Maxillary growth in a congenital cleft palate canine model for surgical research

Craniofacial and three-dimensional palatal analysis in cleft lip and palate patients treated in Spain

Growth alterations have been described in patients operated on for oral clefts. The purpose of this work was to analyze the craniofacial and palate morphology and dimensions of young adults operated on for oral clefts in early childhood in Spain. Eighty-three patients from eight different hospitals were divided into four groups based on their type of cleft: cleft lip (CL, n = 6), unilateral cleft lip and palate (UCLP, n = 37), bilateral cleft lip and palate (BCLP, n = 16), and cleft palate only (CPO, n = 24). A control group was formed of 71 individuals. Three-dimensional (3D) digital models were obtained from all groups with an intraoral scanner, together with cephalometries and frontal, lateral, and submental facial photographs. Measurements were obtained and analyzed statistically. Our results showed craniofacial alterations in the BCLP, UCLP, and CPO groups with an influence on the palate, maxilla, and mandible and a direct impact on facial appearance. This effect was more severe in the BCLP group. Measurements in the CL group were similar to those in the control group. Cleft characteristics and cleft type seem to be the main determining factors of long-term craniofacial growth alterations in these patients. Prospective research is needed to clearly delineate the effects of different treatments on the craniofacial appearance of adult cleft patients.

A new congenital cleft palate New Zealand rabbit model for surgical research

Cleft palate repair is a challenging procedure for cleft surgeons to teach, and in research, it can be difficult to evaluate different techniques and develop new treatments. In this study, a congenital cleft palate New Zealand rabbit model has been described and could be beneficial in future studies concerning cleft palate repair. Pregnant New Zealand rabbits received 1.0 mg dexamethasone injection intramuscularly once a day from the 13th gestation day (GD13) to GD16. On GD31. Newborn rabbits were delivered by cesarean sections, fed with a standardized gastric tube feeding method, and divided into two groups. The rate of survival and the incidence of cleft palate was calculated. Weight, appearance, behavior, maxillary occlusal view, and regional anatomic and histological comparisons were recorded within 1 month after birth. Infants from the two groups with similar physiological conditions were selected for continuous maxillofacial and mandibular Micro-CT scan and three-dimensional reconstruction analysis. Ten pregnant rabbits gave birth to 48 live infants. The survival and cleft palate rates were 65.6% and 60.4% respectively. Both groups survived over 1 month with no difference in weight, appearance, and behavior. The cleft type was stable, and anatomical defects, histological characteristics, and nasal-maxillary abnormalities of the cleft were similar to those of humans. There was no statistically significant difference in maxillary and mandible development between the two groups within one month after birth. This congenital cleft palate model is considered to have more research possibilities with efficient cleft induction, reliable feeding methods, stable anatomical defects, and maxillofacial development similar to those seen in humans.

Secondary Palate Development in the Dog (Canis lupus familiaris)

OBJECTIVE

To investigate the gestational timing of morphologic events in normal canine secondary palate development as a baseline for studies in dog models of isolated cleft palate (CP).

METHODS

Beagle and beagle/cocker spaniel-hybrid fetal dogs were obtained by cesarean-section on various days of gestation, timed from the initial rise of serum progesterone concentration. Morphology of fetal heads was determined by examining serial coronal sections.

RESULTS

On gestational day 35 (d35), the palatal shelves pointed ventrally alongside the tongue. On d36, palatal shelves were elongated and elevated to a horizontal position above the tongue but were not touching. On d37, palatine shelves and vomer were touching, but the medial epithelial seam (MES) between the apposed shelves remained. Immunostaining with epithelial protein markers showed that the MES gradually dissolved and was replaced by mesenchyme during d37-d44, and palate fusion was complete by d44. Examination of remnant MES suggested that fusion of palatal shelves began in mid-palate and moved rostrally and caudally.

CONCLUSION

Palate development occurs in dogs in the steps described in humans and mice, but palate closure occurs at an intermediate time in gestation. These normative data will form the basis of future studies to determine pathophysiologic mechanisms in dog models of CP. Added clinical significance is the enhancement of dogs as a large animal model to test new approaches for palate repair, with the obvious advantage of achieving full maturity within 2 years rather than 2 decades.

Mind the gap: natural cleft palates reduce biting performance in bats

Novel morphological traits pose interesting evolutionary paradoxes when they become widespread in a lineage while being deleterious in others. Cleft palate is a rare congenital condition in mammals in which the incisor-bearing premaxilla bones of the upper jaw develop abnormally. However, ∼50% of bat species have natural, non-pathological cleft palates. We used the family Vespertilionidae as a model and linear and geometric morphometrics within a phylogenetic framework to (1) explore evolutionary patterns in cleft morphology, and (2) test whether cleft morphological variation is correlated with skull shape in bats. We also used finite element (FE) analyses to experimentally test how presence of a cleft palate impacts skull performance during biting in a species with extreme cleft morphology (hoary bat, Lasiurus cinereus). We constructed and compared the performance of two FE models: one based on the hoary bat's natural skull morphology, and another with a digitally filled cleft simulating a complete premaxilla. Results showed that cleft length and width are correlated with skull shape in Vespertilionidae, with narrower, shallower clefts seen in more gracile skulls and broader, deeper clefts in more robust skulls. FE analysis showed that the model with a natural cleft produced lower bite forces, and had higher stress and strain than the model with a filled cleft. In the rostrum, safety factors were 1.59-2.20 times higher in the model with a filled cleft than in the natural model. Our results demonstrate that cleft palates in bats reduce biting performance, and evolution of skull robusticity may compensate for this reduction in performance.

Incidence patterns of orofacial clefts in purebred dogs

Cleft lip (CL), cleft palate (CP) and cleft lip and palate (CLP) are the most common types of orofacial clefts in dogs. Orofacial clefts in dogs are clinically relevant because of the associated morbidity and high newborn mortality rate and are of interest as comparative models of disease. However, the incidence of CL, CP and CLP has not been investigated in purebred dogs, and the financial impact on breeders is unknown. The aims of this study were to document the incidence patterns of CL, CP and CLP in different breeds of dogs, determine whether defect phenotype is associated with skull type, genetic cluster and geographic location, and estimate the financial impact in breeding programs in the United States by means of an anonymous online survey. A total of 228 orofacial clefts were reported among 7,429 puppies whelped in the 12 preceding months. Breeds in the mastiff/terrier genetic cluster and brachycephalic breeds were predisposed to orofacial clefts. Certain breeds in the ancient genetic cluster were at increased odds of orofacial clefts. Male purebred dogs were at increased odds of CPs. Results confirm that brachycephalic breeds are overrepresented among cases of orofacial clefts. Furthermore, geographic region appeared to be a relevant risk factor and orofacial clefts represented a considerable financial loss to breeders. Improved understanding of the epidemiology of orofacial clefts (frequency, causes, predictors and risk factors) may help in identifying ways to minimize their occurrence. Information gained may potentially help veterinarians and researchers to diagnose, treat and prevent orofacial clefts.

Diagnosis of alveolar and root fractures in macerated canine maxillae: a comparison between two different CBCT protocols

OBJECTIVES

To compare two small-field-of-view (FOV) CBCT protocols with different voxel sizes and number of frames for the diagnosis of root and alveolar fractures in macerated canine maxillae.

METHODS

80 incisor teeth from the canine species were inserted in 80 anterior alveolar sockets of 20 canine maxillae. An operator randomly divided each maxilla site (80 sites in total) into 4 equal groups of 20 sites: 1 (sound tooth and non-fractured alveolar socket); 2 (sound tooth and fractured alveolar socket); 3 (fractured root and non-fractured alveolar socket); and 4 (fractured root and fractured alveolar socket). The CBCT images were obtained using two different protocols: normal (N) (voxel 0.20 mm, 400 frames and radiation exposure 5.6 mGy) and high definition (HD) (voxel 0.15 mm, 500 frames and radiation exposure 7.0 mGy).

RESULTS

Sensitivity numbers for alveolar fractures were lower than specificity, resulting in comparable areas under the receiver operating characteristic curves (AUC) for both protocols. Sensitivity, specificity and AUC for N and HD protocols were very similar for root fractures. When comparing AUC for both N and HD protocols by submitting them to Student's t-test, the comparison among the curves produced statistically non-significant results for alveolar fractures and root fractures likewise.

CONCLUSIONS

Our findings demonstrated that the elected protocol for the diagnosis of root and alveolar fractures was N. This protocol allowed similar diagnosis results than HD protocol; however, with a lower amount of radiation exposure for the patient (5.6 mGy for N vs 7.0 mGy for HD).