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Cleft Lip and Palate

Cleft Lip and Palate. Introduction:Cleft Lip and Palate. Embryology Epidemiology Etiology Genetics Plastic Surgery. Hearing and speech Psychology Orthodontics Anthropology. Embryological facial development. Frontal View. Embryology(Sperber,1992).

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Cleft Lip and Palate

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  1. Cleft Lip and Palate Dr. Gutmann

  2. Introduction:Cleft Lip and Palate • Embryology • Epidemiology • Etiology • Genetics • Plastic Surgery • Hearing and speech • Psychology • Orthodontics • Anthropology Dr. Gutmann

  3. Embryological facial development Frontal View Dr. Gutmann

  4. Embryology(Sperber,1992) 4th- 8th week –closure of Primary Palate(Frazer, 1970) 4th week- Stomodeum(involution of ectomesenchyme) Maxillary and Mandibular processes 5th week- Primary palate formation- fusion of maxillary and frontonasal process. (Lateral and Medial Nasal Swellings/Nasal pits) 6th-10thweek –closure of Secondary Palate(Christensen,1992) 6th week- Palatine Shelves/ muscle of soft palate Dr. Gutmann

  5. Cleft lip w/- w/o Palate • Cleft anterior to Incisive Foramen(Sperber, 1992) • Mesenchymal cells do not penetrate the Nasolacrimal Grooves Cleft lip w/ palate- Primary Palate defect • Cleft posterior to Incisive Foramen(Langman, 1981) Palatine Shelves do not fuse. Dr. Gutmann

  6. Embryological palate development Frontal view Dr. Gutmann

  7. Embryological palate development Inferior view Dr. Gutmann

  8. Prevalence of Cleft Lip & Palate Dr. Gutmann

  9. Epidemiology • Cleft lip w/ or w/o Palate:0.6-2 : 1,000 Births • Japan 1.7/ Whites- 1.0 / Blacks- 0.4 Dr. Gutmann

  10. Epidemiology • Males: More Cleft Lip w/- w/o Palate Females:More Cleft Palate-later fusion Palatine plates /longer period/greater exposure time(Burdi,1969) (Cooper, 2000) Dr. Gutmann

  11. Etiology of Cleft Lip and Palate • Multifocal • Midline facial defect (developmental) Growth hormone defect/Teeth development defect • Genetic(Wyszynski, 1996) - Mendelian/- Multifactorial Twins study (Keush, 1991)- 33%- identical/ 7%- non-identical Dr. Gutmann

  12. Etiology of Cleft Lip and Palate(continue) Environmental factors: Humans: Alcohol, smoking, antiepileptic meds Animal experimentation: Cortizol/ Steroids(Richtsmeir, 1994) Bixler, 1991) Anti- Asthmatic/ X-ray (Sa’ad, 1994) Dr. Gutmann

  13. Multifactorial inheritance Relatives- (Balgir,1984) First degree- 4% Uncles- 0.6% Cousins(First degree)-0.4% Siblings- (one sibling) Bilateral cleft lip and palate- 5.7% Unilateral cleft lip and palate-4.2% Cleft lip w/o palate- 2.5% (Bixler, 1981/ Fraser, 1970) 2 siblings affected- additional (9.0%) (Wyszynski, 1996) Dr. Gutmann

  14. Frequency Majority of CL/Ps are isolated Majority of CPs are syndromic (McCarthy) Dr. Gutmann

  15. Predicted Occurrence, % (McCarthy) Dr. Gutmann

  16. 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 Dr. Gutmann

  17. Examples of Cleft lip: Unilateral and Bilateral • Normal/ Unilateral/ Bilateral Dr. Gutmann

  18. Repair of cleft lip Dr. Gutmann

  19. Repair of cleft palate Dr. Gutmann

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