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PubMed1988

Immediate microvascular reconstruction of combined palatal and midfacial defects using soft tissue only.

Maxillary and midface defects with or without orbital involvement are disfiguring and disabling problems especially in the elderly cancer patient. Often, palatal prostheses are required to enable speech and swallowing. Elderly patients or those with compromised vision often find these appliances cumbersome and difficult to manage. To help obviate these problems a one-stage method of immediate palatal reconstruction was needed to obturate the palate and restore facial contour. Over the past 18 months six patients have undergone immediate reconstruction of complex, composite defects of the maxillary and midface structures after tumor extirpation, three of which extended into the orbit. The latissimus dorsi musculocutaneous flap was utilized because of its bulk, reliable anatomy, ample pedicle length and diameter, and minimal donor site morbidity. No flap loss, suture line dehiscence, or infection occurred. All patients were capable of deglutition and intelligible speech. This technique is a one-stage reconstruction of the palate and accompanying defects of the midface and maxilla that obviates the need for cumbersome palatal appliances.

Carcinoma, Squamous Cell↗
PubMed1978

Epidermal growth factor potentiates cortisone-induced cleft palate in the mouse.

Epidermal growth factor (EGF) injected into pregnant mice increased the frequency of cleft palate (CP) in cortisone-treated mouse fetuses. EGF alone produced proliferation and thickening of the epithelium of the palatal processes, but CP was not significantly increased over saline injected controls. Cortisone alone produced thinning of the palatal epithelium and caused CP in 61 percent of formed fetuses. The combination of EGF and cortisone treatment induced CP in 100 percent of formed fetuses; epithelial thickening still occurred with the combination treatment. Thus, EGF may be teratogenic under special circumstances. These observations suggest that the relative thickness of the palatal shelf epithelium may not be a critical factor in the fusion of the palatal shelves.

Abnormalities, Drug-Induced↗
PubMed1992

Comparisons of the effects of TCDD and hydrocortisone on growth factor expression provide insight into their interaction in the embryonic mouse palate.

Cleft palate (CP) can be induced in embryonic mice by a wide range of compounds, including glucocorticoids and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Hydrocortisone (HC), a glucocorticoid, retards embryonic growth producing small palatal shelves, while TCDD exposure blocks the fusion of normally sized shelves. TCDD induction of CP involves altered differentiation of the medial epithelial cells. Recent studies indicate that growth factors such as EGF, TGF-alpha, TGF-beta 1, and TGF-beta 2 are involved in palatogenesis, regulating proliferation, differentiation, and extracellular matrix production. A synergism has been observed between HC and TCDD in which doses too low to induce CP alone are able to produce greater than 90% incidence when coadministered. In the present study a standard teratology protocol was performed in C57BL/6N mice to examine the synergism at doses lower than those previously published. Data from this study indicate synergistic interactions at doses as low as 3 micrograms TCDD/kg + 1 mg HC/kg. This extreme sensitivity suggests the involvement of a receptor-mediated mechanism possibly resulting in altered regulation of gene expression. Mechanisms of interaction were further studied by comparing growth of the shelves, fate of the medial epithelium, and expression of growth factor mRNAs and peptides. Pregnant mice were dosed on GDs 10-13 with HC (100 mg/kg sc) or with HC (25 mg/kg sc) + TCDD (3 micrograms/kg orally), doses producing 30% and 99% CP, respectively. The interaction between HC and TCDD results in a small HC-like palate, rather than the morphology typical of TCDD-induced clefting. Both compounds inhibited programmed cell death of the medial epithelium, which instead differentiated into an oral-like epithelium. The alterations in growth factor expression after HC or HC + TCDD were similar. Expression of EGF, TGF-beta 1, TGF-beta 2, and EGF receptor increased in specific palatal regions. Increased levels of mRNA were observed only for TGF-beta 1. The effect of TCDD alone on growth factor expression differ from those seen with HC or HC + TCDD. These divergent effects on growth factor expression may contribute to the differences in shelf size and thus to the different mechanisms of HC and TCDD clefting. Thus the synergism between HC and TCDD may involve similar and potentially additive effects on regulators of proliferation and differentiation in the palate, but additional contributing factors cannot be excluded.

Animals↗
PubMed2002

Programmed cell death is required for palate shelf fusion and is regulated by retinoic acid.

The actual role of programmed cell death (PCD) in embryonic processes and the extrinsic signals that define the death fate in developing cells are still poorly understood. Here, we show that during secondary palate shelf fusion in the mouse, PCD appeared in the medial edge epithelia (MEE) of the anterior region only after shelf contact. Contact was necessary for efficient cell death activation in the MEE. However, exogenous all-trans-retinoic acid (RA) increased cell death independently of contact. Competence to induce cell death by contact or by RA exposure was obtained when the MEE were close to touch. Endogenous RA is a relevant regulator of the secondary palate PCD since this was reduced by a retinol dehydrogenase inhibitor and an RAR specific antagonist. Bmp-7 expression was positively regulated by RA. However, BMP-7 was unable to activate cell death within the palate tissue and NOGGIN, a natural BMP antagonist, did not block PCD. Reduction of PCD at the MEE directly with a caspase inhibitor or by inhibiting retinol dehydrogenase resulted in unfused palate shelves, but adhesion was not affected. In contrast, exogenous RA also blocked fusion, but in this situation the increased cell death within the MEE appeared to affect adhesion, thereby causing cleft palate in vivo.

Animals↗
PubMed1994

Interactive regulation of Ah and glucocorticoid receptors in the synergistic induction of cleft palate by 2,3,7,8-tetrachlorodibenzo-p-dioxin and hydrocortisone.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a wide-spread environmental contaminant that produces adverse biological effects including carcinogenesis, reproductive toxicity, immune dysfunction, hyperkeratosis, hepatotoxicity, thymic involution and teratogenesis. In the mouse embryo, TCDD induces cleft palate and hydronephrosis. Glucocorticoids are endogenous steroid compounds that have an important role in development, but are teratogenic at pharmacological doses. The synthetic glycocorticoid, hydrocortisone (HC), induces cleft plate and a potent, synergistic interaction has been observed between TCDD and HC. Both TCDD and HC act through receptor-mediated mechanisms and each compound has its own receptor, the Ah receptor (AhR) and the glucocorticoid receptor (GR), respectively. The morphology and etiology of TCDD- and HC-induced clefts are distinctly different, as HC clefting is due to formation of small palatal shelves, while TCDD-treated shelves fail to fuse due to effects on epithelial cell proliferation and differentiation. The present study examines the expression of AhR and GR in the embryonic palate following exposure to TCDD, HC, and HC + TCDD. C57BL/6N pregnant mice were treated with HC (25 or 100 mg/kg/day GD10-13, sc), TCDD (3 micrograms/kg/day GD10-13, or 24 micrograms/kg GD10, orally), or HC + TCDD (25 mg/kg/day sc and 3 micrograms/kg/day orally, GD10-13). Craniofacial tissues were collected from the embryos on GD14 and examined for AhR and GR expression using in situ hybridization. Northern blots, and immunohistochemistry. We found that in the embryonic palate exposed to TCDD, the AhR was downregulated and the GR expression increased. Conversely, following HC exposure, the GR was downregulated and AhR levels were elevated. HC + TCDD produced increased expression of both receptors. Effects on AhR appeared to be regulated at the transcriptional level, as both protein and mRNA were altered in similar directions. The observed cross-regulation of the receptors is believed to be important in the synergistic interaction between TCDD and HC for the induction of cleft palate.

Animals↗
PubMed2001

Surgically assisted rapid palatal expansion. An acoustic rhinometric, morphometric and sonographic investigation.

This study aimed to evaluate the effect of surgically assisted rapid palatal expansion on the skeletal structures of the midface. Ten patients (mean age 28.5 years) were investigated by means of acoustic rhinometry, study model analysis and sonography before and after the procedure of surgically assisted rapid palatal expansion. The measurements revealed that surgically assisted rapid palatal expansion not only resulted in transverse expansion of the maxilla, providing dental arch space for lining up the teeth; the procedure also caused a substantial enlargement of the maxillary apical base and of the palatal vault, providing space for the tongue for correct swallowing and thus preventing relapse. There was a distinct subjective improvement in nasal breathing associated with enlargement of the nasal valve towards normal values and with an increase of nasal volume in all compartments. The measurements showed a marked influence of surgically assisted rapid palatal expansion on the skeletal structures of the midface. The significant widening can be demonstrated by non-invasive examination. Success of the osteotomy procedure can be readily monitored by sonographic examination of the expansion and the subsequent ossification, which allows individually adjusted retention periods and avoids frequent radiation exposure.

Acoustic Impedance Tests↗
PubMed2002

[Positioning of the premaxilla in cases of bilateral cleft lip, alveolus and palate using Latham's appliance].

UNLABELLED: SUBJECT MATTER: In cases of bilateral cleft lip, alveolus and palate, preoperative positioning of the premaxilla using Latham's appliance has been described. This method is controversial, since it may cause growth defects. PATIENTS AND METHODS: From 1992 to 2000, Latham's appliance was inserted preoperatively into 20 patients with bilateral lip, alveolus and palate clefts with extreme premaxillary protrusion. Pin fixation ensued at the age of 3 months. After adjustment of the premaxilla, the soft palate was closed and bilateral lip adhesion as well as bilateral gingivoperiosteoplasty were performed directly after the removal of the appliance. Final lip closure took place 4-6 weeks later. At the age of 2 years, the hard palate was closed. Evaluation was based on combined face-maxilla models, standard photographs and, when available, lateral skull x-rays showing the relative position of the segments, the influence of Latham's appliance on the nasal septum and the relation of the upper jaw to the skull base and mandibula. RESULTS: In all cases, a satisfactory alveolar alignment was achieved; thickening and curvature of the nasal septum occurred but receded. Neither growth disturbances nor dental germ damage were seen. In two cases, complications arose from suture dehiscence of the lip adhesion: in one patient, a screw defect caused a loosening of the appliance and there was also a transmigration of the postpremaxillary pin. CONCLUSIONS: On the basis of our experience, the use of Latham's appliance, combined with consistent orthodontic supervision and, if necessary, treatment, represents a practical option for the treatment of bilateral cleft lip, alveolus and palate, especially in cases with extreme protrusion of the premaxilla.

Alveoloplasty↗
PubMed1989

Inhibition of palatal fusion in vitro by indomethacin in two strains of mice with different H-2 backgrounds.

Susceptibility to glucocorticoid-induced cleft palate in mice has been related to the H-2 histocompatibility complex on chromosome 17. Indomethacin administered in vitro to palatal processes from 13.5-day-old mouse embryos inhibited palatal fusion. Strains with the A background and the H-2a haplotype had significantly higher rates of inhibition than their partners with the H-2b haplotype. The inhibition was prevented in both strains by the addition to the media of prostaglandin E2, but this corrective effect was greater in the A strain with the H-2a haplotype. Thus, blockade of palatal fusion involves prostaglandins, suggesting a similar genetic and biochemical pathway for the different susceptibilities to cleft palate induced by both indomethacin and glucocorticoids.

Animals↗
PubMed1991

A histological study of tissue response to simulated cleft palate surgery at different ages in beagle dogs.

The response of maxillary tissues to mucoperiosteal manipulation at different ages was studied microscopically early after operation and at maturity. Thirty-two Beagles were divided into three experimental groups, a sham-operated group and a control group. At the age of 6, 16 or 25 weeks in the experimental groups an elliptical mucoperiosteal flap was excised in the midsagittal region of the palate, relaxation incisions were made and the mucoperiosteum was elevated and closed in the midline leaving two areas of denuded bone adjacent to the teeth. The animals were killed 1, 2 or 3 weeks after the operation or at the age of 37 weeks and serial sections of the jaw tissues were examined. Two weeks after the operation, scar had formed, its lack of elastic fibres indicating a more rigid type of tissue. The palatal bone showed rapid trabecular deposition. Cervico-palatal and apico-buccal bone resorption in the alveolar socket indicated medial tipping of the teeth. The different soft tissue composition persisted until maturity. In the areas where scar tissue had developed, attachment by means of Sharpey's fibres from the mucoperiosteum to the palatal bone was found at the age of 37 weeks. Thus the different mechanical properties of scar tissue adjacent to the teeth and its attachment to the palatal bone may influence the growth and development of dento-alveolar structures.

Alveolar Process↗
PubMed2005

A comparison of tongue and soft palate squamous cell carcinoma treated by primary surgery in terms of survival and quality of life outcomes.

In the surgical management of oral cancer the resection and reconstruction of the mobile tongue and soft palate are most important if function is to be maintained. The present trend towards primary laryngeal surgery for early disease has emphasized the importance of primary surgery if good functional outcomes can be achieved. This study compares the functional and health-related quality of life outcomes for primary surgery and reconstruction of the anterior tongue and soft palate. From a cohort of 566 patients treated from 1992 to 2002, 118 fitted the criteria for anterior tongue and 44 for soft palate resection. University of Washington Quality of Life scores were available in around three quarters of patients. In terms of speech and swallowing a 3/4 or total anterior glossectomy had a worse outcome than a 1/4 or 1/2. In patients having a 3/4 or total resection of the soft palate however, the results showed a similar outcome to those with 1/4 or 1/2 resection. The functional results of 3/4 and total soft palate reconstruction were superior to 3/4 and total anterior tongue resections and were similar to the whole cohort. This finding extends the role of functional surgery in the oropharynx for which primary radiotherapy is often preferred to preserve function.

Carcinoma, Squamous Cell↗
PubMed2000

Melanotic neuroectodermal tumor of infancy (MNTI) of the hard palate: presentation and management.

OBJECTIVE: To discuss the presentation and management of melanotic neuroectodermal tumor of infancy (MNTI) of the hard palate. METHOD: Case presentation and literature review. CASE: A 6-month-old girl presented with a slow growing, non-tender anterior oral hard palate mass. Radiologic imaging revealed a well-circumscribed cystic lesion containing teeth. After excision, histopathologic and electron microscopic evaluation revealed MNTI. No recurrence was seen at 12-month follow-up. CONCLUSIONS: This case and a review of the literature reveal MNTI to be a rare, benign hard palate tumor, which may present as a smooth, firm, painless, slow-growing anterior palatal lesion. Imaging reveals a well-circumscribed cystic lesion. Complete excision should be curative. Management requires attention to the potential need for palatal reconstruction, orthodontic care and correction of secondary nasal deformities.

Female↗
PubMed1989

A comparative clinical study of Pierre Robin syndrome and isolated cleft palate.

Thirty seven infants with Pierre Robin syndrome were compared with children who had isolated cleft palate. A female preponderance was seen in both groups. Skeletal II jaw relation was observed in 32% of the children with isolated cleft palate. Associated malformations such as hypertelorism and strabismus were more common in infants with Pierre Robin syndrome and also in those with isolated cleft palate combined with a skeletal II jaw relationship when compared with infants who had cleft palate with a skeletal I jaw relationship. The frequency of hypodontia also was greater in the former two groups than in the latter. Furthermore, no difference was found in the frequencies of U- and V-shaped clefts. The frequencies of near relatives with clefts were also not different between groups. Whilst it may be possible to observe from these findings an association between Pierre Robin syndrome and isolated cleft palate, it is difficult to conclude that they support any of the postulates regarding the aetiology of Pierre Robin syndrome.

Child, Preschool↗
PubMed2002

Comparison of the expression patterns of two LIM-homeodomain genes, Lhx6 and L3/Lhx8, in the developing palate.

OBJECTIVES: To compare and contrast the gene expression of two LIM-homeobox type transcription factors, Lhx6 and L3/Lhx8, in secondary palate formation. METHODS: In situ hybridization histochemistry with digoxygenin (DIG) labelled cRNA probes specific for Lhx6 and L3/Lhx8. MATERIALS: Serial cryo-sections of embryonic day (E)13.5, 14.5, and 15.5 mice (C57BL/6). OUTCOME MEASURE: Comparison of the signal intensities of NBT/BCIP precipitate by alkaline phosphatase conjugated anti-DIG antibody. RESULTS: From E13.5 to E15.5, Lhx6 and L3/Lhx8 signals are detected in palatal mesenchyme, but the L3/Lhx8 signal is much more intense than the Lhx6 signal. In palatal epithelium, covering the mesenchyme, Lhx6 mRNA is transiently expressed at E14.5, while L3/Lhx8 mRNA expression is never detected throughout the development. CONCLUSION: Lhx6 and L3/Lhx8 functions may be partially redundant in the mesenchyme of the secondary palate, but not in the palatal epithelium.

Animals↗
PubMed2002

Soft tissue healing after parasagittal palatal incisions in segmental maxillary surgery: a review of 311 patients.

PURPOSE: This study retrospectively evaluated the soft tissue healing after using parasagittal soft tissue incisions for surgical segmental maxillary expansion. PATIENTS AND METHODS: The records of 311 patients (224 females, 87 males), with an average age of 28.5 years (range, 12 to 62 years) who had transverse maxillary hypoplasia, were retrospectively evaluated. All patients underwent segmental maxillary osteotomies, surgical maxillary expansion greater than 5 mm, and placement of midpalatal porous block hydroxyapatite (PBHA). Parasagittal palatal soft tissue incisions were used to facilitate expansion, minimize soft tissue damage, and maintain soft tissue coverage over the PBHA implants. At postoperative follow-up visits, any signs or symptoms of complications associated with the use of the parasagittal incisions were recorded. RESULTS: Average patient follow-up was 3.4 years (range, 1.0 to 7.2 years). In 293 patients (94%), the palates healed uneventfully without complications. Eighteen patients (6%) had complications; 9 (2.9%) had infections associated with the midpalatal implants, 8 (2.6%) had oronasal communications, and 1 (0.3%) had problems associated with a palatal wire. Six patients with midpalatal implant problems required removal of the implant, 4 patients required closure of their oronasal communications, and 1 patient required removal of a palatal wire. Therefore, 11 patients (3.5%) required minor secondary surgical procedures. No teeth or alveolar bone were lost in any of the cases. CONCLUSIONS: The use of parasagittal palatal incisions appears to be a safe technique for soft tissue management during large surgical maxillary expansions associated with segmental maxillary osteotomies and midpalatal placement of PBHA implants.

Adolescent↗
PubMed2002

Unrepaired clefts in the hard palate: speech deficits at the ages of 5 and 7 years and their relationship to size of the cleft.

The purpose of the study was to investigate the relationship between the size of oronasal openings in the hard palate and speech deficits. Audiotape recordings and plaster casts were taken according to standard procedures at 5 and 7 years of age from 22 consecutive children born with complete unilateral cleft lip and palate treated at Sahlgrenska University Hospital, Göteborg, Sweden. The soft palate had been repaired before the age of 12 months, whereas the cleft in the hard palate was left unrepaired, to be closed later. Perceptual judgements of nine speech variables at 5 and 7 years of age were correlated with measures of the area of the residual cleft in the hard palate. "Retracted oral articulation" (to velar place) found in nine of the 22 children correlated significantly with the area of the cleft at the age of 5 years but not later. The establishment of this particular speech error seems to be related to the size of an oronasal opening.

Articulation Disorders↗
PubMed1996

Stimulation of bone formation in the expanding mid-palatal suture by transforming growth factor-beta 1 in the rat.

The most intense endogenous transforming growth factor (TGF)-beta 1 expression was detected in osteoblasts and fibroblasts in the mid-palatal suture 24 hours after the start of palatal expansion with an immunohistochemical technique. Based on these data, local effects of transforming growth factor-beta 1 (TGF-beta 1) in the expanding mid-palatal suture of the rat were examined. Single doses of human recombinant (rhu) TGF-beta 1 (40 and 200 ng, and 1 microgram) were injected into the expanding mid-palatal suture 24 hours after expansion started. Calcein was also injected immediately, and 6 and 12 days after expansion. The width of each calcein label was measured to evaluate bone formation along the suture with bone histomorphometry. In the experimental groups, bone formation during the 12-day expansion period was stimulated significantly (P < 0.05), in a dose-dependent manner, compared with that in the control group. Furthermore, bone formation during the later stage (6-12 days) of the 12-day expansion period, was still significantly higher than that in the control group. In addition, the amount of bone formation in response to a course of 3 injections of 200 ng rhu TGF-beta 1 on days 3, 6, and 9 was almost equal to that induced by a single injection of 200 ng rhu TGF-beta 1 on day 1. These results suggest that TGF-beta 1 may play an important role in bone formation at the active site of the suture in response to rapid palatal expansion and application of TGF-beta 1 during the early stages may induce rapid bone formation.

Acid Phosphatase↗
PubMed2004

Pleomorphic adenoma of the palate.

Pleomorphic adenoma, is the most common tumor (50%) of the major and minor salivary glands. Seventy percent of the tumors of the minor salivary glands are pleomorphic adenomas, and the most common intraoral site is the palate, followed by the upper lip and buccal mucosa. Pleomorphic adenoma appears as a painless firm mass and, in most cases, does not cause ulceration of the overlying mucosa. Generally it is mobile, except when it occurs in the hard palate. Intraoral mixed tumors, especially those noted within the palate, lack a well-defined capsule. Lesions of the palate frequently involve periosteum or bone. Approximately 25% of benign mixed tumors undergo malignant transformation. Treatment for the pleomorphic adenoma is radical surgery. Inadequate resection leads to local recurrence. The authors report a palate pleomorphic adenoma in a 67-year-old female patient.

Adenoma, Pleomorphic↗
PubMed1993

Intraoperative rapid expansion in cleft palate repair.

Intraoperative rapid expansion in cleft palate repair increases surface area by distension of the palate and recruitment of the surrounding palate tissue. A 5-cc Foley catheter with the distal tip trimmed is employed as the tissue expander. Intraoperative rapid palate expansion is proposed for closure with less tension of large gaps between cleft borders. This procedure has not demonstrated any deleterious clinical effects in cleft palate repair.

Catheterization↗