OBJECTIVE: The use of composite chondromucosal nasal septal flaps (ccNSF) has been demonstrated to be effective in cadaveric studies for the anterior skull base and the orbit. However, their application in the clinical setting remains unexplored. Our study aims to introduce a new method for treating palatal defects using ccNSF. Additionally, we studied the average NSF area and compared it to the average palate area.
METHODS: We collected 108 CT scans from the medical records of patients without head and neck pathologies from a tertiary medical institution. We quantified the quadrangular (septal) cartilage and palate areas. Furthermore, we included a clinical case in which we used the ccNSF for the palatal defect reconstruction. This was to compare the mean area between the palate and the septal cartilage.
RESULTS: The ccNSF covered the palatal defect without any significant complications for the first 9 months of follow-up. A total of 102 CT scans met the inclusion criteria and were measured. We found that the mean quadrangular cartilage had a length of 2.50 (±0.52) cm, a width of 2.28 (±0.51) cm, and an area of 5.43 (±1.68) cm2. The mean palate length was 2.73 (±0.44) cm, with a width of 3.13 (±0.34) cm, and area of 7.87 (±1.43) cm2.
CONCLUSIONS: The ccNSF proved successful in palatal defect reconstruction, resulting in positive outcomes and no major complications until the 9-month follow-up. The ccNSF is a useful flap that avoids the use of free flap transfer and its associated morbidities.
METHODS: 4 Laryngoscope, 2024.

Cleft palate is the most common facial birth defect worldwide. It is caused by environmental factors or genetic mutations. Environmental factors such as pharmaceutical exposure in women are known to induce cleft palate. The aim of the present study was to investigate the protective effect of Sasa veitchii extract against medicine-induced inhibition of proliferation of human embryonic palatal mesenchymal cells. We demonstrated that all-trans-retinoic acid inhibited human embryonic palatal mesenchymal cell proliferation in a dose-dependent manner, whereas dexamethasone treatment had no effect on cell proliferation. Cotreatment with Sasa veitchii extract repressed all-trans-retinoic acid-induced toxicity in human embryonic palatal mesenchymal cells. We found that cotreatment with Sasa veitchii extract protected all-trans-retinoic acid-induced cyclin D1 downregulation in human embryonic palatal mesenchymal cells. Furthermore, Sasa veitchii extract suppressed all-trans-retinoic acid-induced miR-4680-3p expression. Additionally, the expression levels of the genes that function downstream of the target genes ( ERBB2 and JADE1 ) of miR-4680-3p in signaling pathways were enhanced by cotreatment with Sasa veitchii extract and all-trans-retinoic acid compared to all-trans-retinoic acid treatment. These results suggest that Sasa veitchii extract suppresses all-trans-retinoic acid-induced inhibition of cell proliferation via modulation of miR-4680-3p expression.

Palatal injections are considered to be one of the most painful dental procedures. As a result, it was important to find alternatives to this painful injection to improve children\'s cooperation. The dental literature mentioned using EMLA cream as a possible alternative to conventional injections, but its anesthetic effect was debated. Therefore, it was valuable to research the impact of microneedle patches to enhance the effectiveness of this cream. The purpose of this randomized controlled clinical trial was to compare the effectiveness of different methods of anesthesia and pain levels in children aged 7-11 years. The study compared the use of EMLA cream, EMLA with microneedles, and conventional palatal injections. A total of 90 children were randomly assigned to three groups: Group 1 received conventional palatal anesthesia (control), Group 2 received EMLA cream only, and Group 3 received EMLA with microneedles. Pain levels were assessed using the FLACC and Wong-Baker scales at three different time points: T1(during anesthesia), T2(on palatal probing), and T3(during extraction). The FLACC scale revealed a significant difference in pain between groups only at T1 (P value = 0.000). It was found that the conventional palatal injection group had a higher pain level than the EMLA cream-only group and the group using microneedle patches with EMLA cream (P value = 0.000). However, the other groups did not show significant differences in pain levels during the anesthesia (P value  = 1.00). Similarly, the Wong-Baker scale also demonstrated a statistically significant difference in pain between groups only at T1 (P value  = 0.000). It was found that the conventional palatal injection group had a higher pain level than the EMLA cream-only group and the group using microneedle patches with EMLA cream (P value  = 0.000). However, the other groups did not show significant differences in pain levels during the anesthesia (P value  = 0.091). The study concludes that both EMLA cream alone and EMLA with microneedles can be used as an alternative to conventional palatal anesthesia for children.

The present systematic review (SR) aims to evaluate manuscripts in order to help further elucidate the following question: is the micronucleus assay (MA) also a useful marker in gingiva, tongue, and palate for evaluating cytogenetic damage in vivo? A search was performed through the electronic databases PubMed/Medline, Scopus, and Web of Science, all studies published up to December 2023. The comparisons were defined as standardized mean difference (SMD), and 95% confidence intervals (CIs) were established. Full manuscripts from 34 studies were carefully selected and reviewed in this setting. Our results demonstrate that the MA may be a useful biomarker of gingival tissue damage in vivo, and this tissue could be a useful alternative to the buccal mucosa. The meta-analysis analyzing the different sites regardless of the deleterious factor studied, the buccal mucosa (SMD = 0.69, 95% CI, - 0.49 to 1.88, p = 0.25) and gingiva (SMD = 0.31, 95% CI, - 0.11 to 0.72, p = 0.15), showed similar results and different outcome for the tongue (SMD = 1.19, 95% CI, 0.47 to 1.91, p = 0.001). In summary, our conclusion suggests that the MA can be a useful marker for detecting DNA damage in gingiva in vivo and that this tissue could be effective site for smearing.

BACKGROUND This study aimed to evaluate the morphological characteristics of the anterior maxillary nasopalatine canal and the width of the buccal bone using cone-beam computed tomography (CBCT) in 150 adults in Northern Cyprus. MATERIAL AND METHODS The study included 150 participants, and their anterior maxillary morphometric measurements (eg, length of the nasopalatine canal and anteroposterior diameter of the nasal foramen) were taken using CBCT with the scanning parameters of 90 kvP, 24 s, 4 mA, voxel size 0.3 mm, and field of view 10×6 cm. The shapes of the nasopalatine canal (NPC) were categorized into 4 types: cylindrical, hourglass, funnel-shaped, and banana (54%, 20.6%, 18.6%, and 4%, respectively). RESULTS The findings showed a clear link between the shape of the NPC and the horizontal dimensions of the anterior maxilla\'s morphometric properties. In general, decreased horizontal bone dimensions were found in the premaxilla at the banana- and funnel-shaped type for the nasopalatine canal. Also, the anteroposterior diameter of a nasal foramen in the hourglass shape was significantly larger in diameter than all other shapes. Additionally, the morphology of the nasopalatine canal is influenced by its shape. The sagittal cross-section has shown significant correlations with the sizes of the incisive foramen, nasal foramen, and the length of the nasopalatine canal. CONCLUSIONS The study found a correlation between the shape of the NPC and the horizontal dimensions of the anterior maxilla\'s anatomy. The measurements of NPC in a North Cyprus population slightly differ from the established standards found in the existing literature. Conducting more extensive studies with a larger number of CBCT images will offer additional insights.

BACKGROUND: The primary purpose of this two-arm, parallel design, randomized controlled study is to compare healing of the palatal tissue donor site when platelet-rich fibrin (PRF) is used as a wound dressing compared to the use of a hemostatic agent. Secondary outcomes of patient pain perception and analgesic intake were also evaluated.
METHODS: Seventy-four patients receiving free gingival grafts were randomized to receive either PRF (test) or hemostatic agent (control) as a palatal wound dressing by patients selecting a sealed envelope containing their group assignment (initially 37 envelopes for PRF group and 37 for hemostatic agent group). Patient pain assessment and analgesic consumption were documented using a 21-point numerical scale (NMRS-21) at 24, 48, and 72 hours post-surgery. At 1-, 2-, 3-, and 4-week follow-up appointments palatal early healing index (PEHI) scores including wound color, epithelialization, presence or absence of swelling, granulation tissue, and bleeding on gentle palpation were generated by direct intraoral examination by a blinded examiner unaware of the patients\' treatment group.
RESULTS: NMRS-21 pain scores showed a significant reduction in pain over time in both groups, with no significant difference between groups at any time point. No significant between-group difference was found in the amount of analgesics taken by patients at 24, 48, and 72 hours. There was significant improvement in PEHI scores over the 4-week time period in both groups, but there was no significant difference in PEHI score at each time point (1, 2, 3, 4 weeks) between groups.  CONCLUSIONS: Study findings suggest that there is no difference in early palatal wound healing, patient pain perception, or analgesic consumption between use of PRF or a hemostatic agent as donor-site wound dressings.

Mucoepidermoid carcinoma is a malignant tumor that arises from the salivary glands. The recommended treatment strategy typically involves surgical intervention, sometimes complemented by radiotherapy, depending on the histological grade of the tumor. A case of a 22-year-old female patient without medical history was described. The clinical examination revealed a bluish lesion located on the hard palate. The histological examination confirmed the diagnosis of a low-grade mucoepidermoid carcinoma. Resection of the lesion was performed and oro-nasal communication was immediately closed by a prosthetic obturator and later on by a rotational palate flap. The patient was followed up for 12 months, and there was no evidence of any recurrence. This article highlights the importance of prompt clinical diagnosis of such lesions and provides an opportunity to review these cancer therapeutic measures to reduce postoperative morbidity.

BACKGROUND The nasopalatine canal (NPC), or incisive canal, is located in the midline of the palate, posterior to the maxillary central incisors. Its anatomy is important in prosthetic dentistry procedures. This study aimed to assess the anatomical morphology of the NPC according to age, sex, and dental status using cone-beam computed tomography (CBCT) in 335 patients. MATERIAL AND METHODS In this retrospective cross-sectional study, a total of 335 patients were recruited and categorized according to sex, age, and dental status. Individual CBCT images were analyzed in the sagittal, coronal, and axial planes. Also, we recorded the dimensions and morphological shape of the NPC and adjacent buccal bone plate (BBP) under standardized conditions. The associations between sex, age group, NPC shapes and types, and presence of central incisors were assessed. A significance level was set at P<0.05. RESULTS Mean labio-palatal and mediolateral measurements of the incisive foramen were 5.13±1.45 mm and 3.21±0.96 mm, whereas the mean diameter of Stenson foramen was 2.57±1.25 mm, and the total length of the NPC was 11.79±2.50 mm. Funnel, Y, and round-shaped canals were the most prevalent shapes of the NPC in sagittal, coronal, and axial planes. BBP was greater in men, with P=0.011, P=0.000, and P=0.001 at BBP1, BBP2, and BBP3, respectively. CONCLUSIONS NPC and BBP parameter values were slightly higher among male patients. NPC parameters increased with older age. The crest width of BBP decreased with older age and after missing maxillary central incisor teeth.

OBJECTIVE: This study investigated the influence of different palatal morphologies on the accuracy of intraoral scanning (TRIOS 4) of edentulous maxillae.
METHODS: Six typodonts were fabricated for different palatal morphologies with flat (F), medium (M), and deep (D) palates, with palatal wrinkles (W), or smooth palates (S), resulting in six groups: WF, WM, WD and SF, SM, SD. Ten scans were performed for each group; standard tessellation language files obtained were imported into a software to measure trueness and precision in micrometer. Trueness was calculated as the mean of the standard deviation values obtained by superimposing each scan onto the reference scan. Precision was achieved by overlapping each scan with that with the best trueness in the group. Descriptive and post-hoc analyses were conducted.
RESULTS: The mean values for trueness were as follows: WM=48.7±4.7, WD=161.7±18.4, WF=85.9±16, SM=48.1±2.4, SD=349.9±8.8, and SF=349.1±25.5. The precision values were as follows: WM=46.7±7.3, WD=46.9±9, WF=48.9±6.7, SM=46±2.7, SD=105.9±17.4, SF=72.6±10.8. Significant differences were observed for trueness between SM and SD (P < 0.001), SM and SF (P < 0.001), and WF and SF (P = 0.003); whereas for precision, significant differences were reported between WD and SD (P = 0.015). Regarding trueness and precision, no difference was found between WM and SM (P = 1.0).
CONCLUSIONS: Medium palatal depth showed the best accuracy. The mean accuracy values were within the clinical acceptability thresholds for all palatal morphologies. The presence of rugae improved the precision of deeper palates and the trueness of flat palates. No differences were observed in the medium palates with or without rugae.

OBJECTIVE: To overview the literature to answer the following question: \"What is the performance of different therapies on wound healing and postoperative discomfort after palatal ASTG removal?\"
METHODS: SRs that evaluated the wound healing (WH), postoperative pain, bleeding, and analgesic consumption of patients submitted to de-epithelialized/free gingival grafts (FGG) or subepithelial connective tissue grafts (SCTG) removed from the palate were included. The searches were conducted on six white and two gray databases up to December 2023. Methodological quality was evaluated through AMSTAR 2. The synthesis of results was described as a narrative analysis.
RESULTS: Ten SRs (involving 25 randomized clinical trials) related to low-level laser therapy (LLLT) (3), platelet-rich fibrin (PRF) (4), cyanoacrylate tissue adhesives (CTA) (2), and ozone therapy (OT) (1) were included in this overview. All techniques demonstrated improvements in WH. LLT, PRF, and CTA reduced pain and analgesic consumption. PRF and CTA reduced bleeding. Regarding methodological quality, the SRs were classified as critically low (2), low (5), moderate (2), or high quality (1).
CONCLUSIONS: In SRs related to LLLT, PRF, CTA, and OT, the use of different therapies after palatal ASTG removal improved WH and postoperative discomfort. Due to the studies\' low methodological quality and high heterogeneity, data should be interpreted with caution.
CONCLUSIONS: The present overview compiles the evidence of SRs related to different therapies for WH and patients\' postoperative experience and reveals that different treatments can significantly improve the clinical outcomes of patients who require ASTG removal for periodontal or peri-implant surgeries.
BACKGROUND: PROSPERO registration number: CRD42022301257.