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' Reprints: Peggy Mccardle, Ph.D. Exceptional Family Member Program Department of Pediatrics Walter Reed Army Medical Center Washington, D.C

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' Reprints: Peggy Mccardle, Ph.D. Exceptional Family Member Program Department of Pediatrics Walter Reed Army Medical Center Washington, D.C ABSTRACTS BELENCHIA P, MCCARDLE P. Goldenhar's syndrome: a case study. J Commun Disord 1985; 18:383-392. The authors very briefly review the etiology, clinical features, differential diagnosis, and management of Goldenhar's syndrome. They also present the case history of a 19-month-old male, the sole survivor of triplets, with Goldenhar's syndrome. The patient exhibited microtia and mild hemifacial microsomia, incomplete cleft lip, a submucous cleft palate, right-ear atresia, and vertebral anomalies. At 12 months of age the patient was tested as having a 6 month deficit in communication skills. Following 6 months of participation in a multidisciplinary, early intervention program that included speech-language therapy, the patient's language abilities were normal at 19 months of age. However, articulation errors, hyper- nasality, and audible nasal emission continued to contribute to reduced speech intelligibility. Belenchia and McCardle stress the value of an interdisciplinary team approach combined with parent-centered early inter- vention for children with Goldenhar's syndrome. (Cohn) ' Reprints: Peggy McCardle, Ph.D. Exceptional Family Member Program Department of Pediatrics Walter Reed Army Medical Center Washington, D.C. 2037-5001 BELL R, KIyAK HA, JoonNDEPH DR, McNEILL RW, WALLEN TR. Perceptions of facial profile and their influence on the decision to undergo orthognathic surgery. Am J Orthod 1985; 88:323-332. The facial profile of 80 patients was evaluated by 46 orthodontists, 37 oral surgeons, 43 lay persons, and the patients. The findings indicated that: (1) self perceptions of profile are more important in the patient's decision to elicit surgical correction than the recommendation of the dental specialists; (2) although oral sur- geons and orthodontists had similar perceptions of the profile, oral surgeons recommended surgery more fre- quently; (3) lay persons are more likely to rate a profile as '"normal'' than the dental specialists; (4) patients perceive their profile differently (less critically) than the other groups. (Bishara) Reprints: Dr. H.A. Kiyak Department of Oral and Maxillofacial Surgery School of Dentistry University of Washington Seattle, WA 98198 BLUEsTONE CD, DovyLE WJ, ARJONA SK, EDs. Eustachian tube function: physiology and role in otitis media. Ann Otol Rhinol Laryngol [Suppl] 1985; 94:6-60. This publication constitutes the report of a workshop at the Otitis Media Research Center, Children's Hospital of Pittsburgh, September 1984. Subject matter covered includes: anatomy, pathology, physiology, animal models, pathophysiology, and role of otitis media and certain related conditions. The only direct reference to craniofacial clefting is by W. J. Doyle in the section on pathophysiology, ''Eustachian Tube Function In Special Populations: Cleft Palate Children.'' The findings reported are from a prospective study started in 1981 to evaluate eustachian tube function longitudinally in palatal cleft children. Methodology and results are reported briefly. From limited data, the author indicates that tubal dilation was similar before and after palatal surgery. A beneficial effect resulting in an improved function of palatoplasty could not be demonstrat- ed, and palatal repair decreases the pressures that passively close the eustachian tube. To those treating pa- tients with craniofacial anomalies this publication should be of interest. (Gregg) Reprints: Charles D. Bluestone, M.D. 125 De Soto Street Pittsburgh, PA 15213 159 160 Cleft Palate Journal, April 1986, Vol. 23 No. 2 BooRMAN JG, SomMERLAD BC. Levator palati and palatal dimples: their anatomy, relationship and clinical significance. Br J Plast Surg 1985; 38:326-332. The significance of dimpling of the normally elevated palate when the patient says '""Ah'' was investigated by cadaveric dissection in which traction on the levator palati reproduced the palatal indentation. Further dis- section of the palati itself revealed not only that the dimpling corresponded to the fusion of the palatopharyn- geus muscle to the posterior border of the levator but that the latter muscle occupied the intermediate 40 percent of the soft palate. In the discussion it was recommended that the levator palati should be surgically positioned into this correct anatomical site and that absent dimpling in the presence of velopharyngeal incompetence indicated inadequate muscular correction. (Ward) Reprints: Mr. B. C. Sommerlad, F.R.C.S. N. E. Thames Regional Plastic Surgery Centre St. Andrew's Hospital Billericay, Essex, England BooRMAN JG, SOMMERLAD BC. Musculus uvulae and levator palati: their anatomical and func- tional relationship in velopharyngeal closure. Br J Plast Surg 1985; 38:333-338. The gross histology and dissection of the soft palate directed at the interrelationship of the musculus uvulae and levator palati showed that the uvular muscles form a convexity on the nasal aspect of the palate overlying the levator sling. From nasendoscopic studies in normal patients and patients with inadequate repair of the palate, it was concluded that a more efficient seal of the velopharynx is provided by the bulk of the uvular tissues acting as a central plug on elevation of the levator palati. In the course of palatal repair it follows that not only should the levator palati and musculus uvulae be correctly repaired but their innervation be care- fully protected. (Ward) Reprints: Mr. B. C. Sommerlad, F.R.C.S. N. E. Thames Regional Plastic Surgery Centre St. Andrew's Hospital Billericay, Essex, England BrRowN AS, SILVERMAN J, GREENBERG S, MALAMUD DF, AuBum M, RW, SarsHIK M. A team approach to drool control in cerebral palsy. Ann Plast Surg 1985; 15:423-430. This article from New Jersey and Pennsylvania is an analysis of the surgical reduction of drooling in chil- dren with cerebral palsy. The surgical procedure used was that of bilateral submandibular gland excision and bilateral ligation of the parotid gland ducts. The amount of drooling was substantially reduced in the 10 chil- dren selected as candidates for this study by the team. Psychologically, all of the children benefitted. (Lindsay) Reprints: Arthur S. Brown, M.D. Suite 813 300 Broadway Camden, NJ 08103 Cappy CM, Rei CD. An atraumatic technique for harvesting cancellous bone for secondary al- veolar bone grafting in cleft palate. Br J Plast Surg 1985; 38:540-543. ' In this article from the Department of Plastic Surgery, Frenchay Hospital, Bristol, England, the authors note that secondary alveolar bone grafting has evolved as a method of choice in promoting total dental re- habilitation of patients with alveolar clefts. The authors note that the ilium, rib, and calvarium have their advocates as donar sites. The ilium has been criticized because of postoperative discomfort. They describe the operative technique for the use of the Craig bone biopsy set for obtaining bone from the ilium. This is done through a less than 1 cm incision in the skin below the level of the iliac crest, 5 cm posterior to it's anterior superior spine. Multiple cores of cancellous bone can be harvested through this hole by the technique described by the authors. They conclude that, in their experience, the esthetic and functional results of alveo- ABSTRACTS 161 lar bone grafting using this technique are superior to previously described methods. The reader must assume that this statement applies to the donor site only. (Lindsay) Reprints: Mr. C. D. Reid, F.R.C.S. Department of Plastic Surgery Frenchay Hospital Bristol, BS16 1LF, England CHEN Y, FairHgoLm D. Fronto-Orbital-Sphenoidal Fibrous Dysplasia. Ann Plast Surg 1985; 15:190-203 . Eight patients with fronto-orbital-sphenoidal fibrous dysplasia between 9 and 37 years of age are reviewed. All had longstanding frontal bulging and proptosis. Decreased vision on the affected side was present in four patients and optic nerve compression present in three patients. They underwent radical or nearly radical excision with immediate bone graft reconstruction. Postoperative results were good with no further visual loss and some visual improvement in the patients who underwent optic nerve decompression. The experience of the authors shows early diagnosis of fronto-orbital-sphenoidal dysplasia is important, since this condition is progressive. Radical surgical excision of the affected bone is safe, may cure the dis- ease, and prevents the long-term effects of progression. (Snively) Reprints: Yu-Ray Chen, M.D. Department of Plastic and Reconstructive Surgery Chang Gung Memorial Hospital 199 Tung-Hwa North Road Taipei, Taiwan CHEPENIK KP, GEORGE M, GREENE RM. Effects of dexamethasone on phospholipase activities in palate mesenchyme cells in vitro. Teratology 1985; 32:119-123. These authors have previously reported a role for prostaglandins in regulating development of the palate. This paper reports on a study to test the effects of the synthetic glucocorticoid, dexamethasone, on the activity of phospholipase A, an enzyme necessary for prostaglandin synthesis, in palate mesenchyme cells from mouse strains differing in susceptibility to cleft palate induced by glucocorticoids. Cultured palate mesenchyme cells from the glucocorticoid-sensitive A/J strain and the less sensitive C57BL/6J strain at comparable develop- mental stages were exposed to 10-6 M dexamethasone. Phospholipase activity of the cells was determined by a chromatographic technique involving the release of radiolabeled fatty acids from prelabeled phospholipids. Dexamethasone significantly inhibited phospholipase activity in cells of the susceptible
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