Cleft Lip &

Palate
Anatomy of the Lip
Facial Muscles
Cross section of the Lip
 Incidence of Cleft Lip and Palate
1/750-1000 live births (2nd to club foot)

45% CL/P; 15% CL; 40% CP

Males CL/P; females CL

2nd baby 1/30 (genetic counseling)

 Aetiology
Genetic all forms of inheritance have been
described , with chromosomal abnormalities
(esp.trisomy 13 and 18) in 1-2%

Environmental
viral?
steroids, anticonvulsants 5%

Syndromes
- occurs as part of >100 syndromes
- 50% CP and 15 % CL/P have associated
anomalies
 Embryology of Cleft Lip
Weeks 4-7

frontonasal, maxillary,
and mandibular
processes form the
face

CL happens due to
failure of fusion of
median nasal and
maxillary processes
 Muscles in Cleft Lip
The orbicularis oris
muscles run parallel to
the edge of the cleft
and inserts into the
alar margin.

There is no muscle in
the prolabium in
bilateral cleft
 Types of cleft Lip
Unilateral Cleft Lip

Complete Incomplete
 Types of cleft Lip
Bilateral Cleft Lip

Complete Incomplete
 Problems of cleft lip
Disfigurement:

Abnormal in shape
Can't be hide
Embarrassing
If untreated will cause psychological disorders
 Problems of cleft lip
Feeding difficulties:

Difficulty in controlling mothers nipple

Impossible to create negative pressure
Poor suckling
 Problems of cleft lip
Failure to thrive:

Improper feeding
Repeated infection
Electrolytes disturbance
Growth retardation
Mental retardation
 Problems of cleft lip
Ear infections:

Ear infections are often due to a dysfunction of

the tube that connects the middle ear and the
throat.
Recurrent infections can then lead to hearing
loss.
 Problems of cleft lip
Speech and language delay:

Due to the opening of the mouth and the lip,

muscle function may be decreased, which can
lead to a delay in speech or abnormal speech.
 Problems of cleft lip
Dental problems:

As a result of the abnormalities, teeth may not

erupt normally and orthodontic treatment is
usually required.
 Multi Disciplinary Team
PSYCHOLOGIST

ENT/AUDIOLOGY ORTHODONTIST

SPEECH CHILD & FAMILY DENTIST

THERAPIST

SPECIALIST
NURSE GENETICIST SURGEON
 Feeding a baby with cleft lip
Breastfeeding is allowed. It will take extra time
and patience.
Holding infant in an upright position to help
keep the food from coming out of the nose.
Small, frequent feedings are recommended.
Other feeding devices may be utilized.
 Role of 10

Ten Hb

Ten weeks

Ten bounds
Surgical intervention
Unilateral cleft lip
Bilateral cleft lip
Cleft Palate
Anatomy of Palate
Muscles of Palate
 Types of Palatal Clefts

Soft Hard
incomplete Complete
Bi-partite

Hard
Complete
Tri-partite
Lip and palate
 Problems of cleft Palate
Deformity
Feeding problems
Infection : otitis media & chest infection
Speech problem
Dental problem
 Speech difficulty
Speech problems: As would be expected, the
malformations associated with cleft palate and
lip may impact articulation. The most common
issue tends to be a nasal quality to their voice.
Corrective surgery may lessen these speech
issues but most children with cleft lip and/or
palate benefit from formal speech therapy.
 Dental problem
Dental problems: Children with cleft lip and/or
palate commonly have issues with missing and
malformed teeth and commonly require
orthodontic treatments and occasionally oral
surgery if the upper jawbone (maxilla) has
impaired function (such as improper placement
and abnormal positioning of permanent teeth).
 Objectives of Palate Repair
Normal speech
Preservation of facial growth
Preservation of hearing
Separation of oral/nasal cavities
Normal dental occlusion
Normal swallowing
 Multi Disciplinary Team
PSYCHOLOGIST

ENT/AUDIOLOGY ORTHODONTIST

SPEECH CHILD & FAMILY Paediatrician

THERAPIST

SPECIALIST
NURSE GENETICIST SURGEON
 Role of 10
Ten Hb

Ten months

Ten kg
Palate Repair