Cleft lip and palate

1. DR DURGA PRASAD
Professor, Dept Of Orthodontics.
Navodaya Dental College, Raichur.

2. One of the most common congenital deformity – at birth
Usually not life threatening
They can also associated with other congenital deformities
Have numerous problems – patient, parents and also to docters

3. Embryology
Development of the face

8. Development of the palate

11. Incidence
1 in every 600 – 1000 births
Negroids – least Mongoloids - highest
Cleft lip – males
Cleft palate - females
Unilateral – 80%
Bilateral – 20%
Left side - 70%
Right side - 30%

12. Etiology
Multifactorial
Heredity
Environmental
Teratogens
Rubella virus
Cortisone
Mercatopurine
Methatrexate
Valium
Dilantin

13. Predisposing factors
Increased maternal age
Racial
Blood supply

14. Possible mechanism for formation of isolated cleft
palate
1. Agenesis or hypoplasia of the tissue
involved.
2. Palatal tissues may be obstructed from
moving dorsal to the tongue by lack of
intrinsic or extrinsic motivational force or
by physical obstruction
3. Poor adherence of medial edge
epithelium of the palatal process

15. 4. Persistence of midlines seam due to a
failure of cellular degeneration might result
in post fusion breakdown in midline
5. lack of mesenchymal growth in the
midline region may result in submucous
cleft formation

16. Classification
Davis and Ritchie classification
Group I – pre alveolar cleft
unilateral
bilateral
median
Group II – post alveolar cleft
Group III – alveolar cleft
unilateral
bilateral
median

17. Veau’s classification
Group 1 – involving soft palate only
Group 2 – hard and soft palate extending up to incisive foramen
Group 3 – coplete unilateral cleft invloving soft palate, hard
palate, lip and alveolar ridge
Group 4 – coplete bilateral cleft

18. Schuhardt and Pfifer”s symbolic classification

19. Kernahans stripped ‘Y’ classification
Block
1 and 4 – lip
2 and 5 – alveolus
3 and 6 - hard palate anterior to
incisive foramen
7 and 8 - hard palate posterior to
incisive foramen
9 – soft palate

20. Lahshal classification (Okriens)
L – lip
A – alveolus
H – hard palate
S – soft palate
H – hard palate
A – alveolus
L - lip

21. Problems associated with clefts
1. Dental
2. Esthetic
3. Speech and hearing
4. Psychologic

22. Dental problems

23. Compromised esthetics

24. Management
Multidisciplinary approach
4 stages
Stage 1 – birth to 18 months
Stage 2 – 18 months to 5th year
Stage 3 – 6th to 11th year
Stage 4 – 12th 18th year

25. Stage 1 – birth to 18 months
Fabrication of maxillary obturator
Presurgical orthopedics
Surgical management of cleft lip
Surgical management of cleft palate
Millard rule of ten
Age 10 months
Weight 10 pounds
Hb 10 grams%

26. Stage 2 – 18 months to 5th year
In the primary dentition stage
Adjustment of intraoral obturator
To maintain check on eruption pattern and timing
Oral hygiene
Restoration of decayed teeth

27. Stage 3 – 6th to 11th year
Mixed dentition phase
Correction of anterior cross bite – removable appliance
Buccal segment cross bite
Stage 4 – 12th 18th year
Permanent dentition phase
All local irregularities
prosthesis
Bone support and scar tissue

28. Pre surgical orthopedics by
extra oral strapping across the
maxilla

29. Incision design of Delaire

30. Mirault-Blair technique

31. Millard rotation technique

32. Von longenback procedure or palatoplasty
Wardill’s four flap operation

33. Case treated with face mask