الدكتور علي القصير اختصاص الجراحه التجميليه والتقويميه Cleft Lip & Palate الدكتور علي القصير اختصاص الجراحه التجميليه والتقويميه

introduction Facial clefting is the second most common congenital deformity (after clubfoot). Affects 1 in 750 births Problems are cosmetic, dental, speech, swallowing, hearing, facial growth, emotional

Prevalence CL/P is more common than CP and varies by ethnicity. CL/P High in American Indians and Asians (1/500 newborns) Low in American blacks (1/2000 newborns) Intermediate level in Caucasians (1/1000 newborns) More common in male Isolated CP occurs in only 1/2500 newborns , does not display variation by ethnicity and more common in female.

Cleft Lip Complete closure at 35 days postconception: 7 weeks from the LMP. Lateral nasal, median nasal, and maxillary mesodermal processes merge. Failure of closure can produce unilateral, bilateral, or median lip clefting. Left side unilateral cleft is the most common.

Cleft Palate Lack of fusion of the palatal shelves. Abnormalities in programmed cell death may contribute to lack of palatal fusion(?). Isolated disruption of palate shelves can occur after closure of the lip Palatal closure is not completed until 9 weeks post-conception.

emberology Primary Palate- Triangular area of hard palate anterior to incisive foramen to point just lateral to lateral incisor teeth Includes that portion of alveolar ridge and four incisor teeth. Secondary Palate- Remaining hard palate and all of soft palate

embryology Primary Palate Forms during 4th to 7th week of Gestation Two maxillary swellings merge Two medial nasal swelling fuse Intermaxillary Segment Forms: Labial Component (Philtrum) Maxilla Component (Alveolus + 4 Incisors) Palatal Component(Triangular Primary Palate)

embereology Secondary Palate Forms in 6th to 9th weeks of gestation Palatal shelves change from vertical to horizontal position and fuse Tongue must migrate antero-inferiorly

anatomy Hard Palate Bones: Maxilla( Palatine Processes) + Palatine Bones(Horizontal Lamina) Blood Supply: Greater Palatine Artery Nerve Supply: Anterior Palatine Nerve

Anatomy Soft Palate Fibromuscular shelf attached like a shelf to posterior portion of hard palate Tenses, elevates, contacts Passavant’s Ridge Muscles: Tensor Veli Palatini(CNV), Levator Veli Palatini(Primary Elevator), Musculus Uvulae, Palatoglossus, Palatopharyngeus(CN IX and X)

Etiology Several agents that are associated with an increased frequency of midfacial malformation. Genetics Medications —phenytoin, sodium valproate, methotrexate. With corticosteroids there is no evidence of an increase in malformations. Possible association could not be excluded

Etiology Cigarette smoking Alcohol Folate deficiency Noted with mothers of children with facial clefting, both CL/P and CP. Teratogenesis has been attributed to hypoxia as well as a component of tobacco (cadmium). Alcohol Associated with an increased risk of fetal facial clefting. Alterations in cell membrane fluidity or reduced activity of specific enzymes such as superoxide dismutase. Folate deficiency Contributes to a range of birth defects. Evidence is emerging for a similar association with the development of CL/P.

Cleft formation Cleft result in a deficiency of tissue Cleft lip occurs when an epithelial bridge fails Clefts of primary palate occur anterior to incisive foramen Clefts of secondary palate occur posterior to incisive foramen

Unilateral complete lip and palate                    Unilateral incomplete Unilateral complete Bilateral complete                    Incomplete cleft palate Unilateral complete lip and palate Bilateral complete

Examples of Cleft Palate Cleft of Back Soft Palate Cleft of Soft Palate Cleft of Soft and Hard Palate Cleft of Soft and Hard Palate and Cleft Lip

treatment Feeding respiratory tract and ear infection Orthodontic Surgery

Surgery Cleft lip repair =role of ten ( wt: 10 pounds, age :10 weeks and 10 gm /ds litter haemoglobin) Cleft palate repair at 10 month to 18 months . Cp repair before speeking