Hypernasality vs hyponasality ENT

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CLEFT LIP AND PALATE • INTRODUCTION • DEVELOPMENT OF LIP AND PALATE. • PATHOPHYSIOLOGY OF CLEFT LIP AND PALATE. • CLASSIFICATION OF CLEFT LIP AND PALATE. • TREATMENT PROTOCOLS.  DIAGNOSIS AND TREATMENT PLANNING.  SURGICAL MANAGEMENT  Primary palate.  Secondary palate.  ORTHODONTIC MANAGEMENT.  Phase 1.  Phase 2 Phase 3 • PROSTHETIC MANAGEMENT.  Maxillary orthopedics  Naso-alveolar molding.  Speech appliances. • Pharyngeal obturator. • Hard palate obturator For children • Anterior prosthesis. • Fixed • Removable For adults • affected infants are born every day • EMBRYOLOGY Development of facial structures starts at the end of 4th week • 2 medial nasal processes fuse in midline – upper lip. • Mandibular processes fuse in midline – lower lip • Primary palate. – maxillary and medial nasal process merge • Parts of palate Primary • Clefts of the lip and alveolar processes • Unilateral cleft lip • Cleft Lip and Palate Q A • ANTERIOR CLEFT PALATE POSTERIOR CLEFT PALATE COMPLETE CLEFT PALATE (ANTERIOR POSTERIOR) • Etiology Multifactorial Genetic Environmental factors • PREDISPOSING FACTORS • Davis and Ritchie’s classification • Pre-alveolar process cleft • VEAU CLASSIFICATION • KERNAHAN AND STARK • American Cleft Palate–Craniofacial Association • KERNAHAN CLASSIFICATION • TESSI • Oro-facial clefts • MODIFIED STRIPED Y • Triangle 1: right nostril floor • DIAGNOSIS AND TREATMENT PLANNING • General case history • Impressions for study casts • Photographs. • For diagnosis, teaching • Otologic and hearing examination • Transabdominal US. - Not reliable till gestational age of 15 weeks • PALATAL OBTURATOR CLEFT LIP SOFT PALATE HARD PALATE SPEECH THERAPY BONE GRAFTING • PROBLEMS ASSOCIATED WITH CLEFT LIP PALATE • MULTIDISCIPLINARY MANAGEMENT • SURGICAL MANAGEMENT “RULE OF 10s • Bilateral cleft Major problems • Unilateral cleft TIMING OF SURGERY. • Cleft of hard palate • ORTHODONTIC MANAGEMENT PHASE • MAXILLARY ORTHOPEDICS • McNeil School to stimulate the growth of tissues to obtain closure of palatal defects without surgical interventions • Fixing a Cleft Palate with Craniofacial Surgery - The Science of Healing CLIP • presurgical step of treatment have been cited • TYPES OF APPLIANCES PASSIVE OR HOLDING ACTIVE OR EXPANSION • EXPANSION APPLIANCE collapse • Dentomaxillary advancement (DMA) appliance Latham • HOLDING APPLIANCE • NASOALVEOLAR MOLDING Samuel Berkowitz. Celft Lip and Palate • Naso alveolar molding appliance • CORRECTION OF THE UNILATERAL ORONASAL CLEFT DEFORMITY • Infant • Maxillary and mandibular trays must be constructed • Irreversible hydrocolloid is used • Maxillary impression • CONVENTIONAL MOLDING PLATE • WEEKLY MODIFICATIONS • EXTRAORAL RETENTIVE BUTTON • NASAL STENT • When the alveolar cleft width has been reduced to less than 6mm • NASAL STENT • Cleft Diagnosis - Pediatric Playbook - Hospital • NASOALVEOLAR MOLDING AFTER NASAL MOLDING JUST PRIOR TO SURGERY • CORRECTING THE BILATERAL ORONASAL CLEFT DEFORMITY • intraoral molding plate is fabricated that encompasses the lateral alveolar segments and the premaxilla • PROSTHETIC SPEECH APPLIANCES FOR CHILDREN • PHARYNGEAL OBTURATOR • RATIONALE FOR PHARYNGEAL BULB • Irreversible hydrocolloid is used • Maxillary impression is made with the infant’s head tilted downward at an angle of 15 degrees • Head is tilted upward for mandibular impressions • Tray should not be overloaded Older children and adults • Stock tray of adequate dimensions is selected • Early morning empty stomach appointments. • Topical anaesthetic used in case of severe gagging • Tray should not be overloaded • All oral perforations should be packed with gauze saturated with petroleum jelly • CONSTRUCTION • High fusing modelling • Patient is instructed to flex the neck fully to achieve contact of the chin to the chest • Vowels: produced with resonated sound and little air flow • After even reduction of compound a coating of mouth temperature wax is applied • Cleft Treatment - Pediatric Playbook - Boston Children's Hospital • HARD PALATE OBTURATOR • Two Methods of Cleft Palate Repair in Patients With Complete Unilateral Cleft Lip and Palate • Method 2. : Unilateral cleft palate repair • RECENT ADVANCES. • Fetal surgery – done in intrauterine life • CONCLUSION. • Oral clefts are the second most common congenital anamoly, having multifactorial origin • Cleft lip and palate repair: Jane's Journey • A considerable knowledge about the etiology and embryology is required for proper diagnosis and treatment planning of such patients. patient with clefts palate presents a complex biologic, sociologic and psychologic problems. • Treatment begins soon after birth continues till adulthood requiring a team approach. team approach with the members including the paediatrician, plastic surgeon, pedodontist, otolaryngologist, orthodontist, speech pathologist, prosthodontist, geneticist, paediatric psychiatrist and social workers. • lectures dentist : Playlist: All Lectures • • MINIMAL INTERVENTION DENTISTRY • Facebook: / cudman.buck

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