This document discusses the management of congenital maxillofacial defects. It defines maxillofacial prosthodontics and describes types of maxillary defects including cleft lip, cleft palate, and acquired defects from surgery or trauma. For congenital defects, it covers cleft lip and palate etiology, incidence, classification including Veau's system, objectives of prosthetic treatment, and treatment modalities including surgical repair and preoperative prosthetic devices for feeding.

1. Management of
congenital
maxillofacial
defects
DR/ Sara Zaky Mohamed

2. Definations
 Maxillofacial prosthodontia is the art and
science of functional or cosmetic
reconstruction by means of non living
substitutes for those regions in the maxilla,
mandible, and face that are missing or
defective because of surgical intervention,
trauma, pathology, or developmental or
congenital malformation.

4. Types of maxillary defect
congenital
Cleft lip Cleft palate
acquired
Partial
maxillectomy
Total
maxllectomy

5. Congenital maxillary defect
 Cleft lip occurs due to improper fusion
between the front-nasal and maxillary
process. If this occurs on one side it leads to
a unilateral cleft. If it occurs in both sides, it
leads to a bilateral cleft.

7. Etiology Hereditary
 Infections (German measles)
 drugs (phenytoin, ethanol and barbiturates)
 poor diet (deficiency in vitamins A and riboflavin)
 hormonal imbalance in the first trimester
 genetic factor (13 trisomy ptau’s syndrome)
 Radiation and x-ray

8. Incidence of Congenital defect
 Cleft lip with or without cleft plate occurs in a
ratio of 1:1000.
 It is twice as common in males when
compared to females.
 It can either be unilateral or bilateral.
Unilateral cleft lip is more common on the left
side.
 Isolated cleft palate is more common in
females

9. Classification of clefts
 Cleft can be classified into three types under
this category,
 • Type I: Cleft lip with cleft alveolus (primary
palate)
 • Type II: Cleft on hard and soft palate
(secondary palate)
 • Type III: combination of I and II

10. Type i
Cleft lip and cleft alveolus

11. Type ii
Cleft on hard and soft palate

12. Type iii
Combination of I & ii

13. Veau’s Classification of Cleft
Palate
• Class I: Cleft involving the soft palate. It can also be a sub-
mucous cleft, which appears normal
• Class II: A midline cleft involving the bone, present only on
the posterior part of the palate
• Class III: A unilateral cleft extending alone the mid-palatine
suture and a suture between pre- maxilla and palatine shelf
• Class IV: A unilateral cleft extending alone the mid-palatine
suture and both suture between pre-maxilla and palatine
shelf

15. Objective of the maxillofacial
prosthesis
 Restore function
 Improvement of esthetics
 Preservation of residual structures

16. Treatment modalities
 Surgical repair
 Prosthetic restoration
- Preoperative device
a. feeding device
b. expansion type prosthesis
- Simple obturators
a. Speech aid prosthesis
b. Meatus obturator
c. mobile prosthesid

17. 1- surgical repair
 Treatment of choice for clef palate
 If the cleft involves the lip it is advisable to
repair as early as possible (about 6 weeks
after birth)
 For repair of cleft palate surgery not
performed early for:
1- produce longer and more mobile spft palate
with better muscular development
2- habilitate the patient for normal speech

18. 2- prosthetic rehabilitation
 1- preopertive device
a. Feeding device
Most infants with cleft lip and palate are unable
to nurse from breast or ordinary bottle due to
lose of negative pressure

19. For cleft lip
 Infant with isolated cleft lip often feed normally
 Leakage my be due inability to form seal on
breast
 This can be improved by placing finger over
the lip defect as child nurse or using the
areola (special ring ) to fill lip defect
 Broad base nipple

20. For cleft palate
 Usually it is advised to use syringe for feeding
 Soft nipples conform better to palatal defect than
do regular hard nipples
 Crosscut nipples allow for easier flow
 Longer nipple as they can be positioned posterior
to the defect
 Squeeze bottle as it allows the parent to squeeze
and control the flow into the mouth

21.  Feeding in semi-upright position reduce nasal reguration
 Feeding should take longer time

23. Simple feeding device
 Temporary prosthesis until lip and palate
closed surgically
 Composed of two parts
 Simple obturator covering palate with
extended wire
 Nipple with large head hole
 Can be used together or independently

24. Feeding device
For nursing of children with cleft
palate

25. In the end of the lecture you
should know
 Types of congenital defects
 Classification
 Etiology
 Management