Management of cleft lip & palate
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Transcript of Management of cleft lip & palate
Management of cleft lip & palate
Cleft lip & palate
Dr.Mohamed Rahil( Maxillofacial surgeon )
Tikrit dentistry college
introductionAre the most common major congenital Craniofacial abnormalityCleft lip present in approximately 1 in 700 live births male to female 2:1 while cleft palate present approximately 1 in 2000 live births and effects male to female 1:2
Embryology At approximately 6 weeks of human embryologic development the median nasal prominence fuses with the lateral nasal prominences and maxillary prominences to form the base of the nose , nostrils , upper lip, and premaxilla ,the confluence of this interior components becomes the primary palate , when this mechanism fails , clefts of the lip and /or maxilla occur
At approximately 8 weeks of the fetal life the palatal shelves elevate beside the tongue , then the tongue descend inferiorly and interiorly with the developing mandible , the vertical palatal shelves movie horizontally to fuse with the septum to form the intact secondary palate ,when the palatal shelves fails to fuse a cleft of the secondary palate occurs
Cleft lip
Cleft palate
Facial cleft
Etiology : multifactorial etiology
Chemical exposures Radiations Maternal hypoxia and habits ( smoking , alcohol )Teratogenic drugs (anti convulsing ,diazepam, hydrocortisone)Nutritional deficiencies (folic acid ,iron ) Vitamin abuse (vit . A)Physical obstruction
Hereditary Environmental
classification Unilateral Bilateral Microform Incomplete Complete And my involve the lip , nose , primary palate and /or secondary palate
Problems of individuals with cleft1.Esthetic2.Dental problems3.Malocclusion4.Nasal deformity5.FeedingEar problemsSpeech difficultiesAssociated anomalies
Treatment
Normalized aesthetic appearance of the lip and nose Intact primary and secondary palate Normal speech , language , and hearing Nasal airway patencyClass I occlusion with normal masticatory functionGood dental and periodontal health Normal psychosocial development The aim of Treatment
Treatment planning and timing
Feeding the child with a cleft palateInfant with cleft palate enable to form an adequate seal between the tongue and palate to create sufficient negative pressure to such fluid from a bottle , nasal regurgitation
Specialised nipples and bottles are necessary
splint
Mead Johnson/Enfamil Cleft Feeder Special Needs Feeder / Haberman Feeder
Pigeon Feeder Dr. Browns Natural Flow to relieve gas
procedureTime frameCleft lip repair
Cleft palate repair
Pharyngoplasty
Maxillary / alveolar reconstruction With born grafting
Cleft orthognathic surgery
Cleft rhinoplasty
Cleft lip revision After 10 weeks
Age 9 -18 months
Age 3 5 years or later based on speech development
Age 6-9 years based on dental development
Age 14-16 years in girls 16-18 years in boys
After age 5 years but preferably at skeletal maturity after arthognathic surgery when possible
Any time once initial remodelling and scar maturation s completed , best after age 5 years
Cleft lip repair
Pre surgical orthopedic
Techniques for lip repair
Rotation and advancement flap (millard technique )
Triangular flap
Cleft palate repair
Soft palate VS hard palate repair
Hard palate closureAdvantage of early closure Better feeding ,hygiene , development of phonation Preserve auditory tube function Improve psychological state for baby and his parents
Disadvantages of early closureDifficult surgery due to small structuresGrowth restriction of maxilla due to scar formation
Speech development
Velopharyngeal incompetence
Treatment of Velopharyngeal incompetence
Speech aid applaince
Pharyngeal flap, superiorly or inferiorly based flap
Sphincter pharyngoplasty
Posterior pharyngeal flap augmentation
Alveolar cleft graftTIME
AdvantagesProvide bone support for maxillaClosure of oronasal fistula Augmentation of alveolar ridge to facilitate implant , prosthesisCreation of base to support lip and ala of nose
procedureTime frameCleft lip repair
Cleft palate repair
Pharyngoplasty
Maxillary / alveolar reconstruction With born grafting
Cleft orthognathic surgery
Cleft rhinoplasty
Cleft lip revision After 10 weeks
Age 9 -18 months
Age 3 5 years or later based on speech development
Age 6-9 years based on dental development
Age 14-16 years in girls 16-18 years in boys
After age 5 years but preferably at skeletal maturity after arthognathic surgery when possible
Any time once initial remodelling and scar maturation s completed , best after age 5 years
Nasal repairPrimary Early Late
Orthognathic surgery
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