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PubMed1978

A rapid method of measuring the palatal surface area of cleft palate infants.

A method is described for rapidly measuring the surface area of the palate by adapting a piece of soft plastic to a model of the upper jaw using a vacuum moulding technique. Tests with a hemisphere of known surface area showed the method to be consistent and to have a low degree of systematic error. When measuring models with unrepaired cleft palates, the error was found to be 2.1 per cent (compared with 3 per cent using stereophotogrammetry) but 7.1 percent when measuring intact palates. Because of the consistency of the method, the true palatal area could be calculated from the measured area by the use of a multiplying factor. These findings are described, and the application of the technique to the pretreatment assessment of cleft cases is illustrated by showing that, in a series of 30 cleft palate and 30 normal infants, a tissue deficiency of 16.8 per cent existed in the cleft subjects at birth.

Cleft Palate↗
PubMed1993

[Tumors of the soft palate and the palatal vault. Our experiences].

The palate neoplasias are rare and come from either the minor salivary glands or the stratified epithelium. The malignant tumors of the hard palate are present 3-4 times more frequently than the malpighian carcinomas which, on the contrary, are prevailing at the soft palate. The malignant tumors of the palate may be located or extended to the neighbouring anatomical structures. The application of extended surgical operations for their treatment often creates great anatomical deficiencies which need the application of a reparatory intervention for restoration. We present, in this study, our experience with 6 benign and 8 malignant tumors of the hard and soft palate that we treated through surgical operation.

Adenoma↗
PubMed1997

Palate structure in human holoprosencephaly correlates with the facial malformation and demonstrates a new palatal developmental field.

In this study we analyzed palate structure in holoprosencephaly and correlated it with the facial malformations. Eleven human holoprosencephalic fetuses (three cyclopic, two ethmocephalic, one cebocephalic, four with median cleft lip, and one with short philtrum) at 17-23 weeks of gestation and three children (age 2 1/2, 6 and 7 years) with a single central incisor were studied. Photographic and radiographic methods were used. We found that in holoprosencephaly palate structure is abnormal. The severity of this malformation decreases with decreasing severity of facial malformation. Thus, the study shows a close relationship between the facial and the palatal malformation. In all phenotypes the premaxillary area is malformed. From this region, a fan-shaped field along the midpalatal suture is involved in all facial phenotypes, the fan being broadest in cyclopia and narrowest in the short philtrum malformation. A similar fan-shaped field can be discerned in the face, where the broadest fan also indicates the greatest severity with cyclopia, and the narrowest fan the least severe median lip malformation. In the palate field, the anteroposterior furrows seemingly demarcate the field. The findings may be of importance for the future evaluation of palatal malformations in children.

Child↗
PubMed2004

Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate.

BACKGROUND: Cleft lip and cleft palate are common birth defects, affecting about one baby of every 700 born. Feeding these babies is an immediate concern and there is evidence of delay in growth of children with a cleft as compared to those without clefting. In an effort to combat reduced weight for height, a variety of advice and devices are recommended to aid feeding of babies with clefts. OBJECTIVES: This review aims to assess the effects of these feeding interventions in babies with cleft lip and/or palate on growth, development and parental satisfaction. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials register (June 2001), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to May 24th 2004), EMBASE (1980 to August 7th 2002), CINAHL (1982 to August 7th 2002), PsychINFO (1967 to August 13th 2002), AMED (1985 to August 13th 2002). Attempts were made to identify both unpublished and ongoing studies. There was no restriction with regard to language of publication. SELECTION CRITERIA: Studies were included if they were randomised controlled trials (RCTs) of feeding interventions for babies born with cleft lip, cleft palate or cleft lip and palate up to the age of 6 months (from term). DATA COLLECTION AND ANALYSIS: Studies were assessed for relevance independently and in duplicate. All studies meeting the inclusion criteria were data extracted and assessed for validity independently by each member of the review team. Authors were contacted for clarification or missing information whenever possible. MAIN RESULTS: Four RCTs with a total of 232 babies, were included in the review. Comparisons made within the RCTs were squeezable versus rigid feeding bottles (two studies), breastfeeding versus spoon-feeding (one study) and maxillary plate versus no plate (one study). No statistically significant differences were shown for any of the primary outcomes when comparing bottle types, although squeezable bottles were less likely to require modification. No statistically significant difference was shown for infants fitted with a maxillary plate compared to no plate. A statistically significant difference in weight (kg) at 6 weeks post-surgery was shown in favour of breastfeeding when compared to spoon-feeding (mean difference 0.47; 95% CI: 0.20, 0.74). REVIEWERS' CONCLUSIONS: Squeezable bottles appear easier to use than rigid feeding bottles for babies born with clefts of the lip and/or palate, however, there is no evidence of a difference in growth outcomes between the bottle types. There is weak evidence that babies should be breastfed rather than spoon-fed following surgery for cleft lip. No evidence was found to assess the use of any types of maternal advice and/or support for these babies.

Cleft Lip↗
PubMed1986

Developmental stage specificity and dose response of secalonic acid D-induced cleft palate and the absence of cytotoxicity in developing mouse palate.

Incidence of cleft palate (CP) in full-term mouse fetuses was evaluated following administration of 25 mg/kg of the mycotoxin, secalonic acid D (SAD), to groups of female mice on each of Days 10, 11, 12, 13, 14, or 15 of pregnancy. Although the highest numerical incidence (45.3%) of cleft palate resulted following SAD exposure on Day 12 of pregnancy, and the response tapered off to 16.9% on Day 10 and 0% on Day 15 of pregnancy, similar responses were produced also following exposures on Days 11 (38.4%) and 13 (39.9%) of pregnancy. Maternal exposure to doses of 0, 15, 20, 25, or 30 mg/kg of SAD, given on Day 12 of pregnancy indicated that although fetuses in the 30-mg/kg group had the highest incidence (51.9%) of CP, the effect was associated with increased resorptions and decreased fetal weights. The 25-mg/kg dose was optimally teratogenic (45.3% cleft palate) and maximally tolerable with neither an increase in resorptions nor a decrease in fetal body weights. Cytotoxicity of the optimally teratogenic dose of SAD (25 mg/kg given ip) on Day 12 of pregnancy was evaluated as a possible mechanism of SAD teratogenicity using indices such as mesenchymal cell density, mitotic index, and the uptake of [3H]thymidine in the developing palatal shelves. No evidence of SAD cytotoxicity was obtained in palatal shelves indicating a possible role for nonlethal cellular effects of SAD in the pathogenesis of CP. These studies also suggest the suitability of the maternal 25-mg/kg dose of SAD to study cellular biochemical effects in the developing embryo without the complicating influence of cytotoxic effects.

Animals↗
PubMed2004

Three-dimensional dental arch and palatal form changes after extraction and nonextraction treatment. Part 2. Palatal volume and height.

The purpose of this study was to investigate the changes in palatal volume and palatal height in patients treated with and without premolar extractions. Records were collected at pretreatment, at bracket removal, at the end of retention, and 5 years out of retention. Stone casts were mounted in a SAM 2 articulator with an anatomic face-bow and a central wax record, and measurements were made with a 3-dimensional digitizer. The hypothesis, that orthodontic treatment with premolar extractions changes the palatal form, was verified. Increases in palatal volume and height were demonstrated in the nonextraction group. The extraction group showed a decrease in palatal volume but could compensate for some loss by an increase in volume in the anterior segment.

Adolescent↗
PubMed2002

[Alveolar and hard palate repair by tibial periosteal graft in complete unilateral cleft lip and palate. Long-term follow-up of 51 cases].

PURPOSE OF THE STUDY: The purpose of this study was double: appreciate the osteogenic and growth capacities of the free tibial periosteal graft concerning the alveolar and hard palate repair in the complete unilateral cleft lip and palate, and evaluate long-term follow-up concerning maxillo-mandibular morphology and palatal air-tight. MATERIAL AND METHOD: This retrospective study concerns 51 patients, of more than 13 years of age, treated for complete unilateral cleft lip and palate. The treatment included a Skoog type cheiloplasty, a tibial periosteal graft between 4 and 6 months (as described by M. Stricker) and a staphyloraphy between 8 and 18 months. Our documentation was: figures, pictures and precise description of the initial cleft, dental casts, teleradiographies, dental panorams performed at different stages of treatment, orthodontic, orthophonic and otologic follow-up. Growth was evaluated using casts during the first 6 years then by profil teleradiographies after puberty. Ossification was evaluated quantitatively by CT scan in 18 patients. RESULTS: Results confirm an ossification of the periosteal graft in 72% of cases and the advantage of periosteal graft in palatal air-tight. 85% of cases show equilibrated squeletal growth with good occlusion, and 13.7% of cases needed deferral osteotomy. CONCLUSION: We propose a method for long-term cleft results evaluation, with the use of periosteal graft.

Adolescent↗
PubMed1999

The use of the pedicled buccal fat pad (BFP) and palatal rotating flaps in closure of oroantral communication and palatal defects.

The use of the buccal fat (BFP) and palatal rotating flaps for the closure of oro-antral communication and reconstruction of palatal defects was compared clinically. The BFP proved to be consistently successful in closing oro-antral fistulae and palatal defects resulting from tumour resection, preserving the normal anatomical architecture of the oral mucosa. No denuded area requiring secondary granulation was required as in the case of palatal flaps. In addition, no facial disfigurement was observed on the operated side. BFP is considered a reliable, convenient method for closure of palatal defects and closure of oro-antral communication. It can also be considered as a reliable back-up procedure in the event of failure of other techniques.

Adipose Tissue↗
PubMed1999

Comparisons of facial growth in patients with unilateral cleft lip and palate treated by different regimens for two-stage palatal repair.

The aim of this study was to compare facial development, particularly growth of the maxilla, of two groups of patients with unilateral cleft lip and palate in whom palatal surgery had been done slightly differently, particularly the timing of the procedures. Two-stage palatal repair had been used at 8 (velar closure) and 102 months (hard palate surgery) at one cleft centre and at 20 and 62 months at another centre. Lateral roentgencephalograms were used to analyse the first sample of 20 patients, who were followed longitudinally from 7-16 years of age. The other group comprised 17 subjects in the same age range, who were investigated cross-sectionally, also by cephalometry. Generally, the outcome of the two surgical regimens was similar and equally satisfactory, with no evident difference in facial or maxillary morphology between the two samples. From the midfacial growth point of view, it might be questioned whether it is necessary to delay closure of the cleft in the hard palate until the mixed dentition stage as was done at the first cleft centre.

Adolescent↗
PubMedDate not supplied

Response of Merkel cells in the palatal rugae to the continuous mechanical stimulation by palatal plate.

The aim of the present study was to investigate the responses of Merkel cells that are numerous in the palatine rugae, due to the continuous mechanical stimulation exerted by the palatal plate. Forty golden hamsters were used in this experiment. The palatal plate was made of adhesive resin and it was set on the palate of the animal. To exert a continuous pressure, a 0.8 mm elevation on the internal surface of the palatal plate was created at the middle portion of the fourth palatine ruga. Thereafter, the number of Merkel cells in the mucosa was calculated by immunohistochemical observation. Morphological changes of Merkel cells were examined by electron microscopy. There was significant difference among the control and any of the treated groups on the number of CK20 positive Merkel cells (p < 0.05) and that numbers were decreased at the sites where continuous mechanical stimulation was exerted. Degeneration of the cytoplasm mitochondria and nerve endings, and a decrease in both the number of neurosecretory granules and cytoplasmic processes were observed. Furthermore, the presence of nuclear chromatin aggregation and fragmentation was recognized. The continuous mechanical stimulation by the palatal plate affected the responses of Merkel cells and nerve endings, thus inducing a decrease in the number of Merkel cells. A portion of these changes was also associated with the expression of apoptosis.

Animals↗
PubMed2004

Evaluation of hearing thresholds in 3-month-old children with a cleft palate: the basis for a selective policy for ventilation tube insertion at time of palate repair.

Hearing thresholds in children with a cleft palate prior to cleft palate repair are not widely documented, and audiological criteria for short-term ventilation tube insertion do not exist. The aims of this prospective study are to estimate hearing thresholds in 40 children with a cleft palate by 3-month developmental age with auditory brainstem responses (ABRs) under natural sleep and to estimate a hearing threshold guideline for short-term ventilation tube insertion. Our results show a wide range of air conduction hearing thresholds using click ABRs (2-4 Hz), which ranged from 25 to 102 dBnHL in the left ear and from 25 to 80 dBnHL in the right ear with means of 53 and 49 and standard deviations of 17 and 13 respectively. The bone conduction thresholds ranged from 0 to 55 dBnHL with a mean of 26 and a standard deviation of 13. Eighty-three per cent of children had flat, type B, on high-frequency tympanograms, indicative of middle ear effusion. Thirty per cent of the infants had a cleft palate associated with a known syndrome. Currently, it is the authors' practice to use short-term ventilation tubes on a selective basis at the time of cleft palate repair when there is a conductive hearing loss of more than 55 dBnHL in the better ear as determined by ABR with type B high-frequency tympanograms. This threshold level takes into account electrophysiological and auditory pathway maturation discrepancies. With this as the guideline, between 28% and 35% of the children in this study would be eligible for surgery. This criterion still requires further validation.

Acoustic Impedance Tests↗
PubMed2000

Combined bone grafting and delayed closure of the hard palate in patients with unilateral cleft lip and palate: facilitation of lateral incisor eruption and evaluation of indicators for timing of the procedure.

OBJECTIVE: To compare outcomes of bone grafting performed before eruption of the lateral incisor to outcomes of grafting performed before eruption of the canine and to evaluate the long-term results of bone grafting combined with delayed closure of the hard palate during mixed dentition. DESIGN: Seventy consecutive patients (52 men and 18 women) with complete unilateral cleft lip and palate were studied. All patients underwent bone grafting with simultaneous closure of the cleft in the hard palate at the stage of mixed dentition. The velum had been repaired in infancy. Mean age for the bone grafting procedure was 8.4 years. Bone grafting was performed to facilitate eruption of the lateral incisor in 43 (61%) of the patients and to facilitate eruption of the canine in the remaining 27 (39%) patients. Intraoral radiographs were used to evaluate the morphologic characteristics of the cleft and the stage of eruption of the permanent lateral incisor and canine before bone grafting. Mean follow-up time was 4.0 years (range, 1-10.1 years). RESULTS: The mean time for the surgery, which included bone grafting and repair of the residual cleft in the hard palate, was 109 minutes, and the mean amount of bleeding was 121 ml. The rate of dehiscence in the flap covering the alveolar bone graft was 14%, and the rate of total failure of bone grafting was 3%. An oronasal fistula developed in the hard palate of 13% of patients, but the fistula was of sufficient size to serve as an indication for reoperation in only 6%. The postoperative alveolar bony height in the cleft area was more than 75% of the normal height in 94% of patients. Closure of the cleft space in the dental arch was performed or planned to be achieved orthodontically in 91% of patients. When bone grafting was performed to facilitate eruption of the lateral incisor, the cleft space was closed orthodontically in 100% of patients. The optimal indicator for timing of the bone grafting procedure from an orthodontic point of view was when the permanent lateral incisor or the canine close to the cleft was covered by a thin shell of bone (i.e., 7-9 years of age).

Alveolar Ridge Augmentation↗
PubMed2006

Trp53 affects the developmental anomaly of clefts of the palate in irradiated mouse embryos but not clefts of the lip with or without the palate.

Trp53-deficient mice exhibit increased incidences of developmental anomalies when irradiated, probably due to lack of Trp53-dependent apoptosis. A/J strain-derived CL/Fr mice develop clefts of the lip with or without the palate (CL/P) in approximately one-fifth of the embryos. We produced Trp53-deficient CL/Fr mice and examined the susceptibility to spontaneous development of CL/P and clefts of palate only (CPO), which differ in their developmental mechanisms, CL/P resulting from clefts of the primary palate and CPO from clefts of the secondary palate. The effect of radiation on the two phenotypes was also studied. Unexpectedly, no increase in the frequency of CL/P was observed under either condition, indicating that Trp53 deficiency does not contribute to genesis of CL/P. On the other hand, radiation enhanced the incidence of CPO in Trp53(+/+) embryos but not in Trp53(+/-) and Trp53(-/-/) embryos, suggesting that the absence or presence of only one allele of Trp53 is insufficient to hinder differentiation and proliferation of cells involved in the secondary palate formation. These results indicate that Trp53 function adversely affects the development of CPO when certain damaging agents such as radiation are given.

Animals↗
PubMed2004

Effects of timing and number of palate repair on maxillary growth in complete unilateral cleft lip and palate patients.

This cross-sectional study was conducted on 40 subjects to investigate the effects of timings and number of palate surgeries on maxillary growth in complete unilateral cleft lip and palate patients. The number of surgeries performed for palate repair was not an important growth inhibiting factor of maxilla, rather the age at which the initial palate surgery was performed for palate repair was an important factor in influencing maxillary growth.

Adolescent↗
PubMed1991

Split palatal U-flap: a new technique for repair of caudal hard palate defects.

Oronasal fistulas located in the central portion of the hard palate can be surgically repaired using a transposition flap of hard palate mucoperiosteum from tissue adjacent to the defect. The purpose of this report is to describe a new technique, the split palatal U-flap, for the surgical repair of large caudal hard palate defects in the dog and cat. A description of this new technique and case reports of a dog and a cat in which this technique was utilized to repair caudal hard palate defects are included.

Animals↗
PubMed1991

[The effect of the postoperative use of a palatal plate for the prevention of maxillary contraction in cleft palate].

We have already reported that the maxillary was markedly contracted 1 month after a cleft palate operation. Since we thought that this was mainly attributable to cicatrized contraction of the operation region, we prepared a palatal plate and inserted it from an early stage after palate plasty. In this paper we present our summarized findings on the use of the palatal plate. We report on its use both immediately after the operation, and for a period of 3 months after the operation. Its use in both cases is intended to prevent maxillary contraction following surgical treatment of the cleft palate.

Cleft Palate↗
PubMed1996

[Cleft palate repair with a combined method of mucosal flap pushback of the hard palate].

From January of 1992, we applied a combined method to repair cleft palate in 20 patients and received satisfactory results. The method is characterized by pushing back the mucosal flap of the hard palate, a Z-plasty on the nasal mucosa, repositioning the levator muscle to lengthen the palate, circumferential pharyng oplasty using denervated extensor hallucis brevis muscle, without making relaxing incisions and elevating the mucoperiosteal flap, avoiding interference to the greater and lesser palatine vessels and nerves, without relaxing palatal aponeurosis. The advantages of this method are preserving the normal anatomy and function of the palate and nasopharyngeal cavity, improving the function of velopharyngeal closure and minimizing secondary deformities.

Adolescent↗
PubMed1997

Keratinization of palatal mucosa beneath metal-based removable partial and acrylic-based complete dentures compared with normal palatal mucosa: a clinical, cytological and histological study.

Normal human palatal epithelium is an orthokeratinizing tissue with a well-developed stratum corneum. Several cytological and histological studies showed that when the palate covered by a denture fully or partially, keratinization of the mucosa changes. The results of some studies suggested that keratinization changes from orthokeratosis to parakeratosis, and there is a reduction in the thickness of stratum corneum. Whereas the results of some other studies showed increased orthokeratinization. This study was planned to determine changes in keratinization of palatal mucosa in denture wearers compared with normal palatal mucosa. Keratinization of palatal mucosa was examined by mainly exfoliative cytology in three groups. Group-1 consisted of 51 patients wearing metal-based removable partial denture; group-2 consisted of 50 patients wearing acrylic-based complete denture and group-3 including 57 healthy volunteers who have not been wearing denture served as the controls. In each group, the results of exfoliative cytology were supported by histological examinations. Statistical results showed that either acrylic-based complete or cobalt-chromium-based removable partial dentures seem to reduce the quantity and/or quality of the keratin layer. The mean values of keratinization and the thickness of stratum corneum were significantly lower in the complete denture group than in the partial denture group. Furthermore the reliability of exfoliative cytology was confirmed by the guidance of histological examination.

Acrylic Resins↗