Deformation of the palate in preterm infants

Abstract

Aim-To investigate the eVect of gestation, postmenstrual age, and orotracheal intubation on palate morphology. Methods-A prospective study was made of 76 newborn infants of 25 to 41 weeks' gestation. Palate dimensions were measured on plaster models produced from serial palatal impressions. Palate size relative to that of the mouth was assessed using a ratio of palate depth to palate width (Palatal Index). Results-Palate depth and width were related to postmenstrual age and gestation. Palatal Index ranged from 0.15 to 0.57, indicating a wide variation in palate shape, but gestation and postmenstrual age had no eVect. Prolonged intubation had a small eVect, equivalent to an increase in palatal depth of less than 2 mm at 32 weeks' postmenstrual age. The eVect was transient. Conclusion-Prolonged orotracheal intubation (>10 days) leads to a small and temporary increase in palatal depth. However, this is unlikely to account for palatal grooving, which is probably caused by an overgrowth of the lateral palatine ridges. (Arch Dis Child Fetal Neonatal Ed 1998;78:F29-F32)

Isolated aglossia congenita: A rare case of oromandibular limb hypogenesis syndrome type I B

“…They defined palatal grooving as “a narrow channel of variable depth located near the midline of the palate.” Procter et al . [11] concluded that palatal grooving is due to overgrowth of lateral palatine ridges and conceded that this may be due to irritation by endotracheal tube in preterm infants or because normal resting tongue posture against the palatal vault is limited by endotracheal tube. In this case, the patient gave no history of endotracheal intubation in the neonatal period.…”

Palatal Development and Orofacial Function: Possible Effects of Preterm Care

“…(9)(13)(14)(15)(16) One study shows that while controlling for cranial width, PI is unaffected by short-term intubation (Ͻ9 days) but is greater (0.37) in preterm infants intubated for more than 10 days. (9) The PI difference resolves by term. Other studies report intubation-related changes that have lasting effects.…”

“…(12) Alternative hypotheses are head-shape narrowing and palatal collapse consequent to prolonged supine nursing amenable to head cushioning (17) or unrestrained medial growth of alveolar ridges because of open-mouth posturing. (9) A systematic review concluded that there was evidence for altered palatal morphology (grooves, asymmetries, and high-vaulted palate) in preterm infants, that intubation was a likely contributing factor, and that effects were seen early, although the evidence for persisting defects affecting the occlusion was inconsistent. (18) Some investigators have shown that palatal groove formation can be prevented using custom-made acrylic plates, (10)(19) but generic alternatives (20) or softer endotracheal tubes are ineffective.…”

“…Preterm infants have a mean PI of 0.3, as do term infants, and this remains remarkably stable during growth. (9) A leading hypothesis states that intubation affects these parameters. (9)(13)(14)(15)(16) One study shows that while controlling for cranial width, PI is unaffected by short-term intubation (Ͻ9 days) but is greater (0.37) in preterm infants intubated for more than 10 days.…”

Les jumeaux : une réponse à la question de l'influence génétique/environnement sur le développement ?

“…Les consé-quences rapportées à long terme seraient le déve-loppement d'une voûte palatine étroite, profonde et/ou asymétrique [23]. Une revue de la littérature récente [11] a souligné l'absence de consensus sur ces études et le manque de suivi à long terme sur ces enfants.…”