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At least 91 records · Page 5Linked to original sources
PubMed1998

Speech outcome after cleft palate surgery with the Göteborg regimen including delayed hard palate closure.

The regimen for treatment of children with cleft lip and palate in Göteborg, Sweden, until 1996 included early soft palate repair at 6-8 months of age and delayed closure of the hard palate at about 8 years of age to improve maxillary growth. The aims of this report were to describe the treatment concept and to present speech data of 59 children treated by this method. The speech of 38 children with unilateral and 21 with bilateral cleft lip and palate was evaluated perceptually from standardised tape recordings of repeated sentences and spontaneous speech at five ages from 3 to 16 years of age. All patients were not evaluated at each age level. The results showed a low prevalence of hypernasality after hard palate closure and pharyngeal flap surgery in only five children (8%), indicating a primary velopharyngeal insufficiency in less than 10% of the children. Only three children with bilateral clefts had glottal articulation when at pre-school age and no child with a unilateral cleft did. These results were interpreted as an indication of velopharyngeal competence (VPC) in most of the children. In addition, the speech problem found in these children consisted of retracted oral articulation of alveo-dental pressure plosives, which is almost always an indicator of VPC. However, we do consider that retracted oral articulation is a problem and to improve our results further we have decided to modify the technique for soft palate closure slightly and place the vomer flap further anteriorly to encourage narrowing of the cleft in the hard palate, and to close the hard palate at 3 years of age.

Adolescent↗
PubMed1997

Musculature of the soft palate: clinico-anatomic correlations and therapeutic implications in the treatment of cleft palates.

OBJECTIVE: Hypoplasia of the maxilla, often described as a classic sequela to surgical repair of the cleft palate, has been rare in our experience. We believe that our surgical technique, which includes dividing the nasal mucosa and the abnormal muscular insertions at the posterior border of the hard palate, is an important factor in preventing this sequela. METHOD: We compared the anatomy of 12 normal palates in cadavers to the anatomy of cleft palates seen at operation and to the anatomy of one cleft palate in a fetus aged 34 weeks. RESULTS: In cleft palates, the muscular fibres have an abnormal sagittal orientation, inserting on the posterior border of the hard palate. CONCLUSION: The division of both the nasal mucosa and these abnormal muscular insertions at the posterior border of the hard palate enables the surgeon to eliminate the abnormal posterior pull of these fibers on the maxilla.

Cleft Palate↗
PubMed1999

Perception of middorsum palatal stops from the speech of three children with repaired cleft palate.

OBJECTIVE: The purpose of this study was to examine listeners' perception of the middorsum palatal stop, a compensatory articulation used by individuals with repaired cleft palates. DESIGN: This study tested whether listeners could discriminate middorsum palatal stops from matched alveolar (/t/) and velar (/k/) stops using a two-button "change/no-change" procedure. It also explored how listeners identified the palatal stop by rating each sound on a scale of one to eight. PARTICIPANTS: Twenty listeners, 10 untrained and 10 trained in general phonetics (graduate students in speech-language pathology), participated in discrimination and identification tasks during a 1-hour session in the Speech Perception Laboratory at the University of Buffalo. MEASURES: Discrimination was measured using d-prime, a score based on listeners' hits, correct rejections, misses, and false alarms to the changes/no changes in the stimuli. Identification was measured by the mean rating score for each class of stops. RESULTS: Listeners discriminated middorsum palatal stops from alveolar and velar stops, but their ratings for the middorsum palatal stops did not differ from those for the regular stop consonants. The two groups differing in phonetic training did not perform differently. CONCLUSIONS: Listeners can discriminate middorsum palatal stops from other stop articulations, but they did not identify them differently from alveolar and velar stop consonants. The results suggest that considerable training listening to middorsum palatal stops is necessary for listeners to be able to reliably identify them.

Adult↗
PubMed2003

[Simultaneous repair of cleft lip and closure of cleft hard palate with vomer flaps in patients with unilateral complete cleft lip and palate].

OBJECTIVE: The purpose of this study was to retrospect the prognosis of simultaneous repair of cleft lip and closure of cleft hard palate with vomer flaps in patients with unilateral complete cleft lip and palate. METHODS: A retrospective study was carried out in 47 patients with unilateral complete cleft lip and palate and, simultaneously received repair of cleft lip and closure of cleft hard palate with vomer flaps. The duration of operation, as well as the blood loss during the operation was recorded, and compared with those patients who only received cleft lip repair. RESULTS: All the operations were successful, and the wound healed well. The procedure of simultaneous repair of cleft lip and closure of cleft hard palate with vomer flaps did not prolong the operating time, compared with simple cleft lip repair. No blood transfusion was needed due to closure of cleft hard palates with vomer flaps. CONCLUSION: Simultaneous repairs of cleft lip and closure of cleft hard palate with vomer flaps are safe for patients with unilateral complete cleft lip and palate.

Abnormalities, Multiple↗
PubMed2006

Cytokeratin expression in palatal and marginal mucosa of cleft palate patients.

OBJECTIVE: The margin of a palatal cleft is a unique anatomical site since the palatal mucosa is continuous with the nasal or nasopharyngeal mucosa. The aim of this study was to compare the expression patterns of cytokeratins and basal membrane components of the mucosa in the area of the cleft. DESIGN: Biopsies from the mucosa of the hard palate and from the cleft margin in the soft palate were obtained from five patients during the primary surgical closure of the cleft. The tissues were processed for haematoxylin-eosin staining and for immunohistochemistry. Antibodies against the cytokeratins (CK) 4, 7, 8, 10, 13, 16 and 18, and the basal membrane components heparan sulphate (HS) and collagen type IV (CIV) were used for immunostaining. RESULTS: The nasopharyngeal epithelium was thinner than the epithelium of the soft palatal mucosa, and showed less interpapillary ridges. The nasopharyngeal epithelium was stratified but expressed the keratins of a simple epithelium (CK 7, 8 and 18). The expression pattern abruptly changed into that of a typical non-keratinized stratified epithelium (CK 4, 13) at the transition to the soft palatal epithelium. The epithelium of the hard palate was a fully differentiated, keratinized and stratified epithelium (CK 10, 16). The basal membrane was thinner in the nasopharyngeal epithelium, which might be related to the presence of abundant inflammatory cells. CONCLUSION: The area around the palatal cleft showed three different types of epithelium. There was an abrupt transition in phenotype of the epithelium from the oral side to the nasopharyngeal side.

Child, Preschool↗
PubMedDate not supplied

Cleft palate by picrotoxin or 3-MP and palatal shelf elevation in GABA-deficient mice.

gamma-Aminobutyric acid (GABA) is a major inhibitory neurotransmitter in the mammalian central nervous system. Gene targeting of GABA-synthetic glutamic acid decarboxylase (GAD) 67 and GABAA receptor beta(3) subunit induces cleft palate in the mouse. These findings appear to contradict previous pharmacological investigations using benzodiazepines and GABA itself, which indicate that GABA suppresses palatogenesis. Therefore, the effects of picrotoxin and 3-mercaptopropionic acid (3-MP) on palate formation were investigated in the present study. Picrotoxin and 3-MP impair GABA functions by blocking the GABA receptor and synthesis, respectively. Pregnant mice in the critical period [Embryonic Day (E) 11-15] of palatogenesis were administered these substances by subcutaneous injection or continuous infusion at subconvulsive doses, and their fetuses at E17-18 were investigated. A complete cleft in the secondary palate was observed in 15% of 333 embryos in 28 litters. In the remaining fetuses, a complete cleft palate was not observed, but microscopic examination of serial sections revealed partial defects of the palate. Furthermore, rescue from cleft palate in GAD67-deficient mice was attempted by GABA infusion. Horizontal elevation of palatal shelves, which is not observed in nontreated mice, did occur after the infusion in all 14 GABA-infused GAD67-deficient fetuses, although cleft palate still persisted. These results indicate that GABA is required for palatogenesis and is consistent with findings in gene knockout mice.

3-Mercaptopropionic Acid↗
PubMed2003

Palatal reconstruction with the palatal island flap.

OBJECTIVES/HYPOTHESIS: The management of palatal defects resulting from the extirpation of benign and malignant lesions uses a variety of methods, with the optimal techniques allowing maximal postoperative function with minimal morbidity. The palatal island flap is an effective, reliable technique for reconstructing postablative oral cavity defects. METHODS: All patients who underwent palatal resections for benign or malignant lesions at a tertiary care, referral-based head and neck cancer center since 1995 were eligible. Ten patients were identified whose surgical defects were reconstructed with palatal island flaps. The cases were reviewed for the symptomatology, tumor features, defect size, perioperative and postoperative management, complications, and impact on palatal function. RESULTS: Ten patients ranging in age from 18 to 81 years underwent palatal island mucoperiosteal flaps after resection of a variety of benign and malignant tumors, most arising from minor salivary glands. The defects ranged in size from 5 to 15 cm2, with extension into the floor of the nose in four cases and to the skull base in two. Nine patients were discharged on a regimen of oral diet, and no patient manifested permanent velopharyngeal insufficiency, speech impairment, or airway compromise. Follow-up ranged from 3 months to 6 years, with an average follow-up of 18.5 months. Delayed donor site re-epithelialization required debridement in one case, and two patients required obturation of small oronasal fistulae. CONCLUSION: The palatal island mucoperiosteal flap provides an effective means of reconstructing hard and soft palate defects with few complications and low morbidity.

Adolescent↗
PubMed1997

Maxillary growth following atelocollagen implantation on mucoperiosteal denudation of the palatal process in young rabbits: implications for clinical cleft palate repair.

OBJECTIVE: The implantation of atelocollagen matrix on the denuded surface of palatal bone following cleft palate repair has been used because it enhances wound healing. This study was performed to determine whether the beneficial effect of atelocollagen matrix implantation on the prevention of scar tissue contraction also inhibits the scar's interference with the growth of maxillary bone. METHOD: Fifty New Zealand White rabbits (aged 4 weeks) underwent palatal mucoperiosteal denudation, and etelocollagen matrix was implanted on the left palatal process. The opposite side was left open as a control. RESULTS: Histopathologically, the implantation side exhibited early infiltration of mononuclear cells and fibroblasts, and better growth of connective tissue strands and epithelium. In addition, the formation of rate ridges were seen that were similar to the normal mucosa. The bone of the atelocollagen-implanted side was covered with regenerated periosteum-like layers, but that of the control side was lined by granulation tissue, suggesting the existence of continuous inflammation on the periosteal region. When the animals reached adulthood (aged 24 weeks), the areas of scars and palatal processes, palatal shelf width, molar teeth incline, and bone mineral contents were measured and compared between sides. The atelocollagen-applied scars showed less contraction, the area and width of atelocollagen-implanted palatal processes showed more satisfactory growth, and the dental arch deformity was suppressed in comparison with the control side. CONCLUSIONS: Our results suggest that the use of atelocollagen matrix on the denuded bone surface following cleft palate repair decreases the scar's effect on maxillary growth.

Aging↗
PubMed2002

New design of a palatal lift prosthesis combined with a palatal bar.

OBJECTIVE: In the past, palatal lift prostheses (PLPs) have been problematic with respect to stability. This stability problem has been addressed by designing a PLP that includes a palatal bar. STRUCTURE: A PLP combined with a palatal bar is functionally characterized by a palatal bar that holds down the posterior palatal plate. By making this location the fulcrum, the force exerted by the soft palate on the lamina actually functions to stabilize the prosthesis instead of acting to overturn it. CASES: This new prosthetic design was applied to patients with cleft palate and those who had undergone cerebral contusion operations. The experimental group was composed of a total of 13 patients (7 men and boys, 6 women and girls) who ranged in age at the time of introduction of the prosthesis from 4 years 6 months old to 54 years 5 months. The period of follow-up after prosthetic insertion ranged from 2 months to 4 years 1 month. In all cases, the stability of the prosthesis was sufficiently maintained. CONCLUSION: Because of increased stability, this technique can be applied to not only adult patients but also children in whom insertion during the deciduous dentition period can be difficult. The new PLP was also found to be effective in patients with cleft palate with a short clinical crown.

Acrylic Resins↗
PubMed2003

Speech development of children with cleft palate before and after palatal surgery.

OBJECTIVE: This study examined the speech production abilities of children with cleft palate before and after palate repair. PARTICIPANTS: Twenty-eight children participated in the study, 14 with cleft palate and 14 without clefts matched for age, gender, and mothers' educational level. MAIN OUTCOME MEASURES: Comparisons were made between the children with cleft palate before and after surgery for canonical babbling ratios, size of consonant inventories, place and manner characteristics, and early developing sounds [p, b, t, d, k, g, m, n, eta]. Also, comparisons were made between the children with cleft palate and their peers without clefts at postsurgery/17 months for the measures described above. RESULTS: Paired t tests revealed differences in pre- and postsurgery performance of the children with cleft palate for production of canonical syllables and size of consonant inventories. Although no significant differences were noted for place and manner features, production of oral stops doubled from the time before surgery to that after surgery. Specifically, production of the bilabial stop [b] showed significant change over time. Results of independent t tests indicated no difference between groups for production of canonical syllables and size of consonant inventories at 17 months. However, significant group differences were noted for production of stops, oral stops, nasals, glides, and alveolars. The children without clefts produced more stops, oral stops, and alveolars. In contrast, more nasals and glides were seen in the vocalizations of the children with cleft palate. CONCLUSIONS: Children with cleft palate made gains in production of canonical syllables and size of consonant inventories postsurgery; however, they continued to show deficits in production of stops and alveolar place features.

Case-Control Studies↗
PubMed1983

Palatal myositis in horses with dorsal displacement of the soft palate.

The histologic and histochemical features of palatine muscles from 53 horses were studied; 25 of the horses were racehorses that had upper airway obstruction associated with dorsal displacement of the soft palate and 28 of the horses did not have any respiratory disorders and served as controls. Pathologic features observed included myonecrosis, phagocytosis, mononuclear cell infiltration of perimysial connective tissue, alkaline phosphatase-positive myofibers, and myofibers with cytoarchitectural changes that included irregular staining of the intermyofibrillar sarcoplasm and sarcoplasmic masses. These histopathologic features were judged to be indicative of myositis. Those features were found in both control horses and horses with dorsal displacement of the soft palate; however, their prevalence was higher in horses with dorsal displacement of the soft palate. For the control horses as well as the horses with dorsal displacement of the soft palate, the inflammatory changes were more prevalent in older horses. The finding of myositis suggests that palatal muscle weakness may contribute to the development of dorsal displacement of the soft palate; however, the myositis might have been secondary to trauma associated with displacement of the soft palate. We could not distinguish between these 2 possibilities. A large number of horses with dorsal displacement of the soft palate also had concurrent pharyngeal lymphoid hyperplasia. Extension of the mucosal inflammatory changes associated with pharyngeal lymphoid hyperplasia into the underlying palatine muscle might have accounted for the myositis.

Airway Obstruction↗
PubMed1984

Palatal analysis and osteology of the hard palate of the Kenyan African skulls.

One hundred twenty-five dry skulls from Kenya that consisted of about 90% Bantu individuals were examined to obtain data on the gross anatomy of the hard palate. The palatine index showed that 43.2% of the total sample of skulls has narrow (leptostaphyline), 23.7% intermediate (mesostaphyline), and 33.1% wide (brachystaphyline) palates. The palatine height index showed that 40% skulls had low (chamestaphyline), 57% intermediate (orthostaphyline), and 3.0% deep (hypsistaphyline) palates. Mean palatal length, breadth, and height for the total sample was 4.92 cm, 4.02 cm, and 1.22 cm, respectively. The incisive foramen and canal was cone shaped in 80% where the diameter of the foramen was less than 0.4 cm, while it was cylindrical in 20% where the diameter was greater than 0.4 cm. Forty-nine per cent of the skulls had two-five lesser palatine foramina present. The greater palatine foramen was found to lie at the level of the third molar in 76%, intermediate between second and third molars in 13.6%, and opposite the second molar in 10.4%. The greater palatine foramen opened antero-medially in 74% and perpendicularly in 26% of the palates. Extensive longitudinal palatal grooves were found bilaterally in all the palates, 70% showed divisions of the grooves, 63.2% had crests along the border of the grooves, and 19.2% had bridges in the posterior part of the groove near the opening of the greater palatine foramen. The incidence of palatine torus was 4.8%. The incisive suture was present in 6.4% of the adult palates.

Anthropometry↗
PubMed1982

Maxillary sinus development in patients with cleft palates as compared to those with normal palates.

Maxillary sinusitis appears to be more prevalent in the cleft palate population than in the normal population. The increase in sinusitis may be due to the fact that the maxillary sinus develops differently embryonically in cleft palate patients than in those patients with normal palates. A double blind study was done by measuring the maxillary sinus cephalometric x-rays in cleft palate patients and then comparing them to patients with normally developed palates. The groups studied were 3 months to 20 years of age. It was concluded that in each of these groups there was no significant difference in size, shape, or rate of development of the maxillary sinus in cleft palate patients compared to the normal population. It is probable that the increased incidence of maxillary sinusitis in cleft palate patients is due mainly to the open palate with constant contamination of the nasal mucosa by food pushed into the nares and sinus ostia, resulting in maxillary sinusitis.

Adolescent↗
PubMed1980

Developmental pattern of cAMP, adenyl cyclase, and cAMP phosphodiesterase in the palate, lung, and liver of the fetal mouse: alterations resulting from exposure to methylmercury at levels inhibiting palate closure.

Exposure to methylmercury (MeHg: 10 mg Hg/kg maternal body weight) on 12(6) (days hours) of gestation significantly delays palate closure in the Swiss Webster CFW mouse. The cAMP content and activity of adenyl cyclase and phosphodiesterase (PDE) were measured in the tissues of control and MeHg-induced cleft palates between 13(6) and 17(6) of gestation. Lung and liver were investigated similarly to determine if MeHg affected the adenyl cyclase system of the palate in a unique manner. In control palatal tissue, cAMP levels increased sharply from 13(22) (undetectable) to 14(6) (maximum). PDE activity increased similarly up to 14(2), but decreased 50% between 14(2) and 14(6). Since it has been reported that cAMP induces the synthesis of PDE, the difference in cAMP/PDE from 13(22) to 14(2) and from 14(2) to 14(6) suggests the localization of relatively high levels of cAMP in at least two separate compartments. Between 14(6) and 14(10), the adenyl cyclase activity of control palates decreased significantly. This rapid decrease suggests relatively high adenyl cyclase activity in the medial edge epithelial cells which undergo autolysis prior to shelf fusion (centered at 14(15). Maternal MeHg administration at 12(6) delayed the median time of palatal shelf rotation (14(13)) by 5 hours, and significantly altered the developmental pattern of the adenyl cyclase system. Thus, the increase in cAMP between 14(2) and 14(6) was abolished and the decrease in adenyl cyclase activity between 14(6) and 14(10) was delayed by almost 20 hours. These changes may be manifestions of a MeHg-induced delay in medial edge epithelial cell differentiation. In a previous study, we observed that the fetal liver exhibits the highest MeHg concentration of all tissues. Since MeHg only slightly altered the adenyl cyclase system of the fetal liver compared to the lung and palate (in which MeHg uptake is considerably less), it may be that the effects of MeHg on palatal tissue are not due to a direct effect of MeHg on components of the adenyl cyclase system.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed2004

Palatal shelf movement during palatogenesis: a fate map of the fetal mouse palate cultured in vitro.

Day-13 fetal mouse palates (plug day=day 0) were labeled with carbon particles at various sites of palatal shelves and cultivated in a chemically defined medium for up to 48 h. During the culture period, the bilateral palatal shelves came in contact and fused with each other, which simulated in vivo palatogenesis. The carbon study revealed that at the midpalatal region, the medial edge of the palatal shelf elevated to the horizontal plane, elongated toward the midline, and made contact with the medial edge of the opposing shelf. On the other hand, near the anterior and posterior ends of the shelf, some new tissue was formed at the medial edge of the shelf by remodeling and this newly formed tissue took part in palatal fusion. The results of the present study indicate that during mouse palatogenesis, the anterior and posterior regions of the palatal shelf behave differently from the midpalatal region. It seems that in the fetal mouse palate, the midpalate closes mainly by means of rotation and medial elongation of the shelf, whereas the anterior and posterior parts of the palate close mainly by tissue remodeling of the medial edge and partly by medial elongation of the shelf.

Animals↗