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Download MBBS Burns and Plastic Surgery PPT 3 Cleft Lip Cleft Palate And Craniofacial Syndromes Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Burns and Plastic Surgery PPT 3 Cleft Lip Cleft Palate And Craniofacial Syndromes Lecture Notes

This post was last modified on 07 April 2022




Cleft lip, cleft palate and

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craniofacial syndromes

Department of Burns and Plastic Surgery

Cleft lip and palate

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Epidemiology

Embryology

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? Face starts forming by 4 rth week and completed by 8 th week
? Palate formation is completed by 10 th week

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What is unique about craniofacial development?

? Dual origin

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? Tissue interactions
? Elaborately choreographed morphogenic movements



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Cyclopia

? Part of holoprosencephaly
? Holoprosencephaly also associated with-

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Establishment and fusion of the facial

prominences

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? basic morphology of the face is established between the 4th and 10th weeks
? midline frontonasal prominence,
? 3 paired prominences, the maxillary, lateral nasal, and mandibular

prominences

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The frontonasal prominence

? forehead, midline of the nose, the philtrum, the middle portion of the

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upper lip, and the primary palate.

? b/l cleft lip


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The lateral nasal prominences

? alae of the nose
? failure in the fusion between the lateral nasal prominences and either

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the frontonasal or the maxillary processes

The maxil ary prominences

? upper jaw and the sides of the face

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? the sides of the upper lip
? the secondary palate.


The mandibular prominences

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? Lower jaw and lip
? Very rare
? Wide array of phenotypes

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Pharyngeal arches


ETIOPATHOGENESIS

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ETIOPATHOGENESIS

They can be classified in to 4 groups

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1. Chromosomal

2. Single gene

3. Multifactorial

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4. Mitochondrial


ETIOPATHOGENESIS

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Etiopathogenesis


3. Environmental factors

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Maternal Smoking or tobacco

exposure

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Viral infections

Poor nutrition

Drugs

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Teratogens- Rubel a,

cortisone/steroids/ mercaptopurine

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Methotrexate, Valium, Dilantin



Diagnosis

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USG


Problems with clefts

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Feeding problems

Oronasal fistula

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Nasal regurgitation

Bottle cup, spoon feeding

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30-45 deg angle to aid swallowing


Syndromes

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? Inherited syndrome


Teratogenic syndrome

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? Fetal alcohol syndrome
? Fetal phenytoin syndrome
? Fetal valproate syndrome

Management by Multidisciplinary approach

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Cheiloplasty

Cleft palate surgery

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Von langenback
VY palatoplasty by Veau
Furlows palatoplasty
Wardil-kilner Pushback palatoplasty

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Bone grafting

Recent advances

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Fetal endoscopic approach
Fetal surgery in intrauterine life (less than 20 weeks)
Open fetal surgery
Conclusion

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? Second most common congenital anomaly
? Embryogenesis and etiology to be kept in mind
? Team approach
? Research to be aimed at Epigenetic modification

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