Dec 31, 2015
Cleft Lip & PalateCleft Lip & Palate
الدكتور علي القصيراختصاص الجراحه
Facial clefting is the second most common congenital deformity (after clubfoot).
Affects 1 in 750 births Problems are cosmetic, dental, speech,
swallowing, hearing, facial growth, emotional
PrevalencePrevalence CL/P is more common than CP and varies CL/P is more common than CP and varies
by ethnicity.by ethnicity. CL/P CL/P
High in American Indians and Asians (1/500 High in American Indians and Asians (1/500 newborns)newborns)
Low in American blacks (1/2000 newborns)Low in American blacks (1/2000 newborns) Intermediate level in Caucasians (1/1000 Intermediate level in Caucasians (1/1000
newborns)newborns) More common in male More common in male
Isolated CP occurs in only 1/2500 newborns Isolated CP occurs in only 1/2500 newborns , does not display variation by ethnicity and , does not display variation by ethnicity and more common in female. more common in female.
Cleft LipCleft Lip Complete closure at 35 days Complete closure at 35 days
postconception:postconception: 7 weeks from the LMP. 7 weeks from the LMP. Lateral nasal, median nasal, and maxillary Lateral nasal, median nasal, and maxillary
mesodermal processes merge.mesodermal processes merge. Failure of closure can produce Failure of closure can produce
unilateral, bilateral, or median lip unilateral, bilateral, or median lip clefting.clefting.
Left side unilateral cleft is the most Left side unilateral cleft is the most common. common.
Cleft PalateCleft Palate Lack of fusion of the palatal shelves. Lack of fusion of the palatal shelves. Abnormalities in programmed cell Abnormalities in programmed cell
death may contribute to lack of death may contribute to lack of palatal fusion(?).palatal fusion(?).
Isolated disruption of palate shelves Isolated disruption of palate shelves can occur after closure of the lipcan occur after closure of the lip
Palatal closure is not completed until Palatal closure is not completed until 9 weeks post-conception. 9 weeks post-conception.
emberologyemberology Primary Palate- Triangular area of
hard palate anterior to incisive foramen to point just lateral to lateral incisor teeth Includes that portion of alveolar ridge
and four incisor teeth. Secondary Palate- Remaining hard
palate and all of soft palate
embryologyembryology Primary Palate Forms during 4th to 7th week of
Gestation Two maxillary swellings merge Two medial nasal swelling fuse Intermaxillary Segment Forms:
Labial Component (Philtrum) Maxilla Component (Alveolus + 4 Incisors) Palatal Component(Triangular Primary Palate)
embereologyembereology Secondary Palate
Forms in 6th to 9th weeks of gestation Palatal shelves change from vertical to
horizontal position and fuse Tongue must migrate antero-inferiorly
anatomyanatomy Hard Palate
Bones: Maxilla( Palatine Processes) + Palatine Bones(Horizontal Lamina)
Blood Supply: Greater Palatine Artery Nerve Supply: Anterior Palatine Nerve
Soft Palate Fibromuscular shelf attached like a
shelf to posterior portion of hard palate Tenses, elevates, contacts Passavant’s
Ridge Muscles: Tensor Veli Palatini(CNV),
Levator Veli Palatini(Primary Elevator), Musculus Uvulae, Palatoglossus, Palatopharyngeus(CN IX and X)
EtiologyEtiology Several agents that are associated with Several agents that are associated with
an increased frequency of midfacial an increased frequency of midfacial malformation.malformation.
Genetics Genetics MedicationsMedications —phenytoin, sodium —phenytoin, sodium
valproate, methotrexate. valproate, methotrexate. With corticosteroids there is no evidence With corticosteroids there is no evidence
of an increase in malformations.of an increase in malformations. Possible association could not be excluded Possible association could not be excluded
EtiologyEtiology Cigarette smokingCigarette smoking
Noted with mothers of children with facial Noted with mothers of children with facial clefting, both CL/P and CP.clefting, both CL/P and CP.
Teratogenesis has been attributed to hypoxia as Teratogenesis has been attributed to hypoxia as well as a component of tobacco (cadmium).well as a component of tobacco (cadmium).
AlcoholAlcohol Associated with an increased risk of fetal facial Associated with an increased risk of fetal facial
clefting.clefting. Alterations in cell membrane fluidity or reduced Alterations in cell membrane fluidity or reduced
activity of specific enzymes such as superoxide activity of specific enzymes such as superoxide dismutase.dismutase.
Folate deficiencyFolate deficiency Contributes to a range of birth defects. Contributes to a range of birth defects. Evidence is emerging for a similar association Evidence is emerging for a similar association
with the development of CL/P.with the development of CL/P.
Cleft formationCleft formation Cleft result in a deficiency of tissue Cleft lip occurs when an epithelial
bridge fails Clefts of primary palate occur
anterior to incisive foramen Clefts of secondary palate occur
posterior to incisive foramen
Incomplete cleft palate
Unilateral complete lip and palate
Examples of Cleft Palate Cleft of Back Soft Palate Cleft of Soft Palate Cleft of Soft and Hard Palate Cleft of Soft and Hard Palate and Cleft Lip
Feeding respiratory tract and ear infection Orthodontic Surgery
Cleft lip repair =role of ten ( wt: 10 pounds, age :10 weeks and 10 gm /ds litter haemoglobin)
Cleft palate repair at 10 month to 18 months .
Cp repair before speeking