CLEFT PALATE

CLEFT PALATE


    CLEFT PALATE

  • Cleft palate is a type of clefting (fissure or gap) congenital deformity caused by abnormal facial development during gestation.
  • Imperfect fusion or developmental anomalies of median nasal process, maxillary process and palatine process (which fuses around 6-8 weeks of intrauterine life).

 

ETIOLOGY-

  • Genetic predisposition
  • Environmental factor (drugs like steroids, diazepam, phenytoin)

 

TYPES OF CLEFT PALATE-

I) According to the extension-

  1. Incomplete-
  • Cleft of the hard palate remains attached to nasal septum and vomer and leads to Bifid uvula, whole length of soft palate is bifd.

     2. Completed-

  • Nasal septum and vomer are completely separated from palatine processes.
  • Then nasal cavity and mouth are interconnected.
II) Accordimg to location-
1. Unilateral
2. Bilateral
II.  Classification of degrees of cleft palate:

  • First: Cleft or bifid uvula
  • Second: Presence of ununited palatal process
  • Third:  Presence of united palatal process and a cleft on one side of pre maxilla
  • Fourth: Presence of united palatal process cleft on both sides of palatal process
  • Fifth: Presence of bilateral cleft lip and jaw due to failure of fusion of premaxilla with palatal process.

 

CLINICAL FEATURES-

  • Difficulty in swallowing
  • Speech difficulty
  • Upper lateral incisors may be absent or teeth crowding seen.
  • Feeding difficulties in infants
  • Ear infections and hearing loss.
  • Associated anomaly is Pierre- Robin syndrome.
  • Cleft lip, cleft palate, scalp defects suggest Trisomy 13 or Patau syndrome.
  • Trisomy 13 and Trisomy 18 share several clinical features.
  • The highest discriminatory values are for ectodermal scalp defects and harelip and cleft palate in trisomy 13 and elongated skull and simple arches on all digits for trisomy 18

 

DIAGNOSIS-

  • Prenatal ultrasound can detect a cleft palate before child birth.

 

TREATMENT-

  • Best balance is achieved by repairing cleft palate between one and half years of age (12- 18 months).
  • Palate is repaired by palatal shalves (mucoperiosteal flaps)
  • Most commonly used method is V- Y pushback palatoplasty
  • LAHSAL system of classification
 

For bilateral CL and CP
  • No cleft- Dot
  • Complete cleft- Capital letter
  • Incomplete cleft- small letter
 

Exam Important

  • Cleft palate is a type of clefting (fissure or gap) congenital deformity caused by abnormal facial development during gestation.
  • Imperfect fusion or developmental anomalies of median nasal process, maxillary process and palatine process (which fuses around 6-8 weeks of intrauterine life).
TREATMENT-

  • Best balance is achieved by repairing cleft palate between one and half years of age (12- 18 months).
  • Palate is repaired by palatal shalves (mucoperiosteal flaps)
  • Most commonly used method is V- Y pushback palatoplasty.
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