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PubMed1984

Folate deficiency and in vitro palatogenesis II: Effects of methotrexate on rabbit palate fusion, folate pools, and dihydrofolate reductase activity.

Folate deficiency during pregnancy induced by dietary deprivation or folate antagonists is teratogenic. Methotrexate is a commonly used antifolate drug that produces congenital defects, with the craniofacial complex being especially vulnerable. The molecular action of this compound, therefore, was examined in vitro using fetal rabbit palates in an organ culture system. Dihydrofolate reductase activity was measured in these palates on the 4 days preceding fusion. There was no significant fluctuation in activity with gestational age. Methotrexate treatment of the palates in vitro resulted in significant reduction of enzyme activity and also decreased total folate concentration. However, the in vitro fusion ability of these palates was not altered by exposure to methotrexate. These results suggest that since methotrexate is a potent inhibitor of DNA synthesis and has its maximal effect on rapidly dividing systems, the peak in cellular proliferative activity in the fetal rabbit palate occurs very early in its development.

Animals↗
PubMed1980

Craniofacial morphology in twins discordant for cleft lip and/or palate.

The craniofacial structure in 44 pairs of like-sexed twins discordant for cleft of the lip and/or palate was investigated using lateral cephalometric radiographs. While only a slight rotation of the mandible was evident in the twins having cleft lip, more extensive rotation of the mandible was found in the twins discordant for unilateral cleft lip and palate. Larger, though generally non-significant, changes were recorded for the twins affected with bilateral cleft lip and palate. In the twins discordant for cleft palate only, statistically significant differences were found for maxillary length, mandibular corpus length, cranial base flexure (Ar-S-Na), horizontal and vertical positioning of the posterior maxilla, mandibular plane angle, and gonial angle. Although the effect of sex on the within twin differences was not statistically significant, the effects of age, zygosity, and cleft type were. It is suggested that there is an increasing degree of dysmorphism, with increasing severity of clefting from cleft lip only to bilateral cleft lip palate.

Adolescent↗
PubMed1980

[Tibial periostal graft in the repair of the primary cleft palate: preliminary report of a new technique (author's transl)].

Reconstruction of the oral plane of a primary cleft palate using tibial periostal graft at the primary repair stage seems a highly appealing technique: -- the osteogenic power of the periosteum used as a free transplant has been demonstrated long ago (Ollier, Axhausen); -- two requisites must be filled when primary palate repair is undertaken: maintainance of the nasal fossa size and maintenance of the palatal fibromucosa that must be not submitted to any traction whatsoever, otherwise endognathia will arise. A vast, tight and strong periostal plane will be obtained with the periostal graft, the latter bringing also bone to the cleft. Better still, such a periostal graft can be extended backwards over the entire length of the cleft bony palate which will subsequently create a situation requiring simple soft palate repair.

Child, Preschool↗
PubMed1994

Does reduced hospital stay affect morbidity and mortality rates following cleft lip and palate repair in infancy?

Insurance carriers affected decisions regarding admissions and length of stay in our hospital in 1987. Charts were reviewed retrospectively to determine whether this affected morbidity and mortality rates following cleft lip and palate operations in infants. Two periods were studied: May of 1983 through April of 1987 (group I) and April of 1987 through May of 1991 (group II). A total of 248 infants with cleft lip and/or palate underwent 398 operations: lip adhesion (74), definitive lip repair (130), and palatoplasty (194). Half were performed in each period. Admission status, length of stay, length of operation, and short-term morbidity were documented. Morbidity included spontaneous and traumatic lip dehiscence, palatal dehiscence, and palatal fistula. Intergroup analysis was performed by the chi-squared method; p < or = 0.05 was statistically significant. In group I, 93 percent of patients were admitted before surgery. In group II, 5 percent were admitted before surgery and 79 percent the day of surgery. Hospital stay decreased nearly 2 days for each operation. There was no statistically significant difference between groups in distribution of operations, length of operations, or morbidity: lip surgery complications (p = 0.263), palatoplasty complications (p = 0.624). Reductions of hospital admissions and length of stay do not affect outcome of cleft lip and palate surgery in infants. The reduction in hospital days is equivalent to a savings of $138,000 (1991 dollars).

Ambulatory Surgical Procedures↗
PubMed1994

Submucous cleft palate.

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

Adolescent↗
PubMed1993

Dermatoglyphics in cleft lip and cleft palate anomalies.

Dermatoglyphic characteristics of sixty nine cases of cleft lip with or without cleft palate and twenty eight isolated cleft palate cases were evaluated for digital patterns, interdigital patterns, palmar simian crease and sydney line, and model types of C- and D-line terminations. Increased frequency of ulnar and radial loops than the arches and whorls was observed in cleft lip with or without cleft palate patients compared to controls. Interdigital patterns were less frequent in cleft lip and cleft palate patients. Simian crease and Sydney line were more common in patients than in controls. Model types of C- and D-line terminations showed variations in patients and controls. Wider 'atd' angle (more than 30 degrees) and dermatoglyphic asymmetry were noted in the patient groups. The findings suggest the dichotomy or heterogeneity of cleft lip and cleft palate anomalies. The role and utility of dermatoglyphics in genetical etiology of congenital defects were emphasized.

Adolescent↗
PubMed1996

[Prenatal ultrasonic diagnosis of cleft lips and palates].

The purpose of this communication is to demonstrate the possibility of prenatal diagnosis of cleft lips and palates by routine ultrasound screening. As obstetrical ultrasound improves, anomalies of the fetal face can be diagnosed more and more frequently in utero. From 1991 to 1994 9 cases with cleft face syndrome were detected prenatally. In 8 cases the presence of cleft lip and palate was isolated. In one case the cleft lip and palate was associated with phocomelia. In cases with cleft palate the widening of nasal cavity was observed. In cases with bilateral cleft palate polyhydramnions were observed twice and undulating movements of the tongue were also seen.

Adult↗
PubMed1997

Effect of bilateral tenectomy of the tensor veli palatini muscle on soft palate function in horses.

OBJECTIVE: To determine the effect of bilateral tenectomy of the tensor veli palatini muscle on soft palate and nasopharyngeal function in exercising horses. ANIMALS: 5 Standardbreds. PROCEDURE: Treadmill videoendoscopy was performed on 5 Standardbreds exercising at 50, 75, and 100% of the speed that produced maximum heart rate; tracheal and pharyngeal pressures were measured before and after surgery. Tenectomy of the tensor veli palatini muscle was performed bilaterally on each horse while under general anesthesia, using a transoral approach. RESULTS: Peak inspiratory tracheal pressures were significantly (P = 0.016) more negative and there was a trend (P = 0.06) for peak pharyngeal inspiratory pressure to be less negative following bilateral tenectomy of the tensor veli palatini muscle, compared with preoperative values. The rostral half of the soft palate was unstable and collapsed dorsally into the nasopharynx during inspiration, causing partial obstruction of the nasopharynx. The caudal free margin of the soft palate remained ventral to the epiglottis, and dorsal displacement of the soft palate did not occur in any horse. CONCLUSIONS: Bilateral tenectomy of the tensor veli palatini muscle did not cause dorsal displacement of the soft palate in horses while exercising at maximum heart rate, but resulted in collapse of the nasopharynx during inspiration. CLINICAL RELEVANCE: Results of our study indicate that the tensor veli palatini muscle functions to support and dilate the nasopharynx during intense inspiratory efforts in horses by tensing the palatine aponeurosis.

Anesthesia, General↗
PubMed1997

[When a child is born with a cleft lip and palate].

The child born with cleft lip and palate. Cleft lip, cleft palate and cleft lip and palate are among the most common facial abnormalities. The birth of a child with any of these and the prospect of a schedule of treatments that will continue into late adolescence puts enormous stress on the entire family. Between 1989 and 1994, 160 babies with such malformations were born in Quebec. In a study of eight families from this population, the author examines ways in which they communicate, share tasks, react to difficulties, show interest and solve problems. By means of interviews and three questionnaires, the author determined that the first three months following the birth are the most crucial. During this time, the nurse can help the family through a redefinition of roles brought on by the prospect of numerous medical and surgical procedures. The nurse can also provide the family with emotional and educational support; help them understand and come to terms with the child's malformation, so that the child is fed properly; and help lessen the family's feelings of helplessness. The nurse must ensure that these parents are adequately informed and provide them with additional information about cleft lip, cleft palate and cleft lip and palate. She must be aware of appropriate resources and, whenever possible, refer the families to an organization or a centre specializing in this type of malformation.

Adaptation, Psychological↗
PubMedDate not supplied

Mandibular movements during elevation and fusion of palatal shelves evaluated from the course of Meckel's cartilage.

The purpose of the present study was to investigate whether the course of Meckel's cartilage could reveal the mandibular movements during the elevation and fusion of the soft tissue palatal shelves. Histological sections, cut serially in the horizontal plane from 64 human mandibles, 16-104 mm CRL, were analyzed. The course of the anterior and medial part of Meckel's cartilage changed markedly during the three palatal stages, i.e., before, during, and after palate formation. The medial part changed during these stages from a straight course through a curled, S-shaped course to a crochet-hook-shaped course. The anterior part of Meckel's cartilage developed from a separation in the symphysis menti region to a fusion and later to a separation again. It is suggested that these changes in the course of Meckel's cartilage are due to different muscle activities. It is supposed that during the palatal developmental stages the activity of the geniohyoid and genioglossus muscles caused the mandibular retraction and the widening of the angulation between the bilateral hemimandibles. The S-shape of Meckel's cartilage is a result of these movements. Later mandibular proclination and narrowing of the bilateral hemimandibles resulted in an anterior mechanical fusion of Meckel's cartilage due to the activity of the mylohyoid muscle. This stage is followed by a retraction and re-widening of the angulation between the bilateral bony components, which disrupts the fusion of Meckel's cartilage in the symphysis menti region. Thus, the course of Meckel's cartilage revealed the mandibular movements in the sagittal and transverse planes during palate formation.

Bone Development↗
PubMed1997

The use of a prosthetic appliance to manage a large palatal defect in a dog.

Large defects of the hard palate can result from a congenital abnormality, trauma, or surgical treatment of oral masses. Closure of these defects can be challenging as dehiscence is common. Large, inoperable hard palate defects may be managed with prosthetic obturators, which recreate the separation between the oral and nasal cavities. This report describes the use of a palatal obturator to manage a large palatal defect that persisted after resection of a palatal fibrosarcoma. Three prior attempts at surgical closure of the defect had failed.

Animals↗
PubMed1976

Cleft palate induction in hamster fetuses by glucocorticoid hormones and their synthetic analogues.

The effect of prenatal administration of different doses of cortisone, corticosterone, dexamethasone, triamcinolone and prednisolone on the fetus and its palatal development was studied. All the glucocorticoids, except cortisone, produced cleft palate in the fetuses. Both the total frequency and morphologically different types of cleft palate were related to the dose of the teratogen. Triamcinolone appeared to be more potent than other glucocorticoid in inducing cleft palate. An association was noted between fetal growth inhibition, the dose of the teratogen and the frequency and type of cleft palate.

Abnormalities, Drug-Induced↗
PubMed2004

Reconstruction of the hard palate using the radial forearm free flap: indications and outcomes.

BACKGROUND: Although prosthetic obturation is the "gold standard" for restoration of hard-palate defects, obturators can be problematic. We present 10 cases of palatal reconstruction with the radial forearm free flap and compare patient satisfaction with defect-matched patients rehabilitated with prosthetic obturation. METHODS: Twelve patients who underwent radial forearm free flap (RFFF) reconstruction of a hard-palate defect and eight patients, with similar-sized defects who were rehabilitated with a prosthetic obturator, were evaluated for donor site and recipient site complications, diet, and patient satisfaction. RESULTS: All the patients in both groups were able to resume an unrestricted diet with normal mastication and articulation. Both groups achieved equivalent satisfaction scores with regard to appearance, chewing, and taste; however, the patients reconstructed with an RFFF reported higher satisfaction scores in speech, comfort, convenience, and social interaction. CONCLUSIONS: RFFF reconstruction of hard-palate defects provides a functional alternative to conventional prosthetic obturators.

Female↗
PubMed1978

A new method for the closure of a cleft palate.

Contrary to the advocated linear approximation of the muscles in closure of the soft palate we have developed a different method which finds its anatomical confirmation in a publication by Kriens. Since we normally have intermingling vertical and horizontal muscle fibres within the soft palate it seemed logical to copy nature by the surgical technique. We believe that we are better able to reestablish normal anatomical findings by two opposing Z-plastics compared with the methods previously described. With this procedure we are also able to shift the centre of muscle function further dorsally, thus achieving a lengthening of the palate as well. Since the procedure is quite atraumatic on account of the oblique cuts, we seldom see tissue dehiscenses and have been able to observe a well functioning palate.

Child↗
PubMed2001

Comprehensive management of cleft lip and palate deformities.

PURPOSE: The controversy regarding the timing of repair of the deformities associated with cleft lip and palate still exists. The goal of this article is to present a versatile, universal philosophy of management of these deformities involving early repair. PATIENTS AND METHODS: Over 20 years, 2,698 new patients with cleft lip and palate deformities were treated. These included 1,298 unilateral and 320 bilateral cleft lip and palate patients. The remaining patients (1,018) had isolated palatal clefts. All patients were operated according to the same protocol and the same surgical procedure. The treatment philosophy was based on early, wide myoperiosteal-periosteo-sutural reconstruction by a modified Delaire functional cheilorhinoplasty and alveolar gingivoperiosteoplasty at 3 months, followed by soft and hard functional palatoplasty at 9 months. RESULTS: All patients were followed longitudinally and retrospectively. The parameters investigated were facial symmetry, presence or absence of growth retardation, and oropharyngeal and nasal function. The parameters studied indicated that when this treatment schedule was followed and the procedures were performed on time and according to the protocol, there was minimal growth retardation of the maxilla. When early gingivoperiosteoplasty was performed in 25% of the patients there was a sufficient amount of alveolar bone for eruption of the primary and permanent dentition. This negated the need for secondary alveolar bone grafting. The development of the upper lip was harmonious, and usually no further corrective procedures were necessary. The nose was usually well developed and functionally normal. CONCLUSION: Optimal rehabilitation of the patients was achieved by following the principles and treatment strategies described. If the treatment principles are not incorporated in the functional repair (ie, joining of the primary and the secondary growth centers during corrective procedures), compromised results are to be expected.

Child↗
PubMedDate not supplied

Articulatory placement for /t/, /d/, /k/ and /g/ targets in school age children with speech disorders associated with cleft palate.

This study used electropalatography (EPG) to identify place of articulation for lingual plosive targets /t/, /d/, /k/ and /g/ in the speech of 15 school age children with repaired cleft palate. Perceptual judgements indicated that all children had correct velar placement for /k/, /g/ targets, but /t/, /d/ targets were produced as errors involving palatalization or velar placement. An EPG classification scheme identified alveolar, palatal and velar placement. Articulations involving contact in alveolar and velar regions simultaneously were identified as alveolar velar double articulations (AVDAs). The classification revealed that AVDAs were relatively frequent, with 28% of alveolar and 12% of velar targets affected, and ten out of the 15 children produced one or more of these abnormal articulations. The majority of children had variable placements, with alveolar more variable than velar targets. The positive finding from the EPG data revealed that most children with perceptual errors for /t/, /d/ were able to make closure in the alveolar region during at least some of their attempts to articulate these targets. It is argued that appropriate analysis and interpretation of EPG data provide clinically relevant information about tongue placement in cleft palate speech.

Adolescent↗
PubMed2004

Influence of the Furlow palatoplasty for patients with submucous cleft palate on facial growth.

The purpose of this study was to investigate the facial growth in patients with submucous cleft palate operated on using the Furlow palatoplasty. A total of 30 patients with submucous cleft palate underwent Furlow palatoplasty from 1993 to 1998. The mean follow-up period was 4 years and 3 months. Twenty-five of 30 patients were followed up. Mid-facial growth was measured using lateral cephalograms in 18 patients whose age was greater than 8 years. The parameters obtained in the lateral cephalogram were compared with those of a healthy population in Korea. Eleven (61.1%) of 18 patients observed were within the clinical normal range for the age group for the parameter of the span between the anterior nasal spine and posterior nasal spine, 6 patients (33.3%) were over the range, and 1 patient (5.6%) was below the range. For the sella-nasion-subspinale angle, 55.6% of patients were within the clinical normal range, 27.8% were over the range, and 16.6% were below the range. For the sella-nasion-supramentale angle, 55.6% of patients were within the clinical normal range, 22.2% were over the range, and 22.2% were below the range. For the sella-nasion-subspinale-sella-nasion-supramentale angle, 72.2% of patients were within the clinical normal range, 27.8% were over the range, and none were below the range. For the span between the basion and posterior nasal spine, 50.0% of patients were within the clinical normal range, 27.8% were over the range, and 22.2% were below the range. In conclusion, our results suggest that the Furlow palatoplasty is a useful procedure as an initial treatment of submucous cleft palate and that this technique has a less harmful effect on facial growth because there is no excessive surgical intervention on the hard palate and alveolar process.

Adolescent↗
PubMed1985

The Cronin push-back palate repair with nasal mucosal flaps: a speech evaluation.

This is a retrospective study of 92 cleft palate patients who had been repaired with the Cronin push-back palate repair with nasal mucosal flaps. The patients were evaluated by a speech pathologist for intelligibility, articulation, and resonance and rated using a 5-point scale devised for this study. Readily intelligible speech was present in 78 percent. Normal articulation was present in 66 percent. Normal resonance was present in 78 percent of the total subject group. Secondary procedures were performed in 14 percent of the group. Repaired clefts of the soft palate achieved a high rate of normal intelligibility, articulation, and resonance. Repaired submucous clefts and short palates achieved the lowest percent of normal articulation and resonance. Educational placement, hearing, and type of structural deformity all appear to influence the ultimate communication outcome.

Child↗