Surgery 5th year, 3rd lecture/part one (Dr. Ari Raheem Qader)

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The lecture has been given on May 12th, 2011 by Dr. Ari Raheem Qader.

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Surgery 5th year, 3rd lecture/part one (Dr. Ari Raheem Qader)

  1. 1. CLEFT LIP AND PALATE Presentation by Dr. Ari Zangana Plastic surgeon
  2. 2. Introduction <ul><li>Facial clefting is the second most common congenital deformity (after clubfoot). </li></ul><ul><li>Affects 1in 750 births </li></ul><ul><li>Problems are cosmetic, dental, speech, swallowing, hearing, facial growth, emotional </li></ul>
  3. 3. Anatomy <ul><li>Primary Palate- Triangular area of hard palate anterior to incisive foramen to point just lateral to lateral incisor teeth </li></ul><ul><ul><li>Includes that portion of alveolar ridge and four incisor teeth, philtrum </li></ul></ul><ul><li>Secondary Palate- Remaining hard palate and all of soft palate </li></ul>
  4. 4. Anatomy
  5. 5. Embryology <ul><li>Primary Palate </li></ul><ul><ul><li>Forms during 4th to 7th week of Gestation </li></ul></ul>
  6. 6. Embryology <ul><li>Secondary Palate </li></ul><ul><ul><li>Forms in 6th to 9th weeks of gestation </li></ul></ul>
  7. 7. Cleft Formation <ul><li>Cleft result in a deficiency of tissue </li></ul><ul><li>Clefts of primary palate occur anterior to incisive foramen </li></ul><ul><li>Clefts of secondary palate occur posterior to incisive foramen </li></ul>
  8. 8. Classification <ul><li>Although various classification systems have been proposed, only a few have found wide clinical acceptance. </li></ul>
  9. 9. VEAU classification
  10. 10. The striped Y classification.
  11. 11. <ul><ul><li>FIG LAHSHAL Classification </li></ul></ul>
  12. 17. Incidence <ul><li>In oriental 1:600----black population 1:2000 </li></ul><ul><li>Cleft Lip + Palate- 50% </li></ul><ul><li>Cleft Palate- 30% </li></ul><ul><li>Cleft Lip- 20% </li></ul><ul><li>Unilateral Lt: Unilateral Rt:Bilateral-6:3:1 </li></ul><ul><li>Cleft Lip +/- Palate- 2 Male: 1 Female </li></ul><ul><li>Cleft Palate - 2 Female: 1 Male </li></ul>
  13. 18. CAUSES OF CLEFT LIP AND/ OR PALATE <ul><li>Familial Syndromic Environmental </li></ul>
  14. 19. Familial <ul><ul><li>Cleft Lip, With or Without Cleft Palate: </li></ul></ul><ul><ul><ul><li>One Parent-2% </li></ul></ul></ul><ul><ul><ul><li>One Sibling- 4% Two Siblings- 9% </li></ul></ul></ul><ul><ul><ul><li>One Parent + One Sibling- 15% </li></ul></ul></ul><ul><ul><li>Cleft Palate: </li></ul></ul><ul><ul><ul><li>One Parent- 7% </li></ul></ul></ul><ul><ul><ul><li>One Sibling- 2% </li></ul></ul></ul><ul><ul><ul><li>One Parent + One Sibling- 17% </li></ul></ul></ul>
  15. 20. syndromic <ul><li>More than 200 syndromes include clefts </li></ul>
  16. 24. Environmental <ul><li>Drugs: Anticonvulsants, Anxiolytic, Asprin, cortison,Cytotoxic, Warfarin. </li></ul><ul><li>Nutrition:Vitamin deficiency, </li></ul><ul><li>Radiation </li></ul><ul><li>Smoking </li></ul><ul><li>Alcohol </li></ul><ul><li>DM </li></ul><ul><li>Epilepsy </li></ul><ul><li>Stress </li></ul>
  17. 25. Management
  18. 26. goals of treatment are: <ul><li>Improvement of appearance . Improved speech . Establishment of a fully functional dentition . Achieving good patient self-image and confidence </li></ul>
  19. 27. Timing of SURGERY : <ul><li>Cleft lip repair: </li></ul><ul><li>Cleft lip defects may be repaired shortly after birth, but it is preferable to operate according to the &quot;rule of 10&quot;: when the child is at least 10 weeks old and weighs at least 10 pounds and hemoglobin level 10gm. </li></ul><ul><li>Cleft palate repair </li></ul>
  20. 29. .

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