Multi Disciplinary Approach to Cleft Lip and Palate / orthodontic courses by Indian dental academy

Multi disciplinary approach to cleft lip and palate

Multi disciplinary approach to cleft lip and palate INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com

CONTENTS

IntroductionEmbryological aspectClassification of cleft lip and palateAnatomy of cleft lip and palateRole of various specialities a. Pediatrician b. speech therapist c. orthodontist d. oral and maxillofacial surgery6. Feeding difficulties7. Presurgical orthopaedics


8. Surgical aspect9. Alveolar bone grafting10. Orthognathic surgery11. Distraction osteogenesis12. Conclusion13. Referenceswww.indiandentalacademy.com

INTRODUCTION


EMBRYOLOGYThe first pharyngeal arch (mandibular arch), develops two prominences: The maxillary prominence The mandibular prominence






As the medial nasal prominences merge with the maxillary prominence, they form an intermaxillary segment.


The intermaxillary segment gives rise to :-philtrum of the upper lip.The premaxillary part of the maxillaThe primary palate.


PALATE EMBRYOLOGY


CLASSIFICATION OF CLEFT LIP AND PALATE


DAVIS AND RITCHIE CLASSIFICATION (1922):They classified congenital clefts based on the position of the cleft in relation to the alveolar process.

Group I-Pre alveolar clefts Lip clefts only with subdivisions for unilateral, median, bilateral. Group II-Post alveolar clefts degrees of involvement of soft and hard palate to be specified till the alveolar ridge, submucous clefts included.

Group III-Alveolar clefts is complete clefts of palate, alveolus ridge and lip with subdivisions for unilateral, median, bilateral.


VEAUS CLASSIFICATION (1931):

Group I-Cleft of soft palate only

Group II- Cleft of hard and soft palate, extending no further than the incisive foramen thus involving the secondary palate alone.


Group III - Complete unilateral cleft of soft and hard palate, lip and alveolar ridge

Group IV - Complete bilateral cleft of soft and hard palate, lip and alveolar ridge on both sides.


FOGH ANDERSON CLASSIFICATION (1942) A) Hare lip includes alveolus & as for back as incisive foramen

B) Hare lip & cleft palate

C) Isolated cleft of the palate as forward as the incisive foramenwww.indiandentalacademy.com

KERNAHAN & STARKS CASSIFICATION OF CLEFTS

A. Clefts of primary palate 1. Unilateral (r/ l) complete incomplete

2. Median complete (premaxilla absent) incomplete (premaxilla rudimentary)

3. Bilateral complete incomplete


B) Clefts of secondary palate only complete incomplete submucous

C) Clefts of primary and secondary palate 1. unilateral ( r / l ) complete incomplete 2. median complete incomplete 3. bilateral complete incompletewww.indiandentalacademy.com

KERNAHANS STRIPED Y CLASSIFICATION (1971):

In this classification the incisive foramen is taken as the reference point Y logo are each divided into three sections, representing the lip, the alveolus and the hard palate as far back as the incisive foramen. The stem of the Y is also divided into three parts, representing varying degrees of clefting of the hard and soft palates.


MILLARDS CLASSIFICATION (1977):

A modification of Kernahans striped Y classification. . The inverted triangles represent the nasal arch the upright triangles represent the nasal floor.


CLEFT ANATOMYUnilateral cleft lip


Bilateral cleft lip


Role of various specialitieswww.indiandentalacademy.com

NEONATES TO 2 YEARS PEDIATRICIANS ROLEORTHODONTISTS ROLE SPEECH THERAPIST ROLESURGEONS ROLEwww.indiandentalacademy.com

FEEDING DIFFICULTIES


PRESURGICAL ORTHOPEDICS


PRIMARY DENTITION PERIOD


MIXED DENTITION PERIOD


PERMANENT DENTITION PERIOD


SURGICAL TECHNIQUESwww.indiandentalacademy.com

Cleft lipTiming of surgery


History


Techniques Unilateral cleft lip Millards rotationadvancement technique



Bilateral cleft lip



Cleft palateTiming of surgerywww.indiandentalacademy.com

History


Primary and secondary palate


Von Langenbeck procedure


Secondary palate



ALVEOLAR BONE GRAFTING(ABG)


ORTHOGNATHIC SURGERY/ DISTRACTION OSTEOGENESIS


SECONDARY SURGERIES


CONCLUSION


Refernces PLASTIC SURGERY. Vol.4. Cleft lip & palate and Craniofacial Anomalies edited by Joseph C. McCarthy. W. B. Saunders 1990Grabb and Smiths PLASTIC SURGERY. edited by Aston, Beasly and Thoma. Lippincott-Raven 1997.Textbook of Plastic, Maxillofacial and Reconstructive Surgery. Volume I. Part III. Head and Neck. G. S. Georgiade, N. G. Georgiade, R. Riefkohl, W. T. Barwick (eds). 1992.Complete management of cleft lip and palate. edited by Dr. N. S. GopalakrishnanHuman Embryology. Inderbir Singh6th edition1996.Surgery of Mouth and Jaws. edited by J. R. Moore 1985Textbook of Oral and Maxillofacial Surgery. Gustav O. Kruger; 6th edition; 1984.Starks PLASTIC SURGERY. 1974.


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Multi Disciplinary Approach to Cleft Lip and Palate / orthodontic courses by Indian dental academy

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