ISSN:1021-7762    

DOI:10.1159/000266445

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The occurrences (birth prevalences) of different types of isolated and multiple orofacial clefts are known in Hungary. The empiric risk figures in the first-degree relatives of probands with cleft lip ± cleft palate, cleft palate, Robin sequence and multiple congenital abnormalities including orofacial clefts as component defects were also determined. Finally the recent controversial data concerning the primary prevention of isolated orofacial clefts by periconceptional folic acid-containing multivitamins are summarized

ISSN:1021-7762    

DOI:10.1159/000266446

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Over the last 4 decades remarkable progress has been made in the treatment of cleft palate: the rate of attaining normal or nearly normal speech after surgery has risen from about 65% 40 years ago to nearly 90% or more nowadays. One of the main factors is intratracheal intubation anesthesia that has made the surgery much safer and easier. Improved surgical technique and speech therapy also played a great role. This paper deals with two problems: (1) Slight velopharyngeal incompetence: The combined use of fiberscopy and fluorovideoscopy can provide useful information as to: (a) the exact place of the faulty articulation, (b) the detailed pattern of inconsistent velopharyngeal function, (c) changes in articulation induced by speech therapy, and (d) the relation between velopharyngeal function and faulty articulation. All the above information greatly facilitates speech therapy for cleft palate speech. It should be done with utmost care though due to possible adverse effects of radiation. (2) Analysis of faulty articulation: It was revealed that faulty articulations such as laryngeal fricative and affricates, pharyngeal stop, and glottal stop in cleft palate speech, secondary to velopharyngeal incompetence, were produced by articulation in the larynx at various sites such as the epiglottis, arytenoids, aryepiglottic folds and vocal folds. These faulty articulation points were located lower than supposed on the basis of auditory perception.

ISSN:1021-7762    

DOI:10.1159/000266447

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Proper assessment of patients with velopharyngeal valve incompetence is a mandatory prerequisite for optimal management. The protocol of assessment of Ain Shams University, Phoniatric Department, uses three levels of assessment of velopharyngeal valve incompetence according to the complexity of the armamentarium used. This allows application of those parts of the protocol that suit the needs of the different socioeconomic levels and geographical locations. Firstly, the elementary diagnostic procedures, which are rather simple, noninvasive, but essentially subjective. Despite the clinical feasibility of these procedures, documentation of the data is made utilizing the tools at the second level of assessment in that protocol (clinical diagnostic aids). This level comprises video-nasofiberscopy and high fidelity voice recording. An attempt to extract quasi-quantitative measures from the hitherto qualitative video-nasofiberscopy is made. The third level of assessment, namely additional instrumental measures, comprises CT scanning of the velopharyngeal port, aerodynamics, and acoustic analysis. The results of the three levels of the protocol are presented. Their significance and clinical efficacy are discussed. Some community-related problems that have faced the cleft palate team are outlined. Their sociocultural significance in a developing country is discussed.

ISSN:1021-7762    

DOI:10.1159/000266448

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Articulation testing provides a structure for evaluating children with cleft or velopharyngeal incompetency in a specific manner so that they can be compared with normative data and later to themselves. Results from an articulation test should always be compared to the precept of what is heard in conversation, specifically on articulation, nasality, and velopharyngeal competency. Analysis of an articulation test provides data for the speech clinician to develop a therapy program which is realistic and structured. Articulation tests also help clinicians evaluate the child’s progres

ISSN:1021-7762    

DOI:10.1159/000266449

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The article comprises the proposal made by the Cleft Palate Committe of IALP to standardize the parameters of the speech and hearing evaluation in individuals with cleft palate/velopharyngeal incompetence (CP/VPI). The suggested parameters are the following: nasal resonance, nasal escape, articulation and its disorders, facial grimacing, speech intelligibility, patient teachability, expressive language and voice. The authors recommend a five-point scale description system, which can be used also for assessment of hearing, velopharyngeal competence and other attributes of the CP/VPI individual. The most important diagnostic pharyngoscopy, nasometry procedures are: X-ray (video/cinefluoroscopy), nasometry; in dubious cases it is also fundamental to clarify the etiology with electrophysiological methods. The utilization of this proposal might contribute to a more accurate diagnosis and a more effective treatment on an international basis.

ISSN:1021-7762    

DOI:10.1159/000266450

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

There is international consensus about some fundamental elements concerning treatment of cleft lip and palate (CLP): (1) multidisciplinary teamwork, (2) centralization, (3) team continuity, (4) long-term treatment planning (from birth to adulthood), (5) documentation, (6) evaluation, (7) follow-up studies, (8) research and (9) quality assurance. Every year 120–140 children are born with CLP in Norway (2 per 1,000 live births). For more than four decades the treatment of CLP has been centralized to the University Clinics in Oslo and Bergen. The cost of treatment as well as the travel expenditures for patients born with facial clefts are paid by the Norwegian government (social security). In a speech study of 180 6-year-old children with CLP/CP first operated in Bergen during 1973–1981, normal resonance was found in 76.7% of the children, moderate hypernasality in 11.7%, while 11.6% had marked hypernasal

ISSN:1021-7762    

DOI:10.1159/000266451

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Morphological and functional alterations in patients with cleft lip and palate act as predisposing factors in eustachian tube dysfunctions and as a result thereof in the occurrence of mucosecretory ear disease (MSED) and its complications. Development of MSED is the result of tube dysfunction and it consists of: (a) fluctuating conductive hearing loss, (b) swallowing alterations and (c) respiratory functional disorders. Once this syndrome is confirmed in children with clefts, action must be taken through a coordinated multidisciplinary approach with plastic surgery, odontology, and speech therapy to achieve morphological and functional reconstruction, thus allowing early middle ear ventilation.

ISSN:1021-7762    

DOI:10.1159/000266452

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Malformations, deformations and abnormal intermaxillary relationships varying in severity can be found in cleft lip and/or palate children. Such multiple deformities have an influence on speech resonance and articulation, as well as on masticatory, auditive and respiratory functions. Therefore, a multidisciplinary team should monitor these patients from birth on to adulthood. This article describes our treatment protocol, discusses the limitations of dental orthopedic action and the indications for orthognathic surgery. Timing and techniques of different surgical interventions are presented and the impact of these procedures on velopharyngeal function is evaluated.

ISSN:1021-7762    

DOI:10.1159/000266453

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Zur Beantwortung der Frage, ob ein kranial gestielter Pharynxlappen bei Gaumenspaltträgern die Nasenatmung behindert, wurden 49 Kinder mittels aktiver anteriorer Rhinomanometrie vor und nach Abschwellung der Nasenschleimhaut untersucht. Alle Patienten waren zwischen 10 und 12 Jahre alt. 18 von ihnen hatten eine Velopharyngoplastik mit einem kranial gestielten Pharynxlappen im durchschnittlichen Alter vom 3,5 Jahren erhalten. Die Kontrollgruppe bestand aus 21 Kinder, die mit einer intravelaren Veloplastik ohne einen Pharynxlappen im Alter von 11–13 Monaten versorgt worden waren. Keiner der Patienten wies eine nennenswerte Einengung der Nasenwege auf. Mittels des U-Testes fanden wir keine signifikante Differenz zwischen dem inspiratorischen Atemvolumen beider Gruppen. Die Differenz zwischen in- und exspiratorischem Volumen in jeder Gruppe zeigte ebenfalls keine Signifikanz, während sich die Volumina vor und nach Abschwellung signifikant unterschieden. Schlussfolgernd können wir nicht davon ausgehen, dass der kranial gestielte Pharynxlappen die Nasenatmung bei Gaumenspaltträgern im Vergleich zu denen ohne einen Pharynxlappen behi

ISSN:1021-7762    

DOI:10.1159/000266454

出版商:S. Karger AG    

年代:1997

数据来源: Karger