Definition
A cleft lip or palate is an abnormal separation in the oral-facial region that happens because tissue of the mouth or lip does not form correctly in fetal development.B- Normal Palate
- Primary palate- Secondary palate
Soft palate
Hard palate
Clinical Aspects of Cleft Lip/Palate Reconstruction
Great anatomic variation in types of clefts!
Anatomic Classification based on:1) Location
2) Completeness (Incomplete/Complete)
3) Extent
Clinical Aspects of Cleft Lip/Palate Reconstruction
Classification
Standardized methods Key anatomic structure Incisive foramen Primary palate Lip Premaxilla Alveolus Secondary palate Soft palate Hard palateCleft of primary palate (cleft lip) Unilateral Incomplete Lip only Complete Primary palate Lip, nasal floor, alveolus
Result from deficiency of mesenchyme in the maxillary prominences and intermaxillary segment
Cleft of primary palate (cleft lip) Bilateral Incomplete Lip only Complete Primary palate Lip, nasal floor, alveolus
Cleft of secondary palate - Soft palat only (incomplete cleft palat) Soft and hard palat (complete cleft palat) Submucus cleft
Caused by defective development of the secondary palate and result from the growth distortions of the lateral palatine processes (shelves) which prevent their medial migration and fusion
A cleft of the secondary palate can be incomplete, such as a bifid uvula or cleft of the velum only.
A complete cleft of the secondary palate includes the entire velum and hard palate to the incisive foramen.
A submucous cleft palate is a congenital defect that affects the underlying structures of the palate, while the structures on the oral surface are intact. This defect can involve the muscles of the velum and can also involve the bony structure of the hard palate.
Clefts of both the primary and secondary palate are common. When there is a combination, each section (primary palate and secondary palate) can be unilateral, bilateral, complete, or incomplete.
Requires team approach throughout life neonatal period toddler grade school adolescence young adulthood
Successful treatment requires a multidisciplinary approach
The Neonatal Period
Directs care is necessary To establishes feeding complete clefts preclude feeding 1- Breast feeding not possible 2- A soft, large bottle with large hole is required 3- A palatal prosthesis may be required1
Haberman Feeder
The Neonatal Period
Presurgical Orthodontics (Baby Plates) Molds palate into more anatomically correct position decreases tension may improve facial growth Grayson, presurgical nasal alveolar molding (PSNAM)1
Feeding plates to assist in early feeding
Obturator plate12th July 2008
Pre surgical plates, moulding plates, feeding plates……. 12th July 2008
The Neonatal Period
Surgical RepairCleft LipIn US - “the rule of tens” - 10 wks, 10 lbs, Hgb 10Lip adhesion vs baby plates Cleft PalateVaries from 6-18 months - most around 10 moEarly repair may lead to midface retrusionEarly repair improves speech 1The Toddler Years
Priority: Speech“Cleft errors of speech” in 30%Velopharyngeal insufficiencyGrowth hormone deficiency 40 times more common in CLAP 2The Grade School Years
Three primary issues Orthodontics poor occlusion congenitally absent teeth alveolar bone grafting fills alveolar defect - around age 12 psychological growth3
The Teenage Years
Midface retrusion Psychological development Rhinoplasty usually last procedure performed, around age 204
Repaired cleft palate in 8 year old
12th July 2008Quadhelix to expand prior to ABG
12th July 200812th July 2008
Advantages of alveolar bone grafting (ABG)Provides continuity of alveolar ridge…Provides bone for canine to erupt Osseous support for adjacent teethMajority of canines erupt spontaneously…others require surgical exposure often in combination with orthodontics.The erupting teeth often appear to then stimulate the formation of new alveolar bone 12th July 2008
Dr. Christine Underhill
erupted canine
12th July 200812th July 2008
Adolescent treatment12th July 2008