Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Its concerns the restoration and/or replacement of remaining teeth and associated oral and facial structures
with artificial substitutes.
Types of maxillofacial defects
Congenital defects Acquired defects Developmental defects
Cleft palate, cleft lip, missing ear and Due to surgery, disease or traumatic Prognathism, retrognathism,
facial cleft. accidents. micrognathia and macrognathia.
Maxillofacial Team
1- Surgeon: Repair and surgical reconstruction of deformities.
2- Prosthodontist: when artificial restoration is the only way in rehabilitation of maxillofacial patients.
3- Orthodontist: treating malocclusion associated with cleft lip and/or platate.
4- Otolaryngologist (ENT): Assist in evaluation and management of ear infection or hearing loss.
5- Audiologist (hearing specialist): professional who assist and manages any hearing difficulties.
6- Psychologist: helps the patient to accept his problem, raise his moral and psychological attitude and to gain
patient’s co-operation during treatment.
7- Pediatrician: To follow the child as he grows and coordinate the multiple specialists involved.
8- Pediatric dentist: to evaluate and care for child’s teeth.
9- Speech Therapist: to correct the defective speech due to palatal defects. Most valuable in congenital cleft cases.
10- Nurse: experienced pediatric nurse and link between the family and the Team
11- Genetic Counselor: professional who reviews medical and family history to help in diangosis. Also counselor
regarding possible risk of recurrence in future pregnancy.
12- Social worker: discus the problem with parents, educate parent and patient, guidance for future life after treatment.
13- Dental technician: very important role in constructing a successful and accurate appliance needed for the case.
|Incidences|
- One in every 800 born infants.
- Unilateral clefts are more common than bilateral.
- Left side more than right side.
- Males twice than femals.
|Anatomy|
- Maxilla:
o Pyramidal shaped bone.
o Has a body forming the midface.
o Has four processes:
Frontal Process: directed upwards
Zygomatic Process: directed upwards
Alveolar Process: directed downwards carries the teeth.
Palatine Process: directed downwards 2/3 posterior of the hard palate.
- Hard Palate:
o Composed of the maxillary and palatine bone plates.
2/3 anterior by the palatine process from the maxillary bone.
1/3 posterior by the horizontal maxillary plate of the palatine bone.
o Divided by the midline suture.
o Anterior portion of the palate is formed of anterior portion of the alveolar process (carrying the anterior
teeth and pre-maxilla).
o Nerve supply anteriorly from the incisive foramina and lateral-posteriorly from the greater and lesser
palatine foramen.
- Soft palate:
o It’s attached to the posterior rim of the hard palate.
o It’s not ossified portion of the palate, it consists of series muscles and dense elastic fibers.
o The soft palate and with pharynx forms a sphincter that opens and close the orifice between the nasal
cavity (superiorly) and oro-pharyngeal cavity (inferiorly)
o Medially there is the uvula (which is attached to the velum) a posterior and downward extension.
It acts as a valve for the pharyngeal cavity.
- Palato (velo) Pharyngeal Sphincter:
o It’s important for proper swallowing, deglutition and speech.
o During closure important for swallowing and pronunciation of most letters except nasal sounds (M).
o During Swallowing it closes to prevent food entering the naso-pharynx.
o During Speech it closes to allow air to go though the oral cavity to produce noise.
o The valve is coordinated by the muscles of the soft palate and pharynx.
o Ridge of passavant:
Is a horizontal roll of tissue on the posterior wall of the pharynx forming prominence on the
posterior wall of the pharynx, its located at the level of the plate (at the level of the atlas vertebra).
More prominent in cases of soft palate defects with a compensating mechanism.
A guide for placement of prophesies restoring palatal defects.
- Primary palate, secondary plate and nasal septum fuse forming the lip, maxilla and hard palate.
- Union between the processes begins at the meeting point of the primary plate and the two lateral palatine
processes.
- From this point union continues in to direction:
o Anteriorly pre-maxilla, upper anterior ridge and lip.
o Posterior hard palate and soft palate.
- Due to union failure between the pre-maxillary process and the two lateral processes on each side.
- Various extension between a simple Notch of the lower boarder of the upper lip on one side to complete
bilateral cleft of the lip (hare lip) leading to a middle segment of the lip (Prolabriun) to be only attached to
the nasal septum.
|cleft Palate|
- Failure of union between the primary palate and the lateral palatine process.
- Classification: Veau’s classification
o Class I cleft including the soft palate only.
o Class II cleft including the soft and hard palate till the incisive foramen
o Class III cleft on both (hard and soft) plate unilaterally till the alveolar ridge and upper lip.
o Class IV cleft on both (hard and soft) plate bilaterally till the alveolar ridge and upper lip.
- Main: Changes in the embryo position, Changes in the pressure of the aminiotic fluid, Persistence of
epithelium at the junction of the inferring with the process fusion.
- Hereditary Factors: it’s greater if the parents had deformities.
- Infection or disease: During pregnancy German measles
- Diet deficiency: Deficiency may induce cleft formation Vit.A and riboflavin deficiency.
- Chemical irritation: Exposure of the mother to chemical irritants during pregnancy may induce cleft
formation Hypoxia or hyper vitaminosis.
- Radiation: Exposure of mother to X-ray or therapeutic radiation of the pelvis during pregnancy.
- Hormonal disturbance or cortisone may influence cleft formation.
- Physiological: Stress, anxiety during the first trimester may induce cleft formation.
2- Phonation:
o During air leaving the lungs and passing the trachea and larynx:
Vocal Cords: modify the stream of air and forming Laryngeal sound (with characteristic sound and
intensity) thus producing voice.
Soft palate and pharynx (Plato-pharyngeal sphincter): Controls the direction of air stream, either to:
The oral cavity: production of all vowels and most letters except for the nasal
The nasal Cavity: production of the nasal letters.
3- Resonance:
o The laryngeal sound is amplified through resonant chambers (Pharynx, oral cavity and nasal cavity)
4- Articulation:
o The laryngeal sound is modified (by the tongue, teeth , lips and palate) to give new sounds.
o The tongue change in position gives the sound special form and quality.
5- Neurologic Integration:
o The speech mechanism is coordinated by the central nervous system, thus any impairments
neurologically will affect the component the speech mechanism (soft palate, tongue or the entire speech
mechanism).
6- Audition:
o It’s the ability to receive sounds signals (hearing).
o This allows reception and interpretation of sound signals to help the speaker to monitor and control his
speech.
|Info|
- Production of correct sound depends on rapid and accurate positioning of the soft palate.
- When speaking (all except of the nasal letters “M,N,Ing”) the soft palate is raised to prevent air entering
the nasal cavity and directing it into the oral cavity.
- Nasal sounds are the only sounds made when the soft palate is lowered to allow the air to escape into
through the nasal cavity (Nose).
2. Surgical Treatment:
o It should be done in the proper time when there are no contraindications for the surgery.
Lips Repair:
6-12 weeks after birth to help in feeding and improve appearance.
Lip closure should be done without EXCESSIVE tension to establish good contour of the pre-maxillary area.
Palatal Repair:
1 year to 4 years of age depending on Childs general health, need for growth and the width of cleft.
Early closure should be avoided to allow normal growth of the palate which helps narrowing the cleft.
Its goal is to improve normal speech development, proper swallowing and breathing, minimize dento-
alveolar deformities and maintain proper maxillary growth.
Treatment concerns closure of the cleft in many cases by lengthening of the palate.
Treatment modalities:
Palatoplasty: Relaxing incisions are made in the palatal mucosa. The mucosa is then
elevated and displaced medially towards the cleft palate.
Push back operation: Anterior & lateral incisions are made The mucosa is pushed back &
sutured
Pharyngeal flap operations.
Bone grafts.