Cleft Lip and Palate

Question 1

What are non-syndromic clefts?

Answer 1

Orofacial clefts in normal children with no other congenital deformity

Question 2

What are some signs of syndromic orofacial clefts?

Answer 2

Mental retardation, missing fingers and toes

Question 3

When does the development of face start and end?

Answer 3

Starts: End of 4th week of gestation

Ends: 8th week

Question 4

What happens to the face 10th week in utero?

Answer 4

Face and palate are completely formed

Question 4

What happens to the face 7th week in utero?

Answer 4

1. Maxillary processes advance medially below the lateral nasal process
2. Maxillary process will fuse with the medial nasal processes
3. Medial nasal processes fuse with each other
4. Complex fusion of maxillary and medial nasal processes form primary palate

Question 5

What are the causes of a cleft?

Answer 5

1. Hypoplasia
2. Abnormal direction of growth of mesenchymal processes
3. Failure of fusion
4. Breakdown of fusion of mesenchymal process

Question 6

What are the clinical signs of Pierre Robin syndrome?

Answer 6

1. Mandibular hypoplasia
2. Cleft palate
3. Large tongue

Question 7

What is the incidence of cleft deformity?

Answer 7

1 in 700 births

Question 8

What is the recurrence rate of clefts?

Answer 8

Highest risk of recurrence in females with bilateral cleft lip and palate

Lowest risk of recurrence in males with unilateral CL/CP

Question 9

What is the etiology of a cleft?

Answer 9

Interaction between genetic and environmental factors (steroids, thalidomide, alcohol, smoking, anticonvulsants)

Question 10

What are the cleft child’s problems?

Answer 10

1. Feeding
2. Malocclusion
3. Retruded maxilla/mandible
4. Facial and other congenital deformities
5. Speech and hearing deficiencies

Question 11

What are the problems in feeding?

Answer 11

1. Risk of aspiration
2. Airway obstruction with CP and micrognathia
3. Cleft and nasal regurgitation

Question 12

Management of feeding problems?

Answer 12

1. Feeding plate
2. Soft feeding bottle with a hole and soft flange. Bottle is squeezed intermittently

Question 13

What age is surgical correction of clefts indicated?

Answer 13

Cleft lip 3 months: 10lbs, 10mg of Hb, 10 weeks

Cleft palate 9-18 months

Question 14

What are the type of surgeries done for Cleft lips and palates?

Answer 14

1. Palatal lengthening/pharyngoplasty
2. Alveolar bone grafting 7-9 years old
3. Possible osteotomy at puberty
4. Nose revision at puberty

Question 15

What does the Eustachian Tube connect?

Answer 15

Connects middle ear to nasopharynx

Question 16

What are the muscles that open and close ET?

Answer 16

Tensor veli palatini and Levator veli palatini

Question 17

What is the function of ET?

Answer 17

Equalizes atmospheric pressure in middle ear

Question 18

What causes hearing deficiencies in a cleft child?

Answer 18

1. ET malfunctions and cause pathological changes in middle ear
2. Infection of middle ear (Otitis media)
3. Otitis media often leads to hearing loss

Question 19

What is the management of hearing deficiencies in a cleft child?

Answer 19

Myringostomy (tympanostomy) and placement of ventilation tubes

Question 20

Why does the cleft child have speech difficulties?

Answer 20

1.Velopharyngeal mechanisms may not be adequate for normal speech

2. May not hear well
3. Poor dental condition

Question 21

Dental problems in cleft palate child?

Answer 21

1. Congenitally missing teeth
2. Supernumerary teeth
3. Irregularities in tooth size
4. Delayed eruption of teeth in cleft
5. Collapsed dental arches
6. Dental caries

Question 22

What is the role of orthodontist at the mixed dentition stage?

Answer 22

Reduce anterior cross-bites

Expand arches to correct buccal alignment