Cleft Lip Flashcards
What is cleft lip/ palate?
Multi factorial genetic condition (and environmental triggers)
What causes a cleft lip and primary palate?
Failure of fusion of medial nasal, lateral nasal and maxillary process
At 6 week IUL
What causes cleft secondary palate?
Failure of fusion of palatal shelves
At weeks 8-10 IUL
What are some environmental triggers for cleft lip/ palate?
Folic acid deficiency
Maternal infections
Nicotine
Anticonvulsants
Aspirin
What is the epidemiology of cleft lip and cleft palate?
Greater prevelance of cleft palate only in females
Cleft lip and palate mote common in males
What is the classification of cleft lip and palate?
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
Where woulda cleft be if classed as LAHS
Under nostril to lip (L)
Through alveolus (A)
Through hard palate (H)
Through soft palate (S)
What is the aetiology of CLP?
Genetic- FH, sex ratio, syndromes (cardiac anomaly in 50%)
Environmental- social deprivation, smoking, alcohol, anti epileptics
Why is it common to also have cardiac anomaly when have CLP?
Due to neural crest cell migration and brachial arches
What are the different types of CLP?
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
What are common dental findings in CLP?
Hypotonia
Supernumeraries (causing impacted teeth)
Crowding
Growth affected
Caries risk
Microdontia
Hypoplasia and hypermineralisation
Pulp stones
Torrodonts
What are implications to the patient with CLP?
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
What is the patient journeys for CLP?
3 months- lip closure
6-12 months- palate closure
8-10 years- alveolar bone graft
12-15 years- definitive ortho
18-20 years- surgery
What is IOTN for CLP?
IONTN 5p
Which muscle is involved in lip closure?
Orbicularis oris
Why is palate surgery later than lip?
Baby’s are nasal breathers until 6 months
Closure by 1 year as this is when babys start to babble and make sounds
Where does the bone for the bone graft come from?
From the hip
What are the most common teeth to be missing into CLP?
Lateral incisors
Why might teeth become impacted in CLP
Supernumeraries are common
Central incisor may come in squint due to lack of bone
Why is crowding common in CLP?
Constricted upper arch
High caries risk therefore deciduous teeth extracted leading to crowding
What is the prevalence of class 3 skeletal base in CLP and why?
20% have class 3 tenancy as maxilla doesn’t grow forward
Why is there an increased caries risk in CLP?
Teeth come through differently making it hard to clean
Hypoplasia is common
May have reduced clearance
What is the prevention schedule for CLP?
Enhanced prevention
Who is involved in the MDT?
GDP
Paeds dentist
Dental therapist
Orthodontics
Restorative dentist
Oral surgeon
Speech and language therapist
Cleft surgeon and nurse
ENT specialist
Psychologist
