Cleft Lip and Palate

meaning of cleft

abnormal opening

CLAP/CLP is the __________

4th most common birth defect and most common congenital defect of the face

CL what and what it effects

facial aesthetics, feeding, and dentition

failure of part of the lip to come together in fetus

CP why and what it effects

feeding, ME function, and speech

-section of the roof of the mouth do not fuse normally

CLAP is at high risk for what

problems with aesthetics, feeding, speech, resonance, hearing, and dentition

what does it mean that structures are hypoplastic?

under or incomplete development of a tissue or organ

multiple malformation syndrome

nose, eyes, and other facial structures may be malformed

neural crest cells theory

cells migrate at different rates and if migration fails or is delayed => affects formation of facial structures (like clefts)

Development of lip and alveolus

• 6-7 weeks of gestation

• begins at incisive foramen and proceeds in an anterior direction to form the alveolus

• that closure then proceeds to form the base of the anterior nose and upper lip

what does median + two lateral lip segments form when they are fused?

philtrum and philtral lines

-this mean formation of the upper lip is done

development of the hard palate

• 8-9 weeks of gestation

• tongue is high up and posterior and palatal shelves are vertical and on each side of the tongue

• at 7/8 weeks the tongue drops and the palatal shelves move to a horizontal position

• it will fuse at pre-maxilla at incisive foramen and then with each other and move posterior along the median palatine suture line

-hard palate is complete

vomer at 8/9 weeks

moves down and fuses with superior of the hard palate

bilateral- no vomer or it’s way off

-nasal cavity is complete

when is soft palate completed?

once HP is formed, the SP is fused at midline and is the last thing formed at 12 weeks

classifications of clefts: 2 groups

• clefts of the primary palate

• clefts of the secondary palate

-incisive foramen is the dividing point

primary palate

structures that are anterior to the incisive foramen, lip and alveolus

secondary palate

posterior to the incisive foramen, hard palate, uvula, and soft palate

clefts of the primary palate: 2

P: complete cleft and incomplete cleft

complete cleft of the primary palate

extends through entire lip, nostril sill, and alveolus

incomplete cleft lip of the primary palate

doesn’t extend to the incisive foramen, partial cleft lip, can be subcutaneous or be whole lip and part of the alveolus

-can be unilateral or bilateral

unilateral incomplete cleft of the primary palate

• will be on the left side

• nasal cavity is smaller than in bilateral

• may also result in dental and occlusal abnormalities, small oral cavity

• interfere with articulation and resonance

bilateral complete cleft of the primary palate

• nose appears wide and flattened due to separation of orbicularis oris

• results in nasal cavity deformities

• may also result in dental and occlusal abnormalities, small oral cavity

• interfere with articulation and resonance

Clefts of the secondary palate: 2

S: incomplete and complete

incomplete cleft palate of the secondary palate

could be slight line in midline or bifid uvula

-may extend into velum or HP

complete cleft palate of the secondary palate

extends through uvula and velum, follows the median palatine suture line through the HP → incisive foramen

vomer in an uni/bi cleft of the secondary palate

uni: attached to the longer of the 2 palatal segments

bi: not attached to either segment

isolation CP

Pierre Robin Sequence

palatal muscles are hypoplastia and nonfunctional=

velopharyngeal dysfunction (VPD)

clefts of the secondary palate: adverse effects

• on feeding, nasal regurgitation, articulation, resonance, OM, and conductive hearing loss

hypoplasia

short/thin velum, has an adverse effect on velar closure

Submucous cleft

congenital defect

• affects underlying structure of the palate and oral surface mucosa is intact

range: slight bifid uvula → a cleft under the oral mechanism that comes through muscles of velum and bone of HP → incisive foramen

• under oral mucosa and appears bluish

• may have no effect or VPD

• can cause nasal regurgitation during 1st year

• high risk for OM and conductive HL

• Eustachian tube may not be working

• however, many will be completely normal in all aspects