Cleft palate and congenital alveolar synechia syndrome

This report describes a newborn boy with cleft palate and congenital trismus preventing normal feeding. After surgical division of the fibrous bands between the maxillary and mandibular alveolar ridge, oral feedings progressed without difficulty. Historical reports of congenital oral bands are reviewed.     

Thickness of masticatory mucosa in the human hard palate and tuberosity dependent on gender and body mass index

The aim of this study was to clinically determine the thickness of masticatory mucosa in the hard palate and tuberosity as potential donor sites for subepitelial grafts for ridge augmentation procedures of small and moderate alveolar ridge defects to improve aesthetics of a pontic area of fixed partial dentures. In 102 periodontally healthy fully dentate subjects the thickness of mucosa was assessed by bone sounding with a periodontal probe. Twenty measurement points were defined, 18 on hard palate located on 3 lines running at different distances parallel to gingival margin and 2 on tuberosity. Data were analysed to determine differences between gender and different body mass index using t-test. The mucosa on the hard palate was significantly thicker than on the tuberosity. The thickest mucosa was registered on the second and the third line behind canines and on all 3 lines behind the first premolar. These areas are recommended as potential donor sites. Males had significantly thicker mucosa than females (p < 0.01), except for the sites behind the first molar (p > 0.05) where the mucosa was the thinnest in the both gender, which was attributed to the protuberance of the palatal root of the first molar. The same was with the body mass index. Therefore canine-premolar palatal region is recommended for harvesting free subepitelial grafts for moderate augmentation of alveolar ridges for achieving optimal aesthetics of the pontic area.     

Correlation between mandibular retrognathia and induction of cleft palate with 6-aminonicotinamide in the rat.

A single injection of the niacin antimetabolite 6-aminonicotinamide (6-AN) late in gestation produces cleft palate in the rat. In order to achieve an understanding of the mechanism of induction of cleft palate, craniofacial growth and palate development were studied in Sprague-Dawley rats after treatment with 6-AN on day 15 of gestation. The rats were maintained on a high niacin diet (95 ppm) and subjected to three different teratogenic levels of 6-AN. The first group was injected with 8 mg/kg, the second was fasted and injected with 8 mg/kg and the third was treated with 16 mg/kg. The lowest teratogenic dose, 8 mg/kg, produced mild mandibular retrognathia on day 16, delayed shelf elevation a few hours and resulted in small rostral and small caudal clefts of the secondary palate. The moderate dose, 8 mg/kg with fasting, produced more severe mandibular retrognathia, delayed shelf elevation about 24 hours and resulted in 37% full clefts and 63% partial clefts of the palate. The highest teratogenic dose, 16 mg/kg, produced severe mandibular retrognathia, delayed shelf elevation by more than 24 hours and resulted in 100% full clefts of the palate. In each 6-AN group, the most severe mandibular retrognathia was present between days 16 and 17, the critical time for palate closure in the rat. Treatment with 6-AN also produced abnormality of the epithelial cells of the palate, the toothbuds and the nasal septum. Molar and incisor toothbuds were small and malformed, and the epithelial surfaces of the palate and the soft tissue nasal septum did not fuse.     

Chondrodystrophic mice with coincidental agnathia: evidence for the tongue obstruction hypothesis in cleft palate

Mice homozygous for either of two mutations, chondrodysplasia (cho) or cartilage matrix deficiency (cmd), have short-limbed chondrodystrophy. This phenotype includes retrognathia, relative macroglossia, and cleft palate. It has been postulated that the cleft palate in these mice is the result of tongue obstruction during palatogenesis. Agnathia associated with microglossia is an independent spontaneously occurring defect in the strains bearing these mutations. The coincidental occurrence of agnathia-microglossia with chondrodystrophy lends itself to the study of the mechanism of cleft palate formation. We examined approximate midsagittal histological sections of normal and chondrodystrophic newborn mice, both with and without agnathia. Mandibular measurements and examinations of palate closure and tongue structure were made from photographic prints. Typical chondrodystrophic mutants with cleft palates had a mean mandibular length that was 66% of normal and a tongue that appeared large relative to the shortened mandible. Chondrodystrophic mutants with agnathia and microglossia had a mean mandibular length that was further reduced to 30% of normal, yet had a closed palate. We also observed two nonagnathic chondrodystrophic mutants that had slightly decreased mandibular lengths, microglossia, and closed palates. These observations suggest that tongue obstruction during palatogenesis is the pathogenetic mechanism of cleft palate in chondrodystrophic mice. A similar tongue obstruction hypothesis has been proposed as the mechanism of cleft palate formation in the human Pierre Robin sequence, which consists of retrognathia, glossoptosis, and cleft palate. This mechanistic hypothesis has been challenged, but our findings support the tongue obstruction hypothesis in the Robin cleft.     

Modified technique of presurgical infant maxillary orthopedics for complete unilateral cleft lip and palate

This article introduces a modified device fabrication and facial taping method that increases the efficiency and efficacy of presurgical infant maxillary orthopedic therapy for babies born with complete cleft lip and palate. Interarch and intra-arch relationships of the maxillary and mandibular dental arches were evaluated on mounted stone models before and after treatment. The palatal plate device was custom-fabricated in a manner that bypassed the need for periodic acrylic addition and removal, thereby eliminating the risk of natural maxillary growth restriction during therapy. Elastic labial tapes were fabricated and applied in a configuration that mimicked normal function of the orbicularis oris muscle. A nasal stent wire was utilized from the initiation of therapy to enhance intraoral retention and stability of the device. Examples of infants undergoing a unilateral complete cleft lip and palate treatment protocol are presented. Treatment objectives were achieved within 7 to 8 weeks of therapy for patients who had an initial alveolar cleft size more than 10 to 12 mm. The modified protocol of presurgical infant maxillary orthopedic therapy is an effective and efficient treatment modality in reversing the pre-existing orofacial dysmorphism by redirecting the infant's natural growth.     

新生儿唇腭裂术前矫治方法与技术的临床探讨

目的:评价新生儿唇腭裂术前进行鼻-牙槽突-腭畸形矫治方法的疗效。方法:对28例单双侧唇腭裂新生儿进行术前鼻-牙槽突-腭畸形矫治治疗,在面部确定基点,利用数码相机拍射照片,通过image-Pro Plus5.1软件测量相关距离及角度,测量治疗前后的鼻小柱倾斜度、鼻小柱长度、鼻孔宽度和鼻孔高度。治疗前后取上颌石膏模型进行牙槽骨裂隙宽度的测量,比较矫治治疗前后腭部裂隙最大处及牙槽突裂隙的变化。结果:鼻小柱倾斜度平均减小27.11°,鼻孔宽度平均减小4.39 mm(单)或5.29 mm(双),鼻孔高度平均增加2.56 mm(单)或3.57 mm(双),牙槽突裂隙平均减少3.18 mm,腭部裂隙最大处平均减少5.77 mm。治疗前后的各项差异均有统计学意义(P0.05),鼻塌陷畸形程度也得到显著改善。结论:术前进行鼻-牙槽突-腭畸形矫治治疗可为唇腭裂患者手术治疗创造有利条件,提高其整复效果。     

Occlusal forces and mandibular bone strain: Is the primate jaw “overdesigned”?

Finite element modelling of the function of the periodontium and surrounding alveolar bone suggests these tissues are subjected to unusually large strains in comparison with the bone of the basal mandibular corpus. These studies, in addition to certain experimental investigations, have led to the suggestion that the strains experienced in the basal mandibular corpus are not functionally important. Under this view, size and shape of the basal corpus are not functionally linked to masticatory forces. Since previous comparative investigations have been premised on the assumption that masticatory strains in the basal corpus are functionally important, the assertion that masticatory stresses are concentrated primarily in the alveolar process undermines the credibility of this body of work. The hypothesis that the biomechanical effects of masticatory forces are localized in the alveolar process can be evaluated by reference to a number of bone strain investigations, as well as through consideration of current understanding of bone biology and behavior. Experimental studies indicate that the effects of occlusal forces during mastication are quite apparent in alveolar bone, although relatively large strains are also observed in regions well-removed from a loaded alveolus. It is also apparent that both alveolar and basal mandibular bone are subject to bending and twisting strains associated not only with occlusal forces, but also with muscular and condylar reaction forces. The result is that strain levels in alveolarvs.basal bone may be roughly similar, in contradiction to some published theoretical models. Based on empirical evidence and theoretical considerations, it is premature to conclude that mandibular corpus size and shape are not functionally linked to the biomechanics of chewing and biting.     

拔除下颌第三磨牙对下颌角区形态影响的CBCT 研究

目的:探讨下颌第三磨牙的拔除会否造成下颌角区骨骼形态的变化以及这种变化对面型的影响。方法:30例因矫治需要拔除下颌第三磨牙的成人正畸患者,在拔牙前和拔牙后6个月拍摄CBCT片,采用三维测量软件mimics10.01测量下颌第三磨牙所在的下颌角区牙槽骨骨质的宽度、高度和长度,利用SPSS18.0统计软件分析前后数值有无差异。结果:下颌第三磨牙拔除前后下颌角区骨质宽度和高度减小,差异有统计学意义(P<0.05),下颌角区骨质前后向长度未见明显差异。结论:拔除下颌第三磨牙能从一定程度上减小下颌角区骨质高度和宽度,但是前后向长度度基本没有变化。     

One-stage closure of the entire primary palate

Timing of the closure of the anterior palate and alveolus is a subject of debate. Late repair of this defect is complicated by high fistula formation and subjects the patient to the problems of palate fistula for extended periods of time. We have utilized a single procedure performed when the child is 3 months of age that completely closes the anterior hard palate and alveolus along with the cleft lip. Our series consisted of 61 consecutive patients with unilateral clefts of the primary and secondary palate. Mucosal turnover flaps from the vomer along with lateral nasal mucosal flaps provide the nasal lining. A buccal sulcus flap with a Veau flap completes the oral repair. Ninety-five percent (58 of 61) of the patients had complete and stable closure of their anterior palate and alveolus after 1 year. The incidence of fistula formation in our series (3 of 61) is much lower than that reported with the utilization of other protocols. Excellent exposure of the anterior palate and alveolar defect during lip repair, early restoration of anatomic relationships, establishment of a good nostril floor and sill, and very low fistula formation are among the benefits of this procedure. The increase in operative time is considered minimal in light of aforementioned advantages.     

Morphology of the soft palate of the vervet monkey (Cercopithecus pygerythrus)

The heads of 31 vervet monkeys were dissected to investigate the morphology of the soft palate. This extended posteriorly from the hard palate and was delineated laterally by a fold raised by the pterygomandibular raphé. The palatoglossal arch was more prominent than the palatopharyngeal arch and four types of uvulae were seen. These were conical, bifid, trifid, and triangular. Twenty five to forty raised papillae were present on the anterior half of the oral surface. Within the soft palate, the bulk of tissue consisted of glands with a lesser amount of striated muscle. The muscles consisted of the tensor veli palatini, levator veli palatini, palatoglossus, palatopharyngeus, and uvular muscles which differed slightly in their attachments to similar muscles in man. The innervation of the tensor veli palatini muscle was a branch of the mandibular nerve but no nerves could be traced to the other muscles. The soft palate of the vervet monkey is sufficiently similar to that in man to be of practical use in experimental surgery aimed at correcting human soft palate abnormalities.     

The influence of alveolar structures on the torsional strain field in a gorilla corporeal cross-section

Anthropologists have often used mandibular torsional properties to make inferences about primate dietary adaptations. Most of the methods employed are based on assumptions related to periodontal and alveolar properties. This study uses the finite element method to evaluate some of these assumptions with a cross-section through the third molar of a gorilla. Results indicate that the properties of alveolar bone play an important role in determining the strain field. In comparison, the exact stiffness values of the periodontal ligaments seem to have a much smaller impact. Replacing the dental roots and periodontal ligaments with alveolar bone, however, has a significant influence on the strain field. It underestimates the maximum shear strain by about 28% along its periosteal aspect when alveoli are modeled as cortical bone. It overestimates the strain by a smaller amount when alveoli are modeled as trabecular bone.This study supports the assumption that primate mandibles behave like a closed-section under torsion under the limiting condition that the alveolar bone stiffness is more than half of the value of cortical bone; alveolar bone can then be modeled as cortical bone with a minimal loss of accuracy. In addition, this study suggests that the minimum cortical thickness should be considered for torsional strength. Finally, modeling accuracy can be significantly increased if both dental and periodontal structures can be realistically incorporated into mandibular biomechanical models. However, this may not be always feasible in studies of fossil mandibles. This is due mainly to the difficulties involved in estimating alveolar bone densities and in distinguishing boundaries between cortical bone, alveolar bone, periodontal ligaments, and dental roots in fossil specimens.     

Intraosseous veins of the maxilla in the newborn]

The intraosseous veins of the maxilla in newborns grow larger with enlargement of the bone and become disposed in three mutually perpendicular planes. The venous plexus of the alveolar process is large. V. v. vallares are thin and interlace forming a network. The veins of interdental septum are well pronounced. The thick venous network of the periosteum and the mucous membrane of the nasal surface of the palatine process includes the vessels transversal and longitudinal to the nasal septum. The venous loops of the incisor part are of triangular, pentagonal and polygonal shape. The veins of the palatine process are connected with 3-4 large vessels falling into the vessels of the tear duct. The transversal and oblique veins of the oral surface of the palatine process are connected with large vessels disposed in parallel to the medial structure of the hard palate. The venous network of the incisor part of the bone is restricted by densified small arc-shaped plexuses. Two-three largest veins lie sagittally and, connected by arc-shaped anastomoses, are tributaries of the vessels of the palate bone, soft palate and pharynx.     

A clinical and anatomical study of the location of the mental foramen in adult Chinese mandibles

One hundred mandibles of adult Chinese cadavers of both sexes without missing teeth, alveolar bone resorption and malposition of teeth were studied. The anatomical location of each mandibular mental foramen was measured by using a combination of three previous methods. Our results showed that the location of the mental foramen below the apex of the lower second premolar (relation IV: 58.98%) was the most common. On average, the distance between the most anterior portion of the anterior border of the mental foramen and the mandibular symphysis was 28.06 mm, between the most anterior portion of the anterior border of the mental foramen and the posterior border of the ramus 74.14 mm, between the inferior border of the mental foramen and the lower border of the mandibular body 14.70 mm, between the superior border of the mental foramen and the bottom of the lower second premolar socket 2.50 mm. The distance across the mental foramen between the alveolar crest and the lower border of the mandibular body was 30.29 mm. Our results were compared with those of other investigators. The significance of identifying the anatomical location of the mental foramen in dental practice is discussed.     

Study of the mechanisms of BUdR-induced cleft palate in the mouse

This study was designed to examine the pathogenesis of bromodeoxyuridine (BUdR)-induced clefts of the secondary palate in the LACA mouse. Intraperitoneal injections of BUdR (500 mg/kg body weight) were given at various days and combinations of days between E11 and E15 (plug day = E1). Treatment on E11 alone resulted in approximately 22% of fetuses with cleft palate when the latter were examined either on E16 or E19. Treatment on E11 and E12 approximately doubled the above incidence, and treatment on E11, 12 and 13 raised it to 100%. However, no treatment, either single or multiple, caused cleft palate when given later than E11. This suggests that the cellular changes caused by BUdR that lead to cleft palate must be inflicted during E11 and that such damage can be repaired in about 80% of embryos. All fetuses with cleft palate had severe micrognathia on E16 and E19, which skeletal staining showed to be the result of a bilateral sigmoid buckling of Meckel's cartilage. Studies with the scanning electron microscope (SEM) on E15, 16, and 19 suggested strongly that the micrognathia caused a relative macroglossia and hence mechanical interference with palatal shelf reorientation. Histological studies with the light microscope showed that BUdR caused cellular necrosis in many embryonic tissues during the 24 hours after its administration. This necrosis was strikingly more severe in the mandibular rudiment of the first branchial arch than in the maxillary. The latter observation accords well with findings by other workers that cell proliferation is more rapid in the mandibular blastema than in the maxillary. Transmission electron microscope (TEM) studies of the buckled region of Meckel's cartilage failed to reveal any ultrastructural differences from control Meckel's cartilage. Hence BUdR had only interfered with the shape of the cartilage but not with its histiogenesis. We conclude that BUdR, by its cytotoxicity or antidifferentiative effects, interfered with the formation of the anterior end of Meckel's cartilage, initiating a chain of events leading through micrognathia and relative macroglossia to failure of palatal shelf reorientation and cleft palate.     

下颌种植覆盖义齿的生物力学研究进展

口腔生物力学是用生物力学的概念和方法,研究口腔医学中的有关基础性科学问题、解决口腔医学中的临床实际问题、发展口腔临床技术的一门学科。在口腔正畸学、修复学、种植学及口腔颌面外科学等领域存在着大量的生物力学问题,生物力学已成为口腔医学的基础科学之一。传统全口义齿修复常常会出现固位稳定差、咀嚼效率低、患者有疼痛感、适应时间长等情况,很大程度上不能满足患者的修复要求。种植覆盖义齿对于下颌牙槽嵴严重吸收的患者,效果尤为明显。种植覆盖义齿是义齿与种植体之间以不同的附着体作为连接,形成患者可以自行摘戴的种植体支持的覆盖义齿修复。下颌种植覆盖义齿因其能有效地提高下半口义齿的固位性和稳定性、显著提高了患者的咀嚼效率,目前已成为修复下颌牙槽骨严重吸收的无牙颌患者的有效修复方法。本文针对下颌种植覆盖义齿的生物力学研究进展作一综述。     

3-D model analysis of the maxilla of infants with lip-jaw-palate clefts]

For the investigation of three-dimensional morphological changes in the maxilla of children with cleft lip and palate, the use of two-dimensional test analysis is inadequate. Since no standardised three-dimensional method has so far been available, a three-dimensional digital, computer-aided procedure was developed to visualize and metrically analyse the growth of the edentulous maxilla of infants with cleft lip and palate. Chronologically consecutive casts of the maxillas (obtained at the ages of one week, and three, six and twelve months) of five children with complete unilateral CLP were measured optically with the instrument Micromeasure 70. Following digitation, the casts were reconstructed in the computer, aligned and superimposed using the Orthosurf program. The distances between the surfaces were then measured; in addition, the surfaces were segmented perpendicular to the alveolar crest at reference points C1, C1', C2, C2' and I. The volumes of the resulting segments were determined and compare with one another. Specially designed software automated the following steps: 1. identification of reference points; 2. alignment of the cloud of points in a system of coordinates, and 3. identification of the alveolar crest. Our initial results show that (1) the new method enables visualization of the extent and direction of morphological changes of the mucosal surface, and (2) reproducible quantification of these changes via the determination of changes in the volume of defined alveolar segments. The three-dimensional analysis presented here permits a comprehensive three-dimensional measurement of the models of the edentulous maxilla of infants with cleft lip and palate.     

Ultrastructure of alveolar bone during tooth eruption in the dog

Previous work from our laboratories has established that eruption of the permanent mandibular premolars in dogs is dependent upon the presence of the dental follicle and that it involves resorption of alveolar bone and the roots of the deciduous predecessor above and formation of alveolar bone below the developing crown. This study illustrates the topography of the bone surfaces of the crypt by scanning electron microscopy and the ultrastructure of the cells on alveolar bone surfaces during tooth eruption. Above the developing crown where the eruption pathway forms, the bone surface is a pitted sheet, the characteristic topographic feature of bone resorption; between the crown and the mandibular canal, the bone surface has numerous interconnecting trabeculae. Transmission electron microscopy of bone cells lining the eruption pathway area of the crypt showed numerous osteoclasts with adjacent mononuclear cells. Both cell types contained specific, membrane-bound cytoplasmic vesicles shown by the work of others to be characteristic features of osteoclasts and their precursors. Basal trabeculated bone in the crypt was covered by plump osteoblasts. These data show that the metabolic events in alveolar bone associated with tooth eruption have the appropriate cellular and bony surface correlates and that the suspected control of alveolar bone resorption by the dental follicle may be mediated by its recruiting and directing to adjacent bone surfaces the mononuclear precursors of osteoclasts.     

Growth status of children treated for unilateral cleft lip and palate

Cephalometric distances, angles, and proportions were evaluated for 32 children 5 to 8 years of age treated for unilateral cleft lip and palate. The children were age and sex matched with untreated controls with normal skeletal relationships. The unilateral cleft lip and palate sample was treated by the same surgeon and orthodontist using the same techniques and appliances. Measures of overall facial proportions, facial convexity, and prognathism were not significantly different between the two groups. The primary group differences pertain to the posterior aspect of the maxilla, which is vertically short in the unilateral cleft lip and palate sample. Horizontally, the maxilla of the unilateral cleft lip and palate children was significantly longer, producing a steeper palatal plane. In addition, the zygoma and orbits of unilateral cleft lip and palate children were somewhat retruded; the posterior cranial base and total mandibular length also were longer in the unilateral cleft lip and palate children.     

Tooth and bone development in a Danish medieval mandible with unilateral absence of the mandibular canal.

A Danish anthropological collection of medieval human skeletons excavated in 1986 involves a mandible (No. 212) from an adult female born without the lower alveolar nerve and mandibular canal. It is believed that the defect has resulted in lack of tooth development on the affected side and that the mylohyoid nerve has partially compensated for this defect by development of teeth in localized areas. The defective mandibular dentition has caused a compensatory development of the alveolar process in the maxilla. The missing occlusal support has altered muscular traction on the mandible. This has caused an alteration in mandibular shape. Whether the asymmetric development of the mandible is caused by muscular dysfunction, by failure in angular growth apposition, or by a combination of these factors is discussed. The case presents valuable data in the ongoing discussion about the interaction between nerve tissue and tooth formation and about the interaction between occlusion, jaw morphology, and muscular traction. The study shows how archeological material in an interdisciplinary cooperation between archeological, embryological and orthodontic research can contribute to the clarification of current biological problems.