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Objective: Upper airway obstruction and mouth breathing influence facial growth and development, which may result in breathing disorders while asleep. The purpose of the present investigation was to analyze cephalometric alterations between patients with cleft palate and a noncleft control group in an obstructive sleep disordered breathing-specific tracing., Setting: The study was conducted in the cleft palate clinic of a university hospital., Participants: Fifty-three subjects with a mean age of 12.3 +/- 3.7 years (range 6.3 to 17.2 years). The cohort included 33 subjects (13 females, 20 males; mean age 12.1 +/- 3.8 years, mean body mass index 17.5 +/- 2.9 kg/m(2)) with surgical closure of a unilateral or bilateral cleft palate and a matched control of noncleft participants. None of the subjects suffered from sleep disordered breathing syndrome., Results: Compared with the controls, patients with cleft palate had a significant narrow anterior-posterior dimension of the pharynx at the level of the maxillary plane and the narrowest width, a more downward hyoid position, and a longer uvula., Conclusions: Patients with cleft palate appear to present pharyngeal and craniofacial distinctive features that characterize patients with obstructive sleep disordered breathing and differ from those of a noncleft control.

Objective: Although classic and occult submucous clefts have been well described with respect to clinical features and endoscopic findings, there is a paucity of information regarding the histologic characteristics of the midline palatal area and its role in the clefting process. This preliminary study describes the histopathologic features of classic and occult submucosal clefts., Design: Twenty-eight patients with classic submucous cleft (12 patients) and occult submucous cleft (16 patients) were available for study. Histopathologic evaluation of two biopsies from each patient (muscular uvulae biopsy; levator muscle bundle biopsy) was performed., Results: Submucosal fibrosis with relatively dense collagen deposition was noted in both the musculus uvulae and levator muscle bundle biopsy sites. Individual myocytes and myocyte fascicles were entrapped and encased by fibrotic tissue, resulting in disruption of the fascicular organization. Most fascicles were disrupted by intervening dense collagen bands within and interposed between the fascicles. The myocytes had an atrophic or hypoplastic appearance with cross-sectional diameters ranging from 42% to 61% (mean reduction, 53%) less than those expected for myocytes from normal palates. There was fascicular disorganization with intermixing of longitudinally and cross-sectionally oriented myocyte groups. Minor salivary glands were affected as well with increased collagen deposition between and within lobules of salivary gland tissue., Conclusions: This histopathologic study indicates that significant fibrosis is present within submucosal cleft regions and is associated with myocyte atrophy or hypoplasia. The relatively dense fibrosis appears to be a well-organized, chronic process and is present in the absence of significant chronic inflammation. In addition, there is myocyte fascicular disorganization with a haphazard arrangement. This disorderly arrangement may imply that there is a failure of resorption of the epithelial/mesenchymal tissue during palatine shelf closure with retention of mesenchymal tissue that contains the insertion of the velopharyngeal musculature apparatus.

The files of 585 patients who had had pharyngeal flap surgery for the correction of velopharyngeal insufficiency were reviewed. Eighteen patients, ranging in age from 6 to 16 years, showed clinical symptoms of obstructive sleep apnea syndrome. All of these cases had a polysomnographic evaluation and videonasopharyngoscopy. Fifteen cases met the criteria for the diagnosis of obstructive sleep apnea syndrome and eventually underwent surgical treatment. A modified uvulopalatopharyngoplasty was done in 14 of the 15 cases. One patient had a prominent uvula flipping into the port of a Jackson's type pharyngoplasty, so a partial resection of the uvula was performed. Surgical treatment was successful in 14 of 15 cases, including the case with the partial uvular resection. In one case, severe sleep apnea persisted after surgery and a complete section of the flap was performed to correct the obstruction. Sizeable tonsils were found in 13 out of 15 cases, whereas flap width appeared unrelated to obstruction. Preoperative assessment of tonsillar tissue is of vital importance before pharyngeal flap surgery.

The purpose of this study was to determine the prevalence of bifid uvula among elementary school children in grades K through 5. Three examiners performed independent intraoral examinations of 709 children enrolled in a Jacksonville, Florida metropolitan public school. The structure of the uvula was evaluated as normal or bifid. If bifid, the cleft was classified as: (a) notched, (b) extending up to 1/4 the length of the uvula, (c) extending from 1/4 to 3/4 of the length of the uvula, or (d) extending the full length of the uvula. Prevalence of some form of uvular cleft was observed among 16 (2.26%) of the children while full length uvular cleft was found in only two (0.3%) of the children. These findings are congruent with percentages reported in other studies. It is recommended that speech-language pathologists identify children with bifid uvulas and provide appropriate counseling and follow-up study.