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[The effect of lip repair on maxillary growth in patients with complete unilateral cleft lip and(or) palate].

OBJECTIVE: To investigate the different effects of lip repair on maxillary growth among patients with cleft lip and(or) palate, and also the possible mechanisms accounting for that differences. METHODS: The lateral cephalometric analysis was applied to 84 Chinese patients with unilateral cleft lip and(or) palate at the early stage of permanent dentition, which included 32 UCLA, 20 UCLP (CP unrepaired), and 32 UCLP, and 37 normal Chinese of the same age as controls. RESULTS: The patients with unilateral cleft lip and palate who had lip repaired while the palate was left unrepaired exhibited the similar inhibition on maxillary growth to those who had both lip and palate repaired but the patients with unilateral cleft lip and alveolus had much less inhibition on their maxilla. CONCLUSIONS: The cleft and tissue defect of patients with cleft lip and palate might be the main cause that induced the inhibitive effects of lip repair on maxillary growth.

Cleft Lip↗

Three-dimensional hard tissue palatal size and shape: a 10-year longitudinal evaluation in healthy adults.

A 10-year longitudinal evaluation of the morphology (size and shape) of hard tissue palate was performed in 6 female and 6 male healthy adults (mean age at the second evaluation was 33 years, SD = 2.2). All subjects had a complete permanent dentition, including the second molars, and were free from respiratory problems. Palatal landmarks were digitized with a computerized 3D instrument, and their coordinates were used to derive a mathematical model of palatal form. Palatal shape (size-independent) was assessed by a fourth-grade polynomial in the sagittal and frontal plane projections. Palatal dimensions in the frontal and sagittal planes were computed and compared between the 2 evaluations by paired Student t tests. A great variability was observed, and no significant modifications in size were found (P > .05 for all variables). No variations in shape were observed. Sex had no significant effect for any variable (Student t for independent samples, P > .05). This study showed that in healthy subjects, hard tissue palatal morphology does not seem to change between the third and the fourth decades of life.

Adult↗

[Mixed and palatal salivary secretion in denture-wearing healthy people and in patients with Sjogren syndrome].

Denture retention is related to forces necessary to completely remove the denture from its basal seat. The liquid-joint model for explaining denture retention is accepted by most of the authors. According to this model retentive force is a function of saliva surface tension, liquid film thickness, surface of contact and the liquid-denture contact angle. Based upon the literature, mucosa covered with the least amount of saliva exists at the area of the palate and the upper lip, consequently at the area of the upper denture retention. Dryness is dependent on the volume of saliva present on the oral mucous membranes and the rate of its evaporation of them. However, the hard palate contains few minor glands and it is an area of high evaporation. Based on the above mentioned facts, patients with xerostomia might have problems with the stability of the complete dentures. To verify it, authors investigated 24 healthy people and 11 patients with Sjögren's syndrome (SS). Further aim of the authors was to determine how the new dentures influence the whole resting and the palatal saliva flow rate. According to the results whole resting saliva flow rate is decreased in SS because of the focal inflammation of the salivary glands, but surprisingly the palatal secretion rate does not change in SS related to the initial values of the healthy people. Although every patient had xerostomia (WRS < or = 0.1 ml/min), none of them complained about denture instability. Based upon this study, authors agree with the statement of the literature, that palatal mucous saliva can help to stabilize the maxillary denture. Results suggest that whole resting and palatal saliva flow rates are not influenced by the placement of new dentures in healthy complete denture wearers.

Aged↗

[Inhibitive effects of lip repair on maxillary growth in patients with complete unilateral cleft lip and palate].

OBJECTIVE: The aim of this study was to assess the isolated effects of lip repair on inhibition of maxillary growth in patients with complete unilateral cleft lip and palate. METHODS: The lateral cephalometric analysis were applied to 20 patients with unilateral cleft lip and palate who only had lip repaired in childhood, 32 patients with unilateral cleft lip and palate who had both lip and palate repaired in childhood, as well as 37 normal Chinese of the same age as controls. RESULTS: Both complete unilateral cleft lip and palate groups had almost the same significant degree of maxillary retrusion compared with the normal control group. CONCLUSION: Lip repair is one of important factors that could inhibit maxillary growth in patients with complete unilateral cleft lip and palate.

Adolescent↗

Incidence and management of middle ear effusion in cleft palate patients.

For a complete overall rehabilitation of cleft palate patients a multi-disciplinary approach should be adopted. Plastic and Head and Neck Surgeons in whom most of the treatment are entrusted should be concerned not only at achieving palatal function and cosmetic acceptability but also the various other problems associated with cleft palate especially hearing loss. In this study, 66 patients with repaired and unrepaired cleft palates were examined for the presence of hearing loss due to middle ear effusion. The incidence of middle ear effusion was high (57.6%). It was also found that only eight of these patients (12.1%) ever complained of hearing loss or any associated symptoms and repair of the cleft palate did not influence the incidence of middle ear effusion. As such, screening should be done in all cleft palates and otolaryngologists should therefore play an important role in the multi-disciplinary team which should comprise the paediatrician, plastic surgeon, speech therapist, orthodontist and dental specialist.

Child↗

[Familial cleft lip with or without coexisting cleft palate].

Etiopatology of clefts has not been explained yet. It is assumed that the cause of this defect is complex and heterogeneous. Genes which induce the incidence of cleft have not been detected too but clinical observations indicate a familial predisposition. At the Plastic Surgery Clinic of the Łódz Medical Academy, on years 1972-2001, 3180 children with cleft lip or/and palate were being treated. The group under examination consisted of 540 children with positive family histories. Two genetic groups were confirmed and each of them with a different risk of the reoccurrence of the defect. The first group--cleft lip and palate, the second group--an isolated cleft palate. A correlation between the type of cleft and a child's sex and its cleft affected parent was found. Among children of mothers with cleft lip there were 60% of boys and only 15% of girls with the same type of cleft. In mothers with cleft lip and palate the same type of cleft has been detected in 70% of boys and 18% girls. Similar results were obtained when affected fathers were taken into account. However, in case of mothers and fathers who were affected with isolated cleft palate there were significantly more girls than boys who had cleft palate. An in-depth study of cleft inheritance mechanisms will make in the future a more precise prediction of the occurrence of the defect in consecutive generations possible. Perhaps, the chance to work out cleft preventions will emerge and the gathered data will be taken advantage of in genetic counselling.

Child↗

[Presurgical orthopedic treatment for cleft lip and palate].

INTRODUCTION: A multidisciplinary approach with several specialits allows a complete treatment for Cleft Lip and Palate. We show our experience in presurgical orthopedic treatment in these patients, their advantages, their problems and the results. MATERIAL AND METHODS: Since 1999 presurgical orthopedy has been applied to 12 patients (3 bilateral cleft lip and palate and 9 unilateral cleft lip and palate). This approach was applied when there was a long distance between the alveolar segments. A palate mould and the location of Latham's appliance have been made in the operating room under general anesthesia. The patients were controlled by the orthodoncist and Latham's appliance was removed when cleft lip was closed. RESULTS: Latham's appliance was kept for 4-7 weeks with once a week controls until the distance between the maxillary segments was less than 1 mm; in bilateral cases of cleft lip and palate the premaxilla was moved between lateral segments. Then, lip closure and nasoplasty was made and, sometimes, an obturador was placed. CONCLUSIONS: Latham's appliance permit to achieve a perfect alignment of alveolar segments decreasing the soft tissues tension and facilitating the lip surgery, thus, a better aesthetic and functional results can be achieved. A more anatomic position of palate can be made and easier future orthopedic treatments are possible.

Child, Preschool↗

[Effect of ventilation tube insertion on otitis media with effusion in cleft palate children].

OBJECTIVE: To explore the effect of eardrum tubing in the repair of cleft palate on alleviating the otitis media with effusion (OME) and hearing loss in cleft palate patients. METHODS: Nineteen ears of 19 cleft palate children with OME and hearing loss were treated with the ventilation tube insertion in the repair of the cleft palates, while the untreated opposite ears were selected as the control group. All patients were followed up from 2 weeks to 18 months postoperatively and their middle ear condition and hearing thresholds were reevaluated by otoscopy and pure-tone audiometry. RESULTS: Significant differences were found in the incidences of hearing loss between pre and postoperative patients in treated ears, and there are no differences in the untreated ears. Postoperative hearing thresholds become lower than that before the operation and no serious complications were found in the treated ears. CONCLUSIONS: The ventilation tube insertion in medial ear is safe and effective to restore the hearing impaired by OME in the cleft palate patients. It can be used as a regular management for OME and hearing loss in cleft palate children.

Child↗

[Observing the distribution of Annexin I and cPLA2 in the palatal process of mice by immunohistochemical staining].

OBJECTIVE: To observe the distribution of Annexin I and cytosolic phospholipose A2 (cPLA2) in the palatal process of dexamethasome teratogenerated mice. METHODS: Cutting along the coronary plane of the heads of fetal mice to obtain palate in the 14th, 15th, 16th day of gestation by 10-week-old in-bred mice. The distribution of Annexin I and cPLA2 was checked by immunohistochemical staining. RESULTS: During the fusing of the palatal processes, the staining of Annexin I and cPLA2 was positive in the epithelial and mesenchymal cells of the palatal process, and the intensity of staining changed with time. CONCLUSION: Annexin I and cPLA2 can modulate the development of fetal palate to some extent, and they may be important mediators in the development of cleft palate induced by dexamethasone.

Animals↗

A technique for augmenting the palatal connective tissue donor site: clinical case report and histologic evaluation.

This case report describes a simple method for augmenting tissue at prospective palatal connective tissue donor sites. The patient was referred for treatment of facial marginal tissue recession on the maxillary left canine. Clinical examination indicated that the palatal mucosa was thin and did not provide an adequate volume of soft tissue for donor harvesting, precluding the use of a palatal connective tissue graft for treatment of the recession defect. Sterile lyophilized bovine collagen sponge was therefore surgically inserted between a full-thickness palatal flap and bone at the prospective donor site. Eight weeks postoperative, the augmented palatal donor area showed a significant clinical increase in thickness and volume and served as a connective tissue donor source in the treatment of the facial marginal tissue recession. Histologic analysis of the donor tissue demonstrated normal structure, fibrous connective tissue, and abundant collagen. Clinical examination 6 months following surgery showed complete root coverage, with tissue texture, volume, and color similar to those of the adjacent soft tissue. Healing of the donor site was uneventful. This case report demonstrates that sterile lyophilized collagen sponge material may be used to augment palatal donor connective tissue and can subsequently be used as a donor source for soft tissue grafting.

Adult↗

[Analysis of psychological condition of parents with cleft lip and/or palate children].

OBJECTIVE: To evaluate the psychological situations of cleft lip and/or palate children's parents, to discuss the relationship between psychological situations and cleft types, and to provide clinical treatment to improve the psychological situations of these parents. METHODS: 100 parents whose children were proceeded the primary surgery treatment were selected as the study group, and other 34 parents whose children were normal as the control group. All parents were inquired and tested by the life event scale (LES) and self-rating anxiety scale (SAS). RESULTS: The LES total scores of the cleft lip and/or palate patients' parents were significantly high compared with the normal (P < 0.05). The SAS total scores of the cleft lip and/or palate patients' parents had no significant difference with the control group (P > 0.05). The scores of cleft lip and/or palate patients' parents were the highest and the scores of cleft palate patients' parents were the lowest. CONCLUSION: Most of the cleft lip and/or palate patients' parents were disturbed by a negative psychological situation. Some kind of negative psychological situation may manifest some body symptoms. Meanwhile,the three subgroups' data had the significant difference, which indicated that parents may much more care about the appearance abnormality.

Child↗

[Separation and culture of mouse embryonic palatal mesenchymal cells in vitro].

OBJECTIVE: To modify the operation of dissecting embryonic palatal shelves and purify the mouse embryonic palatal mesenchymal (EPM) cells in primary culture. METHODS: The embryonic palatal shelves were dissected using a surgical microscope by modified operation. Then the embryonic palatal shelves were incubated with Dispase and the isolated EPM cells were cultured. Immunofluorescence technique was used to identify the characteristics of cells. RESULTS: Embryonic palatal shelves could be dissected accurately and easily with a modified operation. The purified EPM cells contained scarcely epithelial cells. EPM cells were anti-HNK-1, S-100, vimentin positive and anti-CK negative. CONCLUSION: A modified method for dissecting embryonic palatal shelves and purifying the EPM cells of primary culture was established.

Animals↗

[Palatal necrosis in children. Case report].

Palate necrosis as a consequence of palate infection it's an exceptional condition about there's not too much references at literature. We present a case of a 6 months old child who present a palatal necrosis after a supurative medial otitis that involved hard and soft palate, with positive culture for Pseudomona aeruginosa causing a almost complete absence of the palate that simulate a bilateral palatal cleft.

Biopsy↗

[Alpha-tocopherol levels in mothers of children with cleft lip or with cleft lip and palate].

OBJECTIVES: Environmental factors may play equally critical role as genes in facial embryogenesis. It was suggested that cleft palate occurring in association with cleft lip may result from environmental factors that affect development of both the lip and the palate. Cleft lip forms from the third through seventh week of embryonic development. During these period fetal nutrition is histotrophic, pressure of oxygen is low, genes for antioxidant enzymes are supressed and alpha-tocopherol play an essential role in the fetal tissues antioxidant capacity. Cleft palate forms from the fifth through twelfth weeks of gestation, when hemonutrition and antioxidant enzymes are developing, and hypothetical deficiency of tocopherol is not so crucial. AIM: The goal of the study was to investigate concentrations of alpha-tocopherol in women who gave birth to a child with cleft lip and mothers of children with cleft lip and palate. MATERIAL AND METHODS: Blood samples from 31 healthy mothers of children with isolated cleft lip (CL) and 29 healthy mothers of children with isolated cleft lip and palate (CLP) were collected. Fasting plasma alpha-tocopherol concentrations were measured by the high performance liquid chromatography. Kolmologorov-Smirnov test with Lilefors correction and k-means cluster analysis were applied to determine differences between the groups of women. RESULTS: We found that alpha-tocopherol concentrations were lower in CL compared to CLP, but the difference did not achieve level of statistical significantly (medians: 15.8 micromol/L vs. 20.0 micromol/L; p = 0.066). There were identified three clusters of alpha-tocopherol concentrations: 14.0 micromol/L (19CL+8CLP), 19.6 micromol/L (8CL+13CLP), and 21.1 micromol/L (4CL+8CLP). The distribution of results to the clusters was dependent on type of the orofacial cleft (chi squared = 6.95 with 2 degrees of freedom, p = 0,031). CONCLUSIONS: Analysis for environmental risk factors should be performed separately for cleft lip and cleft lip and palate because these two conditions appear to be etiologically distinct. The role of a higher periconceptional intake of alpha-tocopherol in reduction of risk of giving birth to a child with cleft lip requires further research.

Adult↗

Quantitative evaluation with CBCT of palatal bone thickness in growing patients.

The purpose of this study was to evaluate the most suitable region of the palate for the insertion of miniscrews. We analysed 4 different paracoronal sections of Digital Volumetric Tomographies of 52 patients with ages ranging between 10 and 15 years and measured the thickness of the palatine bone in 20 different sites. For each section we measured the height of the palatal bone at 0, 3 and 6 mm increments laterally from the midline. The results indicate that the thickest part of the palate is found 6 mm to the left and right of the suture in the anterior part of the palate, 4 mm from the incisal foramen. In the other paracoronal sections, the thicknesses tend to decrease progressively, but the highest values are always found corresponding to suture. Therefore, we can conclude that the thickest part of the palate is the anterior region. Although the bone is thinner in the posterior region of the palate, it is also suitable for the insertion of miniscrew.

Adolescent↗

Does the tongue play a role in the initial development of vertical palatal shelf in hamster?

A study was undertaken to examine whether the tongue plays any role in determining the primordial development of palatal shelves in a vertical direction in mammals. Control and 6-mercaptopurine-treated embryos from Golden Syrian hamsters were examined by scanning electron microscopic and histological techniques for the spatio-temporal relationship of primordial development of the palate, tongue, and mandible. DNA synthesis, measured by 3H-thymidine incorporation, was used as an index of growth. The data indicated that in controls, vertical palate development began in the anterior half from the roof of the oronasal cavity, whereas the tongue bulges and the mandibular process developed in the posterior half of the oronasal cavity. A burst in DNA synthesis occurred in the palate and mandible, but not in the tongue. In 6-mercaptopurine-treated fetuses, although the chronological appearance of primordia of all three structures was normal, DNA synthesis was inhibited in all three structures. The recovery in DNA synthesis, albeit partial, was faster in the palate and mandible than in the tongue. On the basis of observations from the present study, along with those from other vertebrates, it is suggested that the developing tongue may not play any role in determining the direction of development of the palatal primordia.

Animals↗

[Value of the use of a vicryl-collagen tape for the treatment of cleft palate. Experimental study in dogs].

The purpose of this study was to evaluate the bone forming capacity of a Vicryl/collagene tape, placed in a defect of the palatal bone. In order to decrease the rate of bucco-nasal fistulaes after primary closure of a cleft palate, the authors carried out an experiment on dogs. First of all, we had to demonstrate the good tolerance of the tape in the buccal cavity. The first group of 5 dogs redieved the tape between buccal mucosae and palatal bone. The tolerance was excellent concerning the 12 biopsies on the mucosae after 1 month; 10 were totally normal and 2 revealed signs of inflammation on the medial incision. Concerning the second group, we needed to know the delay of bone formation of a "neo-palatal" defect; for that reason a 2 cm2 bone resection and a histological observation after 1 month and 1,5 months, in the right palatal bone was performed. Then we performed the same resection in 5 other dogs, and let the vicryl tape in the defect before closing the mucosae. The histological results of the second group showed that the ossification began after 1 month, and after 1.5 months the defect was totally covered by bone. The good results we obtained led us to go on with this experiment even if the low number of dogs included in this series does not allow us to a statistical evaluation. Exact responsibility of both, vicryl and collagene, has to be determined by a longer experiment, before realising the device in child's cleft palate.

Animals↗

Optimal timing of cleft palate closure. Speech, facial growth, and hearing considerations.

We have presented an updated overview of the controversy surrounding the timing of cleft palate closure based upon the goals of cleft palate surgery: attainment of normal speech, maxillofacial growth, and hearing. From a critical analysis of the conflicting literature in these areas, we have developed our own philosophy of the cleft palate closure over the past decade that incorporates these three primary goals in the multidisciplinary care of the cleft palate patient. We feel that only through an objective, long-term, goal-oriented, prospective study of our patients will we be able to obtain realistic data in this controversial area. To date, there are no long-term, prospective, double-blind studies available in the area of cleft palate surgery. In the interim, we must objectively assess our results and, above all, adhere to the primary principle of medicine of doing no harm in the multidisciplinary management of the cleft palate patient.

Age Factors↗