Cleft lip and palate

CLEFT LIP AND PALATE

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INDIAN DENTAL ACADEMY
Leader in continuing dental education


INTRODUCTION
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CLEFT LIP AND PALATE IS THE MOST
COMMON FACIAL ANAMOLY
OCCURS IN APPROXIMATELY 1 IN 1000
NEWBORNS
ISOLATED CLEFT LIP AND PALATE
OCCUR IN ABOUT 1 IN 2000
NEWBORNS
THE ANAMOLY APPEARS TO BE
GENETICALLY DETERMINED
ALTHOUGH MAJORITY ARE OF
UNKNOWN CAUSE OR ARE
ATTRIBUTABLE TO TERATOGENIC
CAUSE.

What is a Cleft?
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Any opening or division in some part of the
anatomy that is not normally open or divided.
Result of some problem during
embryological development.
Problem specifically occurs during the
first trimester of pregnancy.
Failure of parts to fuse at the midline.

Clefts
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Result of problem with structure formation during
the first trimester of pregnancy.
CLEFT LIP – failure of the upper lip to fully
form.
Lower lip forms earlier; cleft would accompany
cleft of the mandible which would be much more
serious and usually be accompanied by other
(fatal) problems.
CLEFT PALATE – opening in the hard or soft
palate.
Result = connection between the oral and
nasal cavities

CLEFTS
® Clefts of lip or palate occur at different
times
during development.
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Lip closure – occurs at 7-9 weeks
gestation.
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Palate closure – occurs at 9-11 weeks
gestation.
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Only 5% of cleft lips occur without
accompanying clefts of the palate.
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Whatever disrupts lip closure will
probably also disrupt palatal closure .

DEVELOPMENT OF THE FACE


DEVELOPMENT OF LIP


CLASSIFICATION OF CLEFT LIP AND
PALATE

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VARIOUS CLASSIFICATIONS HAVE
BEEN GIVEN HOWEVER THE
MOST ACCEPTED
CLASSIFICATION WAS GIVEN BY
VEAU
® VEAU CASSIFIED CLEFT LIP AND
CLEFT PALATE SEPERATELY


VEAU’S CLASSFICATION Of Cleft Lip
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CLASS I---a unilateral notching of the
vermillion not extending into lip.


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CLASS II…..
a unilateral notching of the vermillion with
cleft extending into the lip but not
including the floor of the nose……


CLASS II-CLEFT LIP


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CLASS III
a unilateral notching of the vermillion
border with cleft extending into the floor
of the nose……


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CLASS IV…….
Any bilateral clefting of the lip,whether it
be incomplete notching or complete
clefting……


DEVELOPMENT OF PALATE


VEAU’S CLASSFICATION Of Cleft Palate
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CLASS I….
Involves only the soft palate

Soft
palte

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CLASS II………
Involves the soft and hard palates but not the
alveolar process………


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CLASS III…..
Involves both soft and hard palates and
the alveolar process on one side of the
pre-maxillary area……


CLEFT PALATE—CLASS III


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CLASS IV…….
Involves both soft and hard palates and
continues through the alveolus on both
sides of the pre-maxilla,leaving it free
and often mobile……


CLEFT PALATE—CLASS IV


MULTIDISCIPLINARY APPROACH TO


MULTIDISCIPLINARY APPROACH TO
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The complexity of problems associated with
cleft lip and palate requires that numerous
healthcare professionals co-operate in
providing the specialised knowledge and
skills neccesary to ensure comprehensive
care.
A protocol has been established by
AMERICAN CLEFT PALATE CRANIOFACIAL
ASSOCIATION(www.cleftpalatecraniofacial.org)

MULTIDISCIPLINARY APPROACH
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THE TEAM IS COMPOSED OF
® DENTAL SPECIALITIES
1.ORTHODONTICS
2.ORAL SURGERY
3.PEDODONTICS
4.PROSTHODONTICS
MEDICAL SPECIALITIES
1.GENETICS
2.OTOLARYNGOLOGY
3.PEDIATRICS
4.PLASTIC SURGERY
5.PSYCHIATRY

MULTIDISCIPLINARY APPROACH
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ALLIED HEALTH CARE FIELDS
1.AUDIOLOGY
2.NURSING
3.PSYCHOLOGY
4.SOCIAL WORK
5.SPEECH THERAPY


ETIOLOGY OF CLEFT PALATE AND
CLEFT LIP
Some possible causes related to CLEFT
PALATE AND CLEFT LIP can be categorized
as:
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GENETIC
NUTRITIONAL
SMOKING
DRUGS
ENVIRONMENTAL
SYNDROMES ASSOCIATED WITH CLEFT PALATE AND
CLEFT LIP


GENETICS
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Clefts commonly have a genetic basis,.
Clefts of the lip and palate can run in families
and be due to a single gene.
If the gene is transmitted from one affected
parent to their offspring, then it is generally
considered to be dominant.
If neither parent is affected, then the gene
could be recessive, and would require that
both parents contribute the same recessive
gene to their affected child

NUTRITIONAL
® EXCESSIVE AMOUNTS OF VITAMIN-A AND
DEFICIENCY OF FOLIC ACID DURING
PREGNANCY HAVE BEEN KNOWN TO
CAUSE CLEFTING


SMOKING
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SMOKING DOUBLES RISK FOR
CLEFTS
Those who smoked twenty or more
cigarettes per day were more than two
times as likely to have babies with cleft
lip and/or cleft palate. Those who
smoked less were about one and a half
times as likely to have babies with oral
clefts


DRUGS
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VARIOUS DRUGS HAVE BEEN KNOWN TO BE
TERATOGENIC AND HAVE BEEN KNOWN TO
CAUSE VARIOUS ANOMALIES IN THE
FOETUS,INCLUDING CLEFT LIP AND PALATE.
EXAMPLES
TETRACYCLINE
METRONIDAZOLE
TRIMETHOPRIM
SULPHONAMIDES


ENVIRONMENTAL
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SOME OF THE COMMONLY USED INSECTICIDES
AND PESTICIDES USED HAVE KNOWN TO
CAUSE CLEFTING
EXAMPLES
CYNIZINE
HEXACHLOROBENZENE
THIRAM


SYNDROMES ASSOCIATED WITH CLEFT LIP
AND PALATE
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SOME COMMON SYNDROMES ASSOCIATED
ARE:
Phenylketonuria
Retinoblastoma
Crouzon craniofacial dysostosis
Apert syndrome
Diastrophic dysplasia
Basal cell nevus syndrome (Gorlin syndrome)
DiGeorge syndrome
Treacher Collins mandibulofacial dysostosis
Pallister-Hall syndrome

ORAL CONDITIONS ASSOCIATED WITH CLEFT LIP
AND PALATE
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NATAL OR NEONATAL TEETH
CONGENITALLY MISSING TEETH
SUPERNUMERARY TEETH
ANOMALIES OF TOOTH MORPHOLOGY
{ enamel hypoplasia,microdontia,macrodontia,fused
teeth,abberations in crown shape.}
UNILATERAL OR BILATERAL CROSSBITE(muscle forces)
TEETH THAT ERUPT ADJACENT TO THE CLEFT HAVE
INSUFFICIENT BONE SUPPORT LEADING TO PREMATURE
LOSS
PROFILE IS CONCAVE DUE TO TRUE OR PSEUDO
MANDIBULAR PROGNATHISM
DEEP BITE LEADING TO GINGIVAL STRIPPING OF LABIAL
ATTACHED GINGIVA OF MANDIBULAR INCISORS.
TEETH THAT ERUPT ADJACENT TO THE CLEFT ARE
ROTATED OR WITH DEVIATIONS OF AXIAL ROOT
INCLINATIONS> www.indiandentalacademy.com

TREATMENT PROTOCOL
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VARIOUS TREATMENT PROTOCOLS ARE FOLLOWED IN THE
TREATMENT FOR CLEFT LIP AND PALATE :
® Below is the most common treatment protocol presently used in most
cleft treatment centers:
•
Newborn - Diagnostic examination, general counseling of parents,
feeding instructions, palatal obturator (if necessary); genetic evaluation
and specification of diagnosis; empiric risk of recurrence of cleft
calculated; recommendation of a protocol for the prevention of a cleft
recurrence in the family
•
Age 3 months - Repair of CLEFT LIP
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Age 6 months - Presurgical orthodontics, if necessary; first speech
evaluation
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Age 9 months - Speech therapy begins
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Age 9-12 months - Repair of CLEFT PALATE
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Age 1-7 years - Orthodontic treatment
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Age 7-8 years - Alveolar bone graft
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Older than 8 years - Orthodontic treatment continues
® Other surgical procedures can be performed in patients with severe
clefts as necessary

SURGICAL PROTOCOL
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Undoubtedly, closure of the CL is the first major
procedure that tremendously changes children's
future development and ability to thrive. Variations
occur in timing of the first lip surgery; however, the
most usual time occurs at approximately age 3
months.
Pediatricians used to strictly follow a rule of "three
10s" as a necessary requirement for identifying the
child's status as suitable for surgery (i.e., 10 lb, 10
mg/L of hemoglobin, and age 10 wk). Although
pediatricians are presently much more flexible, and
some surgeons may well justify a neonatal lip
closure, considering the rule of three 10s is still very
useful

THANK YOU!

Leader in continuing dental education


Cleft lip and palate

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