Cleft Palate Defects Research Articles

Management of Smith-Lemli-Opitz Syndrome Type II associated with Cleft Palate

Rationale: This case report presents the management of a patient with the rare occurrence of SmithLemli-Opitz Syndrome (SLOS) and complete cleft palate Patient Concerns: The patient's cleft palate repair was not done in infancy, and she reported to the dental institution complaining of difficulty with proper food intake and speech. A clinical examination revealed muscle deformity, limited neck mobility, scoliosis, malocclusion, and inadequate oral health. The patient exhibited facial and limb anomalies characteristic of SLOS, in tandem with substantial challenges in speech and nutrition due to the cleft palate. Diagnosis: The patient was referred to the dental wing to manage the cleft palate defect. On dental examination a complete cleft of the hard and soft palate, which had not been surgically corrected during infancy, was confirmed through clinical and radiological investigation. Additional musculoskeletal complications, including scoliosis and muscle deformity, were also identified. Interventions: The treatment plan addressed both SLOS and cleft palate. A prosthodontic appliance was prepared to assist with palatal function and speech therapy. Comprehensive care for SLOS included genetic counselling, nutrition management, and targeted physical therapy. The patient was also referred to an orthodontist, oral surgeon and a speech-language therapist further intervention. Conclusion: This case emphasizes the importance of early diagnosis and intervention in congenital disorders. It advocates for proactive, multidisciplinary care from infancy to enhance the quality of life for individuals with complex syndromes, underscoring the need for ongoing support and resources

Severe dental malocclusion in a case of repaired unilateral cleft palate managed by orthodontic mechanotherapy alone

Cleft palate is a developmental abnormality that perforates the palate, and divides the arch segments producing grave malocclusion. Crossbites, labiolingual displacements, rotations, archform distortion and incompatibility are a few facets characterizing the problem. Teeth may be congenitally missing or periodontally infirm in the vicinity of the breakdown. If the skeletal jaw base discrepancy is not major, orthognathic surgery may be omitted and orthodontic mechanics alone can suffice to manipulate the teeth into a decent occlusion. Restorative work for esthetic embellishment can enhance the overall result, particularly if teeth are malformed. This case report describes how severe dental malocclusion arising from a repaired unilateral cleft palate defect was corrected with a fixed preadjusted edgewise appliance, adorning smile esthetics and boosting the patient’s self-confidence.

Osteogenic potency of dental stem cell-composite scaffolds in an animal cleft palate model

ObjectiveTo evaluate the osteogenic potency of stem cells isolated from human exfoliated deciduous teeth (SHED) in polycaprolactone with gelatin surface modification (PCL-GE) and poly (lactic-co-glycolic acid)-bioactive glass composite (PLGA-bioactive glass (BG)) scaffolds after implantation in a rat cleft model. MethodsCleft palate-like lesions were induced in Sprague-Dawley rats by extracting the right maxillary first molars and drilling the intact alveolar bone. Rats were then divided into five groups: Control, PCL-GE, PCL-GE-SHED, PLGA-BG, and PLGA-BG-SHED, and received corresponding composite scaffolds with/without SHED at the extraction site. Tissue samples were collected at 2, 3, and 6 months post-implantation (4 rats per group). Gross and histological analyses were conducted to assess osteoid or bone formation. Immunohistochemistry for osteocalcin and human mitochondria was performed to evaluate bone components and human stem cell viability in the tissue. ResultsBone tissue formation was observed in the PCL-GE and PLGA-BG groups compared to the control, where no bone formation occurred. PLGA-BG scaffolds demonstrated greater bone regeneration potential than PCL-GE over 2–6 months. Additionally, scaffolds with SHED accelerated bone formation compared to scaffolds alone. Osteocalcin expression was detected in all rats, and positive immunoreactivity for human mitochondria was observed in the regenerated bone tissue with PCL-GE-SHED and PLGA-BG-SHED. ConclusionPCL-GE and PLGA-BG composite scaffolds effectively repaired and regenerated bone tissue in rat cleft palate defects. Moreover, scaffolds supplemented with SHED exhibited enhanced osteogenic potency. Clinical significancePCL-GE and PLGA-BG scaffolds, augmented with SHED, emerge as promising biomaterial candidates for addressing cleft repair and advancing bone tissue engineering endeavors.

A Randomised Controlled Trial on the Effect of Hamulectomy on Hearing Outcomes in Cleft Palate Patients - A Comparative Study.

Cleft palate, a common congenital craniofacial defect, requires surgical repair and many surgical approaches have been employed for the same to reduce the risk of post-operative complications and improve outcomes. In order to achieve tension free closure, fracture of pterygoid hamulus has been advised. However, the effect of this manoeuvre on auditory functions remains debatable. The study was designed to evaluate the effect of hamulectomy on auditory function during the post-operative period after palatoplasty. The present study enrolled 100 participants aged 10 months-2 years with isolated cleft palate defect. They were randomly divided into two groups: palatoplasty with hamulectomy (n = 50) and palatoplasty without hamulectomy (n = 50). Hearing outcomes were evaluated using objective measures (otoscopy, tympanometry, and otoacoustic emission [OAE] tests) at 1-month and 6-month post-operative follow-up visits. The Chi-square test was used to analyse the data and significance level was kept at P ≤ 0.05. The findings of otoscopy, tympanometry and OAE tests were statistically similar between the two study groups (P > 0.05; Chi-square test) at both one month and six months follow-up visits. Another noteworthy observation was improvement in auditory function during follow-up period indicating recovery of middle ear function following palatoplasty. The addition of hamulectomy to the palatoplasty treatment may improve the hearing outcomes for cleft palate patients and can be adopted to achieve tension free closure.

Patterns of primary and secondary defects associated with non-syndromic cleft lip and palate: An epidemiological analysis in a Kenyan population.

Cleft lip and palate deformities substantially burden individuals and families, particularly in low-income communities. However, a comprehensive understanding of the patterns and distribution of these deformities in Kenya remains limited. This retrospective cross-sectional study analyzed 647 clinical records from the BelaRisu Foundation registry in Kenya, spanning 2018-2022. After meticulous record verification and data extraction, cleft pattern modeling was used to analyze each case. Data were imported to SPSS version 29.0 and descriptive statistics were calculated, which included means, ranges, frequencies, percentages, and standard deviations. Additionally, a comparative analysis between genders was conducted. The findings revealed a higher average age of presentation compared with previous studies in Kenya, along with a greater susceptibility of males to cleft lip and palate defects overall. Noteworthy disparities in case distribution across provinces were observed. Cleft lip emerged as the most observed primary defect, while palatal fistulae constituted the most frequent secondary defect. Interestingly, while some results aligned with global trends, others diverged significantly from the existing literature, warranting further exploration and investigation. These findings shed light on the unique patterns and distribution of cleft lip and palate deformities in Kenya, highlighting the need for targeted interventions and support systems.

Caregivers' Experience with Lip Taping as a Presurgical Orthopedic Treatment for Cleft Lip and Palate Defects.

This study aimed to assess caregivers' experiences and perceptions of applying lip taping as presurgical orthopedic therapy (PSO) for infants with a cleft lip and palate. A retrospective survey was conducted, inviting parents to respond to a series of structured questions between September 2022 and June 2023. The questionnaire focused on evaluating parents' experience with lip taping, a crucial component of PSO. Descriptive statistics and the Chi-square test were employed to analyze relationships between categorical variables. Of the 157 participants, overall, 122 completed the survey, forming the dataset for analysis. A majority (90.0%) reported sufficient experience in using lip taping and no major difficulties with lip taping application. Caregivers with higher education levels exhibited a significantly positive correlation (p = 0.015). Additionally, 93.4% confirmed the efficacy of lip taping for premaxillary segment retraction, with this outcome being correlated with caregivers' knowledge and education (p = 0.008). Interestingly, caregivers' age also demonstrated a substantial association (p = 0.020). While a vast majority expressed positive experiences with lip taping as a presurgical treatment, continuous, tailored education on cleft lip and palate is imperative. This education should be directed towards caregivers and individuals offering direct support to parents of children with CLP, ensuring optimal care and preparation for surgical treatment.

A novel technique predicting velopharyngeal insufficiency risk in newborns following primary cleft repair. A randomized clinical trial comparing buccinator flap and Bardach two-flap palatoplasty

The study aimed to assess the efficacy of buccinator myomucosal flap (BMF) compared to Bardach two-flap use in primary cleft palatoplasty on palatal length and fistulation rate. Palatal length in relation to the pharynx is a critical factor regarding velopharyngeal function. The goal was to predict the risk of velopharyngeal insufficiency by comparing the potential of two different techniques in lengthening the palate and to decrease the fistulation rate. A total of 46 patients with complete wide cleft palate were randomly divided into two equal groups: a study group, in which the cleft palate defect was repaired by BMF; and a control group, in which patients’ clefts were repaired by Bardach (two-flap) palatoplasty during primary repair. All patients were evaluated at 1-, 3- and 6-month intervals to detect the fistulation rate and to measure the palatal length by taking impressions, pouring casts to measure the palatal length from anterior reference point (incisive foramen) to the posterior reference point(uvula) and calculating the change of palatal length. There was a significant increase in the palatal length measurements in the study (BMF) group (immediate postoperatively and at 3 and 6 months) compared to the control group (p < 0.001). Regarding the fistulation rate, there was no statistically significant difference (p = 0.346). The use of the buccinator flap during primary repair of cleft palate decreased the fistulation rate.

Standing laryngeal tie‐forward as a successful treatment of cleft palate in a 3‐month‐old foal

AbstractA 3‐month‐old Warmblood colt was referred for evaluation of coughing and dysphagia. An asymmetrical, short defect of the soft palate and secondary aspiration pneumonia was diagnosed and surgically treated with a standing laryngeal tie‐forward procedure. Intraoperative endoscopy was used to guide the procedure and confirm appropriate epiglottic positioning. By 4 days post‐operatively, the dysphagia resolved. Upper respiratory tract endoscopy performed 2 days post‐operatively confirmed maintenance of the intraoperative laryngohyoid positioning. When contacted 2 years post‐operatively, the owner reported being satisfied with the outcome of surgery. Clinical signs of dysphagia had resolved in 4 days and pneumonia within 2 months of surgery. This report demonstrates that small cleft palate defects can be treated successfully in foals using a standing laryngeal tie‐forward. When used in appropriate cases, the technique provides a valid alternative to primary closure, which mitigates the need for general anaesthesia in a potentially high‐risk population.

Stem Cell-Based Tissue Engineering for Cleft Defects: Systematic Review and Meta-Analysis.

This study aimed to analyze the efficacy of stem cell-based tissue engineering for the treatment of alveolar cleft (AC) and cleft palate (CP) defects in animal models. Systematic review and meta-analysis. Preclinical studies on alveolar cleft repair in maxillofacial practice. Electronic search was performed using PubMed, Embase, and Cochrane databases. Pre-clinical studies, where stem cell-based tissue engineering was used in the reconstruction of AC and CP in animal models were included. Quality of the selected articles was evaluated using SYRCLE (SYstematic Review Centre for Laboratory animal Experimentation). Review of alveolar cleft bone augmentation interventions in preclinical models. Outcome parameters registered were new bone formation (NBF) and/or bone mineral density (BMD). Thirteen large and twelve small animal studies on AC (21) and CP (4) reconstructions were included. Studies had an unclear-to-high risk of bias. Bone marrow mesenchymal stem cells were the most widely used cell source. Meta-analyses for AC indicated non-significant benefits in favor of: (1) scaffold + cells over scaffold-only (NBF P = .13); and (2) scaffold + cells over empty control (NBF P = .66; BMD P = .31). Interestingly, dog studies using regenerative grafts showed similar to superior bone formation compared to autografts. Meta analysis for the CP group was not possible. AC and CP reconstructions are enhanced by addition of osteogenic cells to biomaterials. Directions and estimates of treatment effect are useful to predict therapeutic efficacy and guide future clinical trials of bone tissue engineering.

The role of Botulinum toxin type A for prevention and treatment of cleft lip palate (CLP) post-operative scar: a systematic review

Background. Cleft lip palate (CLP) defects are the common orofacial defects found in newborns. The main treatment is lip and palate surgery, often resulting in a hypertrophic scar that significantly affects the patient's aesthetic appearance. Several studies showed the role of Botulinum toxin type A injections for prevention and treatment of CLP post-operative scarThis systematic review aims to review the role of Botulinum toxin type A for prevention and treatment of cleft lip palate surgery scar. Method. Online databases were searched for relevant studies from Google Scholar, PubMed and ProQuest. Data sources were searched using MeSH terms "botulinum toxin," "cleft lip palate," and "surgery scar" for all publications up to October 2022. All English papers regarding the role of Botulinum toxin type A in preventing and treating CLP post-operative scar were included. Papers not available in full text or English and not an experimental study were excluded. Result. Six studies are included in this systematic review consisting of three randomized controlled trials and three clinical studies. The experimental group received Botulinum toxin type A injections, while the control group received an injection of normal saline or other topical treatment. All of the included studies showed positive results regarding the role of Botulinum toxin type A marked with reduced scar width, good Vancouver Scar Scale (VSS), Visual Analogue Scale (VAS), patient satisfaction and no complications or side effects were found. Conclusion. The Botulinum toxin type A showed promising results for the prevention and treatment of CLP post-operative scar.

Surgical closure of cleft palate defects in dogs using a modification of the traditional von Langenbeck technique: 12 cases (2015-2022).

To describe the author's surgical guidelines for the effective use of a modified von Langenbeck technique, utilizing bilateral bipedicle mucoperiosteal flaps in the dog. 12 client-owned dogs with cleft palate defects of the hard and soft palates. 12 dogs with cleft palate were presented to the Angell Animal Medical Center from May 20, 2015, to March 24, 2022. The patient's ages ranged from 5 months to 3 years. All 12 dogs had closure of the hard palate clefts by use of modifications of the original von Langenbeck technique in this prospective study. Successful closure of the cleft (hard and soft) palate defects was achieved in all 12 dogs in a single surgical procedure. A small residual opening was noted at the level of the incisive papilla in each dog; this was of no clinical consequence in this report. The von Langenbeck technique, using the simple closure modifications reported, was effective in closing both narrow and wide defects. Successful execution requires the complete elevation of each flap, which facilitates their tension-free advancement over the palatal cleft. Vertical mattress sutures evert the flap margins, allowing for direct collagen surface contact for proper healing. Placement of sutures in the rugal folds increases the tissue purchase to reduce the risk of suture cut-out. Fine interrupted sutures, placed between the vertical mattress sutures, maintains the proper alignment of the incisional margins. The author waits a minimum of 5 months before closing cleft palate defects, enabling the donor areas time to mature and improving their ability to retain sutures more effectively.

A Review of the Use of Buccal Fat Pad in Cleft Palate Repair.

To review the available evidence on the use of the Buccal Fat Pad in primary and secondary Cleft Palate repair. This is a narrative review. A computerized literature search was conducted for articles published till February 2022 using the Mesh phrases buccal fat pad AND cleft palate, Bichat's Fat pad AND cleft palate, buccal fat pad OR Bichats Fat pad AND cleft palate. A total of 35 articles were included in this review based on the set eligibility criteria. Most of the studies were retrospective case reviews (n = 16, 45.7%), and the aggregate number of patients from all included studies was 666. Reported uses of the buccal fat pad (BFP) in association with cleft palate repair include the closure of central cleft palate defect and nasal floor in primary cleft palate repair, oronasal fistula repair following primary repair of cleft palate, and closure of relieving incision defect in primary repair of cleft palate. Complications reported were 24 cases of Oronasal Fistula (ONF), 2 dehiscences, and 4 transient mucosal defects. The high success rate, vascularity, ease of tissue harvest, and low donor site morbidity all support its use as an adjunct flap in cleft palate repair, especially in the closure of wide palatal clefts, to prevent post-palatal repair fistula, wound contracture, and subsequently velopharyngeal insufficiency and possibly midface hypoplasia.

Awareness about Patterson syndrome among dental students.

The aim is to create awareness about Patterson syndrome among dental students. Patterson-Stevenson-Fontaine syndrome is a very rare condition marked by irregular facial bone and tissue growth (mandibulofacial dysostosis) as well as limb abnormalities. A recessed jaw (retrognathism), cleft palate, and external ear defects are all possible symptoms of this disorder. A total of 112 undergraduate dental students participated in a longitudinal cross-sectional sample. To assess college students' awareness about Patterson syndrome, a self-administered, closed-ended questionnaire was developed and distributed. The only language allowed was English. The results were analyzed in SPSS software version 23. 10.71% of females and 14.29% of males were aware about Patterson syndrome. 32.14% of females and 38.39% of males were aware that Patterson syndrome was a rare adrenal disorder. We can conclude that very few of the population which was only 25% of the dental students were aware about Patterson syndrome and this survey helped in creating awareness about this syndrome.

Palatal teratoma associated with cleft palate- A rare case report

Teratomas are benign tumours that are commonly seen in the sacrococcygeal region and in ovaries. It consists of cells from the layers of ectoderm, endoderm and mesoderm. Localised teratomas in the head and neck region are rare in origin. It can be in the size of a small polyp or it may grow as an extension to the skull base. This rare case report highlights the presence of congenital teratoma in the palatine region of a child. The palatine processes and the median nasal septum have failed to fuse, thus leading to a development of cleft palate in the child. This failure of fusion may be related to the presence of the epignathus obstructing the oropharyngeal connection. The diagnosis of teratoma was confirmed radiologically and histopathologically. The lesion was surgically excised and the cleft palate defect was corrected in a single stage surgical procedure.

A rare complication of hemolacria after Le fort I osteotomy: a case presentation

BackgroundNasolacrimal duct obstruction (NDO) is a common pathology preventing the proper drainage of the tears, and its main symptom is epiphora. Secondary acquired nasolacrimal duct obstruction (SANDO) can be due to a variety of causes including infection, trauma, or neoplasms. It has been reported to occur with different forms of maxillofacial trauma, especially Le Fort II, Le Fort III, naso-orbital-ethmoidal, and orbital floor fractures.Case presentationA 20-year-old Egyptian female presented to correct a facial disharmony due to a cleft lip and palate defect. The patient reported a history of congenital NDO and had deficient lateral nasal walls. Bimaxillary surgery was planned, including a Le Fort I osteotomy for the maxilla and bilateral sagittal split osteotomy for the mandible. The surgery was uneventful, but the patient complained from bloody tears or hemolacria few days postoperatively. This complication began to cease spontaneously after 2 days and completely recovered after 4 days.ConclusionHemolacria is an infrequent finding after maxillofacial surgeries and may be associated with CLP surgeries more than other surgeries. In this case, it was easily managed, and surgeons should be more aware of it to try to prevent its occurrence.

Prefabricated Trays Stock for Impression of Cleft lip and Palate Orthopedic Appliances: A Three-Dimensional Computational Analysis of Maxillary Jaws.

This study aimed to propose digitally designed impression trays, for newborns with cleft lip and palate (CLP) defects, using the computer-assisted design and manufacturing (CAD/CAM) technique, based on measurements of width, length, and height made on processed and scanned plaster models. Thus, we will describe the different software and concepts that can be used for the design of these impression trays. A total of 59 plaster casts of newborn patients with CLP were collected and then scanned. After that, digital dental casts were three-dimensional (3D) evaluated, using precise anatomical landmarks. The Maxillofacial Prosthodontics Team at the Dental consultation and treatment center in Rabat, Morocco. The study involved plaster casts of newborns with CLP, who had undergone presurgical neonatal treatment in the Maxillofacial Prosthodontics service in Rabat, Morocco. None. 3D evaluation of 59 scanned plaster casts of newborn patients with CLP. This work allowed us to obtain digital impression trays for each anatomical variation of orofacial clefts. These trays will limit the problems linked to conventional techniques for making neonatal orthopedic plates. We also emphasized the importance of a multidisciplinary approach involving several professionals in Morocco from various fields and specialties. This original technique is advantageous for the practitioner as well as for the patients and their parents. It allows for precise recording, better adaptation, time-saving, and parental comfort.

Exposure to corticosteroids in the first trimester is associated with an increased risk of urogenital congenital anomalies.

Does maternal exposure to first trimester corticosteroids in IVF/ICSI treatment result in an increased risk of congenital anomalies? Children born with the aid of IVF/ICSI whose mothers were treated with adjuvant corticosteroids during the first trimester had an increased risk of cryptorchidism, hypospadias and talipes. Maternal exposure to corticosteroids may increase the risk of congenital anomalies such as cleft palate and neural tube defects. However, the existing studies have conflicting outcomes, are underpowered, and do not study a population undergoing IVF/ICSI, a group known to be at increased risk of abnormalities. This retrospective cohort analysis covering Monash IVF fertility clinics in Melbourne, Australia assessed the outcomes of 12 426 live births from both fresh and frozen embryo transfers between 2010 and 2016. There were 618 live births included in our study group of mothers exposed to corticosteroids (oral prednisolone or dexamethasone) during their IVF/ICSI treatment, with the remainder of births not exposed to steroids (control, n = 11 808). The primary outcome measured was the presence of congenital anomalies and secondary outcomes were birth weight and gestation length. Multivariate binary logistic regression was used to assess the independent effects of corticosteroid exposure and the freezing of embryos, with adjustment for maternal age at oocyte retrieval, smoking status, number of cycles taken, BMI, etiology of the infertility and the use of ICSI. Results are presented as incidence rate ratios (IRRs) with 95% CIs. Amongst 12 426 live births, and 597 birth defects, multivariate logistic regression demonstrated there was an increased incidence in talipes equinovarus (1.33% vs 0.32%, adjusted IRR = 4.30, 95% CI = 1.93, 9.58; P < 0.001), hypospadias (0.66% vs 0.18%, adjusted IRR = 5.90, 95% CI = 2.09, 16.69; P = 0.001) and cryptorchidism (0.83% vs 0.19%, adjusted IRR = 5.53, 95% CI = 1.91, 15.42; P = 0.001) in the offspring of mothers exposed to corticosteroids compared to those who were unexposed. The incidence of neither neural tube defects nor cleft palate were significantly increased in babies exposed to corticosteroids. The sex ratio of infants exposed to corticosteroids during a fresh embryo transfer cycle significantly favored males but reverted to the normal sex ratio in infants conceived in frozen embryo transfer cycles. This was a retrospective observational cohort study using administrative datasets with the potential for measurement error and unobserved confounding. Missing outcome data were obtained from patients using self-report leading to possible ascertainment bias. Given the rare incidence of some of the anomalies assessed, the study was underpowered to identify differences in abnormality rates for some specific anomalies. The findings of this study, the largest of its kind, suggest that caution should be heeded when prescribing corticosteroids to women undergoing IVF/ICSI, given that this study has now identified three previously unassociated serious neonatal complications (talipes, hypospadias and cryptorchidism), plus a potential alteration in sex ratio. Physicians should be careful in using corticosteroids in the critical first trimester and should counsel patients regarding the potential risks of this treatment. There was no funding sought or obtained for this study. K.T., V.T., B.V. and D.Z.-F. are employees or contractors to Monash IVF and hold a minority stock position in Monash IVF. R.J.W. reports no conflict of interest. N/A.

ПРИМЕНЕНИЕ ДИОДНОГО ЛАЗЕРА, УЛЬТРАФОНОФОРЕЗА И РАЗОБЩАЮЩЕЙ НЕБНОЙ ПЛАСТИНКИ В ПРЕДОПЕРАЦИОННОЙ ПОДГОТОВКЕ К РЕОПЕРАЦИИ ДЕФЕКТА НЕБА У ДЕТЕЙ ПОСЛЕ УРАНОПЛАСТИКИ

Objectives. Analysis of oral fluid in children with congenital cleft palate and palate defect after uranoplasty.&#x0D; Purpose. To analyze oral fluid in children with congenital cleft palate and palate defect after uranoplasty to determine the levels of pro-inflammatory (IL-1β, IL-6, TNF-α) and anti-inflammatory (IL-4, IL-10) cytokines and secretory immunoglobulin sIgA and evaluate physico-chemical (salivation rate, kinematic viscosity, pH) and biochemical parameters (calcium, magnesium, phosphorus, protein) of mixed saliva.&#x0D; Methodology. The article presents the results of studying the parameters of the oral fluid of 109 children aged 6–12 years with congenital cleft palate and palate defect after uranoplasty and 50 practically healthy children of the same age.&#x0D; Results. Hyperstimulation of pro-inflammatory (IL-1β, IL-6, TNF-α) and anti-inflammatory (IL-4, IL-10) cytokines in the oral fluid and a decrease in the average level of secretory immunoglobulin sIgA. In children with congenital cleft palate and defects remaining after uranoplasty, there was a deviation in the physicochemical and biochemical parameters of the oral fluid, which are manifested by a decrease in the rate of salivation, an increase in its viscosity and a shift in pH to the acid side. In contrast to the group of children without dental pathology, children with cleft palate and defects after uranoplasty showed a decrease in the content of total protein, phosphorus and calcium in the mixed saliva and an increase in the content of magnesium.&#x0D; Conclusions. The obtained laboratory data indicate the presence of a local inflammatory process in the oral cavity and a decrease in local immunological anti-inflammatory factors. This should be taken into account for the development of methods for preoperative sanitation of the oral mucosa in children with congenital cleft palate and a palate defect after uranoplasty at the stage of preparation for reoperation.

ИММУНОЛОГИЧЕСКИЕ, ФИЗИКО-ХИМИЧЕСКИЕ И БИОХИМИЧЕСКИЕ ПОКАЗАТЕЛИ РОТОВОЙ ЖИДКОСТИ У ДЕТЕЙ С ВРОЖДЕННОЙ РАСЩЕЛИНОЙ НЕБА И ПОСЛЕОПЕРАЦИОННЫМ ДЕФЕКТОМ НЕБА

Objectives. Analysis of oral fluid in children with congenital cleft palate and palate defect after uranoplasty.&#x0D; Purpose. To analyze oral fluid in children with congenital cleft palate and palate defect after uranoplasty to determine the levels of pro-inflammatory (IL-1β, IL-6, TNF-α) and anti-inflammatory (IL-4, IL-10) cytokines and secretory immunoglobulin sIgA and evaluate physico-chemical (salivation rate, kinematic viscosity, pH) and biochemical parameters (calcium, magnesium, phosphorus, protein) of mixed saliva.&#x0D; Methodology. The article presents the results of studying the parameters of the oral fluid of 109 children aged 6–12 years with congenital cleft palate and palate defect after uranoplasty and 50 practically healthy children of the same age.&#x0D; Results. Hyperstimulation of pro-inflammatory (IL-1β, IL-6, TNF-α) and anti-inflammatory (IL-4, IL-10) cytokines in the oral fluid and a decrease in the average level of secretory immunoglobulin sIgA. In children with congenital cleft palate and defects remaining after uranoplasty, there was a deviation in the physicochemical and biochemical parameters of the oral fluid, which are manifested by a decrease in the rate of salivation, an increase in its viscosity and a shift in pH to the acid side. In contrast to the group of children without dental pathology, children with cleft palate and defects after uranoplasty showed a decrease in the content of total protein, phosphorus and calcium in the mixed saliva and an increase in the content of magnesium.&#x0D; Conclusions. The obtained laboratory data indicate the presence of a local inflammatory process in the oral cavity and a decrease in local immunological anti-inflammatory factors. This should be taken into account for the development of methods for preoperative sanitation of the oral mucosa in children with congenital cleft palate and a palate defect after uranoplasty at the stage of preparation for reoperation.

Prosthetic Rehabilitation of an Unusually Self-Obturated Cleft Palate Defect in an Adult Edentulous Patient Living in a Remote Rural Area. A Clinical Report

Patients with unrepaired cleft palate defects still exist within remote rural areas. The prosthodontic rehabilitation of an adult edentulous cleft patient could be very demanding for treating maxillofacial prosthodontist, since most of them are edentulous, challenging the retention and the stability of the maxillary prosthesis. It is therefore highly important that cleft palate patients seek dental and prosthodontic care as early in their life as possible. In this report, an unusual case of a patient self-obturated cleft palate defect is presented. The patient’s self-made prosthesis was replaced by an appropriately fabricated pharyngeal obturator prosthesis in order to improve speech and swallowing.