Submucous cleft palate is defined as a bifid uvula, palatal muscle diastasis, and a notch in the posterior surface of the hard palate. Since submucous cleft palate is presently felt to be of clinical relevance only in the presence of velopharyngeal inadequacy, the evaluation and diagnosis of occult submucous cleft palate are only pursued if the patient has velopharyngeal incompetency. The age for surgical correction of submucous cleft palate is one of the most important factors determining the speech outcome of surgical treatment. The available evidence suggests that earlier repairs yield better speech results than late repairs and that later treatment is associated with a higher rate of velophryngeal incompetency. But, treatment of patients with submucous cleft palate depend on the diagnosis of the velopharyngeal incompetency and therefore nearly always occurs later than the time for optimal treatment. Twenty submucous cleft palate patients aged 5 to 12 years with normal hearing and intelligence who visited Yonsei university plastic and reconstructive surgery department from January 1993 to January 1996 were evaluated as an experimental group and nineteen children aged 7 to 12 years with normal hearing and intelligence who randomly selected from the Hyosung elementary school were evaluated as a control group.In this study we analyzed the cranial base and soft tissue structures in submucous cleft palate using velopharyngogram. The results are summarized as follows: 1. The survey of the nasopharynx with submucous cleft palate indicated that the angle of cranial base was outside the range toward the obtusity considering analysis of covariance. 2. The pharyngeal angle(Ba-S-PNS) exceeds normal limits and the ratio of anteroposterior distance of nasopharynx with submucous cleft palate is larger in submucous cleft palate group considering analysis of covariance. 3. The patients with submucous cleft palate have relatively short soft palate in the neutral state and during phonation. 4. The soft palate of submucous cleft palate patients has lessened mobility in submucous cleft palate group. 5. The distance between both lateral pharyngeal wall shows shorter in submucous cleft palate group only during "Su" phonation. From these result, the submucous cleft palate patients have relatively obtuse cranial base and wide nasopharynx of deficient velum with limited mobility, so velopharyngeal incompetency is inevitable.
Child ; Cleft Palate ; Diagnosis ; Hearing ; Humans ; Intelligence ; Nasopharynx ; Palatal Muscles ; Palate, Hard ; Palate, Soft ; Phonation ; Plastics ; Skull Base ; Uvula

PURPOSE: When MRI and CT of the oral cavity utilize the traditional closed-mouth approach, direct contact between the tongue and surrounding structures may give rise to difficulty in recognizing the anatomy involved and demonstrating the possible presence of pathologic features. we describe a more appropriate scan technique, involving open-mouthed imaging, which may be used to demonstrate the anatomy of the oral cavity in detail. MATERIALS AND METHODS: Axial and coronal MR imaging and axial CT scanning were performed in 14 healthy volunteers, using both the closed and open-mouth approach. For the latter, a mouth-piece was put in place prior to examination. In all volunteers, open-mouth MR and CT examinations involved the same parameters as the corresponding closed-mouth procedures. The CT and MR images obtained by each method were compared, particular attention being paid to the presence and symmetry of motion artifact of the tongue and the extent of air space in the oral cavity. Comparative imaging analysis was based on the recognition of 13 structures around the boundaries of the mouth. For statistical analysis, Student 's t test was used and a p value < 0.05 was considered significant. RESULTS: Due to symmetry of the tongue, a less severe motion artifact, and increased air space in the oral cavity, the open-mouth method produced excellent images. The axial and coronal MR images thus obtained were superior in terms of demarcation of the inferior surface and dorsum of the tongue, gingiva, buccal surface and buccal vestibule to those obtained with the mouth closed (p<0.05). In addition, axial MR images obtained with the mouth open showed better demarcation of structures at the lingual margin and anterior belly of the digastric muscle (p<0.05), while coronal MR images of the base of the tongue, surface of the hard palate, soft palate, and uvula, were also superior (p<0.05). Open-mouth CT provided better images at the lingual margin, dorsum of the tongue and buccal surface than the closed-mouth approach (p<0.05). CONCLUSION: Open-mouth MRI and CT are both practical and useful for evaluation of the structures of the oral cavity. The images thus obtained are superior to those acqhired with the month closed.
Artifacts ; Gingiva ; Healthy Volunteers ; Humans ; Magnetic Resonance Imaging* ; Mouth* ; Palate, Hard ; Palate, Soft ; Tomography, X-Ray Computed ; Tongue ; Uvula ; Volunteers

OBJECTIVEInvestigate the response of the patients with obstructive sleep apnea hypopnea syndrome (OSAHS) patients to combination of transpalatal advancement pharyngoplasty and uvulopalatopharyngoplasty.

METHODSThirty two patients with OSAHS, age ranged from 27 to 54, mean value (x +/- s) 39.1 +/- 7.8, male, body mass index (BMI) ranged from 22.9 to 36. 7 kg/m2, mean value (29.0 +/- 3.6) kg/m2, preoperative apnea and hypopnea index (AHI) was 11.7/h to 113.7/h, mean value (61.8 +/- 21.9)/h, the lowest blood oxygen saturation was 0.10 to 0.85, mean value 0.64 +/- 0. 13. With preoperative endoscopic technique, bony nasopharynx cavity narrowing were present, 14 patients had concomitant tonge-base obstruction. Cephalometric result, SNA ranged from 72.9 degrees to 87.0 degrees, mean value (80.7 +/- 4.1) degrees; SNB 69.50 to 85.0 degrees, mean value (76.8 +/- 4.5) degrees; PAS 0.5 cm to 2.1 cm, mean value (1.2 +/- 0.5) cm; MP-H: ranged from 1.2 cm to 3.5 cm, mean value (2.2 +/- 0.7) cm; PNS ranged from 2.4 cm to 3.5 cm, mean value (2.8 +/- 0.4) cm. All the patients had H-UPPP and concomitant transpalatal advancement pharyngoplasty. Fourteen patients with tonge-base obstruction had chin advancement. Results Six months after the operations, the patients were evaluated the response to the operations using Epworth sleep scale, OSAHS filtration questionnaire scale and polysomnography (PSG). There were 27 patients with the decrease percent of AHI reaching or more than 25% and 22 patients with the decrease percent of AHI reaching or more than 50% including 8 patients with AHI less than 5. The other 5 patients were ineffective. After operation, the Epworth sleep scale decreased from (9.2 +/- 4.5) to (4.7 +/- 2. 8) and OSAHS filtration questionnaire scale decreased form (56.0 +/- 15.3) to (17.5 +/- 11.5). Both of the differences were obvious (P < 0.01).

CONCLUSIONSCombination of transpalatal advancement pharyngoplasty and H-UPPP can improve the efficacity and in some patients with pure retropalatal airway narrowing, the cure rate can be improved.

Adult ; Humans ; Male ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; Palate, Hard ; surgery ; Palate, Soft ; surgery ; Sleep Apnea, Obstructive ; surgery ; Treatment Outcome ; Uvula ; surgery

OBJECTIVETo investigate the mechanism of new bone formation in the distraction osteogenesis (DO) for correction of cleft palate (CP) in rhesus.

METHODSCP was created by operation in 23 rhesus. The CP was corrected with DO in 21 animals as experimental group. The distraction rate was 0.8 mm per day, two times a day. The bone fragments were fixed after cleft closure, every 3 animals were sacrificed to get specimen after 1, 2, 4, 6, 8, 12, 24 weeks of fixation. 6 days before sacrifice, tetracycline was administrated for labeling (30 mg/kg).

RESULTSThe hard and soft tissue def of fixation. At the same time, the bone volume and calcification between the distraction gap increased. The cleft in the control group could not b ect was successfully closed with DO by intramembrane osteogenesis. The new formed bone was remodeling and became maturation during the period e corrected spontaneously.

CONCLUSIONSThe DO can successfully correct both the soft and hard tissue defect in CP by intramembrane osteogenesis. The fixation is important for remodeling and maturation of the new formed bone.

Animals ; Biomarkers ; Cleft Palate ; pathology ; surgery ; Macaca ; Osteogenesis, Distraction ; Palate, Hard ; pathology ; Palate, Soft ; pathology

Furlow's palatoplasty has been used as the primary treatment for cleft palate. From 1991 to 1999, 24 submucous cleft palate patients underwent Furlow's palatoplasty. The follow-up period was 3 months to 8 years (mean 24 months). Patients were selected after a thorough study for velopharyngeal insufficiency including intraoral examinatioin, speech assessment, digital subtraction radiography (DSR). Postoperatively velopharyngeal function was reevaluated with speech assessment and digital subtraction radiography in the 7 cooperative patients. Speech parameters including hypernasality, nasal emission, and Allison scale were improved after surgery. Digital subtraction radiography provided the value of velopharyngeal gap and the degree of the motion of lateral pharyngeal wall, both of which were improved after surgery. Furlows palatoplasty has advantage such as no impairment of nasopharyngeal physiology, no hannful effect on the hard palate and the realignment of the levator muscle which plays important role on the movement of the soft palate. The results show that a Furlow's palatoplasty can satisfactorily correct velopharyngeal insufficiency in carefully selected submucous cleft palate patients.
Cleft Palate* ; Follow-Up Studies ; Humans ; Palate, Hard ; Palate, Soft ; Physiology ; Radiography ; Velopharyngeal Insufficiency

OBJECTIVETo study the relationship between velopharyngeal morphology and velopharyngeal function in operated cleft palate patients with velopharyngeal competence (VPC) with levator veli palatini retropositioning according to Sommerlad.

METHODSThree groups were included in the study. The experimental group comprised 18 incomplete cleft patients (group T1) repaired with VPC repaired with levator veli palatini retropositioning according to Sommerlad and 14 incomplete cleft patients (group T2) with velopharyngeal incompetence (VPI) repaired with Langenbeck's technique. The control group was composed of 13 normal adults. The outcome of the velopharyngeal function by nasopharyngoscopy and lateral cephalogram was assessed. Skeletal landmarks and measurements were derived from the tracing of lateral cephalograms. The measurements included velar length, pharyngeal depth, and adequate ratio of velar length to pharyngeal depth. The cranial base, cervical vertebrae, posterior nasal spine, and the position of the posterior pharyngeal wall (PPW) in the pharyngeal triangle were also analyzed. All data were subjected to student's t-test of statistical significance.

RESULTSAll 18 subjects in group T1 obtained complete velopharyngeal closure. Velopharyngeal closure in seven, five, and two subjects in group T2 was 70%, 50% to 70%, and less than 50%, respectively, according to the results of nasopharyngoscopy. The lateral velar length (25.7 mm + 2.3 mm) in group T1 was similar to that of the control group (29.9 mm + 2.7 mm) (P > 0.05). The pharyngeal depth in group T1 was shorter than that in the other two groups, and the adequate ratio (1.43 + 0.26) was similar to that in the normal group (1.45 + 0.26). Group T2 had a significantly short velar length (22.9 mm + 2.3 mm) and normal pharyngeal depth, resulting in a small length/depth ratio (0.95 + 0.14) than that in group T1 and the control group. PPW in the pharyngeal triangle was positioned superiorly in group T2 compared with the control group.

CONCLUSIONThe velopharyngeal morphology of operated cleft palate patients with VPC with levator veli palatini retropositioning according to Sommerlad was found to be similar to that of the normal control group. VPI cleft palate patients are characterized by a shorter palate, smaller adequate ratio (< 1.0), slightly counterclockwise-rotated pharyngeal triangle, and superiorly positioned PPW.

Adult ; Cleft Palate ; Humans ; Palatal Muscles ; Palate, Soft ; Pharynx ; Velopharyngeal Insufficiency

Pain on the soft palate and pharynx can originate in several associated structures. Therefore, diagnosis of patients who complain of discomfort in these areas may be difficult and complicated. Pterygoid hamulus bursitis is a rare disease showing various symptoms in the palatal and pharyngeal regions. As such, it can be one of the reported causes of pain in these areas. Treatment of hamular bursitis is either conservative or surgical. If the etiologic factor of bursitis is osteophytic formation on the hamulus or hypertrophy of the bursa, resection of the hamulus is usually the preferred surgical treatment. We report on a case of bursitis that was managed successfully by surgical treatment and a review of the literature.
Bursitis ; Facial Pain ; Humans ; Hypertrophy ; Palatal Muscles ; Palate ; Palate, Soft ; Pharynx ; Rare Diseases

Major concerns in cleft palate repair are improved speech results and adequate maxillary growth. In these respects, Furlow's double reversing Z-plasty which requires minimal hard palatal dissection and redirects palatal muscles to produce an overlapping muscle sling is theoretically optimal method to close the cleft palate. However, it often requires backcut around the maxillary tubercle even dissection around the pedicle on oral mucosal Z-plasty flap. Raw surface heals secondarily but leads to scarring within the soft palate. In the current study, IIpatients all had incomplete cleft palate and were operated double reversing Z-palatoplasty using intraoperative rapid mucosal expansion (IRME), from November, 1996 till July, 1997. With the IRME, we reduced the incidence of backcut or dissection on the oral mucosal flap. Only three patients need small backcut incision and two of these were closed primarily with V-Y fashion. To examine the histologic changes and expansion rate with the IRME, same procedures were performed to palatal mucosa of three cats. Expanded mucosal size was increased to 33.3% and histologically, change of mucosal architecture was not found except capillary dilatation. As a result, intraoperative mucosal expansion offers sufficient mucosal size, reduce incidence of backcut, therefore minimizes palatal scar formation. Balanced maxillofacial growth and normal occlusion are expected with this procedure.
Animals ; Capillaries ; Cats ; Cicatrix ; Cleft Palate ; Dilatation ; Humans ; Incidence ; Mucous Membrane ; Palatal Muscles ; Palate, Soft

Humans ; Palate, Soft ; Pharynx ; Snoring ; Uvula

uvula in a cleft palate patient are rare. Intraoral examination in a 14-month-old boy with a complete cleft lip and palate revealed a cystic lesion on the right uvula. The lesion was excised and push-back palatorrhaphy with Z-plasty on the uvula was performed. Histopathological examination diagnosed an epithelial cyst. We report a case of an epithelial cyst of uvula in a patient with a unilateral complete cleft lip and palate.]]>
Cleft Lip ; Cleft Palate ; Humans ; Infant ; Male ; Mouth ; Mouth Floor ; Palate ; Palate, Soft ; Uvula