Department of Orthodontic.

1. MANAGEMENT OF CLEFT LIP AND
PALATE.
DEPARTMENT OF ORTHODONTICS.

2. CLEFT LIP & PALATE
The term cleft lip & palate is
commonly used to represent two types of
malformation.
• Cleft lip with or without cleft palate (CL/P).
• cleft palate (CP).

3. Bilateral cleft of lip & palate.

4. cleft of the hard & soft palates.

5. Unilateral cleft of lip.

6. Cleft of lip & Palate.

7. Unilateral and Bilateral Cleft lip.

9. Classification.
• The Veau Classification system.
• The Striped-Y Classification system.

10. The Veau Classification system
Class Description
I Soft palate only
II Hard & soft palate to the incisive foramen
III Complete unilateral of soft, hard, lip, & alveolar
ridge.
IV Complete bilateral of soft, hard, and/or lip and
alveolar ridge
These descriptions can be modified with the words incomplete,
right, left, one/third, and so on.

11. The Striped-Y Classification system

12. Management of Cleft lip and Palate.
 Clefts involving the lip and palate
are the most commonly seen
congenital deformities that occur
at the time of birth.
 Children born with cleft lip and
palate have a number of problem
that have to be solved for successful
rehabilitation.
 Cleft Lip and Palate are common
congenital deformities that often
affect speech, hearing, and
cosmesis; and may at times lead to
airway compromise.

13. •The complexity of the problem requires that a number of
health care practitioners co-operate to ensure
comprehensive care of the patient.
This led to the concept of a multidisciplinary cleft palate
team comprising of the paediatrician ,pedodontist,
orthodontist, oral and maxillofacial surgeron,
prosthodontist, social worker, genetic scientist, ENT
surgeon, plastic surgeon, psychiatrist and a speech
pathologist.

15. •The individuals of the cleft palate team should be flaxible
and respect each other’s option.
•The cleft lip and palate team has been described as a close,
co-operative, democratic, multi professional union devoted to
the single cause of patient well being.
•The management of cleft lip and palate can be divided into
the following stages:

16. STAGES IN MANAGEMENT OF
CLEFT LIP AND PALATE.
 Stage one,
 Stage two,
 Stage three,
 Stage four.

17. 1.STAGE ONE,
 This comprises of the treatment done from birth to 18 month of age.
2.STAGE TWO,
 This is from the 18th month to the fifth year of life.
 It generally corresponds to the primary dentition stage.
3.STAGE THREE,
 This includes treatment that is carried out during the mixed
dentition stage.
 It spans from the sixth to the eleventh year of life.
4.STAGE FOUR,
 This includes treatment done during the permanent dentition stage
i.e.12-18 of age.

18. A) Primary Management
Antenatal Diagnosis:
•It is possible to diagnose by ultrasound scan after
18 weeks of gestation. Isolated cleft palate cannot
be diagnosed by USS.
•When diagnosis is confirmed referral to cleft
surgeon is appropriate for genetic counseling.

20.  Feeding Difficulties:
• Most affected babies
feed well and thrive
provided appropriate
advise and support to
mother is given.
• Some mothers are
successful in breast
feeding particularly in
incomplete clefts.
• Soft bottles and modified
teats can help.

21.  Airway Problems:
• Major respiratory obstruction is uncommon but
can occur in some cases.
• Intermittent airway obstruction is more frequent
and managed by nursing the baby prone.
• More severe and persistent airway compromise
can be managed by retained nasopharyngeal
intubations.
• Surgical adhesion of tongue to lip c/a
Labioglossopexy can be an alternate in first few
days but it is less commonly practiced.

23. B) Surgical Techniques
 Principles of Surgery:
• Surgical techniques are aimed to restore the normal
anatomy of lip, nose, and face.
• Normal or near normal anatomy promotes normal
function, thereby encouraging normal growth and
development of lip, nose, palate and facial skeleton.

24.  Timing of Surgery:
Rule of tens
• At least 10 weeks old
• Weighs at least 10 pounds
• Has Hb. Of 10 gm.
Better results are obtained when the child is at
least 3 months.

26.  Muscle Realignment:
• In this condition Nasolabial and bilabial muscle
rings are disrupted on one or both side resulting
in deformity.
• This has to be taken into consideration while
planning repair.

27.  Pre Opreative Orthopaedic Treatment:
• Realignment of alveolus prior to lip repair
improves the balance and symmetry and future
development of mid face.

28. • Operative Procedures (Cleft Lip)
Two surgical techniques are used most widely in cleft lip
surgery:
o Rotation-advancement technique
o Triangular flap technique
Lip adhesions – Difference of opinion.
• It is first stage of two stage lip reconstruction.

29.  Rotation Advancement
Technique
• Millard 1957
• Does not require precise
markings and
measurements
• Based on surgeons
ability to use the basic
design and to adjust the
tissue as the operation
progresses until
acceptable alignment is
achieved.

30. Triangular Flap Technique
•Based on idea of using the
design to establish equal
vertical dimensions on both
lip segments.
•Construction of equilateral
triangular flaps on each side.
Lip repair by Bardach
technique

32. Operative Procedure (Cleft Palate)
• Several Techniques- Trend is towards less scarring
and less tension on palate
• Scarring of palate may cause impaired midfacial
growth (alveolar arch collapse, mid face
retrusion, malocclusion)
• Facial growth may be less affected if surgery
is delayed until 18-24 months, but feeding,
speech, socialization may suffer.

33. C) REHABILITATION
Hearing Management:
• It has been recently recognized that
a child with craniofacial anomaly
including cleft lip and palate is at
increased risk of sensori-neural
hearing deficit.
• All children born with cleft lip and
palate should be assessed for SNHL
and Conductive hearing loss before 12
months of age, by ABR and
tympanometry.
• SNHL is managed by Hearing aid
• Conductive Hearing loss is managed
by Surgical and medical management
of OME.

34. Speech Problems and Management:
•Velopharyngeal incompetence
(Increased nasal airflow and
resonance
produing nasal or hyper nasal
quality of speech)
•Articulation problems:
Speech problems are
managed by Speech and language
therapy
•Secondary palatal surgery
1.Intravelar veloplasty (muscular
reconstruction of soft palate
2.Pharyngoplasty
•Speech training devices

35. Dental Problems and Management
• Delayed tooth development
• Delayed eruption of teeth
• Morphological abnormalities
• Decreased number of teeth
(hypodontia) or increased number of
teeth (Hyperdontia)
• Regular examination should be done.
Many patients require orthodontic
treatment.
 Secondary Surgery for Cleft Lip and
Palate Despite adequate primary surgery,
residual problems do occur and are
managed by appropriate secondary
surgical procedures.

36. Non Surgical Treatment
•Lip Adhesions
•Dental Obturator
•For high-risk patients or those that refuse
surgery.
Advantage- High rate of closure
Disadvantage- Need to wear a prosthesis,
and need to modify prosthesis as child grows.

37. THANK
YOU..!