Cleft lip and palate Flashcards
what is the primary palate?
lip, alveolus, and palate anterior to incisive foramen
what is the secondary palate?
soft and hard palate up to incisive foramen
what are the types of clefts that can occur in the primary palate?
unilateral - complete/incomplete
bilateral - complete/incomplete
what are the types of clefts that occur in the secondary palate?
complete
incomplete
submucous
what are the types of clefts of the primary and secondary palates?
unilateral - complete/incomplete
bilateral - complete/incomplete
what race is CLP more common in?
what side of the face is more commonly affected?
caucasians
left
how does CLP occur?
isolated deformity or part of a syndrome
genetic reasons
environmental reasons
what genetically causes a CLP to occur?
short palatal shelves
what environmental factors can cause a baby to be born with CLP?
maternal alcohol and smoking
anticonvulsant or steroid therapy
folic acid deficiency
if there is a family history of CL with or without palatal involvement what are the risks to the child?
40% risk of offspring having it
2nd child 1 in 20 chance
if there is a family history of CP what are the risks for the child?
20% risk of offspring having it
lesser genetic component - risk of 1in 80 of further offspring being affected
when does the development of the face/upper lip begin?
5th and 9th week i.u
what is the lip formed from?
fusing of maxillary processes
how is the palate formed and when is it formed?
palate is formed from the palatal processes of maxillary processes - 6-11th week i.u
what begins at 7th wee i.u?
tooth development
what may clefts cause in dental development?
duplication of tooth types, malformed roots and crowns, enamel hypoplasia, absence/ectopic teeth
what problems can CLP cause to a baby?
feeding/hearing/speech/emotional/dental
why is feeding a problem in babies with CLP?
cannot create a negative intra oral pressure
- haeberman feeder can fix
why is hearing a problem with CLP?`
problems with middle ear ventilation of eustacian tube
surgery of palate can impede tube function
why do CLP cause problems with speech?
affected by fistula
or soft palate not being able to make contact with pharynx
secondary to poor hearing
what is electropaltalography?
URA with electrodes
what procedure can be done at 3 months?
lip repair
what procedure can be done at 6-12 months?
palate repair
what can be done between 8 and a half and 10 years?
expansion/ alveolar bone graft
what treatment will need done when CLP baby enters the permanent dentition?
ortho
orthagnathic surgery
plastic surgery
what are pre surgery orthopaedics?
URA - stop tongue sitting in cleft - encourages shelf growth
aids feeding
approximates cleft segments
what is lip strapping used for?
controls growth of pre maxilla = facilitates lip closure
how is a lip repair done?
muscles of lip and alar are dissected out and re opposed
minimal to reduce scarring
if palate is cleft it can be defect is corrected at same time
how is palate repair done?
6-12 months
oral and nasal cavities are seperated
mobilisation of tissues laterally and displaced across the midline to cover the cleft
what is Cleftsis?
care until 16years
asses at 9-12 months, 2-5 years, 7-15yrs
aim to maintain primary and secondary teeth and encourage good dental care
what problems may arise in the mixed dentition as a result of a CLP?
delayed eruption hypodontia reduction of tooth size abnormalities of tooth size and shape enamel defects ortho probs
what ortho tx is needed in CLP?
presurgical orthopaedics in birth
align max dentition
obturators, palatal lift and EPG appliances
before alveolar bone grafting what needs to be done?
XLA any deciduous/SN teeth in the cleft
FA to align max/mandib teeth
FA to align skeletal discrepancy for orthagnathic surgery
when does alv bone grafting occur?
between 8 and a half and ten years - canine roots are a half to two thirds formed
what does allowing the canine to erupt into the graft do?
fuses the maxilla, provides alar base support
what bone is used for a graft?
cancellous bone from iliac crest, tibia or cranium
what is plastic surgery used to treat?
improves nasal aesthetics
lip revision
close residual palatal fistulae
why might a rhinoplasty be needed after orthagnathic surgery?
underlying bone can affect the contour of the nose
