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1

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 (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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2

Taney, Kendall. "Secondary Cleft Palate Repair." Journal of Veterinary Dentistry 25, no. 2 (2008): 150–53. http://dx.doi.org/10.1177/089875640802500220.

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3

Oliveira, Giovanna Carolina Rothert de, Rafael Ricardo Huppes, and Ivan Torres Gregorio da Silva. "Secondary cleft palate correction with 3D-printed thermoplastic polyurethane film – a case report." Acta Scientiarum. Animal Sciences 46 (August 16, 2024): e67125. http://dx.doi.org/10.4025/actascianimsci.v46i1.67125.

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Cleft palate is an oronasal communication that can affect the area comprehending the lips and the soft palate. Its clinical signs vary depending on the degree of the defect and the age of the animal, ranging from nasal secretion, coughing, sneezing, halitosis, respiratory difficulty, aspiration pneumonia, and loss of body condition. Its diagnosis is based on inspection of the oral cavity and imaging tests. Palatal defects must be surgically corrected as quickly as possible, using mucosal flaps, grafts, or implants. A desire to evolve alternative treatments for cleft palates drives the search for ways to manufacture customized pieces. 3D printing and biomaterials have enhanced in detail and applicability; combined with design tools and imaging exams, they allow for the making of precise implants and anatomical models for the planning and execution of surgical procedures. This report describes the case of a female, mixed-breed feline treated at a veterinary clinic; it was diagnosed with secondary cleft palate, had a history of falling, and underwent previous palatoplasties with recurrence. A surgical reintervention was performed to implant a 3D-printed TPU film to close its secondary cleft palate.
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4

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 (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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5

Banks, P. "Secondary bone grafts (alveolus, palate)." British Journal of Plastic Surgery 42, no. 3 (1989): 353–54. http://dx.doi.org/10.1016/0007-1226(89)90165-3.

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6

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 (2014): 301–9. http://dx.doi.org/10.1016/j.cps.2013.12.008.

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7

Sitzman, Thomas J., Alexander C. Allori, Damir B. Matic, et al. "Reliability of Oronasal Fistula Classification." Cleft Palate-Craniofacial Journal 55, no. 6 (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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8

Sasaki, Y., S. Tanaka, T. Hamachi, and Y. Taya. "Deficient Cell Proliferation in Palatal Shelf Mesenchyme of CL/Fr Mouse Embryos." Journal of Dental Research 83, no. 10 (2004): 797–801. http://dx.doi.org/10.1177/154405910408301012.

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How secondary palate formation is affected in the cleft lip genotype remains poorly understood. The purpose of this study was to analyze regional patterns of cell proliferation in CL/Fr mouse embryos with or without cleft lip. Pairs of palatal shelves were dissected at E13.5 from CL/Fr normal embryos (CL/Fr-N), CL/Fr embryos with bilateral cleft lip (CL/Fr-BCL), and a control strain of C57BL embryos (C57BL). The explants were examined histologically after 48 hrs of organ culture. Cell kinetics for proliferation in the palatal shelves was examined at E13.5 by the bromodeoxyuridine method in vivo. The CL/Fr-BCL palates fused as well as the CL/Fr-N palates in vitro. There were inter-group differences in the absolute number of BrdU-positive cells and the ratio of positive/(positive+negative) cells in the palate’s mesenchyme (C57BL > CL/Fr-N > CL/Fr-BCL) and epithelium (C57BL > CL/Fr-N = CL/Fr-BCL). These findings indicate that a cleft palate follows reduced cell proliferation of secondary palatal mesenchyme in CL/Fr mice.
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9

Gregg, Terry, Dorothy Boyd, and Andrew Richardson. "The Incidence of Cleft Lip and Palate in Northern Ireland from 1980–1990." British Journal of Orthodontics 21, no. 4 (1994): 387–92. http://dx.doi.org/10.1179/bjo.21.4.387.

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This study reports the incidence of the various types of cleft lip and/or palate drawn from a regional database of all affected children born in Northern Ireland during the period 1980–1990. The incidence of these anomalies was 1·28 per 1000 live births (1:781). Fifty-three per cent of clefts involved the secondary palate only, 16 per cent the primary palate only, 26 per cent involved both primary and secondary palate, and 5 per cent were unconnected. Overall, more males than females were affected and there were more males than females in the group having complete clefts. Separate clefts of lip and palate occurred exclusively in males with only one exception. Unilateral clefts were more common on the left side. Within the group showing complete unilateral cleft of the primary and secondary palate, left-sided clefts were more commonly male, right-sided clefts were more commonly female. There were no statistically significant sex differences between sides in the unilateral primary palate cleft group.
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10

Liu, Jia, Jing Chen, Dong Yuan, et al. "Dynamic mRNA Expression Analysis of the Secondary Palatal Morphogenesis in Miniature Pigs." International Journal of Molecular Sciences 20, no. 17 (2019): 4284. http://dx.doi.org/10.3390/ijms20174284.

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Normal mammalian palatogenesis is a complex process that requires the occurrence of a tightly regulated series of specific and sequentially regulated cellular events. Cleft lip/palate (CLP), the most frequent craniofacial malformation birth defects, may occur if any of these events undergo abnormal interference. Such defects not only affect the patients, but also pose a financial risk for the families. In our recent study, the miniature pig was shown to be a valuable alternative large animal model for exploring human palate development by histology. However, few reports exist in the literature to document gene expression and function during swine palatogenesis. To better understand the genetic regulation of palate development, an mRNA expression profiling analysis was performed on miniature pigs, Sus scrofa. Five key developmental stages of miniature pigs from embryonic days (E) 30–50 were selected for transcriptome sequencing. Gene expression profiles in different palate development stages of miniature pigs were identified. Nine hundred twenty significant differentially expressed genes were identified, and the functional characteristics of these genes were determined by gene ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. Some of these genes were associated with HH (hedgehog), WNT (wingless-type mouse mammary tumor virus integration site family), and MAPK (mitogen-activated protein kinase) signaling, etc., which were shown in the literature to affect palate development, while some genes, such as HIP (hedgehog interacting protein), WNT16, MAPK10, and LAMC2 (laminin subunit gamma 2), were additions to the current understanding of palate development. The present study provided a comprehensive analysis for understanding the dynamic gene regulation during palate development and provided potential ideas and resources to further study normal palate development and the etiology of cleft palate.
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11

Merry, AJ, CS Potten, and Mwj Ferguson. "Cell Proliferation during Secondary Palate Development." Clinical Science 87, s31 (1994): 40P—41P. http://dx.doi.org/10.1042/cs045040pc_pt2.

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12

Gritli-Linde, Amel. "Molecular control of secondary palate development." Developmental Biology 301, no. 2 (2007): 309–26. http://dx.doi.org/10.1016/j.ydbio.2006.07.042.

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13

Logan, Shaun M., L. Bruno Ruest, M. Douglas Benson, and Kathy K. H. Svoboda. "Extracellular Matrix in Secondary Palate Development." Anatomical Record 303, no. 6 (2019): 1543–56. http://dx.doi.org/10.1002/ar.24263.

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14

Bulleit, Robert F., and Ernest F. Zimmerman. "The effect of reducing ATP levels on reorientation of the secondary palate." Development 93, no. 1 (1986): 73–84. http://dx.doi.org/10.1242/dev.93.1.73.

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The force for directing palate shelf reorientation appears to be associated with elements of the presumptive hard palate (Brinkley & Vickerman, 1979; Bulleit & Zimmerman, 1985). The palatal elements that mediate this process do not require palate cells to be metabolically active for expression of the force. This contention was demonstrated using an in vitro system that allows substantial reorientation of the hard palate to occur. ATP levels were reduced by treatment with metabolic inhibitors and the degree of reorientation was measured 1 h following pretreatment with inhibitors. Treatment of cultured embryonic heads under anoxic conditions with 2,4-dinitrophenol or KCN had noeffect on the degree of reorientation occurring in vitro. These agents reduced ATP levels by 71 % and 62 %, respectively. Treatment of cultured heads with 2-deoxy-D-glucose under anoxia also had no effect on reorientation. This treatment reduced ATP levels in embryonic heads by 92–94%. A similar reduction was observed if ATP levels were measured in palate tissue alone. The treatment of cultured heads with 2-deoxy-D-glucose and anoxia not only reduced levels of ATP but also reduced CTP, GTP and UTP. These results indicate that palate shelf reorientation is independent of cellular metabolic activity and supports the hypothesis that reorientation is dependent on a pre-existing infrastructure within the palate shelves.
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15

Deshmukh, Mazin M., and Gaurav Deshpande. "Musculomucosal Flap: A Technique for Correction of Velopharyngeal Insufficiency by Palate Lengthening." Journal of Contemporary Dentistry 7, no. 3 (2017): 174–77. http://dx.doi.org/10.5005/jp-journals-10031-1209.

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ABSTRACT A small but significant percentage of patients have inadequate velopharyngeal closure, or secondary velopharyngeal incompetence, following primary palatoplasty. The use of the buccinator musculomucosal (MM) flap has been described for both primary palate repair with lengthening and secondary palate lengthening for the correction of insufficient velopharyngeal closure. The MM flap was first described in 1969 for the primary repair of a wide cleft palate by Mukherji, and it was Bozola et al in 1989 who first formally described it and gave first description of its anatomy. The first report on its use to lengthen the palate in secondary velopharyngeal insufficiency (VPI) was published by Hill et al in 1999. This case report presents a patient who had correction of secondary velopharyngeal incompetence using bilateral buccinator MM flaps used as a sandwich and also gives a brief review of the literature regarding its application in cases of secondary VPI. How to cite this article Deshmukh MM, Deshpande G. Musculomucosal Flap: A Technique for Correction of Velopharyngeal Insufficiency by Palate Lengthening. J Contemp Dent 2017;7(3):174-177.
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16

Dhulipala, Vamsidhara C., Wade V. Welshons, and Chada S. Reddy. "Cell cycle proteins in normal and chemically induced abnormal secondary palate development: a review." Human & Experimental Toxicology 25, no. 11 (2006): 675–82. http://dx.doi.org/10.1177/0960327106070848.

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Cell cycle progression and thus proper cell number is essential for normal development of organs and organisms. Craniofacial tissues including the secondary palate are vulnerable to disruption of cell cycle progression and proliferation by many chemicals including mycotoxin, secalonic acid D (SAD), glucocorticoids, retinoic acid and 2,3,7,8-tetrachlorodibenzodioxin. Induction of cleft palate (CP) by SAD in mice occurs from a reduction in the size of developing palatal shelves. This is associated with an inhibition of proliferation of murine and human embryonic palatal mesenchymal (MEPM and HEPM) cells as well as a G1/S block of cell cycle. In murine embryonic palates and HEPM cells, SAD inhibited G1/S-phase-specific cyclin-dependent kinase (CDK)2 activity, reduced the level of cyclin E and increased the level of the CDK2 inhibitor, p21. These results, together with those from other laboratories, suggest that common cell cycle protein targets (biomarkers), relevant to the pathogenesis of CP by multiple chemical exposures, that can form the basis for the diagnosis and the development of preventive strategies, are likely to exist.
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17

Abdulai, E. R., K. K. Baidoo, A. A. Jangu, K. Searyoh, and Y. Ahonon. "Assessment Of Hearing Threshold Among Post Repaired Cleft Palate Patients In Korle-Bu Teaching Hospital, Ghana." Postgraduate Medical Journal of Ghana 9, no. 2 (2022): 82–89. http://dx.doi.org/10.60014/pmjg.v9i2.231.

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Objective: The aim of the study was to assess the hearing threshold in patients with repaired cleft palate and to determine the degree of hearing loss in various types of cleft palate.Methods: This was a cross-sectional study which was conducted on 97 consenting patients with clinical diagnosis of repaired cleft palate at the Plastic and Reconstructive surgery unit, Korle Bu Teaching Hospital. The hearing loss threshold levels in the rightand left cleft palates were then compared using Chisquare test of independence.Results: A total of 97 participants who had cleft palate were seen that is 194 ears were examined. Most of patients had cleft of secondary palate (n=65, 67.0%), only one participant had cleft of primary palate only (1.0%) and the rest had cleft of both primary andsecondary palate (n=31, 32.0%). The age range of patients in this study was between the ages of 6 years to 12 years with a mean (±SD) age of 7.43 (3.85) and the male to female ratio was 1:1. Out of the total ear examined, 76 were mild conductive hearing loss and 95 ears had abnormal tympanogram. The overall prevalence rate for the abnormal tympanograms (B, C1, C2) in both ears is 49%. Therewas no statistically significant association between the level of hearing loss and the type of cleft palate for the left ear and the right ear respectively as well as the association between the type of tympanogram and the type of cleft palate for the left ear and the right ear respectively (p>0.05).Conclusion: Prevalence rate of hearing loss among post repaired cleft palate subjects is 33%. This hearing loss is usually mild conductive hearing loss only. Mild conductive hearing loss and abnormal tympanogram was common between the ages of 6-8yearsirrespective of the type of cleft palate.
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Risandy, Ditia Widhani, Jilvientasia, Utami Gladya, et al. "The Evaluation of Hospital Social Responsibility Services in Gatot Soebroto Indonesia Central Army Hospital in 2015 – 2019 of Cleft Lip and Palate Patients." International Journal Of Medical Science And Clinical Research Studies 02, no. 11 (2022): 1346–50. https://doi.org/10.5281/zenodo.7354951.

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<strong>Background :&nbsp;</strong>Cleft lip and cleft palate are the most common congenital craniofacial anomalies treated by plastic surgeons. The incidence of cleft lip and palate is higher at lower socioeconomic levels. Hospital Social Responsibility (HSR) in Gatot Soebroto Central Army Hospital provides free cleft lip and palate surgeries to those who need it the most. The HSR services still need to be evaluated, to get an overview of epidemiologic profile of cleft lip and palate patients, and to improve the services itself. &nbsp; <strong>Materials and Method:&nbsp;</strong>The authors conducted a retrospective descriptive study based on online data of Smile Train HSR RSPAD Cleft Center from period of January 2015 to December 2019. All patients presented with cleft lip and/or palate were included. &nbsp; <strong>Results :&nbsp;</strong>Of all 713 patients in total; The gender distribution male 62.2% (444/713) was higher than female 37.7% (269/713). Most of the patients came from Java Island 77.5% (553/713). 685 were primary surgeries, 28 secondary surgeries. Among the primary surgeries, lip repair has the highest numbers 71.6% (491/685), followed by palate repair 27.2% (187/685), and alveolar bone grafting 1% (7/685). The most widely used surgical technique in lip surgery was the Millard 50% (345/685), while the most widely used surgical technique in palate surgery was the Bardach technique&nbsp; 22.9% (157/685). The median age for the primary lip repair patients was 1 year (range, 3 months to 60 years), and the median age for the primary palate repair patients was 4 year (range, 7 months to 26 years). Among secondary surgeries, lip revision with Millard technique was the highest (82.1%), followed by scar revision 3.57%, fistula repair (7.1%). The most common diagnosis was unilateral cleft lip (left 34.4%, right 13.2%) and followed by complete cleft palate (22.7%) &nbsp; <strong>Conclusion</strong>&nbsp;: Male patients were more dominant than females. The most common diagnosis was unilateral cleft lip. Incomplete diagnostic data and clinical photos of patients make it difficult to determine the complete diagnose of cleft lip and palate.
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19

Oberoi, Snehlata, Radhika Chigurupati, Pawandeep Gill, William Y. Hoffman, and Karin Vargervik. "Volumetric Assessment of Secondary Alveolar Bone Grafting Using Cone Beam Computed Tomography." Cleft Palate-Craniofacial Journal 46, no. 5 (2009): 503–11. http://dx.doi.org/10.1597/08-153.1.

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Objective: To assess the radiographic outcome of secondary alveolar bone grafting in individuals with nonsyndromic unilateral or bilateral cleft lip and palate using cone beam computed tomography. Methods: This prospective study was conducted at the University of California at San Francisco Center for Craniofacial Anomalies on 21 consecutive nonsyndromic complete cleft lip and palate individuals between 8 and 12 years of age who required alveolar bone grafting. Seventeen unilateral and four bilateral cleft lip and palate individuals had preoperative and postoperative cone beam computed tomography scans that were analyzed using Amira 3.1.1 software. Results: The average volume of the preoperative alveolar cleft defect in unilateral cleft lip and palate was 0.61 cm3, and the combined average volume of the right and left alveolar cleft defects in bilateral cleft lip and palate was 0.82 cm3. The average percentage bone fill in both unilateral cleft lip and palate and bilateral cleft lip and palate was 84%. The outcome of alveolar bone grafting was assessed in relation to (1) type of cleft, (2) size of preoperative cleft defect, (3) presence or absence of lateral incisor, (4) root development stage of the maxillary canine on the cleft side, (5) timing, and (6) surgeon. None of these parameters significantly influenced the radiographic outcome of alveolar bone grafting. Conclusions: Secondary alveolar bone grafting of the cleft defect in our center was successful, based on radiographic outcome using cone beam computed tomography scans. Volume rendering using cone beam computed tomography and Amira software is a reproducible and practical method to assess the preoperative alveolar cleft volume and the adequacy of bone fill postoperatively.
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20

Thorley, DS, AR Simons, O. Mirza, and V. Malik. "Palatal and retropharyngeal injury secondary to intubation using the GlideScope® video laryngoscope." Annals of The Royal College of Surgeons of England 97, no. 4 (2015): e67-e69. http://dx.doi.org/10.1308/003588415x14181254789727.

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Introduction There are few reports of injury to the soft palate and retropharynx sustained during intubation with the GlideScope® video laryngoscope. Most reports are of isolated injury to the soft palate. Case History We describe a patient in whom the retropharynx was injured but the extent of the injury was not observed initially. The patient did not suffer severe sequelae from this injury. However, this injury can cause serious sequelae if it is not recognised (eg development of a retropharyngeal abscess). Conclusions We recommend that any patient who sustains injury to the soft palate during intubation (particularly if the endotracheal tube passes through the soft palate) should be reviewed an otolaryngologist before removal of the endotracheal tube.
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21

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 (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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Mitic, Vladimir, Marina Jonovic, Nadica Mitic, et al. "Incidence of lip and palate clefts in children in Nis from 1990 to 2007." Srpski arhiv za celokupno lekarstvo 139, no. 5-6 (2011): 298–303. http://dx.doi.org/10.2298/sarh1106298m.

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Introduction. Cleft lip and palate is a complex congenital anomaly of the orofacial system in children. Objective. The aim of this study was to determine the incidence of live-born children with cleft lip and/or palate compared to the total number of children born in the period from January 1, 1990 to December 31, 2007. Methods. Epidemiological investigation was based on the records of live-born children at the Hospital of Gynaecology and Obstetrics of the Clinical Centre Nis. The study included 61,116 live-born children, i.e. 56,905 full-term babies. Results. The total number of registered clefts during the investigation period was 43 (22 boys and 21 girls). The most frequent were the secondary palate clefts (44.2%); combined clefts were present in 34.9%, while primary palate clefts were reported in 20.9%. In respect to the season and order of birth, there was no statistically significant difference in the frequency of the primary, secondary and complete palate clefts. The age of mothers was not identified as a risk factor for the occurrence of cleft lip and palate. Conclusion. In the studied period, 43 children were born with the cleft lip and/or palate, equally in boys as in girls. The secondary palate clefts were most frequent. The season and order of birth had no statistical influence on the occurrence of this anomaly.
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Goodwin, A. F., C. P. Chen, N. T. Vo, J. O. Bush, and O. D. Klein. "YAP/TAZ Regulate Elevation and Bone Formation of the Mouse Secondary Palate." Journal of Dental Research 99, no. 12 (2020): 1387–96. http://dx.doi.org/10.1177/0022034520935372.

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Clefting of the secondary palate is one of the most common congenital anomalies, and the multiple corrective surgeries that individuals with isolated cleft palate undergo are associated with major costs and morbidities. Secondary palate development is a complex, multistep process that includes the elevation of the palatal shelves from a vertical to horizontal position, a process that is not well understood. The Hippo signaling cascade is a mechanosensory pathway that regulates morphogenesis, homeostasis, and regeneration by controlling cell proliferation, apoptosis, and differentiation, primarily via negative regulation of the downstream effectors, Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ). We deleted Yap/ Taz throughout the palatal shelf mesenchyme as well as specifically in the posterior palatal shelf mesenchyme, using the Osr2Cre and Col2Cre drivers, respectively, which resulted in palatal shelf elevation delay and clefting of the secondary palate. In addition, the deletion resulted in undersized bones of the secondary palate. We next determined downstream targets of YAP/TAZ in the posterior palatal shelves, which included Ibsp and Phex, genes involved in mineralization, and Loxl4, which encodes a lysyl oxidase that catalyzes collagen crosslinking. Ibsp, Phex, and Loxl4 were expressed at decreased levels in the ossification region in the posterior palatal shelf mesenchyme upon deletion of Yap/ Taz. Furthermore, collagen levels were decreased specifically in the same region prior to elevation. Thus, our data suggest that YAP/TAZ may regulate collagen crosslinking in the palatal shelf mesenchyme, thus controlling palatal shelf elevation, as well as mineralization of the bones of the secondary palate.
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Warner, Dennis R., Partha Mukhopadhyay, Cindy L. Webb, Robert M. Greene, and M. Michele Pisano. "Chromatin immunoprecipitation-promoter microarray identification of genes regulated by PRDM16 in murine embryonic palate mesenchymal cells." Experimental Biology and Medicine 237, no. 4 (2012): 387–94. http://dx.doi.org/10.1258/ebm.2012.011258.

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The transcription factor PRDM16 regulates differentiation of brown adipocyte tissue in mice. Recently, however, it has been demonstrated that genetic knockout of Prdm16 in mice leads to a complete cleft of the secondary palate in offspring. To identify genes whose promoters bind PRDM16 in mouse embryonic palate/maxillary mesenchymal cells, we have conducted a chromatin immunoprecipitation-promoter microarray analysis (ChIP-Chip). One hundred and twenty-two gene promoters were identified as capable of binding PRDM16. These could be functionally grouped to include those on genes linked to muscle development, chondrogenesis and osteogenesis, in addition to many transcription factors. These results suggest that PRDM16 may play a role in differentiation of mesenchymal cells in the embryonic secondary palate that contribute to the anterior, bony palate and posterior, muscular palate.
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25

Bulleit, Robert F., and Ernest F. Zimmerman. "The influence of the epithelium on palate shelf reorientation." Development 88, no. 1 (1985): 265–79. http://dx.doi.org/10.1242/dev.88.1.265.

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The intrinsic forces necessary for directing the reorientation of the secondary palate appear to reside in the anterior two thirds of the palate or presumptive hard palate. The hard palate could reorient regardless of whether it was intact or separated from the posterior third or presumptive soft palate. The soft palate could only reorient if the palate shelves are left intact. These intrinsic forces, within the hard palate, may be mediated by the mesenchymal cells, their extracellular matrix, or the epithelium surrounding the shelves. This latter possibly was tested by removing the epithelium, from either the presumptive oral or nasal surface followed by measurement of reorientation in vitro. Only after removal of the oral epithelium was a significant inhibition in reorientation observed. The treatment used to remove the epithelium, EDTA and scraping, was shown to remove 41 % of the oral epithelium leaving the majority of the basement membrane intact. The observed inhibition of reorientation did not appear to be a consequence of wound healing. Creation of wounds twice the area that was observed after treatment with EDTA and scraping inhibited reorientation minimally. These results suggest that the epithelium and particularly the anterior oral epithelium plays a major role in the reorientation of the murine secondary palate.
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26

Brinkley, Linda L., and Fred L. Bookstein. "Cell distribution during mouse secondary palate closure." Development 96, no. 1 (1986): 111–30. http://dx.doi.org/10.1242/dev.96.1.111.

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The patterns of distribution of both total mesenchymal cells and the ratios of [3H]thymidinelabelled to total cells were mapped during secondary palatal shelf reorientation in vivo and in vitro. Smoothed spatial averaging, a computer-assisted method which takes into account the positions of all cells across an entire histological section of the shelf, was employed. Changes in shelf cross-sectional area and cell size were also measured. Three shelf regions, anterior and posterior presumptive hard and presumptive soft palate, were studied at developmental stages which were 30, 24 and 18 h prior to expected in vivo elevation, after in vivo reorientation and during the course of in vitro reorientation. Region-specific patterns of cell distribution change with shelf reorientation. These changes were observable within 6 h. Increases in cell number by cell division may enhance some high local cell densities, but cannot account for decreases in cell density. Increase in cell size is not a factor in decreasing cell density, nor is cell death. Displacement of cells by expansion of the extracellular matrix may be involved.
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SHAH, RAVINDRA M., DWAYNE M. OGASAWARA, and KIMBERLY M. CHENG. "Embryogenesis of the Secondary Palate in Pigeons." Poultry Science 67, no. 6 (1988): 865–70. http://dx.doi.org/10.3382/ps.0670865.

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28

Seelan, R. S., P. Mukhopadhyay, M. M. Pisano, and R. M. Greene. "Developmental Epigenetics of the Murine Secondary Palate." ILAR Journal 53, no. 3-4 (2012): 240–52. http://dx.doi.org/10.1093/ilar.53.3-4.240.

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29

Takato, Tsuyoshi. "Secondary Rhinoplasty for Cleft Lip and Palate." Journal of Oral and Maxillofacial Surgery 65, no. 9 (2007): 20–21. http://dx.doi.org/10.1016/j.joms.2007.06.059.

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30

Cintra, Henrique Ladvocat, Filipe V. Basile, Tatiana T. Tournieux, Ivo Pitanguy, and Antonio Roberto Basile. "Midline palate perforation secondary to cocaine abuse." Journal of Plastic, Reconstructive & Aesthetic Surgery 61, no. 5 (2008): 588–90. http://dx.doi.org/10.1016/j.bjps.2007.08.028.

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31

Nemec, A., L. Barinka, and V. Simecek. "Secondary bone graft implantation in cleft palate." Plastic and Reconstructive Surgery 81, no. 1 (1988): 144. http://dx.doi.org/10.1097/00006534-198801000-00060.

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32

Thaller, Seth R. "Staged Repair of Secondary Cleft Palate Deformities." Journal of Craniofacial Surgery 6, no. 5 (1995): 375–79. http://dx.doi.org/10.1097/00001665-199509000-00008.

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33

Campbell, S. "Prenatal ultrasound examination of the secondary palate." Ultrasound in Obstetrics and Gynecology 29, no. 2 (2007): 124–27. http://dx.doi.org/10.1002/uog.3954.

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34

Ermiş, Ayşe Gizem, and Mehmet Can. "Morphological characterization of hard palate in the Tabby cats." Revista Científica de la Facultad de Ciencias Veterinarias XXXIII, no. 2 (2023): 1–7. http://dx.doi.org/10.52973/rcfcv-e33285.

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The aim of this study was to carry out the morphological characterization of the Tabby cat’s hard palate by light and scanning electron microscopy (SEM), in addition to gross and morphometric analysis. A total of 20 Tabby cat heads used. The materials was provided from the Balıkesir Metropolitan Municipality Street Animals Temporary Nursing Home and Rehabilitation Center, Balıkesir, Turkey. Adult, regardless of gender difference, died from variety of reasons and 20 Tabby cat cadavers which weigh approximately 3–4 kg were brought to the laboratory in accordance with the procedure. Hard palates were subjected to gross examination, morphometric analysis, light and SEM.The Tabby cats hard palate was split up rostral and caudal parts and incisive papilla (papilla incisive), rugae palatine and with a gutter between them, the presence of palatine raphe and secondary rugae palatine were observed. The rostral and caudal parts of the hard palate were determined to have a smooth appearance with SEM 540X magnification and the presence of epithelial desquamations was found out. It was determined that the rostral and caudal part of the Tabby cat’s hard palate had a honeycomb appearance of the microplicae of the 3000X magnification hard palate epithelium with SEM. Round islets were detected with the SEM at the magnification of 600X of the incisive papilla, the 270X of the rostral–caudal parts and the 44X of the gutter between the palatine rugae. These adaptations of the Tabby cat’s hard palate might increase its efficiency during ingestion and mastication of hard food and in directing the food backward. The study shows the detailed anatomical description of the hard palate of the Tabby cat with light and SEM.
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35

Lough, K. J., K. M. Byrd, D. C. Spitzer, and S. E. Williams. "Closing the Gap: Mouse Models to Study Adhesion in Secondary Palatogenesis." Journal of Dental Research 96, no. 11 (2017): 1210–20. http://dx.doi.org/10.1177/0022034517726284.

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Secondary palatogenesis occurs when the bilateral palatal shelves (PS), arising from maxillary prominences, fuse at the midline, forming the hard and soft palate. This embryonic phenomenon involves a complex array of morphogenetic events that require coordinated proliferation, apoptosis, migration, and adhesion in the PS epithelia and underlying mesenchyme. When the delicate process of craniofacial morphogenesis is disrupted, the result is orofacial clefting, including cleft lip and cleft palate (CL/P). Through human genetic and animal studies, there are now hundreds of known genetic alternations associated with orofacial clefts; so, it is not surprising that CL/P is among the most common of all birth defects. In recent years, in vitro cell-based assays, ex vivo palate cultures, and genetically engineered animal models have advanced our understanding of the developmental and cell biological pathways that contribute to palate closure. This is particularly true for the areas of PS patterning and growth as well as medial epithelial seam dissolution during palatal fusion. Here, we focus on epithelial cell-cell adhesion, a critical but understudied process in secondary palatogenesis, and provide a review of the available tools and mouse models to better understand this phenomenon.
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36

Brennan, Tara, Tristan Tham, and Peter Costantino. "The Temporalis Muscle Flap for Palate Reconstruction: Case Series and Review of the Literature." International Archives of Otorhinolaryngology 21, no. 03 (2017): 259–64. http://dx.doi.org/10.1055/s-0037-1598653.

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Introduction The temporalis myofascial (TM) is an important reconstructive flap in palate reconstruction. Past studies have shown the temporalis myofascial flap to be safe as well as effective. Free flap reconstruction of palate defects is also a popular method used by contemporary surgeons. We aim to reaffirm the temporalis myofascial flap as a viable alternative to free flaps for palate reconstruction. Objective We report our results using the temporalis flap for palate reconstruction in one of the largest case series reported. Our literature review is the first to describe complication rates of palate reconstruction using the TM flap. Methods Retrospective chart review and review of the literature. Results Fifteen patients underwent palate reconstruction with the TM flap. There were no cases of facial nerve injury. Five (33%) of these patients underwent secondary cranioplasty to address temporal hollowing after the TM flap. Three out of fifteen (20%) had flap related complications. Fourteen (93%) of the palate defects were successfully reconstructed, with the remaining case pending a secondary procedure to close the defect. Ultimately, all of the flaps (100%) survived. Conclusion The TM flap is a viable method of palate defect closure with a high defect closure rate and flap survival rate. TM flaps are versatile in repairing palate defects of all sizes, in all regions of the palate. Cosmetic deformity created from TM flap harvest may be addressed using cranioplasty implant placement, either primarily or during a second stage procedure.
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Kuzniak, Nataliya B., Roman R. Dmytrenko, Larysa Ya Fedoniuk, et al. "DEVELOPMENT OF THE INNER NASAL CAVITY IN ANIMALS IN PHYLO- AND ONTOGENESIS: FUNCTIONAL ANATOMIC SIGNIFICANCE IN THE DEVELOPMENT PERIOD." Wiadomości Lekarskie 72, no. 3 (2019): 432–35. http://dx.doi.org/10.36740/wlek201903121.

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Іntroduction: Main functions of the inner nose in humans are respiration and olfaction. Therefore, human needs a large surface of inhalable and exhalable air contact, warming and moistening. Importance of these organs in animals in phylogenesis before and after the secondary palate development can explain their anatomic and functional designation. The aim is to find out the functional significance of some anatomic formations of the inner nose and their development peculiarities in phylo-and ontogenesis. Materials and methods: We used a comparative anatomy method where we compared well-known facts of different animals’ development before and after secondary palate formation in phylo- and ontogenesis. Review: Olfactory organ in lower vertebrates develops as canal with two openings through which as a result of water penetration the olfactory ability increases. Sinuses formation in animals happens after secondary palate formation. Secondary palate in embryo develops by second month of development, and sinuses’ development begins on the 3-4 month. As a result, upper jaws and facial skull became stronger. Importance of mucous and lacrimal glands of the nose cavity and mucous glands of mouth received new functions of animal and vegetable food digestion. Conclusions: development of the secondary palate in warm-blooded vertebrates changed (limited) functional applicability of the lacrimal gland and nasolacrimal canal, mucous glands of nose and vegetative innervation. Groups of lacrimal, mucous glands of nose and mouth are unified system of primary, neurosecretory reaction to environment.
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38

Sundoro, Ali, Dany Hilmanto, Hardisiswo Soedjana, Ronny Lesmana, and Selvy Harianti. "Epidemiology of cleft lip and palate charity mission surgery at Bandung Cleft Lip and Palate Center, Indonesia: a 14-year institutional review." Archives of Craniofacial Surgery 25, no. 2 (2024): 62–70. http://dx.doi.org/10.7181/acfs.2023.00416.

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Background: The management of cleft lip and palate aims at improving the patient’s aesthetic and functional outcomes. Delaying primary repair can disrupt the patient’s functional status. Long-term follow-up is essential to evaluate the need for secondary repair or revision surgery. This article presents the epidemiology of cleft lip and palate, including comprehensive patient characteristics, the extent of delay, and secondary repair at our institutional center, the Bandung Cleft Lip and Palate Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.Methods: This retrospective study aimed to determine the epidemiology and recurrence rates of cleft lip and palate at the Bandung Cleft Lip and Palate Center, Indonesia, from January 2007 to December 2021. The inclusion criteria were patients diagnosed with cleft lip and/or palate. Procedures such as labioplasty, palatoplasty, secondary lip and nasal repair, and alveolar bone grafting were performed, and data on recurrence were available.Results: In total, there were 3,618 patients with cleft lip and palate, with an age range of 12 months to 67 years. The mean age was 4.33 years, and the median age was 1.35 years. Males predominated over females in all cleft types (60.4%), and the cleft lip was on the left side in 1,677 patients (46.4%). Most cases were unilateral (2,531; 70.0%) and complete (2,349; 64.9%), and involved a diagnosis of cleft lip and palate (1,981; 54.8%).Conclusion: Delayed primary labioplasty can affect daily functioning. Primary repair for patients with cleft lip and palate may be postponed due to limited awareness, socioeconomic factors, inadequate facilities, and varying adherence to treatment guidelines. Despite variations in the timing of primary cleft lip repair (not adhering to the recommended protocol), only 10% of these patients undergo reoperation. Healthcare providers should prioritize the importance of the ideal timing for primary repair in order to optimize physiological function without compromising the aesthetic results.
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Smith, Darren M., Lisa Vecchione, Shao Jiang, et al. "The Pittsburgh Fistula Classification System: A Standardized Scheme for the Description of Palatal Fistulas." Cleft Palate-Craniofacial Journal 44, no. 6 (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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40

Li, C., Y. Lan, R. Krumlauf, and R. Jiang. "Modulating Wnt Signaling Rescues Palate Morphogenesis in Pax9 Mutant Mice." Journal of Dental Research 96, no. 11 (2017): 1273–81. http://dx.doi.org/10.1177/0022034517719865.

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Cleft palate is a common birth defect caused by disruption of palatogenesis during embryonic development. Although mutations disrupting components of the Wnt signaling pathway have been associated with cleft lip and palate in humans and mice, the mechanisms involving canonical Wnt signaling and its regulation in secondary palate development are not well understood. Here, we report that canonical Wnt signaling plays an important role in Pax9-mediated regulation of secondary palate development. We found that cleft palate pathogenesis in Pax9-deficient embryos is accompanied by significantly reduced expression of Axin2, an endogenous target of canonical Wnt signaling, in the developing palatal mesenchyme, particularly in the posterior regions of the palatal shelves. We found that expression of Dkk2, encoding a secreted Wnt antagonist, is significantly increased whereas the levels of active β-catenin protein, the essential transcriptional coactivator of canonical Wnt signaling, is significantly decreased in the posterior regions of the palatal shelves in embryonic day 13.5 Pax9-deficent embryos in comparison with control littermates. We show that small molecule–mediated inhibition of Dickkopf (DKK) activity in utero during palatal shelf morphogenesis partly rescued secondary palate development in Pax9-deficient embryos. Moreover, we found that genetic inactivation of Wise, which is expressed in the developing palatal shelves and encodes another secreted antagonist of canonical Wnt signaling, also rescued palate morphogenesis in Pax9-deficient mice. Furthermore, whereas Pax9del/del embryos exhibit defects in palatal shelf elevation/reorientation and significant reduction in accumulation of hyaluronic acid—a high molecular extracellular matrix glycosaminoglycan implicated in playing an important role in palatal shelf elevation—80% of Pax9del/del;Wise-/- double-mutant mouse embryos exhibit rescued palatal shelf elevation/reorientation, accompanied by restored hyaluronic acid accumulation in the palatal mesenchyme. Together, these data identify a crucial role for canonical Wnt signaling in acting downstream of Pax9 to regulate palate morphogenesis.
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41

Mukhopadhyay, Partha, Irina Smolenkova, Dennis Warner, Michele M. Pisano, and Robert M. Greene. "Spatio-Temporal Expression and Functional Analysis of miR-206 in Developing Orofacial Tissue." MicroRNA 8, no. 1 (2018): 43–60. http://dx.doi.org/10.2174/2211536607666180801094528.

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Background:Development of the mammalian palate is dependent on precise, spatiotemporal expression of a panoply of genes. MicroRNAs (miRNAs), the largest family of noncoding RNAs, function as crucial modulators of cell and tissue differentiation, regulating expression of key downstream genes. &lt;/P&gt;&lt;P&gt; Observations: Our laboratory has previously identified several developmentally regulated miRNAs, including miR-206, during critical stages of palatal morphogenesis. The current study reports spatiotemporal distribution of miR-206 during development of the murine secondary palate (gestational days 12.5-14.5). &lt;/P&gt;&lt;P&gt; Result and Conclusion: Potential cellular functions and downstream gene targets of miR-206 were investigated using functional assays and expression profiling, respectively. Functional analyses highlighted potential roles of miR-206 in governing TGF&amp;#223;- and Wnt signaling in mesenchymal cells of the developing secondary palate. In addition, altered expression of miR-206 within developing palatal tissue of TGF&amp;#223;3-/- fetuses reinforced the premise that crosstalk between this miRNA and TGF&amp;#223;3 is crucial for secondary palate development.
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42

McCance, Andrew, David Roberts-Harry, Martyn Sherriff, Michael Mars, and William J. B. Houston. "Sri Lankan Cleft Lip and Palate Study Model Analysis: Clefts of the Secondary Palate." Cleft Palate-Craniofacial Journal 30, no. 2 (1993): 227–30. http://dx.doi.org/10.1597/1545-1569(1993)030<0227:slclap>2.3.co;2.

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43

Mccance, Andrew, David Roberts-Harry, Martyn Sherriff, Michael Mars, and William J. B. Houston. "Sri Lankan Cleft Lip and Palate Study Model Analysis: Clefts of the Secondary Palate." Cleft Palate-Craniofacial Journal 30, no. 2 (1993): 227–30. http://dx.doi.org/10.1597/1545-1569_1993_030_0227_slclap_2.3.co_2.

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The study models of a group of adult Sri Lankan patients with clefts of the secondary palate were investigated. Tooth-size and arch-dimension comparisons were made with a comparable control group. Significant differences were found between the cleft and control groups in tooth sizes, chord lengths, and arch widths. The cleft group dimensions were generally smaller than those of the control group. Overjets were larger in the cleft group.
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44

Jin, Jiu-Zhen, Zhenmin Lei, Zi-Jian Lan, Partha Mukhopadhyay, and Jixiang Ding. "Inactivation of Fgfr2 gene in mouse secondary palate mesenchymal cells leads to cleft palate." Reproductive Toxicology 77 (April 2018): 137–42. http://dx.doi.org/10.1016/j.reprotox.2018.03.004.

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45

Romero, Martín, Ralph Latham, Ana Romance, and Rafael Salvan. "Treatment of an Infant with a Rare Cleft Resolved with Use of an Orthopedic Appliance." Cleft Palate-Craniofacial Journal 40, no. 6 (2003): 642–44. http://dx.doi.org/10.1597/02-106.

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Objective Cases of bilateral complete clefts of the primary palate and unaffected secondary palate are very rare. One of these cases as well as a new method of presurgical orthopedics to solve the protruding premaxilla protrusion is presented.
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46

Ferguson, Mark W. J. "Palate development." Development 103, Supplement (1988): 41–60. http://dx.doi.org/10.1242/dev.103.supplement.41.

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In all vertebrates, the secondary palate arises as bilateral outgrowths from the maxillary processes. In birds and most reptiles, these palatal shelves grow initially horizontally, but do not fuse with each other resulting in physiological cleft palate. In crocodilians, shelf fusion occurs resulting in an intact secondary palate. Mammalian palatal shelves initially grow vertically down the side of the tongue, but elevate at a precise time to a horizontal position above the dorsum of the tongue and fuse with each other to form an intact palate. Palatal shelf-elevation is the result of an intrinsic shelf elevating force, chiefly generated by the progressive accumulation and hydration of hyaluronic acid. In all vertebrates the nasal epithelium differentiates into pseudostratified ciliated columnar cells and the oral epithelia differentiates into stratified squamous cells, but the medial edge epithelial (MEE) phenotype differs in different groups. In mammals, the MEE of opposing shelves adhere to each other to form an epithelial seam which then disrupts by cell death and cell migration into the mesenchyme accompanied by an epitheliomesenchymal transformation. In birds, the MEE keratinize resulting in cleft palate whereas, in alligators, the MEE migrate onto the nasal aspect of the palate. In all vertebrates, this regional, temporal and species-specific epithelial differentiation is specified by the underlying mesenchyme. Signalling of this interaction is complex but involves both extracellular matrix and soluble factors e.g. minor collagen types, tenascin, EGF, TGFα, TGFβ, PDGF, FGF. These soluble growth factors have a biphasic effect: directly on the epithelia and on the mesenchyme where they stimulate or inhibit cell division and synthesis of specific extracellular matrix molecules. The extracellular matrix molecules (and bound growth factors) synthesized by the mesenchymal cells may then directly affect the epithelium. These signals cause differential gene expression via second messenger systems e.g. cAMP, cGMP, Ca2+, pH, pI etc. Molecular markers for nasal, medial and oral epithelial cell differentiation include the types of cytokeratin intermediate filaments and specific cell surface molecules recognized by monoclonal antibodies: the genes for such molecules are probably expressed in response to mesenchymal signals. Using such an approach, it is possible to go from a morphological description of palate development to a cellular analysis of the mechanisms involved and then to identification of candidate genes that may be important for screening and diagnosis of cleft palate.
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47

Mayo, Robert, Rodger M. Dalston, and Donald W. Warren. "Perceptual Assessment of Resonance Distortion in Unoperated Clefts of the Secondary Palate." Cleft Palate-Craniofacial Journal 30, no. 4 (1993): 397–400. http://dx.doi.org/10.1597/1545-1569_1993_030_0307_paordi_2.3.co_2.

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The purpose of this study was to examine the frequency with which five speech-language pathologists made judgments of hypernasality during the clinical assessment of young children with unoperated and repaired clefts of the secondary palate. Among the 293 nonsyndromic patients with secondary palate clefts included in this study, 219 were between 1 and 2 years of age. Of those, 83 had undergone primary palatoplasty whereas 136 had not. The remaining 74 children were between the ages of 4 and 5 years and presented with repaired secondary palatal clefts. The results showed that the clinicians were unable or unwilling to assess hypernasality in 31% of the 1 to 2 year old children with unoperated clefts. The same clinicians failed to evaluate oral-nasal resonance balance in only 12% of the children in the 1- to 2-year age group who had undergone palate repair. Only 1 of the 74 older children (1.4%) was not evaluated for hypernasality. Possible explanations for these findings are presented and discussed.
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48

Beckman, Brett. "Repair of Secondary Cleft Palate in the Dog." Journal of Veterinary Dentistry 28, no. 1 (2011): 58–62. http://dx.doi.org/10.1177/089875641102800114.

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49

Teng, Teng, and Jeffrey Bush. "Collective epithelial cell migration in secondary palate fusion." FASEB Journal 34, S1 (2020): 1. http://dx.doi.org/10.1096/fasebj.2020.34.s1.06292.

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50

Grist, Fiona. "Secondary surgery in cleft lip and palate care." Dental Nursing 5, no. 4 (2009): 212–14. http://dx.doi.org/10.12968/denn.2009.5.4.41083.

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