Labio Schiz Is
Transcript of Labio Schiz Is
-
8/10/2019 Labio Schiz Is
1/24
Anatomy
-
8/10/2019 Labio Schiz Is
2/24
-
8/10/2019 Labio Schiz Is
3/24
Definition
Congenital abnormal space or gap in the upper lip
and palate
-
8/10/2019 Labio Schiz Is
4/24
Embryological Background
Development of the Lip: Unpaired Frontonasal Prominence
Medial and Lateral Nasal prominences 2 maxillary prominences
2 mandibular prominences
Development abnormality of nasomedial andmaxilary prominencelabioschizis / cleft lip
-
8/10/2019 Labio Schiz Is
5/24
Embryological Background
Development of Palate: We have two parts of two different embryonic origins:
1 ) primary palate :lip, alveolus and hard palate to
the incisive foramen (4thand 8thweek of gestation)
2 ) secondary palate : hard and soft palateposterior to the incisve foramen (8thand 12thweek of
gestation)
-
8/10/2019 Labio Schiz Is
6/24
-
8/10/2019 Labio Schiz Is
7/24
Insidence
Cleft lip
1 : 600 birth Cleft palate1: 1000 birth
Boys > girls
The highest frequentAsians
Less frequentAfricans
-
8/10/2019 Labio Schiz Is
8/24
Etiology
Unknown Predispotition factor :
Genetic(inherited characteristic) from one or both
parents
Maternal diet and vitamin intake Medications take during pregnancy
Infection
Maternal age
Women with diabetes diagnosed before pregnancy
-
8/10/2019 Labio Schiz Is
9/24
Pathogenesis
Classic theory
Failure of fusion of the maxillary and frontonasal
processes during the time interval yields a cleft of the
primary palate
Mesodermal penetration theory propelled by Stark
Palate closure is predicted on mesodermal penetration
Without this mesodermal migration and reinforcement,
ephitelial breakdown and separation ensuescleft
-
8/10/2019 Labio Schiz Is
10/24
Classification
-
8/10/2019 Labio Schiz Is
11/24
Clinical Manifestation
MAY APPEAR AS:
A split in the lip and roof of the mouth and palate that can affect
both sided of the face
A split in the lip that can appear as only a small notch in the lip
or can extend from the lip through the upper gum and palate into
the bottom of the nose
A split in the roof of the that doesntaffect the appearance of the
face.
Difficulty in swallowing
Nasal Speaking voice
Recurring ear infections
Change in Nose shape
Poorly aligned teeth
-
8/10/2019 Labio Schiz Is
12/24
PROBLEMS ASSOCIATED WITH OROFACIAL CLEFT:
Failure to gain weightFeeding problems
Flow of milk through nasal passage during feeding
Poor growth
Speech difficulties
-
8/10/2019 Labio Schiz Is
13/24
Diagnosis
Diagnosing a cleft palate with ultrasonography isvery difficult
Three-dimensional imaging has been introducedto prenatal ultrasonography diagnostics of cleft
anomalies
-
8/10/2019 Labio Schiz Is
14/24
Treatment
Cleft lip= makes it more difficultfor an infant to suck on a nipple use special nipples to allow
the baby to latch properly(either pump or use formula)
Cleft Palatemay causeformula or breast milk to be
accidentally taken up into thenasal cavity
NGT
Intake nutritionproblem
-
8/10/2019 Labio Schiz Is
15/24
Treatment
The principle of surgery treatment : To close the cleft lip and palate
the child's speech develops normally
the child's feeding normally
Decrease nose regurgitation Prevent injury of maxillary development
-
8/10/2019 Labio Schiz Is
16/24
Treatment
Pre operation Rule of ten
The child weighs 10 pounds
The child has a hemoglobin of at least 10 grams %
The child has a white count of no higher than 10,000 The child is at least 10 weeks of age
-
8/10/2019 Labio Schiz Is
17/24
Labioplasty
Millard Technique
Incision the corner of cleft lip and nose The bottom side of nostril is united with sutura
The upper side of lip is united
The stretch suturing is to closing the cleft totally
-
8/10/2019 Labio Schiz Is
18/24
Von Langenbeck Palatoplasty
This technique is still used in isolated cleft palate
repair. The muscle dissection and muscle suturingare done as additional procedures to create a
muscle sling
-
8/10/2019 Labio Schiz Is
19/24
Veau Wardill Kilner Pushback
palatoplasty (V-Y)
these drawbacks pushback and V-Y techniques have
fallen into disrepute and now less and less centres
practise this technique
-
8/10/2019 Labio Schiz Is
20/24
Bardach Two flap
Modification of the von
Langenbeck technique
Incision is made along the
cleft margin and the alveolar
margin. These are joined
anteriorly to free the
mucoperiosteal flaps
This is a techniquecommonly followed
presently
-
8/10/2019 Labio Schiz Is
21/24
Furlow Z plasty
Double line is incisionline and dash line is fold
line
Left flap contains muscle
and mucosa oral Righ flap contains
mucosa oral
Suturing of Z plasty
tehnique
-
8/10/2019 Labio Schiz Is
22/24
Complication
Wound dehiscence
Wound expansion
Wound infection
Malposisi Premaksilar Whistle deformity
Abnormality or asimetry of lip
-
8/10/2019 Labio Schiz Is
23/24
Multi Disciplinary Team
CHILD & FAMILY
PSYCHOLOGIST
SPEECH
THERAPIST
DENTIST
ORTHODONTIST
GENETICIST
ENT/AUDIOLOGY
SURGEON
-
8/10/2019 Labio Schiz Is
24/24