LETTERS TO THE EDITOR

February 4, 1981 To:; Cleft Journal This is a response to Dr. Ralph A. Latham's answer to my criticism (C.P.J., January, 1981) of his paper, "Or- thopedic Advancement of the Cleft Maxillary Segment: A Preliminary Report", (C.P.J., July, 1980). Since Dr. Latham is considered to be an anatomist as well as an orthodontist and especially since most of his published work has dealt with palatal structures, I am surprised to read in his response that he utilized a plastic surgeon's descriptive statement of nasal structures to spacially locate the underlying skeletal palatal structures. Should not an anatomist ask whether it is possible that the "depressed alar bases" (as Latham suggests in Millard's Cleft Craft, Vol. I, page 21) is only a graphic description of the nasal area caused by the lateral distortion of the palatal and alar segments brought on by aberrant mus- cular forces and not the result of the lesser palatal segment being more posteriorly positioned? Each of these possible causes should be evaluated independently. Only then can a cause-and-effect relationship be postulated. Latham has failed to do this and has countered my original position with the statement that the lesser palatal seg- ment is posteriorly positioned, so it would not be wrong to attempt to move it anteriorly. I believe the problem of the "depressed alar base" should be considered secondarily to repair and only after molding of the laterally displaced palatal segments has occurred. Also, the lesser segment is not posteriorly positioned. I support the need to reduce nasal/lip tension in complete clefts either by uniting lip musculature in some fashion or by the use of extraoral elastic traction (if the surgeon needs this aid) in order to move the palatal segments medially into a more normal geometric position. Samurt Berkowitz, D.D.8 6601 SW. 80th Street South Miami, Florida

225

BOOK REVIEWS

BorpEn, GroRIA J., and Harris, KaturRINE S., Speech Science. While the biographies are interest- Speech Science Primer. Baltimore: Williams and Wil- ing, they add little to the actual subject matter of kins, 1980, $19.95, paperback. the book. In my opinion, a more valuable approach would have been to provide an historical Borden and Harris attempted "to satisfy a need perspective by topic, including specific works where for a comprehensive but elementary book on speech appropriate. The final section of this chapter iden- science." According to the authors, "the need was tifiles some of the major journals and laboratories for text that is easy to understand and that inte- currently involved in speech science research. grates material on production, acoustics, and per- Chapter 3 is entitled "Acoustics." A rather tra- ception of speech." I agree with the authors con- ditional approach is utilized, beginning with a cerning the need and I feel they have done an discussion of pure tones, progressing through com- admirable job of satisfying that need. The authors plex tones, frequency and pitch, the decibel, inten- utilize a refreshing writing style different from the sity and loudness, velocity of sound, wavelength, usually stilted style of scientific or textbook writing. and resonance, and ending with a very brief dis- This will likely maintain the interest of beginning cussion of speech acoustics, a topic discussed fur- students in particular. ther in the following chapter. While the chapter This soft cover book consists of 297 pages in- covers most of the salient aspects of acoustics, it cluding three appendices listing the American Eng- does so in a rather choppy abbreviated fashion. It lish phonetic alphabet (based on the IPA), the is likely that each topic will have to be further cranial nerves important for speech and hearing, explained and expanded by an instructor. and the spinal nerves important for speech. Also Chapter 4, entitled "Speech Production," com- included is an eleven-page glossary. The book is prises the bulk of the book (114 of 297 pages). peppered with 217 figures, 107 in the fourth chap- Major sections include neurophysiology of speech, ter alone, which enhance the book's clarity. respiration, phonation, articulation and resonance, Bibliographies arranged by topic are presented English speech sounds, feedback mechanisms in at the end of each chapter. The advantage of this speech, and models of speech production. A large format is that the bibliographies may be used portion of the chapter is devoted to acoustic as well relatively independently of the text. The student as physiologic descriptions of speech with inten- can focus on a particular topic and quickly find tionally minimal coverage of anatomy. Several pertinent sources without having to scan the text spectrograms are included, but, unfortunately, material. One weak aspect of the writing style is some are of rather poor quality. In general, the that the authors do not include the year of publi- material presented is current and accurate and cation with authors in the text. Moreover, Borden consists of an easy-to-follow sequence pitched at an and Harris often refer to a study by senior author ideal level for the beginning student. The chapter only without "et al." or an accompanying date so concludes with a detailed and unique seven-page that the reader sometimes must guess as to the chart listing neuromuscular activity, movements, specific citation in the bibliography or even and aerodynamic events involved in the production whether the work is listed at all. of the sentence, "We beat you in soccer." The book is divided into seven chapters. The Chapter 5 is entitled "Speech Perception." A depth and level of coverage is fairly homogeneous preliminary section deals with the hearing mecha- throughout, although in places the discussion may nism. Subsequent sections describe acoustic cues in be somewhat too advanced for beginning students speech perception, categorical perception, neuro- and may require supplemental material or further physiology of speech perception, and theories of explanation by an instructor. speech perception. This is an excellent chapter and Chapter 1 is entitled "Speech, Language, and satisfies a great need for written material that I Thought." The authors very skillfully integrate have experienced in teaching this topic to begin- these important aspects in a cohesive easy-to-un- ning speech science students. This chapter alone derstand discussion. Also included is a section deal- may be worth the purchase of the book. ing with development of language and speech. The Chapter 6 is entitled "Research Tools in Speech chapter serves very nicely as a precursor to the Science." While this chapter certainly is not com- remainder of the text. prehensive with respect to the many research tools Chapter 2 is entitled "Pioneers in Speech Sci- available, nor with respect to each tool described, ence." The material presented in this chapter is it nevertheless provides a good sampling of the peculiar, by far the weakest of the book, and could major techniques currently being used. The value easily have been omitted. The authors provide of the chapter could have been increased by pre- brief biographies of a few well-known people in senting specific product information in conjunction 226 BOOK REVIEW 227 with the various tools described. The inclusion of tionary aspects of communication. this chapter is a positive feature of the book in that I have found this book dealing with speech most speech science texts omit this very important science at an introductory level to be the best information. written since the classic work by Denes and Pinson The seventh and final chapter is entitled "Evo- in 1963. I strongly recommend the "Speech Science lution of Language and Speech." This is also an Primer" as a primary text in an undergraduate excellent chapter. The authors utilize a skill remi- course of speech science. In addition, professionals niscent of the first chapter in integrating the var- in allied fields will find the book valuable in pro- ious notions and issues involved in evolutionary viding information basic to an understanding of concepts. The topic itself is fascinating and typi- the speech communication process. cally has aroused the interest of a wide spectrum of Davin P. Ph.D. the scientific as well as of the lay community. Department of Speech Pathology and Audiology Perhaps the greatest strength of this chapter lies in University of Denver the interest it may generate in novices to continue Denver, Colorado, 80208 exploration in speech science fields. The final sec- Editor's Note: A review of this book was also tion of the chapter, headed "A Likely Tale," is published in January, 1981. The reader may wish especially thought-provoking and consists of the to refer to that in conjunction with the review authors' own very reasonable ideas about evolu- appearing here.

[ABSTRACTS I

Baro CosmaAn, M.D., EDitOR

NATIONAL COMMITTEE

Oscar E. Beder, D.D.S John B. Gregg, M.D. Robby Meijer, M.D. William Cooper, M.D. Jerry Alan Greene, D.V.M. Dennis O. Overman, Ph.D. Jack C. Fisher, M.D. Norman J. Lass, Ph.D. Dennis M. Ruscello, Ph.D. Stephen Glaser, M.D. Jay W. Lerman, Ph.D. F. T. Sporck, M.D. Alexander Goldenberg, D.D.S. Daubert Telsey, D.D.S.

INTERNATIONAL COMMITTEE

Paul Fogh-Andersen, M.D., Copenhagen, Denmark Seiichi Ohmori, M.D., Tokyo, Japan Jean L. Grignon, M.D., Nevilly, France Anthony D. Pelly, M.D., Sydney, Australia Jose Guerrero-Santos, M.D., Guadalajara City, Mex- Helena Peskova, M.D., Prague, Czechoslovakia ico H. Reichert, M.D., Stuttgart, West Germany Stewart B. Heddle, M.D., Ontario, Canada W. H. Reid, M.D., Glasgow, Scotland Junji Machida, D.D.S., Shiojiri City, Japan E. Schmid, M.D., Stuttgart, West Germany Francesco Minervini, M.D., Rome, Italy Jean Claude Talmant, M.D., Nantes, France

Barro, W.B., and LatHam, R.A., Palatal periosteal re- Full thickness grafts from the groin were considered sponse to surgical trauma, Plast. Reconstr. Surg., 67, 6- superior in three more recent patients. (Fisher) 16, 1981. A response of palatal periosteum to surgical trauma BrppLE, F.G., Palate development in the mouse: A quan- was investigated in young dogs, and results were exam- titative method that permits the estimation of time ined histologically and by fluorescence of tetracycline and rate of palate closure, Teratology, 22, 239-246, 1980. and other bone-labelling devices. Palatal periosteum el- A method using the cumulative frequency of mouse evated and replaced showed evidence of a proliferative embryos that have reached specific stages of palate clo- cellular response of the inner periosteal layer and renewed sure at specific times during development in order to osteogenic activity on the third day post-operatively. The estimate the median times at which different closure immediate post-trauma period was characterized by the events take place is described. The method has the ad- formation of an expanded medullary zone after which vantage of using Walker and Fraser's familiar mouse osteogenesis appeared to return to normal. Repair bone palate rating system, which describes palate development in the resected area was not related primarily to the in terms of normal probability in keeping with the con- periosteal flap but always appeared at and extended from ceptual basis for threshold models and allows the esti- the edges of the resection cavity. Palatal periosteal ele- mation, within certain confidence limits, of median times vation interrupted osteogenesis for two or three days and and rates of closure. Using this method, different geno- stimulated an intense cellular proliferation. Free palatal types, treatments, or both can be compared. As an ex- periosteum overlying a resection pocket, however, was ample, data collected from two strains of mice, A/J and not seen to form bone spontaneously within a three-week A.B6 Fi, were compared. The two strains are genetically period. A discussion of the paper by John B. Mulliken different but have the same maternal environments. The reviews some of the different interpretations which have author compares the data for the two strains and discusses historically followed observations of periosteal contribu- the application of the described method. (Overman) tions to bone healing. (Cosman) EncERTON, M.T., and Janr, A.A., Vertical orbital dysto- pia-surgical correction, Plast. Reconstr. Surg., 67, 121- Ben-Hur, N., Reconstruction of the floor of the mouth 138, 1981. by a free dorsalis pedis flap with microvascular anas- tomosis, /J. Maxillofacial Surg., 8, 73-77, 1980. The authors outline some of the difficult problems in assessing appropriate eye position in the multiply mal- For repair of large anterior floor and mouth defects, formed skull and detail some of the clinical questions the author demonstrates the advantages of the free dor- that must be asked relative to the feasibility and desira- salis pedis flap. Flap thinness, pliability, and reliable bility of shifting eyes and/or orbits in the vertical direc- blood supply have afforded him extraordinary success in tion. They point out that the tolerance for such move- five consecutive cases. A sensory nerve supply can be ments is much narrower than for horizontal movements included if desired. Split grafts were found to be unsat- in simple hypertelorism. The study suggests the necessity isfactory for repair of donor defects in two initial patients. for early correction of vertical discrepancies if stereoscopic 228 amstracts 229 vision is to be achieved. A number of illustrative cases tient often has to carry the pain of social isolation and are presented in which some degree of vertical motion or stigma. Physicians caring for these children should be the appearance thereof was achieved surgically. (Cos- cognizant of their coping styles so that development can man) be directed to move away from deviance to successful "immigration into the country of normals" and adapta- Furupa, T., Nisumura, T., Mizo®awa, N., Goto, T., tion to life. (Glaser) Wapa, T.; iatmd Mmvazax1, T., A new type obturator for the postgéperative fistula of cleft palate cases, Jap. Harapa, T., and SanDo, I., Temporal bone histopatho- J. Oral Surg:, 25(1), 203-209, 1979. logic findings in Down's syndrome, Arck. Otolaryng., 107, 96-103, 1981. In this study, the authors describe how to make an obturator to cover palatal fistula in post-operative cleft The histopathologic findings in 12 temporal bones palate cases and discuss the usefulness of such devices. removed from seven patients who had Down's syndrome The obturator is supported by elastic material inserted and were aged three days to 15 years at the time of death into the undercut of the fistula using no clasp on the are reported. Hearing loss in patients with Down's syn- teeth. It is wide enough to cover either the whole of the drome is also discussed. Numerous middle ear abnormal- hard palate or only the fistula. The obturator was suffi- ities were found, but only a few inner ear anomalies were ciently supported even in cases with many severe carious present. The majority of the cochleas were shortened, but teeth. Blowing ability was improved in all cases. the majority of the vestibular dimensions were within movements during speech articulation were improved in normal limits. Unusual temporal bone, middle ear anom- 17 cases but not in four. Leakage of food and liquid from alies included a remnant of mesenchymal tissue in the the nose and the nasty smell were eliminated in all cases. round window niche in 9, wide angle of the facial genu (Machida) in seven, a remnant of the stapedial artery in 5, and large bony dehissence of the facial canal in 5. The commonest GrEmmE®, G., BontoLu1, E., Rurra, G., and Lacor10, V., inner ear abnormality was apical endolymphatic hy- The Weaver-Smith syndrome, / Pediat., 97, 962-964, drops, which was found in seven bones. In this series, 1980. hearing was reported to be essentially normal hearing in one individual whose temporal bones were studied, but A syndrome of accelerated skeletal maturation with there was no other documentation of hearing capabilities peculiar facies was described by Weaver et al. in 1974. available. The authors postulate that the remnants of An additional case is recorded to confirm the existence of mesenchymal tissue in the round window niche may be this syndrome. The most striking features are the facies, a factor in conductive hearing loss. (Gregg) the advanced skeletal maturation, and the gigantism. Other features include a discrepancy between carpal and Henpricks, A.G., Simtverman, S., PErrrEormt, M., and general skeletal age, and other anomalies such as met- sphyseal broadening, mottled epiphyses, and bilateral StErrEK, A.J., Teratological and radiocephalometric analysis of craniofacial malformations induced with camptodactyly. The peculiar facies is characterized by a retinoic acid in rhesus monkeys (Macaca mulatta), large forehead, hypertelorism, antimongoloid slant of the Teratology, 22, 13-22, 1980. eyes, micrognathia, and mandibular hypoplasia. Other minimal findings, such as hyperconvex, thin nails, and Using Macaca mulatta as a model for the study of prominent finger pads, may be useful in confirming the craniofacial development, the authors induced malfor- clinical diagnosis. (Glaser) mations by treatment with retinoic acid given by gavage between 19 and 45 or 17 and 45 days of gestation. Frontal Hanus, S. H., BernstEn, N. R., and Kapp, A., Immi- and lateral skull radiographs of treated and age-matched grants into society: children with craniofacial anoma- control offspring were taken at 6 months post-partum lies, Clinical Pediat., 20, 37-41, 1981. and cephalometric analysis was performed using cran- iometric points as close to those used in humans as Some of the adaptive coping styles of children with possible. It was observed that malformations of the man- craniofacial anomalies are discussed. Three cases of chil- dible, midface, ears, and cranium were more common dren with microtia are described to illustrate develop- following treatment between 24 and 35 days of gestation, mental pathways used in adapting to their deformities. a time period corresponding to the development of the The complexity of the chronic medical and psychological branchial arches and to early craniofacial development. challenges these children face is illustrated and discussed. The authors discuss the role of the basicranium in regu- In contrast to previous frameworks dealing with the lating growth of the craniofacial skeleton and note that problems of deviance and stigmatization, the authors use pre-natal retinoic acid treatment resulted in retarded a psychological-historical framework drawing an analogy growth and subsequent flattening of the basicranium to Handlin's work on immigration. These children are during the first six months of post-natal life. (Overman) born into a world that considers them strange and abhor- ent. They can be considered aliens entering a society of Inour, K., Matsuvya, T., Tanarka, T., NisHto, J., Hama- normal, nondisfigured people. The craniofacial center is MURA, Y., Wapa, K., FuKupa, T., and MrryazaK1, T., conceptualized as a "naturalization" office where highly Respiratory resistance of the velopharynx after pha- valued health care professionals are counted upon to ryngeal flap operation, J. Jap. Cleft Palate Assoc., 5(1), reconstruct facial appearance and function. An enduring 19-26, 1980. attachment and bonding process to the staff takes place, and the center becomes of considerable importance to The present study was designed to clarify the chron- the craniofacial patient's identity. The craniofacial pa- ological changes in the aerodynamics of nasal resistance 230 Cleft Palate Journal, July 1981, Vol. 18 No. 3 after a velopharyngealplasty. The subjects were 17 in NewrrL-Mora®riIs, L., Siriannt1, J.E., SurparD, TH., Fan- number and were eight to 28 years old. Nasal resistance TEL, A.G., and MorrEtt, B.C., Teratogenic effects of (NR) was presented as follows: NR=intraoral air pres- retinoic acid in pigtail monkeys (Macaca nemestrina). sure/nasal air flow rate (cmH»O/L/sec). Some of the II. Craniofacial features, Teratology, 22, 87-101, 1980. results were as follows: (1) Nasal resistance decreased This paper describes the craniofacial defects observed gradually until about six months after the operation and in a series of Macaca nemestrina fetuses between the ages of then remained at nearly the same level, (2) Nasal resist- 81 and 185 days of gestation following maternal treat- ance in youngsters was about twice as high as it was in ment with retinoic acid between days 20 and 44 of adults. The authors speculated that the small pharyngeal pregnancy. Examined fetuses showed a diversity of re- port in the youngsters was responsible for the difference. sponses, which most commonly included facial hypopla- (3) No significant difference was found between nasal sia, concavity of the inferior border of the mandible, resistance during inhalation and exhalation. (Machida) distortion of the occipital bone, hypertelorism, and cleft palate. Cephalometric analysis of the affected fetuses Kasuvya, M., Tamax1, H., Tonna1, I., KEnEpa, T., and showed that they had small craniofacial dimensions when Oja, T., Analysis of results of surgery and findings of measurements were compared to regression curves which character tests on a cheilognathoschisis and cleft palate predict the size of normal fetuses of the same age. Com- case, J. Jap. Cleft Palate Assoc., 5(1), 40-46, 1980. parison with other standard growth predictors indicated that the craniofacial dimensions were differentially re- Speech and psychological conditions were analyzed in duced rather than a reflection of an overall size reduction. a 16-year-old girl who suffered from emotional problems The authors discuss the use of normal growth curves for based on cleft palate speech and unsuccessfully treated comparison when dealing with single-birth, non-human cleft lip. The tests were done before and after operation primates, and they compare the macaque retinoic acid using an articulation test, MMPI test, MAS test, and Ta- syndrome with mandibulofacial dysostosis syndromes in ken test for diagnosing parent-child relations. Some of humans. (Overman) the results were as follows: The MMPI test found exces- sive sensitivity and a suspicious disposition. The Pa score suggested apprehension, fear, and obsession in the patient OnasH1, Y., Team approach in the treatment of cleft lip and active thought and behaviour disorder in the mother. and/or palate patients, /. Jap. Stomatological Soc., 29, The authors emphasize the importance of psychological 531-548, 1980. guidance in the treatment of patients with cleft lip, cleft Four hundred and eight cleft lip and/or palate pa- palate, or both. (Machida) tients seen during the period of 1974 to 1980 at the Niigata University Dental School were analyzed as to the type of clefts, side of the cleft, accompanying anomalies, Kawai, T., Koca, K., OnnisH1, M., Narita, T., MaTsuUK1I, inheritance, age of the parents at birth, body weights, M., Tom:, T., and Asoo, M., Use of a muscular pedicle and other factors. Hypertrophy of the thymus was found island flap in secondary correction of bilateral cleft to be dominant in the cleft group as measured by roent- , J. Jap. Cleft Palate Assoc., 5(1), 27-33, 1980. genography, reaction to ACTH, and level of cortisol in A technique for treating whistle tip deformity of the the blood. (Machida) repaired bilateral cleft lip is reported. Muscle pedicle island flaps from the lateral lip segments are sutured to the denuded depressed medial portion of the upper lip to Osserc, P.E., and Wirzer, M.A., Physiologic basis for increase the height and depth of that portion. Satisfactory hypernasality during connected speech in cleft palate results were obtained in all of seven cases subjected to patients: a nasendoscopic study, Plast. Reconstr. Surg., this method. (Machida) 67, 1-5, 1981. Twenty-five patients with repaired cleft were examined by nasoendoscopy, speech evaluation, and na- KumesBerRGc, I., and J., Regional nerve block of the sal resonance grading. Videotapes were obtained through - temporomandibular joint capsule: a technique for clin- the nasendoscopy approach and were compared with ical research and diagnosis, J. Dert. Res., 59, 1930- reference to shape of closure, degree of lateral wall motion 1935, 1980. during connected speech, and the degree of velar move- A technique is described for regional nerve blocking ment during connected speech. Two consistent patterns of the articular capsule of the temporomandibular (TM) of velopharyngeal movement were encountered. Hyper- joint. An anesthetic solution is accurately and reproduc- nasal speech was routinely associated with attempted ibly introduced posteriorly and laterally to the TM joint velopharyngeal closure using the lateral walls with min- to achieve anesthesia of the joint. It has been shown that imal soft palate movement resulting in a circular midline the posterior articular capsule and nerve contain the defect. Velopharyngeal closure using soft palate move- greatest density of receptors and articular nerve endings ment but no lateral wall movement left a transverse respectively. The application of this regional nerve block slitlike gap and was not associated with hypernasality should, therefore, be sufficient to anesthetize the majority despite the persistence of a gap. The authors conclude of the articular nerve endings. It is anticipated that this that the recognition of distinct dysfunctional patterns technique will be useful in clinical studies to separate the opens the door to nonsurgical correction of hypernasality motor control of the jaw muscles and the role of the joint in selected patients using the nasendoscope and video capsule in differential diagnosis of orofacial pain. (Telsey) display. (Cosman) ABSTRACTS 231

OTsux1, H., KatsuK1, T., Koca, T., and TasHiro, H., An search of the literature revealed two other patients having attempt to rear mice with cleft palates by artificial both conditions. However, a number of other individuals nutrition, /. Jap. Cleft Palate Assoc., 5(1), 34-39, 1980. have been reported with Goldenhar or related syndromes An attempt was made to rear cleft palate dd N mice associated with malformations in the caudal region or, which were born from mother mice that were given conversely, with the caudal regression syndrome and dexamethasone (3 mg/kg) subcutaneously on the 11th cranial anomalies. Possible explanations for the common- day of gestation. They were reared using one of four ality of malformations seen in these syndromes are pre- kinds of food-(1) cow's milk, (2) sterilized cow's milk, sented and discussed. It is suggested that the term "axial (3) curd from stomachs of normal newborn mice, and (4) mesodermal dysplasia spectrum" be used in patients sterilized curd from newborn mouse stomachs. The food manifesting this overlap to emphasize the importance of was poured into the stomach via a rubber tube of 1.0 mm searching for the other malformations seen in this spec- in diameter. Those fed by methods (1) and (3) were kept trum of anomalies. Goldenhar syndrome consists of epi- in a room, but those fed by (2) and (4) were kept in a bulbar dermoids, auricular appendages, pretragel blind- sterilized box. The mice did not live more than 5.5 days ended fistulas, and vertebral anomalies. Other features after birth in any of the four categories. (Machida) which are frequently seen include upper eyelid colobom- ata, ear anomalies, facial asymmetry, and congenital heart disease. The caudal regression syndrome includes RaaTikxA, M., Rapura, J., TuuTERI, L., Lounimo, I., and sacral agenesis, renal dysplasia or agenesis, imperforate SaAvILAHTA, E., Familiar third and fourth pharyngeal anus, and lower limb and uterine malformations. (Glaser) pouch syndrome with truncus arteriosus: Di George syndrome, Pediatrics, 67, 173-175, 1981. SETZER, E.S8., Ru1z-CastANEDA, A., Severn, C., RyoEn, This article presents a family in which three of four S., and Frias, J.L., Etiologic heterogeneity in the ocu- siblings had truncus arteriosus and other anomalies com- loauriculovertebral syndrome, J. Pediatr., 98, 88-90, 1981. patible to the third and fourth pharyngeal pouch syn- drome (Di George syndrome). The usual manifestations The oculoauriculovertebral syndrome (Goldenhar syn- are various combinations of defective thymus and para- drome) is a pattern of malformations with wide variabil- thyroid glands with congenital heart disease. The syn- ity of expression characterized by ocular, auricular, and drome often includes cleft palate and abnormal facial skeletal defects as well as other orofacial and extrace- features. In most cases conotruncal and/or aortic arch phalic anomalies. The criteria for diagnosis consist of a malformations are present. Although otherwise a rare lipodermoid or lipoma of the conjunctiva, an epibulbar malformation, truncus arteriosus communis is one of the dermoid, or an upper lid coloboma and two of the most common heart anomalies in the pharyngeal pouch following three: (1) small size or abnormal shape of the syndrome. The syndrome is uncommon and most of the ears, preauricular skin tags, or both, (2) unilateral aplasia reported cases have been solitary. In this family, an or hypoplasia of the ramus of the mandible, and (3) autosomal recessive inheritance is possible. (Glaser) vertebral anomalies. This syndrome was observed in three unrelated families: two monozygotic twinships discordant for the disorder and a third family affected in an apparent RintTALA, A.E., Surgical closure of palatal fistulae: follow- autosomal dominant mode. These cases are presented to up of 84 personally treated cases, Scandinavian Journal of emphasize the probability of etiologic heterogeneity of Plast. Reconstr. Surg., 14, 235-238, 1980. the syndrome. (Glaser) An 82% closure rate was achieved in a series of 84 palatal fistulae repaired by the author over a five-year SHERMAN, J.E., and Gouran, D., The successful one- period. 75% of the patients required one operation, 14% stage surgical management of a midline cleft of the two, and 11% three or more operations. Double-hinged lower lip, mandible and tongue, Plast. Reconstr. Surg., flaps and bone grafts were the usual procedures. (Cos- 66, 756-759, 1980. man) ' A one-stage repair of a cleft of the lower lip, tongue, and mandible, with bone graft to the mandible, is illus- Rimtaca, A., LEist1, J., Lissmaa, M., and Ranta, R., trated in a patient born with complete cleft of the man- Oblique facial clefts: case report, Scand. J. Plast. Re- dible, anterior tongue, and lower lip. A good single stage constr. Surg., 14, 291-297, 1980. repair was achieved. A four-year follow-up showed com- An incidence of 3.1% of oblique facial clefts were plete ossification at the mandibular operative site with observed in 3,600 cleft lip cleft palate cases. Medial oro- relatively good mandibular growth up to that time. ocular and naso-ocular clefts were the most common. (Cosman) The lachrimal apparatus was involved to some degree in all but a few cases. The literature is reviewed and several SHPRINTZEN, R.] ., GOLDBERG, R.B., Younc, D., and Wor- case reports presented. (Cosman) roRD, L., The velo-cardio-facial syndrome: a clinical and genetic analysis, Pediatrics, 67, 167-172, 1981. RussELL, L. J., Weaver, D.D., and Burr, M.J., The axial Thirty-nine patients with the velo-cardio-facial syn- mesodermal dysplasia spectrum, Pediatrics, 67, 176-182, drome are described in order to further delineate this 1981. probably common recurrent pattern congenital malfor- Features of both the Goldenhar and the caudal regres- mation syndrome. Frequent features include cleft palate, sion syndromes were found in the patient described. A cardiac anomalies, typical facies, and learning disabili- 232 Cleft Palate Journal, July 1981, Vol. 18 No. 3 ties. Less frequent findings include microcephaly, mental Turpin, L. M., Furnas, D.W., and Amuie, R.N., Craniofa- retardation, small stature, slender hands and digits, mi- cial duplication (diprosopus), Plast. Reconstr. Surg., 67, nor auricular anomalies, and inguinal hernia. The Robin 139-142, 1981. malformation sequence was found in four patients. The Three infants with craniofacial duplication were born congenital heart anomalies most frequently involved a in a recent 12-month period in the neighborhood of the ventricular septal defect, with or without a right-sided University of California at Irvine. This remarkable series aortic arch. There were four instances of familial trans- is presented here, and the world literature involving 16 mission in the sample population. These included two other cases since 1864 is reviewed. Details of this massive cases of maternal transmission of the syndrome to daugh- and lethal deformity are presented in the cases depicted. ters, one case of maternal transmission to a son, and one (Cosman) case of maternal transmission to both a son and a daugh- ter. There was no particular difference in expression between male and female patients so that, even though Wapa, T., C.R., and MryazaAx1, T., Midfacial X-linked dominant transmission is possible, the velo-car- . growth effects of surgical trauma to the area of the dio-facial syndrome is likely to be an autosomal dominant vomer in beagles, J. Osaka Univ. Dent. Sch., 20(1), 241- recurrent pattern syndrome. (Glaser) 276, 1980. In an effort to obtain information about the possible influences of vomer surgery on midfacial growth, 24 StuRLA, F., Asst, D., and BuguEt, J., Anatomical and weanling female beagle dogs were used in an eight-month mechanical considerations of craniofacial fractures: an longitudinal study of the effects of vomer resection. One experimental study, Plast. Reconstr. Surg., 66, 815-820, group of eight pups had surgery at the end of the sixth 1980. post-natal week for resection of the major part of the vomer. The surgical approach was via access flaps in the On the basis of experimental work inflicting blows on hard palate. Eight other pups had surgery simulating cadaver heads and subsequently studying the trauma that for vomer resection, but the vomer was left in place. produced, the authors present a new classification of A third group of eight pups served as unoperated controls. craniofacial fractures based upon the recognition of skull Maxillofacial growth records included maxillary and "pillars." The entire craniofacial structure is viewed as a mandibular casts and X-ray cephalograms. Results lattice work with strong supporting pillars, and injury in showed significantly less growth in the group that had one area of a pillar suggests search for injury in the vomer resections than in the other groups in three an- others. These pillars appear to be related to those initially teroposterior dimensions measured on maxillary casts defined by Shapiro and Converse, but they are presented and in four anteroposterior dimensions measured on ce- as of interest to craniofacial surgeons as well as to those phalograms. The findings in this model suggest that, taking care of craniofacial trauma itself. (Cosman) while resection or absence of the vomer was an important determinant of anteroposterior growth, the palate surgery Tatematsu, M., The difference in morphological crani- necessary to gain access to the vomer was not. (Machida) ofacial patterns due to surgical methods of and types of cleft lip and palate. J. Jap. Cleft Palate Wapa, T., Matsuva, T., and T., The use of Assoc., 5(1), 1-18, 1980. mucosal flaps in surgery for clefts of the soft palate, J. Osaka Univ. Dent. Sch., 20(1), 291-296, 1980. The purpose of the study was to evaluate the differ- ences in the craniofacial patterns of cleft lip and/or A surgical method using three palatal mucosal flaps is palate in relation to surgical methods and types of clefts. described for repairing clefts of the soft palate. The One hundred thirty-four cleft lip and/or palate patients method uses mucosal flaps from the posterior one-third who were operated upon by one surgeon between 1972 of the hard palate, and palatal neurovascular bundles and 1974 were divided into six groups according to type remain in situ. The incision is designed to preserve the of cleft. The cleft lip group was subdivided by the types area of bony defect on the hard palate. None of the of operations used. The ages of the subjects ranged be- patients have yet reached the age for critical evaluation tween three years, eight months, and four years, six of the effects on maxillary growth and speech. (Machida) months, for the cleft group and three years, 9 months, and four years, seven months, for the control group of 30 Worms, FW., Speiper, TM., Bevis, R.R., and Warre, children. Several angles and lengths were measured on D.F., Post treatment stability and esthetics of orthog- the roentgenocephalographs, and the following results nathic surgery, Angle Orthodont., 50, 251-273, 1980. were obtained: (1) No significant differences were found between children whose cleft lips were repaired using the The past decade has seen an enormous increase in triangular-flap method and those who had the rotation- orthognathic surgery to correct developmental and con- advancement procedure. (2) The cleft lip group did not genital dento-facial-cranio-malformations. Enough time differ significantly from the control group. (3) In contrast, has now elapsed to evaluate the post-treatment stability retardation of anteroposterior maxillary development and esthetics of this surgery. The authors have identified was marked in the groups with complete cleft lip and seven areas that contribute to post-surgical success or palate, incomplete cleft lip and complete cleft palate, failure: 1. condyle displacement, 2. condyle resorption, 3. and incomplete cleft palate; and it was slight in the group gnathological errors, 4. fibrous union, 5. misdiagnosis, 6. with clefts of the soft palate only. (4) No retarded devel- degree of reliance upon orthodontics or surgery, 7. pro- opment of the cranial base was found in any type of cleft. portional relationship between nose and lip and the (Machida) esthetic effect of surgery on these structures. (Telsey)

ANNOUNCEMENTS

FOURTH ANNUAL CONFERENCE ON SURGICAL TECHNIQUES IN CLEFT LIP AND PALATE TO BE HELD AT BAYLOR UNIVERSITY MEDICAL CENTER NOVEMBER 16-20, 1981

The Fourth Annual Conference on Surgical Techniques in Cleft Lip and Palate will be held November 16-20, 1981 at Baylor University Medical Center, Dallas, Texas. _ Director: Kenneth E. Salyer, M.D., Dallas, Texas Co-Director: Janusz Bardach, M.D., Iowa City, Iowa, V. Michael Hogan, M.D., New York, New York Special Invited Guest: Fernando Ortiz-Monasterio, Mexico City, Mexico The conference emphasis will be on the current surgical techniques used in primary cleft lip and palate repair correction, of cleft nasal deformity and the treatment of secondary maxil- lofacial defects associated with cleft lip and palate. The surgical correction of velopharyngeal incompetency will also be a major topic. Informal discussion as well as diadactic lecture will be augmented with live operative case presentations. Participants will be able to observe the surgical techniques presented in the discussion. Surgery will be scheduled for Tuesday and Thursday mornings. An interdisciplinary faculty will participate. AMA-CME Credits, Category 1, Fee $500/ Residents $250, Enrollment limited. For further information contact: Marcy Rogers, Administrative Assistant, c/o of Dr. Kenneth Salyer, 3600 Gaston Avenue, #1157, Dallas, Texas 75246, 214-826-1000.

CORRECTION

"Services for Children With Congenital Facial Clefts Through a State Crippled Children's Service Program", Roger B. White, Cleft Palate Journal, April, 1981, Volume 18, Number 2, 116-121. Because of a printer's error, Table 4 appearing on page 120 contained incomplete infor- mation. A corrected version of Table 4 appears below:

TABLE 4. Mean One Way Distance Traveled by CCS Children for Facial Cleft Treatment

Mean Distance Number Percent 0111732361352“

Within same community 285 34.9 34.9 2-5 miles 83 10.2 45.1 6-10 miles 76 9.3 54.4 11-15 miles 89 10.9 65.3 16-20 miles 59 7.2 72.5 21-30 miles 109 13.4 85.9 31-40 miles 53 6.5 92.4 41-50 miles 28 3.4 95.8 51-171 miles 34 4.2 100.0 TOTAL 816 100.0

Sum of one way distance traveled = 11,753 Mean Distance = 14.4 miles

233 Three-Dimensional Approach to Analysis and Treatment of Hemifacial Microsomia, Leonard B. Kaban, John B. Mulliken, and Joseph E. Murray, Cleft Palate Journal, April, 1981, 90-99.

Because of an error in marking photographs, Figures 7A and 7B, page 98, were reversed. The correct presentation of the cephalograms will be found below.

FIGURE 7. 7A: A-P cephalogram illustrating the typical distortion of a patient with end-stage Type II hemifacial microsomia. 7B: Postoperative A-P cephalogram shows the lateral position of the newly constructed temporoman- dibular joint and ramus, the corrected ramus length, and mandibular skeletal midline.

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