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Ortho > Cleft lip and palate > Flashcards

Cleft lip and palate Flashcards

1
Q

What classification is used to code for Cleft lip and palate?

A

LAHSAL

Based on the Y striped diagramatic classification

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2
Q

Which structures does the LAHSAL classification include?

A

Lip

Alveolus

hard palate

soft palate

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3
Q

Using the LAHSAL classification, what does “al” with regards to the right mean?

A

Incomplete right cleft lip and alveolus

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4
Q

Using the classification, what does LAHSAL mean?

A

Bilateral complete cleft lip and palate

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5
Q

What does “HS” mean using the classification?

A

Complete cleft for the hard and soft palate

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6
Q

In terms of clefts, what is the incidence of a cleft palate?

A

40%

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7
Q

In terms of clefts, what is the incidence of a unilateral cleft lip and palate?

A

25%

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8
Q

In terms of clefts, what is the incidence of a bilateral cleft lip and palate?

A

10%

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9
Q

What is the incidence of cleft lip and palate in the UK?

A

1 in 700 births

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10
Q

Which gender are more likely to be affected by cleft lip and palate?

A

Males

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11
Q

Is a right or a left sided cleft more common?

A

Left

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12
Q

Which gender are more likely to be affected by a cleft palate?

A

Females

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13
Q

What percentage are cleft lip and palates associated with other syndroms?

A

15%

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14
Q

Whats syndrome are cleft-lip and palate associated with?

A

>400

Di George

Pierre Robin

Sticklers

Van der Woudes

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15
Q

What was the CSAG report of 1998?

A

The Clinical Standards Advisory Report Group

Found that of the 57 centres, 50% were operating on less than 5 clefts a year. (generally poor outcome)

Re-organised so that there are specialist centres 8-15, with specialist training

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16
Q

Overall care for cleft lip and palate patients, involves many teams. Which teams are involed?

A

Corrective surgergy - MaxFax and Plastics

Speech (SLT)

Hearing (audiologists, ENT)

Dental (Paediatric, Ortho, Restorative)

Psychological

17
Q

Can you diagnose clefts prenatally?

A

Yes. Can see a cleft lip on an ultrasound

18
Q

What causes a cleft lip, and when does it form?

A

Forms 3-7 weeks in utero

**CAUSED BY FAILURE OF 4 PROCESSES TO UNITE - **

  1. Maxiallry process
  2. Lateral nasal process
  3. Medial nasal process
  4. Frontonasal process
19
Q

What causes a cleft palate and when does it form?

A

Forms 5-12 weeks in utero

There is a primary and secondary cleft palate

20
Q

What happen at birth with cleft lip and palate babies?

A

The require contact within 24 hours and specialist nursing.

Breast feeding is often not possible, so special soft bottles have to be used

sympathetic support should also be given to the parents

21
Q

When is lip repair carried out and why?

A

Lip repair at 3 months

The muscular layer is corrected

The reason for this surgery is for aesthetic and functional reasons

22
Q

When is the palatal repair carried out and why?

A

6-9/12 months

closure of the hard palate to allow velopharyngeal competance

allows the baby to eat and develop speech adequately

23
Q

What are the characteristics of cleft palate speech?

A

Nasal emisson

Nasal turbulance

Nasal grimace

Hypernasality

Together this is called - VELOPHARYNGEAL DYSFUNCTION

24
Q

What is the name of the secondary speech surgery that can be carried out to correct velopharyngeal dysfunction?

A

Furlow palatoplasty

25
Q

Which types of orthodontic treatments can be carried carried out for CLP patients?

A
  1. pre-surgical orthopaedics
  2. pre-bone graft orthodontics
  3. orthodontics
  4. orthodontics with osteotomies
26
Q

When is pre-surgical orthopaedics carried out and what are its benefits?

A

carried out between birth and 3-6 months

it is to faciliate feeding and help with growth and reduce the gap aiding surgery

However, it is of questionable benefit

27
Q

What dental support can we give to CLP patients?

A
  1. regular OHI instruction
  2. Fluoride supplements
  3. Diet advice
  4. regular dental check ups
28
Q

How does having a cleft affect dental development?

A
  1. Hypodontia
  2. Microdontia
  3. Abnormal tooth shape
  4. Enamel defects
  5. Rotated near the cleft
  6. Delayed eruption
29
Q

What is alveolar bone grafting in relation to clefts?

A

bone graft is placed into alveolar clefts

it is a surgical/orthodontic procedure

allows non-prosthetic allignment

30
Q

What is pre-bone graft orthodontics?

A

the upper arch is expanded laterally

anterior cross bites are corrected

corrections are retained

Incisors are splinted in BLCP patients

31
Q

What are the benefits of alveolar bone grafting?

A
  1. Allows the permanent canine to erupt
  2. Intact maxialla
  3. close the residual oro-nasal fistula
  4. stabilise the premaxilla in bilateral cleft and palate
  5. Improved ala-base support
32
Q

When would you perform orthodontics with an osteotomy?

A

Skeletal class 3

Treat when growth is complete

Ortho (4 decks)

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