Speech Outcomes of 10-year-old Children after Early Palatoplasty Using Presurgical Orthodontics at 6 Months of Age.

OBJECTIVE: We aimed to assess whether patients who underwent early palatoplasty have normal speech. METHODS: 19 patients with unilateral cleft lip and palate were enrolled in this study. At 6 months of age, we performed simultaneous lip, maxilla, and palate repair using presurgical orthodontics. Speech development was assessed by evaluating velopharyngeal function (VPF) and development of articulation for 10 years. RESULTS: No articulation disorders were observed after 4 years of age. Although palatalized articulation was evidently temporary in 3 cases before 4 years of age, all patients recovered without any speech training. Normal VPF rates were as follows: at 4 and 7 years of age 78.9% (n = 15), 10 years of age 73.7% (n = 4). 10 patients temporarily presented with mild VPI after 5 years of age although they had a normal VPF until 4 years of age. CONCLUSION: Early palatoplasty after narrowing the cleft palate using presurgical orthodontics is beneficial for development of articulation. The rate of normal VPF did not decrease over the years.

Perspectiva de las prácticas de atención temprana centradas en la familia desde la logopedia / Speech pathologist perspective in family centered practices

En España, en los últimos años, la atención temprana está viviendo un proceso de transformación. Se empiezan a conocer experiencias que van haciendo la transición desde un modelo de intervención ambulatorio, clínico, centrado fundamentalmente en el niño, a uno más social, en el cual la familia y el entorno cobran especial relevancia y protagonismo. En este proceso de cambio los logopedas tienen un papel relevante. Por un lado, por el mero hecho de ser parte integrante de los equipos de intervención. Por otro, por ser los responsables de velar por el desarrollo de capacidades fundamentales en la evolución del niño como son la comunicación, el habla y el lenguaje. Por este motivo es necesario llevar a cabo una reflexión acerca de cómo se está produciendo esta transformación de los servicios, lo que implica y cómo debe ser asumida por los logopedas. En este artículo se delimita el concepto de prácticas centradas en la familia en atención temprana, se repasan los elementos clave que las han impulsado desde su aparición, así como los componentes que las caracterizan y diferencian de otras prácticas que también pueden incluir la participación familiar. A partir de todo ello, se resalta la importancia del logopeda en los equipos transdisciplinares de atención temprana que han de desarrollar las prácticas centradas en la familia (AU)

In Spain, in recent years, early intervention is undergoing a process of transformation. Experiences begin to be known that are making the transition from a model of outpatient intervention, clinical, focused primarily on the child; towards one more social, where the family and the environment are particularly relevant and prominent. In this process of change, speech therapists play an important role. On the one hand, by the mere fact of being an integral part of the intervention teams. On the other, being responsible for ensuring the development of core competencies in the development of the child as is communication, speech and language. It is therefore necessary to carry out a reflection on how this transformation is occurring in services, what it means, and how it should be assumed by speech therapists. This article defines the concept of family-centered in Early Care Practices, outlines the key elements that have driven it since its inception, and it also reviews components that characterize and differentiate it from other practices that may also include family involvement. From all this, the importance of the speech therapist in transdisciplinary early intervention teams, where they must develop family-centered practices, is highlighted (AU)

Longitudinal Evaluation of Community Support Project to Improve Oral Function in Japanese Elderly.

Change in oral function was evaluated longitudinally in elderly persons participating in an Exercises for Healthy Oral Function program implemented as part of the Long-Term Care Prevention Project. The participants comprised high-risk and healthy persons aged 65 yr or over. A questionnaire was used to classify them into two groups ('every day or sometimes' or 'rarely') at the end of the study for a comparison of change in repetitive saliva swallowing test (RSST) scores and oral diadochokinesis between 3 time points: at before, at immediately after, and at 1 yr after completion of the program. The average RSST score showed a decrease at 1 yr after intervention, but the difference was not statistically significant. Oral diadochokinesis showed a significant increase for all syllables upon completion of the program compared with at the beginning. This was followed by a significant decrease at 1 yr later compared with at the time of completion in the 'rarely' group for all syllables, but not in the 'every day or sometimes' group. In addition, the number of repetitions was significantly lower in the 'rarely' group than in the 'every day or sometimes' group for all syllables at 1 yr after completion. The results of the present study suggest that Long-Term Care Prevention Projects are necessary to maintain and improve oral function.

Extent of palatal lengthening after cleft palate repair as a contributing factor to the speech outcome.

Operative techniques in performing cleft palate repair have gradually evolved to achieve better speech ability with its main focus on palatal lengthening and accurate approximation of the velar musculature. The authors doubted whether the extent of palatal lengthening would be directly proportional to the speech outcome. Patients with incomplete cleft palates who went into surgery before 18 months of age were intended for this study. Cases with associated syndromes, mental retardation, hearing loss, or presence of postoperative complications were excluded from the analysis. Palatal length was measured by the authors' devised method before and immediately after the cleft palate repair. Postoperative speech outcome was evaluated around 4 years by a definite pronunciation scoring system. Statistical analysis was carried out between the extent of palatal lengthening and the postoperative pronunciation score by Spearman correlation coefficient method. However, the authors could not find any significant correlation. Although the need for additional research on other variables affecting speech outcome is unequivocal, we carefully conclude that other intraoperative constituents such as accurate reapproximation of the velar musculature should be emphasized more in cleft palate repair rather than palatal lengthening itself.

Rhythmic priming enhances speech production abilities: evidence from prelingually deaf children.

OBJECTIVE: Following recent findings that rhythmic priming can enhance speech perception, the aim of this experiment was to investigate whether this extends to speech production. METHOD: The authors measured the influence of rhythmic priming on phonological production abilities in 14 hearing impaired children with hearing devices. Children had to repeat sentences that were or were not preceded by a rhythmical prime. In addition, this rhythmic prime either matched or mismatched the meter (i.e., stress contrasts) of the sentence. RESULTS: Matching conditions resulted in a greater phonological accuracy of spoken sentences compared to baseline and mismatching conditions. Cochlear implant users were also more sensitive to rhythmic priming than hearing aid users. CONCLUSIONS: These results suggest that musical rhythmic priming can enhance phonological production in HI children via an enhanced perception of the target sentence. Overall, these findings suggest that musical rhythm engages domain-general expectations which can enhance both in perception and production of speech.

[Contributions of medical hypnosis to orthodontic treatment]. / Apport de l'hypnose médicale aux traitements d'ODF.

Hypnosis is making a comeback in all of the medical disciplines. But in a world where everyone wants to control everything and manage everything, it's helpful to know that hypnosis is a dynamic process that cannot be forced on anyone, a psychic reality, clearly demonstrated today by brain imaging. Hypnosis does not take any power over the individual. It is just one more tool to help ease patient's discomfort. It is also useful to avoid professional burnout to provide care without depleting our energy and without wasting our valuable time. Medical hypnosis is a real asset for providing comfortable orthodontic treatment and creating a serene atmosphere. It can be done simply and rapidly to take high quality impressions, to place braces comfortably on a patient who is sitting quietly. Orthodontic treatment requires cooperation and motivation, so let's give our patients a new sense of confidence and a willingness to cooperate.

[Face replantation using labial artery for revascularization. Case report]. / Reimplante facial con arteria labial para revascularización. Reporte de un caso.

BACKGROUND: Restoration of the face function and cosmetic appearance after a traumatic complex wound is a challenge for the plastic surgeon. Worldwide, few cases have been reported about face replantation. OBJECTIVE: To present the case of the first partial face replantation reported in the national bibliography, using the labial artery for revascularization. CLINICAL CASE: On June 19th 2011, a 7 years old male presented to the emergency room of the Mexican Institute of Social Security at Monterrey, Mexico, 4 hours after a partial face amputation secondary to a dog bite. The amputated segment was composed of 75% of the upper lip, 33% of the lower lip, oral commissure and 75% of the left cheek. The labial coronary artery and vein were anastomosed with 11-0 nylon sutures and the miorraphy of the orbicularis oris, the depressor anguli oris and the depressor labii inferioris with 4-0 vycril sutures. Six months after the surgery, the functional and aesthetic outcomes were excellent with reestablishment of total labial continence and total recovery of articulation of words. CONCLUSIONS: amputations of any facial component should be initially managed with replantation. The function and cosmetics are better than any other technique of reconstruction. The labial coronary artery is an excellent choice for revascularization up to 25% of the face (lips and cheek).

antecedentes: la restauración cosmética y funcional de la cara luego de un traumatismo complejo es todo un reto para el cirujano plástico. En el ámbito internacional se han reportado pocos casos de reimplante facial. Objetivo: reportar el caso del primer reimplante parcial de cara con la utilización de la arteria labial como aporte vascular. Caso clínico: paciente masculino de siete años de edad. Ingresó al servicio de Cirugía Plástica en el mes de junio de 2011 por lesiones secundarias en la cara ocasionadas por la mordedura de un perro. A la exploración física se encontró avulsión de 75% del labio superior, 33% del labio inferior, incluida la comisura oral, y 75% de la mejilla izquierda. Los músculos avulsionados incluían: el orbicular de los labios, depresor del ángulo oral y depresor del labio inferior. El tiempo total de isquemia fue de ocho horas. La anastomosis término-terminal de la arteria coronaria labial se efectuó con nylon 11-0, posteriormente se escogió la vena con mejor retorno y la anastomosis se realizó con nylon 11-0. Se hizo miorrafía de los músculos mencionados con vicril 4-0, la sutura de la mucosa oral se realizó con vicril 5-0, y de la piel con nylon 5-0. Seis meses después de la cirugía, el resultado cosmético y funcional se consideró excelente, con restablecimiento total de la continencia labial y articulación completa de las palabras. Conclusiones: las amputaciones de cualquier componente facial deben ser inicialmente tratadas con reimplante. La arteria coronaria labial es una buena opción para revascularización, incluso en 25% del total de la cara (labios y mejilla).

The effect of homonymy on learning correctly articulated versus misarticulated words.

PURPOSE: The goal of the current study was to examine the effect of homonymy (learning a second meaning for a known word form vs. learning a novel meaning and novel word form) and articulation accuracy (IN vs. OUT sounds) on word learning by preschool children. An added goal was to determine whether word frequency altered the effect of homonymy on word learning. METHOD: Twenty-nine 3- to 4-year-old children were taught homonyms and novel words. Stimuli further varied in whether homonymy was present in both the adult input and the child's output (as for IN sounds) versus present only in the child's output (as for OUT sounds). RESULTS: For IN sounds, children learned homonyms more rapidly than novel words. Moreover, the homonym advantage was modulated by word frequency, such that children learned a new meaning for a high-frequency word more accurately than they learned a new meaning for a low-frequency word. In contrast, for OUT sounds, there was no evidence that homonymy influenced learning. CONCLUSIONS: Homonymy in the adult input facilitates word learning by preschool children, whereas homonymy in the child's output alone does not. This effect is captured in a usage-based model of phonology and the lexicon.

Impact of early synchronous lip and palatal repair on speech.

AIMS: The purpose of this study was to describe articulation and resonance characteristics of Ugandan English-speaking children with cleft lip and palate (CLP) after synchronous lip and palatal closure (Sommerlad technique) prior to the age of 6 months in comparison with an age- and gender-matched control group. METHODS: Eleven Ugandan patients with CLP (mean age 4;9 years), repaired during a synchronous lip and (soft and hard) palatal closure at a mean age of 3.4 months, were included as well as a control group (n = 22) consisting of 2 Ugandan age- and gender-matched noncleft children for each patient (mean age 4;10 years). Objective and perceptual speech assessment techniques were applied. RESULTS: Consonant inventories were significantly smaller in the CLP group. Moreover, phonetic disorders and phonological processes occurred in 91 and 100% of the CLP group, respectively. Perceptual consensus evaluation revealed absence of hyponasality and cul-de-sac resonance in all patients. Hypernasality and nasal emission/turbulence occurred in 18 and 27% of the patients, respectively. No significant group differences were observed regarding the mean nasalance values of oral speech samples. CONCLUSION: Various deviations from normal speech development seem to occur in patients with CLP following synchronous lip and palatal closure before 6 months of age.

Speech outcome after early repair of cleft soft palate using Furlow technique.

OBJECTIVE: The earlier closure of palatal cleft is the better the speech outcome and the less compensatory articulation errors, however dissection on the hard palate may interfere with facial growth. In Furlow palatoplasty, dissection on the hard palate is not needed and surgery is usually limited to the soft palate, so the technique has no deleterious effect on the facial growth. The aim of this study was to assess the efficacy of Furlow palatoplasty technique on the speech of young infants with cleft soft palate. METHODS: Twenty-one infants with cleft soft palate were included in this study, their ages ranged from 3 to 6 months. Their clefts were repaired using Furlow technique. The patients were followed up for at least 4 years; at the end of the follow up period they were subjected to flexible nasopharyngoscopy to assess the velopharyngeal closure and speech analysis using auditory perceptual assessment. RESULTS: Eighteen cases (85.7%) showed complete velopharyngeal closure, 1 case (4.8%) showed borderline competence, and 2 cases (9.5%) showed borderline incompetence. Normal resonance has been attained in 18 patients (85.7%), and mild hypernasality in 3 patients (14.3%), no patients demonstrated nasal emission of air. Speech therapy was beneficial for cases with residual hypernasality; no cases needed secondary corrective surgery. CONCLUSION: Furlow palatoplasty at a younger age has favorable speech outcome with no detectable morbidity.

Robotic assisted reconstruction of the oropharynx.

PURPOSE OF REVIEW: Oropharyngeal reconstruction has undergone significant advances over the last several decades. Transoral robotic surgery (TORS) is a new approach to managing tumors of this location and requires unique reconstructive principles. RECENT FINDINGS: The advent of TORS has popularized transoral approaches and has presented new challenges related to reconstruction. Although TORS provides a minimally invasive approach to the oropharynx, there is a paucity of data related to reconstruction of extensive defects following TORS. Our institutional practice is to reconstruct defects based on the Classification for Oropharyngeal Robotic Defects (CORD) classification system. The CORD system considers size, location, number of involved oropharyngeal subsites, pharyngocervical communication, and exposure of carotid artery to guide reconstruction. This system uses more advanced reconstructions to manage increasingly complex defects. SUMMARY: Herein, we present principles of robotic assisted oropharyngeal reconstruction and the method for applying the CORD system.

Speech prognosis and need of pharyngeal flap for non syndromic vs syndromic Pierre Robin Sequence.

BACKGROUND: The aim of this retrospective study was to evaluate speech outcome and need of a pharyngeal flap in children born with nonsyndromic Pierre Robin Sequence (nsPRS) vs syndromic Pierre Robin Sequence (sPRS). METHODS: Pierre Robin Sequence was diagnosed when the triad microretrognathia, glossoptosis, and cleft palate were present. Children were classified at birth in 3 categories depending on respiratory and feeding problems. The Borel-Maisonny classification was used to score the velopharyngeal insufficiency. RESULTS: The study was based on 38 children followed from 1985 to 2006. For the 25 nsPRS, 9 (36%) pharyngeal flaps were performed with improvements of the phonatory score in the 3 categories. For the 13 sPRS, 3 (23%) pharyngeal flaps were performed with an improvement of the phonatory scores in the 3 children. There was no statistical difference between the nsPRS and sPRS groups (P = .3) even if we compared the children in the 3 categories (P = .2). CONCLUSIONS: Children born with nsPRS did not have a better prognosis of speech outcome than children born with sPRS. Respiratory and feeding problems at birth did not seem to be correlated with speech outcome. This is important when informing parents on the prognosis of long-term therapy.

Fisiopatología de la rigidez articular: bases para su prevención / Physiopathology of articular stiffness: preventive bases

El objetivo del presente trabajo es realizar una revisión bibliográfica de la fisiopatología de la rigidez articular y de sus repercusiones en el enfoque preventivo de la fisioterapia. La falta de movimiento y de tensiones aplicadas sobre las articulaciones da como resultado rigidez articular. El desconocimiento del origen de la rigidez puede llevar consigo una recurrencia del problema. El conocimiento de las causas y sus cambios histológicos permitirá aplicar las técnicas más oportunas obteniendo mejores resultados. Método: Revisión bibliográfica de textos clásicos y Bases de Datos específicas. Resultados: La rigidez articular se da como resultado de la falta de movimiento y de fuerzas aplicadas sobre las articulaciones. La falta de estrés altera las características morfológicas, bioquímicas y biomecánicas de los tejidos. La inmovilización produce proliferación del tejido conectivo y desorganización del colágeno de los distintos tejidos. La prevención de la rigidez se basa en minimizar los efectos nocivos de la inmovilización y pasa por un completo tratamiento de fisioterapia, iniciado en fase de inmovilización. Las medidas preventivas se resumen en medidas antiedema, movilización pasiva y activa, isométricos, inicio temprano del tratamiento y Movilización Pasiva Continua combinada con fisioterapia

This article takes a look at the scientific basis of articular stiffness throughout a bibliographic review of the physiopathology and its repercussions in physical therapy. Lack of movement and joint stress lead to articular stiffness. If the origin of the restriction is unknown, recurrence of the problem may occur. The causes knowledge and histological changes let us apply appropriate techniques to get better results. Methodology: bibliographic review of classic works and specific Databases. Results: articular stiffness is the consequence of lack of movement and joint stress deprivation. Stress deprivation alters the morphologic, biochemical and biomechanical characteristics of tissues. Proliferation of connective tissue and collagen disorganization appear as a result of immobilization. Stiffness prevention is based in minimizing dangerous effects of immobilization and goes through a complete physical therapy treatment, initiated during immobilization phase. Preventive measures are edema's treatment, active and passive mobilization, isometrics, early beginning of the treatment and Passive Continuous Motion (combined with physical therapy)

The effect of preoperative use of an orthopedic plate on articulatory function in children with cleft lip and palate.

OBJECTIVE: To evaluate the effect of preoperative use of an orthopedic plate (OP) on postoperative articulatory function in children with cleft lip and palate. SUBJECTS: The subjects had complete unilateral or bilateral cleft lip and palate and were scheduled for a one-stage palatoplasty. MAIN OUTCOME MEASURES: Tongue movements during sucking were analyzed by ultrasonography. Postoperative articulatory behavior was also assessed at 5 years 4 months of age. RESULTS: There was an excessive downward excursion of the rear portion of the tongue during sucking regardless of the use or nonuse of the OP. This indicated that infants with cleft palate could not create negative pressure in the oral cavity, even with the OP. However, the OP appeared effective for preventing irregular movements of the tongue during sucking. The proportion of subjects obtaining excellent articulation was significantly higher in the group using the OP until palatoplasty than in the group who did not continue using the OP. The proportion of subjects with disturbed articulatory function in the latter group was comparable with that in the control group, who never used the OP. CONCLUSIONS: Continuous use of the OP up to the time of palatoplasty appeared to be effective for the postoperative articulatory function in children with complete cleft lip and palate. Inhibiting irregular movements of the tongue, the OP might assist in preventing "palatalized articulation."

Prevention and cure of rhinogenous deafness at the Thermal Baths "Bagni delle Galleraie".

INTRODUCTION: Hearing is foundamental for human social life. Secretory Otitis Media (SOM) is the most important cause of trasmissive hypoacusis in early childhood. METHODS: The Department of Physiopathology, Experimental Medicine and Public Health of Siena University in collaboration with the Thermal Baths "Bagni delle Galleraie" proposed a prevention and cure campaign of rhinogenous deafness in June 2002 in some primary schools in the Colle val D'Elsa district. A sample of 87 children was involved in the study (average age of 5,64 +/- 1,41 years). On entering the thermal baths a questionnaire was administered to the parents, to point out possible risk factors. RESULTS: Among the 87 children, 28 cases of SOM and 21 cases of severe tubal disorder were found. Only 19 cases out of 49 were already known to the parents and only 28 joined the study and were examined for three years consecutively. DISCUSSION: Out of the 35 children examined in 2002, 28 returned to "The Galleraie" for the two following years. They repeated the thermal cure for two years as a preventive measure. At present they are not affected by SOM and during the winters suffered a lower number of infections in the primary airways and took less antibiotics. CONCLUSIONS: Our study focuses on infant school children because of their critical age for linguistic and social development. Early diagnosis and therapy prevent any negative social development.

The buccal flap--a useful technique in cleft palate repair?

OBJECTIVE: To evaluate speech quality and oronasal fistula after primary palate repair using a buccal mucosal flap. DESIGN: Retrospective study cohort of patients with cleft palate. SETTING: Primary care center for treatment of craniofacial congenital anomalies. PATIENTS AND METHODS: One hundred fifty-six nonsyndromic patients underwent palatoplasty with the buccal myomucosal flap by the senior surgeon between 1989 and 2002. The preoperative workup, surgical technique, and other factors that might affect the outcome were identical in every case. Oronasal fistula and variables affecting speech quality were analyzed. RESULTS: The most common type of cleft was unilateral cleft lip and palate (43.5%). The median follow-up was 5.8 years (0.4 to 21 years), and the median age at repair was 6.2 months. The overall fistula formation was 3.6%, decreasing progressively: 1989 to 1994: 2.9%, 1995 to 2002: 0.7% (p <.05). Velopharyngeal incompetence (VPI) occurred in 8.8% of the patients, decreasing from 5.3% to 3.5% in the last years. VPI and oronasal fistulae were observed mainly in unilateral and bilateral clefts of the lip and palate. Velopharyngeal adequacy occurred in 91.1% of the children, and resonance was normal in 91.1 %. None of the patients had severe hypernasality or hyponasality. Articulation was normal in 97.9% of the children. Speech quality was good in 89% of the patients. CONCLUSIONS: The technique presented has been effective, with the advantages of palatal closure without tension, good muscular reconstruction, lengthening of the nasal layer, and palatal closure without raw areas. The technique, early repair, and surgeon's skills were the most important variables for good outcomes regarding speech and fistula formation.

Veloplasty using the wave-line technique versus classic intravelar veloplasty.

OBJECTIVE: A well-known problem in primary surgery of the soft palate is its shortness and the deficit of local soft tissue. This article introduces a modification of the primary intravelar veloplasty, allowing lengthening of the soft palate, and compares this alternative technique to the classic intravelar veloplasty. METHOD: The soft palate wave-line technique adds a wavy incision at the velar cleft margins to the intravelar veloplasty. In 24 patients with complete clefts of the palate, either the newly developed or classic technique was performed. Four years following primary surgery, speech performance and type of breathing were analyzed. RESULTS: Even in wide clefts of the soft palate, repair was easily accomplished using the wave-line technique. Complete closure of the nasal, muscular, and oral layers was achieved, and no postoperative fistula was observed. An average lengthening of the soft palate of 56% (range 24% to 83%) was observed immediately following velar repair with the wave-line technique. Speech was significantly better in the wave-line group (p <.05). Furthermore, physiological breathing was observed more often in these patients. CONCLUSION: Primary repair of clefts of the soft palate using the wave-line technique is straightforward, safe, and easy. On the basis of the present results, this technique seems superior to the classic intravelar veloplasty.

To what extent do deviations from an ideal occlusion constitute a health risk?

Selection of patients for orthodontic treatment should be based on a thorough analysis of the consequences of malocclusions for the individual. The mere presence of deviations from the concept of the ideal occlusion should have no influence on orthodontic treatment decisions. According to available studies, the influence of malocclusion on periodontal health, speech and chewing is fairly minor. Neither can orthodontic treatment be justified as an effective means of preventing TMD but it may be indicated to reduce existing signs and symptoms of TMD in certain carefully selected cases. Interceptive or preventive orthodontic treatment may be indicated to reduce the negative influence on growth and occlusal development of functional malocclusions (anterior or lateral forced bite) or ectopic tooth eruption. Similarly, early correction of large overjet may be valuable in order to reduce the risk of traumatic injuries. Such treatment is usually motivated during the primary or mixed dentition periods. From the teenage period and onwards, psychosocial or aesthetic reasons for orthodontic treatment are dominating. Decisions to start orthodontic treatment in order to improve aesthetics should usually not be taken before the child has reached sufficient maturity for these decisions, normally after the age of 12 years. Special consideration needs to be given to subjects with craniofacial syndromes or handicap in order to develop effective treatment methods to promote as normal growth and occlusal development as possible.