This document summarizes a seminar on cleft lip and palate. It discusses the development, etiology, classification, incidence, clinical features, and associated syndromes of cleft lip and cleft palate. Various theories for the development are provided. Genetic and environmental factors that may cause clefts are described. Different classification systems for clefts are outlined, including those based on morphology and embryology.

1. ``welcome``

2. Seminar on CLEFT LIP AND PALATE

3. CLEFT LIP: Cleft lip is a birth defect that results in a unilateral or bilateral opening in the upper lip between the mouth and nose. CLEFT PALATE: Cleft palate is a birth defect characterized by an opening in the roof of the mouth caused by a lack of tissue development.

4. DEVELOPMENT OF CLEFT (a) Cleft Lip : Various theories have been given for its development. - Failure of fusion between median nasal process and maxillary process. - Failure of mesodermal migration between the two layered epithelial membrane. This leads to a breakdown and cleft formation. - Rupture of cyst formed at the site of fusion.

5. (b) Cleft Palate : Various theories have been given for its development. - Alteration in intrinsic palatal shelf force - Failure of tongue to drop down - Non fusion of shelves - Failure of mesodermal migration - Rupture of cyst formed at the site Of fusion.

6. ETIOLOGY Genetic factors Nutritional disturbances during development Physiologic, Emotional or traumatic stresses during development Defective vascular supply to the area involved A mechanical disturbance where the size of the tongue may prevent the union of parts Various environmental factors like infections (e.g. Rubella), exposure to radiation, drugs like thalidomide, antiepileptic durgs, hormonal pills, quinine etc. Maternal consumption of alcohol and smoking

7. CLASSIFICATION Morphological Classification (a) By Davies and Ritchie (1922) (b) By Veau (1931) Embryological Classification (a) By Kernahan & Stark (1958) (b) By Spina (1974)

8. 1.a Classification by Veau Group-I Cleft of the soft palate only Group-II Cleft of the hard and soft palate till the incisive foramen. Group-III Complete unilateral cleft of the soft palate,hard palate,the alveolar ridge and the lip on one side Group-IV Complete cleft of the soft palate, hard palate, the alveolar ridge and lip on the both side.

9. 2.a Classification by Kernahan and Stark Group-I Cleft of the primary palate only (i) Unilateral (ii) Bilateral (iii) Total (iv) Sub-total Group-II Cleft of the secondary palate only (i) Total (ii) Sub-total (iii) Submucous Group-III Cleft of the primary & secondary palate (i) Unilateral -Total, Sub-total (ii) Median - Total, Sub-total (iii) Bilateral -Total, Sub-total

10. 2.b Classification by Spina Group-I Pre-incisive foramen clefts (i) Unilateral (ii) Bilateral (iii) Median Group-II Tran-incisive foramen clefts (i) Unilateral (ii) Bilateral Group-III Post-incisive foramen clefts (i) Total (ii) Partial Group-IV Rare facial clefts

11. SYMBOLIC AND COMPUTERGRAPHIC PRESENTATION By Kernahan (1971) Modified by Ehlsaky & Millard (Rt) 1,5 : Nasal floor (Lt) 2,6 : Lip 3,7 : Alveolus 4,8 : Hard palate anterior to incisive foramen. 9,10: Hard palate posterior to incisive foramen 11 : Soft palate

12. NORMAL ANATOMY (ACCORDING TO KERNAHAN AND STARK CLASSIFICATION) GROUP 1 UNILATERAL GROUP 1a UNILATERAL GROUP 1a BILATERAL

13. (CONTD.) GROUP II COMPLETE GROUP III UNILATERAL GROUP III BILATERAL

14. CLEFTS OF LIP

15. BILATERAL COMPLETE CLEFT PALATE

16. INCOMPLETE CLEFT PALATE

17. BILATERAL CLEFT LIP AND PALATE

18. UNILATERAL CLEFT LIP AND PALATE

19. INCIDENCE Among different races  Whites - One out of 800  Blacks - One out of 2000  Japanese or Indians - One out of 500 (b) Of different clefts  Cleft lip alone - 25%  Cleft palate alone - 25%  Cleft lip and palate both - 50% (c) Males > Females (for combined cleft lip & palate) Females > Males (for cleft palate only) (d) Unilateral defects > Bilateral defects (e) Left sided defects > Right sided defects (f) Increase in parental age  increase risk of producing affected child.

20. CLINICAL FEATURES FACIAL DEFORMITY – NOSE TIP DEVIATED TO NORMAL SIDE, ALA ON CLEFT SIDE FLARED, NOSTRIL HORIZONTALLY ORIENTED, LIP DEFORMITY, HYPOPLASTIC AND A COLLAPSED MAXILLA ON SIDE OF THE CLEFT AND THE CLEFT PALATE . - FOR BILATERAL CLEFTS ADDITIONAL FEATURES LIKE PROTRUDED PRE-MAXILLA, SMALL PRO-LABIUM, ABSENT COLUMELLA AND SHALLOW GINGIVOLABIAL SULCUS. INABILITY TO SUCK MOTHER’S MILK NASAL INTONATION FOR CLEFT PALATE NASAL REGURGITATION (CONTD.)

21. TOOTH DEFECTS – WHICH MAY BE SUPER NUMERARY TEETH CONGENITALLY MISSING TEETH T- CINGULUM PEG LATERALS THICK CURVED HYPOPLASTIC INCISORS NATAL TEETH GERMINATION DELAYED ERUPTION OF PERMANENT TEETH HYPOPLASTIC INCISORS NEXT TO ALVEOLAR DEFECTS ASSOCIATED SYNDROMES – CLEFT LIP MAY BE ASSOCIATED WITH FOLLOWING SYNDROMES DOWN’S SYNDROME WARDEN BURG’S SYNDROME VANDERWOUDE’S SYNDROME ORO-FACIAL DIGITAL SYNDROME TREACHER COLLIN’S SYNDROME PIERRE ROBIN’S SYNDROME KLIPPEL FEIL’S SYNDROME

22. REFERENCES: 1. TEXTBOOK OF PEDODONTICS: SHOBHA TANDON 2. DENTISTRY FOR CHILDHOOD AND ADOLESCENT: McDONALD, AVERY

23. THANK YOU