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

2. 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

3. 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.

4. 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.

5. 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.

6. 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

7. 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)

8. 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

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

10. 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)

11. 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

12. 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.

13. 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

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

15. 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

21. treatment Feeding respiratory tract and ear infection Orthodontic
Surgery

22. 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