cleft lip and palate

1. Dr. Gutmann1
Cleft Lip and Palate

2. Dr. Gutmann2
Introduction:Cleft Lip and Palate
 Embryology
 Epidemiology
 Etiology
 Genetics
 Plastic Surgery
 Hearing and
speech
 Psychology
 Orthodontics
 Anthropology

3. Dr. Gutmann3
Embryological facial development
Frontal View

4. 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
-10th
week –closure of Secondary
Palate(Christensen,1992)
6th
week- Palatine Shelves/ muscle of soft palate

5. 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.

6. Dr. Gutmann6
Embryological palate development
Frontal view

7. Dr. Gutmann7
Embryological palate development
Inferior view

8. 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

9. 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

10. 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

11. 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

12. 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)

13. Dr. Gutmann13
Multifactorial inheritance
Siblings- (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%

14. 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 isolated
Majority of CPs are syndromic )McCarthy(

15. 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

16. 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

17. Dr. Gutmann17
Examples of Cleft lip:
Unilateral and Bilateral
 Normal/ Unilateral/ Bilateral

18. Dr. Gutmann18
Repair of cleft lip

19. Dr. Gutmann19
Repair of cleft palate