The craniofacial morphology of 30 young adults with the Pierre Robin sequence, aged 17.0-27.1 years (mean, 20.8), was analyzed and compared with the craniofacial morphology of 116 young adults with isolated cleft palate, aged 16.9-20.6 years (mean, 18.8). All patients had been examined and operated on at the Cleft Center, Department of Plastic Surgery, Helsinki University Central Hospital. The skeletal dimensions of patients with Pierre Robin sequence differed from those of patients with isolated cleft palate by the shorter posterior cranial base, maxilla, and mandibular ramus. The mandible was also more retruded and more posteriorly rotated, and the soft tissue profile more convex in Pierre Robin sequence patients. In the pharyngeal area, the lower sagittal depth of the pharynx was significantly shorter and the hyoid bone position more inferior in those with Pierre Robin sequence than in those with isolated cleft palate.
Maxillary advancement may result in movement of the posterior border of the hard palate with its soft palate attachment, which may cause impairment of velopharyngeal (VP) function. We examined VP function before and after Le Fort I osteotomy in 15 cleft lip and palate patients. The extent of maxillary advancement was measured by means of standard cephalometric radiographs taken before and after the operation. VP function was evaluated in terms of perceptual speech assessments, pressure-flow data and nasalance scores preoperatively and 2, 6 and 12 months after the operation. The results showed that maxillary advancement resulted in impairment of VP function in 4 (27%) of the patients.
Introduction: Maxillary advancement may affect speech in cleft patients. The aim of this study was to evaluate whether preoperative velopharyngeal (VP) function and cleft type can predict VP function after a Le Fort I maxillary osteotomy. Materials and methods: One hundred consecutive nonsyndromic cleft patients (54 females, 64 males) who underwent Le Fort I osteotomies were retrospectively evaluated. Pre-and postoperative VP function was assessed perceptually and instrumentally by a Nasometer. A five-point scale was used to rate velopharyngeal insufficiency symptoms (VPI 0e4). To assess reliability, 30 video recordings were reevaluated. Results: Preoperatively, 89% of patients had normal or insignificant VPI (0e1), and only 3% had moderate VPI (3). Postoperatively, 77% of patients had VPI values of 0e1 and 14% had moderate to severe VPI values (VPI 3e4). A positive correlation was found between pre-and postoperative VPI scores, whereas the cleft type did not affect speech results. Patients with a preoperatively normal VPI (0) were not at risk for postoperative velopharyngeal incompetence. Conclusions: There was an overall significant negative change in speech after a Le Fort I osteotomy. Atrisk patients presented with borderline (1) or more severe VPI (2 and 3) preoperatively.
Seventy-three children with submucous cleft palate (38 girls and 35 boys), mean age 8.2 years (range 7.7-9.5), were studied retrospectively from orthopantomograms. Dental abnormalities in permanent dentition were found in 26 patients (36%). Missing teeth, mainly lower 2nd premolars, upper lateral incisors, and upper 2nd premolars, were found in 12 patients (16%). Most of the patients had 1 or 2 missing teeth, 2 had 3 missing teeth. In 5 patients hypodontia was associated with another dental abnormality. Other dental abnormalities included peg-shaped lateral incisors in 7 patients (10%), ectopic eruption of upper 1st molars in 6 patients (8%), transposition of upper canines and 1st premolars in 3 patients (4%), supernumerary teeth in 2 patients (3%), and palatally displaced upper canines in 1 patient (1%). As children with submucous cleft palate have a tendency towards increased frequency of missing teeth and other dental abnormalities, the need for thorough clinical and radiological dental examination is emphasized.
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