Surgical Management of Cleft Lip and Palate (I)

a cleft is a
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Embryology: The entire process takes place between the ______weeks of fetal life..fifth and tenthEmbryology: 6th weekthe medial nasal processes have merged with one another and with the maxillary processes to form the upper lip and primary palate.Embryology: 7th weekthe palatal shelves make contact with one another and begin to fuse.Embryology: 10th weekfusion of the secondary palatal shelves with one another and with the nasal septum, and primary palate is completed to form the palateDevelopment of Cleft Lip: Cleft Lip occurs when there is failure of fusion of...Medial nasal and maxillary processes in the 6th week of embryonic development..Development of Cleft Palate: Cleft Palate occurs due to the failure of fusion of...Secondary palatal shelves with one another and with the nasal septum and/or primary palate.What are the causative factors?Heredity plays a significant role in the causation. Environmental factors when the lip and palatal halves are fusing. Nutritional deficiencies, and vitamin excesses or deficiencies. Radiation. Smoking. Alcohol. Several drugs Hypoxia. VirusesWhat are the causative factors? several dugsphenytoin corticosteroids etcthe exact cause of clefting is ______ in most casesunknown_______ can be identified as the causeno single factorIt is important to distinguish between isolated clefts and clefts associated with _________other birth or health disorders or syndromes..Syndromes account ______% of the total number of cases of cleft L & P. Nearly _____% of cases of isolated cleft palate.15 50Clefts may be associated with many syndromes like:Vander Woude's syndrome Orofacial digital syndrome. Treacher collins syndrome Down's syndrome. Wardenburg's syndrome. Pierre Robin syndrome. Klippel Feil syndrome..Vander Woude's syndromeLip pitsTreacher collins syndromeMandibulofacial dysostosisOral clefts commonly affect the _________lip, alveolar ridge, and hard and soft palates.3/4 of clefts are ______deformities 1/4 is ________unilateral bilateralwhich side is involved more frequently when the defect is unilateral??the left sideThe cleft may be __________; it may not extend the entire _______complete or incomplete lip or palateIsolated cleft lip may occur without _______, and isolated cleft palate may occur without _________clefting of the palate clefting of the lipA useful classification divides the anatomy intothe primary palate the secondary palate an individual may have clefting of the primary palate, the secondary palate, or both..the primary palateanterior to the incisive foramen (the lip and the alveolus). So, Cleft lip is cleft of primary palate.the secondary palateposterior to the incisive foramen (the hard and soft palates). So, Cleft Palate is cleft of secondary palateClefts of the lip may range froma minute notch on the edge of the vermilion border to a wide cleft that extends into the nasal cavity and divides the nasal floor.Clefts of the palate may also show wide variations from a ____ to a ______bifid uvula wide inoperable cleft..Anatomic Classification of Cleft Lip and Palate: It is based on:location completeness extentAnatomic Classification of Cleft Lip and Palate: It is based on: LOCATIONright leftAnatomic Classification of Cleft Lip and Palate: It is based on: COMPLETENESSincomplete completeAnatomic Classification of Cleft Lip and Palate: It is based on: EXTENTLip - Alveolus - Hard Palate - Soft Palate - UvulaLAHSHAL classificationcapital letter for complete clefts small letter for incomplete cleftsClassification of Clefts:Unilateral cleft lip. Bilateral cleft lip. Cleft of the lip and alveolus. Unilateral cleft lip and palate. Bilateral cleft lip and palate. Cleft palate. Submucous cleft. Bifid uvula.flip----normalunilateral cleft lipbilateral cleft lipcleft uvulabilateral cleft palateunilateral cleft palatebilateral cleft lip and full palateunilateral cleft lip and anterior palatebilateral cleft lip and anterior palateunilateral cleft lip and full palate-----flip backUnilateral cleft lip: involvesthe vermilion border of the upper lip and may extend through the lip toward nostril. may be either incomplete or complete.Unilateral cleft lip: noseAffects the shape of the nose Abnormal muscle distorts nose extensively and creates wide clefts between the lip segmentsunilateral complete cleft lipruns entire width of lip to floor of noseunilateral incomplete cleft lipmay appear as a partial unilateral incisions of the vermilion border and lipbilateral cleft lip involvesinvolves the vermillion border of the upper lip. May extend through the lip toward the nostril. usually involve the palate..bilateral cleft lip noseAffect the shape of the nose. The columella of the nose is absent and the tip of the nose very flat.Cleft of the lip and alveolus: the alveolar processis usually significantly deformed and is separated until the incisional foramen.Cleft of the lip and alveolus: in bilateral formsthe pre-maxillary segment is isolated and secured only to the nasal septum and vomer..Unilateral cleft lip and palate: Extends fromthe external portion of the upper lip and floor of the nose, through the alveolar ridge and hard and soft palate..Unilateral cleft lip and palate: In complete unilateral cleft lip and palate, _____________ are cleftthe lips, jaw, and palateUnilateral cleft lip and palate: On the cleft side the ________ is lacking..entire bony part of the floor of the nosemost severe form of cleftsbilateral cleft lip and palateBilateral cleft lip and palate:The lip and the alveolar ridge are cleft under both nostrils. The central portion of the lip, alveolar ridge, and the premaxilla are positioned abnormally.Bilateral cleft lip and palate: noseThe tip of the nose attached directly to the lip.Cleft Palate: The malformation affects the palate and can include ________both the hard and the soft palate, or the soft palate only.Clefts of the soft palate the defect is limited to the ______ of the soft palate..musclesSubmucous cleft:Muscles of the soft palate failed to fuse (Muscular cleft). Cleft is covered by a thin layer of mucosal tissue that can some times hide it.Submucous cleft: may causeVPI (Velopharyngeal insufficiency or incompetence)..bifid uvulacleft in uvula often considered as a marker for sub mucous cleftbifid uvula compared to the normal oneit has fewer amounts of muscular tissuesflip again----unilateral complete cleft of lip and palateisolated cleft palatepalatal viewbifid uvula -bilateral cleft lip and palate complete on right incomplete on left-flip backProblems Of Individuals With Clefts:dental problems malocclusion nasal deformity feeding ear problems speech difficultiesProblems Of Individuals With Clefts: dental problems -can often affect the development of the ____________primary and permanent teeth and the jaw itselfProblems Of Individuals With Clefts: dental problems examplesCongenital absence of teeth. Supernumerary Teeth. Severely displaced teeth. Morphologically deformed teeth. Hypomineralized teeth..Problems Of Individuals With Clefts: malocclusion-individuals affectedwith clefts (esp cleft palate)Problems Of Individuals With Clefts: malocclusion-individuals affected with clefts (esp cleft palate) may have:skeletal discrepancies between size, shape, and position of their jaws class III malocclusion mandibular prognathism missing or extra teeth may partially contribute to the malocclusionProblems Of Individuals With Clefts: malocclusion- class III malocclusionseen in most cases caused by many factorsProblems Of Individuals With Clefts: malocclusion-mandibular prognathism causecaused more by the retrusion of the maxilla than by protrusion of the mandible (ie: pseudoprognathism)Problems Of Individuals With Clefts: nasal deformity: commonly seen withcleft lipsProblems Of Individuals With Clefts: nasal deformity If the cleft extends into the floor of the nose...the alar cartilage on that side is flared, and the columella of the nose is pulled toward the side without the cleft.Problems Of Individuals With Clefts: nasal deformity A lack of what compounds the problem?Underlying bony support to the base of the noseProblems Of Individuals With Clefts: feeding -When a nipple is placed in the baby's mouth, the __________sucking and swallowing REFLEXES are normal.Problems Of Individuals With Clefts: feeding- They can swallow normally once the material being fed reaches the _________hypopharynx.Problems Of Individuals With Clefts: feeding- is the sucking effective?no The musculature is not properly oriented to allow the sucking to be effectiveProblems Of Individuals With Clefts: feeding: they have extreme difficulty producing the necessary _________ in their mouth to allow _________negative pressure sucking breast milk or bottle milkProblems Of Individuals With Clefts: feeding recommendations: the problem is easily overcome throughThe use of nipples that are elongated and extend further into the baby's mouth. The opening should be enlarged because the suck will not be as effective.Problems Of Individuals With Clefts: feeding recommendations: because the child will swallow a considerable amount of air during feeding....the child is NOT usually fed in the recumbent position, and burping is necessaryProblems Of Individuals With Clefts: ear problemsChildren with a cleft of the soft palate are predisposed to middle ear infections.speech: in the normal individual, the position of the _________________ results in the sounds of speech being produced.tongue, lips, lower jaw, and soft palate working together in a highly coordinated fashionProblems Of Individuals With Clefts: speech difficultiesCleft lip and palate patients have retardation of consonant sounds (i.e., "p," "b," "t," "d," "k," and "g").Problems Of Individuals With Clefts: speech difficulties: because consonant sounds are necessary fro the development of early vocabulary..... ______ is lacking until the palate is closedmuch language activity is omitted Good sound discrimination