CLEFT LIP & PALATE MANAGEMENT

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www...
Incidence
CLP- is a common congenital anomaly
Incidence- 1 in 600 births
C. Lip- m>f
C. Palate F>M
( since fusion of palat...
Aetilogy
Multifactorial
1. Defective vascular supply in the area
involved
2. Mechanical disturbance- the size of the
tongu...
3. Viral infection in utero
4. Abnormal fetal position in Utero
5. X radiation in Utero
6. Familial inheritance in CLP
Cle...
6. Associated anomalies
Downs syndrome, Pierre Robin
Syndrome, Trecher Collins syndrome,
Goldenhar syndrome, hemifacial
mi...
Classification
Kernehan and Stark 1958
1. Clefts of the primary palate only
Unilateral, Complete/ incomplete
Median , Comp...
2. Cleft of the secondary palate only
complete/incomplete/ submucous
3. Cleft of primary and secondary palate
Unilateral, ...
KRENS Classification
LASHAL
----AL
------al
-----S—
---HSH—
LASH---Incomplete- lowercase; * submucous
Complete upper case
...
Submucous cleft- overlying mucosa is
intact, 1 in 1200 births, 90 %
asymtomatic, speech, hearing and
feeding problems may ...
Clinical problems
1. Feeding- Oro nasal communication,
difficulty in suckling
2. Speech/ hearing-Normal speech
requires ve...
3. Conductive deafness- abnormal
attachments of tensor veli palatini into
post part of HP instead of mid palatine
raphae, ...
4. Dental anomalies
Missing lateral and canine, SNT,
hypo plastic teeth, delayed/ abnormal
eruption, teeth of abnormal mor...
6. Facial appearance and growthClass III jaw relation, adverse effects of
the palatal scarring on facial growth, in
partic...
Aims of treatment
1. Improved aesthetics- lip, nose
dentition, jaw relation
2. Good function- speech, hearing
occlusion, r...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
CLEFT TEAM
OMS SURGEON
Plastic surgeon
ENT Surgeon
GDP/ GP
Orthodontist
Speech therapist
Psychologist
www.indiandentalacad...
Geneticist
Cleft support Nurse
Dental Hygienist
Dental Technician
Multi disciplinary- team approach

www.indiandentalacade...
Management
In Utero- Fetal ultra sound- 20 week IU
TOP or intervention in utero for the cleft
Neonatal- Feeding plates, Me...
Pre surgical orthopedics- strapping,
appliance
Improves alignment of arch segments,
aids feeding, better long term result,...
0 to 3 days

Counseling,
plate fitting,
pre surgical
orthopedics

3 months

Repair of lip

6 months to 18
months

6 months...
4to 6 years

Secondary lip
surgery if
required
,pharyngoplasty

8 to 10 years

ABG to allow
ectopic incisor,
canine to eru...
Secondary surgery
Pharyngoplasty- 7 years to adult life
OGS
ABG
Rhinoplasty
Secondary lip surgery
Closure of fistula

www....
Lip repair
3 months to 6 months
Millard rotational / advancement flap
1960
De Laires functional repair
(Cheilorhinoplasty)...
Objectives of lip repair
1. To close defect,
2. Inconspicuous scar
3. Restore cupid bow
4. Close the nasal floor
5. Recrea...
Palate repair
2

stages- SP- 6 months
 HP 12 to 18 months
 Some say both HP and SP at 18 months
 Defer repair to older...
Objectives of palate
repair
1. To produce a palate of adequate
length
2. To produce a palate sufficiently
mobile to allow ...
Speech therapy
Pre school
2 years of age – therapy starts to
identify VPI and lip function
5 years- videofluoroscopy,
nase...
Hearing problems
Pre school audiology
Recurrent middle ear infection due to
eustachian tube dysfunctionGROMMETS placed int...
Dental/ Orthodontic
Anterior Xbite correction
Buccal expansion prior to ABG
Fluoride and preventive dentistry
Continued de...
Clinical standards
Advisory group -CSAG
74 surgeons in 45 centres
2/3 UK surgeons do less than 10 cases
a year
Poor result...
THANK YOU!
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
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Cleft lip and palate management /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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Cleft lip and palate management /certified fixed orthodontic courses by Indian dental academy

  1. 1. CLEFT LIP & PALATE MANAGEMENT INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Incidence CLP- is a common congenital anomaly Incidence- 1 in 600 births C. Lip- m>f C. Palate F>M ( since fusion of palatine shelves in F takes one week longer than M) www.indiandentalacademy.com
  3. 3. Aetilogy Multifactorial 1. Defective vascular supply in the area involved 2. Mechanical disturbance- the size of the tongue may prevent union of the parts Circulating substanceDrugs( anti- epileptic), diazepam, alcohol www.indiandentalacademy.com
  4. 4. 3. Viral infection in utero 4. Abnormal fetal position in Utero 5. X radiation in Utero 6. Familial inheritance in CLP Cleft lip alone shows 20% family history and palate 40% www.indiandentalacademy.com
  5. 5. 6. Associated anomalies Downs syndrome, Pierre Robin Syndrome, Trecher Collins syndrome, Goldenhar syndrome, hemifacial microsomia. www.indiandentalacademy.com
  6. 6. Classification Kernehan and Stark 1958 1. Clefts of the primary palate only Unilateral, Complete/ incomplete Median , Complete/ incomplete Bilateral , Complete/ incomplete www.indiandentalacademy.com
  7. 7. 2. Cleft of the secondary palate only complete/incomplete/ submucous 3. Cleft of primary and secondary palate Unilateral, Complete/ incomplete Median , Complete/ incomplete Bilateral , Complete/ incomplete www.indiandentalacademy.com
  8. 8. KRENS Classification LASHAL ----AL ------al -----S— ---HSH— LASH---Incomplete- lowercase; * submucous Complete upper case www.indiandentalacademy.com
  9. 9. Submucous cleft- overlying mucosa is intact, 1 in 1200 births, 90 % asymtomatic, speech, hearing and feeding problems may present later. Recognized by the presence of bifid uvla, a central greyish translucent zone in the soft palate midline, palpable notch in the HP. www.indiandentalacademy.com
  10. 10. Clinical problems 1. Feeding- Oro nasal communication, difficulty in suckling 2. Speech/ hearing-Normal speech requires velo- pharyngeal competence and normal hearing. Palate function is impaired in the presence of a cleft, preventing an oro nasal seal. www.indiandentalacademy.com
  11. 11. 3. Conductive deafness- abnormal attachments of tensor veli palatini into post part of HP instead of mid palatine raphae, inability to close and open eustachian tube to equalize middle ear pressure- poor middle ear drainage and conductive deafness www.indiandentalacademy.com
  12. 12. 4. Dental anomalies Missing lateral and canine, SNT, hypo plastic teeth, delayed/ abnormal eruption, teeth of abnormal morphology 5. Malocclusion www.indiandentalacademy.com
  13. 13. 6. Facial appearance and growthClass III jaw relation, adverse effects of the palatal scarring on facial growth, in particular down and forward growth of maxilla. 7. Self image- esteem www.indiandentalacademy.com
  14. 14. Aims of treatment 1. Improved aesthetics- lip, nose dentition, jaw relation 2. Good function- speech, hearing occlusion, respiration 3. Permanence of result- preventive dentistry, life long dental care, stability of occlusion 4. Improved self image www.indiandentalacademy.com
  15. 15. www.indiandentalacademy.com
  16. 16. www.indiandentalacademy.com
  17. 17. www.indiandentalacademy.com
  18. 18. www.indiandentalacademy.com
  19. 19. www.indiandentalacademy.com
  20. 20. CLEFT TEAM OMS SURGEON Plastic surgeon ENT Surgeon GDP/ GP Orthodontist Speech therapist Psychologist www.indiandentalacademy.com
  21. 21. Geneticist Cleft support Nurse Dental Hygienist Dental Technician Multi disciplinary- team approach www.indiandentalacademy.com
  22. 22. Management In Utero- Fetal ultra sound- 20 week IU TOP or intervention in utero for the cleft Neonatal- Feeding plates, Mead Johnson bottle, Nuyke teat,Habberman teat. Emergency counseling done by the cleft support nurse, www.indiandentalacademy.com
  23. 23. Pre surgical orthopedics- strapping, appliance Improves alignment of arch segments, aids feeding, better long term result, reduces prominence of premaxilla www.indiandentalacademy.com
  24. 24. 0 to 3 days Counseling, plate fitting, pre surgical orthopedics 3 months Repair of lip 6 months to 18 months 6 months- soft palate repair 15 to 18 months -HP www.indiandentalacademy.com
  25. 25. 4to 6 years Secondary lip surgery if required ,pharyngoplasty 8 to 10 years ABG to allow ectopic incisor, canine to erupt, Lip revision 16 and above OGS, lip repair, Rhinoplasty, www.indiandentalacademy.com
  26. 26. Secondary surgery Pharyngoplasty- 7 years to adult life OGS ABG Rhinoplasty Secondary lip surgery Closure of fistula www.indiandentalacademy.com
  27. 27. Lip repair 3 months to 6 months Millard rotational / advancement flap 1960 De Laires functional repair (Cheilorhinoplasty) www.indiandentalacademy.com
  28. 28. Objectives of lip repair 1. To close defect, 2. Inconspicuous scar 3. Restore cupid bow 4. Close the nasal floor 5. Recreate the missing philtral line 6. Buccal sulcus to be deepened 7. To form normal rounded ala www.indiandentalacademy.com
  29. 29. Palate repair 2 stages- SP- 6 months  HP 12 to 18 months  Some say both HP and SP at 18 months  Defer repair to older age decreases the growth disturbance but poor speech, greater psychological impact  Von Langenbeck 1977 – midline repair  Furlow- Z plasty 1986 www.indiandentalacademy.com
  30. 30. Objectives of palate repair 1. To produce a palate of adequate length 2. To produce a palate sufficiently mobile to allow closure of velopharyngeal space 3. To produce a palate whose dorsal surface conforms to the shape of the pharyngeal wall www.indiandentalacademy.com
  31. 31. Speech therapy Pre school 2 years of age – therapy starts to identify VPI and lip function 5 years- videofluoroscopy, nasendoscopy to objectively assess and record palate function www.indiandentalacademy.com
  32. 32. Hearing problems Pre school audiology Recurrent middle ear infection due to eustachian tube dysfunctionGROMMETS placed into middle ear to drain out pus www.indiandentalacademy.com
  33. 33. Dental/ Orthodontic Anterior Xbite correction Buccal expansion prior to ABG Fluoride and preventive dentistry Continued dental care www.indiandentalacademy.com
  34. 34. Clinical standards Advisory group -CSAG 74 surgeons in 45 centres 2/3 UK surgeons do less than 10 cases a year Poor results compared to EU centres Recommended 8 to 15 centres www.indiandentalacademy.com
  35. 35. THANK YOU! www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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