This chapter has sought to review the social and ethi- cal ramifications of craniofacial surgery for children born with major craniofacial conditions. The remark- able tools of craniofacial surgery and neonatal life support/intensive care have made it possible for many more children with serious defects to live. Their sur- vival has raised questions about how much a society is willing to invest in their care, especially considering the impact that even a repaired defect will have on the patient’s quality of life. The availability of prenatal diagnosis and abortion may present additional choic- es to parents and clinicians. After a birth of a child with a major birth defect, the intense expense and the high degree of clinical activism involved heighten our perception of the costs of craniofacial surgery. The desire to utilize new techniques, to advance a disci- pline, and provide patient benefits may affect clini- cian decisions. In the context of these often conflicting social currents, many questions about justice and the
distribution of resources arise [27]. Should society in- vest large amounts of effort and resources in costly corrections of rare and disabling conditions, or should it spend limited health dollars on population- based preventive efforts? [28, 29] Decisions about rationing care will arise in the context of limited re- sources and in societies where demands on the health system exceed the system capacity. Craniofacial care poses many social, ethical, and health policy issues [30–36] for health professionals, parents, and the community-at-large.
References
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A
Abbe flap 470, 518 Aberrant muscle force 43 Abnormal growth 10 Accutane 290 Achondroplasia 290 Acoustic bridge 355
ACPA see American Cleft Palate-Cranio- facial Association
Acrylic palatal vault 453
Acrylic resin 398, 726, 727, 728, 731, 732
Adaptol 731 Adenoid 647, 649 – morphology 668 – size 634
Adenoidectomy 52, 660, 669, 677, 709 Adenoid mass 52
Aerodynamic testing 710 Aesthetic facial balance 525 Aesthetic scale 610 Air flow assessing device 741 Airway deficiency 657 – maintenance 286 – obstruction 221, 519 Alar cartilage 463 – framework 472 – suspension 461 Alar marginal incision 461 Alar rim 452, 456 Alginate 243, 244 Allergy 265 Allograft 596
Alpha-smooth muscle actin see ASMA Alternate Rapid Maxillary Expansions and Constrictions see ALT-RAMEC ALT-RAMEC (Alternate Rapid Maxillary
Expansions and Constrictions) 537, 539, 541, 542, 549
Alveolar bone 603
Alveolar bone graft/grafting 59, 72, 84, 91, 96, 118, 207, 460–462, 525, 540, 544, 547, 548, 575
– secondary 111, 118, 119, 149, 151, 158, 162, 163, 166, 179, 208, 323, 351, 364–366, 409, 414, 432, 444, 482, 484, 488–490, 507, 512, 758
Alveolar bone growth 137 Alveolar bone support 133 Alveolar cleft 548 – deformity 452 – space 80, 382
– secondary bone grafting 601 Alveolar cranial bone graft 76, 82, 91 – secondary 123, 129, 132, 143 Alveolar crest 481, 603, 605 Alveolar deficiency 274 Alveolar fistula 524 Alveolar labial plate 332 Alveolar osseous base 593 Alveolar periosteplasty 279 Alveolar process 63
Alveolar ridge 364, 377, 383, 401, 447, 453, 474, 592, 593
– analysis 343
– optimum position 383 Alveoloperiosteoplasty 398 Alveolus 46, 55, 56, 57, 58, 59 Ambryonic gut tube 4
American Association of Oral Surgeons 276
American Association of Plastic Sur- geons, Chicago 276
American Cleft Palate Center 343 American Cleft Palate Craniofacial Asso-
ciation /ACPA) 285, 416, 459, 488, 691, 694, 705, 777
– meeting St. Louis 391, 395 – meeting Tampa 385
American Institute of Ultrasound in Medicine 14
Amyotrophic lateral sclerosis 740 ANB angle 83
Aneuploidy 14, 15 Angle of convexity 274 Angular changes 522 Angular gyrus 711 Ankyloblepharon 203
Ankyloglossia 203 Anoxia 274
ANS (anterior nasal spine) 522 Antepartum obstetrical ultrasono-
graphic evaluation 14 Anterior alveolar ridge 363 Anterior arch discrepancy 127 Anterior bony apposition 759 Anterior cleft
– closure 323
– space 129, 130, 136, 137, 153, 154, 156, 163, 175, 185
Anterior cranial base 18 – growth 123, 186
Anterior crossbite 124, 128, 488, 489, 509, 512, 522, 528, 602
– correction 94
Anterior displacement of maxilla 536 Anterior nasal spine see ANS
Anterior palatal oronasal opening 151 Anterior removable prosthesis 78 Anterior-posterior arch length 433 Anteroposterior crossbite 591 Anteroposterior maxillary development
382
Anteroposterior maxillomandibular dis- crepancy 525
Anxiety 258
Apert syndrome 268, 287, 530, 635, 777 Apoptosis 303
Armamentarium of pharyngeal flap 503
Arnold expander 142, 204, 205 Articulation
– age 696 – competence 607 – development 698, 708 Articulatory therapy 712
Ascending ramus 555–557, 561, 563, 569
ASMA (Alpha-smooth muscle actin) 303
Atlanto-axial dislocation 628 Atlanto-dental angulation 630 Attractiveness, studies on 258
Audiology 289
– early identification 289 – management 289 – monitoring 289
Auditory brainstem response testing 355, 356
Auditory canal, external 357 Auditory system 355 Auditory training 639, 640 Autogenous bone 180
– graft/grafting 507, 512, 525, 530 Autogenous cancellous bone 587 Autologous cancellous bone 604, 605 Autologous cartilage graft 676 Autopolymer 731
B
Babbling 711 Basioccipital bone 623 Basion horizontal 18, 19, 29, 31 – concept 28
– facial polygon 131
– method (Coben) 76, 83, 90, 93, 141, 158, 172, 186, 341, 484
– procedure 439, 445
Bayley Scales of Infant Development see BSID
BCCLP (bilateral complete cleft lip and palate) 226, 227, 229, 230
BCL (bilateral cleft of the lip) 317 BCLP (bilateral cleft of the lip and
palate) 26, 27, 31, 49, 50, 107, 108, 142, 159, 163, 172, 173, 201, 202, 208, 210, 238, 239, 322, 327, 330, 351, 387, 389, 397, 398, 431, 452, 487, 495–497, 521, 528, 540, 547, 575–577, 579, 580, 660, 664, 696, 708
– unoperated 247, 248 – variations 50 Behavior problem 257
Bergen Cleft Palate-Craniofacial Center 488, 491
Bergen rationale 487, 491, 493 Berkowitz and Millard palatal cleft
closure timing 344 Berkowitz study 755 Berkowitz’s cephalometric and
nasopharyngoscopic studies 52 Berkowitz’s clinical report 329 Berkowitz’s observations 753 Berkowitz’s serial growth study 342,
385
Berkowitz’s serial occlusal study of CICLP 342
Bifid uvula 53
Bilateral alveolar cleft 48 Bilateral cleft lip nose 273 Bilateral cleft of the lip and palate
see BCLP
Bilateral complete cleft of the hard and soft palate 646
Bilateral posterior crossbite 494 Bilingual family 712
Bimaxillary protrusion 252 Bimaxillary retrognathia 227, 229,
233
Bimaxillary retrusion 249 Biocompatible synthetic membrane
307
Biofeedback therapy 618 Biomedical technology 780 Biostereometric technique 22 Bipedicle island flap 515, 516 Bird face deformity 561, 562, 569 BMP cytokine 587, 596 Bolton standards 106 Bone Autotransplantation 604 Bone graft/-ing (s. also Autogenous bone
grafting) 66, 599 – material 596 – primary 279 – secondary 279 – surgical procedure 592 Bone manipulation 599 Bone remodeling 32 Bone vascularity 568 Boneless bone grafting 278 Bonferroni procedure 365 Bony ankylosis 341 Bony alveolar bridge 423 Bony overgrowth 102 Bony pharynx 65
Bony union across alveolar cleft 551 Breast malignancy 280
Bridgework 605
Broad personality type 257, 258 Brogan technique 398 Brophy method 396, 448
BSID (Bayley Scales of Infant Develop- ment) 715
Buccal alveolar surface 318 Buccal and anterior occlusion 331 Buccal crossbite 84, 109, 112, 120, 121,
124, 146, 162, 330, 337, 447, 503, 509, 512, 602
– correction 203, 204, 205, 206, 207, 208
Buccal flap 593 Buccal mucosa 302
Buccal occlusion 56, 88, 169, 333, 348, 481
– class I 161, 413 – class III 414, 418 Buccal sulcus (Burian) 512 Buccinator 43, 44 Bulbar polio 637, 740
C
Calvarium 463 Cancellous bone 592 Cancellous iliac crest bone 105 Canine tooth 593
Caries 209, 325 Carotid artery 669 Carpenter syndrome 287 Carry effect 315 Cartilage implant 641
Cartilage intercellular matrix 451 Cartilaginous growth 28 Cartilaginous septum 104 Catch-up growth 329, 342, 344 Caucasian population 706 CBCLP(complete bilateral clefts
of the lips and palate) 28, 37, 39, 44, 45, 47, 99, 100, 102, 103, 105, 111, 113, 114, 124, 132, 151, 173, 210, 316, 321, 323, 328, 343, 344, 364, 365, 367, 374, 376, 383, 386, 389, 398, 409, 410, 414, 415, 418, 428, 440, 441, 443–446, 449, 470, 479, 484, 751, 755, 756, 760–762 CDI (Communicative Development
Inventory): Toddler 714 Cell enhacement through tissue
culturing 599 Cellular destruction 103 Cellular proliferation 325 Cephalometric evaluation 521 Cephalometric laminagraphy 51 Cephalometric measurement 17 Cephalometric roentgenogram 49, 215,
222
Cerebral vascular accident 650, 740 Cervical periodontal ligament 305 Cervical spine anomaly 628–631 Cervical vertebrae 21, 622 Chewing 711
Chicago Dental Institute 276 Child
– adjustment 259
– early communication attempts 697 – overcontrolled 258
– undercontrolled 258 Children’s Hospital of Phila-
delphia 280
Children’s Memorial Hospital Cleft Palate Clinic, Chicago 297, 397 Chin disproportion 582 Choanal atresia 286 Cholesteatoma 360, 361 Chondrocostal grafting 569 Chondrocranium 26
Chromosomal abnormality 14, 15 Chromosome 22-deletion DiGeorge
syndrome 5
Chromosome 22q11.2 deletion 673 Cinefluoroscopy 616
Cineradiographic study 721 Circumzygomatic wire 514 CL (cleft lip) 48, 55–59 – inheritance 52 – isolated 227, 230 – repair 588 – rhinoplasty 470, 518 – surgery,secondary 188
CL with or without cleft palate 290 – chromosomal testing 290 – multifactorial inheritance 290 – prenatal diagnosis 290 Cleft buccal segment 69, 74 Cleft Center 684
Cleft embryo-pathogenesis 487 Cleft lip see CL
Cleft lip and palate see CLP Cleft maxillary hypoplasia 521 Cleft of the uvulae 55, 59, 60 Cleft orbicularis oris muscle 102, 315 Cleft palatal segment 44
Cleft palate see CP
Cleft Palate Center of Amsterdam Free University Hospital 400 Cleft Palate Center of Nijmegen
Universty Medical Center 400 Cleft Palate Center of Rotterdam
Erasmus University Hospital 400 Cleft Palate Centre of the University
of Illinois 215, 218, 219 Cleft Palate Institute of the North-
western University Dental School 384
Cleft Palate Team at New York University Medical Cente 399
Cleft palate only see CPO CP (cleft palate) 48 – closure 320, 363, 461 – growth 316 – inheritance 52 – isolated 50 – orofacial growth 383 – prosthesis 723 – speech 691, 700 – submucous 52, 53 – surgery 307, 308, 719 – surgical history 344 – team 682, 683 – timing 363ff CP alone
– chromosomal testing 291 – molecular (DNA) testing 291 CP-craniofacial team 607 Cleft research 751 Cleft subject 364 Cleft surgeon 573 Cleft surgery 753 Cleft team 259 Cleft, submucous 285 Cleftal bone
– defect 596 – grafting 587 Clefting process 210
Cleft-orthognathic surgery 573 Clinical practice 772
Clinical research 692, 751 – scientific evidence 692
Clinical Standards Advisory Group 773 Clinical trial 20
Close the hole 319
CLP (cleft lip and palate) 226, 229, 230, 233, 237, 257–259, 487–489, 495, 698, 713, 715
– relationship to brain structures and function 259
– treatment 491
Coben’s basion horizontal analysis (s. also Basion horizontal) 65 Coben’s growth philosophy 19 Cocaine abuse 462
Cognitive development 258 Cohort study 774 Collagen 676 – type I 304, 305, 309 – type III 303, 304 – type IV 4
Collito-Walker technique 317 Columella 49, 451, 452, 455 – absent 451
– deficient 451 – elongation 474
– nonsurgical elongation 453 – nonsurgical lengthening 455, 461 – oblique 451, 452
Combination prothesis 738, 739, 740 Communication
– development 695, 699, 700 – disorder 678
– failure 692 – impairment 615, 716 Comparative growth study 375 Complete bilateral clefts of the lip
and palate see CBCLP Complete nasal obstruction 634 Complete rotation advancement 468 Complete unilateral cleft lip
and palate see CUCLP
Concave facial profile 418, 427, 524 Congenital palatal insufficiency see CPI Consensus recommendations 771 Contiguous anatomy 349 Contiguous skeletal structure 210 Continuous phonation 735 Continuous positive airway pressure
see CPAP
Conventional osteotomy surgery 570 Convex facial profile 444
Core curriculum 283ff Cortical bone 601
Corticotomy 556, 557, 560, 561, 569 Cortisone 7
Cost-effectiveness 400, 403, 460 – ratio 487
CP (cleft palate) 230, 233 CPAP (continuous positive airway
pressure) 673 – therapy 711, 712, 717
CPI (congenital palatal insufficiency) 53, 628, 629
CPO (cleft palate only) 713, 715 Cranial base abnormality 635 Cranial bone graft 70, 505 Cranial cartilaginous tissue 27
Cranial cell migration, disruption 259 Cranial floor 24
Cranial neural crest 4 Cranial stabilization 530 Craniofacial anomalies 285, 286 Craniofacial biology
– basic definitions 288 – developmental 287 Craniofacial building block 3 Craniofacial care 782
Craniofacial Center at the Univesity of Illinois College of Medicine 762 Craniofacial Center of the Hospital
for Sick Children 64 Craniofacial cleft 287 Craniofacial complex 325 Craniofacial disjunction 566 Craniofacial embryology 287 Craniofacial growth 18, 28, 63, 233,
304, 558, 571, 697, 749 – direction 17 – postnatal 28, 29
Craniofacial morphogenesis 3, 225 Craniofacial morphology 227 Craniofacial psychology 263ff Craniofacial scoliosis 555 Craniofacial skeleton 555, 559 – remodeling 555ff
Craniofacial surgery 749, 777, 778, 780–782
Craniofacial synostosis 32 Craniofacial treatment,
decision-making 777 Cranio-maxillary complex 28 Craniomaxillofacial fixation 577 Craniomaxillofacial skeleton 530 Craniostenosis 361
Craniosynostosis 286, 287, 555, 564, 568, 570
– syndromal 287 Cribriform plate 625
Crouzon syndrome 287, 290, 361, 530, 567, 635
CUCLP (complete unilateral cleft lip and palate) 22, 28, 31, 37, 38, 44, 47, 61, 62, 64, 66–68, 79, 84, 89, 94, 95, 210–212, 241, 243, 318, 319, 337, 341, 343–345, 350, 364–367, 374, 376, 383–387, 391, 398, 409, 410, 414, 415, 417, 418, 425, 427, 434, 436, 437, 444, 448, 449, 479, 481, 490, 524, 751, 754–756, 761, 762, 765 Cul-de-sac shifting 738 Cultural background 267 Cupid’s bow 273, 274, 275, 276, 318,
461, 470
Cushing elevator 510
Cuspid crossbite 63, 166, 183, 346, 347, 348, 481
Cuspid substition 462 Cyanosis 215
Cytokines, pro-inflammatory, pro-fibrotic 302
D
Dahl’s Danish group 341 Danish study of craniofacial
morphology 229 Dautrey osteotomy 510 Deciduous dentition 118 Decreased shelf forces 753 Deep pharynx 647
Deficiency in lateral wall move- ments 52
Deficient soft palate 723
Degenerative central nervous system disease 740
Deglutition 396
Delaire-style protraction facial mask 91, 93, 111, 480, 428, 602
Delayed surgery 724 Dental adjustment 491 Dental changes 523e 525 Dental crossbite 344 Dental crowding 338, 427 Dental defect 46 Dental dysplasia 207 Dental malocclusion (s. also
malocclusion) 209, 489
Dental occlusal and facial study 409 Dental occlusion 113, 326, 348, 363,
409, 417, 441, 487, 555, 557 – ideal 86
Dental overbite 127 Dental overjet 127 Dental protrusion 32 Dental reconstruction 177 Dental stone 453, 728
Dental study model 238, 239, 240, 241, 249
Dentition 201, 204, 301, – permanent 206, 207 Dentition 301 – aberrant 524
– decidous 206, 207, 209, 326, 351, 375, 418, 495, 496
– mandibular 538 – maxillary 496 – mixed 118, 207, 209, 479 – mutilated 580
– permanent 207, 375, 418, 489, 495, 602, 604, 727
Dentoalveolar growth 329 Dentoalveolar mandibular proclina-
tion 488
Dentoalveolar process 304 Dentoalveolar proclination 495 Dentoalveolar prominence 540 Dentoalveolar relapse 602 Dentofacial complex 17 Dentomaxillary growth 304 Dento-osseous-musculo-mucosal
flap 577
Denture prosthesis 720
Detrimental psychosocial ramification 524
Developing/least developed world 237 Developmental critical period 8 Developmental field concept 5 Developmental malformation 268 Developmental reading disability 259 Developmental study 752
Deviated septum 662
Diagnosis-related checklist 497 Differential diagnosis 342, 344, 363, 376 DiGeorge syndrome 5, 715
Disability group 263 Discrimination 263
Distorted neonatal cleft arch form 35 Distorted nostril 47
Distraction osteogenesis 111, 418, 463, 529, 530, 535, 540, 555ff, 569, 570, 573, 582, 774
Donor cavity 601 Donor site 604
Donor-site morbidity 571 Dorsal position of the tongue 396 Dorsiflexion 221
Double-hinged expander 539 Double-hinged rapid maxillary
expander 536, 537 Down syndrome 280, 716 Downward displaced premaxilla in
bilateral cleft patients 540 Duoderm 457
DUTCHCLEFT Study 400–404, 699 Dynamic sphincter 672, 673 Dyslexia, 259
– dysnomia model 258 Dysmorphogenesis 10
E Ear
– pneumatic system 355 – reconstruction 286 Early facial morphogenesis 7 Economic health evaluation 403 Ectodermal dysplasia 530 Ectopic tooth eruption 88, 207 Edentulous maxilla 530 Effective maxillary orthopedic
protraction 535
EGF (epidermal growth factor) 302 EGFR 9
Elastic traction 35
Electromechanical digitizer 129, 136 Electromyographic (EMG) activity 711 Emotional self-regulation 257 Emotional adjustment 259, 266 Encephalitis 650
Endoscopic optical system 355 Endotracheal anesthesia 566 Epidermal growth factor see EGF Epiglottis 216, 217, 617 Epilepsy 265
Epinephrine/hyaluronidase solution 503, 510
Epithelialization 329, 750, 752 Equine appearance 540, 541 Esophagus 621
Estrogen – level 452 – maternal 460 Ethical Committee 400 Ethical guideline 21 Ethmoid bone 211, 625
Eurocleft Clinical Network 765, 771, 773, 774
Eurocleft Cohort Study 765 Eurocleft Policy Statements 771, 773 Eurocleft Practice Guidelines 771, 773 Eurocleft studies 280
EUROCRAN(European Collaboration in Cranofacial Anomalies) Research Programme 765, 770, 773, 775 European cleft palate center 343 European Collaboration in Cranofacial
Anomalies see EUROCRAN European research capability 773 European services 771
Eustachian tube 243, 244, 355, 357, 358, 359,361, 647, 674, 732
– patency 356 – test 360
Excessive scar tissue 457 Exogenous cytokine 599 Exophthalmos 361 Expansion prosthesis 724 Exspiratory phase 662
Extensive mucoperiosteal undermining 207
External cervical root resorption 604 Extraction of mandibular teeth 489 Extraoral anchorage 451
Extraoral strapping 395
F Face
– flattening 64
– mask distraction groups 523 – mask elastic distraction 522, 523,
529
Face-to-face interaction 265 Face-to-face professional interaction
and discussion 770
Facial aesthetics 512, 326, 343, 363, 487, 497
Facial and palatal growth study 326 Facial angle 18
Facial appearance 490 Facial bone growth 274 Facial cleft 13
– antenatal diagnosis 13 – deformity
– – severity 266, 267, 268 – – self-perception 267 Facial concavity 527 Facial deformity 263
Facial development of cleft children 225
– iatrogenic factors 225 – adaptive factors 225 Facial force diagram 35 Facial grimacing 682 Facial growth 21, 23, 79, 84 – direction 28
– malformation 325 – pattern 76, 449, 749, 752 – rotations 31
– standards 64 – studies 113, 105, 325 – – longitudinal 316 Facial landmark 18, 19 Facial morphology 226 Facial occlusion 441 Facial polygon 18
Facial profile evaluation 433 Facial protraction mask 420 Facial scar 265
Facial skeletal surgery 749 Facial surgery 530 Facial symmetry 557
Facial-palatal growth study 185 – longitudinal 329
Facioscapulohumeral muscular dystrophy 650
Failure to fuse 753 Family anamnesis 488 Family crisis 777 Faradization 740
Fascination with disfigurement in mythology and Western liteature 777
Faulty learning 626 Feeding 286
Fetal alcohol syndrome 780 FGF (fibroblast growth factor) 4, 302,
303, 309
FGFR (Fibroblast growth factor receptor) 288
Fibrinogen 302
Fibroblast growth factor see FGF Fibroblast growth factor receptor
see FGFR Fibroblast – dermal 309, 310 – fetal 309 – mucosal 310 – oral 309
Fibronectin 4, 302, 303 Fibrosis 103
Fibrous bands of scar tissue 325 Final occlusion 565
Finnish-speaking child 708 First International Congress on Plastic
Surgery, Stockholm 275 Fishmouth 670
Fistula 202, 204, 547 – closure 525, 577 – formation 349
Fixed appliance therapy 602
Flexible fiberoptic tube 617 Florida Cleft Palate Association 459 Foramen magnum 19, 29
Forced-response test 360 Fork flap procedure 165 Forward-growing mandible 444 Frankfor horizontal plane 18, 19, 615,
617
French nose 568 Frenum attachment 456
Friede and Pruzansky’s cephalometric report 107, 108
Frontonasal prominence 7 Fronto-orbital advancement 564 Fronto-orbital area 566
FSIQ (full scale intelligence quotient) 258, 259, 267
Full dental rehabilitation 605 Full scale intelligence quotient see FSIQ Function Matrix Principle 23, 24 Functional distortion 301
Furlow double opposing Z-palatoplasty 667, 462, 640, 673-675
G
Gatekeeper role 778, 779 Gene therapy 599
Gene-environment interaction study 774
General dentist 573 Genetic Control Theory 23
Genetic engineering treatment method 599
Genetics 290 Genioplasty 575, 578 Genitourinary system 203 – anomalies 203
Geometric displacement 44 Gingival mucoperiosteum 302 Gingival recession 550 Gingivitis 209
Gingivoperiosteoplasty (GPP) 38, 112, 279, 400, 411, 417, 460, 461, 463, 468–470, 547, 551
Global context 775
Glossoptosis 215, 218, 219, 221, 222, 227
Glottal stop substitution 740 Goldenhar’s syndrome 555 Good Practice Archive 769, 774 GOSLON yardstick 238, 245 Goteborg Team 384 GPP see gingivoperiosteoplasty Great Debate 395
Greatest esthetic challenge 451 Growth
– acceleration curve 350 – center 396
– deficiency 381, 391 – disturbance 301, 398, 400 – hormone secretion 252
– retardation 349, 750
– studies 218, 220, longitudinal 221 – velocity 368, 369, 372, 373, 374, 387
H
Haapane, Veija and Pettay study 709 Hard and soft palate 364
Hard palate 622 Hawley appliance 162 Hawley retainer 167, 180, 187 Health care 781
– financing and policy 780 – history 691
– worker 705
Health Insurance and Accountability Act see HIPAA
Hearing – acuity 607 – deficiency 713 – loss 355
Hemifacial microsomia 286, 555–561 Hemoglobin 317
Hepatocyte, growth factor 309 High density barium 617
HIPAA (Health Insurance and Account- ability Act) 694
Holtz treatment protocol 390 Horiontal lip tape 455
Horizontal maxillary osteotomy 549 Hospital admission 454
Hospital for Sick Children 608 Hotz and Gnoinski treatment principles
399
Hotz presurgical orthopedic protocol 363, 364
HOX gene 4, 5, 288 HOXA2 9
Huddart’s passive orthopedic appliance 384
Human Development Index (HDI) 252 Human Subject Research Review
Committee 21 Hyaluronic acid 451
Hynes pharyngoplasty 671, 672 Hyoid bone 218, 622
Hypernasal resonance 698 – postpalatoplasty 708 Hypernasal speech 648, 649, 652 Hypernasality 52, 53, 327, 412, 418, 610,
618, 624, 629, 636, 649–651, 667, 669, 670, 676–678, 682, 705, 706, 708–711, 716, 735, 737, 739–741
– postoperative 608
Hypertonic lip musculature 117 Hypertrophic tonsil 649 Hypochondroplasia 290 Hyponasal resonance 685
Hyponasality 361, 618, 636, 649, 651, 672, 710
Hypopharynx 653
Hypoplastic adenoid tissue 647
Hypoplastic maxilla 535f, 538, 553, 564 – fistula 535
Hypoplastic velar muscles 510 Hypotonic lip pressure 172 Hyrax expander 142, 536
I
IBCLP (incomplete bilateral cleft lip and palate) 100, 110, 120, 143, 145, 165, 317, 318, 432, 238, 239, 470 ICP (isolated cleft palate) 193ff, 225–227, 229, 230, 250, 251, 756 – arch widths 249
– chord lengths 249 – overjets 249 – tooth sizes 249 – unoperated 249
IDEA (Individuals with Disability Education Act) 706
Ideal speech 487
IDO (interdental distraction osteo- genesis) 547, 548, 549 IFN(Interferon)-g 303, 309 IL(Interleukin)-1 308 IL-1b 310
IL-6 308, 309 IL-10 308
Iliac bone graft 277, 505 Iliac crest 601
Iliac crest bone graft 588, 598 Ilium 463
IMF see intermaxillary fixation Immunology 597
Impedance testing 356 Incisal canal 51
Incomplete bilateral cleft lip and palate see IBCLP
Incomplete unilateral cleft lip and palate see IUCLP
Incomplete unilateral cleft lip see UICL Indian writings of Susrata 273 Individual craniofacial structure 644 Individual with facial deformities 263,
264, 265, 266, 268
– with Disability Education Act see IDEA
Infant orthopedics (IO) 397, 401, 402, 403, 404
Inferior nasal conchae 626 Infraorbital foramen 521
Infraorbital neurovascular bundle 521 Inheritance
– autosomal dominant 204 – X-linked 204
Initial state 751, 752 Innate language ability 607 Insitute for Speech Disorders
in Copenhagen and Arhus 225 Inspiratory phase 662
Institutional Review Board see IRB
Intact facial muscular force 43 Intellectual capacity 607 Intellectual development 259 Intellectual functioning study 713 Intelligence
– verbal 258 – nonverbal 258 Intelligibility rating 403 Interalveolar bony septum 604 Interarch congruency 206 Intercenter Comparison 768, 769 Intercenter collaboration 756 Interceptive orthopedics 489, 490, 491,
493, 495, 497
– long-term prognosis 496 Interdental distraction 551 – osteogenesis (IDO) 535, 547–553 – site 549
Interdental osteotomy 549 Interferon Regulatory Factor see IRF Interferon see IFN
Interleukin see IL
Intermaxillary fixation (IMF) 577 Internal cortical flayer 556 Internalizing behavior 713 International Congress on Cleft Palate
and Craniofacial Anomalies, Singapore 395
International research strategy 775 International Working Group 652, 653,
654
Interplay of genetic and environmental factor 9
Interpterygomaxillary disjunction 566 Intracellular dye 3
Intracranial dissection 568 Intraoral flap 520 Intraoral framework 480
Intraoral maxillary protraction spring 538, 539, 547
Intraoral molding plate 453 Intraoral orthodontic splint 519 Intraoral orthopedics 699 Intraoral palatal expander 420 Intraoral pressure 663, 664 Intraoral splint 530
Intraoral surgical manipulation 521 Intraoral tooth-borne distraction
device 545
Intravelar veloplasty see IVV
Intrinsic developmental deficiency 301 Intrinsic growth deficiency 247, 304 Iowa Pressure Articulation Test see IPAT IPAT (Iowa Pressure Articulation
Test) 707
IRB (Institutional Review Board) 694 Island flap 329–331, 337
– pushback 91, 326, 330, 333 Isolated cleft palate see ICP
IUCLP (incomplete unilateral cleft lip and palate) 48, 50
IVV (intravelar veloplasty) 326, 461, 463, 685
J
Jaw discrepancy 583 Jaw relation record 728
Johansson Blizzard syndrome 530 Juvenile diabetes 280
K
Kawamoto osteotomy 504, 510 Kent Infant Development Scale 714 Keratinocytes
– allogeneic 307 – autologous 307 – biology 309 – epidermal 307 – growth factor 309 – oral 307, 309 – palatal 307
Kernahan Rosenstein procedure 383, 397
Kinesthetic feedback system 608 Kirschner wire 176
L
Labial frenum attachment 453 Labial osseous bridge 589 Labial-palatal wire framework 480 Labio-facial complex 750
LAFH see Lower anterior facial height Laminin 4
Lancaster Cleft Palate Clinic 277, 280, 735, 739
Language
– comprehension 258 – development 699, 700, 712 – stimulation 712
Lateral cephalometric headplate 51 Lateral cephalometric tracing 45, 117 Lateral incisor 69, 70, 73, 92 – pontic tooth 86
Lateral pharyngeal wall 617, 637, 649, 653, 654
Lateral port control 669, 670 Lateral pterygoid plate 479 Lateral skull X-ray 238, 239, 240 Latham appliance 460, 463, 468, 469,
417, 423, 426
Latham’s pinned premaxillary retractive device 382
Latham’s presurgical orthopedic appliance 410, 414
Latham-Millard pinned appliance 398 Latham-Millard Presurgical Orthpedics Periosteoplasty with Lip Adhesion see POPLA
Latham-Millard PSOT 434, 440, 443, 445
Learning disability (LD) 713, 716