCLUSIONS The CLOCK study represents an effort to overcome the challenges of characterizing the phenotypic and neurodevelopmental outcomes of CFM in a large, demographically and geographically diverse cohort.
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Affiliation(s)
- Daniela V Luquetti
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Matthew L Speltz
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Erin R Wallace
- 1 Seattle Children's Research Institute, Seattle, WA, USA
| | - Babette Siebold
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA
| | - Brent R Collett
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Kathleen A Kapp-Simon
- 6 Shriners Hospitals for Children, Chicago, IL, USA.,7 University of Illinois, Chicago, IL, USA
| | - Sara L Kinter
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA
| | - Brian G Leroux
- 8 University of Washington School of Dentistry, Seattle, WA, USA
| | - Leanne Magee
- 9 Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Norton
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Kathleen Sie
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Carrie L Heike
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Renkema R, Caron C, Wolvius E, Rooijers W, Schipper J, Dunaway D, Forrest C, Koudstaal M, Padwa B. Vertebral anomalies in craniofacial microsomia: a retrospective analysis of 991 patients. Int J Oral Maxillofac Surg 2018; 47:1365-1372. [DOI: 10.1016/j.ijom.2018.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/11/2018] [Accepted: 05/16/2018] [Indexed: 11/24/2022]
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Caron CJ, Pluijmers BI, Joosten K, Dunaway D, Padwa BL, Wolvius EB, Koudstaal MJ. Feeding difficulties in craniofacial microsomia: A multicenter retrospective analysis of 755 patients. J Craniomaxillofac Surg 2018; 46:1777-1782. [DOI: 10.1016/j.jcms.2018.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/29/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022] Open
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Speltz ML, Kapp-Simon KA, Johns AL, Wallace ER, Collett BR, Magee L, Leroux BG, Luquetti DV, Heike CL. Neurodevelopment of Infants with and without Craniofacial Microsomia. J Pediatr 2018; 198:226-233.e3. [PMID: 29685618 PMCID: PMC6019149 DOI: 10.1016/j.jpeds.2018.02.076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine whether infant cases with craniofacial microsomia (CFM) evidence poorer neurodevelopmental status than demographically similar infants without craniofacial diagnoses ("controls"), and to examine cases' neurodevelopmental outcomes by facial phenotype and hearing status. STUDY DESIGN Multicenter, observational study of 108 cases and 84 controls aged 12-24 months. Participants were assessed by the Bayley Scales of Infant and Toddler Development-Third Edition and the Preschool Language Scales-Fifth Edition (PLS-5). Facial features were classified with the Phenotypic Assessment Tool for Craniofacial Microsomia. RESULTS After adjustment for demographic variables, there was little difference in Bayley Scales of Infant and Toddler Development-Third Edition or Preschool Language Scales-Fifth Edition outcomes between cases and controls. Estimates of mean differences ranged from -0.23 to 1.79 corresponding to standardized effect sizes of -.02 to 0.12 (P values from .30 to .88). Outcomes were better among females and those with higher socioeconomic status. Among cases, facial phenotype and hearing status showed little to no association with outcomes. Analysis of individual test scores indicated that 21% of cases and 16% of controls were developmentally delayed (OR 0.68, 95% CI 0.29-1.61). CONCLUSIONS Although learning problems have been observed in older children with CFM, we found no evidence of developmental or language delay among infants. Variation in outcomes across prior studies may reflect differences in ascertainment methods and CFM diagnostic criteria.
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Affiliation(s)
- Matthew L Speltz
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics and Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Kathleen A Kapp-Simon
- Cleft-Craniofacial Center, Shriners Hospital for Children, Chicago, IL; Craniofacial Center, Department of Surgery, University of Illinois, Chicago, IL
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Erin R Wallace
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
| | - Brent R Collett
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics and Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA
| | - Leanne Magee
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Brian G Leroux
- University of Washington School of Dentistry, Seattle, WA
| | - Daniela V Luquetti
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics and Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA
| | - Carrie L Heike
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics and Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA
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Renkema R, Caron C, Wolvius E, Dunaway D, Forrest C, Padwa B, Koudstaal M. Central nervous system anomalies in craniofacial microsomia: a systematic review. Int J Oral Maxillofac Surg 2018; 47:27-34. [DOI: 10.1016/j.ijom.2017.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/27/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
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14
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van de Lande LS, Caron CJJM, Pluijmers BI, Joosten KFM, Streppel M, Dunaway DJ, Koudstaal MJ, Padwa BL. Evaluation of Swallow Function in Patients with Craniofacial Microsomia: A Retrospective Study. Dysphagia 2017; 33:234-242. [PMID: 29103155 PMCID: PMC5866261 DOI: 10.1007/s00455-017-9851-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/19/2017] [Indexed: 11/29/2022]
Abstract
Craniofacial microsomia (CFM) is characterized by underdevelopment of the structures derived from the first and second pharyngeal arches resulting in aesthetic, psychological, and functional problems including feeding and swallowing difficulties. The aim of this study is to gain more insight into swallowing difficulties in patients with CFM. A retrospective study was conducted in the population of patients diagnosed with CFM at three major craniofacial units. Patients with feeding difficulties and those who underwent video fluoroscopic swallow (VFS) studies were included for further analyses. The outcome of the VFS-studies was reviewed with regard to the four phases of swallowing. In our cohort, 13.5% of the 755 patients were diagnosed with swallowing difficulties. The outcome of the VFS-studies of 42 patients showed difficulties in the oral and pharyngeal phases with both thin and thick liquids. Patients with more severe mandibular hypoplasia showed more difficulties to form an appropriate bolus compared to patients who were less severely affected. This is the first study to document swallowing problems in patients with CFM. Difficulties were seen in both the oral and pharyngeal phases. We recommend routine screening for swallowing issues by a speech and language therapist in all patients with CFM and to obtain a VFS-study in patients with a type III mandible.
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Affiliation(s)
- Lara S van de Lande
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus MC, Sophia Children's Hospital Rotterdam, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Cornelia J J M Caron
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus MC, Sophia Children's Hospital Rotterdam, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Britt I Pluijmers
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus MC, Sophia Children's Hospital Rotterdam, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Koen F M Joosten
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus MC, Sophia Children's Hospital Rotterdam, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Marloes Streppel
- The Dutch Craniofacial Center, Department of Ear, Nose and Throat Surgery, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - David J Dunaway
- The Craniofacial Unit, Great Ormond Street Hospital, London, UK
| | - Maarten J Koudstaal
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus MC, Sophia Children's Hospital Rotterdam, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.,The Craniofacial Unit, Great Ormond Street Hospital, London, UK.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, USA
| | - Bonnie L Padwa
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, USA
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15
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Renkema R, Caron C, Mathijssen I, Wolvius E, Dunaway D, Forrest C, Padwa B, Koudstaal M. Vertebral anomalies in craniofacial microsomia: a systematic review. Int J Oral Maxillofac Surg 2017; 46:1319-1329. [DOI: 10.1016/j.ijom.2017.04.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/27/2017] [Indexed: 11/16/2022]
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16
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Intelligence and Academic Achievement of Adolescents with Craniofacial Microsomia. Plast Reconstr Surg 2017; 140:571-580. [PMID: 28841618 DOI: 10.1097/prs.0000000000003584] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The authors compared the IQ and academic achievement of adolescents with craniofacial microsomia (cases) and unaffected children (controls). Among cases, the authors analyzed cognitive functioning by facial phenotype. METHODS The authors administered standardized tests of intelligence, reading, spelling, writing, and mathematics to 142 cases and 316 controls recruited from 26 cities across the United States and Canada. Phenotypic classification was based on integrated data from photographic images, health history, and medical chart reviews. Hearing screens were conducted for all participants. RESULTS After adjustment for demographics, cases' average scores were lower than those of controls on all measures, but the magnitude of differences was small (standardized effect sizes, -0.01 to -0.3). There was little evidence that hearing status modified case-control group differences (Wald p > 0.05 for all measures). Twenty-five percent of controls and 38 percent of cases were classified as having learning problems (adjusted OR, 1.5; 95 percent CI, 0.9 to 2.4). Comparison of cases with and without learning problems indicated that those with learning problems were more likely to be male, Hispanic, and to come from lower income, bilingual families. Analyses by facial phenotype showed that case-control group differences were largest for cases with both microtia and mandibular hypoplasia (effect sizes, -0.02 to -0.6). CONCLUSIONS The highest risk of cognitive-academic problems was observed in patients with combined microtia and mandibular hypoplasia. Developmental surveillance of this subgroup is recommended, especially in the context of high socioeconomic risk and bilingual families. Given the early stage of research on craniofacial microsomia and neurodevelopment, replication of these findings is needed. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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17
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Abstract
A retrospective cohort study was set up to analyse the prevalence and treatment of obstructive sleep apnoea (OSA) in relation to the severity of the deformity in patients with craniofacial microsomia (CFM). This study included a population of 755 patients with CFM from three craniofacial centres. Medical charts were reviewed for severity of the deformity, types of breathing difficulty, age at which breathing difficulty first presented, treatment for OSA, and treatment outcome. In total, 133 patients (17.6%) were diagnosed with OSA. Patients with Pruzansky IIB/III classification or bilateral craniofacial microsomia were significantly more often diagnosed with OSA than unilaterally affected patients of Pruzansky I/IIA classification. The initial treatment of OSA consisted of adenotonsillectomy, tracheotomy, or non-invasive positive pressure ventilation. Thirty-seven patients received more than one treatment (range 1-3). In this study, the prevalence of OSA in patients with CFM was higher than the prevalence in the healthy population described in the literature. Although several treatment modalities are available for the treatment of OSA in patients with CFM, treatment should be individualized and based on clinical symptoms, the severity of the deformity, and comorbidities.
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18
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Goetze TB, Sleifer P, Rosa RFM, da Silva AP, Graziadio C, Zen PRG. Hearing characterization in oculoauriculovertebral spectrum: A prospective study with 10 patients. Am J Med Genet A 2016; 173:309-314. [PMID: 27774762 DOI: 10.1002/ajmg.a.38017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/23/2016] [Indexed: 11/09/2022]
Abstract
Oculoauriculovertebral spectrum (OAVS), also known as Goldenhar syndrome, is considered a condition associated to failing of embryogenesis involving the first and second branchial arches, leading to structural abnormalities arising from it. The aim of this study is to verify the hearing features presented by patients with OAVS and provide additional information that may contribute to improvement of speech therapy. The sample consisted of 10 individuals diagnosed with OAVS and cared for by the Clinical Genetics Service. All patients underwent objective assessment of auditory function through tonal and vocal audiometry. This evaluation was completed using TOAE and BERA. The patient's age ranged from 1 year and 9 months to 27 years and 4 months. At physical examination it was found that 10 had microtia, 7 preauricular tags, 6 low-set ears, 6 ear canal atresia, and 2 preauricular pits. Among the patients, five presented with abnormal hearing. Three patients had conductive hearing loss ranging from mild to moderate, and two patients had sensorineural hearing loss from mild to profound. Three patients had hearing loss in both ears. Speech-language disorders are common in children with OAVS. Thus, the referral to the audiologist and speech pathologist is indicated as soon as possible. Early recognition and detailed understanding of aspects related to the etiology, clinical features, and outcome of patients with OAVS are essential for their proper management. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Thayse Bienert Goetze
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Pricila Sleifer
- Speech Language Pathology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Rafael Fabiano Machado Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Clinical Genetics, UFCSPA and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, RS, Brazil.,Graduate Program in Biosciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Alessandra Pawelec da Silva
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Carla Graziadio
- Clinical Genetics, UFCSPA and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, RS, Brazil
| | - Paulo Ricardo Gazzola Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Clinical Genetics, UFCSPA and Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), Porto Alegre, RS, Brazil.,Graduate Program in Biosciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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19
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Feeding difficulties in craniofacial microsomia: a systematic review. Int J Oral Maxillofac Surg 2015; 44:732-7. [DOI: 10.1016/j.ijom.2015.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 12/30/2022]
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20
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Glaser TS, Rauen KA, Jeng LJB, de Alba Campomanes AG. Lipodermoid in a patient with Emanuel syndrome. J AAPOS 2013; 17:211-3. [PMID: 23528375 DOI: 10.1016/j.jaapos.2012.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 11/30/2022]
Abstract
We report an 8-month-old boy with Emanuel syndrome who also had the clinical features of Goldenhar syndrome. At birth, he was observed to have bilateral microtia with multiple auricular pits, retrognathia, and a unilateral lipodermoid. Further testing revealed cardiac defects. The finding of a lipodermoid in Emanuel syndrome demonstrates phenotypic overlap between Goldenhar and Emanuel syndromes and suggests a role for genetic analysis in all patients with clinical features that include ear anomalies and lipodermoids. Correct identification of patients with Emanuel syndrome is important for determining whether there is risk of long-term neurodevelopmental disability, and genetic testing can determine parental carrier status to aid in family planning.
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Affiliation(s)
- Tanya S Glaser
- Department of Ophthalmology, University of California-San Francisco, San Francisco, California, USA
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21
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Collett BR, Speltz ML, Cloonan YK, Leroux BG, Kelly JP, Werler MM. Neurodevelopmental outcomes in children with hemifacial microsomia. ACTA ACUST UNITED AC 2011; 165:134-40. [PMID: 21300653 DOI: 10.1001/archpediatrics.2010.271] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine whether preadolescent children with hemifacial microsomia (HFM) have higher risk of neurodevelopmental delays than unaffected control individuals. DESIGN Case-control follow-up study of neurodevelopment in children with and without HFM. SETTING Case individuals were originally recruited from 26 craniofacial centers across the United States and Canada, and controls were recruited through community pediatricians. PARTICIPANTS One hundred thirty-six children with HFM (cases) and 568 unaffected children (controls). Main Exposure History of HFM. MAIN OUTCOME MEASURES The Peabody Picture Vocabulary Test-Third Edition, the Beery-Buktenica Developmental Test of Visual Motor Integration-Fifth Edition, and the Academic Competence scales from the Child Behavior Checklist and the Teacher Report Form. RESULTS Children with HFM scored lower than controls on all measures (effect size = -0.27 to -0.45; P < .001 to P = .008). Compared with controls, cases were 2 to 3 times as likely to score in the at-risk range. Relative to controls, outcomes were worse for male cases and those whose mothers were 25 years or younger at the time of their birth. Cases with HFM plus other malformations had poorer outcomes, as did cases with hearing, vision, or speech impairments. CONCLUSIONS This is the first study, to our knowledge, to show that children with HFM have poorer neurodevelopmental outcomes than unaffected children, but further study using more detailed assessments is indicated. Clinically, the findings suggest that early neurodevelopmental screening is warranted for all children with HFM.
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Affiliation(s)
- Brent R Collett
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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22
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Clawson EP, Palinski KS, Elliott CA. Outcome of intensive oral motor and behavioural interventions for feeding difficulties in three children with Goldenhar Syndrome. ACTA ACUST UNITED AC 2009; 9:65-75. [PMID: 16352509 DOI: 10.1080/13638490500144809] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The facial anomalies and surgeries associated with Goldenhar Syndrome often lead to feeding problems. The purpose of this study was to demonstrate the outcome of Goldenhar Syndrome children admitted to the day patient paediatric feeding programme. SUBJECTS Three children with Goldenhar Syndrome and feeding difficulties participated, mean age 3 years. Average length of stay was 8 weeks. Upon admission all were dependent on tube feedings. METHODS The children received four therapeutic sessions daily. The sessions included oral motor interventions, behavioural techniques and a structured meal. Data regarding children's feeding were collected at admission and discharge. RESULTS The patients had 52% acceptance of food/drink at admission and 88.7% at discharge. Expels were 30% at admission and 14% at discharge. Mouth clean was 9.3% at admission and 97% at discharge. Total inappropriate feeding behaviours averaged 83% at admission and 27.3% at discharge. Children averaged 3.4 g per meal at admission and 105.4 g at discharge. Two children were completely weaned from tube feedings by discharge. CONCLUSIONS Results support the hypothesis that combining oral motor and behavioural interventions offer effective treatment for children with Goldenhar Syndrome. Many children with Goldenhar Syndrome are reliant on tube feedings and this regimen allows them to eat orally, thereby improving their nutrition and quality of life.
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23
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Affiliation(s)
- Joseph Lam
- Rady Children's Hospital, University of California, San Diego School of Medicine, San Diego, California, USA
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24
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Abstract
Early identification of hearing loss and rapid rehabilitative intervention are the two key elements that will give an infant the best chance to develop normal speech and allow the family members to make appropriate adjustments that will enhance communication in the home environment. Hearing loss in an infant may be only one feature of a syndromic disorder, and the physician must aspire to diagnose and treat the entire dysfunction. While a limited laboratory evaluation and appropriate referrals to related specialties are helpful, a comprehensive history and a complete physical examination are the most effective means to identify syndromic hearing loss and to direct future evaluation and therapy.
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Affiliation(s)
- B P Pickett
- Department of Otolaryngology, Plastic, and Reconstructive Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131-5341, USA
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