Developmental Defects of the Lip and Palate - PowerPoint Presentation

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Developmental Defects of the Lip and Palate

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OROFACIAL CLEFTS

• 1-CLEFT LIP AND PALATECleft lip: It is a developmental anomaly characterized by a wedge-shaped defect in the lip, which results from failure of two parts of the lip to fuse together at the time of development. This defect is more commonly seen in relation to the upper lip.

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CLEFT PALATE

It is a developmental defect of palate characterized by lack of complete fusion of two lateral halves of the palate resulting in a cleft. Cleft in the palate leads to communication between oral and the nasal cavity.

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ETIOLOGY:

 Heredity. Environmental factors such as: Insufficent nutrition to pregnant women Defective vascular supply Size of the tongue prevent union of affected parts Infections , certain alcohol ,drugs and toxins

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Classification

• cleft lip • Unilateral (usually on the left side), with or without an anterior alveolar ridge cleft • Bilateral, with or without alveolar ridge clefts, complete or incomplete Palatal clefts • Bifid uvula

•

Soft palate only

•

Both hard and soft palate

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Combined lip and palatal defects

• Unilateral, complete or incomplete • Cleft palate with bilateral cleft lip, complete or incomplete

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Oblique Facial Cleft

Extends from the upper lip to the eye. It is nearly always associated with CP.Some of these clefts may represent failure of fusion of the lateral nasal process with the maxillary process.

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Lateral Facial cleft

It is caused by lack of fusion of the maxillary and mandibular processes. This cleft may be unilateral or bilateral.Extending from the commissure toward the ear, resulting in macrostomia. May occur as an isolated defect, but more often it is associated with other disorders.

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Congenital lip pits

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Commissural lip pits

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Developmental Defects of the Jaw Bones

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AGNATHIA

Absence of one of the jawsRare conditionMostly occurs in mandible

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MACROGNATHIA

Abnormally large jawDue to :- Fibrous dysplasia- Bone tumors - Odontogenic cysts- Associated with acromegaly or pagets disease

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MICROGNATHIA

Abnormally small size of one of the jawsMay be associated with Pierre Robin syndrome

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coronoid

HyperplasiaA rare developmental anomaly that may result in limitation of mandibular movement. The cause of coronoid hyperplasia is unknown. Because most cases have been seen in pubertal males, an endocrine influence has been suggested. Coronoid hyperplasia may be unilateral or bilateral,

Unilateral enlargement of the

coronoid

process also can result from a

true tumor, such as an

osteoma

or

osteochondroma

,.

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Condylar

HyperplasiaExcessive growth of one condyleUnknown causeEndocrine disturbances and trauma may be etiological factors

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Hemifacial

HypertrophyUnilateral enlargement of face as a result of increased neurovascular supply of to the affected side of the face resulting in A symmetry of the face , malocclusion, deviation f the affected side of face to unaffected one.

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Hemifacial

AtrofyUnknown etiologyAtrophic changes affecting one side of the face.Mouth and nose are deviated toward the defective side

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STAFNE DEFECT (STAFNE BONE CYST;LINGUAL MANDIBULAR SALIVARYGLAND DEPRESSION)

Developmental concavity of the cortex of the mandible in the molar area.Formed around an accessory lateral lobe of submandibular glandRadiographic appearance is of well circumscribed cystic lesion within the bone usually below the inferior alveolar canal.Histologically normal salivary gland tissue suggesting that it is developmental defects

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Mandibular

dysostosis (treacher –collins syndrome)Autosomal dominant disorderHypoplastic zygoma resulting narrow face with depressed cheek..

Underdeveloped mandible with

retruded

chin and cleft palate may be seen.

Mandibulofacial

dysostosis

. Patient exhibits a

hypoplastic

mandible.

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Cleidocranial

dysplasia or dysostosisRare familial disorder characterised by defective formation of clavicles sometimes retrusion of maxilla.Delayed eruption of permanent dentition Supernumerary teeth may be seen radigraphically

.

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Condylar

hypoplasia, or underdevelopment of the mandibular condyle Can be either congenital or acquired. Congenital condylar hypoplasia often is associated with head and neck syndromes, including

mandibulofacial

dysostosis

and

hemifacial microsomia

.

Acquired

condylar

hypoplasia

results from disturbances of the growth center of the developing

condyle

.

The most frequent cause is trauma to the

condylar

region during infancy or childhood.

Other causes include infections, radiation therapy, and rheumatoid

arthritis.

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Bifid

condyle It is a rare developmental anomaly characterized by A double-headed mandibular condyle.Most bifid condyles have a medial and lateral head divided by an anteroposterior

groove.

Some

condyles

may be divided into an anterior and posterior head.

The cause of bifid

condyle

is uncertain.

Anteroposterior

bifid

condyles

may be of traumatic origin, such

as a childhood fracture.

Mediolaterally

divided

condyles

may result from trauma, abnormal muscle attachment

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Bifid

condyle. Radiograph of the mandibularcondyle showing a double head (arrow).

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Torus

palatinus Presents as a bony hard mass that arises along the midline suture of the hard palate

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Torus Palatinus

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Tori sometimes are classified according to their morphologic appearance: -The flat torus has a broad base and a slightly convex, smooth surface. It extends symmetrically onto both sides of the midline raphe.-The spindle torus has a midline ridge along the palatal raphe. -The nodular torus arises as multiple protuberances, each with an individual base.

-The lobular torus is also a

lobulated

mass, but it rises from a single base.

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Torus

Mandibularis It is an exostosis covered with normal mucosa that appears on the lingual surfaces of the mandible, usually in the area adjacent to the bicuspids .The incidence of torus mandibularis is about 6%. Bilateral exostoses occur in 80% of the cases. Clinically, it is an asymptomatic growth that varies in size and shape.

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Torus mandibularis

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Bony

Exostoses Multiple exostoses are rare and may occur on the buccal surface of the maxilla and the mandible. Clinically, they appear as multiple asymptomatic small nodular, bony elevations below the muccolabial fold covered with normal mucosa. The cause is unknown and the lesions are benign, requiring no therapy.

Problems may be encountered during denture preparation.