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Development of the palate
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The development of the palate is of utmost importance to the anatomist, the midwife, the gynaecologist and obstetrician, the paediatric nurse, the general practitioner, the pediatrician, the dentist, the 'ear-nose-throat' specialist, the maxillofacial surgeon and the plastic surgeon.
All of these occupations deal frequently with children who are unfortunately inflicted with facial and oral cavity developmental issues.
Through proper training and a sound anatomical background, these anomalies can be handled and the patients themselves can feel secure with a cemented plan ahead of them for recovery, consisting of minimally invasive surgery and maximum cooperation between a medical team, the family and the patient themselves. This journey starts here, with the natural development of the palate in utero.
Knowing how things should go initially can guide medical professionals to accurately and speedily diagnose a problem, as well as perfect the advised course of treatment.
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Embryological background
The in utero palate consists of the primary palate and the secondary palate. The primary palate is otherwise known as the intermaxillary segment and the protrusions from the maxillary prominences make up the secondary palate.
Anatomy and supply
The intermaxillary segment is the part of the palate that develops first overall and contains the central and lateral incisors (teeth).
Shelves are formed in the maxillary prominence that first appear as swellings and project medially towards the tongue. As the tongue descends into the floor of the mouth, it ceases to separate the converging palatal shelves and they eventually conjoin. This merger forms the secondary palate. The incisive foramen is the meeting point of both the primary and secondary palates.
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The definitive palate develops when the final fusion of the primary and secondary palates occurs, plus that of the nasal septum.
Cleft palate
A cleft palate is a common occurrence which leaves a gap between the two palatine shelves when they grow medially during development. This can result in problems with infant feeding and the main form of treatment is surgery with post-surgical orthodontic treatment and speech therapy. The lack of fusion is categorized with reference to the incisive foramen and can occur in three different ways. The description of primary, secondary and complete clefts can be seen below:
Primary cleft
This cleft is before the mark of the incisive foramen and therefore in the primary palate. The mesenchyme in the lateral palatine shelves doesn’t merge with the primary palate or intermaxillary segment as it is also known. The most common types of primary cleft include the unilateral cleft lip, the unilateral cleft alveolus, the unilateral cleft lip and primary cleft palate and the bilateral cleft lip and primary palate.
Secondary Cleft
The secondary clefts occur posterior to the incisive foramen in the secondary palate. The lateral palatine shelves don’t fuse to one another and there is a gap running down the midline of the roof of the mouth. Secondary clefts include clefts in the soft palate, unilateral clefts in the soft and hard palate and bilateral clefts in the soft and hard palate.
Complete cleft
In a complete cleft, the lip, the primary palate and the secondary palate are all affected and are all part of one big cleft. The nasal septum, the primary palate and the lateral palatine shelves all fail to fuse together in that order. This lack of development results in either a unilateral cleft lip and cleft palate or a bilateral cleft lip and cleft palate.
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