This document discusses cleft lip and palate, including their development, classification, causes, problems they can create, and methods of surgical repair. Cleft lip and palate are congenital abnormalities caused by a failure of fusion during development of the lip and palate in utero. Surgical repair aims to restore function and appearance, with cleft lip repaired as early as 3 months and cleft palate typically repaired at 18 months. Repair requires a team approach and may involve additional procedures over the patient's lifetime.

1. Dr. Dinesh. M.G
Professor of Surgery
J.J.M.M.C.
Davangere

2. Cleft lip and Palate
 Cleft Lip and Palate are congenital abnormal gaps in the upper
lip, alveolus or palate
 Cleft lip occurs due to defect in fusion of medial nasal process
with maxillary process
 Cleft palate is due to failure of fusion of palatal processes of
maxilla

3. Development of lip and palate
 5th week of intrauterine life following features are developing in the
area of face
 Frontonasal process
 Medial nasal process
 Lateral nasal process
 The medial nasal processes fuse
with one another and with
maxillary process to form the upper
lip and premaxilla(primary palate)
 Mandibular process fuse in the
midline to form lower lip
 The palatal shelves grow medially
from maxillary process and fuse in
the midline to form hard &
soft palate(secondary palate)

5. Development of palate
 Primary palate : the triangular part of hard palate
anterior to incisor foramen which originate from the
premaxilla ( frontonasal prominences)
 Secondary palate : remaining part of the hard palate
and all soft palate posterior to incisive foramen which
comes from palatine shelves of the maxillary
prominences

6. Cleft lip and palate
Incidence
 In 75% of cases it is unilateral: common on left side
 In 50% of cases it is combined cleft lip and palate
occurring in 1:600 live births. Common in boys
 In 15-25% of cases it is cleft lip alone
 In 25-40% of cases it is cleft palate alone occurring in
1:1000 live births. Common in girls

7. Cleft lip and palate-Aetiology
 Environmental factors
 Vitamin B6 deficiency
 Radiation exposure
 Drugs(steroids, phenytoin)
 Genetic factors
 If parents are affected with cleft, risk to first child is 4% and
in second child the risk increases to 17%
 Associated anomalies
 Anomalies involving heart, skull, nervous system and
extremities

8. Classification-LAHSHAL
L = Lip (right)
A = Alveolus (right)
H = Hard Palate (right)
S = Soft Palate (median)
H = Hard Palate (left)
A = Alveolus (left)
L = Lip (left)
Capital letter = complete cleft
Lowercase letter = incomplete cleft
“.” or “-” = normal
Examples
LA….l = complete right cleft lip and alveolus,
incomplete left cleft lip
LAHS = complete right unilateral cleft lip,
alveolus, hard, and soft palate

9. Classification
I. Cleft lip alone
 Unilateral
 Bilateral
 Median
II. Cleft of primary palate
 Complete(absence of pre-maxilla)
 Incomplete( rudimentary pre-maxilla)
 Unilateral
 Bilateral
 Median
III. Cleft of secondary palate
 Complete(nasal septum and vomer are separated from palatine
process
 Incomplete
 Submucous
It can be cleft with or without soft palate involvement
IV. Cleft of both primary and secondary palates
V. Cleft lip and cleft palate together

10. Cleft lip and palate
Problems
Cleft lip
 Cosmetic
 Psychological secondary to cosmetic appearance
Cleft palate
 Defective speech
 Nasal regurgitation of food
 Abnormal facial growth
 Abnormal dentition
 Hearing problems due to improper opening and closure of
Eustachian tube.

11. Aims of surgical repair
Cleft lip
 To give cosmetically acceptable face
Cleft palate
 To provide intact roof to the mouth and a mobile soft
competent palate helping in phonation and swallowing
 To give well aligned teeth and avoiding loss of hearing

12. Timing of surgical repair
Cleft lip
As early as possible, usually at 3months of age(rule of 10)
 10 weeks of age
 10 pounds of weight
 10gm% of haemoglobin
Cleft palate
Repair is delayed, usually done at 1½ years of age
The problem of nasal regurgitation is tackled by spoon
feeding or by bottle feeding that has long nipple with a big
hole

13. Cleft lip repair
 Accurate repair of skin, muscles and mucous membrane
 Maintaining of white line and ‘cupid's bow’
 To give a long zigzag scar that doesn’t contract to produce
notching
 Techniques
 Millard technique

14. Cleft palate repair
 Pairing the edges of cleft
 Raising the mucoperiosteal flaps on either side of cleft
 Relaxation incisions on lateral sides to help medial
movement of flaps
 Soft palate muscles are dissected from bony edge of the
posterior hard palate, realigned transversely and sutured
 Nasal mucosal lining is sutured
 Oral mucosal lining is sutured

15. Cleft lip repair
Cleft Lip Repair
Unilateral
rotation-advancement flap developed
by Millard
Complications
Dehiscence
infection
excess tension

16. Cleft palate repair

17. Cleft lip and palate repair
 The overall management of cleft lip and palate requires a
team approach
 In cleft palate patients, speech therapy is required after
surgery
 Hearing problems require ENT specialist and dental
problems of occlusion require care by orthodontic surgeon
 In many cases secondary operations are required during
later life to improve appearance and functions

18. Thank you