Cleft Lip and Palate Flashcards
How are cleft lip and palate caused?
Due to interaction between crania-facial and embryological processes
Likely due to issue w/ volume or failure of flow of mesenchyme = failure to fuse
What is cleft lip and palate?
Failure of fusion
How chart cleft lip and palate?
LAHSHAL
Dental charting - right to left
Lip, alveolus, hard palate, soft palate, hard palate, alveolus, lip
Difference LAHSHAL and lahshal?
lower case denote incomplete
upper case complete cleft
How denote left hand side complete cleft affecting lip, alveolus, hard palate and soft palate?
….SHAL
How chart complete bilateral cleft?
LAHSHAL
How chart incomplete cleft lip?
Depends on side
l…..
What are incomplete cleft lip referred to as?
Forme Fustra
How to incomplete cleft lip present?
Defect vermillion border and minor degree asymmetry of nose
What is often cause of incomplete cleft lip?
Lack of failure rather lack mesenchyme
How to chart isolated cleft palate?
..HSH../…S….
Issue w/ isolated palatal clefts?
Speech
How do sub-mucosal cleft palate present clinically?
Bifid uvula
Blue translucent zone
Abnormal muscle insertion
What hx may see in sub-mucosal palatal cleft?
Hx of problems feeding
How common is CL&P
1 in 650 births
Aetiology of CL&P
Genetic
Environment
Likely genetic triggered by environment
What are environmental factors in CL&P
Anti-convulsant drug, nutritional defect, anaemia
Smoking, alcohol, obesity
Diagnosis of CLP?
Ante natal scan - around 20-40 weeks
Screening offered to all women
What feature of ante-natal scan may increase suspicion?
Incorrect naso-labial angle
What happens if suspicion CLP on scan?
Have 3D scan - extent of cleft lip - hard know palate involved
What happens if child dx w/ cleft lip before birth?
Family seen before birth and within 24 hours of birth
Why are babies visited cleft service within 24 hr birth?
Help issue w/ breathing/ feeding
Check co-morbidities
What are 3 syndromes associated w/ CP?
Van de Woude
Pierre Robin sequence
Foetal Alcohol Spectrum Disorder
What see in Van de Woude?
Lip pits
Hypodontia
Cardiac abnormalities
CP
What see in Pierre Robin sequence?
CP
Mandibular retrognathia - head to chest during foetal growth
Issue w/ mandibular retrognathia in Pierre Robin?
Small jaw - issue maintaining airway and issue w/ feeding
What see is FASD?
Small head, low body weight, learning diff, co-ordination issue
When are cleft lip and palate repaired?
When baby thriving - good circulating volume
When can cleft lip be repaired?
From 3 month
When can cleft palate be repaired?
From 6 month
What impact on growth can be seen following CLP surgery?
Development class II
What should do with neonatal teeth?
Removal w/ topical LA if impede feeding/ risk inhalation
If not XLA time CLP repair
What abnormality can see in pt w/ CLP?
Neonatal teeth
Why is there neonatal teethn in CLP?
Disruption dental lamina
Common dental abnormalities in CLP?
Class III incisor - inhibition maxillary development
Hypoplastic enamel
Displaced teeth at cleft site
Dental consideration CLP?
OH and dental advice
Hypoplastic enamel - prone plaque build up
Why CLP pt higher risk of caries?
Diet - cariogenic, communication makes hard to eat some foods
OH - limited access, reluctance brush near site
Reduced salivary flow
Access care
Preventative advice for CLP?
Water night F- toothpaste Diet advice Preserve primary teeth - maintain space Referral specialist
What can also be issue in CLP pt?
Speech and hearing
What do all CLP pt receive?
Speech therapy
What ear issues do CLP pt suffer from?
Glue ear - issue drainage from Eustachian tube (linked palatal movement) - less issue as older and tube become more vertical
What age is alveolar bone grafting considered?
Age 9-11
Aim of alveolar bone grafting?
Address bony alveolar deficit
Aims encourage eruption maxillary canine
Close oronasal fistula
What do to if CLP pt has adverse facial growth?
Orthognathic referral
What age are CLP pt seen up to?
20 years
What may older CLP pt complain of ?
Nasal drip
Food nose
Unhappy appearance
What team provides cleft care?
MDT
