Cleft lip/palate

Physical Challenges

> Birth- Obstructive breathing problems
> Food Intake-
- Poor oral suction
- Lengthy feeding times
- Nasal regurgitation
- Gagging Excessive air intake
> Surgery
> Middle ear infections
> Velopharyngeal closure (speech and voice problems)
> Dentition and dental occlusion

Development Face + Palate

> Face and anterior aspects of mouth- formed 5-8 weeks
> Normal dev. of face and mouth-
- Result of fusion of 5 embryonic processes:
~ mandibular, (right and left)
~ frontonasal,
~ maxillary processes (2).

Development: Face and palate; fusion of R and L mandibular processes

> 4 & 5 week of gestation
> Forms mandible & Lower lip
> R & L grow toward each other and fuse at midline
> Completed- 6 wks (embryo) (Figure a)

Development: Face and palate; frontonasal process grows

Frontonasal Process grows-
> 5th week gestation
> Grow downward into 2 separate masses:
~ Nasomedian Process
~ Lateral Nasal process
> Depression between nasomedian and lateral nasal are olfactory pits (become nasal cavities) (Figure b.)

Development: face and palate; lateral nasal processes

Lateral Nasal Processes-
Fuse with paired maxillary processes forming nasal alae (flared portion of nostril) and the anterior aspects of the face below the eyes (figure b.)

Development: face and palate part 2 (fusion)

> Fusion of the nasomedian processes and the maxillary processes occurs.
> Primitive tissue from nasomedian processes become:
- Ant. Portion of upper lip
- Ant. Aspect of alveolar process (holds upper teeth- central incisors)
- Ant. Aspect of hard palate (premaxilla)
> Figure b- Facial development complete (8th week gestation)
> Clefting (lip and or palate) occur when fusion process between nasomedian and maxillary process is interrupted by abnormal genetic condition or by environmental agents (teratogens) 

Development of secondary palate part 2 (shelves)

> 2 Palatal Shelves grow downward from the inner aspects of the maxillary processes.
> Up to 9th week the tongue projects into nasal cavity.
> Growth spurt during 8th and 9th week-
- Mandible width and length increase, pulling tongue down away from palatal shelves

Development of secondary palate part 3

- Figure 11.2- Fusion of palate (anterior to posterior)
> As palate fuses , nasal septum grows downward to meet palatal shelves in the midline, this separates right and left nasal cavities.
- Muscles of soft palate evolve from palatal shelf
> SP development during 10th week
> Fusion of secondary palate complete at 12 weeks

Definitions

- Columella ("little column"):
> tissue underneath the nasal tip and between the nostrils
> made of cartilage & mucosa
at the lower end of the nasal septum
- Nares: nostrils
- Alae:
> Two curved sides of nostril
> made up of base and rim

Cleft lip and palate classification systems

- Veau system
> General reference for nature and extent of clefts
> Four classes of clefts (roman numerals)

Clinical features of cleft

Clefts vary in type and severity
- Classification of clefts:
> Unilateral or bilateral cleft of lip
> Unilateral cleft of lip and palate
> Bilateral cleft of lip and palate
> Submucous cleft
> Bifid uvula

Clinical features of cleft part 2 (cleft of lip)

Cleft of lip
- Involves vermillion portion of upper lip (reddish portion) and may extend into nostril.
- Incomplete- minor V-shaped notch involving vermillion
- Complete- cleft continues through the upper lip into floor of nostril
- Effects shape of nose, flaring nostril on side of cleft., columella short and misaligned

Clinical features of cleft: unilateral

- Unilateral Cleft of Lip and Palate
> Extends from the external portion of the upper lip through the alveolus, hard and soft palate
- Cleft of palate without cleft of lip can occur

clinical features of cleft; bilateral

Bilateral Cleft of the Lip and Palate
- Most severe
- Lip and alveolus cleft under both nostrils and prolabium (central portion of lip), alveolar process and premaxilla positioned abnormally at the tip of nasal septum; protruding mass of tissue
- Columella usually absent

clinical features of cleft; submucous

Submucous Cleft-
> Muscular cleft in the region of the soft palate
> Cleft covered by thin layer of mucosal tissue
> May not be discovered until later in childhood
> Indicators:
- Bifid uvula may indicate sub clefting
- Bluish coloration in the middle of the soft palate where muscles fail to fuse

uvula

last thing that forms in palate

Cranio facial anomalies

• Malformations of the upper lip/hard and soft palate

  • Abnormal opening in an anatomical structure representing a failure to fuse structures or merge early in embryonic development

dental arch

alveolus

ant. aspect of the hard palate

premaxilla

Unilateral cleft lip tends to be on the

left side

primary

- Ant. Portion of upper lip
- Ant. Aspect of alveolar process (holds upper teeth- central incisors)
- Ant. Aspect of hard palate (premaxilla)

anything ant. to incisive foramen

secondary

• hard/soft palate

anything post. to incisive foramen