eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Cleft Palate: Multimedia

Author: Peter D Witt, MD, Associate Clinical Professor, Department of Surgery and Pediatrics, University of California San Francisco; Medical Director, Department of Pediatric Plastic Surgery, Children's Hospital Central California
Contributor Information and Disclosures

Updated: Aug 28, 2008

Multimedia

Two morphologically distinct parts comprise the s...
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Media file 1: Two morphologically distinct parts comprise the secondary palate, soft tissue (posterior), and bony palatal components. Note the transverse orientation of the levator muscles. Also note the position of the incisive foramen separating the anterior structures, which are involved in the prepalatal (primary) palatal clefts, compared with the posterior structures, which are involved in the palatal (secondary) palatal clefts.
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Two morphologically distinct parts comprise the s...

Two morphologically distinct parts comprise the secondary palate, soft tissue (posterior), and bony palatal components. Note the transverse orientation of the levator muscles. Also note the position of the incisive foramen separating the anterior structures, which are involved in the prepalatal (primary) palatal clefts, compared with the posterior structures, which are involved in the palatal (secondary) palatal clefts.

Embryology processes of abnormal palatal developm...
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Media file 2: Embryology processes of abnormal palatal development. Normally, the palatal shelves assume a vertical orientation and are directed downward. Free communication exists between the oral cavity and the nose at 7 weeks. Thus, the tongue is in direct contact with the inferior border of the nasal septum. The palatal shelves move horizontally as the process of fusion commences. Failure of fusion of the palatal shelves (medial extensions of the maxillary prominence), from any cause, may lead to cleft palate.
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Embryology processes of abnormal palatal developm...

Embryology processes of abnormal palatal development. Normally, the palatal shelves assume a vertical orientation and are directed downward. Free communication exists between the oral cavity and the nose at 7 weeks. Thus, the tongue is in direct contact with the inferior border of the nasal septum. The palatal shelves move horizontally as the process of fusion commences. Failure of fusion of the palatal shelves (medial extensions of the maxillary prominence), from any cause, may lead to cleft palate.

Development of the secondary palate. The process ...
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Media file 3: Development of the secondary palate. The process is initiated when outgrowths of the palatal shelves push medially and bilaterally from the maxilla.
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Development of the secondary palate. The process ...

Development of the secondary palate. The process is initiated when outgrowths of the palatal shelves push medially and bilaterally from the maxilla.

Palatal shelves grow downward and adjacent to the...
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Media file 4: Palatal shelves grow downward and adjacent to the tongue.
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Palatal shelves grow downward and adjacent to the...

Palatal shelves grow downward and adjacent to the tongue.

Palatal shelves assume a level above the tongue a...
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Media file 5: Palatal shelves assume a level above the tongue and assume a horizontal position. Fusion of the 3 processes forms the normal secondary palate.
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Palatal shelves assume a level above the tongue a...

Palatal shelves assume a level above the tongue and assume a horizontal position. Fusion of the 3 processes forms the normal secondary palate.

Spectrum of cleft palate morphologies (from upper...
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Media file 6: Spectrum of cleft palate morphologies (from upper left panning to right). A. Normal development. B. Unilateral clefting of the lip. C. Unilateral clefting of the lip and primary palate. D. Bilateral clefting of the lips and primary palate including the incisive canal. E. Secondary palate cleft including the incisive canal. F. Unilateral clefting of lip, primary palate, incisive canal, and secondary palate.
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Spectrum of cleft palate morphologies (from upper...

Spectrum of cleft palate morphologies (from upper left panning to right). A. Normal development. B. Unilateral clefting of the lip. C. Unilateral clefting of the lip and primary palate. D. Bilateral clefting of the lips and primary palate including the incisive canal. E. Secondary palate cleft including the incisive canal. F. Unilateral clefting of lip, primary palate, incisive canal, and secondary palate.

The left illustration is of normal soft palatal a...
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Media file 7: The left illustration is of normal soft palatal anatomy. Notice the transverse orientation of the levator muscles across the posterior portion of the soft palate. The right illustration shows cleft anatomy, in which the levator muscles are orientated more longitudinally and insert on the posterior edge of the palatal bone and along the bony cleft edges.
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The left illustration is of normal soft palatal a...

The left illustration is of normal soft palatal anatomy. Notice the transverse orientation of the levator muscles across the posterior portion of the soft palate. The right illustration shows cleft anatomy, in which the levator muscles are orientated more longitudinally and insert on the posterior edge of the palatal bone and along the bony cleft edges.

Millard modification of Kernohan striped-Y classi...
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Media file 8: Millard modification of Kernohan striped-Y classification for cleft lip and palate. The small circle indicates the incisive foramen; the triangles indicate the nasal tip and nasal floor.
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Millard modification of Kernohan striped-Y classi...

Millard modification of Kernohan striped-Y classification for cleft lip and palate. The small circle indicates the incisive foramen; the triangles indicate the nasal tip and nasal floor.

Illustration of Furlow technique, first step.
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Media file 9: Illustration of Furlow technique, first step.
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Illustration of Furlow technique, first step.

Illustration of Furlow technique, first step.

Illustration of Furlow technique, second step.
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Media file 10: Illustration of Furlow technique, second step.
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Illustration of Furlow technique, second step.

Illustration of Furlow technique, second step.

Illustration of Furlow technique, third step.
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Media file 11: Illustration of Furlow technique, third step.
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Illustration of Furlow technique, third step.

Illustration of Furlow technique, third step.

Illustration of Furlow technique, fourth step.
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Media file 12: Illustration of Furlow technique, fourth step.
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Illustration of Furlow technique, fourth step.

Illustration of Furlow technique, fourth step.

Animation of face development.
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Media file 13: Animation of face development.
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Animation of face development.

Animation of face development.

Animation of palate development.
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Media file 14: Animation of palate development.
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Animation of palate development.

Animation of palate development.

Animation of palate development.
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Media file 15: Animation of palate development.
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Animation of palate development.

Animation of palate development.

Animation of palate development.
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Media file 16: Animation of palate development.
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Animation of palate development.

Animation of palate development.

More on Craniofacial, Cleft Palate

References
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References

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Further Reading

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Keywords

cleft palate, palate development, palatoplasty, velopharyngeal dysfunction, VPD, bifid uvula, velopharynx dysfunction, clefted palate, dysfunctional speech, speech dysfunction, speech impediment, communication impairment, speech impairment, facial cleft, hearing dysfunction

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Contributor Information and Disclosures

Author

Peter D Witt, MD, Associate Clinical Professor, Department of Surgery and Pediatrics, University of California San Francisco; Medical Director, Department of Pediatric Plastic Surgery, Children's Hospital Central California
Peter D Witt, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Hand Surgery, American Association of Pediatric Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Plastic Surgeons, and Plastic Surgery Research Council
Disclosure: Nothing to disclose.

Medical Editor

Larry Hollier, Jr, MD, Assistant Professor, Department of Plastic Surgery, Baylor University College of Medicine
Larry Hollier, Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, AO Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

S Anthony Wolfe, MD, Chief, Division of Plastic Surgery, Miami Children's Hospital; Voluntary Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami School of Medicine
S Anthony Wolfe, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic and Reconstructive Surgery, Florida Medical Association, and Southeastern Society of Plastic and Reconstructive Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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