Cleft lip and palate

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Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

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Cleft lip and palate

  1. 1. CLEFT LIP AND PALATE www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. INTRODUCTION ® ® ® ® CLEFT LIP AND PALATE IS THE MOST COMMON FACIAL ANAMOLY OCCURS IN APPROXIMATELY 1 IN 1000 NEWBORNS ISOLATED CLEFT LIP AND PALATE OCCUR IN ABOUT 1 IN 2000 NEWBORNS THE ANAMOLY APPEARS TO BE GENETICALLY DETERMINED ALTHOUGH MAJORITY ARE OF UNKNOWN CAUSE OR ARE ATTRIBUTABLE TO TERATOGENIC CAUSE. www.indiandentalacademy.com
  4. 4. www.indiandentalacademy.com
  5. 5. What is a Cleft? ® ® ® ® Any opening or division in some part of the anatomy that is not normally open or divided. Result of some problem during embryological development. Problem specifically occurs during the first trimester of pregnancy. Failure of parts to fuse at the midline. www.indiandentalacademy.com
  6. 6. Clefts ® ® ® ® ® Result of problem with structure formation during the first trimester of pregnancy. CLEFT LIP – failure of the upper lip to fully form. Lower lip forms earlier; cleft would accompany cleft of the mandible which would be much more serious and usually be accompanied by other (fatal) problems. CLEFT PALATE – opening in the hard or soft palate. Result = connection between the oral and nasal cavities www.indiandentalacademy.com
  7. 7. www.indiandentalacademy.com
  8. 8. CLEFTS ® Clefts of lip or palate occur at different times during development. ® Lip closure – occurs at 7-9 weeks gestation. ® Palate closure – occurs at 9-11 weeks gestation. ® Only 5% of cleft lips occur without accompanying clefts of the palate. ® Whatever disrupts lip closure will probably also disrupt palatal closure . www.indiandentalacademy.com
  9. 9. www.indiandentalacademy.com
  10. 10. DEVELOPMENT OF THE FACE www.indiandentalacademy.com
  11. 11. www.indiandentalacademy.com
  12. 12. DEVELOPMENT OF LIP www.indiandentalacademy.com
  13. 13. CLASSIFICATION OF CLEFT LIP AND PALATE ® VARIOUS CLASSIFICATIONS HAVE BEEN GIVEN HOWEVER THE MOST ACCEPTED CLASSIFICATION WAS GIVEN BY VEAU ® VEAU CASSIFIED CLEFT LIP AND CLEFT PALATE SEPERATELY www.indiandentalacademy.com
  14. 14. VEAU’S CLASSFICATION Of Cleft Lip ® CLASS I---a unilateral notching of the vermillion not extending into lip. www.indiandentalacademy.com
  15. 15. VEAU’S CLASSFICATION Of Cleft Lip ® CLASS II….. a unilateral notching of the vermillion with cleft extending into the lip but not including the floor of the nose…… www.indiandentalacademy.com
  16. 16. CLASS II-CLEFT LIP www.indiandentalacademy.com
  17. 17. VEAU’S CLASSFICATION Of Cleft Lip ® CLASS III a unilateral notching of the vermillion border with cleft extending into the floor of the nose…… www.indiandentalacademy.com
  18. 18. VEAU’S CLASSFICATION Of Cleft Lip ® CLASS IV……. Any bilateral clefting of the lip,whether it be incomplete notching or complete clefting…… www.indiandentalacademy.com
  19. 19. DEVELOPMENT OF PALATE www.indiandentalacademy.com
  20. 20. DEVELOPMENT OF PALATE www.indiandentalacademy.com
  21. 21. DEVELOPMENT OF PALATE www.indiandentalacademy.com
  22. 22. VEAU’S CLASSFICATION Of Cleft Palate ® CLASS I…. Involves only the soft palate Soft palte www.indiandentalacademy.com
  23. 23. VEAU’S CLASSFICATION Of Cleft Palate ® CLASS II……… Involves the soft and hard palates but not the alveolar process……… www.indiandentalacademy.com
  24. 24. VEAU’S CLASSFICATION Of Cleft Palate ® CLASS III….. Involves both soft and hard palates and the alveolar process on one side of the pre-maxillary area…… www.indiandentalacademy.com
  25. 25. CLEFT PALATE—CLASS III www.indiandentalacademy.com
  26. 26. VEAU’S CLASSFICATION Of Cleft Palate ® CLASS IV……. Involves both soft and hard palates and continues through the alveolus on both sides of the pre-maxilla,leaving it free and often mobile…… www.indiandentalacademy.com
  27. 27. CLEFT PALATE—CLASS IV www.indiandentalacademy.com
  28. 28. MULTIDISCIPLINARY APPROACH TO CLEFT LIP AND PALATE www.indiandentalacademy.com
  29. 29. MULTIDISCIPLINARY APPROACH TO CLEFT LIP AND PALATE ® ® The complexity of problems associated with cleft lip and palate requires that numerous healthcare professionals co-operate in providing the specialised knowledge and skills neccesary to ensure comprehensive care. A protocol has been established by AMERICAN CLEFT PALATE CRANIOFACIAL ASSOCIATION(www.cleftpalatecraniofacial.org) www.indiandentalacademy.com
  30. 30. MULTIDISCIPLINARY APPROACH ® THE TEAM IS COMPOSED OF ® DENTAL SPECIALITIES 1.ORTHODONTICS 2.ORAL SURGERY 3.PEDODONTICS 4.PROSTHODONTICS MEDICAL SPECIALITIES 1.GENETICS 2.OTOLARYNGOLOGY 3.PEDIATRICS 4.PLASTIC SURGERY 5.PSYCHIATRY www.indiandentalacademy.com
  31. 31. MULTIDISCIPLINARY APPROACH ® ALLIED HEALTH CARE FIELDS 1.AUDIOLOGY 2.NURSING 3.PSYCHOLOGY 4.SOCIAL WORK 5.SPEECH THERAPY www.indiandentalacademy.com
  32. 32. ETIOLOGY OF CLEFT PALATE AND CLEFT LIP Some possible causes related to CLEFT PALATE AND CLEFT LIP can be categorized as: ® ® ® ® ® ® GENETIC NUTRITIONAL SMOKING DRUGS ENVIRONMENTAL SYNDROMES ASSOCIATED WITH CLEFT PALATE AND CLEFT LIP www.indiandentalacademy.com
  33. 33. GENETICS ® ® ® ® Clefts commonly have a genetic basis,. Clefts of the lip and palate can run in families and be due to a single gene. If the gene is transmitted from one affected parent to their offspring, then it is generally considered to be dominant. If neither parent is affected, then the gene could be recessive, and would require that both parents contribute the same recessive gene to their affected child www.indiandentalacademy.com
  34. 34. NUTRITIONAL ® EXCESSIVE AMOUNTS OF VITAMIN-A AND DEFICIENCY OF FOLIC ACID DURING PREGNANCY HAVE BEEN KNOWN TO CAUSE CLEFTING www.indiandentalacademy.com
  35. 35. SMOKING ® SMOKING DOUBLES RISK FOR CLEFTS Those who smoked twenty or more cigarettes per day were more than two times as likely to have babies with cleft lip and/or cleft palate. Those who smoked less were about one and a half times as likely to have babies with oral clefts www.indiandentalacademy.com
  36. 36. DRUGS ® ® VARIOUS DRUGS HAVE BEEN KNOWN TO BE TERATOGENIC AND HAVE BEEN KNOWN TO CAUSE VARIOUS ANOMALIES IN THE FOETUS,INCLUDING CLEFT LIP AND PALATE. EXAMPLES TETRACYCLINE METRONIDAZOLE TRIMETHOPRIM SULPHONAMIDES www.indiandentalacademy.com
  37. 37. ENVIRONMENTAL ® ® SOME OF THE COMMONLY USED INSECTICIDES AND PESTICIDES USED HAVE KNOWN TO CAUSE CLEFTING EXAMPLES CYNIZINE HEXACHLOROBENZENE THIRAM www.indiandentalacademy.com
  38. 38. SYNDROMES ASSOCIATED WITH CLEFT LIP AND PALATE ® ® ® ® ® ® ® ® ® ® SOME COMMON SYNDROMES ASSOCIATED ARE: Phenylketonuria Retinoblastoma Crouzon craniofacial dysostosis Apert syndrome Diastrophic dysplasia Basal cell nevus syndrome (Gorlin syndrome) DiGeorge syndrome Treacher Collins mandibulofacial dysostosis Pallister-Hall syndrome www.indiandentalacademy.com
  39. 39. ORAL CONDITIONS ASSOCIATED WITH CLEFT LIP AND PALATE ® ® ® ® ® ® ® ® ® NATAL OR NEONATAL TEETH CONGENITALLY MISSING TEETH SUPERNUMERARY TEETH ANOMALIES OF TOOTH MORPHOLOGY { enamel hypoplasia,microdontia,macrodontia,fused teeth,abberations in crown shape.} UNILATERAL OR BILATERAL CROSSBITE(muscle forces) TEETH THAT ERUPT ADJACENT TO THE CLEFT HAVE INSUFFICIENT BONE SUPPORT LEADING TO PREMATURE LOSS PROFILE IS CONCAVE DUE TO TRUE OR PSEUDO MANDIBULAR PROGNATHISM DEEP BITE LEADING TO GINGIVAL STRIPPING OF LABIAL ATTACHED GINGIVA OF MANDIBULAR INCISORS. TEETH THAT ERUPT ADJACENT TO THE CLEFT ARE ROTATED OR WITH DEVIATIONS OF AXIAL ROOT INCLINATIONS> www.indiandentalacademy.com
  40. 40. TREATMENT PROTOCOL ® VARIOUS TREATMENT PROTOCOLS ARE FOLLOWED IN THE TREATMENT FOR CLEFT LIP AND PALATE : ® Below is the most common treatment protocol presently used in most cleft treatment centers: • Newborn - Diagnostic examination, general counseling of parents, feeding instructions, palatal obturator (if necessary); genetic evaluation and specification of diagnosis; empiric risk of recurrence of cleft calculated; recommendation of a protocol for the prevention of a cleft recurrence in the family • Age 3 months - Repair of CLEFT LIP • Age 6 months - Presurgical orthodontics, if necessary; first speech evaluation • Age 9 months - Speech therapy begins • Age 9-12 months - Repair of CLEFT PALATE • Age 1-7 years - Orthodontic treatment • Age 7-8 years - Alveolar bone graft • Older than 8 years - Orthodontic treatment continues ® Other surgical procedures can be performed in patients with severe clefts as necessary www.indiandentalacademy.com
  41. 41. SURGICAL PROTOCOL ® ® Undoubtedly, closure of the CL is the first major procedure that tremendously changes children's future development and ability to thrive. Variations occur in timing of the first lip surgery; however, the most usual time occurs at approximately age 3 months. Pediatricians used to strictly follow a rule of "three 10s" as a necessary requirement for identifying the child's status as suitable for surgery (i.e., 10 lb, 10 mg/L of hemoglobin, and age 10 wk). Although pediatricians are presently much more flexible, and some surgeons may well justify a neonatal lip closure, considering the rule of three 10s is still very useful www.indiandentalacademy.com
  42. 42. THANK YOU! www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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