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Cleft Lip or Palate

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Clefts of the lip, alveolus and hard palates are the most common congenital deformities affecting

the upper jaw leading to difficulty in feeding. However, cleft lip alone generally doesn’t interfere

with feeding. There are chances of regurgitation of milk, associated lung infections and chronic

otitis media, Conductive hearing loss and delayed speech in the patients of cleft palate. They

generally occur as isolated deformities and very rarely are associated with congenital heart

disease and genetic conditions such as Apert’s or Down’s syndrome.

INCIDENCE: 1 in 2500 live births. Clefts are highest among Asians and lowest among blacks.

 cleft lip and palate in conjoint predominate in males. Cleft palate alone is more common in

females.

ETIOLOGY:- possible etiology include maternal drug exposure during pregnancy, syndrome

malformation complex, or genetic . This condition of cleft lip and palate is inherited in a

dominant fashion, (van der woude syndrome)

Embryology of Normal fetus: the masticatory muscles in conjoint with internal pterygoid 

Muscle allows the mandibular teeth to forcefully contact the maxillary teeth. When teeth meet

simultaneously, the force is distributed over a large area of bone to tooth attachment and

resulting to the joining of medial nasal and maxillary processes.

Embryo histology: The cleft of the lip appears because of the hypoplasdia of the mesenchymal

layer, resulting in failure of the medial nasal and maxillary processes to join. Cleft of the palate

appears to represent failure of the palatal shelves to approximate or fuse. Genetic influences

more significant in cleft lip/palate than cleft palate alone where environmental factors exert a

greater influence.

Clinical features: cosmetically looks ugly: Cleft lip may vary from a small notch in the

vermillion border to a complete separation extending in to the floor of the nose. Clefts may be

unilateral or bilateral and may involve the alveolar ridge.  Cleft palate may result to difficulty in

feeding, regurgitation ,lung infections, middle ear infections, dental decay  and  speech

delay/hyper nasal speech, inability to whistle, gargle, blow out a candle, of inflate a balloon .

MANAGEMENT :                               

COSMETIC SURGERY  : the correction of cleft lip is undertaken earlier because Of the

  • obvious cosmetic problems.(three months of age)

SURGICAL CLOSURE OF THE DEFECT:   restoring the normal anatomy of the cleft

palate undertaken later, but before the development of speech(around ten months of age)

Treatment of lung infection  like pneumonia and atelectasis

orthodontic correction,

Speech therapy :If surgery is delayed beyond three years of age, a contoured speech bulb

can be attached to the posterior of a maxillary denture to accomplish occlusion of the

naso pharynx and help the child develop intelligible speech.

Treatment of middle ear infection e.g., otitis media and conductive hearing loss.

Healthy diet:-feeding can be continued with a Mead Johnson bottle or a cup.

Use a crosscut nipple to prevent choking. Any nipple can be crosscut manually using a

single-edged razor blade. The crosscut is on the tongue side.

CONCLUSION

Cleft lip or palate is a congenital developmental deformity probably caused by maternal

exposure of drugs during pregnancy Because of this deformity the neonate gets difficulty in

feeding along with lung and middle ear infections. The only management remedy is surgical

correction of the defect.

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