Cleft Lip and Palate Flashcards
what is the most common craniofacial abnormality?
> cleft lip and palate
> 1-700 births
> 30 per year in NI
what are the different cleft lip and palate presentations?
> Lip only
> Palate only
> Complete unilateral
> Complete bilateral
> Submucous cleft (bifid uvula + nasal speech)
what are the anatomical aspects associated with cleft lip and palate and what they affect?
> Presentation related to abnormal embryology
- Can affect lip, alveolar process, hard palate, soft palate
- Surgery can (partially) correct disrupted anatomy
> Dental problems (alveolus)
- Disruption of dental lamina – missing teeth and supernumerary (extra) teeth
> Orthodontic problems (alveolus, hard palate)
- Problems with facial growth
> Speech problems (soft palate)
> Appearance (lip, facial growth)
what are the problems for CLP patients?
> Feeding
> Speech development
> Effects of surgery (growth/hearing)
> Dental
> Acceptance by peers
> Multiple hospital visits
> 2 degrees alveolar cleft
> May need jaw surgery
> Will need orthodontic treatment
what are the early problems after birth for CLP patients?
> Feeding
- Modified teats to bottles
- Feeding plate
- Nasogastric tube
what is the rule for repairing the lip after birth of a CLP patient?
> Rule of 10s -
- 10/52
- Hb 10g
- 10lbs
what are the intermediate problems until age 10 in CLP patients?
> 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
what are the dental problems in CLP patients?
> Growth restriction in upper jaw
> Bone defect in alveolar process in cleft
> Disruption of the dental lamina
- Missing teeth (“Hypodontia”) – upper lateral incisors
- Extra teeth (“Supernumerary Teeth”)
- Malformed/hypoplastic teeth
- Delayed dental development
> Distorted (narrow) upper dental arch form
what is the problems with maxillary growth in CLP patients?
> Maxillary Retrognathia (Class III skeletal)
- maxilla is underdeveloped
- 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
at what do you start alveolar cleft grafting and how to do you carry it out?
> 10
> fill the bony defect
> Allow eruption of the canine tooth
> close any oronasal fistulas
> provide support for the alar base of the nose
what is pre graft Orthodontics and what age is it carried out?
> 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
> On average 6-8 months of treatment with orthodontic appliances (braces)
> age 8/9
what orthodontic appliance is used in CLP patients?
> double cantilever (“Z”) spring
> 0.5mm stainless steel wire
what is the final phase of orthodontic treatment for CLP patients and what age is it carried out at?
> 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
> 12/14 years
