Surgical Treatment Of Cleft Palate Research Articles

" The Use Of Stem Cells In The Surgical Treatment Of Cleft Palate "

Mesenchymal stem cells, pluripotent and differentiable cells found naturally within bone marrow, adipose tissue, the blood of the umbilical cord, and dental pulp have the capability to transform the field of oral surgery. With the capability to ..

Quality of Speech Following Cleft Palate Surgery in Children

Background: Surgical treatment of cleft palate is accompanied with speech problems. Speech therapy in these children after surgery can improve their speech. In this study, we aimed to evaluate the quality of speaking in operated cleft palate patients and speech therapy effects in a small group of these patients. Methods: In this cross-sectional study, speech quality of 55 children with operated cleft palate was assessed regarding resonance, audible nasal emission, consonant production and speech acceptability. Speech outcomes after therapy were evaluated in 19 patients. Results: Cleft palate types were unilateral cleft and lip palate in 18 cases, bilateral cleft and lip palate in 4 cases, secondary cleft palate type in 30 cases and of mere-soft palate in 3 cases. Thirty-five children were operated during the first year of life and 20 were operated after the first year. More than 55% of patients had normal hypernasality with few cases of severe hypernasality and less than 45% had error in consonant production. Patients operated during first year of life had more speech problems. Speech parameters were improved in 19 patients after speech therapy. Conclusion: In conclusion, children with cleft palate have some degrees of speech disorders after repair surgery than could be improved by the speech therapy. Speech therapy should be considered as one of the main treatment protocols along with repair surgery in children with cleft palate.

Aborduri actuale în tratamentul despicăturilor labiopalatine

Objective. To evaluate the present state of cleft palate surgical treatment based on clinical studies after an extensive research of medical literature. Methods. The research was made in PubMed database between 2007-2014 taking in consideration surgical treatment of cleft palate and eliminating case reports, case series and reviews. Results. There was 1,677 articles with relevance for cleft palate surgical treatment and after applying exclusion criteria were retained 43 – 29 retrospective studies and 14 prospective. Conclusion. There isn’t a protocol treatment recognized by all the cleft palate centers, existing a variety of ways to manage this malformation. There are few studies that adress treatment of cleft palate and in particular the surgical treatment of this disease and of these many are retrospective studies. This review reinforces the importance of performing prospective studies with long-term outcomes to elucidate the effect of each protocol for obtaining optimal results.

Evaluation of survival rate and athletic ability after nonsurgical or surgical treatment of cleft palate in horses: 55 cases (1986–2008)

To determine survival rate and athletic ability after nonsurgical or surgical treatment of cleft palate in horses. Retrospective case series. 55 horses with cleft palate. 13 of the 55 horses died or were euthanized without treatment and were not included in all analyses. Medical records were reviewed for signalment, history, method of diagnosis, soft or hard palate involvement, type of surgical procedure performed, postoperative complications, and survival to hospital discharge. Information on athletic ability was acquired from race records and follow-up conversations with owners, trainers, or referring veterinarians. The predominant reason for initial evaluation was milk or feed in the nostrils (60%). The diagnosis was confirmed by means of videoendoscopy of the upper portion of the airway in all cases. Most cases involved the soft palate only (92.7%). Twenty-six of the 55 (47.3%) horses underwent surgical repair, and 12 of these had dehiscence at the caudal edge of the soft palate. Among potential racehorses, 14 of 33 had surgery. Of these, 12 of 14 survived to discharge and 2 horses raced. Among potential racehorses, 10 of 33 were discharged without surgery and 2 of these raced. Among nonracehorses, 12 of 22 underwent surgery and 11 survived to discharge. All horses that were discharged and for which follow-up information was available survived to 2 years of age or older without ill thrift despite dehiscence at the caudal edge of the soft palate and continued mild nasal discharge. Horses with cleft palate had a higher survival rate than previously reported.

Palatoplasty and Growth of the Temporal Bone Mastoid Air Cells

The present study was undertaken to analyze the relationship between the method used for manipulation of the levator veli palatini muscle and the area of the mastoid air cells in patients with cleft palate. Retrospective study. The subjects were 50 patients seen for surgical treatment of cleft palate. Palatoplasty was carried out using the mucosal flap method in 25 patients and the mucoperiosteal flap method in 25 patients. In the mucosal flap method, the levator veli palatini muscle was overlapped and sutured, followed by posterior movement of the muscle bundle (the posterior relocation group). In the mucoperiosteal flap method (the control group), the mucoperiosteal flap was pushed back, followed by end-to-end suturing of the muscle. The area of the mastoid air cells was measured on X-rays when patients were 5 years old. The mastoid air cell area did not differ significantly between the posterior relocation group (mean, 5.00 cm(2); range, 1.66 to 19.7 cm(2)) and the control group (mean, 5.3 cm(2); range, 2.29 to 15.9 cm(2)). No significant growth of mastoid air cells was noted following posterior relocation of the levator veli palatini muscle. Thus, in cases of cleft palate in which significant growth of mastoid air cells is not expected following reconstruction of the levator veli palatini muscle, the results confirm the view that tympanic ventilation tube insertion is the most suitable method for the treatment of otitis media.

Surgical Treatment of Cleft Palate and Velopharyngeal Insufficiency in Hungary

Surgical Treatment of Cleft Palate and Velopharyngeal Insufficiency in Hungary

Correction of incomplete cleft palate by u-shaped flap palatoplasty

During cleft palate repair, velopharyngeal sphincter reconstruction is still a challenge to plastic surgeons. To improve results of surgical treatment of cleft palate and secondary velopharyngeal incompetence, a carefully designed modified procedure for palatoplasty is presented. Thirty patients with incomplete cleft palate corrected by this procedure from April 2003 to October 2007 were included. A u-shaped incision was made in the anterior palate to separate bipedicle flap based on the greater palatine arteries of both sides. After complete dissection of the nasal and palatal mucosa, palatal muscles were carefully dissected from the posterior edge of the bones of the hard palate, wherein the well-mobilised flap receded backward spontaneously and elongated the soft palate. After suturing the nasal mucosa in the midline, the dissected palatal muscles of both sides were sutured together in the anterior third of the soft palate. On suturing the nasal mucosa and the palatal muscles, the soft palate became elongated and the oral mucosa was seen receding backward spontaneously to cover the anterior part of the soft palate. All corrected patients showed good results, with no recurrence, no post-operative fistulae, with accepted speech pattern and no need for further pharyngoplasty. The line of the sutured nasal mucosa and the palatal muscles became covered by the healthy non-sutured oral mucosa and the soft palate became elongated, with narrowing of the vellopharyngeal isthmus after this technique. The designed flap allows covering of sutured nasal mucosa and palatal muscles with a healthy unsutured oral mucosa and elongates the soft palate. Thus, there was no incidence of post-operative fistula and no need for further pharyngoplasties.

Analysis of Velopharyngeal Morphology in Adults With Velopharyngeal Incompetence After Surgery of a Cleft Palate

This study analyzed the relationship of velopharyngeal morphology and velopharyngeal function among 13 adults with velopharyngeal incompetence (VPI), 14 adults with velopharyngeal competence (VPC) after primary surgical treatment of cleft palate, and 20 noncleft adults. The measurements included velar length, pharyngeal depth, pharyngeal height, and the need ratio of pharyngeal depth to velar length. In addition, the cranial base, cervical vertebrae, posterior nasal spine, and also the position of the posterior pharyngeal wall (PPW) in the pharyngeal triangle were analyzed. All data were subjected to the Student t test of statistical significance. The results showed that the VPI group had normal pharyngeal depth and a significantly shorter velar length, resulting in a greater depth/length ratio than those of the VPC group and normal control subjects. The position of PPW in the pharyngeal triangle was located significantly more superior in the VPI group compared with the VPC group and normal control subjects. Measurements of the anteroposterior and the vertical dimensions in the regions of the cranial base and cervical vertebrae revealed no significant difference among the 3 groups. According to this study, the velopharyngeal morphology of adults with VPI is characterized by a shorter palate, greater need ratio, slightly counterclockwise-rotated pharyngeal triangle, and superiorly positioned PPW.

Surgical Treatment Of Cleft Palate

During the period 1958-1985, 230 patients with cleft palate were operated on in the Department of Plastic Surgery, University of Göteborg, Sweden. A modified push-back technique according to Wardill and Kilner was used. The children were operated on at a mean age of 13 months. They were divided into two groups, the first in which the cleft affected the velum only (n = 121) and the other in which it also affected the hard palate (n = 109). Postoperative dehiscences and fistulas occurred in 19 (8%) patients, of which 16 (15%) belonged to the group in which the cleft affected the hard palate. Only three (2%) of the 121 patients with a cleft in the soft palate only developed dehiscences. The total number of patients who had to be reoperated on because of dehiscences were 10 (4%) and palatopharyngeal flaps had to be performed in 25 patients (11%) because of speech problems.

Primary surgical correction of congenital clefts of the lip and palate

No one procedure for surgical closure is adequate for all types of palatal clefts. The use of prosthetics is elective in instances of gross tissue deficiency. Surgical treatment of cleft palate always is the method of choice whenever its goals can be reasonably attained. The surgical method selected depends largely on the extent of the cleft and on anatomic and physiologic details of the related parts. Two case reports illustrate some of the problems encountered in the surgical management of cleft palates.