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PubMed2001

Vocal development of 9-month-old babies with cleft palate.

This study compared the prelinguistic vocal development of 9-month-old babies with unrepaired cleft palate (n = 30) and age-matched peers (n = 15). Samples of the babies' spontaneous vocalizations were obtained while they interacted with their primary caregiver during play. The groups were compared on a number of variables including (a) canonical babbling ratios, (b) percentage of babies who reached the canonical babbling stage by 9 months, (c) syllable and segmental aspects of babbling, and (d) vocal frequency. Results indicated that the babies with cleft palate had smaller canonical babbling ratios than their age-matched peers, with just 57% of the babies with cleft palate reaching the canonical babbling stage by 9 months compared to 93% of the noncleft babies. Although syllable types and length were similar for the two groups, differences were noted for consonant characteristics. The babies with cleft palate had smaller consonant inventories, with fewer stops, glides, and velars noted. Glottals occurred more frequently in the vocalizations of the babies with cleft palate. Finally, no statistically significant difference was noted in the number of vocalizations produced by the two groups. Some possible explanations for why babies with cleft palate are delayed in babbling are explored.

Child Language↗
PubMed1999

Palatal mucoperiosteal wound healing in the rat.

The objective of this study was to analyze the changes in tissue architecture and matrix composition during healing of palatal wounds of immature rats, and to compare this with rats of the same age that did not receive mucoperiosteal wounds. Wounds were made in the mucoperiosteum of the palate of 35-d-old rats. Samples were evaluated histologically at numerous points in time after wounding. The DNA, hydroxyproline and sulphated glycosaminoglycan contents were determined at 8, 15, 30, and 60 d post-wounding. Eight-d-old granulation tissue contained 43% less hydroxyproline, and 100% more glycosaminoglycans and cells than unwounded palatal tissue of 43-d-old rats. Sixty-d-old wounds contained 100% more DNA and 39% more hydroxyproline than unwounded tissue of 95-d-old rats. At the same time, densely packed and transversely aligned collagen fibres were present. It is concluded that palatal mucoperiosteal wounds made in 35-d-old rats heal with distinct scar tissue formation. The scar contains more collagen than non-wounded palatal tissue of rats of the same age. Therefore, this model may be of use for the development of therapies aiming to reduce palatal scarring.

Animals↗
PubMed2001

Ageing, soft-palate tone and sleep-related breathing disorders.

UNLABELLED: We compared the tissue tone of the soft palate in 10 young (18-29 years) and 15 middle-aged (30-70 years) apnoeics with 10 young and 10 middle-aged non-snorers and healthy volunteers of the same ages. The obstructive sleep apnoea syndrome (OSAS) was diagnosed by means of the self-reported questionnaire about the medical history of the subjects and polysomnography (PSG) with overnight pulse oximetry. Computerized endopharyngeal myotonometry (CEM) was used to measure the tissue tone of the soft palate. The CEM study is performed while the subjects are awake. CEM records and analyses the biomechanical properties of tissue in response to a brief mechanical impact. Tissue stiffness is expressed as a frequency and elasticity as a logarithmic decrement of damped oscillation. RESULTS: The values of the tissue stiffness (13.5, SD 2.5 Hz) and elasticity (1.2, SD 0.4) of the soft palate in young adults with OSAS reveal no important differences in comparison with the tissue stiffness (12.7, SD 2.4 Hz) and elasticity (0.9, SD 0.2) in non-snoring young adults. The difference in the value of the tissue stiffness of the soft palate is significant among middle-aged patients with OSAS (20.3, SD 4.7 Hz) and non-snoring middle-aged persons (13.9, SD 2.3 Hz). A non-significant difference was observed in the value of the tissue elasticity among middle-aged patients with OSAS (1.7, SD 0.8) and non-snoring middle-aged persons (1.6, SD 0.3). The tissue tone of the soft palate in young and middle-aged healthy subjects differs by elasticity but not by stiffness. CONCLUSIONS: We found that some biomechanical properties of the tissues of the soft palate may be changed by OSAS and some by age.

Adolescent↗
PubMed2001

Postoperative speech development based on cleft types in children with cleft palate.

BACKGROUND: The purpose of this historical cohort study was to compare the speech development of children with three types of cleft palate while controlling for some confounding factors. METHODS: Subjects included 28 children with bilateral cleft lip and palate (BCLP), 74 with unilateral cleft lip and palate (UCLP), 33 with isolated cleft palate (ICP), and 168 normal control children. Children with cleft palate attended a speech clinic in Fukuoka, had attained adequate velopharyngeal function after palatoplasty carried out within 18 months after birth, and had no syndromic diseases, persistent hearing loss, mental retardation, or central nervous system problems. RESULTS: Children with BCLP began using two-word sentences later than other children (3 months, P<0.01). However, the difference based on sex was also statistically significant. Female patients started using two-word sentences earlier than male patients (2 months, P<0.01). Children with BCLP had lower verbal scores on the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) than other children (12.4-14.9 points, P<0.01). There was no significant difference based on sex. CONCLUSIONS: The results of this research indicate the following: speech development of children with ICP and UCLP was similar to that of normal children; however, speech development of children with BCLP was delayed compared with other children with or without cleft palate.

Age Factors↗
PubMed2000

Characterisation of human soft palate muscles with respect to fibre types, myosins and capillary supply.

Four human soft palate muscles, and palatopharyngeus, the uvula, the levator and tensor veli palatini were examined using enzyme-histochemical, immunohistochemical and biochemical methods and compared with human limb and facial muscles. Our results showed that each palate muscle had a distinct morphological identity and that they generally shared more similarities with facial than limb muscles. The palatopharyngeus and uvula muscles contained 2 of the highest proportions of type II fibres ever reported for human muscles. In contrast, the levator and tensor veli palatini muscles contained predominantly type I fibres. A fetal myosin heavy chain isoform (MyHC), not usually found in normal adult limb muscles, was present in a small number of fibres in all palate muscles. The mean muscle fibre diameter was smaller than in limb muscles and the individual and intramuscular variability in diameter and shape was considerable. All palate muscles had a high capillary density and an unusually high mitochondrial enzyme activity in the type II fibres, in comparison with limb muscles. No ordinary muscle spindles were observed. The fibre type and MyHC composition indicate that the palatopharyngeus and uvula muscles are functionally involved in quick movements whereas the levator and tensor veli palatini muscles perform slower and more continuous contractions. The high aerobic capacity and the rich capillarisation suggest that the palate muscles are relatively fatigue resistant. Absence of ordinary muscle spindles indicates a special proprioceptive control system. The special morphology of the palate muscles may be partly related to the unique anatomy with only one skeletal insertion, a feature consistent with muscle work at low load and tension and which may influence the cytoarchitecture of these muscles. Other important factors determining the special morphological characteristics might be specific functional requirements, distinct embryological origin and phylogenetic factors.

Aged↗
PubMed2004

Interferon regulatory factor 6 (IRF6) gene variants and the risk of isolated cleft lip or palate.

BACKGROUND: Cleft lip or palate (or the two in combination) is a common birth defect that results from a mixture of genetic and environmental factors. We searched for a specific genetic factor contributing to this complex trait by examining large numbers of affected patients and families and evaluating a specific candidate gene. METHODS: We identified the gene that encodes interferon regulatory factor 6 (IRF6) as a candidate gene on the basis of its involvement in an autosomal dominant form of cleft lip and palate, Van der Woude's syndrome. A single-nucleotide polymorphism in this gene results in either a valine or an isoleucine at amino acid position 274 (V274I). We carried out transmission-disequilibrium testing for V274I in 8003 individual subjects in 1968 families derived from 10 populations with ancestry in Asia, Europe, and South America, haplotype and linkage analyses, and case-control analyses, and determined the risk of cleft lip or palate that is associated with genetic variation in IRF6. RESULTS: Strong evidence of overtransmission of the valine (V) allele was found in the entire population data set (P<10(-9)); moreover, the results for some individual populations from South America and Asia were highly significant. Variation at IRF6 was responsible for 12 percent of the genetic contribution to cleft lip or palate and tripled the risk of recurrence in families that had already had one affected child. CONCLUSIONS: DNA-sequence variants associated with IRF6 are major contributors to cleft lip, with or without cleft palate. The contribution of variants in single genes to cleft lip or palate is an important consideration in genetic counseling.

Cleft Lip↗
PubMed2000

Cautery-assisted palatal stiffening operation for the treatment of obstructive sleep apnea syndrome.

Cautery-assisted palatal stiffening operation (CAPSO) is a recently developed single office-based procedure performed with local anesthesia for the treatment of palatal snoring. A midline strip of soft palate mucosa is removed, and the wound is allowed to heal by secondary intention. The flaccid palate is stiffened, and palatal snoring ceases. This prospective study evaluated the ability of CAPSO to treat obstructive sleep apnea syndrome (OSAS). Twenty-five consecutive patients with OSAS underwent CAPSO. Responders were defined as patients who had a reduction in apnea-hypopnea index (AHI) of 50% or more and an AHI of 10 or less after surgery. By these strict criteria, 40% of patients were considered to have responded to CAPSO. Mean AHI improved from 25.1+/-12.9 to 16.6+/-15.0 (P = 0.010). The Epworth Sleepiness Scale, a subjective measure of daytime sleepiness, improved from 12.7+/-5.6 to 8.8+/-4.6 (P<0.001). These results indicate that CAPSO is as effective as other palatal surgeries in the management of OSAS.

Adult↗
PubMed2000

Cautery-assisted palatal stiffening operation.

Outpatient surgical therapy of habitual snoring and mild obstructive sleep apnea has evolved significantly in recent years. We introduce the cautery-assisted palatal stiffening operation (CAPSO) and detail its important advantages over uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty, and palatal radiofrequency ablation. CAPSO is critically analyzed with regard to extent of surgery, need for repetition of procedure, results, complications, predictors of success, and cost analysis. CAPSO is a mucosal surgery that induces a midline palatal scar that stiffens the floppy palate. Two hundred six consecutive patients underwent CAPSO over an 18-month period, followed by office examination and telephone evaluation. The success rate was initially 92% and dipped to 77% after 1 year. CAPSO eliminates excessive snoring caused by palatal flutter and has success rates that were comparable with those of traditional palatal surgery. CAPSO is a simple and safe office procedure that avoids the need for multiple-stage operations and does not rely on expensive laser systems or radiofrequency generators and hand pieces.

Adult↗
PubMed1993

Concordance between isolated cleft palate in mice and alterations within a region including the gene encoding the beta 3 subunit of the type A gamma-aminobutyric acid receptor.

Genetic and molecular analyses of a number of radiation-induced deletion mutations of the pink-eyed dilution (p) locus in mouse chromosome 7 have identified a specific interval on the genetic map associated with a neonatally lethal mutation that results in cleft palate. This interval, closely linked and distal to p, and bracketed by the genes encoding the alpha 5 and beta 3 subunits of the type A gamma-aminobutyric acid receptor (Gabra5 and Gabrb3, respectively), contains a gene(s) (cp1; cleft palate 1) necessary for normal palate development. The cp1 interval extends from the distal breakpoint of the prenatally lethal p83FBFo deletion to the Gabrb3 locus. Among 20 p deletions tested, there was complete concordance between alterations at the Gabrb3 transcription unit and inability to complement the cleft-palate defect. These mapping data, along with previously described in vivo and in vitro teratological effects of gamma-aminobutyric acid or its agonists on palate development, suggest the possibility that a particular type A gamma-aminobutyric acid receptor that includes the beta 3 subunit may be necessary for normal palate development. The placement of the cp1 gene within a defined segment of the larger D15S12h (p)-D15S9h-1 interval in the mouse suggests that the highly homologous region of the human genome, 15q11-q13, be evaluated for a role(s) in human fetal facial development.

Animals↗
PubMed2005

Transforming growth factor-beta3 restores fusion in palatal shelves exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin.

The pollutant, 2,3,7,8-tetrachlorodibenzo-p-dioxin ("dioxin"), has been implicated in the etiology of a wide variety of human birth defects. In an effort to identify pharmacological blockers of dioxin-induced terata, we performed a histological and microscopic analysis of the developing murine palate that had been exposed to dioxin. In both in vivo and in vitro model systems, we observed that dioxin exposure leads to a reduction in the number of filopodial extensions at the medial epithelial edge of the developing palate. Given that this filopodial aberration is similar to the phenotype observed in Tgfbeta3 null mice, a mutant known to display a 100% incidence of cleft palate, we examined the interaction between TGFbeta3 and dioxin in palatal fusion. We found that that the addition of TGFbeta3 to an in vitro palate culture model prevented the dioxin-induced reduction in filopodial density. Moreover, TGFbeta3 exposure completely prevented the dioxin-induced block of palatal fusion in this system. Although these data do not point to a direct cellular or molecular mechanism for TGFbeta3 dioxin antagonism, these results do suggest that TGFbeta3 or stimulators of this signaling pathway hold potential as antidotes for dioxin-induced terata and that this opposing pharmacology may extend to additional toxicological endpoints.

Animals↗
PubMedDate not supplied

Speech production in Parkinson's disease: I. An electropalatographic investigation of tongue-palate contact patterns.

Previous studies have indicated that consonant imprecision in Parkinson's disease (PD) may result from a reduction in amplitude of lingual movements or articulatory undershoot. While this has been postulated, direct measurement of the tongue's contact with the hard palate during speech production has not been undertaken. Therefore, the present study aimed to use electropalatography (EPG) to determine the exact nature of tongue-palate contact in a group of individuals with PD and consonant imprecision (n = 9). Furthermore, the current investigation also aimed to compare the results of the participants with PD to a group of aged (n = 7) and young (n = 8) control speakers to determine the relative contribution of ageing of the lingual musculature to any articulatory deficits noted. Participants were required to read aloud the phrase 'I saw a _ today' with the artificial palate in-situ. Target words included the consonants /l/, /s/ and /t/ in initial position in both the /i/ and /a/ vowel environments. Phonetic transcription of phoneme productions and description of error types was completed. Furthermore, representative frames of contact were employed to describe the features of tongue-palate contact and to calculate spatial palatal indices. Results of the perceptual investigation revealed that perceived undershooting of articulatory targets distinguished the participant group with PD from the control groups. However, objective EPG assessment indicated that undershooting of the target consonant was not the cause of the perceived articulatory errors. It is, therefore, possible that reduced pressure of tongue contact with the hard palate, sub-lingual deficits or impaired articulatory timing resulted in the perceived undershooting of the target consonants.

Adult↗
PubMed2001

Effect of a thick palatal appliance on muscular symptoms in craniomandibular disorders: a preliminary study.

Several treatment modalities for myofascial pain dysfunction syndrome (MPD) are being used at present. However, from the standpoint of patients' quality of life, it would be reasonable to seek a more effective treatment modality. This study aimed to show clinical data of a preliminary study regarding the effect of a thick palatal appliance, designed to fill the palatal concavity with a thick resin base, on muscular symptoms in eighteen MPD patients. Shown here are the clinical results of two volunteer patients using palatal appliances of two different thicknesses. In this study, MPD patents were divided into the three following groups: 1. no-treatment group; 2. thick palatal appliance group; and 3. medication group. Based on the results of this study, it was suggested that the thick palatal appliance could bring about early improvement of MPD syndrome. It is suggested that the thickness of the palatal plate was an important factor in obtaining the clinical effect.

Adult↗
PubMed1999

A locus for isolated cleft palate, located on human chromosome 2q32.

We present evidence for the existence of a novel chromosome 2q32 locus involved in the pathogenesis of isolated cleft palate. We have studied two unrelated patients with strikingly similar clinical features, in whom there are apparently balanced, de novo cytogenetic rearrangements involving the same region of chromosome 2q. Both children have cleft palate, facial dysmorphism, and mild learning disability. Their karyotypes were originally reported as 46, XX, t(2;7)(q33;p21) and 46, XX, t(2;11)(q33;p14). However, our molecular cytogenetic analyses localize both translocation breakpoints to a small region between markers D2S311 and D2S116. This suggests that the true location of these breakpoints is 2q32 rather than 2q33. To obtain independent support for the existence of a cleft-palate locus in 2q32, we performed a detailed statistical analysis for all cases in the human cytogenetics database of nonmosaic, single, contiguous autosomal deletions associated with orofacial clefting. This revealed 2q32 to be one of only three chromosomal regions in which haploinsufficiency is significantly associated with isolated cleft palate. In combination, our data provide strong evidence for the location at 2q32 of a gene that is critical to the development of the secondary palate. The close proximity of these two translocation breakpoints should also allow rapid progress toward the positional cloning of this cleft-palate gene.

Cells, Cultured↗
PubMed1998

Morphological aspects of the mid-palatal suture in the human foetus: a light and scanning electron microscopy study.

Morphological features of the mid-palatal suture were studied in human foetuses from 4 to 9 months of intra-uterine life. The foetuses were divided into three age groups, GI (16-23 weeks), GII (24-31 weeks) and GIII (32-39 weeks). The mid-palatal suture in GI foetuses is rectilineal in form with a wide space between the palatal processes of the maxilla. The suture has a sinuous nature in GII and GIII foetuses due to growth of the bone processes crossing the mid-line. A wide zone of cellular proliferation observed in GI narrows in GII and GIII foetuses. The imbricating nature of the suture in GII and GIII is caused by bone growth adjacent to the mid-palatal suture. Sharpey's fibres, emerging from the bone processes, run to the median region of the mid-palatal suture and are observed from GI foetuses onwards. The collagen fibres of the mid-palatal suture are orientated transversely under the oral epithelium and exhibit a regular meshwork with a predominance of sagittal fibres in the median region of the suture. These fibres are orientated transversely and obliquely at the junction with the nasal septum.

Collagen↗
PubMed2006

Tongue to palate contact during speech in subjects with and without a tongue thrust.

The aims of this study were to determine the location and movements of the tongue on the palate during pronunciation of Persian consonants and selected words in subjects with and without a tongue thrust (TT). Ten patients with a TT and 10 control subjects, 9-13 years of age, matched for age, gender, ethnicity, type and severity of malocclusion, with no history of orthodontic treatment, surgery, or systemic disease were selected. Maxillary alginate impressions were taken to construct upper removable appliances with 12 electrodes. Fine wires connected the electrodes to a specially designed electropalatovision (EPU) device. The removable appliance was inserted in the upper arch and then the Persian consonants and some selected words were pronounced by both groups. An electromechanical marker was included on each electrode which showed the tongue movements on the palate. Tongue movements, the quantity of the tongue contacts, and the location of the tongue were compared using t- and Chi-square tests. In the TT group, the tongue had more contact with the palate on six electrodes (P < 0.001). When pronouncing the consonants, the tongue made contact anteriorly on the palate in the TT group. The quantity of tongue contacts with the palate was similar in both groups. During pronunciation of selected words, the contact points of the tongue to the palate were similar in both groups.

Adolescent↗
PubMed2004

Induction of cell-cycle arrest by all-trans retinoic acid in mouse embryonic palatal mesenchymal (MEPM) cells.

all-trans retinoic acid (atRA), the oxidative metabolite of vitamin A, is essential for normal embryonic development. Also, high levels of atRA are teratogenic in many species and can effectively induce cleft palate in the mouse. Most cleft palate resulted from the failed fusion of secondary palate shelves, and maintenance of the normal cell proliferation is important in this process of shelf growth. To clarify the mechanism by which atRA causes cleft palate, we investigated the effect of atRA on proliferation activity and cell cycle distribution in mouse embryonic palatal mesenchymal (MEPM) cells. atRA inhibited the growth of MEPM cells by inducing apoptosis in a dose-dependent manner. atRA also caused a G1 block in the cell cycle with an increase in the proportion of cells in G0/G1 and a decrease in the proportion of cells in S phase, as determined by flow cytometry. We next investigated the effects of atRA on molecules that regulate the G1 to S phase transition. These studies demonstrated that atRA inhibited expression of cyclins D and E at the protein level. Furthermore, atRA treatment reduced phosphorylated Rb and decreased cdk2 and cdk4 kinase activity. These data suggest that atRA had antiproliferative activity by modulating G1/S cell cycle regulators and by inhibition of Rb phosphorylation in MEPM cells, which might account for the pathogenesis of cleft palate induced by retinoic acid.

Animals↗
PubMed1987

Objectives for cleft palate repair.

Improved anesthesia and nutrition are permitting earlier safe cleft palate repair, with higher success rates. Three factors that are considered necessary to obtain satisfactory function of the soft palate for speech are (1) adequate length, (2) adequate mobility, which should include consideration of resting tension and elasticity of the levator and depressor muscles, and (3) the need for conformity of the dorsal surface to the pharyngeal wall, which this paper seeks to emphasize. These concepts are examined with reference to the literature and observations made by the author from endoscopic and x-ray studies and from electrical stimulation of the palate muscles prior to palate repair. A technique for relocating the musculus uvulae is described. It is concluded that at least 9 out of 10 palates are long enough at birth and have sufficient mobility, provided that this is not impaired iatrogenically, to obtain satisfactory speech. Emphasis needs to be placed on providing a normal dorsal convexity and, where levator activity appears to be inadequate, means need to be found whereby inappropriate activity or tension of the palate depressors can be diagnosed and effective treatment devised.

Cleft Palate↗
PubMed1999

A management strategy for palatal fractures: a 12-year review.

Fractures of the palate are frequently associated with the more common and well-described Le Fort fractures. Palatal fractures may present diagnostic and exposure challenges and, if not satisfactorily treated, will result in occlusal problems after surgery. From 1986 through 1998, 116 complex maxillary fractures were treated at the authors' center. Among these, 13 patients were diagnosed with fracture of the palate. Patients with gunshot wounds to the face were excluded from the present study. Open reduction and internal fixation of the palatal fractures were achieved through elevation of the entire palatal mucoperiosteal flap to avoid late hardware exposure. This paper presents a unique approach to visualizing the whole bony palatal surface for accurate reduction and internal fixation of fractures.

Adolescent↗