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Effects of methanol on embryonic mouse palate in serum-free organ culture.

Methanol has widespread applications in industry and manufacturing and is under consideration as an alternative automotive fuel. Human exposure to methanol would be expected to increase if applications expand in coming years. Methanol has been shown to be a reproductive and developmental toxicant in the rodent, producing cleft palate in the CD-1 mouse. Developmental toxicity has also been demonstrated in vitro for rat and mouse embryos in whole embryo culture. The present study examines the developmental toxicity of methanol in the palate using a serum-free organ culture model. Gestation day 12 CD-1 mouse embryos were dissected and mid-craniofacial tissues were cultured in BGJ medium at 37 degrees C for 4 days with medium changes at 24 hr intervals. Cultures were exposed to methanol from 0-20 mg/ml for 6 hr, 12 hr, 1 or 4 days. Some cultures were exposed to ethanol for 4 days at doses ranging from 0-15 mg/ml. All cultures were gassed with a 50% O2, 5% CO2, and 45% N2 upon addition of fresh medium and prior to the addition of alcohol. Following organ culture the craniofacial explants were examined for effects on morphology, fusion, proliferation, and growth. Incidence and completeness of palatal fusion decreased with increasing exposure. Depending on the concentration and duration of methanol exposure, the medial epithelium either degenerated completely or remained intact in unfused palates and either condition would interfere with fusion. Cellular proliferation appeared to be a specific and sensitive target for methanol as craniofacial tissues responded to methanol with reduction in total DNA content at an exposure that did not affect total protein. However, both DNA and protein decreased with increasing exposure to methanol. Incorporation of thymidine decreased significantly after 4 day exposure and autoradiography of 3H-thymidine (TdR) demonstrated exposure-dependent reduction in proliferation of palatal mesenchymal cells. Ethanol decreased fusion score, total protein, and DNA, but 3H-TdR/DNA was not significantly changed. In general the ethanol was more potent than methanol for inhibition of protein and DNA synthesis and palatal fusion. This study demonstrated that methanol can selectively affect specific sensitive cell populations and has effects on proliferation and cell fate.

Animals↗

Calcitonin gene-related peptide (CGRP)-immunoreactive sensory and motor nerves of the mammalian palate.

The distribution of calcitonin gene-related peptide (CGRP)-immunoreactive nerve fibres in the palate of rat, cat and monkey was studied using immunocytochemistry and radioimmunoassay. CGRP-containing nerve fibres were found, in all species studied, to form a rich plexus in the subepithelial and submucous layers, around excretory ducts and blood vessels. A small number of CGRP-containing nerve fibres penetrated the epithelium of the hard and soft palate, and terminated as free endings. Some CGRP-containing nerve fibres were found in the vicinity of the mucous glands. CGRP-immunoreactive motor end plates were seen in the striated muscle (tensor veli palatini) of the soft palate. Following capsaicin treatment a small depletion in CGRP-immunoreactive nerve fibres in the rat palate epithelium was noted. In contrast, CGRP immunoreactive fibres forming rich plexuses in other layers of the palate, including motor end plates, were not affected. The extractable CGRP showed no significant depletion (normal animals [n = 10] 21.7 +/- 2.4 pmol/g compared with capsaicin-treated animals [n = 10] 17.5 +/- 1.8 pmol CGRP/g wet weight). The reduction in the number of visible immunoreactive nerves following capsaicin application tends to confirm the sensory character of the CGRP-containing nerve fibres terminating in the epithelium of the hard and soft palate. The capsaicin insensitive CGRP-immunoreactive nerve fibres may thus have a predominantly motor function.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Rat embryonic palatal shelves respond to TCDD in organ culture.

TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin), a highly toxic environmental contaminant, is teratogenic in mice, inducing cleft palate (CP) and hydronephrosis at doses which are not overtly maternally or embryo toxic. Palatal shelves of embryonic mice respond to TCDD, both in vivo and in organ culture, with altered differentiation of medial epithelial cells. By contrast, in the rat TCDD produces substantial maternal, embryonic, and fetal toxicity, including fetal lethality, with few malformations. In this study the possible effects of maternal toxicity on induction of cleft palate were eliminated by exposure of embryonic rat palatal shelves in organ culture. The shelves were examined for specific TCDD-induced alterations in differentiation of the medial cells. On Gestation Day (GD) 14 or 15 palatal shelves from embryonic F344 rats were placed in organ culture for 2 to 3 days (IMEM:F12 medium, 5% FBS, 0.1% DMSO) containing 0, 1 x 10(-8), 1 x 10(-9), 1 x 10(-10), or 5 x 10(-11) M TCDD. The medial epithelial peridermal cells degenerated on shelves exposed to control media or 5 x 10(-11) M TCDD. Exposure to 10(-10), 10(-9), and 10(-8) M TCDD inhibited this degeneration in 20, 36, and 60% of the shelves, respectively, and was statistically significant at the two highest doses. A normally occurring decrease in [3H]TdR incorporation was inhibited in some GD 15 shelves cultured with 10(-10) and 10(-9) M TCDD. The medial cells of TCDD-exposed shelves continued to express high levels of immunohistochemically detected EGF receptors. The altered differentiation of rat medial epithelium is similar to that reported for TCDD-exposed mouse medial cells in vivo and in vitro. However, in order to obtain these responses, the cultured rat shelves require much higher concentrations of TCDD than the mouse shelves. Thus TCDD induces the same effects at a cellular level in medial epithelium of rats and mice, but cleft palate is not seen in rats because the level required to produce the cellular effects would result in maternal and embryonic toxicity including fetal lethality.

Animals↗

Use of the palatal flap for closure of an oronasal fistula.

Palatal obturators are frequently used in the initial treatment of postoperative palatal fistulae to address the associated problems experienced with speech and swallowing. Many reconstructive surgical techniques for palatal defects have been reported. Although palatal-based flaps are less frequently reported, they can offer a relatively simple reconstructive option with minimal morbidity in patients with acquired palatal defects. We present a case report of a patient requiring reconstruction of a midline oronasal fistula after resection of a palatal malignancy and review the literature concerning this technique.

Female↗

The Furlow Z-plasty in two-staged palatal repair modifications and complications.

OBJECTIVES: To report the modifications and complications of the Furlow palatoplasty for two-stage closure of the palate. PATIENTS AND METHODS: Prospective study of a consecutive series of 45 primary closures of the soft palate portion of clefts extending into the hard palate; mean (S.D.) age at repair 12 (2) months; median follow-up 4 years 4 months (range 2 months to 9 years). The hard palatal part of the cleft was closed in 18 patients at the mean age of 3 years 11 months. RESULTS: The main modifications that we made were the use of quilting sutures, lateral V-Y closures, and fibrin glue application, and the omission of lateral releasing incisions. Patients stayed in hospital for a median of 4 days (range 3-8 days). Two patients had postoperative partial obstruction of the airway and were given steroids. In six patients, a smaller portion of the oral layer of the wound broke down; it healed by secondary intention in five, but resulted in partial dehiscence in one. There were no oronasal fistulas in the 18 patients who had delayed closure of the hard palate part of the cleft. Secondary pharyngoplasty was not necessary in any patient. CONCLUSION: Furlow's technique has been modified for use in the two-stage closure of complete cleft palates (with or without cleft lip or alveolus) with an acceptable rate of complications.

Airway Obstruction↗

Snail family members and cell survival in physiological and pathological cleft palates.

Palate fusion is a complex process that involves the coordination of a series of cellular changes including cell death and epithelial to mesenchymal transition (EMT). Since members of the Snail family of zinc-finger regulators are involved in both triggering of the EMT and cell survival, we decided to study their putative role in palatal fusion. Furthermore, Snail genes are induced by transforming growth factor beta gene (TGF-beta) superfamily members, and TGF-beta(3) null mutant mice (TGF-beta(3)-/-) show a cleft palate phenotype. Here we show that in the wild-type mouse at the time of fusion, Snail is expressed in a few cells of the midline epithelial seam (MES), compatible with a role in triggering of the EMT in a small subpopulation of the MES. We also find an intriguing relationship between the expression of Snail family members and cell survival associated to the cleft palate condition. Indeed, Snail is expressed in the medial edge epithelial (MEE) cells in TGF-beta(3)-/-mouse embryo palates, where it is activated by the aberrant expression of its inducer, TGF-beta(1), in the underlying mesenchyme. In contrast to Snail-deficient wild-type pre-adhesion MEE cells, Snail-expressing TGF-beta(3) mutant MEE cells survive as they do their counterparts in the chick embryo. Interestingly, Slug is the Snail family member expressed in the chick MEE, providing another example of interchange of Snail and Slug expression between avian and mammalian embryos. We propose that in the absence of TGF-beta(3), TGF-beta(1) is upregulated in the mesenchyme, and that in both physiological (avian) and pathological (TGF-beta(3)-/-mammalian) cleft palates, it induces the expression of Snail genes promoting the survival of the MEE cells and permitting their subsequent differentiation into keratinized stratified epithelium.

Animals↗

Rapid palatal expansion. Part 2: Dentoskeletal changes in cats with patent versus synostosed midpalatal suture.

Intercanine expansion (C-C) following rapid palatal expansion is made up of sutural displacement (Sd-Sd), tooth tip (Tt-Tt), tooth displacement (Td-Td), and alveolar process tipping and bending (At+b-At+b). The involvement of these four components was studied on 10 rapid palatal expansion treated and two control cats during an active phase (25 days), a retention phase (60 days), and a relapse phase (60 days). The midpalatal suture was analyzed for linear measurements, radiopaque versus radiolucent zones and optical density from occlusal radiographs. Nine treated cats exhibited sutural split and one treated cat showed no split as a result of synostosis of the suture. The contribution of the four constituents [(Sd-Sd):(Tt-Tt):(Td-Td):(At+b-At+b)] to the C-C expansion changed from active to relapse phase from [45%:15%:25%:15%] to [50%:25%:25%:0%] in the animals with sutural split and from [0%:40%:60%:0%] to [0%:0%:100%:0%] in the cat without sutural split, implying the major role of sutural displacement in patent suture, and tooth displacement in synostosed suture. The latter indicates the potential buccal corticalis fenestration, dehiscence or perforation in synostosed suture undergoing RPE. In patent suture (animals with sutural split), optical density increased during rapid palatal expansion (soft tissue build-up) and decreased during retention (remineralization) and relapse phases (medial convergence of the palatal processes). In the animal without sutural split, a continuous decrease in the optical density (predetermined ossification) was found. The progressive six-fold surge in coefficient of variation of C-C expansion during the relapse phase indicates limitation in predicting rapid palatal expansion stability. Clinically, the use of serial occlusal radiographs during rapid palatal expansion is recommended to evaluate patency and extent of retention period.

Animals↗

The pathology of the velopharyngeal musculature in cleft palates.

AIMS: This article draws attention to a pathological finding in the cleft palate condition that has not been previously described: It is demonstrated that the palatal aponeurosis exists even in cleft palates, but it is disrupted, malpositioned and folded in 2 layers. It is possible to dissect the 2 layers and to unfold the aponeurosis to form a tough tendinous plane. Thus, the retropositioning of the levator veli palatini muscle sling is facilitated. CONCLUSION: For a normal reconstruction of the cleft palate it is not only necessary to reconstruct the levator veli palatini muscle sling but also to approximate and to suture the fibres of the palatal aponeurosis to the corresponding fibres of the opposite side after unfolding them in a mediodorso-cranial direction. In this manner a continuous palatal aponeurosis can be created and subsequently it can serve as a transmitter of the muscle forces.

Cleft Palate↗

Craniofacial morphology in children with complete unilateral cleft lip and palate: a comparison of two surgical protocols.

The facial morphology of 2 groups of complete unilateral cleft lip and palate children (n = 75), ranging in age from 4 to 7 years old, were retrospectively studied cephalometrically before the beginning of the orthodontic treatment. Each group was submitted to a different surgical protocol. The control group was comprised of 53 children (33 males and 20 females) and was treated according to the surgical protocol of the Hospital for Rehabilitation of Craniofacial Anomalies (HRCA) from the University of São Paulo, in Bauru, Brazil. Lip repair was performed between 3 months and 27 months of age (mean age of 9 months) and palate repair between 12 months and 44 months of age (mean age of 19 months). The experimental group was comprised of 22 children (12 males and 10 females). They were treated with Malek's surgical protocol, modified at the HRCA, with lip and soft palate repair at 5.5 months of age on average and hard palate repair at 20 months of age on average. The cephalometric results did not show any difference, suggesting that both surgical protocols have the same influence on facial growth, at least during the age range studied. Therefore, palate repair in 2 surgical times with earlier closure of the soft palate (Malek's protocol) did not cause greater restriction to the midface growth.

Age Factors↗

[Plastic reconstructive surgery of soft palate defects--functional and oncological aspects].

BACKGROUND: Resection of the soft palate in tumor surgery can lead to significant swallowing disorders. Therefore rehabilitation needs a functional reconstruction of the remaining defects. MATERIALS AND METHODS: In four years, nine patients received a partial removal, and six patients a total removal of the soft palate including adjacent parts of the oropharynx in six cases due to oropharyngeal carcinoma. Partial defects were reconstructed with a neurovascularized infrahyoidal muscle flap, total defects with fasciocutaneous flaps of the lateral arm, radial forearm or scapula region. The function of the new palate was evaluated by interview, cinematography, and pressure measurements of the pharynx. RESULTS: These investigations demonstrated proper swallowing without aspiration or regurgitation in all cases. Values of 60% of normal pressure behind the palate have been achieved after palate reconstruction with a pressure slope directed into the hypopharynx. Decannulation was possible on average 34 days postoperatively, removal of the feeding tube on average 29 days postoperatively. Now 87% of our patients are free of tumor after a mean observation time of 24 months. In light of the fact that two-thirds of all patients suffered from advanced carcinoma, results can be considered as good. This study shows good functional and oncologic results after tissue reconstruction of the soft palate.

Adult↗

The healing process of palatal tissues after operations with and without denudation of bone: an experimental study in dogs.

The aim of this study was to evaluate wound healing clinically and histologically in beagle dogs after palatal repair during growth by the partially split flap technique and the von Langenbeck technique. A standardised soft tissue defect was created in the medial region of the palate. The partially split flap technique was performed in 14 dogs (age 12 weeks). Von Langenbeck repair was simulated in 12 dogs (age 12 weeks). Four dogs (age 12 weeks) served as controls. Standardised slides of the palate were taken on eight occasions and the wound surface areas were measured. Histological sections were prepared at three different ages. The animals were studied until the age of 25 weeks. Re-epithelialisation was complete in roughly two weeks in dogs after palatal repair by the partially split flap technique. The histological features of this group were close to normal limits. After the von Langenbeck's procedure re-epithelialisation took about three weeks and scar tissue was firmly attached to bundle bone by Sharpey's fibres. We conclude that the histological appearance of the palatal tissues in dogs after palatal repair during growth by the partially split flap technique was close to normal. We assume that this is reason for more favourable dentoalveolar development after the partially split flap technique compared with von Langenbeck's repair.

Animals↗

Inhibition of adenylate cyclase in perfusion mouse palate by secalonic acid D.

Glucocorticoids (GC) induce cleft palate (CP) in the offspring of exposed pregnant mice. Glucocorticoids induce prostaglandin (PG) synthesis inhibition via reduced arachidonic acid (AA) release from membranes, and this results from inhibition of phospholipase A2. This metabolic event is associated with reduced palatal cAMP levels in the prefusion stages (d 13 of gestation). The mycotoxin secalonic acid D (SAD) induces CP in the offspring born to treated mothers, elevates maternal plasma corticosterone levels, and reduces prefusion palatal cAMP levels. In addition, an increase in cAMP was noted in the postfusion period (d 15 of gestation). Since exogenous AA given simultaneously to GC-exposed mothers may protect against GC-induced CP in the offspring, such a possibility was tested for SAD. Pregnant CD1 mice given a teratogenic dose of SAD (30 mg/kg, ip, on gestational d 11) were simultaneously treated with maximal tolerated doses of AA (200 mg/kg, sc, on gestational d 11, 12, and 13). At term, no significant reduction in SAD-induced CP was seen as a result of AA treatment. To evaluate if SAD-induced alterations in palatal cAMP are due to reduced palatal membrane-associated adenylate cyclase (AC) activity during pre- and postfusion periods, SAD-treated mothers were sacrificed at 12-h intervals between gestational d 13.5 and 15.5, palate shelves were collected from the fetuses, and AC activity (cAMP formed/mg protein/min) was assayed in the presence or absence of the enzyme stimulator, sodium fluoride (NaF). Although SAD did not alter unstimulated AC activity, it significantly reduced the NaF-induced stimulation of enzyme activity in the prefusion period. This inhibition could not be reversed by excess GTP in the incubation mixture. Since NaF stimulation of AC indicates post-receptor-site function involving GTP-binding and catalytic units, and since addition of GTP failed to correct SAD-induced alteration of NaF stimulation of the enzyme, it is suggested that SAD may inhibit the AC sensitivity to stimuli by its effect on the catalytic unit in a manner that does not affect enzymic basal activity.

Adenylyl Cyclases↗

Human prenatal palatal shelf elevation related to craniofacial skeletal maturation.

Much attention has been focused on the mechanisms responsible for the elevation and fusion of the palatal processes during formation of the secondary palate. In a former publication this closure, defined as fusion of the palatal shelves along their length, was described as occurring at a period in osseous palatal development characterized by incipient ossification of the maxillae and palatine bones, and at a stage in early mandibular development when the mandibular condyle has not developed. The purpose of the present study was to examine the osseous maturation of the cranial base at the time of palatal closure. The investigation was based on 62 human embryos and fetuses, CRL 22-57 mm, and general skeletal hand and foot maturation CNO = 0-0 to CNO = 8-1 (CNO, Composite Number of Ossified bones in hand and foot). From the fetuses, cranial tissue was dissected out and skeletal maturity was determined radiographically according to formerly described skeletal maturity stages in the cranial base. The study revealed that the soft tissue palatal shelves always elevate and fuse along their length at a specific, well-defined stage of maturity in the cranial base. The cranial base development in this stage is characterized by unossified cartilage. This information is essential for understanding abnormal skeletal development of the oral and nasal cavities.

Facial Bones↗

Gross and microscopic anatomical studies of palate structure and osteotomy site.

A normal 1-year-old infant palate and a newborn cleft palate were studied grossly, radiographically, and microscopically for histological structure in hard palate osteotomy sites. A correlated study of biopsies from an osteotomy site seven days postoperatively and another at twelve months following osteotomy was also made. The findings showed that successful osteotomy in infant cleft palate surgery translocates autogenous fibrous bone and osteogenic cells into a cleft-bridging position. Woven fibrous bone rapidly forms across the cleft, and then matures by lamellar bone replacement and haversian system remodeling. Both normal and cleft palates have a rich anastomosis of microscopic blood supply that is vitally important in the remodeling process. These factors may help to explain successful long-term results in early cleft palate osteotomy surgery.

Cartilage↗

Solitary metastatic melanoma of the soft palate.

Melanoma of the oral mucosa is frequently situated in the area of the hard palate but extremely rarely in the soft palate. Even metastatic tumors are very rare in this location, and surgery at this stage is seldom indicated. Two patients with solitary metastatic melanoma of the soft palate are described. In both, a subtotal excision of the soft palate was performed, completed by reconstruction with pharyngeal flaps and island flaps from the hard palate. Both patients are alive and free from recurrence 12 years and 4 years after the primary diagnosis of melanoma and 2 years and 18 months after the palatal reconstruction. One patient has normal speech with no nasality; the other patient has very slight hypernasality but no other problems.

Adult↗

Lipoinjection augmentation of the soft palate for velopharyngeal stress incompetence.

OBJECTIVES/HYPOTHESIS: Velopharyngeal stress incompetence in professional musicians is an uncommon but potentially career-ending problem. Pharyngeal flaps, V-Y palatal pushback procedures, Teflon or collagen injection of the posterior pharyngeal wall, and speech therapy have all been used to address this problem. The ideal procedure for this subset of patients with velopharyngeal incompetence (VPI) with high-pressure, mild VPI would be one that combines low morbidity and an expedient recovery for the busy musician. We describe an approach of endoscopically assisted autologous lipoinjection of the soft palate. STUDY DESIGN: A retrospective review of our experience treating high-pressure stress VPI in two professional musicians. METHODS: Literature review and retrospective chart review. RESULTS: Two musicians underwent autologous lipoinjection of the soft palate for stress VPI. Patients resumed full play within 2 weeks of the operation with no serious complications. There has been no recurrence of the VPI after 18 and 12 months of follow-up, respectively. CONCLUSIONS: Velopharyngeal stress incompetence in musicians is an uncommon disorder. Velopharyngeal incompetence in these patients may not present as in a typical manner with hypernasality but may go undiagnosed for years mistakenly rationalized as a declining performance ability rather than a curable structural problem. The performance demands of professional musicians necessitate a timely solution to their VPI. More precise and limited contouring of palatal bulk can be achieved through the lipoinjection technique than compared with traditional palatal V-Y pushback or a standard pharyngeal flap. Lipoinjection of the palate can be performed as an outpatient procedure with only minor discomfort and an expedient recovery for the career musician.

Adipose Tissue↗

Surgical technique for the correction of postpalatoplasty fistulae of the hard palate.

Postpalatoplasty fistulas of the hard palate remain challenging. The reported recurrence rate after surgical correction ranges between 33 and 37 percent. The authors describe a surgical technique for the correction of postpalatoplasty fistulas by total elevation of the palatal gingivoperiosteum starting at the dental sulcus, excision of the fistula, and watertight separate closure of the nasal and palatal mucosa by means of the transoral approach. This technique has the advantages of providing adequate exposure for closure of the nasal mucosal gap and allowing closure of the palatal defect under minimal tension. Placement of interdental sutures leaves no raw bone surfaces exposed. The authors have used this technique on 60 consecutive patients with fistulas of the primary and secondary hard palate between 1998 and 2003. Their overall success rate of fistula closure was 90 percent. The success rate for previously unoperated postpalatoplasty fistulas was 96.9 percent. All of the failures occurred in patients who had bilateral cleft lip and palate. No complications of tooth loss or gingival recession were observed. A detailed description of the technique with illustrations is provided.

Adolescent↗

Short hard palate in prenatal trisomy 21.

OBJECTIVE: The aim of the present study was for the first time to examine on postmortal material the total midpalatal length of the hard palate and the length of its two components (the maxillary and palatine parts) in trisomy 21 fetuses, and to compare the results to normal standards. DESIGN: Material from 31 human fetuses with genetically verified trisomy 21 was studied. The fetuses were derived from legally induced or spontaneous abortions. Palates were, after sectioning, radiographed in lateral projection (Grenz Ray radiographic apparatus). Cephalometric measurements were performed with a digital caliper. Statistically, the length measurements for the two groups were compared, adjusting for crown rump length (CRL) through linear regression. At two specific ages (150 and 170 mm CRL), the length of the palatal components in trisomy 21 was compared to normal standards. RESULTS: For CRL 150 mm and CRL 170 mm it appears that all three palatal lengths, total length, maxillary length, and palatinal length are significantly shorter in fetuses with trisomy 21. CONCLUSION: The main conclusion of our study is that the total palatal length in prenatal trisomy 21 is shorter than normal and that this is due both to a shortness of the maxillary and the palatine components of the hard palate.

Cephalometry↗