Cleft Lip & Palate

1. Cleft Lip & Palate الدكتور علي القصير اختصاص الجراحه التجميليه والتقويميه

2. introduction • Facial clefting is the second most common congenital deformity (after clubfoot). • Affects1in 750 births • Problems are cosmetic, dental, speech, swallowing, hearing, facial growth, emotional

3. Prevalence • CL/P is more common than CP and varies by ethnicity. • CL/P • High in American Indians and Asians (1/500 newborns) • Low in American blacks (1/2000 newborns) • Intermediate level in Caucasians (1/1000 newborns) • More common in male • Isolated CP occurs in only 1/2500 newborns , does not display variation by ethnicity and more common in female.

4. Cleft Lip • Complete closure at 35 days postconception: • 7 weeks from the LMP. • Lateral nasal, median nasal, and maxillary mesodermal processes merge. • Failure of closure can produce unilateral, bilateral, or median lip clefting. • Left side unilateral cleft is the most common.

5. Cleft Palate • Lack of fusion of the palatal shelves. • Abnormalities in programmed cell death may contribute to lack of palatal fusion(?). • Isolated disruption of palate shelves can occur after closure of the lip • Palatal closure is not completed until 9 weeks post-conception.

6. emberology • 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

7. embryology • 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)

8. embereology • 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

9. anatomy • Hard Palate • Bones: Maxilla( Palatine Processes) + Palatine Bones(Horizontal Lamina) • Blood Supply: Greater Palatine Artery • Nerve Supply: Anterior Palatine Nerve

10. Anatomy • 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)

11. Etiology • Several agents that are associated with an increased frequency of midfacial malformation. • Genetics • Medications —phenytoin, sodium valproate, methotrexate. • With corticosteroids there is no evidence of an increase in malformations. • Possible association could not be excluded

12. Etiology • Cigarette smoking • Noted with mothers of children with facial clefting, both CL/P and CP. • Teratogenesis has been attributed to hypoxia as well as a component of tobacco (cadmium). • Alcohol • Associated with an increased risk of fetal facial clefting. • Alterations in cell membrane fluidity or reduced activity of specific enzymes such as superoxide dismutase. • Folate deficiency • Contributes to a range of birth defects. • Evidence is emerging for a similar association with the development of CL/P.

13. Cleft 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

15. 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

21. treatment • Feeding • respiratory tract and ear infection • Orthodontic • Surgery

22. 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