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PubMed1997

The influence of different types of hard-palate closure in two-stage palatoplasty on maxillary growth: cephalometric analyses and long-term follow-up.

Using cephalometric analysis we investigated the influence on maxillary growth of two different types of hard-palate closure in two-stage palatoplasty. In 12 patients with complete unilateral cleft lip, alveolus, and palate, the lip and soft-palate were closed between 3 and 7 months of age. These 12 patients were then assigned to two groups of 6. In one group the hard palate was closed at 1 year 5 to 11 months of age by a vomer flap with a skin graft (VF group, Osada's two-stage palatoplasty) and in the other group it was closed by the mucoperiosteal pushback procedure (PB group). Sella-nasion-point A (SNA) in the VF group at 3 to 4 and after 10 years of age were within normal range and significantly larger than in the PB group. Two patients in the PB group required orthognatic surgery to obtain normal occlusion and a well-balanced profile. We concluded that in two-stage palatoplasty better maxillary growth can be obtained using the vomer flap method than using the pushback procedure.

Adolescent↗
PubMed2005

Natal teeth: a potential impediment to nasoalveolar molding in infants with cleft lip and palate.

The purpose of this article is to describe two cases of bilateral cleft lip and palate with natal/neonatal teeth. Clinical features, prevalence, possible complications, and treatment modalities are discussed. Two patients with cleft lip and palate and natal/neonatal teeth are described. The first patient was a 4-week-old infant with bilateral cleft lip and palate. On initial inspection an odontogenic vestige was noticed on the right lateral border of the premaxillary segment, bordering the cleft. The second patient was a newborn with a vestige on the right side of the premaxilla. At 20 days, another swelling representing a neonatal tooth on the left side was found. Because the teeth interfered with the fabrication and application of the nasoalveolar molding (NAM) appliance, they were removed from both patients. In the first patient, at 1 week after extraction, the NAM device was placed without difficulty. At 8 months, the infant had adapted well to the NAM device and nursed without problems. The second patient did not follow-up for the placement of the NAM device. In patients with cleft lip and palate with natal/neonatal teeth who require NAM, the tooth must be removed to facilitate the fabrication and placement of the device. Natal/neonatal teeth must be extracted with caution because the tooth buds of neighboring teeth may be damaged and remnants of the dental papillae may be left behind. Although general anesthesia is not always indicated for the removal of these teeth, in cases in which the premaxilla is loose, such as the current cases, general anesthesia is warranted.

Cleft Lip↗
PubMed1998

Reconstruction of the soft palate by uvulopalatal flap.

Surgical removal of the soft palate in cases of neoplastic disease has a functionally detrimental effect on the patient, resulting in rhinolalia and nasal regurgitation. The authors describe their original surgical technique for repairing the lateral soft palate defect using a uvulopalatal flap. The flap is readily available and the procedure is single staged and without sequela. The aim of this reconstructive procedure is to obtain a diminished soft palate defect by primary surgery. In five patients who underwent a partial excision of the soft palate, the surgical defect was corrected at the time of initial surgery by a uvulopalatal flap. In this technique, the surface of the defect was diminished, postoperative rhinolalia and regurgitation were unremarkable, and sometimes an obturator was obviated. Using a local myomucosal flap, the procedure is simple, safe, and effective.

Adult↗
PubMed2000

The uvulopalatal flap for reconstruction of the soft palate.

OBJECTIVE: To determine the indications, complications, and outcomes of the uvulopalatal flap in the reconstruction of defects of the soft palate. STUDY DESIGN: Retrospective review. METHODS: Patient data were obtained from the hospital records of 18 patients who had soft palate defects reconstructed with the uvulopalatal flap over a 5-year period at a tertiary academic medical center. RESULTS: Eleven patients had the uvulopalatal flap as the sole method of reconstruction, whereas this flap was used in combination with a radial forearm free flap, pectoralis flap, and skin graft in 4, 2, and 1 patients, respectively. All flaps were successful in soft palate reconstruction. One flap was successfully revised after additional tumor resection. A partial flap dehiscence occurred in one patient and healed uneventfully. Speech and swallowing function was dependent on initial tumor stage and the scope of tumor resection. CONCLUSIONS: The uvulopalatal flap is a simple and effective method of soft palate reconstruction either alone or in combination with other methods of reconstruction for selected oropharyngeal defects.

Adult↗
PubMed2001

Palatal fistulas: rare with the two-flap palatoplasty repair.

The purpose of this study was to examine the palatal fistula rate after repair with the two-flap palatoplasty technique. This is a retrospective review of 119 consecutive cleft-palate repairs performed over a 5-year interval by a single surgeon. The two-flap palatoplasty technique was used to provide tension-free, multilayer repairs. The age of these children at the time of repair ranged from 7 to 84 months (mode, 9 months). The initial follow-up visit occurred 2 to 12 weeks after the repair operation (mean, 4 weeks). The postoperative follow-up duration ranged from 7 to 48 months. This review of 119 cleft-palate repairs revealed a fistula rate of 3.4 percent (four fistulas in 119 repairs). This experience demonstrates the lowest reported palatal fistula complication rate with use of the two-flap palatoplasty technique.

Child↗
PubMed2006

Cervical metastasis from squamous cell carcinoma of the maxillary alveolus and hard palate.

OBJECTIVES: Squamous cell carcinoma has a predilection for regional lymphatic metastasis. The occurrence of occult cervical metastases from squamous cell carcinoma of the hard palate and maxillary alveolar ridge has not been studied systematically. We have observed many patients who have returned after resection of a primary cancer in these sites with a delayed cervical metastasis. Some of these patients have died of regional or distant metastasis despite control of their primary cancer. METHODS: We have studied 26 patients with squamous cell carcinoma of the maxillary alveolar ridge and hard palate to define incidence of cervical metastasis. RESULTS: Overall incidence of cervical metastasis was: clinical 2 of 26 (7.6%) and occult 7 of 26 (27%) for a total of 9 of 26 (34.6%). The 5-year disease-specific survival was 13 of 22 (59%). Surgery for regional failure was successful in 66% (6 of 9). Radiation was administered after surgery in eight of nine patients. CONCLUSION: Cervical metastasis from cancer of the palate and alveolar ridge is significant. Regional surgery for recurrent disease usually requires radical or modified radical neck dissection. Selective elective neck dissection should be offered to patients with cancer of the hard palate and alveolar ridge. It affords the patient and the treatment team valuable histologic information, which may help to guide therapy and reduce the potential need for future hospitalization, chemoradiation, and more radical surgery.

Carcinoma, Squamous Cell↗
PubMed2006

Unilateral complete cleft lip and palate repair using lip adhesion combined with a passive intraoral alveolar molding appliance: surgical results and the effect on the maxillary alveolar arch.

BACKGROUND: A number of combined maxillary orthopedic and surgical treatment protocols have been proposed for the initial phase of therapy for infants with a complete cleft lip and palate. METHODS: Lip adhesion was used in combination with a passive intraoral molding appliance to treat a unilateral complete cleft lip and palate. The proposed protocols are lip adhesion, along with positioning of a passive alveolar molding appliance, at 4 to 6 weeks of age, then definitive cheiloplasty at 4 to 5 months of age, and palatoplasty at 12 months of age. Twenty-five patients with a complete cleft lip and palate were treated using this protocol between 1994 and 2003. The follow-up period was between 6 months and 10 years. RESULTS: The alveolar gap, the length of the maxillary alveolar cleft, and the palatal gap were 10.1 +/- 4.2 mm, 6.1 +/- 0.9 mm, and 13.4 +/- 2.9 mm for lip adhesion, 3.1 +/- 1.4 mm, 2.6 +/- 0.8 mm, and 9.6 +/- 1.5 mm for definitive cheiloplasty, and 0.2 +/- 0.1 mm, 1.5 +/- 0.7 mm, and 8.3 +/- 1.1 mm for palatoplasty. For the following maxillary dental casts for 3 to 10 year olds, the intercanine width and canine arch lengths were within the normal value. The intermolar width and the molar arch length, however, decreased slightly compared with the control normal values. CONCLUSIONS: Lip adhesion and a passive alveolar molding appliance achieved a normal position and stabilized the arch in a symmetrical platform.

Alveolar Process↗
PubMed2003

Cleft palate with congenital midline teratoma.

A 4-year-old girl presented with hypernasal speech. On examination, in addition to velopharyngeal incompetence noted by speech examination, a palatal tumor was found in between the cleft palate. The computed tomographic and magnetic resonance imaging examinations were suspicious for midline teratoma. Total excision of the nasopalatal tumor was performed, and the pathology revealed benign teratoma. After 6 months of follow-up, no recurrence was noted. A two-flap palatoplasty with a superior-based pharyngeal flap was then performed to reconstruct the palatal defect and to correct the velopharyngeal incompetence. An anterior oronasal fistula developed after the operation, but a tongue flap was transferred to cover the defect successfully. The purpose of this case report is to present the relationship between a congenital midline nasopalatal tumor and cleft palate.

Child, Preschool↗
PubMed1995

Distribution of p21ras during primary palate formation of non-cleft and cleft strains of mice.

Cleft lip, with or without cleft palate, is one of the most common defects in craniofacial formation. The primary palatogenesis of mice is similar to that of humans and spontaneous cleft lip is associated with genotype in both mice and humans. To investigate the temporal and spatial expression of ras genes in cleft (A/WySn) and non-cleft strains of mice (BALB/cBy), a broad spectrum ras antibody was used. Positive staining was found in ectodermal, mesenchymal, and neuroepithelial cells of facial prominences before the primary palate formation stage (10 d 20 hr) in both strains. During the primary palate formation stage (11 d 20 hr), positive staining was found in the ectodermal and mesenchymal cells of the facial prominences of the non-cleft strain but not in those of the cleft strain. These results suggest ras genes may play a role in the primary palatogenesis of mice. Cleft lip could be associated with the deficiency of ras gene expression during primary palate formation of mice.

Animals↗
PubMed1999

TGFbeta isoforms and decorin gene expression are modified in fibroblasts obtained from non-syndromic cleft lip and palate subjects.

Interaction between extracellular matrix (ECM) and cytokines is thought to be crucial for palatal development. The localization of transforming growth factors (TGFalpha and TGFbeta isoforms) in craniofacial tissues suggests that they carry out multiple functions during development. In the present report, we studied TGFalpha, TGFbeta1, and TGFbeta3 expressions and their effects on ECM macromolecule production of normal and cleft palatal fibroblasts in vitro, to investigate the mechanisms by which the phenotypic modulation of fibroblasts occurs during the cleft palate process. The results indicated that, while TGFalpha mRNA was not evidenced in CLP or normal fibroblasts, a reduced TGFbeta1 hybridization signal was detected in CLP fibroblasts. In addition, these secreted more active TGFbeta3 than TGFbeta1, as evaluated in a biological assay. The CLP phenotype, which differed from the normal one because of its higher PG decorin expression and greater production of GAG and collagen, was further modified by the addition of growth factors. In fact, in CLP fibroblasts, TGFalpha and TGFbeta1 down-regulated PG decorin transcript, TGFbeta1 increased collagen and GAG in both cellular and extracellular compartments, and TGFbeta3 promoted secretory processes of cells. In conclusion, the data represent the first report in a human model in vitro that TGFbeta1 and beta3 are differently expressed and are correlated to the CLP phenotype. Thus, strength is given to the hypothesis that TGFbeta isoforms are the potential inducers of phenotypic expression in palatal fibroblasts during development and that an autocrine growth factor production mechanism may be responsible for the phenotypic modifications.

Analysis of Variance↗
PubMed1987

Effects of chlorcyclizine-induced glycosaminoglycan alterations on patterns of hyaluronate distribution during morphogenesis of the mouse secondary palate.

Chlorcyclizine (CHLR) enhances the degradation of hyaluronate (HA) into smaller molecular weight pieces with no effect on its synthesis. Administration of CHLR to pregnant CD-1 mice on gestational days 10.5, 11.5 and 12.5 results in 100% cleft palate in the fetuses. The caudal two thirds of the palatal shelves are reduced in size and unable to reorient in vitro, while anterior shelf regions are relatively unaffected. Alcian blue staining combined with specific enzymic digestion was used to identify HA in sections of CHLR-treated shelves. With the aid of computer-assisted image subtraction the patterns of HA distribution across the tissue section were objectively identified. Anterior, posterior and presumptive soft palatal shelf regions were examined at gestational days 13.25, 13.5, 13.75 and 14.5. Acquisition of a normal pattern of HA distribution was delayed by about 24 h, as compared to untreated specimens in all three shelf regions. The posterior and soft regions, comprising the caudal two thirds of the shelf, also showed pronounced shape change. These regions only displayed normal curvature of the nasal surface when a normal pattern of HA distribution was attained. These results suggest that, for the caudal two thirds of the palatal shelf, normal shape and the ability to remodel are linked to the molecular configuration of HA and to a specific pattern of HA distribution.

Animals↗
PubMed2002

A solitary huge neurofibroma of the soft palate.

Neurofibroma of the soft palate, an extremely rare tumour, is probably not yet reported in the literature. We report the first case of an isolated neurofibroma of the soft palate not associated with von Recklinghausen's disease (VRD), which is also, probably, the first reported case of neurofibroma of the soft palate. The tumour was completely removed from the soft palate after performing tracheostomy, necessitated due to difficulties in intubation.

Female↗
PubMed2004

Morphological evaluation of changes in velopharyngeal function following maxillary distraction in patients with repaired cleft palate during mixed dentition.

OBJECTIVE: To describe the morphological changes of nasopharyngeal components after maxillary distraction and clarify whether the morphological characteristics are related to velopharyngeal function (VPF). DESIGN: Perceptual judgments of hypernasality and nasendoscopy were performed before and after treatment. Lateral cephalograms were obtained to describe the morphological changes. SETTING: Department of Oral and Maxillofacial Surgery, Miyazaki Medical College, Miyazaki, Japan. PARTICIPANTS: Nine patients with repaired cleft palate in the mixed dentition stage underwent maxillary distraction using a face mask and an intraoral fixed appliance system. OUTCOME MEASURES: The severity of hypernasality, velopharyngeal insufficiency, and measurements such as pharyngeal depth, velar length, and the rotation of the palatal plane were evaluated. RESULTS: Increase in pharyngeal depth was not always proportional to the amount of advancement. It depended on the posture of the posterior pharyngeal wall and the rotation of palatal plane. CONCLUSION: Cephalometric measurements of the nasopharynx before and after surgery confirmed subsequent changes in VPF. These were suggested to be useful in predicting future VPF. When performing maxillary distraction in patients with cleft palate in the mixed dentition stage, and when velopharyngeal closure is found to occur by velar contact against the hypertrophied adenoid, patients should be counseled about risks of subsequent deterioration in their speech before surgery.

Adenoids↗
PubMed1990

Histologic study of the normal human adult soft palate.

Detailed information about the tissue components of the soft palate is needed to construct biomechanical models that are functionally useful. Soft palates were removed from 10 adult cadavers, four males and six females. One-half of each palate was further divided into 10 blocks of equal anterior-to-posterior thickness. The face of each block was sectioned and stained using three different stains, thus providing a sample of 300 histologic slides. Each slide was carefully examined and major anatomic characteristics were noted and recorded. The results indicate that a typical adult soft palate consists of several major tissue layers including: (1) the oral aspect, which is glandular with a zone of adipose tissue located somewhat laterally; (2) the two middle layers are muscular with the more inferior layer consisting mainly of transverse levator veli palatini fibers and the overlying longitudinal layer of musculus uvulae fibers; (3) a superoanterior layer consisting of the tensor veli palatini tendon; and (4) a posteroinferior layer consisting of a mixture of tissue that is primarily glandular. The oral mucosa consists of stratified squamous epithelium with a basement membrane that is reinforced with a dense meshwork of elastic fibers. The nasal mucosa consists of pseudostratified ciliated columnar epithelium anteriorly and stratified squamous epithelium posteroinferiorly. The functional implications of these findings are discussed.

Adipose Tissue↗
PubMed1992

Soft palate reflex: technical requirements and first results.

The present study describes technical prerequisites for soft palate reflex measurements and first results. Reflex measurements can be done using standard electromyographic methods. The data-processing system that records and processes the electromyographic signals was activated when the soft palate was stimulated by a newly developed device. The first results of objective soft palate reflex measurements in 15 healthy subjects show that the musculus levator veli palatini reacts to a mechanical stimulation of the soft palate with a contraction that can be measured electromyographically. The response latencies were constant in the individual subjects. In 12 subjects a minimum of 30 ms and a maximum of 61 ms was recorded. In one healthy subject, the reflex was activated only after 167 ms. No reflex could be evoked in two subjects. The stimulus was always supraliminal. Reaction time was longer following surface anesthesia of the oral mucosa.

Adult↗
PubMed1993

Perceptual assessment of resonance distortion in unoperated clefts of the secondary palate.

The purpose of this study was to examine the frequency with which five speech-language pathologists made judgments of hypernasality during the clinical assessment of young children with unoperated and repaired clefts of the secondary palate. Among the 293 nonsyndromic patients with secondary palate clefts included in this study, 219 were between 1 and 2 years of age. Of those, 83 had undergone primary palatoplasty whereas 136 had not. The remaining 74 children were between the ages of 4 and 5 years and presented with repaired secondary palatal clefts. The results showed that the clinicians were unable or unwilling to assess hypernasality in 31% of the 1 to 2 year old children with unoperated clefts. The same clinicians failed to evaluate oral-nasal resonance balance in only 12% of the children in the 1- to 2-year age group who had undergone palate repair. Only 1 of the 74 older children (1.4%) was not evaluated for hypernasality. Possible explanations for these findings are presented and discussed.

Child Language↗
PubMed2000

The basis for presurgical orthopedic treatment of infants with unilateral complete cleft lip and palate.

OBJECTIVE: The purpose of this study was to describe the posttreatment morphology of the upper part of the oral cavity of complete unilateral cleft lip and palate (UCLP) patients and to compare it to noncleft contemporaries. Patients were treated according to a protocol designed to keep a proper resting posture of the oral cavity. DESIGN: Retrospective study on dental casts. SETTING: The study was performed at a maxillofacial center serving a population of 2 million inhabitants. Data for noncleft subjects are the result of a longitudinal study at the same institution. PATIENTS: Twenty-one Caucasian UCLP patients (13 males, 8 females) aged 5 to 9 years with no other congenital anomalies and no postoperative orthodontic treatment. INTERVENTIONS: Each patient received 5 to 6 months of preoperative orthopedics with a passive plate and external nonelastic strapping with definitive lip repair at age 5 to 7 months, soft palate repair at 11 to 15 months, and hard palate repair with mucoperiosteal closure of the alveolus at 30 to 36 months. Each patient was compared to the mean values obtained from a longitudinal study of a group of 25 healthy noncleft children of the same ethnic group (11 males, 14 females). RESULTS: Analysis of dental casts indicated that 16 patients had a width, depth, and length of the alveolar arch in the range of the mean normal values minus two standard deviations. Their analyzed palates were flatter than normal. Six of 21 children had too small an alveolar arch for their ages, and they did not acquire a correct posture of the oral cavity. CONCLUSION: The results indicate that the upper part of the oral cavity of UCLP patients can reach the dimensions of noncleft contemporaries despite surgery.

Child↗
PubMed2001

Characteristic forms of the upper part of the oral cavity in newborns with isolated cleft palate.

OBJECTIVE: To determine the functional and morphological compensation of the lack of integrity in the upper part of the oral cavity in newborns with isolated cleft palate. Integrity of the upper part of the oral cavity is required for the effective pumping of amniotic fluid, the essential mode of nutrition in intrauterine life. The adaptation could be seen immediately after birth. MATERIALS: Plaster casts of the upper part of the oral cavity in 60 newborns with isolated cleft palate of various extent and plaster casts of the upper part of the oral cavity in 27 newborns without cleft were used. A number of surface points were identified and used for a trigonometric morphological analysis. RESULTS: The parameters of the upper part of the oral cavity in four groups of newborns with various extent of isolated cleft palate were compared with newborns without cleft palate. The results indicate a shift of the functional oral cavity into the nasal cavity and the pharynx, depending on the extent of the cleft. CONCLUSION: The pumping activity of the tongue forms the upper part of the oral cavity and consequently the tongue moves into the nasal cavity and pharynx, depending on the extent of the cleft. In this way, effective pumping of amniotic fluid is possible despite the cleft. This is of vital importance for the fetus during intrauterine life. A poorly passable or even unpassable respiratory way is only of secondary importance during that time.

Adaptation, Physiological↗