Olafur P. Jakobsson

Dental abnormalities and ectopic eruption in patients with isolated cleft palate

The aim of this study was to evaluate the influence of cleft size and surgical treatment on the development of permanent teeth in patients with isolated cleft palate. The series comprised 109 children with isolated cleft palate, 70 girls and 39 boys, including 14 patients with Robin sequence. The patients were grouped according to the sagittal extent of the palatal cleft, measured on dental casts obtained before the primary palate surgery. Forty-six children were treated by one-stage palatoplasty, and 63 in two stages. The dentition was studied on orthopantomograms taken at 5, 8, 11, and 14 years of age. Congenitally missing permanent teeth (third molars excluded) were found in 33 subjects (30%). Children with large clefts had significantly more missing teeth than children with small clefts. The tooth most usually missing was the mandibular second premolar, followed by the maxillary lateral incisor, and the upper second premolar. The incidence of dental malformation was 23%, mostly mild forms. Ectopic eruption of the upper first permanent molars was seen in 23 (45%) of the subjects with large clefts, and in 18 (31%) of those with small clefts. The surgical method did not significantly affect the direction of the eruption. There is a correlation between cleft size and hypodontia, dental deformity, and ectopic eruption. Children with Robin sequence had almost the same incidence of hypodontia, malformed teeth, and ectopic eruption as children with large clefts. There was no correlation between surgical method and ectopic eruption of the maxillary first permanent molars.

Oedema measurements in a standard burn model

A highly standardized, reproducible burn model on rat hind paw as well as a method to measure oedema volume non-invasively is described. Along with a review of the literature on earlier methods to measure post-burn oedema we present a statistical evaluation of the present model with notes on its applicability in various experimental settings.

The effect of prompt local cooling on oedema formation in scalded rat paws

A standardized, reproducible burn model on rat paw was used and the effect of prompt local cooling on the oedema formation was measured using a newly developed non-invasive method. A transient reduction in oedema formation was observed lasting for a longer period of time with decreasing temperature down to 0 degrees C and increasing cooling time up to 120 min. The decrease in oedema formation was followed by an increase towards or above the amount of oedema in untreated scald injury. This post-cooling increase in oedema formation was related to the temperature and the exposure time of the cooling fluid. The immediate effects of cooling are most likely due to local restriction of the blood flow as a result of cold-induced vasoconstriction. The increase of the oedema formation after the cooling period may be due to reactive hyperaemia.

Classification, recording, and cleft palate surgery at the Uppsala Cleft Palate Centre.

This paper describes the classification system, method of recording, and surgical techniques used in Uppsala for children with isolated cleft palate. The classification is based on the system described by Kernahan and Stark and the more detailed system described by the American Cleft Palate Association. Separation of the hard palate into thirds, and into right and left sides, assures a detailed description of the cleft, and separates small morphological differences. The longitudinal registration system was introduced into the Uppsala Cleft Palate Centre in 1967. After the initial recording at the time of primary surgery, it is repeated at 5, 8, 11, 14, 17, and 20 years. By emphasising the therapeutic aspects of various stages of growth, it has been possible to limit the recording to once every third year. This has resulted in an important reduction in the dose of radiation without compromising the reliability of the results. Children born before 1975 had clefts of both the soft and hard palate closed at 18-24 months in a one-stage procedure. For children born in 1975 and later a two stage technique has been used, while clefts limited to the soft palate only have been closed entirely in the first operation. At first, the soft palate cleft was closed at 18 months of age and the hard palate at 4 to 5 years. The timing was changed in several steps to the present soft palate closure at 6 months and hard palate closure at 2 years of age.

Morphology of isolated cleft palate in children, including robin sequence, treated with one or two-stage operations

A classification developed at the Uppsala Cleft Palate Centre was used to describe isolated cleft palate in children with and without Robin sequence. The study included 109 patients born between 1968 and 1983 with isolated cleft palate. In 46 patients the cleft was closed in a single operation and 63 were treated by a two-stage procedure. Of the 109 patients 70 (64%) were girls. In 19 patients (17%), the cleft was limited to the soft palate. Ninety of the patients had clefts of the hard palate and in 39 (43%) of these patients the clefts involved less than a third of the hard palate. Only four children (4%) had total clefts of both the hard and soft palate. The Robin sequence was diagnosed in 14 children (13%), and it was more common in boys with isolated cleft palate (7/39; 18%) than in girls (7/70; 10%). In those with Robin sequence the cleft was U-shaped anteriorly in nine (64%), with great variations in width. Generally, however, the clefts were wider than other clefts involving the hard palate. In all cases, closure of the soft palate was followed by a spontaneous reduction in the width of the remaining cleft in the hard palate. The greatest improvement was noted in subjects with the U-shaped clefts, in whom the position of the tongue probably had the greatest influence on the development of wide primary clefts. In 10 subjects with clefts of the soft palate only and 12 patients in whom the cleft included part of the hard palate (35%), only the first operation of the two-stage procedure was done because there was no residual cleft. In these subjects the original cleft had involved less than a third of the length of the hard palate.

PROFILE: a user-configurable system for the measurements of angles and distances on pictures

PROFILE is a user-configurable system to make series of predefined geometric measurements on various types of pictures. The primary use is for collecting data for statistical analysis. The computer-based method is much faster than manual measuring, effectively replacing the ruler and protractor traditionally used for this type of work with a digitizer. The results are available immediately as printed reports and as ASCII files which are easily imported by most database, spreadsheet and statistics programs for further study. The programs run on suitably equipped IBM and fully compatible personal computers.

Early post-burn oedema in leucocyte-free rats

A highly standardized, reproducible burn model on rat hind paws with objective measurement of oedema volume was used to study the post-burn oedema formation in leucocyte-free rats as compared to a matched group of normal rats. No difference in oedema volume could be detected during the first 4 h post-burn. Thus the mechanical effect of sticking leucocytes in the injured area or leucocyte derived substances do not seem to play any significant role in the early local oedema formation which we postulate is entirely mediated by local events.

Database interface for digital calipers

With emphasis on an advanced user interface this program was designed to collect measurements from digital sliding calipers and micrometers for subsequent inclusion into a database. The original project was measurements of dental casts, but the general nature of the program makes it adaptable to fields as diverse as medicine, archaeology and industrial quality control. The gain realized, compared to earlier manual methods, is a substantial reduction of the time spent on actual measuring, as the error-prone scale reading and handling of the results (writing down, entering, etc.) have been made superfluous. The CALIPER program runs on suitably equipped IBM personal computers while digital instruments, gauge blocks and multiplexer interface are supplied by Mitutoyo Co.

Computer Data Base for Cleft Lip and Palate Research

This is a description of a comprehensive system for collection and storage of information about treatment and follow-up of cleft lip and palate (CLP) patients. The emphasis is on clinical research, including as much data as possible, and storing it according to the rules of the relational data base model to maintain flexibility. The information is derived from hospital records, clinical examinations, speech evaluations, and measurements of dental casts and cephalograms. In this complex setting, it is important to respect the rules of proper computer data base organization and implementation to insure the long-term correctness and integrity of stored data.

Acral Lentiginous Malignant Melanoma

We present a case of a regressing acral lentiginous malignant melanoma of the sole with metastases en route and to regional lymph nodes. The histological findings at the primary site were classed as Clarks level I, stressing the difficulty in diagnosing this type of tumours early enough for effective treatment.