‫‪Cleft Lip & Palate‬‬
‫الدكتور علي القصير‬
‫اختصاص الجراحه التجميليه‬
‫والتقويميه‬
introduction
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Facial clefting is the second most common
congenital deformity (after clubfoot).
Affects 1 in 750 births
Problems are cosmetic, dental, speech,
swallowing, hearing, facial growth, emotional
Prevalence
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CL/P is more common than CP and varies by ethnicity.
CL/P
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High in American Indians and Asians (1/500 newborns)
Low in American blacks (1/2000 newborns)
Intermediate level in Caucasians (1/1000 newborns)
More common in male
Isolated CP occurs in only 1/2500 newborns , does not
display variation by ethnicity and more common in
female.
Cleft Lip
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Complete closure at 35 days postconception:
7 weeks from the LMP.
 Lateral nasal, median nasal, and maxillary
mesodermal processes merge.
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Failure of closure can produce unilateral,
bilateral, or median lip clefting.
Left side unilateral cleft is the most common.
Cleft Palate
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Lack of fusion of the palatal shelves.
Abnormalities in programmed cell death may
contribute to lack of palatal fusion(?).
Isolated disruption of palate shelves can occur
after closure of the lip
Palatal closure is not completed until 9 weeks
post-conception.
emberology
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Primary Palate- Triangular area of hard palate
anterior to incisive foramen to point just lateral
to lateral incisor teeth
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Includes that portion of alveolar ridge and four
incisor teeth.
Secondary Palate- Remaining hard palate and all
of soft palate
embryology
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Primary Palate
Forms during 4th to 7th week of Gestation
Two maxillary swellings merge
 Two medial nasal swelling fuse
 Intermaxillary Segment Forms:
Labial Component (Philtrum)
Maxilla Component (Alveolus + 4 Incisors)
Palatal Component(Triangular Primary Palate)
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embereology
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Secondary Palate
Forms in 6th to 9th weeks of gestation
 Palatal shelves change from vertical to horizontal
position and fuse
 Tongue must migrate antero-inferiorly
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anatomy
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Hard Palate
Bones: Maxilla( Palatine Processes) +
Palatine Bones(Horizontal Lamina)
 Blood Supply: Greater Palatine Artery
 Nerve Supply: Anterior Palatine Nerve
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Anatomy
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Soft Palate
Fibromuscular shelf attached like a shelf to posterior
portion of hard palate
 Tenses, elevates, contacts Passavant’s Ridge
 Muscles: Tensor Veli Palatini(CNV),
Levator Veli
Palatini(Primary Elevator), Musculus Uvulae,
Palatoglossus, Palatopharyngeus(CN IX and X)
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Etiology
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Several agents that are associated with an
increased frequency of midfacial malformation.
Genetics
Medications —phenytoin, sodium valproate,
methotrexate.
With corticosteroids there is no evidence of an
increase in malformations.
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Possible association could not be excluded
Etiology
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Cigarette smoking
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Alcohol
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Noted with mothers of children with facial clefting, both
CL/P and CP.
Teratogenesis has been attributed to hypoxia as well as a
component of tobacco (cadmium).
Associated with an increased risk of fetal facial clefting.
Alterations in cell membrane fluidity or reduced activity of
specific enzymes such as superoxide dismutase.
Folate deficiency
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Contributes to a range of birth defects.
Evidence is emerging for a similar association with the
development of CL/P.
Cleft formation
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Cleft result in a deficiency of tissue
Cleft lip occurs when an epithelial bridge fails
Clefts of primary palate occur anterior to
incisive foramen
Clefts of secondary palate occur posterior to
incisive foramen
Unilateral incomplete
Incomplete cleft palate
Unilateral complete
Unilateral complete lip and
palate
Bilateral complete
Bilateral complete
Examples of Cleft Palate
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Cleft of
Cleft of
Cleft of
Cleft of
Back Soft Palate
Soft Palate
Soft and Hard Palate
Soft and Hard Palate and Cleft Lip
treatment
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Feeding
respiratory tract and ear infection
Orthodontic
Surgery
Surgery
 Cleft
lip repair =role of ten ( wt:
10 pounds, age :10 weeks and 10
gm /ds litter haemoglobin)
 Cleft palate repair at 10 month
to 18 months .
 Cp repair before speeking