labio schiz is

8/10/2019 Labio Schiz Is

1/24

Anatomy


2/24


3/24

Definition

Congenital abnormal space or gap in the upper lip

and palate


4/24

Embryological Background

Development of the Lip: Unpaired Frontonasal Prominence

Medial and Lateral Nasal prominences 2 maxillary prominences

2 mandibular prominences

Development abnormality of nasomedial andmaxilary prominencelabioschizis / cleft lip


5/24

Embryological Background

Development of Palate: We have two parts of two different embryonic origins:

1 ) primary palate :lip, alveolus and hard palate to

the incisive foramen (4thand 8thweek of gestation)

2 ) secondary palate : hard and soft palateposterior to the incisve foramen (8thand 12thweek of

gestation)


6/24


7/24

Insidence

Cleft lip

1 : 600 birth Cleft palate1: 1000 birth

Boys > girls

The highest frequentAsians

Less frequentAfricans


8/24

Etiology

Unknown Predispotition factor :

Genetic(inherited characteristic) from one or both

parents

Maternal diet and vitamin intake Medications take during pregnancy

Infection

Maternal age

Women with diabetes diagnosed before pregnancy


9/24

Pathogenesis

Classic theory

Failure of fusion of the maxillary and frontonasal

processes during the time interval yields a cleft of the

primary palate

Mesodermal penetration theory propelled by Stark

Palate closure is predicted on mesodermal penetration

Without this mesodermal migration and reinforcement,

ephitelial breakdown and separation ensuescleft


10/24

Classification


11/24

Clinical Manifestation

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 doesntaffect the appearance of the

face.

Difficulty in swallowing

Nasal Speaking voice

Recurring ear infections

Change in Nose shape

Poorly aligned teeth


12/24

PROBLEMS ASSOCIATED WITH OROFACIAL CLEFT:

Failure to gain weightFeeding problems

Flow of milk through nasal passage during feeding

Poor growth

Speech difficulties


13/24

Diagnosis

Diagnosing a cleft palate with ultrasonography isvery difficult

Three-dimensional imaging has been introducedto prenatal ultrasonography diagnostics of cleft

anomalies


14/24

Treatment

Cleft lip= makes it more difficultfor an infant to suck on a nipple use special nipples to allow

the baby to latch properly(either pump or use formula)

Cleft Palatemay causeformula or breast milk to be

accidentally taken up into thenasal cavity

NGT

Intake nutritionproblem


15/24

Treatment

The principle of surgery treatment : To close the cleft lip and palate

the child's speech develops normally

the child's feeding normally

Decrease nose regurgitation Prevent injury of maxillary development


16/24

Treatment

Pre operation Rule of ten

The child weighs 10 pounds

The child has a hemoglobin of at least 10 grams %

The child has a white count of no higher than 10,000 The child is at least 10 weeks of age


17/24

Labioplasty

Millard Technique

Incision the corner of cleft lip and nose The bottom side of nostril is united with sutura

The upper side of lip is united

The stretch suturing is to closing the cleft totally


18/24

Von Langenbeck Palatoplasty

This technique is still used in isolated cleft palate

repair. The muscle dissection and muscle suturingare done as additional procedures to create a

muscle sling


19/24

Veau Wardill Kilner Pushback

palatoplasty (V-Y)

these drawbacks pushback and V-Y techniques have

fallen into disrepute and now less and less centres

practise this technique


20/24

Bardach Two flap

Modification of the von

Langenbeck technique

Incision is made along the

cleft margin and the alveolar

margin. These are joined

anteriorly to free the

mucoperiosteal flaps

This is a techniquecommonly followed

presently


21/24

Furlow Z plasty

Double line is incisionline and dash line is fold

line

Left flap contains muscle

and mucosa oral Righ flap contains

mucosa oral

Suturing of Z plasty

tehnique


22/24

Complication

Wound dehiscence

Wound expansion

Wound infection

Malposisi Premaksilar Whistle deformity

Abnormality or asimetry of lip


23/24

Multi Disciplinary Team

CHILD & FAMILY

PSYCHOLOGIST

SPEECH

THERAPIST

DENTIST

ORTHODONTIST

GENETICIST

ENT/AUDIOLOGY

SURGEON


24/24

labio schiz is

Documents