Cleft lip and palate is known to be associated with a number of other skeletal anomalies. The purpose of this study was to investigate the prevalence of possible malformations of the cervical spine and their relationship to velopharyngeal incompetence. The lateral cephalometric radiographs of 30 patients aged between 14 and 27 years of age with cleft lip and palate were compared with these of a control group, who had been involved in cycle accidents. The radiographs were assessed for morphological anomalies of the first and second cervical vertebrate and, in addition, longitudinal and angular measurements performed. Speech was assessed by electromagnetic articulography. A greater number of cervical spine anomalies were found in patients with cleft lip and palate and these were also associated with significantly (P < 0.05) greater osseous-nasopharyngeal depth.

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A 29-year-old male patient suffering from communicating hydrocephalus was treated by placement of a ventriculoatrial shunt (Pudenz-Heyer bur-hole valve). A disturbingly loud, pulse-synchronous, bruit in the ear on getting up from lying down remained unrecognized for 3 years as possibly generated by air bubbles in the valve. Clinical and technical investigations by a phonocardiographic and a transcranial Doppler device demonstrated that the noise was a functional indicator of shunting activity, relying on intracranial pressure conductional on arterial blood pressure as determined by its close relationship to the cardiac cycle. When this phenomenon was looked for, it was detected in three other patients, one of whom saw it as a shunt-function indicator.

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