Here are the key steps in the treatment plan:
1. Use RME to correct the posterior crossbite and expand the maxilla.
2. Use orthodontic treatment to align the teeth and correct the midline shift. Extraction of the displaced canine may be needed.
3. Monitor jaw growth and consider orthognathic surgery if the class 3 skeletal relationship does not improve with growth.
4. Address any residual speech or functional issues.
5. Continue follow up into adulthood to ensure stability of the treatment results.
The multidisciplinary treatment aims to improve occlusion, function and facial esthetics for the patient. Close monitoring of jaw growth is important given his age.
This document provides an overview of cleft lip and palate, including:
- The incidence of cleft lip and palate is approximately 1 in 600 births worldwide. It is the second most common birth defect.
- The embryology of facial development and how failures in processes like fusion of the medial nasal processes can result in clefting.
- Cleft lip and palate have multifactorial etiology involving both genetic and environmental factors. Risk is increased with positive family history or exposure to teratogens.
- Classification systems have evolved over time but still categorize clefts as involving the lip, palate, or both, and as unilateral or bilateral. The Victor Veau system from 1931 remains influential
Cleft Lip and Palate - Presentation.
Cleft Lip and Palate is the 2nd most common Congenital Anomaly after Clubfoot. This presentation goes in depth about the Presentation, eitiology, Genetics, Medical management, Nasoalveolar Moulding, Surgical management of Cleft Lip & Palate
Cleft lip and palate are congenital anomalies that require a multidisciplinary team for treatment. They can involve the lip, alveolus, hard and soft palates. Treatment involves a coordinated approach between multiple specialties and begins with surgery to repair the cleft, followed by ongoing dental, orthodontic and reconstructive procedures over many years.
Cleft lip and palate is the second most common birth defect. It results from the failure of facial structures to fuse properly during embryonic development. The document discusses the goals, classification, problems, and multidisciplinary management of cleft lip and palate. Treatment aims to achieve a normalized appearance and function and involves a team of specialists coordinating surgical and orthodontic interventions from infancy through adulthood.
Surgical management cleft lip and palateNikitha Sree
1) Surgical management of cleft lip and palate is a multidisciplinary approach involving multiple procedures from infancy to adulthood. These include lip repair between 4-6 weeks, palate repair between 12-18 months, alveolar bone grafting at 8-11 years, and orthognathic surgery in late adolescence.
2) Clefts can involve the lip, alveolus, hard and soft palate, and result from failure of fusion between embryonic processes. Classification systems describe the anatomical extent and location of the cleft.
3) Treatment aims to restore form and function, including feeding, speech, dental alignment and facial growth. Key procedures are lip repair to close
The document discusses the management of cleft lip and/or cleft palate patients. It begins with an overview of neonatal maxillary orthopaedics, which aims to align the alveolar processes before lip repair surgery. It then covers presurgical nasoalveolar moulding, which uses appliances to slowly reshape the nose and alveolus over time to improve aesthetic outcomes of primary lip and palate repair surgery. Finally, it provides details on the components and use of nasoalveolar moulding appliances in the presurgical treatment of cleft patients.
This document provides information about nasoalveolar molding (NAM) for treating cleft lip and palate. It defines cleft lip and cleft palate, and describes presurgical NAM which reshapes the alveolar and nasal segments before surgical repair. The key steps of NAM include taking an impression, fabricating an acrylic molding plate with a nasal stent, inserting the plate and using tape for retention, and making weekly adjustments to reshape the tissues over 3-5 months before surgery. The goals of NAM are to decrease the cleft deformity and improve symmetry, with benefits such as reducing the need for future bone grafts or surgeries.
This document provides an overview of cleft lip and palate, including:
- The incidence of cleft lip and palate is approximately 1 in 600 births worldwide. It is the second most common birth defect.
- The embryology of facial development and how failures in processes like fusion of the medial nasal processes can result in clefting.
- Cleft lip and palate have multifactorial etiology involving both genetic and environmental factors. Risk is increased with positive family history or exposure to teratogens.
- Classification systems have evolved over time but still categorize clefts as involving the lip, palate, or both, and as unilateral or bilateral. The Victor Veau system from 1931 remains influential
Cleft Lip and Palate - Presentation.
Cleft Lip and Palate is the 2nd most common Congenital Anomaly after Clubfoot. This presentation goes in depth about the Presentation, eitiology, Genetics, Medical management, Nasoalveolar Moulding, Surgical management of Cleft Lip & Palate
Cleft lip and palate are congenital anomalies that require a multidisciplinary team for treatment. They can involve the lip, alveolus, hard and soft palates. Treatment involves a coordinated approach between multiple specialties and begins with surgery to repair the cleft, followed by ongoing dental, orthodontic and reconstructive procedures over many years.
Cleft lip and palate is the second most common birth defect. It results from the failure of facial structures to fuse properly during embryonic development. The document discusses the goals, classification, problems, and multidisciplinary management of cleft lip and palate. Treatment aims to achieve a normalized appearance and function and involves a team of specialists coordinating surgical and orthodontic interventions from infancy through adulthood.
Surgical management cleft lip and palateNikitha Sree
1) Surgical management of cleft lip and palate is a multidisciplinary approach involving multiple procedures from infancy to adulthood. These include lip repair between 4-6 weeks, palate repair between 12-18 months, alveolar bone grafting at 8-11 years, and orthognathic surgery in late adolescence.
2) Clefts can involve the lip, alveolus, hard and soft palate, and result from failure of fusion between embryonic processes. Classification systems describe the anatomical extent and location of the cleft.
3) Treatment aims to restore form and function, including feeding, speech, dental alignment and facial growth. Key procedures are lip repair to close
The document discusses the management of cleft lip and/or cleft palate patients. It begins with an overview of neonatal maxillary orthopaedics, which aims to align the alveolar processes before lip repair surgery. It then covers presurgical nasoalveolar moulding, which uses appliances to slowly reshape the nose and alveolus over time to improve aesthetic outcomes of primary lip and palate repair surgery. Finally, it provides details on the components and use of nasoalveolar moulding appliances in the presurgical treatment of cleft patients.
This document provides information about nasoalveolar molding (NAM) for treating cleft lip and palate. It defines cleft lip and cleft palate, and describes presurgical NAM which reshapes the alveolar and nasal segments before surgical repair. The key steps of NAM include taking an impression, fabricating an acrylic molding plate with a nasal stent, inserting the plate and using tape for retention, and making weekly adjustments to reshape the tissues over 3-5 months before surgery. The goals of NAM are to decrease the cleft deformity and improve symmetry, with benefits such as reducing the need for future bone grafts or surgeries.
Cleft lip and palate are the most common craniofacial anomalies treated by plastic surgeons. They require a coordinated multidisciplinary approach for treatment. The treatment plan involves multiple stages including primary lip and palate repairs in infancy, followed by revision surgeries, orthodontic treatment, bone grafting, and other procedures throughout childhood and adolescence to address issues such as dental problems, speech difficulties, and nasal deformities. Careful feeding strategies and pre-surgical orthopedics are also important aspects of management. The goal is to optimize outcomes from each intervention and provide holistic care from birth through adulthood.
This document provides an overview of cleft lip and palate, including:
- The incidence is approximately 1 in 700 live births. Males are more commonly affected by cleft lip while females are more commonly affected by cleft palate.
- Clefts occur due to both genetic and environmental factors like certain viruses, medications, and smoking. They may also be associated with other syndromes.
- Clefts are classified based on their location and severity, with unilateral cleft lip and palate (UCLP) being one of the most common types.
- Individuals with cleft lip and palate can experience problems with feeding, speech, hearing, and psychosocial issues. Timely management including
1. Cleft lip and palate is a congenital defect caused by the failure of fusion between embryonic processes during lip and palate development.
2. It has a multifactorial etiology including both genetic and environmental factors. The exact cause is often unknown.
3. Cleft lip and palate occurs in about 1 to 2 per 1000 births globally, with varying prevalence across ethnic groups. Classification systems describe the location and extent of the cleft.
This document discusses evaluation and treatment approaches for secondary cleft lip deformities. It covers five broad areas of deformity - scarring, lip dimensions, vermilion borders, muscle abnormalities, and buccal sulcus issues. For each type of deformity, the document outlines potential causes and recommended surgical techniques, which may include scar revision, lip lengthening/shortening procedures, fat or tissue grafting, and muscle/mucosa reapproximation. Optimal timing for secondary cleft lip surgery is generally between ages 4-5 years.
The document discusses several craniofacial anomalies including craniosynostosis. Craniosynostosis occurs when one or more of the fibrous sutures in the skull fuse prematurely, restricting skull growth. It can be primary, due to a defect in ossification, or secondary, due to inadequate brain growth. Primary craniosynostosis affects a single suture and causes specific head shapes like scaphocephaly or brachycephaly, while secondary craniosynostosis involves multiple sutures fusing. Treatment involves surgery to reshape the skull if increased intracranial pressure develops by age 2-4 months.
CASE HISTORY AND EXAMINATION IN ORTHODONTICS Jubin Babu
This document provides information on case history and clinical examination in orthodontic diagnosis. It discusses collecting relevant personal details from patients, such as name, age, sex, and address. Medical history is also important, including prenatal history, birth trauma, syndromes, and habits. Clinical examination involves assessing the patient's general appearance, body build, facial symmetry, and facial profile. Diagnostic aids like study models and radiographs help with comprehensive orthodontic evaluation. Collecting a thorough case history and performing a detailed clinical exam are essential for orthodontic diagnosis.
Management of cleft lip and palate involves a multidisciplinary team approach. The document discusses the history, classification, prevalence, etiology and development of clefts. It also covers clinical features, parental attitudes, feeding techniques, and the treatment plan which involves multiple stages including maxillary orthopedics, presurgical orthodontics, surgical lip and palate closure, and primary repair between 10-18 months of age. The goal is to surgically correct the deformity while addressing issues such as feeding, speech, and dental development.
Surgical correction of anterior openbiteMaher Fouda
This document discusses the diagnosis and surgical correction of anterior open bite (AOB). It defines AOB and describes three main surgical techniques for correction: differential posterior impaction of the maxilla, segmental impaction of the posterior maxilla, and isolated mandibular surgery. It covers topics like the etiology of AOB, diagnostic features indicating a skeletal origin, principles of orthodontic preparation, and postoperative orthodontics. The goal of surgery is to elevate the posterior maxilla and allow forward rotation of the mandible to close the bite.
Pierre Robin syndrome is a congenital condition characterized by three main features: cleft palate, retrognathia (underdeveloped lower jaw), and glossoptosis (backward displacement of the tongue). It is caused by mandibular hypoplasia during a critical period of gestation, which prevents normal palate formation. Diagnosis is typically at birth based on characteristic facial features. Management focuses on maintaining a patent airway and enabling feeding, which may require conservative measures or surgery depending on severity. With proper treatment, individuals with PRS can expect a good prognosis.
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.
This document provides an overview of rapid maxillary expansion (RME) in orthodontics. It discusses the history of RME dating back to 1860. It also covers anatomy related to RME, including the midpalatal suture. Key topics covered include indications and contraindications for RME, types of expansion screws used, jackscrew turn schedules, and different types of RME appliances such as the Haas expander and Hyrax expander. The document is an educational resource on the clinical use and mechanics of RME.
This document provides guidelines for providing anticipatory guidance to parents at different stages of their child's development. It covers topics such as oral development, nutrition, oral hygiene, fluoride use, habits, and injury prevention. Guidelines are provided for prenatal counseling, and ages 6-12 months, 12-24 months, 2-6 years, 6-12 years, and adolescence. The document emphasizes educating parents on establishing good oral health habits and preventing dental injuries at each stage.
Cleft lip and palate are common birth defects that affect speech, hearing, breathing, and appearance. They require a team-based approach involving multiple specialists like otolaryngologists. The document discusses the management of cleft lip and palate, including the roles of different specialists in examining, diagnosing, and treating issues related to feeding, airway, speech, hearing, and surgery. Surgical techniques aim to restore normal anatomy and function through procedures on the lip and palate.
This document discusses orthognathic surgery decision making, treatment planning, and timing of surgery. It covers collecting patient data, diagnosing issues, cephalometric analysis, developing a treatment plan, and predicting soft tissue changes. Treatment options include orthodontics, dentofacial orthopedics, and orthognathic surgery to correct jaw and facial skeletal issues.
This document discusses thumb sucking habits in children. It begins by defining habits and classifying different types of oral habits. It then defines thumb sucking and classifications for normal versus abnormal thumb sucking. Various theories for the etiology of thumb sucking are presented, including classical Freudian theory, oral drive theory, sucking reflex theory, and learning theory. Clinical findings, diagnosis, and management strategies are outlined. Finally, several journal articles on topics related to thumb sucking are summarized in 1-3 sentences each.
Pierre Robin syndrome is a condition characterized by three components: cleft palate, mandibular micrognathia or retrognathia, and glossoptosis. It is caused by the mechanical theory where cleft palate prevents palatal shelf fusion and mandibular hypoplasia constrains growth, leading to tongue displacement. Achondroplasia is caused by mutations affecting endochondral ossification, leading to disproportionate short stature and limb shortening, large head size, and restricted joint motion. Both conditions are diagnosed based on clinical features and imaging findings, and require multidisciplinary care.
The document discusses temporomandibular joint ankylosis, including its causes, clinical features, diagnosis using radiographs, and various treatment methods. Key points include: TMJ ankylosis is the fusion of the mandibular condyle with the glenoid fossa, immobilizing the mandible. Common causes are trauma, infection, and inflammation. Treatment involves surgical resection of the ankylotic mass with coronoidectomy and interpositional arthroplasty using grafts to prevent re-ankylosis, followed by aggressive physiotherapy. Complications can include recurrence if physiotherapy is not continued long-term.
Crouzon syndrome is a genetic disorder characterized by premature fusion of skull bones. It was first described in 1912 by French neurologist Octave Crouzon. It is caused by mutations in the Fibroblast Growth Factor Receptor 2 gene and is inherited in an autosomal dominant pattern. Physical signs include a tall, flattened forehead; wide head; bulging eyes; wide-set eyes; underdeveloped midface; beaked nose; and low-set ears. Complications can include increased intracranial pressure, vision problems, and dental abnormalities. Diagnosis involves physical exam, imaging, and genetic testing. Treatment involves early surgery to prevent brain damage from abnormal skull growth.
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.for more details please visit
www.indiandentalacademy.com
- The document discusses clinical aspects of cleft lip repair, including epidemiology, embryology, surgical anatomy, classification, management, and future directions.
- Cleft lip is the most common craniofacial malformation, occurring in about 1 in 1,000 live births. The rotation-advancement technique developed by Millard is currently the most commonly used repair method.
- The goals of cleft lip repair are to reconstitute lip competence and symmetry while minimizing scar visibility. Proper postoperative care and follow-up are important to monitor for complications and ensure good healing. Fetal surgery and in utero repair may be future areas of development.
This document discusses cleft lip and cleft palate, which are birth defects where the lip and roof of the mouth do not fully form. Cleft lip involves a separation of the upper lip, while cleft palate involves an opening in the roof of the mouth. The causes may include genetic and environmental factors. Treatment requires a team approach including surgery and other therapies. Dental problems are common in individuals with cleft lip and palate.
The document describes cleft lip and palate in a newborn patient. There are three types of cleft lip and three types of cleft palate. Treatment includes specialized feeding methods, hearing tests, and surgical repair of the cleft lip at 3 months and palate at 6 months. Cleft lip and palate can cause feeding difficulties, ear infections, speech problems, and other issues if not treated properly. The document provides details on the causes, incidence, signs, and potential complications of cleft lip and palate.
Cleft lip and palate are the most common craniofacial anomalies treated by plastic surgeons. They require a coordinated multidisciplinary approach for treatment. The treatment plan involves multiple stages including primary lip and palate repairs in infancy, followed by revision surgeries, orthodontic treatment, bone grafting, and other procedures throughout childhood and adolescence to address issues such as dental problems, speech difficulties, and nasal deformities. Careful feeding strategies and pre-surgical orthopedics are also important aspects of management. The goal is to optimize outcomes from each intervention and provide holistic care from birth through adulthood.
This document provides an overview of cleft lip and palate, including:
- The incidence is approximately 1 in 700 live births. Males are more commonly affected by cleft lip while females are more commonly affected by cleft palate.
- Clefts occur due to both genetic and environmental factors like certain viruses, medications, and smoking. They may also be associated with other syndromes.
- Clefts are classified based on their location and severity, with unilateral cleft lip and palate (UCLP) being one of the most common types.
- Individuals with cleft lip and palate can experience problems with feeding, speech, hearing, and psychosocial issues. Timely management including
1. Cleft lip and palate is a congenital defect caused by the failure of fusion between embryonic processes during lip and palate development.
2. It has a multifactorial etiology including both genetic and environmental factors. The exact cause is often unknown.
3. Cleft lip and palate occurs in about 1 to 2 per 1000 births globally, with varying prevalence across ethnic groups. Classification systems describe the location and extent of the cleft.
This document discusses evaluation and treatment approaches for secondary cleft lip deformities. It covers five broad areas of deformity - scarring, lip dimensions, vermilion borders, muscle abnormalities, and buccal sulcus issues. For each type of deformity, the document outlines potential causes and recommended surgical techniques, which may include scar revision, lip lengthening/shortening procedures, fat or tissue grafting, and muscle/mucosa reapproximation. Optimal timing for secondary cleft lip surgery is generally between ages 4-5 years.
The document discusses several craniofacial anomalies including craniosynostosis. Craniosynostosis occurs when one or more of the fibrous sutures in the skull fuse prematurely, restricting skull growth. It can be primary, due to a defect in ossification, or secondary, due to inadequate brain growth. Primary craniosynostosis affects a single suture and causes specific head shapes like scaphocephaly or brachycephaly, while secondary craniosynostosis involves multiple sutures fusing. Treatment involves surgery to reshape the skull if increased intracranial pressure develops by age 2-4 months.
CASE HISTORY AND EXAMINATION IN ORTHODONTICS Jubin Babu
This document provides information on case history and clinical examination in orthodontic diagnosis. It discusses collecting relevant personal details from patients, such as name, age, sex, and address. Medical history is also important, including prenatal history, birth trauma, syndromes, and habits. Clinical examination involves assessing the patient's general appearance, body build, facial symmetry, and facial profile. Diagnostic aids like study models and radiographs help with comprehensive orthodontic evaluation. Collecting a thorough case history and performing a detailed clinical exam are essential for orthodontic diagnosis.
Management of cleft lip and palate involves a multidisciplinary team approach. The document discusses the history, classification, prevalence, etiology and development of clefts. It also covers clinical features, parental attitudes, feeding techniques, and the treatment plan which involves multiple stages including maxillary orthopedics, presurgical orthodontics, surgical lip and palate closure, and primary repair between 10-18 months of age. The goal is to surgically correct the deformity while addressing issues such as feeding, speech, and dental development.
Surgical correction of anterior openbiteMaher Fouda
This document discusses the diagnosis and surgical correction of anterior open bite (AOB). It defines AOB and describes three main surgical techniques for correction: differential posterior impaction of the maxilla, segmental impaction of the posterior maxilla, and isolated mandibular surgery. It covers topics like the etiology of AOB, diagnostic features indicating a skeletal origin, principles of orthodontic preparation, and postoperative orthodontics. The goal of surgery is to elevate the posterior maxilla and allow forward rotation of the mandible to close the bite.
Pierre Robin syndrome is a congenital condition characterized by three main features: cleft palate, retrognathia (underdeveloped lower jaw), and glossoptosis (backward displacement of the tongue). It is caused by mandibular hypoplasia during a critical period of gestation, which prevents normal palate formation. Diagnosis is typically at birth based on characteristic facial features. Management focuses on maintaining a patent airway and enabling feeding, which may require conservative measures or surgery depending on severity. With proper treatment, individuals with PRS can expect a good prognosis.
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.
This document provides an overview of rapid maxillary expansion (RME) in orthodontics. It discusses the history of RME dating back to 1860. It also covers anatomy related to RME, including the midpalatal suture. Key topics covered include indications and contraindications for RME, types of expansion screws used, jackscrew turn schedules, and different types of RME appliances such as the Haas expander and Hyrax expander. The document is an educational resource on the clinical use and mechanics of RME.
This document provides guidelines for providing anticipatory guidance to parents at different stages of their child's development. It covers topics such as oral development, nutrition, oral hygiene, fluoride use, habits, and injury prevention. Guidelines are provided for prenatal counseling, and ages 6-12 months, 12-24 months, 2-6 years, 6-12 years, and adolescence. The document emphasizes educating parents on establishing good oral health habits and preventing dental injuries at each stage.
Cleft lip and palate are common birth defects that affect speech, hearing, breathing, and appearance. They require a team-based approach involving multiple specialists like otolaryngologists. The document discusses the management of cleft lip and palate, including the roles of different specialists in examining, diagnosing, and treating issues related to feeding, airway, speech, hearing, and surgery. Surgical techniques aim to restore normal anatomy and function through procedures on the lip and palate.
This document discusses orthognathic surgery decision making, treatment planning, and timing of surgery. It covers collecting patient data, diagnosing issues, cephalometric analysis, developing a treatment plan, and predicting soft tissue changes. Treatment options include orthodontics, dentofacial orthopedics, and orthognathic surgery to correct jaw and facial skeletal issues.
This document discusses thumb sucking habits in children. It begins by defining habits and classifying different types of oral habits. It then defines thumb sucking and classifications for normal versus abnormal thumb sucking. Various theories for the etiology of thumb sucking are presented, including classical Freudian theory, oral drive theory, sucking reflex theory, and learning theory. Clinical findings, diagnosis, and management strategies are outlined. Finally, several journal articles on topics related to thumb sucking are summarized in 1-3 sentences each.
Pierre Robin syndrome is a condition characterized by three components: cleft palate, mandibular micrognathia or retrognathia, and glossoptosis. It is caused by the mechanical theory where cleft palate prevents palatal shelf fusion and mandibular hypoplasia constrains growth, leading to tongue displacement. Achondroplasia is caused by mutations affecting endochondral ossification, leading to disproportionate short stature and limb shortening, large head size, and restricted joint motion. Both conditions are diagnosed based on clinical features and imaging findings, and require multidisciplinary care.
The document discusses temporomandibular joint ankylosis, including its causes, clinical features, diagnosis using radiographs, and various treatment methods. Key points include: TMJ ankylosis is the fusion of the mandibular condyle with the glenoid fossa, immobilizing the mandible. Common causes are trauma, infection, and inflammation. Treatment involves surgical resection of the ankylotic mass with coronoidectomy and interpositional arthroplasty using grafts to prevent re-ankylosis, followed by aggressive physiotherapy. Complications can include recurrence if physiotherapy is not continued long-term.
Crouzon syndrome is a genetic disorder characterized by premature fusion of skull bones. It was first described in 1912 by French neurologist Octave Crouzon. It is caused by mutations in the Fibroblast Growth Factor Receptor 2 gene and is inherited in an autosomal dominant pattern. Physical signs include a tall, flattened forehead; wide head; bulging eyes; wide-set eyes; underdeveloped midface; beaked nose; and low-set ears. Complications can include increased intracranial pressure, vision problems, and dental abnormalities. Diagnosis involves physical exam, imaging, and genetic testing. Treatment involves early surgery to prevent brain damage from abnormal skull growth.
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.for more details please visit
www.indiandentalacademy.com
- The document discusses clinical aspects of cleft lip repair, including epidemiology, embryology, surgical anatomy, classification, management, and future directions.
- Cleft lip is the most common craniofacial malformation, occurring in about 1 in 1,000 live births. The rotation-advancement technique developed by Millard is currently the most commonly used repair method.
- The goals of cleft lip repair are to reconstitute lip competence and symmetry while minimizing scar visibility. Proper postoperative care and follow-up are important to monitor for complications and ensure good healing. Fetal surgery and in utero repair may be future areas of development.
This document discusses cleft lip and cleft palate, which are birth defects where the lip and roof of the mouth do not fully form. Cleft lip involves a separation of the upper lip, while cleft palate involves an opening in the roof of the mouth. The causes may include genetic and environmental factors. Treatment requires a team approach including surgery and other therapies. Dental problems are common in individuals with cleft lip and palate.
The document describes cleft lip and palate in a newborn patient. There are three types of cleft lip and three types of cleft palate. Treatment includes specialized feeding methods, hearing tests, and surgical repair of the cleft lip at 3 months and palate at 6 months. Cleft lip and palate can cause feeding difficulties, ear infections, speech problems, and other issues if not treated properly. The document provides details on the causes, incidence, signs, and potential complications of cleft lip and palate.
Cleft lip and palate are birth defects that occur when certain tissues fail to fuse properly during embryonic development. Cleft lip involves an opening in the upper lip, while cleft palate involves an opening in the roof of the mouth. Infants with cleft lip and palate experience feeding difficulties, respiratory infections, ear infections, and speech problems. Diagnosis involves physical examination and imaging. Treatment involves surgical repair of the cleft, with the lip often repaired at 3 months and the palate repaired between 6-18 months. Nursing care focuses on supporting feeding, monitoring for infections, managing anxiety, and educating parents.
Management of Orofacial Cleft Dr. Sunil (2).pptx Management of Orofacial Clef...ssuser12303b
Management of Orofacial Cleft Dr. Sunil (2).pptxManagement of Orofacial Cleft Dr. Sunil (2).pptxManagement of Orofacial Cleft Dr. Sunil (2).pptxManagement of Orofacial Cleft Dr. Sunil (2).pptx
management of orofacial clefts.pptxmanagement of orofacial clefts.pptxmanagement of orofacial clefts.pptxmanagement of orofacial clefts.pptxmanagement of orofacial clefts.pptx
This document provides information about cleft lip and cleft palate including causes, risk factors, diagnosis, treatment, and social aspects. It describes how cleft lip occurs when the tissues of the lip do not fully fuse before birth, and cleft palate occurs when the roof of the mouth does not fully close. Treatment often begins in infancy and may include surgery, dental care, speech therapy, and psychological support. The document also discusses cultural beliefs and stigma around cleft conditions as well as organizations providing cleft care in India.
This document discusses natal and neonatal teeth. Natal teeth are present at birth, while neonatal teeth erupt within the first month of life. They are uncommon anomalies that can lead to complications like feeding difficulties, trauma to the tongue, and premature eruption of other teeth. Management may involve smoothing sharp edges, protective dressings, or extraction if the tooth is loose or interfering with feeding. The exact causes are unknown but may involve genetic and environmental factors.
This document provides information on cleft lip and palate, including definitions, classifications, embryology, problems, and management. It defines cleft lip and palate as an abnormal separation in oral-facial tissue that occurs due to incomplete formation during fetal development. Treatment requires a multidisciplinary approach from prenatal diagnosis through adulthood and aims to address functional, aesthetic, and developmental issues through procedures such as cheilorrhaphy, palatorrhaphy, and alveolar bone grafting. Successful management of cleft lip and palate patients presents ongoing challenges due to the variety of impairments and extended treatment time required.
The most common congenital craniofacial anomaly is cleft lip and palate. It is a separation that occurs in the lip or palate or both. Cleft occurs when the lip and/or the palate do not completely fuse during fetal development between the 6th and 9th week of pregnancy. While many factors have been associated with clefts, the cause of this condition seems complex and most cases of cleft lip and palate are thought to occur by an interaction of genetic and environmental factors or as a part of a genetic syndrome. Children with cleft lip and palate often have problems with feeding, speech, dentition, hearing, and aesthetics.
Cleft Lip, Cleft Palate: What is a cleft lip, cleft palate by Dr.Rajat Sachde...Dr. Rajat Sachdeva
Rebuilding Lives One Smile at a Time.
Cleft lip and cleft palate, also known as orofacial cleft, is a group of conditions that includes cleft lip, cleft palate and both together.. A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate is when the roof of the mouth contains an opening into the nose.
Cleft lip and palate are the result of tissues of the face not joining properly during development. As such, they are a type of birth defect. The cause is unknown in most cases.
A cleft lip or palate can be successfully treated with surgery. This is often done in the first few months of life for cleft lip and before eighteen months for cleft palate. Speech therapy and dental care may also be needed. With appropriate treatment and properly skilled surgeons, outcomes are excellent.
Contact us
The cleft lip and palate team at Dr.Rajat Sachdeva's Dental welcomes your phone calls for questions and consultations. For more information, or to make an appointment, please use the following phone numbers:
For appointments or questions , please call +919818894041 , 01142464041
#dentalclinicinashokvihar #cleftpalate #cleftlip #cleftpalatetreatmentindelhi #cleftlip #cleftpalsvic #cleftlipandpalate #cleftstrong #cleftproud #cleftawareness #cleftsmile #delhidental #dentaldelhi
Cleft lip/Cleft Palate | Cleft Lip, Cleft Palate: What is a cleft lip, cleft...Dr. Rajat Sachdeva
Cleft Lip/ Cleft Palate
A congenital disorder which occurs during development of facial structure. Whenever failure of fusion occurs, cleft happens.
Defective fusion of medial nasal process with maxillary one leads to Cleft Lips.
Lateral Facial Cleft Occurs due to lack of fusion of maxillary & mandibular process.
Deformities in Cleft:-Feeding problem, Nasal Problem, Dental Problem, Skeletal problem, Speech Problem, Ear Problems associated with some anomalies like congenital heart defects and mental retardation
Management of Clefts includes:-
Non-surgical management, involves obturator aids in feeding,
Presurgical Appliances envolves custom-made acrylic plate for anchorage and moulding of lips, palate and alveolar structure.
Surgical phase to correct clefts.
We at Dr. Sachdeva's Dental Institute providing best treatment facilities and comfort that our patients deserve.
Call us to book your appointment:-+919818894041,01142464041
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The document discusses ankyloglossia (tongue-tie), including its incidence, potential complications, clinical assessment, and treatment options. Ankyloglossia is a congenital condition where the lingual frenulum limits tongue mobility and can impair functions like speech, swallowing, and breastfeeding. Surgical techniques like frenotomy and frenectomy aim to release the frenulum and improve tongue function. Assessment considers factors like a patient's ability to protrude and elevate their tongue tip.
This document discusses several controversies in orthodontics, including growth prediction, the etiology of malocclusion, extraction vs non-extraction treatment, and the role of nasal obstruction, tongue thrust, and respiratory patterns in causing malocclusions. It notes that while some craniofacial growth and tooth movements can be predicted, the exact magnitude and timing cannot. The etiology of malocclusions involves a complex interplay between genetic and environmental factors. The relationship between nasal obstruction, mouth breathing, and malocclusions is unclear, as total nasal obstruction is rare in humans and mouth breathing alone does not necessarily cause malocclusions.
Cleft lip and palate - Introduction and Orthodontic ConsiderationsWaqar Jeelani
This document provides information on cleft lip and palate, including:
- Prevalence is highest in South Asians at 1 in 500, and lowest in Africans at 1 in 2000.
- Males are more commonly affected than females, with a ratio of 3:2.
- Clefts can be unilateral (75% of cases) or bilateral. The left side is more frequently involved.
- Multiple surgical procedures are often required from birth through adulthood to address issues like feeding, speech, dental problems, and facial appearance.
Cleft lip and palate is a common congenital abnormality affecting the lip and palate that occurs when tissues do not fuse properly during development in utero. It has a multifactorial etiology including genetic and environmental factors. Treatment aims to achieve a normalized appearance, intact palate, normal speech and function, and involves a coordinated series of procedures from infancy through adolescence including lip and palate repair, speech therapy, dental work, and reconstructive surgery. The timing and techniques for each procedure are important for optimal outcomes.
Cleft lip and cleft palate are birth defects where the tissues of the lip and roof of the mouth do not fully fuse during development in the womb. They occur in approximately 1 in 700 births. Cleft lip involves a split in the upper lip while cleft palate involves an opening in the roof of the mouth. Treatment involves surgery to repair the cleft, with lip surgery typically within the first few months and palate surgery between 6-12 months. Ongoing care from a multidisciplinary team is often required and may include management of feeding issues, speech therapy, dental care and psychological support.
Cleft lip and cleft palate are birth defects where the tissues of the lip and roof of the mouth do not fully fuse during development in the womb. They occur in approximately 1 in 700 births. Cleft lip involves a split in the upper lip while cleft palate involves an opening in the roof of the mouth. Treatment involves surgery to repair the cleft, with lip surgery typically within the first few months and palate surgery between 6-12 months. Ongoing care from a multidisciplinary team is often required and may include management of feeding issues, speech therapy, dental care and psychological support.
Cleft lip and cleft palate are birth defects where the tissues of the lip and roof of the mouth do not fully fuse during development in the womb. They occur in approximately 1 in 700 births. Cleft lip involves a split in the upper lip while cleft palate involves an opening in the roof of the mouth. Treatment involves surgery to repair the cleft, with cleft lip surgery typically occurring in the first few months of life and cleft palate surgery between 6-12 months. Long term care is multidisciplinary and aims to address issues with feeding, speech, hearing and socialization that can arise.
Cleft lip and cleft palate are congenital defects caused by the failure of facial structures to fuse properly during fetal development. Cleft lip involves the upper lip and nose, while cleft palate involves the roof of the mouth. Treatment requires a multidisciplinary team and may involve several surgeries over many years to repair the defects and address issues like feeding, speech, and dental/jaw development. Nursing care focuses on supporting nutrition, preventing infection or injury post-surgery, managing pain, and educating parents on feeding techniques and the treatment process.
Elastomeric chains and nickel titanium coil springs are commonly used force delivery systems in orthodontics. [1] Elastomeric chains experience rapid loss of force over time due to stress relaxation and absorption of saliva, with about 50-70% loss in the first day. [2] Nickel titanium coil springs also lose force rapidly initially but then plateau, and can provide a more consistent force than elastomeric chains if properly activated. [3] However, several studies have found that elastomeric chains and nickel titanium coil springs close spaces at similar rates clinically.
Introduction to Orthodontic treatment in Mixed dentition Khaled Wafaie
This document provides an introduction to orthodontic treatment options in the mixed dentition stage. It discusses treatments for anteroposterior discrepancies like Class 2 malocclusions which can be addressed with functional appliances or fixed functional appliances for the mandible, and headgear for the maxilla. Class 3 malocclusions may involve advancing the mandible or restricting maxillary growth. Transverse discrepancies can be corrected with slow or rapid expansion appliances. Vertical issues can target the anterior or posterior bite. Habit appliances and temporary spacers are also mentioned.
Temporary Anchorage Device (TAD) or Mini (screw ,implant)Khaled Wafaie
Orthodontic Temporary Anchorage Device (TAD) or Mini (screw ,implant).
I am hoping that this presentation is beneficial for everyone
For more information and for further contact join us on ( Orthodontic Institution) Group on Facebook.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Cleft lip and palate from embryological development till maturity.
1. Cleft lip and palate from
embryological development till
maturity.
By
Dr. Khaled Wafaie
Master of science in orthodontics
University of Dundee
Orthodontic specialist at Smile Train and Operation
Smile
2. Classification of cleft lip and palate?
• Clefts of the lip and palate are generally divided into two groups
isolated cleft palate and cleft lip with or without cleft palate,
representing a heterogeneous group of disorders affecting the lips
and oral cavity.
• These defects arise in about 1·7 per 1000 live born babies with ethnic
and geographic variation.
• Cleft lip with or without cleft palate is most frequent in males, and
isolated cleft palate is most typical in females
3. (A) Cleft lip and alveolus. (B) Cleft palate. (C) Incomplete unilateral cleft lip and
palate. (D) Complete unilateral cleft lip and palate. (E) Complete bilateral cleft lip
and palate. Shaw WC. Orthodontics and occlusal management. Oxford: Butterworth-Heinemann, 1993.
4. • Effects on speech, hearing, appearance, and psychology can lead to
long lasting adverse outcomes for health and social integration.
• Evidence show that cleft patients have higher morbidity and mortality
throughout life than do unaffected individuals. Findings of studies
have shown an increased frequency of structural brain abnormalities
• Typically, children with these disorders need multidisciplinary care
from birth to adulthood nursing, plastic surgery, maxillofacial surgery,
otolaryngology, speech therapy, audiology, counselling, psychology,
genetics, orthodontics, and dentistry.
5. 4th week-> paired maxillary and mandibular processes
6th week-> merging of medial nasal processes with maxillary processes to form upper lip and primary palate
7th week-> the palatal shelves rise to a horizontal position above the tongue and come into contact and fuse
10th week-> In addition to fusing in the midline, the secondary palate fuses with the primary palate and the nasal septum
6. • Since the lip and primary palate have distinct developmental origins
from the secondary palate, clefts of these areas can be subdivided
into cleft lip with or without cleft palate and isolated cleft palate in
which the lip is not affected.
• This subdivision is validated by the finding that, under most
circumstances, cleft lip with or without cleft palate and isolated cleft
palate do not segregate in the same family.
• Genes responsible for cleft Osr2, Lhx8, Msx1, Fgf10, Fgfr2b, Tgfb2,
and Tgfbr2.
Any familiar gene?
7. Lifestyle and environmental risk factors
• Environmental risk factors might be important in cleft lip and palate,
and maternal exposure to tobacco smoke (increase risk by 20%),
alcohol (fetal alcohol Syndrome), poor nutrition (not enough
evidence), viral infection, medicinal drugs, and teratogens in the
workplace and at home in early pregnancy have all been investigated.
-Little J, Cardy A, Munger RG. Tobacco smoking and oral clefts:
a meta-analysis. Bull World Health Organ 2004; 82: 213–18.
-Honein MA, Rasmussen SA, Reefhuis J, et al. Maternal smoking and
environmental tobacco smoke exposure and the risk of orofacial
clefts. Epidemiology 2007; 18: 226–33.
8. • In most studies, maternal use of multivitamin supplements in early
pregnancy has been linked to decreased risk of orofacial clefts; in a
meta-analysis, multivitamin use was associated with a 25% reduction
in birth prevalence of orofacial clefts.
• Johnson CY, Little J. Folate intake, markers of folate status and oral clefts: is the evidence
converging? Int J Epidemiol 2008; 37: 1041–58.
9. • Folate deficiency increased risk of orofacial clefts in people. In North
America, where fortification of grains with folic acid has been
mandatory since the late 1990s, some evidence suggests a decline in
prevalence at birth of cleft lip with or without cleft palate.
• Hernández-Diaz S, Werler MM, Walker AM, Mitchell AA. Folic acid antagonists during pregnancy
and the risk of birth defects. N Engl J Med 2000; 343: 1608–14.
10. • Zinc is important in fetal development, and deficiency of this nutrient
causes isolated cleft palate and other malformations. In the
Philippines, zinc deficiency is widespread, and high maternal amounts
of zinc in plasma were associated with low risk of orofacial clefts with
a dose-response relation.
• Warkany J, Petering HG. Congenital malformations of the central nervous system in rats produced
by maternal zinc defi ciency. Teratology 1972; 5: 319–34.
• Tamura T, Munger RG, Corcoran C, et al. Plasma zinc concentrations of mothers and the risk of
nonsyndromic oral clefts in their children in the Philippines.
11. • Maternal occupational exposure to organic solvents and parental
exposure to agricultural chemicals have been associated
inconsistently with cleft lip, cleft lip and palate, and cleft palate alone.
• Gordon JE, Shy CM. Agricultural chemical use and congenital cleft lip and/or palate. Arch Environ
Health 1981; 36: 213–21. 101
• García AM. Occupational exposure to pesticides and congenital malformations: a review of
mechanisms, methods, and results. Am J Ind Med 1998; 33: 232–40.
12. • Interferon regulatory transcription factors are activated after viral
infection. Association of IRF6 with clefts raises the possibility that viral
infection in the first trimester of pregnancy might enhance risk of a
cleft.
• Acs NA, Bánhidy F, Puhó E, Czeizel AE. Maternal influenza during pregnancy and risk of congenital
abnormalities in off spring. Birth Defects Res A Clin Mol Teratol 2005; 73: 989–96.
13. • Foetal moulding: decreased level of amniotic fluid can lead to the
head being flexed against the chest preventing growth of the
mandible.
• May cause a cleft palate as the tongue is forced upwards preventing
normal closure of the palatal shelves.
14. Genetic factors
• Cleft lip with or without cleft palate is listed as a feature of more than
200 specific genetic syndromes, and isolated cleft palate is recorded
as a component of more than 400 such disorders.
• The proportion of orofacial clefts associated with specific syndromes
is between 5% and 7%.
• Tolarova MM, Cervenka J. Classifi cation and birth prevalence of orofacial clefts. Am J Med Genet
1998; 75: 126–37.
15. Clinical management
1) Identification of modifiable risk factors for oral clefts is the first step towards
primary prevention.
2) Birth to six weeks – feeding assistance, support for parents, hearing tests and
paediatric assessment.
3) 3-6 months – surgery to repair a cleft lip
4) 6-12 months – surgery to repair a cleft palate
5) 18 months – speech assessment.
6) Three years – speech assessment.
7) Five years – speech assessment
8) 8-12 years – bone graft to a palatal cleft and RME to correct posterior crossbite
caused by palatal closure scar
9) 12-15 years – orthodontic treatment and monitoring jaw growth (Orthognathic
surgery)
10) These will usually be recommended until they're around 21 years of age, when
they're likely to have stopped growing.
16. Surgery for cleft lip
• The operation usually takes one to two
hours.
• A slight scar may remain, but the
surgeon will attempt to line up the scar
with the natural lines of the lip to make
it less noticeable. It should fade and
become less obvious over time.
18. Additional surgery (Bone graft)
Alveolar bone grafting between the ages (9 and 11) it encourages dental development and
subsequent treatment at the area of cleft. There is moderate evidence that it improves nasolabial
esthetics.
19. Feeding help and advice
• Many babies with a cleft palate have problems with breastfeeding because of the gap
in the roof of their mouth.
• They may struggle to form a seal with their mouth – so they may take in a lot of air and
milk may come out of their nose. They may also struggle to put on weight during their
first few months.
• A specialist cleft nurse can advise on positioning, alternative feeding methods and
weaning if necessary.
• If breastfeeding isn't possible, they may suggest expressing your breast milk into a
flexible bottle that is specially designed for babies with a cleft palate.
• Very occasionally, it may be necessary for your baby to be fed through a tube placed
into their nose until surgery is carried out.
20. Treating hearing problems
• Children with a cleft palate are more likely to develop problems
because of fluids builds up in the ear.
• This is because the muscles in the palate are connected to the middle
ear. If the muscles aren't working properly because of the cleft, sticky
secretions may build up within the middle ear and may reduce
hearing.
21. Speech and language therapy
• Repairing a cleft palate will significantly reduce the chance of future
speech problems, but in some cases, children with a repaired cleft
palate still need some form of speech therapy.
• A speech and language therapist (SLT) will carry out several
assessments of your child's speech as they get older.
22. Role of Orthodontics in cleft patients
• Orthopedic appliances to improve surgical results (Pre-maxillary
alignment), but according to recent evidence it is non significant to
use it.
NAM
23. What’s NAM appliance?
• First invented in 1950 as an adjunctive to correct cleft lip and palate, its
indication is to reduces the severity of the initial cleft alveolar and nasal
deformity.
• Initial impression of the cleft lip and palate infant is obtained within the
first week of birth. A heavy-bodied silicone impression material is used to
take the initial impression. The infant is held upside down by the surgeon
and the impression tray is inserted into the oral cavity. Air way must be
under supervision.
• The mouth is examined for residual impression material.
29. • The plate is made of hard, clear self-cure acrylic with 2-3mm
thickness.
• A retention button is fabricated and positioned anteriorly at an angle
of 40° to the plate. The vertical position of the retention arm should
be at the junction of the upper and lower lip. Its position is
determined in clinic.
• It is used to secure the molding plate in the mouth with the help of
orthodontic elastics and tapes.
• A small opening measuring 6–8 mm in diameter is made on the
palatal surface of the molding plate to provide an airway in the event
that the plate drops down posteriorly.
• The nasal stent is not fabricated at this time. Instead its construction
is delayed until the cleft of the alveolus is reduced to about 5–6 mm
in width.
30.
31. • Check for any sharp edges or rough surfaces that may irritate the soft
tissue. The appliance is then secured extra-orally to the cheeks and
bilaterally by surgical tapes that have orthodontic elastic bands at one
end.
• The use of skin barrier tapes on the cheeks.
• The horizontal surgical tapes are a quarter inch in width and about 3–
4 inches in length.
• Parents are instructed to keep the plate in the mouth full time and to
remove it for daily cleaning. The infant may require time to adjust to
feeding with the NAM appliance in the first few days.
• The baby is seen weekly to make adjustments to the moulding plate
to bring the alveolar segments together.
32.
33. Make sure that the
mother is educated
enough to deal with any
situation.
34. Nasal stent
• The nasal stent component of the NAM appliance is incorporated
when the width of the alveolar gap is reduced to about 5 mm. (WHY?)
• The rationale for delaying the addition of the nasal stent is that as the
alveolar gap is reduced, the base of the nose and the lip segment
alignment is also improved.
• The stent is made up of 0.36 inch, round stainless steel wire and takes
the shape of a ‘Swan Neck’, entering 3-4 mm of the nose.
35. Long-Term Effects of Presurgical Infant Orthopedics in Patients With
Cleft Lip and Palate: A Systematic Review (Aslihan Uzel and Nazan Alparslan)
• Based on the results of this study, treatment with passive IO
appliances have no positive effects on the seven treatment outcomes
(motherhood satisfaction, feeding, speech, facial growth, maxillary
arch dimension, occlusion, nasolabial appearance) in patients with
UCLP until the age of 6 years.
• Active appliances have no positive effects on feeding in patients with
UCLP.
• There is evidence on the improvement of nasal symmetry in patients
with UCLP using NAM appliances.
36. At the age of 9
• Bone graft placement at the bony defect, to help in canines eruption
and start orthodontic movements.
• Start to correct class skeletal relation by using facemask (for 12 hours
a day) with expansion to correct posterior cross-bite found in most
cases because of the scar of the palatal surgery.
37. Case scenario 1
• A.H is a 10 years old Egyptian female presented with a unilateral left
cleft lip and palate with class 3 incisor on class 3 skeletal base with
decreased vertical proportion. The overjet is -5mm with increased
incomplete overbite. Canine is unclassified and molar is class 3, She is
presented with bilateral transposition of upper canines and first
premolars and 2 supernumerary teeth with hypodontia in upper right
lateral incisor. Severe crowding upper arch and mild lower. She
performed first surgery when she was 6 months for the cleft lip then
she performed the first surgery for the palate when she was 1.5 years
old then second surgery for the palate when she was 2.5 years.
45. Additional surgery (Bone graft)
Alveolar bone grafting between the ages (9 and 11) it encourages dental development and
subsequent treatment at the area of cleft. There is moderate evidence that it improves nasolabial
esthetics.
46. Mid-treatment - Extra Oral views
Profile
Smile
Cleft patients have late growth, facemask can be used till 12
years of age. Facemask is used for shorter periods in cleft
patients (10-12hours). (Delaire et al)
48. Case scenario 2
• M.A is a 18 years old Egyptian male presented with class 1 incisor
relation on class 3 skeletal base with bilateral posterior crossbite. This
was complicated with increased complete overbite with cross-bite in
lower left central with upper right central. Hypodontia of upper left
lateral and extracted upper right displaced canine. Upper midline
shifted to the left by 5mm. Lip surgery performed at 6 months of age.
First palatal surgery performed at 1.6 years. Second surgery at 3
years. Third palatal surgery performed at 9 years. Grade 3 bone defect
at the palate.
53. References
• Mossey, Peter A., et al. "Cleft lip and palate." The Lancet 374.9703
(2009): 1773-1785.
• Uzel, Aslihan, and Z. Nazan Alparslan. "Long-term effects of
presurgical infant orthopedics in patients with cleft lip and palate: a
systematic review." The Cleft Palate-Craniofacial Journal 48.5 (2011):
587-595.