Cleft lip and palate Flashcards
what is the primary palate made up of?
lip
alveoulus
palate- anterior to incisive foramen
what is the secondary palate made up of?
soft and hard palate up to the incisive foramen
how can clefts of the primary palate be classified?
1- unilateral complete or incomplete
2- bilateral complete or incomplete
how can clefts of the secondary palate be classified?
1- complete
2-incomplete
3- submucous
how can clefts of the primary and secondary palate be classified?
unilateral or bilateral - complete or incomplete
what is the incidence of both cleft lip and palate?
1 in 750
2:1 male:famale
what is the incidence of just cleft lip?
1 in 2000
1:2 male: female
what is the most common form of cleft?
isolated cleft lip
what is the least coming for of cleft?
bilateral cleft lip and palate
what syndromes may be associated with cleft lip and palate?
pierre robin
aperts
crouzons
what are genetic causes of clefts?
shortened palatal shelves
what environmental factors can contribute to clefts?
maternal alcohol smoking anticonvulsant drugs folic acids deficiency steroid therapy
what is the risk for offspring if a parent is affected with cleft lip and palate?
40% incidence in offspring
what is the risk for subsequent offspring if first child of unaffected partents has cleft?
1 in 20
how does the genetic component differ between cleft lip and cleft lip and palate?
lesser genetic component in just cleft lip
When does the development of the face and upper lip begin?
5-9 week IU
how does the lip normally form?
maxillary processes fuse together
how does the palate form?
palatal processes of the maxillary processes fuse 6-11th week IU
when do tooth germs develop?
7th week IU
what defects may appear in teeth where clefts are present?
duplication of tooth types malformed roots/crowns enamel hypoplasia hypodontia ectopic teeth
what other problems may sufferers of clefts experience?
feeding problems hearing difficulties speech difficulties emotional problems dental anomolies
Why may issues occur with feeding?
child may be unable to create adequate negative intra oral pressure
results in extended feeding times and reduced nutritional intake
what device can help feeding in children with clefts?
haberman feeders
Why are problems with hearing often associated?
problems can occur with middle ear ventilation or Eustachian tubes
palatal surgery can also help what function?
Eustachian tube function
How can speech be adversely affected?
fistulae or soft palate may not make contact with pharynx
poor speech often comes secondary to poor hearing
what can aid speech?
SALT
Electropalatography EPG
what order does specialist treatment come in?
birth- parental councilling and feeding advice
3 months- lip repair
6-12 months- palate repair
SALT and ENT
mixed dentition- preventative advice and ortho Ax
8.5-10 year- expansion and alveolar bone grafting
permanent dentition- definitive ortho, orthognatic surgery and plastics
what pre surgery orthopaedics can be carried out?
URA
prevent tongue sitting in cleft
encourages lateral palatal shelf growth
aids feeding in infants
describe lip repair surgery
carried out at 3 months
dissect and re oppose muscles of lip and alar base
why is minimal dissection important in lip repair surgery?
so scarring is limited and growth not further limited
describe palatal surgery
carried out 6-12 months
aims to separate nasal and oral cavity
what issues may be seen in the mixed dentition?
delayed eruption hypodontia general smaller tooth size abnormalities in tooth size and shape enamel defects
what role does orthodontics take re. clefts?
provision of pre surgery orthopaedics
from 6 years- alignment of maxillary dentition and correction of cross bites
provision of obturators
what preparation should be taken prior to alveolar bone grafting
removal of any supernumeraries or decisuous teeth prior to surgery
pre surgery expansion in maxillary segments
allignement of upper anteriors with FA during expansion
where is bone sourced for bone grafting?
cancellous bone is used
iliac crest
tibia
cranial cancellous bone
what definitive ortho should be carried out in permanent dentition?
FA if no skeletal discrepancies
if Skeletal discrepancy- orthagnatic surgery when growth has ceased
what ortho surgery is commonly required?
maxilla is often required to be expanded due to inhibited growth
