Letter to the Editor Dear Dr. McWilliams: May 12, 1977 - In response to Dr. Rood's "Letter to the Editor" appearing in the July, 1977 edition of The Cleft Palate Journal regarding our article "The Morphology of Musculus Uvulae," which appeared in the January, 1977 The Cleft Palate Journal, we would like to emphasize that in attempting to flatten the soft palate for histological sectioning, some curvature remained since the tissue was already embalmed prior to flattening, we stated that serial sections were cut. The section in Figure 3 was taken from the most superior portion of musculus uvulae and shows horizontally cut muscle fibers. The sections shown in Figures 4 and 5 were taken from inferior portions. Therefore, the muscle fi- bers were cut more obliquely and some even in cross section due to the curvature relative to that portion shown in Figure 3. The photomicrographs were selected from over eight hundred serial sections in order to illustrate the points discussed in the paper. We strongly disagree with Dr. Rood regarding the quality of the photomicrographs. We believe that the printing process of The Cleft Palate Journal did reproduce the photomicrographs exactly as submitted. All the photomicrographs were indeed of superior quality. Sincerely, Nabil A. Azzam, Ph.D. Professor of Anatomy David P. Kuehn, Ph.D. Research Scientist University of Iowa Hospitals and Clinics Department of Otolaryngology and Maxillofacial Surgery The University of Iowa Iowa City, Iowa 52242 331 Book Review BoonrE, DANIEL R., The Voice and Voice Therapy (2nd ed.) Englewood Cliffs: Prentice Hall, Inc., 1977, 250 pages, $10.95. | Dr. Boone possesses a skill so many writers in the clinical sciences seem to lack: the ability to synthesize both classic and current research data into a solid framework for approaches to therapy.' Speech physiologists will be pleased to see that the therapeutic techniques presented in this book are based on more than introspection. And clinicians will be pleased that "Approaches to Voice Therapy" begins on page 1 instead of being confined to the last five pages preceding the bibliography. Since my own experience in voice disorders is limited, I restricted my "critical" reviewing to the one area in which I had some expertise -that on therapy for resonance disorders. The information presented in this chapter is admirably complete and current, although I know of no evidence to substantiate the statement that "a thin layer of mucosal tissue (over a bony palatal defect) may not be "thick enough to prevent oral cavity sound waves from traveling into the nasal cavity." . Dr. Boone covers the spectrum in this book, both in terms of the types of disorders discussed and the indispensable information the clinician must have in hand to be a competent diagnostician and therapist. He has, in short, accomplished his stated goal- " . to take some of the magic out of voice therapy." But a comment to Prentice Hall: That jacket cover is enough to precipitate diplopia, acute nervous tension, or both. EaRLENE TasH PayNTER, PH.D. 2108 65th Street Lubbock, texas 79412 ! Not to be faulted for omission of recent data (Monoson, P. K., A Quantitative Study of Whisper, un- from laryngeal photography indicating that the vocal published doctoral dissertation, University of Illinois, folds do not, in fact, approximate at any point along 1976.) their length during production of quiet whisper. - _ 332 ABSTRACTS Bard Cosman, M.D., Editor National Committee Oscar E. Beder, D.D.S. John B. Gregg, M.D. Jay W. Lerman, Ph.D. William Cooper, M.D. Jerry Alan Greene, D.V.M. Joseph Luban, D.D.S. Stephen Glaser, M.D. Norman J. Lass, Ph.D. Dennis 0. Overman, Ph.D. International Committee Paul Fogh-Andersen, M.D. Francesco Minervini, M.D. H. Reichert, M.D. Copenhagen, Denmark Rome, Italy Stuttgart, Germany Jean L. Grignon, M.D. Nevilly, France Seiichi Ohmori, M.D. W. H. Reid, M.D. Tokyo, Japan Glasgow., Scotland Jose Guerrero-Santos, M.D. Guadalajara City, Mexico Anthony D. Pelly, M.D. E. Schmid, M.D. Stewart B. Heddle, M.D. Sydney, Australia Stuttgart, West Germany Burlington, Ontario, Canada Junji Machida, D.D.S. Helena Peskova, M.D. Jean Claude Talmant, M.D. Shiojiri City, Japan Prague, Czechoslovakia Nantes, France ALTONEN, M., Structures of the midface on cylindri- evaluate the blood flow in the segment. Xenon-133 cal pantomograms, J. Maxillofacial Surg., 4, 171- was used as a radioactive indicator to measure local 177, 1976. blood flow. Removal of the indicator was taken as an A detailed study of the anatomical structures of the indication of circulatory function. The labial and pal- middle third of the face visualized in cylindrical pan- atal blood flow appeared not to be decreased in the anterior maxillary segment as measured by this tomograms and details of positioning and interpreta- tion are presented. (Cosman) means. (Cosman) CoTTon, R. T. and QUATTROMANI, F., Lateral defects Brromann, H., HaAvLIK, E., HorrE®, R., JESCH, W., in velopharyngeal insufficiency, Arch. Otolaryng., and WunpErRER, S., Labial and palatal blood flow 103, 90-93, 1977. measurement before and after maxillary opera- This is a study to evaluate pharyngeal closure tions, J. Maxillofacial Surg., 4, 102-106, 1976. assessing lateral pharyngeal wall mobility utilizing the Eleven patients who underwent the operation of Towne view to better demonstrate lateral defects. Wunderer for severe maxillary prognathism were Because it is perpendicular to the velopharyngeal studied. This procedure involves section of the palate sphincter, this view shows a purse string action. The in the pre-molar level with severance of the palatine authors have assessed pharyngeal closure in 40 con- arteries such that the anterior maxillary segment re- secutive patients. They feel that adequate preopera- ceives its blood flow primarily through the mucoper- tive evaluation of all components of the sphincteric iostal pedicle of the labial maxillary mucous mem- action with mapping of residual velopharyngeal de- branes. While clinically necrosis and loss of teeth has fect should help plan for more adequate pharyngeal never been observed, this study was undertaken to flap surgery. (Gregg) 333 334 Cleft Palate Journal, October 1977, Vol. 14 No. 4 Coury, G., HurEaw, J., and TrssiErR, P., The anat- transposed backwards to close maxillary fistulae in omy of the external palpebral ligament in man, J. the region of the incisive foramen. Five cases were so Maxillofacial Surg., 4, 195-197, 1976. treated of which four flaps survived and one became necrotic medially. (Cosman) Many procedures in the cramo-facial area involve the detachment and reattachment of the lateral or external palpebral ligament. Knowledge of its anat- FirzraTRIcKk, B. N., Multiple and total mandibular omy in these procedures as well as in congenital alveolar osteotomy, J. Maxillofacial Surg., 4, 206- defects is important and therefore a discussion of the 210, 1976. normal anatomy is presented. (Cosman) Procedures in the restoration of good occlusion in a number of mandibular jaw deformities are pre- DirEwrERT, V. M., Graphic reconstructions of crani- sented. Alveolar osteotomies show less tendency to ofacial structures during secondary palate develop- relapse than mandibular osteotomies. The use and ment in rats, Teratology, 14, 291-314, 1976. advantage of metal cap splints is considered in the The determination of the role of differential treatment of multiple and total segmental osteoto- growth in normal and abnormal development of the mies of the mandibular alveolus. (Cosman) palate is difficult because of the complex three-di- mensional changes in craniofacial structure. The FREIHOFER, J. P., Jr., The lip profile after correction usual method of studying palate development, the of retromaxillism in cleft and non-cleft patients, J. analysis of coronal sections, allows for little apprecia- Maxillofacial Surg., 4, 136-140, 1976. tion of the three-dimensional structure of developing heads and the differences between them. The author Twenty-five cases of unilateral cleft of the lip, al- describes a technique for the production of lateral veolus and palate with retromaxillism and 25 cases and ventral reconstructions of craniofacial anatomy with pure retromaxillism were studied following ad- in rat fetuses. Accurate sections of heads in the sagit- vancement of the maxilla by a Le Fort I osteotomy. In tal and coronal planes at four stages of secondary general, the base of the upper lip followed the base of palate development were used for mapping the man- the maxilla in a ratio of four to seven, and the free dible, tongue, Meckel's cartilage, palatal processes, end of the upper lip was pushed forward by the front oral cavity, and the bases of the maxillary and man- teeth in a ratio of five to nine. This suggests that to dibular molar dental laminae. Tracings of the heads achieve a specified lip advancement the maxilla has to at different stages were superimposed using accurate be brought forward about double the amount. There anatomical markers to produce the reconstructions. was, however, considerable spread in the measure- Study of the reconstructions indicated that a number ments and therefore considerable uncertainty in the of key relations, such as the position of the tongue actual degree of movement necessary to achieve an and Meckel's cartilage relative to the primary palate appropriate correction in terms of pre-operative and the medial palatine process, the development of planning. (Cosman) the lateral palatine processes and their relationship to the tongue, and the relationship of growth changes in HARING, F. N., Dental development in cleft and non- various dimensions are all involved, indicating once cleft subjects, Angle Orthod., 46, 47-50, 1976. again that it is misleading to attribute palatal closure Serial dental analyses were undertaken for ten chil- primarily to one factor. The graphic reconstruction dren with bilateral complete and eight with unilateral technique itself promises to be useful in evaluating complete cleft lips and palates.