Cleft lip and palate Flashcards
Prevalence?
Most common craniofacial abnormality – 1 in 700 births (approx)
*Approx 30 cases born per year in N.I.
Different presentations of cleft lip palate?
Lip only
*Palate only
*Complete unilateral
*Complete bilateral
*Submucous cleft (bifid uvula + nasal speech
Cleft Lip & Palate: Anatomical Aspects-
what problems does the patient have due to CLP
Presentation related to abnormal embryology
*Dental problems (alveolus)
*Orthodontic problems
*Speech problems (soft palate)
*Appearance (lip, facial growth)
Presentation related to abnormal embryology
what structures does cleft lip palate affect?
surgery can?…
Can affect lip, alveolar process, hard palate, soft palate
*Surgery can (partially) correct disrupted anatomy
Dental problems (alveolus)
Missing teeth and supernumerary (extra) teeth- due to disruption of the dental lamina
Orthodontic problems
(alveolus, hard palate)
Problems with facial growth
dont need to know the weeks skip past all this section Development of the face key stages occur between weeks
7 and 10
Lateral nasal prominence in week 7 turns into what by week 10
Nasolacrimal groove
Medial nasal prominence in week 7 turns to what by week 10
Philtrum
What is the intermaxillary segment and what components are there
Deep part of medial nasal prominences
Labial component
Upper jaw component
Palatal component
Key embryological features week 6 and week 7
Nasal septum
Nasal chamber
Primary palate
Palatine shelf
Tongue
Week 10 what has developed
Nasal conchae
Fused palatine shelves
Incisive foramen
Uvula
Cleft palate diagnostic aid
Pre natal ultrasonic scanning
Problems for CLP patients immediate?
Feeding
*Speech development
*Effects of surgery (growth/hearing)
*Dental
Problems for CLP patients long term?
Acceptance by peers
*Multiple hospital visits
*20 alveolar cleft
*May need jaw surgery
*Will need orthodontic treatment
CLP: Early problems (after birth)
Feeding
Modified teats to bottles
Feeding plate
Nasogastric tube
*Repair of lip
Rule of 10s - 10/52, Hb 10g, 10lbs
Intermediate Problems (until age 10)
Palate closure (12-18 months)
*To allow speech development
*Speech therapy & hearing testing – ENT
*Dental supervision & treatment
*Family support & counselling
*Alveolar cleft grafting – age 9-10
In order to treat CLP…what must be carried out?
Repair of Levator Veli Palatini muscle
What are the Dental Problems?
Growth restriction in upper jaw
*Bone defect in alveolar process in cleft
*Disruption of the dental lamina
*Distorted (narrow) upper dental arch form
Disruption of dental lamina causes?…
Missing teeth (“Hypodontia”) – upper lateral incisors
*Extra teeth (“Supernumerary Teeth”)
*Malformed/hypoplastic teeth
*Delayed dental development
Other problems?
Orthodontic problems
Maxillary Growth
Describe the issue
*Maxillary Retrognathia (Class III skeletal) aka maxillary growth restriction
*maxilla is underdeveloped
Maxillary growth in terms of surgical?
Surgical scarring and/or congenital aetiology
*Growth restriction highly correlated with surgical technique: scarring, incisions and denuded bone.
*Can be corrected by surgical maxillary advancement
Alveolar Cleft Grafting (approx age 10)
Describe how
fill the bony defect
*Allow eruption of the canine tooth
*close any oronasal fistulas
*provide support for the alar base of the nose
What age alveolar cleft grafting
10
What age pre graft orthodontics
8/9
Pre graft orthodontics (age 8/9) is the
Restoration of the normal shape of the upper jaw
Usually involves
transverse expansion of the upper jaw
*Correction of upper incisors which are behind the bite (class III incisor correction)
Overview of pre graft orthodontics
On average 6-8 months of treatment with orthodontic appliances (braces)
Class III incisor correction is done by
Double cantilever Z spring
0.5mm stainlsteel wire
After pre graft ortho ?
Alveolar bone graft
Followed by
Final phase of orthodontics
Final phase of orthodontics done at age
12/14 years
Final phase of orthodontics (age 12/14) entails
Fixed orthodontic appliances 18-24 months
*Extractions may be required
*May need orthognathic surgery if severe maxillary growth restriction
*Replacement of missing teeth
*Bridges
*Dental implants
