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Embryological Development Disorders
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
CL: Cleft of structures anterior to incisive foramenUnilateral or bilateralComplete (involving alveolus), incomplete, or microform
Clefts and craniofacial
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
During week 6, the palatal shelves grow out from the maxillary swellings to lie lateral to the tongue. These shelves then ascend with hydration of glycosaminoglycans and fuse in the midline to form the secondary palate; the vertical movement takes place very rapidly (less than 1 second in rat embryos). The secondary palate fuses anteriorly with the primary palate with the junction marked by the incisive foramen.
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The hard palate is a conglomerate of many structures making up the roof of the oral cavity and these structures also seamlessly contribute to nearby regions. These include the incisive foramen located just posterior to the incisors teeth, alveolar processes superior and adjacent to the teeth and palatine process of the maxilla, the horizontal plate, perpendicular plate, greater palatine foramen, and lesser palatine foramen of the palatine bone, located posterior to the maxilla and the hamulus of the medial plate of the pterygoid process, the lateral plate of the pterygoid process, the scaphoid fossa, and the pterygoid canal of the sphenoid bone located superior and slightly posterior to the maxilla and palatine bones (Plate 3.9). As you can see, the hard palate is made up of many bony parts. The hard palate is also the structure typically subject to facial clefting birth defects (see Branchial arches at the beginning of Chapter 3).
Outcome of the ‘waiting until spontaneous extrusion’ strategy for long-term tympanostomy tube placement in children with cleft palate
Published in Acta Oto-Laryngologica, 2022
Yuri Nomura, Hidetoshi Oshima, Kazuhiro Nomura, Risako Kakuta, Ryoukichi Ikeda, Ai Kawamoto Hirano, Jun Ota, Tetsuaki Kawase, Yukio Katori
This study retrospectively reviewed the medical charts of all children with CP who regularly visited the Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, from December 2016 to November 2017 and who received long-term VT placement (Tympanic drain type B, #1542 KOKEN, Tokyo, Japan) for the first time at our department (Figure 1). Information, including age at the time of VT insertion, age at the time of VT loss (spontaneous extrusion or surgical removal), status of the tympanic membrane after the VT loss, cleft severity, and other coexisting congenital anomalies, was collected from children’s medical records. Regarding cleft severity, we divided the cleft into four categories according to the Veau classification [11]: clefts of the soft palate (I), clefts of the soft and hard palate up to the incisive foramen (II), clefts of the soft and hard palate extending unilaterally through the alveolus (III), and clefts of the soft and hard palate extending bilaterally through the alveolus (IV). Cleft severity increased in ascending order. Other coexisting congenital anomalies included the Pierre Robin sequence, CHARGE syndrome, and Down syndrome.
Bilateral suprazygomatic maxillary nerve block versus palatal block for cleft palate repair in children: A randomized controlled trial
Published in Egyptian Journal of Anaesthesia, 2018
Mohamed M. Abu Elyazed, Shaimaa F. Mostafa
A cotton swab was pressed opposite the first molar tooth then moved posteriorly until it fell into a depression, the GP foramen, situated at the junction of alveolar and palatine bone. A 23G needle was used to block GPN bilaterally just anterior to the GP foramen by injecting 0.5 ml local anesthetic solution 1 cm medial to 1st / 2nd maxillary molar at a depth < 1 cm without entering the canal. 0.5 ml local anesthetic solution was injected bilaterally to block LPN at the LP foramen, identified just lower and lateral to GP foramen, at a depth of less than 1 cm. NPN was blocked lateral to the incisive papilla using 0.5 ml of the solution at a depth of <1 cm. A single injection was sufficient to achieve bilateral block. In case of a complete cleft, the block was performed at the incisive papilla as the vessels will be emerging from the incisive foramen (IF).
Speech outcomes at 5 and 10 years of age after one-stage palatal repair with muscle reconstruction in children born with isolated cleft palate
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Jill Nyberg, Erik Neovius, Anette Lohmander
CPO is defined as a cleft behind the incisive foramen. The purpose of cleft palate repair is to establish a separation between the oral and nasal cavities and to restore a functioning velopharyngeal closure, which is a prerequisite for normal speech production. Previous studies of speech outcomes after CPO repair involve different surgical techniques. For example, Pulkkinen et al. [11] compared Veau-Wardill-Kilner pushback with the Cronin modification technique, while also comparing two different cleft types (UCLP and CPO). Follow-up of the children in that study occurred at 3, 6, and 8 years of age. The authors found no significant differences in speech outcomes related to the different surgical technique. However, they demonstrated a significant difference in number of velopharyngeal flaps related to cleft type: 34% of children with CPO received a velopharyngeal flap, as compared to 13% in the UCLP group. Timmons et al. [1] performed a similar study, comparing different surgical techniques to repair the hard palate: the Veau technique and variations of von Langenbeck, or a combination of the two methods. The soft palate was repaired using the intravelar veloplasty in all children. The age range for speech assessment in their study was 5–12 years. The authors concluded that articulatory difficulties were more frequent in the UCLP group, whereas velopharyngeal problems, measured in terms of a high velopharyngeal flap rate, were significantly more common in the CPO group (with 37% receiving velopharygeal flap in the CPO group, vs none in the UCLP group).