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PubMed1983

Midfacial skeletal profile in early and late closure of the hard palate.

The midfacial profile (anterior projection of the maxilla) was studied in 57 white children with cleft lip and palate and Veau type III clefts operated upon by one surgeon. These patients were divided into three groups delineated by the time of repair of the hard palate. One group had hard palate repair at 2 years of age, the second group at 3 or 4 years of age, and the third after eruption of the first permanent molar teeth, at about 6 years of age. Lateral cephalograms were obtained and SNA measured. In this study it was the timing of hard palate closure, not the presence or absence of the prosthesis, that was evaluated. There was a statistically significant difference in the midfacial profile (which is dependent on the anterior projection of the maxilla) in those whose hard palate was repaired before and after eruption of the first permanent molar teeth.

Age Factors↗

PubMed2003

Hard and soft palate reconstruction.

Palate reconstruction remains one of the most challenging areas for the head and neck reconstructive surgeon. Although small defects in the palate are managed without significant difficulty, larger defects, particularly total maxillectomy defects, require special attention. The lack of a uniform classification for palate defects has limited prospective comparison of reconstructive methods. In most cases, these defects require bone containing microvascular free flaps for reconstruction if preoperative function is to be approached. Promising results have been documented for fibular, scapular, and iliac crest/internal oblique free flaps in the reconstruction of total or near-total maxillectomy defects. Our lack of ability to reconstruct the dynamic function of the soft palate continues to be disappointing. Limited studies have shown promise in soft palate reconstruction without the complications of velopharyngeal insufficiency.

Bone Transplantation↗

PubMed2006

Sialolipoma of the hard palate.

Sialolipoma is a new variant of salivary gland lipoma, which was first proposed by Nagao et al. (Histopathology 2001; 38: 30) in 2001. We report this rare case of sialolipoma in the hard palate. A 60-year-old Japanese woman was referred to our department complaining of a painless swelling on the right side of the hard palate. Intra-oral examination revealed a soft, elastic, dome-shaped mass with 1 cm in diameter located in the posterior part of the hard palate. Magnetic resonance imaging examination revealed high intensity on T(1)-weighted image and isointensity on T(2)-weighted image. Incisional biopsy revealed that the tumor was encapsulated by fibrous tissue, consisted of adipose tissue, and also contained normal salivary gland tissue peripherally. First diagnosed as an ordinary lipoma of the hard palate, the tumor was excised. According to the recent criteria of histologic findings of sialolipoma, we rediagnosed the tumor as sialolipoma of the hard palate.

Diagnosis, Differential↗

PubMed2006

Electropalatographic, acoustic, and perceptual data on adaptation to a palatal perturbation.

Exploring the compensatory responses of the speech production system to perturbation has provided valuable insights into speech motor control. The present experiment was conducted to examine compensation for one such perturbation-a palatal perturbation in the production of the fricative /s/. Subjects wore a specially designed electropalatographic (EPG) appliance with a buildup of acrylic over the alveolar ridge as well as a normal EPG palate. In this way, compensatory tongue positioning could be assessed during a period of target specific and intense practice and compared to nonperturbed conditions. Electropalatographic, acoustic, and perceptual analyses of productions of /asa/ elicited from nine speakers over the course of a one-hour practice period were conducted. Acoustic and perceptual results confirmed earlier findings, which showed improvement in production with a thick artificial palate in place over the practice period; the EPG data showed overall increased maximum contact as well as increased medial and posterior contact for speakers with the thick palate in place, but little change over time. Negative aftereffects were observed in the productions with the thin palate, indicating recalibration of sensorimotor processes in the face of the oral-articulatory perturbation. Findings are discussed with regard to the nature of adaptive articulatory skills.

Adult↗

PubMed2006

Patterns of oral-nasal balance in normal speakers with and without cleft palate.

OBJECTIVE: The aero-acoustic aspects of nasalization that distinguish speakers with velopharyngeal adequacy from those with velopharyngeal inadequacy are well known. Differences in aerodynamic aspects of nasalization also have been demonstrated in normal speakers with cleft palate and their noncleft counterparts. The purpose of this study was to compare the amplitude and temporal patterns of oral-nasal balance in speakers with cleft palate and normal speech to those with normal speech without cleft palate. PATIENTS AND METHODS: Using the Nasal Accelerometric Vibrational Index technique, the time course and amplitude of oral-nasal balance were studied in 10 children with cleft palate and velopharyngeal adequacy and 10 noncleft controls. The speech sample included syllable, word, and sentence contexts, most of which were devoid of nasal consonants. RESULTS: The results indicate few differences between the two groups in contexts devoid of nasal consonants. However, significant differences were evident with regard to temporal aspects of oral-nasal balance in a nasal-oral consonant word context. CONCLUSIONS: Subtle structural-motor differences that may exist between normal speakers with and without cleft palate may be more evident when the spatiotemporal requirements for velar movement become more complex and result in a greater possible combination of oral-nasal impedance ratios.

Case-Control Studies↗

PubMed2004

Disruption of Fgf10/Fgfr2b-coordinated epithelial-mesenchymal interactions causes cleft palate.

Classical research has suggested that early palate formation develops via epithelial-mesenchymal interactions, and in this study we reveal which signals control this process. Using Fgf10-/-, FGF receptor 2b-/- (Fgfr2b-/-), and Sonic hedgehog (Shh) mutant mice, which all exhibit cleft palate, we show that Shh is a downstream target of Fgf10/Fgfr2b signaling. Our results demonstrate that mesenchymal Fgf10 regulates the epithelial expression of Shh, which in turn signals back to the mesenchyme. This was confirmed by demonstrating that cell proliferation is decreased not only in the palatal epithelium but also in the mesenchyme of Fgfr2b-/- mice. These results reveal a new role for Fgf signaling in mammalian palate development. We show that coordinated epithelial-mesenchymal interactions are essential during the initial stages of palate development and require an Fgf-Shh signaling network.

Animals↗

PubMed1998

Diphenylhydantoin affects glycosaminoglycans and collagen production by human fibroblasts from cleft palate patients.

During embryonic development, the proper production of extracellular matrix molecules mediates morphogenetic processes involved in palatogenesis. In the present study, we investigated whether any differences exist in glycosaminoglycan (GAG) and collagen synthesis between palate fibroblasts from infants, with or without cleft palate, in two age ranges. Subsequently, the effects of diphenylhydantoin (PHT), a teratogen known to induce cleft palate in human and mammalian newborns, on extracellular matrix (ECM) production were studied. We found that cleft palate fibroblasts (CPFs) synthesize greater amounts of GAG and collagen than normal fibroblasts (NFs). CPFs produced less cellular hyaluronic acid (HA) and more sulphated GAG. HA was the principal GAG species in the medium, and its percentage was lower in one- to three-year-old CPFs. Cleft palate fibroblasts produced more extracellular chondroitin 4- and 6-sulphate (CS) and dermatan sulphate (DS). Associated with a higher production of sulphated GAG, we observed a higher synthesis of type III and type I collagen with a normal ratio of alpha2(I) to alpha1(I) chains. PHT treatment of NFs reduced collagen and GAG synthesis, with a marked effect on sulphated GAG. The drug changed collagen synthesis, whereas it did not affect GAG production in CPFs whose phenotype may already be impaired. These findings indicate that, in CPFs, modifications in the pattern of ECM components, which are most likely responsible for the anomalous development, persist in infants. In addition, NFs and CPFs with a different phenotype respond differently to PHT treatment.

Cells, Cultured↗

PubMed2006

Cell cycle proteins in normal and chemically induced abnormal secondary palate development: a review.

Cell cycle progression and thus proper cell number is essential for normal development of organs and organisms. Craniofacial tissues including the secondary palate are vulnerable to disruption of cell cycle progression and proliferation by many chemicals including mycotoxin, secalonic acid D (SAD), glucocorticoids, retinoic acid and 2,3,7,8-tetrachlorodibenzodioxin. Induction of cleft palate (CP) by SAD in mice occurs from a reduction in the size of developing palatal shelves. This is associated with an inhibition of proliferation of murine and human embryonic palatal mesenchymal (MEPM and HEPM) cells as well as a G1/S block of cell cycle. In murine embryonic palates and HEPM cells, SAD inhibited G1/S-phase-specific cyclin-dependent kinase (CDK)2 activity, reduced the level of cyclin E and increased the level of the CDK2 inhibitor, p21. These results, together with those from other laboratories, suggest that common cell cycle protein targets (biomarkers), relevant to the pathogenesis of CP by multiple chemical exposures, that can form the basis for the diagnosis and the development of preventive strategies, are likely to exist.

Abnormalities, Drug-Induced↗

PubMed1992

Recent advances in primary palate and midface morphogenesis research.

During the sixth week of human development, the primary palate develops as facial prominences enlarge around the nasal pits to form the premaxillary region. Growth of craniofacial components changes facial morphology and affects the extent of contact between the facial prominences. Our recent studies have focused on developing methods to analyze growth of the primary palate and the craniofacial complex to define morphological phases of normal development and to determine alterations leading to cleft lip malformation. Analysis of human embryos in the Carnegie Embryology Collection and mouse embryos of cleft lip and noncleft strains showed that human and mouse embryos have similar phases of primary palate development: first, an epithelial seam, the nasal fin, forms; then a mesenchymal bridge develops through the nasal fin and enlarges rapidly. A robust mesenchymal bridge must form between the facial prominences before advancing midfacial growth patterns tend to separate the facial components as the medial nasal region narrows and elongates, the nasal pits narrow, and the primary choanae (posterior nares) open posterior to the primary palate. In mouse strains with cleft lip gene, maxillary growth, nasal fin formation, and mesenchymal replacement of the nasal fin were all delayed compared with noncleft strains of mice. Successful primary palate formation involves a sequence of local cellular events that are closely timed with spatial changes associated with craniofacial growth that must occur within a critical developmental period.

Animals↗

PubMed2025

Current Advances in Surgical Techniques for Secondary Cleft Palate Repair: A Systematic Review.

ObjectiveTo systematically review advances in surgical techniques for secondary cleft palate repair, emphasizing their impact on velopharyngeal function, speech outcomes, and the methodological validity of speech assessments used in published studies.DesignFollowing PRISMA 2021 guidelines, six electronic databases were searched for articles from January 2012 to February 2025 using MeSH terms related to secondary cleft palate repair, velopharyngeal insufficiency, palatoplasty, and speech outcomes. Eligible studies included clinical reports with ≥10 patients undergoing secondary repair. Data on surgical methods, outcomes, and complications were extracted and qualitatively synthesized due to heterogeneity across studies.SettingAll published clinical studies evaluating secondary cleft palate repair outcomes.Patients/ParticipantsIndividuals presenting with residual velopharyngeal insufficiency, recurrent fistula, or speech dysfunction following primary palatoplasty.Main Outcome MeasuresSpeech resonance and intelligibility, velopharyngeal closure rate, fistula recurrence, donor-site morbidity, and obstructive sleep apnea risk.ResultsFourteen studies met the inclusion criteria. Palate-based re-repair with Furlow double-opposing Z-plasty and buccal myomucosal flaps improved resonance and closure in small to moderate gaps. Pharyngeal flap and sphincter pharyngoplasty achieved satisfactory closure in larger defects but increased the risk of airway obstruction. However, most studies lacked validated speech protocols or controlled for articulatory errors and fistula effects, limiting confidence in the interpretation of outcomes.ConclusionsWhile secondary repairs often improve resonance and velopharyngeal competence, evidence remains constrained by heterogeneity and non-validated assessment methods. Future multicenter research integrating standardized, speech pathologist-verified protocols is essential to establish evidence-based algorithms for secondary cleft palate repair.

Humans↗

PubMed2005

Protein kinase C and chemical-induced abnormal palate development.

The protein kinase C (PKC) family of proteins mediates the action of growth factors and other ligands by activating a network of transcription factors that bind to TRE sequences in the promoters of many genes that regulate cell proliferation, differentiation, extracellular matrix synthesis, apoptosis and others in a cell type-, isozyme- and context-specific manner. The critical role of PKC in embryonic development is indicated by early death of embryos in which one or more of these isozymes are inactivated. Our studies together with others show that palatal PKC signalling is functional and may be essential for normal palate development. Although single gene knockouts have failed to exhibit the cleft palate (CP) phenotype, owing to compensation by other kinases, many chemicals including the mycotoxin, secalonic acid D, disrupt palatal PKC signalling leading to altered palatal mesenchymal gene expression. The potential relevance of such effects to chemical-induced CP is discussed.

Abnormalities, Drug-Induced↗

PubMed1987

Computer-assisted analysis of hyaluronate distribution during morphogenesis of the mouse secondary palate.

Hyaluronate mediated extracellular matrix swelling has been hypothesized to play a major role in reorientation of the secondary palatal shelves. A computer-assisted method utilizing image registration and subtraction was used to visualize the distribution of hyaluronate (HA) during morphogenesis of the secondary palate. Patterns of HA distribution in anterior, posterior and presumptive soft palate were examined in the secondary palatal shelves of CD-1 mouse fetuses that were 30, 24 and 18 h prior to, and at the time of, shelf reorientation. Adjacent serial sections were taken from each shelf region of three to six specimens from a minimum of three litters for each gestational age. One section was incubated in buffer as a control, the other digested with Streptomyces hyaluronidase to specifically remove HA. Both sections were stained with Alcian blue to visualize the extracellular matrix and counterstained with nuclear fast red to visualize cells. Two different videoimages were then digitized for each tissue section, one using wavelengths of light that were at or near the maximum absorbance of the matrix stain, the other using wavelengths that were at the maximum absorbance of the cellular stain. Thus, a matrix image and a cell image of both control and digested sections were produced. Next, the cell image was subtracted from its respective matrix image, resulting in a control matrix-only image and a digested (HA-removed) matrix-only image. These images were mathematically warped to one another, if necessary, and registered with one another. The digested image was then subtracted from the control image. The resultant difference picture displayed the pattern and relative intensities of HA distribution across the tissue section. Prior to and during shelf reorientation, unique region-specific patterns of HA distribution and relative intensity were identified which became homogeneous after reorientation. Presumptive soft palate shows the most extensive and intense patterns of HA distribution, followed by the posterior region. The anterior region has the most sparse pattern of the three regions examined. The results are consistent with the hypothesized role of HA in shelf reorientation.

Animals↗

PubMed1978

Diagnosis of palatal defects by trispiral tomography: a pilot study.

A pilot study is presented in which 12 selected patients, ages 3-11 years, were evaluated for a palatal defect utilizing trispiral tomography. Each patient, because of speech and hearing abnormalities, was evaluated by a speech pathologist and an otolaryngolgist and voice recordings, audiometry, tympanometry and plain and cine radiographic X-rays were obtained. Those children with speech and hearing abnormalities in whom the question of a palatal defect was raised underwent trispiral palatal tomography. Nine of the 12 patients selected for tomography demonstrated a palatal defect that was not detected by other means. Trispiral tomography appears to be a useful tool in the diagnosis of suspected palatal defects in selected patients.

Child↗

PubMed2006

The effect of preoperative use of an orthopedic plate on articulatory function in children with cleft lip and palate.

OBJECTIVE: To evaluate the effect of preoperative use of an orthopedic plate (OP) on postoperative articulatory function in children with cleft lip and palate. SUBJECTS: The subjects had complete unilateral or bilateral cleft lip and palate and were scheduled for a one-stage palatoplasty. MAIN OUTCOME MEASURES: Tongue movements during sucking were analyzed by ultrasonography. Postoperative articulatory behavior was also assessed at 5 years 4 months of age. RESULTS: There was an excessive downward excursion of the rear portion of the tongue during sucking regardless of the use or nonuse of the OP. This indicated that infants with cleft palate could not create negative pressure in the oral cavity, even with the OP. However, the OP appeared effective for preventing irregular movements of the tongue during sucking. The proportion of subjects obtaining excellent articulation was significantly higher in the group using the OP until palatoplasty than in the group who did not continue using the OP. The proportion of subjects with disturbed articulatory function in the latter group was comparable with that in the control group, who never used the OP. CONCLUSIONS: Continuous use of the OP up to the time of palatoplasty appeared to be effective for the postoperative articulatory function in children with complete cleft lip and palate. Inhibiting irregular movements of the tongue, the OP might assist in preventing "palatalized articulation."

Articulation Disorders↗

PubMed2006

Cleft palate in Kabuki syndrome: a report of six cases.

Kabuki syndrome is a syndrome of rare congenital anomalies that was named after its characteristic appearance, a face resembling that of an actor in a Kabuki play. Although cleft palate is a feature that is sometimes observed in patients with Kabuki syndrome, there are few clinical reports of cleft palate associated with Kabuki syndrome. This report presents six cases of Kabuki syndrome with cleft palate and reviews their clinical features. Our results suggest that (1) patients with cleft palate in Kabuki syndrome tend to fail in acquiring normal velopharyngeal function and (2) submucous cleft palate might be more common in patients with Kabuki syndrome than previously was reported.

Abnormalities, Multiple↗

PubMed1995

Longitudinal study on the changes of maxillary arch dimensions in Japanese children with cleft lip and/or palate: infancy to 4 years of age.

The focus of this study was an analysis of maxillary arch growth changes prior to the time of cheiloplasty up to 4 years of age. Serial dental casts were obtained and measured in 95 children with cleft lip and palate, or both: 7 unilateral cleft lip and alveolus (CLA), 52 unilateral cleft lip and palate (UCLP), 24 bilateral cleft lip and palate (BCLP), and 12 isolated cleft palate (CP). The children were treated at the Kyushu University Dental Hospital. The results are as follows: (1) Prior to cheiloplasty, the maxillary buccal segments in the subjects with cleft lip and palate showed lateral displacement. The premaxilla in BCLP subjects was protruded. (2) Cheiloplasty influenced maxillary anterior arch width, but not posterior width. The operation caused posterior displacement of the premaxilla in BCLP subjects. (3) Palatoplasty affected the growth of the maxillary arch in the transverse and anteroposterior dimensions. (4) A variety of growth patterns observed in the patients (e.g., increasing or decreasing of the maxillary arch dimensions) suggests that maxillary arch dimensions were affected not only by surgery, but also by other individual factors such as genetic facial pattern and severity of the cleft.

Alveolar Process↗

PubMed1995

Wound healing in beagle dogs after palatal repair without denudation of bone.

The connection of scar tissue to palatal bone by Sharpey's fibers, after cleft palate surgery, might lead to maxillary growth inhibition. The aim of this study, in beagle dogs, was to investigate the possibility of preventing the development of Sharpey's fibers by means of a modified surgical technique. In group 1, palatal repair according to von Langenbeck, was simulated. In group 2, palatal surgery was performed using a new partially split flap technique. The palates were histologically evaluated 12 weeks after surgery and compared with a control group. In group 1, the scar tissue was firmly attached to bundle bone by means of Sharpey's fibers. In group 2 and in the control group, this kind of attachment was not found; the bone was of the lamellar type. The partially split flap technique had led to the development of vaguely demarcated scar tissue and it had prevented, to a large extent, development of Sharpey's fibers.

Animals↗

PubMed1996

Isolated influences of lip and palate surgery on facial growth: comparison of operated and unoperated male adults with UCLP.

Our aim was to evaluate the isolated effects of cheiloplasty and palatoplasty on dentofacial morphology. Ninety-three lateral cephalograms of white male adult patients with complete unilateral cleft lip and palate were analyzed in this study. The sample was divided into three groups according to the surgical treatment received: (1) nonoperated group (NO)-35 patients without surgical treatment; (2) operated lip group (OL)-23 subjects with lip closure only; (3) operated lip and palate group (OLP)-35 individuals with both lip and palatal closure. No statistically significant differences in the cephalometric measurements between the OL and OLP groups were found. There were, however, several significant differences between these two groups (OL and OLP) and the nonoperated group (NO). Thus, the differences in dentofacial morphology in patients with unilateral cleft lip and palate, seem to be influenced principally by the surgically repaired lip. Influences of the palatal repair appeared to be minimal and statistically insignificant.

Adolescent↗