1. Cleft Lip and Palate
Dr. Gutmann

2. Introduction:Cleft Lip and Palate
Embryology
Epidemiology
Etiology
Genetics
Plastic Surgery
Hearing and speech
Psychology
Orthodontics
Anthropology
Dr. Gutmann

3. Embryological facial development
Frontal View
Dr. Gutmann

4. Embryology(Sperber,1992)
4th- 8th week –closure of Primary Palate(Frazer, 1970)
4th week- Stomodeum(involution of ectomesenchyme)
Maxillary and Mandibular processes
5th week- Primary palate formation- fusion of maxillary and frontonasal process.
(Lateral and Medial Nasal Swellings/Nasal pits)
6th-10thweek –closure of Secondary Palate(Christensen,1992)
6th week- Palatine Shelves/ muscle of soft palate
Dr. Gutmann

5. Cleft lip w/- w/o Palate
Cleft anterior to Incisive Foramen(Sperber, 1992)
Mesenchymal cells do not penetrate the Nasolacrimal Grooves
Cleft lip w/ palate- Primary Palate defect
Cleft posterior to Incisive Foramen(Langman, 1981)
Palatine Shelves do not fuse.
Dr. Gutmann

6. Embryological palate development
Frontal view
Dr. Gutmann

7. Embryological palate development
Inferior view
Dr. Gutmann

8. Prevalence of Cleft Lip & Palate
Author
Prevalence
Years
Country
Rintala, 1986
1.74
Finland
Tolarova, 1998
0.97
Israel
Druschel, 1996
1.30
USA
Vanderas, 1987
2.68
Japan
Stoll, 2000
1.9
France
Cooper, 2000
1.2
China
Iregbulem, 1982
0.37
Nigeria
Dr. Gutmann

9. Epidemiology Cleft lip w/ or w/o Palate:0.6-2 : 1,000 Births
Japan 1.7/ Whites / Blacks- 0.4
Dr. Gutmann

10. Epidemiology Males: More Cleft Lip w/- w/o Palate
Females:More Cleft Palate-later fusion Palatine plates /longer period/greater exposure time(Burdi,1969)
(Cooper, 2000)
Dr. Gutmann

11. Etiology of Cleft Lip and Palate
Multifocal
Midline facial defect (developmental)
Growth hormone defect/Teeth development defect
Genetic(Wyszynski, 1996)
- Mendelian/- Multifactorial
Twins study (Keush, 1991)-
33%- identical/ 7%- non-identical
Dr. Gutmann

12. Etiology of Cleft Lip and Palate (continue)
Environmental factors:
Humans: Alcohol, smoking, antiepileptic meds
Animal experimentation:
Cortizol/ Steroids(Richtsmeir, 1994) Bixler, 1991)
Anti- Asthmatic/ X-ray (Sa’ad, 1994)
Dr. Gutmann

13. Multifactorial inheritance
Siblings- (one sibling) Bilateral cleft lip and palate- 5.7%
Unilateral cleft lip and palate-4.2%
Cleft lip w/o palate- 2.5%
(Bixler, 1981/ Fraser, 1970)
2 siblings affected- additional (9.0%)
(Wyszynski, 1996)
Relatives- (Balgir,1984)
First degree- 4%
Uncles- 0.6%
Cousins(First degree)-0.4%
Dr. Gutmann

14. Frequency 6:3:1 Unilateral left to Unilateral right to Bilateral 2:1
CL/P male to female
CP female to male
1.5-3:1
CL/P to CL
21% to 46% to 33%
CL to CL/P to CP
Majority of CL/Ps are isolated
Majority of CPs are syndromic
(McCarthy)
Dr. Gutmann

15. Predicted Occurrence, %
CL/P P
One sibling affected 4 2
One parent affected 6
One sibling and one parent affected 17 15
Two siblings affected 9 1
One sibling plus family history 7
(McCarthy)
Dr. Gutmann

16. 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
Dr. Gutmann

17. Examples of Cleft lip: Unilateral and Bilateral
Normal/ Unilateral/ Bilateral
Dr. Gutmann

18. Repair of cleft lip
Dr. Gutmann

19. Repair of cleft palate
Dr. Gutmann

20. Dr. Gutmann