Craniofacial Anomalies Seminar

8132019 Craniofacial Anomalies Seminar

httpslidepdfcomreaderfullcraniofacial-anomalies-seminar 161

DR RANJITHA S

PG STUDENT

DEPT OF ORTHODONTI

craniofacial anomalies



contents

Introduction

Definition of craniofacial anomalies(CFA)

Types of anomalies

Etiology

Role of an orthodontist in CFA

Cleft lip and palate



INTRODUCTION The birth of a child with a facial deformity is a devastating

event for most parents who often have never seen orheard about similar malformations For some parents it isvery difficult to accept the deformity of the child becauseit involves the face making the child appear completelydifferent from all the others Feelings of rejection guiltand anxiety gradually develop



Three-quarters of the malformations diagnosed at birth fall in the category ldquocraniofacialrdquo The most commonfacial malformations are cleft lip and cleft palate

Less frequent are the syndromes of the I and II branchialarches such as hemifacial microsomia (Oto-mandibularSyndrome) or Franceschetti syndrome (Treacher Collins)

Even more rare are the forms that primarily involve themidface and the skull called cranio-facial-synostosissuch as Apert Syndrome (1 born in 100000) or Crouzon

syndrome (1 in 25000)



Craniofacial anomalies (CFA) are a diverse group ofdeformities in the growth of the head and facial bones

Anomaly is a medical term meaning irregularity or

different from normal These abnormalities arecongenital (present at birth) and there are numerousvariations - some are mild and some are severe andrequire surgery



Types of Anomaliesbull Malformations

ndash Occur during formation of structures

bull Complete or partial absencebull Alterations of its normal configuration

bull Disruptions

ndash Morphological alterations of structures after formation

bull Due to destructive processes

bull Deformations

ndash Due to mechanical forces that mold a part of fetus over aprolonged period of time

bull Clubfeet due to compression in the amniotic cavity

bull Syndromes

ndash Group of anomalies occuring together with a specific

common etiologybull Dia nosis made amp risk of recurrence is known



Etiology of CFAbull

GeneticchromosomalEnviornmental

bull Incidence

2-3 of newborn (4-6 by age 5)

In 40-60 of all birth defects cause is unknownbull Geneticchromosomal

10-15

bull Environmental

10bull Multifactorial (genetic amp environmental)

20-25



CAUSES OF CRANIOFACIAL ABNORMALITIES

1Chromosomal abnormalities

Numerical abnormalities Structural abnormalities

Autosomes Sex chromosomes

1 Deletion2 Duplication3 Inversion

4 Translocation

Down syndrome Turner syndrome Congenitalabnormalities

(if unbalanced)



Environmental factors

bull Infectious agents rubella cytomegalovirus HSV syphilistoxoplasmosis

bull Radiation teratogenic effects

bull Chemical Agentsdrugs thalidomidevaliumphenytoin valproic acid amphetamines

bull Hormones

bull Late pregnancies downrsquos syndrome

bull Nutritional Deficiencies folic acid deficiencies



Role of an orthodontist in craniofacial anomalies

The orthodontist is an essential member of any craniofacial team

The role of the orthodontist on the team is tobull Help determine which craniofacial structures are abnormal in theaffected patientbull Determine the facial growth pattern and predict the futuremorphology

bull Estimate the effect that various treatment modalities particularlysurgery would have on subsequent growth and advise on theappropriate nature and timing of treatmentbull To Plan with the surgeon for the desired skeletal and soft tissue

alterationsbull To Prepare for the orthognathic component of the surgery bymanipulating the teeth and alveolar process and completeorthodontic corrections after the surgery



Cleft lip

Defective fusion of medial

nasal process with the

maxillary process leads to

cleft lip (CL)



Cleft palate

Similarly failure of fusion

of palatal shelves leads to

cleft palate (CP)



Frequently CL amp CP occur together

Approximately 45 cases are CL + CP while 30 areisolated CL and 25 isolated CP

Isolated CP appears to represent a separate entity

Other rare facial clefts like lateral facial cleft occurs as a

result of failure of fusion of maxillary and mandibularprocesses leading to a cleft from corner of mouth towardear

Oblique facial cleft extends from upper lip towards theeye and is almost always associated with CP Caused byfailure of fusion between maxillary process with lateralnasal process

Midline cleft of upper lip is extremely rare and representsfailure of fusion of medial nasal processes in the midline



ETIOLOGY Cause is still being debated

Important to distinguish between isolated clefts andclefts associated with developmental syndromes

More than 250 syndromes are associated with orofacialclefts and account for 3 - 8 of orofacial clefts eg

Pierre Robin syndrome Treacher-Collins syndrome etc Environmental factors like alcohol consumption viruses

etc also may combine with developmental factors

SYNDROMES

velocardiofacial syndrome goldenhar syndromestickler amp treacher collins syndromes



CLINICAL FEATURES

RACIAL PREVALENCE -

Clefting is one of the most common congenital defects in

humans

Prevalence varies between races mongoloids with the

highest incidence of 1 in 600-1000 births and the negroid

race with the least incidence of 1 in 2000 births

Isolated CP is less common than CL + - CP



SEX PREDILECTION -

CL + - CP is more common in males

More severe the defect greater is the male predilection

Male to female ratio for isolated CL is 15 1

MF ratio for CL+CP is 2 1

In contrast isolated CP is commoner in females with the MF

ratio being 1 2



SIGNS amp SYMPTOMS -

About 80 cases of CL are unilateral with 70 of

unilateral cases occurring on left side

A complete CL extends till the nose

A CP shows considerable variation in severity with the

defect involving both hard and soft palate or soft palate

alone



CLASSIFICATION

1 Veaursquos simple classification (1931)

2 Pfeiferrsquos symbolic classification (1966)

3 Kernahan amp Starkrsquos striped Y classification (1971)

4 Krienrsquos LAHSHAL classification (1987)



Classification - Veau

GROUP IClefts of soft palateonly

GROUP IIClefts of soft andhard palate reaching anteriorly

to incisive foramen GROUP IIIComplete unilateral

alveolar clefts - generallyinvolve the lip as well

GROUP IVBilateral alveolarclefts - associated with bilateralclefts of the lip



PFEIFERrsquos SYMBOLIC



KERNAHANrsquos STRIPED Y





Problems associated with clefts

Cleft patients suffer from many direct as well as well asindirect problems

The most obvious problem is clinical appearance leadingto psychosocial problems

Feeding difficulties

Poor growth

Recurrent Ear infections

speech difficulties are common especially with CP

CP also causes collapsing of maxillary arch missing ofteeth supernumerary teeth leading to malocclusion



24

Management of cleft lip and palate

Family Systems Counseling

Considers each family member as part of asystem

Each member affects the others

System is interdependent

Within the system are subsystems



Feeding problems often associated with cleft anomaliesmake it difficult for the infant to maintain adequate

nutrition

These problems include insufficient suction to pull milkfrom the nipple excessive air intake during feeding

choking nasal discharge and excessive time required totake nourishment



Feeding by nasogastric tube



Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle



Cleft Babies Should Be

Kept In Upright Position

For Feeding To Make

Gravity Aid In Milk

Feeding



Feeding plates to assist in early feeding



OBTURATOR

The feeding obturator is a prosthetic aid that is designed to obturate

the cleft and restore the seperation between the oral and nasal

The obturator prevents the tongue from entering the defect and

interfering with spontaneous growth of the palatal shelves

Reduces nasal regurgitation

Also helps in the development of the jaws and speech



Cleft Lip Repair

Rule of 10rsquos by MILLARD Surgery gt 10 weeks old

Weight gt 10 pounds

Hemoglobin level gt 10 gdL



Cleft Lip Repair(types)

Millard Repair - Rotation advancement technique

Randall - Graham - Triangular flap interposition

Rose - Thompson - Straight line repair Risk of verticalcontracture



Cleft Lip Repair

Goals Bridge the cleft

Create a complete muscular sling around the entirecircumference of the oral cavity

Approximate cleft edges Maintain Cupids bow and philtral dimple

Align vermillion border

Create an intact nasal floor and sill

Produce symmetry of the alar base and columella

Reconstituting the circumferential integrity of theorbicularis oris muscle



Speech and Hearing

A tympanostomy tube is often inserted into the

eardrum to aerate the middle ear

Speech problems are usually treated by a speech-language pathologist

Encourage the childs early attempts to make soundseven before the cleft is repaired



Role of Orthodontics

a Infant Orthopedics

b Treatment in deciduous dentition

c Treatment in mixed dentition

d Treatment in permanent dentition



Role of presurgical orthopedics

Introduced by McNeil in early 1950rsquos

Proposed Benefits

1 Control and modify the post-natal maxillary and Orofacialdevelopment2 Stimulation of palatal shelf growth3 Constriction of expanded anterior part of maxilla

4 Reposition of premaxilla to aid the surgeon prior to lip repairor primary bone grafting



Neonatal Orthopaedics

Performed on new born before surgicalrepair of lip

Rationalerealignment of the collapsedsegments before surgery Either simple passive active orthopaedic

extra orally activated pin retained Definitely makes lip and anterior palate

surgery easier at the time



Naso Alveolar Molding(NAM)

NAM is non surgical method of reshaping alveolus lip andnostrils before cleft lip and palate surgery lessening theseverity of cleft

It is the passive method of bringing the gum and lip together

by redirecting the forces of natural growth It is a modern presurgical orthopedic device that allows for a

positive growth of alveolar ridges into a improved arch form



Advantages of performing NAM

provides a more coalescent cleft and an ideally shapedalveolar arch form

It diminishes tension during primary surgerymaking scarformation more diificult

Alignment of alveolar segment creates the foundation forgood lip symmetry

More favourable bone formation by reducing the cleft gap

Allows the surgeon to definitely correct the nose without

extensive dissection Diminished need for bone grafting during the mixed dentition

stage

Premaxillary Retraction




In cases of bilateral cleft lip and palate premaxillarysegment may be positioned severely anterior to the maxillary arch if lipsurgery is undertaken with the premaxilla in such an abnormal positionthe chances of lip dehiscence by increased pressure at the suture linesare increased

Segments may be deviatedlaterally to one side of the cleftdefect In such cases a straightextra oral force would not placethe pre maxilla in the facialmidline this can be retracted by

the application of sequentialdifferential force to thepremaxilla with elastic strapsattached to the bulb prosthesis



An impression is made of the infants premaxilla forconstruction of an external acrylic bulb prosthesis

This appliance isfitted over theprotruding and

laterally displacedpremaxilla andanchored to theinfants head with abonnet appliance

LATHAMrsquo S APPLIANCE FOR PRESURGICAL



LATHAM S APPLIANCE FOR PRESURGICAL

REPOSITIONING OF THE PROTRUDED PREMAXILLA INBILATERAL CLEFT LIP AND PALATE

The appliance is designed so that it could be secured to the palatal segments

with stainless steel pins(pinning principle as described by Georgiade in 1970)



Turning the screw expandsthe gap between the

anterior borders of thelateral segments

The appliance is availablecommercially and

individually adapted to aplaster cast with the helpof an acrylic plate

Journal of Cranio-Maxillo-Facial Surgery 19922099-110



Angle brackets to keep roots

away from cleft



Mixed Dentition -

Maxillary protraction

Maxillary protraction is done using face mask



A study was done to investigate biomechanical effects of

maxillary protraction with and without maxillary expansion

on unilateral cleft lip and palate(UCLP)model before and after

alveolar bone graft (ABG)

The results showed that maxillary protraction with expansion

could presumably promote the orthopedic effects of the

facemask on UCLP patients and more uniform force would

obtain after ABG

Shanghai Kou Qiang Yi Xue 2012 Jun21(3)287-93



Face mask therapy

Indications

1 Sagittal deficiency of maxilla2 Anterior cross bite

3 Low mandibular plane angle

Contraindication - - True mandibular prognathism

- high mandibular plane angle

Advantage- No Need of RME



Palatal expansion

Objectives of treatmentAchievement of proper anterior andlateral overjet correction Correction of the antero-posteriordiscrepancy

Various expansion appliances used areFan shaped maxillary expanderButter fly expanderRapid maxillary expanderNickel titanium expander

Quad helix expansion applianceThe banded hyrax appliance andBonded rapid palatal expander



Cleft Palate Repair(surgical management)

V-Y Pushback

Two Flap Palatoplasty

Four Flap Palatoplasty

Schweckendickrsquos Primary Veloplasty

Furlow Palatoplasty



Alveolar bone grafting

Types -

- Primary bone grafting ndash 2yrs of age

- Secondary bone grafting ndash 6-15years

- Delayed secondary grafting

Donor Site- Cancellous bone from Iliaccrest



Alveolar bone grafting (ABG)

Provides continuity of alveolar ridgehellip Provides bone for canine to erupt

Osseous support for adjacent teeth

Majority of canines erupt spontaneouslyhellipothers

require surgical exposure often in combination

with orthodontics

The erupting teeth often appear to thenstimulate the formation of new alveolar bone



Indications for Alveolar bone Graft

1 To stabilize the premaxilla2 To close the oronasal fistula3 To ensure better periodontal support to erupting teeth andteeth adjacent to cleft site

4 To lend support to the depressed lip over the cleft5 To provide bony continuity in the alveolus for tooth eruptionand for orthodontic movement of teeth adjacent to cleft into

their optimal position



A study was done by timo peltoma to examine possibleassociations between severity of clefting in infants and maxillary

growth in children with complete unilateral cleft lip and palateThe results demonstrated the large variation in the severity ofunilateral cleft lip and palate deformity at birth Patients withlarge clefts and small arch circumference arch length or both

demonstrated less favorable maxillary growth than those withsmall clefts and large arch circumference

TIMO PELTOMAuml KI BRUNO L VENDITTELLI

Cleft PalatendashCraniofacial Journal November 2001 Vol 38 No 6

T i D i i



Treatment in permanent Dentition

This is the phase of comprehensive Orthodontic treatment

Main features including -

1 Face mask therapy with prior RME2 Tooth movement to finalise the occlusion

3 Management of arches4 Correction of individual tooth irregularity5 Closure of spaces wherever possible6 Planned space maintenance in areas of missing teeth for

prosthetic replacement7 Pre and postsurgical orthodontics



Retention-

One of the nightmares for an orthodontst is Greater chance ofrelapse in CLP patients brsquocoz of the Surgical scarUsually require a long term retention

Appliances-

- Soldered lingual retainer- Upper Hawleyrsquos retainer

- Bonded spiral wire retainer in UL anterior region

Di t ti O t i



Distraction Osteogenesis

Indicated in cases of severe maxillo- mandibular discrepancy

Advantages-Less relapse tendency

It results in reliably lengthening the bones ofthe midface and mandibleMaxillary advancement between 4 and 12 mm isachieved during 3-4 weeks and a satisfactory class1 or class 2 molar

Relationship can be obtained



A study was done to evaluate the treatment outcome andlong-term stability of skeletal changes following maxillary

advancement with distraction osteogenesis in adult subjectsof cleft lip and palateCONCLUSIONS Successful advancement of maxilla wasachieved by distraction osteogenesis in adult subjects

with cleft lip and palate Most of the relapse occurred duringthe first 6 months of post-distraction period and after thatthe outcomes were stable

Singh SP Jena AK Rattan V Utreja AK Unit of Orthodontics Oral Health Sciences Centre PostGraduate Institute of Medical Education and Research

Chandigarh India



summary

Oro facial clefts require a multidisciplinaryapproach

Treatment extends over many years and risksexhausting patient cooperation

Need to keep the patients best interests inmind



ldquoThere is no area of dentistry more fascinating and

satisfying than rendering dental care to the

unfortunate patients with cleft lip and palaterdquo



Cleft lip amp palate Diagnosis amp Management by samuel berkowitz

Dental orthopedia amp treatment of cleft palate by calvin case Management of cleft lip and palate in the developing world by

michael mars et al

The orthodontist and complex craniofacial anomalies by Bruce Ross

Longmanrsquos text book of medical embryology

Peltomaki T Associations Between Severity of Clefting andMaxillary Growth in Patients With Unilateral Cleft Lip and PalateTreated With InfantOrthopedicsCleft PalatendashCraniofacial JournalNovember 2001 Vol 38 No 6 582-86

Chen ZX pan XG Maxillary protraction with and without maxillaryexpansion on unilateral cleft lip and palate model a finite elementanalysis Shanghai Koi Qiang Yi Xue2012 Jun21(3)287-93

Treatment outcome and long-term stability of skeletal changesfollowing maxillary distraction in adult subjects ofcleft

lip and palate by Singh SP Rattan V





contents

Introduction

Definition of craniofacial anomalies(CFA)

Types of anomalies

Etiology

Role of an orthodontist in CFA

Cleft lip and palate





















bull Disruptions



bull Deformations



bull Syndromes





Etiology of CFAbull


bull Incidence



10-15

bull Environmental


20-25








4 Translocation


(if unbalanced)







bull Hormones












Cleft lip




cleft lip (CL)



Cleft palate



cleft palate (CP)

















SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al





























bull Disruptions



bull Deformations



bull Syndromes





Etiology of CFAbull


bull Incidence



10-15

bull Environmental


20-25








4 Translocation


(if unbalanced)







bull Hormones












Cleft lip




cleft lip (CL)



Cleft palate



cleft palate (CP)

















SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al

























bull Disruptions



bull Deformations



bull Syndromes





Etiology of CFAbull


bull Incidence



10-15

bull Environmental


20-25








4 Translocation


(if unbalanced)







bull Hormones












Cleft lip




cleft lip (CL)



Cleft palate



cleft palate (CP)

















SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al



















bull Disruptions



bull Deformations



bull Syndromes





Etiology of CFAbull


bull Incidence



10-15

bull Environmental


20-25








4 Translocation


(if unbalanced)







bull Hormones












Cleft lip




cleft lip (CL)



Cleft palate



cleft palate (CP)

















SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al














bull Disruptions



bull Deformations



bull Syndromes





Etiology of CFAbull


bull Incidence



10-15

bull Environmental


20-25








4 Translocation


(if unbalanced)







bull Hormones












Cleft lip




cleft lip (CL)



Cleft palate



cleft palate (CP)

















SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











Etiology of CFAbull


bull Incidence



10-15

bull Environmental


20-25








4 Translocation


(if unbalanced)







bull Hormones












Cleft lip




cleft lip (CL)



Cleft palate



cleft palate (CP)

















SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al
















4 Translocation


(if unbalanced)







bull Hormones












Cleft lip




cleft lip (CL)



Cleft palate



cleft palate (CP)

















SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al















bull Hormones












Cleft lip




cleft lip (CL)



Cleft palate



cleft palate (CP)

















SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al


















Cleft lip




cleft lip (CL)



Cleft palate



cleft palate (CP)

















SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











Cleft lip




cleft lip (CL)



Cleft palate



cleft palate (CP)

















SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











Cleft palate



cleft palate (CP)

















SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al

























SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al
















SYNDROMES




CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











CLINICAL FEATURES

RACIAL PREVALENCE -


humans







SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











SEX PREDILECTION -






ratio being 1 2









alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al

















alone



CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











CLASSIFICATION



























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al































Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al























Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al




















Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al

















Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al















Poor growth






24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











24










nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al












nutrition








Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al














Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











Feeding of

cleft lip and

palate

patients

Pigeon feeder

Haberman feeder

Squeeze bottle





For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al













For Feeding To Make

Gravity Aid In Milk

Feeding






OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al














OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











OBTURATOR









Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











Cleft Lip Repair


Weight gt 10 pounds










Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al

















Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











Cleft Lip Repair










Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











Speech and Hearing
















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al




















Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al













Proposed Benefits


























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al
































stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al

























stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al


















stage






























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al





































away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al































away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al

























away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al



















away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al












away from cleft



Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











Mixed Dentition -












obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al


















obtain after ABG




Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











Face mask therapy

Indications








Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











Palatal expansion







V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al












V-Y Pushback




Furlow Palatoplasty




Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al












Types -












with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al
















with orthodontics















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al






















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al
















T i D i i











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al



















Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al











Retention-


Appliances-



Di t ti O t i














Chandigarh India



summary













michael mars et al






















Chandigarh India



summary













michael mars et al















Chandigarh India



summary













michael mars et al











summary













michael mars et al


















michael mars et al













michael mars et al











Documents

Craniofacial Anomalies Seminar