Note - This page is an undergraduate science embryology student group project 2011.

Cleft Palate and Lip

Introduction

History

Timeline

In 1295- 1351, Jean Yperman noted that cleft had a congenital origin classifying the various forms of the condition and outlining corresponding treatment principles (1)

In 1460 Heinrich von Pfolsprundt passed stitches through all the layers to repair the cleft instead of simply suturing the skin accomplishing a better repair of the lip. (2)

In 1537-1619, Fabricius ab Aquapendente first described the embryological basis of cleft lip. (3)

In 1561, Pierre Franco described the techniques of correction of both unilateral and bilateral cleft lips in Traite des Hernies using dry sutures, pins and a triangular bandage. He emphasized that an accurate surgery procedure can produce an inconspicuous scar, an outcome which was “particularly desirable when the patient was a girl”. (4)

In 1808, Meckel pubished his theory of the embryological development of the lips which stated that the lips formed from five distinct processes which eventually united, three for the upper lip and two for the lower lip. (5)

In 1838 Philippe Frederick Blandin suggested that facial cleft resulted from a failure of the premaxilla and the maxillary segments to unite at a later stage in development. (6)

In 1844, Germanicus Mirault introduced a triangular flap from the lateral side into a gap created by making a horizontal incision on the medial side of the lip creating a nostril floor and reducing the linear scar on the lip. (7) In 1872, Jacob August Estlander, a Finnish surgeon introduced a method to correct the mid-face retrusion that was left by the bilateral lip repair process. He recommended a wedge resection of the vomer which allowed the protruding premaxilla to be pushed back. (8) In 1935, Faltin, another Finnish surgeon recommended that the procedure described by Jacob A Estander be abandoned because it routinely left serious maxillary retrusion. (9) In 1960, Peter Randall standardized the triangular flap repair method with accurate and reproducible measurements. (10) In 1965, W. M. Manchester introduced a procedure for the bilateral cleft surgery. (11) In 2000, Hua Xi Kou Qiang demonstrated that simultaneous primary palate repair and alveolar bone grafting are safe for unoperated cleft palate patients, and this procedure should be performed in unoperated cleft palate patients above 8 years old. (12)

In 2008, J Y Wong published a study describing that craniofacial anthropometry using the 3dMDface System is applicable and reliable. Application of software algorithms merging the different overlapping images into a single three-dimensional image can remarkably improve landmark identification. (13) In 2010, B Mishra along with team of Indian doctors published a study describing Nasoalveolar molding can be a useful adjunct for treatment of cleft lip nasal deformity. It serves as a cost-effective technique that can diminish the number of future surgeries such as alveolar bone grafting and secondary rhinoplasties in under developed countries. (14) References: 1. Yperman J. La chirurgie de maitre Yperman mise au jour et annotee par JMF Carolus. Gand: F and D Gyselynch; 1854. 2. Pfolsprundt H von. Buch de Bündth-Ertsnei von H von Pfolsprundt Brunder de deutschen ordens 1490. Herausgegeben von H. Haeser und A Middledorpf, Reimer, Berlin:1868 3. Bhattacharya S, Khanna V, Kohli R. Cleft lip: The historical perspective.Indian J Plast Surg. 2009 Oct;42 Suppl:S4-8. PubMed PMID: 19884680; PubMed Central PMCID: PMC2825059. 4. Franco P. Traite des Hernies. Lyons: Thibauld Payan; 1561. 5. Meckel JF. Beitrage zur Gesichischte des menschlichen Foetus. Beitr Verlag Anat. 1808;1:72. 6. Blandin PF. Operation to remedy a division of the velum palati or cover of the palate. New York J Med. 1838;10:203. 7. Mirault G. Deux lettres sur l'operation du bec-delievre. J Chir. 1844;2:257 8. Estlander JA. Eine method aus der einen lippe substanzverluste der anderen zu ersetzen. Arch Klin Chir. 1872;14:622 9. Faltin R. History of plastic surgery in Finland. Finsk Lak Sallsk Handl. 1937;80:97 10. Randall P. Triangular flap operation for unilateral clefts of the lip. Plast Reconstr Surg. 1959;23:331. 11. Manchester WM. The repair of bilateral cleft lip and palate. Br J Surg. 1965 Nov;52(11):878-82. PubMed PMID: 5842977 12. Mao C, Ma L, Li X. [Simultaneous primary palate repair and alveolar bone grafting in unoperated cleft palate patients over 8 years old]. Hua Xi Kou Qiang Yi Xue Za Zhi. 2000 Oct;18(5):323-5. Chinese. PubMed PMID: 12539652 13. Wong JY, Oh AK, Ohta E, Hunt AT, Rogers GF, Mulliken JB, Deutsch CK. Validity and reliability of craniofacial anthropometric measurement of 3D digital photogrammetric images. Cleft Palate Craniofac J. 2008 May;45(3):232-9. PubMed PMID: 18452351 14. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916669/?tool=pubmed

Development of Disease

Aetiology

Developmental Process

Developmental Staging

Two main stages of palate development, primary and secondary
Morphology of face established between weeks four and five
7th week – intermaxillary process formed, Intermaxillary process gives rise to primary palate
End of 7th week – palantine shelves start to move into position and fuse together to form secondary palate
Failure of these palantine shelves to fuse results in cleft palate
Secondary palate fused during 10th week
Cleft lip results in failure of the two maxillary processes to fuse with the descending part of the intermaxillary process

Abnormality Classification

There has been a new proposed classification system
Cleft palate and cleft lip have different embryological origins
More than 300 syndromes involving facial clefting
Can be unilateral or bilateral
Cleft palate and cleft lip may be seen together or individually without the other one present

Pathophysiology

Genetic Configuration

Surgical Timeline

Current and Future Research

External Links

Glossary/Terms

Gallery

References

Textbooks

2011 Group Project 11

Contents