Cleft Palate And Lip Flashcards
Cleft palate and lip palate
Physical Challenges of Clefts Through the Lifespan
Development of the Face and Palate
Cleft Lip and Palate Classification Systems
Clinical Features of Clefts
Etiologies of Clefts
Incidence of Clefts
Sex and Racial Differences
The Cleft Palate Team and General Management Issues Through The Lifespan
Communication Problems Associated with Clefts
Craniofacial anomalies
*Congenital malformations involving the head
and face
Clefts
Abnormal openings in anatomical structures
Velopharyngeal Incompetence (VPI)
Velopharyngeal Mechanism does not close adequately
Clefts interfere with basic biological functioning and communication
Birth
Obstruction of breathing
*Difficulty with food intake
3 months
3 months
*Clefts of the Lip are surgically closed
*Monitored for ear infections
9-12 months
9-12 months
*Surgeons close clefts of the palate
*Secondary surgery may be required later
2 years
2 years
*Correction of dentition
Later orthodontic treatment
Facial Development
Facial Development
*5-8 weeks gestation: Face/anterior aspects
*Mandibular processes: Mandible/lower lip
*Frontonsal processed: Nasomedian processes and lateral nasal processes
*Olfactory Pits
*Maxillary processes
*Clefts of the lip: Fusion is
interrupted or teratogens
Development of the Secondary Palate
Development of the Secondary Palate
*8-12 weeks gestation: Processes of hard and
soft palate fuse
*Palatal Shelves
*Nasal Septum
*Clefts of the palate. Fusion of palatal shelf is interrupted
Veau System
Veau System
*Quick general Reference
*Nature and extent of Clefts
In this system, you classify clefts into four different classes.
1) Cleft of the soft palate only.
2) Cleft of the hard and soft palate
3) Complete unilateral cleft of the soft and hard palate and on the lip and alveolar ridge on one side.
4) Complete bilateral cleft of the soft and hard palate and/or the lip and alveolar ridge on both sides.
Kernahan’s Striped Y-
Kernahan’s Striped Y-a visual identification system based on location, and developed by the American Cleft Palate Association (ACPA) focuses on the primary and secondary palates.
Clefts are commonly classified
*Unilateral or bilateral cleft of the lip
*Unilateral or bilateral cleft of the palate
*Bilateral cleft or the lip and palate
*Submucous Cleft
*Bifid Uvula
Cleft of the lip
Involves vermillion of the upper lip and can extend to nostril
Incomplete cleft
Complete cleft
Flattened nose, flaring nostril
Columella short, misaligned
Most commonly on left side (unilateral)
If bilateral, usually cleft palate also
Isolated cleft of the lip is rare
Unilateral complete cleft of lips and palate extend
Unilateral complete cleft of lip and palate extends
*External portion of upper lip
*Through alveolus
*Through hard and soft palate
Clefts of secondary palate alone vary in severity
Bilateral cleft of the upper lip
Most severe because of lack of tissue
Features
*Lip and alveolar processes clefted under each nostril
*Abnormal position of
**Prolabium, alveolar processes, premaxilla
*Columella, usually absent
**Tip of nose attaches to lip
Nasal Septum not attached to palatal shelves
Submucous cleft
Cleft of the muscular region of the soft palate Thin layer of mucosal tissue covers cleft
May not be detected until later
Bifid Uvula
Zona pellucida
Notch on posterior border of hard palate Velopharyngeal Incompetence
Genetic Disorders
Genetic Disorders
*Account for substantial percentage of clefts Syndromes
*Pierre Robin Syndrome (Robin sequence)
*Treacher Collins Syndrome
*Velocardiofacial Syndrome
*Apert Syndrome
Chromosomal Aberrations
*Trisomy 13
*Multiple Congenital Abnormalities
Pierre Robin syndrome
Micrognathia
Isolated cleft of the hard and soft palate Congenital Heart Problems
Digital Abnormalities
Conductive Hearing Loss
Retracted and elevated tongue
Delayed language
Teacher Collins syndrome
Malar hypoplasia
Conductive hearing loss
Cleft palate
Projection of scalp hair onto the cheek Communication Problems
Velocardiofacial syndrome
Language deficits
Learning Disabilities
Cleft Palate
Small stature with broad, flatten nose Underdeveloped cheek bones
Heart Problems
Communication problems
Apert syndrome
Craniosynostosis
Syndactyly
High and narrow arched palate Clefts occur is 30% of
People with Apert
Expressive language
delay
Chromosomal aberration
Trisomy 13 results in cleft lip with or without cleft palate in 60-70% of cases
Teratogenically Induced Disorders
Teratogenically Induced Disorders
Recognized teratogens
**Dilantin, thalidomide, excessive aspirin use,
excessive use of alcohol, caffeine, nicotine
**X-rays, viruses, environmental substances
Mechanically Induced Abnormalities
Mechanically Induced Abnormalities
**Impinge on embryo
**Amniotic rupture
**Intrauterine crowding
Incidence of clefts
Occur in one of every 750 live births
Cleft of lip with or without cleft palate occur more often than cleft palate alone
Submucous clefts
*One in every 1,200 births
Sex and racial differences
Clefts of lip with or without palate
*Twice as frequent in males
*More severe
Clefts of palate alone
*More frequent in females
Submucous clefts
*Similar frequency in males and females
In the U.S., Native Americans have highest incidence rates
Cleft palates team and general management
Clinical Management of persons with clefts requires cooperation among many professionals
Key professions include:
*Surgeons
*Dental Specialists
*Speech-Language-Pathologists
*Audiologists
Surgical Management of Clefts
Surgical Management of Clefts
Palatoplasty
**Primary Surgical Correction
**Secondary Surgical Correction
Dental Management of Clefts
Orthodontics
Orthodontics
**Prosthodontics
*Prosthodontic Obturator
*Speech bulb
Audiological Management of Clefts
Audiological Management of Clefts
*Higher incidence of hearing disorder, middle
ear disease
*Eustachian Tube Dysfunction
Tensor veli palatini
Tensor veli palatini
MYRINGOTOMY
*Ventilating tubes inserted
Screen hearing every 3-6 months
Pyschosocial Management of Clefts
*Provide appropriate treatment or referral
Communication problems associated with cleft
80% expected to develop good speech
Voice Disorders
*Vocal hyperfunction as compensatory
*Bilateral vocal nodules
*Soft-Voice Syndrome
Assessment
*Case history, personality, phonation, modification
Treatment
*Reduce hyperfunction, eliminate hard glottal attacks, habituating new voice
Resonance Disorders
Resonance Disorders
*Hypernasality most common
*Hyponasality
*Assessment
**Standardized rating scales, noninstrumental methods, nasaometer, multiview, videofluoroscopy
Treatment
*Behavioral treatment doesn’t work alone
*Continuous Positive Airway Pressure (CPAP)
Nasal Emissions
Nasal Emissions
Compensatory Articulation errors
Assessment
*Articulation tests, specialized tests for VPI, phonological processes
Treatment
*Intervention before first surgery
*Increase consonant inventory, difference between oral/nasal sounds, eliminate excessive use of glottal stops, electropalatograpy
Language Disorders
May have language delays or less well-developed language
Assessment
*Should be routinely examined
*Include environmental factors, motor/mental development, hearing acuity
Treatment
*Not specialized for individuals with cleft
*Prevention
*Familycounseling,aggressivetreatmentof middle ear disease, language enrichment programs
