African Americans represent the second largest ethnic group in the United States. Even though there are mixtures of other races and cultures, their primary ancestry is African. Because of their heritage and cultural practices in the United States, the acceptance of the diagnosis and treatment of craniofacial anomalies is different from that of other groups. Positive aspects of the culture that augment the treatment of disorders include the strength of the family and a strong religious belief system. Factors that may impede the effectiveness of clinical intervention are economics and accessibility to medical care.
Latinos are expected to form the largest ethnic minority in the United States by the year 2000. Although there is considerable diversity within this group, a number of simllarities prevail. Folk theories of etiology and treatment, family loyalties, attitudes toward health professionals, and hospitals appear similar across Latino subgroups. Successful treatment requires the knowledge and appreciation of cultural attitudes.
This paper presents a brief overview of some cultural, ecologic, and demographic influences on the treatment and maltreatment of infants and children with congenital anomalies. Based on research on the selective neglect of infants leading to death in parts of the developing world, it is suggested that such practices be viewed as "ethno-eugenic" survivalist strategies altogether distinct from malicious child abuse and neglect in the modern, industrialized world. Caution with respect to heroic (and not so heroic) medical interventions and "child saving" in the contexts of both developing and modern societies is stressed.
Neural crest cells migrate extensively during embryonic development and give rise to numerous and varied derivatives. Two important and unresolved questions are: what controls the migration and differentiation of these cells? This review summarizes recent experiments that address these issues. Specifically, this overview describes the pathways of neural crest cell migration, the functional importance of interactions between neural crest cells and the extracellular matrix for their movement, and studies on neural crest cell lineage in vivo by labelling individual precursor cells.
The present study addressed two questions. Does the skeletal pattern of children with cleft lip and palate who require a pharyngeal flap differ from children with similar clefts who do not? Following a pharyngeal flap does the pattern of facial development change? Skeletal form prior to pharyngeal flap was compared using cephalograms in 52 subjects with unilateral cleft lip and palate (UCLP) who subsequently received a superiorly based pharyngeal flap and 52 UCLP controls matched for sex and age. The flap group had slightly smaller maxillary length and anterior face heights and greater mandibular protrusion (p less than 0.5) before the pharyngeal flaps were done. Preoperative and five year (minimum) postoperative records were analyzed for 29 early pharyngeal flap cases and 29 matched controls. Subsequent growth demonstrated some assimilation of the flap group with the controls, but repeated measures analysis of variance failed to identify any important differences in growth after pharyngeal flap, suggesting that the superiorly based pharyngeal flap carries no systematic risk of interference with facial growth.
Fifty-seven consecutive complete unilateral cleft lip and palate patients were followed longitudinally from birth to 21 years of age. All patients were operated with the same primary surgical procedures. Reevaluation at age 21 with respect to speech, dental condition, need for secondary surgery, and skeletal and soft tissue facial growth was completed. Speech results indicated that 13 patients (23 percent) had required a pharyngeal flap, and that at age 21 only one patient still had unacceptable speech. The majority of patients had slight speech disturbances related to articulation and voice quality. Fifty-one patients had acceptable occlusion following orthodontic treatment, twenty-two patients (39 percent) without need for prosthodontic treatment of the cleft area. Secondary surgery for correction of nasal deformities was required for fifty-two patients. Growth analysis demonstrated deficiency in growth; however, normal and acceptable profiles were obtained in 50/57 of the patients.
A 16-item questionnaire designed to survey opinions on the management of velopharyngeal insufficiency (VPI) was distributed to all members (N = 296) of the American Cleft Palate Association who were speech-language pathologists. Questionnaires were completed by 173 respondents (58.4 percent). There were differences of opinion among speech-language pathologists on various management issues related to VPI, including the value of instrumental assessment of VPI, the importance of oral examination of velopharyngeal function, and the effectiveness of speech therapy in the treatment of VPI. The implications of these findings for clinical training in VPI are discussed.
The pressure-flow method introduced by Warren and DuBois is a useful method for estimating velopharyngeal orifice area. However, this investigation shows that unless geometric similarity of subject and model exists, the value of the flow coefficient k used in the equation to estimate velopharyngeal orifice area cannot be established from model tests. Use of k = 0.65 is questioned as that value is typical of thin plate orifices, a geometry that is not a good representation of the velopharyngeal passage. Values of k from the literature and from steady state tests using a model similar to Warren's are presented to show the effect of various inlet shapes. The influence of inlet shape supports the conclusion that k may be significantly higher than 0.65, conceivably approaching values in the range of 0.9 to 0.97, depending on the orifice geometry.
A case of a rare first branchial arch anomaly with severe hypoplasia of the mandible and fusion between the mandible and adjacent bones is presented. The patient also had intracranial, cardiac, and acral deformities. The craniofacial malformations may reflect incomplete separation of the first branchial arch into its maxillary and mandibular processes. The association between the craniofacial and other corporal anomalies is unknown.
Culture impacts both professional practice and patient health behaviors. This paper Introduces the concept of culture and examines how it may be of Importance to health professionals engaged in craniofacial care. The taking of a cultural history is presented as a way of assessing cultural differences. This paper is the first in a series of interrelated papers that define cultural perspectives toward health and craniofacial care in United States sub-populations.
Glucocorticoid-induced cleft palate (CP) has been used as an animal model for hormonal teratogenesis. In mice, the susceptibility to glucocorticoid-induced CP varies with the strain, A/J being very sensitive and C57/BL6J relatively resistant. Studies in adult and embryonic murine tissues have attempted to correlate the number of glucocorticoid receptors and CP susceptibility, with conflicting results. The relative quantities of dexamethasone receptors were now studied in established palatal and lung fibroblast cell cultures obtained from adult C57 and A/J mice. A rapidly saturable, stable binding system was demonstrated. Scatchard plots were linear indicating a single class of high affinity receptors. The glucocorticoid receptor number ranged from 6.2 x 10(-16) mole/microgram prot to 8.6 x 10(-16) mole/microgram prot, while the KD varied from 1.0 x 10(-8) M to 2.8 x 10(-8) M. The differences in receptor characteristics between murine strains were not significant (p greater than 0.05). The absence of a difference in receptor number between the two strains may reflect the limitation of fibroblast cell culture in assessing glucocorticoid binding in vivo. Alternatively, if a difference in palatal dexamethasone receptor levels between mice strains exists, it may occur only in the embryo.
The purpose of this study was to compare the influence of two different ages at the time of palatal closure and two surgical methods on the size of the dental arches at the age of 3 years in children, with CP, UCLP, and BCLP. In 88 children the one-stage palatal closure had been performed at the age of 1.8 years and In 92 children at the age of 1.1 years. In both groups palatal surgery had been performed with a V to Y push back procedure (Veau-Wardill-Killner) or with the Cronin modification. Dimensions of the maxillary arch in both groups at age 3 were smaller than In noncleft children, but the timing of palatal closure did not affect arch dimensions In children with CP, UCLP, or BCLP. Arch dimensions at 3 years of age were not related to the method used in palatal closure.
This paper describes the training, which took place in Sri Lanka, of five speech therapy assistants in cleft palate speech therapy. The context in which this training occurred is described. The original aims of the training and the criteria drawn up for the selection of the assistants are contrasted with the modifications required to these, once the British therapists started working in Sri Lanka. Information is given on the training objectives, syllabus, curriculum, and methods of evaluation of the assistants' progress. The achievements of the assistants are described. Factors relating to the difficulties and ease with which the assistants were trained are highlighted. The paper concludes with a discussion of the cultural, political, and clinical problems encountered in this type of training, and highlights the special difficulties encountered in the training of assistants in the field of speech therapy in developing countries.
This study examines the hearing status of individuals with clefts of the palate or lip and palate without other major malformations or syndromes. A total of 1,699 audiometric records were reviewed and classified on the basis of race, gender, cleft type, age, and birth year (pre or post 1969). The results indicate that race, age, and date of birth affect the frequency of hearing loss.
Craniofacial parameters were studied clinically and by cephalometry in 11 trigonocephalic patients from infancy to 4 years of age. Six of the most severe patients had surgery between 6 and 18 months of age. Analysis of morphology indicated that bony interorbital distance was reduced in patients selected for surgery and hypotelorism persisted at final examination. All patients demonstrated orbital width measurements above the mean for the norm, while orbital height was essentially normal. All but one of the patients had a variably prominent forehead bony ridge that was eliminated or reduced as a result of surgery and/or growth. However, the forehead of most patients, whether operated or not, was too narrow when compared to normal skulls. Thus, although some of the striking features of trigonocephaly are eliminated, minor characteristics of the anomaly still persevere at 4 years of age.
The transmission characteristics of nasal tract energy to a nasal accelerometer were evaluated in relation to nasal tract airway resistance. Ten adult speakers repeated three utterances while recordings of nasal bone vibration, as detected by miniature accelerometers, were obtained simultaneously from both sides of the nose and referenced to a common throat signal. Average nasal-to-oral accelerometry ratios recorded from the more resistant side of the nose were significantly larger in magnitude than those recorded simultaneously from the less resistant side of the nose. While accelerometer ratio waveforms from each side of the nose essentially overlapped for some subjects, others displayed unilateral variations in accelerometer output as a function of time. The anatomic and physiologic condition of the nasal passage appears to be an important variable in the detection of nasal tract acoustic energy using the accelerometric technique.
This paper investigates the effects of surgery on facial growth and morphology in Sri Lankan males with unilateral cleft lip and palate who were over 13 years of age at the time of study with cephalometry and dental study models. Three separate subgroups were analyzed: those who had totally unrepaired cleft lip and palate, those who received lip repair In Infancy but not palatal repair, and those who had lip and palate repair in infancy. Twenty-three healthy noncleft Sri Lankan males over 13 years formed a control group from the same racial background. The results show that subjects who had no surgery had a potential for normal maxillary growth. Subjects who have had lip repair in early infancy show relatively normal maxillary growth, but maxillary hypoplasia is common when the palate has also been repaired early.
