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CLEFT PALATE“Palatoschisis”

Name:Faisal Moteq Moshabab Al-QahtaniI.D.N: 431803127

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Definition The palate is essentially the roof of

the mouth.

It is composed of two parts, the hard palate and the soft palate.

The teeth erupt in the anterior hard palate called the alveolar ridge , and the posterior hard palate serves as the base of the nasal cavity.

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•The soft palate is the posterior portion of the roof of the mouth. •The soft palate is mobile and is composed of several muscles important for normal speech and proper function of the eustachian tubes (associated with the middle ear).

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Cleft palate: An opening in the roof of the mouth due to a failure of the palatal shelves to come fully together from either side of the mouth and fuse during the first months of development as an embryo. The opening in the palate permits communication between the nasal passages and the mouth. Surgery is needed to close the palate. Cleft palate can occur alone or in association with cleft lip.

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Basic classification of cleft palate

A cleft palate is first categorized according to whether it affects the hard palate, the soft palate, or both .

The hard palate is the front part of the roof of the mouth.

The soft palate is the back part of the roof of the mouth. This description may include whether the uvula is affected .

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Schematic diagrams of the development of the palate

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development cont.a | The developing frontonasal prominence, paired maxillary processes and paired mandibular processes surround the primitive oral cavity by the fourth week of embryonic development.b | By the fifth week, the nasal pits have formed, which leads to the formation of the paired medial and lateral nasal processes. c | The medial nasal processes have merged with the maxillary processes to form the upper lip and primary palate by the end of the sixth week. The lateral nasal processes form the nasal alae. Similarly, the mandibular processes fuse to form the lower jaw. d | During the sixth week of embryogenesis, the secondary palate develops as bilateral outgrowths from the maxillary processes, which grow vertically down the side of the tongue. e | Subsequently, the palatal shelves elevate to a horizontal position above the tongue, contact one another and commence fusion. f | Fusion of the palatal shelves ultimately divides the oronasal space into separate oral and nasal cavities.

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Cleft palate etiology•Cleft palate occur when tissues in the baby's face and mouth don't form properly. • Normally, the tissues that make up the lip and palate fuse together in the second and third months of pregnancy, but in babies with cleft palate, the fusion never takes place or occurs only partially, leaving an opening (cleft).• Researchers believe that most cases of cleft palate are caused by an interaction of genetic and environmental factors. • In many babies, a definite cause isn't discovered.• Genes inherited from the parents. Either the mother or the father can pass on genes that cause clefting, either as an isolated defect or as part of a syndrome that includes clefting as one of its signs. In some cases, babies inherit a gene that makes them more likely to develop a cleft, and then an environmental trigger actually causes the cleft to occur.• Exposure to certain substances during pregnancy. • Cleft palate may be more likely to occur in pregnant women who smoke cigarettes, drink alcohol and take certain medications.

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Cleft palate complications1. Difficulty feeding your baby . (a cleft palate can

make sucking difficult or cause gagging or breast milk to come out through the nose )

2. Ear infections and hearing loss. (Otitis media)(Babies with cleft palate are especially susceptible to middle ear infections. Over time, repeated ear infections increase the risk of hearing loss)

3. Dental problems.(If the cleft extends through the upper gum, tooth development will likely be affected.)

4. Speech difficulties.(Because the palate is used in forming sounds, the development of normal speech can be affected by a cleft palate)

5. Challenges of coping with a medical condition. (Children with clefts may face social, emotional and behavioral problems due to differences in appearance , a psychologist and a social worker can help your child  

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Treatments are available for cleft palate• You will need to speak with your baby's doctor to determine what is best for your child. • Many clefts can be fixed with surgery. • Surgery can't happen right away but is done when your child is the right age and size.• Some children need more than one surgery to fix the cleft over time. • Many children see a team of professionals who are experts in helping families with children who have cleft lips and palates.

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Surgical Repair- Cleft Palate• Several Techniques- Trend is towards less scarring and less tension on palate• Scarring of palate may cause impaired mid-facial growth(alveolar arch collapse, midface retrusion, malocclusion)• Facial growth may be less affected if surgery is delayed until 18-24 months, but feeding, speech, socialization may suffer.• Bardach Method- Two Flap technique1. Medial incisions made, which separate oral and nasal

mucosa2. Lateral incisions made at junction of palate and

alveolar ridge3. Elevate flaps, preserve greater palatine artery. 4. Detach velar muscles from posterior palate 5. Close in 3 layers

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Non-Surgical TreatmentDental Obturator• For high-risk patients or those that refuse surgery.• Advantage- High rate of closure• Disadvantage- Need to wear a prosthesis, and need to modify prosthesis as child grows.

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Conclusions•Cleft Palate is common congenital deformities that often affect speech, hearing, and cosmesis; and may at times lead to airway compromise. •The otolaryngologist is a key member of the cleft palate team, and is in a unique position to identify and manage many of these problems .