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

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

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  • 1. CLEFT LIP AND PALATE Presentation by Dr. Ari Zangana Plastic surgeon
  • 2. Introduction
    • Facial clefting is the second most common congenital deformity (after clubfoot).
    • Affects 1in 750 births
    • Problems are cosmetic, dental, speech, swallowing, hearing, facial growth, emotional
  • 3. Anatomy
    • Primary Palate- Triangular area of hard palate anterior to incisive foramen to point just lateral to lateral incisor teeth
      • Includes that portion of alveolar ridge and four incisor teeth, philtrum
    • Secondary Palate- Remaining hard palate and all of soft palate
  • 4. Anatomy
  • 5. Embryology
    • Primary Palate
      • Forms during 4th to 7th week of Gestation
  • 6. Embryology
    • Secondary Palate
      • Forms in 6th to 9th weeks of gestation
  • 7. Cleft Formation
    • Cleft result in a deficiency of tissue
    • Clefts of primary palate occur anterior to incisive foramen
    • Clefts of secondary palate occur posterior to incisive foramen
  • 8. Classification
    • Although various classification systems have been proposed, only a few have found wide clinical acceptance.
  • 9. VEAU classification
  • 10. The striped Y classification.
  • 11.
      • FIG LAHSHAL Classification
  • 12.  
  • 13.  
  • 14.  
  • 15.  
  • 16.  
  • 17. Incidence
    • In oriental 1:600----black population 1:2000
    • Cleft Lip + Palate- 50%
    • Cleft Palate- 30%
    • Cleft Lip- 20%
    • Unilateral Lt: Unilateral Rt:Bilateral-6:3:1
    • Cleft Lip +/- Palate- 2 Male: 1 Female
    • Cleft Palate - 2 Female: 1 Male
  • 18. CAUSES OF CLEFT LIP AND/ OR PALATE
    • Familial Syndromic Environmental
  • 19. Familial
      • Cleft Lip, With or Without Cleft Palate:
        • One Parent-2%
        • One Sibling- 4% Two Siblings- 9%
        • One Parent + One Sibling- 15%
      • Cleft Palate:
        • One Parent- 7%
        • One Sibling- 2%
        • One Parent + One Sibling- 17%
  • 20. syndromic
    • More than 200 syndromes include clefts
  • 21.  
  • 22.  
  • 23.  
  • 24. Environmental
    • Drugs: Anticonvulsants, Anxiolytic, Asprin, cortison,Cytotoxic, Warfarin.
    • Nutrition:Vitamin deficiency,
    • Radiation
    • Smoking
    • Alcohol
    • DM
    • Epilepsy
    • Stress
  • 25. Management
  • 26. goals of treatment are:
    • Improvement of appearance . Improved speech . Establishment of a fully functional dentition . Achieving good patient self-image and confidence
  • 27. Timing of SURGERY :
    • Cleft lip repair:
    • Cleft lip defects may be repaired shortly after birth, but it is preferable to operate according to the "rule of 10": when the child is at least 10 weeks old and weighs at least 10 pounds and hemoglobin level 10gm.
    • Cleft palate repair
  • 28.  
  • 29. .
  • 30.  
  • 31.