CLEFT LIP AND CLEFT PALATE

Dr Deepthi Viswaroopan M.D(Ay)

Assistant Professor, Parul University
drdeepthiviswaroopan@gmail.com
Introduction
• Cleft lip and Cleft palate are congenital
malformations
• Resulting from the failure of fusion of axillary
process during intrauterine development
 CLEFT LIP (Cheiloschisis)
• It results from failure of fusion of maxillary
process with nose elevation on frontal
prominence.
• Types:
– Partial or incomplete
– Complete
– Unilateral
– Bilateral
 CLEFT PALATE (Palatoschisis)
• It results from failure of fusion of the hard
palate with each other and with the soft
palate.
• Cleft lip also usually occurs with cleft palate.
• Type: -
– Complete
– Incomplete
CAUSES
• Medication taken by mother (Anticonvulsants,
chemo drugs)
• Exposure to viruses or chemicals
• Excess exposure to X-ray
• Maternal Anemia
• Maternal alcohol abuse
• Maternal smoking
EMBRYOLOGY
Development of facial structures starts at the end of
4th week
5 facial prominences:
1. Unpaired frontonasal process
2. Paired maxillary prominences
3. Paired mandibular prominences
In following 2 weeks –
• The 2 medial nasal processes fuse in midline –
upper lip
• Mandibular processes fuse in midline – lower lip
• Frontonasal process – bridge of the nose
• Medial nasal process – tip of nose and philtrum of
upper lip
• Lateral nasal process – ala of the nose
PATHOPHYSIOLOGY
• Embryological Development
• Lower lip and nose fuses with 5
major facial prominences
– Lip development: 3rd and 7th week
– Palate development: 5th and 12th
week
• The face and facial structures are
formed out of three plates, each
migrating toward a meeting point
in the middle area of the face.
PATHOPHYSIOLOGY...
• Failure of fusion of the maxillary
and premaxillary process
• Failure of palatal process fusion
• Complete or partial non- union
may affect the palatal bone,
upper lip along with maxilla,
premaxilla and tissue of soft
palate and uvula
• CLEFT LIP & CLEFT PALATE
TYPES
Clinical complaints
i. Feeding problems
ii. Failure to gain weight
iii. Respiratory infections
iv. Repeated Ear infections/ hearing loss
v. Speech problems
vi. Dental problems
DIAGNOSIS
• MATERNAL USG : Prenatal diagnosis

• Physical examination : Detected immediately

after birth
Surgical management
CLEFT LIP –
• Chieloplasty
• Requires one or two surgeries depending on the severity of defect
• The initial surgery is done at the age of 3 months
• MEDICAL MANAGEMENT• Assessment of the child• • Feeding the child•
• 15. SURGICAL MANAGEMENT• •

CLEFT PALATE
• Platatoplasty
• It requires multiple surgeries over a course of 18 years
• 1st Surgery: 6 – 12 months
• 2nd Surgery: 8 years
• 3rd Surgery : After permanent teeth grows
Precautions
• Reassurance to parents - Explain the
possibility of defect correction
• Airway clearance
• Breast feeding is possible with the use of
palatal prosthesis
• Explain to parents about the risk of aspiration
• Infection prevention