CLEFT LIP AND PALATE
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INTRODUCTION 速 速 速
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CLEFT LIP AND PALATE IS THE MOST COMMON FACIAL ANAMOLY OCCURS IN APPROXIMATELY 1 IN 1000 NEWBORNS ISOLATED CLEFT LIP AND PALATE OCCUR IN ABOUT 1 IN 2000 NEWBORNS THE ANAMOLY APPEARS TO BE GENETICALLY DETERMINED ALTHOUGH MAJORITY ARE OF UNKNOWN CAUSE OR ARE ATTRIBUTABLE TO TERATOGENIC CAUSE. www.indiandentalacademy.com
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What is a Cleft? 速 速 速 速
Any opening or division in some part of the anatomy that is not normally open or divided. Result of some problem during embryological development. Problem specifically occurs during the first trimester of pregnancy. Failure of parts to fuse at the midline. www.indiandentalacademy.com
Clefts ® ® ®
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Result of problem with structure formation during the first trimester of pregnancy. CLEFT LIP – failure of the upper lip to fully form. Lower lip forms earlier; cleft would accompany cleft of the mandible which would be much more serious and usually be accompanied by other (fatal) problems. CLEFT PALATE – opening in the hard or soft palate. Result = connection between the oral and nasal cavities www.indiandentalacademy.com
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CLEFTS ® Clefts of lip or palate occur at different times during development. ® Lip closure – occurs at 7-9 weeks gestation. ® Palate closure – occurs at 9-11 weeks gestation. ® Only 5% of cleft lips occur without accompanying clefts of the palate. ® Whatever disrupts lip closure will probably also disrupt palatal closure . www.indiandentalacademy.com
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DEVELOPMENT OF THE FACE
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DEVELOPMENT OF LIP
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CLASSIFICATION OF CLEFT LIP AND PALATE
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VARIOUS CLASSIFICATIONS HAVE BEEN GIVEN HOWEVER THE MOST ACCEPTED CLASSIFICATION WAS GIVEN BY VEAU 速 VEAU CASSIFIED CLEFT LIP AND CLEFT PALATE SEPERATELY
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VEAU’S CLASSFICATION Of Cleft Lip ®
CLASS I---a unilateral notching of the vermillion not extending into lip.
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VEAU’S CLASSFICATION Of Cleft Lip ®
CLASS II….. a unilateral notching of the vermillion with cleft extending into the lip but not including the floor of the nose……
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CLASS II-CLEFT LIP
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VEAU’S CLASSFICATION Of Cleft Lip ®
CLASS III a unilateral notching of the vermillion border with cleft extending into the floor of the nose……
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VEAU’S CLASSFICATION Of Cleft Lip ®
CLASS IV……. Any bilateral clefting of the lip,whether it be incomplete notching or complete clefting……
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DEVELOPMENT OF PALATE
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DEVELOPMENT OF PALATE
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DEVELOPMENT OF PALATE
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VEAU’S CLASSFICATION Of Cleft Palate ®
CLASS I…. Involves only the soft palate
Soft palte www.indiandentalacademy.com
VEAU’S CLASSFICATION Of Cleft Palate ®
CLASS II……… Involves the soft and hard palates but not the alveolar process………
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VEAU’S CLASSFICATION Of Cleft Palate ®
CLASS III….. Involves both soft and hard palates and the alveolar process on one side of the pre-maxillary area……
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CLEFT PALATE—CLASS III
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VEAU’S CLASSFICATION Of Cleft Palate ®
CLASS IV……. Involves both soft and hard palates and continues through the alveolus on both sides of the pre-maxilla,leaving it free and often mobile……
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CLEFT PALATE—CLASS IV
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MULTIDISCIPLINARY APPROACH TO CLEFT LIP AND PALATE
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MULTIDISCIPLINARY APPROACH TO CLEFT LIP AND PALATE 速
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The complexity of problems associated with cleft lip and palate requires that numerous healthcare professionals co-operate in providing the specialised knowledge and skills neccesary to ensure comprehensive care. A protocol has been established by AMERICAN CLEFT PALATE CRANIOFACIAL ASSOCIATION(www.cleftpalatecraniofacial.org) www.indiandentalacademy.com
MULTIDISCIPLINARY APPROACH 速
THE TEAM IS COMPOSED OF 速 DENTAL SPECIALITIES 1.ORTHODONTICS 2.ORAL SURGERY 3.PEDODONTICS 4.PROSTHODONTICS MEDICAL SPECIALITIES 1.GENETICS 2.OTOLARYNGOLOGY 3.PEDIATRICS 4.PLASTIC SURGERY 5.PSYCHIATRY www.indiandentalacademy.com
MULTIDISCIPLINARY APPROACH 速
ALLIED HEALTH CARE FIELDS 1.AUDIOLOGY 2.NURSING 3.PSYCHOLOGY 4.SOCIAL WORK 5.SPEECH THERAPY
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ETIOLOGY OF CLEFT PALATE AND CLEFT LIP Some possible causes related to CLEFT PALATE AND CLEFT LIP can be categorized as: ® ® ® ® ® ®
GENETIC NUTRITIONAL SMOKING DRUGS ENVIRONMENTAL SYNDROMES ASSOCIATED WITH CLEFT PALATE AND CLEFT LIP
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GENETICS 速 速 速
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Clefts commonly have a genetic basis,. Clefts of the lip and palate can run in families and be due to a single gene. If the gene is transmitted from one affected parent to their offspring, then it is generally considered to be dominant. If neither parent is affected, then the gene could be recessive, and would require that both parents contribute the same recessive gene to their affected child www.indiandentalacademy.com
NUTRITIONAL 速 EXCESSIVE AMOUNTS OF VITAMIN-A AND DEFICIENCY OF FOLIC ACID DURING PREGNANCY HAVE BEEN KNOWN TO CAUSE CLEFTING
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SMOKING 速
SMOKING DOUBLES RISK FOR CLEFTS Those who smoked twenty or more cigarettes per day were more than two times as likely to have babies with cleft lip and/or cleft palate. Those who smoked less were about one and a half times as likely to have babies with oral clefts
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DRUGS 速
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VARIOUS DRUGS HAVE BEEN KNOWN TO BE TERATOGENIC AND HAVE BEEN KNOWN TO CAUSE VARIOUS ANOMALIES IN THE FOETUS,INCLUDING CLEFT LIP AND PALATE. EXAMPLES TETRACYCLINE METRONIDAZOLE TRIMETHOPRIM SULPHONAMIDES
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ENVIRONMENTAL 速
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SOME OF THE COMMONLY USED INSECTICIDES AND PESTICIDES USED HAVE KNOWN TO CAUSE CLEFTING EXAMPLES CYNIZINE HEXACHLOROBENZENE THIRAM
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SYNDROMES ASSOCIATED WITH CLEFT LIP AND PALATE ® ® ® ® ® ® ® ® ® ®
SOME COMMON SYNDROMES ASSOCIATED ARE: Phenylketonuria Retinoblastoma Crouzon craniofacial dysostosis Apert syndrome Diastrophic dysplasia Basal cell nevus syndrome (Gorlin syndrome) DiGeorge syndrome Treacher Collins mandibulofacial dysostosis Pallister-Hall syndrome www.indiandentalacademy.com
ORAL CONDITIONS ASSOCIATED WITH CLEFT LIP AND PALATE ® ® ® ®
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NATAL OR NEONATAL TEETH CONGENITALLY MISSING TEETH SUPERNUMERARY TEETH ANOMALIES OF TOOTH MORPHOLOGY { enamel hypoplasia,microdontia,macrodontia,fused teeth,abberations in crown shape.} UNILATERAL OR BILATERAL CROSSBITE(muscle forces) TEETH THAT ERUPT ADJACENT TO THE CLEFT HAVE INSUFFICIENT BONE SUPPORT LEADING TO PREMATURE LOSS PROFILE IS CONCAVE DUE TO TRUE OR PSEUDO MANDIBULAR PROGNATHISM DEEP BITE LEADING TO GINGIVAL STRIPPING OF LABIAL ATTACHED GINGIVA OF MANDIBULAR INCISORS. TEETH THAT ERUPT ADJACENT TO THE CLEFT ARE ROTATED OR WITH DEVIATIONS OF AXIAL ROOT INCLINATIONS> www.indiandentalacademy.com
TREATMENT PROTOCOL ®
VARIOUS TREATMENT PROTOCOLS ARE FOLLOWED IN THE TREATMENT FOR CLEFT LIP AND PALATE : ® Below is the most common treatment protocol presently used in most cleft treatment centers: • Newborn - Diagnostic examination, general counseling of parents, feeding instructions, palatal obturator (if necessary); genetic evaluation and specification of diagnosis; empiric risk of recurrence of cleft calculated; recommendation of a protocol for the prevention of a cleft recurrence in the family • Age 3 months - Repair of CLEFT LIP • Age 6 months - Presurgical orthodontics, if necessary; first speech evaluation • Age 9 months - Speech therapy begins • Age 9-12 months - Repair of CLEFT PALATE • Age 1-7 years - Orthodontic treatment • Age 7-8 years - Alveolar bone graft • Older than 8 years - Orthodontic treatment continues ® Other surgical procedures can be performed in patients with severe clefts as necessary www.indiandentalacademy.com
SURGICAL PROTOCOL 速
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Undoubtedly, closure of the CL is the first major procedure that tremendously changes children's future development and ability to thrive. Variations occur in timing of the first lip surgery; however, the most usual time occurs at approximately age 3 months. Pediatricians used to strictly follow a rule of "three 10s" as a necessary requirement for identifying the child's status as suitable for surgery (i.e., 10 lb, 10 mg/L of hemoglobin, and age 10 wk). Although pediatricians are presently much more flexible, and some surgeons may well justify a neonatal lip closure, considering the rule of three 10s is still very useful www.indiandentalacademy.com
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