32073259 Cleft Management Pedo

8/8/2019 32073259 Cleft Management Pedo

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DEPARTMENT OF PAEDIATRICDEPARTMENT OF PAEDIATRICDENTISTRYDENTISTRY

SEMINAR OF CLEFTSEMINAR OF CLEFT

MANAGEMENTMANAGEMENT


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CONTENTSCONTENTS PrenatalPrenatal DiagnosisDiagnosis..

ProtocolProtocol ForFor DentalDental CareCare.. AA MultiMulti-- DisciplinaryDisciplinary TeamTeam..

ManagementManagement

DentofacialDentofacial OrthopedicsOrthopedics

ManagementManagement ofof cleftcleft LipLip && NasalNasal DeformityDeformity.. CleftCleft PalatePalate RepairRepair..

OrthodonticOrthodontic TreatmentTreatment..

RoleRole ofof EE..NN..TT.. Specialist,Specialist, SpeechSpeech PathologistPathologist..

CorrectionCorrection ofof MaxillaryMaxillary HypoplasiaHypoplasia CorrectionCorrection ofof EnamelEnamel HypoplasiaHypoplasia..

RoleRole ofof ProsthodonticsProsthodontics

RoleRole ofof PsychologistPsychologist


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PRENATAL DIAGNOSISAND COUNSELING

Intrauterine diagnosis of orofacial clefts ispossible by ultrasonography.

Complete clefts are seen easily at 16

weeks gestation.

Incomplete clefts are seen more readily at27 weeks.

Palatal clefts are difficult to visualize byprenatal ultra sonography.

The family or obstetrician may request

prenatal consultation with a surgeon.


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Protocol For Dental Care of CleftLip and Palate in Children

At BirthAt Birth PredentalPredental treatmenttreatment isis providedprovided whichwhich comprisescomprises feedingfeeding

plate,plate, prepre surgicalsurgical orthopedicsorthopedics andand helpshelps surgeonsurgeon inin repairrepairbyby stimulatingstimulating palatalpalatal bonebone growthgrowth andand preventingpreventing collapsecollapseofof dentaldental archesarches..

33--5 Month.5 Month. AlignmentAlignment ofof thethe primaryprimary teethteeth andand palatalpalatal expansionexpansion toto bebe

startedstarted usingusing aa simplesimple fixedfixed applianceappliance likelike warchwarch && ArnoldArnoldexpanderexpander plasticplastic surgeonsurgeon toto repairrepair thethe liplip..

SuctionSuction myringotomymyringotomy forfor GlueGlue earear

12 Months.12 Months. PedodonticPedodontic reviewreview palatalpalatal propro stheticsthetic speechspeech..

ApplianceAppliance maymay byby requiredrequired toto correctcorrect velovelopharygealpharygeal incompetenceincompetence..

PlasticPlastic surgeonsurgeon toto repairrepair thethe cleftcleft palatepalate..


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22--66 YearsYears.. PedodonticPedodontic showedshowed reviewreview facialfacial growthgrowth andand developmentdevelopment withwith

regularregular monitoringmonitoring oneone yearyear intervalinterval.. PreventivePreventive measuresmeasures forfor cariescaries likelike fissure,fissure, sealing,sealing, fluoridefluoride..

RestorativeRestorative

66--77 yearsyears.. RemovalRemoval ofof supersuper numerarynumerary teeth,teeth, correctioncorrection ofof crosscross bitebite..

OrthodonticOrthodontic consultationconsultation..

88--99 yearsyears.. SuitabilitySuitability aboutabout bonebone graftinggrafting..

DentalDental bonebone assessmentassessment (OPG,(OPG, wrist,wrist, laterallateral cephalogram,cephalogram,..

ReviewReview byby thethe plasticplastic surgeon,surgeon, speechspeech pathologistpathologist && ENTENTsurgeonsurgeon..

IfIf neededneeded toto relieverelieve crowdingcrowding andand retroclinationretroclination ofof thethe anterioranteriorteethteeth..


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9 years.9 years.

CombinedCombined orthodontistorthodontist andand pedodontistpedodontistcoalescencecoalescence..

BoneBone graftgraft alveolaralveolar cleftcleft atat halfhalf toto 11//33 rootrootdevelopmentdevelopment ofof permanentpermanent cuspidcuspid..

1010--12 years.12 years. Orthodontic consultationOrthodontic consultation

Monitoring changing dentition and growth.Monitoring changing dentition and growth.

1212--15 years.15 years. Orthodontic treatment.Orthodontic treatment.

Speech pathologist to review changing ofSpeech pathologist to review changing ofthe pitch of voice in boys.the pitch of voice in boys.


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A MultiA Multi--Disciplinary Team for CleftDisciplinary Team for Cleft

Lip and Palate Patients.Lip and Palate Patients. ObstetricianObstetrician == RefersRefers thethe childchild toto plasticplastic surgeonsurgeon

andand pediatricianpediatrician forfor expertexpert opinionopinion counselingcounseling thetheparentsparents..

PediatricianPediatrician oror Neonatology'sNeonatology's==ProvideProvide medicalmedicalcarecare refersrefers thethe casecase toto thethe plasticplastic surgeonsurgeon..

PlasticPlastic SurgeonSurgeon::--CarriesCarries outout initialinitial liplip repairrepairandand palatepalate surgerysurgery performsperforms pharyngoplastypharyngoplasty ororreversionaryreversionary liplip && nosenose surgerysurgery..

OromaxillofacialOromaxillofacial SurgeonSurgeon==U

suallyU

sually comescomes inin thethepicturepicture ofof bonebone graftinggrafting ifif anyany finalfinal orthopedicorthopedicsurgerysurgery isis performedperformed atat laterlater stagestage..

NeurosurgeonNeurosurgeon== anyany craniofacialcraniofacial syndromesyndrome isisassociatedassociated..


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Pedodontist=Pedodontist= AA keykey membermember whowho seessees thethe babybaby andand thethe parentparent atat

thethe timetime ofof repairrepair ofof thethe liplip.. ProvidesProvides prepre surgicalsurgical orthopedicorthopedic treatmenttreatment forfor thethe

babybaby..

PedodontistPedodontist monitormonitor thethe growthgrowth andand developmentdevelopment..

ToTo maintainmaintain perfectperfect oraloral healthhealth.. ToTo guideguide thethe occlusionocclusion andand facialfacial growthgrowth..

MotivatesMotivates thethe parentparent && thethe childchild toto cooperatecooperate withwiththethe treatmenttreatment..

OrthodontistOrthodontist:: CarriesCarries outout definitivedefinitive orthodonticorthodontictreatmenttreatment onceonce thethe fullfull permanentpermanent dentitiondentition isis

eruptederupted..


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SpeechSpeech pathologistpathologist:: == MonitorsMonitors thethe speechspeech developmentdevelopment toto normalnormal..

TestTest forfor anan adequateadequate palatopalato pharyngealpharyngeal closureclosure andand guidingguidingthethe surgeonsurgeon asas toto whetherwhether aa pharyngealpharyngeal flapflap maymay bebenecessarynecessary..

AudiologistAudiologist::-- ToTo testtest hearinghearing inin thethe babybabyinfantsinfants && thethe youngyoung childchild providingproviding essentialessentialinformationinformation inin hearinghearing lossloss forfor bothboth speechspeechpatholigistpatholigist andand otolarynologistotolarynologist..

OtolarynologistOtolarynologist:: ConcernsConcerns withwith thethe healthhealth ofofnasopharyngealnasopharyngeal tissuestissues includingincluding tonsils,tonsils, adenoidsadenoidsandand middlemiddle earear structuresstructures..

BlockageBlockage ofof thethe auditoryauditory canalcanal andand gluteneousgluteneoussecretionsecretion (glue(glue ear)ear) isis veryvery commoncommon inin thesethese diseasedisease..

PsychologistPsychologist:: PlaysPlays onon importantimportant rolerole whenwhen thethechildschilds familyfamily isis underunder stressstress..


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MANAGEMENT:MANAGEMENT:

Infancy:Infancy:

GeneralGeneral ConsiderationConsideration::-- PatientsPatients withwith CC..LL..PP.. requires,requires,interdisciplinaryinterdisciplinary carecare fromfrom aa teamteam ofof providesprovides includingincluding aageneticist,geneticist, plasticplastic surgeon,surgeon, oraloral andand maxillofacialmaxillofacialsurgeon,surgeon, otolaryngologist,otolaryngologist, dentist,dentist, orthodontist,orthodontist, speechspeechtherapictherapic audiologist,audiologist, psychologist,psychologist, socialsocial workerworker && nursenurse..TheThe rolerole ofof eacheach specialistspecialist dependsdepends onon thethe ageage ofof thethe

patientpatient..

During the first days of the infants life:During the first days of the infants life:--

TheThe infantsinfants withwith aa cleftcleft palatepalate cannotcannot generategenerate thethe negativenegativeintraoralintraoral pressurepressure neededneeded toto sucksuck fromfrom aa bottlebottle..

TheThe NurseNurse onon thethe teamteam oror anotheranother feedingfeeding specialistspecialist mustmustinstructinstruct thethe parentsparents inin thethe useuse ofof specialspecial feedingfeeding devicedevice forfor thetheinfantinfant egeg::-- HabermanHaberman nipple,nipple, cathetercatheter && syringe,syringe, spoonspoon feedingfeeding..

InfantsInfants withwith cleftcleft palatepalate havehave difficultydifficulty ventilatingventilating thethe eustachianeustachiantubetube.. ThisThis resultresult inin thethe accumulationaccumulation ofof fluidfluid inin thethe mustmust bebetreatedtreated promptlypromptly withwith antibioticsantibiotics..


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DENTOFACIAL ORTHOPEDICSDENTOFACIAL ORTHOPEDICS

InIn unilateralunilateral completecomplete cleftcleft liplip andand palatepalate (UCCLP)(UCCLP) ororbilateralbilateral completecomplete cleftcleft liplip andand palatepalate (BCCLP)(BCCLP) withwith aaprotrudingprotruding premaxilla,premaxilla, labiallabial repairrepair isis oftenoftencompletedcompleted withwith tensiontension onon thethe closureclosure..

OrthopedicOrthopedic appliancesappliances bringbring thethe dentoalveloardentoalveloarsegmentssegments togethertogether facilitatingfacilitating aa tensiontension freefree labiallabialrepairrepair thatthat requiresrequires underminingundermining ofof tissuestissues..

InIn addition,addition, alveolaralveolar approximateapproximate formsforms thethe skeletalskeletalplateformplateform forfor correctioncorrection ofof thethe nasalnasal deformitydeformity andandpermitspermits gingivoperiosteoplastygingivoperiosteoplasty.. AlveolarAlveolar closureclosureeliminateseliminates anan aroundaround fistulafistula..

TheThe applianceappliance isis removedremoved atat thethe timetime ofof labiallabial repairrepairandand replacedreplaced withwith aa passivepassive applianceappliance toto maintainmaintain

thethe alveolaralveolar positionposition..


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Management of Cleft Lip And NasalManagement of Cleft Lip And Nasal

DeformityDeformity SingleSingle stagestage:: repairrepair thethe unilateralunilateral completecomplete cleftcleft liplip

andand nasalnasal deformitydeformity inin aa singlesingle stagestage..

TwoTwo stagestage repairrepair:: FirstFirst repairrepair unilateralunilateral cleftcleft liplip &&thanthan liplip nasalnasal adhesionadhesion..

Reasons For Two Stage RepairReasons For Two Stage Repair

MinimizeMinimize tensiontension..

IncreaseIncrease thethe bulkbulk ofof thethe orbicularisorbicularis orisoris musclemuscle totoconstructconstruct thethe filtralfiltral ridgeridge..

IncreaseIncrease thethe verticalvertical dimensiondimension ofof labiallabial elementselements..ParticularlyParticularly onon thethe medicalmedical sideside andand

GivesGives thethe surgeonsurgeon twotwo chanceschances toto correctcorrect thethe positionpositionofof thethe lowerlower laterallateral cartilagecartilage..


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TIMING OF NASOLABIAL REPAIRTIMING OF NASOLABIAL REPAIR

LabialLabial repairrepair isis traditionallytraditionally carriedcarried outout whenwhen thethe childchild isisapproximatelyapproximately 1010 weeksweeks ofof age,age, weightweight 1010 pounds,pounds, andand hashas aaserumserum hemoglobinhemoglobin valuevalue ofof 1010mgmg 11 mlml && totaltotal leukocyteleukocyte countcountlessless thanthan 1010,,000000/C/C..CC.. itit isis importantimportant toto waitwait untiluntil thethe periodperiod ofofpostnatalpostnatal anemiaanemia isis correctedcorrected.. TheThe childchild shouldshould bebe gaininggainingweightweight andand growinggrowing beforebefore underunder goinggoing nasolabilanasolabila repairrepair..

TECHNIQUESTECHNIQUES OFOF NAGOLABIALNAGOLABIAL REPAIRREPAIR.. TypeType ofof cleftcleft liplip surgerysurgery::--

MillardsMillards rotationrotation advancementadvancement flapflap andand tennisontennison randallrandall triangulartriangularflapflap methodsmethods..

RoseRose ThompsonThompson straightstraight lineline repair,repair, thethe skoogsskoogs procedureprocedure areare lesslessfrequentlyfrequently usedused..

RectangularRectangular flapflap methodmethod ofof triangulartriangular hagedornhagedorn lele mesuriermesurier arearerarelyrarely usedused..

ForFor bilateralbilateral cleftcleft liplip cancan bebe repairedrepaired inin twotwo stagestage byby inin aa singlesinglestagestage byby veauveau --IIIIII procedure,procedure, millardsmillards singlesingle stagestage procedureprocedure ororblackblack procedureprocedure..

BasicBasic stepssteps inin cleftcleft liplip repairrepair..

TheThe liplip isis closedclosed inin threethree layerslayers mucosa,mucosa, muscle,muscle, skinskin..


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AIM OF REPAIRAIM OF REPAIR

ToTo achieveachieve equalequal lengthlength ofof filtralfiltral ridgesridges anan eithereithersideside..

HorizontalHorizontal cupidscupids bowbow..

AccurateAccurate repairrepair ofof muscle,muscle, skin,skin, mucosamucosa withoutwithout

vermilionvermilion deformitydeformity..

ProperProper alignmentalignment ofof whitewhite lineline..

SymmetricalSymmetrical nostrilnostril floor,floor, andand finallyfinally anan estheticallyestheticallyacceptableacceptable scarscar..

11..StraightStraight LineLine LipLip RepairRepair..

IndicationIndication::-- ofof incompleteincomplete andand narrownarrow cleftsclefts..

AdvantageAdvantage ::-- EasyEasy repairrepair

DisadvantageDisadvantage::-- LimitedLimited IndicationsIndications..


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Tennison Randall RepairTennison Randall Repair AA triangulartriangular flapflap isis createdcreated onon thethe laterallateral sideside

ofof thethe cleftcleft toto fitfit intointo thethe triangulartriangular..

ThisThis procedureprocedure cancan bebe plannedplanned exactlyexactly afterafterinitialinitial measurementsmeasurements thethe resultsresults cancan notnot bebemodifiedmodified onceonce thethe liplip isis cutcut..

TheThe scarscar isis moremore prominentprominent thanthan inin otherotherproceduresprocedures..

AdvantageAdvantage::-- MeasuredMeasured techniquestechniques

MoreMore easilyeasily taughttaught..

CanCan bebe usedused forfor widewide deptdept..

DisadvantageDisadvantage:: ScarScar interruptsinterrupts thethe philtrumphiltrum

lineline difficultdifficult toto modifymodify duringduring

procedureprocedure..


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VEAU REPAIRVEAU REPAIR

ThereThere isis onlyonly aa displacement,displacement, deformationdeformation andand underunder

developmentdevelopment ofof thethe musclesmuscles andand thethe skeletalskeletal tissuetissue..

TheThe surgicalsurgical procedureprocedure shouldshould thusthus aimaim atat returningreturningtherethere structuresstructures toto theirtheir correctcorrect positionspositions..

TheThe nasonaso labiallabial musclesmuscles areare reconstructedreconstructed accuratelyaccurately

andand withinwithin aa fewfew weeks,weeks, withoutwithout anyany formform ofof flapflapclosureclosure..

ThisThis methodmethod givesgives satisfactorysatisfactory resultsresults inin bilateralbilateralcleftcleft liplip..

MILLARDSMILLARDS TechniquesTechniques (Rotation(Rotation advancementadvancementtechnique)technique) principlesprinciples ofof closingclosing bilateralbilateral cleftcleft liplip..

MaintainMaintain symmetrysymmetry

designdesign thethe prolabiumprolabium ofof properproper sizesize && shapeshape..

EnsureEnsure primaryprimary muscularmuscular continuitycontinuity..


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ConstructConstruct thethe medianmedian tubercletubercle fromfrom laterallateral labiallabialelementselements..

PeeformPeeform primaryprimary constructionconstruction ofof thethe columellacolumella &&

nasalnasal tiptip..

ProcedureProcedure ::--rotationrotation flapflap andand columellacolumella flapflap areareplannedplanned onon thethe medialmedial sideside ofof thethe cleftcleft.. afterafter fullfullthicknessthickness ofof thethe liplip isis cutcut alongalong thethe markingmarking rotationrotation

gapgap isis producedproduced onon thethe medialmedial sideside whichwhich isis filledfilled bybyanan advancementadvancement flapflap plannedplanned onon thethe laterallateral sideside ofofcleftcleft..

AdvantageAdvantage::-- MinimalMinimal tissuetissue isis discardeddiscarded

AllowsAllows modificationmodification duringduring repairrepairDisadvantageDisadvantage:: DifficultDifficult forfor useuse inin widewide cleftcleft..

MayMay narrownarrow thethe nostrialnostrial..


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Basic goals of palate repairBasic goals of palate repair Separation of oral and nasal cavities.Separation of oral and nasal cavities.

ConstructionConstruction ofof watertightwatertight andand airtightairtight velopharyngealvelopharyngeal valvevalve..

PreservationPreservation ofof facialfacial growthgrowth..

DevelopmentDevelopment ofof estheticesthetic dentitiondentition..

DevelopmentDevelopment ofof functionalfunctional occlusionocclusion..

TIMINGTIMING OFOF SURGERYSURGERY

EarlyEarly repairrepair leadsleads toto aa betterbetter speechspeech developmentdevelopment butbut severeseveremidmid facialfacial growthgrowth retardationretardation andand dentaldental malocclussionmalocclussion..

PalatePalate repairrepair afterafter fullfull growthgrowth ofof maxillamaxilla midfacialmidfacial growthgrowthretardationretardation && dentaldental malocclusionmalocclusion problemproblem isis lessless butbut speechspeechproblemproblem becomebecome moremore severesevere..

PalatePalate repairrepair shouldshould bebe donedone 11--11 yearsyears ageage givegive thethe bestbestbalancedbalanced resultresult..

OnlyOnly softsoft palatepalate areare closedclosed byby 66--1818 monthsmonths..

CLEFT PALATE REPAIRCLEFT PALATE REPAIR


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TECHNIQUES OF PALATEREPAIRTECHNIQUES OF PALATEREPAIR Single stare technique.Single stare technique.

eg:eg:-- von langenbeck repairvon langenbeck repairVen wardill kilner vVen wardill kilner v--y push back palatoplasty at arey push back palatoplasty at are1 years.1 years.

Two stare technique:Two stare technique:-- First stage : soft palate repair before 18 month.First stage : soft palate repair before 18 month.

Second stage hard palate repair at 4Second stage hard palate repair at 4--5 years.5 years.eg. Schweckendiek technique.eg. Schweckendiek technique.

1)1) Primary Veloplasty By SchweekendiekPrimary Veloplasty By Schweekendiek.. First soft palate is closed at an early age 16First soft palate is closed at an early age 16--12 months)12 months)

Hard palate closed after few years.Hard palate closed after few years.

Principle of this techniques is that the soft palate aids in thePrinciple of this techniques is that the soft palate aids in thespeech and is essential to be closed early for velopharyngealspeech and is essential to be closed early for velopharyngealmechanism.mechanism.

DisadvantageDisadvantage::-- Speech problem (Severe)Speech problem (Severe)

Additional surgical procedure.Additional surgical procedure.


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2) VON LANGENBECKS PALATO PLASTY.2) VON LANGENBECKS PALATO PLASTY.

UseUse bipedicledbipedicled mucoperiostealmucoperiosteal flapsflaps ofof thethe

hardhard andand softsoft palatepalate forfor repairrepair ofof thethe defectdefect.. ThereThere interiorlyinteriorly andand posteriorlyposteriorly basedbased flapsflaps

areare advancedadvanced mediallymedially closedclosed thethe palatalpalataldefectdefect..

AdvantageAdvantage::-- EasyEasy toto perform,perform, requiresrequireslessless dissectiondissection.. resultsresults inindecreaseddecreased denudeddenuded palatepalate..

DisadvantageDisadvantage::-- FailureFailure toto provideprovide additionaladditionalpalatalpalatal lengthlength..

-- PoorPoor resultsresults inin largelarge cleftsclefts..

-- CurrentlyCurrently notnot commonlycommonly usedused..


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VeauVeau--WardillWardill--KilnarKilnar--vv--yy-- PushbackPushbackpalatoplasty.palatoplasty.

TwoTwo mucoperiostealmucoperiosteal flapsflaps areare raisedraised fromfrom aa hardhardpalatepalate andand nasalnasal layerslayers areare mobilizedmobilized abnormalabnormalattachmentattachment ofof palatalpalatal musclesmuscles areare divideddivided fromfrom thetheposteriorposterior borderborder ofof thethe hardhard palatepalate toto bebe suturedsuturedinin midlinemidline toto thethe oppositeopposite sideside thethe palatalpalatal musclemuscle..

SuturingSuturing donedone anterioranterior ofof thethe nasalnasal layerlayer andandprogressedprogressed towardtoward UvulaUvula..

ORTHODONTICS AND MAXILLARYORTHODONTICS AND MAXILLARYORTHOPAEDICS.ORTHOPAEDICS.

Different stages of dentition methods.Different stages of dentition methods.A)A) predentalpredental treatmenttreatment..B)B) DeciduousDeciduous dentitiondentition (( 33 toto 66 years)years)

C)C) EarlyEarly mixedmixed dentitiondentition (( 77 toto 99 years)years)

D)D) LateLate mixedmixed andand earlyearly permanentpermanent dentitiondentition..

E)E) PermanentPermanent dentitiondentition..


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A) PRE DENTAL TREATMENTA) PRE DENTAL TREATMENT

II FeedingFeeding palatepalate properproper feedingfeeding adviseadvise prepre--surgicalsurgicalfeedingfeeding plateplate..

IIII..ToTo helphelp thethe surgeonsurgeon inin thethe repairrepair ofof thethe cleftcleft bybypushingpushing..

IIIIII.. ToTo stimulatestimulate palatalpalatal bonebone growthgrowth andand toto restorerestore

orofacialorofacial functionalfunctional matrixmatrix..IVIV.. ToTo expandexpand oror preventprevent thethe collapsecollapse ofof maxillarymaxillary

segmentsegment..

B)B) PRIMARYPRIMARY DENTITIONDENTITION TREATMENTTREATMENT-- SimpleSimple formform ofof fixedfixed maxillarymaxillary linguallingual applianceappliance (i(i..ee

warchwarch oror anan ArnoldArnold expander)expander) areare preferredpreferred overover thetheremovableremovable palatalpalatal expansionexpansion forfor improvingimproving speechspeech..


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C)MIXED DENTITION TREATMENTC)MIXED DENTITION TREATMENT

I.I. MinorMinor crossbitescrossbites maymay bebe neglectedneglected butbut severesevere

crossbitescrossbites oneone correctedcorrected byby expansionexpansion byby usualusualmethodmethod..

II.II. RetroclinationRetroclination ofof permanentpermanent incisionincision andand anterioranteriorcrosscross bitebite toto correctcorrect thisthis usuallyusually partialpartial bandedbandedapproachapproach isis neededneeded ..

III.III. CrowdedCrowded dentitiondentition:: ThisThis maymay requirerequire serialserialextractionextraction primaryprimary cupidscupids areare removedremoved toto treattreatincisiorincisior crowdingcrowding && thethe primaryprimary molarsmolars..

IV.IV. AfterAfter alveoloralveolor bonebone graftinggrafting..

ToTo movementmovement carriagecarriage enoughenough spacespace isis createdcreatedinin thethe archarch toto allowallow thethe cuspidscuspids toto erupterupt..


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PERMANENT DENTITION TREATMENTPERMANENT DENTITION TREATMENT TheThe problemproblem atat thisthis stagestage areare posteriorposterior crosscross bitebite

andand malposedmalposed permanentpermanent incisorsincisors..

IfIf orthognathicorthognathic surgerysurgery isis donedone toto correctcorrect thetheunderlyingunderlying skeletalskeletal imbalanceimbalance prepre operativeoperative andand postpostoperativeoperative orthodonticorthodontic treatmenttreatment isis neededneeded totoachieveachieve properproper alignment,alignment, positionposition andand indicationindication ofofthethe teethteeth onon theirtheir respectiverespective archesarches..

ROLE OF ENT SPECIALIST, SPEECHROLE OF ENT SPECIALIST, SPEECH

PATHOLOGISTS AND SPEECH THERAPYPATHOLOGISTS AND SPEECH THERAPY

ENTENT specialist,specialist, AudiologistAudiologist andand speechspeech specialistspecialistworkwork togethertogether toto notenote thethe middlemiddle earear problemsproblems andand

progressprogress inin speechspeech.. DetectDetect abnormalitiesabnormalities inin articulationarticulation andand resonanceresonance

whichwhich isis developsdevelops duedue toto velopharyngealvelopharyngeal inincompetencecompetence afterafter palatoplastypalatoplasty..

TheThe abnormalitiesabnormalities detecteddetected byby videovideo fluoroscopyfluoroscopy oror

nasopharyngoscopynasopharyngoscopy..


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PROCEDURE FORCORRECTION OFPROCEDURE FORCORRECTION OFVELOPHARYNGEAL INSUFFICIENCYVELOPHARYNGEAL INSUFFICIENCY

Pharyngeal flap 2) Sphincter pharyngoplasty.Pharyngeal flap 2) Sphincter pharyngoplasty.

-- PharyngealPharyngeal flapflap designeddesigned onon thethe basisbasis ofof locationlocation andand extentextent ofoflaterallateral pharyngealpharyngeal wallwall motionmotion.. TheThe rawraw underunder surfacesurface ofof thetheflapflap isis linedlined withwith tissuetissue fromfrom thethe nasalnasal sideside ofof thethe softsoft tissuetissuepalatepalate toto preventprevent contracturecontracture andand narrowingnarrowing ofof thethe flapflap thethedonordonor sitesite onon thethe posteriorposterior pharyngealpharyngeal isis closedclosed..

ALVEOLARALVEOLARBONEBONE GRAFTINGGRAFTING TIMETIME 88--1111 yearsyears..-- CancellousCancellous bonebone isis usedused forfor alveolaralveolar graftinggrafting..

-- ItIt promotespromotes moremore rapidrapid vascularizationvascularization duedue toto presencepresence ofoflivingliving osteoblastsosteoblasts..

-- DONARDONARSITESITE OFOF BONEBONE

-- Ilium,Ilium, calvaria,calvaria, tibiatibia mandiblemandible oror ribsribs..

-- TheThe bonebone shouldshould bebe placedplaced withinwithin thethe cleftcleft fromfrom thethe piriformpiriformapertureaperture toto thethe levellevel ofof thethe alveolaralveolar crestcrest..

-- GingivalGingival mucoperiostealmucoperiosteal flapsflaps areare usedused forfor oraloral closureclosure overover ananalveolaralveolar bonebone graftgraft becausebecause theythey areare wellwell vascularizedvascularized..


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ADVANTAGEADVANTAGE

Bony support to teeth.Bony support to teeth.

Helps stabilize the maxillary segments.Helps stabilize the maxillary segments.

Aesthetic appearance of the alveolus.Aesthetic appearance of the alveolus.

Closure of oro nasal fistula.Closure of oro nasal fistula.

Gives supports to the alar bone of the nose.Gives supports to the alar bone of the nose.

Provides bone for a titanium implants.Provides bone for a titanium implants.

OPERATIVE CORRECTION OF MAXILLARYOPERATIVE CORRECTION OF MAXILLARYHYPOPLASIAHYPOPLASIA

Maxillary hypoplasia is three dimensionalMaxillary hypoplasia is three dimensionaldeficiencydeficiency

Class III malocclusion ( Sagittal plane)Class III malocclusion ( Sagittal plane)

Narrowed arch (horizontal plane)Narrowed arch (horizontal plane)

Over closure the mandible (vertical plane)Over closure the mandible (vertical plane)


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TREATMENTTREATMENT Destruction osteogenesis.Destruction osteogenesis.

PrePre surgicalsurgical orthodonticsorthodontics && LefortLefort II osteotomyosteotomy.. FabricationFabrication ofof anan overover laylay denturedenture maymay bebe necessarynecessary

forfor improvedimproved occlusionocclusion andand appearanceappearance..

DENTALDENTAL ENAMELENAMEL HYPOPLASIAHYPOPLASIA::

DefectDefect occursoccurs inin centralcentral && laterallateral incisorsincisors..TreatmentTreatment

RestorationRestoration

PlacementPlacement ofof stainlessstainless steelsteel crowncrown..

FluorideFluoride applicationapplication..

DietaryDietary adviceadvice..

PreventivePreventive oraloral healthhealth carecare


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ROLE OF PROSTHODONTISTROLE OF PROSTHODONTIST Replacement of absent maxillary lateral incisor.Replacement of absent maxillary lateral incisor. ReplacementReplacement byby fixedfixed partialpartial denturedenture andand

implantationimplantation methodmethod..

ROLEOF PSYCHOLOGISTROLEOF PSYCHOLOGIST TheThe psychiatristpsychiatrist andand psychologistpsychologist evaluateevaluate thethe

patientpatient forfor strengthstrength andand weaknessweakness inin cognitivecognitiveinterpersonal,interpersonal, emotional,emotional, behaviouralbehavioural andand socialsocialdevelopmentdevelopment:: emphasisemphasis isis placedplaced onon thethe patientspatients

abilityability toto copecope withwith thethe emotionalemotional andand psychealpsychealstressstress createdcreated byby thethe cleftcleft defectdefect.. ConsultationConsultation withwiththethe parentsparents andand schoolsschools regardingregarding educationaleducational ororbehaviouralbehavioural managementmanagement ifif carriedcarried outout whenwhenindicatedindicated..


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CONCLUSIONCONCLUSION

The management of cleft lip & palate isThe management of cleft lip & palate isnecessary at correct time. If delayed innecessary at correct time. If delayed inthe treatment there may be possibility tothe treatment there may be possibility to

developed abnormalities.developed abnormalities. So to prevent some problems like speechSo to prevent some problems like speech

problem facial asymmetry, feedingproblem facial asymmetry, feedingproblem & infection to nasal cavity &problem & infection to nasal cavity &

unasthetic appearance. The treatment isunasthetic appearance. The treatment isnecessary.necessary.


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REFERENCESREFERENCES

Pediatric Oral & Maxillofacial Surgery byPediatric Oral & Maxillofacial Surgery byLeonard B. Kaban , Maria T. Troulis.Leonard B. Kaban , Maria T. Troulis.

Facial cleft and cranio synostosis ByFacial cleft and cranio synostosis By

Timothy A. Turvey, Kathorine W L VIG ,Timothy A. Turvey, Kathorine W L VIG ,Raymond J. Fansecu.Raymond J. Fansecu.

Clinical Pedodontics By Sidney B. Finn.Clinical Pedodontics By Sidney B. Finn.

Oral & Maxillofacial Surgery by ChitraOral & Maxillofacial Surgery by ChitraChakravarthyChakravarthy

Clinical Pedodontics By Shobha Tandon.Clinical Pedodontics By Shobha Tandon.


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32073259 Cleft Management Pedo

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