Introduction to Cleft lip and palate for undergraduates

2. Cleft Lip &Palate
Presented by : Dr. Mahmoud Motawea

3. Embryological considerations
Oral region develops during the 4th
to 8th
weeks
The oral membrane is surrounded by 5 processes
•Frontonasal part
•Maxillary part
•Mandibular part

4. Etiology
Familial risk
Environmental factors: Steroids, irradiation, viral
infection (rubella), alcohol intake.
Syndromic:
Pierre Robin syndrome

5. Definition
Cleft lip :
Failure of fusion between the median part of
frontonasal process and one or both lateral
maxillary processes in developing face.

6. Types
I) Lateral or Median
II) Unilateral or Bilateral
III) Complete or Incomplete

7. Complications
•Flaring & flatness of nares on the affected
side if complete.
•Disfigurement.
•Abnormal teeth growth
•Nasal tone.

8. Treatment
•Millard’s operation:
•Time : 3 -6 months.
•Pre-requisities : rule of 10s
•Goals of repair: cosmosis, orbivularis oris
function
•Alveolus repair

9. Definition
Cleft palate :
arrest of fusion between the two palatal
processes and possibly with the premaxilla

10. Types
• Cleft uvula.
• Cleft soft palate.
• Cleft soft and hard palate (complete)
• Complete cleft + one side of premaxilla
(Bipartite cleft).
• Complete cleft + both sides of premaxilla

11. Complications
•lmpairment of suckling: due to inability to create -ve intra-oral
pressure.
•lmpaired speech:
• Due to lnadequate velopharyngeal mechanism
• Nasaltone is due to naso-oral communication.
•Hearing loss.
•lmpairment of dentation if the alveolar margin is reached.
•Impared eustachian tube finction: otitis media
• Distortion of facial growth.
•Recurrent chest infection (due to reflux into nose).

12. Treatment
•Time : 9-12 months.
•Pre-requisities : Chest condition,
feeding precautions
•Goals of repair: competent
velpharyngeal function, closure of
defect in layers