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Cleft lip and palate Normal development of the face and palate

Cleft lip and palate Normal development of the face and palate. Primary palate upper lip and alveolar ridge develop between 4 th and 8 th week of gestation Secondary palate hard and soft palates develop between 8 th and 12 th week of gestation

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Cleft lip and palate Normal development of the face and palate

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  1. Cleft lip and palate Normal development of the face and palate Primary palate upper lip and alveolar ridge develop between 4th and 8th week of gestation Secondary palate hard and soft palates develop between 8th and 12th week of gestation Development can be interrupted by abnormal genetic conditions or environmental agents (teratogens)

  2. Cleft lip and palateClassification systems Numerous classification systems: • Veau • American Cleft Palate-Craniofacial Assn (ACPA) • Kernahan and Stark Veau’s system: I Cleft of soft palate only II Cleft of hard and soft palate to incisive foramen III Complete unilateral cleft of soft and hard palate and lip and alveolar ridge on one side IV Complete bilateral cleft of soft and hard palate and lip and alveolar ridge on both sides

  3. Causes of cleft lip and palate • Genetic disorders • Chromosomal abnormalities • Environmental factors (teratogenic agents) • Mechanical factors

  4. Genetic factors • Syndrome vs. sequence • Pierre Robin sequence • Small mandible (micrognathia) causes failure of tongue to descend • Failure of the tongue to descend causes cleft • Heart problems, conductive hearing loss, developmental deficits • about 40% of infants with Pierre Robin have Stickler Syndrome and about 15% have Velocardiofacial Syndrome • Treacher Collins syndrome • Under-developed cheekbones with scalp hair • Malformed ears • Conductive hearing loss • Normal cognitive functioning

  5. Chromosomal abnormalities • Trisomy 13 • Rare chromosomal abnormality • Multiple congenital malformations • Mean life expectancy is 130 days

  6. Environmental factors • Recognized teratogenic agents • Drugs • Aspirin overdose • Acne medications • Alcohol overdose

  7. Mechanical factors • Intrauterine crowding (tumors, multiple births, placenta abnormalities)

  8. Incidence of cleft lip and palate 1:750 live births Clefts of lip only more frequent, more severe in males Clefts of palate only more frequent in females Native Americans have highest prevalence African Americans have lowest prevalence

  9. Management of clefts • Surgical • Primary • Secondary • Dental • Audiological • Speech and Language

  10. Speech & Language • Speech • Articulation • Voice • Whistling-Blowing therapy • Continuous Positive Airway Pressure (CPAP) • Language

  11. Cleft lip and palate http://www.cleftline.org/ http://www.youtube.com/watch?v=l067ggy7ywc&feature=channel Video-endoscopy assessment tape Nasometer demonstration from CD See-scape demonstration

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