Cleft Lip

Question 1

What is cleft lip/ palate?

Answer 1

Multi factorial genetic condition (and environmental triggers)

Question 2

What causes a cleft lip and primary palate?

Answer 2

Failure of fusion of medial nasal, lateral nasal and maxillary process
At 6 week IUL

Question 3

What causes cleft secondary palate?

Answer 3

Failure of fusion of palatal shelves
At weeks 8-10 IUL

Question 4

What are some environmental triggers for cleft lip/ palate?

Answer 4

Folic acid deficiency
Maternal infections
Nicotine
Anticonvulsants
Aspirin

Question 5

What is the epidemiology of cleft lip and cleft palate?

Answer 5

Greater prevelance of cleft palate only in females
Cleft lip and palate mote common in males

Question 6

What is the classification of cleft lip and palate?

Answer 6

LAHSHAL classification

Lip - Alveolus - Alveolus - Lip
Hard palate
Soft palate

Assign a letter to every part which has a cleft
Capital letter for full cleft, small for partial cleft

Question 7

Where woulda cleft be if classed as LAHS

Answer 7

Under nostril to lip (L)
Through alveolus (A)
Through hard palate (H)
Through soft palate (S)

Question 8

What is the aetiology of CLP?

Answer 8

Genetic- FH, sex ratio, syndromes (cardiac anomaly in 50%)
Environmental- social deprivation, smoking, alcohol, anti epileptics

Question 9

Why is it common to also have cardiac anomaly when have CLP?

Answer 9

Due to neural crest cell migration and brachial arches

Question 10

What are the different types of CLP?

Answer 10

Can involve primary palate (lip and alveolus to incisive foramen) and/ or secondary palate (hard palate from incisive forma en to soft palate).

Can be unilateral or bilateral

Can have submucous cleft- goes undetected as overlying mucosa is unaffected - usually noticed when speech development is poor

Question 11

What are common dental findings in CLP?

Answer 11

Hypotonia
Supernumeraries (causing impacted teeth)
Crowding
Growth affected
Caries risk
Microdontia
Hypoplasia and hypermineralisation
Pulp stones
Torrodonts

Question 12

What are implications to the patient with CLP?

Answer 12

Aesthetics
Speech - soft palate doesn’t work when there is a cleft, air goes through nose causing nasal tone
Hearing - brachial arches also responsible for ear formation, if there isn’t neural migration, may be failure to hear
Other syndromes
Dental - hypotonia etc

Baby cant suckle feed

Question 13

What is the patient journeys for CLP?

Answer 13

3 months- lip closure
6-12 months- palate closure
8-10 years- alveolar bone graft
12-15 years- definitive ortho
18-20 years- surgery

Question 14

What is IOTN for CLP?

Answer 14

IONTN 5p

Question 15

Which muscle is involved in lip closure?

Answer 15

Orbicularis oris

Question 16

Why is palate surgery later than lip?

Answer 16

Baby’s are nasal breathers until 6 months
Closure by 1 year as this is when babys start to babble and make sounds

Question 17

Where does the bone for the bone graft come from?

Answer 17

From the hip

Question 18

What are the most common teeth to be missing into CLP?

Answer 18

Lateral incisors

Question 19

Why might teeth become impacted in CLP

Answer 19

Supernumeraries are common

Central incisor may come in squint due to lack of bone

Question 20

Why is crowding common in CLP?

Answer 20

Constricted upper arch
High caries risk therefore deciduous teeth extracted leading to crowding

Question 21

What is the prevalence of class 3 skeletal base in CLP and why?

Answer 21

20% have class 3 tenancy as maxilla doesn’t grow forward

Question 22

Why is there an increased caries risk in CLP?

Answer 22

Teeth come through differently making it hard to clean
Hypoplasia is common
May have reduced clearance

Question 23

What is the prevention schedule for CLP?

Answer 23

Enhanced prevention

Question 24

Who is involved in the MDT?

Answer 24

GDP
Paeds dentist
Dental therapist
Orthodontics
Restorative dentist
Oral surgeon
Speech and language therapist
Cleft surgeon and nurse
ENT specialist
Psychologist