The goal of this prospective randomized clinical trial was to compare 2 cohorts of standardized cleft patients with regard to functional speech outcome and the presence or absence of palatal fistulae. The 2 cohorts are randomized to undergo either a conventional von Langenbeck repair with intravelar velarplasty or the double-opposing Z-plasty Furlow procedure. A prospective 2 × 2 × 2 factorial clinical trial was used in which each subject was randomly assigned to 1 of 8 different groups: 1 of 2 different lip repairs (Spina vs. Millard), 1 of 2 different palatal repair (von Langenbeck vs. Furlow), and 1 of 2 different ages at time of palatal surgery (9-12 months vs. 15-18 months). All surgeries were performed by the same 4 surgeons. A cul-de-sac test of hypernasality and a mirror test of nasal air emission were selected as primary outcome measures for velopharyngeal function. Both a surgeon and speech pathologist examined patients for the presence of palatal fistulae. In this study, the Furlow double-opposing Z-palatoplasty resulted in significantly better velopharyngeal function for speech than the von Langenbeck procedure as determined by the perceptual cul-de-sac test of hypernasality. Fistula occurrence was significantly higher for the Furlow procedure than for the von Langenbeck. Fistulas were more likely to occur in patients with wider clefts and when relaxing incisions were not used.

A atenção sustentada e vigilância são alguns dos processos que caracterizam a atenção e fundamentais para o desenvolvimento de algumas habilidades. OBJETIVO: Propor um instrumento comportamental simples, de fácil e rápida aplicação para auxiliar na avaliação da habilidade de atenção auditiva sustentada. Estudo prospectivo. MATERIAL E MÉTODO: Crianças voluntárias de 6 a 11 anos de idade, 139 do gênero feminino e 141 do masculino. O teste foi denominado Teste da Habilidade da Atenção Auditiva Sustentada e baseado no Teste de Desempenho Contínuo. Consiste na apresentação biaural e diótica, de uma lista de 100 palavras monossilábicas nas quais estão inclusas 20 vezes o monossílabo que deverá ser identificado. Esta lista é apresentada seis vezes sem interrupção. É realizado em cabina acústica, com auxílio de um CD player acoplado a um audiômetro de dois canais a 50 dBNS e tem uma duração média de 9 minutos.O resultado do teste é obtido pela pontuação total e pelo decréscimo de vigilância. RESULTADOS: A obtenção dos resultados mostrou-se fácil e rápida. Não foi encontrada significância estatística nos resultados para ambos os gêneros, porém significativa diferença foi encontrada entre as idades. CONCLUSÃO: O teste proposto não apresentou qualquer desconforto às crianças participantes e mostrou-se altamente sugestivo para avaliar a habilidade de atenção auditiva sustentada em crianças.

Objective Cleft palate increases the risk of chronic middle ear disease and hearing loss. The goal of this report was to determine which of two palate surgeries and which timing of palate surgery were associated with better otologic and audiologic outcomes in children with unilateral cleft lip and palate at 5 to 6 years of age. Design Subjects were randomly assigned to the von Langenbeck with intravelar veloplasty or Furlow palate repair, to palate surgery at 9 to 12 months or 15 to 18 months of age, and to the Spina or Millard lip repair. Setting Centralized, tertiary care craniofacial treatment center. Patients A total of 673 infants with unilateral cleft lip and palate. Interventions Palate and lip were repaired using established techniques. Serial otoscopic and audiometric evaluations were performed. Main Outcome Measures Hearing and otoscopic findings at 5 to 6 years old. Results There were 370 children available for analysis. Hearing and need for tympanostomy tube placement did not differ by palatoplasty, age at palatoplasty, cheiloplasty, or surgeon. Risk of developing cholesteatoma or perforation was higher with Millard cheiloplasty (odds ratio = 5.1, 95% confidence interval = 1.44 to 18.11, p = .012). Type and age at palatoplasty were not significantly associated with either the rate of developing these sequelae or the rate of achieving bilaterally normal hearing and ear examinations. Conclusions Type of palatoplasty did not influence otologic and audiologic outcomes in 5- to 6-year-olds with unilateral cleft lip and palate. The potential influence of lip repair on otologic outcomes warrants further investigation.

Cl eft lip and palate (CLP) is a risk indicator to middle ear alterations, which may damage the development of auditory abilities such as attention that is essential to learn new skills, oral and written communication. Studies on attention process with CLP population are recent and poorly explored in the specific literature. Thus, this study aims to contribute with new subsidies in the field as it investigates the performance of children with CLP in Sustained Auditory Attention Ability Test (SAAAT). Material and Method: Comparison of SAAAT performance between children with CLP and children without it. Prospective study. Results: ANOVA was used as variance analysis model with two factors to study the variables such as group and gender. The CLP group showed an average of 2.5 units higher than the control group. This difference is between 0.7 and 4.4 with 95% certain. Conclusion: children with cleft lip and palate had poorer performance on SAAAT when compared to those without such craniofacial anomaly, considering attention reduction only.

Objective To study the growth of children with complete unilateral cleft lip and palate (UCLP) from birth to 2 years of age and to construct specific UCLP growth curves. Design Physical growth was a secondary outcome measure of a NIH sponsored longitudinal, prospective clinical trial involving the University of Florida (USA) and the University of São Paulo (Brazil). Patients 627 children with UCLP, nonsyndromic, both genders. Methods Length, weight, and head circumference were prospectively measured for a group of children enrolled in a clinical trial. Median growth curves for the 3 parameters (length, weight, head circumference) were performed and compared to the median for the National Center for Health Statistics (NCHS, 2000) curves. The median values for length, weight, and head circumference at birth, 6, 12, 18 and 24 month of age were plotted against NCHS median values, and statistically compared at birth and 24 months. Setting Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, Brazil (HRAC-USP). Results At birth, children of both genders with UCLP presented with smaller body dimensions in relation to NCHS median values, but the results suggest a “catch up growth” for length, weight, and head circumference for girls and for weight (to some degree) and head circumference for boys. Conclusions Weight was the most compromised parameter for both genders followed by length and then head circumference. There was no evidence of short statue. This study established growth curves for children with UCLP.