Cleft lip and palate

Question 1

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

Answer 1

LAHSAL

Based on the Y striped diagramatic classification

Question 2

Which structures does the LAHSAL classification include?

Answer 2

Lip

Alveolus

hard palate

soft palate

Question 3

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

Answer 3

Incomplete right cleft lip and alveolus

Question 4

Using the classification, what does LAHSAL mean?

Answer 4

Bilateral complete cleft lip and palate

Question 5

What does “HS” mean using the classification?

Answer 5

Complete cleft for the hard and soft palate

Question 6

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

Answer 6

40%

Question 7

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

Answer 7

25%

Question 8

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

Answer 8

10%

Question 9

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

Answer 9

1 in 700 births

Question 10

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

Answer 10

Males

Question 11

Is a right or a left sided cleft more common?

Answer 11

Left

Question 12

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

Answer 12

Females

Question 13

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

Answer 13

15%

Question 14

Whats syndrome are cleft-lip and palate associated with?

Answer 14

>400

Di George

Pierre Robin

Sticklers

Van der Woudes

Question 15

What was the CSAG report of 1998?

Answer 15

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

Question 16

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

Answer 16

Corrective surgergy - MaxFax and Plastics

Speech (SLT)

Hearing (audiologists, ENT)

Dental (Paediatric, Ortho, Restorative)

Psychological

Question 17

Can you diagnose clefts prenatally?

Answer 17

Yes. Can see a cleft lip on an ultrasound

Question 18

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

Answer 18

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

Question 19

What causes a cleft palate and when does it form?

Answer 19

Forms 5-12 weeks in utero

There is a primary and secondary cleft palate

Question 20

What happen at birth with cleft lip and palate babies?

Answer 20

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

Question 21

When is lip repair carried out and why?

Answer 21

Lip repair at 3 months

The muscular layer is corrected

The reason for this surgery is for aesthetic and functional reasons

Question 22

When is the palatal repair carried out and why?

Answer 22

6-9/12 months

closure of the hard palate to allow velopharyngeal competance

allows the baby to eat and develop speech adequately

Question 23

What are the characteristics of cleft palate speech?

Answer 23

Nasal emisson

Nasal turbulance

Nasal grimace

Hypernasality

Together this is called - VELOPHARYNGEAL DYSFUNCTION

Question 24

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

Answer 24

Furlow palatoplasty

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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

Question 27

What dental support can we give to CLP patients?

Answer 27

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

Question 28

How does having a cleft affect dental development?

Answer 28

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

Question 29

What is alveolar bone grafting in relation to clefts?

Answer 29

bone graft is placed into alveolar clefts it is a surgical/orthodontic procedure allows non-prosthetic allignment

Question 30

What is pre-bone graft orthodontics?

Answer 30

the upper arch is expanded laterally anterior cross bites are corrected corrections are retained Incisors are splinted in BLCP patients

Question 31

What are the benefits of alveolar bone grafting?

Answer 31

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

Question 32

When would you perform orthodontics with an osteotomy?

Answer 32

Skeletal class 3 Treat when growth is complete