1. Clinical Oral Surgery Class
5th year, 2nd semester, 1.5.2012
Cleft Lip and Palate
Dr. Faiyaz Ahmed
Oral & Maxillofacial surgeon
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3. Objectives
Development of cleft lip & palate
Factors that cause cleft deformities
Management of cleft patients
Principles & techniques of cleft lip
& palate repair
Diagnose and classify cleft lip and palate
Alveolar bone grafting
Problems in cleft patients
Time table and sequence of treatment
12. • UCLP - most frequent combination, seen
more often in boys, hereditary incidence is
fairly high, predominantly – left side
• Isolated Cleft palate more frequently seen
in girls, incidence 1 in 2000
17. Objectives
Development of cleft lip & palate
Factors that cause cleft deformities
Management of cleft patients
Principles & techniques of cleft lip
& palate repair
Diagnose and classify cleft lip and palate
Alveolar bone grafting
Problems in cleft patients
Time table and sequence of treatment
19. Problems of individuals with clefts
• Congenital absence of
teeth.
• The cleft usually extends
between the lateral incisor
and canine
• Supernumerary teeth are
left until 2 to 3 months
before the ABG because
these teeth, although nonfunctional, maintain the
surrounding alveolar bone
23. Nasal deformity
• Alar cartilage on the
cleft side is flared
• Columella is pulled
towards the non cleft
side
• Nasal revision may be
the last corrective
surgical procedure the
cleft patient undergoes
24. Ear problems
• More predisposed to
middle ear infections
• Chronic serous otitis
media is common
among children with
cleft palate
26. Speech difficulties : articulation
• Dental malformation, malocclusion, and
abnormal tongue placement may develop
before the palate is closed and thus
produce an articulation problem.
27. Speech difficulties
• Hearing loss at an early age is especially
detrimental to the development of normal
speech skills
28. • The levator veli palatini muscle functions
to elevate the velum and enable
appropriate speech production
29. Objectives
Development of cleft lip & palate
Factors that cause cleft deformities
Management of cleft patients
Principles & techniques of cleft lip
& palate repair
Diagnose and classify cleft lip and palate
Alveolar bone grafting
Problems in cleft patients
Time table and sequence of treatment
30. Classification of clefts
The typical classification system used clinically
to describe standard clefts of the lip and palate
is based on careful anatomic description.
Clefts can be unilateral or bilateral;
microform, incomplete, or complete;
and may involve the lip, nose, primary
palate, and/or secondary palates
39. Management Protocol for Cleft lip & Palate
• Prenatal - Diagnosis & Psychological counseling
• At Birth – Evaluation by cleft lip & palate team ,
Feeding advice. Naso alveolar molding
• 3-6 months –Cleft lip repair ( Millard’s Rule of 10)
40. Naso alveolar molding
• Done during the first 3 months to
bring the cleft segments closer and
facilitate lip repair
41. Rule of 10
• 10 gm% Hb
• 10 pounds wt
• 10 weeks old
42. The ideal cleft lip repair should provide a
symmetrical Cupid’s bow,
natural-appearing philtral columns,
a philtral dimple ,
a well aligned continuous white roll
and
minimum visible scar in the line of the philtral column.
There should be ample vermilion and mucosa with a slight central
tubercle, a normally functioning orbicularis oris muscle
with harmonious symmetry of the nostrils
60. • 9 mon –1 ½ years :-) Cleft palate repair
• 5 years :-) assess speech; manage VPI
• 5 – 8 years :-) interceptive orthodontics
• 5 – 7 years :-) pharyngeal flap (if needed)
• 7 – 8 years :-) maxillary expansion (if needed)
• 8 –11 years :-) SABG
• 16 –21 Orthognathic surgery and Rhinoplasty
61. SABG
• Specific timing is based on the child’s dental
development instead of chronological age
• Timing is based on the development of the permanent
maxillary canine
• Root resorption and graft failure are common when bone
grafts are placed after eruption of the canine
62. Goal of bone grafting
• Provide bony matrix for the developing teeth
• Create alveolar ridge continuity
• Closure of any residual oronasal fistulas
• Improve bony support for the nasal base on the
cleft side
64. Objectives
Development of cleft lip and palate
Factors that cause cleft deformities
Diagnose and classify cleft lip and palate
Management of cleft patients
Principles & techniques of cleft lip
& palate repair
Alveolar bone grafting
Problems in cleft patients
Time table and sequence of treatment