Clefting of the Alveolus: Emphasizing the Distinction from Cleft Palate

Abstract

Oral clefting is one of the most common significant fetal abnormalities. Cleft lip and cleft palate have drastically different clinical ramifications and management from one another. A cleft of the alveolus (with or without cleft lip) can confuse the diagnostic picture and lead to a false assumption of cleft palate. The cleft alveolus should be viewed on the spectrum of cleft lip rather than be associated with cleft palate. This is made evident by understanding the embryological development of the midface and relevant terminology. Cleft alveolus carries significantly different clinical implications and treatment options than that of cleft palate. Accurately distinguishing cleft alveolus from cleft palate is crucial for appropriate discussions regarding the patient's care.

Keywords

cleft lip - cleft palate - cleft alveolus - oral cleft - prenatal diagnosis cleft - craniofacial

• References

• 1 Gillham JC, Anand S, Bullen PJ. Antenatal detection of cleft lip with or without cleft palate: incidence of associated chromosomal and structural anomalies. Ultrasound Obstet Gynecol 2009; 34 (4) 410-415
• 2 Derijcke A, Eerens A, Carels C. The incidence of oral clefts: a review. Br J Oral Maxillofac Surg 1996; 34 (6) 488-494
• 3 Offerdal K, Jebens N, Syvertsen T, Blaas HG, Johansen OJ, Eik-Nes SH. Prenatal ultrasound detection of facial clefts: a prospective study of 49,314 deliveries in a non-selected population in Norway. Ultrasound Obstet Gynecol 2008; 31 (6) 639-646
• 4 Vermeij-Keers C, Mazzola RF, Van der Meulen JC, Strickler M. Cerebro-craniofacial and craniofacial malformations: an embryological analysis. Cleft Palate J 1983; 20 (2) 128-145
• 5 Hinrichsen K. The early development of morphology and patterns of the face in the human embryo. Adv Anat Embryol Cell Biol 1985; 98: 1-79
• 6 Gritli-Linde A. The etiopathogenesis of cleft lip and cleft palate: usefulness and caveats of mouse models. Curr Top Dev Biol 2008; 84: 37-138
• 7 Luijsterburg AJ, Rozendaal AM, Vermeij-Keers C. Classifying common oral clefts: a new approach after descriptive registration. Cleft Palate Craniofac J 2014; 51 (4) 381-391
• 8 Jiang R, Bush JO, Lidral AC. Development of the upper lip: morphogenetic and molecular mechanisms. Dev Dyn 2006; 235 (5) 1152-1166
• 9 Brito LA, Meira JG, Kobayashi GS, Passos-Bueno MR. Genetics and management of the patient with orofacial cleft. Plast Surg Int 2012; 2012: 782821
• 10 Nyberg DA, Sickler GK, Hegge FN, Kramer DJ, Kropp RJ. Fetal cleft lip with and without cleft palate: US classification and correlation with outcome. Radiology 1995; 195 (3) 677-684
• 11 Kernahan DA. The striped Y—a symbolic classification for cleft lip and palate. Plast Reconstr Surg 1971; 47 (5) 469-470
• 12 Smith AW, Khoo AK, Jackson IT. A modification of the Kernahan “Y” classification in cleft lip and palate deformities. Plast Reconstr Surg 1998; 102 (6) 1842-1847
• 13 Maarse W, Pistorius LR, Van Eeten WK , et al. Prenatal ultrasound screening for orofacial clefts. Ultrasound Obstet Gynecol 2011; 38 (4) 434-439
• 14 Redford-Badwal DA, Mabry K, Frassinelli JD. Impact of cleft lip and/or palate on nutritional health and oral-motor development. Dent Clin North Am 2003; 47 (2) 305-317
• 15 Masarei AG, Sell D, Habel A, Mars M, Sommerlad BC, Wade A. The nature of feeding in infants with unrepaired cleft lip and/or palate compared with healthy noncleft infants. Cleft Palate Craniofac J 2007; 44 (3) 321-328
• 16 Reid J, Reilly S, Kilpatrick N. Sucking performance of babies with cleft conditions. Cleft Palate Craniofac J 2007; 44 (3) 312-320
• 17 Maarse W, Rozendaal AM, Pajkrt E, Vermeij-Keers C, Mink van der Molen AB, van den Boogaard MJ. A systematic review of associated structural and chromosomal defects in oral clefts: when is prenatal genetic analysis indicated?. J Med Genet 2012; 49 (8) 490-498
• 18 Santiago PE, Schuster LA, Levy-Bercowski D. Management of the alveolar cleft. Clin Plast Surg 2014; 41 (2) 219-232
• 19 Bajaj AK, Wongworawat AA, Punjabi A. Management of alveolar clefts. J Craniofac Surg 2003; 14 (6) 840-846
• 20 Francis CS, Mobin SS, Lypka MA , et al. rhBMP-2 with a demineralized bone matrix scaffold versus autologous iliac crest bone graft for alveolar cleft reconstruction. Plast Reconstr Surg 2013; 131 (5) 1107-1115
• 21 Matic DB, Power SM. Evaluating the success of gingivoperiosteoplasty versus secondary bone grafting in patients with unilateral clefts. Plast Reconstr Surg 2008; 121 (4) 1343-1353 , discussion 1368–1369