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PubMed2006

A quantitative study of the equine soft palate using histomorphometry.

Dorsal displacement of the soft palate is a common cause of upper airway obstruction in racehorses and is of unknown aetiology. To determine whether the palate may displace for structural reasons, knowledge of the normal soft palate is required. The present study aimed to describe, qualitatively and quantitatively, the structure of the normal equine soft palate using histomorphometry. In soft palates from 12 Thoroughbreds, glandular tissue predominated (ca. 40% of total area), located mainly in the rostral and ventral regions. Rostrally, muscles attached to a tendinous aponeurosis located dorsal to the glandular tissue. Muscle was most abundant in the dorsal mid region and decreased caudally. The oral mucosa consisted of a non-keratinised stratified squamous epithelium whereas the nasopharyngeal mucosa was pseudostratified, columnar and ciliated. Elastin fibres were observed in the nasopharyngeal submucosa, becoming more prevalent caudally. The palates were bilaterally symmetrical although the proportion of tissue types varied considerably between individuals.

Airway Obstruction↗
PubMed1998

Localization of atrial natriuretic peptide receptors in the rat tongue and hard palate.

Atrial natriuretic peptide (ANP) receptors were characterized in rat oral mucosa using quantitative in vitro autoradiography and activation of particulate guanylyl cyclase (GC) by natriuretic peptides. Competition-binding analysis performed by quantitative in vitro autoradiography demonstrated specific [125I]rANP(1-28) binding sites in the tongue and hard palate. The precise location of this binding was revealed on the basal and parabasal cells of the epithelia by microautoradiography. The dissociation constant (Kd) and maximal binding capacity (Bmax) of these sites were 3.34+/-1.35 nM and 2.71+/-2.21 fmol/mm2 on the epithelium of the tongue, and 4.09+/-1.52 nM and 3.45+/-3.01 fmol/mm2 on the epithelium of the hard palate, respectively. Receptor subtypes were characterized by competition with des [Gln18, Ser19, Gly20, Leu21, Gly22] ANP(4-23) (C-ANP), a specific ligand for the clearance receptor (NPR-C). These binding sites were displaced by C-ANP with inhibition constant (Ki) of 8.96+/-3.18 nM and Bmax of 2.89+/-2.45 fmol/mm2 on the epithelium of the tongue, and Ki of 9.12+/-2.71 nM and Bmax of 3.08+/-2.94 fmol/mm2 on the epithelium of the hard palate, respectively. Production of cyclic GMP by particulate GC in the epithelial membranes of the tongue and hard palate was stimulated by rANP(1-28), porcine brain natriuretic peptide (BNP)(1-26), and C-type natriuretic peptide (CNP)(1-22) in a dose-dependent manner. These results indicate that ANP-binding sites in the epithelium of the tongue and hard palate are mainly clearance receptors (NPR-C) but biological receptors (NPR-A and/or NPR-B) with GC activity are also present, and suggest that ANP may have a role in the proliferation of the oral epithelial cells, especially in the tongue and hard palate.

Analysis of Variance↗
PubMed2002

Phosphatase regulation of gene expression during development of the palate.

In mammalian cells, including those of the embryonic palate, the level of phosphorylation of cellular proteins at any given time reflects the activities of protein kinases and protein phosphatases. Both protein phosphatase-1 (PP-1) and PP-2A inhibit cAMP-mediated increases in transcription by dephosphorylating CREB at ser-133. Western blot analysis indicated that protein phosphatase 1 (PP-1) was expressed constitutively in palatal tissue during its development. Expression of PP-2A was regulated developmentally with maximal expression on gestational day (gd) 14. Densitometric scanning revealed a 30% increase in expression from gd 13 to gd 14. Virtually all phosphatase activity in the tissue extracts could be inhibited by 5 microM okadaic acid, demonstrating that PP-1 and PP-2A account for all detectable ser/thr protein phosphatase activity present in the developing palate. Moreover, no significant differences in PP-1 and PP-2A activities were observed during the period of palate development. Treatment of primary cultures of murine embryonic palate mesenchymal (MEPM) cells with forskolin (20 microM) to elevate intracellular cAMP levels, resulted in a time-dependent increase in CREB ser-133 phosphorylation and a corresponding time dependent decrease in PP-1 and PP-2A levels. Moreover, treatment of MEPM cells with okadaic acid resulted in a dramatic increase in basal CREB ser-133 phosphorylation. This suggests that PP-1 activity may contribute to transcriptional regulation of CREB and that PP-1 and PP-2A are regulated differentially by cAMP. Treatment of MEPM cells with TGF beta 1 (1 ng/ml) under conditions of TGF beta-induced CREB phosphorylation resulted in no effect on the expression of either PP-1 or PP-2A proteins and no significant alterations in total basal protein phosphatase activity. These results demonstrate that transcriptional regulation of CREB in embryonic palatal issue is dependent on the coordinate activity of specific kinases and phosphatases.

Animals↗
PubMed1984

Role of cyclic AMP, prostaglandins, and catecholamines during normal palate development.

The biochemical regulatory mechanisms controlling palatal differentiation are largely unknown. Published data suggest that hormonally regulated levels of cyclic AMP may be important in normal, as well as abnormal, development of the secondary palate. Palatal cAMP, prostaglandins, and catecholamines appear to be integrally involved in cellular differentiation during normal palatal development. Studies such as those outlined in this chapter are fundamental to meaningful investigations probing the etiology of abnormal development. Questions dealing with biochemical mechanisms of action of potential cleft palate teratogens, or with genetically based orofacial malformations, must be grounded on a thorough understanding of biochemical events and regulation of these events during normal craniofacial development. Evidence suggests that cyclic AMP levels, possibly regulated by prostaglandin and/or catecholamine receptor occupancy, may play an important role in normal growth and differentiation of the developing orofacial region and may serve as metabolic foci for teratogenic perturbation resulting in palatal clefting.

Animals↗
PubMed1984

Biochemical mechanism of glucocorticoid-and phenytoin-induced cleft palate.

The production of cleft palate by glucocorticoids and phenytoin is a complicated interference in a complex developmental program involving many genetic and biochemical processes. The H-2 histocompatibility region includes genes which affect (1) susceptibility to glucocorticoid- and phenytoin-induced cleft palate; (2) glucocorticoid receptor level in a variety of tissues including maternal and embryonic palates, adult thymuses, and lungs; and (3) the degree of inhibition of prostaglandin and thromboxane production by glucocorticoids and phenytoin in thymocytes. A gene linked to a minor histocompatibility locus (H-3) on the second chromosome also influences susceptibility to glucocorticoid- and phenytoin-induced cleft palate. Phenytoin is an alternate ligand for the glucocorticoid receptor affecting prostaglandin and/or thromboxane production. The capacity of glucocorticoids to induce cleft palate is correlated with their anti-inflammatory potency. At least some of the anti-inflammatory effects of glucocorticoids can be explained by the inhibition of prostaglandin and/or thromboxane release, which in turn could be caused by inhibition of arachidonic acid release from phospholipids. Similar mechanisms may be involved in cleft palate induction, as exogenous arachidonic acid injected into pregnant rats and mice at the same time as glucocorticoids reduces the teratogenic potency of the steroids, and indomethacin, an inhibitor of cyclooxygenase, blocks the corrective action of arachidonic acid. Glucocorticoids and phenytoin cause a delay in shelf elevation, and this delay is promoted by fetal membranes and the tongue. However, the cells of the medial edge epithelium are programmed to die whether contact is made with the apposing shelf or not. Glucocorticoids and phenytoin interfere with this programmed cell death, and this interference by both drugs seems to be glucocorticoid receptor mediated, to require protein synthesis, and to be related to arachidonic acid release.

Animals↗
PubMed2003

Incidence and outcome of middle ear disease in cleft lip and/or cleft palate.

OBJECTIVE: Otitis media with effusion is known to be very common among children with cleft palate, however, less is known regarding the natural history and outcome in this group. The purpose of the present study was to examine the incidence, natural history, treatment, and outcome of middle ear disease in children with clefts. METHODS: A questionnaire was sent to the parents of all children registered on the cleft lip and palate database at our institution. The medical records of all respondents were also reviewed. Statistical analysis of the results was performed using Fisher's exact test in contingency tables and binary logistic regression analyses, where appropriate. RESULTS: 397 fully completed questionnaires were returned. Ear disease was much more common in children with cleft palate, or cleft lip and palate, than in children with cleft lip. Among children with cleft palate, ear problems (infections and/or hearing loss) were most prevalent in the 4-6-year-old age group. However, ear problems persisted at a substantial level for many years after this; only after the age of 12 years did problems appear to settle. The incidence of below normal current hearing and of surgery for chronic otitis media was significantly related to history of ear infections (P=0.000 and 0.000, respectively), and to increased number of ventilation tube insertions (P=0.000 and 0.000, respectively). CONCLUSIONS: Middle ear disease is common in children with cleft palate, and, unlike the case for children without clefts, has a prolonged recovery, and a substantial incidence of late sequelae. The higher incidence of below normal hearing and surgery for chronic otitis media in children undergoing a greater number of ventilation tube insertions, although most likely reflecting an increased underlying severity of otitis media in these children, also underlines the lack of long-term benefits of ventilation tubes in this group.

Adolescent↗
PubMed1998

A methodology report of a randomized prospective clinical trial to assess velopharyngeal function for speech following palatal surgery.

Cleft lip and palate occurs in approximately 1 in every 750 live human births, making it one of the most common congenital malformations. Surgical closure of the palatal cleft does not always result in a velopharyngeal port capable of supporting normal speech. The University of Florida (UF), in collaboration with the University of São Paulo (USP), is engaging in a 5-year prospective, randomized controlled study to compare velopharyngeal function for speech outcomes between patients undergoing palatoplasty for complete unilateral cleft lip and palate performed using the von Langenbeck procedure with intravelar velarplasty and those receiving the Furlow double-reversing Z-plasty palatoplasty. The von Langenbeck procedure was selected as the time-tested standard against which the Furlow procedure could be judged. The Furlow procedure, a relatively new operation, has been reported to yield substantially higher rates of velopharyngeal competency for speech than have most other reported series and theoretically should result in less disturbance to midfacial growth. A total of 608 patients will be entered into one of two age categories. Inclusion of two age groups will allow a comparison of results between patients having surgery before 1 year of age (9-12 months) and patients undergoing surgery at approximately 1.5 years of age (15-18 months). Speech data will be collected and will be available for definitive analysis throughout the last 3 years of the study. Collection of preliminary growth data will require more than 5 years; growth analysis is anticipated to continue until all patients have reached maturity. The Hospital for Research and Rehabilitation of Patients with Cleft Lip and Palate at the University of São Paulo (USP-HPRLLP) in Bauru, Brazil, is uniquely situated for conducting this study. The well-equipped and modern facilities are staffed by well-trained specialists representing all disciplines in cleft-palate management. In addition, an already existing social services network throughout Brazil will ensure excellent follow-up of study cases. The clinical caseload at this institution currently exceeds 22,000, and more than 1200 new cases are added annually. This project represents a unique opportunity to obtain prospective data from a large number of subjects while controlling the variables that have traditionally plagued cleft-palate studies. This study is designed to determine which of the two proposed surgical procedures is superior in constructing a velum capable of affecting velopharyngeal competency for the development of normal speech.

Cleft Palate↗
PubMed1998

Comparative study of diagnostic measures in borderline surgical cases of unilateral cleft lip and palate and noncleft Class III malocclusions.

Patients with complete unilateral cleft lip and palate present difficult growth problems. Their anteroposterior discrepancies in jaw and dentition are frequently so severe that some epidemiologic studies report the necessity of orthognathic surgery in 25% of their sample. The aims of this study were three-fold: (1) to delineate diagnostic measures in borderline surgical cases of unilateral cleft lip and palate, (2) to verify the significance of negative overjet as a measure of anteroposterior discrepancy, and (3) to compare these diagnostic measures with those of borderline surgical cases of noncleft Class III malocclusions. The sample consisted of 29 patients with unilateral cleft lip and palate and 25 noncleft Class III Korean patients (mean age, 18.69 years); all had crossbites of all four incisors. Each of their pretreatment study casts and cephalograms were analyzed. The group with unilateral cleft lip and palate was divided into two subgroups on the basis of the method of their anterior crossbite resolution; 18 subjects were treated with orthodontics alone (Cleft-NS) and 11 subjects with orthognathic surgery (Cleft-Surg). The noncleft Class III group was divided into two subgroups; 6 of the subjects were orthodontically treated (Cl III-NS), and 19 were surgically treated (Cl III-Surg). The group with unilateral cleft lip and palate showed smaller SNA and SNB angles than the noncleft Class III group, but the ANB angles and the amount of anterior crossbites showed no statistical differences. When the Cleft-NS and the Cleft-Surg groups were compared, the ANB angle and the Wits measurements were significantly different. When the Cl III-NS and Cl III-Surg groups were compared, the SNB, ANB, L1GoGn, Wits, and the crossbite showed significant differences. For borderline surgical Class III unilateral cleft lip and palate cases, ANB angle, Wits appraisal, and ABGoGn angle were critical diagnostic parameters. On the other hand, the magnitude of anterior crossbite, the negative overjet, was shown not to be a significant measure of anteroposterior discrepancy.

Adolescent↗
PubMed1998

The use of the frog palate preparation to assess the effects of oxidants on ciliated epithelium.

This work was designed to develop a simple method based on the frog palate preparation to study the effects of hydrogen peroxide (H2O2) on ciliated epithelium. For this purpose, five sets (n = 10 per set) of frog palate preparations (Rana catesbeiana) were studied during 35 min after immersion in increasing concentrations of H2O2: 1, 8, 16, 32, and 64 microM. The effects of H2O2 on ciliated epithelium were assessed by measuring transepithelial potential difference (PD) and mucociliary transport (MT). Measurements were performed at 5-min intervals. In addition, the palates submitted to the 64 microM dose were immersed in Ringer's solution and followed by another 30 min to assess the possible recovery after maximal injury. Transepithelial potential difference (PD) was measured by means of agar-filled microelectrodes connected to the high input of a grounded electrometer. Mucociliary transport (MT) was determined by directly monitoring the movement of autologous mucus along the palate surface. Significant decrease in MT was observed in 16 microM and beyond and significant change in PD was observed in 32 microM and 64 microM. Palates submitted to 64 microM of H2O2 returned to their baseline levels of PD and MT within 30 min of recovery in Ringer's solution. In conclusion, the frog palate preparation was shown to be an efficient experimental tool to assess the deleterious effects of H2O2 on the ciliated epithelium.

Analysis of Variance↗
PubMed1992

Influence of surgery on maxillary growth in cleft lip and/or palate patients.

Using a sample of 204 caucasian adults of both sexes, with complete unilateral cleft lip and alveolus, isolated cleft palate and complete unilateral cleft lip, alveolus and palate, the influence of surgery on maxillary morphology and spatial position for the three main types of cleft lip and/or palate were evaluated. 113 cleft patients operated on at conventional timings were compared to 91 cleft patients who had never been operated on. Findings permit the conclusion that cheiloplasty in cleft lip and alveolus patients is associated with osseous remodelling in the anterior alveolar region, without significant changes in anterior nasal spine or other areas of the maxilla. In isolated cleft palate subjects palate repair does not promote significant changes in maxillary morphology and spatial position. The most evident effects were seen in the cleft lip, alveolus and palate group: reconstructive surgery in these patients leads to a severe maxillary retroposition associated with a downward rotation.

Adolescent↗
PubMed1995

Pathogenesis of bromodeoxyuridine-induced cleft palate in mice.

This study was designed to examine the pathogenesis of bromodeoxyuridine-induced (BrdU) clefts of the secondary palate in mice. Intraperitoneal injections of BrdU (500 mg/kg body weight) were given on days 11 and 12 to some pregnant mice and on days 12 and 13, and days 11, 12 and 13 to others. Evaluation of craniofacial relations and palate development in BrdU-treated mice revealed inhibition of vertical development of the palatal shelves, mandibular hypoplasia which led to failure of downward displacement of the tongue and the creation of an obstacle to reorientation of the palatal shelves. The results of this study demonstrate a strong correlation between induction of cleft palate and the presence of structural alterations in the mandible, and the mechanism of BrdU-induced cleft palate resembles the defect in the Pierre Robin anomaly.

Abnormalities, Drug-Induced↗
PubMed1999

Speech outcome in children with cleft palate: aerophonoscope assessment of nasal emission.

The quality of speech is an important outcome measure of the success of primary surgery for clefts of the palate. A competent velopharyngeal mechanism is essential for normal speech, and disorders of resonance and nasal airflow are significant manifestations of velopharyngeal dysfunction in cleft palate subjects. The aim of this study was to determine the level of nasal emission during speech in patients with functionally repaired clefts of the palate and compare this with age and sex-matched controls. Forty-four children between the ages of 3 and 9 years were assessed for nasal emission using an Aerophonoscope. All these patients had primary functional surgery carried out at this unit by the same surgeon, and fell into three groups; complete bilateral, complete unilateral and soft palate clefts. Nasal breathing, blowing and groups of vowels and voiceless pressure consonants were assessed. There was no nasal emission in close to, or over, 90% of the patients for these parameters. The results indicate that a highly significant percentage of children with functionally repaired clefts of the palate have normal velopharyngeal function and speech, without inappropriate nasal emission. The Aerophonoscope provides an accurate, reliable and user-friendly diagnostic aid, and indeed therapeutic adjunct, to speech management in cleft palate patients.

Child↗
PubMed1998

Palatal canalicular adenoma: report of 12 cases and review of the literature.

Canalicular adenoma is the second most common type of adenoma of the oral region and arises almost exclusively in the upper lip. Other locations include the buccal mucosa, the palate, and the parotid gland. We report 12 cases of canalicular adenoma that arose in the palates of nine women and three men between the ages of 42 and 76 years. The tumor presented as a nonulcerated (eight patients) or ulcerated (four patients) lesion, usually at the junction of the hard and soft palates. Two tumors were misdiagnosed: one as adenoid cystic carcinoma and the other as low-grade adenocarcinoma. Both patients had had partial maxillectomy; the patient diagnosed with adenoid cystic carcinoma also received radiotherapy. One patient reported having had an adenoma removed from the palate 10 years previous to presentation; thus, the tumor was classified as a recurrence. Evidence of tumor metastasis was absent in all cases during the follow-up period, which ranged from 1 to 25 years. Eleven patients are alive and disease free; one died of other causes. Canalicular adenoma does not commonly occur in the palate. This tumor has an excellent prognosis after conservative surgical treatment in all locations. Pathologists should be aware of the occurrence of this neoplasm in the palatal region and of its histopathology so they can distinguish it from malignant tumors of the salivary gland.

Adenoma↗
PubMed1978

An otorhinological study of children with cleft palates.

An otorhinological study of 245 children with cleft palate was carried out in two groups from two different hospitals. The incidences of deafness and exudative otitis media were much higher in the group where each child was seen by an otologist and hearing tested by audiogram. The lower incidence in the second group could be explained by the fact that a large number of children with exudative otitis media and deafness were missed as they were neither routinely seen by an otologist nor were they screened by audiograms. We found 37% of asymptomatic children were deaf. It is important therefore that all children with clefts of the palate should be seen by an otologist and investigated by audiogram and impedance test. The incidence of deafness was less if the cleft involved soft palate only and if the palate was repaired early. The incidence was also less in children who had their tonsils and adenoids removed. Infracture of the pterygoid hamulus during the repair of the soft palate failed to show any increase in the incidence of deafness. In this study we found a higher incidence of deafness amongst children with nasal escape. Fifty per cent of the children with clefts of the palate and lip had deviated nasal septum producing nasal obstruction.

Adenoidectomy↗
PubMed2002

Effects of locally injected interferon-beta on palatal mucoperiosteal wound healing.

BACKGROUND: Wound contraction and scar formation in the palatal mucoperiosteum after cleft palate surgery impair maxillary growth. The aim of this study was to determine the effects of IFN-beta on palatal mucoperiosteal wound healing in growing rats. METHODS: Standardized wounds were made in the palatal mucoperiosteum of young rats. Either IFN-beta or vehicle were injected at the wound site between 4 and 29 days after wounding. The results were compared with control wounds. Tissue samples were collected at 8, 15, 30, and 60 days PW for biochemical and microscopic analysis. RESULTS: IFN-beta stimulated re-epithelialization but did not reduce the number of myofibroblasts or scar tissue formation. Surprisingly, the injection of vehicle alone delayed the healing process. CONCLUSION: IFN-beta might be suitable to stimulate re-epithelialization but it does not reduce scar tissue formation in rat palatal wound healing. The injection of agents into palatal wounds might severely impair the healing process.

Analysis of Variance↗
PubMed2002

Longitudinal investigation of soft palate and nasopharyngeal airway relations in different rotation types.

The relationship between the soft palate and the nasopharyngeal airway in different mandibular growth rotation models was investigated. A total of 72 lateral cephalograms were obtained three years longitudinally from 24 individuals. The subjects had a mean age of 10.7 +/- 1.2 years and showed a normal (n = 8), posterior (n = 8), and anterior (n = 8) mandibular rotation pattern. Linear and angular measurements of the soft palate and nasopharyngeal airway were recorded by using PORDIOS computer program and were examined by means of descriptive statistics and paired t-tests. A linear increase in the soft palate length (SPL) was observed in all groups, with the posterior mandibular rotation group showing the largest increase within the observation period (28.56 +/- 4.83 to 34.98 +/- 2.87; P < .01). According to the paired t-test, palatal plane (ANS-PNS)/soft palate tip (SPT) angle showed a statistically significant decrease in the posterior rotation group (P < .01). The ratio between SPL and superior nasopharyngeal space (SPS) did not show a statistically significant difference among the groups. Although various amounts of soft palate and nasopharyngeal airway growth occurred in the different mandibular rotation types, the ratio between SPL and SPS (SPL/SPS), which plays an indispensable role in velopharyngeal functions, did not show a statistically significant difference in the groups. This assured velopharyngeal closure throughout the active growth period.

Cephalometry↗
PubMed2006

Anchorage effect of osseointegrated vs nonosseointegrated palatal implants.

Palatal implants can be used with a transpalatal arch (TPA) connected with the second premolar to provide anchorage. The purpose of this study was to compare the anchorage effects of an osseointegrated palatal implant (OPI) with a nonosseointegrated palatal implant (NOPI), using finite element analysis. One model, which was composed of two maxillary premolars, periodontal ligament (PDL), alveolar bone, a palatal implant, palatal bone, a bracket, band, and TPA, was created on the basis of the clinical situation. The palatal implant was treated as either NOPI or OPI. The force on the premolars was investigated under three conditions: a distomesial horizontal force, a buccolingual horizontal force, and a vertical intrusive force. The PDL stress was calculated and compared with a model without an implant. The result showed that OPI could reduce PDL stress significantly. (The average stress was reduced by 14.44% for the distomesial horizontal force, 60.28% for the buccolingual horizontal force, and 17.31% for the vertical intrusive force.) The NOPI showed almost the same anchorage effect as OPI. The stress on the NOPI surface was higher than that on the OPI surface, but the stress was not high enough to result in failure of the implant. These results suggested that waiting for osseointegration might be unnecessary for an orthodontic implant.

Alveolar Process↗
PubMed2006

Predictive factors of vertical bone depth in the paramedian palate of adolescents.

OBJECTIVE: To determine whether a relationship exists between the vertical bone depth in the paramedian palate (PP) of growing patients and age, gender, and palatal morphology. Clinically detectable traits may decrease the need for further imaging prior to implant placement for orthodontic anchorage. MATERIALS AND METHODS: Cone beam computed tomagraphic scans (Newtom-9000, Verona, Italy) were acquired in 183 orthodontic patients (10-19 years old). Vertical bone depth was measured at nine unilateral locations in the PP of each subject. Measurements were analyzed with univariate and multivariate statistical tests. RESULTS: Significant variability in the bone thickness was found among locations and among subjects. Male subjects had significantly greater mean bone thickness in six of the nine locations measured, showing a mean of 1.22 mm more vertical bone than females showed at these locations. Age and palatal measurements did not demonstrate a clinically useful relationship with bone depth. CONCLUSIONS: Age and palatal morphology are not valid predictors of bone height in the PP. Because of the large variability of bone thickness in this region, computed tomographic imaging remains valuable prior to paramedian implant placement in growing individuals. The paramedian palate presents a promising region for palatal implant placements when the midpalatal suture is to be avoided.

Adolescent↗