CLEFT LIP & CLEFT

PALATE
Dr. Ali Yaldrum
B.D.S, M.Sc (London)

Faculty of Dentistry, SEGi University

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 Learning Objectives

At the end of this lecture, students should be able to:

• Develop an understanding terms Cleft lip & Palate

• Develop an understanding of incidence of the condition
• Describe the etiology and pathogenesis
• Describe classification and dental implications
 Contents
1. Cleft Lip & Palate

2. Incidence

3. Causes
8. Dental Implications
4. Method of Transmission
9. References
5. Pathogenesis

6. Normal Process

7. Classification
 Cleft Lip & Palate

The term cleft lip & palate is commonly

used to represent two types of
malformation
• cleft lip with or without cleft palate (CL/P)(fig.1)
• cleft palate (CP) (fig.2)
 sult in clefting.
NCE
Extraoral Characteristics: Not applicable
Perioral and Intraoral Characteristics: Refer to
Figure 6.24 for examples of cleft lip, cleft palate, and cleft
onsidered to

Bilateral cleft of lip & palate

(fig.1)
ount for about 70% of
DCR, 2006).
he method of transmis-
cause of the clefting.
dence of autosomal dom-
x-linked inheritance pat- cleft of the hard & soft palates
spontaneous mutation or
While genetic factors ap- (fig.2)
r clefting, environmental
elopment of the cleft.
ng of some type occurs in
 at account for about 70% of
me (NIDCR, 2006).
on: The method of transmis-
ecific cause of the clefting.
bit evidence of autosomal dom-
and sex-linked inheritance pat-
lt of a spontaneous mutation or
enes. While genetic factors ap-
dual for clefting, environmental
se development of the cleft.
l clefting of some type occurs in
to 550 live births in the United
use of oral clefting is highly re-
vidual and the type of cleft in-
bilateral cleft have the greatest
s and the lowest number of en-
les with a unilateral cleft have
tic influences and the highest
ctors (Tolarova, July 2005).
/palate occurs when there is
the palate, premaxilla, and re-
e 6th to 8th week of embry- Figure 6.24. Oral clefting. A. Bilateral cleft of the lip and
palate. (From Rubin E, Farber JL. Pathology. 3rd ed.
ifactorial inheritance implies
n the environment will either Unilateral cleft of lip
Philadelphia: Lippincott Williams & Wilkins, 1999.) B. Cleft
of the hard and soft palates. (Courtesy of R Chase.) C.
ment of a cleft or enhance the Unilateral cleft of the upper lip. (Courtesy of R Chase.)
(fig.3)
cleft of lip & palate
(fig.4)
Bifid uvula
(fig.5)
Cleft lip, cleft palate, and the combination
of cleft lip and palate are considered to
have a multifactorial cause, including both
environmental and genetic elements.
 incidence

• common congenital malformation

• reported incidence varies from 1 in 500
to 1 in 2500 live births
• male:female 2:1
• Asian population have higher incidence
compared to the caucasian population
 Causes

• Oral clefts have been linked to genes

located on more than several
chromosomes including 1, 2, 4, 6, and
19, among others
 Causes

• maternal smoking (especially more than

20/day) and exposure to passive smoke
• Drugs: Accutane, phenytoin, warfarin
ethanol
• maternal folic acid deficiency
• ingest large quantities of Vit A
Method of Transmission

• Depends on the specific cause of the clefting.

• Multifactorial clefts can exhibit evidence of
autosomal dominant, autosomal recessive,
and sex-linked inheritance patterns
• spontaneous mutation or mutations in one or
more genes.
 Method of Transmission

• If one of the parent has a cleft lip, his/her

child face a risk of 20%
• If their is one child with cleft lip, the following
child faces risk of 14%
• A non cleft parent with a cleft lip faces a risk
of 4% for the following child
 Pathogenesis

• The face and facial structures are formed

out of three plates, each migrating
toward a meeting point in the middle
area of the face.
• The facial structures of the orbicularis
muscle form the lip. They are joined at
the philitrum lines.
• join by 4th week of pregnancy
• The palate is then formed out of the
structure that begins as the tongue and
palate.
• Between the fourth and the eighth weeks
of gestation, the tongue drops down and
the palatal segments then move from the
sides and toward the middle, fusing in
the center.
• A cleft, therefore, is not something that is
formed, so much as it is something that
does not form.
 Normal Process

6 Weeks
• Maxillary process
• Lateral nasal process
• Median nasal process
These three processes join and fuse to form the
primary palate
 Normal Process

7 Weeks
Median nasal process and maxillary process have
fused creating upper lip and anterior maxillary
alveolus
 Normal Process

8 Weeks
Complex totally fused and mesodermal migration
completed Tongue, which has been postured
superiorly between lateral palatal shelves of maxilla,
moves inferiorly allowing palatal processes to grow
toward midline and fuse, form nasopalatine foramen
to uvula
 Normal Process

11 Weeks
Total palatal closure
 Classification

• The Veau Classification system (table.1)

• The Striped-Y Classification system (fig.6)

The Veau Classification system

Class Description

I Soft palate only

II Hard & soft palate to the incisive foramen

Complete unilateral of soft, hard, lip, &

III alveolar ridge
Complete bilateral of soft, hard, and/or lip and
IV alveolar ridge

These descriptions can be modified with the words

incomplete, right, left, one/third, and so on.
(Table.1)
* 18/9/03 09:14 Página 25

The Striped-Y Classification

First East Indian International Cleft Surgery Workshop
system
R L
I
Lip

Alveolus

ion in clefts is considerable.

Primary
palate
N
y to record a cleft lip is by Foramen
hy. A better way to record a incisivum
t is to fill in the following
h stripes and dots. Vomer T

Spinae
Soft
pa late
R

R L (fig.6)

O
figure with stripes and dots.

Vo
Soft
pa lat

R L

Fig. 2
Cleft palate
R L

Cleft palate
(fig.7)

Fig. 3
 Fig. 2
Cleft palate
R L

Fig. 3
Left-sided unilate
cleft lip and palat

R L

Left-sided unilateral complete cleft lip and palate

(fig.8)
Fig. 4
Bilateral complete
 Fig. 3
Left-sided unila
cleft lip and pal

R L

Fig. 4
Bilateral comple
and palate

R L

Bilateral complete cleft lip and palate

Fig. 5
(fig.9)
Bilateral-right i
complete-cleft li
 Fig. 4
Bilateral compl
and palate

R L

Fig. 5
Bilateral-right
complete-cleft l
palate

Bilateral-right incomplete, left complete-

cleft lip and primary palate
25
(fig.10)
 Dental Implications

• The dental implications of cleft lip and/or

palate depend on the number of dental
abnormalities present and the stage of
treatment.
• The dentist play an important role in
managing the care of the individual with a
cleft lip and/or palate through education
and preventive dental hygiene therapy.
• Numerous surgical and other medical
and dental treatments are necessary to
correct cleft lip/palate. The surgeries are
scheduled starting at about 3 months of
age & ending at about 1 year to correct
simple clefts.
 References

• Dr. B. Sudarshan & Dr. Bhanu Murthy, “Plástikos - Cleft Surgeons & Doctors -
Smile Train Partners” in First East Indian International Cleft Surgery Workshop,
2003. http://medpro.smiletrain.org.uk/library/images/WS-India-Manual.pdf

• Leslie DeLong, Nancy W. Burkhart, “Developmental, Hereditary and Congenital

Disorders” in General Oral Pathology for Hygienists, 1st Edition, Lippincott
Williams and Wilkins, 2008 pp 110-146.

• Development of Face, Interactive guide: http://www.indiana.edu/~anat550/

hnanim/face/face.html