L3: Cleft Lip & Palate Flashcards
Embryology of Face
Embryology of Face
- Fronto-Nasal Process
a. Forehead.
b. Nose.
c. Philtrem.
d. Premaxilla.
Embryology of Face
- 2 Maxillary Processes
- Cheeks.
- Upper lip except philtrum.
- Nasal septum.
- 2 lateral palatine processes.
Embryology of Face
- 2 Mandibular Processes
a. Cheek cover mandible.
b. Mandible.
c. Lower lip.
The lip is formed of 3 layers: ……
Skin, muscle & mucous membrane.
Vermillion
the red part of the lip between the skin & the mucous membrane.
White roll
White line demarcate the junction between the skin and the vermilion.
- The upper lip is characterized by a median cosmetic unit (the philtram) that projects downward in the vermilion creating Cupid’s bow.
…
- Orbicularis oris is the main muscle responsible of the function of the lip, Its fibers normally decussate in the midline.
…
Anatomically, the palate is divided into:
- Hard palate: The anterior bony part.
- Soft palate: The fleshy posterior part composed of 5 pairs of muscles.
The palate is divided embryologically into:
Incidence of Cleft lip & Palate
Cleft lip & palate: One in 700 live births 1:700
Incidence of Cleft lip Alone
Cleft lip alone (15-20% of all cleft patients):
- Upper lip > Lower lip.
- Unilateral cleft lip (80%) > Bilateral cleft lip (20%).
- Left side > Right side.
- Male > Female.
Incidence of Cleft Palate Alone
Cleft palate alone (40%)
Incidence of Cleft lip & Palate Combined
Cleft lip and palate (45% commonest presentation)
- 85% of bilateral lip & 70% of unilateral lip are associated with cleft palate.
Etiology of Cleft Lip & Palate
Etiology of Cleft Lip & Palate
- Genetic
- A Child with cleft lip has 30% chance of having an associated syndrome. Yet, most cleft patients are non-syndromic.
Etiology of Cleft Lip & Palate
- Environmental
Components of deformities in cleft patients
How to Describe a Cleft Lip?
How to Describe a Cleft Lip?
- Upper Lip or Lower Lip?
How to Describe a Cleft Lip?
- Median or Lateral?
How to Describe a Cleft Lip?
- Unilateral or Bilateral?
How to Describe a Cleft Lip?
- If Unilateral, ……..
Incomplete Clift Lip
Complete Cleft Lip
Alveolar Defects
Cleft lip may be associated with defect in the gum & premaxilla (cleft alveolus) or not.
Nasal deformities
Cleft Palate
Types of Cleft Palate
Types of Cleft Palate
- Cleft of 2ry Palate only (Post. to incisive foramen)
a. Cleft uvuia.
b. Cleft soft palate.
c. Cleft soft & hard palate (Intermaxillary)
Types of Cleft Palate
- Cleft of 1ry & 2ry Palate
Function of Speech is dependent on …….
5 paired muscles (levator veli palatini & tensor veli palatini are the most important).
Insertion of these muscles
- Normally these muscles form a transverse sling that enable the palate to move posteriorly to close oropharynx from nasopharynx.
Abnormality in soft palate muscles in Cleft Palate
- In cleft palate, the muscles are inserted aberrantly at edges of bony cleft with velopharyngeal dysfunction.
Pierre Robin Sequence
Management of Pierre Robin Sequence
- Airway obstruction is managed by instructions to keep the child in prone position.
- Severe cases may need glossopexy or tracheostomy.
Complications of Cleft Lip & Palate
Complications of Cleft Lip & Palate
- Impaired Normal Suckling
- Abnormal lip function
- Inability to create negative intra-oral pressure because of oro-nasal communication.
Complications of Cleft Lip & Palate
- Food Regurgitation into nasal Cavity
- Acute sinusitis, aspiration: pnuemonia.
Complications of Cleft Lip & Palate
- Abnormal levator palati insertion prevent adequate areation of Eustachian tube leading to
- Inadequate emptying of middle ear
- Predispose to recurrent otitis media.
- This may lead to hearing loss.
Complications of Cleft Lip & Palate
- Interference with normal teeth alignment in cases with
- Alveolar defects & cleft of primary palate (Premaxilla)
Complications of Cleft Lip & Palate
- Speech Defects
Speech defects secondary.to:
- Inadequate velopharyngeal menanism causing nasal tone.
- Hearing loss resulting from recurrent otitis media.
Complications of Cleft Lip & Palate
- Distortion of facial growth
- Affection of bony centers of the maxilla on early surgical repair of hard palate.
Complications of Cleft Lip & Palate
- Disfigurements & Psychological upset of parents.
….
Multidisciplinary care of cleft patients
Management of Cleft Lip & Palate
Management of Cleft Lip & Palate
- Care At Birth
Management of Cleft Lip & Palate
- At age 3-6 months
Management of Cleft Lip & Palate
- At age about 2 weeks
Management of Cleft Lip & Palate
- At age 4-6 Months
Role of Otolaryngolgists:
* Assess & manage recurrent otitis media to avoid hearing affection.
Management of Cleft Lip & Palate
- At age 9-18 months
Management of Cleft Lip & Palate
- At age 2.5 - 5 years
Speech pathologist
- assess speech & velopharyngeal function.
Pediatric/ Plastic surgeon
- correct velopharyngeal dysfunction surgically if required (Pharyngoplasty)
Management of Cleft Lip & Palate
- At age 4 - 7 Years
Dentists/ Oral surgeons
- Correct teeth abnormalities.
Management of Cleft Lip & Palate
- At age 7 - 10 Years
Platic surgeons
- correct alveolar defect by bone graft.
Management of Cleft Lip & Palate
- At age > 12 years
Plastic surgeons/ Otolaryngolists
- Correct residual nasal deformities (Rhinoplasty).