Craniofacial growth after iatrogenic cleft palate repair in a fetal ovine model.

Controversy exists over the impact of scar formation on craniofacial growth after cleft palate repair. The fetal ovine model presents an opportunity to study a group of animals with little or no scar using cephalometric studies of cranio-facial growth after iatrogenic cleft palate repair. Grossly evident scar is formed in the palates of lambs repaired at 118 days or later in gestation, while those animals operated at 70 and 77 days' gestation exhibited no scar grossly and minimal scar histologically in the submucosa with normal nasal and oral mucosal surfaces. For this study, 15 lambs were studied: four were unoperated, three were operated at 70 days, one at 77 days, and seven had clefts produced and repaired at 118 to 133 days' gestation. The animals were euthanized at 1 month of age and the heads removed and frozen until analyzed. Computerized tomography of the heads was used to create voxel (volume pixel) data sets, and volume rendering and measurement software (Voxblast) was used to create a three-dimensional reconstruction of the skull. Palate measurements were obtained by selecting points on the upper deciduous premolars. A plane was set through the palate and upper deciduous premolars using standard points on the skull to maintain consistent visualization and point selection. The measurements were normalized to skull size measured by the distance between points on the right and left zygomatic bones. Using one-way analysis of variance, followed by a protected t test, no significant differences were found between the means of any measurement in the three treatment groups. Fetal palate repair, with or without scarring, resulted in normal craniofacial growth in the 1-month-old lamb.

Globulomaxillary cyst revisited.

Classically, the globulomaxillary cyst was considered to be an inclusion or developmental cyst that arises from entrapped nonodontogenic epithelium in the globulomaxillary suture. Subsequently Christ disputed the existence and histogenesis of this lesion stating that the evidence indicated that facial processes per se did not exist. The development of the anterior maxilla was attributed to the merging of growth centers rather than fusion of facial processes, and hence ectodermal entrapment was ruled out. Recent embryologic studies, however, have demonstrated that Christ's view of facial development was incorrect. Fusion of facial processes does occur, and epithelium is entrapped in areas that later will lie between the maxillary lateral incisors and canines. This review argues that embryologically and histopathologically the globulomaxillary cyst should again be considered as an identifiable clinicopathologic entity.

Intraneural and perineural epithelial structures.

The fact that numerous embryologic epithelial remnants are a normal occurrence in the oral region is well known. That some of these epithelial remnants occur within peripheral nerves is less well known. This study presents examples of intraneural epithelial rests from 3 different anatomic sites: the soft tissues of the jaws (a juxtaoral organ of Chievitz), the posterior maxilla (an ondotogenic rest), and the anterior maxilla (a nasopalatine duct remnant). The purpose of this paper is to draw the attention of surgical pathologists to this phenomenon in the head and neck in order to avoid extensive unnecessary surgery.

A histologic and embryologic analysis of so-called globulomaxillary cysts.

In an attempt to clarify the confusing concept of the so-called globulomaxillary cyst, we have reviewed all cases of this lesion occurring in the files of the CMDNJ-NJDS Biopsy Service between 1967--1977. We have discussed our cases in terms of the criteria used inconsistently in the literature of the globulomaxillary cyst: its location, the vitality of adjacent teeth, its histologic structure and its supposed origin from non-odontogenic embryonic epithelial remnants. We concluded that none of the criteria established the globulomaxillary cyst as a distinct entity and suggest that use of the term be discontinued.