Cleft palate

Cleft palate
by hafiz m waseem

1. HAFIZ M WASEEM UNIVERSITY OF EDUCATION LAHORE

2. TOPIC : CLEFT PALATE

3. CONTENTS: Introduction Definition Symptoms Anatomy of normal palate
Types of cleft palate Causes of cleft palate Genetic basis
Complications Risk factors Treatment Conclusion Reference

4. INTRODUCTION: Result from incomplete closure of the roof of the mouth There is often an associated deformity of the nose on the effected side. Facial structure that are developing in an unborn baby don’t close completely. Most common birth defect Approximately one in 700 birth.

5. DEFINITION “Cleft palate is a condition in which the two plates of the skull that form the hard palate (roof of the mouth) are not completely joined”. The soft palate is in these cases cleft as well.

6. SYMPTOMS: Usually, a split (cleft) in the palate is immediately identifiable at birth. Cleft palate may appear as:
A split in the roof of the mouth that doesn’t affect the appearance of the face.

7. ANATOMY OF NORMAL PALATE To understand the cleft palate ,first we should know about the anatomy of normal palate. Normal palate consist of following parts; MUCOSA : The mucosa is the moist, pink tissue that lines the inside of certain body parts. HARD PALATE : The hard palate is the bony part of the roof of the mouth. It makes up the front part of the palate. It is in front of the soft palate. It seperates the mouth from the nose. SOFT PALATE : The soft palate is the posterior, fleshy part of the palate.When there is a cleft in the palate muscle, it does not function and speech is impaired. Specifically, speech becomes difficult to understand because air is going out of the nose instead of the mouth.

8. UVULA : The uvula is the part of the soft palate that hangs down the middle in the back of the mouth. ALVEOLAR RIDGES :The alveolar ridge is also known as the “dental arch” or “gums.” The alveolar ridge is where the teeth emerge. PRIMARY PALATE: The primary palate is the portion of the palate in front of the incisive foramen. It includes the front portion of the hard palate and is triangular in shape.

9. SECONDARY PALATE: The secondary palate is the back portion of the hard palate (the portion behind the incisive foramen). including the posterior alveolar ridge and all of the soft palate and uvula. INCISIVE FORAMEN: The incisive foramen is a structure that separates the primary palate from the secondary palate. It is an opening in the bony palate . It is directly behind the two front teeth.

10. TYPES OF CLEFT PALATE INCOMPLETE CLEFT PALATE
A cleft in the back of the Palate (usually in soft palate) with uvula and extend forward. It also involves secondary palate. It may extend to incisive foramen.

11. Bifid uvula- It is a type of incomplete cleft palate which is least severe and most common. It is also known as cleft uvula . This type of cleft palate is due to the splitting of the uvula( part of the soft palate that hang down in the middle of the back of the mouth).

12. SOFT PALATE CLEFT:
This type of cleft palate starts from the top of the uvula and stop before at the junction of the soft and hard palate.
COMPLETE CLEFT PALATE
In complete cleft palate both soft and hard palate are effected. The mouth and nose cavities are exposed to each other.A complete cleft palate can be unilateral or bilateral. If the cleft palate is bilateral, both sides may be complete, or one side may be complete and the other side may be incomplete.

13. SUBMUCOUS CLEFT PALATE
A cleft involving the hard and/or soft palate, covered by the mucous membrane lining the roof of the mouth. May be difficult to visualize
Less commonly, a cleft occurs only in the muscles of the soft palate (submucous cleft palate), which are at the back of the mouth and covered by the mouth’s lining. This type of cleft often goes unnoticed at birth and may not be diagnosed until later when signs develop.

14. SIGNS:
Signs and symptoms of submucous cleft palate may include:
* Difficulty with feedings
* Difficulty in swallowing, with potential for liquids or foods to come out the nose
* Nasal speaking voice
* Chronic ear infections

15. CAUSES Normally, the tissues that make up the lip and palate fuse together in the second and third months of pregnancy. But in babies with cleft lip and cleft palate, the fusion never takes place or occurs only part way, leaving an opening (cleft).
CLEFT palate are caused by an interaction of genetic and environmental factors. In many babies, a definite cause isn’t discovered.

16. Environmental factors ~ Exposure to German measles which is also known as Rubella and other infections.
~ Deficiency of certain vitamins during early pregnancy.
~ Use of alcohol and drugs during pregnancy
~ Smoking of cigarettes during early pregnancy.
~ Use of certain medicine like topiramate or valoporoic acid for the treatment of epilepsy.

17. Genetics basis: Approximately 50% of the cleft palate are associated with a malformation syndrome. The most common syndrome which can cause cleft palate is Velocardiofacial Syndrome ( VCFS). This syndrome is a result of microdeletion of chromosome 22q . However abnormalities in chromosomes 1,2,4,6,11,14,17 and 19 can also cause cleft palate.

18. RISK FACTORS Several factors may increase the likelihood of a baby developing a cleft palate, including:
Family history- Parents with a family history of cleft palate face a higher risk of having a baby with a cleft.
Use of certain substances during pregnancy- pregnant women who smoke cigarettes, drink alcohol or take certain medications.
Having diabetes.
Obese during pregnancy.
Males are more likely to have a cleft lip with or without cleft palate. Cleft palate without cleft lip is more common in females

19. COMPLICATIONS RELATED TO CLEFT PALATE: Children with cleft palate face following health problems:
✓ Feeding problem
✓ Tooth development
✓Hearing problem
✓ Speech problem
✓ Social and emotional impacts on children with cleft palate

20. PREVENTIONS: GENETIC COUNSELING
If a person have family history of cleft, tell the doctor before she become pregnant. Doctors may refers a genetic counselor who can help to find out the risk of having baby with cleft palate.
USE OF PRENATAL VITAMINS:
Use prenatal vitamins as prescribed by the doctor to lower the risk of having baby with cleft palate.
NOT USE OF TOBACCO AND ALCOHOL:

21. USE OF CERTAIN MEDICINE:
During first trimester woman who use certain medicine to cure epilepsy like topiramate or valoporoic acid have increased chance to have a baby with cleft palate as compared to those who do not use these medicine . Therefore during pregnancy avoid to use these medicines.

22. TREATMENT: Cleft palate is treatable depending on the type and severity of the cleft.
PLATOPLASTY:
A cleft palate can be treated with the help of surgery which is known as palatoplasty. This surgery is done when the baby is 10 month to one year old.
GOALS:
Following are the goals of palatoplasty:
° Close the opening which is present between the nose and mouth.
° Help to produce a palate that function well for speech
° Prevent the food and liquid coming out of the nose

23. PROCEDURE/ SURGERY:
In this surgery , the surgeon follow these steps
1. Place a device or brace into the child mouth to keep the mouth open during surgery. Close the cleft in layer.
2. The muscles of the soft palate are repositioned and mend so that it works well during speech.
3. Make two notches or incisions on each of the Palate behind the gums to relieve tightness or tension on palate repair. The incision inside the child mouth is look like “Z”.

24. CONCLUSION Both genetical and environmental factors can cause cleft palate, but if we take preventions seriously then the risk of having cleft palate in newborns become lower. Cleft palate can be treated successfully with no lasting problems with the help of surgery .

25. REFERENCES: http://www.acpa-cpf.org/uploads/site/Parameters_Rev_2009.pdf
pdf icon external icon
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706041/
https://kidshealth.org/en/parents/cleft-palate.html
https://en.wikipedia.org/w/index.php?title=Cleft_lip_and_cleft_palate&oldid=988228017
https://www.mayoclinic.org/diseases-conditions/cleft-palate/symptoms-causes/syc-20370985