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Potentiation of triamcinolone-induced cleft palate in mice by maternal high dietary fat.

This study investigated whether the current range in dietary fat levels, which has arisen partly in response to some major health concerns, would affect frequency of congenital anomalies if continued into the period of early pregnancy. The effect of 5.6%, or 48% of calories from fat in the maternal diet, was tested on pregnant strain CD-1 mice injected with triamcinolone in doses of 0.01 mg, 0.02 mg, 0.04 mg, or 0.06 mg per day on days 11 through 14 of gestation. Frequency of cleft palate increased with increasing doses of triamcinolone, with clefts of the palate being rare at the two lower doses. No clefts appeared without triamcinolone on either diet. In combination with triamcinolone treatment, 226 fetuses exposed to a maternal low fat diet had normal palates and 86 had cleft palates. With exposure to high fat, 186 fetuses had normal palates and 101 had cleft palates, which was a significant increase in clefting (p < 0.05). Also, the latter group showed a greater degree of retardation in palate development (p < 0.05). Thus both a greater frequency and a more severe form of clefting support the conclusion that high dietary fat potentiated the cleft palate-producing effects of triamcinolone in mice.

Animals↗

Ultrasound antenatal diagnosis of cleft palate by a new technique: the 3D "reverse face" view.

OBJECTIVE: To assess the clinical value of a novel three-dimensional (3D) ultrasound technique, the reverse face view (3D RF view), in the antenatal categorization of facial clefting and in particular clefting of the hard palate. METHODS: Eight cases of suspected orofacial clefting were examined by 3D surface rendering. The fetal lips and alveolar ridge were examined in the frontal plane and the face was then rotated through 180 degrees on the vertical axis to examine the secondary palate by the 3D RF view. RESULTS: In each case described, we were able to visualize the fetal face, lips and palate and make an antenatal diagnosis as to whether the palate was affected. In all cases, the antenatal diagnosis was subsequently confirmed. In one case with a left-sided cleft in the lips and alveolar ridge and an intact hard palate, the correct diagnosis was made but a cleft in the soft palate was missed. CONCLUSION: Although clefts of the lips and alveolar ridge are readily diagnosed on high-quality antenatal ultrasound, visualization of the fetal palate using existing techniques is unreliable. In the patients described here, the 3D RF technique allowed relatively straightforward assessment of the fetal palate with a high degree of accuracy.

Cleft Lip↗

Medial edge epithelial cell fate during palatal fusion.

To explain the disappearance of medial edge epithelial (MEE) cells during palatal fusion, programmed cell death, epithelial-mesenchymal transformation, and migration of these cells to the oral and nasal epithelia have been proposed. However, MEE cell death has not always been accepted as a mechanism involved in midline epithelial seam disappearance. Similarly, labeling of MEE cells with vital lipophilic markers has not led to a clear conclusion as to whether MEE cells migrate, transform into mesenchyme, or both. To clarify these controversies, we first utilized TUNEL techniques to detect apoptosis in mouse palates at the fusion stage and concomitantly analyzed the presence of macrophages by immunochemistry and confocal microscopy. Second, we in vitro infected the MEE with the replication-defective helper-free retroviral vector CXL, which carries the Escherichia coli lacZ gene, and analyzed beta-galactosidase activity in cells after fusion to follow their fate. Our results demonstrate that MEE cells die and transform into mesenchyme during palatal fusion and that dead cells are phagocytosed by macrophages. In addition, we have investigated the effects of the absence of transforming growth factor beta(3) (TGF-beta(3)) during palatal fusion. Using environmental scanning electron microscopy and TUNEL labeling we compared the MEE of the clefted TGF-beta(3) null and wild-type mice. We show that MEE cell death in TGF-beta(3) null palates is greatly reduced at the time of fusion, revealing that TGF-beta(3) has an important role as an inducer of apoptosis during palatal fusion. Likewise, the bulging cells observed on the MEE surface of wild-type mice prior to palatal shelf contact are very rare in the TGF-beta(3) null mutants. We hypothesize that these protruding cells are critical for palatal adhesion, being morphological evidence of increased cell motility/migration.

Animals↗

Palate morphogenesis. VI. Identification of stellate cells in culture.

Mesenchymal cells from the palate of mouse embryos at day 14.5 of gestation produce a minor population of stellate cells in culture. These cells are often bipolar and spindle-shaped with long cytoplasmic processes similar to neural-crest cells. Culturing of explants of palatal mesenchyme enriched for this type of cell. Stellate cells were the first to migrate from explants, followed by fibroblast-like cells and then by squamous cells. The majority of the cells in the explant were fibroblast-like. Squamous cells were present mostly in the anterior and mid-palate and least frequently in those from the posterior palate. They may represent tooth-germ epithelium. When pieces of palate were dissected out and cultured for enrichment of non-muscle contractile systems, most of the migrating cells were stellate. These may represent the highly migratory cells that are, in part, responsible for elevation of the palate shelf. Serotonin was measured in cultured mesenchymal cells from the palate. Its occurrence is consistent with regulation of movement of palate cells.

Animals↗

[Speech outcome after simple and multiple cleft palate operations].

OBJECTIVES: If the primary palatal closure in a patient with cleft lip and palate is unsuccessful, defects such as palatal fistulas and a short velum have to be corrected by secondary operations. It is an informal belief among surgeons that these reoperations can have detrimental effects on the patients' nasal resonance and articulation. It was our aim to critically evaluate the validity of this belief. MATERIAL AND METHODS: One hundred and twenty-four patients with cleft lip and palate were divided into three groups. The 70 patients in group 1 had only undergone a primary palatal closure operation. The 33 patients in group 2 had undergone one or more palatal reoperations. The 21 patients in group 3 had undergone an additional pharyngeal flap operation. Resonance and articulation were evaluated perceptually. Nasalance was assessed with the NasalView system, and the mean speech rate was analyzed with the MODIAS software. RESULTS: There were no significant differences for any of the speech measures between groups 1 and 2. Patients in group 3 had significantly worse results for all speech measures. CONCLUSIONS: The speech outcomes for patients with multiple palatal reoperations were no different from those of patients with single palatal closure operations. The pharyngeal flap operation did not lead to sufficient improvements in the speech of the patients in group 3.

Adolescent↗

Oral language characteristics of adult cleft-palate speakers compared on the basis of cleft type and sex.

Several language measures were administered to 103 cleft-palate adults and analyses were carried out with the subjects classified according to type of cleft (cleft palate only, unilateral cleft lip and palate, bilateral cleft lip and palate) and sex. Between-group differences according to cleft type and sex indicate that patients with cleft lip and palate have better speech and language skills than the cleft-palate-only groups. The results of this study also suggest that females have more complete sentence structure than male cleft-lip and palate subjects. Appropriate habilitative measures should continue through later ages until the cleft-palate individuals gain acceptable levels of communication.

Adult↗

Evaluation of speech intelligibility for children with cleft lip and palate by means of automatic speech recognition.

OBJECTIVE: Cleft lip and palate (CLP) may cause functional limitations even after adequate surgical and non-surgical treatment, speech disorders being one of them. Interindividually, they vary a lot, showing typical articulation specifics such as nasal emission and shift of articulation and therefore a diminished intelligibility. Until now, an objective means to determine and quantify the intelligibility does not exist. METHOD: An automatic speech recognition system, a new method, was applied on recordings of a standard test to evaluate articulation disorders (psycholinguistic analysis of speech disorders of children PLAKSS) of 31 children at the age of 10.1+/-3.8 years. Two had an isolated cleft lip, 20 a unilateral cleft lip and palate, 4 a bilateral cleft lip and palate, and 5 an isolated cleft palate. The speech recognition system was trained with adults and children without speech disorders and adapted to the speech of children with CLP. In this study, the automatic speech evaluation focussed on the word accuracy which represents the percentage of correctly recognized words. Results were confronted to a perceptive evaluation of intelligibility that was performed by a panel of three experts. RESULTS: The automatic speech recognition yielded word accuracies between 1.2 and 75.8% (mean 48.0+/-19.6%). The word accuracy was lowest for children with isolated cleft palate (36.9+/-23.3) and highest for children with isolated cleft lip (72.8+/-2.9). For children with unilateral cleft lip and palate it was 48.0+/-18.6 and for children with bilateral cleft lip and palate 49.3+/-9.4. The automatic evaluation complied with the experts' subjective evaluation of intelligibility (p<0.01). The multi-rater kappa of the experts alone differed only slightly from the multi-rater kappa of experts and recognizer. CONCLUSION: Automatic speech recognition may serve as a good means to objectify and quantify global speech outcome of children with cleft lip and palate.

Adolescent↗

Thrombospondin-2 gene expression and protein localization during embryonic mouse palate development.

The mammalian palate develops from projections of the paired maxillary processes termed palatal shelves. Shelf growth is an essential in normal palatal morphogenesis. Mesenchymal proliferation in the palatal shelves is modulated by transforming growth factor-1 (TGF-1), among other growth factors. Several pathways effect TGF-beta activation, including one which utilizes thrombospondin (TSP). TSP-1 is a major activator of TGF-beta in vivo and has been localized in head mesenchyme, including palates. TSP-2 appears to inhibit TSP-1 activation of latent TGF-beta by competitively binding the latent TGF-beta. Here the TSP-2 mRNA transcript and the immunolocalization of TSP-2 protein with progressive palatogenesis were quantified. There was a significant (p < 0.05) decline of TSP-2 transcript with palatal maturation; there was no evidence correlating the TSP-2 transcription with the amount of activated TGF-beta. At the vertical shelf stage of palatogenesis, TSP-2 protein was found throughout the extracellular matrix of shelf mesenchyme. By the horizontal shelf stage, TSP-2 protein was principally localized to the ossification centres of the developing maxilla, both in extracellular matrix and bone; far less was seen in palatal shelves proper. These results suggest that TSP-2 is multifunctional during embryonic palate formation.

Animals↗

Photoelastic analysis of the effect of palatal support on various implant-supported overdenture designs.

STATEMENT OF PROBLEM: The effect of palatal support on various types of implant-supported maxillary overdenture designs has not been sufficiently assessed. PURPOSE: The purpose of this study was to photoelastically evaluate the palatal support of 3 designs of maxillary implant-supported overdentures. MATERIAL AND METHODS: A photoelastic model of an edentulous maxilla was fabricated with four 3.75 x 13-mm 3i implants. Three maxillary overdenture designs were fabricated: a splinted Hader bar incorporating 2 distal ERA attachments with anterior clips; non-splinted Zaag 4-mm direct abutments and attachments; and nonsplinted Locator 2-mm direct abutments and attachments. All restorative components and attachments were fitted and observed for passivity of fit and alignment. The overdentures were first tested with complete palatal coverage. Unilateral 25-lb loads were applied at the left and right first molars and the incisive papilla area. The photoelastic effects were monitored and recorded photographically. The palatal area was removed from the 3 overdentures and the loading regimens were repeated. RESULTS: The highest stresses under central loading were seen with the splinted Hader bar and complete palatal coverage, followed by similar levels of stress with either Zaag or Locator attachments. After removal of the palate, the center load demonstrated greater differences between designs. The highest stresses were observed with the Hader bar, followed by the Zaag and then Locator attachments. Lack of palatal coverage demonstrated higher levels of stress around implants and visible supporting tissues. The unilateral load produced the highest stress for the splinted Hader bar, followed by Locator, and then Zaag. CONCLUSIONS: Removal of the palatal support produced a greater effect and more concentrated stress difference for maxillary overdentures than differences between the attachment designs tested.

Dental Abutments↗

Morphology of the palatal vault of primary dentition in transverse view.

The purpose of this study was to investigate the transverse view of the morphology of the palatal vault in the primary dentition at the primary second molar level. Observations were obtained from 150 dental stone casts of normal children (78 boys and 72 girls; aged four to five years). Palatal width, palatal depth, arch width, and primary second molar angulation were measured. There were no significant differences in palatal depth and primary second molar angulation between boys and girls or between the right and left sides. However, girls had a statistically significantly narrower upper dental arch width and palatal width than did boys. Palatal widths on the left side were statistically significantly larger than those on the right side for both sexes. Asymmetry in the palatal width greater than two mm was present in 21.8% of boys and 16.7% of girls. There was a correlation between buccal tipping in the upper primary second molar and greater palatal width.

Cephalometry↗

Anchorage effects of a palatal osseointegrated implant with different fixation: a finite element study.

The purpose of this study was to compare the anchorage effect of the osseointegrated implant with different fixation types using finite element analysis. Three fixation types were investigated. fixation type 1: implant neck in the oral-palatal cortical bone and implant tip in the cancellous bone; fixation type 2: implant neck in the oral-palatal cortical bone and implant tip in the nasal-palatal cortical bone; fixation type 3: implant neck in the oral-palatal cortical bone and implant tip projecting into the nasal cavity. Three finite element models were constructed. Each consisted of two maxillary second premolars, their associated periodontal ligament (PDL), alveolar bones, palatal bone, palatal implant, and a transpalatal arch. Another model without an implant was used to compare with the previous models. The horizontal force (mesial five N, palatal one N) was loaded at the buccal bracket of each second premolar. The stress was calculated in the PDL and implant surrounding bone. The result showed that the palatal implant could significantly reduce von Mises stress (maximum von Mises stress was reduced 30%) and evenly distribute stress in the PDL. The stress magnitude and distribution in the PDL was almost the same in the three implant models. These results suggest that different implant fixation types have almost the same anchorage effects.

Bone Screws↗

[The child with lip, maxillary, palatal cleft].

Clefting of lip, alveolus and palate may occur in multiple variations. It causes aesthetic and functional detractions. Soft palate clefts may result in hearing-, speech- and swallowing-disorders. Therefore the otolaryngologist is a very important member in the interdisciplinary team directory. A cleft-palate child belongs to an interdisciplinary consulting hour in special hospitals, where different medical specialties are involved. Most important for a sufficient medical rehabilitation are maxillofacial surgery, otolaryngology, paediatrics, plastic surgery, speech therapy, psychology and human genetics. Also many other specialties may be involved. The cleft demands a complete follow up from the child's birth until it is grown up. Hearing disorders are caused by eustachian tube disfunction. There is a high prevalence of hearing loss and middle ear diseases in cleft palate patients. Hearing losses due to middle ear effusions in the very young child. Without therapy up to 50% of the cleft palate population will develop chronic middle ear diseases with and without cholesteatomas. Early and consequent therapy with myringotomy and insertion of a tympanostomy ventilation tube is necessary and helps to avoid chronic hearing problems. There is no general accepted system of speech disorders in cleft palate patients because of the difference in shaping of the cleft and rehabilitation development. Essential for speech rehabilitation are an intact velopharyngeal system and a keen sense of hearing. Both of it is disturbed in cleft palate children. Speech disorders are treated by speech therapists with prior consultation of the interdisciplinary team. The author presents a system of primary, secondary and tertiary speech disorders in cleft palate children. Primary speech disorders are caused by faulty velopharyngeal valving, offering in hypernasality, weak plosives, fricatives and affricates. Secondary speech disorders are substitute mechanisms for plosives, nasal and pharyngeal sounds. Tertiary speech disorders are hyper- and hypofunctional dysphonias following primary and secondary speech dysfunctions.

Adolescent↗

The influence of tray type and other variables on the palatal depth of casts made from irreversible hydrocolloid impressions.

STATEMENT OF PROBLEM: There are conflicting data regarding the effect of various factors on the palatal depth of casts made from irreversible hydrocolloid impressions. PURPOSE: This study examined the influence of tray type, water temperature, pouring technique, and stone expansion on the palatal depth of casts. MATERIAL AND METHODS: Irreversible hydrocolloid impressions were made of a model under simulated oral conditions. Palatal depth was measured relative to a reference plane with a microscope. The reference planes were standardized by subjecting the data to three 2-dimensional mathematic rotations. A 2-factor analysis of variance (alpha=.05) was used to determine whether differences existed among tray types and among palatal locations. RESULTS: The palatal depth of the casts increased approximately 0.06 mm compared with the master model with all but 2 variables. Statistical testing revealed that increased depth was not attributable to water temperature (52 degrees F or 72 degrees F) or tray type (custom resin, perforated metal, metal rimlock, or rimlock with built-up palate). Custom resin tray impressions poured with a lower expansion stone and perforated tray impressions inverted onto a base made from the same mix of stone resulted in casts with palatal depths most similar to that of the master model (P<.001). CONCLUSIONS: Casts with palatal contours of comparable accuracy were obtained with the use of a stock metal or customized tray and the use of differing water temperatures to mix the impression material.

Acrylic Resins↗

Cleft palate in spondyloepiphyseal dysplasia congenita: case reports.

Cleft palate is one of the common features of spondyloepiphyseal dysplasia congenita (SEDC). However, there are few clinical data about cleft palate in SEDC. We report four patients with cleft palate and SEDC including two with overt cleft palate and two with submucous cleft palate. Our results suggested that SEDC associated with cleft palate should be treated in the same way as solitary cleft palate, and submucous cleft palate may be more common in patients with SEDC than previously appreciated.

Abnormalities, Multiple↗

Space conditions and dental and occlusal features in patients with palatally impacted maxillary canines: an aetiological study.

The aetiology of palatal canine impaction is unclear. The aim of this research was to investigate the occlusal features that could contribute to the aetiology of palatal maxillary canine impaction. The material consisted of the pre-treatment dental casts of 34 patients (27 female and seven male) with unilateral palatal canine impaction (impaction group). The average age of this group was 17.7 years (+/- 4.6). These were matched according to age, gender and type of malocclusion with a comparison group of pre-treatment dental casts from unaffected orthodontic patients. From the dental casts the following parameters were obtained: (1) dentoalveolar arch relationship, (2) missing or anomalous teeth, (3) the mesiodistal width of each maxillary tooth, (4) the upper arch perimeter, (5) the maxillary inter-premolar and inter-molar widths. The arch length-tooth size discrepancy was only calculated for subjects with no missing teeth. Palatal canine impaction occurred most frequently in subjects with a Class II division 2 malocclusion. There was an association between palatal canine impaction and anomalous lateral incisors (P = 0.01). The transverse arch dimension was significantly wider in the impaction group than in the comparison group (P < 0.01). There was no statistically significant difference in the mesiodistal width of maxillary teeth or in the arch length-tooth size discrepancy between the palatal canine impaction group and their matched comparisons (P > 0.05). These results suggest that the presence of an 'excess palatal width' and anomalous lateral incisor may contribute to the aetiology of palatal canine impaction.

Adolescent↗

Alterations in apoptosis and epithelial-mesenchymal transformation in an in vitro cleft palate model.

The processes of apoptosis and epithelial-mesenchymal transformation have been identified as two major mechanisms by which secondary palatal shelves achieve fusion. The aim of this study was to investigate alterations in these mechanisms by changing the physical distance between paired palatal shelves in an in vitro model of palatogenesis. Wild-type palatal pairs were dissected from E13.5 CD1 mouse embryos and allowed to grow in tissue culture for 48 hours at various intershelf distances. During the fusion process, medial edge epithelial cell fate was assessed using terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining, to evaluate apoptosis, and carboxyfluorescence (carboxy-2,7'-dichlorofluorescein diacetate succinimidyl ester) labeling, to measure transformation to mesenchymal cells. Palatal pairs separated in culture greater than or equal to 0.4 mm failed to fuse. TUNEL staining showed that the number of apoptotic cells in the palatal shelves increased as the intershelf distance increased, becoming marked in shelves that did not achieve fusion. The amount of epithelial-mesenchymal transformation, however, decreased with increasing intershelf distance. These results suggest that the contribution of epithelial-mesenchymal transformation and apoptosis to palatal shelf development and fusion can be altered by physical proximity. Therefore, one mechanism behind clefting in utero may result from an imbalance in epithelial-mesenchymal transformation and apoptosis as observed in vitro where palatal shelves are challenged to fuse by physical separation. This effect could be significant in the understanding and treatment of developmental palatal abnormalities. Perhaps in utero manipulation of intershelf spacing or epithelial-mesenchymal transformation and/or apoptosis could reverse the clefting paradigm.

Animals↗

Maxillofacial morphology in children with complete unilateral cleft lip and palate treated by one-stage simultaneous repair.

BACKGROUND: There is a common belief among the majority of surgeons occupied with cleft lip-cleft palate repair that early one-stage simultaneous repair of hard and soft palates affects maxillofacial development adversely. This proposition has not been proven with long-term clinical studies. In this study, the effects of one-stage repair on the maxillofacial development of children with complete unilateral cleft lip-cleft palate were investigated, and the results were compared with those of the cleft children treated with conventional two-stage repair. METHODS: The study was designed as follows. Group 1 consisted of 19 children (mean age, 85.4 +/- 12.8 months) treated with a one-stage procedure. In this group, cleft lip, palate, and alveolus were repaired simultaneously at a single surgical session in the first 10 months of life (mean age at time of surgery, 6.8 +/- 1.2 months). Group 2 consisted of 22 children (mean age, 90.1 +/- 13.0 months) treated in two stages as follows: lip repair was performed at a mean age of 4.8 +/- 1.0 months and palate repair was performed at a mean age of 14.6 +/- 2.0 months. The follow-up period was approximately 6.3 years for both study groups. Group 3 (control) consisted of 27 children (mean age, 87.1 +/- 11.7 months) without cleft who were matched for age. RESULTS: Compared with the control group, the children in both cleft groups revealed a greater maxillomandibular retrognathism, a more open palatal plane, larger anterior facial heights, and decreased posterior vertical maxillofacial heights. No significant difference was determined between study groups 1 and 2. CONCLUSIONS: Because both of the surgical treatment procedures give rise to similar maxillofacial development outcomes, regardless of the timing of surgery, the one-stage procedure offers several important advantages, such as less psychosocial trauma, low cost, and possibly an improvement in speech results because of less scarred palatal fields and the low rate of palatal fistula.

Cephalometry↗

The clinical observation of difficult laryngoscopy and difficult intubation in infants with cleft lip and palate.

BACKGROUND: The aims of this study were to evaluate the incidence of difficult laryngoscopy in infants with cleft lip and palate and to observe its relationships with age, sites, and degrees of deformities. METHODS: A total of 985 infants aged 1 month to 3 years, undergoing repair of cleft lip and palate were included in this study. The infants suffering from unilateral cleft lip, simple cleft palate, and combined bilateral cleft lip and palate were 465, 421, and 79 respectively. They were divided into three groups according to age; 1-6 months group, 6-12 months group and 1-3 years group. RESULTS: The total incidence of difficult laryngoscopy was 4.77%. The incidence of difficult laryngoscopy was closely related to age, sites and degrees of deformities, and micrognathia. The incidence of difficult laryngoscopy was 7.06% in 1-6 months group, 2.90% in 6-12 months group, and 3.13% in 1-3 years group, and was greatest for infants with combined bilateral cleft lip and palate, less for those with left cleft lip and least for those with right cleft lip and simple cleft palate. The incidences of difficult laryngoscopy in infants with and without micrognathia were 50% and 3.83% respectively. The incidences of moderately difficult, difficult, and failed intubations were 1.02%, 0.91%, and 0.102% respectively. CONCLUSIONS: Infants with cleft lip and palate, left cleft lip and alveolus, combined bilateral cleft lip and palate, micrognathia, and age <6 months were the important risk factors for difficult laryngoscopy. Difficult intubation occurred mainly in infants with laryngoscopic views of grade III and IV.

Child, Preschool↗