Cleft lip and palate.pptx

Lecture notes for medical students

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.

2. Introduction

3. Introduction Orofacial clefts — cleft lip ( CL) cleft lip and palate ( CLP) cleft palate (CP) alone

4. Introduction

5. Aetiology

6. Aetiology Idiopathic Congenital/Genetic Traumatic Infections /Infestation Autoimmune Neoplastic (Benign/Malignant) Degenerative Iatrogenic

7. Pathophysiology

8. Pathophysiology Embryology The upper lip is derived from medial nasal and maxillary processes. Failure of merging between the medial nasal and maxillary processes at 5 weeks' gestation, on one or both sides, results in CL.

9. Pathophysiology Embryology Primary palate forms by the growth and fusion of the medial nasal, lateral nasal, and maxillary processes Secondary Palate develops from the right and left palatal Shelves. Fusion of palatal shelves begins at 8 weeks' gestation and continues usually until 12 weeks' gestation .

10. Pathophysiology Embryology The incisive foramen is the key landmark in the bony palate The premaxilla lies anterior to the incisive foramen and includes the 2 premaxillary bones: the alveolus and the incisors. Primary palate -nasal tip and the upper central lip. Posterior to the incisive foramen lies the secondary palate, comprising the hard palate and soft palate.

11. Anatomy of palate

12. Demography

13. Demography Orofacial cleft types combined occur in white populations with a frequency of 1 per 500-550 live births . cleft lip and cleft lip and palate occur significantly more often in males, and cleft palate occurs significantly more often in females . The lowest rate is for blacks A high prevalence of CL/P was found for the Japanese population, and the highest prevalence was found for the North American Indian populations . no remarkable variation among races was found in isolated CP.

14. Risk of recurrence

15. Risk of recurrence Two factors are most important in evaluating the risk of recurrence for CL/P: Sex of the individuals ( ie , patient and individual at risk) Severity of the effect in the patient ( eg , unilateral vs bilateral) The lowest recurrence risk for CL/P is for the subcategory of male patients with unilateral cleft (see the first image below) and, within this category, for sisters of males with a unilateral cleft and for daughters of fathers with a unilateral CL/P  . The highest risk of recurrence of CL/P is for the subcategory of female patients affected with a bilateral CL/P . The risk of recurrence for CP seems to be influenced only by sex. The risk is highest for daughters of fathers affected with a CP and lowest for sons of mothers affected with a CP 

16. Risk of recurrence

17. Symptoms

18. Symptoms Cleft lip (CL) can occur either unilaterally (on the left or right) or bilaterally . CL may occur with a wide range of severity, from a notch located on the left or right side of the lip to the most severe form, bilateral CL and alveolus.

19. Symptoms

20. Types of CP

21. Types of CP Cleft of Uvula. Cleft soft palate Complete cleft – hard palate, soft palate and uvula. submucous CPI- cleft of the hard palate is covered by mucosa .

22. Types of CP

23. Classification

24. Classification Group I – Defects of the lip or alveolus Group II – Clefts of the secondary palate (hard palate, soft palate, or both) Group III – Any combination of clefts involving the primary and secondary palates

25. Associated Problems Nasal deformities. The soft palate plays an important role in speech and swallowing. Speech pathology with velopharyngeal incompetence eustachian -tube obstruction with resultant middle-ear effusion, infections, and possible hearing loss.

26. Management

27. Management Newborn – Diagnostic examination general counseling of parents feeding instructions palatal obturator (if necessary )

28. Management Age 3 months - Repair of CL Age 6 months - Presurgical orthodontics, if necessary; first speech evaluation Age 9 months - Speech therapy begins Age 9-12 months - Repair of CP Age 1-7 years - Orthodontic treatment Age 7-8 years - Alveolar bone graft Older than 8 years - Orthodontic treatment continues

29. Rule of "three 10s"

30. Rule of "three 10s" Status suitable for surgery 10 lb, 10 g/ dL of hemoglobin , age 10 weeks).

31. Ventilation tubes

32. Ventilation tubes Anatomic differences predispose children with CLP and those with isolated CP to ear infections. Therefore, ventilation tubes are placed to ventilate the middle ear and prevent hearing loss secondary to otitis media with effusion.

33. Prevention

34. Prevention supplementation of folic acid and multivitamins.

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