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PubMedDate not supplied

Elevation of the soft palate in speech and swallowing in normal female participants and females with motor neuron disease: an innovative procedure for measuring palatal elevation.

The aim was to measure the angle of elevation of the soft palate during the separate conditions of swallowing of pudding, swallowing of liquid and during production of 'may/pay', using videofluroscopy and innovative computer software. We then determined whether soft palate elevation (as reflected in measures of an angle) differed in those separate conditions. Twelve female participants were studied, aged 40-70 years. The trends observed were that the highest soft palate elevation was displayed in the liquid-swallowing condition and the lowest soft palate elevation was displayed in the speech conditions. The results did not reach statistical significance, but the findings support the suggestions of Rubesin et al. (1987) and Fritzell (1969) that soft palate elevation is higher during swallowing than during speech. This same method was then used to measure soft palate elevation under the same three conditions in nine females, all aged > 40 years, who had motor neuron disease. Again, the highest soft palate elevation was displayed when swallowing liquid, but this time the lowest elevation occurred when swallowing pudding. Owing to small numbers, results did not reach statistical significance, but the trends may be important to replicate in a larger study. This pilot study developed a comprehensive and accurate method of measuring the soft palate elevation using digitization and computer software.

Adult↗
PubMed2006

Synchronous palatal closure and premaxillary setback in older children with bilateral complete cleft of lip and palate.

BACKGROUND: Achieving good results after primary repair in older children with complete bilateral cleft lip and palate is a Herculean task, particularly when the premaxilla is protruding and twisted. The authors faced the problems of protruding premaxilla in children older than 5 years of age with bilateral complete cleft lip and palate who presented late for primary repairs. Due to financial constraints and the distances traveled, these patients prefer to come for fewer procedures with maximum benefits. These factors encouraged the authors to carry out synchronous palatal closure and premaxillary setback in older children with bilateral complete cleft of the lip and palate. METHODS: Synchronous palatal repair and premaxillary setback were carried out in 14 patients. During palate repair, good exposure of the vomer made premaxillary setback easy without compromising the blood supply to it. The premaxilla, after osteotomy, was immobilized in all patients using the simple technique of Kirschner wire fixation; an additional gingivoperioplasty was performed in a few patients. Palatal closure was achieved with two flap techniques with intravelar veloplasty. RESULTS: Proper positioning of the premaxilla was achieved in all patients, with good labial repair 6 months after the primary palate closure. There were no major complications, such as loss of the premaxilla or vascular compromise. Two patients had an anterior open bite and one patient had a postalveolar fistula. CONCLUSIONS: This technique had a few minor complications, but the overall surgical outcome was satisfactory. This protocol proved advantageous in achieving good results with fewer procedures and in reducing the total expenditures and the length of the patient's hospital stay.

Adolescent↗
PubMed2004

Terminal differentiation of palatal medial edge epithelial cells in vitro is not necessarily dependent on palatal shelf contact and midline epithelial seam formation.

During fusion of the mammalian secondary palate, it has been suggested that palatal medial edge epithelial (MEE) cells disappear by means of apoptosis, epithelial-mesenchymal transformation (EMT) and epithelial cell migration. However, it is widely believed that MEE cells never differentiate unless palatal shelves make contact and the midline epithelial seam is formed. In order to clarify the potential of MEE cells to differentiate, we cultured single (unpaired) palatal shelves of ICR mouse fetuses by using suspension and static culture methods with two kinds of gas-mixtures. We thereby found that MEE cells can disappear throughout the medial edge even without contact and adhesion to the opposing MEE in suspension culture with 95% O2/5% CO2. Careful examination of MEE cell behavior in the culture revealed that apoptosis, EMT, and epithelial cell migration all occurred at various stages of MEE cell disappearance, including the transient formation and disappearance of epithelial triangles and islets. In contrast, MEE cells showed poor differentiation in static culture in a CO2 incubator. Furthermore, mouse and human amniotic fluids were found to prevent MEE cell differentiation in the cultured single palatal shelf, although paired palatal shelves fused successfully even in the presence of amniotic fluid. We therefore conclude that terminal differentiation of MEE cells is not necessarily dependent on palatal shelf contact and midline epithelial seam formation, but such MEE cell differentiation appears to be prevented in utero by amniotic fluid unless palatal shelves make close contact and the midline epithelial seam is formed.

Amniotic Fluid↗
PubMed2003

[The influence of the osteogenesis in cleft palate after palatal surgery to the transverse growth of dental occlusion].

OBJECTIVE: To compare the transverse growth of the dental cast following palatal surgery with or without osteogenesis in palatal gap. METHODS: 31 patients at 13 - 28 years old with repaired palate were selected to take the dental cast, the width of the dental arch, alveolar base and the matching degree between arches were measured and the average was calculated. After the length of the bone bridge in palate was measured through CT scan, the relationship between the osteogenesis in palatal gap and the transfers growth of dental cast was studied. RESULTS: The critical length of the bone regeneration in palatal gap to affect the dental growth is 4 mm, mean while the sufficient length is 8 mm. The group of sufficient bone bridge has a better development in both the width of dental alveolar base and that of dental arch and the matching degree than the group of unsurficience. And this intendance was more obvious in premolar region than in molar region. CONCLUSIONS: The osteogenesis in palatal gap following palatal surgery can strongly support the transfers growth in the width of dental arch, the width of alveolar base and the matching degree between upper and lower dental arch.

Adolescent↗
PubMed1990

Maxillary growth after two-stage palatal closure in complete (unilateral and bilateral) clefts of the lip and palate from infancy until 10 years of age.

The purpose of the study is to clarify the maxillary growth effects following different types of palatal closure in complete clefts of the lip and palate from infancy to 10 years of age. Lip repair, carried out at 5 months in one stage, was accomplished by Tennison's procedure. These patients were then assigned randomly to each of the 4 experimental groups according to the types of clefts and of palatal closure. One group of 14 patients in unilateral cases (Unil-S) and another group of 8 patients in bilateral cases (Bil-S) received mucoperiosteal palatal push-back procedure in a single stage at 20 months. The third group of 16 patients in unilateral cases (Unil-T) and the fourth group of 7 patients in bilateral cases (Bil-T) received the two-stage palatal closure based on Perko technique in which primary veloplasty was accomplished at 20 months and hard palate closure at 5 year 10 months. Non-cleft subjects were served as Controls. A longitudinal maxillary growth was monitored by the measurements of maxillofacial cast models obtained from each of the subjects. The results showed that the growth in depth and height of the maxilla of the Unil-T showed catch-up growth after primary veloplasty and resulted in no significant differences compared to that of the Control in the later phases, however, the Unil-S did not. The maxillary growth inhibition in height was characteristic in both Bil-S and Bil-T after palatal closure. There were no differences between the Bil-S and Bil-T in any dimensions and observation phases. The results indicate that the employment of the two-stage palatal closure is more beneficial for the unilateral cases, however, careful consideration is needed in bilateral cases.

Cephalometry↗
PubMed1981

The association of submucous cleft palate and clefting of the primary palate.

478 records of patients with cleft palate were reviewed to determine the prevalence and significance of submucous cleft palate associated with clefting of the primary palate. The prevalence of submucous cleft palate in the 71 patients with clefts of the primary palate (SMCP-CL) was 13 per cent. This is two to three times greater than the prevalence of isolated submucous cleft palate found in cleft palate clinic patients. Patients with SMCP-CL often had the symptoms of velopharyngeal incompetence (VPI) and middle ear disease. The increased prevalence of SMCP and frequent symptomatology of patients with clefting of the primary palate make it essential that patients with cleft lip have early, thorough evaluation for SMCP. Early detection of SMCP associated with cleft lip and close follow-up permits the prevention of ear problems and the proper management of VPI should it develop.

Child, Preschool↗
PubMed2003

Early maxillary growth in complete cleft lip, alveolus and palate patients following Widmaier-Perko's, or a modified Furlow's technique of soft palate repair.

INTRODUCTION: The aim was to study the differences in early maxillary growth following the use of two techniques for soft palate repair in complete cleft lip, alveolus and palate patients. MATERIAL AND METHODS: Out of sixty-four primary soft palate repairs, two model samples (one of each) having been matched (gender, age, cleft type, maxillary anterior and posterior width at time of soft palate repair) were selected from the groups treated according either to Furlow or to Widmaier-Perko. The Wilcoxon Test for small samples was used to test for differences. RESULTS: At the age of 4 years, posterior transverse cleft size was significantly smaller by 2.26 mm on average (SD 2.23) in the Furlow sample. The posterior maxillary segment had grown sagitally 1.5 mm (SD 0.76) more in the Furlow sample. At the age of 4 years, all other parameters, including inter-canine point and inter-tuberosity distances did not significantly differ between the two samples. CONCLUSION: Transverse posterior growth was not statistically different between the samples and seemed to be within normal limits in both. There was more sagittal growth in the posterior maxillary segment in the Furlow sample, possibly related to less fibrotic contracture in the posterior hard palate and the soft palate. The transverse posterior cleft size was more reduced in the Furlow sample. This could not be correlated with the techniques chosen to close the hard palate cleft at the age of 4 years.

Alveolar Process↗
PubMed2001

Comparison between the palatal configurations in complete and incomplete unilateral cleft lip and palate infants under 18 months of age.

OBJECTIVE: The purpose of this study was to examine the three-dimensional characteristics of the palatal configurations in incomplete unilateral cleft lip and palate (UCLP) patients and to determine whether there are differences in the effect of early orthopedic treatment between complete and incomplete UCLP patients. DESIGN: Eight infants with incomplete UCLP and 12 infants with complete UCLP, selected at random, wore Hotz plates, and 8 other infants with complete UCLP did not. Palatal impressions were taken of these patients immediately after birth and at 1, 2, 3, 4 (just before cheiloplasty), 6, and 18 months of age (just before palatoplasty). Using our measuring system, the palatal casts were measured and compared three-dimensionally. RESULTS AND CONCLUSIONS: The palate of the incomplete UCLP patients measured immediately after birth, compared with complete UCLP, showed: (1) smaller posterior arch width; (2) sagittal arch length did not differ; (3) incisal point was located more mesially; (4) the gap between the alveolar arch forms of the major and minor segments was smaller; and (5) the curvature of the palatal surface forward the nasal cavity in the minor segment was less. At 18 months of age, the following characteristics could be observed: (1) the difference observed at birth in the posterior arch width between the incomplete and complete UCLP infants vanished; (2) a significant difference in the location of the incisal point was observed only between the incomplete UCLP infants and the complete UCLP infants with a Hotz plate; and (3) the curvature was less in the incomplete UCLP infants than in the complete UCLP infants. Furthermore, the morphological change of the palatal surface was less in the incomplete UCLP infants than in the complete UCLP infants. This suggested that any influence of the Hotz appliance might be less in incomplete UCLP than in complete UCLP.

Age Factors↗
PubMed1999

A cephalometric study of the relationship between the level of velopharyngeal closure and the palatal plane in patients with repaired cleft palate and controls without clefts.

To find out whether the palatal plane is a useful indicator for evaluating the level of velopharyngeal closure, we did a cross-sectional study from early childhood to puberty of the vertical relationship between the palatal plane and the level of velarpharyngeal contact during velopharyngeal functioning in 61 patients with repaired cleft palate (unilateral cleft lip and palate = cleft group) and 82 controls without clefts (control group). Measurements on the vertical dimension were derived from a coordinate system and landmarks on lateral cephalograms, and the significance of differences in measurements was analysed using Student's t-test. Changes in the points of velarpharyngeal contact in relation to the palatal plane with growth showed a consistent tendency though differed between the two groups. In the control group, the PPW (point where palatal plane extension intersects the posterior pharyngeal wall) was maintained at a level that did not differ significantly from the level of midpoint of velarpharyngeal contact during phonation of /a/, and was maintained at a level that did not differ significantly from the level of the inferior point of velarpharyngeal contact. In the cleft group, however, it was maintained at a level that was slightly higher than the superior point of velarpharyngeal contact both during phonation of /a/ and during blowing. These results suggest that the palatal plane is useful as an indicator for evaluating the level of velopharyngeal closure.

Adolescent↗
PubMedDate not supplied

Abnormal patterns of tongue-palate contact in the speech of individuals with cleft palate.

Individuals with cleft palate, even those with adequate velopharyngeal function, are at high risk for disordered lingual articulation. This article attempts to summarize current knowledge of abnormal tongue-palate contact patterns derived from electropalatographic (EPG) data in speakers with cleft palate. These data, which have been reported in 23 articles published over the past 20 years, have added significantly to our knowledge about cleft palate speech. Eight abnormal patterns of tongue-palate contact are described and illustrated with data from children and adults with repaired cleft palate. The paper also discusses some of the problems in interpreting EPG data from speakers with abnormal craniofacial anatomy and emphasizes the importance of quantifying relevant aspects of tongue-palate contact data. Areas of research requiring further investigation are outlined.

Adolescent↗
PubMed2006

Speech development in patients with unilateral cleft lip and palate treated with different delays in closure of the hard palate after early velar repair: a longitudinal perspective.

We wanted to find out if different timing of delayed repair of the hard palate in a two-stage procedure had an impact on the speech of 26 patients with unilateral cleft lip and palate (UCLP). The soft palate was closed at the age of 7 months and the hard palate between 38 and 89 months of age. Speech audio recordings at the age of 3 years (baseline, before any repair of the hard palate) and at the ages of 5, 7, and 10 years (the latter obtained at least one year after closure) were analysed. We used standardised speech assessments at routine follow-up and assessment by one external listener. The prevalence of speech errors caused by the cleft was similar to those described in previous reports from our centre in which hard palate repair was delayed. Unexpectedly, the results showed no difference in speech production related to timing of hard palate repair, except for nasal air leakage at the age of 7 years.

Age Factors↗
PubMed2001

Surgical treatment of submucous cleft palate: a comparative trial of two modalities for palatal closure.

Submucous cleft palate is a congenital malformation with specific clinical and anatomical features. It can be present with or without velopharyngeal insufficiency. Surgical treatment of this malformation is indicated only when velopharyngeal insufficiency has been demonstrated. This article compares two modalities of surgical treatment for submucous cleft palate. The first includes a minimal incision palatopharyngoplasty, as described in a previous report. The second combines the first technique with additional individualized velopharyngeal surgery (individualized pharyngeal flap or sphincter pharyngoplasty) performed simultaneously. The individualized part of the procedure was selected and performed according to the findings of videonasopharyngoscopy and multiview videofluoroscopy, as reported previously. Two hundred and three patients with submucous cleft palate were studied from 1990 to 1999. Videonasopharyngoscopy and multiview videofluoroscopy demonstrated velopharyngeal insufficiency in 72 patients, who were randomly divided into two groups. Those in group 1 (n = 37) underwent a minimal incision palatopharyngoplasty. Patients in group 2 (n = 35) also underwent that procedure but simultaneously received individualized pharyngeal flap or sphincter pharyngoplasty, according to the findings of videonasopharyngoscopy and multiview videofluoroscopy. The median age of the patients from both groups was not significantly different (p > 0.5). The frequency of residual velopharyngeal insufficiency after palatal closure was not significantly different in both groups of patients (14 percent versus 11 percent; p > 0.5). The mean size of the gap at the velopharyngeal sphincter during speech was not significantly different in both groups of patients before surgery (23 percent versus 22 percent; p > 0.5). After the surgical procedures, there was a nonsignificant difference between both groups of patients in mean residual size of the gap in cases of velopharyngeal insufficiency (7 percent versus 8 percent; p > 0.5). It seems that minimal incision palatopharyngoplasty is a safe and reliable procedure for palatal closure in patients with submucous cleft palate. The use of additional individualized velopharyngeal surgery performed simultaneously did not seem to decrease the frequency of residual velopharyngeal insufficiency. Moreover, the residual size of the gap at the velopharyngeal sphincter was not significantly reduced when an additional surgical procedure was performed simultaneously with palatal closure.

Articulation Disorders↗
PubMed2005

Bone regeneration in the hard palate after cleft palate surgery.

BACKGROUND: The purpose of this study was to observe bony healing in the hard palate after cleft palate repair and to discuss the factors affecting it. METHODS: Fifty-two patients with repaired cleft palate were examined at least 1 year postoperatively by means of computed tomographic scanning. The incidence of bone regeneration automatically after repair was calculated, and the region of bone formation and the quality of bone tissue were measured according to the scanned image. RESULTS: The formation of a bone bridge was found in 37 of 52 patients (71 percent). The length of regenerated bone tissue (in the anteroposterior direction) ranged from 2 to 20 mm, with an average length of 8.3 mm. The male-to-female ratio of the patients who had a bone bridge was 1:1. There was no obvious difference between the two different cleft types. Considering the relationship of age at operation and bone formation, the most popular age at which bone bridging occurred was 4 to 7 years, and the location in the hard palate with the highest percentage of bone formation was the area between the premolar and anterior part of the molar. CONCLUSIONS: Regenerated bone tissue can occur after palatal repair in cleft palate patients. The age at operation could be an important factor affecting regeneration of bone tissue. The authors were not able to find a significant effect of sex or clinical type of cleft palate based on the sample size in this study.

Adolescent↗
PubMed2004

Prevalence of palatal and alveolar cysts in babies with cleft lip and palate.

OBJECTIVE: To evaluate the prevalence of palatal and alveolar cysts in babies with cleft lip and/or palate. DESIGN: Cross-sectional. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP), Bauru, São Paulo, Brazil. PARTICIPANTS: Two hundred ninety-one Caucasian babies divided into four groups according to the type of cleft: cleft lip with or without cleft alveolus (70), complete unilateral cleft lip and palate (112), complete bilateral cleft lip and palate (56), and cleft palate (53). RESULTS: A low prevalence of palatal and alveolar cysts was observed among patients with the four different types of clefts, with no statistically significant difference between genders. The maxilla and the anterior area of the mouth were more affected than the mandible and the posterior area. CONCLUSIONS: The low prevalence of palatal and alveolar cysts in the four groups of babies with clefts included in this study may have been due to the high mean age of the sample.

Alveolar Process↗
PubMed2002

The impact of early palatal obturation on consonant development in babies with unrepaired cleft palate.

OBJECTIVE: The purpose of this investigation was to determine whether palatal obturators enhance consonant development during babbling for babies with unrepaired cleft palate. PARTICIPANTS: Fourteen babies with cleft palate who had worn anterior palatal obturators prior to palatal surgery were matched to 14 unobturated babies according to cleft type, sex, and age at time of presurgical evaluation. MAIN OUTCOME MEASURES: Spontaneous vocalizations of the obturated and unobturated groups were compared to determine whether differences were evident in size of consonant inventory as well as place and manner of consonant production. RESULTS: Paired t tests revealed no significant differences between the groups in size of consonant inventory or place and manner of consonant production. There was a trend for babies in the obturated group to produce more glottal consonants. CONCLUSIONS: In general, the findings of this study suggested that palatal obturators do not appear to facilitate production of anterior palatal consonants during babbling.

Acoustic Impedance Tests↗
PubMed2002

Toward pathogenesis of Apert cleft palate: FGF, FGFR, and TGF beta genes are differentially expressed in sequential stages of human palatal shelf fusion.

OBJECTIVE: Critical cellular events at the palatal medial edge epithelium (MEE) occur in unperturbed mammalian palatogenesis, the molecular control of which involves a number of growth factors including transforming growth factor beta 3 (TGF beta 3). Apert syndrome is a monogenic human disorder in which cleft palate has been significantly correlated to the fibroblast growth factor receptor (FGFR) 2-Ser252Trp mutation. We report the relative expression of these genes in human palatogenesis. METHODS: The expression of the IgIIIa/b and IgIIIa/c transcript isoforms of FGFR2 and the proteins FGFR1, FGFR2, and FGFR3 was studied in situ throughout the temporospatial sequence of human palatal shelf fusion and correlated with the expression of TGF beta 3. In addition, the immunolocalization of the ligand FGFs 2, 4, and 7 was undertaken together with the intracellular transcription factor STAT1, which is activated by FGFR signaling. RESULTS: FGFRs are differentially expressed in the mesenchyme and epithelia of fusing palatal shelves, in domains overlapping those of their ligands FGF4 and FGF2 but not FGF7. Coexpression is seen with TGF beta 3, which is implicated in MEE dynamics and FGF and FGFR upregulation, and STAT1, an intracellular transcription factor that mediates apoptosis. CONCLUSIONS: The coregulation of molecules of the FGFR signaling pathway with TGF beta 3 throughout the stages of human palatal fusion suggests their controlling influence on apoptosis and epitheliomesenchymal transdifferentiation at the MEE. Experimental evidence links FGFR2-IgIIIa/b loss of function with palatal clefting, and these correlated data suggest a unique pathological mechanism for Apert cleft palate.

Acrocephalosyndactylia↗
PubMed2003

Influence of early hard palate closure in unilateral and bilateral cleft lip and palate on maxillary transverse growth during the first four years of age.

OBJECTIVE: To evaluate and compare the effects of early primary closure of the hard palate on the anterior and posterior width of the maxillary arch in children with bilateral (BCLP) and unilateral (UCLP) cleft lip and palate during the first 4 years of life. DESIGN: A retrospective, mixed-longitudinal study. SETTING: Cleft Palate Center of the University of Erlangen-Nuremberg. SUBJECTS AND METHODS: The present investigation analyzes longitudinally 42 children with UCLP and 8 children with BCLP between 1996 and 2000 with early simultaneous primary closure of lip and hard palate (4 to 5 months). Palatal arch width was measured on dental casts with a computer-controlled three-dimensional digitizing system, and their growth velocities were calculated from consecutive periods (mean follow-up 39 months). Differences in growth velocities were compared with those of 25 children with UCLP and 15 children with BCLP with delayed closure of hard palate (12 to 14 months). RESULTS AND CONCLUSIONS: There was no significant difference in terms of anterior and posterior maxillary width between early and delayed closure of hard palate within the first 4 years of life.

Age Factors↗
PubMed1997

[Examination of low palatal arch with long low hanging soft palate in obstructive sleep apnea syndrome and cephalometry].

In order to clarify morphological abnormalities of the upper airway in patients with obstructive sleep apnea syndrome (OSAS), and to predict the severity as well as the effect of surgery, we statistically examined the relationship between the degree of low palatal arch and the result of cephalometry in 45 adult male patients with OSAS who underwent uvulopalatopharyngoplasty. The patients were divided into 3 types, A, B and C, according to the degree of low palatal arch on inspection, and type C was regarded as having a low palatal arch with a long low-hanging soft palate. It was found that (1) type C patients showed a higher preoperative apnea index and lower minimal blood oxygen saturation, suggesting a serious condition. (2) In type C patients, the long axis (PNS-H) of the airway was larger, and the oral area was smaller. The area of the entire tongue, especially the upper half of the tongue, was larger than that in patients of other types. Type C patients were further divided into 3 subtypes: (1) those with a substantially long low-hanging soft palate; (2) those with a long low-hanging soft palate and large tongue; and (3) those in whom the large tongue is the main factor for the apparent low-hanging soft palate. These subtypes should be confirmed by cephalography before treatment for effective surgical results.

Adult↗