Cleft Of Hard Palate Research Articles

Surgical repair of hard palate cleft with absorbable membrane: the new surgical technique and its clinical application.

This study evaluated a new surgical technique with absorbable membrane to repair hard palate cleft without extensive mobilisation of the mucoperiosteum. From 2001 to 2002, 32 selected patients with complete unilateral clefts underwent this surgical operation. The traditional flap surgical operation was performed at the soft palate, uvula and anterior alveolar cleft. The absorbable membrane was implanted to the hard palate cleft gap to guide the regeneration of the mucoperiosteum. The patients were followed up for 1-6 months after the operation. The speech assessment was carried out 12 months after the operation. Of 32 patients, 30 were successfully operated by this method and no obvious complications occurred. Primary healing on tissue defect of hard palate was obtained in 27 patients and secondary healing in 3 patients. Eighty percent of the 30 patients had good or excellent speech 12 months after the operation. The operation failed in 2 patients. The surgical technique with absorbable membrane to repair hard palate appears to have several valuable advantages including the decreased area of the hard palate involved and favourable outcome for speech in the majority of cases.

Surgical repair of hard palate cleft with absorbable membrane: the new surgical technique and its clinical application.

This study evaluated a new surgical technique with absorbable membrane to repair hard palate cleft without extensive mobilisation of the mucoperiosteum. From 2001 to 2002, 32 selected patients with complete unilateral clefts underwent this surgical operation. The traditional flap surgical operation was performed at the soft palate, uvula and anterior alveolar cleft. The absorbable membrane was implanted to the hard palate cleft gap to guide the regeneration of the mucoperiosteum. The patients were followed up for 1-6 months after the operation. The speech assessment was carried out 12 months after the operation. Of 32 patients, 30 were successfully operated by this method and no obvious complications occurred. Primary healing on tissue defect of hard palate was obtained in 27 patients and secondary healing in 3 patients. Eighty percent of the 30 patients had good or excellent speech 12 months after the operation. The operation failed in 2 patients. The surgical technique with absorbable membrane to repair hard palate appears to have several valuable advantages including the decreased area of the hard palate involved and favourable outcome for speech in the majority of cases.

Delayed detection of cleft palate: an audit of newborn examination

Aims: To identify prevalence of delayed detection of cleft palate, and associated factors that could lead to improved identification at neonatal clinical examination. Methods: Audit of hospital notes, parental questionnaire...

Distraction Osteogenesis for Cleft Palate Closure in a Canine Model

To assess the utility of distraction osteogenesis (DO) when applied to closure of a hard palate cleft in dogs. A midline hard palate cleft was created in 10 mature dogs. Two were controls and had no distraction; the other 8 dogs underwent osteotomies with installation of customized DO devices to the hard palate. After a 10-day latency, distraction commenced at 1 mm/d. After a 14-day consolidation period, the device was removed and the mucosa closed. Each dog was injected with fluorochrome labels and serially killed at 2-week intervals. Bone healing was analyzed further with traditional histologic analysis and fluorochrome labeling. No serious complications occurred. Bone resorption and cleft widening occurred in both control dogs. Complete bone closure of the hard palate cleft was achieved with DO in 5 of 8 experimental dogs. Three experimental dogs had bone resorption and incomplete palatal closure. The application of DO techniques in closure of a hard palate cleft in a canine model is safe and well tolerated. Furthermore, in some cases, it proved effective in achieving bony closure of the cleft. Further investigation is warranted into innovative use of DO in treating children born with cleft palate.

Nasal airflow and olfactory function after the repair of cleft palate (with and without cleft lip)

The objective of this study was to examine nasal airflow and olfactory functions in patients with repaired cleft palate compared with matching normal controls. The all-cleft group consisted of 25 patients with hard palate cleft comprising 15 patients with unilateral cleft palate and lip (UCLP); 2 with CP but no cleft lip (UCLP subgroup) and 8 patients with bilateral cleft lip and palate (BCLP subgroup). All had had surgical correction of the palate in infancy. The control group consisted of 20 nonaffected orthodontic patients. The median age of both groups was 14 years. The tests included the following: (1) nasal airflow measured by anterior rhinomanometry, (2) smell threshold for isoamyl-acetate determined using a 3-way forced choice method, (3) a self-administered questionnaire regarding the subjective perception of smell sense function, and (4) orthonasal and retronasal smell identification (correct/incorrect) and hedonics using visual analog scale (VAS). The respective test results follow. (1) When compared with the control group, the total airflow in the UCLP subgroup was significantly lower especially on the affected side; while in the BCLP subgroup it was lower than in the control group bilaterally. No significant difference was found between the cleft side of UCLP and BCLP subgroups. (2) The smell threshold of the UCLP subgroup was significantly higher than that of the control group and BCLP subgroup. No significant differences were found between right and left nostrils within the BCLP patients and between them and the control group. (3) No difference was found between the groups regarding the subjective perception of smell. (4) No significant differences were found between the UCLP and BCLP subgroups and between the all-cleft group and the control group, except for one item, regarding orthonasal and retronasal smell identification and hedonics. Although nasal airflow is significantly lower and the smell threshold higher on the cleft side, the day-to-day function of the sense of smell of cleft patients is similar to that of normal controls.

Use of Adhesives in Cleft Palate Surgery:A New Flap Fixation Technique

N-Butyl-2-cyanoacrylate (NB2C) is a synthetic tissue adhesive, and it has been used in many surgical procedures. This study was aimed at evaluating its efficacy in cleft palate repairs. Fifteen patients with soft palate and hard palate clefts had clefts repaired with the use of this synthetic adhesive. The ages at repair ranged from 11 months to 17 years, with an average of 2.4 years. Follow-up time ranged from 14 months to 24 months. No complications were found. The advantages of using NB2C were shorter operative time, more pushback gained, better hemostasis, early and well-tolerated feeding, tension-free closure, and better patient comfort. This study shows NB2C as a useful adjunctive material for affixing the mucoperiosteal flaps to the hard palate.

Advances in EPG for treatment and research: an illustrative case study

Electropalatography (EPG), a technique which reveals tongue‐palate contact patterns over time, is a highly effective tool for speech research. We report here on recent developments by Articulate Instruments Ltd. These include hardware for Windows‐based computers, backwardly compatible (with Reading EPG3) software systems for clinical intervention and laboratory‐based analysis for EPG and acoustic data, and an enhanced clinical interface with client and file management tools. We focus here on a single case study of a child aged 10± years who had been diagnosed with an intractable speech disorder possibly resulting ultimately from a complete cleft of hard and soft palate. We illustrate how assessment, diagnosis and treatment of the intractable speech disorder are undertaken using this new generation of instrumental phonetic support. We also look forward to future developments in articulatory phonetics that will link EPG with ultrasound for research and clinical communities.

Early maxillary growth in complete cleft lip, alveolus and palate patients following Widmaier-Perko's, or a modified Furlow's technique of soft palate repair

Introduction: The aim was to study the differences in early maxillary growth following the use of two techniques for soft palate repair in complete cleft lip, alveolus and palate patients. Material and methods: Out of sixty-four primary soft palate repairs, two model samples (one of each) having been matched (gender, age, cleft type, maxillary anterior and posterior width at time of soft palate repair) were selected from the groups treated according either to Furlow or to Widmaier-Perko. The Wilcoxon Test for small samples was used to test for differences. Results: At the age of 4 years, posterior transverse cleft size was significantly smaller by 2.26 mm on average (SD 2.23) in the Furlow sample. The posterior maxillary segment had grown sagitally 1.5 mm (SD 0.76) more in the Furlow sample. At the age of 4 years, all other parameters, including inter-canine point and inter-tuberosity distances did not significantly differ between the two samples. Conclusion: Transverse posterior growth was not statistically different between the samples and seemed to be within normal limits in both. There was more sagittal growth in the posterior maxillary segment in the Furlow sample, possibly related to less fibrotic contracture in the posterior hard palate and the soft palate. The transverse posterior cleft size was more reduced in the Furlow sample. This could not be correlated with the techniques chosen to close the hard palate cleft at the age of 4 years.

Aspectos clínicos e macroscópicos da palatoplastia imediata com implante de cartilagem da pina articular, conservada em glicerina a 98%, após indução experimental de fenda palatina em cães

Os defeitos de espessura completa do palato que resultam em comunicação oro-nasal raramente cicatrizam espontaneamente. Eles requerem reparo cirúrgico, porém, pode ser difícil obter cicatrização satisfatória devido às condições próprias das cavidades nasal e oral. Neste experimento, foram utilizados 14 cães, reunidos em dois grupos de igual número. Todos animais foram submetidos à indução de fenda palatina experimental. O grupo G1 foi o controle, cuja palatoplastia foi realizada a partir da confecção de "flap" muco-periósteo. No grupo G2, foi utilizada cartilagem da pina auricular conservada em glicerina a 98% entre o osso palatino e o muco-periósteo. Os animais foram avaliados macroscopicamente quanto ao processo cicatricial, por radiografias para a regeneração óssea e por rinoscopia para observar a regeneração da mucosa nasal. Foi observada a cicatrização da mucosa oral a partir do 10º dia, com deiscência de sutura em dois animais do grupo G1. A radiografia demonstrou evolução na cicatrização óssea, num processo mais acelerado no grupo G2 quando comparado ao grupo G1. A rinoscopia revelou, aos 60 dias, completa regeneração da mucosa nasal em ambos os grupos. Ao final do período de avaliação foi observada macroscopicamente, completa fusão óssea nos animais do grupo G2 e incompleta nos do grupo G1, o que demonstrou a interferência benéfica do implante no processo cicatricial do grupo G2.

Complete Agenesis of the Soft Palate

This report documents the physical characteristics and treatment of a patient with the extremely rare finding of complete agenesis of the soft palate. The posterior hard palate cleft and soft palate agenesis were treated with a palatal pushback procedure.

Sutural expansion osteogenesis for management of the bony-tissue defect in cleft palate repair: experimental studies in dogs.

A series of experimental studies on sutural expansion osteogenesis for management of the bony-tissue defect in cleft palate repair was performed between 1995 and 1997. Forty-five young dogs in weaning were used in four experiments that were divided into two parts. Part I probed the possibility of closing the surgically constructed hard palate cleft not only with mucoperiosteum but also with bony tissue by the technique of sutural expansion of lateral palatine sutures. Part II explored the possibility of pushing the palatine bone posteriorly and advancing the maxillary segment anteriorly by transverse palatine suture expansion. In Part I, a ring-shaped suture expander made of nickel-titanium shape memory alloy was used to expand the lateral suture of palatine bones. Expansion forces of 200 G, 360 G, and 480 G were used for the first experiment. A force of 360 G was chosen for two other experiments; this force is equivalent to the distraction rate of 0.5 mm per day of a jackscrew device. The ring-shaped suture expander was opened and its two feet were fixed in the medial sides of residual horizontal plates of the palatine bones immediately after a hard palate cleft was constructed surgically under endotracheal general anesthesia. At the eighth postoperative day, under the traction of 360 G, the two sides of the 8-mm-wide hard palate cleft were brought into contact with each other, and 8 or 9 days later the closed palatal cleft had healed completely with mucosal tissue. This experiment was repeated twice and yielded the same results. Sutural expansion osteogenesis was evaluated physically, fluorescently, histologically, and ultrastructurally to examine the deposition of the regenerated bone in the suture areas. Additionally, the influence of sutural expansion osteogenesis of the palatal bones on other facial bones was also studied cephalometrically. In Part II, a bow-shaped suture expander made of nickel-titanium shape memory alloy was applied to expand either the left or the right side of the transverse palatal suture of each of the experimental dogs. At the postoperative week 4 to 6, the maxillary segment was moved forward 5 to 6 mm on the expanded side, and the palatal bone was pushed backward 5 mm. The changes of bone position were assessed radiographically and cephalometrically. Tissue response of circum-maxillary sutures was examined histologically. These experiments led to the following conclusions: (1) Bony closure of the surgically constructed hard palate cleft with a ring-shaped suture expander made of nickel-titanium shape memory alloy is possible. (2) Anterior advancement of the maxillary segment and posterior lengthening of the hard palate using a bow-shaped suture expander made of nickel-titanium shape memory alloy applied at the palatomaxillary suture (transverse palatal suture) of the hard palate are also possible. Thus, in humans, a new approach for cleft palate repair may be a worthwhile investigation.

A retrospective study of hearing, speech and language function in children with clefts following palatoplasty and veloplasty procedures at 18–24 months of age

Many cleft palate teams currently schedule palatoplasty and veloplasty within the child’s first year of life. At Hannover Medical School, palatoplasty and veloplasty are performed at ∼18–24 months of age. It was questioned which speech and language outcome was achieved and whether it may be influenced by: (1) type and extent of the clefts; (2) velopharyngeal inadequacy; and (3) hearing disorders. A retrospective evaluation of data collected from 1985 to 1993 was performed summarizing receptive and expressive speech and language skills of 370 children aged 4.5 years. Cleft types were unilateral cleft lip and palate (UCLP, 30.0%), bilateral cleft lip and palate (BCLP, 28.7%), cleft hard and soft palate (CP, 21.6%), cleft soft palate (cleft velum, CV, 10.8%), cleft lip and alveolus (CLA, 5.8%) and submucous clefts (SUB, 3.2%). n=86 had constant normal hearing, and n=284 had conductive hearing loss >20 dB (500–4000 Hz). Severe developmental phonology errors were found in 30–50% of children with repaired cleft palate and in less than 8% of patients with CLA and SUB. Posterior compensatory misarticulation was below 15% in the groups UCLP, BCLP, CP, CV and SUB. Nasal resonance and air emission was nearly normal in CLA, but was increased in 27% to 38% of the other cleft types. Children with conductive hearing loss had significantly more and severely affected phonology, morphology, syntax, vocabulary, language comprehension, and auditory perception than normal hearing children. Findings indicated that speech and language function in CLP patients were predominantly related to the hearing status.

Occurrence of Dental Consonant Misarticulations in Different Cleft Types

To study the occurrence and type of misarticulations in dental consonants /r/, /s/ and /l/ 280 (115 girls, 165 boys) 6-year-old cleft children were examined by 1 of the 2 experienced speech pathologists of the cleft team. The patients included 82 children with isolated cleft palate (CP), 82 with cleft lip with (34) or without (48) cleft alveolus [CL(A)], 85 with unilateral cleft lip and palate (UCLP) and 31 with bilateral cleft lip and palate (BCLP). CP children were first divided into subgroups; there were 17 children with soft palate cleft, 49 with partial and 16 with complete hard palate cleft. All patients were native Finnish speakers, and had normal hearing, no known syndrome or associated anomalies possibly affecting speech or psychomotor retardation. The results showed that the occurrence and severity as well as the number of errors of all studied sounds separately or grouped increased with the severity of the cleft being constantly greatest in the BCLP group and lowest in the CL(A) group. Altogether 44% of the patients misarticulated at least one studied sound; 41% distorted and 5% substituted, and 2% both distorted and substituted. The /r/ sound was misarticulated by 36%, the /s/ sound by 23%, and the /l/ sound by 18% of the patients. Boys tend to have more problems in producing the studied sounds correctly.

Spontaneous Narrowing of Residual Hard Palate Cleft after Velar Closure in Two-Stage Palatoplasty

Spontaneous Narrowing of Residual Hard Palate Cleft after Velar Closure in Two-Stage Palatoplasty

Palatal Plate for Covering Hard Palate Cleft after Veloplasty in Two-stage Cleft Palate Surgery

Palatal Plate for Covering Hard Palate Cleft after Veloplasty in Two-stage Cleft Palate Surgery

Intravelar veloplasty: Surgical modification according to anatomical defect

The patient is often left with an oro-nasal fistula after the intravelar veloplasty procedure for the primary closure of the hard and soft palate cleft. The junction between the hard and soft palate is submitted to maximal tension during this procedure and is where the fistula most often occurs. The primary intravelar veloplasty procedure is discussed and 7 surgical modifications are introduced. The aim of these modifications is the prevention of an oro-nasal fistula and each is specifically adapted according to the existing anatomical form and defect of the cleft palate. The surgical modifications are divided into 2 main groups: those based on localised swivel flaps and those based on distant flaps.

Staging in Cleft Lip and Palate Habilitation

Treatment staging in cleft lip and cleft palate habilitation is a controversial and complex subject because of the number of variables involved. The time of surgical intervention, as well as the specific surgical technique, should have normal speech as well as optimal growth as realistic goals. A protocol for habilitation includes perinatal presurgical maxillary orthopedics. Lip adhesion is proposed for wide unilateral and asymmetrical bilateral cleft lips at approximately 6 weeks of age. Definitive lip closure is accomplished by the rotationadvancement technique at 3 months of age if lip adhesion is not required or 3 to 4 months after lip adhesion. The soft and hard palate clefts should be closed by 6 to 9 months for optimal speech. Closure of the dentoalveolar cleft is accomplished with a graft of autogenous iliac bone prior to the eruption of the permanent canine when the tooth root is one fourth to one half developed. Palatopharyngoplasty is considered after 3 to 4 years of age following speech therapy and thorough evaluation. Orthognathic surgery may be considered from adolescence to adulthood.

Improved Primary Surgical and Dental Treatment of Clefts

The improved combination of surgical and dental teamwork in the primary treatment of clefts presented here is consistent with principles. In fact, this is a staged design for correction of classic clefts of the lip and palate that, based on biological principles, facilitates the continuance of the failed embryonic "migrations" toward a normal end point. Positioning of the alveolar segments, dissection of mucoperiosteum out of the cleft, and union of mucoperiosteum across the alveolar and anterior hard palate cleft make it possible to create a periosteal tunnel across the bony gap and set up a condition conducive to bone formation and eventual tooth eruption in the cleft area. Lip closure by adhesion reduces the tension of the primary lip closure and allows gentle molding until solidification of the arch occurs. Thus a complete cleft has been rendered an incomplete cleft. With a balanced, stabilized maxillary platform, the definitive lip and nose corrections can be carried to completion early (by 2 to 4 years of age). These planned actions bypass a persistent cleft, fistulas, raw areas, malposition of alveolar segments, and probably the necessity for later bone grafting. The only question not totally answered is the effect of this approach on final growth. Although most reports seem to indicate that growth has and will proceed within normal limits, another 10 years of careful follow-up is indicated and, in fact, is in progress.

片側唇裂口蓋裂例の鼻呼吸機能と鼻中隔変形

Nasal resistance was measured aerodynamically through one or both nostrils. Cleft lip nose deformity alone had a negative effect on nasal air-passages, especially on the side of the cleft. Thirty per cent of the patients with cleft lip alone complained of nasal obstruction. Patients with unilateral cleft lip and palate usually have characteristic nasal deformities, including nostril flattening, afar base ptosis and deviation of the nasal columella. In addition, deformity of the nasal cavity is also frequent. CT scans of the nasal septum were analyzed in cleft lip and palate patients. The nasal septum was deviated to the non-cleft side at and around the nostril. This anterior deviation was conspicuous in cases of alveolar cleft. Posteriorly, the nasal septum deviated to the cleft side in both horizontal and vertical planes, especially in cases of cleft hard palate. Posterior septal deviation seems to interfere with nasal respiration much less than anterior nasal deformity.

Cornelia de lange syndrome with cleft palate

4 cases of Cornelia de Lange syndrome with cleft palate are presented. All cases had the characteristic features of this syndrome. As to oral manifestations, high arches were noted in 2 cases, cleft of hard and soft palate in 1 case, submucous cleft palate in 2 cases. As the other abnormalities, partial anodontia and microdontia were presented. In this report, characteristic features of these 4 cases with referential literature are described.