Classification Of Cleft Lip And Cleft Palate

Classification Of Cleft Lip And Cleft Palate

Write briefly on the classification of cleft lip and palate defects.

Answer: The following are the classifications:

Davis and Ritchie (1922)
Group I: Prealveolar cleft.
Group II: Post alveolar cleft.
Group III: Alveolar cleft.

Cleft lip Veau (1931)

• Group I: Cleft of soft palate only
• Group II: Cleft of the hard and soft palate extending no further than the incisive foramen, thus involving the secondary palate alone.
• Group III: Complete unilateral cleft, extending from uvula to the incisive foramen, thus the uvula to the incisive foramen in the midline, then deviating to one side and usually extending through the alveolus at the position of the future lateral incisor tooth
• Group IV: Complete bilateral cleft, resembling Group III with two clefts extending from the incisive foramen through the alveolus.

Cleft lip Kernahan And Stark (1958)

• Incomplete cleft of secondary palate
• Complete cleft of secondary palate
• Incomplete cleft of primary and secondary palate
• Unilateral complete cleft of primary and secondary palate.
• Bilateral complete cleft of the primary and secondary palate.

Cleft lip Harkins and Associates (1962)

Cleft or primary palate:

Cleft lip

• Unilateral: Right, left (Extent; one-third, two-thirds, complete)
• Bilateral: Right, left (Extent: one—third, two-thirds, complete)
• Median (Extent: one-third, two-third, complete)
• Prolabium: Small, medium, large
• Congenital scar: Right, left, median (one-third, two-thirds, complete)

Cleft of the alveolar process

• Unilateral: Right, left (Extent: one-third, two-thirds, complete)
• Bilateral: Right, left (Extent: one-third, two-thirds, complete)
• Median (Extent: one-third, two-thirds, complete)
• Submucous: Right, left, median
• Absent incisor tooth

Cleft of the palate:

Soft palate

• Posteroanterior: One-third, two-thirds, complete
• Width: Maximum
• Palatal shortness: None, slight, moderate, marked
• Submucous cleft (Extent: one-third, two-thirds, complete)

Hard palate

• Posteroanterior (Extent: one-third, two-thirds, complete)
• Width: Maximum (mm)
• Vomer attachment: Right, left, absent
• Submucous cleft (Extent: one-third, two-thirds, complete)

Mandibular process clefts:

• Lip extent: One-third, two-thirds, complete
• Mandible (Extent: one-third, two-thirds, complete)

Lip pits: Congenital lip sinuses

• Naso-ocular: Extending from the nasal region towards the medial canthus
• Oro-ocular: Extending from the angle of the mouth towards the palpebral fissure
• Oro-aural: Extending from the angle of the mouth towards the tragus of the ear.

Role Of Orthodontist In Cleft Lip And Palate

Write a short note on orthodontic treatment of cleft lip and palate.

Answer. One of the clinical features common to cleft lip and palate is a constricted and distorted maxillary arch.

The more severe the cleft, the more severe the arch deformity due to collapse.

Orthodontic treatment is necessary to correct the deformity.

Orthodontic treatment should be started during mixed dentition and continued through the permanent dentition.

Permanent teeth especially, those adjacent to the cleft are malposed, often severely rotated, and poorly calcified.

They certainly need to be orthodontia.

If extracted, especially the supernumerary one.

Even with complete orthodontic treatment, there is a maxillomandibular discrepancy, which may need surgical correction in the form of maxillary advancement with or without mandibular pushback, with or without genioplasty.

Functional Anatomy Of Cleft Lip And Palate

Write about pathogenesis, classification, and structural and functional problems of cleft lip and palate. Write a note on principles of management.

Answer.

Pathogenesis of Cleft lip and Cleft Palate

• Cleft lip results from abnormal development of the medial nasal process and maxillary process.
• A cleft palate occurs due to the fusion of two palatine processes.
• Defect in the fusion of lines between the premaxilla and palatine processes of the maxilla one on each side.
• When the premaxilla and both palatine processes do not fuse, it leads to complete cleft palate.
• Incomplete fusion of all three components leads to incomplete cleft palate.

Functional and Structural Problems of Cleft Lip and Cleft Palate

• Difficulty in sucking and swallowing
• Speech is defective especially in the cleft palate, mainly due to phonating B, D, K, P,T, and G
• Altered dentition or supernumerary teeth
• Recurrent upper respiratory tract infection
• Respiratory obstruction
• Hypoplasia of maxilla
• Cosmetic problem
• Chronic otitis media and middle ear problems.