Palatal Defects Research Articles

Menrath ulcers in cats: four cases (2014-2023).

To report the clinical presentation, treatment and outcomes of four cats diagnosed with Menrath ulcers causing significant oral haemorrhage. For all cats, data on signalment, history, physical examination, treatment and outcomes were collected by reviewing medical records. Information regarding outcomes was collected from communication logs between primary care veterinarians and owners, and the original case clinicians after discharge of the patient from the hospital. Four cats were included. All patients survived to discharge. Follow-up outcomes were available between 1 and 8.5 months post discharge. Post-operative complications were classified according to The Accordion Severity Classification of Post-operative Complications. Two of the four patients had recurrence of oral haemorrhage post-ligation originating from the major palatine artery. One classified as a severe complication, due to requiring revision surgery of the ipsilateral major palatine artery. The other classified as mild, since the patient was managed conservatively. Additionally, one patient was documented to have developed an acquired palatal defect post-operatively. This is the largest case series of Menrath ulcers to date and the first to describe post-operative complications including acquired palatal defect and recurrence of oral haemorrhage from the original ulcer despite ligation of the ipsilateral major palatine artery.

Management of an Acquired Palatal Defect With a 3-Dimensional Printed Palatal Obturator in a Dog.

Large defects in the hard palate can be difficult to treat surgically, as dehiscence is common. These defects may instead be managed with a palatal obturator, which can serve to separate the oral and nasal cavities. In this report, a 7-year-old, mixed breed dog was treated with a palatal obturator, after presenting with an acquired palatal defect following treatment of a giant cell tumor of bone in the hard palate. The palatal obturator was designed and manufactured using computer-aided design and manufacturing (CAD/CAM), and 3-dimensional printing. The obturator, anchored to 4 maxillary teeth, was easy to apply and remove, allowing daily cleaning without the need for sedation. The patient showed no symptoms or discomfort related to the obturator or acquired palatal defect over 2 years after initial presentation to the dental clinic.

The Preliminary Results of a Modified Von Langenbeck Cleft Palate Repair With Tension-free Mucoperiosteal Flap Near Nasal Cavity Without Relaxation Incision.

To explore the application of modified Von Langenbeck cleft palate repair with tension-free mucoperiosteal flap near the nasal cavity and without relaxation incision, and the cleft palate defect was repaired by covering both sides of the edge of the in situ mucoperiosteal flap. This treatment method provides a good aesthetic restoration effect. Modified Von Langenbeck cleft palate repair with mucoperiosteal flap near the nasal cavity without tension and relaxation incision was used to repair the cleft palate. At the same time, the affected side nasal malformation was corrected. The modified Von Langenbeck cleft palate repair with mucoperiosteal flap near the nasal cavity without tension and relaxation incision is a good choice, without additional relaxation incision near the gingiva, which is closest to the physiological state of anatomic repair. The mucosa and gingival side palatal mucosa return to where they should be. There was no limited mouth opening and scar contracture of loose incision near the gingiva. The modified Von Langenbeck cleft palate repair with mucoperiosteal flap near the nasal cavity without tension and relaxation incision is a safe and reliable method with a high success rate and simple operation for various types of cleft palate. Even if the cleft palate recurs, this mucosal flap can be used again to repair it.

The Submental Artery Island Flap for Reconstruction of Acquired Maxillary and Palatal Defects After Tumor Ablation: Reversed Flow Versus the Extended Antegrade Design.

The submental artery island flap (SIF) is a valid option for palatal reconstruction. However, the main limitation for its application for palatal defects is the arc of rotation. A novel modification for tunneling of the antegrade design of SIF that allows a compliant easy reach to the defect is described. Eighteen patients with Brown class II maxillectomy defects were included. Reconstruction started using reversed flow SIF in five patients then shifted to the modified antegrade technique in the remaining patients. Speech, swallowing, chewing, other parameters, and oncological outcomes were assessed. The reversed flow group has high complications. In the antegrade SIF group, all flaps survived. One developed marginal flap necrosis that healed spontaneously. The follow-up period ranged from 1 to 4.2 years with favorable functional outcome and with no evidence of recurrence. The modified SIF antegrade design is a reliable option for palate reconstruction that allows favorable functional and oncological outcome.

Transcriptional factor ISL1 regulates palate development by tuning the SHH cascade.

Cleft palate is one of the most common birth defects in humans, and palate morphogenesis depends on epithelial-mesenchymal interaction. In this study, we report that ablation of Isl1 in the epithelium leads to complete cleft palate. A significant reduction in mesenchymal cell proliferation was detected in the Isl1Pitx2Cre mutant palates, but there was no significant difference in apoptosis between wild-type and mutant embryos. Fewer rugae structures were observed in Isl1Pitx2Cre mutant embryos. Shh, Sox2, Foxe1, Foxd2, and Msx1 expression was downregulated in the developing palate in Isl1 mutant embryos. We found that ISL1 can directly regulate Shh expression in palatal epithelial cells, suggesting a critical role for ISL1 in epithelial-mesenchymal interactions during palate development. Remarkably, cleft palate defects due to Isl1 deletion were rescued by a conditional transgenic allele (Tg-pmes-Ihh), confirming the genetic integration of Hedgehog signaling. Our findings indicate that ISL1 controls palatal shelf morphogenesis by modulating epithelial-mesenchymal communication via SHH signaling.

Airway Management in Microvascular Reconstruction of the Head and Neck: Current Practice Patterns.

To identify current airway management practice patterns during free tissue transfer (FTT) reconstruction of head and neck defects. A 27-question survey distributed to American Head and Neck Society (AHNS) members. Correlation between surgeon and patient variables with likelihood to perform tracheotomy and tracheotomy technique were evaluated. Our survey yielded 151 respondents. The majority (69.5%) reported performing tracheotomy for "most"/"every" FTT case. There was higher likelihood (p < 0.05) toward tracheotomy for patients with poor preoperative pulmonary status, larger defect size, and reconstruction of glossectomy and oropharyngeal defects. Tracheotomy was less likely (p < 0.05) during reconstruction of maxillary or palatal defects. Surgeons in practice for > 10 years were less likely to perform tracheotomy following reconstruction of hemiglossectomy defects (OR 0.36, p = 0.018, 95% CI 0.18-0.72). This study identified practice patterns of airway management in patients undergoing head and neck FTT reconstruction. There is no current consensus regarding perioperative airway management in these patients.

Traumatic Palatal Defect Closure With Prosthesis Post Surgical Reconstruction: A Team Approach

Background: Palatal defect may be a result of congenital malformations, trauma or tumors. In most maxillopalatal trauma, surgical reconstruction is required to restore the function and appearance. Any palatal defect caused by maxillopalatal loss that cannot be achieved with surgical reconstruction needs special and comprehensive treatment. This can be done by prosthodontist prosthesis rehabilitation.Patients and Methods: A 20-year-old man underwent open reduction and internal fixation for severe maxillopalatal fracture and palatal loss. Intraoperative, the palatal defect could not be approximated due to palatal loss. In 3-month-follow up, there was a palatal defect and slight malocclusion due to anterior dental loss. Instead of performing complicated surgical procedures, we collaborate with the prosthodontist to assemble prosthesis with dental prosthesis that accommodate the closure of defect and improve appearance aesthetically. Result: The use of prosthesis improves functional and psychological wellbeing. It does not only close the palatal defect, but it also fills the anterior dental loss thus overcoming the malocclusion. Satisfying functional and aesthetic outcome was achieved. Summary: Rehabilitation of maxillopalatal defect has been well defined for prosthodontists and surgeons. A successful prosthetic design for functional restoration of the palatal defect utilizes the remaining palate and dentition to maximize the support, stability and appearance. In this case,prosthodontist and dentition prosthesis was used as modalities that offer simple solution to close the palatal defect compared to a more complicated surgical intervention.

The Non-denuded Mucoperiosteal Palatoplasty Technique in Precipitating Healing Process of Palatal Lateral Defect

Background: Conventional two-flap palatoplasty technique which is a very common technique used including in our center, will result in lateral defects without any periosteal coverage. In this conventional technique, epithelialization of lateral defect was achieved within 3-4 weeks. These denuded lateral defects are prone to contamination and infection. The wound healing process in these wound will involve wound contraction, trigger scar formation, and will result in maxillary growth impairment. In our center, the retrospective study showed that conventional two-flap palatoplasty technique resulted in a fair maxillary growth (mean Goslon score=3.5). Thus, we explore other technique, which is non-denuded mucoperiosteal palatoplasty technique. We intend not to elevate all layers of mucoperiosteal flap in order to gain lateral defect covered by a thin sub-mucosa and periosteal layer. We assume that this technique will precipitate the re-epithelialization process. Faster re-epithelialization is expected to decrease wound contraction thus reducing scar formation, and in the long run will result in good maxillary growth. Method: Total 48 patients with unilateral or bilateral cleft palate were divided into 2 groups. Twenty-four patients underwent the non-denuded mucoperiosteal technique (intervention group) and another 24 patients underwent the conventional two-flap palatoplasty technique (control group). Evaluation of lateral defect closure was done in both groups and compared statistically. Result: Faster epithelialization was significantly influenced by age, WBC count and non-denuded mucoperiosteal technique.Summary: The non-denuded mucoperiosteal technique, along with age and WBC count, significantly accelerate the process of epithelialization of lateral defect post palate repair.

Accelerated Healing of The Wider Lateral Defects in Adult Cleft Palate Repairs

Background: Adult primary palatoplasty is more challenging tha n in infants because the gaps are wider. The risk ofintraoperative bleeding and palatal fistula are higher. Most adults with un-operated palatal cleft have good maxillary growth but poor speech. The aim of this study is to introduce our technique in repairing wide cleft palate in adult patients. Patients and Methods: We report four patients with cleft palate who underwent palatoplasty at adulthood. The age ranges from 17 to 20 years. Interspina distance were between 2 to 3.5 cm. All of them were nonsyndromic and had normal maxillary growth. The surgical technique used on these patients was two-flap palatoplasty with an additional 3 mm gingival bulk on the lateral side of the flap. Honey was given as oral drops postoperatively. Result: Lateral palatal defect healed well and epithelialized completely between 7 -14 days postoperative and only one small palatal fistula was found with this modified technique. All subjects had good maxillary growth, and speech outcome was poor to begin with.Summary: Two-flap palatoplasty can adequately provide palatal closure, especially with an additional lateral flap extension to include gingival components. This extension widens the flaps and aid palatal closure by not leaving lateral defects too wide.

The Effect Of Honey Give As Oral Drops In Precipitating Epithelialization Of Lateral Palatal Defects Post TwoFlap Palatoplasty

Background : Two-flap palatoplasty, which is a very common technique used including in our institution, will result in lateral palatal defects without any periosteal coverage. Faster epithelialization is expected to decrease wound contraction thus reducing scar formation, and in the long run will result in good maxillary growth. In our institution, the retrospective study showed a fair maxillary growth (mean GOSLON score=3.5). Thus, we explore possibilities to precipitate the epithelialization process in pursuit of good maxillary growth in the future.Method :This is a prospective cohort study conducted in Cipto Mangunkusumo Hospital, on consecutive patients who underwent two-flap palatopasty from October 2010-February 2011. We followed up these patients weekly for 4 consecutive weeks to observe the rate of epithelialization of the lateral palatal defects.Result : Two-flap palatoplasty was performed in 48 patients, 23 among them were given honey as oral drops. Eighty-seven point five percent had unilateral complete cleft lip and palate and 12.5% had bilateral complete cleft lip and palate. Faster epithelialization of the lateral palatal defects post two-flap palatoplasty was significantly in!uenced by intraoral honey application on the wound as oral drops (RR 2.1, 95% CI 1.314 - 3.391, p &lt; 0.001).Conclusion: Honey given as oral drops significantly precipitates the epithelialization process of the lateral palatal defects post two flap palatoplasty 2.1 times faster.

Bifid Tongue and Cleft Palate: A Rare Congenital Malformation

Background: Congenital bifid tongue without other craniofacial abnormalities is a very rare malformation. Here, we discuss a case of the bifid tongue with cleft palate, reported in a 7-month-old girl with no other syndromes or craniofacial abnormalities. Case Reports: This case report described a 7-month-old girl with an anterior bifid tongue, separated medially by a soft, solitary sublingual mass measuring 3 cm x 2 cm in size. There was also an associated incomplete cleft palate. A soft solitary mass measuring 2 cm x 2 cm in size was also seen within the cleft palate. Results: Computed facial tomography (CT) revealed a midline hard palate defect with an intact alveolar process of the maxilla. Pedunculated cystic lesion suspected with epulis was noted to arise on premaxillary alveolar mucosa. Excision of the tongue and hard palate mass and repair of the bifid tongue were done. Summary: Congenital bifid tongue with a cleft is a very rare malformation with different variations. Early surgical intervention is critical to prevent speech impairment and swallowing disorders. A multidisciplinary approach, including well-planned staged operations and rehabilitation, is important to achieve favorable outcomes.

Phase I-IIa clinical trial to evaluate the safety, feasibility and efficacy of the use of a palate mucosa generated by tissue engineering for the treatment of children with cleft palate: the BIOCLEFT study protocol

IntroductionThe current gold standard treatment for patients with orofacial clefts is surgical repair of the palatal defect (uranostaphylorrhaphy), which is associated with growth defects and hypoplasia of the maxillofacial structures....

Reconstruction of Palatal Defects Using a Composite Chondromucosal Nasoseptal Flap and Comparative Analysis.

The use of composite chondromucosal nasal septal flaps (ccNSF) has been demonstrated to be effective in cadaveric studies for the anterior skull base and the orbit. However, their application in the clinical setting remains unexplored. Our study aims to introduce a new method for treating palatal defects using ccNSF. Additionally, we studied the average NSF area and compared it to the average palate area. We collected 108 CT scans from the medical records of patients without head and neck pathologies from a tertiary medical institution. We quantified the quadrangular (septal) cartilage and palate areas. Furthermore, we included a clinical case in which we used the ccNSF for the palatal defect reconstruction. This was to compare the mean area between the palate and the septal cartilage. The ccNSF covered the palatal defect without any significant complications for the first 9 months of follow-up. A total of 102 CT scans met the inclusion criteria and were measured. We found that the mean quadrangular cartilage had a length of 2.50 (±0.52) cm, a width of 2.28 (±0.51) cm, and an area of 5.43 (±1.68) cm2. The mean palate length was 2.73 (±0.44) cm, with a width of 3.13 (±0.34) cm, and area of 7.87 (±1.43) cm2. The ccNSF proved successful in palatal defect reconstruction, resulting in positive outcomes and no major complications until the 9-month follow-up. The ccNSF is a useful flap that avoids the use of free flap transfer and its associated morbidities. 4 Laryngoscope, 134:4882-4887, 2024.

Bone morphogenetic protein signaling pathway– Ethanol interactions disrupt palate formation independent of gata3

Fetal Alcohol Spectrum Disorders (FASD) describes a wide array of neurological defects and craniofacial malformations, associated with ethanol teratogenicity. While there is growing evidence for a genetic component to FASD, little is known of the genes underlying these ethanol-induced defects. Along with timing and dosage, genetic predispositions may help explain the variability within FASD. From a screen for gene-ethanol interactions, we found that mutants for Bmp signaling components are ethanol-sensitive leading to defects in the zebrafish palate. Loss of Bmp signaling results in reductions in gata3 expression in the maxillary domain of the neural crest in the 1st pharyngeal arch, leading to palate defects while upregulation of human GATA3 rescues these defects. Here, we show that ethanol-treated Bmp mutants exhibit misshaped and/or broken trabeculae. Surprisingly, up regulation of GATA3 does not rescue ethanol-induced palate defects and gata3 expression was not altered in ethanol-treated Bmp mutants or dorsomorphin-treated larvae. Timing of ethanol sensitivity shows that Bmp mutants are ethanol sensitive from 10 to 18 hours post-fertilization (hpf), prior to Bmp’s regulation of gata3 in palate formation. This is consistent with our previous work with dorsomorphin-dependent knock down of Bmp signaling from 10 to 18 hpf disrupting endoderm formation and subsequent jaw development. Overall, this suggests that ethanol disrupts Bmp-dependent palate development independent of and earlier than the role of gata3 in palate formation by disrupting epithelial development. Ultimately, these data demonstrate that zebrafish is a useful model to identify and characterize gene-ethanol interactions and this work will directly inform our understanding of FASD.

Outcomes of Palatal Fistula Closure with Tongue Flap Using a Parachute Technique.

To evaluate the efficacy of tongue flaps in closing large palatal fistulas secondary to cleft palate repair in terms of functionality, esthetics, and donor site morbidity. Tertiary academic center. We report our 8-year surgical experience with tongue flaps, with our parachute suture technique in flap inset, and not using tongue fixation methods or feeding tubes. Nineteen patients having recurrent secondary palatal fistula, post-cleft treatment were treated with anteriorly based dorsal tongue flaps. Patients were evaluated for outcome in terms of flap uptake and effectiveness, correction of oronasal regurgitation, speech and nasality improvement, donor site morbidity, and esthetics. A total of 19 patients in the age range of 1.5 to 34 years were treated with anteriorly based tongue flap. Detachment of the tongue flap was observed in 1 patient. Furthermore, tongue flap necrosis was not observed in any of the patients. Nasal regurgitation was resolved completely in 15 cases (78.9%), and 2 out of 4 failed cases were due to fistula presence in a position out of flap territory. In addition, fistula persists in the case of flap detachment and another case at the location of pedicle division. Speech intelligibility and hypernasality changes were reported as noticeable improvement in 9 (47.4%) and no obvious change in 10 patients (52.6%). Using parachute suturing technique can facilitate successful lingual tissue inset in palatal defects with negligible remnant fistula. Moreover, avoiding tongue fixation methods and nasogastric tube-assisted feeding wasn't associated with increased flap dehiscence or suture loosening.

Bone Morphogenetic Protein signaling pathway - ethanol interactions disrupt palate formation independent of gata3.

Bmp pathway mutants are ethanol sensitive resulting in palate defects. Ethanol disrupts Bmp-dependent palate development independent of gata3 . Timing of ethanol sensitivity suggests ethanol disrupts Bmp-dependent epithelial morphogenesis.

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

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

HOLLOW DEFINITE OBTURATOR FOR UNILATERAL SUBTOTAL MAXILLECTOMY REHABILITATION - A CLINICAL REPORT

Palatal defects, resulting from congenital malformations, trauma, diseases, radiation therapy, or surgical interventions like maxillectomy, pose significant functional and aesthetic challenges. These defects often lead to speech impediments, difficulties in mastication and swallowing and compromised oral hygiene. An obturator prosthesis plays a crucial role in rehabilitating these patients by restoring oronasal separation, improving speech, mastication and overall quality of life. This case report details the prosthetic rehabilitation of a 45-year-old female patient with a subtotal maxillectomy defect using a definitive hollow obturator. The transition from an interim to a definitive obturator significantly enhanced the prosthesiss retention, stability and patient comfort. The fabrication process for the hollow obturator, along with the clinical challenges and solutions, is discussed in detail. The successful outcome highlights the importance of sound prosthodontic principles and the strategic design of obturator prostheses to optimize both function and aesthetics. Future directions may include advancements in 3D printing technologies to further improve obturator fabrication and patient outcomes.

Secondary Reconstruction of Premaxilla With a π-Shaped Fibula Osteocutaneous Flap.

Midface deformities due to oncologic bony defects are often difficult to secondarily correct. The authors herein report 2 cases of secondary reconstruction of an oncological premaxillary defect using a π-shaped fibula osteocutaneous flap. The authors divided the fibula into 3 pieces and made it π-shaped to reconstruct the curvature of the premaxilla. The palatal mucosal defect was closed with a skin paddle. The vascular pedicle was hooked up to the neck vessels either directly or by interposition of vessel grafts. Reconstruction was successful in both cases. The facial appearance was greatly improved, the palatal defects were closed, and the need for obturator prosthetics was eliminated. Immediate bony reconstruction is preferred for premaxilla defects. However, secondary reconstruction with a π-shaped fibula osteocutaneous flap is a feasible option with high potential for improving aesthetic and functional outcomes.

Comparison of palatal fistula incidence post palatoplasty with Veau-wardill kilner technique between men and women

Cleft palate is a congenital abnormality that occurs in the mouth and surrounding structures. The most used classification of cleft palate by Veau (1931). To repair the palatal defect, shape and function, surgical correction is necessary. There are various types of palatoplasty techniques that can be used, such as Veau-Wardill-Kilner. Palatoplasty may causes complications such as palatal fistula. Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Airlangga University has been carrying out a social service for cleft lip and palate surgery repair since year 2008 in various regions in Indonesia. However, until now, there is no data available related with the incidence of palatal fistula. Purpose: To observe the comparison between the palatal fistula incidence post palatoplasty using Veau-Wardill-Kilner technique based on gender. Methods: This study based on 113 palatoplasty cases using Veau-Wardill-Kilner technique taken from Oral and Maxillofacial Cleft Palate Surgery Social Service data, Faculty of Dental Medicine, Airlangga University from the period of 2013 until 2022. Data analysis used Kruskal-Wallis on IBM SPSS version 29 Windows. Results: from 113 patients, 20 cases (17,7%) showed that there is developed palatal fistula. Between the incidence of palatal fistula in men and women observed after palatoplasty procedure using Veau-Wardill-Kilner, higher percentages of palatal fistula were found in women (p=0.426). Conclusion: The incidence of palatal fistula post palatoplasty using Veau-Wardill-Kilner technique in women is higher than men.