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PubMed1982

The prosthodontic management of cleft palate patients.

The role of the prosthodontist in the multidisciplinary approach to the treatment of the cleft palate patient has been described. A brief review of the literature on the historical background, epidemiology, and pathogenesis of the cleft palatal defect has been presented. A technique for constructing a cleft palate prosthesis has been outlined in detail. Treatment of several patients using this technique has produced excellent results. Prosthetic therapy aids the patient in developing normal speech, promoting deglutition and mastication and in closing off the oral cavity from the nasal cavity. The esthetic benefits can be instrumental in the psychologic and social acceptance of the cleft palate patient.

Adult↗
PubMed1992

Radiographic demonstration of oronasal fistulas in patients with cleft palate with the use of barium sulfate contrast.

The purpose of this investigation was to determine the overlapping and unique contributions that radiographic techniques might provide for accurate characterization of hard palate fistulas associated with cleft palate. Five subjects with oronasal fistulas were selected for radiographic imaging, and their informed consent was obtained. Results indicated that radiographs with contrast can provide important supplemental and unique information. Qualitative descriptions of the inferior-superior course and location, and the size of the narrowest aperture could be obtained from the combination of maxillary occlusal, posteroanterior tomographic, and lateral tomographic projections. This information could not be obtained from the common clinical methods in use to describe fistulas. This technique can provide valuable information to all members of a multidisciplinary cleft palate team to document palatal fistulas for both clinical and research purposes.

Barium Sulfate↗
PubMed1988

Occurrence of oronasal fistulas in operated cleft palate patients.

Oronasal fistulas, a troublesome complication, often occur after cleft palate repair. Seventy-three patients in a series of 346 cases of cleft palate (21%) were found to have fistulas, most located at the junction of hard and soft palate (42%). Langenbeck's method of cleft palate repair resulted in more fistulas than Wardill's method. Fistulas occurred more frequently in bilateral clefts than in the unilateral type. Nasality was found to be the most common symptom in patients with oronasal fistulas. No treatment was needed for 17 patients, 10 were given obturators, and surgical repair was performed in 46. Treatment was totally successful in 56% of the patients and partially so in 34%.

Child↗
PubMed2004

Three-dimensional assessment of morphologic changes of the maxilla: a comparison of 2 kinds of palatal expanders.

Previous studies of the morphologic changes of the maxilla after palatal expansion have used 2-dimensional methodologies. In the present study, we used a 3-dimensional surface laser scanning technique and computerized cast analysis, in addition to analysis of anteroposterior cephalograms, to assess the morphologic changes of the palate by 2 kinds of expanders: tissue borne (Haas; n = 9) and tooth borne (Hyrax; n = 10). Cast analysis demonstrated that, although all patients started treatment with similar malocclusion, treatment outcomes were different depending on the appliance used. Both appliances generated maxillary expansion (ie, improved mean surface area, mean intermolar linear distance, and mean perimeter) (P <.05). However, the appliances performed differently to achieve the final expansion. Haas appliances demonstrated a greater orthopedic movement (ie, improvement of the mean interpalatal distance) (P <.05), and Hyrax appliances demonstrated dentoalveolar expansion by increasing the mean palatal angulation of the alveolus (P <.05). Anteroposterior cephalometric analysis showed that both appliances increased mean maxillary width and mean intermolar distance significantly (P <.05). On the other hand, differences in nasal cavity width and upper incisal apex distance were not statistically significant (P >.05). This new 3-dimensional methodology proved useful for comparing treatment outcomes by evaluating the morphologic changes induced by palatal expansion and generated a better visualization of these outcomes.

Adolescent↗
PubMed2004

The quantitative evaluation of palatal elongation after Furlow palatoplasty.

PURPOSE: Furlow "double-opposing Z-palatoplasty" (FP) operation lengthens the soft palate by using only soft palate tissues. It is used in cleft palate repair and velopharyngeal incompetence. The aim of this study was to define the importance of the length and ratio of the soft palate elongation after FP. PATIENTS AND METHODS: This study included 17 patients who were operated on by the same surgeon using FP. The mean follow-up period time was 4.5 years. Preoperative, intraoperative, and late postoperative velar lengths were measured and elongation ratios were calculated. RESULTS: Mean intraoperative elongation and ratio were 16.11 mm and 69.05%, and mean late postoperative elongation and ratio were 12.47 mm and 55.47%, respectively. CONCLUSION: Significant and permanent elongation in velar length was obtained using the FP.

Adolescent↗
PubMed2004

Obturation of the partial soft palate defect.

A partially resected soft palate represents a more significant challenge for effective prosthodontic obturation than for complete soft palate resections. In fact, for some patients it may not be possible to prosthetically rehabilitate with partial soft palate resections, resulting in velopharyngeal dysfunction, which could include hypernasal voice quality and nasal regurgitation of food and liquids. This article presents a technique for recording the contours of a partial soft-palate defect for prosthetic obturation.

Denture Bases↗
PubMed2000

Alteration in the expression of bone morphogenetic protein-2,3,4,5 mRNA during pathogenesis of cleft palate in BALB/c mice.

To identify the function of these bone morphogenetic proteins (BMP) during pathogenesis of cleft palate, an experimental model was established in BALB/c mice. Cleft palate was induced by exposure to retinoic acid on embryonic day (E)12. The expression of BMP-2,3,4,5 mRNA in normal and abnormal embryonic palatal shelves was then examined from E13 to E16 by in situ hybridization. The results showed that BMP-4 mRNA was expressed strongly and uniformly in normal epithelial cells and dispersed mesenchymal cells on E13. BMP-2,5 mRNA expression appeared only in dispersed mesenchymal cells. With the development of shelves, the staining density of BMP-2,4,5 decreased gradually in mesenchymal cells outside of the condensation and increased inside the condensation. After shelves had fused on E16, no positive signals for BMP-2,4,5 were detected in dispersed mesenchymal cells, but their expression persisted in the condensation. Exposure to retinoic acid delayed the formation of the condensation and decreased BMP-2,4,5 mRNA dramatically in mesenchyme from E13 to E15. BMP-3 mRNA expression were almost negative in either control or retinoic acid-treated groups during all stages. It was concluded that spatial and temporal expression of BMP-2,4,5 was required during normal palatogenesis, and that a deficiency of their mRNA expression may contribute to the pathogenesis of cleft palate.

Animals↗
PubMed1975

U-shaped palatal defect in the Robin anomalad: developmental and clinical relevance.

The palatal defect in patients with the Robin anomalad was found to be U shaped. This finding is compatible with the hypothesis that the underlying dysmorphic event is usually early mandibular hypoplasia with secondary extrinsic obstruction of palatal closure by a posteriorly displaced tongue. The more common V-shaped defects of palate closure arise by a different mechanism. Unfortunately, available recurrence risk data for cleft palate do not allow for this distinction. Furthermore, physicians should be alert for instances in which the Robin anomalad is but one feature of a broader pattern of malformation. In the current study, 25% of the 28 patients ascertained as having the Robin anomalad had a recognizable syndrome for which specific, but varying, genetic counsel was indicated.

Child↗
PubMed2001

Squamous cell carcinomas of the soft palate treated with radiation therapy alone or followed by planned neck dissection.

PURPOSE: The present study presents the experience at the University of Florida with treatment of unselected patients with carcinomas of the soft palate with radiation therapy (RT) alone or followed by planned neck dissection. METHODS AND MATERIALS: One hundred seven patients treated with curative intent with RT alone or followed by neck dissection from 1965 to 1996 were included in the study. All patients had follow-up for at least 2 years. No patients were lost to follow-up. RESULTS: Local control rates at 5 years were 86% for T1, 91% for T2, 67% for T3, and 36% for T4 carcinomas. T-stage and overall treatment time significantly affected local control in multivariate analysis. Nodal control rates at 5 years were 86% for NO, 76% for N1, 61% for N2, and 67% for N3 carcinomas. Overall treatment time and planned neck dissection significantly affected nodal control in multivariate analysis. Ultimate local-regional control rates at 5 years were 90% for Stage I, 92% for Stage II, 84% for Stage III, and 60% for Stage IV disease. Overall treatment time and planned neck dissection significantly affected ultimate local-regional control in multivariate analysis. The overall survival rate at 5 years was 42% for all patients. Overall stage, overall treatment time, and planned neck dissection significantly affected overall survival in multivariate analysis. The cause-specific survival rate at 5 years was 70% for all patients. Overall treatment time and planned neck dissection significantly affected cause-specific survival in multivariate analysis. Three patients sustained severe postoperative complications and 3 patients sustained severe late complications. Sixteen patients had synchronous and 14 patients had metachronous carcinomas of the head and neck mucosal sites. CONCLUSION: For limited carcinomas of the soft palate, RT (alone or followed by planned neck dissection) results in relatively high local-regional control and survival rates. For advanced carcinomas of the soft palate, local-regional control and survival rates are relatively low and local-regional recurrence rates are substantial. Advanced carcinomas of the soft palate may be better treated with RT and concomitant chemotherapy.

Adult↗
PubMed1998

The nature of arch width difference and palatal depth of the anterior open bite.

Measurements were made of study casts of patients with anterior open bite to compare the width of maxillary and mandibular arches and the depth of the palate. This study was designed to (1) explore the nature of the arch width difference for patients with anterior open bite, whether dental or skeletal in nature, and (2) clarify the general impression of "high" palatal vaults for anterior open bite cases, to make sure if there are "absolutely high" or "relatively high" palatal vaults. Measurements in male and female patients with open bite malocclusions were analyzed and compared with those in male and female patients with normal occlusions. Similar trends were found for both sexes. Skeletally narrowed maxillary posterior width and dentally widened mandibular posterior widths were found. Palatal depth was in the normal range in the patients with anterior open bite. Orthopedic widening of the maxillae and inclining of the mandibular posterior teeth lingually are recommended when orthodontic treatment is to be rendered to patients with anterior open bite.

Adolescent↗
PubMed2003

Differences in cephalometric and occlusal outcome of cleft palate patients regarding different surgical techniques.

INTRODUCTION: The purpose of this study was to assess differences of the long-term results following surgical treatment in patients with cleft palate treated by two different surgical concepts. PATIENTS: Fifty-nine adult patients operated on for cleft palate were examined. Thirty palates were closed by a two stage (Widmaier and Veau) and 29 by a single-stage procedure (Veau's pedicled flap). METHODS: Lateral cephalometric and model analysis was performed. In the cephalometric analysis, the vertical and horizontal parameters of the position of maxilla and midface and transverse and sagittal dimensions of the models were compared between the two groups. RESULTS: Model analysis: According to the Bolton analysis the maxillary dental arch was too large in 22 patients in each group. The other patients had mandibular arches that were too large. In 18 patients with two-stage closure and in 9 patients with one-stage closure, a space deficit in the lateral part of the maxilla was observed. Persisting transverse deficits were seen in all patients with two-stage repairs and in 11 patients with one-stage repairs. The deficit was more severe in the molar area in the first group and almost equally severe in the premolar and the molar regions of the second group. A sagittal deficiency was found more often in patients with two-stage repairs while Angle's class I occlusion was seen more often in patients with one-stage surgery. Lateral cephalometry: Similar SNA-angles were seen in both groups whereas the ANB-angle was greater following two-stage repair. In both patient groups a low inclination of the midface was seen. The vertical dimension of the midface in comparison with the lower face was normal in the one-stage group; in the other group a deficiency of the anterior midface height was registered. CONCLUSION: There was a more severe growth impairment of the midface in patients with this type of two-stage palatal repair. The horizontal deficiency was similar in both groups. The long-term occlusal result revealed smaller sagittal and transverse deficiencies in patients with this type of single-stage closure.

Adolescent↗
PubMed2006

Presurgical nasoalveolar molding in patients with unilateral clefts of lip, alveolus and palate. Case study and review of the literature.

INTRODUCTION: The case of a newborn female patient with unilateral cleft lip, alveolus and palate is presented with a markedly sunken nasal wing at the cleft side. This finding may lead to a very unsatisfactory aesthetic result after primary cheiloplasty and nasoplasty. PATIENT AND METHOD: Five months prior to surgery, the patient was treated with a palatal plate and additionally with a nasoalveolar conformer for 4 months thereof. The device consisted of an acrylic pelotte (attached to the maxillary plate with a wire) which lifted the nasal dome and was activated regularly. Under this presurgical treatment, the cleft edges moved closer to each other by 1.8 mm at the alveolar ridge and by 4.5 mm in the palatal area. The nasal wing was lifted by 5 mm. This was enabling elevation of the nasal wing during primary surgery in the case described. Questions are raised as to the remaining effects on nasal symmetry until completion of growth and, on the other hand, as to the chances to reduce postsurgical alar relapse by continued nasal molding beyond primary surgery. CONCLUSION: Presurgical nasal molding seems to improve aesthetics of the nose in patients with unilateral clefts of lip, alveolus and palate and distinctly flattend nasal wings.

Alveolar Process↗
PubMed1972

A correlative histocytological study of carcinoma and epithelial atypia of the palate among Indian reverse smokers.

A correlative histocytological study was made of 6 patients with palatal carcinomata and 342 patients with palatal lesions (primarily leukoplakias) associated with reverse smoking from the Srikakulam district of Andhra Pradesh. Among 6 histologically diagnosed carcinomata only 2 showed cytological findings typical of carcinoma. Of the 46 atypias diagnosed histologically among the other palatal lesions, only 6 (13%) were diagnosed cytologically. Our findings show that cytological examination of precancerous and cancerous lesions located on the hard palate, which is a highly keratinized area of the oral cavity, may not be reliable enough for revealing premalignant or malignant changes.

Cytodiagnosis↗
PubMed1995

Transforming growth factor-beta 3 is required for secondary palate fusion.

Mice lacking TGF-beta 3 exhibit an incompletely penetrant failure of the palatal shelves to fuse leading to cleft palate. The defect appears to result from impaired adhesion of the apposing medial edge epithelia of the palatal shelves and subsequent elimination of the mid-line epithelial seam. No craniofacial abnormalities were observed. This result demonstrates that TGF-beta 3 affects palatal shelf fusion by an intrinsic, primary mechanism rather than by effects secondary to craniofacial defects.

Animals↗
PubMed1985

Speech production and oral motor skill in an adult with an unrepaired palatal cleft.

The aim of this study was to identify maneuvers and strategies that enabled an adult speaker to produce "pressure" consonants intelligibly despite an open cleft of the palate. Dynamic palatometry indicated that this was achieved in part by increasing linguapalatal contact in stop sound production and narrowing the linguapalatal groove in sibilant sound production. These adaptations apparently enabled the talker to compensate for reduced air supply in a manner similar to that identified previously in responses of subjects with esophageal speech. Oral motor skill was examined in a nonspeech task that involved tongue tip placement at six points along the palate with and without visual feedback. This revealed precise control of the tongue even in the region of the cleft. Less accurate tongue placement skills were found in the central palatal region despite intactness of the palate. This supports the hypothesis that phonetic inventories of human languages are shaped by oral motor capabilities.

Adult↗
PubMed2002

Impacted supernumerary tooth developed under palatal polyp.

We present a rare case of an infant's palatal polyp associated with an impacted supernumerary tooth. We have previously reported three cases of palatal polyps in infants [1]. In one case, after surgical removal of the palatal polyp at the age of 1 year and 8 months, the lesion subsequently began swelling. A periapical radiograph at the age of 2 years and 9 months revealed a small calcified mass in the maxillary left incisor region. The swelling was kept under observation, the calcified mass developed gradually and was removed surgically at the age of 5 years and 5 months. The removed calcified mass was clinically diagnosed as an impacted supernumerary tooth and this was confirmed histologically. Histological findings did not indicate any relationship between the palatal polyp and the impacted supernumerary tooth.

Humans↗
PubMed2000

[Speech improvement with velopharyngoplasty in patients with lip-jaw-palate clefts].

BACKGROUND: Despite successful closure of the hard and soft palate and intensive speech therapy a velopharyngeal insufficiency is not completely avoidable in each case of cleft palate. An improvement by velopharyngoplasty should be possible. PATIENTS AND METHODS: Two hundred and ninety patients suffering from cleft palate were examined before and one year after velopharyngoplasty according to Sanvenero-Rosselli. Four main symptoms of the affected speech were assessed: changes of the resonance, inappropriate nasal air emission, articulary disorders (deviations from articulation areas), and non-physiological facial expression during speaking, each divided into three grades. Afterwards, the complete speech quality was classified. RESULTS: Assessing the symptoms separately and summarised the therapy including velopharyngoplasty was suitable to improve the speech quality in 83.1% of the cases, resulting in a widely unaffected speech. The improvement was greater in younger patients undergoing operation (Gamma-test, p < 0.001). But the final results were independent from age due to poorer initial situation in younger patients (Gamma-test, p < 0.001). CONCLUSIONS: The velopharyngoplasty is an important method for repair of velopharyngeal insufficiency in patients with cleft palate. In each individual case it is necessary to consider carefully if and when this operation should be performed. An intensive interdisciplinary co-operation of all specialists involved in the treatment is indispensable.

Adolescent↗
PubMed2005

The 'essentials' of essential palatal tremor: a reappraisal of the nosology.

Essential palatal tremor (EPT) is an uncommon disorder, distinct from symptomatic palatal tremor (SPT), but characterized by superficially similar rhythmic movements of the soft palate. While the pathophysiology of SPT has been relatively well defined, this is not the case in EPT. Based on an analysis of 103 published cases, we reviewed EPT in the context of other movement disorders with similar features and outline possible pathophysiological mechanisms. Phenomenologically it remains best classified as a tremor. Four major causes, including a central generator, peripheral/mechanical, voluntary/special skill and psychogenic, appear to account for the majority of cases of EPT, although there is considerable overlap in the pathogenic mechanisms underlying these categories. Among the cases reviewed, a large proportion fit into the latter two categories, although there are others where multiple mechanisms are likely at play. Based on our reappraisal, we suggest a change in designation to 'isolated palatal tremor', with primary and secondary subtypes. This retains the distinction from SPT and emphasizes the non-uniform, heterogeneous nature of the disorder.

Adolescent↗