Category Archives: Management of Patients with Orafacial Clefts

Speech Difficulties

Speech Difficulties Four speech problems are usually created by cleft lip and palate deformity. Retardation of consonant sounds u is the most common finding. Because consonant sounds are necessary for the development of early vocabulary  much language activity is omitted. As a result, good sound discrimination is lacking by the time the palate is.closed. Hypernasality is usual in the patient with a deft of t

Ear Problems

Ear Problems Children afflicted with a cleft of the soft palate are predisposed to middle ear infections. The reason for this becomes clear on review of the anatomy of the soft palate musculature. The elevator veli palatini and tensor veli palatini, which are normally inserted into the same muscles on the opposite side, are left unattached when the soft palate is cleft. These muscles have their origins either


Feeding Babies with cleft palates can swallow normally once the material being fed reaches the hypopharynx but have extreme difficulty producing the necessary negative pressure in their mouth to allow sucking either breast or milk. When a nipple is placed in the baby’s mouth, he or she starts to suck just like any other newborn, becaese the FIG. 27-6 A, Facial profile of typical cleft patient. Note pseudo

Nasal Deformity

Nasal Deformity Deformity of normal nasal architecture is commonly seen in individuals with cleft lips (see Fig. 27-2). If the cleft extends into the floor of the nose, the alar cartilage on that side is flared and the columella of the nose is  ulled toward’the noncleft side. A lack of underlying bony support to the base of the “nose compounds the problem. Surgical correction of nasal deformities


Malocclusion Individuals affected with cleft deformities, especially those of the palate, show skeletal discrepancies between the size, shape, and position of their jaws. Class III malocclusion. seen in most cases, is caused by many factors. A common finding is mandibular prognathism, which is frequently relative and is caused mo\e by the retrusion of the maxilla than by protrusion of the mandible (i.e., pseu


Dental Problems A cleft of the alveolus can often affect the development of the primary and permanent teeth, and the jaw Itself.” The most common problems may be related to congenital absence of teeth and, ironically, supernumerary teeth (Fig. 27-5). The cleft usually extends between the lateral . incisor and canine area. These teeth, because of their proximity to the cleft, may be absent; when present,


CAUSATIVE FACTORS The causes of facial elefting have been extensively investigated. The exact cause of elefting is unknown in most cases. Fdr most cleft conditions, no single factor can be identified as the cause. However, it is important to distinguish between isolated clefts (in which the patient has no other related health problem) and clefts associated with other birth disorders or syndromes. A syndrome i


EMBRYOLOGY To understand the causes. of oral clefts, a review of nose, lip and palate embryology is necessary. The entire process takes place between the fifth and tenth weeks of fetal lifer’ During the fifth week, two fast-growing ridges, the atemand media! nasa/ swellings, surround the nasal- vestige (Fig. 27,-3). The lateral swellings will form the alae of the nose; the medial swellings will give rise

Management of Patients with Orafacial Clefts

CHAPTER OUTLINE EMBRYOLOGY , tAUSATIVE fACTORS PROBLEMS OF CLEFT-AFFLICTED INDIVIDUALS Dental Problems Malocclusion Nasal Deformity Feeding Ear Problems Speech Difficulties Assoclated Anomalies TREATMENT OF CLEFT LIP AND PALATE Timing of Surgical Repair Cheilorrhaphy Objectives’ Surgical Techniques Palatorrhaphy Objectives Surgical Techniques Hard Palate Closure Soft Palate Closure Alveolar Cleft Grafts Timin