Cleft palate


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embryology,classification,complication.diagnosis& treatment of cleft palate

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Cleft palate

  1. 1. بسم الله الرحمن الرحيم
  2. 2. <ul><li>Collection of data :- </li></ul><ul><li>Dina M. Aboelata </li></ul><ul><li>Dina M. Elnoamany </li></ul><ul><li>Rania M. Matar </li></ul><ul><li>Arrangment :- </li></ul><ul><li>Dina Sabry Esmail </li></ul><ul><li>Powerpoint :- </li></ul><ul><li>Dina Hamdey Abdella </li></ul><ul><li>Presented by:- </li></ul><ul><li>Dina Gamal Ghanem </li></ul><ul><li>Dina Hassan Mustafa </li></ul>Cleft palate BY
  3. 3. What is Cleft-palate ? <ul><li>Cleft palate is types of clefting congenital deformity caused by abnormal facial development during gestation. </li></ul><ul><li>A cleft is a fissure or opening gap. </li></ul><ul><li>It is the non-fusion of the body’s natural structures that form before birth. </li></ul><ul><li>Clefts can also affect other parts of the face, such as the eyes, ears, nose, cheeks and forehead. </li></ul>
  4. 4. Embryology
  5. 5. primary palate:- <ul><li>During the fifth week the primary palate forms by the growth and fusion of the medial nasal, lateral nasal, and maxillary processes </li></ul><ul><li>The maxillary process, derived from the proximal half of the first arch, grows to meet and fuse with the nasal processes </li></ul>
  6. 6. secondary palate:- <ul><li>During the sixth week two shelflike outgrowths from the maxillary swelling to form the secondary palate. </li></ul><ul><li>The 2 palatal shelves initially are in a vertical position because of the interposed tongue. </li></ul>
  7. 7. <ul><li>At 7 weeks With extension of the head and mandibular growth, the tongue is withdrawn and the palatal shelves become into a midline for fusion and formation of a hard and soft palate </li></ul><ul><li>Anteriorly the shelves fuse with the triangular primary palate, and the incisive foramen is formed at this junction </li></ul>
  8. 8. secondary palate primary palate
  9. 9. <ul><li>Clefts of the primary palate </li></ul><ul><li>result from a failure of mesoderm to penetrate into the grooves between the medial nasal and maxillary processes, which prohibits their from fusion with each another </li></ul><ul><li>Clefts of the secondary palate </li></ul><ul><li>result from a failure of the palatine shelves to fuse with one another . The cause for this is failure of the tongue to descend into the oral cavity . </li></ul>
  10. 10. Normal palate Cleft palate
  11. 11. Classification
  12. 12. Classification veau:- <ul><li>Classification system proposed in 1938 </li></ul><ul><li>Group I (A):- </li></ul><ul><li>Defects of the soft palate alone </li></ul><ul><li>Group II (B) </li></ul><ul><li>Defects involving the hard and soft palates (not extending anterior to the alveolus) </li></ul>
  13. 13. <ul><li>Group III (C) </li></ul><ul><li>Defects involving the palate through to the alveolus </li></ul><ul><li>Group IV (D) </li></ul><ul><li>Complete bi-lateral clefts. </li></ul>
  14. 15. Spina classification <ul><li>Classification system proposed in 1974. </li></ul><ul><li>Pre-incisive foramen clefts (lip +/- alveolus) </li></ul><ul><ul><li>Uni-lateral </li></ul></ul><ul><ul><li>Bi-lateral </li></ul></ul><ul><ul><li>Median </li></ul></ul><ul><li>Trans-incisive foramen cleft (lip, alveolus, palate) </li></ul><ul><ul><li>Uni-lateral </li></ul></ul><ul><ul><li>Bi-lateral </li></ul></ul><ul><li>Post-incisive foramen clefts (secondary cleft palate) </li></ul><ul><li>Atypical (rare) facial clefts. </li></ul>
  15. 16. What aboute comlication?
  16. 17. ( 1)Feeding difficulties <ul><li>One of the most immediate concerns after birth is feeding as cleft palate make sucking difficult or cause gagging or nasal regurgitatio </li></ul><ul><li>To overcome this problem by using a special bottle nipple or a small artificial palate (obturator) that fits into the roof of the mouth . </li></ul><ul><li>The upright sitting position allows gravity to help the baby swallow the milk more easily </li></ul>
  17. 18. (2)Ear infections and hearing loss <ul><li>Babies with cleft palate are especially susceptible to middle ear infections . Ear infections are often due to a dysfunction of the tube that connects the middle ear and the throat. </li></ul><ul><li>Over time, repeated ear infections can damage hearing , but hearing loss may resolve with treatment. </li></ul><ul><li>It's important for children with cleft palate to be evaluated regularly by an audiologist. </li></ul><ul><li>Most children with clefts have tubes inserted in their ears to drain fluids and help prevent infections. </li></ul>
  18. 19. (3)Dental problems :- <ul><li>If the cleft extends through the upper gum , tooth development will likely be affected. </li></ul><ul><li>A pediatric dentist should monitor tooth development and oral health from an early age. </li></ul>
  19. 20. (4)Speech difficulties:- <ul><li>Because both the lip and palate are used in forming sounds, the development of normal speech can be affected. A speech pathologist can evaluate your child and provide speech therapy . </li></ul>
  20. 21. (5)Psychological challenges :- <ul><li>Children with clefts may face social, emotional and behavioral problems due to differences in appearance and the stress of intensive medical care </li></ul>
  21. 22. How to manage that disease?
  22. 23. Diagnosis:- <ul><li>prenatal ultrasounds can detect a cleft palate prior a child's birth. </li></ul><ul><li>By detecting the cleft abnormality during a pregnancy, the expecting parents can have a prenatal consultation with a plastic surgeon. </li></ul><ul><li>The symptoms of these abnormalities are visible during the first examination after birth. </li></ul>
  23. 24. Treatments for Children With Cleft Palate:- <ul><li>Children born with a cleft palate may need the skills of several medical professionals to correct the problems associated with the cleft </li></ul><ul><li>Treatment usually requires a complex, lengthy treatment plan lasting until adulthood (see table below). </li></ul>
  24. 25. Assess ears and hearing Assess speech and language Check development 16-24 months Check feeding and growth Repair cleft lip Check ears and hearing 1-15 months Referred to cleft lip and palate team Diagnosis and genetic counseling Address psychosocial issues Provide feeding instructions Make feeding plan Prenatal Birth-1 month Intervention Age
  25. 26. Jaw surgery, rhinoplasty as needed Orthodontic bridges implants as needed 12-21 years Orthodontic interventions Alveolar bone graft 6-11 years Assess , manage velopharyngeal insufficency Assess development and psychosocial adjustment 2-5 years
  26. 27. Aim of repair:- <ul><li>separate the oral and nasal cavities , this separation involves the formation of a valve that is necessary for normal speech. </li></ul><ul><li>also the muscles at the back of the palate need to be put in their proper place across the cleft so the child can learn to speak normally </li></ul>
  27. 28. Time of operation :- <ul><li>General agreement exists that surgical correction of a cleft palate should be accomplished when patients are younger than 1 year , before significant speech development occurs. </li></ul>
  28. 29. <ul><li>The six advantages for early closure of palatal defects:- </li></ul><ul><li>(1) better palatal and pharyngeal muscle development once repaired </li></ul><ul><li>(2) ease of feeding </li></ul><ul><li>(3) better development of phonation skills </li></ul><ul><li>(4) better auditory tube function </li></ul><ul><li>(5) better hygiene when the oral and nasal partition is competent </li></ul><ul><li>(6) improved psychologic state for parents and baby. </li></ul>
  29. 30. Langenbeck’s operation:- <ul><li>1- Bare cleft edge </li></ul><ul><li>2- release incision in mucoperosteum </li></ul><ul><li>3- close nasal mucosa at floor of the nose </li></ul><ul><li>4- close mucoperiostium of hard palate </li></ul><ul><li>5- fracture ptyrigoid hamulus if needed to relax the flap </li></ul>
  30. 31. Before After
  31. 32. What should be expected post-operatively? <ul><li>Immediate postoperative airway management and pain management. </li></ul><ul><li>Diet in the postoperative period is generally limited to liquids and soft foods that do not require chewing </li></ul><ul><li>The use of bottles is avoided because the nipples may interfere with the repair. The use of spoons is also avoided for similar reasons. </li></ul><ul><li>Feeding is accomplished by using either a cup or a Breck feeder (a red rubber catheter attached to a syringe). </li></ul><ul><li>Normal diet and feeding may be resumed after 10-14 days, depending on the type of repair. </li></ul>
  32. 33. Normal regimen for follow up care:- <ul><li>Once discharged from the hospital, the patient should have follow-up visits at 7-10 days and at 3 weeks . </li></ul><ul><li>If a small fistula or a wound breakdown is noted in this period, waiting at least 6 months prior to attempting closure is advised. </li></ul><ul><li>This delay allows for maximal wound contracture and for reestablishment of the blood supply to the tissues </li></ul>
  33. 34. Complication of sugery:- <ul><li>Airway obstruction </li></ul><ul><li>Results from the tongue falling back into the airway while the patient remains sedated from anesthetics. Placement of a tongue traction suture helps in the prevention of airway obstruction. </li></ul><ul><li>Airway obstruction can also be a problem because of changes in airway dynamics , especially those in children with a small jaw. placement and maintenance of a tube in the trachea is necessary until palate repair is complete. </li></ul>
  34. 35. <ul><li>Bleeding </li></ul><ul><li>Because of the rich blood supply of the palate </li></ul><ul><li>Preoperative assessment of the hemoglobin level and the platelet count is important. </li></ul><ul><li>Specific medication injected into the area being operated on, such as Epinephrine, can help significantly decrease blood loss. </li></ul>
  35. 36. <ul><li>Palatal fistula </li></ul><ul><li>Wound breakdown occur as a complication in the immediate postoperative period, or it can be a delayed problem. </li></ul><ul><li>palate fistulas can be managed in 2 ways:- </li></ul><ul><li>1-In a patient without any symptoms, a dental prosthesis can be used to close the defect with good results. </li></ul><ul><li>2- patient with symptoms may require surgery. Closure of persistent fistulas should be attempted no sooner than 6-12 months after </li></ul>
  36. 37. New Treatments for Cleft Palate:- <ul><li>Recent advances is presurgical orthopedics </li></ul><ul><li>These are palatal plates which adjust the palate and alveolus to a more normal shape. </li></ul><ul><li>Early interventions that reduce the need for surgeries as the child grows </li></ul><ul><li>They are now viewed as adjuvants for surgery </li></ul>
  37. 38. In conclusion: <ul><li>Keep in mind that surgery to repair a cleft palate is only the beginning of the process </li></ul><ul><li>Family support is critical for your child. Love and understanding will help him or her grow up with a sense of self-esteem that extends beyond the physical defect. </li></ul>
  38. 39. Thank you