Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Overview/Introduction ++ Cleft lip with or without cleft palate is the most common congenital malformation of the head and neck occurring in 1:1000 live births. Each patient should be evaluated for congenital anomalies, developmental delay, neurologic disorders, and psychosocial concerns. A multidisciplinary team is recommended to ensure that every aspect of care is appropriately coordinated among providers. A fundamental understanding by the surgeon of each step of care is warranted. +++ Anatomy ++ Lip (Figure 52-1) Primary muscle: orbicularis oris (innervated by CN VII)—creates a sphincter around the mouth Primary blood supply: superior labial artery—runs deep to the orbicularis oris muscle Vermillion border (white roll): mucoepithelial junction between the cutaneous lip and mucosal lip—a 1-mm discrepancy in reapproximation is easily visible Philtral ridges: paramedian columns formed at embryonic fusion plane between maxillary and frontonasal prominences—elevation of the vermillion at the junction with the philtrum forms the peak of cupid’s bow Philtral dimple: midline dimple above central portion of cupid’s bow formed by decussation of muscles to contralateral philtral column and attachment of orbicularis oris to dermis Palate Primary palate: anterior to the incisive foramen and includes alveolar ridge Secondary palate: posterior to the incisive foramen Hard palate: posterior to incisive foramen but anterior to Levator veli palitini muscle Soft palate: posterior to hard palate, comprised of Levator veli palitini, Tensor veli palitini, Musculus uvula Bony anatomy: the hard palate consists of the premaxilla (anteriorly) and vertical segments of the palatine bone (posteriorly) which contain the greater palatine foramina and the lesser palatine foramina Greater palatine foramen: contents included the greater palatine vessels and greater palatine nerve Lesser palatine foramen: lesser palatine nerves Muscles: are all innervated by CN X except tensor veli palatini (innervated by V3) Levator veli palatini Tensor veli palatini Palatoglossus Palatopharyngeus Musculus uvula Primary blood supply Hard palate: greater palatine artery Soft palate: descending palatine branch of the facial artery, palatine branch of the ascending pharyngeal artery, and lesser palatine artery ++ Figure 52-1 Anatomy of the lip. (Reproduced with permission from Lee KJ: Essential Otolaryngology. 7th ed. Stamford, CN: Appleton & Lange; 1999.) Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ Embryology ++ Lip (Figure 52-2) Gestational week 4: paired maxillary prominences begin to appear from the first pharyngeal arches and frontonasal prominence (only unpaired prominence) from mesenchyme ventral to forebrain Gestational week 5: nasal placodes invaginate forming medial and lateral nasal prominences Gestational weeks 6-7: medial growth of paired maxillary prominences meet paired medial nasal prominences and frontonasal prominence forming upper lip Palate Gestational weeks 5-12: maxillary prominences push medial nasal prominences medially and fuse by 12 weeks; intermaxillary segment (with 4 incisor teeth buds) is formed by fusion of the paired medial nasal prominences; disruption in this process leads to clefting of the primary palate Gestational weeks 5-6: soft palate musculature migrates toward midline from both ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.