Cleft lip and palate

Question 1

What is OFC?

Answer 1

Orofacial clefting.

Most common facial genetic abnormalities, covering cleft palate and cleft lip and palate.

Question 2

How does a cleft form?

Answer 2

A failure of the branchial processes to meet and form.

Question 3

Classification of CLP

Answer 3

The LASHAL classification:

-Lip
-Alveolus
-Hard Palate
-Soft Palate
-Alveolus
-Lip

Question 4

What are the genetic aetiological factors for CLP?

Answer 4

Syndromes
Family history
Sex ratio
laterality (more common on right)
Ethnic dist.

Question 5

What are the environmental aetiological factors for CLP?

Answer 5

Social deprivation
Smoking
Alcohol
Anti-epileptics
Multi-vitamins

Question 6

What is the most common abnormality relating to CLP patients?

Answer 6

Over 50% chance of some sort of cardiac anomaly

Due to neural crest migration

Question 7

Who is involved in the MDT for care of patients with CLP?

Answer 7

ENT
Speech therapist
Plastic surgeon
Other anomalies
Dental

Question 8

Why do clp patients require speech therapists

Answer 8

Malformation of the soft palate which prevent plosive sounds. (Sounds which require air being forced throughout the mouth)

Question 9

Why can CLP stop dental development.

Answer 9

When the cleft runs through the alveolar crest it prevents tooth development

Question 10

Outline the patient care journey for UCLP.

Answer 10

Lip closure (3-6 months)
Palate closure (6-12 months)
Alveolar bone graft )8-10 years)
Definitive ortho (12-15years)
Surgery (18-20 years)

Question 11

Whats the IOTN for a patient with CLP?

Answer 11

5p.

Question 12

Why can the palate not be repaired before 6 months old.

Answer 12

Babies are obligate nasal breathers for the first 6 months, if you repair the palate you block their airway.

Question 13

What factors should a dentist be aware of in terms of CLP

Answer 13

1. Missing teeth, can be away from cleft site.
2. Higher chance of impacted teeth.
3. Greater degree of crowding.
4. Abnormal facial growth
5. High caries risk from difficulty cleaning and socioeconomic factors.
   Hypoplastic teeth

Question 14

What % of kids with a CLP with be a class 3?

Answer 14

Around 20% have a class III skeletal growth tendency

Question 15

What care do CLP patients need above normal measures from their GDP?

Answer 15

None. Preventative treatment and caries management.

Checking in with their MDT.

Question 16

What other implications can patients with CLP also have?

Answer 16

Other abnormalities (Craniofacial, cardiac)
Speech impact
Hearing impairment
Airway complications