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Cleft_Lip___Palate__pedo_ by mani0642

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									       Seminar on

CLEFT LIP AND PALATE




     MANISH GOUTAM

     PCDS &RC BHOPAL
CLEFT LIP:
Cleft lip is a birth defect that results in a
unilateral or bilateral opening in the upper lip
between the mouth and nose.


CLEFT PALATE:
Cleft palate is a birth defect characterized by
an opening in the roof of the mouth caused by
a lack of tissue development.
     DEVELOPMENT OF CLEFT
(a) Cleft Lip : Various theories have been
given for its development.
- Failure of fusion between median
nasal process and maxillary process.
- Failure of mesodermal migration between
the        two       layered      epithelial
membrane.      This       leads   to      a
breakdown and cleft formation.
- Rupture of cyst formed at the site of
fusion.
(b)   Cleft Palate : Various theories have
      been given for its development.
      - Alteration in intrinsic palatal shelf force
      - Failure of tongue to drop down
      - Non fusion of shelves
      - Failure of mesodermal migration
      - Rupture of cyst formed at the site
        Of fusion.
                     ETIOLOGY
1. Genetic factors
2. Nutritional disturbances during development
3. Physiologic, Emotional or traumatic stresses during
   development
4. Defective vascular supply to the area involved
5. A mechanical disturbance where the size of the tongue
   may prevent the union of parts
6. Various    environmental      factors  like     infections
   (e.g. Rubella), exposure to radiation, drugs like
   thalidomide, antiepileptic durgs, hormonal pills, quinine
   etc.
7. Maternal consumption of alcohol and smoking
            CLASSIFICATION

1. Morphological Classification
  (a) By Davies and Ritchie (1922)
  (b) By Veau (1931)
2. Embryological Classification
  (a) By Kernahan & Stark (1958)
  (b) By Spina (1974)
1.a   Classification by Veau
Group-I             Cleft of the soft palate only

Group-II            Cleft of the hard and soft palate
             till the incisive foramen.

Group-III    Complete unilateral cleft of the
      soft palate,hard palate,the
             alveolar ridge and the lip on one
                   side

Group-IV            Complete cleft of the soft palate,
             hard palate, the alveolar ridge
      and lip on the both side.
2.a   Classification by Kernahan and Stark
Group-I    Cleft of the primary palate only
           (i)     Unilateral     (ii)   Bilateral
           (iii)   Total        (iv)     Sub-total

Group-II   Cleft of the secondary palate only
           (i)   Total (ii)      Sub-total
  (iii)Submucous

Group-III Cleft of the primary &
    secondary palate
           (i)     Unilateral -Total, Sub-total
           (ii)    Median - Total, Sub-total
           (iii)   Bilateral -Total, Sub-total
2.b   Classification by Spina
Group-I    Pre-incisive foramen clefts
           (i)     Unilateral   (ii)   Bilateral
           (iii)   Median

Group-II   Tran-incisive foramen clefts
           (i)     Unilateral   (ii)   Bilateral

Group-III Post-incisive foramen clefts
           (i)     Total
           (ii)    Partial

Group-IV Rare facial clefts
SYMBOLIC AND COMPUTERGRAPHIC
        PRESENTATION
By Kernahan (1971)
Modified by Ehlsaky & Millard
(Rt)
1,5 : Nasal floor    (Lt)
                     2,6 : Lip
                     3,7 : Alveolus
                     4,8 : Hard palate
                           anterior to incisive
                     foramen.
                     9,10: Hard palate
                           posterior to incisive
                     foramen
                     11 : Soft palate
                     NORMAL ANATOMY


   (ACCORDING TO KERNAHAN AND STARK CLASSIFICATION)




GROUP 1 UNILATERAL   GROUP 1a UNILATERAL   GROUP 1a BILATERAL
(CONTD.)




GROUP II COMPLETE   GROUP III UNILATERAL   GROUP III BILATERAL
CLEFTS OF LIP
BILATERAL COMPLETE CLEFT PALATE
INCOMPLETE CLEFT PALATE
BILATERAL CLEFT LIP AND PALATE
UNILATERAL CLEFT LIP AND PALATE
                    INCIDENCE
(a) Among different races
     Whites                 -   One out of 800
     Blacks             - One out of 2000      
      Japanese or Indians -      One out of 500
(b) Of different clefts
     Cleft lip alone               - 25%
     Cleft palate alone              -        25%
     Cleft lip and palate both       -        50%
(c) Males > Females (for combined cleft lip & palate)
    Females > Males (for cleft palate only)
(d) Unilateral defects > Bilateral defects
(e) Left sided defects > Right sided defects
(f) Increase in parental age  increase risk of producing
        affected child.
CLINICAL FEATURES
(1)   FACIAL DEFORMITY – NOSE TIP DEVIATED TO
      NORMAL SIDE, ALA ON CLEFT SIDE FLARED,
      NOSTRIL HORIZONTALLY ORIENTED, LIP
      DEFORMITY, HYPOPLASTIC AND A COLLAPSED
      MAXILLA ON SIDE OF THE CLEFT AND THE CLEFT
      PALATE .
                       - FOR BILATERAL CLEFTS
      ADDITIONAL FEATURES LIKE PROTRUDED PRE-
      MAXILLA, SMALL PRO-LABIUM, ABSENT COLUMELLA
      AND SHALLOW GINGIVOLABIAL SULCUS.

(2)   INABILITY TO SUCK MOTHER’S MILK
(3)   NASAL INTONATION FOR CLEFT PALATE
(4)   NASAL REGURGITATION
                                           (CONTD.)
(5)   TOOTH DEFECTS – WHICH MAY BE
•     SUPER NUMERARY TEETH
•     CONGENITALLY MISSING TEETH
•     T- CINGULUM
•     PEG LATERALS
•     THICK CURVED HYPOPLASTIC INCISORS
•     NATAL TEETH
•     GERMINATION
•     DELAYED ERUPTION OF PERMANENT TEETH
•     HYPOPLASTIC INCISORS NEXT TO ALVEOLAR DEFECTS
(6)   ASSOCIATED SYNDROMES – CLEFT LIP MAY BE
      ASSOCIATED WITH FOLLOWING SYNDROMES
•     DOWN’S SYNDROME
•     WARDEN BURG’S SYNDROME
•     VANDERWOUDE’S SYNDROME
•     ORO-FACIAL DIGITAL SYNDROME
•     TREACHER COLLIN’S SYNDROME
•     PIERRE ROBIN’S SYNDROME
•     KLIPPEL FEIL’S SYNDROME
REFERENCES:
 1. TEXTBOOK OF PEDODONTICS:
   SHOBHA TANDON
 2. DENTISTRY FOR CHILDHOOD AND
   ADOLESCENT:
   McDONALD, AVERY

								
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