Gothic palate is an abnormally high palate. The phenomenon is the symptom of various malformation complexes and thus usually has a mutation as its cause. Since severe manifestations can cause drinking and eating disorders, surgical correction is usually the treatment of choice.
What is a gothic palate?
The palate forms the roof of the oral cavity and at the same time corresponds to a floor structure of the nasal cavity. The hard palate thus separates the oral cavity from the nasal cavity. The anatomical structure serves as an abutment for the tongue during swallowing. The soft palate in turn separates the oral cavity from the nasopharynx during swallowing. In addition, the palate performs important functions in articulation and is thus a relevant tool in communication. The tissues of the palate can be affected by various malformations and anomalies that impair the functions of the palate. We speak of a gothic palate when the anatomical structure is too high. The gothic palate corresponds to a congenital malformation of the palatal tissue, which does not necessarily have to be pathological. If it is mild, it may be an anomaly that does not affect the patient further. A severe expression is associated with disease value and significantly hinders the patient’s daily life.
Causes
The cause of a palate that is too high can be found in embryonic development or genetics. The phenomenon cannot be acquired, but is basically a congenital malformation. In most cases, the malformation of the palate refers to a superordinate syndrome and is thus to be interpreted merely as a symptom of a certain primary disease. For example, the pointed or steep palate is the symptom of syndromes such as Marfan syndrome, Möbius syndrome, Noonan syndrome, Cornelia de Lange syndrome, Pallister-Killian syndrome, Sotos syndrome, and Cohen syndrome, or refers to conditions such as trisomy 8. In most cases, the primary cause of the palate malformation is a genetic mutation. The mentioned syndromes are associated with heredity. As a symptom of these syndromes, gothic palate may also be subject to familial clustering and thus may be passed on in different heritabilities. Which mutations and developmental disorders cause the malformations in detail depends in each individual case on the specific disease framework. Patients with a gothic palate are affected by a number of different symptoms. The leading symptom of the malformation is an excessively high palate structure, which impairs the function of the palate to a greater or lesser extent depending on its severity. For this reason, patients often suffer from problems with swallowing. They choke frequently and may even be prone to choking. In particular, weakness in drinking is a common accompanying symptom of palatal malformation. In addition, food particles may be aspirated. In severe cases, patients sometimes choke on their own saliva, which they frequently aspirate, for example. The speech development of patients with a strongly pronounced gothic palate is usually more difficult. Speech disorders occur. The other symptoms associated with the gothic palate depend on the underlying cause of the malformation. Disorders such as Marfan syndrome or Möbius syndrome are malformation complexes associated with malformations of a wide variety of organs and body tissues.
Diseases with this symptom
- Noonan syndrome
- Trisomy 8
- Cornelia de Lange syndrome
- Prader-Willi syndrome
- Pallister-Killian syndrome
- Sotos syndrome
Diagnosis and course
The diagnosis on a gothic palate is usually made on the basis of radiographic imaging. Not only swallowing disorders call for this radiographic imaging. In symptom complexes such as the syndromes mentioned further above, radiographic imaging usually takes place to assess and detect the cause of obvious malformations. A severely gothic palate worsens the prognosis of various malformation syndromes. The risk of food and fluid aspiration is high. For this reason, an untreated acute palate is often associated with a relatively high lethality.
Complications
A Gothic palate can lead to sometimes serious complications due to late or inadequate treatment on the one hand and therapeutic measures on the other. If the gothic palate is left untreated, dehydration, malnutrition, and various deficiencies can occur as a result of the food and fluid aspiration that occurs. In severe cases, a gothic palate can alter salivary flow to such an extent that choking episodes occur and subsequently lead to the patient’s death. Weakness in drinking is a common accompanying symptom of a malformation of the palate and is often accompanied by aspiration of ingested food. If the malformation is surgically corrected early, long-term consequences can be averted. However, normal speech development is rather unlikely and can only be secured to a certain extent by logopedic measures. Affected patients are not able to use the soft and hard palate to form sounds, even with early surgery. This leads to speech restrictions, which are compensated for by special techniques as part of the therapeutic measures. The operation itself also harbors complications: if the palate structure cannot be relocated, the patient may have to be fed intravenously to prevent further choking. If no further surgery is possible, the symptoms will persist and the patient may be permanently dependent on artificial feeding. Early treatment significantly reduces the risk of such complications.
When should you see a doctor?
Gothic palate is a congenital malformation of the palate and varies in severity in each case. Gothic palate is often diagnosed shortly after birth during early childhood medical examinations. This palate malformation does not always need to be corrected. If gothic palate is diagnosed early, parents should closely monitor their child and keep in close contact with the doctor or pediatrician. If this particular palate shape has not yet been recognized, problems with swallowing and speaking will occur early on if the deviation from the norm is too great, which in turn will soon result in a visit to the doctor. It is important to know that the palate separates the oral cavity from the nasal cavity. It acts as the roof of the oral cavity as well as the floor of the nasal cavity. The higher the curvature of the gothic palate, the greater difficulties it causes. An only slightly elevated gothic palate often does not need to be treated. On the other hand, more severe manifestations must be surgically corrected, since the Gothic palate then has the character of a massive physical handicap and without treatment would significantly impair the physical as well as psychological development of the child. Drinking difficulties in infants, difficulties in feeding and speech disorders are prominent effects of a gothic palate. With this anatomical malformation, a visit to the doctor is virtually a duty for parents with their child.
Treatment and therapy
In the context of malformation syndromes, no therapeutic options are available for causal treatment of a gothic palate. Causal therapeutic pathways address the cause of a particular condition. In the narrower context, only gene therapy can be considered as a causal therapy for the aforementioned syndromes. However, these approaches are not yet in the clinical phase. For this reason, the gothic palate is treated symptomatically in the context of malformation syndromes. Treatment of the anomaly is usually necessary even in cases of low severity and should take place as early as possible to ensure the patient’s ability to eat and breathe. Treatment is surgical and is broadly equivalent to relocation of the palatal structure to its anatomically intended location. If contraindications to surgery exist or repositioning is unsuccessful, the patient may need to be artificially fed and given intravenous fluids to prevent choking if the symptom is severe. Salivary suppressant medications may prevent choking attacks due to the patient’s own salivation. If the gothic palate is asymptomatic for the time being, it does not necessarily need to be corrected. However, symptoms will appear at the latest during speech development even if it is extremely subtle. To ensure normal speech development, logopedic accompaniment of the patient may be necessary.Since it is anatomically impossible for them to form sounds with the aid of the soft or hard palate, speech therapy does not correct the actual cause of the speech disorder, but merely teaches the affected person techniques for compensation.
Outlook and prognosis
In most cases, a gothic palate leads to various problems and discomforts with eating and drinking. The extent of these complaints depends largely on the development of the palate and its malformation. In most cases, the affected person then has to rely on surgical intervention to correct these disorders. Above all, the risk of aspiration is increased by the gothic palate, so that children are at increased risk in this regard. It is not uncommon for the disease to lead to dehydration or malnutrition. Underweight is a very unhealthy condition for the human body and should be treated in any case. If the complaint is removed in childhood, usually no secondary damage or complications occur. Similarly, gothic palate can cause speech disorders. These can be treated in various therapies.
Prevention
Gothic palate in most cases is the symptom of a genetic mutation. Because hardly avoidable factors of internal structure and external world play a role for most of them, gothic palate is difficult to prevent. Genetically inherited syndromes with symptomatic gothic palate can at best be prevented by genetic counseling.
What you can do yourself
A Gothic palate does not always require treatment by a physician. Typical complaints as a result of the malposition can be reduced with a number of measures and home remedies. Speech disorders as a result of a Gothic palate can be reduced by logopedic techniques and daily practice, among other things. Preparations from the pharmacy as well as saliva-reducing foods such as salt sticks or dried fruit help against salivation. To prevent dehydration as a result of possible fluid aspiration, sufficient water should be drunk. Malnutrition is avoided by a balanced diet. In case of severe discomfort, gothic palate should always go to the doctor. The ENT physician prescribes medication against the excessive salivation and may refer the affected person to a speech therapist, who will take further steps. At the same time, the acute palate should be spared so that the already irritated oral cavity is not further stressed. To prevent the development of a Gothic palate, parents should always encourage their children to breathe through their nose. In addition, a doctor should be consulted at the first sign of a pointed palate, as the deformity may still be correctable.