Tooth Developmental Disorder Cleft Palate

Question: Discuss About The Tooth Developmental Disorder Cleft Palate? Answer: Introducation Craniofacial interruptions occur between 4th-10th weeks of embryological growth. During these stages, the mouth and nose of the fetus develop between 5th-12th weeks. The palatine ledges in fetus join at the middle and form the back of palate. If this joining gets interrupted, a gap appears and results in the formation of a cleft in the palate. Cleft palate is the second common birth anomaly worldwide. It has a prevalence of 7.75-10.63% per 10,000 births in the U.S (Mahabir et al., 2014). The completed palate is formed by the fusion of primary and secondary palates that are separated by incisive foramen, forms a complete cleft palate. The primary palate, formed by fusion of medial nasal prominences contains hard palate, located anterior to the incisive foramen and maxillary alveolar arch, which has 4 incisors. Secondary palate formation soon follows. The bilateral maxillary process gives out shelf like outgrowths during the 6th week. They vertically grow down on either sides of the tongue. The tongue moves inferiorly and migration of the palatal shelves occur above them, to a horizontal position. Uvular fusion and palatal fusion occur in anterior-posterior direction. When these medial and maxillary nasal prominences fail to fuse unilaterally or bilaterally, unilateral and bilateral cleft lips are formed with or without primary palate (Allori et al., 2017). When the palatal shelves fail to fuse, secondary palate clefts are formed. Palatal clefts are also produced by a reduction in the space of oral cavities. This impedes the displacement of tongue in downward direction. They lead to facial deformity, speech disorders, hearing impairment, feeding problems and psychological issues. Genetic predisposition may lead to this malformation (Farronato et. al., 2014). Evidence has been found that correlate formation of cleft palate to teratogen exposure in early pregnancy. Some of the drugs that can increase the risk of this congenital abnormality are ondansetron, benzodiazepine, dilantine, barbiturates and valproic acid. Retrospective studies show that maternal exposure to smoking, retinoic acid and alcohol during the first trimester of pregnancy increases the likelihood of the fetus to have oral clefts (Molina-Solana et al., 2013). These teratogens delay the closure time during palate formation and lead to this malformation. Treatment procedures are generally done within 12 months. Wider clefts are operated after the palatal shelves grow inwards and come closer. Surgeons close the cleft in the nasal lining, oral lining and the muscles. Palate repair is performed to improve speech, restore function of Eustachian tube, close oronasal fistula and minimize maxillary growth alterations. Incisions are made on either sides of the cleft and tissues are moved towards the midline or centre of the roof of the mouth. The palate gets rebuilt and the muscles are joined together. This leads to an increase in the length of the palate (Peterson-Falzone et al., 2016). This restores the feeding pattern and speech skills in the child. Speech therapies are also practiced in some children. Pharyngoplasty is carried out in those who report persistent speech problems. Fine refinements in the palate are often done by a maxillofacial surgeon in teenagers. Thus, cleft palate treatment involves plastic surgeons, speech therapisits, ENT surgeons and orthodontists. References Allori, A. C., Mulliken, J. B., Meara, J. G., Shusterman, S., & Marcus, J. R. (2017). Classification of cleft lip/palate: then and now. The Cleft Palate-Craniofacial Journal, 54(2), 175-188. Farronato, G., Cannalire, P., Martinelli, G., Tubertini, I., Giannini, L., Galbiati, G., & Maspero, C. (2014). Cleft lip and/or palate. Minerva stomatologica, 63(4), 111-126. Mahabir, R. C., Tanaka, S. A., Jupiter, D. C., & Menezes, J. M. (2014). Reply: updating the epidemiology of isolated cleft palate. Plastic and reconstructive surgery, 133(1), 68e-69e. Molina-Solana, R., Yáñez-Vico, R. M., Iglesias-Linares, A., Mendoza-Mendoza, A., & Solano-Reina, E. (2013). Current concepts on the effect of environmental factors on cleft lip and palate. International journal of oral and maxillofacial surgery, 42(2), 177-184. Peterson-Falzone, S. J., Trost-Cardamone, J., Karnell, M. P., & Hardin-Jones, M. A. (2016). The Clinician’s Guide to Treating Cleft Palate Speech-E-Book. Elsevier Health Sciences.

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