23 introduction cleft lip & palate
TRANSCRIPT
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Dr V.RAMKUMAR
CONSULTANT DENTAL&FACIOMAXILLARY SURGEON
REG NO:4118-TAMILNADU –INDIA(ASIA)
INTRODUCTION TO CLEFT LIP & PALATE
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PHARYNGEAL ARCHES
• PHARYNGEAL ARCHES DEVELOPS IN THE 4TH AND 5TH WEEK.
• 5 PHARYNGEAL ARCHES• EACH ARCH CONTAINS
CARTILAGENOUS,MUSCULAR 8 NERVE COMPONENTS
• PREMAXILLA AND MAXILLA DEVELOPS FROM 1ST ARCH.
• ORBICULARIS ORIS DEVELOPS FROM 2ND ARCH.
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FORMATION OF FACE
• AT ABOUT 24 DAYS – 1ST ARCH –MAXILLARY & MANDIBULAR PROCESS.
• AT ABOUT 28 DAYS – NASAL PLACODES CONVERTS INTO NASAL PITS.
• LATERAL,MEDIAL AND FRONTONASAL PROCESSES
• FORMATION OF MIDDLE PORTION OF LIP (UPPER) & PORTION OF MAXILLA & PRIMARY PALATE.
• FORMATION OF UPPER & LOWER LIPS.
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FORMATION OF PALATE
• COMMON ORONASAL CAVITY
• PALATAL PROCESSES ARE DIRECTED DOWNWARDS ON EACH SIDE OF TONGUE
• 7TH WEEK – TONGUE IS WITH DRAWN
• 8TH WEEK - TONGUE IS DEPRESSED.
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ANATOMY OF PATATINE BONES
• TWO PALATINE BONES• IT HELPS TO FORM
- FLOOR & LATERAL WALL OF NASAL
CAVITY.
- ROOF OF ORAL CAVITY
- PTERYGOPALATINE & PTERYGOID
FOSSAE.
- INFERIOR ORBITAL FISSURE.
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PARTS
• HORIZONTAL & PERPENDICULAR PLATES
• PYRAMIDAL,ORBITAL & SPHENOIDAL PROCESSES.
• TWO HORIZONTAL PLATES FORMS POSTERIOR 1/4TH OF HARD PALATE.
• PERPENDICULAR PLATE FORMS THE MEDIAL WALL OF PRERYGOPALATINE FOSSA.
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CONT…(PROCESSES)
• PYRAMIDAL PROCESS
- LIES BETWEEN THE TUBEROSITY OF MAXILLA &PTERYGOID PLATES OF SPHENOIDBONE.
- ORBITAL PROCESS
- SPHENOIDAL PROCESS.
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SOFT PALATE
• SUSPENDED FROM THE POSTERIOR BORDER OF THE HARD PALATE.
• MUSCLES: TENSOR PALATI
LEVATOR PALATI
MUSCULUS UVULAE
PALATOGLOSSUS
PALATOPHARYNGEUS.
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NORMAL ANATOMY & PHYSIOLOGY OF THE LABIO-NASO-GENIAL MUSCULATURE & THE
MEDIAL SEPTUM OF THE UPPER LIP.
• UPPER LIP CONTAINS - EXTERNAL & INTERNAL ORBICULARIS & INCISAL BANDS.
• 3 SPHINTER RINGS – FACE TO CHIN
• UPPER, MIDDLE & LOWER RING.
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CONT….
• UPPER RING:
- TRANSVERALIS NASI
- LEVATOR LABISUPERIORIS
- LEVATOR LABI SUPERIORIS
ALAEQUE NASI
- ZYGOMATICUS MAJOR &
- LEVATOR ANGULARIS ORIS.
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CONT…
• MIDDLE RING: - INTERNAL ORBICULARIS LABII SUPERIORIS. - EXTERNAL ORBICULARIS LABII SUPERIORIS. - INCISAL FIBRES - MYRTIFORMIS• LOWER RING: - ORBICULARIS INFERIOR - TRIANGULARIS LABII & - QUADRATUS LABII INFERIORIS.
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ANATOMY OF PREPALATAL & PALATAL CLEFTS.
• CLEFT USUALLY FOLLOW THE LINES OF FUSION
• UNILATERAL CLEFT – ANTERIOR FLARRING OF PREMAXILLA
• BILATERAL CLEFT – PROTRUSION.• UNILATERAL CLEFT – VOMER ATTACHED
TO MAXILLA ON NON –CLEFT SIDE.• BILATERAL CLEFT – VOMER UNATTACHED
LATERALLY.
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CLEFTS OF SOFT PALATE
• LEVATOR PALATI MUSCLE ORIENTED IN MORE LONGITUDINAL DIRECTION.
• SUBMUCOSAL CLEFT – SOFT PALATE MUCOSA INTACT.
• TENSOR PALATI MUSCLES ARE ALSO ABNORMAL.
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ANATOMY OF THE UNILATERAL CLEFT LIP
• SUBCUTANIOUS CLEFT LIP:
- DURING LIP MOVEMENT MUSCLE
BULGES
- IMBALENCED MUSCLE
TRACTION.
- CHANGES OF THE UNDERLYING
BONY STRUCTURES.
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PARTIAL CLEFT LIP
• INVOLVEMENT OF VERMILLON – 2/3RD OF LIP HEIGHT.
• ORBICULARIS ORIS IS DIVIDED COMPLETELY.
• NASAL DEFORMITIES &ASYMMETRIC FUSION OF LIP.
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PARTIAL CLEFT LIP
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COMPLETE CLEFT LIP
• AFFECTS FACIAL GROWTH
• DIFFERENT FORCES ACTING ON EACH SIDE OF THE CLEFT
• HYPOPLASIA OF THE SOFT TISSUES & BONY STRUCTURES
• COLUMELLA DEVIATED TO THE NON –CLEFT SIDE
• SIMONART’S BAND.
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NASAL DEFORMITY ASSOCIATED WITH UNILATERAL CLEFT LIP.
• COLUMELLA IS SHORTER ON THE CLEFT SIDE.
• COLUMALLA BASE DEVIATED TO THE NON CLEFT SIDE
• S- SHAPED FOLD• LOWER LATERAL CARTILAGE & NASAL TIP• VESTIBULAR DOME IS EXCESSIVELY
OBTUSE• HORIZONTAL ORIENTATION OF NOSTRIL
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CONT….
• NOSTRIL IS RETROPOSITIONED
• NOTRIL IS SMALLER OR LARGER THAN OPPOSITE
• NASAL FLOOR IS LOWER ON THE CLEFT SIDE
• NASOLABIAL FISTULA
• NASAL SEPTUM DEVIATED
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CONT….
• NASAL FLOOR IS ABSENT
• HYPOPLASIA OF THE MAXILLA ON THE CLEFT SIDE
• PREMAXILLA IS DISPLACED ON THE NON-CLEFT SIDE.
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NASAL DEFORMITY ASSOCIATED WITH UNILATEREL CLEFT
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ANATOMY OF THE BILATERAL CLEFT LIP
• ENTIRE HEIGHT OF THE LIP.
• SIZE OF PROLABIUM VARIES.
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COMPLETE BILATERAL CLEFT OF THE LIP & ALVEOLUS
• RARE DEFORMITY
• ISOLATION OF PROLABIUM & PREMAXILLA
• SIZE OF THE PRE-MAXILLA VARIES
• COLUMAEELA IS SHORT.
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COMPLETE BILATERAL CLEFT & ALVELOUS
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COMPLETE BILATERAL CLEFT LIP,ALVEOLUS & PALATE.
• MOST COMMEN
• PREMAXILLA IS ROTATED & DISPLACED
• LOWER EDGE OF VOMER,APPARENT THROUGH PALATAL CLEFT
• LITTLE OR NO COLUMELLA
• NASAL TIP IS FLAT & ALAR DOMES IS TOO WIDE.
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COMPLETE BILATERAL CLEFT LIP,ALVEOLUS AND PALATE.
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REFERENCES
1.PLASTIC SURGERY – GRAB & SMITH2.PLASTIC SURGERY - MC CARTHY(VOL-IV)3.SURGICAL TECNIQUES IN CLEFT LIP & PALATE – JANUSZ BARDACH KENNETH E. SALYER4.OSTEOLOGY - S.PODDAR5.HUMAN ANATOMY – B.D.CHAURASIA6.EMBRYOLOGY – TENCATES7.OUTLINE OF ORAL &MAXILLOFACIAL SURGERY- WARD BOOTH.
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