José Carlos Jorge

Prospective clinical trial comparing outcome measures between Furlow and von Langenbeck Palatoplasties for UCLP.

The goal of this prospective randomized clinical trial was to compare 2 cohorts of standardized cleft patients with regard to functional speech outcome and the presence or absence of palatal fistulae. The 2 cohorts are randomized to undergo either a conventional von Langenbeck repair with intravelar velarplasty or the double-opposing Z-plasty Furlow procedure. A prospective 2 × 2 × 2 factorial clinical trial was used in which each subject was randomly assigned to 1 of 8 different groups: 1 of 2 different lip repairs (Spina vs. Millard), 1 of 2 different palatal repair (von Langenbeck vs. Furlow), and 1 of 2 different ages at time of palatal surgery (9–12 months vs. 15–18 months). All surgeries were performed by the same 4 surgeons. A cul-de-sac test of hypernasality and a mirror test of nasal air emission were selected as primary outcome measures for velopharyngeal function. Both a surgeon and speech pathologist examined patients for the presence of palatal fistulae. In this study, the Furlow double-opposing Z-palatoplasty resulted in significantly better velopharyngeal function for speech than the von Langenbeck procedure as determined by the perceptual cul-de-sac test of hypernasality. Fistula occurrence was significantly higher for the Furlow procedure than for the von Langenbeck. Fistulas were more likely to occur in patients with wider clefts and when relaxing incisions were not used.

Otologic and audiologic outcomes with the Furlow and von Langenbeck with intravelar veloplasty palatoplasties in unilateral cleft lip and palate.

Objective Cleft palate increases the risk of chronic middle ear disease and hearing loss. The goal of this report was to determine which of two palate surgeries and which timing of palate surgery were associated with better otologic and audiologic outcomes in children with unilateral cleft lip and palate at 5 to 6 years of age. Design Subjects were randomly assigned to the von Langenbeck with intravelar veloplasty or Furlow palate repair, to palate surgery at 9 to 12 months or 15 to 18 months of age, and to the Spina or Millard lip repair. Setting Centralized, tertiary care craniofacial treatment center. Patients A total of 673 infants with unilateral cleft lip and palate. Interventions Palate and lip were repaired using established techniques. Serial otoscopic and audiometric evaluations were performed. Main Outcome Measures Hearing and otoscopic findings at 5 to 6 years old. Results There were 370 children available for analysis. Hearing and need for tympanostomy tube placement did not differ by palatoplasty, age at palatoplasty, cheiloplasty, or surgeon. Risk of developing cholesteatoma or perforation was higher with Millard cheiloplasty (odds ratio = 5.1, 95% confidence interval = 1.44 to 18.11, p = .012). Type and age at palatoplasty were not significantly associated with either the rate of developing these sequelae or the rate of achieving bilaterally normal hearing and ear examinations. Conclusions Type of palatoplasty did not influence otologic and audiologic outcomes in 5- to 6-year-olds with unilateral cleft lip and palate. The potential influence of lip repair on otologic outcomes warrants further investigation.

Longitudinal Study of Growth of Children with Unilateral Cleft-Lip Palate from Birth to Two Years of Age:

Objective: To study the growth of children with complete unilateral cleft lip and palate (UCLP) from birth to 2 years of age and to construct specific UCLP growth curves. Design: Physical growth was a secondary outcome measure of a National Institutes of Health–sponsored longitudinal, prospective clinical trial involving the University of Florida (United States) and the University of São Paulo (Brazil). Patients: Six hundred twenty-seven children with UCLP, nonsyndromic, both genders. Methods: Length, weight, and head circumference were prospectively measured for a group of children enrolled in a clinical trial. Median growth curves for the three parameters (length, weight, head circumference) were performed and compared with the median for the National Center for Health Statistics (NCHS) curves. The median values for length, weight, and head circumference at birth and 6, 12, 18, and 24 months of age were plotted against NCHS median values and statistically compared at birth and 24 months. Setting: Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, Brazil (HRAC-USP). Results: At birth, children of both genders with UCLP presented with smaller body dimensions in relation to NCHS median values, but the results suggest a catch-up growth for length, weight, and head circumference for girls and for weight (to some degree) and head circumference for boys. Conclusions: Weight was the most compromised parameter for both genders, followed by length and then head circumference. There was no evidence of short stature. This study established growth curves for children with UCLP.

Clinical and fiberoptic endoscopic evaluation of swallowing in Robin sequence treated with nasopharyngeal intubation: the importance of feeding facilitating techniques.

Objective To evaluate oral feeding capacity, the swallowing process, and risk for aspiration, both clinically and during fiberoptic endoscopic evaluation of swallowing, in infants with isolated Robin sequence treated exclusively with nasopharyngeal intubation and feeding facilitating techniques. Design Longitudinal and prospective study. Setting Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru, Brazil. Patients Eleven infants with isolated Robin sequence, under 2 months of age, treated with nasopharyngeal intubation. Interventions Feeding facilitating techniques were applied in all infants throughout the study period. The infants were evaluated clinically and through fiberoptic endoscopic evaluation of swallowing at first, second, and, if necessary, third week of hospitalization (T1, T2, T3). The mean volume of ingested milk was registered during clinical evaluation, and events were registered during feeding. Results The respiratory status of all infants was improved after nasopharyngeal intubation; 72% of them presented risk for aspiration during fiberoptic endoscopic evaluation of swallowing at T1. This risk was less frequent when thickened milk was given to the infants and at subsequent evaluations (T2 and T3). Conclusions Nasopharyngeal intubation aids in stabilizing the airway in isolated Robin sequence, but it does not relate directly to feeding. The risk for aspiration was present in most of the infants, mainly during the first week of hospitalization, and improved within a few weeks, after the use of feeding facilitating techniques.

A methodology report of a randomized prospective clinical trial to assess velopharyngeal function for speech following palatal surgery

Cleft lip and palate occurs in approximately 1 in every 750 live human births, making it one of the most common congenital malformations. Surgical closure of the palatal cleft does not always result in a velopharyngeal port capable of supporting normal speech. The University of Florida (UF), in collaboration with the University of São Paulo (USP), is engaging in a 5-year prospective, randomized controlled study to compare velopharyngeal function for speech outcomes between patients undergoing palatoplasty for complete unilateral cleft lip and palate performed using the von Langenbeck procedure with intravelar velarplasty and those receiving the Furlow double-reversing Z-plasty palatoplasty. The von Langenbeck procedure was selected as the time-tested standard against which the Furlow procedure could be judged. The Furlow procedure, a relatively new operation, has been reported to yield substantially higher rates of velopharyngeal competency for speech than have most other reported series and theoretically should result in less disturbance to midfacial growth. A total of 608 patients will be entered into one of two age categories. Inclusion of two age groups will allow a comparison of results between patients having surgery before 1 year of age (9-12 months) and patients undergoing surgery at approximately 1.5 years of age (15-18 months). Speech data will be collected and will be available for definitive analysis throughout the last 3 years of the study. Collection of preliminary growth data will require more than 5 years; growth analysis is anticipated to continue until all patients have reached maturity. The Hospital for Research and Rehabilitation of Patients with Cleft Lip and Palate at the University of São Paulo (USP-HPRLLP) in Bauru, Brazil, is uniquely situated for conducting this study. The well-equipped and modern facilities are staffed by well-trained specialists representing all disciplines in cleft-palate management. In addition, an already existing social services network throughout Brazil will ensure excellent follow-up of study cases. The clinical caseload at this institution currently exceeds 22,000, and more than 1200 new cases are added annually. This project represents a unique opportunity to obtain prospective data from a large number of subjects while controlling the variables that have traditionally plagued cleft-palate studies. This study is designed to determine which of the two proposed surgical procedures is superior in constructing a velum capable of affecting velopharyngeal competency for the development of normal speech.

Achados otoscópicos e timpanométricos em lactentes com fissura labiopalatina

Tympanometry plays a fundamental role in the identification of middle ear alterations, which are frequent in the population with cleft lip and palate. AIM: do a retrospective analysis of the otoscopy and tympanometric exams of infants with cleft lip and palate who were not operated. Retrospective study. MATERIALS AND METHODS: we analyzed 273 charts from infants with cleft lip and palate whom, from March 1996 to April of 2002 underwent pneumatic otoscopy and tympanometry with a 226 Hz probe. RESULTS: We did not find statistical significance in the otoscopic and tympanometric findings considering ears and genders. We observed 84% of alterations in otoscopy (opacification/83.4%, visible fluid in the middle ear /1.5%, the ear drum does not move during inflation /1.8 and retraction/0.7) and 65% in tympanometric curves (B/38%), A/36.5%, As/21%, C/4% and Ad/0.5%). CONCLUSION: female and male infants with cleft lip and palate did not differ as far as otoscopic and tympanometry findings are concerned. All types of tympanometric curves were present, and types A and B were the most frequent ones. Ear drum opacification was the most frequent otoscopic finding. Pneumatic otoscopy identified a larger number of alterations when compared to conventional tympanometry.

Otoscopic and tympanometric findings in infants with cleft lip and palate

UNLABELLED Tympanometry plays a fundamental role in the identification of middle ear alterations, which are frequent in the population with cleft lip and palate. AIM do a retrospective analysis of the otoscopy and tympanometric exams of infants with cleft lip and palate who were not operated. Retrospective study. MATERIALS AND METHODS we analyzed 273 charts from infants with cleft lip and palate whom, from March 1996 to April of 2002 underwent pneumatic otoscopy and tympanometry with a 226 Hz probe. RESULTS We did not find statistical significance in the otoscopic and tympanometric findings considering ears and genders. We observed 84% of alterations in otoscopy (opacification/83.4%, visible fluid in the middle ear /1.5%, the ear drum does not move during inflation /1.8 and retraction/0.7) and 65% in tympanometric curves (B/38%), A/36.5%, As/21%, C/4% and Ad/0.5%). CONCLUSION female and male infants with cleft lip and palate did not differ as far as otoscopic and tympanometry findings are concerned. All types of tympanometric curves were present, and types A and B were the most frequent ones. Ear drum opacification was the most frequent otoscopic finding. Pneumatic otoscopy identified a larger number of alterations when compared to conventional tympanometry.

Displasia fibrosa do osso temporal: relato de caso e revisão da literatura

Displasia fibrosa e uma doenca caracterizada por progressiva substituicao dos elementos normais do osso por tecido fibroso. E uma patologia benigna incomum de etiologia desconhecida. Existem duas categorias primarias da doenca: displasia fibrosa monostotica que envolve somente um osso e displasia fibrosa poliostotica acometendo multiplos ossos. Embora o esqueleto crânio-facial seja sede frequente da doenca, o osso temporal raramente esta envolvido. O envolvimento do osso temporal tem como sintoma mais comum a surdez. O diagnostico e baseado em imagens radiologicas. Quando a displasia fibrosa e acompanhada por sintomas clinicos significantes, o tratamento cirurgico e recomendado. O acompanhamento clinico do paciente e fundamental para o diagnostico precoce de recidivas. Neste artigo relatamos um caso de displasia fibrosa do osso temporal e revisao da patologia na literatura.