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BDS4 CDS Ortho > Cleft Lip and Palate > Flashcards

Cleft Lip and Palate Flashcards

1
Q

cleft management - need to know

4

A
  • multifactorial
  • multidisciplinary
  • dental team aspect
  • caries risk
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2
Q

orofacial clefting (OFC) classed as

A

craniofacial nomaly

common

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3
Q

types of orofacial clefting

2

A

cleft palate

cleft lip with/without palate

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4
Q

what orofacial clefting type is this

A

cleft palate

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5
Q

what orofacial clefting type is this

A

unilateral cleft lip and palate

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6
Q

cleft palate causes

A

issues with speech mainly

less likley dental impact

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7
Q

cleft lip with/without palate causes

A

larger dental impact

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8
Q

classification systems for orofacial clefting

A

Kernahan and Stark 1958
* Cleft lip +/- Palate -> cleft Lip Cl or Cleft Lip and Palate CLP
* Cleft palate -> Cleft Palate CP

LAHSHAL – use

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9
Q

how to use LAHSHAL

A

Very descriptive on what cleft about

  • What unilateral or bilateral cleft lip/palate goes through
  • Lip
  • Alveolus
  • Hard palate
  • Soft palate

Small letters not complete - notch in lip

LAHS

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10
Q

use LAHSHAL classification to classify this orofacial cleft

A

LAHSHAL

(bilateral cleft lip and palate exending form lip to soft palate on both sides)

nasal septum divides

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11
Q

Unilateral : Bilateral
cleft lip and palate

A

80%:20%

4:1 unilateral:bilateral

Bilateral has the bigger impact - growth, teeth, challenges with speech etc

Variety of shapes and sizes of clefts

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12
Q

describe

A

LAHS cleft lip and palate

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13
Q

describe

A

microformed cleft lip
l

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14
Q

describe

A

Extreme bilateral – premaxilla attached to nasal septum,

inferior turbinates (nose) visible

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15
Q

describe

A

bilateral cleft lip and palate

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16
Q

cleft lip and palate facts

A

1:700 live births
* 100 clefts births per year in Scotland approx.

70% sporadic

Cleft lip +/- palate: males> females (Scotland)
Cleft lip : males :females 3 :1 (Scotland)
Cleft palate: females > males (3:2 EU)

CLP> CP (England and Wales)
CP=CLP Scotland

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17
Q

number of live births per year wiht CLP

A

1 in 700

100 clefts per year scotland

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18
Q

sex ratio of cleft lip +/- palate (scotland)

A

males>females

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19
Q

sex ratio of cleft palate (EU)

A

females>males
3:2

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20
Q

ratio cleft lip to cleft lip and palate
Scotland
England and Wales

A

scotland - CP=CLP
eng and wales - CLP>CP

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21
Q

aetiology of cleft lip and palate

A

MULTIFACTORIAL
genetic and enviornmental

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22
Q

genetic factors that may contribute to cleft lip and palate

5

A

Syndromes
* More common in syndromes e.g. Aperts, Treacher Collins

Family history
* 5% chance next child will have

Sex ratio
* Males more common have CLP, females CP

Laterality
* Missing and ectopic teeth more common on left, alike clefting

Ethnic dist

no pure genetic link yet

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23
Q

sex ratio of cleft lip (scotland)

A

males :females 3 :1 (Scotland)

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24
Q

environmental factors that may contribute to CLP

5, 3 key

A

social deprivation

smoking

alcohol

anti-epileptics

multivitamins

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25
Q

effect of smoking ban in public areas on CP

A

reduction in cleft palate since smoking ban in public areas - passive smoking environmental aspect

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26
Q

5 areas impacted by UCLP

A
  • Aesthetics
  • Speech
  • Other anomalies
  • Hearing airway
  • Dental
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27
Q

aesthetics impact of UCLP

A

Baby born with cleft
* Shock to parents if not picked up prenatal

Cleft nurses - 5 in Glasgow cover whole of Scotland
* see pt in 24hrs within baby born
* Reassure pt, talk through pathway, explain how to feed

  • Aesthetics correction
  • Primary surgery lips 6 months - no health reason, social interaction (parents can find hard the change in appearance)
  • Primary surgery on palate 1 year
  • cannot close before 6 months, as babies obligate nasal breathers, palate swells and cannot breath if closed earlier
  • done at 1 year as that is when baby starts to babble more and want to try to develop sound and speech as normally as possible
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28
Q

how to feed baby with UCLP

A
  • When cleft goes through palate - hard to feed, cannot suckle
  • soft bottle as cannot breast feed
29
Q

speech impact on UCLP

A

when cleft goes through palate, air can escape through nose when trying to speak
* hypernasal
* speech sounds different
* to make plosive soft pharynx blocks the pharynx – cannot happen in cleft palate - check

speech therapists assess their development

30
Q

hearing airway impact of UCLP

A

more prone to glue ear and brachial arch discrepancies

ENT and audiologists

31
Q

other anomalies tha can impact child with UCLP

A

40% have some form of cardiac anomaly

Scottish cleft care centralised in Glasgow- cardiac&airway service there

32
Q

team members of Cleft Care Scotland team

7

A

Cleft nurse

Surgeon

Speech therapist

Dental team

ENT Respiratory
* Audiologist
* Airway consultant

Geneticist

Psychologist

33
Q

what can parents refer to regarding there tx journey

A

national cleft pathway

34
Q

UCLP pt journey

**

A

3 months - lip closure
6-12months - palate closure
8-10years - alveolar bone graft
12-15 years - definitive orthodontics
18-20years - surgery (lips, orthognathic (after end of growth))

35
Q

UCLP pt journey
3 months

A

lip closure

36
Q

UCLP pt journey
6-12months

A

palate closure

37
Q

UCLP pt journey
8-10years

A

alveolar bone graft

38
Q

UCLP pt journey
12-15years

A

definitive orthodontics

39
Q

UCLP pt journey
18-20years

A

surgery (Lips, nose, orthognathic (after end of growth))

40
Q

clinics part of cleft care scotland

A
  • baby MDT (newborn)
  • Children’s clinic - see every 6 months till 7years
  • bone graft clinic
  • transition clinic
  • adult clinic

fit timescales of pt journey

41
Q

5 dental impacts of cleft lip and palate

A

missing teeth
impacted teth
crowding
growth
caries

42
Q

missing teeth in UCLP

A

almost always missing where cleft goes thorugh (common lateral incisor)

central closes to cleft is often small and/or hypoplastic

43
Q

crowding in UCLP

A

Supernumeraries coming through at cleft site

Jaw is small and compressed
* Crowded
* Scar tissue means less space for teeth -Impacted teeth

Deciduous decay leads to extractions, loss of space = crowding permanent

44
Q

facial growth in UCLP

A

Class III growth discrepancy common

Top jaw not grown forwards
* Scarring stops translocation
* Fine till bone graft and then growth of maxilla stops whilst mandible continues

Affect ortho tx
* Incisor relationship

45
Q

caries occurence in UCLP

A

challenging to reduce
* sociodemographic
* hypoplastic teeth
* hard to clean - access, misalligned

46
Q

6 people in dental team for cleft care

A

Paediatric dentist consultant
Dental therapist
Orthodontist
Orthodontic therapist
Restorative dentist consultant
Oral surgeon

47
Q

paediatric dentist in cleft team concern is

A

prevention of decay (SIGN guidelines, SDCEP, duraphat etc)

48
Q

restorative dentist in cleft team concern is

A

aesthetics

majority is to disguise fact had cleft - space open and restoraitve tx
* some aim for simple closure so minimal maintenance
* discuss with pt

can be more complicated e.g. malocclusion

unilateral cleft, 3 erupted, RBB for 2 and composite build up 1

49
Q

4 stages in orthodontist care of UCLP pt

A

Pre-surgical orthopaedics
Expansion/ Bone grafting
Definitive orthodontics
Orthognathic surgery

50
Q

pre-surgical orthopaedics

2 aspects

A

Dento-alevolar moulding - Rare
* Plate fits inside child’s mouth
* Theory was Help them feed, speech develop - encourage segments together. RCT say not
* Impression of baby - hard
* Fill mouth with alginate - obligate nasal breather so cannot breath - hypoxia risk

Lip Strapping
* Silicone between sticky tape
* Sometimes done

51
Q

expansion/bone grafting role

A

if teeth done right then makes ortho tx easier

as teeth come through in right place to be aligned

52
Q

key for expansion/bone graft

A

timing of placement
* Aim is for tooth to come through as otherwise will be lost in 3 year
* time around teeth developing by cleft site
* wait at least till 8/9 - earlier will damage underlying teeth

53
Q

radiological assessment for expansion/bone graft UCLP

A

OPT at 7-8 years

No justification for CBCT – doesn’t offer anything that OPT wouldn’t tell you

Want canine to be 50% formed
* Root takes 4 years to form

Here – crown is just formed so another 2 years till graft
Usually around 9 years for graft

54
Q

process for expansion/bone graft for UCLP

A

remove all supernumeries and deciduous teeth around site

bone graft is from hip bone (aim for it to be at least 3 months prior to eruption, 50% formed on OPT)

pt discharged on the day

radiogical assessment of graft 6 months post op

clinical assessment
* aim is for canine to erupt through bone graft site
* 60% erupt in corect place

55
Q

defintive orthodontics for UCLP
3 things to consider

A

bone graft

growth

dental aesthetics

56
Q

defintive orthodontics considerations re bone graft

A

did it work?
is ther ebone to move teeth around in? (too thin then limited ortho option)

57
Q

defintive orthodontics considerations re child growth UCLP

A

how are they growing?

possible to push teeth to correct incisor relationship or not?
not really any health benefit of class I incisor relationship over class III

58
Q

defintive orthodontics considerations re dental aesthetics for UCLP

A

Restorative like symmetry
* If try to open space where bone graft placed, possible to lose graft but gain symmetry

Central incisor in CLP by cleft site
* 10-20% smaller than other central
* Slightly hypoplsatic
* Options to mask with composite
* Veneer or build up
* Some find better as if open gap and replace with RBB or implant – more expensive maintenance

Unilateral CLP
* Find nose asymmetry and lip line more noticeable than masked canine

59
Q

classes of growers
**

defintive ortho tx

A

good growers

poor growers

boderline growers

60
Q

good growers

UCLP def ortho

A

don’t become class III incisor relationship

space closure with composite build up OR space opening and bridge replacement

61
Q

poor growers

UCLP def ortho

A

line up teeth with definitive ortho (leave in Class III incisor relationship)

pt tends to be concerned with upper arch aesthetics rather than lower arch so accept camouflage

62
Q

boderline growers

UCLP def ortho

A

line up dentition and see where you get to

tricky

63
Q

when is orthognathic surgery used for UCLP pts

A

When significant class III incisor malocclusion

Number of aspects with cleft make it more difficult
* Mainly speech concerned – scarring of soft palate from previous surgery make it less flexible, so when increase space that it needs to close over to reach pharynx can make plosives harder

64
Q

how long is pt in cleft care

A

life long

65
Q

dental prevention for UCLP

A

early is key

dentist see more than cleft care to enforce prevention

66
Q

dental teams for cleft care

A

made of many people
* Paediatric dentist consultant
* Dental therapist
* Orthodontist
* Orthodontic therapist
* Restorative dentist consultant
* Oral surgeon

lothian, glasgow, grampian, tayside, inverness

refer to for advice

67
Q

cause of clefts

A

multifactorial (genetics and environment)

68
Q

cleft care team is

A

multi-disciplinary

cleft care scotlands website - refer for advice, any age of pt

BDS4 CDS Ortho (9 decks)

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