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CLEFT LIP AND PALATE

CLEFT LIP AND PALATE INTRODUCTION • DEVELOPMENT OF LIP AND PALATE. • PATHOPHYSIOLOGY OF CLEFT LIP AND PALATE. • CLASSIFICATION OF CLEFT LIP AND PALATE. • TREATMENT PROTOCOLS.  DIAGNOSIS AND TREATMENT PLANNING.  SURGICAL MANAGEMENT  Primary palate.  Secondary palate.  ORTHODONTIC MANAGEMENT.  Phase 1.  Phase 2 Phase 3 PROSTHETIC MANAGEMENT.  Maxillary orthopedics  Naso-alveolar molding.  Speech appliances. • Pharyngeal obturator. • Hard palate obturator For children • Anterior prosthesis. • Fixed • Removable For adults affected infants are born every day EMBRYOLOGY Development of facial structures starts at the end of 4th week 2 medial nasal processes fuse in midline – upper lip. • Mandibular processes fuse in midline – lower lip Primary palate. – maxillary and medial nasal process merge Parts of palate Primary Clefts of the lip and alveolar processes Unilateral cleft lip Cleft Lip and Palate Q&A ANTERIOR CLEFT PALATE POSTERIOR CLEFT PALATE COMPLETE CLEFT PALATE (ANTERIOR & POSTERIOR) Etiology Multifactorial Genetic Environmental factors PREDISPOSING FACTORS Davis and Ritchie’s classification Pre-alveolar process cleft VEAU CLASSIFICATION KERNAHAN AND STARK American Cleft Palate–Craniofacial Association KERNAHAN CLASSIFICATION TESSI Oro-facial clefts MODIFIED STRIPED Y • Triangle 1: right nostril floor DIAGNOSIS AND TREATMENT PLANNING General case history Impressions for study casts Photographs. • For diagnosis, teaching Otologic and hearing examination Transabdominal US. - Not reliable till gestational age of 15 weeks PALATAL OBTURATOR CLEFT LIP SOFT PALATE HARD PALATE SPEECH THERAPY BONE GRAFTING PROBLEMS ASSOCIATED WITH CLEFT LIP & PALATE MULTIDISCIPLINARY MANAGEMENT SURGICAL MANAGEMENT “RULE OF 10s Bilateral cleft Major problems Unilateral cleft TIMING OF SURGERY. • Cleft of hard palate ORTHODONTIC MANAGEMENT PHASE MAXILLARY ORTHOPEDICS McNeil School to stimulate the growth of tissues to obtain closure of palatal defects without surgical interventions Fixing a Cleft Palate with Craniofacial Surgery - The Science of Healing CLIP presurgical step of treatment have been cited TYPES OF APPLIANCES PASSIVE OR HOLDING ACTIVE OR EXPANSION EXPANSION APPLIANCE collapse Dentomaxillary advancement (DMA) appliance Latham HOLDING APPLIANCE NASOALVEOLAR MOLDING Samuel Berkowitz. Celft Lip and Palate Naso alveolar molding appliance CORRECTION OF THE UNILATERAL ORONASAL CLEFT DEFORMITY Infant • Maxillary and mandibular trays must be constructed • Irreversible hydrocolloid is used • Maxillary impression CONVENTIONAL MOLDING PLATE WEEKLY MODIFICATIONS EXTRAORAL RETENTIVE BUTTON NASAL STENT • When the alveolar cleft width has been reduced to less than 6mm NASAL STENT Cleft Diagnosis - Pediatric Playbook - Hospital NASOALVEOLAR MOLDING AFTER NASAL MOLDING JUST PRIOR TO SURGERY CORRECTING THE BILATERAL ORONASAL CLEFT DEFORMITY intraoral molding plate is fabricated that encompasses the lateral alveolar segments and the premaxilla PROSTHETIC SPEECH APPLIANCES FOR CHILDREN PHARYNGEAL OBTURATOR RATIONALE FOR PHARYNGEAL BULB Irreversible hydrocolloid is used • Maxillary impression is made with the infant’s head tilted downward at an angle of 15 degrees • Head is tilted upward for mandibular impressions • Tray should not be overloaded Older children and adults • Stock tray of adequate dimensions is selected • Early morning & empty stomach appointments. • Topical anaesthetic used in case of severe gagging • Tray should not be overloaded • All oral perforations should be packed with gauze saturated with petroleum jelly CONSTRUCTION High fusing modelling Patient is instructed to flex the neck fully to achieve contact of the chin to the chest Vowels: produced with resonated sound and little air flow After even reduction of compound a coating of mouth temperature wax is applied Cleft Treatment - Pediatric Playbook - Boston Children's Hospital HARD PALATE OBTURATOR Two Methods of Cleft Palate Repair in Patients With Complete Unilateral Cleft Lip and Palate Method 2. : Unilateral cleft palate repair RECENT ADVANCES. • Fetal surgery – done in intrauterine life CONCLUSION. • Oral clefts are the second most common congenital anamoly, having multifactorial origin Cleft lip and palate repair: Jane's Journey A considerable knowledge about the etiology and embryology is required for proper diagnosis and treatment planning of such patients. patient with clefts palate presents a complex biologic, sociologic and psychologic problems. • Treatment begins soon after birth continues till adulthood requiring a team approach. team approach with the members including the paediatrician, plastic surgeon, pedodontist, otolaryngologist, orthodontist, speech pathologist, prosthodontist, geneticist, paediatric psychiatrist and social workers. lectures dentist : Playlist: All Lectures    • MINIMAL INTERVENTION DENTISTRY   Facebook:   / cudman.buck