Khe Hở Môi Và Vòm Miệng: Chẩn Đoán Và Quản Lý Điều Trị (Cleft Lip and Palate)

968
Index
Children care, craniofacial conditions (cont.)
legislative and judicial decisions , 959
medical education , 959
patient and family relationship , 959
professional time and patient fi nancial
resources , 958
responsibility , 958
social and psychological rationales , 958
technological innovations , 959
historical perspectives , 957–958
justice and resources distribution , 962
prenatal diagnosis and imaging , 959–960
social justice and resource allocation
cost-bene fi t thinking , 961–962
health policy , 960
poverty and ethnic minority status , 961
rationing of health care , 961
social investment , 962
treatment decision making
dis fi gurement , 956
family crisis , 956
medical and societal resources , 956–957
social ambivalence , 956
sociocultural settings , 956
Chin augmentation , 183, 214–216
Choanal atresia , 16
Cleft jaw deformity
bilateral cleft lip and palate
mixed dentition grafting , 565–567
pitting, lower lip , 563
van der Woude syndrome , 563, 565
coordinated team approach , 572
distraction osteogenesis , 587
ectodermal dysplasia , 587, 588
initial surgical healing , 582–583
isolated cleft palate
articulated dental casts , 568, 571
malocclusion , 568, 569
mixed dentition , 568
LeFort I osteotomy ( see LeFort I osteotomy)
maxillary hypoplasia , 587, 589
maxillary reconstruction
bilateral cleft lip and palate , 587
unilateral cleft lip and palate , 586–587
orthodontic considerations
bilateral cleft lip and palate , 575
isolated cleft palate , 575–576
unilateral cleft lip and palate , 574–575
orthognathic surgical approach ( see Orthognathic
surgery)
residual deformity ( see Residual deformity)
treatment protocol , 572–573
unilateral cleft lip and palate
alveolar process reconstruction , 557, 562
articulated dental casts , 557, 561
frontal views , 557, 559
gingival periosteoplasty (GPP) , 562–563
lateral cephalometric radiographs , 557, 562
LeFort I osteotomy, prevelance of , 557
oblique facial views , 557, 559
occlusal views , 557, 560
orthognathic surgery , 557
pro fi le views , 557, 560
Cleft palate
adult patient , 809–810
articulation development , 807
clinical data contribution , 806–807
Fauchard appliances design , 822
hypernasality , 803–804
language development and learning
cognitive ability , 813
educational problems , 812–813
intellectual functioning , 813
language-learning disabilities , 814
learning disability , 814
parent questionnaire , 814
personality and behavioral studies , 813
preattentive auditory discrimination , 814
reading disability , 813–814
nasal air emission , 804
palatoplasty age , 807
preschool and school-aged investigations ,
815–816
prosthetic speech appliances
acrylic tray , 832
alginate material , 832
appliance insertion , 836
contraindications for , 829–830
deciduous teeth for retention , 831, 832
design and construction of , 823
diagnosis , 823–824
jaw relation records , 832
mouth preparations , 824
operated palates , 828–829
permanent cast gold speech appliance , 830, 831
pharyngeal section/speech bulb , 833–836
preliminary impression , 830–831
rehabilitation , 823
soft tissue displacement , 824
speech bulb , 824–826, 836
temporary acrylic resin , 830
treatment planning , 824
unoperated palates ( see Unoperated palates)
velar section, construction of , 833
weight and size of , 824
scar tissue , 804
secondary palate , 805–806
speech therapy
CPAP , 811
lip muscle activity , 811
oral motor exercises , 810–811
parents role , 812
surgeons role , 821
VCFS , 805
velo-cardio-facial syndrome , 816–817
velopharyngeal functioning , 807–808
Cleft Palate Audit Protocol for Speech–Augmented
(CAPS A) , 940
Cleft palate surgery
Africa cleft teams
centres , 860
clinical outcomes , 861–862

969
Index
evidence-based treatment , 863
single-stage repair , 860, 861
treatment protocol formulation , 863–864
treatment protocols , 859–860
wide palatal defect , 861
age considerations , 866
factors affecting , 864–865
fundamental components , 865
Malek’s protocol , 864
palatoplasty , 857–859
surgery outcome measures , 859
unilateral cleft lip and palate , 861
Clinical record
cephaloradiographs
basion horizontal tracing , 36, 40
lateral cephalometrics, facial changes , 37
projecting facial landmark , 36, 39
purpose , 35–36
superimposed facial polygons , 36, 38
diagnostic and prognostic information , 40
geometric and quantitative analysis , 42–43
plastic surgeon training , 35
research method
clinical trails ( see Clinical trails)
prospective study , 41
retrospective study , 40–41
Clinical trails
de fi nition , 41
ethics , 42
informed consent , 42
randomization , 41–42
Collagen, granulation tissue contraction , 312
Complete bilateral cleft lip and palate (CBCLP) , 87
alveolar bone graft , 157
anterior cleft spaces closure , 172, 198, 199
anterior dental crossbite , 481
anterior palatal cleft space reduction , 184–185
buccal and anterior occlusion , 203, 204
cephalometric tracings , 152, 153, 482
cephaloradiographs , 176
chin augmentation , 183, 214–216
cleft space size , 220
crowded anterior maxillary incisors
advancement , 491
degree of osteogenic de fi ciency , 191
Delaire-type facial mask , 489
dental occlusion
at adolescence , 154–155
after birth , 150, 154
in deciduous dentition , 154
mixed dentition , 154
permanent retention , 155
facial growth studies , 142
facial skeletal and soft tissue pro fi le changes , 160
fi xed palatal expander , 156
growth-inhibiting scar tissue prevention , 205
intraoral neonatal maxillary orthopedics , 147
Kirschner wire , 211
Latham’s presurgical premaxillary mechanical
retraction procedure , 161–162
Lefort I posterior impaction , 194
long-term facial growth fi ndings , 143
malocclusion , 147, 148
mandibular autorotation , 195
mandibular incisors , 482, 492
midfacial growth retardation , 210
midfacial osteotomy , 183
midfacial protrusion reduction , 176
Millard’s surgical lip procedure , 148, 149
orthognathic-orthodontic procedure , 208–210
palatal casts , 205
palatal expansion appliances , 177
palatal growth rate , 220
palatal length , 482, 506, 507
palatal outlines , 172
palatal segments , 192
pharyngeal space, cephalometric evaluation , 199
physiological maxillary surgery , 207
posterior cleft spaces closure , 172
premaxilla alignment and eruption , 490
premaxilla and lateral palatal segments modeling ,
181–182
premaxillary excision , 213
premaxillary incision , 212
premaxillary protrusion
after lip repair , 147–148, 151
anterior cleft space , 189–191
at birth , 186–188
extraoral elastics , 163–165, 168–169
facial pro fi le fl attening , 183
orthodontic-surgical care , 222
palatal casts, computerized drawings , 166
position determination , 151
PVS ( see Premaxillary vomerine suture)
rigid arch wire , 222
secondary alveolar bone grafting , 193
septum , 136, 137
surgical setback and palatal cleft closure , 152
symmetrical/asymmetrical , 134
treatment planning , 221
two-stage lip closure , 136
premaxilla’s growth , 206
premaxilla ventro fl exion , 147, 173, 200–202,
217–219
protraction orthopedic forces , 482, 502
protraction orthopedics , 196, 197
secondary cleft lip surgery , 223
septum deviation , 170–171
serial lateral cephaloradiographic tracings , 167
serial palatal cast changes , 158–159
stereophotogrammetry , 175
surface area , 223, 224
surgical-orthodontic treatment , 156
time sequence analysis, serial palatal
growth , 174
vomer fl ap
degree of midfacial protrusion , 144
growth-retarding effect , 144
head bonnet , 144, 145
lip adhesion , 144, 145
Oslo CLP team , 144
prolabium , 144, 146

970
Index
Complete unilateral cleft lip and palate (CUCLP)
alveolar bone graft , 130
alveolar process , 97
alveolar segments , 121
anterior dental crossbites , 481, 486
anterior teeth advancement , 488
arch crowding , 130
bilateral buccal and anterior crossbites , 127
buccal occlusion , 122
cephalometric tracings , 127
cleft size reduction , 109
collapsed arch form , 95, 96
concave facial pro fi le , 488, 489
conservative treatment , 128
cuspid crossbite , 97
3D analysis , 480
ectopic eruption , 122
facial characteristics
cephalographs , 98
cephalometry , 98
craniofacial growth , 97
craniofacial morphology , 98
gonial angle , 97
Oslo sudy , 98–99
prepubertal and pubertal periods , 98
Ross’s multicenter study , 99–101
facial pro fi le fl attening , 131
frontal cephaloradiograph , 117
incisor teeth uncrowding , 487
inferior turbinate , 97
laminographs , 95
lateral cephalometric tracings , 110, 117
lateral incisor space loss , 494, 495
lip adhesion , 129
lip/nose revision , 484
Logan’s bow , 101, 102
midface, forward growth , 498
midfacial recessiveness , 486, 487
Millard’s rotation advancement procedure , 113
nasal septum , 97, 114–116
occlusal stability , 485
orthodontic treatment , 123
orthopedic protraction forces , 97
palatal and facial growth , 103–105, 113, 114
palatal growth chart , 109
palatal length , 482, 506, 507
palatal segments , 496, 497
medial movement and growth changes , 106–108
movements , 480, 481
palatal shelves , 97
palate growth and remodeling , 101, 102
panorex , 116
presurgical/nonpresurgical orthopedics , 482, 504
protraction maxillary orthopedics , 125, 126
protraction orthopedic forces , 502, 503
retarded midfacial growth , 499, 500
secondary alveolar cranial bone grafts , 118–120
skeletal and soft tissue changes , 124
superimposed polygons , 110, 124, 127
surgical and prosthetic treatment , 111–112
symmetrical arch form , 95, 96
temporary tooth bearing palatal plate placement , 483
tooth eruption , 110
treatment , 101
upper left lateral incisor replacement , 501, 502
von Langenbeck procedure , 97
Conductive hearing loss
audiograms , 302
management
implanted bone-anchored hearing device , 304
softband bone conduction device , 303–304
Congenital palatal insuf fi ciency , 79
Congenital palatopharyngeal incompetence , 722
Craniofacial team
assessment and improvement
brainstorming activities , 890
evaluation phase , 900
plan-do-check-act cycle , 900
team functioning , 899
team performance , 899
team’s strengths and weaknesses , 899
UNC Craniofacial Team Peer Review
questionnaire , 899
cognitive con fl ict management , 896–897
communication
discipline-speci fi c jargon , 893
effects of , 892–893
group discussions , 893
patient and family , 893–894
team meeting , 893
decision making , 890–891
functions , 889
goals , 895–896
history of , 885–886
leadership
authoritative style , 889
coaching style , 889
democratic style , 889–890
directive leadership , 890
healthy team functioning , 889
institutional managers , 889
internal and external support , 890
responsibility , 889
mission , 888
mutual trust and respect , 894–895
parameters of
craniofacial difference , 886
interdisciplinary teams , 886–887
multidisciplinary teams , 886
physical issues , 886
transdisciplinary teams , 886
roles
dysfunctional or blocking roles , 892
informal roles , 891
personal and social roles , 891–892
professional roles , 891
task-focused roles , 891
team collaboration skills development , 892
team composition , 888–889
team formation

971
Index
“adjourning” stage , 888
forming stage , 887
norming stage , 887
performing stage , 887
storming stage , 887–888
underdeveloped countries
ACPA Visiting Scholar Program , 881
mission trips , 880–881
parameters of care , 879
team care , 879–880
values and ethics , 897–899
Craniosynostosis
distraction devices placement , 662
fl exible endoscope insertion , 662
frontal osteotomy , 663
fronto-orbital advancement , 662, 663
horizontal osteotomy , 662
Le Fort III osteotomy , 661
malar-zygoma advancement , 662, 663
monoblock disjunction , 663
nasolacrimal groove , 662
periosteum dissection , 661
postdistraction lateral cephalogram , 662, 663
preoperative lateral cephalogram , 662, 663
true monoblock , 662, 664
D
Dental occlusion
at adolescence , 154–155
after birth , 150, 154
in deciduous dentition , 154
mixed dentition , 154
permanent retention , 155
Differential diagnosis
cleft research , 615–616
cleft types
age , 614
child’s oral volume , 615
clinical management , 614
epidemiological research , 613–614
natural history of , 614
palatal deformation , 614
size and shape of , 614
skeletal malformations , 614
staged treatment , 614
sugery types , 614
clinical research Feinstein
initial state , 616
maneuver , 617
failure values , 613
neonatal palatal form
cleft surgery in fl uence , 618–619
muscle forces effect , 618
palatal embryopathology , 617–618
three-dimensional techniques
computer-generated images , 620, 621
electromechanical digitizer , 620
von Langenbeck surgical techniques , 619
Distraction osteogenesis (DO)
bone lengthening , 649
cleft midface growth and relapse , 693–694
craniosynostosis
distraction devices placement , 662
fl exible endoscope insertion , 662
frontal osteotomy , 663
fronto-orbital advancement , 662, 663
horizontal osteotomy , 662
Le Fort III osteotomy , 661
malar-zygoma advancement , 662, 663
monoblock disjunction , 663
nasolacrimal groove , 662
periosteum dissection , 661
postdistraction lateral cephalogram , 662, 663
preoperative lateral cephalogram , 662, 663
true monoblock , 662, 664
dental occlusion , 661
distraction vectors , 666
dynamics of , 694–695
hemifacial microsomia
age , 652
consolidation period , 652
corticotomy location , 651
dental occlusion , 653, 656
distraction vectors , 651
facial symmetry , 652–653
hypoplasia , 650
malocclusion , 653, 654
mandibular corticotomy , 653, 655
overcorrection , 652
side-cutting burr , 650
soft tissue expansion , 653
unidirectional external device insertion , 650
vestibular incision , 650
incomplete osteotomy , 696
increased mandibular mass and length , 665–666
intraoral appliance system fi xation , 659
maxilla advancement , 659
maxillary hypoplasia , 659
micrognathias
bidirectional elongation, corticotomy ,
655, 656
bird face deformity , 655, 657
osteotomies/skin expansion , 655, 657
midface retrusion , 660, 666
operative technique , 695
overcorrection , 666, 696
patient selection , 694
planning and assessment , 694
preoperative orthodontics , 659
quad-helix fi xed appliance , 659
relapse evaluation
intraoral photographs , 696, 699
posttreatment , 696, 698
pretreatment , 696, 697
reverse pull headgear, retention , 695
sagittal mandibular elongation , 664
serial cephalometric evaluation , 696, 700–701
soft tissue expansion , 664
subperiosteal dissection , 659

972
Index
Distraction osteogenesis (DO) (cont.)
temporomandibular joint ankylosis , 658
treatment outcomes , 701–702
Downward displaced premaxilla
premaxillary orthopedic intrusion ( see Premaxillary
orthopedic intrusion)
primary maxillary incisors removal , 677
E
Embryogenetics
cleft palate threshold , 8
early embryology
brain , 9
cheiloschisis , 17–18
facial formation , 12–16
neural crest , 11–12
organizing centers , 10–11
pathophysiology, diseases, and dysmorphology ,
9, 10
upper lip development , 16–17
genes associated with craniofacial development , 5–7
gene signaling patterns , 3
IRF6 gene , 8
lower lip formation , 18–19
molecular pathway and networks , 4–5
MSX1 , 8
non-syndromic cleft lip , 5, 8
palatogenesis
embryonic head movements , 20, 21
epithelial-mesenchymal transformation , 24
genetic heterogeneity , 24
hard and soft palate , 19
ossi fi cation , 24–25
palatal lifting , 20
palatal shelf elevation and fusion , 20–23
palatoschisis , 25–27
respiratory chamber separation , 19
sonic hedgehog signaling , 22
transforming growth factor- b signaling pathway , 23
SATB2 , 8
stages , 8, 9
TBX22 , 8
TGF b 3 , 8
vaulted gestational development , 4
whole exome sequencing , 5
Eurocleft cohort study , 930
follow-up , 931
mean dental arch relationship scores , 932
mean soft tissue pro fi le , 932
outcome and amount of treatment , 932–933
outcome and satisfaction , 933
outcomes at age 9 , 931
Treatment Experience survey , 931
wider networks , 934
F
Face, embryogenetics
24-day-old human embryo , 12
32-day-old human embryo , 12, 13
gene expression patterns , 15
gene mutation and misregulation , 12–13
nasal pit , 16
nasal placodes , 14, 16
perioral muscles , 14
prechordal plate , 12
Facial growth. See also Midfacial growth
and occlusion
clinical uncertainty , 329
closure stages , 332
craniofacial development , 338
delayed hard palate closure
dentofacial growth , 331
vs. early closure , 330–331
exceptional delay , 330
growth velocity , 331
maxillary prominence , 330
extensive orofacial muscle dissection , 332
factors in fl uencing , 329–330
gingivoperiosteoplasty , 333–334
high-volume surgeons , 334–335
intercentre comparisons , 336–337
intracentre comparisons , 337
intrinsic facial differences
anteroposterior cephalograms , 327
cleft maxilla vs. non-cleft individuals ,
327–328
individuality of patients , 328
lateral cephalograms , 327
twin and fetal studies , 328
UCLP vs. BCLP , 327
late deterioration , 327
later lip closure , 331
limitations , 338
mandibular development in cleft palate , 53–55
maxillary and mandibular growth
basion horizontal concept , 51–53
functional matrix theory , 46–48
genetic control theory , 45–46
nasal septum theory , 48–51
newborn palate with cleft , 45
nasoalveolar moulding , 333
palatal surgical repair
dentoalveolar processes , 313
factors in fl uencing , 313–314
maxillary growth effects , 313
mucoperiosteal fl aps , 313
postnatal growth patterns
bone remodeling during growth , 56
mandibulofacial dysostosis , 55
maxillary growth , 56
unilateral agenesis , 55
premaxillary setback procedure , 336
presurgical infant orthopaedics , 333
primary bone grafting , 333
prospective cohort studies , 337
randomised control trials , 337–338
repaired bilateral cleft lip palate
maxilla , 326–327
modi fi ed von Langenbeck technique , 335
premaxillary osteotomy , 336

973
Index
vs. UCLP, growth pattern , 327
repaired unilateral cleft lip palate
delaying hard palate closure , 335–336
growth pattern , 325–326
maxilla and mandible , 325
maxillary prominence changes , 326
vs. non-cleft subjects , 325, 326
retrospective comparison studies , 336
Sri Lankan cleft lip and palate project
in fl uencing factors , 275–276
lip surgery ( see Lip surgery)
palate surgery ( see Palate surgery, SLCLPP)
Vomerine fl ap , 273–275
Wardill-Kilner vs. Von Langenbeck repair , 273
surgery effect, factors in fl uencing , 275–276
surgical iatrogenesis , 328–329
surgical protocol selection , 338–339
trauma and scarring reduction , 331–332
vomer fl ap , 322
Facial morphology and growth, infants
craniofacial skeleton, UCCLP and UICL group ,
252, 253
Danish study
BCCLP , 246, 247
cleft lip , 247
CLP , 250
ICP , 246–249
Robin sequence , 246, 249–250
Tennison procedure , 246
three-projection infant cephalometer , 246
UCCLP , 246, 247
intuitive visualization , 252, 254–255
morphological traits , 251
short and retrognathic mandible , 251
Fibroblast, wound contraction , 312
Forked fl ap , 150, 154
Functional matrix theory , 46–48
Furlow double-opposing Z-palatoplasty , 766–767
G
Genetic control theory , 45–46
Gingivoperiosteoplasty (GPP) , 333–334, 462, 562
Glossoptosis , 293, 294
H
Hard palate repair (HPR), delayed
American rejection of , 415
Gothenburg cleft team
cancellous bone grafting , 423
gingival incisions , 422
maxillary growth , 423, 425–428
palatal fl aps , 423
residual cleft , 423, 424
speech outcomes , 425–431
timing for HPR , 423
vomer and mucoperiosteal fl ap , 423, 424
growth-restricting palatal scars , 416
maxillary growth results , 418–419
residual cleft , 416–417
speech outcomes , 418
thick palatal mucoperiosteum inclusion , 417
timing of , 417
Zürich cleft team , 419
Hearing loss
atresia surgery , 303
conductive hearing loss
audiograms , 302
diagnostic ABR evaluation , 303
implanted bone-anchored hearing device , 304
medical management , 303
softband bone conduction device , 303–304
sensorineural
audiograms , 302
CHARGE syndrome , 303
cochlear implants , 304
cochlear or labyrinthine dysplasias , 303
craniosynostosis , 303
Stickler syndrome , 303
velocardiofacial syndrome , 303
Hemifacial microsomia
age , 652
consolidation period , 652
corticotomy location , 651
dental occlusion , 653, 656
distraction vectors , 651
facial symmetry , 652–653
hypoplasia , 650
malocclusion , 653, 654
mandibular corticotomy , 653, 655
overcorrection , 652
side-cutting burr , 650
soft tissue expansion , 653
unidirectional external device insertion , 650
vestibular incision , 650
Hypoplastic maxilla, unilateral /bilateral cleft
Alt-RAMEC , 674
double-hinged rapid maxillary expander ,
672–674
maxillary orthopedic protraction ( see Maxillary
orthopedic protraction)
treatment protocol for , 674
I
Incomplete bilateral cleft lip and palate
(IBCLP) , 135, 146, 178–180, 200–202
Intact facial muscular forces on maxillary arch , 61
Interceptive orthopedics , 521–526
Interdental distraction osteogenesis
distraction protocol , 687
interdental distraction site , 686–687
orthodontic tooth movement , 687–688
postdistraction alveolar bone grafting , 688–689
postdistraction maintenance , 687–688
presurgical orthodontic preparations , 686
surgical procedures , 687, 688
treatment outcomes , 689, 690
Interdisciplinary team model , 886
Interest-Based Relational (IBR) Approach , 897
Intraoral wound healing process , 309–310

974
Index
Intrauterine wound healing , 319
Isolated cleft palate (ICP) , 246–249
cleft jaw deformity
articulated dental casts , 568, 571
malocclusion , 568, 569
mixed dentition , 568
orthodontic considerations , 575–576
orthognathic surgical approach , 582, 584
geometric variation
computerized 3D tracing , 75
palatal and cleft space change , 76
hard and soft palate , 71, 72
palatal fusion , 70
Pierre Robin sequence , 288–290
variation in , 70, 77
von Langenbeck surgery , 73, 74, 76
K
Kernahan Rosenstein procedure , 458–459
L
Laterally displaced premaxilla . See Premaxillary
orthopedic medial repositioning
Latham-Millard Pinned Appliance , 459–460
LeFort I osteotomy , 635
autogenous bone grafts , 546, 547
cushing elevator , 546
lip and nasal work surgery , 545
midfacial advancement , 547, 548
mixed dentition , 585
mucosal incision , 546
multiple maxillary osteotomies , 550–553
nasal intubation , 545
osteosynthesis wires , 546
pre-and postmaxillary advancement ,
547, 548
skeletal relapse after , 585–586
standard vs. DO approach , 587
surgical maxillary advancement
instrumentation , 538
intermaxillary fi xation , 540
maxillary tuberosity , 541
mucosal incision , 537
palatine bone sectioning , 538
sagittal splitting procedure , 539
Schuchardt procedure , 539, 540
stability , 541–542
total maxillary advancement , 542–544
velopharyngeal function , 584–585
Lip clefts
after and before surgery , 80
after orthodontics , 82
lip adhesion treatment and alveolar bone graft , 83
lip revisions , 81
secondary alveolar bone graft , 79, 80
Lip pits
caries , 237
central and lateral incisors , 229
clefting process and contiguous skeletal structures
cleft maxilla position , 237–238
cranial base , 238
nasal cavity and arch form , 238, 239
crossbite correction
anterior and buccal crossbite correction , 233
anterior and posterior crossbite , 232, 233
bilateral cleft lip and palate , 235
maxillary central incisors , 234
orthopedic protraction forces , 235
palatal Arnold expander , 231
palatal expansion , 231
palatal helix expander , 231
palatal scarring , 234
three-phase treatment , 230
unilateral cleft lip and palate , 234–235
dental malocclusion , 236–237
frequency , 228
inheritance , 229–230
lower lip , 227, 228
malformations , 229
morphology , 228–229
supernumerary teeth , 236
tooth abnormalities , 236
upper lip , 227, 228
Lip surgery , 88, 90
CBCLP , 353
cephalometry , 265
GOSLON fi gures , 265
incomplete bilateral cleft lip and palate , 349
lip adhesion
Collito-Walker technique , 350–351
incisions , 350
“over ten” rule , 350
premaxillary ventro fl exion , 352
localised effects , 266, 267
Sri Lankan cleft lip and palate project
cephalometry , 265
GOSLON fi gures , 265
localised effects , 266, 267
timing of , 266, 268
timing of , 266, 268
Lip taping , 443–445
M
Maternal care coordination (MCC), cleft
surgery , 856
Maxillary deformity
alveolar cleft
interdental distraction osteogenesis , 685–690
maxillary orthopedic protraction , 684–685
protocol for approximating , 684
downward displaced premaxilla ( see Downward
displaced premaxilla)
hypoplastic maxilla ( see Hypoplastic maxilla,
unilateral /bilateral cleft)
laterally displaced premaxilla ( see Premaxillary
orthopedic medial repositioning)
Maxillary distraction osteogenesis
cranial stabilization devices , 645
diagnosis and gender , 633

975
Index
external traction hooks , 635
face mask elastic distraction
angular cephalometric measurements , 644
maximum-maxillary sagittal advancement , 644
fi xed distraction device , 643
history and clinical examination , 634
internal distraction devices
disadvantage of , 644–645
transverse maxillary osteotomy , 645
intraoral orthodontic splint insertion , 634–635
LeFort I osteotomy , 635
maxillary hypoplasia
left unilateral cleft lip and palate , 639, 641
predistraction and postdistraction , 639, 643
repaired bilateral cleft lip and palate , 639, 642
right unilateral cleft lip and palate, crossbites ,
639, 640
sagittal maxillary relapse, long-term results
of , 639
treatment protocols , 638
maxillary segments mobilization , 635
patient selection criteria , 633
rigid external distraction
advantages of , 645–646
angular changes , 637–638
cephalometric evaluation , 636
dental changes , 638
limitations of , 645
linear changes , 638
maxillary movements , 643–644
overjet correction , 644
period of rigid retention , 635
perioperative antibiotics , 636
postdistraction cephalometric radiographs ,
636–637
treatment groups , 635
time of surgery , 633
Maxillary orthopedic protraction
alveolar cleft
clinical procedures for , 684
treatment outcomes , 684–685
intraoral maxillary protraction spring , 674, 675
treatment protocol for , 674
treatment results and effects , 674–677
Maxillofacial growth and development
palatal repair , 313–314
scar tissue , 314
surgical effects, animal models
cleft creation , 314
mobilized mucosal split fl ap modi fi cation , 315
mucoperiosteal excisions , 314–315
wound healing , 315–316 ( see also Wound healing)
tissue engineering
biocompatible membranes , 316–317
composite substitutes , 317–318
epithelial sheets , 317
Middle ear disease
cholesteatoma , 300
otitis media
acute otitis media , 300
diagnosis , 300
Eustachian tube function , 299
medical treatment , 300
otitis media with effusion , 300
prevalence , 299
tympanostomy tube placement , 300
otoscopy , 300
surgical repair , 300–301
tympanometry , 300
Midfacial growth and occlusion
anteroposterior and vertical relationships , 347
carry effect , 348
cleft lip and palate closure , 348–349 ( see also
Orthodontic surgical approach)
differential diagnosis and treatment planning
cleft space narrowing , 382
clinician’s treatment protocol design , 382
deciduous cuspid crossbite , 380–381
dental and occlusal problems , 379
developmental age , 382
longitudinal palatal and facial growth
study , 382
palate surgical history , 379
speech problems , 379, 382
lip surgery ( see Lip surgery)
maxillary growth
autogenous graft transplantation , 357
contractility factor , 357
serial facial growth studies , 357–358
Slaughter and Pruzansky method , 358–359
wounds contraction , 357
palatal cleft surgery
fl aps , 351
lateral cephalometric results, Oslo team ,
384–385
maxillary and mandibular arches , 352
morphological differences , 356–357
overexpanded lateral palatal segment
molding , 351
serial BCLP casts , 354
three- fl ap Wardill-Kilner pushback , 352, 356
Von Langenbeck (simple closure) palatoplasty , 355
palate-maxillary arch composite relocation , 347
palatoplasty ( see Palatoplasty)
premaxillary vomerine suture , 348
pressure forces , 348
speech development
articulation skills , 360
cleft space , 359
Langenbeck procedure , 359
maxillofacial development , 359
nonphysiological surgery , 359–360
past surgical strategies , 360
unilateral and bilateral cleft lip , 360
Millard’s surgical lip procedure , 148, 149
Multicenter collaboration
intercenter comparisons , 930
obligations , 929
outcome measures , 929–930
standardization of records , 930
Multiple maxillary osteotomies , 550–553
Myo fi broblast, wound contraction , 312

976
Index
N
Nasal septum growth thesis , 137
Nasal septum theory , 48–51
Nascent cleft teams, developing countries
collaborative research approach , 875
congenital malformations , 871
cultural context , 872
foreign physician roles and language , 872
interdisciplinary care , 873
local partnership development , 873
medical care, foreign settings
geography and landscape , 872
preparation , 873
timing , 872–873
medical resources and healthcare practitioners ,
871–872
patient follow-up , 874
patient selection , 873
safety , 873–874
sustainable cleft care
education access , 875
educational access , 875
funding and supplies , 874–875
local practitioners , 875
local volunteerism , 875
training local medical personnel , 874
West Bank, Palestine , 875–876
Nasoalveolar molding therapy , 442, 460–462
Nasometer , 711–712
Nasopharyngeal skeletal architecture
cervical spine anomalies
anterior tubercle , 722
atlanto-dental angulation , 722, 726
congenital palatopharyngeal incompetence (CPI) ,
722, 724
pharyngeal space con fi guration , 722, 725
posterior arches C2–C3 fusion , 722, 727
growth variations
basilar portion of , 717
cleft vs. noncleft group , 717
height and depth of , 716
skull base malformations , 717
lateral roentgencephalometrics
noncleft individual , 722
size and shape of , 722, 723
velopharyngeal competency , 722, 724
nasal cavity
fl oor of , 720
nasal septum , 720, 721
roof of , 720
VPD , 722
VPI , 721
pharynx
auditory tubes , 715
lateral cephaloradiograph , 715, 716
lining of , 715–716
oropharynx , 715
palatopharyngeal fold , 715
swallowing , 717–718
velum , 715
speech
degree of motion , 720
oropharyngeal constriction , 718
palatoglossus activity , 720
Passavant’s pad , 718
uvulus muscle , 720
velopharyngeal closure patterns , 718, 719
velum length , 718, 719
swallowing , 717–718
velar closure
adenoid size , 728, 730
hard and soft palates , 728, 729
nasal obstruction , 728, 731
pharyngeal fl aps , 731–733
posterior pharyngeal wall augmentation , 737–738
pterygoid plates , 728
push-back procedures , 736–737
speech aid appliances , 733–736
sphincteric pharyngoplasty (SP) , 737
velar elevation , 722
Nasopharyngoscopy , 754–755
Neonatal cleft arch form distortion
CBCLP , 87
elastic traction , 88, 89
lip surgery , 88, 90
palate’s arch form variations , 87–88
physical changes , 87
PSOT , 88, 91, 92
soft-tissue forces , 87
Neonatal maxillary orthopedics
bene fi ts of , 457–458
DUTCHCLEFT trial
background , 462–463
cost-effectiveness , 466–467
experimental design , 463
feeding and general body growth , 463–464
maxillary arch dimensions , 464–466
speech effect , 466
early history of , 456–457
Kernahan Rosenstein procedure , 458–459
Latham-Millard Pinned Appliance , 459–460
nasoalveolar molding Grayson , 460–462
Zürich approach , 460
Newborn hearing screening
air conduction audiometry , 301–302
auditory brainstem response test , 301
behavioral tests , 301
otoacoustic emissions measurement , 301
O
Occult submucous cleft palate , 747–748
Orofacial clefts (OFCs)
clinical evaluation , 855
timeliness in surgery
craniofacial centres and teams , 856
fi nancial and non- fi nancial barriers , 856–857
income group , 856
MCC/ANC , 856
parental perception , 856

977
Index
personal barriers , 857
racial/ethnic factors , 856
residence , 856
timely primary cleft surgery , 856
Orthodontic surgical approach
dental adjustments for boys and girls , 527
interceptive orthopedics , 521–526
maxillary incisors alignment , 527
palatal growth inhibition
acellular band of fi brous tissue , 372
age and palate size , 361
catch-up growth , 362
facial changes , 369
island fl ap , 363, 364
lateral cephalometric tracings , 373
Le Fort I maxillary advancement , 364–368
longitudinal cephaloradiographs , 362
mandibular prominence , 373
midfacial protrusion , 373
Millard’s island fl ap pushback procedure , 362
Pierre Robin sequence , 362
scarring effects , 370–372
superimposed polygon tracings , 374
surgical history and outcomes , 361–362
palate cleft closure controversies , 361
permanent dentition , 527
presurgical orthopedics , 521
secondary alveolar bone grafting , 527
treatment phases , 521
vomer fl ap , 361
Orthognathic-orthodontic procedure , 208–210
Orthognathic surgery
bilateral cleft lip and palate
LeFort I osteotomy , 579–580
premaxillary osteotomy , 581
results and complications , 583–584
isolated cleft palate , 582, 584
timing , 573
unilateral cleft lip and palate
differential maxillary segmental repositioning , 577
LeFort I osteotomy , 577–578
results and complications , 583
Osteosynthesis wires , 546
Otitis media with effusion (OME) , 300
Otoacoustic emissions (OAE) measurement , 301
Overt clefts
adenoid size , 746
frequency of , 744
middle ear disease , 745
nasopharynx volume , 747
pharynx, height and width , 746
types of , 744, 745
VCFS , 745
P
Palatal clefts, variation in , 67
Palatal ef fi ciency rating computed instantaneously
(PERCI) , 712
Palatal embryopathology , 617–618
Palatal growth
mandibular development in cleft palate , 53–55
maxillary and mandibular growth
basion horizontal concept , 51–53
functional matrix theory , 46–48
genetic control theory , 45–46
nasal septum theory , 48–51
newborn palate with cleft , 45
postnatal growth patterns
bone remodeling during growth , 56
mandibulofacial dysostosis , 55
maxillary growth , 56
unilateral agenesis , 55
Palatal lift prostheses
etiology , 844
lift type
evaluation methods , 849–850
objectives in , 849
palatal elevation , 845, 846
palatopharyngeal insuf fi ciency , 845
patients tolerance and acceptance , 850
prerequisites of , 845, 849
soft palate , 845, 847–849
velar elevation , 845, 846
palatopharyngeal insuf fi ciency , 845
speech characteristics , 844
symptoms , 844
traditional speech treatment , 844
Palate surgery, SLCLPP
cephalometry , 266
mandibular protrusion , 271
maxillary growth , 268
maxillary length , 270
maxillary-mandibular relationship , 269
maxillary protrusion , 270, 271
palatal length , 269
study model analysis , 266, 268, 271, 272
Palatoplasty
age considerations
cause and effect , 790, 792
cleft palate , 807
clefts types , 794
clinical trials , 788–789
communication success vs. failure , 788
contaminating factors, timing for closure , 787–788
delayed hard palate closure , 858
Dorf and Curtin review , 793
early palatal repair , 857–858
heterogeeous etiology , 789
mild hypernasality , 809
normal communication development , 788
Peterson-Falzone review , 792–793
poorer articulation , 809
primary veloplasty ( see Primary veloplasty)
rank-orders research designs , 790
sample selection , 789
speech sound acquisition and resonance , 808–809
timing of , 794
vocabulary development , 788, 789
vomer fl ap , 859

978
Index
Palatoplasty (cont.)
dental occlusion, vomer fl ap
bone formation , 363
catch-up growth , 374–377
modi fi ed von Langenbeck procedure , 363, 374
posterior lingual crossbite , 363
prevalence , 362
sagittal molar relationship , 363
transverse maxillary growth , 363
two layer palatoplasty–vomerplasty , 363
differential diagnosis , 378
palatal closure duration , 378–379
primary vs. secondary , 810
Panorex , 116
Patient record information form
physical systems and structures , 948–952
surgical/facial growth changes , 947
Periosteoplasty , 443
Physiological maxillary surgery , 207
Pierre Robin sequence
airway management
decannulation , 281, 282
GILLS scoring system , 283
inclusion criteria , 280
indications for , 282
MIST criteria , 283
nasopharyngoscopy , 283
orthopedic devices , 282
perioperative and postoperative complications , 280
prone positioning , 281
surgical modalities , 282
syndromic , 281, 284
tracheostomy , 280, 281
cephalometric roentgenography , 288
cleft palate and mandibular micrognathia , 290–292
degree of obstruction, airway , 293, 294
glossoptosis , 293, 294
growth-stimulating properties , 294
ICP group , 249
isolated cleft palate , 288–290
lateral cephalometric fi lm , 294
lifesaving procedure , 294
mandible traction , 294
maxillary tuberosities , 293
mean facial diagram , 248, 249
nonsyndromic cases of , 249
stertorous breathing , 293
Plan-do-check-act (PDCA) cycle , 900
Plastic surgery , 259, 527
Posterior pharyngeal fl ap surgery
complication rate , 769
fl ap width , 768–769
surgical outcome , 768
Posterior pharyngeal wall augmentation , 737–738
Premaxillary excision , 213
Premaxillary incision , 212
Premaxillary orthopedic intrusion
device for , 678, 679
mechanisms of , 680, 681
orthodontic preparation , 678
treatment outcomes , 678, 680
Premaxillary orthopedic medial repositioning
device for , 682
mechanisms of , 682–684
orthodontic preparation , 682
treatment results for , 682, 683
Premaxillary protrusion
after lip repair , 147–148, 151
anterior cleft space , 189–191
at birth , 186–188
extraoral elastics , 163–165, 168–169
facial pro fi le fl attening , 183
orthodontic-surgical care , 222
palatal casts, computerized drawings , 166
position determination , 151
PVS ( see Premaxillary vomerine suture)
rigid arch wire , 222
secondary alveolar bone grafting , 193
septum , 136, 137
surgical setback and palatal cleft closure , 152
symmetrical/asymmetrical , 134
treatment planning , 221
two-stage lip closure , 136
Premaxillary vomerine suture (PVS) , 135, 136, 477
facial convexity , 137, 141, 142
growth testing , 137
metallic implants , 137
nasomaxillary complex , 138
roentgencephalometric data , 137
serial cephalometric tracings and digital cast
study , 137–140
Premaxilla ventro fl exion , 147, 173, 200–202, 217–219
Presurgical infant orthopaedics , 333
Presurgical orthopedics and periosteoplasty with lip
adhesion (POPLA)
age level , 480
Brophy procedure , 507
buccal crossbite , 481
CBCLP
anterior dental crossbite , 481
cephalometric tracings , 482
crowded anterior maxillary incisors
advancement , 491
Delaire-type facial mask , 489
mandibular incisors , 482, 492
palatal length , 482, 506, 507
premaxilla alignment and eruption , 490
protraction orthopedic forces , 482, 502
collapse , 480
CUCLP
anterior dental crossbites , 481, 486
anterior teeth advancement , 488
concave facial pro fi le , 488, 489
3D analysis , 480
incisor teeth uncrowding , 487
lateral incisor space loss , 494, 495
lip/nose revision , 484
midface, forward growth , 498
midfacial recessiveness , 486, 487
occlusal stability , 485
palatal length , 482, 506, 507
palatal segmental movements , 480, 481

979
Index
palatal segments , 496, 497
presurgical/nonpresurgical orthopedics , 482, 504
protraction orthopedic forces , 502, 503
retarded midfacial growth , 499, 500
temporary tooth bearing palatal plate
placement , 483
upper left lateral incisor replacement , 501, 502
elastic chain , 474
external and internal palatal compression
techniques , 507
IBCLP , 492, 493
midfacial de fi ciency , 475
midfacial distraction osteogenesis , 478
non-POPLA conservative treatment , 478–479,
503–507
palatal osteogenic de fi ciency , 505
post-surgical psychosocial therapy , 481
premaxillary retrusion , 475–476
protraction facial mask , 477
PVS , 477
screw knob controls , 474
Presurgical orthopedic treatment (PSOT) ,
88, 91, 92
Primary veloplasty
closure stages , 795–796
hard palate closure , 796
incidence of , 797
intraoral plate , 796
Prominent premaxilla
lip taping , 443–445
maxillary growth , 451
postsurgical management
alveolar molding , 445
central incisor loss and implant replacement ,
447–449
Le Fort advancement , 449–451
maxillary expansion , 445–446
over-extruded premaxilla , 446–447
presurgical treatment approaches
Latham appliance , 442
mandibular length , 441, 442
nasoalveolar molding therapy , 442
periosteoplasty/bone grafting , 443
surgical setback , 441
Protraction facial mask
Delaire-style , 512
facial growth pattern , 516
fi xed retention , 517
midfacial orthopedic protraction forces , 511
midfacial retrusion correction
anterior crossbite , 520
Bergen rationale , 529
clinical results , 531–532
fi xed retention , 531
long-term prognosis , 533
optimal rehabilitation , 519
orofacial function , 520–521
orthopedic/orthodontic treatment ( see Orthodontic
surgical approach)
permanent incisors , 532
plastic surgery , 259, 527
quad-helix spring , 528–531
soft-tissue pro fi le , 532–533
stability/relapse , 532
transverse expansion , 529–530
treatment timing , 531
UCLP patients , 520
palatal expansion , 512, 516
treatment time , 516
UCLP , 513–515
Protraction orthopedics , 196, 197
Psychosocial support and interventions
challenges
adolescence , 909
adults , 909–910
childhood , 908–909
infancy , 907–908
methodological , 911–912
cognitive factors , 912
face-to-face interventions , 912–913
individual differences , 910
lay-led organisations , 913
online interventions , 913
positive psychological adjustment, HP , 912
psychological adjustment , 910–911
research efforts , 913
social interactions skills training , 912
stepped approach , 913
R
Repaired bilateral cleft lip palate (BCLP)
maxilla , 326–327
vs. UCLP, growth pattern , 327
Repaired unilateral cleft lip palate (UCLP)
growth pattern , 325–326
maxilla and mandible , 325
maxillary prominence changes , 326
vs. non-cleft subjects , 325, 326
Residual deformity
bilateral cleft lip and palate , 574
isolated cleft palate , 574
unilateral cleft lip and palate , 573–574
Rigid external distraction
S
Sagittal splitting procedure , 539
Schuchardt procedure , 539, 540
Secondary bone grafting
canine eruption , 603, 604
closure types , 607–609
erupting teeth , 603, 604
goal of , 604
interdental septum evaluation , 604, 607
maxillary growth , 603, 609–610
root resorption rates , 609, 610
timing of , 606–607
Soft palate , 84
Soft palate repair (SPR), early
American rejection of , 415
Gothenburg cleft team , 415

980
Index
Soft palate repair (SPR), early (cont.)
age considerations , 420
incisions , 421, 422
mucosal fl aps , 421
scar position variation , 421
surgical procedure , 420–421
vomer fl ap , 421–422
historical background , 414
maxillary growth results , 418–419
modern methods , 416
Schweckendiek method , 414–415
speech outcomes , 418
timing of , 417
velopharyngeal incompetence , 415
velum, tension reduction , 415–416
Zürich, Switzerland team
posterior vomer fl ap , 419
preoperative maxillary orthopedic
treatment , 419
speech outcomes , 420
Zürich cleft team , 415
Speech
aeromechanical measurement
PERCI , 712
TONAR , 712
Warren and Dubois technique , 712
aid appliances
auditory training , 735–736
congenital neurologic disorders , 734
metallic castings , 734
palatal lift appliance (PLA) , 736
palatal section , 734–735
pharyngeal bulb , 735
prosthetic dental appliances , 734
velar section , 735
articulation tests , 707
cephalometrics , 708
cine fl uoroscopy , 708–709
nasometer , 711–712
nasopharyngeal skeletal architecture
degree of motion , 720
oropharyngeal constriction , 718
palatoglossus activity , 720
Passavant’s pad , 718
uvulus muscle , 720
velopharyngeal closure patterns , 718, 719
velum length , 718, 719
rating scales , 707
ratings of intelligibility , 707–708
ultrasound , 710
video fl uoroscopy
base/Towne’s view , 710
frontal view , 709–710
high-density barium , 709
lateral view , 709
radiation dosage , 709
video nasopharyngoscopy , 710–711
Speech bulb
adaptol , 833, 835
modeling compound , 833, 834
position of , 833, 836
wire loop attachment , 833, 834
Speech-language pathologists (SLPs) , 940
Spheno-occipital synchondrosis , 717
Sphincter pharyngoplasty , 737
complications , 771
port size , 770–771
timing of surgery , 771–772
vertical incisions , 770
Sri Lankan cleft lip and palate project
(SLCLPP)
primary surgery effect, facial growth
in fl uecing factors , 275–276
lip surgery ( see Lip surgery)
palate surgery ( see Palate surgery, SLCLPP)
Vomerine fl ap , 273–275
Wardill-Kilner vs. Von Langenbeck repair , 273
records collection , 259
un-operated unilateral cleft lip and palate
cephalometry , 260, 262
clinical features , 260–262
study model analysis , 260, 263, 264
Submucous cleft palate , 78, 747
Surgical-orthodontic treatment , 156
Surgical treatment planning
bilateral data
clinical signi fi cance , 405–406
growth velocity , 401, 403
posterior cleft areas , 401, 405
posterior vs. total surface area , 401, 403–405
surface area , 401–403
cleft and palatal size , 389
cleft palate surgical history , 408
delaying palatal closure , 407
differential diagnosis ( see Differential diagnosis)
patient’s age and tissue defect , 389
presurgical orthopedics , 407–408
quantitative analyses
cleft subjects , 392–393
clinics and patients , 390
controls , 393
control sample , 390
Hotz presurgical protocol , 391–394
hypothesis testing , 389
institutional location and cleft type , 391
Miami sample , 391
midpalatal suture , 390
participating institutions , 390–391
statistical analysis , 393–395
serial cast records , 389
speech problems , 408
surgical goals , 406–407
treatment protocols , 395
unilateral data
clinical signi fi cance , 405–406
growth velocity , 395, 397–398
posterior cleft areas , 398–399
posterior cleft area vs. total surface area ,
399–401
total surface area , 395, 396

981
Index
T
Teasing and bullying
cleft population
attractiveness and friendships , 919
attribution theory , 918
family systems theories , 918
learned helplessness , 918
locus of control , 918
moral reasoning , 918
resilience , 919
shame and moral disgust , 918–919
social desirability and modelling , 918
stereotyping, stigmatisation and scapegoating , 918
consequences of , 920–921
de fi nition , 917–918
developmental analysis
adolescence , 920
adulthood , 920
birth, infancy and preschool years , 919
school age , 919–920
intervention and management recommendations
adolescence , 922
children , 922
cognitive behavioural therapy , 922
family therapy , 922
future aspects , 923–924
legal frameworks , 923
preschool years , 922
school-age children , 922
school programs , 923
younger children , 922–923
prevalence , 918
The Oral-Nasal Acoustic Ratio (TONAR) , 712
Thomas-Kilmann Con fl ict Mode Instrument , 897
Tissue engineering
biocompatible membranes
collagen-based membranes , 316–317
split-mouth design , 317
synthetic membranes , 316
composite substitutes , 317–318
epithelial sheets , 317
Two-stage palatal surgery
delayed hard palate repair ( see Hard palate repair
(HPR), delayed)
early soft palate repair ( see Soft palate repair (SPR),
early)
Scandcleft study , 431–433
Tympanometry , 300
U
Unilateral clefts of lip and palate (UCLP)
complete , 65 ( see also Complete unilateral cleft lip
and palate (CUCLP))
incomplete , 65
protraction facial mask , 513–515, 520
variation in , 66, 68
Unilateral complete cleft lip and palate (UCCLP) , 246, 247.
See also Complete unilateral cleft lip
and palate (CUCLP)
Unoperated palates
combined prosthesis and orthodontic appliance ,
828, 829
de fi cient soft palate , 826, 827
delayed surgery , 828
hard palate , 827
neuromuscular de fi ciency , 827–282
spatial relations , 828
Uvulae , 84
V
Van der Woude syndrome , 18–19, 563, 565
Velar closure
adenoid size , 728, 730
hard and soft palates , 728, 729
nasal obstruction , 728, 731
pharyngeal fl aps
articulation errors , 733
hypernasality/hyponasality , 732
lateral wall movements , 733
placement of , 731, 732
push-back procedures , 733
small adenoid , 731, 732
posterior pharyngeal wall augmentation ,
737–738
pterygoid plates , 728
push-back procedures , 736–737
speech aid appliances
auditory training , 735–736
congenital neurologic disorders , 734
metallic castings , 734
palatal lift appliance (PLA) , 736
palatal section , 734–735
pharyngeal bulb , 735
prosthetic dental appliances , 734
velar section , 735
sphincteric pharyngoplasty , 737
Velo-cardio-facial syndrome (VCFS) , 745, 805
Velopharyngeal closure
developmental changes
adenoid involution , 749
aerodigestive tract , 748
upper airway infants vs. adults , 748
evaluation of , 751
levator palatini orientation , 742, 743
multi-view video fl uoroscopy
advantages and disadvantages of , 755–756
barium sulfate suspension instillation , 754
radiation exposure duration , 753
radiographic views, rest and during speech , 753
nasal air escape
cul-de-sac nasal resonance , 752
manometers and rhinometers , 752
nostrils occlusion , 752
nasopharyngoscopy
advantages and disadvantages of , 755–756
fi ber-optic endoscopes , 754
fl exible and rigid instruments , 754
topical anesthesia , 755

982
Index
Velopharyngeal closure (cont.)
neurogenic and myopathic disorders , 750–751
Passavant’s ridge , 743, 744
planes of movement , 742
structural anomaly
hypertrophic tonsils , 750
lingual tonsil enlargement , 749
occult submucous cleft palate , 747–748
overt clefts ( see Overt clefts)
palatine tonsils , 749
submucous cleft palate , 747
valve anatomy , 741, 742
valving failure , 743–744
Velopharyngeal dysfunction (VPD) , 722
differential diagnosis , 781
evaluation of
auditory perceptual screening , 780
dynamic sphincter , 777
excessive nasal resonance , 779
image interpretation , 780
instrumental evaluations , 780
nasal and oral cavities secretion , 778
speech/language evaluation , 779
hypodynamic/adynamic velopharyngeal sphincter ,
784
management of
complete/partial fl ap dehiscence , 772
scarred fl ap , 772
posterior pharyngeal fl ap
complication rate , 769
fl ap width , 768–769
surgical outcome , 768
preoperative assessment
craniofacial and intraoral examination , 761
Furlow double-opposing Z-palatoplasty , 766–767
instrumental assessment , 762
medical history , 760
MVVF , 764–765
nasopharyngoscopy , 763–764
patient-family interview , 760
speech evaluation , 761–762
syndromic diagnoses and comorbid conditions ,
760–761
prosthetic management , 781–782
sagittal gap , 783–784
series of management algorithms , 777–779
small midline gap , 783
sphincter pharyngoplasty
complications , 771
port size , 770–771
timing of surgery , 771–772
vertical incisions , 770
surgical alteration of , 782
surgical management , 782
Velopharyngeal incompetency and insuf fi ciency
cephalometric radiographs , 842
number of patients , 839
palatal lift prostheses
etiology , 844
lift type , 845–850
palatopharyngeal insuf fi ciency , 845
speech characteristics , 844
symptoms , 844
traditional speech treatment , 844
palatal lifts, patients status , 842–843
pharyngeal fl ap surgery , 842
questionnaire for data acquisition ,
839–841
referral source for , 839, 841
tonsils and adenoids of , 839, 841
treatment methodology for , 842
type of , 839
Video nasopharyngoscopy , 710–711
Visual reinforcement audiometry , 301
Vomer fl ap , 859
degree of midfacial protrusion , 144
growth-retarding effect , 144
head bonnet , 144, 145
lip adhesion , 144, 145
Oslo CLP team , 144
prolabium , 144, 146
W
Wound healing
maxillary growth, surgical effects
cell culture models , 319–320
collagen , 319
growth factors , 319
palatoplasty , 319
pro-in fl ammatory factors , 318
TGFbs and FGFs , 318–319
phases in
in fl ammatory phase , 311
remodeling phase , 311–312
tissue formation phase , 311
scar tissue formation , 313
skin and oral mucosa
in fl ammation , 309
intraoral wounds , 309–310
palatal and buccal wound healing , 310
palatal mucoperiosteum , 310
tissue remodeling , 309
wound contraction , 312
Z
Zürich approach , 460