Cleft palate is a congenital deformity caused by abnormal facial development during gestation. It results from the failure of structures like the lip and palate to fuse properly before birth. Treatment requires a team approach and several surgeries over many years to repair the palate and address issues like feeding difficulties, speech problems, dental abnormalities, and ear infections. The goal of palate repair surgery is to separate the oral and nasal cavities to allow for normal speech and feeding.

1. بسم الله الرحمن الرحيم

2. Collection of data :- Dina M. Aboelata Dina M. Elnoamany Rania M. Matar Arrangment :- Dina Sabry Esmail Powerpoint :- Dina Hamdey Abdella Presented by:- Dina Gamal Ghanem Dina Hassan Mustafa Cleft palate BY

3. What is Cleft-palate ? Cleft palate is types of clefting congenital deformity caused by abnormal facial development during gestation. A cleft is a fissure or opening gap. It is the non-fusion of the body’s natural structures that form before birth. Clefts can also affect other parts of the face, such as the eyes, ears, nose, cheeks and forehead.

4. Embryology

5. primary palate:- During the fifth week the primary palate forms by the growth and fusion of the medial nasal, lateral nasal, and maxillary processes The maxillary process, derived from the proximal half of the first arch, grows to meet and fuse with the nasal processes

6. secondary palate:- During the sixth week two shelflike outgrowths from the maxillary swelling to form the secondary palate. The 2 palatal shelves initially are in a vertical position because of the interposed tongue.

7. At 7 weeks With extension of the head and mandibular growth, the tongue is withdrawn and the palatal shelves become into a midline for fusion and formation of a hard and soft palate Anteriorly the shelves fuse with the triangular primary palate, and the incisive foramen is formed at this junction

8. secondary palate primary palate

9. Clefts of the primary palate result from a failure of mesoderm to penetrate into the grooves between the medial nasal and maxillary processes, which prohibits their from fusion with each another Clefts of the secondary palate result from a failure of the palatine shelves to fuse with one another . The cause for this is failure of the tongue to descend into the oral cavity .

10. Normal palate Cleft palate

11. Classification

12. Classification veau:- Classification system proposed in 1938 Group I (A):- Defects of the soft palate alone Group II (B) Defects involving the hard and soft palates (not extending anterior to the alveolus)

13. Group III (C) Defects involving the palate through to the alveolus Group IV (D) Complete bi-lateral clefts.

15. Spina classification Classification system proposed in 1974. Pre-incisive foramen clefts (lip +/- alveolus) Uni-lateral Bi-lateral Median Trans-incisive foramen cleft (lip, alveolus, palate) Uni-lateral Bi-lateral Post-incisive foramen clefts (secondary cleft palate) Atypical (rare) facial clefts.

16. What aboute comlication?

17. ( 1)Feeding difficulties One of the most immediate concerns after birth is feeding as cleft palate make sucking difficult or cause gagging or nasal regurgitatio To overcome this problem by using a special bottle nipple or a small artificial palate (obturator) that fits into the roof of the mouth . The upright sitting position allows gravity to help the baby swallow the milk more easily

18. (2)Ear infections and hearing loss Babies with cleft palate are especially susceptible to middle ear infections . Ear infections are often due to a dysfunction of the tube that connects the middle ear and the throat. Over time, repeated ear infections can damage hearing , but hearing loss may resolve with treatment. It's important for children with cleft palate to be evaluated regularly by an audiologist. Most children with clefts have tubes inserted in their ears to drain fluids and help prevent infections.

19. (3)Dental problems :- If the cleft extends through the upper gum , tooth development will likely be affected. A pediatric dentist should monitor tooth development and oral health from an early age.

20. (4)Speech difficulties:- Because both the lip and palate are used in forming sounds, the development of normal speech can be affected. A speech pathologist can evaluate your child and provide speech therapy .

21. (5)Psychological challenges :- Children with clefts may face social, emotional and behavioral problems due to differences in appearance and the stress of intensive medical care

22. How to manage that disease?

23. Diagnosis:- prenatal ultrasounds can detect a cleft palate prior a child's birth. By detecting the cleft abnormality during a pregnancy, the expecting parents can have a prenatal consultation with a plastic surgeon. The symptoms of these abnormalities are visible during the first examination after birth.

24. Treatments for Children With Cleft Palate:- Children born with a cleft palate may need the skills of several medical professionals to correct the problems associated with the cleft Treatment usually requires a complex, lengthy treatment plan lasting until adulthood (see table below).

25. Assess ears and hearing Assess speech and language Check development 16-24 months Check feeding and growth Repair cleft lip Check ears and hearing 1-15 months Referred to cleft lip and palate team Diagnosis and genetic counseling Address psychosocial issues Provide feeding instructions Make feeding plan Prenatal Birth-1 month Intervention Age

26. Jaw surgery, rhinoplasty as needed Orthodontic bridges implants as needed 12-21 years Orthodontic interventions Alveolar bone graft 6-11 years Assess , manage velopharyngeal insufficency Assess development and psychosocial adjustment 2-5 years

27. Aim of repair:- separate the oral and nasal cavities , this separation involves the formation of a valve that is necessary for normal speech. also the muscles at the back of the palate need to be put in their proper place across the cleft so the child can learn to speak normally

28. Time of operation :- General agreement exists that surgical correction of a cleft palate should be accomplished when patients are younger than 1 year , before significant speech development occurs.

29. The six advantages for early closure of palatal defects:- (1) better palatal and pharyngeal muscle development once repaired (2) ease of feeding (3) better development of phonation skills (4) better auditory tube function (5) better hygiene when the oral and nasal partition is competent (6) improved psychologic state for parents and baby.

30. Langenbeck’s operation:- 1- Bare cleft edge 2- release incision in mucoperosteum 3- close nasal mucosa at floor of the nose 4- close mucoperiostium of hard palate 5- fracture ptyrigoid hamulus if needed to relax the flap

31. Before After

32. What should be expected post-operatively? Immediate postoperative airway management and pain management. Diet in the postoperative period is generally limited to liquids and soft foods that do not require chewing The use of bottles is avoided because the nipples may interfere with the repair. The use of spoons is also avoided for similar reasons. Feeding is accomplished by using either a cup or a Breck feeder (a red rubber catheter attached to a syringe). Normal diet and feeding may be resumed after 10-14 days, depending on the type of repair.

33. Normal regimen for follow up care:- Once discharged from the hospital, the patient should have follow-up visits at 7-10 days and at 3 weeks . If a small fistula or a wound breakdown is noted in this period, waiting at least 6 months prior to attempting closure is advised. This delay allows for maximal wound contracture and for reestablishment of the blood supply to the tissues

34. Complication of sugery:- Airway obstruction Results from the tongue falling back into the airway while the patient remains sedated from anesthetics. Placement of a tongue traction suture helps in the prevention of airway obstruction. Airway obstruction can also be a problem because of changes in airway dynamics , especially those in children with a small jaw. placement and maintenance of a tube in the trachea is necessary until palate repair is complete.

35. Bleeding Because of the rich blood supply of the palate Preoperative assessment of the hemoglobin level and the platelet count is important. Specific medication injected into the area being operated on, such as Epinephrine, can help significantly decrease blood loss.

36. Palatal fistula Wound breakdown occur as a complication in the immediate postoperative period, or it can be a delayed problem. palate fistulas can be managed in 2 ways:- 1-In a patient without any symptoms, a dental prosthesis can be used to close the defect with good results. 2- patient with symptoms may require surgery. Closure of persistent fistulas should be attempted no sooner than 6-12 months after

37. New Treatments for Cleft Palate:- Recent advances is presurgical orthopedics These are palatal plates which adjust the palate and alveolus to a more normal shape. Early interventions that reduce the need for surgeries as the child grows They are now viewed as adjuvants for surgery

38. In conclusion: Keep in mind that surgery to repair a cleft palate is only the beginning of the process Family support is critical for your child. Love and understanding will help him or her grow up with a sense of self-esteem that extends beyond the physical defect.

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