L1 - Cleft lip and palate

Cleft lip and palate

One of the most common developmental disorders

1:800 to 1:1200 live births

Incidence for Birth

1:1000

Incidence for Birth: Philippines

Male>female

For gender

Incidence of this disorder:

Embryogenesis

Etiology:

Unknown disturbance during

1. Autosomal recessive trait

2. Multifactorial

Etiology:

1. Inherited as?

2. And can be?

Anti-epileptic drugs, maternal alcohol, cigarette use

Etiology:

Non-genetic factors

Van der Woude syndrome

Velocardiofacial syndrome

Charge syndrome

Kabuki syndrome

Stickler syndrome

Common syndromes and abnormalities associated with cleft lip & palate

Premaxilla, Lip, Columella, Nasal tip

Primary palate

Premaxilla

triangular portion located in the front

1. Maxillary components of the first pharyngeal arch (lateral)

2. Frontonasal prominence (midline)

primary palate is formed by two parts:

Anterior hard palate

Posterior soft palate

secondary palate can also be divided in two anatomical parts:

Anterior hard palate

Secondary palate:

ossified, meaning it has bones

(contributions from the maxilla and palatine bones)

Posterior soft palate

Secondary palate:

Muscular, includes uvula

Cleft lip

Failure fusion:

Maxillary processes with medial nasal processes

Cleft palate

Failure fusion:

Palatine shelves, failure of tongue to descend

Bifid uvula

🔊First sign of sub cleft? — very common:

• Feeding

• Rotation, missing, supernumerary, enamel hypoplasia, peg lateral (a debate)

Challenges encountered

• Otolaryngologist, OMS, speech pathologist,

• geneticist, pediatrician, psychologist, audiologist,

• orthodontist/prosthodontist, general dentist/pediatric dentist,

• nurse, social worker

Cleft team

So before surgery:

• Treat all active caries (tooth decay)

• Remove non-restorable teeth

• Teach proper oral hygiene

• Make sure mouth is infection-free

Why treat caries & do dental clearance before cleft surgery (palatoplasty/cheiloplasty)?

Usually done at 3–6 months old

Cheiloplasty

Cheiloplasty

Surgery to repair the cleft lip

Palatoplasty

Surgery to repair the cleft palate

Cheiloplasty

Goal:

• Close the split in the lip

• Restore normal lip shape and function

• Improve appearance and help with feeding

Usually done at 12-18 (9–18 months) old

Palatoplasty

Palatoplasty

Goal:

• Close the gap in the roof of the mouth

• Help the child speak properly

• Improve feeding and prevent food from entering the nose

• Support facial growth

0 to 3 months

Timing of Treatment

• infant orthopedic treatment

(NASOALVEOLAR MOLDING APPLIANCE)

3 to 6 months

Timing of Treatment

🔊In cheiloplasty, there are requirements

🔊 Patient should have a weight of 5 kg or

10 lbs, 10 hemoglobin, 10 weeks old

6 to 12 months

Timing of Treatment

initial consultation with the dentist

🔊oral health education with the mother

12 to 18 months

Timing of Treatment

Palatoplasty

• 18 month: speech therapist

2.5 to 3 years

Timing of Treatment

speech therapy begins

4 to 6 years

Timing of Treatment

VPI (Velopharyngeal Insufficiency) surgery (if needed) and revisions of lip and nose (if needed)

Note: ang VPI kay after na palatoplasty

7 to 11 years

Timing of Treatment

PHASE 1 orthodontic treatment:

expansion, crossbite correction and 2x4 appliance; ABG; lip and nose revision (if needed)

7 to 11 years

Timing of Treatment

Alveolar bone grafting is also done

12 to 16 years

Timing of Treatment

PHASE 2 orthodontic treatment: comprehensive

17 years & above

Timing of Treatment

PHASE 2 orthodontic treatment:

comprehensive; orthognathic surgery (if needed)

Elastomeric Taping

• Soft sticky tape on the baby's cheeks/lip

• Brings cleft segments closer together before surgery

Lip taping

Repositions the premaxilla

Repositions the deviated columella

Nasoalveolar molding

• Assist in feeding and decreases risk for aspiration

• Non surgical nose lifting (sana all hihi)Lengthening of columella

Latham Appliance

• Surgically fixed appliance with screws

• Gradually moves wide cleft segments together

NAM Appliance

• Custom mouthpiece with nasal stent

• Shapes gums, nose, and lip; used before lip repair

Fabrication of NAM

• Made by taking baby's mouth impression

• custom mold to fit baby's mouth + nasal support

NAM & Taping

• Combined early treatment before surgery

• Aligns tissues, improves facial symmetry, and helps surgeons with repair

Every 3 months

high caries risk patient

silver diamine fluoride

Arrest caries technique