Lesson content:

Defects of the hard and soft palate can be congenital and acquired. The first relate to malformations of the maxillofacial region, the second arise as a result of trauma (gunshot, mechanical), after removal of tumors, may be a consequence of inflammatory processes (osteomyelitis), gunshot wounds. Defects of the palate in syphilis and tuberculous lupus are currently extremely rare.

Regardless of the cause of the formation of a defect in the palate, when communicating the oral cavity with the nasal cavity, functional disorders occur: speech is distorted, breathing changes, the act of swallowing is disrupted — food enters the nose and causes chronic inflammation in it.

Rehabilitation of this group of patients consists in restoring the function of chewing, swallowing, recreating the appearance, phonetics.

Acquired defects have a rash localization and shape. Unlike them, the congenital ones are located in the middle of the sky and have the shape of a cleft. Acquired defects can be located in the area of the hard or soft palate, or in both places at the same time. Unlike congenital, they are accompanied by cicatricial changes of the mucous membrane. There are anterior, lateral and median defects of the hard palate.

Anterior defects can be combined with damage to the alveolar process. At the same time, the transitional fold is deformed by scars, the upper lip is western, there is a connection of the oral cavity with the nasal cavity, there is a violation of aesthetics. In the lateral part of the palate, the defect can spread to the alveolar process with the formation of communication with the maxillary and nasal cavities. The transitional fold is also deformed by scars.

The condition of the tissues of the edge of the defect is of great importance when creating the obturating part of the prosthesis. In some patients, the defect of the hard palate is limited to a bone covered with a mucous membrane of varying degrees of compliance (hard edge). In others, the edge of the defect is formed only by soft tissues devoid of a bone base (soft edge) and easily mixed during palpation.

Defects of the hard and soft palate

Due to the communication of the oral cavity with the nasal cavity, defects in the palate can cause anomalies of individual functions. Food intake is disrupted, liquid food enters the nasal cavity, causing chronic inflammation of the mucous membrane. The change in speech manifests itself in the form of an open nasal.

Cicatricial shortening of the soft palate as a result of trauma causes swallowing disorder and can lead to hearing changes. As is known, the muscle straining the soft palate (i.e., veil palaIini) begins from the cartilaginous and membranous part of the auditory tube, facilitating the passage of air into the tympanic cavity. Damage to this muscle leads to a gaping of the auditory tube, which is the cause of chronic inflammation of the inner ear and, as a result, hearing loss.

Prosthetics of palate defects is carried out only with contraindications to plastic surgery or if the patient refuses surgery . The purpose of prosthetics is to separate the oral cavity and the nasal cavity and restore the lost functions. Prosthetics for defects of the palate in each patient has its own characteristics, determined by the presence of teeth on the upper jaw, the localization and magnitude of the defect and the condition of the tissues of its edge.

If a patient has a cleft palate, it is necessary to carry out differential diagnosis with Stickler syndrome. According to Christian St011 and Charlotte 0pitz (2004), in newborn children this syndrome occurs with a frequency of 1: 10,000 to 1:20,000. The basis of this syndrome is degenerative changes in the joints, organs of vision and hearing (hereditary progressive arthroophthalmopathy). Autosomal dominant inheritance with full penetrance and very variable expressiveness has been established. At the age of 15-30, early progressive arthritis appears, but its severity gradually decreases. Arthritis is manifested by painful limitations of joint mobility, sometimes inflammatory signs, an increase in large joints of the extremities, hip subluxations with walking disorders, as well as thoracic kyphosis and scoliosis. At the same time, progressive myopia of a high degree is observed.

In 50% of patients with Stickler syndrome, progressive retinal detachment occurs. On average, 21% of patients have hearing impairment with impaired sound perception and sound conduction. Usually such patients are of low stature and significantly lag behind in development.

From an orthodontic point of view, the anomaly of the teeth and jaws is important, since in addition to hypoplasia of the upper jaw, Pierre Robin syndrome is observed: micrognathia of the lower jaw, glossoptosis, as well as complete or hidden cleft palate.Patients have muscle hypotension, and 43% of men and 50% of women have mitral valve prolapse.Early correct diagnosis of this syndrome is a prerequisite for a positive effect on the further course of the disease, For the success of appropriate treatment, the cooperation of various specialists is necessary: pediatrician, pediatric cardiologist, orthopedist, ophthalmologist, maxillofacial-a facial surgeon, a phoniator. teacher-audiologist, otolaryngologist, medical geneticist, dentist, orthodontist.

 PROSTHETICS for MEDIAN DEFECTS OF THE HARD PALATE AND THE PRESENCE OF TEETH IN THE UPPER JAW

Patients with small defects of the hard palate located in its middle part, in the presence of a sufficient number of teeth for clamp fixation, are prosthetics with arc prostheses. The arch of the prosthesis carries the obturating part. When there are no conditions for fixing the arch prosthesis or there is an extensive defect of the hard palate, a removable plate prosthesis is used. It should fit snugly to the edges of the defect, creating a reliable separation of the oral cavity and nose. To do this, it is recommended, retreating from the edge of the defect by mm, to make a roller, which, plunging into the mucous membrane, creates a closing valve around the defect. However, with a thin and slightly malleable mucous membrane or the presence of scars along the edge of the defect, such a roller can damage the prosthetic bed. To create a tight fit of the prosthesis around the defect, you can use an elastic plastic lining or use the following method. A layer of gypsum 0.3—0.5 mm thick and mm wide from the edge of the defect is removed on the gypsum model before replacing the wax with plastic. The prosthesis made on such a model will squeeze the mucous membrane around the defect, creating a good closing valve.

In the presence of all teeth on the jaw and a median defect of the hard palate, an arc prosthesis or a palatal base plate is used. The impression from the upper jaw is removed with elastic impression materials with preliminary tamponade of the defect with gauze napkins.

PROSTHETICS FOR MEDIAN DEFECTS

HARD PALATE AND TOOTHLESS UPPER JAW

The main difficulty encountered by an orthopedic dentist in prosthetics of patients of this group is the fixation of the prosthesis. It is not possible to ensure a good fixation of a complete removable prosthesis using known techniques. When inhaled through the nose, air enters through the defect under the prosthesis and resets it. Thus, it is impossible to create negative air pressure under the prosthesis in the usual way. Some authors recommend using magnets and springs to hold the prosthesis on the toothless upper jaw. The introduction of the rigid obturating part of the prosthesis into the defect of the palate and the prosthesis did not justify itself. The proposal of V. Y. Kurlandsky, who proposed to create external and internal closing valves in such conditions, deserves attention. The inner one was provided with a roller on the palatine surface of the prosthesis