A palatoplasty via the push-back method is applied for the patients with cleft palate. Disturbances such as impaired growth of maxilla, narrowing of the maxillary dental arch, malalignment, and lingual slanting of teeth occasionally occur as poor prognosis of this surgical method. The etiology of these complications has not been fully elucidated. In this research, mucoperiosteal scraping was experimentally performed at the palate, and the influence of the surgery on the early reparative processes of the palate was explored for 2 weeks postoperatively, both with histopathological and multiple fluorescence labeling approaches. The findings acquired were as follows:
1. At three days after surgery, inflammatory infiltrates and bone resorption were observed at the surface and medial side of the molar alveolar bone. A calcein (CA) labeling line produced by fluorescent pigments immediately before surgery disappeared at the medial area of the palate around the molars, while an alizarin red S (AR) line formed by the third postoperative day, and was generally thin and irregular, unlike those of the control.
2. At 1 week after surgery, the analysis of the CA line disclosed that bone resorption progressed at the medial area of the palatal bone around the molars, and subsequently the height of the palate was lowered. In these areas, sequester-like free bone fragments that showed both fluorescent CA and AR lines existed in the palatal mucosa and inflammatory granulation tissue formed around the bone fragments.
3. Free bone fragments (sequesters) were observed in the palatal mucosa at 2 weeks as well as 1 week after surgery. The height of the palatal bone lowered at the molar areas by progressive bone resorption, having a slightly concave appearance.
4. In combination with analyses of fluorescent CA and AR lines, free bone fragments were formed at both 1 week and 2 weeks after surgery, and the height of palatal bone was subsequently lowered. It is conceivable that these changes could be a plausible cause of the impaired growth of maxilla, the narrowing of maxillary dental arch, malalignment and lingual slanting of teeth after surgery.
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