PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/146302 Please be advised that this information was generated on 2021-10-10 and may be subject to change. SUBPERIOSTEAL PALATAL SOFT TISgUE^EXEANSIOPL ^PY"-**" 33 ίΐί^Γί RI gjffi1'Д: : Jg? '.r Г-І: ж 1996 SUBPERIOSTEAL PALATAL SOFT TISSUE EXPANSION An experimental study in growing domestic cats SUBPERIOSTALE PALATINALE WEEFSELEXPANSIE Een experimenteel onderzoek bij groeiende katten CIP-DATA KONINKLIJKE BIBLIOTHEEK, DEN HAAG Van Damme, Philippus Anne Subperiosteal palatal soft tissue expansion - An experimental study in growing domestic cats / Phihppus Anne Van Damme -[SI s η ] -111 Thesis Nijmegen - With ref -With summary in Dutch ISBN: 90-9009954-9 Subject headings tissue expansion / cleft palate / experimental study / reconstructive surgery / growth & development С Ph A Van Damme, Nijmegen, 1996 No part of this book may be reproduced in any form, by print, photoprint or any other means without written permission from the publisher Niets uit deze uitgave mag worden verveelvoudigd en/of openbaar gemaakt door middel van druk, fotokopie, microfilm of welke andere wijze dan ook, zonder voorafgaande toestemming van de uitgever SUBPERIOSTEAL PALATAL SOFT TISSUE EXPANSION An experimental study in growing domestic cats Een wetenschappelijke proeve op het gebied van de Medische Wetenschappen. PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Katholieke Universiteit Nijmegen, volgens besluit van het College van Decanen in het openbaar te verdedigen op vrijdag 6 december 1996 des namiddags om 1.30 uur precies door Philippus Anne van Damme geboren op 4 juni 1953 te Yerseke 1996 Druk: Drukkerij Elinkwijk b.v., Utrecht Promotores Prof.dr. H.P.M. Freihofer Prof.dr. A.M. Kuijpers-Jagtman Copromotor Dr. J.C. Maltha Manuscriptcommissie Prof.dr. P.H.M. Spauwen Prof.dr. P. van den Broek Prof.dr. P. Egyedi (UU) Prof.dr. P.CM. van de Kerkhof Dr. J.H.A. van Rappard Deze studie werd verricht op de afdeling Mond- en Kaakchirurgie van het Academisch Ziekenhuis Nijmegen, St. Radboud (hoofd: Prof.dr. H.P.M. Freihofer), op het Centraal Dierenlaboratorium (hoofd: Dr. J.P. Koopman, eertijds Prof.dr. W.J.L. van der Gulden) en bij de vakgroep Orthodontie en Orale Biologie (hoofd: Prof.dr. A.M. Kuijpers-Jagtman, eertijds Prof.dr. F.P.G.M, van der Linden) van de Katholieke Universiteit Nijmegen. Dit onderzoek was onderdeel van hoofdprogramma VI "Orale Aandoeningen en Steunweefselziekten". SUBPERIOSTEAL PALATAL SOFT TISSUE EXPANSION An experimental study in growing domestic cats A scientific proof in the field of Medical Sciences THESIS submitted to fulfil the requirements of the Ph D Degree in Medical Sciences of the University of Nijmegen, according to the decision of the Board of Deans to be defended in public on Friday December 6, 1996 at 1 30 ρ m by Philippus Anne van Damme born June 4, 1953 in Yerseke 1996 Printed in the Netherlands by Drukkerij Ehnkwijk b ν , Utrecht Paranimfen Dr С Jansen Drs BJC Rijnders This research-project was materially supported by CUI, Cox Uphoff International, Carpintería, Ca , U S A , Inamed В V , Breda, The Netherlands, J Laverman Dental Laboratory В V , Ewijk, The Netherlands The realisation and publication of this thesis was financially supported by Byk Nederland В V (Tramal"), Zwanenburg, The Netherlands, Cavex Holland В V (CA 37 Superior Pink"), Haarlem, The Netherlands, Hoechst Pharma (Ultracain"), Amsterdam, The Netherlands, ICI Farma (Corsodyl"), Ridderkerk, The Netherlands, Inamed В V (CUIR, IntraventTni), Breda, The Netherlands, Jansen-Cilag (Durogesic"), Tilburg, The Netherlands, Johnson & Johnson Medical В V (Ethicon Division, Vicryl"), Amersfoort, The Netherlands, Knoll В V (former Boots Pharmaceuticals В V , Hilversum) (Brufen" Bruis), Amsterdam, The Netherlands, Krijnen Medical В V (WurzburgR), Beesd, The Netherlands, J Laverman Dental Laboratory В V , Ewijk, The Netherlands, Nutricia Nederland В V (Nutrison"), Zoetermeer, The Netherlands, Roche Nederland В V (former Sarva-Syntex Nederland В V , Rijswijk) (Naprosyne"), Mijdrecht, The Netherlands, J Van Straten Medische Techniek, Nieuwegein, The Netherlands Cover CUIR custom-made tissue expanders photographed by J A Η Meeuwissen (1990) To the memory of my parents To Akke To our children Maximilian, Rebecca and Damián Contents Chapter 1 General introduction 13 Chapter 2 Cranio-maxillofacial tissue expansion, experimentally based or clinically empiric? A review of the literature . 29 Published in the Journal of Cranio-Maxillofacial Surgery (1992) 20: 61-69. Chapter 3 Two-dimensional cephalometric analysis of the effects of subperiosteal palatal soft tissue expansion in growing cats 59 Accepted for publication by the Journal of Plastic and Reconstructive Surgery, 1996. Chapter 4 Three-dimensional morphometric analysis of the effects of subperiosteal palatal soft tissue expansion in growing cats 83 International Journal of Oral and Maxillofacial Surgery (1996). In press. Chapter 5 Histological analysis of the effects of palatal mucoperiosteal soft tissue expansion in growing cats ... 105 Submitted to International Journal of Oral and Maxillofacial Surgery, 1996. Chapter 6 Palatal mucoperiosteal expansion as an adjunct to palatal fistula repair. Case report and review of the literature 135 Published in Cleft Palate-Craniofacial Journal (1996) 33: 255-257. Chapter 7 General discussion 145 Chapter 8 Summary 161 Chapter 9 Samenvatting 167 Chapter 10 Survey of recent literature 173 Acknowledgements 189 Curriculum vitae 195 Publications 197 Chapter 1 General introduction General introduction 1.1 Prevalence of cleft lip and palate Cleft lip and palate (CLP) comprises a complex of congenital anomalies with a prevalence in the Netherlands of approximately 175/100.000 births/year (Van den Akker et ai, 1987; NVSCA, 1996). The mean prevalence in the whole of Europe is approximately 88/100.000 births (Cornel et al., 1992). There is a variability in the prevalence throughout Europe, with higher figures in the North-West and unexplained lower figures in the South and South-East. CLP may occur unilaterally or bilaterally, and the cleft can be complete or incomplete. Isolated clefts in the palate or the lip do occur. Different combinations of clefts in lip, alveolus and palate are the most common forms (Härtel et al., 1991). Clefts may be associated with known sequences and syndromes such as Pierre Robin sequence, orofacial clefting, Van der Woude, Stickler, Shprintzen, Saethre-Chotzen, Treacher Collins, and Apert syndromes, as well as with other anomalies (Gorlin et al., 1990, Morris et al. 1993). The aetiology and pathogenesis of the disorder are multifactorial. Genetic abnormalities and/or noxious stimuli during the first weeks of gestation, when early development of the face takes place (Pfeifer, 1991), are the main causes. Disturbances in the fusion or merging of nasal and maxillary processes may give rise to various types of clefts (Härtel et al., 1991). Inadequate apoptosis or programmed cell death might be involved in the development of clefts (Vermeij-Keers et al., 1983, 1990; Mangold, 1991). 1.2 Aspects of treatment related to maxillary growth The interdisciplinary treatment of CLP in the Netherlands is basically organized in multidisciplinary cleft palate centres, which are generally attached to university hospitals. The Nijmegen Cleft Palate Centre is one of the major centres in the Netherlands. The treatment in Nijmegen starts, if need be, with presurgical orthopaedic appliances directly after birth, according to the principles of Hotz and Gnoinski (1979), followed by closure of the cleft of the lip at the age of 3-6 months. At the age of 12-18 months, 15 Chapter 1 the soft palate cleft is closed (Kuijpers-Jagtman and Borstlap, 1992). Closure of the hard palate and alveolar cleft is delayed until the age of 8 to 12 years and is performed before eruption of the permanent canines through the alveolar bone (Koberg, 1973; Egyedi, 1985; Witsenburg, 1985; Borstlap et al., 1990; Witsenburg and Freihofer, 1990; Freihofer et al., 1991; Freihofer and Kuijpers-Jagtman, 1993; Freihofer et al., 1993). In other centres, however, different schedules of surgical treatment are used, based on different philosophies and strategies. Early closure of the hard palate is claimed to be beneficial for speech development, and according to several authors it does not cause serious maxillary growth retardation (Pfeifer, 1991; Correa Normando et al., 1992). On the other hand it has been reported that any kind of lip and/or palatal surgery at an early age, gives rise to retardation and impairment of growth and development of the dentomaxillary complex especially in those cases in which the bone is denuded by stripping of the mucoperiosteum and in which healing is allowed by secondary intention (Herfert, 1954; Bardach and Eisbach, 1977; Eisbach et α/. ,1978; Bardach and Mooney, 1984; Wijdeveld et al., 1988; Pfeifer, 1991; Correa Normando et ai, 1992, Noverraz et ai, 1993; Kuijpers-Jagtman, 1995; Leenstra et al., 1995b). Antero-posterior and vertical growth disturbances of the maxillo­ facial structures are less pronounced in cases where the cleft is surgically untreated. In such cases, hardly any visual impact on the profile of the non- cleft side is apparent (Bishara et al., 1976; Derijcke et ai, 1990; Mars and Houston, 1990; Correa Normando et ai, 1992). Untreated cases,