Cleft Lip & Palate - PDF

Cleft Lip & Palate Dr. Fatma T. Alkaff B.D.S , Dip. PC RCSI, MFD RCSI, MCLinDent in prosthodontics Cleft lip an palate are considered one of the most common birth defects that possess significant medical ,psychological ,social and financial implication on the af...

Cleft Lip & Palate Dr. Fatma T. Alkaff B.D.S , Dip. PC RCSI, MFD RCSI, MCLinDent in prosthodontics Cleft lip an palate are considered one of the most common birth defects that possess significant medical ,psychological ,social and financial implication on the affected individual and families  Incidence ❑ Cleft lip alone =15% ❑ Cleft lip and palate------45%, F > M ❑ Cleft palate alone-=40% M>F  ETIOLOGY Genetic Family history: 1 st degree affected have risk of(1:25 live birth) Syndrome: over 150 syndromes are associated Pierre robin syndrome Syickler syndrome Isolated Shprintzen syndrome Down syndrome. treacher collins syndrome Factors Recognized teratogenic agents Maternal epilepsy Drug ( Environment steroid, phenytoin, diazepam),maternal age, maternal smoking Treacher Collins syndrome Is a genetic disorder characterized by deformities of ears, eye and cheekbones and chin.  Roberts syndrome is a genetic disorder characterized by limb and facial abnormalities. Affected individuals also grow slowly before and after birth ❖ Clefting of upper lip and primary palate:- ❖ Clefting of secondary palate The lateral palatal processes of The medial and lateral nasal the maxillary prominence rotate prominences fuse with the maxillary and fuse at 8 weeks of gestation prominences at 4 to 7 weeks of to form the secondary palate gestation to form the primary palate.  Physiology of Palate Separate the nasal cavity from oral cavity. Soft palate cuts off oropharynx from nasopharynx during feeding. Palate generating suction with their mouths, during feeding the infant. During speech, closure of soft palate is essential. Proper drainage of the middle ear.  Veau Classification 1931 Group I Group II – Group III – Group IV – Defects of Defects Defects Complete the soft involving the involving the bilateral palate only hard palate soft palate to clefts Veau and soft the alveolus, classification palate usually of cleft lip involving the and palate. lip  Iowa system classification Group I Group II Group III Group IV Cleft of Cleft of Cleft of Cleft of lip and the lip the lip alveolus(pr only palate ,alveolus imary only and clefts palate palates and lip  Spina (1974) Group I Preincisive foramen clefts (clefts lying anterior to the incisive foramen). Unilateral,Bilateral, Median Group II Transincisive foramen clefts (clefts of the lip, alveolus, and palate)- Unilateral, Bilateral. Group III Postincisive foramen clefts. Group IV Rare facial clefts  Lahshal system 1985 Problems associated with cleft lip and palate:- Feeding Associated anomalies Speech difficulties Ear problem Nasal deformity Esthetic problems Dental  Management of the cleft and palate Diagnosis Prenatal ultrasound - 2D or 3D Prenatal counselling 22%to 33% rates for detecting facial cleft 73% cleft lip 1.4%isolated cleft palate  Advantage of the prenatal diagnosis Disadvantage of prenatal diagnosis ❑Psychological preparation for parents to have realistic expectations ❑Parent education for cleft management ❑Emotional disturbance ❑Preparation for neonatal car and ❑High maternal anxiety and dysfunction feeding ❑Termination of pregnancy ❑Opportunity to investigate other abnormalities  2months-1 year(third stage) Protruding the 2-6 years(fifth 12 to 15 years(seventh Prenatal visit premaxilla is stage) stage) (first stage) shifted to more speech Orthodontic treatment Discussing the plan of distal position and assessment and monitoring jaw management aids in sucking(lip Orthodontic growth repair) analysis Birth to 6 weeks 1-2 years(fourth 6 to 12 years(sixth (second stage) stage) stage) 18-20 years(eighth stage) Feeding assistance, surgery to repair bone graft to repair a Orthognathic surgery support for parents, a cleft palate cleft in the gum area, hearing tests 1:2 hard palate maxillary expansion and pediatric 1:6 soft palate assessment. Role of Prosthodontist Indication of the prosthesis  Partial Removable prosthesis Complete removable prosthesis Prosthesis Fixed prosthesis Implant prosthesis Feeding of cleft lip and palate Orogastric/nasogastric tubes Used only for limited time Specially designed nipples with enlarged opening Allow the flow for formula with less effort Feeding plate (obturator) Prosthetic aid designed to obturate the cleft so that the infant can generate negative pressure within the oral cavity and can suck the milk and formula Feeding obturators Is a prosthetic aid that designed to obturate the cleft and restore the separation between the oral and nasal cavities Helps maintain adequate nutrition by covering the defect and providing rigid platform toward which the infant can press the breast or extract the milk It assist in normal sucking and thus lead to development of normal oromotor and swallowing reflexes Reduces feeding difficulties such as nasal regurgitation choking and shortens the feeding time It position the tongue in correct position which will prevent it to enter in to the defect ,thus helps in the growth of the maxilla and maxillary shelves together Reduce the passage of milk in to the nasopharynx and thus reduces the incidence of nasopharyngeal infection and otitis media Helps in pre surgical nonalveolar molding Presurgical NasoAlveolar Molding (PNAM) Was introduced to reshape the alveolar and nasal segment prior to surgical repair The first presurgical NasoAlveolar appliance was design by Grayson 1999  Principle NAM works on the Negative sculpturing and passive molding In negative sculpturing serial modification are made to the internal surface molding appliance with addition or reduction of material in certain plate area to get desired shape of the alveolus and nose. In passive molding ,custom made molding plate of acrylic is used gently to direct the growth of the alveolus to get the desired result later on Objective of NAM appliance  In bilateral CLAP , the use of non surgical lengthening of the columella ,retraction of premaxilla and centering of premaxilla along he mid sagittal plane Move the alar domes anteriorly in a sagittal path for increasing length of columella Impression Technique Impression of nasal region Appliances Fabrication Retentive Taping Retentive Buttons Nasal Stent Timing of wear Postinsertion evaluation Follow up