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.
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
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.