Parents are worried about
Is it possible to be normal with treatment?
Why did happened, Who has fault?
How should I feed my baby?
What about my future childern?
Epidemiology
The second most common congenital anomaly
Affects 1in 750 births
The incidence of cleft lip/palate varies among different populations
The most common in asians (1:500)
In whites (1:750)
The lowest in blacks (1:1000 or less)
Cleft lip more often in boys (left side)
Isolated cleft palate more often in girls
Young mothers are less risky
ETIOLOGY (Multifactorial)
Genetic factors (% 25-40)
Otozomal ressesive
Environmental factors (% 60-75)
Environmental factors(% 60-75)
Mothers sickness during first trimester (viral infections)
Chronic diseases ( Diabetes Mellitus etc.)
Drugs (tranquilizer, hipnotics, sedatives, cortizon, etc)
Smoking
Aspirin
X Rays
Problems in Cleft Lip and Cleft Palate
Feeding . Growing retardation
Frequent upper respiratuary tract infection
Otitis media
Aspiration pneumenia
Psycological problems (family)
Cleft lip and palate treatment team
Surgeon experienced in cleft management
Pediatrist, Pediatric dentist
Orthodontist
Geneticist
Spech Terapist
Social Worker
Nurse experienced in cleft problems
Schedule of Treatment
Birth:
Initial Assessment
Pre-surgical assessment
3 Month:
Primary Lip repair
9-18 month:
Palate Repair
2 Year:
Speech assessment
3-5 Year:
Lip Revision Surgery
8-9 Year:
Initial interventional Orthodontics
Preparation for alveolar bone grafting
10 Year:
Alveolar Bone Grafts
12-14 Year:
Definite Orthodontics
16 Year:
Nasal Revision Surgery
17-20 Year:
Orthognathic Surgery
When to Operate
Generally (Rules of 10’s)
Weight > 10 pound (4500 gr)
Hb > 10 gr
Age > 10 weeks
Cleft lips between 3-6 months
Cleft palate between 12-18 months (preferred before speech devolops)
How do you manage ear disease?
96% of children with cleft palate required tympanostomy tube placement
50% of these children required repeat tympanostomy tube placement.
Frequency of otitis media decreases as the child with CP ages
Audiology and tympanometry as well as exams / clinical history
right unilateral primary and secondary cleft palate
Postoperative 6 months
Postoperative 1,5 years
Bilateral Cleft Lip
More complex and difficult to treat
Incomplet or complet
It is important to retropositon the premaxilla with presurgical orthopedic treatment
Surgical techniques used for unilateral cleft lip repair are used for bilateral cleft lip repair in one or two stage operation (Millard, Tennison...)
Goal of Palatal Repair
speech
No maxillary retrusion
No hearing problem
Good occlusion
Before After
Pierre Robin Sequence
Micrognathy
Glossoptosis
Airway obstruction
Cleft palate( % 50 )
Quadhelix to expand prior to ABG
angle brackets to keep roots away from cleft
المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .
الرجوع الى لوحة التحكم
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