as a human embryo is developing inside of its mother I don't want you to think that its head is growing and expanding like a balloon is inflating as much as tissues are wrapping around meeting and forming the face if that makes sense and where they meet occurs in a few different locations and if there's a failure point in that meeting that Fusion process or multiple failure points you can end up with what's called an Oro facial cleft and that's like a cleft lip or a cleft pallet so if we take a look at the body donor here so this is a midsagittal section of the human head we can see part of the frontal bone as it's transitioning into the nasal septum this divides the left and right aspects of the nasal cavity and then we can see the pallet the pallet is going to be obviously a big focus of our attention here today so we'll come back to this in a second we can also see the upper lip then we can see the lower lip we can see the mandible and we can see the tongue now it's important to note that this donor does not have teeth but the teeth would be projecting and coming out from these aspects of the mandible and the Maxa bone but what we're saying here an oral facial CFT would occur in this region here because this between the upper lip as it extends all the way back to the soft pallette this is where all the tissues are going to meet together now these tissues all arise from what are called the germ layers now we're not going to get too detailed into the germ layers just understand that everything that forms the human body comes from three sheets of tissue and around week four these sheets fold on themselves this is week four of gestation they fold on themselves and form this kind of like shrimp tadpole looking thing that we call and recognize as the embryo and if we were to look at the head aspect of that you would find what are called These are this kind of of wordy but there's two masses of tissue here that we need to understand and the first is called the fronto nasal prominence the fronto nasal prominence creates the central core of your face so it creates part of your forehead or that frontal bone it creates the nasal cavity it creates the nasal septum and then it's going to wrap around and create the middle part of your upper lip as well as this aspect here if you look really closely look really closely hopefully you can see this there's like this little hole here this is called the incisive fmen this is a location where blood vessels and nerves are going to be exiting um that are going to be supplying variety of tissues in the oral cavity but just in front of this this is what we call the primary palette the primary palette as well as the middle part of your upper lip if you look you can't probably see this all that well with my facial hair but there's an indentation just below the nose as it meets the upper lip that is called the filtrum the filtrum is vestigial meaning it's a leftover of evolution in other mammals such as dogs it actually serves a function of assisting in them smelling it doesn't work like that for you instead it's just this characteristic thing that we can all recognize but the filtrum so if we go back here so we have that primary pallet the filtrum and that middle portion of the upper lip and then all of this going all the way up to the forehead is going to come from that fronto nasal prominence but then you also have What's called the Fingal apparatus this is going back to around week four of embryonic development and the Fingal apparatus is what wraps around to create and we'll go back to the donor here it's going to create the tongue the Mand the lower lip and then the lateral aspects of the upper lip right so what's going to happen is the upper lip is coming around like this and it's going to meet that frontal nasal prominence is coming down the center so they're going to actually meet and connect right there there in the middle but it's also going to create the rest of the hard pette so again if we come to that incisive for Raymond this aspect of bone here is the rest of the hard pallet and then it's also going to create the soft pallet so you have multiple tissues wrapping around to meet here at the upper lip and at the pallet and I'm sure you can now understand why if we have a failure in these points that can create that Oro facial CFT so let's now go ahead and discuss cleft pallets specifically because they can actually manifest in about three different ways so if you recall this spot here is called the incisive for rayment and just in front of it is that primary pallet then behind it is the secondary pallette you could have a cleft in either of those or you could have a cleft in a combination of them but how those cfts appear or manifest is going to happen differently so for instance if you have a cleft in the primary pette that's a failure in the fusion of the fronto nasal prominent meaning that Fingal apparatus now that could be the same thing here because as you can see right you have the Fingal apparatus is responsible for that secondary pallet and maybe it doesn't quite meet up with the primary pallet so you could have a Clift here but another option is that well I guess the best way to describe it is we have to describe how the tongue develops so the tongue doesn't actually develop all the way down here instead it develops higher up and then descends so if you picture like this this is the tongue and then on either side you have the secondary pallet and so they're all on the same plane and then the tongue will descend into the oral cavity and then secondary pallet will come over and then form the roof of the mouth but if it doesn't quite make it over you now have a Clift and that is another option so another way that you can have that Clift is that that Fingal apparatus on either side is not meeting up with itself and that can extend all the way back into the soft pallet which could be a problem for ear ear infections you see this little hole here this is the entrance to the fingo tanic tube which connects to your middle ear and the same musculature the Fingal muscles that help open and close that are going to play a part in closing off the naso ferx with this soft pallet so if this is not properly developed this could be open in ways that could make it more susceptible for ear infections but we also then have to think what if you have a hole in this pallet you have an abnormal connection between the nasal cavity and oral cavity that could mean food and drink could get in here which this is not you know meant to digest or process those things which could create another infection but then you have to think you could have breathing problems because air if you're breathing through the nose is supposed to go through the nasal cavity and then down but if all of a sudden it's coming through here that's another issue or breathing is this way and then especially if you're an infant right think like a newborn a newborn is going to have feeding problems because if they're trying to nurse from their mother the milk could go up here or they might just not be able to create enough suction Force because everything's compromised which means parents are going to need feeding assistance with their newborns if they have a cleft pallet and again this could be more severe right so it's like this is a more of a minor Cliff pallet but that's still a significant issue but what if you had a combination of both and it extends all the way back here you're then going to have to have multiple surgeries to fix this entire process and that's not even including a cleft lip right so if we go back to this filtrum a cleft lip Li on the other hand that is a failure where that Fingal apparatus coming on either side is failing to meet up with that frontal nasal prominence and here's the thing it could happen on one side so let's say like my left upper lip meets properly but my right doesn't I now have what's called a unilateral Clift it's only happening on one side but I could also have a bilateral Clift where there's a failure in the fusion point on both sides and here's the thing that can extend all the way back right you could have a cleft lip that translates into a cleft pallet and could even go all the way back there are some individuals that it happens in the cleft lip the primary palette and the secondary pette on both sides that's obviously going to require multiple surgeries and is going to be much more expensive than it would be to treat say just a cleft lip in treatments there's a variety of different surgical procedures but I should say that they happen at different times so if you're having a cleft pallet uh repair they usually will Target that between 6 and 12 months to fix the issue here but if you have a cleft lip they'll usually Target that around 3 months so if you have both you're going to have to have multiple surgeries in order to do that at different timelines and those surgeries could be more extensive or more limited depending on what's actually affected now to my understanding you know clef pallets or rather Oral Facial cfts in general are one of the most common birth effects in the human species they happen in about one in every 700 births worldwide although they do affect certain populations more than others such as Asian populations and Native American populations but they cost around $100,000 in lifetime treating cost at least in the United States that's pretty expensive right that includes prenatal and postnatal care as well as possible speech therapy and all sorts of things that can come from outside of that right if you aren't able to fix it within those timelines speech problems can occur breathing problems digestive problems infections all sorts of things that can even be life-threatening can occur which is why having access to Modern Medical Care is so important when treating these types of conditions but $100,000 is pretty expensive but hopefully that 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