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Objective methods for the assessment of velopharyngeal function
56 Journal of Cranio-Maxillofacial Surgery Speech Results after Cleft Palate Repair During the First Year of Life
Honigmann K., Miiller A., Ernst B., Prein J.
Clinicfor Reconstructive Surgery, Division of MaxillofaciaI Surgery, KantonsspitallUniversity Clinic, Basel, Switzerland One of our aims in cleft treatment is to enable the children their school entrance with a completely closed cleft and a normal colloquial speech. In a prospective study over the last decade, speech development of those children whose clefted soft and hard palate has been closed operatively during their first year of life has been recorded. Speech documentation has been carried out by speech therapists with the aid of NARSOM. This method of speech documentation and the speech results at the age of school entrance in the respective group of patients is presented.
The Application of Demineralized Bone Allografting to the Maxillofacial Region
Hosny M., Hassib A., Hassan H., Barghash H.
Department of Oral and Maxillofacial Surgery, El Fayrouz Hospital, Cairo, Egypt In spite of all the major conceptual advances in bone grafting in the last two decades, the ideal bone graft is yet to be introduced. After bone grafting, three phases of bone formation consequently take place. The first phase is effected by superficial osteogenic cells, the second by osteoconduction, the third by osteoinduction. The latter is a major contributing factor in graft repair. Urist and Reddi revealed the osteoinductive capacity of demineralized bone. The latter was shown to trigger the genetic machinery of differentiated mesenchymal cells to produce bone through endochondral ossification. We previously reported on osteoinduction in rats and monkeys. In this presentation, the application of demineralized bone in humans in distraction osteogenesis, trauma, orthognathic surgery, cleft palate and cystic cavities will be discussed. From our results we report the following findings: (i) demineralized bone was easy to process and store, (ii) aseptic collection eliminated infection in our series, (iii) banked bone eliminated the harvesting procedures and consequently decreased the operative time, (iv) demineralized bone supported bone formation during distraction osteogenesis, (v) demineralized bone induced bone that supports teeth eruption in cleft defects, and (vi) the demineralized bone graft host incorporation might be enhanced in the future by the addition of bone inductive protein fractions.
Delivery Systems for Bone Morphogenetic Protein
Hotz G.1, Herr G.2
¢Department of Maxillofacial and Plastic Surgery, University of Heidelberg, Heidelberg, Germany 2Department of Orthopedics, Universityof Tiibingen, Tiibingen, Germany Osteoinductive growth factors such as bone morphogenetic protein (BMP) could provide an alternative to autograft for use in a variety of cranio-maxillofacial procedures. Purified
BMP is highly soluble when used without a carrier, so that it disperses immediately after implantation and exerts no effect on bone induction. To be used for intraosseous filling, contour augmentation or discontinuity reconstruction the BMP carriers should fulfil quite different requirements with respect to their chemical, biological and mechanical properties. For this purpose we investigated in several experimental studies HA-ceramics, a tricalcium phosphate, glass ceramics and collagen matrix to determine their suitability as a delivery system for BMP. The 3 glass ceramics investigated are chemically derived from a TCP. Compared with a TCP their solubility is increased up to 16-fold. In bioassay the BMP- coated glass ceramics show an accelerated biodegradation which is, however, accompanied by inflammatory foreign body reactions, tissue necrosis and BMP proteolysis. The examined rapidly resorbable glass ceramics are, therefore, no suitable carriers for BMP whereas collagen, HA and aTCP appear to offer a good potential as carriers for clinical use.
Objective Methods for the Assessment of Velopharyngeal Function
Huet P., Toquet J., Mercier J.
Clinique de Stomatologie et Chirurgie Maxillo-Faciale, CHU H6tel-Dieu, Nantes, France Before and after velopharyngeal anomaly treatment, it is essential to be able to assess velopharyngeal function. The study of speech disturbances remains the most widely used method, but it is based on subjective listener judgement. Same criticisms are made to clinical, radiological, or nasofibroscopical tests, as the assessment depends on the examiner. Several objective evaluating techniques have been described. We explain them by classifying them according to physical parameters studied (acoustics, pressure or flow) and we insist on the measure of nasal airflow with the aerophonoscope. We think it is the simplest, the quickest, and the most suited method in daily practice. With this method, we are able to select indications and assess the results of speech therapy as well as the results of velopharyngeal surgery.
Treatment of Condylar Fractures: Arguments for a Standardization of Result Criteria
Huet P., Taiariol L., Behaghel M., Mercier J.
Clinique de Stomatologie et Chirurgie MaMllo-Faciale, CHU H6tel-Dieu, Nantes, France The methods of treatment of the condylar fractures are numerous, as well as the method of assessment of the results. Therefore, comparison of the different series of the literature is often difficult, and sometimes impossible. The utilization of a follow-up sheet in our department, allowing the valuation of, on the one hand, the functional effects (masticatory, occlusial, and joint function) and on the other hand, the architectural effects (facial symmetry, vertical posterior height, and facial growth), bring us to propose a standardization of result criteria. This standardization is necessary for the long-term follow-up of these fractures and comparing the results of the different teams. This topic is illustrated by a clinic, a radiographic and a teleradiographic iconography, and the presentation of our follow-up sheet.
Honigmann K., Miiller A., Ernst B., Prein J.
Clinicfor Reconstructive Surgery, Division of MaxillofaciaI Surgery, KantonsspitallUniversity Clinic, Basel, Switzerland One of our aims in cleft treatment is to enable the children their school entrance with a completely closed cleft and a normal colloquial speech. In a prospective study over the last decade, speech development of those children whose clefted soft and hard palate has been closed operatively during their first year of life has been recorded. Speech documentation has been carried out by speech therapists with the aid of NARSOM. This method of speech documentation and the speech results at the age of school entrance in the respective group of patients is presented.
The Application of Demineralized Bone Allografting to the Maxillofacial Region
Hosny M., Hassib A., Hassan H., Barghash H.
Department of Oral and Maxillofacial Surgery, El Fayrouz Hospital, Cairo, Egypt In spite of all the major conceptual advances in bone grafting in the last two decades, the ideal bone graft is yet to be introduced. After bone grafting, three phases of bone formation consequently take place. The first phase is effected by superficial osteogenic cells, the second by osteoconduction, the third by osteoinduction. The latter is a major contributing factor in graft repair. Urist and Reddi revealed the osteoinductive capacity of demineralized bone. The latter was shown to trigger the genetic machinery of differentiated mesenchymal cells to produce bone through endochondral ossification. We previously reported on osteoinduction in rats and monkeys. In this presentation, the application of demineralized bone in humans in distraction osteogenesis, trauma, orthognathic surgery, cleft palate and cystic cavities will be discussed. From our results we report the following findings: (i) demineralized bone was easy to process and store, (ii) aseptic collection eliminated infection in our series, (iii) banked bone eliminated the harvesting procedures and consequently decreased the operative time, (iv) demineralized bone supported bone formation during distraction osteogenesis, (v) demineralized bone induced bone that supports teeth eruption in cleft defects, and (vi) the demineralized bone graft host incorporation might be enhanced in the future by the addition of bone inductive protein fractions.
Delivery Systems for Bone Morphogenetic Protein
Hotz G.1, Herr G.2
¢Department of Maxillofacial and Plastic Surgery, University of Heidelberg, Heidelberg, Germany 2Department of Orthopedics, Universityof Tiibingen, Tiibingen, Germany Osteoinductive growth factors such as bone morphogenetic protein (BMP) could provide an alternative to autograft for use in a variety of cranio-maxillofacial procedures. Purified
BMP is highly soluble when used without a carrier, so that it disperses immediately after implantation and exerts no effect on bone induction. To be used for intraosseous filling, contour augmentation or discontinuity reconstruction the BMP carriers should fulfil quite different requirements with respect to their chemical, biological and mechanical properties. For this purpose we investigated in several experimental studies HA-ceramics, a tricalcium phosphate, glass ceramics and collagen matrix to determine their suitability as a delivery system for BMP. The 3 glass ceramics investigated are chemically derived from a TCP. Compared with a TCP their solubility is increased up to 16-fold. In bioassay the BMP- coated glass ceramics show an accelerated biodegradation which is, however, accompanied by inflammatory foreign body reactions, tissue necrosis and BMP proteolysis. The examined rapidly resorbable glass ceramics are, therefore, no suitable carriers for BMP whereas collagen, HA and aTCP appear to offer a good potential as carriers for clinical use.
Objective Methods for the Assessment of Velopharyngeal Function
Huet P., Toquet J., Mercier J.
Clinique de Stomatologie et Chirurgie Maxillo-Faciale, CHU H6tel-Dieu, Nantes, France Before and after velopharyngeal anomaly treatment, it is essential to be able to assess velopharyngeal function. The study of speech disturbances remains the most widely used method, but it is based on subjective listener judgement. Same criticisms are made to clinical, radiological, or nasofibroscopical tests, as the assessment depends on the examiner. Several objective evaluating techniques have been described. We explain them by classifying them according to physical parameters studied (acoustics, pressure or flow) and we insist on the measure of nasal airflow with the aerophonoscope. We think it is the simplest, the quickest, and the most suited method in daily practice. With this method, we are able to select indications and assess the results of speech therapy as well as the results of velopharyngeal surgery.
Treatment of Condylar Fractures: Arguments for a Standardization of Result Criteria
Huet P., Taiariol L., Behaghel M., Mercier J.
Clinique de Stomatologie et Chirurgie MaMllo-Faciale, CHU H6tel-Dieu, Nantes, France The methods of treatment of the condylar fractures are numerous, as well as the method of assessment of the results. Therefore, comparison of the different series of the literature is often difficult, and sometimes impossible. The utilization of a follow-up sheet in our department, allowing the valuation of, on the one hand, the functional effects (masticatory, occlusial, and joint function) and on the other hand, the architectural effects (facial symmetry, vertical posterior height, and facial growth), bring us to propose a standardization of result criteria. This standardization is necessary for the long-term follow-up of these fractures and comparing the results of the different teams. This topic is illustrated by a clinic, a radiographic and a teleradiographic iconography, and the presentation of our follow-up sheet.