23 introduction cleft lip & palate

1. Dr V.RAMKUMAR
CONSULTANT DENTAL&FACIOMAXILLARY SURGEON
REG NO:4118-TAMILNADU –INDIA(ASIA)
INTRODUCTION TO CLEFT LIP & PALATE

2. PHARYNGEAL ARCHES
•PHARYNGEAL ARCHES DEVELOPS IN THE
4
TH
AND 5
TH
WEEK.
•5 PHARYNGEAL ARCHES
•EACH ARCH CONTAINS
CARTILAGENOUS,MUSCULAR 8 NERVE
COMPONENTS
•PREMAXILLA AND MAXILLA DEVELOPS
FROM 1
ST
ARCH.
•ORBICULARIS ORIS DEVELOPS FROM 2
ND

ARCH.

4. FORMATION OF FACE
•AT ABOUT 24 DAYS – 1
ST
ARCH –MAXILLARY
& MANDIBULAR PROCESS.
•AT ABOUT 28 DAYS – NASAL PLACODES
CONVERTS INTO NASAL PITS.
•LATERAL,MEDIAL AND FRONTONASAL
PROCESSES
•FORMATION OF MIDDLE PORTION OF LIP
(UPPER) & PORTION OF MAXILLA &
PRIMARY PALATE.
•FORMATION OF UPPER & LOWER LIPS.

6. FORMATION OF PALATE
•COMMON ORONASAL CAVITY
•PALATAL PROCESSES ARE DIRECTED
DOWNWARDS ON EACH SIDE OF
TONGUE
•7
TH
WEEK – TONGUE IS WITH DRAWN
•8
TH
WEEK - TONGUE IS DEPRESSED.

8. ANATOMY OF PATATINE BONES
•TWO PALATINE BONES
•IT HELPS TO FORM
- FLOOR & LATERAL WALL OF NASAL
CAVITY.
- ROOF OF ORAL CAVITY
- PTERYGOPALATINE & PTERYGOID
FOSSAE.
- INFERIOR ORBITAL FISSURE.

9. PARTS
•HORIZONTAL & PERPENDICULAR
PLATES
•PYRAMIDAL,ORBITAL & SPHENOIDAL
PROCESSES.
•TWO HORIZONTAL PLATES FORMS
POSTERIOR 1/4
TH
OF HARD PALATE.
•PERPENDICULAR PLATE FORMS THE
MEDIAL WALL OF PRERYGOPALATINE
FOSSA.

10. CONT…
(PROCESSES)
•PYRAMIDAL PROCESS
- LIES BETWEEN THE TUBEROSITY OF
MAXILLA &PTERYGOID PLATES OF
SPHENOIDBONE.
- ORBITAL PROCESS
- SPHENOIDAL PROCESS.

11. SOFT PALATE
•SUSPENDED FROM THE POSTERIOR
BORDER OF THE HARD PALATE.
•MUSCLES: TENSOR PALATI
LEVATOR PALATI
MUSCULUS UVULAE
PALATOGLOSSUS
PALATOPHARYNGEUS.

12. NORMAL ANATOMY & PHYSIOLOGY OF THE
LABIO-NASO-GENIAL MUSCULATURE & THE
MEDIAL SEPTUM OF THE UPPER LIP.
•UPPER LIP CONTAINS -
EXTERNAL & INTERNAL
ORBICULARIS & INCISAL BANDS.
•3 SPHINTER RINGS – FACE TO
CHIN
• UPPER, MIDDLE & LOWER RING.

13. CONT….
•UPPER RING:
- TRANSVERALIS NASI
- LEVATOR LABISUPERIORIS
- LEVATOR LABI SUPERIORIS
ALAEQUE NASI
- ZYGOMATICUS MAJOR &
- LEVATOR ANGULARIS ORIS.

14. CONT…
•MIDDLE RING:
- INTERNAL ORBICULARIS LABII
SUPERIORIS.
- EXTERNAL ORBICULARIS LABII
SUPERIORIS.
- INCISAL FIBRES
- MYRTIFORMIS
•LOWER RING:
- ORBICULARIS INFERIOR
- TRIANGULARIS LABII &
- QUADRATUS LABII INFERIORIS.

15. ANATOMY OF PREPALATAL &
PALATAL CLEFTS.
•CLEFT USUALLY FOLLOW THE LINES OF
FUSION
•UNILATERAL CLEFT – ANTERIOR FLARRING
OF PREMAXILLA
•BILATERAL CLEFT – PROTRUSION.
•UNILATERAL CLEFT – VOMER ATTACHED
TO MAXILLA ON NON –CLEFT SIDE.
•BILATERAL CLEFT – VOMER UNATTACHED
LATERALLY.

16. CLEFTS OF SOFT PALATE
•LEVATOR PALATI MUSCLE ORIENTED
IN MORE LONGITUDINAL DIRECTION.
•SUBMUCOSAL CLEFT – SOFT PALATE
MUCOSA INTACT.
•TENSOR PALATI MUSCLES ARE ALSO
ABNORMAL.

17. ANATOMY OF THE UNILATERAL
CLEFT LIP
•SUBCUTANIOUS CLEFT LIP:
- DURING LIP MOVEMENT MUSCLE
BULGES
- IMBALENCED MUSCLE
TRACTION.
- CHANGES OF THE UNDERLYING
BONY STRUCTURES.

18. PARTIAL CLEFT LIP
•INVOLVEMENT OF VERMILLON – 2/3
RD

OF LIP HEIGHT.
•ORBICULARIS ORIS IS DIVIDED
COMPLETELY.
•NASAL DEFORMITIES &ASYMMETRIC
FUSION OF LIP.

19. PARTIAL CLEFT LIP

20. COMPLETE CLEFT LIP
•AFFECTS FACIAL GROWTH
•DIFFERENT FORCES ACTING ON
EACH SIDE OF THE CLEFT
•HYPOPLASIA OF THE SOFT TISSUES &
BONY STRUCTURES
•COLUMELLA DEVIATED TO THE NON –
CLEFT SIDE
•SIMONART’S BAND.

21. NASAL DEFORMITY ASSOCIATED WITH
UNILATERAL CLEFT LIP.
•COLUMELLA IS SHORTER ON THE CLEFT
SIDE.
•COLUMALLA BASE DEVIATED TO THE NON
CLEFT SIDE
•S- SHAPED FOLD
•LOWER LATERAL CARTILAGE & NASAL TIP
•VESTIBULAR DOME IS EXCESSIVELY
OBTUSE
•HORIZONTAL ORIENTATION OF NOSTRIL

22. CONT….
•NOSTRIL IS RETROPOSITIONED
•NOTRIL IS SMALLER OR LARGER
THAN OPPOSITE
•NASAL FLOOR IS LOWER ON THE
CLEFT SIDE
•NASOLABIAL FISTULA
•NASAL SEPTUM DEVIATED

23. CONT….
•NASAL FLOOR IS ABSENT
•HYPOPLASIA OF THE MAXILLA ON
THE CLEFT SIDE
•PREMAXILLA IS DISPLACED ON THE
NON-CLEFT SIDE.

24. NASAL DEFORMITY ASSOCIATED
WITH UNILATEREL CLEFT

25. ANATOMY OF THE BILATERAL
CLEFT LIP
•ENTIRE HEIGHT OF
THE LIP.
•SIZE OF
PROLABIUM
VARIES.

26. COMPLETE BILATERAL CLEFT OF THE
LIP & ALVEOLUS
•RARE DEFORMITY
•ISOLATION OF PROLABIUM &
PREMAXILLA
•SIZE OF THE PRE-MAXILLA VARIES
•COLUMAEELA IS SHORT.

27. COMPLETE BILATERAL CLEFT
& ALVELOUS

28. COMPLETE BILATERAL CLEFT
LIP,ALVEOLUS & PALATE.
•MOST COMMEN
•PREMAXILLA IS ROTATED &
DISPLACED
•LOWER EDGE OF VOMER,APPARENT
THROUGH PALATAL CLEFT
•LITTLE OR NO COLUMELLA
•NASAL TIP IS FLAT & ALAR DOMES IS
TOO WIDE.

29. COMPLETE BILATERAL CLEFT
LIP,ALVEOLUS AND PALATE.

30. REFERENCES
1.PLASTIC SURGERY – GRAB & SMITH
2.PLASTIC SURGERY - MC CARTHY(VOL-IV)
3.SURGICAL TECNIQUES IN CLEFT LIP & PALATE –
JANUSZ BARDACH
KENNETH E. SALYER
4.OSTEOLOGY - S.PODDAR
5.HUMAN ANATOMY – B.D.CHAURASIA
6.EMBRYOLOGY – TENCATES
7.OUTLINE OF ORAL &MAXILLOFACIAL SURGERY-
WARD BOOTH.