Palatal Groove Formation and Oral Endotracheal Intubation

Carrillo, Peter

doi:10.1001/archpedi.1985.02140110013008

Cited by 6 publications

(7 citation statements)

References 5 publications

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“…In the experience of some authors, the prominence of the lateral palatine ridges recedes after extubation, with a normal tongue motion ensuing and the palate having a normal appearance by the age of 2 years [ 2 , 21 , 22 ].…”

Section: Resultsmentioning

confidence: 99%

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Palatal development of preterm and low birthweight infants compared to term infants – What do we know? Part 2: The palate of the preterm/low birthweight infant

et al. 2005

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BackgroundWell-designed clinical studies on the palatal development in preterm and low birthweight infants are desirable because the literature is characterized by contradictory results. It could be shown that knowledge about 'normal' palatal development is still weak as well (Part 1). The objective of this review is therefore to contribute a fundamental analysis of methodologies, confounding factors, and outcomes of studies on palatal development in preterm and low birthweight infants.MethodsAn electronic literature search as well as hand searches were performed based on Cochrane search strategies including sources of more than a century in English, German, and French. Original data were recalculated from studies which primarily dealt with both preterm and term infants. The extracted data, especially those from non-English paper sources, were provided unfiltered for comparison.ResultsSeventy-eight out of 155 included articles were analyzed for palatal morphology of preterm infants. Intubation, feeding tubes, feeding mode, tube characteristics, restriction of oral functions, kind of diet, cranial form and birthweight were seen as causes contributing to altered palatal morphology. Changes associated with intubation concern length, depth, width, asymmetry, crossbite, and contour of the palate. The phenomenon 'grooving' has also been described as a complication associated with oral intubation. However, this phenomenon suffers from lack of a clear-cut definition. Head flattening, pressure from the oral tube, pathologic or impaired tongue function, and broadening of the alveolar ridges adjacent to the tube have been raised as causes of 'grooving'. Metrically, the palates of intubated preterm infants remain narrower, which has been examined up to the age of the late mixed dentition.ConclusionThere is no evidence that would justify the exclusion of any of the raised causes contributing to palatal alteration. Thus, early orthodontic and logopedic control of formerly orally intubated preterm infants is recommended, as opposed to non-intubated infants. From the orthodontic point of view, nasal intubation should be favored. The role that palatal protection plates and pressure-dispersing pads for the head have in palatal development remains unclear.

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Section: Resultsmentioning

confidence: 99%

“…However, one study revealed that grooving occurred even with laterally positioned tubes. The author attributed this to insufficient tongue thrust against the palatal shelves, allowing the shelves to grow together [ 22 ]. Even a laterally positioned tube may exert pressure in the rear palatal area, also giving rise to grooving [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

Palatal development of preterm and low birthweight infants compared to term infants – What do we know? Part 2: The palate of the preterm/low birthweight infant

et al. 2005

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“…These findings are in line with authors who reported the need for OTI in relation to birth weight, since 100% of the children born with a birth weight ≤ 1000 g require IMV by OTI, while 85.5% of children with a birth weight between 1001 g and 2500 g required IMV by IOT [12][13][14][15] . The duration of IMV by OTI is influenced by iatrogenic effects related to the palate [16][17][18][19] . Herein, the mean duration of OTI was 25.3 days, which is shorter than that observed by Fadavi et al 20 and Hohoff et al 21 , who recommended a period longer than 30 days.…”

Section: Discussionmentioning

confidence: 99%

Influence of orotracheal intubation on preterm infant palate shape between 12 and 24 months old

Costa¹,

Santos²,

Carvalho³

et al. 2017

J Oral Diag

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Introduction: Mechanical ventilation (MV) is indicated in diverse clinical situations in which the individual develops acute or chronic respiratory failure. Objective: To evaluate the palate shape of preterm infants aged 12 to 24 months who were submitted to orotracheal intubation (OTI) and mechanical ventilation. Methods: This cross-sectional observational study included preterm infants submitted to MV by OTI for at least seven days, who weighed less than 2000 g at birth, and were attended at the Preterm Infant Care Outpatient Clinic of the University Hospital of the University of São Paulo and the Premature Infant Outpatient Clinic of the Children's Institute of the Clinics Hospital of the School of Medicine of the University of São Paulo. Sociodemographic data were collected from neonatal medical records of the participating children. The oral cavity was examined to classify palate shape into square, narrow or ovoid. Statistical analyses were performed using the ANOVA F, Kruskal-Wallis and Chi-square tests, with a 5% significance level. Results: The mean period of OTI was 25.3 ± 25.8 days, and the children presented a significantly higher percentage of narrow shaped palate (p<0.001). Conclusion: The palate in preterm infants submitted to invasive MV by OTI is predominantly narrow and deep.

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“…The groove is caused by constriction of the palate adjacent to the tube [ 47 ]. This broadening of the alveolar ridges creates the false impression that the palate has been eroded as a groove; in fact, the palate is intact but partially obscured [ 50 - 52 ]. This finding is confirmed metrically [ 32 ]: ' Palatal grooving did not always correspond with relative palatal depth, but did usually occur in intubated infants.…”

Section: Discussionmentioning

confidence: 99%

“…4. Several authors [ 4 , 28 , 50 - 52 ] regard an impeded tongue function as the cause of the palatal deformation. Grooving was observed even when the tube did not have a midline location, as there was also an absence of tongue thrust against the palatal shelves, which allowed the shelves to grow together [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Palatal development of preterm and low birthweight infants compared to term infants – What do we know? Part 3: Discussion and Conclusion

et al. 2005

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BackgroundIt has been hypothesized that prematurity and adjunctive neonatal care is 'a priori' a risk for disturbances of palatal and orofacial development which increases the need for later orthodontic or orthognathic treatment. As results on late consequences of prematurity are consistently contradictory, the necessity exists for a fundamental analysis of existing methodologies, confounding factors, and outcomes of studies on palatal development in preterm and low birthweight infants.MethodA search of the literature was conducted based on Cochrane search strategies including sources in English, German, and French. Original data were recalculated from studies which primarily dealt with both preterm and term infants. The extracted data, especially those from non-English paper sources, were provided unfiltered in tables for comparison (Parts 1 and 2).ResultsMorphology assessment of the infant palate is subject to non-standardized visual and metrical measurements. Most methodologies are inadequate for measuring a three-dimensional shape. Several confounding factors were identified as causes contributing to disturbances of palatal and orofacial development.ConclusionTaking into account the abovementioned shortcomings, the following conclusions may be drawn for practitioners and prospective investigators of clinical studies. 1) The lack of uniformity in the anatomical nomenclature of the infant's palate underlines the need for a uniform definition. 2) Metrically, non-intubated preterm infants do not exhibit different palatal width or height compared to matched term infants up to the corrected age of three months. Beyond that age, no data on the subject are currently available. 3) Oral intubation does not invariably alter palatal morphology of preterm and low birthweight infants. 4) The findings on palatal grooving, height, and asymmetry as a consequence of orotracheal intubation up to the age of 11 years are inconsistent. 5) Metrically, the palates of orally intubated infants remain narrower posteriorly, beginning at the second deciduous molar, until the age of 11 years. Beyond that age, no data on the subject are currently available. 6) There is a definite need for further, especially metrical, longitudinal and controlled trials on palatal morphology of preterm and low birthweight infants with reliable measuring techniques. 7) None of the raised confounding factors for developmental disturbances may be excluded until evident results are presented. Thus, early orthodontic and logopedic control of formerly premature infants is recommended up to the late mixed dentition stage.

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Palatal Groove Formation and Oral Endotracheal Intubation

Cited by 6 publications

References 5 publications

Palatal development of preterm and low birthweight infants compared to term infants – What do we know? Part 2: The palate of the preterm/low birthweight infant

Palatal development of preterm and low birthweight infants compared to term infants – What do we know? Part 2: The palate of the preterm/low birthweight infant

Influence of orotracheal intubation on preterm infant palate shape between 12 and 24 months old

Palatal development of preterm and low birthweight infants compared to term infants – What do we know? Part 3: Discussion and Conclusion

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