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PubMed2006

Soft palate mucosal adhesion as a preparation for Furlow's double-opposing Z-palatoplasty.

BACKGROUND: Furlow's double-opposing Z-palatoplasty enables both soft palate lengthening and palatal muscle reorientation, and outstanding speech results have been reported. However, Z-plasty often results in horizontal stress and requires relaxing incisions in some cases. This article presents the authors' novel two-stage Furlow double-opposing Z-palatoplasty used in 13 cleft lip-cleft palate patients. METHODS: During cheiloplasty, partial soft palate adhesion was performed. Only mucosal tissue was approximated to prevent damage to the palatal muscle. The residual palatal cleft decreased gradually, and palatoplasty was scheduled at the age of 1 year. Adhesive soft palate tissue was incised and Furlow's double-opposing Z-palatoplasty was performed in the usual manner. RESULTS: Eleven patients underwent Furlow's palatoplasty without relaxing incisions, and in two patients relaxing incisions were required along the inside of the alveolus. Relaxing incisions around the maxillary tuberosities were not required in any of the 13 cases. Analysis of the palatal cast models was carried out on the adhesion group (n = 13) and the control group (n = 9). In both groups, the mean distance between the tuberosities increased, and cleft widths at the alveolus and the middle of the hard palate were decreased. Furthermore, cleft width at the junction of the hard and soft palates was decreased significantly in the adhesion group compared with the control group. CONCLUSIONS: As a preparation for Furlow's palatoplasty, soft palate adhesion induced a decrease of cleft width without interfering with the transverse growth of the posterior maxilla and enabled Z-plasty of an adequate size without relaxing incisions.

Cleft Lip↗
PubMed2006

Comparative study of maxillary growth and occlusal outcome after autogenous rib grafting in complete cleft palate defect.

Cleft palate is a congenital deformity with soft tissue and hard tissue defects. Normal cleft palate repairing surgery only repairs soft tissue defects, whereas bone defects in the hard palate still exist. Therefore, we conducted this study in beagles to observe the influence of bone grafting at primary surgery on craniofacial growth and occlusal relationships in individuals with complete cleft palate and to provide experimental evidence for optimal surgical procedures for cleft palate. Using 60 beagle puppies as subjects, we tested the effects of bone grafting in surgically induced palatal defect. The animals were randomly and equally divided into four groups: (1) unoperated controls; (2) surgically induced unilateral cleft palate, not repaired; (3) two-flap palatoplasty used to close the soft defect of the surgically induced cleft palate; (4) autogenous bone (a piece of rib bone) implanted into the palatal defect before two-flap palatoplasty was performed.Cephalometric roentgenography and plaster casts of the maxillary were taken preoperatively and every 4 weeks after surgery. Sixty metric cranial variables were measured directly from the cleaned skulls after the animals were killed the 34th week postoperatively. The measurement results indicated that bone grafting may reduce the disturbance of maxillary growth caused by the cleft palate and the denuded bone, but it may cause other maxillary deformities. This finding suggests that surgeons should be careful in choosing the method of primary bone grafting in repairing complete cleft palate.

Animals↗
PubMed2007

Amniotic fluid induces rapid epithelialization in the experimentally ruptured fetal mouse palate--implications for fetal wound healing.

Cleft of the secondary palate is one of the most common congenital birth defects in humans. The primary cause of cleft palate formation is a failure of fusion of bilateral palatal shelves, but rupture of the once fused palate has also been suggested to take place in utero. The possibility of post-fusion rupture of the palate in humans has hardly been accepted, mainly because in all the cleft palate cases, the cleft palatal edge is always covered with intact epithelium. To verify whether the intrauterine environment of the fetus plays roles in wound healing when the once fused palate is torn apart, we artificially tore apart fetal mouse palates after fusion and cultivated them in culture medium with or without mouse or human amniotic fluid. We thereby found that the wounded palatal edge became completely covered with flattened epithelium after 36 hours in culture with amniotic fluid, but not in culture without amniotic fluid. Using histological and scanning electron microscopic analyses of the healing process, it was revealed that the epithelium covering the wound was almost exclusively derived from the adjacent nasal epithelium, but not from the oral epithelium. Such actions of amniotic fluid on the fetal wound were never simulated by exogenous epidermal growth factor (EGF), albumin, or both. In addition, the rapid epithelialization induced by amniotic fluid was not prevented by either PD168393 (an inhibitor of the EGF receptor-specific tyrosine kinase) or SB431542 (a specific inhibitor of TGFbeta receptor type I/ALK5). The present study provides new insights into the unique biological actions of amniotic fluid in the repair of injured fetal palate.

Activin Receptors, Type I↗
PubMed1996

Palatal morphology and type of clefting.

In this study, the variation in palatal dimensions, particularly for height, width, and depth, were evaluated in subjects with different types of cleft palate using the moiré technique. The sample consisted of 95 subjects with cleft palate and 68 noncleft individuals. Effects of cleft type, gender, developmental stage of the dentition, missing teeth, and 11 skeletal and pharyngeal cephalometric variables on palatal dimensions were assessed using multiple-regression analyses. The typing of clefts had an effect on the all palatal dimensions. The palate was shallower in subjects with clefts involving the secondary palate than in other types of clefts or in noncleft individuals. The palatal width was decreased in subjects with cleft in the primary palate, and the palatal depth was affected by all cleft types except submucous cleft. Gender, developmental stage of the dentition, missing teeth, and some of the cephalometric variables also had a certain effect on the palatal dimensions.

Adolescent↗
PubMed2001

Long-term evidence for favorable midfacial growth after delayed hard palate repair in UCLP patients.

OBJECTIVE: To investigate whether delayed hard palate repair resulted in better midfacial growth in the long term than previously achieved with "conventional" surgical methods of palatal closure. DESIGN AND SETTING: Long-term cephalometric data from patients with unilateral cleft lip and palate were available from two Scandinavian cleft centers. The patients had been treated by different regimens, particularly regarding the method and timing of palatal surgery. Patients were analyzed retrospectively, and one investigator digitized all radiographs. PATIENTS: Thirty consecutively treated subjects from each center, with cephalograms taken at three comparable stages between 10 and 16 years of age. RESULTS AND CONCLUSIONS: Patients whose hard palates were repaired late (early soft palate closure followed by delayed hard palate repair at the stage of mixed dentition) had significantly better midfacial development than patients in whom the hard palate was operated on early with a vomer flap, and then during the second year of life, the soft palate was repaired with a push-back procedure. As the growth advantage in the delayed hard palate repair group was accomplished without impeding long-term speech development, the delayed repair regimen proved to be a good alternative in surgical treatment of patients with unilateral cleft lip and palate.

Adolescent↗
PubMed2001

Thickness of palatal masticatory mucosa associated with age.

BACKGROUND: The palatal masticatory mucosa is widely used as a donor material in periodontal plastic surgery. However, there are relatively few studies investigating the volume or thickness of the palatal mucosa. The purpose of this study was to determine the thickness of palatal masticatory mucosa in Asian subjects aged 14 to 59 years by a direct clinical technique. The associations of age and gender with the thickness of palatal mucosa were also examined. METHODS: Sixty-two systemically and periodontally healthy Asians (31 males; 31 females; age range 14 to 59 years) participated in this study. The younger age group (age 14 to 21 years) consisted of 32 subjects with a mean age of 16.8 years, whereas the older age group (age 30 to 59 years) consisted of 30 subjects with a mean age of 38.7 years. A bone-sounding method using a periodontal probe with minimal anesthesia and a prepared clear acrylic stent were utilized to assess the thickness of palatal mucosa at 15 measurement sites defined according to the gingival margin and mid-palatal line. Multiple linear regression analysis was performed to examine the associations of age and gender with the mean mucosal thickness at the subject level. The Wilcoxon test was used to determine the difference in mucosal thickness between the 2 age groups, and between gender at each measurement point. RESULTS: The mean thickness of palatal masticatory mucosa ranged from 2.0 to 3.7 mm. The younger age group had significantly thinner mucosa (mean 2.8 +/- 0.3 mm) than the older age group (mean 3.1 +/- 0.3 mm). Females had thinner mucosa than males in the same age group, but the difference was not statistically significant. Overall, the thickness of palatal mucosa increased from the canine to second molar areas and in the sites furthest from the gingival margin towards the mid-palate (with the exception of the first molar area, where significantly decreased thickness was observed). CONCLUSIONS: Within the limits of the present study, the canine and premolar areas appear to be the most appropriate donor site for grafting procedures in both young and adult individuals. The subepithelial connective tissue graft procedure can be considered as a treatment modality in young patients, since a sufficient volume of donor tissue can be obtained from the hard palate area. Other factors that may influence the thickness of palatal mucosa such as racial and genetic factors and body weight need to be further investigated.

Acrylic Resins↗
PubMed2000

[Comparative research on forms of dental and palatal arches between adults and children after rapid maxillary expansion].

OBJECTIVE: To study changes of dental and palatal arch forms between adults and children after rapid maxillary expansion (RME). METHODS: Trans-arch and trans-palatal widths, and molar and palatal angles on plaster models of 47 children and 47 adults were measured pre- and post-treatment with RME. RESULTS: 1. Trans-arch width: Increases of trans-molar and trans-cuspid widths were significantly greater in the child group than those in the adult group, except first and second premolars. In the child group, there was no significant difference of increased widths between posterior teeth and cuspids. But, in the adult group, increased widths in trans-arch of first molars, first and second premolars were significantly greater than those in cuspids. 2. Transpalatal width: Trans-palatal increases at mid-palates and the apex of palates were significantly greater in the child group than those in the adult group. 3. Molar angle: In the child group, no difference existed in the molar group between pre- and post-treament. But, in the adult group, statistical difference existed between pre- and post-treatment. Prior to RME, the molar angle was the same between the child group and the adult group. The molar angle was significantly greater in the adult than that in the child group after RME. 4. Palatal angle: The changes were not of statistical significance in child palatal angles between pre- and post-RME. Significant differences existed in the adult group between pre- and post-RME. Increases of palatal angles were significantly greater in the adult than those in the child group. CONCLUSION: Significant differences existed between the child and the adult group in forms of dental arches and palatal arches, which focused on the changes of molars and palatal angles after RME.

Adult↗
PubMed1990

[Speech outcome after early or delayed hard palate closure].

Delayed hard palate closure (after age 6-7) was widely used for palatal repair in cleft palate children from 1976 to 1982. Since 1982, the approach has been revised into early complete closure of the soft and hard palate (before age 2). The articulation skills of 60 children with cleft lip and palate (age 3-5:11) who underwent early complete palate closure were compared with 47 children of similar age with soft palate closure only. The results indicated that the early complete closure group had more children with adequate articulation skills than the delayed hard palate closure group. Detailed analysis of the articulation patterns in each group revealed that the articulation substitution patterns made by the early complete closure group followed the trends of developmental articulation patterns, i.e. unaspirated, stopping and fronting phonological features. On the contrary, the articulation substitution patterns made by the delayed hard palate closure group were more related to structural deficits, i.e. compensatory articulation. Age 3-5 is a critical period for articulation maturation. We advocate that the complete palatal closure should be achieved before age 2 in order to equip cleft palate children with an equally normal oral structures to enhance speech/language development in a normal learning process during this critical period.

Age Factors↗
PubMed2000

Comparison of cleft palate induction by Nicotiana glauca in goats and sheep.

The induction of cleft palate by Nicotiana glauca (wild tree tobacco) during the first trimester of pregnancy was compared between Spanish-type goats and crossbred western-type sheep. Cleft palate was induced in 100% of the embryonic/fetal goats when their pregnant mothers were gavaged with N. glauca plant material or with anabasine-rich extracts from the latter, during gestation days 32-41. Seventy-five percent of newborn goats had cleft palate after maternal dosing with N. glauca during gestation days 35-41, while no cleft palates were induced when dosing periods included days 36-40, 37-39, or day 38 only. The induced cleft palates were bilateral, involving the entire secondary palates with complete detachment of the vomer. Eleven percent of the newborn goats from does gavaged during gestation days 32-41 had extracranial abnormalities, most often contractures of the metacarpal joints. Most of these contractures resolved spontaneously by 4-6 weeks postpartum. One newborn kid also had an asymmetric skull due to apparent fetal positioning. No cleft palates were induced in lambs whose mothers were gavaged with N. glauca plant or anabasine-rich extracts during gestation days 34-41, 35-40, 35-41, 36-41, 35-51, or 37-50. Only one of five lambs born to three ewes gavaged with N. glauca plant material during gestation days 34-55 had a cleft palate, but all five of these lambs had moderate to severe contractures in the metacarpal joints. The slight to moderate contracture defects resolved spontaneously by 4-6 weeks postpartum, but the severe contractures resolved only partially. Embryonic/fetal death and resorption (determined by ultrasound) occurred in 25% of pregnant goats fed N. glauca compared to only 4% of pregnant sheep. Nicotiana glauca plant material contained the teratogenic alkaloid anabasine at 0.175% to 0.23%, dry weight, demonstrating that Spanish-type goats are susceptible to cleft palate induction by the natural toxin anabasine, while crossbred western-type sheep are resistant. However, clinical signs of toxicity were equally severe in goats and sheep, even though maternal alkaloid tolerance was generally lower in sheep. We postulate that an alkaloid-induced reduction in fetal movement during the period of normal palate closure is the cause of the cleft palate and multiple flexion contractures. Teratology 61:203-210, 2000. Published 2000 Wiley-Liss, Inc.

Abnormalities, Drug-Induced↗
PubMed1992

Quantification and localization of ornithine decarboxylase in the embryonic palate.

Ornithine decarboxylase (ODC; EC4.1.1.17), the key enzyme in polyamine biosynthesis, and intracellular polyamines increase rapidly and markedly in tissues and cells that are actively proliferating as well as differentiating and decrease as these processes cease. ODC activity has also been implicated as playing a role in the proliferation and differentiation of cells derived from the developing palate. Ornithine decarboxylase activity was thus quantified and ODC localized in the developing murine palate in vivo. Levels of ODC activity showed little variation during the ontogeny of the palate, averaging 126 pmol CO2/mg protein/hr. When difluoromethylornithine (DFMO), an irreversible inhibitor of ODC activity, was administered to pregnant mice throughout the period of palate development (days 11-14), palatal tissue ODC activity was reduced by 85%. No craniofacial malformations were observed, however. The lack of a teratogenic effect by DFMO treatment could be due to sufficient remaining ODC activity in craniofacial tissue and/or maintenance of intracellular polyamine levels by the activity of a polyamine transport system. The activity of this system was demonstrated by the ability of palatal tissue in vivo to take up radiolabeled putrescine. The presence of a polyamine transport system was previously suggested by the demonstration of such a system in palate mesenchymal cells in vitro. Dramatic temporal and spatial shifts in tissue patterns of immunolocalization for ODC in developing palatal tissue were also seen. Immunostaining for ODC was evenly distributed in oral, nasal, and medial edge palate epithelial cells on day 12 of gestation. The basal aspects of epithelial cells were, however, more intensely stained. Mesenchymal cells exhibited a peri-nuclear immunostaining pattern. On days 12 and 13 of gestation, the staining patterns for ODC in palate epithelial and mesenchymal cells were comparable. On day 14 of gestation, all regions of the palate epithelium, particularly the medial edge epithelia, were immunostained for ODC, whereas the intensity of staining in the mesenchymal cells was significantly reduced. This study represents essential initial observations toward understanding the role that ODC may play in normal craniofacial development.

Animals↗
PubMed2006

Adaptation to an electropalatograph palate: acoustic, impressionistic, and perceptual data.

PURPOSE: The purpose of this study was to evaluate adaptation to the electropalatograph (EPG) from the perspective of consonant acoustics, listener perceptions, and speaker ratings. METHOD: Seven adults with typical speech wore an EPG and pseudo-EPG palate over 2 days and produced syllables, read a passage, counted, and rated their adaptation to the palate. Consonant acoustics, listener ratings, and speaker ratings were analyzed. RESULTS: The spectral mean for the burst (/t/) and frication (/s/) was reduced for the first 60-120 min of wearing the pseudo-EPG palate. Temporal features (stop gap, frication, and syllable duration) were unaffected by wearing the pseudo-EPG palate. The EPG palate had a similar effect on consonant acoustics as the pseudo-EPG palate. Expert listener ratings indicated minimal to no change in speech naturalness or distortion from the pseudo-EPG or EPG palate. The sounds [see text] were most likely to be affected. Speaker self-ratings related to oral comfort, speech, tongue movement, appearance, and oral sensation were negatively affected by the presence of the palatal devices. CONCLUSIONS: Speakers detected a substantial difference when wearing a palatal device, but the effects on speech were minimal based on listener ratings. Spectral features of consonants were initially affected, although adaptation occurred. Wearing an EPG or pseudo-EPG palate for approximately 2 hr results in relatively normal-sounding speech with acoustic features similar to a no-palate condition.

Adaptation, Psychological↗
PubMed2000

Fetal cleft lip and palate detection by three-dimensional ultrasonography.

OBJECTIVES: To demonstrate a standardized approach for the evaluation of cleft lip and palate by three-dimensional (3D) ultrasonography. DESIGN: This was a retrospective study of seven fetuses with confirmed facial cleft anomalies. Post-natal findings were compared to a blinded review of 3D volume data from abnormal fetuses with seven other normal fetuses that were matched for gestational age. Upper lip integrity was examined by 3D multiplanar imaging. Sequential axial views were used to evaluate the maxillary tooth-bearing alveolar ridge contour and anterior tooth socket alignment. Alveolar ridge disruption suggested cleft palate. Premaxillary protrusion, either by multiplanar imaging or surface rendering, indicated bilateral cleft lip and palate. RESULTS: Post-natal findings confirmed bilateral cleft lip and palate (four cases), unilateral cleft lip and palate (one case), and unilateral cleft lip (two cases). Multiplanar review identified all three fetuses with unilateral cleft lip, three of four fetuses with bilateral cleft lip, one fetus with unilateral cleft palate, and three of four fetuses with bilateral cleft palate. Surface rendering correctly identified all cleft lips, with the exception of one fetus, who was thought to have a unilateral cleft lip and palate, despite the actual presence of a bilateral lesion. One cleft palate defect was directly visualized by 3D surface rendering. No false-positives occurred. CONCLUSION: Interactive review of standardized 3D multiplanar images allows one to evaluate labial defects, abnormalities of the maxillary tooth-bearing alveolar ridge, and presence of premaxillary protrusion for detecting cleft lip and palate anomalies. Surface rendering may increase diagnostic confidence for normal or abnormal studies. This technology provides an array of visualization tools that may improve the prenatal characterization of facial clefts, particularly of the palate.

Cleft Lip↗
PubMed1996

In vivo/in vitro studies on the effects of cyclophosphamide on growth and differentiation of hamster palate.

A study was undertaken to examine the effects of cyclophosphamide (CP) on growth and differentiation of palatal tissues. An in vivo/in vitro approach was designed to analyze (1) whether the damage caused by in vivo administration of CP in the developing palate can be altered in vitro, and (2) to determine the effects of CP on the synthesis of collagen and glycosaminoglycan (GAG), which are essential for proper palate development. In addition, effects of vitamin B1 and/or B6 on in vivo modulation of CP teratogenicity was evaluated. Pregnant hamsters were given 30 mg/kg CP or 1 ml saline on day 10 of gestation. Control and CP-treated embryonic palates were dissected on day 11 of gestation and incubated in vitro in the presence or absence of CP. In order to allow metabolic activation of CP in vitro, either a slice of hamster liver or microsomal S9 fraction of liver was added to the culture medium. To study collagen and GAG synthesis, palates were obtained between days 10 and 13 of gestation, and incubated in growth medium supplemented with [14C]proline or [3H]glucosamine, as appropriate. The rates of collagen and GAG synthesis were determined. The results showed that, in the controls, the presence of a liver slice or S9 fraction in the culture medium had no effects on in vitro closure of palate. In vivo CP exposed palates did not fuse in vitro. When drug was given in vitro, or both in vivo and in vitro, palatal closure did not occur. CP reduced synthesis of both collagen and GAG in the vertically developing palate. The drug-treated shelves reoriented only after the rates of collagen and GAG synthesis were restored to the levels comparable to the control counterparts. Co-administration of vitamin B1 and B6 did not interfere with the teratogenicity of CP. It was suggested that CP treatment affected DNA synthesis and injured growing cells, which in turn reduced the synthesis of GAG and collagen and affected the expansion of shelf volume to delay the reorientation of the palatal shelves. Furthermore, it appears that in vivo treatment with CP changes the programming of palatal tissues to prevent the fusion process in vivo, which could not be altered in vitro.

Animals↗
PubMed1995

Cumulative operative procedures in patients aged 14 years and older with unilateral or bilateral cleft lip and palate.

Sixty-seven consecutive patients over the age of 14 with either unilateral (n = 38) cleft lip and palate or bilateral (n = 29) cleft lip and palate seen over a 15-month period at the University of Michigan Craniofacial Program were reviewed to determine the total number of surgical procedures performed over the course of treatment. The demographics of the two groups differed: There were 25 males and 13 females who were a mean age of 17 years and 9 months with unilateral cleft lip and palate and 23 males and 6 females who were a mean age of 18 years and 5 months with bilateral cleft lip and palate. Lip and palate repairs were carried out on all patients. Lip adhesions were performed in 29 and 62 percent; pharyngoplasties (either pharyngeal flap or modified Ortichochea) in 39 and 38 percent; alveolar bone grafts in 82 and 79 percent; Abbé flaps in 0 and 10 percent; and orthognathic surgery was done in 10.5 and 13.8 percent and recommended and/or done in 26 and 24 percent of patients with unilateral cleft lip and palate and bilateral cleft lip and palate, respectively. Lip revisions averaged 1.13 and 2.17 per patient and secondary nasal surgeries averaged 1.13 and 1.18 per patient in the unilateral cleft lip and palate and bilateral cleft lip and palate, respectively. All totaled, the average number of operations was 6.12 per patient (range 3 to 12) in the unilateral cleft lip and palate and 8.04 per patient (range 5 to 15) in the bilateral cleft lip and palate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Delayed detection of cleft palate: an audit of newborn examination.

AIMS: To identify prevalence of delayed detection of cleft palate, and associated factors that could lead to improved identification at neonatal clinical examination. METHODS: Audit of hospital notes, parental questionnaire incorporating open ended questions, and telephone questionnaire of junior doctors in the referring hospitals incorporating fixed choice questions. RESULTS: Of 344 cleft palate patients without cleft lip or submucous cleft palate, the day the cleft was detected was recorded in 92%. Delayed detection, after the first day, was 28% overall, distributed as 37% with isolated cleft palate and 23% with syndromic cleft palate. Narrow V shaped clefts were more likely to be delayed in detection compared with broad U shaped clefts, as were soft palate clefts compared with hard palate clefts. Five with isolated cleft palates were not detected until after the first year. Babies born at home were unlikely to be detected on day 1. Symptoms were significantly increased in the delayed detection group for feeding problems and nasal regurgitation. A telephone questionnaire of trainee paediatricians in referring units revealed that digital examination was more commonly practised than visual inspection, and few recalled receiving specific instruction on examination of the palate. CONCLUSION: Delayed detection of cleft palate was not uncommon, and the features of those more likely to be missed suggested digital examination was related. Trainee doctors and midwives should be instructed to inspect visually using a light and tongue depressor, then digitally if submucous cleft palate is suspected.

Abnormalities, Multiple↗
PubMed1988

Palate development.

In all vertebrates, the secondary palate arises as bilateral outgrowths from the maxillary processes. In birds and most reptiles, these palatal shelves grow initially horizontally, but do not fuse with each other resulting in physiological cleft palate. In crocodilians, shelf fusion occurs resulting in an intact secondary palate. Mammalian palatal shelves initially grow vertically down the side of the tongue, but elevate at a precise time to a horizontal position above the dorsum of the tongue and fuse with each other to form an intact palate. Palatal shelf-elevation is the result of an intrinsic shelf elevating force, chiefly generated by the progressive accumulation and hydration of hyaluronic acid. In all vertebrates the nasal epithelium differentiates into pseudostratified ciliated columnar cells and the oral epithelia differentiates into stratified squamous cells, but the medial edge epithelial (MEE) phenotype differs in different groups. In mammals, the MEE of opposing shelves adhere to each other to form an epithelial seam which then disrupts by cell death and cell migration into the mesenchyme accompanied by an epitheliomesenchymal transformation. In birds, the MEE keratinize resulting in cleft palate whereas, in alligators, the MEE migrate onto the nasal aspect of the palate. In all vertebrates, this regional, temporal and species-specific epithelial differentiation is specified by the underlying mesenchyme. Signalling of this interaction is complex but involves both extracellular matrix and soluble factors e.g. minor collagen types, tenascin, EGF, TGF alpha, TGF beta, PDGF, FGF. These soluble growth factors have a biphasic effect: directly on the epithelia and on the mesenchyme where they stimulate or inhibit cell division and synthesis of specific extracellular matrix molecules. The extracellular matrix molecules (and bound growth factors) synthesized by the mesenchymal cells may then directly affect the epithelium. These signals cause differential gene expression via second messenger systems e.g. cAMP, cGMP, Ca2+, pH, pI etc. Molecular markers for nasal, medial and oral epithelial cell differentiation include the types of cytokeratin intermediate filaments and specific cell surface molecules recognized by monoclonal antibodies: the genes for such molecules are probably expressed in response to mesenchymal signals. Using such an approach, it is possible to go from a morphological description of palate development to a cellular analysis of the mechanisms involved and then to identification of candidate genes that may be important for screening and diagnosis of cleft palate.

Animals↗
PubMed1997

The thickness of masticatory mucosa in the human hard palate and tuberosity as potential donor sites for ridge augmentation procedures.

The aim of the present investigation was to clinically determine the thickness of masticatory mucosa in the hard palate and tuberosity as potential donor sites for ridge augmentation procedures. In 31 periodontally healthy, fully dentate subjects the masticatory mucosa thickness was assessed by bone sounding with a periodontal probe. Eighteen standard measurement points were defined in the hard palate, located on 3 lines which ran at different distances parallel to the gingival margin. Six positions were designated on each of these 3 lines between the level of the canine and the second molar. In the tuberosity, 6 standard measurement points were defined, located on 2 lines running parallel to the gingival margin at 2 different distances from the distal aspect of the second molar. Three positions were designated on each line. The hard palate and tuberosity were anesthetized by a spray followed by carticain injection with an epinephrine vasoconstrictor of 1:100,000. Data were analyzed to determine differences in gender, between different positions, and between lines, using an analysis of variance and Wilcoxon test. The mucosa of the tuberosity was significantly thicker than in the hard palate region. Gender did not influence the thickness of masticatory mucosa, either in the hard palate or the tuberosity with the exception of the most distant line in the palate. The mucosa was thickest at the mid-distal position of the tuberosity. In the hard palate, mucosa thickness increased with greater distances from the marginal gingiva. The mucosa over the palatal root of the maxillary first molar was significantly thinner than at all other positions in the hard palate. This represents an anatomical barrier in graft harvesting. It was concluded that two different regions may be defined for soft tissue graft harvesting from an anatomic point of view: 1) In the canine-premolar region rather wide and shallow grafts may be harvested. This region extends distally to the first palatal molar root with a significantly thinner mucosa. 2) The tuberosity revealed a significantly more soft tissue thickness in comparison to the hard palate. This region allows the harvesting of deeper grafts, but graft size is limited by the width of keratinized tissue.

Adult↗
PubMed2006

Connective tissue graft for gingival recession treatment: assessment of the maximum graft dimensions at the palatal vault as a donor site.

BACKGROUND: The palatal masticatory mucosa is widely used as a connective tissue donor site in gingival recession treatment. However, concern has been raised regarding the potential risk of damaging the greater palatine artery (GPA) due to anatomical variations in the palatal vault. The anatomy of the palatal vault in terms of size and shape may affect the maximum dimensions of the graft that can be safely taken from the palatal vault. In a cohort of patients free of periodontal disease, the purpose of this study was to assess the maximum dimensions of the graft, particularly the height and length, that could be safely taken from the palatal vault. METHODS: Plaster impressions were made from 198 patients free of periodontal disease. Because the connective tissue graft is usually taken from an area extending from the mid-palatal aspect of the canine to the mid-palatal aspect of the second molar, this interval was measured and represented the maximum length dimension. The emergence of the GPA was assumed to be localized at the junction of the vertical and horizontal palatal walls of vault, and its course was marked on the plaster casts. The maximum height of the graft corresponded to the distances measured from the gingival margin to the marked course of the GPA of each tooth at its interproximal and mid-palatal aspects. RESULTS: The length of the maximum available tissue graft was 31.7 +/- 4.0 mm. The distance extending from the gingival margin to the greater palatine artery ranged from 12.07 +/- 2.9 mm at the canine level to 14.7 +/- 2.9 mm at the mid-palatal aspect of the second molar level. Therefore, in the premolar area, it was possible to harvest a connective tissue graft measuring 5 mm in height in all cases and 8 mm in height in 93% of cases. CONCLUSION: Our findings suggest that the maximum available tissue graft as measured in the palatal vault was large enough to allow a safe withdrawal from this donor site in a high percentage of our patient population free of periodontal disease.

Adult↗