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CLEFT LIP AND PALATE.pptx
- 1. ACHEBE JU HONORARY CONSULTANT PLASTIC SURGEON UNTH
- 2. Common congenital abnormality of the face Involves the lips, nose and mouth Produces functional or aesthetic problems or both
- 27. Structures that will form the face present about 4-6wks of gestation Frontonasal process, paired maxillary and mandibular prominences Bilateral nasal placodes form from the frontonasal process They have medial and nasal processes Upper lip formed by fusion of medial nasal process with each other and maxillary prominence These events occur in the first trimester.
- 30. Structures destined to form the palate by 8wks Two palatal shelves of the maxilla, initially vertical with the tongue in between Palatal shelves rotate to become horizontal while the tongue descends Palatal shelves start fusion from in front and proceeds backwards
- 31. Failure of fusion Lack of mesodermal infiltration after fusion both
- 32. CLEFT LIP --unilateral- complete or incomplete bilateral -complete or incomplete median CLEFT OF THE PALATE----- extent CLEFT OF THE LIP AND PALATE—unilateral or bilateral—complete or incomplete SUBMUCOUS CLEFT.
- 34. Cleft of primary palate anterior to incisive foramen –eg cleft lip Cleft of the secondary palate- posterior to incisive foramen-eg cleft palate
- 35. White ancestry : 1 in 1000 live births Asian ancestry : 1 in 500 live births African ancestry : 1 in 2000 live births Cleft palate no racial bias 1:2000 live births
- 36. White population CLP > CP > CL NIGERIA 8o’s CL > CP > CLP NIGERIA now CLP > CL > CP CL and CLP different entity from CP CL and CLP more common on the left and males Isolated cleft palate more common in females Associated anomalies including syndromes more common in CP
- 37. Environmental teratogens phenytoin steroids alcohol smoking GENETIC FACTORS positive family history syndromes with cleft—Van der Woudes pierre robin sequence velocardiofacial syndro trisomy 21 Cleft lip and cleft lip and palate gentically different from isolated Cleft palate
- 38. From childhood to adult Multidisciplinary team
- 39. PLASTIC SURGEON ORAL SURGEON ENT SURGEON ORTHODONTIST PEDIATRICIAN SPEECH THERAPIST CHILD PSYCHIATRIST PEDIATRIC NURSES
- 40. History antenatal , family and social history Immediate problem feeding, and airway Nasal regurgitation of food Examination also look for associated abnormality Examine the mouth Baseline investigation Clinical photograph Reassure parents and outline management programme Submucous clefts could be missed ANTENATAL ULTRSOUND SCAN
- 47. For cleft palate assess the ear Higher incidence of sensorineural and conductive hearing loss
- 48. MICROGNATHIA CONGENITAL HEART DISEASE LIMB ABNORMALITIES LIP PITS CONGENITAL HERNIA
- 51. Cleft lip from 3months Cleft lip and palate lip repair as from 3mths palate repair 10-12mths Cleft palate palate repair 10-12mths Pierre Robin’s sequence palate 18 months
- 52. RULE OF TEN >10wks >10 Ibs >10gms
- 53. Normal appearance of lip, nose and face Normal speech Normal dentition Normal facial development
- 54. PRE-OP EVALUATION DEFORMITY RULE OF TEN CLEFT ORBICULARIS ORIS NASAL DEFORMITY MAXILLARY HYPOPLASIA DENTAL PROBLEM
- 58. ROTATION ADVANCEMENT TECHNIQUE [MILLARD] STRAIGHT LINE CLOSURE
- 67. ASSOCIATED PROBLEM SPEECH MIDDLE EAR INFECTION PIERRE ROBIN SYNDROME FEEDING PROBLEM
- 68. Adequate mechanism Hearing Intelligence Stimulating environment
- 69. consonants Hyper nasality Nasal escape Omission substitution
- 70. Poor aeration of middle ear Secretory otitis media with hearing loss Myringotomy and ventilating tubes
- 71. 10mths ----- 12mths
- 72. PRE-OP ASSESMENT TIMING OF REPAIR METHOD OF REPAIR V-Y PALATOPLASTY LANGENBECH PALTOPLASTY FURLOW TECHNIQUE BARDACH TECHNIQUE
- 80. HEMORRAGE AIR WAY OBSTRUCTION BREAK DOWN OF REPAIR FISTULA VPI MAXILLARY HYPOPLASIA
- 81. History Physical exam Nasendoscopy videofluroscopy
- 83. REVISION OF LIP 4-6yrs PHARYNGOPLASTY 6-9yrs ALVEOLAR BONE GRAFT 8-11yrs MAXILLARY OSTEOTOMY 15-18yrs ORTHODONTIC PROCEDURE RHINOPLASTY 15-18yrs
- 87. LACK OF OTHER SPECIALISTS IN THE CLEFT TEAM Speech language pathologists Orthodontists Maxillofacial surgeons interested in clefts Limited involvement of ENT surgeons in cleft care Poor follow up poverty
- 88. Functional reconstruction of cleft lip Functional reconstruction of cleft palate Primary nasal repair at the time of lip repair Charity organizations that sponsor cleft care in the developing countries
Editor's Notes
- NORMAL LIP NOSE