CLEFT LIP

&
CLEFT PALATE
DEFINATION
DEFINATION
Cleft of the lip, alveolus ,hard and soft palate are the most
common congenital abnormalities of the orofascial structures.
Can be isolated.
Associated with cardiac abnormalities.
In syndromic variety genetic counselling is advised.
TESSLER’S CLASSIFICATION.
O= orbital alteration.
M= mandibular deformity,
E= ear deformity.
N= nerve involvement.
S= soft tissues.
 INTRODUCTION
Every year more than165,000 children are born with
clefts: most can't afford surgery

Unrepaired Clefts
Most cannot eat or speak properly, aren’t allowed to attend
school or hold a job.

Shame & Isolation

Being born with a cleft in a developing country is truly a
curse. Every baby born in Uganda with a cleft is given the
name Ajok which means literally, “cursed by God.” Some
newborns are killed or abandoned right after birth.
 STATICS
CL + Palate 1 in 1000 live births (Aus)
1 in 500 (Asians) 1 in 2000(Africans)

cleft lip and palate 46%,

Isolated cleft palate 33%
Isolated cleft lip 21%.

Unilateral clefts are nine times as common as bilateral clefts

Occur twice as frequently on the left side than on the right.
Left :Right :Bilateral is 6:3:1

Males are predominant in the cleft lip and palate population

isolated cleft palate occurs more commonly in female
ETIOLOGY
ISOLATED CLEFT LIP:
Intrauterine exposure to the anticonvulsant phenytoin
(10-fold)
Maternal smoking during pregnancy (2 times)

CLEFT LIP AND PALATE

 alcohol, anticonvulsants, and retinoic acid,
van der Woude syndrome.
GENITIC FACTORS
Recent studies, a meta-analysis of 13 genome scans by
Marazita et al. (2004) revealed multiple cleft lip/palate
genes on 16 chromosomal regions
If the family has one affected child or parent with CLP,
the risk of the child of the next pregnancy having CLP
is 4%.
If two previous children have CLP, the risk increases
to 9%, and
if one parent and one child were previously affected,
the risk to children of subsequent pregnancies is 17%.
SYNDROMES (approx 150)
Pierre Robin sequence.
Stickle’s.(ophthalmic and muskuloskeletal)
Shprintzen’s (cardiac )
Down’s
Apert
Treacher Collon’s
van der Woude syndrome
ANATOMY (LIP) Landmarks
ANATOMY (PALATE)
ANATOMY (PALATE)
ANATOMY OF CLEFT LIP AND
PALATE
The fascial muscles divided into 3 muscular rings of delve.
 nasolabial--- nasal aperture.
Bilabial- oral aperture.
Labiomental- lower lip and chin.
IN unilateral cleft lip nasolabial and bilabial muscles are
disrupted on one side as an assymetrical deformity involving
external nasal cartilage, nasal septum, and anterior maxilla. In
bilateral cases symmetrical superior muscle rings are
disrupted on both sides.
Primary palate consists of all anatomical structure anterior to
incisive foramen, alveolus and upperlip.
Secondary palate is structure behind the incisive foramen.
CLASSIFICATION
LAHSHAL
• Otto Kriens described this palindromic acronym for clefts.
• Represents the Lip, Alveolus, Hard palate and Soft palate.
• The letters read from the patient’s right to left.
• Upper case letters represent complete clefts.
• Lower case letters represent incomplete clefts.
• No cleft is represented with a dot.
• An asterisk represents a microform cleft.
• For example:
∘ . . HSH . . is a complete cleft of the secondary palate.
∘ l . . . . . . is a right-sided incomplete CL.
∘ LA . . . AL is a bilateral complete CL and alveolus.
MANAGEMENT
DIAGNOSIS
upper lip develops at around five weeks of pregnancy.
it is usually picked up at the routine ultrasound scan
at 18-20 weeks
pregnancy.
PRENATAL & NEONATAL
MANAGENENT
Ultrasound.
Genetic counselling.
Termination.
Meeting with parents and children with same
pathology.
NEONATAL management focuses on,
Airway problems,
Breathing
Eye protection.
Feeding problems.
PREVENTION

Taking a daily supplement of 400 micrograms of folic

acid in the month before conception and in the first
two months of pregnancy can help prevent cleft lip
Problems related to cleft lip and
palate
Feeding

Speech

Hearing

Teeth and jaws

Airway
Typical members of a cleft team
audiologist,
dentist,
nurse,
 nutritionist/dietitian,
oral surgeon,
 orthodontist,
otolaryngologist,
pediatrician,
plastic surgeon,
psychologist,
speech pathologist
FEEDING
PROSTODONTICS
TIMMINGS OF CLEFT LIP & PALATE
REPAIR
CLEFT LIP.= unilateral 1 operation at 5-6 months.
Bilateral at 4-5 months.
CLEFT PALATE.= soft palate only 1 surgery at 6 months.
Soft palate and hard palate 2 surgeries soft palate at 6 months and
hard palate at 15- 18 months.
CLEFT LIP AND PALATE.
UNILATERAL. 2 operation lip and soft palate at 5-6 months.
Hard palate and gumpad with or without lip revision at 15-18
months.
BILATERAL.. 2 surgeries. Cleft lip and soft palate at 4-6 months.
Hard palate and gum pad with or without lip revision at 15- 18
months.
SURGERY (CLEFT LIP)
Objectives of good palate repair
Techniques of cleft palate repair

Two Flap technique

Von Langenbeck
PRINCIPLES OF CLEFT
SURGERY
Cleft lip surgery attaches and reconnects the muscle
around the oral sphincter.
Cleft palate surgery aims to bring together mucosa
and muscle with minimal scarring,
2 stage procedure minimizes dissection.
Restoration of normal anatomy,
Delaire technique is performed,
ALVEOLAR BONE GRAFTING
SECONDARY SURGERY
Cleft lip revision,
Alveolar bone graft.
Secondary palate procedure.
Dentoalveolar procedure.
Orthognathic surgery.
Rhinoplasty.
THANK YOU