2011 Group Project 11

Note - This page is an undergraduate science embryology student group project 2011. 2011 Projects: Turner Syndrome | DiGeorge Syndrome | Klinefelter's Syndrome | Huntington's Disease | Fragile X Syndrome | Tetralogy of Fallot | Angelman Syndrome | Friedreich's Ataxia | Williams-Beuren Syndrome | Duchenne Muscular Dystrolphy | Cleft Palate and Lip

Cleft Palate and Lip

--Mark Hill 12:11, 8 September 2011 (EST) This project shows extremely poor progress at this time. May empty sub-sections and many of you have not met the requirements as required in an earlier laboratory assessment to add your content to the project page. Given the scope of your project topic there are an enormous number of resources, which have not been researched or utilised.

• Timeline would look better as bullet points with the date in bold as the first text.
• Only figure added is incorrectly named File:Pierre-Joseph_Desault-jpg.jpg. I had previously contacted and asked for this to be fixed and a citation added, neither has been done.
• I cannot provide you any further constructive comments at this stage, because there is insufficient for me to work with.

Introduction

--Mark Hill 12:10, 8 September 2011 (EST) There is no introductory text here.

History

In ancient times many congenital deformities, including the cleft lip and palate, were considered to be evidence of the existence of an evil spirit in the affected child. The reaction of the birth of a deformed child has varied widely from culture to culture where the infant was often removed from the tribe or cultural unit and left to die in the surrounding wilderness, a practise that was common in Antiquity and still happens today in certain parts of African tribes. In Sparta the unfortunate newborns were abandoned on Mount Tagete, while in Rome they were drowned in the Tarpeian rock.

The renowned philosopher Plato discussed it in one of his dialogues in the Republic, explaining that it was indeed a means of eradicating evil omens and preserving the soundness of the race.

This state of lack of knowledge is evident up until 1889 when Keating published his opinion that a series of congenital anomalies were provoked in each case, by the mother looking at a person with similar deformity during her pregnancy. The first persuasive explanation regarding the actual causation of the condition offered by Philippe Frederick Blandin between 1838 to1896 has revolutionised the perception of the condition. It sparked interest among physicians to investigate further into embryological development and the possible origin of clefting.

Since 1896 to the 19th century both understanding and the surgery of cleft lip witnessed remarkable improvements. Surgeons around the world continued to research and propose refinements on the early procedure striving to accomplish precise and reproducible methods.

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.

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.

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

In 1561, Pierre Franco and Ambroise Pare 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”.

File:Pierre-Joseph Desault-jpg.jpg

Pierre-Joseph Desault-A French pioneer of bilateral cleft surgery

In 1795, Pierre Joseph DeSault, a French pioneer of bilateral cleft surgery at La Charité and Hôtel-Dieu in Paris developed a new method for teaching anatomy and taught the procedure of bilateral cleft surgery

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.

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.

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.

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.

In 1935, Faltin, another Finnish surgeon recommended that the procedure described by Jacob A Estander be abandoned because it routinely left serious maxillary retrusion.

In 1960, Peter Randall standardized the triangular flap repair method with accurate and reproducible measurements.

In 1965, W. M. Manchester introduced a procedure for the bilateral cleft surgery.

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.

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.

In 2010, B Mishra along with a team of Indian doctors published a study concluding that Nasoalveolar molding can be a useful adjunct for management 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.

Development of Disease

--Mark Hill 12:18, 8 September 2011 (EST) There is no text here.

Aetiology

--Mark Hill 12:18, 8 September 2011 (EST) There is no text here.

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

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Genetic Configuration

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Treatment

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Current and Future Research

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External Links

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Glossary/Terms

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Gallery

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References

Textbooks

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2011 Projects: Turner Syndrome | DiGeorge Syndrome | Klinefelter's Syndrome | Huntington's Disease | Fragile X Syndrome | Tetralogy of Fallot | Angelman Syndrome | Friedreich's Ataxia | Williams-Beuren Syndrome | Duchenne Muscular Dystrolphy | Cleft Palate and Lip