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Management of cleft lip & palate

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A lecture for 5th stage dentistry students

Publié dans : Santé & Médecine
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Management of cleft lip & palate

  1. 1. Cleft lip & palate Dr.Mohamed Rahil ( Maxillofacial surgeon ) Tikrit dentistry college
  2. 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. 3. 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
  4. 4. Cleft lip
  5. 5. Cleft palate
  6. 6. Facial cleft
  7. 7. Etiology : multifactorial etiology  Chemical exposures  Radiations  Maternal hypoxia and habits ( smoking , alcohol )  Teratogenic drugs (anti convulsing ,diazepam, hydrocortisone)  Nutritional deficiencies (folic acid ,iron )  Vitamin abuse (vit . A)  Physical obstruction Hereditary Environmental
  8. 8. classification  Unilateral  Bilateral  Microform  Incomplete  Complete  And my involve the lip , nose , primary palate and /or secondary palate
  9. 9. Problems of individuals with cleft 1.Esthetic 2.Dental problems 3.Malocclusion 4.Nasal deformity 5.Feeding Ear problems Speech difficulties Associated anomalies
  10. 10. Treatment
  11. 11.  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
  12. 12. Treatment planning and timing
  13. 13. 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
  14. 14. Mead Johnson/Enfamil Cleft Feeder Special Needs Feeder / Haberman Feeder Pigeon Feeder Dr. Brown’s Natural Flow to relieve gas
  15. 15. 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
  16. 16. Cleft lip repair
  17. 17. Pre surgical orthopedic
  18. 18. Techniques for lip repair Rotation and advancement flap (millard technique ) Triangular flap
  19. 19. Cleft palate repair
  20. 20. Soft palate VS hard palate repair
  21. 21. 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
  22. 22. Speech development Velopharyngeal incompetence
  23. 23. Treatment of Velopharyngeal incompetence Speech aid applaince Pharyngeal flap, superiorly or inferiorly based flap Sphincter pharyngoplasty Posterior pharyngeal flap augmentation
  24. 24. 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
  25. 25. 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
  26. 26. Nasal repair Primary Early Late
  27. 27. Orthognathic surgery
  28. 28. Thank you for listening

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