Anterior Hard Palate Research Articles

A nasopalatine duct cyst in an orthodontic patient: a case report

This case report describes the presentation of a nasopalatine duct cyst in a 27-year-old orthodontic patient. The patient presented with pain in the anterior hard palate and a Class II division 2 occlusion with a complete overbite. The cyst was discovered upon further radiographic investigation. Following discussion at a joint orthognathic clinic, the decision was made to leave the cyst under active monitoring and review the patient clinically and radiographically after 12 months. CPD/Clinical Relevance: Nasopalatine duct cysts are common, therefore awareness of their clinical and radiographic features and treatment options is essential.

A brief insight regarding Nasopalatine duct cyst- Report of two cases with a review of literature

Abstract Nasopalatine duct cysts (NPDCs) are among the most common nonodontogenic cysts, typically located in the midline of anterior maxillary hard palate. They usually arise from the embryonic epithelial vestiges of the nasopalatine duct. NPDCs predominantly affect adult males, generally during their fourth decade of life. Clinically, they present as asymptomatic or occasionally painful, fluctuant or discharging swellings involving the hard palate. Radiographically, NPDCs are characterized by a well-defined, fairly corticated, inverted pear-shaped or heart-shaped radiolucency situated between the roots of the maxillary incisors. Histopathologically, NPDCs exhibit a wide spectrum of findings. The lining may be comprised of stratified squamous, pseudostratified ciliated columnar, columnar, or cuboidal epithelium, or a combination and transition of these types. The cystic capsule is fibrocollagenous and can exhibit certain unique features, such as neurovascular bundles, mucous glands, and cartilaginous rests. NPDCs are typically managed through surgical enucleation, and recurrences are rare. Herein, we present two cases of NPDCs, along with a brief overview of their origin, relevant diagnostic features, and management.

Dehiscence and Fistula Formation Following Anterior Palatal Reconstruction With Vomer Flap.

Anterior palatal reconstruction using vomer flaps has been described during primary cleft lip repair. In this procedure, the mucoperiosteal tissue of the vomer is elevated to reconstruct the nasal mucosa overlying the cleft of the hard palate. Here the authors, evaluate the efficacy of a technique in which a superiorly based vomer flap is sutured to the lateral nasal mucosa. The authors assess vomer flap dehiscence rates and compare the likelihood of fistula development in this cohort to patients who underwent palatoplasty without vomer flap reconstruction. A retrospective chart review was conducted of all palatoplasties performed by the senior author at an academic institution during a 7-year period. Medical records were reviewed for demographic variables, operative characteristics, and postoperative complications up to 1 year following surgery. Logistic regression analysis was conducted to assess the effects of vomer flap reconstruction on fistula formation, adjusting for age and sex. Fifty-eight (N=58) patients met the inclusion criteria. Of these, 38 patients (control group) underwent cleft palate reconstruction without previous vomer flap placement. The remaining 20 patients underwent cleft lip repair with vomer flap reconstruction before palatoplasty (vomer flap group). When bilateral cases were counted independently, 25 total vomer flap reconstructions were performed. Seventeen of these 25 vomer flap reconstructions (68%) were completely dehisced by the time of cleft palate repair. In the vomer flap group, 3 of the 20 patients (15%) developed fistulas in the anterior hard palate following the subsequent palatoplasty procedure. In the control group, only 1 of the 38 patients (2.6%) developed a fistula in the anterior hard palate. There was no significant association between cohorts and the development of anterior hard palate fistulas [odds ratio=10.88, 95% confidence interval (0.99-297.77) P =0.07], although analysis was limited by low statistical power due to the small sample size. In our patient population, anterior palatal reconstruction using a superiorly based vomer flap technique was associated with complete dehiscence in 68% of cases. Fistula formation in the anterior hard palate was also proportionately higher following initial vomer flap reconstruction (15% versus 2.6%). These results prompted the senior author to adjust his surgical technique to 1 in which the vomer flap overlaps the oral mucosa. While follow-up from these adjusted vomer flap reconstruction cases remains ongoing, early evidence suggests a reduced requirement for surgical revision following implementation of the modified technique.

Extra-Nasopharyngeal Angiofibroma of the Hard Palate: An Uncommon Case Reported in an Adult Female

Angiofibromas, accounting for a mere 0.05-0.5% of all head and neck neoplasms, are uncommon benign tumors originating from connective tissue and characterized by a high vascularity and local aggressiveness. Juvenile Nasopharyngeal Angiofibroma, extensively discussed in medical literature, represents the most common subtype and is typically found in the nasopharynx. Extra-nasopharyngeal angiofibromas, which occur in locations outside the nasopharynx, are quite rare, with the maxillary sinus being the most typical site according to existing research. This paper presents a unique case of Extra-nasopharyngeal Angiofibroma affecting the hard palate in an adult female. This case is noteworthy due to the tumor's anterior hard palate location, its occurrence in a female patient, and its clinical resemblance to a fibroma, making it the first reported case of its kind.

Morphometric analysis of palatal bone in dentate and edentulous maxillae and literature review. Part I. Incisive Foramen

Objective:To carry out a descriptive study of the morphology of the anterior hard palate, compare the anatomical changes and evaluate the anthropometric measurements that are observed in both dentate and edentulous upper jaws.Methods: Forty dentate and 39 edentulous maxillae of unknown sex, age, and phenotypic traits from a South American population were measured for multiple anatomical landmarks related to the incisive foramen (IF) and buccal bone table between maxillary central incisors and spine. posterior nasal (PNS) with a digital caliper. Means and standard deviation were calculated. Pooled T-Student or Mann-Whitney U tests were used (p < 0.05).Results: The distance between the buccal bone table and the anterior edge of the FI was 6.95 mm in dentate maxillaeand 3.87 mm in edentulous maxillae. The maximum anteroposterior diameter of the FI was 8 mm in dentate and 7 mm in edentulous. The anteroposterior diameter of the FI was 4.91 mm in dentate and 4.21 mm in edentulous. The distance between the vestibular bone table and the PNS was 56.01 mm in dentate and 49.82 mm in edentulous. The distance between the FI and the right and left FPM was 36.12 mm and 36.61 mm, respectively, in dentate patients and 35.95 mm and 36.12 mm in edentulous patients.Conclusion: The present study provides morphometric data of the region of the anterior palatal vault and could help to afford surgeries in this anatomical region

Renal osteodystrophy and brown tumours of the jaw associated with tertiary hyperparathyroidism in the context of cystinosis: a case report

Chronic kidney disease is one of the main manifestations of cystinosis that may lead to hyperparathyroidism. Although head and neck involvement in hyperparathyroidism is rare, lesions can occur in the jaws and cause serious functional handicap. We presented the case of a 24-year-old woman with congenital cystinosis and chronic renal failure complaining from symptomatic expansion of the jawbones. Medical imaging showed radiolucent lesions particularly in anterior hard palate and body of mandible. A diagnosis of renal osteodystrophy and brown tumours related to tertiary hyperparathyroidism was established. Following a subtotal parathyroidectomy and stabilization of parathyroid hormone levels, a conservative mandibular osteoplasty was undertaken to increase the available space for tongue movements. Although non-surgical management remains the primary modality for the treatment of brown tumours, adjunctive surgical approach may be considered in cases of severe functional impairment. It is imperative that underlying systemic imbalances be addressed prior to any maxillofacial intervention to prevent relapse.

A Non-Invasive Method for Monitoring Osteogenesis and Osseointegration Using Near-Infrared Fluorescent Imaging: A Model of Maxilla Implantation in Rats.

Currently, computed tomography and conventional X-ray radiography usually generate a micro-artifact around metal implants. This metal artifact frequently causes false positive or negative diagnoses of bone maturation or pathological peri-implantitis around implants. In an attempt to repair the artifacts, a highly specific nanoprobe, an osteogenic biomarker, and nano-Au-Pamidronate were designed to monitor the osteogenesis. In total, 12 Sprague Dawley rats were included in the study and could be chategorized in 3 groups: 4 rats in the X-ray and CT group, 4 rats in the NIRF group, and 4 rats in the sham group. A titanium alloy screw was implanted in the anterior hard palate. The X-ray, CT, and NIRF images were taken 28 days after implantation. The X-ray showed that the tissue surrounded the implant tightly; however, a gap of metal artifacts was noted around the interface between dental implants and palatal bone. Compared to the CT image, a fluorescence image was noted around the implant site in the NIRF group. Furthermore, the histological implant-bone tissue also exhibited a significant NIRF signal. In conclusion, this novel NIRF molecular imaging system precisely identifies the image loss caused by metal artifacts and can be applied to monitoring bone maturation around orthopedic implants. In addition, by observing the new bone formation, a new principle and timetable for an implant osseointegrated with bone can be established and a new type of implant fixture or surface treatment can be evaluated using this system.

A new perspective on the relationship between anchorage and palatal morphology: Three-dimensional digital model analysis.

The tooth movements were generally analyzed in two dimensions on cephalometric radiographs. Nowaday, 3D digital model analysis, which does not have any harmful effects on patients, can be used to evaluate the palatal morphology and coronal tooth movements in a very comfortable and easy way. To investigate the effect of palatal morphology on anchorage reinforcement during intraoral molar distalization with pendulum appliance using 3D model analysis. The material consisted of before (T0) and after (T1) dental plaster models of Class II malocclusion patients (17 females, 3 males) treated with pendulum appliance for molar distalization and Nance appliance for anchorage. T0 and T1 digital models were superimposed using the palatal area as a reference via three points and surface-matching software, and the changes in teeth movement were calculated for left and right central incisors, first premolars, and first and second molars. Palatal morphology was evaluated at T0 on digital models as palatal inclination, palatal depth angles, and anterior hard palate area. Wilcoxon test was used to evaluate the treatment results and Spearman's correlation analysis was performed to evaluate the relationship between palatal morphology and dental movement. The upper limit for the level of significance was taken as 0.05. Mesial movement of first premolars and distal movement of first and second molars were found to be statistically significant (P < 0.001). A weak negative correlation was found between the palatal inclination and the movement of first premolars (P < 0.045 and P < 0.003). Palatal depth angles and anterior hard palate area had no correlation with dental movements. Presented results supported that the mesial movement of premolar teeth decreased as the inclination of the palate increased.

Six-year post-surgical evaluation in the treatment protocols in the dental arches of children with oral cleft: longitudinal study.

Oral cleft surgical repairs are performed using different techniques worldwide. Objective To evaluate and compare the development of the dental arches of children with unilateral cleft lip and palate before and after the primary surgeries performed with different techniques at the first months and six years of life.Methodology This is a retrospective longitudinal study. The sample comprised 56 dental casts divided int the following groups: Group 1 (G1) – cheiloplasty (Millard technique) at three months and one-step palatoplasty (von Langenbeck technique) at 12 months; and Group 2 (G2) – cheiloplasty (Millard technique) and two-step palatoplasty: anterior hard palate closure (Hans Pichler technique) at three months and posterior soft palate closure (Sommerlad technique) at 12 months. The digitized dental casts were evaluated at three months – pre-surgical (T1) and six years of life– post-surgical (T2). The following linear measurements were analyzed: intercanine (C–C’), intertuberosity (T–T’) distances; anterior dental arch (I–CC’), anterior intersegment (I–C’), and total arch (I–TT’) lengths. The palate area was also measured. Parametric and non-parametric tests were applied (p<0.05).Results In G1, the intragroup comparison showed statistically significant smaller I–CC’ and I–C’ at T2 (p=0.001 and p<0.001, respectively), while T–T’, I–TT’, and area comparisons were significantly greater (p<0.001, p=0.002, and p<0.001, respectively). In G2, the intragroup comparison exhibited statistically significant smaller C–C’ and I–C’ at T2 (p=0.004, for both), whereas T–T’, I–TT’ and area comparisons were significantly greater (p<0.001, p=0.004, and p<0.001, respectively). At T2, the intergroup analysis revealed that G1 had a statistically significant smaller I–CC’ (p=0.014). The analysis of the intergroup differences (∆=T2–T1) showed that G1 had a statistically smaller I–CC’ (p=0.043).Conclusion The two-step palatoplasty showed a more favorable prognosis for the maxillary growth than one-step palatoplasty in children with oral clefts.

FROM A NONSPECIFIC INFLAMMATORY-LIKE GINGIVAL LESION TO A RAPIDLY PROGRESSING ORAL SQUAMOUS CELL CARCINOMA: A CASE OF DECEPTIVE PRESENTATION OF ORAL CANCER

<h3>Introduction</h3> White/red lesions, exophytic masses with or without ulceration, are well-recognized typical presentations of oral squamous cell carcinoma (OSCC). Rarely, clinical characteristics may mimic benign lesions. <h3>Objective</h3> To report an unusual case of OSCC of the anterior maxillary gingiva and hard palate, with an initial nonspecific clinical and histologic presentation mimicking benign inflammatory lesions. <h3>Case Presentation</h3> A 58-year-old, otherwise healthy woman was referred with mild pain and a reddish, papillary, gingivopalatal, inflammatory-like lesion of 6 months' duration. Medications, systemic medical conditions, tobacco use, and parafunctional habits that could generate the appearance were excluded. Radiographs did not reveal any bone involvement. Repeated periodontal treatment, improvement of oral hygiene, topical applications of disinfectant, an antifungal, and corticosteroids all failed to yield any improvement. During a period of 18 months, 3 biopsies were taken from the affected gingiva, showing only benign epithelial hyperplasia with dense chronic inflammation devoid of any evidence of malignancy. Following rapidly progressing tooth mobility of the lateral incisor concomitant with accelerated overgrowth of the anterior palatal gingiva, dental radiography was repeated, and computed tomography was performed. Both revealed an extensive osteolytic lesion in the premaxilla. A new biopsy taken from the affected gingiva and adjacent maxillary alveolar bone yielded a diagnosis of OSCC. Treatment included resection of the premaxilla and floor of the nose with bilateral neck dissection. <h3>Conclusions</h3> This case emphasizes the possibility of a deceptive initial appearance of OSCC, the sudden burst and rapid disease progression, and the importance of close follow-up of unusual nonspecific inflammatory-like processes in the oral cavity.

Clinical study of age-related sensory innervation of the anterior hard palate

The present study aimed to explore the innervation of the anterior hard palatine and its relationship with individual development stage. Specifically, the effects of anesthesia on patients of different ages were observed, and neurodevelopment in the maxillofacial region was invesitgated. References that are helpful in selecting local anesthesia were provided. A total of 182 patients with mixed dentition were randomly divided into the nasopalatine nerve block and greater palatine nerve block groups. Then, 219 patients with permanent dentition were divided into an adolescent group (13-18 years old) and adult group (over 19 years old), all of whom underwent bilateral greater palatine nerve block. Palatal mucosal pain sensation was tested pre- and post-anesthesia with Von Frey hairs. Among the children with mixed dentition, bilateral greater palatine nerve block tended to result in better anesthetic effects than nasopalatine nerve block (P<0.05), except in the incisive papilla. No difference in anesthetic effect was observed between adolescents and adults (P>0.05). The bilateral greater palatine nerve block was more effective in inducing an anesthestic effect in the anterior hard palatine in mixed dentition than in permanent dentition (over 13 years old; P<0.05). The sensation of the anterior hard palatine seems mainly dominated by the greater palatine nerve until mixed dentition and gradually shifted to the nasopalatine nerve in conjunction with maxillary development and tooth replacement. Hence, the innervation of the anterior hard palatine induce a secondary development during the development of the maxilla.

Microsurgical reconstruction of the hard palate after resections for malignant tumors

Background. The main aims of hard palate reconstruction include separation of the nasal and oral cavities, restoration of chewing, swallowing, speech, ensuring good aesthetic results, and preparation for dental rehabilitation. The choice of reconstruction method is determined by such factors as the nature and location of the defect, surgeon’s experience in certain reconstruction methods, cancer prognosis, and patient’s preference. The study objective is to analyze the results of microsurgical reconstruction of hard palate defects using different types of flaps. Materials and methods. Forty-one (41) patients underwent microsurgical reconstruction of defects of the hard palate, soft palate, and alveolar process between 2014 and 2020. Defects of the anterior portion of the hard palate (grade I, IIc, IId according to the classification of J.S. Brown; grade IB, II, III according to the classification of D.J. Okay) were formed in 13 cases; all of them involved the alveolar margin of the maxilla to some extent. To repair these defects, we used flaps containing revascularized bone (n = 10; scapular tip flaps in 8 patients and fibular flaps in 2 patients) and fasciocutaneous or musculocutaneous flaps (n = 3; radial fasciocutaneous flaps in 2 patients and musculocutaneous flap from the anterior surface of the thigh in 1 patient). Defects of the posterior portion of the hard palate (grade Ib according to the classification of J.S. Brown; grade Ib according to the classification of D.J. Okay) were formed in 18 patients. To repair these defects, we used radial fasciocutaneous flaps (n = 17) and fibular autologous graft containing skin, muscles, and bone (n = 1). Soft palate resection was performed in 10 patients; all surgeries were combination, since the lateral oropharyngeal wall was included in the block of removed tissues. None of the patients had the opposite side affected. These defects were repaired using radial fasciocutaneous flaps.Results. Six patients (15 %) developed total flap necrosis due to venous thrombosis on days 2, 3, and 6 postoperatively; two patients developed flap necrosis due to arterial thrombosis 2 days postoperatively. Good speech quality was achieved in 33 patients (80 %), while 6 patients (15 %) had satisfactory speech; rhinolalia was observed in 2 patients (5 %). All patients with defects of the posterior hard palate and of the soft palate had excellent aesthetic results. Among participants with defects of the anterior hard palate and alveolar process, 10 patients had excellent aesthetic results, while 5 individuals had good results. Three patients had unsatisfactory results due to scarring in the middle portion of the face.Conclusion. Patients with subtotal defects of the hard palate and defects of its anterior portion (grade I, IIb, IIc according to the classification of J.S. Brown; grade II, III according to the classification of D.J. Okay) require repair of the alveolar margin of the maxilla; flaps containing revascularized bone are preferable in this case. The method of choice is defect repair using musculoskeletal scapular tip flap. In patients with short defects, defects located posteriorly, minimal or no defect of the alveolar margin of the maxilla (grade Ia, IB according to the classification of J.S. Brown; grade Ia, Ib according to the classification of D.J. Okay; grade V according to the classification of M.A. Aramany), soft palate defects, radial fasciocutaneous flaps should be used.

A Solitary Extra-osseous Neurofibroma of the Hard Palate: a Case Report and Literature Review

Neurofibromas are benign neoplasm arising from peripheral nerves which are composed of Schwann cells, perineural cells, and a variable amount of mature collagen. A solitary neurofibroma is a single neurofibroma that occurs in an individual who does not have hereditary neurofibromatosis. The occurrence of solitary neurofibromas in the oral cavity is less frequent, and those in the hard palate are even rare. We report an interesting case of the solitary neurofibroma in a 50-year-old female, who presented with a slowly progressive swelling in the anterior hard palate. Histopathological examination of the excised specimen revealed a neurofibroma. Immunohistochemistry by S-100 and demonstration of mast cells by toluidine blue staining confirmed the histopathological diagnosis of neurofibroma. Neurofibroma should be considered as one of the differential diagnosis while evaluating a swelling involving the hard palate.

DIAGNOSIS OF SYSTEMIC PARACOCCIDIOIDOMYCOSIS THROUGH AN ORAL LESION: A CASE REPORT

Paracoccidioidomycosis is a systemic fungal infection that can affect an oral mucosa. A 75-year-old male patient who was a farmer, smoker, and drinker had complaint of injury in the mouth that did not regress and caused pain. He had no systemic or extraoral changes. At the intraoral examination a reddish nodule with firm consistency measuring 1.0 × 1.0 × 0.3 cm was observed on the anterior hard palate. An incisional biopsy was performed, and chest x-ray was requested. Histopathologic examination confirmed a first clinical case of oral paracoccidioidomycosis, and the chest image showed lungs changes compatible with deep fungal infection. The patient was refereed to an infectious disease physician who prescribed antifungal treatment, and he appeared to be well after treatment, which was seen during his follow-up with a stomatologist. This fact illustrates the importance of a professional stomatologist in the diagnosis of deep fungal infections. Paracoccidioidomycosis is a systemic fungal infection that can affect an oral mucosa. A 75-year-old male patient who was a farmer, smoker, and drinker had complaint of injury in the mouth that did not regress and caused pain. He had no systemic or extraoral changes. At the intraoral examination a reddish nodule with firm consistency measuring 1.0 × 1.0 × 0.3 cm was observed on the anterior hard palate. An incisional biopsy was performed, and chest x-ray was requested. Histopathologic examination confirmed a first clinical case of oral paracoccidioidomycosis, and the chest image showed lungs changes compatible with deep fungal infection. The patient was refereed to an infectious disease physician who prescribed antifungal treatment, and he appeared to be well after treatment, which was seen during his follow-up with a stomatologist. This fact illustrates the importance of a professional stomatologist in the diagnosis of deep fungal infections.

Pleomorphic Adenoma of the Anterior Hard Palate: A Rare Case Report

Pleomorphic adenoma (PA) is a benign tumor of the salivary glands that has components of both epithelialand mesenchymal origin. The most common site for the PA is the parotid or submandibular glands. On rareoccasions, the tumor may arise from the minor salivary glands and present as an intraoral swelling overthe hard palate or lip. But the anterior hard palate is not the commonest site for PA. We report the case of a42-year old man who came with a complaint of a swelling in the anterior region of the hard palate and laterdiagnosed as pleomorphic adenoma based on histopathological examination.

Estimation of height and width of bone in anterior hard palate as a donor site for autogenous bone graft using IOPA by long cone paralleling technique.

The purpose of this study was to determine the amount of bone available for harvesting from the anterior palate region using IOPA (Intra Oral Peri Apical) radiographs. A total of 80 patients visiting the outpatient Department of Periodontics were selected. Two groups of male and female consisting 40 patients each were made. They were further subdivided into two groups based on age, 18-30 and 31-60 years of age, each with twenty patients. The patients were subjected to radiographic examination consisting of IOPA radiographs. All IOPA radiographs were taken using long cone paralleling technique. Availability of bone for harvesting, above the apices of teeth was calculated. The bone available in the incisor region was approximately 6.5 to 6.9 mm in height and 7.4 to 8 mm in width, in canine region 6.35 to 6.65 mm in height and 7.6 to 8.1 mm width, and in the premolar region 3.65 to 3.75 mm in height and width. When the bone height and width were compared gender and age wise for CI (central incisors), LI (lateral incisors), canine and premolars, using Student's t- test the results were not statistically significant. For the purpose of harvesting autogenous bone, from the region of incisor and canine approximately 6.35 to 6.9 mm height and 7.4 to 8.1 mm width of bone may be harvested maintaining a safe distance from the apices of the teeth and the nasal floor. The premolar region does appear to yield sufficient bone at safe distances from the maxillary sinus and the apices of the premolars.

Whole saliva and residual mucosal saliva in patients with burning mouth syndrome: a case-control study

Objectives Burning mouth syndrome (BMS) is a chronic pain condition. Xerostomia is a common complaint among patients with BMS. However, previous studies have reported inconsistent findings regarding salivary flow rate reduction among these patients. The aim of this study was to examine unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) flow rates, degree of mucosal hydration, and xerostomia in female patients with BMS compared with controls. Study Design The study included female patients diagnosed with BMS (ICD-10 code K14.6) at a university oral medicine clinic. Controls were similarly aged women without BMS. Collection of salivary samples and other data took place during a 1-hour session between 9:00 a.m. and 12:00 noon. UWS was collected under resting conditions by passive drooling into a plastic tube for 10 minutes; to assess mucosal hydration, residual mucosal saliva (RMS) was collected by using filter paper strips, from 4 mucosal sites—anterior hard palate, buccal mucosa, anterior tongue, and lower lip. The strips were then placed in a microcentrifuge tube and weighed. SWS was collected while the patient chewed on gum base for 5 minutes. Low UWS was defined as 0.1 mL/min or less and low SWS as 0.7 mL/min or less. Participants completed the Short Form of the Xerostomia Inventory (SXI-D). We used the χ2 test to assess the association between UWS, SWS, and BMS and t tests to assess the differences in residual mucosal saliva (RMS) levels. Results Fifty-six women (27 cases and 29 controls) participated in this study. Mean age was 61 years for cases and 58 for controls (n.s.). Most participants in each group were postmenopausal; 66% of cases versus 38% of controls had low UWS (P = .03; and 48% of cases versus 34% of controls had low SWS (P =.06). Compared with controls, BMS cases had lower mean levels of tongue RMS (0.007 g vs 0.01 g; P = .03); 55% of the cases versus 7% of controls reported xerostomia (P Conclusions Patients with BMS had statistically significant reductions in UWS and tongue RMS and a higher prevalence of xerostomia. Low hydration of the tongue should be further investigated as a possible trigger of xerostomia sensation.

Range and timing of surgery, and surgical sequences used, in primary repair of complete unilateral cleft lip and palate: The Cleft Care UK study.

To describe the range of surgery used to repair the lip and palate in the UK with specific interest in the sequence/timing used in complete unilateral cleft lip and palate (cUCLP). The Cleft Care UK study, a cross-sectional study of 268 5-year-olds, born from 2005 to 2007, with complete unilateral cleft lip and palate. Information on surgery was extracted from medical notes by surgeons during research clinics and transcribed onto a standardized questionnaire. Surgical data were available for 251 (94%) children from all cleft centres in the UK (n=18). Over a two-year period, 32 surgeons used 10 different surgical sequences in primary repair of the cleft lip and palate. The most frequently used sequence was repair of cleft lip and anterior hard palate followed by repair of posterior hard palate and soft palate (70%). Four surgical sequences were used only once. Most surgeons had a preferred sequence, but 38% (11/29) used more than one sequence during the study period. The timing of repair of the lip, the hard palate and the soft palate varied with surgical sequence, and also between surgeons, even adjusting for the different sequences used. Despite centralization of cleft services in the UK, there remains considerable variation in both the sequence and timing of surgical repair of cleft lip and palate in infancy. Further work is required to understand whether these factors are associated with differences in outcome.

TERAPI IMUNOSUPRESAN PADA PASIEN ANEMIA APLASTIK DENGAN PERDARAHAN GUSI: MENYEMBUHKAN ATAU MEMPERPARAH?

Background: Aplastic anemia (AA) is a hematologic disorder characterized by hypoplastic bone marrow and peripheral pancytopenia. The main symptoms are fatigue and bleeding. In the oral cavity, gingival bleeding is the common complaint.Case Management: A 18-year-old female patient referred from internal medicine department due to swelling of palate since 2 days before that interrupted eating activity. She routinely consumes Sandimun®100 mg tablets. A 2 x 1 cm black blood clot in anterior hard palate and ulcerative lesion at dorsal tongue regio 45 surrounded by necrotic area were found on intra oral examination. Patient was diagnosed with necrotizing ulcer-related neutropenia accompanied by AA-associated hemorrhagic bullae in the hard palate. Patient treated with mouthwash containing 0.1% hyaluronicacid and 1% feracrylum.Discussion: Immunosuppressant is the AA gold standard therapy. Cyclosporine (CsA) as imunosupressant is common drug to prevent T cells from attacking stem cells in bone marrow. The side effects of CsA is gingival hiperplasia.Conclusions: Gingival bleeding and gingival hiperplasia due to thrombocytopenia and the use of cyclosporine are vicious circles that need to be aware. With comprehensive management, good oral conditions will be obtained, therefore the quality of life can increase.

Papillomatosis of the hard palate

A 21-year-old woman was referred by her periodontist to the Department of Dentistry at University Hospital in London, Ontario, Canada, for evaluation. The patient had a 4-year history of recurrent papillary growths of the anterior hard palate and palatal attached gingiva. The patient’s medical history was significant for a hemangioma of the ankle and a lipoma of the left supraclavicular region. Her developmental history was normal, and her family history was noncontributory. Ms. Leon is a third year dental student, Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Dr. Shuen was a medical geneticist, Division of Medical Genetics, Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada. Dr. Shuen is now a medical geneticist, The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Vizirakis is a periodontist, Sarnia Periodontics and Dental Implants, Sarnia, Ontario, Canada. Dr. McCord is an assistant professor, Departments of Pathology and Laboratory Medicine and Dentistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and a staff oral pathologist, Department of Dentistry, London Health Sciences Centre, London, Ontario, Canada.