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Cleft Lip and Palate: An Overview

Brett A. Ueeck DMD, MD, FACS. Cleft Lip and Palate: An Overview. Multidisciplinary Approach to Cleft Lip and Palate Care – Team Members. Cleft surgeon Otolaryngologist Pediatrician Orthodontist General Dentist Prosthodontist. Geneticist Speech therapist Audiologist Nursing

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Cleft Lip and Palate: An Overview

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  1. Brett A. Ueeck DMD, MD, FACS Cleft Lip and Palate: An Overview

  2. Multidisciplinary Approach to Cleft Lip and Palate Care – Team Members • Cleft surgeon • Otolaryngologist • Pediatrician • Orthodontist • General Dentist • Prosthodontist • Geneticist • Speech therapist • Audiologist • Nursing • Social worker

  3. Introduction • Anatomy • Genetics and Incidence • Classification • Associated Otolaryngology problems • Airway problems • Feeding problems • Ear problems • Speech problems • Dental problems • Cosmetic problems

  4. Anatomical Disturbances with Cleft Palate • Primary palate • Secondary palate • Hard palate • Soft palate • Eustachion tube

  5. Incidence • 1 in 700-750 births in the US • 1 in 550-600 births in Asians • 1 in 1000 births in Afro-Americans • In Czech study • CL was 1 in 2243 births • CL and CP was 1 in 826 births • CP was 1 in 1650 births

  6. Genetics • Risk in male > female for CL and CL+CP • Risk in female > male for CP alone

  7. Familial Risk • One parent has a cleft lip or cleft lip/palate • Risk to first child is approximately 4-5% • Risk for second child if first child has a cleft is approximately 20% • If the parent has a bilateral cleft, the risk is higher than if they have a unilateral cleft • If the parent has a cleft palate only, the risk is approximately 7% • Sibling has a cleft – risk is approximately 4% • Second or third degree relative has a cleft – risk is <1%

  8. Classification of Cleft Lip Defects • Formes frustes

  9. Classification of Cleft Lip Defects • Incomplete cleft lip • Unilateral

  10. Classification of Cleft Lip Defects • Incomplete cleft lip • Bilateral

  11. Classification of Cleft Lip Defects • Complete cleft lip • Unilateral

  12. Classification of Cleft Lip Defects • Complete cleft lip • Bilateral

  13. Classification of Cleft Palate Defects • Primary palate • Alveolar notch • Complete cleft • Unilateral • Bilateral

  14. Classification of Cleft Palate Defects • Cleft of the secondary palate • Bifid uvula • Submucous cleft • Cleft of the soft palate only • Complete cleft palate

  15. Classification of Cleft Palate Defects • Submucous cleft

  16. Classification of Cleft Palate Defects • Cleft of the soft palate only

  17. Classification of Cleft Palate Defects • Complete cleft palate • Cleft of the primary palate • Cleft of the secondary palate • Unilateral • Bilateral

  18. Airway Problems • Airway obstruction at time of cleft palate repair • Pierre-Robin Syndrome

  19. Feeding Problems • Failure to thrive • Nasal regurgitation

  20. Ear Problems • Eustachion tube dysfunction • Otitis media with effusion (OME) • Myringotomy with ventilation tubes • Atelectatic middle ear • Cholesteatoma

  21. Speech Problems • Articulation errors • Secondary to hearing loss • Oronasal fistula • Velopharyngeal incompetence

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