cleft lip and palate Flashcards
What is the incidence of orofacial clefting?
100 per year in Scotland
1,000 per year in the UK
What gender is affected more in cleft lip and cleft lip and palate?
Cleft lip and palate - M>F
Cleft palate - F>M
Which branchial arch forms the maxilla and mandible?
1st
How is cleft lip and palate classified?
LAHSHAL
What is the ratio of cleft lip and palate to cleft palate?
2:1 in England and Wales
1:1 in Scotland
What is involved in the genetic aetiology of cleft lip and palate?
Syndromes
Family history
Sex ratio
Laterality
Ethnic distribution
What is involved in the environmental aetiology of cleft lip and palate?
Social deprivation
Smoking
Alcohol
Anti-epileptics
Multivitamins
What effect did the smoking ban have on orofacial clefting?
Reduced cleft palate by 10%
No effect on cleft lip
What is the chance of a cardiac anomaly in cleft lip and palate and why is this?
> 50% chance
Due to neural crest migration problems into the branchial arches
What are the issues of cleft lip and palate?
Aesthetics
Speech - can’t make plosive sounds, air escapes through nose, become hyper nasal
Dental
Hearing - branchial arches - ear development
Airway
Can’t feed properly
Other anomalous eg - Apert’s syndrome
What is the patient journey in cleft lip and palate?
3 months - lip closure
6-12 months - palate closure
8-10 years - alveolar bone graft
12-15 years - definitive orthodontics
18-20 years - surgery
Why is the palate surgery done at 6-12 months?
Babies are obligate breathers until 6 months
Would block the airway
Want to normalise palate by 1 year as this is when babies start to babble
What is the success rate of alveolar bone grafting?
95-99%
What are the dental implications of cleft lip and palate?
Missing teeth
Impacted teeth
Supernumeraries
Crowding
Grows - 20% associated with class III malocclusion
Caries
Hypoplastic teeth
Who is involved in the dental MDT for clefts?
GDP
Paediatric dentist
Dental therapist
Orthodontist
Orthodontic therapist
Restorative dentist
Oral surgeon
