The Effect of Preoperative Use of an Orthopedic Plate on Articulatory Function in Children with Cleft Lip and Palate

Presurgical orthopedics by drink plates does not significantly normalize deglutition in infants with cleft lip and palate

OBJECTIVE

To test the null hypothesis of no significant difference between intraoral pressure characteristics in infants with cleft lip and palate (CLP) with or without presurgical orthopedic (PSO) plates (groups CLP and CLP-PSO), compared with noncleft infants.

MATERIALS AND METHODS

Intraoral atmospheric pressure assessments were performed on 17 subjects with preoperative CLP (m/f, 11/6; mean/SD, 4.76/0.92 months) and a matched control group (n = 24; m/f, 15/9; mean/SD, 4.88/0.9 months), for 200 seconds, simultaneously at the vestibulum (vestibular space [VS]) and at the palate (subpalatal space [SPS]), using a prepared pacifier connected to a digital manometer. Areas under the pressure curves (AUC), frequencies, durations, and magnitudes of swallowing peaks and pressure resting plateaus were compared between trial groups and locations (VS, SPS) using a two-factor analysis of variance for repeated measures, Kruskal-Wallis test, and Mann-Whitney U-test (α = .05).

RESULTS

The null hypothesis was rejected: Globally, there were statistically significant differences in intraoral pressure characteristics between groups CLP, CLP-PSO, and control (all P < .01), with significantly higher negative pressures (AUC) in the control subjects compared with those of CLP or CLP-PSO. There were significant effects by the location of pressure recordings (VS, SPS) and their interaction with all treatment groups. Differences between noncleft and CLP subjects were more pronounced in the VS than in the SPS. There was no significant effect by PSO.

CONCLUSION

PSO does not improve deviated swallowing characteristics during suction in CLP infants.

Relationships Between Formant Frequencies of Sustained Vowels and Tongue Contours Measured by Ultrasonography

PURPOSE

The purpose of this study was to explore the formant-articulation relationships in corner vowels by acoustic analysis of speech signals and measuring tongue contour using ultrasonography.

METHOD

Eighteen healthy adults (8 men, 10 women), aged between 20 and 40 years, were enrolled. Speech signals of sustained vowels /ɑ/, /i/, and /u/ were recorded to obtain the first 2 formant frequencies. Tongue height, tongue advancement, and lengths of posterior tongue surface (LPTS) and anterior oral cavity (LAOC) were obtained using ultrasound image processing technique in order to examine the resonance mechanism of the oral vocal tract.

RESULTS

LPTS and LAOC, as well as mean frequencies of the first and second formants, showed significant differences between sexes and among vowels. The first formant significantly and better correlated with LPTS than with tongue height (r = -.78, p < .001, Pearson's correlation). The correlation of the second formant with LAOC (r = -.85, p < .001) was also significant and better than the correlation with tongue advancement. Sex, however, did not show significant correlation with the formant frequencies.

CONCLUSIONS

Ultrasonographic measurements of tongue contour correlated well to the formant frequencies. The results stressed the importance of tongue shaping in articulation. Although more studies are necessary in clinical implications, disorders associated with abnormal tongue shaping may be the target applications in the future.

Current status of presurgical infant orthopaedic treatment for cleft lip and palate patients: A critical review

Rehabilitation of cleft lip and palate (CLP) patients is a challenge for all the concerned members of the cleft team, and various treatment modalities have been attempted to obtain aesthetic results. Presurgical infant orthopaedics (PSIO) was introduced to reshape alveolar and nasal segments prior to surgical repair of cleft lip. However, literature reports lot of controversy regarding the use of PSIO in patients with CLP. Evaluation of long-term results of PSIO can provide scientific evidence on the efficacy and usefulness of PSIO in CLP patients. The aim was to assess the scientific evidence on the efficiency of PSIO appliances in patients with CLP and to critically analyse the current status of PSIO. A PubMed search was performed using the terms PSIO, presurgical nasoalveolar moulding and its long-term results and related articles were selected for the review. The documented studies report no beneficial effect of PSIO on maxillary arch dimensions, facial aesthetics and in the subsequent development of dentition and occlusion in CLP patients. Nasal moulding seems to be more beneficial and effective in unilateral cleft lip and palate patients with better long-term results.

Presurgical orthopedic treatment ameliorates postoperative nasal deformity after cheiloplasty

We assessed the postoperative nasal form and symmetry after presurgical use of a Hotz plate (HP) in patients with unilateral complete cleft lip and palate (UCLP). The subjects were 28 infants with UCLP who underwent cheiloplasty. Of these subjects, 14 underwent presurgical orthopedic treatment using the HP (HP group) and 14 underwent the same treatment without the HP (non-HP group). Photographic records were obtained 1 and 6 months after cheiloplasty, and the results of anthropometric analysis were compared between the 2 groups. The nasal inclination and the ratio of the width of the nasal base to the total width of the nose were significantly improved in the HP group compared with the non-HP group at both postoperative time points. Thus, presurgical use of the HP significantly improved the nasal asymmetry and deformity in UCLP patients after primary cheiloplasty and nasal repair.

Using Ultrasound to Quantify Tongue Shape and Movement Characteristics

Objective

Previous experimental studies have demonstrated abnormal lingual articulatory patterns characterizing cleft palate speech. Most articulatory information to date has been collected using electropalatography, which records the location and size of tongue-palate contact but not the tongue shape. The latter type of data can be provided by ultrasound. The present paper aims to describe ultrasound tongue imaging as a potential tool for quantitative analysis of tongue function in speakers with cleft palate. A description of the ultrasound technique as applied to analyzing tongue movements is given, followed by the requirements for quantitative analysis. Several measures are described, and example calculations are provided.

Measures

Two measures aim to quantify overuse of tongue dorsum in cleft palate articulations. Crucially for potential clinical applications, these measures do not require head-to-transducer stabilization because both are based on a single tongue curve. The other three measures compare sets of tongue curves, with the aim to quantify the dynamics of tongue displacement, token-to-token variability in tongue position, and the extent of separation between tongue curves for different speech sounds.

Conclusions

All measures can be used to compare tongue function in speakers with cleft palate before and after therapy, as well as to assess their performance against that in typical speakers and to help in selecting more effective treatments.

Application of the International Classification of Functioning, Disability, and Health–Children and Youth Version (ICF-CY) to Cleft Lip and Palate

Objective

In recent health policy discussions, the World Health Organization has urged member states to implement the International Classification of Functioning, Disability, and Health: Children and Youth Version in their clinical practice and research. The purpose of this study was to identify codes from the International Classification of Functioning, Disability, and Health: Children and Youth Version relevant for use among children with cleft lip and/or palate, thereby highlighting the potential value of these codes for interprofessional cleft palate-craniofacial teams.

Design

The scope of recent published research in the area of cleft lip and/or palate was reviewed and compared with meaningful terms identified from the International Classification of Functioning, Disability, and Health: Children and Youth Version. In a five-step procedure, a consensus-based list of terms was developed that was linked separately to International Classification of Functioning, Disability, and Health: Children and Youth Version categories and codes. This provided a first draft of a core set for use in the cleft lip and/or palate field.

Conclusions

Adopting International Classification of Functioning, Disability, and Health: Children and Youth Version domains in cleft lip and/or palate may aid experts in identifying appropriate starting points for assessment, counseling, and therapy. When used as a clinical tool, it encourages health care professionals to go beyond treatment and outcome perspectives that are focused solely on the child and to include the children's environment and their familial/societal context. In order to establish improved, evidence-based interdisciplinary treatments for children with cleft lip and/or palate, more studies are needed that seek to identify all the influencing conditions of activities, children's participation, and barriers/facilitators in their environments.

A expansão rápida da maxila com haas e a fala na fissura labiopalatina transforame

OBJETIVO: verificar os efeitos da Expansão Rápida da Maxila (ERM), com aparelho Haas, na fala do paciente com fissura labiopalatina (FLP) Transforame. MÉTODOS: 12 indivíduos entre sete e 14 anos, sendo seis meninos e seis meninas, divididos em dois grupos. O Grupo 1 (G1), submetido à ERM com protocolo de ativação convencional e, o Grupo 2 (G2), submetido à ERM com protocolo de ativação preconizado por Liou e Tsai (2005) com expansões e constrições alternadas. Realizou-se avaliação da fala, análise acústica com programa Praat e avaliação perceptivo-auditiva por julgadores fonoaudiólogos e leigos. RESULTADOS: a medição dos tempos de emissão das vogais por análise acústica mostrou diferença estatisticamente significante na avaliação pós-ERM da vogal /i/ no G1 e da vogal /a/ no G2. Na avaliação perceptivo-auditiva, não houve diferenças estatisticamente significantes entre os grupos nas avaliações de Nasalidade e Clareza na Articulação, porém, na medida em que os julgadores atribuíram melhora à Nasalidade, também atribuíram melhora à Articulação e, assim também em relação as variáveis "Melhor", "Igual" e "Pior". CONCLUSÃO: a diminuição dos tempos de emissão pós-ERM, indica que o aumento no escape aéreo nasal ocasiona menores tempos de emissão. A análise perceptivo-auditiva mostrou-se um instrumento eficaz de avaliação, havendo concordância entre julgadores leigos e fonoaudiólogos. Essa avaliação indicou também, que na medida em que a nasalidade diminui ocorre maior clareza na articulação.