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At least 127 records · Page 7Linked to original sources
PubMed2006

Low fistula rate in palatal clefts closed with the Furlow technique using decellularized dermis.

BACKGROUND: Despite the advances in cleft palate closure over the past 20 years, postoperative fistulas are still a significant problem. Fistula rates average 10 to 23 percent, and it has been suggested that wide clefts have a higher rate of fistula formation. METHODS: In an attempt to improve closure rates, the authors placed decellularized dermal graft within the closure of 31 consecutive palatal cleft closures using the Furlow technique, with one attending surgeon. A retrospective review of this series of patients was analyzed for cleft width, Veau type, and rate of healing. RESULTS: Average cleft width was 12.2 mm (range, 8 to 15 mm). There were one Veau type I, five Veau type II, 20 Veau type III, and six Veau type IV patients. The average age at time of palate repair was 11.75 months (range, 8 to 28 months). One patient (Veau type IV, 15-mm width) developed fistula (3.2 percent fistula rate overall). There was no evidence of rejection, scarring, or impaired palatal motion by examination. CONCLUSIONS: A low fistula rate was obtained in Furlow technique palatal cleft repairs using decellularized dermis when compared with historical controls. Decellularized dermis may provide an additional barrier to wound breakdown in the postoperative period and may improve fistula rate.

Child, Preschool↗
PubMed1996

[Cephalometric measurements of nasopharyngeal and palatal flow in cleft palate children by comparison with hearing impairment].

The comparison of the audiological results (audiometry, tympanometry 226 Hz and multifrequency tympanometry) and cephalometric measurements of the nasopharynx in cleft palate children was presented. A group of 85 children 7-15 years old, operated because of cleft lip and palate during early childhood were considered for the purpose of this study. With the results of the audiological examination, as the base, the children were divided on three subgroups: the first characterized by pathological audiogram and tympanogram, the second with normal audiograms and pathological tympanograms, the third with normal audiograms and tympanograms. On the radiological pictures (lateral tele-radiograms) the linear measurements of certain were introduced as follows: the nasopharyngeal airflow (PN) and the palatal airflow (PP). In order to obtain the radiological coefficients (PN/A) and (PP/A), the linear measurements mentioned above in relation to the adenoid size were used. The results of measurements obtained for the first and second subgroup were significant different to the relevant results in the third subgroup and controls but the best correlation obtained between audiological parameters and radiographic nasopharyngeal airway. This results prove the existence of certain relation between measured quantities and audiological examination in cleft palate children.

Acoustic Impedance Tests↗
PubMed2002

Skeletal stability of Le Fort I osteotomy in patients with isolated cleft palate and bilateral cleft lip and palate.

The skeletal stability of Le Fort I osteotomy was evaluated retrospectively in 14 patients with isolated cleft palate (CP, mean age 27.2 years) and 11 patients with bilateral cleft lip and palate (BCLP, mean age 23.7 years). The osteotomy was fixed with titanium plates and the osteotomy gap was grafted with autologous bone. Neither intermaxillary fixation nor occlusal splints were used postoperatively. Skeletal stability was analysed both horizontally and vertically by cephalograms taken shortly before operation, immediately afterwards, and at six months and at one year postoperatively. In the CP group the mean maxillary horizontal advancement (point A) was 4.7 mm (range 0.3-7.8) and the mean vertical lengthening 3.6 mm (range 0.7-6.1). One year postoperatively the mean relapse was 8.5% (0.4 mm) horizontally and 16.7% (0.6 mm) vertically. In the BCLP group the mean horizontal advancement was 5.3 mm (range 0.2-10.7) and the mean vertical lengthening 7.3 mm (range 0.6-11.8). The mean postoperative relapse was 9.4% (0.5 mm) horizontally and 17.8% (1.3 mm) vertically. The skeletal stability and relapse were similar in both cleft types although BCLP patients had more residual cleft problems and their mean surgical advancement was greater. There was great individual variation.

Adolescent↗
PubMed2003

[Comparative morphometrical study on development of palatal shelves in cleft and non-cleft palate mice].

OBJECTIVE: To quantitatively compare the relationship between the congenital cleft palate and development of the palatal shelf. METHODS: Fifty two pairs palatal shelves were macroscopic measured, and 60 series coronal sections were microscopically measured, which were precisely orientated in the coronal plane and serially sectioned at 7 micro m thickness. With the aid of computer imaging analysis system the widths and areas of the palatal shelves in vertical and coronal direction, the maximal areas of the palatal bone and palatal process and alveolar process were measured and compared quantitatively between the cleft group and non-cleft group. RESULTS: The widths and areas of palatal shelves in cleft foetuses showed significant reduction macroscopically and microscopically as well as the maximal areas of the palatal bone, in addition, both of two processes of the maxilla showed significant developmental deficiency. CONCLUSIONS: The palatal shelves show significant developmental hypoplasia in three dimension directions, which have significant correlation between palatal cleft and trisomic condition.

Animals↗
PubMed1994

Submucous cleft palate.

Submucous cleft palate (SMCP) is a subgroup of cleft palate which is often unawared by general practitioners. The diagnostic triad of (1) bifid uvula, (2) translucent zone in soft palate and (3) bony notch in the posterior edge of the hard palate can be variable in their severity among each patient. Some patients with SMCP will have speech problems with velopharyngeal insufficiency (VPI) and/or articulation errors. Patients will also have middle ear effusion as in an overt cleft palate. Surgical treatment is indicated in the presence of VPI or recurrent otitis media. There are controversies on the timing and type of surgical intervention. This study was the first part of an ongoing study on SMCP. It was a retrospective review of the SMCP patients treated before June 1988 to compare the results among different age groups and surgical procedures. It was found that neither age nor type of surgery was a determinant for a satisfactory correction of VPI. Unless the patient had recurrent otitis media, surgery should not be performed before having a thorough speech evaluation including perceptual assessment and instrumental assessment. The type of surgery should be decided according to the findings from the instrumental assessment.

Adolescent↗
PubMed1992

Free forearm flap for closure of difficult oronasal fistulas in cleft palate patients.

There were four patients with palatal clefts who had been operated on many times previously but who still had large oronasal defects due to wound disruption. Moreover, there was considerable scar in the residual palatal tissue, which was contracted in the anteroposterior dimension. These patients were treated with a radial forearm flap transfer. The technical aspects of this reconstruction are emphasized, especially methods to enhance primary healing and to facilitate in setting the flap. Three of the patients were successfully reconstructed with one operation. The fourth had a small area of dehiscence anteriorly that was later closed with advancement of the flap tissue. There were no other complications. With the replacement of healthy tissue, the palate could be pushed further back to achieve better repair of the muscle. This would contribute to better speech function. In every patient, nasal regurgitation was eliminated, and speech quality improved significantly. The radial forearm flap is ideal for intraoral use, providing thin, hairless skin with a long, large-caliber vascular pedicle. It can reconstruct defects in one stage with well-vascularized tissue and minimal dissection of the palate. In a select group of cleft palate patients, this free-tissue transfer should be considered to achieve closure of large oronasal fistulas in patients with dense scar.

Adult↗
PubMed2004

Magnetic resonance imaging and surgical repair of cleft palate in a four-week-old canine (Canis familiaris): an animal model for cleft palate repair.

Successful cleft palate repair (palatoplasty) was accomplished in a male canine pup from a kindred with autosomal recessive transmission for a complete cleft palate phenotype. This case represents the potential application of a new animal model for cleft palate repair. This reproducible congenital defect provides a clinically relevant model to improve research into the human anomaly, as compared with previous iatrogenic or teratogenically induced animal models. This case report presents the basis for new repair techniques and for studying the genetic basis of the cleft palate defect.

Animals↗
PubMed1996

Is there a no-effect dose for corticosteroid-induced cleft palate? The contribution of endogenous corticosterone to the incidence of cleft palate in mice.

Teratology and genetic counselors are frequently asked whether very low exposures of drugs and chemicals can cause a child's congenital malformations. One critical factor on which the counseling is based is the dose. Because teratogenic effects follow a toxicologic dose-response curve with a no-effect dose, frequently counselors can refute a causal relationship because the dose was far below the no-observable-effect dose. Recently, some investigators have suggested that some teratogens which are present in physiologic levels such as cortisone, glucose, insulin, or sex steroids may contribute to the background incidence of congenital malformations and, therefore, there is no safe dose. Using corticosteroid-induced cleft palate in mice as the model, we conducted experiments to test this hypothesis. Adrenalectomy of A/J or CD-1 dams resulted in a reduction of endogenous corticosterone, but did not reduce the spontaneous incidence of cleft palate in the offspring. In A/J mice, the incidence of isolated cleft palate increased with adrenalectomy indicating that the spontaneous incidence of this defect is not due to endogenous corticosterone. Adrenalectomy did not affect the susceptibility of CD-1 mice to cortisone induced cleft palate demonstrating that endogenous corticosterone did not contribute significantly to the incidence of cleft palate induced by the exogenous corticosteroid. Finally, results in CD-1 mice clearly indicate that cortisone, like other teratogens, has a no-effect level for teratogenesis. These studies support the concept of a threshold in the dose-response relationship for corticosteroid-induced cleft palate in mice.

Adrenal Glands↗
PubMed2002

Cytophotometrical and immunohistochemical analysis of soft palate muscles of children with isolated cleft palate and combined cleft lip and palate.

Palatal muscle biopsies from the cleft margin of children were subjected to cytophotometrical and immunohistochemical analysis. Muscle fiber types were classified according to the enzyme activity of myofibrillic adenosine triphosphatase, glycerol-3-phosphate-dehydrogenase and succinate dehydrogenase assessed cytophotometrically. Fiber type-related immunoreactivity of nitric oxide synthase (NOS) isoforms I, II, III, as a physiological modulator of skeletal muscle function, was related to the oxidative and glycolytic activity of the muscle fibers. Fast oxidative glycolytic fibers with high oxidative activity showed strong NOS I immunoreactivity, whereas fast glycolytic fibers with high glycolytic activity were stronger immunolabelled for NOS III. NOS II expression was similar in all fiber types. No differences in NOS immunoreactivity were found between the two investigated forms of deformity. Additionally to the usual skeletal muscle fiber types, a slow tonic fiber type was for the first time identified in cleft palate muscles. Comparison of two forms of cleft palate, isolated cleft palate and combined cleft lip and palate has shown decreased enzyme activities in muscle fibers of palatal muscles from combined cleft lip and palate. Fast oxidative glycolytic fibers were mainly effected. Cytophotometrical and immunohistochemical analysis indicated a depressed performance of the cleft palatal muscles from combined cleft lip and palate as a stronger deformity compared with isolated cleft palate.

Adenosine Triphosphatases↗
PubMed1984

[Prevention of lip-maxilla-palate clefts].

Cheilognathopalatoschisis is among the common isolated congenital malformations. Its occurrence is more frequent than random incidence would be, with high familial incidence. Preventive attempts have been guided by the concept that nutritive factors are involved in the realisation of these inhibitory malformations. A multivitamin substitution course initiated even before conception was found to be correlated with a significant reduction of recurrence rates in several studies. The statistical and practical implications and problems are discussed. This treatment can be recommended as an individual preventive measure in case of pregnancies with risk of cheilognathopalatoschisis, but it will not be helpful in familial incidence of median cleft palate.

Cleft Lip↗
PubMed1997

Bilateral buccal flaps with double opposing Z-plasty for wider palatal clefts.

Described is a technique that has evolved from the challenges of closure of larger cleft palate defects and that we are now using in preference over other techniques to repair a wide variety of clefts. Soft-palate closure and muscular sling reconstruction are accomplished using a modified Furlow technique. An associated cleft of the hard palate and the gaps produced by posterior displacement of the reconstructed soft palate are closed by adding tissue, buccal flaps, rather than by closure under tension or leaving residual raw surfaces. Palate lengthening is achieved both by the Z-plasty effect and by the interposition of buccal flaps between the hard and soft palate. Seventy-six palates have been repaired using this procedure. There were three postoperative fistulas.

Cleft Palate↗
PubMed1989

Pin and screw retained palatal prostheses in cleft palate patients.

This article reviews the rationale and technical procedures for pin and screw retained palatal prostheses. These prostheses provide a useful treatment modality for cleft palate patients requiring two stage palatal repair, obturation for a large fistula, or single stage repair requiring palatal expansion in the presence of an unerupted primary dentition. Additionally, dental arch alignment can be achieved through the incorporation of an expansion screw device in the prosthesis. Post insertion problems of air and fluid leakage around the prosthesis, inflammation of the tissue underneath the prosthesis and possible damage to unerupted teeth have been observed, but are rare occurrences in properly selected cases.

Bone Screws↗
PubMed1979

Simplified method of feeding infants born with cleft palate with or without cleft lip.

Most infants born with a cleft palate with or without cleft lip are undergrown and have histories of difficult feeding. For the past two years, all of the infants born with isolated cleft palate with or without cleft lip, referred to the Boston Floating Cleft Palate Clinic, were fed using a simplified method. A standard nipple that was cross cut and a standard glass baby bottle were used. The infants were fed in the sitting position and burped frequently. Data indicating that nutrition in these infants is adequate as judged by weight gain was provided.

Bottle Feeding↗
PubMed1991

Cleft palate repair.

Cleft palates are congenital or acquired and effect the primary palate (lip) or the secondary (hard and soft) palate. Surgical repair of congenital cleft palate is indicated at an early age. Preservation of maximal tissue and tissue blood supply and a tension-free closure of the defect are requisite for successful repair. Multiple surgical procedures are often performed prior to resolution of this problem. Aspiration pneumonia is often present concurrently and should be treated with appropriate antibiotic therapy.

Anesthesia, Inhalation↗
PubMed2002

Cephalometric analysis in submucous cleft palate: comparison of cephalometric data obtained from submucous cleft palate patients with velopharyngeal competence and incompetence.

OBJECTIVE: The purpose of this study was to investigate the relationship between craniofacial and nasopharyngeal morphology and velopharyngeal function in submucous cleft palate. DESIGN AND PATIENTS: Fifty-two lateral cephalometric radiographs of 46 submucous cleft palate (SMCP) patients with velopharyngeal competence (24 patients) and incompetence (22 patients) at 4 and 7 years of age were studied. The patients had not received any surgical or orthodontic treatment prior to cephalography being performed. RESULTS: Significant differences were found between cephalometric variables (N-Ba, N-S-Ba angle) in children with velopharyngeal competence and incompetence. However, the results of our study showed that cephalometric data alone are not useful for predicting velopharyngeal function and can not serve as an absolute prognostic indicator. CONCLUSION;There are many factors that can influence velopharyngeal function in SMCP patients. Cephalometric data did not demonstrate a strong relationship to velopharyngeal function.

Age Factors↗
PubMed2005

Real-time magnetic resonance imaging aids prenatal diagnosis of isolated cleft palate.

OBJECTIVE: Cleft of the secondary palate without cleft lip is difficult to visualize sonographically. This study was performed to assess the utility of sonography, standard magnetic resonance (MR) imaging, and real-time MR imaging in the diagnosis of isolated cleft palate. METHODS: We prospectively assessed 5 fetuses at risk for isolated cleft palate on the basis of family history, micrognathia, or both, using sonography and standard and real-time single-shot fast spin echo MR sequences. Written informed consent was obtained under our Institutional Review Board-approved Health Insurance Portability and Accountability Act-compliant protocol. Images were assessed for confidence in a diagnosis of cleft or normal palate. Prenatal and postnatal diagnoses were compared. RESULTS: In 3 fetuses, micrognathia was visualized by sonography and MR imaging with standard and real-time sequences. One fetus at 19 weeks had a wide cleft of the entire secondary palate, and another fetus at 33 weeks had a cleft of the soft palate; these defects were seen only with real-time MR imaging. One 35-week gestational age fetus had a cleft soft palate that was visualized on standard and real-time MR imaging. Two fetuses with no abnormalities had the normal midline secondary palate seen only on real-time MR imaging. In all fetuses, real-time images were helpful in assessing the secondary palate because the entire midline naso-oropharynx could be visualized. CONCLUSIONS: Real-time MR imaging allows for rapid assessment of the midline structures, providing accurate diagnosis of isolated cleft palate.

Cleft Palate↗
PubMed2002

Tympanoplasty results in patients with cleft palate: an age- and procedure-matched comparison of preliminary results with patients without cleft palate.

OBJECTIVE: Because of continued eustachian tube abnormalities, the presence of a cleft palate repair has been thought to be associated with poor outcomes after tympanoplastic surgery. However, little published data exist regarding the results of major otologic surgery in patients with cleft palate. The objective of this study was to review our results of otologic surgery in these patients and compare results with those of age- and procedure-matched controls. METHODS: Our otologic database was used to identify patients with a repaired cleft palate who underwent otologic surgery between March 1994 and December 1999. Two control patients were identified for each cleft palate patient. Results of hearing, graft take, and need for postoperative pressure-equalizing tubes were compared. RESULTS: No significant difference existed between patients with a repaired cleft palate and control patients with regard to postoperative air-bone gap (P = 0.6805), graft survival rate (P = 1.00), and need for postoperative intubation (P = 0.457). CONCLUSION: Results in patients with cleft palate appear to be similar to those in patients without cleft palate.

Adolescent↗