Biomedical subjects

G Semb

Publications and source records attributed to G Semb.

At least 19 recordsLinked to original sources

PubMed2002

A cephalometric inter-centre comparison of growth in children with cleft lip and palate.

AIM: To examine whether the treatment provided by the Mount Vernon Cleft Team produces craniofacial growth outcomes comparable with that of the Oslo Team. LOCATION: Mount Vernon Hospital, Middlesex, UK. DESIGN: A retrospective cephalometric investigation. SUBJECTS: Seventy-five Mount Vernon children and 150 Oslo children with complete unilateral or bilateral clefts of the lip and palate METHOD: The subjects were matched for age, gender, and cleft type, and their radiographs were digitized. The radiographs from each site were grouped according to patient age (9-11 or 14-16) and cleft classification (bilateral/unilateral). Patients with associated craniofacial anomalies were excluded from the study. RESULTS: Of the four variables studied (SNA, SNPg, NGn, sNANsPG) significant differences in maxillary growth were noted for bilateral and unilateral cleft groups at 14-16 years of age. The soft tissue profile was significantly flatter in bilateral and unilateral Mount Vernon cases at 14-16 years. The craniofacial growth exhibited by the Mount Vernon patients demonstrated 3.9-5.1 degrees reduction in maxillary prominence with respect to the Oslo sample. The bilateral cases from Mount Vernon had greater anterior face heights at 14-16 years. CONCLUSION: The treatment provided by the Mount Vernon Cleft team leads to a reduced maxillary prominence in children aged 14-16 years compared with the Oslo sample. This reduction is statistically significant in unilateral cleft lip and palate.

Adolescent↗

PubMed2001

The Eurocleft project 1996-2000: overview.

INTRODUCTION: The original Eurocleft project, a European intercentre comparison study, revealed dramatic differences in outcome, which were a powerful stimulus for improvement in the services of respective teams. The study developed a preliminary methodology to compare practices and the potential for wider European collaboration including opportunities for the promotion of clinical trials and intercentre comparison was recognized by the European Commission. Therefore, the project: 'Standards of Care for Cleft Lip and Palate in Europe: Eurocleft' ran between 1996 and 2000 and aimed to promote a broad uplift in the quality of care and research in the area of cleft lip and palate. RESULTS: The results of the 1996-2000 project include: a register of services in Europe, with details of professionals and teams involved in cleft care, service organization, clinical protocols and special facilities for research; a set of common Policy Statements governing clinical practice for European cleft teams, Practice Guidelines describing minimum recommendations for care that all European children with clefts should be entitled to and recommendations for Documentation governing minimum records that cleft teams should maintain; encouraging initial efforts to compare outcomes (results) of care between centres. A survey showed a wide diversity in models of care and national policies as well as clinical practices in Europe. Of the 201 centres that registered with the network, the survey showed 194 different protocols being followed for only unilateral clefts. CONCLUSION: Cleft services, treatment and research have undoubtedly suffered from haphazard development across Europe. Attainment of even minimum standards of care remains a major challenge in some communities and both the will to reform and a basic strategy to follow are overdue. It is hoped that the Eurocleft Consensus Recommendations reached during the present project will assist in improving the opportunities for tomorrow's patients. It is also hoped that the collaborative research now beginning under the European Commission's Framework V Programme will provide a focus for European researchers wishing to improve understanding, treatment and prevention of clefts of the lip, alveolus and palate in the years ahead.

Child↗

PubMed2001

Outcomes of cleft care in Western Australia: a pilot study.

The purpose of this study was to compare outcomes and delivery of cleft care in Western Australia with the average standard of care in the United Kingdom (UK). This was achieved through a cross-sectional study involving children born with unilateral cleft lip and palate between April 1983 and March 1985 (12 year olds) or between April 1990 and March 1992 (5 year olds). A total of 38 children born with unilateral cleft lip and palate were under the care of the cleft team based at Perth's Princess Margaret Hospital. Dental arch relations, facial skeletal pattern, speech, hearing, success of alveolar bone grafting and dental health were measured. It was found that fewer Princess Margaret Hospital children in both age cohorts had revision surgery and speech therapy compared with the UK average. The facial skeletal pattern, speech, hearing and alveolar bone grafting outcomes from Princess Margaret Hospital were similar to the UK at age 12. Seventeen per cent of the Princess Margaret Hospital 12 year olds had a poor dental arch relationship compared with 39 per cent in the UK. In the 5 year olds, most outcomes in Princess Margaret Hospital patients appeared better than the UK with lower residual treatment needs. While it is difficult to draw firm conclusions because of the small numbers involved, this study indicates standards need to be set and determined for Australia.

Bone Transplantation↗

PubMed2001

The prevalence of anomalies of the upper cervical vertebrae in subjects with cleft lip, cleft palate, or both.

OBJECTIVE: The purpose of this study was to examine the prevalence of cervical vertebral anomalies in individuals with cleft palate only (CPO) and bilateral (BCLP) and unilateral (UCLP) complete cleft lip and palate and make a comparison with a group without cleft. SETTING: This retrospective comparison was performed at the Dental Unit, Department of Plastic Surgery, National Hospital and at the Department of Orthodontics, Faculty of Dentistry, University of Oslo, Oslo, Norway. MATERIAL AND METHODS: Six hundred eleven subjects (334 boys, 277 girls) with three different cleft subtypes at age 6 years or older and 264 children (121 boys, 143 girls) without clefts were included in this study. Their lateral cephalometric radiographs were studied for cervical vertebral anomalies and categorized into posterior arch deficiencies or fusions. RESULTS: In the total cleft sample, 111 subjects (18.2%) had cervical vertebral anomalies; of these, 10 subjects had more than one anomaly. Posterior arch deficiency was found in 7.7% and fusions in 12.1%. In the sample without cleft, 9.1% had cervical vertebral anomalies, 5% posterior arch deficiency, and 4.1% fusions. When the cleft sample was divided into the three cleft subtypes, the prevalence of cervical vertebral anomalies was 25.6% in the CPO group, 16.3% in the BCLP group, and 11.1% in the UCLP group. Differences were statistically significant between the CPO and the group without cleft for both posterior arch deficiency and fusion anomalies (p <.01). CONCLUSION: Cervical vertebral anomalies occur more frequently in individuals with clefts as compared with those without clefts. This was statistically significant for the CPO group.

Atlanto-Occipital Joint↗

PubMed1999

The influence of alveolar bone grafting on the orthodontic and prosthodontic treatment of patients with cleft lip and palate.

The introduction of mixed dentition bone grafting of alveolar clefts means that the alveolar process can be fully restored, permitting adjacent teeth to migrate or be orthodontically moved into the grafted bone. Thus a complete dental arch can be obtained without prosthodontics in the great majority of patients. In addition, oral-nasal fistulae are closed, mucosal recesses eliminated (facilitating oral hygiene) and the long-term periodontal health of the teeth adjacent to the former cleft is improved. Alveolar bone grafting with subsequent orthodontic treatment, together with advances in dental materials, have contributed substantially to the care of patients with alveolar clefts, reducing the need for prosthodontic procedures and allowing completion of the dental treatment at an earlier age.

Alveolar Ridge Augmentation↗

PubMed1999

Asymmetry of left versus right unilateral cleft impairments: an experimental study of face perception.

OBJECTIVE: Previous psychosocial studies of adults born with cleft lip and palate have provided circumstantial evidence that surgically repaired right-sided unilateral clefts may be more disfiguring than left-sided clefts. The present study asked if such asymmetries are physiognomic asymmetries or arise "in the eye of the beholder," representing perceptual processes in face recognition. DESIGN: Color slides of 160 children (6 years of age) and young teenagers (16 years of age) were rated by subjects for perceived disfigurement. Sixty of the subjects had unilateral complete cleft lip and palate (30 had a right-sided cleft and 30 had a left-sided cleft), 60 had unilateral cleft lip/alveolus (30 right-sided and 30 left-sided clefts), 32 children had bilateral cleft lip and palate, and 8 children had cleft palate only. Faces were shown in normal and in mirror-reversed versions; the order in which faces were shown was randomized, as were other stimulus factors such as cleft type, age, and gender. SETTING: The study was conducted as a classroom-type experiment at the Vision Laboratory, Department of Psychology, Oslo, Norway. PARTICIPANTS: Thirty-seven students of psychology at the University of Oslo, who were ignorant of the purpose of the study, acted as subjects. MAIN OUTCOME MEASURE: Subjects rated perceived disfigurement using a visual analog scale. RESULTS: Modest but highly consistent hemifacial asymmetries in judged disfigurement were found, with left-sided unilateral clefts rated as less disfiguring than right-sided unilateral clefts. Unilateral clefts were judged as being less disfiguring than the bilateral clefts, and cleft lip/alveolus was judged as being less disfiguring than cleft lip and palate. The patterns of facial judgments were almost identical in the normal and reversed-slides conditions. CONCLUSIONS: Asymmetries between left- and right-sided clefts reside in physiognomic factors rather than in hemispheric asymmetries controlling the perceptual process of face judgment.

Adolescent↗

PubMed1998

Facial growth after different methods of surgical intervention in patients with cleft lip and palate.

Studies of the influence of surgery on facial growth in cleft lip and palate must take into account inherent variations in craniofacial form independent of surgery. Primary surgery, the most important iatrogenic influence on facial form, can differ in technique, timing, and sequence, and one of the major challenges in researching the topic is the remarkably varied clinical protocols in current use. Unfortunately, systematic attempts to compare dentofacial outcomes reported in the literature are unlikely to be reliable, as methodologic biases cannot be overcome. Rigorous intercenter studies can improve the dependability of data and provide evidence of the success of cleft services as a whole, but they are still subject to biases introduced by differences in surgical skills and underlying craniofacial form. These shortcomings are finally being overcome through multicenter randomized control trials.

Adolescent↗

PubMed1998

Early detection of differences in surgical outcome for cleft lip and palate.

This study examined the dento-alveolar relationships of 5-year-old children born with a unilateral cleft lip and palate with primary surgical repair performed in one of two centres (Bristol or Oslo). The Bristol sample comprised 46 sets of study models and the Oslo CLP Growth Archive provided 54 cases with a very similar sex distribution. We used a recently developed 5-year-old index to measure differences in outcome between the two centres. The Oslo sample were assessed as having up to 57 per cent in the ideal groupings (1 and 2), in the Bristol group this was only 35 per cent. Bristol had up to 46 per cent of cases assessed in the worst groups (4 and 5). The comparative figure from the Oslo group was 15 per cent. These results suggest that it is possible to detect differences in surgical outcome at 5 years of age.

Age Factors↗

PubMed1998

Craniofacial morphology in adult patients with unoperated complete bilateral cleft lip and palate.

OBJECTIVE: This report is a retrospective study that compares the craniofacial morphology of adult subjects with unoperated bilateral complete cleft lip and palate (BCLP) with that of a noncleft group. METHODS: The study was performed on standardized lateral cephalograms obtained at the Hospital for Research and Rehabilitation of Cleft Lip and Palate, University of São Paulo, Brazil. The research group consisted of 28 subjects (20 males, 8 females) with unoperated BCLP, ranging in age from 15 to 41 years. The control group was matched to the cleft group with regard to gender and age. The findings were analyzed on the basis of the two-way analysis of variance (ANOVA) for cleft and gender. RESULTS: The most striking difference between the groups was the extremely prominent premaxilla in the cleft group that gave the BCLP face a very convex profile. The mandible exhibited a vertical growth pattern that resulted in a steep mandibular plane, an obtuse gonial angle and a long lower face height. The posterior face height was reduced. The cranial base dimensions were smaller, but there was no difference in cranial base angulation. CONCLUSIONS: These findings confirm that in subjects with unoperated BCLP, the initial characteristics of the cleft malformation persist during growth.

Adolescent↗

PubMed1997

A new index for assessing surgical outcome in unilateral cleft lip and palate subjects aged five: reproducibility and validity.

OBJECTIVE: This study assessed the reproducibility, reliability, and predictive validity of a previously developed index by the authors for assessing surgical outcome in unilateral cleft lip and palate (UCLP) children aged 5. METHODS: Sixty randomly selected study models of 5- to 6-year-old complete UCLP subjects were obtained and the index was used to assess their surgical outcomes. RESULTS: Assessment of these study models using the new index demonstrated excellent intra-examiner agreement. The inter-examiner agreement was shown to be good. The corresponding longitudinal models at 16 to 18 years of 54 of the initial 5- to 6-year-old sample were also acquired. These subjects had undergone orthodontic treatment but not orthognathic surgery. The need for osteotomy amongst these models was assessed. Between 13% and 18% (depending on examiner) of 5-year-olds' models were scored in the groups likely to require orthognathic surgery. In the corresponding 16- to 18-year-olds' models, 9% were assessed as likely to benefit from an osteotomy. However, on an individual basis, it was not possible to predict future growth from study models at age 5. CONCLUSIONS: This study has provided a reliable and reproducible index for assessing the outcome of surgery in UCLP subjects earlier than indices already available. True validation of the index was not possible but it appears that it relies on face validity.

Adolescent↗

PubMed1996

[Long term results of the use of Björk-Shiley convex-concave heart valves. Ullevol hospital 1978-83].

In recent years, Björk-Shiley CC-valves have become the object of suspicion after several reports of strut fracture with embolization of the tilting disk and acute heart failure. At Ullevål Hospital Björk-Shiley CC-valves were used in 341 patients during the period October 1978 to March 1983. Strut fracture occurred in four cases, three of the patients died and one survived an emergency heart operation with replacement of the valve. In four patients, prophylactic replacement of the valves was performed. During the observation period concluded in September 1995 a total of 187 patients died. These included 26 operative deaths (7.6%). Of the late deaths, 40% were due to heart failure and 21% were sudden deaths. Strut fracture was the cause of death in 2% of the late deaths.

Aortic Valve↗

PubMed1996

Facial growth in patients with unilateral clefts of the lip and palate: a two-center study.

Two groups of 10-year-old patients with complete unilateral clefts of the lip and palate were examined in this study. Two centers; Bristol, U.K. and Oslo, Norway, who had different treatment regimens were used. The groups comprised 40 patients from Oslo and 32 from Bristol. The groups were matched, in proportion to the size of the groups, for age, sex, and presence of Simonart's bands. In Oslo, a Millard lip repaired was performed at 3 months of age with a von Langenbeck palatal repair at 18 months, no presurgical orthopedics was employed and there was no primary nasal correction. The Bristol center also repaired the lip at 3 months with a Millard type repair but also performed a radical nasal correction at the same time. The palate was repaired at 6 months with a Veau repair, and presurgical orthopedics using a pinned arch orthopedic plate was carried out. In addition, the volume of primary repairs per surgeon was much higher in Oslo, and a much stricter treatment protocol was used compared with Bristol. Lateral cephalograms obtained within 1 year of the child's tenth birthday were digitized, and the craniofacial morphology of the two groups was compared. Significant differences in maxillary growth and soft tissue profile were noted with a much more retruded mid-face and flatter nasiolabial angle in the Bristol group. The main factors for the better results in Oslo are suggested to be the absence of presurgical orthopedics, no radical nasal correction, the high volume of operations performed per surgeon, and the stricter protocol.

Age Factors↗

PubMed1994

Reduced complement and granulocyte activation with heparin-coated cardiopulmonary bypass.

Plasma concentrations of the complement activation products C3b, iC3b, and C3c; the terminal C5b-9 complement complex; and the granulocyte proteins calprotectin, myeloperoxidase, and lactoferrin were assessed in two groups of patients undergoing aortocoronary bypass procedures. In 10 patients operated on, the bypass circuits were coated by the Carmeda Bio-Active Surface and systemic heparinization was reduced to 1.5 mg/kg; in another 10, the systems were uncoated and the dosage of systemic heparinization was 4 mg/kg. In both groups, significant complement activation was observed after the onset of cardiopulmonary bypass, but the maximum levels of C3b, iC3b, and C3c and the terminal C5b-9 complement complex were significantly lower in the heparin-coated group. In both groups, a significant increase in calprotectin, myeloperoxidase, and lactoferrin release was observed by the end of operation. The maximum myeloperoxidase levels were significantly lower in the heparin-coated group than those in the uncoated group (p = 0.03). There was a correlation of borderline significance between the formation of terminal C5b-9 complement complex and lactoferrin release, as well as between the formation of terminal C5b-9 complement complex and myeloperoxidase release (p = 0.05). The postoperative blood loss did not differ significantly between the two groups. We conclude that coating by end point-attached and functionally active heparin allows a significant reduction in the amount of systemic heparinization, and significantly reduces complement and granulocyte activation.

Aged↗

PubMed1994

Prevalence of a soft tissue bridge in a sample of 2014 patients with complete unilateral clefts of the lip and palate.

This study examines the prevalence of a soft tissue bridge (Simonart's band) on 2014 Brazilian Caucasian patients with unilateral complete cleft lip and palate (UCLP). A soft tissue bridge occurred in 19.6% of the subjects; 94.9% of the soft tissue bands had skin coverage. The presence of soft tissue bridges was unrelated to gender and the laterality of the cleft.

Adolescent↗

PubMed1994

Dentofacial form in the five-year-old child with unilateral cleft lip and palate.

It is generally believed that studies of outcome for children with clefts of the lip and palate should be based on patients who are in their teens. This means that health care workers who look after these children would have to wait many years until the quality of treatment could be evaluated. In this study, significant differences between two centers, Oslo and Manchester, in facial form at the age of 5 years were detected. Based on cephalometric analysis, children from Manchester were more likely to have a retrognathic maxilla with the upper lip significantly behind the esthetic plane. An important future step may be the setting up of "reference centers" with a large archive of database information for each racial group. This would assist smaller centers in comparing their outcomes.

Age Factors↗

PubMed1993

A six-center international study of treatment outcome in patients with clefts of the lip and palate: evaluation of maxillary asymmetry.

This investigation was carried out by the European Cleft Lip and Palate Research Group. The purpose of this part of the investigation was to compare and evaluate maxillary asymmetry in children born with complete unilateral cleft lip and palate treated at cleft palate centers with different surgical management. Posteroanterior radiographs from three of the six participating centers were included in the investigation. Statistically significant differences were found in the symmetry of the anterior part of the maxillary complex. Children with a primary bonegrafting procedure involved in their primary treatment procedure had a more symmetric dentoalveolar development. Children from centers with primary surgical procedures including a vomer plasty and no involvement of the alveolar process had a more asymmetric development with a tilted premaxilla and a deviating inclination of the central incisors.

Analysis of Variance↗

PubMed1993

Lip and nose morphology in patients with unilateral cleft lip and palate from four Scandinavian centres.

Sixty patients with unilateral cleft lip and palate were compared for lip and nose appearance. All patients were photographed from an anteroposterior and a basal view at 7-10 years of age. The photographic registration method was tested for validity and accuracy. Although the four groups of 15 patients each were treated according to different protocols, many similarities were found with shorter lip heights at the cleft side and inclination of the rima oris. Asymmetry of nose and retropositioning at the cleft side naris were generally seen. Significantly straighter noses were demonstrated in the group treated with a two-stage lip nose operation combined with nose plugs, and the two groups where vomer flaps were used showed the greatest deviation of the nose.

Child↗

PubMed1993

A multicentre comparison of treatment regimens for unilateral cleft lip and palate using a multiple regression model.

The European Cleft Lip and Palate Research Group consists of specialists in orthodontics from six centres for the treatment of cleft palate in northern Europe. The purpose of this part of the multicentre study was to investigate whether differences in outcomes could be explained by specific treatment regimens. Three regimens that were assumed to influence the outcome of treatment were selected: Presurgical orthopaedics, closure of the palate, and primary bone grafting. The sample comprised 151 children with complete unilateral cleft lip and palate from the six centres. The result of multiple regression analysis showed that within that sample it was not possible to reach definite conclusions as to which factors exerted the most favourable influence on facial growth, but primary bone grafting was associated with reduced maxillary inclination and presurgical orthopedics with increased mandibular inclination.

Bone Transplantation↗