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A comparison of palatal adaptation in acrylic resin denture bases using conventional and anchored polymerization techniques.

PURPOSE: The study investigated the effects of palatal depth and a resin anchoring system on the adaptation of denture base resin to the master cast after compression molding and heat polymerization. MATERIALS AND METHODS: Forty-eight virtually identical polymethyl methacrylate dentures were fabricated on master casts with either a deep or shallow palatal vault. One half of the master casts of each palate type were altered by the addition of anchoring holes along the posterior land area, as well as perpendicularly in the midsaggital area. Anchoring holes were made with a #8 round bur to a depth of 5 mm. Twenty-four hours after polymerization, the bases on their casts were sectioned at the posterior border and evaluated for degree of adaptation using a traveling microscope. Maladaptation at the interface of the denture base and master cast was measured at predetermined mediolateral locations. A split-plot analysis of variance (alpha = 0.05) was performed followed by a post-hoc Dunn Multiple Comparison Test. RESULTS: In general, depth of the palatal vault did not significantly influence denture palatal discrepancy (p =.0780), but the use of the anchoring system significantly reduced mean gap distances (p =.000). At lateral and midpalate locations, gap distances between the denture bases and their casts were reduced from approximately 0.3 mm to approximately 0.1 mm when the anchoring system was used. CONCLUSIONS: Mean gap distances for steep palate dentures were significantly less than shallow palate dentures at vestibule and lateral palate locations, and anchoring holes placed in an edentulous master cast along the posterior land area and at the midline significantly improved the adaptation of denture bases.

Acrylic Resins↗

Organ culture of the fetal mouse palate for screening the developmental toxicity of chemicals: a validation study.

Using in vitro organ culture of the fetal mouse palate in a chemically defined serumless medium, the toxicity of 24 chemical compounds was investigated. Explanted palates of day-12.5 mouse fetuses were exposed for 72 h in vitro to various concentrations of each chemical, and the fusion rate and growth parameters were compared between the experimental group and respective controls. The average rate of palate fusion was 84% in vehicle controls. For compounds that are teratogenic in experimental animals in vivo, the fusion rates of palatal shelves decreased as the concentration of the test chemicals increased, showing a dose-dependent relationship. Palate fusion was inhibited by 11 of the 15 in vivo teratogens, and the predictability of in vivo developmental toxicity in this culture system was 73%. Cyclophosphamide itself did not inhibit the growth and fusion of explanted palates, but supplementation of hepatic S-9 fraction and cofactors for a monooxygenase system converted it to a toxic substance, as was shown in other in vitro systems. The 50% inhibitory concentration (IC50) value calculated based on the fusion rate was also found to be a useful parameter for evaluating the developmental toxicity of drugs. The teratogenic risk in the human fetus could be assessed by comparing the minimal toxic concentrations of the test compound on cultured palates with the maximal plasma level in pregnant women under therapeutic conditions and with the plasma concentrations when its minimal teratogenic dose is given to pregnant mice. This organ culture system of the fetal palate should be useful for screening the developmental toxicity of drugs and other environmental agents, and its value should increase when it is used in combination with other battery test systems.

Animals↗

Results of cleft palate repair with the double-reverse Z-plasty performed by residents.

The double-reverse Z-plasty (Furlow) repair of soft palate clefts has the advantages of lengthening the soft palate while reconstructing the palatal muscle sling to optimize velopharyngeal function. Because soft tissue from the hard palate is not mobilized to lengthen the soft palate, this technique has an additional theoretic advantage of minimizing disturbances of maxillofacial growth. Cited disadvantages of the technique include increased technical difficulty and operating time compared with other procedures. We performed a retrospective study of 20 consecutive Furlow repairs of the soft palate performed by residents under supervision of one attending surgeon between 1989 and 1992. All children had complete cleft of the soft palate; 14 had incomplete cleft and six had complete cleft of the hard palate, which were repaired by a modified Von Langenbeck technique or with vomer flaps. Mean age of patients was 15 months, and mean operating time (including placement of pressure-equalizing tubes) was 162 minutes, with an average estimated blood loss of less than 25 ml. Average time until adequate oral intake was achieved was 1.7 days, and duration of hospitalization averaged 2.4 days. Immediate postoperative complications included transient tongue edema in one patient and atelectasis and pneumonia in one patient with multiple congenital anomalies. Delayed postoperative complications included symptoms of sleep apnea in four patients, which subsequently improved after tonsillectomy and/or superior adenoidectomy. Fistulas occurred in two patients (10%), which compares favorably with published results of other techniques. Preliminary functional evaluations reveal that all repairs appear to have adequate length and good mobility; speech evaluations are in progress.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗

Eustachian tube compliance in cleft palate--a preliminary study.

With the use of the tubal compliance test and the forced response test (FRT), the compliance and ventilatory functions of the eustachian tube (ET) were examined in 19 children with otitis media with effusion (OME) and cleft palate, in 31 children with OME but without cleft palate, and in 19 individuals with traumatic perforation of the eardrum without history of other otological disease (controls). The tubal compliance results in the group with both cleft palate and OME were significantly higher than the results obtained with the controls, but did not differ significantly from the results obtained with the patients with OME but without cleft palate; this indicated that the ETs of those patients with OME and cleft palate, and the ETs of those patients with OME but without cleft palate, appeared to be more collapsible than the ETs of normal subjects. It was speculated that such an aerodynamic property of the ET observed in the group with OME and cleft palate and in the group with OME but without cleft palate may be due mainly to possible inflammatory condition of the tubal mucosa rather than to abnormal anatomy or to an abnormal physical property of the framework (such as cartilage) of the ET.

Child↗

Programmed cell death is not a necessary prerequisite for fusion of the fetal mouse palate.

It has been widely accepted that programmed cell death (PCD) is an essential event in palatogenesis and that its failure can result in cleft palate, one of the most common birth defects in the human. However, some conflicting results have been reported concerning the timing of cell death occurring in the fusing palate and therefore the role of PCD in palatal fusion is controversial. In order to clarify whether cell death is indispensable for mammalian palatogenesis, we cultivated the palates of day-13 mouse fetuses in vitro and prevented cell death by treating them with the inhibitors of caspases-1 and -3 or with aurintricarboxylic acid which inhibits the activity of caspase-activated DNase. Even when cell death was almost completely inhibited, palatal fusion took place successfully. Histological examination revealed that in the absence of apoptotic cell death, the medial edge epithelia of opposing palatal shelves adhered to each other and subsequently, the midline epithelial seam was disrupted and disappeared to bring about mesenchymal confluence across the palate. It seems that cell death is not a necessary prerequisite for palatal fusion but it may help to efficiently eliminate unnecessary cells which failed to migrate or differentiate properly.

Animals↗

Human prenatal nasal bone lengths: normal standards and length values in fetuses with cleft lip and cleft palate.

OBJECTIVE: The aim of this study was to present prenatal autopsy standards for nasal bone length in normal fetuses, as well as to compare nasal bone lengths in human fetuses with cleft lip and palate with those standards. MATERIAL AND METHODS: The material consisted of human fetuses investigated in connection with diagnosed and legally approved abortions and spontaneous abortions; 40 were normal and 26 had cleft lip and palate (7 isolated cleft lip, 12 isolated cleft palate, and 7 combined cleft lip and palate). Menstrual ages (MA) ranged from 12 to 25 weeks, crown-rump length (CRL) from 55 to 210 mm and foot length (FL) from 7 to 44 mm. All fetuses were radiographed in lateral projection, and, using these images, the nasal bone lengths were measured with a digital caliper. Regression analyses were performed. RESULTS: Standards for normal nasal bone length at different ages are expressed as menstrual age, crown-rump length, or foot length. Comparisons with normal standards showed that the isolated cleft lip group had a significantly smaller nasal bone length than the normal fetuses had. Fetuses with isolated cleft palate and fetuses with combined cleft lip and palate showed no significant deviation from normal standards. CONCLUSION: Normal nasal bone standards can contribute to information on deviations in nasal bone length for aborted fetuses with known and unknown genotypes. The differences in nasal bone lengths in fetuses with different lip and palate clefting can contribute to understanding the pathogenesis of cleft lip and palate.

Aborted Fetus↗

Early assessment of dental arch development in repaired unilateral cleft lip and unilateral cleft lip and palate versus controls.

OBJECTIVE: To evaluate dental arch relationships and dimensions, relative to an age matched noncleft sample, in Caucasian 3-year-old children with repaired unilateral cleft lip (UCL) or unilateral cleft lip and palate (UCLP). DESIGN: Prospective, cross-sectional, case-control study performed in Scotland, U.K. PARTICIPANTS: Eleven children with repaired unilateral cleft lip, 16 children with repaired unilateral cleft lip and palate, and 78 children as controls. MAIN OUTCOME MEASURES: Dental arch relationships and linear arch dimensions. RESULTS: Prevalence of Class III incisor relationship was 31.3% in children with unilateral cleft lip and palate compared with 9.1% in children with unilateral cleft lip. A buccal crossbite was present in 36% of children with unilateral cleft lip, compared with 75.6% of children with unilateral cleft lip and palate.Mean linear maxillary arch dimensions did not differ significantly between children with unilateral cleft lip and the controls. Except for second intermolar width, statistically significant differences existed in mean linear maxillary arch dimensions between the unilateral cleft lip and the unilateral cleft lip and palate groups; the mean linear maxillary arch dimensions were significantly greater in the control group than in the unilateral cleft lip and palate group. The mean cleft-affected anterior quadrant length appeared to be the arch dimension with the greatest power of discrimination among the three groups. There were no significant differences in mean linear mandibular arch dimensions among the three groups. CONCLUSIONS: Anterior crossbite was almost three times more common in the unilateral cleft lip and palate group than in the unilateral cleft lip group. Mean linear maxillary arch dimensions differed significantly between the unilateral cleft lip and palate group and the control group. There were no significant differences in mean linear maxillary arch dimensions between unilateral cleft lip and controls or between mean linear mandibular arch dimensions for unilateral cleft lip, unilateral cleft lip and palate, and controls.

Analysis of Variance↗

Differential growth among components of the palate in rhesus monkeys (Macaca mulatta).

To understand the etiology of maxillary hypoplasia better, which is common in individuals with cleft palate and other craniofacial anomalies, the relative growth and contribution of the maxillary and palatine segments to enlargement of the hard palate was examined in rhesus monkeys. The purpose of the study was to identify and evaluate sites of differential growth of the palatine and maxillary segments as they contribute to the development of the midface and facial prognathism. One hundred and eight male and 107 female skulls ranging from 1.0 to 7.0 years of age were examined. Measurements of the maxillary and palatine lengths, palatal width, midface depth, canine length, and molar surface areas in the ontogenetic sample were collected. Univariate and bivariate statistics were used to describe dimensional changes and evaluate region-specific sex differences. The relative growth of palatal dimensions was evaluated using allometric analysis methods. Significant sex differences were observed (t-test, p < or = .05) for all palatal dimensions by 4 years of age. However, proportions of the maxillary and palatine segments to overall palate length appeared to be similar throughout growth for both sexes. The results suggest that sutures of the midface, in particular the transverse palatine suture, may be important in the bony development of the palate during growth. These sutures may contribute to the overall modulation of palatal development.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗

Clinical and epidemiologic studies of cleft lip and palate in the Philippines.

Clinical and epidemiologic studies of defined geographic populations can serve as a means of establishing data important for genetic counseling and as a first step in identifying strategies best suited for identification of causes. Under the sponsorship of Operation Smile International, clinical, genetic, and epidemiologic studies were carried out at six sites within the Philippines between 1989 and 1996. Patients who were being evaluated for surgical repair of craniofacial anomalies (primarily clefts of the lip and palate) were briefly examined for the presence of associated anomalies, and a family history was obtained to look for the frequency of cleft lip and palate in siblings. Birth records of 47,969 newborns over an 8-year period at one hospital in Bacolod City in the province of Negros Occidental were reviewed. Medical records of infants born with clefts of the lip and/or palate and other major anomalies were reviewed and birth prevalence rates calculated. Findings include a birth prevalence of 1.94 per 1000 live births for cleft lip with/without palate in the Philippines. Recurrence rates in siblings for nonsyndromic clefts of the lip and palate were 23 per 1000 for cleft lip with or without cleft palate, and 14 per 1000 for cleft palate only. The percentage of clefts associated with multiple anomalies was 21% at birth and 6% for individuals examined during the screening process, providing evidence for a high postnatal death rate. These data provide groundwork for additional etiologic studies including segregation analysis and molecular genetic studies involving linkage or association, as well as for studies of environmental contributions to clefting such as vitamin deficiencies. Preliminary molecular analysis using an association approach is reported in a companion paper. The findings suggest a high incidence of cleft lip and palate in native-born Filipinos.

Abnormalities, Multiple↗

Speech outcomes in isolated cleft palate: impact of cleft extent and additional malformations.

OBJECTIVE: The purpose of the study was to study the speech outcome in a series of 5-year-old children born with an isolated cleft palate and compare the speech with that of noncleft children and to study the impact of cleft extent and additional malformation on the speech outcome. DESIGN: A cross-sectional retrospective study. SETTING: A university hospital serving a population of 1.5 million inhabitants. SUBJECTS: Fifty-one patients with an isolated cleft palate; 22 of these had additional malformations. Thirteen noncleft children served as a reference group. INTERVENTIONS: A primary soft palate repair at a mean of 8 months of age and a hard palate closure at a mean age of 4 years and 2 months if the cleft extended into the hard palate. MAIN OUTCOME MEASURES: Perceptual judgment of seven speech variables assessed on a five-point scale by three experienced speech pathologists. RESULTS: The cleft palate group had significantly higher frequency of speech symptoms related to velopharyngeal function than the reference group. There were, however, no significant differences in speech outcome between the subgroup with a nonsyndromic cleft and the reference group. Cleft extent had a significant impact on the variable retracted oral articulation while the presence of additional malformations had a significant impact on several variables related to velopharyngeal function and articulation errors. CONCLUSION: Children with a cleft in the soft palate only, with no additional malformations, had satisfactory speech, while children with a cleft palate accompanied by additional malformations or as a part of a syndrome should be considered to be at risk for speech problems.

Articulation Disorders↗

Nerve growth factor receptor immunolocalization during human palate and tongue development.

OBJECTIVE: To investigate the temporospatial pattern of nerve growth factor receptor (NGFR) immunolocalization during human palatal closure. MATERIALS: Human palate and tongue tissues from 33 embryos/fetuses, 9 to 22 weeks of fertilization age. METHODS: Tissues were divided according to developmental stage and palatal development (before, during, and after closure) and then subjected to decalcification, paraffin embedding, serial sectioning, survey staining, and p75NGFR immunohistochemical staining. RESULTS: Specific temporospatial patterns of p75NGFR reactivity were observed; reactivity was intense in the soft tissue palatal shelves before and during palatal closure and was weaker in the palate after palatal closure. In the tongue, intense reactivity was seen throughout 9 to 22 weeks. CONCLUSION: The observed patterns suggest that p75NGFR may enable the visualization of physiological events in palatal closure during normal human development.

Antibodies, Monoclonal↗

Relationship of maxillary molar root angulation and palatal vault height.

If the vertical angulation of maxillary molar roots could be reliably predicted, this might affect the choice of roots resection procedures. In an attempt to develop this prediction, angulation of palatal roots was compared to palatal vault height. Human cadaveric maxillae with molars were sectioned faciopalatally through each tooth root to the palatal midline and photographed. Root angles and palatal height were measured on the photographs in relation to a reference line connecting buccal and palatal cementoenamel junctions (CEJ). Palatal vault heights were classified as low, medium, or high according to the perpendicular distance from the midpalatal suture to the reference line. Root angles were subtended by a line following the length of pulp canals and perpendicular to the CEJ reference. Analysis by Spearman's Rank Correlation Coefficient demonstrated a weak nonsignificant relationship between palatal vault height and the angulation of the various maxillary molar roots. Thus, palatal vault height would not be a reliable predictor of root angulation if this were to be used as a basis for root retention.

Adult↗

[The application of the pedicled buccal fat pad graft in cleft palate repair].

OBJECTIVE: The purpose of this paper is to provide the experience in using the pedicled buccal fat pad (BFP) graft in cleft palate repair when healing by secondary intention may need to be considered due to the width of the cleft; the qualitative or quantitative tissue constraints, the dead cavity between the oral and nasal layers or single layer closure of the hard palate with the vomer and marginal pedicled mucosoperiosteal flap. METHODS: The body and buccal extension of BFP is gently torn out from its bed and advanced into the palate vault around the posterior aspect of the maxilla to cover the raw surface of the hard palate cleft and/or fill the dead cavity between the oral and nasal tissue layers, specifically in the conjunction of the hard and soft palate. RESULTS: Six cleft palates were repaired with the BFP graft. The postoperative course was uneventful. The BFP graft is viable without the occurrence of fistula or infection. CONCLUSION: The pedicled BFP graft has provided an excellent soft tissue support for secondary epithelialization when primary dehiscence has or would have otherwise thwarted ultimate closure of the palatal defect. The pedicled BFP graft permits closure of palatal defects that could not be repaired by conventional procedures.

Adolescent↗

Local anesthesia in the palate: a comparison of techniques and solutions.

It was the purpose of the present investigation to determine if there were differences in soft-tissue anesthesia in the palate following infiltration and greater palatine nerve block anesthesia and to compare lidocaine with lidocaine plus epinephrine as palatal soft tissue anesthetics. Two studies using 10 volunteers were performed. In one trial, volunteers received a palatal infiltration opposite the second maxillary bicuspid on one side and a greater palatine nerve block on the other. Response to sharp probing and pain-pressure thresholds were measured on each side over a 1-hour census period. In the second trial, volunteers received 2% plain lidocaine as a palatal infiltration on one side and a similar infiltration of 2% lidocaine with 1:80,000 epinephrine on the other in a double-blind randomized fashion. Response to sharp probing was assessed over a 55-minute period. Data were analyzed using Student's paired t tests. The response to sharp probing and pressure-pain thresholds did not differ between palatal infiltration and greater palatine nerve block over the 1-hour period. Lidocaine with epinephrine provided longer lasting anesthesia than plain lidocaine following palatal infiltration (P < .001). Greater palatine nerve block and palatal infiltration provide similar soft-tissue anesthesia. Lidocaine with epinephrine produces longer-lasting soft-tissue anesthesia than plain lidocaine following palatal infiltration.

Adult↗

[Diagnosis and treatment of congenital recessive cleft palate].

OBJECTIVE: To explore an effective method to diagnose and treat the congenital recessive cleft palate. METHODS: For the treatment of congenital recessive cleft palate, an operation was designed to recover the anatomic length and function mobility of the soft palate. The operation procedure includes incising vertically the midline mucous membrane of the soft palate, creating and pushing back the mucosal flap of the hard palate, making Z-plasty on the nasal mucosa, reconstructing the sling of the levator veli palatini muscle and repairing the palatal defects with the buccinator muscularis mucosae flap. 12 cases of congenital recessive cleft palate have treated with this method. RESULTS: All of the 12 cases obtained good results. Their pronunciation improved obviously. CONCLUSION: The method is effective for diagnosis and treatment of congenital recessive palate, which is worthy of further application.

Adolescent↗

TGF-beta3 is required for the adhesion and intercalation of medial edge epithelial cells during palate fusion.

Transforming growth factor-beta3 (TGF-beta3) plays a critical role during palate development, since mutations of the TGF-beta3 gene give rise to cleft palate in both humans and mice. Striking alterations have been reported in the behaviour and differentiation of medial edge epithelial (MEE) cells in TGF-beta3 knockout mouse palates. In the present paper, we provide evidence of alterations in MEE intercellular adhesion in TGF-beta3 -/- mouse palates using immunohistochemistry with monoclonal antibodies to a panel of cell adhesion and cytoskeletal molecules including E-cadherin, alpha and beta catenin, beta actin, vinculin and beta2 integrin. In vitro labeling of opposing MEE with two different lipophilic markers and subsequent analysis by confocal microscopy revealed that wild type MEE cells intercalate as soon as the midline epithelial seam forms. This finding indicates that the palate may elongate in a dorso-ventral direction by means of convergent extension, as occurs in other embryonic developmental processes. In contrast, this intercalation does not occur in the TGF-beta3 -/- MEE but it can be rescued by the exogenous addition of TGF-beta3. Thus, the substantial alteration of MEE intercellular adhesion observed in TGF-beta3 -/- palates may account for the defect in palatal shelf adhesion and the formation of cleft palate.

Animals↗

[Molecular mechanism of cleft palate induced by retinoic acid].

OBJECTIVE: To explore the molecular mechanism of cleft palate induced by chemicals. METHODS: Retinoic acid was used as a known teratogen to induce cleft palate in ICR mice and a suppression subtractive hybridization (SSH) technique was applied to identify differentially expressed genes that related to cleft palate of ICR mice. RESULTS: 14 reverse differently and 9 forward differentially expressed clones were obtained. Some clones were selected to be sequenced and aligned to GenBank. CONCLUSION: In this study, suppressed Gpc3 and Insulin-Induced protein 1 could affect growth of palate shelves and resulted in cleft palate by reducing the size of the palate shelves. Down-regulation of Ptprs interfered with a cell signal pathway and down-regulation of Tn C inhibited the cell de-adhesion and expression of Egfr, then suppressed Egfr prevented the normal expression of MMPs that influenced the medial edge epithelium disruption and caused cleft palate. Tn C could bind to Ptprs and Gpcs, and HSPGs were ligands for Ptrps. Up-regulate of Rps25 might play a role in cleft palate by excessively apoptosis.

Animals↗

[The influence of autogenous bone graft in cleft palate on maxillary growth: an experiment study in rats].

PURPOSE: This study was designed to investigate the influence of autogenous bone graft in cleft palate on maxillary growth in rats. METHODS: Forty Wistar strain male rats aged 4 weeks were randomly divided into four groups. Each group had 10 rats. Group 1 was the unoperated control group. Group 2 had a surgically created cleft palate but unrepaired. Group 3 also had a surgically created cleft palate which followed by a two-flap palatoplasty repair immediately. Group 4(experimental group) also had a surgically created cleft palate, but the cleft palate was reconstructed by autogenous rib graft with two-flap repair. All animals were sacrificed on the 10th week after operation. The data were analyzed using SPSS. And one-way ANOVA was used for comparison of the four groups. RESULTS: The experimental group was significantly smaller than unoperated control group and cleft palate group in the maxillary widths variables, length variables (AD),height variables(P<0.01).Except rats in the experimental group had significantly greater posterior palate width than rats in two-flap repair group(P<0.01),there were no significant difference between the two procedures in maxillary growth variables(P>0.05).But the experimental group was smaller in the maxillary heights, length variables than the two-flap group. CONCLUSIONS: These findings showed that repair of the cleft palate by autogenous rib graft had positive effect on preventing the contraction of maxillary width. But in the maxillary anteroposterior and vertical development, the experimental group possibly had more severe retardation than two-flap repair group.

Animals↗