Case report on bilateral cleft palate with protuded premaxilla

Cleft palate (ICD 10-Q 35.9) with Protruding of premaxilla is common feature in patient with bilateral cleft lip and palate it is due to the under trained growth at anterior nasal septal and vomero-premaxillary suture without lateral continuities. Hippocrates (400BC) AND Galen(150AD) mansion cleft lip, but not cleft palate in their writing, Cleft palate –Fanco.(1556), Repair of cleft lip –as early as 255-206 BC in CHINA. The first successful closure of a soft palate defect was reported in 1764 by LEMONNIERa French dentist.

Acute Herpetic Nasopharyngitis in an Adult Patient: A Case Report and Literature Review

Objective: To report a case of herpes virus-associated nasopharyngitis in an adult patient. Methods: The patient’s medical record was reviewed for demographic and clinical data. For literature review, all case reports or other publications published in English literature were identified using Pubmed with the MeSH terms “herpes,” “nasopharyngitis,” and “upper respiratory infection.” Results: A 40-year-old male presented for nasal congestion and a suspected nasal mass. Computed tomography of the sinuses revealed edematous changes in the nasopharynx which exerted a downward mass effect at the right aspect of the soft palate. Flexible fiberoptic laryngoscopy (FFL) revealed a lesion arising from the posterior aspect of the soft palate with extension into the posterior nasal cavity as well as copious mucopurulent secretions consistent with a superimposed acute sinusitis. Rigid nasal endoscopy demonstrated a friable and ulcerated lesion arising from the aforementioned anatomical location. Biopsy of this lesion and subsequent immunohistochemical analysis revealed a diagnosis of herpetic nasopharyngitis. Conclusions: Herpetic infection should be in the differential diagnosis of patients presenting with atypical symptoms of nasopharyngitis. Early accurate diagnosis and appropriate specific management can limit the duration of disease course and prevent further complications.

Morphometric and Immunohistochemical Characteristics of the Adult Human Soft Palate Muscles

The soft palate is the only structure that reversibly separates the respiratory and gastrointestinal systems. Most species can eat and breathe at the same time. Humans cannot do this and malfunction of the soft palate may allow food to enter the lungs and cause fatal aspiration pneumonia. Speech is the most defining characteristic of humans and the soft palate, along with the larynx and tongue, plays the key roles. In addition, palatal muscles are involved in snoring and obstructive sleep apnea. Considering the significance of the soft palate, its function is insufficiently understood. The objectives of this study were to document morphometric and immunohistochemical characteristics of adult human soft palate muscles, including fiber size, the fiber type, and myosin heavy chain (MyHC) composition for better understanding muscle functions. In this study, 15 soft palates were obtained from human autopsies. The palatal muscles were separated, cryosectioned, and stained using histological and immunohistochemical techniques. The results showed that there was a fast type II predominance in the musculus uvulae and palatopharyngeus and a slow type I predominance in the levator veli palatine. Approximately equal proportions of type I and type II fibers existed in both the palatoglossus and tensor veli palatine. Soft palate muscles also contained hybrid fibers and some specialized myofibers expressing slow-tonic and embryonic MyHC isoforms. These findings would help better understand muscle functions.

MORPHOLOGICAL CHANGES IN SOFT PALATINE TISSUES STANDING BEHIND OBSTRUCTIVE SLEEP APNEA SYNDROME: GENERAL PATTERN AND ROLE OF HUMAN PAPILLOMA VIRUS

snoring and obstructive sleep apnea syndrome (OSAS) are a serious medical problem, as they lead to a complex of complications from various body systems, disrupt the socio-economic sphere and stigmatize patients. To date, a set of treatments has been developed, the most effective of which are conservative therapy using CPAP and surgical interventions - various modifications of uvulopalatopharyngoplasty. However, only a small number of studies have elucidated soft palate tissue pathology in patients with chronic and OSAS. But understanding the morphological changes is one of the key aspects for the development of treatment tactics. The aim of current study is to justify the choice of surgical intervention in the treatment of snoring and OSAS by description of morphological changes of the soft palate and to estimate the impact of HPV infection on the progression of soft palatine remodeling. The study included soft palatine tissue samples, which were removed during surgery for snoring and OSAS in 15 patients. Histological (H&E) and immunohistochemical techniques (Ki-67, p16, Human Papilloma Virus). All patients were divided in two groups according HPV-positivity: 5 persons in HPV-positive group and 10 persons in HPV-negative group. For indicators were estimated: number of cellular layers (CL), number of intraepithelial lymphocytes (per 100 epitheliocytes) (IEL), number of vessels per x100 field (NV), Ki-67 proliferation index (PI). Results shows in HPV+ group: CL - 24,2 (±2,17); IEL - 37,8 (±20,97), NV - 21 (±8,46); PI - 17,6 (±2,51). In HPV- group: CL - 6 (±4,78); IEL - 3,3 (±1,77); NV - 10,7 (±2,67); PI - 7,3 (±2,71). Mann-Whitney criterion shows statistical significant difference between groups for all mentioned indicators. In conclusion: patients with snoring and obstructive sleep apnea syndrome had hypertrophy of the soft palate structures caused by changes in epithelial and connective tissue components. Subepithelial structures underdo the disorganization of connective tissue components with a violation of the histoarchitectonics of collagen fibers, edema and angiomatosis. Thus, the study revealed a number of irreversible pathological processes of soft palate tissues, which is the basis for the choice of surgical treatment tactics including the resection of excess tissue. At the same time HPV-infection leads to more pronounced changes in the epithelial layer and subepithelial tissue with concomitant inflammation that likely to create a negative background for further treatment of OSA syndrome.

A preliminary study on nasalization and phonation

Although it is widely acknowledged that different speech processes may interact with each other, the way that nasalization affects phonation remains poorly understood. This paper explores the relationship between nasalization and phonation, by analyzing the phonetic cues of the tense/lax distinction both in nasalization and non-nasalization in the Bai language. The data for discussion is from two Bai dialects, Chengbei and Jinhua, which have a tense/lax distinction in both nasalized and non-nasalized syllables. Three phonation parameters – fundamental frequency (F0), open quotient (OQ), and speed quotient (SQ) – are extracted from EGG signals for analysis. It is found that the influence of nasalization on phonation varies with the tone contours. As for the level tones, the role of phonation manner in tone distinction is not evident in nasalization in that tense tones can be distinguished from lax tones only by pitch. However, in non-nasalization, phonation manner plays an indispensable role in tone distinction, in that the contrast between tense and lax tones are reflected not only on F0 but also on OQ and SQ. Moreover, non-nasalized tense tones are more likely to be accompanied by non-modal phonation that is characterized by a significantly higher SQ. In terms of articulatory explanation, high SQ in non-modal phonation is the result of the vibration of tightened vocal folds, and the tension of vocal folds is caused by raising the soft palate in non-nasalization. As for the falling tones, the role of phonation manner in tone distinction is more salient in nasalization than in non-nasalization in Chengbei Bai, but it is not attested in Jinhua Bai. This study shows that the interaction between nasalization and phonation in Bai can be revealed in the analysis of phonation parameters, i.e. F0, OQ, and SQ.

Comparative Evaluation of Palatal Length, Speech Outcome, and Surgical Complications With Use of Von Langenbeck and Bardach 2 Flap Technique for the Repair of Cleft Palate: A Prospective Randomized Study

Purpose: Successful closure of cleft palate is no more the sole criteria for determining the success of palatoplasty. Approximating soft palate musculature plays an equally important role. A continuous palate with muscular sling, speech and unhampered maxillary growth are 3 important goals of palatoplasty. The current study compared 2 popular palatoplasty techniques and also focused on other vital secondary parameters which would alter the final outcome of palatoplasty. Methods: Thirty-two primary cleft palate patients with repaired cleft lip ranging from 4 to 30 years were randomly and equally divided into 2 groups. Group A underwent Langenbeck and Group B underwent Bardach palatoplasty. Sommerlad’s Intra-Velar Veloplasty was performed in all patients. The patients were evaluated for certain palatal and cleft measurements, speech, and surgical complications. The study also compared impact of cleft severity on speech and complications. Results: All the patients showed improvement in palatal length and speech. Significant palatal lengthening was achieved by Bardach as compared to Langenbeck palatoplasty ( P = .002). Amongst the various speech parameters so compared Bardach group showed better speech articulation post-operatively ( P = .020). No significant difference was found between the 2 groups in relation to other speech parameters. Total 4 complications were encountered 2 belonging to each group. Conclusion: Hard palate cleft repair technique plays little role as far as speech outcomes are concerned. It was Intravelar Veloplasty which reestablished the velopharyngeal sphincter and improved the quality of speech. Hence restoring the muscular sling of soft palate using radical dissection should be stressed upon by the surgeons besides the closure of cleft. The current study found few confounding factors such as age, cleft width, and Veau’s class which altered the speech outcomes and/or complications of palatoplasty.