Cleft lip and palate is a congenital anomaly caused by failure of fusion during embryonic development. It has a multifactorial etiology involving genetic and environmental factors. It can present as cleft lip alone, cleft palate alone, or a combination of both. Management requires a multidisciplinary approach including surgery to repair the cleft, dental treatment like orthodontics and prosthodontics, and speech therapy. The goal is to close the cleft, improve function, and achieve optimal facial form and appearance.

1. Cleft lip & palate

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.

6. Etiology

7. Genetic
-Important etiological factor
-Transmitted as a dominant or a recessive trait.

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

15. Problems
 Dental
 Esthetic
 Speech & hearing
 Psychologic

16. Dental
 Congenitally missing teeth
 Presence of supernumerary teeth
 Ectopically erupting teeth
 Anomalies of tooth morphology
 Enamel hypoplasia
 Microdontia
 Posterior & anterior crossbites.

17. Skeletal
 Maxillary deficiency
 Mandibular prognathism
 Class IIII malocclusion
 Concave profile

18. Management
 Multidisciplinary cleft palate team
 -Pediatrician
 -Plastic surgeon
 -Oral surgeon
 -Pedodontist
 -Orthodontist
 -ENT surgeon
 -Speech therapist
 -Psychiatrist

19. In infancy
 -Fabrication of Obturator
 -Presurgical Orthopedics

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%

24. Surgical palate closure
 12-24 months of age.
 -Normal speech, hearing and improved swallowing.

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.

27. Permanent dentition
 Fixed Orthodontic appliances
 Prosthesis.

28.  Orthognathic surgery to bring the deficient maxilla forward may be required
typically at the age of 18 years.

29.  Thank you