Transcript
CLEFT LIP and PALATE
EPIDEMIOLOGY of CLP
• Incidence– 1 per 1000– Mongoloid > Caucasian > Negro
• Gender ratio– 2 males : 1 female
• Site– 3% of CLP involved with syndromes– 66% of unilateral clefts on left side
CLEFT PALATE CLINICS
• Women’s and Children’s Hospital• Flinders Medical Centre• Accreditation - Medicare
CLEFT PALATE TEAM• Plastic Surgeon• General Surgeon - Neurosurgeon• Oral and Maxillofacial Surgeon• Orthodontist• Dentist• Geneticist• Speech Therapist• Psychologist• Social Worker - Counsellor• Nurses, administrators, students
EMBRYOLOGY
•Lip•Palate
Second, third and fourthbranchial arches
Mandibular archStomodeumMaxillary process
Nasal placodeFrontonasal process
Cardiac swelling
Eye
5 week old embryo
6 week old embryo
Frontonasalprocess
Nasal pitEye
Maxillary process
Mandibular arch
Cardiac swelling
Maxillary processes fuses with the lateral nasal process. If fusion does not occur - clefting results.
Primary palate
Nasal septumLateral palatal shelf
(Bent vertically)
7 week old embryo
Secondary palate is the first to form before the primary palate.If the primary palate is affected, the secondary palate would definitely be affected. Not vice verca.
Lateral palatal shelf
Nasal septum
Oronasalchamber
Coronal cross section of 7 week old embryo
Lateral palatal shelf
Nasal septum
Coronal cross section of 8 week old embryo
Tongue
- Palatal shelves rising up to fuse.They rise up from the back to the front. - However fusion occurs in the opposite direction (front to back)
Bifid uvula
AETIOLOGY of CLP• Genetics– Syndromes
• Environment–Drugs, medication–Diseases–Nutrition– Teratogens
thalidomide
No. of affected parents No. of affected siblings CL ± CP Isolated CP
- - 0.12% 0.05%- 1 4%-5% 2%-3%1 - 2% 1.7%1 1 13%-14% 14%-17%2 - 13%-14% 14%-17%- 2 13%-14% 14%-17%2 1 20%-25% 25%-50%2 2 15%-20% 50%
RISK OF GIVING BIRTH TO A CHILD WITH A CLEFT
CLASSIFICATION of CLP
A. Unilateral left incompletecleft lip
B. Complete cleft of hardand soft palate
D. Unilateral left complete cleft of lip, alveolar ridge andhard and soft palate
F. Complete bilateral cleft of primary and secondary palates
E. Complete bilateral cleft of lip and primary palate
C. Unilateral left complete cleft of lip and alveolar ridge
Kernahan and Stark’s (1958) classification based on the incisive foramen as the dividing point between clefts of the lip and alveolar ridge (primary palate)
and clefts of the palate (secondary palate)
lips are okay
PROBLEMS in CLP
• Aesthetics• Function
• Feeding • Swallowing• Dental
• Otolaryngological• Speech• Psychological• Growth
can cause inflammation of the ear
MANAGEMENT of CLP
• Surgery– Lip– Palate
• Speech• Dental• Orthodontic
- Usually at 4-5 y/o- May have a second surgery at 10 years to align the canines or allow to erupt
speech therapy - sound production
lip repair at 3months - "z plasty"
surgeon has difficulty in replicating the cupids bow
bilateral CLP with the premaxilla hanging down
Device helps to improve the posiition of the palatal shelves before surgery
SPEECH
• Soft palate function• Surgery• Velopharyngeal incompetence
DENTAL ANOMALIES in CLP
• Displaced teeth - ectopia, impactions• Missing teeth, supernumaries• Transposition• Crossbites• Occlusal plane cants• A- P relations• Midlines, smile line• Gingival contours• Oral hygiene
lateral incisiors are usually missing
Canine eruption Bone graftingbone grafting procedure at around 10 years old
maxillary hypoplasia, lack of development, Would need further surgery to advance the maxilla
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