Anatomy

Definition

Congenital abnormal space or gap in the upper lip

and palate

Embryological Background

Development of the Lip:

Unpaired Frontonasal Prominence

Medial and Lateral Nasal prominences
2 maxillary prominences
2 mandibular prominences

Development abnormality of nasomedial and

maxilary prominence labioschizis / cleft lip

Embryological Background

Development of Palate:

We have two parts of two different embryonic origins:

1 ) primary palate : lip, alveolus and hard palate to
the incisive foramen (4th and 8th week of gestation)
2 ) secondary palate : hard and soft palate
posterior to the incisve foramen (8th and 12th week of
gestation)

Insidence

Cleft lip 1 : 600 birth

Cleft palate 1: 1000 birth
Boys > girls
The highest frequent Asians
Less frequent Africans

Etiology

Unknown
Predispotition factor :

Genetic (inherited characteristic) from one or both

parents
Maternal diet and vitamin intake
Medications take during pregnancy
Infection
Maternal age
Women with diabetes diagnosed before pregnancy

Pathogenesis

Classic theory

Failure of fusion of the maxillary and frontonasal

processes during the time interval yields a cleft of the
primary palate

Mesodermal penetration theory propelled by Stark

Palate closure is predicted on mesodermal penetration

Without this mesodermal migration and reinforcement,

ephitelial breakdown and separation ensues cleft

Classification

Clinical Manifestation

MAY APPEAR AS:

A split in the lip and roof of the mouth and palate that can affect
both sided of the face
A split in the lip that can appear as only a small notch in the lip
or can extend from the lip through the upper gum and palate into
the bottom of the nose
A split in the roof of the that doesnt affect the appearance of the
face.

Difficulty in swallowing
Nasal Speaking voice
Recurring ear infections
Change in Nose shape
Poorly aligned teeth

PROBLEMS ASSOCIATED WITH OROFACIAL CLEFT:

Failure to gain weight
Feeding problems
Flow of milk through nasal passage during feeding
Poor growth
Speech difficulties

Diagnosis

Diagnosing a cleft palate with ultrasonography is

very difficult
Three-dimensional imaging has been introduced
to prenatal ultrasonography diagnostics of cleft
anomalies

Treatment
Intake nutrition
problem

Cleft lip= makes it more difficult

for an infant to suck on a nipple
use special nipples to allow
the baby to latch properly
(either pump or use formula)

Cleft Palate may cause

formula or breast milk to be
accidentally taken up into the
nasal cavity

NGT

Treatment

The principle of surgery treatment :

To close the cleft lip and palate

the child's speech develops normally
the child's feeding normally
Decrease nose regurgitation
Prevent injury of maxillary development

Treatment

Pre operation

Rule of ten

The child weighs 10 pounds

The child has a hemoglobin of at least 10 grams %
The child has a white count of no higher than 10,000
The child is at least 10 weeks of age

Labioplasty

Millard Technique

Incision the corner of cleft lip and nose

The bottom side of nostril is united with sutura
The upper side of lip is united
The stretch suturing is to closing the cleft totally

Von Langenbeck Palatoplasty

This technique is still used in isolated cleft palate

repair. The muscle dissection and muscle suturing
are done as additional procedures to create a
muscle sling

Veau Wardill Kilner Pushback

palatoplasty (V-Y)

these drawbacks pushback and V-Y techniques have

fallen into disrepute and now less and less centres
practise this technique

Bardach Two flap

Modification of the von

Langenbeck technique
Incision is made along the
cleft margin and the alveolar
margin. These are joined
anteriorly to free the
mucoperiosteal flaps
This is a technique
commonly followed
presently

Furlow Z plasty

Double line is incision

line and dash line is fold
line
Left flap contains muscle
and mucosa oral
Righ flap contains
mucosa oral
Suturing of Z plasty
tehnique

Complication

Wound dehiscence
Wound expansion
Wound infection
Malposisi Premaksilar
Whistle deformity
Abnormality or asimetry of lip

Multi Disciplinary Team

PSYCHOLOGIST
ENT/AUDIOLOGY

ORTHODONTIST

DENTIST
CHILD & FAMILY
SPEECH
THERAPIST
SURGEON

GENETICIST