Cleft Lip and Palate
Cleft Lip and PalateDr. Faisal Ameer MS, MCh, MRCSEdInternational Scholar for 2015, Plastic Surgery Foundation of ASPS/ASMSInternational Member of American Society of Plastic SurgeonsMember of Royal College of Surgeons EdinburghAssociate Professor Plastic SurgeryLLRM Medical CollegeMeerut, U.P. India+91 9557721163www.plasticsurgicraft.com
ObjectivesRecap of embryologyRelevant Anatomy and PathophysiologyClassificationCounseling of parentsBasic repair techniques
IntroductionFacial clefting is the second most common congenital deformity (after clubfoot).Affects 1in 1000 birthsProblems are cosmetic, dental, speech, swallowing, hearing, facial growth, emotional
PathophysiologyComplex mechanism of swallowing, hearing, speech and breathing are impairedFeeding difficulty in neonate. (Cleft makes creation of negative pressure difficult)Eustachian tube dysfunctionSecondary defect of tooth development. Psychological problem.
GeneticsNon-syndromic inheritance is multifactorialCleft Lip, With or Without Cleft Palate:One Parent-2%One Sibling- 4% Two Siblings- 9%One Parent + One Sibling- 15%Cleft Palate:One Parent- 7%One Sibling- 2% Two Siblings- 1%One Parent + One Sibling- 17%
Antenatal diagnosis
EpidemiologyCleft Lip +/- Palate- M:F 2:1Cleft Palate - F:M 2:1Cleft Lip +/- Palate- Native Americans > Oriental and Caucasians > BlacksCleft Palate- Same among ethnic groupsEnvironmental: Ethanol, Rubella virus, Thalidomide, Aminopterin B
Embryology
ClassificationNagpur classificationGroup I cleft lip onlyGroup Ia cleft lip + cleft alveolus Group II cleft palate onlyGroup III cleft lip + cleft alveolus + cleft palate
Joaquin Rafael Phoenix13
Anatomy
PhiltrumPhiltral RidgesCupids BowPhiltral DimpleCommisureWhite rollTubercle
History & Examination Cosmetic disfigurement (cleft lip)Feeding problems in cleft palateSuckling difficultiesNasal regurgitationEar diseaseRespiratory infectionsMalnutrition and failure to thrive (wt. for age)Other congenital anomalies digits, cardiac, craniofacial syndromes etc.
Pre operative evaluationHistory Physical examination Laboratory dataHb%Syndromes Xray mandible, Cardiac workup
Investigations Blood OPG (for canine tooth eruption)Occlusal viewSpeech evaluationNasendoscopyLateral/Frontal videofluroscopyFlowmeteryCephalometry lateral / AP
Management
Care of the newborn
Lip Repair
Timing of Cleft Lip RepairAt three months of age Larger anatomical parts Safer anesthesia
Rule of 1010 weeks 10 grams10 pounds10k WBC
Millard Lip Reapir
Randall-Tenisson Lip Reapir
Veau Lip Reapir
Palate Repair
Timing of Cleft Palate repairEarly repair (< 24 mts) speech and hearing improvedDelayed closure (>4y) less retardation of mid facial growthOptimal time Soft palate 3 6 mtsHard palate 15-18 mts
VWK Palate Reapir
Intervelar Veloplasty
Furlows Palate Reapir
Surgical Complications
EarlyAirway compromiseBleeding LateFistulaReduced movement of the soft palatePersistent VPIUnder developed facial skeleton
ConclusionsEmbryology and Anatomy extremely important.Counseling and communicationMeticulous technique and tissue respectEasy to learnCleft team
Thank youTeamwork is the key !