Facial Cleft

Cranio-facial clefts are a wide spectrum of malformations affecting the face and cranium in a great variety of forms. The low frequency of most of them has made its study, statistics and classification complex and uncertain for many, many years.

Clefts in the cranio-facial region range from the most commonly known cleft lip and palate to extensive cranio-facial clefts that can be dramatically disfiguring. Facial clefts constitute the most challenging malformation as they are never the same.

The surgeon must be skilful in cranio-facial surgery, maxillofacial techniques, soft tissues procedures for soft tissue reconstruction, and no less important, have a solid background in management of cranio-facial anomalies.

Despite all this, restoring, functional and aesthetically, a clefted face is one of the most rewarding surgeries.

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What is cleft palate?

Cleft palate is a treatable birth defect in which the baby's roof of the mouth (palate) does not develop normally during pregnancy, leaving an opening (cleft) that may go through to the nasal cavity.

Cleft palate may involve any part of the palate, including the front part of the roof of the mouth (hard palate) or the small tag of tissue that hangs down from the soft palate (uvula). It may also occur by itself or along with other birth defects of the face and skull, particularly cleft lip.

Cleft palate and cleft lip are the most common congenital defects of the head and neck. Until treated surgically, cleft palate can interfere with feeding, speech development, and hearing.

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Cleft Lip

 

 

 

 

Cleft lip, with or without cleft palate, is a congenital malformation. Generally, facial clefting results when medial, lateral, and maxillary nasal processes on either left, right or both sides of the forming craniofacial complex do not fuse completely.

Early embryonic changes (during the fourth and tenth weeks of gestation) may result in clefting.

Suspected causes include:

1) environmental insults (i.e. maternal diseases, chemotherapy, radiation, alcohol, excess retinoic acid and anticonvulsant medications); or

2) genetic factors.

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Kendall Tullis's Story

I am Kendall Tullis, and I was born with a cleft lip and palate. I am 14 years old. I would have to say that being born with a cleft lip has left its mark on me. I have learned that in order for people to accept me, I have to just be myself. When I was in elementary school, it was hard. I was so very shy then, and I was afraid of most people. I would come home crying many days, because some stupid person would have decided that because I was different they had the right to make fun of me. Those people made me feel like I was less of a person because I was born with something I could not help. During that time, I had only a few friends who I felt comfortable with and who liked me for me. Even one of my good friends Jason made fun of me one day. He did it because one of his friends was teasing me, but it broke my heart. Fortunately, we have become closer since then. I finally realized that not everyone judges you on how you look when I meet Halie, who today is still my best friend. Halie taught me that I should like myself for who I am. She discovered that I was a great person, but that I was just not letting people see it. I had my 22nd surgery on June 17, 2003. I am so afraid of surgeries, but I realize that they will help me make it through my life more easily. Now that I am in high school, I know that when I am myself, people overlook what they see on the outside and see the truly great person I am on the inside. I am not one of the girls who gets the most dates at my school, but I am the most liked because I don’t look at my cleft palate as something horrible but as something that makes me who I am. I cannot stand people who belittle other people. Watching a person being picked on who just stands there and takes people’s insults bothers me, too. When I was little, I used to think if I just ignored people who picked on me, they would stop. But I soon realized that sometimes I could not just go on letting people belittle me, so I faced the bullies. When they realized how insensitive they were being, they felt bad. Having a cleft palate sometimes makes you have to act older than you really are because you have experienced more than most people will in their lifetime. Having a cleft palate has made me realize that I am unique and special in many ways. I would not change anything about me if I could. From www.cleftline.org/story_of_the_month/apr04

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Etiology

The upper lip is derived from medial nasal and maxillary processes. Failure of merging between the medial nasal and maxillary processes at 5 weeks' gestation, on one or both sides, results in cleft lip.

Cleft lip usually occurs at the junction between the central and lateral parts of the upper lip on either side. The cleft may affect only the upper lip, or it may extend more deeply into the maxilla and the primary palate. (Cleft of the primary palate includes cleft lip and cleft of the alveolus.) If the fusion of palatal shelves is impaired also, the cleft lip is accompanied by cleft palate, forming the cleft lip and palate abnormality. Read more...

Introduction

Cleft lip (cheiloschisis) and cleft palate (palatoschisis) (colloquially known as harelip), which can also occur together as cleft lip and palate, are variations of a type of clefting congenital deformity caused by abnormal facial development during gestation.

 

Note that harelip is now considered as a derogatory term. A cleft is a fissure or opening -- a gap. It is the non-fusion of the body's natural structures that form before birth.

Clefts can also affect other parts of the face, such as the eyes, ears, cheeks and forehead. In 1976, Dr. Paul Tessier described fifteen lines of cleft. These craniofacial clefts are rare and are frequently described as Tessier clefts using the numerical locator devised by Dr. Tessier.

A cleft lip or palate can be successfully treated with surgery soon after birth. Cleft lips or palates occur in somewhere between one in 600-800 births.

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