Download - Cleft lip and palate
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Dr. Gutmann1
Cleft Lip and Palate
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Dr. Gutmann2
Introduction:Cleft Lip and Palate
Embryology Epidemiology Etiology Genetics Plastic Surgery
Hearing and speech
Psychology Orthodontics Anthropology
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Dr. Gutmann3
Embryological facial development
Frontal View
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Dr. Gutmann4
Embryology(Sperber,1992)4th- 8th week –closure of Primary Palate(Frazer, 1970)
4th week- Stomodeum(involution of ectomesenchyme)Maxillary and Mandibular processes
5th week- Primary palate formation- fusion of maxillary and frontonasal process.
(Lateral and Medial Nasal Swellings/Nasal pits)
6th-10thweek –closure of Secondary Palate(Christensen,1992)
6th week- Palatine Shelves/ muscle of soft palate
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Dr. Gutmann5
Cleft lip w/- w/o Palate
Cleft anterior to Incisive Foramen(Sperber, 1992) Mesenchymal cells do not penetrate the
Nasolacrimal Grooves
Cleft lip w/ palate- Primary Palate defect
Cleft posterior to Incisive Foramen(Langman, 1981)
Palatine Shelves do not fuse.
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Dr. Gutmann6
Embryological palate development
Frontal view
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Dr. Gutmann7
Embryological palate development
Inferior view
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Dr. Gutmann8
Prevalence of Cleft Lip & Palate
Country Years Prevalence Author
Finland 1948-1975 1.74 Rintala, 1986
Israel 1974-1988 0.97 Tolarova, 1998
USA 1983-1990 1.30 Druschel, 1996
Japan 1948-1954 2.68 Vanderas, 1987
France 1974-1996 1.9 Stoll, 2000
China 1980-1989 1.2 Cooper, 2000
Nigeria 1976-1980 0.37 Iregbulem, 1982
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Dr. Gutmann9
Epidemiology
Cleft lip w/ or w/o Palate:0.6-2 : 1,000 Births Japan 1.7/ Whites- 1.0 / Blacks- 0.4
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Dr. Gutmann10
Males: More Cleft Lip w/- w/o Palate
Females:More Cleft Palate-later fusion Palatine plates /longer period/greater exposure time(Burdi,1969)
(Cooper, 2000)
Epidemiology
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Dr. Gutmann11
Etiology of Cleft Lip and Palate
Multifocal Midline facial defect (developmental)
Growth hormone defect/Teeth development defect Genetic(Wyszynski, 1996)
- Mendelian/- Multifactorial
Twins study (Keush, 1991)-
33%- identical/ 7%- non-identical
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Dr. Gutmann12
Etiology of Cleft Lip and Palate(continue)
Environmental factors:
Humans: Alcohol, smoking, antiepileptic meds
Animal experimentation:
Cortizol/ Steroids(Richtsmeir, 1994) Bixler, 1991)
Anti- Asthmatic/ X-ray (Sa’ad, 1994)
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Dr. Gutmann13
Multifactorial inheritanceSiblings- (one sibling) Bilateral cleft lip and palate- 5.7%Unilateral cleft lip and
palate-4.2%Cleft lip w/o palate- 2.5%(Bixler, 1981/ Fraser,
1970)2 siblings affected-
additional (9.0%)(Wyszynski, 1996)
Relatives- (Balgir,1984)First degree- 4%Uncles- 0.6%Cousins(First degree)-
0.4%
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Dr. Gutmann14
Frequency
Unilateral left to Unilateral right to Bilateral
6:3:1
CL/P male to female 2:1
CP female to male 2:1
CL/P to CL 1.5-3:1
CL to CL/P to CP 21% to 46% to 33%
Majority of CL/Ps are isolatedMajority of CPs are syndromic )McCarthy(
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Dr. Gutmann15
Predicted Occurrence, %
)McCarthy(
CL/P P
One sibling affected 4 2
One parent affected 4 6
One sibling and one parent affected 17 15
Two siblings affected 9 1
One sibling plus family history 4 7
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Dr. Gutmann16
Examples of Cleft Palate Cleft of Back Soft Palate Cleft of Soft Palate Cleft of Soft and Hard Palate Cleft of Soft and Hard Palate and Cleft Lip
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Dr. Gutmann17
Examples of Cleft lip: Unilateral and Bilateral
Normal/ Unilateral/ Bilateral
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Dr. Gutmann18
Repair of cleft lip
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Dr. Gutmann19
Repair of cleft palate