Cleft Lip - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N. P ARKER , ...

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A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Cleft Lip: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00265-5 1. Cleft Lip-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on cleft lip. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON CLEFT LIP .................................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Cleft Lip ...................................................................................... 11 E-Journals: PubMed Central ....................................................................................................... 32 The National Library of Medicine: PubMed ................................................................................ 33 CHAPTER 2. NUTRITION AND CLEFT LIP ........................................................................................ 81 Overview...................................................................................................................................... 81 Finding Nutrition Studies on Cleft Lip ....................................................................................... 81 Federal Resources on Nutrition ................................................................................................... 84 Additional Web Resources ........................................................................................................... 84 CHAPTER 3. ALTERNATIVE MEDICINE AND CLEFT LIP .................................................................. 87 Overview...................................................................................................................................... 87 National Center for Complementary and Alternative Medicine.................................................. 87 Additional Web Resources ........................................................................................................... 91 General References ....................................................................................................................... 92 CHAPTER 4. DISSERTATIONS ON CLEFT LIP .................................................................................... 93 Overview...................................................................................................................................... 93 Dissertations on Cleft Lip ............................................................................................................ 93 Keeping Current .......................................................................................................................... 94 CHAPTER 5. BOOKS ON CLEFT LIP .................................................................................................. 95 Overview...................................................................................................................................... 95 Book Summaries: Federal Agencies.............................................................................................. 95 Book Summaries: Online Booksellers........................................................................................... 98 Chapters on Cleft Lip ................................................................................................................... 99 Directories.................................................................................................................................. 104 CHAPTER 6. MULTIMEDIA ON CLEFT LIP ..................................................................................... 105 Overview.................................................................................................................................... 105 Video Recordings ....................................................................................................................... 105 CHAPTER 7. PERIODICALS AND NEWS ON CLEFT LIP .................................................................. 107 Overview.................................................................................................................................... 107 News Services and Press Releases.............................................................................................. 107 Newsletters on Cleft Lip............................................................................................................. 109 Newsletter Articles .................................................................................................................... 109 Academic Periodicals covering Cleft Lip.................................................................................... 110 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 115 Overview.................................................................................................................................... 115 NIH Guidelines.......................................................................................................................... 115 NIH Databases........................................................................................................................... 117 Other Commercial Databases..................................................................................................... 119 The Genome Project and Cleft Lip ............................................................................................. 119 APPENDIX B. PATIENT RESOURCES ............................................................................................... 123 Overview.................................................................................................................................... 123 Patient Guideline Sources.......................................................................................................... 123 Associations and Cleft Lip ......................................................................................................... 133 Finding Associations.................................................................................................................. 134 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 137 Overview.................................................................................................................................... 137 Preparation................................................................................................................................. 137 Finding a Local Medical Library................................................................................................ 137

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Medical Libraries in the U.S. and Canada ................................................................................. 137 ONLINE GLOSSARIES................................................................................................................ 143 Online Dictionary Directories ................................................................................................... 144 CLEFT LIP DICTIONARY ........................................................................................................... 145 INDEX .............................................................................................................................................. 187

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with cleft lip is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about cleft lip, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to cleft lip, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on cleft lip. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to cleft lip, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on cleft lip. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON CLEFT LIP Overview In this chapter, we will show you how to locate peer-reviewed references and studies on cleft lip.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and cleft lip, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “cleft lip” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Guidelines for Patients with Cleft Lip-Palate and Other Craniofacial Anomalies Source: Pediatric Dentistry. 21(5): 53-54. Reference Manual 1999-2000. Contact: Available from American Academy of Pediatric Dentistry. Publications Department, 211 East Chicago Avenue, Suite 700, Chicago, IL 60611-2616. Summary: A child born with cleft lip or palate or other craniofacial anomalies has multiple and complex problems, including early feeding and nutritional concerns, middle ear disease, hearing deficiencies, deviations in speech and resonance, dentofacial and orthodontic abnormalities, and psychosocial adjustment problems. This chapter from the American Academy of Pediatric Dentistry's Reference Manual reprints the current statements of the American Cleft Palate Craniofacial Association. Ten fundamental principles identified as critical to optimal cleft or craniofacial care are

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listed. The chapter then describes 13 areas where pediatric dentists should provide dental services in close cooperation with their orthodontic, oral, and maxillofacial surgery and prosthodontic colleagues. These areas include diagnostic testing (including radiographs), diagnostic records, presurgical maxillary orthopedics, dental care for primary dentition, monitoring for malocclusion, orthodontic treatment (for primary, mixed, or permanent dentition), the use of functional orthodontic appliances, surgical correction of facial deformities, the replacement of congenitally missing teeth, patient monitoring, prosthetic obduration of palatal fistulae (clefts or fistula in the palate), and prosthetic speech devices. The guidelines stress that the best care is multidisciplinary, specific to the needs of the individual, and readily accessible. 2 references. •

Young Child with Cleft Lip and Palate: Intervention Needs in the First Three Years Source: Infants and Young Children. 11(2): 12-20. October 1998. Contact: Available from Aspen Publishers, Inc. 7201 McKinney Circle, Frederick, MD 21704. (800) 234-1660. Website: www.aspenpublishers.com. Summary: Cleft lip and cleft palate (CLP) comprise the fourth most common congenital disability and affect approximately 1 out of every 700 children born in the United States. The treatment needs of children with CLP are numerous and complex, requiring the specialized, coordinated care of an interdisciplinary team. This article discusses the multiple medical, dental, therapeutic, psychosocial, and early intervention needs faced during the first 3 years of life. The authors stress that young children and their families face a situation in which they must adapt to the impact of a congenital disability and the subsequent onslaught of emotions, questions, physician appointments, surgeries, and hospitalizations that accompany CLP. The authors note that prenatal detection of a cleft can help parents prepare emotionally for the birth of a child with a craniofacial anomaly and conclude by reiterating that a child can achieve optimal outcomes and functioning if care is coordinated by an interdisciplinary team that specializes in craniofacial anomalies and if care is begun as soon as possible. 3 figures. 1 table. 19 references.

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Incidence of Cleft Lips, Palates Rising Source: JADA. Journal of the American Dental Association. Volume 123: 61-65. November 1992. Summary: Cleft lip or cleft palate occur in about 1 in 700 live human births. This article explores some of the socioeconomic factors that may be responsible for the recent rise in the incidence of these congenital anomalies. Topics covered include public health education; the etiology and incidence of cleft lip and palate; the roles of genetic and environmental factors; other risk factors, including lack of prenatal care during pregnancy, alcohol consumption, lack of a balanced diet, and the chronic use of nonprescribed drugs or substance abuse; feeding, hearing, and learning problems in children with cleft lip or palate; prevention issues; and genetic research, including advances in developmental biology.

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Maxillary Distraction Osteogenesis for Cleft Lip and Palate Children Using an External, Adjustable, Rigid Distraction Device: A Report of 2 Cases Source: Journal of Oral and Maxillofacial Surgery. 59(12): 1492-1496. December 2001. Contact: Available from W.B. Saunders Company. Periodicals Department, P.O. Box 629239, Orlando, FL 32862-8239. (800) 654-2452. Website: www.harcourthealth.com.

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Summary: Distraction osteogenesis is a useful method for in vivo bone regeneration. In this method, osteotomized bone segments are distracted gradually at a regular interval of 1 millimeter per day after surgery, and callus is stretched with a distraction device to generate new bone formation. This article describes the use of this method in 2 children with cleft lip and palate who had severe maxillary hypoplasia (undergrowth of the upper jaw). Postoperative changes in the maxilla were examined up to 1 year after surgery with computed tomography (CT), three dimensional CT, and lateral cephalograms. The authors discuss their findings and the advantages and disadvantages of the distraction system. 7 figures. 12 references. •

Orthodontic Management of the Cleft Lip and Palate Patient Source: Clinics in Plastic Surgery. 20(4): 733-753. October 1993. Summary: In this article, from a special issue on the advances and management of cleft lip and palate, the authors discuss their approach for orthodontic management during the stages of infancy, transitional dentition, and permanent dentition in patients with cleft lip and/or palate. The authors focus on the role of the orthodontist and the importance of the dentition in each of these stages. Management of these patients should be based upon sound principles of growth and development, careful and precise surgical techniques, and timely intervention. The article includes numerous clinical photographs documenting the cleft lip/palate and the orthodontic treatments utilized. 26 figures. 1 table. 44 references.

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Feeding Management of Infants with Cleft Lip and Palate and Micrognathia Source: Infants and Young Children. 12(1): 70-81. July 1999. Contact: Available from Aspen Publishers, Inc. 7201 McKinney Circle, Frederick, MD 21704. (800) 234-1660. Website: www.aspenpublishers.com. Summary: The baby with cleft lip, palate, or micrognathia (small jaws) presents a feeding challenge for both parents and health professionals. These oral facial anomalies may disrupt the feeding process and put the baby at risk for growth failure and sometimes aspiration. The feeding difficulties of these babies are widely reported in the literature, but no consensus on how to select the most appropriate remediation techniques is evident. This article outlines the normal infant feeding process and how it is affected by these oral facial anomalies. Focusing on the child's specific pattern of anomalies, the authors discuss a variety of feeding techniques and management strategies; they also develop a rationale for using these strategies for bottle feeding and breastfeeding infants with cleft lip, palate, or micrognathia. 4 figures. 1 table. 41 references.

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Comprehensive Management of Cleft Lip and Palate Deformities Source: Journal of Oral and Maxillofacial Surgery. 59(9): 1062-1075. September 2001. Contact: Available from W.B. Saunders Company. Periodicals Department, P.O. Box 629239, Orlando, FL 32862-8239. (800) 654-2452. Summary: The controversy regarding the timing of repair of the deformities associated with cleft lip and palate still exists. This article presents a versatile, universal philosophy of management of these deformities involving early surgical repair. Over 20 years, 2,698 new patients with cleft lip and palate deformities were treated. These included 1,298 unilateral and 320 bilateral cleft lip and palate patients. The remaining patients (1,018) had isolated palatal clefts. All patients were operated according to the

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same protocol and the same surgical procedure. The treatment philosophy was based on early, wide myoperiosteal-periosteo-sutural reconstruction by a modified Delaire functional cheilorhinoplasty and alveolar gingivo-periosteoplasty at 3 months of age, followed by soft and hard functional palatoplasty at 9 months of age. All patients were followed longitudinally and retrospectively. The parameters investigated were facial symmetry, presence or absence of growth retardation, and oropharyngeal and nasal function. The parameters studied indicated that when this treatment schedule was followed and the procedures were performed on time and according to the protocol, there was minimal growth retardation of the maxilla (upper jaw). When early gingivoperiosteoplasty was performed in 25 percent of the patients there was a sufficient amount of alveolar bone for eruption of the primary and permanent dentition (teeth). This negated the need for secondary alveolar bone grafting. The development of the upper lip was harmonious, and usually no further corrective procedures were necessary. The nose was usually well developed and functionally normal. The authors caution that if the treatment principles are not incorporated in the functional repair (i.e., joining of the primary and the secondary growth centers during corrective procedures), compromised results are to be expected. 13 figures. 47 references. •

Introduction of the CO2 Laser in Cleft Lip and Palate Surgery Source: Journal of Oral Laser Applications. 1(2): 135-139. Autumn 2001. Contact: Available from Quintessence Publishing Co., Inc. 551 Kimberly Drive, Carol Stream, Ill. 60188. (630) 682-3223. Website: www.quintessenz.de. Email: [email protected]. Summary: This article describes how the CO2 (carbon dioxide) laser improves a wellestablished operative method in cleft surgery. The healing process and the reduction or avoidance of scars after laser surgery is presented in the case of a nine year old boy with a congenital unilateral (one side) cleft lip and palate, who, after several operations, still possessed a remaining median hard palate defect. The treatment with the CO2 laser is performed after the same preparation and planning as for conventional surgery. The authors note the importance of working in tandem with the orthodontist, the speech therapist, and the pediatrician. Postoperative treatment includes nourishment per stomach intubation for a period of 8 to 10 days (until suture removal), and daily wound cleaning. The patients usually stay in the hospital until 8 to 10 days after surgery. The authors conclude by summarizing their rationale for the benefits of lasers in cleft surgery. 11 figures. 16 references.

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Dental Care for the Patient with a Cleft Lip and Palate. Part 2: The Mixed Dentition Stage Through to Adolescence and Young Adulthood Source: British Dental Journal. 188(3): 131-134. February 12, 2000. Contact: Available from Stockton Press. Houndmills, Basingstoke, Hampshire, RG21 6XS, United Kingdom. E-mail: [email protected]. Summary: This article discusses dental care for the patient with a cleft lip and palate. This article focuses on dental care from the mixed dentition stage through to adolescence and young adulthood. The patient is encouraged to start accepting responsibility for his or her own dental health at this time of life, with prevention playing a key role. The authors caution that patient motivation can decrease in the teenage years. Good communication with the cleft team is essential. Dental extractions should be carried out only after consultation with the orthodontist involved with cleft care. The authors review the details of preventive management, particularly home care

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such as toothbrushing. The authors stress that thorough treatment planning, patient support, and skillful behavior management are important aspects of the dental care required for this patient population. 6 figures. 14 references. •

Psychological Aspects of Cleft Lip and Palate Source: European Journal of Orthodontics. 20(4): 407-415. August 1998. Summary: This article explores the psychological aspects of cleft lip and palate (CLP). In addition to the influences of family dynamics, educational, and vocational factors on the social development and rehabilitation of CLP patients, psychological problems (such as lowered self esteem and difficulties during social interaction) are also experienced by these individuals. Only 20 percent of cleft patient care teams worldwide carry out a psychological assessment for their patients, thus it is likely that the prevalence of psychological problems is higher than the literature suggests. The authors stress that, to maximize the chances of a positive outcome in the care of cleft affected individuals, CLP patients who are concerned about their appearance of who experience psychosocial problems need to be identified by cleft teams. Interventions, such as counseling or social interaction skills training, should be offered in order that the patient's self esteem and social self confidence can be increased. The authors also explore several areas of methodological weakness in current research on patient and parent satisfaction with cleft care. 77 references.

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Assessment of the Patient with Cleft Lip and Palate: A Developmental Approach Source: Clinics in Plastic Surgery. 20(4): 607-621. October 1993. Summary: This article presents a developmental approach to the assessment of the patient with cleft lip and palate. The authors describe the hierarchic developmental stages of the child and the tasks of the family and child during these stages. They also discuss briefly the services required by the child and family from members of the interdisciplinary cleft palate team during each of these stages. Within each stage, the authors consider airway, feeding, growth and development, genetics, psychology, audiology, otology, speech and language, surgery, dental care, and cleft palate team issues. The authors stress that a lack of family-centered, coordinated interdisciplinary care leaves children with cleft lip and palate at risk for unnecessary anesthetics, unnecessary surgeries owing to timing of care, and academic impairment. 3 tables. 92 references.

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Orthognathic Surgery in the Cleft Lip and Palate Patient Source: Clinics in Plastic Surgery. 20(4): 755-768. October 1993. Summary: This article presents orthognathic surgical procedures for patients with cleft lip and palate. The authors discuss preoperative planning; presurgical orthodontics; rigid fixation; osteotomies; and the management of coexisting conditions including palate fistula, pharyngeal flap, and soft-tissue deformity. They note that procedures that move the maxilla as a single unit are usually preferred because of stability and technical ease. Division of a pharyngeal flap is indicated to facilitate nasal intubation and maxillary advancement. Soft-tissue correction of the upper lip and nose adds significantly to the overall aesthetic result but should be performed at a separate procedure. Numerous before-and-after photographs are provided. 7 figures. 3 tables. 32 references.

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Are We Ready to Predict Speech Development from Babble in Cleft Lip and Palate Children? Source: International Journal of Language and Communication Disorders. 36(Supplement): 115-120. 2001. Contact: Available from Taylor and Francis Inc. 1900 Frost Road, Suite 101, Bristol, PA 19007. Summary: This article reports on a study in which the speech development of nine children (6 males, 3 females) with cleft lip and or palate was followed longitudinally from nine months to three years of age. Five children had isolated nonsyndromic cleft palates, three had complete unilateral cleft lip and palates and one had an incomplete cleft lip and isolated cleft of the soft palate. The results indicate speech sound development closer to the non cleft population than previous studies. Nasal fricatives previously not extensively described in the literature may be an experimental stage of developmental babble, which spontaneously reduce. The authors note that it may be useful to channel resources at their clinical center for children who at nine months may be more at risk for speech disorders, i.e., children with bilateral clefts and known developmental delay. 3 figures. 1 table. 9 references.

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Speech and Language Status of Toddlers with Cleft Lip and/or Palate Following Early Vocabulary Intervention Source: American Journal of Speech-Language Pathology. 8(1): 81-93. February 1999. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 8970157. Website: www.asha.org. Summary: This article reports on a study that examined the effects of a vocabulary intervention for three children with cleft lip or cleft palate (or both) who showed limited consonant inventories and delayed expressive language. In a multiple baseline design across behaviors, a vocabulary intervention was implemented using a milieu model. The treatment produced an increase in vocabulary production that generalized to a conversational language sample in the clinic and home as reported by parents. Phonological variables, including consonant repertoire and syllable structure, were monitored before and after language treatment for all children. Phonological performance improved and did not need to be addressed as a separate goal in intervention. 3 figures. 4 tables. 42 references. (AA).

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Provision of General Dental Care for Children with Cleft Lip and Palate: Parental Attitudes and Experiences Source: British Dental Journal. 189(8): 432-434. October 28, 2000. Contact: Available from Stockton Press. Houndmills, Basingstoke, Hampshire, RG21 6XS, United Kingdom. E-mail: [email protected]. Summary: This article reports on a study undertaken to evaluate the attitudes of parents of 4 to 8 year old children with cleft lip and palate (CLP) towards the provision of pediatric dental care and to assess their experience of treatment within the General Dental Services (the dental arm of the British health care system). The study featured a postal questionnaire distributed to all parents of 4 to 8 year old children in the Birmingham CLP database. The response rate was 77 percent. Most of the children (99 children, 91 percent of the respondees) were registered with a dentist. In other areas, 75

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children (69 percent) had previously received preventive advice and 32 children (29 percent) had experienced restorative intervention. The majority of parents (64 percent) expressed a wish for a dental check up to be provided at the designated Cleft Centre, with 42 (39 percent) requesting preventive advice. Fifty-eight (67 percent) of the parents who requested a dental check up were agreeable for treatment to be provided in the primary sector. The authors conclude that their survey indicates there is parental support for pediatric dental assessment at cleft clinics, with subsequent arrangement of treatment in the primary sector. The inclusion of pediatric dental support within the multidisciplinary cleft team should be considered as Regional Cleft Centres are established. One appendix reprints the questionnaire used in the study. 3 tables. 14 references. •

Salivary Gland Aplasia with Cleft Lip and Palate: A Case Report and Review of the Literature Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 87(5): 594-599. May 1999. Contact: Available from Mosby, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146-3318. (800) 453-4351 or (314) 453-4351. Summary: This article reports the case of a patient with lifelong symptoms of xerostomia (dry mouth) and a repaired bilateral cleft lip and palate. The clinical evaluation of the patient demonstrated aplasia (lack) of the major salivary glands. The authors present a review of the literature pertaining to salivary gland aplasia, along with a summary of the data regarding patient gender, defect sites, hereditary background, and combined manifestations. The authors also discuss diagnostic methods, possible pathogenesis, and patient management. The clinical presentation of salivary gland aplasia varies depending on the number of missing glands and their contribution to whole saliva. Symptoms range from those that are negligible to profound and persistent dry mouth. Patients with salivary gland aplasia can be treated only symptomatically, typically with artificial saliva administered for comfort. The dental health of patients with salivary gland aplasia can be maintained with intensive preventive care. 5 figures. 1 table. 53 references. (AA-M).

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Primary Cleft Lip and Palate Source: Journal of the Canadian Dental Association. 65(5): 279-283. May 1999. Summary: This article reviews some aspects of primary cleft surgery (the first surgeries performed to repair cleft lip or palate) that will affect the future dental care of young children. The author cautions that if, after primary surgery of the lip, oral labial dysfunctions exist, they will exert negative influences throughout a child's growth and lead to long term dental and facial imbalances. The author emphasizes that the dentist must conduct a rigorous program of surveillance of operated patients, even when the aesthetic results are satisfactory, in order to identify and correct any dysfunction as early as possible. The author discusses primary cleft lip, primary cleft palate, and the cleft alveolus. 12 figures. 5 references.

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Oral and Maxillofacial Surgeon's Role in the Care of Patients with Cleft Lip and Palate Deformities Source: New York State Dental Journal. 64(7): 24-29. August-September 1998.

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Cleft Lip

Contact: Available from Dental Society of the State of New York. 7 Elk Street, Albany, NY 12207. (518) 465-0044. Summary: This article reviews the role of the oral and maxillofacial surgeon (OMFS) in the care of patients with cleft lip and palate deformities. The authors comment that perhaps no conditions other than cleft lip and palate and oral cancer assemble teams of dentists and physicians so intensely focused on treatment and rehabilitation. The oral and maxillofacial surgeon's role is often pivotal, especially in the 20-year term of care for the child born with a cleft lip and palate deformity (CLPD). Issues of basic orofacial functions of mastication (chewing), respiration (breathing), and communication overlay human considerations of self-esteem and image. Early issues for a child with a CLPD concern parent and family acceptance and insuring basic life functions. While not generally a part of the immediate surgical unit, the OMFS often provides surgical consultation, educational and emotional support for the family. The OMFS must offer a clear picture of the treatment that will unfold over the next two decades. Realistic optimism is the approach advocated by the authors. Topics include the assessment process, alveolar cleft grafting, the cleft dental gap, and managing facial growth abnormalities. 9 figures. •

Current Trends in Managing Cleft Lip and Palate Source: ADVANCE for Speech-Language Pathologists and Audiologists. 5(34): 6-7. August 28, 1995. Contact: Available from Merion Publishers, Inc. 659 Park Avenue, Box 61556, King of Prussia, PA 19406-0956. (800) 355-1088 or (610) 265-7812. Summary: This article, from a professional newsletter for speech-language pathologists and audiologists, discusses current trends in managing cleft lip and palate. Topics covered include the use of various endoscopic procedures for diagnostic purposes; the patient care team for neonates and children born with craniofacial anomalies; related problems in the areas of speech, swallowing, and hearing and their management; the growing interest among speech-language pathologists in working with this population; parent education and parent participation in the team approach to health care; the use of continuous positive airway pressure (SPAP) in reducing hypernasality in young speakers with cleft palate; the advantages and disadvantages of pharyngeal flap surgery; the need for ongoing assessment and modification of speech therapy; evaluating hearing loss in children with cleft palate; and the use of ventilation tubes in these children. The article concludes with the addresses and telephone numbers of the primary researchers interviewed in the article. 3 figures.

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Dental Care for the Patient with a Cleft Lip and Palate. Part 1: From Birth to the Mixed Dentition Stage Source: British Dental Journal. 188(2): 78-83. January 22, 2000. Contact: Available from Stockton Press. Houndmills, Basingstoke, Hampshire, RG21 6XS, United Kingdom. E-mail: [email protected]. Summary: This article, the first in a series of two articles about dental care for the patient with a cleft lip and palate, reviews the care of a child with a cleft lip and palate from birth through to the mixed dentition stage. The authors stress that the dentist has an essential role in giving early preventive advice and help the parents focus on the importance of good oral health for their child. Particular attention should be given to toothbrushing in the cleft region and reassurance regarding the variability of dental

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development in the cleft area is helpful. The authors remind readers that an appreciation of the family situation is important to allow for the optimum delivery of dental care. Incorporating the parents, and then the patient, into the patient care team, and building good relationships therein will greatly enhance the child's dental care and success of treatments. 7 figures. 25 references. •

Comprehensive Management of Cleft Lip and Palate Deformities. (discussion) Source: Journal of Oral and Maxillofacial Surgery. 59(9): 1075-1077. September 2001. Contact: Available from W.B. Saunders Company. Periodicals Department, P.O. Box 629239, Orlando, FL 32862-8239. (800) 654-2452. Summary: This discussion article comments on a preceding article in which the authors report on the early surgical repair of 2,698 new patients with cleft lip and palate deformities (1,298 unilateral and 320 bilateral cleft lip and palate patients; 1,018 with isolated palatal clefts). All patients were operated according to the same protocol and the same surgical procedure. This commentary article discusses the comprehensive management of cleft lip and palate deformities. The author describes where his approach is similar and where it differs from the series presented in the first article. The commentary article presents one illustrative case report. 1 figure. 5 references.

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Prospectives in Cleft Lip and Palate Repair Source: Clinics in Plastic Surgery. 20(4): 815-821. October 1993. Summary: This review article considers the future prospects of intrauterine cleft lip repair as the next generation of surgical advances in the treatment of cleft lip. Topics covered include the potential advantages of fetal cleft lip repair, fetal diagnosis, and animal studies that approximate human fetal surgery. Because of the fetus' marked plasticity, fetal repairs may achieve superior cosmetic results. The authors note that a great deal of speculation remains about the real benefits when compared with the risks of fetal surgery for non-life-threatening anomalies. 5 figures. 46 references.

Federally Funded Research on Cleft Lip The U.S. Government supports a variety of research studies relating to cleft lip. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to cleft lip. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use

2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Cleft Lip

animals or simulated models to explore cleft lip. The following is typical of the type of information found when searching the CRISP database for cleft lip: •

Project Title: BIRTH DEFECTS TREATMENT AND PREVENTION PROGRAM Principal Investigator & Institution: Murray, Jeffrey C.; Professor; Pediatrics; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 17-AUG-2001; Project End 30-APR-2006 Summary: (Provided by applicant): Cleft lip and cleft palate can serve as a sentinel for birth defects in general for the impact that they have on fetal and maternal health. As sentinels, they are easy to identify and require a high input of surgical and medical care, but also commonly result in long-term survival of affected individuals, even when untreated. They are common with the average frequency of about 1:1000 in most South American countries. Their etiology is complex, although it is clear that genes and genetic and environment interactions play an important role. Nutritional factors in clefts are well recognized and have been studied for over 40 years. Recent evidence that folate or B6 deficiency, as well as a role for smoking and alcohol use, suggest that environmental interventions in the form of supplementation or preventive strategies may be effective in decreasing the frequency of these birth defects. The South American birth defects registry, Estudio Collaborativo Latinoamericano de Malformaciones Congenitas (ECLAMC), has for many years provided epidemiologic information on the frequency of birth defects throughout South America. At the present time, folate supplementation has been introduced to one country in South America (Chile) and it is now possible to measure changes in outcomes of this based around the known preventive effect of folic acid supplementation for neural tube defects and the likely effect that it may have on cleft lip and cleft palate. Extensive populations of affected individuals such as those followed by the Centrinho clinic in Bauru provide high risk populations in which targeted interventions can be effectively studied. In this proposal, the applicants will use cleft lip and cleft palate as a sentinel defect to study the impact of birth defects in general on maternal, fetal and neonatal health and to carry out direct interventions on decreasing the number of these birth defects using both behavioral and medical interventions. The specific aims will include measuring the impact of the interventional use of folic acid supplementation on cleft lip and cleft palate and neural tube defects, measuring the impact of having a child born with a cleft on subsequent maternal, infant and family health, and finally, interventions to decrease the number of birth defects through the direct prevention strategies of smoking intervention and vitamin supplementation. The outcome of this project will be to further strengthen collaborative relationships in the area of craniofacial anomalies between Brazil and the US, to better understand the effects of birth defects and craniofacial anomalies in particular on maternal family units and to decrease the burden of these defects directly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BRAIN STRUCTURE/FUNCTION IN OROFACIAL CLEFTING DISORDERS Principal Investigator & Institution: Nopoulos, Peggy C.; Professor; Psychiatry; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 30-MAR-2004 Summary: Clefts of the lip and palate are developmental craniofacial abnormalities that result from a failure of neural crest cells to migrate properly. As a group, clefting disorders are comprised of those that are isolated to facial clefts only (non-syndromic)

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and those in which the facial cleft is part of a well-defined syndrome of additional anomalies. Non-syndromic clefting has been shown to be associated with cognitive dysfunction. In syndromic clefting disorders, cognitive dysfunction is ubiquitous and often severe. The fact that clefts of the lip and/or palate are associated with brain abnormalities is intuitive as the development of the brain and face are intimately related. However, the systematic study of the types of brain anomalies present in patients with clefts of the lip and/or palate (and the functional consequences thereof) has been almost completely overlooked. This is an application for a Mentored Patient Oriented Research Career Development Award. During the award period, the candidate proposes an organized program of training and supervised research. While the candidate has training in structural imaging of the brain, she requires additional training in developmental biology, cognitive assessment, clinical assessment of genetic syndromes, and molecular and quantitative genetics. This training will be integrated with a research project in which the candidate proposes to phenotype Van der Woude Syndrome (VDWS), an autosomal dominant disorder manifesting as isolated clefts of the lip and/or palate and lip pits, by: 1) evaluating brain structure of patients using Magnetic Resonance Imaging, and 2) evaluating brain function in these patients using neuropsychological tests. In addition, these patients with VDWS will be screened for microdeletions using an allele loss assay. This will allow direct phenotype/genotype correlations to explore the relationship between the genetic determinants of facial clefting and brain structure/function. These findings will lead to a better understanding of the neurobiology underlying the cognitive dysfunction that significantly impairs the life of many patients with facial clefts. In turn, these findings may lead to early intervention with detection and treatment of cognitive deficits. This award would provide the candidate with the necessary background for further studies into brain structure and function in other craniofacial syndromes as well as into the genetic determinants of brain development. This award will also provide the candidate with the background necessary for ongoing research and funding leading to an independent research career. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHILDREN WITH CLEFT LIP AND PALATE Principal Investigator & Institution: Richman, Lynn C.; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002 Summary: This study is designed to examine the relationships of risk factors for children with non-syndromic cleft lip and palate (CL&P) to psychological adjustment. The objective is to determine which risk factors have a primary influence on the behavioral inhibition or shyness seen in many children with CL&P. The specific aims are to determine how facial appearance and speech contribute to behavioral adjustment and how other individual characteristics such as verbal expression deficit and auditory memory deficits may affect the relationship. Also, it is planned to perform a behavioral analysis and intervention to determine if excessive behavioral inhibition occurs in all situations and whether it is modifiable. The analyses will compare children with CL&P, who have different forms of behavioral inhibition and determine if differences are related to the risk factors. Predictive equations will determine how much early characteristics of verbal disability or memory deficit versus speech and facial appearance contributes to behavior inhibition and possible anxiety. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Cleft Lip

Project Title: CLEFT CONSORTIUM

LIP

GENETICS:

MULTICENTER

INTERNATIONAL

Principal Investigator & Institution: Lidral, Andrew C.; Associate Professor; Orthodontics; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2003; Project Start 07-AUG-2003; Project End 30-JUN-2008 Summary: (provided by applicant): The focus of my research career is to identify the causes of craniofaciai anomalies, which will provide the foundation to develop strategies and therapies to prevent this common group of birth defects. The specific goals of this award are to 1) provide intensive research time in order to accomplish the goals of the research plan; 2) immerse myself in the literature to stay abreast of new discoveries and technologies such that they can be rapidly integrated into this project when warranted; and 3) broaden my expertise in human genetics as well as molecular and developmental biology to allow me to develop a set of life long skills as my career progresses from disease gene identification and molecular characterization, to the development and study of animal models to finally the development and implementation of prevention therapies. Cleft lip with or without cleft palate (CL/P) is a common birth defect. Previous studies have indicated that CL/P is a complex trait that is caused by a combination of genetic and environmental factors. This complexity has limited studies, such that disease mutations have only been identified in one unique family. It is also unlikely that all disease loci have been identified. The overall objective of this project is to identify disease genes involved in nonsyndromic CL/P by applying new multistage linkage and linkage disequilibrium (LD) strategies to affected relative pairs and extended pedigrees. This multistage approach, which has not yet been applied to CL/P, is very powerful in that no prior knowledge about the involved genetic or biological processes is needed. Hypothesis to be tested: Nonsyndromic CLIP is caused by Genetic Variants at one or more loci. To test this hypothesis, CL/P families with both multiple affected members and mother/father and affected child trios will be recruited from a variety of clinical centers. The families will be the basis for initially evaluating candidate genes to test the above hypothesis using the genetic tools of linkage and linkage disequilibrium to reject (exclude) or provide evidence for support (i.e. linkage) the hypotheses. A 10 cM genome-wide screen will also be performed to find additional loci. Positive loci will be further evaluated by a combination of multipoint, multi-locus and TDT/association analyses using more densely spaced markers. It will be through multi-center projects such as this one, in which worldwide collaborations have been established to apply a combination of complimentary genetic strategies, that disease loci for CL/P wilt be identified. Ultimately, this will further the understanding of normal and abnormal craniofacial development, such that therapies to prevent CL/P can be developed and implemented. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLONING AND CHARACTERIZATION OF THE VAN DER WOUDE GENE Principal Investigator & Institution: Schutte, Brian C.; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 10-JUL-2002; Project End 31-JUL-2002 Summary: Cleft lip and palate (CL/P) is a major congenital structural anomaly that is notable for significant lifelong morbidity and complex etiology. The extensive psychological, surgical, speech and dental involvement emphasize the importance of understanding the underlying causes. For the investigator, cleft lip and palate, like

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other complex diseases, provides a challenge in determining the multiple genetic, environmental and stochastic factors that lead to its phenotype. In this proposal, we will pursue the complex causes of cleft lip and palate through our investigations of a genetically simple form of clefting, Van der Woude syndrome (VDWS). VDWS is the most frequent syndromic form of cleft lip and palate and the form we fell is best suited to contribute to an increased understanding of the more common non-syndromic form of cleft lip and palate and the form we feel is best suited to contribute to an increased understanding of the more common non-syndromic form. Specific goals in this project will include: 1) identification of the VDWS gene. A genetic screen for disease-causing micro-deletions will be used to further restrict the region that contains the VDWS gene. Powerful gene-finding techniques, including the sequence analysis of the entire critical region, will be used to identify transcriptional units. Mutation screens will then be used to find disease causing changes in the DNA. Extensive mutation screens will be performed to search for functional domains. 2) characterization of the VDWS gene and its mouse homolog, including complete cDNA and genomic sequence analysis, the study of temporal and tissue-specific expression to identify developmental pathways that require the VDWS gene functional and screens for gene homologs which may function in the same pathway. 3) identification of sequences that regulate VDWS gene expression and the development of transgenic mouse models, including a mouse knockout that will be used in 4) long-term studies that will include complementation experiments to identify other genes in the pathway and investigate the effects of environmental factors on the VDWS gene and other genes in the same pathway. The impact of this project is that studies of CL/P are valuable, both for the importance of the defect itself as a contributor to morbidity and for providing a model for a complex human birth defect. The identification of the VDWS and VDWS-like genes will immediately provide for better risk counseling, and their characterization under environmental stresses hold the promise for contribution to preventative strategies and improved therapeutics. In addition, the identification of the VDWS gene is relevant to studies of CL/P because of its similarities to the more frequent non-syndromic forms of CL/P and because it will provide a foothold into the earliest steps of craniofacial development. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONTEXT INTERVENTIONS

FOR

FILIPINO

CB

CLEFT

PREVENTION

Principal Investigator & Institution: Daack-Hirsch, Sandra; None; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2003; Project Start 01-JAN-2004; Project End 31-DEC-2006 Summary: (provided by applicant): The purpose of this proposal is to obtain contextual data prior to planning for community-based (CB) interventions in the Philippines aimed at informing people about causes and preventing orofacial clefting. In the Philippines, 1/500 live born children will have a cleft lip with or without a cleft palate. Here there is a high prevalence of clefting and treatment is limited or unavailable. Anthropological reports describe Asian beliefs about the cause of illness as supernatural. If Filipinos hold this belief then interventions inconsistent with their understanding of cause and prevention may not be accepted. Therefore, an ethnographic study is warranted to describe attitudes and beliefs regarding the cause, prevention and treatment of clefting. Using an explanatory models framework, qualitative methods will be used to describe current beliefs about the causes, prevention and treatment of orofacial clefting, and willingness to participate in prevention trials of orofacial clefts among Filipinos and

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Cleft Lip

health care workers. In-depth interviews will be conducted with people who have a cleft or child with cleft, people who neither have cleft or children with cleft, and Filipino health workers. Interviews will be coded for broad categories. More specific descriptive sub-codes will be assigned to the data grouped under the broad categories. Data will be analyzed for regularities in terms of themes or concepts within each group and across the three groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COPING WITH CRANIOFACIAL DISORDERS Principal Investigator & Institution: Slifer, Keith J.; Kennedy Krieger Institute, Inc. 707 N Broadway Baltimore, Md 21205 Timing: Fiscal Year 2002 Summary: Children with craniofacial disorders have increased incidence of anxiety, withdrawal and social competence problems, but they tend to rate their own appearance more positivity than it is rated by others. Some may learn to cope with facial impairment by minimizing it an developing compensatory behavior. Direct observations of these children reveal social interactions that differ significantly from peers. Other data suggest they have impaired ability to communicate emotion through facial expressions. This study will employ: (1) microanalytic direct observation methods, and (2) computerautomated recognition of facial expressions to quantify the social and facial behavior of 8 to 16 year-old subjects videotaped during: (1) an analogue social interaction with a confederate peer, and (2) a structured facial encoding task. Results will be compared across matched Craniofacial (oral cleft and craniosynostosis). Non-facial (short stature), and Normal Control groups. Within-group comparisons will examine ow subjects with positive self-perceptions differ from those with comparable physical impairments and average or negative self-perceptions. Differences in self ratings of appearance and selfconcept are expected to be significantly correlated with observable differences in social behavior. Craniofacial subjects (particularly those with oral clefts) are expected to evidence impaired ability to encode emotion through facial expressions. Some differences in social and facial behavior may reflect compensatory behavior developed by those who are better-adjusted and more socially competent, which could be taught those who are less competent. If differences in ability to generate facial expression are found in subjects with craniofacial disorders, and associated with impaired social competence, the results may lead to assessment techniques for detecting subtle but clinically significant facial dysfunction. Some may be amenable to surgical correction, others to behavioral intervention (e.g. response shaping with reinforcement contingencies or biofeedback training of facial muscles). Such intervention could be tested by subsequent demonstration projects. The combined results will provide an empirical basis for selecting specific skills to be taught in future prospective interventions for children with craniofacial disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DENTAL AND ORTHODONTIC ACCESS IN CRANIOFACIAL CARE Principal Investigator & Institution: Cunningham, Michael L.; Associate Professor; Children's Hospital and Reg Medical Ctr Box 5371, 4800 Sand Point Way Ne, Ms 6D-1 Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): The ability of children with special health care needs to access dental care is an understudied area. Access to dental and orthodontic care for

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children with craniofacial disorders is of particular importance since these children require dental and orthodontic care as a direct result of their medical condition and as an essential part of their reconstructive treatment. The overall objectives of this study are to develop tools to characterize barriers to accessing dental and orthodontic care for patients with craniofacial disorders and to identify potential strategies by which access to care may be improved. With that in mind, four specific aims are proposed. In the first project, instruments will be developed, using information obtained from key informant interviews of patients and families, to identify and characterize barriers to accessing timely and appropriate dental and orthodontic care for children with craniofacial disorders. In the second project, Washington state Medicaid claims data will be analyzed to characterize dental and orthodontic care utilization and travel distance for care for low-income children with cleft lip and/or palate. Areas of Washington State where Medicaid beneficiaries with craniofacial disorders have difficulty accessing local dental/orthodontic care will be identified. In the third project, a statewide survey will be developed to assess current level of involvement of community orthodontists in caring for children with craniofacial disorders and to identify factors that could potentially promote or impede increased participation in the future. In the final project, models of patient advocacy programs will be identified and collaborations between the Law School and the Craniofacial Center will be developed with the goal of developing an advocacy program aimed at improving access to dental and orthodontic care for children with craniofacial disorders. At the completion of this planning grant period, we will be prepared to implement a large scale assessment to characterize barriers to accessing dental and orthodontic care and their consequences, as well as intervention projects specifically targeted at the barriers we identify. The overarching goal of the subsequent full-scale project will be to improve access to dental and orthodontic care and thus promote optimal outcomes for all children with craniofacial disorders. This model could potentially be applied to children in other states and to other groups of children with special health care needs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPMENT MESENCHYME

OF

THE

PALATE

AND

CRANIOFACIAL

Principal Investigator & Institution: Hay, Elizabeth D.; Professor; Cell Biology; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-AUG-1994; Project End 31-JUL-2004 Summary: (adapted from the Investigator's abstract): The broad objective of this application is to understand the tissue transitions involved in the development of the palate and craniofacial mesenchyme. Transformation of the medial edge epithelia (MEE) to mesenchyme in the paired palatal shelves from avian and rodent models will be examined. This represents a model for embryonic tissue remodeling and has potential importance to better understand failure of the palatal shelves to fuse in humans. The Principal Investigator's laboratory was the first to propose and demonstrate that the MEE undergoes epithelial-mesenchymal transformation (EMT) after fusing to form a midline seam, and that the resulting mesenchymal cells become part of the palate connective tissue, thus establishing confluence of the palatal stroma. It is likely that EMT is involved in other craniofacial processes where epithelial fuse, consequently studies are proposed to examine the formation of the upper lip. Understanding the cellular mechanism of palatal EMT will result in new approaches to defining the causes of congenital facial anomalies, such as cleft palate and other facial clefts that may result from failure of the EMT process. The specific aims are to study (1) the role of cell-cell

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Cleft Lip

contacts between opposing palatal shelves in initiation of EMT in the MEE; (2) the role of cell-matrix interactions and TGF-beta3 in the emigration phase of EMT; and (3) the role of defective EMT in cleft palate and in cleft lip. It is expected that beta-catenin and plakoglobin associated with the newly formed MEE junctions are the signaling molecules involved in initiating palatal EMT. Also it is expected that matrix-stimulated tyrosine kinases interact with growth factors at the plasmalemma level to promote emigration. Knowledge of the basic cell biology will lead to more effective treatment of human facial clefting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ECM, INTEGRINS, AND ACTION IN SALIVARY MORPHOGENESIS Principal Investigator & Institution: Larsen, Melinda; U.S. Nat'l Inst/Dental/Craniofacial Res Dental & Craniofacial Research Bethesda, Md 20892 Timing: Fiscal Year 2002; Project Start 01-SEP-2002 Summary: (provided by applicant) Branching morphogenesis is a complex process that occurs during the development of the salivary gland, lung, kidney, prostate, and mammary gland. Using the salivary gland organ culture system, some molecules required for branching have been identified, including integrins, the extracellular matrix (ECM), and the actin cytoskeleton, but mechanisms remain unclear. The first step in branching is formation of clefts in the epithelial surface. Collagen III has been localized to clefts, indicating it may play a role in cleft formation. Integrins are heterodimeric molecules, which span the plasma membrane and mediate interaction of the ECM with the actin cytoskeleton and are, therefore, likely involved in coordinating cell movements and/or shape changes involved in branching morphogenesis. This proposal will address the role of integrins and actin cytoskeleton in submandibular gland development with three specific aims: 1) identify the role of collagen III in cleft formation, 2) define the actin rearrangements and regulators required for cleft formation, and 3) determine if there is an adhesion complex assembled at the sites of cleft formation. Understanding the composition and function of cell-matrix contacts in salivary branching morphogenesis will lead to further understanding of complex developmental processes and provide insights that may facilitate development of rational approaches for salivary gland regeneration in cancer and Sjogren?s syndrome patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EUSTACHIAN TUBE FORM/FUNCTION IN CLEFT LIP AND PALATE Principal Investigator & Institution: Gungor, Anil; Children's Hosp Pittsburgh/Upmc Hlth Sys of Upmc Health Systems Pittsburgh, Pa 152132583 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2005 Summary: (provided by applicant): Non-syndromic clefts of the lip and/or palate are among the most common malformations of the head and neck. Hearing loss and otitis media and effusion (OME) are common in cleft palate (CP patients because of poor Eustachian tube (ET) function resulting from hypoplasia and malpositioning of the palatal muscles, hypoelasticity of the ET cartilage and neuromuscular immaturity. One goal of palatal reconstruction is to establish more normal muscle vectors and attachments so as to improve tubal function and prevent future OME episodes. Unfortunately, that goal has not been realized because of a limited knowledge of the anatomical foundation for ET function. Recent methodological advances for evaluating ET function and for in vivo assessment of soft tissue anatomy hold much promise to address that deficiency. In the proposed study, quantitative magnetic resonance

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imaging (MRI) measurements of the ET and paratubal muscles in combination with measurement of ET function will be used to develop the form-function identity for the ET system in CP patients. Specifically, we will enroll 40 children aged 7-10 years with repaired, unilateral and bilateral complete CP (n+20/group) and with and without tympanostomy tubes for persistent OME (n=10/subgroup). Each child will have an MRI to define ET anatomy and a comprehensive battery of ET function tests to assess function. These data will be compared to those available for non-CP patients and analyzed for consistency with predictions that: 1) compared to age matched non-CP patients. CP patients have a hyperplastic ET cartilage, undeveloped paratubal muscles, aberrant origins and/or insertion for those muscles, greater ET compliance and poorer muscle-assisted ET opening: 2) the relative degrees of poor function and abnormal morphology are graded with the unilateral complete CP patients having lesser deficiencies than the bilateral complete CP patients: 3) the degree of functional impairment in these patients is directly related to the degree of anatomical deficiency, and 4) the anatomical deficiencies noted for CP patients with patent tympanostomy tubes are more extreme than those in the age-matched CP patients without a tympanostomy tube and no recent history of OME. If these predictions are valid, an early MRI study of CP infants be prognostic of the severity and longevity of ME disease and may serve to guide the type of palatal reconstruction for individual patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FOLATE PATHWAY GENES AND RISK FOR OROFACIAL CLEFTS Principal Investigator & Institution: Shaw, Gary M.; Research Director; March of Dimes Birth Defects Foundation 1900 Powell St, Ste 1050 Emeryville, Ca 946081836 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: The research program will investigate nutritional and genetic risk factors for orofacial clefts. The specific aims for the 3-year study are to assess the potential "geneenvironmental" interplay between genetic variation of 3 potential folate pathway genes (folate receptor gene, reduced folate carrier, and the N-acetal transferace 1 gene) among probands, maternal folic acid/multivitamin intake, and the risk of orofacial clefts. We propose to investigate the hypothesis that one or more of the 3 folate pathway genes are responsible for inadequate transport, accumulation, or metabolism of folate during critical stages of craniofacial development, making embryos susceptible to orofacial clefts even in the presence of clinically adequate maternal folate intake. By combining state-of-the-art molecular biology approaches, new genetic findings, and one of the largest case-control studies done on orofacial clefts, we will determine if maternal supplemental folic acid intake overcomes folate transport or metabolic dysfunction that may occur as a result of the embryo's genotypic variation for the 3 folate pathway genes and thus reduce the risk for orofacial clefting. The project has 3 collaborating research centers: California Birth Defects Monitoring Program, University of Nebraska, and Children's Hospital, Oakland. The research design will be case-control, including approximately 1200 cafes and controls, and will utilize maternal interview data in conjunction with genotyping of the folate receptor gene. Infants' DNA for genotyping will be obtained from residual newborn screening bloodspots, of which about 1250 DNA samples will be available for this study. Information on a variety of relevant covariates, such as parental cigarette smoking and the infant's genotype for transforming growth factor-alpha polymorphisms, will be available to analytically assess their contribution to risk for orofacial clefts. As one of the first attempts at investigating environmental and molecular genetic interactions in the epidemiology of congenital anomalies, this study endeavors to enhance our general understanding of the

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causes of orofacial clefts as well as our specific understanding of the apparent protective effect of folate supplementation on the occurrence of clefts. We observed a 50% reduction in risk for orofacial clefts among pregnant women who used vitamins. If this association ultimately proves causal, many of these anomalies will be preventable every year in the United States once it is understood what vitamin/diet component is important in facilitating the reduction in risk. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTIONAL OUTCOMES OF CLEFT LIP SURGERY Principal Investigator & Institution: Trotman, Carroll Ann.; Associate Professor; Orthodontics; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 01-MAY-2001; Project End 30-APR-2005 Summary: (from the abstract) The prevalence of cleft lip and palate in the United States is approximately 1 in 1000 live births (range of 0.7 to 1.3). Children born with this congenital birth defect exhibit obvious disfigurement of the upper lip and nose. Although the initial surgery to the cleft lip achieves adequate closure of the defect, it is widely recognized that additional (revision) surgeries are needed to achieve optimal lip form and function. The decision to perform these additional surgeries, however, is based largely on subjective clinical assessments made by the operating surgeon. Given that facial form during function has a major impact on how a person is perceived in society, it is important that objective measures of function be incorporated into the decision making process. This is currently not the case. The goals of this project are the following: (1) to evaluate the gain/loss in esthetics and impairment both at rest and during function of lip revision surgery; (2) to measure and quantify functional facial impairment in cleft patients; (3) to compare objective measures of function to subjective evaluations made by experienced plastic surgeons; and (4) to assess the usefulness of functionally-relevant outcome for patient evaluation. The subjects for this project consist of two groups of cleft lip and palate patients treated at the University of North Carolina Craniofacial Center: one group will be patients who have been judged to need lip revision surgery; the second group will be matched patients who have been judged not to need lip revision; an additional group will be matched non-cleft patients who present for routine dental care at the UNC School of Dentistry. The global hypothesis to be tested is that although contemporary lip revision surgery may improve lip form at rest, function may be further impaired. This hypothesis will be tested by using new methods that can systematically quantify motor function, tissue biomechanics, and sensory functions in cleft and non-cleft subjects. The efficacy of lip revision surgery will be evaluated in a prospective non-randomized controlled clinical trial. By comparing the objective assessments of dynamic function with the clinical judgements of craniofacial plastic surgeons, who perform lip revision surgery, the investigators will evaluate the potential of the new methods for clinical application. To accomplish the goals of this project in an effective and cost-efficient way, the investigators have employed subcontracts with both the University of Kansas and the University of Michigan. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENE DISCOVERY FOR CRANIOFACIAL DISORDERS Principal Investigator & Institution: Spritz, Richard A.; Professor and Director; Human Medical Genetics Program; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508

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Timing: Fiscal Year 2003; Project Start 18-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): Birth defects affect approximately 5% of all infants in the USA, three-fourths involving the head, face, and oral tissues. The most frequent craniofacial birth defects are orofacial clefts: cleft lip +/- cleft palate (CL/P) affects ~1 per 1100 births in the USA, and cleft palate ~1 per 1600 births. Orofacial clefts thus represent a considerable public health problem and expense, and most cases cannot now be predicted or prevented. Isolated, "non-syndromic" CL/P (nsCL/P) is the most common craniofacial birth defect, accounting for approximately 70% of all cases of CL/P. nsCL/P is a non-Mendelian, multifactorial disorder, due to multiple genes, each exerting a relatively small effect, interacting with each other and with environmental factors to ultimately result in defective action of specific pathways and genetic networks during fetal craniofacial development. However, few of the genes, and none of the environmental influences, that contribute to nsCL/P are currently known with certainty. The goal of this proposal is to identify the genes, pathways, and genetic networks that are involved in craniofacial development and that thus represent potential targets for genetic and non-genetic determinants of nsCL/P. Identification of these targets will be necessary to devise therapeutic strategies ultimately aimed at preventing this debilitating and disfiguring birth defect. It is currently very difficult to accurately study gene action during craniofacial development in the human. Accordingly, we plan a careful microarray study of gene expression profiles in the developing face of the mouse, in which genetic background (C57BL/6J), careful timing of fetal age, sampling at numerous timepoints, and analyses of many replicate samples can all be readily achieved. In addition, we plan an analogous study of facial development in mice homozygous for a null knockout allele of the Ski locus, carried on the C57BL/6J background. These Ski -/- mice have an exceedingly high rate of midline facial clefts, providing an invaluable comparison of gene expression during aberrant craniofacial development that, in particular, should identify genetic pathways and networks of the developing facies that are responsive to Ski. For genes that appear of particular importance during facial development, we will identify and validate human SNPs for use in future linkage and association studies of nsCL/P. We will apply state-of-art bioinformatics tools to analyze and interpret the data, all of which we will deposit in appropriate public data repositories. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENE-ENVIORNMENT INTERACTIONS IN FACIAL CLEFTS Principal Investigator & Institution: Christensen, Kaare; Research Professor; University of Southern Denmark Campusvej 55 Odense, Timing: Fiscal Year 2003; Project Start 01-MAR-1998; Project End 31-MAY-2007 Summary: (provided by applicant): Clefts of the lip and/or palate are among the most common and easily diagnosed birth defects, and can provide a model for complex trait analysis. Family and twin studies have clearly indicated a genetic role in the etiology of cleft lip and palate, but environmental components play a major role, as well. The environmental risk factors identified (e.g., medications, alcohol, smoking, nutritional deficiencies) are weak (O.R. < 1.5). Similarly, genetic analysis has not as yet identified any strong single gene as playing a major role in clefting. In the previous funding cycle of this proposal, we were able to analyze a large sample for both case parent triads and case controls for environmental data and molecular analysis. The initial submission took advantage of the cleft population that has been studied in Denmark since the 1930s and which provided an ethnically homogenous population, as well as an extensive historic database to carry out the studies. In this resubmission, we will now partner with parallel

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efforts underway in Norway, and take advantage of a well-established collaboration between Norway, Denmark and the United States. In addition, we have added a stateof-the-art epidemiologic analytic team based at the National Institutes of Environmental and Health Sciences who are developing new analytic tools to take advantage of the sample sizes available. Finally, advances in molecular technologies--particularly the identification of single nucleotide polymorphisms (SNPs)--have afforded the opportunity to carry out genotyping at an unprecedented level for a group of genes which have a high prior probability of being directly involved in clefting. The combination of these unique resources affords the opportunity to study cleft lip and palate in detail. In this project, we will characterize 50 candidate genes and 150 SNP markers within those genes in a total of 600 case parent triads for both isolated cleft palate and cleft lip with or without cleft palate. Positive findings from this initial analysis will then be confirmed in a case control analysis using over 800 cases and 2800 controls. Confirmed findings at this stage will then undergo statistical analysis with an emphasis on gene-gene interaction and, eventually, studies of gene-environment interaction. This project will also set the stage for our use of two large cohort studies taking place in Denmark and Norway in which 200,000 consecutive pregnancies will be ascertained, and detailed epidemiologic, environmental, and biological data made available for studies of clefting. This study will provide a new level of understanding for a complex birth defect trait. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC AND DEVELOPMENTAL ANALYSIS OF MOUSE CLEFT PALATE Principal Investigator & Institution: Maas, Richard L.; Associate Professor and Chief; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): Non-syndromic CP and CL(P) exemplify complex birth defects with both multigenic and environmental contributions. However, relatively little is known about the developmental or genetic basis for orofacial clefting. This may relate to heterogeneity in the combinations of genes that predispose to CP and CL(P), and to constraints imposed by human genetic variation. We suggest that the mouse offers certain advantages for furthering our genetic and molecular understanding of CP and CL(P). Specifically, the large battery of available mouse orofacial clefting mutants provides a unique opportunity to develop a systematic, mechanism-based classification for genes whose function is required for palatogenesis. We posit that mouse clefting mutants can be grouped into specific developmental classes based on the step at which the respective genes act. Moreover, we propose that within each class of mutants, genes that are co-expressed, or that - based on existing functional annotation - can be logically considered to act within a specific pathway, should have a high likelihood of interacting genetically when the respective mutant alleles are compounded. Conversely, genes that reside in different classes should not. In this way, we hope to begin to model the complex inheritance of CP and CL(P). In Aim 1, we will clone the genes for four new recessive mouse clefting mutants generated in our ENU mutagenesis screen. Three mutants, cpo1, ctcp and Ic express a cleft secondary palate, and we have already cloned cpo1, revealing a novel Zn-finger gene. A fourth mutant, clf3, expresses isolated cleft lip. In Aim 2, we will analyze the mutant phenotypes in comparison with existing mouse clefting mutants to determine the specific developmental step at which each gene acts. Lastly, in Aim 3, we will test specific hypotheses about the relationship between the respective genes and their products. This will involve carefully selected

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developmental and molecular experiments, and the generation of genetic compound heterozygotes to test whether combinations of the recessive loci identified model the complex inheritance of CP or CL(P). In sum, these experiments should identify new genes involved in orofacial clefting, advance our understanding of the developmental mechanisms involved, integrate the genes into developmental and molecular pathways, and reveal how these loci interact genetically to contribute to orofacial clefting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC BASIS OF CLEFT LIP AND PALATE Principal Investigator & Institution: Jiang, Rulang; Assistant Professor; Eastman Dentistry; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): The long-term goal of the proposed research is to understand the molecular pathogenic mechanisms underlying facial cleft formation. Facial clefts, including cleft lip and cleft palate, are common birth defects that affect approximately 1 in 700 live births worldwide. Individuals with facial clefts undergo extensive surgical, dental, speech and psychological therapies that usually last for many years from infancy through the teenage years. Despite the frequent occurrence and extensive medical treatment associated with such birth defects, the causes and the pathogenic processes that lead to cleft lip and/or cleft palate are not well understood. Whereas there is strong evidence for genetic predisposition to facial clefting, attempts at identifying susceptibility loci via family and case control studies have proved inconsistent. This research program has identified a unique animal model for studying the etiology and pathogenic mechanisms of orofacial clefting. Mice homozygous for a spontaneous mutation, Dancer, exhibit cleft lip and cleft palate. Dancer heterozygous mice show predisposition to clefting: these mutant mice show cleft lip after outcrossing to a different genetic background and they also exhibit significantly increase susceptibility to teratogen-induced clefting. Preliminary studies have mapped the Dancer mutation to a 2.2 Mb genomic region, which is syntenic to a human chromosomal region with strong linkage to cleft susceptibility. Thus, the Dancer mutant mice provide a unique opportunity to identify a cleft predisposing gene and to characterize the molecular pathogenic processes, including gene-gene and geneenvironment interactions that lead to orofacial clefting. Two specific aims are proposed for this application: (1) to characterize the molecular basis of the Dancer mutation through a combination of candidate gene analysis and positional cloning; and (2) to characterize the gene expression profiles contributing to cleft pathogenesis in the Dancer mutants using a combination of microarray, real-time quantitative PCR, in situ hybridization and bioinformatic analyses. These studies will greatly increase our understanding of the pathogenic mechanisms underlying orofacial cleft formation and will lead to development of methods for better diagnosis, treatment and/or prevention of orofacial clefting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENETIC DETERMINANTS OF ISOLATED CLEFT PALATE IN MICE Principal Investigator & Institution: Everett, Eric T.; Assistant Professor; Oral Facial Development; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2002; Project Start 01-MAR-2001; Project End 28-FEB-2003

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Summary: Development of the mammalian secondary palate is a complex and critical process then when perturbed can lead to cleft palate (CP). Clefts of the primary and/or secondary palate are consistently included among he more common congenital anomalies occurring in humans. Children born with a cleft frequently require several different types of services, e.g., surgery, dental/orthodontic care, and speech therapy, all of which need to be provided in a coordinated manner over a period of years in order to obtain successful rehabilitation. Feeding, hearing, and speech problems are common sequelae of CP making this a significant disability particularly for the very young. Even though the combination of cleft lip with/or without cleft palate (CL/P) is more often seen, CP accounts for approximately one-third of all clefting cases and carries an incidence of 3 to 9 per 10,000 live births/year. CP is considered to an etiologically heterogeneous trait with an important genetic contribution. CP can be associated with more than 370 characterized disord4ers, yet in more than 50%^ cases, CP occurs as an isolated trait (non-syndromic). Our long- term objectives focus on understanding the molecular processes that govern mammalian secondary palate formation and on identifying and characterizing those genetic determinants that contribute directly and/or indirectly to the occurrence of CP in humans. The identification of genes responsible for CP in mice will permit characterization of their temporospatial patterns of expression and function activities during normal palatogenesis; and facilitate investigation of any putative roles played by their human counterparts in familial and sporadic forms of CP. We have identified four lines of transgenic mice resulting from recessive insertional mutations that cause non-syndromic CP. FISH analysis revealed the chromosomal localization of the transgene integration sites in three of the lines. The mutant loci map to Chromosome 3 at bands B-C and F3, in lines of OVE270 and OVE1226B, respectively. The transgene complex in the OVE1328 line localizes to Chromosome 4 at band A2. As a prelude to positional cloning strategies that will lead to the identification and characterizing the gene(s) disrupted, we will focus initially on one transgenic line in order to accomplish following specific aims: (1) identify and map the genomic DNA flanking the transgene complex integration site and (2) determine the interval of genomic DNA that in wildtype mice exists between the DNA that flanks the transgene integration site characterized in aim 1. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERNATIONAL GENETIC EPIDEMIOLOGY OF ORAL CLEFTS Principal Investigator & Institution: Beaty, Terri H.; Professor; Epidemiology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2004; Project Start 03-MAR-2004; Project End 31-DEC-2008 Summary: (provided by applicant): Cleft lip with/without cleft palate (CLP) is a complex and heterogeneous birth defect that represent a major public health burden because of the high prevalence and the medical burden they create for both affected infants and their families. The etiology of oral clefts remains enigmatic despite strong evidence that both genetic and environmental factors must be involved, both individually and through interaction. We propose an international multi-center, casefamily study of CL/P that will test a number of candidate genes and candidate chromosomal regions using haplotype and multipoint tests for linkage and disequilibrium due to linkage. Isolated, nonsyndromic CL/P cases and their families will be recruited from 5 sites: Maryland (Johns Hopkins Univ.), Singapore, Taiwan, Beijing and Weifang City in Shandong Province. The specific aims are: 1) To conduct a descriptive analysis of case families ascertained from these 5 sites using demographic, family and medical history information; 2) To type multiple single nucleotide

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polymorphisms (SNP) markers in a large number of candidate genes using a combination of high throughput SNP typing methods along with more robust sequence based methods for SNP genotyping at the National University of Singapore. Analysis of allele and haplotype frequencies among parents of cases will provide estimates of genetic distance among populations; 3) To use family-based association tests for linkage in the presence of disequilibrium with statistical models that can consider both individual markers and multipoint data; 4) To test for gene-environment and gene-gene interaction using haplotype-based analyses and conditional logistic regression models. This international multicenter study will be able to accumulate large numbers of casefamilies in a timely fashion, and providing adequate statistical power to identify genes controlling risk to CL/P even when they may interaction with one another or with environment factors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MAPPING NONSYNDROMIC CLEFT LIP AND PALATE GENETIC LOCI Principal Investigator & Institution: Hecht, Jacqueline T.; Professor; Pediatrics; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2003; Project Start 01-APR-1999; Project End 31-MAR-2007 Summary: (provided by applicant): Nonsyndromic cleft lip with or without cleft palate (NSCLP) is one of the five most common birth defects affecting 4,000 newborns per year in the United States. The etiology of NSCLP is complex. Although a number of susceptibility loci have been identified, they are postulated to play only a small etiologic role. The challenge now is to identify the genes that play a major role. A recent study in the mouse suggests that there are major NSCLP loci and that they can be identified. To accomplish this task, it is important to have a defined population and the methodology to detect linkage with and without association. Towards these goals, we have identified and characterized a large sample of multiplex NSCLP families. This unique resource of NSCLP families provides strong evidence that genetic factor(s) play an important role. Using these families, we have positionally identified four new candidate chromosomal regions and confirmed six chromosomal regions from a recent sib-pair analysis study that may contain NSCLP loci. In this continuing work, we will use our unique and large set of multiplex NSCLP families to refine these new candidate regions and test a set of biologically relevant candidate genes. At the same time, we will expand our multiplex families and then conduct a dense 5 cM genome-wide scan to optimize detection of NSCLP genetic loci. Parametric and nonparametric analyzes will incorporate environmental and vitamin exposures and maternal genotype information. Finally all candidate NSCLP genes yielding positive results will be tested in ethnically diverse simplex trios that we are collecting. The results of this study will provide insights into the causes of familial NSCLP and may yield new information about isolated NSCLP. Finally, identification of high-risk genotypes may lead to the development of prevention programs in selected populations and may suggest gene-based prevention strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MOUSE MODELS FOR VELOCARDIOFACIAL SYNDROME Principal Investigator & Institution: Reeves, Rodger; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 191044399 Timing: Fiscal Year 2002

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Summary: The goal of this study is to develop animal models of Velocardiofacial Syndrome (VCFS) that will allow comprehensive assessment of craniofacial development both prenatally and post-natally, and that will provide a system for identifying the genes responsible for known anomalies of this syndrome. Haploinsufficiency for a minimal critical region of Chr22 is strongly correlated with the occurrence of cleft lip and palate. We have mapped and are currently sequencing 1.5 MB of mouse Chr 16 that is homologous to human Chr 22 in collaboration with Dr. Bruce Roe, University of Oklahoma. These studies provide the information necessary to develop targeted deletions in embryonic stem cells to develop a VCFS model. In the first step, targeted homologous recombination has been used to delete the Gsc1 gene to permit assessment of its possible contribution to craniofacial disorders. (Disruption of the closely related gene, Gsc, results in craniofacial anomalies). PAC transgenic mice will be tested for complementation of defects seen in knock-out mice, localizing the region containing the relevant gene(s). Candidate genes from the deleted region identified from our independent sequencing project, or genes that may be affected downstream by the deletion will further elucidate gene function in this region. Specifically, our goals are to: 1. Create haplo-insufficiency in mice analogous to that in humans with Velocardiofacial Syndrome. 2. Assess VCFS-related phenotypes of heart and cranio-facial development in mice that are nullisomic (if viable), monosomic or trisomic for the affected region. 3. Analyze gene expression in aneuploid mice. Expression of individually targeted genes will be assessed directly by RT-PCR, Northern and (where applicable) Western blotting, and by in situ hybridization. To study the larger changes expression patterns, large cDNA arrays will be hybridized with RNA from corresponding tissues of control and engineered mice. 4. Identify by positional and functional cloning the genes responsible for VCFS-related phenotypes. We will complement deletion phenotypes with BAC/PAC transgenesis as a first step in positional cloning of genes responsible for the phenotypes. We will also mate deleted mice to ENU- treated males to uncover recessive mutations in genes from the VCFS region. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NELL-1, A CBFA1 DOWNSTREAM TARGET, IN BONE FORMATION Principal Investigator & Institution: Ting, Kang; Dental Research Institute; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2004; Project Start 01-JUL-2004; Project End 30-JUN-2009 Summary: (provided by applicant): Cbfa1 mediates mesenchymal cell commitment to an osteochondroprogenitor lineage and supports continued differentiation and function in committed osteoblasts. However, definitive downstream mediators of Cbfa1 that critically impact osteoblast differentiation and bone formation have yet to be described. Ne1 (a protein strongly expressed in neural tissue encoding epidermal growth factor like domain) was first identified in chicken embryos. The preliminary data shows that Nell-1 (Ne1-like molecule-1) in vivo is associated with normal and pathological suture fusion, while Nell- 1 in vitro is associated with increased osteoblast differentiation and mineralization. Furthermore, the human Nell-1 promoter contains three osteoblastspecific cis-acting element 2 (OSE2) response elements for Cbfa1 and that Nell-1 overexpression mice can functionally compensate for some aspects of intramembranous bone deficiency in heterozygous Cbfa1 deficient mice. These data have led to the hypothesis that Nell-1 is a central downstream target of Cbfa1 that supports continued differentiation and function in committed osteoblasts and proper Nell-1 expression is required for normal membranous bone growth and formation. To test this hypothesis,

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this proposal will analyze the following: 1) the regulation of Nell-1 transcription by Cbfa1 during osteoblast formation and function and by Cbfa1 through OSE2 response elements; 2) the functional compensation of Cbfa1 deficiency by Nell-1 in vivo and in vitro; and 3) the effects of targeted Nell-1 disruption in vivo. If Nell-1 is proven to be a critical mediator of intramembranous bone formation, it can further aid in understanding the development of intramembranous vs. endochondral bone. In addition, since sutures are major sites of calvarial intramembranous bone growth the close association of Nell-1 with calvarial sutures can also impact present knowledge on cranial vault development. Lastly, Nell-1 can be tremendously useful as a clinical tool to inhibit or induce intramembranous bone growth, with the secretory nature of Nell-1 making this utility even more feasible. Controlled inhibition of intramembranous bone growth by anti-Nell-1 strategies in CS patients may offer a less invasive, biologically based, therapeutic alternative to radical surgical craniofacial reconstruction. In addition, the ability of Nell- 1 to induce calvarial osteoblast differentiation may be clinically applied to situations where membranous bone formation and regeneration are desirable (e.g., cleft lip or cleft palate repair and craniofacial distraction osteogenesis). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ORAL FACIAL CLEFT FAMILIES--PHENOTYPE AND GENETICS Principal Investigator & Institution: Marazita, Mary L.; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002 Summary: Oral-facial clefts, particularly cleft lip with or without cleft palate (CL/P), are a major public health problem, affecting one in every 500- 1000 births worldwide. Therefore, many research groups have attempted to identify genetic loci contributing to the etiology of CL/P, with limited success to date. There have been several allelic associations identified in European Caucasian populations, a few potentially linked markers; however, these results have not been consistent across study populations. It appears that the genetic contribution to the etiology of oral-facial clefting is complex, possibly heterogeneous, or possibly due to interacting effects of multiple loci. A possible impediment to identifying loci for clefting is that the cleft itself is unlikely to be the proximate phenotype coded by the etiologic gene or genes. There is increasing evidence that developmental asymmetry effects may contribute to the etiology of oral-facial clefts. If we can more accurately identify the phenotype that is segregating at a genetic level in these families, then gene mapping and association studies will be more successful. Furthermore, it we can identify unaffected individuals who are likely to carrying cleft genes (e.g. individuals with sub-clinical phenotypic expression), then recurrence risk calculation and genetic counseling for this common birth defect will be vastly improved. The goal of this project is to investigate phenotypic features in multiplex kindreds (i.e. with 2 or more affecteds) ascertained through CL/P individuals served by the University of Pittsburgh Cleft Palate- Craniofacial Center. The specific features that will be investigated included: handedness, craniofacial measurements, asymmetry (based on dermatoglyphic patterns and craniofacial measurements), and anatomy of the orbicularis oris muscle. These features will be evaluated in each member of the multiplex kindreds. Each individual feature will be analyzed, as well as composite traits composed of two or more features. Statistical genetic methods will be used to investigate the segregation patterns of each trait in the sample of kindreds. In addition, a sample of controls with no known family history of clefting will be evaluated for the same phenotypic features in order to compare to the unaffected relatives (of cleft individuals). DNA will be obtained from all study participants in order to investigate a

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number of loci that have shown linkage and/or association with CL/P in other studies. These loci are located in specific regions of chromosomes 1, 2, 4, 6, 17 and 19. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OUTCOMES OF FURLOW&CONVENTIONAL PALATOPLASTY PROCEDURES Principal Investigator & Institution: Havlik, Robert J.; Surgery; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-MAY-2004 Summary: (provided by applicant): This clinical trial planning grant is to design a multicenter, multi-disciplinary prospectively randomized trial to evaluate the outcomes following two cleft palate repair techniques--Furlow double-Z palatoplasty (Double Z) and intra-velar veloplasty (IVV). The specific aims of the study are to determine if the primary endpoints of the occurrence of oro-nasal fistulae and the rate of velopharyngeal insufficiently of children undergoing double Z or IVV palatoplasty at 10-12 months of age are the same. It is also believed that cleft type and cleft width may influence these primary endpoints, a series of specific measurements of palatal architecture will be made at the time of palatal repair. Secondary endpoints will be to determine if the occurrence of oro-nasal fistulae or velopharyngeal competence differs as a result of any of these architectural parameters in the two techniques of palatal repair. Patients will be recruited from four major referral sites: Riley Hospital for Children, Children's Medical Center of Akron, Mott Children's Hospital and Children's Mercy Hospital in Kansas City. Total planned enrollment in the trial is 300 cleft patients over three years. Prior to surgery, appropriate screens will be performed to exclude patients with cognitive delay, sensori-neuronal hearing loss, or neuromuscular disorders. All non-syndromic patients with cleft palate, with or without cleft lip, will be offered participation in the trial. Audiology testing will be performed throughout the study to minimize the influence of hearing loss upon the data. A speech-language assessment will be performed at nine months of age, and follow-up speech language assessments will be at six-month intervals until 36 months of age, and on an annual basis thereafter until six years of age, or until secondary surgical management is recommended. In addition, a master tape at the 48-month visit will be sent to five independent speech-language pathologists for evaluation in a blinded fashion. Velopharyngeal assessment will be made using nasometry management and analysis will be performed through a separate data center. There are no randomized controlled trials published that compare these techniques of double Z or IVV, and, furthermore, there have been very few randomized trials published in cleft studies, despite this being the third most common birth defect. In addition, there have been no studies on the palatal architecture parameters and their influence upon oronasal fistulae and velopharyngeal competence that have been published. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PALATE FORMATION IN A MURINE MODEL Principal Investigator & Institution: Jezewski, Peter A.; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002 Summary: Dr. Jezewski is currently in the Dentist Scientist program at The University of Iowa College of Dentistry. He is pursuing clinical specialty training in Periodontics and a PhD in Oral Science. Dr. Jezewski mapped 4 of 5 exmons form one the candidate genes

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implicated in a mouse model of cleft lip and palate. He was able to obtain preliminary results using in situ hybridization techniques that signaling proteins implicated by the candidate genes are in fact expressed at the appropriate time and expected developing mouse embryo. Dr. Jezewski participated in the University of Iowa Annual Table Clinic competition winning third place in Graduate Awards. He attended a craniofacial development conference at NIH, Bethesda, MD November 21-25, 1998. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REGISTRY OF CRANIOFACIAL TREATMENT OUTCOMES Principal Investigator & Institution: Philips, Betty J.; Dental Ecology; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 01-JAN-1998; Project End 31-DEC-2003 Summary: The purpose of this project is to promote improvement in craniofacial health care outcomes. This study addresses two hypotheses: 1) tha significant discrepancies occurring in the outcomes of craniofacial health wil be identified when treatment outcomes of health care providers are compared an when the outcomes are compared with those suggested by published research and professional papers, and 2) that identification of discrepancies in craniofacial health care, coupled with actions taken by craniofacial teams, will result in improvement of health care outcomes. The aims of this project are: 1) development of a Craniofacial Registry for collection of clinical outcome date, 2) development of researched clinical outcome measures, 3) introduction of researched measures for widespread (national) data collection, 4) promotion of internal (self) assessment by craniofacial teams based on comparison of their performance with aggregate data, and 5) assessment of changes in aggregate data as teams take actions to improve outcomes. Procedure include: 1) design of multiple outcome measures, 2) clinical evaluation of outcome measures, 3) widespread data collection using the researched outcome measures, 4) transfer of the data on clinical outcomes to a Craniofacial Registry, 5) analysis and reporting of aggregate data, 6) comparative analysis of outcome performance of craniofacial teams, 7) report to the Registry of actions taken to improve clinical outcomes, 8) continued collection and transfer of data, and 9) assessment of changes in data over time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REGULATION OF NODAL SIGNALING IN HOLOPROSENCEPHALY Principal Investigator & Institution: Ding, Jixiang; Mol/Cell/Craniofacial Biology; University of Louisville Jouett Hall, Belknap Campus Louisville, Ky 40292 Timing: Fiscal Year 2004; Project Start 01-JUL-2004; Project End 30-JUN-2009 Summary: (provided by applicant): Holoprosencephaly represents a common birth defect (1:16,000 in live births and 1:250 in stillbirths) with a broad spectrum of craniofacial malformations ranging from distressful cyclopia to mild symptom of a single central incisor. It is caused by defects in the specification of the ventral forebrain (a part of the anterior axial midline), which subsequently lead to incomplete separation of the brain into the left and right hemispheres. Recent studies indicated that Nodal signaling plays a central role in controlling midline development, we therefore will focus on the regulation of Nodal signaling in mouse embryogenesis with a special interest in anterior axial midline formation. Nodal is a member of the transforming growth factor beta (TGF-beta) superfamily that utilizes a signaling pathway defined by Activin type I and II receptors, Smad2 and 4, and FoxH1 (FAST). Importantly, members of the EGF-CFC family of extracellular proteins such as mouse Cripto are essential co-

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factors for Nodal. We previously reported a Cripto Null allele, and recently we generated a Cripto hypomorphic allele, Cripto3-loxP, by genetic manipulation. Approximately 50 percent of the Cripto3-loxP/CriptoNull mice displayed a wide range of axial midline defects resembling holoprosencephaly. In contrast, TGIF is a homeobox gene encoding a nuclear protein that antagonizes TGF-( signaling by blocking Smad2 function. Interestingly, mutations in human TGIF gene are associated with holoprosencephaly, suggesting its function in axial midline formation, presumably through regulating Nodal/Smad2 signaling pathway. Based on these results, we will pursue the following Specific Aims in the proposed research: I) Analysis of the Cripto3loxP/CriptoNull mice as a model system for ventral forebrain defects and HPE by detailed analysis of the defects in Cripto3-loxP/CriptoNull mice at morphology and molecular levels; II) Investigation of mechanisms underlying Cripto function in mouse axial midline formation by identifying the tissues and cells where Cripto is functioning and downstream target genes of Cripto; III) Investigation of TGIF function in mouse axial midline development by generating TGIF null embryos and examining the modulation of Nodal signaling by TGIF. These studies should improve our understanding of mammalian axial midline formation and human holoprosencephaly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SKELETAL MUSCLE STEM CELLS FOR TISSUE REPAIR Principal Investigator & Institution: Kramer, Randall H.; Professor; Stomatology; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-MAY-2007 Summary: (provided by applicant): A major problem confronting craniofacial repair is the difficulty in restoring soft-tissue function and contour in patients with anomalies including hemifacial microsomia, unilateral clefts of lips and palate as well as defects in the TMJ. In particular, repair of skeletal muscle defects is limited by difficulty in its transplantation and survival. A logical approach is to use existing population of muscle satellite cells which are quiescent undifferentiated precursors found beneath the basement membrane of mature muscle fibers. Following injury, activated satellite cells regenerate muscle after initiating a differentiation program whereby they migrate along laminin-rich basement membrane, proliferate, differentiate, and integrate with preexisting myofibers. Recent evidence supports the notion that satellite cells are heterogeneous and have stem cell potential. We have shown that the laminin-binding alpha 7 integrin, which is important for myoblast migration, is expressed on a subset of satellite cells and is upregulated in terminally differentiated myotubes. In this application, we propose to examine the potential of using alpha 7-positive human satellite cells for direct repair of muscle defects. We will explore the hypothesis that alpha 7 expressing satellite cells are pluripotent stem cells capable of regenerating skeletal muscle and other tissue such as bone. The proposal represents three aims. In aim 1 we will characterize human muscle-derived satellite cells and correlate expression of alpha 7 integrin with their differentiation potential for skeletal muscle and other tissue lineages. Aim 2 will determine the expression and function of the alpha 7 integrin during human skeletal muscle development. Aim 3 is focused on the use of alpha 7expressing human skeletal muscle stem cells to engineer in vitro three-dimensional skeletal muscle myofibers. These studies will form the basis for strategies that target the mechanical reintegration of regenerating myotubes to repair orofacial muscle structures using adult skeletal muscle stem cells. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SNP DISCOVERY AND ANALYSIS IN CRANIOFACIAL BIRTH DEFECTS Principal Investigator & Institution: Scott, Alan F.; Director; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-MAY-2000; Project End 30-APR-2005 Summary: (Adapted from the Applicant's Description): This application proposes to locate single nucleotide polymorphisms SNPs using high throughput sequencing of genomic PCR products amplified from genes with demonstrated or presumed relevance to human birth defects. High throughput screening for this panel of SNPs will be applied first to a well characterized set of parent- offspring trios ascertained through a case with non-syndromic oral-facial clefts (OFC), including cleft lip with or without cleft palate (CLIP) and cleft palate (CP) using a high-throughput screening process, and second to patients with non-syndromic craniosynostosis. These case-parent trios are drawn from separate studies of oral clefts or craniosynostosis designed to identify genes involved in the etiology of this common group of birth defects and test for possible interaction with environmental exposures. The case- parent trio design proposed here tests for linkage in the presence of linkage disequilibrium, and the availability of these DNA samples on a large number of case-parent trios will allow immediate tests for the SNP markers developed as part of this proposal. Following the OFC study the investigators will extend SNP screening to a collection of craniosynostosis patients and their parents from a previous study conducted by the investigators and from the Centers of Birth Defect Research and Prevention sponsored by the Centers for Disease Control (CDC). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRANSCRIPTION FACTORS REGULATING PALATOGENESIS Principal Investigator & Institution: Darling, Douglas S.; Mol/Cell/Craniofacial Biology; University of Louisville Jouett Hall, Belknap Campus Louisville, Ky 40292 Timing: Fiscal Year 2002; Project Start 01-MAR-2001; Project End 28-FEB-2003 Summary: Defects in craniofacial development to cleft palate and/or cleft lip in more than 1 out of 1,000 births. Investigation of the molecular mechanisms of craniofacial development will lead to improved diagnosis, treatment, and prevention of these birth defects. The long term objective of this project is to understand the role of the transcription factor Zfhep in craniofacial development. Targeted disruption of the Zfhep/deltaEF-1 gene in mice created cleft secondary palate, hypertrophy of Meckel's cartilage, and perinatal death. However, it is unknown whether these facial defects are due to a direct, or indirect involvement of Zfhep in development. Defining the temporalspacial expression of Zfhep is an essential step towards determining whether it has a direct role in craniofacial development. The specific goals of this project are to determine the expression pattern of both Zfhep-1 and Zfhep-2 in the mesenchyme and epithelium of the palate, and in Meckel's cartilage during mouse development using both in situ hybridization and immunohistochemistry. We will also investigate the expression of Zfhep during development of tooth buds. We will determine the specific cell types (prechrondrocytes, chrondrocytes, or hypertrophy chrondrocytes) expressing Zfhep during development of Meckel's cartilage. The results of this R03 application will provide a complete picture of the temporal and spatial expression pattern of Zfhep during craniofacial development, and demonstrate where Zfhep can have direct effects on development. Subsequent work will investigate the molecular mechanism(s) of Zfhep action during craniofacial development.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VELOPHARYNGEAL FUNCTION FOR SPEECH AFTER PALATAL SURGERY Principal Investigator & Institution: Williams, William N.; Director and Professor; Oral Biology; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2002; Project Start 30-SEP-1994; Project End 30-JUN-2005 Summary: The incidence of cleft lip/palate is 1/750, making it one of the most common congenital malformations. The primary goal in surgically repairing the palatal cleft is to construct a competent velopharyngeal port for the development of normal speech. Failure to establish velopharyngeal competency results in speech characterized by hypernasality, loss of intraoral air pressure through the nose, and articulation disorders. The University of Florida, in collaboration with the University of Sao Paulo, Bauru, Brazil, is proposing a five-year continuation prospective randomized, controlled study to complete the assessment of velopharyngeal function for speech following palatoplasty (by the von Langenbeck procedure with intravelar velar plasty, and the Furlow double opposing z-plasty palatoplasty) for 352 subjects with complete unilateral cleft lip and palate. The von Langenbeck procedure has been selected as the time tested standard against which the Furlow procedure can be judged. The Furlow procedure has been reported to yield higher rates of velopharyngeal competency than identified in most other reported series, which also theoretically should result in less disturbance to mid-facial growth. Fewer patients than projected (explained in the text), were available for enrollment by the end of the initial study (9/99), and less than 50 were old enough for reliable assessment of their velopharyngeal competency for speech. Continuation of the study will allow enrollment of all 352 patients and the comparison of results between patients operated between 9-12 months of age and patients 15-18 months of age. Perceptual and instrumental measures of speech and velopharyngeal function will be obtained on all patients within the five year time frame of the proposed project. Facial growth analysis, although not a part of the proposed study, will continue until all patients reach maturity. The clinical caseload at the University of Sao Paulo currently exceeds 29,000 and over 1,500 new cases of cleft lip/palate are added yearly. This project represents a unique opportunity to obtain prospective data with a large number of subjects, controlling the variables which have traditionally plagued cleft palate studies. This study should definitively answer the question of which of the two surgical procedures is superior in constructing a velum capable of effecting velopharyngeal competency for the development of normal speech. In addition, this study may serve as a model for international prospective clinical trials, such as in Russia and Ukraine where treatment of cleft palate is centralized. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and 3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age.

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unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “cleft lip” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for cleft lip in the PubMed Central database: •

Genome scan for teratogen-induced clefting susceptibility loci in the mouse: Evidence of both allelic and locus heterogeneity distinguishing cleft lip and cleft palate. by Diehl SR, Erickson RP.; 1997 May 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=24661

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Hyperoxia and hypoxia in pregnancy: simple experimental manipulation alters the incidence of cleft lip and palate in CL/Fr mice. by Millicovsky G, Johnston MC.; 1981 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=348841

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Long-term follow up study of survival associated with cleft lip and palate at birth. by Christensen K, Juel K, Herskind AM, Murray JC.; 2004 Jun 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=421777

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with cleft lip, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “cleft lip” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for cleft lip (hyperlinks lead to article summaries): •

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A case of cleft lip and palate associated with Seckel syndrome. Author(s): Murthy J, Seshadri KG, Ramanan PV, Rajamani A, Hussain A. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2004 March; 41(2): 202-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14989682

The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A clinical profile to assess the potential risk factors for cleft lip and palate. Author(s): Rajesh P, Rajesh R, Narayanan V, Baig MF, Prabhu VR, Venkatesan A. Source: J Indian Soc Pedod Prev Dent. 2000 December; 18(4): 147-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11601185

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A comparison of craniofacial form in Northern Irish children with unilateral cleft lip and palate treated with different primary surgical techniques. Author(s): Johnston CD, Leonard AG, Burden DJ, McSherry PF. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2004 January; 41(1): 42-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14697071

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A comparison of the effects of the Latham-Millard procedure with those of a conservative treatment approach for dental occlusion and facial aesthetics in unilateral and bilateral complete cleft lip and palate: part I. Dental occlusion. Author(s): Berkowitz S, Mejia M, Bystrik A. Source: Plastic and Reconstructive Surgery. 2004 January; 113(1): 1-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14707617

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A computer-aided cleft lip simulation surgery system. Author(s): Tanaka D, Kobayashi M, Fujino T, Nakajima T, Chiyokura H. Source: The Keio Journal of Medicine. 2001 March; 50 Suppl 2: 121-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11584502

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A longitudinal group study of speech development in Danish children born with and without cleft lip and palate. Author(s): Hutters B, Bau A, Brondsted K. Source: International Journal of Language & Communication Disorders / Royal College of Speech & Language Therapists. 2001 October-December; 36(4): 447-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11802497

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A new approach to classify cleft lip and palate. Author(s): Ortiz-Posadas MR, Vega-Alvarado L, Maya-Behar J. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 November; 38(6): 545-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11681986

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A quantitative three-dimensional assessment of soft tissue facial asymmetry of cleft lip and palate adult patients. Author(s): Ferrario VF, Sforza C, Dellavia C, Tartaglia GM, Colombo A, Caru A. Source: The Journal of Craniofacial Surgery. 2003 September; 14(5): 739-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501340

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A randomised prospective clinical trial into the effect of infant orthopaedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft). Author(s): Prahl C, Kuijpers-Jagtman AM, van't Hof MA, Prahl-Andersen B. Source: European Journal of Oral Sciences. 2001 October; 109(5): 297-305. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11695749

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A simple method for lower lateral cartilage repositioning in cleft lip nose deformity. Author(s): Demirseren ME, Ohkubo F, Kadomatsu K, Hosaka Y. Source: Plastic and Reconstructive Surgery. 2004 February; 113(2): 649-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14758229

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Adverse association of oesophageal atresia and cleft lip and palate (Br J Surg 2003; 90: 716-717). Author(s): Deurloo JA, Aronson DC. Source: The British Journal of Surgery. 2003 September; 90(9): 1166. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12945093

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An anthropometric analysis of indices of severity in the unilateral cleft lip. Author(s): Yeow VK, Huang MH, Lee ST, Fook Chong SM. Source: The Journal of Craniofacial Surgery. 2002 January; 13(1): 68-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11886996

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An epidemiologic study of isolated cleft lip, palate, or both in Victoria, Australia from 1983 to 2000. Author(s): Vallino-Napoli LD, Riley MM, Halliday J. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2004 March; 41(2): 185-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14989685

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An international surgical exchange program for children with cleft lip/cleft palate in Manaus, Brazil: patient and family expectations of outcome. Author(s): Reeve ME, Groce NE, Persing JA, Magge SN. Source: The Journal of Craniofacial Surgery. 2004 January; 15(1): 170-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14704585

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Analgesia for cleft lip and palate: comment on Takemura et al. Author(s): Castilla M. Source: Paediatric Anaesthesia. 2003 September; 13(7): 646; Author Reply 647. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12950882

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Analysis of nasal and labial deformities in cleft lip, alveolus and palate patients by a new rating scale: preliminary report. Author(s): Anastassov Y, Chipkov C. Source: Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. 2003 October; 31(5): 299-303. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14563331

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Analysis of polymorphic TGFB1 codons 10, 25, and 263 in a German patient group with non-syndromic cleft lip, alveolus, and palate compared with healthy adults. Author(s): Stoll C, Mengsteab S, Stoll D, Riediger D, Gressner AM, Weiskirchen R. Source: Bmc Medical Genetics [electronic Resource]. 2004 June 22; 5(1): 15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15212689

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Arm restraint in children with cleft lip and palate. Author(s): Skoll PJ, Lazarus DA. Source: Plastic and Reconstructive Surgery. 2004 April 15; 113(5): 1523. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15060385

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Association between 10 microsatellite markers and nonsyndromic cleft lip palate in the Chilean population. Author(s): Blanco R, Suazo J, Santos JL, Paredes M, Sung H, Carreno H, Jara L. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2004 March; 41(2): 163-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14989688

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Associations between severity of clefting and maxillary growth in patients with unilateral cleft lip and palate treated with infant orthopedics. Author(s): Peltomaki T, Vendittelli BL, Grayson BH, Cutting CB, Brecht LE. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 November; 38(6): 582-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11681991

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Basal cell carcinoma arising in a cleft lip repair scar. Author(s): Wright MW, McCarthy RA, Kelly EB, Wright ST, Wagner RF. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2001 February; 27(2): 195-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11207698

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Bilateral cleft lip and palate and limb deformities: a presentation of amniotic band sequence? Author(s): Jabor MA, Cronin ED. Source: The Journal of Craniofacial Surgery. 2000 July; 11(4): 388-93. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11314389

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Bilateral cleft lip and palate associated with increased nuchal translucency and maternal cocaine abuse at 14 weeks of gestation. Author(s): Markov D, Jacquemyn Y, Leroy Y. Source: Clin Exp Obstet Gynecol. 2003; 30(2-3): 109-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12854855

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Bilateral complete cleft lip and nasal deformity: an anthropometric analysis of staged to synchronous repair. Author(s): Mulliken JB. Source: Plastic and Reconstructive Surgery. 1995 July; 96(1): 9-23; Discussion 24-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7604136

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Bilateral infraorbital nerve block is superior to peri-incisional infiltration for analgesia after repair of cleft lip. Author(s): Prabhu KP, Wig J, Grewal S. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 1999 March; 33(1): 83-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10207969

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Bilateral one-stage rotation advancement technique for Saudi children with isolated bilateral incomplete cleft lip: low revision rate despite multiple imperfections. Author(s): Al-Qattan MM. Source: Annals of Plastic Surgery. 2002 April; 48(4): 365-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12068217

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Bilaterally cleft lip, limb defects, and haematological manifestations: Roberts syndrome versus TAR syndrome. Author(s): Urban M, Opitz C, Bommer C, Enders H, Tinschert S, Witkowski R. Source: American Journal of Medical Genetics. 1998 September 23; 79(3): 155-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9788553

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Binderoid complete cleft lip/palate. Author(s): Mulliken JB, Burvin R, Padwa BL. Source: Plastic and Reconstructive Surgery. 2003 March; 111(3): 1000-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12621169

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Bipedicled axial cross-lip flap for correction of major vermilion deficiency after cleft lip repair. Author(s): Wagner JD, Newman MH. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1994 March; 31(2): 148-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8186224

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Birth prevalence of cleft lip and palate in Colorado by sex distribution, seasonality, race/ethnicity, and geographic variation. Author(s): Amidei RL, Hamman RF, Kassebaum DK, Marshall JA. Source: Spec Care Dentist. 1994 November-December; 14(6): 233-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7754460

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Birth prevalence of cleft lip and palate in Sucre, Bolivia. Author(s): McLeod NM, Urioste ML, Saeed NR. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2004 March; 41(2): 195-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14989684

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Birth weight and gestational age of newborns with cleft lip with or without cleft palate and with isolated cleft palate. Author(s): Wyszynski DF, Sarkozi A, Vargha P, Czeizel AE. Source: J Clin Pediatr Dent. 2003 Winter; 27(2): 185-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12597694

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Bone grafting in the mixed and permanent dentition in cleft lip and palatepatients: long-term results and the role of the surgeon's experience. Author(s): Kalaaji A, Lilja J, Friede H, Elander A. Source: Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. 1996 February; 24(1): 29-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8707939

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Bone grafting of cleft lip and palate patients for placement of endosseous implants. Author(s): Jansma J, Raghoebar GM, Batenburg RH, Stellingsma C, van Oort RP. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1999 January; 36(1): 67-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10067765

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Bone grafting the piriform aperture deformity in isolated cleft lip patients: indication, technique, and results. Author(s): van der Wal KG, van der Meulen BD, van der Biezen JJ, Mulder JW. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1997 October; 55(10): 1089-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9331231

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Branchio-oculo-facial syndrome with cleft lip and bilateral dermal thymus. Author(s): Bennaceur S, Buisson T, Bertolus C, Couly G. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1998 September; 35(5): 454-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9761567

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Breast feeding for cleft lip and palate patients, using the Hotz-type plate. Author(s): Kogo M, Okada G, Ishii S, Shikata M, Iida S, Matsuya T. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1997 July; 34(4): 351-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9257027

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Breast feeding or spoon feeding after cleft lip repair: a prospective, randomised study. Author(s): Darzi MA, Chowdri NA, Bhat AN. Source: British Journal of Plastic Surgery. 1996 January; 49(1): 24-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8705098

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Breast-feeding and sugar intake in babies with cleft lip and palate. Author(s): da Silva Dalben G, Costa B, Gomide MR, Teixeira das Neves LT. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 January; 40(1): 84-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12498610

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Brief report: cleft lip and palate: longitudinal behavior and relationships of cleft conditions to behavior and achievement. Author(s): Richman LC, Millard T. Source: Journal of Pediatric Psychology. 1997 August; 22(4): 487-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9302846

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Candidate genes for nonsyndromic cleft lip and palate. Author(s): Vieira AR, Orioli IM. Source: Asdc J Dent Child. 2001 July-August; 68(4): 272-9, 229. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11862881

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Caries experience and oral health behavior in Chinese children with cleft lip and/or palate. Author(s): Bian Z, Du M, Bedi R, Holt R, Jin H, Fan M. Source: Pediatr Dent. 2001 September-October; 23(5): 431-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11699170

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Chromosomal defects and associated malformations in fetal cleft lip with or without cleft palate. Author(s): Perrotin F, de Poncheville LM, Marret H, Paillet C, Lansac J, Body G. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 November; 99(1): 19-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11604181

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Cleft lip and palate incidence among the live births in the Republic of Korea. Author(s): Kim S, Kim WJ, Oh C, Kim JC. Source: Journal of Korean Medical Science. 2002 February; 17(1): 49-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11850588

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Cleft lip and palate services. Author(s): Crown J. Source: International Journal of Paediatric Dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children. 2004 March; 14(2): 146-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15005704

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Cleft lip and palate services. A review of developments five years after the CSAG report. Author(s): Murray JJ. Source: International Journal of Paediatric Dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children. 2003 November; 13(6): 395402; Discussion 403. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14984045

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Cleft lip and palate surgery. Author(s): Lilja J. Source: Scand J Surg. 2003; 92(4): 269-73. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14758916

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Cleft lip and palate: a review for dentists. Author(s): Precious DS, Goodday RH, Morrison AD, Davis BR. Source: Journal (Canadian Dental Association). 2001 December; 67(11): 668-73. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11841748

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Cleft lip and palate: new genetic clues. Author(s): Aldred MA. Source: Trends in Molecular Medicine. 2001 December; 7(12): 539-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11733204

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Cleft lip/nose deformity and rhinolith. Author(s): Turan A, Gozu A, Genc B, Dayicioglu D, Ozsoy Z, Yasar H, Kilavuz ES. Source: Plastic and Reconstructive Surgery. 2004 March; 113(3): 1079-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15108916

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Clinical and microbiological evaluation of the periodontal status of children with unilateral complete cleft lip and palate. Author(s): Costa B, Lima JE, Gomide MR, Rosa OP. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 November; 40(6): 585-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14577819

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Comparison of three nonradiographic methods of mixed dentition analysis in cleft lip and palate patients. Author(s): Wangpichit K, Huntington NL, Kapala JT. Source: Pediatr Dent. 2001 November-December; 23(6): 476-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11800446

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Complex segregation analysis of 1,792 cleft lip and palate families in South America: 1967-1997. Author(s): Vieira AR, Romitti PA, Orioli IM, Castilla EE. Source: Pesquisa Odontologica Brasileira = Brazilian Oral Research. 2003 April-June; 17(2): 161-5. Epub 2003 October 10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14569360

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Comprehensive management of cleft lip and palate deformities. Author(s): Anastassov GE, Joos U. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2001 September; 59(9): 1062-75; Discussion 1075-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11526580

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Controversies in cleft lip and palate management. Author(s): Moss A. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2001 November; 18(5): 420-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11844158

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Cleft Lip

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Correction of cleft lip nasal deformity in Orientals using a refined reverse-U incision and V-Y plasty. Author(s): Cho BC, Baik BS. Source: British Journal of Plastic Surgery. 2001 October; 54(7): 588-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11583495

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Correction of severe secondary cleft lip nasal deformity using a composite graft: current approach and review. Author(s): Cho BC, Park JW, Baik BS. Source: Annals of Plastic Surgery. 2002 February; 48(2): 131-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11910217

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Cost-effectiveness of infant orthopedic treatment regarding speech in patients with complete unilateral cleft lip and palate: a randomized three-center trial in the Netherlands (Dutchcleft). Author(s): Konst EM, Prahl C, Weersink-Braks H, De Boo T, Prahl-Andersen B, Kuijpers-Jagtman AM, Severens JL. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2004 January; 41(1): 71-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14697066

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Cranial base growth and morphology in second-trimester normal human fetuses and fetuses with cleft lip. Author(s): Sherwood TF, Mooney MP, Sciote JJ, Smith TD, Cooper GM, Siegel MI. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 November; 38(6): 587-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11681992

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Cross-talk between interleukin-6 and transforming growth factor-beta3 regulates extracellular matrix production by human fibroblasts from subjects with nonsyndromic cleft lip and palate. Author(s): Baroni T, Carinci P, Bellucci C, Lilli C, Becchetti E, Carinci F, Stabellini G, Pezzetti F, Caramelli E, Tognon M, Bodo M. Source: J Periodontol. 2003 October; 74(10): 1447-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14653390

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Demographic and prenatal factors of patients with cleft lip and cleft palate. A pilot study. Author(s): Abramowicz S, Cooper ME, Bardi K, Weyant RJ, Marazita ML. Source: The Journal of the American Dental Association. 2003 October; 134(10): 1371-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14620018

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Dental abnormalities, bone graft quality, and periodontal conditions in patients with unilateral cleft lip and palate at different phases of orthodontic treatment. Author(s): Dewinter G, Quirynen M, Heidbuchel K, Verdonck A, Willems G, Carels C. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 July; 40(4): 343-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12846599

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Dental anesthetic procedures for cleft lip and palate patients. Author(s): da Silva Dalben G, Costa B, Gomide MR, das Neves LT. Source: J Clin Pediatr Dent. 2000 Spring; 24(3): 153-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11318002

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Dental anomalies of the permanent lateral incisors and prevalence of hypodontia outside the cleft area in complete unilateral cleft lip and palate. Author(s): Lourenco Ribeiro L, Teixeira Das Neves L, Costa B, Ribeiro Gomide M. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 March; 40(2): 172-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12605523

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Dental arch relationships in Yorkshire children with unilateral cleft lip and palate. Author(s): Morris DO, Roberts-Harry D, Mars M. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2000 September; 37(5): 453-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11034027

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Dental arches and occlusion in bilateral cleft lip and palate patients after two different routines for palatal surgery. Author(s): Melissaratou A, Friede H. Source: Journal of Orofacial Orthopedics = Fortschritte Der Kieferorthopadie : Organ/Official Journal Deutsche Gesellschaft Fur Kieferorthopadie. 2002 July; 63(4): 300-14. English, German. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12198745

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Dental care for the patient with a cleft lip and palate. Part 2: The mixed dentition stage through to adolescence and young adulthood. Author(s): Rivkin CJ, Keith O, Crawford PJ, Hathorn IS. Source: British Dental Journal. 2000 February 12; 188(3): 131-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10717999

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Cleft Lip

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Dental development of permanent lateral incisor in complete unilateral cleft lip and palate. Author(s): Ribeiro LL, das Neves LT, Costa B, Gomide MR. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 March; 39(2): 193-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11879078

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Dental health indices and caries associated microflora in children with unilateral cleft lip and palate. Author(s): Lucas VS, Gupta R, Ololade O, Gelbier M, Roberts GJ. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2000 September; 37(5): 447-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11034026

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Dental maturity in children with a complete bilateral cleft lip and palate. Author(s): Heidbuchel KL, Kuijpers-Jagtman AM, Ophof R, van Hooft RJ. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 September; 39(5): 509-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12190338

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Dental rehabilitation using endosseous implants and orthognathic surgery in patients with cleft lip and palate: report of two cases. Author(s): Fukuda M, Takahashi T, Yamaguchi T, Kochi S, Inai T, Watanabe M, Echigo S. Source: Journal of Oral Rehabilitation. 2000 June; 27(6): 546-51. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10888283

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Dento-alveolar development in unilateral cleft lip, alveolus and palate. Author(s): Noguchi M, Suda Y, Ito S, Kohama G. Source: Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. 2003 June; 31(3): 137-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12818597

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Dentocraniofacial morphology of 12 Japanese subjects with unilateral cleft lip and palate with a severe Class III malocclusion: a cephalometric study at the pretreatment stage of surgical orthodontic treatment. Author(s): Tateishi C, Moriyama K, Takano-Yamamoto T. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 November; 38(6): 597-605. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11681993

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Description of a clinical technique for tooth extraction in the cleft lip and palate area. Author(s): Dalben GS, Gomide MR, Costa B, Neves LT. Source: International Journal of Paediatric Dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children. 2001 March; 11(2): 143-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11310139

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Descriptive epidemiology of nonsyndromic cleft lip with or without cleft palate in Shanghai, China, from 1980 to 1989. Author(s): Cooper ME, Stone RA, Liu Y, Hu DN, Melnick M, Marazita ML. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2000 May; 37(3): 274-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10830807

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Developmental dental changes in isolated cleft lip and palate. Author(s): Pham AN, Seow WK, Shusterman S. Source: Pediatr Dent. 1997 March-April; 19(2): 109-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9106872

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Diencephalic neuronal hamartoma associated with congenital obstructive hydrocephalus, anophthalmia, cleft lip and palate and severe mental retardation: a possible new syndrome. Author(s): Rossiter JP, Khalifa MM, Nag S. Source: Acta Neuropathologica. 2000 June; 99(6): 685-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10867803

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Does the interaction between maternal folate intake and the methylenetetrahydrofolate reductase polymorphisms affect the risk of cleft lip with or without cleft palate? Author(s): van Rooij IA, Vermeij-Keers C, Kluijtmans LA, Ocke MC, Zielhuis GA, Goorhuis-Brouwer SM, van der Biezen JJ, Kuijpers-Jagtman AM, Steegers-Theunissen RP. Source: American Journal of Epidemiology. 2003 April 1; 157(7): 583-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12672677

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Duplication (22)(q11.22-q11.23) without coloboma and cleft lip or palate. Author(s): Sonoda T, Kouno K, Sawada K, Takagi J, Nunoi H, Harada N, Matsumoto N. Source: Pediatrics International : Official Journal of the Japan Pediatric Society. 2003 February; 45(1): 97-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12654079

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Duplication of (2)(q11.1-q13.2) in a boy with mental retardation and cleft lip and palate: another clefting gene locus on proximal 2q? Author(s): Riegel M, Schinzel A. Source: American Journal of Medical Genetics. 2002 July 22; 111(1): 76-80. Review. Erratum In: Am J Med Genet. 2002 December 1; 113(3): 313. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12124740

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Early maxillary growth in complete cleft lip, alveolus and palate patients following Widmaier-Perko's, or a modified Furlow's technique of soft palate repair. Author(s): Mommaerts MY, Kablan F, Sheth S, Laster Z. Source: Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. 2003 August; 31(4): 209-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12914705

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Early predictors of attachment in infants with cleft lip and/or palate. Author(s): Speltz ML, Endriga MC, Fisher PA, Mason CA. Source: Child Development. 1997 February; 68(1): 12-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9084121

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Ectodermal dysplasia, cleft lip/palate, and severe cutaneous and osseous syndactyly in a mentally retarded girl: a new multiple malformation syndrome. Author(s): Freihofer HP, Walji S, Brunner HG. Source: American Journal of Medical Genetics. 1997 June 13; 70(3): 211-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9188655

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Ectopic tooth in a cleft lip and palate patient. Author(s): Yilmaz AB. Source: Plastic and Reconstructive Surgery. 2002 November; 110(6): 1598-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12409790

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Ectrodactary, ectodermal dysplasia, and cleft lip-palate syndrome. Author(s): Choong YY, Norazlina B. Source: Med J Malaysia. 2001 March; 56(1): 88-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11503303

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Effect of primary surgery for cleft lip and palate on mid-facial growth. Author(s): Markus AF, Precious DS. Source: The British Journal of Oral & Maxillofacial Surgery. 1997 February; 35(1): 6-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9042997

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Effects of cheiloplasty on maxillary dental arch development in infants with unilateral complete cleft lip and palate. Author(s): Huang CS, Wang WI, Liou EJ, Chen YR, Chen PK, Noordhoff MS. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 September; 39(5): 513-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12190339

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Effects of orthognathic surgery on speech and breathing of subjects with cleft lip and palate: acoustic and aerodynamic assessment. Author(s): Trindade IE, Yamashita RP, Suguimoto RM, Mazzottini R, Trindade AS Jr. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 January; 40(1): 54-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12498606

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Effects of timing and number of palate repair on maxillary growth in complete unilateral cleft lip and palate patients. Author(s): Jena AK, Duggal R, Roychoudhury A, Parkash H. Source: J Clin Pediatr Dent. 2004 Spring; 28(3): 225-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15163151

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Effects of variation in the timing of palatal repair on sagittal craniofacial morphology in complete cleft lip and palate children. Author(s): Nandlal, Utreja A, Tewari A, Chari PS. Source: J Indian Soc Pedod Prev Dent. 2000 December; 18(4): 153-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11601187

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Effects of variation of the timing of palatal repair on nasality of speech in complete cleft lip and palate children. Author(s): Nandlal B, Tewari A, Utreja AK, Chari PS, Raghunathan N. Source: J Indian Soc Pedod Prev Dent. 1999 December; 17(4): 146-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10863511

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Epidemiology of cleft lip and cleft palate in Pakistan. Author(s): Elahi MM, Jackson IT, Elahi O, Khan AH, Mubarak F, Tariq GB, Mitra A. Source: Plastic and Reconstructive Surgery. 2004 May; 113(6): 1548-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15114113

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Evaluation of primary dentition in cleft lip and palate children with and without natal/neonatal teeth. Author(s): Cabete HF, Gomide MR, Costa B. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2000 July; 37(4): 406-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10912720

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Evaluation of the results of cleft lip and palate surgical treatment: preliminary report. Author(s): Mortier PB, Martinot VL, Anastassov Y, Kulik JF, Duhamel A, Pellerin PN. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1997 May; 34(3): 247-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9167077

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Evidence for linkage of nonsyndromic cleft lip with or without cleft palate to a region on chromosome 2. Author(s): Zeiger JS, Hetmanski JB, Beaty TH, VanderKolk CA, Wyszynski DF, BaileyWilson JE, de Luna RO, Perandones C, Tolarova MM, Mosby T, Bennun R, Segovia M, Calda P, Pugh EW, Doheny K, McIntosh I. Source: European Journal of Human Genetics : Ejhg. 2003 November; 11(11): 835-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14571267

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Evidence of a sex-dependent association between the MSX1 locus and nonsyndromic cleft lip with or without cleft palate in the Chilean population. Author(s): Blanco R, Chakraborty R, Barton SA, Carreno H, Paredes M, Jara L, Palomino H, Schull WJ. Source: Human Biology; an International Record of Research. 2001 February; 73(1): 81-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11332647

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Evidence of linkage to 6p23 and genetic heterogeneity in nonsyndromic cleft lip with or without cleft palate. Author(s): Scapoli L, Pezzetti F, Carinci F, Martinelli M, Carinci P, Tognon M. Source: Genomics. 1997 July 15; 43(2): 216-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9244439

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Excellence in cleft lip and palate treatment. Author(s): Salyer KE. Source: The Journal of Craniofacial Surgery. 2001 January; 12(1): 2-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11314183

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Experience of teenagers born with cleft lip and/or palate and interventions of the health nurse. Author(s): Chapados C. Source: Issues in Comprehensive Pediatric Nursing. 2000 January-March; 23(1): 27-38. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11011661

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Experience with unoperated cleft lip and palate patients in a Nigerian teaching hospital. Author(s): Olasoji O, Arotiba T, Dogo D. Source: Trop Doct. 2002 January; 32(1): 33-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11991025

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Facial appearance in adults who had cleft lip and palate treated in childhood. Author(s): Marcusson A, Paulin G, Ostrup L. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 2002; 36(1): 1623. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11925823

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Facial asymmetry--3D assessment of infants with cleft lip & palate. Author(s): Hood CA, Bock M, Hosey MT, Bowman A, Ayoub AF. Source: International Journal of Paediatric Dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children. 2003 November; 13(6): 40410. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14984046

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Facial characterization of infants with cleft lip and palate using a three-dimensional capture technique. Author(s): Hood CA, Hosey MT, Bock M, White J, Ray A, Ayoub AF. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2004 January; 41(1): 27-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14697073

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Facial growth after different methods of surgical intervention in patients with cleft lip and palate. Author(s): Semb G, Shaw WC. Source: Acta Odontologica Scandinavica. 1998 December; 56(6): 352-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10066115

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Facial growth and development in unilateral complete cleft lip and palate from palate surgery up to adulthood. Author(s): Smahel Z, Betincova L, Mullerova Z, Skvarilova B. Source: Journal of Craniofacial Genetics and Developmental Biology. 1993 JanuaryMarch; 13(1): 57-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8478419

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Factors related to relapse after Le Fort I maxillary advancement osteotomy in patients with cleft lip and palate. Author(s): Hirano A, Suzuki H. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 January; 38(1): 1-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11204674

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Failure to thrive in babies with cleft lip and palate. Author(s): Pandya AN, Boorman JG. Source: British Journal of Plastic Surgery. 2001 September; 54(6): 471-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11513506

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Failure to thrive in babies with cleft lip and palate. Author(s): Willis K, Moss AL. Source: British Journal of Plastic Surgery. 2002 March; 55(2): 175. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11987969

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Feeding babies with cleft lip and palate. Author(s): Carlisle D. Source: Nurs Times. 1998 January 28-February 3; 94(4): 59-60. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9510813

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Feeding behaviour of infants with cleft lip and palate. Author(s): Mizuno K, Ueda A, Kani K, Kawamura H. Source: Acta Paediatrica (Oslo, Norway : 1992). 2002; 91(11): 1227-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12463323

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Fetal cleft lip and palate detection by three-dimensional ultrasonography. Author(s): Lee W, Kirk JS, Shaheen KW, Romero R, Hodges AN, Comstock CH. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2000 September; 16(4): 314-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11169306

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Fetal cleft lip and palate: sonographic diagnosis, chromosomal abnormalities, associated anomalies and postnatal outcome in 70 fetuses. Author(s): Berge SJ, Plath H, Van de Vondel PT, Appel T, Niederhagen B, Von Lindern JJ, Reich RH, Hansmann M. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2001 November; 18(5): 422-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11844159

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Fetal unilateral cleft lip and palate: detection of enzymic anomalies in the amniotic fluid. Author(s): Raposio E, Panarese P, Santi P. Source: Plastic and Reconstructive Surgery. 1999 February; 103(2): 391-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9950523

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Finite element method analysis of craniofacial morphology in unilateral cleft lip and palate prior to palatoplasty. Author(s): Hammond AB, Smahel Z, Moss ML. Source: Journal of Craniofacial Genetics and Developmental Biology. 1993 JanuaryMarch; 13(1): 47-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8478418

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Formation and enlargement of the paranasal sinuses in normal and cleft lip and palate human fetuses. Author(s): Smith TD, Siegel MI, Mooney MP, Burrows AM, Todhunter JS. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1997 November; 34(6): 483-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9431465

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Formation of philtral column using vertical interdigitation of orbicularis oris muscle flaps in secondary cleft lip. Author(s): Cho BC, Baik BS. Source: Plastic and Reconstructive Surgery. 2000 October; 106(5): 980-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11039367

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Free dermis-fat graft to correct the whistle deformity in patients with cleft lip. Author(s): Patel IA, Hall PN. Source: British Journal of Plastic Surgery. 2004 March; 57(2): 160-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15037173

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Free flap closure of recurrent palatal fistula in the cleft lip and palate patient. Author(s): Ninkovic M, Hubli EH, Schwabegger A, Anderl H. Source: The Journal of Craniofacial Surgery. 1997 November; 8(6): 491-5; Discussion 496. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9477835

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From birth to maturity: a group of patients who have completed their protocol management. Part I. Unilateral cleft lip and palate. Author(s): Schnitt DE, Agir H, David DJ. Source: Plastic and Reconstructive Surgery. 2004 March; 113(3): 805-17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15108870

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Cleft Lip

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Functional analysis of cleft lip and palate patients with modified Rakosi method. Author(s): Akcam MO, Altiok T, Ozdiler FE. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 January; 39(1): 101-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11772176

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Gene symbol: PVRL1. Disease: non-syndromic cleft lip and palate (CL+P). Author(s): Item BC, Turhani D, Thurnher D, Sinko K, Stoeckler-Ipsiroglu S, Kapral D, Yerit K, Ewers R, Watzinger F. Source: Human Genetics. 2003 September; 113(4): 365. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12974274

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Gene/environment causes of cleft lip and/or palate. Author(s): Murray JC. Source: Clinical Genetics. 2002 April; 61(4): 248-56. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12030886

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General anaesthesia for cleft lip and palate surgery team activities in Cambodia. Author(s): Ishizawa Y, Handa Y, Tanaka K, Taki K. Source: Trop Doct. 1997 July; 27(3): 153-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9227009

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General body growth in children with cleft lip and palate in a developing country. Author(s): Grippaudo FR, Kennedy DC. Source: British Journal of Plastic Surgery. 1999 December; 52(8): 672-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10658144

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Genetic association studies of cleft lip and/or palate with hypodontia outside the cleft region. Author(s): Slayton RL, Williams L, Murray JC, Wheeler JJ, Lidral AC, Nishimura CJ. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 May; 40(3): 274-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12733956

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Genetic epidemiology of birth defects: nonsyndromic cleft lip and neural tube defects. Author(s): Mitchell LE. Source: Epidemiologic Reviews. 1997; 19(1): 61-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9360903

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Genetic variation in transforming growth factor alpha: possible association of BamHI polymorphism with bilateral sporadic cleft lip and palate. Author(s): Stoll C, Qian JF, Feingold J, Sauvage P, May E. Source: Human Genetics. 1993 August; 92(1): 81-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8103504

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Genetic-counseling implications for cleft lip if an autosomal recessive major locus accounts for all cases. Author(s): Hook EB. Source: American Journal of Human Genetics. 1993 June; 52(6): 1270-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8503455

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Genetics of cleft lip and palate revisited. Author(s): Batra P, Duggal R, Parkash H. Source: J Clin Pediatr Dent. 2003 Summer; 27(4): 311-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12924730

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Genetics of cleft lip and palate. Author(s): Bender PL. Source: Journal of Pediatric Nursing. 2000 August; 15(4): 242-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10969497

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Genetics of nonsyndromic cleft lip and palate: a review of international studies and data regarding the Italian population. Author(s): Carinci F, Pezzetti F, Scapoli L, Martinelli M, Carinci P, Tognon M. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2000 January; 37(1): 33-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10670887

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Genome scan for loci involved in cleft lip with or without cleft palate, in Chinese multiplex families. Author(s): Marazita ML, Field LL, Cooper ME, Tobias R, Maher BS, Peanchitlertkajorn S, Liu YE. Source: American Journal of Human Genetics. 2002 August; 71(2): 349-64. Epub 2002 June 26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12087515

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Genome scan for teratogen-induced clefting susceptibility loci in the mouse: evidence of both allelic and locus heterogeneity distinguishing cleft lip and cleft palate. Author(s): Diehl SR, Erickson RP. Source: Proceedings of the National Academy of Sciences of the United States of America. 1997 May 13; 94(10): 5231-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9144220

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Genome-scan for loci involved in cleft lip with or without cleft palate in consanguineous families from Turkey. Author(s): Marazita ML, Field LL, Tuncbilek G, Cooper ME, Goldstein T, Gursu KG. Source: American Journal of Medical Genetics. 2004 April 15; 126A(2): 111-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15057975

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Gingivoperiosteoplasty in 3-to-5-year-old patients with cleft lip and palate: a preliminary communication. Author(s): Anastassov YC. Source: Folia Med (Plovdiv). 2000; 42(2): 80-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11217292

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Growth of the dental arch in patients with complete unilateral cleft lip and palate after primary periosteoplasty. Author(s): Tomanova M, Mullerova Z. Source: Acta Chir Plast. 1994; 36(4): 119-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7610757

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Growth of the facial skeleton following the Malek repair for unilateral cleft lip and palate. Author(s): Ross RB. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1995 May; 32(3): 194-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7605786

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Growth sites and growth mechanisms at risk in cleft lip and palate. Author(s): Friede H. Source: Acta Odontologica Scandinavica. 1998 December; 56(6): 346-51. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10066114

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Growth status of Saudi patients with cleft lip and palate. Author(s): Barakati SF, Alkofide EA. Source: Saudi Med J. 2002 July; 23(7): 823-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12174234

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Guidelines for the design and analysis of studies on nonsyndromic cleft lip and cleft palate in humans: summary report from a Workshop of the International Consortium for Oral Clefts Genetics. Author(s): Mitchell LE, Beaty TH, Lidral AC, Munger RG, Murray JC, Saal HM, Wyszynski DF; International Consortium for Oral Clefts Genetics. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 January; 39(1): 93-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11772175

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Hand immobilization for postoperative cleft lip babies. Author(s): Smoot EC. Source: Plastic and Reconstructive Surgery. 2001 November; 108(6): 1830. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11711985

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Hardikar syndrome: a new syndrome with cleft lip/palate, pigmentary retinopathy and cholestasis. Author(s): Cools F, Jaeken J. Source: American Journal of Medical Genetics. 1997 September 5; 71(4): 472-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9286458

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Height and weight achievement in cleft lip and palate. Author(s): Azcona C, Stanhope R. Source: Archives of Disease in Childhood. 1997 August; 77(2): 187-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9301377

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Height and weight achievement in cleft lip and palate. Author(s): Lee J, Nunn J, Wright C. Source: Archives of Disease in Childhood. 1997 January; 76(1): 70-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9059168

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Height and weight achievement in cleft lip and palate. Author(s): Lee J, Nunn J, Wright C. Source: Archives of Disease in Childhood. 1996 October; 75(4): 327-9. Corrected and Republished In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8984920

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Hereditary cleft lip/palate and Wilms tumor: a rare association. Author(s): Yu CC, Wong FH, Lo LJ, Chen YR. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 May; 39(3): 376-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12019017

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Heterotopic brain tissue in the upper lip of a neonate mimicking bilateral cleft lip features. Author(s): Mendez R, Montero M, Tellado MG, Somoza I, Liras J, Pais E, Vela D. Source: Journal of Pediatric Surgery. 2002 September; 37(9): E25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12194148

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High prevalence of cleft lip among the Bari Indians of western Venezuela. Author(s): Ballew C, Beckerman SJ, Lizarralde R. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1993 July; 30(4): 411-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8104482

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Histological comparison of the alar nasal cartilages in unilateral cleft lip. Author(s): Modolin M, Baracat GZ, Kamakura L, Cintra W Jr, Cruz LG, Ferreira MC. Source: Revista Do Hospital Das Clinicas. 2002 July-August; 57(4): 143-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12244334

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Histology of the cleft lip nose. Author(s): Pennisi VR. Source: Plastic and Reconstructive Surgery. 1988 December; 82(6): 1103-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3200952

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History of cleft lip nasal repair. Author(s): Randall P. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1992 November; 29(6): 527-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1450193

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Holoprosencephaly, bilateral cleft lip and palate and ectrodactyly: another case and follow up. Author(s): Konig R, Beeg T, Tariverdian G, Scheffer H, Bitter K. Source: Clinical Dysmorphology. 2003 October; 12(4): 221-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14564207

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Hypodipsic hypernatremia and hypertriglyceridemia associated with cleft lip and cleft palate: a new hypothalamic dysfunction syndrome? Author(s): Ben-Amitai D, Rachmel A, Levy Y, Sivan Y, Nitzan M, Steinherz R. Source: American Journal of Medical Genetics. 1990 July; 36(3): 275-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2363421

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Hypodontia in twins discordant or concordant for cleft lip and/or palate. Author(s): Laatikainen T, Ranta R. Source: Scand J Dent Res. 1994 April; 102(2): 88-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8016560

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Hyponatremia caused by a reset osmostat in a neonate with cleft lip and palate and panhypopituitarism. Author(s): Thiagarajan R, La Gamma E, Dey S, Blethen S, Wilson TA. Source: The Journal of Pediatrics. 1996 April; 128(4): 561-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8618194

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Identification and characterization of a novel gene disrupted by a pericentric inversion inv(4)(p13.1q21.1) in a family with cleft lip. Author(s): Beiraghi S, Zhou M, Talmadge CB, Went-Sumegi N, Davis JR, Huang D, Saal H, Seemayer TA, Sumegi J. Source: Gene. 2003 April 24; 309(1): 11-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12727354

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Identification of a stop codon mutation in the CBFA1 runt domain from a patient with cleidocranial dysplasia and cleft lip. Author(s): Yamachika E, Tsujigiwa H, Ishiwari Y, Mizukawa N, Nagai N, Sugahara T. Source: Journal of Oral Pathology & Medicine : Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 2001 July; 30(6): 381-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11459326

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Imaging of cartilage and mimic muscles with MRI: anatomic study in healthy volunteers and patients with unilateral cleft lip and palate. Author(s): Kleinheinz J, Joos U. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 July; 38(4): 291-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11420008

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Immediate unrestricted feeding of infants following cleft lip and palate repair. Author(s): Cohen M. Source: British Journal of Plastic Surgery. 1997 February; 50(2): 143. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9135435

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Impact of cleft lip and/or palate on nutritional health and oral-motor development. Author(s): Redford-Badwal DA, Mabry K, Frassinelli JD. Source: Dent Clin North Am. 2003 April; 47(2): 305-17. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12699233

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Importance of soft tissue for skeletal stability in maxillary advancement in patients with cleft lip and palate. Author(s): Baumann A, Sinko K. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 January; 40(1): 65-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12498607

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In utero surgery for cleft lip/palate: minimizing the "Ripple Effect" of scarring. Author(s): Lorenz HP, Longaker MT. Source: The Journal of Craniofacial Surgery. 2003 July; 14(4): 504-11. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12867864

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Incidence and outcome of middle ear disease in cleft lip and/or cleft palate. Author(s): Sheahan P, Miller I, Sheahan JN, Earley MJ, Blayney AW. Source: International Journal of Pediatric Otorhinolaryngology. 2003 July; 67(7): 785-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12791455

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Incidence of cleft lip and palate in a newborn Zairian sample. Author(s): Ogle OE. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1993 March; 30(2): 250-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8452851

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Incidence of cleft lip and palate in the northeast of Mexico: a 10-year study. Author(s): Blanco-Davila F. Source: The Journal of Craniofacial Surgery. 2003 July; 14(4): 533-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12867870

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Incidence of cleft lip or palate in 303738 Japanese babies born between 1994 and 1995. Author(s): Natsume N, Kawai T, Kohama G, Teshima T, Kochi S, Ohashi Y, Enomoto S, Ishii M, Nakano Y, Matsuya T, Kogo M, Yoshimura Y, Ohishi M, Nakamura N, Katsuki T, Goto M, Shimizu M, Yanagisawa S, Mimura T, Sunakawa H. Source: The British Journal of Oral & Maxillofacial Surgery. 2000 December; 38(6): 605607. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11092775

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Indications for combined orthodontic and surgical (orthognathic) treatments of dentofacial deformities in cleft lip and palate patients and their impact on velopharyngeal function. Author(s): Jaques B, Herzog G, Muller A, Hohlfeld J, Pasche P. Source: Folia Phoniatrica Et Logopaedica : Official Organ of the International Association of Logopedics and Phoniatrics (Ialp). 1997; 49(3-4): 181-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9256540

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Influence of early hard palate closure in unilateral and bilateral cleft lip and palate on maxillary transverse growth during the first four years of age. Author(s): Lehner B, Wiltfang J, Strobel-Schwarthoff K, Benz M, Hirschfelder U, Neukam FW. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 March; 40(2): 126-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12605517

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Influence of lip repair on craniofacial morphology of patients with complete bilateral cleft lip and palate. Author(s): da Silva Filho OG, Valladares Neto J, Capelloza Filho L, de Souza Freitas JA. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 March; 40(2): 144-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12605519

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Interdisciplinary care for persons with cleft lip and palate in the year 2001. Author(s): Moller KT. Source: Northwest Dent. 2001 January-February; 80(1): 29-36, 51. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11413604

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Intranasal tooth as a complication of cleft lip and alveolus in a four year old child: case report and literature review. Author(s): Gupta YK, Shah N. Source: International Journal of Paediatric Dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children. 2001 May; 11(3): 221-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11484473

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Intravelar veloplasty in cleft lip, alveolus and palate and outcome of speech and language acquisition: a prospective study. Author(s): Bitter K, Wegener C, Gomille N. Source: Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. 2003 December; 31(6): 348-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14637063

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Isolated nasalis muscle reconstruction in secondary unilateral cleft lip nasal reconstruction. Author(s): Bagatain M, Khosh MM, Nishioka G, Larrabee WF Jr. Source: The Laryngoscope. 1999 February; 109(2 Pt 1): 320-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10890786

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Isolated soft tissue cleft lip: the influence on the nasal cavity and supernumerary laterals. Author(s): Gundlach KK. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 March; 40(2): 220; Author Reply 221. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12605534

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Isolated soft tissue cleft lip: the influence on the nasal cavity and supernumerary laterals. Author(s): Hansen K, Mehdinia M. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 May; 39(3): 322-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12019009

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Kabuki make-up syndrome (Niikawa-Kuroki syndrome) with cleft lip and palate. Author(s): Handa Y, Maeda K, Toida M, Kitajima T, Ishimaru J, Nagai A, Oka N. Source: Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. 1991 April; 19(3): 99-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2071696

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Kallmann syndrome with associated cleft lip and palate: case report and review of the literature. Author(s): Tompach PC, Zeitler DL. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1995 January; 53(1): 85-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7799130

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Keloid formation after cleft lip repair. Author(s): Nichter LS, Abrams RS. Source: Plastic and Reconstructive Surgery. 1988 November; 82(5): 923-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3174889

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Lack of evidence for a significant association between nonsyndromic cleft lip with or without cleft palate and the retinoic acid receptor alpha gene in the Japanese population. Author(s): Kanno K, Suzuki Y, Yang X, Yamada A, Aoki Y, Kure S, Matsubara Y. Source: Journal of Human Genetics. 2002; 47(6): 269-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12111375

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Lack of linkage disequilibrium between transforming growth factor alpha Taq I polymorphism and cleft lip with or without cleft palate in families from Northeastern Italy. Author(s): Scapoli L, Pezzetti F, Carinci F, Martinelli M, Carinci P, Tognon M. Source: American Journal of Medical Genetics. 1998 January 13; 75(2): 203-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9450887

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Lack of linkage of apparently dominant cleft lip (palate) to two candidate chromosomal regions. Author(s): Pierpont JW, Storm AL, Erickson RP, Kohn BR, Pettijohn L, DePaepe A. Source: Journal of Craniofacial Genetics and Developmental Biology. 1995 April-June; 15(2): 66-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7635931

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Language skills of young children with unilateral cleft lip and palate following infant orthopedics: a randomized clinical trial. Author(s): Konst EM, Rietveld T, Peters HF, Kuijpers-Jagtman AM. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 July; 40(4): 356-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12846601

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Left or right hand dominance in children with cleft lip and palate. Author(s): Jeffery SL, Boorman JG. Source: British Journal of Plastic Surgery. 2000 September; 53(6): 477-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10927675

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Linear growth characteristics of children with cleft lip and palate. Author(s): Cunningham ML, Jerome JT. Source: The Journal of Pediatrics. 1997 November; 131(5): 707-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9403650

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Linkage analysis of candidate regions in Swedish nonsyndromic cleft lip with or without cleft palate families. Author(s): Wong FK, Hagberg C, Karsten A, Larson O, Gustavsson M, Huggare J, Larsson C, Teh BT, Linder-Aronson S. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2000 July; 37(4): 357-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10912714

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Cleft Lip

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Linkage disequilibrium between GABRB3 gene and nonsyndromic familial cleft lip with or without cleft palate. Author(s): Scapoli L, Martinelli M, Pezzetti F, Carinci F, Bodo M, Tognon M, Carinci P. Source: Human Genetics. 2002 January; 110(1): 15-20. Epub 2001 November 10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11810291

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Lip and nose morphology in patients with unilateral cleft lip and palate from four Scandinavian centres. Author(s): Enemark H, Friede H, Paulin G, Semb G, Abyholm F, Bolund S, Lilja J, Ostrup L. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 1993; 27(1): 417. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8493483

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Lip height and lip width after extended Mohler unilateral cleft lip repair. Author(s): Cutting CB, Dayan JH. Source: Plastic and Reconstructive Surgery. 2003 January; 111(1): 17-23; Discussion 24-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12496561

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Lip movement in patients with a history of unilateral cleft lip. Author(s): Rutjens CA, Spauwen PH, van Lieshout PH. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 September; 38(5): 468-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11522168

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Lip posture and mouth width in children with unilateral cleft lip. Author(s): Zhu NW, Senewiratne S, Pigott RW. Source: British Journal of Plastic Surgery. 1994 July; 47(5): 301-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8087366

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Location and distribution of epithelial pearls and tooth buds in human fetuses with cleft lip and palate. Author(s): Arnold WH, Rezwani T, Baric I. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1998 July; 35(4): 359-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9684775

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Longitudinal study of craniofacial growth in subjects with cleft lip and palate: from cheiloplasty to 8 years of age. Author(s): Han BJ, Suzuki A, Tashiro H. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1995 March; 32(2): 156-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7748878

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Longitudinal study on the changes of maxillary arch dimensions in Japanese children with cleft lip and/or palate: infancy to 4 years of age. Author(s): Honda Y, Suzuki A, Ohishi M, Tashiro H. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1995 March; 32(2): 149-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7748877

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Long-term outcome of cleft lip nasal reconstruction in childhood. Author(s): Kane AA, Pilgram TK, Moshiri M, Marsh JL. Source: Plastic and Reconstructive Surgery. 2000 April; 105(5): 1600-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10809087

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Long-term outcome of simultaneous repair of bilateral cleft lip and nose (a 15 year experience). Author(s): Nakajima T, Ogata H, Sakuma H. Source: British Journal of Plastic Surgery. 2003 April; 56(3): 205-17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12859915

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Long-term prosthodontic follow-up and revisional treatment of patients with cleft lip and palate: case presentation. Author(s): Ramstad T. Source: Int J Prosthodont. 2001 September-October; 14(5): 417-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12066635

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Long-term results of the two-stage palatoplasty/Hotz' plate approach for complete bilateral cleft lip, alveolus and palate patients. Author(s): Silvera Q AE, Ishii K, Arai T, Morita S, Ono K, Iida A, Hanada K, Takagi R. Source: Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery. 2003 August; 31(4): 215-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12914706

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Lower jaw bone graft of the alveolar cleft region in a cleft lip and palate patient using the third-molar extraction procedure. Author(s): Natsume N, Kawai T. Source: Plastic and Reconstructive Surgery. 1994 May; 93(6): 1309-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8171157

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Management of an infant with cleft lip and palate with phocomelia in dental practice. Author(s): Muthu MS. Source: J Indian Soc Pedod Prev Dent. 2000 December; 18(4): 141-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11601183

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Management of cleft lip and palate in Brazil. Author(s): Franco D, Goncalves LF, Franco T. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 2003; 37(5): 272-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14649685

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Mandibular asymmetry and antigonial notching in individuals with unilateral cleft lip and palate. Author(s): Kyrkanides S, Richter L. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 January; 39(1): 30-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11772167

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Mandibular dysmorphology in patients with unilateral cleft lip and cleft palate. Author(s): Lo LJ, Wong FH, Chen YR, Wong HF. Source: Chang Gung Med J. 2002 August; 25(8): 502-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12392361

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Maternal 677CT/1298AC genotype of the MTHFR gene as a risk factor for cleft lip. Author(s): Shotelersuk V, Ittiwut C, Siriwan P, Angspatt A. Source: Journal of Medical Genetics. 2003 May; 40(5): E64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12746418

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Maternal drug use and infant cleft lip/palate with special reference to corticoids. Author(s): Kallen B. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 November; 40(6): 624-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14577813

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Maxillary development and dental occlusion in patients with unilateral cleft lip and palate after combined velar closure and lip-nose repair at different ages. Author(s): Kontos K, Friede H, Cintras H, Celso LB, Lilja J. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 2001 December; 35(4): 377-86. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11878174

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Maxillary distraction osteogenesis for cleft lip and palate children using an external, adjustable, rigid distraction device: a report of 2 cases. Author(s): Harada K, Baba Y, Ohyama K, Enomoto S. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2001 December; 59(12): 1492-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11732043

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Modified nasal alveolar molding appliance for management of cleft lip defect. Author(s): Da Silveira AC, Oliveira N, Gonzalez S, Shahani M, Reisberg D, Daw Jr JL, Cohen M. Source: The Journal of Craniofacial Surgery. 2003 September; 14(5): 700-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501332

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Muscle reconstruction in cleft lip repair. Author(s): Seagle MB, Furlow LT Jr. Source: Plastic and Reconstructive Surgery. 2004 May; 113(6): 1537-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15114112

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Mutation of PVRL1 is associated with sporadic, non-syndromic cleft lip/palate in northern Venezuela. Author(s): Sozen MA, Suzuki K, Tolarova MM, Bustos T, Fernandez Iglesias JE, Spritz RA. Source: Nature Genetics. 2001 October; 29(2): 141-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11559849

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Nasal morphology and shape parameters as predictors of nasal esthetics in individuals with complete unilateral cleft lip and palate. Author(s): Russell KA, Waldman SD, Tompson B, Lee JM. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 September; 38(5): 476-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11522169

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Nasalance measures in Marathi consonant-vowel-consonant syllables with pressure consonants produced by children with and without cleft lip and palate. Author(s): Nandurkar A. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 January; 39(1): 59-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11772171

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Neonatal cleft lip and cleft palate repair. Author(s): Sandberg DJ, Magee WP Jr, Denk MJ. Source: Aorn Journal. 2002 March; 75(3): 490-8; Quiz 501-4, 506-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11921819

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Neonatal palatal cysts and their morphology in cleft lip and palate. Author(s): Richard BM, Qiu CX, Ferguson MW. Source: British Journal of Plastic Surgery. 2000 October; 53(7): 555-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11000069

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New directions in the management of cleft lip. Author(s): Punjabi AP, Thaller SR. Source: Clin Plast Surg. 2001 October; 28(4): 661-9, Vi. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11727852

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New treatment and research strategies for the improvement of care of cleft lip and palate patients in the new millennium. Author(s): Lee ST. Source: Ann Acad Med Singapore. 1999 September; 28(5): 760-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10597367

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No evidence of linkage for cleft lip with or without cleft palate to a marker near the transforming growth factor alpha locus in two populations. Author(s): Wyszynski DF, Maestri N, Lewanda AF, McIntosh I, Smith EA, GarciaDelgado C, Vinageras-Guarneros E, Wulfsberg E, Beaty TH. Source: Human Heredity. 1997 March-April; 47(2): 101-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9097091

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Nonsyndromic cleft lip and palate is not associated with cancer or other birth defects. Author(s): Steinwachs EF, Amos C, Johnston D, Mulliken J, Stal S, Hecht JT. Source: American Journal of Medical Genetics. 2000 January 3; 90(1): 17-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10602112

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Nonsyndromic cleft lip and palate: complex genetics and environmental effects. Author(s): Prescott NJ, Winter RM, Malcolm S. Source: Annals of Human Genetics. 2001 November; 65(Pt 6): 505-15. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11851981

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Nonsyndromic cleft lip with or without cleft palate in China: assessment of candidate regions. Author(s): Marazita ML, Field LL, Cooper ME, Tobias R, Maher BS, Peanchitlertkajorn S, Liu YE. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 March; 39(2): 149-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11879070

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Occlusal relationship in patients with bilateral cleft lip and palate during the mixed dentition stage: does neonatal maxillary arch configuration predetermine outcome? Author(s): Perlyn CA, Brownstein JN, Huebener DV, Marsh JL, Nissen RJ, Pilgram T. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 May; 39(3): 317-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12019008

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Occurrence of cleft lip and palate in the Faroe Islands and Greenland from 1950 to 1999. Author(s): Jakobsen LP, Molsted K, Christensen K. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 July; 40(4): 426-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12846608

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Open tip rhinoplasty along with the repair of cleft lip in cleft lip and palate cases. Author(s): Thomas C, Mishra P. Source: British Journal of Plastic Surgery. 2000 January; 53(1): 1-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10657441

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Optical non-contact 3D profilometry of the palate in subjects with cleft lip and/or palate. Author(s): Trefny P, Smahel Z, Formanek P, Mullerova Z, Vitova L. Source: Acta Chir Plast. 2001; 43(4): 132-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11789053

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Oral health of individuals with cleft lip, cleft palate, or both. Author(s): Lages EM, Marcos B, Pordeus IA. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2004 January; 41(1): 59-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14697068

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Orthodontic treatment for jaw deformities in cleft lip and palate patients with the combined use of an external-expansion arch and a facial mask. Author(s): Sakamoto T, Sakamoto S, Harazaki M, Isshiki Y, Yamaguchi H. Source: Bull Tokyo Dent Coll. 2002 November; 43(4): 223-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12687727

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Orthognathic surgery in the patient with cleft lip and palate. Author(s): Bennett J, Efaw D. Source: Atlas Oral Maxillofac Surg Clin North Am. 1995 March; 3(1): 51-61. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11873687

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Orthopedic intrusion of premaxilla with distraction devices before alveolar bone grafting in patients with bilateral cleft lip and palate. Author(s): Liou EJ, Chen PK, Huang CS, Chen YR. Source: Plastic and Reconstructive Surgery. 2004 March; 113(3): 818-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15108871

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Outcome of bone grafting in relation to cleft width in unilateral cleft lip and palate patients. Author(s): van der Meij AW, Baart JA, Prahl-Andersen B, Kostense PJ, van der Sijp JR, Tuinzing DB. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2003 July; 96(1): 19-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12847439

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Outpatient cleft lip repair. Author(s): Rosen H, Barrios LM, Reinisch JF, Macgill K, Meara JG. Source: Plastic and Reconstructive Surgery. 2003 August; 112(2): 381-7; Discussion 388-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12900594

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Parental evaluation of informing interviews for cleft lip and/or palate. Author(s): Byrnes AL, Berk NW, Cooper ME, Marazita ML. Source: Pediatrics. 2003 August; 112(2): 308-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12897279

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Periodontal attachment loss over 14 years in cleft lip, alveolus and palate (CLAP, CL, CP) subjects not enrolled in a supportive periodontal therapy program. Author(s): Salvi GE, Bragger U, Lang NP. Source: Journal of Clinical Periodontology. 2003 September; 30(9): 840-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12956661

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Possible relationship between the van der Woude syndrome (vWS) locus and nonsyndromic cleft lip with or without cleft palate (NSCL/P). Author(s): Houdayer C, Bonaiti-Pellie C, Erguy C, Soupre V, Dondon MG, Burglen L, Cougoureux E, Couderc R, Vazquez MP, Bahuau M. Source: American Journal of Medical Genetics. 2001 November 15; 104(1): 86-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11746036

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Preliminary report of two-stage secondary alveolar bone grafting for patients with bilateral cleft lip and palate. Author(s): Kamakura S, Yamaguchi T, Kochi S, Sato A, Motegi K. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 September; 40(5): 449-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943445

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Premolar development in Greek children with cleft lip and palate. Author(s): Mitsea AG, Spyropoulos MN. Source: Quintessence Int. 2001 September; 32(8): 639-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11526893

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Prenatal diagnosis of cleft lip and palate: detection rates, accuracy of ultrasonography, associated anomalies, and strategies for counseling. Author(s): Jones MC. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 March; 39(2): 169-73. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11879073

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Prenatal diagnosis of cleft lip: what the sonologist needs to tell the surgeon. Author(s): Mulliken JB, Benacerraf BR. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 2001 November; 20(11): 1159-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11758020

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Prenatal ultrasonography and the diagnosis of fetal cleft lip. Author(s): Robinson JN, McElrath TF, Benson CB, Doubilet PM, Westgate MN, Holmes L, Lieberman ES, Norwitz ER. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 2001 November; 20(11): 1165-70; Quiz 1172-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11758021

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Prevalence of aneuploidy and additional anatomic abnormalities in fetuses and neonates with cleft lip with or without cleft palate: a population-based study in Utah. Author(s): Walker SJ, Ball RH, Babcook CJ, Feldkamp MM. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 2001 November; 20(11): 1175-80; Quiz 1181-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11758022

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Primary repair of the unilateral cleft lip. Author(s): Castiglione CL. Source: Atlas Oral Maxillofac Surg Clin North Am. 1995 March; 3(1): 5-12. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11873686

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Quality of life in adults with repaired complete cleft lip and palate. Author(s): Marcusson A, Akerlind I, Paulin G. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 July; 38(4): 379-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11420018

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Quantitative 3D maxillary arch evaluation of two different infant managements for unilateral cleft lip and palate. Author(s): Prasad CN, Marsh JL, Long RE Jr, Galic M, Huebener DV, Bresina SJ, Vannier MW, Pilgram TK, Mazaheri M, Robison S, Bartell T. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2000 November; 37(6): 562-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11108526

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Quantitative evaluation of the shape and the elasticity of repaired cleft lip. Author(s): Susami T, Kamiyama H, Uji M, Motohashi N, Kuroda T. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1993 May; 30(3): 309-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8338861

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Questionnaire evaluation of feeding methods for cleft lip and palate neonates. Author(s): Trenouth MJ, Campbell AN. Source: International Journal of Paediatric Dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children. 1996 December; 6(4): 241-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9161191

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Questionnaire survey of attitudes and concerns of patients with cleft lip and palate and their parents. Author(s): Noar JH. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1991 July; 28(3): 279-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1911816

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Radical correction of secondary nasal deformity in unilateral cleft lip patients presenting late. Author(s): Ahuja RB. Source: Plastic and Reconstructive Surgery. 2001 October; 108(5): 1127-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11604608

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Re: High serum levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) in mothers of children with cleft lip. Author(s): Hozyasz KK, Gajewska J, Ambroszkiewicz J, Dudkiewicz Z. Source: The British Journal of Oral & Maxillofacial Surgery. 2003 June; 41(3): 205-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12804560

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Recalled relationships with parents and perceptions of professional support in mothers of infants treated for cleft lip. Author(s): Hill J, Murray L, Woodall P, Parmar B, Hentges F. Source: Attachment & Human Development. 2004 March; 6(1): 21-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14982677

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Reconstruction of microform cleft lip. Author(s): Tosun Z, Hosnuter M, Senturk S, Savaci N. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 2003; 37(4): 232-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14582757

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Reconstruction of shallow upper buccal sulcus deformity secondary to cleft lip and palate repair. Author(s): Aydin Y, Yucel A, Yildirim MA, Guzel MZ. Source: The Journal of Craniofacial Surgery. 2001 September; 12(5): 490-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11572257

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Reconstruction of the superior labial sulcus in secondary bilateral cleft lip deformities: an inverted U-shaped flap. Author(s): Erol OO, Agaoglu G. Source: Plastic and Reconstructive Surgery. 2001 December; 108(7): 1871-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11743370

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Reliability of a multidimensional questionnaire for adults with treated complete cleft lip and palate. Author(s): Marcusson A, List T, Paulin G, Akerlind I. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 2001 September; 35(3): 271-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11680395

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Repair of bilateral cleft lip: review, revisions, and reflections. Author(s): Mulliken JB, Wu JK, Padwa BL. Source: The Journal of Craniofacial Surgery. 2003 September; 14(5): 609-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501318

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Repair of the unilateral cleft lip/nose deformity. Author(s): Clark JM, Skoner JM, Wang TD. Source: Facial Plastic Surgery : Fps. 2003 February; 19(1): 29-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12739180

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Risk factors for poor dental arch relationships in young children born with unilateral cleft lip and palate. Author(s): Williams AC, Sandy JR. Source: Plastic and Reconstructive Surgery. 2003 February; 111(2): 586-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12560679

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Secondary correction of the wide nasal root in bilateral nasal deformity associated with cleft lip in five Oriental patients. Author(s): Omori M, Takato T, Eguchi T, Mori Y, Tomizuka K. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 2003; 37(4): 216-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14582753

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Secondary rhinoplasty using flying-bird and vestibular tornado incisions for unilateral cleft lip patients. Author(s): Matsuya T, Iida S, Kogo M. Source: Plastic and Reconstructive Surgery. 2003 August; 112(2): 390-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12900595

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Secondary unilateral cleft lip nasal deformity: functional and esthetic reconstruction. Author(s): Cohen M, Smith BE, Daw JL. Source: The Journal of Craniofacial Surgery. 2003 July; 14(4): 584-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12867876

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Sequelae of otitis media with effusion among children with cleft lip and/or cleft palate. Author(s): Sheahan P, Blayney AW, Sheahan JN, Earley MJ. Source: Clinical Otolaryngology and Allied Sciences. 2002 December; 27(6): 494-500. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12472518

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Simultaneous reconstruction of the secondary bilateral cleft lip and nasal deformity: Abbe flap revisited. Author(s): Lo LJ, Kane AA, Chen YR. Source: Plastic and Reconstructive Surgery. 2003 October; 112(5): 1219-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14504504

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Single-follicular-unit hair transplantation to correct cleft lip moustache alopecia. Author(s): Reed ML, Grayson BH. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 September; 38(5): 538-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11522178

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Soft tissue profile changes of the midface in patients with cleft lip and palate following maxillary distraction osteogenesis: a preliminary study. Author(s): Harada K, Baba Y, Ohyama K, Omura K. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2002 December; 94(6): 673-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12464889

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Speech and language development disorders in infants and children with cleft lip and palate. Author(s): Sharp HM, Dailey S, Moon JB. Source: Pediatric Annals. 2003 July; 32(7): 476-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12891765

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Surgical creation of a Cupid's bow using W-plasty in patients after cleft lip surgery. Author(s): Takeshita A, Nakajima T, Kaneko T, Yazawa M, Tamada I. Source: British Journal of Plastic Surgery. 2003 June; 56(4): 375-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12873466

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Surgical treatment in unilateral cleft lip-nose patients: long-term follow-up using a personal approach based on rose and spina techniques. Author(s): Martins DM, Martins JL. Source: The Journal of Craniofacial Surgery. 2003 September; 14(5): 797-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501351

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The Cleft Lip and Palate Assistance Centre (CAIF) in Curitiba, Brazil. Author(s): Walter AM, Souza D, Poerner F. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2004 March; 41(2): 220-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14989675

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The complex genetics of cleft lip and palate. Author(s): Cobourne MT. Source: European Journal of Orthodontics. 2004 February; 26(1): 7-16. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14994877

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The effects of lactation education and a prosthetic obturator appliance on feeding efficiency in infants with cleft lip and palate. Author(s): Turner L, Jacobsen C, Humenczuk M, Singhal VK, Moore D, Bell H. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 September; 38(5): 519-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11522174

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The functional anatomy of the muscles of facial expression in humans with and without cleft lip and palate. A contribution to refine muscle reconstruction in primary cheilo- and rhinoplasties in patients with uni- and bilateral complete CLP. Author(s): Breitsprecher L, Fanghanel L, Noe A, Lockett E, Raab U. Source: Ann Anat. 2002 January; 184(1): 27-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11876479

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The prevalence of anomalies of the upper cervical vertebrae in subjects with cleft lip, cleft palate, or both. Author(s): Ugar DA, Semb G. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 September; 38(5): 498-503. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11522172

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Three-dimensional analysis of morphological changes in the maxilla of patients with cleft lip and palate. Author(s): Braumann B, Keilig L, Bourauel C, Jager A. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 January; 39(1): 1-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11772163

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Three-dimensional nasal morphology in cleft lip and palate operated adult patients. Author(s): Ferrario VF, Sforza C, Dellavia C, Vizzotto L, Caru A. Source: Annals of Plastic Surgery. 2003 October; 51(4): 390-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14520067

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Transforming growth factor-beta3 gene SfaN1 polymorphism in Korean nonsyndromic cleft lip and palate patients. Author(s): Kim MH, Kim HJ, Choi JY, Nahm DS. Source: J Biochem Mol Biol. 2003 November 30; 36(6): 533-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14659070

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Treatment of the unilateral cleft lip nasal deformity. Author(s): Sundine MJ, Phillips JH. Source: The Journal of Craniofacial Surgery. 2004 January; 15(1): 69-76; Discussion 76-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14704567

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Two- or three-dimensional cast analysis in patients with cleft lip and palate? Author(s): Braumann B, Rosenhayn SE, Bourauel C, Jager A. Source: Journal of Orofacial Orthopedics = Fortschritte Der Kieferorthopadie : Organ/Official Journal Deutsche Gesellschaft Fur Kieferorthopadie. 2001 November; 62(6): 451-65. English, German. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11765708

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Unilateral advancement of the maxillary minor segment by distraction osteogenesis in patients with repaired unilateral cleft lip and palate: report of two cases. Author(s): Kuroe K, Iino S, Shomura K, Okubo A, Sugihara K, Ito G. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 May; 40(3): 317-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12733963

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Unilateral cleft lip complicated by a hemangioma. Author(s): Yavuzer R, Latifoglu O, Ozmen S, Ataoglu O, Cenetoglu S, Atabay K, Celebi MC. Source: Plastic and Reconstructive Surgery. 2002 September 15; 110(4): 1084-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12198422

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Unilateral cleft lip with hemangioma. Author(s): Sarifakioglu N, Aslan G. Source: Plastic and Reconstructive Surgery. 2003 September 15; 112(4): 1174; Author Reply 1174-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12973241

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Unilateral cleft lip-nose repair: a 33-year experience. Author(s): Salyer KE, Genecov ER, Genecov DG. Source: The Journal of Craniofacial Surgery. 2003 July; 14(4): 549-58. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12867873

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Unilateral complete cleft lip and palate repair using lip adhesion and passive alveolar molding appliance. Author(s): Cho B. Source: The Journal of Craniofacial Surgery. 2001 March; 12(2): 148-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11314626

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Unravelling the complex genetics of cleft lip in the mouse model. Author(s): Juriloff DM, Harris MJ, Brown CJ. Source: Mammalian Genome : Official Journal of the International Mammalian Genome Society. 2001 June; 12(6): 426-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11353389

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Use of a perceptual evaluation instrument to assess the effects of infant orthopedics on the speech of toddlers with cleft lip and palate. Author(s): Konst EM, Rietveld T, Peters HF, Weersink-Braks H. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 November; 40(6): 597-605. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14577817

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Use of nasoalveolar molding appliance to direct growth in newborn patient with complete unilateral cleft lip and palate. Author(s): Yang S, Stelnicki EJ, Lee MN. Source: Pediatr Dent. 2003 May-June; 25(3): 253-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12889702

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Use of octyl-2-cyanoacrylate in cleft lip repair. Author(s): Magee WP Jr, Ajkay N, Githae B, Rosenblum RS. Source: Annals of Plastic Surgery. 2003 January; 50(1): 1-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12545101

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Use of three-dimensional computer graphic animation to illustrate cleft lip and palate surgery. Author(s): Cutting C, Oliker A, Haring J, Dayan J, Smith D. Source: Computer Aided Surgery : Official Journal of the International Society for Computer Aided Surgery. 2002; 7(6): 326-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12731095

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Van der Woude syndrome and nonsyndromic cleft lip and palate. Author(s): Hecht JT, Wang Y, Blanton SH, Daiger SP. Source: American Journal of Human Genetics. 1992 August; 51(2): 442-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1642245

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Vertical changes in the positions of the cleft segments of patients with unilateral cleft lip and palate. Changes from birth to palatoplasty at the age of 10-14 months. Author(s): Bornert H, Dannhauer KH, Schmalzried D. Source: Journal of Orofacial Orthopedics = Fortschritte Der Kieferorthopadie : Organ/Official Journal Deutsche Gesellschaft Fur Kieferorthopadie. 2002 January; 63(1): 51-61. English, German. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11974453

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Video-imaging assessment of nasal morphology in individuals with complete unilateral cleft lip and palate. Author(s): Russell KA, Waldman SD, Lee JM. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2000 November; 37(6): 542-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11108523

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Videos showing cleft lip very helpful. Author(s): Danner SC. Source: Journal of Human Lactation : Official Journal of International Lactation Consultant Association. 1996 June; 12(2): 95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8932038

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Vocal characteristics of children with cleft lip/palate and associated velopharyngeal incompetence. Author(s): Lewis JR, Andreassen ML, Leeper HA, Macrae DL, Thomas J. Source: The Journal of Otolaryngology. 1993 April; 22(2): 113-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8515508

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Vocalizations of toddlers with cleft lip and palate. Author(s): Chapman KL. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1991 April; 28(2): 172-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2069973

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Voluntary health care for children with unrepaired cleft lip and cleft palate in developing countries--a personal perspective. Author(s): McGovern E. Source: J Ir Dent Assoc. 2003; 49(4): 142-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14705365

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Vomeronasal organ growth and development in normal and cleft lip and palate human fetuses. Author(s): Smith TD, Siegel MI, Mooney MP, Burdi AR, Todhunter JS. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1996 September; 33(5): 385-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8891369

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Walker-Warburg syndrome with cleft lip and cleft palate in two sibs. Author(s): Burton BK, Dillard RG, Weaver RG. Source: American Journal of Medical Genetics. 1987 July; 27(3): 537-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3631127

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Web-based educational tool for cleft lip repair using XVL. Author(s): Tanaka D, Kobayashi M, Chiyokura H, Nakajima T, Fujino T. Source: Stud Health Technol Inform. 2001; 81: 485-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11317795

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Weight comparisons of infants with complete cleft lip and palate. Author(s): Richard ME. Source: Pediatric Nursing. 1994 March-April; 20(2): 191-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8159506

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What information do parents of newborns with cleft lip, palate, or both want to know? Author(s): Young JL, O'Riordan M, Goldstein JA, Robin NH. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2001 January; 38(1): 55-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11204683

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What syndrome is this? Ankyloblepharon-ectodermal defects--cleft lip and palate (Hay-Wells) syndrome. Author(s): Mancini AJ, Paller AS. Source: Pediatric Dermatology. 1997 September-October; 14(5): 403-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9336818

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When is enough enough? Secondary surgery for cleft lip and palate patients. Author(s): Marsh JL. Source: Clin Plast Surg. 1990 January; 17(1): 37-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2302918

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Wrap-around cartilage flap for correction of unilateral cleft lip nose deformity. Author(s): Peled IJ, Ramon Y, Ullmann Y. Source: Plastic and Reconstructive Surgery. 1997 June; 99(7): 2085-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9180738

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Wrap-around cartilage flap for the correction of unilateral cleft lip-nose deformity. Author(s): Peled IJ, Ramon Y, Ullmann Y, Ronen J. Source: Plastic and Reconstructive Surgery. 2003 January; 111(1): 371-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12496606

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CHAPTER 2. NUTRITION AND CLEFT LIP Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and cleft lip.

Finding Nutrition Studies on Cleft Lip The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “cleft lip” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “cleft lip” (or a synonym): •

A study of cleft lip and palate in neonates born in a large Malaysian maternity hospital over a 2-year period. Author(s): Department of Paediatrics, Faculty of Medicine, National University of Malaysia, Kuala Lumpur. Source: Boo, N Y Arshad, A R Singapore-Med-J. 1990 February; 31(1): 59-62 0037-5675

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Ambulatory surgery for cleft lip repair. Author(s): University of Massachusetts Medical Center, Division of Plastic and Reconstructive Surgery, Worcester 01655, USA. Source: Kim, T H Rothkopf, D M Ann-Plast-Surg. 1999 April; 42(4): 442-4 0148-7043

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B group vitamins and cleft lip and cleft palate. Author(s): Universitatsklinik fur Mund, -Kiefer- und Plastische Gesichtschirurgie, Martin-Luther-Universitat Halle-Wittenberg, Germany. Source: Schubert, J Schmidt, R Syska, E Int-J-Oral-Maxillofac-Surg. 2002 August; 31(4): 410-3 0901-5027

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Clinical and epidemiologic studies of cleft lip and palate in the Philippines. Author(s): Department of Pediatrics, University of Iowa, Iowa City 52242-1083, USA. Source: Murray, J C Daack Hirsch, S Buetow, K H Munger, R Espina, L Paglinawan, N Villanueva, E Rary, J Magee, K Magee, W Cleft-Palate-Craniofac-J. 1997 January; 34(1): 7-10 1055-6656

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Craniofacial morphology in patients with Kallmann's syndrome with and without cleft lip and palate. Author(s): Department of Orthodontics, School of Dentistry, Faculty of Health Sciences, University Hospital of Copenhagen, Denmark. Source: Molsted, K Kjaer, I Giwercman, A Vesterhauge, S Skakkebaek, N E Cleft-PalateCraniofac-J. 1997 September; 34(5): 417-24 1055-6656

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Decrease in cleft lip and palate by vitamin B12 in CL/FR mice. Source: Narukawa, T Natsume, N Miura, S Kawai, T Aichi-Gakuin-Dent-Sci. 1988; 12934 0916-2062

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Dermatography as an adjunctive treatment for cleft lip and palate patients. Author(s): Department of Oral and Cranio-Maxillo-Facial Surgery, Eeuwfeestkliniek, Antwerpen, Belgium. Source: van der Velden, E M van der Dussen, M F J-Oral-Maxillofac-Surg. 1995 January; 53(1): 9-12 0278-2391

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Discordant anencephaly with a cleft lip and palate in a pergonal-induced triplet pregnancy. Author(s): Pediatrics Department, King Faisal Specialist Hospital, Riyadh, Saudi Arabia. Source: Rejjal, A R Abu Osba, Y K J-Perinat-Med. 1992; 20(3): 241-4 0300-5577

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Epidemiology of cleft lip and cleft palate in Mississippi. Author(s): Department of Surgery, University of Mississippi Medical Center, Jackson 39216, USA. Source: Das, S K Runnels, R S Smith, J C Cohly, H H South-Med-J. 1995 April; 88(4): 43742 0038-4348

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Folinic acid reduces cleft lip [CL(P)] in A/WySn mice. Author(s): Department of Biological Sciences, DePaul University, Chicago, Illinois 60614, USA.

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Source: Paros, A Beck, S L Teratology. 1999 December; 60(6): 344-7 0040-3709 •

Increased caries prevalence in 2.5-year-old children with cleft lip and/or palate. Author(s): Department of Orthodontics, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. [email protected] Source: Bokhout, B Hofman, F X van Limbeek, J Kramer, G J Prahl Andersen, B Eur-JOral-Sci. 1996 Oct-December; 104(5-6): 518-22 0909-8836

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Maternal risk factors in cleft lip and palate: case control study. Author(s): The Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan. Source: Natsume, N Kawai, T Ogi, N Yoshida, W Br-J-Oral-Maxillofac-Surg. 2000 February; 38(1): 23-5 0266-4356

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Oral health status of Russian children with unilateral cleft lip and palate. Author(s): Department of Pediatric Dentistry, University of Florida College of Dentistry, Gainesville 32610, USA. Source: Turner, C Zagirova, A F Frolova, L E Courts, F J Williams, W N Cleft-PalateCraniofac-J. 1998 November; 35(6): 489-94 1055-6656

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Orofacial clefts in Czechoslovakia. Incidence, genetics and prevention of cleft lip and palate over a 19-year period. Source: Tolarova, M Scand-J-Plast-Reconstr-Surg-Hand-Surg. 1987; 21(1): 19-25 02844311

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Prevalence of Streptococcus mutans and lactobacilli in 18-month-old children with cleft lip and/or palate. Author(s): Department of Orthodontics, Academic Centre for Dentistry, Amsterdam (ACTA), The Netherlands. Source: Bokhout, B van Loveren, C Hofman, F X Buijs, J F van Limbeek, J Prahl Andersen, B Cleft-Palate-Craniofac-J. 1996 September; 33(5): 424-8 1055-6656

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Protective family regimen in cleft lip and palate. Source: Cerny, M Fara, M Hrivnakova, J Acta-Chir-Plast. 1989; 31(2): 108-17 0001-5423

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Recurrent cleft lip and palate in siblings of a patient with malabsorption syndrome, probably caused by hypovitaminosis a associated with folic acid and vitamin B(2) deficiencies. Author(s): Department of Obstetrics, Centre Hospitalier Universitaire de Quebec (CHUQ), Universite Laval, Quebec, Quebec, Canada. [email protected] Source: Faron, G Drouin, R Pedneault, L Poulin, L D Laframboise, R Garrido Russo, M Fraser, W D Teratology. 2001 March; 63(3): 161-3 0040-3709

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Sagittal position of the left and right maxillary segment in children with cleft lip and palate. Author(s): Department of Orthodontics, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. Source: Ras, F van Aalten, L Janse, A Mobers, S Prahl Andersen, B Cleft-PalateCraniofac-J. 1997 September; 34(5): 438-42 1055-6656

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Significance of maternal and fetal genotype and the effect of retinoic acid on the incidence of cleft lip on A/JWySn and A/J strains of mice. Source: Song, I Beck, S L Forbes, D P Silverstein, R S Northwest-Dent-Res. 1994 Winter; 4(2): 17-20 1062-0311

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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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The following is a specific Web list relating to cleft lip; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com

•

Minerals Gabapentin Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND CLEFT LIP Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to cleft lip. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to cleft lip and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “cleft lip” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to cleft lip: •

A short history of the treatment of cleft lip and cleft palate. Author(s): Goldberg HJ, Pinsky TM, Jones NE. Source: Bull Hist Dent. 1977 October; 25(2): 71-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=346100

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An ancient Chinese text on a cleft lip. Author(s): Boo-Chai K. Source: Plastic and Reconstructive Surgery. 1966 August; 38(2): 89-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5330449

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Asian-American cultural perspectives on birth defects: focus on cleft palate. Author(s): Cheng LR.

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Source: Cleft Palate J. 1990 July; 27(3): 294-300. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2197040 •

Axo-mama and the embryo. Author(s): Jelliffe DB. Source: Lancet. 1972 September 23; 2(7778): 649. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4116789

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B group vitamins and cleft lip and cleft palate. Author(s): Schubert J, Schmidt R, Syska E. Source: International Journal of Oral and Maxillofacial Surgery. 2002 August; 31(4): 4103. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12361075

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Case-control study of periconceptional folic acid supplementation and oral clefts. Author(s): Hayes C, Werler MM, Willett WC, Mitchell AA. Source: American Journal of Epidemiology. 1996 June 15; 143(12): 1229-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8651221

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Children with special health care needs program: urban/rural comparisons. Author(s): Saywell RM Jr, Zollinger TW, Schafer ME, Schmit TM, Ladd JK. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 1993 Fall; 9(4): 314-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10171770

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Cleft lip and jaw induced in fetal rats by vincristine. Author(s): Demyer W. Source: Arch Anat Histol Embryol. 1965; 48(1): 179-86. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4955317

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Cleft palate rehabilitation: interim strategies in Indonesia. Author(s): Willcox DS. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1994 July; 31(4): 316-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7918528

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Combined cleft and craniofacial team--multidisciplinary approach to cleft management. Author(s): Chen YR, Chen SH, Wang CY, Noordhoff MS. Source: Ann Acad Med Singapore. 1988 July; 17(3): 339-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3218923

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Comparative anti-caries effects of tablet and liquid fluorides in cleft children. Author(s): Lin YT, Tsai CL. Source: J Clin Dent. 2000; 11(4): 104-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11460274

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Congenital malformations in aborigines and non-aborigines in Western Australia, 1980-1987. Author(s): Bower C, Forbes R, Seward M, Stanley F. Source: The Medical Journal of Australia. 1989 September 4; 151(5): 245-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2770601

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Cortical auditory dysfunction in children with oral clefts: relation with cleft type. Author(s): Ceponiene R, Hukki J, Cheour M, Haapanen ML, Ranta R, Naatanen R. Source: Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology. 1999 November; 110(11): 1921-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10576488

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Culture, rehabilitation, and facial birth defects: international case studies. Author(s): Strauss RP. Source: Cleft Palate J. 1985 January; 22(1): 56-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2937578

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Development of speech, feeding, eating, and facial expression in Mobius sequence. Author(s): Sjogreen L, Andersson-Norinder J, Jacobsson C. Source: International Journal of Pediatric Otorhinolaryngology. 2001 September 28; 60(3): 197-204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11551610

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Early prenatal diagnosis of cleft lip and the potential impact on the number of babies with cleft lip. Author(s): Winstanley RP. Source: The British Journal of Oral & Maxillofacial Surgery. 1997 August; 35(4): 296. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9291272

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Effect of folic acid supplementation on congenital malformations due to anticonvulsive drugs. Author(s): Biale Y, Lewenthal H. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1984 November; 18(4): 211-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6519344

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Eustachian tube function in cleft lip and palate patients. Author(s): Cole RM, Cole JE, Intaraprasong S.

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Source: Arch Otolaryngol. 1974 May; 99(5): 337-41. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4832614 •

Incidence and epidemiology of cleft lip/palate in Singapore. Author(s): Tan KL. Source: Ann Acad Med Singapore. 1988 July; 17(3): 311-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3265300

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No association of emotional stress or vitamin supplement during pregnancy to cleft lip or palate in man. Author(s): FRASER FC, WARBURTON D. Source: Plastic and Reconstructive Surgery. 1964 April; 33: 395-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14142137

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Otoacoustic emissions in screening cleft lip and/or palate children for hearing loss--a feasibility study. Author(s): Anteunis LJ, Brienesse P, Schrander JJ. Source: International Journal of Pediatric Otorhinolaryngology. 1998 August 1O; 44(3): 259-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9780072

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Periconceptional supplementation with vitamins and folic acid to prevent recurrence of cleft lip. Author(s): Tolarova M. Source: Lancet. 1982 July 24; 2(8291): 217. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6123916

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Physicians and the communication of “bad news”: parent experiences of being informed of their child's cleft lip and/or palate. Author(s): Strauss RP, Sharp MC, Lorch SC, Kachalia B. Source: Pediatrics. 1995 July; 96(1 Pt 1): 82-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7596729

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Presurgical anxiety treated with cognitive behavioral therapy in a 13-year-old female with cleft lip and palate: a psychological case report. Author(s): Whitehead TD, Tobiasen JM, Hiebert JM. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 1996 May; 33(3): 258-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8734729

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Some implications of superstitions and folk beliefs for counseling parents of children with cleft lip and cleft palate. Author(s): Crocker EC, Crocker C.

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Source: Cleft Palate J. 1970 January; 7: 124-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5266325 •

The importance of embryological research in the surgical management of the cleft lip deformity. Author(s): Green MF. Source: Ann Acad Med Singapore. 1988 July; 17(3): 315-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3218920

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Vitamin supplementation as a possible factor in the incidence of cleft lip/palate deformities in humans. Author(s): Briggs RM. Source: Clin Plast Surg. 1976 October; 3(4): 647-52. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=135668

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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•

Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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The following is a specific Web list relating to cleft lip; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Herbs and Supplements Anticonvulsants Source: Healthnotes, Inc.; www.healthnotes.com Valproic Acid Source: Healthnotes, Inc.; www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON CLEFT LIP Overview In this chapter, we will give you a bibliography on recent dissertations relating to cleft lip. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “cleft lip” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on cleft lip, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Cleft Lip ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to cleft lip. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Attitudes of mothers and fathers toward their child with a cleft lip and palate by Kanal, Barbara H., DSW from ADELPHI UNIVERSITY, SCHOOL OF SOCIAL WORK, 1998, 142 pages http://wwwlib.umi.com/dissertations/fullcit/9914065

•

Dermatoglyphic variability and asymmetry of patients with cleft lip and cleft palate. by OWSLEY, DOUGLAS WILLIAM, PHD from THE UNIVERSITY OF TENNESSEE, 1978, 195 pages http://wwwlib.umi.com/dissertations/fullcit/7911701

•

Exploring the role of family appraisal and coping with caregiver stress: The experience of caring for children with cleft lip and palate by Nishimoto, Patricia Ann, PhD from UNIVERSITY OF HAWAI'I, 1999, 252 pages http://wwwlib.umi.com/dissertations/fullcit/9925289

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•

Genetics of spontaneous and 6-aminonicotinamide-induced cleft lip in mice by Juriloff, Diana M; PhD from MCGILL UNIVERSITY (CANADA), 1978 http://wwwlib.umi.com/dissertations/fullcit/NK38262

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Learning and adjustment of children with cleft lip palate by MILLARD, THOMAS LEE, PHD from THE UNIVERSITY OF IOWA, 1996, 116 pages http://wwwlib.umi.com/dissertations/fullcit/9629697

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Predisposing factors to formation of cleft lip and palate: Inherited craniofacial skeletal morphology by Chatzistavrou, Evangelia, MSc from UNIVERSITY OF TORONTO (CANADA), 2003, 97 pages http://wwwlib.umi.com/dissertations/fullcit/MQ84235

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. BOOKS ON CLEFT LIP Overview This chapter provides bibliographic book references relating to cleft lip. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on cleft lip include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “cleft lip” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on cleft lip: •

Cleft Lip and Palate: From Origin to Treatment Source: New York, NY: Oxford University Press, Inc. 2002. 536 p. Contact: Available from Oxford University Press. Customer Service Department, 2001 Evans Road, Cary, NC 27513. (800) 445-9714. Fax (919) 677-1303. E-mail: [email protected]. Website: www.oup-usa.org. PRICE: $125.00 plus shipping and handling. ISBN: 0195139062. Summary: Cleft lip with or without cleft palate and isolated cleft palate, collectively termed oral clefts, are the second most common birth defects among newborns. This textbook on cleft lip and palate covers a broach range of theoretical, experimental, and clinical topics and is written by experts in the fields of craniofacial development, biomedical sciences, genetics, epidemiology, and public health. The text includes 42 chapters in six sections: basic embryology, clinical features, epidemiology, genetics, treatment, and public health issues. Specific topics include the orofacial examination,

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classification, syndromes with orofacial clefting, epidemiology, birth defects surveillance systems, international perspective on oral clefts, maternal nutrition, environmental risk factors, the Human Genome Project, twin studies, patient care team, infant feeding, stage of cleft lip and palate reconstruction, evaluation and management of speech and language disorders, pediatric dental care, the role of the orthodontist, genetic counseling, psychological care of children with cleft lip and palate in the family, international surgical missions, prevention of oral clefts (folic acid and multivitamin supplements), personal and societal implications of oral clefts, insurance and coverage of care, ethical issues, and translating research findings into public health action. Each chapter concludes with a list of references and the text concludes with a directory of Internet resources, a glossary of terms, and a subject index. •

Someone Like Me: A Booklet for Children Born with Cleft Lip and Palate Source: Brownsburgh, IN: Riley Hospital. 1992. 32 p. Contact: Available from Riley Hospital. 506 Maxine Manor, Brownsburgh, IN 46112. (317) 274-2489. PRICE: $5.00 each. Summary: This booklet presents a story of a child born with cleft lip and palate. Illustrated with detailed watercolor paintings, the story begins with a simplified version of fetal development and what happens when the lip or palate do not close before birth. The story continues as the child grows and has different types of surgery to repair cosmetic problems, to address dental concerns, and to provide a better environment for speech and breathing. The story also describes health care professionals who provide care for children with cleft lip and palate. The booklet concludes with a glossary of useful terms.

•

Looking Forward: A Guide for Parents of the Child with Cleft Lip and Palate Source: Evansville, IN: Mead Johnson and Company. 1995. 43 p. Contact: Available from Mead Johnson and Company. 2404 Pennsylvania Street, Evansville, IN 47721. (800) 247-7893. PRICE: Single copy free. Summary: This booklet provides information and guidance for the parents of a child born with cleft lip or palate. The booklet encourages parents to educate themselves and to work closely with the health care team assigned to the child's care. With their expertise, the baby's cleft lip or palate may be corrected early to help the child develop normal or nearly normal speech and appearance. Topics covered include genetic counseling, development of cleft lips and palates, hospitalizations, reactions of other children (including siblings), members of the cleft palate team, types of clefts, anatomy of the roof of the mouth, feeding considerations, feeding methods (breast or bottle), surgery planning, cleft lip surgery, cleft palate surgery, artificial palates, dentition (teeth), hearing tests and ear exams, role of hearing in language development, speech development, role of the speech pathologist, financial assistance issues, and parent support groups. The booklet concludes with a list of resources to help parents take the next step in educating themselves about clefts. The brochure is illustrated with a series of line illustrations and a center section of full-color photographs of families with a family member that has a cleft. 23 figures. 2 tables.

•

As You Get Older: Information for Teens Born with Cleft Lip and Palate Source: Chapel Hill, NC: Cleft Palate Foundation. 2002. 20 p.

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Contact: Available from Cleft Palate Foundation. 104 South Estes Drive, Suite 204, Chapel Hill, NC 27514. (800) 24-CLEFT or (800) 242-5338 or (919) 933-9044. Fax (919) 933-9604. E-mail: [email protected]. Website: www.cleftline.org. PRICE: Single copy free. Summary: This brochure helps teenagers understand some of their health care choices for care of their cleft lip or cleft palate, and encourages them to educate themselves to be good health care consumers. Readers are encouraged to work closely with their parents and the entire cleft palate team to make good choices in each individual situation. Topics covered include getting braces (orthodontics), the options for surgery, jaw surgery, appliances for the mouth, speech considerations, health concerns for the ears, nose and throat, and social relationships. The brochure concludes with the stories of three teens who have cleft lip or palate. A brief list of resources and the contact information for the Cleft Palate Foundation (800-242-5338 or www.cleftline.org) is provided. 4 figures. •

Cleft Lip and Palate: Lesions, Pathophysiology and Primary Treatment Source: London, England: Martin Dunitz Ltd. 2001. 278 p. Contact: Available from Martin Dunitz Ltd, The Livery House. 7-9 Pratt Street, London, England NW1 0AE. 4404074822202. Website: www.dunitz.co.uk. Email: [email protected]. PRICE: $150.00 plus shipping and handling. ISBN: 1853174912. Summary: This text offers an update on the lesions, pathophysiology, and primary treatment of cleft lip and palate. Each chapter of the book includes a study of anatomical pathology preceded by a background refresher on normal anatomy. Correction of these disorders is the purpose of surgical repair and always implies the same aim: to reestablish a state of anatomy that is as close to normal as possible. The book offers 25 chapters in four sections: general, the lip and the nose, the isolated cleft palate, and complete clefts. Specific topics include circumstances of the initial examination, embryology, classification and anatomical clinical forms, the lesions and their consequences, normal anatomy, pathological anatomy, primary treatment, the anatomy and physiology of the normal palate, pathological anatomy and physiology in isolated cleft palate, the Malek procedure, other surgical procedures, pharyngoplasty, speech results, Pierre Robin syndrome, the normal maxillary (upper jaw) skeleton, the nature and consequences of bone lesions, lesions of the nose, guidelines for primary treatment, early primary palate repair, early primary veloplasty, the second stage (cheiloplasty), and long term results. The book concludes with a select bibliography and a detailed subject index. The book is illustrated with full color photographs and line drawings.

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Communicative Disorders Related to Cleft Lip and Palate. 4th ed Source: Austin, TX: PRO-ED, Inc. 1997. 570 p. Contact: Available from PRO-ED, Inc. 8700 Shoal Creek Boulevard, Austin, TX 787576897. (512) 451-3246. Fax (800) 397-7633. PRICE: $56.70 plus shipping and handling. ISBN: 0890797013. Summary: This textbook explores in great detail cleft lip and cleft palate and the communicative disorders that can result from these conditions. After an introductory chapter, 22 chapters cover topics including the anatomy and physiology of normal and disordered velpharyngeal function for speech; basic genetic concepts in craniofacial

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anomalies; social and psychological perspectives on cleft lip and palate; primary surgical correction of cleft palate; secondary surgical procedures to correct postoperative velopharyngeal incompetencies found after primary palatoplasties; and prosthodontic management of the individual with cleft lip and palate for speech habilitation needs. The authors also discuss health supervision and the coordination of the craniofacial team; etiological factors related to managing cleft palate speech disorders; congenital and acquired velopharyngeal inadequacy; audiological management of patients with cleft palate and related disorders; the clinical assessment, evaluation, and management of 11 categorical aspects of cleft palate speech disorders; the diagnosis of specific cleft palate speech error patterns for planning therapy or physical management needs; the use of nasometry in the assessment and remediation of velopharyngeal inadequacy; the radiographic assessment of velopharyngeal function for speech; nasopharyngoscopy; and aerodynamic assessments and procedures used to determine the extent of velopharyngeal inadequacy. Topics related to therapy include the rationale, methods, and techniques of cleft palate speech therapy; counseling and early management of feeding and language skills development for infants and toddlers with cleft palate; therapy considerations for preschool children with cleft palate; speech and voice therapy techniques for school age and adult patients with remaining cleft palate speech disorders; considerations for the behavioral treatment of velopharyngeal closure for speech; and behavioral treatments of velopharyngeal impairment. Each chapter includes black and white photographs or illustrations and extensive references; a subject index concludes the textbook.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “cleft lip” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “cleft lip” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “cleft lip” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

21st Century Complete Medical Guide to Cleft Lip and Cleft Palate, Craniofacial Genetics, Authoritative Government Documents, Clinical References, and Practical Information for Patients and Physicians (CD-ROM) by PM Medical Health News; ISBN: 159248722X; http://www.amazon.com/exec/obidos/ASIN/159248722X/icongroupinterna

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A colour atlas of cleft lip surgery (Single surgical procedures) by R. J Maneksha; ISBN: 0815157533; http://www.amazon.com/exec/obidos/ASIN/0815157533/icongroupinterna

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Atlas of Cleft Lip and Cleft Palate Surgery (Comprehensive surgical atlases in otolaryngology and head and neck surgery) by Howard W. Smith; ISBN: 0808915932; http://www.amazon.com/exec/obidos/ASIN/0808915932/icongroupinterna

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Communicative disorders related to cleft lip and palate; ISBN: 0316119369; http://www.amazon.com/exec/obidos/ASIN/0316119369/icongroupinterna

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Early Treatment of Cleft Lip and Palate: Proceedings of the Third International Symposium, September 27-29, 1984, University of Zurich, Switzerland; ISBN: 0920887015; http://www.amazon.com/exec/obidos/ASIN/0920887015/icongroupinterna

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Management of Cleft Lip and Palate by Robert M Bumsted; ISBN: 9991669566; http://www.amazon.com/exec/obidos/ASIN/9991669566/icongroupinterna

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Multidisciplinary Management of Cleft Lip and Palate by Janusz Bardach, Hughlett L. Morris; ISBN: 0721629512; http://www.amazon.com/exec/obidos/ASIN/0721629512/icongroupinterna

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Neonatal Surgery of the Cleft Lip and Palate by Sanu N. Desai; ISBN: 9810231164; http://www.amazon.com/exec/obidos/ASIN/9810231164/icongroupinterna

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Plastic Surgery Cleft Lip Palate (Plastic Surgery) by McCarthy; ISBN: 0721625452; http://www.amazon.com/exec/obidos/ASIN/0721625452/icongroupinterna

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Salyer & Bardach's Atlas of Craniofacial & Cleft Surgery, Volume II: Cleft Lip and Palate Surgery by Kenneth E. Salyer, et al; ISBN: 0781726050; http://www.amazon.com/exec/obidos/ASIN/0781726050/icongroupinterna

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Speech Language and Psycholocial Aspects of Cleft Lip and Cleft Palate: The State of the Art; ISBN: 9995847507; http://www.amazon.com/exec/obidos/ASIN/9995847507/icongroupinterna

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Symposium on Management of Cleft Lip and Palate and Associated Deformities;: Proceedings (Proceedings of the symposium of the Educational Foundation o. of Plastic and Reconstructive Surgeons, v. 8); ISBN: 0801618002; http://www.amazon.com/exec/obidos/ASIN/0801618002/icongroupinterna

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What Is a Cleft Lip and Palate?: A Multidisciplinary Update - Proceedings of an Advanced Workshop, Bremen 1987 by O. Kriens; ISBN: 3137434017; http://www.amazon.com/exec/obidos/ASIN/3137434017/icongroupinterna

Chapters on Cleft Lip In order to find chapters that specifically relate to cleft lip, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and cleft lip using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “cleft lip” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on cleft lip: •

Oral Care for Children with Cleft Lip or Cleft Palate Source: in Sutton, A.L. Dental Care and Oral Health Sourcebook. 2nd ed. Detroit, MI: Omnigraphics. 2003. p. 393-400. Contact: Available from Omnigraphics. 615 Griswold Street, Detroit, MI 48226. (313) 961-1340. Fax: (313) 961-1383. E-mail: [email protected]. www.omnigraphics.com. PRICE: $78.00; plus shipping and handling. ISBN: 780806344.

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Summary: A cleft lip is a separation of the two sides of the lip. The separation often includes the bones of the upper jaw or upper gum. A cleft palate is an opening in the roof of the mouth in which the two sides of the palate did not fuse as the unborn baby was developing. This chapter on oral care for children with cleft lip or cleft palate is from a book that provides information about dental care and oral health at all stages of life. Topics include how cleft lip or palate affects the teeth, early dental care, proper tooth cleaning, good nutrition, the use of fluoride, orthodontic care, coordinated dental and surgical care, prosthodontic care, missing teeth in children with cleft lip or cleft palate, the members of the patient care team, options for the permanent replacement of the lateral incisor, and options for a patient who has had a bone graft. 2 figures. •

Management of Cleft Lip and Palate Source: in Cameron, A.C. and Widmer, R.P., eds. Handbook of Pediatric Dentistry. London, England: Mosby. 1997. p. 289-306. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. PRICE: $44.95. ISBN: 0723430683. Summary: Children with clefting conditions will require extensive interdisciplinary medical treatments, involving plastic surgery, maxillofacial or craniofacial surgery, dentistry, ear nose and throat surgery, audiology, speech therapy, psychology, and in some cases ophthalmology and neurosurgery. This chapter on management of cleft lip and palate is from a resource book that presents the essentials of the contemporary dental care of children, including behavior management and treatment of oral and dental trauma, dental caries, and oral infections. A special focus on pediatric dental preventive strategies, risk assessment, fluoridation, and restorative techniques is provided. The authors of this chapter cover the anatomy of the facial skeleton in cleft lip and palate, dental anomalies, current concepts of cleft management, the importance of dental care in overall management, surgical management, orthodontic management, and speech therapy. Dental care topics include patient referral, initial consultation, the role of the pediatric dentist (coordination), preventive dental care, dental extractions and minor oral surgery, and cosmetic restoration of malformed anterior teeth and alveolar cleft. 9 figures. 1 table. 9 references.

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Multidisciplinary Team Approach to Cleft Lip and Palate Management Source: in McDonald, R.E. and Avery, D.A., eds. Dentistry for the Child and Adolescent. 7th ed. St. Louis, MO: Mosby, Inc. 2000. p. 742-773. Contact: Available from Harcourt Health Sciences. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Fax (800) 874-6418. Website: www.harcourthealth.com. PRICE: $72.00 plus shipping and handling. ISBN: 0815190174. Summary: Cleft lip with cleft palate is a severe birth defect occurring in approximately 1 of every 750 to 1000 newborns in the United States. This chapter on the multidisciplinary team approach to cleft lip and palate management is from a textbook on dentistry for the child and adolescent that is designed to help undergraduate dental students and postdoctoral pediatric dentistry students provide comprehensive oral health care for infants, children, teenagers, and individuals with various disabilities. Topics include classification of cleft lip and palate; the multidisciplinary cleft lip and palate team; general responsibilities of team members, including dental specialties, and medical and allied health specialties; and the multidisciplinary sequencing of treatment in clefts, including the recommended surgical techniques used at each stage. The authors remind readers that children born with clefts vary widely in their clinical

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presentation and therefore in the appropriate treatment approach. The complexity of cleft problems requires that numerous health care practitioners cooperate in providing the specialized knowledge and skills necessary to ensure comprehensive care. 33 figures. 57 references. •

Health Care for Children With Cleft Lip and Palate: Comprehensive Services and Infant Feeding Source: in Wyszynski, D.F., ed. Cleft Lip and Palate: From Origin to Treatment. New York, NY: Oxford University Press, Inc. 2002. p. 303-318. Contact: Available from Oxford University Press. Customer Service Department, 2001 Evans Road, Cary, NC 27513. (800) 445-9714. Fax (919) 677-1303. E-mail: [email protected]. Website: www.oup-usa.org. PRICE: $125.00 plus shipping and handling. ISBN: 0195139062. Summary: Cleft lip with or without cleft palate and isolated cleft palate, collectively termed oral clefts, are the second most common birth defects among newborns. This chapter on health care (comprehensive services and infant feeding) for children with cleft lip and palate is from a textbook on cleft lip and palate. The author notes that the child's long term outcome is influenced by many factors, including the underlying condition or syndrome, strengths of the child and family, access to services, and completion of a comprehensive treatment plan. Clefts may be associated with syndromes, early feeding problems, airway compromise, growth and developmental abnormalities, speech disorders, recurrent ear infections, and psychosocial concerns. Topics covered in the chapter include key times for providing care, the birth experience and first clinical encounter, community health services, the cleft palate team, the roles and responsibilities of the primary care provider, the biology of sucking, determining an infant's ability to be orally fed, and feeding practices (including breastfeeding) in a clinical setting. 1 table. 95 references.

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Cleft Lip and Cleft Palate Source: in Vinson, B.P. Essentials for Speech-Language Pathologists. San Diego, CA: Singular Publishing Group. 2001. p. 179-202. Contact: Available from Thomson Learning Group. P.O. Box 6904, Florence, KY 41022. (800) 842-3636. Fax (606) 647-5963. Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 0769300715. Summary: This chapter on cleft lip and cleft palate is from a textbook that is designed to help new professionals with the transition to clinical practice in speech language pathology. The author describes and defines the condition and emphasizes the importance of a comprehensive, multidisciplinary approach to the care of a child with a cleft. The author notes that cleft lip and palate are associated with over 350 syndromes, and more than 50 percent of children with cleft palate only are likely to have developmental deficits or other associated malformations. The author discusses velo cardio facial syndrome (VCFS); velopharyngeal function; assessment issues, including the oral facial examination, oral health in children with cleft lip and palate, voice, language, speech (hypernasality and nasal emission, compensatory articulation strategies, modified tongue anchor procedure, and cul de sac resonance), and acoustic measures; and treatment considerations, divided by age groups (immediately after birth, first year, second year, third year, etc., through early adolescence), including feeding, pharyngeal flap, the nonsurgical treatment of hypernasality, social emotional

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development, and issues relating to school age children (including adolescents). One appendix offers a checklist for the assessment of clients with clefts. •

Dentofacial Deformities Associated with Cleft Lip and Palate Source: in Epker, B.N.; Stella, J.P.; Fish, L.C. Dentofacial Deformities, Volume III: Integrated Orthodontic and Surgical Correction. 2nd ed. St. Louis, MO: Mosby. 1998. p. 1571-1713. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. PRICE: $149.00. ISBN: 0815131291. Summary: This chapter on dentofacial deformities associated with cleft lip and palate is from a textbook that outlines the integrated orthodontic and surgical correction of dentofacial deformities. The chapter is divided into three parts. The first describes the most common or usual orthodontic and surgical treatment of the deformity in question. The second part presents adjunctive surgical techniques that are frequently helpful in the treatment of select individuals. The third section presents alternative treatment approaches. In the chapter, a step by step approach to presurgical orthodontic treatment, immediate presurgical planning, surgical techniques, and postsurgical orthodontic treatment is described. Special factors discussed include velopharyngeal function, the presence of a pharyngeal flap, the quality of the palatal soft tissues, the status of the alveolar cleft, patency of the nasal airway, quality and quantity of the tissues of the upper lip and vestibule, and coexistence of a skeletal transverse deficiency. In addition, considerations regarding the timing of any indicated lip-nose revision are given special attention. The chapter is illustrated with black and white photographs, and extensive anatomical illustrations of surgical techniques. 78 figures. 83 references.

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Social and Psychological Perspectives on Cleft Lip and Palate Source: in Bzoch, K.R., ed. Communicative Disorders Related to Cleft Lip and Palate. 4th ed. Austin, TX: PRO-ED, Inc. 1997. p. 95-113. Contact: Available from PRO-ED, Inc. 8700 Shoal Creek Boulevard, Austin, TX 787576897. (512) 451-3246. Fax (800) 397-7633. PRICE: $56.70 plus shipping and handling. ISBN: 0890797013. Summary: This chapter on social and psychological perspectives is from a textbook that explores cleft lip and cleft palate and the communicative disorders that can result from these conditions. Aside from the psychological influences that customarily relate to development, learning, self concept, and mental health, people with cleft lip or palate have unique challenges that relate to their quality of life. The authors discuss stigma and appearance, dealing with stigma, treatment activism, the psychological impacts of treatment, cultural issues, birth issues and diagnosis, psychological issues and delivery of care, the role of team-based patient care, neuropsychological and cognitive issues, and directions in psychosocial research (medical model versus social sciences model). The authors stress that psychological influences are defined by the social and cultural contexts in which a child develops. These contexts affect how the child with cleft lip or palate is received, how the family interacts socially with the child, and how the community responds socially to the child. 124 references.

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Dynamics of Speech and Orthodontic Management in Cleft Lip and Palate Source: in Shprintzen, R.J.; Bardach, J., eds. Cleft Palate Speech Management: A Multidisciplinary Approach. St. Louis, MO: Mosby-Year Book, Inc. 1995. p. 305-326.

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Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146-3318. (800) 633-6699; Fax (800) 535-9935. PRICE: $61.95 plus shipping and handling. ISBN: 0801664470. Summary: This chapter on the dynamics of speech and orthodontic management in cleft lip and palate is from a textbook for speech pathologists on managing patients with clefts. The authors emphasize a transdisciplinary approach in the clinical application of assessment and management, most notably the relationship between the professions of orthodontics and speech pathology. Topics covered include the craniofacial complex in cleft lip and palate, the dynamics of speech and dentition, articulatory errors in this population, articulation and resonance in clefting, and the recommended clinical management of children with clefts. 18 figures. 52 references. •

Role of the Orthodontist in the Management of Patients With Cleft Lip and/or Palate Source: in Wyszynski, D.F., ed. Cleft Lip and Palate: From Origin to Treatment. New York, NY: Oxford University Press, Inc. 2002. p. 381-396. Contact: Available from Oxford University Press. Customer Service Department, 2001 Evans Road, Cary, NC 27513. (800) 445-9714. Fax (919) 677-1303. E-mail: [email protected]. Website: www.oup-usa.org. PRICE: $125.00 plus shipping and handling. ISBN: 0195139062. Summary: This chapter on the role of the orthodontist in the management of patients with cleft lip or cleft palate is from a textbook on cleft lip and palate. The authors describe the team approach to comprehensive care, which requires the orthodontist to work in a collaborative way to determine the timing and sequencing of treatment interventions. This patient-centered care by a team of caregivers provides the basis for a rational approach to diagnosis and treatment planning and delivery. The authors divide the timing and sequencing of orthodontic care into four distinct developmental periods, defined by age and dental development (neonate, primary dentition, mixed dentition, and permanent dentition). These should be considered time frames for the accomplishment of specific objectives. This avoids the all too common tendency to allow an early phase of treatment intervention to extend through childhood into adolescence and beyond. The authors note that speech considerations and the communicative skills of the patient with a cleft are important aspects in planning orthognathic surgery for this group of patients. Also, subsequent nose and lip revisions for cosmetic improvement must not be underestimated in the enhancement of the final result following correction of the skeletal and dental discrepancies. 13 figures. 43 references.

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Orthodontic Treatment of Children with Cleft Lip and Palate Source: in Shprintzen, R.J.; Bardach, J. Cleft Palate Speech Management: A Multidisciplinary Approach. St. Louis, MO: Mosby-Year Book, Inc. 1995. p. 295-304. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146-9934. (800) 426-4545 or (314) 872-8370; Fax (800) 535-9935 or (314) 4321380; E-mail: [email protected]; http://www.mosby.com. PRICE: $61.95 plus shipping and handling. ISBN: 0801664470. Summary: This chapter, from a text on cleft palate speech management, discusses the orthodontic treatment of children with cleft lip and palate. The author focuses on describing typical morphologic findings at five developmental stages and on providing an overview of the orthodontist's assessment and treatment approaches at these stages. Orofacial structures and various orthodontic treatment procedures are described for the

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stages of early infancy (up to 12 months), primary dentition (1 to 6 years), early mixed dentition (6 to 9 years), late mixed dentition (9 to 12 years), and adolescence (12 to 18 years). The author relates various treatment modalities and intraoral findings to hazards for normal speech production. 10 figures. 8 references. (AA-M).

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to cleft lip have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:8 •

Self-Help Sourcebook: Finding and Forming Mutual Aid Self-Help Groups. 4th ed Source: Denville, NJ: American Self-Help Clearinghouse. 1992. 226 p. Contact: Available from American Self-Help Clearinghouse. Attn: Sourcebook, St. Clares-Riverside Medical Center, 25 Pocono Road, Denville, NJ 07834. Voice (201) 6257101; TTY (201) 625-9053. PRICE: $9.00 book rate; $10.00 first class mail. ISBN: 0963432206. Summary: This sourcebook lists self-help groups in a wide variety of topic areas, including addictions and dependencies, bereavement, disabilities, health, mental health, parenting and family, physical and/or emotional abuse, and miscellaneous categories. Topics relevant to deafness and communication disorders include acoustic neuroma, alternative/augmentative communication, autism, cleft palate and cleft lip, cochlear implants, developmental disabilities, developmentally delayed children, Down syndrome, dystonia, ear anomalies, elective mutism, hearing impairment, inner ear problems, laryngectomy, late-deafened adults, learning disabilities, Meniere's disease, neck-head-oral cancer, parents of children with hearing impairment, speech dysfunction, speech impairments, stuttering, tinnitus, Tourette syndrome, and Usher's syndrome. In addition to basic information about the self-help groups, the sourcebook lists self-help clearinghouses, toll-free helplines, resources for rare disorders, resources for genetic disorders, housing and neighborhood resources and resources for the homeless, how-to ideas for developing self-help groups, and using a home computer for mutual help. The book includes a bibliography and key word index.

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You will need to limit your search to “Directory” and “cleft lip” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “cleft lip” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

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CHAPTER 6. MULTIMEDIA ON CLEFT LIP Overview In this chapter, we show you how to keep current on multimedia sources of information on cleft lip. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on cleft lip is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “cleft lip” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “cleft lip” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on cleft lip: •

Giving Your Child a Smile: Correcting Cleft Lip and Palate Source: Urbana, IL: Baxley Media Group. 1990. (videocassette). Contact: Available from Baxley Media Group. 110 West Main Street, Urbana, IL 618012700. (217) 384-4838. Fax (217) 384-8280. PRICE: $150.00 for purchase; $65 for 3 days rental or $100 for 5 days rental. Also available from Health Sciences Consortium. 201 Silver Cedar Court, Chapel Hill, NC 27514-1517. (919) 942-8731; Fax (919) 942-3689. PRICE: $276.50 for HSC members; $395.00 for non-members. Rentals (per title) $80.00; HSC Members $55.00; plus shipping and handling. Previews (per title) $30.00; HSC members $20.00; plus shipping and handling. Order Number D900-VI-041. Summary: This videotape is designed for parents of babies with cleft lip and palate. It is designed to calm their fears, answer many of the questions they will have, and prepare them to begin making the necessary decisions about their children's future. Medical illustrations and computer graphics are combined with narration to reassure parents that cleft lip and palate are correctable. Pediatricians, plastic surgeons, ENT surgeons,

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speech pathologists, orthodontists, oral surgeons, and geneticists explain the role they each play and the benefits of using a team approach to correct a child's problem. The video includes before and after pictures of children who have had corrective surgery. (AA-M). •

Face Facts: Understanding Facial Disfigurement. Featured Segment: Cleft Lip and Palate Source: New York, NY: Forward Face. 1991. (videocassette). Contact: Available from Forward Face. 317 East 34th Street, Suite 901A, New York, NY 10036. Voice (800) 393-FACE or (212) 684-5860; Fax (212) 684-5864. PRICE: $10.00 for members; $15.00 for nonmembers. Summary: This videotape program is designed to help parents of children with craniofacial anomalies learn about positive opportunities for their children to grow and develop. Narrated by Cliff Robertson, the program emphasizes the importance of developing a positive self-image in children with facial differences. The film depicts numerous children and their families, as they cope with doctor's offices and surgeries, go to school, and live at home. In addition, basic facts about craniofacial anomalies are presented, including information about cleft lip and palate; craniosynostosis, including Apert, Crouzon's, Pfeiffer's, and Treacher-Collins syndrome; orbital hypertelorism; and hemifacial microsomia. Children with each of these anomalies are shown shortly after birth and as they grow. One segment explores the situation of cleft lip and palate in more detail. The program emphasizes the need for early medical intervention, the role of a health care team, and the importance of support for the family and child. The video concludes with the toll-free telephone number of Forward Face, a support organization.

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Children with Cleft Lip and Palate Source: Princeton, NJ: Films for the Humanities and Sciences. 1996. (videocassette). Contact: Available from Films for the Humanities and Sciences. P.O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126 or (609) 275-1400. Fax (609) 275-3767. E-mail: [email protected]. Website: www.films.com. PRICE: $149.00 plus shipping and handling. Item number VCS 6779. Summary: This videotape program shows how the members of a patient care team cooperate to provide help for children and families of children born with cleft lip or cleft palate, or both. The support team consists of a plastic surgeon, orthodontist, general dentist, logopedist, dental surgeon, otorhinolaryngologist, and a social worker. The various types of clefts are shown, both before and after corrective surgery. The surgical techniques are described through animation. (AA-M).

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CHAPTER 7. PERIODICALS AND NEWS ON CLEFT LIP Overview In this chapter, we suggest a number of news sources and present various periodicals that cover cleft lip.

News Services and Press Releases One of the simplest ways of tracking press releases on cleft lip is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “cleft lip” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to cleft lip. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “cleft lip” (or synonyms). The following was recently listed in this archive for cleft lip: •

New cleft lip and palate gene identified Source: Reuters Health eLine Date: September 02, 2002

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Binge drinking linked to cleft lip birth defects Source: Reuters Health eLine Date: March 30, 1999

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Incidence Of Cleft Lip And Palate Underestimated In UK Source: Reuters Medical News Date: February 25, 1998

•

Folic Acid Supplementation During Pregnancy May Prevent Cleft Lip And Cleft Palate In Offspring Source: Reuters Medical News Date: August 11, 1995 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “cleft lip” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “cleft lip” (or synonyms). If you know the name of a company that is relevant to cleft lip, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.

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BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “cleft lip” (or synonyms).

Newsletters on Cleft Lip Find newsletters on cleft lip using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “cleft lip.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “cleft lip” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Wide Smiles Special Edition 1993: New Parent Outreach Source: Wide Smiles. Special Edition 1993. p. 1-32. Contact: Available from Wide Smiles. P.O. Box 5153, Stockton, CA 95205-0153. (209) 9422812. Fax (209) 464-1497. Website: www.widesmiles.org. PRICE: $3.25 each for 1-5 copies; bulk discounts available. Summary: This special edition of the Wide Smiles newsletter is designed specifically for first contact with new parents of infants with cleft lip and/or palate. Many of the articles in this issue are stories from other parents about experiencing the first few weeks and months with a child who has a cleft. Also included is a section of letters to the editor; a question-and-answer forum about early cleft concerns; an article discussing the importance of a multidisciplinary approach and detailing the role of each of the patient care team members; a book review; a discussion of how to deal with nosy questions in public; and a column written by a registered nurse. Information about subscribing to the quarterly newsletter is also included.

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “cleft lip” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on cleft lip: •

Premaxillary Orthopedic: Unilateral Cleft Lip and Palate Source: Cleft Palate Reflections. p. 1-2, 4. Fall 1993. Contact: Available from Shadyside Maxillofacial and Cleft Palate Prosthetic Center. Shadyside Medical Center, Suite 207, 5200 Centre Avenue, Pittsburgh, PA 15232. (412) 621-4310.

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Summary: This article on the use of premaxillary orthopedics in unilateral cleft lip and palate is from a newsletter for cleft palate patients, parents, and health care providers on cleft palate treatment teams. After a description of the differences between a unilateral and bilateral cleft, the author considers whether premaxillary orthopedics need to be performed in every unilateral cleft lip and palate case. The author notes that premaxillary orthopedics is not indicated in many of these patients. When the cleft is narrow, the surgical repair of the lip is sufficient to mold the major segment towards the minor segment, producing a symmetrical dental arch. However, in the subgroup of unilateral cleft lip and palate patients that have wide clefts (i.e., 10 to 20 mm in width), there may be a role for premaxillary orthopedic treatment. The objective of premaxillary orthopedic treatment is to reduce the width of the cleft by overcoming the lateral pull of the facial muscles and preventing the tongue from resting in the cleft. Care must be taken to prevent collapse of the cleft segments during treatment by overzealous extraoral traction. The article concludes with a discussion of three common ways to perform premaxillary orthopedic treatment: extraoral strapping alone, extraoral strapping with an intraoral appliance, and the use of a Latham appliance. 5 figures. •

Management of the Cleft Lip-Palate Patient Source: AAOMS Surgical Update. p. 1-6. Winter 1992. Contact: Available from American Association of Oral and Maxillofacial Surgeons (AAOMS). Committee on Public Information, 9700 West Bryn Mawr Avenue, Rosemont, IL 60018-5701. (800) 366-6725 or (847) 678-6200; Fax (847) 678-6286 or (630) 241-9805; http://www.aaoms.org. Summary: This issue of Surgical Update examines the types of cleft conditions and available treatment regimens, and offers guidelines for dealing with some of the special challenges confronting the dentist and the cleft team. Topics include the diagnostic classification of cleft lip and palate; dentofacial considerations in the infant; pre-primary dentition, primary dentition, mixed dentition, and permanent dentition; surgical orthodontics; treating patients who did not experience early and continuous dental intervention, who present with various dental problems; and controversial issues in this area, including timing for total cleft palate closure and the real benefits of early maxillofacial orthopedic treatment. The author conclude that a coordinated team effort, which provides the earliest possible diagnosis, preventive and treatment regimens with ongoing evaluation and maintenance, can vastly improve function, esthetics, and overall quality of life for these patients. 8 figures.

Academic Periodicals covering Cleft Lip Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to cleft lip. In addition to these sources, you can search for articles covering cleft lip that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical

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periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute9: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

9

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.10 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:11 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

10

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 11 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway12 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “cleft lip” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 9709 212 107 0 255 10283

HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.16 Simply search by “cleft lip” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

12

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

13

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 14 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 15 16

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists17 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.18 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.19 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

The Genome Project and Cleft Lip In the following section, we will discuss databases and references which relate to the Genome Project and cleft lip. Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).20 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. 17 Adapted 18

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 19 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 20 Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

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To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “cleft lip” (or synonyms) into the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. In particular, the option “Database Links” will search across technical databases that offer an abundance of information. The following is an example of the results you can obtain from the OMIM for cleft lip: •

Coloboma, Uveal, with Cleft Lip and Palate and Mental Retardation Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=120433

•

Ectodermal Dysplasia, Anhidrotic, with Cleft Lip and Cleft Palate Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=129400

•

Lagophthalmia with Bilateral Cleft Lip and Palate Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=600990 Genes and Disease (NCBI - Map)

The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to revisit it from time to time. The following systems and associated disorders are addressed: •

Cancer: Uncontrolled cell division. Examples: Breast and ovarian cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html

•

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html

•

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, atherosclerosis, Best disease, Gaucher disease, glucose galactose malabsorption, gyrate atrophy, juvenile-onset diabetes, obesity, paroxysmal nocturnal hemoglobinuria, phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

•

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

•

Nervous System: Mind and body. Examples: Alzheimer disease, amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, fragile X syndrome,

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Friedreich’s ataxia, Huntington disease, Niemann-Pick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html •

Signals: Cellular messages. Examples: Ataxia telangiectasia, Cockayne syndrome, glaucoma, male-patterned baldness, SRY: sex determination, tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

•

Transporters: Pumps and channels. Examples: Cystic fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez

Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: •

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

•

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

•

Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

•

NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

•

Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

•

OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

•

PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

•

ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

•

Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

•

PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

•

Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” Enter “cleft lip” (or synonyms) into the search box and click “Go.” Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database21 This online resource has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database22 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “cleft lip” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms).

21

Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 22 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html - mission.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on cleft lip can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to cleft lip. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to cleft lip. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “cleft lip”:

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Birth Defects http://www.nlm.nih.gov/medlineplus/birthdefects.html Cleft Lip and Palate http://www.nlm.nih.gov/medlineplus/cleftlipandpalate.html Facial Injuries and Disorders http://www.nlm.nih.gov/medlineplus/facialinjuriesanddisorders.html Genetic Disorders http://www.nlm.nih.gov/medlineplus/geneticdisorders.html Head and Brain Malformations http://www.nlm.nih.gov/medlineplus/headandbrainmalformations.html

Within the health topic page dedicated to cleft lip, the following was listed: •

Treatment Bone Grafting the Cleft Maxilla Source: Cleft Palate Foundation http://www.cleftline.org/publications/bonegraft.htm Cleft Lip and Palate Surgery Source: American Society of Plastic Surgeons http://www.plasticsurgery.org/public_education/procedures/CleftLipPalate.cfm Treatment for Adults with Cleft Lip and Palate Source: Cleft Palate Foundation http://www.cleftline.org/publications/adult.htm

•

Coping Caring for a Newborn with Oral Clefting Source: Nemours Foundation http://kidshealth.org/parent/medical/ears/caring_oral_clefting.html Preparing Your Child for Social Situations Source: Cleft Palate Foundation http://www.cleftline.org/publications/social.htm

•

Children Cleft Lip and Cleft Palate Source: Nemours Foundation http://kidshealth.org/kid/health_problems/birth_defect/cleft_lip_palate.html

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Law and Policy Dealing with Your Insurance Company/HMO Source: Cleft Palate Foundation http://www.cleftline.org/publications/insurance.htm

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Organizations Cleft Palate Foundation http://www.cleftline.org/welcome/ National Institute of Dental and Craniofacial Research http://www.nidcr.nih.gov/ National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov/

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Pictures/Diagrams Cleft Lip Source: Cleft Palate Foundation http://www.cleftline.org/aboutclp/cleft_lip.htm Cleft Palate Source: Cleft Palate Foundation http://www.cleftline.org/aboutclp/cleft_palate.htm

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on cleft lip. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Cleft Palate and Cleft Lip Source: Danbury, CT: National Organization for Rare Disorders, Inc. (NORD). 2002. 6 p. Contact: Available from National Organization for Rare Disorders, Inc. (NORD). 55 Kenosia Avenue, P.O. Box 1968, Danbury, CT 06813-1968. (203) 744-0100. Fax: (203) 7982291. TDD: (203) 797-9590. Email: [email protected]. Website: www.rarediseases.org. PRICE: Full-text available online for $7.50. Summary: Cleft lip and palate are common malformations that are noticeable at birth (congenital). A cleft is an incomplete closure of the palate or lip or both. These are genetic disorders that occur in the first trimester of pregnancy and may be barely noticeable or may be severe enough to require surgical and dental are, as well as speech therapy. This fact sheet reviews this condition, covering synonyms, a general introduction, the symptoms, causes (etiology), affected population, related disorders, and standard therapies. The fact sheet concludes with a list of resources for more

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information and a list of references. The fact sheet includes the contact addresses for the National Organization for Rare Disorders. 20 references. •

Parameters for Evaluation and Treatment of Patients with Cleft Lip-Palate or Other Craniofacial Anomalies: Summary of Recommendations Source: Chapel Hill, NC: American Cleft Palate-Craniofacial Association. 1998. [4 p.]. Contact: Available from American Cleft Palate-Craniofacial Association. 1829 East Franklin Street, Suite 1022, Chapel Hill, NC 27514. (919) 933-9044; Fax (914) 933-9604; Email: [email protected]. PRICE: Single copy free. Summary: The complex needs of a child with a cleft lip or palate or any other craniofacial anomaly are best met by a dedicated cleft or craniofacial team of health care providers with special expertise and experience in the care of such disorders. This brochure presents the parameters for the evaluation and treatment of these patients, as established by the American Cleft Palate Craniofacial Association (ACPA). The brochure outlines ten arenas of care: audiologic care, cleft lip or palate surgery, craniofacial and maxillofacial surgery, dental care, genetic or dysmorphology services, nursing care, otolaryngologic care, pediatric care, psychological and social services, and speech language services. These children are at high risk for hearing disorders and thus should be assessed from infancy through adolescence. Treatment may involve myringotomies and placement of ventilation tubes, hearing aids, auditory training systems, bone conduction amplification, and surgery. The comprehensive care of these children typically requires long-term monitoring of the ears, nose and throat (otolaryngology) due to the prevalence of ear disease, ear malformations, and upper airway problems. Children who have craniofacial anomalies are also at high risk for speech language disorders. Speech language evaluations should occur within the first year of life, and then often enough to assure adequate documentation of each child's progress and to develop appropriate recommendations for intervention. The brochure concludes with a brief description of the ACPA, a professional organization established to optimize the care of people affected by craniofacial anomalies through education, stimulation of research, and promotion of interdisciplinary collaboration and team care.

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Cleft lip and cleft palate: The first four years. (Rev. ed.) Source: Chapel Hill, NC: Cleft Palate Foundation. 1998. 24 pp. Contact: Available from Cleft Palate Foundation, 1829 East Franklin Street, Suite 1022, Chapel Hill, NC 27514. Telephone: (919) 933-9044. Summary: The purpose of this booklet is to provide answers for the questions of parents about what can be done to help their baby with a cleft and lessen parental concerns about the future. The information has been prepared by health care professionals who are members of the American Cleft Palate - Craniofacial Association and by lay persons who are members of parent-patient support groups. Much of the information in this booklet is based on interactions with parents. The information in the booklet will help parents know how to care for their their baby and is presented in the general order in which parents may need to cope with various situations. A glossary at the end of the booklet defines certain words parents may read or hear. Words in the glossary are bolded when they first appear in the booklet.

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Nursing Your Baby with a Cleft Palate or Cleft Lip Source: Waco, TX: Childbirth Graphics, Health EDCO. 1996. 16 p.

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Contact: Available from Childbirth Graphics. Health EDCO, P.O. Box 21207, Waco, TX 76702-1207. (800) 299-3366 or (817) 776-6461. Fax (888) 977-7653. PRICE: Single copy free; bulk rates available. Summary: This booklet helps mothers of infants with cleft palate or cleft lip successfully breastfeed their babies. The brochure briefly reviews the benefits of breastfeeding, including fewer infections, essential parent-infant interaction and closeness, better face and mouth development, and extra protection after oral surgery. The brochure then provides detailed suggestions for breastfeeding a baby with a cleft lip or cleft palate. Other topics include dealing with a palatal obturator, helping the infant to nurse adequately, finding different positions to support nursing, using chin support for the baby, burping, breastfeeding after oral surgery, establishing the length of feedings, stimulating the milk supplies, supplementing the breastfeeding with a pacifier feeding technique, and the importance of taking good care of the mother, both physically and psychologically. The brochure is illustrated with numerous black and white photographs depicting babies with clefts in various nursing positions. The brochure concludes with information about the Cleft Palate Foundation and with suggestions for finding other support groups, including the La Leche League. •

Cleft Lip and Palate: The School-Aged Child. 2nd ed Source: Chapel Hill, NC: Cleft Palate Foundation. 1999. 27 p. Contact: Available from Cleft Palate Foundation. 104 South Estes Drive, Suite 204, Chapel Hill, NC 27514. (800) 242-5338. Website: www.cleft.com. PRICE: Single copy free. Summary: This booklet is the second entry in a developmental series produced by the Cleft Palate Foundation. The first booklet was written for parents of babies born with clefts. This next booklet in the series discusses some of the concerns parents may feel as their children begin kindergarten and progress on to middle school (ages 5 to 12 years). During these school years, the child's focus widens to include not only the family, but the larger world of neighborhood and school as well. Children may become concerned about how they look and talk. The booklet was written for families, but is intended to be shared with the affected child, other family members, friends, and teachers. Section One focuses on the medical, dental, and speech decisions which must be made to promote the best appearance and good speech. Section Two focuses on the school experience. The authors stress the importance of maintaining normal hearing, explore the possibility of learning problems and the options for managing them, and discuss how children can handle teasing and increase their ability to make friends. The section concludes with a teacher's presentation of what it means to have a child with a cleft or craniofacial birth defect in the class. The booklet includes three photographs and brief biographies of young people with clefts. 8 figures.

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Cleft Lip and Cleft Palate: Information for the Teenager Born with a Cleft Source: Chapel Hill, NC: Cleft Palate Foundation. 1997. 14 p. Contact: Available from Cleft Palate Foundation. 104 South Estes Drive, Suite 204, Chapel Hill, NC 27514. (800) 242-5338. Fax (919) 933-9604. E-mail: [email protected]. Website: www.cleft.com. PRICE: Single copy free. Summary: This booklet provides information about concerns that teenagers born with a cleft lip or a cleft palate may have. The booklet notes that, by the teenage years, most children will have undergone primary surgeries repairing the cleft, but may still have some questions about additional treatment or other issues. The booklet includes eight

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chapters that cover the development and genetics of cleft lip and palate, surgery and surgical techniques, additional surgery, otolaryngology and the role of the otolaryngologist, orthodontics (braces) and oral hygiene, prosthodontics, speech language therapy, and social functioning. A final section briefly describes a number of programs specifically designed for teenagers and young adults with clefts. The brochure concludes that, generally speaking, teenagers with clefts have the same chance to be physically and emotionally healthy as do their noncleft peers. •

Cleft Lip and Palate: The Adult Patient Source: Chapel Hill, NC: Cleft Palate Foundation. 1997. 35 p. Contact: Available from Cleft Palate Foundation. 104 South Estes Drive, Suite 204, Chapel Hill, NC 27514. (800) 242-5338. Fax (919) 933-9604. E-mail: [email protected]. Website: www.cleft.com. PRICE: Single copy free. Summary: This booklet, one in a series of patient education materials, discusses some of the issues affecting adults with cleft lip or palate. Ideally, by the time an individual with a cleft lip or palate reaches adulthood, the cleft should not affect self confidence, relations with others, employment, or physical function. While this is the case for some adults with clefts, others continue to experience the effects of having a cleft. Adults with cleft lip or palate may be concerned about particular issues such as hearing, speech, dental, psychological, physical appearance, or reproduction concerns (including genetics). Adults with cleft lip or palate may seek a support group to meet others with clefting and may desire to share experiences with others. Financial concerns may also be important in seeking additional services in the adult years. The booklet discusses each of these issues, providing information to help readers understand their options regarding their cleft. The booklet opens with two chapters providing the perspective of an adult man and an adult women with cleft lip and palate. The booklet concludes with the contact information for the Cleft Palate Foundation and AboutFace, two organizations that offer support and resources for people with clefts. 6 figures. (AA-M).

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Cleft Lip, Palate and Craniofacial Birth Defects: The Multidisciplinary Treatment that is Reinforced by Smiles Source: Chapel Hill, NC: Cleft Palate Foundation. 199x. [2 p.]. Contact: Available from Cleft Palate Foundation, Inc. 104 South Estes Drive, Suite 204, Chapel Hill, NC 27514. (800) 242-5338 or (919) 933-9044. Fax (919) 933-9604. Website: www.cleft.com. PRICE: Single copy free. Summary: This brochure is designed to familiarize healthcare providers with the CleftLine service that is available from the Cleft Palate Foundation (CPF). The Foundation supports the concept of providing information and support to the parents as soon as possible following the birth of a child with cleft lip or cleft palate. The brochure includes a perforated Rolodex-type card with the CPF toll-free number (800-24-CLEFT). This CleftLine is available to everyone seeking information and referral for the treatment of cleft lip, cleft palate, and other craniofacial anomalies. Lists of cleft palate and craniofacial teams in a particular state or region and contacts for parent support groups will be provided by the CleftLine.

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Cleft Lip and Palate Program Source: New York, NY: New York University Medical Center.

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Contact: Available from Variety Center for Craniofacial Rehabilitation. Institute of Reconstructive Plastic Surgery, New York University Medical Center, 550 First Avenue, New York, NY 10016. (212) 263-5834. PRICE: Single copy free. Summary: This brochure is designed to provide information to the parents of children born with cleft lip and/or cleft palate. Written in a question-and-answer format, the brochure includes a definition of a cleft, their epidemiology, the causes of cleft lip and palate, how to feed a child with cleft lip and/or palate, the importance of parent support groups, the best time to surgically repair a cleft, the treatment provided prior to surgery, the first surgical procedure, when and how the cleft palate is repaired, indications for speech therapy, other problems arising from cleft palate, orthodontic therapy for children with cleft palate, and indications for future surgery. The brochure includes before-and-after photographs of children with cleft lip and/or palate. •

Parameters for Evaluation and Treatment of Patients with Cleft Lip-Palate or Other Craniofacial Anomalies Source: Chapel Hill, NC: American Cleft Palate-Craniofacial Association. 1993. 17 p. Contact: Available from American Cleft Palate-Craniofacial Association. 1829 East Franklin Street, Suite 1022, Chapel Hill, NC 27514. (919) 933-9044; Fax (919) 933-9604; Email: [email protected]. PRICE: Single copy free; bulk orders available at cost; distributed with 'The Cleft and Craniofacial Team'. Summary: This document presents a consensus statement on evaluation and treatment of children with palate and/or craniofacial anomalies. The statement is based on 1987 recommendations from the U.S. Surgeon General. That statement stressed that the care of these children should be comprehensive, coordinated, culturally sensitive, specific to the needs of the individual, and readily accessible. The brochure outlines recommended practices in the care of patients with craniofacial anomalies. It describes the composition and qualifications of interdisciplinary team members, team practices during the neonatal period and infancy, and longitudinal evaluation and treatment issues, including audiologic care, cleft lip/palate surgery, craniofacial and maxillofacial surgery, dental care, genetic/dysmorphology services, nursing care, otolaryngologic care, pediatric care, psychological and social services, speech-language services, quality management, and revisions of clinical practices. Included as appendices are a list of members of the Grant Project Committee, the authors and titles of position papers presented at a May 1991 Consensus Conference, a list of additional Conference participants, and a list of peer reviewers. The contact information for the American Cleft Palate-Craniofacial Association is also provided.

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Parameters for Evaluation and Treatment of Patients with Cleft Lip/Palate or Other Craniofacial Anomalies Source: Chapel Hill, NC: American Cleft Palate-Craniofacial Association. 1993. 35 p. Contact: Available from American Cleft Palate-Craniofacial Association. 1829 East Franklin Street, Suite 1022, Chapel Hill, NC 27514. (919) 933-9044; Fax (919) 933-9604; Email: [email protected]. PRICE: $2.00 per copy (1 to 14 copies); $1.80 per copy (15 or more copies). Summary: This document, a result of a 1991 Consensus Development Conference, outlines parameters for the evaluation and treatment of children with cleft lip/palate and other craniofacial anomalies. Three sections discuss interdisciplinary medical teams, including their composition, the qualifications of team members, and team

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responsibilities; the neonatal period and infancy; and longitudinal evaluation and treatment, including audiologic care, cleft lip/palate surgery, craniofacial and maxillofacial surgery, dental care, genetic services, nursing care, pediatric care, psychological and social services, speech-language services, quality management, and revisions of clinical practices. 4 references. •

Information About Treatment for Adults with Cleft Lip and Palate Source: Chapel Hill, NC: Cleft Palate Foundation, 1993. 2 p. Contact: Available from Cleft Palate Foundation. 104 South Estes Drive, Suite 204, Chapel Hill, NC 27514. (800) 242-5338. Fax (919) 933-9604. E-mail: [email protected]. Website: www.cleft.com. PRICE: Single copy free. Summary: This fact sheet contains information about treatment for adults with cleft lip and palate. Common questions are answered about cleft lip and palate, such as treatment, patient concerns, appearance, speech problems, counseling, and funding.

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Public Health Education Information Sheet: Cleft Lip and Palate Source: White Plains, NY: March of Dimes Birth Defects Foundation. 1995. 2 p. Contact: Available from March of Dimes Birth Defects Foundation. P.O. Box 1657, Wilkes-Barre, PA 18703-1657. (800) 367-6630; Fax (717) 825-1987. PRICE: Single copy free; bulk orders available. Summary: This fact sheet present general information about cleft lip and palate. Written in a question-and-answer format, the fact sheet covers a definition of cleft lip and palate, the causes of these problems, the genetic implications, how clefts affect a baby's face, how clefts can be repaired surgically, the importance of a multidisciplinary patient care team, feeding considerations, cleft-associated problems with middle ear disease, how speech is affected by clefts, dental problems in children with clefts, preventive efforts, and present research in this area. The fact sheet concludes with the address and telephone hot-line number (800-242-5338) of the Cleft Palate Foundation.

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Information on dental care of a child with cleft lip and palate Source: Chapel Hill, NC: Cleft Palate Foundation. ca. 1996. 2 pp. Contact: Available from Cleft Palate Foundation, 1829 East Franklin Street, Suite 1022, Chapel Hill, NC 27514. Telephone: (919) 933- 9044 or (800) 243-5338 / e-mail: [email protected] / Web site: http://www.cleft.com. Available at no charge. Summary: This fact sheet provides information about oral health care for children with a cleft lip or cleft palate. Information is presented on dental anomalies, which frequently accompany cleft lip and palate. The fact sheet gives an overview of proper cleaning and dental, orthodontic, and prosthodontic care. A glossary is included.

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Cleft Lip and Palate: Effects on Speech, Language, and Development Source: in Schrader, M., ed. Parent Articles 1: Enhance Parent Involvement in Language Learning. San Antonio, TX: Communication Skill Builders. 1988. p. 199-200. Contact: Available from Communication Skill Builders. Customer Service, 555 Academic Court, San Antonio, TX 78204-2498. (800) 211-8378; TTY (800) 723-1318; Fax (800) 2321223. PRICE: $52.00 plus shipping and handling. Order Number 076-1674-39X-MS799.

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Summary: This fact sheet provides parents with information on cleft lip and palate and the effects of clefts on speech, language, and child development. Topics covered include a description of cleft lip and cleft palate; related speech problems including speech delay, articulation, voice quality, dental problems, and ear infections; and developmental problems, including language delay, feeding difficulties, and social development. The author also provides a list of related vocabulary terms. The fact sheet is one of a series of instructional materials designed to enhance parent involvement in language learning. The fact sheets share information on speech therapy and speech/language disorders targeted to parents of children 1 to 7 years old. The fact sheets also answer frequently-asked questions and suggest related activities to enhance children's speech and language skills. •

Feeding young children with cleft lip and palate Source: Minneapolis, MN: Minnesota Department of Health Services for Children with Handicaps. 1988. 44 pp. Contact: Available from Minnesota Department of Health, P. O. Box 64882, 85 East Seventh Place, Minneapolis, MN 55164-0882. Telephone: (612) 623- 5000. Available at no charge. Summary: This illustrated booklet was written for parents of infants and children with cleft palate and discusses good nutrition and growth, challenges in feeding, feeding techniques, common difficulties and solutions, breastfeeding, feeding aids, dental considerations, and nutrition before and after surgery.

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The genetics of cleft lip and palate: Information for families Source: Chapel Hill, NC: Cleft Palate Foundation. 1996. 7 pp. Contact: Available from Cleft Palate Foundation, 1829 East Franklin Street, Suite 1022, Chapel Hill, NC 27514. Telephone: (919) 933- 9044 or (800) 243-5338 / e-mail: [email protected] / Web site: http://www.cleft.com. $2.00; shipping and handling for 12 items $1.75, shipping and handling for 3-5 items $2.25. Summary: This pamphlet gives information about the genetic factors affecting the incidence of cleft lips and palates. The pamphlet reviews the causes of clefts, risks of recurrence in other children in a family, and genetic counseling. The intended audience is parents of children with clefts.

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Cleft lip and palate: The school-aged child Source: Chapel Hill, NC: Cleft Palate Foundation. 1996. 32 pp. Contact: Available from Cleft Palate Foundation, 1829 East Franklin Street, Suite 1022, Chapel Hill, NC919 27514. Telephone: (919) 933- 9044 or (800) 243-5338 / e-mail: [email protected] / Web site: http://www.cleft.com. $2.00; shipping and handling for 1however2 items $1.75, shipping and handling for 3however5 items $2.25. Summary: This pamphlet provides information on how to achieve the best possible appearance and speech for school-age children with cleft lip or cleft palate. Information on surgery, speech therapy, and orthodontia is presented, together with suggestions for helping to create a good school experience for children with cleft lip or cleft palate. This section covers the importance of protecting a childs hearing (especially for children with cleft palate, who are at greater risk for hearing problems), dealing with learning

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problems, and handling teasing. Advice for teachers of children with cleft lip or cleft palate is included. •

Genetics of Cleft Lip and Palate: Information for Families Source: Chapel Hill, NC: Cleft Palate Foundation. 199x. 10 p. Contact: Available from Cleft Palate Foundation, Inc. 104 South Estes Drive, Suite 204, Chapel Hill, NC 27514. (800) 242-5338 or (919) 933-9044. Fax (919) 933-9604. Website: www.cleft.com. PRICE: Single copy free. Summary: This pamphlet was written primarily for parents of children with cleft lip and/or cleft palate. The authors review some commonly accepted information regarding the causes of cleft lip and palate, the risks of recurrence, and the nature and process of genetic counseling. One section discusses what is involved in a genetic evaluation, including the history and physical examination, other studies, and the summary conference; and a second section describes how families can find a genetic counselor. 2 figures.

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Selected Bibliography for Parents of Children with Cleft Lip/Palate Source: Chapel Hill, NC: Cleft Palate Foundation. 1998. 2 p. Contact: Available from Cleft Palate Foundation, Inc. 104 South Estes Drive, Suite 204, Chapel Hill, NC 27514. (800) 242-5338 or (919) 933-9044. Fax (919) 933-9604. Website: www.cleft.com. PRICE: Single copy free. Summary: This two-page bibliography lists publications for parents of children with cleft lip or palate. The booklets and fact sheets prepared by the Cleft Palate Foundation and the journal of the American Cleft Palate-Craniofacial Association are listed on the first page. The second page provides a bibliography of information published by other sources. These items include newsletters, books, articles, and brochures. Availability (address or phone number) and pricing information are included for the listed publications. Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Information for Parents: Cleft Lip and Cleft Palate Summary: On this page you'll find information on caring for your cleft-affected newborn, basics on doctors, what to tell siblings, taking pictures, stress reduction, and starting your own support groups. Source: Wide Smiles http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7673

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The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to cleft lip. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •


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Family Village: http://www.familyvillage.wisc.edu/specific.htm

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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

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Med Help International: http://www.medhelp.org/HealthTopics/A.html

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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

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WebMDHealth: http://my.webmd.com/health_topics

Associations and Cleft Lip The following is a list of associations that provide information on and resources relating to cleft lip: •

Cleft Lip and Palate Association (CLAPA) Telephone: 020 7431 0033 Fax: 020 7431 8881 Email: [email protected] Web Site: http://www.clapa.com Background: The Cleft Lip and Palate Association (CLAPA) is a registered charity in the United Kingdom and is dedicated to providing information, resources, and support to individuals affected by cleft lip and/or cleft palate, their families, and caregivers. Cleft lip and palate are common malformations that are present at birth (congenital). A cleft is an incomplete closure of the roof of the mouth (palate), lip, or both. These birth defects occur when the pair of long bones that form the upper jaw (maxillae) do not fuse properly during the early development of the embryo. The cleft may be barely noticeable or result in severe deformities requiring surgical correction. CLAPA was established in 1979 and currently consists of 45 chapters operating throughout the United Kingdom. The founding purpose of CLAPA was to forge a partnership between

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parents and health professionals concerned with the care of children with and the treatment of cleft lip and palate. Today, CLAPA s mission has evolved to include organizing local parent support groups through a nationwide network of branches; operating a specialist service for parents and health professionals who require help in feeding infants with cleft lip and palate; encouraging and supporting research into its causes and treatment; representing the interests of patients by helping to influence national health policy; conducting educational seminars for health care professionals and the general public; raising funds for specific treatment and equipment; and raising public awareness of cleft lip and palate through a wide range of informational materials. 'How Does Your Palate Work,' 'Cleft Lip Palate - What Is It?,' and 'What Is A Pharyngoplasty?' are educational brochures published by CLAPA. Relevant area(s) of interest: Cleft Lip

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to cleft lip. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with cleft lip. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about cleft lip. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “cleft lip” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information.

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The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “cleft lip”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “cleft lip” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “cleft lip” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

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Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)24: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

24

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on cleft lip: •

Basic Guidelines for Cleft Lip Cleft lip and palate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001051.htm Cleft lip repair Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002979.htm

•

Signs & Symptoms for Cleft Lip Hearing loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003044.htm Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Speech problems Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003204.htm

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Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm •

Diagnostics and Tests for Cleft Lip X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm

•

Nutrition for Cleft Lip Nursing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002450.htm

•

Background Topics for Cleft Lip Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Breathing problems Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000007.htm Cleft palate - support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002165.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Prosthetic device Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002286.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

145

CLEFT LIP DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 6-Aminonicotinamide: A vitamin antagonist which has teratogenic effects. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Aborigines: Native inhabitants or indigenous individuals of a country. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Actin: Essential component of the cell skeleton. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Alfalfa: A deep-rooted European leguminous plant (Medicago sativa) widely grown for hay and forage. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Alopecia: Absence of hair from areas where it is normally present. [NIH]

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Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amnion: The extraembryonic membrane which contains the embryo and amniotic fluid. [NIH]

Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneuploidy: The chromosomal constitution of cells which deviate from the normal by the

Dictionary 147

addition or subtraction of chromosomes or chromosome pairs. In a normally diploid cell the loss of a chromosome pair is termed nullisomy (symbol: 2N-2), the loss of a single chromosome is monosomy (symbol: 2N-1), the addition of a chromosome pair is tetrasomy (symbol: 2N+2), the addition of a single chromosome is trisomy (symbol: 2N+1). [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anophthalmia: Absence of an eye or eyes in the newborn due to failure of development of the optic cup or to disappearance of the eyes after partial development. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticonvulsive: An agent that prevents or relieves convulsions. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aplasia: Lack of development of an organ or tissue, or of the cellular products from an organ or tissue. [EU] Approximate: Approximal [EU] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the

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intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articulation: The relationship of two bodies by means of a moveable joint. [NIH] Articulation Disorders: Disorders of the quality of speech characterized by the substitution, omission, distortion, and addition of phonemes. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atresia: Lack of a normal opening from the esophagus, intestines, or anus. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Audiology: The study of hearing and hearing impairment. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Avian: A plasmodial infection in birds. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its

Dictionary 149

subdivisions is the basal (basement) lamina. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Bone Regeneration: Renewal or repair of lost bone tissue. It excludes bony callus formed after bone fracture but not yet replaced by hard bone. [NIH] Bony Callus: The bony deposit formed between and around the broken ends of a fractured bone during normal healing. [NIH] Bottle Feeding: Use of nursing bottles for feeding. Applies to humans and animals. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Brain Diseases: Pathologic conditions affecting the brain, which is composed of the intracranial components of the central nervous system. This includes (but is not limited to) the cerebral cortex; intracranial white matter; basal ganglia; thalamus; hypothalamus; brain stem; and cerebellum. [NIH] Brain Neoplasms: Neoplasms of the intracranial components of the central nervous system, including the cerebral hemispheres, basal ganglia, hypothalamus, thalamus, brain stem, and cerebellum. Brain neoplasms are subdivided into primary (originating from brain tissue) and secondary (i.e., metastatic) forms. Primary neoplasms are subdivided into benign and malignant forms. In general, brain tumors may also be classified by age of onset, histologic type, or presenting location in the brain. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH]

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Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell Movement: The movement of cells from one location to another. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebellar: Pertaining to the cerebellum. [EU]

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Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]

Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Child Development: The continuous sequential physiological and psychological maturing of the child from birth up to but not including adolescence. It includes healthy responses to situations, but does not include growth in stature or size (= growth). [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholestasis: Impairment of biliary flow at any level from the hepatocyte to Vater's ampulla. [NIH]

Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chromosome Abnormalities: Defects in the structure or number of chromosomes resulting in structural aberrations or manifesting as disease. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH]

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Cleft Palate: Congenital fissure of the soft and/or hard palate, due to faulty fusion. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Cochlear Implants: Electronic devices implanted beneath the skin with electrodes to the cochlear nerve to create sound sensation in persons with sensorineural deafness. [NIH] Cochlear Nerve: The cochlear part of the 8th cranial nerve (vestibulocochlear nerve). The cochlear nerve fibers originate from neurons of the spiral ganglion and project peripherally to cochlear hair cells and centrally to the cochlear nuclei (cochlear nucleus) of the brain stem. They mediate the sense of hearing. [NIH] Codon: A set of three nucleotides in a protein coding sequence that specifies individual amino acids or a termination signal (codon, terminator). Most codons are universal, but some organisms do not produce the transfer RNAs (RNA, transfer) complementary to all codons. These codons are referred to as unassigned codons (codons, nonsense). [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations

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which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Coloboma: Congenital anomaly in which some of the structures of the eye are absent due to incomplete fusion of the fetal intraocular fissure during gestation. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Communication Disorders: Disorders of verbal and nonverbal communication caused by receptive or expressive language disorders, cognitive dysfunction (e.g., mental retardation), psychiatric conditions, and hearing disorders. [NIH] Community Health Services: Diagnostic, therapeutic and preventive health services provided for individuals in the community. [NIH] Competency: The capacity of the bacterium to take up DNA from its surroundings. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH]

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Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementation: The production of a wild-type phenotype when two different mutations are combined in a diploid or a heterokaryon and tested in trans-configuration. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computer Graphics: The process of pictorial communication, between human and computers, in which the computer input and output have the form of charts, drawings, or other appropriate pictorial representation. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Congenita: Displacement, subluxation, or malposition of the crystalline lens. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the

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new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Cortices: The outer layer of an organ; used especially of the cerebrum and cerebellum. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Craniofacial Abnormalities: Congenital structural deformities, malformations, or other abnormalities of the cranium and facial bones. [NIH] Crossing-over: The exchange of corresponding segments between chromatids of homologous chromosomes during meiosia, forming a chiasma. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclopia: Elements of the two eyes fused into one median eye in the center of the forehead of a fetal monster. [NIH] Cytogenetics: A branch of genetics which deals with the cytological and molecular behavior of genes and chromosomes during cell division. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Defense Mechanisms: Unconscious process used by an individual or a group of individuals

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in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dentists: Individuals licensed to practice dentistry. [NIH] Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Dentition, Primary: The teeth first in order or time of development that will be replaced by permanent dentition upon their loss. [NIH] Deoxyguanosine: A nucleoside consisting of the base guanine and the sugar deoxyribose. [NIH]

Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Developmental Biology: The field of biology which deals with the process of the growth and differentiation of an organism. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU]

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Dominance: In genetics, the full phenotypic expression of a gene in both heterozygotes and homozygotes. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Ectoderm: The outer of the three germ layers of the embryo. [NIH] Ectodermal Dysplasia: A group of hereditary disorders involving tissues and structures derived from the embryonic ectoderm. They are characterized by the presence of abnormalities at birth and involvement of both the epidermis and skin appendages. They are generally nonprogressive and diffuse. Various forms exist, including anhidrotic and hidrotic dysplasias, focal dermal hypoplasia, and aplasia cutis congenita. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryogenesis: The process of embryo or embryoid formation, whether by sexual (zygotic) or asexual means. In asexual embryogenesis embryoids arise directly from the explant or on intermediary callus tissue. In some cases they arise from individual cells (somatic cell

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embryoge). [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Encephalocele: Cerebral tissue herniation through a congenital or acquired defect in the skull. The majority of congenital encephaloceles occur in the occipital or frontal regions. Clinical features include a protuberant mass that may be pulsatile. The quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. Visual defects, psychomotor developmental delay, and persistent motor deficits frequently occur. [NIH]

Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort

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studies, and cross-sectional studies. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermal Growth Factor: A 6 kD polypeptide growth factor initially discovered in mouse submaxillary glands. Human epidermal growth factor was originally isolated from urine based on its ability to inhibit gastric secretion and called urogastrone. epidermal growth factor exerts a wide variety of biological effects including the promotion of proliferation and differentiation of mesenchymal and epithelial cells. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Essential Tremor: A rhythmic, involuntary, purposeless, oscillating movement resulting from the alternate contraction and relaxation of opposing groups of muscles. [NIH] Ethmoid: An unpaired cranial bone which helps form the medial walls of the orbits and contains the themoidal air cells which drain into the nose. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Facial: Of or pertaining to the face. [EU] Facial Asymmetry: Congenital or acquired asymmetry of the face. [NIH] Facial Expression: Observable changes of expression in the face in response to emotional stimuli. [NIH] Family Health: The health status of the family as a unit including the impact of the health of one member of the family on the family as a unit and on individual family members; also,

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the impact of family organization or disorganization on the health status of its members. [NIH]

Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fathers: Male parents, human or animal. [NIH] Feeding Methods: Methods of giving food to humans or animals. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Fluoridation: The addition of fluorine usually as a fluoride to something, as the adding of a fluoride to drinking water or public water supplies for prevention of tooth decay in children. [NIH] Fluorine: A nonmetallic, diatomic gas that is a trace element and member of the halogen family. It is used in dentistry as flouride to prevent dental caries. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies

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located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glossopalatine: A root of the facial nerve arising from the sensory nucleus, lateral and posterior to the motor root, containing parasympathetic fibers coursing to the lacrimal gland via the great superficial petrosal nerve which synapses in the sphenopalatine ganglion. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH]

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Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanine: One of the four DNA bases. [NIH] Haematological: Relating to haematology, that is that branch of medical science which treats of the morphology of the blood and blood-forming tissues. [EU] Haematology: The science of the blood, its nature, functions, and diseases. [NIH] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] Hamartoma: A focal malformation resembling a neoplasm, composed of an overgrowth of mature cells and tissues that normally occur in the affected area. [NIH] Handedness: Preference for using right or left hand. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Hearing aid: A miniature, portable sound amplifier for persons with impaired hearing, consisting of a microphone, audio amplifier, earphone, and battery. [NIH] Hearing Disorders: Conditions that impair the transmission or perception of auditory impulses and information from the level of the ear to the temporal cortices, including the sensorineural pathways. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobinuria: The presence of free hemoglobin in the urine. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatocyte: A liver cell. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterodimers: Zippered pair of nonidentical proteins. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they

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are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Heterozygotes: Having unlike alleles at one or more corresponding loci on homologous chromosomes. [NIH] Holoprosencephaly: Anterior midline brain, cranial, and facial malformations resulting from the failure of the embryonic prosencephalon to undergo segmentation and cleavage. Alobar prosencephaly is the most severe form and features anophthalmia; cyclopia; severe mental retardation; cleft lip; cleft palate; seizures; and microcephaly. Semilobar holoprosencepaly is characterized by hypotelorism, microphthalmia, coloboma, nasal malformations, and variable degrees of mental retardation. Lobar holoprosencephaly is associated with mild (or absent) facial malformations and intellectual abilities that range from mild mental retardation to normal. Holoprosencephlay is associated with chromosome abnormalities. [NIH] Homeobox: Distinctive sequence of DNA bases. [NIH] Homodimer: Protein-binding "activation domains" always combine with identical proteins. [NIH]

Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Homozygotes: An individual having a homozygous gene pair. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydrocephalus: Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial hypertension; headache; lethargy; urinary incontinence; and ataxia (and in infants macrocephaly). This condition may be caused by obstruction of cerebrospinal fluid pathways due to neurologic abnormalities, intracranial hemorrhages; central nervous system infections; brain neoplasms; craniocerebral trauma; and other conditions. Impaired resorption of cerebrospinal fluid from the arachnoid villi results in a communicating form of hydrocephalus. Hydrocephalus ex-vacuo refers to ventricular dilation that occurs as a result of brain substance loss from cerebral infarction and other conditions. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperlipoproteinemia: Metabolic disease characterized by elevated plasma cholesterol and/or triglyceride levels. The inherited form is attributed to a single gene mechanism. [NIH]

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Hypertelorism: Abnormal increase in the interorbital distance due to overdevelopment of the lesser wings of the sphenoid. [NIH] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypoplasia: Incomplete development or underdevelopment of an organ or tissue. [EU] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypovitaminosis: A condition due to a deficiency of one or more essential vitamins. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Immaturity: The state or quality of being unripe or not fully developed. [EU] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incisional: The removal of a sample of tissue for examination under a microscope. [NIH] Incisor: Anything adapted for cutting; any one of the four front teeth in each jaw. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins,

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intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Insertional: A technique in which foreign DNA is cloned into a restriction site which occupies a position within the coding sequence of a gene in the cloning vector molecule. Insertion interrupts the gene's sequence such that its original function is no longer expressed. [NIH] Integrins: A family of transmembrane glycoproteins consisting of noncovalent heterodimers. They interact with a wide variety of ligands including extracellular matrix glycoproteins, complement, and other cells, while their intracellular domains interact with the cytoskeleton. The integrins consist of at least three identified families: the cytoadhesin receptors, the leukocyte adhesion receptors, and the very-late-antigen receptors. Each family contains a common beta-subunit combined with one or more distinct alpha-subunits. These receptors participate in cell-matrix and cell-cell adhesion in many physiologically important processes, including embryological development, hemostasis, thrombosis, wound healing, immune and nonimmune defense mechanisms, and oncogenic transformation. [NIH] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Interorbital: Between the orbits. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Hemorrhages: Bleeding within the intracranial cavity, including hemorrhages in the brain and within the cranial epidural, subdural, and subarachnoid spaces. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intraocular: Within the eye. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH]

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Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Lacrimal: Pertaining to the tears. [EU] Lactation: The period of the secretion of milk. [EU] Laminin: Large, noncollagenous glycoprotein with antigenic properties. It is localized in the basement membrane lamina lucida and functions to bind epithelial cells to the basement membrane. Evidence suggests that the protein plays a role in tumor invasion. [NIH] Language Development: The gradual expansion in complexity and meaning of symbols and sounds as perceived and interpreted by the individual through a maturational and learning process. Stages in development include babbling, cooing, word imitation with cognition, and use of short sentences. [NIH] Language Development Disorders: Conditions characterized by language abilities (comprehension and expression of speech and writing) that are below the expected level for a given age, generally in the absence of an intellectual impairment. These conditions may be associated with deafness; brain diseases; mental disorders; or environmental factors. [NIH] Language Disorders: Conditions characterized by deficiencies of comprehension or expression of written and spoken forms of language. These include acquired and developmental disorders. [NIH] Language Therapy: Rehabilitation of persons with language disorders or training of children with language development disorders. [NIH] Laryngectomy: Total or partial excision of the larynx. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Laser Surgery: The use of a laser either to vaporize surface lesions or to make bloodless cuts in tissue. It does not include the coagulation of tissue by laser. [NIH]

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Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Linkage Disequilibrium: Nonrandom association of linked genes. This is the tendency of the alleles of two separate but already linked loci to be found together more frequently than would be expected by chance alone. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lucida: An instrument, invented by Wollaton, consisting essentially of a prism or a mirror through which an object can be viewed so as to appear on a plane surface seen in direct view and on which the outline of the object may be traced. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy

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based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malabsorption syndrome: A group of symptoms such as gas, bloating, abdominal pain, and diarrhea resulting from the body's inability to properly absorb nutrients. [NIH] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Melanin: The substance that gives the skin its color. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH]

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Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]

Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Mesoderm: The middle germ layer of the embryo. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Millimeter: A measure of length. A millimeter is approximately 26-times smaller than an inch. [NIH] Mineralization: The action of mineralizing; the state of being mineralized. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Monosomy: The condition in which one chromosome of a pair is missing. In a normally diploid cell it is represented symbolically as 2N-1. [NIH] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH]

Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH]

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Mucosa: A mucous membrane, or tunica mucosa. [EU] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Mutism: Inability or refusal to speak. [EU] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Nasal Cavity: The proximal portion of the respiratory passages on either side of the nasal septum, lined with ciliated mucosa, extending from the nares to the pharynx. [NIH] Nasal Septum: The partition separating the two nasal cavities in the midplane, composed of cartilaginous, membranous and bony parts. [NIH] Nasalis: A small fly whose larvae are parasites of the horse, the adult female fly depositing them into and around the nostrils, from where they later migrate to the pharynx or larynx of their host. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Nephropathy: Disease of the kidneys. [EU] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural Crest: A strip of specialized ectoderm flanking each side of the embryonal neural plate, which after the closure of the neural tube, forms a column of isolated cells along the dorsal aspect of the neural tube. Most of the cranial and all of the spinal sensory ganglion cells arise by differentiation of neural crest cells. [NIH] Neural tube defects: These defects include problems stemming from fetal development of

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the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida, anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects have difficulty walking and with bladder and bowel control. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuroma: A tumor that arises in nerve cells. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropsychological Tests: Tests designed to assess neurological function associated with certain behaviors. They are used in diagnosing brain dysfunction or damage and central nervous system disorders or injury. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Oncogenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Optic cup: The white, cup-like area in the center of the optic disc. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Hygiene: The practice of personal hygiene of the mouth. It includes the maintenance of oral cleanliness, tissue tone, and general preservation of oral health. [NIH] Oral surgeon: A dentist with special training in surgery of the mouth and jaw. [NIH] Orbicularis: A thin layer of fibers that originates at the posterior lacrimal crest and passes outward and forward, dividing into two slips which surround the canaliculi. [NIH]

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Orbit: One of the two cavities in the skull which contains an eyeball. Each eye is located in a bony socket or orbit. [NIH] Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Orofacial: Of or relating to the mouth and face. [EU] Orthodontics: A dental specialty concerned with the prevention and correction of dental and oral anomalies (malocclusion). [NIH] Orthopedics: A surgical specialty which utilizes medical, surgical, and physical methods to treat and correct deformities, diseases, and injuries to the skeletal system, its articulations, and associated structures. [NIH] Ossification: The formation of bone or of a bony substance; the conversion of fibrous tissue or of cartilage into bone or a bony substance. [EU] Osteoblasts: Bone-forming cells which secrete an extracellular matrix. Hydroxyapatite crystals are then deposited into the matrix to form bone. [NIH] Osteogenesis: The histogenesis of bone including ossification. It occurs continuously but particularly in the embryo and child and during fracture repair. [NIH] Osteotomy: The surgical cutting of a bone. [EU] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Otitis Media with Effusion: Inflammation of the middle ear with a clear pale yellowcolored transudate. [NIH] Otolaryngologist: A doctor who specializes in treating diseases of the ear, nose, and throat. Also called an ENT doctor. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Otology: The branch of medicine which deals with the diagnosis and treatment of the disorders and diseases of the ear. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Palatal Muscles: The muscles of the palate are the glossopalatine, palatoglossus, levator palati(ni), musculus uvulae, palatopharyngeus, and tensor palati(ni). [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH]

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Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [NIH]

Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Advocacy: Promotion and protection of the rights of patients, frequently through a legal process. [NIH] Patient Care Team: Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pediatric Dentistry: The practice of dentistry concerned with the dental problems of children, proper maintenance, and treatment. The dental care may include the services provided by dental specialists. [NIH] Peer Review: An organized procedure carried out by a select committee of professionals in evaluating the performance of other professionals in meeting the standards of their specialty. Review by peers is used by editors in the evaluation of articles and other papers submitted for publication. Peer review is used also in the evaluation of grant applications. It is applied also in evaluating the quality of health care provided to patients. [NIH] Pelvic: Pertaining to the pelvis. [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phocomelia: Congenital deformity that leaves the child without legs. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived

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from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plastic surgeon: A surgeon who specializes in reducing scarring or disfigurement that may occur as a result of accidents, birth defects, or treatment for diseases. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Pneumonia: Inflammation of the lungs. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH]

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Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Care: Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality. [NIH] Prenatal Diagnosis: Determination of the nature of a pathological condition or disease in the postimplantation embryo, fetus, or pregnant female before birth. [NIH] Preoperative: Preceding an operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Preventive Health Services: Services designed for promotion of health and prevention of disease. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Promotor: In an operon, a nucleotide sequence located at the operator end which contains all the signals for the correct initiation of genetic transcription by the RNA polymerase holoenzyme and determines the maximal rate of RNA synthesis. [NIH] Prosencephalon: The part of the brain developed from the most rostral of the three primary vesicles of the embryonic neural tube and consisting of the diencephalon and telencephalon. [NIH]

Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH]

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Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prosthodontics: A dental specialty concerned with the restoration and maintenance of oral function by the replacement of missing teeth and structures by artificial devices or prostheses. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteoglycans: Glycoproteins which have a very high polysaccharide content. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

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Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quiescent: Marked by a state of inactivity or repose. [EU] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive

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error (myopia, hyperopia, or astigmatism). [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Response Elements: Nucleotide sequences, usually upstream, which are recognized by specific regulatory transcription factors, thereby causing gene response to various regulatory agents. These elements may be found in both promotor and enhancer regions. [NIH]

Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Rhinolith: Condition caused by the accumulation of various dusts. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Saccule: The smaller of the 2 sacs within the vestibule of the ear. [NIH] Sagittal: The line of direction passing through the body from back to front, or any vertical plane parallel to the medial plane of the body and inclusive of that plane; often restricted to the medial plane, the plane of the sagittal suture. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH]

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Satellite: Applied to a vein which closely accompanies an artery for some distance; in cytogenetics, a chromosomal agent separated by a secondary constriction from the main body of the chromosome. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Concept: A person's view of himself. [NIH] Self-Help Groups: Organizations which provide an environment encouraging social interactions through group activities or individual relationships especially for the purpose of rehabilitating or supporting patients, individuals with common health problems, or the elderly. They include therapeutic social clubs. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sequence Analysis: A multistage process that includes the determination of a sequence (protein, carbohydrate, etc.), its fragmentation and analysis, and the interpretation of the resulting sequence information. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH]

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Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sex Determination: The biological characteristics which distinguish human beings as female or male. [NIH] Sex Distribution: The number of males and females in a given population. The distribution may refer to how many men or women or what proportion of either in the group. The population is usually patients with a specific disease but the concept is not restricted to humans and is not restricted to medicine. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shyness: Discomfort and partial inhibition of the usual forms of behavior when in the presence of others. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Social Behavior: Any behavior caused by or affecting another individual, usually of the same species. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Sciences: Disciplines concerned with the interrelationships of individuals in a social environment including social organizations and institutions. Includes Sociology and Anthropology. [NIH] Social Security: Government sponsored social insurance programs. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU]

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Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Soybean Oil: Oil from soybean or soybean plant. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Speech Disorders: Acquired or developmental conditions marked by an impaired ability to comprehend or generate spoken forms of language. [NIH] Speech pathologist: A specialist who evaluates and treats people with communication and swallowing problems. Also called a speech therapist. [NIH] Sperm: The fecundating fluid of the male. [NIH] Sphenoid: An unpaired cranial bone with a body containing the sphenoid sinus and forming the posterior part of the medial walls of the orbits. [NIH] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroma: The middle, thickest layer of tissue in the cornea. [NIH] Submandibular: Four to six lymph glands, located between the lower jaw and the submandibular salivary gland. [NIH] Submaxillary: Four to six lymph glands, located between the lower jaw and the submandibular salivary gland. [NIH] Superstitions: A belief or practice which lacks adequate basis for proof; an embodiment of fear of the unknown, magic, and ignorance. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH]

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Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Teratogen: A substance which, through immediate, prolonged or repeated contact with the skin may involve a risk of subsequent non-hereditable birth defects in offspring. [NIH] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Terminator: A DNA sequence sited at the end of a transcriptional unit that signals the end of transcription. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH]

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Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonicity: The normal state of muscular tension. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Traction: The act of pulling. [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transforming Growth Factor alpha: Factor isolated in a variety of tissues including epithelium, and maternal decidua. It is closely related to epidermal growth factor and binds to the EGF receptor. TGF-alpha acts synergistically with TGF-beta in inducing phenotypic transformation, but its physiological role is unknown. [NIH] Transforming Growth Factor beta: A factor synthesized in a wide variety of tissues. It acts synergistically with TGF-alpha in inducing phenotypic transformation and can also act as a negative autocrine growth factor. TGF-beta has a potential role in embryonal development, cellular differentiation, hormone secretion, and immune function. TGF-beta is found mostly as homodimer forms of separate gene products TGF-beta1, TGF-beta2 or TGF-beta3. Heterodimers composed of TGF-beta1 and 2 (TGF-beta1.2) or of TGF-beta2 and 3 (TGFbeta2.3) have been isolated. The TGF-beta proteins are synthesized as precursor proteins. [NIH]

Translating: Conversion from one language to another language. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Trisomy: The possession of a third chromosome of any one type in an otherwise diploid cell. [NIH]

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Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberous Sclerosis: A rare congenital disease in which the essential pathology is the appearance of multiple tumors in the cerebrum and in other organs, such as the heart or kidneys. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venter: Belly. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricles: Fluid-filled cavities in the heart or brain. [NIH] Ventricular: Pertaining to a ventricle. [EU] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle

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and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH] Vincristine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitamin E: Vitamin found largely in plant materials, especially wheat germ, corn, sunflower seed, rapeseed, soybean oils, alfalfa, and lettuce. It is used as an antioxidant in vegetable oils and shortenings. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Voice Quality: Voice quality is that component of speech which gives the primary distinction to a given speaker's voice when pitch and loudness are excluded. It involves both phonatory and resonatory characteristics. Some of the descriptions of voice quality are harshness, breathiness and nasality. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] Xerostomia: Decreased salivary flow. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

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Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

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INDEX 6 6-Aminonicotinamide, 94, 145 A Abdominal, 145, 168, 172 Abdominal Pain, 145, 168 Aberrant, 19, 21, 145 Aborigines, 89, 145 Acoustic, 47, 101, 104, 145, 185 Actin, 18, 145 Adaptation, 145, 174 Adjustment, 3, 13, 145 Adolescence, 6, 43, 101, 103, 104, 126, 145, 151 Adverse Effect, 145, 180 Age Groups, 101, 145 Aged, 80 and Over, 145 Airway, 7, 10, 101, 102, 126, 145 Alfalfa, 145, 185 Algorithms, 145, 149 Alkaloid, 145, 152 Alleles, 22, 145, 163, 167 Alopecia, 73, 145 Alternative medicine, 108, 146 Alveoli, 146, 156, 184 Amino Acids, 146, 152, 173, 174, 176 Amnion, 146 Amniotic Fluid, 51, 146, 161 Amphetamines, 146, 152 Amplification, 126, 146 Ampulla, 146, 151, 158 Anaesthesia, 35, 52, 146 Anal, 22, 146, 158, 160 Analogous, 21, 26, 146, 183 Anaphylatoxins, 146, 153 Anatomical, 18, 97, 102, 146, 151, 158, 164, 179 Anemia, 121, 146, 160 Anesthesia, 145, 146 Anesthetics, 7, 146, 159 Aneuploidy, 70, 146 Animal model, 14, 23, 26, 147 Anophthalmia, 45, 147, 163 Antibacterial, 147, 181 Antibiotic, 147, 181 Antibodies, 147, 163, 164 Antibody, 147, 153, 163, 164, 165, 168 Anticonvulsive, 89, 147 Antigen, 147, 153, 163, 164, 165, 168

Antigen-Antibody Complex, 147, 153 Antioxidant, 147, 185 Anus, 146, 147, 148, 153, 165 Anxiety, 13, 16, 90, 147 Aplasia, 9, 147, 157 Approximate, 11, 147 Aqueous, 147, 148, 155, 158 Arterial, 147, 151, 176 Arteriosclerosis, 147, 164 Artery, 147, 148, 151, 179 Articulation, 32, 101, 103, 131, 148 Articulation Disorders, 32, 148 Aseptic, 148, 172 Aspiration, 5, 148 Assay, 13, 148 Ataxia, 121, 148, 163, 182 Atresia, 35, 148 Atrophy, 120, 121, 148 Audiology, 7, 28, 100, 148 Auditory, 13, 89, 126, 148, 162 Avian, 17, 148 Axillary, 148 B Bacteria, 147, 148, 156, 169, 181, 184 Bacterium, 148, 153 Basal Ganglia, 148, 149, 161 Basal Ganglia Diseases, 148 Base, 42, 148, 156, 166, 182 Basement Membrane, 30, 148, 159, 166 Biliary, 149, 151 Biochemical, 145, 149 Biological therapy, 149, 162 Biomechanics, 20, 149 Biotechnology, 32, 33, 108, 117, 119, 120, 121, 122, 149 Bladder, 149, 154, 164, 171, 176, 184 Bloating, 149, 168 Blood vessel, 149, 150, 151, 166, 167, 169, 173, 180, 182, 184 Bone Regeneration, 5, 149 Bony Callus, 149 Bottle Feeding, 5, 149 Bowel, 146, 149, 171, 181 Brain Diseases, 149, 166 Brain Neoplasms, 149, 163, 182 Buccal, 71, 149 C Calcium, 149, 153

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Callus, 5, 150, 157 Carbohydrate, 150, 179 Carbon Dioxide, 6, 150, 160, 161, 178 Carcinogenic, 150, 165, 171, 175 Carcinogens, 150, 171 Carcinoma, 36, 150 Case report, 11, 59, 60, 90, 150, 152 Case-Control Studies, 19, 150, 158 Catheter, 150, 165 Catheterization, 150, 165 Causal, 20, 150, 158 Cell Adhesion, 150, 165 Cell Division, 120, 148, 150, 155, 162, 174, 179 Cell Movement, 18, 150 Cell Respiration, 150, 178 Cell Survival, 150, 162 Central Nervous System, 146, 149, 150, 152, 161, 162, 163, 171 Central Nervous System Infections, 150, 162, 163 Cerebellar, 148, 150, 177 Cerebral, 148, 149, 151, 155, 158, 159, 160, 163 Cerebral Cortex, 148, 149, 151, 160 Cerebral Infarction, 151, 163 Cerebrospinal, 151, 163 Cerebrospinal fluid, 151, 163 Cerebrum, 151, 155, 184 Cervical, 74, 151 Cervix, 151 Chemotactic Factors, 151, 153 Child Development, 46, 131, 151 Chin, 127, 151, 168 Cholestasis, 55, 151 Chromosomal, 23, 24, 25, 40, 50, 61, 146, 151, 179 Chromosome, 24, 48, 147, 151, 163, 167, 169, 179, 183 Chromosome Abnormalities, 151, 163 Chronic, 4, 120, 151, 158, 165, 166, 174 Chronic renal, 151, 174 CIS, 26, 151 Clinical study, 152, 155 Clinical trial, 11, 28, 32, 35, 117, 152, 154, 155, 170, 176, 177 Cloning, 23, 24, 26, 149, 152, 165 Coagulation, 149, 152, 162, 166 Coca, 152 Cocaine, 37, 152 Cochlea, 152, 165 Cochlear, 104, 152, 182, 185

Cochlear Diseases, 152, 182 Cochlear Implants, 104, 152 Cochlear Nerve, 152, 185 Codon, 57, 152 Cofactor, 152, 176 Cognition, 152, 166 Cohort Studies, 22, 152, 159 Collagen, 18, 148, 153, 160, 175 Collapse, 110, 153 Coloboma, 45, 120, 153, 163 Colon, 120, 153 Communication Disorders, 8, 34, 104, 116, 125, 153 Community Health Services, 101, 153 Competency, 32, 153 Complement, 26, 146, 153, 154, 161, 165 Complementary and alternative medicine, 87, 92, 153 Complementary medicine, 87, 154 Complementation, 15, 26, 154 Compliance, 19, 154 Computational Biology, 117, 119, 154 Computed tomography, 5, 154 Computer Graphics, 105, 154 Computerized axial tomography, 154 Computerized tomography, 154 Conception, 154, 160 Conduction, 126, 154 Congenita, 154, 157 Connective Tissue, 17, 153, 154, 156, 160, 167, 169 Connective Tissue Cells, 154 Constriction, 154, 166, 179 Consultation, 6, 10, 100, 154 Contraindications, ii, 154 Control group, 16, 154, 175 Controlled clinical trial, 20, 155, 177 Controlled study, 32, 155 Convulsions, 147, 155 Coordination, 98, 100, 155 Cornea, 155, 181 Cortices, 155, 162 Cranial, 27, 42, 152, 155, 159, 162, 163, 165, 170, 173, 181, 185 Craniocerebral Trauma, 148, 155, 162, 163, 182 Craniofacial Abnormalities, 12, 155 Crossing-over, 155, 177 Cross-Sectional Studies, 155, 159 Curative, 155, 182 Cutaneous, 46, 155 Cyclopia, 29, 155, 163

189

Cytogenetics, 155, 179 Cytoplasm, 155, 158, 167, 169 Cytoskeleton, 18, 155, 165 D Data Collection, 29, 155 Decidua, 155, 183 Defense Mechanisms, 155, 165 Degenerative, 156, 178 Deletion, 26, 156 Dental Care, 4, 6, 7, 8, 9, 10, 16, 20, 96, 99, 100, 126, 129, 130, 156, 173 Dental Caries, 100, 156, 160 Dentists, 4, 10, 40, 156 Dentition, 4, 5, 6, 10, 38, 41, 43, 47, 67, 96, 103, 104, 110, 156 Dentition, Primary, 110, 156 Deoxyguanosine, 71, 156 Dermis, 51, 156, 182 Developing Countries, 77, 156 Developmental Biology, 4, 13, 14, 49, 51, 61, 156 Diagnostic procedure, 108, 156 Diarrhea, 156, 168 Diffusion, 156, 165 Digestion, 149, 156, 167, 181 Dihydrotestosterone, 156, 177 Dilation, 156, 163 Diploid, 147, 154, 156, 169, 174, 183 Direct, iii, 12, 13, 16, 17, 30, 31, 76, 156, 157, 167, 177 Distal, 156, 176 Dominance, 61, 157 Dopamine, 152, 157, 173 Dorsal, 157, 170, 174 Drug Interactions, 157 Duct, 146, 150, 157, 178, 182 Duodenum, 157, 158, 181 Dysplasia, 46, 57, 121, 157 Dystonia, 104, 157 Dystrophy, 120, 157 E Ectoderm, 157, 170 Ectodermal Dysplasia, 46, 120, 157 Effector, 153, 157 Efficacy, 20, 157, 183 Effusion, 18, 157 Elasticity, 70, 147, 157 Elastin, 153, 157 Elective, 104, 157 Electrons, 147, 148, 157, 166, 177 Embryo, 19, 29, 88, 133, 146, 157, 169, 172, 175

Embryogenesis, 29, 157 Embryology, 95, 97, 158 Empirical, 16, 158 Emulsion, 158, 160 Enamel, 156, 158 Encephalocele, 158, 171 Endemic, 158, 181 Endoscope, 158 Endoscopic, 10, 158 Endotoxins, 153, 158 End-stage renal, 151, 158, 174 Enhancer, 158, 178 Environmental Exposure, 31, 158, 171 Environmental Health, 116, 118, 158 Enzymatic, 149, 153, 156, 158 Enzyme, 157, 158, 176, 177, 185 Epidemic, 158, 181 Epidemiologic Studies, 82, 158 Epidermal, 26, 159, 168, 183 Epidermal Growth Factor, 26, 159, 183 Epidermis, 156, 157, 159 Epinephrine, 157, 159, 184 Epithelial, 17, 18, 62, 155, 159, 166 Epithelial Cells, 159, 166 Epithelium, 31, 148, 159, 183 Erythrocytes, 146, 159 Esophagus, 148, 159, 173, 181 Essential Tremor, 120, 159 Ethmoid, 159, 173 Eukaryotic Cells, 159, 164 Expiration, 159, 178 Extracellular, 18, 29, 42, 154, 159, 160, 165, 172 Extracellular Matrix, 18, 42, 154, 159, 160, 165, 172 Extracellular Space, 159 Extraction, 45, 63, 159 F Facial Asymmetry, 34, 159 Facial Expression, 16, 74, 89, 159 Family Health, 12, 159 Family Planning, 117, 160 Fat, 51, 160, 180, 183 Fathers, 93, 160 Feeding Methods, 70, 96, 160 Fetus, 11, 160, 175, 184 Fibroblasts, 42, 154, 160, 165 Fibrosis, 121, 160, 179 Fissure, 152, 153, 160 Fistula, 4, 7, 51, 160 Fixation, 7, 160 Fluoridation, 100, 160

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Fluorine, 160 Folate, 12, 19, 45, 160 Folic Acid, 12, 19, 83, 85, 88, 89, 90, 96, 108, 160 Foramen, 151, 160 Fovea, 160 G Ganglion, 152, 160, 161, 170, 185 Gas, 150, 156, 160, 161, 163, 168, 171, 184 Gas exchange, 161, 184 Gastric, 159, 161 Gene Expression, 15, 21, 23, 26, 121, 161 Genetic Engineering, 149, 152, 161 Genotype, 13, 19, 25, 64, 83, 161, 173 Gestation, 37, 153, 161, 173 Gestational, 38, 161 Gestational Age, 38, 161 Gland, 9, 18, 161, 167, 172, 176, 179, 181, 182 Glossopalatine, 161, 172 Glucose, 120, 161, 162 Glutamic Acid, 160, 161, 175 Glycoprotein, 161, 166 Governing Board, 161, 175 Graft, 42, 43, 51, 63, 100, 161 Grafting, 6, 10, 38, 39, 68, 69, 124, 161 Grasses, 160, 161 Growth factors, 18, 162 Guanine, 156, 162 H Haematological, 37, 162 Haematology, 162 Hair follicles, 156, 162 Hamartoma, 45, 162 Handedness, 27, 162 Headache, 162, 163 Health Policy, 134, 162 Health Status, 83, 159, 162 Hearing aid, 126, 162 Hearing Disorders, 126, 153, 162 Hemoglobin, 146, 159, 162 Hemoglobinuria, 120, 162 Hemostasis, 162, 165 Hepatocyte, 151, 162 Hereditary, 9, 55, 157, 162, 178 Heredity, 66, 161, 162 Heterodimers, 162, 165, 183 Heterogeneity, 22, 33, 48, 53, 162 Heterozygotes, 23, 157, 163 Holoprosencephaly, 29, 56, 163 Homeobox, 30, 163 Homodimer, 163, 183

Homologous, 26, 145, 155, 163, 179 Homozygotes, 157, 163 Hormonal, 148, 163 Hormone, 159, 163, 182, 183 Hybridomas, 163, 165 Hydrocephalus, 45, 163, 165 Hydrogen, 148, 150, 163, 169 Hydroxylysine, 153, 163 Hydroxyproline, 153, 163 Hyperlipoproteinemia, 163, 164 Hypertelorism, 106, 164 Hypertriglyceridemia, 56, 164 Hypertrophy, 31, 164 Hypoplasia, 5, 18, 157, 164 Hypothalamic, 56, 164 Hypothalamus, 149, 164 Hypovitaminosis, 83, 164 Hypoxia, 33, 164, 182 I Immaturity, 18, 164 Immune system, 149, 164, 184 Immunodeficiency, 120, 164 Immunohistochemistry, 31, 164 Immunologic, 151, 161, 164 Impairment, 7, 16, 19, 20, 98, 104, 148, 151, 164, 166, 168, 169 In situ, 23, 26, 29, 31, 164 In Situ Hybridization, 23, 26, 29, 31, 164 In vitro, 26, 30, 164 In vivo, 5, 18, 26, 164 Incision, 42, 164, 166 Incisional, 37, 164 Incisor, 29, 44, 100, 164 Incompetence, 77, 164 Incontinence, 163, 164 Infancy, 5, 23, 63, 104, 126, 129, 130, 164 Infant, Newborn, 145, 164 Infection, 148, 149, 151, 164, 167 Infiltration, 37, 165 Inflammation, 160, 165, 172, 174, 178 Initiation, 18, 165, 175, 183 Inner ear, 104, 152, 165 Insertional, 24, 165 Integrins, 18, 165 Interleukin-6, 42, 165 Interorbital, 164, 165 Intestinal, 165, 168 Intestines, 145, 148, 165, 179 Intoxication, 165, 185 Intracellular, 165 Intracranial Hemorrhages, 163, 165, 182

191

Intracranial Hypertension, 162, 163, 165, 182 Intraocular, 153, 165 Intrinsic, 148, 165 Intubation, 6, 7, 150, 165 Invasive, 27, 166, 167 Involuntary, 148, 159, 166 Ionizing, 158, 166 Ions, 148, 163, 166 Ischemia, 148, 166 K Kb, 116, 166 Keratolytic, 156, 166 Kidney Disease, 116, 121, 166 L Labile, 153, 166 Labyrinth, 152, 165, 166, 179, 184 Lacrimal, 161, 166, 171 Lactation, 74, 77, 166 Laminin, 30, 148, 166 Language Development, 73, 96, 166 Language Development Disorders, 73, 166 Language Disorders, 96, 126, 131, 153, 166 Language Therapy, 128, 166 Laryngectomy, 104, 166 Larynx, 166, 170 Laser Surgery, 6, 166 Latent, 167, 175 Lesion, 167 Lethargy, 163, 167 Leukemia, 120, 167 Ligament, 167, 176 Ligands, 165, 167 Linkage, 14, 21, 23, 24, 25, 28, 31, 48, 61, 62, 66, 167 Linkage Disequilibrium, 14, 31, 61, 167 Liver, 145, 149, 158, 160, 162, 167 Localization, 24, 164, 167 Localized, 18, 156, 160, 165, 166, 167, 174 Lucida, 166, 167 Lymph, 148, 151, 167, 181 Lymph node, 148, 151, 167 Lymphatic, 165, 167, 169, 182 Lymphatic system, 167, 182 Lymphocytes, 147, 163, 167, 182 Lymphoid, 147, 167 Lymphoma, 120, 167 M Magnetic Resonance Imaging, 13, 19, 167 Malabsorption, 83, 120, 168 Malabsorption syndrome, 83, 168

Malformation, 46, 162, 168 Malignant, 120, 149, 168, 170 Malnutrition, 148, 168, 170 Mammary, 18, 168 Mandible, 151, 168, 178 Mastication, 10, 168 Maxillary, 4, 5, 7, 35, 36, 46, 47, 50, 58, 59, 63, 64, 65, 67, 70, 73, 75, 83, 97, 168, 173 Medial, 17, 148, 159, 168, 178, 181 Mediate, 18, 152, 157, 168 Mediator, 27, 168 MEDLINE, 117, 119, 121, 168 Megaloblastic, 160, 168 Melanin, 168, 173, 184 Melanocytes, 168 Melanoma, 120, 168 Membrane, 18, 30, 146, 153, 159, 166, 168, 170, 174, 178 Memory, 13, 168 Mental Disorders, 166, 168, 176 Mental Health, iv, 11, 102, 104, 116, 118, 168, 176 Mental Processes, 169, 176 Mental Retardation, 45, 46, 120, 122, 153, 163, 169 Mesenchymal, 17, 26, 159, 169 Mesoderm, 169 Microbiological, 41, 169 Microbiology, 145, 169 Microorganism, 152, 169, 185 Micro-organism, 156, 169 Microscopy, 148, 169 Migration, 30, 169 Millimeter, 5, 169 Mineralization, 26, 169 Modification, 10, 161, 169, 177 Molecular, 13, 14, 19, 21, 22, 23, 24, 30, 31, 41, 117, 119, 149, 154, 155, 169 Molecule, 26, 147, 148, 153, 157, 165, 169, 177, 184 Monitor, 169, 171 Monocytes, 165, 169 Monosomy, 147, 169 Morphogenesis, 18, 169 Morphological, 74, 157, 168, 169 Morphology, 19, 30, 42, 44, 47, 51, 59, 62, 65, 66, 74, 77, 82, 94, 162, 169 Mucins, 169, 178 Mucosa, 170 Multicenter study, 25, 170 Muscle Fibers, 30, 170 Muscular Atrophy, 120, 170

192

Cleft Lip

Mutagenesis, 22, 170 Mutagens, 170 Mutism, 104, 170 Myotonic Dystrophy, 120, 170 N Nasal Cavity, 60, 170, 173 Nasal Septum, 170 Nasalis, 59, 170 NCI, 1, 115, 151, 170 Neonatal, 12, 47, 66, 67, 99, 129, 130, 170 Neonatal period, 129, 130, 170 Neoplasia, 120, 170 Neoplasm, 162, 170 Nephropathy, 166, 170 Nervous System, 120, 150, 168, 170, 171, 182 Networks, 21, 170 Neural, 12, 26, 52, 158, 170, 175 Neural Crest, 12, 170 Neural tube defects, 12, 52, 170 Neurologic, 158, 163, 171 Neuroma, 104, 171 Neuromuscular, 18, 28, 171 Neuronal, 28, 45, 171 Neurons, 152, 171, 182, 185 Neuropsychological Tests, 13, 171 Neurosurgery, 100, 171 Nitrogen, 145, 160, 171, 184 Nonverbal Communication, 153, 171, 176 Nuclear, 30, 148, 157, 159, 161, 171 Nuclei, 152, 157, 161, 168, 171, 185 Nucleic acid, 164, 170, 171 Nursing Care, 126, 129, 130, 171 O Oncogene, 120, 171 Oncogenic, 165, 171 Ophthalmology, 100, 160, 171 Optic cup, 147, 171 Oral Health, 10, 40, 99, 100, 101, 130, 171 Oral Hygiene, 128, 171 Oral surgeon, 106, 171 Orbicularis, 27, 51, 171 Orbit, 172 Orbital, 106, 172 Organ Culture, 18, 172 Orofacial, 10, 15, 19, 21, 22, 23, 30, 43, 75, 77, 83, 95, 103, 172 Orthodontics, 7, 14, 20, 74, 82, 83, 97, 103, 110, 128, 172 Orthopedics, 4, 36, 43, 61, 75, 76, 77, 110, 172 Ossification, 172

Osteoblasts, 26, 172 Osteogenesis, 4, 5, 27, 65, 73, 75, 172 Osteotomy, 50, 172 Otitis, 18, 73, 172 Otitis Media, 18, 73, 172 Otitis Media with Effusion, 73, 172 Otolaryngologist, 128, 172 Otolaryngology, 73, 77, 98, 126, 128, 172 Otology, 7, 172 Ovum, 155, 161, 172 Oxygen Consumption, 172, 178 P Palatal Muscles, 18, 172 Palliative, 172, 182 Pancreas, 145, 172 Pancreatic, 120, 172 Pancreatic cancer, 120, 172 Paranasal Sinuses, 51, 173 Paroxysmal, 120, 173 Pathologist, 173 Pathophysiology, 97, 173 Patient Advocacy, 17, 173 Patient Care Team, 7, 10, 11, 96, 100, 106, 109, 130, 173 Patient Education, 125, 128, 138, 140, 144, 173 Pediatric Dentistry, 3, 83, 100, 173 Peer Review, 81, 129, 173 Pelvic, 173, 176 Peptide, 173, 174, 176 Perception, 162, 173, 179 Perfusion, 164, 173 Perinatal, 31, 173 Phallic, 160, 173 Pharmacologic, 146, 173, 183 Pharynx, 170, 173 Phenotype, 13, 15, 27, 154, 173 Phenylalanine, 173, 184 Phocomelia, 64, 173 Phospholipids, 160, 173 Physical Examination, 132, 161, 174 Physiologic, 174, 177, 178 Physiology, 97, 145, 174 Pigment, 168, 174 Pilot study, 42, 174 Pitch, 174, 185 Plants, 145, 150, 152, 161, 169, 174 Plasma, 18, 147, 162, 163, 174, 179 Plastic surgeon, 20, 105, 106, 174 Plasticity, 11, 174 Pneumonia, 154, 174 Polycystic, 121, 174

193

Polymorphic, 36, 174 Polymorphism, 53, 61, 75, 174 Polypeptide, 153, 159, 174 Port, 32, 174 Port-a-cath, 174 Posterior, 146, 148, 157, 161, 171, 172, 174, 181 Postnatal, 50, 174, 181 Postoperative, 5, 6, 55, 98, 174 Practicability, 175, 183 Practice Guidelines, 118, 175 Precursor, 157, 158, 173, 175, 183, 184 Predisposition, 23, 175 Pregnancy Tests, 161, 175 Prenatal, 4, 42, 69, 89, 157, 175 Prenatal Care, 4, 175 Prenatal Diagnosis, 89, 175 Preoperative, 7, 175 Prevalence, 7, 15, 20, 24, 38, 43, 56, 70, 74, 83, 126, 175 Preventive Health Services, 153, 175 Primary endpoint, 28, 175 Progression, 147, 175 Progressive, 151, 170, 175 Proline, 153, 163, 175 Promoter, 26, 175 Promotor, 175, 178 Prosencephalon, 163, 175 Prospective study, 59, 175 Prostate, 18, 120, 176 Prosthodontics, 128, 176 Protein C, 152, 176 Protein S, 26, 121, 149, 176 Proteins, 29, 146, 147, 153, 162, 163, 169, 171, 173, 174, 176, 180, 183 Proteoglycans, 148, 176 Proteolytic, 153, 176 Protocol, 6, 11, 51, 176 Protozoa, 169, 176 Proximal, 46, 156, 170, 176 Psychiatric, 153, 168, 176 Psychiatry, 12, 160, 176, 184 Psychic, 168, 176, 179 Psychoactive, 176, 185 Psychology, 7, 39, 100, 176 Psychotherapy, 176, 177 Public Health, 4, 21, 24, 27, 95, 118, 130, 176 Public Policy, 117, 176 Publishing, 6, 33, 101, 176 Q Quality of Health Care, 173, 177

Quality of Life, 102, 110, 177 Quiescent, 30, 177 R Race, 38, 169, 177 Radiation, 158, 166, 177, 185 Radioactive, 163, 171, 177 Radiography, 161, 177 Randomized, 20, 28, 32, 42, 61, 157, 177 Randomized clinical trial, 61, 177 Randomized Controlled Trials, 28, 177 Reassurance, 10, 177 Receptor, 19, 60, 145, 147, 157, 177, 183 Recombination, 26, 177 Rectum, 147, 153, 161, 164, 176, 177 Recurrence, 27, 90, 131, 132, 177 Red Nucleus, 148, 177 Reductase, 45, 177 Refer, 1, 149, 153, 160, 167, 177, 180, 184 Refraction, 177, 181 Regeneration, 18, 27, 178 Regimen, 83, 157, 178 Relapse, 50, 178 Remission, 177, 178 Research Design, 19, 178 Resorption, 163, 178 Respiration, 10, 150, 169, 178 Respiratory Physiology, 178, 184 Response Elements, 26, 178 Response rate, 8, 178 Retina, 178 Retinoblastoma, 120, 178 Retinopathy, 55, 178 Rhinolith, 41, 178 Risk factor, 4, 13, 19, 21, 34, 64, 72, 83, 96, 158, 175, 178 S Saccule, 178, 185 Sagittal, 47, 83, 178 Saliva, 9, 178 Salivary, 9, 18, 172, 178, 181, 185 Salivary glands, 9, 178 Satellite, 30, 179 Schizoid, 179, 185 Schizophrenia, 179, 185 Schizotypal Personality Disorder, 179, 185 Sclerosis, 120, 148, 179 Screening, 19, 31, 90, 152, 179 Sebaceous, 156, 179 Sebaceous gland, 156, 179 Secretion, 159, 166, 169, 179, 183 Secretory, 27, 179 Segmentation, 163, 179

194

Cleft Lip

Segregation, 27, 41, 177, 179 Seizures, 163, 173, 179 Self Concept, 102, 179 Self-Help Groups, 104, 179 Semen, 176, 179 Semicircular canal, 165, 179 Sensibility, 146, 179 Sequence Analysis, 15, 179 Sequencing, 26, 31, 100, 103, 179 Serum, 71, 146, 153, 180 Sex Characteristics, 145, 180, 182 Sex Determination, 121, 180 Sex Distribution, 38, 180 Shock, 180, 183 Shyness, 13, 180 Side effect, 145, 149, 180, 183 Signs and Symptoms, 178, 180 Skeletal, 30, 58, 94, 102, 103, 172, 180 Skeleton, 54, 97, 100, 145, 180 Skull, 155, 158, 171, 172, 180, 182 Social Behavior, 16, 180 Social Environment, 177, 180 Social Sciences, 102, 180 Social Security, 177, 180 Social Work, 106, 180 Socioeconomic Factors, 4, 180 Soft tissue, 18, 34, 58, 60, 73, 102, 180 Somatic, 145, 157, 180 Sound wave, 154, 181 Soybean Oil, 181, 185 Specialist, 82, 134, 156, 181 Species, 159, 169, 177, 180, 181, 183, 185 Spectrum, 29, 181 Speech Disorders, 8, 98, 101, 181 Speech pathologist, 96, 103, 106, 181 Sperm, 151, 181 Sphenoid, 164, 173, 181 Spina bifida, 171, 181 Spinal cord, 150, 151, 161, 170, 171, 181, 182 Sporadic, 24, 53, 65, 178, 181 Stem Cells, 26, 30, 181 Stomach, 6, 145, 159, 161, 163, 165, 173, 181 Stool, 153, 164, 181 Stress, 4, 7, 10, 90, 93, 102, 127, 132, 144, 175, 181 Stroma, 17, 181 Submandibular, 18, 181 Submaxillary, 159, 181 Superstitions, 90, 181

Supplementation, 12, 20, 88, 89, 90, 91, 108, 181 Support group, 96, 126, 127, 128, 129, 132, 134, 144, 181 Sweat, 156, 182 Sweat Glands, 156, 182 Sympathetic Nervous System, 171, 182 Symphysis, 151, 176, 182 T Telangiectasia, 121, 182 Temporal, 15, 31, 162, 182 Teratogen, 23, 33, 53, 182 Teratogenic, 145, 182 Terminator, 152, 182 Testosterone, 177, 182 Thalamic, 148, 182 Thalamic Diseases, 148, 182 Therapeutics, 15, 182 Thrombosis, 165, 176, 182 Thymus, 39, 167, 182 Thyroid, 182, 184 Tinnitus, 104, 172, 182, 185 Tomography, 183 Tone, 171, 183 Tonicity, 157, 183 Toxic, iv, 158, 161, 183 Toxicity, 157, 183 Toxicology, 118, 183 Traction, 110, 183 Transcription Factors, 178, 183 Transfection, 149, 183 Transforming Growth Factor alpha, 53, 61, 66, 183 Transforming Growth Factor beta, 29, 183 Translating, 96, 183 Transmitter, 157, 168, 183 Transplantation, 30, 73, 151, 183 Trauma, 100, 183 Treatment Outcome, 29, 183 Triglyceride, 163, 164, 183 Trisomy, 147, 183 Tryptophan, 153, 184 Tuberous Sclerosis, 121, 184 Tyrosine, 18, 157, 184 U Ultrasonography, 50, 69, 161, 184 Unconscious, 146, 155, 184 Urethra, 176, 184 Urinary, 163, 164, 184 Urine, 149, 159, 162, 164, 184 Uterus, 151, 155, 184

195

V Vaccine, 176, 184 Vascular, 156, 165, 184 Vector, 165, 184 Vein, 171, 179, 184 Venous, 151, 176, 184 Venter, 184 Ventilation, 10, 126, 184 Ventral, 29, 164, 184 Ventricles, 151, 163, 184 Ventricular, 163, 184 Vertebrae, 74, 181, 184 Vertigo, 172, 184, 185 Vestibular, 72, 184, 185 Vestibule, 102, 152, 165, 178, 179, 184 Vestibulocochlear Nerve, 152, 182, 185 Vestibulocochlear Nerve Diseases, 182, 185 Veterinary Medicine, 117, 185

Villi, 163, 185 Vinca Alkaloids, 185 Vincristine, 88, 185 Viruses, 169, 184, 185 Vitamin A, 145, 185 Vitamin E, 25, 185 Vitro, 27, 185 Vivo, 27, 185 Voice Quality, 131, 185 W Withdrawal, 16, 185 Wound Healing, 165, 185 X Xenograft, 147, 185 Xerostomia, 9, 185 X-ray, 144, 154, 171, 185 Y Yeasts, 173, 186

196

Cleft Lip

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