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PubMed1994

Respiratory-related activity of soft palate muscles: augmentation by negative upper airway pressure.

We studied respiratory-related activity of the soft palate muscles in 10 anesthetized tracheostomized supine dogs. Moving time average (MTA) electromyographic (EMG) activity was measured in the palatinus (PAL), levator veli palatini (LP), and tensor veli palatini (TP) with bipolar fine-wire electrodes and in the diaphragm with bipolar hook electrodes. Measurements were made during tracheostomy breathing and nasal breathing with the mouth sealed (NB). During tracheostomy breathing, all soft palate muscles displayed respiratory-related phasic inspiratory and expiratory as well as tonic EMG activity. During NB, peak inspiratory EMG activity increased in PAL, LP, and TP because of an increase in both phasic inspiratory and tonic MTA activity. In contrast, phasic expiratory activity did not change. A constant negative pressure equal to peak inspiratory tracheal pressure during NB was applied to the caudal end of the isolated upper airway with the nose occluded. This was associated with soft palate muscle responses qualitatively similar to the responses during NB but accounted for only 39, 25, and 32% of the magnitude of the peak inspiratory MTA EMG responses to NB in PAL, LP, and TP, respectively. Our results demonstrate that the soft palate muscles exhibit respiratory-related activity in common with other upper airway muscles. Furthermore, such activity is augmented in each soft palate muscle during NB, and negative upper airway pressure makes a substantial contribution to the recruitment of soft palate muscle activity.

Anesthesia↗
PubMed1993

Evaluation of speech after completed late closure of the hard palate.

Speech was analyzed about 1 year postoperatively in 30 patients with cleft lip and palate who were the first ones to undergo late closure of the hard palate in Gothenburg, Sweden. Fourteen had bilateral and 16 had unilateral clefts. Soft palate closure had been performed at the mean age of 8 months, and the hard palate was closed at the mean age of 8 years with a range of 7-11 years. Imitated and spontaneous speech was analyzed at an average of 15 months after palatal repair. Six percent had moderate to severe hypernasal speech and 23% had retraction of dental consonants. No glottal articulation was found. Hoarseness and deviant s articulation were frequent. For 6 of the patients the same speech analysis was also made 1-3 months postoperatively. At this time there was no change in the speech of these 6 children compared with preoperative speech. Thus, the closure of the palate did not improve the speech directly. The improvement of the speech seems to be a gradual process.

Child↗
PubMed2005

Distraction osteogenesis for bony repair of cleft palate by using persistent elastic force: experimental study in dogs.

OBJECTIVE: The purpose of this study was to investigate the possibility of closing a cleft and lengthening the hard palate by the technique of distraction osteogenesis with elastic forces and to evaluate the influence of the management on the facial structure. DESIGN: Thirty 6-month-old mongrel dogs were assigned randomly to two groups with five subgroups for different purpose. INTERVENTIONS: An 8- x 25-mm cleft was surgically created in the posterior hard palate in experimental and sham control dogs. Bone markers were implanted in the hard palate. Osteotomies were carried out followed by the installation of a distractor made of NiTi-shape memory alloy. OUTCOME MEASURES: The results were evaluated clinically, radiographically, and histologically. Anthropometric data that represented the length, width, and height of the maxilla were taken on the dry skull of the control and experimental dogs and were analyzed statistically. RESULTS: The cleft was closed and the hard palate was lengthened after 2 to 3 weeks of distraction in all the experimental dogs. New bone formation was found at the site of osteotomy. The variables of facial length, height, and width showed no significant difference between the two groups (p > .05). The length of the hard palate in the experimental group was longer than that in the control group (p < .01). CONCLUSION: Distraction osteogenesis with the elastic device of NiTi-shape memory alloy is effective for closing the cleft and lengthening the hard palate in a canine cleft model. There is no interference on the growth of the maxillofacial structures with the technique.

Animals↗
PubMed2006

Early postnatal development of the mandible in children with isolated cleft palate and children with nonsyndromic Robin sequence.

OBJECTIVE: Analysis of early postnatal mandibular size and growth velocity in children with untreated isolated cleft palate (ICP), nonsyndromic Robin sequence (RS), and a control group of children with unilateral incomplete cleft lip (UICL). MATERIAL: 114 children (66 isolated cleft palate, 7 Robin sequence, 41 unilateral incomplete cleft lip) drawn from a group representing all Danish cleft children born from 1976 through 1981. All children were examined at both 2 and 22 months of age. METHODS: Cephalometric x-rays and maxillary plaster casts. Mandibular length and height were measured and mandibular growth velocity (mm/year) was calculated. Cleft width was measured on the casts at 2 months of age. RESULTS: Mean mandibular length and posterior height were significantly smaller in isolated cleft palate and Robin sequence, compared with unilateral incomplete cleft lip. Mandibular length in Robin sequence was also significantly shorter, compared with isolated cleft palate. No significant difference was found between mean mandibular growth velocities in the three groups. No significant correlation was found between mandibular length and cleft width in either isolated cleft palate or Robin sequence at 2 months of age. CONCLUSION: The children with isolated cleft palate and Robin sequence had small mandibles shortly after birth, but with a relatively normal growth potential. No true mandibular catch-up growth was found up to 22 months of age in either group. No significant correlation was found between mandibular size and cleft width in either group at 2 months of age. However, there was a significant trend toward the shorter the mandible, the more severe the sagittal extension of the cleft.

Age Distribution↗
PubMed1995

Levator veli palatini muscle activity in relation to intraoral air pressure variation in cleft palate subjects.

A comparison of the ranges of levator veli palatini EMG activity for speech versus a nonspeech task for subjects with cleft palate was the focus of this study. EMG values are also compared with subjects without cleft palate obtained in a previous study. Hooked-wire electrodes were inserted into the levator muscle of five adult subjects with cleft palate exhibiting mild hypernasality. Intraoral air pressure was measured concurrently. A blowing task was used to determine the subject's operating range for the levator muscle. Both the nonspeech and speech tasks were designed to sample the widest possible ranges of levator EMG activity. It was found that the subjects with cleft palate used a relatively high activation level for the levator muscle during speech, in relation to their total activation range, compared with the subjects without cleft palate. Implications are discussed in relation to possible anatomic and physiologic differences for cleft palate subjects compared to normal.

Adult↗
PubMed1996

Mesenchymal cell activity during 5-fluoro-2-deoxyuridine-induced cleft palate formation in the rat.

Biosynthetic activity of the mesenchymal cells within the palatal shelves was determined during cleft palate formation induced by 5-fluoro-2-deoxyuridine (FUDR). The palatal shelves of 30 fetal rat heads with palatal clefts were surveyed at stages corresponding to normal palatogenesis, nucleolar organizer region (NOR) staining being employed to determine cell activity. Comparing cellular activity during normal and cleft palatogenesis, significantly lower counts were recorded for most stages of cleft formation. When anterior or posterior regions were compared, significant changes in NOR counts cell were found at a time corresponding to the pre-elevation stage of normal palatogenesis. At a time equivalent to normal fusion, the shelves in the anterior region showed signs of recovery, but posteriorly significantly lower activity occurred throughout all stages of palate dysmorphogenesis. The depressed level of cellular activity found after treatment with FUDR may be directly or indirectly related to the abolition of an intrinsic shelf-elevation force and, subsequently, cleft palate formation.

Analysis of Variance↗
PubMed1997

Craniofacial growth after iatrogenic cleft palate repair in a fetal ovine model.

Controversy exists over the impact of scar formation on craniofacial growth after cleft palate repair. The fetal ovine model presents an opportunity to study a group of animals with little or no scar using cephalometric studies of cranio-facial growth after iatrogenic cleft palate repair. Grossly evident scar is formed in the palates of lambs repaired at 118 days or later in gestation, while those animals operated at 70 and 77 days' gestation exhibited no scar grossly and minimal scar histologically in the submucosa with normal nasal and oral mucosal surfaces. For this study, 15 lambs were studied: four were unoperated, three were operated at 70 days, one at 77 days, and seven had clefts produced and repaired at 118 to 133 days' gestation. The animals were euthanized at 1 month of age and the heads removed and frozen until analyzed. Computerized tomography of the heads was used to create voxel (volume pixel) data sets, and volume rendering and measurement software (Voxblast) was used to create a three-dimensional reconstruction of the skull. Palate measurements were obtained by selecting points on the upper deciduous premolars. A plane was set through the palate and upper deciduous premolars using standard points on the skull to maintain consistent visualization and point selection. The measurements were normalized to skull size measured by the distance between points on the right and left zygomatic bones. Using one-way analysis of variance, followed by a protected t test, no significant differences were found between the means of any measurement in the three treatment groups. Fetal palate repair, with or without scarring, resulted in normal craniofacial growth in the 1-month-old lamb.

Analysis of Variance↗
PubMed1997

Examination of craniofacial morphology in 10-month to 5-year-old children with cleft lip and palate.

OBJECTIVE: The purpose of this study was to assess craniofacial growth in children from 10 months to 5 years of age with cleft lip and/or palate and to develop a systematic method of cephalometric measurements. DESIGN: A case-control study. SETTING: Craniofacial unit of a teaching hospital for children. PATIENTS: A consecutive series of the first 22 patients with cleft lip and/or palate who underwent early reconstructive treatment [isolated cleft lip (CL) 6; isolated cleft palate (CP) 7; unilateral cleft lip and palate (UCLP) 7; and bilateral complete cleft lip and palate (BCLP) 2] (mean age, 27.9 months) and 22 age- and sex-matched noncleft children. INTERVENTIONS: Lateral cephalometric headfilms of the children were taken using a pediatric cephalostat. MAIN OUTCOME MEASURES: Cephalometric landmarks were measured according to Ricketts cephalometry. RESULTS: As compared with controls, CL patients had a lingual position and inclination of maxillary and mandibular incisors, an increase of interincisal angle and a decrease of incisor overjet, an increase in facial convexity, and a decrease in facial depth and mandible body length. In CP patients, palatal plane inclination and mandible arch were significantly reduced. In UCLP patients, there was a decrease in molar relation and incisor overbite, an increase in interincisal angle, reduced position and inclination of maxillary incisors and inclination of mandibular incisors, an increase in facial convexity, and lower facial height. CONCLUSIONS: Based on the absence of midface growth reduction, these short-term results suggest a tendency toward normal maxillomandibular growth.

Case-Control Studies↗
PubMed1998

Spontaneous cleft palate in a newborn gorilla (Gorilla gorilla gorilla).

OBJECTIVE: We report the first case of cleft palate in a newborn male gorilla (Gorilla gorilla gorilla). CASE HISTORY AND RESULTS: The full-term infant was born to clinically healthy, wild-caught parents and survived 5 days. Autopsy disclosed a unilateral cleft palate, moderate scalp hemorrhage (birth versus postnatal trauma), cerebral edema, and a sterile fibrin vegetation in the heart. The palate was also shorter and narrower than expected, and the biorbital breadth was reduced; otherwise, growth and development appeared normal. Standard cranial and intraoral radiographs and three-dimensional reconstructions of computerized tomographic (CT) scans provided thorough and noninvasive methods of studying the craniofacial complex and extracranial skeleton. By this technique, major findings were: intact premaxilla, interpremaxillary, and premaxillary/maxillary sutures; intramaxillary cleft with ipsilateral choanal atresia; mildly asymmetric inferior turbinates; and normal nasal septum and vomer. CONCLUSIONS: Except for choanal atresia, cleft palate was not associated with other major craniofacial or extracranial anomalies in this case. Choanal atresia has been observed at times with cleft palate, but to our knowledge, the association has not been reported in nonhuman primates. Cleft palate, with or without cleft lip, has been recognized in a variety of nonhuman primates, including the lemur, marmoset, tamarin, squirrel monkey, and macaque. Some occurrences are spontaneous, while others are syndromic and/or arise from genetic or teratogenic influences. Each mode of presentation is poorly understood in nonhuman primates, but in this case, the absence of relevant environmental or parental history suggests that the occurrence was spontaneous. Anatomic studies of nonhuman primates are particularly valuable when they involve endangered species and will hopefully increase our understanding of the pathogenesis and etiology of congenital disorders, as well as other relationships between nonhuman primates and humans.

Animals↗
PubMed2000

Double tongue, intraoral anomalies, and cleft palate--case reports and a discussion of developmental pathology.

OBJECTIVE: Isolated cleft palate is the most common presentation of the nonsyndromic cleft lip/palate combinations and is multifactorial in etiology. We report two cases of children with clefts of the secondary palate coexistent with double tongue and in either case mandibular epulis or superiorly displaced salivary gland. RESULTS AND DISCUSSION: In each case, the palatal cleft correlated anatomically with the intraoral space-occupying lesion. The ratio of tongue volume to intraoral volume during palatogenesis is discussed with reference to the pathogenesis of cleft palate. These clinical cases propose the model of a unifying sequence of developmental events whereby deformation of palatal shelf elevation results in secondary palatal clefting.

Choristoma↗
PubMed2001

Nasal airflow patterns during the velopharyngeal closing phase in speech in children with and without cleft palate.

OBJECTIVES: (1) To study the nasal airflow patterns during the velopharyngeal closing phase in speech produced by children with and without cleft palate. (2) To compare the nasal airflow patterns in bilabial, dental, and velar articulation in these children. DESIGN: Prospective, cross-sectional study of a consecutive series of children with cleft palate referred for routine speech evaluation and controls. SETTING: Sahlgrenska University Hospital, Göteborg, Sweden. PARTICIPANTS: Seventeen children with cleft lip and palate or cleft palate only and 22 controls aged 7 and 10 years. METHOD: Nasal airflow was transduced with a pneumotachograph attached to a nose mask and registered together with the acoustic speech signal. Sentences containing nasal-to-stop combinations in bilabial, dental, and velar articulatory positions were used. MAIN OUTCOMES MEASURES: The duration from peak to 5% nasal airflow, the maximum flow declination rate, and the nasal airflow at selected points in time during the transition from nasal-to-stop consonants. RESULTS: In the cleft palate group, duration from peak to 5% nasal airflow was clearly longer than among the controls (p <.0001). The declination of airflow was slower (p <.006) and the rate of nasal airflow at the release of the stop consonant was higher (p <.004) in the cleft palate group. Differences between bilabial versus dental and velar articulation were found in the control group. CONCLUSION: Studies of the temporal and dynamic characteristics of the nasal airflow variations during speech appear potentially useful for the assessment of velopharyngeal function.

Articulation Disorders↗
PubMed1979

Single layered periosteoplasty in experimental mid-palatal clefts. A histological study in the cat.

At the age of 2 months, the mid-palatal suture, with adjacent bone and nasal mucoperiosteum, was resected in 20 domestic cats leaving postoperatively only the oral side of the more than 5 mm wide osseous defect covered with mucoperiosteum. After cessation of general growth this single layered "palatal cleft periosteoplasty" had, an all animals, resulted in the formation of new bone extending from the resection edges, i.e. nearly butting in the midline in about 85% of the cases. Bone bridges interlocking the palatal halves were, as in normal untreated individuals, never observed. In 3 out of 20 other cats where merely an oral mucoperiosteal flap had been elevated and replaced, i.e. a shamoperation without resection of bone or mucoperiosteum, a beginning synostosis of the mid-palatal suture was found. In the remaining 17 cats of this last group and in further 20 unoperated controls, the suture was open even at 2 1/2 years of age. The results seem to indicate that soft tissue trauma inevitable in palatal surgery may interfere with periosteal and sutural integrity. In addition, the findings may render new informations in palatal/maxillary growth following cleft palate periosteoplasty.

Animals↗
PubMed1979

Transversal maxillary growth in experimental submucous mid-palatal clefts. A roentgen-cephalometric study in the cat.

At the average age of 2 1/2 months the mid-palatal suture and adjacent bone was extirpated in 24 domestic cats resulting in a 5 mm wide submucous cleft in the hard palate. In 16 other animals the corresponding mucoperiosteal flap was elevated and replaced without resection of the suture, i.e. testing the effect of the soft resection of the suture, i.e. testing the effect of the soft tissue trauma implied. Twenty-eight unoperated cats of corresponding age served as controls. The transversal maxillary growth was then studied radiographically by measuring the increase in distance, on cephalograms, between metallic implants inserted into both sides of the hard palate. Up to 50% reduction of transversal growth appeared where the mid-palatal suture had been extirpated. The palatal dimensions of the sham operated- and the unoperated groups did not diverge. The results obtained seem to indicate that growth in the mid-palatal suture is a combination of active growth due to proliferation of the sutural tissue, and passive growth induced by external forces exerting a traction in lateral direction.

Animals↗
PubMed1992

Correlation between the age at repair and speech outcome in patients with isolated cleft palate.

The effect of the age at primary palatal repair on the speech of 3-year old children with isolated cleft palate was assessed. The group comprised 108 consecutive children whose palates were repaired at the mean ages of 12.9 (n = 45), 18.5 (n = 18) and 22.1 months (n = 45). Signs of cleft palate speech and the degree of speech impairment were recorded. The signs sought were: hypernasality, audible nasal air emission, and misarticulations associated with velopharyngeal insufficiency. The speech impairments were subdivided into three categories by combining the signs of cleft palate speech. The results showed that children who were operated on at the age of about 12-18 months were significantly better speakers than those operated on later. Of these 46 were rated as normal or practically normal speakers (73%), compared with 10 of the children who had their repairs delayed until about 22 months (22%). As a result of the speech evaluations, it was predicted that 5 (11%), 0 and 21 (47%) children in the early, middle, and late closure groups, respectively, required secondary surgery to eliminate signs of cleft palate speech associated with velopharyngeal inadequacy. The numbers who had secondary surgery were 4, 0 and 18 in the three groups.

Age Factors↗
PubMed1996

Delayed closure of the hard palate: a comparison of speech in children with open and functionally closed residual clefts.

The speech of 20 children with cleft in the hard palate that had not yet been repaired was evaluated and analysed at 7 years of age. The cleft in the hard palate was open in 14 patients and functionally closed in six. All children were born with cleft lip and palate and treated surgically according to a routine that included delayed closure of the hard palate until age 8-10 years. The soft palate was repaired at approximately 6-8 months of age. Tape recordings were used for perceptual analysis of the speech. Maxillary casts were used to assess approximate age for functional closure of the residual cleft. Speech results showed only mild hypernasality for both groups of subjects which indicates acceptable velopharyngeal function in the whole group. Children with open residual clefts had significantly more nasal escape and a higher prevalence of compensatory retracted articulation than children with functionally closed clefts. The functional closure seems to have occurred at about the age of 18-36 months. Factors which appear to facilitate narrowing of the residual cleft include the original width of the cleft, the amount of tissue in the alveolar and palatal processes, and anterior placement of a vomer flap.

Age Factors↗
PubMed2006

Surgical repair of hard palate cleft with absorbable membrane: the new surgical technique and its clinical application.

This study evaluated a new surgical technique with absorbable membrane to repair hard palate cleft without extensive mobilisation of the mucoperiosteum. From 2001 to 2002, 32 selected patients with complete unilateral clefts underwent this surgical operation. The traditional flap surgical operation was performed at the soft palate, uvula and anterior alveolar cleft. The absorbable membrane was implanted to the hard palate cleft gap to guide the regeneration of the mucoperiosteum. The patients were followed up for 1-6 months after the operation. The speech assessment was carried out 12 months after the operation. Of 32 patients, 30 were successfully operated by this method and no obvious complications occurred. Primary healing on tissue defect of hard palate was obtained in 27 patients and secondary healing in 3 patients. Eighty percent of the 30 patients had good or excellent speech 12 months after the operation. The operation failed in 2 patients. The surgical technique with absorbable membrane to repair hard palate appears to have several valuable advantages including the decreased area of the hard palate involved and favourable outcome for speech in the majority of cases.

Absorbable Implants↗
PubMedDate not supplied

Expression and activity of protein kinase C isoenzymes during normal and abnormal murine palate development.

Protein kinase C (PKC) plays a critical role in signal transduction, mediating various cellular events critical for normal development, including that of the palate. In vivo and in vitro studies suggest the relevance of the inhibition of PKC by the mycotoxin, secalonic acid D (SAD), to its induction of cleft palate (CP) in mice. In the present study, temporal and spatial expression and the activity of various PKC isoenzymes were studied in the control and SAD-exposed murine embryonic palate during gestational days (GD) 12-14.5 by western blotting, immunohistochemistry, and phosphotransfer assay. The Ca2+-dependent isoenzymes, PKC alpha and PKC betaII, showed significant expression on GD 12.0, which gradually decreased through GD 14.5, whereas PKC betaI and PKC gamma were negligible throughout. All Ca2+-independent isoenzymes (epsilon, delta, and zeta) were expressed more abundantly and, in contrast to the Ca2+-dependent ones, progressively increased with age. SAD failed to alter this pattern of expression but enhanced the phosphorylation of PKC epsilon throughout development. Immunohistochemical analysis revealed an isoenzyme-specific distribution of PKC between the epithelium and mesenchyme. As expected, SAD significantly inhibited the total Ca2+-dependent PKC activity in palatal extracts. Although total Ca2+-independent PKC activity in palatal extracts was unaffected by SAD, individual pure isoenzymes were either selectively inhibited (PKC zeta), stimulated (PKC delta), or unaffected (PKC epsilon) by SAD. These results show that PKC isoenzymes exhibit dynamic temporal and spatial patterns of expression and activity in the developing palate and that the induction of CP by SAD is associated with an alteration in their activation and/or activity.

Animals↗
PubMed1999

[Tissue response in circum-maxillary sutures after transverse palated suture expansion].

OBJECTIVE: This study was carried out to investigate the histological reactions of midfacial sutures induced by transverse palatal suture expansion. METHODS: Nine mongrel dogs of 8-week old were used in the study. Six of them were used as experimental group as described in a previous paper. The additional three served as controls. In the experimental dogs, a NiTi-shape memory alloy (NiTi-SMA) arch wire was used to expand the transverse palatal suture. Tetracycline was injected intramuscularly (50 mg/kg) three days before operation and at the time of sacrifice. Tissue reactions of premaxillo-maxillary suture, transverse palatal suture, zygomatico-maxillary suture, zygomatico-temporal suture and fronto-maxillary suture were observed in undecalcified tetracycline labeled sections and decalcified histological sections. RESULTS: The sutures in normal young dogs showed active bone formation. With the increase of age, the cellular components of the suture decreased. A great amount of new bone apposition was found in the bony front of expanded transverse palatal suture of the experimental dogs. Degenerative changes were found in premaxillo-maxillary suture at the expanded side while the contralateral showed active osteogenesis. Other sutures manifested both bone apposition and deposition due to the irregular interdigitations. CONCLUSION: After expansion, a great amount of new bone formed in the transverse palatal suture and thus the hard palate was lengthened. All the circum-maxillary sutures reacted in different patterns.

Animals↗