23 introduction cleft lip & palate

Dr V.RAMKUMAR

CONSULTANT DENTAL&FACIOMAXILLARY SURGEON

REG NO:4118-TAMILNADU –INDIA(ASIA)

INTRODUCTION TO CLEFT LIP & PALATE

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.

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.

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.

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.

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.

CONT…(PROCESSES)

• PYRAMIDAL PROCESS

- LIES BETWEEN THE TUBEROSITY OF MAXILLA &PTERYGOID PLATES OF SPHENOIDBONE.

- ORBITAL PROCESS

- SPHENOIDAL PROCESS.

SOFT PALATE

• SUSPENDED FROM THE POSTERIOR BORDER OF THE HARD PALATE.

• MUSCLES: TENSOR PALATI

LEVATOR PALATI

MUSCULUS UVULAE

PALATOGLOSSUS

PALATOPHARYNGEUS.

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.

CONT….

• UPPER RING:

- TRANSVERALIS NASI

- LEVATOR LABISUPERIORIS

- LEVATOR LABI SUPERIORIS

ALAEQUE NASI

- ZYGOMATICUS MAJOR &

- LEVATOR ANGULARIS ORIS.

CONT…

• MIDDLE RING: - INTERNAL ORBICULARIS LABII SUPERIORIS. - EXTERNAL ORBICULARIS LABII SUPERIORIS. - INCISAL FIBRES - MYRTIFORMIS• LOWER RING: - ORBICULARIS INFERIOR - TRIANGULARIS LABII & - QUADRATUS LABII INFERIORIS.

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.

CLEFTS OF SOFT PALATE

• LEVATOR PALATI MUSCLE ORIENTED IN MORE LONGITUDINAL DIRECTION.

• SUBMUCOSAL CLEFT – SOFT PALATE MUCOSA INTACT.

• TENSOR PALATI MUSCLES ARE ALSO ABNORMAL.

ANATOMY OF THE UNILATERAL CLEFT LIP

• SUBCUTANIOUS CLEFT LIP:

- DURING LIP MOVEMENT MUSCLE

BULGES

- IMBALENCED MUSCLE

TRACTION.

- CHANGES OF THE UNDERLYING

BONY STRUCTURES.

PARTIAL CLEFT LIP

• INVOLVEMENT OF VERMILLON – 2/3RD OF LIP HEIGHT.

• ORBICULARIS ORIS IS DIVIDED COMPLETELY.

• NASAL DEFORMITIES &ASYMMETRIC FUSION OF LIP.

PARTIAL CLEFT LIP

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.

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

CONT….

• NOSTRIL IS RETROPOSITIONED

• NOTRIL IS SMALLER OR LARGER THAN OPPOSITE

• NASAL FLOOR IS LOWER ON THE CLEFT SIDE

• NASOLABIAL FISTULA

• NASAL SEPTUM DEVIATED

CONT….

• NASAL FLOOR IS ABSENT

• HYPOPLASIA OF THE MAXILLA ON THE CLEFT SIDE

• PREMAXILLA IS DISPLACED ON THE NON-CLEFT SIDE.

NASAL DEFORMITY ASSOCIATED WITH UNILATEREL CLEFT

ANATOMY OF THE BILATERAL CLEFT LIP

• ENTIRE HEIGHT OF THE LIP.

• SIZE OF PROLABIUM VARIES.

COMPLETE BILATERAL CLEFT OF THE LIP & ALVEOLUS

• RARE DEFORMITY

• ISOLATION OF PROLABIUM & PREMAXILLA

• SIZE OF THE PRE-MAXILLA VARIES

• COLUMAEELA IS SHORT.

COMPLETE BILATERAL CLEFT & ALVELOUS

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.

COMPLETE BILATERAL CLEFT LIP,ALVEOLUS AND PALATE.

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.