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BDS4 Orthodontics > Cleft Lip and Palate > Flashcards

Cleft Lip and Palate Flashcards

1
Q

What is cleft palate?

A

CP- cleft goes through soft and hard palate
 Issues with speech but no dental impact generally

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2
Q

What is cleft lip?

A

A cleft which involves lip and may or may not involve palate

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3
Q

How are cleft lip and palate classified?

A

By LAHSHAL- letter added for every part the cleft passes through
L- lip
A- alveolus
H- hard palate
S- soft palate
H- hard palate
A- alveolus
L- lip
-> if all it would be bilateral cleft lip and palate

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4
Q

What proportion of CLP is made up by unilateral?

A

80%

-> Bilateral have bigger growth deficiency, speech/dental issues

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5
Q

How do cleft lips form?

A

Premaxilla attaches to nasal septum and everts/rotates out without attachment

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6
Q

How common is cleft lip and palate

A

1:700 live births

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7
Q

What is meant by sporadic in CLP?

A

No obvious aetiology

-> This makes up for 70% of cases

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8
Q

How does sex alter the prevalence of different cleft conditions?

A

CLP- m>f

CL- males:females is 3:1

CP- Females: males is 3:2

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9
Q

What are the genetic factors involved in aetiology of CLP?

A

Syndromes- apert’s, crouzons, TCS

FH- if one child born with cleft there is a 5% chance the next child will have one

Sex

Laterality- more common on LHS

Ethnicity

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10
Q

What are the environmental factors involved in aetiology of CLP?

A

Smoking

Alcohol

Social deprivation

Anti-epileptics

Multi-vitamin use

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11
Q

What is the role of the cleft nurse?

A

They come and see patient within 24 hours of baby being born
 Difficult to feed if CP- difficulty suckling
 Reassure patients- talk them through the pathway
 Advise use of soft bottles- squirt milk in when lip move

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12
Q

What are the implications of CLP?

A

Aesthetic issues

Speech issues- issues with plosive sounds

Dental issues

Hearing/airway issues- more likely to suffer glue ear and ears may not properly form

Other- more likely to have cardiac abnormality

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13
Q

Why is primary surgery of CP done when the patient reaches one?

A

As babies are obligate nasal breathers at birth and closing palate earlier would cause swelling which blocks nose

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14
Q

What would happen to a patient’s speech if they never had cleft palate repaired?

A

It would have a hyper-nasal quality as air would escape through palate

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15
Q

Who are the members of the cleft care team in Scotland?

A

Surgeons
Cleft nurses
Dental team
Psychologist
ENT respiratory doctor
Speech therapist
Geneticist

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16
Q

What are the steps in the journey of the cleft patient?

A

3 months- lip closure

1 year- palate closure
-> done before baby starts to talk/babble to ensure palate is as normal as possible for this

8-10 year- alveolar bone graft

12-15 years- definitive orthodontics

18-20 years- Surgery (secondary)

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17
Q

What is fixed in secondary surgery?

A

Lips, nose, orthognathic issues

-> done when patient fully grown

18
Q

Which clinics look after children with clefts?

A

Baby MDT- Newborns

Childrens clinic- 0-7 years

Bone graft clinic- 7-12 years

Transition clinic- 12-16 years

Adult clinic- 16+

19
Q

What are the dental implications of CLP?

A

Missing teeth

Impacted teeth

Crowding

Growth

Caries

20
Q

What are the features of missing teeth in CLP patients?

A

 Whatever tooth associated with area of cleft is missing (Often lateral incisor)
-> Central closest to cleft is usually small and hyperplastic

21
Q

Which historic treatment for CLP is no longer used?

A

Premaxilla which is not connected may be removed and soft tissue closure done
-> causes loss of these teeth

22
Q

What are the causes of impacted teeth in patients with CLP?

A

 Supernumeraries at cleft site- prevents teeth coming through
 Jaw is small and crowding results- not enough room for eruption

23
Q

What causes crowding in patients with CLP?

A

 Scarring on repairing of cleft makes top jaw smaller- not enough room
 Social demographic- poor attenders, high caries rate (deciduous teeth need to be removed leading to crowding)

24
Q

What jaw relationship do patients with CLP tend to have?

A

Tends to be class III jaw relationship
-> Scarring in top jaw stops translation/growth of maxilla
-> Improves after bone grafting

*may be hesitant about fixing incisor relationship due to growth imbalance

25
Q

Why do cleft patients have more caries?

A

Teeth are often hypoplastic

Teeth come through in strange positions/crowding can make it difficult to clean

26
Q

Who are the members of the dental team involved in treatment of CLP?

A

Paediatric dentist

Orthodontist

Oral surgeon

Dental and Orthodontic therapists

Restorative dentists

27
Q

What is the role of the paediatric dentist in treating patients with CLP?

A

Follow guidelines
-> FV application

28
Q

What are the roles of restorative dentists in CLP?

A

Placing restorations to fix any spaces
 Bridges etc
 Over dentures may be good to provide aesthetic outcome

29
Q

What is the main role of orthodontist in treating CLP patients?

A

Close spaces

30
Q

What are the aspects of orthodontic treatment for CLP patients?

A

Pre-surgical orthopaedics

Expansion/bone grafting

Definitive Ortho

Orthognathic surgery

31
Q

What is involved in pre-surgical orthopaedics?

A

Placing plate in child’s mouth to help them feed
-> encourages segments of cleft to get closer together
-> help speech development

*now been found to be not effective

32
Q

What is the main issue with pre-surgical orthopaedic plates?

A

Difficult as you need to take an impression- creates hypoxia while alginate sets

33
Q

What is lip strapping?

A

Using silicone straps to bring cleft segments together in babies

-> done by cleft nurses

34
Q

Why is bone grafting to fix then cleft done at age 8-9?

A

So not to damage permanent successors

35
Q

What is done before and after bone grafts in CLP patients?

A

Before:
Remove all supernumeraries around cleft site or any teeth interfering with cleft site- 3 months later do bone graft

After:
Close spaces
-> Canine may be modified to help it look like a lateral

36
Q

How is the correct timing for bone grafting in CLP that will allow eruption of canine determined?

A

Timing is based off OPT radiograph taken at 7-8 years
 Canine should be 50% formed
 Root formation takes 4 years- so if 50% formed then it’ll be 2 years from then that it will erupt

37
Q

Where do the grafts used to fix CLP come from? How are they harvested?

A

Grafts come from hip bone using coffin lid incision
 Drip with LA
 Patient discharged the same day
 95-96% success rate- only fails if decay or infection

38
Q

What percentage of the time do canines come into correct position replacing missing lateral in CLP patients?

A

60%

39
Q

What may the aesthetic concerns be in patients with CLP?

A

Central incisor often hypoplastic
-> build up?

Lateral incisor may be absent- creating lack of symmetry as canine is next to central (if unilateral)
-> accept?
-> as lip line is often low on that side- modify canine with veneer or composite for aesthetic result

40
Q

What are the options for fixing class III incisor relationship in different growth types in CLP patients?

A

 Good growers- space closure, space opening with bridge (needs replacement)
 Poor grower- line up teeth and leave relationship
 Borderline- line up dentition and see what happens

41
Q

What treatment can be done if the CLP patient is significantly class III? What are the issues in these patients?

A

Orthognathic
 More difficult in cleft patients- more scarring and less flexibility in soft palate in cleft patients so moving the jaw can create a hole again

BDS4 Orthodontics (14 decks)

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