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Oro facial clefts
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Oro facial clefts

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Oro facial clefts Presentation Transcript

  • 1. ORO-FACIAL CLEFTSDr. Ali Tahir
  • 2. ORO-FACIAL CLEFTS The formation of face & oral cavity involves the development of multiple tissue processes that must Dr. Ali Tahir merge & fuse in highly orchestrated fashion Disturbances in the growth of these tissues or their fusion results in oro-facial clefts During 6th & 7th weeks of development, upper lip is formed when  Medial nasal processes merge with each other  Medial nasal processes merge with the maxillary process Lateral nasal processes are not involved in the formation of upper lip, they form alae of nose
  • 3. ORO-FACIAL CLEFTSPrimary Palate Is formed by the fusion of medial nasal processes Also called the premaxilla containing the anterior four teeth Dr. Ali TahirSecondary Palate Makes up 90% of hard & soft palates Formed by fusion of maxillary processes Bilateral projection from medial aspect of maxillary processes emerge during 6th week oriented vertically one ach side of developing tongue As the mandible grows, the tongue drops down Shelves fuse anteriorly with each other & with anterior palate & nasal septum, proceeds posteriorly
  • 4. CLEFT LIP/CLEFT PALATE Defective fusion of medial nasal process with maxillary process  cleft lip (CL) Defective fusion of palatal shelves  cleft palate (CP) Dr. Ali Tahir 45% are CL + CP 30% isolated CP 25% isolated CL CL±CP is considered a separate entity and CP as separate More than 250 syndromes are associated with CL & CP Median cleft of upper lip is rare, due to faulty fusion of medial nasal processes
  • 5. CLASSIFICATIONInternational confederation for plastic and reconstructive surgery classification (1968)Group ICleft of anterior primary palate Dr. Ali Tahira. Lip  Right, Left, Bothb. Alveolus  Right, Left, BothGroup IIClefts of anterior & posterior palatea. Lip  Right, Left, bothb. Alveolus Right, left, bothc. Hard palate  right, left, bothGroup IIIClefts of posterior secondary palatea. Hard palate  Right, leftb. Soft palate  Median
  • 6. Dr. Ali Tahir
  • 7. CLEFT LIP/CLEFT PALATEClinical Features: Most common major congenital defect Dr. Ali Tahir Considerable racial variation In whites, 1 of every 700-1000 births has CL ± CP In Asians, it is 1.5 times higher than whites Isolated CP is less common CL ± CP is more common in males Isolated CP is more common in females 80% of cases, CL is unilateral 70% of unilateral clefts occur on left side A complete CL extends upward into the nostril
  • 8. CLEFT LIP/CLEFT PALATE When involves the alveolus, usually Dr. Ali Tahir occurs between lateral incisor & canine Sometimes lateral incisor may be missing
  • 9. CLEFT LIP/CLEFT PALATE CP may range from involvement of soft palate alone or both hard & soft palate Dr. Ali Tahir Minimal manifestation is bifid uvula (much common 1 in every 10 Asians) Sometimes, a sub-mucosal cleft palate develops
  • 10. CLEFT LIP/CLEFT PALATE Dr. Ali Tahir
  • 11. PIERRE ROBIN ANOMALY Cleft Palate Mandibular micrognathia Dr. Ali Tahir GlossoptosisRetruded mandible results in Post placement of tongue Lack of support of tongue musculature Airway obstruction
  • 12. PATIENT’S COMPLAIN Clinical appearance Psycho-social difficulties Dr. Ali Tahir Feeding Speech Malocclusion Missing/supernumerary teeth
  • 13. MANAGEMENT Treatment involves a multi-disciplinary approach  Paediatrician Dr. Ali Tahir  Oral & maxillo-facial surgeon  Otolaryngologist  Plastic surgeon  Paediatric dentist  Orthodontist  Prosthodontist  Speech pathologist
  • 14. MANAGEMENT Treatment involves multiple primary & secondary procedures throughout childhoodBirth – 24 months: Dr. Ali Tahir Primary lip closure is done in the early months of life (age 10 months, weight 10 pounds, Hb 10gm% by Millard) Followed later by repair of palate (12-24months, 9-12years)2 – 6years Formation of feeding plate or passive maxillary obturator6-12 years (mixed dentition) Often prosthetic or orthopedic appliances are used to expand maxillary segments before closure of defect Arch expansion, maxillary protraction, fixed orthodontic treatment
  • 15. MANAGEMENTPermanent dentition: (12years onward) Secondary soft tissue & orthognathic procedures Dr. Ali Tahir are done to improve function & aesthetics Final corrections including alignment, exposure of canine (if not erupted yet) & occlusion settled Orthognathic surgery may be required Permanent retention may be required by the Prosthodontist using fixed bridges or cast partial dentures Lip revision, nasal corrections can be done after completion of orthodontic treatment
  • 16. OTHER CLEFTS Lack of fusion of maxillary & mandibular processes  Lateral facial cleft Dr. Ali Tahir May be associated with ‘Mandibulo facial dysostosis’ Extends from commissures towards the ear May be unilateral or bilateral Failure of fusion of lateral nasal process with maxillary process  oblique facial cleft
  • 17. Dr. Ali Tahir