2. introduction
Are the most common major congenital
Craniofacial abnormality
Cleft lip present in approximately 1 in 700 live
births
male to female 2:1
while cleft palate present approximately 1 in
2000 live births and effects male to female 1:2
3.
4.
5. Embryology
At approximately 6 weeks of human embryologic
development the median nasal prominence fuses with the
lateral nasal prominences and maxillary prominences to
form the base of the nose , nostrils , upper lip, and
premaxilla ,the confluence of this interior components
becomes the primary palate , when this mechanism fails ,
clefts of the lip and /or maxilla occur
At approximately 8 weeks of the fetal life the palatal
shelves elevate beside the tongue , then the tongue
descend inferiorly and interiorly with the developing
mandible , the vertical palatal shelves movie horizontally
to fuse with the septum to form the intact secondary
palate ,when the palatal shelves fails to fuse a cleft of the
secondary palate occurs
25. Normalized aesthetic appearance of the lip and
nose
Intact primary and secondary palate
Normal speech , language , and hearing
Nasal airway patency
Class I occlusion with normal masticatory function
Good dental and periodontal health
Normal psychosocial development
The aim of Treatment
27. Feeding the child with a cleft palate
Infant with cleft palate enable to form an
adequate seal between the tongue and palate to
create sufficient negative pressure to such fluid
from a bottle , nasal regurgitation
Specialised nipples and bottles are necessary
splint
28.
29. Mead Johnson/Enfamil Cleft Feeder Special Needs Feeder / Haberman Feeder
Pigeon Feeder Dr. Brown’s Natural Flow to relieve gas
30. procedure Time frame
Cleft lip repair
Cleft palate repair
Pharyngoplasty
Maxillary / alveolar reconstruction
With born grafting
Cleft orthognathic surgery
Cleft rhinoplasty
Cleft lip revision
After 10 weeks
Age 9 -18 months
Age 3 – 5 years or later based on
speech development
Age 6-9 years based on dental
development
Age 14-16 years in girls
16-18 years in boys
After age 5 years but preferably at
skeletal maturity after
arthognathic surgery when
possible
Any time once initial remodelling
and scar maturation s completed ,
best after age 5 years
42. Hard palate closure
Advantage of early closure
Better feeding ,hygiene , development of phonation
Preserve auditory tube function
Improve psychological state for baby and his
parents
Disadvantages of early closure
Difficult surgery due to small structures
Growth restriction of maxilla due to scar formation
44. Treatment of Velopharyngeal incompetence
Speech aid applaince
Pharyngeal flap, superiorly or inferiorly
based flap
Sphincter pharyngoplasty
Posterior pharyngeal flap augmentation
45.
46.
47. Alveolar cleft graft
TIME
Advantages
Provide bone support for maxilla
Closure of oronasal fistula
Augmentation of alveolar ridge to facilitate implant ,
prosthesis
Creation of base to support lip and ala of nose
48. procedure Time frame
Cleft lip repair
Cleft palate repair
Pharyngoplasty
Maxillary / alveolar reconstruction
With born grafting
Cleft orthognathic surgery
Cleft rhinoplasty
Cleft lip revision
After 10 weeks
Age 9 -18 months
Age 3 – 5 years or later based on
speech development
Age 6-9 years based on dental
development
Age 14-16 years in girls
16-18 years in boys
After age 5 years but preferably at
skeletal maturity after
arthognathic surgery when
possible
Any time once initial remodelling
and scar maturation s completed ,
best after age 5 years