Cleft management _pedo_
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Cleft management _pedo_

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Cleft management _pedo_ Cleft management _pedo_ Presentation Transcript

  • DEPARTMENT OF PAEDIATRICDEPARTMENT OF PAEDIATRIC DENTISTRYDENTISTRY SEMINAR OF CLEFTSEMINAR OF CLEFT MANAGEMENTMANAGEMENT
  • CONTENTSCONTENTS  Prenatal Diagnosis.Prenatal Diagnosis.  Protocol For Dental Care.Protocol For Dental Care.  A Multi- Disciplinary Team.A Multi- Disciplinary Team.  ManagementManagement  Dentofacial OrthopedicsDentofacial Orthopedics  Management of cleft Lip & Nasal Deformity.Management of cleft Lip & Nasal Deformity.  Cleft Palate Repair.Cleft Palate Repair.  Orthodontic Treatment.Orthodontic Treatment.  Role of E.N.T. Specialist, Speech Pathologist.Role of E.N.T. Specialist, Speech Pathologist.  Correction of Maxillary HypoplasiaCorrection of Maxillary Hypoplasia  Correction of Enamel Hypoplasia.Correction of Enamel Hypoplasia.  Role of ProsthodonticsRole of Prosthodontics  Role of PsychologistRole of Psychologist
  • PRENATAL DIAGNOSIS AND COUNSELING • Intrauterine diagnosis of orofacial clefts is possible by ultrasonography. • Complete clefts are seen easily at 16 weeks gestation. • Incomplete clefts are seen more readily at 27 weeks. • Palatal clefts are difficult to visualize by prenatal ultra sonography. • The family or obstetrician may request prenatal consultation with a surgeon.
  • Protocol For Dental Care of Cleft Lip and Palate in Children  At BirthAt Birth • Predental treatment is provided which comprises feedingPredental treatment is provided which comprises feeding plate, pre surgical orthopedics and helps surgeon in repairplate, pre surgical orthopedics and helps surgeon in repair by stimulating palatal bone growth and preventing collapseby stimulating palatal bone growth and preventing collapse of dental arches.of dental arches.  3-5 Month.3-5 Month. • Alignment of the primary teeth and palatal expansion to beAlignment of the primary teeth and palatal expansion to be started using a simple fixed appliance like warch & Arnoldstarted using a simple fixed appliance like warch & Arnold expander plastic surgeon to repair the lip.expander plastic surgeon to repair the lip. • Suction myringotomy for “Glue ear”Suction myringotomy for “Glue ear”  12 Months.12 Months. • Pedodontic review palatal pro sthetic speech.Pedodontic review palatal pro sthetic speech. Appliance may by required to correct veloAppliance may by required to correct velo pharygeal incompetence.pharygeal incompetence. • Plastic surgeon to repair the cleft palate.Plastic surgeon to repair the cleft palate.
  •  2-6 Years.2-6 Years. • Pedodontic showed review facial growth and development withPedodontic showed review facial growth and development with regular monitoring one year interval.regular monitoring one year interval. • Preventive measures for caries like fissure, sealing, fluoride.Preventive measures for caries like fissure, sealing, fluoride. • RestorativeRestorative  6-7 years.6-7 years. • Removal of super numerary teeth, correction of cross bite.Removal of super numerary teeth, correction of cross bite. • Orthodontic consultation.Orthodontic consultation.  8-9 years.8-9 years. • Suitability about bone grafting.Suitability about bone grafting. • Dental bone assessment (OPG, wrist, lateral cephalogram,.Dental bone assessment (OPG, wrist, lateral cephalogram,. • Review by the plastic surgeon, speech pathologist & ENTReview by the plastic surgeon, speech pathologist & ENT surgeon.surgeon. • If needed to relieve crowding and retroclination of the anteriorIf needed to relieve crowding and retroclination of the anterior teeth.teeth.
  •  9 years.9 years. • Combined orthodontist and pedodontistCombined orthodontist and pedodontist coalescence.coalescence. • Bone graft alveolar cleft at half to 1/3 rootBone graft alveolar cleft at half to 1/3 root development of permanent cuspid.development of permanent cuspid.  10-12 years.10-12 years. • Orthodontic consultationOrthodontic consultation • Monitoring changing dentition and growth.Monitoring changing dentition and growth.  12-15 years.12-15 years. • Orthodontic treatment.Orthodontic treatment. • Speech pathologist to review changing ofSpeech pathologist to review changing of the pitch of voice in boys.the pitch of voice in boys.
  • A Multi-Disciplinary Team for CleftA Multi-Disciplinary Team for Cleft Lip and Palate Patients.Lip and Palate Patients.  ObstetricianObstetrician == Refers the child to plastic surgeonRefers the child to plastic surgeon and pediatrician for expert opinion counseling theand pediatrician for expert opinion counseling the parents.parents.  Pediatrician or Neonatology'sPediatrician or Neonatology's==Provide medicalProvide medical care refers the case to the plastic surgeon.care refers the case to the plastic surgeon.  Plastic Surgeon:-Plastic Surgeon:-Carries out initial lip repairCarries out initial lip repair and palate surgery – performs pharyngoplasty orand palate surgery – performs pharyngoplasty or reversionary lip & nose surgery.reversionary lip & nose surgery.  Oromaxillofacial SurgeonOromaxillofacial Surgeon== Usually comes in theUsually comes in the picture of bone grafting – if any final orthopedicpicture of bone grafting – if any final orthopedic surgery is performed at later stage.surgery is performed at later stage.  NeurosurgeonNeurosurgeon== any craniofacial syndrome isany craniofacial syndrome is associated.associated.
  •  Pedodontist=Pedodontist=  A key member who sees the baby and the parent atA key member who sees the baby and the parent at the time of repair of the lip.the time of repair of the lip.  Provides pre surgical orthopedic treatment for theProvides pre surgical orthopedic treatment for the baby.baby.  Pedodontist monitor the growth and development.Pedodontist monitor the growth and development.  To maintain perfect oral health.To maintain perfect oral health.  To guide the occlusion and facial growth.To guide the occlusion and facial growth.  Motivates the parent & the child to cooperate withMotivates the parent & the child to cooperate with the treatment.the treatment.  Orthodontist:Orthodontist: Carries out definitive orthodonticCarries out definitive orthodontic treatment once the full permanent dentition istreatment once the full permanent dentition is erupted.erupted.
  •  Speech pathologist: =Speech pathologist: = • Monitors the speech development to normal.Monitors the speech development to normal. • Test for an adequate palato pharyngeal closure and guidingTest for an adequate palato pharyngeal closure and guiding the surgeon as to whether a pharyngeal flap may bethe surgeon as to whether a pharyngeal flap may be necessary.necessary.  Audiologist:-Audiologist:- To test hearing in the babyTo test hearing in the baby infants & the young child providing essentialinfants & the young child providing essential information in hearing loss for both speechinformation in hearing loss for both speech patholigist and otolarynologist.patholigist and otolarynologist.  OtolarynologistOtolarynologist:: Concerns with the health ofConcerns with the health of nasopharyngeal tissues including tonsils, adenoidsnasopharyngeal tissues including tonsils, adenoids and middle ear structures.and middle ear structures.  Blockage of the auditory canal and gluteneousBlockage of the auditory canal and gluteneous secretion (glue ear) is very common in these disease.secretion (glue ear) is very common in these disease.  Psychologist:Psychologist: Plays on important role when thePlays on important role when the child’s family is under stress.child’s family is under stress.
  •  MANAGEMENT:MANAGEMENT:  Infancy:Infancy: General ConsiderationGeneral Consideration:-:- Patients with C.L.P. requires,Patients with C.L.P. requires, interdisciplinary care from a team of provides including ainterdisciplinary care from a team of provides including a geneticist, plastic surgeon, oral and maxillofacialgeneticist, plastic surgeon, oral and maxillofacial surgeon, otolaryngologist, dentist, orthodontist, speechsurgeon, otolaryngologist, dentist, orthodontist, speech therapic audiologist, psychologist, social worker & nurse.therapic audiologist, psychologist, social worker & nurse. The role of each specialist depends on the age of theThe role of each specialist depends on the age of the patient.patient.  During the first days of the infant’s life:-During the first days of the infant’s life:- The infants with a cleft palate cannot generate the negativeThe infants with a cleft palate cannot generate the negative intraoral pressure needed to suck from a bottle.intraoral pressure needed to suck from a bottle.  The Nurse on the team or another feeding specialist mustThe Nurse on the team or another feeding specialist must instruct the parents in the use of special feeding device for theinstruct the parents in the use of special feeding device for the infant eg:- Haberman nipple, catheter & syringe, spoon feeding.infant eg:- Haberman nipple, catheter & syringe, spoon feeding.  Infants with cleft palate have difficulty ventilating theInfants with cleft palate have difficulty ventilating the eustachian tube. This result in the accumulation of fluid in theeustachian tube. This result in the accumulation of fluid in the must be treated promptly with antibiotics.must be treated promptly with antibiotics.
  • DENTOFACIAL ORTHOPEDICSDENTOFACIAL ORTHOPEDICS  In unilateral complete cleft lip and palate (UCCLP) orIn unilateral complete cleft lip and palate (UCCLP) or bilateral complete cleft lip and palate (BCCLP) with abilateral complete cleft lip and palate (BCCLP) with a protruding premaxilla, labial repair is oftenprotruding premaxilla, labial repair is often completed with tension on the closure.completed with tension on the closure.  Orthopedic appliances bring the dentoalveloarOrthopedic appliances bring the dentoalveloar segments together facilitating a tension free labialsegments together facilitating a tension free labial repair that requires undermining of tissues.repair that requires undermining of tissues.  In addition, alveolar approximate forms the skeletalIn addition, alveolar approximate forms the skeletal plateform for correction of the nasal deformity andplateform for correction of the nasal deformity and permits gingivoperiosteoplasty. Alveolar closurepermits gingivoperiosteoplasty. Alveolar closure eliminates an around fistula.eliminates an around fistula.  The appliance is removed at the time of labial repairThe appliance is removed at the time of labial repair and replaced with a passive appliance to maintainand replaced with a passive appliance to maintain the alveolar position.the alveolar position.
  • Management of Cleft Lip And NasalManagement of Cleft Lip And Nasal DeformityDeformity  Single stage:Single stage: repair the unilateral complete cleft liprepair the unilateral complete cleft lip and nasal deformity in a single stage.and nasal deformity in a single stage.  Two stage repairTwo stage repair: First repair unilateral cleft lip &: First repair unilateral cleft lip & than lip nasal adhesion.than lip nasal adhesion. Reasons For Two Stage RepairReasons For Two Stage Repair  Minimize tension.Minimize tension.  Increase the bulk of the orbicularis oris muscle toIncrease the bulk of the orbicularis oris muscle to construct the filtral ridge.construct the filtral ridge.  Increase the vertical dimension of labial elements.Increase the vertical dimension of labial elements. Particularly on the medical side andParticularly on the medical side and  Gives the surgeon two chances to correct the positionGives the surgeon two chances to correct the position of the lower lateral cartilage.of the lower lateral cartilage.
  • TIMING OF NASOLABIAL REPAIRTIMING OF NASOLABIAL REPAIR  Labial repair is traditionally carried out when the child isLabial repair is traditionally carried out when the child is approximately 10 weeks of age, weight 10 pounds, and has aapproximately 10 weeks of age, weight 10 pounds, and has a serum hemoglobin value of 10mg 1 ml & total leukocyte countserum hemoglobin value of 10mg 1 ml & total leukocyte count less than 10,000/C.C. it is important to wait until the period ofless than 10,000/C.C. it is important to wait until the period of postnatal anemia is corrected. The child should be gainingpostnatal anemia is corrected. The child should be gaining weight and growing before under going nasolabila repair.weight and growing before under going nasolabila repair.  TECHNIQUES OF NAGOLABIAL REPAIR.TECHNIQUES OF NAGOLABIAL REPAIR. • Type of cleft lip surgery:-Type of cleft lip surgery:- • Millard’s rotation advancement flap and tennison randallMillard’s rotation advancement flap and tennison randall triangular flap methods.triangular flap methods. • Rose Thompson straight line repair, the skoog’s procedure are lessRose Thompson straight line repair, the skoog’s procedure are less frequently used.frequently used. • Rectangular flap method of triangular hagedorn le mesurier areRectangular flap method of triangular hagedorn le mesurier are rarely used.rarely used. • For bilateral cleft lip can be repaired in two stage by in a singleFor bilateral cleft lip can be repaired in two stage by in a single stage by veau -III procedure, millards single stage procedure orstage by veau -III procedure, millards single stage procedure or black procedure.black procedure. • Basic steps in cleft lip repair.Basic steps in cleft lip repair. • The lip is closed in three layers – mucosa, muscle, skin.The lip is closed in three layers – mucosa, muscle, skin.
  • AIM OF REPAIRAIM OF REPAIR  To achieve equal length of filtral ridges an eitherTo achieve equal length of filtral ridges an either side.side.  Horizontal cupid’s bow.Horizontal cupid’s bow.  Accurate repair of muscle, skin, mucosa withoutAccurate repair of muscle, skin, mucosa without vermilion deformity.vermilion deformity.  Proper alignment of white line.Proper alignment of white line.  Symmetrical nostril floor, and finally an estheticallySymmetrical nostril floor, and finally an esthetically acceptable scar.acceptable scar. 1.1.Straight Line Lip Repair.Straight Line Lip Repair. IndicationIndication:- of incomplete and narrow clefts.:- of incomplete and narrow clefts. AdvantageAdvantage :- Easy repair:- Easy repair DisadvantageDisadvantage:- Limited Indications.:- Limited Indications.
  • Tennison Randall RepairTennison Randall Repair  A triangular flap is created on the lateral sideA triangular flap is created on the lateral side of the cleft to fit into the triangular.of the cleft to fit into the triangular.  This procedure can be planned exactly afterThis procedure can be planned exactly after initial measurements the results can not beinitial measurements the results can not be modified once the lip is cut.modified once the lip is cut.  The scar is more prominent than in otherThe scar is more prominent than in other procedures.procedures. • AdvantageAdvantage:-:- Measured techniquesMeasured techniques More easily taught.More easily taught. Can be used for wide dept.Can be used for wide dept. • DisadvantageDisadvantage: Scar: Scar interrupts the philtruminterrupts the philtrum line difficult to modify duringline difficult to modify during procedure.procedure.
  • VEAU REPAIRVEAU REPAIR  There is only a displacement, deformation and underThere is only a displacement, deformation and under development of the muscles and the skeletal tissue.development of the muscles and the skeletal tissue.  The surgical procedure should thus aim at returningThe surgical procedure should thus aim at returning there structures to their correct positions.there structures to their correct positions.  The naso labial muscles are reconstructed accuratelyThe naso labial muscles are reconstructed accurately and within a few weeks, without any form of flapand within a few weeks, without any form of flap closure.closure.  This method gives satisfactory results in bilateralThis method gives satisfactory results in bilateral cleft lip.cleft lip.  MILLARD’S Techniques (Rotation advancementMILLARD’S Techniques (Rotation advancement technique) principles of closing bilateral cleft lip.technique) principles of closing bilateral cleft lip. • Maintain symmetryMaintain symmetry • design the prolabium of proper size & shape.design the prolabium of proper size & shape. • Ensure primary muscular continuity.Ensure primary muscular continuity.
  • • Construct the median tubercle from lateral labialConstruct the median tubercle from lateral labial elements.elements. • Peeform primary construction of the columella &Peeform primary construction of the columella & nasal tip.nasal tip. Procedure :-Procedure :-rotation flap and columella flap arerotation flap and columella flap are planned on the medial side of the cleft. after fullplanned on the medial side of the cleft. after full thickness of the lip is cut along the marking rotationthickness of the lip is cut along the marking rotation gap is produced on the medial side which is filled bygap is produced on the medial side which is filled by an advancement flap planned on the lateral side ofan advancement flap planned on the lateral side of cleft.cleft. AdvantageAdvantage:-:- Minimal tissue is discardedMinimal tissue is discarded Allows modification during repairAllows modification during repair DisadvantageDisadvantage:: Difficult for use in wide cleft.Difficult for use in wide cleft. May narrow the nostrial.May narrow the nostrial.
  • Basic goals of palate repairBasic goals of palate repair  Separation of oral and nasal cavities.Separation of oral and nasal cavities.  Construction of watertight and airtight velopharyngealConstruction of watertight and airtight velopharyngeal valve.valve.  Preservation of facial growth.Preservation of facial growth.  Development of esthetic dentition.Development of esthetic dentition.  Development of functional occlusion.Development of functional occlusion. TIMING OF SURGERYTIMING OF SURGERY  Early repair leads to a better speech development but severeEarly repair leads to a better speech development but severe mid facial growth retardation and dental malocclussion.mid facial growth retardation and dental malocclussion.  Palate repair after full growth of maxilla midfacial growthPalate repair after full growth of maxilla midfacial growth retardation & dental malocclusion problem is less but speechretardation & dental malocclusion problem is less but speech problem become more severe.problem become more severe.  Palate repair should be done 1-1½ years age give the bestPalate repair should be done 1-1½ years age give the best balanced result.balanced result.  Only soft palate are closed by 6-18 months.Only soft palate are closed by 6-18 months. CLEFT PALATE REPAIRCLEFT PALATE REPAIR
  • TECHNIQUES OF PALATE REPAIRTECHNIQUES OF PALATE REPAIR  Single stare technique.Single stare technique. eg:- von langenbeck repaireg:- von langenbeck repair Ven wardill kilner v-y push back palatoplasty at areVen wardill kilner v-y push back palatoplasty at are 1½ years.1½ years.  Two stare technique:-Two stare technique:- • First stage : soft palate repair before 18 month.First stage : soft palate repair before 18 month. • Second stage hard palate repair at 4-5 years.Second stage hard palate repair at 4-5 years. eg. Schweckendiek technique.eg. Schweckendiek technique.  1)1) Primary Veloplasty By SchweekendiekPrimary Veloplasty By Schweekendiek.. • First soft palate is closed at an early age 16-12 months)First soft palate is closed at an early age 16-12 months) • Hard palate closed after few years.Hard palate closed after few years. • Principle of this techniques is that the soft palate aids in thePrinciple of this techniques is that the soft palate aids in the speech and is essential to be closed early for velopharyngealspeech and is essential to be closed early for velopharyngeal mechanism.mechanism. DisadvantageDisadvantage::- Speech problem (Severe)- Speech problem (Severe) Additional surgical procedure.Additional surgical procedure.
  • 2) VON LANGENBECK’S PALATO PLASTY.2) VON LANGENBECK’S PALATO PLASTY. • Use bipedicled mucoperiosteal flaps of theUse bipedicled mucoperiosteal flaps of the hard and soft palate for repair of the defect.hard and soft palate for repair of the defect. • There interiorly and posteriorly based flapsThere interiorly and posteriorly based flaps are advanced medially closed the palatalare advanced medially closed the palatal defect.defect. AdvantageAdvantage:-:- Easy to perform, requiresEasy to perform, requires less dissection. results inless dissection. results in decreased denuded palate.decreased denuded palate. DisadvantageDisadvantage:-:- Failure to provideFailure to provide additionaladditional palatal length.palatal length. - Poor results in large clefts.- Poor results in large clefts. - Currently not commonly used.- Currently not commonly used.
  •  Veau-Wardill-Kilnar-v-y- PushbackVeau-Wardill-Kilnar-v-y- Pushback palatoplasty.palatoplasty.  Two mucoperiosteal flaps are raised from a hardTwo mucoperiosteal flaps are raised from a hard palate and nasal layers are mobilized abnormalpalate and nasal layers are mobilized abnormal attachment of palatal muscles are divided from theattachment of palatal muscles are divided from the posterior border of the hard palate to be sutured inposterior border of the hard palate to be sutured in midline to the opposite side the palatal muscle.midline to the opposite side the palatal muscle.  Suturing done anterior of the nasal layer andSuturing done anterior of the nasal layer and progressed toward Uvula.progressed toward Uvula. ORTHODONTICS AND MAXILLARYORTHODONTICS AND MAXILLARY ORTHOPAEDICS.ORTHOPAEDICS. Different stages of dentition methods.Different stages of dentition methods. A)A) predental treatment.predental treatment. B)B) Deciduous dentition ( 3 to 6 years)Deciduous dentition ( 3 to 6 years) C)C) Early mixed dentition ( 7 to 9 years)Early mixed dentition ( 7 to 9 years) D)D) Late mixed and early permanent dentition.Late mixed and early permanent dentition. E)E) Permanent dentition.Permanent dentition.
  • A) PRE DENTAL TREATMENTA) PRE DENTAL TREATMENT II Feeding palate proper feeding advise pre-surgicalFeeding palate proper feeding advise pre-surgical feeding plate.feeding plate. II.To help the surgeon in the repair of the cleft byII.To help the surgeon in the repair of the cleft by pushing.pushing. III. To stimulate palatal bone growth and to restoreIII. To stimulate palatal bone growth and to restore orofacial functional matrix.orofacial functional matrix. IV. To expand or prevent the collapse of maxillaryIV. To expand or prevent the collapse of maxillary segment.segment. B) PRIMARY DENTITION TREATMENTB) PRIMARY DENTITION TREATMENT - Simple form of fixed maxillary lingual appliance (i.eSimple form of fixed maxillary lingual appliance (i.e warch or an Arnold expander) are preferred over thewarch or an Arnold expander) are preferred over the removable palatal expansion for improving speech.removable palatal expansion for improving speech.
  • C) MIXED DENTITION TREATMENTC) MIXED DENTITION TREATMENT I.I. Minor crossbites may be neglected but severeMinor crossbites may be neglected but severe crossbites one corrected by expansion by usualcrossbites one corrected by expansion by usual method.method. II.II. Retroclination of permanent incision and anteriorRetroclination of permanent incision and anterior cross bite to correct this usually partial bandedcross bite to correct this usually partial banded approach is needed .approach is needed . III.III. Crowded dentition: This may require serialCrowded dentition: This may require serial extraction primary cupids are removed to treatextraction primary cupids are removed to treat incisior crowding & the primary molars.incisior crowding & the primary molars. IV.IV. After alveolor bone grafting.After alveolor bone grafting. To movement carriage enough space is createdTo movement carriage enough space is created in the arch to allow the cuspids to erupt.in the arch to allow the cuspids to erupt.
  • PERMANENT DENTITION TREATMENTPERMANENT DENTITION TREATMENT  The problem at this stage are posterior cross biteThe problem at this stage are posterior cross bite and malposed permanent incisors.and malposed permanent incisors.  If orthognathic surgery is done to correct theIf orthognathic surgery is done to correct the underlying skeletal imbalance pre operative and postunderlying skeletal imbalance pre operative and post operative orthodontic treatment is needed tooperative orthodontic treatment is needed to achieve proper alignment, position and indication ofachieve proper alignment, position and indication of the teeth on their respective arches.the teeth on their respective arches. ROLEOFENTSPECIALIST, SPEECHPATHOLOGISTSROLEOFENTSPECIALIST, SPEECHPATHOLOGISTS ANDSPEECHTHERAPYANDSPEECHTHERAPY  ENT specialist, Audiologist and speech specialistENT specialist, Audiologist and speech specialist work together to note the middle ear problems andwork together to note the middle ear problems and progress in speech.progress in speech.  Detect abnormalities in articulation and resonanceDetect abnormalities in articulation and resonance which is develops due to velopharyngeal inwhich is develops due to velopharyngeal in competence after palatoplasty.competence after palatoplasty.  The abnormalities detected by video fluoroscopy orThe abnormalities detected by video fluoroscopy or nasopharyngoscopy.nasopharyngoscopy.
  • PROCEDURE FOR CORRECTION OFPROCEDURE FOR CORRECTION OF VELOPHARYNGEAL INSUFFICIENCYVELOPHARYNGEAL INSUFFICIENCY  Pharyngeal flap 2) Sphincter pharyngoplasty.Pharyngeal flap 2) Sphincter pharyngoplasty. -- Pharyngeal flap designed on the basis of location and extent ofPharyngeal flap designed on the basis of location and extent of lateral pharyngeal wall motion. The raw under surface of thelateral pharyngeal wall motion. The raw under surface of the flap is lined with tissue from the nasal side of the soft tissueflap is lined with tissue from the nasal side of the soft tissue palate to prevent contracture and narrowing of the flap thepalate to prevent contracture and narrowing of the flap the donor site on the posterior pharyngeal is closed.donor site on the posterior pharyngeal is closed. • ALVEOLAR BONE GRAFTING TIME 8-11 years.ALVEOLAR BONE GRAFTING TIME 8-11 years. - Cancellous bone is used for alveolar grafting.Cancellous bone is used for alveolar grafting. - It promotes more rapid vascularization due to presence ofIt promotes more rapid vascularization due to presence of living osteoblasts.living osteoblasts. - DONAR SITE OF BONEDONAR SITE OF BONE - Ilium, calvaria, tibia mandible or ribs.Ilium, calvaria, tibia mandible or ribs. - The bone should be placed within the cleft from the piriformThe bone should be placed within the cleft from the piriform aperture to the level of the alveolar crest.aperture to the level of the alveolar crest. - Gingival mucoperiosteal flaps are used for oral closure over anGingival mucoperiosteal flaps are used for oral closure over an alveolar bone graft because they are well vascularized.alveolar bone graft because they are well vascularized.
  • ADVANTAGEADVANTAGE  Bony support to teeth.Bony support to teeth.  Helps stabilize the maxillary segments.Helps stabilize the maxillary segments.  Aesthetic appearance of the alveolus.Aesthetic appearance of the alveolus.  Closure of oro nasal fistula.Closure of oro nasal fistula.  Gives supports to the alar bone of the nose.Gives supports to the alar bone of the nose.  Provides bone for a titanium implants.Provides bone for a titanium implants. OPERATIVE CORRECTION OF MAXILLARYOPERATIVE CORRECTION OF MAXILLARY HYPOPLASIAHYPOPLASIA Maxillary hypoplasia is three dimensionalMaxillary hypoplasia is three dimensional deficiencydeficiency  Class III malocclusion ( Sagittal plane)Class III malocclusion ( Sagittal plane)  Narrowed arch (horizontal plane)Narrowed arch (horizontal plane)  Over closure the mandible (vertical plane)Over closure the mandible (vertical plane)
  • TREATMENTTREATMENT  Destruction osteogenesis.Destruction osteogenesis.  Pre surgical orthodontics & Lefort – I osteotomy.Pre surgical orthodontics & Lefort – I osteotomy.  Fabrication of an over lay denture may be necessaryFabrication of an over lay denture may be necessary for improved occlusion and appearance.for improved occlusion and appearance. DENTAL ENAMEL HYPOPLASIA:DENTAL ENAMEL HYPOPLASIA: Defect occurs in central & lateral incisors.Defect occurs in central & lateral incisors. TreatmentTreatment  RestorationRestoration  Placement of stainless steel crown.Placement of stainless steel crown.  Fluoride application.Fluoride application.  Dietary advice.Dietary advice.  Preventive oral health carePreventive oral health care
  • ROLE OF PROSTHODONTISTROLE OF PROSTHODONTIST  Replacement of absent maxillary lateral incisor.Replacement of absent maxillary lateral incisor.  Replacement by fixed partial denture andReplacement by fixed partial denture and implantation method.implantation method. ROLE OF PSYCHOLOGISTROLE OF PSYCHOLOGIST  The psychiatrist and psychologist evaluate theThe psychiatrist and psychologist evaluate the patient for strength and weakness in cognitivepatient for strength and weakness in cognitive interpersonal, emotional, behavioural and socialinterpersonal, emotional, behavioural and social development: emphasis is placed on the patient’sdevelopment: emphasis is placed on the patient’s ability to cope with the emotional and psychealability to cope with the emotional and psycheal stress created by the cleft defect. Consultation withstress created by the cleft defect. Consultation with the parents and schools regarding educational orthe parents and schools regarding educational or behavioural management if carried out whenbehavioural management if carried out when indicated.indicated.
  • CONCLUSIONCONCLUSION  The management of cleft lip & palate isThe management of cleft lip & palate is necessary at correct time. If delayed innecessary at correct time. If delayed in the treatment there may be possibility tothe treatment there may be possibility to developed abnormalities.developed abnormalities.  So to prevent some problems like speechSo to prevent some problems like speech problem facial asymmetry, feedingproblem facial asymmetry, feeding problem & infection to nasal cavity &problem & infection to nasal cavity & unasthetic appearance. The treatment isunasthetic appearance. The treatment is necessary.necessary.
  • REFERENCESREFERENCES  Pediatric Oral & Maxillofacial Surgery byPediatric Oral & Maxillofacial Surgery by Leonard B. Kaban , Maria T. Troulis.Leonard B. Kaban , Maria T. Troulis.  Facial cleft and cranio synostosis ByFacial cleft and cranio synostosis By Timothy A. Turvey, Kathorine W L VIG ,Timothy A. Turvey, Kathorine W L VIG , Raymond J. Fansecu.Raymond J. Fansecu.  Clinical Pedodontics By Sidney B. Finn.Clinical Pedodontics By Sidney B. Finn.  Oral & Maxillofacial Surgery by ChitraOral & Maxillofacial Surgery by Chitra ChakravarthyChakravarthy  Clinical Pedodontics By Shobha Tandon.Clinical Pedodontics By Shobha Tandon.