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Oro facial clefts


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Oro facial clefts

  1. 1. ORO-FACIAL CLEFTSDr. Ali Tahir
  2. 2. ORO-FACIAL CLEFTS The formation of face & oral cavity involves the development of multiple tissue processes that must Dr. Ali Tahir merge & fuse in highly orchestrated fashion Disturbances in the growth of these tissues or their fusion results in oro-facial clefts During 6th & 7th weeks of development, upper lip is formed when  Medial nasal processes merge with each other  Medial nasal processes merge with the maxillary process Lateral nasal processes are not involved in the formation of upper lip, they form alae of nose
  3. 3. ORO-FACIAL CLEFTSPrimary Palate Is formed by the fusion of medial nasal processes Also called the premaxilla containing the anterior four teeth Dr. Ali TahirSecondary Palate Makes up 90% of hard & soft palates Formed by fusion of maxillary processes Bilateral projection from medial aspect of maxillary processes emerge during 6th week oriented vertically one ach side of developing tongue As the mandible grows, the tongue drops down Shelves fuse anteriorly with each other & with anterior palate & nasal septum, proceeds posteriorly
  4. 4. CLEFT LIP/CLEFT PALATE Defective fusion of medial nasal process with maxillary process  cleft lip (CL) Defective fusion of palatal shelves  cleft palate (CP) Dr. Ali Tahir 45% are CL + CP 30% isolated CP 25% isolated CL CL±CP is considered a separate entity and CP as separate More than 250 syndromes are associated with CL & CP Median cleft of upper lip is rare, due to faulty fusion of medial nasal processes
  5. 5. CLASSIFICATIONInternational confederation for plastic and reconstructive surgery classification (1968)Group ICleft of anterior primary palate Dr. Ali Tahira. Lip  Right, Left, Bothb. Alveolus  Right, Left, BothGroup IIClefts of anterior & posterior palatea. Lip  Right, Left, bothb. Alveolus Right, left, bothc. Hard palate  right, left, bothGroup IIIClefts of posterior secondary palatea. Hard palate  Right, leftb. Soft palate  Median
  6. 6. Dr. Ali Tahir
  7. 7. CLEFT LIP/CLEFT PALATEClinical Features: Most common major congenital defect Dr. Ali Tahir Considerable racial variation In whites, 1 of every 700-1000 births has CL ± CP In Asians, it is 1.5 times higher than whites Isolated CP is less common CL ± CP is more common in males Isolated CP is more common in females 80% of cases, CL is unilateral 70% of unilateral clefts occur on left side A complete CL extends upward into the nostril
  8. 8. CLEFT LIP/CLEFT PALATE When involves the alveolus, usually Dr. Ali Tahir occurs between lateral incisor & canine Sometimes lateral incisor may be missing
  9. 9. CLEFT LIP/CLEFT PALATE CP may range from involvement of soft palate alone or both hard & soft palate Dr. Ali Tahir Minimal manifestation is bifid uvula (much common 1 in every 10 Asians) Sometimes, a sub-mucosal cleft palate develops
  10. 10. CLEFT LIP/CLEFT PALATE Dr. Ali Tahir
  11. 11. PIERRE ROBIN ANOMALY Cleft Palate Mandibular micrognathia Dr. Ali Tahir GlossoptosisRetruded mandible results in Post placement of tongue Lack of support of tongue musculature Airway obstruction
  12. 12. PATIENT’S COMPLAIN Clinical appearance Psycho-social difficulties Dr. Ali Tahir Feeding Speech Malocclusion Missing/supernumerary teeth
  13. 13. MANAGEMENT Treatment involves a multi-disciplinary approach  Paediatrician Dr. Ali Tahir  Oral & maxillo-facial surgeon  Otolaryngologist  Plastic surgeon  Paediatric dentist  Orthodontist  Prosthodontist  Speech pathologist
  14. 14. MANAGEMENT Treatment involves multiple primary & secondary procedures throughout childhoodBirth – 24 months: Dr. Ali Tahir Primary lip closure is done in the early months of life (age 10 months, weight 10 pounds, Hb 10gm% by Millard) Followed later by repair of palate (12-24months, 9-12years)2 – 6years Formation of feeding plate or passive maxillary obturator6-12 years (mixed dentition) Often prosthetic or orthopedic appliances are used to expand maxillary segments before closure of defect Arch expansion, maxillary protraction, fixed orthodontic treatment
  15. 15. MANAGEMENTPermanent dentition: (12years onward) Secondary soft tissue & orthognathic procedures Dr. Ali Tahir are done to improve function & aesthetics Final corrections including alignment, exposure of canine (if not erupted yet) & occlusion settled Orthognathic surgery may be required Permanent retention may be required by the Prosthodontist using fixed bridges or cast partial dentures Lip revision, nasal corrections can be done after completion of orthodontic treatment
  16. 16. OTHER CLEFTS Lack of fusion of maxillary & mandibular processes  Lateral facial cleft Dr. Ali Tahir May be associated with ‘Mandibulo facial dysostosis’ Extends from commissures towards the ear May be unilateral or bilateral Failure of fusion of lateral nasal process with maxillary process  oblique facial cleft
  17. 17. Dr. Ali Tahir