This document discusses cleft lip and palate, including the causes, classification, diagnosis, clinical manifestations, and management. It begins by explaining the common Veau and Kernahan-Stark classification systems. Prenatal diagnosis via ultrasound is possible for cleft lip but difficult for cleft palate alone. Management is divided into preoperative, primary operative, and secondary operative stages. Primary surgery involves lip and palate repair techniques. Secondary procedures include alveolar bone grafting to provide bone and tissue support. The goals and complications of each treatment stage are outlined.

1. BY
Ahmed Amer ibraheem
Farah abid yousif
Supervised by Dr. Auday Alanee

2. Hello doctor
can you help
me please?
what is your
problem ?

3. My son has
cleft lip and
cleft palate .
Ok. Don’t
worry I can
help you .

4. Is my son the
only one
suffering from
this problem?
No, it's a common
problem for many.

5. What are the
causes that lead
for this
deformity?
There are genetic
and environmental
factors .

6. I’ll explain all the
details of this
problem for you .

9. EMBRYOLOG
Y

11. CLASSIFICATION
In order to standardize documentation and communicate
effectively, various types of classification systems have been
described. The early Veau classification included groups 1–4 with
increasing severity of clefting:
group 1 – cleft of the soft palate.
group 2 – cleft of the hard and soft palate up to incisive foramen.
group 3 – complete unilateral cleft lip and palate.
group 4 – complete bilateral cleft lip and palate.

13. Kernahan and Stark classification of clefts.

14. PRENATAL
DIAGNOSIS
With the appearance high resolution three-dimensional
(3D) ultrasonography and genetic tests for screening of
birth defects, intrauterine diagnosis of cleft lip is possible.
 Clefts of palate alone are rarely visualized on ultrasound.

16. CLINICAL
MANIFESTATION

18. Oblique cleft
Transvers cleft

19. Can you tell me the
suspected
difficulties that may
face my baby ?

20. The most
suspected
difficulties are :
1-dental problems
2-Malocclusion
3-Nasal deformity
4-Feeding
5-Ear problems
6-Speech difficulty
7-cosmetic & psychological

21. What is the most
optimum time for
treatment?

22. The most optimum time
for treatment can be
summarized in this table .
procedure Timing
Cl repair After 10 weeks
CP repair 9 -18 months
Pharyngeal flap 3-5 years or later based on speech
development
Alveolar reconstruction
with bone grafting
6-9 years based on dental
development
Cleft orthognathic
therapy
14-16 years girls
16-18 years boys
Cleft rhinoplasty After 5 years
Cleft lip revision After 5 years

23. The aims of management
• Normalize aesthetic
• Intact primary and secondary palate
• Normalize speech and hearing
• Nasal air patency
• Cl I occlusion
• Good dental and periodontal health
• Normal psychological development

24. How can you
manage my
son’s problem
?

25. The management
of CLP patient can
be divided into :
1- preoperative management
2- primary operative management
3- secondary operative management

26. PREOPERATIVE
MANAGEMENT
Feeding

27. Presurgical orthopedic ( pso )
• Alveolar molding
• Lip strap or taping
• Nasoalveolar molding
Active appliance action
passive appliance action

29. PRIMARY OPERATIVE
MANAGEMENT
Surgical procedures for CL
• lip adhesion
• straight line repair
• Tennison-Randall
triangular flap repair
• Millard’s rotation-
advancement flap repair

30. • lip adhesion

31. • straight line repair

32. • Tennison-Randall triangular flap repair

33. • Millard’s rotation- advancement flap repair

34. PRIMARY OPERATIVE
MANAGEMENT
Surgical procedures for CP
• The von Langenbeck tec.
• The furlow tec.
• Two – flap tec.
• V-Y pushback tec.

35. • The von Langenbeck tec.
• The furlow tec.

36. • Two – flap tec.

37. • V-Y pushback tec.

38. COMPLICATIONS AFTER PROCEDURE OF PRIMARY
OPERATIVE MANAGEMENT :
• Immediate post operative complications
• Breakdown of the repair
• Palatal ischemia
• Secondary truma
• Bleeding
• Oronasal fistula
• Long term complications
• Mid face growth deficiency
• Velopharyngeal incompetence
• Sleep apnea
• Recurrent fistula

39. 1.no nipples for feeding or sucking
2.elbow restrains for 3 weeks
3.regular fallow up
POST OPERATIVE CARE OF PRIMARY OPERATIVE
MANAGEMENT :

41. SECONDARY OPERATIVE
MANAGEMENT
Alveolar bone grafting
Secondary ( delay ) grafting Primary ( early) grafting
Secondary graftingEarly secondary grafting Late grafting

42. GOALS OF ALVEOLAR BONE GRAFT:
1.provide bone support and adequate attached
gingival width for teeth adjacent to cleft
2.provide support for alar nasal baseand lip
3.close remaining oronasal fistula
4.improve nasal symmetry
5.augmentation of alveolar ridge to facilitate use of
prosthesis and dental implant
6.create appropriate ridge to allow optimization of
orthodontics treatment

43. SOURCE OF BONE GRAFT MATERIALS
Iliac crest
Cranium
Tibia
Mandibular symphysis
Bone graft substitute

45. COMPLICATIONS AFTER PROCEDURE OF SECONDARY
OPERATIVE MANAGEMENT :
1.wound dehiscence
2.infection
3.persistant fistula
3.loss of graft

46. • Antibiotics
• Oral hygiene
• Good nutrition
• Liquid and soft diet
POST OPERATIVE CARE OF SECONDARY OPERATIVE
MANAGEMENT:

47. ORTHOGNATHIC SURGERY
Indications of orthognathic surgery
1.maxillary hypoplasia
2.reduce lower facial height
3.assymmetries
4.anterior cross bite
(severe negative overjet)

48. DISTRACTION OSTEOGENESIS

51. REFERENCES