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Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
Cleft lip and palate  management /certified fixed orthodontic courses by Indian dental academy
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Cleft lip and palate management /certified fixed orthodontic courses by Indian dental academy

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The 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.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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  • 1. CLEFT LIP & PALATE MANAGEMENT INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. Incidence CLP- is a common congenital anomaly Incidence- 1 in 600 births C. Lip- m>f C. Palate F>M ( since fusion of palatine shelves in F takes one week longer than M) www.indiandentalacademy.com
  • 3. Aetilogy Multifactorial 1. Defective vascular supply in the area involved 2. Mechanical disturbance- the size of the tongue may prevent union of the parts Circulating substanceDrugs( anti- epileptic), diazepam, alcohol www.indiandentalacademy.com
  • 4. 3. Viral infection in utero 4. Abnormal fetal position in Utero 5. X radiation in Utero 6. Familial inheritance in CLP Cleft lip alone shows 20% family history and palate 40% www.indiandentalacademy.com
  • 5. 6. Associated anomalies Downs syndrome, Pierre Robin Syndrome, Trecher Collins syndrome, Goldenhar syndrome, hemifacial microsomia. www.indiandentalacademy.com
  • 6. Classification Kernehan and Stark 1958 1. Clefts of the primary palate only Unilateral, Complete/ incomplete Median , Complete/ incomplete Bilateral , Complete/ incomplete www.indiandentalacademy.com
  • 7. 2. Cleft of the secondary palate only complete/incomplete/ submucous 3. Cleft of primary and secondary palate Unilateral, Complete/ incomplete Median , Complete/ incomplete Bilateral , Complete/ incomplete www.indiandentalacademy.com
  • 8. KRENS Classification LASHAL ----AL ------al -----S— ---HSH— LASH---Incomplete- lowercase; * submucous Complete upper case www.indiandentalacademy.com
  • 9. Submucous cleft- overlying mucosa is intact, 1 in 1200 births, 90 % asymtomatic, speech, hearing and feeding problems may present later. Recognized by the presence of bifid uvla, a central greyish translucent zone in the soft palate midline, palpable notch in the HP. www.indiandentalacademy.com
  • 10. Clinical problems 1. Feeding- Oro nasal communication, difficulty in suckling 2. Speech/ hearing-Normal speech requires velo- pharyngeal competence and normal hearing. Palate function is impaired in the presence of a cleft, preventing an oro nasal seal. www.indiandentalacademy.com
  • 11. 3. Conductive deafness- abnormal attachments of tensor veli palatini into post part of HP instead of mid palatine raphae, inability to close and open eustachian tube to equalize middle ear pressure- poor middle ear drainage and conductive deafness www.indiandentalacademy.com
  • 12. 4. Dental anomalies Missing lateral and canine, SNT, hypo plastic teeth, delayed/ abnormal eruption, teeth of abnormal morphology 5. Malocclusion www.indiandentalacademy.com
  • 13. 6. Facial appearance and growthClass III jaw relation, adverse effects of the palatal scarring on facial growth, in particular down and forward growth of maxilla. 7. Self image- esteem www.indiandentalacademy.com
  • 14. Aims of treatment 1. Improved aesthetics- lip, nose dentition, jaw relation 2. Good function- speech, hearing occlusion, respiration 3. Permanence of result- preventive dentistry, life long dental care, stability of occlusion 4. Improved self image www.indiandentalacademy.com
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  • 20. CLEFT TEAM OMS SURGEON Plastic surgeon ENT Surgeon GDP/ GP Orthodontist Speech therapist Psychologist www.indiandentalacademy.com
  • 21. Geneticist Cleft support Nurse Dental Hygienist Dental Technician Multi disciplinary- team approach www.indiandentalacademy.com
  • 22. Management In Utero- Fetal ultra sound- 20 week IU TOP or intervention in utero for the cleft Neonatal- Feeding plates, Mead Johnson bottle, Nuyke teat,Habberman teat. Emergency counseling done by the cleft support nurse, www.indiandentalacademy.com
  • 23. Pre surgical orthopedics- strapping, appliance Improves alignment of arch segments, aids feeding, better long term result, reduces prominence of premaxilla www.indiandentalacademy.com
  • 24. 0 to 3 days Counseling, plate fitting, pre surgical orthopedics 3 months Repair of lip 6 months to 18 months 6 months- soft palate repair 15 to 18 months -HP www.indiandentalacademy.com
  • 25. 4to 6 years Secondary lip surgery if required ,pharyngoplasty 8 to 10 years ABG to allow ectopic incisor, canine to erupt, Lip revision 16 and above OGS, lip repair, Rhinoplasty, www.indiandentalacademy.com
  • 26. Secondary surgery Pharyngoplasty- 7 years to adult life OGS ABG Rhinoplasty Secondary lip surgery Closure of fistula www.indiandentalacademy.com
  • 27. Lip repair 3 months to 6 months Millard rotational / advancement flap 1960 De Laires functional repair (Cheilorhinoplasty) www.indiandentalacademy.com
  • 28. Objectives of lip repair 1. To close defect, 2. Inconspicuous scar 3. Restore cupid bow 4. Close the nasal floor 5. Recreate the missing philtral line 6. Buccal sulcus to be deepened 7. To form normal rounded ala www.indiandentalacademy.com
  • 29. Palate repair 2 stages- SP- 6 months  HP 12 to 18 months  Some say both HP and SP at 18 months  Defer repair to older age decreases the growth disturbance but poor speech, greater psychological impact  Von Langenbeck 1977 – midline repair  Furlow- Z plasty 1986 www.indiandentalacademy.com
  • 30. Objectives of palate repair 1. To produce a palate of adequate length 2. To produce a palate sufficiently mobile to allow closure of velopharyngeal space 3. To produce a palate whose dorsal surface conforms to the shape of the pharyngeal wall www.indiandentalacademy.com
  • 31. Speech therapy Pre school 2 years of age – therapy starts to identify VPI and lip function 5 years- videofluoroscopy, nasendoscopy to objectively assess and record palate function www.indiandentalacademy.com
  • 32. Hearing problems Pre school audiology Recurrent middle ear infection due to eustachian tube dysfunctionGROMMETS placed into middle ear to drain out pus www.indiandentalacademy.com
  • 33. Dental/ Orthodontic Anterior Xbite correction Buccal expansion prior to ABG Fluoride and preventive dentistry Continued dental care www.indiandentalacademy.com
  • 34. Clinical standards Advisory group -CSAG 74 surgeons in 45 centres 2/3 UK surgeons do less than 10 cases a year Poor results compared to EU centres Recommended 8 to 15 centres www.indiandentalacademy.com
  • 35. THANK YOU! www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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