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PubMed1995

Effect of palatal injections on pulpal blood flow in premolars.

The effect of palatal infiltration injections using 2% lignocaine hydrochloride with 1:80,000 adrenaline was evaluated for sound maxillary first premolar teeth. The influence of the injections on pulpal blood flow and local anaesthesia was investigated. Ten human volunteers were given the following injections on different days: 1 ml palatal infiltration; 1 ml buccal infiltration; 1 ml palatal and 1 ml buccal infiltration; and 2 ml buccal infiltration. The blood flow was observed with a laser Doppler flowmeter with the probes held against the buccal surfaces of the teeth by a splint. Blood flow was recorded digitally on a computer in machine units. Pulpal anaesthesia was assessed using a monopolar electric pulp tester. All injections significantly reduced blood flow from baseline levels (p<0.05). The 1-ml palatal injection produced a significantly longer period of reduced blood flow (mean 40 min) compared with the other injections (p<0.05). The duration of blood flow reduction was shorter than the duration of pulpal anaesthesia for every injection. Only seven out of 10 palatal injections achieved pulpal anaesthesia. The 2-ml buccal injection and the combined buccal and palatal injections produced significantly longer anaesthesia than the 1-ml buccal injection (p<0.05).

Adult↗
PubMed2006

Anterior palatal mouthguard margin location and its effect on shock-absorbing capability.

The purpose of this study was to evaluate the influence of a mouthguard's (MGs) anterior palatal margin location on its shock absorbing capability. A simulation study was conducted on a maxillary phantom model with maxillary teeth, bone, and soft tissue. Miniature strain gauges were attached to the labial and palatal surfaces of the right central incisor as well as the bone surface on the palatal side. MGs were made with ethylene vinyl acetate sheets, with thickness of 2.0, 3.0, and 4.0 mm, using a pressure-forming machine. The locations of the anterior palatal MG margins were set at 4.0, 2.0, and 0 mm from the cervical margin in three experimental configurations. The control situation was without a MG. A calibrated 7N of shock was applied to the middle portions of the labial and palatal surfaces of the central incisor. The amount of tooth deflection was evaluated. The results were analyzed with one-way anova accompanied by the Scheffe's test and multiple regression analysis (P<0.05), designating the strain as the dependent value. The results indicated that the thickness rather than the location of the anterior palatal margin of the MG has a significant influence on the reduction of tooth deflection against a horizontal blow.

Adult↗
PubMed2005

The tongue stops here: ultrasound imaging of the palate (L).

This letter presents a method for imaging the palate and extracting the palate contour from ultrasound images. Ultrasound does not usually capture the palate because the air at the tongue surface reflects the ultrasound beam back to the transducer. However, when the tongue touches the palate during a swallow, the ultrasound beam is transmitted through the soft tissue until it reaches and is reflected by the palate. In combination with tongue contours, the palate contour has the potential for disambiguation of the tongue surface, registration of images within and across subjects, and calculation of phonetically important measures.

Adolescent↗
PubMed1990

Submucous cleft palate in the differential diagnosis of feeding difficulties.

Submucous cleft palate is a missed or forgotten diagnosis. We reviewed 81 patients with submucous cleft palate seen over a 15 year period; 26 of these patients were interviewed. The patients were divided into three main groups according to the referral pattern. Children under 2.5 years were referred by a paediatrician for feeding problems; children aged 2.5-10 were referred mainly by speech therapists; and those over 10 had a varied pattern of referral. Thirty nine of the 81 had problems with feeding, but of the 26 interviewed, 22 had feeding problems. Not all patients with a submucous cleft palate are symptomatic and require active treatment, but children with this condition have the same high incidence of middle ear disease as those with overt cleft palate. We suggest that the diagnosis of submucous cleft palate be included in the differential diagnosis of feeding difficulties, with early referral to a specialist cleft palate team.

Adolescent↗
PubMed1982

A family study of isolated cleft palate.

A family study was based on 245 boy and 329 girl patients treated surgically for non-syndromic cleft palate between 1920 and 1929; 86 and 81 respectively were traced and had had children. These 167 were the probands for the family study and were interviewed in their homes. None was born to a consanguineous marriage. Altogether they had had 384 children of whom 11 had cleft palate (2.9 +/- 0.9%). They had 398 sibs of whom five had cleft palate, 117 grandchildren of whom one was affected, and 517 nephews and nieces of whom one was affected. This is the largest series yet available on which to base an estimate of the risks to children of patients with non-syndromic cleft palate. The risk is probably increased where a parent or sib of the proband is affected and increased to a lesser degree where a second or third degree relative is affected. The family patterns in these and other studies suggest that the aetiology of cleft palate is heterogeneous, with some families showing modified dominant inheritance. This is in contrast to cleft lip (+/- cleft palate) where the data are consistent with a multifactorial threshold model.

Adult↗
PubMed1990

Corpuscular bodies in the palate of the rat. 2. Innervation and central projection.

The source of innervation of the corpuscular bodies in the palate and the central projections of the afferent fibres of the entire palate was studied in rats by transganglionic transport of horseradish peroxidase conjugated to wheat germ agglutinin (WGA-HRP) and with substance P (SP) immunohistochemistry. WGA-HRP injected into the incisal papilla was taken up by the nerve fibres that terminated in the corpuscles. Retrogradely labelled neurons were observed in the trigeminal ganglion as well as anterogradely labelled terminals in the dorsolateral part of the spinal trigeminal nucleus and in the lateral part of the nucleus of the solitary tract. No labelling could be found in the geniculate ganglion, the facial nerve and the hypoglossal nucleus. Following WGA-HRP injection in the intermolar area and in the soft palate, labelling was only restricted to the trigeminal ganglion. The lamina propria of the entire palate and the corpuscle-enriched area of the incisal papilla and the soft palate were richly innervated by SP-containing fibres. Numerous SP-containing fibres were also observed in the nerve plexus at the base of the corpuscle. In addition, SP-positive neurons were identified in the trigeminal ganglion and SP-labelled terminals in the sensory trigeminal nuclear complex and in the solitary tract nucleus. On the basis of our morphological observations we conclude that the palatal corpuscular bodies are involved in taste perception which is of trigeminal origin.

Animals↗
PubMed1993

Injuries of the hard palate and the horizontal buttress of the midface.

Traumatic injuries to the hard palate occurred in 20% of all Le Fort midfacial fractures. The side of a palatal split was directly related to the side that received the highest Le Fort injury. In a symmetric midfacial injury, the palate had a true midline split. Repair of palatal injuries from blunt trauma involved either wire and splinting (eight patients) or miniplate fixation without a splint (11 patients). There were fewer complications in those treated by the miniplate fixation technique (two of 11), as compared to those treated with wire and splinting (four of eight). In miniplate fixation of midfacial fractures, attention is focused on the reconstruction of the supporting buttresses of the midface, both vertical and horizontal. In regard to the palate, this requires union of the inferior horizontal buttress. Gunshot wounds accounted for 21% of the patients and resulted in large bony disruption of the palate, which required free soft tissue and bone grafts for repair of the inferior horizontal buttress.

Adolescent↗
PubMed1999

Treatment outcome in cleft lip and palate: issues and perspectives.

In the last 40 years, great progress has been made toward a better understanding of many aspects of the cleft lip and palate defect, but there is still a long way to go before there is agreement on the optimal treatment procedures. With regard to the primary operations, it can be stated, in a somewhat simplified form, that there are two main schools of thought in cleft treatment. One advocates early closure of the lip and palate, a procedure which imparts a high priority to early speech function. The other recommends delayed closure of the hard palate, thereby according a high priority to the growth of the maxilla. A number of intercenter and multicenter studies have been carried out recently in an effort to elucidate which procedures give the best result, both esthetically and functionally. The results are ambiguous, and this has led a number of researchers to suggest that the randomized clinical trial is the only way to resolve the ambiguity. The fact that it has proved difficult to identify the optimal procedures in the field of cleft lip and palate treatment need not only be due to a less than optimal research design; a contributory factor might also be the great variability in craniofacial morphology and in the response to treatment in patients who have exactly the same cleft lip and palate diagnosis. Intensive research has made it possible to state categorically that clefts occur due to many different factors in an interplay between genetics and environment. Therefore, it is not likely that a single gene can be responsible for clefting. Since scar tissue presents many problems-for instance, impairment of growth-the reduction or prevention of scar formation has long been a desirable goal. The discovery that a fetus can heal without scar formation has led to many animal experiments. The timing of the surgical intervention on fetuses is critical, since late-gestation fetuses heal with adult-like scarring. There are still many unsolved problems connected with fetal surgery, and at present prenatal surgery for repair of cleft lip and palate is not ethically defensible in humans. On the other hand, it appears that there are considerable possibilities for the reduction of human scarring after surgery with the introduction of various wound-healing medications.

Animals↗
PubMed1998

Mucus transportability: the bovine trachea and frog palate models compared.

For nearly 30 yrs, the mucus-depleted frog palate has been used to measure the ciliary transportability of respiratory and other mucus gels, but the data obtained from this amphibian digestive system may not be applicable to human airway mucociliary clearance. This study compared this model with the mucus-depleted bovine trachea, a mammalian respiratory system. Assessments were made of the reproducibility of each model, and of the behaviour of sputum subjected to changes to its salinity or hydration. The bovine tracheal model was more reproducible than the frog palate. On the trachea but not the frog palate, sputum was transported more slowly than mucus from healthy animals. Increasing the salinity of sputum caused it to be transported 129% more quickly by the trachea (p=.001), but made no significant change to its transportability by the frog palate. Removal of water by evaporation led to an 83% increase in its bovine tracheal transportability but a 60% fall in its frog palate transportability (p<0.001). Therefore, the models make opposite predictions for the clinical value of altering mucus osmolality. The applicability of the frog palate model in the study of airway mucociliary clearance should be seriously questioned.

Animals↗
PubMed2006

Description of the methodology used in an ongoing pediatric care interventional study of children born with cleft lip and palate in South America [NCT00097149].

BACKGROUND: The contribution of birth defects, including cleft lip and palate, to neonatal and infant mortality and morbidity is substantial. As other mortality and morbidity causes including infections, hygiene, prematurity, and nutrition are eradicated in less developed countries, the burden of birth defects will increase proportionally. METHODS/DESIGN: We are using cleft lip and palate as a sentinel birth defect to evaluate its burden on neonatal and infant health and to assess the effectiveness of systematic pediatric care during the first month and first two years of life in decreasing this burden. The neonatal intervention, consisting of weekly pediatric evaluation and referral to appropriate care, is delivered to about 696 infants born with cleft lip and/or palate in 47 hospitals in South America. Neonatal mortality in this group will be compared to that in a retrospective control group of about 464 infants born with cleft lip and/or palate in the same hospitals. The subgroup of infants with isolated clefts of both the lip and palate (about 264) is also randomized into two groups, intervened and non-intervened, and further followed up over 2 years. Intervened cases are evaluated by pediatricians every three months and referred for appropriate care. The intervened and non-intervened cases will be compared over study outcomes to evaluate the intervention effectiveness. Non-intervened cases are matched and compared to healthy controls to assess the burden of cleft lip and palate. Outcomes include child's neurological and physical development and family social and economic conditions. DISCUSSION: Large-scale clinical trials to improve infant health in developing countries are commonly suggested, making it important to share the methods used in ongoing studies with other investigators implementing similar research. We describe here the content of our ongoing pediatric care study in South America. We hope that this may help researchers targeting this area to plan their studies more effectively and encourage the development of similar research efforts to target other birth defects or infant outcomes such as prematurity and low birth weight.

Cleft Lip↗
PubMed1992

The fate of medial edge epithelial cells during palatal fusion in vitro: an analysis by DiI labelling and confocal microscopy.

Fusion of bilateral shelves, to form the definitive mammalian secondary palate, is critically dependent on removal of the medial edge cells that constitute the midline epithelial seam. Conflicting views suggest that programmed apoptotic death or epithelial-mesenchymal transformation of these cells is predominantly involved. Due in part to the potentially ambiguous interpretation of static images and the notable absence of fate mapping studies, the process by which this is achieved has, however, remained mechanistically equivocal. Using an in vitro mouse model, we have selectively labelled palatal epithelia with DiI and examined the fate of medial edge epithelial (MEE) cells during palatal fusion by localisation using a combination of conventional histology and confocal laser scanning microscopy (CLSM). In dynamic studies using CLSM, we have made repetitive observations of the same palatal cultures in time-course investigations. Our results concurred with the established morphological criteria of seam degeneration; however, they provided no evidence of MEE cell death or transformation. Instead we report that MEE cells migrate nasally and orally out of the seam and are recruited into, and constitute, epithelial triangles on both the oral and nasal aspects of the palate. Subsequently these cells become incorporated into the oral and nasal epithelia on the surface of the palate. We hypothesize an alternative method of seam degeneration in vivo which largely conserves the MEE population by recruiting it into the nasal and oral epithelia.

Animals↗
PubMed2001

Tympanometric findings in cleft palate patients: influence of age and cleft type.

Tympanometry was analysed according to cleft type with respect to age in 239 cleft palate patients (57 with bilateral cleft lip and palate (BCLP)), 122 with unilateral cleft lip and palate (UCLP) and 60 with isolated cleft palate (ICP). The frequency of type B tympanograms was 46.5 per cent in the BCLP group, 50.6 per cent in the UCLP group and 58.3 per cent in the ICP group. Type A tympanograms were more frequently observed in older patients (median age 11 years) in comparison to type B (median age five years; p < 0.001) and type C (median age six years; p < 0.001). The total sample showed an age-related decrease in the frequency of type B tympanograms (rs = -0.3942; p < 0.001). The frequency of type A tympanograms increased significantly with age (rs = 0.4263; p < 0.001), whereas type C was not correlated with age. In the UCLP group, the frequency of type B tympanograms decreased with age (rs = -0.4430; p < 0.001), the decrease being faster than in the BCLP group (rs = -0.3186; p = 0.001) and the ICP group (rs = -0.3378; p < 0.0001)). Type B tympanograms had the highest correlation with a hearing loss of 21-40 dB at mean hearing level at speech frequencies (MHLSF) (rs = 0.4574; p < 0.001), a lower correlation with a hearing loss of 11-20 dB (rs = 0.2184; p = 0.02) and the lowest correlation with hearing loss above 40 dB. At the ages of one to three, the frequency of type B is higher in UCLP patients than in the BCLP and ICP groups, decreasing at seven to 12, increasing again at 13 to 15, and thereafter showing a continuous decrease. In the BCLP group, the frequency of type B increased significantly at the ages of four to six and then decreased continuously from seven to 18. In ICP patients, the changes in the frequency of type B with age are not significant until the age of 15; at the age of seven, it is higher than in the BCLP and ICP groups. The type C tympanogram is not typically found in cleft palate patients and its frequency is not correlated with age. It can be presumed that each type of cleft lip and palate, due to its characteristic conditions in the epipharynx, will favour a different mode of pathophysiological development of middle-ear disease.

Acoustic Impedance Tests↗
PubMed2004

The buccal flap--a useful technique in cleft palate repair?

OBJECTIVE: To evaluate speech quality and oronasal fistula after primary palate repair using a buccal mucosal flap. DESIGN: Retrospective study cohort of patients with cleft palate. SETTING: Primary care center for treatment of craniofacial congenital anomalies. PATIENTS AND METHODS: One hundred fifty-six nonsyndromic patients underwent palatoplasty with the buccal myomucosal flap by the senior surgeon between 1989 and 2002. The preoperative workup, surgical technique, and other factors that might affect the outcome were identical in every case. Oronasal fistula and variables affecting speech quality were analyzed. RESULTS: The most common type of cleft was unilateral cleft lip and palate (43.5%). The median follow-up was 5.8 years (0.4 to 21 years), and the median age at repair was 6.2 months. The overall fistula formation was 3.6%, decreasing progressively: 1989 to 1994: 2.9%, 1995 to 2002: 0.7% (p <.05). Velopharyngeal incompetence (VPI) occurred in 8.8% of the patients, decreasing from 5.3% to 3.5% in the last years. VPI and oronasal fistulae were observed mainly in unilateral and bilateral clefts of the lip and palate. Velopharyngeal adequacy occurred in 91.1% of the children, and resonance was normal in 91.1 %. None of the patients had severe hypernasality or hyponasality. Articulation was normal in 97.9% of the children. Speech quality was good in 89% of the patients. CONCLUSIONS: The technique presented has been effective, with the advantages of palatal closure without tension, good muscular reconstruction, lengthening of the nasal layer, and palatal closure without raw areas. The technique, early repair, and surgeon's skills were the most important variables for good outcomes regarding speech and fistula formation.

Articulation Disorders↗
PubMed2005

Speech production of preschoolers with cleft palate.

OBJECTIVE: The present investigation was conducted to examine the prevalence of preschoolers with cleft palate who require speech therapy, demonstrate significant nasalization of speech, and produce compensatory articulations. The relationship among these three dependent variables and the independent variables of cleft type and age of primary palatal surgery was also examined. PARTICIPANTS: The participants included 212 preschoolers with repaired cleft palate aged 2 years 10 months to 5 years 6 months. MAIN OUTCOME MEASURES: Chi-square analyses were performed to examine the relationship between two independent variables (cleft type and age of surgery) and three dependent variables (percentage of children requiring speech therapy, percentage demonstrating moderate to severe hypernasality and receiving secondary management for velopharyngeal insufficiency, and percentage producing glottal/pharyngeal substitutions). RESULTS: Sixty-eight percent of the children were enrolled in (or had previously received) speech therapy. Thirty-seven percent of the children demonstrated moderate-severe hypernasality or had received secondary surgical management for velopharyngeal insufficiency. Chi-square analyses revealed a significant relationship between cleft type and the number of children referred for speech therapy as well as the number of children with significant hypernasality. The analyses also revealed a significant relationship between age of palatal surgery and number of children with significant hypernasality. CONCLUSIONS: Despite advances in surgical management and the advantages offered by team care, the majority of preschoolers with cleft palate continue to demonstrate delays in speech sound development that require direct speech therapy. An optimal treatment regimen for these children is one that includes primary palatal surgery no later than 13 months of age.

Age Factors↗
PubMed2005

Retrospective evaluation of craniofacial growth of Japanese children with isolated cleft palate: from palatoplasty to adolescence.

OBJECTIVES: The purposes of this study were to analyze the craniofacial growth in women with an isolated cleft palate, to compare their matured craniofacial form with that of women with normal occlusion, and to survey the factors that influenced the matured craniofacial morphology of the adults with cleft palate during their growth process. MATERIALS AND METHODS: Eighteen women with nonsyndromic isolated cleft palate were chosen from patients who received a palatoplasty at the Kyushu University Hospital, Fukuoka, Japan. Their lateral cephalometric radiographs were taken longitudinally from palatoplasty to adolescence. Fifty women with normal occlusion were chosen as controls. From their lateral cephalographs, linear and angular variables were calculated using the x,y coordinates of 20 skeletal landmarks. RESULTS: Maxillary length was shorter and the nasomaxillary complex was positioned more posteriorly in relation to the anterior cranial base of the adults with isolated cleft palate, compared with the controls. The mandible was shorter and was rotated inferiorly and posteriorly. However, remarkable deviation from the average craniofacial growth pattern was not recognized from palatoplasty to adolescence. The factors that influenced the craniofacial growth in the subjects with cleft palate were the forward growth of the A point from 2 to 5 years of age, the downward growth of the Ba point, the anterior upper facial height N-Ans in puberty, and the vertical position of the point Ba at the time of palatoplasty. CONCLUSION: This study provided evidence of the growth tendency and the factors influencing the intermaxillary relationship in subjects with isolated cleft palate. These are significant for orthodontic treatment planning.

Adolescent↗
PubMed2006

Conversational skills of children with cleft lip and palate: a replication and extension.

OBJECTIVE: To replicate and to extend a previous study examining the conversational skills of children with cleft lip and palate. PARTICIPANTS: Thirty-four children (33 to 44 months) participated: 17 children with cleft lip and palate and 17 noncleft children. METHODS: The children were observed during an interaction with caregivers in their homes. Samples of caregiver-child interactions were coded as assertive or responsive, for type of conversational act, and for discourse level categories. Profiles of conversational activity were determined for each child based on the coding. Correlations were performed to examine the relationship between assertiveness and speech variables (articulation and resonance) for the children with cleft lip and palate. RESULTS: Group comparisons revealed that the children with cleft lip and palate produced fewer assertive utterances, were less likely to respond adequately to comments by caregivers, and produced more topic maintaining and fewer topic extending utterances than did their noncleft peers during conversational interactions. Examination of individual child data indicated that 35% of the children with cleft lip and palate exhibited conversational profiles characterized by either low assertiveness or low responsiveness. Finally, a significant positive correlation was noted between conversational assertiveness and speech production skills. CONCLUSION: These findings suggested that the children with cleft lip and palate were less conversationally assertive than their noncleft peers. Further, there appeared to be a relationship between speech production skills and conversational skills, suggesting that poor speech may be impacting language performance for these children.

Assertiveness↗
PubMed2006

Prevalence of a Simonart's band in patients with complete cleft lip and alveolus and complete cleft lip and palate.

OBJECTIVE: To investigate the prevalence of the presence of a soft tissue bridge (Simonart's band) in patients with complete cleft lip and alveolus and complete cleft lip and palate. DESIGN: Cross-sectional. SAMPLE: We assessed 407 consecutive unoperated patients first attending the Hospital for Rehabilitation of Craniofacial Anomalies of University of São Paulo, in Bauru, São Paulo, Brazil, in the year 2000. The patients were classified as presenting complete cleft of the primary palate or of the primary and secondary palate, unilateral or bilateral, as follows: unilateral cleft lip, bilateral cleft lip, unilateral cleft lip and palate, and bilateral cleft lip and palate. METHOD: Clinical examination. The band was considered as present whenever there was a soft tissue bridge between the separated alveolar ridges, regardless of volume and position. Results were analyzed by descriptive statistics and were expressed as percentages, according to the type of cleft. CONCLUSION: 31.2% of patients presented with Simonart's band. The band was observed more frequently in patients with unilateral clefts than in patients with bilateral clefts, and in patients with complete cleft lip and alveolus than in patients with complete cleft lip and palate.

Adolescent↗
PubMed2007

Tongue-palate contact during bilabials in normal speech.

OBJECTIVE: Previous research using electropalatography (EPG) identified a compensatory articulation called bilabial-lingual double articulations. These double articulations were produced for bilabials by some speakers with cleft palate and involved closure at the lips occurring simultaneously with complete tongue-palate constriction. However, no normative English EPG data exist to confirm the abnormal status of these double articulations. DESIGN: This study reports normative data for EPG contact during bilabial closure. Acoustic and EPG data were recorded for bilabials in different vowel contexts. PARTICIPANTS: Eight normal English-speaking adults. MEASURES: One measure identified complete tongue-palate constriction, and a second measure calculated percent contact. RESULTS: There were no instances of complete tongue-palate constriction, though some EPG contact occurred in the lateral regions of the palate. The vowel context significantly affected the amount of contact present, with /i/ having the most and /a/ having the least amount of contact. CONCLUSION: Complete tongue-palate constriction during bilabials of the type found in bilabial-lingual double articulations is not a feature of normal English speech and can therefore be considered an abnormal articulation pattern. Speech-language pathologists who use EPG in their clinical work should be aware that some lateral contact during bilabial closure is normal.

Adult↗