presentation (staff) - dr. pritham

Upload: vikas-vats

Post on 04-Jun-2018

236 views

Category:

Documents


0 download

TRANSCRIPT

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    1/25

    RARE CRANIOFACIAL CLEFTS :

    A Review

    Dr. Pritham N. ShettyMDS

    Prof. Y.S.Rai MS FRCS

    Dr. Niranjan KumarMS MCh

    Dr. GopalkrishnanMDS FDSRCS

    Dr. Dinesh KadamMS MCh

    Departments of Maxillofacial & Plastic Surgery

    Craniofacial Surgery & Research Centre

    S.D.M. College of Dental Sciences & Hospital

    Dharwad, Karnataka S D MDHARWADDEC 2003

    MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    2/25

    KULUMUS in 1732

    EtiopathogenesisFailure of mesodermal structures to fuse

    Vascular disruption

    Aberrant tissue bandsRupture of the amnion

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    3/25

    No. of cases: 27 out of 1350 clefts

    Incidence: 2% (9.534 for every1000 clefts)

    Male : female:- 15:12

    Duration of the study : 20012003

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    4/25

    CLASSIFICATION

    American Association of Cleft palate

    rehabilitation

    Boo-Chai

    Karfik

    Van der meulen

    Tessier

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    5/25

    Tessier classification

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    6/25

    Tessier classification

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    7/25

    RARE CRANIOFACIAL CLEFTS

    10

    21

    9

    1

    4

    Tessier 0

    Tessier 3Tessier 4

    Tessier 5

    Tessier 6

    Tessier 7

    S D MDHARWAD

    DEC 2003MANGALORE

    Distribution

    n = 27

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    8/25

    Tessier no 0

    Midline deformity of the upper lip & nose

    Commonly associated with no 14 cleft

    C.T. scan of the brain

    Tissue

    RARE CRANIOFACIAL CLEFTS

    Deficiency

    Excess

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    9/25

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    10/25

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    11/25

    Tessier no3(oblique or oro-naso-ocular cleft)

    Morion

    Cleft passes through the mouth,

    nose, maxillary sinus and orbit

    Nasolacrimal drainage systemPreservation of vision

    Canthopexy

    Skeletal reconstruction

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    12/25

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    13/25

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    14/25

    Tessier no 4(oro-ocular cleft)

    Boo-Chai

    Cleft starts lateral to the

    cupids bow and end at the

    lower eyelid medial to the

    punctum

    ,

    RARE CRANIOFACIAL CLEFTS

    Osseous component is less extensive

    Loss of vision

    MicrophthalmosS D M

    DHARWADDEC 2003

    MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    15/25

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    16/25

    Tessier no 5(oculofacial cleft II)

    Cleft starts medial to the oral

    commissure, traverses the cheekto enter the lower eyelid in its

    middle third

    Very rareUsually associated with no. 9 cranial cleft

    Early correction to prevent blindness

    Orbital dystopia

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    17/25

    Tessier no 6(zygomaticomaxillary cleft)

    Cleft presents as a vertical furrow

    from the commissure to the lateralaspect of the inferior eyelid

    RARE CRANIOFACIAL CLEFTS

    Incomplete form of treacher-collins

    syndromeNo alveolar cleftLower lid ectropionColobomasRarely hearing deficit

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    18/25

    Tessier no 7(Hemifacial microsomia ,first and

    second branchial arch syndrome)

    Cleft runs from the oralcommissure to the pre auricular

    region, never crosses the anterior

    border of masseter

    Most common

    Males are more commonly

    affected

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    19/25

    Associated anomalies:

    Fifth or seventh cranial nerve weakness

    Accessory auricular tags

    Coloboma

    Facial asymmetry

    Epibulbar dermoid

    Parotid gland or duct may be absent

    Fascial skeletal discrepancy

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    20/25

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    21/25

    Tessier no 11Cleft transverses the medial third

    of the upper eye lid ,the eye brow

    and progress towards the frontal

    hairline

    RARE CRANIOFACIAL CLEFTS

    Cranial extension of no 3 cleft

    orbital hypertelorism

    pneumatisation of ethmoid air cell

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    22/25

    Hemifacial microsomiaGoldenhar syndrome

    Treacher - collins syndrome

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    23/25

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    24/25

    CONCLUSIONNeeds immediate attention

    Multiple surgeries

    Other anomalies

    The greatest obstacles in the reconstruction

    of rare craniofacial clefts depends upon the

    extent of soft tissue hypoplasia and our

    limited ability to normalize them

    RARE CRANIOFACIAL CLEFTS

    S D MDHARWAD

    DEC 2003MANGALORE

  • 8/13/2019 Presentation (Staff) - Dr. Pritham

    25/25

    Thank YouS D MDEC 2003