Cleft Lip And Cleft Palate Types and Treatment

Cleft Lip And Cleft Palate

Write a short note on the cleft palate.

Answer. The palate is formed from the Y- Y-shaped fusion of premaxilla and two palatine processes.
Imperfect fusion of these processes or developmental anomalies results in cleft palate.

Cleft palate Types

Complete cleft palate

• Failure of fusion of the palatine process and premaxilla results in a complete cleft palate.
• The nasal cavity and the mouth are interconnected.
• This may be unilateral or bilateral.

Incomplete cleft palate

• When the fusion of three components of the palate takes place.
• It starts from the uvula and then backward.

Various types

• Bifi uvula
• The whole length of the soft palate is bifid.
  The whole length of the soft palate and the posterior part of the hard palate are involved.

Effects Of Cleft Palate

• Interferers with swallowing and speech.
• Unable to make the constant sound like B, P, D, K, and T.
• Teeth: Upper incisors may be small maxilla tends to be smaller. Teeth are crowded.
• Nose: Oral organisms contaminate the upper respiratory mucous membrane.
• Hearing: Even with repair, acute and chronic hearing problems can occur.

Management of Cleft Palate

• The cleft palate is usually repaired in l2–l8 months. Early repair causes retarded maxillary growth. Late repair causes speech defects.
• Both soft and hard palates are repaired.
• Abnormal insertion of tensor palati is released. Mucoperiosteal flaps are raised in the palate which is sewn together.
• If maxillary hypoplasia is present, then osteotomy of the maxilla is done. With orthodontic teeth extraction and alignment of dentition is done.
• Regular examination of the ear, nose, and throat during the follow-up period, i.e. postoperative speech therapy.
• Whenever complicated problems are present, a staged surgical procedure is done.
• Wardill-Kilner pushback operation or V—Y pushback palatoplasty by raising mucoperiosteum flps based on greater palatine vessels.

V—y Pushback Palatoplasty or Wardill Kilner Push Back Palatoplasty

• This palate is infiltrated by a 1:2 adrenaline saline solution.
• Both mucoperiosteal flaps are raised, one from either side of palatal shelves and then nasal layers should be mobilized.
• Closure of the palate is done in three layers, i.e. nasal layer, muscle layer, and oral layer.
• In this procedure, palatal lengthening is achieved by V Y plasty.
  The hook of the hamulus can be fractured to relieve tension on the suture line by relaxing the tensor palate muscle.

Cleft Palate Secondary Management

• Hearing support is given using hearing aids if the defect is present; control of otitis media.
• Speech problems occur due to velopharyngeal incompetence; articulation problems also can occur.
  Speech therapy is given. It is corrected by pharyngoplasty, pyeloplasty, and speech devices.
• Dental problems like uneruption and unalignment are common.
  They should be corrected by proper dentist opinion and reconstructive surgery.
• Orthodontic management with alveolar bone graft, and maxillary osteotomy is done in 8–11 years.
• Veloplasty, dental implants, rhinoplasty, orthognathic surgeries etc.

Cleft Lip Treatment And Management

Write brief notes on the treatment of cleft lip.

Answer.

Following is the treatment of cleft lip:

• Millard’s criterion is used to undertake surgery for cleft lip, i.e. rule of ten, 10 pounds in weight; 10 weeks old; 10 g% hemoglobin.
• If the cleft lip is bilateral and is extensive two surgeries should be done to close the cleft. Surgery on one side should be done first and later on, after a few weeks surgery on the second side is done.
• Millard’s rotation advancement flap technique is commonly used.
  In this correction of both lip and nasal deformity is done.
  Realigning muscles and lips and their correct anatomical position is an important part of this repair.
  In this technique, the medial lip element is rotated inferiorly and the lateral lip element is advanced into the resulting upper lip defect.
  The columellar flap is then used to create a nasal sill.
• Hagedorn-LeMesurier repair: In this method, the medial lip element should be lengthened by introducing the quadrilateral flap which is developed from the lateral lip element.
• Tennyson-Randall repair: In this method medial lip element is lengthened by introducing a triangular flap from the inferior portion of the lateral lip element.
• Proper postoperative management like control of infection, training for sucking, swallowing, and speech therapy should be done