2. Introduction
Cleft lip and cleft palate are the most common congenital craniofacial
anomalies seen at birth.
Clefts of lip and palate can occur individually or together in various
combinations.
3. Incidence
1 in every 600-1000 births.
Negroid race has the least incidence.
Mongoloids have the highest incidents.
Cleft lip more common in males.
Cleft palate more common in females.
Unilateral clefts more common than bilateral.
Left side affected more than right.
4. Embryology
Upper lip is formed by the fusion of frontonasal process with the right and left
maxillary process. Failure to fuse completely leads to various forms of cleft.
Lip.
5. The palate is formed by the fusion of three components.These are the right
and left palatal processes (arising from the maxillary process) and the
primitive palate (derived from the frontonasal process).Deficiency in fusion
leads various forms of cleft palate.
8. Environment
-Teratogens are certain drugs or agents that cause disturbed growth &
development in the foetus.-
-Rubella virus
-Cortison
-Mercatopuri
-Valium
-Dilantin
9. Multifactorial etiology
-Cannot be either genetic or environmental
-More than one factor
-Unless a person is genetically susceptible,the environmental factors may not
by themselves cause clefts.
10. Predisposing factors
Increased maternal age
-women who conceive late
Folic acid deficiency
Racial
-Mongoloids
Blood supply
-Any factor that reduces blood supply to the nasomaxillary area.
11. Classification
David & Ritchie classification-
- Group I-Prealveolar clefts-These are clefts involving only the lip.
- Unilateral
- Bilateral
- Median
12. Group II-Post alveolar clefts: This group comprises of hard and soft palate
cleft that extends up to the alveolar ridge.
Group III-Complete clefts involving the palate, alveolar ridge and the lip.
-Unilateral
- Bilateral
-Median
13. Veau’s Classification
Group 1:Clefts involving the soft palate only.
Group 2:Clefts of the hard & soft palate extending up to the incisive foramen.
Group 3:Complele unilateral clefts involving the soft palate, the hard palate,
lip & the alveolar ridge.
Group 4:Complete bilateral clefts affecting the soft palate, the hard palate,
the lip and alveolar ridge.
14. Kernahan stripped ‘Y’ classification
Stripped ‘Y’ having numbered blocks.
Each block represents a specific area of the oral cavity.
Block 1 & 4 –Lip
Block 2 &5 – Alveolus.
Block 3 & 6 –Hard palate anterior to the incisive foramen.
Block 7 & 8-Hard palate posterior to incisive foramen
Block 9 – Soft palate.
The boxes are shaded in areas where the cleft has
occured
20. Passive maxillary obturator
A feeding appliance is a device that creates a seal between the oral and nasal
cavities and helps the infant to express milk.
It also provides maxillary cross arch stability preventing the arch from
collapsing.
21. Presurgical Orthopedics
The aim of pre-surgical orthopaedics is to achieve an uppe arch form that
conforms to the lower arch.
22. Advantages
Reduces the size of the cleft there by aiding in surgery.
Partial obturation of cleft assists in feeding.
Improved speech as size of the defect is reduced.
Reassures the parents at a crucial time.
23. Surgical lip closure
3-6 months.
Millard rule of 10.
-Surgery shouldn’t be performed
-less than 10 weeks of age.
-when body weight is not less than 10 pounds
-When blood Haemoglobin not less than 10 gram%
25. Primary dentition Phase
-Adjustment of intraoral obturator to accommodate the erupting deciduous
teeth.
-Maintain a check on eruption pattern and timing.
-Oral hygiene instructions.
-Restoration of decayed teeth.
26. Mixed dentition phase
-Correction of anterior crossbite.
-Correction of posterior cross bite.
-Placement of alveolar bone graft.(7-10 years).Ideally the lateral or the
canine should erupt through the graft.
