Cleft lip and palate

Question 1

Incidence + Etiological factors

Answer 1

1:750 – 1:2000
Etiological factors:
1. Genetics
2. Drugs (steroids, anticonvulsivants, valium)
3. Maternal infections (rubella,toxoplasmosis)
4. Hipervitaminosis A
5. Intoxications
6. Iradiations

Question 2

week 5,6

Answer 2

The nasal swellings are gradually separated from the maxillary swelling by deep furrows

Question 3

week 7

Answer 3

The maxillary swellings have fused with the medial nasal swellings

Question 4

week 10

Answer 4

Philtrum

Question 5

Anatomical types

A. Simple cleft lip

Answer 5

Right sided
Bilaterals
Left sided

Question 6

Anatomical types

B. Complete cleft lip

Answer 6

– involves also the nasal floor

Question 7

Anatomical types

C. Cleft lips associated with cleft at the level of

Answer 7

the dental arch and cleft palate

Question 8

Clinical picture

Answer 8

• Ala of nose from the cleft side – deformed, enlarged
• One of the hemi-lips is more hypoplastic
• The nostril on the cleft side is enlarged
• Nasal septum is deformed
• Teeth growth disturbancies

Question 9

Clinical picture

When is associated with cleft palate:

Answer 9

• suction deficiencies
• sialorrhea
• higher incidence of upper
  respiratory/ears infections

Question 10

Treatment

A. Unilateral cleft – principles

Answer 10

• economical excision of the cleft borders
• delicate dissection
• upper lip detachment from the maxila
• creation of triangular flaps using equal, arched
  incisions
• by suturing one achieve:
• unbroked Cupid’s bow
• simetrical highed upper lip
• normal nasal sill
• symetrical nose

Question 11

B. Bilateral cleft lip – principles

Answer 11

• one-stage anatomical repair
• economical resection of the cleft borders
• orbicular oris muscle repair, which will
  actively arrange in a line the premaxila
  together with the hemi – maxilaes
• preservation of the philtrum and of a
  mucosal part from the median bud

Question 12

A. Cleft palate
Incidence
Etiological factors:

Answer 12

1: 700
- heredity
- ……

Question 13

The intermaxillary segment gives rise

Answer 13

to the philtrum of the upper lip;

the median part of the maxillary bone and its four incisor teeth; and the triangular primary palate

Question 14

Anatomical types

Answer 14

A. Posterior cleft palate
(incomplete, soft palate)
B. Total cleft palate
(soft + hard palate)

Question 15

Cleft palate

Clinical picture

Answer 15

• suction and speech deficiencies
• respiratory tract infections
• ear infections (deafness)

Question 16

Principles of treatment

• Goals

Answer 16

– Normal feeding
– Psichological support
– Normal growth of the midface
– Normal speech
– Normal normal appearance
– Normal maxillary arch and teeth
– No hearing deficiencies

Question 17

Treatment

First

Answer 17

• Psichological support and comprehensive
information about the treatment plan
• Feeding support – special teats (bigger
than normal) and bottles (squeezable)

Question 18

Treatment

Answer 18

• different techniques

- one stage/ two stages procedures

Question 19

Palatoplasty – von Langenbeck

Answer 19

Advantages

• Single stage procedure
• Minor disturbancies on facial growth

Disadvantages, in wide clefts

• High percentage of postop fistulae
• Abnormal speech patterns

Question 20

Soft Palate Repair (SPR) – 6 months

Answer 20

• Push back technique
• Re-orientation of the levator veli palatine muscles
• Using a vomerian flap

Question 21

Hard Palate Repair (HPR) – I

2 y

Answer 21

• Two layers closure
• Using vomerian flaps
• One or two palatal flaps, depending on
  the wideness of the cleft