Primary Bilateral Cleft Lip-Nose Repair: The Tawanchai Cleft ...
embryogenesis cleft lip palate.pdf
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Ocky Pranata
EMBRY
OGENESIS OF CLEFT LIP
AND PALATE
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abnormal opening or a fissure in an anatomical
structure that is normally closed.
Cleft
Clefts of the lip and/or palate are
common birth defects
with an incidence
of 1/500 to 1/1000 births worldwide
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Orofacial cleft
Cleft lip and/oralveolus
Cleft palate
Combined
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• Cleft lip with or without cleft palate occurs
about twice as often in males than in
females and is usually more severe in males
• Cleft palate occurs about twice in females
as in males
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• It has been speculated that it could be related todifferences of the lip and the palate in the embryo.
• In the male human embryo, the horizontal
positioning and subsequent closure of thesecondary palate occurs earlier than in the female
embryo.
•
Because the palatal shelves are open longer in thefemale, there is greater period of time during
which there is susceptibility to environment
teratogens
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Stage
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• begins at around 6 to 7 weeks of gestation
and starts at the incisive foramen.
•
Fusion begins at the incisive foramen and then proceeds in an anterior direction to form the alveolus
through the fusion of the bilateral incisive suture lines.
• Closure the proceeds to form the base of the anterior
nose and finally the upper lip.• The median and two lateral lip segments are then
fused, forming the philtrum and philtral lines which
completes the formation of the upper lip.
EMBRYOLOGICAL DEVELOPMENT
OF THE LIP AND ALVEOLUS
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• During 4th week of gestation, as the maxillary and mandibular
processes of the first pharyngeal arch are developing and
growing anteriorly, a median bulge covering the brain enlarges
and grows forward.
• This frontonasal prominence, with its two lateral thickened
areas, the nasal placodes, develops just above the stomodeum.
Later, the medial and lateral rims of the nasal placodes grow
around the placode, leaving a depression, the nasal pit.
• Continued anterior growth of these rims through the fifth week
causes a thinning and rupture of the epithelium covering the
floor of the nasal pit.
EMBRYOLOGICAL DEVELOPMENT
OF THE LIP AND ALVEOLUS
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• At this point, as this bucconasal membrane ruptures, a
communication is established with the roof of the developing
oral cavity. The lateral rims of the nasal placodes the lateral
nasal swellings, which will become the alae of the nose. The
medial rims of the nasal placodes, (the median nasal swellings),
fuse together to form the intermaxillary segment form the
bulbus of the nose
• Continued growth of this intermaxillary segment anterior and
inferior to the nose will give rise to the inferior aspect of the
nasal septum, columella of the nose, philtrum of the upper lip,
labial tubercle, and primary palate (premaxilla).
EMBRYOLOGICAL DEVELOPMENT
OF THE LIP AND ALVEOLUS
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• teeth and their supporting structures as well as the gingiva will also
develop from the intermaxillary segment
• During this approximately 2-week period, the maxillary swellings have
moved anteriorly, meeting the intermaxillary segment and fusing with
it to seal the nasolacrimal groove, a deep furrow running between the
medial aspect of the eye and the primitive oral cavity on the face. The
epithelium lining this groove separates from the surface ectoderm,
finally forming the nasolacrimal duct (tear duct) opening into the
nasal cavity
EMBRYOLOGICAL DEVELOPMENT
OF THE LIP AND ALVEOLUS
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• During this period, the mandibular processes have
fused anteriorly, forming the mandible, thereby
reducing the size of the primitive mouth. Also at thistime, mesoderm of the second arch has invaded the
area, forming the muscles of facial expression over
the entire face
EMBRYOLOGICAL DEVELOPMENT
OF THE LIP AND ALVEOLUS
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• starts at around 8 to 9 week of gestation. The
palatal shelves are vertical and positioned on
each side of the tongue.• Around the 7th or 8th week of gestation, the
tongue begin to gradually drop down the
palatal shelves move slowly from a vertical to
horizontal position and fuse, first with the premaxilla at the incisive foramen and then with
each other.
EMBRYOLOGICAL
DEVELOPMENT OF THE PALATE
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• The process of fusion begins and the incisive foramen
and then proceeds between the palatal shelves, moving
in a posterior direction along the median palatine
suture line. This completes the formation of the hard
palate.
• The vomer forming a portion of the nasal septum,
moves downward and fuses with the superior surfaceof the hard palate, thus completing the separation of
the nasal cavity. Once the hard palate is formed, the
velum and finally the uvula are formed. This process is
usually complete by 12 weeks of gestation.
EMBRYOLOGICAL
DEVELOPMENT OF THE PALATE
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Direction of growth and resorption of the facial
bones at various sites
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• due to disruption or delays in cell migration or palatal
shelf movement
• include chomosomal disorders and genetic disorders.
• Older parental age has also been linked with an increased
risk for both cleft lip and palate.
• In addition cleft can be caused by environmental
teratogens or by mechanical factors in utero.
• Environmental teratogens include cigarette smoke,
phenytoin, thalidomide, valium, virus (including rubella
and even influenza), lack of maternal vitamin b6
CAUSES OF CLEFT
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