Palate Cases Research Articles

Some Modifications of the Furlow Palatoplasty in Wide Clefts—A Preliminary Report

Authors encounter a large percentage of wide cleft palates while operating in a Third World situation. They define the terms wide clefts and unrepairable clefts in terms of measurement. They describe their technique, which they developed to deal with wide clefts. They describe some previously unreported modifications. They also report the velar lengthening obtained. A total of 77 cases of primary cleft palate repaired with this technique by a single author, during the period May 2006 to February 2009, were selected for the study. These were divided into two groups on the basis of measurements. Group B consisted of all clefts deemed wide or unrepairable. Group A consisted of all other cleft palates. Difference in fistula rate was studied. Velar lengthening was measured in all patients. Two fistulae occurred in Group B. The overall fistula rate for the series was 2.6%. The series consisted of 44% wide clefts, which included one case of unrepairable cleft. Lengthening in the velum ranged from 20% to 155%. Statistically significant correlations were found between narrow clefts and age group 0 to 1 year (p = .0094) and Veau Group 4 with wide clefts (p = .0194). The Furlow technique as originally described has shortcomings. The authors describe their technique of incorporating the Furlow repair, which enables them to use it as a primary palatoplasty, in a scenario consisting of a large percentage of wide clefts in an older age group, thereby minimizing the fistula rate while increasing palatal length.

Various Shapes of Soft Palate: A Lateral Cephalometric Study

ABSTRACT Objective Though the soft palate presents with varied morphology, very few studies have described its diversity. The aim of our study was to investigate various shapes of soft palate in normal individuals. Methods The study comprised of 80 individuals requiring orthodontic treatment but without any speech abnormality, whose age ranged from 9 to 31 years. Velar shape was examined on digital lateral cephalograms and was allocated to one of the six patterns as described by You M et al. The difference in proportion of each type and also difference between genders were studied. Results The normal soft palate can be classified into six types based on its shape. Type 2—rat-tail shape is most common in both the genders. There is no significant difference in proportion of various shapes of soft palate between genders. Conclusion Soft palate may have variable morphology. Knowledge of varied spectrum of velar morphology may help in successful functional and structural repair in cleft palate cases, and shed some light towards the causes of obstructive sleep apnea and related disorders.

Alveolar bone grafting: results of a national outcome study

In 1998, the Clinical Standards Advisory Group (CSAG) report demonstrated a successful radiographic outcome of 58%, for alveolar bone grafting, from 157 cases of unilateral cleft lip and palate (UCLP) in children aged 12 years. No further national studies have assessed the current level of radiographic outcome following the re-organisation of cleft services since the recommendations from the CSAG report. In 2008, radiographic images were requested for alveolar bone grafts performed in calendar year 2006 from each of the now established UK cleft centres. A sample of 206 patients with 235 grafted sites was scored by a panel of trained assessors, following a calibration exercise, using a modified Kindelan index. Inter- and intra-observer variation was assessed. The overall radiographic success rate for the 2006 images assessed was 85%. There was no statistical difference for radiographic success between centres or surgeons or cleft type when defined as either a bilateral or unilateral alveolar defect for a patient. Alveolar bone grafting appears to have improved radiographic outcomes when compared with the CSAG report following the re-organisation of surgical services for children with cleft lip and/or palate.

A rare complication after septoplasty procedure in a misdiagnosed submucous cleft palate case: Palatal fistula

Nasal septoplasty is a common and low-risk procedure performed very frequently in plastic surgery as well as in otorhinolaryngology. The development of a palatal perforation following a nasal septoplasty procedure is a very rare event with only a few cases reported in the literature. A patient with palatal fistula formation after septoplasty procedure is presented here, who was later on diagnosed with submucous cleft palate during the repair of the palatal fistula.

Maternal fever during early pregnancy and the risk of oral clefts

An increased risk of birth defects after hyperthermic exposures has been confirmed in animal studies, but population studies have yielded inconsistent results. Oral clefts are a common birth defect and have been associated with these exposures in some of these studies. In this study, data from the National Birth Defects Prevention Study was used to evaluate the association of maternal report of febrile illness in early pregnancy and the risk of oral clefts. All oral cleft cases born between 1997 and 2004 were compared with nonmalformed controls born in the same geographical region during the same time period. Mothers reporting febrile illness during pregnancy were stratified by fever grade and antipyretic use. Logistic regression models were used to generate crude and adjusted odds ratios for exposure to fever and association with each oral cleft phenotype. The dataset included 5821 controls, 1567 cases of cleft lip with or without cleft palate (CL+/-P) and 835 cases of cleft palate only. A modestly increased risk was observed for isolated CL+/-P (odds ratio, 1.28; 95% confidence interval, 1.01-1.63). Stratification by fever grade (body temperature <101.5 degrees or > or =101.5 degrees F) did not yield significant differences in risk. Risk estimates were higher among women who reported a fever, but did not take antipyretics to control their fever, particularly for nonisolated compared with isolated oral clefts. This finding suggests that adequate control of fever may diminish the deleterious effects of fever in cases of oral cleft.

Caracterização da fala de indivíduos submetidos à palatoplastia primária

OBJETIVOS: Descrever as características de fala de indivíduos submetidos à palatoplastia primária; relacioná-las com tipo de fissura, técnica cirúrgica e idade na ocasião da cirurgia; e descrever as condutas fonoaudiológicas após a cirurgia. MÉTODOS: Estudo retrospectivo de 167 casos, de ambos os gêneros, com fissura labiopalatina, submetidos à palatoplastia primária. Foram coletadas informações relativas ao tipo de fissura, idade na palatoplastia, técnica cirúrgica, e as análises subjetivas sobre as características da fala, realizadas por fonoaudiólogas. RESULTADOS: Na avaliação perceptiva da fala após a cirurgia, encontrou-se inteligibilidade de fala alterada (46%), ressonância hipernasal (33%), articulações compensatórias (26%), emissão de ar nasal (14%), mímica facial (11%) e fraca pressão aérea intra-oral (8%). Na associação entre a ressonância e as articulações compensatórias com tipo de fissura, técnica cirúrgica e faixa etária, não houve diferença significativa. A conduta mais frequentemente tomada foi a de terapia fonoaudiológica (38%), para correção das articulações compensatórias e/ou outras alterações. CONCLUSÃO: A maioria dos indivíduos apresentou ressonância equilibrada ou hipernasalidade aceitável e ausência de articulações compensatória, independente do tipo de fissura, da técnica cirúrgica e da faixa etária, embora não tenha ocorrido diferença significativa. Dentre as condutas adotadas após a primeira avaliação pós-palatoplastia primária, a terapia fonoaudiológica foi a mais frequente.

放射線併用超選択的動注化学療法が有効であった軟口蓋扁平上皮癌の4例

放射線併用超選択的動注化学療法が有効であった軟口蓋扁平上皮癌の4例

Role of remodeling of pharyngeal cavity in velopharyngoplasty for treating obstructive sleep apnea hypopnea syndrome and its related anatomic study

To investigate a new velopharyngoplasty (VPP), including its anatomic character and its mechanism of remodeling of oral-pharynx cavity for treating obstructive sleep apnea hypopnea syndrome (OSAHS). Two cases of soft palate were dissected in adult male cadavers. And the model of VPP was established to further observe its technical characteristics. A total of 85 OSAHS patients were studied by PSG. And all cases received velopharyngoplasty (VPP) and follow-ups. Ten cases were selected for CT scanning of palatal pharyngeal cavity and CT workstation was employed for imaging measurements. The measured parameters of pharyngeal palate included soft palate length, maximal thickness of soft palate, soft palate to posterior pharyngeal edge of free space, parapharyngeal space (distance between tonsils), uvula length, width of uvula base, velopharyngeal cross-sectional area and cross-sectional area of angina. All these parameters had a significantly difference between pre-operation and post-operation [(37.8 +/- 5.5) mm vs (27.0 +/- 4.1) mm, (13.3 +/- 2.2) mm vs (9.3 +/- 2.5) mm, (7.1 +/- 2.8) mm vs (10.3 +/- 1.7) mm, (45.2 +/- 25.5) mm(2) vs (135.3 +/- 26.4) mm(2), (2.0 +/- 21.8) mm(2) vs (208.4 +/- 15.9) mm(2)]; however there was no significant difference in retropharyngeal wall thickness [(6.8 +/- 2.9) mm vs (7.0 +/- 2.5) mm]. VPP remodels palatopharyngeal region through the design of incision, the management of pharyngopalatine arch tonsillectomy and the suture of laterapharynx mucisae. This surgical procedure can obviously upgrade the velum platinum, enlarge the oropharyngeal airway effectively. It is a significant modified-UPPP surgical technique.

Islandization of Hemipalatal Flaps and Lateral Relaxing Incisions in Palatoplasty

Sir: We read with interest the article entitled “Superior Results Using the Islandized Hemipalatal Flap in Palatoplasty: Experience with 500 Cases” by Bindingnavele et al., published in Plastic and Reconstructive Surgery in 2008.1 We also realized that the study was presented at two plastic surgery meetings in the United States in 2001. In their article, the authors mentioned that the islandization of the hemipalatal flaps (332 cases) and lateral relaxing incisions (168 cases) are able to close the hard palate clefts without tension after having the standard double-opposing Z-plasty procedures performed in soft palatal portions of the cleft. The authors also emphasized the lower fistula formation rate by this approach and declared that they would analyze their data in terms of velopharyngeal insufficiency and maxillary growth. Our generation has been familiar with the double-opposing Z-plasty cleft palate repair, described by Furlow in 1986.2 Afterward, almost the world over, including in Turkey, the technique was considered as a revolution in cleft palate repair, after two classic techniques, those of von Langenbeck and Veau-Wardill-Kilner. The majority of the cleft palate surgeons have applied this new technique, and in time this technique has been evaluated as a good approach in narrow clefts. Dr. Cihandide met Dr. Leonard Furlow during the Activation by Rotaplast, held in Maracaibo, Venezuela, between August 30 and September 10, 2000. As known, this activation was related to only cleft lip and palate surgery. Dr. Angelo Capozzi was the chief of the classic cleft team with 44 people. Surprisingly, Dr. Furlow was in the team with another five plastic surgeons. During the activation, 225 children were examined by the team and 182 of them were operated on. More than half of the patients were cleft palate cases and all cases underwent repair by means of Dr. Furlow’s technique. Because it was like a cleft lip and palate school, Dr. Cihandide was able to observe almost all of the details and steps of the technique first hand. This is why he felt himself to be very lucky. During the activation, Dr. Cihandide observed that the islandization procedure was a routine step, achieved through a certain order of his technique, especially in large clefts. Possibly, Dr. Furlow was doing this before 2000, the time at which Dr. Cihandide first observed it. Although more dissection and related early and late problems are inevitable in this approach, we congratulate the authors because their contribution can be considered as a confirmation of the step taken by Dr. Furlow. Adnan Uzunismail, M.D. Ercan Cihandide, M.D. Department of Plastic, Reconstructive, and Aesthetic Surgery Haydarpaşa Numune Training and Research Hospital Istanbul, Turkey

Current practice of distraction osteogenesis for craniofacial anomalies in Europe: A web based survey

Aim of the study was to get more insight into the opinion of European surgeons and orthodontists on the use of distraction osteogenesis (DO) for patients with different diagnoses and treatment protocols. A web based survey was set up, showing records of four patients with different conditions: hemifacial microsomia (case 1), bilateral mandibular deficiency (case 2), cleft lip and palate (case 3) and Crouzon syndrome (case 4). Respondents from 181 Eurocleft centres were asked to fill out a questionnaire for each patient. Most of the respondents considered case 1 (80%), case 3 (81%) and case 4 (86%) suitable for DO, while only 31% were considering case 2 for DO. There was lack of consensus among the respondents about many aspects of DO. Out of six different treatment parameters, an acceptable degree of agreement was only seen in two: a latency period of 3-7 days and a distraction rate of 1mm per day. Furthermore, there was noticeable disagreement on the ideal age for treatment, surgical technique, distraction device, and retention period. Our results showed that there is a wide variety in treatment approaches for craniofacial anomalies in Europe. There is disagreement on essential steps in the distraction procedures.

Distraction osteogenesis for correction of hypoplastic maxilla in cleft lip and palate cases

Distraction osteogenesis for correction of hypoplastic maxilla in cleft lip and palate cases

Radial forearm‐palmaris longus tenocutaneous free flap; implication in the repair of the moderate‐sized postoncologic soft palate defect

Moderate resection of the soft palate results in suboptimal outcomes in terms of postoperative velopharyngeal function. We propose the radial forearm tenocutaneous free flap incorporating the palmaris longus tendon for reconstruction of the levator sling in these cases. Twenty-six patients underwent reconstruction with this method. Group I defect involved up to one-fourth of the soft palate. Group II defect involved up to one-half of the soft palate whether or not including the uvula. Group III defect involved more than three-fourths of the soft palate. Postoperative function was assessed by means of speech intelligibility, swallowing performance, nasalance score, and nasoendoscopy. Groups I and II showed normal results for speech intelligibility and swallowing function at 44 months. In group III, both parameters proved to be suboptimal. Moderate-sized soft palatal resection cases (group II) benefited most from this particular method of dynamic reconstruction using the radial forearm tenocutaneous free flap.

Frequency and Pattern of Oral and Maxillo-facial Carcinomas

Objective : To determine the frequency and pattern of carcinomas in Oral and Maxillofacial region, in particular relation to the primary sub site and involvement of the level of lymph nodes in the neck. Study Design : Descriptive study. Place and Duration of the Study : Oral and Maxillofacial Surgery Department, King Edward Medical University/ Mayo Hospital Lahore and Institute of Nuclear Medicine and Oncology Lahore (INMOL), from 1 st October 2007 to 30 th September 2008. Patients and Methods: Inclusion criteria: patients of all age groups and gender with biopsy (incisional or excisional) proven carcinomas of the oral and maxillofacial region. Exclusion criteria: Irradiated patients and patients with metastatic carcinomas in head and neck region. Results : Squamous cell carcinoma was found in 84.28% (n = 118) patients out of 140 cases, Adenocarcinoma was 5.7% (n = 8), Basal cell carcinoma was 0.7% (n = 1), Acinic cell carcinoma was 1.4% (n = 2), Adenoid cystic carcinoma was 3.6% (n = 5), Mucoepidermoid carcinoma was 3.6% (n = 5) and Verrucous carcinoma was found in 0.7% (n = 1) patients. The levels of lymph nodes involved were as follows; level I 35.7% (n = 50), level II 24% (n = 34), level III 11.4% (n = 16), level IV 6.4% (n = 9) and level V 3.5% (n = 5) in all 140 cases. There were 10% (n = 14) cases of parotid gland tumors, 28.6% (n = 39) tongue carcinomas, 11.4% (n = 16) maxilla, 22.1% (n = 31) buccal mucosa, 15% (n = 21) mandible, 8.5% (n = 12) floor of the mouth and 4.3% (n = 6) cases of palate. Most of the patients with Squamous cell carcinoma presented with T3 and T4 which were 33.9% (n=40) and 43% (n=51) respectively. Histopathologically, SCC with well-differentiated, moderately differentiated and poorly differentiated varieties were 27.12% (n = 32), 33.9% (n = 40) and 38.98% (n = 46) respectively. Most of the SCC patients were of stage stage-III or stage IV 41.5% (n = 49) and 35.5% (n = 42) respectively. Conclusion : Squamous cell carcinoma is the most common cancer of oral and maxillofacial region and most frequent site for squamous cell carcinoma is oral tongue. Key words: Oral carcinoma, squamous cell carcinoma, precancerous lesions, TNM staging.

Rehabilitation of an Edentulous Cleft Lip and Palate Patient with a Soft Palate Defect Using a Bar-Retained, Implant-Supported Speech-Aid Prosthesis: A Clinical Report

Prosthetic rehabilitation of an edentulous cleft lip and palate patient with a combined hard and soft palate defect is a great challenge, due to the lack of retention of the obturator prosthesis as a result of its weight and the inability to obtain a border seal. Dental implants improve the retention, stability, and occlusal function of prostheses when used in carefully selected cleft lip and palate cases. This clinical report presents an edentulous unilateral cleft lip and palate patient who has hard and soft palate defects and an atrophied maxilla, treated with an implant-supported speech-aid prosthesis.

Pattern of Cleft Lip and Palate in Hospital-Based Population in Saudi Arabia: Retrospective Study

To report the patterns of cleft lip and/or cleft palate in Saudi Arabia from data collected at a tertiary care hospital. King Faisal Specialist Hospital and Research Center, Riyadh. All the cleft lip and/or cleft palate patients registered in the Cleft Lip/Palate and Craniofacial Anomalies Registry from June 1999 to December 2005. Retrospectively, 807 cases of cleft lip and/or palate were registered. There were 451 boys and 356 girls. Cleft lip and palate was more common (387) than isolated cleft palate (294) and isolated cleft lip (122). Boys predominated in cleft lip and palate and cleft lip; whereas, girls predominated in isolated cleft palate, with boy to girl ratios of 1.6:1, 1.2:1, and 0.9:1 for cleft lip and/or palate, isolated cleft lip, and isolated cleft palate, respectively. The Riyadh region had more cases (32.0%) than the Asir (15.6%) and Eastern (14.6%) regions. Parents of 439 individuals had consanguineous marriages. A positive family history of cleft was seen in 224 cases. Of 238 cases with associated anomalies, 91 had congenital heart disease. Of the children with isolated cleft palate, 40.5% had associated anomalies, whereas only 23.0% of the children with isolated cleft lip or cleft lip and palate had associated malformations. The pattern of cleft observed in this study does not differ significantly from those reported in the literature for Arab populations.

Cleft palate associated with hamartomatous bifid tongue. Report of two cases

Congenital tumours of the tongue may have a detrimental effect on the simultaneously developing adjacent structures. Palate formation may be affected as it develops in the same period of organogenesis as the tongue. We present two such rare cases of cleft palate with tumour of the dorsal tongue as the probable causative factor. To analyse such an entity, it is necessary to understand the embryogenesis of the palate and tongue. The management and possible elucidation of the occurrence with respect to the developmental phases of tongue and palate are detailed in brief.

The value of the postnatal examination in improving child health

This paper reviews the evidence regarding whether a standardised examination in the newborn period can improve infant health. The review considers aspects of delivering such a service from timing and...

Evaluation of Dynamic Magnetic Resonance Imaging in Assessing Velopharyngeal Insufficiency During Phonation

Velopharyngeal insufficiency (VPI) expresses the structural and neuromuscular disorder of soft palate and pharyngeal walls inhibiting the normal functions of velopharyngeal (VP) sphincter mechanism. In this study, efficacy of dynamic magnetic resonance imaging in the diagnosis of VPI is investigated. A total of 32 cases, 16 controls and 16 cleft palates, were included in this study. T1 fast spin echo-weighted imaging during rest, dynamic investigations with True-fast imaging with steady-state precession sequence during /sss/ and /mmm/ phonations were performed. During /sss/ phonation, complete closure was observed in the control group, whereas mean VP opening was 4.11 cm2 preoperatively and 0.21 cm2 postoperatively in the cleft palate group. In the postoperative period, only 3 patients did not have complete closure. In the second operations, performed 6 months later, only muscle repair was done. All 3 had complete closure. In cleft palate cases with delayed diagnosis, appropriate application of muscle repair will be sufficient for anatomic repair of VPI without any extra procedures. In addition, dynamic magnetic resonance imaging is an objective, noninvasive, reliable, and effective modality that may be used in the diagnosis and treatment of VPI without any extra investigations.

Prevalencia de fisura labiopalatina e indicadores de riesgo: Estudio de la población atendida en el Hospital Clínico Félix Bulnes de Santiago de Chile

Introduction. The study of the prevalence of cleft lip and palate and the identification of risk groups helps to improve the treatment of this condition. Occurrence may be prevented by improving environmental conditions during pregnancy and ensuring early diagnosis, thus lessening the emotional impact on the family and reinforcing the early mother-child bond. The aim of this study was to improve prevention levels and thus enhance health resources. Material and method. The frequency of cleft lip and palate and its association with risk factors was studied in live births of the Felix Bulnes University Hospital in Santiago between January 1998 and june 2005. Maternal conditions and exposure to environmental agents associated with cleft lip and/or palate were examined. Results. Out of a total of 36.041 births, 51 cases of cleft lip and palate were found, which yielded a rate of 1.42 x 1000 births. Conclusions. Analysis of risk indicators identified: mothers under the age of 20 years, usually with their first pregnancy, a high degree of Amerindian admixture and family history positive for this malformation. Our study supports the multifactorial inheritance theory of susceptibility to cleft lip and palate.

Caninos permanentes retidos por palatino: diagnóstico e terapêutica: uma sugestão técnica de tratamento

Os dentes seguem uma seqüência de erupção favorável no desenvolvimento da oclusão normal, mas algum distúrbio desse mecanismo, nesse período de transição da dentadura mista para a permanente, pode levar a alterações na seqüência ou mesmo no trajeto de erupção, levando a impactação de dentes. Os caninos superiores permanentes, depois dos terceiros molares, apresentam maior ocorrência de impactação, especialmente na região palatina, mesmo na presença de espaço suficiente para o seu alinhamento na arcada dentária. Na impossibilidade do diagnóstico precoce, esforços serão empregados para reposicionar o dente no arco dentário evitando sua extração, dada a sua importância no equilíbrio, harmonia e função do arco dentário. Nos casos não diagnosticados ou tratados inadequadamente podem ocorrer perturbações mecânicas, infecciosas ou neoplásicas. O prognóstico depende da posição do canino em relação às estruturas adjacentes e à possibilidade de movimentação ortodôntica. O presente trabalho aborda os principais fatores a serem considerados nos casos de caninos superiores permanentes impactados, tais como processo de erupção, etiologia, diagnóstico e uma forma de tração proposta para caninos impactados. Também será apresentado um caso clínico em que se optou pelo tratamento ortodôntico-cirúrgico, cuja técnica de tração tem-se mostrado bastante eficiente nos casos de impactação de caninos no palato.