Cleft Lip

Def:abnormal development of median nasal and maxillary process

Development of palate
Palate develop around 6-8 weeks from 3 components
1.premaxilla-from median nasal process
2 & 3 maxillary process which contributes 1 palatine process on each side
Fusion of these process
In form of Y letter
Types of cleft
Central
Lateral

Complete/incom
plete
Simple/compoun
d

-very rare
-due to failure fusion of 2
median nasal process
-common
-cleft between frenulum and
lateral upper lip
-due to imperfect fusion of
maxillary process with median
nasal process
-unilateral/bilateral
-cleft does not extend up to
nostril
-compound cleft lip associated
with cleft in alveolus

Functional effects
1.interferes with swallowing
2.unable to make sound like B,D,K,P,T
3.teeth:upper incisors may be small/absent
4.nose:oral organisms contaminate upper respiratory mucous membrane
5.hearing
Pathogenesis of cleft lip
1.genetics,chromosomal abnormalities 4p,4q,5p
2.alcohol,smoking,drugs:phenytoin
3.maternal folic acid deficiency
Cleft Lip repair
1.timing:
a)early repair
-retarted maxillary growth due to surgical trauma to growth centre and
periosteum
b)delay repair:-speech defect
Best balanced:by repairing between 1 and half yr
Types of cleft lip repair:
unilateral cleft lip
-millards rotation advancement
-flap and tennison
-triangular flap method

bilateral cleft lip

1,single stage
-Veau III method
2,two stages
-triangular flap method
-flap and tennison
-interval of 3-6 months

Management of cleft lip and cleft palate

1.multidisciplinary approach
-plastic surgery, -paediatrics
-orthodontics
-speech pathology
-prosthodontics
2.feeling advice
-baby unable to suck milk because intraoral negative pressure cannot be
created
-expressed mothers milk given by spoon with head of baby elevated 45
degree

-swallow air during feeding is released frequently by burping