Subperiosteal early resection of the mid-palatal suture. A morphological study in twelve patients operated for choanal atresia

Spontaneous Bone Regeneration After Closure of the Hard Palate Cleft: A Literature Review

PURPOSE

A wide range of surgical techniques have been described for the treatment of palatal clefts. Some of these surgical procedures result in postoperative osteogenesis at the palatal fissure. The aims of this review were to discuss the current approaches to cleft palate surgery leading to spontaneous bone regeneration and to compare these different procedures. Moreover, the causes of bone regeneration, effects on maxillary growth, and factors affecting bone regeneration on the hard palate are discussed.

MATERIALS AND METHODS

The selected articles were found via MEDLINE and Web of Science. The keywords for the search were "cleft palate," "bone regeneration," "palatoplasty," "reconstructive surgical procedures," and "cleft palate surgery." Studies that examined the effect of primary palatoplasty on spontaneous bone regeneration in the hard palate in children were included in this review. Four articles were analyzed in the qualitative synthesis.

RESULTS

Because of differences in patient characteristics and evaluation methods, it was difficult to compare different surgical procedures. The use of a mucoperiosteal flap in combination with adequate closure of the mucosa is needed to obtain bone formation. The area with the largest amount of regenerated bone was located in the middle of the hard palate. In the literature, it was found that complete closure was considered unfavorable because of the negative effects on maxillary growth, but more studies are needed to confirm this. Of the factors that have been studied, only age turned out to be borderline relevant.

CONCLUSIONS

Only a few studies with small sample sizes have been published on bone regeneration in the hard palate. More research is needed to validate these findings.

[Choanal atresia an institutional review]

Choanal atresia is a rare congenital disease, it occurs in 1/8000 live newborns.

AIM OF THE STUDY

retrospective review of patients with choanal atresia treated at the Department of Pediatric Otolaryngology of Medical University in Lublin. Twenty-two children were evaluated, 16 females, 6 males, age range from 6th day to 11th year of life, operated between 2004 and 2009. We analized: age of the parents, mothers diseases during pregnancy, place of live, type of atresia, associated abnormalities, age of children at time of surgery, results of treatment. The age of parents didn't differ significantly from the mean age of parents of children without abnormality. Choanal atresia was bilateral in 10 patients (45%), unilateral in 12 cases (55%)--right-sided in 75% and left-sided in 3 children. The membranous barrier was stated in 60.7%, bone in 25%, and mixed in 14.7%. Choanal atresia was an isolated disease in 12 patients, and in 10 it was associated with other abnormalities. The most common were: central nervous system abnormalities (5 children), heart defect (5), facial dysmorphy (4), hearing loss only in 2 cases. All patients were operated with transnasal technique with stents placement for 6-8 weeks period. The necessity of repleacing the stents occurred in 4 patients because of tendency of the granulation. These problems were absent in patients who were operated during the newborn period. Undoubtedly, the transnasal technique is a procedure by choice, decision, to place a stent or not, depend on the experience of the surgeon and his/her own results.

Choanal atresia: embryologic analysis and evolution of treatment, a 30-year experience

OBJECTIVES

Choanal atresia (CA) is a congenital obstruction of the posterior nasal apertures. Multiple surgical techniques have been proposed to repair the atresia. The purpose of this study is to review the basic science and embryology of CA with emphasis on the senior author's extensive experience, and refinement of the treatment of CA. In addition, we will review the outcomes after surgical correction of pediatric patients with CA.

PATIENTS AND METHOD

: Retrospective review of 73 pediatric patients. Demographic information was recorded, including type of CA, concomitant medical problems, surgical method, and date of last follow-up by the surgeon.

RESULTS

Our series show a 1.6:1 ratio of unilateral atresia to bilateral atresia. The incidence in males and females is statistically equal. High-arched palate and cross-bite deformities are particularly present if the patients undergo the transpalatal approach in the first year of life. The senior author has evolved to favoring the endoscopic approach, having a minimal long-term complication rate, and low stenosis rate (12%).

CONCLUSIONS

The first repair of choanal atresia is the one most likely to succeed. The nasal endoscopic technique is the favored technique. It has the advantages of a low restenosis rate, does not violate the palate, and does not cause the cross-bite and palate arch deformities seen in the transpalatal technique.

Bone regeneration in the hard palate after cleft palate surgery

BACKGROUND

The purpose of this study was to observe bony healing in the hard palate after cleft palate repair and to discuss the factors affecting it.

METHODS

Fifty-two patients with repaired cleft palate were examined at least 1 year postoperatively by means of computed tomographic scanning. The incidence of bone regeneration automatically after repair was calculated, and the region of bone formation and the quality of bone tissue were measured according to the scanned image.

RESULTS

The formation of a bone bridge was found in 37 of 52 patients (71 percent). The length of regenerated bone tissue (in the anteroposterior direction) ranged from 2 to 20 mm, with an average length of 8.3 mm. The male-to-female ratio of the patients who had a bone bridge was 1:1. There was no obvious difference between the two different cleft types. Considering the relationship of age at operation and bone formation, the most popular age at which bone bridging occurred was 4 to 7 years, and the location in the hard palate with the highest percentage of bone formation was the area between the premolar and anterior part of the molar.

CONCLUSIONS

Regenerated bone tissue can occur after palatal repair in cleft palate patients. The age at operation could be an important factor affecting regeneration of bone tissue. The authors were not able to find a significant effect of sex or clinical type of cleft palate based on the sample size in this study.

Coexistence of choanal atresia and Tessier's facial cleft number 2

Choanal atresia is one of the most commonly observed congenital abnormalities of the nose. This defect is frequently associated with other congenital anomalies. One of the anomalies, which is rarely encountered is a Tessier's facial cleft 2. In this report, we present a 6-year-old girl who was brought to our department with complaints of nasal obstruction and chronic nasal discharge. On examination, a scar was seen on the left ala of her nose due to the former repair of a congenital defect. We found hypoplastic nasal cavities and bilateral choanal atresia demonstrated by rigid and flexible endoscopy. A CT scan supported these findings. This coexistence of bilateral choanal atresia with a number 2 facial cleft is an addition to a formerly proposed classification of laterofacial clefts. We think that this classification is better for describing the extent and origin of these complex lesions.

Choanal atresia, CHARGE association, and congenital nasal stenosis

Congenital bilateral narrowing or obstruction of the nasal airway can result in significant respiratory distress in the neonate, requiring emergency intervention. Some of these children have associated congenital malformations that may also impact on the management of the nasal anomaly. The embryology, presentation, and management of this spectrum of disorders are discussed, and the major surgical controversies are reviewed.

Surgery of choanal atresia in infants and children: historical notes and updated review

This review of the surgical treatment of congenital choanal atresia starts with the first descriptions of the disease and its successful operations in the 19th century. Then, data concerning the facial development of the untreated and surgically corrected disease are presented. After that, advantages and drawbacks of the transnasal, transpalatal and transseptal approaches are discussed.

Growth of the dental arches after ablation of the mid-palatal suture. A study in the domestic cat

The present investigation comprises a group of 18 domestic cats with surgically created, and finally histologically verified, submucous mid-palatal clefts. In addition 18 unoperated control animals were examined, along with 12 sham-operated cats, the latter serving as controls on the effect of the surgical soft tissue trauma applied. Measurements were made in regard to width and length of the dental arches, starting at the age of 2 1/2 months, ending at 12 2/3 months, i.e. throughout both the deciduous and the permanent dentition. Data of existing dimensions and growth were obtained. The statistical analysis revealed a significant reduction in final transverse dimensions in the posterior regions of both the upper and the lower dental arches in the deciduous and permanent dentition, in animals where the mid-palatal suture was missing. The soft tissue trauma did not seem to interfere significantly with normal growth.

Single layered periosteoplasty in experimental mid-palatal clefts. A histological study in the cat

At the age of 2 months, the mid-palatal suture, with adjacent bone and nasal mucoperiosteum, was resected in 20 domestic cats leaving postoperatively only the oral side of the more than 5 mm wide osseous defect covered with mucoperiosteum. After cessation of general growth this single layered "palatal cleft periosteoplasty" had, an all animals, resulted in the formation of new bone extending from the resection edges, i.e. nearly butting in the midline in about 85% of the cases. Bone bridges interlocking the palatal halves were, as in normal untreated individuals, never observed. In 3 out of 20 other cats where merely an oral mucoperiosteal flap had been elevated and replaced, i.e. a shamoperation without resection of bone or mucoperiosteum, a beginning synostosis of the mid-palatal suture was found. In the remaining 17 cats of this last group and in further 20 unoperated controls, the suture was open even at 2 1/2 years of age. The results seem to indicate that soft tissue trauma inevitable in palatal surgery may interfere with periosteal and sutural integrity. In addition, the findings may render new informations in palatal/maxillary growth following cleft palate periosteoplasty.