Palate Center Research Articles

The current treatment and Future Prospects of the Cleft Lip and/or Palate Center, Kyushu Dental University Hospitat

The current treatment and Future Prospects of the Cleft Lip and/or Palate Center, Kyushu Dental University Hospitat

Primary Maxillary Hypoplasia in Complete Unilateral Cleft Lip and Palate: Analysis of Clinical Data and Associations

Objective: Investigate the volumetric differences between the cleft and noncleft hemi-maxillae in patients with complete unilateral CLP and compare them with the average population. It also aimed to correlate the hemi-maxilla volumetry with maxillary sinuses’ volumes, with the occlusal index in digitized models and tooth agenesis. Design: This is a retrospective cohort study. Setting: Cleft lip and palate center in quaternary-level institutions. Patients, Participants: This study included 23 patients with complete unilateral CLP who underwent cheiloplasty between 2008 and 2012 and a control group of 24 patients without craniofacial abnormalities. Interventions: None. Main Outcome Measure(S): The computed tomography scans of cleft patients were analyzed before and after alveolar bone grafting. Following 3-dimensional tomographic reconstruction, a volumetric index was calculated as the ratio of cleft and normal side volumes (CV/NV). Cuts and measurements were also conducted in the control group. Additionally, the volumetric index of the maxillary sinuses (MSCV/MSNV) was calculated, and occlusal index analyses were performed using digitized models. In addition, dental agenesis was observed. Results: The CV/NV relationship was significantly lower in the prealveolar and postalveolar bone grafting periods than in the normal population (P<0.01), confirming primary maxillary hypoplasia in patients with complete unilateral CLP. The CV/NV decreased progressively with worsening occlusal index classifications (P=0.03). No associations were observed between MSV and any of the studied variables. Conclusion: The complex anatomy of patients with complete unilateral CLP impairs treatment outcomes, and maxillary hypoplasia must be considered an important predictive factor.

Epidemiology of cleft lip and palate charity mission surgery at Bandung Cleft Lip and Palate Center, Indonesia: a 14-year institutional review.

The management of cleft lip and palate aims at improving the patient's aesthetic and functional outcomes. Delaying primary repair can disrupt the patient's functional status. Long-term follow-up is essential to evaluate the need for secondary repair or revision surgery. This article presents the epidemiology of cleft lip and palate, including comprehensive patient characteristics, the extent of delay, and secondary repair at our institutional center, the Bandung Cleft Lip and Palate Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia. This retrospective study aimed to determine the epidemiology and recurrence rates of cleft lip and palate at the Bandung Cleft Lip and Palate Center, Indonesia, from January 2007 to December 2021. The inclusion criteria were patients diagnosed with cleft lip and/or palate. Procedures such as labioplasty, palatoplasty, secondary lip and nasal repair, and alveolar bone grafting were performed, and data on recurrence were available. In total, there were 3,618 patients with cleft lip and palate, with an age range of 12 months to 67 years. The mean age was 4.33 years, and the median age was 1.35 years. Males predominated over females in all cleft types (60.4%), and the cleft lip was on the left side in 1,677 patients (46.4%). Most cases were unilateral (2,531; 70.0%) and complete (2,349; 64.9%), and involved a diagnosis of cleft lip and palate (1,981; 54.8%). Delayed primary labioplasty can affect daily functioning. Primary repair for patients with cleft lip and palate may be postponed due to limited awareness, socioeconomic factors, inadequate facilities, and varying adherence to treatment guidelines. Despite variations in the timing of primary cleft lip repair (not adhering to the recommended protocol), only 10% of these patients undergo reoperation. Healthcare providers should prioritize the importance of the ideal timing for primary repair in order to optimize physiological function without compromising the aesthetic results.

Investigation of the effectiveness of articulation therapy through tele-practice on children with cleft palate in Khuzestan Province during COVID-19 pandemic

IntroductionA cleft palate is a common type of facial malformation. Compensatory articulation errors are one of the important causes of unclear speech in children with cleft palate. Tele-practice (TP) helps to connect therapists and clients for assessment and therapy. Our goal is to investigate the effectiveness of articulation therapy through tele-practice on cleft palate children in Khuzestan Province during the COVID-19 pandemic. Materials & methodsBefore starting the treatment, a 20-min speech sample was recorded individually from all the children. Speech intelligibility and the percentage of correct consonants were assessed for each speech sample. The control group received treatment sessions in person at the cleft palate center, and the other group received treatment via tele-practice using the ZOOM platform. Treatment sessions were provided in the form of 45–60-min group sessions, twice a week, for 5 weeks (10 sessions in total). After 10 treatment sessions, the speech sample was recorded again. The level of parental satisfaction was measured using a Likert 5-level survey. ResultsThe mean score of intelligibility of the two groups decreased (−1.4400 and 0.7200). The two groups' mean percentage of correct consonants increased. (26.09 and 17.90). In both groups, the mean score of parents’ satisfaction with the treatment was high (3.44 and 3.84). The mean of difference before and after the speech intelligibility and the percentage of correct consonants variables in both groups was statistically significant (P = 0.001 and P = 0.002, respectively). In both groups, the satisfaction variable was not associated with a statistically significant difference (P = 0.067). ConclusionThe effectiveness of in-person therapy over a certain period of time is higher than tele-practice. Nevertheless, the results demonstrated an increase in the intelligibility of speech and the percentage of correct consonants in both groups, thus proving the effectiveness of articulation therapy in correcting compensatory articulation errors in children with cleft palate through in-person and tele-practice.

THE INFLUENCE OF CLEFT LIP AND PALATE SEVERITY ON SURGICAL OUTCOMES

Highlights: The severity of unilateral CLP was assessed by categorizing preoperative photo data based on the severity of the cleft, and this severity was then correlated with the surgical outcomes. The way wounds heal is influenced by the width of the gap and suture tension, which are crucial factors in determining surgical outcomes. Abstract: Introduction: An orofacial cleft is a congenital abnormality in which an abnormal opening or cleft of the lips and/or palate. Data in 2017 showed that the most encountered characters are patients with cleft lip and palate. The distribution of the incidence of cleft lip and palate at Cleft Lip and Palate (CLP) Center Faculty of Medicine University of Muhammadiyah Malang was dominated by the complete unilateral type, which was 45.22%. Generally, the severity of cleft lip and/or palate is influenced by the severity of the preoperative cleft. Methods: This study used a retrospective cohort design taken from 40 medical records at Cleft Lip and Palate (CLP) Center Faculty of Medicine University of Muhammadiyah Malang. The preoperative photo data were categorized according to the severity of the cleft, then postoperative photos were assessed according to the Visual Rating Chart (VRC) indicator. Results: The intraclass correlation coefficient (ICC) reliability test between evaluators has a strength of > 0.8 on the outcome of lip and nose surgery and also > 0.9 on the outcome of the palate, indicating that there was no perception gap between evaluators. The Mann-Whitney non-parametric test had a significance of p < 0.05, indicating that there was a positive correlation between the severity of unilateral cleft lip and palate and the outcome of surgery. Conclusion: There is a correlation between the severity of the unilateral cleft lip and palate and the surgical outcome.

Perceptual Assessment of Cleft Palate Speech—Bridging the Gap From Research to Clinical Practice—the Swedish Perspective

Purpose:The purpose of this tutorial is to describe an evidence-based scientifically sustainable perceptual assessment of cleft palate speech and how standardized assessment methods for research on cleft palate speech have been implemented in clinical practice in Sweden, which makes it possible to carry out research on clinical data.Method:This tutorial is based on a literature review and own research on how to perform a valid and reliable perceptual cleft palate speech assessment and the description of clinical practice in Sweden. Perceptual speech assessment of cleft palate speech is discussed in terms of speech material, documentation, perceptual speech analysis, speech outcome measures, cross-linguistic comparisons, calculation of reliability, interpretation of results, and subject selection. We also describe the conditions that have made it possible to integrate research and clinic in cleft palate speech-language pathology in Sweden.Conclusions:Knowledge acquired from national and international research has had a great impact on the development of cleft palate speech assessment procedures in Sweden and has contributed to standardized evaluation of treatment results. This has enabled open comparisons of treatment results from the different Swedish cleft lip and palate (CLP) centers to provide a basis for improved CLP care.

CLEFT RR- New app to Calculate Recurrence Risk in Cleft lip and Palate.

To describe the Cleft Recurrence Risk (Cleft RR) App, designed to be used on genetic counseling for cleft lip and/ or palate. A validation study, single cohort. Tertiary care children's Hospital. The manual obtained the results of 100 cases undergoing genetic counseling at the cleft lip and palate treatment center. The application for genetic counseling for cleft lip and/ or palate is designed to calculate quickly the recurrence risk considering the ancestry, cleft type, sex, and family history and thus encourage the implementation of genetic counseling in cleft lip and palate centers around the world. The data were submitted to the Bland-Altman statistics. After defining parameters the application development follows the steps: development, prototyping, and documentation. The validation of the calculated data was performed by comparing the results of 100 cases undergoing genetic counseling at the cleft lip and palate treatment center obtained by the manual method with the results obtained by the mobile app method; the data were submitted to the Bland-Altman statistics and a high concordance was found. The mobile app for use by healthcare professionals proved to be simple to use, easy to apply, and provided accurate results. Cleft Recurrence Risk is an application for smartphones developed for genetic counseling in cleft lip and palate, supplementary use by health professionals, and should not replace professional performance.

Bilateral Maxillary Canine Substitution with High Impaction in the Center of Anterior Palate

Bilateral Maxillary Canine Substitution with High Impaction in the Center of Anterior Palate

Maxillary Arch Dimensions in Children with Unilateral Cleft Lip and Palate Receiving Alveolar Bone Grafting.

To analyse the maxillary arch dimensions of children aged 9 and 12 with unilateral cleft lip and palate (UCLP) who received orthodontic treatment and secondary alveolar bone grafting. This retrospective cohort study was performed on 30 patients with UCLP. All patients were treated at the Cleft Lip and Palate Centre, which is part of the University Medical Centre Amsterdam and Academic Centre for Dentistry Amsterdam, the Netherlands. Children with non-syndromic UCLP who received pre- and postsurgical orthodontics combined with secondary alveolar bone grafting between the ages of 9 and 12 years were included. Maxillary arch dimensions were assessed on 60 digitised dental casts with measurements of the intermolar widths, interpremolar widths, arch perimeters, arch lengths, arch widths, and palatal depths. The results of a paired-samples t-test revealed a statistically significant increase (P < .05) in intermolar width 1, intermolar width 3, interpremolar width 1, arch perimeter, and arch width between the ages of 9 (T0) and 12 (T1). Intermolar width 2 and the palatal depth decreased statistically significantly between T0 and T1. Analysis of maxillary arch dimensions of children with UCLP indicates significant changes between 9 and 12 years of age. This suggests that orthodontic treatment and secondary alveolar bone grafting can be effective in improving maxillary arch dimensions. However, there is a need for collaborative research and data collection in order to provide sensible and evidence-based care to patients with cleft lip and palate.

Cleft lip and palate surgery during COVID-19 pandemic in Indonesia: a 36-month experience at the Bandung Cleft Lip and Palate Center.

In Indonesia, the prevalence of cleft lip and palate increased from 0.08% to 0.12% between 2013 and 2018. Children with cleft deformities typically undergo staged surgery. However, the coronavirus disease 2019 (COVID-19) pandemic has had negative impacts on the healthcare sector, including the suspension of elective procedures; this has raised concerns about the safety of performing surgery and the functional consequences of delaying treatment, the latter of which is associated with poor prognosis. The purpose of this study was to report the characteristics of clefts treated by the Bandung Cleft Lip and Palate Center team during the pandemic period. This brief comparative study based on a chart review was conducted at the Bandung Cleft Lip and Palate Center. We statistically evaluated data from all patients treated between September 2018 and August 2021. Frequency analysis was performed to analyze the average number of each procedure by age before and during the COVID-19 pandemic. Data from 18-month periods before (n = 460) and during (n = 423) the pandemic were compared. Cheiloplasty procedures were examined (pre-pandemic, n = 230; pandemic, n = 248); before the pandemic, 86.1% were performed according to the treatment protocol (patient < 1 year old), and this proportion non-significantly dropped to 80.6% during the pandemic (p = 0.904). Palatoplasty procedures were also compared (pre-pandemic, n = 160; pandemic, n = 139); the treatment protocol (patient 0.5-2 years old) was followed for 65.5% of procedures before the pandemic and 75.5% during the pandemic (p = 0.509). Additionally, 70 (mean age, 7.94 years) revision and other procedures were performed before the pandemic and 36 (mean age, 8.52 years) during the pandemic. The cleft procedures performed at the Bandung Cleft Lip and Palate Center did not significantly change during the COVID-19 pandemic.

Epidemiological and Spatiotemporal Descriptive Analysis of Patients with Nonsyndromic Cleft Lip and/or Palate: A 12-Year Retrospective Study in Southern Iran.

The current study is aimed at evaluating epidemiological characteristics and spatiotemporal distribution of cleft lip and/or palate (CL/P) in the south of Iran. Data were extracted from the 1840 medical records of patients who were referred to the Cleft Lip and Palate Center of Shiraz University of Medical Sciences, from January 1, 2011, to September 1, 2022. The collected variables included demographic data (gender, birth date and season, place, birth order, and weight), cleft types and the subtypes, parental information (health status, education level, marital status, and age during the pregnancy), and other basic parameters. The chi-square test at a significance level of 0.05 was used to analyze collected data. The geographic information system (GIS) analysis was also used for analyzing the spatial distribution of CL/P patients. Based on our inclusion criteria, 1281 nonsyndromic patients were included in this study. The most common type was cleft lip and palate (CLP) with 48.32%, whereas cleft palate (CP) and cleft lip (CL) accounted for 40.75% and 10.93% of the patients, respectively. There was a progressive increase in the frequency of all types of clefts, and most of them were male (P ≤ 0.001). The urban population outnumbered the rural ones in all provinces. Parents were mostly healthy (>80%) with low educational status (47.5%). Most born CL/P patients were from consanguineous marriages (58.9%), especially between first-degree relatives. A majority of CL/P patients (73.1%) were born in the first two gestations with a birth weight of 2500-4000 g (77.4%). Most infants with CL/P (84.3%) were born from mothers who had at least one of the predisposing factors. In this study, the frequency of cleft types and subtypes was similar to the existing literature. However, high rate of consanguineous marriage, especially between first-degree relatives, was the most notable feature of this population.

Prevalence of Simonart's band in cleft children at a cleft center in Indonesia: A nine-year retrospective study.

Simonart's band is a soft tissue band that connects the cleft gap of the base of the nostril or the margin of the alveolus. While research on the prevalence of Simonart's band in cleft lip and palate cases has been carried out in various countries, research on Simonart's band in Indonesia has yet to be conducted. This study aimed to determine the prevalence of different types of Simonart's band at a cleft center in Indonesia. The data of cleft patients were reviewed retrospectively over a 9-year period at the Cleft Lip and Palate Center Center, Harapan Kita Women and Children Hospital, Jakarta, Indonesia. The patients were divided based on the type of cleft and the type of Simonart's band. The results were analyzed by means of descriptive statistics. Out of 638 cleft patients from the period 2008-2016, 77 patients had Simonart's band. The liptolip band was most commonly found (52 cases, 67.5%). The lip-to-alveolus band was found in 20 cases (26.0%) and the alveolus-to-alveolus band had the lowest prevalence of 5 cases (6.5%). Associations between the cleft type (unilateral cleft lip and palate (UCLP), unilateral cleft lip and alveolus (UCLA), and bilateral cleft lip and palate (BCLP)) and Simonart's band type were all significant (p = 0.001, according to Fisher's exact test), which indicates significant differences in the distribution of the bands with regard to different cleft types. There was a significant difference in the distribution of the bands between the UCLP and UCLA groups (p = 0.000). On the other hand, the distribution of the bands in the UCLP group did not differ much from that in the BCLP group (p = 0.065). The prevalence of Simonart's band was significantly higher in the patients with the unilateral complete cleft of the primary and secondary palate than in the subjects with the cleft of the primary palate. In the UCLP group, most patients had the lip-to-lip band type. In the BCLP group, the majority also had the lip-to-lip band type. In contrast, in the UCLA group, the majority showed the lip-to-alveolus band type.

Role of PAX7 Gene rs766325 and rs4920520 Polymorphisms in the Etiology of Non-syndromic Cleft Lip and Palate: A Genetic Study.

Non-syndromic cleft lip and palate (NSCLP) is one of the most common birth defects in humans with an overall prevalence of ∼1 in 700 live births around the world. The etiology of NSCLP is complex involving multiple genes, environmental factors, and gene-to-gene interactions. Several genome-wide associations (GWA) studies have shown the association of the paired box 7 ( PAX7 ) gene in the etiology of cleft lip and palate in different populations worldwide. However, there are no reported studies on the association between the rs766325 and rs4920520 polymorphisms and the risk of developing NSCLP in the Indian population. Hence, the present study aimed to test for the probable association between rs766325 and rs4920520 polymorphisms among NSCLP Indian population using a case-parent trio design. Forty case-parent trios were selected from the cleft lip and palate center based on the inclusion and exclusion criteria. Genomic DNA was isolated from the cases and their parents. The rs766325 and rs4920520 polymorphisms of the PAX7 gene were analyzed for their association using the MassARRAY analysis. The statistical analysis was done using the PLINK software. The rs766325 and rs4920520 polymorphisms were tested for the Hardy–Weinberg equilibrium. None of the polymorphisms showed any statistical significance. Hence, the rs766325 and rs4920520 polymorphisms of the PAX7 gene were found to be not associated with NSCLP in the Indian case-parent trios.

Monogenic Versus Multifactorial Inheritance in the Development of Isolated Cleft Palate: A Whole Genome Sequencing Study.

Craniofacial morphogenesis is highly complex, as is the anatomical region involved. Errors during this process, resulting in orofacial clefts, occur in more than 400 genetic syndromes. Some cases of cleft lip and/or palate (CLP) are caused by mutations in single genes; however, complex interactions between genetic and environmental factors are considered to be responsible for the majority of non-syndromic CLP development. The aim of the current study was to identify genetic risk factors in patients with isolated cleft palate (CP) by whole genome sequencing. Patients with isolated CP (n = 30) recruited from the Riga Cleft Lip and Palate Centre, Institute of Stomatology, Riga, were analyzed by whole genome sequencing. Pathogenic or likely pathogenic variants were discovered in genes associated with CP (TBX22, COL2A1, FBN1, PCGF2, and KMT2D) in five patients; hence, rare disease variants were identified in 17% of patients with non-syndromic isolated CP. Our results were relevant to routine genetic counselling practice and genetic testing recommendations. Based on our data, we propose that all newborns with orofacial clefts should be offered genetic testing, at least for a panel of known CLP genes. Only if the results are negative and there is no suggestive family history or additional clinical symptoms (which would support additional exome or genome-wide investigation), should multifactorial empiric recurrence risk prediction tools be applied for families.

Medical-Dental Collaboration and Interprofessional Training for Maxillofacial Diseases at Tohoku University Hospital.

The Tohoku University Hospital has been a clinical and research facility for all the related departments of Tohoku University. Medical-dental and interprofessional collaboration has resulted in special treatment teams, made up of members of departments such as the center for head and neck cancer, the center for dysphagia, and the cleft lip and palate center. Those treatment teams held conferences, case study meetings, reading sessions, and in-hospital seminars. The purpose of this study was to evaluate the outcomes of various medical-dental and the interprofessional collaboration at Tohoku University Hospital and training program to equip hospital dentists in higher medical institutions. The attainment targets are the acquisition of basic medical skills and knowledge under the guidance of supervising doctors. As a result, the hospital dentists could acquire their own specialized knowledge and skills certificated by each academic society. The smooth team treatment has been achieved, and the number of cases discussed by cancer boards and center for dysphagia has increased year by year due to the efficiency of their clinical pathways. On the dental care side as well, the wearing rates of maxillofacial prosthetic devices such as maxillofacial prostheses and palatal augmentation prostheses (PAP) have improved, which have contributed to improving patient's stomatognathic function. Tohoku University Hospital has been practicing collaboration between medical and dental professionals and it has produced mutual benefits. Our interprofessional training system based on the medical-dental collaboration could develop professionals who have acquired cross-disciplinary knowledge and skills from experienced doctors.

Examining Risk of Speech-Language Disorders in Children With Cleft Lip.

Although it is well-established that children with cleft palate are at high risk for communication disorders, little is known about the speech-language profiles of children with cleft lip (with or without cleft alveolus), who do not have an overt cleft palate. The purpose of this study was to determine the prevalence of speech-language disorders in a consecutively evaluated group of children with cleft lip, with or without cleft alveolus (CL ± A) from a single cleft lip and palate center in the United States. We also explored the types of speech and language disorders in this cohort and examined the impact of co-occurring syndromes and other diagnoses (eg, submucous cleft palate). Eighty-six children (58 males, 28 females) with CL ± A, evaluated between the ages of 12 and 72 months, were included in the study. Forty children had cleft lip and alveolus; 46 children had isolated cleft lip. We examined the proportion of children with CL ± A who received team care, speech-language evaluations, and audiograms, as well as the number of children with CL ± A diagnosed with a communication disorder. Fifty-three percent (n = 46) of children with CL ± A had received at least 1 speech-language evaluation. Approximately 40% of children with CL ± A who underwent evaluation by a speech-language pathologist were diagnosed with some type of communication disorder. Nine children (21%) with CL ± A displayed an articulation disorder and 12 (27%) presented with a language delay/disorder. Statistical analysis examined the potential impact of comorbid diagnoses such as submucous cleft palate and other congenital anomalies, and results were essentially unchanged. Results of this study are congruent with past reports suggesting children with CL ± A have a higher risk of communication disorders than the general pediatric population. Surgeons should be aware of the growing body of evidence that children with CL ± A benefit from cleft team care, which should include routine speech-language assessments starting at an early age to ensure identification of conditions warranting intervention.

Distribution of Cleft Lip and Palate at Cleft Lip and Palate Center Medical Faculty, Universitas Muhammadiyah Malang, Indonesia

Cleft lip and palate (CLP) and cleft palate (CP)are a common head and neck hereditary deformity. The highnumber of cases has prompted the Medical Faculty, Universitas Muhammadiyah Malang to start communityservice by providing free surgery to repair cleft lip and palate (Cleft Lip and Palate Center Medical Facultyof Universitas Muhammadiyah Malang (CLP MFUMM)).Purpose: To find the distribution of cases from the year of surgery, sex, side of CL/P, cleft palate (CP),hospital where the surgery was performed and parent education level in CLP MFUMM, from 2019 until2020.Patients and Methods: Two hundred and five consecutive cleft lip subjects, with or without palates, andcleft palate attending CLP MFUMM from 2019 until 2020 were studied.Results:The most surgeries done is at the year of 2019 (69%). Most of the patients were male (55%).CL/P were the most frequent cases (94%). Complete cleft found mostly in male patient with left unilateralcleft (23%), while incomplete cleft found mostly in female patient also with left unilateral cleft (7%). Thepalate involvement found mostly in soft palate only and female patients (46%). The surgeries were mostlyperformed at RSI Aisyiyah Malang (60%). The education level of the parents is mostly elementary school(father 36%, mother 34%).Conclusion: CL/P were the most frequent. Complete cleft mostly in male patient with left unilateral cleft,while incomplete cleft mostly in female patient also with left unilateral cleft. The cleft palate was mostlysoft palate only and female patients.

Dental fear among adolescents with cleft.

Dental fear is a prevalent phenomenon among children and adolescents globally. To investigate dental fear among 18-year-olds with cleft lip and/or palate (CLP) at their final follow-up cleft clinic visit, and to evaluate the association between dental fear and OHRQoL. This cross-sectional study included the cohort of children with CLP treated at the Oulu University Hospital Cleft Lip and Palate Center, in northern Finland since 1995. A total of 62 of 64 individuals participated in this study. The validated Finnish version of the Oral Health Impact Profile (OHIP-14) was used to assess OHRQoL. Dental fear was studied using the validated Modified Dental Anxiety Scale (MDAS) and cognitive vulnerability model (CVM). Almost two fifths of the participants reported moderate dental fear. Participants with cleft including lip and participants reporting impact on OHRQoL reported higher mean MDAS scores. In an unadjusted model, adolescents with cleft including lip had risk for higher dental MDAS scores compared with the ones with cleft including only palate. Dental fear is common among adolescents with CLP, specifically among those with clefts involving the lip. OHRQoL and dental fear seem to be associated.

Dental Arch Relationship Outcomes Following 2-Stage Palatoplasty for Japanese Patients With Complete Unilateral Cleft Lip and Palate: A 3-Center Study

To compare dental arch relationship outcomes following 3 different 2-stage palatal repair protocols. Retrospective, cross sectional. Three cleft palate centers (A, B, C) in Japan. Ninety (A: 39, B: 26, C: 25) consecutively treated Japanese patients with complete unilateral cleft lip and palate. In A, the soft palate and the posterior half of the hard palate were repaired at a mean age of 1 year 7 months. In B, the soft palate and hard palate were closed separately at a mean age of 1 year 6 months and 5 years 8 months, respectively. In C, the soft palate and hard palate were closed at a mean age of 1 year and 1 year 5 months, respectively. Dental arch relationships were assessed using the 5-Year-Olds' (5-Y) index by 5 raters and the Huddart/Bodenham (HB) index by 2 raters. Intra- and inter-rater reliabilities showed substantial or almost perfect agreement for the 5-Y and HB ratings. No significant differences in mean values and distributions of 5-Y scores were found among the 3 centers. The mean HB index scores of molars on the minor segment were significantly smaller in C than those in A and B (P < .05). There were no significant differences in dental arch relationships at 5 years among the times and techniques of hard palate closure. However, further analysis of the possible influence of infant cleft size as a covariable on a larger sample size is needed.

Structural and Ultrastructural Characteristics of the Red-Rumped Agouti (Dasyprocta leporina-Linnaeus, 1758) Palatine Epithelium.

The palate is a fundamental region in food swallowing and presents different adaptations in species. This research aimed to describe structural and ultrastructural characteristics of the palatine epithelium and the connective tissue cores (CTCs) of ten red-rumped agoutis (Dasyprocta leporina—Linnaeus, 1758) using macroscopic, light microscopy, scanning electron microscopy, and transmission electron microscopy. We found nine palatine ridges in the diastema and hard palate, and a smooth surface in the soft palate. Stratified squamous keratinized epithelium with projections of lamina propria and soft palate had gland clusters. Epithelial removal revealed CTCs with a conical shape with high density in the hard palate and the sides of the soft palate. Near the CTCs were nerve fibers in the hard palate, and the soft palate had muscular tissue below the gland clusters. The structural and ultrastructural characteristics enable stability of the hard palate and fixation to the soft palate sides, while the soft palate center has greater mobility thus assisting in food swallowing. We concluded that structural characteristics are similar to other mammals, although the morphology of agouti's palate differs in the amount and disposition of palatine ridges, and the conical CTC's morphology.