Module 5 - Head and Neck
Cleft Lip & Palate
Anatomy
- Primary Palate vs. Secondary Palate
- Nose - ala, columella, tip, nostrils, alar bases
- Lip - Free border (white roll, vermillion, red line, dry mucosa, wet mucosa), lateral lip elements and the philtrum (Cubid's bow, philtral columns)
- Palate - Premaxilla, the two lateral shelves of the hard palate, the structures comprising the soft palate
Embryology of Primary Palate
- Fusion theory (Meckel) vs. Mesodermal penetration theory (Veau/Stark)
- Primary palate: ANS, columella, medial portion of upper lip (4-7 wk)
- Merging of the two LNPs with the MNP
Embryology of Secondary Palate
- Secondary palate: Hard and soft palate (7-12 wk)
- Palatal shelves move horizontally & meet in the midline
- Incisive foramen divides two palatal components - anterior & primary
Classification of Cleft Lip Deformities (Primary)
- Syndromic vs. Non-syndromic
- Forme fruste
- Unilateral Incomplete
- Unilateral Complete
- Bilateral Incomplete
- Bilateral Complete
- Asymmetric bilateral
Classification of Cleft Lip Deformities (Secondary)
- Syndromic vs. Non-Syndromic
- Bifid uvula
- Submucous
- Unilateral Incomplete
- Unilateral Complete
- Bilateral Incomplete
- Bilateral Complete
Epidemiology
- Bifid Uvula - 2%
- Submucous cleft - 0.05%
- Asians - 0.21%
- Black - 0.041%
- Caucasians - 0.1%
- Cleft Palate - 0.41 - 0.50 persons per 1000
- Lt unilateral: Rt unilateral: Bilateral 6:3:1
Associated Anomalies
- Associated anomalies are present in:
- isolated cleft lip - 7-13%
- isolated cleft palate -
- cleft lip/palate - 11-14%
- Drops to 2% for those that survive the neonatal period
Team Approach to Treatment
Cleft Palate Team:
- Coordinator
- Plastic Surgeon
- Dentist
- Orthodonist
- Speech Pathologist
- Maxillofacial surgeon
- Psychiatrist and related
- Social work & numerous others
Author: Dr. R. Bendor-Samuel