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1.
Rev. Odontol. Araçatuba (Impr.) ; 45(2): 48-51, maio-ago. 2024. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1553297

RESUMO

INTRODUÇÃO: O manejo dos pacientes vítimas de PAF possui vertentes divergentes a respeito do tratamento cirúrgico, que pode ser realizado de forma imedata ou tardia. Em lesões auto-infligidas, a distância entre a arma e a região acometida é menor, causando consequências estéticas e funcionais mais devastadoras. Aliado ao fato desse tipo de trauma criar uma ferida suja devido à comunicação com a cavidade oral e seios paranasais, o manejo das lesões representam um desafio mesmo à cirurgiões experientes. OBJETIVO: Estre trabalho relata o manejo cirúrgico de uma ferida auto-infligida por arma de fogo que resultou em avulsão dos tecidos moles na região maxilofacial. DESCRIÇÃO DO CASO: Paciente do sexo masculino, 35 anos, vítima de projétil de arma de fogo auto-infligido em região maxilofacial, cursando com extenso ferimento em região de língua e mento. Clinicamente, o paciente não apresentava sinais de fratura em ossos da face. Ambos os ferimentos apresentavam secreção purulenta e o paciente manifestava disfonia devido a grande destruição tecidual. CONSIDERAÇÕES FINAIS: O tratamento de ferimentos por arma de fogo não só é um grande desafio para o cirurgião, como para toda a equipe multidisciplinar requerida para tais casos, visto que não há protocolos bem definidos para o tratamento dessas lesões(AU)


INTRODUCTION: The management of patients who are victims of FAP has divergent aspects regarding surgical treatment, which can be performed immediately or late. In self-inflicted injuries, the distance between the weapon and the affected region is smaller, causing more devastating aesthetic and functional consequences. Allied to the fact that this type of trauma creates a dirty wound due to the communication with the oral cavity and paranasal sinuses, the management of injuries represents a challenge even for experienced surgeons. OBJECTIVE: This paper reports the surgical management of a self-inflicted gunshot wound that resulted in soft tissue avulsion in the maxillofacial region. CASE DESCRIPTION: Male patient, 35 years old, victim of a self-inflicted firearm projectile in the maxillofacial region, coursing with extensive injury in the region of the tongue and chin. Clinically, the patient did not show signs of facial bone fractures. Both wounds had purulent secretion and the patient had dysphonia due to extensive tissue destruction. FINAL CONSIDERATIONS: The treatment of gunshot wounds is not only a great challenge for the surgeon, but also for the entire multidisciplinary team required for such cases, since there are no well-defined protocols for the treatment of these injuries(AU)


Assuntos
Humanos , Masculino , Adulto , Língua/lesões , Infecção dos Ferimentos , Ferimentos por Arma de Fogo , Palato Duro/lesões , Ferimentos e Lesões , Ferimentos Penetrantes , Palato Duro , Equimose , Edema , Traumatismos Maxilofaciais
2.
Clin Oral Investig ; 28(5): 277, 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38668852

RESUMO

OBJECTIVES: To evaluate the influence of collateral vascularization on surgical cleft palate closure and deformities. MATERIALS AND METHODS: Corrosion casting was performed using red-colored acrylic resin in twelve fresh adult cadavers with a normal hard palate. Additionally, white-colored barium sulfate was injected into a fetus with a unilateral complete cleft palate, and layer-by-layer tissue dissection was performed. Both substances were injected into the external carotid arteries. Corrosion casting involved dissolving the soft and hard tissues of the orofacial area utilizing an enzymatic solution. RESULTS: In normal palates, bilateral intraosseous infraorbital arteries formed a network in the premaxilla with the intraosseous nasopalatine- and greater palatine arteries (GPAs). The perforating GPAs anastomosed with the sphenopalatine artery sub-branches. Bilateral extraosseous GPA anastomoses penetrated the median palatine suture. Complex vascularization in the retrotuberal area was detected. In the cleft zone, anastomoses were omitted, whereas in the non-cleft zone, enlarged GPAs were distributed along the cleft edges and followed the anatomical course anteriorly to initiate the network with facial artery sub-branches. CONCLUSIONS: The anatomical subunits of the palate exhibited distinct anastomosis patterns. Despite omitted anastomoses with collateral circulation in the cleft zone, arteries maintained their anatomical pattern as seen in the normal specimen in the non-cleft zone. CLINICAL RELEVANCE: Based on the findings in normal- and cleft palates, surgeons may expect developed anastomosis patterns in the non-cleft zone. Due to the lack of microcirculation in the cleft zone, the existent anastomoses should be maintained as much as possible by the surgical technique. This applies anteriorly in the incisive canal territory, alveolar ridges, and posteriorly in the retrotuberal area.


Assuntos
Cadáver , Fissura Palatina , Circulação Colateral , Molde por Corrosão , Palato Duro , Humanos , Fissura Palatina/cirurgia , Circulação Colateral/fisiologia , Palato Duro/irrigação sanguínea , Feminino , Masculino , Sulfato de Bário , Adulto , Feto/irrigação sanguínea
3.
Head Face Med ; 20(1): 18, 2024 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-38461271

RESUMO

OBJECTIVE: The aim of the present study was to assess the need for secondary palatal corrective surgery in a concept of palate repair that uses a protocol of anterior to posterior closure of primary palate, hard palate and soft palate. METHODS: A data base of patients primarily operated between 2001 and 2021 at the Craniofacial and Cleft Care Center of the University Goettingen was evaluated. Cleft lips had been repaired using Tennison Randall and Veau-Cronin procedures in conjunction with alveolar cleft repair. Cleft palate repair in CLP patients was accomplished in two steps with repair of primary palate and hard palate first using vomer flaps at the age of 10-12 months and subsequent soft palate closure using Veau/two-flap procedures 3 months later. Isolated cleft palate repair was performed in a one-stage operation using Veau/two-flap procedures. Data on age, sex, type of cleft, date and type of surgery, occurrence and location of oronasal fistulae, date and type of secondary surgery performed for correction of oronasal fistula (ONF)and / or Velophyaryngeal Insufficiency (VPI) were extracted. The rate of skeletal corrective surgery was registered as a proxy for surgery induced facial growth disturbance. RESULTS: In the 195 patients with non-syndromic complete CLP evaluated, a total number of 446 operations had been performed for repair of alveolar cleft and cleft palate repair (Veau I through IV). In 1 patient (0,5%), an ONF occurred requiring secondary repair. Moreover, secondary surgery for correction of VPI was required in 1 patient (0,5%) resulting in an overall rate of 1% of secondary palatal surgery. Skeletal corrective surgery was indicated in 6 patients (19,3%) with complete CLP in the age group of 15 - 22 years (n = 31). CONCLUSIONS: The presented data have shown that two-step sequential cleft palate closure of primary palate and hard palate first followed by soft palate closure has been associated with minimal rate of secondary corrective surgery for ONF and VPI at a relatively low need for surgical skeletal correction.


Assuntos
Fenda Labial , Fissura Palatina , Procedimentos de Cirurgia Plástica , Humanos , Adolescente , Adulto Jovem , Adulto , Lactente , Fissura Palatina/cirurgia , Fissura Palatina/complicações , Estudos Retrospectivos , Retalhos Cirúrgicos , Palato Duro/cirurgia , Fenda Labial/cirurgia , Fístula Bucal/complicações , Fístula Bucal/cirurgia , Resultado do Tratamento
4.
Clin Oral Investig ; 28(4): 221, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38499908

RESUMO

OBJECTIVES: To establish a three-dimensional finite element model of the upper palate, pharyngeal cavity, and levator veli palatini muscle in patients with unilateral complete cleft palate, simulate two surgical procedures that the two-flap method and Furlow reverse double Z method, observe the stress distribution of the upper palate soft tissue and changes in pharyngeal cavity area after different surgical methods, and verify the accuracy of the model by reconstructing and measuring the levator veli palatini muscle. MATERIALS AND METHODS: Mimics, Geomagic, Ansys, and Hypermesh were applied to establish three-dimensional finite element models of the pharyngeal cavity, upper palate, and levator veli palatini muscle in patients with unilateral complete cleft palate. The parameters including length, angle, and cross-sectional area of the levator veli palatini muscle etc. were measured in Mimics, and two surgical procedures that two-flap method and Furlow reverse double Z method were simulated in Ansys, and the area of pharyngeal cavity was measured by hypermesh. RESULTS: A three-dimensional finite element model of the upper palate, pharyngeal cavity, and bilateral levator veli palatini muscle was established in patients with unilateral complete cleft palate ; The concept of horizontal projection characteristics of the palatal dome was applied to the finite element simulation of cleft palate surgery, vividly simulating the displacement and elastic stretching of the two flap method and Furlow reverse double Z method during the surgical process; The areas with the highest stress in the two-flap method and Furlow reverse double Z method both occur in the hard soft palate junction area; In resting state, as measured, the two flap method can narrow the pharyngeal cavity area by 50.9%, while the Furlow reverse double Z method can narrow the pharyngeal cavity area by 65.4%; The measurement results of the levator veli palatini muscle showed no significant difference compared to previous studies, confirming the accuracy of the model. CONCLUSIONS: The finite element method was used to establish a model to simulate the surgical procedure, which is effective and reliable. The area with the highest postoperative stress for both methods is the hard soft palate junction area, and the stress of the Furlow reverse double Z method is lower than that of the two-flap method. The anatomical conditions of pharyngeal cavity of Furlow reverse double Z method are better than that of two-flap method in the resting state. CLINICAL RELEVANCE: This article uses three-dimensional finite element method to simulate the commonly used two-flap method and Furlow reverse double Z method in clinical cleft palate surgery, and analyzes the stress distribution characteristics and changes in pharyngeal cavity area of the two surgical methods, in order to provide a theoretical basis for the surgeon to choose the surgical method and reduce the occurrence of complications.


Assuntos
Fissura Palatina , Insuficiência Velofaríngea , Humanos , Fissura Palatina/cirurgia , Fissura Palatina/complicações , Análise de Elementos Finitos , Insuficiência Velofaríngea/complicações , Insuficiência Velofaríngea/cirurgia , Músculos Palatinos/cirurgia , Palato Mole/cirurgia , Palato Duro
5.
Eur. j. psychiatry ; 38(1): [100230], Jan.-Mar. 2024.
Artigo em Inglês | IBECS | ID: ibc-229232

RESUMO

Background and Objectives Supporting the neurodevelopmental model of schizophrenia, minor physical anomalies (MPAs) are markers of abnormalities in early fetal development. The mouth seems to be a common region for the occurrence of MPAs in patients with schizophrenia. This study aimed to compare the palatal rugae patterns, according to their length, shape, and orientation, between patients with schizophrenia and controls in a blinded fashion. The palatal rugae patterns were also evaluated by sex, as its effect on neurodevelopment was relevant. Methods Dental stone models were fabricated from maxilla impressions of patients with schizophrenia (N = 105) and controls (N = 105). Based on their lengths, three types of palatal rugae were classified; primary, secondary, and fragmentary. Primary rugae were further categorized according to their shape and direction. Results The most detected palatal rugae were the primary ones in both groups. The primary, secondary, and fragmentary rugae numbers in both groups were no different. There were significant differences in the shape and orientation of the primary rugae between the two groups. Curved (OR:1.76, p = 0.006), island (OR:2.97, p = 0.001) and nonspecific (OR:5.44, p = 0.004) primary rugae shape were found to be significant predictive variables for schizophrenia. Randomly oriented rugae numbers were higher in schizophrenics than controls (p = 0.018). The two sexes had different preferences in primary rugae shapes and directions compared to same-sex controls in patients with schizophrenia. Conclusion Identifying subtle changes in the primary rugae pattern, which appear to be sex-specific, is consistent with impaired neurodevelopment in schizophrenia. (AU)


Assuntos
Humanos , Morfogênese , Esquizofrenia , Palato Duro , Palato Mole
6.
Eur J Orthod ; 46(2)2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38364325

RESUMO

BACKGROUND/OBJECTIVES: Recently, lateral cephalograms have been proposed for guided miniscrew insertion planning. Therefore, the aim was to assess the reliability and safety of such planning on corresponding cone-beam computer tomography (CBCT) images. MATERIALS/METHODS: Intraoral scans, lateral cephalograms, and CBCT images of 52 subjects (even sexes distribution), aged 15.1 ±â€…2.5 years, were included. Miniscrew (n = 104) insertion planning was performed using lateral cephalograms superimposed on the maxillary intraoral scans, while the assessment of their bicortical placement, length in bone, contact with adjacent teeth, incisive canal, and nasal floor perforation was done on corresponding superimposed CBCT images. Moreover, maxillary incisor inclination, crowding, and the maxillary intercanine width were measured. RESULTS: The overall miniscrew length in bone was 7.2 ±â€…1.3mm. Bicortical placement was seen in 58.7% of the sample (38.5% of subjects). Incisive canal and nasal floor perforation was seen in 25% and 21.2% of subjects, respectively. No contact of the miniscrew with adjacent teeth was recorded. A negative significant interaction was seen between the miniscrew length in bone, the percentage of total miniscrew length and maxillary anterior teeth crowding (ß, -0.10, P = .047 and ß, -0.90, P = .006, respectively). Moreover, a positive significant interaction was seen between the incisive canal perforation and maxillary anterior teeth crowding (OR = 1.32, P = .021). LIMITATIONS: Exclusion of subjects with impacted teeth. CONCLUSIONS: Miniscrew insertion planning using lateral cephalograms, despite being safe in preventing contact with adjacent teeth, is limited in achieving bicortical placement and insufficient in completely avoiding incisive canal and nasal floor perforation.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Palato Duro , Humanos , Reprodutibilidade dos Testes , Tomografia Computadorizada de Feixe Cônico/métodos , Maxila/diagnóstico por imagem , Incisivo/diagnóstico por imagem
8.
Cleft Palate Craniofac J ; 61(3): 508-512, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36594232

RESUMO

OBJECTIVE: The objective of this study was to investigate how cleft surgeons classify palatal fistulas. We focused on three different anatomical locations (ie, hard palate, soft palate, junction hard/soft palate) to analyze agreement/disagreement at various anatomical locations. DESIGN: Cross-sectional survey study. PARTICIPANTS: Participants in an international webinar that focused on palatal fistula treatment were included. INTERVENTION: Participants were presented with a survey pre- and post-webinar. MAIN OUTCOMES: Frequency of used classification systems for classifying oronasal fistulas and the inter-rater reliability of the Pittsburgh classification system. RESULTS: A total of 141 participants completed the questionnaires prior to the webinar and 109 participants completed the survey after the webinar. In total, four classification systems were used (ie, Pittsburgh, Pakistan Comprehensive Fistula Classification [PCFC], anatomical and 'other'). The Pittsburgh classification was the most commonly used system in all cases. However, Pittsburgh inter-rater reliability was low (κ = 0.136 pre-webinar, and κ = 0.174 post-webinar). Surprisingly, a substantial shift was observed from the anatomical to Pittsburgh classification after the webinar, indicating increased awareness of the usability of the Pittsburgh classification system. CONCLUSIONS: This study demonstrates a large heterogeneity with regards to the classification of cleft palate fistulas. Interestingly, a shift was observed from the anatomical to Pittsburgh classification after the webinar. However, the inter-rater reliability for using the Pittsburgh classification was low. Classifying palatal fistulas in a homogenous fashion could enhance comparison of primary palate repair and could improve treatment of palatal fistulas.


Assuntos
Fenda Labial , Fissura Palatina , Fístula , Humanos , Fissura Palatina/cirurgia , Fenda Labial/cirurgia , Reprodutibilidade dos Testes , Estudos Transversais , Estudos Retrospectivos , Complicações Pós-Operatórias/cirurgia , Palato Duro
9.
Spec Care Dentist ; 44(1): 136-142, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37055926

RESUMO

BACKGROUND: Medication-related osteonecrosis of the jaw bones have been frequently reported. However, its occurrence in torus palatinus is very rare with only 10 cases published in the English-language literature. CASE REPORT: We describe an additional case in a 79-year-old woman, who was referred for evaluation of a painful swelling with areas of suppuration on the hard palate. CONCLUSION: Conservative treatment was performed and after spontaneous sequestrectomy, total healing was achieved.


Assuntos
Exostose , Osteonecrose , Feminino , Humanos , Idoso , Palato Duro , Osteonecrose/induzido quimicamente
10.
J Forensic Sci ; 69(1): 189-198, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37706423

RESUMO

Recent advances in imaging technologies, such as intra-oral surface scanning, have rapidly generated large datasets of high-resolution three-dimensional (3D) sample reconstructions. These datasets contain a wealth of phenotypic information that can provide an understanding of morphological variation and evolution. The geometric morphometric method (GMM) with landmarks and the development of sliding and surface semilandmark techniques has greatly enhanced the quantification of shape. This study aimed to determine whether there are significant differences in 3D palatal rugae shape between siblings. Digital casts representing 25 pairs of full siblings from each group, male-male (MM), female-female (FF), and female-male (FM), were digitized and transferred to a GM system. The palatal rugae were determined, quantified, and visualized using GMM computational tools with MorphoJ software (University of Manchester). Principal component analysis (PCA) and canonical variates analysis (CVA) were employed to analyze palatal rugae shape variability and distinguish between sibling groups based on shape. Additionally, regression analysis examined the potential impact of shape on palatal rugae. The study revealed that the palatal rugae shape covered the first nine of the PCA by 71.3%. In addition, the size of the palatal rugae has a negligible impact on its shape. Whilst palatal rugae are known for their individuality, it is noteworthy that three palatal rugae (right first, right second, and left third) can differentiate sibling groups, which may be attributed to genetics. Therefore, it is suggested that palatal rugae morphology can serve as forensic identification for siblings.


Assuntos
Palato Duro , Irmãos , Masculino , Feminino , Humanos , Palato Duro/anatomia & histologia , Software , Análise de Componente Principal
11.
Laryngoscope ; 134(2): 981-986, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37672634

RESUMO

OBJECTIVE: The aim was to determine the potential association between palate shape and unilateral hypoglossal nerve stimulation (HNS) outcomes. METHODS: Preoperative drug-induced sleep endoscopy (DISE) videos were reviewed and scored by 3 blinded reviewers to determine airway narrowing at the hard-soft palate junction (HP), soft palate genu, and inferior velum, as described by Woodson (2014). Scoring was as follows: 1-open airway, 2-narrow, 3-severe narrowing. Overall palate shape (oblique, intermediate, or vertical) was determined based on prior criteria. Successful surgical treatment was defined by the HNS titration polysomnogram as a reduction of ≥50% in the apnea-hypopnea index (AHI) to <15 events/h. RESULTS: Of 332 adults, the majority was male (77%) with an average BMI of 29.2 ± 3.6 kg/m2 . Overall success rate was 73%. Success rate was lower in patients with vertical palate shape compared with the other shapes (56% vs. 75%, p = 0.029). HP score 3 compared with scores 2 and 1 was associated with lower success rates (60% vs. 76%, p = 0.028), but genu and velum scores were not associated with outcomes. Patients with both HP score 3 and complete oropharyngeal lateral wall-related obstruction had notably worse outcomes (22% vs. 74%, p = 0.026). HP score 3 (OR 0.45, 95%CI 0.22-0.92) and vertical palate shape (OR 0.33, 95%CI 0.15-0.78) were independently associated with lower odds of surgical response after adjustment for DISE findings, age, gender, and BMI. CONCLUSION: Vertical palate shape and narrowing at the hard-soft palate junction are independently associated with lower HNS surgical success rates. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:981-986, 2024.


Assuntos
Apneia Obstrutiva do Sono , Adulto , Humanos , Masculino , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/complicações , Nervo Hipoglosso , Palato Mole/cirurgia , Orofaringe , Endoscopia , Palato Duro
12.
Am J Obstet Gynecol ; 230(3): 356.e1-356.e10, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37741531

RESUMO

BACKGROUND: Prenatal diagnosis of cleft palate is challenging. Numerous 2-dimensional and 3-dimensional methods have been proposed to assess the integrity of the fetal palate, yet detection rates remain relatively low. We propose the "Hard Palate Sweep," a novel 2-dimensional method that enables clear demonstration of the entire fetal palate throughout pregnancy, in a single sweep, avoiding acoustic shadows cast by surrounding bones. OBJECTIVE: This study aimed to assess the feasibility and performance of the Hard Palate Sweep, performed throughout pregnancy. STUDY DESIGN: This was a prospective cross-sectional study performed between 2018 and 2022 in pregnant patients referred for a routine or targeted anomaly scan between 13 and 40 weeks of gestation. The presence or absence of a cleft palate was determined using the "Hard Palate Sweep." This was compared with the postnatal palate integrity assessment. Test feasibility and performance indices, including sensitivity, specificity, and positive and negative predictive values were calculated. Offline clips were reviewed by 2 investigators for the assessment of inter- and intraoperator agreement, using Cohen's kappa formula. The study protocol was approved by the institutional ethics committee. All participating patients were informed and provided consent. RESULTS: A total of 676 fetuses were included in the study. The Hard Palate Sweep was successfully performed in all cases, and 19 cases were determined to have a cleft palate. Of these, 13 cases were excluded because postmortem confirmation was not performed, leaving 663 cases available for analysis. Six cases determined to have a cleft palate were confirmed postnatally. In 655 of 657 cases prenatally determined to have an intact palate, this was confirmed postnatally. In the 2 remaining cases, rare forms of cleft palate were diagnosed postnatally, rendering 75% sensitivity, 100% specificity, 100% positive predictive value, and 99.7% negative predictive value for the Hard Palate Sweep (P<.001). There was complete intra- and interoperator agreement (kappa=1; P<.0001). CONCLUSION: The Hard Palate Sweep is a feasible and accurate method for prenatally detecting a cleft palate. It was successfully performed in all attempted cases between 13 and 40 weeks of gestation. This method is reproducible, offering high sensitivity and specificity. Implemented routinely, the Hard Palate Sweep is expected to increase the prenatal detection of cleft palate.


Assuntos
Fenda Labial , Fissura Palatina , Gravidez , Feminino , Humanos , Fissura Palatina/diagnóstico por imagem , Palato Duro/diagnóstico por imagem , Fenda Labial/diagnóstico por imagem , Estudos Prospectivos , Estudos Transversais , Ultrassonografia Pré-Natal/métodos
13.
Arch Oral Biol ; 158: 105856, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38056227

RESUMO

OBJECTIVES: This study aimed to investigate the effect of Periplaneta americana extract, a traditional Chinese medicine, on hard palate mucosal wound healing and explore the underlying mechanisms. DESIGN: Hard palate mucosal wound model was established and the effects of Periplaneta americana extract on hard palate mucosal wound healing were investigated by stereomicroscopy observation and histological evaluation in vivo. Human oral keratinocytes and human gingival fibroblasts, which play key roles in hard palate mucosal wound healing, were selected as the main research cells in vitro. The effects of Periplaneta americana extract on cell proliferation, migration, and collagen formation were determined by cell counting kit-8 (CCK-8) assay, Transwell assay, and Van Gieson staining. The underlying mechanism was revealed by RNA sequencing, and results were verified by western blot assay. RESULTS: Stereomicroscopy observation and H&E staining confirmed that Periplaneta americana extract accelerated the healing rate of hard palate mucosal wound (p < 0.001) in vivo. Transwell assay and Van Gieson staining assay showed that Periplaneta americana extract promoted the migration and collagen formation of human oral keratinocytes (p < 0.001) and human gingival fibroblasts (p < 0.001) in vitro. Mechanistically, RNA sequencing and western blot assay demonstrated that Periplaneta americana extract promoted hard palate mucosal wound healing via PI3K/AKT signaling, and the beneficial effects of Periplaneta americana extract were abrogated by the PI3K inhibitor LY294002. CONCLUSIONS: Periplaneta americana extract shows promising effects for the promotion of hard palate mucosal wound healing and may be a novel candidate for clinical translation.


Assuntos
Periplaneta , Masculino , Humanos , Animais , Camundongos , Periplaneta/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Palato Duro , Cicatrização , Transdução de Sinais , Colágeno/metabolismo
14.
Cleft Palate Craniofac J ; 61(1): 61-67, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-35912430

RESUMO

PURPOSE: A palatal fistula is an adverse outcome of cleft palate repair. It is unknown if a palatal fistula will influence velopharyngeal closure, even after repair of the fistula. This study determines the effect of a soft palate fistula on the risk of developing velopharyngeal insufficiency. METHODS: A retrospective chart review was conducted on patients who underwent primary cleft palate repair between 2000 and 2015, with complete records at 4 years of age. Fistulae involving the secondary palate following primary palatoplasty were classified as the soft or hard palate. A forced-entry multivariate logistic regression model was built to detect predictors of velopharyngeal dysfunction. RESULTS: Records of 329 patients were analyzed with a mean follow-up of 8.7 years. A palatal fistula was identified in 89/329 patients (27%) and 29/329 patients (9%) underwent an independent fistula repair. Of the patients with fistula, 44% were located in the hard palate only and 56% had soft palate involvement. Compared to patients without a fistula, rates of velopharyngeal dysfunction were significantly higher in patients with a fistula involving the soft palate (OR 3.875, CI: 1.964-7.648, P < .001) but not in patients with a hard palate fistula (OR 1.140, CI: 0.497-2.613, P = .757). Veau class, age at primary repair, and syndromic status were not significant predictors of VPI (0.128≤P ≤ .975). CONCLUSIONS: A palatal fistula involving the soft palate is a significant predictor for development of velopharyngeal dysfunction after primary palatoplasty. Surgical intervention, at the time of fistula repair, to add vascularized tissue may be indicated to prophylactically decrease the risk of velopharyngeal dysfunction.


Assuntos
Fissura Palatina , Fístula , Insuficiência Velofaríngea , Humanos , Fissura Palatina/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Fístula/etiologia , Palato Duro/cirurgia , Palato Mole/cirurgia , Insuficiência Velofaríngea/etiologia , Insuficiência Velofaríngea/cirurgia
15.
J Am Vet Med Assoc ; 262(1): 1-10, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38103378

RESUMO

OBJECTIVE: To describe the use of a barrier membrane in dogs for repair of congenital hard palate defects and closure of oronasal fistulae (ONF) remaining after previous cleft palate (CFP) repair. ANIMALS: 7 client-owned dogs. METHODS: The hard palate defect was closed with medially positioned flaps (Von Langenbeck technique) or pedicle flaps (2-flap palatoplasty) and a membrane composed of autologous auricular cartilage from the pinna or allogenous fascia lata underlying the mucoperiosteal flaps. RESULTS: All palate defects were considered to have a high risk of dehiscence based on their type and size and the characteristics of the surrounding tissue. The barrier membrane was used in 5 dogs for repair of congenital hard palate defects and in 2 dogs for closure of ONF remaining after previous CFP repair. Resolution of clinical signs occurred in all cases. Complete success (ie, complete closure of the palate defect and absence of clinical signs) was achieved in 5 dogs (4 with congenital hard palate defects and 1 with an ONF remaining after previous CFP repair). The persistent ONF in 1 dog with functional success (incomplete closure, but no clinical signs) was smaller than prior to surgery. CLINICAL RELEVANCE: Barrier membranes underlying mucoperiosteal flaps may constitute an alternative technique in dogs for repair of congenital hard palate defects and closure of ONF remaining after previous CFP repair.


Assuntos
Fissura Palatina , Doenças do Cão , Doenças Nasais , Procedimentos de Cirurgia Plástica , Humanos , Cães , Animais , Fissura Palatina/cirurgia , Fissura Palatina/veterinária , Palato Duro/cirurgia , Procedimentos de Cirurgia Plástica/veterinária , Retalhos Cirúrgicos/veterinária , Fístula Bucal/cirurgia , Fístula Bucal/veterinária , Doenças Nasais/cirurgia , Doenças Nasais/veterinária , Doenças do Cão/cirurgia
16.
Clin Oral Investig ; 28(1): 55, 2023 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-38157063

RESUMO

OBJECTIVES: Skull morphology and growth patterns are essential for orthodontic treatment, impacting clinical decision making. We aimed to determine the association of different cephalometric skeletal configurations on midface parameters as measured in 3D CT datasets. MATERIALS AND METHODS: After sample size calculation, a total of 240 fully dentulous patients between 20 and 79 years of age (mean age: 42 ± 15), who had received a CT of the skull within the scope of trauma diagnosis or intracranial bleeding, were retrospectively selected. On the basis of cephalometric analysis, using MPR reconstructions, patients were subdivided into three different vertical skull configurations (brachyfacial, mesofacial, dolichofacial) and the respective skeletal Class I, II, and III relationships. Anatomic parameters were measured using a three-dimensional post-processing console: the thickness of the maxillary and palatine bones as well as the alveolar crest, maxillary body and sutural length, width and height of the hard palate, maxillary facial wall thickness, and masseter muscle thickness and length. RESULTS: Individuals with brachyfacial configurations had a significantly increased palatal and alveolar ridge thicknesses compared to those with dolichofacial- or mesofacial configurations. Brachyfacial configurations presented a significantly increased length and thickness of the masseter muscle (4.599 cm; 1.526 cm) than mesofacial (4.431 cm; 1.466 cm) and dolichofacial configurations (4.405 cm; 1.397 cm) (p < 0.001). Individuals with a skeletal Class III had a significantly shorter palatal length (5.313 cm) than those with Class I (5.406 cm) and Class II (5.404 cm) (p < 0.01). Sutural length was also significantly shorter in Class III (p < 0.05). CONCLUSIONS: Skeletal configurations have an impact on parameters of the bony skull. Also, measurable adaptations of the muscular phenotype could result. CLINICAL RELEVANCE: The association between viscerocranial morphology and midface anatomy might be beneficial for tailoring orthodontic appliances to individual anatomy and planning cortically anchored orthodontic appliances.


Assuntos
Face , Maxila , Adulto , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Face/anatomia & histologia , Cefalometria/métodos , Maxila/diagnóstico por imagem , Maxila/anatomia & histologia , Palato Duro
17.
BMJ Case Rep ; 16(11)2023 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-37963659

RESUMO

A woman in her 70s reported to the outpatient department of our tertiary care hospital with chief complaints of painless swelling in the right cheek and palatal area. The patient was a known case of diabetes mellitus and hypertension on medications with controlled sugars and blood pressure. The swelling was 10×8 cm in size extending from right infraorbital region up to the lower mandible. CT demonstrated a permeative lytic pattern of bone destruction noted involving the hard palate and maxillary bone.Using the Weber Ferguson approach, a surgical resection was carried out under general anaesthesia. Resection included from right total maxillectomy (excluding roof of maxilla), nasal septum up to left medial maxillectomy including hard palate and the tumour was resected en bloc. The palatal obturator was fixed. On the basis of histopathology, grade 1 well-differentiated chondrosarcoma was diagnosed. The patient received postoperative radiotherapy and had a good recovery.


Assuntos
Condrossarcoma , Maxila , Feminino , Humanos , Maxila/cirurgia , Septo Nasal/cirurgia , Palato Duro , Bochecha , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/cirurgia
18.
Vestn Otorinolaringol ; 88(5): 58-62, 2023.
Artigo em Russo | MEDLINE | ID: mdl-37970771

RESUMO

Data on the features of the anatomical structure of the hard palate are little described in the scientific literature, and therefore are not taken into account when planning surgical treatment. One of the intraoperative complications during intervention on the lower part of the nasal septum is perforation of the bottom of the nasal cavity, which can develop during a christotomy. This complication mainly depends on the features of the anatomical structure of the hard palate. OBJECTIVE: To study the anatomical structure of the hard palate from the point of view of rhinosurgery, using vector analysis of multispiral computed tomography (MSCT), and to establish anatomical features that should be taken into account when performing surgical interventions on the nasal septum. MATERIAL AND METHODS: 107 patients (30 men, 77 women) were examined without congenital cleft palate and surgical interventions on the structures of the nasal cavity and hard palate. All patients underwent MSCT of the nose and paranasal sinuses (PNS) followed by multiplanar image reconstruction. The key point relative to which the measurements were carried out was the posterior wall of the incisor canal from the side of the nasal cavity. The line corresponding to the bottom of the nasal cavity was chosen as the main vector. In the work, measurements of the thickness of the hard palate (THP) at the level of the palatal suture and the width of the palatal suture (WPS) were carried out. RESULTS: Statistical analysis of the obtained results showed that the THP is 1.74 mm [min 0.28; max 6.46], the WPS is 0.9 mm [min 0.2; max 2.51] (conditional norm). In 19 patients (17.8%), the THP was 0.82 mm, in 2 patients (1.9%) - 0.2 mm. In 3 patients (2.8%), the WPS was equal to 2.5 mm. CONCLUSION: Thus, the data obtained by us indicate that the surgical anatomy of the hard palate is characterized by significant variability, while in some patients the THP can be reduced by 8.8 times, and the WPS increased by 2.7 times compared to normal values. Such anatomical features of the structure of the hard palate should be taken into account when planning septoplasty, since this contingent of patients has an increased risk of developing iatrogenic perforation of the nasal floor during surgical intervention on the lower floor of the nasal septum.


Assuntos
Fissura Palatina , Rinoplastia , Masculino , Humanos , Feminino , Palato Duro/diagnóstico por imagem , Palato Duro/cirurgia , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/cirurgia , Septo Nasal/cirurgia , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Rinoplastia/efeitos adversos
19.
Indian J Dent Res ; 34(2): 187-190, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37787210

RESUMO

Background: In post-mortem scenarios, often it is a very difficult process to establish a person's identity. Rugae are unique in that they are protected from trauma as they are insulated from heat by tongue and buccal pad of fat unlike fingerprint or lip print that is prone to destruction. Aim and Objectives: This study was aimed to compare the palatal rugae among people of different races. The sole objectives of the study were to assess the predominant pattern in the selected groups, reliability of rugae pattern in personal identification, to evaluate reliability of sex determination and to compare the total number of rugae on right and left sides of the palate among the males and females. Study Design: A total of 90 subjects were enrolled into the study and divided into three groups that are African, Dravidian and Mongoloid population. Shapes of rugae present were analyzed according to the classification given by Kapali et al. (1997) and Thomas & Kotze (1983). Result: The predominant rugae shape in African and Dravidian population was wavy pattern, whereas Mongoloid race was predominant in curve pattern. African and Dravidian males were predominant in wavy pattern when compared to Mongoloid males where unification type was more predominant. Conclusion: A statistically significant association between the rugae shape in three populations exists, although subtle yet definite.


Assuntos
Palato Duro , Análise para Determinação do Sexo , Masculino , Feminino , Humanos , Projetos Piloto , Reprodutibilidade dos Testes , Mucosa Bucal
20.
Med Eng Phys ; 120: 104036, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37838410

RESUMO

We present a calibration system called Dried Water Column (DWC). It applies pressure on a sensor with a latex finger filled with water, which pressure is controlled with a water column. This is intended to mimic the way the deformable tongue mechanically interacts with the hard palate. We show that, once some specificities of the elastic/plastic behavior of the latex finger are taken into account, namely the softening due to Mullins Effect and the non-elastic deformation occurring above a certain pressure level, the DWC provides a reliable measure of the linear relation between the pressure and the output voltage of the sensor within the limited pressure range [0, 2.5 kPa]. Such a precise calibration would not be possible with a rigid actuator, which position on the sensor can dramatically influence the measures. Extrapolating the linear relationship thus determined to a larger pressure range compatible with speech production and swallowing ([0, 35 kPa]), is possible once it has been verified that the behavior of the sensor is linear over this pressure range. This can be done with any rigid or semi rigid actuator. This reliable calibration procedure can be easily reproduced in any laboratory, and can be applied to any pressure sensor.


Assuntos
Látex , Palato Duro , Humanos , Água , Calibragem , Pressão , Língua , Deglutição
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