1. ORO-FACIAL CLEFTS
Dr. Ali Tahir

2. ORO-FACIAL CLEFTS
 The formation of face & oral cavity involves the
development of multiple tissue processes that must
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merge & fuse in highly orchestrated fashion
 Disturbances in the growth of these tissues or their
fusion results in oro-facial clefts
 During 6th & 7th weeks of development, upper lip is
formed when
 Medial nasal processes merge with each other
 Medial nasal processes merge with the maxillary
process
 Lateral nasal processes are not involved in the
formation of upper lip, they form alae of nose

3. ORO-FACIAL CLEFTS
Primary Palate
 Is formed by the fusion of medial nasal processes
 Also called the premaxilla containing the anterior four
teeth
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Secondary Palate
 Makes up 90% of hard & soft palates
 Formed by fusion of maxillary processes
 Bilateral projection from medial aspect of maxillary
processes emerge during 6th week oriented vertically
one ach side of developing tongue
 As the mandible grows, the tongue drops down
 Shelves fuse anteriorly with each other & with anterior
palate & nasal septum, proceeds posteriorly

4. CLEFT LIP/CLEFT PALATE
 Defective fusion of medial nasal process with maxillary
process  cleft lip (CL)
 Defective fusion of palatal shelves  cleft palate (CP)
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 45% are CL + CP
 30% isolated CP
 25% isolated CL
 CL±CP is considered a separate entity and CP as
separate
 More than 250 syndromes are associated with CL &
CP
 Median cleft of upper lip is rare, due to faulty fusion of
medial nasal processes

5. CLASSIFICATION
International confederation for plastic and reconstructive
surgery classification (1968)
Group I
Cleft of anterior primary palate
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a. Lip  Right, Left, Both
b. Alveolus  Right, Left, Both
Group II
Clefts of anterior & posterior palate
a. Lip  Right, Left, both
b. Alveolus Right, left, both
c. Hard palate  right, left, both
Group III
Clefts of posterior secondary palate
a. Hard palate  Right, left
b. Soft palate  Median

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7. CLEFT LIP/CLEFT PALATE
Clinical Features:
 Most common major congenital defect
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 Considerable racial variation
 In whites, 1 of every 700-1000 births has CL ± CP
 In Asians, it is 1.5 times higher than whites
 Isolated CP is less common
 CL ± CP is more common in males
 Isolated CP is more common in females
 80% of cases, CL is unilateral
 70% of unilateral clefts occur on left side
 A complete CL extends upward into the nostril

8. CLEFT LIP/CLEFT PALATE
 When involves the
alveolus, usually
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occurs between lateral
incisor & canine
 Sometimes lateral
incisor may be missing

9. CLEFT LIP/CLEFT PALATE
 CP may range from involvement of soft palate
alone or both hard & soft palate
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 Minimal manifestation is bifid uvula (much common
1 in every 10 Asians)
 Sometimes, a sub-mucosal cleft palate develops

10. CLEFT LIP/CLEFT PALATE
Dr. Ali Tahir

11. PIERRE ROBIN ANOMALY
 Cleft Palate
 Mandibular micrognathia
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 Glossoptosis
Retruded mandible results in
 Post placement of tongue
 Lack of support of tongue
musculature
 Airway obstruction

12. PATIENT’S COMPLAIN
 Clinical appearance
 Psycho-social difficulties
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 Feeding
 Speech
 Malocclusion
 Missing/supernumerary teeth

13. MANAGEMENT
 Treatment involves a multi-disciplinary approach
 Paediatrician
Dr. Ali Tahir
 Oral & maxillo-facial surgeon
 Otolaryngologist
 Plastic surgeon
 Paediatric dentist
 Orthodontist
 Prosthodontist
 Speech pathologist

14. MANAGEMENT
 Treatment involves multiple primary & secondary procedures
throughout childhood
Birth – 24 months:
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 Primary lip closure is done in the early months of life (age 10
months, weight 10 pounds, Hb 10gm% by Millard)
 Followed later by repair of palate (12-24months, 9-12years)
2 – 6years
 Formation of feeding plate or passive maxillary obturator
6-12 years (mixed dentition)
 Often prosthetic or orthopedic appliances are used to expand
maxillary segments before closure of defect
 Arch expansion, maxillary protraction, fixed orthodontic treatment

15. MANAGEMENT
Permanent dentition: (12years onward)
 Secondary soft tissue & orthognathic procedures
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are done to improve function & aesthetics
 Final corrections including alignment, exposure of
canine (if not erupted yet) & occlusion settled
 Orthognathic surgery may be required
 Permanent retention may be required by the
Prosthodontist using fixed bridges or cast partial
dentures
 Lip revision, nasal corrections can be done after
completion of orthodontic treatment

16. OTHER CLEFTS
 Lack of fusion of maxillary & mandibular processes
 Lateral facial cleft
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 May be associated with ‘Mandibulo facial
dysostosis’
 Extends from commissures towards the ear
 May be unilateral or bilateral
 Failure of fusion of lateral nasal process with
maxillary process  oblique facial cleft

17. Dr. Ali Tahir