Uncommon associations with cleft palate: Plausibility of postclosure opening as a cause of cleft palate

Abstract

ObjectiveCurrent consensus from numerous animal studies has emerged that disturbances at any stage of palatal development can cause cleft palate. However, several clinical cases of uncommon forms of cleft palate that may have resulted from rupture after palatal fusion have been previously reported and treated. This hypothesis of postclosure opening as a cause of cleft palate was reviewed in the literature. Materials and methodsWe reviewed Japanese and English-language literature describing uncommon forms of cleft palate, which included palatal remnants, perforation, and divided nevi. In addition, a retrospective chart review of over 1300 cleft palate repairs performed by the authors was done. ResultsThere were many reports of palatal remnants and perforations, but no reports of divided nevi on the cleft palate. Our retrospective chart review revealed that 12 cases may have resulted from postclosure opening, with 5 cases due to epithelial remnants on the hard palate, 5 cases of cleft palate with perforation, 1 case of a palatal sinus, and 1 case of a divided nevus over the cleft. ConclusionsEpithelial remnants did not seem to be evidence of a postclosure opening event, because they were found in 23–85% of intact palates. However, perforation of the hard palate and a divided nevus on the cleft cannot be explained by embryology, which might indicate postclosure opening as a cause of the cleft. Clinical or animal studies are required to test this hypothesis further.