CLEFT LIP & CLEFT

PALATE
CONTENTS
 EMBRYOLOGY
 CLASSIFICATION

- CLEFT LIP
- CLEFT PALATE
 PROBLEMS WITH CLEFT LIP &

PALATE
 TREATMENT
EMBRYOLOGY
 Face is formed by 5 processes which
surround the opening- ‘stomodeum’
 These 5 processes are:

- Frontonasal Process (single process)

- Maxillary Processes (one on each
side)
- Mandibular Process (one on each
side)
 Frontonasal process-divided into a
central part called Median nasal
process (MNP) & 2 Lateral nasal
processes (LNP) ,by olfactory pits.
- Olfactory pits form nostrils
- MNP develops a ‘globular process’
on each side.
-MNP & Globular process form,
1.Septum of nose
2. Philtrum of upperlip
3. Premaxilla
- LNP forms side of the nose.
 Maxillary Process-forms,
1.Cheek
2.Whole upperlip except the
philtrum
3.Most of the upper jaw
4.Palate
 Mandibular process-forms lower jaw.
 The ‘upper lip’ is thus formed
centrally from the superficial part of
MNP (Philtrum) ,lateral part is
formed by Maxillary process from
each side which fuses with MNP.
 Therefore defect in fusion of MNP
with Maxillary process will lead to
development of ‘Cleft lip.’
 The Palate develops from 3
components:
- premaxilla
- 2 palatine process of maxilla
come from each side and fuse in the
centre. The line of fusion is ‘Y’
shaped, and defect in this leads to
Cleft palate.
CLEFT LIP
 Developmental error in the formation of
the upper lip will lead to the formation of
cleft lip.
 Classification (A)

CLEFT LIP

INCOMPLETE COMPLETE
 CLEFT LIP
(B)

CENTRAL LATERAL

UNILATERAL BILATERAL
Unilateral complete Unilateral incomplete

Bilateral
complete
UNILATERAL CLEFT LIP
(C)
CLEFT
LIP

SIMPLE COMPOUND
(D)

CLEFT LIP

UNCOMPLICATED COMPLICATED
CLEFT PALATE
 It is due to failure of fusion of premaxilla
and 2 palatine process.
 Classification:

CLEFT
PALATE

COMPLETE INCOMPLETE
Incomplete cleft palate Unilateral complete Cleft
lip and palate

Bilateral complete cleft

lip and palate
BILATERAL COMPLETE CLEFT

LIP& PALATE
UNILATERAL COMPLETE
CLEFT LIP & PALATE
PROBLEMS WITH CLEFT LIP
 Cosmetic problem
 Difficulty in sucking
 Defective Dentition
 Defective Speech-
esp., with labial
words like ‘B’, ‘F’,
‘M’, ‘P’, ‘V’
 Deformed nostril
Root development of
permanent lateral incisor
in cleft lip &palate
Root development of permanent lateral incisor in
cleft lip & palate children:
PROBLEMS WITH CLEFT
PALATE
 Difficulty in sucking
 Difficulty in eating-due to
regurgitation of food into nose
 Difficulty in speech- cannot
pronounce palatal consonents like
B,D,K,P,T.
 Recurrent otitis media leading to
deafness.
A baby being fed
using the Cleft
Nurser by Mead
Johnson.
 Dental problems
 Defect in smelling
 Repeated respiratory tract infections

There are chances of aspiration

bronchopnuemonia.
TREATMENT
(A) Treatment of cleft lip:
 Optimum time for repair is at the
age of 3 months when the baby is 5
to 6 kg wt. This is always
performed before the time for
primary dentition to avoid defective
dentition.
 Technique of surgery- ‘Mirault Blair
operation.’
 Postop care- Suture are removed on
5th post op day . Pt’s hands should be
fixed in splints , so that he will not
be able to touch the operation site.
6 month old girl
before going into The same girl,1 month after
surgery the surgery.
Again the same girl, age 5.4 years
old
B) Treatment for cleft palate:
 Optimum time for surgery is at the
age of 1 to 1 ½ yrs i.e., before the
child acquires bad habit of nasal
speech.Too early repair may lead to
maldevelopment of maxillae in later
life.so closure of hard palate defect
should not be performed till the time
of secondary dentition
 Type of Surgery
-Langenbeck’s operation
-Wardill’s Operation
 An infant with a cleft palate will have
greater success feeding in a more
upright position. Gravity prevents
regurgitation
 Gravity feeding can be accompanied

By using specialized equipment like

Habermann Feeder.