Postnatal changes in osseous and mucosal morphology of the hard palate

We investigated the postnatal changes in the dimensions, configuration, and surface pattern of the hard palate in 68 skulls, ranging in age from birth to 90 years of age. The number of palatine rugae of the palatine mucosa was assessed in 168 living subjects aged 11-98 years. Before the first dentition appeared, the osseous palate was concave, smooth, and lacked alveolar processes. In maxillar specimens from the end of the first year to the end of the fourth year of life, balloon-like osseous formations, containing the elements of permanent teeth, appeared bilaterally behind the deciduous incisors. With age, the concavity of the palate diminished and became flat with the loss of the teeth. The presence of teeth was associated with the height of the alveolar ridge, which decreased from 7.3 +/- 4.4 mm in specimens with intact teeth to 4.7 +/- 4.1 mm in specimens without teeth (P = 0.020). Palatine rugae were a common finding in living subjects, but were more often absent in older age (2.2% in 11-50 age group vs. 12.8% in 51-98 age group, P = 0.0183). Our results suggest that the morphology of the hard palate rapidly changes during deciduous and permanent teeth eruption and is related to the presence of alveolar ridges and teeth in adults. Palate osseous morphology may be morphologically and functionally independent from its mucosal morphology. Changes in the morphology of the osseous palate are clinically relevant for dental prosthetics and tooth implantation.     

Clinical anatomy of the posterior maxilla pertaining to Le Fort I osteotomy in Thais

This article studies the anatomy of the posterior maxilla pertaining to bone-cut design of Le Fort I osteotomy to avoid the injury to the descending palatine artery in Thais. Fifty-five skulls (38 males, 17 females) were assessed for the anatomical landmarks by a combination of direct inspection, computerized imaging, and computed tomography scan analysis. The results showed that 27.28% of the pterygomaxillary junction (PMJ) became synostosis. The mean heights of the PMJ, posterior maxilla, and maxillary tuberosity were 15.14 +/- 2.46 mm, 22.51 +/- 3.50 mm, and 7.45 +/- 2.76 mm, respectively. The mean length of the medial sinus wall measuring from the piriform rim to the descending palatine canal at the Le Fort I level was 34.40 +/- 2.96 mm. The mean widths of the posterior incision of Le Fort I osteotomy at the maxillary tuberosity and PMJ were 20.38 +/- 2.82 mm and 11.60 +/- 1.57 mm. The mean length of the posterior maxilla was 27.18 +/- 2.49 mm. Distances from the greater palatine foramen to the maxillary tuberosity incision and PMJ incision were 1.76 +/- 1.12 mm and 3.59 +/- 1.40 mm. The mean angle between the descending palatine canal and the hard palate was 57.33 +/- 4.54 degrees . There were no significant differences in any measurements between sides and genders, except the pterygoid process width and posterior maxilla length of males were longer than those of females (P < 0.05). This study could provide better understanding of the posterior maxillary anatomy that is important for the bone-cut design of Le Fort I osteotomy to avoid excessive intraoperative and postoperative hemorrhage including ischemia of the mobilized maxilla.     

Functional morphology of the pterygoid hamulus.

The pterygoid hamulus (PH), a structure on the under surface of the skull base which has so far hardly been described, is in a peculiar situation biomechanically. The aim of this study is to accumulate sufficient morphological data to enable a functional interpretation to be provided. A total of 93 adult skulls and 24 children's skulls have been examined, and also an additional 20 heads in which the relationship to the surrounding muscles could be investigated. Measurements were made with a sliding gauge, and sections cut from specimens embedded in methyl methacrylate were examined histologically. The hamulus is a variable structure which can, however, be allotted to one of a few basic types. As nomenclature we suggest the following terms: the base: Basis; body: Corpus, sulcus: Sulcus; neck: Collum; head: Caput of the hamulus. The average measurements are: length 7.2 mm, sagittal breadth 1.4 mm, transverse breadth 2.3 mm. The sections show that the medial cortical lamella is thicker than the lateral, and that the 2 are bound together by oblique trabeculae. The medial gradient angle of the collagen fibers is smaller than that of the lateral. A few muscles take origin from the hamulus, the tensor veli palatini turns round the neck, and a few of its fibers take origin here. The distribution of the material within the hamulus suggests that its body is subjected to greater loading in the medio-dorsal direction, but that the head is freely pulled away laterally and caudally. Its exposed position at the distal end of the upper dental arch and the formation of a bursa or sliding layer in the sulcus suggest that it may be a potential source of irritation.     

不同术式治疗单侧完全性唇腭裂的疗效及颌面形态影响研究

目的　研究Millard法（旋转推进法）和改良Tennison法（三角瓣法）治疗单侧完全性唇腭裂的疗效及对患者颌面形态的影响。 方法　根据治疗方法的不同，将本院收治的52例单侧完全性唇腭裂患者分为Millard治疗组和改良Tennison治疗组，每组26例。术后6个月，评价2组患者的临床疗效；并于手术治疗前后，采用照片测量法测量患儿的鼻部形态指标，包括Enw（内眦间距）、BAW（鼻部高度）、BADH（双侧鼻翼高度差）、CHW（口角间距）、CL（鼻小柱高度）、CW（鼻小柱宽度）、NBD（鼻背倾斜度）、CD（鼻小柱倾斜度），测量患儿的健侧和患侧唇高。 结果　治疗后，改良Tennison组的临床修复优良率为88.46%，高于Millard组（69.23%），P<0.05。改良Tennison组平均BAW、CL、CW均大于对照组，平均BADH、CD均小于对照组（P＜0.05），改良Tennison组健侧-患侧唇高差小于Millard组（P<0.05）。 结论　改良Tennison法治疗单侧完全性唇腭裂的整体疗效优于Millard法，能较好地保持鼻部和唇部形态的对称性，更好地控制患者颌面形态，维持颜面美观的形态学机制，值得临床推广应用。     

不同术式治疗单侧完全性唇腭裂的疗效及颌面形态影响研究

目的　研究Millard法（旋转推进法）和改良Tennison法（三角瓣法）治疗单侧完全性唇腭裂的疗效及对患者颌面形态的影响。 方法　根据治疗方法的不同，将本院收治的52例单侧完全性唇腭裂患者分为Millard治疗组和改良Tennison治疗组，每组26例。术后6个月，评价2组患者的临床疗效；并于手术治疗前后，采用照片测量法测量患儿的鼻部形态指标，包括Enw（内眦间距）、BAW（鼻部高度）、BADH（双侧鼻翼高度差）、CHW（口角间距）、CL（鼻小柱高度）、CW（鼻小柱宽度）、NBD（鼻背倾斜度）、CD（鼻小柱倾斜度），测量患儿的健侧和患侧唇高。 结果　治疗后，改良Tennison组的临床修复优良率为88.46%，高于Millard组（69.23%），P<0.05。改良Tennison组平均BAW、CL、CW均大于对照组，平均BADH、CD均小于对照组（P＜0.05），改良Tennison组健侧-患侧唇高差小于Millard组（P<0.05）。 结论　改良Tennison法治疗单侧完全性唇腭裂的整体疗效优于Millard法，能较好地保持鼻部和唇部形态的对称性，更好地控制患者颌面形态，维持颜面美观的形态学机制，值得临床推广应用。     

Development of the human tensor veli palatini: specimens measuring 13.6-137 mm greatest length; weeks 6-16 of development

The present study seeks to determine the main events that occur in the development of the tensor veli palatini (TVP). A light microscope was used on serial sections of 60 human specimens from weeks 6 to 16 of development. The TVP becomes visible in an embryo of 14.5 mm greatest length (GL; week 6) from a common blastema with the medial pterygoid muscle. In embryos of Carnegie stage 20 (week 7), the TVP is differentiated and relates to the anlage of the pterygoid hamulus. At week 8 of development, when the palatal shelves become horizontal, the presence of the anlage of the palatine aponeurosisis distinguished and is reached by the TPV. In an embryo of 30 mm GL, the chondrification nucleus of the pterygoid hamulus and the synovial bursa of the TVP are identifiable. At week 9, the TVP is continuous with the palatine aponeurosis. At week 13, a connective tissue lamina appears between the TVP and the intramembranous ossification center for the anterior process of the malleus, which we know as the goniale and interpret as an attachment of the muscle to the primary vertebrate jaw or incudomalleal joint. The TVP from its origin, innervation and relation to the goniale appears to be a muscle of mastication that, at the end of the embryonic period, reaches the palatine aponeurosis anlage and the mesenchyme of the auditory tube and specializes in the movements of the soft palate and the auditory tube.     

Palatal analysis and osteology of the hard palate of the Kenyan African skulls

One hundred twenty-five dry skulls from Kenya that consisted of about 90% Bantu individuals were examined to obtain data on the gross anatomy of the hard palate. The palatine index showed that 43.2% of the total sample of skulls has narrow (leptostaphyline), 23.7% intermediate (mesostaphyline), and 33.1% wide (brachystaphyline) palates. The palatine height index showed that 40% skulls had low (chamestaphyline), 57% intermediate (orthostaphyline), and 3.0% deep (hypsistaphyline) palates. Mean palatal length, breadth, and height for the total sample was 4.92 cm, 4.02 cm, and 1.22 cm, respectively. The incisive foramen and canal was cone shaped in 80% where the diameter of the foramen was less than 0.4 cm, while it was cylindrical in 20% where the diameter was greater than 0.4 cm. Forty-nine per cent of the skulls had two-five lesser palatine foramina present. The greater palatine foramen was found to lie at the level of the third molar in 76%, intermediate between second and third molars in 13.6%, and opposite the second molar in 10.4%. The greater palatine foramen opened antero-medially in 74% and perpendicularly in 26% of the palates. Extensive longitudinal palatal grooves were found bilaterally in all the palates, 70% showed divisions of the grooves, 63.2% had crests along the border of the grooves, and 19.2% had bridges in the posterior part of the groove near the opening of the greater palatine foramen. The incidence of palatine torus was 4.8%. The incisive suture was present in 6.4% of the adult palates.     

Palatal asymmetry during development: an anatomical study

The purpose of this study was to evaluate hard palate asymmetry during development. The palates of 248 dry skulls were photographed and evaluated digitally. The skulls were divided into seven groups: fetus, newborn, infant, child, adolescent, adult, and aged. Linear measures were obtained from great palatine foramen (GPF) to incisive fossa (INC) and to posterior nasal spine (PNS). Angular measures were obtained from the former landmarks plus the point on sutures intersection between maxillary and palatine bones. Asymmetry was evaluated intra and intergroups. All skulls showed some degree of right-left asymmetry in the hard palate. Regardless of hard palate asymmetry, none of the right-left side differences was statistically significant. For the intergroups assessment, none of the asymmetry index means were statistically different. The posterior part of palate (PNS x GPF) measures was more asymmetric than the anterior part (INC x GPF), showing, respectively, 4.6% and 2.8% of mean asymmetry index. Angular measures showed a more symmetric behavior than the linear ones. Hard palate asymmetry occurs even in the absence of masticatory function, showing that this feature begins early in fetal life and persists through development.     

Morphological analysis of the maxillary arch and hard palate in edentulous maxilla of South Indian dry skulls

Purpose

The purpose of this study is to demonstrate the role of aging\edentulousness on the maxillary arch, the size of the alveolar process, the shape and thickness of the hard palate in the South Indian dry skulls to customize more appropriate treatment of elderly edentulous patients.

Methods

One hundred dry skulls were divided into dentate and edentulous groups and were subgrouped into male and female. They were subjected to various morphological and morphometrical analyses.

Results

The data have revealed a more significant reduction in the depth and width (p?p?p?Conclusion The observed data from specific group of population may provide relevant data for their comparative analysis between different populations for a better understanding of their regional differences with respect to environmental and social influence. Moreover, the data can provide a better idea to evaluate a promising treatment strategy in prosthodontics and orthodontics in South India.     

低浓度尼古丁对大鼠硬腭软组织缺损愈合的影响

背景：最新系列研究发现低浓度尼古丁具有促进血管生成,加速皮肤伤口愈合的作用,但低浓度尼古丁能否在颌面部软组织创伤修复中尤其是口腔黏膜创伤修复中发挥作用目前还不清楚。 目的：观察低浓度尼古丁对大鼠硬腭黏膜缺损修复的影响。 方法：Wistar大鼠65只,于硬腭第一磨牙近中至第三磨牙远中的黏膜作一直径为3 mm的圆形切创缺损。造模后局部给药,大鼠随机分成低浓度尼古丁+凝胶组、凝胶组、空白对照组,每组动物分别在3,7,10,14 d处死,苏木精-伊红染色观察组织愈合过程,并通过大体标本结合图像测量分析比较各组间伤口愈合差异。 结果与结论：修复后3 d各组间愈合情况差异无显著性意义;修复后7,10 d组低浓度尼古丁+凝胶组愈合快于凝胶组和空白对照组(P < 0.05);修复后14 d各组创面已基本愈合,各组间差异无显著性意义。提示低浓度尼古丁可能具有促进大鼠硬腭膜缺损修复的作用。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

颊脂垫瓣移植术联合腭帆提肌重建术治疗腭裂患儿的临床效果

目的探讨颊脂垫瓣移植联合腭帆提肌重建术治疗腭裂患儿的临床效果。方法选择2016年3月至2018年3月在本院进行治疗的唇腭裂患儿120例进行前瞻性研究,根据随机数字表将其分为观察组和对照组,每组60例。观察组患儿采取腭帆提肌重建术联合带蒂颊脂垫瓣移植手术治疗,对照组患儿仅采用腭帆提肌重建术治疗。对比观察2组患儿的愈合情况、临床美观性、SF-36评分以及家长满意度。结果观察组患儿的有效率(95.00%)高于对照组(83.33%),差异有统计学意义(P<0.05);治疗3个月后,2组患儿的上前牙槽突裂隙宽度、上唇裂隙宽度明显降低,鼻小柱长度、鼻底宽度明显上升,且观察组患儿的上前牙槽突裂隙宽度、上唇裂隙宽度显著短于对照组,鼻小柱长度、鼻底宽度显著长于对照组,差异均有统计学意义(P<0.05);观察组患儿的SF-36总分高于对照组,差异有统计学意义(P<0.05);2组患儿发生感染情况的差异无统计学意义(P>0.05);观察组家长满意度(93.33%)高于对照组(66.67%),差异具有统计学意义(P<0.05)。结论颊脂垫瓣移植术联合腭帆提肌重建术治疗腭裂可有效改善患儿上腭裂隙情况,其安全性较好,家长满意度较高。     

Histological study of the developing pterygoid process of the fetal mouse sphenoid

The pterygoid process undergoes ossification of both the cartilage and membrane. However, few studies have attempted to explore the sequential development of the pterygoid process. Using histological examination, we performed morphological observations of the pterygoid process and surrounding tissue. ICR mice at embryonic days 13.5–18.0 and postnatal day 0 were used for morphological observations of the pterygoid process. By embryonic day 14.5, a mesenchymal cell condensation forming the anlage of the future medial pterygoid process differentiated into osteoid-like tissue and cartilage. At embryonic days 15.5–16.5, cartilage cells were clearly evident in the medial pterygoid process. In the medial pterygoid process, a bone collar was evident and calcified bone tissue surrounded the cartilage. At this point, a mesenchymal cell condensation formed the anlage of the pterygoid hamulus. At embryonic days 17.0–18.0, the cartilages were located along the lower and posterior border of the medial pterygoid process. A metachromatically stained matrix first became detectable around cells located in the pterygoid hamulus. On the other hand, at embryonic day 13.5, a metachromatically stained matrix was already evident in the space between the flattened cells in the lateral pterygoid process. At embryonic day 17.0, a hypertrophic cell zone had clearly formed in the diaphysis. On the basis of our present investigation, the lateral pterygoid process can be classified as primary cartilage, whereas the medial pterygoid process can be classified as secondary cartilage. Furthermore, it was found that the pterygoid hamulus is formed latest in the medial pterygoid process.     

Radiofrequency surgery of the soft palate in the treatment of snoring. A placebo-controlled trial

STUDY OBJECTIVES: Recent publications have demonstrated a reduction in snoring with radiofrequency (RF) surgery of the soft palate. Yet so far, all published data has been based on non-controlled trials. DESIGN: Aim of this study was to assess the efficacy of RF surgery of the soft palate in a randomized, placebo-controlled trial. SETTING: Outpatients department at university hospital, department of otorhinolaryngology. PATIENTS: 26 patients with primary snoring (AHI < 15, BMI < 35). Interventions: Patients were treated with temperature-controlled RF surgery of the soft palate under local anesthesia. In accord with a randomization protocol they received 2 sessions of RF surgery (total amount of energy: 3.300 Joule) or placebo (insertion of device needle without energy delivery). MEASUREMENTS AND RESULTS: Snoring was evaluated by the bed partner with 10 cm visual analogue scales. 23 patients completed the study; 12 received RF-surgery and 11 received placebo. Snoring scores did not change in the placebo group (8.4 +/- 1.6 to 8.0 +/- 2.3) while improving in the RF-group (8.1 +/- 1.3 to 5.2 +/- 2.4). The difference between the groups was statistically significant (p < 0.05). CONCLUSION: RF-surgery was significantly better than placebo, although the reduction in snoring was only moderate in our group of patients. This study underlines the necessity for well-controlled clinical trials in the treatment of snoring.     

Ectopic supernumerary tooth on the inferior nasal concha

Variations regarding the location of an ectopic tooth in the human nasal cavity, although rare, are documented in the literature, but presence of an ectopic tooth on the inferior nasal concha (INC) has not been reported. We observed an anomalous tooth projecting from the posterior margin of the right INC in two adult female skulls. A small quadrangular tooth projected beyond the posterior margin of the hard palate in one of the skulls and a medium sized conical tooth was observed in the other skull. The affected INC in both skulls were located more inferiorly compared to the opposite side and were in close approximation with the hard palate. No similar findings were noted on the contralateral side nor were there any associated congenital or iatrogenic deformity. The phylogenetic, ontogenetic, and clinical importance of this variant is described. Knowledge of such an anomaly is of paramount importance to otorhinolaryngologists, reconstructive and dental surgeons, and radiologists for identification of such rarities encountered during invasive or non-invasive procedures.     

3D morphometry of the transverse and alar ligaments in the occipito-atlanto-axial complex: an in vitro analysis

This study verifies the three-dimensional anatomical features of the transverse and alar ligaments with reference to the axis using a direct in vitro approach. In 20 fresh spine specimens, metal markers were inserted on the cranium, atlas, and axis. After registration of the intact specimen, the bony segments were separated, and markers and anatomical landmarks were digitized. The length and the orientation of the ligaments with reference to the axis were derived from the relative position data. The transverse ligaments of the atlas have a mean estimated length of 21 mm and an absolute angle (i.e., independent of any reference frame) of 119 degrees +/- 17 degrees . The alar ligaments have a mean length of 9 +/- 2.5 mm, and the mean absolute angle between the ligaments is 117 degrees +/- 31 degrees . The plane of the alar ligaments shows a mean backward inclination of -10 degrees +/- 52 degrees . This plane has a mean inclination of 6 degrees +/- 4 degrees with reference to the sagittal plane indicating left-right symmetries. The transverse ligament arches around the dens and demonstrating its function as a stabilizer for the dens as well as guidance for axial rotation movements. A posterior inclination of the alar ligaments may induce a coupled extension in combination with a lateral bending during axial rotation. These detailed aspects of motion steering may be important to consider when attempting to reduce or restore movement.     

A family study of isolated cleft palate.

A family study was based on 245 boy and 329 girl patients treated surgically for non-syndromic cleft palate between 1920 and 1929; 86 and 81 respectively were traced and had had children. These 167 were the probands for the family study and were interviewed in their homes. None was born to a consanguineous marriage. Altogether they had had 384 children of whom 11 had cleft palate (2.9 +/- 0.9%). They had 398 sibs of whom five had cleft palate, 117 grandchildren of whom one was affected, and 517 nephews and nieces of whom one was affected. This is the largest series yet available on which to base an estimate of the risks to children of patients with non-syndromic cleft palate. The risk is probably increased where a parent or sib of the proband is affected and increased to a lesser degree where a second or third degree relative is affected. The family patterns in these and other studies suggest that the aetiology of cleft palate is heterogeneous, with some families showing modified dominant inheritance. This is in contrast to cleft lip (+/- cleft palate) where the data are consistent with a multifactorial threshold model.     

桥本氏甲状腺炎患者年龄、性别分布及自身免疫抗体水平分析

目的:分析桥本氏甲状腺炎(HT)在不同年龄男女性患者分布差异及相关抗体水平变化特点。方法:2014-01-01—2018-12-31五年间本院收治的HT患者共2705例,先按年龄分为儿童组(n=32)、青春期组(n=135)和成人组(n=2538),再将成人组中女性分为≤50岁组(n=1645)及>50岁组(n=519)两组,比较不同年龄组HT男女性占比差异,分析不同年龄组以及50岁前后女性甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)的水平变化。结果:在三年龄组中,HT总病例数以成人组最多,儿童组较少。各年龄组间男性、女性HT占比差异有统计学意义(P<0.01);各年龄组内女性占比均显著高于男性,尤以成人组女性占比最高(P<0.01)。三年龄组间TPOAb、TgAb水平有显著统计学意义(均P<0.01)。青春期组及成人组TPOAb水平均低于儿童组(P<0.01),成人组与青春期组TPOAb水平差异无统计学意义(P>0.05);青春期组TgAb水平低于儿童组(P<0.01),儿童组与成人组间、青春期组与成人组间TgAb水平的差异均无统计学意义(P>0.05)。≤50岁与>50岁女性的TPOAb和TgAb水平比较均无统计学差异(P>0.05)。结论:成年人(>18岁)HT明显多于非成年人,且女性占比显著高于男性。TPOAb下降可能是成人HT的内分泌影响因素之一。     

Variations of the prominences of the bony palate and their relationship to complete dentures in Korean skulls.

The osteological and morphological variations of the prominences in the bony palate of 160 Korean skulls were studied. The frequency of the occurrence of the posterior palatine crest, located on the posterior border of the greater palatine foramen, was 13.8%. Palatal ridges were observed commonly in the skulls; however, the smooth type, which has no palatal ridges in the palate, was shown in 14.7% of cases, and palatal spines were observed in 33.8%. The prevalence of palatal tubercles was 11.6%, and all were found in the molar region. The palatine torus was found in 18.8% of cases and the most common type was along the median palatine suture from the incisive foramen to the posterior border of the palatine bone (63.3%). No significant differences between sexes or sides were found in the posterior palatine crest, palatal ridges, and palatal tubercle. However, the sex distribution of the palatine torus was significantly different (P < 0.05). These results would be helpful clinically in fabricating maxillary complete dentures for edentulous patients.     

Cranial base kyphosis and the surface morphology of the anterior cranial fossa.

We investigated the relationship between the surface morphology of the anterior cranial fossa and cranial base kyphosis (sphenoid angle) in 52 cephalometric craniograms. Among them there were 25 female (mean age 54 +/- 15; range 31-82) and 27 male (mean age 43 +/- 18, range 19-85) skulls. The sphenoid angle and the altitudes of the highest elevation of the endofrontal eminence (cranial base over the orbital roof in the anterior cranial fossa) and the middle point of the sphenoid planum, measured according to the Frankfort horizontal, were analysed using classical cephalometric and morphometric analysis. Statistical analysis was performed by Pearson's product-moment correlation and simple linear regression. The sphenoid angle ranged from 97 degrees to 137 degrees (mean 118 +/- 9 degrees). The altitude ratio of the highest elevation of the endofrontal eminence and the middle point of the sphenoid planum ranged from 1.5 to 1.8 (mean 1.6 +/- 0.1). A significant correlation was found between this ratio and the sphenoid angle (r = -0.65; p < 0.001; coefficient of determination = 0.43). The elevation of the endofrontal eminence relative to the sphenoid planum was higher in skulls with increased cranial base kyphosis, whereas reduced sphenoid angle was associated with an increase in the elevations of the endofrontal eminence. Although the sphenoid angle has a significant effect on the morphology of the anterior cranial fossa, only 43% of the variance in altitude of the endofrontal eminence is likely to be explained by its relationship with the sphenoid angle.