Cleft lip and palate Normal development of the face and palate

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Cleft lip and palate Normal development of the
face and palate

• Primary palate
• upper lip and alveolar ridge
• develop between 4th and 8th week of gestation
• Secondary palate
• hard and soft palates
• develop between 8th and 12th week of gestation
• Development can be interrupted by abnormal
  genetic conditions or environmental agents
  (teratogens)

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Cleft lip and palateClassification systems

• Numerous classification systems
• Veau
• American Cleft Palate-Craniofacial Assn (ACPA)
• Kernahan and Stark
• Veaus system
• I Cleft of soft palate only
• II Cleft of hard and soft palate to incisive
  foramen
• III Complete unilateral cleft of soft and hard
  palate and lip and alveolar ridge on one side
• IV Complete bilateral cleft of soft and hard
  palate and lip and alveolar ridge on both sides

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Causes of cleft lip and palate

• Genetic disorders
• Chromosomal abnormalities
• Environmental factors (teratogenic agents)
• Mechanical factors

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Genetic factors

• Syndrome vs. sequence
• Pierre Robin sequence
• Small mandible (micrognathia) causes failure of
  tongue to descend
• Failure of the tongue to descend causes cleft
• Heart problems, conductive hearing loss,
  developmental deficits
• about 40 of infants with Pierre Robin have
  Stickler Syndrome and about 15 have
  Velocardiofacial Syndrome
• Treacher Collins syndrome
• Under-developed cheekbones with scalp hair
• Malformed ears
• Conductive hearing loss
• Normal cognitive functioning

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Chromosomal abnormalities

• Trisomy 13
• Rare chromosomal abnormality
• Multiple congenital malformations
• Mean life expectancy is 130 days

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Environmental factors

• Recognized teratogenic agents
• Drugs
• Aspirin overdose
• Acne medications
• Alcohol overdose

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Mechanical factors

• Intrauterine crowding (tumors, multiple births,
  placenta abnormalities)

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Incidence of cleft lip and palate

• 1750 live births
• Clefts of lip only more frequent, more severe in
  males
• Clefts of palate only more frequent in females
• Native Americans have highest prevalence
• African Americans have lowest prevalence

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Management of clefts

• Surgical
• Primary
• Secondary
• Dental
• Audiological
• Speech and Language

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Speech Language

• Speech
• Articulation
• Voice
• Whistling-Blowing therapy
• Continuous Positive Airway Pressure (CPAP)
• Language

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Website

• http//craniofacialcenter.uiowa.edu88/speechpath/
  Instruction/VPI.htm