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PubMed2003

[Bone regeneration on hard palate after palatal surgery on cleft palate and the relative factors].

OBJECTIVE: Attending to observe the bony healing on hard palate after palatal repair, and to discuss the factors affecting on it. METHODS: 52 patients with repaired cleft palate over 5 years postoperatively were examined, the CT scan of head was taken. The incidence of the bone regeneration among the patients examined was calculated, the position and quality of bone tissue were measured according to the CT images. After all, analysis was applied to evaluate the factors affecting on the bone tissue formation. RESULTS: Formation of bone bridge was found in the 37 cleft gaps out of 52 patients (71%), the ratio of the sex among the patients who had bone bridge was 1:1, there was no obvious difference between unilateral and bilateral cleft palate. Considering the operation age with the bone formation, the highest percentage of bone bridge formation fell into the group of 4-7 years old, and the most occurring region were in premolar and anterior part of molar area. CONCLUSION: There could be bony healing(regeneration bone tissue RBT) after palatal repair on cleft palate patients. The operation age could be an important affecting factor to RBT, but the sex and the clinical type of cleft palate make no difference on the bone tissue formation.

Age Factors↗
PubMed1985

Strain differences between C57BL/6 and SWV mice in time of palate closure and induction of palatal slit and cleft palate.

Palatal slit, which occurs spontaneously in C57BL/6 (C57BL) mice, is increased in frequency among C57BL fetuses from dams treated with triamcinolone acetonide, but is not induced in SWV fetuses. On the other hand, C57BL is more resistant than SWV to cleft palate induction by triamcinolone. Using these C57BL and SWV mice, the relation of palate stage and chronological age was examined from 1 P.M. on day 14 to 9 A.M. on day 16 in untreated embryos, and the condition of the palate after triamcinolone treatment on day 12 was examined at 9 A.M. on day 16. In untreated embryos, horizontalization and fusion of the palatal shelves occurred earlier in C57BL than in SWV embryos, but fusion of the primary palate with the secondary palate occurred later. After triamcinolone treatment, the development of the palate was delayed in both C57BL and SWV embryos. These results suggest that the times of normal palate closure are related to the differences between C57BL and SWV mice in their susceptibilities to palatal slit and cleft palate induction and that triamcinolone produces palatal slit and cleft palate by delaying palate closure.

Abnormalities, Drug-Induced↗
PubMed2003

[Epidemiology of lip-maxilla-palate clefts in the canton of Vaud].

Epidemiological variables in oral clefts were examined in a cohort of patients with congenital malformations from the canton of Vaud in Switzerland during the years 1990-1999. Among 77'259 newborns or foetuses, 144 cases of oral clefts were identified in the Registre Vaudois des Anomalies Congénitales (RVAC), yielding a total prevalence of 18.6 per 10'000. These clefts consisted of 84 (58%) cases of cleft lip with or without cleft palate (CL/P) and 60 (42%) cases of cleft palate only (CP). Associated anomalies were found in 45% of cases. Our results are compared with previous reports in other parts of Europe.

Abnormalities, Multiple↗
PubMed1995

Ethical issues in the case of surgical repair of cleft palate.

There are some advantages to prospective randomized clinical trials (PRCT) to resolve some limited clinical problems. But, when this method is used to determine the best surgical procedure to close the palatal cleft space, there are strong ethical considerations that cannot be overcome. There are two basic problems. The first is having the surgeon perform surgical procedures which he/she does not believe is the treatment of choice or that can be performed as skillfully as others, even after demonstrations. Secondly, this method does not consider the theoretical aspect that many clefts within the same cleft type are different in the relative size of cleft space to size of soft tissue available for closing the cleft space, thereby creating different degrees of scarring. Different outcomes to the same surgery must, therefore, result irrespective of the surgeons' skills or treatment plans. Retrospective research studies, whether they involve one or more institutions, have been and are still very valuable in improving the knowledge base of all areas of cleft palate habilitation.

Cicatrix↗
PubMed1985

Epithelial changes of the nasal columella of the palatal slit and cleft palate defects in C57BL/6 mouse fetuses.

Palatal slit and cleft palate are induced in fetuses of C57BL/6 female mice treated with triamcinolone acetonide. In this study, the progressive changes in the epithelia of the presumptive fusion areas of the nasal columella and the anterodorsal part of the secondary palate were examined histologically. No difference was seen in the epithelial changes of the nasal columella of fetuses with palatal slit and those with cleft palate. In the treated palates the basal cuboidal epithelial cells in the presumptive fusion area of the nasal columella extended further toward the nasal cavity, and the vacuolization of the nasal epithelial cells appeared earlier than in the untreated palates. Although the treatment produced epithelial changes of the presumptive fusion area, its primary effect does not seem to be the disturbance of the epithelial fusion processes. The induction of palatal slit may be due to a failure of the primary and secondary palates to make adequate contact and fuse at the appropriate developmental stage because the secondary palate closure is delayed.

Animals↗
PubMed1998

Survey of dentists' experience with cleft palate children in Chile.

OBJECTIVE: This study was designed to study the experience of dentists with children with palatal clefts seeking treatment in Santiago, Chile. DESIGN: A 13-item questionnaire was sent to 203 pediatric and general dentists treating children. Of the 141 dentists who voluntarily completed the questionnaire, 118 were selected for this study. These professionals worked in private and public health centers in the Santiago, Chile, metropolitan area. RESULTS AND CONCLUSIONS: The results showed that a majority of dentists had treated a low number (1 to 3) of cleft palate children in the previous years, using a combination of preventive-curative and radical treatments. Although a majority reported that there were no differences in the treatment of the cleft and noncleft children, a majority had problems during the course of treatment. The results suggest the need for more current information about the care of cleft children.

Adolescent↗
PubMed1986

Epigenetically regulated genomic expressions for shortened stature and cleft palate are regionally specific in the 11-day mouse embryo.

Chronokinetic synergism, a holistic and extremely sensitive experimental design, has shown in the mouse embryo that site-specific epigenetic forces differentially regulate genesis of the palate (cleft palate) and limb bud organogenesis (shortened stature). Acute exposures of 11-day pregnant mice to minimally effective doses of thymidine or ethanol followed 5 or 8 hr later by minimal exposure to retinoic acid have enabled quantitative and qualitative assay for genomic-epigenetic interactions. These site-specific morphogenetic regulations occurred during palatal genesis from the maxillary prominence of the first pharyngeal arch and during limb bud prechondrogenesis. Thymidine is presumed to induce its response by inhibition of DNA polymerase and hence by transitory cytostatic block. (Embryo size was not detectably changed). Ethanol is interpreted, guilt by associated response, indirectly to interfere with histone regulation of transcription. Two central findings have demonstrated the coordinated regulation of genomic and epigenetic positional information. First, thymidine or ethanol as epigenetic probes for limb prechondrogenesis and palatal precursor cells have activated distinctive site-specific responses. Second, responses to chronokinetic synergisms have indicated that epigenetic regulators for limb and palate dysmorphogenesis may affect distinctly different phases of the cell division cycle and hence induce differential DNA expressions. Although each of palate and limb is concurrently susceptible to epigenetic regulation, their differential intrinsic genomic capabilities appear to have been uncoupled. The putative homeostatic balance of genomic expressions in the palate precursor and the prechondrogenic limb bud cells of the 11-day mouse embryo has been characterized as epigenetically regulated, alternatively expressed, and positionally restricted. We propose that the chronokinetic synergisms have disclosed the existence of distinctive palate-determining genes and stature-determining genes.

Abnormalities, Drug-Induced↗
PubMed1990

[Orthomorphic facial treatment of patients with sequelae of bilateral lip-palate cleft by the "mask-lifting" procedure].

The clinical study of the major cranio-facial malformations such as Apert syndrome, Treacher-Collins syndrome, Blepharophimosis and Bilateral Cleft Palate patients, lead us to note a similarity of the orbito-palpebral region. A characteristic obliquity and narrowness of the orbits associated with an antimongoloid eyelids disposal was noted after X-rays, CT-scan and clinical evaluation. Authors suggest a facial orthomorphic restoration of bilateral cleft palate patients by the "mask-lifting" procedure associated to the conventional maxillo-facial surgery.

Bone Transplantation↗
PubMed2002

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

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

Articulation Disorders↗
PubMed1988

[Effect of the surgical treatment of cleft palate on pathology of the middle ear. Apropos of 49 cases].

The presence of middle ear disease was analyzed in 49 patients with soft palate cleft, and more particularly the influence of surgical repair and early therapy. Clinical examination, impedancemetry and audiometry carried out preoperatively and at follow up more than 3 months after surgery showed that although surgical closure of cleft provokes some improvement (40% of cases) some degree of seromucous otitis persisted in most patients, with a very partial positive influence of early surgery. Other physiopathologic factors are involved in the genesis of seromucous otitis, which cannot be cured by early surgery for soft palate cleft alone.

Acoustic Impedance Tests↗
PubMed2005

[Classification and repairing investigation of the whistling deformities in the patients with bilateral cleft lip or bilateral cleft lip and cleft palate after primary cleft lip repair].

OBJECTIVE: To classify the whistling deformities of the patients with bilateral cleft lip or bilateral cleft lip and cleft palate after primary cleft lip repair. METHODS: According to exposure degrees of the gum and the crown of the anterior upper incisors, 136 patients with whistling deformities after primary repair of bilateral cleft lip at the Department of Oral and Maxillofacial Surgery of Xiang Ya Hospital, Central South University were examined and the whistling deformities were classified into four grades. Grade I: the crowns of the left and the right upper incisors were exposed about one-second. Grade II: the whole crowns of the upper incisors were exposed or plus the exposure of the crowns of medial sagittal portion of the left and the right upper lateral incisors. Grade III: the whole crowns of two upper incisors and one-second of the attached gum of two upper incisors or the crowns and one-second of attached gum of the two upper incisors with over two-third of transverse crowns of the lateral incisors were exposed. Grade IV: the crowns and corresponding attached gum of the upper incisors and over two-third of medial sagittal crowns of the upper lateral incisors were exposed. The relation between the degrees of the whistling deformities and the primary procedures of the bilateral cleft lip or the bilateral cleft lip and cleft palate was analyzed. RESULTS: Sixty patients (44.2 percent) had grade I whistling deformities; forty-seven patients (34.5 percent) were Grade II; 16 patients (11.8 percent) were Grade III; 13 cases (9.5 percent) were Grade IV. The results showed that grade I and grade II whistling deformities were obviously more (about 3.7 times) than grade IlI and grade IV whistling deformities. CONCLUSIONS: Classification of whistling deformities provided the objective basis for the selection of operation techniques of cleft lip.

Adolescent↗
PubMed2001

[A primary clinical analysis of artificial bone implantation of cleft palate].

OBJECTIVE: To observe whether repairing the hard palate can improve velopharyngeal function. METHODS: 40 patients with hard palate cleft were randomly divided into two groups: the control group and the implantation group. Each group had 20 patients. The patients in the implantation group were implanted with compound artificial bone of HA--Bone cement. All patients hag been followed up for three months postoperatively. The patients in the repaired group were examined using computer tomography. All patients were examined using NPF. RESULTS: The implanted artificial bone had no rejection. The computer tomography showed that the implanted artificial bone in hard palate had no shifting, subsidence or breakage. The movement of soft palate of the implantation group was greater than the control group. The velopharyngeal function of the implantation group was much better than the control group. CONCLUSION: Repairing the hard palate cleft with artificial bone can improve velopharyngeal function.

Biocompatible Materials↗
PubMed1996

Palatal asymmetry in cleft palate subjects.

In subjects with different types of cleft palate, palatal shape and symmetry were evaluated utilizing the moiré contourography technique. The sample consisted of 95 subjects with cleft palate and 68 controls. The differences between cleft and control subjects in the transverse and anteroposterior location of the highest point of the palate, palatal axis angle, and the palatal index were assessed by analysis of variance. Effects of cleft type, gender, developmental stage of the dentition, missing teeth, and eight skeletal and pharyngeal cephalometric variables on palatal shape and symmetry were assessed using multiple-regression analyses. In comparison with the noncleft individuals, the cleft palate subjects showed parallel but clearly more remarkable asymmetry in palatal shape and position of the first maxillary molars. The anteroposterior location of the deepest point in the palate was more posterior, and the palate was relatively shallower. The severity of the cleft type affected both the anteroposterior and transverse position of the highest point in palatal morphology.

Adolescent↗
PubMed2006

Comparative study of maxillary growth and occlusal outcome after autogenous rib grafting in complete cleft palate defect.

Cleft palate is a congenital deformity with soft tissue and hard tissue defects. Normal cleft palate repairing surgery only repairs soft tissue defects, whereas bone defects in the hard palate still exist. Therefore, we conducted this study in beagles to observe the influence of bone grafting at primary surgery on craniofacial growth and occlusal relationships in individuals with complete cleft palate and to provide experimental evidence for optimal surgical procedures for cleft palate. Using 60 beagle puppies as subjects, we tested the effects of bone grafting in surgically induced palatal defect. The animals were randomly and equally divided into four groups: (1) unoperated controls; (2) surgically induced unilateral cleft palate, not repaired; (3) two-flap palatoplasty used to close the soft defect of the surgically induced cleft palate; (4) autogenous bone (a piece of rib bone) implanted into the palatal defect before two-flap palatoplasty was performed.Cephalometric roentgenography and plaster casts of the maxillary were taken preoperatively and every 4 weeks after surgery. Sixty metric cranial variables were measured directly from the cleaned skulls after the animals were killed the 34th week postoperatively. The measurement results indicated that bone grafting may reduce the disturbance of maxillary growth caused by the cleft palate and the denuded bone, but it may cause other maxillary deformities. This finding suggests that surgeons should be careful in choosing the method of primary bone grafting in repairing complete cleft palate.

Animals↗
PubMed1998

Pathology of the palatal aponeurosis in cleft palate.

OBJECTIVE: The palatal aponeurosis is a controversial structure, both in terms of its anatomy and its function. This article points out a pathologic finding in the cleft palate condition that has not been previously described. DESIGN AND METHOD: By means of surgical dissections, this study demonstrates in detail that the palatal aponeurosis exists even in cleft palates, but it is disrupted, malpositioned, and folded in two layers. PATIENTS: This dissection method has been performed on more than 150 patients with cleft of the hard and soft palate, with or without cleft of the lip and alveolus. At the time of operation, the children were between 6 and 8 months of age. RESULTS: It is possible to dissect the two layers of the palatal aponeurosis, to unfold the aponeurosis, and to form a tough tendinous plane. CONCLUSION: For a functional physiologic reconstruction of the cleft palate, it is necessary not only to reconstruct the levator veli palatini and palatopharyngeus muscle slings, but also to approximate and suture the fibers of the palatal aponeurosis to the corresponding fibers of the opposite side after unfolding them in a medio-dorso-cranial direction. In this manner, a continuous palatal aponeurosis can be created, which subsequently can serve as a transmitter of the muscle forces.

Cleft Palate↗
PubMed1979

A comparison of intelligence and social maturity in children with unilateral complete clefts and those with isolated cleft palates.

Intelligence and social development were evaluated in 226 subjects with palatal clefts. The subjects were divided into four groups composed of 111 with unilateral complete clefts of the lip and palate (Unilateral Group); 16 with unilateral complete clefts with associated congenital malformations (Unilateral-C Group); 76 with clefts of the palate only (Palatal Group; and 39 with clefts of the palate only with other congenital malformations (Palatal-C Group). Comparisons among groups suggested that subjects in the Unilateral Group were most competent both mentally and socially followed by those in the Palatal, Unilateral-C, and Palatal-C Groups. The presence of congenital abnormalities other than cleft increased the risk of developmental disabilities, particularly in subjects with isolated palatal clefts.

Child↗
PubMed1993

Submucous cleft palate with a discontinuous bony deformity.

An unusual submucous palatal cleft is presented. In addition to the usual triad of bifid uvula, posterior bony notching, and diastasis of the velar musculature, there was a linear bony cleft involving only the maxillary component of the hard palate. The palatine bone was intact between the posterior notch and the maxillary cleft. A discontinuous palatal cleft is an extremely rare deformity and is interesting because existing theories of cleft pathogenesis do not readily explain such a defect.

Child, Preschool↗