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PubMed2007

A cross-sectional study of speech in 10-year-old children with cleft palate: results and issues of rater reliability.

OBJECTIVES: To describe speech based on perceptual evaluation in a group of 10-year-old children with cleft palate. A secondary aim was to investigate the reliability of speech-language pathologists' perceptual assessment of cleft palate speech. DESIGN: Retrospective cross-sectional study in children with cleft palate. External raters made assessments from randomized speech recordings. SUBJECTS: Thirty-eight children with unilateral cleft lip and palate (UCLP) or cleft palate only (CPO) and 10 children in a comparison group. MAIN OUTCOME MEASURES: Ratings of hypernasality, hyponasality, audible nasal air leakage, weak pressure consonants, and articulation. Exact agreement and weighted kappa values were used for reliability. RESULTS: Hypernasality was found in 25% of children with a cleft of the soft palate (CSP), 33% of children with a cleft of the hard and soft palate (CHSP), and 67% of children with a UCLP. Similar results were found for audible nasal air leakage. Articulation errors were found in 6% of the CHSP group and 25% of the UCLP group, whereas no child in the CSP group had articulation errors. The reliability was moderate to good for different variables, with lowest values for hypernasality. CONCLUSIONS: Speech results in this series seem less satisfactory than those reported in other published international studies, but it is difficult to draw any certain conclusions about speech results because of large methodological differences. Further developments to ensure high reliability of perceptual ratings of speech are called for.

Articulation Disorders↗
PubMed1992

Medical students' knowledge of and exposure to cleft palate.

To compare the knowledge and experience of medical students in 1989 with that of those surveyed in 1973, a questionnaire about the various aspects of cleft palate was completed by 209 medical students from West Virginia University and the Louisiana State University Medical Center at Shreveport and New Orleans. Results revealed that 1989 students were more familiar with the embryology of cleft palate, racial and gender differences, and intellectual and psychologic issues (p less than .05). In contrast, the 1973 students were more able to define cleft palate, submucous cleft palate, and pharyngeal flap. There was no difference between the two groups of students in the amount of clinical exposure to cleft palate. These findings support the need for greater emphasis on cleft palate at the pre- and postdoctoral levels, as well as within continuing education programs. As part of current programs, the standard of practice of multidisciplinary team management for an individual with cleft palate should be underscored.

Cleft Palate↗
PubMed1996

Characterization of cultured rat embryonic palatal mesenchymal cells.

To investigate developmental palatogenesis, the establishment of palatal cell culture in vitro is preferable to eliminate several complicated biases present in the in vivo environment. We established a primary culture of rat embryonic palatal mesenchymal cells using a special technique to dissect embryonic palatal shelves, and characterized these embryonic cells by immunohistochemical analysis against histiocytic markers. Following preparation of the maxilla of 15.5-day-old rat fetuses, a midline incision of the maxilla was established while the occiput was fixed with microforceps. This procedure allowed eversion of the maxillary process and easy dissection of the palatal shelf. The technique allowed preparation of a large number of palatal shelves with no appendages using a small number of fetuses. Cells cultured with DMEM/F-12 and 10% FBS showed multipotential nature (i.e., not only mere mesenchymal character but also neural, endothelioid, and/or myoblastoid origin were identified by immunostaining with anti-epithelium membrane antigen, keratin, vimentin, S-100 protein, factor VIII, desmin, and lysozyme antibodies, respectively). Our results demonstrated that, during several cell passages, the cultured cell gained myoblastoid characteristics in addition to a neural nature. Further in vitro studies using cultured embryonic palatal mesenchymal cells will assist in characterization of proliferation and differentiation of cells forming the palate.

Animals↗
PubMed1996

Dental findings in parents of children with cleft lip and palate.

The incidence of dental abnormalities in the cleft lip and palate population has been reported to be much higher than in the normal population. The role of genes in the production of a cleft lip and palate, and dental anomalies is thought to be complex, with autosomal dominant, recessive, and x-linked genes all playing a role. Noncleft parents can carry some of the cleft lip and palate genes, which produce clinically subtle manifestations in their facial skeleton. The purpose of this study was to look for evidence of increased dental anomalies in the non-cleft parents of cleft lip and palate children. The dentitions of the parents of 60 children with different types of cleft lip and palate were examined prospectively to see whether or not they exhibited features found more readily in the cleft lip and palate rather than did the normal population. Their dentitions were studied to record the following dental features: congenitally missing teeth, supernumerary teeth, or morphologic changes of the crowns of the permanent teeth. The number and position of any frenal attachments were also recorded. The results of this study did not show any differences in incidence of dental anomalies from the noncleft population. There was no evidence to support the hypothesis that congenital absence of lateral incisors is a microform of cleft lip and palate. Further, these results also failed to reveal any consistent pattern in the number and position of frenal attachments.

Adolescent↗
PubMed1998

Quantitative description of the morphology of the human palate by a mathematical equation.

OBJECTIVE: To derive a three-dimensional mathematical description of normal human hard tissue palatal size and shape. METHODS: The maxillary dental casts of 30 adolescents free from respiratory problems, who had a complete (28 teeth) permanent sound dentition with normal occlusion, were studied. The x, y, z coordinates of several standardized palatal and dental landmarks were obtained with a computerized three-dimensional digitizer. Palatal landmarks were used to derive a mathematical equation of palatal shape in the frontal and sagittal planes. Palatal width, length, frontal and sagittal heights, and sagittal slope, as well as dental arch transverse and anteroposterior dimensions, were computed. RESULTS: Neither the size nor the shape of the palate was significantly influenced by gender. Only the intercanine distance was larger (p < .025) in males than in females. CONCLUSIONS: Data collected in the present investigation could represent a first database for the quantitative description of normal human palatal morphology in subjects with a complete permanent dentition.

Adolescent↗
PubMed1991

A histochemical study of the development of premaxilla and maxilla during secondary palate formation in the mouse embryo.

The development of premaxilla and maxilla in the mouse fetus during secondary palate formation from the 12th to the 16th days of gestation was histochemically assessed. To determine the developmental stages, a classification based on the morphogenesis of the limbs, or the "limb score" (LS) was employed. The stage of LS coincided with the gestational age from the 13th to the 15th days. Early on the 12th day, alkaline phosphatase (ALPase) activity was intense in the mesenchyme lateral to the incisor tooth bud and latero-inferior to the inferior orbital nerve. Subsequently, osteoblasts differentiated at these two sites. The ALPase positive area grew concomitantly with the nasal capsule, the molar tooth germ, and the closure of the secondary palate. The area of bone differentiation contoured the orbital nerve and extended to the rostral part of the secondary palate. At the LS stage -6 (13.52 days), ALPase activity was observed in the mesenchyme medial to, and also surrounding the molar tooth germ. The area of osteogenesis of the secondary palate spread along the medial side of the molar tooth germ, where the formation of the medial alveolar process of the maxilla was completed by the LS stage 3 (15.35 days). The ALPase positive area extended to the horizontal palatal shelves. By late on the 16th day, the palatal process was fully developed. In parallel, bone resorption began on the molar side of the alveolar process. Acid phosphatase and tartrate-resistant acid phosphatase activities (ACPase and TRACPase activity, respectively) revealed ACPase and TRACPase positive mononuclear cells around the molar tooth germ long before ossification occurred. Our results thus suggest an involvement of the incisor tooth bud and the infra-orbital nerve in the initial osteogenesis of the premaxilla and maxilla. Enzyme activities lead to the consideration that osteoclast precursors initiate differentiation around the molar tooth germ. Ostensibly, the mechanical force from the growth of the molar tooth would promote differentiation and activation of osteoclasts located on the alveolar process. Also, the LS classification would improve and simplify future studies of the development of the secondary palate.

Acid Phosphatase↗
PubMed1989

Hard palate and retropalatal space in adult Japanese dry skulls.

This is a basic study designed to elucidate the correlation between the lengths of the hard palate and retropalatal space. We also measured the mean lengths of the hard palate and the retropalatal space, emphasizing on measuring the mean proportional lengths of the hard palate and retropalatal space in relation to the total lengths of these two. This osteometric study was done on 89 adult Japanese dry skulls involving, the measurement of five linear dimensions including two modified dimensions. The lengths of the hard palate had a statistically significant correlation with the retropalatal space length. Clinical significance of this study is that, it will be advantageous for the better assessment of the bony anatomy of palatal inadequacy patients, with speech problems, resulting from abnormalities in the palate and the velopharyngeal port. This study also reports a new term "RETROPALATAL SPACE" to represent the gap in the base of dry skulls between the posterior border of the hard palate and the anterior margin of the for-a men magnum.

Asian People↗
PubMed2005

MR findings of nine cases of palatal tumor.

PURPOSE: To assess the magnetic resonance imaging (MRI) findings of pathologically confirmed palatal tumors. METHODS: Nine cases of palatal tumor were studied. Clinical data, MRI findings, and pathological diagnoses were evaluated. RESULTS: Five cases were tumors of the hard palate and four of the soft palate. Signal intensity on T1-weighted images varied, and hyperintensity was observed on T2-weighted images. Adenoid cystic carcinoma and diffuse large B cell lymphoma showed homogenous signal intensity. Other tumors showed heterogeneous signal intensities. On dynamic contrast analysis, malignant pleomorphic adenoma, adenoid cystic carcinoma, diffuse large B cell lymphoma, and peripheral T cell lymphoma showed early enhancement. On post-contrast T1-weighted images, hard palate pleomorphic adenoma, malignant pleomorphic adenoma, adenoid cystic carcinoma, diffuse large B cell lymphoma, and peripheral T cell lymphoma showed strong enhancement. Although the borders of the tumors were classified as clear in 6 cases treated surgically, macroscopic and microscopic borders of the tumors were unclear. Adenoid cystic carcinoma and hard palate diffuse large B cell lymphoma invaded the maxillary bone. CONCLUSION: Magnetic resonance findings of palatal tumor varied in different histologies. Even with a small palpable portion, malignant tumors could directly infiltrate surrounding structures, which demonstrated well on MRI.

Adenoma, Pleomorphic↗
PubMed1996

The relationship between the palatal form and the maxillary sinus in orang-utan.

The relationship between the palatal form and the maxillary sinus was studied in 40 skulls of male and female Bornean orangutans (Pongo satyrus borneensis) ontogenetically. Univariate analyses of the measurements of the palate and the maxillary sinus showed that the sexual dimorphism appeared earlier in palatal length than in the maxillary sinus volume. Bivariate statistical analyses, including correlation and linear regression analyses, revealed close relationships between the characteristics of the palate and the maxillary sinus for both the growth period and the adult status. Partial correlation coefficients showed, however, that these relations were highly influenced by the skull size. Except significant correlations between the maxillary sinus width and the palatal volume in the adult status, all partial correlation coefficients were clearly below the Pearson's correlation coefficients. In contrast to the situation in humans, this study suggests that under physiological conditions the influence of the palatal form on the maxillary sinus size in the orang-utan is very small. Alterations of the craniofacial morphology during the evolution of the hominids, such as facial reduction and decrease of the maxillary sinus size, are considered important factors which led to changes of the relations between the palatal form and the maxillary sinus.

Animals↗
PubMed1977

Taste acuity of the human palate. I. Studies with electrogustometry and taste solutions on young adults.

The purposes of the study were to determine whether or not taste perception was present in the area which would have been covered by the base plate of a full upper denture and, if taste perception was present there, to compare its strength to that of the remainder of the soft palate and of the apex and base of the tongue. The taste acuity of 32 dental students was measured at the apex and base of the tongue and on the hard and soft palate using two methods, an electric current and sweet, salty, sour and bitter test solutions, the latter in order to determine whether or not there exist differences in the perception of the different taste modalities in these areas. No taste perception could be demonstrated on the hard palate except in the region close to the border between the hard and soft palate, where the threshold values were very high compared with those for the soft palate immediately behind this border and for the tongue. The inter-individual range of the threshold values for the soft palate was very large. Further studies on the taste acuity of the human palate and its role in the total perception of taste are indicated.

Adult↗
PubMed1976

The influence of primary periosteoplasty on maxillary growth and deciduous occlusion in cases of complete unilateral cleft lip and palate. A longitudinal study from infancy to the age of 5.

The influence of infant periosteoplasty upon the growth of the maxilla, its form and size, and the prevalence of malocclusion in the deciduous dentition was investigated. The material consisted of 66 patients with total unilateral clefts of the primary and secondary palate. Thirty-six had periosteoplasty performed in conjunction with cleft-lip and/or palate repair. Thirty patients were operated upon without periosteoplasty and served as controls. Repair of the lip had a notable effect upon the width of the alveolar cleft and palatal cleft, both in the periosteoplasty cases and in the controls, with no certain difference between the groups. Following lip repair, the anterior width of the alveolar arch was slightly reduced. After palatal repair a further reduction was noted in the deciduous dentition, both in the cases treated with periosteoplasty and in the controls, while the posterior width of the palate across the tuberosities increased during growth. In the deciduous dentition, no differences were found in intercanine and intermolar dimensions between the periosteoplasty cases and the controls. Thus, the new bone formed in the cleft area after periosteoplasty does not seem to withstand the contracting forces introduced by palate surgery. An increased length of the buccal alveolar arch on the cleft side, compared with that on the non-cleft side, was found at both the lip repair and the palate repair in the periosteoplasty cases, as well as in the controls. In the deciduous dentition, this difference was negligible. In the deciduous dentition an anterior position of the lateral maxillary segment proved more common in the periosteoplasty cases than in the controls. On the non-cleft side, there was an increased frequency of mesial occlusion and a corresponding decrease of neutral and distal occlusion in the periosteoplasty cases. No increased frequency of anterior crossbite was found even after repeated periosteoplasty, nor was the maxillary dental-arch length unfavourably influenced. Descriptive analysis of occlusion revealed an increase of buccal crossbite in the periosteoplasty cases of a select group of the widest clefts, treated by repeated periosteoplasty. These cases also had the highest total occlusal score according to the numerical classification, while the total occlusal score after one periosteoplasty in patients with less wider clefts was smaller than in the controls. In all patients who had undergone periosteoplasty new bone formed within the alveolar cleft. A good amount of new bone developed in about half the number of cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone Development↗
PubMed1978

The influence of cleft length and palatoplasty on the dental arch and the deciduous occlusion in cases of clefts of the secondary palate.

In patients with clefts of the secondary palate, the effect of surgical reconstruction was studied from the time of the palate repair, at the age of 18-24 months, to the age of 5 years. The material comprised 99 children (37 boys and 62 girls). The material was grouped according to the antero-posterior size of the cleft. The changes of the maxillary dimensions were studied on the casts by linear measurements. The occlusion was analysed by descriptive and numerical methods. In the deciduous dentition the smallest intercanine and intermolar dimensions were recorded in patients with large palatal clefts. A the age of 5, the frequency of anterior crossbite was 38% in patients with large palatal clefts, compared with 19--21% in patients with smaller clefts. In boys with cleft palates, the frequency of anterior crossbite was 13% higher than in girls, in spite of the fact that in the material the incidence of large palatal clefts was lower in boys than in girls. In cases of large clefts of the secondary palate, the incidence of anterior crossbite was 12.5 times higher than in a material of non-cleft patients of the same age.

Anthropometry↗
PubMedDate not supplied

Altered expression of retinoic acid (RA) receptor mRNAs in the fetal mouse secondary palate by all-trans and 13-cis RAs: implications for RA-induced teratogenesis.

Retinoic acid (RA) is mandatory for various biological processes and normal embryonic development but is teratogenic at high concentrations. In rodents, one of the major malformations induced by RA is cleft palate (CP). RA mediates its effects by RA receptors (RARs), but the expression patterns of RARs in the developing palate are still unclear. We investigated the normal expression of RAR alpha, beta, and gamma messenger RNAs (mRNAs) in the fetal mouse secondary palate and the effects of all-trans and 13-cis RAs on the expression of RAR mRNAs by Northern blot analysis. RAR alpha (2.8, 3.8 kb), RAR beta (3.3 kb), and RAR gamma (3.7 kb) mRNAs were detected in the fetal palate on gestational days (GD) 12.5-14.5. The expression of RAR alpha and gamma mRNAs did not show apparent sequential changes, but that of RAR beta mRNA increased at GD 13.5. Treatment of pregnant mice with 100 mg/kg all-trans RA induced CP in 94% of the fetuses and elevated the levels of RAR beta and gamma mRNAs in the fetal palate. The up-regulation of RAR beta mRNA by all-trans RA was more marked than that of RAR gamma mRNA. Treatment with 100 mg/kg 13-cis RA induced CP in only 19% of the fetuses. Although 13-cis RA elevated the RAR beta and gamma mRNA levels in fetal palates, its up-regulation was slower and less marked than that induced by all-trans RA. These findings indicate that the induction of RAR beta mRNA in the fetal palate correlates well with the tissue concentration of all-trans RA after RA treatment, and RAR beta may be one of the most influential candidate molecules for RA-induced teratogenesis.

Animals↗
PubMed1999

[Integrated treatment of cleft lip and palate. Organization of a treatment team].

OBJECTIVE: Collect the team experience in the treatment of children with cleft lip and palate, indicating the evolution of the team composition, advantages and improvement aspects, trying to transmit the need of team treatment. METHOD: The Bilbao cleft palate team was created in 1983, since then a cleft palate clinic, a parents group and a unit of velopharyngeal function has been developed. At present the team is composed by: pediatric reconstructor surgeon, speech therapist, orthodontist, dentist, pediatrician, ENT, maxillofacial surgeon, dismorphologyst, geneticist, nursing. RESULTS: One of the achievements has been the data unification, obtaining speech cephalometrics, photographic dental casts and video images with prospective view. At this time 403 cleft lip and palate children have been intervened, being essential the transdisciplinar team approach between surgeon, speech therapist and orthodontist. The importance of the team coordinator is pointed. The results of an audit of the two stage cleft palate closure in complete unilateral cleft lip and palate have obligated us to vary our surgical policy. The unresolved aspects are the lack of multidisciplinary team recognition at official level and the non existence of orthodontist in staff, without cost coverage of this treatment by public health system. CONCLUSIONS: In our experience the team treatment of cleft lip and palate has resulted in improvement of the clinic results, treatment protocols and training.

Adolescent↗
PubMed2000

The TGF-beta type III receptor is localized to the medial edge epithelium during palatal fusion.

During palatal fusion, the medial edge epithelial cells (MEE) but not the oral/nasal palatal epithelium, selectively undergo epithelial-mesenchymal transformation. It is known that this process is regulated, at least in part, by endogenous TGF-beta3. One conceivable mechanism is that restricted expression of TGF-beta receptors (TbetaRs) in a subpopulation of cells may localize TGF-beta responsiveness (Brown et al., 1999). However, TGF-beta type II receptor (TbetaR-II) is expressed by all palatal epithelial cells during palatal fusion (Cui et al., 1998) and therefore cannot localize TGF-beta3 responsiveness. To investigate the role of TGF-beta type III receptor (TbetaR-III) in MEE transformation, we examined the expression pattern of TbetaR-III in the developing palate from E12 to E15 mice in vivo and in vitro by immunohistochemistry and compared the expression pattern to that of type I receptor (TbetaR-I). The expression of TbetaR-III was temporo-spatially restricted to the MEE during palatal fusion, while the expression of TbetaR-I was primarily localized in all palatal epithelia, consistent with the expression patterns of TbetaR-II and TGF-beta3 (Cui et al., 1998). These results support our hypothesis that TbetaR-III localizes and mediates the developmental role of TGF-beta3 on MEE transformation by specific expression in the MEE. TbetaR-III may modulate TGF-beta3 binding to TbetaR-II in the MEE cells to locally enhance TGF-beta3 autocrine signaling through the TbetaR-I/TbetaR-II receptor complex, which contributes to MEE selective epithelial-mesenchymal transformation.

Activin Receptors, Type I↗
PubMedDate not supplied

Palate vault morphology in Down syndrome.

Moire topography was used to quantitatively determine the shape of the palatal vault in 57 Spanish patients with Down syndrome (DS) (38 males and 19 females; age range 18-36 years) and in 100 normal controls (N) (76 males and 24 females; age range 20-29 years). The topographic image for each palatal vault was analyzed and approximately 40 sets of coordinates (x, y, z) were recorded. Other parameters, including length, width and maximum height, were recorded from the palate vault images. No appreciable sexual dimorphism in palate dimensions was observed in DS subjects versus the situation in N subjects. Globally, the average N dimensions were significantly greater than those in the DS patients (P < 0.005). A special palatal morphology was found to be associated with DS, with different ratios for the three dimensions (mean factor 0.88 for length, 0.81 for width and 0.73 for height), versus the healthy palatal vaults. It is concluded that palatal morphology in DS fits an elliptic paraboloid. On the other hand, no lineal correlation was observed between height, width and length in the DS and N groups. The scatter plots of bivariate data exhibited a shapeless morphology. The lineal correlation coefficients ranged from 0.008 to 0.33 for the DS and N groups.

Adolescent↗
PubMed2001

Intraoperative fabrication of palatal prosthesis for maxillary resection.

BACKGROUND: Immediate placement of a palatal prosthesis has become the standard of care after maxillectomy or palatectomy, except when free-flap reconstruction is used. Palatal prostheses are usually fabricated preoperatively. Infrequently, the surgeon may face a situation where upper jaw resection has been performed and a prefabricated prosthesis is not available. OBJECTIVE: To describe a method of rapid intraoperative fabrication of a palatal prosthesis, which allows immediate oral intake and excellent speech. PROCEDURE: Two sheets of thermoplastic dressing (Aquaplast; WFR/Aquaplast Corporation, Wyckoff, NJ) were immersed in hot water. As they became soft and pliable, they were applied to the remaining hard palate and alveolar ridge. As the material cooled, it hardened, with its shape conforming to the remaining hard palate, alveolar ridge, and teeth. The rigid stent was then removed, trimmed, and fashioned to cover the palatal and maxillary defect. The stent was then wired to the remaining alveolar ridge and to the ipsilateral zygomatic buttress or lateral orbital rim. Removal of the stent was easily accomplished in an office setting. PATIENTS: Twelve patients required partial upper jaw resection without available prefabricated prostheses. Of these, 3 patients underwent emergency surgery for mucormycosis and 2 for bleeding malignant tumors; 3 underwent bone resection more extensive than that anticipated preoperatively; and 4 did not have prefabricated prostheses for other reasons. RESULTS: The thermoplastic prosthesis achieved its goals in all 12 patients. Eleven patients achieved oral food intake within 24 hours. One patient remained in a coma after extensive maxillary, orbital, and skull base resection for mucormycosis. The prosthesis was removed after 4 to 12 weeks and replaced with a permanent implant in 11 of the 12 patients. CONCLUSIONS: This simple, quick, and inexpensive intraoperative fabrication of palatal prosthesis requires no special expertise and equipment. It allows immediate oral intake and excellent speech.

Carboxymethylcellulose Sodium↗
PubMed1998

[The influence of implantal autograft bone in total cleft palate on maxillary growth an experiment study in dogs].

OBJECTIVE: To test the hypothesis that implant autograft bone in total cleft palate at primary cleft palate repair which may resists the disturbance of maxillary growth by cleft and denud bony wound. METHODS: 40 dogs were randomly divided into four groups: three control groups and one experimental group. The first control group was unoperated, the second group had a surgically created cleft plate, the third group also had a surgically created cleft palate. Using a two-flap procedure immidiately, the experiment group had a surgically created cleft palate, but the palate was recontracted by implanting a piece of autograft rib bone with two-flap repair. All animals were sacrificed on the 34th week after operation (43 weeks postnatal). Thirty-four metricranial variables were measured directy from the cleaned skulls. RESULTS: The method is useful for maxillary growth and development by bone implant in total cleft palate, but it can cause maxillary deformity. CONCLUSION: Clinical doctors should be cautious in using the method of primary-delay bone grafting in reparing total cleft of cleft palate.

Animals↗