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  • 1. ``welcome``
  • 2. Seminar on CLEFT LIP AND PALATE
  • 3. 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.
  • 4. 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.
  • 5. (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.
  • 6.
    • ETIOLOGY
    • Genetic factors
    • Nutritional disturbances during development
    • Physiologic, Emotional or traumatic stresses during development
    • Defective vascular supply to the area involved
    • A mechanical disturbance where the size of the tongue may prevent the union of parts
    • Various environmental factors like infections (e.g. Rubella), exposure to radiation, drugs like thalidomide, antiepileptic durgs, hormonal pills, quinine etc.
    • Maternal consumption of alcohol and smoking
  • 7.
    • CLASSIFICATION
    • Morphological Classification
    • (a) By Davies and Ritchie (1922)
    • (b) By Veau (1931)
    • Embryological Classification
    • (a) By Kernahan & Stark (1958)
    • (b) By Spina (1974)
  • 8. 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.
  • 9. 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
  • 10. 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
  • 11. 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
  • 12. NORMAL ANATOMY (ACCORDING TO KERNAHAN AND STARK CLASSIFICATION) GROUP 1 UNILATERAL GROUP 1a UNILATERAL GROUP 1a BILATERAL
  • 13. (CONTD.) GROUP II COMPLETE GROUP III UNILATERAL GROUP III BILATERAL
  • 14. CLEFTS OF LIP
  • 15. BILATERAL COMPLETE CLEFT PALATE
  • 16. INCOMPLETE CLEFT PALATE
  • 17. BILATERAL CLEFT LIP AND PALATE
  • 18. UNILATERAL CLEFT LIP AND PALATE
  • 19.
    • INCIDENCE
    • 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.
  • 20. CLINICAL FEATURES
    • 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.
    • INABILITY TO SUCK MOTHER’S MILK
    • NASAL INTONATION FOR CLEFT PALATE
    • NASAL REGURGITATION
    • (CONTD.)
  • 21.
    • 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
    • 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
  • 22. REFERENCES:
    • 1. TEXTBOOK OF PEDODONTICS:
    • SHOBHA TANDON
    • 2. DENTISTRY FOR CHILDHOOD AND
    • ADOLESCENT:
    • McDONALD, AVERY
  • 23. THANK YOU