CLEFT LIP AND PALATE

Presentation by

Dr. Ari Zangana

Plastic surgeon

Introduction

Facial clefting is the second most common congenital deformity (after clubfoot).

Affects 1in 750 births Problems are cosmetic, dental, speech,

swallowing, hearing, facial growth, emotional

Anatomy

Primary Palate- Triangular area of hard palate anterior to incisive foramen to point just lateral to lateral incisor teeth– Includes that portion of alveolar ridge and four incisor

teeth, philtrum Secondary Palate- Remaining hard palate and all

of soft palate

Anatomy

Embryology Primary Palate

– Forms during 4th to 7th week of Gestation

Embryology Secondary Palate

– Forms in 6th to 9th weeks of gestation

Cleft Formation

Cleft result in a deficiency of tissue Clefts of primary palate occur anterior to incisive

foramen Clefts of secondary palate occur posterior to

incisive foramen

Classification

Although various classification systems have been proposed, only a few have found wide clinical acceptance.

VEAU classification

The striped Y classification.

FIG LAHSHAL Classification

Incidence

In oriental 1:600----black population 1:2000 Cleft Lip + Palate- 50% Cleft Palate- 30% Cleft Lip- 20% Unilateral Lt: Unilateral Rt:Bilateral-6:3:1 Cleft Lip +/- Palate- 2 Male: 1 Female Cleft Palate - 2 Female: 1 Male

CAUSES OF CLEFT LIP AND/ OR PALATE

FamilialSyndromic Environmental

Familial

– Cleft Lip, With or Without Cleft Palate:• One Parent-2%• One Sibling- 4% Two Siblings- 9%• One Parent + One Sibling- 15%

– Cleft Palate:• One Parent- 7%• One Sibling- 2% • One Parent + One Sibling- 17%

syndromic

More than 200 syndromes include clefts

Environmental

Drugs: Anticonvulsants, Anxiolytic, Asprin, cortison,Cytotoxic, Warfarin.

Nutrition:Vitamin deficiency, Radiation Smoking Alcohol DM Epilepsy Stress

Management

goals of treatment are:

Improvement of appearance.Improved speech.Establishment of a fully functional dentition.Achieving good patient self-image and confidence

Timing of SURGERY:

Cleft lip repair: Cleft lip defects may be repaired shortly

after birth, but it is preferable to operate according to the "rule of 10": when the child is at least 10 weeks old and weighs at least 10 pounds and hemoglobin level 10gm.

Cleft palate repair

.