Seminar on

CLEFT LIP AND

PALATE
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.
 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.
(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
 ETIOLOGY
1. Genetic factors
2. Nutritional disturbances during
development
3. Physiologic, Emotional or traumatic stresses
during development
4. Defective vascular supply to the area
involved
5. A mechanical disturbance where the size of
the tongue may prevent the union of parts
6. Various environmental factors like
infections
(e.g. Rubella), exposure to radiation, drugs
like thalidomide, antiepileptic durgs,
 CLASSIFICATION

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

 SYMBOLIC AND
COMPUTERGRAPHIC
PRESENTATION
By Kernahan (1971)
Modified by Ehlsaky & Millard
(Rt) (Lt)

1,5 : Nasal floor 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
 NORMAL ANATOMY

(ACCORDING TO KERNAHAN AND STARK CLASSIFICATION)

GROUP 1 UNILATERAL GROUP 1a UNILATERAL GROUP 1a BILATERAL

(CONTD.)

GROUP II COMPLETE GROUP III UNILATERAL GROUP III BILATERAL

CLEFTS OF LIP
BILATERAL COMPLETE CLEFT PALATE
INCOMPLETE CLEFT PALATE
BILATERAL CLEFT LIP AND PALATE
UNILATERAL CLEFT LIP AND PALATE
 INCIDENCE
(a)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
CLINICAL FEATURES
(1) 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.

(2) INABILITY TO SUCK MOTHER’S MILK

(3) NASAL INTONATION FOR CLEFT PALATE
(4) NASAL REGURGITATION
(CONTD.)
(5) 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
(6) 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
REFERENCES:
1. TEXTBOOK OF PEDODONTICS:
SHOBHA TANDON
2. DENTISTRY FOR CHILDHOOD AND
ADOLESCENT:
McDONALD, AVERY