Palatal Processes Research Articles

Evaluation of interradicular space, soft tissue, and hard tissue of the posterior palatal alveolar process for orthodontic mini-implant, using cone-beam computed tomography

To investigate the anatomy of the posterior palatal alveolar process, which is often used for placement of the orthodontic mini-implant (OMI), and to suggest simple guidelines for safe placement of OMI. Cone-beam computed tomography (CBCT) scans of 60 patients (30 men, 30 women; age range, 18-39years; average age, 25.8years) was used to measure the palatal interradicular distance, the palatal bone thickness, and the palatal soft-tissue thickness. Measurements were performed on the area from the maxillary canine to the maxillary secondmolar based on the vertical distance apical from the cementoenamel junction. The CBCT data were analyzed by Bonferroni correction for multiple testing and the multivariable mixed linear model. The palatal interradicular distance was the widest between the second premolar and the first molar and the narrowest between the first and second premolars. The palatal bone thickness at interdental sites was the thickest between the first and second premolars and the thinnest between the first and secondmolars. The interdental palatal soft-tissue thickness from the canine to the second premolar was thicker than any other area. There were minor measurement differences between genders and positive correlations between vertical distance from the cementoenamel junction plane and all of the parameters. In this study, we evaluated the anatomy of the posterior palatal area using CBCT scans of adult patients. The data will provide guidelines to the clinicians before OMI placement in the posterior palatal alveolar process.

Seasonal Influence on the Numbers of Gender-Related Orofacial Cleft Conceptions in the Netherlands.

In the multifactorial etiology of orofacial clefts (OFCs), environmental factors play an important role. To trace the influence of these factors, the timing of the cell biological mechanisms that occur during embryological development of the primary and secondary palates must be taken into account. That is, the fusion process of the facial and palatal processes, respectively, followed by their differentiation into bone and musculature, which take place during the first trimester of pregnancy. During this period, harmful seasonal influences such as viral infections and vitamin deficiencies could induce OFC in the embryo. The aim of this study is to find out whether a seasonal conception period with an increased risk of OFC development exists, particularly gender related. This was a retrospective cross-sectional study on children with OFC born in the Netherlands from 2006 to 2016. Total conception rates of live births in the Netherlands were used as a control group. χ2 tests were performed to analyze monthly and seasonal differences. Males and females, positive and negative family history and subphenotype groups based on fusion and/or differentiation (F- and/or D-) defects, and their timing in embryogenesis were analyzed separately. In total, 1653 children with OFC, 1041 males and 612 females, were analyzed. Only males with FD-defects showed a significant seasonal variation with an increase in conceptions during spring, most often in May. Males with FD-defects showed a significant seasonal variation with an increase in conceptions during spring. No other seasonal trends could be demonstrated.

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 new caimanine alligatorid from the Middle Eocene of Southwest Texas and implications for spatial and temporal shifts in Paleogene crocodyliform diversity.

Dramatic early Cenozoic climatic shifts resulted in faunal reorganization on a global scale. Among vertebrates, multiple groups of mammals (e.g., adapiform and omomyiform primates, mesonychids, taeniodonts, dichobunid artiodactyls) are well known from the Western Interior of North America in the warm, greenhouse conditions of the early Eocene, but a dramatic drop in the diversity of these groups, along with the introduction of more dry-tolerant taxa, occurred near the Eocene–Oligocene boundary. Crocodyliforms underwent a striking loss of diversity at this time as well. Pre-Uintan crocodyliform assemblages in the central Western Interior are characterized by multiple taxa, whereas Chadronian assemblages are depauperate with only Alligator prenasalis previously known. Crocodyliform diversity through the intervening Uintan and Duchesnean is not well understood. The middle Eocene Devil’s Graveyard Formation (DGF) of southwest Texas provides new data from southern latitudes during that crucial period. A new specimen from the middle member of the DGF (late Uintan–Duchesnean) is the most complete cranial material of an alligatorid known from Paleogene deposits outside the Western Interior. We identify this specimen as a caimanine based on notched descending laminae of the pterygoids posterior to the choanae and long descending processes of the exoccipitals that are in contact with the basioccipital tubera. Unlike Eocaiman cavernensis, the anterior palatine process is rounded rather than quadrangular. The relationships and age of this new taxon support the hypothesis that the modern distribution of caimanines represents a contraction of a more expansive early Cenozoic distribution. We hypothesize that the range of caimanines tracked shifting warm, humid climatic conditions that contracted latitudinally toward the hothouse-icehouse transition later in the Eocene.

Evaluation of Results of the Furlow’s Modified Technique in the Management of Cleft Palate in the Teaching Hospital of Conakry

Introduction: Cleft palate (CP) is a congenital dysmorphosis that results from a failure of the palatal processes of the maxillary buds and nasal septum to merge. The objectives of this study were to determine the frequency of complications of the modified Furlow technique and to evaluate its anatomical and functional outcomes. Materials and Method: This was a retrospective study that took place over a period of 4 years (from January 1st, 2015 to December 31th, 2018) in the Department of Odontostomatology and Maxillofacial Surgery at the National Hospital of Donka (Conakry, Guinea). Data retrieval consisted of records from patients operated on for cleft palate according to Furlow’s modified technique only. The operative technique consisted of marginal incisions of the cleft according to the technique of the double Z-plasty of Furlow. Subsequently, the defect created between the 2 flaps and the anterior edge of the cleft was filled by two fat masses of Bichat sutured to each other with Vicryl 3-0. Four years after surgery, the patients were recalled for an evaluation of the anatomical and functional results. Results: 13 patients underwent surgical loading according to the modified Furlow technique. The average age of the patients was 6.9 years with an age range of 7 months and 17 years. Females were the most affected, with 61.54% of cases and a sex ratio of 0.62. The primary repair rate was 84.61% of cases. Immediate operative follow-up was simple with epithelialization of the flaps in all patients. Four (4) years after the surgeries, 12 patients were reevaluated (92.30%), among them one case (8.33%) of fistula complication was noted. The mobility of the veil and the phonation were good in 85.71% and 60% respectively. Articular disorders with nasonation were found in 2 patients (16.67%). Swallowing was normal in 85.72% of cases. Conclusion: The modified Furlow technique is an important contribution to cleft palate surgery significantly reducing the occurrence of postoperative complications. However, the delay of the surgical operation remains a real obstacle for obtaining a normal phonation.

ACESSANDO O SIGNIFICADO SOCIAL DA PALATALIZAÇÃO /t, d/

Ao considerar a língua como sistema inerentemente variável, a Teoria da Variação e Mudança (WEINREICH; LABOV; HERZOG, 2006 [1968]) postula que as variantes linguísticas apresentam o mesmo significado referencial, mas tendem a apresentar significados sociais diferentes. Esses significados podem ser associados a valores positivos, negativos ou neutros na comunidade. Neste estudo, mensuramos os significados sociais associados ao processo de palatalização /t, d/ por estudantes universitários do agreste alagoano, a partir de seis parâmetros de julgamento social: percepção da variação na cidade onde mora, crença a respeito do próprio uso linguístico, avaliação da variação, percepção do uso quanto à variação diatópica, quanto à escolarização e quanto ao preconceito linguístico. Adotamos uma abordagem direta (GARRET; COUPLAND; WILLIAMS, 2003) através de um questionário de crenças e atitudes linguísticas, que foi aplicado a 102 estudantes universitários. Os dados evidenciam que a percepção dos estudantes é sensível ao contexto linguístico, revelando que, para a palatalização regressiva, há uma avaliação positiva, indicando ser um estereótipo positivo, ao passo que, para a palatalização progressiva, há uma avaliação negativa, indicando um caso de estereótipo negativo na comunidade.

Electrical stimulation enhances early palatal wound healing in mice

Background/objectiveElectrical stimulation (ES) has been used to treat chronic wound and other clinical applications, showing favorable results in wound closure. It was hypothesized that ES can present a positive effect on oral mucosa healing. The aim of this study was to investigate the effects of ES during the palatal mucosa early healing process in Swiss mice. MethodsNinety animals were divided into two groups: Control (C; n = 45), which received Sham ES applications, and Test (ES; n = 45), which received ES (100 μA; 9 kHz; 660 mVpp) once a day for 3 days. A full thickness wound was performed with a 1.5 mm diameter biopsy punch in the hard palate. Histologically, the following parameters were evaluated: palatal wound closure and epithelial and connective wound edge distance (EED and CED). Furthermore, IL-1β, IL-6, IL-10 TNF-α, and VEGF cytokine levels were evaluated by multiplex assay. The percentage of collagen fibers was assessed using the polarization method and the Smad proteins using the immunofluorescence method. ResultsPalatal wound closure presented a significant reduction on day 5 in the ES group (p = 0.01). Additionally, both EED and CED were shorter for all time points in the ES group (p < 0.05), and the inflammatory markers IL-6, IL-10, TNF-α, and VEGF were reduced (p < 0.05). There were no differences in collagen fibers and phospho-Smad2 between the groups. ConclusionES had a positive effect on early palatal wound closure outcomes, as well as on inflammatory markers.

A crossover clinical study to evaluate pain intensity from microneedle insertion in different parts of the oral cavity

The objective of the present study was to evaluate discomfort and safety of microneedle (MN) insertion in several intraoral regions. A device was developed to standardize MN insertions. MNs were inserted in the following regions of the oral cavity: gingiva, palatine alveolar process, buccal mucosa, dorsum of the tongue and inner portion of the lower lip. Perforations from MNs post insertion were confirmed with topical gentian violet stain. Pain was evaluated in a randomized, double-blinded, crossover study in 30 volunteers. Each volunteer received a MN patch, a 30G hypodermic needle (positive control) and an identical MN patch with its needles laying flat in the plane of the patch (negative control). Adverse events were visually evaluated immediately after (0 h) and 24 h post MN application. The application device developed a consistent application force (10 N) and promoted perforation of all individual MNs on a patch. At all sites, insertion of the hypodermic needle promoted more pain when compared to the negative control (p < 0.001). Application of the MNs promoted less pain than the hypodermic needle (p < 0.05), but slightly more pain as compared to the negative control (p < 0.05) at all sites except the tongue, where the MN did not differ from the negative control (p > 0.05). Hypodermic needle caused bleeding at all insertion sites. In contrast, MNs did not cause bleeding at most sites except in some cases of insertion into the hard gingiva and the palatine alveolar process where tiny blood spots appeared immediately after MN application for few of the MNs on the patch. There were no cases of bleeding at 24 h post MN application. In conclusion, MNs can perforate different sites of the oral cavity in a safe and significantly less painful manner as compared to the 30G hypodermic needle. Thus, analogous to the skin, MN-based approaches could be an attractive approach for drug delivery in the oral cavity.

Ten years of miniscrew use in a U.S. orthodontic residency program

Orthodontic miniscrews have become popular not only because they can provide an absolute form of anchorage, but also because they can reduce the required patient compliance when compared with traditional orthodontic anchorage. The objective of this study was to examine success rates of miniscrews placed by orthodontic residents and to evaluate which factors may affect insertion outcomes. The sample consisted of 109 consecutive miniscrews placed in 60 patients (27 males and 33 females). Miniscrews were placed at 4 different insertion sites (anterior palate [n=31], palatal alveolar process [n=25], maxillary buccal alveolar process [n=15], and mandibular buccal alveolar process [n=38]). Analysis of variance tests were used to evaluate the influence of insertion sites and anchorage type (direct vs indirect) on the success rate. The overall success rate for miniscrews was 72.5%. The success rate was 83.9% in the anterior palate, 76% in the palatal alveolar process, 60% in the maxillary buccal alveolar process, and 65.8% in the mandibular buccal alveolar process. The success rate was significantly higher in indirect anchorage (84.2%) compared with direct anchorage (58.8%). Palatal miniscrews were more successful than buccal miniscrews. Indirect anchorage mechanics had a higher success rate than direct anchorage mechanics.

Msx1 Heterozygosity in Mice Enhances Susceptibility to Phenytoin-Induced Hypoxic Stress Causing Cleft Palate.

Cleft palate is among the most frequent congenital defects in humans. While gene-environment multifactorial threshold models have been proposed to explain this cleft palate formation, only a few experimental models have verified this theory. This study aimed to clarify whether gene-environment interaction can cause cleft palate through a combination of specific genetic and environmental factors. Msx1 heterozygosity in mice (Msx1+/-) was selected as a genetic factor since human MSX1 gene mutations may cause nonsyndromic cleft palate. As an environmental factor, hypoxic stress was induced in pregnant mice by administration of the antiepileptic drug phenytoin, a known arrhythmia inducer, during palatal development from embryonic day (E) 11 to E14. Embryos were dissected at E13 for histological analysis or at E17 for recording of the palatal state. Phenytoin administration downregulated cell proliferation in palatal processes in both wild-type and Msx1+/- embryos. Bone morphogenetic protein 4 (Bmp4) expression was slightly downregulated in the anterior palatal process of Msx1+/- embryos. Although Msx1+/- embryos do not show cleft palate under normal conditions, phenytoin administration induced a significantly higher incidence of cleft palate in Msx1+/- embryos compared to wild-type littermates. Our data suggest that cleft palate may occur because of the additive effects of Bmp4 downregulation as a result of Msx1 heterozygosity and decreased cell proliferation upon hypoxic stress. Human carriers of MSX1 mutations may have to take more precautions during pregnancy to avoid exposure to environmental risks.

Observation of the Epithelial Cell Behavior in the Nasal Septum During Primary Palate Closure in Mice.

Epithelial fusion is critical in palatogenesis, and incomplete fusion results in various type of facial cleft, depending on the region that fails to fuse. In mammalian palatogenesis, the bilateral secondary palatal processes fuse in the middle of the face to form the secondary palate. Later, the dorsal side of the secondary palatal shelves fuses with the nasal septum to complete palatogenesis. Importantly, the anterior border of the secondary palatal shelf fuses with the primary palate, which is located at the anterior and ventral border of the nasal septum. While numerous studies have investigated the mechanism of fusion between secondary palatal shelves, very little is known about how the primary palate touches and fuses with the secondary palatal shelves. In this study, we investigate the possible epithelial cell behaviors on the surface of the primary palate using palatal explant cultures of K14-GFP mice. A time-lapse observation of the GFP-labeled epithelium and an SEM analysis revealed that the extrusion epithelium appeared at the region corresponding to the fusing area and expanded rostrally on the nasal septum surface in the absence of the secondary palatal processes. Unlike on the secondary palate surface, cellular migration and subsequent autonomous mesenchymal exposure were not evident on the nasal septum or the primary palate. TUNEL staining revealed that these extrusion epithelia were undergoing apoptosis. These findings indicated that extrusion with apoptosis was autonomously initiated at the presumptive region of the fusion without contact with the opposing secondary palate.

T cells participate in bone remodeling during the rapid palatal expansion.

Palatal expansion has been widely used for the treatment of transverse discrepancy or maxillae hypoplasia, but the biological mechanism of bone formation during this procedure is largely unknown. Osteoclasts, which could be regulated by T cells and other components of the immune system, play a crucial role in force-induced bone remodeling. However, whether T cells participate in the palatal expansion process remains to be determined. In this study, we conducted the tooth borne rapid palatal expansion model on the mouse, and detect whether the helper T cells (Th) and regulatory T cells (Treg) could affect osteoclasts and further bone formation. After bonding open spring palatal expanders for 3-day, 5-day, 7-day, and retention for 28-day, micro-computed tomography scanning, histologic, and immunofluorescence staining were conducted to evaluate how osteoclasts were regulated by T cells during the bone remodeling process. We revealed that the increased osteoclast number was downregulated at the end of the early stage of rapid palatal expansion. Type 1 helper T (Th1) cells and Type 17 helper T (Th17) cells increased initially and promoted osteoclastogenesis. Thereafter, the regulatory T (Treg) cells emerged and maintained a relatively high level at the late stage of the experiment to downregulate the osteoclast number by inhibiting Th1 and Th17 cells, which governed the new bone formation. In conclusion, orchestrated T cells are able to regulate osteoclasts at the early stage of rapid palatal expansion and further facilitate bone formation during retention. This study identifies that T cells participate in the palatal expansion procedure by regulating osteoclasts and implies the potential possibility for clinically modulating T cells to improve the palatal expansion efficacy.

Different speakers, different grammars: Productivity and representation of Xhosa labial palatalization

While cross-linguistic studies suggest that palatalization is preferentially triggered by high and front vocoids, and that it targets coronals or dorsals, Xhosa has a process of palatalization that is triggered by [w], and that targets only bilabials. This paper presents a wug test experiment, showing that some Xhosa speakers do systematically generalize this phenomenon to nonce words. This suggests that for those speakers, labial palatalization is indeed learned as part of their phonological grammar. Additionally, our findings show that some other speakers systematically do not apply palatalization in nonce words, suggesting that they have learned it as a pattern in the lexicon, and not as part of phonology. Drawing on evidence from a separate wug test experiment, we show that the inter-speaker variation in our results cannot be explained away as a task effect. As such, our results show that different speakers can have fundamentally different grammatical representations of the same sound pattern. Though Xhosa’s labial palatalization pattern is phonetically unnatural, that does not indicate that it is necessarily outside the domain of phonology proper.

MRI Features of the Vomeronasal Organ in Dogs (Canis Familiaris).

According to current knowledge, the vomeronasal organ (VNO, Jacobson's organ) is the structure responsible for semiochemical signal detection. In dogs and other mammals, it is located close to the vomer and palatine processes of the incisive and maxillary bones. Although there are reports describing the anatomy and histology of this structure, there are limited available reports assessing this organ in live individuals and no direct visualization reports in dogs. The aim of this study was 2-fold: (1) preparation and optimization of a protocol for magnetic resonance imaging (MRI) examination of the VNO in a cadaver study with precise visualization and localization, and (2) characterization of the physiological VNO image features in MRI of live dogs. The first part of the study was performed on 10 beagle cadavers, the second on 8 live beagle dogs. For the VNO visualization, a 1.5T MRI (Philips® Ingenia) scanner and 20-channel digital head-neck spine coil were used (Philips®, Holland). The cadaver study allowed confirmation of the organ's location by the topical application of an MRI contrast agent (gadolinium) via the external entrance of the VNO canal. Accurate delineation of the VNO was obtained using a high resolution submillimeter three-dimensional T1-fast field echo (FFE) 3D sequence. Imaging of the VNO in 8 living dogs allowed the description of the morphological MRI features and direct evaluation of its shape and size. The results obtained demonstrate the ability to visualize the VNO in vivo and to evaluate its structure in dogs.

QUALITY OF ORTHOPEDIC REHABILITATION OF PATIENTS WITH POST-TRAUMATIC DEFECTS OF THE UPPER JAW BY CHARACTERISTICS OF BIOCENOSIS OF THE ORAL CAVITY

The aim of the research was to study the dynamics of the microbiota's features of oral mucosal membrane during orthopedic rehabilitation of patients with removable dentures which has an obturating part with two-layer bases. Materials and methods: To achieve this goal, our bacteriological examination of oral cavity mucosa was performed for 25 patients with partial adentia of the upper jaw and defect of hard palate and alveolar process. Results and conclusions: Of the conducted studies indicate significant shifts in the qualitative and quantitative composition of microbiocenosis in the oral cavity in patients with partial adenia of the upper jaw and a defect of hard palate and alveolar process due to representatives of moraksel, enterobacteria (representatives of the kinds Klebsiella and E. coli). The сomparing of frequency of extraction and the density of microbial colonization showed us the persistence in biotope of representatives near 13 kinds of bacteria and yeast-like fungi of the kind Candida in averages from lg (2,5 ± 0,19) to lg (5,4 ± 0,17) CFU/g. For patients who have been made a two-layered basis, materials of which are based on carboxymethylcellulose and polyvinialacetate in the period of adaptation to removable dentures, showed us that the detection of 5 component associations at 30 days was reduced by 2 times (χ2 = 5,991; ν = 2; p <0,05) . The frequency of removal and density of microbial colonization of the experimental group did not differ statistically. Among patients in the control group, the microbial colonization density increased for Enterococcus spp, for Klebsiella spp and for Candida spp. Yeast-like fungi. A significant decrease in the microbial density of the resident microflora was 1.4 times for Neisseria spp, 1.6 timesfor Lactobacillus spp (p <0,05).

Epignathi Teratoma Co-Existing with Tongue Choristoma and Cleft Palate in a Neonate: Report of a Rare Case and Review of Literature

Background: Oral epignathus teratoma is an extremely rare neoplasm that occurs exclusively in neonates. The tumor can grow to a large size obstructing airways and it may prevent fusion of the nasal septum with the palatine processes, which may result in cleft palate formation. The rare tumor may also co-exist with other congenital malformations such as hamartoma and choristoma causing airway obstruction and death. Case report: We present a case of a one-day-old male neonate who presented with oral mass associated with difficulty in breathing and inability to suck breast milk. Computed Tomography (CT) scan revealed multiple masses involving the alveolar, palate, and tongue along with cleft palate. Emergency surgery was done to relieve the airway and histology confirmed epignathi teratoma with tongue choristoma. Conclusion: Epignathus teratoma is a rare condition that requires prenatal prompt diagnosis. However, in countries with underprivileged hospital facilities, early surgical intervention during the neonatal period is what is required to save the patient from airway obstruction. Association of the tumor with midline anomalies is mostly the norms, however, 5% of cases with malignant transformation have been reported and the tumor is commonly associated with endodermal sinus tumor. Therefore long term follow-up of patients with serum tumor markers is highly recommended.

Surgical-associated expansion of the jaws with asymmetric deformations

One of the most common abnormalities in the development of the jaw is the narrowing of the alveolar process of the maxilla. In childhood, the elimination of such a deformation is quite common. But with age, the only effective option is the inclusion of a surgical procedure in the rehabilitation plan. The medial and parasagittal osteotomy of the maxilla for the purpose of its expansion by a distraction device has a number of important nuances which can significantly affect the result. These include: localization of sagittal osteotomy of the palate and alveolar process; the direction of cutting the walls of the maxillary sinus; type of fixation of the device (dental-borne or bone-borne). The article summarizes the experience of 74 surgical-associated expansions of the jaws with asymmetric deformations performed over 2 years. A retrospective analysis according to cone beam computed tomography is given. of complex treatment with the inclusion of sparing osteotomy of the maxilla in the rehabilitation plan and a differentiated approach to performing surgical manipulation allow to achieve optimal aesthetic and functional results and to correct the asymmetry to the greatest extent.

Palatalization as a Non-uniform Phonological Process: A Diachronic Analysis

The aim of this study is to analyse a non-uniform process of palatalization in the Mid- dle English Northern dialect, with the main focus on the range of operation of the pro- cess, its conditioning environment and the direction of the change in the four lemmas: EACH, MUCH, SUCH, and WHICH. The fact that palatalization was an active process in the North has been proved by 47% of the Northern texts from the Innsbruck Cor- pus of Middle English Prose, which have demonstrated cases of palatalization in the forms of the lemmas. Referring to the studies of a perceptually motivated sound change and observing certain correlations between the palatalization processes occurring now and in the past, one may infer that the scope of palatalization in the North might have been even wider.

PREVALENCE OF EPSTEIN’S PEARLS AND BOHN’S NODULES AMONG CONGENITAL ORAL ABNORMALITIES

INTRODUCTION: Epstein’s pearls and Bohn’s nodules are characterized as inclusion cysts of the newborn, resulting from epithelial remnants that were trapped during the fusion of palatal processes. They are asymptomatic and transient cystic lesions and, therefore, do not require treatment by means of drugs or surgical intervention. This issue is problematic, since dental or pediatric professionals find it difficult to accurately identify and diagnose the cyst, failing to inform parents who are often distressed to realize the pathology. OBJECTIVE: The purpose of this paper is to develop an integrative literature review to analyze whether, in fact, Bohn’s nodules and Epstein pearls are the most common congenital oral lesions in newborns. METHODOLOGY: Articles indexed in SciELO, PubMed / Medline and Lilacs. The keywords used were: Epstein’s pearls, Bohn’s nodules, newborn, prevalence, palatine cysts, gingival cysts. As inclusion criteria, complete articles published in the last 10 years, in the Portuguese and English languages and that answered the research question. We found 23 articles and after applying the inclusion criteria, we selected 17 articles, 9 of which formed the present abstract, using them to explore the content. RESULTS AND DISCUSSION: Epstein’s pearls and Bohn’s nodules appeared in the literature as high frequency oral abnormalities among newborns. The data obtained in the base articles took age, location and gender as criteria, with differences between their percentages. Despite this dissonance, research has always resulted in about 50% more cases, compared to other congenital oral abnormalities. Thus, there is a comparative table between the studies that shows the results more easily in order to make explicit the prevalence of these cystic oral lesions. No evidence was found on causes related to these pathologies, only embryological origin, and further research is needed. CONCLUSION: Based on the findings, it is noticeable the prevalence of Epstein Pearls and Bohn’s Nodes, given the high frequency of these inclusion cysts in the clinical routine. Given this, the present literature review brings the necessary keys to clarify the predominance of these congenital oral anomalies so that it is possible to set up an accurate diagnosis and clarification of parents.

Removal of a maxillary tumor with simultaneous placement of intraosseous zygomatic implants

The study objective is to report a case of successful placement of intraosseous zygomatic implants for functional and aesthetic rehabilitation of a patient with a maxillary defect resulted from maxillary resection for right-sided stage IIB maxillary sarcoma (сT2N0M0, G3). Materials and methods . A 34-year-old male patient visited a doctor in P.A. Herzen Moscow Oncology Research Institute with complaints of maxillary tumor. During the examination of the oral cavity, we found a dense endophytic tumor in the area of two missing teeth (17 and 18) involving the alveolar process and palatine process of the maxilla. Computed tomography revealed destruction of the alveolar process, lateral, medial, and posterior walls of the maxillary sinus on the right, and tumor invasion into the right iliac fossa, pterygopalatine fossa, and right maxillary sinus. We also observed tumor destruction of the right palatine process of the maxilla. The patient was diagnosed with osteogenic sarcoma. Results. The patient received 4 courses of polychemotherapy with cisplatin and doxorubicin, which resulted in disease stabilization. Then the patient underwent en-block resection of the fragment of the right maxilla with alveolar and palatine processes, fragments of the zygomatic bone, wings of the sphenoid bone on the right side, and adjacent soft tissues. Simultaneously, we placed two zygomatic implants to provide supportfor the maxillary plate denture. To create an additional supporting point, we extracted tooth 11 and installed an implant with external hexagonal connection. Later, we produced and installed a specially designed palatal obturator. Conclusion. Installation of removable dentures supported by implants ensures complete and rapid rehabilitation, allowing a patient to chew, swallow, and speak normally. A palatal obturator on implants supports the soft tissues of the medial face, thus ensuring complete aesthetic rehabilitation.