Closure of Oronasal Fistulae Post Palatoraphy with Tongue Flap in Bilateral Complete Cleft Lip Palate Patient: A Case Report

ABSTRACT@#Oronasal fistulae are common complication following palatoraphy. There are several surgical procedures to repair oronasal fistulae. However, conventional oronasal fistulae closure technique is not always possible, especially when the surrounding tissue is replaced by fibrotic tissue due to previous palatoraphy. Tissue defects in oronasal fistulae should be replaced with tissues providing good vascularisation such as pedicle tongue flap. A case of pedicle tongue flap used to close oronasal fistulae was reported. Eleven-year-old girl, presented with oronasal fistulae and bilateral alveolar cleft after previous palatoraphy. The oronasal fistulae were closed with pedicled tongue flap. The healing was uneventful, and the division of the pedicle tongue flap was done three weeks later and closed primarily. There was no dehiscence of the wound and masticatory functions were recorded. Vascularised flap such as pedicle tongue flap is a preferred technique to close oronasal fistulae after palatoraphy.

Effects of Bulb Type Palatal Lift Prosthesis Therapy on Nasality and Velopharyngeal Function of Patients Following Palatoplasty / Oral Science International

In the present study, the effects of bulb type palatal lift prosthesis (bulb-PLP) therapy on nasality and velopharyngeal function (VPF) of patients with velopharyngeal incompetence (VPI) following palatoplasty were longitudinally assessed.The subjects included 18 patients (3 to 52 years of age) who had shown persistent VPI following palatoplasty and who had received bulb-PLP therapy. Nasality and VPF were assessed by perceptual voice analysis, nasometer test, blowing test, and cephalometric radiographic examination. Based on the outcomes of bulb-PLP therapy, the subjects were classified into two groups: the effective group and the ineffective group. Furthermore, the obturating and VPF-activating effects by bulb-PLP therapy were analyzed, and factors relating to different VPF activities were determined.All subjects achieved adequate VPF by wearing a bulb-PLP. After treatment, 10 patients (55.6%) achieved successful activation of VPF without bulb-PLP (the effective group), while persistent VPI remained in 8 patients (the ineffective group). The beginning-blowing ratio of the effective group was significantly greater than that of the ineffective group (P < 0.05) and the velopharyngeal distance (V-P distance) of the effective group tended to be smaller (P = 0.07). Regarding the shape of the bulb head, the angular type was dominant in the ineffective group, while the round type was dominant in the effective group.Bulb-PLP therapy was useful for providing adequate VPF activation. Possible signs of the subsequent effective activation of VPF are considered to be: 1) preexisting adequate VPF on blowing, 2) smaller V-P distance, and 3) synchronized palatopharyngeal movement.

3-D Analysis of Palatal Morphology Associated with Palatalized Articulation in Patients with Unilateral Cleft Lip and Palate / Oral Science International

Palatalized articulation is one of the major articulation disorders which patients with cleft palate face after palatoplasty. Various causal factors have been suggested to date, but the main cause remains poorly understood. To clarify the possible causes of palatalized articulation in speakers with cleft palate, three-dimensional palatal morphology in patients with/without palatalized articulation in unilateral cleft lip and palate (UCLP) was analyzed.Twelve UCLP patients with palatalized articulation (P group) and 20 UCLP patients with normal articulation (N group) participated in the present study. Speech was assessed in the two groups at the age of about four. Dental casts of the maxilla taken at the same time were analyzed three-dimensionally, and measurements in the horizontal, frontal, and sagittal planes were compared between patients with palatalized articulation and those with normal articulation. All dental casts were measured with a non-contact 3D laser scanner and the 3D data were analyzed with 3D-analyzing software.Our study demonstrated three major findings of palatal morphology in UCLP patients with palatalized articulation when compared with their non-palatalized counterparts: 1) the posterior region of the palate was narrow in the horizontal plane, 2) asymmetry of the anterior palate was severe in the frontal plane, and 3) the palate was flat and shallow in the sagittal plane.These findings suggested that palate deformities can affect the lingual-contact pattern, and may account for the backward movement of the articulation point.

An Anti-apoptotic Role of NF-κB in TNFα-induced Apoptosis in an Ameloblastoma Cell Line / Oral Science International

Nuclear factor-κB (NF-κB) is involved in the promotion of cell survival in a variety of cell types. The present study focused on the role of NF-κB in TNFα-induced apoptosis in an ameloblastoma. Immunohistochemical staining revealed p65 NF-κB protein to be expressed in ameloblastoma tissues. Furthermore, immunoblotting and immunocytochemistry analyses showed that the stimulation of TNFα in an ameloblastoma cell line (AM-1) induced p65 NF-κB translocation from the cytoplasm to the nucleus, indicating NF-κB activation. These findings were confirmed by an NF-κB luciferase reporter assay, which detected enhanced NF-κB transcription activity of AM-1 cells by TNFα stimulation. Moreover, pretreatment with SN50, a nuclear translocation inhibitor, prior to TNFα stimulation, effectively inhibited TNFα-induced NF-κB activation in AM-1 cells. In order to reveal the role of NF-κB activation during TNFα-induced apoptosis in AM-1 cells, an apoptosis assay was performed, and showed that the potential of TNFα in inducing apoptosis in AM-1 cells was significantly elevated by inhibiting the NF-κB activation. These results suggest that NF-κB plays an anti-apoptotic role in TNFα-induced apoptosis in AM-1 cells.