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palate palate Presentation Transcript

  • Cleft lip and palate Normal development of the face and palate
    • Primary palate
    • upper lip and alveolar ridge
    • develop between 4 th and 8 th week of gestation
    • Secondary palate
    • hard and soft palates
    • develop between 8 th and 12 th week of gestation
    • Development can be interrupted by abnormal genetic conditions or environmental agents (teratogens)
  • 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 palate
    • Genetic disorders
    • Chromosomal abnormalities
    • Environmental factors (teratogenic agents)
    • 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 deficits
      • about 40% of infants with Pierre Robin have Stickler Syndrome and about 15% have Velocardiofacial Syndrome
    • Treacher Collins syndrome
      • Under-developed cheekbones with scalp hair
      • Malformed ears
      • Conductive hearing loss
      • Normal cognitive functioning
  • Chromosomal abnormalities
    • Trisomy 13
      • Rare chromosomal abnormality
      • Multiple congenital malformations
      • 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 abnormalities)
  • Incidence of cleft lip and palate
    • 1:750 live births
    • Clefts of lip only more frequent, more severe in males
    • Clefts of palate only more frequent in females
    • Native Americans have highest prevalence
    • African Americans have lowest prevalence
  • 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 http://craniofacialcenter.uiowa.edu:88/speechpath/Instruction/VPI.htm Video-endoscopy assessment tape Nasometer demonstration from CD See-scape demonstration