Cleft palate by hafiz m waseem

1. HAFIZ M WASEEM UNIVERSITY OF
EDUCATION LAHORE

2. TOPIC:
CLEFT PALATE

3. CONTENTS:
• Introduction
• Definition
• Symptoms
• Anatomy of normal palate
• Types of cleft palate
• Causes of cleft palate
• Genetic basis
• Complications
• Risk factors
• Treatment
• Conclusion
• Reference

4. INTRODUCTION:
• Result from incomplete closure of the roof of the mouth
• There is often an associated deformity of the nose on the effected
side.
• Facial structure that are developing in an unborn baby don’t close
completely.
• Most common birth defect
• Approximately one in 700 birth.

5. DEFINITION
“Cleft palate is a condition in which the two plates of the skull that
form the hard palate (roof of the mouth) are not completely joined”.
The soft palate is in these cases cleft as well.

6. SYMPTOMS:
• Usually, a split (cleft) in the palate is immediately identifiable at
birth. Cleft palate may appear as:
• A split in the roof of the mouth that doesn’t affect the appearance of
the face.

7. ANATOMY OF NORMAL PALATE
• To understand the cleft palate ,first we should know about the
anatomy of normal palate. Normal palate consist of following parts;
• MUCOSA: The mucosa is the moist, pink tissue that lines the inside of
certain body parts.
• HARD PALATE: The hard palate is the bony part of the roof of the
mouth. It makes up the front part of the palate. It is in front of the
soft palate. It seperates the mouth from the nose.
• SOFT PALATE: The soft palate is the posterior, fleshy part of the
palate.When there is a cleft in the palate muscle, it does not function
and speech is impaired. Specifically, speech becomes difficult to
understand because air is going out of the nose instead of the mouth.

8. UVULA: The uvula is the part of the soft palate that hangs down the
middle in the back of the mouth.
ALVEOLAR RIDGES:The alveolar ridge is also known as the “dental arch”
or “gums.” The alveolar ridge is where the teeth emerge.
PRIMARY PALATE:The primary palate is the portion of the palate in
front of the incisive foramen. It includes the front portion of the hard
palate and is triangular in shape.

9. • SECONDARY PALATE:The secondary palate is the back portion of the
hard palate (the portion behind the incisive foramen).
• including the posterior alveolar ridge and all of the soft palate and
uvula.
• INCISIVE FORAMEN: The incisive foramen is a structure that
separates the primary palate from the secondary palate. It is an
opening in the bony palate . It is directly behind the two front teeth.

11. TYPES OF CLEFT PALATE
• INCOMPLETE CLEFT PALATE
• A cleft in the back of the Palate (usually in soft palate) with uvula and
extend forward. It also involves secondary palate. It may extend to
incisive foramen.

12. • Bifid uvula- It is a type of incomplete cleft palate which is least
severe and most common. It is also known as cleft uvula . This type
of cleft palate is due to the splitting of the uvula( part of the soft
palate that hang down in the middle of the back of the mouth).
•

13. • SOFT PALATE CLEFT:
• This type of cleft palate starts from the top of the uvula and stop
before at the junction of the soft and hard palate.
• COMPLETE CLEFT PALATE
• In complete cleft palate both soft and hard palate are effected. The
mouth and nose cavities are exposed to each other.A complete cleft
palate can be unilateral or bilateral. If the cleft palate is bilateral, both
sides may be complete, or one side may be complete and the other
side may be incomplete.

15. • SUBMUCOUS CLEFT PALATE
• A cleft involving the hard and/or soft palate, covered by the mucous
membrane lining the roof of the mouth. May be difficult to visualize
• Less commonly, a cleft occurs only in the muscles of the soft palate
(submucous cleft palate), which are at the back of the mouth and
covered by the mouth’s lining. This type of cleft often goes unnoticed
at birth and may not be diagnosed until later when signs develop.

16. • SIGNS:
• Signs and symptoms of submucous cleft palate may include:
• * Difficulty with feedings
• * Difficulty in swallowing, with potential for liquids or foods to
come out the nose
• * Nasal speaking voice
• * Chronic ear infections

17. CAUSES
• Normally, the tissues that make up the lip and palate fuse together in
the second and third months of pregnancy. But in babies with cleft lip
and cleft palate, the fusion never takes place or occurs only part way,
leaving an opening (cleft).
• CLEFT palate are caused by an interaction of genetic and
environmental factors. In many babies, a definite cause isn’t
discovered.

18. Environmental factors
• ~ Exposure to German measles which is also known as Rubella and
other infections.
• ~ Deficiency of certain vitamins during early pregnancy.
• ~ Use of alcohol and drugs during pregnancy
• ~ Smoking of cigarettes during early pregnancy.
• ~ Use of certain medicine like topiramate or valoporoic acid for the
treatment of epilepsy.

19. Genetics basis:
• Approximately 50% of the cleft palate are associated with a
malformation syndrome. The most common syndrome which can
cause cleft palate is Velocardiofacial Syndrome ( VCFS). This syndrome
is a result of microdeletion of chromosome 22q .
• However abnormalities in chromosomes 1,2,4,6,11,14,17 and 19 can
also cause cleft palate.

20. RISK FACTORS
• Several factors may increase the likelihood of a baby developing a
cleft palate, including:
• Family history- Parents with a family history of cleft palate face a
higher risk of having a baby with a cleft.
• Use of certain substances during pregnancy- pregnant women who
smoke cigarettes, drink alcohol or take certain medications.
• Having diabetes.
• Obese during pregnancy.
• Males are more likely to have a cleft lip with or without cleft palate.
Cleft palate without cleft lip is more common in females

21. COMPLICATIONS RELATED TO CLEFT PALATE:
• Children with cleft palate face following health problems:
• ✓ Feeding problem
• ✓ Tooth development
• ✓Hearing problem
• ✓ Speech problem
• ✓ Social and emotional impacts on children with cleft palate

22. PREVENTIONS:
• GENETIC COUNSELING
• If a person have family history of cleft, tell the doctor before she
become pregnant. Doctors may refers a genetic counselor who can
help to find out the risk of having baby with cleft palate.
• USE OF PRENATAL VITAMINS:
• Use prenatal vitamins as prescribed by the doctor to lower the risk of
having baby with cleft palate.
• NOT USE OF TOBACCO AND ALCOHOL:

23. • USE OF CERTAIN MEDICINE:
• During first trimester woman who use certain medicine to cure
epilepsy like topiramate or valoporoic acid have increased chance to
have a baby with cleft palate as compared to those who do not use
these medicine . Therefore during pregnancy avoid to use these
medicines.

24. TREATMENT:
• Cleft palate is treatable depending on the type and severity of the cleft.
• PLATOPLASTY:
• A cleft palate can be treated with the help of surgery which is known as
palatoplasty. This surgery is done when the baby is 10 month to one year
old.
• GOALS:
• Following are the goals of palatoplasty:
• ° Close the opening which is present between the nose and mouth.
• ° Help to produce a palate that function well for speech
• ° Prevent the food and liquid coming out of the nose

25. • PROCEDURE/ SURGERY:
• In this surgery , the surgeon follow these steps
• 1. Place a device or brace into the child mouth to keep the mouth
open during surgery. Close the cleft in layer.
• 2. The muscles of the soft palate are repositioned and mend so that it
works well during speech.
• 3. Make two notches or incisions on each of the Palate behind the
gums to relieve tightness or tension on palate repair. The incision
inside the child mouth is look like “Z”.

27. CONCLUSION
• Both genetical and environmental factors can cause cleft palate, but
if we take preventions seriously then the risk of having cleft palate in
newborns become lower. Cleft palate can be treated successfully with
no lasting problems with the help of surgery .

28. REFERENCES:
• http://www.acpa-cpf.org/uploads/site/Parameters_Rev_2009.pdf
• pdf icon external icon
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706041/
• https://kidshealth.org/en/parents/cleft-palate.html
• https://en.wikipedia.org/w/index.php?title=Cleft_lip_and_cleft_palat
e&oldid=988228017
• https://www.mayoclinic.org/diseases-conditions/cleft-
palate/symptoms-causes/syc-20370985