Cleft Lip and Palate
• Most common among the facial clefts.
• Cleft is a division or separation of parts of
the lip or palate that is formed during the
early months of development of the fetus.
• Clefts may be unilateral or bilateral.
• They can vary in severity.
• 3-8% of clefts are associated with
Frequency of Occurrence
• In whites,CL ± CP occur in 1 of every 700-1000
• In Asians,prevalence is 1.5 times higher.
• In African Americans,less than 0.4 in 1000.
• in Native Americans fequency is 3.6per 1000birth
• Incidence of clefts is highest in Native American
population and lowest in African Americans
Frequency of occurrence
Isolated Cleft Lip :
Isolated Cleft Palate :
Cleft Lip + Cleft Palate : 45%
CL ± CP : more common in males.
For isolated CL , M : F = 1.5 : 1
For CL + CP, M : F = 2 : 1
Isolated CP is more common in females.
• Cleft Lip is more commonly unilateral
• 70% of cleft lips on left side.
• Complete CL extends upward into nostril.
• CP may involve hard and soft palate or soft
• Cleft or Bifid Uvula is more common.
Whites: 1 in 80
Asian and Native American: 1 in 10
African Americans: 1 in 250
Submucous palatal cleft : surface mucosa is
intact but underlying musculature of soft
palate is defective.
Problems associated with clefts
Difficulty in breathing ,feeding and speech
Recurrent upper respiratory tract infections.
• Multidisciplinary approach
• Plastic surgery,
h pathology,Genetics and Pediatrics
• SURGICAL REPAIR.
Cleft lip repair
• Objective: Closure of cleft to create a
pleasing face that will develop normally
with minimum scarring
• Performed by plastic surgeon when baby is
approx. 3 months of age and weighs atleast
• Surgery under GA( takes approx 2-3 hours)
• Special considerations in positioning and
• Takes approx. 3 weeks for the wound to
gain enough strength.
• The lip scar is initially red and swollen but
begins to mature and improve in appearance
in 6-12 months.
• In Bilateral cleft lip , repair in stages.
• In alveolar cleft, bone graft required ( 5-10
Cleft palate repair
• Objective: To close the palate to restore
normal function of eating and drinking and
to enhance the development of normal
• Best accomplished in one surgical
procedure before the child reaches 12-14
months of age.
Pierre Robin syndrome
• Infant placed in prone position until
adequate growth of jaws occur.
• Tongue- Lip adhesion/Tracheostomy
• Mandibular bone expansion- Distraction
Osteogenesis with an expansion device.
Late cleft treatment
Cleft palate surgery
Intensive speech therapy regimen
• In Non syndromic cases, risk of
Cleft development in a sibling or
offspring is 3-5% if no other first
degree relative is affected. It
increases to 10 – 20 % if another
first degree relative is affected
Developmental disorders of Lips
• Lip Pits:
• Para median Lip Pits
• Commissural Lip Pits
• Double Lip
Paramedian Lip Pits
• Autosomal dominant
• Persistence of lateral
sulci on embryonic
• Bilateral symmetric
fistulas on either side
of the midline
Paramedian Lip Pits
• Appearance varies from
subtle depressions to
• Pits can extend to a depth
of 1.5 cm and may express
• Seen in Van der Woude
syndrome with CL±CP
• Surgical excision for
Commissural Lip Pit
• Small mucosal
corners of the mouth
on vermilion border.
• Failure in the normal
fusion of maxillary
Commissural Lip Pit
• Seen in 12-20 % of
• Males > Females
• Unilateral / Bilateral
• May be associated
with preauricular pits
• No treatment required
• Redundant fold of
tissue on the mucosal
side of the lip.
• May be Congenital or
acquired( from trauma
or oral habits such as
• More common in
• Sometimes both
• Seen on smiling.
• Feature of Ascher’s
• Triad of :
• Double lip
• Nontoxic enlargement of thyroid gland
• Hemi hyperplasia
Carcinoma and other
• Edentulous state
Cretinism and Beckwith Weidemann Syn:
Smooth, diffuse generalized enlargement
Pebbly appearance with multiple vesicle
• Amyloidosis, Neurofibromatosis:
• Multinodular appearance
• Down Syndrome:
• Papillary fissured surface
• Hemifacial Hyperplasia,
• Unilateral enlargement
• Lateral spreading of tongue.
• Oromandibular- limb hypogenisis syndrome
• Frequently Seen along with hypoplasia of mandible
by short thick lingual
frenum resulting in
restriction in tongue
Sever case tongue fused
to floor of mouth
Frenum some time
attached to tip of the
• Seen in 2-5 % of the
• Males > Females
• May be partial or
• May cause speech
• Surgery if the
anomaly is severe
• Failure of primitive
thyroid gland to
descend into the neck
• About 10 % of both
men and women may
show thyroid tissue if
biopsy is taken from
posterior part of
• Symptomatic and
lingual thyroid seen
• 4 - 7 times more
common in females
• May cause dyspnoea,
• In 70% of cases this
ectopic gland is the
patient’s only thyroid
• Thyroid scans using
Iodine isotopes or
• CT and MRI to know
the size and extent
No treatment, Periodic follow up
Suppressive therapy with thyroid supplements
In case of airway obstruction,surgery with auto
transplantation to another body site.
• In males over 30 years ,prophylactic surgical
excision as there is a risk of malignancy.
• Accumulation of keratin on the filiform papillae
may be due to increased production of keratin or
decrease in the normal keratin desquamation
Poor oral hygiene
Use of oxidizing mouth wash or antacid
Overgrowth of fungus or bacterial organism
Histopathology- it is characterized by
marked elongation and hyper keratosis of
• Multiple grooves and furrows on the surface of the tongue
• Strong association noted between geographic tongue
• Seen some time in Melkersson Rosenthal syndrome
• Abnormally dilated
and tortuous veins
• Seen in 2/3rds of
people older than 60
years of age(indicating
Developmental disorders of the jaws
Exostoses and Tori