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Biomedical subjects

J Lilja

Publications and source records attributed to J Lilja.

At least 37 records · Page 2Linked to original sources
PubMed1994

Pre-speech in children with cleft lip and palate or cleft palate only: phonetic analysis related to morphologic and functional factors.

Pre-speech in 35 children with clefts of the lip and palate or palate only were analyzed for place and manner of articulation. Transcriptions were made from tape recorded babbling sequences. Two children without clefts were used as reference. All of the children with clefts were treated according to a regimen of early surgical repair of the velum cleft and delayed closure of the cleft in the hard palate. The frequency of selected phonetic features was calculated. Correlations between phonetic/perceptual and functional and morphological factors were tested. Supraglottal articulation dominated among all the children indicating a sufficient velopharyngeal mechanism. The results also showed correlations between cleft type and place of articulation. Anteriorly placed sounds (i.e., bilabial, dental, and alveolar sounds) occurred frequently among the children with cleft palate only and in the noncleft children. In children with cleft lip and palate, posteriorly placed articulations predominated. It was postulated that early intervention may have a positive effect on articulatory development.

Age Factors↗
PubMed1994

Dentofacial morphology in adolescent or early adult patients with cleft lip and palate after a treatment regimen that included vomer flap surgery and pushback palatal repair.

Dentofacial morphology was evaluated in 94 adolescent or early adult patients born with unilateral or bilateral cleft lip and palate. As well as lip closure, the primary treatment included vomer flap surgery and pushback palatal repair. Roentgencephalometric measurements as well as classification of the patients into different classes of dentofacial deformity indicated development of bimaxillary retrognathia with severe midfacial deficiency in about a quarter of the cases. Our results were similar to those reported by other teams who used similar surgical regimen.

Adolescent↗
PubMed1994

Social pharmacology: unresolved critical issues.

This article describes and analyzes decision-making by patients, physicians, and drug information providers about registered medical drugs. Based on a cognitive psychology perspective, cognitive variables (the individual's mediating system) are assumed to be critical factors determining both patient and physician behavior. The individual's psychological functioning is seen as a continuous reciprocal interaction between behavioral, cognitive, and environmental influences; i.e., an interactional paradigm is applied. The importance of research models including cognitive and situation variables to guide the search for appropriate research methods is stressed. An intensive research strategy with a small sample of respondents will often be necessary. Also, respondents should be asked to describe their reactions to specific medical situations. The drug information sender has to select a set of goals for disseminating information to patients. Among the goals most often selected are: message comprehension, receiver satisfaction, changes in knowledge, attitudes, and drug behavior, as well as health effects. More research is needed on how the patient's mediating system, the actual situation, and the perceived situation steer his search for the use of new drug information. A different set of factors influence the patient's decision to start a medicinal or drug treatment than the factors that influence his decision to continue a treatment. The latter factors include forgetfulness, misunderstandings, and the patient's interpretation of physiological signs. More cognitive-oriented research about drug compliance must be undertaken. In such studies the mediating systems of a group of patients could be considered before and after intervention. There are a great number of types of inappropriate (irrational) prescribing. However, a physician may prescribe rationally in one area but irrationally in another. Face-to-face education of physicians has been shown to be effective in reducing inappropriate prescribing in a number of studies. "Overprescribing" of benzodiazepine has been an issue of intensive professional debate during the last decades. The two groups who criticize and defend the existing use of benzodiazepines build their views on different assumptions about the interaction between mind and brain as well as making different value assumptions regarding the use of a psychotropic drug. There is a need for prescription studies where a cognitive and interactional perspective is combined with an information-processing and a normative perspective. The benzodiazepines dependency problem has provoked lively discussion among professionals and the general public. Long-term benzodiazepine use and personality disorders increase the risk of the patient becoming dependent. A great number of research models have been suggested for the analysis of prescription drug dependency and as guides to the treatment of dependency.(ABSTRACT TRUNCATED AT 400 WORDS)

Benzodiazepines↗
PubMed1994

The appointment-keeping habits of managed care patients.

Among the controversies surrounding the provision of health care in a managed care environment is the belief that patients, because they have no particular allegiance to a single physician, are more casual in regard to their keeping appointments. To test this proposition, the authors conducted a study at a California independent practice association, comparing the habits of managed care patients with those of other types of patients. The findings, although based on a limited sample, suggest that managed care patients do indeed have a greater tendency to be appointment no-shows.

Appointments and Schedules↗
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

Surgical treatment of cleft palate. 27 years' experience of the Wardill-Kilner technique.

During the period 1958-1985, 230 patients with cleft palate were operated on in the Department of Plastic Surgery, University of Göteborg, Sweden. A modified push-back technique according to Wardill and Kilner was used. The children were operated on at a mean age of 13 months. They were divided into two groups, the first in which the cleft affected the velum only (n = 121) and the other in which it also affected the hard palate (n = 109). Postoperative dehiscences and fistulas occurred in 19 (8%) patients, of which 16 (15%) belonged to the group in which the cleft affected the hard palate. Only three (2%) of the 121 patients with a cleft in the soft palate only developed dehiscences. The total number of patients who had to be reoperated on because of dehiscences were 10 (4%) and palatopharyngeal flaps had to be performed in 25 patients (11%) because of speech problems.

Child↗
PubMed1993

Maxillary dental arch and occlusion in patients with repaired clefts of the secondary palate. Influence of push back palatal surgery.

Maxillary morphology and dental occlusion were studied from infancy to age 10 years in 32 patients born with isolated cleft palate. Wardill-Kilner push back repair of the palate had been done at a mean age of 7.5 months. Measurements obtained from casts of the jaws showed that the average maxillary dimensions before as well as after operation were less than those reported for children without clefts. The mean reduction was similar whether the cleft reached into the hard palate or affected the soft palate only. Preoperative anterior maxillary arch width in particular, and also distance from scar line to selected teeth seemed to influence postoperative development of the maxillary dental arch in individual patients.

Cleft Palate↗
PubMed1993

Assessment of speech in children after repair of isolated cleft palate.

The speech of 31 consecutive patients with isolated cleft palate was evaluated when they were between 10 and 14 years of age. All the children had Wardill-Kilner push-back repairs at a mean age of 7.9 months. Several speech variables were assessed by two trained listeners. In addition, an overall evaluation of the quality of the patients' speech was made by the listeners and by the patients themselves. The patients had some remaining speech problems, mainly hypernasality which was moderate or severe in 7 (23%). The prevalence of compensatory articulations was low, however (n = 4, 13%), and most patients thought that their own speech was normal or relatively normal.

Adolescent↗
PubMed1991

Craniofacial and occlusal characteristics in unilateral cleft lip and palate patients from four Scandinavian centres.

Craniofacial morphology and dental occlusion were studied at early school age in 15 consecutive patients with unilateral cleft lip and palate from each of four Scandinavian cleft centres. Treatment differed mainly in the techniques of palatal repair. Push-back closure of the palate particularly impaired maxillary development, which resulted in an increased incidence of crossbite and reduced intercanine distance when compared with patients who had been operated on by the von Langenbeck method or in whom the anterior palate had not yet been closed.

Cephalometry↗
PubMed1991

Repositioning of craniofacial tumorous bone after autoclaving.

Thirteen bone tumours that were invading the craniofacial skeleton were operated on by intracranial procedures. The resected tumorous bone was autoclaved and put back. Follow up of no less than one year included 122mTc scanning, computed tomography, radiography, bone biopsy and clinical examination. In every case, when rigidly fixed, most of the autoclaved bone was gradually revitalised by invading new and normal bone. We conclude that autoclaved bone will be replaced by normal bone, and that the present technique is justified for reconstruction of complicated structures or large areas of bone after operations for tumours invading the craniofacial skeleton.

Adolescent↗
PubMed1990

Trigonocephaly: clinical and cephalometric assessment of craniofacial morphology in operated and nontreated patients.

Craniofacial parameters were studied clinically and by cephalometry in 11 trigonocephalic patients from infancy to 4 years of age. Six of the most severe patients had surgery between 6 and 18 months of age. Analysis of morphology indicated that bony interorbital distance was reduced in patients selected for surgery and hypotelorism persisted at final examination. All patients demonstrated orbital width measurements above the mean for the norm, while orbital height was essentially normal. All but one of the patients had a variably prominent forehead bony ridge that was eliminated or reduced as a result of surgery and/or growth. However, the forehead of most patients, whether operated or not, was too narrow when compared to normal skulls. Thus, although some of the striking features of trigonocephaly are eliminated, minor characteristics of the anomaly still persevere at 4 years of age.

Cephalometry↗
PubMed1990

Posterior repositioning of the entire maxilla without postoperative intermaxillary fixation. A clinical and cephalometric study.

In 30 patients posterior repositioning of the entire maxilla has been performed. No postoperative intermaxillary fixation (IMF) has been applied. The surgical procedure is described and data given on the distance of repositioning. Results of cephalometric analysis indicate good long-term stability after surgery. We concluded that omitting IMF not only enhances patient comfort, but has no deleterious effect on postoperative stability of the maxilla.

Adolescent↗
PubMed1990

Cleft lip and palate patients prior to delayed closure of the hard palate: evaluation of maxillary morphology and the effect of early stimulation on pre-school speech.

Speech and maxillary development were analysed in two groups of patients with unilateral cleft lip and palate; both groups had early jaw orthopaedic treatment and a surgical regimen that included two-stage lip surgery (mean ages of 2 and 19 months) and soft palate repair (8 months). Closure of the hard palate was postponed until the children were 8 to 10 years of age. The first group comprised 10 consecutive patients who were analysed at 5 and 7 years of age, and the second group seven patients who were studied at the age of 5. Both groups were thus investigated before the repair of the cleft in the hard palate. In addition to surgical and jaw orthopaedic treatment, the second group of patients received early stimulation of lip and tongue tip movements. Our results indicated that hypernasality was less a problem than was retracted palatal or velar articulation of dental consonants. These deviations tended to be reduced, however, after early stimulation. There seemed to be no clear association between the size of the residual cleft in the hard palate and the extent of speech development. The average size of the residual cleft in our patients was comparatively small, and decreased further during follow up. We conclude that preschool children with unilateral cleft lip and palate may develop good speech, in spite of the residual cleft, if they use an intraoral plate and are given extra lip and tongue tip stimulation, together with early speech therapy if necessary.

Child↗
PubMed1989

Sagittal split osteotomy of the mandible without postoperative intermaxillary fixation. A clinical and cephalometric study.

A modified sagittal split technique has been evaluated in 42 dentate patients, in whom no postoperative intermaxillary fixation was used. Twenty-three patients had mandible set-back performed and 19 patients mandibular advancement. The method makes possible a safe split osteotomy under controlled conditions. The design of the osteotomy and screw osteosynthesis counteracts relapse. Omitting intermaxillary fixation facilitates postoperative handling of the patient and promotes rehabilitation.

Adolescent↗
PubMed1989

Maxillary osteotomies without postoperative intermaxillary fixation (anterior, superior and inferior repositioning of entire maxilla). A clinical and cephalometric study.

Surgical correction of maxillary anomalies with anterior-superior or anterior-inferior repositioning of the segment was performed in 50 patients. The maxillary segment was stabilized by means of steel wires as horizontal mattress sutures, which, in all cases, gave very good primary stability. In case of insufficient bone contact miniplates were used. Postoperatively no rigid intermaxillary fixation (IMF) was applied. There are several advantages to not using intermaxillary fixation: 1) It is possible to carry out immediate postoperative inspection of the location of the condyles and thereby confirm that the segments are in the expected position. 2) Segment fixation is not disturbed by mandibular movements during recovery from general anaesthesia. 3) Manipulations by the anaesthesiologist immediately after surgery are not interfered with. 4) For the patient there is better postoperative comfort with no breathing, talking or feeding problems. 5) Minor corrections of intercuspation by means of orthodontic elastics are possible. These can act in the required direction and will not disturb the masticatory function. Masticatory function was resumed immediately after surgery and was usually normalized within 2-3 weeks. Cephalometric analysis revealed no significant relapse subsequent to surgery. Thus we conclude that omitting IMF, among other advantages, enhances patient comfort and has no negative effect on the postoperative stability of the maxilla.

Adolescent↗
PubMed1988

Simultaneous correction of maxillary and mandibular dentofacial deformities without the use of postoperative intermaxillary fixation. A clinical and cephalometric study.

Simultaneous correction of maxillary and mandibular anomalies was performed in 23 patients. The maxillary segment was stabilized by means of steel wires as horizontal mattress sutures, which, in all cases, gave good stability. A modified sagittal split has been applied in all cases. The method makes a safe split osteotomy possible under controlled conditions. The design of the osteotomy and the screw osteosynthesis counteract relapse. Postoperatively, no rigid intermaxillary fixation (IMF) was used. Masticatory function was started from the 1st postoperative day and in most cases was normalized 2-3 weeks after surgery according to the patients own judgement. Cephalometric analysis was performed on 15 patients by a superimposition technique. There was an overall good postoperative stability of the maxilla and mandible in the horizontal and vertical planes. We conclude that omitting IMF has no negative effect on the postoperative stability of the fragments.

Adolescent↗
PubMed1988

Features of maxillary arch and nasal cavity in infancy and their influence on deciduous occlusion in unilateral cleft lip and palate.

The purpose of this study was to test the statistical relationship between certain preoperative characteristics of the maxilla and nasal cavity and later occlusal development in patients born with complete unilateral cleft lip and palate. The sample consisted of 51 patients and 22 of them had undergone surgical treatment which included vomer flap and pushback palatal repair, while the remaining 29 patients were treated with a routine characterized by delayed closure of the hard palate. Twelve variables related to 4 different maxillary and nasal areas were recorded from maxillary casts and frontal cephalograms obtained in infancy. Crossbite scores and maxillary intercanine width were determined from dental casts taken at 3 years of age. Multiple linear regression analysis showed that the preoperative variables selected as predictors of maxillary development at the age of 3 did not explain more than half of the variation found in our subjects. Also, the predictors were not the same in the two surgical subgroups. To improve our ability to predict, further variables should be tested and, if possible, added to the regression formulae.

Child, Preschool↗