Posterior Hard Palate Research Articles

Polymorphisms of rs7055763 and rs41307258 in TBX22 Gene Haplotype as Risk Factors for Non-syndromic Cleft Palate Indonesian Deutero-Malay Population

Non-syndromic cleft palate (NS-CP) is a multifactorial congenital malformation affected by genetic and environmental factors. The incidence of non-syndromic cleft lip with or without cleft palate (NS-CLP) varies considerably between ethnic groups and geographical regions. TBX22 is a crucial determinant for the formation of intramembranous bone in the posterior hard palate. Therefore, TBX22 is fundamental to palatogenesis and supports normal palate progress. The rs7055763 and rs41307258 polymorphisms in the TBX22 gene are associated with risk factors for NS-CP in the Indonesian Deutero-Malay population. In the previous study, NS-CP still needed to be investigated in the Deutero-Malay population. However, there are different races, mainly for the Deutero-Malay population. This study aims to determine whether rs7055763 and rs41307258 polymorphisms in the TBX22 gene are risk factors for NS-CP in the Deutero-Malay population. This study was conducted in Terpadu Laboratory, Faculty of Dentistry, Universitas Padjadjaran, from February until June 2023. The design of this study was a case-control study. The DNA patient samples were obtained from saliva and whole blood. Moreover, DNA is extracted, and the rs7055763 and rs41307258 segments are analyzed using PCR and Sanger sequencing. PCR data was analyzed by chi-square testing. In this study analysis, polymorphisms of rs7055763 (G>A) and rs41307258 (T>A) in the TBX22 gene show no significant differences between case and control groups, namely 0.911 and 0.645, respectively. However, the genotype in the rs41307258 shows the p-value as 0.027, indicating substantial differences and the OR is 1.390. In conclusion, the rs7055763 and rs41307258 polymorphisms in the TBX22 gene do not appear to be risk factors for developing NS-CP in the Indonesian Deutero-Malay population.

Liposarcoma of Maxilla- A Rare Case Report.

Sarcomas of the head and neck region account for less than 10% of soft tissue sarcomas, and comprise less than 1% of head and neck malignancies. Approximately 80% of sarcomas arise from soft tissue, with the remaining originating from bone or cartilage. Head and neck sarcomas typically occur more frequently in men. Our patient was a 30 year old male who presented with a ulceroproliferative mass over the soft palate increasing in size over past 6 months. Punch biopsy of the lesion was suggestive of carcinosarcoma. MRI PNS was suggestive of 38 × 39 × 33 mm sized lobulated lesion involving soft palate on right side, crossing midline and displaces uvula. The lesion involved right side of hard palate, right retromolar trigone with abutment of right medial pterygoid. It was also suggestive of bilateral sub centimetric nodes involving bilateral level 2 neck nodes. The patient received 3 cycles neoadjuvant chemotherapy Ifosfamide and Doxorubicin and patient had no subjective response to chemotherapy with subjective increase in the size of lesion. MRI PNS post neoadjuvant chemotherapy was suggestive of 46 × 46 × 41 mm lobulated lesion involving right side of the soft palate crossing midline over to the left, involving right posterior hard palate and right retromolar trigone, tonsillar fossa and TL sulcus. CECT thorax was negative for lung metastasis. Our patient was a 30 year old male who presented with a ulceroproliferative mass over the soft palate increasing in size over past 6 months. Punch biopsy of the lesion was suggestive of carcinosarcoma. MRI PNS was suggestive of 38x39x33mm sized lobulated lesion involving soft palate on right side, crossing midline and displaces uvula. The lesion involved right side of hard palate, right retromolar trigone with abutment of right medial pterygoid. It was also suggestive of bilateral sub centimetric nodes involving bilateral level 2 neck nodes. The patient received 3 cycles neoadjuvant chemotherapy Ifosfamide and Doxorubicin and patient had no subjective response to chemotherapy with subjective increase in the size of lesion. MRI PNS post neoadjuvant chemotherapy was suggestive of 46 × 46 × 41 mm lobulated lesion involving right side of the soft palate crossing midline over to the left, involving right posterior hard palate and right retromolar trigone, tonsillar fossa and TL sulcus. CECT thorax was negative for lung metastasis. The patient underwent wide local excision with medial maxillectomy via a bilateral Weber-Ferguson incision with Diffenbach extension and sent for frozen. The margins were negative and free of tumor. Bilateral modified neck dissection type 3 was done for lymph node clearance. A bilateral temporalis flap was done for reconstruction of the defect with a temporary obturator placement. Sarcomas of the sinonasal region may present a diagnostic challenge, as their location in the sinuses or nasal cavity may lead to presenting symptoms such as epistaxis, nasal congestion, or sinus pain and pressure that may be attributed to more benign causes such as chronic sinusitis, sinonasal polyposis, or allergic rhinitis. The less common sinonasal sarcoma subtypes may present a diagnostic challenge as their histopathological characteristics may overlap, especially with variations in tumor grade or with dedifferentiation. Additionally, the ideal treatment modality may present a therapeutic challenge, as the response to radiation and/or chemotherapy may vary according to the sarcoma subtype. Surgery is considered to be the mainstay in the management of carcinosarcomas of head and neck. Based on the evidence presented herein, elective neck dissection should be considered to treat squamous cell carcinomas of the maxillary palate, ginigiva, and alveolus.

Análisis morfométrico de paladares óseos secos en huesos maxilares dentados y desdentados. Parte II: Foramen Palatino Mayor

Objective: To carry out a descriptive study of the morphology and the most relevant accidents of the posterior hard palate, compare bone modifications and evaluate the anthropometric measurements in dentate and edentulous upper jaws. Methods: 40 dentate and 39 edentulous maxillae were measured in vitro using a digital caliper. The following were measured: 1) horizontal and anteroposterior diameter of both greater palatine foramina (FPM) 2) distance between the buccal bone between the upper central incisors and both FPM 3) distance between both FPM, 4) location of the FPM in relation to the molars, 5) length, width and height of the palate, 6) palatal index in % (PI), 7) palatal height index in % (PHI). Results: The distance between the buccal bone between the maxillarycentral incisors and the right FPM was 49.77 mm in dentate and 44.97 mm in edentulous (p < 0.05) and with respect to the left FPM it was 49.73 mm in dentate and 44.99 mm in edentulous (p < 0.05). The distance between both FPM was on average 28.06 mm in the dentate group and 28.34 mm in the edentulous group, with no significant differences between groups. Regarding the dimensions of the FPM, no significant differences were found between both groups. Significant differences were found in palatal length and height between both groups. Conclusion: The present study provides morphometric data of the region of the palatal vault of a South American population that could be useful to compare and complement other similar studies

Does Notching Along the Nasal Velar Surface During Nasopharyngoscopy Predict Discontinuity of the Underlying Levator Veli Palatini Muscle?

Thirty-seven patients who presented with hypernasality and/or audible nasal emission on speech evaluation and completed nasopharyngoscopy and velopharyngeal MRI study as part of their preoperative clinical evaluation.

Sialadenoma Papilliferum of Hard Palate Mimicking Squamous Cell Carcinoma: A Case Report

The occurrence of unusual ulcers in the oral cavity has fundamental value regarding oral and systemic diseases and abnormalities, as it can show clinical evidence that differs from other lesions, contributing to the diagnosis process. A 64-years-old female patient reported with a non healing of an oral lesion since two months (seeking clinical treatment for an atypical hard palate ulcer). A 64- years-old female patient was presented with a two month history of an oral lesion that did not repair. Her medical record indicated past smoking habits and hypertension. During clinical evaluation, an exophytic ulceration located at the left posterior hard palate, with a rounded form and elevated edges, was observed. An incisional biopsy was performed to confirm the diagnosis. Histopathological complementary exams revealed biphasic papillary projections, extending from the epithelium through the connective tissue, that are considered ductal structures. The final diagnosis was sialadenoma papilliferum, and total surgical excision was performed as a treatment. Follow-up showed no recurrence over 14 months. Sialadenoma papilliferum is a rare benign salivary gland tumour, mostly known for its papillary aspect and categorized as a ductal papilloma. Sialadenoma papilliferum origin is not precisely defined, nor associated with a single cause, given that different investigators pointed to multiple variables to Sialadenoma papilliferum origin. Being one of the rarest salivary gland tumours, SialP’s clinical aspects and its resemblance to other benign salivary gland tumours can lead to a wrong diagnosis if not properly and microscopically analyzed, hence the importance of knowing its features.

A Preliminary Study of Anatomical Changes Following the Use of a Pedicled Buccal Fat Pad Flap During Primary Palatoplasty.

The purpose of this study was to examine the surgical impact of the pedicled buccal fat pad (BFP) flap on the levator veli palatini (LVP) muscle and surrounding velopharyngeal (VP) anatomy following primary palatoplasty using magnetic resonance imaging (MRI). Observational, prospective. MRI studies were completed at 3 different facilities. All participants with BFP flap were operated on by the same surgeon. Five pediatric participants with cleft palate with or without cleft lip (CP±L) who underwent primary palatoplasty with BFP flap placement. Comparison groups consisted of 10 participants: 5 with CP±L who did not receive the BFP flap and 5 healthy controls. All participants underwent nonsedated MRI 2 to 5 years postoperatively. Anatomical measures of the velopharynx and LVP among the 3 participant groups. Median values were significantly different among groups for velar length (P = .042), effective velar length (P = .048), effective VP ratio (P = .046), LVP length (P = .021), extravelar LVP length (P = .009), and LVP origin-origin distance (P = .030). Post hoc analysis revealed a statistically significant difference between the BFP and traditional repair groups for effective VP ratio (P = .040), extravelar LVP length (P = .033), and LVP length (P = .022). This study provides preliminary support that the BFP flap creates a longer velum, with increased distance between the posterior hard palate and the LVP, and a larger effective VP ratio compared to traditional surgical techniques. Future research is needed to determine whether this procedure provides a more favorable mechanism for VP closure.

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.

Palatal Necrotic Ulcer Following Local Anesthesia: A Rare Complication

The everyday practice of dentistry relies heavily on achieving adequate local anesthesia. Even though the safety record of local anesthetic agents is high, complications do occur. Palate is a favorable site for soft-tissue lesions. Various factors such as direct effects of the drug, blanching of the tissues during injection, relatively poor blood supply, and reactivation of the latent forms of herpes can all promote to tissue ischemia and a lesion in the palate. Among various complications, anesthetic necrotic ulcer is a rare and uncommon condition occurring mostly in the hard palate possibly after a local anesthetic infiltration. We report a case of palatal ulceration in a female patient after the administration of a local anesthetic to the right posterior hard palate and follow-up

An Intraoperative Salvage After Transection of the Greater Palatine Artery During Cleft Palate Repair: A Case for Buccal Fat and Buccal Myomucosal Flaps

Recently, several adjunctive procedures have gained traction to aid cleft surgeons in repairing especially challenging palatal clefts. Buccal fat flaps and buccal myomucosal flaps have demonstrated particular utility in reinforcing thin palatal flaps or tissue deficits. Although their use has not been widely accepted, they may be particularly helpful in the setting of significant scarring or vascular compromise. Here the authors describe the case of an intraoperative salvage using bilateral buccal fat flaps and a right buccal myomucosal flap after transection of the right Greater Palatine artery (GPA) during palatoplasty on a 14-month old female with Pierre Robin Sequence and a wide Veau II cleft palate. For this operative salvage, bilateral buccal fat flaps were used to reinforce the hard-soft palate junction and a 4 cm × 2 cm flap of the right-sided buccal mucosa and buccinator muscle was inset along the majority of the right-sided soft and posterior hard palate. At 2 years follow-up, the patient had no significant complications and was doing well with healthy-appearing palatal tissue and age-appropriate speech.

ADENOMATOID HYPERPLASIA OF THE MINOR SALIVARY GLANDS: CASE REPORT

Adenomatoid hyperplasia (AH) is a rare nonneoplastic enlargement of minor salivary glands with unknown etiology. The present report describes a case of 57-year-old male patient who presented with complaint of swelling at his right side of posterior hard palate with painful symptomatology. Clinically, the lesion was a nodule covered by healthy mucosa and was of soft consistency. Radiographic examination did not demonstrate any bone involvement. An excisional biopsy was performed, and the specimen sent for microscopic analysis. Histopathologic examination revealed epithelial covering of orthokeratinized stratified squamous type. In the submucosal layer, there were minor salivary gland parenchyma exhibiting hyperplasic, ductal ectasia, and discrete acinar atrophy. The diagnosis was compatible with AH. The patient is under follow-up with no sign of recurrence after 6 months. We emphasize the importance of the correct diagnosis because clinically this lesion can be confused with benign or malignant salivary gland tumors.

ORAL KAPOSI SARCOMA FIRST MISDIAGNOSED AS AN INFLAMMATORY DISEASE

Kaposi sarcoma is a malignant neoplasm associated with human herpesvirus type 8 (HHV-8) infection that usually affects HIV-positive patients. A 34-year-old man was referred because of a swelling in the palate lasting 4 months that was initially interpreted and treated as an inflammatory endoperiodontal disease affecting teeth 21 and 22. Medical history revealed HIV infection. Physical examination revealed multiple purplish patches in the skin of the arms. Oral examination showed an exophytic reddish growth in the gingiva and palatal area close to the described teeth and a purplish patch in the left posterior hard palate. Periapical radiograph showed a radiolucent image involving the apexes of the aforementioned teeth. Clinical diagnosis was Kaposi sarcoma, and a biopsy was performed. Histologic analysis showed a proliferation of neoplastic HHV-8–positive spindle cells confirming the diagnosis of Kaposi sarcoma. The patient was referred to the infectious disease specialist, is currently under highly active antiretroviral treatment, and has been followed-up for the oral lesions.

Range and timing of surgery, and surgical sequences used, in primary repair of complete unilateral cleft lip and palate: The Cleft Care UK study.

To describe the range of surgery used to repair the lip and palate in the UK with specific interest in the sequence/timing used in complete unilateral cleft lip and palate (cUCLP). The Cleft Care UK study, a cross-sectional study of 268 5-year-olds, born from 2005 to 2007, with complete unilateral cleft lip and palate. Information on surgery was extracted from medical notes by surgeons during research clinics and transcribed onto a standardized questionnaire. Surgical data were available for 251 (94%) children from all cleft centres in the UK (n=18). Over a two-year period, 32 surgeons used 10 different surgical sequences in primary repair of the cleft lip and palate. The most frequently used sequence was repair of cleft lip and anterior hard palate followed by repair of posterior hard palate and soft palate (70%). Four surgical sequences were used only once. Most surgeons had a preferred sequence, but 38% (11/29) used more than one sequence during the study period. The timing of repair of the lip, the hard palate and the soft palate varied with surgical sequence, and also between surgeons, even adjusting for the different sequences used. Despite centralization of cleft services in the UK, there remains considerable variation in both the sequence and timing of surgical repair of cleft lip and palate in infancy. Further work is required to understand whether these factors are associated with differences in outcome.

Varying width ratio patterns of posterior hard palate cleft to posterior maxillary tuberosity plane in cleft palate

The varying width ratio patterns of posterior hard palate cleft to posterior maxillary tuberosity plane and their relationship with growth and development were studied in specific-age patients with simple cleft palate before surgery to provide a reference for evaluating operation difficulty and predetermining operative period. A total of 581 patients with simple cleft palate who received surgical treatment and are aged 8 months to 38 years participated in this study. All patients were categorized into seven groups based on age at preoperative measurement. The widths of posterior maxillary tuberosity plane and hard palate cleft were selected from the preoperative direct measurements. The relative width ratio of the hard palate to posterior maxillary tuberosity plane in each patient was used to objectively reflect the relative width of cleft palate. For patients with simple cleft palate, the widths of posterior maxillary tuberosity plane and hard palate showed remarkably increasing trends. The transverse proportion of cleft palate fissure in the upper mandible increases statistically with age, suggesting the need for complex operation.

SYMMETRICAL PALATAL fiBROMATOSIS (SPF) – 5 NEW CASES AND A LOGICAL DIAGNOSTIC NAME FOR A RARE LESION WITH A DOZEN DIFFERENT NAMES

Objective To present 5 new cases of a lesion reported fewer than 20 times in the literature, under a dozen different names, and to recommend the most appropriate name. Methods 5 new SPF cases are clinically and microscopically characterized, with a literature review. Findings 5 cases (3F & 2M) presented in patients 20-39 years of age. All presented as bilateral, symmetrical, asymptomatic, sessile, moderately firm or soft (n = 2) masses of the lateral posterior hard palate; 2 were isolated to the tuberosities. All masses were normal in color, with smooth, nonulcerated surfaces and occasional broad surface nodularity. One case had bilateral secondary, anterior extensions. Underlying bone was radiographically normal, and adjacent teeth were asymptomatic. All masses seemed to originate from tissues over the palatal bone, only secondarily extending to gingivae and/or crestal tuberosity bone, i.e. this does not appear to be a gingival entity, as previously thought. Cases had been present 2-15 years, with no familial or environmental etiologies identified. Histopathologically, masses were comprised of dense, avascular fibrous connective tissue with scattered thick bands of collagen and occasional slight surface nodularity. Surface epithelium showed regions with long, pointed and/or thin rete processes, and subepithelial stroma contained scattered large, angular fibroblasts, sometimes with multiple nuclei, sometimes with a “smudged” appearance, consistent with those in giant cell fibroma; melanin granules were not present. Conservative surgical excision affected cure in all cases. Conclusion The present investigators propose SPF as the most accurate name for this chronic, presumably rare and certainly unique entity. It fits the definition of fibromatosis more than reactive fibrous hyperplasia, and the presence of giant fibroblasts in the stroma is a unique, possibly required, histopathologic feature. Conservative surgical excision is the recommended treatment, with no recurrences reported to date.

Symmetrical palatal fibromatosis: Five new cases and a review of the literature.

To present five cases of symmetrical palatal fibromatosis (SPF), a lesion reported very rarely in the English language literature, under more than a dozen different names, and to recommend the most appropriate name. Five SPF cases are characterized with a literature review. Three females and two males, aged 20-39years, presented with bilateral, symmetrical, asymptomatic, sessile, moderately firm, or soft (n=2) masses of the lateral posterior hard palate; two were isolated to the tuberosities. All masses were normal in color, with smooth, non-ulcerated surfaces and occasional surface nodularity. Underlying bone was radiographically normal, and adjacent teeth were asymptomatic. All masses originated from supra-periosteal tissues over palatal bone, only secondarily extending to gingivae and/or crestal tuberosity. Cases were present between 4months and 15years, with no familial or environmental etiologies identified. Histopathologically, masses were comprised of dense, avascular fibrous tissue with scattered thick bands of collagen. Surface epithelium showed occasional long, thin, sometimes pointed rete processes, and subepithelial stroma contained scattered large, angular fibroblasts. Conservative surgical excision appeared curative in all cases. The present investigators propose SPF as the most accurate name for this rare entity.

Assisted resection of lateral extension of juvenile nasopharyngeal angiofibroma using a sphenopalatine fossa dissector.

Juvenile nasopharyngeal angiofibroma often attaches firmly to the adjoining bony region around the sphenopalatine foramina-sphenopalatine fossa-pterygomaxillary fissure. This can result in hourglass-shaped constriction and predispose to incomplete resection (residual disease) with a transpalatal approach. This paper describes attempts to address this 'inaccessible' area with a novel instrument, used since 2012. Measurements of the sphenopalatine foramen, nasal septum, posterior nasopharyngeal wall and hard palate were undertaken in 20 skulls and 10 computed tomography scans (lateral extension). A device was designed (in terms of angulation and length) following several trials with malleable wire. A search of patents was also undertaken. Recurrence rates were compared in cases of device use and non-use. The novelty of the sphenopalatine fossa dissector was established and the device was patented. This device has significantly improved our 17.59 per cent recurrence rate of the past 4 decades; of 63 cases over 3 years, there were only 3 recurrences and 2 residual disease cases. Findings of our previous studies with or without the device are compared. Existing evidence supports the incorporation of this inexpensive instrument in the armamentarium for resecting lateral extension of juvenile nasopharyngeal angiofibroma during a transpalatal approach.

Acute Necrotising Sialometaplasia

Introduction Acute Necrotising Sialometaplasia (ANSM) is a benign, rare and self-limiting inflammatory condition of salivary gland tissue which classically presents as a unilateral necrotic ulcer on the hard palate. The primary aetiology is trauma of minor salivary gland tissue which has been reported to occur following local anaesthetic infiltrations, surgery, heavy smoking, excessive alcohol consumption and violent vomiting such as in patients with bulimia. The most significant issue is that is may, both clinically and histologically, mimic malignancy which could potentially result in an incorrect diagnosis and unnecessary treatment. ANSM is self-limiting and usually heals spontaneously between 3-12 weeks without complication. Case description A 43-year-old Caucasian female was referred to the Oral and Maxillofacial Surgery department by her general practitioner following an eight-day history of a painful ulcer on the hard palate. Her medical history was unremarkable, and she was a non-smoker with a low alcohol consumption. On examination, there was a 1.0x1.5cm diameter 'punched out' ulcer on the left posterior hard palate which extended down to bone. An urgent incisional biopsy was undertaken which confirmed a diagnosis of ANSM and excluded dysplasia. The patient was reassured and subsequently discharged at an eight-week review following resolution of the lesion. Results and conclusions ANSM can present a diagnostic dilemma as it mimics malignancy both clinically and histologically. It is therefore vital that practitioners have an awareness of the condition and appreciate its benign and self-limiting nature to avoid unnecessary surgical intervention and patient distress. An urgent referral to a specialist in Oral and Maxillofacial Surgery or Oral Medicine is vital such that an incisional biopsy can be undertaken to confirm a diagnosis and exclude malignancy. Take-home message Clinicians should be aware of ANSM and understand the importance of an urgent referral to a specialist to exclude malignancy.

Unusual neoplasm on the hard palate of a child: a case report

BackgroundMyoepitheliomas account for less than 1% of salivary gland tumors. They mostly affect the parotid glands of adults during the third to fifth decades.Case presentationA 10-year-old Indian boy reported a small swelling in the roof of his mouth of 10 days’ duration. History revealed that the lesion was painless and not associated with bleeding or pus discharge. On examination, a purplish well-circumscribed growth was noted on his posterior hard palate. Magnetic resonance imaging was suggestive of a well-encapsulated hemangioma. An excisional biopsy was performed and histopathology along with immunohistochemistry analysis showed that the lesion was a spindle cell variant of benign myoepithelioma.ConclusionPalatal myoepitheliomas are rare and their occurrence in young individuals is rarer.

Intracranial Anatomic Landmarks for Endoscopic Endonasal Transcribriform Approach to Anterior Skull Base.

To help surgeons locating anatomic landmarks when performing endoscopic endonasal transcribriform approach to anterior skull base. High-resolution axial computed tomography (CT) images at thickness of 0.6 mm, and reconstructed 0.41-mm thick gapless sagittal and coronal CT images were taken from 123 subjects. Using mimics software, first located elementary points and line: nasal spine, midpoint of posterior hard palate and the line between them; then located measured points right/left posterior and anterior points; measured distances between measured points and from measured points to nasal spine and angles between lines connecting measured points to nasal spine and the basic line. The distances from nasal spine to right/left posterior and anterior points of anterior skull base are 68.67 ± 6.04 and 61.71 ± 5.09 mm, corresponding angles are 45.89 ± 4.20° and 72.07 ± 4.06°, respectively. The width and length of defect of anterior skull base are 24.45 ± 2.62 and 31.03 ± 4.96 mm; its area ranges from 373.75 ± 94.08 to 800.91 ± 195.07 mm. The study provides information about anterior skull base anatomic landmarks, which can help surgeons to locate them and avoid relative complications during endoscopic endonasal transcribriform approach to anterior skull base. The measurements can be used as surgical indicators to investigate the landmarks.

OSTEOPLASTY OF THE MAXILLA IN PATIENTS WITH UNILATERAL CLEFT LIP AND PALATE BY A MANDIBULAR BONE GRAFT WITH THE USE OF 3D COMPUTER MODELING

Rationale: Maxillary defects in patients with unilateral cleft lip and palate are very heterogeneous. The existing methods to assess the results of osteoplasty are suboptimal. The ways to measure the volume of a defect are not truly three-dimensional; instead, they are based on the sum of the sizes of maxillary defect measured in the sections done across the alveolar process. This is a more or less precise approximation and its calculation may be time-consuming. Aim: To evaluate efficacy of osteoplasty with a mandible bone autograft in children with cleft lip and palate and to determine the optimal pre-requisites for satisfactory treatment results. Materials and methods: We examined and treated 30 patients with unilateral cleft lip and palate and maxillary defects, aged from 7 to 17 (mean age 11.2 ± 3.5 years). The following types of abnormalities were found: incomplete cleft lip, alveolar process and palate; complete cleft lip, alveolar process and palate; complete cleft lip, alveolar process and palate with partial ossification of the posterior hard palate related to previous surgeries. In all patients, the surgical intervention consisted of maxillary osteoplasty with a combination graft consisting of the cortical plate from the mandible body, shaped to the existing defect, an autologous bone chips taken from the mandible ramus, and a Bio-Oss xenograft. The patients were divided into 4 groups, depending on their age, diagnosis, defect size, and postoperative complications. Three-dimensional modeling to determine the volume of the defect was performed as follows: a geometrical model of the mandible defect was obtained based on the mirror copy of the contralateral healthy part; the volume of the defect was computed as the difference between the baseline and the mirror model. The results of the osteoplasty were assessed by Bergland and Chelsea scales, as well as by our own scales. Results: The defect volumes were in the range of 0.46 to 2.9 cm3 (mean, 1.32 ± 0.54 cm3). According to Bergland and Chelsea scales, good results of osteoplasty were obtained in 83% (25 / 30) of the cases. The regenerated bone thickness was good in 94% (28 / 30) of the patients. The edge of the foramen piriformis was well shaped in 90% (27 / 30) of them. After surgery, the volumes of the defects in the patients with incomplete cleft lip, palate and alveolar process were significantly smaller than those in the patients with complete cleft and partial ossification of the posterior hard palate (on average, by 0.8 cm3, p = 0.0071). In all cases, where cortical mandible grafts were taken, it was possible to obtain cortical blocks of the needed size, starting from the age of 7, without any risk of damage to the immature permanent teeth. Graft formation from the mandible body was not associated with any local complications in any patient. Conclusion: Our method of 3D modeling to determine the volume of mandible defects is a truly 3D approach, which allows for a highly accurate quantitative assessment of the defects. The use of the combination grafts from the mandible body and the Bio-Oss xenografts for osteoplasty helps to replace the maxillary defect irrespective of the patient's age and the defect volume. Cortical grafts can be taken from the mandible starting from the age of 7 without any risk of damage to the immature permanent teeth. Irrespective of the clinical situation, the osteoplasty results are influenced predominantly by adherence to the surgical technique and to post-operative recommendations.