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PubMed1996

Healing of osseous submucous cleft palates with guided bone regeneration.

The aim of this study was to develop an experimental model in rats of an osseous submucous cleft palate and to examine if bone regeneration can be achieved in such defects by the placement of membranes according to the principle of guided tissue regeneration (GTR). An osseous submucous cleft palate defect (5 mm x 2 mm) was created surgically in Wistar rats. Membranes of expanded polytetrafluoroethylene were placed so that they covered both the nasal and the palatal aspect of the defect before the palatal mucoperiosteal flap was repositioned and sutured. Histological analysis after seven weeks of healing showed that significantly more test animals (5/9) healed with newly formed bone and a suture-like tissue in the middle of the defects than controls treated without membranes (0/17). In specimens evaluated macroscopically after 12 weeks, the corresponding rates for the test group were 12/12 compared with 0/13. These observations indicate that an experimental model of an osseous submucous cleft palate can be established in rats, and that complete osseous healing and creation of a midpalatal suture-like tissue in the bony defect is favoured by the placement of membranes according to the principle of GTR.

Animals↗
PubMed1983

Mucociliary clearance in chronic sinusitis: related human nasal clearance and in vitro bullfrog palate clearance.

Nasal mucociliary clearance was measured in both healthy subjects and patients with chronic sinusitis using saccharin granule technique. Nasal mucociliary transit time (ST) was significantly slower in the patients with chronic sinusitis compared with that in controls (p less than 0.005). Nasal mucus collected from each nasal cavity was used for in vitro bullfrog palate clearance studies and compared to the in vivo nasal ST. Mucociliary clearance rate (MTR) on frog palate was 12.5 +/- 2.5 mm/min in the mucus from control subjects, 6.1 +/- 1.5 mm/min in the mucus from the patients. The difference was statistically significant (p less than 0.005). The MTR on frog palate in the patients whose nasal ST was within normal range was significantly slower than that in controls (p less than 0.005), but not significantly different from that in the patients whose nasal ST was over the normal range. These results suggest that the nasal mucous properties which decreased the mucociliary clearance on frog palate did not contribute to the mucociliary clearance of the patients who had a normal one. No significant correlation existed between MTR on frog palate and nasal ST in both control and chronic sinusitis. In chronic sinusitis patients, decelerated nasal ST was recovered significantly by normal saline nebulization compared with the value before the nebulization (p less than 0.01). None of the significant change of ST was observed in control before and after the nebulization.

Adolescent↗
PubMed2005

Pattern of clefts of the lip and palate managed over a three year period at a Nairobi hospital in Kenya.

BACKGROUND: The pattern of cleft lip and palate in the African population remains uncertain. The few studies of clefts in African populations have suggested that the pattern of these defects may be significantly different from those reported in other population groups. However, most of these studies have been based on very small sample sizes bringing into question the validity of those findings. OBJECTIVE: To analyse the pattern of cleft lip and palate cases managed at a Nairobi hospital. DESIGN: A retrospective descriptive study. SETTING: Gertrude's Garden Children's Hospital, a private exclusive children's hospital in Nairobi, where cleft lip and palate treatment was being offered at subsidised rates to needy children under the sponsorship of an international organization. SUBJECTS: Three hundred and nine cases were seen during the study period. RESULTS: Age at presentation ranged between 1 week and 45 years, with 75% presenting between 0-5 years. The average age was 10 months. Gestation histories were missing for most cases but for those with gestation histories none were significant. Most children ranked between first to third birth orders, suggesting birth to young mothers. Six cases of associated deformities were identified among the cases. No syndromic clefts were seen. The most common cleft deformity was the cleft lip and palate (CL+P) followed by isolated cleft lip (CL). Isolated cleft palate was least common. There was a male preponderance in all cleft types and most of the clefts occurred on the left side. CONCLUSION: The pattern of clefts in this study does not differ significantly from those reported in the literature for the non-African populations.

Adolescent↗
PubMedDate not supplied

Reconstruction of a bilateral hypoplastic soft palate in a cat.

A 2-year-old, female spayed, domestic shorthair cat was presented with a history of dyspnea, upper respiratory congestion, and aspiration. Physical examination revealed a bilaterally hypoplastic soft palate resembling a uvula. A novel surgical technique was performed to reconstruct the soft palate, utilizing both a hard palate-derived mucoperiosteal flap combined with two pharyngeal wall-derived, random-pattern mucosal flaps. This is the first report of a bilaterally hypoplastic soft palate in the cat, as well as a description of a new surgical method for soft palate reconstruction.

Animals↗
PubMed2000

[The fate of epithelial cells during fusion of primary palate in vitro].

It has been demonstrated that palatal shelf epithelium transforms into mesenchymal cells during fusion of the secondary palate. However, the fate of epithelial cells in primary palate formation is still unclear. To specify the presumptive fusion area of the primary palate, focal labeling of epithelial cells of medial nasal prominence (MNP), lateral nasal prominence (LNP) and maxillary prominence (Mx) of gestational day 12.0 rat embryos was initially done with fluorescent DiI, and they were cultured for 24 h. As a result, the presumptive fusion area was identified and it was found that there was a difference of the fusion process between MNP-Mx and MNP-LNP. Next, in order to elucidate the fate of epithelial cells in the fusion areas, facial epithelium was labeled with a recombinant adenovirus, Adex-LacZ in the whole embryo culture system and they were observed over time (12 h, 24 h, 36 h and 48 h). LacZ positive cells were observed in the fused region of MNP-Mx and MNP-LNP. Moreover, it was found that there were not only double positive cells of LacZ and TUNEL staining of apoptosis but also some TUNEL nonpositive cells. These findings indicated that a number of epithelial cells in the fusion area become apoptosis, but some cells survive by epithelial-mesenchymal transformation during primary palate formation.

Animals↗
PubMed1976

The mathematics of cleft lip and palate treatment evaluation: measuring the desirability of treatment outcomes.

A study was undertaken to investigate the applicability of utility theory to cleft lip and palate treatment decision making. Questionnaires were used to assess value judgements and attitudes toward risk from 119 individuals associated with seventeen cleft lip and palate treatment centers. Significant differences were found to exist between the values expressed by clinicians grouped according to their specialty or the facility to which they were affiliated. Fathers of cleft lip and palate children differed from cleft palate teams in their judgements regarding the relative values of speech and cosmetic treatment outcomes. No such differences were found between team members and mothers, however. It is suggested that these differences affect the desirability of treatment decisions and the outcomes that follow from them. Therefore, cleft lip and palate treatment planning and the evaluation of alternative therapeutic interventions might be based on a mathematical theory of decision making that explicitly incorporates the subjective assessment of a child's habilitative needs and the goals of the habilitative process.

Cleft Lip↗
PubMed1998

[A method of unilateral operation for early cleft palate repair].

OBJECTIVE: This paper presents a new method for cleft palate repair. METHOD: Six changes have been made to the conventional procedures. After all of these six changes have been carried out on one side of the palate, the operated side becomes completely relaxed. It can be moved both posteriorly and medially to lengthen the side of the palate and to contact with the cleft margin of the non-operated side without tension. Obviously, there is no need to perform the same surgical maneuvers on the other side again. The cleft is then closed by layers. RESULT: Totally 151 cases of unilateral and bilateral cleft palate have been repaired with this method. The age of these patients ranged from 4 months to 5 years. Postoperatively, there was neither one death nor one dehiscence. All of the baby patients who received treatment before they began to speak had good quality of speech or near normal speech function. CONCLUSION: In the unilateral operation, the surgical trauma, blood loss and time required for the operation are all less than that of conventional procedures which operate on both sides. It is a safer method for early cleft palate repair.

Age Factors↗
PubMed2000

Rapid disappearance of the medial epithelial seam during palatal fusion occurs by multifocal breakdown that is preceded by expression of alpha smooth muscle actin in the epithelium.

Breakdown of the medial epithelial seam (MES) is essential to allow bridging of the mesenchyme during palatal fusion. Evidence exists for three mechanisms for this breakdown that are incompatible at the level of individual cells in the seam. To determine if breakdown of the seam was regionally restricted, 3-dimensional reconstructions were generated using volume rendering software from 1 micron serial sections in the sagittal plane of rat palates fixed during the process of fusion. The earliest break detected in electron micrographs was cell separation and in reconstructions was a discrete defect, with a rounded outline, nearer to the nasal than to the oral margin of the seam. Further breakdown produced a pattern of rounded defects along the nasal margin of the seam resulting in interconnected columns of cells preferentially attached to the oral epithelium. Computer generated slicing of reconstructed seams showed that groups of cells evident in cross-sections as islands at this stage of breakdown of the MES could be artifacts. Unequivocal islands of epithelial cells formed later in fusion had a rounded outline, an incomplete basal lamina and a halo of cells containing phagocytosed apoptotic debris. The pattern of breakdown indicated that the MES breaks down under tension. Laser confocal microscopy of sections and whole-mounts of palates demonstrated alpha-smooth muscle actin preferentially localized in the epithelial cells of the palatal shelves immediately before and during formation of the seam. Expression in epithelial cells of the isoform of actin normally restricted to smooth muscle cells engaged in tonic contraction supported an interpretation that the epithelial cells of the seam may be capable of generating tension during the palatal fusion event.

Actins↗
PubMed2000

Analysis of the candidate genes responsible for non-syndromic cleft lip and palate in Japanese people.

In order to assess the association of alleles for candidate genes with non-syndromic cleft lip and palate, DNA samples from 43 Japanese patients were compared with those from 73 control subjects with respect to the genes encoding transforming growth factor alpha (TGFalpha), TGFbeta and gamma-aminobutyric acid type A receptor beta3 (GABRB3). The restriction fragment length polymorphisms of the 3'-non-coding region of the TGFalpha gene K-primer region were observed after digestion with NcoI and HinfI. Allele 4 was the most common among cases of cleft lip with or without cleft palate, whereas allele 2 was the most common among controls. A significant difference was found in this region between groups with cleft lip (with or without cleft palate) and controls (chi2=10.190; P=0.017). Three alleles of the TGFbeta2 gene were tested, and allele 2 was the most common in both cases and controls. The proportion of allele 2 in the case group was greater than that in the control group, showing a significant difference between cases of cleft lip (with or without cleft palate) and controls (chi(2)=19.208; P<0.0001). No significant differences in variants of TGFbeta3 or GABRB3 between case and control populations were observed. Thus it is concluded that TGF genes play a role in craniofacial development, and that alleles of TGFalpha or/and TGFbeta2 are associated with cleft lip and cleft palate in Japanese populations.

Adolescent↗
PubMed1998

[The effect of palate repair on middle ear function].

By means of acoustic impedance and otoscopic examinations the middle ear function and incidence of secretory otitis media (SOM) were demonstrated in 43 cases of cleft palate children pre- and post palatal closure. The results showed that 61.36% of the 86 ears had SOM prior to palatal closure and there was no difference between cleft types (P > 0.05). The patient with the age of 9 years or less have higher incidence of SOM than the older ones (P < 0.05). The study indicated that the middle ear status can be improved by palatal surgery for the cleft palate children.

Adolescent↗
PubMed2001

[Incidence of the cleft lip and palate in the University of Chile Maternity Hospital and in maternity Chilean participating in the Latin American Collaborative Study of Congenital Malformations (ECLAMC)].

BACKGROUND: ECLAMC is a registry, aimed to assess the incidence of congenital malformations, that started in 1967 and Chile incorporated to it in 1969. AIM: To report the incidence of cleft lip/palate, updated to 1999 in the University of Chile Maternity Hospital and other Chilean hospitals participating in the ECLAMC. PATIENTS AND METHODS: A review of the ECLAMC database that registers all births or stillbirths of more than 500 g. RESULTS: The incidence of orofacial cleft, at the University of Chile Maternity Hospital, in the period 1991-1999 was 17.8 per 10,000 (12.6 for cleft lip and 5.2 for cleft palate). The incidence in the rest of participating hospitals was 12.04 and 4.6 respectively. Males had a higher incidence of cleft lip and 80% of children with cleft palate, had other malformations, most of them as part of a syndrome (13 and 18 trisomy, holoproscencephalia, Pierre Robin, Apert en EE syndromes, anencephaly etc). In three of 12 children with cleft lip but without cleft palate, there was a relative with the same malformation. CONCLUSIONS: It is proposed that both entities, cleft lip with or without cleft palate and cleft palate without cleft lip, are two etiopathogenically different conditions.

Chi-Square Distribution↗
PubMed1984

Acceleration of fusion in mouse palates by in vitro exposure to excess G.

Palatal shelves from 13- and 14-day mouse embryos were excised and cultured in contiguous pairs. Experimental cultures were exposed to 2.6 G in a culture centrifuge; controls were in the same incubator. After 24 hours, palates were prepared for light or electron microscopy. Scoring of paraffin sections according to the stage of fusion seen in the medial epithelial edges (MEE) showed that palates exposed to excess G were in more advanced stages of fusion than were controls. Ultrastructurally, control MEE had tightly apposed cell membranes and numerous desmosomes; in centrifuged MEE, desmosomes had been removed and there was much intercellular space. Nuclear membranes were intact in control MEE, but showed marked deterioration in MEE of centrifuged palates. Few lysosomes and no necrosis were seen in control MEE; centrifuged MEE had numerous lysosomes as well as necrotic cells. Basal lamina were intact in controls, but interrupted in centrifuged palates. The results confirm the hypothesis that gravitational increases speed up the differentiative process.

Animals↗
PubMed2001

[The effects of otitis media with effusion and hearing loss on the speech outcome after cleft palate surgery].

OBJECTIVE: To find out the exact effect of OME and hearing loss on the speech outcome post palatoplasty in cleft palate patients. METHODS: Otoscopy and tympanometry were performed in 18 cleft palate patients whose ages ranged from 5 to 23 years old and hearing thresholds were also tested before cleft palates repair. All patients were followed up from 3 to 18 months postoperatively. Articulation scores were evaluated and linear correlation analysis was performed between these results and their mean hearing thresholds for air conduction in speech frequencies before the palate closure. The incidences of the OME were compared among the groups with different articulation scores. RESULTS: The postoperative articulation scores correlate negatively (r = -0.504, P = 0.032 < 0.05) to the degrees of hearing loss. But the incidences of OME had no significant differences among the groups with different articulation scores. CONCLUSIONS: The hearing level preoperation is more important than tympanometric data on the foresight of the speech result postoperation in cleft palate patients.

Adolescent↗
PubMed2002

[Distraction osteogenesis for repair of cleft palate: an experimental study].

OBJECTIVE: To observe the repair of cleft palate (CP) bone defect under the application of distraction osteogenesis (DO); to investigate the correction mechanism in thin bone of palatal shelf and to search a possible new treatment approach for repair of CP. METHODS: 14 cats were assigned randomly to 3 groups: (1) Empty control, 2 cats unoperated with euthanasia at the end of 2 weeks; (2) Experimental control, 2 cats underwent 8 mm x 18 mm palatal osteoectomy in saggital direction as the experimental model of CP with euthanasia in 6 weeks; (3) Experimental group, 10 cats were performed the same palatal osteoectomy as group (2), the newly designed and individual manufactured intraoral distractors were fixed to teeth by brackets and to bilateral palate bone across the defect with titanium miniscrews. 4 weeks later the transport disc (TD) osteotomy were performed and gradual distraction was started after 6 days latency period at the rate of 0.4 mm x 2/day till the TD reached the opposite edge of the CP. Roentgenographic, gross meterage and ultrastructural observation were performed 2, 4, 6, 8, 12 weeks after completion of distraction. RESULTS: All the examinations revealed the TD recombination to the opposite bone edge of the CP, simultaneously, the proportional expansion of overlay mucoperiosteal flap was achieved. The bone defect were filled with de move osteogenesis. Roentgenographically, the new bone mineralization was along the DO vector, developed from the bone cut edges bilaterally to the central translucent zone until turned to thin fissure. Comparison of the plaster casts showed no change in the occlusion or dentomaxillofacial framework. CONCLUSIONS: The intraoral distractor is able to get both effective distraction and steady fixation. The examination results suggest that the CP bone and soft tissue defect could be repaired and acheived functional reconstruction under DO, which could be a new treatment approach for repair of CP.

Animals↗
PubMed2002

[Application of distraction osteogenesis in severe maxillary hypoplasia secondary to cleft palate].

OBJECTIVE: To evaluate the effect of distraction osteogenesis in correction of severe undeveloped maxilla secondary to cleft palate and to evaluate the selection of distraction modality. METHODS: Distraction osteogenesis was performed upon 8 patients, 6 males and 2 females, aged 11 to 25 years, one with incomplete cleft palate, 4 with unilateral complete left palate, and 3 with bilateral complete cleft palate, all accompanied with severe maxillary hypoplasia. The 7 adult patients were treated by modified high-stepped Le Fort I osteotomy, the other patient, a child, was treated by Le Fort I osteotomy followed by rigid external distraction. X-ray films of skull in lateral, frontal, or panoramic positions, and X-ray film of temporomandibular joint in Schiller's position were taken pre- and postoperatively. In model surgery the accurate distraction distance was measured and the direction of distraction designed. Orthodontic therapy was started immediately after the distraction was completed and the distractor was removed after a period of 4 months' consolidation. RESULTS: The designed distraction was achieved in a11 8 patients. Except in one case with a bone defect 1 cm x 0.5 cm at the osteotomy line in the lateral wall of the right maxillary sinus, dense new bone was formed in the area of distraction in the other cases. The postoperative occlusal relationship was good and stable. No infection and other complication was found. During an average of 20 months' follow-up, the maxilla and occlusion were stable, and no relapse was found. The distance of forward distraction of the maxilla reached an average of l2 mm (5 approximately 15 mm). The SNA angle increased from 71 degree on average preoperatively to an average of 79 degree postoperatively. Both the facial appearance and occlusal relationship returned to normal in a11 the patients. CONCLUSION: Without need of bone grafting and with a stable effect and little influence on platatopharyngeal competence, distraction osteogenesis is an effective method of correcting maxillary hypoplasia secondary to cleft palate and is worthy of spreading.

Adolescent↗
PubMed2000

Preservation of rat palatal scar tissue myofibroblasts in organ culture.

In order to modulate palatal scar tissue, especially its myofibroblastic component, there is a pressing need for an in vitro model of this tissue. In the present, study we established an organ culture model of the rat palatal scar tissue. After excision of palatal mucoperiosteum, explants from the developing immature scar tissue and from the normal palatal mucosa were used to observe myofibroblasts in vivo and their maintenance in organ culture. Explants were cultured at the gas-liquid interface in serum-free Waymouth's MB 752/1 medium and in a humid atmosphere containing 55% O2/5% CO2 in air at 37 degrees C for 3 days. Viability of the cultured explants was evaluated with morphological and histological criteria and BrdU incorporation. After organ culture, the scar tissue showed good preservation of the in vivo histology. The myofibroblasts and smooth muscle cells of the cultured scar tissues showed continuous expression of alpha-smooth muscle actin (alpha-SMA), mimicking the in vivo situation. In the normal tissues, only smooth muscle cells of the blood vessels expressed alpha-SMA. These results demonstrate that the established model provides a useful in vitro experimental tool for investigating the palatal scar tissue in general and its myofibroblasts in particular.

Actins↗
PubMed2002

[Analysis of 5459 cleft lip and palate cases].

OBJECTIVE: To analyse the constitution of 5459 cleft lip and palate cases and to review the development of surgical treatment to them. METHODS: The data of the 5459 cleft lip and palate cases were collected and classified. The ratio of sex and disease pattern were calculated and analyzed statistically. Also, by means of classification of the disease pattern, the operation methods and the operation time, the change of the surgical methods and the first operation age were analyzed. RESULTS: In the cleft lip and palate cases, the sex ratio is different. There were obvious differences in the first operative ages in different periods. The main repair methods for cleft lip and palate changed with time. CONCLUSION: The male is more than the female in the cleft lip and palate patients. The average first operation age has been decreased and the main repair methods have changed since 1980.

China↗
PubMed2001

[Factors involved in intelligent development of children with cleft lip and palate].

OBJECTIVE: The objective of this study was to investigate the possible factors involved in intelligent development of children with cleft Lip and palate. METHODS: The intelligence quotient (IQ) and developmental quotient (DQ) of 152 children with cleft lip and palate under 14 years old were conducted, and the control group was made up of 80 healthy children. The considered factors included degrees of deformation, situation of perinatal period, way of feeding, psychological conditions of the children, general situation of their parents and education of these children. The data were statistically analyzed and compared. RESULTS: The IQ value of these children generally was normal, but the mean value was still lower than that of the control group (P < 0.01). The mean IQ value of the group of children with only cleft lip or cleft palate was higher than that of the group with both cleft lip and cleft palate, and the mean IQ value of these children with II degree deformity was higher than that of children with III degree deformity. The mean IQ value of these children feed with mother's milk was higher than that of those feed with artificial milk. These children more than 5 years old were disturbed psychologically, and their parents were also with pressure. CONCLUSION: The intelligent development of children with cleft lip and palate is affected by many factors, including types and degrees of deformity, feeding ways, illnesses and social psychological factors in different periods of development. Therefore, it is very important to take steps before 5 years old, including correctly feeding, repairing the deformity as early as possible, preventing the illnesses, necessary psychological treatment, improving social environment.

Adolescent↗