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PubMed1986

Fate of unfused medial edge epithelia in rat fetuses with experimentally induced cleft palate: I. From 16.3 to 17.7 days of gestation.

The fate of unfused medial edge epithelia (MEE) was studied in rat (Sprague-Dawley) fetuses with experimentally induced cleft palate. Clefting was the result of amniotic sac puncture and the age of fetuses was individually determined ( = MA-age). The MEE (at five selected areas), the oral palatal, and the nasal septum epithelia of six specimens (with individual ages of 16.3, 16.8, 16.9, 17.0, 17.5, and 17.7 days) were illustrated by scanning electron and light microscopy. At day 16.3 of MA-age, the MEE was covered with cells of a regular shape. In the anterior elevation area, visible signs of cell death and surface alterations could not be observed until day 17.7. In the middle elevation area, a small region of exposed mesenchyme occurred at the level of the first and second rugae between day 16.9 and 17.5 of MA-age. At day 17.7, reepithelialization was complete. In the posterior elevation area and the anterior and posterior soft palate area, a narrow band of surface alterations (ie, surface accumulations of cell blebs, filopodial-like structures, and loss of villi-like cell boundaries) appeared cranial to a thickened termination of the hard palate epithelium between days 16.9 and 17.7 of MA-age. The residual MEE remained undifferentiated until day 17.5 of MA-age. At this point in time, small ciliated cells appeared in the MEE-domain near the borderline to the nasal epithelium. It is concluded that the fate of the unfused MEE differs in the various areas located along the anteroposterior shelf axis, so-called "programmed cell death" is restricted to a small zone in the middle elevation area, surface alterations observed along the thickened termination of the oral palate epithelium possibly reflect phenomena of epithelial rearrangement between the latter and the undifferentiated MEE, and the MEE remains undifferentiated, at least until day 17.5 of MA-age.

Animals↗
PubMed1987

Regeneration in surgically produced cleft palate in rabbits. A microscopical study.

In order to study the effects of surgical procedures on the regeneration process in cleft palate, an artificial cleft was made in 4-weeks old female New Zealand rabbits. The 47 animals were divided into 5 groups: group 1: controls, group 2: cleft made in the bony palate, using a dental burr (phi 3 mm), group 3: cleft as in group 2, oral mucosa stitched, group 4: cleft made without perforating the nasal mucosa; oral mucosa stitched ("Veau"), group 5: cleft made as in group 4; before stitching the oral mucosa pieces of autologous rib bone were introduced into the cleft ("Schuchardt"). At the ages of 4, 5, 6, 8, 12, 18 and 24 weeks, one or two animals per group were sacrificed. The palatal region was microscopically studied using 10 mu paraffin sections stained according to Herovici. It was found that it is difficult to make a reproducible cleft on the histological level. A large interindividual variation in local damage due to the surgical procedure was observed; this might contribute to the variation in growth results of the facial skeleton reported in literature. Signs of excessive bone resorption were found. The presence of bone in places where sutural tissue should be present, observed in some growing animals, will contribute to reduction of palatal width, medial collapse of the palate and asymmetry of the facial skeleton. There appeared to be no striking differences between the three methods of repair, used in group 3, 4 and 5 respectively.

Animals↗
PubMed1986

[Velofacial hypoplasia and submucous cleft palate: histologic analogies. A comparative histologic and histomorphometric study of velum musculature].

Velofacial hypoplasia (VFH) is particularly characterised by severe open nasalising with palate-throat insufficiency due to an abridged palatal velum. The cause of this disorder is unknown. Submucosal cleft palates (SMG), which may cause similar signs, are considered to be caused genetically, or acquired during pregnancy as an impedimental malformation. We compared histologically and histomorphometrically the palatal velums of patients with VFH and SMG, with normal specimens. In VFH and SMG, the muscle fibres of the palatal velums feature pathological variations of their diameters; moreover, these specimens contain more fibrous than muscle tissue compared with the controls. These changes do not indicate clearly either a neuropathogenic or a myopathogenic or other pathogenesis. However, the similarities of the clinical, histological and histomorphometric findings do indicate a common formal pathogenesis. Anamnestic examinations of the pregnancies (particularly of the first trimenon) of mothers of patients with VFH may reveal further findings supporting our assumption.

Child↗
PubMed1986

Experience with the Furlow double-reversing Z-plasty for cleft palate repair.

One-hundred and six cases of soft palate closure using the Furlow double-reversing Z-plasty technique have been reported. Most of these patients have been done in the past 2 years. There seem to be a number of worthwhile advantages to this procedure, with few disadvantages or complications. The operation is adaptable for use in early soft palate closure (3 to 6 months) as well as late closure (12 to 14 months), in submucosal clefts, as well as in secondary palatal repair where lengthening and repositioning of the levator muscle is desired. With this type of palatoplasty, the need for raising or shifting large mucoperiosteal flaps from the hard palate has been completely avoided. The operation can be combined with a primary posterior pharyngeal flap if desired, although this is not advised if early palatal closure (3 to 6 months) is used because of a high incidence of sleep apnea. Preliminary speech results are very encouraging.

Child, Preschool↗
PubMed1979

Elevation of lesioned palatal shelves in vitro.

Fetuses were obtained from CD-1 mice at a time estimated to be 12 h prior to vivo secondary palate closure. One of the palatal shelves of each partially dissected fetal head was lesioned in one of five ways, the other left intact to serve as control. Single transverse cuts extending the width of the shelf were made at one of three positions along the longitudinal axis of the shelf: one-third, one-half or two-thirds the shelf length estimated from the rostral edge. Some specimens were cut in two places, dividing the shelf into three equal segments. Another group received a lesion which separated the caudal third of the shelf from its maxillary connections. All specimens were cultured for 18 h. At the end of the culture period the heads were fixed, examined and the degree of elevation of each shelf piece assessed. Intact, control shelves of all preparations were elevated in the rostral two-thirds of the shelf, while the caudal third was partially elevated. Results seen in lesioned shelves depended upon both the size of the segment and the region of the shelf contained in the segment. The rostral two-thirds of the shelf, the presumptive hard palate, whether intact or in segments elevated without physical connections to neighboring shelf tissue. Thus, it is unlikely that this elevation requires a wave of contraction be transmitted from the caudal soft palate region. In contrast, the presumptive soft palate requires continuity with the rostral portions of the shelf both to maintain structural stability and to elevate.

Animals↗
PubMed1984

Studies on facial growth and arch size in cleft lip and palate.

A study of facial growth and palatal dimensions was done on 32 patients with unilateral cleft lip and palate. The study population, treated by a single surgeon, was separated into two groups: those whose palates were closed before age 4 years, and those whose palates were closed after 4 years. Maxillary growth was better in patients who had late surgery than in those who had early surgery. In addition, palatal dimensions were more nearly normal in the late group than in the early group.

Age Factors↗
PubMed1978

Allophenic mice in cleft-palate investigations.

T1Wh (Rb (5;19)1Wh), an albino strain of mice not previously used in the investigation of cleft palate (CP), is homozygous for a (5;19) Robertsonian translocation which provides conspicuous chromosomal markers. Preliminary studies in this laboratory revealed that CP is induced in all the offspring of T1Wh females treated with 2.5 mg of cortisone acetate on days 11-14 of pregnancy and that palatal closure is accomplished at a later morphological and chronological age than in C57BL/6J strain mice. The latter strain had a CP frequency of 42% under similar experimental conditions. Eight- to 16-cell embryos were aggregated in the following combinations: T1Wh in equilibrium T1Wh, C57BL/6J in equilibrium C57BL/6J and T1Wh in equilibrium C57BL/6J. The resulting allophenic blastocysts were transferred to pseudopregnant C57BL/6J recipients which were given the above cortisone treatment and killed on the 18th day of pregnancy. CP was found in all of the 48 T1Wh in equilibrium T1Wh fetuses, 4 (20%) of of 20 C57BL/6J in equilibrium C57BL/6J fetuses and in 17 (26.2%) of 65 T1Wh in equilibrium C57BL/6J fetuses. Analysis of chromosome preparations from the palates of the T1Wh in equilibrium C57BL/6J fetuses demonstrated that there is a positive correlation between the presence of CP and the percentage of susceptible cells in the palate (P less than 0.02). Other data suggest a possible growth advantage in favor of C57BL/6J cells in the palates of T1Wh in equilibrium C57BL/6J allophenic mice.

Animals↗
PubMedDate not supplied

Ultrastructural observations on the development of triamcinolone-induced cleft palate in hamsters.

Cleft palate was induced in fetuses by administration of triamcinolone to pregnant hamsters. Twenty hours after treatment, alterations were seen at the epithelial-mesenchymal interface in the prospective fusion epithelium of the vertical shelf. The alterations included contacts between the epithelial and mesenchymal cells, and disruptions in the continuity of the basal lamina. Thirty-two hours after triamcinolone treatment, the basal epithelial cells in some of the reorienting palatal shelves were necrotic. When compared with normal cells, the drug treated necrotic cells were lighter in appearance due to reduced polyribosomes; they also lacked lysosomes. In other reorienting shelves, the basal cells were lost and the epithelial continutity was maintained by the superficial cells. The alterations at the epithelial-mesenchymal interface, and the necrotic changes in the basal cells, became more severe with delayed horizontal reorientation of the palatal shelves. The necrotic debris was cleared by macrophages. At a later stage, the opposing epithelia of the horizontal shelves did not fuse but underwent stratification. It appears that triamcinolone induces alterations at the epithelial-mesenchymal interface, and inhibits the normal process of protein synthesis in the epithelial cells during palatogenesis. This, along with delayed differentiation of mesenchymal cells, distrupts the timing of coordinated development of the palatal tissues. These changes are associated with a delay in the reorientation of the palatine shelves, and cleft palate results.

Animals↗
PubMed1980

Morphological study of cleft palate development in 5-fluorouracil-treated hamster fetuses.

Morphogenesis of palate was studied in normal and 5-fluorouracil-treated hamster fetuses. The results showed that normal palatal development was completed between days 12 and 13 of gestation. In 5-fluorouracil-assaulted palate the reorientation of shelves from a vertical to horizontal plane was delayed. Crown-rump length, gestational age and fetal weight were reliable predictors of the stages of normal palatal development, whereas the morphological rating system was not. Following 5-fluorouracil treatment, however, crown-rump length, weight and morphological rating were poor indicators of the stage of palatal development.

Abnormalities, Drug-Induced↗
PubMed1993

The effect of two-stage palatoplasty on facial development in unilateral cleft lip and palate.

Measurements on X-ray films were used for the assessment of facial development in 24 individuals with complete unilateral cleft lip and palate, ranging in age from 10 to 11 years and operated upon in two stages. The suture of the velum was performed simultaneously with cheiloplasty at the age of 7 months, the suture of the hard palate followed at the age of 6 years. They were compared with a series of 27 individuals with the same type of cleft who were subjected to one-stage closure of the palate at the age of 4 years. But for the more favourable occlusion of incisors after two-stage palatoplasty, which was due to the more intense orthodontic therapy, these two series showed no differences in facial growth and development. The delay of surgical repair of the hard palate by two years did not improve the growth and development of jaws. However, it is not possible to exclude favourable effects of a delay of the suture of hard palate into a substantially more mature age.

Cleft Lip↗
PubMed1994

[Artery supply of the lip and palate in normal and cleft patients].

50 normal and 10 cleft lip and palate head and neck specimens were studied by dissection and arteriography. The results are as follows: 1. In unilateral complete cleft lip, the superior labial artery runs along the labial margin and cleft edge, ending in base of nasal wing on the lateral side. In the medial side, upper labial artery ends in the base of the columella. 2. In the bilateral complete cleft lip, artery supply of superior lip is similar to the lateral side of unilateral complete cleft lip. The artery supplying the philtrum and premaxilla comes from the posterior septal artery, anterior ethmoid artery, nasal alar artery and/or lateral nasal artery. 3. Normal palate is supplied by six pairs of arteries. They are greater and lesser palatine artery, lesser palatine artery, nasopalatine artery, ascending palatine artery, ascending pharyngeal and palatine, artery tonsillar artery. In the cleft palate, the anterior branch of the ascending palatine artery becomes smaller and the posterior branch has shifted forward and runs forward along the cleft edge. The palatine branch of the ascending pharyngeal does not run along the palato--pharyngeal muscle, but descends from the base of skull along the levator palate muscle to the soft palate.

Arteries↗
PubMed1993

Cellular activity in the developing palate of the rat assessed by the staining of nucleolar organiser regions.

To provide information concerning biosynthetic activities within the mesenchymal cells of rat palatal shelves, the numbers of nucleolar organiser regions (NORs) were detected using an Ag-NOR staining technique within tissues obtained from coronal sections of 30 fetal heads prepared for light microscopy. The study involved comparisons between stages of palatogenesis and between location along the palatal shelves, anterior and posterior regions being analysed to correspond to the presumptive hard and soft palates. For both anterior and posterior regions, the mean Ag-NOR count/cell was initially high (approximately 3.4 anteriorly and approximately 3.0 posteriorly). The count/cell decreased significantly immediately after elevation but increased again after shelf reorientation and complete fusion. When comparisons were made between anterior and posterior regions of the palatal shelves, no differences were discerned at a stage prior to elevation (day 15) and a stage after the shelves had elevated and completely fused (day 17). Immediately post-elevation (day 16.5), however, the mean count/cell was significantly higher anteriorly. Thus the degree of mesenchymal cell activity, as expressed in terms of protein biosynthesis, can change in the developing palate according to both site and stage of development.

Animals↗
PubMed1996

[Warthin tumor of the palate: an unusual location].

UNLABELLED: Warthin's tumor (papillary cystadenoma lymphomatosum) primarily involves the parotid gland, whereas localization in the palate has been reported by a few authors. A new case of true Warthin's tumor arising from the hard palate is here presented and histogenesis and differential diagnosis are briefly discussed. CASE REPORT: A 50 year-old woman who was referred to us because of the presence of multiple contiguous bluish cyst-like lesions involving both sides of the hard palate mucosa. The lesion was removed with a wide excision involving almost all the soft tissues of the hard palate. Histologic diagnosis (E.E stain) was: papillary cystadenoma lymphomatosum. DISCUSSION AND CONCLUSION: The histogenesis of Warthin's tumor is still controversial. The most widely accepted theory is that the tumor represents a neoplastic proliferation of salivary gland ducts entrapped in pre-existing lymph nodes. In fact, immunohistochemical analysis and cell-surface markers studies have shown that the lymphoid component is predominantly formed by T-lymphocytes, with a relatively small number of polyclonal B-lymphocytes. On the contrary, other authors found opposite relationship between T and B lymphocytes. These findings supported the concept that lymphoid tissue in Warthin's tumor represented a reactive cellular infiltrate in a pattern similar to that seen in reactive lymph nodes. Similar results have been found in this report; moreover, the hard palate does not usually contain lymphatic tissue. This could support the idea that the lymphoid tissue associated with this case is reactive and a direct origin from the ductal epithelium with secondary lymphocytic infiltration is more likely to occur in this area.

Adenolymphoma↗
PubMed1997

Two different hard palate closure techniques in two-stage palatoplasty: effects on velopharyngeal closure and articulation.

Two different hard palate closure techniques, in two-stage palatoplasty, was evaluated in 12 patients. The lip and soft palate were closed at 3 to 7 months of age. The patients were then divided into two groups of six and the hard palate closed at 17 to 23 months of age, either by a vomer flap (VF) with a skin graft (Osada's two-stage palatoplasty) in the VF group, or by the push-back (PB) procedure of the mucoperiosteal flap in the PB group. Velopharyngeal closure (VPC) during a gag reflex before and after hard palate closure, and the articulation of these patients after closure, were evaluated and compared between the two groups. Regarding VPC before hard palate closure, three "Poor" and three "Borderline" outcomes were noted in each group. We conclude that, by introducing the pharyngeal flap, the patients in the VF group obtained good articulation, actually comparable to that in the PB group.

Articulation Disorders↗
PubMed1978

Prosthetic reconstruction following resection of the hard and soft palate.

The restoration of the soft palate presents a challenge completely different from that of the hard palate. The mobility of the soft palate tends to interfere with velar extensions. The reduction in size of the soft palate extension to prevent impingement upon the mobile margins of the defect will lead to insufficient oronasal separation during functional activities. The solution is to construct a specially designed prosthesis to attain the maximum utilization of the remaining structures and their motility. Although each pharyngeal extension is different in shape, they give the patient an effective functional mechanism that enhances speech and swallowing.

Humans↗
PubMed2005

Treatment protocol for unilateral cleft lip and palate patients: questioned by two case reports.

BACKGROUND: The types and severity of clefts as well as palatal development and growth in children with repaired cleft lip and palate deformities can vary greatly. Independent of the technique used surgery produces scar tissue, which restricts palatal growth so that by the second decade many patients have an underdeveloped maxilla. Experience has shown that the maxillary retrognathism found in many cleft patients is not amenable to nonsurgical correction. Few long-term studies have evaluated the procedures, sequencing and timing of the treatment methods found to give the best results. This lack of reliable information means there is a serious gap in our ability to assess the value of different treatment modalities. AIMS AND METHODS: From the viewpoint of orthodontics, this article describes the treatment protocol used by the cleft lip and palate team at the University Hospitals of the KU Leuven. The present treatment protocol is illustrated and questioned by two cases. The roles of prediction of facial growth and distraction osteogenesis are discussed.

Alveoloplasty↗
PubMedDate not supplied

Radial forearm free flap for soft palate reconstruction.

Defects of the soft palate resulting from head and neck oncologic surgery traditionally have been rehabilitated using a prosthetic obturator. In general, the results of soft palate obturation have been satisfactory, with most patients achieving velopharyngeal competence during speech and swallowing. However, soft palate obturators have several disadvantages. Device stability and retention are impaired in patients who are edentulous. In addition, prosthetic obturators cover large areas of sensate mucosa in the hard palate, maxillary alveolus, and oropharynx, contributing significantly to the loss of sensory feedback from the oral cavity and oropharynx. Considerable evidence suggests that sensory impairment within the oral cavity and pharynx results in impaired mastication, deglutition, and articulation. A minority of patients find palatal obturators to be unsatisfactory, secondary to either inconvenience or device discomfort.

Forearm↗
PubMed2002

Combined intraoral and lateral temporal approach for palatal malignancies with temporalis muscle reconstruction.

OBJECTIVE: To evaluate the use of a combined lateral temporal fossa and intraoral approach to resect palatal carcinomas and the use of a temporalis myofascial flap for reconstruction. DESIGN: Retrospective chart review of a case series. SETTING: Tertiary university referral hospital. PATIENTS: Sixteen patients underwent a combined approach for resection of palatal carcinoma; 5 of the 16 were edentulous. Six types of tumors were treated: adenoid cystic carcinoma (3 patients), low-grade mucoepidermoid carcinoma (5 patients), squamous cell carcinoma (3 patients), polymorphous low-grade adenocarcinoma (2 patients), osteosarcoma (1 patient), ameloblastoma (1 patient), and hyalinizing clear cell carcinoma (1 patient). MAIN OUTCOME MEASURES: The postoperative diet, velum competence, flap viability, complications, and survival. RESULTS: Fifteen (94%) of 16 patients were able to resume their preoperative diets. No velopharyngeal insufficiency was encountered. All flaps survived and none required repeated surgical intervention. Five patients developed serous otitis media and 2 patients required flap revision secondary to posterior choanal obstruction. One patient died of complications unrelated to the procedure. CONCLUSIONS: A combined intraoral and lateral temporal fossa approach allows for (1) en bloc resection of palatal malignancies along with resection of involved pterygoid muscles, (2) isolation and resection of descending palatine nerves and the proximal second division of the trigeminal nerve, and (3) primary reconstruction of the palatal defect by means of the temporalis muscle rotated into the operative defect. This method is especially useful in treating patients with perineural spread of palatal carcinoma, and in those who are edentulous.

Adult↗