1. Cleft lip and palate

2. Definition
A cleft lip or palate is an abnormal separation in the oral-facial region that happens because tissue of the mouth or lip does not form correctly in fetal development.

3. B- Normal Palate - Primary palate - Secondary palate Soft palate
Hard palate
Clinical Aspects of Cleft Lip/Palate Reconstruction

5. Cleft Variants Great anatomic variation in types of clefts!
Anatomic Classification based on:
1) Location
2) Completeness (Incomplete/Complete)
3) Extent
Clinical Aspects of Cleft Lip/Palate Reconstruction

6. Classification Standardized methods Key anatomic structure
Incisive foramen
Primary palate
Lip
Premaxilla
Alveolus
Secondary palate
Soft palate
Hard palate

7. Cleft of primary palate (cleft lip)
Unilateral
Incomplete
Lip only
Complete
Primary palate
Lip, nasal floor, alveolus
Result from deficiency of mesenchyme in the maxillary prominences and intermaxillary segment

8. Cleft of primary palate (cleft lip)
Bilateral
Incomplete
Lip only
Complete
Primary palate
Lip, nasal floor, alveolus

9. Cleft of secondary palate
- Soft palat only (incomplete cleft palat)
Soft and hard palat (complete cleft palat)
Submucus cleft
Caused by defective development of the secondary palate and result from the growth distortions of the lateral palatine processes (shelves) which prevent their medial migration and fusion

10. A cleft of the secondary palate can be incomplete, such as a bifid uvula or cleft of the velum only.

11. A complete cleft of the secondary palate includes the entire velum and hard palate to the incisive foramen.

12. A submucous cleft palate is a congenital defect that affects the underlying structures of the palate, while the structures on the oral surface are intact.
This defect can involve the muscles of the velum and can also involve the bony structure of the hard palate.

13. Clefts of both the primary and secondary palate are common.
When there is a combination, each section (primary palate and secondary palate) can be unilateral, bilateral, complete, or incomplete.

14. Etiology of cleft lip and palate

15. Treatment

16. Successful treatment requires a multidisciplinary approach
Requires team approach throughout life
neonatal period
toddler
grade school
adolescence
young adulthood

17. 1 Haberman Feeder The Neonatal Period Directs care is necessary
To establishes feeding
complete clefts preclude feeding
1- Breast feeding not possible
2- A soft, large bottle with large hole is required
3- A palatal prosthesis may be required
Haberman Feeder

18. 1 The Neonatal Period Presurgical Orthodontics (Baby Plates)
Molds palate into more anatomically correct position
decreases tension
may improve facial growth
Grayson, presurgical nasal alveolar molding (PSNAM)

19. Feeding plates to assist in early feeding
Obturator plate
12th July 2008

20. Pre surgical plates, moulding plates, feeding plates…….
12th July 2008

21. 1 Surgical Repair The Neonatal Period Cleft Lip Cleft Palate
In US - “the rule of tens” - 10 wks, 10 lbs, Hgb 10
Lip adhesion vs baby plates
Cleft Palate
Varies from 6-18 months - most around 10 mo
Early repair may lead to midface retrusion
Early repair improves speech

22. 2 The Toddler Years Priority: Speech Growth hormone deficiency
“Cleft errors of speech” in 30%
Velopharyngeal insufficiency
Growth hormone deficiency
40 times more common in CLAP

23. 3 The Grade School Years Three primary issues Orthodontics
poor occlusion
congenitally absent teeth
alveolar bone grafting
fills alveolar defect - around age 12
psychological growth

24. 4 The Teenage Years Midface retrusion Psychological development
Rhinoplasty
usually last procedure performed, around age 20

25. Repaired cleft palate in 8 year old
12th July 2008

26. Quadhelix to expand prior to ABG
12th July 2008

27. 12th July 2008

28. Advantages of alveolar bone grafting (ABG)
Provides continuity of alveolar ridge…
Provides bone for canine to erupt
Osseous support for adjacent teeth
Majority of canines erupt spontaneously…others require surgical exposure often in combination with orthodontics.
The erupting teeth often appear to then stimulate the formation of new alveolar bone
12th July 2008
Dr. Christine Underhill

29. erupted canine
12th July 2008

30. Adolescent treatment
12th July 2008

31. 12th July 2008

32. Adult treatment- Orthognathic surgery
12th July 2008

33. Thank you