Beruflich Dokumente
Kultur Dokumente
OREGON
I-IEALTI-I SCIENCES UNIVERSIlY
CIIII..I) I)EVELOPMENT & REHAUIfJTA'Il0N CENTER
1'.0. Box 57/i~ Portland, Oregon 97207-0574
June I, 1994
This 38 year old I1lan has a repaired unilateral cleft lip and palate. His primary surgery was
done in Pennsylvania and he had SOITIe secondary work including a pharyngeal flap for
speech, in Florida.
Since speech treatlnent for serious hypernasality has been unsuccessful up to this point, the
Examination shows objectionable hypernasality with moderate nasal emission of air which
markedly weakens all 16 air pressure phonemes. Use of the fiber-optic nasendoscope on May
26th verified that the pharyngeal flap, done three years ago (for speech), has pulled loose.
The treatment plan is to utilize a telnporary speech prosthesis (for circa two years) to
markedly obturate all sounds froln entering the nasal cavity. After normal oral resonance is
obtained and Inaintained for about four to five ITIonths, an obturator reduction program would
begin whereby the throat and palate 111usculature would be "challenged" by slowly making the
obturator sl11aller, in stages. At the end of approximately two years, it is expected that oral
nasal resonance anti oral air pressure would be close to normal limits and that pharyngeal and
palate 111usculalurc \vould have inlproved considerably. This is expected to nlake the patient's
velopharyngeal systenl nluch Inore anlenabie to a surgical procedure to substitute for the
Respectfully sublnitted,
blak/b:gille~pi.
OREGON
NEIL GILLESPIE
1001 COOPER PT RD SW #140-180
OLYMPIA WA 90505
Dear Mr. Gillespie:
I am enclosing a copy of your dental record. With any adult
prosthesis, you are encouraged to have routine dental care and
maintenance in order to optimize the usefulness of the device.
Sincerely,
\l-~
April 1994, dinner at the Multnomah Athletic Club (MAC), Portland, Oregon
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53
OBTURATORS
PALATAL
BEFORE
WERE
ROGERS
NOTED IN
INTERESTINGLY
WAS FOUND
AT
BC
2500
THE
EARLIEST
EVIDENCE
EL
GIZEH
DATING
OF
SIMPLE
FIOM
END
THE
IT
BEEN
1971
DENTAL
RETENTIVE
MANS EARLY
INLE
SUCH AN IMPORTANT
THE INVENTOR
AS
EARH
MANS
TIMES
IN
THE
IN
1560
TO
LUSITANUS
WHAT
DESCRIBE
IS
AS
1537
TO 15
39
SIN
PREVIOULY
OF
KNOWN TODAY
PRESENTED
LUSITANUS
WHO DESIGNED
LEIBOWITZ
PROSTHESIS
OF
AMATUS
LUSITANUS
THE
WAS PROBABLY
USE
OF THE
IN
PALATE
TO
WORDS TRANS
ARE HIS
OF HEBREW UNIVERSITY
FIRST
GREEK
OBTURATOR
FISRULA
THESE
WITH
THEIR
ALPS
THE
PALATAL
LUETIC
PERMANENT
OF CLEFT
EVOLUTION
HE HAD OHSER EL
ANCONA
AS
THAT PLAYED
WCINHUIGER
NOBLEMAN
LATED BY JOSHUA
THE SUPPORTERS
DESPITE
OF THE OHTURAROR
PALARAL CHRURATORS
THE
THUS
MARGINS
PROSTHESES
IN
SUHSEQUENR CENTURIES
AND SURGERY
PALATE THERAPY
AS
IN
CIRCA
TOGETHER
THE INTRAOIAL
TO CONSTIUCT
ATTEMPTS
PROSTHESIS
OLD EMPIRE
THE
OF
AND THIRD MOLARS AND HAD HEEN WOVEN AROUND THEIR GINGIVAL
HEGAN
DEVELOPED
SCHOLAR BLAIR
TO HISTORICAL
AND PALATE
LIP
CLEFT
HAD
PALATE
USE ACCORDING
IN
OBTURATORS
AS
OF THE
SURGERY
WHILE
ISRAEL
AT
YALE
PAY ATTENTION
TO THE
WA
INVENTED
THE FOLLOWING
SPEECH
AS IF
EXTRAORDINATY
AITIFICE
ILLNESS
ORDERED
NAIL
SMALL
WHEREAS THE
SPONGE WAS
FORAMEN WHERE
871
TO PREPARE
GOLDENHEADED
NAIL
THE
HEAD OF THE
FORAMEN
RIP
GOLDSMITH
IT
TIP
OF THE NAIL
FITTED
AS
OF THE
AND TO THIS
HAD TO INTRODUCE
INTO
THE
THIS
OBTURATOR
WAS IN
THE
HOULLIERS
JACQUES
PLUG PALATE
IN
1561
WHO HAVE
IN
CLEFT
PALATES
IF
ARE
OBTURATORS
ONLY SLIGHTLY
IS
AMBROISE PAR
HIS
CALLED
EXPLAINED
OF THE
PALAT WITH
THE CAVITIE
LIKE
SELF
IT
UNTO
BUT
IS
DISH
IT
SMALL
AND
CLEFT
IF
AND FIRM
FAST
SINCE
CULTIES
OF THE
WHICH ROGERS
MEDICAL
HIS
TECHNIQUE
OF
LITTLE
SURGICAL
IF
AND
FAUCHARD
FIXATION
WINGS
PRINCIPLE
MODERN
FAUCHARDS
878
THEIR
FILL
IN
FILL
CANNOT
FALL
HARD PALATE
DEFECT
OFFERED DIFFI
DOWN
BUT
SELF
TO
PLAGUE
PRAISE
DENTAL
WHEN HE
PROSTHESIS
SOPHISTICATED
DESIGN
HE
MOST
PALATAL
MARGINS THESE
PERFORATIONS
WERE
ON
ILLUSTRATED
TRAT
BY PIERRE
INAUGURATED
DESCRIBED
FIVE
OPERATED
WHICH COULD
OF
WILL
PALAT
IT
PALATE
THE FATHER OF
YEARS
IT
BE
AS
THE
OBTURATORS
IRREGULAR
OF
SHALL
OF THE OBTURATOR
DIFFERENT
OF
AIDS
THE ARTIFICIAL
STOOD
CORRECTION
FOR CENTURIES
PROSTHETIC
IT
BIGGER
CROWN AND
AS
IN
PALAR
AS
THAT
HISTORY
MUST
THAT
CAN BE
COUVERCIES
AND ON THE
FIGURE
WHICH
UPPER SIDE
TOWARDS THE BRAIN WILL HECOM MORE SWOLN AND
PUFFED UP SO THAT
CONCAVIRIE
CAN HE
IT
OR LEAD
OBTURATORS
IN
ALWAYS
OR PERHAPS EVEN AS
TO OBTURATEUR
TIME
FIRST
PAR
DEFECTS
THE CAVITIE
NAME
CHANGED THE
AND THEY
OF SILVER
PALATE
THERE
STAND
WERE
PERFORATIONS
MORE CLEARLY
CONJECTURED
THE
WHEN
CENTULY
TO CURE
DIFFICULT
WILL SPEAK
1575
MADE
MORE
THE PALATE
AND ONLY IN
THAN
AND PALATAL
1564
LUETIC
SUCH PRIMITIVE
TO
THERE
IF
APPLIED
FILLING
WAS OUT
IT
OF WAX OR
SPONGE
USE
OF THE SIXTEENTH
ULCERS
FRANCO
AS
SUGGESTS
SYPHILITIC
PIERRE
PLUGGED WITH
THE
IT
AND RECOGNIZABLE
PREVALENT
THOSE
THE
THAT
BUCCOPHARYNGEAL
IN
MENTION OF
PERFORATIONS
WERE ALREADY
SPEAK
WHEN
ELEGANT
WHILE
DEFICIENT
TOTALLY
WELL
SPEECH WAS
PATIENTS
FOR CLEANING
DAILY
AES
SOFT
SPONGES
NO MATTER HOW
IN
PLATE
DENTS
38
1746
OF
J6
L26
IN
BOURDET IRNPRUVCD
1757
THE
TO
CLASPS
MOVE
TEETH
THE
VELAR SECTION
TO THE PALATE
ATTACHED
OF ELASTIC
GUM
MOHAMED ARAMANY
THE
THAT
SNELL
JAMES
YEARS AFTER
CLEFTS
TO
SNELLS
AND
PALATE
OF OCCUPYING
STOPPED SHORT
HIS
OWN
OF PITTSBUIGH
CLEFT
THE
FIRST
IN
DESCRIBING
LUETIC
CLEFTS
CONGENITAL
CLEFT
ATTEMPT
THE
FIRST
MADE
TO
STUDYING
REPORTED
PALATE
TO
ATTEMPT
1828
THE
ABOUT 300
AN OBTURATOR FOR
RESTORE
THE
PHARYNGEAL SPACE IN
SOFT
1841
PART
THE
WITH OBTURATORS
BE
WERE
TEETH
MOVABLE
MANAGEMENT OF
WAS BELIEVED
TREATMENT OF CONGENITAL
RESTORE
OF THE UNIVERSITY
OF PROSTHETIC
HISTORY
MINERAL
BY MEANS OF SPRINGS
TO
MUSCLES
THE PALATAL
OF THE PROSTHESIS
LATERAL
RUBBER
CONSTRUCTED
DELABARRE
WAS ATTACHED
THEM
BY FIXING
THE
1820
IN
OBTURATORS
PROSTHESIS
TO
OR INSIDE
ITSELF
PALATAL
TO EXTEND
THE
SPEECH
AN APPLIANCE
AID
INTO
THE
PHARYNGEAL AREA
IN
NOTEN
879
1845
SIMON
HULLIHEN
OF VHEELING
WEST VIRGINIA
WHERE THE
OSSEOUS
GRANULATIONS OR BY
CAN
THE
MUST
1860
VELAR
BE CLOSED
GOLD OBTURATOR
INTO
THE
WORKED WITH
BILATERAL
SEVERE
AND
WILHELM
1867
THE
IN
PHARYNX
THE
THAT
VELUM
IN
1385
TO
WALL
OLFI
SCHITISKY
PHIRYN
IN
ALL
CASES
ALSO
DENTIST
OF THE
ACTIVITY
WAS
POSTERIOR
1912
THE
1894
AFTER
SUCCESSFUL
VELUM WAS
WOLFF
WAS CONSTRUCTED
PALATOPLASRY
IN
AFTER
OF
NEW
RATHER
OF THE
THE
FIRST
TO
OF AN OBTU
OF THE
COMBINED
PICKERILL
PHARYNX
DISPLACEMENT
CLEFT
DISCARDED
LIKE
USE
THE
OPERA
THE
OBTURATOR FOR
THIS
WHICH
SCHLITSKY
EXCEPT
ONE
OF
SURGERY
ZEALAND
COMBINED
PROSTHESIS
OBTURATIR
PALATE
SOFT
MATERIAL
IN
MPHA
FOR THE
PROSTHESIS
THE
IMPROVED
AND
PROSTHESIS
EARLY
BY
1863
IN
HAHNS
OBTUSATOIS
AT
FOR
INCISION
WHICH
OF THE PHARYNX IN
DESIGN
GOLD MEDAL
KINGSLEY
MAINTAIN
OF BEILIN
IN
SPEECH APPLIANCE
NORMAN
1860
1880
TRANSVERSE
WOLFF
IN
EMPLOYED
OF GARIEL
AFTER
MUSCLE
HARYNGEAL
PASSAVANT
ALSO
SARATOGA
FIXED
CONTACT
OBTUR
OF
BENEFIT
AND EXTENDED
PROSTHESIS
GERMAN
OF THE
TEMPORARILY
1878
AT
CONSTRUCTING
SECURING
WITH
PROSTHESIS
SCBLITSK
MUCH
IMPROVED STEAMS
LATER
SUERSEN
IMPORTANCE
RTICULARLY
FIXED
ADVANCE HE RECEIVED
THIS
STEAMS APPLIANCE
IN
OF AN
APERTURE
TO CONSTRUCT
TO
OR LESS
PALATE BEFORE
NASOPHARYNX
STEAM
CLEFT
FOR
IT
SIMPLIFYING
SIZED
EITHER
OR ARTIFICIAL
MCGRATH INTRODUCED
SECTION
KINGSLEY
IN
MORE
INVOLVED
DERIVED
BE
IN
PF
LIKEWISE
IS
PALATE
WILL
WAY
WITH
IN
ATTENTION
CAREFUL
WITH
HIS
INSINUATED
AND
BY HAROLD
GILLIES
THE
MUSCLES
COMBINED HOLE OF
THE
THAT
SOFT
CREATED
PALATES
VELUM
OF THE
PUSHBACK
THE ANTERIOR
THIS
25
CHAPTER
TEETH
FOR
PROSTHESIS
CONTOUR AND
FACIAL
PALATE
OBTURATOR
THE LANCET
IN
WITH
GILLIES
REVEALED HIS
KILNER
DECIPHERING
EARLY
IN
DENTAL
1921
ACHIEVE
TO
COMBINED
1932
DEFECT
DESCRIBED
IS
TECHNIQUE
INTO
OBTURATOR DESIGNED
VELAR
PALATOPHARYNGEAL
ALSO IN
APPLIANCE
HARD PALATE
THE
TO
THE PROSTHESIS
CONTACTED
IN
THE
CASE DEVELOPED
1921
SURGERY
THE COMMONEST CONTOUR DEFORMITY
IS
OF THE
PTODUCED BY FLATNESS
SEEN IN
FLAT LIP
MAXILLA
LESSER
THE
TYPC
WHOLE
MA
THE
SIRUARCD
IS
OF THE
OBSEIVED
OPENING
THOSE
PARTS
OF
PULL WHICH
THOSE
ULTRAPROMINENT
IN
1932
PROSTHETIC
TIGHT
NOSES
AND KILNER
PRINCIPLE
FIRST
PATIENT
OF THE
SUPPORT ATTACHED
881
JAW
IS
CREATING
ONE
AS
NOR
THAN
THAN
ORIGIN
THAT
OF
OF THE
DISPLACEMENT
CLOSURE
LIP
THAT
AS
FOLLOWS SUCCESSFUL
THE
SEPTUM
IN
NATURAL
THE
UPPER
INEFFICIENT
PYRIFORM
FAILURE IN
THE
TO
THE
COROLLARY
TEETH
COME
TO LIE
AND AN
MASTICATION
LOWER LIP
GILLIES
AND
OF THE LOWER
WHICH
MAXILLAE
BACKV
PRESENT
BOD
THE
OF
UNDERDEVELOPMENT
THE
NASAL
AXIS
THE
INCLUDE
WELL
HI
MOIE COMPLICATED
HAS
DEFINITE
PALATE CLEFT
IN
EITHER
ETRICAL
FIOM
RESULTING
BONE
THE
NEATER
THE UNDETIVING
OR UNILATERAL
NASAL DEFORMITY
FACTORS
LIP
IN
OBVIOUS
IS
IT
REMOVED BUT
HAS BEEN
OF LIPS
LARGE PROPORTION
OF DEPICMCD
THIS
INAXILLAC
OF
IN
DEGREE
PALATE CASES
CLEFT
NOSE
CAUSED
THAT THE
IS
OF THE
AND DEPRESSION
LIP
AND
OLD HARELIP
LUETIC
TO THE
DEVELOPED BY GILLIES
BUT ADMIRABLE
DEFORMITY
IN
TOO
IN
FACT
AND
FRY
INLAY
IN
1921
THE CONTRACTED
INTRANASAL
AND
FOR
FACES
PROSTHETIC
INTRODUCED INTO
UPPER PLATE COULD BE
THE
LUETIC
SUNDAY
MONDAY
NOSE
SKINGRAFTLINED
SO THAT
IT
BRIDGES
IS
PERFECTLY
FOR
POSSIBLE
AND
RACIAL
TO POCKET SEVERAL
DIFFERENTSHAPED
PATIENT
FACIAL
CHARACTERISTICS
BY
SIMPLE
SLEIGHT
OF
SATURDAY
PREOPERATIVELY
THE
TEETH
EXISTING
IT
HELD
SMALL
THIERSCH
USED TO BUILD
THE
GRAFT TO LINE
SULCUS INCISION
ADJUSTABLE
THE SOFT
THIERSCH
THE
INNER
HAIRLESS
MOLDED
OF THE LIP
GRAFT HAD
CE THE
HIDE
WHICH WAS
TRAY
TAKEN
WHILE LEAVING
NASAL
AND
BASE
FIXED
OCCLUDE
FROM
CAP
SPLINT
TO REPLACE
MISSING
COMMUNICATION
ITS
THE
TO
MISPLACED
RAW
THIS
TEETH
INTO
ASPECT
OVER THE
STENT
LISHED
TO
THROUGH AN UPPER
FRONT
TISSUES
IN
TRAY
TO
NORMALLY
WITH
THOSE
AND
OF THE
MANDIBLE
AS NOTED BY
THE
FE
ATE
CH
HOLE
THE
OCEASIONALL
THERE
DOOMED
FESS
IRRITANT
THE
IS
IS
TIMES
ARE
CECASIONS
OF THE FACE
PATIENT
ER OCCASIONALLY
AN
AND KILNER
GILLIES
ALTEICD
IS
EVEN TODAY
METHOD
THE
HCTTCI
DENTUTE HESS
DROPS OF IMBIBED
IHINORRHEA
HE
FOT
TO WEAR
FOR
PELSISUS
WHTN
THIS
MAN
HACK
ESCAPE
OF US
FLUID
DIASS
NOSE AND
TIME
IPPROEH
IS
USED
AND ON
RARE
OF CHOICE
COOPER
HERBERT
IN
THE
COOPER AN
LATE
20S
AND
30S BEGAN
EARLY
THROIDECTOMIES
WOULD
AFTER
FULL
FISTULAE
INDICATED
ADDED
IN
AND SCAIRING
MADE
8S2
TN
EFFORT
TO
COMBINE
FOTEES
PALATE
HIS
DENTAL
THE PALATE
STT
CSS
ITH
AND
TO THE JUNIOR
PALATES
THAT NO FURTHER
SURGERY
TO HELP
CLEFT
CASES
AND DURING
BULB TO THE
PROSTHESIS
MANY
MORNING OF COLECTOMIES
COOPER FELT
SUCH DISASTERS
TO SEE
THE CLEFT
TURN UVET
OF LANCASTER PENNSYLVANIA
ORTHODONTIST
RESTORATION
IN
UP
WAS
HE
OBTURATORS
AND
WITH
THE
IRRITATED
THROWING
DOWN
PUSHBACK
PROCEDURE
CAN
SPEECH GEORGE
HIS
THE
SHOWDOWN
SAME
HAVE GOOD
THIS
CHALLENGE
BRIDGE
FIXED
INITIAL
HARVOLD NOW OF
EGIL
INTO
ABOUT
WHICH
DENTALLY
DORRANCE
SAID
IVY
TO
OPELATION
PUSHBACK
FINALLY
COOPER
BOAST
DORRANCE
THE
COOPER RESPONDED
YOULL BRING
IF
TO
GAUNTLET
CASES THAT
100
BRING
THE
INCH
FOOT
UNASSUMING
QUIET
DORRANCE
FOOT
OVER
RECALLED
1938
ABOUT
CLINIC
PALATE
DOMINEERING
DOGMATIC
HEAVY
CLEFT
IN
AN EPISODE
GLEE
OF BOTH
FRIEND
ROBERT IVY
OF OSLO
OF CALIFORNIA
THE UNIVERSITY
WHILE
MODELS
NORMAL
AT THE
CLEFT
FIRST
IN
ARCH
PALATE
ARCH
ARYDEL
BEGAN
AFTER ORTHODONTIC
THE
TOR IN
INWARD
RELOCATCD
ORTHODONTIC
BY
INDIVIDUAL
BBHN
OF THIS
DISLOCATED
MEANS AND
THEN
1973
WHICH
DENTAL
THE
FIXED
ABNORMALITIES
BRIDGE
SHOWN
TREATMENT
HERE
THE
IS
IS
ITH
OBTURATOR
TREATMENT
00
ORTHODONTICS
BY
MEANS OF
RELATIVELY
OF THE UNIVERSITY
CLEFT
SEVERAL IMPRESSIVE
RESULLS
WERE CORRECTED
PIOSTHODONTIC
ONE OF
HIS
AN EIGHTUNIT
IN
POSITION
IN
CASES IN
WHILE
HE NOTED
TREATMENT OF CHOICE
BILATERAL
RETENTION
AND INCISOR
WITH REFERENCE
AREA
OF OSLO
THE
FISLULA
OF THE
POSITION
CLEFT
BE
SEGMCNTS COULD
RAM STAD
REGIMEN
THIS
FOLLOWING
THE
MISSING
BEFOIT
TO
THE
CLEFTS
BRIDGE
AFTER
WITH
RELATIONSHIP
ORTHODONTIC
IEMOVABLC
SATISFACTORY
POSRPROSTHODON TIC
ADULT
RITFNTION
1V
ITCH
IUATNMNT
DEMON
HARVOLD
THE
TT
PALATC
AFT
RETAINED
COULD BE PERMANENTLY
SHORT SPLINT
LEFT
FULCRUM IN
IN
TREATMLNT
TEETH
AND 1967
191
AROUND
SEGMENTS
THAT THE
AND 1963
195I
MALOCCLUSION WAS AN
PALATE
FOR CORRECTION
MOVEMENT
IN
CLEFT
MAXILLARY
OF THE MAXILLARY
TOOTH
TMOD
OF THU
ROTATION
THE REGION
UAL
OF THE
DEVELOPMENT
LINT
OCCLUSION
63
IN
AND
UNILATERAL
BILATERAL
19
CLEFT
COMPLETE
CASES
WERE NOTED
NO
BUCCAL
BILATERAL
THE
CROSSBITE
CLEFT
OCCURRED
CASES
POSITIVE
AND IN
UNILATERAL
ALL
635
IN
OF THE UNILATERAL
BILATERAL
789
AND IN
OCCURRED IN
ALMOST
OF THE
90
OF
CASES
ROBERTS PRESENTED
1965
COMPLEX
MOVEMENT
OF THE WINGS
THE
IN
ACHIEVED
IS
OBTURATORS
CLEFT
TO PROVIDE
BY USING
SOPHISTICATED
THAT
PALATE
MORE TRAUMATIC
FUNCTION
OF
INSUMCIENCY
CONGENITAL
BUT
SHELF
SOME
IN
TISSUE
THE
TO
RETENTION
KEY
WHEN LESS
LATER
SO SCARRED
THE
CASES
OF SEVERE
OBTURATOR
HAS BEEN
THE
UNDER CERTAIN
AREAS
HAD
AND ALSO IN
PALATAL
THE
AND
SURGERY
WAS IMPAIRED
ATTRIBUTED
CONDITIONS
MAY
IT
BE OF
VALUE
MODERN STAND
PALATE
PROSTHESIS
ROBERT
IP
MILLARD
LANCASTER
CLEFT
OF SPEECH
DIRECTOR
PALATE
CLINIC
AND PAATE
HE PRESENTED
WHICH
PROSTHESIS
INDICATIONS
FOR PROSTHESES IN
WIDE
CLEFT
WIDE
UNOPERATECI
NEUROMUSCULAR
CASES WITH
GUIDELINES
INSUFFICIENT
FOR
CASES
LZ
IN
LOCAL TISSUE
AVAILABLE
TO
REPAIR
DEFICIT
WHEN
OF THE
SOFT
PALATE
VOMER
FLAP
AND PHARYNX
MEDICAL CONTRAINDICATION
SURGERY
IS
TO SURGERY SUCH AS
DELA ED
EXPANSION
PROSTHESIS
FOR
COMBINED
PROSTHESIS
AND ORTHODONTIC
APPLIANCE
884
FOR CLEFT
OF
TISSUE
JUSTIFIED
OR
MAJORITY
THE
PALATES
LOCAL
DYSCRASIA
INTERESTING
1971
AT
FUNCTIONAL
CLEFT
OR OTHER
SOME
SERVICES
THAT THE
PROCEDURES IN
ACCOMPLISH
AND HEARING
ACKNOWLEDGED
CLEFTS
LOB
ON
IMPRO EMENT
OF SPATIAL
ICLATIONSHIPS
BLOOD
IN
FOR PROSTHESIS
INDICATIONS
IN
FAILURESFISTULAS
SURGICAL
VELUM
THE
BEHIND
MECHANISM WITH
VELOPHARYNGEAL
INCOMPETENT
PALATES
OPERATED
CONTRAINDICATL
THE
ALVEOLUS
PRUI THUSIS
FOR
FEASIBILITY
OF PRIMARY
DIAGNOSTIC
METHODS
OR SECONDARY SURGICAL
BASED ON DEFINITIVE
REPAIR
MENTAL RETARDATION
SEVERE
AND PARENTS
PATIENT
UNCOOPERATIVE
TRAINED
PROSTHODONTIST
NEW YORK
KENNETH ADISMAN OF
1971
CEFT LIP
SINCE
1971
MEDICAL
RECONSTRUCTIVE
THE
ARE
THREE
OR IMMOBILE
FIXED
AND SPEECH
TYPES
WHICH
PROSTHESIS
NEW YORK
THE
AT
DENTAL
INTEGRATE
GENERAL
FOR THE
TRAINED
TO
SURGERY
PLASTIC
THERE
ADISMAN
CENTER
CENTER
PROSTHETICS
HAS
DENTAL
UNIVERSITY
UNIVERSITY
DENTINOGENESIS
THERAPY
ACCORDING
LATEIAL
REMAINS
THE
IS
TO
OF PROSTHESIS
JISMAN
STATIONARY
PERMITTING
WITH
TREATMENT
AGAINST
PE FOR PIOSTLIETIC
ACCEPTED
THERAPY
THC HINGE
WHICH
MOVEAHIC
NI
DIFFICULT
TYPE
WITH AN AIRWAY
INDICATED
ADISMAN
PROVIDED
TISSUE
FOR UNIEPAIRED
CONSIDERS
COLLAPSED
SURGERY
HE
MODERN
STANDARD
THE
IN
NINCREENRH
CENRUIS
NASAL CASITY
HARD
CLOSURE
SECTION
AND RCTAINCD
ON THE
IS
HN
CLEFT
CLEFTS
IN
LIE
ILEXILDIE
FOR
LACK
OF
CONJUNCTION
PALATE
COMPOSED OF
SIMPLE ACT
TEETH
INDICATED
EXRENSIVC
OF HIS
TYPE
FEED
SURGERY OR
FORWARDED EXAMPLES
PROSTHESIS
IS
THIS
CLEFTS
INRERVCNRION
PROSTHETIC
OF THE PHARYNX
INSTEAD
PEIFORATION
ARCHES OR FAILED
MAXILLARS
835
BY
THE
PRACTICAL
THE
POPULAI
SOFT PALATE
EXTENDED INTO
AIDS
ING
THE
TO
THE MEARUS
IS
PIOSTHESIS
ATTEMPRCD TO IMITATE
PROSTHESIS
THREE
OR
LOCAL
WITH
THE
PARTS
THE HARD PALATE
THE
THE
PALATAL EXTENSION
SOFT PALATE
SECTION
AND ENDS IN
OF THE
NASOPHARYNGEAL
SECTION
THE NASOPHARYNGEAL
ON
DEPENDING
IT
TION
IN
SO THAT
MUST BE
LARGE
ENDS IN
IS
ENOUGH TO
MADE OF
USUALLY
OF THE
IRRITATION
AND SWALLOWING
PHONATION
IT
DEFORMITY
RCSIN
METHACRYLATC
DETECTED
THE
WHICH
SECTION
PROVIDE
CLEAR
NASOPHARYNX
NASAL SPINE
THE
VELOPHARYNGEAL
PLACED LOWER IN
POSTOPERATIVE
THE VELOPHARYNGEAL
CLOSING
IN
METHYL
WITH
LINE
DURING
HIGH IN THE
THE POSTERIOR
SEAL
FOR RESPIRA
SIZE
IS
GENERALLY
AIDS IN
PARTIALLY
BY THE
VITH
THE
FOR SEASHELL
IS
SHO
PATIENT
886
SAME
ATTISTIC
COLLCCTING
TO IMPIOVE
IN
TAKING
STIEIK
ACHS
II
IN
THAT ATTIACTS
CONSTIUCTS
BOTH FUNCTION
USEFUL
LE
IN
HIM
CLEFT
TO THE BEICHES
PALATE
AND APPEATANCE
SOCIET
PIOSTHESES
TO
HELP
THE
CAN BE CONSTIUCTED
PROSTHESES
BERKOWITZ
OR LIFTING
STIMULATION
THAT
REPORT
LUMEN
RHETIC
ACIYLIC
CLOSURE
AID
VELOPHARYNGEAL
THE
SPEECH
ELOPHARY OGEAL
OPENING
OF THE
POSITIONING
PROSTHETIC
WHEN PHARYNGEAL
887
SPLTCLL
HICH
SX
PHARVNGEAL
FAILURES
THAT
SECTIONS
UD
WHEN
THE
CLOSURE
IPPLI
IN
IS
TO
THE
EXISTS
PROSTHESIS
SPEECH
SPHINCTERIC
TYPE
BE ASSISTED
CAN
EXTENSION
OF THE ELAR
BEHAVIOR
CREATING
DIMENSION
USUALLY
SHAPE
IS
CIITICAL
AND POSITION
HICH
ARE INAPPROPRIATE
TO PROSTHETIC
DO NOT IMPROS
IN
SI7E
SHAPE
OF
P105
CONSTRUCTED
THE
DURING FUNCTION THEREFORE
SECTION
THOSE
IN
TRAINING
OF MIAMI
UNIVERSITY
SYNERGISTIC
INADEQUATE
BULB PHARVNGEAL
ROUST CONFORM
IESIN
OMPERCNR
IS
OF THE
SPEECH AID
THOUGHTS ABOUT
HIS
EXPRESSED
FOR PALATAL
AS APPLIANCES
OF
OF THE
PI
SUCCESS
SPEECH
IESULR
OR PLACEMENT
THE THICE
SPCECH AID APPLIANCE
BULB
CONNECTED
II TS
PECTH
TO
DENTURE
SHANK
STATE THAT
THEY
PLANE FROM
VELOPHARYNGEAL CLOSURE
YEARS OF
TO
FIRST
CERVICAL
SLIGHTLY
VERTEBRA
IT
IS
SLIGHTLY
POOR LANDMARK
IS
OF THE NASOPHAIYNX
WELL
AS
REST
TO THE
PALATAL
SECTION
THE
AS
PHONATION
FOR
THE
AFTER
BY THE
SOFT
OF THE
PLACEMENT
MAKE
MUST
POSTERIOR
RELATED
CLOSELY
THE PHARYNGEAL
PHARYNGEAL SECTION
ASPECTS
IS
AGE
IS
CONTACT
WITH
MUSCLES OF THE
THE
LATERAL
DURING FUNCTION
PALATE
OF UL
POOI PROSTHESIS
PROPER PROSRHCSI
ARARN
SUBTELNY
INCOMPETENT
THIS
AID
SPEECH
VELUM
NATURE
NANCE ALTHOUGH
OF ADEQUATE
IMPTOX
APPLIANCE
SCARRED AND
WAS HEAVILX
IT
WIDTH
WAS HYPOPLASTIC
OF THE
ELUM
MADC
CONTACT
IT
SPECCH HAD
STILL
IT
DID
THE
SPEECH
AND TBEICFORE
OH
NOT FUNCTION
IT
FAILED
BULB
AS
FAILCD
THE POSTERSOS
AND DO
888
IMMOBILE
ALL
INTO
IT
ON
RCDUC
TO
PM
TO ELEVATE
NGEAL
NASAL
ALL
AND
IESO
XX
AS
PLMR NX
IT
XX
OULD
COMBINED USE
AND PHARYNGEAL
OBTURATOR
RUSSELL
AND
QUIGLEY COFFEY QUERZE
ORDER TO AVOID
SURGERY WAS
EARLIER
AREA UNTIL
OF THIS
SURGERY
COMING UNDER
AT
GROWTH RETARDATION
MAXILLARY
PROPOSED THE
OF BROOKLINE
THE AGE OF
AS
SCRUTINY
TO
AS
YEARS
CAUSE OF
POSSIBLE
SAME TIME
THE
IN
USE OF AN OBTURATOR
EARLY
WEBSTER WITH
IN
1958
IN
OF
FLAP
IN
VARIATIONS
ORDER NOT TO
IN
IMPEDE
THE
AN EXTENSIVE
THE ABOVE
IMPROVE
THE
INDICATE
HYPERNASALITY
THAT
AID
PHAR
NGEAL FLAP
PHATYNGEAL
AND
SPEECH BUT
SURGERY
IS
CLEFT
PALATE
WITH
PATIENTS
SEEMS TO BE USEFUL
IT
AID
SPEECH
THAN PHARYNGEAL
EFFECTIVE
LESS
ORDER TO IMPROVE
IN
AND
SURGEIY
FLAP
OF
DYSARTHRIA
SPEECH AID
NASOPHARYNGEAL INCOMPETENCE
FLAP
AFTER
CONCLUDED
STUDY
RESULTS
OF
TOMOHIRO SHIGEMATSU
1973
IN
TO SET
SPEECH
SPEECH
POSTOPERATIVE
RESULTS
TEMPORARY OBTURATOR
PENDTNQ POSSTBLE LATER
ROBEIT
BLAKELEY
IA
GOT TO COLLEGE
OUTDOORS
CONTENTION
FOR THE
SPEECH
PROSTHESIS
PIONEERED
FOR CLEFT
UNSUCCESSFUL HERE
IT
IS
RESUM
IS
OR
ERRORS ARE
CLINICIAN
IN
1972
8A9
IF
USUALLY
THAT
AT
HALF OF LAW
HIS
COMMENTS
EARLY
THE
1977
IN
ENOUGH FOR
HABITUATED
PRESSURE
HABITUATED
ALTERABLE
EASILY
IS
WAS
EACH CHILD
OF THC 16
AIR
OF
OF TEMPORARY
WHOM SURGERY
IN
AND
THE UNIVERSITY
REDUCTION
PATIENTS
NASAL EMISSION
WE STOP
SUBSTANTIALLY
STRONG
ITH
OF SPEECH PATHOLOGY
SPECIALTY
OF
THE MICHIGAN
YEAR AND
AFTER
SYSTEMATIC
PALATE
IN
HURDLES
HIGH
THIS
SURG
GROWING UP
EXCITEMENT
THE
THE
OLYMPIC GAMES
SCHOOL HE DISCOVERED
OREGON
LAD
LANKY
TALL
STOPGAP
AS
PRM IDED
BY
EALLY
THE
EATH
COMPENSA
PATIENT
ENOUGH
DIFHCULT
COMPENSATORY ERRORS ARE
ANDOR
AS
NOTED
TO
UNDO
ROBERT BLAKELEY
WITH
EVEN
CHILDREN
FORMAL
WITH REPAIRED
THE TEMPORARY
NASAL
ASSISTANCE
IN
OR
QUALITY
TWO
TO SEVEN
SLIGHT
OF
DEPENDING
PRESCHOOL
UPON MANAGE
OF COURSE
AIR
ALL
VIRTUALLY
DAYS
EMISSION
DUTING
CAN BE CONSTRUCTED
PLACED AND THE CHILD
PROSTHESIS
AND COOPERATION
FOR
SPEECH GOAL
AFTER HABITUATION
SCHOOL
OF
THE
PROCEDURES
SHOULD BE PREVENTION
PALATE
GIADE
PERIOD
OF THE CHILD
ABILITY
IN
SPEECH
OBTURATED WITHIN
THE
CLEFT
NOT CORRECTION
YEARS
HABILITATION
SPEECH
THE OBTURATOR
WILL
PARENTPROFESSIONAL
WHEN
TEMPORARY HYPONASALITY
CHILD
IS
IT
IS
IN
PLACED
THE
CHILDS
MOUTH
THE OREGON
HAS
PRESENTLY
CHILDRENS
CRIPPLED
THE
AS
YOUNG
OBTURATOR
MUSCULARUIE
THE
REDUCTION
THIS
TENDS
RELAX THE
HABITUALLY
OBTURATOR RAKING
THE
IN
ATLAS
THEREAFREI
ALONE
THE
AFTER
ARTICULATION
SPEECH
DENTIST
NOT TO IMPINGE
IS
HAS
IT
TESTING
THIS
EACH
HYPERNASALIRY
THE
SAME
890
IS
EMISSION
SOFT
VIA
TISSUE
THE
OVEILYING
TO CONSONANT
SAX
REQUIRED
FOUR TO EIGHT
RRTICULATION
OF
MANIPULATION
SIDE
IS
CARRIED
RIME
TEST
THAT
OUR BY
RESTING
IN
OF THE
OBTURATOR
THE
PORTION
OF
PASTE
ALTERING
IS
THE
FROM
OF THE
AND
NASAL LISTENING
ON THE OBTURATOR
PLACE
THE
OF REDUC
EG
APPOINTMENT
PROCESS
IS
BECAUSE
DIFFERENCE
HIS
OF
SIGNS
THEN DISCON
REPRODUCED IN DENTAL
APPROXIMAREL
TO
AND
ANTERIOR
TO DETECT SUBCLINICAL
REDUCTION
REDUCTION
MADE UP
PATIENT
SPEECH PATHOLOGIST
MM FROM
BEGINS
APPROACH TO OBRURAROI
USUALLY
THE
UTILIZATION
AND
PATHOLOGIST
NASAL EMISSION
IS
REDUCTION
RETURNS IN
HAS
SYSTEMATIC
STEPS AT EACH
GRADUAL
AND
PLACE
PRESSURE INDICATOR
THE SPEECH
ANDOR
THIS
IN
MONTHS THAT
MUSCULATURE
UPON
OBTURATOR
TLIC
AT
PERMANENT
MAY
OR
INITIALLY
ORAL
HYPERNASALIRV
SPECIFIC
OBTURATOR
OF SPEECH
DETERMINED
CONTINUES UNTIL
TINUED
ARE
WITH
IS
COMBINATION
THEREBY
OBTURATOR
RML
TOO
OF THE VOICE
WORN AN
SPEAKER
CAN BEGIN
MM ON
THE
UPON
OHTUI AROI
TION
AND
HYPERNASALITY
FORCE
ONE MUST
BY MATURATION ALONE BY
PARENT
DURING SPEECH
AN
INITIALLY
OVERIMPINGEMENT
FROM THE
ORAL
USING
THIS
PATHOLOGIST
OBTURATOR
DRAW AWAY
MANAGEMENT
THE PATIENT
HABITUAL
AN
IS
OTHER
OF THE
SIZE
ENTAILS
LIKE
TO ELIMINATE
IN
MONTHS
ENOUGH
ALWAYS
OF OREGON
UNIVERSITY
EIGHT
LARGE
RECOMMENDATIONS
THE
NO
VITRUALLY
CAIC
ORDER
THE
RESPONSE THUS
LEARNED
HISHER
AT
PATIENTS
YEARS
MADE
IS
OF THE
PATIENT
TWO
AS
OBTURATOR OF NECESSITY
NASAL EMISSION
WEAR
SOME 750
PROGRAM ENCOMPASSING
FOR CHILDREN
WHO
CHILDREN
125
PROGRAM
FOUR
STONE
AS
MONTHS FOR
PALAROPHARYNGEAL
THIS
RIME
IN
AN
CONTINUES
OBTURATOR REDUCTION
CLOSURE
MOST OF THE
BY THE
FELT
IS
VP
SATED
MUSCULATURE
PHARYNGEAL
NORMAL SPEECH
ADAMS AND
DENTIST
1964
IN
AND MAXIMALLY
VP
FOR SECONDARY
THAN
PURPOSES
SPEECH
WITH
CHILD
BETTER CANDIDATE
FAR
IS
IN
NORMAL MONITORING
OF
BECAUSE
AND
ARE APPROACHED
PROCEDURE USUALLY
PUBLISHED
AS
NINE
OVER SIX
THEIR
PROSTHESIS
BLAKELEY
FASHION
VP
COMPLETE
COMPENSATION
LINDGREN
SURGEON
PATHOLOGIST
SPEECH
VP
SURGICAL
FOR THE
SUBSTITUTE
BECOMES
FLAP
OF
THIS POINT IN
AT
THUS ANY
AND ARTICULATION
VOICE
IT
PATIENTS
THIS
IN
FOR
QUO
MAINTENANCEOFTHESTATUS
PHYSIOLOGIC
APPARENT
SURGERY
OF
TO
USE
PATIENTS
19
COMPEN
THE
FOR
SPEECH
PROSTHESIS
IN
ONE STUDY
WITH
REDUCED IN
WAS
IT
REDUCTION
CULATURE
HOW TO
IZATIONS
CAN
NGEAL
WALLS AND
29
MM
IN
THE
IN
SUMOTOJAPAN
CLEFT
THE
UPON
SUCH TIME
DENTAL
SOME
MUS
THE
IN
THE
OF THE
SIXTH
RECALLED THAT 10
SUUD NOTED
WAS
REDUCTION
CON
INTERNATIONAL
HIROSE
SURGERY
OF
MAT
CASE OF PURPURA IN
SURGERY THIS
TO FACILITATE
RHC LATERAL
MUSCULATURE DOES
MEAN
YEARS BEFORE
EARLY
CLOSURE
VP
THE 60 PATIENT
MMWHILE
MODELS OF
STONE
OCCURS IN
OBVIOUSLY
PATIENTS
TRANSACTIONS
AS SURGICAL
EATING
WAS INDICATED
PRECIPITATED
THE
HIROSES
SUBSEQUENT
EXPERIENCE
WERE MOST
TO
WHEN
EFFECTIVE
THE POSTERIOR
SNUGLY
POSTERIOR
WAS IT5
OF AN OBTURATOR
FITTING
EXTENDED
NUMBER OF
HAD PREVENTED
PALATE
MUSCLE
PATIENT
REACH
TO
HISRORKAL
AND RECONSTRUCTIVE
OF PLASTIC
PATIENTS
VP COMPENSATION
OF
COMPENSATORY HYPERRROPHY
REDUCTION
LATERAL
1975
GRESS
BASED
OF THE
OPTIMALLY
SUBSTANTIAL
TAKE PLACE IN
MEAN
MADE
BE
OBTURATOIS
OBTURATOIS
THE
FUNCTION
FOR
PROGRAM
WEANING
REDUCTION
AND OBTURATOR
OBRURARION
THEIR
THAT
FELT
REDUCTION
THOSE
WERE REFERRED
THE REMAINDER
SIZE
PATIENTS
60
OF THE
PERCENT
OF THE
PERCENT
REMOVAL LEAVING
OF
POINT
AN OBRUIAROR
IN
HYPERTROPHY
INTO
THE
PHARYNGEAL
NORMAL SPEECH
891
THE
TO
ONE
FITTED
OBTURATOR
THIRTY
CONTINUED
EARLY
SIZE
VOICES
PHAI
OF 60
1970
IN
NORMAL
SUBSTITUTE
SURGICAL
ME
WERE REDUCED IN
OBRURATORS
PATIENTS
BY
THEY
COVERED THE
PHARYNGEAL WALL
CLEFT
ALL
AND
FIVE
ITS
OUT
TIP
OF
CLEFT
CORRECTLY AND
WHENTHE
ALMOST
EIGHT
VELAR
TOUCHED
PATIENTS
PIECE
THE
OBTAINED
MNOIE
WHEN
THE
COVERED THE
VELAR
PIECE
THE
CLEFT
TIP
THE
AT
TO BEGIN
AGE
THAT TIME
CAN USE
THEM
TO WEAI
THE
UISES
IN
LARCI
PARTIAL
DATE
OVER
VINYL
RESIN
CAST
IN
OCCLUSION
RUBBER
POSTERIOR
NORMAL
SPEECH
MOLARS
ALMOST FINISHED
IS
NOT LIKE
THE
THE
TO SPEAK
PUSHBACK
NORMAL SPEECH
CHILDREN
THE
WE
SOON LIKED
OR EAT WITHOUT
THE
AS
PER
OPERATION
METHOD AND
BY THIS
ALL
PI
PREMAXILLA
TO
FIX
MISSING
CONSISTS
LATERAL
TEETH
MAXILLARY
FIXED
PREMAXILLA
FLOATING
CHILD
TEENAGE
FOR THE
TO
AND
OF ACRYLIC
THE
RESULT
IS
OR VINYL
ACRYLIC
OR
FIXATION
OF
FUNCTIONAL
PROCESSES
SUPERIMPOSED
DENTURE
PROSTHESES
WHO RECLUIRE
AND
ARE
INDICATED
UNDERDEVELOPED MAXILLA
DISHARMONY
FIRST
SEEMED TO BE TWO
YEARS
WITH CLASPS
OBTAINED
SPEEC
THE
PONTICS
OVERLAY
892
THE
PREMAXILLA
PALATE
ALL
CAN BE USED
DENTURE
RESIN
THE
OBTAINED
OBTURATOT
CASES OF WHICH
FLOATING
PROSTHESIS
OF
NINE
NORMAL
EIAINCD
THE
WEAIING
THE DCNRITION
OBTUIATOIS
AT
FOR
SILICONE
ALMOST TOUCHING
AGAIN
OBRURATORS
FORMED
ELASTIC
NOTED
PROPEI
BECAUSE
SOFT
OF NINE PATIENTS
HIIOSE
MADE OF
OT
FOR PATIENTS
CLEFT
IMPROVEMENT BECAUSE OF
OVERDEVELOPED MANDIBLE
MAIRELATIONSHIP
WITH
BETWEEN
THE
TO CORRECT THE
TWO WHERE
FOR
SOME
CORRECTIVE
REASON
IN
WHO HAD
WITH
IMPOSED
THE
PALATE PATIENTS
ABUTMENT TEETH
THE
ROBERT
SPEECH
THE
IN
THE
AID
OF
THE
FAILURE
THE
SURGEON
SCARRED
RECONSTRUC
OF LHE PIOSUHESIS
PROSTHESIS
MAY
OF
AN
BETTER ENVIRONMENT
CREATE
OF RETENTION
INSERTS
TO
AID
IN
PROSTHESIS
EMPHASIZED
AND
AND THE
THE
PARENTS
THE
WORK
PROSTHODONTIST
TO ACHIEVE
THE
THE
OF HAVING
IMPORTANCE
WITH
TOGETHER
OPTIMAL
USE
OF THE
SPEECH APPLIANCE
IS
CAN BE OF INESTIMABLE
AWAITING
PROSTHESIS
OF
TO
FAVORABLE NASOPHARYNGEAL
THE
VALUE
IN
OPTIMUM RIME
IN
SURGERY
OR
UNWILLINGNESS
OT
FUNCTION
MAINTAINING
OF VIEW
SURGERY FROM THE SURGEONS POINT
FOR
RELATION
PROSTHODONTIST
MILLARD
PROSTHESES
WHILE ONE
OCCLUSAL
GROWTH AS COMPARED
THE
OF
PREMAXILLA
PATHOLOGIST
PROSRHCRIC
FOR
THE
IN
PATIENT
NUM
MORE
SECTION
PLACEMENT
AND
PROSTHESIS
THE
TO
TO CREATE
OF THIS
OBSTRUCTING FLOATING
RETAINING
TO
SULCUS OR EXCISION
LABIAL
PERFORATIONS
OF MAXILLARY
CUM
REDIVIDED
MAY BE
FACILITATE
TOT
MORE
LIP
DEVELOPMENT
CAN
SUPER
FOR
THE
COLLAPSED
EXHIBITING
DUE TO INHIBITION
PROSTHODONTIST
NON OF
SO
CONTOUR
ASSISTANCE
SURGEON CAN BE OF
PALATE
WHOM THE
IN
CLEFT
MANDIBULAR
AS
AND
LATERAL
ABNORMAL RELATIONSHIPS
IN
AND TIGHTNESS
COLLAPSE
LIP
FACIAL
POSTOPERATIVE
SHIPS
OCCLUSAL
GROWTH
PROSTHESIS
HARMONIOUS
BER OF
RESULTING
ARE CONTRACTED
MAXILLAE
PATIENTS
LIFE
FORESHORTENED
LEAVING
PATIENTS
IN
EARLY
IN
ANTEROPOSTERIOR
THAT
RESECTION
PREMAXILLARY
CONTRACTION
MAXILLARY
RELATIONSHIP
DEN
OVERLAY
FOR
PATIENTS
CONTRAINDICATED
IS
SURGERY
AS
RESPECT NO
GROWTH
INABILITY
INDICATES
NO
EITHER
CARRY
OUR
CALIFORNIA
AFTER
PROSTHETIC
SURFACE AGAINST
DELIVERY
BBY WILSON
IVLACKBY
CLEFT
DEVICES
WHEN PLACCD
TO OBTURATE
HELP
THE VALUE
EMPHASIZED
IMMEDIATELY
DURES
THE
IT
AFTER LIP
AND
MAY
ALSO AFFORD
BE
SOME
OUTCOME OF
THE
DEVICES
HELP
SURGICAL
PROCE
APPLIANCES
FIRM
PROVIDES
AND
FACILITATE
DELICATE
NASAL
IRRITANTS
ICTAIN
NOTED
INTRAORAL
APPLIANCE
PROTECTION
BE EXPOSED TO
SHE
AND
PU
FAVOJ ABLE
MAXILLARYMANDIBULAI
REGULATED
BY MODIFYING
THE
OF THE PALATAL
RELATIONSHIPS
APPLIANCES
AS
THE
GROWS
INFANTS
SECURING
894
MORE
1978
HOSPITAL
BEFORE
PROSTHETICS
PALATAL DEFECT
TONGUE WILL
SIMILAR
FORM CAN
WHEN PALATAL
THE
THIS
THE
DURING FEEDING
THE INFANTS
PIOMOTE
ARCH
MAXILLARY
CHILD
CLOSURE
AFFECT
NEONATE WITH
CLEFT
WHICH
OF FLUIDS
OF VARIOUS
CAN POSITIVELY
IN
LOS AMIGOS
SURGERY IN
PALATE
SHELVES
OF RANCHO
WILSONMACKBY
LIBBY
THIS
REPAIR
IS
TONGUE BY CONTOURING
WAFER IN
POSITION
ITH
PLASTIC
CAN BE PROTECTED
CONRAINCI
ABSOIBABLE
SUTURE
LID
TO THE
MATERIALS
ARCH
FROM
AND
PROGRESS REPORT
Notll prairllss of caslI. complications. chanilll In dlaposls
415-13
Rev. ]-8]
CHART COpy
GILLESPIE, Neil
#74123
7/22/85
GILLESPIE, Neil
Page Two .
7/22/85
My impression and recommendation to the patient generated
three specific areas of interest. One relates to the scar revision
of his upper nose and the relationships of his nasal tip, nose,
and secondary deformities in this area. The second area of interest
in importance is the alveolar cleft with the naso-oral fistula.
The third area is the palate with obvious velopharyngeal incompetence
and a foreshort and scarred palate.
My initial recommendations will be that the patient undergo
orthodontic evaluation.
I will arrange for him to see Dr. Rosario
Mayro for evaluation as well as x-rays to assess his occlusal
relationships.
It also should be noted that he, in general, had
a fairly satisfactory occlusal relationship.with some lateral collapse
and crossbite on the minor segment on the left and evaluate his
adequacy as a candidate for bone graftin~which I think he would
qualify. Subsequent to this, I will have him see Dr. Harvey Rosen
concerning the actual surgical procedure and also he will be seen by
Miss Marilyn Cohen, a speech pathologist with special interest in
patients having cleft lip and palate for an evaluation concerning
feasibility of posteropharyngeal flap in a patient of this age group.
Concerning the external revisions, this can be accomplished concerning
the upper lip, possibly at the same time as the fistula closure with
orlllcularis redirection, a revision of the nostril sill and the
lateral alar base, and also possibly tip rhinoplasty or this can
be accomplished at a later date with a formal rhinoplasty in concert
with other procedures.
In addition, the vermilion border should be
repaired.
This can be done by Z-plasty technique.
The patient, therefore, will be seen by the consultants and a
general plan with timing'for surgery, etc., will be made. We will
arrange to make these arrangements and follow-up with the patient.
No letter.
ep
s1ak, M.D.
econstructive Surgery
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RE:
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Neil Gille.pie
Dear Joei"" ,
This lllorning your patient, t-lr. Neil Gillespie, was seen in
consultation regarding his secondary cleft lip and palate deformi
ties. His major concern at this point in time is the edentulous
space in the region of the left lateral incisor which necessitates
wearing a removable appliance. This area has never been bone grafted.
On physical examination there is the obvious stigmatA of an unilateral
left sided cleft lip and palate. Examination of the lip reveals poor
aligrunent of the vermilion border. There is lack of muscle continui'ty
high in the lip. Nasal examination shows a deviated septum with the
body of the septum in the left nasal airway and the caudal end pre
senting in the right nasal airway. There is a fla~~Q,~lar base. Tho
alar sill i~ recessed. There is a slumping of the left alar rim.
Tht:: right lower lateral cartilage is hypertrophied compared to the
left lower lateral cartilage. Intraoral examination reveals an
edentulous space in the region of the left li1teral incisor. There
is an obvious oronasal fistula. There i~ a slight posterior cross
bite in the lett posterior segment. There is marked velopharyngeal
escape.
I exp~a1nwd to Mr. Gillespie that in order for nim to have a iix~d
bridge appliance made 60 thathhe could be rid of his removable ap
pliance, an alveolar bone graft would be necGssary. Whether or
not the posterior cro86bite should be corrected prior to this time
is up to Dr. Mayro. At the &~e time that the bone graft is per
formed lip revision could be done as well. At a secondary procedure
a posterior pharyngeal flap And naaal reviaion could be performed.
and The Institute. III North 49th Street I Philadelphia, Pennsylvania 19139 I Telephone (215) 471.2000
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Sest revarda.
Sincerely youre,
cel
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~UUNUtD
11155
Philadelphia. Pa 19104
(215) 596-9120
Philadelphia, PA 19111
RE:
Neil Gillespie
B.D. 3/19/56
Dear Joe:
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M.D~.
PlASTIC SURGERY: Peter Randall, M.D., Don LaRossa, M.D., Linton Whitaker, M. D., Ralph Hamilton, M. D., R:Barrett Noone, M.D.,). Brian Murphy,
, ,:" Arthur Brown, M.D.
SPEECH PATHOLOGY: Marilyn Cohen, B.A., Marilyn Bernhard, M.A.; DENTIST."" Rosario Mayro, D.M.D., 'Imes Schweipi;
D.D.S.;
QTORHINOLARYNGOLOGY: William Potsic, M.D., Steven Handler, M.D., Ralph Wetmore, M.D.; AUDIOLOGY: Richard Winchester,
Ph.D.;
PEDIATRICS: Patrick Pasquariello, M.D.; SOCIAL WORK: Susan Freimark, A.C.S.W.
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(2)
Marilyn A. Cohen
Speech Pathologist
MAC/med
cc:
Gillespie
2020 t~lalnut Street
Philadelphia, Penna., 19103
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Gillespie:
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Rosario F. r4:lyro,
D.~-1.D.
RFl-1:er
P~nnsylvania
19103
215-735-5211
Pennsylvania ~ospital
Suite 309
Re:
Neil Gillesoie
Dear Harvey:
Mr. Neil Gillespie has began orthodontic treatment
Best regards,
Sincerely yours,
,~
Rosario F. r:layro, D.J.LD.
RFi'1:er
cc:
215-735-5211
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PeriodontICS and
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1850
RE:
NEIL GILLESPIE
DEAR ROSIE:
CC:
JUL 0,,1986
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.~NSYLVANIA HOSPJ~ ~L
. N.tion's Fint HOIpit.11 FoundN 1751
Four Silverstein
RE:
Neil Gillespie
Dear Peter:
I have asked Mr. Neil Gillespie to see you in consultation regarding
a secondary cleft nasal deformity. Mr. Gillespie had been referred
to me by Joseph Kusiak for a bone grafting procedure to his residual
alveolar cleft. When first seen by me he had a very large nasal pal
atal fistula with a significant alveolar defect. In addition, he had
a rather severe cleft nasal deformity with a large amount of velopharyn
geal insufficiency. A pharyngeal flap was discussed, but he declined
this and wanted to concentrate on the bone grafting of his alveolar
cleft as well as some secondary nasal surgery. He was operated upon
last spring, at which time he underwent bone grafting of his rather
,..-extensive alveolar cleft and, at the same time, repositioning of the
nasal septum and nasal' spine in the midline. He did wel~ followinq
~ these procedures, and approximately six months
later he underwent
a rhinoplasty procedure involving further work on his septum with
only minimal resection, reduction of a dorsal nasal hump, and reduc
tion of his left alar flaring. As a Desult of the last mentioned
maneuver, he has developed some blockage of the left nasal airway due
to excessive buckling of the lower lateral cartilage. It is-significant
to note that prior to his nasal surgery he denied having anY}di,fficul
ties wi t~ nas';ll br 7athing.. For thi~ reason. no extensi.Y,~.~~9r:kwa~~~ne
to the r~ght ~nfer~or turb~nate, wh~ch is s~.'.~~;J~
".t'IY'hypertrop~~ed,
and the nasal septum was not more ~~--.e:i.el~'~rese'6ted.
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Best regards.
Sincerely yours,
'1 '
.:;~ .
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Suite 3H
Phi1ade1phLa, PA 19106
RE:
Neil Gillespie
Dear Harvey:
Thank you so much for your letter concerning Mr. Neil Gillespie.
This certainly sounds like an interesting and rather difficult
situation. I would be very pleased to see him. I will
certainly keep you in touch with any plans, and do appreciate so
much information.
Thanks again.
~oseph
Kusiak, M.D.
UNIVERSITY OF PENNSYLVANIA
DIVISION OF PLASTIC SURGERY
(215) 662-2044
Externally, some addi tional grafting could be done on the tip of the
nose on the left side.
The purpose would be to try to elevate the tip of
the nose to make it more even wi th the opposi te side.
For both of these
grafting procedures cartilage can be taken from ei ther the septum, if there
is a sufficient amount, or from the cupped portion of the ear.
This is
done through an incision behind the ear and usually leaves very Ii ttle in
any noticeable deformi ty.
There is of course a scar present behind the
ear where the incision is made, but in most people this is not conspicuous
because of its location.
The shortness of your palate is contributing to some nasality of your
speech.
I pointed out that if you were to improve the left nasal airway,
your speech might deteriorate since the reduced air flow on the left side
is actually helping to control the loss of air through the nose during speech.
If this obstruction is relieved air .may flow more freely through your nose
making your speech more nasal sounding.
If this were to occur addi tional
surgery might be needed. This would consist of a posterior pharyngeal flap
where a piece of tissue from the back of the throat is connected into the
palate to help to reduce the air flow into the nose.
An obturator could
also be used to accomplish the same thing.
As you know, obtura tors are
like extended upper dentures with a part that helps to lift the palate or
to reduce the amount of air space coming up into the nose.
Although there are some possible benefits to be derived from the surgery
we discussed, you should consider the possible complications and the risk
that things might not work out the way ei ther you or I expected them to.
If you feel that the possible benefits as I outlined them to you would
outweigh the risk of complications for disappointment and feel that you
would like to have the surgery done, please let me know so that appropriate
letters can be wri tten to your insurance company for a pre-authorization
for the surgery. If you would like to discuss this at greater length, please
make another appointment to see me.
Thank you for asking my opinion and
for the privilege of sharing in your medical care.
Sincerely yours,
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DLR:dg
cc:
FOUNDED 1855
Philadelphia, PA 19104
(215) 596-9120
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Sincerely yours,
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Marilyn E. Cohen
Speech Pathologist
MEC:sam
cc:
PLASTIC SURGERY: Peter Randall, M.D., Don LaRossa, M.D., linton Whitaker, M.D., Ralph Hamilton, M.D., Harvey M. Rosen, M.D., Joseph F. Kusiak, M.D., R. Barrett Noone,
M.D., ). Brien Murphy, M.D. SPEECH PATHOLOGY: Marilyn Cohen, B.A., Marilyn Bernhard, M.Ed. DENTISTRY: Rosario F. Mayro, D.M.D., Dennis G. Sanfacon, D.M.D., Barry
S. Kayne, D.D.S., Stanley Horwitz, D.D.S., Howard M. Rosenberg, D.D.S.
OTORHININOLARYGOLOGY: William Potsic, M.D., Steven Handler, M.D., Ralph Wetmore, M.D.,
AUDIOLOGY: Dan F. Konkle, Ph.D.
PEDIATRICS: Patrick Pasquariello, M.D.
SOCIAL WORK: David ). Beele, M.S.W., A.C.S.W.
Lawrence W. C. Tom, M.D.
GROWTH/ANTHROPOLOGY: Nancy Minugh-Purvis, Ph.D. GENETICS: Elaine H. Zackai, M.D., Donna M. McDonald, M.s. PATIENT EDUCATION: Pamela H. Onyx, B.A.
NURSING: Kelly Gould, R.N.
thony
December 3, 1990
~urs.
Chris Montoto
Secretary to Dr. Millard
December 6, 1990
Christy Barcelona
Pennsylvania Blue Shield
Pre-authorization Request
P. O. Box 890041
Camp ~ill, PA 1708900041
S)7Z:t:~r:L
Marisol Pardo,
Insurance Secretary
~1P/a
JUN 29 1993
MUTAZ B. HABAL., M.D., F.R.C.S.C., FAC.S.
PLASTIC AND RECONSTRUCTNE SURGERY
801 W. Dr. ".rtin L ICing, Jr. BIwI.
Tampa, FL 33603-3301
Telephone: 813/231HH09
FacsOnBe: 813/.238-1119
May 5, 1993
RE:
NEIL GILLESPIE
/U V/ G.-i~- fr~{t:-L--l
Mutaz B. Habal, M.D.
(dictated but not read)
MBH/bbd/5-8
June 2, 1993
Robert E. Williams, Ed.D.
certified Rehabilitation Counselor
Department of Labor and Employment Security
Divisional of vocational Rehabilitation
11213 B North Nebraska Avenue
Tampa, Florida 33612
Willia~s,
'<\MPA
ST. PETERSBURG
SARASOTA
FORT MYERS
LAKELAND
fLe~:l~y~,~'t.G-<A.,c...'l/t.."',
~/i6
euerle,
CCC-SLP
Professor
Craniofacial Center
Health Science Center
PO Box 100424
Gainesville, FL 32610-0424
Telephone: (352) 846-0801
Fax: (352) 846-1539
e-mail: Wiliiams@dentaLufLedu
Re:
Dental No.:
Medical No.:
Neil Gillespie
18-80-41
10-44-032
This forty year old white male was seen on November 25, 1996 for a videofluoroscopic
assessment of his velopharyngeal port during function for speech. Mr. Gillespie is currently
wearing a speech bulb obturator, and his speech resonance frequently alternates between
hyponasality and hypernasality. The purpose oftoday's filming was to determine the size,
configuration and placement of the bulb in the nasal pharynx to determine if alteration of
these factors can improve his overall resonance quality. The nasal pharyngeal structures
were coated with a thin barium sulfate solution to aid in defining soft tissue contrast.
Records were obtained in the lateral and frontal (A-P) planes with and without the speech
bulb obturator.
Detailed analysis of the film revealed the following conditions:
1. Without the obturator the soft palate is mobile, demonstrating a movement pattern
appropriate to the several speech samples Jared produced. Although there is good velar
mobility, contact with the posterior pharyngeal wall is not achieved. That is!, a consistent gap
of 10 - 12 mm exists between the elevated velum and the posterior pharyngeal wall during
speech.
2. The depth of the nasopharynx, as measured along the palatal plane from the posterior
nasal spine to the posterior pharyngeal wall is 25 mm. This compares to the norm of 24 mm
2 mm/SD revealing Mr. Gillespie's nasopharyngeal depth to be well within normal limits
for his age.
3. The configuration of the posterior pharyngeal wall is nearly vertical above and below the
palatal plane, a pattern well within normal limits.
4. An A-P view revealed symmetrical mesial movement of the lateral pharyngeal walls
approximately 25 - 50% of the distance from rest to midline.
Neil Gillespie
Fluoroscopic assessment of VP Function for Speech
November 25, 1996
In summary, Mr. Gillespie presents with a speech pattern characterized by near normal
resonance but which frequently alternates between hyponasality and hypernasality. He is
currently wearing a speech bulb obturator and today's assessment revealed placement and
configuration to be near optimal.' Without the obturator, Mr. Gillespie's speech is
significantly hypernasal and although the velum elevates appropriately there remains a
consistent gap of 10 - 12 mm during speech. In order to further define whether any
improvement can be made to the speech bulb obturator or if a secondary surgical technique
might be a viable consideration, a nasendoscopic assessment should be conducted.
If I can be of any further assistance in the interpretation of this film please call me at (352)
8:;~~
W. N. Williams, Ph.D.
Speech-language Pathologist
cc:
Apt. C-2