CLEFT LIP and PALATE

EPIDEMIOLOGY of CLP
Incidence
1 per 1000
Mongoloid > Caucasian > Negro

Gender ratio
2 males : 1 female

Site
3% of CLP involved with syndromes
66% of unilateral clefts on left side

CLEFT PALATE CLINICS

Womens and Childrens Hospital
Flinders Medical Centre
Accreditation - Medicare

CLEFT PALATE TEAM

Plastic Surgeon
General Surgeon - Neurosurgeon
Oral and Maxillofacial Surgeon
Orthodontist
Dentist
Geneticist
Speech Therapist
Psychologist
Social Worker - Counsellor
Nurses, administrators, students

EMBRYOLOGY
Lip
Palate

Eye
Frontonasal process
Nasal placode
Maxillary process
Stomodeum
Mandibular arch
Second, third and fourth
branchial arches

Cardiac swelling

5 week old embryo

Frontonasal
process
Eye

Nasal pit

Maxillary process

Mandibular arch
Cardiac swelling

6 week old embryo

Maxillary processes fuses with the lateral nasal

process. If fusion does not occur - clefting results.

Secondary palate is the first to form

before the primary palate.
If the primary palate is affected, the
secondary palate would definitely be
affected. Not vice verca.

Primary palate

Lateral palatal shelf

(Bent vertically)

Nasal septum

7 week old embryo

Nasal septum

Oronasal
chamber

Lateral palatal shelf

Coronal cross section of 7 week old embryo

Nasal septum
- Palatal shelves rising up to fuse.
They rise up from the back to the front.
- However fusion occurs in the opposite
direction (front to back)

Lateral palatal shelf

Tongue
Coronal cross section of 8 week old embryo

Bifid uvula

AETIOLOGY of CLP
Genetics
Syndromes

Environment
Drugs, medication
Diseases
Nutrition
Teratogens

thalidomide

RISK OF GIVING BIRTH TO A CHILD WITH A CLEFT

No. of affected parents

1
1
2
2
2

1
1
2
1
2

No. of affected siblings

0.12%
0.05%
4%-5% 2%-3%
2%
1.7%
13%-14% 14%-17%
13%-14% 14%-17%
13%-14% 14%-17%
20%-25% 25%-50%
15%-20% 50%

CL CP

Isolated CP

CLASSIFICATION of CLP

A.

Unilateral left incomplete

cleft lip

C. Unilateral left complete cleft of

lip and alveolar ridge

E. Complete bilateral cleft of lip

and primary palate

B. Complete cleft of hard

and soft palate

lips are okay

D. Unilateral left complete cleft of lip,

alveolar ridge and
hard and soft palate

F. Complete bilateral cleft of primary

and secondary palates

Kernahan and Starks (1958) classification based on the incisive foramen

as the dividing point between clefts of the lip and alveolar ridge (primary palate)
and clefts of the palate (secondary palate)

PROBLEMS in CLP
Aesthetics
Function
Feeding
Swallowing
Dental

Otolaryngological
Speech
Psychological
Growth

can cause inflammation of the ear

MANAGEMENT of CLP
Surgery
Lip lip repair at 3months - "z plasty"
at 4-5 y/o
Palate -- Usually
May have a second surgery at 10 years to align
the canines or allow to erupt

Speech
Dental
Orthodontic

speech therapy - sound production

surgeon has difficulty in

replicating the cupids
bow

bilateral CLP with the

premaxilla hanging down

Device helps to improve the posiition of the palatal

shelves before surgery

SPEECH
Soft palate function
Surgery
Velopharyngeal incompetence

DENTAL ANOMALIES in CLP

Displaced teeth - ectopia, impactions
Missing teeth, supernumaries
lateral incisiors are usually missing
Transposition
Crossbites
Occlusal plane cants
A- P relations
Midlines, smile line
Gingival contours
Oral hygiene

Canine eruption

Bone grafting
bone grafting
procedure at around
10 years old

maxillary hypoplasia, lack of

development, Would need further
surgery to advance the maxilla