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Publications (15)

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    José Alberto de Souza Freitas · Ivy Kiemle Trindade Suedam · Daniela Gamba Garib · [...] · João Henrique Nogueira Pinto
    Full-text available · Article · May 2013 · Journal of Applied Oral Science
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    Simone Soares · Ana Lúcia Pompéia Fraga de Almeida · José Alberto de Souza Freitas · [...] · João Henrique Nogueira Pinto
    Full-text available · Article · Mar 2013 · Journal of Applied Oral Science
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    José Alberto de Souza Freitas · Ivy Kiemle Trindade-Suedam · Daniela Gamba Garib · [...] · João Henrique Nogueira Pinto
    [Show abstract] [Hide abstract] ABSTRACT: The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology.
    Full-text available · Article · Mar 2013 · Journal of applied oral science: revista FOB
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    José Alberto de Souza Freitas · Daniela Gamba Garib · Ivy Kiemle Trindade-Suedam · [...] · João Henrique Nogueira Pinto
    [Show abstract] [Hide abstract] ABSTRACT: This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.
    Full-text available · Article · Dec 2012 · Journal of applied oral science: revista FOB
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    Simone Soares · José Alberto de Souza Freitas · Daniela Gamba Garib · [...] · João Henrique Nogueira Pinto
    [Show abstract] [Hide abstract] ABSTRACT: T his paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.
    Full-text available · Article · Jul 2012 · Journal of Applied Oral Science
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    José Alberto de Souza Freitas · Daniela Gamba Garib · Thais Marchini de Oliveira · [...] · João Henrique Nogueira Pinto
    [Show abstract] [Hide abstract] ABSTRACT: T he aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies-University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft OLSS DQGG SDODWHH VLQFHH WKHH ¿UVWW PRQWKVV RII OLIHH XQWLOO HVWDEOLVKPHQWW RII WKHH PL[HGG GHQWLWLRQ craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone JUDIWWSURFHGXUHH6%*3$WWKLVVVWDJHUDSLGGPD[LOODU\H[SDQVLRQQLVVSHUIRUPHGGDQGGDD¿[HGG palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.
    Full-text available · Article · Apr 2012 · Journal of Applied Oral Science
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    José Alberto de Souza Freitas · Daniela Gamba Garib · Marchini Oliveira · [...] · João Henrique Nogueira Pinto
    [Show abstract] [Hide abstract] ABSTRACT: The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies-University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.
    Full-text available · Article · Apr 2012 · Journal of applied oral science: revista FOB
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    J.A. Freitas · D.G. Garib · M. Oliveira · [...] · J.H. Pinto
    [Show abstract] [Hide abstract] ABSTRACT: The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies-University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.
    Full-text available · Article · Mar 2012 · Journal of applied oral science: revista FOB
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    [Show abstract] [Hide abstract] ABSTRACT: Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.
    Full-text available · Article · Feb 2012 · Journal of applied oral science: revista FOB
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    Simone Soares · José Alberto de Souza FREITAS · Lucimara Teixeira das Neves · [...] · João Henrique Nogueira Pinto
    [Show abstract] [Hide abstract] ABSTRACT: Cleft lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.
    Full-text available · Article · Oct 2011 · Journal of Applied Oral Science
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    Giovana Rinalde Brandão · José Alberto de Souza Freitas · Katia Flores Genaro · [...] · José Roberto Pereira Lauris
    [Show abstract] [Hide abstract] ABSTRACT: The objective of the study was to analyze if individuals with velocardiofacial syndrome (VCFS) present the same characteristics of speech and velopharyngeal function (VPF) compared with patients with nonsyndromic submucous cleft palate, as well as to compare the effectiveness of palate surgery on the speech function and VPF between groups. This was a prospective study performed at the Speech Therapy Sector and Physiology Laboratory, Hospital for Rehabilitation of Craniofacial Anomalies/University of São Paulo.The procedure performed was primary palatoplasty associated or not to superiorly based pharyngeal flap surgery.There were 50 patients with velopharyngeal insufficiency: 25 with signals of VCFS (VCFS group) and 25 without syndrome with submucous cleft palate (SMCP group).The hypernasality was scored by 3 examiners; nasalance was evaluated by nasometry, and VPF was assessed by the size of the velopharyngeal gap on the nasoendoscopy. The evaluations were conducted before and, in average, 18 months after surgery. Before surgery, the VCFS and SMCP groups presented similar speech function and VPF characteristics in all parameters, with no statistically significant differences. After surgery, there was reduction in the hypernasality, nasalance, and VPF in, respectively, 20%, 31%, and 36% of patients in the VCFS group and in 24%, 30%, and 30% in the SMCP group. Elimination/normalization of variables was obtained in 28%, 19%, and 8% of patients in the VCFS group and 20%, 40%, and 25% in the SMCP group, respectively, for hypernasality, nasalance, and VPF. There was no statistically significant difference between groups. Patients with VCFS presented similar speech function and VPF characteristics as patients with nonsyndromic SMCP. The surgery for velopharyngeal insufficiency correction was equally effective for the improvement and resolution of speech symptoms and VPF in patients with VCFS compared with the SMCP group.
    Full-text available · Article · Sep 2011 · The Journal of craniofacial surgery
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    [Show abstract] [Hide abstract] ABSTRACT: Introduction : The literature suggests that individuals with history of cleft lip and palate who present with midfacial growth deficiency are at higher risk of presenting lisping. The relationship between distortions during production of linguoalveolar fricative sounds and the severity of malocclusion, however, has not been established for the population with cleft. Objective : To study the association between lisping and dental arch relationship. Methodology : Speech samples and dental arch casts were obtained from 106 children with operated unilateral cleft lip and palate (UCLP) during the stage of mixed dentition and before orthodontic treatment. Videotaped productions of the phrase /u saci saiw sedu/ were rated by speech-language pathologists for the identification of lisping during [s]. Dental arch casts were rated by orthodontists using the Goslon Yardstick and the Five-Year Index to establish dental arch relationship. Results : Multiple logistic regression showed no significant association between lisping and dento-occlusal index (p  =  .802) and age (p  =  .662). Substantial interjudge agreement during auditory-perceptual ratings was found (kappa  =  .63). Almost perfect agreement was found between orthodontists while establishing the dental arch relationship (kappa  =  .81). Discussion : This study failed to reveal an association between lisping and dental arch relationship in children with operated UCLP. Multiple variables may play a role in determining occurrence of lisping, warranting further investigation.
    Full-text available · Article · Jul 2011 · The Cleft Palate-Craniofacial Journal
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    Rosana Ribeiro Manoel · Mariza Ribeiro Feniman · Maria José Monteiro Benjamin Buffa · [...] · José Alberto de Souza Freitas
    [Show abstract] [Hide abstract] ABSTRACT: Introdução: Grande similaridade entre o comportamento de pacientes com fissura labiopalatina e aqueles com transtorno de processamento auditivo são relatadas por pais e professores. Objetivo: Verificar a escuta de crianças com fissura labiopalatina em seis condições de escuta. Método: Professores de 224 escolares (7 a 11 anos) com fissura completaram um questionário, visando julgar a escuta do escolar no ruído, condição ideal, com múltiplos estímulos, no silêncio, quando solicitado recordar a informação ouvida e durante longo período de escuta, comparando-o ao de outro sem fissura de mesma idade e condição de escuta. Estudo Prospectivo. Resultados: A média do julgamento (-0,08, desvio padrão de 0,27) dos alunos com fissura, realizado pelo professor, foi aproximadamente ao de "mesma dificuldade" (zero), quando comparado com o escolar sem fissura. Não foi encontrada significância estatística para qualquer uma das condições, nem para o valor total do questionário considerando os gêneros e as séries escolares. Conclusão: As características de escuta dos escolares com fissura labiopalatina foram similares ao de outro sem esta malformação craniofacial de mesma idade e condição de escuta semelhante. No ruído, quando a memória e a atenção auditiva são requeridas foram as condições mais difíceis.
    Full-text available · Article · Sep 2010
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    Rosana Ribeiro Manoel · Mariza Ribeiro Feniman · Maria José Monteiro Benjamin Buffa · [...] · José Alberto de Souza Freitas
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: A great similarity between the patients with cleft lip and palate' behavior and those with auditory processing disorder are related by parents and professors. Objective: To verify the listening in children with cleft lip and palate in six conditions of listening. Method: Professors of 224 students (7 to 11 years old) with cleft completed a questionnaire aiming to judge the student listening in the noise, ideal condition, with multiple stimulus, in the silence, when it is solicited to remember the listened information and during a lengthy period of listening, comparing it to the other of the same age and listening condition, without cleft. A Prospective Study. Results: The mean of the trial (-0, 08, standard deviation of 0,27) of the students with cleft, performed by professor was about the "same difficulty" (zero), when compared with the student without cleft. It was not found statistical significance to anyone conditions, neither to the total value of the questionnaire, considering the gender nor the school year level. Conclusion: The listening characteristics of the students with cleft lip and palate were similar to the other without this craniofacial deformity of the same age and similar listening condition. In the noise, the conditions more difficult occurred when the memory and the auditory attention were required.
    Full-text available · Article · Sep 2010
  • [Show abstract] [Hide abstract] ABSTRACT: Cleft lip and palate occurs in approximately 1 in every 750 live human births, making it one of the most common congenital malformations. Surgical closure of the palatal cleft does not always result in a velopharyngeal port capable of supporting normal speech. The University of Florida (UF), in collaboration with the University of São Paulo (USP), is engaging in a 5-year prospective, randomized controlled study to compare velopharyngeal function for speech outcomes between patients undergoing palatoplasty for complete unilateral cleft lip and palate performed using the von Langenbeck procedure with intravelar velarplasty and those receiving the Furlow double-reversing Z-plasty palatoplasty. The von Langenbeck procedure was selected as the time-tested standard against which the Furlow procedure could be judged. The Furlow procedure, a relatively new operation, has been reported to yield substantially higher rates of velopharyngeal competency for speech than have most other reported series and theoretically should result in less disturbance to midfacial growth. A total of 608 patients will be entered into one of two age categories. Inclusion of two age groups will allow a comparison of results between patients having surgery before 1 year of age (9–12 months) and patients undergoing surgery at approximately 1.5 years of age (15–18 months). Speech data will be collected and will be available for definitive analysis throughout the last 3 years of the study. Collection of preliminary growth data will require more than 5 years; growth analysis is anticipated to continue until all patients have reached maturity. The Hospital for Research and Rehabilitation of Patients with Cleft Lip and Palate at the University of São Paulo (USP-HPRLLP) in Bauru, Brazil, is uniquely situated for conducting this study. The well-equipped and modern facilities are staffed by well-trained specialists representing all disciplines in cleft-palate management. In addition, an already existing social services network throughout Brazil will ensure excellent follow-up of study cases. The clinical caseload at this institution currently exceeds 22,000, and more than 1200 new cases are added annually. This project represents a unique opportunity to obtain prospective data from a large number of subjects while controlling the variables that have traditionally plagued cleft-palate studies. This study is designed to determine which of the two proposed surgical procedures is superior in constructing a velum capable of affecting velopharyngeal competency for the development of normal speech.
    Article · Jul 1998 · Controlled Clinical Trials