CLEFT PALATEand

CLEFT LIP

Virola, Maria Soledad T.DMD2D

CLEFT PALATE (cheiloschisis) is a condition in which the two palates of the skull that form the hard palate are not completely joined. The soft palate in these cases are cleft as well.

CLEFT PALATE / CLEFT LIP

CLEFT LIP (palatoschisis) is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.

• Between the 6th and 12th weeks of fetal gestation,the left and right sides of the face and facial skeleton fuse in the midddle. When they do fail to do so, the result is a craniofacial cleft.

• Cleft palate without cleft lip occurs more in females (57%) than males (43%). Cleft lip with or without cleft palate occurs twice as many males than females.

• It is possible that facial clefts are caused by a disorder in the migration of neural crest cells.

• Another theory is that facial clefts are caused by failure of the fusion process and failure of inwards growth of the mesoderm.

OROFACIAL CLEFT (CLEFT | LIP)

As with a complete cleft lip deformity, the nose has some distortion. The distortion is usually to a lesser degree. The nostril may be widened, but the floor of the nostril is intact.

Incomplete cleft lips can take on a variety of appearances. There may be just a small gap or cleft in the vermillion or it may slightly extend into the skin above the lip or extend almost to the nostril.

A mild form of a cleft lip is a microform cleft. A microform cleft can appear as small as a little dent in the red part of the lip or look like a scar from the lip up to the nostril.

CLASSIFICATION

In a bilateral incomplete cleft lip deformity, the nose is affected, although not to the same degree as with a bilateral complete cleft lip deformity.

A bilateral complete cleft lip affects both the right and left sides of the lip. There are no philtral columns, no philtral dimple, and there is no orbicularis muscle in the central segment. On both sides, the cleft extends from the vermillion to the nostril.

CLEFT PALATE

CLEFT LIP

GENETIC FACTORS – a study has identified that 4 different regions of the human genome contains genes controlling risk for cleft lip and palate:• IRFG Gene on chromosome 1• MAFB gene on chromosome 20• ABCA4 on chromosome 1• a region on chromosome 8

ENVIRONMENTAL FACTORS• Maternal smoking• Maternal alcohol abuse• Maternal diet and vitamin intake• Medications take during pregnancy• Exposure to viruses in chemicals of fetus• Women with diabetes diagnosed before pregnancy

PATHOGENESIS/CAUSES

DIAGNOSTIC TEST/ EXAMS

• Orofacial clefts can be detected during pregnancy by ROUTINE ULTRASOUND.

• Usually, orofacial clefts are diagnosed when the baby is born.

• Minor clefts might not be diagnosed until later in life.

• Diagnosis can also be made by PHYSICAL EXAMINATION.

MAY APPEAR AS: • A split in the lip and roof of the mouth and palate that can affect both sided of the face• A split in the lip that can appear as only a small notch in the lip or can extend from the lip through the upper gum and palate into the bottom of the nose• A split in the roof of the that doesn’t affect the appearance of the face.

SIGNS AND SYMPTOMS Difficulty in swallowing Nasal Speaking voice Recurring ear infections Change in Nose shape Poorly aligned teeth

PROBLEMS ASSOCIATED WITH OROFACIAL CLEFT:• Failure to gain weight• Feeding problems• Flow of milk through nasal passage during feeding• Poor growth• Speech difficulties

• SURGERY - to close the cleft lip is often done when the child is between 6 weeks and 9 months old. Surgery may be needed later in life if the problem has a big effect on the nose area.• A cleft palate is usually closed within the first year of life so that the child's speech develops normally. Sometimes a prosthetic device is temporarily used to close the palate so the baby can feed and grow until surgery can be done

TREATMENT•Children born with orofacial clefts also might need different types of treatments and services, such as special DENTAL OR ORTHODONTIC CARE or SPEECH THERAPY.• Because children and individuals with orofacial clefts often require a variety of services that need to be provided in a coordinated manner, services and treatment by cleft team is recommended. These team usually consist of experienced and qualified physicians and health care providers from different specialties.

DENTAL CORRELATION

A Team Approach is Required The cleft lip and palate team must work together for the benefit of the young patient. The team usually consists of the following members: the pediatrician, plastic surgeon, oral & maxillofacial surgeon, dentist, orthodontist, ENT physician, psychiatrist, psychologist, prosthodontist, speech therapist, audiologist, and coordinator.

• Dentists recommend that the first dental visit be scheduled at about one year of age or even earlier if there are special dental problems.

• A cleft of the lip and/or palate in the front of the mouth can produce a variety of dental problems. These may involve the number, size, shape, and position of both the baby teeth and the permanent teeth.

• The teeth most commonly affected by the clefting process are those in the area of the cleft, primarily the lateral incisors. Clefts occur between the cuspid (eye tooth) and the lateral incisor. In some cases the lateral incisor may be entirely absent.

•In other cases there may be a “twinning” (twin = two) of the lateral incisor so that one is present on each side of the cleft.

• Finally, the teeth in the area of the cleft may be displaced, resulting in their erupting into abnormal positions.

A Partial List of Oral Problems in Children with Cleft Lip & Palate •Feeding Problems •Missing teeth- 50% •Supernumerary Teeth- 20% •Dystrophic (hypoplastic) teeth- 30% •Disturbances of tooth eruption •Ectopic tooth eruption •Malocclusion- 100% •Dental caries and gingivitis

GENETIC CLASSIFICATION

Genetic disorders may also be complex, multifactorial, or polygenic, meaning they are likely associated with the effects of multiple genes in combination with lifestyles and environmental factors. Multifactorial disorders include heart disease and diabetes. Although complex disorders often cluster in families, they do not have a clear-cut pattern of inheritance. This makes it difficult to determine a person’s risk of inheriting or passing on these disorders. Complex disorders are also difficult to study and treat because the specific factors that cause most of these disorders have not yet been identified.

On a pedigree, polygenic diseases do tend to “run in families”, but the inheritance does not fit simple patterns as with Mendelian diseases. But this does not mean that the genes cannot eventually be located and studied.

Multifactorial inheritance, also called complex or polygenic inheritance. Multifactorial inheritance disorders are caused by a combination of environmental factors and mutations in multiple genes. Some common birth defects can occur as a single isolated condition and are often caused by many factors. With one affected child in the family, the chances of having the condition reoccur are one to five per cent depending on the type of birth defect.

Common Examples of Multifactorial Birth Defects are:

• Cleft lip/and palate• Club foot• Congenital Heart Defects• Neural Tube Defects (Spina Bifida)