Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.

Management of cleft lip & palate

1.998 Aufrufe

Veröffentlicht am

A lecture for 5th stage dentistry students

Veröffentlicht in: Gesundheit & Medizin
  • Did u try to use external powers for studying? Like ⇒ www.HelpWriting.net ⇐ ? They helped me a lot once.
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • Have u ever tried external professional writing services like ⇒ www.WritePaper.info ⇐ ? I did and I am more than satisfied.
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier

Management of cleft lip & palate

  1. 1. Cleft lip & palate Dr.Mohamed Rahil ( Maxillofacial surgeon ) Tikrit dentistry college
  2. 2. introduction  Are the most common major congenital Craniofacial abnormality  Cleft lip present in approximately 1 in 700 live births  male to female 2:1  while cleft palate present approximately 1 in 2000 live births and effects male to female 1:2
  3. 3. Embryology At approximately 6 weeks of human embryologic development the median nasal prominence fuses with the lateral nasal prominences and maxillary prominences to form the base of the nose , nostrils , upper lip, and premaxilla ,the confluence of this interior components becomes the primary palate , when this mechanism fails , clefts of the lip and /or maxilla occur At approximately 8 weeks of the fetal life the palatal shelves elevate beside the tongue , then the tongue descend inferiorly and interiorly with the developing mandible , the vertical palatal shelves movie horizontally to fuse with the septum to form the intact secondary palate ,when the palatal shelves fails to fuse a cleft of the secondary palate occurs
  4. 4. Cleft lip
  5. 5. Cleft palate
  6. 6. Facial cleft
  7. 7. Etiology : multifactorial etiology  Chemical exposures  Radiations  Maternal hypoxia and habits ( smoking , alcohol )  Teratogenic drugs (anti convulsing ,diazepam, hydrocortisone)  Nutritional deficiencies (folic acid ,iron )  Vitamin abuse (vit . A)  Physical obstruction Hereditary Environmental
  8. 8. classification  Unilateral  Bilateral  Microform  Incomplete  Complete  And my involve the lip , nose , primary palate and /or secondary palate
  9. 9. Problems of individuals with cleft 1.Esthetic 2.Dental problems 3.Malocclusion 4.Nasal deformity 5.Feeding Ear problems Speech difficulties Associated anomalies
  10. 10. Treatment
  11. 11.  Normalized aesthetic appearance of the lip and nose  Intact primary and secondary palate  Normal speech , language , and hearing  Nasal airway patency  Class I occlusion with normal masticatory function  Good dental and periodontal health  Normal psychosocial development The aim of Treatment
  12. 12. Treatment planning and timing
  13. 13. Feeding the child with a cleft palate  Infant with cleft palate enable to form an adequate seal between the tongue and palate to create sufficient negative pressure to such fluid from a bottle , nasal regurgitation  Specialised nipples and bottles are necessary  splint
  14. 14. Mead Johnson/Enfamil Cleft Feeder Special Needs Feeder / Haberman Feeder Pigeon Feeder Dr. Brown’s Natural Flow to relieve gas
  15. 15. procedure Time frame Cleft lip repair Cleft palate repair Pharyngoplasty Maxillary / alveolar reconstruction With born grafting Cleft orthognathic surgery Cleft rhinoplasty Cleft lip revision After 10 weeks Age 9 -18 months Age 3 – 5 years or later based on speech development Age 6-9 years based on dental development Age 14-16 years in girls 16-18 years in boys After age 5 years but preferably at skeletal maturity after arthognathic surgery when possible Any time once initial remodelling and scar maturation s completed , best after age 5 years
  16. 16. Cleft lip repair
  17. 17. Pre surgical orthopedic
  18. 18. Techniques for lip repair Rotation and advancement flap (millard technique ) Triangular flap
  19. 19. Cleft palate repair
  20. 20. Soft palate VS hard palate repair
  21. 21. Hard palate closure Advantage of early closure Better feeding ,hygiene , development of phonation Preserve auditory tube function Improve psychological state for baby and his parents Disadvantages of early closure Difficult surgery due to small structures Growth restriction of maxilla due to scar formation
  22. 22. Speech development Velopharyngeal incompetence
  23. 23. Treatment of Velopharyngeal incompetence Speech aid applaince Pharyngeal flap, superiorly or inferiorly based flap Sphincter pharyngoplasty Posterior pharyngeal flap augmentation
  24. 24. Alveolar cleft graft TIME Advantages Provide bone support for maxilla Closure of oronasal fistula Augmentation of alveolar ridge to facilitate implant , prosthesis Creation of base to support lip and ala of nose
  25. 25. procedure Time frame Cleft lip repair Cleft palate repair Pharyngoplasty Maxillary / alveolar reconstruction With born grafting Cleft orthognathic surgery Cleft rhinoplasty Cleft lip revision After 10 weeks Age 9 -18 months Age 3 – 5 years or later based on speech development Age 6-9 years based on dental development Age 14-16 years in girls 16-18 years in boys After age 5 years but preferably at skeletal maturity after arthognathic surgery when possible Any time once initial remodelling and scar maturation s completed , best after age 5 years
  26. 26. Nasal repair Primary Early Late
  27. 27. Orthognathic surgery
  28. 28. Thank you for listening

×