Bryan J. Williams

Spontaneous cleft palate in a newborn gorilla (Gorilla gorilla gorilla)

OBJECTIVE We report the first case of cleft palate in a newborn male gorilla (Gorilla gorilla gorilla). CASE HISTORY AND RESULTS The full-term infant was born to clinically healthy, wild-caught parents and survived 5 days. Autopsy disclosed a unilateral cleft palate, moderate scalp hemorrhage (birth versus postnatal trauma), cerebral edema, and a sterile fibrin vegetation in the heart. The palate was also shorter and narrower than expected, and the biorbital breadth was reduced; otherwise, growth and development appeared normal. Standard cranial and intraoral radiographs and three-dimensional reconstructions of computerized tomographic (CT) scans provided thorough and noninvasive methods of studying the craniofacial complex and extracranial skeleton. By this technique, major findings were: intact premaxilla, interpremaxillary, and premaxillary/maxillary sutures; intramaxillary cleft with ipsilateral choanal atresia; mildly asymmetric inferior turbinates; and normal nasal septum and vomer. CONCLUSIONS Except for choanal atresia, cleft palate was not associated with other major craniofacial or extracranial anomalies in this case. Choanal atresia has been observed at times with cleft palate, but to our knowledge, the association has not been reported in nonhuman primates. Cleft palate, with or without cleft lip, has been recognized in a variety of nonhuman primates, including the lemur, marmoset, tamarin, squirrel monkey, and macaque. Some occurrences are spontaneous, while others are syndromic and/or arise from genetic or teratogenic influences. Each mode of presentation is poorly understood in nonhuman primates, but in this case, the absence of relevant environmental or parental history suggests that the occurrence was spontaneous. Anatomic studies of nonhuman primates are particularly valuable when they involve endangered species and will hopefully increase our understanding of the pathogenesis and etiology of congenital disorders, as well as other relationships between nonhuman primates and humans.

A one-year survey of inpatient dental consultations at a children's hospital.

This study describes dental consultations for pediatric inpatients. Records of inpatient dental consultations in 2007 were analyzed to determine consultation reasons, diagnoses, treatment, and demographics. Consultations from Hematology-Oncology (Hem-Onc) and Transplant Oncology (T-Onc) were further analyzed. One hundred and fifty-five consultations were performed for 133 subjects. Hem-Onc (37%) and T-Onc (17%) were the most frequent consultations. Requests were most frequently for baseline evaluation (33%) and oral pain/discomfort (10%). Frequent dental diagnoses were soft tissue conditions (29%) and caries (23%). A dental home preexisted for 48% of subjects and in 44% of consultations with caries and 53% without caries. Caries was present in 30% of consultations where Medicaid was sole payer versus 18% with non-Medicaid payers. Subjects from the Oncology department had more baseline evaluations, frequently had soft tissue diagnoses, and more often received preventive counseling and treatment under general anesthesia. In conclusion, dentists play an important role in optimal management of certain hospital inpatients.

Ethics for orthodontists.

When treating children, important ethical issues may arise relating to the best interests of the child and decision making for minors. The case of a child with a cleft lip and palate whose parents failed to bring her in for medically indicated orthodontic care is presented. Ethical features of the case are discussed, including the need to benefit the patient, avoid harm, and respect the preferences of the parents. Ethical codes of the American Dental Association and American Medical Association are referenced. Ethical dilemmas include the conflict between the orthodontists obligation to the child and the need to respect parental autonomy. Parental autonomy is respected up until the point at which significant harm to a child may result. The orthodontists primary ethical responsibility is to the child, not the parents. The orthodontist providing medically indicated care should involve the craniofacial team or hospital social worker when parental decision making is in question.