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PubMed2002

Cleft lip and palate incidence among the live births in the Republic of Korea.

We present an epidemiologic study of cleft lip and palate in the Republic of Korea from January 1, 1993 through December 31, 1993. In 1993, the number of total live births was 715,817. And from 1993 through 1995, a total of 1,293 new patients with cleft lip and palate who were born in 1993 were identified. The incidence of cleft lip and palate was 1.81 per 1000, that is, 1 per 554 live births. The cleft lip: cleft lip and palate: cleft palate alone ratio was 1.13:1:1.19. The male: female ratio was 2.1:1 in the cleft lip group, and 2.5:1 in the cleft lip and palate group. We could detect a male predominance in both groups. In contrast, the ratio was 0.95:1 in the cleft palate group. The left: right: bilateral ratio was 1.9:1:0.23 in cleft lip group, and the ratio was 2.2:1:1.1 in the cleft lip and palate group. This is the first nation-wide study to provide detailed data on the incidence of cleft lip and palate in the live births in the Republic of Korea.

Cleft Lip↗
PubMed2006

The premaxillary triangle: clue to the diagnosis of cleft lip and palate.

OBJECTIVE: The prenatal detection rate of cleft lip and palate is low, especially in low-risk patients who undergo targeted sonography. The reason is that evaluating surface anatomy is relatively difficult and requires operator expertise. Our purpose was to describe a technique to improve the diagnostic accuracy of facial clefts (lip and palate) and to assess the feasibility of including this technique as part of standard protocol during targeted imaging. METHODS: A prospective study was done during 2000 through 2002 to evaluate the accuracy of the "premaxillary triangle (PMT) sign": a new sign to diagnose unilateral cleft lip and palate in women referred for prenatal sonography at our center. Patients with only isolated unilateral cleft lip and palate and cleft lip were included in this study. Before this, all examiners were trained to image the PMT. The images were reviewed by a senior consultant. It was later decided to include this sign as part of the protocol of targeted sonography done between 18 and 22 weeks in our institution. However, depending on the fetal position, the PMT was documented even in patients referred for the first time in late second and third trimesters. RESULTS: Twenty-nine cases of isolated facial clefts were diagnosed during the study period, of which 2 had unilateral cleft lip and 27 had unilateral cleft lip and palate. The PMT sign was absent in all cases of unilateral cleft lip and palate but was present in 2 cases of isolated cleft lip without cleft palate. CONCLUSIONS: The PMT sign can be easily incorporated into targeted sonography at 18 to 22 weeks' gestation. Its inclusion would help in increasing the detection rate of unilateral cleft lip and palate. It may also be potentially used for differentiating between isolated cleft lip and cleft lip and palate, which helps in better prenatal counseling.

Cleft Lip↗
PubMed2000

Bulging medial edge epithelial cells and palatal fusion.

The surface of the medial edge epithelium of embryonic day 12, 13 and 14 mouse palatal shelves was observed utilising Environmental Scanning Electron Microscopy (ESEM). This technique offers the advantage of visualisation of biological samples after short fixation times in their natural hydrated state. Bulging epithelial cells were observed consistently on the medial edge epithelium prior to palatal shelf fusion. Additionally, we have used ESEM to compare the morphology and surface features of palatal shelves from embryonic day 13 to 16 mouse embryos that are homozygous null (TGF-beta3 -/-), heterozygous (TGF-beta3 +/-) or homozygous normal (TGF-beta3 +/+) for transforming growth factor beta-3 (TGF-beta3). At embryonic day 15 and 16 most TGF-beta3 +/- and +/+ embryos showed total palatal fusion, whilst all TGF-beta3 null mutants had cleft palate: the middle third of the palatal shelves had adhered, leaving an anterior and posterior cleft. From embryonic day 14 to 16 abundant cells were observed bulging on the medial edge epithelial surface of palates from the TGF-beta3 +/- and +/+ embryos. However, they were never seen in the TGF-beta3 null embryos, suggesting that these surface bulges might be important in palatal fusion and that their normal differentiation is induced by TGF-beta3. The expression pattern of E-Cadherin, beta-catenin, chondroitin sulphate proteoglycan, beta-Actin and vinculin as assayed by immunocytochemistry in these cells shows specific variations that suggest their importance in palatal shelf adhesion.

Actins↗
PubMedDate not supplied

Secalonic acid D alters the expression and phosphorylation of the transcription factors and their binding to cAMP response element in developing murine secondary palate.

Secalonic acid D (SAD), a cleft palate-inducing mycotoxin, reduces palatal cyclic AMP (cAMP) levels. cAMP relays its signals via the transcription factors (TF) such as cAMP response element (CRE) binding protein (CREB), CRE modulator (CREM) and activator transcription factor-1 (ATF-1) to CRE-containing genes. These studies tested the hypothesis that these TF are present and functional in the developing palate and that SAD alters their expression and function along with that of the CRE-containing gene, proliferating cell nuclear antigen (PCNA). Electrophoretic mobility shift assays (EMSA), using nuclear extracts of control and SAD-treated developing palate tissues and 32P-labeled CRE revealed the formation of a DNA-protein complex. Supershift/ablation assays with TF antibodies showed the presence of CREB, CREM and another unidentified TF but not ATF-1 in the complex. Western analyses of the DNA-protein complex from preparative EMSA revealed increased binding of CREB to CRE in direct correlation with increase in phospho-CREB (pCREB) in the controls. Exposure to SAD significantly reduced CREB binding throughout palate development. This was in correlation with reductions in pCREB levels on gestational day (GD) 13 and 14 palates. On GD 12, however, SAD dramatically increased CREB phosphorylation. The ontogeny of palatal CREB and CREM (several isoforms) expression remained unchanged in controls whereas SAD increased that of the repressor isoform of CREM. The expression of PCNA was inhibited by SAD on GD 12. These results show that the cAMP signaling pathway is functional in the palate and that SAD alters CREB phosphorylation and inhibits its binding to CRE. leading to altered expression of genes involved in cell proliferation, an event critical for normal palate development.

Animals↗
PubMed2001

[Applied anatomical study of blood supply in human palate].

OBJECTIVE: To investigate the origins and distributions of palatal vasculature and the three dimensional architecture. METHODS: Materials consisted of 14 normal and 10 cleft palate head-and-neck specimens. After vascular infusion, specimens were seprately analysed by stereomicroscopy, radiography, histological study and scanning electron microscopy. RESULTS: The greater palatine artery was the main vessel to supply the hard palate and the ascending palatine artery provided the principal supply of soft palate. The branches of greater palatine artery formed abundant anastomoses with the neighbor vessels. The ascending palatine artery divided into two branches in the soft palate. The artery branches in hard palate took on tree-like appearance and were arranged parallel. The capillary network was loosely packed. Whereas, the arteries in soft palate were always found to be crooked. The angles of the branches from the main trunk were changeable. The capillary network was packed densely. The vascular origins and courses of the cleft palate specimens were the same as the normal person, but the distributions and anastomoses were different. CONCLUSIONS: The blood supplies of hard and soft palate come from different vascular vessels and their vascular architectures have their own character.

Child, Preschool↗
PubMed2000

Teratological effect of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD): induction of cleft palate in the ddY and C57BL/6 mouse.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), a highly toxic halogenated aromatic hydrocarbon, is a teratogen to induce cleft palate when exposed during the pregnancy. There are inter-strain differences in the sensitivity to cleft palate induced by TCDD and other chemicals including polychlorinated terphenyls (PCTs). The C57BL/6 mouse and the ddY mouse had been shown to be different in the induction of cleft palate following the treatment of PCTs, which attempts us to evaluate the TCDD-induced cleft palate in two mouse strains to understand the mechanism through which TCDD and PCTs induce cleft palate. This study evaluated the induction of cleft palate in the fetuses of ddY and C57BL/6 mice after subcutaneous treatment of TCDD on gestation day (GD) 10.5-14.5 or oral treatment on GD 8.5-13.5. Our results clearly showed that ddY mice, a susceptible strain to PCTs-induced cleft palate, are resistant to the induction of cleft palate by TCDD comparably to the high susceptibility of C57BL/6 mice, suggesting a different teratological mechanism between TCDD and PCTs. In addition, at the low doses, our study supported the concept of "window effect" of TCDD on around GD 12 for the induction of cleft palate in C57BL/6 and ddY mice.

Administration, Oral↗
PubMed2004

Palatal and dental arch morphology in Down syndrome.

The analysis of palatal vault morphology and maxillary dental arch shape was carried out in the sample of 42 Down syndrome (DS) patients with trisomy 21. The data were compared to those of healthy controls from the same population matched for age and sex. Palatal morphology and upper dental arch shape were studied on hard plaster casts of the patients and controls. No sexual dimorphism in palatal and dental arch shape was observed in DS and controls. Normal palatal shape was more frequent in controls than in DS subjects (52.38% vs. 28.57%; p < 0.05). DS patients displayed significantly higher frequency of shelf-like or "stair palate" (38.1%) than controls (11.9%) (p < 0.02). The younger age group (3-14 year) showed much higher frequency of "stair palate" than controls (26.19% vs. 2.38%; c2 = 9.72; p = 0.003). The older group of DS patients did not show increased frequency of such shape of the palatal vault. There was no significant difference in dental arch shape between DS patients and controls. High frequency of shelf-like palate in DS subjects is decreasing by age. The obtained results indicate that palatal vault morphology is subjected to the age related changes. These changes can be attributed to the growth of caraniofacial structures and increased tonus of tongue and other orofacial muscles.

Adolescent↗
PubMed2005

[CT diagnosis of palatal malignant tumors].

To investigate CT features of palatal malignant tumors and to evaluate, CT diagnostic value. CT manifestations of 32 cases of palatal malignant tumors were analyzed retrospectively. All cases were confirmed by pathology. There were 27 males and 5 females between 23 and 80 years of age. Axial contrast enhancement CT scan was performed in all cases, among them, nonenhancement CT scan was also performed in 8 cases and coronal CT scan was performed in 2 cases. The main signs of palatal malignant tumors were as follows: (1) Masses in palate in 26 cases, thickened palatal soft tissue in 6 cases and destruction of palate bone in 8 cases. The lesions were located in soft palate in 22 cases, in hard palate in 4 cases, and in the junction region between soft and hard palate in 3 cases; (2) Other adjacent structures and organs were involved in 27 cases; (3) Lymph nodes of neck metastasis were demonstrated in 17 cases. CT is an excellent technique, which can show the gross pathologic features and the invasion pathway of palatine malignant tumors, and it can provide some important information for the relevant clinical treatment and prognosis.

Adult↗
PubMed1988

In vitro differentiation of the Japanese quail secondary palate.

Differentiation of the Japanese quail secondary palate was studied in vitro. Results indicated that the medial edge epithelia (MEE) of quail were capable of full differentiation in vitro from a very early age. In contrast to in vitro mammalian palatal development, the quail palatal processes never fused. The cells of the MEE in the quail continued to divide, and the cyclic adenosine monophosphate (AMP) levels in the quail palatal tissues remained constant during development. In contrast to in vitro differentiation of MEE in the chick palate, the quail palatal MEE differentiated to parakeratinized epithelium. The results suggest that: (1) the programming of events of MEE differentiation in birds is different from that in mammals, (2) intraspecies differences in the MEE biology of chick and quail palate are intrinsic to the palate, not the environment, and (3) an inverse relationship between the levels of cyclic AMP and the synthesis of DNA in the MEE may exist during secondary palate development, which in turn may regulate the fate of the MEE in birds and mammals.

Animals↗
PubMed1979

A comparison of intelligence and social maturity in children with unilateral complete clefts and those with isolated cleft palates.

Intelligence and social development were evaluated in 226 subjects with palatal clefts. The subjects were divided into four groups composed of 111 with unilateral complete clefts of the lip and palate (Unilateral Group); 16 with unilateral complete clefts with associated congenital malformations (Unilateral-C Group); 76 with clefts of the palate only (Palatal Group; and 39 with clefts of the palate only with other congenital malformations (Palatal-C Group). Comparisons among groups suggested that subjects in the Unilateral Group were most competent both mentally and socially followed by those in the Palatal, Unilateral-C, and Palatal-C Groups. The presence of congenital abnormalities other than cleft increased the risk of developmental disabilities, particularly in subjects with isolated palatal clefts.

Child↗
PubMed1985

Timing cleft palate closure--age should not be the sole determinant.

Attainment of normal speech, facial and palatal development, and dental occlusion is possible without compromising one objective for another. Although speech development may benefit from early palatal closure, there are instances when cleft closure should be postponed to a later age to permit conservative palatal surgery. Increase in palatal size with the spontaneous narrowing of the cleft space can occur early, late, or not at all, and, in rare instances, the cleft may even widen. Nonphysiological surgery causes facial and palatal maldevelopment by extensive undermining and displacement of mucoperiosteum, fracture of bone, or destruction of blood supply. To avoid these consequences, timing of palatal closure should be related to the anatomical and functional assets in the individual and not determined by age alone. Serial studies of 36 unilateral (UCLP) and 29 bilateral (BCLP) cleft lip and palate cases with good speech demonstrated that conservative palatal surgery is conducive to good speech as well as palate and facial development. Speech appliances may be necessary as an interim device after 2 years of age.

Age Factors↗
PubMed1980

The influence of simultaneous cleft lip and palate repair on facial growth in rabbits.

This study was designed to test the influence of simultaneous cleft lip and palate repair on facial growth in rabbits. Three groups of rabbits were used. Group I consisted of control rabbits who had no surgery; Group II had surgically created, but unrepaired, clefts of the lip, alveolus, and palate; and Group III had surgically created clefts of the lip, alveolus, and palate followed by immediate simultaneous lip and palate repair. In Group III, the lip was repaired using the Millare technique and the palate using two-flap palatoplasty, leaving no bare bone exposed. All animals were sacrificed after twenty weeks. Results of the direct cephalometry of the skulls confirmed that simultaneous lip and palate repair results in inhibition of anterior-posterior and transverse maxillary growth. Some significant changes were also found in mandibular length and nasal deflection. All 15 rabbits with simultaneous cleft lip and palate repair developed anterior crossbites and functional shifts to the left or cleft side. Further analysis comparing the results of facial growth inhibition in this study with inhibition following lip repair only or palate repair only will be necessary to assess the severity of secondary maxillo-facial deformities resulting from lip and palate repair.

Animals↗
PubMed1995

The distribution of PDGFs and PDGF-receptors during murine secondary palate development.

The distribution of the 2 homodimer isoforms of platelet-derived growth factor (PDGF)-AA and -BB, and their receptors (PDGF alpha-receptor and PDGF beta-receptor) were mapped immunocytochemically during the development of the embryonic mouse secondary palate, from embryonic day (E) 12 to E15. The staining patterns of PDGF-AA/alpha-receptor and PDGF-BB/beta-receptor are different. Generally, the former is present and the latter is sparse/absent during the period of palate development. The localisations of PDGF-AA and alpha-receptor are more intensive in the epithelia than in the mesenchyme, and change temporally during palatal shelf elevation, midline epithelial seam formation and disruption. Before the palatal shelf has elevated (E13), PDGF alpha-receptor is present in the palatal mesenchyme, nasal and medial edge epithelia (MEE), whilst PDGF-AA stains lightly in the palatal epithelia. During palatal midline epithelial seam formation and following its degeneration throughout E14, PDGF-AA and PDGF alpha-receptor were intensively colocalised in the nasal and midline seam epithelia. These findings indicate that the interaction between PDGF-AA and its receptor may participate in palate development, particularly in regulating palatal midline epithelial seam formation and degeneration.

Amino Acid Sequence↗
PubMed1993

[Hard palate shape in the Japanese and Indian children on moiré topography with lateral movement of a grating].

In the present study, the hard palate of Japanese and Indian children was investigated. These children lived in different geographical areas and have different cranial characteristics, pronunciation and eating habits. Fifty-one Japanese children (26 boys and 25 girls, 3 years of age) and 66 Indian school children (31 boys and 35 girls, 5-7 years of age). The maxillary negative cast models were observed and three-dimensional measurements were taken of the hard palate with moiré Topography. The following results were obtained. 1. The palatal width and length in Japanese children was larger than the Indian children, but not in palatal height. The palatal height was significantly larger in the Indian children than in the Japanese children. 2. Observation of the moiré fringes on the deepest palate by moiré Topography shows that the Japanese children and Indian girls have a higher incidence of Crosswise type than Lengthwise type. The Indian boys have a slightly higher incidence of Lengthwise type than Crosswise type. The girls have a higher incidence of the Butterfly and Separate types than the boys. 3. The anteroposterior location on the deepest palate by moiré Topography: the Japanese children have significantly higher incidences of anterior location than the Indian children. Changes of anteroposterior location between the ages of 5 and 7 in the Indian children: the prevalence of posterior location appears to increase with age. 4. The hard palate shapes of the Japanese children appear to be broad and shallow, but those of the Indian children appear to be narrow and deep. This difference appears to be more remarkable in the boys. The shape and size of the hard palate appears to be due to genetic differences, in addition to the weather conditions, pronunciation and eating habits.

Anthropometry↗
PubMed1996

[Middle ear function in children with cleft palate].

Middle ear problems in patients with cleft palate have for a long time received insufficient attention. The present study was designed to evaluate middle ear function in 56 children with cleft palate and in a control group of 50 children without cleft palate. The age ranging between 5 and 14 years was similar in both groups. All children underwent routine otoscopic examinations of ear, nose and throat, and were also examined using the Madsen acoustic impedance audiometer. Four major parameters (static compliance, middle ear pressure, acoustic stapedius reflex and Eustachian tube function) were analyzed. It was found that the negative middle ear pressures were higher and the static compliance, which reflected the elasticity of the conducting mechanism of the middle ear, was poorer in children with cleft palate than in the controls. The proportion of children with cleft palate who showed the presence of the acoustic stapedius reflex was also lower than in the control children. Children with cleft palate have a limited ability to actively open the Eustachian tube by swallowing, as evidenced by a poor ability to equilibrate applied positive or negative middle ear pressure. A multidisciplinary approach should be adopted for the complete overall rehabilitation of children with cleft palate. Plastic surgeons to whom most of the treatment is entrusted should be concerned not only with achieving palatal function and acceptable speech, but also with the various other problems associated with cleft palate, especially those affecting the middle ear.

Abnormalities, Multiple↗
PubMed1984

Prenatal repair of experimentally induced clefts in the secondary palate of the rat.

A refined technique of amniotic sac puncturing at day 16.2 (i.e., 16 + 2/10 days) of gestation was employed in order to produce a series of total clefts and rare forms of partial clefts in Sprague-Dawley rat fetuses. From a total of 410 fetuses of a precise, individually determined age, 95 upper jaws were examined in the scanning electron microscope and, in part, in serial Epon sections. All fetal heads were examined macroscopically. Total clefts were found in 48.9% of a total of 184 viable rat fetuses examined at day 17.8 of smear age and in 21.8% of a total of 211 fetuses examined at day 19.3. Partial clefts were observed in 14.1% and 18.5% of fetuses at days 17.8 and 19.3 of smear age, respectively. At day 19.3, 16.1% of the viable fetuses showed a very inconspicuous, small abnormality (with residual clefting and incomplete fusion with the nasal septum) in the region of the palatine foraminae. Morphological observations suggested that under conditions of detained palatal closure (1) fusion of the soft palatal shelves commences independently from and prior to fusion of the hard palate, (2) delayed palatal shelf fusion proceeding in the anterior direction may occur with or without remaining sickle-shaped clefts in the anterior hard palate, and (3) in fetuses with small sickle-shaped clefts, fusion of the palatal shelves with the nasal septum does not occur. The present data imply that an almost total prenatal repair and delayed closure of the secondary palate may occur in rats that, at day 16.2 of multiple analysis age, most certainly had a total palatal cleft resulting from tongue resistance.

Amniocentesis↗
PubMed1997

Three-dimensional morphometric analysis of the effects of subperiosteal palatal soft-tissue expansion in growing cats.

A prospective longitudinal study in 75 growing cats was conducted to evaluate palatal soft-tissue expansion in cleft lip and palate surgery. In 31 cats, palatal scars were induced by simulated Langenbeck surgery at the age of 8 weeks. At the age of 14 weeks, custom-made tissue expanders were inserted in 61 animals. Tissue expansion was performed by weekly inflation in 33 cats (16 without and 17 with scars) for an 8-week period. The remaining 28 cats (14 without and 14 with scars) served as sham groups. A control group was formed by 14 animals (without scars and without tissue expander). The effects of the experimental interventions were evaluated on a series of dental casts during the inflation period and until 8 weeks after removal of the tissue expander. The results indicate that soft-tissue expansion of the palatal mucoperiosteum is feasible. Until 20 weeks of age, no differences were found between both expansion and sham groups. Thereafter, significant soft-tissue surface-area gain was quantified in relation to the base surface and base diameter of the tissue expander. Iatrogenic side-effects of active tissue expansion consisted of significant transversal growth retardation in the anterior part of the bony palate and dentoalveolar structures. After removal of the tissue expanders, some accelerated growth in the tissue-expansion, scarred-tissue group was seen. It is concluded that palatal soft-tissue expansion is possible in growing cats, with and without the presence of palatal scars; however, this technique, like other kinds of palatal surgery, impairs dentomaxillary growth and development.

Age Factors↗
PubMed1999

The incidence of cleft lip and palate deformities in the south-east of Scotland (1971-1990).

This retrospective study reports the incidence of infants born with the cleft lip and palate anomaly within the Edinburgh Cleft Units catchment area, between 1 January, 1971, and 31 December, 1990. The importance of accurate data collection for local, regional, and national data bases is discussed with reference to the recent CSAG report on cleft lip and palate services in the UK. Five-hundred-and-two cleft lip and palate patients were identified (291 males, 211 females). The incidence is reported as 1.4 per 1000 live births (1 in 711). Twenty-five per cent of clefts affected the primary palate, 45 per cent affected the secondary palate, and the remaining 30 per cent were clefts of both the primary and secondary palate. Overall, a higher percentage of males were affected (58 per cent males to 42 per cent females). Clefts of the secondary palate, however, were more common in females (56 per cent females to 44 per cent males). Data presented in this study is similar to that previously reported from UK centres. It is suggested the accuracy of the UK cleft lip and palate data collection needs to be improved. Prospective data collection in a standardized format carried out on a national basis has to be a priority as recommended by the CSAG report.

Catchment Area, Health↗