Cleft Lip and Palate Flashcards
What age in utero does cleft LIP occur?
Day 28-38
What age in utero does cleft PALATE occur?
Day 42-55/ week 7
How does a cleft palate occur?
Failure of fusion of the palatal shelves
Roughly week 7 in utero
How do you distinguish between cleft palate and cleft lip?
Cleft palate - does not affect alveolus or teeth
Do males or females get cleft palate more?
F>M for cleft palate
Do males or females get combined CLP more?
M>F
CLP more common than cleft palate alone.
What age is cleft lip typically repaired?
3-6 months
What age is cleft palate typically repaired?
6-12 months - generally 9 months
What are the dental associations of CLP?
- Caries - difficulty maintaining OH in cleft palate region.
- Impacted teeth
- Crowding
- Hypodontia
- Supernumeraries
- Hypoplastic/ hyperplastic teeth
- Ectopic teeth
- Transposed teeth
- Dens in dente
What support is available for CLP patients and their families?
CLP association
Who is involved in a cleft MDT?
- Dentist (paediatric dentist)
- Child’s surgeon - max fax
- GP
- Speech therapist
- Dental nurse
- Orthodontist
- Audiologist
Psychologist
What syndromes are associated with CLP?
Down syndrome
Treacher collins syndrome
Stickler syndrome
Which branchial arch forms the lip, hard and soft palate?
the 1st branchial arch
How is a cleft lip formed?
Failure of fusion of the medial and lateral nasal processes with the maxillary process.
Briefly explain how LAHSAL classification is used for CLP?
L - lip (R/L)
A - alveolus (R/L)
H - hard palate
S - soft palate
Assign a capital letter for complete cleft
Assign lowercase letter for incomplete cleft
No cleft - dot assigned
What is the difference between primary and secondary palate?
The primary palate is a triangular plate of tissue that extends from back on intermaxillary segment to incisive foramen of the skull. Includes the alveolar arch
The secondary palate includes the hard and soft palate
What is the difference between complete and incomplete palate?
A complete cleft of the entire palate involves the length of the primary and secondary palate. An incomplete cleft involves only the secondary palate.
What is the environmental aetiology of CLP?
Social deprivation
Smoking
Alcohol
Anti-epileptics
Lack of multivitamins
If you have a child with CLP what is the % likelihood that your next child will?
5%
What is the % chance that someone with a CP will also have a cardiac anomaly?
50%
Due to neural crest migration and branchial arches
What are the issues with a newborn having CLP?
Baby can’t suckle/ feed
What are problems with CLP speech and why?
Soft palate doesn’t work well when there’s a cleft
Can’t stop air going through nose - become hyper-nasal
Plosive sounds
What are the 3 compulsory operations for someone with CLP?
Lip surgery
Palate surgery
Bone grafting
Operations beyond this if mum/pt. is concerned
At what age is an alveolar bone graft surgery typically done?
8-10 years
At what age is definitive ortho typically done for someone with CLP?
12-15 years
What is the IOTN for CLP?
5p
Why do you do primary palate surgery at 9 months?
Babies are nasal breathers until 6 months - want palate surgery by age 12 months as this is when babies babble and make sounds
Want it to be repaired by this time to ensure their speech isn’t impacted when learning to make sounds.
What is the most common missing tooth in CLP patients?
Lateral incisors most common because cleft typically runs through here
Why do you typically get crowding in CLP?
Constricted upper arch
Prone to decay so deciduous teeth often removed early leading to crowding
High relapse rate following ortho
Impacted teeth common in CLP
Why is someone with CLP more prone to caries?
Crowding
More prone to hypoplastic teeth
Nature of children - lower demographic areas = more caries
