CLEFT LIP AND CLEFT PALATE

CL aka Hare lip, cheiloschisis; CP aka palatoschisis Incomplete fusion of the lip and palate during the embryonic formation period.

INCIDENCE OF CLEFT LIP 1- 800 to 1000 births More common in males More common in native Americans and asians than in whites Less common in blacks 20% 25% of all cases

INCIDENCE OF CLEFT PALATE 1 2000 live births More common in females 20% - 30% of all cases

Cleft lip and Palate make up 50% of all clefts

ETIOLOGY Medication eg: Phenytoin (Dilantin) Genetic Syndrome Environmental factors such as a womans exposure to cigarette smoke, or lack of prenatal vitamins Mothers use of cocaine and alcohol

PATHOPHYSIOLOGY Cleft lip wit or without cleft lip palate results when the maxillary processes fail to fuse with the elevations on the frontal prominences during the 3rd 12th week of gestation. Fusion of the secondary palate (hard and soft palate) takes place later, between the 7th and 12th week of gestation. In the process of migration to a horizontal position, the palates are separated by the tongue for a short time. If there is a delay in this movement, or if the tongue fails to descend soon enough, the remainder of development process but the palate never fuses.

SIGNS AND SYMPTOMS Apparent at birth May be a simple dimple in the vermilion border of the lip or a complete separation extending to the floor of the nose Difficulty breathing Feeding difficulties eg. On the breast

DIAGNOSTIC TESTS Ultrasound can be performed at 15 weeks of gestation

MANAGEMENT AIM: To prevent further complications and enhancing normal growth and development SURGICAL 1. Sutured together by either diagonal incision or a staggered suture line (z-plasty) used to minimize notching of tissue - 2-3 months of age/ neonatal period - May require more than one surgery 2. Cheilopasty: - use of metal or adhesive strips Reduces tension 3. Logan bar/ clamp 4. Working with a body of professionals which includes: - ENT specialist (otolaryngologist) - Pediatrition - Orthodonist - Nutritionist - Audiologist - Plastic Surgion - Genetisis - Pediatric Dentist - Speech therapist - Psychologist or Social Worker 5. Palatoplasy cleft palate procedure

VARIATIONS IN CLEFT LIP AND PALATE AT BIRTH 1. 2. 3. 4. Notch in vermilion border Unilateral cleft lip and palate Bilateral cleft lip and palate Cleft palate

COMPLICATIONS 1. 2. 3. 4. 5. 6. Re-current otitis media, which can lead to tympanic membrane scarring and hearing loss. Breathing problems Aspiration Unable to feed adequately, taking more air than food Dental problems Speech problems: - speeching clearly - sounding certain letters and/ or words

OESOPHAGEAL ASTRESIA