Influence of anesthetics on pharyngeal flap surgery: a 23-year study.

This study assessed the influence of anesthetics on early complications after pharyngeal flap surgery. A 23-year retrospective chart review was carried out of all patients at the authors' institution who underwent superiorly based pharyngeal flap surgery. Variables analyzed were gender, age at the time of surgery, cleft type, anesthesia procedure used and complications in the early postoperative period. 2299 patients (50% male; 50% female) who underwent pharyngeal flap surgery between 1980 and 2003 were reviewed. The highest number of surgeries was performed in patients aged 11-20 years. There were 1042 patients with at least one type of complication. Of these, 39 required reoperation to control complications such as bleeding and airway obstruction. There were no records of death. Vomiting and pain were the most frequent postoperative complications (16% and 14% of patients, respectively). Lower complication rates were observed when anesthesia protocols included sevoflurane, propofol and opioids.

Electromyographic analysis of lip muscle function in operated cleft subjects.

EMG activity of the upper lip was measured with bipolar surface electrodes during speech and nonspeech tasks in order to assess labial function in subjects with repaired clefts. Eighteen patients between 15 and 23 years of age with repaired unilateral cleft lip (isolated or combined with repaired cleft palate) were compared to 24 matched noncleft subjects. Data analysis demonstrated that the amplitude of action potentials of the upper lip was significantly greater in the cleft group. We hypothesize that the enhanced activity of the repaired upper lip during function may contribute to the facial growth abnormalities usually seen in the cleft population.

Pulmonary function of individuals with congenital cleft palate.

Ventilatory pulmonary function was investigated in 160 children and adults with repaired or unrepaired congenital cleft palate in comparison with 130 normal children and adults. Pulmonary function tests included measurement of lung volumes, of maximal voluntary ventilation (MVV) and of forced spirometry parameters: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio and mean forced expiratory flow during the middle half of FVC (FEF25-75). Patients with cleft palate demonstrated significant differences from normal individuals in some of the measurements made. Functional alterations were observed at higher frequency among adult patients with unrepaired clefts and mainly consisted of a reduction in expiratory flows and MVV. However, the deviations observed were usually discrete and probably of low physiopathologic significance. The results permit us to conclude that, in contrast to data reported by others, subjects with congenital cleft palate have little impairment of pulmonary ventilatory function.

Masseteric electromyographic silent period duration in patients with temporomandibular joint dysfunction

The present study compared the duration of the electromyographic silent period (SP) of the masseter muscles elicited by chin-tapping in normal asymptomatic adults (N=39) and in a group with sympstoms of temporomandibular joint dysfunction (TMJD)(N=3).EMG activity was recorded from right (RM) and left (LM) masseter muscles using bipolar surface electrodes coupled to a DISA 1500 EMG-system.During maximal clenching, ten taps were applied downwards to the chin with a reflex hammer. The mean SP durations obtained for the normal group were 25.45ñ4.20 ms (RM) and 25.33ñ4.18ms (LM), whereas the TMJD group presented significantly greater values (P<0.01,Student t-test) of 41.89ñ12.94ms (RM) and 42.40ñ12.99ms (LM).The upper limits of normality calculated for RM and LM were 32.36 ms and 31.21 ms, respectively. Eighty-four percent of patients with TMJD showed SP durations above these limits. The results indicate that the measurement of masseteric SP duration may be used as an objective diagnostic method of TMJ disorders, provided that borderline values are interpreted with caution along with clinical impressions

Masseteric electromyographic silent period duration in patients with temporomandibular joint dysfunction.

1. The present study compared the duration of the electromyographic silent period (SP) of the masseter muscles elicited by chin-tapping in normal asymptomatic adults (N = 39) and in a group with symptoms of temporomandibular joint dysfunction (TMJD) (N = 31). 2. EMG activity was recorded from right (RM) and left (LM) masseter muscles using bipolar surface electrodes coupled to a DISA 1500 EMG-System. During maximal clenching, ten taps were applied downwards to the chin with a reflex hammer. 3. The mean SP durations obtained for the normal group were 25.45 +/- 4.20 ms (RM) and 25.33 +/- 4.18 ms (LM), whereas the TMJD group presented significantly greater values (P less than 0.01, Student t-test) of 41.89 +/- 12.94 ms (RM) and 42.40 +/- 12.99 ms (LM). The upper limits of normality calculated for RM and LM were 32.36 ms and 31.21 ms, respectively. Eighty-four percent of patients with TMJD showed SP durations above these limits. 4. The results indicate that the measurement of masseteric SP duration may be used as an objective diagnostic method of TMJ disorders, provided that borderline values are interpreted with caution along with clinical impressions.

Consonantal intraoral air pressure characteristics in Brazilian postoperative cleft palate speakers with velopharyngeal disorders

1. In the present study we measured intraoral air pressure (Po) during the production of the stop consonant/p/, in a syllabic contes, in normal and surgically repaired cleft palate subjects. po was measured by placing a sensing catheter between the lips in the oral cavity. The catheter was connected to a pressure transducer and the output signals were amplified and transmitted to a recorder. 2. When compared to normal individuals, cleft patients with velopharyngeal insufficiency (VPI) and oral articulation for/p/presented significantly lower Po levels (P<0.01) but pressure curves of normal shape. 3. In cleft palate patients with VPI and glottal coarticulation for/p/, Po was absent or markedly reduced; in the latter case, the Po curve was of a characteristically irregular shape. 4. These results suggest thata measurement of Po during the production of a selected consonant appears to be a suitable instrumental method for identifying VPI and discrininating an oral stop from the compensatory glottal stop often observed in postoperative cleft palate speakers

Consonantal intraoral air pressure characteristics in Brazilian postoperative cleft palate speakers with velopharyngeal disorders.

1. In the present study we measured intraoral air pressure (Po) during the production of the stop consonant /p/, in a syllabic contex, in normal and surgically repaired cleft palate subjects. Po was measured by placing a sensing catheter between the lips in the oral cavity. The catheter was connected to a pressure transducer and the output signals were amplified and transmitted to a recorder. 2. When compared to normal individuals, cleft palate patients with velopharyngeal insufficiency (VPI) and oral articulation for /p/ presented significantly lower Po levels (P less than 0.01) but pressure curves of normal shape. 3. In cleft palate patients with VPI and glottal coarticulation for /p/, Po was absent or markedly reduced; in the latter case, the Po curve was of a characteristically irregular shape. 4. These results suggest that measurement of Po during the production of a selected consonant appears to be a suitable instrumental method for identifying VPI and discriminating an oral stop from the compensatory glottal stop often observed in postoperative cleft palate speakers.