Syllabus
Cleft lip and palate is one of the most common congenital disorders. Full rehabilitation of these patients requires multidisciplinary treatment, which begins immediately after birth and lasts until adulthood because of the congenital defect linked hypoplasia of affected area. On a comprehensive treatment gradually, depending on the postnatal development, health and growth affected, a specialist team is involved. It consists of the plastic surgeon, dentist (orthodontist, maxillofacial surgeon, and stomatological prosthetian), speech specialist, foniatrist, audiologist, and ultimately clinical psychologist . Cleft of primary and secondary palate lie in the failure of the various embryonic processes, which may occur together. To differentiate facial participating in all three germ strips. In patients with cleft follow-up to the birth defect hypoplasia of the affected tissue centrofaciální area. Based on the physiological growth is possible, to a certain extent, to predict the resulting secondary deformity. Embryological development of the face begins at the beginning of the fourth week around a large stomodea and lasts until the end of the eighth week of gestation. Process is extremely complex. During the short period of 4 weeks is an enormous demand on the coordination of cell separation, migration and interaction. The correct amount of tissue must be the right place at the right time - any error leads to disastrous consequences. At the end of embryonic period, the human form of the face, during the fetal period, the child develops the proportions of the face. While some clefts are found in atypical locations, the majority, as well as rare cleft, will occur at site of predictable embryonic lines. So in the normal lines of fusion of different tissue . Primarily the morphological character defect has severe negative consequences for the functioning swallowing, breathing, biting and the formation of speech. Due to the presence of a number of deformities in the orofacial area, it can be assumed the dysfunction of appetite, which is very stressful for the patient and may have a negative impact not only on its maintenance, but also the overall quality of life. Clinical project will be verified objectification morphological differences (the number and quality of nerve endings, mucous membrane structure and its papillae) and through examination of necropsy. The mucosa root tongue of dead embryos with the cleft is compared with the necropsy embryos that do not have this defect. Tissue obtained from the root of the language they are ready cuts, which after processing stained. Tests will be done standart histological and imunohistologickými methods with a focus on card acetylcholinesterasy, neuron-specific enolasy, synaptophysinu and Chromogranin. The planned number of samples in each group is at least thirty. The aim is therefore to the establishment of qualitative and quantitative changes in the receptors, their number, histology, histochemistry and immunohistochemical examination due to possible pathological changes.
Part of the 3rd Medical School is a plastic surgery department, which, in the form of the Center for Cleft provides care for these patients, more than 100 years. Scientific projects are to improve, both curative and preventive care, such as benefits for detailed knowledge of origin, development and consequences of cleft lip and palate. Testing will take place at the Department of Plastic Surgery, Institute of Pathology and the Institute of Child and Youth Health with the use of technical equipment of these offices. To assess the innervation language will be chosen a random set of patients with cleft lip and palate. Findings will be compared with results of the control group, created from healthy subjects like gender and age. In addition, the existence of defects will be monitored the incidence and the potential impact of the following parameters: the number of operations in the mouth, the use of orthodontic devices, disease of upper and lower breathing ways , especially allergies and the frequency of inflammation. With regard to the innervation language will be carried out tests on the motor, sensitivity and sensors. Motor function will be examined by simple observation of crawling and tongue movements. When testing sensitive functions probes will move on stick out tongue from root to tip, from the middle of the line ends. We explore different sense of touch power . To test the sensor functions we use the sweet, salty, sour and bitter solution. The solutions will be applied gradually by cotton aplicators to taste receptors located on the edges and root language of each half separately. To a statistical evaluation method will be used logistic regression to carry out modeling the effect of monitored parameters on the perception of taste.
Tests will be conducted in both groups as well and the results will be compared and then statistically processed.
Annotation
Cleft lip and palate are one of the most common congenital defects of the face. Morphological characteristics of the cleft lip and palate has primary negative functional impact on swallowing, breathing, ,mastication, and speech formation. Therefore we also assume alterations in the innervation of the tongue. The tested group of patients will be examined with regard to these differentnesses. The results of probands will be compared with results of a group of healthy individuals.
By examining necropsies of tongue mucosa in dead embryos with cleft lip and palate which will be compared with necropsies of embryos wihout this congenital defect, will be distinguished discrepancies belonging to the prenatal period and/or to subsequent development.