Cleft lip and palate Normal development of the face

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Cleft lip and palate Normal development of the face Powered By Docstoc
					 Cleft lip and palate
 Normal development of
   the face and palate
Primary palate
• upper lip and alveolar ridge
• develop between 4th and 8th week of
Secondary palate
•hard and soft palates
•develop between 8th and 12th week of
Development can be interrupted
by abnormal genetic conditions
or environmental agents
         Cleft lip and palate
        Classification systems
Numerous classification systems:
• Veau
• American Cleft Palate-Craniofacial Assn (ACPA)
• Kernahan and Stark
Veau’s system:
I Cleft of soft palate only
II Cleft of hard and soft palate to incisive foramen
III Complete unilateral cleft of soft and hard palate
   and lip and alveolar ridge on one side
IV Complete bilateral cleft of soft and hard palate
   and lip and alveolar ridge on both sides
    Causes of cleft lip and
• Genetic disorders
• Chromosomal abnormalities
• Environmental factors (teratogenic
• Mechanical factors
          Genetic factors
  Syndrome vs. sequence
• Pierre Robin sequence
  – Small mandible (micrognathia) causes failure of tongue
    to descend
  – Failure of the tongue to descend causes cleft
  – Heart problems, conductive hearing loss, developmental
  – about 40% of infants with Pierre Robin have Stickler
    Syndrome and about 15% have Velocardiofacial
• Treacher Collins syndrome
  –   Under-developed cheekbones with scalp hair
  –   Malformed ears
  –   Conductive hearing loss
  –   Normal cognitive functioning
Chromosomal abnormalities
• Trisomy 13
   – Rare chromosomal
   – Multiple congenital
   – Mean life expectancy is
      130 days
    Environmental factors
• Recognized teratogenic agents
  – Drugs
  – Aspirin overdose
  – Acne medications
  – Alcohol overdose
      Mechanical factors
• Intrauterine crowding (tumors,
  multiple births, placenta
  Incidence of cleft lip and
1:750 live births
Clefts of lip only more frequent, more
  severe in males
Clefts of palate only more frequent in
Native Americans have highest
African Americans have lowest
     Management of clefts
• Surgical
  – Primary
  – Secondary
• Dental
• Audiological
• Speech and Language
     Speech & Language
• Speech
 – Articulation
 – Voice
   • Whistling-Blowing therapy
   • Continuous Positive Airway Pressure (CPAP)
• Language
Cleft lip and palate
      Online presentation
 Video-endoscopy assessment
  Nasometer demonstration
           from CD
   See-scape demonstration