Cleft lip and cleft palate

BY
Ahmed Amer ibraheem
Farah abid yousif
Supervised by Dr. Auday Alanee
what is your  Hello doctor can
problem ? you help me
please?
Ok. Don’t
worry I can
 My son has cleft
help you . lip and cleft
palate .
No, it's a common  Is my son the only
problem for many.
one suffering from
this problem?
There are genetic and
environmental
 What are the causes
factors . that lead for this
deformity?
I’ll explain all the
details of this
problem for you .
EMBRYOLOGY
CLASSIFICATION
 In order to standardize documentation and communicate effectively,
various types of classification systems have been described. The early
Veau classification included groups 1–4 with increasing severity of
clefting:
 group 1 – cleft of the soft palate.
 group 2 – cleft of the hard and soft palate up to incisive foramen.
 group 3 – complete unilateral cleft lip and palate.
 group 4 – complete bilateral cleft lip and palate.
Kernahan and Stark classification of clefts.
 PRENATAL DIAGNOSIS
 With the appearance high resolution three-dimensional (3D)
ultrasonography and genetic tests for screening of birth defects,
intrauterine diagnosis of cleft lip is possible.
 Clefts of palate alone are rarely visualized on ultrasound.
CLINICAL
MANIFESTATION
 Oblique cleft

Transvers cleft
 Can you tell me the
suspected difficulties
that may face my
baby ?
 The most suspected
difficulties are :

1-dental problems
2-Malocclusion
3-Nasal deformity
4-Feeding
5-Ear problems
6-Speech difficulty
7-cosmetic & psychological
What is the most
optimum time for
treatment?
 The most optimum time for
treatment can be
summarized in this table .

procedure Timing

Cl repair After 10 weeks

CP repair 9 -18 months

Pharyngeal flap 3-5 years or later based on speech

development

Alveolar reconstruction 6-9 years based on dental development

with bone grafting

Cleft orthognathic 14-16 years girls

therapy 16-18 years boys

Cleft rhinoplasty After 5 years

Cleft lip revision After 5 years

The aims of management

• Normalize aesthetic
• Intact primary and secondary palate
• Normalize speech and hearing
• Nasal air patency
• Cl I occlusion
• Good dental and periodontal health
• Normal psychological development
 How can you
manage my son’s
problem ?
 The management of
CLP patient can be
divided into :

1- preoperative management
2- primary operative management
3- secondary operative management
 PREOPERATIVE
MANAGEMENT
Feeding
Presurgical orthopedic ( pso )

• Alveolar molding
• Lip strap or taping
• Nasoalveolar molding

Active appliance action

passive appliance action

PRIMARY OPERATIVE
MANAGEMENT

Surgical procedures for CL

• lip adhesion

• straight line repair

• Tennison-Randall triangular
flap repair

• Millard’s rotation-
advancement flap repair
• lip adhesion
• straight line repair
• Tennison-Randall triangular flap repair
• Millard’s rotation- advancement flap repair
PRIMARY OPERATIVE
MANAGEMENT

Surgical procedures for CP

• The von Langenbeck tec.

• The furlow tec.

• Two – flap tec.

• V-Y pushback tec.

• The von Langenbeck tec.

• The furlow tec.

• Two – flap tec.
• V-Y pushback tec.
COMPLICATIONS AFTER PROCEDURE OF PRIMARY OPERATIVE MANAGEMENT :

• Immediate post operative complications

• Breakdown of the repair
• Palatal ischemia
• Secondary truma
• Bleeding
• Oronasal fistula

• Long term complications

• Mid face growth deficiency
• Velopharyngeal incompetence
• Sleep apnea
• Recurrent fistula
POST OPERATIVE CARE OF PRIMARY OPERATIVE MANAGEMENT :

1.no nipples for feeding or sucking

2.elbow restrains for 3 weeks
3.regular fallow up
SECONDARY OPERATIVE
MANAGEMENT
Alveolar bone grafting

Secondary ( delay ) grafting Primary ( early) grafting

Early secondary grafting Secondary grafting Late grafting

GOALS OF ALVEOLAR BONE GRAFT:

1.provide bone support and adequate attached

gingival width for teeth adjacent to cleft
2.provide support for alar nasal baseand lip
3.close remaining oronasal fistula
4.improve nasal symmetry
5.augmentation of alveolar ridge to facilitate use of
prosthesis and dental implant
6.create appropriate ridge to allow optimization of
orthodontics treatment
SOURCE OF BONE GRAFT MATERIALS
 Iliac crest
 Cranium
 Tibia
 Mandibular symphysis
 Bone graft substitute
COMPLICATIONS AFTER PROCEDURE OF SECONDARY
OPERATIVE MANAGEMENT :

1.wound dehiscence
2.infection
3.persistant fistula
3.loss of graft
POST OPERATIVE CARE OF SECONDARY OPERATIVE
MANAGEMENT:

• Antibiotics
• Oral hygiene
• Good nutrition
• Liquid and soft diet
ORTHOGNATHIC SURGERY
Indications of orthognathic surgery

1.maxillary hypoplasia
2.reduce lower facial height
3.assymmetries
4.anterior cross bite
(severe negative overjet)
 DISTRACTION OSTEOGENESIS
REFERENCES
 t en i n g
u f or l is
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