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PubMed1990

Effect of timing and method of cleft palate repair on dental arches at the age of three years.

The purpose of this study was to compare the influence of two different ages at the time of palatal closure and two surgical methods on the size of the dental arches at the age of 3 years in children, with CP, UCLP, and BCLP. In 88 children the one-stage palatal closure had been performed at the age of 1.8 years and in 92 children at the age of 1.1 years. In both groups palatal surgery had been performed with a V to Y push back procedure (Veau-Wardill-Killner) or with the Cronin modification. Dimensions of the maxillary arch in both groups at age 3 were smaller than in noncleft children, but the timing of palatal closure did not affect arch dimensions in children with CP, UCLP, or BCLP. Arch dimensions at 3 years of age were not related to the method used in palatal closure.

Age Factors↗

PubMed1991

Biologic basis for a risk assessment model for cleft palate.

A biologic model for palatogenesis is presented, intended as a basis for risk assessment. It comprises a sequence of developmental stages: growth and migration of neural crest cells, downward growth of palatal buds, elevation of palatal shelves, and differentiation of the epithelium followed by shelf fusion. Several events representing these stages and amenable to mathematical translation may be measurable in the form of biomarkers such as DNA and protein synthesis, phospholipid metabolism, and signal transducing systems. Interrupting components of the model will result in cleft palate. Teratogens with known mechanisms of action are compared with the model. The quantitative risk of cleft palate is conceived as a sequence of mathematical probabilities that any stage of the model runs an abnormal course. Stage-specific probabilities are determined by a chemical's potency and dose, and by duration of exposure and gestational age. Species or strain sensitivity may be expressed as quantitative differences in model parameters. Although the model is designed for cleft palate, the risk model may also estimate a multiple response risk to the same exposures.

Animals↗

PubMed1992

Phonetic and phonologic skills of two-year-olds with cleft palate.

This article examines the phonetic and phonologic skills of 2-year-olds with cleft palate. Fifteen children, 10 children with cleft palate and five noncleft children, participated in the study. The children with cleft palate all received palatal surgery after 12 months of age and after the onset of meaningful speech. All subjects were video and audiotaped while interacting with their mothers during unstructured play. At least one hundred different spontaneous word productions were phonetically transcribed and analyzed for (1) percent consonants correct, (2) phonologic processes, and (3) "compensatory" articulation patterns. A comparison between the groups indicated that although the children with cleft palate exhibited more errors overall, they were similar to their noncleft peers in their phonologic process usage with two exceptions. Additionally, few "compensatory" articulation errors were noted in the speech of these children.

Adaptation, Physiological↗

PubMed1993

Unilateral absence of the soft palate: case report of reconstruction with a mucoperiosteal island flap.

Congenital absence of half of the soft palate is a rare deformity. There is little in the literature about its definition and management. This article presents a case with velopharyngeal insufficiency caused by unilateral absence of the soft palate. The patient was treated with a modification of the mucoperiosteal island flap, first designed by Millard, to provide nasal lining during pushback lengthening of a short cleft palate. The speech quality of the patient improved noticeably after the operation. Although island flap has limited use in primary cleft palate surgery, it may be effective in reconstruction of soft palate defects, when standard pushback procedures are not adequate for solving the problem.

Child↗

PubMed1996

Comparison of facial form in primary alveolar bone-grafted and nongrafted unilateral cleft lip and palate patients: intercenter retrospective study.

The purpose of this study was to describe and compare posttreatment craniofacial morphology in samples of complete unilateral cleft lip and palate (CUCLP) patients treated at two leading clinics: The Children's Memorial Hospital Cleft Palate Clinic, Chicago, Illinois, and the Lancaster Cleft Palate Clinic, Lancaster, Pennsylvania. These centers have well-defined treatment protocols that allow the long-term effects on craniofacial form of the following treatment regimes to be contrasted: (1) Chicago--primary alveolar bone grafting, with definitive lip repair at age 4 to 6 months and hard and soft palate repair at 6 to 12 months; and (2) Lancaster--definitive triangular-flap lip repair at 3 months of age, followed by staged surgeries of the hard and soft palates, both completed by 18 months of age, but without primary alveolar bone grafting. Although the Lancaster center now performs secondary alveolar bone grafting, the majority of the patients studied here were treated before this procedure became part of their protocol. Patients were eligible for inclusion if they had no other congenital anomalies and no previous orthodontic treatment. A sample of 43 (24 male, 19 female) CUCLP patients was obtained from the Chicago Center, each of which was then matched to a nongrafted Lancaster CUCLP patient. The matching criteria were age, sex, and sella-nasion distance (to control, at least in part, for size differences). Lateral cephalometric radiographs of these 86 CUCLP patients were traced, digitized, and analyzed. Additionally, all linear data were adjusted to a standard magnification of 8% because the cephalograms from each center featured different enlargements. The Chicago and Lancaster samples had mean posttreatment ages of 10.32 years (SD = 1.96) and 10.40 years (SD = 2.18), respectively. The grafted Chicago group had faces that were on average less maxillary protrusive compared with the nongrafted Lancaster sample; it appeared, however, that the mandible compensated for the maxillary position by downward and backward rotation. As a result, a similar maxillomandibular relationship was noted in both groups, although, in the Chicago group, the lower anterior facial height increased.

Alveolar Process↗

PubMed1996

Comparison of the hearing histories of children with and without cleft palate.

Aggressive otologic management has been recommended for children with cleft palate because of the almost universal occurrence of otitis media with effusion (OME) in these children and the association of OME with hearing loss and possible language, cognitive, and academic delays. In this study, 28 children with cleft palate and 29 noncleft children were seen at 3-month intervals from 9 to 30 months to compare otologic treatment and management. Hearing and middle ear function were tested at each session; information on ventilation tube placement was obtained from medical records. Ventilation tubes were placed earlier and more often in children with cleft palate, but children with cleft palates failed the hearing screening more often. The correlation between age at first tube placement and frequency of hearing screening failures was significant for the children with cleft palate, indicating that the later tubes were first placed, the poorer the child's hearing.

Acoustic Impedance Tests↗

PubMed1998

Oral and dental health status of children with cleft lip and/or palate.

OBJECTIVE: To ascertain the oral and dental health status of children with cleft lip and/or palate. DESIGN: Oral and dental examinations were carried out on 114 selected children with cleft lip and/or palate, using standard criteria and indices. SETTING: These children were examined at two cleft palate clinics in the United Kingdom. PATIENTS: All children examined were between the ages of 3 and 18 years. RESULTS: Sixty one (53.5%) of the subjects exhibited no evidence of previous caries experience, but as many as 20% exhibited active decay. The mean caries experience in the deciduous dentition (dmfs) was 2.3, and that in the permanent dentition (DMFS) was 0.9. Caries experience of the Caucasian children of the sample was lower (mean dmfs 1.9) than that of the Asian children (mean dmfs 5.5). The mean simplified debris index of the sample was 0.9, and the mean gingival bleeding index was 0.4. Children with cleft lip and palate had generally poorer oral and gingival health than those with isolated clefts of the lip or palate. CONCLUSION: Twenty percent of the sample had active decay. These children had poor oral health in the surgically repaired anterior segment.

Adolescent↗

PubMed1998

Oral health status of Russian children with unilateral cleft lip and palate.

OBJECTIVE: To evaluate the oral and dental health of Russian children who underwent Frolova primary palatoplasty. DESIGN: Eighty-nine children (62 boys and 27 girls; age range, 5 to 9 years) who had undergone repair of unilateral cleft lip and palate were included in this oral/dental evaluation. Factors such as stage of dentition; oral hygiene; carious, missing and restored teeth; and occlusion were recorded. RESULTS: Twenty-six of the 89 patients presented with a palatal fistula. Oral hygiene of patients without a palatal fistula was significantly better than that of patients with a fistula (p < .01). Forty-five percent of patients had eight or more decayed teeth. Significantly more patients with palatal fistulae had class II soft tissue facial profiles than those without palatal fistulae. Anterior crossbites were found in 48% of patients, unilateral posterior crossbites in 58%, and bilateral posterior crossbites in 12%. CONCLUSIONS: The high percentage of poor oral hygiene and dental caries found in this group of patients is likely due to the general unavailability of dental hygiene products and the high cost of these products when available. In addition, it seems there is limited understanding by parents of the importance of dental hygiene and appropriate diet in preventing dental disease.

Child↗

PubMed2002

Endoscopic partial adenoidectomy for children with submucous cleft palate.

OBJECTIVE: Children with submucous cleft palate who suffer from chronic nasal obstruction because of hypertrophic adenoids usually are not subjected to adenoidectomy because of the fear of postoperative velopharyngeal insufficiency. These patients present a therapeutic challenge because we are aware more than ever of the importance of normal nasal breathing and nocturnal respiration, especially during childhood. Our hypothesis was that transnasal endoscopic horizontal limited adenoidectomy may relieve nasal obstruction while preserving the function of the velopharyngeal valve. The objective of this study was to evaluate the efficacy of transnasal endoscopic horizontal partial adenoidectomy in patients with submucous cleft palate and adenoidal hypertrophy. SETTING: Patients were either referred to the outpatient clinic of the Palate Surgery Unit (seven patients) or were patients referred to the senior author's (Y.F.) private clinic. All the patients had been operated on by this senior author (Y.F.). PATIENTS: Ten children aged 3.5 to 13 years (six girls and four boys) with submucous cleft palate and hypertrophic adenoids were included in the study. All the patients were hyponasal and suffered nasal obstruction, loud snoring, and episodes of apnea. INTERVENTIONS: Endoscopic partial adenoidectomy was accomplished to open the lower third of the choanae. Nasal breathing was achieved in all the patients, and only mild snoring remained in two patients. The hyponasality disappeared and speech intelligibility normalized. Mild hypernasality developed in two patients but was still perceived as an overall improvement in speech. CONCLUSIONS: Transnasal endoscopic horizontal partial adenoidectomy may be an effective surgical method for relief of nasal obstruction while preserving velopharyngeal valve function in patients with submucous cleft palate who suffer from obstructive adenoids.

Adenoidectomy↗

PubMed2003

Genetic association studies of cleft lip and/or palate with hypodontia outside the cleft region.

OBJECTIVE: The purpose of this study was to determine whether the candidate genes previously studied in subjects with cleft lip, cleft palate, or both are associated with hypodontia outside the region of the cleft. SUBJECTS: One hundred twenty subjects from the Iowa Craniofacial Anomalies Research Center were selected based on the availability of both dental records and genotype information. METHOD: The type of orofacial clefting and type and location of dental anomalies (missing teeth, supernumerary teeth, or peg laterals) were assessed by dental chart review and radiographic examination. Genotype analysis of candidate genes was performed using polymerase chain reaction/single-strand conformation polymorphism analysis. RESULTS: The prevalence of hypodontia in this sample was 47.5%, with 30.0% of subjects having missing teeth outside the cleft. There was a positive association between subjects with cleft lip or cleft lip and palate who had hypodontia outside the cleft region (compared with noncleft controls) and both muscle segment homeo box homolog 1 (MSX1) (p =.029) and transforming growth factor beta 3 (TGFB3) (p =.024). It was not possible in this analysis to determine whether this association was specifically associated with orofacial clefting combined with hypodontia or whether it was due primarily to the clefting phenotype. CONCLUSIONS: In this sample, there was a significantly greater incidence of hypodontia outside the cleft region in subjects with cleft lip and palate, compared with cleft lip only or cleft palate only. Cleft lip and/or palate with hypodontia outside the cleft region was positively associated with both TGFB3 and MSX1, compared with noncleft controls.

Anodontia↗

PubMed2003

The impact of cleft type on early vocal development in babies with cleft palate.

OBJECTIVE: The purpose of the present investigation was to examine the impact of cleft type on early sound development in children with cleft palate (with or without cleft lip). PARTICIPANTS: The participants included 53 babies with unrepaired cleft palate aged 8 to 10 months. Thirty-five babies had cleft lip and palate (CLP) and 18 had cleft palate only (CPO). MAIN OUTCOME MEASURES: Spontaneous vocalizations of the CLP and CPO groups were compared to determine whether differences were evident in canonical babbling, size of consonant inventory as well as place and manner of consonant production, and frequency of vocalization. RESULTS: Student's t tests revealed no significant differences between the groups in canonical babbling, size of consonant inventory, place and manner of consonant production, or frequency of vocalization. However, there was a trend for babies in the CPO group to produce fewer compensatory stop consonants and more anterior place features. In addition, a larger percentage of children in the CPO group had entered the canonical babbling stage at the time of this study. CONCLUSIONS: In general, the findings of this study suggested that cleft type does not appear to play a significant role in early consonant development for babies with cleft palate. Additional study using a larger CPO group is recommended to further investigate the trend toward better performance noted in this group.

Articulation Disorders↗

PubMed2003

Cephalometric assessment of the posterior airway space in patients with cleft palate after palatoplasty.

OBJECTIVE: Upper airway obstruction and mouth breathing influence facial growth and development, which may result in breathing disorders while asleep. The purpose of the present investigation was to analyze cephalometric alterations between patients with cleft palate and a noncleft control group in an obstructive sleep disordered breathing-specific tracing. SETTING: The study was conducted in the cleft palate clinic of a university hospital. PARTICIPANTS: Fifty-three subjects with a mean age of 12.3 +/- 3.7 years (range 6.3 to 17.2 years). The cohort included 33 subjects (13 females, 20 males; mean age 12.1 +/- 3.8 years, mean body mass index 17.5 +/- 2.9 kg/m(2)) with surgical closure of a unilateral or bilateral cleft palate and a matched control of noncleft participants. None of the subjects suffered from sleep disordered breathing syndrome. RESULTS: Compared with the controls, patients with cleft palate had a significant narrow anterior-posterior dimension of the pharynx at the level of the maxillary plane and the narrowest width, a more downward hyoid position, and a longer uvula. CONCLUSIONS: Patients with cleft palate appear to present pharyngeal and craniofacial distinctive features that characterize patients with obstructive sleep disordered breathing and differ from those of a noncleft control.

Adolescent↗

PubMed2003

Dental occlusion after Veau-Wardill-Kilner versus minimal incision technique repair of isolated clefts of the hard and soft palate.

OBJECTIVE: To compare the Veau-Wardill-Kilner technique with a technique similar to the minimal incision technique described by Mendosa et al. on the basis of surgical complications and dentoalveolar status in the deciduous dentition. DESIGN: Retrospective study of medical and dental records and casts. PATIENTS: A consecutive series of 129 Caucasian children born with isolated cleft palate between 1980 and 1992. MAIN OUTCOME MEASURES: From medical records, the variables of time for surgery, blood loss, complications in the immediate postoperative period, and frequency of fistulas were evaluated. On dental casts, the variables of sagittal, transversal, and vertical relations; structure of the palatal mucosa; and height of the palatal vault were studied. RESULTS: Time for surgery was shorter in the extensive clefts repaired with a Veau-Wardill-Kilner technique. Blood loss was higher using the Veau-Wardill-Kilner technique. The width of the upper jaw was significantly narrower in the Veau-Wardill-Kilner group, compared with the minimal incision group. Scar tissue and pits of the palate were more frequently found in the Veau-Wardill-Kilner group. CONCLUSIONS: The minimal incision technique in this study has been shown to result in better development of the upper jaw with a better dental occlusion and palatal mucosa with significantly less scar tissue.

Cephalometry↗

PubMed2000

Immunohistochemical demonstration of nerve terminals in the whole hard palate of rats by use of an antiserum against protein gene product 9.5 (PGP 9.5).

Sensory innervation of the entire hard palate was investigated in the rat using serial sections immunostained for protein gene product 9.5 (PGP 9.5), a neuronal marker. PGP 9.5-immunoreactive nerve endings were widely distributed in the hard palate, but the innervation pattern and density differed among portions. They were numerous at papillary protrusions including the incisal papilla, antemolar/intermolar rugae, and postrugal filiform papillae. Immunoreactive free nerve endings gathered at the summits of the connective tissue papillae, some of them entering deeply into the epithelium. Electron microscopy demonstrated that nerves in the postrugal filiform papillae reached the stratum corneum. The atrial region, possibly the most sensitive in the hard palate, showed unique innervation: its anterior part, adjacent to incisors, developed intraepithelial networks of fine and beaded nerves, whereas its posterior part revealed cone-shaped nerve terminals formed on the connective tissue papillae of the atrial folds which comprised two lines of longitudinal flaps. Taste bud-like corpuscles gathered in the medial walls of the incisal canals and in the "Geschmacksstreifen" (taste stripes) present at the most anterior part of the soft palate. The hard palate of the rat is thus richly innervated, and is characterized by region-specific nerve endings which may be involved in mechano- and chemoreception in the oral cavity.

Animals↗

PubMed1989

[Experimental study on changes of temperature at palatal mucosa after denture wearing].

The purpose of this study is to estimate objectively temperature changes of palatal mucosa after denture wearing. Temperature at 7 measurement points of palatal mucosa in 10 normal dentate subjects were measured to determine the time constant by carrying out a least square approximation of the relation between temperature and time from the time of commencement of temperature measurement until the time of temperature elevation to a steady state. Changes in the time constant by thermal stimulation with cold and warm water and by wearing of an experimental palatal plate were studied. It was found that if the time constant is obtained from values measured at 60-second intervals, the predicted and measured values of steady-state temperature are well approximated and that the time constant is significantly reduced from 3 days after wearing of an experimental palatal plate and is significantly increased (prolonged) from 3 days after thermal stimulation. These results demonstrated that temperature changes of the palatal mucosa during the use of a removable denture can be subjectively and quantitatively estimated with accuracy on the basis of the time constant obtained by least square.

Body Temperature↗

PubMed2001

Evaluation of carbon dioxide laser and conventional incisional techniques for resection of soft palates in brachycephalic dogs.

OBJECTIVE: To compare clinical outcome, healing, and effect of tracheostomy in conventional incisional and carbon dioxide (CO2) laser techniques for resection of soft palates in brachycephalic dogs. DESIGN: Prospective randomized trial. ANIMALS: 20 adult brachycephalic dogs. METHODS: Dogs were randomly allocated into 4 groups, and 1 of the following was performed: palate resection by use of a CO2 laser; incisional palate resection and closure with suture; and palate resection by use of a C02 laser or incision with tracheostomy. A clinical score for respiratory function was assigned to each dog at 0, 2, 8, 16, and 24 hours. Biopsy specimens of incision sites obtained at days 0, 3, 7, and 14 were examined. Data were analyzed to determine the effects of technique on clinical and histologic outcome. RESULTS: Mean surgical time for laser (309 seconds) was significantly shorter than for sharp dissection (744 seconds). Surgical technique significantly affected clinical scores at 3 of the 5 postoperative time points, but differences were not clinically apparent. Tracheostomy significantly affected clinical scores at 3 of 5 postoperative time points. After tracheostomy tube removal, clinical scores were similar to those of dogs without tracheostomies. Inflammation, necrosis, and ulceration were evident in all groups at day 3; these lesions had almost resolved by day 14. Most complications were associated with tracheostomy. CONCLUSIONS AND CLINICAL RELEVANCE: Clinical outcomes appear to be similar with the laser and incisional techniques. Regarding surgical time and ease, laser resection of the soft palate appears advantageous. Tracheostomy is not warranted in dogs that have uncomplicated surgeries and recoveries.

Animals↗

PubMed1981

Growth of the middle face in experimental early bony fusion of the vomeropremaxillary, vomeromaxillary and mid-palatal sutural system. A roentgencephalometric study in the domestic cat.

In 23 domestic cats, 21/2 months of age, the junction between the nasal septum/vomer and the hard palate was extirpated along with the full extent of the mid-palatal suture. Under the cover of undisrupted oral- and nasal mucoperiosteum the resulting osseous defect was then left for healing. In seven animals histology showed that the vomer, the premaxilla and maxilla had formed one continuous osseous entity with no sign of the sutures ordinarily separating these bones. Neither could a septo-premaxillary ligament be found. By cephalometry, the ensuing mid-facial growth in these cats was compared to that of seven unoperated controls which possessed an unobliterated vomero-mid-palatal suture system. The animals were followed until 13 months of age, i.e. till after cessation of general growth. The expansion of the palate appeared, in the operated cats, to be significantly reduced, indicating that growth in the mid-palatal suture is essential for development in the transversal direction. Concerning vertical and antero-posterior mid-facial growth, however, no disparities were found. Consequently it can be deduced that, at least after the early postnatal period, growth in the basal part of the nasal septum/vomer is of no concern for mid-facial development in the sagittal plane.

Animals↗

PubMed1994

One-stage closure of isolated cleft palate with the Veau-Wardill-Kilner V to Y pushback procedure or the Cronin modification. II. Height, weight and comparison of dental arches.

The body height and weight, and sizes of dental arches in 116 patients with isolated cleft palate were evaluated at 16.9-20.6 years of age. One-stage closure of the soft and hard palate had been done at a mean age of 1.8 years using the Veau-Wardill-Kilner or the Cronin mucoperiosteal palatal V-Y pushback technique. The height attained in both the boys (177.6 cm) and the girls (165.7 cm) was similar to that in the general adult population, even though half of the boys had not reached their final height. The median relative weight for height and sex was 6%. There were no significant differences in dental arch measurements depending on the method of operation but the more palatal operations done the shorter the maxillary and mandibular dental arch widths. The extent of cleft made a significant difference, larger clefts having narrower palatal intercanine widths. Dental arch dimensions were consistently larger in boys than in girls.

Adolescent↗