Journal articles: 'Palate - Surgery'

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Vacher, Christian, Bernard Pavy, and Jeffrey Ascherman. "Musculature of the Soft Palate: Clinico-anatomic Correlations and Therapeutic Implications in the Treatment of Cleft Palates." Cleft Palate-Craniofacial Journal 34, no. 3 (May 1997): 189–94. http://dx.doi.org/10.1597/1545-1569_1997_034_0189_motspc_2.3.co_2.

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Objective Hypoptasia of the maxilla, often described as a classic sequela to surgical repair of the cleft palate, has been rare In our experience. We believe that our surgical technique, which includes dividing the nasal mucosa and the abnormal muscular insertions at the posterior border of the hard palate, is an important factor in preventing this sequela. Method We compared the anatomy of 12 normal palates in cadavers to the anatomy of cleft palates seen at operation and to the anatomy of one cleft palate in a fetus aged 34 weeks. Results In cleft palates, the muscular fibers have an abnormal sagittal orientation, inserting on the posterior border of the hard palate. Conclusion The division of both the nasal mucosa and these abnormal muscular insertions at the posterior border of the hard palate enables the surgeon to eliminate the abnormal posterior pull of these fibers on the maxilla.

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Smyth, Alistair G., and Jianhua Wu. "Cleft Palate Outcomes and Prognostic Impact of Palatal Fistula on Subsequent Velopharyngeal Function—A Retrospective Cohort Study." Cleft Palate-Craniofacial Journal 56, no. 8 (February 12, 2019): 1008–12. http://dx.doi.org/10.1177/1055665619829388.

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Objective: To assess outcomes from cleft palate repair and define the level of impact of palatal fistula on subsequent velopharyngeal function. Design: A retrospective cohort study. Setting: A regional specialist cleft lip and palate center within United Kingdom. Patients, Participants: Nonsyndromic infants born between 2002 and 2009 undergoing cleft palate primary surgery by a single surgeon with audited outcomes at 5 years of age. Four hundred ten infants underwent cleft palate surgery within this period and 271 infants met the inclusion criteria. Interventions: Cleft palate repair including levator palati muscle repositioning with or without lateral palatal release. Main Outcome Measures: Postoperative fistula development and velopharyngeal function at 5 years of age. Results: Lateral palatal incisions were required in 57% (156/271) of all cases. The fistula rate was 10.3% (28/271). Adequate palatal function with no significant velopharyngeal insufficiency (VPI) was achieved in 79% of patients (213/271) after primary surgery only. Palatal fistula was significantly associated with subsequent VPI (risk ratio = 3.03, 95% confidence interval: 1.95-4.69; P < .001). The rate of VPI increased from 18% to 54% when healing was complicated by fistula. Bilateral cleft lip and palate (BCLP) repair complicated by fistula had the highest incidence of VPI (71%). Conclusions: Cleft palate repair with levator muscle repositioning is an effective procedure with good outcomes. The prognostic impact of palatal fistula on subsequent velopharyngeal function is defined with a highly significant 3-fold increase in VPI. Early repair of palatal fistula should be considered, particularly for large fistula and in BCLP cases.

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Denk, Michael J., and William P. Magee. "Cleft Palate Closure in the Neonate: Preliminary Report." Cleft Palate-Craniofacial Journal 33, no. 1 (January 1996): 57–66. http://dx.doi.org/10.1597/1545-1569_1996_033_0057_cpcitn_2.3.co_2.

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Our recent experience with cleft palate closure in the neonatal period (within 28 days of birth) is reviewed in this study. The research involved a series of 21 neonates who presented with untreated cleft palates and underwent a modified Veau-Wardill-Kilner palate closure by a single surgeon between 1991 and 1994. The postoperative clinical follow-up ranged from 8 to 37 months (mean 18 months). All complications discussed do not seem to occur more frequently when surgery is done at this age than at an older age. Our findings demonstrate that cleft palate closure can be safely performed in the neonatal period; we do not, however, recommend that the standard approach should be changed based on this preliminary report.

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Nguyen, Christine, Tina Hernandez-Boussard, Sheryl M. Davies, Jay Bhattacharya, Rohit K. Khosla, and Catherine M. Curtin. "Cleft Palate Surgery." Plastic and Reconstructive Surgery 130 (November 2012): 23. http://dx.doi.org/10.1097/01.prs.0000421724.48320.8d.

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Sitzman, Thomas J., Adam C. Carle, Pamela C. Heaton, Michael A. Helmrath, and Maria T. Britto. "Five-Fold Variation Among Surgeons and Hospitals in the Use of Secondary Palate Surgery." Cleft Palate-Craniofacial Journal 56, no. 5 (September 24, 2018): 586–94. http://dx.doi.org/10.1177/1055665618799906.

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Objective: To identify child-, surgeon- and hospital-specific factors at the time of primary cleft palate repair that are associated with the use of secondary palate surgery. Design: Retrospective cohort study. Setting: Forty-nine pediatric hospitals. Participants: Children who underwent cleft palate repair between 1998 and 2015. Main Outcome Measure: Time from primary cleft palate repair to secondary palate surgery. Results: By 5 years after the primary palate repair, 27.5% of children had undergone secondary palate surgery. In multivariable analysis, cleft type and age at primary palate repair were both associated with secondary surgery ( P < .01). Children with unilateral cleft lip and palate had a 1.69-fold increased hazard of secondary surgery (95% confidence interval [CI]: 1.54-1.85) compared to children with cleft palate alone. Primary palate repair before 9 months had a 3.99-fold increased hazard of secondary surgery (95% CI: 3.39-4.07) compared to repair at 16 to 24 months of age. After adjusting for cleft type, age at repair, and procedure volume, there remained substantial variation in secondary surgery use among surgeons and hospitals ( P < .01). For children with isolated cleft palate, the predicted proportion of children undergoing secondary surgery within 5 years of primary repair ranged from 8.5% to 46.0% across surgeons and 9.1% to 49.4% across hospitals. Conclusions: There are substantial differences among surgeons and hospitals in the rates of secondary palate surgery. Further work is needed to identify causes for this variation among providers and develop interventions to reduce the need for secondary surgery.

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Canady, John W., Steve K. Landas, Hughlett Morris, and Sue Ann Thompson. "In Utero Cleft Palate Repair in the Ovine Model." Cleft Palate-Craniofacial Journal 31, no. 1 (January 1994): 37–44. http://dx.doi.org/10.1597/1545-1569_1994_031_0037_iucpri_2.3.co_2.

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Cleft lip end palate defects assume many forms from mild to severe, but all may be associated with abnormal craniofacial development. Even the most expert and sophisticated methods of surgical repair are followed by scar contraction and fibrosis, which result in skeletal defects, dental abnormalities, cosmetic disfigurement, and speech Impairment. Recent clinical and experimental observations that fetal cutaneous wounds heal without scarring are of great potential interest In the management of cleft lip and palate. The objective of this study was to investigate the effect of prenatal repair of iatrogenically produced cleft palate on scar formation in the fetal lamb model. Ten ewes were operated on ranging in gestation from 70 to 133 days. Fifteen lambs were studied (nine cleft palates produced and repaired In utero; one cleft produced in utero and not repaired, four normal, unoperated palates; and one cleft palate produced and repaired 1 week postnatally). The lambs were delivered normally at 145 to 147 days gestation and maintained with the ewe until 1 month of age. The lambs were euthanized, and the surgical area of the palates studied grossly and histologically. Animals operated at 112 days or later in gestation exhibited scars both clinically and histologically. The animals that had cleft palate produced and repaired at 70 days gestation did not have a visible palatal scar at 1 month of age. Histologically, there was evidence of minimal scarring without disruption of normal architecture. Studies are underway to determine the impact of reduced scarring on craniofacial growth after palatal repair during mid gestation in the ovine model.

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Friede, Hans, and Hans Enemark. "Long-Term Evidence for Favorable Midfacial Growth after Delayed Hard Palate Repair in UCLP Patients." Cleft Palate-Craniofacial Journal 38, no. 4 (July 2001): 323–29. http://dx.doi.org/10.1597/1545-1569_2001_038_0323_lteffm_2.0.co_2.

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Objective: To investigate whether delayed hard palate repair resulted in better midfacial growth in the long term than previously achieved with “conventional” surgical methods of palatal closure. Design and Setting: Long-term cephalometric data from patients with unilateral cleft lip and palate were available from two Scandinavian cleft centers. The patients had been treated by different regimens, particularly regarding the method and timing of palatal surgery. Patients were analyzed retrospectively, and one investigator digitized all radiographs. Patients: Thirty consecutively treated subjects from each center, with cephalograms taken at three comparable stages between 10 and 16 years of age. Results and Conclusions: Patients whose hard palates were repaired late (early soft palate closure followed by delayed hard palate repair at the stage of mixed dentition) had significantly better midfacial development than patients in whom the hard palate was operated on early with a vomer flap, and then during the second year of life, the soft palate was repaired with a push-back procedure. As the growth advantage in the delayed hard palate repair group was accomplished without impeding long-term speech development, the delayed repair regimen proved to be a good alternative in surgical treatment of patients with unilateral cleft lip and palate.

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Pollard, Sarah Hatch, Jonathan R. Skirko, Dallin Dance, Hans Reinemer, Duane Yamashiro, Natalee F. Lyon, and Dave S. Collingridge. "Oronasal Fistula Risk After Palate Repair." Cleft Palate-Craniofacial Journal 58, no. 1 (June 23, 2020): 35–41. http://dx.doi.org/10.1177/1055665620931707.

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Objective: To assess risk factors for oronasal fistula, including 2-stage palate repair. Design: Retrospective analysis. Setting: Tertiary children’s hospital. Patients: Patients with non-submucosal cleft palate whose entire cleft repair was completed at the study hospital between 2005 and 2013 with postsurgical follow-up. Interventions: Hierarchical binary logistic regression assessed predictive value of variables for fistula. Variables tested for inclusion were 2 stage repair, Veau classification, sex, age at surgery 1, age at surgery 2, surgeon volume, surgeon, insurance status, socioeconomic status, and syndrome. Variables were added to the model in order of significance and retained if significant at a .05 level. Main Outcome Measure: Postoperative fistula. Results: Of 584 palate repairs, 505 (87%) had follow-up, with an overall fistula rate of 10.1% (n = 51). Among single-stage repairs (n = 211), the fistula rate was 6.7%; it was 12.6% in 2-stage repairs (n = 294, P = .03). In the final model utilizing both single-stage and 2-stage patient data, significant predictors of fistula were 2-stage repair (odds ratio [OR]: 2.5, P = .012), surgeon volume, and surgeon. When examining only single-stage patients, higher surgeon volume was protective against fistula. In the model examining 2-stage patients, surgeon and age at hard palate repair were significant; older age at hard palate closure was protective for fistula, with an OR of 0.82 ( P = .046) for each additional 6 months in age at repair. Conclusions: Two-stage surgery, surgeon, and surgeon volume were significant predictors of fistula occurrence in all children, and older age at hard palate repair was protective in those with 2-stage repair.

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Min, Jung Gi, Rohit K. Khosla, and Catherine Curtin. "Descriptive Overview of Primary Cleft Palate Surgeries in the Low- and Middle-Income Countries." Cleft Palate-Craniofacial Journal 57, no. 8 (March 24, 2020): 984–89. http://dx.doi.org/10.1177/1055665620911556.

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Objective: To increase access to high-quality and multiregional databases in global epidemiology of cleft surgeries through partnership with an NGO. Design: The study retrospectively analyzes 34 801 primary palate surgeries in 70+ countries from the 2016 electronic health records of an non-governmental organization (NGO). The study also utilizes the Kids’ Inpatient Database to compare the epidemiology of primary cleft palate surgeries in the United States. Participants: Patient records of those undergoing primary cleft palate surgeries only. Main Outcome Measures: Region, age, sex, type of cleft, laterality of cleft. Results: Key findings show that average age of those receiving primary cleft palate surgery in the low- and middle-income countries (LMICs) was 1.95 years. The distribution of males and females receiving surgery corresponds to the US national data. More hard cleft palates were on the left side (66.18%) than the right side (33.82%), independent of gender and region. Conclusions: Databases from an established NGO can be used to enhance our understanding of the disease characteristics in these regions. By increasing the information available regarding cleft surgeries in the LMIC, we hope to increase awareness of the similarities and differences in surgeries across various regions, as part of an effort to inform the goals set by Global Surgery 2030 initiative by the Lancet Commission.

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Uysal, Afsin, and A. Cagri Uysal. "Bone Regeneration in Hard Palate after Cleft Palate Surgery." Plastic and Reconstructive Surgery 117, no. 7 (June 2006): 2505. http://dx.doi.org/10.1097/01.prs.0000219887.67219.1a.

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Sommerlad, Brian C., Felicity V. Mehendale, Malcolm J. Birch, Debbie Sell, Caroline Hattee, and Kim Harland. "Palate Re-Repair Revisited." Cleft Palate-Craniofacial Journal 39, no. 3 (May 2002): 295–307. http://dx.doi.org/10.1597/1545-1569_2002_039_0295_prrr_2.0.co_2.

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Objective: To analyze the results of a consecutive series of palate re-repairs performed using the operating microscope and identify predictive factors for outcome. Design: Prospective data collection, with blind assessment of randomized recordings of speech and velar function on lateral videofluoroscopy and nasendoscopy. Patients: One hundred twenty-nine consecutive patients with previously repaired cleft palates and symptomatic velopharyngeal incompetence (VPI) and evidence of anterior insertion of the levator veli palatini underwent palate re-repairs by a single surgeon from 1992 to 1998. Syndromic patients, those who had significant additional surgical procedures at the time of re-repair (23 patients), and all patients with inadequate pre- or postoperative speech recordings were excluded, leaving a total of 85 patients in the study. Interventions: Palate re-repairs, with radical dissection and retropositioning of the velar muscles, were performed using the operating microscope with intraoperative grading of anatomical and surgical findings. Main Outcome Measures: Pre- and postoperative perceptual speech assessments using the Cleft Audit Protocol for Speech (CAPS) score, measurement of velar function on lateral videofluoroscopy, and assessment of nasendoscopy recordings. Results: There were significant improvements in hypernasality, nasal emission, and nasal turbulence and measures of velar function on lateral videofluoroscopy, with improvement in the closure ratio, velopharyngeal gap at closure, velar excursion, velar movement angle, and velar velocity. Conclusions: Palate re-repair has been shown to be effective in treating VPI following cleft palate repair, both in patients who have not had an intravelar veloplasty and those who have had a previous attempt at muscle dissection and retropositioning. Palate re-repair has a lower morbidity and is more physiological than a pharyngoplasty or pharyngeal flap.

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Imbery, Terence E., Lindsay B. Sobin, Emily Commesso, Lindsey Koester, Sherard A. Tatum, Danning Huang, Dongliang Wang, and Brian D. Nicholas. "Long-Term Otologic and Audiometric Outcomes in Patients with Cleft Palate." Otolaryngology–Head and Neck Surgery 157, no. 4 (June 27, 2017): 676–82. http://dx.doi.org/10.1177/0194599817707514.

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Objective Describe longitudinal audiometric and otologic outcomes in patients with cleft palates. Study Design Case series with chart review. Setting Single academic medical center. Methods Charts of 564 patients with a diagnosis of cleft palate (59% syndromic etiology, 41% nonsyndromic) from 1998 to 2014 were reviewed. Patients without at least 1 audiometric follow-up were excluded from analysis. Patient demographics, surgeries, audiometric tests, and otologic data were recorded for 352 patients. Results Forty-five percent had isolated cleft palates, 34% had unilateral cleft lip and palate, and 21% had bilateral cleft lip and palate. Patients were followed for a mean of 50.3 months with a mean of 3.2 separate audiograms performed. Patients received a mean of 2.93 pressure equalization tubes. Increased number of pressure equalization tubes was not associated with incidence of cholesteatoma, which was identified in only 4 patients. Nine patients underwent eventual tympanoplasty with an 89% closure rate. Analysis of mean air-bone gap by cleft type did not reveal significant differences ( P = .08), but conductive losses and abnormal tympanometry persisted into teenage years. Conclusions Patients with cleft palates have eustachian tube dysfunction, which, in our cohort, resulted in persistent conductive hearing loss, highlighting the importance of long-term follow-up. Cholesteatoma incidence was low and not associated with number of tubes, which at our institution were placed prophylactically. Tympanoplasty was successful in those with persistent perforations.

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Broen, Patricia A., Karlind T. Moller, Jane Carlstrom, Shirley S. Doyle, Monica Devers, and Kathleen M. Keenan. "Comparison of the Hearing Histories of Children with and without Cleft Palate." Cleft Palate-Craniofacial Journal 33, no. 2 (March 1996): 127–33. http://dx.doi.org/10.1597/1545-1569_1996_033_0127_cothho_2.3.co_2.

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Aggressive otologic management has been recommended for children with cleft palate because of the almost universal occurrence of otitis media with effusion (OME) in these children and the association of OME with hearing loss and possible language, cognitive, and academic delays. In this study, 28 children with cleft palate and 29 noncleft children were seen at 3-month intervals from 9 to 30 months to compare otologic treatment and management. Hearing and middle ear function were tested at each session; information on ventilation tube placement was obtained from medical records. Ventilation tubes were placed earlier and more often in children with cleft palate, but children with cleft palates failed the hearing screening more often. The correlation between age at first tube placement and frequency of hearing screening failures was significant for the children with cleft palate, indicating that the later tubes were first placed, the poorer the child's hearing.

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Ortiz-Posadas, M. R., L. Vega-Alvarado, and J. Maya-Behar. "A New Approach to Classify Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 38, no. 6 (November 2001): 545–50. http://dx.doi.org/10.1597/1545-1569_2001_038_0545_anatcc_2.0.co_2.

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Objective: To propose a new method, which allows for a complete description of primary and secondary cleft palates, incorporating elements that are related to the palate, lip, and nose that will also reflect the complexity of this problem. Method: To describe the type of cleft, two embryonic structures were considered: (1) the primary palate, formed by the prolabium, premaxilla, and columella and (2) the secondary palate, which begins at the incisive foramen and is formed by a horizontal portion of the maxilla, the horizontal portion of the palatine bones, and the soft palate. Anatomical characteristics to be considered were defined, and a new method is proposed to more fully describe any cleft. Results: A description of five cases was made using the method proposed in this work and compared with other published methods for the classification and description of clefts. Conclusions: A mathematical expression was developed to characterize clefts of the primary palate, including the magnitude of palatal segment separation and the added complexity of bilateral clefts, yielding a numerical score that reflects overall complexity of the cleft. Clefts of the secondary palate are also considered in a separate score. Using this method, it is possible to incorporate elements that are not considered in other approaches and to describe all possible clefts that may exist.

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Lilja, Jan, Anna Elander, Anette Lohmander, and Christina Persson. "Isolated Cleft Palate and Submucous Cleft Palate." Oral and Maxillofacial Surgery Clinics of North America 12, no. 3 (August 2000): 455–68. http://dx.doi.org/10.1016/s1042-3699(20)30203-x.

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Agrawal, Karoon. "Cleft palate repair and variations." Indian Journal of Plastic Surgery 42, S 01 (October 2009): S102—S109. http://dx.doi.org/10.1055/s-0039-1699382.

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ABSTRACTCleft palate affects almost every function of the face except vision. Today a child born with cleft palate with or without cleft lip should not be considered as unfortunate, because surgical repair of cleft palate has reached a highly satisfactory level. However for an average cleft surgeon palatoplasty remains an enigma. The surgery differs from centre to centre and surgeon to surgeon. However there is general agreement that palatoplasty (soft palate at least) should be performed between 6-12 months of age. Basically there are three groups of palatoplasty techniques. One is for hard palate repair, second for soft palate repair and the third based on the surgical schedule. Hard palate repair techniques are Veau-Wardill-Kilner V-Y, von Langenbeck, two-flap, Aleveolar extension palatoplasty, vomer flap, raw area free palatoplasty etc. The soft palate techniques are intravelar veloplasty, double opposing Z-plasty, radical muscle dissection, primary pharyngeal flap etc. And the protocol based techniques are Schweckendiek's, Malek's, whole in one, modified schedule with palatoplasty before lip repair etc. One should also know the effect of each technique on maxillofacial growth and speech. The ideal technique of palatoplasty is the one which gives perfect speech without affecting the maxillofacial growth and hearing. The techniques are still evolving because we are yet to design an ideal one. It is always good to know all the techniques and variations so that one can choose whichever gives the best result in one's hands. A large number of techniques are available in literature, and also every surgeon incorporates his own modification to make it a variation. However there are some basic techniques, which are described in details which are used in various centres. Some of the important variations are also described.

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Heliövaara, Arja, and Jorma Rautio. "Craniofacial and Pharyngeal Cephalometric Morphology in Seven-Year-Old Boys with Unoperated Submucous Cleft Palate and without a Cleft." Cleft Palate-Craniofacial Journal 46, no. 3 (May 2009): 314–18. http://dx.doi.org/10.1597/07-211.1.

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Objective: To evaluate cephalometrically the craniofacial and pharyngeal morphology in 7-year-old boys with unoperated submucous cleft palate and to compare the findings with the morphology of 7-year-old boys without clefts. Setting and Patients: Thirty-two boys with unoperated submucous cleft palate and 49 boys without a cleft were compared retrospectively from lateral cephalograms taken at the mean age of 7 years (range, 5.5 to 8.6 years). Design: A retrospective case-control study. Outcome Measure: Linear and angular measurements were obtained from lateral cephalograms. A Student's t test was used in the statistical analysis. Results: The maxilla of the boys with submucous cleft palate was shorter and slightly more retrusive in relation to the cranial base than that of boys without clefts. Also, the mandible of the boys with submucous cleft palate was smaller, with a steeper mandibular plane. The relationship between the jaws was similar in both groups; although, those without clefts showed higher values for soft tissue maxillary prominence. In the pharyngeal area, the boys with submucous cleft palate had larger nasopharyngeal depths, smaller hypopharyngeal depths, and shorter soft palates than the boys without a cleft. Conclusions: This small study suggests that the boys with unoperated submucous cleft palate have minor distinctive morphological features in the maxillary, mandibular, and pharyngeal areas.

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Abdollahi Fakhim, Shahin, Nikzad Shahidi, and Gelavizh Karimi Javan. "Quality of Speech Following Cleft Palate Surgery in Children." Advances in Bioscience and Clinical Medicine 6, no. 2 (April 30, 2018): 14. http://dx.doi.org/10.7575/aiac.abcmed.v.6n.2p.14.

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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.

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Yuan, Xingang, Xiaomeng He, Xuan Zhang, Cuiping Liu, Chen Wang, Lin Qiu, Wei Pu, and Yuexian Fu. "Comparative Study of Folic Acid and α-Naphthoflavone on Reducing TCDD-Induced Cleft Palate in Fetal Mice." Cleft Palate-Craniofacial Journal 54, no. 2 (March 2017): 216–22. http://dx.doi.org/10.1597/15-211.

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Objective To compare the effect of folic acid (FA) and α-naphthoflavone on 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-induced cleft palate in fetal mice. Design Pregnant mice were randomly divided into seven groups. The mice treated with corn oil were used as a negative control. The mice in the other six groups were given a single dose of 28 μg/kg TCDD on GD 10 by gavage. For FA treatment, TCDD-treated mice were also dosed with 5, 10, and 15 mg/kg FA on GD 10, while for α-naphthoflavone treatment, the mice received a single dose of 50 μg/kg or 5 mg/kg α-naphthoflavone on GD 10. Main Outcome Measures Fetal mice palates were imaged using light and scanning electron microscopy on GD 13.5, GD 14.5, and GD 15.5, and cleft palate were recorded on GD 17.5. The expression of guanosine diphosphate dissociation inhibitor (GDI) in fetal mice palate on GD 15.5 was examined by immunohistochemistry. Results TCDD successfully induced cleft palate. Ten mg/ml FA and 5 mg/ml α-naphthoflavone significantly reduced TCDD-induced cleft palate. FA and α-naphthoflavone partly reduced TCDD-induced cleft palate but did not affect the expression of Rho GDI. Conclusions FA and α-naphthoflavone may reduce the generation of reactive oxygen species, inhibit MEE apoptosis through anti-oxidation, and increase filopodia and MEE movement. This may result in restoration of the ultrastructure of the palatal surface to a normal state, leading to the fusion and formation of complete palate in TCDD-treated fetal mice.

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Sadhu, Partha. "Oronasal fistula in cleft palate surgery." Indian Journal of Plastic Surgery 42, S 01 (October 2009): S123—S128. http://dx.doi.org/10.1055/s-0039-1699385.

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ABSTRACTOronasal fistula (ONF) is the commonest complication associated with cleft palate surgery. The main symptoms associated with ONF are nasal regurgitation of food matter and hypernasality of voice. Repair of cleft palate under tension is considered to be the main reason of ONF though vascular accidents and infection can also be the cause. Most of the ONFs are situated in the hard palate or at the junction of hard and soft palate. Repair of ONF depends on its site, size and mode of presentation. A whole spectrum of surgical procedures starting from small local flaps to microvascular tissue transfers have been employed for closure of ONF. Recurrence rate of ONF is 25% on an average after the first attempt of repair.

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Nadjmi, Nasser. "Transoral Robotic Cleft Palate Surgery." Cleft Palate-Craniofacial Journal 53, no. 3 (May 2016): 326–31. http://dx.doi.org/10.1597/14-077.

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Lilja, J. "Cleft Lip and Palate Surgery." Scandinavian Journal of Surgery 92, no. 4 (December 2003): 269–73. http://dx.doi.org/10.1177/145749690309200406.

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Podolsky, Dale J., David M. Fisher, Karen W. Y. Wong Riff, Thomas Looi, James M. Drake, and Christopher R. Forrest. "Infant Robotic Cleft Palate Surgery." Plastic and Reconstructive Surgery 139, no. 2 (February 2017): 455e—465e. http://dx.doi.org/10.1097/prs.0000000000003010.

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Bolton, Philip. "Anaesthesia for cleft palate surgery." Anaesthesia & Intensive Care Medicine 7, no. 5 (May 2006): 157. http://dx.doi.org/10.1383/anes.2006.7.5.157.

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Monson, Laura A., David Y. Khechoyan, Edward P. Buchanan, and Larry H. Hollier. "Secondary Lip and Palate Surgery." Clinics in Plastic Surgery 41, no. 2 (April 2014): 301–9. http://dx.doi.org/10.1016/j.cps.2013.12.008.

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Markus, A. F. "Cleft, lip and palate surgery." British Journal of Oral and Maxillofacial Surgery 32, no. 4 (August 1994): 262–63. http://dx.doi.org/10.1016/0266-4356(94)90216-x.

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Alcaraz, Marta, Gabriela Bosco, Nuria Pérez-Martín, Marta Morato, Andrés Navarro, and Guillermo Plaza. "Advanced Palate Surgery: What Works?" Current Otorhinolaryngology Reports 9, no. 3 (June 2, 2021): 271–84. http://dx.doi.org/10.1007/s40136-021-00356-4.

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Birch, M. J., and P. D. Srodon. "Biomechanical Properties of the Human Soft Palate." Cleft Palate-Craniofacial Journal 46, no. 3 (May 2009): 268–74. http://dx.doi.org/10.1597/08-012.1.

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Objective: To measure biomechanical properties of the human soft palate and the variation across anatomic regions. Design: Ex vivo analysis of human tissue. Patients/participants: Ten palates harvested from 10 normal adult human cadavers (age range, 37 to 90 years). Interventions: Computer-controlled uniaxial stress-relaxation mechanical properties tested in physiological saline at 37°C. Main Outcome Measures: Measurement of Young modulus, Poisson ratio, and determination of viscoelastic constants c, τ1, and τ2 by curve-fitting of the reduced relaxation function to the data. Results: One hundred sections were tested from the 10 palates, representative of 10 anatomic zones. The mean Young modulus range was 585 Pa at the posterior free edge to 1409 Pa at regions of attachment. The mean Poisson ratio in the inferior-superior direction was 0.45 (SD 0.26) and in the lateral direction, was 0.30 (SD 0.21). The mean viscoelastic constants for 1-mm extensions were C = −0.1056 (±0.1303), τ1 = 11.0369 (±9.1865) seconds, and τ2 = 0.2128 (±0.0792) seconds, and for 2-mm extensions were C = −0.1111 (±0.1466), τ1 = 14.3725 (±5.2701) seconds, and τ2 = 0.2094 (±0.0544) seconds. Conclusions: The results show agreement with values of the Young modulus estimated by authors (Ettema and Kuehn, 1994; Berry et al., 1999) undertaking finite element modeling of the palate. However, other modulus measurements based on closing pressure are considerably different. The spatial distribution of viscoelastic parameters across the palate shows good consistency.

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Yin, Ningbei, Lian Ma, and Zhenkang Zhang. "Bone Regeneration in the Hard Palate after Cleft Palate Surgery." Plastic and Reconstructive Surgery 115, no. 5 (April 2005): 1239–44. http://dx.doi.org/10.1097/01.prs.0000156777.99552.1d.

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Boo Chai, Khoo. "CLEFT PALATE." Plastic and Reconstructive Surgery 106, no. 6 (November 2000): 1441–42. http://dx.doi.org/10.1097/00006534-200011000-00059.

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Kosowski, Tomasz, William Weathers, Erik Wolfswinkel, and Emily Ridgway. "Cleft Palate." Seminars in Plastic Surgery 26, no. 04 (February 13, 2013): 164–69. http://dx.doi.org/10.1055/s-0033-1333883.

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Russell, Kathleen A., Victoria M. Allen, Mary E. MacDonald, Kirsten Smith, and Linda Dodds. "A Population-Based Evaluation of Antenatal Diagnosis of Orofacial Clefts." Cleft Palate-Craniofacial Journal 45, no. 2 (March 2008): 148–53. http://dx.doi.org/10.1597/06-202.1.

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Objectives: To evaluate the changes in prevalence and antenatal detection of cleft lip with or without cleft palate and isolated cleft palate and to describe the association between anomalies and rates of antenatal diagnosis in Nova Scotia from 1992 to 2002. Design: This population-based cohort study employed the Nova Scotia Atlee Perinatal Database, the Fetal Anomaly Database, and IWK Cleft Palate Database in Halifax, Nova Scotia, Canada. Outcome Measures: Cleft type, mode of diagnosis, and associated abnormalities of orofacial clefts for liveborn infants, stillbirths, and second trimester terminations of pregnancy between 1992 and 2002 were determined. Results: There were 225 fetuses identified as having orofacial clefts. The overall prevalence of clefts was 2.1 in 1000 live births, and this prevalence did not change with time. The overall antenatal detection of cleft lip with or without cleft palate was 23%; however, there was improvement in detection of cleft lip with or without cleft palate from the years 1992 to 1996 (14%) to the years 1997 to 2002 (30%, p = .02). No isolated cleft palates were detected antenatally. Associated structural anomalies were seen in 34.2% of cases with orofacial clefts, and chromosomal abnormalities were associated with 9.8%. Conclusions: The prevalence of orofacial clefts in Nova Scotia has not changed from 1992 to 2002. The proportion of antenatally diagnosed cleft lip with or without cleft palate in Nova Scotia is consistent with rates reported in the literature and has increased from 1992 to 2002.

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Rajendra, Nehete, Nehete Anita, Singla Nehete, and Sankalecha Sudhir. "Soft tissue chondroma of hard palate associated with cleft palate." Indian Journal of Plastic Surgery 45, no. 03 (September 2012): 550–52. http://dx.doi.org/10.4103/0970-0358.105974.

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ABSTRACTSoft tissue chondroma of palate is very rare. It has never been reported in a cleft palate patient. We report a case of 22-year-old male who came with asymptomatic swelling on the palate since birth, along with complete cleft of secondary palate. He had symptoms related to cleft palate only, i.e., nasal regurgitation and speech abnormalities. Swelling was excised and the cleft palate was repaired. Histopathological examination revealed chondroma of the palate. The patient had no recurrence after 2 years of follow-up.

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Kramer, Gem J. C., Jan B. Hoeksma, and Birte Prahl-Andersen. "Early Palatal Changes after Initial Palatal Surgery in Children with Cleft Lip and Palate." Cleft Palate-Craniofacial Journal 33, no. 2 (March 1996): 104–11. http://dx.doi.org/10.1597/1545-1569_1996_033_0104_epcaip_2.3.co_2.

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Early palatal growth and development after primary palatal closure was studied in children with different types of cleft lip and palate (CLP). Palatal dimensions were measured on dental casts taken at fixed ages, from 9 months to 4 years of age. The results showed that soft and hard palatal closure in one stage had a significant impeding influence on posterior sagittal palatal growth compared to closure of the soft palate only. Timing of surgery possibly had a small temporary restrictive effect on posterior transverse palatal growth and development. Type and severity of the oral cleft had a significant effect on transverse palatal development and anterior sagittal dimensions. Anterior arch width was reduced in children with a complete unilateral (U) CLP or bilateral (B) CLP. The palates of the latter children had consistently larger anterior arch depths. Compared to normal children, palates of cleft children changed anteriorly from wider at 9 months of age to narrower at 4 years of age. Arch depths were smaller in cleft children except for anterior arch depths in children with complete BCLP.

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Sitzman, Thomas J., Alexander C. Allori, Damir B. Matic, Stephen P. Beals, David M. Fisher, Thomas D. Samson, Jeffrey R. Marcus, and Raymond W. Tse. "Reliability of Oronasal Fistula Classification." Cleft Palate-Craniofacial Journal 55, no. 6 (February 22, 2018): 871–75. http://dx.doi.org/10.1597/16-186.

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Objective: Oronasal fistula is an important complication of cleft palate repair that is frequently used to evaluate surgical quality, yet reliability of fistula classification has never been examined. The objective of this study was to determine the reliability of oronasal fistula classification both within individual surgeons and between multiple surgeons. Design: Using intraoral photographs of children with repaired cleft palate, surgeons rated the location of palatal fistulae using the Pittsburgh Fistula Classification System. Intrarater and interrater reliability scores were calculated for each region of the palate. Participants: Eight cleft surgeons rated photographs obtained from 29 children. Results: Within individual surgeons reliability for each region of the Pittsburgh classification ranged from moderate to almost perfect (κ = .60-.96). By contrast, reliability between surgeons was lower, ranging from fair to substantial (κ = .23-.70). Between-surgeon reliability was lowest for the junction of the soft and hard palates (κ = .23). Within-surgeon and between-surgeon reliability were almost perfect for the more general classification of fistula in the secondary palate (κ = .95 and κ = .83, respectively). Conclusions: This is the first reliability study of fistula classification. We show that the Pittsburgh Fistula Classification System is reliable when used by an individual surgeon, but less reliable when used among multiple surgeons. Comparisons of fistula occurrence among surgeons may be subject to less bias if they use the more general classification of “presence or absence of fistula of the secondary palate” rather than the Pittsburgh Fistula Classification System.

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Kezirian, Eric J., Clemens Heiser, Armin Steffen, Maurits Boon, Benedikt Hofauer, Karl Doghramji, Joachim T. Maurer, et al. "Previous Surgery and Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea." Otolaryngology–Head and Neck Surgery 161, no. 5 (June 25, 2019): 897–903. http://dx.doi.org/10.1177/0194599819856339.

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Objective To examine whether previous palate or hypopharyngeal surgery was associated with efficacy of treatment of obstructive sleep apnea with hypoglossal nerve stimulation. Study Design Cohort (retrospective and prospective). Setting Eleven academic medical centers. Subjects and Methods Adults treated with hypoglossal nerve stimulation were enrolled in the ADHERE Registry. Outcomes were defined by the apnea-hypopnea index (AHI), in 3 ways: change in the AHI and 2 definitions of therapy response requiring ≥50% reduction in the AHI to a level <20 events/h (Response20) or 15 events/h (Response15). Previous palate and hypopharyngeal (tongue, epiglottis, or maxillofacial) procedures were documented. Linear and logistic regression examined the association between previous palate or hypopharyngeal surgery and outcomes, with adjustment for age, sex, and body mass index. Results The majority (73%, 217 of 299) had no previous palate or hypopharyngeal surgery, while 25% and 9% had previous palate or hypopharyngeal surgery, respectively, including 6% with previous palate and hypopharyngeal surgery. Baseline AHI (36.0 ± 15.6 events/h) decreased to 12.0 ± 13.3 at therapy titration ( P < .001) and 11.4 ± 12.6 at final follow-up ( P < .001). Any previous surgery, previous palate surgery, and previous hypopharyngeal surgery were not clearly associated with treatment response; for example, any previous surgery was associated with a 0.69 (95% CI: 0.37, 1.27) odds of response (Response20 measure) at therapy titration and a 0.55 (95% CI: 0.22, 1.34) odds of response (Response20 measure) at final follow-up. Conclusion Previous upper airway surgery was not clearly associated with efficacy of hypoglossal nerve stimulation.

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Masarei, A. G., A. Wade, M. Mars, B. C. Sommerlad, and D. Sell. "A Randomized Control Trial Investigating the Effect of Presurgical Orthopedics on Feeding in Infants with Cleft Lip and/or Palate." Cleft Palate-Craniofacial Journal 44, no. 2 (March 2007): 182–93. http://dx.doi.org/10.1597/05-184.1.

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Objective: To investigate the controversial assertion that presurgical orthopedics (PSO) facilitate feeding in infants with cleft lip and palate. Design: Randomized control trial of 34 infants with nonsyndromic complete unilateral cleft lip and palate and 16 with cleft of the soft and at least two thirds of the hard palate. Allocation to receive presurgical orthopedics or not used minimization for parity and gender. Other aspects of care were standardized. Setting: The North Thames Regional Cleft Centre. Main Outcome Measures: Measurements were made at 3 months of age (presurgery) and at 12 months of age (postsurgery). Primary outcomes were anthropometry and oral motor skills. Objective measures of sucking also were collected at 3 months using the Great Ormond Street Measure of Infant Feeding. Twenty-one infants also had videofluoroscopic assessment. Results: At 1 year, all infants had normal oral motor skills and no clear pattern of anthropometric differences emerged. For both cleft groups, infants randomized to presurgical orthopedics were, on average, shorter. The presurgical orthopedics infants were, on average, lighter in the unilateral cleft and lip palate group, but heavier in the isolated cleft palate group. Infants with complete unilateral cleft and lip palate randomized to presurgical orthopedics had lower average body mass index (mean difference PSO-No PSO: −0.45 (95% confidence interval [−1.78, 0.88]), this trend was reversed among infants with isolated cleft palates (mean difference PSO-No PSO: 1.98 [−0.95, 4.91]). None of the differences were statistically significant at either age. Conclusions: Presurgical orthopedics did not improve feeding efficiency or general body growth within the first year in either group of infants.

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Cohen, Steven R., Lynn L. Chen, Alphonse R. Burdi, and Carroll-Ann Trotman. "Patterns of Abnormal Myogenesis in Human Cleft Palates." Cleft Palate-Craniofacial Journal 29, no. 1 (January 1992): 345–50. http://dx.doi.org/10.1597/1545-1569_1992_029_0044_poamih_2.3.co_2.

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To test the hypothesis that soft palate muscles are abnormal in cleft palate, we compared soft palate morphogenesis in fetuses with cleft palate (n=4) to age-matched (n=3) and nonmatched (n=1) control specimens. The morphologic status of all soft palate and masticatory structures were classified into one of six stages based on the level of histogenesis. At 54 mm crown-rump length (CRL), the levator vell palatini (L), palatopharyngeus (PP), and palatoglossus (PG) in cleft subjects demonstrated mesenchymal condensation into myoblastic fields, lagging behind the control specimens (97 mm CRL), which displayed definitive fields of myoblasts and myotube formation. In the 175 mm and 225 mm cleft and the 170 mm and 192 mm control specimens, muscular morphology was similar and had reached its postnatal appearance for the tensor veli palatini (175 m only) and L, PP, PG (225 mm only). Muscle fiber directions were, however, disoriented and disorganized, especially close to the medial epithelial edge of the cleft. The levator veli palatini, could not be distinguished as a discrete muscle in the cleft specimens, and what we believed to be the PP and PG seemed “normal” at the level of light microscopy, but malpositioned in a superior direction. This preliminary study demonstrates for the first time that early myogenesis in cleft palates differs from normal.

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Cohen, Steven R., Lynn L. Chen, Alphonse R. Burdi, and Carroll-Ann Trotman. "Patterns of Abnormal Myogenesis in Human Cleft Palates." Cleft Palate-Craniofacial Journal 31, no. 5 (September 1994): 345–50. http://dx.doi.org/10.1597/1545-1569_1994_031_0345_poamih_2.3.co_2.

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To test the hypothesis that soft palate muscles are abnormal in cleft palate, we compared soft palate morphogenesis in fetuses with cleft palate (n=4) to age-matched (n=3) and nonmatched (n=1) control specimens. The morphologic status of all soft palate and masticatory structures were classified into one of six stages based on the level of histogenesis. At 54 mm crown-rump length (CRL), the levator veli palatini (L), palatopharyngeus (PP), and palatoglossus (PG) in cleft subjects demonstrated mesenchymal condensation into myoblastic fields, lagging behind the control specimens (97 mm CRL), which displayed definitive fields of myoblasts and myotube formation. In the 175 mm and 225 mm cleft and the 170 mm and 192 mm control specimens, muscular morphology was similar and had reached its postnatal appearance for the tensor veli palatini (175 m only) and L, PP, PG (225 mm only). Muscle fiber directions were, however, disoriented and disorganized, especially close to the medial epithelial edge of the cleft. The levator veli palatini, could not be distinguished as a discrete muscle in the cleft specimens, and what we believed to be the PP and PG seemed “normal” at the level of light microscopy, but malpositioned in a superior direction. This preliminary study demonstrates for the first time that early myogenesis in cleft palates differs from normal.

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Gardner, Edward, and John L. Dornhoffer. "Tympanoplasty Results in Patients with Cleft Palate: An Age- and Procedure-Matched Comparison of Preliminary Results with Patients without Cleft Palate." Otolaryngology–Head and Neck Surgery 126, no. 5 (May 2002): 518–23. http://dx.doi.org/10.1067/mhn.2002.124933.

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OBJECTIVE: Because of continued eustachian tube abnormalities, the presence of a cleft palate repair has been thought to be associated with poor outcomes after tympanoplastic surgery. However, little published data exist regarding the results of major otologic surgery in patients with cleft palate. The objective of this study was to review our results of otologic surgery in these patients and compare results with those of age- and procedure-matched controls. METHODS: Our otologic database was used to identify patients with a repaired cleft palate who underwent otologic surgery between March 1994 and December 1999. Two control patients were identified for each cleft palate patient. Results of hearing, graft take, and need for postoperative pressure-equalizing tubes were compared. RESULTS: No significant difference existed between patients with a repaired cleft palate and control patients with regard to postoperative air-bone gap ( P = 0.6805), graft survival rate ( P = 1.00), and need for postoperative intubation ( P = 0.457). CONCLUSION: Results in patients with cleft palate appear to be similar to those in patients without cleft palate.

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Smolec, O., D. Vnuk, J. Kos, N. Brkljaca Bottegaro, and B. Pirkic. "Repair of cleft palate in a calf using polypropylene mesh and palatal mucosal flap: a case report ." Veterinární Medicína 55, No. 11 (December 1, 2010): 566–70. http://dx.doi.org/10.17221/3015-vetmed.

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The soft palate plays a critical role in the oral and pharyngeal phases of swallowing. Congenitally cleft soft palates (palatoschisis) in calves are rare and pose a serious challenge for surgical correction due to high complication rates. The main obstacles to repairing palate defects are obtaining complicated access to the soft palate, and reducing the tension on the repair so that the sutures hold. A 21 day old female Simmental calf was submitted to our clinic with a history of frequent episodes of coughing and milk dripping from its nostrils after suckling. After clinical examination, a congenital cleft palate was diagnosed. Surgery was performed under general anaesthesia. First, lateral buccotomy was performed to improve the intraoral approach. The palatal defect was repaired using polypropylene mesh and palatal mucosal flap. An oesophageal tube was placed and anchored to the skin using a Chinese finger trap suture technique. Antibiotic treatment was continued through seven days and a transoesophageal feeding tube was fitted at the end of the surgery allowing the calf to be fed with milk during the postoperative period. Postoperatively, the caudal aspect of the repair broke down resulting in persistent mild bilateral nasal discharge. A combination of the two described techniques can be a good option for resolving palatal defects. However, adequate exposure and repair are still difficult to achieve and these approaches often result in serious postoperative complications.

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Larossa, Don. "The State of the Art in Cleft Palate Surgery." Cleft Palate-Craniofacial Journal 37, no. 3 (May 2000): 225–28. http://dx.doi.org/10.1597/1545-1569_2000_037_0225_tsotai_2.3.co_2.

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Overview This update focuses on current practices and controversies in surgical repair of the hard and soft palate posterior to the alveolus. Our current understanding of the advantages and disadvantages of presurgical active and passive manipulation of the hard palate shelves including the use of periosteoplasty is reviewed. The evolution of the multiple methods of repair of the hard and soft palate is given in a historical context along with a discussion of the concerns about timing of palate repair.

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Razzell, R. "Cleft palate." British Journal of Plastic Surgery 42, no. 3 (May 1989): 369. http://dx.doi.org/10.1016/0007-1226(89)90190-2.

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Smith, Darren M., Lisa Vecchione, Shao Jiang, Matthew Ford, Frederic W. B. Deleyiannis, Mary Ann Haralam, Sanjay Naran, et al. "The Pittsburgh Fistula Classification System: A Standardized Scheme for the Description of Palatal Fistulas." Cleft Palate-Craniofacial Journal 44, no. 6 (November 2007): 590–94. http://dx.doi.org/10.1597/06-204.1.

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Objective: Vague terminology is a problem in cleft palate research. No classification scheme for palatal fistulas has been proposed to date. Although a well-healed velum is a significant outcome of palatoplasty, it is nearly impossible to compare fistula-related palatoplasty results in the literature or in medical records without a standardized vocabulary. We endeavor to devise a palatal fistula classification system that may have clinical and research applicability. Design: PubMed was searched for definitions and classifications of palatal fistula as well as incidence and recurrence rates of this outcome. Next, a 25-year retrospective review of our Cleft Center's records was performed, and fistulas were identified (n = 641 charts reviewed). The fistula descriptions yielded by this chart review were evaluated in the context of anatomical descriptions in the literature, and a clinician-friendly classification scheme was designed. Results: A literature review failed to reveal a standardized fistula classification system. An anatomically based numerical fistula classification system was devised: type I, bifid uvula; type II, soft palate; type III, junction of the soft and hard palate; type IV, hard palate; type V, junction of the primary and secondary palates (for Veau IV clefts); type VI, lingual alveolar; and type VII, labial alveolar. Conclusions: We propose a standardized numerical classification system for palatal fistulas. Its clinical adoption may prospectively clarify ambiguities in the literature and facilitate future cleft palate research and clinical practice.

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TALĂ, Sorin, Dan Mircea ENESCU, and Mircea ANDRIESCU. "An assessment of isolated cleft palate impact on weight gain in preoperative period." Romanian Journal of Medical Practice 11, no. 1 (March 31, 2016): 72–75. http://dx.doi.org/10.37897/rjmp.2016.1.14.

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Objective. Impact assessment of cleft palate only on weight gain in children who did not receive surgery yet. Methods. This paper is a synthesis of a retrospective study conducted during 2005-2008 on 21 patients with cleft palate only and operated in Pediatric Surgery and Plastic Surgery Clinics of „Grigore Alexandrescu“ Emergency Children’s Hospital, Bucharest, taking into account patients’ sex, age and weight in the time of surgery and cleft palate type. Results. This study shows that most patients with cleft palate only who didn’t performed reconstructive surgery have low weight compared with the weight for age growth standards. Thus, 38.09% of patients were under p25 percentile weight curve. The trend is more visible in females: 36.36% of girls’ weight, compared to 27.27% of boys’ weight, is located below this line. Cleft palate type directly correlates with the degree of malnutrition in these patients: 87.5% of children with complete cleft palate showed preoperative weight beneath p25. Conclusions. Cleft palate only children have a weight lower than the average weight for age in preoperative period, a finding that reinforces the need for surgery of this malformation. The study also highlights the importance of closely monitoring the weight of these patients before reparative surgery in order to improve the outcomes.

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Lehman, James A., Jefrey R. A. Fishman, and Gary S. Neiman. "Treatment of Cleft Palate Associated with Robin Sequence: Appraisal of Risk Factors." Cleft Palate-Craniofacial Journal 32, no. 1 (January 1995): 25–29. http://dx.doi.org/10.1597/1545-1569_1995_032_0025_tocpaw_2.3.co_2.

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Mandibular hypoplasia, airway obstruction, and a typical wide U-shaped cleft palate comprise the Robin sequence. Although much has been written regarding the treatment of these patients in the neonatal period, the literature reveals little information regarding later care of the cleft palate in these patients. The purpose of this study is to examine patients with the Robin sequence and evaluate the risk of postsurgical problems and outcome related to the neonatal period. Thirty-six patients with the Robin sequence presenting from 1972 through 1990 were reviewed. A majority of patients had feeding and respiratory difficulties, to varying degrees, following birth. These problems were treated successfully by maneuvers ranging from positioning to two infants who eventually required tracheostomy. Thirty-four patients had palate repair. Age at repair averaged 16.2 months, and one third of patients had associated anomalies. Infants who experienced problems following palatoplasty were those who had histories of severe difficulties and complications in the early months of life. In addition, patients with associated congenital anomalies had significantly more problems at the time of palate repair than those without anomalies. Those patients with the Robin sequence, who historically had minimal difficulty following birth, experienced few complications at the time of palate repair. Of the 34 patients with repaired palates, 23 demonstrated sufficient follow-up to allow for evaluation of speech outcome. Satisfactory or normal speech production was noted in 65.4%. This is not significantly different from that observed in all patients undergoing cleft palate repair during this same time period (74.9%). Secondary pharyngoplasty procedures were required in 17.4%. An overall complication rate of 29.4% was noted with palatal fistula occurring in 11.8%. Examination of an infant's immediate postnatal period, as well as for the presence of associated anomalies, will provide important predictive information on the potential difficulties following cleft palate repair. In addition, palatoplasty, as part of the overall team approach to the cleft patient, results in a satisfactory speech outcome in approximately two thirds of patients with the Robin sequence.

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Sommerlad, Brian C., Christopher Fenn, Kim Harland, Debbie Sell, Malcolm J. Birch, Rupa Dave, Melissa Lees, and Adrian Barnett. "Submucous Cleft Palate: A Grading System and Review of 40 Consecutive Submucous Cleft Palate Repairs." Cleft Palate-Craniofacial Journal 41, no. 2 (March 2004): 114–23. http://dx.doi.org/10.1597/02-102.

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Objective This study was designed to determine whether velar surgery was worthwhile for submucous cleft palate (SMCP) and evaluate whether results were dependent on the degree of the anatomical abnormality. Design A prospective study of a consecutive series of patients fulfilling the entry criteria, assessed blindly from records arranged randomly. Patients Fifty-eight patients diagnosed with SMCP and operated on by a single surgeon between June 1991 and April 1997 were reviewed. Forty patients fulfilled the entry criteria. Minimum follow-up was 6 years. Interventions Radical reconstruction of the soft palate musculature was performed by one surgeon using the operating microscope. A scoring system was devised for grading the anatomical severity of submucous cleft (SMCP score). Main Outcome Measures Postoperative hypernasality and nasal emission scores and the degrees of improvement were considered the primary outcome measures, and the degree of velopharyngeal closure was also assessed. Results There were highly significant improvements in hypernasality, nasal emission, and velopharyngeal closure. A preoperative gap size of more than 13 mm was associated with less satisfactory outcomes, but gap size was not predictive of improvement. Severity of the SMCP did not correlate with the degree of preoperative speech abnormality but was a significant predictor of outcome of surgery, with the less severe (total SMCP score of 0 to 3) having less satisfactory end results and lesser degrees of improvement. Patients with less abnormal muscle anatomy had lesser degrees of improvement. Conclusion Repair of the muscle abnormality in SMCP is recommended as the first line of treatment in most cases.

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Kalisya, Luc Malemo, Jacques Fadhili Bake, Bake Elisee, Kavira Nyavandu, Robert Perry, David H. Rothstein, and Sarah B. Cairo. "Surgical Repair of Orofacial Clefts in North Kivu Province of Eastern Democratic Republic of Congo (DRC)." Cleft Palate-Craniofacial Journal 57, no. 11 (August 13, 2020): 1314–19. http://dx.doi.org/10.1177/1055665620947604.

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Background: There is a high prevalence of orofacial clefts in low- and middle-income countries with significant unmet need, despite having 50% of the population younger than 18 years in countries such as the Democratic Republic of Congo (DRC). The purpose of this article is to report on the experience of general surgeons with orofacial clefts at a single institution. Methods: This is a retrospective study of patients treated for cleft lip/palate in the province of North Kivu, DRC between 2008 and 2017. Results: A total of 1112 procedures (122/year) were performed. All procedures were performed by general surgeons following training by an international nongovernmental aid organization. A total of 59.2% of patients were male and the median age was 3.4 years (interquartile range: 0.7-13 years). Average distance from surgical center to patient location was 242.6 km (range: 2-1375 km) with outreach performed for distances >200 kms. A majority (82.1%) of patients received general anesthesia (GA) with significant differences in use of GA, age, weight, and length of stay by major orofacial cleft category. Of the 1112 patients, 86.1% were reported to have cleft lip alone, 10.5% had cleft lip and palate, and 3.4% cleft palate alone. Despite this, only 5.3% of patients underwent surgical repair of cleft palate. Conclusions: Multiple factors including malnutrition, risk of bleeding, procedural complexity, and cosmetic results may contribute to the distribution of procedures performed where most cleft palates are not treated. Based on previously published estimates, unmet needs and social burden of cleft lip and palate are high in the DRC.

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Cohen, Steven R., Joseph Kalinowski, Don LaRossa, and Peter Randall. "Cleft Palate Fistulas." Plastic and Reconstructive Surgery 87, no. 6 (June 1991): 1041–47. http://dx.doi.org/10.1097/00006534-199106000-00005.

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Moss, A. L. H. "SUBMUCOUS CLEFT PALATE." Plastic and Reconstructive Surgery 84, no. 3 (September 1989): 545. http://dx.doi.org/10.1097/00006534-198909000-00046.

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Journal articles on the topic 'Palate - Surgery'

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