CLEFT LIP AND PALATE

by:
Julia Dupuis Gerbal

Supervisor:
dr. Amru Sungkar.,SpB.,SpBP-RE

SURGICAL DEPARTMENT
MEDICAL FACULTY OF SEBELAS MARET UNIVERSITY
2017
INTRODUCTION
• A cleft is a fissure or split in
either the upper lip or palate
of the mouth
• It can also present as both
• The major goals of surgical
intervention are normal
speech, minimizing growth
disturbances, and establishing
a competent velopharyngeal
sphincter
 DEFINITIONS
• Cleft lip (cheiloschisis):
Failure of fusion of
maxillary and medial nasal
processes.
• Cleft lip can be on one
side only or on both sides.
• It is one of the most
common physical birth
defect
 DEFINITIONS
• Cleft palate (palatoschisis):
Failure of fusion of lateral
palatine/median palatine
processes and nasal septum.
• The roof of the mouth
contains an opening into the
nose
• Can result in feeding
problems, speech problems,
hearing problems, and
frequent ear infections
 EPIDEMIOLOGY
• Cleft lip and palate is the most common facial
birth defect
• Boys are commonly affected with a cleft lip or
combined cleft lip and palate, whereas cleft
palate is more common in girls.
• Recurrence risks for clefting deformities do
not correspond to any Mendelian pattern of
inheritance and it would appear that clefting
is inherited heterogeneously
 SIGN AND SYMPTOMS

• During the fourth and seventh weeks of

gestation, the upper lip forms from the medial

CLEFT LIP
and maxillary processes
• Lack of fusion between the medial nasal and
maxillary processes at the fifth week of gestation
results in an opening or gap
• It can occur unilaterally, bilaterally or at the
center of the lip.
 SIGN AND SYMPTOMS

CLEFT PALATE
• Fusion of the palatal shelves, which eventually
fuse to form the roof of the mouth, begin to
unite between eight and twelve weeks of
gestation.
• Severity ranges from an opening at the back of
the soft palate towards the throat, to a
complete separation of the palate
 DIAGNOSIS
• Generally, orofacial clefts are diagnosed by
physical examination at the time of birth
• During the routine 20-week ultrasound
examination, diagnosis of clefts has been
made when the fetal face is positioned
correctly.
 ETIOLOGY
Several genes have been identified that may be responsible for the cause
of cleft lip and palate.
 Dlx gene
Responsible for guiding the distal skeletogenic mesenchyme to the
palate. Mutations in these genes cause isolated defects in the palate.
 Sonic hedgehog gene
Facilitates ectodermal functions and may play a role in regulating the
outgrowth and fusion of the face.
 TGF-alpha variant

GENETICS
A receptor ligand that may play a role in the development of cleft
defects within families. Cigarette smoking and alcohol may have an
additive teratogenic effect.
 TGF-beta-3 gene
Mutation in this gene results in an isolated cleft palate, as it is
expressed just prior to palatal fusion.
 ETIOLOGY
• Lack of folic acid during pregnancy
• Causes of maternal dehydration: maternal

ENVIRONMENTAL FACTORS
smoking, second hand smoke exposure, maternal
alcohol abuse
• Pesticide exposure
• Retinoid (Vit A) intake
• Medications:
Methotrexate
Isotretinoin (medication used to treat acne)
Anti-seizure medication
• Anti-psychotic medication
 TREATMENT

GOALS:
The goals of treatment for cleft lip and cleft palate
are to improve the child's ability to eat, speak and
hear normally and to achieve a normal facial
appearance
 TREATMENT
SURGERY
• Surgeries typically are performed in this order:
Cleft lip repair — within the first 12 months of age
Cleft palate repair — by the age of 18 months, or
earlier if possible
Follow-up surgeries — between age 2 and late
teen years
 TREATMENT
Procedures may include:
• Cleft lip repair. To close the separation in the lip, the surgeon
makes incisions on both sides of the cleft and creates flaps of
tissue. Initial nasal repair, if needed, is usually done at the
same time.
• Cleft palate repair. Close the separation and rebuild the roof
of the mouth (hard and soft palate),.The surgeon makes
incisions on both sides of the cleft and repositions the tissue
and muscles. The repair is then stitched closed.
• Ear tube surgery. For children with cleft palate, ear tubes may
be placed, typically at 6 months of age, to reduce the risk of
chronic ear fluid, which can lead to hearing loss.
• Surgery to reconstruct appearance. Additional surgeries may
be needed to improve the appearance of the mouth, lip and
nose.
 TREATMENT
• Treatment for complications
 Feeding strategies, such as using a special bottle nipple or
feeder
 Speech therapy to correct difficulty with speaking
 Orthodontic adjustments to the teeth and bite, such as
having braces
 Monitoring by a pediatric dentist for tooth development
and oral health from an early age
 Monitoring and treatment for ear infections, which may
include ear tubes
 Hearing aids or other assistive devices for a child with
hearing loss
 Therapy with a psychologist to help the child cope with the
stress of repeated medical procedures or other concerns