Cleft Lip and Palate Flashcards

Question

effect of smoking ban in public areas on CP

Answer 1

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

Answer 2

* Aesthetics * Speech * Other anomalies * Hearing airway * Dental

Answer 3

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

Answer 4

* When cleft goes through palate - hard to feed, cannot suckle * soft bottle as cannot breast feed

Answer 5

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

Answer 6

more prone to glue ear and brachial arch discrepancies ENT and audiologists

Answer 7

40% have some form of cardiac anomaly | Scottish cleft care centralised in Glasgow- cardiac&airway service there

Answer 8

Cleft nurse Surgeon Speech therapist Dental team ENT Respiratory * Audiologist * Airway consultant Geneticist Psychologist

Answer 9

national cleft pathway

Answer 10

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))

Answer 11

lip closure

Answer 12

palate closure

Answer 13

alveolar bone graft

Answer 14

definitive orthodontics

Answer 15

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

Answer 16

* baby MDT (newborn) * Children's clinic - see every 6 months till 7years * bone graft clinic * transition clinic * adult clinic fit timescales of pt journey

Answer 17

missing teeth impacted teth crowding growth caries

Answer 18

almost always missing where cleft goes thorugh (common lateral incisor) central closes to cleft is often small and/or hypoplastic

Answer 19

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

Answer 20

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

Answer 21

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

Answer 22

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

Answer 23

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

Answer 24

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

Answer 25

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

Answer 26

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

Answer 27

if teeth done right then makes ortho tx easier as teeth come through in right place to be aligned

Answer 28

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

Answer 29

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

Answer 30

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

Answer 31

bone graft growth dental aesthetics

Answer 32

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

Answer 33

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

Answer 34

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

Answer 35

good growers poor growers boderline growers

Answer 36

don't become class III incisor relationship space closure with composite build up OR space opening and bridge replacement

Answer 37

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

Answer 38

line up dentition and see where you get to tricky

Answer 39

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

Answer 40

early is key dentist see more than cleft care to enforce prevention

Answer 41

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

Answer 42

multifactorial (genetics and environment)

Answer 43

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