Cleft lip and palate is an abnormal separation in the oral-facial region that occurs during fetal development when tissues do not form correctly. It can present as an opening in the upper lip and/or roof of the mouth. Treatment involves surgery to repair the cleft, as well as speech therapy and orthodontics, as clefts can cause difficulties with feeding, dental issues, ear infections, speech, and psychosocial challenges. Early intervention is emphasized to optimize outcomes.

2. CLEFT LIP AND PALATE

3. Definition
A cleft lip or
palate is an
abnormal
separation in the
oral-facial region
that happens
because, tissue of
the mouth or lip
does not form
correctly in fetal
development.

4. Cleft Lip
A cleft lip appears as a narrow
opening or gap in the skin of the
upper lip that extends all the way to
the base of the nose

6. Cleft Palate
A cleft palate is an opening between
the roof of the mouth and the nasal
cavity. Some kids have clefts that
extend through both the front and rear
part of the palates, while others have
only partial clefting.

8. Incidence
Cleft lip
•1/1000 live births
Cleft palate
•1/2000 live births
•Cleft lip and palate
•1/600

9. SOME FACTS
 Most common congenital orofacial
abnormality is cleft lip and palate
 1:600
 Associated with congenital heart
disease
 Associated features in 300 syndromes
(Stickler’s,Shprintzen’s,Down’s,Apert’
s,Treachr-Collins)

10. A research finding
 Isolated Cleft palate is more common
in females
 Isolated cleft lip more common in boys
 CP and CL more in males
 Unilateral CL effects the left side in
60% of cases

11. Etiology
 Genetic predisposition and environmental
triggers
 First degree relatives are 25 times more
likely to have a deformities than normal
population
 Combined CP and CL have a more
predominant genetic factor
 CP alone has a more predominant
environmental factor

12. Environmental factors include :
 Maternal epilepsy
 Drugs (steroids,diazepam,phenytoin)
 Infections: Rubella
 Alcohol, Smoking, Hypoxia
 Dietary deficiencies: Folic acid

13. Complications

14. FEEDING
One of the most immediate concerns
after the birth of an infant with cleft lip
and cleft palate is feeding, which can
be difficult due to inadequate suction,
lack of an air-tight latch or nasal
regurgitation.

15. Dental Problems
If the cleft extends through the upper gum,
tooth development will likely be affected.
EAR INFECTIONS AND HEARING DEFEICITS
Hearing may be affected because the
muscles of the palate affect the ear, making
the child more likely to develop "glue ear".
This is a condition where thick sticky fluid
accumulates behind the eardrum as a result
of an infection of the middle ear.

16. Speech And Language
Problems in ARTICULATION
Cleft palates in particular lead to
speech problems as the top of the
mouth is not available for the tongue
to hit in order to make specific words
and sounds.

17. For speakers with a cleft palate,
speech sounds that require
intra oral pressure are mostly
affected, nasal consonants and
semivowels are least affected,
errors increase with increased
phonetic complexity.

18. NASALITY

19. Psychological Challenges
Children with clefts are more
likely to have social, emotional
and behavioral problems due to
differences in appearance and
family stress

20. Treatment & Management
• Treatment
involves many
things which
include plastic
surgery,
orthodontics,
and speech
therapy

21. First Stage-treatment
The first part of
the process is
surgery.

22. Surgical Treatment
➢Cleft lip: "Rule of Tens" -- ten weeks,
ten pounds, hemoglobin of 10
➢Cleft palate: around 1 year, before
speech develops

23. Second Stage-Speech
therapy
The next stage
is therapy.
Because of
surgery being
done so early
hopefully
speech will form
correctly but
because the
child has to
adapt, therapy
is advised.

24. Use of a Straw to Amplify Nasal
Emission and/or Hypernasality

25. ● Auditory Feedback of Hypernasality
and/or Nasal Emission

26. VISUAL FEED BACK USING AIR
PADDLE/ PAPER

27. TACTILE FEED BACK

28. CUL DE SAC TECHNIQUE
(NOSE PINCHING)

29. Compensatory Articulation Productions
Compensatory articulation productions are
usually developed because there is
inadequate oral pressure for normal
productions. Compensatory productions may
result in better intelligibility.
Increase Volume
• Increasing vocal effort and thus volume can
result in an increase in respiratory support,
velopharyngeal effort, oral air pressure, and
the force of articulation
• The ultimate goal is a normal degree of
volume

30. Light, Quick Contacts
• Light, quick contacts during the
production of pressure-sensitive
phonemes, particularly
plosives helps to eliminate the back-
up of air pressure in the
nasopharynx and reduces the
occurrence of nasal air emission and
a nasal rustle

31. Get the back of the tongue down and the
velum up by having the child yawn.
• Have the child co-articulate the yawn
with vowels and anterior sounds.
• Have the child think of the yawn
movements when articulating other
sounds
YAWN AND CO ARTICULATE

32. prosthodontist
Some patients can
get benefits from ,
pharyngeal plates
,which are
especially
designed in a way,
to prevent nasal
emission and teeth
alignment can also
be beneficial

33. Feeding A Child with a Cleft
Make sure child is taking feed in an
upright position. Gravity will help
prevent milk from coming through the
baby's nose. This limits choking and
gas. It also helps to decrease the risk of
ear infections.

35. contd......
Use a cleft palate bottle or other
squeezable bottle. The hole in the nipple
can be madebigger by cutting an X in the
top. With a squeezable bottle, Milk can
actually be pushed into child’s mouth and
he/she doesn't need to suck.

37. contd...
Burp the baby frequently. Infants with
cleft palate tend to swallow a lot of air
during feedings – even when eating in
the upright position.

38. conclusion
Cleft lip and palate are one of the
most common oro-facial congenital
abnormality, resulting in feeding,
listening and speech issues.
Appropriate management at early
stage can lead to good results