The Ogival Palate: A New Risk Marker of Sudden Unexpected Death in Infancy?

Abstract

ObjectiveOgival palate (i.e., a narrow and high-arched palate) is usually described in obstructive breath disorder but has been found in infants unexpectedly deceased. We studied the association between ogival palate and sudden unexpected death in infancy (SUDI) on the basis of a computed tomography (CT) evaluation.MethodsWe conducted a monocentric case-control study of children under 2 years of age who died of SUDI, for which a head CT scan and an autopsy were performed between 2011 and 2018. Each case was matched by sex and age (± 30 days) to two controls selected among living children in the same center who benefited from a cranio-encephalic CT scan. Four parameters of the hard palate were measured by CT: height, width, length, and sagittal angle; the height/width ratio was calculated. The presence of an ogival palate was also subjectively evaluated by the radiologists, independently from the measurements. Standardized odds ratios (OR) were calculated using conditional logistic regression models, all expressed for +1 standard deviation (SD).ResultsThirty-two deceased children were matched to 64 living control children. Mean ages were 5.0 and 5.3 months, respectively. Twenty-eight cases were considered to have died as a result of SIDS. The mean heights of the hard palate were significantly higher in the deceased children [4.1 (± 0.7) millimeters (mm)] than in the living children [3.2 (± 0.6) mm], with OR (+1SD) = 4.30 (95% confidence interval [CI], 2.04–9.06, P = 0.0001). The mean widths of the hard palate were 21.0 (± 1.9) mm and 23.2 (± 2.1) mm, respectively, with OR = 0.15 (95% CI, 0.06–0.40, P = 0.0001). The mean sagittal angles were significantly more acute in deceased children [134.5° (± 9.3)] than in living children [142.9° (± 8.1)], with OR = 0.28 (95% CI, 0.14–0.56, P = 0.0003). The mean height/width ratios were 19.8 (± 3.7) and 14.1 (± 3.3), respectively, with OR = 6.10 (95% CI, 2.50–14.9, P = 0.0001). The hard palate was subjectively considered as ogival in 59.4% (19/32) of the cases versus 12.5% (8/64) of the controls.ConclusionRadiological features of the ogival palate were strongly associated with SUDI. This observation still needs to be confirmed and the corresponding clinical features must be identified.

Conformity between Pacifier Design and Palate Shape in Preterm and Term Infants Considering Age-Specific Palate Size, Facial Profile and Lip Thickness

“…The need for an age-appropriate pacifier dimension is further emphasized by the relationship between palate shape and sudden unexpected death in infancy (SUID). SUID includes deaths from sudden infant death syndrome (SIDS), which are deaths that remain unexplained after complete post-mortem investigations [ 42 , 43 ]. A recent computed tomography and autopsy study of children, who died of SUID at an average age of five months, showed that the SUID group had significantly narrower palates than the control group [ 43 ].…”

“…SUID includes deaths from sudden infant death syndrome (SIDS), which are deaths that remain unexplained after complete post-mortem investigations [ 42 , 43 ]. A recent computed tomography and autopsy study of children, who died of SUID at an average age of five months, showed that the SUID group had significantly narrower palates than the control group [ 43 ]. A pacifier that is too small could be an additional risk factor for palatal predisposition, especially if there are other habits, usually unnoticed, that could have a possible influence on the orofacial structures.…”