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Cleft lip and palate basics
This document discusses cleft lip and palate, including the relevant anatomy, pathophysiology, classification, and surgical repair techniques. Cleft lip and/or palate is the second most common birth defect, affecting speech, feeding, hearing, and emotional development. The causes are multifactorial, with both genetic and environmental factors playing a role. Surgical repair of cleft lip is typically done at 3 months of age, while cleft palate repair is usually between 3-6 months for the soft palate and 15-18 months for the hard palate. The document reviews several techniques for cleft lip and palate repair, as well as complications to watch for. It emphasizes the importance of a multidisciplinary
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Cleft lip and palate basics
- 1. Cleft Lip andPalate Dr. Faisal Ameer MS, MCh, MRCSEd International Scholar for 2015, Plastic Surgery Foundation of ASPS/ASMS International Member of American Society of Plastic Surgeons Member of Royal College of Surgeons Edinburgh Associate Professor Plastic Surgery LLRM Medical College Meerut, U.P. India +91 9557721163 www.plasticsurgicraft.com
- 2. Objectives • Recap ofembryology • Relevant Anatomy and Pathophysiology • Classification • Counseling of parents • Basic repair techniques
- 3. Introduction Facial cleftingis the second most common congenital deformity (after clubfoot). Affects 1in 1000 births Problems are cosmetic, dental, speech, swallowing, hearing, facial growth, emotional
- 4. Pathophysiology Complex mechanismof swallowing, hearing, speech and breathing are impaired Feeding difficulty in neonate. (Cleft makes creation of negative pressure difficult) Eustachian tube dysfunction Secondary defect of tooth development. Psychological problem.
- 5. Genetics Non-syndromic inheritanceis multifactorial ◦ Cleft Lip, With or Without Cleft Palate: One Parent-2% One Sibling- 4% Two Siblings- 9% One Parent + One Sibling- 15% ◦ Cleft Palate: One Parent- 7% One Sibling- 2% Two Siblings- 1% One Parent + One Sibling- 17%
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- 7. Epidemiology Cleft Lip+/- Palate- M:F 2:1 Cleft Palate - F:M 2:1 Cleft Lip +/- Palate- Native Americans > Oriental and Caucasians > Blacks Cleft Palate- Same among ethnic groups Environmental: Ethanol, Rubella virus, Thalidomide, Aminopterin B
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- 11. Classification Nagpur classification ◦Group I – cleft lip only ◦ Group Ia – cleft lip + cleft alveolus ◦ Group II – cleft palate only ◦ Group III – cleft lip + cleft alveolus + cleft palate
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- 19. • Philtrum • PhiltralRidges • Cupid’s Bow • Philtral Dimple • Commisure • White roll • Tubercle
- 24. History & Examination Cosmetic disfigurement (cleft lip) Feeding problems in cleft palate ◦ Suckling difficulties ◦ Nasal regurgitation Ear disease Respiratory infections Malnutrition and failure to thrive (wt. for age) Other congenital anomalies – digits, cardiac, craniofacial syndromes etc.
- 25. Pre operative evaluation History Physical examination Laboratory data Hb% Syndromes – X–ray mandible, Cardiac workup
- 26. Investigations Blood OPG(for canine tooth eruption) Occlusal view Speech evaluation ◦ Nasendoscopy ◦ Lateral/Frontal videofluroscopy ◦ Flowmetery Cephalometry – lateral / AP
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- 28. Care of thenewborn
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- 43. Timing of CleftLip Repair At three months of age ◦ Larger anatomical parts ◦ Safer anesthesia Rule of 10 10 weeks 10 grams 10 pounds 10k WBC
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- 52. Timing of CleftPalate repair Early repair (< 24 mts) – speech and hearing improved Delayed closure (>4y) – less retardation of mid facial growth Optimal time Soft palate 3 – 6 mts Hard palate 15-18 mts
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- 58. Surgical Complications Early Airwaycompromise Bleeding Late Fistula Reduced movement of the soft palate Persistent VPI Under developed facial skeleton
- 59. Conclusions Embryology andAnatomy extremely important. Counseling and communication Meticulous technique and tissue respect Easy to learn Cleft team
- 60. Thank you Teamworkis the key !
Editor's Notes
- #14 Joaquin Rafael Phoenix